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Biomedical subjects

Nicholas J Talley

Publications and source records attributed to Nicholas J Talley.

At least 91 records · Page 5Linked to original sources
PubMed2004

Gastroparesis Cardinal Symptom Index (GCSI): development and validation of a patient reported assessment of severity of gastroparesis symptoms.

BACKGROUND: Patient-rated symptom assessments are needed for evaluating the effectiveness of medical treatments and for monitoring outcomes in gastroparesis. OBJECTIVE: This paper summarizes the development and psychometric evaluation of a new instrument, the Gastroparesis Cardinal Symptom Index (GCSI), for assessing severity of symptoms associated with gastroparesis. METHODS: The GCSI was based on reviews of the medical literature, patient focus groups, and interviews with clinicians. A sample of 169 patients with a documented diagnosis of gastroparesis participated in the psychometric evaluation study. Patients completed the GCSI, the SF-36 Health Survey, and disability days questions at baseline and after 8 weeks. A randomly selected sub-sample of 30 subjects returned at 2 weeks to assess test retest reliability. Clinicians rated severity of symptoms, and both clinicians and patients rated change in gastroparesis-related symptoms over the 8 week study. RESULTS: The GCSI is based on three subscales: post-prandial fullness/early satiety (4 items); nausea/vomiting (3 items), and bloating (2 items). Internal consistency reliability was 0.84 for the GCSI total score and ranged from 0.83 to 0.85 for the subscale scores. Two week test retest reliability was 0.76 for the total score and ranged from 0.68 to 0.81 for subscale scores. Construct validity was supported, given that we observed significant relationships between clinician assessed symptom severity and GCSI total score, significant differences between gastroparesis and dyspepsia patients (n = 760) on GCSI total (p < 0.0001) and subscale scores (p < 0.03 to p < 0.0001), moderate and significant relationships between GCSI total and SF-36 scores, and significant associations between GCSI total score and reports of restricted activity and bed disability days. Patients with greater symptom severity, as rated by clinicians, reported more symptom severity on GCSI total score. GSCI total scores were responsive to changes in overall gastroparesis symptoms as assessed by clinicians (p < 0.0001) and patients (p = 0.0004). CONCLUSION: The findings of this study indicate that the GCSI is a reliable and valid instrument for measuring symptom severity in patients with gastroparesis.

Adolescent↗
PubMed2004

Splitting irritable bowel syndrome: from original Rome to Rome II criteria.

OBJECTIVES: Diagnosis of irritable bowel syndrome (IBS) and other functional bowel disorders (FBD) is based on symptom evaluation. Clinical criteria have changed over time, yielding different proportions of subjects fulfilling diagnostic requirements. According to new diagnostic criteria (Rome II), subjects considered some years ago to have IBS no longer do so. The aim of this article is to evaluate how patients diagnosed as having IBS according to original Rome criteria have been split, and to which clinical diagnosis they belong today. METHODS: Two hundred and eleven subjects meeting original Rome IBS diagnostic criteria were studied: 65 also met Rome II criteria while 146 did not. Subjects were extracted from an epidemiological survey, using home-based personal interviews, on 2000 subjects randomly selected as representative of the Spanish population. Clinical complaints, personal well-being, resource utilization, and health-related quality of life (HRQOL) were compared. RESULTS: Of the subjects meeting original Rome but not Rome II criteria, the present diagnosis should be: 40%"minor" IBS (IBS symptoms of less than 12 wk duration), 37% functional constipation, 12% alternating bowel habit, 7% functional diarrhea, 3% functional abdominal bloating, and 1% unspecified functional bowel disorder (FBD). Thus, 52 subjects (36%) should not be diagnosed with IBS because they really had other FBD, 59 (40%) because of symptoms consistent with IBD diagnosis but not the required duration or frequency, and 35 (24%) because of symptoms consistent with some other FBD diagnosis but not meeting the required duration. Clinical complaints, personal well-being, resource utilization, and HRQOL were more severely affected in IBS than in other FBD as a group, and in "major" rather than in "minor" forms. CONCLUSIONS: Many subjects meeting original Rome criteria for IBS do not meet Rome II criteria: approximately one quarter of subjects do not have sufficient symptom duration or frequency to be diagnosed with IBS and almost half are now considered as having other ("major" or "minor") FBD.

Adolescent↗
PubMed2004

G-protein beta 3 subunit 825 CC genotype is associated with unexplained (functional) dyspepsia.

BACKGROUND & AIMS: In patients with functional dyspepsia, altered alpha-adrenoreceptor function and depression are prevalent, features that are linked to a G-protein beta 3 (GNB3) subunit gene polymorphism (C825T). We aimed to assess the association of specific G-protein beta 3 subunit genotypes with functional dyspepsia. METHODS: In study A, abdominal symptoms were assessed in 67 patients with unexplained, upper abdominal symptoms and 259 consecutive blood donors with and without abdominal symptoms. In study B, a further 56 patients with functional dyspepsia and 112 age- and sex-matched healthy controls from a blood donor population study were evaluated. Genomic DNA was isolated from buccal swabs and genotyping of the C825T polymorphisms was performed by polymerase chain reaction and restriction analysis. RESULTS: In the blood donors with no abdominal symptoms in study A (controls, n = 161), genotype distribution was 17 TT, 77 TC, and 67 CC. In blood donors and patients with unexplained abdominal symptoms, genotype distribution was 22 TT, 54 TC, and 89 CC (P = 0.007 vs. controls). In study B, the genotype distribution in functional dyspepsia patients was 4 TT, 18 CT, and 34 CC compared with 4 TT, 62 CT, and 46 CC in the controls (P < 0.02). Combining studies A and B, the odds ratio (OR) adjusted for age and sex for upper abdominal symptoms associated with the CC genotype was 2.2 (95% confidence interval [CI]: 1.4-3.3), compared with subjects with TC and TT genotype carrying an allele. CONCLUSIONS: Homozygous GNB3 825C carrier status is associated with unexplained predominantly upper abdominal symptoms.

Abdominal Pain↗
PubMed2004

The efficacy of proton pump inhibitors in nonulcer dyspepsia: a systematic review and economic analysis.

BACKGROUND AND AIMS: The evidence that proton pump inhibitor (PPI) therapy affects symptoms of nonulcer dyspepsia is conflicting. We conducted a systematic review to evaluate whether PPI therapy had any effect in nonulcer dyspepsia and constructed a health economic model to assess the cost-effectiveness of this approach. METHODS: Electronic searches were performed using the Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, and SIGLE until September 2002. Dyspepsia outcomes were dichotomized into cured/improved versus same/worse. Results were incorporated into a Markov model comparing health service costs and benefits of PPI with antacid therapy over 1 year. RESULTS: Eight trials were identified that compared PPI therapy with placebo in 3293 patients. The relative risk of remaining dyspeptic with PPI therapy versus placebo was .86 (95% confidence interval, .78-.95; P = .003, random-effects model) with a number needed to treat of 9 (95% confidence interval, 5-25). There was statistically significant heterogeneity between trials (heterogeneity chi(2) = 30.05; df = 7; P < .001). The PPI strategy would cost an extra US dollar 278/month free from dyspepsia if the drug cost US dollar 90/month. If a generic price of US dollar 19.99 is used, then a PPI strategy costs an extra US dollar 57/month free from dyspepsia. A third-party payer would be 95% certain that PPI therapy would be cost-effective, provided they were willing to pay US dollar 94/month free from dyspepsia. CONCLUSIONS: PPI therapy may be a cost-effective therapy in nonulcer dyspepsia, provided generic prices are used.

Clinical Trials as Topic↗
PubMed2004

Antralization of gastric incisura is topographically associated with increased gastric epithelial apoptosis and proliferation, but not with CagA seropositivity.

BACKGROUND AND AIMS: Helicobacter pylori infection is linked with increased antralization at the gastric incisura. The present study aimed to determine if antralization is associated with altered gastric epithelial apoptosis and proliferation and with seropositivity of the cytotoxin-associated gene product A (CagA) of H. pylori. METHODS: Gastric biopsies taken from the antrum, incisura, body and fundus of 75 patients (34 male, 41 female; mean age 59.5 years) were used for diagnosis of H. pylori infection and assessments of histological changes. Apoptosis and Ki-67 expression in epithelial cells were determined for the antral, incisura and body biopsies by immunohistochemistry. Serum samples were tested by enzyme-linked immunosorbent assays for anti-H. pylori and anti-CagA IgG antibodies. RESULTS: Apoptotic index (AI) and Ki-67 proliferation index (PI) were greater in the presence (vs absence) of H. pylori infection at the antrum, incisura and body (all P < 0.001), and topographically associated with chronic gastritis and gastric atrophy/intestinal metaplasia at the antrum and incisura (all P < 0.001). Moreover, AI and PI were greater in the presence (vs absence) of antralization at the incisura (20.2 +/- 0.9 vs 11.4 +/- 0.1.1 and 48.9 +/- 2.5 vs 29.9 +/- 2.5, both P < 0.001). CagA seroprevalence was 41% in the 39 infected patients. CagA seropositivity was associated with gastric atrophy/intestinal metaplasia at the antrum (chi(2) = 4.67, P = 0.03) and incisura (chi(2) = 4.88, P = 0.03), but not associated with gastric epithelial apoptosis and Ki-67 expression, nor with antralization at the incisura. CONCLUSIONS: Antralization of gastric incisura is topographically associated with increased gastric epithelial apoptosis and proliferation, but not with CagA seropositivity.

Adult↗
PubMed2004

Diet, food intake, and disturbed physiology in the pathogenesis of symptoms in functional dyspepsia.

Functional dyspepsia (FD) remains a relatively poorly characterized gastrointestinal disorder of unknown etiology that is frequently difficult to manage. A systematic review of the literature relating to food intake and FD is summarized here. Many patients with FD report symptoms after meal ingestion, including fullness, bloating, epigastric pain, nausea, and vomiting, and this has been interpreted as indicative of an underlying "motor disorder of the stomach or small intestine." Such hypotheses are, however, still largely unsubstantiated, and the data that do exist are inconclusive, particularly as few studies have directly examined the temporal relationships between dyspeptic symptoms, meal ingestion, and disordered gastric motility. Moreover, studies attempting to relate symptoms to specific disturbances in gastric motor function have, in most cases, not evaluated symptoms concurrently with the function test, and/or have used suboptimal symptom scoring to quantify symptoms. Furthermore, the term "early satiety" has been used loosely as a symptom, rather than a quantitative measure of food intake. Currently, the most widely accepted mechanism underlying FD is visceral hypersensitivity, which may contribute to both enhanced motor and symptomatic responses to food ingestion. However, the possible contribution of food and dietary habits to the induction and/or exacerbation of dyspeptic symptoms represents a relatively new area-despite frequent reports by patients that their symptoms are often related to food ingestion; this association has not been formally assessed. Dietary assessments have frequently implicated fatty foods in symptom induction, and these findings are supported by laboratory-based studies, particularly the demonstration that FD patients more often experience symptoms after intraduodenal infusions of fat, than glucose. Further studies into the potential role of dietary factors in the induction of dyspeptic symptom are required to establish whether dietary therapies have any place in the management of FD.

Diet↗
PubMed2004

Psychosocial factors are linked to functional gastrointestinal disorders: a population based nested case-control study.

BACKGROUND: It is widely accepted based on volunteer studies that levels of psychological distress are similar in those with functional gastrointestinal (GI) disorders and health in the community, while increased psychological distress in outpatients is largely explained by health-care seeking. AIMS: To determine if psychological distress, life event stress, or social support is associated with functional GI disorders in a population-based study. METHODS: A nested case-control study was performed by first mailing a self-report bowel disease questionnaire to a random sample of Olmsted County, Minnesota, aged 20-50 yr. All persons who reported symptoms of nonulcer dyspepsia (NUD) or irritable bowel syndrome (IBS) (cases), or an absence of GI symptoms (controls), were invited to complete a series of validated questionnaires designed to measure psychological distress, life event stress, social support, current symptoms, and physician visits. RESULTS: 103 subjects with functional GI disorders and 119 controls participated (85% of eligible). Functional GI disorders were more likely to be reported by those with higher scores on each of the nine SCL-90-R scales used to measure psychological distress (except phobic anxiety), and those with more negative and total life event stress. In a multiple logistic regression model (including age and gender), somatization, interpersonal sensitivity, and total life event stress were independently associated with functional GI disorders. Findings were similar when subjects with the IBS and NUD were analyzed separately compared to controls. CONCLUSIONS: Contrary to current dogma, psychosocial factors were significantly associated with functional GI disorders in this community sample. This suggests that these factors may be involved in the etiopathogenesis rather than just driving health-care utilization.

Adult↗
PubMed2004

Antidepressants in IBS: are we deluding ourselves?

The benefit of selective serotonin reuptake inhibitors (SSRIs) in the irritable bowel syndrome (IBS) has not been clear. In the latest randomized trial published this month in the Journal, paroxetine was superior to placebo in terms of improving well-being, but not abdominal pain or bloating. Based on the results of the most recent studies, both tricyclic antidepressants and SSRIs may improve patient satisfaction or quality-of-life without relieving most of the primary gastrointestinal symptoms. This suggests that antidepressant therapy represents at best only a "band-aid" approach to management. Optimizing the use of antidepressants in IBS is a challenge, and these issues are explored in this Editorial.

Antidepressive Agents↗
PubMed2004

Acupuncture has a placebo effect on rectal perception but not on distensibility and spatial summation: a study in health and IBS.

BACKGROUND: Recent data suggest that acupuncture has effects on gut physiology and perception. Spatial summation is a central mechanism of perception and describes the phenomenon that thresholds for perception are lower if more receptors are stimulated. OBJECTIVES: We assessed perception thresholds for rectal distension and cutaneous referral of symptoms, while inflating one or two rectal balloons and the effect of both electro-acupuncture and placebo-acupuncture on rectal distensibility, perception, and spatial summation. METHODS: A tube with two barostat balloons was placed in the rectum of 12 healthy subjects and nine irritable bowel syndrome (IBS) patients with rectal symptoms. Volume-controlled stepwise distension of the distal balloon only or both balloons was performed first as a control, and thereafter with simultaneous placebo- or electro-acupuncture in dermatomes S3 and S4. A symptom questionnaire and anatomic questionnaire was completed during each distension. RESULTS: Rectal elastance increased from 42.0 +/- 19.6 log mmHg/ml during one-balloon distension to 59.6 +/- 33.1 log mmHg/ml during two-balloon distension (p < 0.05) in healthy subjects, and from 48.8 +/- 14.4 log mmHg/ml (one balloon) to 77.6 +/- 24.2 log mmHg/ml (p < 0.001) in patients with IBS. Electro-acupuncture had no effect on rectal sensation, elastance, and cutaneous referral when compared to placebo-acupuncture. However, acupuncture (both electro- and placebo-) increased volume thresholds for sensation compared to control experiments, while objective parameters like rectal tone and elastance were unaltered. CONCLUSION: Acupuncture has a placebo effect on rectal perception but has no effect on rectal distensibility and visceral referral. Spatial summation affected both rectum distensibility and perception, but was also not altered by acupuncture.

Acupuncture Therapy↗
PubMed2004

Obesity and chronic gastrointestinal tract symptoms in young adults: a birth cohort study.

BACKGROUND: An unexplained epidemic of obesity is occurring but the relationship between obesity and gastrointestinal (GI) tract function is unclear. We aimed to evaluate the association between body mass index (BMI) and specific GI symptoms. METHODS: A birth cohort in Dunedin, New Zealand, aged 26 yr (n = 980, 94% of total original sample) was evaluated using a validated GI symptom questionnaire. Categories of GI symptom complexes were defined a priori. The association of reported GI symptoms with BMI (kg/m(2)) was assessed adjusting for gender. RESULTS: The prevalence of obesity (BMI > or = 30 kg/m(2)) was 12%; 30% were overweight. There was a significant univariate positive association between increased BMI and diarrhea (>3 stools/day, loose stools, or urgency); the sex adjusted odds ratio for obese versus normal weight was 1.8 (95% CI 1.1, 2.9; p= 0.02). Abdominal pain associated with nausea or vomiting was positively associated with increased BMI (OR 2.0, 95% CI 1.0, 2.9; p= 0.04). Being overweight was negatively associated with abdominal pain and constipation (OR 0.4, 95% CI 0.2, 0.9; p= 0.02). Irritable bowel syndrome and reflux symptoms were not significantly associated with increased BMI. Waist-to-hip ratios were not significantly associated with GI symptoms. No study members were taking antiobesity medications. Hemoglobin A1c levels were not associated with any of the GI symptoms. CONCLUSIONS: In a general population sample of young adults, increasing BMI was associated with diarrhea and abdominal pain with nausea/vomiting.

Adult↗
PubMed2004

Obesity is associated with increased risk of gastrointestinal symptoms: a population-based study.

OBJECTIVES: Perception of sensations arising from the gastrointestinal tract may be diminished in obese subjects and thus facilitate overeating. Alternatively, excess food intake may cause gastrointestinal (GI) symptoms in obese patients. We evaluated the relationship between body mass index (BMI) and specific GI symptoms in the community. METHODS: Residents of Olmsted County, MN were selected at random to receive by mail one of two validated questionnaires. The association of reported GI symptoms with BMI (kg/m(2)) was assessed using a logistic regression analysis adjusting for age, gender, psychosomatic symptom score, and alcohol and tobacco use. RESULTS: Response rate was 74% (1,963 of 2,660). The prevalence of obesity (BMI > or = 30 kg/m(2)) was 23%. There was a positive relationship between BMI and frequent vomiting (p= 0.02), upper abdominal pain (p= 0.03), bloating (p= 0.002), and diarrhea (p= 0.01). The prevalence of frequent lower abdominal pain, nausea, and constipation was increased among obese (BMI > or = 30 kg/m(2)) compared to normal weight participants, however, no significant association was found between BMI and these symptoms. CONCLUSIONS: In the community, increasing BMI is associated with increased upper GI symptoms, bloating, and diarrhea. Clarification of the cause-and-effect relationships and the mechanisms of these associations require further investigation.

Adult↗
PubMed2004

The irritable bowel syndrome has origins in the childhood socioeconomic environment.

BACKGROUND: The childhood socioeconomic environment has been linked to adult health status in several studies. However, its role in the pathogenesis of adult irritable bowel syndrome (IBS) remains unknown. We aim to assess the influence of the childhood environment on adult IBS, using data from a New Zealand birth cohort study. METHODS: The Dunedin birth cohort was assembled in 1972-1973 and has been followed prospectively to age 26 (n = 980). IBS was classified according to both Rome and Manning criteria, using self-reported symptom data obtained at age 26 yr. Childhood social class was used as a proxy measure of the quality of the childhood socioeconomic environment and was assigned according to the highest average socioeconomic (SES) level of either parent from interviews across the first 15 yr of life. RESULTS: Childhood social class was significantly associated with IBS according to Manning Criteria (p = 0.05) and Rome II Criteria (p = 0.05). The prevailing trend was identical for both measures of IBS in the sex-adjusted models: this trend can be characterized as a general, and near-linear decrease in the odds of IBS across decreasing levels of social class. Contrasts with the reference group were significant on all comparisons for Manning Criteria IBS (high vs upper middle, p = 0.04; lower middle, p = 0.04; low, p = 0.01), and on comparisons involving the two lower social class groups for Rome II Criteria IBS (high vs lower middle, p = 0.03; low, p = 0.03). The associations were attenuated, but not eliminated by further adjustment for adult social class. CONCLUSIONS: An affluent childhood environment is an independent risk factor for adult IBS.

Adult↗
PubMed2004

Noncoercive sexual contact with similarly aged individuals: what is the impact?

A community sample of 610 adults were grouped into those who reported no sexual abuse experience, others who reported noncoercive sexual contact with an individual that was at most 4 years older, and those who reported more severe sexual abuse. The first two groups did not differ from each other on current social support, trauma-specific symptomatology, and somatic complaints whereas the more severe sexual abuse group reported more problems on these dimensions. Further analyses suggested that of the two variables, coercion was more closely associated with problematic outcome than was the existence of an age difference.

Adolescent↗
PubMed2004

Functional gastrointestinal disorders among people with sleep disturbances: a population-based study.

OBJECTIVE: To determine whether unexplained gastrointestinal (GI) symptoms are more common in people with self-reported sleep disturbance. PARTICIPANTS AND METHODS: From November 1988 to June 1994, valid self-report questionnaires were mailed to age- and sex-stratified random samples of Olmsted County, Minnesota, residents aged 20 to 95 years. RESULTS: Of 2269 study participants (74% response rate), 52% were women (mean age, 45.0 years). The overall age- and sex-adjusted prevalence of sleep disturbance per 100 population was 13.5% (95% confidence interval [CI], 11.7%-15.3%). Among study participants with sleep disturbance, the prevalence of irritable bowel syndrome (IBS) was 33.3% (95% CI, 26.0%-40.5%) and the prevalence of frequent dyspepsia (FD) was 21.3% (95% CI, 14.4%-28.2%). After adjusting for age, sex, and somatization score, IBS was significantly more common in those with sleep disturbance (odds ratio, 1.6; 95% CI, 1.1-2.2), but the univariate association with FD was no longer statistically significant (odds ratio, 1.3; 95% CI, 0.9-1.9). CONCLUSIONS: Both IBS and FD are prevalent in those with self-reported sleep disturbance. Sleep disturbance was independently associated with IBS but not FD in the general population.

Adult↗
PubMed2004

Celiac disease serology in irritable bowel syndrome and dyspepsia: a population-based case-control study.

OBJECTIVE: To determine whether undiagnosed celiac disease is associated with irritable bowel syndrome (IBS) or dyspepsia in the community. SUBJECTS AND METHODS: A self-report bowel disease questionnaire was mailed to a random sample of Olmsted County, Minnesota, residents aged 20 to 50 years. All respondents who reported symptoms of dyspepsia or IBS (cases) and all respondents without notable gastrointestinal symptoms (controls) were invited to participate (260 eligible subjects; 150 [58%] were studied). Each respondent was examined by a physician, and the medical records of each were reviewed (3 subjects did not meet the criteria for dyspepsia or IBS at the time of the physician interview). Serum was obtained to measure antiendomysial antibodies and tissue transglutaminase (TTg) IgA antibodies using validated assays. RESULTS: A total of 34 subjects had dyspepsia (20 had ulcerlike dyspepsia), 50 had IBS (19 had diarrhea-predominant IBS), and 15 met criteria for both dyspepsia and IBS; 78 were asymptomatic healthy controls. The overall prevalence of positive TTg serology was 4% (95% confidence interval [CI], 1.5%-8.5%). The number of subjects who were seropositive for TTg was 2 of 34 (5.9%) with dyspepsia (95% CI, 0.7%-19.7%), 2 of 50 (4.0%) with IBS (95% CI, 0.5%-13.7%), and 2 of 78 (2.6%) of asymptomatic controls (95% CI, 03%-9.0%) (P = .64 IBS vs controls; P = .58 dyspepsia vs controls). No subjects had positive antiendomysial antibodies. CONCLUSION: In this community, celiac disease did not explain the presence of either IBS or dyspepsia.

Adult↗
PubMed2004

Enterochromaffin cells and 5-HT signaling in the pathophysiology of disorders of gastrointestinal function.

Disorders of gastrointestinal function are common and significantly reduce quality-of-life, as well as negatively impacting healthcare costs. Consequently, there is much interest in understanding the pathogenesis of these disorders. Increasing, albeit as yet limited, evidence has implicated alterations in 5-hydroxytryptamine (5-HT) release, and the subsequent interaction of 5-HT with specific 5-HT receptor subtypes, in the altered gut function of patients with irritable bowel syndrome (IBS) and other functional bowel diseases. Alterations to enterochromaffin cells and/or 5-HT signaling can result in gastrointestinal dysmotility, visceral hypersensitivity and secretomotor abnormalities in the gut. Evidence is beginning to link disturbed 5-HT physiology with the pathophysiology of diarrhea and constipation in IBS, and with slow-transit constipation. This review discusses the current evidence on the pathobiology of these systems.

Constipation↗