Christopher Radziwon

Negative Aspects of Close Relationships are More Strongly Associated than Supportive Personal Relationships with Illness Burden of Irritable Bowel Syndrome

OBJECTIVE This study assessed the relative magnitude of associations between IBS outcomes and different aspects of social relationships (social support, negative interactions). METHOD Subjects included 235 Rome III diagnosed IBS patients (M age=41yrs, F=78%) without comorbid GI disease. Subjects completed a testing battery that included the Interpersonal Support Evaluation List (Social Support or SS), Negative Interaction (NI) Scale, IBS Symptom Severity Scale (IBS-SSS), IBS-QOL, BSI Depression, STAI Trait Anxiety, SOMS-7 (somatization), Perceived Stress Scale, and a medical comorbidity checklist. RESULTS After controlling for demographic variables, both SS and NI were significantly correlated with all of the clinical variables (SS rs=.20 to .36; NI rs=.17 to .53, respectively; ps<.05) save for IBS symptom severity (IBS-SSS). NI, but not SS, was positively correlated with IBS-SSS. After performing r-to-z transformations on the correlation coefficients and then comparing z-scores, the correlation between perceived stress, and NI was significantly stronger than with SS. There was no significant difference between the strength of correlations between NI and SS for depression, somatization, trait anxiety, and IBSQOL. A hierarchical linear regression identified both SS and NI as significant predictors of IBS-QOL. CONCLUSIONS Different aspects of social relationships - support and negative interactions - are associated with multiple aspects of IBS experience (e.g. stress, QOL impairment). Negative social relationships marked by conflict and adverse exchanges are more consistently and strongly related to IBS outcomes than social support.

Coping Flexibility, GI Symptoms, and Functional GI Disorders: How Translational Behavioral Medicine Research Can Inform GI Practice.

Coping Flexibility, GI Symptoms, and Functional GI Disorders: How Translational Behavioral Medicine Research Can Inform GI Practice

571 Type, Not Number, of Mental-Physical Comorbidities Increases the Severity of GI Symptoms in Patients With More Severe Irritable Bowel Syndrome

BACKGROUND: While irritable bowel syndrome (IBS) is associated with significant mental and physical comorbidity, little is known about the day to day burden (e.g., quality of life [QOL], physical and mental functioning, distress, IBS symptoms) that comorbidity imposes. METHOD: 175 Rome III-diagnosed IBS patients (M age = 41 yrs, 78% Female, 91% Caucasian) completed psychiatric assessments (MINI International Neuropsychiatric Interview), a physical comorbidity checklist as well as the IBS Symptom Severity Scale, IBSQOL, Brief Symptom Inventory (distress, BSI), abdominal pain intensity scale, and the physical (PCS) and mental (MCS) functioning scales of the SF-12 as part of baseline assessment of an NIH clinical trial. RESULTS. IBS patients in this cohort reported an avg. of 5 diagnosed comorbidities (1 mental, 4 physical). Partial correlations indicated that subjects with more comorbidities reported worse QOL after adjusting for confounding variables. The number of physical comorbidities was more strongly associated with the physical aspects of QOL, while the number of mental comorbidities was more strongly correlated with mental aspects of QOL. The number of comorbidities was unrelated to either the intensity of abdominal pain or global severity of IBS symptoms. Multiple linear regression analyses indicated that comorbidity type was more consistently and strongly associated with illness burden indicators than simple disease counts after confounding variables were held constant. Of 10, 296 possible physicalmental comorbidity pairs, 6 of the 10 most frequent dyads involved a combination of conditions (generalized anxiety disorder, major depression, back pain, agoraphobia, tension headache, insomnia) that were consistently associated with illness (QOL, mental and physical functioning, distress) and symptom (IBS symptom severity, abdominal pain intensity) burden indicators. A comorbidity dyad with consistently large effect sizes was low back pain and major depression. For these patients, scores were expected to decrease by 22 points on the IBS QOL, 10.24 on the PCS, 11.76 on the MCS, and increase by 20.61 points on the BSI in comparison to patients who are not diagnosed with MDD and LBP. For the IBS-SSS, the regression coefficient was 89.67. This means that a patient diagnosed with MDD-LBP had IBS symptom severity scores on the IBS-SSS score that, on average, are 89.67 units higher than a patient undiagnosed with MDD and LBP. CONCLUSIONS. Physical-mental comorbidity in IBS is common, associated with increased distress and QOL impairment and, for patients with specific comorbidity profiles, more severe IBS symptoms. The type of reported comorbidities, rather than their number, may be a more useful way of understanding the full scope of their impact in more severely affected IBS patients. This study was funded by NIH Grant DK77738

(Can’t Get No) Patient Satisfaction: The Predictive Power of Demographic, GI, and Psychological Factors in IBS Patients

Goals: The goal of this study is to assess: (1) the relative contribution of patient factors to satisfaction ratings in irritable bowel syndrome (IBS) patients and (2) the relationship between patient satisfaction (PS) and the number of diagnostic tests patients underwent prior to receiving IBS diagnosis. Background: Although PS is regarded as an important indicator of quality of care, little is known about its determinants. Study: A total of 448 Rome III-diagnosed patients (M age=41 y; 79% F), whose GI symptoms were at least moderate in severity completed patient-reported outcome measures as part of pretreatment evaluation of an NIH-funded clinical trial. PS was measured with the 11-point Hospital Consumer Assessment of Healthcare Providers and Systems global rating scale modified to assess for IBS treatments. A series of multiple regression analyses were conducted for demographic, IBS-specific, general physical health, and psychological predictors before running a final model of significant predictors from each domain. Results: The final regression model was significant, F6,419=6.34, P<0.001, R2=0.08, with race, insurance, number of diagnostic tests, and lower neuroticism predicting PS. Medical tests were rendered nonsignificant when history of seeking care from a gastroenterologist was introduced into the equation. Conclusions: Contrary to hypotheses, neither the IBS symptom severity nor quality of life impairment predicted PS. Patient factors such as a neurotic personality style and sociodemographic profile had a significant but modest impact on PS. Pattern of regression analyses suggests that patients may turn to their gastroenterologist for testing for reassurance, which may in the long-term fuel demand for more testing.

863 What Do IBS Symptom Severity Scales Measure? GI Symptoms, Emotions, Cognitions-or Something Else?

Chirag B. Patel, Madhu Ragupathi, Nilesh Bhoot, Thomas B. Pickron, Eric M. HaasBackground: Obstructed defecation syndrome (ODS) is recognized as both a functional (e.g.,anismusoranaldyssynergia)andanatomic(e.g.,rectoceleandinternalrectalintussusception)defecatory disorder of the pelvic floor. The purpose of this study was to determine outcomesand patient satisfaction following stapled transanal rectal resection (STARR) for the surgicaltreatmentofODS.Methods:BetweenMay2006andJuly2009,1,580patientswereevaluatedfor constipation or rectocele-related symptoms. A subset with ODS was assessed with analphysiology studies and defecography. Thirty-seven of these patients were offered STARRprocedure for rectocele and internal intussusception and comprise the cohort of this study.Demographic data and surgical complications were tabulated. Long-term outcomes wereassessed by comparing pre- and post-operative subsets of the Wexner constipation scoringsystem (paired two-tailed Students t-test) as well as patient satisfaction surveys. Results: Atotal of 37 patients (100% female) with a mean age of 52.9 years (range: 31-74 years)underwent STARR procedure. All patients had clinically significant rectocele as evidencedon defecography and 82% had concomitant intussusception. Postoperative complicationsoccurred in 13 patients (35.1%) during 90-day follow-up (table). Two of these patients(5.4%) required reintervention: dilation of stricture in one and transanal excision of staplegranuloma in another. Long-term follow-up was achieved at a mean of 19.3 months (range:3-36 months) in 84% of patients. Mean pre- and post-operative constipation scores were11.1±3.6 (range: 0-17) and 4.0±3.4 (range: 0-11), respectively (p<1.3x10^-9). Overall out-come was reported as excellent or good in 71% of patients, adequate in 22.5%, and poorin 6.5%. When asked in retrospect if they would undergo the procedure again, 77%responded affirmatively. Of note, 42% of these patients experienced postoperative complica-tions. Conclusions: The STARR procedure for ODS may result in significantly improvedpatient outcomes and satisfaction. Most complications were minor and did not requirereoperative interventions. In appropriately selected patients, the STARR procedure was abeneficialoptionfortheanatomicalcorrectionofODSsecondarytorectoceleandintussuscep-tion.Surgical complications following STARR during 90-day follow up (note: some patientsexperienced more than one complication).