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Lang PA, Thomas L, Lidbury BA. Psychopathology and the Validity of Gastrointestinal Symptom Reporting as Revealed Through Cluster Analyses of MMPI-2-RF Results. Dig Dis Sci 2024; 69:4063-4071. [PMID: 39395928 PMCID: PMC11568024 DOI: 10.1007/s10620-024-08629-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 08/26/2024] [Indexed: 10/14/2024]
Abstract
BACKGROUND Psychological state, self-reported gut symptoms, and somatic complaints are recognized relationships that can impact health assessment and subsequent treatment. AIM To investigate the impact of psychological state and personality on symptom self-reporting and somatization. METHODS Sixty-two (62) participants from the Hunter region of NSW (Australia) undertook a survey of health and lifestyle along with an MMPI-2-RF assessment of personality, psychopathology, and test-taking attitude. Participants also completed the Rome Criteria to assess functional gastrointestinal disorders (FGIDs). To assist the interpretation of MMPI-2-RF results, clustering was applied to identify similar responses and sub-cohort profiles of reporting. RESULTS Cluster analysis revealed four sub-cohorts, stratified by psychopathology, gut-related symptoms, and the validity of self-reported somatic complaints. Sample clustering identified one sub-cohort defined by high rates of negative affectivity and suicidal ideation. Apart from these differences, clusters were uniform for age, sex, smoking, mental health diagnoses, as well as for gut-related conditions. CONCLUSION Results provide further evidence of the interaction of the gut-brain axis and its relationship to serious mental health conditions. It also points to the need to assess the veracity of self-reported symptomatology that may be both pathognomonic for psychopathology but might also be a consequence of gut dysbiosis. Clustering assisted these investigations by defining distinct sub-cohorts based on participant MMPI-2-RF responses.
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Affiliation(s)
- Paris A Lang
- Med-Psych, King St, Newcastle, NSW, 2300, Australia
| | - Linda Thomas
- Med-Psych, King St, Newcastle, NSW, 2300, Australia.
- The National Centre for Epidemiology and Population Health, The ANU College of Health and Medicine, The Australian National University, Canberra, ACT, 2601, Australia.
| | - Brett A Lidbury
- The National Centre for Epidemiology and Population Health, The ANU College of Health and Medicine, The Australian National University, Canberra, ACT, 2601, Australia
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JanssenDuijghuijsen L, van den Belt M, Rijnaarts I, Vos P, Guillemet D, Witteman B, de Wit N. Acacia fiber or probiotic supplements to relieve gastrointestinal complaints in patients with constipation-predominant IBS: a 4-week randomized double-blinded placebo-controlled intervention trial. Eur J Nutr 2024; 63:1983-1994. [PMID: 38653808 PMCID: PMC11329592 DOI: 10.1007/s00394-024-03398-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE To date, no adequate treatment for irritable bowel syndrome with predominant constipation complaints (IBS-C) is available. Fibers with prebiotic properties and probiotic compounds have shown promise in relieving IBS-C-related complaints. We aimed to determine the effects of a 4-week intervention with either an Acacia fiber (AF) with prebiotic properties or a probiotic Bifidobacterium Lactis (BLa80) supplement, compared to a control supplement, on stool pattern, IBS symptoms and Quality of Life (QoL), in IBS-C individuals. METHODS A parallel, double-blind, randomized controlled trial involving 180 subjects meeting the ROME IV criteria for IBS-C was conducted. Following a 4-week observation period, subjects received either AF (10 g), Probiotic BLa80 (4 g; 2 × 1011 CFU/g) or a maltodextrin placebo (10 g) daily for 4 weeks. Subjects reported daily information on stool pattern and gastrointestinal complaints. Before and after each 4-week period, questionnaires on symptom severity, constipation symptoms, anxiety and depression and QoL were completed. Stool mass was measured for 5-days before and after the intervention. RESULTS Stool frequency significantly improved in the AF and Probiotic BLa80 groups compared to placebo (P < 0.001, P = 0.02, respectively). Probiotic BLa80 showed a significant reduction in IBS symptom severity (P = 0.03), for AF a trend towards decreased constipation symptoms (PAC-SYM, P = 0.10) was observed. No significant changes in stool consistency, stool mass or QoL measures were observed between the AF and Probiotic BLa80 compared to placebo. CONCLUSION Daily dietary supplementation with Acacia fiber and probiotic supplements might help IBS-C patients by relieving IBS-related complaints compared to a placebo supplement. REGISTRATION NUMBER OF CLINICAL TRIAL The trial is registered at ClinicalTrials.gov: NCT04798417: Study Details | Nutrition to Relieve IBS Constipation | ClinicalTrials.gov.
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Affiliation(s)
| | - Maartje van den Belt
- Wageningen Food and Biobased Research, Wageningen University & Research, Wageningen, the Netherlands.
| | - Iris Rijnaarts
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
| | - Paul Vos
- Wageningen Food and Biobased Research, Wageningen University & Research, Wageningen, the Netherlands
| | | | - Ben Witteman
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, the Netherlands
- Gastroenterology and Hepatology department, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Nicole de Wit
- Wageningen Food and Biobased Research, Wageningen University & Research, Wageningen, the Netherlands
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Preußel K, Albrecht S, Offergeld R. Compliance of blood donors in Germany with non-sexual deferral criteria. Vox Sang 2024; 119:308-314. [PMID: 38226700 DOI: 10.1111/vox.13586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND AND OBJECTIVES In addition to mandatory testing of blood donations, the deferral of donors in the case of various sexual and non-sexual risk exposures ensures the safety of blood products in Germany. The study aimed to quantify non-disclosure of non-sexual risk exposures, as no data are available so far. MATERIALS AND METHODS We conducted an anonymous online survey among whole-blood donors with successful donations between January and March 2020. Data on travel to countries with endemic malaria, recent mild or febrile infections, tattoos or piercings and drug use were collected. We analysed non-compliance in relation to donor demographics by multivariable analyses. RESULTS Altogether, 5.4% of the donors were non-compliant. Non-disclosure was highest for mild infection with 3.3% of donors, followed by febrile infections (1.4%), travel to malaria endemic countries (0.7%) and body modifications (0.5%). Intravenous drug use was negligible in our study population. Age was a predictor for all investigated risks, with higher prevalence in younger age groups. Prevalence ratios for non-disclosure of body modifications and mild infection were higher in females than males. Donation in blood establishments with mobile services was associated with higher non-disclosure of mild infections. CONCLUSION The considerable degree of non-compliance in some donor groups reflects the prevalence of risk factors in the underlying population (e.g., body modification) as well as probable tendency to socially desirable responding. Donor education should not focus exclusively on sexual risk behaviour, as undisclosed non-sexual exposures may bear risks for recipients and donors.
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Affiliation(s)
- Karina Preußel
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Stefan Albrecht
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Ruth Offergeld
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Hudgi A, Yan Y, Ayyala D, Rao SSC. Accuracy of patient-reported bowel symptoms for fecal incontinence: Historical recall versus prospective evaluation. Neurogastroenterol Motil 2024; 36:e14714. [PMID: 37994807 PMCID: PMC10842103 DOI: 10.1111/nmo.14714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 11/03/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Fecal incontinence (FI) is characterized by both irregular and unpredictable bowel symptoms. An accurate history of symptoms is important for diagnosis and guiding management. Whether a patient's history of bowel symptoms is reliable or if there is recall bias is unknown. AIM To evaluate the accuracy of FI symptoms based on patient's recall compared with a prospective stool diary. METHODS FI (Rome IV) patients completed a bowel questionnaire that included leakage episodes and stool consistency. Subsequently they completed a one-week FI stool diary. Agreement and correlation between historical recall and stool diary were compared. RESULTS One hundred patients participated. On average they reported 12 bowel movements (BMs) and five FI episodes per week. Fifty-two percent had completed under-graduation, 33% high school and 15% postgraduation. Using recall, 23% of patients accurately reported the number of FI episodes, whereas 41% underestimated and 36% overestimated its prevalence compared to the FI diary. Similarly, the concordance for the number of BMs was 30%, urgency was 54%, amount of stool leakage was 16%, and stool consistency was 12.5%. The concordance for nocturnal FI events, use of pads and lack of stool awareness were 63%, 75%, and 66.6% respectively. CONCLUSION There is poor concordance for key bowel symptoms including the number of FI episodes as reported by FI patients, suggesting significant recall bias. Thus, historical recall of chronic FI symptoms may be less accurate. A prospective stool diary could provide more accurate information for the evaluation of FI patients.
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Affiliation(s)
- Amit Hudgi
- Division of Neurogastroenterology/Motility, Augusta University, Augusta, Georgia, USA
| | - Yun Yan
- Division of Neurogastroenterology/Motility, Augusta University, Augusta, Georgia, USA
| | | | - Satish S C Rao
- Division of Neurogastroenterology/Motility, Augusta University, Augusta, Georgia, USA
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Osgood PT, Essner BS, Fountain L, Sullivan EC, Meegan C, Fortunato JE. Intrapyloric Botulinum Toxin Injection for Refractory Nausea and Vomiting in Pediatric Patients. J Pediatr Gastroenterol Nutr 2023; 77:726-733. [PMID: 37794574 DOI: 10.1097/mpg.0000000000003954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
OBJECTIVES Chronic nausea and vomiting may be associated with gastroparesis or other conditions. Poor mechanistic understanding of symptoms often precludes targeted therapy. Numerous case series suggest that intrapyloric botulinum toxin injection (IPBI) may be beneficial in treating gastroparesis and dyspepsia in children. We hypothesized that nausea, vomiting, and other symptoms, independent of gastroparesis, may improve with IPBI. We sought to identify gastric emptying (GE) and manometric patterns in IPBI responders versus nonresponders. METHODS Electronic records of 25 pediatric patients who received IPBI for refractory nausea, vomiting, or both were retrospectively reviewed. We assessed symptom improvement post-IPBI and compared symptoms, GE, and antroduodenal manometry (ADM) findings between IPBI responders and nonresponders. RESULTS At least one major symptom improved in 19 patients (76%) after IPBI. Of 22 patients completing a GE study, 14 had delayed GE with no significant difference between IPBI responders and nonresponders. Of 22 patients who underwent ADM, 18 had normal fasting peristalsis, 5 had postprandial antral hypomotility, 4 had neuropathic findings, and 19 had pylorospasm. IPBI responders, compared to nonresponders, demonstrated higher antral pressures with feeding ( P < 0.0001) and shorter duration of pylorospasm ( P = 0.0036). Antral pressures did not differ significantly with fasting or following motilin agonists. CONCLUSIONS Our findings suggest that IPBI may have therapeutic benefit in pediatric patients with chronic nausea and/or vomiting, independent of gastroparesis. ADM findings of intact antral peristalsis and elevated antral pressures, in conjunction with efficacy of IPBI, support pyloric non-relaxation as a potential contributor to nausea and/or vomiting in pediatric patients.
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Affiliation(s)
- Peter T Osgood
- From the Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Bonnie S Essner
- From the Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Laura Fountain
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Erin C Sullivan
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Carol Meegan
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - John E Fortunato
- From the Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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Dimidi E, Belogianni K, Whelan K, Lomer MCE. Gut Symptoms during FODMAP Restriction and Symptom Response to Food Challenges during FODMAP Reintroduction: A Real-World Evaluation in 21,462 Participants Using a Mobile Application. Nutrients 2023; 15:2683. [PMID: 37375587 DOI: 10.3390/nu15122683] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/04/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND There is limited evidence regarding the use of low FODMAP diet apps. This study aimed to evaluate the effectiveness of an app intended to reduce symptoms in FODMAP restriction and symptoms and tolerance of high FODMAP food challenges during FODMAP reintroduction and personalisation. METHODS Data were collected from 21,462 users of a low FODMAP diet app. Self-reported gut symptoms during FODMAP restriction, reintroduction, and personalisation and dietary triggers were identified from symptom response data for FODMAP food challenges. RESULTS Compared with baseline, at the end of FODMAP restriction, participants (n = 20,553) reported significantly less overall symptoms (11,689 (57%) versus 9105 (44%)), abdominal pain (8196 (40%) versus 6822 (33%)), bloating (11,265 (55%) versus 9146 (44%)), flatulence (10,318 (50%) 8272 (40%)), and diarrhoea (6284 (31%) versus 4961 (24%)) and significantly more constipation (5448 (27%) versus 5923 (29%)) (p < 0.001 for all). During FODMAP reintroduction, participants (n = 2053) completed 8760 food challenges; the five most frequent challenges and n/N (%) of dietary triggers identified were wheat bread 474/1146 (41%), onion 359/918 (39%), garlic 245/699 (35%), milk 274/687 (40%), and wheat pasta 222/548 (41%). The most frequently reported symptoms during food challenges were overall symptoms, abdominal pain, bloating, and flatulence. CONCLUSIONS In a real-world setting, a low FODMAP diet app can help users improve gut symptoms and detect dietary triggers for long-term self-management.
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Affiliation(s)
- Eirini Dimidi
- Department of Nutritional Sciences, King's College London, London SE1 9NH, UK
| | - Katerina Belogianni
- Department of Nutritional Sciences, King's College London, London SE1 9NH, UK
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London SE1 9NH, UK
| | - Miranda C E Lomer
- Department of Nutritional Sciences, King's College London, London SE1 9NH, UK
- Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK
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Hamilton P, Buhler K, MacDonald JK, Kaplan GG, Seow CH, Lu C, Novak KL, Andrews CN, Singh S, Jairath V, Panaccione R, Ma C. Meta-analysis: Placebo rates in microscopic colitis randomised trials and applications for future drug development using a historical control arm. Aliment Pharmacol Ther 2023; 57:837-850. [PMID: 36825479 DOI: 10.1111/apt.17433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/05/2023] [Accepted: 02/11/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Effective medical therapies for patients with microscopic colitis (MC) who fail budesonide are lacking. However, conducting randomised controlled trials (RCTs) in MC has been challenging due to small sample sizes. Understanding placebo responses can help inform more efficient future trials. AIMS The aim of this study is to estimate clinical and histologic placebo response rates and to determine factors associated with placebo response in MC. METHODS EMBASE, MEDLINE, and CENTRAL were searched until 7 January 2022, to identify placebo-controlled RCTs in adult patients with MC. Clinical and histologic response in the placebo arms were pooled using random-effects models. Stratified analyses based on disease- and trial-level characteristics, leave-one-out meta-analysis, and cumulative meta-analysis were performed. RESULTS Twelve RCTs enrolling a total of 391 patients (placebo n = 163) with MC were included. Pooled clinical and histologic placebo response rates were 24.4% (95% CI: 12.4%-38.4%), I2 = 60.8%, p < 0.01, and 19.9% (95% CI: 5.3%-39.0%), I2 = 66.4%, p = 0.01 (tests for heterogeneity), respectively. Clinical response to placebo was numerically higher in patients with lymphocytic compared to collagenous colitis (39.9% vs. 19.8%, p = 0.08). Heterogeneity in clinical response to placebo was significantly reduced when the Miehlke 2014 RCT was excluded in the leave-one-out meta-analysis or when a more stringent secondary definition of response based on the Hjortswang criteria was applied. CONCLUSIONS Approximately one-quarter of patients in MC trials respond to placebo, although with substantial heterogeneity, reflecting the need for standardised outcome definitions and study designs for MC. This analysis also serves to inform future MC trials that may consider incorporating an external, historical placebo control arm, rather than directly randomising patients to placebo.
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Affiliation(s)
- Patrick Hamilton
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Katherine Buhler
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Gilaad G Kaplan
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cynthia H Seow
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cathy Lu
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kerri L Novak
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher N Andrews
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, San Diego, California, USA
| | - Vipul Jairath
- Alimentiv Inc., London, Ontario, Canada
- Division of Gastroenterology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Remo Panaccione
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Ma
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alimentiv Inc., London, Ontario, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Systematic Review of the Effect of a One-Day Versus Seven-Day Recall Duration on Patient Reported Outcome Measures (PROMs). THE PATIENT 2023; 16:201-221. [PMID: 36786931 PMCID: PMC10121527 DOI: 10.1007/s40271-022-00611-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND There is ongoing uncertainty around the most suitable recall period for patient-reported outcome measures (PROMs). METHOD This systematic review integrates quantitative and qualitative literature across health, economics, and psychology to explore the effect of a one-day (or '24-h') versus seven-day (or 'one week') recall period. The following databases were searched from database inception to 30 November 2021: MEDLINE, EMBASE, PsycINFO, Web of Science, EconLit, CINAHL Complete, Cochrane Library, and Sociological Abstracts. Studies were included that compared a one-day (or '24-h') versus seven-day (or weekly) recall period condition on patient-reported scores for PROM and Health-Related Quality-of-Life (HRQoL) instrument scores in adult populations (aged 18 and above) or combined paediatric and adult populations with a majority of respondents aged over 18 years. Studies were excluded if they assessed health behaviours only, used ecological momentary assessment to derive an index of daily recall, or incorporated clinician reports of patient symptoms. We extracted results relevant to six domains with generic health relevance: physical functioning, pain, cognition, psychosocial wellbeing, sleep-related symptoms and aggregated disease-specific signs and symptoms. Quantitative studies compared weekly recall scores with the mean or maximum score over the last seven days or with the same-day recall score. RESULTS Overall, across the 24 quantitative studies identified, 158 unique results were identified. Symptoms tended to be reported as more severe and HRQoL lower when assessed with a weekly recall than a one-day recall. A narrative synthesis of 33 qualitative studies integrated patient perspectives on the suitability of a one-day versus seven-day recall period for assessing health state or quality of life. Participants had mixed preferences, some noted the accuracy of recall for the one-day period but others preferred the seven-day recall for conditions characterised by high symptom variability, or where PROMs concepts required integration of infrequent experiences or functioning over time. CONCLUSION This review identified a clear trend toward higher symptom scores and worse quality of life being reported for a seven-day compared to a one-day recall. The review also identified anomalies in this pattern for some wellbeing items and a need for further research on positively framed items. A better understanding of the impact of using different recall periods within PROMs and HRQoL instruments will help contextualise future comparisons between instruments. Questionnaires ask patients about their health over different time periods (e.g., "what were your symptoms like over the last week?" versus "what were your symptoms like today?"). Studies find that people may report their symptoms as more severe when they are asked to think about their symptoms over the last week compared to the last day. Understanding how different time periods influence patient responses will allow researchers to compare and develop new questionnaires and may help clinicians to choose the best questionnaire to understand their patient's condition. We conducted a systematic literature review on studies which had looked at the impact of using different recall periods on patient responses. We found 24 studies that compared patient scores from questionnaires asking their health "over the last day" compared to "over the last week". Overall, symptoms tended to be reported as more severe and health as poorer when they were reported over the last week compared to the last day on average. We also found 33 studies that asked patients to describe which recall period they preferred. Patients had mixed preferences with more preferring a seven-day recall where symptoms and health impacts varied a lot.
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Are Ecological Momentary Assessments of Pain Valid and Reliable? A Systematic Review and Meta-analysis. Clin J Pain 2023; 39:29-40. [PMID: 36524770 DOI: 10.1097/ajp.0000000000001084] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/17/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to determine the level of evidence for the psychometric properties of Ecological Momentary Assessment (EMA) in populations with persistent pain. MATERIALS AND METHODS Five databases were searched from 1980 to December 2021. Two reviewers independently screened the titles, abstracts, and full text, extracted data, and assessed adherence to reporting standards and methodological rigor before evaluating the quality of evidence. A meta-analysis, including the pooling of correlations for the relevant EMA pain outcomes, was completed. RESULTS Overall, 3270 studies were identified, with 14 studies meeting inclusion criteria. Meta-analyses confirmed good to excellent relationships demonstrated between EMA and recalled pain intensity and interference across different timeframes. Many of the included studies did not fully adhere to recommended reporting standards, and the quality of included studies was either doubtful or inadequate due to methodological flaws. The level of evidence for measurement properties of pain outcomes was low for the criterion validity of pain intensity and interference and very low for reliability and construct validity of pain intensity and interference. DISCUSSION Ecological momentary assessment of pain experience appears both valid and reliable. Although the levels of evidence were low or very low, these findings provide preliminary support for the use of EMA in clinical practice and research settings. Potential strengths of EMA include providing measures with greater ecological validity while also reducing recall bias, both pertinent in pain outcome measurement. More research, including higher-quality studies, is needed to demonstrate further support for EMA, including the need for establishing other types of validity.
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Modest Conformity Between Self-Reporting of Bristol Stool Form and Fecal Consistency Measured by Stool Water Content in Irritable Bowel Syndrome and a FODMAP and Gluten Trial. Am J Gastroenterol 2022; 117:1668-1674. [PMID: 36087104 DOI: 10.14309/ajg.0000000000001942] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/29/2022] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Altered bowel habits constitute a criterion of irritable bowel syndrome (IBS), with the Bristol Stool Form Scale (BSFS) as the recommended tool for assessment of fecal consistency. However, BSFS is devoid of a comprehensive objective evaluation in subjects with IBS. Therefore, we aimed to evaluate the concordance between subjective reporting of BSFS and objective stool water content in subjects with IBS. Furthermore, we evaluated whether intake of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) or gluten would affect stool water content. METHODS Data from a previous crossover trial in IBS with 1-week provocations of FODMAPs, gluten, or placebo were subanalyzed. After each intervention, fecal consistency was subjectively assessed using the BSFS and stool samples were collected. The stool water content was analyzed, where ≤68.5% water content was classified as hard stool, while ≥78% was classified as diarrhea. RESULTS BSFS correlated to stool water content ( r = 0.36, P < 0.0001). The BSFS score increased in parallel with increasing water content, but with considerable overlap between BSFS scores. Stool water content differed between the BSFS categories 1-2, 3-5, and 6-7 (hard, normal, and loose, respectively) ( P < 0.0001). For BSFS categories 1-2, 77% had water content ≤68.5%, whereas for BSFS categories 6-7, 52% had water content ≥78%. There was no difference in stool water content after consumption of FODMAPs, gluten, or placebo ( P = 0.94). DISCUSSION Subjective reporting of BSFS conforms only modestly with stool water content in IBS, warranting caution when subtyping IBS according to the BSFS. High intake of FODMAPs and gluten does not affect stool water content.
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Measurement of Pain and Related Symptoms in Irritable Bowel Syndrome: The Use of Validated Pain Measurement Tools. GASTROINTESTINAL DISORDERS 2022. [DOI: 10.3390/gidisord4010004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
This paper reviews the tools available to assess outcomes of treatment in irritable bowel syndrome, especially the effect on abdominal pain. Tools were identified through a wide-ranging scrutiny of PubMed and Google Scholar, together with a review of further references quoted in those publications. It critically considers their development, relevance and reliability. The Irritable Bowel Severity Scoring System (IBS-SSS) was the first simple method of monitoring the progress of the disease and its treatment. It led on to other instruments, such as The Irritable Bowel Syndrome Quality of Life (IBS-QOL). It is easier to read and faster to complete than the IBS-SSS., However, these and other tools were developed for English speaking populations. This review considers the impact of ethnicity and gender, together with the lack of information on the effect of age on the potential validity of these tools in other populations. Issues with the adequacy and appropriateness of translations of such tools are discussed. The overall conclusion is that there are few tools which meet the criteria necessary to place confidence in their validity as appropriate measures of patient outcomes.
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Bajcar EA, Swędzioł W, Wrześniewski K, Blecharz J, Bąbel P. The Effects of Pain Expectancy and Desire for Pain Relief on the Memory of Pain in Half Trail Marathon Runners. J Pain Res 2022; 15:181-191. [PMID: 35115822 PMCID: PMC8800870 DOI: 10.2147/jpr.s336485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 12/23/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose It has been shown that the memory of pain induced by running might be underestimated. Our previous study showed the contribution of emotional factors to this process. This study aimed to investigate the cognitive factors that might influence the memory of this type of pain, ie expectancy of pain intensity, expectancy of pain unpleasantness, and desire for pain relief. Participants and Methods A total of 49 half-marathon runners rated the intensity and unpleasantness of pain immediately after completing a run and one month later. Participants rated the expected intensity and unpleasantness of the upcoming pain before starting the run, as well as the desire for pain relief after its completion. Those who also participated in the previous edition of the half marathon were asked to recall the pain experienced due to that run. Results Participants underestimated remembered pain intensity and unpleasantness. The desire for pain relief mediated the memory of pain intensity (p < 0.05), while expectancy of pain intensity influenced memory of pain intensity (a × b) through its effect on the experienced pain (bootstrapped point estimate = 0.08; 95% CI: 0.02–0.32). The remembered intensity of pain experienced during the previous half marathon affected the current pain experience directly (p < 0.05) or indirectly (a × b) by generating pain-related expectancy (bootstrapped point estimate = 0.11; 95% CI: 0.01–0.46). The cognitive variables did not influence the memory of pain unpleasantness. Conclusion The memory of pain induced by sports activity may change due to cognitive factors; however, further research is needed to investigate their role in shaping the memory of the sensory and affective dimensions of pain.
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Affiliation(s)
- Elżbieta A Bajcar
- Jagiellonian University, Institute of Psychology, Pain Research Group, Kraków, Poland
- Correspondence: Elżbieta A Bajcar Jagiellonian University, Institute of Psychology, Pain Research Group, ul. Ingardena 6, Kraków, 30-060, PolandTel +48126632431Fax +48126632415 Email
| | - Wojciech Swędzioł
- University of Physical Education in Kraków, Faculty of Tourism and Recreation, Kraków, Poland
| | | | - Jan Blecharz
- University of Physical Education in Krakow, Department of Psychology, Kraków, Poland
| | - Przemysław Bąbel
- Jagiellonian University, Institute of Psychology, Pain Research Group, Kraków, Poland
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13
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Zhang L, Du Z, Li Z, Yu F, Li L. Association of dietary magnesium intake with chronic constipation among US adults: Evidence from the National Health and Nutrition Examination Survey. Food Sci Nutr 2021; 9:6634-6641. [PMID: 34925793 PMCID: PMC8645769 DOI: 10.1002/fsn3.2611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 11/09/2022] Open
Abstract
The association of dietary magnesium intake with chronic constipation has not been well-studied in general population. Therefore, the aim of this study was to examine whether increased intake of dietary magnesium is associated with the presence of chronic constipation. Data from the 2007-2010 National Health and Nutrition Examination Survey (NHANES) were used. A total of 9,519 participants (4,814 men and 4,705 women) aged ≥20 years were included. The individual's bowel habits (chronic constipation) were evaluated using the questionnaire on bowel health and two different definitions of constipation (stool consistency and stool frequency) were used. Dietary magnesium intake was obtained from 24-h dietary recall. Participants were categorized based on the quartiles of magnesium intake. Multivariable logistic regressions models were performed controlling for confounding factors. After multivariable adjustment, dietary magnesium intake was inversely associated with chronic constipation defined by stool frequency, and the ORs (95% CIs) across quartiles 2-4 compared with the lowest quartile were 0.71 (0.51-0.99), 0.78 (0.46-1.31), and 0.39 (0.16-0.95), respectively. In addition, there was a significant trend for the decreased prevalence of chronic constipation by quartiles of magnesium intake only among men (p for trend < .001). However, no statistically significant association between magnesium intake and prevalence of chronic constipation defined by stool consistency was observed. More evidence from longitudinal studies is needed to confirm these findings.
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Affiliation(s)
- Lei Zhang
- Department of Anorectal SurgeryDongyang People's HospitalDongyangChina
| | - Zhang Du
- Department of Anorectal SurgeryDongyang People's HospitalDongyangChina
| | - Zhiang Li
- Department of Anorectal SurgeryDongyang People's HospitalDongyangChina
| | - Fei Yu
- Department of Anorectal SurgeryDongyang People's HospitalDongyangChina
| | - Lijun Li
- Department of Anorectal SurgeryDongyang People's HospitalDongyangChina
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14
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Meyer AND, Giardina TD, Khawaja L, Singh H. Patient and clinician experiences of uncertainty in the diagnostic process: Current understanding and future directions. PATIENT EDUCATION AND COUNSELING 2021; 104:2606-2615. [PMID: 34312032 DOI: 10.1016/j.pec.2021.07.028] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Uncertainty occurs throughout the diagnostic process and must be managed to facilitate accurate and timely diagnoses and treatments. Better characterization of uncertainty can inform strategies to manage it more effectively in clinical practice. We provide a comprehensive overview of current literature on diagnosis-related uncertainty describing (1) where patients and clinicians experience uncertainty within the diagnostic process, (2) how uncertainty affects the diagnostic process, (3) roots of uncertainty related to probability/risk, ambiguity, or complexity, and (4) strategies to manage uncertainty. DISCUSSION Each diagnostic process step involves uncertainty, including patient engagement with the healthcare system; information gathering, interpretation, and integration; formulating working diagnoses; and communicating diagnoses to patients. General management strategies include acknowledging uncertainty, obtaining more contextual information from patients (e.g., gathering occupations and family histories), creating diagnostic safety nets (e.g., informing patients what red flags to look for), engaging in worst case/best case scenario planning, and communicating diagnostic uncertainty to patients, families, and colleagues. Potential strategies tailored to various aspects of diagnostic uncertainty are also outlined. CONCLUSION Scientific knowledge on diagnostic uncertainty, while previously elusive, is now becoming more clearly defined. Next steps include research to evaluate relationships between management and communication of diagnostic uncertainty and improved patient outcomes.
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Affiliation(s)
- Ashley N D Meyer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard (152), Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Traber D Giardina
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard (152), Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Lubna Khawaja
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, 2002 Holcombe Boulevard (152), Houston, TX 77030, USA; Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
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15
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Hartigan S, Finn M, Dmochowski R, Reynolds WS. Real-time daily assessment of work interference on healthcare professionals' restroom use: A pilot study. Neurourol Urodyn 2021; 40:728-734. [PMID: 33616293 DOI: 10.1002/nau.24603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/16/2020] [Accepted: 12/17/2020] [Indexed: 12/31/2022]
Abstract
AIMS Certain occupations may predispose individuals to develop lower urinary tract symptoms presumably through the adoption of unhealthy toileting behaviors. This study aimed to pilot the feasibility of recording healthcare workers' perceptions of daily, work-related interference with toilet use using a cellular, text-based survey tool. METHODS A cohort study of adult healthcare professionals completed a baseline questionnaire, a daily survey for fourteen consecutive days regarding their restroom use for the current workday, and a posttest survey providing feedback on study design and participation. Contributors to daily toilet use were analyzed in a linear mixed effects model that allowed for modeling effects within a given day. A backward stepwise regression was performed to assess for the presence of the effect of toilet use among control variables. RESULTS Increased work burden (i.e., increased inconvenience for using the restroom at work) was provisionally found to be associated with fewer voids per day. The number of voids at work was also associated with the number of breaks, urinary urgency, and limiting fluids. Subjects reported that participation in the study was easy, did not interfere with work, and that they would be willing to participate again in a similar study. CONCLUSION The utilization of a daily text message survey is a feasible way to study healthcare workers and their toileting behaviors at work. A larger similarly designed study could potentially confirm that limitations to restroom use may result in toileting behaviors that could predispose healthcare workers to develop bothersome urinary symptoms. Further investigation is warranted.
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Affiliation(s)
| | - Michael Finn
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Roger Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - W Stuart Reynolds
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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16
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Vernon-Roberts A, Gearry RB, Day AS. Overview of Self-Management Skills and Associated Assessment Tools for Children with Inflammatory Bowel Disease. GASTROINTESTINAL DISORDERS 2021; 3:61-77. [DOI: 10.3390/gidisord3020007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Self-management is a multi-modal approach for managing chronic conditions that encompasses a number of different elements; knowledge, adherence, self-regulation, communication, and cognitive factors. Self-management has been shown to be beneficial for adults with inflammatory bowel disease (IBD), and for children with IBD it may help them learn to take control of their complex treatment regimens and lead to positive disease outcomes. The development of self-management skills for children with IBD is vital in order to maximize their potential for health autonomy, but it is still an emergent field in this population. This review provides an over-arching view of the self-management elements specific to children with IBD, and highlights outcome measures that may be used to assess skills within each field as well as the efficacy of targeted interventions.
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Affiliation(s)
| | - Richard B. Gearry
- Department of Paediatrics, University of Otago, Christchurch 8011, New Zealand
| | - Andrew S. Day
- Department of Paediatrics, University of Otago, Christchurch 8011, New Zealand
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17
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Guha A, Luebbers S, Papalia N, Ogloff JRP. Long-term healthcare utilisation following child sex abuse: A follow-up study utilising five years of medical data. CHILD ABUSE & NEGLECT 2020; 106:104538. [PMID: 32438015 DOI: 10.1016/j.chiabu.2020.104538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/22/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Limited attention has been paid to the long-term physical health consequences experienced by CSA survivors. Research has found that CSA is often associated with increased health burden in adulthood. However, research in this area is plagued by a range of methodological difficulties, rendering it difficult to draw conclusions regarding the health status of CSA survivors. OBJECTIVE This research sought to investigate associations between child sexual abuse (CSA) victimisation and rates of subsequent healthcare utilisation. METHOD The forensic medical records of 2759 cases of CSA between 1964 and 1995 were linked to commonwealth Australian medical data recorded between 2010 and 2015. Differences in rates of health service utilisation during this five-year period were compared between CSA victims and a age and gender matched comparison cohort without known abuse history. FINDINGS CSA was associated with increased levels of attendance at health professionals (OR = 1.51, p < .001) for medical care and for consultations related to dental (OR = 1.28, p < .001) and chronic disease (OR = 1.23, p <.001). CSA was associated with lower mean rates of attendance at gynaecologists. Gender and age at abuse significantly influenced the relationship between CSA and frequency of health service utilisation. CONCLUSIONS Experiencing CSA was associated with increases in rates of contact with health professionals. Abused females and victims abused after 12 years of age demonstrated the greatest elevations in rates of service utilisation. These findings have significance for both researchers in this field, and medical practitioners providing primary care.
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Affiliation(s)
- Ahona Guha
- Swinburne University of Technology, Australia.
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18
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Reduced excitatory neurotransmitter levels in anterior insulae are associated with abdominal pain in irritable bowel syndrome. Pain 2020; 160:2004-2012. [PMID: 31045748 PMCID: PMC6727903 DOI: 10.1097/j.pain.0000000000001589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Irritable bowel syndrome (IBS) is a visceral pain condition with psychological comorbidity. Brain imaging studies in IBS demonstrate altered function in anterior insula (aINS), a key hub for integration of interoceptive, affective, and cognitive processes. However, alterations in aINS excitatory and inhibitory neurotransmission as putative biochemical underpinnings of these functional changes remain elusive. Using quantitative magnetic resonance spectroscopy, we compared women with IBS and healthy women (healthy controls [HC]) with respect to aINS glutamate + glutamine (Glx) and γ-aminobutyric acid (GABA+) concentrations and addressed possible associations with symptoms. Thirty-nine women with IBS and 21 HC underwent quantitative magnetic resonance spectroscopy of bilateral aINS to assess Glx and GABA+ concentrations. Questionnaire data from all participants and prospective symptom-diary data from patients were obtained for regression analyses of neurotransmitter concentrations with IBS-related and psychological parameters. Concentrations of Glx were lower in IBS compared with HC (left aINS P < 0.05, right aINS P < 0.001), whereas no group differences were detected for GABA+ concentrations. Lower right-lateralized Glx concentrations in patients were substantially predicted by longer pain duration, while less frequent use of adaptive pain-coping predicted lower Glx in left aINS. Our findings provide first evidence for reduced excitatory but unaltered inhibitory neurotransmitter levels in aINS in IBS. The results also indicate a functional lateralization of aINS with a stronger involvement of the right hemisphere in perception of abdominal pain and of the left aINS in cognitive pain regulation. Our findings suggest that glutaminergic deficiency may play a role in pain processing in IBS.
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19
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Wilson PB. Associations between physical activity and constipation in adult Americans: Results from the National Health and Nutrition Examination Survey. Neurogastroenterol Motil 2020; 32:e13789. [PMID: 31905422 DOI: 10.1111/nmo.13789] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/26/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND There is mixed evidence that physical activity is associated with constipation on the population level. This analysis aimed to determine whether amount and types of physical activity are cross-sectionally associated with constipation. METHODS A total of 9963 adults from the 2007-2010 National Health and Nutrition Examination Survey (NHANES) were included. Constipation was defined based on low stool frequency (<3 stools/wk) and a hard/lumpy consistency (type 1 or 2 on the Bristol Stool Form Scale). Univariate logistic regression models evaluated associations between physical activity variables and constipation, while multivariate models were built to account for other variables (age, gender, education, race/ethnicity, relationship status, health status, body mass index, fiber intake, and moisture intake). KEY RESULTS Based on <3 stools/wk, 3.4% (95% CI, 2.8%-4.2%) of Americans were constipated, whereas 7.3% (95% CI, 6.7%-8.1%) were deemed constipated when using the hard/lumpy definition. Odds ratios (ORs) of experiencing < 3 stools/wk were 1.82 (95% CI, 1.11-2.97) for people engaging in no vigorous recreational activity (vs. any) and 1.41 (95% CI, 1.08-1.85) for those doing no moderate recreational activity (vs. any). Likewise, doing no moderate recreational activity was associated with slightly higher odds of hard/lumpy stools (OR = 1.23, 95% CI, 1.03-1.46). These associations were attenuated and insignificant in multivariate models (all ORs < 1.45). CONCLUSION On the population level, self-reported physical inactivity is not strongly associated with passing < 3 stools/wk or hard/lumpy stools. Better-designed prospective observational and intervention studies are needed to clarify how physical inactivity impacts different forms of constipation.
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Affiliation(s)
- Patrick B Wilson
- Human Movement Sciences, Old Dominion University, Norfolk, VA, USA
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20
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Hanson L, VandeVusse L, Garnier-Villarreal M, McCarthy D, Jerofke-Owen T, Malloy E, Paquette H. Validity and Reliability of the Antepartum Gastrointestinal Symptom Assessment Instrument. J Obstet Gynecol Neonatal Nurs 2020; 49:305-314. [PMID: 32272088 DOI: 10.1016/j.jogn.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the psychometric properties of the nine-item Antepartum Gastrointestinal Symptom Assessment (AP-GI-SA) instrument. DESIGN Single-group prospective design. SETTING Urban prenatal clinic serving a diverse population. PARTICIPANTS Convenience sample of 45 pregnant women. METHODS Participants completed the AP-GI-SA before a scheduled prenatal care appointment. We used Bayesian structural equation modeling to evaluate the construct validity of the scale and assessed known-groups validity. We assessed reliability through maximal reliability coefficient estimate and measured internal consistency with Cronbach's alpha coefficient. RESULTS Participants completed the instrument in 2 minutes or less. Construct validity was supported by confirmatory factor analysis (posterior predictive p value = 0.49, gamma-hat = 0.970, and root mean square error of approximation = 0.065), which indicated that the single-factor model is a plausible data-generative model for GI symptoms. The maximal reliability coefficient of 0.75 and Cronbach's alpha coefficient of 0.67 supported reliability. Average AP-GI-SA scores were the highest for women in the third trimester. Of all nine GI symptoms, heartburn in the third trimester received the highest score. CONCLUSION Our findings provide preliminary support for the validity and reliability of the AP-GI-SA. The instrument may be used as a measure in intervention studies where GI symptoms of pregnancy are an outcome. The AP-GI-SA could also be useful in clinical settings to quickly evaluate GI symptoms.
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21
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Shah ED, Almario CV, Spiegel BM, Chey WD. Presentation and Characteristics of Abdominal Pain Vary by Irritable Bowel Syndrome Subtype: Results of a Nationwide Population-Based Study. Am J Gastroenterol 2020; 115:294-301. [PMID: 31913193 PMCID: PMC7469977 DOI: 10.14309/ajg.0000000000000502] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Abdominal pain is a cardinal feature of irritable bowel syndrome (IBS); however, differences in abdominal pain among IBS subtypes remain unknown. We aimed to characterize abdominal pain symptoms among established IBS subtypes using data from the National Gastrointestinal (GI) Survey. METHODS Individuals participating in the National GI Survey completed National Institutes of Health GI Patient-Reported Outcomes Measurement Information System (GI-PROMIS) questionnaires. Adults meeting modified Rome III IBS criteria and reporting abdominal pain in the previous 7 days were eligible. Outcomes included abdominal pain severity, bothersomeness, interference with daily activities, frequency, and location. Results were stratified by subtype (diarrhea [IBS-D], constipation [IBS-C], and mixed [IBS-M]). Regression models adjusted for demographics and comorbidities. RESULTS One thousand one hundred fifty-eight individuals (245 IBS-D, 232 IBS-C, and 681 IBS-M) with active IBS symptoms (defined as abdominal pain in the past 7 days) were included. Demographics were similar among the subtypes except for age, race/ethnicity, education, and marital status. The GI-PROMIS score was lower for IBS-D (percentile score of 68.6, SD = 25.1; P = 0.001) and IBS-M (69.1, SD = 25.1; P < 0.001) compared with IBS-C (75.5, SD = 20.7). Abdominal pain was more bothersome (P = 0.001), caused more interference with daily activities (P = 0.03), and was more frequent (P = 0.047) for individuals with IBS-C compared with individuals with IBS-D. No differences in these domains were seen between individuals with IBS-D and IBS-M. Individuals with IBS-C and IBS-M had more widespread pain compared with those with IBS-D. DISCUSSION In this population-based study, we found that abdominal pain characteristics differ between the IBS subtypes. Namely, individuals with IBS-C experience more bothersome, frequent, and diffuse abdominal pain compared with those with IBS-D.
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Affiliation(s)
- Eric D. Shah
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Christopher V. Almario
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brennan M. Spiegel
- Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, California
| | - William D. Chey
- Division of Gastroenterology, Michigan Medicine, Ann Arbor, Michigan
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22
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Wright-McNaughton M, ten Bokkel Huinink S, Frampton CM, McCombie AM, Talley NJ, Skidmore PM, Gearry RB. Measuring Diet Intake and Gastrointestinal Symptoms in Irritable Bowel Syndrome: Validation of the Food and Symptom Times Diary. Clin Transl Gastroenterol 2019; 10:e00103. [PMID: 31800544 PMCID: PMC6970560 DOI: 10.14309/ctg.0000000000000103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 10/08/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Patients with irritable bowel syndrome (IBS) identify food as a trigger for the onset or worsening of gastrointestinal symptoms. Despite this, there is no published validated contemporaneous food and symptom diary to investigate the association between diet and IBS symptoms. The objective of this prospective observational study was to assess the construct validity of a novel food diary and symptom questionnaire, the Food and Symptom Times (FAST) diary, and the predictive validity of the food diary component with relation to fiber and fermentable oligosaccharides, disaccharides, monosaccharides, and polyols consumption and subsequent gastrointestinal symptoms. METHODS Fifty-one participants with IBS completed the FAST diary and several legacy instruments. The relationship between the FAST gastroenterological symptoms and legacy instruments was examined using Spearman correlation coefficients. Further statistical analysis investigated the relationship between diet and postprandial gastrointestinal symptoms. RESULTS Consistent with a priori predictions, the FAST symptoms showed moderate correlations with the most similar Patient-Reported Outcome Measurement Information System gastrointestinal scales (0.328-0.483, P < 0.05) and the most similar Gastrointestinal Symptom Rating Scale questions (0.303-0.453, P < 0.05), with the exception of the weakly correlated subscale constipation for both instruments (-0.050 to -0.119, P > 0.05). The IBS-Quality of Life instrument showed moderate correlations with the FAST symptom abdominal swelling/distension (0.313-0.416, P < 0.05). The consumption of a high fermentable oligosaccharides, disaccharides, monosaccharides, and polyols meal was associated with participants with IBS-D experiencing abdominal bloating and participants with IBS-C not experiencing abdominal swelling (P < 0.05). The consumption of fiber was correlated with abdominal fullness and bloating in participants with IBS-C (P < 0.05). DISCUSSION The FAST diary validly measures gastrointestinal symptoms as they occur in people with IBS and correlates these symptoms with specific aspects of diet.
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Affiliation(s)
| | - Sebastiaan ten Bokkel Huinink
- Department of Medicine, University of Otago, Christchurch, New Zealand;
- Department of Medicine, VU Medical Centre, Amsterdam, the Netherlands;
| | | | | | - Nicholas J. Talley
- Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.
| | | | - Richard B. Gearry
- Department of Medicine, University of Otago, Christchurch, New Zealand;
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Hollister EB, Oezguen N, Chumpitazi BP, Luna RA, Weidler EM, Rubio-Gonzales M, Dahdouli M, Cope JL, Mistretta TA, Raza S, Metcalf GA, Muzny DM, Gibbs RA, Petrosino JF, Heitkemper M, Savidge TC, Shulman RJ, Versalovic J. Leveraging Human Microbiome Features to Diagnose and Stratify Children with Irritable Bowel Syndrome. J Mol Diagn 2019; 21:449-461. [PMID: 31005411 PMCID: PMC6504675 DOI: 10.1016/j.jmoldx.2019.01.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 10/30/2018] [Accepted: 01/06/2019] [Indexed: 02/06/2023] Open
Abstract
Accurate diagnosis and stratification of children with irritable bowel syndrome (IBS) remain challenging. Given the central role of recurrent abdominal pain in IBS, we evaluated the relationships of pediatric IBS and abdominal pain with intestinal microbes and fecal metabolites using a comprehensive clinical characterization and multiomics strategy. Using rigorous clinical phenotyping, we identified preadolescent children (aged 7 to 12 years) with Rome III IBS (n = 23) and healthy controls (n = 22) and characterized their fecal microbial communities using whole-genome shotgun metagenomics and global unbiased fecal metabolomic profiling. Correlation-based approaches and machine learning algorithms identified associations between microbes, metabolites, and abdominal pain. IBS cases differed from controls with respect to key bacterial taxa (eg, Flavonifractor plautii and Lachnospiraceae bacterium 7_1_58FAA), metagenomic functions (eg, carbohydrate metabolism and amino acid metabolism), and higher-order metabolites (eg, secondary bile acids, sterols, and steroid-like compounds). Significant associations between abdominal pain frequency and severity and intestinal microbial features were identified. A random forest classifier built on metagenomic and metabolic markers successfully distinguished IBS cases from controls (area under the curve, 0.93). Leveraging multiple lines of evidence, intestinal microbes, genes/pathways, and metabolites were associated with IBS, and these features were capable of distinguishing children with IBS from healthy children. These multi-omics features, and their links to childhood IBS coupled with nutritional interventions, may lead to new microbiome-guided diagnostic and therapeutic strategies.
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Affiliation(s)
- Emily B Hollister
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas; Texas Children's Microbiome Center, Texas Children's Hospital, Houston, Texas; Diversigen, Inc., Houston, Texas; Department of Pathology, Texas Children's Hospital, Houston, Texas
| | - Numan Oezguen
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas; Texas Children's Microbiome Center, Texas Children's Hospital, Houston, Texas; Department of Pathology, Texas Children's Hospital, Houston, Texas
| | - Bruno P Chumpitazi
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Texas Children's Hospital, Houston, Texas
| | - Ruth Ann Luna
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas; Texas Children's Microbiome Center, Texas Children's Hospital, Houston, Texas; Department of Pathology, Texas Children's Hospital, Houston, Texas
| | - Erica M Weidler
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Children's Nutrition Research Center, Houston, Texas
| | - Michelle Rubio-Gonzales
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas; Texas Children's Microbiome Center, Texas Children's Hospital, Houston, Texas; Department of Pathology, Texas Children's Hospital, Houston, Texas
| | - Mahmoud Dahdouli
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas; Texas Children's Microbiome Center, Texas Children's Hospital, Houston, Texas; Department of Pathology, Texas Children's Hospital, Houston, Texas
| | - Julia L Cope
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas; Texas Children's Microbiome Center, Texas Children's Hospital, Houston, Texas; Department of Pathology, Texas Children's Hospital, Houston, Texas
| | - Toni-Ann Mistretta
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas; Texas Children's Microbiome Center, Texas Children's Hospital, Houston, Texas; Department of Pathology, Texas Children's Hospital, Houston, Texas
| | - Sabeen Raza
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas; Texas Children's Microbiome Center, Texas Children's Hospital, Houston, Texas; Department of Pathology, Texas Children's Hospital, Houston, Texas
| | - Ginger A Metcalf
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas
| | - Donna M Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas
| | - Richard A Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, Texas
| | - Joseph F Petrosino
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas; Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, Texas
| | - Margaret Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington
| | - Tor C Savidge
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas; Texas Children's Microbiome Center, Texas Children's Hospital, Houston, Texas; Department of Pathology, Texas Children's Hospital, Houston, Texas
| | - Robert J Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Section of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Children's Nutrition Research Center, Houston, Texas
| | - James Versalovic
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas; Texas Children's Microbiome Center, Texas Children's Hospital, Houston, Texas; Department of Pathology, Texas Children's Hospital, Houston, Texas; Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas.
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24
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Biasini B, Marchi L, Angelino D, Bedogni G, Zavaroni I, Pruneti C, Galli D, Mirandola P, Vitale M, Dei Cas A, Bonadonna RC, Passeri G, Ventura M, Del Rio D, Martini D. Claimed effects, outcome variables and methods of measurement for health claims on foods related to the gastrointestinal tract proposed under regulation (EC) 1924/2006. Int J Food Sci Nutr 2018; 69:771-804. [PMID: 29376748 DOI: 10.1080/09637486.2018.1427220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Beatrice Biasini
- Department of Food and Drugs, The Laboratory of Phytochemicals in Physiology, University of Parma, Parma, Italy
| | - Laura Marchi
- Department of Food and Drugs, The Laboratory of Phytochemicals in Physiology, University of Parma, Parma, Italy
| | - Donato Angelino
- Department of Food and Drugs, The Laboratory of Phytochemicals in Physiology, University of Parma, Parma, Italy
| | - Giorgio Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Trieste, Italy
| | - Ivana Zavaroni
- Department of Medicine and Surgery, Division of Endocrinology, University of Parma, Parma, Italy
- Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - Carlo Pruneti
- Department of Medicine and Surgery, Clinical Psychology Unit, University of Parma, Parma, Italy
| | - Daniela Galli
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM), University of Parma, Parma, Italy
| | - Prisco Mirandola
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM), University of Parma, Parma, Italy
| | - Marco Vitale
- Department of Medicine and Surgery, Sport and Exercise Medicine Centre (SEM), University of Parma, Parma, Italy
| | - Alessandra Dei Cas
- Department of Medicine and Surgery, Division of Endocrinology, University of Parma, Parma, Italy
- Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - Riccardo C. Bonadonna
- Department of Medicine and Surgery, Division of Endocrinology, University of Parma, Parma, Italy
- Azienda Ospedaliera Universitaria of Parma, Parma, Italy
| | - Giovanni Passeri
- Department of Medicine and Surgery, Unit of Andrology, Metabolic Bone Diseases and Endocrinology, University of Parma, Parma, Italy
| | - Marco Ventura
- Department of Chemistry, Laboratory of Probiogenomics, Life Sciences and Environmental Sustainability, University of Parma, Parma, Italy
| | - Daniele Del Rio
- Department of Food and Drugs, The Laboratory of Phytochemicals in Physiology, University of Parma, Parma, Italy
| | - Daniela Martini
- Department of Food and Drugs, The Laboratory of Phytochemicals in Physiology, University of Parma, Parma, Italy
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25
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COMT Val158Met Polymorphism and Symptom Improvement Following a Cognitively Focused Intervention for Irritable Bowel Syndrome. Nurs Res 2017; 66:75-84. [PMID: 28252569 DOI: 10.1097/nnr.0000000000000199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Our nurse-delivered comprehensive self-management (CSM) program, a cognitive behavioral therapy intervention, is effective in reducing gastrointestinal and psychological distress symptoms in patients with irritable bowel syndrome (IBS). Findings from non-IBS studies indicate that the catechol-O-methyltransferase (COMT) Val158Met polymorphism may moderate the efficacy of cognitive behavioral therapy. It is unknown whether this COMT polymorphism is associated with symptom improvements in patients with IBS. OBJECTIVE We tested whether this COMT Val158Met polymorphism influences the efficacy of our 2-month CSM intervention. METHODS We analyzed data from two published randomized controlled trials of CSM. The combined European American sample included 149 women and 23 men with IBS (CSM, n = 111; usual care [UC], n = 61). The primary outcomes were daily reports of abdominal pain, depression, anxiety, and feeling stressed measured 3 and 6 months after randomization. Secondary outcomes were additional daily symptoms, retrospective psychological distress, IBS quality of life, and cognitive beliefs about IBS. The interaction between COMT Val158Met polymorphism and treatment group (CSM vs. UC) in a generalized estimating equation model tested the main objective. RESULTS At 3 months, participants with at least one Val allele benefited more from CSM than did those with the Met/Met genotype (p = .01 for anxiety and feeling stressed, and p < .16 for abdominal pain and depression). The moderating effect of genotype was weaker at 6 months. DISCUSSION Persons with at least one Val allele may benefit more from CSM than those homozygous for the Met allele. Future studies with larger and more racially diverse samples are needed to confirm these findings. RCT REGISTRATION Parent studies were registered at ClinicalTrials.gov (NCT00167635 and NCT00907790).
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26
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Smith RJ, Crutchley P, Schwartz HA, Ungar L, Shofer F, Padrez KA, Merchant RM. Variations in Facebook Posting Patterns Across Validated Patient Health Conditions: A Prospective Cohort Study. J Med Internet Res 2017; 19:e7. [PMID: 28062392 PMCID: PMC5251170 DOI: 10.2196/jmir.6486] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/13/2016] [Accepted: 12/13/2016] [Indexed: 12/27/2022] Open
Abstract
Background Social media is emerging as an insightful platform for studying health. To develop targeted health interventions involving social media, we sought to identify the patient demographic and disease predictors of frequency of posting on Facebook. Objective The aims were to explore the language topics correlated with frequency of social media use across a cohort of social media users within a health care setting, evaluate the differences in the quantity of social media postings across individuals with different disease diagnoses, and determine if patients could accurately predict their own levels of social media engagement. Methods Patients seeking care at a single, academic, urban, tertiary care emergency department from March to October 2014 were queried on their willingness to share data from their Facebook accounts and electronic medical records (EMRs). For each participant, the total content of Facebook posts was extracted. Using the latent Dirichlet allocation natural language processing technique, Facebook language topics were correlated with frequency of Facebook use. The mean number of Facebook posts over 6 months prior to enrollment was then compared across validated health outcomes in the sample. Results A total of 695 patients consented to provide access to their EMR and social media data. Significantly correlated language topics among participants with the highest quartile of posts contained health terms, such as “cough,” “headaches,” and “insomnia.” When adjusted for demographics, individuals with a history of depression had significantly higher posts (mean 38, 95% CI 28-50) than individuals without a history of depression (mean 22, 95% CI 19-26, P=.001). Except for depression, across prevalent health outcomes in the sample (hypertension, diabetes, asthma), there were no significant posting differences between individuals with or without each condition. Conclusions High-frequency posters in our sample were more likely to post about health and to have a diagnosis of depression. The direction of causality between depression and social media use requires further evaluation. Our findings suggest that patients with depression may be appropriate targets for health-related interventions on social media.
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Affiliation(s)
- Robert J Smith
- Penn Medicine Social Media and Health Innovation Lab, Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States
| | - Patrick Crutchley
- Penn Medicine Social Media and Health Innovation Lab, Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States.,Positive Psychology Center, Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| | - H Andrew Schwartz
- Penn Medicine Social Media and Health Innovation Lab, Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States.,Positive Psychology Center, Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States.,Department of Computer and Information Science, Stony Brook University, Stony Brook, NY, United States
| | - Lyle Ungar
- Penn Medicine Social Media and Health Innovation Lab, Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States.,Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Frances Shofer
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Kevin A Padrez
- Penn Medicine Social Media and Health Innovation Lab, Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States
| | - Raina M Merchant
- Penn Medicine Social Media and Health Innovation Lab, Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA, United States.,Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States
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27
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Lyra A, Hillilä M, Huttunen T, Männikkö S, Taalikka M, Tennilä J, Tarpila A, Lahtinen S, Ouwehand AC, Veijola L. Irritable bowel syndrome symptom severity improves equally with probiotic and placebo. World J Gastroenterol 2016; 22:10631-10642. [PMID: 28082816 PMCID: PMC5192275 DOI: 10.3748/wjg.v22.i48.10631] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the effects of Lactobacillus acidophilus NCFM on irritable bowel syndrome (IBS) symptoms and quality of life (QoL).
METHODS In this randomized triple-blind trial, adult IBS volunteers who were recruited according to Rome III criteria received 109 or 1010 colony-forming units of NCFM or placebo daily for 12 wk. IBS Symptom Severity Score (IBS-SSS), which constituted the primary outcome, and secondary outcomes, including individual IBS symptoms, IBS-related QoL questionnaire, anxiety and depression, defecation frequency, and stool consistency, were assessed at baseline at the end of the 8-wk run-in period, after 4 and 12 wk of intervention, and after a 4-wk washout.
RESULTS A total of 340 of 391 randomized volunteers completed the trial. IBS-SSS improved over 12 wk of treatment in all treatment groups, decreasing by a mean ± SD of 44.0 ± 80.2, 50.8 ± 82.4, and 48.3 ± 72.2 in the placebo, active low-dose, and active high-dose groups, respectively. Similarly, secondary outcomes did not differ between treatment groups. However, in a post hoc analysis of volunteers with moderate to severe abdominal pain at baseline (VAS > 35/100), the treatment significantly reduced the sensation of abdominal pain. Pain scores fell by 20.8 ± 22.8, 29.4 ± 17.9, and 31.2 ± 21.9 in the placebo, active low-dose, and active high-dose groups, respectively (P value for placebo vs combined active doses = 0.0460).
CONCLUSION NCFM alleviates moderate to severe abdominal pain, consistent with earlier observations of this strain mitigating visceral pain through increased analgesic receptor expression.
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28
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Mujagic Z, Keszthelyi D, Aziz Q, Reinisch W, Quetglas EG, De Leonardis F, Segerdahl M, Masclee AAM. Systematic review: instruments to assess abdominal pain in irritable bowel syndrome. Aliment Pharmacol Ther 2015; 42:1064-81. [PMID: 26290286 DOI: 10.1111/apt.13378] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 02/02/2015] [Accepted: 07/31/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Consensus on standard methods to assess chronic abdominal pain in patients with irritable bowel syndrome (IBS) is currently lacking. AIM To systematically review the literature with respect to instruments of measurement of chronic abdominal pain in IBS patients. METHODS Systematic literature search was performed in PubMed/Medline databases for studies using pain measurement instruments in patients with IBS. RESULTS One hundred and ten publications were reviewed. A multitude of different instruments is currently used to assess chronic abdominal pain in IBS patients. The single-item methods, e.g. the validated 10-point numeric rating scale (NRS), and questionnaires assessing gastrointestinal symptoms severity, focus mostly on the assessment of only the intensity of abdominal pain. Of these questionnaires, the validated IBS-Symptom Severity Scale includes the broadest measurement of pain-related aspects. General pain questionnaires and electronic momentary symptom assessment tools have been used to study abdominal pain in IBS patients, but have not yet been validated for this purpose. The evidence for the use of provocation tests, e.g. the rectal barostat with balloon distention, for measurement of abdominal pain in IBS is weak, due to the poor correlation between visceral pain thresholds assessed by provocation tests and abdominal pain as assessed by retrospective questionnaires. CONCLUSIONS The multitude of different instruments to measure chronic abdominal pain in IBS makes it difficult to compare endpoints of published studies. There is need for validated instruments to assess chronic abdominal pain in IBS patients, that overcome the limitations of the currently available methods.
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Affiliation(s)
- Z Mujagic
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - D Keszthelyi
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Q Aziz
- Centre for Digestive Diseases, Blizard Institute of Cell & Molecular Science, Wingate Institute of Neurogastroenterology, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - W Reinisch
- Department Internal Medicine III, Medical University of Vienna, Vienna, Austria.,McMaster University, Hamilton, ON, Canada
| | - E G Quetglas
- Medical Intelligence, Early Clinical Development, Grünenthal GmBH, Aachen, Germany
| | - F De Leonardis
- Medical Intelligence, Early Clinical Development, Grünenthal GmBH, Aachen, Germany
| | - M Segerdahl
- Medical Intelligence, Early Clinical Development, Grünenthal GmBH, Aachen, Germany.,Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - A A M Masclee
- Division Gastroenterology-Hepatology, Department of Internal Medicine, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
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29
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Mujagic Z, Leue C, Vork L, Lousberg R, Jonkers DMAE, Keszthelyi D, Hesselink MA, van Schagen TJC, van Os J, Masclee AAM, Kruimel JW. The Experience Sampling Method--a new digital tool for momentary symptom assessment in IBS: an exploratory study. Neurogastroenterol Motil 2015; 27:1295-302. [PMID: 26100684 DOI: 10.1111/nmo.12624] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 05/26/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Retrospective questionnaires are frequently used for symptom assessment in irritable bowel syndrome (IBS) patients, but are influenced by recall bias and circumstantial and psychological factors. These limitations may be overcome by random, repeated, momentary assessment during the day, using electronic Experience Sampling Methodology (ESM). Therefore, we compared symptom assessment by ESM to retrospective paper questionnaires in IBS patients. METHODS Twenty-six IBS patients (Rome III) were included, of which 16 were diagnosed with panic disorder (DSM-IV-TR). Patients scored symptoms using end-of-day diaries during 14 days and the gastrointestinal symptom rating scale (GSRS) once. ESM was used on seven consecutive days during the same time period. KEY RESULTS End-of-day diary abdominal pain scores were 0.4 (SE 0.1, p < 0.001) point higher (on a 1-to-5-point scale) compared to corresponding ESM mean-scores in IBS patients. The difference was even more pronounced for upper abdominal pain scores assessed by the GSRS (4.77 ± 1.50) compared to ESM mean-scores (2.44 ± 1.30, p < 0.001), both on 1-to-7-point scale. For flatulence, comparable results were found. Nausea and belching scores showed small, but significant differences between end-of-day diary and ESM. All tested symptoms were scored higher on GSRS compared to ESM mean-scores (p < 0.01). Affective comorbidity did not influence differences in pain reporting between methods. CONCLUSIONS & INFERENCES IBS patients report higher scores for abdominal pain in retrospective questionnaires compared to ESM, with a tendency to report peak rather than average pain scores. ESM can provide more insight in symptom course and potential triggers, and may lead to a better understanding of IBS symptomatology.
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Affiliation(s)
- Z Mujagic
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - C Leue
- Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - L Vork
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - R Lousberg
- Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - D M A E Jonkers
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - D Keszthelyi
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - M A Hesselink
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - T J C van Schagen
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - J van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - A A M Masclee
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - J W Kruimel
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
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30
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Self MM, Williams AE, Czyzewski DI, Weidler EM, Shulman RJ. Agreement between prospective diary data and retrospective questionnaire report of abdominal pain and stooling symptoms in children with irritable bowel syndrome. Neurogastroenterol Motil 2015; 27:1110-9. [PMID: 26017930 PMCID: PMC4545505 DOI: 10.1111/nmo.12590] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/17/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND In functional gastrointestinal disorders, patient recall of symptoms drives diagnostic decisions and evaluation of treatment response, and research conclusions about potential treatments. In pediatrics, parent report also impacts assessment and care. Hence, identifying methods for accurately capturing patient and parent report of irritable bowel syndrome (IBS) symptoms is important. This study evaluated correspondence between retrospective questionnaire (parent and child report) and prospective diary data for children and adolescents with IBS. METHODS Participants included 50 children/adolescents with IBS per Rome III criteria. Children completed a 2-week pain and stool diary. Children and parents subsequently completed a 2-week recall questionnaire, reporting number of pain days, maximum pain, days without bowel movement, and days with diarrhea during the diary interval. Intraclass correlation coefficients and Bland-Altman plots assessed agreement. KEY RESULTS For pain and days without bowel movement, overall agreement between child recall questionnaire and child diary was strong, although under conditions likely to facilitate agreement and with individual variation observed. Parent recall and child diary were less concordant, and agreement about diarrhea was poor for parent and child. Age did not significantly correlate with agreement. CONCLUSIONS & INFERENCES Child questionnaire with short recall interval may be a reasonable approximation for diary data, although this varies by individual and replication/investigation of lengthier recall are needed. Relying on parent questionnaire does not appear a suitable proxy, and recall of stool form by both parent and child appears more problematic. These results combined with existing literature support use of diary data whenever possible.
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Affiliation(s)
- Mariella M. Self
- Department of Pediatrics, Houston, Texas,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas,Texas Children’s Hospital, Houston, Texas
| | - Amy E. Williams
- Department of Psychiatry, Indiana University School of Medicine; Psychiatry & Behavioral Sciences, Riley Hospital for Children, Houston, Texas
| | - Danita I. Czyzewski
- Department of Pediatrics, Houston, Texas,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas,Texas Children’s Hospital, Houston, Texas
| | - Erica M. Weidler
- Department of Pediatrics, Houston, Texas,Texas Children’s Hospital, Houston, Texas,Children’s Nutrition Research Center, Houston, Texas
| | - Robert J. Shulman
- Department of Pediatrics, Houston, Texas,Texas Children’s Hospital, Houston, Texas,Children’s Nutrition Research Center, Houston, Texas
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