Pathophysiology of functional heartburn based on Rome Ⅲ criteria in Japanese patients

AIM:To investigate the pathophysiology of functional heartburn(FH) in Japanese patients.METHODS:A total of 111 patients with proton pump inhibitor(PPI)-refractory non-erosive gastroesophageal reflux disease underwent intraesophageal pressure testing and 24-h multichannel intraluminal impedancep H(24MII-p H) testing.The patients also completed several questionnaires while they were receiving the PPI treatment, including the questionnaire for the diagnosis of reflux disease(QUEST), the frequency scale for the symptoms of gastroesophageal reflux disease(FSSG), the gastrointestinal symptoms rating scale(GSRS), SF-36, and the Cornell Medical Index(CMI).The subjects were classified into FH and endoscopy-negative reflux disease(ENRD) groups based on the Rome Ⅲ criteria.RESULTS:Thirty-three patients with esophageal motility disorder were excluded from this study, while 22 patients with abnormal esophageal acid exposure time(p H-POS) and 34 with hypersensitive esophagus(HE) were included in the ENRD group.The FH group included 22 patients with no reflux involvement.Sex, age, and body mass index did not differ significantly between the groups.The mean SF-36 values were < 50(normal) for all scales in these groups, with no significant differences.The GSRS scores in these groups were not different and showed overlap with other gastrointestinal symptoms.The QUEST and the FSSG scores did not differ significantly between the groups.Neuroticism was diagnosed using the CMI questionnaire in 17 of the 78 included subjects within the p H-POS(n=4),HE(n=8),and FH(n=5)groups,with no significant differences.CONCLUSION:Clinical characteristics of the FH and PPI-refractory ENRD groups were similar.Therefore,esophageal function should be examined via manometry and 24MII-p H testing to differentiate between them.

Irritable Bowel Syndrome in General Population of Cotonou: Prevalence and Associated Factors

Introduction: Irritable bowel syndrome (IBS) is a known public health burden in western countries while only a few studies have been published on this disease in Africa. The objective of this study was to determine the prevalence of IBS in the general adult population of Cotonou (Benin), its associated risk factors and its impact on patients’ daily life. Method: This was a descriptive and analytical cross-sectional study conducted over one month. Data was collected via a questionnaire. IBS was defined by the Rome IV criteria. Results: A total of 768 participants were included, with a male predominance (sex ratio 1.8). The mean age of the participants was 30.6 years, with extremes of 15 to 76 years. The prevalence of IBS in our study was 4.2%. IBS-D was the most common subtype (34.4%). IBS symptoms were influenced by diet (46.9%), stress (31.3%) and lack of sleep (15.6%). In the univariate analysis, the risk factors associated with IBS were: Dendi and Otamari ethnicity (p = 0.015), low level of education (p = 0.047), family history of IBS (p = 0.026), smoking (p Conclusion: Despite IBS frequency, patients with IBS rarely seek medical attention. The public should therefore be informed about this condition to reduce its impact on their daily life.

Irritable bowel syndrome: Physicians' awareness and patients' experience

AIM: To study if and how physicians use the irritable bowel syndrome (IBS) diagnostic criteria and to assess treatment strategies in IBS patients. METHODS: A questionnaire was sent to 191 physicians regarding IBS criteria, diagnostic methods and treatment. Furthermore, 94 patients who were diagnosed with IBS underwent telephone interview. RESULTS: A total of 80/191 (41.9%) physicians responded to the survey. Overall, 13 patients were diag-nosed monthly with IBS by specialists in gastroenterology (SGs) and 2.5 patients by general practitioners (GPs). All the SGs knew of the criteria to diagnose IBS, as did 46/70 (65.7%) GPs. Seventy-nine percent used the patient's history, 38% used a physical examination, and 38% exclusion of other diseases to diagnose IBS. Only 18/80 (22.5%) physicians used specific IBS criteria. Of the patients interviewed, 59/94 (62.8%) knew they had experienced IBS. Two out of five patients knew IBS and had seen a physician because of IBS symptoms. Half of those received a diagnosis of IBS. A total of 13% were satisfied with treatment. IBS affected daily activities in 43% of cases. CONCLUSION: Half of the patients with IBS who consulted a physician received a diagnosis. Awareness and knowledge of diagnostic criteria for IBS differ between SGs and GPs.

Irritable bowel syndrome in children: Pathogenesis, diagnosis and evidence-based treatment

Irritable bowel syndrome (IBS) is the commonest cause of recurrent abdominal pain (RAP) in children in both more developed and developing parts of the world. It is defined by the Rome III criteria for functional gastrointestinal disorders. It is characterized by abdominal pain that is improved by defecation and whose onset is associated with a change in stool form and or frequency and is not explained by structural or biochemical abnormalities. It is estimated that 10%-15% of older children and adolescents suffer from IBS. IBS can be considered to be a brain-gut disorder possibly due to complex interaction between environmental and hereditary factors. The diagnosis of IBS is made based on the Rome III criteria together with ruling out organic causes of RAP in children such as inflammatory bowel disease and celiac disease. Once the diagnosis of IBS is made, it is important to explain to the parents (and children) that there is no serious underlying disease. This reassurance may be effective treatment in a large number of cases. Lifestyle modifications, stress management, dietary interventions and probiotics may be beneficial in some cases. Although there is limited evidence for efficacy of pharmacological therapies such as antispasmodics and antidiarrheals; these have a role in severe cases. Biopsychosocial therapies have shown encouraging results in initial trials but are beset by limited availability. Further research is necessary to understand the pathophysiology and provide specific focused therapies.

Rome Ⅲ survey of irritable bowel syndrome among ethnic Malays

AIM:To survey irritable bowel syndrome(IBS) using Rome Ⅲ criteria among Malays from the north-eastern region of Peninsular Malaysia.METHODS:A previously validated Malay language Rome Ⅲ IBS diagnostic questionnaire was used in the current study.A prospective sample of 232 Malay subjects(80% power) was initially screened.Using a stratified random sampling strategy,a total of 221 Malay subjects(112 subjects in a "full time job" and 109 subjects in "no full time job") were recruited.Subjects were visitors(friends and relatives) within the hospital compound and were representative of the local community.Red flags and psychosocial alarm symptoms were also assessed in the current study using previously translated and validated questionnaires.Subjects with IBS were sub-typed into constipation-predominant,diarrhea-predominant,mixed type and un-subtyped.Univariable and multivariable analyses were used to test for association between socioeconomic factors and presence of red flags and psychosocial alarm features among the Malays with IBS.RESULTS:IBS was present in 10.9%(24/221),red flags in 22.2%(49/221) and psychosocial alarm features in 9.0%(20/221).Red flags were more commonly reported in subjects with IBS(83.3%) than psychosocial alarm features(20.8%,P < 0.001).Subjects with IBS were older(mean age 41.4 years vs 36.9 years,P = 0.08),but no difference in gender was noted(P = 0.4).Using univariable analysis,IBS was significantly associated with a tertiary education,high individual income above RM1000,married status,exsmoker and the presence of red flags(all P < 0.05).In multiple logistic regression analysis,only the presence of red flags was significantly associated with IBS(odds ratio:0.02,95%CI:0.004-0.1,P < 0.001).The commonest IBS sub-type was mixed type(58.3%),followed by constipation-predominant(20.8%),diarrheapredominant(16.7%) and un-subtyped(4.2%).Four of 13 Malay females(30.8%) with IBS also had menstrual pain.Most subjects with IBS had at least one red flag(70.8%),12.5% had two red flags and 16.7% with no red flags.The commonest red flag was a bowel habit change in subjects > 50 years old and this was reported by 16.7% of subjects with IBS.CONCLUSION:Using the Rome Ⅲ criteria,IBS was common among ethnic Malays from the north-eastern region of Peninsular Malaysia.

Review of the role of abdominal imaging in irritable bowel syndrome

The role of radiologic imaging in the investigation of irritable bowel syndrome(IBS) remains a subject of debate and there is some evidence, from recent studies of utilization of imaging in IBS, which focused on associated costs and radiation exposure, that imaging is being used relatively widely in these patients. This review aims to assess current best evidence to accurately define the role of radiologic imaging in IBS patients. Primary and secondary literature searches were performed. Evidence suggests that the lack of "red flag" or alarm features in IBS patients should reassure the clinician that the diagnosis of IBS is correct and United States and United Kingdom guidelines recommend no radiologic imaging for IBS patients if alarm features are not present. In patients presenting with IBS symptoms and alarm features, radiologic testing may be used to exclude an alternative diagnosis and the imaging modality should be chosen based on the most likely alternative diagnosis.

Irritable Bowel Syndrome among Medical and Non-Medical Northern Border University Students, Kingdom of Saudi Arabia: Across Sectional Study

Background: Irritable Bowel Syndrome (IBS) is a common functional gastrointestinal disorder (FGID), characterized by abdominal pain or discomfort and alteration in bowel habits. Aim of the study: To determine the overall prevalence, prevalence of each type and risk factors of IBS among Northern Border University (NBU) students, Arar, Kingdom of Saudi Arabia. Material and methods: We use cross sectional, descriptive study with multistage cluster probability sample. Using Rome III criteria questionnaire of IBS;which is a self-administrated consists of ten questions assessing the current status of an apparently normal person. The questionnaire is administrated to Northern Border University students. Results: A total of 228 University students of them, 94 (41.2%) males and 134 (58.8%) females were included in the study. The overall prevalence of IBS according to Rome III criteria in northern border University was (32.5%). The disease prevalence was 33.6% in females and 30.9% in males. Among the study participants, the most common type of IBS was the mixed one 12.7%, followed by the constipation predominant type 10.5%, then the diarrhea pre-dominant type 5.7% while the least common was unsubtyped cases (3.5%). Statistically significant increase in prevalence of this disease was found among female students (60.8% vs. 39.2% in males) (p-value < 0.05), the students who experienced psychic stress and irritability (79.7%) (p-value < 0.05) and students who were obese (p-value < 0.001). Conclusion: The results of this study concluded the prevalence rate of 32.5% for IBS among the students studying in Northern Border University. Stress and high body mass index were significantly associated with IBS. In addition, this study concluded that IBS was not significantly associated with socio-demographic characteristics and smoking.

The Prevalence of Irritable Bowel Syndrome among Medical and Non-Medical Suez Canal University Students

Background: Irritable bowel syndrome (IBS) is one of the most frequently diagnosed gastrointestinal (GI) disorders in primary care and gastroenterology practices, despite the fact that many suffer symptoms without knowing their diagnosis or seek for medical consult, so this study aims to explore the prevalence of irritable bowel syndrome (IBS) among Suez Canal university students. Methods: A cross section. With multistage cluster probability sample. Using Rome criteria III IBS module, the questionnaire was administrated to Suez Canal university students;a population consisting of (86) students of the faculty of medicine & non-medical (84) students of the faculty of commerce English section with total (170) students of the third batch from both faculties (whose mean age is 20 ± 0.82) years old with total (109) females and (61) males. Results: The prevalence of IBS according to Rome III criteria in Suez Canal University was 22.9%. 23.8% were diseased in the faculty of commerce while 22.1% in faculty of medicine. Females in this study represent 64.1% of the sample, 30.3% of them were diseased, while males represent 35.9% about 9.8% of them were diseased. IBS constipation predominant type was 28.2%, diarrhea predominant type was 15.4%, mixed type was 46.2%, the unsubtyped cases represent 10.3%. Conclusion: Irritable bowel syndrome is a common disease among Suez Canal university students, more common in non medical students than medical ones, can be considered as a female predominant disease. And this requires a real medical concern.

罗马Ⅲ标准研究肠易激综合征临床特点及亚型

目的:应用功能性胃肠病罗马Ⅲ诊断标准研究肠易激综合征(IBS)的临床特点及亚型分布.方法:应用罗马Ⅲ诊断标准,对消化科门诊IBS患者进行诊断和亚型分类,大便性状按照Bristol分级,统计学分析应用SPSS软件进行统计学处理.结果:罗马Ⅲ标准诊断IBS患者487例,年龄18-78岁,病程6-720 mo;病程达12 mo以上者420例,占86.2%,6-12 mo者67例,占13.8%.常见的消化道外的伴随症状依次为乏力、腰背痛、失眠、头晕、胸闷、体质量下降(≥5 kg)、头痛、尿频、咽部异物感、肩痛、眼球痛、胸痛.诊断为腹泻型IBS(IBS-D)者316例(65%),便秘型IBS(IBS-C)者59例(12%),混合型IBS(IBS-M)者24例(5%),未定型IBS(IBS-U)者88例(18%).病程中发生亚型转化者16例,占3.29%.不同的IBS亚型性别分布不同(x^2= 30.86,P<0.05),IBS-C和IBS-U中女性较多,IBS-D中男性较多(P<0.05).不同的IBS亚型年龄分布无统计学差异(x^2=16.67,P>0.05).结论:罗马Ⅲ诊断标准可提高IBS的早期诊断率.按照IBS罗马Ⅲ诊断标准,IBS-D最多见,约占2/3;其次为IBS-U,IBS-C及IBS-M.IBS-U在临床上不少见,这一新的亚型值得进一步研究.

北京在校大学生功能性消化不良相关危险因素的调查

目的研究首都大学生功能性消化不良(functional dyspepsia,FD)的相关危险因素,为防治这一常见疾病提供新的依据。方法于2006-2007年对北京市在校大学生490764人,采用分层整群随机抽样法,以罗马Ⅲ成人功能性胃肠病诊断调查问卷对FD进行调查和诊断;以自行设计的相关危险因素问卷表调查可能相关的危险因素,内容包括饮食、生活习惯、工作学习方式、过去疾病史、家族疾病史等。采用SPSS15.0统计软件,用χ2检验、t检验、非参数检验、Logistic回归分析等方法在两组间进行相关因素或可能危险因素的分析、比较。结果共发放问卷9800份,收回问卷8608份,合格问卷6959份,问卷回收率87.8%、合格率80.8%,符合样本估算要求。共有110例被诊断为FD(设为FD组),492例无任何症状(设为正常对照组)。经统计学分析显示FD组的身高、体质量、体质量指数均明显低于对照组(P<0.05,P<0.01)。②FD组暴饮暴食、挑食、常吃生食、冷饮、烫食、辛辣食品、干硬食品、奶制品、忌口、减肥、饮酒的概率明显多于对照组(P<0.01)。③FD组休闲娱乐的概率和内容、睡眠时间、运动时间、周末休息时间明显少于对照组(P<0.01),喜欢熬夜学习的人数、感觉学习强度和学习压力大的人数明显多于对照组(P<0.05)。④FD组食物过敏史、经常服药史、外伤手术史、痢疾史、胃肠炎史、肝胆胰疾病史、家族类似症状史明显多于对照组(P<0.05)。⑤Logistic回归分析显示FD发生率与经常挑食、运动时间少、吸烟、经常服药、外伤手术史、胃肠炎史、家族类似症状史呈正相关(r分别为1.610、1.250、0.814、2.038、1.671、1.236、3.953),与睡眠时间呈负相关(r=-1.057)。结论经常挑食、运动时间少、吸烟、经常服药、外伤手术史、胃肠炎史、家族类似症状史、睡眠时间少等可能是首都大学生FD的相关危险因素。

以罗马Ⅲ标准诊断的功能性胃肠疾病的症状重叠状况研究

目的按照功能性胃肠疾病(FGIDs)罗马Ⅲ分类及诊断标准,研究FGIDs的症状重叠,为更好地诊断及治疗FGIDs提供依据。方法对492例经罗马Ⅲ分类及诊断标准诊断为FGIDs的患者进行分类诊断,研究功能性消化不良(FD)、肠易激综合征(IBS)、慢性功能性便秘(CC)、功能性腹泻(F-D)、功能性腹胀(FB)和功能性嗳气(BD)等功能性胃肠疾病的症状及重叠情况。结果492例FGIDs患者病程6～480个月,中位病程30个月。病程12个月以上者417例,占84.8%,6～12个月者75例,占15.2%。492例中诊断为单一FGIDs的患者302例,占61.4%,列入无重叠组;诊断为2种FGIDs重叠者185例,占37.6%,诊断为3种FGIDs重叠者5例,占1.0%,列入重叠组。其中FD的重叠形式最多,共6种,最常见的3种重叠形式为FD+IBS(100/272,36.8%)、FD+CC(28/272,10.3%)和FD+FB(18/272,6.6%)。FB的重叠形式次之,共5种,最常见的3种重叠形式为FB+FD(15/49,30.6%)、FB+BD(9/49,18.4%)和FB+FD+CC(4/49,8.2%)。BD、CC和F-D患者各有3种重叠形式。重叠组和无重叠组比较,患者的年龄、病程均无统计学差异(P>0.05),但重叠组中女性较多(P<0.05)。就某一种FGIDs而言,可表现为多种重叠形式。结论FGIDs之间症状重叠非常常见,罗马Ⅲ诊断标准提高了FGIDs的早期诊断率。重叠症状的存在提示功能性胃肠疾病常同时具有上、下消化道功能紊乱的特点,在临床中应注意诊断全面。

广西南宁市社区居民肠易激综合征流行病学现状

目的:调查广西南宁市社区居民肠易激综合征(irritable bowel syndrome,IBS)的患病率及其影响因素,以进一步提高本地区IBS的防治水平.方法:以广西南宁市社区居民为调查对象,采用罗马Ⅲ分类及诊断标准设计调查问卷,随机、整群,分层抽样方法进行面访式调查,分析人群IBS患病率及其影响因素.结果:(1)发放问卷2900份,回收有效问卷2773份,有效率达95.62%.其中181例诊断为IBS,南宁市社区居民IBS总体患病率为6.53%;(2)不同性别IBS的患病率不同,女性的IBS患病率比值比(OR)为1.419,明显高于男性;(3)多因素Logistic回归分析结果:IBS的患病与喜食腌制海产品、生冷食物、水果、乳制品及经常情绪不佳有关(P<0.05).结论:广西南宁市社区居民IBS总体患病率为6.53%,患病的影响因素主要有性别、喜食腌制海产品、生冷食物、水果、乳制品及经常情绪不佳等.

符合罗马Ⅲ标准的功能性消化不良患者固体胃排空功能研究

背景:罗马Ⅲ标准对功能性消化不良(FD)的定义作了更新和修订,相应FD患者人群亦发生改变。目的:研究符合罗马Ⅲ标准的FD患者的固体胃排空功能,以及新的FD症状谱和分型与固体胃排空功能之间的关系。方法:对36例符合罗马Ⅲ标准的FD患者和32名健康志愿者行99Tc固体胃排空试验。比较不同症状分型FD患者的固体胃排空功能,分析固体胃排空功能与罗马Ⅲ标准中FD症状的相关性。结果:10例(27.8%)FD患者固体胃半排空时间超过正常上限,9例(25.0%)2h残留率高于正常上限。餐后不适综合征(PDS)、上腹痛综合征(EPS)和PDS+EPS型FD患者固体胃半排空时间分别为(150.3±40.2)min、(118.3±25.1)min和(150.5±51.2)min,三组间差异无统计学意义(P=0.126)。餐后饱胀不适症状与固体胃半排空时间和2h残留率均呈线性正相关,相关系数分别为11.5(P=0.043)和0.045(P=0.040)。结论:本组27.8%的FD患者存在固体胃排空延迟。PDS和PDS+EPS型FD的固体胃半排空时间有长于EPS的趋势。FD患者的餐后饱胀不适症状与固体胃排空延迟有关,固体胃排空延迟是符合罗马Ⅲ标准的FD患者的病理生理机制之一。

胃运动和感觉功能在符合罗马Ⅲ标准的功能性消化不良患者中的特点

目的:研究符合罗马Ⅲ标准的功能性消化不良(FD)患者的胃运动和感觉功能的特点以及不同类型的FD患者病理生理机制的差异.方法:对符合罗马Ⅲ标准的44例FD患者根据罗马Ⅲ分类标准分为餐后不适综合征(PDS,31例)和上腹痛综合征(EPS,13例)两个类型,10例无症状的健康人作为对照组,对所有受试者均进行上胃肠消化不良症状评分、5h胃排空检查、水负荷试验.结果:FD、PDS患者胃排空率较对照组明显减低(57.74%±5.56%,52.26%±8.12%vs84.00%±5.76%,P=0.015,P=0.003),PDS患者胃排空率较EPS有减低趋势(56.26%±8.12%vs68.08%±9.86%,P<0.05).FD、PDS患者的胃感知饮水量和最大饱足饮水量较对照组明显减少(567.61mL±25.22mL,548.23mL±29.36mLvs725.00mL±54.90mL,P=0.006,P=0.01;917.16mL±39.44mL,894.17mL±47.65mLvs1240.00mL±75.57mL,P=0.000,P=0.001).PDS的胃感知饮水量和最大饱足饮水量较EPS有减少趋势.EPS的最大饱足饮水量较对照组明显减少(P=0.025).结论:FD患者存在胃排空和近端胃感觉功能的异常,PDS患者胃排空延迟和近端胃扩张功能及顺应性受损更为明显.

罗马Ⅱ标准在肠易激综合征诊断中的价值

背景:肠易激综合征(IBS)是一种慢性肠功能紊乱性疾病,其诊断标准对IBS患者的确诊至关重要。目的:评价罗马Ⅱ标准诊断IBS的真实性,及其对IBS与其他功能性或器质性消化系统疾病或与健康人鉴别的价值。方法:采用临床流行病学方法对499例来自消化内科门诊和体检中心的对象进行调查。由资深专家根据体格检查和辅助检查结果作出最终诊断,并以此为金标准,计算罗马Ⅱ标准用于IBS与其他功能性或器质性消化系统疾病或与健康人鉴别时的敏感性、特异性等指标。结果:罗马Ⅱ标准用于IBS与非溃疡性消化不良或与溃疡性结肠炎的鉴别时,敏感性及其95%CI相同,特异性及其95%CI、阳性预测值、阴性预测值、阳性似然比和阴性似然比相似,敏感性均为80%,特异性分别为51%和53%。结论:在临床实践中,如严格执行罗马Ⅱ标准,有可能使一部分症状发生频率较低的IBS患者被漏诊。

对中国消化科医生FGIDs罗马标准认知情况的调查

目的通过调查揭示功能性胃肠疾病(FGIDs)罗马标准在中国消化科医生中普及程度、认知情况。方法应用问卷调查方式对参加2007年全国消化会议的消化科医生进行调查。问卷包括23个问题,涵盖了调查对象的基本情况、行医执业特点、对FGIDs知识及罗马标准的认知情况等。结果共分发1 460份问卷,返回558份。经过评估合格问卷549份。调查对象平均年龄40.2岁,男女比例为1.1∶1。被调查者中82.7%已经了解罗马Ⅲ标准。最主要的获知FGIDs最新知识的渠道是消化专业会议(74.8%),消化专业杂志(69.0%)。了解和不了解罗马Ⅲ标准的两组医生在年龄、医院级别、行医年限、专业职称等方面无明显差异。针对FGIDs病人在三级医院就诊情况,27.2%的被调查者认为绝大部分FGIDs病人需要在三级医院诊治,20.6%则持完全相反的态度,他们认为绝大部分FGIDs病人不需要在三级医院诊治。另外49.6%被调查对象认为GERD也可当作一种功能性疾病。结论中国消化科医生对FGIDs罗马标准有较好的认知,但仍有少部分医生尚不了解FGIDs罗马标准的进展,这需要推动继续医学教育制度的完善。

儿童功能性便秘诊断标准的评述与比较

功能性便秘（FC）是儿童期的常见病、多发病,发病率为3%～5%,占儿童消化道门诊的25%。由于便秘病因的复杂性和多样性特点,客观的物理检查缺乏普遍性特点,对于儿童FC的诊断目前大多依靠症状和查体,但儿童语言发育差,对自身症状表述不清,故对儿童便秘的诊断主要来源于家长的主观评述。国内虽然许多学者对儿童FC进行了一定的研究,但目前尚无关于儿童FC的统一标准,对于儿童FC的诊断还一直采用国外儿童的标准。其中几个比较常用的是传统标准、罗马Ⅱ标准和罗马Ⅲ标准。现拟对上述各标准的特点进行评述,比较各诊断标准对儿童FC诊断的异同,结合应用实例分析其诊断的灵敏度和特异度,探讨其对于诊断儿童FC的实用性和有效性。

广西隆安县农村壮族人群功能性消化不良的流行病学调查

目的:调查广西隆安县农村壮族人群功能性消化不良(functional dyspepsia,FD)的患病率及其影响因素,为本地区FD的防治提供一定的科学依据.方法:于2009年采用成人功能性胃肠病罗马Ⅲ诊断性问卷及评分方法,整群随机抽样方法,对隆安县农村常住壮族人群进行FD患病情况的面访式调查,分析人群的FD患病率、患病特点及其影响因素.结果:(1)共发放问卷2200份,回收有效问卷1951份,有效回收率达88.68%,其中154例诊断为FD,隆安县农村壮族人群FD的总体患病率为7.89%;(2)FD患者中,上腹部疼痛或烧灼感发生率最高为94.81%、餐后饱胀不适为43.15%,早饱感为1.30%,其中多个症状重叠率为38.1%;(3)不同性别、年龄、婚姻状况及文化程度的FD患病率不同(P<0.05):女性患病率高于男性;随着年龄的增长,FD的患病率呈升高的趋势;丧偶者的患病率更高;文化程度越低的患者FD的患病率越高;(4)与FD症状发作相关的因素中以生冷食品、辛辣、劳累与FD发作的关系最密切;(5)Logistic多因素回归分析结果:喜酸、喜腌制品与FD的患病呈正相关(P<0.05).结论:隆安县农村壮族人群FD的总体患病率为7.89%,消化不良症状以上腹部疼痛或上腹烧灼感为常见,影响疾病的因素主要有年龄、性别、文化程度、饮食习惯等.

符合罗马Ⅲ标准FD患者心理测试及自主神经功能观察44例

目的:观察功能性消化不良(functional dyspep-sia1,FD)及其不同类型患者的心理状态和自主神经功能,以了解其特点.方法:对符合罗马Ⅲ标准的44例FD患者根据罗马Ⅲ分类标准分为餐后不适综合征(postprandial distress syndrome,PDS)(n=31)和上腹痛综合征(epigastric pain syndrome,EPS)(n=13)两个类型,16例无症状的健康人作为对照组,对所有受试者均进行上胃肠消化不良症状评分、Zung氏量表进行心理测试和自主神经功能检测.结果:FD组抑郁和(或)焦虑状态的比例(24/44),较对照组(1/16)明显多见(P=0.001).FD抑郁评分(49.36±1.71)和焦虑评分(39.83±1.57)均明显高于对照组(34.42±1.98和27.77±0.75,P值均为0.000).餐后不适组抑郁和焦虑评分(51.40±1.80和40.39±2.01)及上腹痛组抑郁和焦虑评分(45.50±3.68和38.52±2.44),均高于对照组(P值分别为0.000、0.000和0.026、0.001).餐后不适组抑郁评分较上腹痛组有增高趋势(P=0.050).FD组自主神经功能检测中深呼吸心率变异(17.61±1.18)较对照组(22.71±2.12)明显减低(P=0.031),上腹痛组深呼吸心率变异(16.17±1.98)亦较对照组明显减低(P=0.038).存在焦虑抑郁状态患者深呼吸心率变异(17.23±1.49)较对照组(22.71±2.12)明显减低(P=0.036);非焦虑抑郁组与对照组及焦虑抑郁组与非焦虑抑郁组自主神经功能检测无明显差异.结论:FD患者焦虑、抑郁状态较明显,餐后不适组抑郁状态更趋严重;FD患者的自主神经功能受损以副交感神经为主;存在抑郁和(或)焦虑状态的FD患者更易出现自主神经功能受损.

功能性胃肠病的腹痛分型、鉴别诊断与罗马Ⅲ诊断标准的应用

目的:探讨功能性胃肠病(FGID)的腹痛分型、症状学鉴别诊断及相应罗马Ⅲ诊断标准的应用.方法:将功能性腹痛综合征(FAPS)85例、肠易激综合征(IBS)128例和功能性消化不良(FD)50例的患者,按一般情况、发病诱因和临床症状作表格登记调查,参照罗马Ⅲ诊断标准进行腹痛分型及鉴别诊断,并分析讨论其胃肠道动力学障碍、感知异常症状和发病机制.结果:FAPS腹痛部位主要集中于腹中线,其与进食排便基本无关、发作周期较短、程度较重、年龄较青及社会一心理影响因子较重;以腹痛表现为主的IBS与FD相互重叠发生率为43.75%和76.00%,与进食排便相关的胃肠道动力障碍样症状明显;所有患者均有相似的精神心理行为失调背景作为胃肠道疼痛阅值降低的感知异常表现.结论:根据腹痛部位、与进食排便相关的特异胃肠道动力障碍、发作周期和疼痛程度一般可对三组FGID腹痛做出分型和鉴别.