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Biomedical subjects

D A Drossman

Publications and source records attributed to D A Drossman.

At least 19 recordsLinked to original sources
PubMed1995

Sexual and physical abuse and gastrointestinal illness. Review and recommendations.

OBJECTIVES: To summarize the existing data on abuse history and gastrointestinal illness, suggest a conceptual scheme to explain these associations, suggest ways to identify patients at risk, and provide information about mental health referral. DATA SOURCES: Review of the pertinent literature by clinicians and investigators at referral centers who are involved in the care of patients with complex gastrointestinal illness and who have experience in the diagnosis and care of patients with abuse history in these settings. STUDY SELECTION: All research articles and observational data that addressed abuse history in gastroenterologic settings. Articles were identified through a MEDLINE search. DATA EXTRACTION: Independent extraction by multiple observers. DATA SYNTHESIS: On the basis of literature review and consensus, it was determined that abuse history is associated with gastrointestinal illness and psychological disturbance; appears more often among women, patients with functional gastrointestinal disorders, and patients seen in referral settings; is not usually known by the physician; and is associated with poorer adjustment to illness and adverse health outcome. Although the mechanisms for this association are unknown, psychological factors (somatization, response bias, reinforcement of abnormal illness behavior) and physiologic factors (psychophysiologic response, enhanced visceral sensitivity) probably contribute. On the basis of these data, recommendations are made on how to identify patients at risk, how to obtain this information, and, if needed, how to make appropriate referrals. CONCLUSIONS: The authors agree with existing data on the association between abuse history and gastrointestinal illness. Physicians should ask patients with severe or refractory illness about abuse history. Appropriate referral to a mental health professional may improve the clinical outcome.

Domestic Violence↗
PubMed1995

Diagnosing and treating patients with refractory functional gastrointestinal disorders.

One of the clinician's most difficult tasks is to successfully care for patients with painful and refractory functional gastrointestinal disorders. Because the diagnosis of these disorders is never assured and symptomatic treatments are not always successful, these patients are susceptible to receiving unnecessary, costly, and sometimes risky studies and treatments. This article offers an approach to the diagnosis and care of these patients that emphasizes 1) using a diagnostic strategy that incorporates symptom-based criteria, a screening evaluation, early symptomatic treatment, symptom monitoring, and reassessment; 2) asking several questions during the first visit to assess the psychosocial contributions to the illness; 3) developing an effective patient-physician relationship through empathy, reassurance, education, and a negotiated and realistic treatment plan; and 4) providing the option for psychological consultation and treatment as a way to help the patient better control symptoms. This approach is likely to improve patient and physician satisfaction, adherence to treatment, and clinical outcome.

Gastrointestinal Diseases↗
PubMed1995

Functional bowel disorders. A multicenter comparison of health status and development of illness severity index.

In a multicenter study of patients with painful functional bowel disorders (FBD), we compared the demographic, health status, and diagnostic features of patients with FBD and developed a functional bowel disorder severity index (FBDSI) for research and clinical care. Two hundred seventy patients with FBD in the United States, England, and Canada were surveyed on symptoms and health status, and their physicians made a diagnosis and rated illness severity as mild, moderate, or severe. Comparisons of 22 demographic and clinical variables were made by study site in addition to physicians' severity ratings. To develop the FBDSI, multiple regression analysis used the demographic and clinical variables to predict the physician's rating of severity. We found that most health status measures of patients with FBD across study sites are comparable and the derived and validated FBDSI scoring system uses three easy to obtain variables: FBDSI = [current pain by visual analog scale (0-100)] + [diagnosis of chronic functional abdominal pain (0 if absent and 106 if present)] + [number of physicians visits over previous six months x 11]. The FBDSI can be used to select patients for research protocols and/or follow their clinical outcome or response to treatments over time.

Abdominal Pain↗
PubMed1995

Comparison of bowel patterns in Hispanics and non-Hispanic whites.

Survey questionnaires can be used to characterize normal bowel habits and the prevalence of bowel dysfunction. To determine whether ethnic and sex-related differences in bowel patterns exist between Hispanics and non-Hispanics whites, we conducted a survey of a nonpatient population in El Paso, on the U.S.-Mexico border. A forced-choice, self-report questionnaire was distributed to 1014 subjects and returned by 1000. Data from the 905 Hispanic and non-Hispanic white subjects were compared. Stool frequency was analyzed by multiple linear regression, and bowel dysfunction variables were analyzed by stepwise logistic regression, in ethnic and sex groups. Data were also analyzed controlling for age, socioeconomic status, dietary factors, and use of laxatives. There was a significant sex difference in mean number of stools per week reported (P < 0.0001): Hispanic males greater than Hispanic females (8.6 vs 7.5) and non-Hispanic white males greater than non-Hispanic white females (9.3 vs 7.2). The frequency of irritable bowel syndrome-type symptoms was greater in females than in males (23.4% vs 9.6%, P < 0.001) and was less in Hispanics than non-Hispanic whites (16.9% vs 21.8%, P < 0.05), but a significant ethnic difference was not found after controlling for covariates. Additionally, females reported more alternating bowel pattern (44.0% vs 28.5%, P < 0.001) and constipation (25.5% vs 12.4%, P < 0.01) than males, and non-Hispanic white females more abdominal pain than the other subgroups (P < 0.05). Ethnic differences in dietary factors that may be relevant to bowel function were identified.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Pain↗
PubMed1995

The relationship of psychiatric illness with gastrointestinal disease.

Higher rates of psychiatric comorbidity as well as more impaired psychosocial adjustment occur with the functional bowel disorders and are particularly high in self-selected referral patients compared with community populations. Reciprocally, some studies show higher rates of functional bowel disturbances in patients with psychiatric diagnoses. Remaining alert for and addressing coexisting psychiatric illness will enhance treatment outcome (increased patient compliance, functioning, and satisfaction). Additionally, psychological factors affect the clinical expression of structural disease. Resetting treatment goals from cure to coping with chronic illness and setting personal limits are important.

Adaptation, Psychological↗
PubMed1992

The irritable bowel syndrome: review and a graduated multicomponent treatment approach.

The irritable bowel syndrome is a common chronic disorder having a broad clinical spectrum of severity. Although only a small proportion of those afflicted seek medical help for their symptoms, a subset have severe and intractable symptoms. A positive diagnosis should be established from the history and physical examination; endoscopic and radiologic investigations should be minimized. We suggest that the physician also assess the severity of the illness based on its symptomatic and functional features and the patient's behavioral response. Classifying the disorder in this manner permits a graduated treatment approach that emphasizes education, reassurance, and dietary adjustment for mild symptoms. Moderate symptom severity requires, in addition, identification and modification of factors exacerbating symptoms, psychotherapeutic and behavioral techniques and, if a certain symptom type predominates, pharmacologic agents directed toward the presumed gastrointestinal motor dysfunction. For severe symptoms, physician-based behavior modification and psychopharmacologic agents are helpful. When the disorder is intractable, referral may be needed, for example, to a pain treatment center. In all cases, the skillful physician must ensure continued psychosocial support to enhance coping and continued focus on the palliative aspects of care rather than on cure.

Colonic Diseases, Functional↗
PubMed1992

Ulcerative colitis and Crohn's disease health status scales for research and clinical practice.

We report the development of ulcerative colitis (UC) and Crohn's disease (CD) Health Status Scales that improve on existing inflammatory bowel disease (IBD) activity measures by their added association with health status. We surveyed 991 members of the Crohn's and Colitis Foundation of America (CCFA) and analyzed the half with greater disease activity (114 UC, 330 CD, ostomies excluded). Our analysis strategy involved (a) identification of items that discriminated active from inactive disease, (b) factor analysis to reduce the items to clusters sharing common symptom relationships, and (c) regression analysis to select those variables best associated with a composite measure of health status (health care use, daily function, psychologic distress). The factor analyses yielded two indexes for UC and CD: "Diarrhea," and "Other GI symptoms" (Cronbach's alpha 0.59-0.84). The regression analyses for both diseases showed that poorer well-being, the Diarrhea index, and dependence on medication for pain were associated with poorer health status. For UC, lower educational attainment and lower steroid dose, and for CD, the Other GI symptoms index and eye disease, also correlated with poorer health status. By design, the UC and CD Scales are better predictors of health status than the survey version of the CD Activity Index (CDAI), explaining 17 and 21% more of the variance of the health status measure. The final UC and CD Health Status Scales can be used in research and clinical care. They contain symptom items used to assess disease activity and also correlate with health status. Prospective assessment is needed to confirm their accuracy in assessing prognosis and treatment response.

Adult↗
PubMed1991

Health status and health care use in persons with inflammatory bowel disease. A national sample.

We randomly surveyed 997 members of the Crohn's and Colitis Foundation of America with inflammatory bowel disease (320 ulcerative colitis and 671 Crohn's disease) in order to: (1) assess their health status, (2) compare members with ulcerative colitis and Crohn's disease, and (3) determine the correlates of health care use. Data collection included variables relating to physical and psychological symptoms, medication use, daily functional status, perceptions of health, and coping styles. The findings indicate that: (1) despite a number of symptoms and complications related to inflammatory bowel disease, the health status of this population is generally good and may be a result of effective coping styles; (2) those with Crohn's disease have more psychosocial difficulties, which appear related to greater symptom severity; (3) both psychosocial and physical health variables are related to number of physician visits, while primarily physical health variables are related to number of hospitalizations and surgeries. Further studies are needed to determine the representativeness of this self-selected sample with others having IBD. In this study, we have provided the basis for developing a more sensitive measure of health status than currently exists, and one which may have implications for future clinical studies.

Adaptation, Psychological↗
PubMed1990

Sexual and physical abuse in women with functional or organic gastrointestinal disorders.

STUDY OBJECTIVES: To determine the prevalence of a history of sexual and physical abuse in women seen in a referral-based gastroenterology practice, to determine whether patients with functional gastrointestinal disorders report greater frequencies of abuse than do patients with organic gastrointestinal diseases, and to determine whether a history of abuse is associated with more symptom reporting and health care utilization. DESIGN: A consecutive sample of women seen in a university-based gastroenterology practice over a 2-month period was asked to complete a brief questionnaire. MEASUREMENTS: The self-administered questionnaire requested information about demographics, symptoms, health care utilization, and history of abuse. Physicians indicated the primary diagnosis for each patient and whether she had ever discussed having been sexually or physically abused. RESULTS: Of 206 patients, 89 (44%) reported a history of sexual or physical abuse in childhood or later in life; all but 1 of the physically abused patients had been sexually abused. Almost one third of the abused patients had never discussed their experiences with anyone; only 17% had informed their doctors. Patients with functional disorders were more likely than those with organic disease diagnoses to report a history of forced intercourse (odds ratio, 2.08; 95% CI, 1.03 to 4.21) and frequent physical abuse (odds ratio, 11.39; CI, 2.22 to 58.48), chronic or recurrent abdominal pain (odds ratio, 2.06; CI, 1.03 to 4.12), and more lifetime surgeries (2.7 compared with 2.0 surgeries; P less than 0.03). Abused patients were more likely than nonabused patients to report pelvic pain (odds ratio, 4.05; CI, 1.41 to 11.69), multiple somatic symptoms (7.1 compared with 5.8 symptoms; P less than 0.001), and more lifetime surgeries (2.8 compared with 2.0 surgeries; P less than 0.01). CONCLUSIONS: We found that a history of sexual and physical abuse is a frequent, yet hidden, experience in women seen in referral-based gastroenterology practice and is particularly common in those with functional gastrointestinal disorders. A history of abuse, regardless of diagnosis, is associated with greater risk for symptom reporting and lifetime surgeries.

Abdominal Pain↗
PubMed1990

Health status in inflammatory bowel disease. Biological and behavioral considerations.

The existing clinical measures of disease activity for inflammatory bowel disease are insufficient to explain a patient's illness experience or health outcomes. Although many disease activity measures have been devised, they are not widely accepted by clinicians because existing ones are no better than a carefully obtained clinical assessment. Furthermore, health status is determined not only by disease activity, but also by the psychological state, cultural influences, degree of social support, and effects of complications, previous surgery, and medication. To develop more accurate appraisals of the impact and severity of IBD, we must prospectively evaluate the biological and psychosocial measures that predict clinically relevant outcomes. We should then be able to develop statistically weighted scales related to specific outcome variables. Such knowledge will help us to develop more sensitive measures of illness, particularly in patients with mild disease for whom present indices are insensitive. This type of assessment should also aid in the understanding of health care utilization, medical vs. surgical options, resource allocation, and the efficacy of therapeutic trials.

Adult↗
PubMed1990

[Characterization of intestinal function and diagnosis of irritable bowel syndrome by surveys and questionnaires].

In order to obtain criteria characteristic of the irritable bowel syndrome (IBS), the authors sent out questionnaires to evaluate the bowel habits and intestinal disorders in patients with IBS and to identify and compare clinical findings with patients who had other gastroenterology pathology. In this article, we discuss the results of this survey conducted in the United States, its clinical consequences and its value in identifying characteristics of patients with the IBS. In 94.2 percent of the population studied (students and employees at the North Carolina University Hospital), stool frequency ranged from 3 per week to 3 per day. Variations were dependent on the race and sex of patients: men had more frequent bowel movements than women (9.2 vs 6.7 per week; p less than 0.0001), and Caucasians had more frequent bowel movements than Blacks (7.8 vs 6.0 per week; p less than 0.0001). Definitions of constipation and diarrhea vary, which shows that the manner in which questions are asked is very important in surveys on intestinal disorders. Symptoms suggesting IBS were found in 15 to 17 percent of cases. The group of subjects with IBS: a) were mostly women (72.6 vs 54.4 percent), b) considered that psychologic stress was a cause of intestinal disorders (84.4 vs 67.6 percent) and intestinal incomfort (68.9 vs 48.0 percent), and c) used laxatives more than once a month (12.6 vs 1.5 percent). The majority of patients (62 to 77 percent) without symptoms of IBS had never sought medical advice before for their symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Pain↗
PubMed1990

[Personality and psychological factors in the irritable bowel syndrome].

The study of the psychologic profile of patients with the irritable bowel syndrome (IBS) has shown that psychologic aggression, personality abnormalities, psychiatric diagnostics and pathologic behaviour patterns are more frequently encountered than in normal subjects or those with other disease. Moreover, patients with IBS often relate psychological events experienced in infancy such as a lost child, divorce of parents, or sexual abuse which can affect their future and particularly their manner of seeking medical advice. As it is known that only between 23 and 38 per cent of patients with IBS seek medical advice, it is also important to know whether these psychologic characteristics are true for all subjects with these symptoms or if they are found in a particular subgroup of patients who seek medical advice because, in fact, they are really ill. Multivariate analysis was used to evaluate the medical and psychologic status of 72 patients with IBS, 82 patients with symptoms suggestive of IBS but who did not seek medical advice, and 84 normal subjects. With regard to semeiologic differences according to whether patients sought medical advice or not, there were more subjects in the first group who complained of diarrhea and pain. Moreover, there were more patients with personality abnormalities, pathologic behaviour patterns, and a lower sensitivity to stress in subjects with IBS seeking medical advice than in those with symptoms who did not seek advice (p less than 0.001) or normal subjects (p less than 0.001). There were no significant differences between the subjects with symptoms but who do not seek medical advice and the normal subjects (p = 0.21).(ABSTRACT TRUNCATED AT 250 WORDS)

Colonic Diseases, Functional↗
PubMed1989

Health-related quality of life in inflammatory bowel disease. Functional status and patient worries and concerns.

The assessment of health-related quality of life may be an adjunct to understanding the chronic illness experience and its effects on health outcomes. In this study, we evaluated health-related quality of life of 150 patients with inflammatory bowel disease (63 ulcerative colitis, 87 Crohn's disease). We used a standardized measure, the Sickness Impact Profile, and a questionnaire we developed that elicits and prioritizes the disease-related worries and concerns of patients with IBD. Our preliminary data indicate that: (1) IBD patients experience moderate functional impairment more in the social and psychological than in the physical dimensions; (2) Crohn's disease patients report psychosocial dysfunction to a greater degree than ulcerative colitis patients; (3) IBD patients report greatest concerns about having surgery, degree of energy, and body image issues such as having an ostomy bag; and (4) functional status and patient concerns correlate better with other measures of health status and previous health care utilization than the physician's rating of disease activity. We believe that questionnaires measuring health-related quality of life (HRQOL) can be used in research and patient care to extend the clinical assessment of patients with IBD. Further work is needed to determine the role of HRQOL relative to disease activity and other physician-based assessments in predicting health outcomes.

Adult↗
PubMed1989

Irritable bowel syndrome.

Irritable bowel syndrome is characterized by bowel irregularity (constipation and/or diarrhea), gaseous distention and abdominal pain. Symptoms usually occur in response to various biological and environmental factors. The diagnosis is made by identifying certain clinical features in association with a negative medical evaluation. Since specific treatment is not available, the patient must be helped to adapt to this chronic or recurrent disorder.

Adult↗