Lu Jia, Shi Lili, Huang Dan, Fan Wenjuan, Li Xiaoqing, Zhu Liming, Wei Jing, Fang Xiucai
Departments of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Departments of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Neurogastroenterol Motil. 2020 Sep 30;26(4):505-513. doi: 10.5056/jnm19166.
BACKGROUND/AIMS: A strong correlation between depression and irritable bowel syndrome with diarrhea (IBS-D) has been identified. The aim of this study is to identify the correlations among depression, structural factors, gastrointestinal (GI) and extra-GI symptoms, and efficacy of neuromodulators in patients with IBS-D.
Patients meeting the Rome III Diagnostic Criteria for IBS-D were enrolled. The intestinal symptoms and psychological states were evaluated using IBS-specific symptom questionnaires and Hamilton Depression Rating Scale.
In total, 410 patients with IBS-D were enrolled, 28.8% (118/410) had comorbid depression. Patients with depression did not readily experience improvement in abdominal pain/discomfort after defecation, and had a higher prevalence of passing mucus, overlapping functional dyspepsia, and extra-GI symptoms. The structural factor "mental disorders" significantly correlated with main bowel symptom score and degree of pre-defecation abdominal pain/discomfort. No structural factor significantly correlated with bowel movements or stool form. Patients who had passing mucus, overlapping functional dyspepsia and extra-GI painful symptoms have higher score of "anxiety/somatization." Patients with sexual dysfunction have higher score of "retardation symptoms." In total, 28.3% of patients with IBS-D were prescribed neuromodulators. Baseline scores of "anxiety/somatization" and "retardation symptoms" positively correlated with improvement of diarrhea after paroxetine, and "sleep disturbances" positively correlated with improvement of abdominal pain/discomfort and diarrhea after mirtazapine.
Comorbid depression and higher scores of structural factors might aggravate GI and extra-GI symptoms other than bowel movements and stool form. Structural factors of Hamilton Depression Rating Scale correlated with efficacy of paroxetine and mirtazapine in patients with IBS-D.
背景/目的：已确定抑郁症与腹泻型肠易激综合征（IBS-D）之间存在密切关联。本研究旨在确定IBS-D患者中抑郁症、结构因素、胃肠道（GI）和胃肠道外症状以及神经调节剂疗效之间的相关性。
纳入符合罗马III型IBS-D诊断标准的患者。使用IBS特异性症状问卷和汉密尔顿抑郁量表评估肠道症状和心理状态。
共纳入410例IBS-D患者，其中28.8%（118/410）合并抑郁症。抑郁症患者排便后腹痛/不适不易改善，黏液便、重叠功能性消化不良和胃肠道外症状的患病率较高。结构因素“精神障碍”与主要肠道症状评分及排便前腹痛/不适程度显著相关。无结构因素与排便次数或大便形态显著相关。有黏液便、重叠功能性消化不良和胃肠道外疼痛症状的患者“焦虑/躯体化”得分较高。性功能障碍患者“迟缓症状”得分较高。共有28.3%的IBS-D患者使用了神经调节剂。“焦虑/躯体化”和“迟缓症状”的基线评分与帕罗西汀治疗后腹泻的改善呈正相关，“睡眠障碍”与米氮平治疗后腹痛/不适和腹泻的改善呈正相关。
合并抑郁症和较高的结构因素评分可能会加重除排便次数和大便形态外的胃肠道和胃肠道外症状。汉密尔顿抑郁量表的结构因素与IBS-D患者中帕罗西汀和米氮平的疗效相关。
