Gradus Jaimie L, Farkas Dóra Körmendiné, Svensson Elisabeth, Ehrenstein Vera, Lash Timothy L, Toft Sørensen Henrik
From the aNational Center for PTSD, VA Boston Healthcare System, Boston, MA; bDepartments of Psychiatry and Epidemiology, Boston University, Boston, MA; cDepartment of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; and dDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
Epidemiology. 2017 May;28(3):354-360. doi: 10.1097/EDE.0000000000000622.
Evidence for the association between posttraumatic stress disorder (PTSD) and gastrointestinal (GI) disorders is mixed, owing in part to methodologic differences across studies. Furthermore, studies which have combined GI disorders or symptoms for examination as one overall category may potentially obscure associations between PTSD and individual GI diagnoses.
This nationwide cohort study examined the incidence of all major nonmalignant GI disorders in patients with a prior PTSD diagnosis (n = 4,076), compared with the general population incidence from 1995 to 2013, using Danish medical registry data. We examined differences by sex, age, marital status, psychiatric and somatic comorbidity, and follow-up time. Risks, standardized incidence rates (SIRs), and confidence intervals (95% CIs) were calculated.
Risk of any GI disorder among PTSD patients was 25% (95% CI: 21%, 29%); the SIR for any GI disorder was 1.8 (95% CI: 1.7, 2.0). Risk and SIRs varied by disorder (e.g., no association with diverticula of the intestines [SIR: 1.1, 95% CI: 0.83, 1.5]; stronger association with peptic ulcer, site unspecified [SIR: 3.3, 95% CI: 1.8, 5.5]). Stratified analyses revealed that some associations were stronger for persons ages 16-39 or unmarried at PTSD diagnosis, persons with comorbid psychiatric diagnoses, and in the year following PTSD diagnosis.
This study documents associations between clinician-diagnosed PTSD and all major nonmalignant GI disorders in an unselected nationwide cohort with long follow-up. Differences in associations across GI disorders and important modifiers may account for previous conflicting research findings.
创伤后应激障碍（PTSD）与胃肠道（GI）疾病之间关联的证据并不一致，部分原因在于各研究的方法存在差异。此外，将胃肠道疾病或症状合并作为一个整体类别进行检查的研究可能会掩盖PTSD与个体胃肠道诊断之间的关联。
这项全国性队列研究利用丹麦医疗登记数据，对先前被诊断为PTSD的患者（n = 4,076）中所有主要非恶性胃肠道疾病的发病率与1995年至2013年的一般人群发病率进行了比较。我们按性别、年龄、婚姻状况、精神和躯体合并症以及随访时间检查了差异。计算了风险、标准化发病率（SIRs）和置信区间（95%CI）。
PTSD患者中出现任何胃肠道疾病的风险为25%（95%CI：21%，29%）；任何胃肠道疾病的SIR为1.8（95%CI：1.7，2.0）。风险和SIR因疾病而异（例如，与肠憩室无关联[SIR：1.1，95%CI：0.83，1.5]；与未指明部位的消化性溃疡关联更强[SIR：3.3，95%CI：1.8，5.5]）。分层分析显示，对于16 - 39岁或在PTSD诊断时未婚的人、患有合并精神疾病诊断的人以及在PTSD诊断后的第一年，某些关联更强。
本研究记录了在一个未经过筛选且随访时间长的全国性队列中，临床医生诊断的PTSD与所有主要非恶性胃肠道疾病之间的关联。胃肠道疾病之间关联的差异以及重要的调节因素可能解释了先前相互矛盾的研究结果。
