小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 腹痛
- 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(PTSD)
- 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
- 定量粪便免疫化学检测(FIT)
- 针对乳糜泻的血清学检测
- 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
Professor of Medicine
Baylor College of Medicine and Marion DeBakey VA Hospital
Houston
TX
Adjunct Professor of Medicine
University of Texas Medical Branch
Galveston
TX
利益声明
NS declares that he is a member on the board of the Kelsey Research Foundation, a non-profit organization. Kelsey Research Foundation has received and awarded private grants for the study of the microbiome in several diseases, including irritable bowel syndrome.
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
- 显微镜结肠炎
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