| Objective to explore the major abdominal symptoms, the habit and shapes of stools,and related risk factors the Chinese patients with IBS through comparing patients withIBS and healthy adults in related symptoms, type of stool, related risk factors, contentof nervous and depression, types of response and experiences, etc. Furthermore, tocompare and analysis standard classification of Manning, Rome Ⅰ, Rome Ⅱ and RomeIII in diagnostic accuracy，diagnostic coverage and overlapping, characteristic ofabdominal symptoms, habit of stool and its shapes, risk factors, etc., in order to makemore well diagnostic standard and more reliable reference evidences in preventing andtherapy of the IBS.Methods all research objects collected in clinic patients and routine physicalexamination adults between Jan,2009and Jan,2013.5000patients with abdominalsymptoms were divided into observing groups and questionnaires were performedaccompanied with blood test, stool and urine test, liver and kidney function tests,images studies and GI endoscopy exams to exclude the organic diseases and find thepatients with IBS. The control group(1602cases) were collected from routine physicalexamination adults in Center of Medical Examination. All the research objectsaccepted investigation questionnaires covering7tables including diagnostic standard,stool classification, related risk factors, nervous self-estimate, depression self-estimate,response types and living conditions. Statistics analyses performed using SPSS19.0,STATA12.0and Excel2007software in logistic single factor, multiple factors test andX2test. And P<0.05was considered significant differences.Results1.Prevalence study of IBS(1)Incidence rate of diagnosisIn the observing groups(5000objects),3242patients were diagnosed with IBS, occupied64.84%of all visiting patients. The diagnostic rates in4different standardswere as followed,2718/5000(83.84%) in Manning standard,1871/5000(57.71%) inRome Ⅰ standard,1912/5000(58.98%) in Rome Ⅱ standard and340/5000(10.49%) inRome Ⅲ standard, Almost all the patients with IBS diagnosed by Rome Ⅰ and Rome Ⅲstandards were accordance by Manning standard, whereas patients with IBS diagnosedby Rome Ⅱ standard wasn’t accordance in1/3by Manning standard.Distribution of symptomsThe symptoms distribution in the patients with IBS was as followed, abdominalpain89.02%, abdominal discomfort86.92%, abdominal pain with discomfort75.94%,abdominal distention60.61%, abnormal stool frequency56.57%，stool abnormalities87.88%, defecation55.56%, difficult in defecation or tenesmus40.40%, mucousstool38.38%.The distribution of defecation traits classificationIn the7stools shapes classification studies, smooth dachshund stools shape orsnake-like stools and soft sheet stools shape or pasty stools shape take a highproportion in IBS. In the3stools shapes classification studies,constipation stools takethe highest proportion in IBS.Related factorsa.There were also some different distributions in the patients with IBS in gender,age, region, race, income, education condition, marriage.Ladies,patients between41to50ys,married race,people with more than5000RMB monthly or less than3000RMBmonthly offered higher incidence.Patients under30ys and patients with highereducation offered lower incidence.b.In the studies on diet factor, people, who had food allergy, commonly on diet,sweet fancy, coffee or tea fancy, cold or raw food taken, too much high proteins, drinktoo much water, milk food more than3time a week, food intake too fast or slow, hadhigher risk factor for IBS. And people, who routinely had breakfast, coarse grains andfrequent intake food with high fiber, obtained better preventing factor for IBS.c.There were also some correlationship between life habits, work condition and IBS suffering.1-2days activities each week or1-4hours exercises each week had lesspossibilities for IBS. Insomnia often offered risk for IBS. People sleep6-8hours eachday had less incidence for IBS, whereas longer or shorter sleep had higher incidence.Living condition bad was another risk factor. Longer working days each week andlonger hours each day could prevent the people from IBS.d.In the history studies, the diseases suffering in half year and the history of acutegastroenteritis were the risk factor for IBS. Abdominal surgery history was also a riskfactor.e.As for the medicine history studies, antibiotics, non-steroidal anti-inflammatorydrugs, especially nitric acid glycerol were risk factor for IBS.f.The study of genetic factors finds that close relatives suffering from IBS is anindependent risk factor.g.Smoking had correlationship with the onset of IBS, as the long history the peoplesmoke, the higher incidence the smoker had, but the quantity had no relationship withIBS. Although there was no relationship between drinking and IBS, there was positiverelationship in the people who smoke and drink.h.In psychological studies, anxious and depression had close influence to IBS thatwas the more serious the people had, the more possibilities the people suffered fromIBS. In the response studies, problem-solving type，help-requiring type, backoff typehad less possibilities for IBS. Self-blame type, especially rationalization type were therisk factor for IBS. Patients with IBS had more negative experiences compared to thecontrol group.2.Comparison of the prevalence of IBS study in four standard(1) Diagnostic overlap rates of four standardManning criteria, Rome Ⅰ, Rome Ⅱ, Rome Ⅲ criteria diagnostic overlap rate were65.89%,51.07%,12.21%; Rome Ⅰ criteria and Manning, Rome Ⅱ, Rome Ⅲ criteriadiagnostic overlap rates were95.72%,63.50%,15.87%; Rome Ⅱ criteria and Manning,Rome Ⅰ, Rome Ⅲ criteria diagnostic overlap rate was72.59%,62.13%,17.78%; RomeIII criteria Manning, Rome Ⅰ, Rome Ⅱ criteria diagnostic overlap rates were97.65%, 87.35%,100.00%; IBS patients are fully in line with the four standard9.16%; complywith Manning, Rome Ⅰ, Rome Ⅱ three standard diagnostic rate was25.02%; complywith Manning, Rome Ⅱ and Rome Ⅲ criteria in three standard diagnosis rate was1.08%; comply with Manning, Rome Ⅰ standard diagnostic rate was21.07%; in linewith Manning, Rome Ⅱ diagnostic two standard IBS diagnosis was7.56%; meet theRome Ⅰ, Rome Ⅱ standard diagnostic rate2.47%; meet Rome Ⅱ, Rome Ⅱ diagnosticrate of0.25%; Only in line with the Manning diagnostic rate was19.96%; Only inline with the Rome Ⅱ diagnostic rate was13.45%.(2)Expression of symptoms in the four standardThe symptoms(abdominal pain, abdominal discomfort, abdominal pain withdiscomfort, abdominal distention, abnormal stool frequency，stool abnormalities,defecation, difficult in defecation or tenesmus,mucous stool) distribution in the patientswith IBS in four standard was as followed: Manning criteria100.00%、84.40%,84.40%,65.82%,63.32%,92.09%,66.56%,43.82%,45.88%;Rome Ⅰ criteria100.00%,81.08%,81.08%,66.11%,70.28%,99.47%,64.08%,40.51%,41.69%;Rome Ⅱcriteria81.38%,100.00%,81.38%,66.95%,76.26%,95.71%,57.11%,47.75%,40.06%;RomeIIIcriteria97.65%,100.00%,97.65%,63.53%,92.06%,100.00%,66.76%,33.82%,30.59%.Comparison of defecation characters and features in four standardIn the7stools shapes classification studies, Manning criteria had positiverelationship with multi-block sausage stools shape,crack sausage stools shape and softsheet stools shape or pasty stools shape;Rome Ⅰ criteria had negative relationship withdry bulb stools shape and had positive relationship the other stools shapes;Rome Ⅱcriteria had positive relationship with crack sausage stools shape and had constipationtype soft clumps stools shape,soft sheet stools shape or pasty stools shape,watery stoolsshape;Rome Ⅲ criteria had positive relationship with pasty stools shape and hadnegative relationship with dry bulb stools shape,multi-block sausage stoolsshape,smooth dachshund stools shape or snake-like stools,soft clumps stools shape andwatery stools shape.In the3stools shapes classification studies, Manning criteria had negative relationship with constipation type;Rome Ⅰ criteria had positive relationshipwith diarrhea type and hybrid type;Rome Ⅲ criteria had positive relationship withconstipation type and had negative relationship with diarrhea type;Rome Ⅲ criteriahad positive relationship with constipation type and diarrhea type.Comparison of related factor in four standarda.Gender,age,region,education condition were related factors in Manningcriteria;gender was related factor in Rome Ⅰ criteria;gender, region were related factorsin Rome Ⅱ criteria;gender, income were related factors in Rome Ⅲ criteria.b.In the studies on diet factor, having breakfast,frequent intake food with high fiberand frequent intake fruits and vegetables were protective factors in Manningcriteria;commonly on diet, sweet fancy, coffee or tea fancy, too much high proteins,drink too much water, high-salt diet were risk factors.In Rome Ⅰ criteria,havingbreakfast,frequent intake food with high fiber,frequent intake fruits andvegetables,food intake too slow were protective factors;commonly on diet, sweet fancy,coffee or tea fancy, too much high proteins, drink too much water were risk factors.InRome Ⅱ criteria,having breakfast,frequent intake food with high fiber,frequent intakefruits and vegetables,food intake too slow were protective factors;commonly on diet,sweet fancy, coffee or tea fancy, too much high proteins, high-salt diet were riskfactors.In Rome Ⅲ criteria,frequent intake fruits and vegetables,food intake too slowwere protective factors; food allergy,commonly on diet,milk food, too much highproteins,drink too much water were risk factors.c.There were some differences of related factors between four standards in lifehabits.In Manning criteria,long week cumulative exercise time was protectivefactor;within two hours of bedtime meal, long daily sleep time,high frequency ofinsomnia,bad living condition were risk factors.In Rome Ⅰ criteria,long weekcumulative exercise time was protective factor; long daily sleep time,high frequency ofinsomnia,bad living condition were risk factors.In Rome Ⅱ criteria,more sports dayswas protective factor;within two hours of bedtime meal,high frequency ofinsomnia,bad living condition were risk factors.In Rome Ⅲ criteria,more sports days,long week cumulative exercise time,high frequency of insomnia were protectivefactors;bad living condition was risk factors.d.Working conditions were different too.In Manning criteria,longer working dayseach week and longer hours each day was protective factors. In Rome Ⅰ criteria,longerworking days was protective factor.In Rome Ⅲ criteria,longer working days each weekwas protective factors.e.There were some differences of related factors between four standards in historystudies.In Manning criteria,the history of dysentery, the history of gastroenteritis andthe history of abdominal surgery were risk factors.In Rome Ⅰ criteria,the history ofdysentery, the history of abdominal surgery were protective factor.In Rome Ⅱcriteria,the history of dysentery, the history of abdominal surgery were protectivefactor.In Rome Ⅲ criteria,the history of dysentery was protective factors;the history ofabdominal surgery was risk factors.f.There were some differences of related factors between four standards inmedicine history studies.In Manning criteria,antibiotics, non-steroidalanti-inflammatory drugs, nitric acid glycerol were risk factors.In Rome Ⅰcriteria,antibiotics,non-steroidal anti-inflammatory drugs,nitric acid glycerol were riskfactors.In Rome Ⅱ criteria,antibiotics,non-steroidal anti-inflammatory drugs,nitric acidglycerol were risk factors.In Rome Ⅲ criteria,non-steroidal anti-inflammatory drugswas protective factors.g.Close relatives suffering from IBS was risk factor in Manning criteria,Rome Ⅰcriteria,Rome Ⅲ criteria.h.Smoking was risk factor in Rome Ⅱ and Rome Ⅲ criteria. Long history thepeople smoke was risk factor in Manning and Rome Ⅲ criteria.The quantity ofsmoking was risk factor in Rome Ⅲ criteria.There was no relationship betweendrinking and four standards.i. Anxiety and depression were risk factors in four standards.Anxiety level anddepression level were risk factors in four standards except depression level in Rome Ⅲcriteria. j.In the response studies, problem-solving type，help-requiring type,self-blame type,back-off type were protective factors in four standards.Rationalization type was riskfactor in four standards.Fantasy type was risk factor in Manning criteria,Rome Ⅰcriteria,Rome Ⅱ criteria.k.Negative experiences was risk factor in four standards.Per capita negative eventsscore was risk factor in Manning criteria,Rome Ⅲ criteria.Conclusion1.There were lots of factors which might influence the onset of IBS includinggender, age, region, races, income, education, marriage. There were also many riskfactors correlated with IBS onset such as rationalization type response,taking nitricacid glycero,habit on diet, poor sleeping,anxiety，the diseases suffering in half year，living condition bad.The main risk factors of Rome Ⅰ criteria include:rationalizationtype response,taking nitric acid glycero,the diseases suffering in half year，habit on diet,Ladies，anxiety.The main risk factors of Rome Ⅱ criteria include：rationalization typeresponse,habit on diet, ladies，taking nitric acid glycero,the diseases suffering in halfyear，poor sleeping. The main risk factors of Rome Ⅲ criteria include：habit on diet,Ladies，rationalization type response,food allergy,anxiety,poor sleeping.2.The incidence of IBS is higher than what we expected, which is occupied2/3ofthe clinical patients with abdominal symptoms. In the four diagnostic criteria, Manningcriteria offered the widest covering of the diseases, but the abdominal discomfortoccurred in84.4%patients and defecation changes in92.09%patients which were notconsidered the evidences in Manning criteria. It’s also no limitation of the time rangeand no diversity classification of defecation habit or stool shapes which might miss theorganic intestinal diseases. Manning criteria should use in the screening in the patientswith abdominal symptoms for its defects. Rome Ⅰ criteria first covered time range andfurthermore made classification of defecation habit and stool shapes which is differentcompared with Manning criteria and more strict in the diagnosis of IBS, thereforeapproximately60%of patients with IBS found through Rome Ⅰ criteria. The researchalso showed that there had81.08%of patients with IBS who had abdominal discomfort, but this symptom was not covered in Rome Ⅰ criteria. Rome Ⅱ criteria, which is broadthe time range and cover abdominal discomfort, showed1/3of the patients with IBSwhich didn’t meet the criteria of Manning and was considered as the complement ofthe Manning criteria. There was still60%patients with defecation,50%patients withdifficult in defecation or tenesmus which wasn’t contained in Rome Ⅱ criteria.Although Rome Ⅲ criteria which limits the time of symptoms occurred offers higheraccuracy in the diagnosis of IBS as our results showed and more suitable for scientificresearch, this criteria could miss part of the patients with IBS because defecationoccurred in2/3patients and difficult in defecation or tenesmus occurred in1/3patientsweren’t covered in the criteria.3.In the symptom distribution of the patients with IBS, abdominal pain, abdominaldiscomfort and defecation traits changes were most commonly met symptoms, whereasmucous stools shapes, difficult defecation or tenesmus was relatively rare symptoms.4.Seven stools shape classification had higher recognition in IBS comparing tothree stool shape classification in any diagnoses standards. And Rome Ⅰ seemed hadless influence by different stool shapes which might offer higher sensitivities to theremaining diagnostic standards. The research is the first time in the world, hoping toprovide a basis for the improvement of the diagnostic criteria of IBS. |
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