機能性胃腸症における心理的偏倚 : その普及度および症状重度と胃機能に及ぼす影響について(シンポジウム:機能性胃腸症(Functional Dyspepsia)の病態を巡る脳腸相関,2008年,第49回日本心身医学会総会(札幌))  [in Japanese] The Psychiatric Bias in Functional Dyspepsia: : The Prevalance and the Relation to the Symptoms Severity and the Gastric Function(Symposium/Brain-gut Interaction in the Pathophysiology of Functional Dyspepsia)  [in Japanese]

背景:機能性胃腸症(FD)の病態は多様であるが,主に胃機能異常と心理的偏倚に二大別される.FD患者ではしばしば心理的偏倚が認められ上腹部症状出現の一因として注目されている.また近年,心理的偏倚と胃機能との関連性にも関心がもたれている.目的:FD患者において心理的偏倚が症状重度に及ぼす影響,および心理的偏倚と胃機能との関連性を検討した.方法:FD患者(Rome II基準)33名に,(1)心理テスト(STAI,SDS,CMI),(2)飲水ドリンクテスト(DT),(3)独自のディスペプシア質問票による症状重度の評価,を行い上記を検討した.結果:各心理テストのスコアが高いほど症状重度スコアは高値であった.心理的偏倚とDT異常との間には有意な相関が認められた.結論:心理的偏倚は,FD患者における症状重度を増幅し,また胃機能(DTにおける容量負荷耐性)を低下させることでFDの病態を増悪させると考えられた.

Underlying causes of symptoms in functional dyspepsia (FD) are multi-factorial, including delayed gastric emptying, impaired gastric accommodation, visceral hypersensitivity and psychiatric distress (PD). However, the impact of these abnormal gastric physiology and psychiatric distress on the severity of daily dyspeptic symptoms (DS), and the correlation among these causes are still unclear. We studied the impact of abnormal gastric physiology and psychiatric distress on the severity of daily DS, and to examine the correlation among these multi-factorial causes in FD. Thirty-three FD (Rome II) patients were evaluated by gastric emptying study (GES), and water load drink test (DT). Subjects also completed STAI, SDS, CMI and the original dyspeptic symptoms questionnaire to examine DS severity (strength and frequency). The correlation between DS severity with GES, DT, and PD were examined. The correlation among GES, DT, and PD were also examined. In FD, both DT and PD correlated significantly with DS severity, and significant correlation was noted between DT and PD. In FD, both intolerance to volume load in DT and PD enhanced DS severity, and PD may influence the gastric physiology assessed by DT.