Charles D. Gerson

Irritable bowel syndrome: an international study of symptoms in eight countries.

Objectives This report is a preliminary comparative study of irritable bowel syndrome symptoms in eight countries, USA, Mexico, Canada, England, Italy, Israel, India, and China. We also assessed global symptom patterns and correlations and relationships to several psychosocial variables. Methods Two hundred and thirty-nine participants completed a bowel symptom scale composed of four symptoms, abdominal pain or discomfort, bloating, diarrhea, and constipation as well as two psychosocial questionnaires, quality of relationship and attribution of symptoms to physical or emotional factors. Results Pain score in Italy, with the least urban population, was significantly higher than six of the seven other countries whereas it was lowest in India and England. Bloating was highest in Italy and constipation was highest in Mexico, both significantly higher than five other countries. Diarrhea was higher in China than five other countries. All significance values were P<0.05. Globally, diarrhea was less common than constipation, P<0.001 and bloating significantly correlated with constipation as well with pain, P<0.05. Composite analysis of psychosocial variables and symptoms indicated that family conflict correlated directly, P<0.05, whereas family support correlated indirectly, P<0.01, with pain and bloating. Pain, bloating and diarrhea were significantly attributed to physical etiology, P<0.01, whereas only diarrhea was attributed to emotional cause, P<0.05. Conclusion This study suggests that there are significant variations in irritable bowel syndrome symptoms in different geographic locations around the world. Various hypotheses that may explain our data such as cultural beliefs, gut contamination, urban and rural location, dietary practice, and psychosocial factors should be further investigated.

A collaborative health care model for the treatment of irritable bowel syndrome.

BACKGROUND & AIMS There have been few reports of successful treatment of chronically symptomatic patients with irritable bowel syndrome. We performed a preliminary single center study to evaluate a new collaborative treatment model that used both gastroenterologist and psychologist working together, compared to medical treatment or psychological treatment alone. A second goal was to determine the sample size that would be necessary to definitively demonstrate efficacy of such a collaborative treatment program. METHODS Forty-one patients with irritable bowel syndrome, seen in a tertiary setting, were randomly assigned to the 3 treatment groups. The research design was weighted toward collaborative treatment, which consisted of 3 biweekly visits. A series of questionnaires, including a 2-week daily diary as well as measures of quality of life, anxiety, depression, and relationships, were administered before treatment, after treatment, and again 3 months later. At termination of the study, patients completed a global assessment scale. RESULTS Sixteen patients completed the collaborative program, 8 completed medical treatment directed at gastrointestinal function, and 6 completed psychological therapy. Eleven patients dropped out of the study; 2 had organic disease. Intent to treat and per protocol analyses showed that global self-assessment improved significantly at long-term follow-up in the collaborative treatment group (P<0.0002). Abdominal pain, diarrhea, and constipation also improved significantly in the collaborative treatment group (P<0.001). Collaborative treatment was statistically superior to medical treatment alone (P<0.05). The psychological treatment group had 50% improvement in global score. There was no significant improvement in the medically treated group. CONCLUSIONS We have demonstrated that short-term treatment with gastroenterologist and psychologist working together is more effective than medical treatment in relieving symptoms in patients with chronic irritable bowel syndrome. Attributes of a collaborative approach are discussed. These pilot data suggest that collaborative treatment programs should be explored in further studies, and they show the importance of dealing with both mind and body in these patients.

A four-country comparison of healthcare systems, implementation of diagnostic criteria, and treatment availability for functional gastrointestinal disorders A report of the Rome Foundation Working Team on cross-cultural, multinational research

Variations in healthcare provision around the world may impact how patients with functional gastrointestinal disorder (FGIDs) are investigated, diagnosed, and treated. However, these differences have not been reviewed.

Conducting multinational, cross-cultural research in the functional gastrointestinal disorders: issues and recommendations. A Rome Foundation working team report

Cross‐cultural, multinational research can advance the field of functional gastrointestinal disorders (FGIDs). Cross‐cultural comparative research can make a significant contribution in areas such as epidemiology, genetics, psychosocial modulators, symptom reporting and interpretation, extra‐intestinal co‐morbidity, diagnosis and treatment, determinants of disease severity, health care utilisation, and health‐related quality of life, all issues that can be affected by geographical region, culture, ethnicity and race.

Group Hypnotherapy for Irritable Bowel Syndrome With Long-Term Follow-Up

Abstract This study tested whether group gut-focused hypnotherapy would improve irritable bowel syndrome (IBS). Several possible outcome predictors were also studied. Before treatment, 75 patients completed a Symptom Severity Scale, a Mind–Body attribution questionnaire, and a Quality of Relationship Inventory (QRI). The symptom scale was completed posttreatment, 3, 6, and 12 months later. There was significant symptom reduction at each data point (p < .001). Sixty percent had a reduction of more than 50 points, indicative of clinical improvement. Initial severity score (p = .0004) and QRI conflict (p = .057) were directly correlated with a response to hypnotherapy, while attribution of symptoms to mind (emotional) causation was inversely correlated (p = .0056). The authors conclude that group hypnotherapy is effective in patients with IBS.

The importance of relationships in patients with irritable bowel syndrome: a review.

Chronic illnesses such as irritable bowel syndrome are not experienced by patients in isolation. They live in a context of relationships, including spouses and partners, other family members, friends and business associates. Those relationships can have an effect, both positive and negative, on the course of illness and may also be affected by the experience of living with a chronic illness like IBS. We review the general literature regarding the effect of relationship factors on chronic illness followed by a focus on IBS symptomatology. We then discuss the challenges experienced by partners of IBS patients, followed by the effects of spousal violence, the particular relationship of mothers with IBS and their children, the effects of social support, and the importance of family dynamics and IBS. The final segment includes conclusions and recommendations. The topic, relationships and IBS, may have a significant effect on the lives of IBS patients and deserves more attention than it has received.

A cross‐cultural investigation of attachment style, catastrophizing, negative pain beliefs, and symptom severity in irritable bowel syndrome

Little information exists regarding whether psychosocial variables in irritable bowel syndrome (IBS) vary by geographic location. Adult attachment is an important psychological concept rooted in childhood relationship experience that has not been previously studied in IBS. Catastrophizing and negative pain beliefs have been described in IBS and may be affected by attachment. Aims: In this cross‐cultural study, we determined: (i) whether attachment differs between IBS patients and controls, (ii) whether geographic location has a significant effect on attachment style, catastrophizing and negative pain beliefs, and (iii) how all three variables correlate with IBS symptom severity.

Technical report: an ePRO patient reported outcome program for the evaluation of patients with irritable bowel syndrome

Patient reported outcome (PRO) is an important healthcare concept that describes patients participation in their care by self‐evaluation, usually in the form of questionnaires. This report describes an unique computerized technique, electronic PRO (ePRO), for following the progress of patients with irritable bowel syndrome (IBS).