Irritable bowel syndrome and sexual/physical abuse history.

There is growing evidence that a history of sexual or physical abuse can affect emotional and physical well-being. Within gastroenterology, attention has focused on the increased frequency of abuse history, particularly for patients with refractory functional gastrointestinal (GI) disorders. Furthermore, regardless of diagnosis, abuse history can impair health status and one's ability to cope with one's medical condition.

Impact of sexual and physical abuse dimensions on health status: development of an abuse severity measure.

Objective: Despite the abundant literature showing a relationship of sexual and/or physical abuse history with poor health status, few studies provide evidence about which dimensions of abuse may have a worse impact on health. In female patients with gastrointestinal (GI) disorders, the present study aims to identify which dimensions of abuse history (eg, number of perpetrators, injury) might predict poor current health status, in order to develop an empirically based severity of abuse measure.

Methods: Of a sample of 239 female patients from a referral gastroenterology clinic, this paper primarily focuses on 121 women with a past history of contact sexual abuse (N = 99), and/or life threatening physical abuse (N = 68).

Diagnosis and treatment of irritable bowel syndrome.

Irritable bowel syndrome is a common disorder characterized by symptoms of abdominal pain with diarrhea and/or constipation. It is associated with significant disability and health care costs. A practical approach to diagnosis utilizes the symptom-based Rome criteria.

Newer aspects of the irritable bowel syndrome.

IBS is a challenging, functional GI disorder that affects many individuals around the world. Early life experiences, the biologic nature of the condition, and the psychosocial milieu interact to affect the severity and outcome of symptoms. Most people do not seek medical attention for their GI symptoms, or they require intermittent, limited medical therapy and assurance from their physician.

Gastrointestinal illness and the biopsychosocial model.

The derivation of and concepts underlying the biopsychosocial model have not been well explained. This model does not relate psychosocial processes to illness in a linear fashion (e.g.

Health status by gastrointestinal diagnosis and abuse history.

Background & Aims: Standardized assessment of health status by diagnosis (functional vs. organic) and the relative influence of abuse history on health status have not been studied previously. The aim of this study was to estimate the health status and abuse history for gastrointestinal diagnoses among patients seen in a tertiary-care gastroenterology clinic and to evaluate the relative predictive effects of diagnosis and abuse history on health status.

A preliminary study of patients' concerns related to GI endoscopy.

Objectives: In addition to the well known complications of bleeding and perforation, GI endoscopy also can produce discomfort, anxiety, and dissatisfaction. In this pilot study, our objective was to obtain information on the fears and concerns of patients about to undergo endoscopy and to assess the relationship of such worries to patient satisfaction and difficulty with the procedure.

Methods: At our two referral hospitals, 793 unsedated patients (45% men, 55% women, average 58 yr) were interviewed by GI nurses before the intended procedure.

The role of psychosocial factors in gastrointestinal illness.

Psychosocial factors have a complex relationship with gastrointestinal illness. Early life factors can contribute to illness susceptibility and condition later illness experiences and behaviors. Existing psychosocial factors, gut physiology and pathology are not associated in a linear or causative fashion, but instead interact to determine symptoms and illness behavior.

Sexual and physical abuse history in gastroenterology practice: how types of abuse impact health status.

Objective: There is an increasing amount of literature pointing to a relationship between sexual and/or physical abuse history and poor health status, although few studies provide evidence concerning which aspects of abuse may impact on health. In female patients with gastrointestinal (GI) disorders, the present study examined the effects on health status of: 1) history of sexual abuse and physical abuse, 2) invasiveness or seriousness of sexual abuse and physical abuse, and 3) age at first sexual and physical abuse.

Method: The sample included 239 female patients from a referral gastroenterology clinic who were interviewed to assess sexual and physical abuse history.

Health-care-seeking behaviors related to bowel complaints. Hispanics versus non-Hispanic whites.

Health-care-seeking behaviors related to bowel complaints may vary between ethnic groups. A survey of a nonpatient population in El Paso, Texas, was conducted in order to examine differences in health care behavior related to bowel dysfunction, and in the perception of health and bowel function, in Hispanics and non-Hispanic whites. Data from 905 subjects who were either Hispanic (580) or non-Hispanic white (325) given a forced-choice, self-report questionnaire were used for analysis.

Sexual and physical abuse and gastrointestinal illness. Review and recommendations.

Objectives: To summarize the existing data on abuse history and gastrointestinal illness, suggest a conceptual scheme to explain these associations, suggest ways to identify patients at risk, and provide information about mental health referral.

Data Sources: Review of the pertinent literature by clinicians and investigators at referral centers who are involved in the care of patients with complex gastrointestinal illness and who have experience in the diagnosis and care of patients with abuse history in these settings.

Study Selection: All research articles and observational data that addressed abuse history in gastroenterologic settings.

Diagnosing and treating patients with refractory functional gastrointestinal disorders.

One of the clinician's most difficult tasks is to successfully care for patients with painful and refractory functional gastrointestinal disorders. Because the diagnosis of these disorders is never assured and symptomatic treatments are not always successful, these patients are susceptible to receiving unnecessary, costly, and sometimes risky studies and treatments. This article offers an approach to the diagnosis and care of these patients that emphasizes 1) using a diagnostic strategy that incorporates symptom-based criteria, a screening evaluation, early symptomatic treatment, symptom monitoring, and reassessment; 2) asking several questions during the first visit to assess the psychosocial contributions to the illness; 3) developing an effective patient-physician relationship through empathy, reassurance, education, and a negotiated and realistic treatment plan; and 4) providing the option for psychological consultation and treatment as a way to help the patient better control symptoms.

Psychosocial factors in inflammatory bowel disease.

From the case example, it can be seen that when the physician considered the psychosocial aspects of the disease in the treatment of Ms. B, she was able to make a complete recovery, something the medications themselves had been unable to do. Although originally thought to be a purely psychosomatic illness, research in IBD in the past three decades has shown that psychosocial aspects are an important component of IBD, but they are not the cause of the disease.

Comparison of bowel patterns in Hispanics and non-Hispanic whites.

Survey questionnaires can be used to characterize normal bowel habits and the prevalence of bowel dysfunction. To determine whether ethnic and sex-related differences in bowel patterns exist between Hispanics and non-Hispanics whites, we conducted a survey of a nonpatient population in El Paso, on the U.S.

Functional bowel disorders. A multicenter comparison of health status and development of illness severity index.

In a multicenter study of patients with painful functional bowel disorders (FBD), we compared the demographic, health status, and diagnostic features of patients with FBD and developed a functional bowel disorder severity index (FBDSI) for research and clinical care. Two hundred seventy patients with FBD in the United States, England, and Canada were surveyed on symptoms and health status, and their physicians made a diagnosis and rated illness severity as mild, moderate, or severe. Comparisons of 22 demographic and clinical variables were made by study site in addition to physicians' severity ratings.

The reliability and validity of a sexual and physical abuse history questionnaire in female patients with gastrointestinal disorders.

Although the literature on the psychological and medical sequelae of sexual and physical abuse has been growing, researchers have made few attempts to standardize the measurement of abuse history. The authors of this article report the first standardization of a screening instrument to identify sexual and physical abuse in a medical population. Reliability was assessed using test-retest methodology, and validity was supported by comparison with an interview (criterion validity).

Sexual and physical abuse and gastrointestinal illness.

Background: Clinicians are becoming aware of the increased attention paid to the occurrence of sexual and physical abuse in our society and its consequences. However, only recently has attention been paid to their association with medical and particularly gastrointestinal illnesses.

Methods And Results: Recently, we investigated the frequency of sexual or physical abuse among female patients in our gastroenterology clinic, and their association with health status.

The relationship of psychiatric illness with gastrointestinal disease.

Higher rates of psychiatric comorbidity as well as more impaired psychosocial adjustment occur with the functional bowel disorders and are particularly high in self-selected referral patients compared with community populations. Reciprocally, some studies show higher rates of functional bowel disturbances in patients with psychiatric diagnoses. Remaining alert for and addressing coexisting psychiatric illness will enhance treatment outcome (increased patient compliance, functioning, and satisfaction).

Irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a common medical disorder that is associated with significant disability and health care costs. A practical approach to diagnosis and management of patients afflicted by this disorder has previously been hampered due to incomplete understanding of its pathophysiology, lack of diagnostic precision, and absence of specific treatments. Over the last decade, epidemiological, physiological, and psychosocial data have emerged to improve our understanding of this disorder and its treatment.

Measuring quality of life in inflammatory bowel disease.

In this study, the authors developed a disease-specific health related quality-of-life (HRQOL) measure that differentiated patients with ulcerative colitis (with and without surgery) from patients with Crohn's disease (with and without surgery). The purpose of the measure, which was facilitated by a questionnaire, was to produce a patient-orientated HRQOL index applicable to physicians' day-to-day management, and to provide a quality assurance mechanism to assess outcomes for these chronic diseases. The interview-directed questionnaire contained 47 items covering the following 4 domains: functional/economic, social/recreational, affect/life, and medical/symptoms.