The digital rectal examination: a multicenter survey of physicians' and students' perceptions and practice patterns.

Objectives: The digital rectal examination (DRE) may be underutilized. We assessed the frequency of DREs among a variety of providers and explored factors affecting its performance and utilization.

Methods: A total of 652 faculty, fellows, medical residents, and final-year medical students completed a questionnaire about their use of DREs.

Partner burden in irritable bowel syndrome.

Background & Aims: Studies have described the burden experienced by caregivers and next of kin to patients with diseases such as cancer. However, the burden of functional gastrointestinal disorders on partners of patients has not been determined. We aimed to quantify the degree of burden to partners of patients with irritable bowel syndrome (IBS), to describe the factors that affect the burden perceived, and to identify the areas of relationship that are affected.

Diagnosis, characterization, and 3-month outcome after detoxification of 39 patients with narcotic bowel syndrome.

Unlabelled: OBFECTIVES: Narcotic bowel syndrome (NBS) is characterized by a paradoxical increase in abdominal pain associated with continued or escalating dosages of narcotics. This study evaluated the clinical and psychosocial features of patients with NBS and the response to detoxification treatment.

Methods: For 2 years, 39 patients seen by the GI consult service at the University of North Carolina at Chapel Hill (UNC) with presumed NBS were placed on a detoxification program.

Parental knowledge of fecal incontinence in children.

Objectives: Fecal incontinence (FI) is a common and stressful symptom of constipation in children. Recurrent FI causes psychological and physiological changes, complicating treatment as symptom duration progresses; however, parental misconceptions about the causes of FI may delay seeking medical care. The aim of the present study was to assess parental knowledge about FI and determine how this relates to the care and treatment of FI.

IBS patients show frequent fluctuations between loose/watery and hard/lumpy stools: implications for treatment.

Objectives: The objectives of this study were to determine how variable stool consistency is in patients with irritable bowel syndrome (IBS) and to assess the relationship between stool consistency and gastrointestinal symptoms.

Methods: Individuals with a physician diagnosis of IBS were recruited by advertisement. Enrollment questionnaires included the Rome III Diagnostic Questionnaire and IBS Symptom Severity Scale.

Development and validation of the irritable bowel syndrome satisfaction with care scale.

Background & Aims: Satisfaction with care is an important measure of quality, from the patients' perspective, and could also affect outcomes. However, there is no standard measure of patient satisfaction for irritable bowel syndrome (IBS) care; a multi-item, condition-specific instrument is needed.

Methods: Using standard qualitative methods, we conducted focus groups to identify items that patients associated with satisfaction in their care for IBS.

Severity in irritable bowel syndrome: a Rome Foundation Working Team report.

Objectives: The concept of severity in irritable bowel syndrome (IBS) is clinically recognized and operative in diagnostic decision making and treatment planning. Yet, there is no consensus on its definition, and there are limited data on the prevalence of severity subgroups, its medical and psychosocial determinants, and its association with other health status measures. The aims of the Rome Foundation Working Team Committee were to summarize current research, to develop a consensus of understanding on this concept, and to make recommendations for its use in research and clinical care.

Characterization of episodes of irritable bowel syndrome using ecological momentary assessment.

Objectives: Patients with irritable bowel syndrome (IBS) report that symptoms occur as episodes. The nature and frequency of episodes have not been well studied.

Methods: Using modified ecological momentary assessment (EMA), we examined clinical factors attributed to IBS symptom episodes and compared them with nonsymptom episode periods in patients with IBS-D (N=21), IBS-C (N=18), or IBS-M (N=19), and healthy controls (N=19).

Abuse, trauma, and GI illness: is there a link?

Our understanding of the relationship of abuse and trauma history with gastrointestinal (GI) disorders has evolved over the last three decades. Although previously seen within a psychiatric context, ongoing studies continue to show that abuse can have multiple effects on GI symptoms, patient illness behaviors, and clinical outcomes. The prevalence of abuse history is greater among those who have more severe symptoms and who are seen in referral settings.

Longitudinal direct medical costs associated with constipation in women.

Background: Although direct medical costs for constipation-related medical visits are thought to be high, to date, there have been no studies examining longitudinal resource utilisation in adults with constipation.

Aim: To estimate the incremental direct medical costs associated with constipation in women.

Methods: This is a nested case-control study.

Psychosocial factors are more important than disease activity in determining gastrointestinal symptoms and health status in adults at a celiac disease referral center.

Background: The relative effects of clinical and psychosocial variables on outcome in celiac disease (CD) has not previously been reported. In adult patients with (CD), we studied the relationships among demographics, psychosocial factors, and disease activity with health-related quality of life (HRQOL), health care utilization, and symptoms.

Methods: Among 101 adults newly referred to a tertiary care center with biopsy-proven CD we assessed: (a) demographic factors and diet status; (b) disease measures (Marsh score, tissue transglutaminase antibody (tTG) level, weight change and additional blood studies); and (c) Psychosocial status (psychological distress, life stress, abuse history, and coping).

The clinical approach to chronic abdominal pain and irritable bowel syndrome in children.

Chronic recurrent abdominal pain is a common complaint evaluated by pediatricians, and a cause of concern for children and parents. Population and school based studies have reported that approximately 8% of children experience chronic abdominal pain. About half of these children will contact a physician about their pain.

Cognitive factors affect treatment response to medical and psychological treatments in functional bowel disorders.

Objectives: For clinical trials in functional bowel disorders (FBD), the definition of a responder, one who meets the predefined criteria for a clinical response, is needed. Factors that determine clinical response aside from treatment itself are unknown. The aim of this study was to determine what baseline and post-treatment factors affect treatment response.

The development and validation of a new coeliac disease quality of life survey (CD-QOL).

Background: Previous studies on coeliac disease (CD)-related quality of life (QOL) have been limited by their use of a 'generic' rather than coeliac disease-specific assessment instruments.

Aim: To develop and psychometrically validate a new coeliac disease-specific instrument, the CD-QOL.

Methods: Through a series of focus groups, we elicited items from patients that related to the specific nature of their disease and its impact on their basic needs.

Conservative and behavioural management of constipation.

This article deals with psychological contributions, such as stool withholding or responses to abuse experiences, to the aetiology of evacuation disorders (with a focus on dyssynergic defecation), and with education and behavioural approaches to treatment.

Irritable bowel syndrome subtypes defined by Rome II and Rome III criteria are similar.

Background: The implications of the Rome III recommendations to change the irritable bowel syndrome (IBS) subtype criteria for stool pattern are unknown.

Aim: (1) Determine the level of agreement between Rome II and Rome III subtypes and (2) compare the behaviors of Rome II and Rome III subtypes over time.

Methods: Female patients (n=148) with Rome II defined IBS were prospectively tracked over 5 consecutive 3-month periods.

International survey of patients with IBS: symptom features and their severity, health status, treatments, and risk taking to achieve clinical benefit.

Background: Although clinicians generally make treatment decisions in irritable bowel syndrome (IBS) related to the type of symptoms, other factors such as the perceived severity and the risks patients are willing to tolerate for effective treatment are also important to consider. These factors are not fully understood.

Objective: To describe among patients with IBS their symptoms and severity, quality of life and health status, medications taken, and the risk that they would take to continue medications for optimal relief.

A focus group assessment of patient perspectives on irritable bowel syndrome and illness severity.

There is a growing need to understand from the patient's perspective the experience of irritable bowel syndrome (IBS) and the factors contributing to its severity; this has been endorsed by the Food and Drug Administration (FDA). Accordingly, we conducted focus groups to address this issue. A total of 32 patients with mostly moderate to severe IBS were recruited through advertising and were allocated into three focus groups based on predominant stool pattern.

Parental worries and beliefs about abdominal pain.

Background: Solicitous parental responses to stomachaches may perpetuate chronic abdominal pain in children. Discussing these issues in clinical practice is difficult because parents feel misunderstood and blamed for their child's pain. Focusing on parental worries and beliefs that motivate solicitous responses may be better accepted.

Atypical antipsychotic quetiapine in the management of severe refractory functional gastrointestinal disorders.

Management of severe refractory functional gastrointestinal disorders (FGIDs) is difficult. Quetiapine, an atypical antipsychotic, may benefit patients by mitigating associated anxiety and sleep disturbances, augmenting the effect of antidepressants, and providing an independent analgesic effect. Outpatient records from a university-based FGID clinic were reviewed, and 21 patients with refractory symptoms who received quetiapine were identified and interviewed.

Recollection of childhood abdominal pain in adults with functional gastrointestinal disorders.

Objective: It is hypothesized that adults who can recall abdominal pain as children are at risk of experiencing a functional gastrointestinal disorder (FGID), but this is not specific to any particular FGID. The aim of this study was to evaluate the association between recollecting abdominal pain as a child and experiencing a FGID.

Material And Methods: A valid self-reported questionnaire of GI symptoms was mailed to a random population-based sample in Olmsted County, Minnesota.

Further characterization of painful constipation (PC): clinical features over one year and comparison with IBS.

Background: There has been some question about the classification of painful constipation (PC) and its relationship to irritable bowel syndrome (IBS), and in particular IBS with constipation (IBS-C). We sought to: (1) compare PC with IBS and its subtypes (IBS-C, IBS-D, and IBS-A) in terms of pain scores, stool habit and clinical features, and to determine which factors predict PC over IBS, (2) determine the variation in pain and stool habit for PC relative to IBS over time, and (3) compare whether there are clinical differences between those with high pain constipation (HPC) and low pain constipation (LPC) over time.

Methods: Among 231 women in an National Institutes of Health trial, Rome II moderate to severe PC (n=41), IBS-A (n=55), IBS-C (n=80), and IBS-D (n=55) received diary cards on stool frequency, consistency, and pain (visual analog scale) daily for 14 days before and after 12-week treatment and at 3-month intervals for 1 year.