[Functional gastrointestinal disorders]

Evaluation of the impact of overlapping upper gastrointestinal symptoms on the clinical characteristics of patients with functional constipation, along with risk factor analysis

OBJECTIVES

Functional constipation (FC), a common functional gastrointestinal disorder, is usually overlapping with upper gastrointestinal symptoms (UGS). We aimed to explore the clinical characteristics of patients with FC overlapping UGS along with the related risk factors.

METHODS

The differences in the severity of constipation symptoms, psychological state, quality of life (QoL), anorectal motility and perception function, autonomic function, and the effect of biofeedback therapy (BFT) among patients with FC in different groups were analyzed, along with the risk factors of overlapping UGS.

RESULTS

Compared with patients with FC alone, those with FC overlapping UGS had higher scores in the Patient Assessment of Constipation Symptoms and Self-Rating Anxiety Scale and lower scores in the Short Form-36 health survey (P < 0.05). Patients with FC overlapping UGS also had lower rectal propulsion, more negative autonomic nervous function, and worse BFT efficacy (P < 0.05). Overlapping UGS, especially overlapping functional dyspepsia, considerably affected the severity of FC. Logistic regression model showed that age, body mass index (BMI), anxiety, exercise, and sleep quality were independent factors influencing overlapping UGS in patients with FC.

CONCLUSIONS

Overlapping UGS reduces the physical and mental health and the QoL of patients with FC. It also increases the difficulty in the treatment of FC. Patient's age, BMI, anxiety, physical exercise, and sleep quality might be predictors for FC overlapping UGS.

Psychological language combined with gastric pacing for treatment of functional dyspepsia: An analysis of 30 cases

AIM: To assess the efficacy of psychological language combined with gastric pacing (GP) for treating functional dyspepsia (FD).

METHODS: Sixty patients with FD diagnosed according to the Rome III criteria were randomly divided into a combination treatment group (n = 30) and a GP group (n = 30). All patients were placed in a quiet environment. The combination treatment group received psychological language and gastric pacing synchronization output, and the voice ran throughout the treatment to guide gastric electrical pacing. The GP group underwent GP only. The treatment (20 min each) was given once daily for seven consecutive days. Researcher-rated symptom scores and patients' self-rated symptom scores (both overall and individual symptom scores) were calculated to assess clinical efficacy before and after treatment. Clinical efficacy was compared between the two groups of subjects.

RESULTS: Researcher-rated symptom scores and patients' self-rated symptom scores decreased in both groups after treatment. Compared to the GP group, the combination treatment group had more significantly decreased researcher-rated overall symptom score (4.033 ± 1.903 vs 1.700 ± 1.579, t = 5.169, P < 0.05), postprandial bloating (0.967 ± 0.850 vs 0.533 ± 0.776, t = 2.062, P < 0.05), early satiety (0.933 ± 0.785 vs 0.300 ± 0.466, t = 3.800, P < 0.05), upper abdominal pain (0.900 ± 0.759 vs 0.400 ± 0.563, t = 2.898, P < 0.05), abdominal burning sensation (0.700 ± 0.702 vs 0.300 ± 0.535, t = 2.482, P < 0.05), and nausea (0.533 ± 0.776 vs 0.200 ± 0.407, t = 2.482, P < 0.05), scores. The overall response was significantly higher in the combination treatment group than in the GP group (96.7% vs 70.0%, χ² = 7.68, P < 0.05). Compared to the GP group, the combination treatment group also had more significantly decreased self-rated overall symptom score (12.633 ± 5.714 vs 6.767 ± 4.232, t = 4.519, P < 0.05), postprandial bloating (3.200 ± 2.188 vs 2.100 ± 1.729, t = 2.161, P < 0.05), early satiety (2.633 ± 2.025 vs 1.500 ± 0.563, t = 2.461, P < 0.05), upper abdominal pain (2.567 ± 1.942 vs 1.267 ± 1.437, t = 2.948, P < 0.05), abdominal burning sensation (2.500 ± 2.403 vs 1.033 ± 1.189, t = 2.996, P < 0.05), and nausea scores (1.733 ± 1.946 vs 0.833 ± 1.177, t = 2.167, P < 0.05). The overall response was significantly higher in the combination treatment group than in the GP group (90.0% vs 80.0%, χ² = 1.18, P < 0.05).

CONCLUSION: Psychological language combined with GP is more effective than GP alone in the treatment of FD, and is a new option for non-drug treatment of FD.

Irritable bowel syndrome subtypes differ in body awareness, psychological symptoms and biochemical stress markers

AIM: To elucidate the differences in somatic, psycho-logical and biochemical pattern between the subtypes of irritable bowel syndrome (IBS).

METHODS: Eighty IBS patients, 30 diarrhoea predominant (D-IBS), 16 constipation predominant (C-IBS) and 34 alternating IBS (A-IBS) underwent physiotherapeutic examinations for dysfunctions in body movements and awareness and were compared to an apparently healthy control group (AHC). All groups answered questionnaires for gastrointestinal and psychological symptoms. Biochemical variables were analysed in blood.

RESULTS: The D-IBS group showed less body awareness, less psychological symptoms, a more normal sense of coherence and psychosocial rating as well as higher C-peptide values. C-IBS had a higher degree of body dysfunction and psychological symptoms, as well as the lowest sense of coherence compared to controls and D-IBS. They also demonstrated the most elevated prolactin levels. A-IBS had the lowest degree of body disturbance, deteriorated quality of life and affected biochemical pattern. All subtypes had higher pain scores compared to controls. In addition they all had significantly increased triglycerides and elevated morning cortisol levels, however, without statistical significance compared with the controls.

CONCLUSION: IBS subtypes showed different profiles in body awareness, somatic and psychological symptoms and in biochemical variables. D-IBS differed compared to the other groups by lowered body awareness, less psychological symptoms and a higher sense of coherence and elevated C-peptide values. C-IBS and A-IBS subtypes suffered more from depression and anxiety, associated with a lower quality of life. These differences may be important and will be taken into account in our treatment of these patients.

Depressive und Angststörungen bei somatischen Krankheiten

Depressiv-ängstliche Störungen sind bei den unterschiedlichen somatischen Erkrankungen häufig. Sie sind nicht nur als Reaktion auf die Situation der Erkrankung zu verstehen, sondern in ein komplexes Bedingungsgefüge eingebettet. Sie sind besonders häufig bei Erkrankungen, die das Zentralnervensystem oder endokrine Regulationssysteme direkt betreffen. Es besteht ein enger Zusammenhang zur Chronizität, Schwere und Prognose der Erkrankung. Eigenständige Effekte von diversen pharmakologischen Substanzgruppen sind wahrscheinlich.