Psychological factors in the development and natural history of functional gastrointestinal disorders.
Psychological factors in the development and natural history of functional gastrointestinal disorders.
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功能性胃肠道疾病的发展和自然史中的心理因素。
DOI：
10.1097/01.mpg.0000338960.40055.4d
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发表时间：
2008
影响因子：
2.9
通讯作者：
Walker,LynnS
中科院分区：
文献类型：
--
作者：
Walker,LynnS
功能性胃肠道疾病（FGID）包括无法通过已知的生化或结构异常解释的慢性或复发性症状的组合。它们代表了一组具有挑战性的条件，这些条件在儿童中经常被误诊，并与显著的发病率和高昂的医疗保健费用有关。他们占儿科胃肠病学实践咨询的50%以上，占所有普通儿科门诊的2%至4%（1）。FGID患者的生活质量远低于一般人群或患有哮喘或偏头痛的患者（2）。在5年的随访中，诊断为功能性腹痛（FAP）或肠易激综合征（IBS）的儿童比对照组有更多的腹部和其他躯体疼痛，功能障碍和精神症状（3），三分之一至一半的受影响儿童在成年后持续腹痛。其他研究表明，儿童功能性腹痛与长期合并症（包括抑郁症、焦虑症、终身精神疾病、社交恐惧症和躯体主诉）之间存在关联（4）。在过去的5年中，对儿童FGID的研究和认识的兴趣已经升级。已经进行了仔细的流行病学研究，提出并验证了诊断标准，在了解其中几种疾病的病理生理机制方面取得了重大进展，并开发了更多基于证据的治疗方法。多学科方法治疗儿童FGID的重要性现在得到了广泛的认可，功能性疾病已经从“在孩子的头脑中”的耻辱或与“孩子没有任何问题”相关的疾病发展到像偏头痛或纤维肌痛这样的实体，被认为是具有公认的神经肠道和中枢神经系统功能障碍的合法疾病。尽管有这些有希望的发展，但显然需要更多的研究来进一步推进这些疾病的病理生理学和治疗的科学基础。阻碍该领域取得进展的一个因素是缺乏一个论坛，来自不同专业的专家可以聚集在一起讨论儿童FGID的不同方面，并为未来的研究制定议程。第二届世界小儿胃肠病学大会神经胃肠病学工作组强调了进一步研究儿童FAP和IBS的必要性（5）。美国儿科学会和北美儿科胃肠病学、肝病学和营养学会（NASPGHAN）腹痛委员会最近建议进一步研究儿童FGID的表现和诊断（6）。最近出版的更新后的罗马标准首次纳入了2个儿科委员会（7，8），也为该领域的其他研究创造了动力。基于这一背景，研讨会“儿童功能性腹痛和肠易激综合征的新见解：多学科方法”旨在汇集基础和临床科学家，他们的主要临床和研究兴趣涉及儿童FAP，IBS和相关疼痛综合征的病理生理学，评估和治疗。研讨会于2007年11月24日在犹他州盐湖城举行，时间是NASPGHAN年会的前一天。它是由NASPGHAN和美国国立卫生研究院共同发起的，并得到了来自工业、基金会和非营利机构的资助。研讨会取得了巨大的成功，吸引了超过...
Functional gastrointestinal disorders (FGID) include a combination of chronic or recurrent symptoms not explained by known biochemical or structural abnormalities. They represent a challenging group of conditions that are frequently misdiagnosed in children and are associated with significant morbidity and high health care costs. They account for more than 50% of the consultations in pediatric gastroenterology practice and 2% to 4% of all general pediatric office visits (1). Quality of life in patients with FGID is substantially poorer than in the general population or in those suffering from asthma or migraine (2). Children diagnosed with functional abdominal pain (FAP) or irritable bowel syndrome (IBS) have more abdominal and other somatic pain, functional impairment, and psychiatric symptoms than controls at 5-year follow-up (3), and one third to half of affected children experience persistence of abdominal pain into adulthood. Other studies have suggested an association between childhood functional abdominal pain and long-term comorbidity including depression, anxiety, lifetime psychiatric disorders, social phobia, and somatic complaints (4). In the last 5 years, interest in the study and recognition of FGID in children has escalated. Careful epidemiological studies have been conducted, diagnostic criteria have been proposed and validated, significant progress has been made in understanding the pathophysiological mechanisms underlying several of these conditions, and more evidence-based treatment approaches have been developed. The importance of a multidisciplinary approach to childhood FGID is now widely recognized, and functional disorders have gone from being conditions with the stigma of ‘‘being in the child’s head’’or that were associated with ‘‘nothing being wrong with the child’’to entities that, much like migraines or fibromyalgia, are recognized as legitimate disorders with accepted neuroenteric and central nervous system dysfunctions. Despite these promising developments, clearly more research is needed to further advance the science underlying the pathophysiology and treatment of these conditions. An impediment to progress in the field has been the absence of a forum in which experts from different specialties can meet to discuss different aspects of FGID in children and establish an agenda for future research. The need to further study FAP and IBS in children was emphasized by the 2nd World Congress of Pediatric Gastroenterology Working Group for Neurogastroenterology (5). The American Academy of Pediatrics and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Committee on Abdominal Pain recently recommended to further investigate the presentation and diagnosis of FGID in children (6). The recent publication of the updated Rome criteria with the inclusion for the first time of 2 pediatric committees (7, 8) also created momentum for additional studies in this field. Based on this background, the symposium ‘‘New Insights Into Childhood Functional Abdominal Pain and IrritableBowelSyndrome: AMultidisciplinaryApproach’’was designed to bring together basic and clinical scientists whose major clinical and research interest relates to the pathophysiology, evaluation, and treatment of childhood FAP, IBS, and related pain syndromes. The symposium was heldonOctober24, 2007inSaltLakeCity, UT, 1daybefore the NASPGHAN annual meeting. It was cosponserd by NASPGHAN and the National Institutes of Health, and received funding from industry, foundations, and nonprofit institutions. The symposium was an unmitigated success, gathering the participation of more than …