| 451. |
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| 452. |
- Simrén, Magnus, 1966, et al.
(författare)
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Health-related quality of life in patients attending a gastroenterology outpatient clinic: functional disorders versus organic diseases.
- 2006
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Ingår i: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. - 1542-3565. ; 4:2, s. 187-95
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: Several gastrointestinal (GI) disorders have major effects on health-related quality of life (HRQOL), but there are few direct comparisons between functional GI disorders and organic GI diseases. This study aimed to compare HRQOL between these 2 groups and to assess factors of importance for HRQOL. METHODS: Three hundred ninety-nine consecutive patients attending a GI outpatient clinic completed HRQOL instruments (Short Form 36 [SF-36] and Psychological General Well-Being index [PGWB]) and the Gastrointestinal Symptom Rating Scale (GSRS). For the analyses we divided the patients into 2 diagnostic groups: functional GI disorders (n = 112) and organic GI diseases (n = 287). RESULTS: Compared with norm values on SF-36 and PGWB, both patient groups exhibited profound reductions in HRQOL. After correcting for age, gender, and disease duration, patients with a functional GI disorder had significantly lower scores than patients with an organic GI disease on 6 of 8 SF-36 domains and 5 of 6 PGWB domains. Vitality and anxiety on PGWB, abdominal pain and diarrhea on GSRS, age, and gender independently contributed to the physical component score of SF-36 (adjusted R(2) = 32%). Patients with a functional GI disorder had more severe reflux, abdominal pain, constipation, and indigestion, but the severity of diarrhea did not differ between the groups. HRQOL was reduced with increasing severity of GI symptoms. CONCLUSION: GI disorders have profound effects on HRQOL, and the impact is greater in patients with functional GI disorders as compared with organic GI diseases. The reduction in HRQOL is associated with the severity of both psychological and GI symptoms.
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| 453. |
- Simrén, Magnus, 1966, et al.
(författare)
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High interdigestive and postprandial motilin levels in patients with the irritable bowel syndrome.
- 2005
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Ingår i: Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society. - : Wiley. - 1350-1925. ; 17:1, s. 51-7
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Tidskriftsartikel (refereegranskat)abstract
- Motilin shows cyclic variation with the different phases of the migrating motor complex (MMC). Altered motilin levels have been found in irritable bowel syndrome (IBS) patients, but in these studies motilin levels were analysed without the knowledge of the phases of MMC. We included 13 healthy controls (HC) and 24 patients with IBS [12 diarrhoea-predominant (IBS-D) and 12 constipation-predominant (IBS-C)]. We performed interdigestive and postprandial antroduodenojejunal manometry and blood samples for analysis of motilin were drawn. Group differences in plasma levels of motilin were analysed during mid-phase II, just before the start of phase III (pre-III), during phase I, immediately before the meal and 30 and 60 min after the 500 kcal mixed meal. Higher motilin levels were observed in IBS vs HC in both the interdigestive and postprandial periods (P < 0.05). No significant differences between IBS-C and IBS-D were observed. The cyclic variation of motilin during MMC and the meal response was similar in IBS and controls. IBS patients, irrespective of the predominant bowel habit, demonstrate higher motilin levels than HCs in all phases of the MMC and also after a meal. These findings may bear some pathophysiological importance in IBS and relate to the gastrointestinal dysmotility often seen in these patients.
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| 454. |
- Simrén, Magnus, 1966
(författare)
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Hypnosis for irritable bowel syndrome: the quest for the mechanism of action.
- 2006
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Ingår i: The International journal of clinical and experimental hypnosis. - : Informa UK Limited. - 0020-7144 .- 1744-5183. ; 54:1, s. 65-84
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Tidskriftsartikel (refereegranskat)abstract
- Irritable bowel syndrome (IBS) is a very common condition in the Western part of the world, and it accounts for a large proportion of the workload of a gastroenterologist. Unfortunately, the pathogenesis and pathophysiology of the syndrome are incompletely understood, and the treatment options are limited. However, hypnotherapy is one treatment option that has proven to be very useful in IBS. The mechanisms of action explaining why hypnosis is effective for IBS are not altogether known, but recent studies have shed some light on this issue. These studies, and what can be learned from them about how hypnosis impacts IBS, are reviewed in this article. Hypnosis may affect IBS partly through changes in colorectal sensitivity and improvement in psychological factors. The effects on GI motility and the autonomic nervous system are less clear and need further evaluation.
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| 455. |
- Simrén, Magnus, 1966
(författare)
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Irritable bowel syndrome. Pathophysiological and clinical aspects
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Irritable bowel syndrome (IBS) is characterized by abdominal pain and/or discomfort related to abnormal bowel habits. Gastrointestinal (GI) motility disturbances, visceral hypersensitivity and psychological factors are involved in the pathophysiology of IBS. A number of unresolved issues regarding pathophysiology and the clinical presentation of IBS were studied.In IBS patients high-resolution manometry disclosed a higher proportion of duodenal individual pressure waves that propagated in a retrograde direction. This was especially pronounced postprandially. Combined high-resolution analysis and a detailed cluster analysis demonstrated abnormal findings in 22/26 (85%) patients compared with 10/26 (38%) with conventional manometric analysis. After duodenal lipid infusion, IBS patients increased their perceptual sensitivity in the sigmoid colon (barostat study) and showed an altered viscerosomatic referral pattern. This reaction was significantly more pronounced than in the controls.Abnormal levels of motilin in plasma and peptide YY (PYY) in the ascending colon were observed in IBS compared with the controls. IBS patients who presented predominantly with diarrhea, compared with those with constipation, exhibited lower plasma levels of motilin and higher levels of corticotropin releasing factor (CRF) and lower levels of neuropeptide Y (NPY) in colonic biopsies.A relationship between GI symptoms and food intake was reported by 63% of IBS patients. Female sex and anxiety predicted a high degree of subjective food intolerance.Quality of life (QOL) was reduced in IBS patients at referral centers compared with primary care. This difference was only obvious in females. Fatigue was related to other aspects of QOL, such as depression, anxiety, well-being and gastrointestinal symptom severity as well as gender.Conclusions: Food-related GI symptoms are common in IBS and may in part be explained by an exaggerated sensory component of the gastrocolonic response. IBS patients show an abnormal propagation pattern of individual duodenal pressure waves. Abnormal levels of motilin, CRF, PYY and NPY may be involved in the pathophysiology of IBS. IBS female patients seen at referral centers constitute a highly selected group with reduced QOL. Fatigue is a common symptom in IBS related to general well-being and psychological and subjective gastrointestinal symptoms.
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| 456. |
- Simrén, Magnus, 1966, et al.
(författare)
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Lipid-induced colonic hypersensitivity in the irritable bowel syndrome: the role of bowel habit, sex, and psychologic factors.
- 2007
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Ingår i: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association. - : Elsevier BV. - 1542-7714. ; 5:2, s. 201-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: Duodenal lipid infusion increases colonic hypersensitivity in irritable bowel syndrome (IBS). Whether this is affected by bowel habit, psychologic factors, or sex is unknown. METHODS: We included 61 patients with IBS (50 women, 11 men), 25 with diarrhea-predominant IBS, 17 with constipation-predominant IBS, 19 with alternating-type IBS, and 20 healthy controls (15 women, 5 men). A colonic distension trial was performed with a barostat before and after a 1-hour duodenal lipid infusion (3 kcal/min). Colonic thresholds, colonic tone, and the viscerosomatic referral pattern were assessed and compared between groups. Patients also completed the Hospital Anxiety and Depression scale. RESULTS: The reduction in colonic pressure thresholds after vs before duodenal lipids was greater in patients than in controls for discomfort (P = .006) and pain (P < .0001). An increased viscerosomatic referral area for pain and discomfort during colonic distensions after vs before duodenal lipids was observed in patients but not in controls. The response was similar in IBS subgroups based on the predominant bowel habit, in patients with vs without anxiety and/or depression, and in women and men with IBS. The colonic tone response during lipid infusion was similar in IBS patients and controls, and in the different IBS subgroups. CONCLUSIONS: IBS patients show increased colonic sensitivity and altered viscerosomatic referral pattern after duodenal lipids. This response is largely unaffected by the predominant bowel habit, psychologic factors, or sex, but seems to be related to IBS per se.
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| 457. |
- Simrén, Magnus, 1966, et al.
(författare)
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Nutrient-dependent enhancement of rectal sensitivity in irritable bowel syndrome (IBS).
- 2007
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Ingår i: Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society. - : Wiley. - 1350-1925. ; 19:1, s. 20-9
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Tidskriftsartikel (refereegranskat)abstract
- Food-related gastrointestinal symptoms are common in irritable bowel syndrome (IBS), but the mechanisms behind this are unclear. Enhanced colorectal sensitivity after duodenal lipid administration in IBS patients has been demonstrated. However, the effects of a regular meal on colorectal sensitivity in these patients and the importance of the composition of the meal are not known. On two separate days, 10 IBS patients and 11 controls randomly received a liquid meal (800 kcal), containing 60% calories from fat (fatty meal) or carbohydrate (carbohydrate meal). Using a barostat rectal sensitivity was assessed during four separate distension sequences before, immediately after and 30 and 60 min after the meal. In the patients, the discomfort (P = 0.04) and the pain thresholds (P = 0.007) were gradually reduced after the fatty meal, whereas only a tendency in the same direction was seen after the carbohydrate meal. In patients VAS ratings for pain increased after the fatty meal (P = 0.03), but not after carbohydrates. In the controls, sensory thresholds were not affected by the meals. In IBS, a liquid meal enhances rectal sensitivity, and this seems to be partly nutrient dependent as a fatty meal has more pronounced effects than a carbohydrate meal. This might be of relevance for their postprandial symptoms.
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| 458. |
- Simrén, Magnus, 1966, et al.
(författare)
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Nutritional aspects in patients with functional gastrointestinal disorders and motor dysfunction in the gut. Working team report of the Swedish Motility Group (SMoG).
- 2007
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Ingår i: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. - : Elsevier BV. - 1590-8658. ; 39:5, s. 495-504
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Forskningsöversikt (refereegranskat)abstract
- In reviews regarding the management of patients with functional gastrointestinal disorders and motility disturbances within the gut nutritional aspects and dietary advice is often put forward as being of great importance. However, there are relatively few high-quality, interventional studies in the literature supporting an important role for general dietary advice to improve symptoms in these patients. Nutritional supplementation to patients with malnutrition due to severe dysfunction of the gastrointestinal tract is of course less controversial, even though different views on how this should be performed exist. The content of this article is based on presentations given by the authors during the second meeting of the Swedish Motility Group held in Gothenburg in March 2005, and aims to give an overview on the role of dietary advice and nutritional supplementation to patients with gastrointestinal dysfunction of different severity.
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| 459. |
- Simrén, Magnus, 1966, et al.
(författare)
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Predictors of subjective fatigue in chronic gastrointestinal disease.
- 2008
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Ingår i: Alimentary pharmacology & therapeutics. - : Wiley. - 1365-2036 .- 0269-2813. ; 28:5, s. 638-47
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Fatigue is a common, but poorly understood symptom in patients with chronic gastrointestinal (GI) diseases. AIM: To evaluate factors of importance for fatigue in patients with chronic GI diseases, and to compare it with fatigue in the general population. METHODS: In all, 399 patients attending a GI out-patient clinic completed questionnaires assessing fatigue, sleep disturbances, psychological general well-being and GI symptom severity. The patients were divided into two diagnostic groups: functional GI disorders (n = 112) and organic GI diseases (n = 287). The severity of fatigue was also evaluated in an age- and gender-matched group of 399 individuals from the general population. RESULTS: Both patient groups had more severe fatigue than controls and patients with functional GI disorders were more fatigued than patients with an organic GI disease. Fatigue was associated with psychological general well-being, GI symptom severity, gender, employment status and sleep disturbances. In a linear regression analysis, psychological general well-being (vitality, general health, self-control), sleep disturbances and employment status were independently associated with the severity of fatigue (adjusted R(2) = 55%). CONCLUSIONS: Fatigue is a troublesome symptom in a subgroup of patients with chronic GI diseases. These patients have a high symptom burden as regards both GI and psychological symptoms, as well as sleep disturbances.
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| 460. |
- Simrén, Magnus, 1966, et al.
(författare)
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Quality of life and illness costs in irritable bowel syndrome.
- 2004
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Ingår i: Digestion. - : S. Karger AG. - 0012-2823 .- 1421-9867. ; 69:4, s. 254-61
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Tidskriftsartikel (refereegranskat)abstract
- Quality of life is reduced in patients with irritable bowel syndrome, and the costs for this disease are substantial to society. During a meeting in London, UK, the IBiS club reviewed the literature on these subjects. Drawbacks and advantages with existing instruments to assess quality of life and costs were discussed and the clinical and scientific relevance of the current knowledge was assessed. A summary from the meeting is presented in this paper.
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