Gastrointestinal disorders
Introduction
Introduction to gastrointestinal dysfunction Gastrointestinal dysfunction, also known as gastrointestinal neurosis, a general term for a group of gastrointestinal syndromes, with a background of mental factors, mainly gastrointestinal motility disorders, and no pathological anatomy Basis, therefore, does not include gastrointestinal dysfunction caused by other systemic diseases. The clinical manifestations are mainly in the gastrointestinal tract involving eating and excretion, etc., often accompanied by insomnia, anxiety, distraction, forgetfulness, nervousness, headache and other functional symptoms, gastrointestinal dysfunction is quite common, currently There is still no accurate statistics on the incidence rate in China. Among the neurosis of various organs, the incidence of gastrointestinal tract is the highest, and it is more common in young adults. basic knowledge The proportion of illness: 1% Susceptible people: no specific population Mode of infection: non-infectious Complications: insomnia, anxiety, headache
Cause
Causes of gastrointestinal dysfunction
Mental factors (70%)
There is no unified understanding of the pathogenesis of this disease. Mental factors play an important role in the occurrence and development of this disease, such as overwork, emotional stress, family disputes, difficulties in life and work, if not long-term reasonable The solution can interfere with the normal activities of high-grade nerves, causing brain-intestinal axis disorders, which in turn cause gastrointestinal dysfunction. Suggestions and self-suggestion are the main pathogenic factors. Patients often have disorders of gastrointestinal myoelectric activity and motility. .
Eating disorders (15%)
The patient overeating, and then excreting undigested food by vomiting or improper excretion (drinking laxatives) may also reduce or even eat, resulting in dysfunction of the gastrointestinal tract.
Laxative or enema (10%)
Regular use of laxatives or enema can constitute adverse stimuli and promote the occurrence and development of gastrointestinal dysfunction.
Prevention
Gastrointestinal dysfunction prevention
Regular life, appropriate physical activity, can enhance physical fitness, relieve psychological barriers, and adjust organ function.
It is especially important to prevent this disease from the following four aspects.
First of all, we must pay attention to mental health, relieve psychological barriers, and adjust organ function.
Secondly, pay attention to food hygiene. When eating, be sure to chew slowly, so that the food is fully ground in the mouth, and mixed with saliva to reduce the burden on the stomach, make the food easier to digest, try to eat less irritating food, not even Drinking and smoking.
The third is to participate in physical exercise and participate in recreational activities. Learning humor can reduce psychological frustration, seek inner peace, and increase the experience of happy life.
The fourth is that life should be regular, less day and night, but not consume physical strength, energy, actively adapt to the society and the surrounding environment, pay attention to the adverse effects of seasonal climate change and interpersonal relationships on the body, to avoid the occurrence of gastrointestinal dysfunction or development of.
Complication
Gastrointestinal dysfunction complications Complications, insomnia, anxiety, headache
More with palpitations, shortness of breath, chest tightness, flushing, insomnia, anxiety, distraction, forgetfulness, nervousness, sweating of hands and feet, polyuria, headache and other manifestations of autonomic imbalance.
Symptom
Symptoms of gastrointestinal dysfunction Common symptoms Fecal gastrointestinal dysfunction ecstasy acid small stomach syndrome small finger half moon armor pink abdominal discomfort diarrhea bloating tension abdominal pain
The clinical features of gastrointestinal dysfunction, especially the condition often fluctuates with mood changes, and the symptoms may temporarily subside due to psychotherapy such as suggestive therapy, suggesting the possibility of this disease.
It must be emphasized that organic diseases, especially malignant lesions of the gastrointestinal tract, must be excluded before the diagnosis of this disease. In the case of IBS, most patients are emotionally nervous, and there are many complaints when they go to the doctor. On paper, for fear of omission, the doctor should first patiently listen to and analyze the patient's statement, carefully conduct physical examinations and routine tests, including blood routine, erythrocyte sedimentation rate, fecal routine, fecal occult blood eggs and bacterial culture, fiber colonoscopy and colonic gas sputum. Contrast, except for colon cancer, inflammatory bowel disease, diverticulitis, dysentery, etc., patients with persistent abdominal pain and weight loss should be treated with clotting of the whole digestive tract, and those with persistent abdominal pain after the meal for gallbladder ultrasound. For abdominal CT and amylase determination, lactose tolerance test should be performed when it is suspected of lactase deficiency; small intestinal mucosal disease except small intestinal mucosa biopsy; colonic mucosal biopsy except colitis, after initial diagnosis, it must be closely followed, after a period of time To ensure that the diagnosis is correct.
Neurological vomiting should be differentiated from chronic stomach disease, pregnancy vomiting, uremia, etc., and should also exclude intracranial space-occupying lesions, anorexia nervosa and gastric cancer, early pregnancy reaction, pituitary or adrenal insufficiency.
Most of the onset is slow, and the course of the disease often lasts for several months. It is persistent or recurrent. The clinical manifestations are mainly gastrointestinal symptoms, which can be limited to the pharynx, esophagus or stomach. However, the most common intestinal symptoms are accompanied by nerves. Other common symptoms of dysfunction.
Here are a few common gastrointestinal disorders:
(1) globular sputum (globushystericus) is subjectively unclear or clumpy, causing fullness, pressure or obstruction, etc. at the level of the cartilage at the base of the pharynx, most likely with the pharyngeal muscle Or related to the dysfunction of the upper esophageal sphincter, the motherland medicine called "Mei nuclear gas", this disease is more common in menopausal women, patients have more mental factors in the onset, personality has a concept of obsessive, often swallowing action to solve the symptoms In fact, the symptoms disappeared when eating, no difficulty in swallowing, long-term no weight loss performance, examination can not find any organic lesions or foreign bodies in the pharyngeal esophagus.
(2) Diffuse esophageal fistula is a strong non-progressive persistent contraction in the middle and lower part of the esophagus, causing diffuse stenosis, typical symptoms are painless slow or sudden difficulty in swallowing and/or post-sternal pain, eating There are other things to interfere with the occasion, or the diet is too cold or too hot to induce symptoms, the symptoms are short, lasting for a few minutes to ten minutes, drinking water or heating can often relieve, chest pain can be radiated to the back, shoulder area and upper arm, occasionally heart Over-relaxation and vasovagal syncope, sometimes difficult to distinguish from angina pectoris, X-ray swallowing examination showed that the 2/3 segment of the esophagus was weakened by peristalsis, there was a strong uncoordinated non-propelled contraction, the esophageal lumen was bead-like, spiral stenosis, esophagus The pressure is measured in the middle and lower part of the esophagus after swallowing. The contraction, repeated contraction and high amplitude non-propelled contraction wave, the lower esophageal sphincter pressure is normal, can be relaxed, and the treatment can be used calcium channel antagonists such as nifedipine, diltiazem. Etc. and nitroglycerin, endoscopic gas or hydrostatic dilator for the strong expansion of the esophagus, can make the esophageal peristalsis return to normal, most cases do not need To be treated surgically.
(C) neurological vomiting often occurs in young women, chronic recurrent vomiting caused by mental factors, often occurs shortly after eating, generally no obvious nausea, vomiting is not large, can eat after vomiting, does not affect appetite and food The amount, most without obvious nutritional disorders, may be accompanied by color of rickets, such as exaggeration, contrived, susceptible to suggestion, sudden onset, intermittent period is completely normal, so also known as rickets vomiting, psychotherapy is effective for some patients.
(4) Patients with neurological hernia (swallowing) have recurrent episodes of continuous heating, attempting to relieve the abdominal discomfort and fullness caused by the patient's gastrointestinal aeration by hernia, in fact, due to unconsciously swallowing Into a large amount of air before the heating is not exhausted, this disease is also criticized, and more in front of others.
(5) Anorexia nervosa is a condition in which anorexia, severe weight loss and amenorrhea are the main manifestations and no organic basis. The prevalence rate of young women in the West is 10%. Patients are often tempered by fear of getting fat and destroying body shape. Diet and even refuse to eat, emotionally isolated, avoiding relatives, although weight loss still thinks that they are overweight, avoiding diet, excessive physical activity, suppressing appetite by taking medication, even taking diuretics and laxatives, losing weight and even reaching cachexia level, patients Often neuroendocrine dysfunction, manifested as amenorrhea, hypotension, bradycardia, hypothermia and anemia and edema, according to the MayoClinic team reported that patients with anorexia nervosa have a variety of gastric electrophysiological and neurohormonal abnormalities, such as gastric rhythm The occurrence of obstacles increases, the antrum of the antrum is impaired, and the gastric emptying of solid foods is obviously slow. These disorders may be related to the symptoms of pre-meal satiety, premature saturated postprandial discomfort and flatulence.
(6) Intestinal irritation syndrome is characterized by changes in bowel habits and is the most common gastrointestinal dysfunction disorder. It accounts for 50% of gastrointestinal diseases in Western countries. Patients are aged 20-50 years old. After the initial onset, there are very few people, more common in women (female: male 2 ~ 5:1), used to call this disease colonic colon, colonic irritation syndrome, mucinous colitis, allergic colitis, colon dysfunction, etc. It has been abandoned, because the disease has no inflammatory lesions, and is not limited to the colon. The 1988 Rome International Conference proposed that the definition of irritable bowel syndrome (IBS) should have:
1 abdominal pain, relieved with bowel movements and changes in traits after bowel movements.
2 Defecation abnormalities, there are more than 2 performances below: changes in the number of bowel movements, changes in stool characteristics, abnormal bowel movements, incomplete bowel movements, mucus, patients often with abdominal flatulence and discomfort.
Although the pathogenesis of IBS is still unclear, clinical and laboratory evidence suggests that IBS is an intestinal motility disorder, and patients have characteristic abnormalities in colonic myoelectric activity, with a slow wave increase of 3 times/min. The short spike potential (SSB, which is related to the regulation of colon segmental contraction and delayed bowel movement), which is mainly caused by abdominal pain and constipation, is increased to 170% to 240% of normal people; and SSB is mainly caused by painless diarrhea. Decreased, IBS patients with abdominal pain mainly increased intra-colon pressure, up to 10 times normal, while those with painless diarrhea have normal or decreased pressure, constipation, abdominal distension, delayed intestinal transit, and diarrhea is accelerated. At the same time, there is an increase in migratory comprehensive exercise. IBS patients have increased sensitivity to stimulation (including food, balloon dilation, neurohormones such as acetylcholine, -blockers and gastrin). After eating, the sigmoid rectum The dynamic activity was delayed but the duration was significantly extended to 3 hours (50 minutes for normal people). The patient was poorly tolerant to rectal balloon dilatation, causing the threshold of contraction and the pain valve to decrease. Amplitude, long duration, the study of mental disorders suggest brain - gut axis of the disorder is abnormal EMG power base.
Clinical manifestations often have spastic abdominal pain (more common in the left lower abdomen, painful and tender, severe sigmoid colon) and constipation, or chronic constipation with intermittent diarrhea, abdominal pain often relieved after defecation, defecation often occurs in After breakfast, rarely occurs in sleep, the platoon can be accompanied by a large amount of mucus, but no bloody stools, symptoms often associated with mental stress, patients generally good, no weight loss, such as patients with loss of appetite, weight loss, rectal bleeding, fever, Nighttime diarrhea often prompts other organic diseases rather than IBS.
Examine
Gastrointestinal dysfunction check
According to different situations, X-ray, endoscopy, gastric juice analysis and stool test, etc., should be performed if necessary, such as ultrasound, CT and other examinations to exclude liver, gallbladder, pancreas and other abdominal organ lesions.
X-ray examination of the gastrointestinal tract showed that the movement of the entire gastrointestinal tract was accelerated, the colonic pocket was deepened, and the tension was enhanced. Sometimes, due to colonic sputum, there was a line shadow below the descending colon, and there was no obvious abnormality in colonic mucosa by colonoscopy.
Diagnosis
Diagnosis and identification of gastrointestinal dysfunction
diagnosis:
The clinical features of gastrointestinal dysfunction, especially the condition often fluctuates with mood changes, and the symptoms may temporarily subside due to psychotherapy such as suggestive therapy, suggesting the possibility of this disease.
Diagnosis can be based on the cause, symptoms and related tests. After the initial diagnosis of this disease, close follow-up is required. After a period of time, the diagnosis can be ensured.
Differential diagnosis:
Organic diseases must be excluded first, especially malignant lesions of the gastrointestinal tract. Excluding colon cancer, inflammatory bowel disease, diverticulitis, dysentery, etc.
Patients with persistent abdominal pain and weight loss should be treated with whole-digestive tract meal except Crohn's disease. Patients with persistent abdominal pain after meal should have gallbladder ultrasound. When suspected pancreatic disease, abdominal CT and amylase should be measured. Suspected lactase deficiency should be suspected. Lactose tolerance test; small intestinal mucosal biopsy except small intestinal mucosal disease; colon mucosal biopsy except colitis. Neurological vomiting should be differentiated from chronic stomach disease, pregnancy vomiting, uremia, etc., and should also exclude intracranial space-occupying lesions. Anorexia nervosa must be differentiated from gastric cancer, early pregnancy response, pituitary or adrenal insufficiency.
