Prevalence of swallowing complaints and clinical findings among 50–79-year-old men and women in an urban population

To determine the prevalence of swallowing and esophageal complaints in the general population, 300 men and 300 women were asked to answer a mailed questionnaire. The participation rate was 92.5%. Complaints were reported by 35%. The most common complaints were symptoms associated with gastroesophageal reflux (GER) and globus sensation, both with a rate of occurrence of 20%. Obstruction of the bolus reported by 3% was the individual symptom that most frequently brought patients to the doctor. To validate the questionnaire and to study possible organic causes behind these symptoms, 46 persons with symptoms were invited to undergo further examination. Cineradiography of the pharynx revealed that 7 of 14 patients with symptoms of GER had abnormalities in the esophagus. Eleven of 55 patients with GER symptoms at least once a week underwent endoscopy. One case of erosive esophagitis and one case of gastric ulcer were diagnosed. Four of nine patients with obstructive symptoms had defective closure of the laryngeal vestibule shown by cineradiography. Endoscopy in four patients with obstructive symptoms revealed benign findings. Thus, an epidemiologic study of patients with swallowing symptoms documented a low incidence of serious organic disease.     

Swallowing in neurological outpatients: Use of a timed test

Swallowing was studied prospectively in a consecutive group of 90 neurology outpatients under 70 years of age. No patient had been referred primarily because of dysphagia. Patients were classified into four groups: those with (1) neurological or (2) non-neurological diagnoses possibly relevant to disordered swallowing, (3) functional disorders, and (4) definite diagnoses not likely to be relevant. They were defined as having abnormal or probably abnormal swallowing if two or more of the following were present: a complaint of swallowing problem, abnormal symptoms or signs, a slow swallowing speed (<10 ml.s^-1). Nineteen patients among the four groups (21%) were found to have abnormal/probably abnormal swallowing. Swallowing speed was significantly slower in patients who perceived a swallowing problem or who had abnormal symptoms or signs compared with those who did not, providing further evidence for the validity of a timed test of swallowing capacity. The study also provides evidence of a significant incidence of disordered swallowing in outpatients who may not have complained spontaneously but who have diagnoses potentially relevant to swallowing.     

The importance of gastrointestinal (GI) symptom severity in rheumatoid and osteoarthritis: symptom rates and risk for GI hospitalization

OBJECTIVE: To determine the prevalence and stability of gastrointestinal (GI) symptoms in outpatients with rheumatoid arthritis (RA) and osteoarthritis (OA); to determine the specific symptoms that contribute to severity; and to determine the predictive value of GI symptoms and GI severity on the risk of future GI hospitalization. METHODS: A questionnaire survey was mailed to 1221 patients with RA and OA on a continuing 6 month schedule. Patients completed an average of 4.4 questionnaires (n = 5,047). Questionnaires included a visual analog scale GI severity scale, and questions regarding GI hospitalizations and specific GI symptoms. Hospitalizations that were reported as relating to the GI system were audited by checking hospital records. RESULTS: We found 57.5%, 40.2%, and 25.5% of patients had at least one assessment in which they had a GI symptom severity of 0.25-0.99, 1.00-1.99, and 2.00 or greater, respectively. Overall 74.9% had at least one score of 0.25 or greater, and 73.6% had one score of < 0.25, the cutoff for GI symptoms. By contrast, 6.45% had a GI hospitalization, and in only 0.75% of the questionnaire assessments were hospitalizations noted. Pyrosis and peptic ulcer symptoms were common, and were found in 62.5% and 42.4% of patients and 28.2% and 12.9% of observations, respectively. Among patients reporting GI severity scores between 2 and 3, roughly 60% and 45% reported the presence of pyrosis and peptic ulcer symptoms, respectively. The presence of a GI severity score > or = 0.25 was associated with 2.8-3.0-fold increase in the risk of hospitalization over the following 6 months. CONCLUSION: These data suggest that symptoms have an importance of their own that relates to quality of life, regardless of the risk of serious GI events like hospitalization, and that more attention should be placed on symptoms and symptom severity in future research. In spite of the statistical predictive value of GI symptom severity on future hospitalizations, it is important to recognize that rate of GI hospitalization increases from 0.92 per 100 patient-years to only 2.90 per 100 patient-years when the GI symptom scale goes from approximately zero to positive values. Thus, in spite of its statistical predictive ability, GI symptom severity is a poor clinical predictor of the hospitalizations that occur in patients with rheumatic diseases. Instead, GI symptom severity and specific GI symptoms have a separate importance to patients.     

Post-traumatic stress disorder and other co-morbidities in a sample population of patients with irritable bowel syndrome

BACKGROUND: High rates of psychiatric co-morbidity have been reported in patients with irritable bowel syndrome (IBS) and high rates of post-traumatic stress disorder (PTSD) have been reported in fibromyalgia, a disorder also associated with IBS. The primary aim of this study was to assess the frequency of PTSD in IBS patients. METHODS: Sixty-four patients who fulfilled the Rome II diagnostic criteria for IBS were asked to complete questionnaires measuring the prevalence and severity of symptoms of PTSD and psychological distress. RESULTS: Although 86% of IBS patients reported a traumatic life experience, only 7.8% met the diagnostic criteria for PTSD. High rates of somatization, obsessive-compulsive behavior, interpersonal sensitivity, and anxiety symptoms were seen among the IBS patients. CONCLUSIONS: The results show a lower than expected prevalence of PTSD among IBS patients, which is similar to that of the general population. Thus, we did not find that PTSD is over-represented in a sample population of IBS patients.     

Quality of life among patients treated for achalasia

The present study is an attempt to capture the quality of life of achalasia patients after a successful treatment. It is also an effort to assess the extent of the subsequent restrictions achalasia may have imposed upon the patients' life-style. All achalasia patients who were successfully treated between 1984 and 1992 were identified. Qualified patients were supplied with a 12-item quality-of-life questionnaire that had been designed to assess the patients' perceptions of their swallowing function and their general health; the restrictions achalasia had imposed on five areas of performance, which encompassed social activities, family relationships, travel experiences, sports and housework activities, were also assessed. Sixty-six patients were offered the questionnaire and 52 (77.6%) returned a completed form. Forty-one of the group had pneumatic dilatation and the remaining 11 had cardiomyotomy. Some form of dysphagia was reported by 36 patients (69%) and a dietary modification was exercised by 29 (56%) of them. Heartburn was reported by 31 (59%) of the patients. Fifteen percent of the patients felt that the disease interfered with their social activities, 8% experienced difficulty in their family relations, 13% believed that the disease restricted travel and athletics, and finally, 9% stated that their symptoms placed restrictions on their ability to do housework. The group that received pneumatic dilatation experienced less restriction in the performance areas of sports, travel, and housework. However, this difference was only significant in the area of sports (P=0.04). It is concluded that: (1) The restoration of the normal swallowing mechanism is not often achieved after treatment for achalasia. The majority of patients who have been treated continue to have a component of difficulty for the rest of their lives. (2) These residual symptoms leave an impact on the patients' life-style. This impact is least important in the performance area of family relationship and most impressive in the area of sports. (3) Finally, those patients who have been treated with cardiomyotomy are more restricted in sport activities than those who received pneumatic dilatation.     

Cross‐sectional survey of diabetic neuropathy in Kanagawa and clinical significance of a touch test using tissue paper

Aims/Introduction: The prevalence of diabetes mellitus is increasing rapidly in Japan, and diabetic neuropathy is a major factor decreasing diabetic patients’ quality of life, as well as a risk factor for sudden death. The present study aimed to determine the prevalence of diabetic neuropathy and raise awareness about it among patients and their physicians. Materials and Methods: Diabetic outpatients (N = 5077) at 249 medical institutions within Kanagawa Prefecture, Japan, were surveyed by questionnaire and underwent foot examinations. The questionnaire included 10 questions about sensory abnormalities of both feet, muscle cramps and autonomic symptoms. Foot examinations included testing for vibratory perception of the medial malleolus, Achilles tendon reflexes and touch sensation of the bottom of the great toe using tissue paper. Results: Of the 5077 patients surveyed, 70.4% reported symptoms. Overall, 75.4% of the patients underwent vibratory perception testing, of whom 44.9% had abnormal thresholds (≤10 s). On the tissue paper touch test, performed in 94.6% of patients, 11.9% had no touch sensation. Of the 2803 type 2 diabetic patients with known background factors who underwent foot examinations, 49.4% had diabetic neuropathy. There was a high prevalence of diabetic neuropathy (36.1%) in patients with <5‐year history. Of the patients with no touch sensation on the tissue paper test, 81.3% had diabetic neuropathy. Conclusions: The present study identified the prevalence of diabetic neuropathy in Kanagawa Prefecture. The tissue paper test is a simple and excellent method of evaluating decreased superficial sensation that can help evaluate the severity of diabetic neuropathy. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00174.x, 2011)     

Prevalence of acid reflux in functional dyspepsia and its association with symptom profile

AIM: A subset of functional dyspepsia patients respond to acid suppressive therapy, but the prevalence of non-erosive reflux disease in functional dyspepsia and its relevance to symptoms have never been established. The aim of the present study was to study 24 hour pH monitoring in consecutive functional dyspepsia patients. METHODS: A total of 247 patients with dyspeptic symptoms (166 women, mean age 44 (SEM 1) year), with a negative upper gastrointestinal endoscopy and without dominant symptoms of heartburn participated in the study. In all patients, the severity of dyspeptic symptoms and the presence of heartburn was assessed by a questionnaire and a 24 hour oesophageal pH monitoring study was performed. All patients underwent a gastric emptying breath test and in 113 a gastric barostat study was performed. RESULTS: Abnormal pH monitoring (acid exposure >5% of time) was found in 58 patients (23%). Of 21 patients with a positive heartburn questionnaire, 76% had pathological pH monitoring, while this was the case in only 18.5% of patients with a negative heartburn questionnaire. Demographic characteristics and the prevalence of other pathophysiological mechanisms did not differ between heartburn negative patients with normal or abnormal acid exposure. Pathological acid exposure in heartburn negative patients was associated with the presence of epigastric pain (65 v 84%, p<0.005) and of moderate or severe pain (48 v 69%, p = 0.005). CONCLUSION: Pathological oesophageal acid exposure is only present in a subset of heartburn negative functional dyspepsia patients, which are characterised by a higher prevalence of epigastric pain.     

Dysphagia without endoscopically evident disease: to dilate or not?

OBJECTIVES: It is not known whether patients with symptoms of dysphagia but normal upper endoscopy benefit from empiric esophageal dilation. The aim of this prospective study was to determine whether patients with solid food dysphagia and normal upper endoscopy have symptomatic benefit from empiric dilation using a through-the-scope balloon. METHODS: Patients who were seen for complaints of solid food dysphagia and who had normal endoscopic examinations at our institution from 1998 through 1999 were identified. Those patients who had agreed before sedation to participate in the study, if eligible, were randomized to either sham or balloon dilation using an 18-mm through-the-scope balloon at the time of esophagogastroduodenoscopy. All potentially eligible patients who had given provisional consent completed a dysphagia questionnaire and a 10-cm visual analog dysphagia scale before endoscopy. Follow-up questionnaires were completed on day 1 and at 3 months and 6 months after the procedure. The primary endpoint of the study was the patient's self-assessment of difficulty swallowing, based on the questionnaires. RESULTS: A total of 83 patients met the study criteria and were randomized to balloon dilation (n = 43) or sham (n = 40). The two groups were comparable in age, sex, severity of baseline dysphagia. and use of antireflux medication. Improvement in dysphagia comparing sham to balloon on day 1 was 66% versus 67% (p = 0.99); at 3 months it was 82% versus 76% (p = 0.56); and at 6 months it was 84% versus 73% (p = 0.38). There were no reported complications in either group. CONCLUSION: The data from this prospective randomized, controlled study do not support the practice of empiric dilation in patients with symptoms of dysphagia without an endoscopically evident cause of dysphagia.     

Symptoms of Daytime Sleepiness and Sleep Apnea in Liver Cirrhosis Patients

Background/proposeSleep disturbance and excessive daytime sleepiness (EDS) have been reported in patients with hepatic cirrhosis with no hepatic encephalopathy (HE). The objective of this study was to evaluate daytime sleepiness and risk of obstructive sleep apnea (OSA) among liver cirrhosis patients.Material and methodsA cross-sectional study was conducted at King Abdulaziz Medical City (KAMC)-Riyadh over a period of six months, using a structured questionnaire that investigated: 1) Sleep patterns and daytime sleepiness using the Epworth Sleeping Scale (ESS), and 2) The risk for sleep apnea using the Berlin Questionnaire (BQ). We enrolled patients with a confirmed diagnosis of liver cirrhosis who were being followed at the hepatology and preliver transplant clinics. Results. We enrolled 200 patients with liver cirrhosis, 57.5% of whom were male. The mean age was 60 (± SD 12.2). The reported prevalence of EDS, OSA, and both EDS and OSA were 29.5%, 42.9%, and 13.6%, respectively. The prevalence of EDS was higher in patients with Hepatitis-C and patients with DM, who experienced short sleep duration. We did not find any association between the severity of liver disease and EDS or OSA as measured by Child-Pugh scores (CPS). Conclusions. The risk of OSA and EDS is high among liver cirrhosis patients. Those patients with cirrhosis secondary to Hepatitis C are at higher risk of EDS and OSA. Both EDS and OSA affect patients designated as CPS Class A more frequently than patients designated as CPS Class B.     

Swallowing Disorders in Sjögren’s Syndrome: Prevalence,Risk Factors,and Effects on Quality of Life

This epidemiological investigation examined the prevalence, risk factors, and quality-of-life effects of swallowing disorders in Sjögren’s syndrome (SS). One hundred and one individuals with primary or secondary SS (94 females, 7 males; mean age 59.4, SD = 14.1) were interviewed regarding the presence, nature, and impact of swallowing disorders and symptoms. Associations among swallowing disorders and symptoms, select medical and social history factors, SS disease severity, and the M.D. Anderson Dysphagia Inventory (MDADI) and Short Form 36 Health Survey (SF-36) were examined. The prevalence of a current self-reported swallowing disorder was 64.4 %. SS disease severity was the strongest predictor of swallowing disorders, including significant associations with the following swallow symptoms: taking smaller bites, thick mucus in the throat, difficulty placing food in the mouth, and wheezing while eating (p < .05). Additional swallowing disorder risk factors included the presence of a self-reported voice disorder, esophageal reflux, current exposure to secondary tobacco smoke, frequent neck or throat tension, frequent throat clearing, chronic post-nasal drip, and stomach or duodenal ulcers. Swallowing disorders did not differ on the basis of primary or secondary SS. Swallowing disorders and specific swallowing symptoms were uniquely associated with reduced quality of life. Among those with swallowing disorders, 42 % sought treatment, with approximately half reporting improvement. Patient-perceived swallowing disorders are relatively common in SS and increase with disease severity. Specific swallowing symptoms uniquely and significantly reduce swallow and health-related quality of life, indicating the need for increased identification and management of dysphagia in this population.     

Evaluation of upper gastrointestinal tract symptoms in patients infected with HIV

OBJECTIVE: Upper gastrointestinal tract (UGI) symptoms are frequent in patients infected with the human immunodeficiency virus (HIV), but little published information exists about their characteristics or methods of evaluation. We evaluated the prevalence of nonesophageal UGI symptoms in a referral population, the utility of esophagogastroduodenoscopy (EGD) for diagnosis, and clinical predictors of abnormal endoscopic findings in patients infected with HIV. METHODS: All HIV-infected patients referred to.the outpatient gastroenterology clinics were prospectively evaluated using recognized symptom questionnaires. EGD indications, results, and the patients' self-reported symptom scores were compared. HIV-infected patients undergoing EGD were compared with HIV-infected patients not receiving an EGD and with symptomatic non-HIV-infected patients undergoing EGD. RESULTS: A total of 201 patients completed 280 questionnaires. Among 93 patients who underwent endoscopy, severe symptoms occurring at least several times per week included: anorexia (70%), upper abdominal pain (34%), vomiting (32%), or a recent weight loss of approximately 15 lb (31%). Patients undergoing EGD had more frequent/severe symptoms, but did not have differences in overall well-being or mean GI symptom score. The frequency of substantial and treatable endoscopic findings among patients infected with HIV was comparable to that found in the non-HIV-infected control group. There were no independent symptoms predicting substantial or treatable disease on EGD. CONCLUSIONS: We conclude that: 1) upper gastrointestinal symptoms are common in HIV-infected patients referred for GI consultation; 2) symptomatic HIV patients have a high prevalence of both treatable and untreatable upper GI pathologies; 3) and physicians use symptom frequency and severity to select patients for EGD, but these factors correlate poorly with abnormalities on EGD. Given this discrepancy, longitudinal study is needed to determine whether treating endoscopic abnormalities improves UGI symptoms.     

Can symptoms discriminate among those with delayed or normal gastric emptying in dysmotility-like dyspepsia?

OBJECTIVE: Different subgroups can be identified in functional dyspepsia based on symptom type or severity, and may correlate with pathophysiological disturbances. In particular, female sex and severe fullness and vomiting have been reported to be strong independent predictors of slow solid gastric emptying. We aimed to determine if symptom patterns or severity could identify those with abnormal gastric emptying among patients with dysmotility-like functional dyspepsia and, for comparison, type I diabetes mellitus. METHODS: Patients with postprandial symptoms and documented functional dyspepsia by endoscopy (n = 551) and patients with type I diabetes who had postprandial dyspepsia (n = 247) enrolling in two separate randomized controlled trials were evaluated at baseline. Patients were assigned to either the delayed or normal gastric emptying strata, based on a validated C13 octanoic acid breath test with sampling over 4 h. A self-report questionnaire measured the presence and severity of eight symptoms on visual analog scales. The validated Nepean Dyspepsia Index measured the frequency, severity, and bothersomeness of 15 upper GI symptoms on Likert scales. RESULTS: Gastric emptying was definitely delayed (t1/2 > 192 min) in 24% of patients with functional dyspepsia and 28% with diabetes. Delayed gastric emptying was associated with female gender but not age or Helicobacter pylori status. The age- and sex-adjusted risk (odds ratio) of delayed gastric emptying for the upper GI symptoms ranged from 0.99 to 1.0 (all p values > or =0.2). The results were very similar in functional dyspepsia and diabetes. There was also no correlation between t1/2 and number of symptoms or symptom severity scores. CONCLUSIONS: Symptom prevalence and severity were similar in dyspeptic patients with and without delayed gastric emptying. Specific symptoms do not seem to be of predictive value in dysmotility-like dyspepsia for identifying alterations of gastric emptying.     

Increased prevalence of gastroesophageal reflux symptoms in patients with COPD

STUDY OBJECTIVES: To determine the prevalence of gastroesophageal reflux (GER) symptoms in patients with COPD and the association of GER symptoms with the severity of airways obstruction as assessed by pulmonary function tests (PFTs). DESIGN: Prospective questionnaire-based, cross-sectional analytic survey. SETTING: Outpatient pulmonary and general medicine clinics at a Veterans Administration hospital. PATIENTS: Patients with mild-to-severe COPD (n = 100) were defined based on American Thoracic Society criteria. The control group (n = 51) consisted of patients in the general medicine clinic without respiratory complaints or prior diagnosis of asthma or COPD. INTERVENTION: Both groups completed a modified version of the Mayo Clinic GER questionnaire. RESULTS: Compared to control subjects, a greater proportion of COPD patients had significant GER symptoms defined as heartburn and/or regurgitation once or more per week (19% vs 0%, respectively; p < 0.001), chronic cough (32% vs 16%; p = 0.03), and dysphagia (17% vs 4%; p = 0.02). Among patients with COPD and significant GER symptoms, 26% reported respiratory symptoms associated with reflux events, whereas control subjects denied an association. Significant GER symptoms were more prevalent in COPD patients with FEV(1) < or %, as compared with patients with FEV(1) > 50% of predicted (23% vs 9%, respectively; p = 0.08). In contrast, PFT results were similar among COPD patients with and without GER symptoms. An increased number of patients with COPD utilized antireflux medications, compared to control subjects (50% vs 27%, respectively; p = 0.008). CONCLUSIONS: The questionnaire demonstrated a higher prevalence of weekly GER symptoms in patients with COPD, as compared to control subjects. There was a trend toward higher prevalence of GER symptoms in patients with severe COPD; however, this difference did not reach statistical significance. We speculate that although GER may not worsen pulmonary function, greater expiratory airflow limitation may worsen GER symptoms in patients with COPD.     

Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes.

AIMS: A cross-sectional study has been performed in order to estimate the prevalence, severity, and current treatment of chronic painful peripheral neuropathy (CPPN) in people with diabetes in the community. METHODS: Using a structured questionnaire and examination we have assessed these factors in a community sample of people with diabetes (n=350) and compared them with 344 age- and sex-matched people without diabetes from the same locality. RESULTS: The prevalence of CPPN was estimated to be 16.2%[95% confidence interval (CI): 6.8-16%] in people with diabetes compared with 4.9% (95% CI: 2.6-7.2%) in the control sample (P < 0.0001). Diabetic subjects with and without CPPN did not differ in age, sex, type and duration of diabetes, body mass index, smoking status and glycaemic control. However, CPPN diabetic subjects had significantly higher Visual Analogue Scale (VAS) scores for pain over the preceding 24 h [median (interquartile range) 3.5 (1.5-6.7) cm vs. 0.7 (0-3.9) cm, P < 0.0001]. Also, the total McGill Pain Questionnaire Score (a measure of pain quality and severity) was 18 (13-31.5) vs. 10 (4-16) (P < 0.0001). Of patients with diabetes and CPPN, 12.5% (7/56) had never reported their symptoms to their treating physician and 39.3% (22/56) had never received any treatment for their painful symptoms. CONCLUSIONS: CPPN is common, often severe but frequently unreported and inadequately treated.     

The prevalence of sexual abuse in women with fibromyalgia

Objective. To determine the prevalence of sexual abuse in women diagnosed as having fibromyalgia (FM) compared with controls. Methods. A self-administered questionnaire designed to obtain information regarding demographics, health care utilization, and history of sexual and physical abuse was completed by 40 women with FM and by 42 women who had no evidence of connective tissue disease or other major medical condition. Results. Women with FM reported more physical symptoms and were significantly different on multiple indices of health compared with controls. Twenty-six FM subjects (65%) reported sexual abuse, in comparison with 22 controls (52%). The prevalence and type of abuse were not significantly different between groups. Sexually abused FM subjects reported significantly more symptoms than did non-sexually abused FM women, but did not differ in the number of symptoms for which they sought medical treatment. Conclusion. Sexual abuse does not appear to be a specific factor in the etiology of FM, but is correlated with the number and severity of associated symptoms.     

Pharmacovigilance through consumer feedback (reporting) in the mass treatment of lymphatic filariasis using diethylcarbamazine and albendazole in two districts of Sri Lanka

Objective  To document the types and severity of adverse drug reactions to diethylcarbamazine and albendazole in randomly selected urban populations from Colombo and rural populations from Gampaha, Sri Lanka.
Methods  Interviewers administered a pre-tested questionnaire to elicit information about the type and severity of adverse drug reactions experienced by recipients. Seeking medical treatment and requiring hospital admission for the adverse drug reactions were used as indicators for severity. The sample population was selected using the cluster sampling method.
Results  Two thousand three hundred and nineteen persons aged 10 to 90 years (median 40.0) responded to the questionnaire; 63.9% of them had received and ingested the drugs. 12.6% reported that they had experienced adverse drug reactions, the proportion being similar in urban and rural areas (χ² = 0.05; p = 0.82). Commonly reported reactions were drowsiness (34.7%), headache (23.1%), gastrointestinal symptoms (18.7%) and dizziness or faintness (11.9%). However, most symptoms were mild (96.3%) and did not interfere with daily activities or require medical attention. 3.2% said that they sought medical advice for their symptoms; one person (0.5%) who had severe abdominal pain was hospitalized.
Conclusions  Fewer people experienced adverse drug reactions than in previous years, possibly due to lower microfilariaemia prevalence after several rounds of mass drug administration against filariasis. Community awareness of adverse drug reactions is essential for improving compliance and for the success of the filariasis elimination programme.     

Reactive arthritis and other sequelae following sporadic Salmonella typhimurium infection in British Columbia,Canada: a case control study

OBJECTIVE: To describe sequelae occurring in the 3 months after sporadic Salmonella typhimurium (ST) infection in British Columbia (BC), Canada. METHODS: We compared the incidence of sequelae to similar symptoms in controls; identified risk factors for developing sequelae; identified the incidence of reactive arthritis (ReA) as diagnosed by a rheumatologist, and assessed primary care physician diagnosis of ReA. A questionnaire was administered by telephone to cases of ST occurring in BC between December 1, 1999, and November 30, 2000; and to controls obtained from the BC provincial client registry. Cases reporting symptoms were followed up by a rheumatologist. RESULTS: Thirty-five of 66 (53%) cases reported any symptom, 17 (26%) reported joint symptoms. The Mantel-Haenszel odds ratio (weighted by sex and pediatric/adult) of a salmonella case reporting "any symptom" compared to controls was 5.42; 95% confidence interval (CI) 2.18-16.27; and reporting joint symptoms was 4.40; 95% CI: 1.25-19.53. The sex distribution of cases reporting joint symptoms was not significantly different. No medication taken during the salmonella infection was significantly different between the cases who had joint symptoms and those who did not. Four cases (2 adults, 2 children) were considered by the rheumatologist to have symptoms consistent with ReA, 2 of these had been told by a physician that their symptoms were related to their ST infection. CONCLUSION: Cases were more than 4 times more likely to report joint symptoms than controls; and despite the loss of many cases to followup, 6% of all cases were considered to have ReA.     

Distress correlates with the degree of chest pain: a description of patients awaiting revascularisation.

AIM: To describe various symptoms other than pain among consecutive patients on the waiting list for possible coronary revascularisation in relation to estimated severity of chest pain. DESIGN: All patients were sent a postal questionnaire for symptom evaluation. SUBJECTS: All patients in western Sweden on the waiting list in September 1990 who had been referred for coronary angiography or coronary revascularisation (n = 904). RESULTS: 88% of the patients reported chest pain symptoms that limited their daily activities to a greater or lesser degree. Various psychological symptoms including anxiety and depression were strongly associated with the severity of pain (P < 0.001), as were sleep disturbances (P < 0.001), and dyspnoea and various psychosomatic symptoms (P < 0.001). Nevertheless only 44% of the patients reported chest pain as the major disruptive symptom, whereas the remaining 56% reported uncertainty about the future, fear, or unspecified symptoms as being the most disturbing. CONCLUSIONS: In a consecutive series of patients on the waiting list for possible coronary revascularisation, half the participants reported that uncertainty and fear were more disturbing than chest pain.     

Complaints of Cold Extremities among Patients on Antihypertensive Treatment

ABSTRACT A total of 758 consecutive patients attending three hypertension clinics answered a questionnaire designed to assess the prevalence and severity of complaints of cold extremities among patients on various antihypertensive drugs. Forty-four per cent claimed to have had complaints of cold extremities and about 50% of these had had symptoms already prior to antihypertensive treatment. Among the newly symptomatic patients the prevalence of symptoms was 18% of those on diuretics and 40% of those on β-blockers (p<0.01). No significant association was found between the prevalence of symptoms and age, sex, use of vibrating tools, smoking or history of various conditions associated with atherosclerosis. No significant difference was found in the prevalence of symptoms among patients on propranolol, alprenolol, pindolol, atenolol and metoprolol. It is concluded that cold hands and feet are common among hypertensive patients and may be aggravated by treatment with not only β-blockers but also diuretics.