Department of Medicine.
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
J Clin Gastroenterol. 2023 Sep 1;57(8):830-834. doi: 10.1097/MCG.0000000000001767.
The estimated prevalence of bloating is 15 to 30% in the adult US population and is even higher in patients with disorders of gut-brain interaction (DGBIs). Despite this frequency, there is little research into patients who endorse bloating as a predominant symptom. The aim of this study was to better characterize these patients.
New patients with DGBIs were asked to identify their 3 most predominant symptoms over the preceding 3 months; those who reported bloating were classified as "bloating predominant." Rome IV and symptom-specific questionnaires were administered to assess for the frequency of DGBIs and other predominant symptoms in this patient population. Using univariable and multivariable modeling, we analyzed the associations between bloating predominance, DGBI subtype, and clinical characteristics.
Of the 586 patients surveyed, 242 (41%) reported predominant bloating. Bloating-predominant patients were more likely to be female, younger, and meet the criteria for IBS-mixed (IBS-M), functional constipation, and functional dyspepsia compared with nonbloating-predominant patients. Bloating-predominant patients were also more likely to endorse concurrently predominant constipation, incomplete evacuation, abdominal pain, belching, and/or nausea. On multivariable logistic regression, constipation and abdominal pain severity were positively associated, although depression was negatively associated with predominant bloating.
Patients with predominant bloating are more likely to have constipation-related symptoms than diarrhea-related symptoms. They are also more likely to have more severe abdominal pain than patients without predominant bloating. These findings help characterize patients with bloating as a predominant symptom and suggest that diagnosing and treating constipation should be considered as first-line treatment.
在成年美国人群中，腹胀的估计患病率为 15%至 30%，而在胃肠道-脑交互障碍（DGBI）患者中甚至更高。尽管这种频率很高，但对于将腹胀作为主要症状的患者的研究甚少。本研究旨在更好地描述这些患者。
新的 DGBI 患者被要求在前 3 个月内识别他们的 3 种最主要的症状；那些报告腹胀的患者被归类为“腹胀为主”。罗马 IV 和症状特异性问卷用于评估该患者人群中 DGBI 和其他主要症状的频率。使用单变量和多变量模型，我们分析了腹胀为主、DGBI 亚型和临床特征之间的关联。
在接受调查的 586 名患者中，有 242 名（41%）报告主要腹胀。与非腹胀为主的患者相比，腹胀为主的患者更可能为女性、年轻且符合 IBS-混合（IBS-M）、功能性便秘和功能性消化不良的标准。腹胀为主的患者也更可能同时存在主要便秘、不完全排空、腹痛、打嗝和/或恶心。在多变量逻辑回归中，便秘和腹痛严重程度呈正相关，尽管抑郁与主要腹胀呈负相关。
以腹胀为主的患者更有可能出现与便秘相关的症状，而不是腹泻相关的症状。与没有主要腹胀的患者相比，他们也更有可能出现更严重的腹痛。这些发现有助于将以腹胀为主的患者进行特征描述，并表明应考虑诊断和治疗便秘作为一线治疗。
