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 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper reviews recent psychological studies of patients with the irritable bowel syndrome (IBS) or 'functional abdominal pain'. Many studies have used unreliable or invalid methods of assessment and some have confused personality with treatable psychiatric illness. Reliable and valid measures have indicated that 40-50% of patients with recently diagnosed functional abdominal pain have demonstrable psychiatric illness; these patients have a worse prognosis than those who are psychologically normal. When psychiatric disorder is diagnosed in a patient with IBS there are three possibilities: (1) The patient may have developed abdominal and psychiatric symptoms simultaneously in which case treatment of the latter may relieve the bowel symptoms. (2) Psychiatric disorder may precipitate increased concern about bowel symptoms, and consequent attendance at the gastroenterology clinic, of those with chronic mild symptoms. In this case it is illness behaviour, rather than abdominal symptoms, that is caused by the anxiety/depression. (3) Those with chronic neurotic symptoms as part of their personality must be screened for organic disease if they have a fresh onset of bowel symptoms; but they are at high risk of becoming persistent clinic attenders. Further research is needed to clarify when psychological abnormalities play a role in the aetiology of IBS and when they are coincidental, but lead to illness behaviour. The role of psychological factors in the aetiology of the irritable bowel syndrome (IBS) is far from clear, but a review of the literature suggests that some consistent patterns are emerging in spite of methodological problems. There have been three major defects with studies that have linked IBS with neurotic symptomatology. First, the measurement of psychological factors has generally been imprecise. Second, most studies have considered IBS patients as a single group, without making allowance for differing symptom patterns. Third, conclusions have been drawn about hospital samples and extrapolated to all IBS subjects, without taking account of factors which affect consulting behaviour. Most studies have been concerned with psychological factors so these will be considered in most detail.
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PMID:Psychological factors in the irritable bowel syndrome. 331 78

A double blind placebo controlled trial of ispaghula husk in 80 patients with irritable bowel syndrome is reported. Global assessment judged treatment to be satisfactory in 82% of patients receiving ispaghula and 53% of the placebo group (p less than 0.02). Bowel habit was unchanged in the placebo group, while constipation significantly improved in patients taking ispaghula (p = 0.026). Transit time decreased significantly in those taking ispaghula compared with placebo (p = 0.001), especially in patients with initially high transit times. Abdominal pain and bloating improved in both groups, with no significant differences between ispaghula and placebo. Four of the eight withdrawals on ispaghula and 10 of the 15 withdrawals on placebo were because of treatment failure. Ispaghula significantly improves overall well being in patients with irritable bowel syndrome, and in those with constipation favourably affects bowel habit and transit time.
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PMID:Double blind study of ispaghula in irritable bowel syndrome. 332 56

Twenty-six Nigerians with irritable bowel syndrome are reported. Twenty-three patients (88.46%) belong either to the middle or upper socioeconomic class; 16 patients (61.5%) had predominantly constipation. Six of the patients (23.1%) had their first symptoms before the age of 15 years. No sex preference is shown by this study. The most common symptoms are flatulence and abdominal pain, which is relieved by bowel motion, belching, and/or passage of flatus. Cow's milk, stress, and a local diet of beans are the most common aggravating factors, while another local high-fiber diet of cassava was found helpful in reducing the intensity and frequency of symptoms in some patients.
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PMID:Irritable bowel syndrome in Nigerians. 334 88

The aim of this work was to answer the two following questions: 1) is there any difference between the right colonic, the left colonic, and the rectosigmoid motility? 2) does the rectosigmoid junction (radiological and endoscopic entity) exhibit a specific motility pattern? Colonic motility was assessed by electromyography. We used an intraluminal probe supporting 15 groups of 3 ring electrodes. Inside the probe a lead pellet was placed opposite each electrode. The probe was inserted through the colon by colonoscopy. A visual analysis of the signal was performed and we distinguished: Long Spike Bursts (LSB) activity (propagating in oral or aboral direction or not propagating) from Short Spike Bursts (SSB) activity as previously described. Twenty patients suffering from the irritable bowel syndrome included in a subgroup defined as abdominal pain, were studied, and two groups were defined as follows: the tip of the probe was positioned in the caecum in 9: group "Right colon" patients. An electrode was specifically located on the rectosigmoid junction in 15: group "Junction" patients. In the "Right colon" group, the postprandial increase of LSB activity in the rectosigmoid lasted longer than in the right and left colons. During the postprandial period, the right colon exhibited a lower LSB activity than the rectosigmoid (p less than 0.01). After the meal LSB activity propagating in aboral direction was increased in the right colon while it was inhibited in the rectosigmoid. LSB activity propagating in the oral direction was increased both in the right colon and rectosigmoid after the meal. In the "Junction" group, we observed a specific myoelectrical activity at the rectosigmoid junction.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Colonic response to the meal of the right colon, the left colon, the rectosigmoid and the rectosigmoidal junction in digestive functional disorders]. 338 55

In this multivariate analysis of the irritable bowel syndrome (IBS) we describe the symptomatic and psychologic features of the condition and their possible contributions to health care seeking. We studied 72 IBS patients, 82 persons with IBS who had not sought medical treatment, and 84 normal subjects. All subjects received complete medical evaluation, diary card assessment of abdominal pain and stool habit, and standard psychologic tests of pain, personality, mood, stressful life events, illness behavior, and social support. Pain and diarrhea were the most important symptoms associated with patient status. When controlling for these symptoms we found that (a) IBS patients have a higher proportion of abnormal personality patterns, greater illness behaviors, and lower positive stressful life event scores than IBS nonpatients (p less than 0.001) and normals (p less than 0.001); (b) IBS nonpatients, although psychologically intermediate between patients and normals, are not different from normals (p less than 0.21); and (c) IBS nonpatients have higher coping capabilities, experience illness as less disruptive to life, and tend to exhibit less psychologic denial than patients. These factors may contribute to "wellness behaviors" among people with chronic bowel symptoms. We conclude that the psychologic factors previously attributed to the IBS are associated with patient status rather than to the disorder per se. These factors may interact with physiologic disturbances in the bowel to determine how the illness is experienced and acted upon.
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PMID:Psychosocial factors in the irritable bowel syndrome. A multivariate study of patients and nonpatients with irritable bowel syndrome. 339 17

Women with symptoms indicative of irritable bowel syndrome who had not consulted a physician were compared with female patients at a gastroenterology clinic to investigate whether self-selection for treatment accounts for psychologic abnormalities in clinic patients' with irritable bowel syndrome. Two sets of diagnostic criteria were compared: restrictive criteria based on the work of Manning and conventional criteria (abdominal pain plus altered bowel habits). Lactose malabsorbers were included as a control group because they have medically explained bowel symptoms similar to those that define irritable bowel syndrome. Thus they control for the causative effects of chronic bowel symptoms on psychologic distress. Women who met restrictive criteria for irritable bowel syndrome but had not consulted a physician had no more symptoms of psychologic distress on the Hopkins Symptom Checklist than asymptomatic controls. However, medical clinic patients with both irritable bowel syndrome and lactose malabsorption had significantly more psychologic symptoms than asymptomatic controls or nonconsulters with the same diagnoses. Individuals who met only the conventional criteria for irritable bowel syndrome reported more psychologic distress than controls, whether or not they consulted a physician. These results suggest that (a) symptoms of psychologic distress are unrelated to irritable bowel syndrome but influence which patients consult a doctor and (b) conventional diagnostic criteria identify more psychologically distressed individuals than do restrictive criteria.
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PMID:Symptoms of psychologic distress associated with irritable bowel syndrome. Comparison of community and medical clinic samples. 339 18

Disturbances in gut motor activity have been proposed as a characteristic phenomenon in patients with irritable bowel syndrome (IBS). The symptoms are often associated with food intake. Several neuropeptides have a stimulatory or inhibitory effect on intestinal smooth muscle contraction. Studies on basal and postprandial plasma levels of different neuropeptides have therefore been performed in patients with IBS and been compared with those of a control group. In the whole group of IBS patients no typical gut hormone profile was found in plasma. When the IBS patients were divided into subgroups based on the predominant syndrome changes in the plasma levels of gastrin, motilin and pancreatic polypeptide (PP) were seen. In diarrhoea fasting levels of motilin and PP and postprandial level of PP were increased. In constipated patients fasting levels of gastrin and motilin and postprandial levels of gastrin, motilin and PP were decreased. Fasting and postprandial levels of gastrin were also decreased in patients with predominantly abdominal pain.
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PMID:Are gut peptides responsible for the irritable bowel syndrome (IBS)? 347 12

Nonulcer dyspepsia remains a difficult disorder to treat because it is a heterogeneous syndrome. Once patients with the irritable bowel syndrome, esophagitis, and other organic diseases are excluded, there remain patients with dyspepsia of unknown cause (termed "essential dyspepsia") and patients with dyspepsia plus symptoms of gastroesophageal reflux without esophagitis. The aim of this study was to determine whether cimetidine or pirenzepine is efficacious in relieving the symptoms of these latter subgroups. Sixty-two consecutive patients were studied who had chronic upper abdominal pain or nausea where endoscopy had shown no evidence of peptic ulceration, esophagitis, or malignancy; 47 had essential dyspepsia, and 15 had dyspepsia plus gastroesophageal reflux. They were initially randomized to either cimetidine or placebo, or pirenzepine or placebo. Patients continued each medication for 1 mo, and, after a washout period, crossed over when again symptomatic; 51 patients completed cimetidine and placebo, and 50 completed pirenzepine and placebo. The results showed that cimetidine was superior to placebo in decreasing the number of upper abdominal pain episodes weekly and the severity of pain, but the absolute improvement was small. Pirenzepine was not superior to placebo in decreasing symptoms.
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PMID:Randomized, double-blind, placebo-controlled crossover trial of cimetidine and pirenzepine in nonulcer dyspepsia. 351 48

Forty patients with irritable bowel syndrome were randomly allocated to treatment with octylonium bromide (20 mg TID) or cimetropium bromide (50 mg BID) in a double-blind trial lasting for six weeks. Drugs were taken before meals, according to a double-blind schedule. Clinical evaluations were made of digestive and other symptoms, objective findings (pain at palpation, contracted colon, tympanites), and overall effectiveness of treatment. Statistically significant decreases in severity of abdominal pain and subjective scores for bowel habits were obtained in both groups. The only statistically significant differences between treatments were in nondigestive symptoms (asthenia, palpitations, tremor, headache, etc.), which improved more in the cimetropium bromide group. No severe side effects were observed in either treatment group.
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PMID:Double-blind study of a new antimuscarinic, cimetropium bromide, in patients with irritable bowel syndrome. 352 59

Dyspepsia or indigestion is one of the most common disorders that is managed by general practitioners and gastroenterologists. Non-ulcer dyspepsia can be defined as upper abdominal pain or nausea in patients in whom endoscopy reveals no evidence of peptic ulceration or gastric cancer. Non-ulcer dyspepsia is a heterogeneous disorder and can be the result of such diverse entities as the irritable bowel syndrome, duodenitis or gastro-oesophageal reflux, or may be idiopathic ("essential" dyspepsia). This review traces the development of modern thought on dyspepsia and non-ulcer dyspepsia, from the 16th century to the present.
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PMID:Dyspepsia and non-ulcer dyspepsia: an historical perspective. 354 May 42


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