The use of complementary and alternative therapies and of psychotherapy by Romanian patients with irritable bowel syndrome.

UNLABELLED: Irritable bowel syndrome (IBS) is an invalidating condition, lacking a perfect therapy. Therefore, many patients use also complementary and alternative therapies (CAT) or psychotherapy (PT). There are no data on the use of CAT and PT in IBS in our area. We looked for this until uncovered aspect of IBS management in Romania. MATERIAL AND METHODS: 250 consecutive patients with IBS (142 F/108M, aged 49 +/- 12 years) referred to a tertiary gastroenterological center were questioned about the use of CAT and PT using a structured specially developed questionnaire. All of the patients accepted to answer the questionnaire after careful instruction. RESULTS: 162 out of 250 pts (64%) admitted to have used one or more CAT, usually together with pharmacological prescriptions. Among CAT users, 32 patients (20%) used only CAT and not allopathic drugs. CAT used were: homeopathy 13%, herbal therapy 72%, acupuncture 3%, bioenergetic resonance 11%, others 13%. Probiotics were used by 30%. Users were mainly females of lower educational levels. Psychotherapy was used by 30 pts (12%). 25 (10%) used CBT, 15 (6%) used relaxation therapy. CONCLUSION: The majority of IBS pts. in our area use CAT usually in association with allopathic therapy. The most frequently used are herbal prescriptions followed by probiotics. PT less frequently used in our IBS patients.

Autonomic neuropathy and plasma catecholamine in patients with diabetes mellitus.

BACKGROUND: Cardiovascular autonomic neuropathy (CAN) is a common form of autonomic dysfunction in diabetes mellitus (DM) patients, but it can be asymptomatic for years. Low baseline plasma noradrenaline levels have been found in diabetic patients, but this decrease seems to associate clinically severe autonomic neuropathy. PURPOSE: To evaluate the impact of DM on heart rate variability (HRV) parameters and to determine the correlations with plasma adrenaline and noradrenaline, as a possible mechanism of early disruption in HRV. METHODS: A group of 34 patients with type 2 diabetes mellitus, without clinical signs of CAN, was enrolled. HRV (as a measure of autonomic balance) was measured using a 24 hour ECG monitoring system in all subjects during normal daily activity. Plasma catecholamines and other laboratory markers were measured. RESULTS: HRV parameters are lower in DM group as compared with control group. More than half of the patients had HRV parameters below the normal range (54%). There are lower levels of noradrenaline value in DM, as compared with controls, but the difference is not statistically significant (p = 0.08). Adrenaline levels were similar in both groups. DISCUSSION AND CONCLUSION: CAN is best evaluated using heart rate variability (HRV) on 24 hours recordings. There is a tendency for HRV parameters to decrease even in asymptomatic patients, especially after years of evolution. We did not find significant correlations between HRV and plasma catecholamine, even if noradrenaline was lower in DM patients. Holter monitoring remains a reliable method for early diagnosis of CAN.

Assessing gastrointestinal symptoms and perception, quality of life, motility, and autonomic neuropathy in clinical studies.

Imprecise characterization of complaints of the upper and lower gastrointestinal (GI) tract puts patients at risks of either a delayed diagnosis or misdiagnosis and contributes to an increase in the overall direct and indirect costs of the health system. The current scenario in the case of functional GI diseases originates from at least two conditions: frequency of diseases and bothersome symptoms with an impact on the quality of life (QoL). To make a correct diagnosis is therefore almost mandatory. Once a positive diagnosis of functional involvement of the GI tract is made, the correct diagnosis assessment includes the study of symptom characteristics, entity and perception, detection of abnormal patterns of GI motor-function (gallblader and gastric emptying, oro-cecal and colonic transit, etc.), potential involvement of the autonomic nervous system (sympathetic, parasympathetic), and overall impact of such abnormalities on the QoL and psychological profiles. Results of these tests can be variable, depending on the type and intensity of the illness. In the present review, the state-of-the-art methods for correct assessment of several factors regarding the onset, perpetuation and outcome of functional GI diseases are discussed.