Internal Medicine and Liver Unit, Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy.
Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
J Gastroenterol Hepatol. 2019 Apr;34(4):713-719. doi: 10.1111/jgh.14375. Epub 2018 Jul 27.
The aims of this study were to better define the relationship between irritable bowel syndrome (IBS) and psychiatric disorders and to examine the efficacy of paroxetine in the treatment of IBS patients.
One hundred fifty subjects with diagnosis of IBS (Roma III criteria) and relative sub-classification (constipated, diarrhea, and mixed) were assessed for psychopathological features and gastrointestinal symptoms using IBS Symptom Severity Score and were consecutively enrolled. Fifty patients assumed paroxetine for 16 weeks and were longitudinally evaluated.
The entire sample had a moderate/severe gastrointestinal symptomatology (IBS-SSS 285.1 ± 98.6). The IBS subtypes were diarrhea (47.3%), constipated (32%), and mixed (20.7%). Panic disorder was found in 17.4% and major depressive episode in 14.7%. More than 50% of the patients showed "psychopathological features." This group showed more severe gastrointestinal symptoms and worse quality of life than the group without any psychiatric comorbidity (44%). Psychiatric patients also showed a significant impairment of physical state, subjective feeling of well-being, and leisure activities when compared with no psychiatric patients. When the IBS-SSS > 300 group was subgrouped in psychiatric (67.2%) and no psychiatric (32.8%), we found significant differences in all clinician-administered and self-reported scales with more severe psychopathological features in psychiatric group (P < 0.01). Among the patients treated with paroxetine, 34 (68%) completed the longitudinal evaluation showing a significant improvement of both psychiatric and gastrointestinal symptoms.
This study confirms a high presence of psychiatric comorbidities, emphasizing the need for psychiatric screening in all patients with IBS; moreover, the longitudinal evaluation of patients treated with paroxetine showed a significant improvement of both psychiatric and gastrointestinal symptoms.
本研究旨在更好地定义肠易激综合征（IBS）与精神障碍之间的关系，并研究帕罗西汀治疗 IBS 患者的疗效。
采用肠易激综合征症状严重程度评分（IBS-SSS）对 150 例符合罗马 III 标准的 IBS 患者（以及相关亚型：便秘型、腹泻型和混合型）进行精神病理学特征和胃肠道症状评估，随后对这些患者进行连续入组。其中 50 例患者接受帕罗西汀治疗 16 周，并进行纵向评估。
所有患者均具有中重度胃肠道症状（IBS-SSS 285.1±98.6）。IBS 亚型分别为腹泻型（47.3%）、便秘型（32%）和混合型（20.7%）。发现惊恐障碍 17.4%，重性抑郁发作 14.7%。超过 50%的患者存在“精神病理学特征”。与无任何精神共病的患者相比，这组患者的胃肠道症状更严重，生活质量更差（44%）。与无精神共病的患者相比，精神共病患者的身体状态、主观幸福感和休闲活动也明显受损。当将 IBS-SSS＞300 组分为精神科（67.2%）和非精神科（32.8%）亚组时，我们发现两组在所有由医生评估和患者自报的量表中均存在显著差异，精神科组具有更严重的精神病理学特征（P＜0.01）。在接受帕罗西汀治疗的患者中，34 例（68%）完成了纵向评估，显示出精神和胃肠道症状均显著改善。
本研究证实了存在较高的精神共病，强调了对所有 IBS 患者进行精神筛查的必要性；此外，对接受帕罗西汀治疗的患者进行纵向评估显示，精神和胃肠道症状均显著改善。
