Functional Gastrointestinal Disorders Patients Research Articles

Group counseling psychotherapy for patients with functional gastrointestinal disorders: development of new measures for symptom severity and quality of life.

Functional gastrointestinal disorders (FGID) can benefit from various psychological interventions. The main objective here was to define the contribution of a new psychotherapeutic intervention, group counseling psychotherapy, for the management of FGID patients. Secondary aims included validation of new measures for gastrointestinal symptoms and quality of life in patients with FGID. Fifty patients seen in a tertiary care center were included in a program of 10 weekly sessions of 2 hr each. Gastrointestinal symptoms, quality of life, and psychological conditions were measured before and after treatment by quantitative indices and by qualitative self-analysis. Gastrointestinal index and quality-of-life index were significantly (P < 0.02) improved at the end of the psychotherapeutic intervention (from 77.5 +/- 4.0 to 63.2 +/- 4.3 and from 67.7 +/- 3.9 to 54.9 +/- 3.9, respectively). In a control group of patients observed for a comparable period of time while waiting for the psychotherapy program, gastrointestinal and quality of life indices remained unchanged. The severity of gastrointestinal symptoms and the quality of life deterioration were highly correlated factors (r = 0.8) at entry into the trial, and their improvement with psychotherapy was also correlated (r = 0.6; P < 0.001). Psychological abnormalities were frequent in these patients (anxiety in 31%, somatization in 29%, depression in 26% of the patients). However, no specific disorder could predict the results of the psychotherapeutic intervention. Over the long term (6-24 months after conclusion of treatment), gastrointestinal status, quality of life, and psychological condition were estimated as improved by 53%, 63%, and 67% of the patients, respectively. The gastrointestinal index and quality of life index we developed were validated to detect the disease and to follow its evolution in response to treatment. In conclusion, group counseling psychotherapy offered a significant contribution for the management, improving gastrointestinal symptoms and quality of life, of FGID patients. New measures for symptom severity and quality of life are available.

Personality and physical symptoms in nonpsychiatric patients with functional gastrointestinal disorder

Objective: We investigated the relationship between personality and reported pain and somatic distress in patients with functional gastrointestinal disorder (FGD) without psychopathology. Methods: Fifty-six patients and 55 controls completed Buss–Durkee Hostility Inventory (BDHI), NEO Personality Inventory (NEO-PI), Eysenck Personality Questionnaire (EPQ: N+L scales), and Giessener Physical Complaints Checklist (GBB). Patients also completed McGill Pain Questionnaire (MPQ) and Visual Analogue Scale (VAS) for abdominal pain and target symptom (abdominal distress). Results: Patients displayed significantly higher levels of neuroticism and covert aggression than controls. Number of words chosen (NWC) to describe pain and sensory pain index (MPQ), but not pain intensity on VAS, were predicted by indirect aggression — and less so by neuroticism — in females and covert aggression in males (stepwise regression model). Patients reported far more extraintestinal somatic complaints than controls. Conclusion: Out of nine dimensions of hostility and five dimensions of personality, only neuroticism and concealed aggression are increased in FGD patients without psychiatric comorbidity compared with healthy controls. These personality traits influence pain reports and should be taken into account when evaluating and treating patients with FGD. Neuroticism and concealed aggression are most likely markers of vulnerability to FGD and not merely reflections of being chronic ill or explained by sample bias secondary to illness behavior.

Pain hypersensitivity in patients with functional gastrointestinal disorders: a gastrointestinal-specific defect or a general systemic condition?

Visceral hypersensitivity was shown in patients with functional gastrointestinal disorders (FGID). The mechanisms underlying this sensory dysfunction remain undetermined. The initial hypothesis of a generalized reduction in pain tolerance was rejected by further studies that suggested a normal tolerance to somatic stimuli and led to the generally accepted assumption that pain intolerance is specific and exclusive for visceral stimuli in these patients. We wanted to revisit this theory by examining whether patients with FGID reported perception and tolerance to somatic pain differently from normal subjects and whether the response to somatic pain stimulus was correlated to gastrointestinal symptoms or psychological status or distress. Thirty-three patients with FGID (Rome II criteria)(F/M: 26/7; mean age 48+/-9.9) and 33 normal controls (F/M: 24/9; mean age 44.1+/-6.8) were asked to immerse their nondominant hand into 4 degrees C water for as long as possible (maximum 120 sec). Time before appearance of: (1) discomfort, (2) pain, and (3) withdrawing of the hand were noted. The intensity of pain was rated on a visual analog scale from 0 to 100. Self-report questionnaires were used to assess the severity of gastrointestinal symptoms (St-Luc GI index) and the psychological distress (SCL-90) in the patient group. Data are expressed in seconds as mean +/- SEM. Discomfort sensory thresholds were similar in controls and FGID patients (28+/-3 and 24+/-2, respectively; NS) whereas pain and withdrawing were significantly lower in FGID (41+/-3 and 76+/-6 sec) than in controls (62+/-6 and 102+/-4; P < 0.05). Pain intensity was similar in both groups (64+/-4 vs 67+/-3; NS). Female patients showed lower sensory thresholds than male patients and control females (pain thresholds: 39.8+/-3.4 vs 67.8+/-16.7 and vs 56.8+/-8.7; P < 0.05). Sensory thresholds were not different in subgroups of patients with FGID (irritable bowel syndrome and functional dyspepsia). No correlation was shown between sensory thresholds and gastrointestinal index or SCL 90-test. In conclusion, FGID patients showed a threshold to painful somatic stimulus that was lower than in normal subjects. These findings suggest that patients with FGID may have hyperalgesia and low pain tolerance that is not limited to the viscera, but that is part of a systemic general condition.

Alexithymia and Functional Gastrointestinal Disorders

Background: Although the alexithymia construct was derived from observations of patients with classical psychosomatic diseases, empirical studies have found only a moderate association between alexithymia and inflammatory bowel disease (IBD). Indeed, there is some evidence that alexithymia may be associated more strongly with functional somatic symptoms than with the psychosomatic diseases. The present study examined the relationship between alexithymia and functional gastrointestinal disorders (FGIDs) in a group of 121 FGID patients, and compared the results with findings from a group of 116 IBD patients and a group of 112 healthy subjects. Method: The subjects completed the 20-item Toronto Alexithymia Scale and the Hospital Anxiety and Depression Scale. Results: The FGID group was significantly more alexithymic than the IBD group, and the two gastrointestinal groups were more alexithymic than the normal healthy group. These differences remained even after controlling for the influence of education, gender, anxiety, depression and gastrointestinal symptoms. Conclusions: The finding of a high rate of alexithymia (66%) in the group of FGID patients is consistent with the propensity of these patients to somatization and to high levels of poorly differentiated psychological distress.

Functional Gastrointestinal Disorders and Eating Disorders: Relevance of the Association in Clinical Management

Background: As functional gastrointestinal disorders (FGID) are common in eating disorder patients, we aimed to assess past eating disorders in patients referred for current FGID. Methods: One hundred and twenty-seven consecutive FGID outpatients and 163 patients with gallstone disease (GD) were enrolled. All patients were interviewed to detect GI symptoms (by means of the GI Symptom Rating Scale), lifetime eating disorders (on the basis of DSM-IV criteria), and current psychologic distress (on the Hospital Anxiety and Depression Scale). Results: Past eating disorders were significantly more prevalent in FGID (15.7%) than in GD patients (3.1%) (chi-square = 14.6, P < 0.001). FGID patients with past eating disorders were significantly younger, more educated, more psychologically distressed, more dyspeptic, and more were women than FGID patients without past eating disorders. Conclusions: This study confirms the previously found association between functional GI symptoms and eating disorders and shows that functional GI symptoms may still persist even after the recovery from eating disorders, particularly in psychologically distressed patients.