1
|
|
2
|
Quigley EMM, Locke GR, Mueller-Lissner S, Paulo LG, Tytgat GN, Helfrich I, Schaefer E. Prevalence and management of abdominal cramping and pain: a multinational survey. Aliment Pharmacol Ther 2006; 24:411-9. [PMID: 16842469 DOI: 10.1111/j.1365-2036.2006.02989.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Though functional gastrointestinal complaints are recognised as being common throughout the world, there have been few comparative studies of prevalence. AIM To compare the prevalence and management of abdominal cramping/pain in nine countries. METHODS In a two-stage community survey, approximately 1000 subjects were interviewed in each of nine countries to establish the demographics of individuals with abdominal cramping/pain (stage 1) followed by market research-driven interviews with >or=200 sufferers per country (stage 2). RESULTS 9042 subjects were interviewed in stage 1. Mexico (46%) and Brazil (43%) had the highest prevalence of abdominal cramping/pain; Japan the lowest (10%). Abdominal cramping/pain was more common in women (12-55%) than in men (7-38%). About 1717 subjects participated in stage 2; 65% were women and the average age at symptom onset was 29 years. The frequency of episodes differed between countries, being highest in the US (61% suffered at least once in a week). Sufferers in the US and Latin America reported a higher usage of medications (around 90%) than those in Europe (around 72%). In most countries over-the-counter drugs were principally used. Antispasmodic drugs were most popular in Latin America and Italy, antacids in Germany and the UK. Drug therapy decreased the duration of episodes (by up to 81% in Brazil). CONCLUSIONS The community prevalence, severity, healthcare seeking and medication usage related to abdominal cramping/pain are high overall, but vary considerably between countries.
Collapse
Affiliation(s)
- E M M Quigley
- Alimentary Pharmabiotic Centre, National University of Ireland, Cork, Ireland.
| | | | | | | | | | | | | |
Collapse
|
3
|
Reilly MC, Barghout V, McBurney CR, Niecko TE. Effect of tegaserod on work and daily activity in irritable bowel syndrome with constipation. Aliment Pharmacol Ther 2005; 22:373-80. [PMID: 16128674 DOI: 10.1111/j.1365-2036.2005.02577.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Tegaserod is a promotility agent with proven efficacy and safety in patients with irritable bowel syndrome with constipation. AIM To assess tegaserod's effect on work productivity and daily activity. METHODS Women, 18-65 years old and meeting Rome II criteria for irritable bowel syndrome with constipation, were randomized to a double-blind, placebo-controlled, multicentre study of tegaserod 6 mg b.d. or placebo. Productivity loss and daily activity impairment because of irritable bowel syndrome were measured with the Work Productivity and Activity Impairment questionnaire for irritable bowel syndrome, modified to exclude diarrhoea as a symptom. Assessments were made at baseline, weeks 2 and 4. RESULTS A total of 2660 women were randomized and, of these, 1675 [tegaserod (n = 1363), placebo (n = 312)] were employed and completed Work Productivity and Activity Impairment for irritable bowel syndrome questionnaires. Compared with placebo, tegaserod significantly reduced work and daily activity impairment at weeks 2 and 4. Tegaserod reduced absenteeism by 2.6% (P = 0.004), presenteeism by 5.4% (P < 0.0001), overall work productivity loss by 6.3% (P < 0.0001), and activity impairment by 5.8% (P < 0.0001) at week 4 (vs. baseline). Assuming a 40-h workweek, tegaserod reduced work productivity loss by 2.5 h/week. CONCLUSIONS Tegaserod significantly reduced work productivity loss and daily activity impairment at 2 weeks, and this benefit was maintained at 4 weeks.
Collapse
Affiliation(s)
- M C Reilly
- Margaret Reilly Associates, Inc., New York, NY, USA.
| | | | | | | |
Collapse
|
4
|
Silk DBA. Chronic idiopathic intestinal pseudo-obstruction: the need for a multidisciplinary approach to management. Proc Nutr Soc 2004; 63:473-80. [PMID: 15373960 DOI: 10.1079/pns2004375] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
At the outset of the research programme into irritable bowel syndrome (IBS) it was perceived that there was a need to develop a symptom-based classification for the patients. Four groups of patients were identified, those with spastic colon syndrome, diarrhoea-predominant spastic colon syndrome, functional diarrhoea and midgut dysmotility. While working with outpatients with IBS it was noted how some of them had suffered symptoms for many years; specifically, a group of patients satisfying the criteria for midgut dysmotility had also suffered from particularly severe and intractable intestinal symptoms. These patients underwent 24 h ambulatory studies of small intestinal motility and the majority were found to have manometric features of chronic idiopathic intestinal pseudo-obstruction (CIIP). To characterise the cause, laparoscopic full-thickness small intestine and colonic biopsies have been obtained in forty-five of the latter group of patients. Of these patients 58% have been found to have complete or partial deficiency of alpha-actin epitope staining in the inner circular layer of small intestinal smooth muscle. This deficiency is believed to represent an important biomarker rather than the cause of CIIP, since alpha-actin epitope deficiency has been observed in association with enteric neuropathy and myopathies. In relation to the management of CIIP patients, a multidisciplinary model is proposed incorporating management of co-morbid psychological and psychiatric pathology, abdominal and musculoskeletal pain, fatigue, urological symptoms and nutrition. A six-stage nutritional management plan for these patients is presented.
Collapse
Affiliation(s)
- D B A Silk
- Department of Gastroenterology and Nutrition, Central Middlesex Hospital, Imperial College, London, UK
| |
Collapse
|
5
|
Affiliation(s)
- D B A Silk
- Surgery, Anaesthetics and Intensive Care Division, Imperial College of Science Technology and Medicine, London, UK
| |
Collapse
|
6
|
Abstract
Diverticular disease is a common disorder affecting 30-55% of the population in the developed world. It has been described as "a deficiency disease of Western civilization", a theory that has been proposed since it was observed that diverticular disease was uncommon in African and other developing countries where dietary fibre consumption was high. At the turn of the century the medical treatment of colonic diverticulosis involved the avoidance of "roughage", which was felt to exacerbate the problem. However, the use of high fibre diets in the prevention and treatment of the symptoms of diverticular disease has now become commonplace, and the development of this practice is discussed in this chapter.
Collapse
Affiliation(s)
- Charles D R Murray
- St Mark's Hospital, Northwick Park, Watford Road, Harrow, Middlesex, HAI 3UJ, UK
| | | |
Collapse
|
7
|
Groll D, Vanner SJ, Depew WT, DaCosta LR, Simon JB, Groll A, Roblin N, Paterson WG. The IBS-36: a new quality of life measure for irritable bowel syndrome. Am J Gastroenterol 2002; 97:962-71. [PMID: 12003433 DOI: 10.1111/j.1572-0241.2002.05616.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We aimed to develop and validate a quality of life instrument for patients with irritable bowel syndrome (IBS). METHODS Using focus groups, existing questionnaires, and literature reviews, five IBS patients and nine gastroenterologists compiled and pilot tested for content validity a 70-item questionnaire. The questionnaire was then administered to 107 IBS patients, and using these data, the 70-item questionnaire was reduced to 36 questions through statistical and consensus methodology. The IBS-36 questionnaire was tested for construct validity, reliability, reproducibility, and responsiveness using a gold standard of structured interviews by three gastroenterologists, the Medical Outcomes Study Short Form Quality of Life Questionnaire, and the Coping Resource Inventory. RESULTS The IBS-36 consists of 36 questions scored on a 7-point Likert scale. It has a very high internal consistency (Cronbach's alpha = 0.95) and a high test-retest reliability (Spearman's r = 0.92) and correlates as hypothesized with the Medical Outcomes Study Short Form Quality of Life Questionnaire (p < 0.001), McGill pain scores (p < 0.001), and IBS patient-reported sleep, symptom, and pain scores (ps = 0.030, <0.001, and <0.001, respectively). CONCLUSIONS The IBS-36 addresses all areas of quality of life affected by IBS and is easy to administer and score. The IBS-36 is a well-validated, condition-specific quality of life measure for IBS patients that is sensitive to clinical intervention and highly correlated with established quality of life measures and patient-reported symptom scores.
Collapse
Affiliation(s)
- Dianne Groll
- The Gastrointestinal Motility Education Centre, Queen's University, Kingston, Ontario, Canada
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Vanner SJ, Depew WT, Paterson WG, DaCosta LR, Groll AG, Simon JB, Djurfeldt M. Predictive value of the Rome criteria for diagnosing the irritable bowel syndrome. Am J Gastroenterol 1999; 94:2912-7. [PMID: 10520844 DOI: 10.1111/j.1572-0241.1999.01437.x] [Citation(s) in RCA: 161] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Our aim was to examine the predictive value of the Rome criteria and absence of so-called "red flags" of clinical practice for diagnosing irritable bowel syndrome. Red flags were relevant abnormalities on physical examination, documented weight loss, nocturnal symptoms, blood in stools, history of antibiotic use, and family history of colon cancer. METHODS In retrospective studies, 98 patients who had one or more Rome criteria and lacked red flags were identified by chart review of a 1-yr period. In prospective studies, 95 patients were identified who met the Rome criteria and lacked red flags. Sensitivity, specificity, predictive value of Rome criteria, and absence of red flags were determined. Consultant's final diagnosis was the gold standard. Investigations before and after referral were recorded and reason for referral was determined in prospective studies. RESULTS In the retrospective series, the Rome criteria and absence of red flags had a sensitivity of 65%, specificity of 100%, and positive predictive value of 100%. None of these patients required revision of their diagnosis during a 2-yr follow-up. In the prospective study, the positive predictive value was 98%. More than 50% of the patients in this group had been referred because of diagnostic uncertainty and 24% had had an abdominal ultrasound; 66% of those <45 yr old underwent at least partial colonic evaluation. CONCLUSIONS These findings suggest that the Rome criteria combined with a lack of red flags have a very high predictive value for diagnosing irritable bowel syndrome. Application of these diagnostic criteria has the potential to alter utilization of health care resources.
Collapse
Affiliation(s)
- S J Vanner
- GI Motility Education Centre, Queen's University, Kingston, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
9
|
Ortolani C, Bruijnzeel-Koomen C, Bengtsson U, Bindslev-Jensen C, Björkstén B, Høst A, Ispano M, Jarish R, Madsen C, Nekam K, Paganelli R, Poulsen LK, Wüthrich B. Controversial aspects of adverse reactions to food. European Academy of Allergology and Clinical Immunology (EAACI) Reactions to Food Subcommittee. Allergy 1999; 54:27-45. [PMID: 10195356 DOI: 10.1034/j.1398-9995.1999.00913.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- C Ortolani
- Department of Allergology and Clinical Immunology, Niguarda Ca Granda Hospital, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Van Dulmen AM, Fennis JFM, Bleijenberg G. Towards effective reassurance in irritable bowel syndrome: The importance of attending to patients' complaint-related cognitions. PSYCHOL HEALTH MED 1998. [DOI: 10.1080/13548509808400614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
11
|
Farup PG, Hovdenak N, Wetterhus S, Lange OJ, Hovde O, Trondstad R. The symptomatic effect of cisapride in patients with irritable bowel syndrome and constipation. Scand J Gastroenterol 1998; 33:128-31. [PMID: 9517521 DOI: 10.1080/00365529850166833] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cisapride improves symptoms in patients with idiopathic constipation. This trial compares the effect of cisapride with that of placebo in patients with irritable bowel syndrome (IBS) and constipation. METHODS Seventy patients were randomized to 12 weeks' treatment with 5 mg cisapride three times daily or placebo in a double-blind trial. The dose could be doubled after 4 weeks in patients without satisfactory improvement. The patients scored their symptoms on a 100-mm visual analogue scale (VAS) (0 = best, 100 = worst), and the investigators evaluated the symptomatic effect. RESULTS The dose was doubled in 17 and 23 patients in the cisapride and placebo groups, respectively, after 4 weeks. The patients' mean VAS score for global evaluation of IBS symptoms in the cisapride and placebo groups was 73 and 71 mm, respectively, at the start of treatment and 47 and 41 mm at the end. The difference between cisapride and placebo at the end was 6 mm in favour of placebo (95% confidence interval (CI), -6, 18) (NS). The investigators evaluated the effect as good or excellent in 39.2% and 58.8% in the cisapride and placebo groups, respectively. The difference in favour of placebo was 19.5% (95% CI, -5, 44) (NS). Nor were any statistically significant differences seen between cisapride and placebo in the other effect factors. CONCLUSIONS The trial seems to exclude a clinically significant effect of 15-30 mg cisapride daily in patients with IBS and constipation during a 12-week treatment period.
Collapse
Affiliation(s)
- P G Farup
- Dept. of Medicine, Gjøvik County Hospital, Norway
| | | | | | | | | | | |
Collapse
|
12
|
van Dulmen AM, Fennis JF, Bleijenberg G. Cognitive-behavioral group therapy for irritable bowel syndrome: effects and long-term follow-up. Psychosom Med 1996; 58:508-14. [PMID: 8902902 DOI: 10.1097/00006842-199609000-00013] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Little is known about the effectiveness of cognitive behavioral treatment for patients with irritable bowel syndrome on a group basis. Previous studies have used only small samples, and studies with long term follow-up are lacking. The arm of the present study was to investigate: a) the effectiveness of a cognitive-behavioral group treatment compared with a waiting list control condition in alleviating abdominal complaints and b) the long term effectiveness of cognitive-behavioral group treatment. In study 1, we performed a controlled study with 25 patients in the group treatment condition and 20 patients in the waiting list control condition. Treatment consisted of eight 2-hour group sessions over a period of 3 months. In study 2, all patients were treated and followed up for an average of 2.25 years (range 6 months-4 years) after the completion of the group treatment. The abdominal complaints of the patients who underwent treatment were found to improve significantly more than the complaints of the patients awaiting treatment. Moreover, in agreement with the purpose of the therapy, the number of successful coping strategies was found to increase more and patients' avoidance behavior was found to decrease more in the treatment group than in the waiting list control group. The positive changes appeared to persist during follow-up. Cognitive-behavioral group treatment is effective in alleviating irritable bowel syndrome, in stimulating coping strategies, and in reducing avoidance behavior. At long term follow-up, the abdominal complaints, the number of successful coping strategies, and the avoidance behavior were still improved compared with the pretreatment assessment.
Collapse
Affiliation(s)
- A M van Dulmen
- Department of General Practice and Social Medicine, University of Nijmegen, The Netherlands
| | | | | |
Collapse
|
13
|
Efskind PS, Bernklev T, Vatn MH. A double-blind placebo-controlled trial with loperamide in irritable bowel syndrome. Scand J Gastroenterol 1996; 31:463-8. [PMID: 8734343 DOI: 10.3109/00365529609006766] [Citation(s) in RCA: 139] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Loperamide has a relaxing effect on localized and segmental large-bowel spasms. On the basis of previously observed effects on pain and stool habits in patients with diarrhoea, the present trial intended to examine the regulating effect in an unselected cohort of patients with the irritable bowel syndrome (IBS). The symptoms in IBS are dependent on variations in motility initiated by different mechanisms. Therefore, when examining the effect of treatment, characterization of the patient material is important. METHODS Ninety patients were included in this prospective double-blind trial comparing loperamide with placebo over 5 weeks. The two groups were characterized and compared with healthy controls (n = 33), matched by age and sex. Demographic, clinical, and biochemical data were recorded. RESULTS Clinical variables and social and personal relationships were similar for the loperamide group (n = 35), the placebo group ( n = 34), the dropouts (n = 21), and controls. Somatic diseases and mental disturbances were increased in the patients compared with the controls. Throughout the 5 weeks of treatment an improved stool consistency (32%), reduced defecation frequency (36%), and reduced intensity of pain (30%) were found in the loperamide group. An increase in nightly pain was observed in the loperamide group. CONCLUSIONS This trial lends support to a multifactorial aetiology in IBS. Treatment must be individualized with regard to both the effect and the risk of constipation and abdominal pain. The trial shows a benefit of loperamide in an unselected cohort of IBS patients with regard to stool frequency, stool consistency, and the overall pain intensity, but with increased abdominal pain during the night. It should be recommended that the patients take the medication in divided daily doses.
Collapse
Affiliation(s)
- P S Efskind
- Medical Dept., Central Hospital in Ostfold, Fredrikstad, Norway
| | | | | |
Collapse
|
14
|
Aldoori WH, Giovannucci EL, Rimm EB, Ascherio A, Stampfer MJ, Colditz GA, Wing AL, Trichopoulos DV, Willett WC. Prospective study of physical activity and the risk of symptomatic diverticular disease in men. Gut 1995; 36:276-82. [PMID: 7883230 PMCID: PMC1382417 DOI: 10.1136/gut.36.2.276] [Citation(s) in RCA: 105] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The relationship between physical activity and risk of symptomatic diverticular disease has not been investigated directly. This association was examined in a prospective cohort of 47,678 American men, 40 to 75 years of age, and free of diagnosed diverticular disease, colon or rectal polyp, ulcerative colitis, and cancer before 1988. During four years of follow up, 382 newly diagnosed cases of symptomatic diverticular disease were documented. After adjustment for age, energy adjusted dietary fibre, and energy adjusted total fat, overall physical activity was inversely associated with the risk of symptomatic diverticular disease (for highest versus lowest extremes, relative risk (RR) = 0.63 (95% confidence interval (CI) 0.45, 0.88). Most of the inverse association was attributable to vigorous activity, for extreme categories RR = 0.60 (95% CI 0.41, 0.87). For activity that was not vigorous the RR was 0.93 (95% CI 0.67, 1.69). Several specific activities were inversely associated with the risk of diverticular disease, but jogging and running combined was the only individual activity that was statistically significant (p for trend = 0.03). For men in the lowest quintile for dietary fibre intake and total physical activity (compared with those in the opposite extreme), the RR was 2.56 (95% CI 1.36, 4.82). Physical activity, along with a high fibre diet, may be an important factor in the prevention of symptomatic diverticular disease.
Collapse
Affiliation(s)
- W H Aldoori
- Department of Nutrition and Epidemiology, Harvard School of Public Health, Boston, MA 02115
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Phillips SF. "Dysmotility syndromes: what can be defined?". Ir J Med Sci 1994; 163:552-4. [PMID: 7843935 DOI: 10.1007/bf02943024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
16
|
Abstract
BACKGROUND Irritable bowel syndrome remains the commonest reason for referral to a gastroenterology clinic. Patients with irritable bowel syndrome are frequently advised to increase their intake of bran fibre, despite inconclusive experimental evidence of benefit. METHODS The effect of dietary supplementation with a bolus of bran fibre (12 g/day) was studied in a block-randomized, placebo-controlled, crossover study of 80 patients with irritable bowel syndrome referred to a District General Hospital outpatient clinic. Comparison of the benefits of bran and placebo was based upon personal assessment of individual and overall symptom profiles, determined from a simple daily symptom score and post-treatment interview. RESULTS Overall symptomatic improvement was reported with bran by 52% and with placebo by 54% of patients. Bran supplementation was no more effective than placebo in improving individual symptoms of irritable bowel syndrome, and for wind-related symptoms it was significantly less effective (P < 0.001). CONCLUSION Dietary supplementation with bran is of no value in the treatment of patients with irritable bowel syndrome referred to a hospital clinic.
Collapse
Affiliation(s)
- J Snook
- Royal Hampshire County Hospital, Winchester, UK
| | | |
Collapse
|
17
|
De Ponti F, Giaroni C, Cosentino M, Lecchini S, Frigo G. Calcium-channel blockers and gastrointestinal motility: basic and clinical aspects. Pharmacol Ther 1993; 60:121-48. [PMID: 8127922 DOI: 10.1016/0163-7258(93)90024-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Several calcium-channel blockers currently in use for the treatment of cardiovascular disorders have recently been tested for their effects on gastrointestinal motility. The rationale for this approach centers on the concept that calcium-channel blockers are at least as potent in inhibiting intestinal smooth muscle as in relaxing vascular smooth muscle. This review will give an outline of the most recent findings on the role of calcium and calcium channels in smooth muscle and neuronal function in the digestive system. It will also consider the mechanisms by which calcium-channel blockers may affect gastrointestinal motility and assess potential clinical applications in gastroenterology. The main goal for researchers in this field will be the development of gut-selective agents, with no cardiovascular side effects.
Collapse
Affiliation(s)
- F De Ponti
- Department of Internal Medicine and Therapeutics, II Faculty of Medicine, University of Pavia, Varese, Italy
| | | | | | | | | |
Collapse
|