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.

罗马Ⅳ功能性肠病诊断标准的修改对我国的影响

罗马Ⅳ强调功能性肠病(functional bowel disorders,FBD)是一组具有相同病理生理机制的连续症状谱,这种概念框架有助于我们更好地理解FBDs中普遍存在的重叠和转换现象。罗马Ⅳ在肠易激综合征的诊断标准中删去了"腹部不适",调整了功能性腹泻等疾病的诊断频度阈值,提出功能性腹胀和腹部膨胀具有不同的病理生理机制,为各种特异性FBD诊断和治疗提出了切实可行的建议。我们需要充分认识到国人FBD的临床表现特点,结合我国的实际情况灵活应用罗马Ⅳ诊断标准。

罗马Ⅲ与罗马Ⅳ标准诊断功能性消化不良的差异

目的比较罗马Ⅲ和罗马Ⅳ标准诊断功能性消化不良(FD)的差异,为罗马Ⅳ诊断标准的临床应用提供参考。方法连续收集因消化不良症状住院的病人,分别应用罗马Ⅲ和罗马Ⅳ标准诊断问卷进行调查,分别按照罗马Ⅲ、罗马Ⅳ标准诊断FD,对比罗马Ⅲ与罗马Ⅳ标准诊断FD的诊断率、症状分布、严重程度、亚型构成比的差异,并分析二者对FD诊断率的差异性。结果 (1)107例临床诊断为FD的患者中,66.36%符合罗马Ⅲ标准,87.85%符合罗马Ⅳ标准,61.68%同时符合两个标准,两个标准诊断率差异有统计学意义(P<0.001)。(2)与罗马Ⅲ标准相比,罗马Ⅳ标准诊断的FD患者及男性患者餐后饱胀不适感症状发生率更低(P<0.05);罗马Ⅲ、罗马Ⅳ标准诊断的男性患者均较女性患者烧心症状发生率高(P<0.05);(3)罗马Ⅲ、罗马Ⅳ标准诊断的FD患者的亚型构成比差异有统计学意义(P<0.001),罗马Ⅳ标准有更高的上腹痛综合征(EPS)构成比及亚型重叠率。结论罗马Ⅳ标准的诊断率、EPS亚型构成比相对高于罗马Ⅲ标准,罗马Ⅳ标准更强调症状的严重程度及发生频率,操作更简便,更有利于临床实践和科研,也更符合FD的临床特点。

功能性消化不良罗马Ⅳ标准亚型临床特征研究

背景功能性消化不良(FD)是消化不良患者的最常见原因,其症状重叠及精神心理异常十分常见,目前FD的诊断主要以功能性胃肠病的罗马标准为依据。目的了解符合罗马Ⅳ标准的FD不同分型患者的症状、重叠症状及精神心理状况。方法选取2017年6—12月于南通大学附属吴江区第一人民医院消化内科门诊就诊、18周岁以上接受胃镜检查的FD患者为研究对象,根据症状分型分为上腹痛综合征(EPS)48例、餐后不适综合征(PDS)74例及混合型(PDS重叠EPS)50例。对其症状构成、重叠症状及合并焦虑和/或抑郁状态情况进行归纳分析。结果EPS患者有餐后饱胀感、早饱、嗳气、上腹胀气症状者占比低于PDS患者,有上腹痛症状者占比高于PDS患者(P<0.017);混合型患者有餐后饱胀感、早饱、餐后恶心或呕吐症状者占比高于EPS患者,有上腹痛、上腹灼烧感症状者占比高于PDS患者(P<0.017)。混合型患者有重叠症状者占比高于EPS患者(P=0.015)。EPS患者症状总积分低于PDS患者,混合型患者症状总积分高于PDS、EPS患者(P<0.05)。无焦虑状态但有抑郁状态、有抑郁状态EPS患者症状总积分低于PDS患者,无焦虑状态但有抑郁状态、有焦虑状态且有抑郁状态、无焦虑状态且无抑郁状态、有焦虑状态、有抑郁状态混合型患者症状总积分高于PDS、EPS患者(P<0.05)。有重叠症状时,EPS患者症状总积分低于PDS患者;不管有无重叠症状,混合型患者症状总积分高于PDS、EPS患者(P<0.05)。结论 PDS患者较EPS患者的症状更复杂及严重,混合型患者较PDS、EPS患者的症状更复杂及严重。

罗马Ⅳ与罗马Ⅲ标准诊断高校大学生功能性胃肠病的比较研究

背景:2016年新发布的罗马Ⅳ标准与罗马Ⅲ标准相比,对功能性胃肠病(FGIDs)具有更严格和精确的定义。罗马Ⅳ标准对诊断标准的调整和完善可能影响FGIDs的临床诊断。目的:比较罗马Ⅳ与罗马Ⅲ标准对诊断高校大学生FGIDs的一致性和差异。方法:选取前期研究团队建立的浙江省大学生FGIDs数据库资料,根据罗马Ⅳ标准对数据进行重新评估和分析,计算各FGIDs的患病率、心理症状评分、疾病重叠情况,并与罗马Ⅲ标准进行比较。结果:共纳入1 870份资料,其中符合罗马Ⅳ标准的FGIDs患者1 025例(54.81%),符合罗马Ⅲ标准的FGIDs患者1 111例(59.41%),两种标准的检出率差异有统计学意义(P<0.01)。罗马Ⅳ标准组嗳气症(2.14%对5.83%,P<0.01)、肠易激综合征(IBS)(2.78%对6.90%,P<0.01)、功能性腹胀(1.28%对4.12%,P<0.01)患病率均显著低于罗马Ⅲ标准组,而功能性腹泻患病率显著升高(3.85%对0.70%,P<0.01)。符合罗马Ⅳ标准的患者具有更高的强迫、抑郁和焦虑评分(P<0.05)。罗马Ⅳ标准使33例(25.58%)原IBS患者纳入功能性腹泻,使6例(4.65%)原IBS患者纳入功能性便秘。两种标准在诊断功能性肠病重叠其他FGIDs(嗳气症、功能性消化不良)的差异有统计学意义(P<0.01,P<0.05)。结论:罗马Ⅳ标准对于FGIDs具有更严格和精准的定义,能更好地反映患者的精神心理和临床特征,准确识别真正需要治疗的患者,在临床实践和科学研究中的应用更高效和可行。

HNS-Ⅳ炸药的短脉冲冲击起爆判据

飞片冲击起爆HNS-Ⅳ炸药是直列式传爆序列的重要研究方向。考虑到能量加载方式(一般为电爆炸驱动、微装药驱动和激光驱动)和飞片材料对冲击起爆的影响,根据文献测量的飞片阈值速度拟合得到了HNS-Ⅳ炸药p^nτ和James判据的系数。同时,利用ANSYS/LS-DYNA程序模拟了铜叠氮化物爆炸驱动飞片冲击起爆HNS-Ⅳ炸药的过程,并根据数值模拟结果修正了HNS-Ⅳ炸药p^nτ和James判据的系数。结果表明,HNS-Ⅳ炸药的p^nτ(其中p为压力,τ为脉冲作用时间)判据应该调整为p^(2.08)τ>1.54GPa^(2.08)·μs(0.001μs<τ<0.14μs,3.8GPa<p<28.0GPa),James判据应调整为0.215/Σ+0.108/E<1(Σ为比动能,E为能通量)。调整后的起爆判据与数值模拟结果相一致,并具有更高的实用性。

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.

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.

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.

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.

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.

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.

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.

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。

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。