精神心理因素在肠易激综合征和功能性消化不良重叠症中的作用

目的探讨精神心理因素在肠易激综合征和功能性消化不良重叠症中的作用。方法对38例肠易激综合征（iBS）与功能性消化不良（FD）重叠症患者采用汉密尔顿焦虑量表（HAMA）14项和汉密尔顿抑郁量表（HAMD）17项版本进行心理测评,并将调查对象分为体力劳动组和非体力劳动组,比较分析各组评分的特点。结果女性FD与IBS重叠症患者焦虑抑郁障碍发病率较男性无显著性差异（68．2％vs75．0％,X2=0．21,P〉0．05）,非体力劳动者FD与IBS重叠症患者焦虑抑郁障碍发病率较体力劳动者显著升高（85．2％vs36．4％,X2=9．09,P〈0．005）。结论非体力劳动者FD与IBS重叠症患者合并精神心理压力可能通过增加内脏敏感性使FD与IBS重叠症发病率更高,提示心理治疗可能有助于治疗FD与IBS重瞢症。     

Impact of coexisting irritable bowel syndrome on symptoms and pathophysiological mechanisms in functional dyspepsia

Epidemiological studies suggest considerable overlap between functional dyspepsia (FD) and irritable bowel syndrome (IBS). AIM: The aim of the present study was to investigate whether coexisting IBS is also associated with symptom pattern or pathophysiology in FD. METHODS: In 309 consecutive FD patients (207 women, age 42 +/- 0.8 yr), questionnaires were used to assess the dyspepsia symptom pattern and the Rome II criteria for IBS. The overall symptom severity was calculated adding the severity score (0-3, 0 = absent, 3 = severe) of eight dyspepsia symptoms. All patients underwent Helicobacter pylori testing, gastric barostat to determine sensitivity to distention and accommodation to a meal, and gastric emptying breath test. RESULTS: Fifty-four percent of the patients had FD alone, whereas 46% had FD + IBS. FD + IBS patients were more likely to be female (75%vs 60%, p < 0.01) and to have a greater weight loss (5.4 +/- 0.6 vs 3.5 +/- 0.4 kg, p < 0.05). Coexisting IBS did not increase the risk of having any of the dyspeptic symptoms but the overall symptom severity was significantly higher in FD + IBS (12.4 +/- 0.4 vs 9.8 +/- 0.3, p < 0.01). FD + IBS patients had a lower threshold for first perception (2.9 +/- 0.3 vs 3.8 +/- 0.3 mmHg, p < 0.05) and for discomfort (7.9 +/- 0.4 vs 9.5 +/- 0.5 mmHg, p < 0.05) and a greater prevalence of hypersensitivity to gastric distention (44%vs 28%, p < 0.05). Gastric emptying, accommodation to a meal, and prevalence of H. pylori infection did not differ in the two groups. CONCLUSION: About half of the FD patients fulfill the Rome II criteria for IBS. FD + IBS is more prevalent in female patients and is associated with a higher weight loss, with greater overall symptom severity, and with hypersensitivity to distention.     

Current medical treatments of dyspepsia and irritable bowel syndrome

Dyspepsia is a highly prevalent condition characterized by symptoms originating in the gastroduodenal region without underlying organic disorder. Treatment modalities include acid-suppressive drugs, gastroprokinetic drugs, Helicobacter pylori eradication therapy, tricyclic antidepressants, and psychological therapies. Irritable bowel syndrome is a multifactorial, lower functional gastrointestinal disorder involving disturbances of the brain-gut axis. The pathophysiology provides the basis for pharmacotherapy: abnormal gastrointestinal motor functions, visceral hypersensitivity, psychosocial factors, intraluminal changes, and mucosal immune activation. Medications targeting chronic constipation or diarrhea may also relieve irritable bowel syndrome. Novel approaches to treatment require approval, and promising agents are guanylate cyclase cagonists, atypical benzodiazepines, antibiotics, immune modulators, and probiotics.     

Food-related gastrointestinal symptoms in the irritable bowel syndrome

BACKGROUND/AIMS: Postprandial symptoms are common in patients with irritable bowel syndrome (IBS). However, existing studies have come to different conclusions about the role of food in the pathophysiology of IBS. We explored the prevalence of subjective food-related gastrointestinal (GI) symptoms and its relationship to clinical characteristics and psychological factors in IBS. METHODS: 330 patients with IBS and 80 healthy volunteers completed a food questionnaire developed for this study. The subjects graded their subjective symptoms after 35 different foods and a food score was obtained by adding the item scores. The relationship between subjective food-related GI symptoms and referral status, IBS subgroup (predominant bowel pattern), sex, anxiety, depression and body mass index (BMI) was estimated. RESULTS: In 209 (63%) of the patients the GI symptoms were related to meals. Gas problems and abdominal pain were the most frequently reported symptoms. Foods rich in carbohydrates, as well as fatty food, coffee, alcohol and hot spices were most frequently reported to cause symptoms. The food score was higher in patients than in controls (p < 0.0001). In the IBS group higher scores were observed in patients with anxiety (p = 0.005), and females (p < 0.001), but the results were unrelated to IBS subgroup, referral status or BMI. The BMI did not differ between groups. CONCLUSION: A majority of IBS patients consider their symptoms to be related to meals. Especially foods rich in carbohydrates and fat cause problems. Nevertheless, the majority of IBS patients are normal or overweight. Female sex and anxiety predict a high degree of food-related symptoms in IBS.     

Epidemiology of colonic symptoms and the irritable bowel syndrome

Functional gastrointestinal disease is believed to be very common, but reports of its prevalence have not usually evaluated random community samples, and validated questionnaires have not been used to elicit symptoms. The prevalence of specific colonic symptoms and the irritable bowel syndrome among representative middle-aged whites was determined from a defined population, and the impact of these symptoms on presentation for medical care was measured. An age- and sex-stratified random sample of 1021 residents of Olmsted County, Minnesota, aged 30-64 years, was obtained. All subjects were mailed a valid self-report questionnaire that identified gastrointestinal symptoms and functional gastrointestinal disorders. The response rate was 82% (n = 835). The age- and sex-adjusted prevalence of abdominal pain (more than six times in the prior year) was 26.2 per 100 (95% confidence interval, 23.1-29.2). The prevalence of chronic constipation (hard stools and straining and/or less than 3 stools per week greater than 25% of the time) was 17.4 (95% confidence interval, 14.8-20.0), whereas the prevalence of chronic diarrhea (loose watery stools, and/or greater than 3 stools per day greater than 25% of the time) was 17.9 (95% confidence interval, 15.3-20.5). The prevalence of abdominal pain and disturbed defecation was similar in women and men, except that infrequent defecation and straining at stool were more common in women. Using the Manning symptom criteria to identify irritable bowel syndrome (greater than or equal to 2 of 6 symptoms in those with abdominal pain more than six times in the prior year), the prevalence of irritable bowel syndrome was 17.0 per 100 (95% confidence interval, 14.4-19.6). Overall, 71 persons (9%) reported visiting a physician for abdominal pain or disturbed defecation in the prior year; a subset of variables related to pain severity were the best predictors of health care seeking after adjustment for age and gender. However, these accounted for only 22% of the log likelihood. In conclusion, more than one third of an unselected middle-aged population reported chronic abdominal pain or disturbed defecation, and more than one in six had symptoms compatible with the irritable bowel syndrome. Only a minority had presented for medical evaluation; moreover, the characteristics of the abdominal complaints did not explain the seeking of health care in most cases.     

Dyspeptic symptoms and gastric emptying in the irritable bowel syndrome

OBJECTIVES: Irritable bowel syndrome (IBS) and dyspepsia often overlap. Delayed gastric emptying has been reported in IBS patients, although conflicting results exist. Whether overlapping dyspepsia correlates with gastric emptying abnormalities in IBS patients has not been clarified. This study aimed to evaluate gastric emptying of solids and its relationship with dyspeptic symptoms in IBS patients. METHODS: A total of 146 IBS outpatients seen in a referral center were evaluated for dyspeptic symptoms using a validated questionnaire. Gastric emptying of solids was evaluated scintigraphically in all patients and in 50 healthy controls. RESULTS: Overlapping dyspepsia was diagnosed in 96 (66%) IBS patients. On average, gastric emptying rates were lower in IBS patients (mean +/- SEM, 33% +/- 1%/h) compared with controls (40% +/- 2%/h; p < 0.01). Specifically, gastric emptying was delayed in IBS patients with overlapping dyspepsia (31% +/- 1%/h; p < 0.01), whereas IBS patients without dyspeptic complaints showed gastric emptying rates (37% +/- 2%/h) that were similar to those of healthy controls (40% +/- 2%/h). Relevant postprandial fullness (OR = 4.7, 95% CI = 1.8-12.5) and relevant nausea (OR = 3.3, 95% CI 1.2-9.3) were independently associated with delayed gastric emptying. CONCLUSIONS: IBS patients without overlapping dyspepsia have normal gastric emptying of solids. A significant association exists in IBS patients between delayed gastric emptying and overlapping relevant postprandial fullness and nausea.     

Upper gastrointestinal and mental symptoms in the irritable bowel syndrome

Gastrointestinal and mental symptoms were assessed in 101 outpatients with the irritable bowel syndrome (IBS). A normal female population was used for comparison of mental symptoms. By definition all patients had abdominal pains and/or change of bowel habits (constipation or diarrhoea, or both) but no demonstrable organic disease. Upper gastrointestinal symptoms without peptic ulcer disease were reported by 87% of the patients. Mental symptoms were reported by almost all patients. Symptoms of anxiety, fatiguability, hostile feelings, sadness, and sleep disturbances were seen significantly more often among IBS women than in the controls. We conclude that patients with IBS frequently have upper gastrointestinal and mental symptoms that should be taken into account in the therapeutic management and evaluation of new modes of treatment.     

肠易激综合征患者消化不良症状与胃排空之间的关系

目的　探讨肠易激综合征(IBS)患者消化不良症状与固体胃排空之间的关系。方法　采用不透X线标志物测定54例IBS患者餐后6小时残留胃内的钡条数,确定6种消化不良症状并对每种症状计分。结果　IBS患者中有消化不良症状者占54%,便秘型IBS患者与腹泻型IBS患者的消化不良症状总积分无明显差异(P>0. 05)。便秘型IBS患者中有消化不良症状者的固体胃排空延迟发生率较无消化不良症状者明显高(P<0. 05 ),腹泻型IBS患者中有消化不良症状者和无消化不良症状者的固体胃排空延迟发生率比较,无明显差异(P>0. 05);便秘型IBS患者的固体胃排空延迟发生率较腹泻型IBS高(P<0. 01)。结论　便秘型IBS患者消化不良症状与固体胃排空延迟可能相关,腹泻型IBS患者消化不良症状与固体胃排空延迟无关。     

5-羟色胺与肠易激综合征关系的研究进展

肠易激综合征(IBS)是一种由胃肠功能紊乱引起的疾病,国内外研究表明IBS与5-羟色胺(5-HT)关系密切,5-HT能使IBS患者的肠道运动增加、对液体的吸收减少和内脏敏感性增高,调控胃肠运动、分泌、吸收及感觉等复杂功能,故5-HT与IBS患者腹痛、腹泻和内脏感觉异常等症状密切相关。     

Predictors of health care seeking for irritable bowel syndrome and nonulcer dyspepsia: a critical review of the literature on symptom and psychosocial factors

OBJECTIVES: Health care use is a costly outcome of the irritable bowel syndrome (IBS) and nonulcer dyspepsia (NUD), but the predictors of this behavior remain poorly defined. We aimed to systematically review the literature to determine which symptoms and psychosocial factors drive health care seeking in these disorders. METHODS: A broad based MEDLINE and Current Contents search between 1966 and 2000 identified 44 relevant publications. References from these articles were also reviewed. RESULTS: The literature suggests that symptom severity is an important factor, but only explains a small proportion of the health care seeking behavior associated with these disorders in population-based studies. Psychosocial factors including life event stress, psychological morbidity, personality, abuse and abnormal illness attitudes and beliefs have been found to characterize those that seek help versus those that do not. The role of other psychosocial factors such as social support, coping style and knowledge about illness are as yet undetermined. CONCLUSIONS: A model for health care seeking for IBS and NUD, with an emphasis on psychosocial factors is presented, but remains to be tested.     

Diagnostic yield of alarm features in irritable bowel syndrome and functional dyspepsia

OBJECTIVE: The diagnostic value of the addition of alarm symptoms in distinguishing functional from organic gastrointestinal disease remains uncertain. We aimed to establish the value of alarm features in differentiating between organic disease and irritable bowel syndrome (IBS) and functional dyspepsia (FD). METHODS: A total of 568 consecutive patients (63% female; mean age 44.7 years) completed a detailed symptom questionnaire and then received a complete diagnostic workup, as required. Questionnaire data were collected prospectively and audited retrospectively; the treating physician was blinded to the results of the questionnaires. Patients were coded and allocated to the following diagnostic groups: IBS, FD, organic diseases of the upper gastrointestinal tract, or organic diseases of the lower gastrointestinal tract. Logistic regression was used to identify the best subset of symptoms that discriminated organic disease from functional illness. Separate models compared IBS (n = 214) with diseases of the lower gastrointestinal tract (n = 66), and FD (n = 70) with diseases of the upper gastrointestinal tract (n = 250). RESULTS: Age (50 years at symptom onset: odds ratio (OR) 2.65 (95% confidence interval 1.4-5.0); p = 0.002) and blood on the toilet paper (OR 2.7 (1.4-5.1);p = 0.002) emerged as alarm features that discriminated IBS from lower gastrointestinal illness. A diagnosis of IBS was typically associated with female sex (OR2.5 (1.3-4.6); p = 0.004), pain on six or more occasions in the previous year (OR 5.0 (2.2-11.1); p<0.001), pain that radiated outside of the abdomen (OR 2.9 (1.4-6.3); p = 0.006), and pain associated with looser bowel motions (OR 2.1 (1.1-4.2); p = 0.03). A model incorporating three Manning criteria and alarm features yielded a correct diagnosis of IBS in 96% and a correct diagnosis of organic disease in 52% of cases. Alarm features did not discriminate FD from upper gastrointestinal disease. Patients with FD were significantly more likely to report upper abdominal pain (OR 3.7 (1.7-8.3); p = 0.002) and significantly less likely to report aspirin use (OR 0.26 (0.1-0.6); p = 0.001). The predictive value of symptoms in diagnosing FD was only 17%. CONCLUSIONS: Symptoms plus alarm features have a high predictive value for diagnosing IBS but the predictive value for a diagnosis of FD remains poor. Current criteria for the diagnosis of IBS should incorporate relevant alarm features to improve the diagnostic yield.     

Microinflammation in the intestinal mucosa and symptoms of irritable bowel syndrome

Journal of Gastroenterology - Potential etiological mechanisms of irritable bowel syndrome (IBS) have been reported, and emerging data suggest that immune activation is present in a major subset of...     

Gastric emptying and dyspeptic symptoms in the irritable bowel syndrome.

Many patients with irritable bowel syndrome (IBS) have symptoms suggestive of disturbances in gastric emptying, but so far no abnormalities in gastric emptying have been demonstrated in these patients. We studied gastric emptying of a solid meal with a 99mTc-labeled pancake in 16 healthy volunteers (8 women and 8 men; age, 20-33 years; mean age, 25 years) and 16 predominantly constipated IBS patients (10 women and 6 men; age, 17-43 years; mean age, 25 years). The incidence and severity of the symptoms nausea, vomiting, early satiety, and pain in the upper abdomen were scored. The duration of the lag phase of gastric emptying of the solid meal did not differ between the groups (controls, 16.6 +/- 4.7 min; IBS patients, 22.2 +/- 14.7 min). In normal subjects lag phase duration and emptying rate were correlated (r = 0.49, p greater than 0.05); in the IBS patients they were not. Post-lag gastric emptying of the solid meal was slower (p less than 0.01) in the IBS patients (0.58 +/- 0.24%/min) than in the control subjects (0.85 +/- 0.24%/min). No correlations were found, however, between the emptying rate and the severity of the upper abdominal symptoms. This study is the first to demonstrate that gastric emptying is delayed in IBS patients. This abnormality, however, appears not to be the major determinant of the upper abdominal symptoms often present in these patients.     

胃食管反流病与功能性消化不良、肠易激综合征症状重叠的研究

目的探讨胃食管反流病（GERD）重叠功能性消化不良（FD）、肠易激综合征（IBS）症状的发生率，分析糜烂性食管炎（EE）和非糜烂性反流病（NERD）亚型患者重叠FD、IBS症状发生率的异同。方法通过胃镜及24h食管pH监测，将147例GERD患者区分为EE47例、病理性酸反流[NERDpH（＋）]42例和生理性酸反流[NERDpH（-）]58例。根据罗马Ⅱ诊断标准对患者重叠FD、IBS症状的情况进行问卷调查。采用《检验比较不同组间重叠症状发生率。结果147例GERD患者中重叠FD症状54例（36．7％），重叠IBS症状19例（12．9％），其中同时重叠FD、IBS症状10例（6．8％）。EE及NERD组重叠FD症状者分别为11例（23．4％）及43例（43．0％），差异有统计学意义（P〈0．05）。EE及NERDpH（＋）组重叠FD症状者分别为n例（23．4％）及13例（31．O％），差异无统计学意义（P〉0．05）。NERDpH（＋）组及pH（-）组重叠FD症状者分别为13例（31．0％）及30例（51．7％），差异有统计学意义（P〈0．05）。EE及NERD组重叠IBS症状者分别为6例（12．8％）及13例（占13．0％），差异无统计学意义（P〉0．05）。NERDpH（＋）组及pH（-）组重叠IBS症状者分别为4例（9．5％）及9例（15．5％），差异无统计学意义（P〉0．05）。结论部分GERD患者重叠FD、IBS症状。无异常食管酸暴露的烧心患者易合并FD症状。     

伊托必利治疗功能性消化不良重叠便秘型肠易激综合征疗效观察

目的 观察伊托必利治疗功能性消化不良(FD)重叠便秘型肠易激综合征(C-IBS)患者的疗效.方法 将符合FD标准及重叠C-IBS患者分为FD治疗组(40例)、FD观察组(20例)、FD重叠C-IBS治疗组(40例)和FD重叠C-IBS观察组(20例),FD治疗组和FD重叠C-IBS治疗组均给予伊托必利100 rag/次,每日3次,疗程8周.观察并记录4组患者上腹饱胀、早饱、腹痛等症状及C-IBS患者便秘改善情况.FD治疗组和FD重叠C-IBS治疗组于治疗前及治疗后2周进行胃排空试验.结果 FD治疗组和FD重叠C-IBS治疗组患者腹痛、上腹饱胀、早饱等症状均有不同程度改善,其中FD重叠C-IBS治疗组改善程度更为明显,且排便情况亦有显著改善.B超监测胃排空显示,与观察组相比,FD治疗组和FD重叠C-IBS治疗组患者治疗后胃窦收缩幅度及胃排空时间均有显著改善(P<0.05).结论 伊托必利治疗FD有效,尤其是对FD重叠C-IBS治疗组的疗效优于FD治疗组.     

Therapeutic strategies for functional dyspepsia and irritable bowel syndrome based on pathophysiology

Functional gastrointestinal disorders (FGIDs) are common and distressing. They are so named because a defined pathophysiology in terms of structural or biochemical pathways is lacking. Traditionally FGIDs have been conceptualized as brain–gut disorders, with subgroups of patients demonstrating visceral hypersensitivity and motility abnormalities as well as psychological distress. However, it is becoming apparent that there are certain structural or biochemical gut alterations among subsets with the common FGIDs, most notably functional dyspepsia (FD) and irritable bowel syndrome (IBS). For example, a sodium channel mutation has been identified in IBS that may account for 2 % of cases, and subtle intestinal inflammation has been observed in both IBS and FD. Other research has implicated early life events and stress, autoimmune disorders and atopy and infections, the gut microbiome and disordered mucosal immune activation in patients with IBS or FD. Understanding the origin of symptoms in FGIDs will allow therapy to be targeted at the pathophysiological changes, not at merely alleviating symptoms, and holds hope for eventual cure in some cases. For example, there are promising developments in manipulating the microbiome through diet, prebiotics and antibiotics in IBS, and testing and treating patients for Helicobacter pylori infection remains a mainstay of therapy in patients with dyspepsia and this infection. Locally acting drugs such as linaclotide have been an advance in treating the symptoms of constipation-predominant IBS, but do not alter the natural history of the disease. A role for a holistic approach to patients with FGIDs is warranted, as brain-to-gut and gut-to-brain pathways appear to be activated.