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- Andersson, Stina, 1977, et al.
(författare)
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A slow caloric satiety drinking test in patients with temporary and permanent gastric electrical stimulation.
- 2010
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Ingår i: European journal of gastroenterology & hepatology. - 0954-691X. ; 22:8, s. 926-932
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Improvement of gastric accommodation has been proposed as a potential explanation for the positive effect of gastric electrical stimulation (GES) on nausea/vomiting. A drinking test has been suggested as a noninvasive measure of gastric accommodation capacity. METHODS: Eight patients with therapy refractory nausea and vomiting and nonapproved diagnosis for GES (chronic intestinal pseudo-obstruction (CIP, n=1), functional dyspepsia (FD, n=3), postsurgical gastroparesis (PSGP, n=4) underwent temporary percutaneous GES for 10-14 days, randomized to stimulation ON or OFF, respectively. 19 patients [CIP (n=1), diabetic gastroparesis (n=5), FD (n=5), idiopathic gastroparesis (n=4), PSGP (n=4)] received permanent GES (Enterra, Medtronic) (follow-up at baseline, 6 and 12 months). At the end of each stimulation period a slow caloric satiety drinking test was performed (Nutridrink 1.5 kcal/ml, 15 ml/min). RESULTS: Healthy volunteers had higher drinking capacity compared to patients at baseline (1630+/-496 kcal vs. 887+/-412; P<0.001) and less composite symptom score (128+/-51 vs. 235+/-83; P<0.001). With temporary percutaneous GES, there was no significant change in drinking capacity during stimulation ON versus OFF (746+/-383 vs. 734+/-427 kcal) and symptom severity at the drinking test was unchanged. For patients having permanent GES there was no significant difference at 6 months (876+/-277 kcal) versus baseline, and no difference between symptomatic responders and nonresponders in change in drinking capacity (P=0.7). CONCLUSION: GES had no effect on proximal gastric function as evaluated by the slow caloric satiety drinking test. This seems to be the case for patients with approved as well as nonapproved indications for GES, and irrespective of the symptomatic response.
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- Elfvin, Anders, 1971, et al.
(författare)
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Temporary percutaneous and permanent gastric electrical stimulation in children younger than 3 years with chronic vomiting.
- 2011
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Ingår i: Journal of pediatric surgery. - : Elsevier BV. - 1531-5037 .- 0022-3468. ; 46:4, s. 655-61
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to investigate whether young children with drug-refractory nausea and vomiting can be treated with gastric electrical stimulation (GES) in a similar way as adults and to evaluate whether temporary percutaneous gastric electrical stimulation (TPGES) can be used in the pediatric population to select the patients who are responders to GES treatment. We report the clinical results in 3 children between 2 and 3 years of age. To the best of our knowledge, these are the youngest patients treated with GES.
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- Lindfors, Perjohan, et al.
(författare)
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Effects of Gut-Directed Hypnotherapy on IBS in Different Clinical Settings-Results From Two Randomized, Controlled Trials.
- 2012
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Ingår i: The American journal of gastroenterology. - : Ovid Technologies (Wolters Kluwer Health). - 1572-0241 .- 0002-9270. ; 107, s. 276-285
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:Gut-directed hypnotherapy has been found to be effective in irritable bowel syndrome (IBS). However, randomized, controlled studies are rare and few have been performed outside highly specialized research centers. The objective of this study was to study the effect of gut-directed hypnotherapy in IBS in different clinical settings outside the traditional research units.METHODS:The study population included IBS patients refractory to standard management. In study 1, patients were randomized to receive gut-directed hypnotherapy (12 sessions, 1h/week) in psychology private practices or supportive therapy, whereas patients were randomized to receive gut-directed hypnotherapy in a small county hospital or to serve as waiting list controls in study 2. Gastrointestinal symptom severity and quality of life were evaluated at baseline, at 3 months follow-up and after 1 year.RESULTS:We randomized 138 IBS patients refractory to standard management, 90 in study 1 and 48 in study 2. In both the studies, IBS-related symptoms were improved at 3 months in the gut-directed hypnotherapy groups (P<0.05), but not in the control groups (ns). In study 1, a significantly greater improvement of IBS-related symptom severity could be detected in the gut-directed hypnotherapy group than in the control group (P<0.05), and a trend in the same direction was seen in study 2 (P=0.17). The results seen at 3 months were sustained up to 1 year.CONCLUSIONS:Gut-directed hypnotherapy is an effective treatment alternative for patients with refractory IBS, but the effectiveness is lower when the therapy is given outside the highly specialized research centers.Am J Gastroenterol advance online publication, 4 October 2011; doi:10.1038/ajg.2011.340.
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- Lindfors, Perjohan, et al.
(författare)
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Effects on gastrointestinal transit and antroduodenojejunal manometry after gut-directed hypnotherapy in irritable bowel syndrome (IBS).
- 2012
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Ingår i: Scandinavian journal of gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 47:12, s. 1480-7
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background. Gut-directed hypnotherapy is an effective treatment in irritable bowel syndrome (IBS) but little is known about the mechanisms of action. In this study we aimed to investigate the effects on gastrointestinal motility when treating IBS with gut-directed hypnotherapy. Methods. We randomized 90 patients with IBS, refractory to standard management to receive gut-directed hypnotherapy 1 h/week for 12 weeks or supportive treatment for the same time period. Eighty-one subjects (40 hypnotherapy, 41 controls) could be evaluated by one or more of the following investigations, both before and after the intervention: gastric emptying time, small bowel transit time, colonic transit time, and antroduodenojejunal manometry. Results. No significant differences in gastric emptying time, small bowel transit time, or colonic transit time was found when comparing the baseline and post-intervention measurements in the hypnotherapy group or in the control group. The same was true concerning the results of the antroduodenojejunal manometry. However, there was a numerical trend toward a higher number of migrating motor complexes at manometry and an accelerated gastric emptying time after hypnotherapy that did not reach statistical significance. Conclusions. In this study, we were not able to find evidence for long-standing effects on gastrointestinal motility as a mediator of the effects on IBS when treating the condition with gut-directed hypnotherapy. Further research to understand the mechanism of action is needed.
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- Lindfors, Perjohan, et al.
(författare)
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Long-term effects of hypnotherapy in patients with refractory irritable bowel syndrome.
- 2012
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Ingår i: Scandinavian journal of gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 47:4, s. 414-20
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Tidskriftsartikel (refereegranskat)abstract
- Gut-directed hypnotherapy is considered to be an effective treatment in irritable bowel syndrome (IBS) but few studies report the long-term effects. This retrospective study aims to evaluate the long-term perceived efficacy of gut-directed hypnotherapy given outside highly specialized hypnotherapy centers.
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- Lindfors, Perjohan, et al.
(författare)
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Patient satisfaction after gut-directed hypnotherapy in irritable bowel syndrome.
- 2013
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Ingår i: Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society. - : Wiley. - 1365-2982 .- 1350-1925. ; 25:2
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Tidskriftsartikel (refereegranskat)abstract
- Background Gut-directed hypnotherapy is an effective treatment option for irritable bowel syndrome (IBS). However, clinical observations suggest that patient satisfaction with hypnotherapy is not always associated with improvement in IBS symptoms. Methods We evaluated 83 patients with IBS treated with gut-directed hypnotherapy (1hweek(-1) , 12weeks). After the treatment period, patients reported their satisfaction with the treatment (ranging from 1=not at all satisfied, to 5=very satisfied) and completed questionnaires to assess IBS symptom severity, quality of life, cognitive function, sense of coherence, depression, and anxiety before and after treatment. Key Results After hypnotherapy improved IBS symptom severity, quality of life, cognitive function, and anxiety were seen. Thirty patients (36%) were very satisfied with the treatment and 57 (69%) patients scored 4 or 5 on the patient satisfaction scale. Patient satisfaction was associated with less severe IBS symptoms and better quality of life after the treatment. In a multiple linear regression analysis, only the quality of life domain sexual relations was independently associated with patient satisfaction after hypnotherapy, explaining 22% of the variance. Using 25% reduction of IBS symptom severity to define an IBS symptom responder, 52% of the responders were very satisfied with hypnotherapy, but this was also true for 31% in the non-responder group. Conclusions & Inferences Patient satisfaction with gut-directed hypnotherapy in IBS is associated with improvement of quality of life and gastrointestinal (GI) symptoms. However, other factors unrelated to GI symptoms also seems to be of importance for patient satisfaction, as a substantial proportion of patients without GI symptom improvement were also very satisfied with this treatment option.
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- Olausson, Eva A, et al.
(författare)
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Measurement of gastric emptying by radiopaque markers in patients with diabetes: correlation with scintigraphy and upper gastrointestinal symptoms
- 2013
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Ingår i: Neurogastroenterology and Motility. - : Wiley. - 1350-1925. ; 25:3
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Tidskriftsartikel (refereegranskat)abstract
- Background Scintigraphy, the gold standard to measure gastric emptying, is expensive and not widely available. Therefore, we compared emptying of radiopaque markers (ROM) from the stomach, by use of fluoroscopy, with scintigraphy in patients with insulin-treated diabetes. Methods On the same day we measured gastric emptying of 20 ROM using fluoroscopy and scintigraphic emptying of a standard solid meal. The subjects also completed a validated gastrointestinal (GI) symptom questionnaire. Key Results We included 115 patients with insulin-treated diabetes (median age 53, range 21–69 years; 59 women). A moderately strong correlation was demonstrated between scintigraphic (% retained at 2 h) and ROM emptying (markers retained at 6 h) (r = 0.47; P < 0.0001). Eighty-three patients had delayed gastric emptying with scintigraphy, whereas only 29 patients had delayed emptying of ROM. Of the 29 patients with delayed emptying of ROM, 28 also had delayed scintigraphic emptying. The sensitivity and specificity of the ROM test was 34% and 97%, respectively. Significant correlations were only noted between scintigraphic gastric emptying and GI symptom severity, with the strongest correlations for fullness/early satiety (r = 0.34; P < 0.001) and nausea/vomiting (r = 0.30; P < 0.001). Conclusions & Inferences A gastric emptying test with ROM is a widely available screening method to detect delayed gastric emptying in patients with diabetes, where a positive result seems reliable. However, a normal ROM test does not exclude delayed gastric emptying, and if the clinical suspicion of gastroparesis remains, scintigraphy should be performed. Results from scintigraphy also correlate with GI symptom severity, which ROM test did not.
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- Törnblom, Hans, 1966, et al.
(författare)
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Colonic Transit Time and IBS Symptoms: What's the Link
- 2012
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Ingår i: American Journal of Gastroenterology. - : Ovid Technologies (Wolters Kluwer Health). - 0002-9270 .- 1572-0241. ; 107:5, s. 754-760
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The relevance of colonic transit alterations for the overall symptom pattern in irritable bowel syndrome (IBS) is incompletely understood. The aim of this study was to assess the total and segmental colonic transit time (CTT) and their relationship to symptoms and subgroups in a large sample of IBS patients. METHODS: Total and segmental CTT was assessed using radiopaque markers in 359 patients with IBS (279 females). These results were compared with existing normal values for healthy men and women without gastrointestinal (GI) symptoms. Stool frequency and consistency (Bristol Stool Form (BSF) scale), and the perceived severity of three GI symptoms (bloating, flatulence, and abdominal pain) were noted in a daily diary during the measurement week. Patients could be classified by the BSF scale characteristics into Rome III subtypes (n = 338), or by use of the Rome II modular questionnaire into Rome II subtypes (n = 143). RESULTS: CTT was normal in 287 patients (80%), whereas 53 (15%) had accelerated and 19 (5%) had delayed CTT. Transit abnormalities in relation to gender-specific reference values were more common in males (30.0%) than in females (17.2%; P<0.05). IBS subgrouping according to Rome III (P<0.0001) and Rome II criteria (P<0.001) was associated with the presence of abnormal CTT. Stool form (r=-0.40; P<0.0001) and stool frequency (r=-0.30; P<0.0001) were moderately and negatively correlated to total CTT. No correlations of clinical significance were found between transit data and the three GI symptoms. CONCLUSIONS: Total and segmental colonic transit alterations are of importance for the abnormal bowel habit seen in men and women with IBS, but of no or minor importance for other IBS symptoms.
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