Whitehead W E, Bosmajian L, Zonderman A B, Costa P T, Schuster M M
Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Gastroenterology. 1988 Sep;95(3):709-14. doi: 10.1016/s0016-5085(88)80018-0.
Women with symptoms indicative of irritable bowel syndrome who had not consulted a physician were compared with female patients at a gastroenterology clinic to investigate whether self-selection for treatment accounts for psychologic abnormalities in clinic patients' with irritable bowel syndrome. Two sets of diagnostic criteria were compared: restrictive criteria based on the work of Manning and conventional criteria (abdominal pain plus altered bowel habits). Lactose malabsorbers were included as a control group because they have medically explained bowel symptoms similar to those that define irritable bowel syndrome. Thus they control for the causative effects of chronic bowel symptoms on psychologic distress. Women who met restrictive criteria for irritable bowel syndrome but had not consulted a physician had no more symptoms of psychologic distress on the Hopkins Symptom Checklist than asymptomatic controls. However, medical clinic patients with both irritable bowel syndrome and lactose malabsorption had significantly more psychologic symptoms than asymptomatic controls or nonconsulters with the same diagnoses. Individuals who met only the conventional criteria for irritable bowel syndrome reported more psychologic distress than controls, whether or not they consulted a physician. These results suggest that (a) symptoms of psychologic distress are unrelated to irritable bowel syndrome but influence which patients consult a doctor and (b) conventional diagnostic criteria identify more psychologically distressed individuals than do restrictive criteria.
将未咨询过医生的、有肠易激综合征症状的女性与胃肠病诊所的女性患者进行比较，以调查自行选择治疗是否导致肠易激综合征临床患者的心理异常。比较了两组诊断标准：基于曼宁研究成果的严格标准和传统标准（腹痛加排便习惯改变）。乳糖吸收不良者被纳入对照组，因为他们有医学解释的肠道症状，与定义肠易激综合征的症状相似。因此，他们可控制慢性肠道症状对心理困扰的因果影响。符合肠易激综合征严格标准但未咨询过医生的女性，在霍普金斯症状清单上的心理困扰症状并不比无症状对照组更多。然而，患有肠易激综合征和乳糖吸收不良的门诊患者，其心理症状明显多于无症状对照组或有相同诊断但未咨询过医生的患者。仅符合肠易激综合征传统标准的个体，无论是否咨询过医生，报告的心理困扰都比对照组更多。这些结果表明：（a）心理困扰症状与肠易激综合征无关，但会影响哪些患者咨询医生；（b）传统诊断标准比严格标准识别出更多心理困扰的个体。
