Department of Medicine, Farncombe Family Digestive Research Institute, McMaster University, Hamilton, Ontario, Canada.
1] Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK [2] Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK.
Am J Gastroenterol. 2015 Jul;110(7):1038-48. doi: 10.1038/ajg.2015.128. Epub 2015 May 12.
Anxiety and depression occur frequently in patients with functional gastrointestinal disorders (FGIDs), but their precise prevalence is unknown. We addressed this issue in a large cohort of adult patients and determined the underlying factors.
In total, 4,217 new outpatients attending 2 hospitals in Hamilton, Ontario, Canada completed questionnaires evaluating FGIDs and anxiety and depression (Hospital Anxiety and Depression scale). Chart review was performed in a random sample of 2,400 patients.
Seventy-six percent of patients fulfilled Rome III criteria for FGIDs, but only 57% were diagnosed with FGIDs after excluding organic diseases, and the latter group was considered for the analysis. Compared with patients not meeting the criteria, prevalence of anxiety (odds ratio (OR) 2.66, 95% confidence interval (CI): 1.62-4.37) or depression (OR 2.04, 95% CI: 1.03-4.02) was increased in patients with FGIDs. The risk was comparable to patients with organic disease (anxiety: OR 2.12, 95% CI: 1.24-3.61; depression: OR 2.48, 95% CI: 1.21-5.09). The lowest prevalence was observed in asymptomatic patients (OR 1.37; 95% CI 0.58-3.23 and 0.51; 95% CI 0.10-2.48; for both conditions, respectively). The prevalence of anxiety and depression increased in a stepwise manner with the number of co-existing FGIDs and frequency and/or severity of gastrointestinal (GI) symptoms. Psychiatric comorbidity was more common in females with FGIDs compared with males (anxiety OR 1.73; 95% CI 1.35-2.28; depression OR 1.52; 95% CI 1.04-2.21). Anxiety and depression were formally diagnosed by the consulting physician in only 22% and 9% of patients, respectively.
Psychiatric comorbidity is common in patients referred to a secondary care center but is often unrecognized. The prevalence of both anxiety and depression is influenced by gender, presence of organic diseases, and FGIDs, and it increases with the number of coexistent FGIDs and frequency and severity of GI symptoms.
焦虑和抑郁在功能性胃肠疾病（FGIDs）患者中很常见，但确切的患病率尚不清楚。我们在一个大型成年患者队列中解决了这个问题，并确定了潜在的因素。
在加拿大安大略省汉密尔顿的 2 家医院就诊的 4217 名新门诊患者完成了评估 FGIDs、焦虑和抑郁的问卷（医院焦虑和抑郁量表）。在 2400 名患者中随机抽取的样本中进行了病历审查。
76%的患者符合罗马 III 标准的 FGIDs，但在排除器质性疾病后仅有 57%被诊断为 FGIDs，后者被纳入分析。与不符合标准的患者相比，FGIDs 患者的焦虑（比值比（OR）2.66，95%置信区间（CI）：1.62-4.37）或抑郁（OR 2.04，95%CI：1.03-4.02）的患病率增加。风险与器质性疾病患者相当（焦虑：OR 2.12，95%CI：1.24-3.61；抑郁：OR 2.48，95%CI：1.21-5.09）。无症状患者的患病率最低（OR 1.37；95%CI 0.58-3.23 和 0.51；95%CI 0.10-2.48；分别用于两种情况）。随着共存 FGIDs 的数量、胃肠道（GI）症状的频率和/或严重程度的增加，焦虑和抑郁的患病率呈阶梯式上升。与男性相比，患有 FGIDs 的女性更常见合并精神疾病（焦虑 OR 1.73；95%CI 1.35-2.28；抑郁 OR 1.52；95%CI 1.04-2.21）。焦虑和抑郁仅分别由会诊医生正式诊断为 22%和 9%的患者。
二级保健中心就诊的患者中常见精神共病，但往往未被识别。焦虑和抑郁的患病率受性别、器质性疾病和 FGIDs 的影响，并随着共存 FGIDs 的数量、GI 症状的频率和严重程度的增加而增加。
