How Valuable Is the Application on Consensus Guidelines in the Management of Functional Gastrointestinal Disorders?

Vaira, Dino; Gatta, Luigi; Ricci, Chiara; D’Anna, L; Miglioli, M.

doi:10.1159/000050684

Cited by 3 publications

(3 citation statements)

References 30 publications

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“…The approach of using specific symptom groupings to diagnose irritable bowel syndrome or non‐ulcer dyspepsia has been challenged on several grounds 17–19 . As the symptoms of irritable bowel syndrome and non‐ulcer dyspepsia often overlap and can be unstable, any subdivision or classification may be arbitrary 38 . Moreover, the exact symptom items that should be used to identify irritable bowel syndrome are unclear 39 ,.…”

Section: Discussionmentioning

confidence: 99%

Empirically derived symptom sub‐groups correspond poorly with diagnostic criteria for functional dyspepsia and irritable bowel syndrome. A factor and cluster analysis of a patient sample

Eslick

Howell

Hammer

et al. 2003

Aliment Pharmacol Ther

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SUMMARYAim: To determine how clusters (groups) of patients with respect to symptoms compare with a clinical diagnosis in patients with irritable bowel syndrome and non-ulcer dyspepsia. Methods: All patients who attended a gastroenterology practice at Nepean Hospital were included in the study. All patients received the previously validated Bowel Disease Questionnaire, and were independently assessed by the gastroenterologist. Factor analysis and a k-means cluster analysis were completed. Results: The study population comprised 897 patients [320 males (36%) and 577 females (64%)]. Factor analysis identified nine symptom factors: (1) diarrhoea; (2) constipation; (3) dysmotility; (4) dyspepsia/reflux; (5) nausea/vomiting; (6) bowel; (7) meal-related pain; (8) weight loss; and (9) abdominal pain. A k-means cluster analysis identified seven distinct subject groups, which included an undifferentiated group: (1) diarrhoea; (2) meal-related pain; (3) abdominal pain; (4) faecal indicators; (5) nausea/vomiting/weight loss; and (6) constipation. The majority of irritable bowel syndrome patients fitted into two cluster groups [diarrhoea (25%) and constipation (20%)], whereas those with non-ulcer dyspepsia predominantly fitted into the undifferentiated cluster (34%) and the nausea/vomiting cluster (18%). Conclusion: This study supports the concept of symptom subgroups, including the subdivision of patients into diarrhoea-and constipation-predominant irritable bowel syndrome.

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Section: Discussionmentioning

confidence: 99%

Empirically derived symptom sub‐groups correspond poorly with diagnostic criteria for functional dyspepsia and irritable bowel syndrome. A factor and cluster analysis of a patient sample

Eslick

Howell

Hammer

et al. 2003

Aliment Pharmacol Ther

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“…The pathophysiology of these symptoms is poorly understood. Small bowel motor disturbances have been considered to be responsible for similar symptoms in functional bowel disorders such as nonulcer dyspepsia 2 or irritable bowel syndrome 3 . Therefore, motor disturbances induced by gallbladder removal could be one explanation for epigastric pain or diarrhoea following cholecystectomy.…”

Section: Introductionmentioning

confidence: 99%

“…Small bowel motor disturbances have been considered to be responsible for similar symptoms in functional bowel disorders such as nonulcer dyspepsia 2 or irritable bowel syndrome. 3 Therefore, motor disturbances induced by gallbladder removal could be one explanation for epigastric pain or diarrhoea following cholecystectomy. One additional argument for cholecystectomy-induced motility disturbances is that this surgical procedure results in an almost continuous bile flow into the duodenum, 4 and bile acids have been shown to influence both interdigestive and postprandial motility, 5 to stimulate small bowel phase II activity, 6 and to promote an antral initiation of phase III.…”

Section: Introductionmentioning

confidence: 99%

The effect of cholecystectomy on duodenojejunal motility in humans

Blanc-Louvry

Denis

Ducrotté

2002

Neurogastroenterology Motil

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We hypothesized that certain gastrointestinal symptoms following cholecystectomy could be explained by motor disturbances. To test this hypothesis, we compared pre- and post-operative motor patterns between symptomatic and asymptomatic patients after surgery to evaluate whether some motor changes could be induced by gallbladder removal and associated with symptoms. Twenty-three patients were prospectively evaluated before and 3 months after cholecystectomy. After surgery, 17 patients were asymptomatic and six were symptomatic. Duodenojejunal manometric recordings were performed for 3 h during fasting, then 3 h after a 750-kcal meal. Patient motor results were compared to those obtained in the duodenojejunum of 20 healthy controls. After surgery, only a few modifications in duodenojejunal motility were observed compared to the preoperative period. Motor changes related to cholecystectomy were increase in phase III amplitude and the absence of progressive decrease of the duodenojejunal motor response after the meal. After surgery, symptomatic patients had a lower postprandial duodenal motility index after the meal than asymptomatic patients (P < 0.03) and more frequent propagated clusters of contractions (PCCs) (P < 0.02). Preoperative motor patterns associated with postoperative symptoms were postprandial only and included a low duodenal motility index (P < 0.03), and a higher number of PCCs (P < 0.02). Removal of the gallbladder has a limited effect on duodenojejunal motility. Few motor differences existed between symptomatic and asymptomatic patients after surgery. However, a low duodenal motor response to a meal and PCCs were often associated with symptoms.

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Symptom Clusters

et al. 2005

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The purpose of this article is to analyze the concept of symptom clusters and to discuss its application to cancer nursing to promote communication and enhance scientific knowledge. Rodgers' evolutionary method of concept analysis served as the framework for reviewing literature from psychology/psychiatry, general medicine, and nursing. Attributes of symptom clusters were relationships of symptoms and relationships of clusters, concurrence, underlying dimensions, stability, and common etiology. The major antecedent was the presence of 2 or more symptoms. Consequences were poorer physical health status, interference with activities of daily living, emotional distress, and increased financial burden. A symptom cluster is defined as consisting of 2 or more symptoms that are related to each other and that occur together. Symptom clusters are composed of stable groups of symptoms, are relatively independent of other clusters, and may reveal specific underlying dimensions of symptoms. Relationships among symptoms within a cluster should be stronger than relationships among symptoms across different clusters. Symptoms in a cluster may or may not share the same etiology. Symptom should be broadened to include both subjective (self-reported) symptoms and objective (observed) signs. Implications for researchers include the need to use a clear definition, determine the optimal methods of identifying etiology and nature of symptom clusters in various populations, assess the clinical utility of symptom clusters, and test interventions. Implications for practitioners include the need to comprehensively assess symptoms over the entire cancer trajectory, select interventions that target single and multiple symptoms, and evaluate outcomes that include quality of life and economic variables.

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How Valuable Is the Application on Consensus Guidelines in the Management of Functional Gastrointestinal Disorders?

Cited by 3 publications

References 30 publications

Empirically derived symptom sub‐groups correspond poorly with diagnostic criteria for functional dyspepsia and irritable bowel syndrome. A factor and cluster analysis of a patient sample

Empirically derived symptom sub‐groups correspond poorly with diagnostic criteria for functional dyspepsia and irritable bowel syndrome. A factor and cluster analysis of a patient sample

The effect of cholecystectomy on duodenojejunal motility in humans

Symptom Clusters

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