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Objective To investigate clinical manifestation of unspecified functional bowel disorder (UFBD), the features of coexistence with functional gastrointestinal disorder (FGID) and its relationship with psychological factors and sleep disturbance in the Chinese Army servicemen.Methodsc FGIDs were diagnosed based on the RomeⅢ Modular Questionnaire. The subjects were 189 servicemen with UFBD (UFBD group) and 372 without FGID (control group). All subjects completed symptom checklist 90 (SCL-90) and Pittsburgh Sleep Quality Index (PSQI) questionnaire.Results'Have to rush to the toilet when having a desire to defecate' was the most frequent symptom of UFBD (93.7%). More than one half of UFBD patients had the symptom 'a feeling of incomplete emptying as bowel movements' or 'straining during bowel movements'. Twenty-eight percent of UFBD subjects had combined FGID (namely cFGID). Among them, the most frequent was proctalgia fugax (7.9%), followed by cyclic vomiting syndrome (6.3%), functional fecal incontinence (6.3%), functional dyspepsia (4.8%) and belching (4.8%). The UFBD group scored significantly higher than the control group in the global severity index (GSI) and in all SCL-90 subscales (P0.05).ConclusionPathogenesis of UFBD may be closely correlated with psychiatric and psychological factors and sleep disturbance. cFGID are associated with an increased severity of psychopathological features.
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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.
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Functional bowel disorders (FBD) refer to a set of bowel symptoms related to the disorders of sensation, secretion and motility yet without a corresponding structural, histological, biochemical, or serological abnormalities.The pathogensesis of FBD is still not very clear.Whether these functional disorders reflect the inadequacy of our understanding of a disease or the limitation of our diagnostic testing is a question.With the development of the biomedical technology, some histological or biochemical changes were revealed, which supported the possibility that organic abnormality might exist in FBD.In this paper the progress of research on organic changes of irritable bowel syndrome and functional constipation was reviewed.
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This article highlights the role of prucalopride in the management of chronic constipation based upon the principles of meta-analysis using data reported in the published randomized, controlled trials. Sixteen randomized, controlled trials on 3943 patients reported the effectiveness of prucalopride in patients with chronic constipation. Prucalopride successfully increased the frequency of spontaneous bowel movements per week in all variable doses of 1 mg (standardized mean difference [SMD], 0.42 [95% CI, 0.18-0.66; P = 0.006]), 2 mg (SMD, 0.34 [95% CI, 0.11-0.56; P = 0.003]), and 4 mg (SMD, 0.33 [95% CI, 0.22-0.44; P = 0.00001]). The risks of adverse events or side effects such as headache, abdominal cramps, excessive flatulence, dizziness, diarrhea, and rash were higher (odds ratio, 1.70 [95% CI, 1.27 to -2.27; P = 0.0004]) in prucalopride group. Prucalopride is clinically a beneficial pharmacotherapy for chronic constipation and its routine use may be considered in patients with chronic simple laxative-resistant constipation.
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Humans , Colic , Constipation , Diarrhea , Dizziness , Drug Therapy , Exanthema , Flatulence , Headache , LaxativesABSTRACT
The true incidence of functional physical disorders is higher in general practice including functional bowel disorders. It leads to a high socio-economic burden by way of delayed diagnosis. ROME III criteria are used to diagnose these disorders. Although there are specific clinical diagnostic features, definite diagnostic investigations are unavailable. Recent scientific studies link the mind and body as part of a system where their dysregulation can produce illness and disease where psycho-social factors do play a role in addition to genetic susceptibility and environmental factors. The brain-gut axis is now an area of intense research in studying these functional disorders and psychotherapy behavioral modification and psycho-pharmacotherapy are are becoming increasingly important to manage such disorders.
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Objective To study the epidemiologic features of functional bowel disorders (FBD)among medical students and science and engineering students in Zhejiang province,China,and to explore the relationship between psychological factors and FBD.Methods This study was a survey of random sampling based on the Rome Ⅲ Diagnostic Questionnaire ( Rome Ⅲ -DQ) conducted from November 2010 to March 2011.The survey was carried out among medical students and science and engineering students respectively in two universities in Zhejiang province.Symptom Check List 90 ( SCL-90 ) was used for psychological analysis.Results Among 1870 participants,1033 were diagnosed as FBD based on Rome Ⅲ criteria,with an overall incidence of 55.24％.The majority cases were unspecified functional bowel disorder,with an incidence of 26.58％ (497/1870),others were functional constipation 16.95％(317/1870),irritable bowel syndrome 6.90％ ( 129/1870),functional bloating 4.12％ (77/1870) and functional diarrhea 0.70％ (13/1870).The prevalence varied in different genders,majors and grades.In the multivariate analysis,women had a higher risk of any FBD than men [ 68.33％ (617/903) vs 43.02％(416/967) ] except for functional diarrhea; and medical students had a higher risk of any FBD than science and engineering students [ 68.53％ ( 734/1071 ) vs 37.42％ ( 299/799 ) ].Generally higher grade undergraduates had relatively higher risks than lower grade students,especially in medical students.Among the participants with FBD,44.05％ (455/1033) had other functional gastrointestinal disorders.In those overlapped parts,9.00％ ( 93/1033 ) had belching disorders,and 8.23％ ( 85/1033 ) had functional dyspepsia.Students with FBD got higher scores in SCL-90 than healthy students.Conclusions This study revealed a high rate of FBD among college students in Zhejiang province.The prevalence varied in different majors,and female higher than male.Psychological factors also had close relationships with FBD.
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Irritable bowel syndrome (IBS) is a highly prevalent disorder that is characterized by chronic abdominal pain and altered bowel habit. The diagnosis of IBS has traditionally been made by matching the complaints of the patient with established clinical criteria, since the underlying pathophysiology was not known. Various new findings have recently been reported in IBS patients that challenge our concept of IBS as a syndrome with no explanation. While the florid inflammation characteristic of inflammatory bowel disease is absent in IBS, changes suggesting immune activation are present in nearly all IBS patients. Is IBS an autoimmune disease, or is the immune activation responding to a trigger? In this review we present evidence that points to a state of immune activation in IBS and show data that suggest that small intestinal bacterial overgrowth triggers immune activation in IBS.
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Humans , Abdominal Pain , Autoimmune Diseases , Inflammation , Inflammatory Bowel Diseases , Irritable Bowel SyndromeABSTRACT
BACKGROUND AND AIMS: Bacterial gastroenteritis seems to be a risk factor of irritable bowel syndrome (IBS). The incidence of post-infectious IBS (PI-IBS) was reported to be in the range of 7-31%, but few studies have reported long term follow-up results. So, we investigated the clinical course and prognosis of PI-IBS three years after shigella infection. METHODS: The subjects were recruited from our previous study, in which we investigated the incidence and risk factors of PI-IBS. We had a questionnaire based on interview with 120 controls and 124 patients who had shigella infection three years ago. Both groups were evaluated for the presence of IBS, functional bowel disorders (FBD) except IBS before, one and three years after the infection, respectively. RESULTS: Ninty-five patients (76.6%) and 105 controls (87.5%) completed the questionnare. In patients group, 7 cases had IBS prior to infection (previous IBS), 12 cases (13.8%) had IBS after 1 year (PI-IBS). Four cases developed IBS newly after 3 years (new IBS). Thirteen cases (14.9%) in patients and 4 cases (4.5%) in controls had IBS over 3 years (OR 3.93: 1.20-12.86). The recovery rate over 3 years were 50.0% (2/4) in previous IBS and 25% (3/12) in PI-IBS. The incidence of PI-IBS after 3 years in previous FBD subjects was 28.6% and was 10.6% in normals (p<0.05). The female gender was a risk factor for FBD. CONCLUSIONS: Bacterial gastroenteritis is a trigger factor of IBS. About a quarter of PI-IBS patients are recovered over 3 years. Previous FBD except IBS is a risk factor after 3 years.