Sexual abuse history in GI illness, how do gastroenterologists deal with it?

[Domestic violence and constipation: an integrative review]

OBJECTIVE

To search the literature for evidence of a relationship between domestic violence and constipation.

METHODS

An integrative review was conducted using the six-step approach and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We examined articles published between 2005 and 2015 investigating the correlation between domestic violence and constipation. The search was performed in September and October of 2015 in PubMed, MEDLINE, Scopus, and Web of Science. The selection of articles was performed in three stages: search, pre-selection, and inclusion.

RESULTS

Of 177 articles identified, 11 were included in the review. Of these 11 articles, seven were quantitative, three were qualitative, and one was mixed. Four articles focused on children and adolescents, two investigated medical knowledge regarding the relationship between domestic violence and constipation, one reviewed digestive disorders in the elderly, one evaluated the results of biofeedback for the treatment of constipated individuals with or without a history of violence, and one evaluated evacuatory disorders and correlated the result of defecography with history of domestic violence. Finally, two studies were specialist reports. Level of evidence was 1B and recommendation grade A in three studies. All studies detected a relationship between domestic violence and intestinal constipation.

CONCLUSION

The results of the present review support a correlation between domestic violence and intestinal constipation. The investigation of this relationship is recommended in clinical practice.

The impact of sexual abuse in patients undergoing colonoscopy

Background

Sexual abuse has been linked to strong effects on gastrointestinal health. Colonoscopy can provoke intense emotional reactions in patients with a sexual abuse history and may lead to avoidance of endoscopic procedures.

Objective

To determine whether care around colonoscopy needs adjustment for patients with sexual abuse experience, thereby exploring targets for the improvement of care around colonoscopic procedures.

Methods

Questionnaires were mailed to patients (n = 1419) from two centers within 11 months after colonoscopy. Differences in experience of the colonoscopy between patients with and without a sexual abuse history were assessed and patients' views regarding physicians' inquiry about sexual abuse and care around endoscopic procedures were obtained.

Results

A total of 768 questionnaires were analyzed. The prevalence of sexual abuse was 3.9% in male and 9.5% in female patients. Patients born in a non-western country reported more sexual abuse (14.9%) than those born in a western country (6.3%; p = 0.008). Discomfort during colonoscopy was indicated on a scale from 0 to 10, mean distress score of patients with sexual abuse was 4.8(±3.47) compared to 3.5(±3.11) in patients without a sexual abuse history (p = 0.007). Abdominal pain was a predictor for higher distress during colonoscopy (β = −0.019 (SE = 0.008); p = 0.02, as well as the number of complaints indicated as reason for colonoscopy (β = 0.738 (SE = 0.276); p = 0.008). Of patients with sexual abuse experience, 53.8% believed gastroenterologists should ask about it, 43.4% said deeper sedation during colonoscopy would diminish the distress.

Conclusions

Sexual abuse is prevalent in patients presenting for colonoscopy. Patients with a sexual abuse history experience more distress during the procedure and indicate that extra attention around and during colonoscopy may diminish this distress.

Psychotherapy improved the sleep quality in a patient who was a victim of child sexual abuse: a case report

INTRODUCTION

Victims of child sexual abuse (CSA) often experience symptoms such as recurrent nightmares, which affect their adult life.

AIM

This study aimed to evaluate the effect of psychotherapy on the quality of life and sleep in a female patient with a previous history of CSA.

METHODS

The patient was climacteric (menopausal transition) and treated in an outpatient clinic. She underwent 40 sessions of psychotherapy and was evaluated before and after the sessions using questionnaires and polysomnography (PSG).

MAIN OUTCOME MEASURES

Measurements were taken using the following: Kupperman Index (KI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Prospective and Retrospective Memory Questionnaire, and PSG. Reports of dream content were also evaluated during the study.

RESULTS

After psychotherapeutic intervention, the frequency of nightmares and their attendant suffering decreased. Additionally, the context of the nightmares changed, and a decrease was noted in the KI, BAI, and BDI parameters. The PSG indicated an increase in rapid eye movement sleep.

CONCLUSION

Psychotherapeutic intervention combined with zolpidem and fluoxetine treatment contributed to a resignification of the dreams of a patient with a history of CSA. The treatment also improved the quality of her dreams and her quality of life.