It must be emphasized that organic diseases, especially malignant lesions of the gastrointestinal tract, must be excluded before diagnosing this disorder. In the case of IBS, for example, most patients are emotionally stressed, and when they visit the doctor, they have a lot of complaints, and some of them write down their symptoms on a piece of paper in order not to miss them. Doctors should first patiently listen to and analyze the patient's statement, and carefully conduct physical examination and routine laboratory tests, including routine blood, blood sedimentation, fecal routine, fecal cryptozooplasmosis and bacterial culture, fiberoptic colonoscopy and colon gas barium double contrast. Except for colon cancer, inflammatory bowel disease, diverticulitis and dysentery. Those who have persistent abdominal pain with weight loss should undergo barium meal ingestion of the whole digestive tract except for clonus disease; those who have persistent epigastric pain after meals should undergo gallbladder ultrasonography; those who suspect pancreatic disease should undergo abdominal CT and amylase measurement; those who suspect lactase deficiency should undergo lactose tolerance test; those who undergo small intestinal mucosa biopsy should except for small intestinal mucosal disease; and those who undergo colonic mucosa biopsy should except for colitis. After the initial diagnosis of the disorder, close follow-up over time is necessary to ensure that the diagnosis is correct.
Neurogenic vomiting should be differentiated from chronic gastric disease, pregnancy vomiting, uremia, etc., and intracranial space-occupying lesions should also be excluded. Anorexia nervosa should be differentiated from gastric cancer, early pregnancy reaction, hypopituitarism or adrenocorticism.
The onset of the disease is mostly slow, and the course of the disease often lasts for years, with persistent or recurrent episodes. Clinical manifestations are mainly gastrointestinal symptoms, which may be confined to the pharynx, esophagus or stomach, but intestinal symptoms are the most common, and may also be accompanied by other common symptoms of neurosis.
The following is a description of several common gastrointestinal dysfunctions:
(I) hysterical globushystericus (globushystericus) is subjectively some kind of unspecified thing or mass, in the bottom of the pharyngeal cricoid cartilage at the level of the distension caused by the feeling of fullness, compression, or obstruction and other discomforts, is likely to be related to the pharyngeal muscle or the dysfunction of the upper esophageal sphincter. In Chinese medicine, this is known as "plum nucleus qi". This disease is most common in menopausal women. The patient has mental factors in the onset of the disease, and has a compulsive concept of character, and often makes swallowing movements in order to relieve the symptoms. In fact, the symptoms disappear when eating, without difficulty in swallowing, and there is no long-term weight loss. Examination does not reveal any organic lesions or foreign bodies in the pharyngo-esophageal region.
(2) Diffuse esophageal spasm is a diffuse stenosis caused by intense non-propulsive sustained contraction of the middle and lower esophagus during the same period. Typical symptoms are painless slow or sudden onset of dysphagia and/or retrosternal pain. Symptoms can be triggered by something else interfering with the eating occasion, or by eating too cold or too hot. Symptoms are short-lived, lasting from a few minutes to ten minutes, and are often relieved by drinking water or warm air. Chest pain may radiate to the back, scapular region and upper arm, occasionally with bradycardia and vasovagal syncope, which is sometimes difficult to distinguish from angina pectoris.X-ray barium swallow reveals weakened peristalsis in the lower 2/3 of the esophagus, with strong uncoordinated nonpropulsive contractions, and bead-like, spiral stenosis of the esophageal lumen. Esophageal manometry shows simultaneous contractions, repetitive contractions and high amplitude non-propulsive contraction waves in the upper middle and lower esophagus after swallowing, and the pressure of the lower esophageal sphincter is mostly normal and can be flaccid. Treatment can be with calcium channel antagonists such as nitrophenylpyridine and thiazodone, as well as nitroglycerin analogs. Endoscopic strong dilatation of the esophagus with gas or hydrostatic dilators can normalize esophageal peristalsis, and most cases do not require surgical treatment.
(3) Neurogenic vomiting often occurs in young women, chronic recurrent vomiting caused by psychogenic factors, often occurring suddenly soon after eating, usually no obvious nausea, vomiting is not large, vomiting can be eaten after vomiting, does not affect the appetite and the amount of food, and most of them do not have obvious nutritional disorders. It may be accompanied by hysterical coloring, such as exaggeration, artifice, susceptibility to suggestion, sudden onset, completely normal in the intervals, and is therefore also called hysterical vomiting. Psychiatric treatment is effective in some patients.
(4) Neurogenic belching (gaseophagia) The patient has recurrent episodes of continuous warmth, in an attempt to relieve the abdominal discomfort and fullness caused by what the patient himself believes to be gastrointestinal insufflation through belching. In fact, it is due to unconsciously and repeatedly swallowing a large amount of air to warm up. The disorder also has hysterical overtones and most often strikes in the presence of others.
(E) Anorexia nervosa is a condition characterized by anorexia, severe weight loss and amenorrhea without an organic basis. The prevalence among young Western women is 10%. Patients are often afraid of gaining weight and destroying their body shape, and they may abstain from eating or even refuse to eat, emotionally isolate themselves, avoid their relatives, think they are too fat even though they have lost weight, avoid eating and drinking, engage in excessive physical activities, take medication to suppress their appetite, and even take diuretics and laxatives. Weight loss even reaches the level of malignant disease. Patients often have neuroendocrine dysfunction, manifested as amenorrhea, hypotension, bradycardia, hypothermia and anemia and edema. According to the MayoClinic study group reported anorexia nervosa patients have a variety of gastric electrophysiological and neurohormonal abnormalities, such as increased occurrence of gastric dysrhythmia, impaired contraction of the sinuses, and significantly delayed gastric emptying of solid foods, and these disorders may be related to the patient's preprandial feeling of satiety, early satiety, and postprandial discomfort gastric flatulence and other symptoms.
(F) irritable bowel syndrome is the most common gastrointestinal dysfunction disorder characterized by changes in bowel habits. In Western countries, it accounts for 50% of gastroenterology outpatient clinics. Most patients are between 20 and 50 years of age, with very few having their first attack in old age. It is more common in females (female: male 2-5:1). In the past, it was called colonic spasm, irritable colon syndrome, mucous colitis, allergic colitis, colonic dysfunction, etc., but now it is abandoned, because there is no inflammatory lesion in this disease, and it is not limited to the colon. 1988, the Rome International Conference proposed the definition of irritable bowel syndrome (IBS), which should have (1) abdominal pain, which is relieved after defecation with changes in the frequency and character of stools; or (and) (2) abnormal defecation, which is characterized by two or more of the following manifestations: changes in the frequency of defecation, changes in the character of stools, or (2) changes in the character of bowel movements. (i) Abnormal bowel movements, with two or more of the following symptoms: change in the number of bowel movements, change in the nature of bowel movements, abnormal bowel movements, sensation of incomplete bowel movements, or mucus in the stools. Patients often have abdominal distension and discomfort.
Although the pathogenesis of IBS is unclear, clinical and laboratory evidence suggests that IBS is a disorder of intestinal motility. Patients have characteristic abnormal colonic electromyographic activity, as evidenced by an increase in slow waves of 3 beats/min. Those with predominantly abdominal pain and constipation have increased short spike potentials (shortspikebursts, SSB, associated with modulation of colonic segmental contractions and delayed defecation), which can reach 170% to 240% of normal, while patients with predominantly painless diarrhea have decreased SSB. Patients with IBS who have predominantly abdominal pain have increased pressure in the lumen of the colon, up to 10 times normal, while those with painless diarrhea have normal or decreased pressure. Small bowel transit is delayed in those with constipation and painful abdominal distension and accelerated in those with predominantly diarrhea, along with an increase in migratory integrated motility.Patients with IBS have an increased sensitivity of the colon to stimuli (including food, balloon dilatation, and neurohormones such as acetylcholine analogs, β-blockers, and gastrin, etc.), and after eating, sigmoido-rectal kinetic activity appears to be delayed but lasts for a markedly longer period of time up to 3 hours (50 minutes in normal subjects). ). Patients have poor tolerance to rectal balloon dilatation, which causes a decrease in the valve value of the contraction and the pain valve, a large contraction amplitude, and a long duration. Studies of psychiatric disorders suggest that disorders of the brain-gut axis underlie abnormal myoelectric dynamics.
Clinical manifestations often include spasmodic abdominal pain (mostly in the left lower abdomen, and the sigmoid colon can be touched with pressure and hardness when in pain) and constipation, or chronic constipation with intermittent episodes of diarrhea. Abdominal pain is often relieved by defecation. Defecation often occurs after breakfast and rarely during sleep. Defecation may be accompanied by large amounts of mucus, but no blood. The onset of symptoms is often associated with stress. The patient is in good general condition with no weight loss. Loss of appetite, weight loss, rectal bleeding, fever, and nocturnal diarrhea are often indicative of other organic diseases rather than IBS.