Organic Gastrointestinal Diseases Research Articles

PedsQL Gastrointestinal Symptoms Module Item Development

The objective of the present qualitative study was to develop the items and support the content validity for the Pediatric Quality of Life Inventory (PedsQL) Gastrointestinal Symptoms Module for pediatric patients with functional gastrointestinal (GI) disorders and organic GI diseases, hereafter referred to as GI disorders. The iterative process included multiphase qualitative methods. A literature review of GI disorders was conducted to generate domains for the focus interviews. Six pediatric gastroenterologists with extensive clinical experience in GI disorders provided expert opinion regarding the conceptual framework. A total of 98 participants, 46 pediatric patients ages 5 to 18, and 52 parents of patients ages 2 to 18 with physician-diagnosed GI disorders (chronic constipation, functional abdominal pain, irritable bowel syndrome, inflammatory bowel disease [Crohn disease, ulcerative colitis], gastroesophageal reflux disease), participated in the focus interviews and cognitive interviewing phases, including think-aloud and cognitive debriefing protocols. Eleven domains were derived from the qualitative methods involving patient and parent interviews and expert opinion, with content saturation achieved, resulting in 76 items. The 11 domains consisted of items measuring stomach pain, stomach upset, food and drink limits, trouble swallowing, heartburn and reflux, gas and bloating, constipation, diarrhea, worry, medicines, and communication. Qualitative methods involving pediatric patients and their parents in the item generation process support the content validity for the new PedsQL Gastrointestinal Symptoms Module. The PedsQL Gastrointestinal Symptoms Module is undergoing national multisite field testing as the next iterative phase.

Dose Irritable Bowel Syndrome and Dysmotility Have an Autoimmune Origin? (Neurogastroenterol Motil 2011;23:1000-1006, e459)

The etiology of irritable bowel syndrome (IBS) and dysmotility has not been well-established. Organic, pathognomic changes have not been described. Recently, Ohlsson et al1 suggested that higher levels of gonadotropin-releasing hormone (GnRH) IgM antibodies in serum were detected in patients with IBS and dysmotility, but not in organic gastrointestinal (GI) diseases, compared with healthy controls. They evaluated the presence of IgM and IgG antibodies against GnRH in serum using an ELISA method from healthy subjects and patients with GI diseases. The prevalence of GnRH IgM antibodies were higher in IBS and dysmotility patients than those in healthy controls (42% vs 23%, P = 0.008), and the expressed levels were higher (P = 0.000). Patients with celiac disease or inflammatory bowel disease had the same or lower levels of antibodies. The authors concluded that antibodies against GnRH were common in patients with IBS and dysmotility, but not in organic diseases, compared with healthy controls, which might explain the symptoms in a subgroup of patients with these diseases. These findings suggested that IBS and dysmotility to some extent might be of an autoimmune origin.

Placebo responses and placebo effects in functional bowel disorders

The nature and determinants of the placebo response are widely unknown, as are the underlying psychological and biological mechanisms. Placebo response rates in functional bowel disorders (functional dyspepsia, irritable bowel syndrome) trials are similar to those in nonintestinal pain conditions and are comparable with other organic gastrointestinal diseases (duodenal ulcer, inflammatory bowel diseases). In this narrative review, different methodologies (meta-analyses, reanalyses, and experimental setups) are discussed that have been applied to the study of the placebo response in functional dyspepsia and the irritable bowel syndrome.

Gastrointestinal symptoms and obesity: a meta‐analysis

Weight loss is a recognized alarm symptom for organic gastrointestinal (GI) disease, yet the association between obesity and specific GI symptoms remains poorly described. A meta-analysis was conducted to determine which GI symptoms predominate among obese individuals. A search of the literature using the databases MEDLINE, EMBASE PubMed and Current Contents (1950 - November 2011) was conducted. All studies assessing GI symptoms and increasing body mass index (BMI)/obesity were included. English and non-English articles were searched. A random effect model of the studies was undertaken. Overall, significant associations between GI symptoms and increasing BMI were found for upper abdominal pain (odds ratio [OR] = 2.65, 95% confidence interval [CI]: 1.23-5.72), gastroesophageal reflux (OR = 1.89, 95% CI: 1.70-2.09), diarrhoea (OR = 1.45, 95% CI: 1.26-1.64), chest pain/heartburn (OR = 1.74, 95% CI: 1.49-2.04), vomiting (OR = 1.76, 95% CI: 1.28-2.41), retching (OR = 1.33, 95% CI: 1.01-1.74) and incomplete evacuation (OR = 1.32, 95% CI: 1.03-1.71). However, no significant associations were found for all abdominal pain, lower abdominal pain, bloating, constipation/hard stools, fecal incontinence, nausea and anal blockage. Several key GI symptoms are associated with increasing BMI and obesity. In addition, there were a number of other GI symptoms that had no relationship with obesity. A greater knowledge of the GI symptoms associated with obesity along with the physiology will be important in the clinical management of these patients.

Understanding and Treating Abdominal Pain and Spasms in Organic Gastrointestinal Diseases

Abdominal pain and spasms are common symptoms in organic gastrointestinal diseases, yet are associated with significant unmet need in terms of recognition and treatment. The aim of this review was to help physicians to understand the pathophysiology and impact to patients of abdominal pain and spasms in inflammatory bowel disease (IBD) and biliary diseases. This may in turn help in the selection of the most appropriate treatment to improve patients' overall daily functioning and quality of life in addition to reducing health resource utilization. Relative to the healthy colon, the mechanisms of pain generation in IBD include peripheral sensitization, including visceral hypersensitivity, central processing and modulation, and associated features or modifiers. Calcitonin gene related peptide, substance P, transient receptor potential vanilloid type, and serotonin biosynthesis in the colon are implicated in these processes. For biliary pain, important factors include pressure change or high pressure in the gallbladder, gallbladder ejection fraction, and change in the shape of gallbladder. Pain management is multifactorial and may involve psychological and physical methods and drugs (nonsteroidal anti-inflammatory agents, opioids, antispasmodics, with regional and epidural analgesia reserved for severe cases) after appropriate risk-benefit assessment. Antispasmodic agents may be effective in selected patients with IBD, especially those who are in remission and have mild/moderate chronic pain.

Patients with irritable bowel syndrome and dysmotility express antibodies against gonadotropin-releasing hormone in serum

The etiology of irritable bowel syndrome (IBS) and dysmotility is in most cases unknown. Organic, pathognomonic changes have not been described. We have previously demonstrated sporadic expressions of antibodies against gonadotropin-releasing hormone (GnRH) in serum from these patients. The aim of this study was to screen for the presence of GnRH antibodies in healthy subjects and patients with gastrointestinal (GI) diseases. Consecutive patients suffering from either IBS, idiopathic dysmotility, GI complaints secondary to diabetes mellitus, celiac disease or inflammatory bowel disease (IBD) were included. Healthy blood donors served as controls. Blood samples were taken for analyzing IgM and IgG antibodies against GnRH using an ELISA method. Medical records were scrutinized with respect to duration of symptoms, co-existing diseases, drug treatments, hereditary factors, and laboratory analyses. Healthy controls expressed low levels of GnRH IgM antibodies in a prevalence of 23%. The prevalence of GnRH IgM antibodies in IBS and dysmotility patients was 42% (P = 0.008), and the levels were higher (P = 0.000). Patients with diabetes mellitus expressed GnRH IgM antibodies in the same prevalence as controls (25%), but in higher levels (P = 0.02). Patients with celiac disease or IBD had the same or lower levels of antibodies. There were no associations between antibodies, other co-existing diseases or laboratory analyses. Higher levels of GnRH IgM antibodies were detected in patients with IBS and dysmotility, but not organic GI diseases, compared with healthy controls. These findings suggest that IBS and dysmotility to some extent may be of an autoimmune origin.

Use of Selective Serotonin Reuptake Inhibitors and Upper Gastrointestinal Disease

Selective serotonin reuptake inhibitors (SSRIs) are the most widely used antidepressants in the world. Recent studies, however, have raised the concern that SSRIs increase the risk of gastrointestinal dysfunction. Therefore, we conducted a case-control study on gastrointestinal symptoms and endoscopic findings in patients who were taking SSRIs in Japan. Forty-one patients who were taking SSRIs (SSRI-treated group) and 82 age- and sex-matched patients who were not taking antidepressants (control group) were selected from the population of patients who underwent endoscopic examination from January 1, 2005 to March 31, 2010 in our institution, and their subjective symptoms and endoscopic findings were analyzed. Patients who were taking proton pump inhibitors (PPIs) and/or histamine H(2)-receptor antagonists (H2RAs) were excluded from this study. The chief complaints at the endoscopic examination were classified into the following 4 categories: reflux symptoms, dysmotility symptoms, ulcer-like symptoms, and no upper abdominal symptoms. No significant difference was found in the complaint rate of each category between the SSRI-treated and the control groups. No significant differences were found between the groups in endoscopic findings, the LANZA score and the rate of chief complaints in patient classes stratified by the endoscopic finding. It was not evident that SSRIs induced mucosal damage of the upper gastrointestinal tract. And, it is considered that SSRIs do not increase the risk of upper gastrointestinal symptoms in patients treated with SSRIs for 1 month or longer. The present study suggests that SSRI medication does not have a bad influence on gastrointestinal symptoms and gastrointestinal organic diseases.

Prospective Diary Evaluation of Unexplained Abdominal Pain and Bowel Dysfunction: A Population-Based Colonoscopy Study

Diagnostic criteria for irritable bowel syndrome (IBS) have not been validated by prospective symptom diary. We investigated the bowel patterns in community subjects with and without non-organic abdominal pain, and compared the symptoms with subjects fulfilling the Rome II criteria (IBS). From the Swedish population register, a random sample completed an abdominal symptom questionnaire. Responders were subsequently invited for a clinical evaluation and offered a colonoscopy regardless of whether they had abdominal symptoms or not. A total of 268 subjects underwent colonoscopy, clinical evaluation by gastroenterologist, laboratory investigations, and completed the Rome questionnaire and prospective gastrointestinal (GI) symptom diaries for 1 week. Twenty-three subjects of 268 were excluded due to organic GI disease. Subjects recorded 2,194 bowel movements and 370 abdominal pain episodes on 1,504 days. Subjects with pain in the diary (n = 81) had higher stool frequency (P = 0.01), more urgency (P = 0.0002), feelings of incomplete evacuation (P = 0.0002), nausea (P = 0.0009), and abdominal bloating (P = 0.0005) than subjects without pain (n = 151). Twenty-eight subjects (12%) fulfilled the Rome II criteria for IBS. Together, they had 96 pain episodes but only 4% were improved by defecation; 29% of the pain episodes started or worsened after a meal. Subjects with IBS and other subjects with non-organic abdominal pain (n = 64) exhibited no differences in terms of the proportions of pain episodes improved by defecation, bloating, stool frequency, consistency, or defecatory symptoms. Current criteria for IBS that rely on recall of the relationship between abdominal pain and bowel disturbance may overcall this association when measured prospectively.

Fecal calprotectin (FC) in newborns: is it a predictive marker of gastrointestinal and/or allergic disease?

Fecal calprotectin seems to provide a safe and non-invasive means of helping differentiate between patients with organic and non-organic intestinal disease. Aim of our study was to evaluate if FC levels at birth and at first month of age can be a predictive biomarker of organic or functional gastrointestinal disease (FGIDs) and/or allergic disease diagnosed in 2 years old children. Between December 2007 and January 2008 a telephonic interview has been proposed to the parents of 109 consecutive healthy children, in which FC was measured at birth two years before. For our study, a modified version of the original paediatric questionnaire on paediatric functional gastrointestinal disorders (QPGS) was used for the interview. Specific questions were added to detect allergic diseases. We did’nt find any statistically significant result between FC measured at birth and during first month of life in children with allergy or not. The interference of familiarity does not lead to a statistically significant change in the fecal calprotectin values during the first month of life.

Differences in the health-related quality of life, affective status, and personality between irritable bowel syndrome and inflammatory bowel disease patients

To investigate differences in the health-related quality of life (HRQoL), number of stressful life events, affective status, and some personality characteristics between patients with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) as well as their possible role in disease activity. Fifty-six IBS outpatients, age range 25-75 years (mean = 48.64; SD = 13.04) and 43 outpatients with IBD, age range 19-74 years (mean = 42.90; SD = 15.44), participated in this study. Patients filled out the following questionnaires: Short-Form 36 Health Survey, Beck Depression Inventory, Spielberger's Trait-Anxiety Inventory, Big Five Inventory, and Stressful Life Events Questionnaire. There were significant differences in the physical component (F = 10.80, P<0.001) of the general HRQoL as well as in anxiety (F = 7.23, P<0.01) and neuroticism (F = 8.90, P<0.01) between patients with IBS and IBD. IBS patients showed a significantly higher level of anxiety and neuroticism and better physical aspects of general HRQoL compared with IBD patients. The results of standard regression analyses indicated that a significant predictor (beta = -0.44, P<0.01) for the perceived disease activity in IBS was neuroticism as a personality trait. The results of this study show that the patients with IBS are more prone to the effect of psychosocial variables on gastrointestinal symptoms compared with patients with organic gastrointestinal diseases such as IBD. IBS patients experienced a higher level of anxiety and expressed a higher level of neuroticism as a personality trait compared with IBD patients.

OC-090 To determine the negative predictive value of faecal calprotectin in predicting future organic gastrointestinal disease

Introduction Faecal calprotectin (FC) levels can be used to predict the likelihood of relapse in patients with inflammatory bowel disease (IBD)1 and as a non-invasive marker to predict organic gastrointestinal disease (OGID)2 However, long-term follow-up of patients with low FC levels has not been done. Our aim was to determine whether patients with low FC levels develop OGID over a 5-year period. Methods York Hospital serves a population of approximately 280 000 and has measured FC where clinically indicated in patients since 2004. Records of patients with a normal FC ( 1 cm, IBD) in the 5 years subsequent to the index FC measurement. The assay used was the PhiCal Calprotectin Elisa kit with a clinical sensitivity of 74% and specificity of 84% at 50 μg/g.3 Results 118 patients (39 male and 79 female) were identified. The mean age was 40.4 years (SEM 1.3); median age was 41 years (range 15–83). The mean FC level was 13.95 μg/g (SEM 1.04). The median was 10 μg/g (range 5–48). 84 patients were diagnosed with Functional Bowel Disease. No patients during the 5-year follow-up period developed OGID. Conclusion A normal FC has an extremely high negative predictive value for developing OGID over the subsequent 5 years.

Prevalence of functional dyspepsia in an outpatient clinic with primary care physicians in Japan

Since little is known about the prevalence of patients with functional gastrointestinal disorders (FGID), this study was performed to clarify the prevalence of FGID, especially functional dyspepsia (FD), in new patients of an outpatient clinic with primary care physicians in Japan. We analyzed consecutive outpatients (n = 5183) who first visited the Department of General Medicine, Asahikawa Medical College Hospital, between April 2004 and March 2009. Out of 5813 patients, 818 (14.1%) visited because of abdominal symptoms. Final diagnoses of the 818 patients were FGID (n = 320, 39.1%), organic gastrointestinal diseases (n = 237, 28.9%), organic non-GI disease (n = 135, 16.5%), and others (n = 126, 15.4%). The 320 patients with FGID had FD (n = 170), irritable bowel syndrome (IBS) (n = 68), and other FGIDs (n = 88). The rate of FGID or FD in all patients was 5.5% or 2.9%, respectively. Among outpatients (n = 381) who complained of upper abdominal symptoms, approximately 45% had FD. There was no gender difference in the frequency of FGID, FD, or IBS in all ages of patients. A lower incidence of FD was shown in female patients over 70 years old and a higher incidence of IBS in male patients under 29 years old. These results suggest that the prevalence of FGID, especially FD, is very high in an outpatient clinic with primary care physicians in Japan.

Rifaximin pharmacology and clinical implications

Rifaximin is a semisynthetic, rifamycin-based non-systemic antibiotic, with a low gastrointestinal absorption and a good antibacterial activity. The antibacterial action covers Gram-positive and Gram-negative organisms, both aerobes and anaerobes. Its antimicrobial action is based on its property to bind to the β-subunit of bacterial DNA-dependent RNA polymerase inhibiting, thereby, the bacterial RNA synthesis. Rifaximin contributes to restore gut microflora imbalance, becoming an important therapeutic agent in several organic and functional gastrointestinal diseases such as hepatic encephalopathy, small intestine bacterial overgrowth, inflammatory bowel disease and colonic diverticular disease. This antibiotic has the advantage of low microbial resistance and few systemic adverse events and is safe in all patient populations, including young children.

Biopsychosocial approaches to a patient with vomiting of 10 years' duration – a case of temporal lobe epilepsy

BackgroundVomiting is commonly encountered in clinical medicine. When organic gastrointestinal, metabolic, and brain diseases are ruled out, many cases are considered to be functional. We experienced an adult patient with epilepsy whose main symptom was vomiting. Biopsychosocial approaches were needed to control the symptoms.Case presentationA 26-year-old female with a 10-year history of persistent vomiting was found to have temporal lobe epilepsy (TLE). Throughout this time, during which the vomiting had become part of a vicious cycle, her epilepsy was poorly controlled by medication. Biopsychosocial approaches were employed successfully and the patient subsequently undertook training to become a home-helper, started a job, and was able to leave her parents' house and live independently. All of her symptoms resolved after she became self-sufficient.DiscussionVomiting without impaired consciousness is seldom considered to be a manifestation of epilepsy. Difficulty in recording an electroencephalogram (EEG) because of the presence of persistent vomiting delayed the diagnosis. The improvement of symptoms was thought to have been due to the patient's emotional stabilization and physical improvement, which may have stabilized the limbic system.ConclusionWhen an illness persists for many years and conditioning and a vicious cycle occur secondarily, systematic biopsychosocial approaches are needed in addition to general treatment. Also, secondary symptoms make the diagnosis more difficult when efforts at treatment are ineffective.

Hypervigilance in irritable bowel syndrome compared with organic gastrointestinal disease

ObjectiveIrritable bowel syndrome (IBS) patients are suggested to selectively attend to gastrointestinal (GI) sensations compared with healthy controls. However, it remains unclear whether there are differences between IBS and other chronic GI disorders. We aimed to evaluate the presence of hypervigilance towards the GI tract in IBS compared with patients with organic GI diseases. MethodsWe included 36 IBS patients and 40 age- and gender-matched patients with organic GI disease. They completed the Hospital Anxiety and Depression Scale (HADS) and underwent three tests: (1) word association—write down as many words as possible representing signs of disease; (2) word recognition (tachistoscope)—four categories of words (positive affects, non-GI symptoms, GI symptoms, negative affects) displayed for increasing time until identified; (3) word recollection—memorize words (10 GI symptoms, 10 positive affects, 10 negative affects). ResultsThe word-association task did not show group differences. IBS patients were significantly faster than organic GI patients at recognizing words representing GI symptoms (21 vs. 26 ms; P=.04) and negative affects (27 vs. 34 ms; P=.03), but also tended to be faster at recognizing positive affects (24 vs. 29 ms; P=.08) and non-GI symptoms (22 vs. 27 ms; P=.2). Both groups remembered a similar number of words, but IBS patients tended to recall more incorrect GI words than organic patients (1.3 vs. 1.0; P=.06). There were no group differences in HADS scores. ConclusionCompared to patients with organic GI disease, IBS patients seem to be hypervigilant for information regarding GI sensations and maybe also negative information.

The Effect of Shift Work on the Prevalence and Clinical Impact of Functional Bowel Disorders in Nurses

Purpose: The gastrointestinal (GI) tract undergoes circadian fluctuations in a variety of physiologic parameters. There is evidence that disruption of the sleep cycle can impact upon normal gastrointestinal functions. The aim of this study was to determine the effect of shift work on the prevalence and clinical impact of functional gastrointestinal disorders (IBS, functional constipation and diarrhea) in nurses. Methods: Nurses engaged in direct patient care who were employed at a large University Health System within the U.S. were invited to anonymously complete a set of online validated surveys (Rome 3, IBS-QOL, modified sleep 50 questionnaire). Based upon their work schedules, respondents were classified as: permanent day-shift workers, permanent night-shift workers and those rotating between day and night shifts. Participants with self-reported organic GI diseases, previous major GI surgery, or who were pregnant were excluded. Results: Complete data were available for 399 nurses (214 day shift, 110 night shift, and 75 rotating shifts). The main study results can be found in the table. More than 85% of respondents were female. Night shift and rotating nurses were younger than day shift nurses (P < 0.0001). There were no significant differences in BMI between groups. Rotating shift nurses had a significantly higher prevalence of IBS compared to day shift nurses (P= 0.009). Multivariable logistic regression correcting for age & gender (OR = 2.0, 1.12–3.45) as well as sleep quality (OR = 2.14, 1.14–4.03) proved this association to be robust. The prevalence of IBS subtypes (IBS-C, IBS-D, IBS-M) was similar between groups with the exception of IBS-D which was more common in night vs. day shifts nurses (11.3% vs. 5.2%, P= 0.03). There were no significant between group differences in the mean total IBS-QOL scores. The prevalence of functional constipation and diarrhea was similar between the groups. Conclusion: When evaluating patients with IBS, it may be important to consider work schedule. These results support the hypothesis that circadian rhythm and sleep disturbances may play a role in GI symptoms & IBS.Table

Efficient diagnosis of suspected functional bowel disorders

Functional bowel disorders (FBDs) are common disorders that are characterized by various combinations of abdominal pain and/or discomfort, bloating and changes in bowel habits. At present, diagnosing FBDs often incurs considerable health-care costs, partly because unnecessary investigations are performed. Patients are currently diagnosed as having an FBD on the basis of a combination of typical symptoms, normal physical examination and the absence of alarm features indicative of an organic gastrointestinal disease. Basic laboratory investigations, such as a complete blood count, measurement of the erythrocyte sedimentation rate and serological tests for celiac disease, are useful in the initial evaluation. No further investigations are needed for most patients who have typical symptoms and no alarm symptoms. The most important alarm symptoms include signs of gastrointestinal bleeding, symptom onset above 50 years of age, a family history of colorectal cancer, documented weight loss and nocturnal symptoms. The presence of alarm symptoms obviously does not exclude an FBD, but further investigation is needed before confirmation of the diagnosis. For patients with predominant and severe diarrhea, a more thorough diagnostic work-up should normally be considered, including colonoscopy with colonic biopsies and a test for bile-acid malabsorption.

Use of Complementary and Alternative Medicine by Pediatric Patients With Functional and Organic Gastrointestinal Diseases: Results From a Multicenter Survey

Many pediatric patients use complementary and alternative medicine, especially when facing a chronic illness for which treatment options are limited. So far, research on the use of complementary and alternative medicine in patients with functional gastrointestinal disease has been scarce. This study was designed to assess complementary and alternative medicine use in children with different gastrointestinal diseases, including functional disorders, to determine which factors predicted complementary and alternative medicine use and to assess the willingness of parents to participate in future studies on complementary and alternative medicine efficacy and safety. The prevalence of complementary and alternative medicine use was assessed by using a questionnaire for 749 children visiting pediatric gastroenterology clinics of 9 hospitals in the Netherlands. The questionnaire consisted of 35 questions on the child's gastrointestinal disease, medication use, health status, past and future complementary and alternative medicine use, reasons for its use, and the necessity of complementary and alternative medicine research. In this study population, the frequency of complementary and alternative medicine use was 37.6%. A total of 60.3% of this group had used complementary and alternative medicine specifically for their gastrointestinal disease. This specific complementary and alternative medicine use was higher in patients with functional disorders than organic disorders (25.3% vs 17.2%). Adverse effects of allopathic medication, school absenteeism, age <or=11 years, and a low effect of conventional treatment were predictors of specific complementary and alternative medicine use. Almost all (93%) of the parents considered it important that pediatricians initiate complementary and alternative medicine research, and 51% of parents were willing to participate in future complementary and alternative medicine trials. Almost 40% of parents of pediatric gastroenterology patients are turning to complementary and alternative medicine for their child. Lack of effectiveness of conventional therapy, school absenteeism, and adverse effects of allopathic medication are more important predictors of complementary and alternative medicine use than the type of gastrointestinal disease. Because evidence on most complementary and alternative medicine modalities in children with gastrointestinal disorders is lacking, there is an urgent need for research in this field.

Predictors of subjective fatigue in chronic gastrointestinal disease

Fatigue is a common, but poorly understood symptom in patients with chronic gastrointestinal (GI) diseases. To evaluate factors of importance for fatigue in patients with chronic GI diseases, and to compare it with fatigue in the general population. In all, 399 patients attending a GI out-patient clinic completed questionnaires assessing fatigue, sleep disturbances, psychological general well-being and GI symptom severity. The patients were divided into two diagnostic groups: functional GI disorders (n = 112) and organic GI diseases (n = 287). The severity of fatigue was also evaluated in an age- and gender-matched group of 399 individuals from the general population. Both patient groups had more severe fatigue than controls and patients with functional GI disorders were more fatigued than patients with an organic GI disease. Fatigue was associated with psychological general well-being, GI symptom severity, gender, employment status and sleep disturbances. In a linear regression analysis, psychological general well-being (vitality, general health, self-control), sleep disturbances and employment status were independently associated with the severity of fatigue (adjusted R(2) = 55%). Fatigue is a troublesome symptom in a subgroup of patients with chronic GI diseases. These patients have a high symptom burden as regards both GI and psychological symptoms, as well as sleep disturbances.

Self-Administered Cognitive Behavior Therapy for Moderate to Severe Irritable Bowel Syndrome: Clinical Efficacy, Tolerability, Feasibility

Given the limitations of conventional therapies and restrictions imposed on newer pharmacologic agents, there is an urgent need to develop efficacious and efficient treatments that teach patients behavioral self-management skills for relieving irritable bowel syndrome (IBS) symptoms and associated problems. Seventy-five Rome II diagnosed IBS patients (86% female) without comorbid gastrointestinal disease were recruited from local physicians and the community and randomized to either 2 versions of cognitive behavior therapy (CBT) (10-session, therapist-administered CBT vs 4-session, patient-administered CBT) or a wait list control (WLC) that controlled for threats to internal validity. Final assessment occurred 2 weeks after the 10-week treatment phase ended. Outcome measures included adequate relief from pain and bowel symptoms, global improvement of IBS symptoms (CGI-Improvement Scale), IBS symptom severity scale (IBS SSS), quality of life (IBSQOL), psychological distress (Brief Symptom Inventory), and patient satisfaction (Client Satisfaction Scale). At week 12, both CBT versions were significantly (P < .05) superior to WLC in the percentage of participants reporting adequate relief (eg, minimal contact CBT, 72%; standard CBT, 60.9%; WLC, 7.4%) and improvement of symptoms. CBT-treated patients reported significantly improved quality of life and IBS symptom severity but not psychological distress relative to WLC patients (P < .0001). Data from this pilot study lend preliminary empirical support to a brief patient-administered CBT regimen capable of providing short-term relief from IBS symptoms largely unresponsive to conventional therapies.