小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 腹部不适
- 腹痛相关的大便习惯改变
- 腹胀或胀气
- 腹部查体正常
其他诊断因素
- 排出黏液便
- 排便紧迫感
危险因素
- 身体与性虐待
- 创伤后应激障碍
- 年龄＜50岁
- 女性
- 前驱肠道感染
- 家族史
- 家庭与工作压力
诊断性检查
首要检查
- 全血细胞计数 (FBC)
需考虑的检查
- 便潜血试验
- 乳糜泻血清学检查
- 粪便钙卫蛋白
- 粪便乳铁蛋白
- 血清 C 反应蛋白 (CRP)
- 红细胞沉降率 (ESR)
- 血清成纤维细胞生长因子 19
- 硒高胆酸牛磺酸（SeHCAT）试验
- 采集 48 小时粪便进行总胆汁酸测定
- 经验性试用胆汁酸结合剂
- 氢/甲烷呼气试验
- 蓝氏贾第鞭毛虫粪便检测
- 腹部平片
- 结肠镜检查
- 可屈性乙状结肠镜检查
治疗流程
便秘为主型
腹泻为主型
便秘与腹泻交替型
撰稿人
作者
Ned Snyder, MD, MACP, AGAF
Chief of Gastroenterology and Hepatology
Kelsey-Seybold Clinic
Clinical Professor of Medicine
Baylor College of Medicine
Houston
Adjunct Professor of Medicine
University of Texas Medical Branch
Galveston
TX
利益声明
NS declares that he is on the board of the Kelsey Research Foundation, a non-profit organisation that sponsors research in the intestinal microbiome; he does not receive direct or indirect compensation. NS received a grant from the State of Texas to study genetic factors in the development of hepatocellular cancer in Hispanic people.
同行评议者
Douglas Drossman, MD
Professor of Medicine and Psychiatry
School of Medicine
Co-Director
UNC Center for Functional GI and Motility Disorders
Chapel Hill
NC
利益声明
DD declares that he has no competing interests.
Simon McLaughlin, MBBS
Research Fellow
Department of Gastroenterology
St Mark's Hospital
Northwick Park
Harrow
UK
利益声明
SM declares that he has no competing interests.
Horace Williams, MBBS
Clinical Research Fellow
Division of Medicine
Imperial College
London
UK
利益声明
HW declares that he has no competing interests.
鉴别诊断
- 克罗恩病
- 溃疡性结肠炎
- 淋巴细胞性和胶原性结肠炎（显微镜下结肠炎）
更多 鉴别诊断指南
- 英国胃肠病学会肠易激综合征管理指南
- ACG 临床指南：肠易激综合征管理
更多 指南患者教育信息
Irritable bowel syndrome: what is it?
Irritable bowel syndrome: what treatments work?
更多 患者教育信息
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