The European journal of surgery. Supplement. : = Acta chirurgica. Supplement最新文献

Functional gastrointestinal disorders are best understood by applying a bio-psycho-social model. The diseases are strongly associated with psychological factors, and in functional dyspepsia, low vagal activity might be a mediating mechanism by which psychological factors (like neuroticism and stress) influence gastrointestinal physiology and cause epigastric discomfort. Low vagal activity may be a manifestation of stress and a cause of impaired gastric accommodation to meals. Epigastric discomfort is elicited when the stomach is distended without prior (vagal) reflex relaxation. Conventional therapy for acid-related dyspepsia does not improve accommodation and hence, is ineffective. The beneficial effect of experimental therapy, like glyceryl trinitrate and sumatriptan, which improve gastric accommodation, gives very good prospects for further development. For patients with irritable bowel syndrome, today's therapy seems similarly inefficacious, but several new potentially effective drugs are at present undergoing clinical trials.

Functional gastrointestinal disorders such as irritable bowel syndrome or functional dyspepsia have traditionally been regarded as syndromes limited to the digestive system. However, both clinical experience and published evidence show that patients with such disorders also report a series of other symptoms of physical distress, such as fibromyalgia and irritable bladder and alterations in vital functions, such as sleep, libido, appetite and energy level. Some of these extraintestinal symptoms can be explained in the context of an evolving comprehensive disease model which views functional gastrointestinal disorders as manifestations of alterations in the interactions between the nervous system, the viscera and the musculoskeletal system. Alterations in central circuits concerned with arousal, attention and fear, cognitions about bodily symptoms and possible alterations in the hypothalamic pituitary adrenal (HPA) axis may all contribute to the wide range of symptoms reported by affected patients.

Irritable Bowel Syndrome (IBS) is a chronic disorder with symptoms that range in intensity from mild and infrequent to severe and continuous. Similarly the impact of IBS on Quality of Life (QOL) measures can range from very small to disabling. In a very simple model one might expect a change in symptom intensity or frequency to be reflected in a similar change in QOL. However, a variety of other factors may alter this straightforward and unidirectional relationship between symptomatic treatment and QOL improvement. This paper presents several classes of these potential moderator variables in QOL outcome in IBS, as well as specific models of symptom, moderator, QOL relationships that can be investigated in future research. An illustrative example of a regression approach to analysis of psychosocial moderator variables indicates both psychosocial measures, and symptom severity, independently contribute to the prediction of QOL in IBS.

Functional gastrointestinal disorders are most commonly divided into gastro-oesophageal reflux disease (GORD), dyspepsia and the irritable bowel syndrome (IBS). GORD is defined as having predominant reflux symptoms, and is nowadays not considered to be a subgroup of dyspepsia. Dyspepsia is divided into subgroups (ulcer-like, dysmotility-like, unspecified and sometimes, when reflux symptoms are combined with abdominal complaints, reflux-like dyspepsia). The clinical relevance of this is however doubtful. If dyspeptic symptoms occur with concomitant bowel habit disturbances, the subject is said to have IBS. In the clinical situation, the patients often present with symptom overlap, and with change in main symptom profile from time to time. Different definition makes prevalence reports less comparable. An approximate average in the literature of the three-month period prevalence of GORD is that it is reported by 10% of the population, of overall reflux symptoms by 25%, of dyspepsia (without predominant reflux symptoms) by 25%, of dyspepsia without concomitant reflux symptoms by 15% and of IBS by 15% of the population.

Irritable Bowel Syndrome (IBS) is a commonly diagnosed gastrointestinal condition which is seen by both primary care providers and gastroenterologists. In the United States, it has been estimated there are upwards of 3.5 million physician visits annually by patients with IBS with these patients representing a large percentage of subspecialty referrals. Interestingly, there are limited data on the rates of health care utilization by patients with IBS and even less data on the economic impact of IBS at a societal level. The objectives of this review of the extant literature are to report on IBS and health care utilization, define and review methods for economic costs assessments in IBS, and evaluate published studies which have examined the economic impact of IBS.

Generic questionnaire such as SF36 and functional gastrointestinal disorder (FGD)-specific questionnaires (i.e. IBSQOL or FGDQL) are now available for the evaluation of new drugs for the treatment of irritable bowel syndrome or functional dyspepsia. For regulatory issues it is necessary to describe in detail the scale of the QOL questionnaire, its psychometric properties and reason for its choice, as well as validation studies, populations concerned, means of administration and methods for analysis. Preselection of few dimensions of the QOL questionnaire, if necessary, has to be explained. QOL results have to be compared with symptom scores. Trials have to be double-blind placebo- controlled studies with a sample size calculation taking account of the high placebo-response. No official guidelines are available in FGD and more validation studies are needed to help in the choice of the specific QOL questionnaire, in the metrologic analysis and in the interpretation of QOL changes during FGD treatment. Then QOL questionnaires could become a primary end point in clinical trials if efficient drugs for FGD treatment are developed.

Background: Irritable bowel syndrome (IBS) is a common disease in the general population. Evaluation of IBS symptoms does not cover all the complaints of patients who report restrictions to social life, the need to diet and psychosocial repercussions. Quality of life (QOL) measurement permits a precise approach to patient status.

Methods: The generic QOL questionnaires SF 36 and two validated specific QOL questionnaires--IBSQOL and Functional Digestive Disorders FDDQL--have been used for the evaluation of IBS patient outcome. IBSQOL measures 9 domains and its reliability and validity have been demonstrated. FDDQL measures 8 domains, an international psychometric validation was obtained in French, English and German by comparison with the SF36. The discriminant validity and responsiveness of the FDDQL have been evaluated.

Results: Generic QOL evaluation and specific questionnaires like the FDDQL were able to measure changes in IBS patient status and QOL during several clinical trials.

Conclusion: Specific QOL questionnaires have been validated in IBS patients and are available for controlled studies. Development of effective new drugs are needed for IBS treatment, complete and precise evaluation of outcome will involve QOL analysis in association with specific validated questionnaires.