Variety of symptoms reported by patients with upper gastrointestinal diseases

Background

The characteristics of symptoms reported by patients with various organic and functional upper gastroduodenal diseases have not been fully studied.

Methods

We used a questionnaire-based survey to investigate abdominal symptoms of patients with reflux esophagitis, nonerosive reflux disease (NERD), peptic ulcers, and functional dyspepsia (FD). Seven hundred thirty-seven patients with those conditions responded to a questionnaire asking about the possible presence of nine kinds of upper abdominal symptoms.

Results

The mean number of symptoms reported was 3.2?±?1.7, and patients with organic diseases tended to have a larger number. Approximately 60% of patients with NERD complained of heartburn and 30% of at least one dyspeptic symptom; more than 50% of patients with FD noted dyspeptic symptoms and 20% complained of reflux symptoms. We found a large overlap in the abdominal symptoms of NERD and FD patients, including the most troublesome symptoms.

Conclusion

In summary, our questionnaire-based study showed that symptom-based classification of NERD and FD is not easy because of symptom overlap. Possible overlap of NERD and FD should always be considered.     

Water load test before and after PPI therapy in patients with gastro-oesophageal reflux disease

BACKGROUND: Patients with gastro-oesophageal reflux disease may complain of epigastric pain, bloating, early satiety, epigastric fullness, epigastric burning, nausea and vomiting. AIMS: To evaluate the symptoms in response to gastric distension and its relationship to a therapeutic course in patients with gastro-oesophageal reflux disease using the water load test, compared to healthy controls. METHODS: Thirty gastro-oesophageal reflux disease patients with grade A oesophagitis (studied before and after 4 weeks of therapy with esomeprazole, 40 mg per day) and 15 patients with reflux-related symptoms demonstrated at wireless pH monitoring (non-erosive reflux disease) were compared to 30 healthy volunteers. RESULTS: Patients with grade A oesophagitis and with reflux-related symptoms ingested significantly lower water volumes than did controls, before onset of fullness, without statistically significant difference between erosive or non-erosive gastro-oesophageal reflux disease; this variable improved in patients after treatment. Nausea scores were higher basally in patients, pre- and post-therapy, and improved after therapy. Thirty-minute fullness and bloating scores improved after therapy in all gastro-oesophageal reflux disease patients compared to controls and pre-therapy. In all pre-treatment patients, a significant correlation was found only with epigastric fullness; after treatment, there was no significant relationship between the water load and the symptom scores. CONCLUSIONS: In patients with reflux-related symptoms, with or without grade A oesophagitis, the water load test is frequently abnormal, suggesting an altered gastric function. This could explain the incomplete resolution of symptoms after treatment in some patients, and should lead to additional studies aimed at exploring gastric function in gastro-oesophageal reflux disease patients.     

Dyspepsia and gastric emptying in end-stage renal disease patients on hemodialysis

Background

Dyspepsia is common among end-stage renal disease (ESRD) patients and its association with delayed gastric emptying is not well established. We assessed the association of dyspepsia with gastric emptying time in ESRD patients undergoing hemodialysis (HD).

Methods

Dyspepsia was assessed through the Porto Alegre Dyspeptic Symptoms Questionnaire (PADYQ). PADYQ’s scores?≥?6 classified participants as dyspeptic. The octanoic acid breath test using ¹³carbon was employed to assess the gastric emptying time. Based on the test, time in minutes to metabolize the first half of the ¹³carbon in the test meal (t1/2) was calculated. Association of dyspepsia with gastric emptying time was tested by the correlation between PADYQ scores and t1/2, and also by comparing t1/2 between dyspeptics and non-dyspeptics.

Results

There were 34 (68.0%) dyspeptic patients. Dyspepsia score was positively correlated with t1/2 (r?=?0.366; p?=?0.009). Dyspeptics had longer t1/2 compared to non-dyspeptics, respectively, 238.0?±?92.9 versus 185.5?±?45.5 minutes (p?=?0.042).

Conclusions

Delayed gastric emptying was associated with dyspepsia. Prokinetic medications could have a role in preventing or relieving dyspeptic symptoms among HD patients. Future research in larger samples is necessary to confirm this association.

     

Long-term Reflux-Related Symptoms After Bariatric Surgery: Comparison of Sleeve Gastrectomy Versus Laparoscopic Adjustable Gastric Banding

Background

Long-term pulmonary reflux-related symptoms following laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) have not been reported.

Methods

We designed a retrospective analysis of consecutive patients who underwent LAGB or LSG between January 2000 and December 2010. All patients provided detailed history and physical examination. We assessed both early and late reflux-related symptoms. All patients underwent spirometry and chest X-ray (CXR).

Results

The analysis included 307 patients who underwent either LAGB (n = 193) or LSG (n = 114). Mean age was 43 ± 12 and 46 ± 11 years, respectively; 144 (76.6 %) and 83 (73 %) were female, respectively. Similar rates of previous pulmonary disease were noted in both LAGB and LSG groups (10.9 vs. 10.5 %, respectively). However, more patients with sleep apnea were in the LSG group (13.2 vs. 6.2 %, p = 0.03). The mean interval between surgery and the onset of pulmonary symptoms was longer in patients who underwent LAGB (72 ± 22 months) than for those who had LSG (36 ± 24 months; p = 0.03). The overall complication rate was higher in the LAGB (7.3 %) than in LSG (4.4 %) group. LSG patients had significantly lower rates of morning cough (12.3 vs. 59.6 %, p = 0.001) and postprandial cough (10.5 vs. 58 %, p = 0.001) compared to the LAGB patients. Two cases of pneumonia occurred in each group. The mortality rate was zero in both groups.

Conclusion

Both surgeries are considered safe and without major reflux-related symptoms. There is a lower incidence of cough with LSG than with LAGB.     

Measuring symptomatic and functional recovery in patients with community-acquired pneumonia

Objective

To determine the rates of resolution of symptoms and return to premorbid health status and assess the association of these outcomes with health care utilization in patients with community-acquired pneumonia.

Design

A prospective, multicenter cohort study.

Setting

Inpatient and outpatient facilities at three university hospitals, one community hospital, and one staff-model health maintenance organization.

Patients

Five hundred seventy-six adults (aged≥18 years) with clinical and radiographic evidence of pneumonia, judged by a validated pneumonia severity index to be at low risk of dying.

Measurements and main results

The presence and severity of five symptoms (cough, fatigue, dyspnea, sputum, and chest pain) were recorded through questionnaires administered at four time points: 0, 7, 30, and 90 days from the time of radiographic diagnosis of pneumonia. A summary symptom score was tabulated as the sum of the five individual severity scores. Patients also provided responses to the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and reported the number of and reason for outpatient physician visits. Symptoms and health status 30 days before pneumonia onset (prepneumonia) were obtained at the initial interview. All symptoms, except pleuritic chest pain, were still commonly reported at 30 days, and the prevalence of each symptom at 90 days was still nearly twice prepneumonia levels. Physical health measures derived from the SF-36 Form declined significantly at presentation but continued to improve over all three follow-up time periods. Patients with elevated symptom scores at day 7 or day 30 were significantly more likely to report pneumonia-related ambulatory care visits at the subsequent day 30 or day 90 interviews, respectively.

Conclusions

Disease-specific symptom resolution and recovery of the premorbid physical health status requires more than 30 days for many patients with pneumonia. Delayed resolution of symptoms is associated with increased utilization of outpatient physician visits.     

Biliary Dyskinesia and Symptomatic Gallstone Disease in Children: Two Sides of the Same Coin?

Background

Despite lack of consensus criteria, biliary dyskinesia (BD) is an increasingly accepted pediatric diagnosis.

Aims

We compared patient characteristics, outcomes, and resource utilization (before and after surgery) between children with BD and symptomatic cholecystolithiasis (LITH).

Methods

Data from the electronic medical record were abstracted for children diagnosed with BD or LITH between December 1, 2002, and November 30, 2012, at Children’s Hospital of Pittsburgh.

Results

Four hundred and ten patients were identified (BD: 213 patients, LITH: 197 patients). Patients with BD had significantly lower BMI, longer symptom duration, more dyspeptic symptoms, and were more likely to present with other symptoms. Forty-one patients (13.8 %) with BD underwent cholecystectomy despite a normal gallbladder ejection fraction (GB-EF). In 32 of these, sincalide triggered pain compared to 75 of the 155 patients with low GB-EF. After surgery, patients with BD more commonly visited gastroenterology clinics and had more GI-related hospitalizations, while emergency room visits decreased in both groups. Only the nature of biliary disease independently predicted continuing pain after surgery, which in turn was the best predictor for higher resource utilization after cholecystectomy.

Conclusions

A large percentage of children with BD did not meet the adult diagnostic standards. Compared to those with LITH, children with BD have more widespread symptoms and continue to use more clinical resources after surgery. These findings suggest that despite its benign prognosis, BD is increasingly treated like other potentially acute gallbladder diseases, although it has the typical phenotype of FGIDs and should be treated using approaches used in such disorders.     

Clinical characteristics and effectiveness of lansoprazole in Japanese patients with gastroesophageal reflux disease and dyspepsia

Background

Patients with gastroesophageal reflux disease (GERD) frequently have symptoms of dyspepsia in addition to reflux symptoms. Treatment options for dyspepsia are not standardized. The aim of this study was to clarify the therapeutic effect of lansoprazole on dyspepsia in Japanese patients with GERD.

Methods

GERD patients with dyspepsia were enrolled and treated with lansoprazole 15 or 30 mg once daily for 4 weeks. Reflux and dyspeptic symptoms were assessed by questionnaires before treatment, and 2 and 4 weeks after the start of lansoprazole treatment.

Results

In the effectiveness analysis set (n = 12,653), heartburn was reported by 91.6 % of patients at study enrollment. Postprandial fullness was the most frequently reported dyspepsia symptom at the start of the study, reported by 79.0 % of enrolled patients. After 4 weeks of lansoprazole treatment, heartburn symptoms were improved in 75.7 % of patients and symptoms of postprandial fullness were improved in 68.7 % of patients. The therapeutic effect of low and high doses of lansoprazole on dyspepsia, as well as on reflux symptoms, was approximately 10 % higher in patients with endoscopy-confirmed erosive esophagitis (60.1–82.2 %), than in patients with non-erosive reflux diseases (53.0–73.3 %). Lansoprazole was well tolerated.

Conclusion

In this large-scale clinical study, lansoprazole effectively relieved dyspepsia in addition to reflux symptoms in patients with GERD.     

Infection à Hélicobacter pylori : aspects épidémiologiques, cliniques et endoscopiques

Abstract

Helicobacter pylori is the only bacterium actually recognized as carcinogenic among the man. His role in various gastroduodenal diseases (type B gastritis, gastric and duodenal ulcers, gastric adenocarcinoma and lymphoma) is now well established. The aim of this work is to study the different characteristics epidemiological, clinical and endoscopic of Hp infection.

Patients and methods

Prospective study spread between December 2010 to January 2012 and based on 234 cases collected in the service of gastroenterology of universitary hospital Med VI in Marrakech.

Results

The average age of our patients was 43.5 years (16–82) with a sex ratio H/F=1.5. We noted 32 cases of taking NSAIDs, 65 cases of purchasing inhibitors of proton pump, active smoking in 16 cases. Access to safe drinking water in 220 patients, the number of siblings was greater than 2 in 203 patients, 196 of our patients shared the same dish and eat by hand. Clinical signs were atypical epigastric pain in 98 cases, epigastralgia ulcer-like in 56 cases, dyspeptic syndrome in 66 cases, the search for H. pylori in cases of ulcer perforation peritonitis in 23 operated cases, vomiting in 21 cases, upper gastrointestinal bleeding in 15 cases and gastroesophageal reflux in 11 cases. The endoscopic aspects found were: pangastritis erythematous in 78 cases, erythematous antral gastritis in 36 cases, nodular pangastritis in 15 cases pangastritis erythemal and atrophic in 26 cases, bulbar ulcer and erosive bulbite in 34 cases, an ulcer gastric in 11 cases, a tumor ulcerative budding process in 15 cases, an ulcerative pyloric stenosis in 8 cases and normal in 11 cases. Anatomopathological study found the H. pylori in 100% of cases, chronic antral gastritis in 16.7% chronic pangastritis in 76.6%, gastric adenocarcinoma in 5.9%, small cell malt lymphoma in 0.8% and intestinal metaplasia in 20.5% of cases.

Conclusion

Hp infection is fairly common in our context. Endoscopic aspects are many and varied.     

Evaluation of Helicobacter pylori status and endoscopic findings among new outpatients with dyspepsia in Japan

Purpose

The 2005 ACG guidelines for the management of dyspepsia recommend eradication and proton pump inhibitors for patients who are H. pylori-positive and-negative, respectively. To establish Japanese guidelines for dyspepsia, we evaluated H. pylori status and endoscopic findings among outpatients with dyspepsia.

Methods

The status of H. pylori in dyspeptic patients was determined by measuring urinary levels of anti-H. pylori antibody (RAPIRAN^®). We then compared the endoscopic findings between H. pylori-positive and -negative patients.

Results

The prevalence of H. pylori among 258 dyspeptic patients was 47.8%, and increased with age (11.1% at age 10–19 years; >50% at age >50 years). The prevalence of H. pylori in each age-group tended to be lower among male than female dyspeptic patients. Endoscopy (n = 138) showed that H. pylori-negative patients rarely had peptic ulcers or gastric cancer, and 84.7% had no endoscopic findings, which was significantly higher when compared to H. pylori-positive patients (67.3%) (p = 0.029).

Conclusions

Over half of the dyspeptic Japanese patients examined were negative for H. pylori. Patients who are H. pylori-positive should undergo endoscopy to rule out gastric malignancy, peptic ulcers and other diseases.     

High Expression of Gastrin Receptor Protein in Injured Mucosa of Helicobacter pylori-Positive Gastritis

Background and Aim

Gastrin is a growth factor for the gastric epithelial cells. However, it is unknown how gastric receptor (GR) expression is regulated in the gastric mucosa. We studied GR expression using a newly raised antibody and investigated the relationship between GR expression and gastritis.

Methods

Gastric receptor expression in 63 human gastric mucosa was studied. Helicobacter pylori infection and histological gastritis status were evaluated in gastric biopsy samples. In gastric ulcer cases, additional biopsy specimens were taken from injured mucosa. Fasting sera were collected and serum gastrin level evaluated. MKN-28 cells were cultured at various pH conditions, and the change in GR expression was determined.

Results

Gastric receptor expression was detected in the foveolar epithelium of the gastric mucosa, and its expression was stronger in patients infected with H. pylori. In particular, higher expression was detected in regenerating injured mucosa. There was no association between gastritis score/serum gastrin level and GR expression in H. pylori-positive cases. In MKN-28 cells, GR protein expression was lower in neutral conditions than in acidic or alkaline conditions.

Conclusion

Gastric mucosal injury with H. pylori infection destroys the pH barrier on the foveolar epithelium and may induce GR expression through pH changes.     

Dyspeptic symptoms associated with hypersensitivity to gastric distension induced by duodenal acidification

BACKGROUND AND AIM: Duodenal acidification might increase sensitivity to gastric distension, which seems to play a role in the genesis of dyspeptic symptoms in a subset of patients with functional dyspepsia. The aim of the present study was to investigate the characteristics of dyspeptic symptoms associated with hypersensitivity to gastric distension induced by duodenal acidification. METHODS: An infusion tube and a barostat bag were positioned in the duodenum and gastric fundus, respectively. Sensitivity to stepwise fundic distensions with severity scoring of the seven dyspeptic symptoms was assessed before and during duodenal acid infusion in 20 healthy subjects. RESULTS: Acid infusion significantly decreased the pressures and the corresponding wall tensions at the thresholds for discomfort. At the distending level of minimal distending pressure (MDP) + 2 mmHg, significantly higher scores of fullness and bloating were obtained during acid infusion. With distending stimuli of MDP + 4 and 6 mmHg, fullness, bloating, nausea, satiety, epigastric burning and epigastric pain were significantly more severe during acid infusion than before acid infusion. At the level of MDP + 8 mmHg, the severity of epigastric pain was significantly greater, compared with that before acid infusion. CONCLUSIONS: Duodenal acidification might aggravate dyspeptic symptoms through the induction of hypersensitivity to gastric distension in healthy individuals. Those symptoms are diverse and variable, depending on the strength of the distending stimuli.     

Manometric Abnormalities in the Postural Orthostatic Tachycardia Syndrome: A Case Series

Background

Postural orthostatic tachycardia syndrome (POTS) is a rare disease that is believed to be mediated by dysautonomia. Gastrointestinal complaints in POTS patients are common and disturbing but not well characterized.

Aims

We hypothesized that gastrointestinal dysmotility may be contributory to these symptoms.

Methods

We studied 12 POTS patients who presented with gastrointestinal symptoms to a tertiary referral center. Gastrointestinal symptoms were quantified using a previously validated symptom questionnaire. All patients underwent gastroduodenal manometry (GDM); select patients also underwent further testing including esophageal manometry (EM), anorectal manometry (ARM), plain abdominal radiography (AXR), abdominal computed tomography (CT), gastric emptying studies (GES), and colonic transit time (CTT) studies.

Results

The four most common symptoms were bloating, constipation, abdominal pain, and nausea/vomiting, all experienced by greater than 70 % of patients. On GDM testing, 93 % of patients demonstrated signs of neuropathy, and the most common abnormalities observed included bursts of uncoordinated phasic activity in both fasting (59 %) and post-prandial (42 %) states, low contractility in the post-prandial state (67 %), and lack of post-prandial pattern (42 %). A total of 67 % of patients undergoing EM and 86 % of those undergoing ARM demonstrated abnormalities consistent with dysmotility. On AXR or CT, 58 % demonstrated either dilated intestinal loops or air-fluid levels. On CTT 80 % demonstrated delayed colonic transit, while on GES 60 % demonstrated delayed gastric emptying.

Conclusions

In this cohort of POTS patients with gastrointestinal symptoms, there is a high prevalence of abnormal manometric and radiographic findings suggestive of dysmotility.     

Pre-dinner administration increases the efficacy of proton pump inhibitors on refractory GERD symptoms in connective tissue disease patients

Background

A significant proportion of patients with connective tissue disease (CTD) have gastric esophageal reflux disease (GERD) symptoms despite receiving proton pump inhibitors (PPIs). Although pre-meal administration of PPIs is recommended in Western countries, the benefit of this administration timing in Japanese CTD patients with refractory GERD symptoms has not been proven.

Objective

To determine whether pre-dinner administration of PPIs is more efficacious for refractory GERD symptoms in Japanese CTD patients.

Methods

CTD patients receiving oral PPIs were instructed to take PPIs 1 h before dinner. Gastrointestinal symptoms were evaluated with frequency scale for the symptoms of GERD (FSSG) and gastrointestinal symptom rating scale (GSRS) before and after the intervention.

Results

Pre-dinner administration of PPIs significantly improved FSSG total score, from a median of 8 to 6.5 (P = 0.005). Pre-dinner administration was more effective in patients with overt GERD symptoms (from median 18 to 10, P < 0.001) than in those with mild GERD symptoms (from median 2 to 2, P = 0.201). In addition to reflux syndrome, pre-dinner administration of PPIs significantly decreased abdominal pain syndrome and constipation syndrome of GSRS.

Conclusion

Pre-dinner administration of PPIs may increase their efficacy in Japanese CTD patients with GERD, especially those with overt symptoms.     

Impaired Viscosity of Gastric Secretion and Its Mucin Content as Potential Contributing Factors to the Development of Chronic Constipation

Background

The alimentary tract mucosa continuously releases mucus-rich secretion. Mucin, the major component of mucus, determines its viscosity and provides lubrication for the luminal content of indigestible food particles.

Aims

To measure mucin secretion rate and its viscosity in patients with chronic constipation (CC) and in asymptomatic volunteers.

Methods

Nineteen patients with symptoms of CC and 19 controls were included in the study. Mucin secretion and viscosity were assessed in aspirated gastric juice in basal conditions and after stimulation with pentagastrin (1 h each). Mucin content was tested by PAS methodology. Viscosity was measured using cone/plate digital viscometer.

Results

Mucin secretion rates in basal and stimulated conditions in controls were 65 and 42 % higher than in patients with CC (P < 0.05 and P < 0.001, respectively). Basal viscosity in controls was 48 % higher than in CC (P < 0.05) at the lowest and 55 % higher (P < 0.05) at the middle velocities. Viscosity in pentagastrin-stimulated conditions in controls was 71 % higher than in CC (P < 0.01) at the lowest and 35 % higher (P < 0.05) at the middle velocities.

Conclusions

(1) The significantly lower rate of soluble mucin secretion in patients with CC than in normal volunteers may reflect impairment in mucin-related lubrication. (2) Significantly lower viscosity of gastric secretion in patients with CC may result from the lower rate of mucin secretion and may also diminish lubrication within the alimentary tract. (3) This may potentially set the stage for the development of symptoms related to chronic constipation and open a new therapeutic avenue for this patient population.     

Gastric emptying is slow in chronic fatigue syndrome

Background

Gastrointestinal symptoms are common in patients with Chronic Fatigue Syndrome (CFS). The objective of this study was to determine the frequency of these symptoms and explore their relationship with objective (radionuclide) studies of upper GI function.

Methods

Thirty-two (32) patients with CFS and 45 control subjects completed a questionnaire on upper GI symptoms, and the 32 patients underwent oesophageal clearance, and simultaneous liquid and solid gastric emptying studies using radionuclide techniques compared with historical controls.

Results

The questionnaires showed a significant difference in gastric (p > 0.01) symptoms and swallowing difficulty. Nocturnal diarrhoea was a significant symptom not previously reported.5/32 CFS subjects showed slightly delayed oesophageal clearance, but overall there was no significant difference from the control subjects, nor correlation of oesophageal clearance with symptoms. 23/32 patients showed a delay in liquid gastric emptying, and 12/32 a delay in solid gastric emptying with the delay significantly correlated with the mean symptom score (for each p ? 0.001).

Conclusions

GI symptoms in patients with chronic fatigue syndrome are associated with objective changes of upper GI motility.

     

Indications et apport de la fibroscopie digestive haute chez l’enfant. A propos de 592 cas

Introduction

The aim of our study was to clarify the contribution of upper gastrointestinal endoscopy (UGIE) in children, through a review of 592 cases.

Materials and methods

This is a retrospective study including 290 boys and 302 girls aged under 16 years collected in gastroenterology department of Sfax between 2002 and 2005.

Results

The UGIE indications were dominated by gastrointestinal bleeding (37.8 %), epigastric pain (22 %) and caustic ingestion (11.48 %). It was normal in 49% of the patients. The frequency of endoscopic lesions decreased with age: it was 83.1 % among new born, 50.7 % among infants and 44% in children. The most common site of injury was the esophagus (33%), followed by the stomach (24%). Esophageal involvement was dominated by reflux esophagitis (59.37 %), while gastric involvement was dominated by purpuric lesions (30 %). Among endoscopic lesions, bulbar ulcer was found in 5.5 % of cases whereas gastric ulcer was present in 0.7 % of cases. In case of gastrointestinal hemorrhage, UGIE showed lesions in two thirds of cases. However, if it was motivated by epigastric pain, it showed lesions in 22% of the patients.

Conclusion

UGIE in children is save and had a great diagnostic and therapeutic contribution. However, its indications should be carefully selected in order to reduce unnecessary explorations.     

Cancer et lésions précancéreuses gastriques au Burundi

Aim

To estimate the prevalence of gastric cancers and precancerous lesions

Method

This is a retrospective study on 5 years (2003–2008) about gastric biopsies done by upper endoscopy in all Bujumbura Centers that practiced upper digestive endoscopy, and examined in the pathology laboratory of Kamenge university hospital.

Results

During that period, we selected 710 patients’ records that contained complete and required data for this study. 415 were males (58,4%) and 295 females (41,6%). The middle age was of 49,1 ±10years with the extremes of 12 to 88 years. The main indication of the upper endoscopy was epigastric pain (92,6% of patients). As pathology results, chronic gastritis was found in 61,3% (435 patients). It was atrophic in 28,6% (203patients) and lymphocytic in 0,6% (4 patients). Other lesions were chronic gastric ulcer: 16,2% (115 patients), adenomatous gastric polyp: 0,4% (3 patients), Fiddler illness 0,4% (3 patients), intestinal metaplasia: 3% (21 patients), severe dysplasia: 8,3% (59 patients), adenocarcinoma: 7,2% (51patients), primary gastric non hodgkin’s lymphoma: 0,7% (5 patients) and Kaposi sarcoma 0,1% (1 patient). The Helicobacter pylori was investigated for 619 patients and was positive for 524 (84,7%).

Conclusion

The gastric cancers and precancerous lesions are frequent in Burundi. Those lesions appeared in the 4th decade of life. More attention should be done on patients aged over 40 years by doing more biopsies to detect precancerous lesions and prevent the degeneration into a cancer.     

Symptom Burden of Adults with Type 2 Diabetes Across the Disease Course: Diabetes & Aging Study

BACKGROUND

Reducing symptom burden is paramount at the end-of-life, but typically considered secondary to risk factor control in chronic disease, such as diabetes. Little is known about the symptom burden experienced by adults with type 2 diabetes and the need for symptom palliation.

OBJECTIVE

To examine pain and non-pain symptoms of adults with type 2 diabetes over the disease course ?C at varying time points before death and by age.

DESIGN

Survey follow-up study.

PARTICIPANTS

13,171 adults with type 2 diabetes, aged 30?C75?years, from Kaiser Permanente, Northern California, who answered a baseline symptom survey in 2005?C2006.

MAIN MEASURES

Pain and non-pain symptoms were identified by self-report and medical record data. Survival status from baseline was categorized into ??6, >6?C24, or alive >24?months.

KEY RESULTS

Mean age was 60?years; 48?% were women, and 43?% were non-white. Acute pain was prevalent (41.8?%) and 39.7?% reported chronic pain, 24.6?% fatigue, 23.7?% neuropathy, 23.5?% depression, 24.2?% insomnia, and 15.6?% physical/emotional disability. Symptom burden was prevalent in all survival status categories, but was more prevalent among those with shorter survival, p?<?.001. Adults ??60?years who were alive >24?months reported more physical symptoms such as acute pain and dyspnea, whereas participants <60?years reported more psychosocial symptoms, such as depressed mood and insomnia. Adjustment for duration of diabetes and comorbidity reduced the association between age and pain, but did not otherwise change our results.

CONCLUSIONS

In a diverse cohort of adults with type 2 diabetes, pain and non-pain symptoms were common among all patients, not only among those near the end of life. However, symptoms were more prevalent among patients with shorter survival. Older adults reported more physical symptoms, whereas younger adults reported more psychosocial symptoms. Diabetes care management should include not only good cardiometabolic control, but also symptom palliation across the disease course.     

How Much Time Do Low-Income Patients and Primary Care Physicians Actually Spend Discussing Pain? A Direct Observation Study

BACKGROUND

We know little about how much time low-income patients and physicians spend discussing pain during primary care visits.

OBJECTIVE

To measure the frequency and duration of pain-related discussions at a primary care clinic serving mostly low-income black patients; to investigate variables associated with these discussions.

DESIGN

We measured the frequency and duration of pain-related discussions using video-recorded primary care visits; we used multiple regression to evaluate associations between discussions and patient self-report variables.

PARTICIPANTS

A total of 133 patients presenting to a primary care clinic for any reason; 17 family medicine residents.

MAIN MEASURES

Independent variables were pain severity, health status, physical function, chief complaint, and whether the patient and physician had met previously. Dependent variables were presence of pain-related discussions and percent of total visit time spent discussing pain.

KEY RESULTS

Sixty-nine percent of visits included pain-related discussions with a mean duration of 5.9?min (34% of total visit time). Increasing pain severity [OR 1.69, 95% CI (1.18, 2.41)] and pain-related chief complaints [OR 4.10, 95% CI (1.39, 12.12)] were positively associated with the probability of discussing pain. When patients discussed pain, they spent 4.5% more [95% CI (0.60, 8.37)] total visit time discussing pain for every one-point increase in pain severity. Better physical function was negatively associated with the probability of discussing pain [OR 0.65, 95% CI (0.48, 0.86)], but positively associated with the percent of total visit time spent discussing pain [3% increase; 95% CI (0.32, 5.75)] for every one-point increase in physical function). Patients and physicians who had met previously spent 11% less [95% CI (-21.65, -0.55)] total visit time discussing pain. Pain severity was positively associated with time spent discussing pain only when patients and physicians had not met previously.

CONCLUSIONS

Pain-related discussions comprise a substantial proportion of time during primary care visits. Future research should evaluate the relationship between time spent discussing pain and the quality of primary care pain management.     

Psychosomatic symptom profiles in patients with restless legs syndrome

Purpose

It has been reported that restless legs syndrome (RLS) might be associated with multiple psychosomatic symptoms. We aimed to identify which psychosomatic symptom is the most related in RLS patients compared to healthy controls. We also attempted to determine the relation between psychosomatic comorbidity and RLS severity regardless of sleep-related symptoms.

Methods

One hundred two newly diagnosed patients with RLS and 37 healthy control subjects participated in the present study. The RLS patients were categorized as mild and severe based on the International RLS Study Group rating scale. Data on demographics were collected. All participants completed the Pittsburgh Sleep Quality Index, Athens Insomnia Scale, and Epworth Sleepiness Scale as sleep-related questionnaires. All participants completed the Symptom Checklist-90-Revision (SCL-90-R).

Results

RLS patients were found to have pervasive comorbid psychosomatic symptoms. Somatization was found to be the most significant contributing factor (OR 1.145, 95 % CI 1.061–1.234, p?<?0.001) for psychosomatic comorbidity in RLS. Severe RLS patients were found to have poorer sleep quality than mild RLS patients. Furthermore, severe RLS patients had higher scores for most psychosomatic symptom domains in SCL-90-R. Anxiety was found to be the most independent contributing factor for psychosomatic comorbidity according to RLS severity (OR 1.145, 95 % CI 1.043–1.257, p?=?0.005).

Conclusions

Our study demonstrates that comorbid psychosomatic distress is considerable in patients with RLS. Furthermore, most psychosomatic comorbidity is increased with the RLS severity in association with poorer sleep quality.