Angel Alvarez-Sanchez

Determinants of Quality of Life in Irritable Bowel Syndrome

Objectives Health-related quality of life (HRQOL) is a main outcome in irritable bowel syndrome (IBS), but most studies have been conducted on moderate-severe patients. We sought to ascertain the relative contribution of severity, anxiety, and personality to impairment of HRQOL in a sample representative of the entire IBS spectrum. Materials and Methods IBS consulters, IBS nonconsulters, and controls were invited to complete questionnaires designed to measure severity of IBS (Functional Bowel Disease Severity Index), anxiety (State-trait Anxiety Inventory), personality (Minnesota Multiphasic Personality Inventory-2), and HRQOL [Short Form 36 (SF-36)]. The SF-36 scores of the study groups were compared, and a multiple regression model was constructed. Results Sixty-six IBS consulters, 70 nonconsulters, and 117 controls were studied. All 3 groups differed in terms of SF-36 physical (46.5±9.4 vs. 50.5±8.0 vs. 54.5±6.0) and mental composite scores (38.2±12.5 vs. 43.2±12.0 vs. 46.7±10.6). Although physical scores were linked to hypochondriasis (β=−0.39; P<0.001), severity of pain (β=−0.28; P<0.001), and age, mental scores were associated with state anxiety (β=−0.36; P<0.001) and trait anxiety (β=−0.40; P<0.001). Conclusions HRQOL is impaired in all subgroups of IBS sufferers, with the degree of impairment depending mostly on symptom severity and psychologic factors (hypochondriasis and anxiety).

Does progesterone fluctuation across the menstrual cycle predispose to gastroesophageal reflux

ObjectiveGastroesophageal reflux (GER) occurs in 30–50% of all pregnancies. The progressive rise in plasma progesterone has been suggested as a possible mediator of GER during pregnancy. It is not known whether progesterone, at physiological concentrations, has an effect on acid contact time. We sought to evaluate the relationship between progesterone concentrations, lower esophageal sphincter pressure (LESP), and acid contact time across the normal menstrual cycle.MethodsLESP, 24-h ambulatory esophageal pH monitoring, and serum progesterone levels were determined in 19 healthy women known to have normal menstrual cycles. All tests were performed during the follicular phase (days 2–7) and the luteal phase (days 22–28) of one or two consecutive menstrual cycles.ResultsDespite marked oscillations in progesterone levels between the follicular phase (0.37 ± 0.3 ng/ml) and luteal phase (4.64 ± 2.92 ng/ml) we observed no significant differences in LESP (29.82 ± 9.49 vs 30.45 ± 8.56 mm Hg) or 24-h ambulatory pH levels (pH < 4) in total time (3.04 ± 0.3%vs 3.18 ± 2.51%), upright time (4.41 ± 3.54%vs 4.18 ± 3.36%), or supine time (0.77 ± 1.32%vs 1.42 ± 2.18%).ConclusionsThe fluctuations in progesterone levels across the normal menstrual cycle have no significant impact on LESP and 24-h ambulatory pH parameters. Progesterone, at physiological concentrations, does not predispose to GER in healthy menstruating women.

A Nation-Wide Study of Prevalence and Risk Factors for Fecal Impaction in Nursing Homes

Background There are no existing studies that provide data regarding the epidemiology of, and risk factors for, fecal impaction, either in the general population or in any sub-group of people. Objective Estimate the prevalence of and factors associated with fecal impaction on a representative sample of the institutionalized elderly population. Design Two-phase study. Phase 1: pilot study validating the methodology in which all residents of a single nursing home participated. Phase 2: national multi-center cross-sectional study. Setting 34 randomly selected nursing homes. Measurements The presence of fecal impaction and associated factors were evaluated using three different tools: data collected from medical records; a self-completion questionnaire filled out by the subjects or a proxy; and a rectal examination. Subjects Older subjects living in nursing homes. Results The prevalence of chronic constipation was 70.7% (95%CI: 67.3–74.1%), of which 95.9% of patients were properly diagnosed and 43.1% were properly controlled. The prevalence of FI according to patient history was 47.3% (43.6–51.0%) and 6.6% (4.7–8.5%) according to rectal examination. Controlled constipation (OR: 9.8 [5.2–18.4]) and uncontrolled constipation (OR: 37.21 [19.7–70.1]), the number of medications (OR: 1.2 [1.1–1.3]), reduced functional capacity (OR: 0.98 [0.97–0.99]) and the occasional use of NSAIDs were independent risk factors for fecal impaction. Conclusions Constipation affects more than 70% of people living in nursing homes. Although it is properly diagnosed in more than 95% of cases, the disease is only controlled in less than 50%. Constipation, especially when not controlled, is the most significant risk factor leading to fecal impaction, which is prevalent in almost 50% of this population.

Atypical symptoms of gastro-esophageal reflux during pregnancy.

BACKGROUND Pregnancy is associated with an increased incidence of heartburn. However, there is no information for other symptoms related to gastro-esophageal reflux (GOR). AIM to assess the prevalence of atypical symptoms of GOR during pregnancy, and to examine its association with typical GOR symptoms. METHODS we report data for 263 women with a pregnancy of less than 12 weeks. They were interviewed at the end of each trimester of pregnancy and at 1-year post-partum, using the Gastro Esophageal Reflux Questionnaire (GERQ). In the first interview, information about symptoms in the year before pregnancy was also collected with GERQ. RESULTS women suffered atypical GOR symptoms during pregnancy more frequently than in the year before: non-cardiac chest pain (NCCP) (9.1 vs. 1.9%), dysphagia (12.6 vs. 2.3%), globus (33.1 vs. 4.6%), cough (26.6 vs. 6.8%), belching (66.2 vs. 19.4%) and hiccups (19.0 vs. 8.4%). Atypical GOR symptoms in pregnancy showed an association with suffering the same symptom before pregnancy and NCCP, globus, belching and hiccups with suffering typical GOR symptoms in the first trimester. CONCLUSIONS Atypical GOR symptoms are highly prevalent in pregnancy, and are associated with atypical symptoms before pregnancy and with typical symptoms of GOR in the first trimester.