Studying The Clinical Characteristics And Therapeutic Effect Of Functional Bloating By Using Single Disease Database

Background and purpose:Functional bloating(FB)is a kind of functional gastrointestinal disorders(FGIDs).The most prominent symptom of FB is bloating,which is mainly manifested as the patient's subjective sensation of increased intraperitoneal pressure or abdominal bloating.FB maybe or may not be accompanied by visible abdominal distention.After carefully studying one's medical history,according to the Rome ? and Rome ?diagnostic criteria,the patient with bloating will be diagnosed as FB when he does not meet the diagnostic criteria of other functional bowel disease,such as irritable bowel syndrome(IBS),functional dyspepsia(FD),functional constipation(FC)or organic gastrointestinal disease.FB leads to poor quality of life,deterioration of mental state and high medical costs.In general,the prevalence of FB increased year by year both at home and abroad.It is difficult to unify clinical treatment plans and the curative effect is not good.Therefore,it is of great clinical significance and social value to use database and large sample size to study the pathogenesis related factors of FB and explore clinical treatment plans.Currently,the pathogenesis of FB is still uncertain,there are many kinds of clinical treatments for FB.However,due to the academic circle is not completely clear about the pathogenic factors of FB,and the pathogenic factors are numerous.A considerable number of patients cannot be completely relieved,and even after the remission,FB is prone to relapse.Therefore,we need to improve the therapeutic effect of FB.In response to this situation,we established a standardized FGIDs clinical research database(http://www.fgiddata.com)in the preliminary work.The clinical database,in the form of an online website,can input patient information into the database anytime and anywhere to achieve information sharing and information management.This database has the information management and the retrieval statistical function.Case report form(CRF)was developed for FB patients according to the previous research results to collect various information of patients.After CRF data were collected,the data were entered into the FGIDs clinical database.A control group was also set up by inputting information about healthy people.Using this database,we can carry out scientific,normative and comprehensive study on FB,which is of great significance for guiding FB clinical diagnosis and treatment and prevention in the future.Part 1 Studying the clinical characteristics and risk factors of functional bloating by using databasePurposeBecause of the current unclear pathogenic factors of FB,the clinical data of FB patients were collected by the single-disease database to study the pathogenic factors of FB.Objects and methods:? In view of the abdominal bloating as the main symptoms,the exclusion of IBS and FD,FC and organic gastrointestinal diseases.According to the Rome ? or Rome? diagnostic criteria,151 cases of FB patients were collected in the Department of Gastroenterology,Nanfang Hospital,Southern Medical University,from January 2014 to December 2018;and 98 cases of control group.? SPSS20.0 statistical software was used to analyze the relevant data of FB patients and the control group,so as to study the potential pathogenic factors and clinical characteristics of FB.Results:? The clinical characteristics of the FB patients:Among the 151 FB patients,58 were male,accounting for 38.4%of all the cases;There were 93 female patients,accounting for 61.6%of all cases.The ratio of male to female is 1:1.60.The average age was 42.89±11.00 years.The high-risk group was 30?59 years old.Unemployed and retired people(33.8%)and intellectuals are the main groups.Rural pathogens accounted for 43%,urban pathogens accounted for 57.0%;BMI ranged from 14.69 to 30.86kg/m2,and the average BMI was 21.04±2.79kg/m2.The main symptoms were upper abdominal bloating,middle and lower abdominal bloating and belching.The duration ranged from 6 to 312 months,with 115 patients with the duration less than 60 months,and 36 patients with the duration more than 60 months,with an average duration of 39.48±47.54 months.? Comparison of the general features between the FB group and the control groupThe proportion of group FB was significantly higher than the control group in lack of exercise,insufficient vegetables and fruits,long-time sitting,combined anxiety or depression,insufficient drinking water,smoking(all P<0.05).No significant difference between the two groups in long-term drinking,insufficient drinking water,average BMI,urban and rural distribution,BMI group and conscious pressure(all P>0.05).? Logistic regression analysis of etiology related to FBLack of exercise,long-time sitting,combined anxiety or depression,insufficient drinking water,smoking,female,insufficient vegetables and fruits were the risk factors for patients with FB.Conclusion:The incidence of FB in females is higher than that in males,and the population aged from 30 to 59 years old has a high incidence.Most of them are unemployed,retirees,intellectuals and civil servants.Most of the patients are urban population.The most important clinical symptoms are upper abdominal bloating,middle and lower abdominal bloating,belching.Insufficient vegetables and fruits,female,smoking,lack of exercise,combined anxiety or depression,insufficient drinking water were risk factors of FB.Part 2 Studying the treatment and influencing factors of functional bloating by using databasePurposeIn order to improve the therapeutic effect of FB,the therapeutic effect of different types of drugs on FB and related factors were analyzed by using single disease database.Objects and methods:? According to the Rome ? or Rome IV diagnostic criteria,151 FB patients enrolled in previous work were studied.? Therapeutic and method:Among 151 patients,FB patients without obvious anxiety were divided into three groups according to the principle of random grouping.The first group used PPI and prokinetics,with 29 patients;the second group used PPI and CAET,with 30 patients;the third group used PPI,prokinetics and CAET,with 72 patients.The remaining 20 patients with obvious anxiety were included in the fourth group,anti-anxiety depression drugs was added.There was no significant difference in sex ratio and age distribution between the 4 groups(P>0.05),which was comparable.Record and analyze the curative effects of 4th weeks,6th weeks,8th weeks in each group.? The evaluation of curative effect was classified as ineffective,effective,markedly effective,recovered.In the database of single disease,the curative effects of different FB regimens and treatment courses were searched and analyzed.Relevant data of FB patients were derived from the database,and statistical analysis was conducted on the data using SPSS20.0 statistical software to explore the correlation between various factors and the efficacy of FB drugs.Results:? Statistical results of the overall efficacy of drugs and various treatment programs:?At 4th weeks,17 cases were ineffective,118 cases improved,16 cases markedly effective,0 case recovered,16 cases were effective(markedly effective and recovered);at 6th weeks,6 case were ineffective,83 cases improved,60 cases markedly effective,2 cases recovered,62 cases were effective;at 8th weeks,1 case were ineffective,35 cases improved,89 cases markedly effective,29 cases recovered,118 cases were effective.?The effective rate of use of PPI and prokinetics group,PPI and CAET group and PPI and prokinetics and CAET group was compared at 4th,6th,8th weeks:13.8%vs 10.0%vs 9.7%,P=0.867;31.0%vs 36.7%vs 40.3%,P=0.683;65.5%vs 63.30%vs 84.7%,P<0.05.?The treatment effect of patients with anxiety and depression of add-anti-anxiety depression drugs group and without anti-anxiety depression drugs group was compared at 4th,6th,8th weeks:10.0%vs 7.7%,P=0.999;65.0%vs 30.8%,P=0.036:95.0%vs 65.4%,P=0.028.II Factors influence the effect of PPI and prokinetics or CAET group using Logistic regression analysis:combined anxiety or depression maybe a risk factor for poor treatment effect.Conclusion:Most of the FB patients relieve symptoms after 4 weeks of drug treatment,after 6 weeks of drug treatment,most of the FB patients markedly effective,after 8 weeks of drug treatment,most of the FB patients markedly effective or recovered.The use of PPI and prokinetics and CAET is better than PPI and prokinetics or PPI and CAET.Factors such as combined anxiety or depression may reduce the efficacy of drugs.As for the patients who combined anxiety or depression,using anti-anxiety depression drugs may be able to improve curative effects.The drug treatment of FB should be lasted for at least 8 weeks.