The occurrence of alexithymia in patients with functional constipation and its influence on the therapeutic efficacy
Objective To explore the occurrence of alexithymia in patients with functional constipation(FC)and its influence on the symptoms,anorectal function and treatment efficacy.Methods From July 4,2022 to September 30,2023,a total of 118 FC patients who visited the outpatient Department of Gastroenterology,the First Affiliated Hospital of Nanjing Medical University and underwent high-resolution anorectal manometry(HR-ARM)were selected.According to twenty-item Toronto alexithymia scale,a total score of＜51 was classified as without alexithymia,and a total score of ≥51 was classified as with alexithymia.The combination of osmotic laxatives and probiotic agents was used for the treatment for 4 weeks.The efficacy of the medication was compared before and after treatment in FC patients with and without alexithymia,as well as the scores of patient assessment of constipation-symptom(PAC-SYM),patient assessment of constipation-quality of life(PAC-QoL),self-rating anxiety scale(SAS),self-rating depression scale(SDS)and HR-ARM results.Independent sample t-test,Mann-Whitney U test and chi-square test were used for statistical analysis.Multivariate logistic regression analysis was performed to analyze the related factors affecting the efficacy of FC treatment.Results Among the 118 FC patients,43.2％(51/118)of FC patients had alexithymia,and 56.8％(67/118)of FC patients had no alexithymia.Among them,43 patients without alexithymia and 32 patients with alexithymia completed the evaluation of treatment efficacy,respectively.There was no statistically significant difference in the frequency of spontaneous defecation before and after treatment in patients with alexithymia(P＞0.05).The frequency of complete spontaneous defecation after treatment was higher than that before treatment in FC patients without alexithymia(5.0(3.0,7.0)vs.3.0(2.0,3.0)),and the increased times of total spontaneous defecation after treatment compared to before treatment in patients with alexithymia was less than that in patients without alexithymia(0.0(0.0,0.0)vs.-2.0(-3.0,0.0)),and the differences were statistically significant(Z=-4.49 and-3.79,both P＜0.001).The scores of PAC-SYM,PAC-QoL,SAS and SDS in FC patients without alexithymia after treatment were all lower than those before treatment(2.0(0.0,8.0)vs.14.0(11.0,16.0),9.0(1.1,16.0)vs.22.0(18.0,40.0),26.0(25.0,30.0)vs.29.0(25.0,34.0),28.0(26.0,30.0)vs.30.0(29.0,35.0)),and the differences were statistically significant(Z=-5.24,-5.08,-3.60,and-5.21,all P＜0.001).Among all the scores,only the PAC-SYM score after treatment was lower than that before treatment in FC patients with alexithymia(14.0(9.5,19.0)vs.17.0(12.5,21.0)),and the difference was statistically significant(Z=-2.66,P=0.008).The effective rate of FC patients without alexithymia was higher than that of patients with alexithymia(72.1％,31/43 vs.18.8％,6/32),and the difference was significant(x2=22.09,P＜0.001).The reduction of PAC-SYM,PAC-QoL,SAS and SDS scores in FC patients with alexithymia after treatment were all lower than those of FC patients without alexithymia(0.0(0.0,2.8)vs.9.0(2.0,14.0),0.0(0.0,0.8)vs.15.0(2.0,19.0),0.0(-1.0,1.0)vs.0.0(0.0,4.0),0.0(0.0,1.0)vs.3.0(1.0,5.0)),and the differences were statistically significant(Z=-4.24,-4.31,-2.59,and-4.60,all P＜0.05).The results of multivariate logistic regression analysis showed that alexithymia was an independent risk factor of ineffective medication treatment of constipation in FC patients(OR=8.930,95％confidence interval 2.011 to 39.658,P=0.004).Conclusions There is a high incidence of alexithymia in FC patients.Alexithymia affects the perception of symptoms and the efficacy of medication treatment of constipation in FC patients.
AlexithymiaFunctional constipationSymptomQuality of lifeEfficacy
NETL
NSTL
万方数据
