功能性烧心与功能性消化不良、肠易激综合征症状重叠研究

Symptom Overlaps Between Functional Heartburn,Functional Dyspepsia,and Irritable Bowel Syndrome

目的研究功能性烧心(FH)患者重叠功能性消化不良(FD)、肠易激综合征(IBS)及其亚型症状的发生率。方法对110例以烧心为主要症状且上消化道内镜检查示食管黏膜无破损的患者行问卷调查、24h食管多通道腔内阻流-pH(MII-pH)联合监测及质子泵抑制剂(PPI)治疗。根据罗马Ⅲ诊断标准对患者重叠FD、IBS症状的情况进行问卷调查,并根据汉密尔顿焦虑/抑郁量表(HAMA/HAMD)调查焦虑及抑郁症状的发生情况。根据24h食管MII-pH监测结果及PPI治疗结果将患者分为非糜烂性反流病(NERD)组及FH组,比较两组重叠FD、IBS症状发生率及其与FD、IBS亚型重叠的情况。结果 FH组女性患者多于NERD组(P<0.05);FH患者焦虑抑郁症状发生率均高于NERD患者(分别为92%vs.75%,88%vs.65%),差异有统计学意义(P<0.05)。52例(47.3%)患者重叠FD症状,31例(28.2%)重叠IBS症状,10例(9.09%)同时重叠FD症状及IBS症状。FH患者重叠FD症状及IBS症状的发生率显著高于NERD患者(分别为62%vs.35%,48%vs.11.7%),差异有统计学意义(P<0.01)。重叠的FD症状以上腹疼痛综合征(EPS)症状略多于餐后不适综合征(PDS)症状、IBS症状以腹泻型(IBS-D)略多于便秘型(分别为29.1%vs.18.2%、16.4%vs.11.8%),但差异无统计学意义(P>0.05)。结论FH较NERD更多见于女性患者,焦虑抑郁症状发生率更高,且更易重叠FD、IBS症状,重叠的症状以EPS及IBS-D亚型更多见。

Objective To determine symptom overlaps between functional heartburn （FH）, functional dyspepsia （FD）, and irritable bowel syndrome （IBS）. Methods One hundred and ten patients with frequent heartburn but no mucosa breakage under endoscopy were enrolled consecutively. They were required to fill out a questionnaire. The overlapped symptoms of FD and IBS symptoms were screened using Rome II1 criteria. The participants were also examined using Hamilton anxiety scale/Hamilton depression scale. All of the participants were followed with 24 h esophageal multichannel intra-luminal impedance monitoring with pH sensor （MII-pH） monitoring and proton pump inhibitor （PPI） trials. The participants were divided into non-erosive reflux disease （NERD） and FH groups. The prevalence of symptom overlaps FD and IBS, between NERD and FH groups was analyzed. Results Women were more likely to present with FH than with NERD （P^0.05）. The participants with FH had higher prevalence of anxiety and depression than those with NERD （920./00 vs. 75%, 88% vs. 65% respectively, P^0.05）. Fifty-two （47.30~ ） patients with heartburn symptom had FD symptoms; 31 （28.2% ） bad IBS symptoms, and 10 （9.09%） had both FD and IBS symptoms. Patients with FH were more likely to have symptom overlaps of FD and IBS than those with NERD （62% vs. 35%, 48% vs. 11.7%, respectively; P〈0.01）. Epigastric pain syndrome （EPS）, a subtype of FD, was slightly more likely to have overlapped NERD and FH symptoms than postprandial discomfort symdrome （PDS）. But the difference was not significant （29. 1% vs. 18. 2%, P〉0.05）. IBS-diarrhea was also slightly more likely to have overlapped NERD and FH symptoms than IBS-constipation. Again, the difference was not significant （16.4% vs. 11.8%, P〉0.05）. Conclusion Female, higher prevalence of anxiety and depression, overlapped FD and IBS symptoms are more likely to appear in FH patients than in NERD patients.