肠易激综合征患者和健康对照者餐后挑战试验后的症状模式。
Symptom pattern following a meal challenge test in patients with irritable bowel syndrome and healthy controls.
机构信息
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ; University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
出版信息
United European Gastroenterol J. 2013 Oct;1(5):358-67. doi: 10.1177/2050640613501817.
BACKGROUND
Patients with irritable bowel syndrome (IBS) often complain of worsening of symptoms after meal intake. Meal challenge tests have previously been used to study symptoms and pathophysiology in functional dyspepsia.
OBJECTIVE
The objective of this article is to evaluate differences in gastrointestinal (GI) symptom response to a standardized meal test in IBS compared to healthy controls.
METHODS
We included 67 patients with IBS and 16 healthy controls. After an overnight fast the subjects were served breakfast (540 kcal; 36% fat, 15% proteins, 49% carbohydrates; 8.9 g fiber). They completed visual analog scales assessing severity of six GI symptoms (abdominal pain, bloating, discomfort, nausea, gas, fullness) before breakfast and every 30 minutes up to 240 minutes after breakfast. The patients also completed a questionnaire (IBS-SSS) to assess IBS symptom severity during the preceding week. The course of symptom scores over time was analyzed using mixed models.
RESULTS
The meal was well tolerated and all subjects completed the test period. In patients, significant effects of time (initial increase to a maximum, followed by a return to baseline) were found for fullness, bloating, nausea and discomfort (all p values < 0.01 for linear, quadratic and third-order effect of time). In IBS patients, an independent significant association between IBS-SSS scores and all postprandial symptoms, except for nausea, was found (all p < 0.01). In controls, a significant linear, quadratic and third-order effect of time (all p < 0.0001) was found for fullness only. The difference in time course for bloating and discomfort between IBS patients and controls was confirmed when comparing the groups directly (significant time-by-group interaction effects, all p < 0.05), but not for nausea. On average, IBS patients scored significantly higher than controls on all symptoms, except for nausea (significant main effects of group, all p < 0.05).
CONCLUSIONS
A standardized meal test seems to be a promising tool to study the symptom pattern in IBS and potentially to follow the effect of interventions.
背景
肠易激综合征（IBS）患者常诉餐后症状加重。餐挑战试验以前曾用于研究功能性消化不良的症状和病理生理学。
目的
本文旨在评估 IBS 患者与健康对照者对标准化餐试的胃肠道（GI）症状反应差异。
方法
我们纳入了 67 例 IBS 患者和 16 例健康对照者。受试者禁食一夜后，给予早餐（540 千卡；脂肪 36%，蛋白质 15%，碳水化合物 49%；纤维 8.9 克）。他们在早餐前和早餐后每 30 分钟至 240 分钟完成 6 种 GI 症状（腹痛、腹胀、不适、恶心、气胀、饱胀）严重程度的视觉模拟评分。患者还在之前一周内完成 IBS 严重程度症状量表（IBS-SSS）问卷。采用混合模型分析症状评分随时间的变化过程。
结果
该餐食耐受性良好，所有受试者均完成了测试期。在患者中，饱胀、腹胀、恶心和不适均发现时间的显著影响（线性、二次和三阶时间效应的所有 p 值均<0.01）。在 IBS 患者中，IBS-SSS 评分与所有餐后症状均存在独立显著相关性，除恶心外（所有 p 值均<0.01）。在对照组中，仅饱胀发现时间的显著线性、二次和三阶效应（所有 p 值均<0.0001）。当直接比较两组时，证实了 IBS 患者和对照组之间腹胀和不适时间进程的差异（时间-组交互作用的显著影响，所有 p 值均<0.05），但恶心则不然。平均而言，除了恶心，IBS 患者在所有症状上的评分均显著高于对照组（组间的主要效应均显著，所有 p 值均<0.05）。
结论
标准化餐试似乎是一种有前途的工具，可用于研究 IBS 的症状模式，并可能用于随访干预的效果。
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