Anxiety and depression as markers of multiplicity of sites of functional gastrointestinal disorders: a gender issue?

BACKGROUND: Anxiety and depression are frequently present in patients with different types of functional gastrointestinal disorders (FGID), and seem to play a major part in both the perception of symptoms and the outcome of treatment. AIMS: The aim of the present study was therefore to evaluate levels of anxiety and depression in adult patients according to the extent and the type of FGID. METHODS: Three hundred and eighty-five consecutive patients (72% female) were evaluated. Each patient filled a standard clinical questionnaire based on diagnostic questions for uro-genital complaints and for FGID according to the Rome III criteria. In addition, they indicated on a 10-cm visual analog scale (VAS) the intensity of constipation, diarrhea, bloating, and abdominal pain, and stool description using the Bristol Stool Form Scale. Anxiety and depression were evaluated using Beck Depression Inventory and Anxiety State and Trait Anxiety Inventory. RESULTS: In FGID patients, levels of depression, state and trait anxiety are higher in patients with several sites of complaint. Females are more depressed than males, regardless of the level of FGID. Females tend to react emotionally to stress with a lot of anxiety ("state" anxiety), as well as in the long run ("trait" anxiety). VAS parameters for constipation, bloating and abdominal pain were related to psychological scores in contrast to VAS diarrhea and stool form. In males, the extent of sites of FGID was strongly related to trait anxiety. In females, it was strongly related to depression. CONCLUSION: Different types of FGID are associated with depression and anxiety according to the number of sites of complaints linked to gender and psychological parameters, as well as the magnitude of complaint expressed by the VAS.

[Carcinoma of the papilla of Vater. Diagnostic and therapeutic problems. An analysis of 32 Tunisian cases]. / Carcinome de l'ampoule de Vater: problémes diagnostiques et therapeutiques. Analyse d'une série de 32 patients.

UNLABELLED: The aim determine the clinical, morphological, endoscopical and progressive profile of patients with ampullary carcinoma. PATIENTS AND METHODS: Thirty-two patients with a carcinoma of the ampulla of Vater, hospitalised in the Gastro-enterology service of Habib Thameur Hospital (Tunis) (1992-2002) have been analysed retrospectively. RESULTS: Twelve men and 20 women of an average age of 66 years have been included. Twelve patients (37%) had had a cholecystectomy into the 3 years preceding the diagnosis of the ampullary carcinoma. A duodenal tumour had been found at 29 patients (91%). After endoscopical sphincterectomy, an intra-ampullar exophytic tumour had been found in I case and an infiltrated aspect of the ampulla of Vater in 2 cases. The jaundice was frequent. The use of lateral duodenoscopy allowed carrying the positive diagnosis in all cases. Five patients had metastasis at the moment of diagnosis. A DPC has been practiced at 15 patients. A palliative biliary diversion has been realized at 9 patients. Six patients had an endoscopical palliative drainage with installation of a plastic prosthesis. The rate of post- operative mortality was 20%. The rate of morbidity linked to the surgery was 21.8%. CONCLUSION: The ampullary carcinoma is a rare tumour diagnosed belated. The postoperative mortality is raised. The identification of factors forecast and the utilization of adjuvant processing will be able to allow the improvement of the prognosis.