难治性功能性胃肠病的心理因素识别

Identification of psychological factors in refractory functional gastrointestinal disorders

功能性胃肠病(FGIDs)主要包括功能性消化不良(FD)、肠易激综合征(IBS)、功能性便秘(FC)和功能性腹痛综合征(FAPS)等。消化门诊中42%～61%FGIDs患者伴有心理因素,其中多为抑郁及焦虑。该类患者多为性格内向,负性生活事件可作为诱因导致抑郁、焦虑情绪而引发和加重功能性胃肠病症状。临床表现为长期腹部不适、腹痛(部分无固定部位)、腹胀、食欲减退、排便习惯改变和胸骨后及上腹部烧灼痛等一种或多种重叠症状,部分具有明显情绪化表现。伴有心理异常的FD者消化不良症状积分明显高于不伴心理异常者,胃排空功能较后者降低。针对FGIDs经系统治疗而症状不愈者多存在躯体化、强迫、人际关系紧张、抑郁、焦虑等心理障碍。故应对难治性功能性胃肠病应进行心理测评,以对其进行早期识别。

Functional gastrointestinal diseases（FGIDs） mainly include functional dyspepsia （FD）, irritable bowel syndrome （IBS） ,functional constipation （FC） and functional abdominal pain syndrome （FAPS）. In gastroenterology outpatient ,42% -61% FGIDs patients have psychological factors, mostly depression and anxiety. The personality of these patients are almost introvert. Negative life events can be an incentive to lead to depression and anxiety which can aggravate the functional gastrointestinal symptoms. Clinical manifestations include long-term abdominal discomfort, abdominal pain （some with no fixed position）, abdominal distension, anorexia, change in bowel habits, retrosternal and upper abdominal burning pain or overlapping symptoms. Some have obvious emotional performance. Dyspepsia symptom score of FD patients with mental disorders are higher than those who have no emotional performance and the gastric emptying decrease greatly than the latter. FGIDs treated by systemic therapy but with no improvement in symptoms may have somatization, compul- sion, interpersonal tension, depression, anxiety and other psychological disorders. So psychological evaluation should be carried out to make early recognition for refractory functional gastrointestinal disorders.