Kibune Nagasako Cristiane, Garcia Montes Ciro, Silva Lorena Sônia Letícia, Mesquita Maria Aparecida
Gastroenterology Unit, State University of Campinas, Brazil.
Rev Esp Enferm Dig. 2016 Feb;108(2):59-64. doi: 10.17235/reed.2015.3979/2015.
Irritable bowel syndrome (IBS) is classified into subtypes according to bowel habit.
To investigate whether there are differences in clinical features, comorbidities, anxiety, depression and body mass index (BMI) among IBS subtypes.
The study group included 113 consecutive patients (mean age: 48 ± 11 years; females: 94) with the diagnosis of IBS. All of them answered a structured questionnaire for demographic and clinical data and underwent upper endoscopy. Anxiety and depression were assessed by the Hospital Anxiety and Depression scale (HAD).
The distribution of subtypes was: IBS-diarrhea (IBS-D), 46%; IBS-constipation (IBS-C), 32%, and mixed IBS (IBS-M), 22%. IBS overlap with gastroesophageal reflux disease (GERD), functional dyspepsia, chronic headache and fibromyalgia occurred in 65.5%, 48.7%, 40.7% and 22.1% of patients, respectively. Anxiety and/or depression were found in 81.5%. Comparisons among subgroups showed that bloating was significantly associated with IBS-M compared to IBS-D (odds ratio-OR-5.6). Straining was more likely to be reported by IBS-M (OR 15.3) and IBS-C (OR 12.0) compared to IBS-D patients, while urgency was associated with both IBS-M (OR 19.7) and IBS-D (OR 14.2) compared to IBS-C. In addition, IBS-M patients were more likely to present GERD than IBS-D (OR 6.7) and higher scores for anxiety than IBS-C patients (OR 1.2). BMI values did not differ between IBS-D and IBS-C.
IBS-M is characterized by symptoms frequently reported by both IBS-C (straining) and IBS-D (urgency), higher levels of anxiety, and high prevalence of comorbidities. These features should be considered in the clinical management of this subgroup.
肠易激综合征（IBS）根据排便习惯分为不同亚型。
研究IBS各亚型在临床特征、合并症、焦虑、抑郁及体重指数（BMI）方面是否存在差异。
研究组纳入113例连续诊断为IBS的患者（平均年龄：48±11岁；女性94例）。所有患者均回答了关于人口统计学和临床数据的结构化问卷，并接受了上消化道内镜检查。焦虑和抑郁通过医院焦虑抑郁量表（HAD）进行评估。
各亚型分布情况为：腹泻型肠易激综合征（IBS-D），46%；便秘型肠易激综合征（IBS-C），32%；混合型肠易激综合征（IBS-M），22%。IBS患者中，分别有65.5%、48.7%、40.7%和22.1%合并胃食管反流病（GERD）、功能性消化不良、慢性头痛和纤维肌痛。发现81.5%的患者存在焦虑和/或抑郁。亚组间比较显示，与IBS-D相比，腹胀与IBS-M显著相关（优势比-OR-5.6）。与IBS-D患者相比，IBS-M（OR 15.3）和IBS-C（OR 12.0）更易出现排便费力，而与IBS-C相比，便急与IBS-M（OR 19.7）和IBS-D（OR 14.2）均相关。此外，IBS-M患者比IBS-D患者更易出现GERD（OR 6.7），且焦虑得分高于IBS-C患者（OR 1.2）。IBS-D和IBS-C之间的BMI值无差异。
IBS-M的特点是具有IBS-C（排便费力）和IBS-D（便急）常见的症状、更高水平的焦虑以及较高的合并症患病率。在该亚组的临床管理中应考虑这些特征。
