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Medically unexplained symptoms: evidence, guidelines, and beyond

机译:医学上无法解释的症状:证据,指南等

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Medically unexplained symptoms (MUS) are frequently presented in primary care.1 In about 25–50% of all symptoms presented in primary health care, no support for an underlying physical disease can be found. MUS are a heterogeneous group of symptoms and can involve almost all types of symptoms that patients present to their GP. Functional somatic syndromes, such as irritable bowel syndrome (IBS), fibromyalgia, and chronic fatigue syndrome (CFS), as well as symptoms stemming from a specific somatic disease that are more severe, more persistent, or limit functioning to a greater extent than expected, based on (objective) disease parameters, are also referred to as MUS. MUS represent a spectrum of severity from mild via moderate to severe, characterised by an increased number and duration of symptoms and functional limitations. Most of the time MUS are transient and self-limiting, but sometimes MUS persist, resulting in extensive investigations and referrals and unnecessary healthcare costs. Therefore, early recognition of MUS is of paramount importance. Although only 2.5% of the patients in general practice meet criteria for persistent or severe MUS (such multiple symptoms that persist for longer than 3 months resulting in severe functional limitations), GPs experience many difficulties in caring for these patients.2 For that reason the Dutch College of General Practitioners decided to publish the evidence-based primary care guideline on MUS, which provides GPs with recommendations for the diagnosis and treatment of patients with mild, moderate, and severe MUS.1
机译:在基层医疗中经常出现无法解释的医学症状(MUS)。1在基层医疗中出现的所有症状中,约有25%至50%找不到基础疾病的支持。 MUS是症状的异类,可能涉及患者向其GP提出的几乎所有类型的症状。功能性躯体综合症,例如肠易激综合症(IBS),纤维肌痛和慢性疲劳综合症(CFS),以及由于某种特定的躯体疾病引起的症状,其症状比预期的更严重,更持久或更严重基于(客观)疾病参数的,也称为MUS。 MUS代表从轻度到中度到重度的一系列严重程度,其特征是症状和功能限制的数量和持续时间增加。在大多数情况下,MUS是短暂的且具有自限性,但有时MUS会持续存在,从而导致大量的调查和转诊以及不必要的医疗费用。因此,MUS的早期识别至关重要。尽管在一般实践中仅2.5%的患者符合持续或严重MUS的标准(这种持续超过3个月的多种症状导致严重的功能受限),但GP照顾这些患者时遇到许多困难。2因此,荷兰全科医生学院决定发布有关MUS的循证初级保健指南,该指南为GP提供了轻,中,重度MUS患者的诊断和治疗建议。1

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