| Objective The incidence of functional gastrointestinal disorders is increasing day byday，but its etiology and pathogenesis is still not entirely clear. Some patients who havecontinued or repeated symptoms，be invalid by conventional therapy, prolonged courseand go to see a doctor frequently are the refractory patients. These patients are oftenaccompanied by significant anxiety and depression,quality of life has also beenseverely affected. For this reason, we made this research in order to observe the clinicalcharacteristic,to investigate the psychological and social factors and to assess theirquality of life of the refractory patients with functional bowel disorders.Methods To select92patients who visits continuously to the gastroenterology clinicin Anhui Provincial Hospital between November1,2011to February29,2012.After adetailed history and relevant examination, according to the Rome Ⅲ diagnosticcriteria diagnosed with refractory functional bowel disorders. Meanwhile according to1:1paired principle, to choose a healthy volunteer with no symptoms who is similar tothe patients with gender, age, occupation in Anhui province hospital physicalexamination center. The investigation includes:1.general situation questionnaire(including name, gender, age, occupation, education background,et al).2.Thegastrointestinal symptoms questionnaire(control group not required).3.The Life EventScale(LES).4.The Zung Self-Rating Depression Scale(SDS) and the Self-ratingAnxiety Scale(SAS).5.The health status questionnaire(SF-36). Result To investigate60refractory patients with functional bowel disordersincluding37females and23males. University degree or above in33cases(35.87%),middle school with37cases(40.22%), primary school and the following degreepatients22cases(23.91%).Different occupation ratio from high to low in turn for:retirees34cases(36.96%),20cases(21.74%) of civil servants, employees15cases(16.30%), farmers11cases(11.96%),7cases(7.61%) of students, businessmen3cases(3.26%), unemployed2cases(2.17%).IBS36cases(39.13%), FC28cases(30.43%), F-D17cases(18.48%), FB8cases(8.7%), nonspecific functional bowel disorders3patients(3.26%).Shortestduration14months, the longest120months. There are41cases(44.57%) were found toexist with the upper gastrointestinal symptoms. The upper digestive tract symptoms ofpostprandial fullness and discomfort incidence was the highest(17cases,18.48%),followed by after sternal unwell(13cases,14.13%) and belching(10cases,10.87%).37cases(40.22%) patients had symptoms of overlap, including IBS+FD7cases(7.61%),IBS+FH9cases(9.78%), FC+FD6cases(6.52%), FC+BD7cases(7.61%), FC+FH4cases(4.35%), and F-D+FD2cases(2.17%), FB+FD2cases(2.17%).The highest frequency of occurrence of negative events in patients with refractoryFBDs is the death of family members(23cases,25%), followed by family members ofseriously ill or injured(19cases,20.65%), economically disadvantaged families(17patients,18.48%),substandard marital relations(13cases,14.13%). Refractoryfunctional bowel diseases group and control group in the positive life events scoresshowed no significant difference(14.99±3.06vs15.29±3.15,P=0.599,P>0.05), thenegative life event scores of functional bowel disorders group was higher than that ofthe control group (24.65±5.93vs10.58±4.89,P=0.000,P <0.05). There are60cases of patients with anxiety and/or depression, anxiety and depressionstate’s most prominent clinical manifestations are sleep disorders, respectively27cases(29.35%) and21cases(22.83%). Refractory FBDsgroups SDS score≥53accountedfor33.7%(n=31),significantly higher than that of control group11.96%(n=11)(χ~2=12.34,P=0.000); SAS integral≥50accounted for40.22%(n=37), significantly higherthan that of control group11.96%(n=11)(χ~2=14.35,P=0.000). Health questionnairecan draw eight latitude, the results showed refractory FBDs groups each latitude scoreswere significantly lower than the control group. Pearson correlation analysis showed anegative life event scores and integral was positively related to anxiety and depression.Conclusions Refractory functional bowel disease accompanied with anxiety anddepression status, quality of life significantly reduced at the same time, and theincidence of negative life events in these patients is higher, and influence the patient’smental state, not only suggests that psychosocial factors closely related to intractablefunctional bowel disorders, also prompted clinicians to identify functional boweldisease should be strengthened the spirit of the psychological barriers, attaches greatimportance to the mental care and family social support. Objective Functional bowel disease is a digestive system common disease,frequently-occurring disease, because of its etiology and pathogenesis is not still clear,so the lack of clinical curative effect definite and safe treatment plan. Some patientswho have continued or repeated symptoms,be invalid by conventional therapy,prolonged course and go to see a doctor frequently are the refractory patients. Suchpatients often accompanied by obvious anxiety and depression, quality of life have alsobeen significant effect. As the mental psychological factors is growing recognition,many studies that try to use antidepressants treating such refractory patients achievedsatisfactory results. To use conventional treatment combined flupentixol and melitracentreating60cases of intractable functional bowel disease. The clinical outcomes wereevaluated by scales changes of clinical symptom，depression，anxiety，and quality oflife at the beginning and6weeks after treatment.Method60patients with FBD accompanied by anxiety and/or depression，defined bythe Rome Ⅲ，were given conventional medicine(as antispasmodic, prokinetic drugs,antidiarrheal, catharsis, probiotics et al) combined with flupentixol andmelitracen(Mild and moderate anxiety and/or depressed patients to be1piece,1time/day of oral, severe patients daily in the morning, at noon, each a piece of oral) for6weeks. Using self-control study,to comparing the respectively clinical symptomseverity and frequency of abdominal pain, abdominal discomfort, bloating,constipation, diarrhea and anxiety, depression and quality of life before treatment and after6weeks treatment. Compare the score to observe the clinical effect and drugadverse reactions.Result All60cases completed therapy and6weeks follow-up visit. The overallresponse rate was96.6%.The general severity score of symptoms(3.78±1.6vs1.98±0.78)were subsided significantly(P<0.01). Symptom severity score value(2.40±1.11vs1.37±1.09,P=0.000) and seizure frequency value(2.59±1.15vs1.45±1.13,P=0.000) were also significantly decreased(P<0.01), The score of theseverity and frequency of single symptom were subsided(P<0.05, respectively)，andconstipation were improved most obviously(score of the severity2.54±1.17vs1.32±1.09,P=0.001;score of frequency2.75±1.14vs1.54±1.17，P=0.001). The score ofdepression(62.68±5.94vs47.74±16.06,P=0.000) and score of anxiety(61.35±6.86vs46.57±14.36,P=0.000) were both lower significantly. The quality of life in all patientswas also improved.The physiological role(56.21±38.79vs87.58±11.36,P=0.000), bodypain(52.51±20.87vs85.67±17.38,P=0.000),emotional function(48.55±39.51vs86.67±21.84,P=0.000) and mental health(52.37±19.52vs80.56±20.95,P=0.000) wereimproved obviously(P<0.001).Conclusions The patients with refractory functional bowel disease have stubbornintestinal symptoms, accompanied by anxiety or depression.The quality of life hassignificantly reduced. The therapeutic efficacy of flupentixol and melitracen combinedwith conventional medicine in patients with refractory functional bowel disorders isexplicit, especially constipation symptoms. The plan can significantly improve patientswith anxiety depression, improve the quality of life. At the same time, the use ofantidepressants should be paid attention to vary from person to person, according to thespecific situation of the small dose of individualized programs, not only easy to accept, and also satisfactory curative effect, less side effects. |
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