North C S, Alpers D H, Thompson S J, Spitznagel E L
Dig Dis Sci. 1996 Apr;41(4):633-40. doi: 10.1007/BF02213117.
High rates of psychiatric disorder have been documented in patients with functional bowel syndromes sampled from physicians' offices. Lifetime psychiatric disorder and/or current psychiatric symptoms are thought to be much more highly associated with current gastrointestinal bowel symptoms in clinical settings than in the community. The relationship of lifetime functional gastrointestinal symptoms to lifetime psychiatric disorders has not been examined systematically in randomly selected samples of general community populations. The current study reports findings from existing data on a large, randomly selected population sample that may help to clarify these associations. Epidemiologic Catchment Area (ECA) project data were analyzed to examine relationships of functional gastrointestinal symptoms and psychiatric diagnoses in the community. Individuals with two or more medically unexplained gastrointestinal symptoms had high rates of psychiatric disorders. This was also true for the subgroup in which abdominal pain was one of the two symptoms. The overwhelming majority of subjects reporting medically unexplained gastrointestinal symptoms said they had consulted physicians for those symptoms. General population ECA data indicate that women in the community report more functional gastrointestinal complaints than men, that individuals with lifetime gastrointestinal complaints have high rates of lifetime psychiatric disorders (not necessarily currently symptomatic), and most have contacted a physician regarding their gastrointestinal symptoms. These data complement studies showing that patients with current gastrointestinal symptoms often do not consult a physician, or when they do, such behavior is associated with active psychiatric symptoms. These present data are consistent with the hypothesis that patients with recurrent symptoms are those who routinely seek medical help and who have high rates of psychiatric disorders, whereas those with symptoms that resolve or are improved by a medical intervention do not maintain treatment-seeking behavior.
在从医生办公室抽取的功能性肠易激综合征患者中，已记录到较高的精神疾病发病率。在临床环境中，终生精神疾病和/或当前精神症状被认为与当前胃肠道症状的关联程度比在社区中更高。在随机抽取的普通社区人群样本中，尚未系统研究终生功能性胃肠道症状与终生精神疾病之间的关系。本研究报告了来自一个大型随机抽取的人群样本的现有数据结果，这些结果可能有助于阐明这些关联。对流行病学集水区（ECA）项目数据进行了分析，以研究社区中功能性胃肠道症状与精神疾病诊断之间的关系。有两种或更多无法用医学解释的胃肠道症状的个体，精神疾病发病率较高。对于腹痛是两种症状之一的亚组也是如此。绝大多数报告有无法用医学解释的胃肠道症状的受试者表示，他们曾就这些症状咨询过医生。普通人群的ECA数据表明，社区中的女性报告的功能性胃肠道不适比男性更多，有终生胃肠道不适的个体终生精神疾病发病率较高（不一定目前有症状），并且大多数人曾就其胃肠道症状咨询过医生。这些数据补充了一些研究，这些研究表明，有当前胃肠道症状的患者通常不会咨询医生，或者即使咨询了，这种行为也与活跃的精神症状相关。目前的数据与以下假设一致：有复发性症状的患者是那些经常寻求医疗帮助且精神疾病发病率较高的人，而那些症状通过医学干预得到缓解或改善的患者不会维持寻求治疗的行为。
