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Biomedical subjects

Michael D Crowell

Publications and source records attributed to Michael D Crowell.

At least 19 recordsLinked to original sources
PubMed2007

Impact of anal incontinence on psychosocial function and health-related quality of life.

The relationship among the frequency of anal incontinence (AI), psychosocial factors, and health-related quality of life (HRQOL) was evaluated. Consecutive patients (n=280) completed a bowel symptom questionnaire, the Symptom Checklist 90 -- Revised (SCL 90-R), and an assessment of HRQOL. Group 1 had no incontinence, Group 2 had AI less than once per week, and Group 3 experienced AI more than once per week. Multivariate analyses were used to evaluate the relationship among symptoms, the SCL-90-R subscales, and HRQOL. Group 3 reported more frequent stools than the other groups. Significant psychological distress was present in both incontinent groups compared to Group 1 (P=0.002). A reduction in overall HRQOL was also seen in the incontinent groups. Depression was inversely correlated with QOL-Satisfaction and QOL-Ratings and positively correlated with QOL-Interference. AI was associated with impaired psychosocial function and decreased HRQOL. The frequency of AI was associated with increased HRQOL-Interference, but minimally with the degree of psychosocial impairment.

Adult↗
PubMed2006

Gut-brain neuropeptides in the regulation of ingestive behaviors and obesity.

The prevalence of obesity has increased to epidemic proportions and has become an urgent public health problem. Obesity causes significant morbidity and mortality and its impact on health-care costs in the United States is growing dramatically. Apart from bariatric surgery treatment, options are limited. Future advances in treatment will rely on a better understanding of the pathogenesis and physiology of obesity. Alterations in gastrointestinal (GI) sensory-motor function and symptoms have been associated with obesity. GI neuroendocrine communications between the periphery and the brain regulate energy balance and ingestive behaviors. These interactions are largely mediated by the gut-brain peptides through negative and positive feedback loops that maintain energy homeostasis. Bariatric surgery has been shown effective, but the mechanisms of weight loss following these procedures clearly require further studies and a better understanding of the affects of bariatric surgery on the gut-brain neuropeptide homeostasis. Gut-brain peptides may provide attractive therapeutic targets in the fight against this very morbid disease. We review alterations in GI function and some of the more important gut-brain neuropeptides that occur in obesity.

Brain↗
PubMed2006

Irritable bowel syndrome and chronic constipation: emerging drugs, devices, and surgical treatments.

Irritable bowel syndrome (IBS) and chronic constipation (CC) are two of the most common functional disorders of the gut. CC and IBS are estimated to affect up to 20% and 27% of the North American population respectively. Although not life-threatening, CC and IBS can profoundly and negatively affect quality of life and are associated with a significant economic burden related to direct and indirect annual health-care costs. Possible etiologies for IBS and CC include alterations in visceral sensation and gastrointestinal motility. IBS may be caused by disturbances in brain-gut interactions affecting gastrointestinal motility and visceral sensitivity. Research efforts in CC have begun to identify abnormalities in myenteric neurons, alterations in neurotransmitters and their receptors, and incoordination of the muscles of the pelvic floor or anorectum. Both disorders may be influenced by genetic predisposition, environmental factors, and stress. In this article, the safety and efficacy of traditional and emerging therapies for CC and IBS are examined. In addition, their pathophysiology and symptoms are briefly reviewed.

Constipation↗
PubMed2006

Coping strategies and interpersonal support in patients with irritable bowel syndrome and inflammatory bowel disease.

BACKGROUND & AIMS: Coping strategies are used to manage conflict and illness and can have adaptive or maladaptive effects on health status. Perceived availability and quality of social support also influences health status. Coping strategies and social support have not been well studied in irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD). To understand their role better, coping strategies, social support, and psychiatric distress were assessed in patients with IBS and IBD and in controls. METHODS: Participants completed the Ways of Coping Questionnaire, the Interpersonal Support Evaluation, Symptom Checklist-90-revised, IBS-Quality of Life (QOL), and IBD-QOL. Participants also completed the Toronto Alexithymia Scale and Somatosensory Amplification Scale. RESULTS: The study population included 55 controls, 74 IBS patients, and 48 IBD patients. The IBS and IBD patients had higher scores on measures of psychiatric distress, alexithymia, and somatosensory amplification than controls, but did not differ from one another. QOL scores did not differ between patients with IBS and IBD. Patients with IBS and IBD reported significantly less interpersonal support than controls. Controls identified planful problem solving as the dominant coping strategy whereas patients with IBS and IBD relied significantly less on planful problem solving and positive reappraisal and more on escape-avoidance strategies. CONCLUSIONS: Compared with controls, IBS and IBD patients had increased levels of psychiatric distress, a poorer QOL, less interpersonal support, and greater reliance on passive coping strategies. These data suggest that psychosocial disturbances are common in IBD and IBS and suggest that the observed differences reflect illness behavior rather than a disorder-specific process.

Adaptation, Psychological↗
PubMed2006

Physicians' attitudes and practices in the evaluation and treatment of irritable bowel syndrome.

OBJECTIVE: Irritable bowel syndrome (IBS) is a common disorder characterized by abdominal discomfort and disordered bowel habits. Despite the high prevalence of IBS, little is known about how physicians perceive this condition. The aims of our study were to measure physicians' understanding of IBS, to assess their attitudes towards patients with IBS, and to determine whether there are differences in the way Internal Medicine physicians (IM), Family Practice physicians (FP), and Gastroenterology physicians (GI) evaluate and treat IBS patients. MATERIAL AND METHODS: A survey was sent to 3000 physicians nationwide, 1000 each to IM, FP, and GI. The survey contained 35 questions assessing demographics, the etiology and pathophysiology of IBS, the use of diagnostic tests, and practice patterns and attitudes. RESULTS: Of the deliverable questionnaires, 501 were returned completed; 472 of the respondents interviewed only adult patients, representing the cohort for this analysis. The mean age of all respondents was 47; most were men (80%). IM and FP made a new diagnosis of IBS 1.3-1.6 times each week, while GI made a new diagnosis 5.4 times each week (p<0.0001). Compared with the perceptions of FP and IM, GI felt that IBS patients were less sick than other patients (p<0.001), although they required more time per visit. More GI compared with FP and IM stated that prior infection and a history of abuse were the causes of IBS (p<0.01), while FP were more likely to believe that diet was a cause of IBS (p<0.01). GI felt a new diagnosis of IBS could be made without further testing 42% of the time. FP and IM felt that one-third of IBS patients needed referral to a GI. CONCLUSIONS: The attitudes and practice patterns of physicians towards patients with IBS differ depending on practice specialty. This may be due to differences in training, the ability to perform specialized tests, and/or differences in referral patterns. Further training may improve the ability of physicians in all specialties confidently to diagnose and treat patients with IBS.

Attitude of Health Personnel↗
PubMed2006

Current concepts and treatment options in eosinophilic esophagitis.

Eosinophilic esophagitis (EE) is an inflammatory disorder of the esophagus that affects both children and adults, and is different from gastro-esophageal reflux disease. The immunopathogenesis of EE involves an allergic response to environmental and food allergens, and the proinflammatory cytokines IL-5 and IL-13. EE may be associated with atopic disorders and peripheral eosinophilia, and may be familial in distribution. The most common presentation is dysphagia and food impaction in adults, with additional manifestations of epigastric pain, emesis, weight loss and failure to thrive in children. Typical endoscopic findings include ringed esophagus, linear furrows, strictures and narrow esophagus. Diagnosis is confirmed by the presence of 20 or more eosinophils per high power field in the esophagus. The available treatment options include elemental diet, avoidance of specific food allergens, topical and systemic corticosteroids, and humanized monoclonal antibodies against IL-5. This review summarizes the etiopathogenesis, clinical, endoscopic and histopathological findings in EE, and describes current available treatment options.

Adrenal Cortex Hormones↗
PubMed2005

New insights into the pathophysiology of irritable bowel syndrome: implications for future treatments.

Irritable bowel syndrome (IBS) is a multifactorial disorder characterized by abdominal pain and altered bowel habits. Chronic symptoms may occur due to changes in gastrointestinal motor function, enhanced perception of gut stimuli, and psychosocial factors. Recent data suggest that abnormal processing of afferent signals occurs in IBS patients. A newly recognized causative factor in a subset of IBS patients is post-infectious IBS. Altered transport of intestinal gas and bowel distention may contribute to abdominal discomfort, pain, and bloating. Changes in gut microflora have also been reported, but data remain scant. Advances have been made in our understanding of serotonin signaling and metabolism in IBS patients, in part due to the introduction of specific receptor agonists and antagonists. Finally, exciting data are emerging on genetic alterations that may contribute to the pathophysiology and treatment of IBS. Increasingly novel mechanisms are being identified that should aid in better understanding of the complex pathophysiology of IBS and developing new therapies.

Brain↗
PubMed2005

Chronic nausea and vomiting: new insights and approach to treatment.

Chronic vomiting of unclear etiology has been given a number of names over time. For many years, it was known as "psychogenic" vomiting because a psychiatric etiology was considered the most likely cause. More recently, the concepts of cyclic vomiting syndrome (CVS) and functional vomiting (FV) have been proposed to better explain this perplexing phenomenon. CVS is a dramatic clinical syndrome characterized by intense episodes of vomiting lasting over a period of days but alternating with periods of intense quiescence. FV, as defined by the Rome II diagnostic criteria, is vomiting of at least 3 months, which need not be consecutive, in the preceding year with at least three separate vomiting episodes in a week. It is found in the absence of obvious metabolic, structural, or psychiatric disorders which could explain the vomiting (Table 1). It will be the purpose of this article to review the history of chronic vomiting from a nomenclature perspective. Methodologic limitations of early studies will be described as well as more contemporary reviews that used updated methodologic approaches to describe this perplexing problem.

Journal Article↗
PubMed2005

Obesity and gastrointestinal sensory-motor function.

Obesity has become a significant public health problem in the United States and has been associated with significant morbidity and mortality. Alterations in gastrointestinal sensory-motor function are now recognized to be associated with obesity and may be the cause of functional gastrointestinal symptoms commonly seen in these patients. The gut peptides are intimately involved in this process and may provide attractive therapeutic targets in the fight against this very morbid disease.

Journal Article↗
PubMed2005

Psychosocial correlates of symptoms in functional dyspepsia.

BACKGROUND & AIMS: Psychosocial factors may influence both symptom generation and reporting in functional dyspepsia. We determined the presence and severity of these factors as well as their relationship to dyspeptic symptoms in patients with functional dyspepsia and healthy subjects. METHODS: A total of 151 consecutive patients with functional dyspepsia referred chiefly from primary care clinics and 90 healthy subjects rated 15 dyspeptic symptoms. Participants completed the Medical Outcomes Study SF-36 and Symptom Checklist-90-revised. RESULTS: Functional dyspepsia patients reported significantly higher symptom scores, poorer quality of life, and greater psychiatric distress than healthy subjects. For both patients and healthy subjects, increasing symptom scores were associated with significant decreases in the Physical but not the Mental Components Summary of the Medical Outcomes Study SF-36. Although functional dyspepsia patients showed significantly greater psychiatric distress than healthy subjects, symptoms were correlated only modestly with scores on the Symptom Checklist-90-revised. A number of symptoms showed significant but modest correlations ( r s < .30) with the somatization scale with chest burning correlating most strongly ( r s = .48). Chest burning also was correlated significantly with depression, anxiety, and phobic anxiety. Functional dyspepsia patients at a secondary level of care have greater symptom severity, poorer quality of life, and greater psychiatric distress than healthy subjects. Increasing symptom severity is associated with poorer quality of life primarily in the areas of physical and social functioning. With the exception of chest burning, symptoms are not correlated highly with psychiatric distress. CONCLUSIONS: These data suggest that although functional dyspepsia patients experience increased psychiatric distress, symptom severity and psychiatric distress are not associated strongly.

Adult↗
PubMed2005

The association of gastrointestinal symptoms with weight, diet, and exercise in weight-loss program participants.

BACKGROUND & AIMS: Studies on the relationship between gastrointestinal (GI) symptoms and obesity are limited. Research on the relationship between GI symptoms (including irritable bowel syndrome [IBS]), weight, and weight-related behaviors are rare. This study assessed rates of GI symptoms in a sample of obese patients in a weight-loss program and explored relationships among GI symptoms and obesity, binge eating, dieting (fat and fruit/fiber consumption), and physical activity. METHODS: A total of 983 participants (70% women) had a mean body mass index (BMI) of 33.2+/-5.7 kg/m2 (range, 25.1-60.8 kg/m2) and a mean age of 52.7+/-12.4 years (range, 20.4-89.8 y). Participants completed a questionnaire about diet and physical activity and a standardized self-report Rome II questionnaire assessing IBS status and GI symptoms. RESULTS: In bivariate analyses BMI was associated positively with abdominal pain and diarrhea whereas healthier diet (lower fat and higher fruit/fiber intake) and higher physical activity were associated with fewer GI symptoms. In multivariate models BMI was not associated with GI symptoms; physical activity remained a protective factor. CONCLUSIONS: Although physiologic mechanisms still need to be explored, associations between GI symptoms and diet and exercise behaviors may have implications for the treatment of both obesity and GI symptoms.

Adult↗
PubMed2005

Age, specialty, and practice setting predict gastroesophageal reflux disease prescribing behavior.

BACKGROUND: Gastroesophageal reflux disease (GERD) affects more than 40% of adults in the United States each month. Although the economic costs of treating this disorder are enormous, the attitudes and prescribing preferences of physicians who treat patients with GERD are not well known. This study was undertaken to determine physician prescribing practices in the treatment of GERD. METHODS: A questionnaire was mailed to 687 randomly selected, practicing gastroenterologists, internists, and family physicians in the State of Maryland. Each questionnaire was identical and contained 7 questions designed to elicit demographic data (age, sex, degree, specialty, practice setting, years in practice, community served), and 16 questions related to the evaluation and treatment of GERD. RESULTS: A total of 214 completed questionnaires were returned (31.1%), nearly equally distributed among the three different specialty groups. A total of 82% of the respondents were male; 60% of the respondents had practiced more than 15 years, and 6% had practiced 4 years or less. Older physicians prescribed proton pump inhibitors more often than younger physicians for mild or intermittent GERD symptoms. Physicians in an academic setting were more likely to use step-down therapy in patients with well-controlled GERD symptoms than were HMO-employed physicians. Family physicians requested a barium swallow in the evaluation of uncomplicated GERD more frequently than did gastroenterologists or internists. Gastroenterologists were more likely than family physicians and internists to recommend upper endoscopy for GERD patients with warning symptoms and for patients with long-standing reflux disease. CONCLUSIONS: Age, specialty, number of years in practice, and practice setting significantly influence how physicians evaluate and treat patients with GERD. Educational efforts to improve the evaluation and treatment of patients with GERD may require different strategies for different types of healthcare providers.

Adult↗
PubMed2005

Symptom reporting by functional dyspeptics during the water load test.

INTRODUCTION: Reporting of symptoms and visceral sensations in functional dyspepsia is subjective and influenced by such factors as somatization and depression. To better understand the role of these factors in symptom reporting, somatization, somatosensory amplification, alexithymia, and depression were evaluated in patients with functional dyspepsia undergoing a water load test. METHODS: Sixty-seven controls and 103 patients with functional dyspepsia underwent a 5-min water load. Participants both recalled dyspeptic symptoms from the previous 2 wk and rated symptoms of nausea, fullness, and bloating during water load. Participants also completed the symptom checklist-90-R, somatosensory amplification scale, and the Toronto alexithymia scale. RESULTS: Compared with controls, patients with dyspepsia had greater psychiatric distress and higher scores for somatosensory amplification and alexithymia. Patients with dyspepsia also reported fullness at significantly lower volumes of water and experienced greater symptoms during water load than controls. Receiver operator characteristics of water load volume and provoked symptoms suggested that water load (WL) volume was a better discriminator of patients with dyspepsia from controls. Patients with dyspepsia recalled significantly more symptoms in the 2 wk prior to study. Symptoms provoked during WL were not associated with measured psychiatric constructs in either controls or patients with dyspepsia whereas recalled symptoms in patients with functional dyspepsia were significantly associated with several measured psychiatric constructs. CONCLUSIONS: Patients with functional dyspepsia report fullness at lower volumes of ingested water and develop more symptoms than do controls. Water load volume better discriminates patients with dyspepsia from controls than does symptoms provoked during water load. Provoked symptoms in dyspepsia are not associated with measured psychiatric constructs but recalled symptoms are.

Adult↗
PubMed2005

Cilansetron.

Irritable bowel syndrome is an extremely common disorder affecting approximately 10-20% of the population of North America and Europe. This disorder is characterized by abdominal pain and altered bowel habit. The altered bowel habit can take a number of forms. These include a predominant diarrhea form, a form with constipation and one in which patients alternate between diarrhea and constipated forms of the disorder. Irritable bowel syndrome to date has not been associated with any excess mortality. However, the morbidity associated with irritable bowel syndrome is quite high. This mainly takes on the form of impairment in health-related quality of life, interference with activities of daily living and a considerable degree of human suffering. Likewise, the economic impact of irritable bowel syndrome is not trivial and has been estimated to be between US$20 to 30 billion in the United States alone. In an effort to address this common disabling disorder, a number of new drugs have been developed. One of the latest is cilansetron, which is a competitive type 3 serotonin (5-HT3) receptor antagonist. In phase III trials, cilansetron has been shown to be efficacious for the relief of a wide spectrum of symptoms related to irritable bowel syndrome with diarrhea both in male and female patients. By and large, cilansetron is extremely well tolerated and highly efficacious. The most common side effect of cilansetron is constipation, which is seen in 3-12% of subjects at 6 months. Ischemic colitis, a side effect associated with previous drugs of this class, has been seen in eight subjects (six women and two men) to date. All of these ischemic colitis events have been self-limited and did not require surgery. Because of its high degree of efficacy, the fact that it is well tolerated by the overwhelming majority of patients and that it shows efficacy in both genders, cilansetron represents a major advance in the treatment of irritable bowel syndrome with diarrhea predominance.

Carbazoles↗
PubMed2004

Regional gastric contractility alterations in a diabetic gastroparesis mouse model: effects of cholinergic and serotoninergic stimulation.

The C57BLKS/J db/db mouse develops hyperglycemia and has delayed gastric emptying that is improved with tegaserod, a partial 5-HT4 agonist. Our aims here were to determine regional gastric contractility alterations in C57BLKS/J db/db mice and to determine the effects of serotonin and tegaserod. The contractile effects of bethanechol, serotonin, and tegaserod in fundic, antral, and pyloric circular muscle were compared in C57BLKS/J db/db mice and normal littermates. The effects of tetrodotoxin, atropine, and 5-HT receptor antagonists were studied. Contractions in response to bethanechol were decreased in the fundus, similar in the antrum, but increased in the pylorus in diabetic mice compared with controls. Serotonin and, to a lesser extent, tegaserod caused contractions that were more pronounced in the fundus than in the antrum and pylorus in both diabetic and normal mice. Serotonin-induced contractions were partially inhibited by atropine, the 5-HT4 antagonist GR113808, and the 5-HT2 antagonist cinanseron but not tetrodotoxin. Regional gastric contractility alterations are present in this diabetic gastroparesis mouse model. Fundic contractility was decreased, but pyloric contractility was increased in the pylorus to cholinergic stimulation in diabetic mice. Serotonin's contractile effect is mediated, in part, through muscarinic, 5-HT2, and 5-HT4 receptors. This study suggests that fundic hypomotility and pyloric hypercontractility, rather than antral hypomotility, play important roles for the gastric dysmotility that occurs in diabetes.

Animals↗
PubMed2004

Relationship of bloating to other GI and menstrual symptoms in women with irritable bowel syndrome.

This report examines the relationships between bloating and other symptoms in young women with irritable bowel syndrome (IBS), using both retrospective and daily diary measures of symptoms. Of the 195 IBS women, 147 (75%) reported retrospectively that they often feel bloated and distended. Across-women analyses of both retrospective and daily diary data show that bloating is most strongly associated with constipation, abdominal pain, and intestinal gas. Within-woman analyses of daily symptoms also show a strong association of bloating with abdominal pain and intestinal gas (i.e., abdominal pain and intestinal gas are higher on days when bloating is higher) but only a weak association with constipation. Bloating is strongly associated with uterine cramping and breast tenderness, but only when perimenses days are included in the analysis. In conclusion, bloating is a very common symptom in women with IBS that is most strongly related to abdominal pain and intestinal gas but may be confounded with menses-associated symptoms.

Abdominal Pain↗