ABSTRACT
Objective To explore the long-term symptom development in functional bowel disorders (FBD) and the effects of lactose-restricted diet on the symptoms.Methods From January 2008 to December 2010,805 patients with FBD were included.Among them 245 patients who completed lactose hydrogen breath test and the lactose intake exceeded median value (48.75 g/month) were followed up with telephone interview.The changes of gastrointestinal symptoms,lactose intake and anxiety/ depression status of the patients were observed.Chi-square test,t test and inspection rank test were performed for statistically analysis.Binary Logistic regression analysis was used for influence factors analysis.Results Among 805 patients with FBD,there were 432 (53.7％) mild patients and 373 (46.3％) severe patients.The proportions of female patients,patients with gastrointestinal disease history (gastroenteritis,ulcers,chronic diarrhea etc.),anxiety,depression and irritable bowel syndrome (IBS) of severe patients were all higher than those of mild patients (50.4％,188/373 vs 40.3％,174/432;53.6％,200/373 vs 43.5％,188/432;29.5％,110/373 vs 16.9％,73/432;32.2％,120/373 vs 21.5％,93/432;77.2％,288/373 vs 45.1％,195/432),and the differences were statistically significant (x2 =8.60,0.90,18.10,22.10 and 8.20,all P＜0.05).Among 245 FBD patients included in telephone follow-up,144 cases (58.8％) were successfully followed up (follow-up group) and the follow-up duration was five to seven years.Since the first visit,some diseases have been detected including five cases of colonic polyps,three cases of ulcerative colitis (UC),three cases of gallbladder common bile duct stones,two cases of H.pylori-related peptic ulcer,one case of digestive tract hemorrhage and one case of chronic pancreatitis.The frequency scores of abdominal pain,abdominal distension,hard stools and loose stools were all lower than initial status (0 (0 to 1) vs 5 (3 to 6),0 (0 to 1) vs 3 (0 to 5),0 (0 to 0) vs 0 (0 to 1),0 (0 to 2) vs 2 (1 to 3));the general sensation improved compared with that of initial status (2(1 to 2) vs 3(3 to 4)),and the differences were statistically significant (Z=11.23,7.82,2.19,8.42 and 11.49,all P＜0.05).During follow-up,anxiety/depression symptoms of patients in follow-up group were improved (4 (3 to 4) vs 3 (3 to 4),1 (1 to 1) vs 2 (1 to 2));and the differences were statistically significant (Z=-5.81 and 5.06,both P＜0.01).The median value of lactose intake was decreased compared with before in follow-up group (27.0 g/month (3.0 g/month to 99.8 g/month) vs 135.1 g/month (91.6 g/month to 238.6 g/month));and the difference was statistically significant (Z=-0.14,P＜ 0.01).Lactose-restricted diet could improve the gastrointestinal symptoms including abdominal pain,bloating,loose stool and overall feelings of patients,and the differences were statistically significant (x2 =6.09,5.46,10.04 and 6.40,all P＜0.05).Conclusions Over time,there is still possibility that FBD developed into organic diseases.So the patients still needed close follow-up.Lactose-restricted diet could improve the symptoms of FBD.