Enteric Neuroscience Program, Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Am J Gastroenterol. 2010 Apr;105(4):822-32. doi: 10.1038/ajg.2010.40. Epub 2010 Feb 16.
Functional gastrointestinal disorders (FGIDs) comprise a constellation of symptoms that have no identifiable structural or biochemical abnormality. In view of the lack of data from large-scale population-based studies evaluating the effects of these disorders on survival, we aimed to examine whether FGIDs are associated with impaired survival.
Between 1988 and 1993, valid self-report questionnaires that recorded gastrointestinal symptoms required for the diagnosis of irritable bowel syndrome (IBS), chronic constipation, chronic diarrhea, dyspepsia, and abdominal pain were mailed to randomly selected cohorts of Olmsted County, Minnesota residents. Minnesota administrative death records were used to identify which of the survey respondents had died over the follow-up period (through April 2008). The association between survival and each FGID was assessed using proportional hazards regression models with univariate and adjusted hazard ratios (HRs, 95% confidence intervals (CIs)), adjusting for age at time of survey, gender, smoking, alcohol, marital status, and Charlson Comorbidity Index (CCI).
Of the 5,262 randomly selected eligible subjects who received a questionnaire, a total of 4,176 responded to the surveys (overall response rate 79%). From these respondents, 243 subjects were excluded because of lack of research authorization (or were registered solely at a different medical institution in Olmsted County, MN), resulting in 3,933 eligible subjects for analysis (eligible response rate 75%); 10% reported symptoms of IBS; 16% chronic constipation; 18% chronic diarrhea; 2% dyspepsia; and 15% abdominal pain. At baseline, the mean (s.d.) age was 54 (18) years, and 52% were female. No association with overall survival was detected for IBS (HR=1.06 (95% CI: 0.86-1.32)), chronic diarrhea (HR=1.03 (95% CI: 0.90-1.19)), abdominal pain (HR=1.09 (95% CI: 0.92-1.30)), or dyspepsia (HR=1.08 (95% CI: 0.58-2.02)). Reporting symptoms of chronic constipation was associated with poorer survival (HR=1.23 (95% CI: 1.07-1.42)). This association remained significant after adjusting for the CCI (HR=1.19 (95% CI: 1.03-1.37)).
In this large population-based cohort study with over 30,000 person-years of follow-up, no significant association was observed between survival and IBS, chronic diarrhea, dyspepsia, or abdominal pain. Furthermore, no association was found between increasing burden of FGIDs and survival. However, in contrast to these other FGIDs, subjects with symptoms of chronic constipation were found to be at increased risk of poorer survival. Further investigation is required to determine the cause of this observed association.
功能性胃肠疾病（FGIDs）由一系列无明显结构或生化异常的症状组成。鉴于缺乏大规模基于人群的研究数据来评估这些疾病对生存的影响，我们旨在研究 FGIDs 是否与生存受损有关。
在 1988 年至 1993 年间，我们向明尼苏达州奥姆斯特德县的随机队列居民邮寄了有效的自我报告问卷，这些问卷记录了诊断肠易激综合征（IBS）、慢性便秘、慢性腹泻、消化不良和腹痛所需的胃肠道症状。我们使用明尼苏达州的行政死亡记录来确定调查对象中有多少人在随访期间（截止到 2008 年 4 月）死亡。我们使用单变量和调整后的危险比（HR，95%置信区间（CI）），调整了调查时的年龄、性别、吸烟、饮酒、婚姻状况和 Charlson 合并症指数（CCI），评估了生存与每种 FGID 之间的关联。
在随机选择的 5262 名合格受试者中，共有 4176 名受试者对问卷做出了回应（总体回应率为 79%）。从这些应答者中，由于缺乏研究授权（或仅在明尼苏达州奥姆斯特德县的另一家医疗机构注册），有 243 名被排除在外，因此有 3933 名合格受试者可供分析（合格应答率为 75%）；10%的人报告有 IBS 症状；16%的人慢性便秘；18%的人慢性腹泻；2%的人消化不良；15%的人腹痛。在基线时，平均（标准差）年龄为 54（18）岁，52%为女性。我们没有发现 IBS（HR=1.06（95%CI：0.86-1.32））、慢性腹泻（HR=1.03（95%CI：0.90-1.19））、腹痛（HR=1.09（95%CI：0.92-1.30））或消化不良（HR=1.08（95%CI：0.58-2.02））与总生存率之间存在关联。报告慢性便秘症状与较差的生存率相关（HR=1.23（95%CI：1.07-1.42））。在调整了 CCI 后，这种关联仍然显著（HR=1.19（95%CI：1.03-1.37））。
在这项超过 30000 人年随访的大型基于人群的队列研究中，我们没有观察到生存与 IBS、慢性腹泻、消化不良或腹痛之间存在显著关联。此外，我们没有发现 FGIDs 负担的增加与生存率之间存在关联。然而，与其他 FGIDs 相比，有慢性便秘症状的受试者被发现生存风险增加。需要进一步的研究来确定这种观察到的关联的原因。
