Avramidou Maria, Angst Felix, Angst Jules, Aeschlimann André, Rössler Wulf, Schnyder Ulrich
Research Department, Rehabilitation Clinic ("RehaClinic"), Quellenstrasse 34, 5330, Bad Zurzach, Switzerland.
Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
BMC Gastroenterol. 2018 Jan 27;18(1):21. doi: 10.1186/s12876-018-0749-3.
Although subacute and chronic gastrointestinal symptoms are very common in primary care, epidemiological date are sparse. The aim of the study was to examine and quantify the prevalence of subacute and chronic gastrointestinal symptoms and their associations with somatic and mental disorders in the general population.
Data were collected prospectively between 1981 (age m = 22, f = 23) and 2008 (age 49/50) from the Zurich Cohort Study (n = 292 men, 299 women), a representative general population survey. The participants were assessed using a semi-structured interview, the "Structured Psychopathological Interview and Rating of the Social Consequences of Psychological Disturbances for Epidemiology" (SPIKE). Prevalence rates were computed to be representative of the general population aged 22-50. Associations were quantified by odds ratios (ORs) and their 99% confidence intervals (CI).
The prevalences of intestinal and of gastric symptoms were significantly higher among women in all categories examined. For example, any gastric symptoms: f. 26.4% vs m.15.2%; any intestinal symptoms: 27.6% vs 14.6%; nausea/vomitus: 19.1% vs 4.5%; constipation: 15.8% vs 6.5% (all p < 0.001). Strong associations (all p < 0.0001) were found between fatigue (1 month) and chronic stomach (OR = 9.96, 99%-CI: 5.53-17.94) and chronic intestinal symptoms (OR = 9.02, 99%-CI: 4.92-16.54). Panic attacks were associated with subacute intestinal symptoms (OR = 4.00, 99%-CI: 2.43-6.59). Anxiety was more strongly associated with subacute intestinal symptoms (OR = 3.37, 99%-CI: 2.23-5.08) than with subacute stomach symptoms (OR = 1.85, 1.20-2.86). Bipolar disorders were associated with subacute stomach symptoms (OR = 1.83, 1.18-2.17) and unipolar depression with subacute intestinal symptoms (OR = 2.05, 1.34-3.15).
Remarkably high prevalence rates of gastric and intestinal complaints were observed in women (over 1/4; men 1/7). Fatigue/neurasthenia was the strongest co-factor in both conditions. Various syndromes related to anxiety, phobia, and panic disorders showed further significant associations. The integration of psychiatric and/or psychological treatment could help address the functional part of gastric and intestinal syndromes.
尽管亚急性和慢性胃肠道症状在初级保健中非常常见，但流行病学数据却很稀少。本研究的目的是调查和量化亚急性和慢性胃肠道症状的患病率及其与普通人群中躯体和精神障碍的关联。
前瞻性收集了1981年（男性平均年龄22岁，女性平均年龄23岁）至2008年（年龄49/50岁）苏黎世队列研究（n = 292名男性，299名女性）的数据，这是一项具有代表性的普通人群调查。使用半结构化访谈“用于流行病学的心理障碍社会后果结构化精神病理学访谈及评定”（SPIKE）对参与者进行评估。计算患病率以代表22 - 50岁的普通人群。通过比值比（OR）及其99%置信区间（CI）对关联进行量化。
在所有检查类别中，女性的肠道和胃部症状患病率显著更高。例如，任何胃部症状：女性为26.4%，男性为15.2%；任何肠道症状：27.6%对14.6%；恶心/呕吐：19.1%对4.5%；便秘：15.8%对6.5%（所有p < 0.001）。发现疲劳（1个月）与慢性胃部症状（OR = 9.96，99% - CI：5.53 - 17.94）和慢性肠道症状（OR = 9.02，99% - CI：4.92 - 16.54）之间存在强关联（所有p < 0.0001）。惊恐发作与亚急性肠道症状相关（OR = 4.00，99% - CI：2.43 - 6.59）。焦虑与亚急性肠道症状的关联更强（OR = 3.37，99% - CI：2.23 - 5.08），而与亚急性胃部症状的关联较弱（OR = 1.85，1.20 - 2.86）。双相情感障碍与亚急性胃部症状相关（OR = 1.83，1.18 - 2.17），单相抑郁与亚急性肠道症状相关（OR = 2.05，1.34 - 3.15）。
观察到女性中胃部和肠道不适的患病率极高（超过1/4；男性为1/7）。疲劳/神经衰弱是这两种情况中最强的共同因素。与焦虑、恐惧症和惊恐障碍相关的各种综合征显示出进一步的显著关联。整合精神科和/或心理治疗可能有助于解决胃肠道综合征的功能性部分。
