Poulsen Chalotte Heinsvig, Eplov Lene Falgaard, Hjorthøj Carsten, Eliasen Marie, Skovbjerg Sine, Dantoft Thomas Meinertz, Schröder Andreas, Jørgensen Torben
Research Centre for Prevention and Health, Capital Region of Denmark, Glostrup.
Copenhagen University Hospital, Mental Health Centre Copenhagen, Hellerup.
Clin Epidemiol. 2017 Jul 31;9:393-402. doi: 10.2147/CLEP.S141344. eCollection 2017.
Irritable bowel syndrome (IBS) is associated with mental vulnerability, and half of patients report comorbid somatic and mental symptoms. We aimed to investigate the relationship between an IBS symptom continuum and the subsequent development of common mental disorders (CMDs) and functional somatic syndromes (FSSs).
A longitudinal population-based study comprising two 5-year follow-up studies, Dan-MONICA 1 (1982-1987) and Inter99 (1999-2004), recruited from the western part of Copenhagen County. The total study population (n = 7,278) was divided into symptom groups according to the degree of IBS definition fulfillment at baseline and/or follow-up and was followed until December 2013 in Danish central registries. Cox regression was used for the analyses, adjusting for age, sex, length of education and cohort membership. In a subsequent analysis, we adjusted for mental vulnerability as a risk factor for both CMDs and FSSs, including IBS.
Over a 5-year period, 51% patients had no IBS symptoms, 17% patients had IBS symptoms without abdominal pain, 22% patients had IBS symptoms including abdominal pain and 10% patients fulfilled the IBS definition. IBS and IBS symptoms including abdominal pain were significantly associated with the development of CMDs and other FSSs identified in secondary care. When adjusting for mental vulnerability, IBS and IBS symptoms including abdominal pain were no longer associated with CMDs, but the significant relationship to other FSSs remained.
In a clinical setting, the perspective should be broadened to individuals not fulfilling the symptom cluster of IBS but who report frequent abdominal pain. Additionally, it is important to combine symptom-based criteria of IBS with psychosocial markers such as mental vulnerability, because it could guide clinicians in decisions regarding prognosis and treatment.
肠易激综合征（IBS）与心理易损性相关，且半数患者报告存在躯体和心理共病症状。我们旨在研究IBS症状连续体与常见精神障碍（CMDs）及功能性躯体综合征（FSSs）后续发生之间的关系。
一项基于人群的纵向研究，包括两项为期5年的随访研究，即丹麦哥本哈根市莫尼卡项目1（1982 - 1987年）和Inter99（1999 - 2004年），研究对象来自哥本哈根县西部。根据基线和/或随访时IBS定义的满足程度，将总研究人群（n = 7278）分为症状组，并在丹麦中央登记处随访至2013年12月。采用Cox回归进行分析，并对年龄、性别、受教育年限和队列成员身份进行调整。在后续分析中，我们将心理易损性作为CMDs和FSSs（包括IBS）的危险因素进行调整。
在5年期间，51%的患者无IBS症状，17%的患者有IBS症状但无腹痛，22%的患者有包括腹痛在内的IBS症状，10%的患者符合IBS定义。IBS以及包括腹痛在内的IBS症状与二级医疗中确诊的CMDs和其他FSSs的发生显著相关。在对心理易损性进行调整后，IBS以及包括腹痛在内的IBS症状与CMDs不再相关，但与其他FSSs的显著关系依然存在。
在临床环境中，应将视角扩大到未符合IBS症状群但报告频繁腹痛的个体。此外，将基于症状的IBS标准与心理社会指标（如心理易损性）相结合很重要，因为这可以指导临床医生进行预后和治疗决策。
