Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina.
Clin Gastroenterol Hepatol. 2019 Apr;17(5):878-886. doi: 10.1016/j.cgh.2018.05.020. Epub 2018 May 29.
BACKGROUND & AIMS: Functional nausea and vomiting disorders (FNVDs) are classified as chronic nausea and vomiting syndrome (CNVS) or cyclic vomiting syndrome (CVS)-CVS includes cannabinoid hyperemesis syndrome. We investigated the population prevalence of FNVDs, their characteristics, and associated factors. METHODS: In the year 2015, an Internet cross-sectional health survey was completed by 5931 adults in the general populations of 3 English-speaking countries; 2100 participants were in the United States, Canada, or the United Kingdom. Quota-based sampling was used to generate demographically balanced and population-representative samples. The survey collected data on demographics, health care visits, medications, somatic symptom severity, quality of life, and symptom-based diagnostic criteria for Rome IV FNVDs as well as for irritable bowel syndrome and functional dyspepsia. Subsequent comparisons were made between Rome IV FNVD subjects and individuals without FNVDs (controls). RESULTS: Overall, 2.2% of the population (n = 131) fulfilled symptom-based diagnostic criteria for Rome IV FNVDs: the United States (3%) had a greater prevalence than Canada (1.9%) or the United Kingdom (1.8%) (P = .02). The prevalence of CNVS was similar among the countries, ranging from 0.8% to 1.2%. However, the prevalence of CVS was higher in the United States (2%) than in Canada (0.7%) or the United Kingdom (1%) (P = .03). The proportion of subjects with CVS taking cannabis did not differ significantly among countries (P = .31), although the 7 cases of cannabinoid hyperemesis syndrome were in the United States. A significantly higher proportion of subjects with CVS reported a compulsive need for hot water bathing to alleviate emetic symptoms than subjects with CNVS (44% vs 19%; P = .03); this behavior was independent of cannabis but augmented by its use. Subjects with FNVDs had significantly greater health impairment and health care utilization than controls. On multivariate analysis, independent factors associated with FNVDs were younger age, increasing somatic symptom severity, lower quality of life, presence of irritable bowel syndrome, and functional dyspepsia. However, on subgroup analysis, somatic symptom severity was associated with CVS but not CNVS, whereas poor quality of life was associated with CNVS but not CVS. CONCLUSIONS: Based on a cross-sectional health survey of adults in the general populations of 3 English-speaking countries, approximately 2% of subjects meet symptom-based criteria for Rome IV FNVDs and have considerable health impairments. Hot water bathing to alleviate emetic symptoms is reported for all FNVDs, and is perpetuated by cannabis use.
背景与目的:功能性恶心和呕吐障碍(FNVDs)被归类为慢性恶心和呕吐综合征(CNVS)或周期性呕吐综合征(CVS)-CVS 包括大麻素过度呕吐综合征。我们调查了 FNVDs 的人群患病率、其特征和相关因素。
方法:在 2015 年,来自 3 个英语国家的 5931 名成年人参与了一项互联网横断面健康调查;其中 2100 名参与者来自美国、加拿大或英国。采用配额抽样生成人口统计学上平衡且具有代表性的样本。该调查收集了人口统计学数据、医疗就诊情况、药物使用、躯体症状严重程度、生活质量以及罗马 IV FNVDs 的症状为基础的诊断标准,以及肠易激综合征和功能性消化不良的诊断标准。随后对罗马 IV FNVD 受试者和无 FNVD 者(对照组)进行了比较。
结果:总体而言,人群中有 2.2%(n=131)符合罗马 IV FNVDs 的症状为基础的诊断标准:美国(3%)的患病率高于加拿大(1.9%)或英国(1.8%)(P=0.02)。各国的 CNVS 患病率相似,范围为 0.8%至 1.2%。然而,美国 CVS 的患病率(2%)高于加拿大(0.7%)或英国(1%)(P=0.03)。在国家间,患有 CVS 并使用大麻的患者比例差异无统计学意义(P=0.31),尽管有 7 例大麻素过度呕吐综合征发生在美国。患有 CVS 的患者报告说,为缓解呕吐症状而强迫性地需要热水浴的比例明显高于患有 CNVS 的患者(44% vs 19%;P=0.03);这种行为独立于大麻,但与大麻的使用有关。患有 FNVDs 的患者的健康受损和医疗利用率明显高于对照组。多变量分析显示,与 FNVDs 相关的独立因素是年龄较小、躯体症状严重程度增加、生活质量较低、患有肠易激综合征和功能性消化不良。然而,亚组分析显示,躯体症状严重程度与 CVS 相关,而与 CNVS 无关,而生活质量较差与 CNVS 相关,而与 CVS 无关。
结论:基于对 3 个英语国家一般人群的成年人进行的横断面健康调查,约有 2%的受试者符合罗马 IV FNVDs 的症状为基础的诊断标准,并存在相当大的健康损害。缓解呕吐症状的热水浴适用于所有 FNVDs,并且会因大麻的使用而持续。
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