饮食因素在功能性胃肠病发病机制中的作用

功能性胃肠病（functional gastrointestinal disorder, FGID）是一组慢性或复发性胃肠道症候群,经检查未能发现可解释症状的器质性疾病、生物化学和病理生理异常［1］,主要包括 IBS、功能性消化不良等。FGID 发病率高,个体差异大,是消化科门诊中常见的一类疾病,往往给患者造成较重的心理和经济负担,严重影响其生命质量。多项研究支持食物摄入在 FGID 发生机制中的作用。大量 FGID 患者称食物摄入诱导产生症状［2-3］。饮食干预可以缓解患者的症状［4-5］。但饮食因素在 FGID 发病中的作用仍未阐明。现就饮食因素在 FGID 发病中的研究进展作一综述。     

功能性胃肠病发病机制的研究进展

功能性胃肠病(FGIDs)是常见的消化道疾病,其发病机制复杂。目前认为FGIDs是由多种因素共同作用的结果,遗传、胃肠动力障碍、内脏高敏感、肠道感染、脑-肠轴功能紊乱等因素与本病发生有关。本文对FGIDs的多种发病机制的最新研究作一综述。     

感染后功能性胃肠病及其发病机制

功能性胃肠病（FGIDs）是一类常见胃肠道疾病，其发病和特定症候群与多种因素相关。胃肠道感染和黏膜炎症背景作为FGIDs发病的诱因近年来备受关注。学者们将那些感染后发生的FGIDs称为感染后FGIDs（PI-FGIDs）。本文就感染与FGIDs的关系以及PI-FGIDs发病机制中的动力异常、黏膜免疫改变、肠神经系统改变等内容作一介绍。     

肠神经系统在功能性胃肠病发病中的作用

肠神经系统对胃肠道运动、分泌和血液供应具有独立的调节作用,功能性胃肠病（FGIDs）的慢性症状如腹泻、便秘和疼痛与肠神经调控的胃肠道功能异常有关。某些FGIDs存在肠神经递质表达异常,甚至神经元退行性改变;肠神经系统与肠道Cajal间质细胞、胶质细胞和免疫细胞连接和功能的异常亦可能参与了FGIDs的发病;脑-肠轴功能紊乱是应激和感染后肠易激综合征的发病机制之一。肠神经系统在FGIDs的发病中具有重要作用,以肠神经为靶点为开发治疗FGIDs的有效药物开辟了广阔的前景。     

重视心理社会因素在功能性胃肠病中的作用

功能性胃肠病（FGIDs）是生理、精神心理和社会因素相互作用而产生的消化系统疾病，在临床上十分常见。心理社会因素在FGIDs的发病中起重要作用，不仅影响患者的胃肠生理、症状表现和疾病行为，也影响患者的生活质量、就诊要求和医疗费用。心理治疗能改善FGIDs患者的症状和病理生理异常。心理社会因素与FGIDs的关系密切，加强对精神心理社会因素在FGIDs中作用的认识十分重要。     

神经调节在功能性胃肠病发病中的作用及其研究进展

功能性胃肠病是消化系统的常见疾病,其发生与脑-肠轴的异常密切相关.脑-肠轴神经调节过程的紊乱产生了以胃肠道动力改变和疼痛、腹胀为主症的消化系疾病.本文总结了脑-肠轴的神经调节机制和介入治疗进展,探讨了神经调节介入治疗功能性胃肠病的临床研究前景.     

食物抗原特异性IgG和IgE在功能性胃肠病发病中的作用

背景：许多功能性胃肠病患者于进食某些食物后出现症状加重。目的：测定肠易激综合征（IBS）和功能性消化不良（FD）患者的血清食物抗原特异性IgG和IgE，探讨食物过敏在功能性胃肠病发病中的作用。方法：符合罗马Ⅱ标准的37例IBS患者、28例FD患者以及20例健康志愿者纳入本研究。以酶联免疫吸附测定（ELISA）检测受试者血清中14种食物抗原特异性IgG和IgE，同时测定血清总IgE水平。通过问卷调查行症状评分，分析血清食物抗原特异性IgG水平与症状总评分的相关性。结果：与健康对照组相比，IBS组血清中螃蟹、鸡蛋、河虾、大豆和小麦抗原特异性IgG水平显著升高（P〈0．05），FD组血清中鸡蛋和大豆抗原特异性IgG水平显著升高（P〈0．05）。三组间血清总IgE水平和食物抗原特异性IgE阳性率差异无统计学意义。IBS组和FD组血清食物抗原特异性IgG水平与症状总评分之间无明显相关性。结论：IBS和FD患者血清中部分食物抗原特异性IgG水平显著升高．提示IgG介导的食物过敏可能是功能性胃肠病潜在的发病机制之一。     

内质网应激在肝衰竭发病机制中的作用

肝衰竭的病理过程复杂,病情进展迅速,病死率高,需对其发病机制进行深入研究。早期的,轻度的内质网应激(ERS)可以通过未折叠蛋白反应维持细胞内环境稳定,而持续的、严重的ERS会促进炎症反应及细胞凋亡引起细胞死亡,因此ERS在疾病的发生发展过程中发挥关键作用。主要阐述ERS及其相关信号通路在肝衰竭发病机制中的作用,为肝衰竭的治疗提供新思路。     

精神心理因素在功能性胃肠病症状重叠中的作用及其机制

功能性胃肠病（FGIDs）是消化系统常见疾病,其发病机制复杂,至今尚未完全明了。近来研究发现,不同类型的FGIDs之间常存在症状重叠,且精神心理因素在FGIDs症状重叠的发生、发展中具有重要作用。本文就精神心理因素在FGIDs症状重叠中的作用及其机制作一综述。     

功能性胃肠病

编著按:胃肠动力学是目前消化系病研究中的热点之一,近年来在国内外取得了显著的成绩.为了进一步提高对胃窦十二指肠协调运动的生理、神经调节及疾病诊治等,中华消化杂志编委会与中华医学会广东省消化、内镜学会于2001年6月25～26日在广东番禹召开"功能性胃肠病"小型专题座谈会.出席会议共有8名编委:许国铭、夏维新(上海),侯晓华(湖北),柯美云、刘新光(北京),周殿元、胡品津、徐克成(广东),副总编辑许国铭教授主持了座谈会.另外还邀请了李瑜元(广州市第一人民医院)、罗金燕(西安医科大学第二医院)、张万岱(第一军医大学南方医院)、陈湖(中山医科大学第一医院)等教授参加,并在中心发言后展开了专题讨论.这是第一次出门办刊,为拓展多种形式、多方位的征稿活动,开辟了新的途径.今后,不少消化专业中的热点及疑难问题,亦可采取这种小型座谈会的方式,既省时、经济、又能比较深入开展交流和讨论.现将座谈会上的发言重点部分,请本人整理后刊出,供大家参考.     

功能性胃肠病与精神障碍共病的流行病学研究进展

功能性胃肠病是一组常见的消化系统疾病。焦虑、抑郁、躯体化症状等精神障碍在功能性胃肠病患者中的共病现象较为常见。这些精神障碍对功能性胃肠病患者的病情程度、生活质量均产生不同程度的影响。该文将对功能性胃肠病与精神障碍共病的流行病学调查结果、共病现象的影响以及精神治疗在功能性胃肠病中的疗效三方面作一综述。     

精神心理因素与功能性胃肠病的关系

功能性胃肠病是近年来研究的一个热点,发病率高,临床上常见.精神心理因素在其发病过程中起着重要作用,可能与胃肠道动力和感觉异常的脑肠轴调节障碍有关.联合抗抑郁药及心理治疗功能性胃肠病在改善精神症状的同时,还能明显减轻躯体症状,对健康相关生活质量的改善及降低复发率有不错的效果.因此,精神心理因素在功能性胃肠病中的作用不容忽视,正确理解并加强认识对诊疗的提高尤为重要.     

功能性胃肠病合并心理障碍的处理策略

本文就功能性胃肠病合并精神心理障碍的情况进行了简要的阐述,对包括消化科医生在内的非精神专科医师在临床工作中如何干预和处理此类患者提出一些建议,包括培养意识、学习技能、治疗和随访等方面。     

Pediatric functional gastrointestinal disorders

Opinion statement  

Age-related functional gastrointestinal disorders

The demographic development will lead to a disproportionate increase of older people and to a significant increase of functional gastrointestinal disorders including dysphagia due to motility and reflux-related disorders, nausea and vomiting by gastrointestinal dysfunction and abdominal and pelvic pain caused by chronic obstipation, stool impaction and incontinence. This implies significant consequences with regard to the development of weight loss, anorexia, social disadvantages and increased mortality with serious socio-economic burden. Ageing processes are determined by differentiated neurogeneration of the myenteric plexus (cholinergic degeneration) through reactive oxygen and nitrogen species and alteration of protective and regenerative processes. Age-related gastrointestinal dysfunctions may be caused by the ageing gastrointestinal tract itself or by other age-related diseases such as tumour, neurological or inflammatory diseases, anatomic changes, therapeutic medication, polymorbidity or malnutrition. Because of the significant therapeutic options, differential diagnostic work-up is mandatory also in elderly patients.     

The microbiota-gut-brain axis in functional gastrointestinal disorders

Functional gastrointestinal disorders (FGIDs) are highly prevalent and pose a significant burden on health care and society, and impact patients’ quality of life. FGIDs comprise a heterogeneous group of disorders, with unclear underlying pathophysiology. They are considered to result from the interaction of altered gut physiology and psychological factors via the gut-brain axis, where brain and gut symptoms are reciprocally influencing each other’s expression. Intestinal microbiota, as a part of the gut-brain axis, plays a central role in FGIDs. Patients with Irritable Bowel Syndrome, a prototype of FGIDs, display altered composition of the gut microbiota compared with healthy controls and benefit, at the gastrointestinal and psychological levels, from the use of probiotics and antibiotics. This review aims to recapitulate the available literature on FGIDs and microbiota-gut-brain axis.     

Clinical and psychological correlates of soiling in adult patients with functional gastrointestinal disorders

Background/aims

Fecal soiling (FS) is the staining of underwear without loss of significant amounts of fecal material. It is frequently associated with defecation disorders in children. The aim of this study was to search for psychological and clinical correlates of adult patients with soiling. Clinically, the complaint of staining is confused with that of fecal incontinence (FI) in the mind of both patients and attending physicians.

Design

Observational study

Patients and method

We included 1454 consecutive outpatients (71% females). They filled out the Rome III questionnaire for functional gastrointestinal disorders (FGIDs); Beck depression inventory, and state and trait anxiety questionnaires; and Likert scales for constipation, diarrhea, bloating, and abdominal pain. Data were analyzed using ANOVA and logistic regression analysis.

Results

Soiling was found in 123 patients (8.5%). They reported similar frequencies of esophageal, gastroduodenal, and abdominal pain as patients without soiling. In contrast, patients with soiling reported higher prevalence of IBS, such as IBS-Diarrhea, Mixed-IBS, functional diarrhea, functional constipation, and levator ani syndrome, and higher Likert scale for diarrhea, bloating, abdominal pain, and softer stools. The multivariable logistic regression analysis shows that patients with soiling have increased odds to report IBS (P?=?0.019; OR?=?1.958; 95% CI?=?[1.118–3.431]), functional diarrhea (P?=?0.040; OR?=?1.901; 95% CI?=?[1.028–3.513]), and high Diarrhea Likert scale (P?<?0.001; OR?=?1.215; 95% CI?=?[1.130–1.306]). No association was found with psychological evaluation.

Conclusion

In FGID patients, soiling is not associated with psychological disorders and is mainly associated with IBS and functional diarrhea.

     

Neuropathophysiology of functional gastrointestinal disorders

The investigative evidence and emerging concepts in neurogastroenterology implicate dysfunctions at the levels of the enteric and central nervous systems as underlying causes of the prominent symptoms of many of the functional gastrointestinal disorders. Neurogastroenterological research aims for improved understanding of the physiology and pathophysiology of the digestive subsystems from which the arrays of functional symptoms emerge. The key subsystems for defecation-related symptoms and visceral hyper- sensitivity are the intestinal secretory glands, the musculature and the nervous system that controls and integrates their activity. Abdominal pain and discomfort arising from these systems adds the dimension of sensory neurophysiology. This review details current concepts for the underlying pathophysiology in terms of the physiology of intestinal secretion, motility, nervous control, sensing function, immuno-neural communication and the brain-gut axis.     

The impact of functional gastrointestinal disorders on quality of life

OBJECTIVE: The impact of functional gastrointestinal disorders (FGIDs) on quality of life is unknown. We aimed to evaluate whether FGIDs impair quality of life in terms of mental and physical functioning in patients and nonpatients. METHODS: A random sample of 4500 subjects, representative of the Australian population, were mailed a questionnaire on gastrointestinal symptoms in the past 12 months. Quality of life was assessed using the valid SF-12, in which the lower the scores, the greater the impairment of quality of life. The response rate was 72%. RESULTS: Among those fulfilling Rome I criteria for a diagnosis of a FGID (n = 1006) versus those not having a FGID (n = 1904) (healthy controls), there was a significant association with impaired mental (43.9 vs. 48.1) and physical (47.7 vs. 51.6) functioning. Mental functioning (43.3 vs. 44.9) and physical functioning (46.0 vs. 50.5) was significantly more impaired in patients versus nonpatients with a FGID. Furthermore, nonpatients with a FGID had more impaired mental and physical functioning than healthy controls. CONCLUSION: FGIDs impair quality of life, particularly in those that consult for health care.