Background-Life stress contributes to symptom onset and exacerbation in the majority of patients with irritable bowel syndrome (IBS) and functional dyspepsia (FD); research evidence is conflicting, however, as to the strength of these effects. Aims-To test prospectively the relation of chronic life stress threat to subsequent symptom intensity over time. Patients-One hundred and seventeen consecutive outpatients satisfying the modified Rome criteria for IBS (66% with one or more concurrent FD syndromes) participated. Methods-The life stress and symptom intensity measures were determined from interview data collected independently at entry, and at six and 16 months; these measures assessed the potency of chronic life stress threat during the prior six months or more, and the severity and frequency of IBS and FD symptoms during the following two weeks. Results-Chronic life stress threat was a powerful predictor of subsequent symptom intensity, explaining 97% of the variance on this measure over 16 months. No patient exposed to even one chronic highly threatening stressor improved clinically (by 50%) over the 16 months; all patients who improved did so in the absence of such a stressor. Conclusion-The level of chronic life stress threat predicts the clinical outcome in most patients with IBS/FD. (Gut 1998;43:256-261) Keywords: irritable bowel syndrome; chronic life stress threat; symptom intensityIn irritable bowel (IBS) and functional dyspepsia (FD) syndromes, major life stress situations precede onset and/or exacerbation of symptoms, 1-3 and early observations suggest that symptoms either disappear or improve following resolution of major life stress problems. 4 Furthermore, an impressive and sustained improvement in symptoms occurs following the acquisition of more eVective stress management skills.5-7 In a recent study of patients with functional gastrointestinal disorders (FGID), 8 we showed a significant correspondence between the intensity of chronic life stress threat and the severity and extent of aVective, gastrointestinal, and extraintestinal symptomatology, particularly in patients with IBS-FD syndromes. Despite these observations, the extent to which life stress contributes to the course of IBS and/or FD symptoms remains uncertain. 10To extend our previous cross sectional findings, our aim was to examine, in patients with IBS, group and individual patterns of change in life stress and symptom intensity over time. Specifically we aimed to determine within subject: (1) covariance of life stress and subsequent symptom intensity over three time frames; (2) time lag relations (with and without relevant covariates); (3) the role of personality, age, sex, and emotional distress in the above; (4) the life stress predictors of any improvement or lack of improvement in symptom intensity over time; and (5) the life stress predictors of clinical (50% or more) improvement or no clinical improvement in symptom intensity over time. We hypothesised that: (1) life stress and subsequent symptom intensity will...

Background-Psychological, social, and extraintestinal (somatic) disturbances are prominent features of functional gastrointestinal disorders (FGID); little attention, however, has been given to diVerences in the nature of these disturbances in the various FGID subgroups. Aims-(1) To determine whether psychological, social, and extraintestinal factors are associated with specific FGID, and/or with the overall severity and extent of FGID disturbance (the number of coexistent FGID subgroups present in any individual); and (2) to determine whether chronic social stressors link gastrointestinal, extraintestinal, and emotional symptomatologies in FGID. Patients-One hundred and eighty eight outpatients, fulfilling standard criteria for one or more functional gastroduodenal or functional bowel disorders. Methods-Utilising detailed and objective interview and questionnaire methods, detailed gastrointestinal, extraintestinal, psychological, and social data were collected. Results-Chronic stressors and extraintestinal and emotional symptomatologies were prominent features of functional dyspepsia (FD) and irritable bowel syndrome (IBS) alone. These particular features were, however, highly specific for particular FD and/or IBS subgroups. The chronic threat component of social stressors predicted the nature and extent of multisystem (gastrointestinal, extraintestinal, and emotional) symptomatology. Conclusions-Notable diVerences between the various FGID subgroups support the symptom based classification of FGID. Chronic stressor provoked psychological and extraintestinal disturbance is most specific for the FD-IBS group of syndromes. (Gut 1998;42:414-420) Keywords: functional gastrointestinal disorders; psychosocial; extraintestinal symptoms; chronic stressThe functional gastrointestinal disorders (FGID) are common disorders in gastroenterology practice and in the community. Although several FGID syndromes may coexist in an individual patient, each syndrome can be reliably identified as a distinct and homogeneous entity.1 Psychological, social, 2-4 and extraintestinal (somatic) disturbances [5][6][7][8][9] are prominent features of FGID in general; whether such factors are distinctive of specific FGID syndromes or subgroups (distinct clusters of symptoms), or whether they reflect the overall severity and/or extent of functional gut disturbance (number of coexistent FGID syndromes), has received little attention. Furthermore, although social stressors that are severe, chronic, and threatening have been implicated in the development of FGID, 3 4 no study has previously assessed the relation of specific objective measures of social stressors to coexistent gastrointestinal, extraintestinal, and emotional symptomatologies in the FGIDs.Our specific aims were therefore, in a large group of patients with various functional gastroduodenal and functional bowel disorders, to determine: (1) the relative importance of specific psychological, social, and extraintestinal (somatic) factors to specific FGID, and/or to severe and e...

Background-The relation of demographic and psychological factors to the presence and extent of gut transit impairment in the functional gastrointestinal disorders has received little attention. Aims-To compare the psychosocial and demographic features of patients with functional gastrointestinal disorders and delayed transit in one region of the gastrointestinal tract with those displaying more widespread delayed transit (that is, delay in two or three regions), and those with normal transit in all three regions. Patients-Of 110 outpatient participants who satisfied standardised criteria for functional gastrointestinal disorders, 46 had delayed transit in one region, 32 had delay in two or three regions, and 17 exhibited normal transit in all regions. Methods-Transit in the stomach, the small intestine, and the large intestine was assessed concurrently using a wholly scintigraphic technique; psychological status was assessed using established psychometric measures. Results-Patients with delayed transit displayed demographic and psychological features that contrasted with patients with normal transit in all regions. In particular, widespread delayed transit featured female sex, a highly depressed mood state, increased age, frequent control of anger, and more severe gastric stasis, while the features distinguishing normal transit were male sex and high levels of hypochondriasis. Conclusion-These data suggest the existence of a distinct psychophysiological subgroup, defined by the presence of delayed transit, in patients with functional gastrointestinal disorders. (Gut 2000;46:83-87)

An analysis was performed of the anaesthesia caseload of the Dili General Hospital for a four-month period from April 21, 2000 to August 20, 2000.

This is a report of a case of a diffuse bleeding tendency in a pregnant woman who presented for emergency splenectomy with a tentative diagnosis of thrombotic thrombocytopenic purpura. The influence of multiple organ dysfunction in the selection of appropriate monitors and the anesthetic technic in such cases are complex.