Nehra V, Bruce B K, Rath-Harvey D M, Pemberton J H, Camilleri M
Division of Gastroenterology and Hepatology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Am J Gastroenterol. 2000 Jul;95(7):1755-8. doi: 10.1111/j.1572-0241.2000.02184.x.
We aimed to evaluate the prevalence of psychological impairment in patients with rectal evacuation disorders and the influence of psychological disorder on the early outcome of behavioral treatment.
We retrospectively reviewed the medical records of patients with rectal evacuation disorders referred for biofeedback retraining at a tertiary referral center. The psychological disorder was classified using the DSM IV criteria. Outcome of biofeedback treatment of evacuation at 2 wk was based on symptoms or on the ability to spontaneously expel a balloon placed in the rectum. Improvements in the groups without versus with a psychological disorder or an eating disorder were compared by Fisher's exact test.
In the 60 patients (55 women; 5 men; mean age, 38 yr), psychological disorders were identified in 39 (65%); also noted were eating disorder (n = 5), rumination syndrome (n = 3), pain disorder (n = 6), anxiety-depression (n = 10), a combination of depression and pain disorder (n = 3), and a combination of eating disorder with anxiety-depression and pain disorder (n = 12). There was an association between psychological status and outcome at 2 wk of behavioral treatment for evacuation disorder (p = 0.03). The coexistence of eating disorder and psychological disorder resulted in an unfavorable outcome (p = 0.02), compared with those without psychological disorder.
Psychological impairment was identified in 65% of the patients with evacuation disorder and constipation in a tertiary care practice, and has a significant negative impact on the outcome of behavioral treatment. These data reinforce the importance of a multidisciplinary approach in the management of these patients.
我们旨在评估直肠排空障碍患者心理障碍的患病率以及心理障碍对行为治疗早期疗效的影响。
我们回顾性分析了在一家三级转诊中心接受生物反馈再训练的直肠排空障碍患者的病历。心理障碍根据《精神疾病诊断与统计手册》第四版标准进行分类。生物反馈治疗2周时的排空结果基于症状或自发排出置于直肠内气囊的能力。通过Fisher精确检验比较无心理障碍组与有心理障碍或饮食障碍组的改善情况。
在60例患者（55名女性；5名男性；平均年龄38岁）中，39例（65%）被确定存在心理障碍；还发现有饮食障碍（n = 5）、反刍综合征（n = 3）、疼痛障碍（n = 6）、焦虑抑郁（n = 10）、抑郁与疼痛障碍合并（n = 3）以及饮食障碍与焦虑抑郁和疼痛障碍合并（n = 12）。在行为治疗2周时，直肠排空障碍的心理状态与疗效之间存在关联（p = 0.03）。与无心理障碍者相比，饮食障碍和心理障碍并存导致疗效不佳（p = 0.02）。
在一家三级医疗中心的实践中，65%的直肠排空障碍和便秘患者存在心理障碍，且对行为治疗的疗效有显著负面影响。这些数据强化了多学科方法在管理这些患者中的重要性。
