The role of psychological and biological factors in postinfective gut dysfunction
The role of psychological and biological factors in postinfective gut dysfunction
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DOI：
10.1136/gut.44.3.400
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发表时间：
1999-03-01
期刊：
影响因子：
24.5
通讯作者：
Read, NW
中科院分区：
文献类型：
--
作者：
Gwee, KA;Leong, YL;Read, NW
背景-心理和生理障碍都有牵连的肠易激综合征（IBS）的病因发病机制，目的-要调查如何的心理因素的行为，以及参与的感染和生理factors. Methods-Concretive胃肠炎住院患者报告生活事件的前12个月，和过去的疾病经验的标准化问卷。他们还完成了焦虑、神经质、躯体化和抑郁的心理测量问卷。在一些患者中，直肠活检标本获得急性疾病期间，并在3个月postinfection. Results-Nine 4例患者完成了所有问卷调查：22例患者被诊断为肠易激综合征后，他们的胃肠炎（IBS+），72例患者恢复正常的排便习惯（IBS-）。IBS+患者比IBS-患者报告更多的生活事件，并且有更高的低血糖评分。生活事件和低血糖指标的预测价值非常显著，并且独立于焦虑、神经质和躯体化评分，这些评分在IBS+患者中也升高。来自29名患者的直肠活检标本在IBS+和IBS-患者中均显示慢性炎症反应。三个月后，来自IBS+患者的标本继续显示慢性炎性细胞计数增加，但来自IBS-患者的标本已恢复至正常水平，与正常对照相比，IBS+和IBS-患者表现出直肠超敏反应和高反应性以及快速结肠运输，但IBS+和IBS-患者的这些生理测量值无显著差异。心理因素最清楚地预测胃肠炎后IBS症状的发展，但生物学机制也有助于症状的表达。
Background-Both psychological and physiological disturbances have been implicated in the aetiopathogenesis of irritable bowel syndrome (IBS).Aims-To investigate how the psychological factors act, and the involvement of infective and physiological factors.Methods-Consecutive patients hospitalised for gastroenteritis reported life events for the previous 12 months, and past illness experiences on standardised questionnaires. They also completed psychometric questionnaires for anxiety, neuroticism, somatisation, and hypochondriasis. In some patients, rectal biopsy specimens were obtained during the acute illness and at three months postinfection.Results-Ninety four patients completed all questionnaires: 22 patients were diagnosed with IBS after their gastroenteritis (IBS+), and 72 patients returned to normal bowel habits (IBS-). IBS+ patients reported more life events and had higher hypochondriasis scores than IBS- patients. The predictive value of the life event and hypochondriasis measures was highly significant and independent of anxiety, neuroticism, and somatisation scores, which were also elevated in IBS+ patients. Rectal biopsy specimens from 29 patients showed a chronic inflammatory response in both IBS+ and IBS- patients. Three months later, specimens from IBS+ patients continued to show increased chronic inflammatory cell counts but those from IBS- patients had returned to normal levels, IBS+ and IBS- patients exhibited rectal hypersensitivity and hyper-reactivity and rapid colonic transit compared with normal controls, but there were no significant differences between IBS+ and IBS- patients for these physiological measurements.Conclusion-Psychological factors most clearly predict the development of IBS symptoms after gastroenteritis but biological mechanisms also contribute towards the expression of symptoms.