Gastrointestinal Sciences Research Group, School of Translational Medicine, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK.
Eur J Gastroenterol Hepatol. 2010 Mar;22(3):296-305. doi: 10.1097/meg.0b013e32832bab61.
To quantify the relative contribution of environmental, clinical, infection and psychosocial factors in the persistence of gastrointestinal (GI) symptoms among new patients presenting to primary care.
We conducted a population-based prospective cohort study of 4986 adults aged 25-65 years. The study team obtained permission from the participants to monitor their general practice records for consultation with GI symptoms and to contact them at that time. Group 1 (n = 177) patients completed a postal questionnaire, whereas those in group 2 (n = 191) completed an identical questionnaire and provided a blood and stool sample. The participants were followed up for 1 and 6 months postconsultation.
Of 610 (12.2%) participants who consulted, 368 (60.3%) agreed to participate. Two hundred and eighty participants (76.1%) completed 1 and 6-month follow-up questionnaires and 106 (37.9%) had persistent (present 1 and 6 months postconsultation) GI symptoms. After adjusting for age, sex, area of residence and duration of symptoms before consultation, symptom persistence was independently predicted by high levels of psychological distress [odds ratio (OR): 2.5, 95% confidence interval (CI): (1.1-5.3)], symptom episode duration of more than 2 h [OR: 3.1, 95% CI: (1.3-7.1)] and symptom interference with daily activities [OR: 2.3, 95% CI: (1.1-4.8)]. Changing diet [OR: 0.2, 95% CI: (0.1-0.9)] and recent gastroenteritis or food poisoning [OR: 0.2, 95% CI: (0.1-0.98)] were associated with protective effects. Infection was not associated. Exposure to three or more of these factors identified 87.3% (n = 92) of the participants with persistent symptoms.
The factors measured at the time of consultation with GI symptoms can accurately predict those patients at increased risk of persistent symptoms up to 6 months later.
定量评估环境、临床、感染和心理社会因素在新发胃肠道（GI）症状患者就诊于初级保健时持续存在的相对贡献。
我们进行了一项基于人群的前瞻性队列研究，纳入了 4986 名 25-65 岁的成年人。研究团队获得了参与者的许可，以监测他们的全科医生记录，以了解与 GI 症状相关的咨询，并在那时与他们联系。第 1 组（n=177）患者完成了一份邮寄问卷，而第 2 组（n=191）患者则完成了一份相同的问卷，并提供了血液和粪便样本。参与者在咨询后 1 个月和 6 个月时进行随访。
在 610 名（12.2%）就诊的参与者中，有 368 名（60.3%）同意参与。280 名参与者（76.1%）完成了 1 个月和 6 个月的随访问卷，106 名（37.9%）存在持续（咨询后 1 个月和 6 个月均存在）的 GI 症状。在校正年龄、性别、居住区域和症状出现前的持续时间后，症状持续存在与较高水平的心理困扰（比值比 [OR]：2.5，95%置信区间 [CI]：（1.1-5.3））、症状发作持续时间超过 2 小时（OR：3.1，95% CI：（1.3-7.1））和症状对日常生活的干扰（OR：2.3，95% CI：（1.1-4.8））独立相关。改变饮食（OR：0.2，95% CI：（0.1-0.9））和近期胃肠炎或食物中毒（OR：0.2，95% CI：（0.1-0.98））与保护作用相关。感染与症状持续无关。这些因素中有 3 个或更多因素与患者症状持续存在相关，可识别出 87.3%（n=92）的持续症状患者。
在出现 GI 症状时进行评估的因素可以准确预测出在随后 6 个月内存在持续症状风险增加的患者。
