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Ahmed S, Alam S, Alsabri M. Health-Related Quality of Life in Pediatric Inflammatory Bowel Disease Patients: A Narrative Review. Cureus 2022; 14:e29282. [PMID: 36277571 PMCID: PMC9578282 DOI: 10.7759/cureus.29282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 12/02/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic autoimmune condition that can have a wide range of symptoms among pediatric patients. Although clinical symptoms like hematochezia, diarrhea, and abdominal pain are commonly addressed, health-related quality of life (HRQOL) is often overlooked in patients with IBD and pediatric patients with chronic disease in general. Examining HRQOL can help improve patient outcomes, but it has been studied sparingly. In this review, we aim to compare HRQOL between pediatric patients suffering from IBD and healthy children, as well as those suffering from other illnesses. We searched through peer-reviewed primary literature related to IBD and HRQOL and selected 10 articles from the PubMed database to be reviewed. Our inclusion criteria included articles published after the year 2000 in English, primary studies, and those that corresponded to the aim of this review. Case reports and secondary and tertiary articles were excluded from our review. We found that patients with IBD reported worse HRQOL in terms of overall health and in various subdomains, including physical health and fatigue, compared to their healthy counterparts. However, children with IBD demonstrated a comparable HRQOL with children suffering from functional abdominal pain (FAP) and obesity. Additionally, children with IBD displayed a greater HRQOL than pediatric patients with gastroesophageal reflux disease (GERD) and chronic constipation. In addressing the aim of this review, we found that children with IBD had a lower HRQOL when compared to healthy children, but a comparable or greater HRQOL than other sick children. Some factors associated with a reduced HRQOL include disease activity, age, fatigue, gender, psychological variables, and associated symptoms. Going forward, HRQOL should be considered by practitioners when caring for pediatric IBD patients in a clinical setting as it can help improve patient care. More studies need to be conducted to further explore HRQOL in pediatric patients. This can help implement early psychosocial interventions in children to reduce the disease burden.
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Abstract
BACKGROUND The use of psychotropic medications, particularly antidepressants, is common in patients with inflammatory bowel disease (IBD) in spite of a lack of their robust efficacy in this population. This review provides an overview of the use trends of different classes of antidepressant and anti-anxiety medication and their effects on mood, nervous system function, gastrointestinal physiology and immunity drawing from the literature available in the general population, other medical conditions, and when available, patients with IBD. It also covers the evidence base for the actions, efficacy, and potential complications of antidepressants organized by different classes. METHODS We conducted a PubMed search of articles relating the different drug classes probed to the terms above in different populations of interest. All types of articles were accepted including case reports and series, open and randomized trials, reviews, and expert opinion. We also examined the reference lists of the publications found. RESULTS Selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) are the most commonly prescribed agents for anxiety and depression in patients with IBD, though their efficacy for these conditions in the general population are mild to moderate at best. SSRIs are generally well tolerated, though at higher doses, they, like most antidepressant classes, can be associated with activation, serotonergic syndrome, and increased suicidal ideation. TCAs have many more serious side effects but have some shown efficacy for functional GI symptoms. A newer class, the serotonin noradrenergic reuptake inhibitors (SNRIs), can be effective for refractory depression, anxiety and chronic pain syndromes with a side effect profile similar to both SSRIs and more mild manifestations of TCAs. Mirtazapine has moderate efficacy for depression if sedation and weight gain side effects are tolerated and some small support for use in nausea and vomiting. Bupropion targets dopamine and noradrenaline reuptake and has moderate efficacy for depression, and some small support for use in fatigue and smoking cessation. Buspirone has an indication for generalized anxiety disorder though studies show only a minimal benefit. It has some growing evidence for use in functional dyspepsia. Most of these agents have physiological effects on the brain, immune system, and gastrointestinal tract (with the exception of bupropion) hence their therapeutic and side effects manifested in these systems. CONCLUSION Antidepressant medications are frequently prescribed for depression, anxiety disorders, and chronic pain syndromes, but overall support for their efficacy is modest at best. Psychological interventions have growing support for having much more robust effects without the side effects of antidepressants and should be considered first-line treatment or at least an adjunct to psychotropic medications for these conditions.
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Wong WK, Chien WT, Lee WM. Self-administered acupressure for treating adult psychiatric patients with constipation: a randomized controlled trial. Chin Med 2015; 10:32. [PMID: 26535053 PMCID: PMC4630845 DOI: 10.1186/s13020-015-0064-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 10/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Constipation has a high prevalence rate (>30 %) in psychiatric patients with psychotropic drugs. Common pharmacological and non-pharmacological interventions for constipation might have longer-term negative and adverse effects that would outweigh their short-term efficacy in symptom reduction. This randomized controlled trial aims to investigate the effect of self-administered acupressure for the management of constipation, in hospitalized psychiatric patients. METHODS Seventy-eight patients were recruited in matched pairs in terms of gender, age and laxative use from five acute psychiatric wards in Hong Kong. Each of these matched pairs of patients was randomly assigned to either a self-administered acupressure (n = 39) or a sham group (n = 39), using computer-generated random numbers. After baseline measurement, the intervention and sham group received the same training in self-administered acupressure and supervised practice once per day for 10 days, except light pressure on non-acupoints was taught to the sham group. The acupoints chosen for acupressure included Zhongwan (RN12), right and left Tianshu (ST25), right and left Quchi (LI11). Participants' symptoms and quality of life regarding constipation were measured at baseline and immediately and 2 weeks after completion of the interventions with constipation assessment scale and patient assessment of constipation quality of life questionnaire, respectively. RESULTS After 2 weeks follow-up, participants who had received self-administered acupressure indicated significantly greater improvements in both symptom severity (P = 0.0003) and quality of life (P = 0.0004) when compared with the sham group. CONCLUSION The psychiatric patients with constipation who practiced self-administered acupressure for 10 days improved their symptom severity and perceived quality of life immediately and 2 weeks after completion of the intervention in comparison with the sham group. TRIAL REGISTRATION The trial was registered with the ClinicalTrials.gov (Reg. No: NCT02187640).
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Affiliation(s)
- Wai Kit Wong
- />School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Wai Tong Chien
- />School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Wai Ming Lee
- />Forensic Community Psychiatric Nursing Team, Castle Peak Hospital, Tuen Mun, Hong Kong
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Golla U, Gajam PK, Bhimathati SS. Evaluation of diuretic and laxative activity of hydro-alcoholic extract of Desmostachya bipinnata (L.) Stapf in rats. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2014; 12:372-8. [DOI: 10.1016/s2095-4964(14)60029-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kojima R, Nozawa K, Doihara H, Keto Y, Kaku H, Yokoyama T, Itou H. Effects of novel TRPA1 receptor agonist ASP7663 in models of drug-induced constipation and visceral pain. Eur J Pharmacol 2013; 723:288-93. [PMID: 24291101 DOI: 10.1016/j.ejphar.2013.11.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 10/17/2013] [Accepted: 11/03/2013] [Indexed: 12/26/2022]
Abstract
Constipation is a major gastrointestinal motility disorder with clinical need for effective drugs. We previously reported that transient receptor potential ankyrin 1 (TRPA1) is highly expressed in enterochromaffin (EC) cells, which are 5-hydroxytryptamine (5-HT)-releasing cells, and might therefore be a novel target for constipation. Here, we examined the effects of ASP7663, a novel and selective TRPA1 agonist, in constipation models as well as an abdominal pain model. ASP7663 activated human, rat, and mouse TRPA1 and released 5-HT from QGP-1 cells, and oral but not intravenous administration of ASP7663 significantly improved the loperamide-induced delay in colonic transit in mice. While pretreatment with the TRPA1 antagonist HC-030031 and vagotomy both inhibited the ameliorating effect of oral ASP7663 on the colonic transit, both orally and intravenously administered ASP7663 significantly inhibited colorectal distension (CRD)-induced abdominal pain response in rats. Taken together, these results demonstrate that ASP7663 exerts both anti-constipation and anti-abdominal pain actions, the former is likely triggered from the mucosal side of the gut wall via activation of vagus nerves while the latter is assumed to be provoked through systemic blood flow. We conclude that ASP7663 can be an effective anti-constipation drug with abdominal analgesic effect.
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Affiliation(s)
- Ryosuke Kojima
- Pharmacology Research Labs, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba, Ibaraki 305-8585, Japan.
| | - Katsura Nozawa
- Pharmacology Research Labs, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba, Ibaraki 305-8585, Japan
| | - Hitoshi Doihara
- Pharmacology Research Labs, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba, Ibaraki 305-8585, Japan
| | - Yoshihiro Keto
- Pharmacology Research Labs, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba, Ibaraki 305-8585, Japan
| | - Hidetaka Kaku
- Chemistry Research Labs, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba, Ibaraki 305-8585, Japan
| | - Toshihide Yokoyama
- Pharmacology Research Labs, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba, Ibaraki 305-8585, Japan
| | - Hiroyuki Itou
- Pharmacology Research Labs, Astellas Pharma Inc., 21 Miyukigaoka, Tsukuba, Ibaraki 305-8585, Japan
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Tack J, Müller-Lissner S, Stanghellini V, Boeckxstaens G, Kamm MA, Simren M, Galmiche JP, Fried M. Diagnosis and treatment of chronic constipation--a European perspective. Neurogastroenterol Motil 2011; 23:697-710. [PMID: 21605282 PMCID: PMC3170709 DOI: 10.1111/j.1365-2982.2011.01709.x] [Citation(s) in RCA: 179] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although constipation can be a chronic and severe problem, it is largely treated empirically. Evidence for the efficacy of some of the older laxatives from well-designed trials is limited. Patients often report high levels of dissatisfaction with their treatment, which is attributed to a lack of efficacy or unpleasant side-effects. Management guidelines and recommendations are limited and are not sufficiently current to include treatments that became available more recently, such as prokinetic agents in Europe. PURPOSE We present an overview of the pathophysiology, diagnosis, current management and available guidelines for the treatment of chronic constipation, and include recent data on the efficacy and potential clinical use of the more newly available therapeutic agents. Based on published algorithms and guidelines on the management of chronic constipation, secondary pathologies and causes are first excluded and then diet, lifestyle, and, if available, behavioral measures adopted. If these fail, bulk-forming, osmotic, and stimulant laxatives can be used. If symptoms are not satisfactorily resolved, a prokinetic agent such as prucalopride can be prescribed. Biofeedback is recommended as a treatment for chronic constipation in patients with disordered defecation. Surgery should only be considered once all other treatment options have been exhausted.
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Affiliation(s)
- J Tack
- Division of Gastroenterology, University Hospital LeuvenLeuven, Belgium
| | - S Müller-Lissner
- Department of Internal MedicinePark-Klinik Weissensee, Berlin, Germany
| | - V Stanghellini
- Department of Clinical Medicine, University of BolognaBologna, Italy
| | - G Boeckxstaens
- Division of Gastroenterology, University Hospital LeuvenLeuven, Belgium
| | - M A Kamm
- Departments of Medicine and Gastroenterology, St Vincent's HospitalMelbourne, Australia and Imperial CollegeLondon, UK
| | - M Simren
- Department of Internal Medicine, Sahlgrenska University HospitalGöteborg, Sweden
| | - J-P Galmiche
- Department of Liver and Gastroenterology, Institute of Diseases of the Digestive System NantesCHU Nantes, France
| | - M Fried
- Division of Gastroenterology and Hepatology, University Hospital ZurichZurich, Switzerland
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Wald A, Sigurdsson L. Quality of life in children and adults with constipation. Best Pract Res Clin Gastroenterol 2011; 25:19-27. [PMID: 21382576 DOI: 10.1016/j.bpg.2010.12.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 12/09/2010] [Accepted: 12/13/2010] [Indexed: 02/08/2023]
Abstract
This review summarises the literature on quality of life (QOL) assessments in both children and adults with functional constipation. Studies of adults with constipation include subjects from both tertiary care centres and population-based surveys whereas there are no population-based studies in children. The preponderance of evidence indicates that the adverse effects of chronic constipation on QOL in both children and adults are comparable to that seen in other chronic gastrointestinal and non-gastrointestinal disorders. There are no data on the effect of treatment of children with constipation with regard to QOL whereas several studies indicate that successful treatment of constipation in adults has a favourable effect on QOL. The emerging concept in the treatment of chronic constipation is to measure both objective measures such as frequency and ease of defecation and subjective parameters such as QOL.
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Affiliation(s)
- Arnold Wald
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Centennial Building, 4th floor, 1685 Highland Avenue, Madison, WI 53705, United States.
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Méité S, Bahi C, Yéo D, Datté JY, Djaman JA, N'guessan DJ. Laxative activities of Mareya micrantha (Benth.) Müll. Arg. (Euphorbiaceae) leaf aqueous extract in rats. Altern Ther Health Med 2010; 10:7. [PMID: 20158903 PMCID: PMC2830176 DOI: 10.1186/1472-6882-10-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Accepted: 02/16/2010] [Indexed: 12/21/2022]
Abstract
Background Mareya micrantha (Benth.) Müll. Arg. (Euphorbiaceae) is a shrub that is commonly used in Côte d'Ivoire (West Africa) for the treatment of constipation and as an ocytocic drug. The present study was carried out to investigate the laxative activity of Mareya micrantha in albino's Wistar rats. Methods Rats were divided in 5 groups of 5 animals each, first group as control, second group served as standard (sodium picosulfate) while group 3, 4 and 5 were treated with leaf aqueous extract of Mareya micrantha at doses of 100, 200 and 400 mg/kg body weight (b.w.), per os respectively. The laxative activity was determined based on the weight of the faeces matter. The effects of the leaves aqueous extract of Mareya micrantha and castor oil were also evaluated on intestinal transit, intestinal fluid accumulation and ions secretion. Results Phytochemicals screening of the extract revealed the presence of flavonoids, alkaloids, tannins, polyphenols, sterols and polyterpenes. The aqueous extract of Mareya micrantha applied orally (100, 200 and 400 mg/kg; p.o.), produced significant laxative activity and reduced loperamide induced constipation in dose dependant manner. The effect of the extract at 200 and 400 mg/kg (p.o.) was similar to that of reference drug sodium picosulfate (5 mg/kg, p.o). The same doses of the extract (200 and 400 mg/kg, p.o.) produced a significant increase (p < 0.01) of intestinal transit in comparison with castor oil (2 mL) (p < 0.01). Moreover, the extract induced a significant enteropooling and excretion of Cl-, Na+, K+ and Ca2+ in the intestinal fluid (p < 0.01). Conclusions The results showed that the aqueous extract of Mareya micrantha has a significant laxative activity and supports its traditional use in herbal medicine.
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Gastrointestinal symptoms and well-being of adults living on a gluten-free diet: a case for nursing in celiac disease. Gastroenterol Nurs 2009; 32:196-201. [PMID: 19506436 DOI: 10.1097/sga.0b013e3181a85e7b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Women with celiac disease (CD) living on a gluten-free diet (GFD) show a lower health-related quality of life and report a higher rate of gastrointestinal (GI) symptoms than men with CD. Uncertainty exists as to whether GI symptoms may explain the poorer treatment outcome of women with CD. This study was designed to explore relationships of GI symptoms and psychological well-being in men and women with long-standing CD. Patients with CD (n = 108; 59% women), aged 45-64 years, treated with a GFD for at least 8 years were evaluated by the Gastrointestinal Symptom Rating Scale and the Psychological General Well-Being index. The results show that women with a high rate of GI symptoms have no lower level of psychological well-being than corresponding men with CD and that women with CD with reduced psychological well-being have no more GI symptoms than corresponding men. Our results fail to support the notion that the reduced subjective health in CD is explained by GI symptoms. They may be secondary to perceived difficulties in managing everyday life, suggesting that launching a nurse-led follow-up may be helpful, as has been proven to be useful in other lifelong disorders.
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Lämås K, Lindholm L, Stenlund H, Engström B, Jacobsson C. Effects of abdominal massage in management of constipation—A randomized controlled trial. Int J Nurs Stud 2009; 46:759-67. [DOI: 10.1016/j.ijnurstu.2009.01.007] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 01/07/2009] [Accepted: 01/07/2009] [Indexed: 12/18/2022]
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Tack J, Müller-Lissner S. Treatment of chronic constipation: current pharmacologic approaches and future directions. Clin Gastroenterol Hepatol 2009; 7:502-8; quiz 496. [PMID: 19138759 DOI: 10.1016/j.cgh.2008.12.006] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 12/04/2008] [Accepted: 12/05/2008] [Indexed: 02/07/2023]
Abstract
Chronic constipation is a common condition that affects up to 27% of the population. Dietary and lifestyle measures are usually the first-line therapy, but if these fail to have an effect then a variety of prescription and consumer laxatives are available. Traditional laxatives include bulking agents, osmotic agents, stool softeners, and stimulants of the gastrointestinal tract. All have been found to be more effective than placebo at relieving symptoms of constipation, but these results have been obtained primarily in short (4-week) trials and no class of laxative has been shown to be superior to another. Traditional laxatives work in many, but not all, patients and some patients cannot cope with the side effects, unpleasant taste, the requirements of the dosing regimen, or the notion of dose increase. New enterokinetic agents that affect peristalsis through selective interaction with 5-hydroxytryptamine-4 receptors and novel agents acting on intestinal secretion could offer an alternative option for patients with chronic constipation who cannot get adequate relief from current laxatives.
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Affiliation(s)
- Jan Tack
- Division of Gastroenterology, University Hospital, Leuven, Belgium.
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Schmulson Wasserman M, Francisconi C, Olden K, Aguilar Paíz L, Bustos-Fernández L, Cohen H, Passos MC, González-Martínez MA, Iade B, Iantorno G, Ledesma Ginatta C, López-Colombo A, Pérez CL, Madrid-Silva AM, Quilici F, Quintero Samudio I, Rodríguez Varón A, Suazo J, Valenzuela J, Zolezzi A. [The Latin-American Consensus on Chronic Constipation]. GASTROENTEROLOGIA Y HEPATOLOGIA 2008; 31:59-74. [PMID: 18279643 DOI: 10.1157/13116072] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Latin-American Consensus on Chronic Constipation aimed to establish guidelines to improve the identification, diagnosis and treatment of this disorder in the region. Two coordinators and an honorary coordinator established the process and the topics to be discussed, based on a systematic review of the literature published in the previous 10 years, since 1995. Seventeen members participated with the support of their local gastroenterology societies. The members reviewed the different subjects based on the levels of evidence and grades of recommendation; the topics were then discussed in a plenary session. A written report was drafted and the coordinators prepared the final declarations to be submitted to a vote by all the members in October 2006. The consensus concluded that chronic constipation has an estimated prevalence of 5-21% in the region, with a female-to-male ratio of 3:1. Among individuals with constipation, 75% use some type of medication, with more than 50% using home remedies. A diagnosis based on Rome Criteria was recommended and diagnostic testing only in persons older than 50 years or with alarm symptoms. The use of barium enema as an initial investigation was recommended only in countries with a high prevalence of idiopathic megacolon or Chagas' disease. Recommendations on treatment included an increase in dietary fiber of up to 25-30 g/day (grade C). No evidence was found to recommend measures such as exercise, increased water intake, or frequent visits to the toilet. Fiber supplements such as Psyllium received a grade B and pharmacological treatments such as tegaserod and polyethylene glycol, both grade A. There was insufficient evidence to recommend lactulose, but the consensus did not disadvise its use when necessary. Complementary investigations such as colonic transit followed by anorectal manometry and defecography were only recommended to rule out colonic inertia and/or obstructive defecation in patients not responding to treatment. Biofeedback was recommended (grade B) for those with pelvic dyssynergia.
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Affiliation(s)
- Max Schmulson Wasserman
- Laboratorio de Hígado, Páncreas y Motilidad (HIPAM). Departamento de Medicina Experimental. Facultad de Medicina. Universidad Nacional Autónoma de México (UNAM). Hospital General de México. México.
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Wald A, Scarpignato C, Kamm MA, Mueller-Lissner S, Helfrich I, Schuijt C, Bubeck J, Limoni C, Petrini O. The burden of constipation on quality of life: results of a multinational survey. Aliment Pharmacol Ther 2007; 26:227-36. [PMID: 17593068 DOI: 10.1111/j.1365-2036.2007.03376.x] [Citation(s) in RCA: 237] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The impact of constipation on quality of life (QoL) may vary in different cultural or national settings. AIM We studied QoL in a multinational survey to compare different social and demographic groups with and without constipation (defined according to Rome III criteria) and to detect country-specific differences among the groups studied. METHODS Health-related QoL (HRQoL) was assessed with the Short Form 36 (SF-36) questionnaire in 2870 subjects in France, Germany, Italy, UK, South Korea, Brazil and USA. Results Respondents were mainly middle-aged, married or living together and part- or full-time employed. General health status, measured by the SF-36 questionnaire, was significantly worse in the constipated vs. non-constipated populations. RESULTS were comparable in all countries. QoL scores correlated negatively with age. Constipated women reported more impaired HRQoL than constipated men. Brazilians were most affected by constipation as to their social functioning (35.8 constipated vs. 51.3 non-constipated) and general health perception (29.4 constipated vs. 54.4 non-constipated). CONCLUSIONS There are significant differences in HRQoL between constipated and non-constipated individuals and a significant, negative correlation between the number of symptoms and complaints and SF-36 scores. The study detected a correlation of constipation with QoL and the influence of social and demographic factors on HRQoL in constipated people.
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Affiliation(s)
- A Wald
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Bengtsson M, Ohlsson B, Ulander K. Women with irritable bowel syndrome and their perception of a good quality of life. Gastroenterol Nurs 2007; 30:74-82. [PMID: 17440306 DOI: 10.1097/01.sga.0000267924.24180.1a] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Irritable bowel syndrome has a negative impact on a person's quality of life, but only a few existing studies have been based on patients' own perceptions. This study therefore aimed to collect information on the view of female patients with irritable bowel syndrome regarding what constitutes a good quality of life for them and to create a healthcare model for these patients. For the study, 30 women with irritable bowel syndrome (median age, 38.5 years; range, 20-65 years) responded in writing to a single, all-inclusive question: "What is your perception of a good quality of life?" When the questionnaires were returned, there was time for a short dialogue, and notes of the conversations were made. Data were analyzed qualitatively according to Burnard's method of thematic content analysis. The answers also were counted and thereby quantified. The women's perception of a good quality of life could be divided into five categories: (a) physical and mental health, (b) social well-being, (c) welfare, (d) strength and energy, and (e) self-fulfillment. According to the results, a healthcare model for patients with irritable bowel syndrome should include four main areas: (a) treatment of the patient's symptoms, (b) confirmation of the patient, (c) confirmation of the diagnosis, and (d) instruction for the patient. The healthcare model should be focused on the primary care level and should include a longitudinal plan of healthcare that also describes the secondary care level.
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Affiliation(s)
- Mariette Bengtsson
- Division of Gastroenterology and Hepatology, Department of Medicine, Malmö University Hospital, Malmö, Sweden.
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Bengtsson M, Ulander K, Börgdal EB, Christensson AC, Ohlsson B. A course of instruction for women with irritable bowel syndrome. PATIENT EDUCATION AND COUNSELING 2006; 62:118-25. [PMID: 16098703 DOI: 10.1016/j.pec.2005.06.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2005] [Revised: 06/09/2005] [Accepted: 06/27/2005] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The aim of this study was to determine the effects a course of instruction about irritable bowel syndrome (IBS) might have on symptoms, psychological well-being, and medical care requirements in these patients. METHODS Twenty-nine women with IBS participated in a programme of instruction on medical care, physical activity, stress-management, diet and health insurance. The women completed the Gastrointestinal Symptom Rating Scale and the Psychological General Well-Being Index and provided information about their requirements of medical care before and after the course. RESULTS Twenty-three of the women included, completed the questionnaires at 12 months after the course. When comparing these values to those at baseline, there were improvements in abdominal pain (p < 0.037) and vitality (p < 0.045) as well as a reduction in the number of visits to physicians (p < 0.037) and dieticians (p < 0.042). CONCLUSION Information related to the disease, might help women with IBS to perceive less pain and more vitality and thereby experience a higher quality of life. PRACTICE IMPLICATIONS A course of instruction for patients with IBS may be of benefit for the patients, and could be a part of a multicomponent approach in the treatment of this patient group.
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Affiliation(s)
- Mariette Bengtsson
- Department of Clinical Sciences, University Hospital Ing 35, S-205 02 Malmö, Lund University, Sweden.
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Chan L, Mulgaonkar S, Walker R, Arns W, Ambühl P, Schiavelli R. Patient-Reported Gastrointestinal Symptom Burden and Health-Related Quality of Life following Conversion from Mycophenolate Mofetil to Enteric-Coated Mycophenolate Sodium. Transplantation 2006; 81:1290-7. [PMID: 16699457 DOI: 10.1097/01.tp.0000209411.66790.b3] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The benefit of converting renal transplant recipients with gastrointestinal (GI) complaints from mycophenolate mofetil (MMF) to enteric-coated mycophenolate sodium (EC-MPS) has not been evaluated using patient-reported outcomes. METHODS A multicenter, open-label, prospective study was undertaken in MMF-treated renal transplant patients. Patients experiencing GI complaints were converted to equimolar EC-MPS (Cohort A). Patients without GI complaints remained on MMF (Cohort B). At baseline and Visit 2 (4-6 weeks postbaseline), patients completed the Gastrointestinal Symptom Rating Scale (GSRS), Gastrointestinal Quality of Life Index (GIQLI) and Psychological General Well-being Index (PGWBI). At Visit 2, patients and physicians completed the Overall Treatment Effect (OTE) scale for GI symptoms. Additionally, patients completed the OTE for health-related quality of life (HRQoL). Minimal important difference (MID) was calculated for GSRS and GIQLI based on patients' and physicians' OTE evaluation. RESULTS Of 328 patients enrolled (i.e. the intent-to-treat and safety populations), 278 formed the per-protocol population (Cohort A, n=177; Cohort B, n=101). At baseline, Cohort A had significantly worse scores on all GSRS, GIQLI and PGWBI subscales compared to Cohort B (all P<0.0001). All GSRS, GIQLI and PGWBI subscale scores improved significantly in Cohort A between baseline and Visit 2 (all P<0.0001). Mean improvements in all GSRS subscales and most GIQLI subscores exceeded the calculated MID. GSRS, GIQLI and PGWBI subscales remained stable in Cohort B. CONCLUSION This first exploratory study indicates that converting patients with mild, moderate or severe GI complaints from MMF to EC-MPS significantly reduces GI-related symptom burden and improves patient functioning and well-being.
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Affiliation(s)
- Laurence Chan
- University Colorado Health Sciences Center, Denver, CO 80262, USA, and Royal Melbourne Hospital, Parkville, Australia.
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