功能性胃肠道疾病罗马诊断标准的历史变迁及标准Ⅳ  

The historical change of diagnostic criteria of Rome and Rome Ⅳ about functional gastrointestinal disorders

作　　者：徐三荣[1] 

机构地区：[1]复旦大学附属华山医院消化科,上海200040

出　　处：《中华诊断学电子杂志》2016年第3期184-190,共7页Chinese Journal of Diagnostics(Electronic Edition)

摘　　要：功能性胃肠道疾病(FGIDs)是最常见的消化科疾病,依据形态学和生理学异常来识别,这两种异常经常合并存在,包括动力紊乱、迷走兴奋性增高、黏膜和免疫功能改变、肠道菌群改变、中枢神经系统信息处理改变。肠-脑互动紊乱的研究是基于使用特殊的诊断标准,因此要进行FGIDs领域中新认识的传播。罗马Ⅳ标准在罗马Ⅲ基础上:(1)更新了基础和临床文献;(2)提供了胃肠道微生态、脑-肠互动、药物基因学组、生物-心理-社会、性别和对FGIDs跨学科认识的新信息;(3)尽可能减少不准确或偶尔会遭到诟病的名称;(4)采用最新的诊断标准;(5)使患者病症体验、生理学亚组或生物标记的资料具体化,以便采用更有针对性的治疗。笔者对FGIDs领域作了历史的回顾,从动力和结构紊乱对FGIDs作了区分,讨论了与罗马Ⅲ的不同,回顾了罗马委员会的工作过程,为FGIDs提供了一个生物-心理-社会的、病理生理学的定义,为患者的治疗提供一个手段。Functional gastrointestinal disorders （FGIDs）,the most common diseases in gastroenterology, are recognized by morphologic and physiological abnormalities which often occur in combination including motility disturbance,increased vagal excitability,altered mucosal and immune function,altered gut microbiota, and altered central nervous system processing.Research on these gut-brain interaction disorders is based on using specific diagnostic criteria.The Rome Foundation has played a pivotal role in creating diagnostic criteria,thus new knowledge in the field of FGIDs should be disseminated.Rome Ⅳ is a compendium of the accumulated knowledge since RomeⅢwas published 10 years ago.It improves upon RomeⅢby：（1）updating the basic and clinical literatures;（2）offering new information on gut microenvironment,gut-brain interactions, pharmacogenomics,biopsychosocial,gender and cross-disciplinary understandings of FGIDs;（3）reducing the use of imprecise and occasionally stigmatizing terms when possible;（ 4） using updated diagnostic criteria;（ 5） incorporating information on illness experience,and physiological subgroups or biomarkers of patient that may lead to more targeted treatment.This introductory article offers a historical overview of the FGIDs field, differentiates FGIDs from motility and structural disorders,discusses the changes from Rome Ⅲ,reviews the Rome committee,provides a biopsychosocial and pathophysiological conceptualization of FGIDs,and offers an approach to patient care.

关 键 词：功能性胃肠道疾病 罗马Ⅳ 诊断 

分 类 号：R57[医药卫生—消化系统]