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  • 1
    Electronic Resource
    Electronic Resource
    Effect of a 5HT3-antagonist (ondansetron) on rectal sensitivity and compliance in health and the irritable bowel syndrome (1993)
    Oxford, UK : Blackwell Publishing Ltd
    Alimentary pharmacology & therapeutics 7 (1993), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: In some patients with the irritable bowel syndrome, rectal urgency and discomfort are major clinical problems and, under experimental conditions, these symptoms are perceived at lesser volumes of rectal distension than they are in asymptomatic controls. Further, a 5-hydroxytryptamine type-3 receptor antagonist increased the threshold for rectal discomfort in irritable bowel syndrome. Our aims were, (a) to measure rectal sensation during isobaric distensions of the rectum, and (b) to test the effect of another selective 5HT3 antagonist, ondansetron 0.15 mg/kg, on rectal sensitivity, colonic tone, rectal tone and manometric responses. Ten healthy volunteers and five patients with diarrhoea-predominant irritable bowel syndrome were studied. A multilumen barostatmanometric assembly was placed in the descending colon, and a second barostat balloon was positioned in the rectum. Tone in the wall of the colon and rectum was measured by the barostat balloon volume during a constant pressure clamp, while intraluminal pressures were recorded by manometry; perceived sensations were also recorded before and after the intravenous administration of ondansetron or placebo in blinded fashion. Rectal resistance to stretch was greater and rectal urgency was induced by lower distending pressures in irritable bowel syndrome, however, basal tone in the rectum was similar in health and irritable bowel syndrome. Ondansetron did not change rectal sensitivity (first sensation or urgency) or tone. Rectal distension did not alter tone in the descending colon or colonic manometry; ondansetron did not influence any index of colonic function. We conclude that in diarrhoea-predominant irritable bowel syndrome there is reduced rectal compliance and the rectum is abnormally sensitive to a pressure stimulus, but this is not altered by 5HT3-blockade with ondansetron at the dose used.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2036.1993.tb00131.x
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  • 2
    Electronic Resource
    Electronic Resource
    Practical examples: trials and conclusions — an interactive segment (2004)
    Oxford, UK : Blackwell Publishing Ltd
    Alimentary pharmacology & therapeutics 20 (2004), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: There is a requirement for a critical review of the literature published in the field of reflux disease management, particularly when the literature is used as a basis for the adoption of specific interventions into everyday practice. Numerous published studies are valid and robust, but many are not. Particularly common is the over-interpretation of positive studies based on small patient numbers, which may be subject to publication bias. Claims of equivalence are invalid without a pre-specified level of equivalence and adequate power to measure this. More generally, a lack of pre-defined primary end-points, clinically relevant and measured appropriately, is a common feature of reflux trial methodology.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2036.2004.02137.x
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  • 3
    Electronic Resource
    Electronic Resource
    Clinical strategies — interactive case discussions (2004)
    Oxford, UK : Blackwell Publishing Ltd
    Alimentary pharmacology & therapeutics 20 (2004), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Interactive case discussions held during the symposium illustrate the practical challenges and dilemmas faced in the management of Barrett's oesophagus. Opinions of the faculty and audience varied widely on how proton pump inhibitor therapy should be used, especially in patients with short-segment Barrett's oesophagus. The therapeutic goal that received most support was to achieve sufficient acid control to keep the patient symptom free and heal any oesophagitis. At the same time, the patient should be reassured of the low risk associated with the endoscopic findings.When long-segment Barrett's oesophagus is detected, it should be assessed in detail, with targeted biopsy of any irregular-surfaced metaplastic mucosa and four quadrant biopsies every 2 cm, to diagnose intestinal metaplasia and to screen for dysplasia or cancer. Repeat endoscopy and biopsy may be appropriate to achieve a sensitive initial assessment because of potential sampling error. Proton pump inhibitor therapy, often twice daily, was considered a requirement for most cases of long-segment Barrett's oesophagus. There was disagreement over the role of surveillance, although proponents viewed it as worthwhile even in patients at low risk for the development of adenocarcinoma, mainly for medico-legal reasons. Endoscopic mucosal resection was seen to be appropriate in carefully selected patients with high-grade dysplasia, depending on factors such as age and comorbidity, the extent of high-grade dysplasia, findings on endoscopic ultrasound and the length of Barrett's oesophagus.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2036.2004.02141.x
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  • 4
    Electronic Resource
    Electronic Resource
    Incidence of a clinical diagnosis of the irritable bowel syndrome in a United States population (2004)
    Oxford, UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 19 (2004), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : The incidence of irritable bowel syndrome is uncertain. We aimed to determine the incidence of clinically diagnosed irritable bowel syndrome in the community.Methods : Using the Rochester Epidemiology Project, all diagnoses of irritable bowel syndrome made among adult residents of Olmsted County, Minnesota, over a 3-year period were identified. The complete medical records of a random sample of the potential subjects were reviewed for the 10 years prior to the irritable bowel syndrome diagnosis and any patient who had received a previous diagnosis of irritable bowel syndrome was excluded (prevalent cases).Results : The diagnostic index listed 1245 possible irritable bowel syndrome patients; 416 patient charts were reviewed and, of these, 149 were physician diagnosed incident cases of irritable bowel syndrome. The age- and sex-adjusted incidence rate was 196 per 100 000 person-years and increased with age (P = 0.006). The age-adjusted annual incidence per 100 000 in women was higher than in men: 238 vs. 141 (ratio 3:2; P = 0.005). The overall symptom frequency at the time of diagnosis was abdominal pain (73%), diarrhoea (41%) and constipation (16%).Conclusions : The incidence of a clinical diagnosis of irritable bowel syndrome in adults was estimated to be two per 1000 per year, increased with age and was higher in women than men. As many people with irritable bowel syndrome do not seek care, the true incidence of irritable bowel syndrome is likely to be higher.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2036.2004.01938.x
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  • 5
    Electronic Resource
    Electronic Resource
    Non-cardiac chest pain: prevalence, risk factors, impact and consulting — a population-based study (2003)
    Oxford, UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 17 (2003), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : Little is known about the prevalence and importance of non-cardiac chest pain in the general population.Aim : To evaluate the magnitude and impact of this condition.Methods : A validated self-report questionnaire was mailed to a sample of 1000 residents of Penrith, selected randomly from the electoral rolls. Symptoms, risk factors, psychological distress, quality of life and demographics were measured.Results : The response rate was 73% (n = 672; mean age, 46 years; 52% female). Chest pain ever was reported by 39% of the population; 7% reported a history of myocardial infarction and 8% a history of angina. Two hundred and nineteen (33%) cases were classified as non-cardiac chest pain; only 23% had consulted a physician about chest pain in the previous year. The only independent risk factor for non-cardiac chest pain was the frequency of heartburn (odds ratio, 1.74; 95% confidence interval, 1.08–2.79; P = 0.02). None of the gastrointestinal (heartburn, dysphagia, acid regurgitation) or psychological (anxiety, depression, neuroticism) risk factors were significantly associated with consulting for non-cardiac chest pain.Conclusions : Non-cardiac chest pain is remarkably common in the general population and negatively impacts on the quality of life. Gastro-oesophageal reflux disease is a key risk factor for non-cardiac chest pain in the community. Health care seeking for non-cardiac chest pain remains unexplained.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.2003.01557.x
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  • 6
    Electronic Resource
    Electronic Resource
    Predictors of conventional and alternative health care seeking for irritable bowel syndrome and functional dyspepsia (2003)
    Oxford, UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 17 (2003), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : The drivers of conventional and, especially, alternative health care use for irritable bowel syndrome and functional dyspepsia are not clear.Aim : To determine the predictors of conventional and alternative health care use for irritable bowel syndrome and functional dyspepsia.Methods : Two hundred and seven subjects with irritable bowel syndrome or functional dyspepsia, identified from a previous population survey, were included in the study. Individuals with irritable bowel syndrome/functional dyspepsia were defined as consulters (n = 103) if they had visited their doctor for gastrointestinal symptoms more than once in the past year. Controls (n = 100) did not report having any abdominal pain. Subjects were given structured interviews to assess the Diagnostic and Statistical Manual – version IV (DSM-IV) and International Classification of Disorders – version 10 (ICD-10) psychiatric diagnosis for anxiety, depression, somatization or any psychiatric diagnosis, aspects of health care use and symptom factors.Results : About one-half (n = 103, 49.8%) of community subjects with irritable bowel syndrome/functional dyspepsia had sought conventional care for gastrointestinal symptoms in the past 12 months. Lifetime rates for alternative health care use for gastrointestinal symptoms were 20.8% (n = 43). Independent predictors of conventional health care use were more frequent abdominal pain, greater interference of gastrointestinal symptoms with work and activities and a greater satisfaction with the physician–patient relationship. Being female independently predicted alternative health care use.Conclusions : Psychological morbidity did not predict conventional or alternative health care use for gastrointestinal symptoms. Other factors were more important.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.2003.01498.x
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  • 7
    Electronic Resource
    Electronic Resource
    Is irritable bowel syndrome more likely to be persistent in those with relatives who suffer from gastrointestinal symptoms? A population-based study at three time points (2003)
    Oxford, UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 17 (2003), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: We tested the hypothesis that subjects with relatives who suffered from abdominal pain or bowel dysfunction would be at an increased risk of more persistent irritable bowel syndrome.Methods: A valid, self-report questionnaire was mailed to an age- and gender-stratified random sample of residents, aged 30–64 years, in Olmsted County, MN, USA, on three occasions over a 4-year period. Persistent irritable bowel syndrome was defined as the presence of irritable bowel syndrome on at least two of the three surveys, and fluctuating irritable bowel syndrome was defined as the presence of irritable bowel syndrome on only one of the surveys.Results: Subjects were less likely to have persistent irritable bowel syndrome over the age of 50 years [odds ratio (OR), 0.20; 95% confidence interval (CI), 0.09, 0.47]. A positive family history was reported by 23%. A family history of gastrointestinal symptoms was independently associated with persistent irritable bowel syndrome (vs. no irritable bowel syndrome: OR, 2.5; 95% CI, 1.3, 4.9) and fluctuating irritable bowel syndrome (vs. no irritable bowel syndrome: OR, 2.4; 95% CI, 1.3, 4.4). However, subjects reporting a positive family history were not more likely to report persistent vs. fluctuating irritable bowel syndrome (OR, 1.2; 95% CI, 0.5, 2.9). The use of non-steroidal anti-inflammatory drugs (OR, 2.3; 95% CI, 1.2, 4.3) and a history of food sensitivity (OR, 3.6; 95% CI, 1.9, 6.9) were the only other predictors of persistent irritable bowel syndrome.Conclusions: A history of abdominal pain or bowel troubles in first-degree relatives appears to be independently associated with both persistent and fluctuating irritable bowel syndrome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.2003.01591.x
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  • 8
    Electronic Resource
    Electronic Resource
    Reliability and validity of the digestive health status instrument in samples of community, primary care, and gastroenterology patients (2001)
    Oxford UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 15 (2001), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We evaluated a previously reported digestive health status instrument in community, primary care, and gastroenterology practice populations. Multiple types of reliability, validity and responsiveness were assessed to determine the performance of the questionnaire.〈section xml:id="abs1-2"〉〈title type="main"〉Methods:Study populations included community, primary care and gastroenterology subjects. Psychometric analyses included internal consistency and test–retest reliability, criterion and construct validity, and responsiveness.〈section xml:id="abs1-3"〉〈title type="main"〉Results:Acceptable internal consistency was seen on all scales in all three populations. Test–retest reliability was excellent in a speciality population with reflux disease. Criterion validity was demonstrated by strong correlation of reflux scale scores and results on 24-h pH monitoring. Scale scores varied predictably in those receiving gastrointestinal tract imaging and according to diagnosis, indicating construct validity. The reflux scale and pain index were sensitive to change with treatment for reflux disease. Multi-trait scaling analyses from the community sample revealed a structure equivalent to that reported from a primary care sample.〈section xml:id="abs1-4"〉〈title type="main"〉Conclusions:The reliability and validity of the digestive health status instrument on multiple measures in multiple settings have been demonstrated. The instrument was responsive to change with treatment for reflux disease. The demonstrated robustness attests to the suitability for future studies and clinical application.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.2001.01026.x
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  • 9
    Electronic Resource
    Electronic Resource
    A dose-ranging, placebo-controlled, randomized trial of alosetron in patients with functional dyspepsia (2001)
    Oxford UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 15 (2001), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Functional dyspepsia is characterized by upper abdominal pain or discomfort.〈section xml:id="abs1-2"〉〈title type="main"〉Aim:To assess the benefit of the 5-HT3-receptor antagonist alosetron in a pilot, dose-ranging, placebo-controlled, multicentre, randomized clinical trial.〈section xml:id="abs1-3"〉〈title type="main"〉Methods:A total of 320 functional dyspepsia patients received placebo (n=81), or alosetron 0.5 mg b.d. (n=77), 1.0 mg b.d. (n=79) or 2.0 mg b.d. (n=83) for 12 weeks, followed by 1 week of follow-up. Primary efficacy was the 12-week average rate of adequate relief of upper abdominal pain or discomfort. Secondary endpoints assessed pain and upper gastrointestinal symptoms.〈section xml:id="abs1-4"〉〈title type="main"〉Results:Twelve-week average rates of adequate relief of pain or discomfort were 46% (95% CI: 37–54%), 55% (95% CI: 46–63%), 55% (95% CI: 47–64%) and 47% (95% CI: 38–55%) in the placebo, 0.5 mg, 1.0 mg and 2.0 mg alosetron groups, respectively. Alosetron 0.5 mg or 1.0 mg showed potential benefit over placebo for early satiety and postprandial fullness. Females showed greater responses compared to males. Patients with adequate relief had significantly (P 〈 0.001) greater reductions in severity and frequency of functional dyspepsia symptoms than those without adequate relief. Constipation was the most commonly reported adverse event.〈section xml:id="abs1-5"〉〈title type="main"〉Conclusions:Alosetron showed potential benefit in relieving functional dyspepsia symptoms compared to placebo. Patients with adequate relief of upper abdominal pain or discomfort showed improvements in multiple functional dyspepsia symptoms.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.2001.00941.x
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  • 10
    Electronic Resource
    Electronic Resource
    Oral hypoglycaemic drugs and gastrointestinal symptoms in diabetes mellitus (2001)
    Oxford UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 15 (2001), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Gastrointestinal symptoms are commonly reported as side-effects of oral hypoglycaemic drugs. It may be very difficult to distinguish between spontaneous and truly drug-related symptoms due to the high background incidence of gastrointestinal symptoms. Gastrointestinal symptoms in diabetic patients have also been linked to factors associated with long-standing disease and suboptimal control.〈section xml:id="abs1-2"〉〈title type="main"〉Aim:To explore the association between gastrointestinal symptoms and treatment with oral hypoglycaemic drugs in a large cohort of subjects with type 2 diabetes.〈section xml:id="abs1-3"〉〈title type="main"〉Patients and methods:956 subjects with type 2 diabetes participated in the study. All subjects completed a validated, self-administered questionnaire on gastrointestinal symptoms, diabetes, drug use and various potential risk factors for gastrointestinal symptoms. The association between oral hypoglycaemics and nine gastrointestinal symptom groups was assessed based on logistic regression.〈section xml:id="abs1-4"〉〈title type="main"〉Results:405 of the 956 patients used oral hypoglycaemic drugs. Metformin use was independently associated with chronic diarrhoea (odds ratio 3.08, 95% CI: 1.29–7.36, P 〈 0.02) and with faecal incontinence (odds ratio 1.95, 95% CI: 1.10–3.47, P 〈 0.05). Use of sulphonylureas was associated with less abdominal pain, but not with any other gastrointestinal symptom.〈section xml:id="abs1-5"〉〈title type="main"〉Conclusions:Troublesome gastrointestinal symptoms do not appear to be caused by oral hypoglycaemics, except for diarrhoea and faecal incontinence, which are strongly and independently associated with metformin use.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.2001.00896.x
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