National University Hospital, National University Health System, Singapore.
MOH Holdings Pte Ltd, Singapore.
J Gastroenterol Hepatol. 2019 Jan;34(1):68-73. doi: 10.1111/jgh.14446. Epub 2018 Sep 10.
Post-traumatic stress disorder (PTSD) is a psychiatric condition characterized by symptoms of hyperarousal and hypervigilance. Increasing research on the "gut-brain" axis (bidirectional signaling between the gut and the brain) has drawn links between PTSD and irritable bowel syndrome (IBS), an exceedingly common yet incompletely understood gastrointestinal condition. This meta-analysis thus aimed to examine the body of evidence and extent of association of PTSD with IBS.
Using the keywords [early abuse OR childhood abuse OR violence OR trauma OR PTSD] AND [irritable bowel syndrome or IBS], a preliminary search on the PubMed, Medline, Embase, ScienceDirect, PsychINFO, Web of Science, and Google Scholar databases yielded 11,257 papers published in English between January 1, 1988, and May 1, 2018. Of these, only eight studies were included in the final meta-analysis.
The eight studies (four cross-sectional and four cohort) contained a total of 648,375 subjects. Most studies were from the USA and conducted on army veterans. The funnel plot revealed a roughly symmetrical distribution of studies, and Egger test was not significant for publication bias (P = 0.583). Random-effects meta-analysis found PTSD to be a significant risk factor for IBS (pooled odds ratio 2.80, 95% confidence interval: 2.06 to 3.54, P < 0.001).
Overall, PTSD is associated with an increased likelihood of IBS. This is the first meta-analysis to specifically examine the association between PTSD and IBS, and it provides insights into the probable (patho)physiology and management of IBS, supporting a holistic consideration of the psychosocial aspects of IBS and further research into effective multi-modal therapeutics.
创伤后应激障碍（PTSD）是一种以过度警觉和过度警惕为特征的精神疾病。越来越多的“肠-脑”轴（肠道和大脑之间的双向信号）研究将 PTSD 与肠易激综合征（IBS）联系起来，IBS 是一种非常常见但尚未完全理解的胃肠道疾病。因此，这项荟萃分析旨在检查 PTSD 与 IBS 相关的证据和关联程度。
使用关键词[早期虐待或童年虐待或暴力或创伤或 PTSD]和[肠易激综合征或 IBS]，对 PubMed、Medline、Embase、ScienceDirect、PsychINFO、Web of Science 和 Google Scholar 数据库进行初步搜索，共检索到 1988 年 1 月 1 日至 2018 年 5 月 1 日期间发表的 11257 篇英文论文。其中，只有八项研究被纳入最终的荟萃分析。
八项研究（四项横断面研究和四项队列研究）共纳入 648375 名受试者。大多数研究来自美国，针对退伍军人进行。漏斗图显示研究的分布大致对称，Egger 检验表明不存在发表偏倚（P=0.583）。随机效应荟萃分析发现 PTSD 是 IBS 的一个显著危险因素（合并优势比 2.80，95%置信区间：2.06 至 3.54，P<0.001）。
总体而言，PTSD 与 IBS 的发生几率增加有关。这是第一项专门研究 PTSD 与 IBS 之间关联的荟萃分析，它提供了对 IBS 可能的（病理）生理学和管理的见解，支持对 IBS 的社会心理方面进行全面考虑，并进一步研究有效的多模式治疗方法。
