| Background:Current researches show that colorectal cancer(CRC)is the second most common cancer in China after lung cancer,and CRC is showing a trend toward younger age.A subset of patients with generally unsatisfactory bowel preparation quality are patients with functional gastrointestinal disorders(FGIDs),and FGIDs often coexist with psychiatric disorders such as depression and anxiety,but there is a relative lack of research on the effects of FGIDs on bowel preparation.The purpose of this paper is to discuss the effects of FGIDs with anxiety and depressive states on bowel preparation,to provide a theoretical basis for clinical selection of the optimal bowel preparation protocol,to improve the quality of bowel preparation,and hopefully to increase the detection rate of colorectal lesions.Objective:To analyze the effects of patients with FGIDs with anxiety and depressive states on bowel preparation before colonoscopy.Methods:Patients who underwent colonoscopy at the Gastrointestinal Endoscopy Center of Henan University Huaihe Hospital between August 2021 and August 2022 and signed an informed consent form were selected for this study.1097 patients were included according to the inclusion and exclusion criteria,including 409 patients diagnosed with FGIDs by completing relevant tests.The Boston Bowel Preparation Scale(BBPS),Hamilton Anxiety Scale(HAMA),and Hamilton Depression Scale(HAMD)were used to score all patients participating in this study.1.Patients with BBPS scores<6 were categorized into the inadequate bowel preparation group and those with BBPS scores≥6 were categorized into the adequate bowel preparation group,and general clinical data were collected from all enrolled patients:gender,age,education,height,weight,body mass index(BMI),history of smoking,history of alcohol consumption,history of abdominal or pelvic surgery,diabetes mellitus,waiting time.The factors influencing the quality of bowel preparation were investigated by univariate and binary logistic regression analysis.2.Patients with FGIDs were further grouped according to the different degrees of anxiety and depression status,and were classified according to the total HAMA score:0-6,no anxiety status group;7-13,possible anxiety status group;14-20,mild anxiety status group;21-28,moderate anxiety status group;≥29,severe anxiety status group.According to the total HAMD score,the group was divided into:0-8points,no depressive state group;9-19 points,possible depressive state group;20-34 points,mild to moderate depressive state group;and≥35 major depressive state group.The groups with different degrees of anxiety and depressive states were compared between groups separately to compare whether there was any statistical difference in the effect of different degrees of anxiety and depressive states on bowel preparation.3.Patients with FGIDs were grouped according to their history of anti-anxiety and anti-depressant medications,including benzodiazepines(BZs).Antidepressants included Tricyclic antidepressants(TCAs),Selective Serotonin Reuptake Inhibitor(SSRI),Selective Noradrenalin Reuptake Inhibitor(SNRI),and Selective Serotonin Reuptake Inhibitor(SSRI).noradrenalin reuptake inhibitors(SNRI).Proprietary Chinese medicines include:Shuhelian Jieyun capsule,Jieyun pill and other antidepressant Chinese medicines.Typical antipsychotics include olanzapine,quetiapine,aripiprazole and other drugs.The grouping was based on medication use,and the anti-anxiety medication group included anti-anxiety medication alone,the antidepressant medication group included antidepressant medication alone and proprietary Chinese medication alone,and the combined medication was divided into antidepressant+antidepressant group,antidepressant+proprietary Chinese medication group,antidepressant+anti-anxiety medication group,and antidepressant+atypical antipsychotic medication group.The effects of drugs on intestinal preparation were explored by univariate and multifactorial analyses.Results:1.Analysis of the adequacy of bowel preparation showed no statistically significant differences between the two groups in terms of gender,age,education,history of smoking,history of alcohol consumption,and history of abdominal or pelvic surgery(P>0.05);statistically significant differences in terms of BMI,diabetes,waiting time,examination time,FGIDs,anxiety status,depression status,and history of anti-anxiety and depression medication use(P<0.05).For factors that were statistically different in the univariate analysis,they were then included in the multifactorial logistic regression analysis,which showed that BMI>28 kg/m~2(OR=6.853,95%CI 1.679～27.974,P=0.007),diabetes mellitus(OR=2.161,95%CI 1.384～3.376,P=0.001),and waiting time of 3-4h(OR=3.849,95%CI 2.268～6.530,P<0.001)and 6-8h(OR=5.895,95%CI 3.628～9.579,P<0.001),examination time in the afternoon(OR=2.665,95%CI 1.709～4.155,P<0.001),and FGIDs(OR=9.504,95%CI 6.157～14.669,P<0.001),anxiety state(OR=3.121,95%CI 1.895～5.142,P<0.001),depressive state(OR=3.52,95%CI 2.113～5.862,P<0.001),taking anti-anxiety depression medication(OR=1.706,95%CI 1.046～2.782,P<0.001)were independent risk factors for inadequate bowel cleansing in patients.2.Comparing the quality of bowel cleansing in patients with FGIDs with different levels of anxiety,the results of the analysis showed that the bowel cleansing adequacy rate was statistically different between the five groups(X~2=23.178,P<0.001),and the higher the anxiety score,the lower the bowel cleansing adequacy rate.Further two-by-two comparisons between different groups showed that there was a statistical difference in the bowel cleanliness adequacy rate between the no-anxiety group and the mild,moderate,and severe anxiety groups,while there was no statistical difference between the remaining groups.3.Comparing the quality of bowel cleansing in patients with FGIDs with different levels of depression,the analysis showed that the bowel cleansing adequacy rate was statistically different between the four groups(X~2=21.298,P<0.001),and the higher the depression score,the lower the bowel cleansing adequacy rate.Further two-by-two comparison between different groups showed that there was a statistical difference in the bowel cleanliness adequacy rate between the no depression group and the mild to moderate and severe depression groups,while there was no statistical difference between the remaining groups.4.Patients with FGIDs were grouped according to their history of taking anti-anxiety and depression medications.The analysis showed that different drug groupings all had an effect on the quality of bowel cleansing and that the combination of drugs had a lower rate of adequate bowel cleansing than single drugs.Adequacy of bowel cleansing was used as the dependent variable,and the factors with statistical differences in Tables 3-5(anti-anxiety drugs,anti-depressants,anti-depressants+anti-depressants group,antidepressants+Chinese medicine group,anti-depressants+anti-anxiety drugs group,and anti-depressants+atypical anti-psychotics group)were used as independent variables in a binary logistic regression analysis,which showed that both single and combined medications were independent risk factors for patients’bowel independent risk factor for inadequate cleansing(P<0.05),and the effect of combination medication group on bowel preparation was greater than that of monotherapy group,with antidepressants combined with atypical antipsychotics having the greatest effect on bowel preparation(OR=6.531,95%CI 2.765～15.425,P<0.001).Conclusion:1.BMI≥28 kg/m~2,diabetes,waiting time 3-4h and 6-8h,examination time in the afternoon,FGIDs,anxiety state,depressive state,and taking anti-anxiety and depressive drugs were independent risk factors for inadequate bowel cleansing in patients.2.For patients with FGIDs with anxiety and depression status,the higher the anxiety and depression scores,the lower the bowel cleansing adequacy rate.3.In patients with FGIDs,anxiolytic and antidepressant applications alone or in combination can decrease bowel cleanliness. |
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