Department of Internal Medicine & Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Gut. 2018 Feb;67(2):255-262. doi: 10.1136/gutjnl-2016-312361. Epub 2017 Jan 19.
Our aim was to evaluate the association between visceral hypersensitivity and GI symptom severity in large cohorts of patients with functional GI disorder (FGID) and to adjust for psychological factors and general tendency to report symptoms.
We included five cohorts of patients with FGIDs (IBS or functional dyspepsia; n=1144), who had undergone visceral sensitivity testing using balloon distensions (gastric fundus, descending colon or rectum) and completed questionnaires to assess GI symptom severity, non-GI somatic symptoms, anxiety and depression. Subjects were divided into sensitivity tertiles based on pain/discomfort thresholds. GI symptom severity was compared between sensitivity tertiles in each cohort and corrected for somatisation, and anxiety and depression.
In all five cohorts, GI symptom severity increased gradually with increasing visceral sensitivity, with significant differences in GI symptom severity between the sensitivity tertiles (p<0.0001), with small to medium effect sizes (partial η: 0.047-0.11). The differences between sensitivity tertiles remained significant in all cohorts after correction for anxiety and depression, and also after correction for non-GI somatic symptom reporting in all of the cohorts (p<0.05).
A gradual increase in GI symptom severity with increasing GI sensitivity was demonstrated in IBS and functional dyspepsia, which was consistent across several large patient groups from different countries, different methods to assess sensitivity and assessments in different parts of the GI tract. This association was independent of tendency to report symptoms or anxiety/depression comorbidity. These findings confirm that visceral hypersensitivity is a contributor to GI symptom generation in FGIDs.
我们旨在评估内脏高敏与功能性胃肠病（FGID）大样本患者胃肠症状严重程度之间的关系，并调整心理因素和一般症状报告倾向。
我们纳入了五组 FGID 患者（IBS 或功能性消化不良；n=1144），他们接受了球囊扩张的内脏敏感性测试，并完成了评估胃肠症状严重程度、非胃肠躯体症状、焦虑和抑郁的问卷。受试者根据疼痛/不适阈值分为三个敏感组。在每个队列中，根据敏感性三分位将胃肠症状严重程度与躯体化、焦虑和抑郁进行比较。
在所有五个队列中，随着内脏敏感性的增加，胃肠症状严重程度逐渐增加，敏感三分位之间的胃肠症状严重程度存在显著差异（p<0.0001），具有小到中等的效应大小（部分η：0.047-0.11）。在所有队列中，校正焦虑和抑郁后，敏感三分位之间的差异仍然显著，在所有队列中校正非胃肠躯体症状报告后也是如此（p<0.05）。
在 IBS 和功能性消化不良中，随着 GI 敏感性的增加，GI 症状严重程度逐渐增加，这在来自不同国家、不同敏感性评估方法和不同 GI 部位评估的几个大型患者群体中是一致的。这种关联独立于症状报告倾向或焦虑/抑郁共病。这些发现证实内脏高敏是 FGID 中胃肠症状产生的一个因素。
