wèi cháng dào gōng néng wěn luàn
2 OverviewGastrointestinal dysfunction (GI dysfunction), a group of gastrointestinal syndromes, is a general term for gastrointestinal dysfunction that has a psychiatric background. Gastrointestinal motility disorders are predominant, and there is no basis for organic lesions in terms of pathoanatomy, so they also do not include gastrointestinal dysfunction caused by other systemic diseases. Clinical manifestations are mainly in the gastrointestinal tract involving abnormalities in feeding and excretion, and are often accompanied by other functional symptoms such as insomnia, anxiety, inattention, amnesia, nervousness, and headache. Gastrointestinal dysfunction is quite common and precise statistics on its incidence are lacking in this country. Among the neuroses of various organs, the gastrointestinal tract has the highest incidence number, mostly in young adults.
3 DiagnosisThe clinical features of gastrointestinal dysfunction, in particular the fact that the condition often fluctuates with mood changes and that symptoms may temporarily subside with psychiatric treatments such as hypnotherapy, suggests the possibility of this disorder.
It is important to emphasize 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 of the patients are emotionally stressed, and when they come to the doctor, they have a lot of complaints, and some of them write down their symptoms on a piece of paper, so they don't want 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 must be differentiated from chronic gastric disease, vomiting in pregnancy, uremia, etc., and should also be excluded from intracranial space-occupying lesions. Anorexia nervosa must be differentiated from gastric cancer, early pregnancy reactions, and hypopituitarism or hypoadrenocorticism.
4 Therapeutic measures
(a) Psychotherapy is effective in 2/3 of patients. The key to the treatment of gastrointestinal functional disorders is to remove psychological barriers to adjust organ function. If the patient suspected or worried about their own suffering from a certain disease, the doctor to carry out targeted examination, relieve the suspicion of stabilizing the mood, which itself is also a means of treatment.
(B) supportive therapy Unless the patient's general condition is very poor, generally do not need bed rest. Regular life and appropriate physical activities can enhance physical fitness and accelerate the recovery of neurological function. Anorexia nervosa with severe malnutrition, nasogastric tube feeding and cause diarrhea patients, need intravenous nutrition. High-fiber foods can relieve the symptoms of IBS patients.
(C) Drug therapy Short-term administration of tricyclic antidepressants is useful for patients with significant psychiatric symptoms. In patients with IBS with spasmodic abdominal pain, the anticholinergic drug dicyclovirine (dicyine 10-20mg, 3-4 times/d) can reduce postprandial abdominal pain and fecal embarrassment; calcium antagonist Deschutney 50mg 3 times/d can reduce the increase in postprandial frontal potential activity, and the calcium antagonist Deschutney 50mg 3 times/d can reduce postprandial increase in frontal potential activity, and the calcium antagonist Deschutney 50mg 3 times/d can reduce postprandial increase in frontal potential activity. Peppermint oil 0.2 ml taken before meals, can relax the smooth muscle have a certain effect on the relief of abdominal pain, loperamide (Emmondia 2mg 4 times / d) is effective in diarrhea type IBS.
(D) Chinese medical treatment
1. Neurogenic vomiting If there is no other witnesses except vomiting, we can use Xiaobianxia and Ling Tang to stop vomiting, which is effective for mild patients.
2. Aerophagia can be treated by adding or subtracting Xuanfu Daichu Tang.
3. Intestinal irritability syndrome If there is abdominal pain and diarrhea, fullness in the abdomen and ribs, and a stringy pulse, it is a disharmony between the liver and the spleen, and can be treated with pain and diarrhea formula. If every day before dawn, abdominal tinnitus and diarrhea, abdominal cold limbs cold, tongue pale pulse strings, for the spleen and kidney yang deficiency, with the annexed zi li zhong tang and the four god pills plus or minus for treatment.
(5) Other treatments Acupuncture, physiotherapy, etc. are sometimes effective and can be used on a case-by-case basis.
5 EtiologyThe pathogenesis of this disease has not been recognized. Mental factors play an important role in the occurrence and development of this disease, such as overwork, emotional tension, family disputes, life and work difficulties, if long-term reasonable solution is not available, can interfere with the normal activities of the higher nervous system, resulting in disorders of the cerebral-intestinal axis, which in turn cause gastrointestinal dysfunction. Suggestion and self-suggestion are the main pathogenic factors, and patients often have disorders of gastrointestinal myoelectric activity and dynamics.
Eating disorders, frequent use of laxatives or ***, can constitute a bad ***, promote the occurrence and development of this disease.
6 Clinical manifestationsMost of the slow onset, the course of the disease is often years, is persistent or recurrent. Clinical manifestations are dominated by gastrointestinal symptoms, which can be limited to the pharynx, esophagus or stomach, but intestinal symptoms are the most common, and can be accompanied by other common symptoms of neurosis.
Here are some common gastrointestinal dysfunctions:
(a) hystericus hystericus (globus hystericus) is subjectively some kind of unspecified thing or mass, in the bottom of the pharynx at the level of the cricoid cartilage caused by distension, pressure or obstruction and other discomforts, is likely to be related to the pharyngeal muscle or the upper esophageal sphincter dysfunction. In Chinese medicine, this is known as "plum nucleus qi". This disease is most common in menopausal women. Patients have mental factors in the onset of the disease, and they have a compulsive concept of character, and often make 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. The examination could not find any organic lesion or foreign body in the pharyngo-esophagus.
(2) Diffuse esophageal spasm is a diffuse narrowing of the lower and middle esophagus caused by strong, non-propulsive, sustained contractions during the same period. Typical symptoms are painless slow or sudden onset 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.
(C) 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, does not affect the appetite and the amount of food, and most of the nutritional disorders are not obvious. 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.
(D) Neurogenic belching (gaseophagia) patients have recurrent episodes of continuous warmth, in an attempt to belch to relieve the patient's own belief that it is gastrointestinal insufflation caused by abdominal discomfort and fullness. 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 episodes occur in the presence of others.
(E) anorexia nervosa is a disorder characterized by anorexia, severe weight loss, and amenorrhea without an organic basis. The prevalence of the disease in young Western women is 10%. Patients are often afraid of getting fat and destroying their body shape and diet or even refuse to eat, emotionally isolated, avoiding relatives, although weight loss is still considered to be too fat, avoiding diets, excessive physical activity, suppressing appetite by taking medication, and even taking diuretics and laxatives. Weight loss even reaches the level of malignant disease. Patients often have neuroendocrine dysfunction, manifested by amenorrhea, hypotension, bradycardia, hypothermia and anemia and edema. According to the Mayo Clinic 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 satiety, early satiety and postprandial discomfort gastric distension and other symptoms.
(F) irritable bowel syndrome is the most common gastrointestinal disorder characterized by changes in bowel habits. In Western countries, it accounts for 50% of all gastroenterology outpatient visits. 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 spikebursts (SSBs, associated with modulation of colonic segmental contractions and delayed defecation), which can reach 170% to 240% of normal, while those with predominantly painless diarrhea have decreased SSBs. 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, with an increase in migratory integrated motility.Patients with IBS have an increased sensitivity of the colon to *** (including food, balloon dilatation, neurohormones such as acetylcholines, β-blockers, and gastrin, etc.), and sigmoid-rectal dynamics appear delayed after eating, but are significantly prolonged to 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 long duration. Studies of psychiatric disorders suggest that disorders of the cerebral-gut axis underlie abnormal myoelectric dynamics.
Clinical manifestations often include spasmodic abdominal pain (in the left lower abdomen, pain can be touched with pressure, hard sigmoid colon) 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, nocturnal diarrhea, etc. often indicate other organic diseases rather than IBS.
7 PrognosisGastrointestinal dysfunction may recur even after treatment, but it does not seriously affect the general condition. Patients with anorexia nervosa who are severely malnourished and malignant have a poor prognosis, with a mortality rate of 5%.
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