情绪和焦虑障碍先于功能性胃肠疾病在患者中出现，但在人群中并非如此。
Mood and Anxiety Disorders Precede Development of Functional Gastrointestinal Disorders in Patients but Not in the Population.
机构信息
Psychology Department, Macquarie University, North Ryde, New South Wales, Australia.
Translational Research Center for Gastrointestinal Disorders, Division of Gastroenterology, University of Leuven, Leuven, Belgium.
出版信息
Clin Gastroenterol Hepatol. 2017 Jul;15(7):1014-1020.e4. doi: 10.1016/j.cgh.2016.12.032. Epub 2017 Jan 10.
BACKGROUND & AIMS: Understanding the interactions between brain and gastrointestinal disorders requires analysis of the order of disease onset. We analyzed data from 2 independent studies to determine the proportion of individuals with diagnoses of functional gastrointestinal disorders (FGIDs) before diagnoses of mood or anxiety disorders (gut to brain), and vice versa (brain to gut).
METHODS
We collected data from a retrospective study of 4966 patients diagnosed with a FGID (irritable bowel syndrome, dyspepsia, or constipation) and mood or anxiety disorder at general practices in the United Kingdom (health care seekers) over an average period of 13.1 years; we recorded which diagnosis appeared first and compared these with patients' sex and socioeconomic factors. We also collected data from a population study of 1002 randomly selected individuals in Australia (non-heath care seekers) followed from 1997 through 2009; we determined whether subjects were free of either FGID or an anxiety or mood disorder at baseline but developed either one after a 12-year follow-up period.
RESULTS
Among the 4966 health care seekers, 3279 patients were diagnosed with a mood or anxiety disorder before an FGID (ratio of 2:1). This ratio increased with socioeconomic disadvantage. The time period between diagnosis of mood or anxiety disorder and FGID was longer (median, 3.5 years) than time period between diagnosis of an FGID and a mood or anxiety disorder (median, 1.8 years). Among non-heath care seekers (population study), equal proportions were diagnosed with a mood or anxiety disorder before versus after an FGID.
CONCLUSIONS
In an analysis of data from a study of patients and a population-based study of individuals with these diagnoses, we found 2-fold more patients to receive a diagnosis of a mood or anxiety disorder before an FGID, but equal proportions of individuals in the population to be diagnosed with the mood or anxiety disorder before versus after an FGID. Among patients, the mood or anxiety disorder was on average diagnosed more than 3 years before the FGID, offering opportunity for prevention. Our findings support a role for adverse socioeconomic factors in development of FGIDs in patients with psychological disorders.
背景与目的
了解脑与胃肠道疾病之间的相互作用需要分析疾病发作的顺序。我们分析了两项独立研究的数据，以确定功能性胃肠道疾病（FGIDs）诊断之前出现情绪或焦虑障碍（肠到脑）以及反之（脑到肠）的个体比例。
方法
我们从英国普通诊所的 4966 例 FGID（肠易激综合征、消化不良或便秘）和情绪或焦虑障碍患者的回顾性研究中收集数据（医疗保健寻求者），平均随访时间为 13.1 年；我们记录了哪种诊断先出现，并将这些与患者的性别和社会经济因素进行了比较。我们还从澳大利亚的一项 1002 例随机选择的个体的人群研究中收集数据（非医疗保健寻求者），该研究从 1997 年持续到 2009 年；我们确定了在 12 年的随访期内，基线时是否没有 FGID 或焦虑或情绪障碍，但之后发展为其中之一。
结果
在 4966 名医疗保健寻求者中，有 3279 名患者在 FGID 之前被诊断为情绪或焦虑障碍（比例为 2:1）。这个比例随着社会经济劣势而增加。与 FGID 相比，情绪或焦虑障碍的诊断与 FGID 的诊断之间的时间间隔较长（中位数为 3.5 年），而 FGID 与情绪或焦虑障碍的诊断之间的时间间隔较短（中位数为 1.8 年）。在非医疗保健寻求者（人群研究）中，FGID 之前和之后被诊断为情绪或焦虑障碍的比例相等。
结论
在对患者研究和个体这些诊断的人群研究的数据进行分析中，我们发现，FGIDs 患者中，有两倍多的患者在 FGIDs 之前被诊断出患有情绪或焦虑障碍，但人群中，FGIDs 之前和之后被诊断出患有情绪或焦虑障碍的个体比例相等。在患者中，情绪或焦虑障碍的平均诊断时间比 FGIDs 早 3 年以上，为预防提供了机会。我们的发现支持了在患有心理障碍的患者中，不良社会经济因素在 FGIDs 发展中的作用。
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