Yuming J. Hu

Selected symptoms associated with sexual and physical abuse history among female patients with gastrointestinal disorders: the impact on subsequent health care visits.

BACKGROUNDnDespite a growing literature pointing to the deleterious health effects of sexual and physical abuse history, few studies provide evidence about which medical symptoms are most affected. The aim of this paper is to determine the impact of sexual and physical abuse history on a selected set of medical symptoms, and to test how such abuse, medical symptoms and functional disability may affect subsequent health care visits.nnnMETHODSnWe studied 239 women from a referral-based gastroenterology clinic; follow-up data were available on 196 of these women. All women were interviewed about sexual and physical abuse history.nnnRESULTSnWomen with abuse history, particularly those with severe abuse, were much more likely to report somatic symptoms related to panic (e.g. palpitations, numbness, shortness of breath), depression (e.g. difficulty sleeping, loss of appetite), musculoskeletal disorders (e.g. headaches, muscle aches), genito-urinary disorders (e.g. vaginal discharge, pelvic pain, painful intercourse), skin disturbance (e.g. rash) and respiratory illness (e.g. stuffy nose). Furthermore, we found that the severity of abuse history, somatic symptoms and functional disability predicted 30% of the variance in health care visits during the subsequent year, and that the effect of abuse severity on visits was explained by abused women having more somatic symptoms and functional disability.nnnCONCLUSIONSnPatients reports of abuse history, somatic symptoms and functional disability appear to be important factors in explaining the number of health care visits among a clinic sample of women with gastrointestinal disorders.

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

Aliment Pharmacol Theru200231, 666–675

Sexual and physical abuse are not associated with rectal hypersensitivity in patients with irritable bowel syndrome

Background: Patients with irritable bowel syndrome (IBS) have reduced pain thresholds for rectal distension. In addition, the prevalence of sexual/physical abuse in referred IBS patients is high and is associated with greater pain reporting, poorer health status, and poorer outcome. This lead to a hypothesis that abuse history may sensitise patients to report pain at a lower threshold. Aim: To compare rectal pain thresholds in women with IBS who had a history of severe abuse to IBS women with no history of abuse. Methods: We studied 74 IBS patients with a history of severe physical and/or sexual abuse and 85 patients with no history of abuse. Abuse history was assessed by a previously validated self-report abuse screening questionnaire. Rectal sensory thresholds were assessed using an electronic barostat and determined by the ascending method of limit (AML) and by the tracking technique. Results: IBS patients with a history of severe abuse had significantly higher rectal pain thresholds, as measured by AML (F (1, 111)u200a=u200a6.06; pu200a=u200a0.015) and the tracking technique (F (1, 109)u200a=u200a5.21; pu200a=u200a0.024). Patients with a history of severe abuse also reported a significantly higher threshold for urgency to defecate (F (1, 113)u200a=u200a11.23; pu200a=u200a.001). Conclusion: Severe sexual/physical abuse is associated with higher urge and pain thresholds for rectal distension in IBS patients. This suggests that the greater pain reporting and poorer health status in IBS patients with abuse history are not related to increased rectal pain sensitivity. Further studies are needed to determine the causes of these findings.

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

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. Clinical, psychosocial, health status, and outcome data were obtained before and after detoxification. Our aims were to: (i) clinically characterize patients with presumed NBS, (ii) assess the clinical response and adverse effects to detoxification, (iii) identify clinical and psychosocial predictors of treatment response, and (iv) determine the clinical outcome at 3 months after detoxification and the time frame for patients who revert back to narcotics.RESULTS:Of the 39 patients detoxified, 89.7% met predefined criteria. Patients were mostly well educated (14.5±2.3 years of school), female (92.3%), and with a variety of diagnoses (21% irritable bowel syndrome IBS/functional, 37% inflammatory bowel disease and other structural, 29% fibromyalgia and other functional somatic, or orthopedic, and 13% postoperative or other). They reported high health-care use (15.3±10.1 MD visits/6 months; 6.5±6.1 hospitalizations/2 years, 6.4±2.0 surgeries/lifetime), and 82.1% were jobless. Despite high dosages of narcotics (total intravenous (IV) morphine equivalent 75.3±78.0u2009mg/day), pain scores were rated severe (52.9±28.8 visual analog scale (VAS); 257.1±139.6 functional bowel disorder severity index (FBDSI); 17.2±10.2 (McGill Pain and greater than labor or postoperative pain). Multiple symptoms were reported (n=17.8±9.2) and rated as moderate to severe. Psychosocial scores showed high catastrophizing (19.9±8.6); poor daily function (Short Form-36 (SF-36) physical 28.3±7.7, mental 34.3±11.0; worse than tetraplegia); 28.2% were clinically depressed and 33.3% anxious (Hospital Anxiety and Depression Scale (HADS)). Detoxification was successfully completed by 89.7%; after detoxification, abdominal pain was reduced by 35% (P<0.03) and nonabdominal pain by 42% (P<0.01) on VAS, and catastrophizing significantly improved (P<0.01). Responder status was met in 56.4% with 48.7% achieving a ≥30% reduction in pain. By 3 months after detoxification, 45.8% had returned to using narcotics. For those who remained off narcotics at 3 months, the VAS abdominal pain score was 75% lower than pretreatment when compared with those who went back on narcotics (24% lower). Successful detoxification and a good clinical response was associated with low abuse potential (Current Opioid Misuse Measure (COMM) score <9).CONCLUSIONS:Despite severe pain, poor coping, and poor health status, almost all patients with NBS undergoing detoxification were able to stop using narcotics and have significant improvement in pain and coping. However, almost ½ reverted to narcotic use at 3 months. Those who stayed off narcotics showed greater improvement in pain scores. This study provides a rationale for treating patients with NBS by detoxification in order to improve their clinical status. Further work is needed to understand the reasons for the high recidivism rate.

Constipation does not develop following elective hysterectomy: A prospective, controlled study

Abstractu2002 Although there have been reports that women develop constipation following hysterectomy, previous studies were either retrospective or uncontrolled. The aim of this prospective, controlled study was to assess whether constipation develops after elective hysterectomy. Women undergoing elective gynaecological surgery were compared to matched non‐surgery controls at enrolment and 3 and 12u2003months after surgery. The subset of women who underwent elective hysterectomy was the study group for the present report. Fifty‐eight of the 132 elective surgery patients underwent hysterectomy and were compared to 123 controls. There was no difference between the groups at any follow‐up point in functional constipation (Pu2003=u20031.0), frequency of stools (Pu2003=u20030.92), stool consistency (Pu2003=u20030.42), straining (Pu2003=u20030.43), feeling of obstruction (Pu2003=u20030.6) or need to manually evacuate stool (Pu2003=u20031.0). Significantly, more hysterectomy patients without baseline pain did develop abdominal pain at 3 or 12u2003months than non‐surgery controls (16.7%vs 3.6%, Pu2003=u20030.008). We conclude that there was no significant change in bowel habit or stool characteristics in women undergoing hysterectomy even though many developed abdominal pain. This prospective, controlled study challenges existing data regarding the effect of hysterectomy on constipation.

Development and validation of the Patient‐Physician Relationship Scale among patients with irritable bowel syndrome

An effective patient‐physician relationship (PPR) is essential to the care of patients with irritable bowel syndrome (IBS). We sought to develop and validate an IBS‐specific instrument to measure expectations of the PPR.

W1378 Patients With IBS Commonly use Narcotics

BACKGROUND: While treating irritable bowel syndrome (IBS) with narcotics is inadvisable (Grunkemeier DMS et al. Clin Gastroenterol Hep 2007), we have observed frequent narcotic use in this population. To better care for these individuals it is important to understand the reasons for their narcotic usage. METHODS: 1,787 adult patients with physician-diagnosed IBS who met Rome III criteria completed an internet-based questionnaire. This assessed:demographic characteristics, clinical features (subtype, duration, severity, most bothersome symptom), self-rated health and quality of life (IBS-QOL), psychological factors (anxiety and depression), health care utilization (number of physician visits for IBS in the last 6 months, hospitalizations in the last 2 years, and lifetime surgeries), satisfaction with care, and medications currently used (Drossman DA et al. J Clin Gastroenterol 2009). Bivariate analyses and then logistic regression analyses were performed to determine factors related to current use of narcotics (other than tincture of opium). RESULTS: A total of 325 (18.2%) patients reported currently using narcotics. On multivariate analyses (see Table) those who had more abdominal pain, lower self-rated health, more IBS related limitations, a greater number of prior hospitalizations and surgeries, and currently used anti-depressants, anxiolytics, and anti-acid medications were all more likely to use narcotics. However, the variance explained in the model was only 9.7%, using a pseudo-R-square approximation of variance. CONCLUSIONS: In this survey of IBS patients, we found that narcotics are commonly used and associatedwith several factors: 1) greater pain with poorer health status, 2) use of psychotropic and anti-acid medications and 3) higher hospitalizations and surgeries. The data also indicate that unmeasured factors to be determined likely explain the propensity for narcotic use. [Supported by NIH R24 DK067674 and International Foundation for Functional GI Disorders.] Logistic Regression Predicting Current Narcotic Use among Patients with IBS (n=1,787)

Narcotic Bowel Syndrome: Characterization of 30 Patients and Preliminary Results After Detoxification

Proof CONTROL ID: 1019563 CURRENT CATEGORY: Neurogastroenterology and Motility PRESENTATION TYPE: AGA Institute Oral or Poster PRESENTER: Douglas Drossman PRESENTER (E-MAIL ONLY): drossman@med.unc.edu

Development and Validation of the Irritable Bowel Syndrome Satisfaction With Care Scale (IBS-SAT)

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. These and additional items identified by experts were placed into a preliminary questionnaire, which was refined through pilot testing and cognitive debriefing by additional patients, as well as standard statistical methods. The resulting instrument and several external validation measures were administered to 300 adult US patients with IBS. Factor analysis was performed to identify clinically relevant subscales and then psychometric properties were assessed. RESULTS: We developed an IBS satisfaction with care scale (IBS-SAT) that has 38 items from 5 clinically relevant subscales (connection with provider, education, benefits of visit, office attributes, and access to care). This IBS-SAT had a high level of internal consistency (Crohnbach’s .96). Convergent validity was established by correlations between the IBS-SAT and a single, global satisfaction with care question (r 0.68; P .001), and a generic, multi-item satisfaction scale (physician satisfaction questionnaire-18) (r 0.75, P .001). Discriminant validity (among known groups) was established across groups that were stratified based on IBS-quality of life (r 0.34; P .0001), IBS severity (functional bowel disorders severity index) (r 0.21; P .001), and number of unmet expectations (r 0.38; P .0001). CONCLUSIONS: The IBSSAT is a validated measure of patient satisfaction with IBS care. As a new, condition-specific instrument, it is likely to be a useful tool for quality measurement, health services research, and clinical trials.

W1387 Preliminary Study on Predictors of Health Status in African-Americans With Functional Bowel Disorders (FBD) Using an NIH Funded Database

days in bed due to GI symptoms in past year, organized into three ordinal categories with none vs. ≤ 1 week vs. > 1 week and (2) number of MD visits over the past 6 months, divided into two categories of≤4 and >4 visits. Predictor variables were stepped into models in the following order: demographic factors (age and education), abuse history (physical, sexual, or any abuse), psychological trait (axis I psychiatric status-DIS, neuroticism-NEO), catastrophizing-CSQ, social support-SSQ, VAS stress, stool frequency, stool consistency (percent time with diarrhea or constipation using the Bristol Stool Form Scale), psychological state (Beck Depression Inventory, SCL-90 GSI), pain cognitions with IMIQ, and barostat tracking pressure. Only those variables with p ≤ 0.10 in bivariate analyses were allowed to enter models. Results: Patients studied had a mean age of 40.0 (± 8.7) years and 14.5 (± 2.4) years of education. (1) The odds of having any days in bed vs. none, or having > 1 week vs. ≤ 1 week over the past year were greater in patients with a history of sexual abuse (OR 7.9, CI:1.6-39.9). Odds of more days in bed were also greater with increase in VAS pain score (OR 1.05, CI: 1.01-1.09) and increasing score on the IMIQ severity/constancy (pain) subscale (OR 3.0, CI:1.4-6.8). (2) Number of physician visits was predicted by greater catastrophizing (OR 1.12, CI:1.01-1.26), andmore days with constipation (OR 1.03, CI:1.001.06). Conclusion: This preliminary analysis suggests that in African American women with moderate to severe FBD, increased days in bed due to GI symptoms was related to a history of sexual abuse and increased pain severity. More physician visits was related to catastrophizing and constipation. Further studies are needed to understand the predictors of healthcare utilization in African Americans. [Supported by NIH R24 DK067674 and T32 DK07634]