Drossman D A, Talley N J, Leserman J, Olden K W, Barreiro M A
University of North Carolina, Chapel Hill, USA.
Ann Intern Med. 1995 Nov 15;123(10):782-94. doi: 10.7326/0003-4819-123-10-199511150-00007.
To summarize the existing data on abuse history and gastrointestinal illness, suggest a conceptual scheme to explain these associations, suggest ways to identify patients at risk, and provide information about mental health referral.
Review of the pertinent literature by clinicians and investigators at referral centers who are involved in the care of patients with complex gastrointestinal illness and who have experience in the diagnosis and care of patients with abuse history in these settings.
All research articles and observational data that addressed abuse history in gastroenterologic settings. Articles were identified through a MEDLINE search.
Independent extraction by multiple observers.
On the basis of literature review and consensus, it was determined that abuse history is associated with gastrointestinal illness and psychological disturbance; appears more often among women, patients with functional gastrointestinal disorders, and patients seen in referral settings; is not usually known by the physician; and is associated with poorer adjustment to illness and adverse health outcome. Although the mechanisms for this association are unknown, psychological factors (somatization, response bias, reinforcement of abnormal illness behavior) and physiologic factors (psychophysiologic response, enhanced visceral sensitivity) probably contribute. On the basis of these data, recommendations are made on how to identify patients at risk, how to obtain this information, and, if needed, how to make appropriate referrals.
The authors agree with existing data on the association between abuse history and gastrointestinal illness. Physicians should ask patients with severe or refractory illness about abuse history. Appropriate referral to a mental health professional may improve the clinical outcome.
总结关于虐待史与胃肠道疾病的现有数据，提出一个概念框架来解释这些关联，提出识别高危患者的方法，并提供有关心理健康转诊的信息。
由转诊中心的临床医生和研究人员对相关文献进行综述，这些人员参与复杂胃肠道疾病患者的护理工作，且在这些环境中具有诊断和护理有虐待史患者的经验。
所有涉及胃肠病学环境中虐待史的研究文章和观察数据。文章通过医学文献数据库检索确定。
由多名观察者独立提取。
基于文献综述和共识，确定虐待史与胃肠道疾病及心理障碍相关；在女性、功能性胃肠疾病患者以及转诊环境中的患者中更常见；医生通常并不知晓；且与对疾病的较差适应及不良健康结局相关。尽管这种关联的机制尚不清楚，但心理因素（躯体化、反应偏差、异常疾病行为的强化）和生理因素（心理生理反应、内脏敏感性增强）可能起作用。基于这些数据，就如何识别高危患者、如何获取此信息以及在需要时如何进行适当转诊提出了建议。
作者认同关于虐待史与胃肠道疾病之间关联的现有数据。医生应询问患有严重或难治性疾病的患者的虐待史。适当转诊至心理健康专业人员可能会改善临床结局。
