Schmulson M, Lee O Y, Chang L, Naliboff B, Mayer E A
Department of Medicine and Physiology, UCLA School of Medicine, Los Angeles, California, USA.
Am J Gastroenterol. 1999 Oct;94(10):2929-35. doi: 10.1111/j.1572-0241.1999.01440.x.
We sought to determine if irritable bowel syndrome (IBS) patients with different bowel habit predominance differ in self-reported viscerosensory symptoms related to the upper and lower gastrointestinal (GI) tract, somatosensory symptoms, and constitutional functions.
Six hundred and twenty-five Rome criteria-positive IBS patients completed a bowel symptom questionnaire (BSQ), psychological symptom checklist (SCL-90), and health status (SF-36). Bowel habit predominance for IBS patients was determined using the Rome criteria for functional constipation (IBS-C; n = 140) and functional diarrhea (IBS-D; n = 216). The BSQ included questions about viscerosensory symptoms of the upper (chest pressure, bloating, fullness, early satiety, nausea) and lower GI tract (bloating, pain, incomplete evacuation), somatosensory symptoms related to the musculoskeletal system (pain in neck/shoulders, lower back/hip, muscles/joints), and constitutional functions (sleep, appetite, libido). Analysis was further conducted between the IBS-C and IBS-D patients, controlling for gender and quality of sleep, and using the Bonferroni correction to control for multiple comparisons.
Female gender was more prevalent among IBS-C than IBS-D (77% vs 56.1%, p < 0.01), whereas age did not differ (40.2 +/- 1.2 yr vs 39.5 +/- 1.0 yr). Symptoms referred to the upper GI were more prevalent in IBS-C than IBS-D: early satiety (56.7% vs 33.9%, p < 0.004), fullness (63.2% vs 38.5%, p < 0.05), and a trend for upper bloating (80.3 vs 62.6%). IBS-C patients reported higher severity ratings for lower GI bloating (p < 0.001). IBS-C more commonly reported musculoskeletal symptoms (92.2% vs 75.4%, p < 0.001), as well as impairment in sleep (31.3 vs 17.5%, p < 0.009), appetite (35.0% vs 18.4%, p < 0.015) and sexual function (45.2% vs 33.1%, p < 0.0021). There were no differences in SCL-90 and SF-36 scores.
Compared with the IBS-D group, the IBS-C patients show greater prevalence of a wide range of symptoms referred to the upper and lower abdomen, musculoskeletal, and constitutional functions. These findings may be related to differences in autonomic or perceptual responses to visceral and somatic stimuli, and are likely to have implications for treatment responses in the two subgroups.
我们试图确定不同排便习惯为主的肠易激综合征（IBS）患者在自我报告的与上、下胃肠道（GI）相关的内脏感觉症状、躯体感觉症状和体质功能方面是否存在差异。
625例符合罗马标准的IBS患者完成了肠道症状问卷（BSQ）、心理症状清单（SCL - 90）和健康状况问卷（SF - 36）。根据功能性便秘（IBS - C；n = 140）和功能性腹泻（IBS - D；n = 216）的罗马标准确定IBS患者的排便习惯为主类型。BSQ包括有关上消化道（胸部压迫感、腹胀、饱腹感、早饱、恶心）和下消化道（腹胀、疼痛、排便不尽）的内脏感觉症状、与肌肉骨骼系统相关的躯体感觉症状（颈部/肩部、下背部/臀部、肌肉/关节疼痛）以及体质功能（睡眠、食欲、性欲）的问题。在IBS - C和IBS - D患者之间进一步进行分析，控制性别和睡眠质量，并使用Bonferroni校正来控制多重比较。
IBS - C患者中女性比IBS - D患者更常见（77%对56.1%，p < 0.01），而年龄无差异（40.2±1.2岁对39.5±1.0岁）。IBS - C患者中上消化道相关症状比IBS - D患者更常见：早饱（56.7%对33.9%，p < 0.004）、饱腹感（63.2%对38.5%，p < 0.05）以及上腹胀有趋势（80.3对62.6%）。IBS - C患者报告下消化道腹胀的严重程度评分更高（p < 0.001）。IBS - C患者更常报告肌肉骨骼症状（92.2%对75.4%，p < 0.001），以及睡眠障碍（31.3%对17.5%，p < 0.009）、食欲障碍（35.0%对18.4%，p < 0.015）和性功能障碍（45.2%对33.1%，p < 0.0021）。SCL - 90和SF - 36评分无差异。
与IBS - D组相比，IBS - C患者在涉及上、下腹部、肌肉骨骼和体质功能的广泛症状方面患病率更高。这些发现可能与对内脏和躯体刺激的自主神经或感知反应差异有关，并且可能对这两个亚组的治疗反应有影响。
