儿童肠易激综合征的临床特征

Clinical features of irritable bowel syndrome in children

目的掌握儿童肠易激综合征(IBS)的临床特征,做到早期诊断和治疗,避免误诊、误治。方法回顾性分析2012年1月至2018年8月在重庆医科大学附属儿童医院消化科诊治的80例IBS患儿的临床资料,结合文献探讨其诊治经验。结果1.80例IBS患儿中,男53例,女27例;年龄(9.70±2.88)岁;中位病程10个月。2.80例IBS患儿均有腹痛表现,其次为腹泻(60例),便秘(31例),自觉腹胀(21例),呕吐(19例),体质量下降(11例),纳差(9例),少见的表现有头痛(3例)。29例患儿发病前存在可疑的诱因,以饮食刺激最为多见。3.80例IBS患儿中腹泻型(IBS-D)46例,便秘型(IBS-C)17例,混合型(IBS-M)13例,未定型(IBS-U)4例;IBS-C、IBS-D男童明显多于女童,IBS-M相反,IBS-U男女相等,各亚型组间比较,性别差异有统计学意义(χ^2=0.83,P=0.001);各亚型间临床症状比较,腹胀在不同亚型间的发生率差异有统计学意义,发生率依次为IBS-M、IBS-C、IBS-D、IBS-U。4.治疗包括对诱因及病情进行疾病宣教、心理干预、饮食管理及药物治疗。治疗6个月后有效随访74例,其中34例得到持续缓解,25例得到部分缓解,总体治疗有效率为79.73%;15例患儿未愈。结论IBS是儿童常见的功能性胃肠病,男多于女;饮食刺激为最常见的诱因;4种亚型中以IBS-D构成比最高;大部分患儿对症治疗有效,少部分患儿治疗效果不佳。

Objective To investigate the clinical features of children with irritable bowel syndrome(IBS),so as to achieve the early diagnosis and treatment,thus avoiding misdiagnosis and mistreatment.Methods A total of 80 hospitalized IBS patients in the Department of Gastroenterology,Children′s Hospital of Chongqing Medical University from January 2012 to August 2018 were enrolled.Their diagnosis and treatment were analyzed by combining with literature reviews.Results(1)A total of 80 cases include 53 boys and 27 girls.The mean age at diagnosis was(9.70±2.88)years,and the median duration of disease was 10 months.(2)Abdominal pain was found in all cases,followed by diarrhea in 60 cases,constipation in 31 cases,abdominal distension in 21 cases,vomiting in 19 cases,weight loss in 11 cases,loss of appetite in 9 cases,and headache in 3 cases.Twenty-nine cases had suspected triggers before onset,mostly diet factor.(3)Eighty cases with IBS include 46 cases with irritable bowel syndrome with diarrhea(IBS-D),17 cases with irritable bowel syndrome with constipation(IBS-C),13 cases with mixed irritable bowel syndrome(IBS-M)and 4 cases with unsubtyped irritable bowel syndrome(IBS-U).The number of boys with IBS-C and IBS-D was higher than that of girls.IBS-M was on the contrary.IBS-U was equal between them.There were significant differences in gender among the subtypes(χ^2=0.83,P=0.001).Abdominal distension among 4 clinical types was statistically diffe-rent,IBS-M had the highest incidence,followed by were IBS-C,IBS-D,IBS-U.(4)Treatment was aimed at patients education,psychological intervention,dietary management and symptomatic therapy.After the first 6 months visit of 74 cases,34 cases were sustained relieved,25 cases were alleviated,and the overall effective rate was 79.73%,but 15 cases were ineffective.Conclusions IBS is a common functional gastrointestinal disease in children,with more boys than girls.Dietary stimulation is the most common cause.Among the 4 subtypes,the composition ratio of IBS-D is the highest.Most of the cases are effective in symptomatic treatment.There are still some patients with poor curative effect.