Department of Surgery, Oncology and Gastroenterology (DISCOG), Gastroenterology Unit, University of Padova-Azienda Ospedaliera di Padova, Padova, Italy.
Farncombe Family Digestive Health Research Institute, Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, ON, Canada.
Aliment Pharmacol Ther. 2021 Jan;53(2):253-264. doi: 10.1111/apt.16184. Epub 2020 Dec 5.
Conventionally, patients with functional dyspepsia are subgrouped based on upper gastrointestinal symptoms, according to the Rome criteria. However, psychological co-morbidity and extraintestinal symptoms are also relevant to functional gastrointestinal disorders.
To investigate whether it is possible to subgroup people with functional dyspepsia using factors beyond upper gastrointestinal symptoms.
We collected demographic, symptom and psychological health data from adult subjects meeting the Rome III criteria for functional dyspepsia in two secondary care cross-sectional surveys in Canada and the UK. We performed latent class analysis, a method of model-based clustering, to identify specific subgroups (clusters). For each cluster, we drew a radar plot, and compared these by visual inspection, describing cluster characteristics.
In total, 400 individuals met Rome III criteria for functional dyspepsia in the Canadian cohort, and 262 the UK cohort. A four-cluster model was the optimum solution and the characteristics of the clusters were almost identical between the two cohorts. The clusters were defined by a pattern of gastrointestinal symptoms and were further differentiated by the extent of extraintestinal and psychological co-morbidity. Cluster 1 (mean age 46.7 years, 66.7% female) consisted of epigastric pain and nausea with high psychological burden, cluster 2 (mean age 41.5 years, 77.7% female) high overall gastrointestinal symptom severity with high psychological burden, cluster 3 (45.8 years, 67.2% female) oesophageal symptoms and early satiety with low psychological burden, and cluster 4 (mean age 40.4 years, 71.5% female) postprandial fullness with low psychological burden. We validated the model derived using the Canadian study population externally by applying it to the UK dataset. We demonstrated reproducibility; it would perform similarly when applied to a different dataset.
Latent class analysis identified four distinct functional dyspepsia subgroups characterised by varying degrees of gastrointestinal symptoms, extraintestinal symptoms and psychological co-morbidity. Further research is needed to assess whether they might be used to direct treatment.
根据罗马标准，传统上，功能性消化不良患者根据上消化道症状进行亚组分类。然而，心理共病和肠外症状也与功能性胃肠疾病相关。
研究是否可以使用上消化道症状以外的因素对功能性消化不良患者进行亚组分类。
我们从满足罗马 III 功能性消化不良标准的成年患者中收集了加拿大和英国的两项二级保健横断面研究中的人口统计学、症状和心理健康数据。我们进行了潜在类别分析，这是一种基于模型的聚类方法，以确定特定的亚组（聚类）。对于每个聚类，我们绘制了一个雷达图，并通过视觉检查进行比较，描述聚类特征。
在加拿大队列中，共有 400 名个体符合罗马 III 功能性消化不良标准，英国队列中则有 262 名。四聚类模型是最佳解决方案，两个队列的聚类特征几乎相同。聚类由胃肠道症状模式定义，并进一步通过肠外和心理共病的严重程度来区分。聚类 1（平均年龄 46.7 岁，女性占 66.7%）由上腹痛和恶心组成，心理负担较重，聚类 2（平均年龄 41.5 岁，女性占 77.7%）总体胃肠道症状严重，心理负担较重，聚类 3（45.8 岁，女性占 67.2%）有食管症状和早饱，心理负担较低，聚类 4（平均年龄 40.4 岁，女性占 71.5%）餐后饱胀，心理负担较低。我们通过将该模型应用于英国数据集，对加拿大研究人群中得出的模型进行了外部验证。我们证明了该模型的可重复性；当应用于不同的数据集时，它的表现也会相似。
潜在类别分析确定了四个不同的功能性消化不良亚组，其特征是胃肠道症状、肠外症状和心理共病的程度不同。需要进一步研究以评估它们是否可用于指导治疗。
