The Symptom Development Of Functional Bowel Disorders And The Effect Of Lactose Restricted Diet On The Symptoms

BackgroundFunctional Bowel Disorders(FBDs) is a functional chronic disease, and mainly diagnosed by symptoms. However, no organic or pathophysiological changes can be used to explain the symptoms. The main symptoms of FBDs include:Abdominal pain, bloating, abnormal defecate and extra. The symptoms exist for long period and tend to break out repeatedly, which will affect patients’ living quality. In2006, Rome III standard was modified in American Digestive Disease week, and FBDs are categorized as follows:Irritable Bowel Syndrome, IBS; Functional Bloating, FB; Functional Constipation, FC; Functional Diarrhea, FD; Unspecified Functional Bowel Disorders, UFBDs. The studies of FBDs have been increasing with the improving of living quality in China. However, the former researches were mainly focus on the factors that cause FBDs1symptoms, and lack of the estimation of the factors that affect the severity of FBDs’ symptoms. There are few long-term follow up researches of FBDs in China, and the symptom development has not been concluded yet. In the meantime, there is no clear conclusion of the effect of lactose restricted diet to FBDs symptoms. Thus, this research will try to discuss and answer some of the remaining uncertainty of FBDs in China, includes the factors that affect the severity of FBDs symptoms; the symptom development of FBDs; the relevance between the lactose restricted diet or other intervene methods and the symptom development of FBDs; and whether the lactose restricted diet is able to improve the symptoms of lactose intolerance patients.Methods805patients were diagnosed as FBDs from2008to2010were selected and included in this research; the total number of example cases is805. All selected patients were required to fill the investigation survey, which includes the regular information; Rome III standard gastrointestinal symptoms rating scale; lactose intake query; intake of FODMAPs; and HADS; etc. After excluding the patients suffered from nonspecific FBDs and patients do not have clear dose amount of lactose intolerance, we chose to telephone interview the patients have more lactose intake (>48.75g/month) than the median (n=245). Patients’symptoms, lactose intake, related medicine intake and anxiety/depression status were recorded during the interviews. The collected data were analyzed by IBM SPSS Statistics22, during the process, the counted data was chi-square tested, binary logistic regression analysis were used and adjustment variables were added during the analysis of the factors affect the severity and the improvement of the FBDs symptoms. Statistical difference were defined as P<0.05.Results1. Factors affect the severity of FBDs symptomsAmong all805selected patients (443male,362female, age44±11.8yr), in comparison of the critical patients and lighter patients, the proportion of female patients is relatively higher(50.4%vs.40.3%, P=0.014), the proportion of patients have abdominal disease history is relatively higher(51.5%vs.41.5%, P=0.002), the proportion of patients have anxiety disorder is relatively higher (29.5%vs.16.9%, P=0.011), the proportion of patients have depression is relatively higher (32.2%vs.21.5%, P=0.027), the proportion of patients diagnosed as IBS is relatively higher (73.6%vs.40.4%, P<0.0001).There is no significant differences based on the FODMAPs intake..2. The symptom development of FBDs.We telephoned follow-up245FBDs patients and144of them were successfully followed up. The mean follow-up time was5-7years. The follow-up rate was58.8%. One patient was died for liver cancer. Among the patients were successfully follow-up interviewed, the gastrointestinal symptoms and regular anxiety/depression symptoms were significantly improved after the first treatment at our clinic. The frequency of the abdominal pain and bloating were significantly reduced compare to the initial status (P<0.0001), the frequency of hard stool decreased significantly (P=0.015), the frequency of loose stool decreased significantly as well (P<0.0001), the overall severity of the symptoms were significantly improved compare to the initial status (P<0.0001). The amount of lactose intake largely decreased compare to the first treatment at our clinic,135.1(91.6-238.6) g/month vs.27.0(3.0-99.8) g/month, P<0.0001.3. The effect of lactose restricted diet to FBDs symptomsWithin the143successful follow-up patients,130has abdominal pain, and104or80%of them effectively improved their symptoms. The abdominal pain of patients who strictly restricted lactose intake subjectively has higher improve rate the other groups (92.5%vs77.1%vs71.4%, OR0.48,95%CI0.26-0.89, P=0.019)110of the patients suffered from bloating,78or70.9%of which improved the symptoms effectively. The patients subjectively restrict their lactose intake have a more significant improve rate (75.0%vs84.2%vs52.8%, OR0.61,95%CI0.36-1.04, P=0.072). After replacing the patients subjectively restrict lactose intake with the patients objectively restrict their lactose intake into the regression model, the bloating symptoms improved as well (85.7%vs64.0%, OR0.24,95%CI0.08-0.75, P=0.015), we also discovered that the symptoms of patients had not taken any GI relevant medicine in the last three months have the trend of better improvement (25.6%vs40.6%, OR0.42,95%CI0.15-1.15, P=0.092).135patients suffered from loose stool,87or64.4%of which improved their symptoms, the patients subjectively restrict lactose intake had better improvement (75.6%vs70.8%vs45.2%, OR0.54, OR0.54,95%CI0.33-0.87, P=0.012) so did the patients without any nervousness (70.3%vs47.1%, OR0.41,95%CI0.18-0.95, P=0.037).66or46.2%of the cases improved their generally feelings. Patients restrict lactose intake subjectively (57.4%vs49.0%vs31.9%, OR0.64,95%CI0.41-1.00, P=0.050) and patients without any nervousness (OR0.38,95%CI0.12-1.16, P=0.090) improved their general feelings better.124or86.7%of the cases effectively improved their overall symptoms. Patients restrict lactose intake subjectively (93.6%vs98.0%vs57.4%, OR0.19,95%CI0.09-0.43, P<0.0001) and patients were diagnosed as IBS (88.8%vs71.1%, OR0.38,95%CI0.12-1.16, P=0.090) improved their overall symptoms better.4. The effect of lactose restricted diet to the symptoms of patients has different dose of lactose intoleranceRestrict the lactose intake subjectively helped both low dose and high dose lactose intolerance patients to improve the abdominal distention symptoms and overall symptoms rating. On the other hand, restrict the lactose intake objectively did not notable improve the symptoms of neither low dose nor high dose lactose intolerance patients. During the processing of adjust the variables in the mixed model, it is discovered that in the low dose lactose intolerance patients, significantly improved the loose stool symptoms and the general feelings of patients without nervousness.Conclusion:1. In all FBDs patients, female patients, patients with past abdominal disease history, patients with anxiety/depression, and IBS patients have more severe symptoms; the lactose intake and other FODMAPs intake do not have clear relevance to the severity of the FBDs symptoms.2. The severity of the FBDs symptoms, including abdominal pain, abdominal distention, dry or loose stool and overall symptoms tends to significantly improve over time.3. FBDs still have risk to development for some organic diseases, such as colon polyps, ulcerative colitis, during long period follow-up. So it need us to closely follow up FBDs patients.4. Patients restrict the lactose intake subjectively significantly improve the abdominal pain, abdominal distention, dry or loose stool and overall symptoms compare to the patients do not restrict their lactose intake. Patients restrict the lactose intake objectively improve the bloating symptoms compare to the patients do not restrict their lactose intake.