Department of Physiology, Université René Descartes, Paris V, Paris, France.
Department of Gastroenterology, Hôpital Avicenne, Bobigny, France.
J Gastroenterol Hepatol. 2021 Aug;36(8):2171-2179. doi: 10.1111/jgh.15438. Epub 2021 Feb 20.
Functional gastrointestinal disorders (FGIDs) are frequently overlapped. The present study was designed to (i) search the clinical differences between patients with single FGID and overlap FGIDs and (ii) define the most common FGIDs associations to identify homogenous subgroups of patients.
A total of 3555 outpatients with FGID filled out the Rome III adult diagnostic questionnaire, Bristol stool form, and four 10-point Likert scales to report the severity of constipation, diarrhea, bloating, and abdominal pain. An unsupervised algorithm was used to estimate the number of groups directly from the data. A classification tree separated patients into different subgroups, according to FGIDs. Multinomial logistic regression was used to characterize the groups of patients with overlap disorders.
Patients reported 3.3 ± 1.9 FGIDs (range 1-10, median = 3); 736 reported only one FGID, while 2819 reported more than one FGID (3.8 ± 1.7). Patients with single FGID had higher body mass index (P < 0.001), never report irritable bowel syndrome (IBS), and rarely report fecal incontinence and anorectal pain (< 1% for each disorder). The non-supervised clustering of the 2819 patients with overlap FGIDs divided this population into 23 groups, including five groups associated with only one disorder (IBS-diarrhea, dysphagia, functional constipation, levator ani syndrome, and IBS-unspecified). Ten groups were related to two overlap disorders and eight groups to three or more disorders. Three disorders were not explicitly associated with a given group: IBS-mixed, proctalgia fugax, and nonspecific anorectal pain.
Patients with FGID mostly report overlap disorders in a limited number of associations, each significantly associated with a few disorders.
功能性胃肠病（FGIDs）常重叠存在。本研究旨在：（i）探寻单一 FGID 与重叠 FGID 患者的临床差异；（ii）明确最常见的 FGIDs 关联，以识别具有同质性的患者亚组。
共 3555 名 FGID 门诊患者填写了罗马 III 成人诊断问卷、布里斯托粪便形态量表和 4 个 10 分制 Likert 量表，以报告便秘、腹泻、腹胀和腹痛的严重程度。采用无监督算法直接从数据中估计分组数量。分类树根据 FGIDs 将患者分为不同的亚组。多分类逻辑回归用于描述重叠疾病患者的分组特征。
患者报告了 3.3±1.9 种 FGIDs（范围 1-10，中位数=3）；736 例患者仅报告了一种 FGID，而 2819 例患者报告了多种 FGIDs（3.8±1.7）。单一 FGID 患者的体重指数更高（P<0.001），从不报告肠易激综合征（IBS），且很少报告粪便失禁和肛门直肠疼痛（每种疾病发生率均<1%）。对 2819 例重叠 FGIDs 患者的非监督聚类将该人群分为 23 组，其中 5 组仅与一种疾病相关（IBS-腹泻、吞咽困难、功能性便秘、肛提肌综合征和 IBS-未特指）。10 个组与两种重叠疾病相关，8 个组与三种或更多疾病相关。三种疾病与特定组没有明确关联：IBS-混合性、直肠痛发作和非特异性肛门直肠疼痛。
FGID 患者大多报告有限数量的重叠疾病，每种疾病都与少数疾病显著相关。
