Mood and Anxiety Disorders Precede Development of Functional Gastrointestinal Disorders in Patients but Not in the Population
Mood and Anxiety Disorders Precede Development of Functional Gastrointestinal Disorders in Patients but Not in the Population
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DOI：
10.1016/j.cgh.2016.12.032
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发表时间：
2017-07-01
影响因子：
12.6
通讯作者：
Talley, Nicholas J.
中科院分区：
文献类型：
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作者：
Jones, Michael P.;Tack, Jan;Talley, Nicholas J.
背景与目的：了解大脑和胃肠道疾病之间的相互作用需要对疾病发病顺序进行分析。我们分析了两项独立研究的数据，以确定在诊断为情绪或焦虑障碍（肠对脑）之前诊断为功能性胃肠道疾病（fgid）的个体比例，反之亦然（脑对肠）。方法：我们收集了一项回顾性研究的数据，该研究包括4966名在英国全科医生（寻求医疗保健者）诊断为FGID（肠易激综合征、消化不良或便秘）和情绪或焦虑障碍的患者，平均时间为13.1年；我们记录了最先出现的诊断，并将其与患者的性别和社会经济因素进行了比较。我们还收集了从1997年到2009年在澳大利亚随机选择的1002名个体（非医疗保健寻求者）的人口研究数据；我们确定受试者在基线时是否没有FGID或焦虑或情绪障碍，但在12年随访期后出现其中任何一种。结果：4966名求医者中，3279名患者在FGID前被诊断为情绪或焦虑障碍（比例为2:1）。这一比例随着社会经济劣势的增加而增加。诊断为情绪或焦虑障碍与FGID之间的时间间隔（中位数，3.5年）比诊断为FGID与情绪或焦虑障碍之间的时间间隔（中位数，1.8年）更长。在非医疗保健寻求者中（人口研究），在FGID之前和之后被诊断为情绪或焦虑障碍的比例相同。结论：在一项患者研究和一项基于人群的诊断个体研究的数据分析中，我们发现在FGID之前接受情绪或焦虑障碍诊断的患者多出2倍，但在FGID之前和之后被诊断为情绪或焦虑障碍的个体比例相同。在患者中，情绪或焦虑障碍的平均诊断时间比FGID早3年多，这为预防提供了机会。我们的研究结果支持不利的社会经济因素在心理障碍患者的FGIDs发展中的作用。
BACKGROUND & AIMS: Understanding the interactions between brain and gastrointestinal disorders requires analysis of the order of disease onset. We analyzed data from 2 independent studies to determine the proportion of individuals with diagnoses of functional gastrointestinal disorders (FGIDs) before diagnoses of mood or anxiety disorders (gut to brain), and vice versa (brain to gut).METHODS: We collected data from a retrospective study of 4966 patients diagnosed with a FGID (irritable bowel syndrome, dyspepsia, or constipation) and mood or anxiety disorder at general practices in the United Kingdom (health care seekers) over an average period of 13.1 years; we recorded which diagnosis appeared first and compared these with patients' sex and socioeconomic factors. We also collected data from a population study of 1002 randomly selected individuals in Australia (non-heath care seekers) followed from 1997 through 2009; we determined whether subjects were free of either FGID or an anxiety or mood disorder at baseline but developed either one after a 12-year follow-up period.RESULTS: Among the 4966 health care seekers, 3279 patients were diagnosed with a mood or anxiety disorder before an FGID (ratio of 2: 1). This ratio increased with socioeconomic disadvantage. The time period between diagnosis of mood or anxiety disorder and FGID was longer (median, 3.5 years) than time period between diagnosis of an FGID and a mood or anxiety disorder (median, 1.8 years). Among non-heath care seekers (population study), equal proportions were diagnosed with a mood or anxiety disorder before versus after an FGID.CONCLUSIONS: In an analysis of data from a study of patients and a population-based study of individuals with these diagnoses, we found 2-fold more patients to receive a diagnosis of a mood or anxiety disorder before an FGID, but equal proportions of individuals in the population to be diagnosed with the mood or anxiety disorder before versus after an FGID. Among patients, the mood or anxiety disorder was on average diagnosed more than 3 years before the FGID, offering opportunity for prevention. Our findings support a role for adverse socioeconomic factors in development of FGIDs in patients with psychological disorders.