Follow-up of ovarian endocrine function in premenopausal women after hysterectomy by daily measurements of salivary progesterone

OBJECTIVE The effect of hysterectomy on ovarian endocrine function of premenopausal women was studied.
DESIGN The patients collected dally salivary samples during one preoperative cycle (1), the cycle of operation (2), the subsequent period of 30 days (3) and the cycle 6 months after operation (4).
PATIENTS Forty-one premenopausal women (aged 33–48 years) undergoing hysterectomy were studied; their preoperative cycles served as controls. The patients were also compared with a reference group of 17 younger fertile women.
MEASUREMENTS Salivary progesterone levels were measured by radiolmmunoassay.
RESULTS Cycle 1 was more frequently short ( P <0.01), with short luteal phase ( P <0.01) and low progesterone secretion ( P <0.05), than the cycles of younger women. Cycle 2 was longer than the other cycles ( P <0.01), due to prolonged follicular phase ( P < 0.01). Cycle 3 differed from cycle 1 by the lesser frequency of short cycles ( P <0.01). Cycle 4 and its follicular phase were longer than those measured in cycle 1 ( P <0.05). Of the women with normal cycle 1,39% ( P <0.01) presented with luteal insufficiency (LPD, low luteal progesterone secretion) or anovulation (8%) in at least one of cycles 2 to 4. The frequency of LPD or anovulation was significantly higher in cycle 3 ( P <0.05) but not in cycle 4, compared to 1.
CONCLUSIONS Acute luteal progesterone deficiency after hysterectomy in premenopausal women is common but in most cases reversible.     

Prevalence of abdominal and pelvic surgeries in patients with irritable bowel syndrome: comparison between Caucasian and African Americans

BACKGROUND: Although controversial, studies suggest that irritable bowel syndrome (IBS) is associated with an increased risk of abdominal and pelvic surgeries. However, the role of race in this interaction has not been defined. We studied the prevalence of appendectomy, cholecystectomy, and hysterectomy among African American patients with IBS among the population at large and compared it with the Caucasians residing in same area. METHODS: A total of 990 adults from 9 different sites in the Jackson, Mississippi, metropolitan area (670 African Americans and 320 Caucasians), completed self-administered questionnaires providing sociodemographic information and details regarding bowel habits and associated symptoms for diagnosing the IBS, based on ROME II criteria. We recorded the patient's name, age, sex, race, history of smoking, and history of surgeries. Subjects with a history of IBD and gastrointestinal cancer were excluded. The prevalence of appendectomy and hysterectomy was compared between IBS patients and non-IBS control subjects. RESULTS: One thousand ninety-nine, or 84%, of those distributed were returned. On checking the exclusion and inclusion criteria, we eliminated 109 subjects. The reasons for elimination of 109 subjects included incomplete questionnaires and incorrect marking of questionnaires that resulted in invalid data. Overall, there was significantly higher prevalence of appendectomy (15.3% vs 5.1%) and cholecystectomy (6.6% vs 3.4%) but not hysterectomy (21.1% vs 17.6%; P = NS) among Caucasian Americans as compared with African Americans. The prevalence of appendectomy among IBS patients (n = 95) versus non-IBS subjects (n = 895) was not statistically significant (10.5% vs 8.2%; OR, 1.3; 95% CI, 0.7 to 2.7; P = 0.43). The prevalence of cholecystectomy in the 2 groups was also similar (5.3% vs 4.4%). Likewise, there was no statistically significant difference for the prevalence of hysterectomy among females IBS patients versus non-IBS females (23.3% vs 18.2%; OR, 1.4; 95% CI, 0.8 to 2.4; P = 0.29). Comparing the prevalence of these surgeries in with IBS patients (African Americans versus Caucasian Americans), we found significant difference in the prevalence of appendectomy to be 1.9% vs 21.4% (P < 0.01). In contrast, there was no difference in the prevalence of cholecystectomy or hysterectomy. Logistical regression suggested that race but not IBS was a significant factor in the prevalence of various surgeries. CONCLUSIONS: Based on responses to ROME II criteria questionnaire administered to community at large, IBS is not associated with greater prevalence of abdominal and pelvic surgeries. Caucasians are more likely to have these surgeries irrespective of whether they have IBS or not. Our study does not exclude the possibility that there may indeed be association between IBS and surgeries if only the IBS patients seeking health care are considered.     

Gender-related differences in visceral perception in health and irritable bowel syndrome

BACKGROUND: Irritable bowel syndrome (IBS) is more common in female subjects, and IBS patients generally exhibit reduced pain thresholds to rectal distension. The aim of the present paper was to determine gender-related differences in rectal perception in both healthy controls and IBS patients. METHODS: Fifty-nine IBS patients (age 20-65 years; mean, 39.2 years; 31 women, 28 men) with symptoms that fulfilled Rome-II criteria and 21 healthy controls (age 25-58 years; mean, 37.8 years; 11 women, 10 men) were recruited. Participants completed a questionnaire regarding bowel symptoms and psychological distress, and maximal tolerable pressures were evaluated via barostat tests. RESULTS: Although healthy women appear to have lower perception thresholds than men, significant gender differences in pain sensitivity were not detected (P > 0.05). In addition, female patients with IBS also exhibited no enhanced colorectal perception, as compared with male IBS patients (P > 0.05). CONCLUSIONS: No gender differences in visceral perception were determined to exist between the healthy controls and the IBS patients. Therefore, the increased prevalence of IBS in women may be related to another set of pathophysiological factors, and not to gender-related differences in visceroperception.     

What Does Pain or Discomfort in Irritable Bowel Syndrome Mean?

Despite many studies on pain of functional gastrointestinal disorders (FGID), the pain mechanism of FGID is not well understood, and pain treatment of FGID is not established. Following our former functional dyspepsia (FD) study, we proposed two subgroups of patients with irritable bowel syndrome (IBS), pain and discomfort (not pain). The duration of disease of discomfort IBS patients was longer than that of pain IBS patients (P < 0.05) The rate of anxiety disorder of pain IBS patients tended to be higher than that of discomfort IBS patients (P = 0.07172). Fifteen (15.2%) of 99 pain IBS patients and 1 (3.4%) of 29 discomfort IBS patients overlapped FD (P < 0.1). We expected that a common psychosocial mechanism would influence both pain dyspepsia patients and pain IBS patients, however, there were some differences between these FGID patients with pain. Anxiety in IBS patients with lower gastrointestinal pain seems to be important in their treatment.     

白细胞介素-10启动子-1082和-819位点基因多态性与肠易激综合征的关系

目的 探讨白细胞介素(IL)-10启动子区基因多态性与肠易激综合征(IBS)的关系.方法 采用聚合酶链式反应结合限制性片段长度多态性分析(PCR-RFLP),对313例IBS患者及281名对照者的1L-10启动子区-1082及-819位点进行基因型分析.结果 在-1082位点与-819位点,IBS组、对照组和总人数组中,各基因型的分布符合Hardy-Weinberg平衡规律.IL-10-819位点T等位基因频率腹泻型(79.8％)和混合型(77.1％)显著高于对照组(65.7％,P＜0.05).IL-10-1082位点A、G等位基因频率在各亚型与对照组间差异无统计学意义(P＞0.05),腹泻型与混合型间差异有统计学意义(P＜0.05).IBS组-819位点T/T基因型频率(51.1％)显著高于对照组(40.2％),C/T基因型显著低于对照组,差异均有统计学意义(P值均＜0.05);-819位点T/T基因型频率IBS的各亚型组显著高于对照组,C/T基因型IBS各亚型显著低于对照组,差异均有统计学意义(P值均＜0.05);C/C基因型在各亚型间差异无统计学意义(P＞0.05).-1082位点基因型在IBS组和对照组间的差异无统计学意义(P＞0.05);IBS腹泻型的-1082位点A/A基因型(93.3％)显著高于混合型IBS(82.4％),A/G基因型低于混合型IBS,差异均有统计学意义(P值均＜0.05);但IBS其他亚型间以及与对照组间差异无统计学意义(P＞0.05).结论 IL-10启动子区域-819位点T/T基因型可能与IBS发生有关,而-1082位点可能与IBS发病无关.     

"Acute abdomen": early laparoscopy or active laparotomic-laparoscopic observation?

BACKGROUND/AIMS: Acute abdomen accounts for 13-40% of all emergency surgical admissions. The aim of this prospective randomized controlled study was to examine the role of early laparoscopy in the management of acute abdomen compared with the more traditional active observation. METHODOLOGY: From July 1993 to August 2004, 522 patients consecutively, admitted with "acute abdomen", were randomized to either early laparoscopy (260 patients) (group 1) or active observation and non-invasive investigation (262 patients) (group 2). Baseline investigations included a full blood count, a pregnancy test in women of reproductive age, chest and/or abdominal radiograph if indicated clinically. RESULTS: Sixty-two patients in the laparoscopy group underwent a total of 116 radiological investigations compared with a total of 558 investigations in all patients in the observation group (P < 0.05). In the observation group 34.7% of patients remained without a clear diagnosis compared with 4.2% of patients in the early laparoscopic group (P < 0.0001). The morbidity rate was 1.1% in group 1 and 27% in group 2 (P < 0.0001). The duration of hospital stay was significantly shorter in group 1 (3.1 vs. 7.3 days) (P < 0.01). Eight patients in group 1 required readmission (total readmission 46 days) compared with 58 patients in group 2 who stayed a total of 201 days (P < 0.05). CONCLUSIONS: Early laparoscopy is valuable in the management of acute abdomen. It provides a significantly higher diagnostic accuracy and a better improvement in quality of life than the more traditional approach observation.     

Modulation of Sleep Quality and Autonomic Functioning by Symptoms of Depression in Women with Irritable Bowel Syndrome

The objective of this study was to determine how depressive symptoms affect autonomic activity during sleep, objective and subjective sleep, and gastrointestinal symptom severity in women with irritable bowel syndrome (IBS). Seventy women who met the Rome II criteria for IBS and 21 healthy volunteers participated. All participants were recruited from the surrounding community. IBS patients were stratified into two groups based on their Beck Depression Inventory II score and 44 IBS patients with depressive symptoms (IBS+DS) were compared to 26 IBS patients without depressive symptoms (IBS-DS). Autonomic activity was measured by heart rate variability (HRV) analysis. Fifteen-minute segments were selected from a baseline presleep period, stage 2, slow-wave sleep, and rapid-eye movement sleep for heart rate variability spectral analysis. Subjective sleep quality was assessed by the Pittsburg Sleep Quality Index (PSQI) and gastrointestinal symptom severity was assessed by an 18-item questionnaire. The IBS+DS group reported significantly (P < 0.01) more sleep complaints, measured by the PSQI, than the IBS-DS group and healthy controls. The IBS+DS group took significantly (P < 0.05) longer to enter their first rapid-eye movement period than healthy controls. The IBS+DS group reported significantly (P = 0.01) increased gastrointestinal symptom severity compared to the IBS-DS group. There were no significant group differences in autonomic activity during the baseline presleep period or sleep stages. The results demonstrated that IBS patients with significant depressive symptoms had increased gastrointestinal symptom severity, increased sleep complaints, and alterations in sleep architecture compared to healthy controls and IBS patients without significant depressive symptoms.     

High risk of lower urinary tract symptoms in patients with irritable bowel syndrome

Background

The aim of the present study was to investigate the prevalence of urinary tract infection (UTI) and the risk of lower urinary tract symptoms (LUTS) in women with irritable bowel syndrome (IBS) (including each subtype: constipation, diarrhea, and mixed) compared to women in the general population.

Methods

Between January 2014 and December 2015, consecutive adult female patients diagnosed with IBS at the outpatient clinic of the University of Salerno and healthy women with regular bowel habits were enrolled in the study. At baseline, we checked for UTI with a dipstick test and questioned patients about the presence of LUTS in the previous 24 h.

Results

We enrolled 141 IBS patients and 91 healthy controls in the study. There was no difference in the prevalence of UTI between IBS patients and healthy controls (4.9 vs 3.3%, p = 0.5). When we excluded patients with UTI, we found a 2.79 higher risk of increased urinary frequency [odds ratio (OR) 2.79, 95% confidence interval (CI) 1.37–5.68], a 2.68 higher risk of urinary urgency (OR 2.68, 95% CI 1.04–6.91), and more than three times the risk of having dysuria (OR 3.25, 95% CI 1.06–9.97) in IBS women compared to healthy controls. The risk of having at least one urinary symptom was independent of IBS subtype and IBS severity.

Conclusions

Our study shows that IBS women have a similar risk of UTI compared to healthy women even if they complain more of LUTS, independently of IBS subtype and severity.

     

Sleep-Related Autonomic Disturbances in Symptom Subgroups of Women with Irritable Bowel Syndrome

The objective was to investigate whether predominant symptom patterns in women with irritable bowel syndrome (IBS) affect autonomic activity during sleep. Seventy-five women with IBS underwent a polysomnographic sleep study. Twenty-two of the IBS patients were diarrhea-predominant (IBS-D), 33 were constipation-predominant (IBS-C), and 20 patients had alternating symptoms (IBS-A). Autonomic activity was measured by heart rate variability. The IBS-D group had significant vagal withdrawal compared to the IBS-A group during REM and non-REM sleep (P < 0.05). The IBS-D symptom subgroup had significantly (P < 0.05) greater sympathetic dominance during non-REM than IBS-A patients. Lower abdominal pain correlated with sympathetic dominance during sleep in the IBS-D group (r=0.54, P < 0.01). The IBS-D patients were physiologically distinct with regard to autonomic functioning during sleep compared to the alternating patients, but not the constipated patients. Sleep appears to unmask differences in autonomic activity that may distinguish IBS patients.     

感染对IBS患者肠黏膜细胞因子表达的影响

目的:探讨感染对肠易激综合征(irritable bowel syndrome,IBS)患者神经-免疫-内分泌网络的影响.方法:感染后肠易激综合征(postinfectious irritable bowel syndrome,PI-IBS)患者45例,non-PI-IBS患者60例及30例对照者,结肠镜下活检回盲部黏膜标本,采用免疫组织化学法检测其肠黏膜SP、IL-2、IFN-γ、SPR与5-HT的表达,肥大细胞(mast cells,MC)采用甲苯胺蓝染色.结果:PI-IBS患者的SP表达分别高于non-PI-IBS与对照组(t=2.5,2.8,P<0.01);PI-IBS患者的MC表达分别高于non-PI-IBS与对照组(t=11.5,12.1,P<0.01).PI-IBS患者的5-HT表达分别高于non-PI-IBS与对照组(t=13.6,14.1,P<0.01);PI-IBS患者的SPR表达分别高于non-PI-IBS与对照组(t=3.8,6.1,P<0.05);PI-IBS患者的IFN-γ表达分别高于non-PI-IBS与对照组(t=13.8,15.2,P<0.05);PI-IBS患者的IL-2表达分别高于non-PI-IBS与对照组(t=12.6,14.7,P<0.05).PI-IBS患者回盲部黏膜MC和SP的表达呈高度正相关(r=0.71,P<0.01).PI-IBS患者回盲部黏膜5-HT和SPR的表达呈密切相关(r=0.18,P<0.05).IFN-γIL-2阳性表达的PI-IBS患者,SP表达高于非PI-IBS组(r=2.2,2.3,P<0.05)和对照组(t=2.3,2.4,P<0.05).结论:肠道感染后,神经纤维在IBS的免疫-神经-内分泌发生机制中的作用至关重要.     

The burden of IBS: Looking at metrics

Irritable bowel syndrome (IBS) is a prevalent and expensive condition that significantly impairs health-related quality of life (HRQOL) and reduces work productivity. Based on strict criteria, 7% to 10% of people have IBS worldwide. Community-based data indicate that IBS-diarrhea and IBS-mixed subtypes are more prevalent than IBS-constipation, and that patients may switch among subtype groups. IBS is 1.5 times more common in women than in men, more common in lower socioeconomic groups, and more commonly diagnosed in patients younger than 50 years of age. Patients with IBS visit the doctor more frequently, use more diagnostic tests, consume more medications, miss more workdays, have lower work productivity, are hospitalized more frequently, and consume more overall direct costs than those without IBS. Resource utilization is highest in patients with severe symptoms and poor HRQOL. Treatment decisions should be tailored to the severity of each patient’s symptoms and HRQOL decrement.     

Irritable bowel syndrome and surgery: a multivariable analysis

BACKGROUND & AIMS: Patients with irritable bowel syndrome (IBS) have high surgical rates. We investigated the demographic and medical factors independently associated with surgical histories of health examinees. METHODS: We applied multiple stepwise logistic regression analysis to self-completed questionnaire data from 89,008 examinees, assessing 6 surgeries as outcomes. We assessed questionnaire/physician record agreement of physician-diagnosed IBS and surgical history on 201 randomly selected examinees with > or =3 years of records. RESULTS: Questionnaire/record agreement for IBS and surgery was 83.6% (kappa = 0.68) and 95.5%-100.0% (kappa = 0.82-1), respectively. IBS was reported by 4587 examinees (5.2%) (1382 men [3.0%] and 3205 women [7.5%]). Subjects with and without IBS, respectively, reported the following surgical procedures: cholecystectomy, 569 (12.4%) versus 3428 (4.1%), P < 0.0001; appendectomy, 967 (21.1%) versus 9906 (11.7%), P < 0.0001; hysterectomy, 1063 (33.2%) versus 6751 (17.0%), P < 0.0001; back surgery, 201 (4.4%) versus 2436 (2.9%), P < 0.0001; coronary artery surgery, 127 (2.8%) versus 2033 (2.4%), P > 0.05; peptic ulcer surgery, 22 (0.5%) versus 277 (0.3%), P > 0.05. Among independent surgery associations, IBS was associated with cholecystectomy (adjusted odds ratio [OR], 2.09; 95% confidence interval [CI], 1.89-2.31; P < 0.0001), appendectomy (OR, 1.45; 95% CI, 1.33-1.56; P < 0.0001), hysterectomy (OR, 1.70; 95% CI, 1.55-1.87; P < 0.0001), and back surgery (OR, 1.22; 95% CI, 1.05-1.43; P = 0.0084). CONCLUSIONS: Health examinees with physician-diagnosed IBS report rates of cholecystectomy 3-fold higher, appendectomy and hysterectomy 2-fold higher, and back surgery 50% higher than examinees without IBS; IBS is independently associated with these surgical procedures.     

Patients with irritable bowel syndrome-diarrhea have lower disease-specific quality of life than irritable bowel syndrome-constipation

AIM: To determine effect of irritable bowel syndrome(IBS) subtype on IBS-specific quality of life(QOL) questionnaire and its subscales.METHODS: We studied IBS patients visiting our functional gastroenterology disorder clinic at a tertiary care center of Unites States.IBS and IBS subtype were diagnosed using Rome-Ⅲ questionnaire.QOL was assessed using IBS-QOL questionnaire.IBSQOL assesses quality of life along eight subscales: dysphoria,interference with activities,body image,health worry,food avoidance,social reactions,sexual health,and effect on relationships.IBS-QOL and its subscales were both scored on a range of 0-100 with higher scores suggestive of better QOL.Results of overall IBS-QOL scores and subscale scores are expressed as means with 95%CI.We compared mean IBS-QOL score and its subscales among various IBSsubtypes.Analysis of variance(ANOVA) was used to compare the mean difference between more than two groups after controlling for age and gender.A posthoc analysis using Bonferroni correction was used only when P value for ANOVA was less than 0.05.RESULTS: Of 542 patients screened,243 had IBS as per Rome-Ⅲ criteria.IBS-mixed(IBS-M) was the most common IBS subtype(121 patients,49.8%) followed by IBS- diarrhea(IBS-D)(56 patients,23.1%),IBSconstipation(IBS-C)(54 patients,22.2%) and IBSunspecified(IBS-U)(12 patients,4.9%).Overall IBSQOL scores were significantly different among various IBS-subtypes(P = 0.01).IBS-QOL of patients with IBS-D(61.6,95%CI: 54.0-69.1) and IBS-M(63.0,95%CI: 58.1-68.0) was significantly lower than patients with IBS-C(74.5,95%CI: 66.9-82.1)(P = 0.03 and 0.02 respectively).IBS-D patients scored significantly lower than IBS-C on food avoidance(45.0,95%CI: 34.8-55.2 vs 61.1,95%CI: 50.8-71.3,P = 0.04) and interference with activity(59.6,95%CI: 51.4-67.7 vs 82.3,95%CI: 74.1-90.6,P 0.001).IBS-M patients had more interference in their activities(61.6,95%CI: 56.3-66.9 vs 82.3,95%CI: 74.1-90.6,P = 0.001) and greater impact on their relationships(73.3,95%CI: 68.4-78.2 vs 84.7,95%CI: 77.2-92.2,P = 0.02) than IBS-C patients.Patients with IBS-M also scored significantly lower than IBS-C on food avoidance(47.2,95%CI: 40.7-53.7 vs 61.1,95%CI: 50.8-71.3,P = 0.04) and social reaction(66.1,95%CI: 61.1-71.1 vs 80.0,95%CI: 72.1-87.7,P = 0.005).CONCLUSION: IBS-D and IBS-M patients have lower IBS-QOL than IBS-C patients.Clinicians should recognize food avoidance,effects on daily activities and relationship problems in these patients.     

Long-term safety and efficacy of alosetron in women with severe diarrhea-predominant irritable bowel syndrome

OBJECTIVES: To assess long-term safety and efficacy of alosetron in women with severe, chronic diarrhea-predominant IBS and in a subset having more frequent urgency (i.e., bowel urgency at least 10 of 14 days during screening). METHODS: Randomized patients received either alosetron 1 mg (n = 351) or placebo (n = 363) twice daily during a 48-wk, double-blind study. The primary endpoint was the 48-wk average rate of adequate relief of IBS pain and discomfort. Secondary endpoints included 48-wk average satisfactory control rates of urgency, stool frequency, stool consistency, and bloating. Other efficacy endpoints were average monthly adequate relief and urgency control rates and impact of provided rescue medication. RESULTS: Alosetron-treated patients had significantly greater 48-wk average adequate relief (p= 0.01) and urgency control (p < 0.001) rates, regardless of rescue medication use, compared with placebo. Results in subjects with more frequent urgency were more robust than those in the overall population (p= 0.005). In weeks without rescue medication use, satisfactory control rates for stool frequency and stool consistency were significantly greater in alosetron-treated patients than placebo. Alosetron-treated patients had significantly greater adequate relief than placebo-treated patients (p < 0.05) in 9 of 12 months and significantly greater urgency control (p < 0.001) in all months. Adequate relief and urgency control were maintained throughout the treatment. Adverse events and serious adverse events were similar between treatment groups, except for constipation. Neither ischemic colitis nor serious events related to bowel motor dysfunction was reported. CONCLUSIONS: Long-term use of alosetron is effective and well-tolerated in women with chronic, diarrhea-predominant IBS, including those with more frequent urgency.     

New developments in the diagnosis and treatment of irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common disorder with major health status and economic effects. Symptom criteria are of paramount importance in diagnosis, but differences among the Manning, Rome I, and Rome II criteria may lead to variable identification of people with the disorder. Practice guidelines are based on evidence and, to a greater degree, on consensus; therefore, experts vary on the specifics of ordering particular diagnostic tests. There is an overlap of IBS symptoms with those of celiac sprue, and selected patients should be tested for the latter disease. Symptom confusion with biliary pain and overlap with chronic pelvic pain could contribute to the predisposition of IBS patients to undergo cholecystectomy and hysterectomy. Development and documentation of effective therapy has been difficult, but depending on the selection of subgroups, there is evidence for usefulness of smooth muscle relaxants, loperamide, and antidepressants. Various forms of psychological therapy and new serotoninmodulating agents seem especially promising. The placebo effect of the physician-patient relationship has important therapeutic benefit.     

Irritable bowel syndrome in patients under age 55 with dyspeptic syndrome

The presence of IBS was studied in 289 patients under 55 years of age with dyspeptic syndrome. The subjects were divided into two groups: group I (240 patients with DS) and group II (49 patients with DS and IBS). The mean duration of follow%shy;up was 10.8 years (130 months). IBS was diagnosed in 49 patients (17%). Females accounted for 64% and 77% of groups I and II, respectively (p < 0.05). There were no differences in mean age or the type of FDS. The patients in group II consulted more often and earlier (92% returned for consultation, and took 27 months in doing so) than those in group I (52% and 40 months)(p < 0.05). The number of diagnostic tests requested was greater in group II. Psychiatric pathology was in turn more common in group II than in group I (20 versus 7%)(p < 0.05).     

Patients and Nonconsulters with Irritable Bowel Syndrome Reporting a Parental History of Bowel Problems Have More Impaired Psychological Distress

Little is known about the prevalence and risk factors for development of irritable bowel syndrome (IBS) in Japan. In the United States, it is reported that heredity and social learning contribute to the development of IBS. Our aims were (1) to estimate the prevalence of IBS, (2) to confirm that subjects with IBS are more likely to have parents with a history of bowel problems, (3) to confirm that gastroenteritis is a risk factor for IBS, and (4) to determine whether these two risk factors interact with psychological distress. Prevalence was estimated from a sample of 417 young adults seen for annual health screening examinations. To evaluate risk factors related to consulting physicians, the 46 subjects who fulfilled Rome II diagnostic criteria for IBS but denied ever having seen a physician about these symptoms (IBS non-consulters) were compared to the 317 subjects who did not meet the criteria for IBS (controls) and to a group of 56 patients diagnosed with IBS by gastroenterologists (IBS patients). All subjects completed the Gastrointestinal Symptoms Rating Scale, the State-Trait Anxiety Inventory, the Self-Rating Depression Scale, the Perceived Stress Scale, and the SF-36 quality of life scale. Fourteen and two-tenths percent (15.5% of females and 12.9% of males) of the community sample met the criteria for IBS diagnosis, of whom 22% consulted physicians. IBS patients and IBS nonconsulters were more likely than controls to have a parental history (33.9 vs. 12.6%, P < 0.001, for patients and 26.1 vs. 12.6%, P < 0.01, for nonconsulters) and were more likely to report an infective history compared to controls (44.6 vs. 16.1%, P < 0.001, for patients and 32.6 vs. 16.1%, P < 0.01, for nonconsulters). Two-way analysis of variance showed that the parental history was associated with a significantly greater impact on symptoms of indigestion, diarrhea, constipation, state and trait anxiety, and the SF-36 scales for social functioning and role emotional and that an infective history was associated with a greater impact on bodily pain. Both a parental history of bowel problems and a history of acute gastroenteritis are significant risk factors for development of IBS in Japan, as reported for the United States. Moreover, patients with such a family history show more psychological distress than other patients.     

Personality factors and profiles in variants of irritable bowel syndrome

AIM: To study the association between irritable bowel syndrome (IBS) variants (constipation,diarrhea,or both) and personality traits in non-psychiatric patients. METHODS: IBS was diagnosed using the Rome Ⅱ diagnostic criteria after exclusion of organic bowel pathology. The entry of each patient was confirmed following a psychiatric interview. Personality traits and the score of each factor were evaluated using the NEO Five Factor Inventory. RESULTS: One hundred and fifty patients were studied. The mean age (± SD) was 33.4 (± 11.0) year (62% female). Subjects scored higher in neuroticism (26.25 ± 7.80 vs 22.92 ± 9.54,P < 0.0005),openness (26.25 ± 5.22 vs 27.94 ± 4.87,P < 0.0005) and conscientiousness (32.90 ± 7.80 vs 31.62 ± 5.64,P < 0.01) compared to our general population derived from universities of Iran. Our studied population consisted of 71 patients with Diarrhea dominant-IBS,33 with Constipation dominant-IBS and 46 with Altering type-IBS. Scores of conscientiousness and neuroticism were significantly higher in C-IBS compared to D-IBS and A-IBS (35.79 ± 5.65 vs 31.95 ± 6.80,P = 0.035 and 31.97 ± 9.87,P = 0.043,respectively). Conscientiousness was the highest dimension of personality in each of the variants. Patients with C-IBS had almost similar personality profiles,composed of higher scores for neuroticism and conscientiousness,with low levels of agreeableness,openness and extraversion that were close to those of the general population. CONCLUSION: Differences were observed between IBS patients and the general population,as well as between IBS subtypes,in terms of personality factors. Patients with constipation-predominant IBS showed similar personality profiles. Patients with each subtype of IBS may benefit from psychological interventions,which can be focused considering the characteristics of each subtype.     

肠易激综合征患者生存质量的评价

目的　探讨与评价社区人群中肠易激综合征 (IBS)患者的健康相关生存质量 (HRQOL)情况。方法　在广东省采用分层、整群、随机抽样的调查中收集到的符合RomeⅡ诊断标准的 2 31例IBS患者 ,并随机选取 6 36例非IBS(NIBS)者为对照组 ;生存质量的调查采用世界卫生组织推荐的SF 36量表。结果　 (1)两组对象在年龄、性别、学历及城乡分布方面 ,经检验差异无显著性 (P >0 0 5 ) ;(2 )IBS组比NIBS组在生理机能、生理职能、情感职能、社会功能、躯体疼痛、精力、一般状况、精神健康、健康变化等各个维度分值均有明显降低 (P <0 0 5 ) ;IBS就诊者SF 36各个维度的分值比非就诊者有所降低 ,但差异无显著性 (P >0 0 5 ) ;(3)SF 36各维度分值与IBS患者每月犯腹痛的次数相关 (P <0 0 5 ) ;并与患者自诉腹痛对生活和工作的影响程度相关 (P <0 0 5 ) ;也与IBS患者是否出现乏力的症状相关 (P <0 0 5 ) ;(4)应对方式与HRQOL明显相关 ;控制应对方式对HRQOL的影响后 ,IBS组仍比NIBS组的HRQOL有明显下降。结论　与NIBS者相比 ,IBS患者生存质量明显下降 ;SF 36量表适用于IBS的HRQOL评估 ;但有必要进行有关IBS特异的生存质量量表的研究分析。