[The Doctor into the net. A study about the use of online consultation service]. / Il medico nella rete. Uno studio sull'utilizzo del Servizio di Consulenza online.

BACKGROUND: To analyse the type of users that access an online Consultancy service. To understand what patient expectations are and how such a service can modify the physician/ patient relationship. EXPERIMENTAL DESIGN: retrospective investigation carried out by questionnaire which was sent out from 10/04/2001 to 05/06/2001. PARTICIPANTS: 65 users who had contacted the unit's online consultancy service. Of these 33 filled out the questionnaire. QUESTIONS: Each user was asked for anagraphic data, in full respect for his/her privacy, and an evaluation of the service. The data obtained, stored in a database, were then analysed and the percentages of each variable calculated. RESULTS: The typical user is resident in the centre-north, is aged an average of 32 with an average level of education. He chose online consultancy largely to obtain a medical opinion in a short time without leaving home and without the long waiting times usually necessary to obtain a further specialist opinion. He was generally fairly pleased with the replies received and therefore judged the system useful. CONCLUSIONS: The system is popular with users who access it to receive specific indications for treatment and to have more information about their condition. Given user expectations, it is necessary to guarantee the quality and reliability of the service and educate users in the correct use of these new technologies.

Gastric emptying and orocecal transit time in pregnancy.

PURPOSE: To evaluate the effects of pregnancy on gastrointestinal function, we determined gastric emptying time, orocecal transit time, and fasting gastrointestinal hormone levels (cholecystokinin, gastrin, pancreatic polypeptide, neurotensin) in 11 women with mild dyspeptic symptoms during the first and third trimesters of their pregnancies, and again 4-6 months after delivery. METHODS: After the women ingested a disaccharide solution, orocecal transit time was determined by monitoring breath hydrogen concentrations at 10-min intervals, and values were compared with the postpartum value. Ultrasound examinations of gastric emptying were performed during the same intervals. RESULTS: The half-emptying time and the final gastric emptying time did not differ in the first and third trimesters and postpartum, but gastrointestinal transit time was significantly longer in the third trimester of pregnancy than postpartum (100.0 min [range, 50.5-240.0 min] vs 70.0 min [range, 40.5-240.0 min; P < 0.05]), respectively. Mean plasma pancreatic polypeptide values were lower in the third trimester of pregnancy than postpartum. and a negative correlation was observed between pancreatic polypeptide levels and transit time in the third trimester (r = -0.65; P = 0.0261). The plasma levels of other gastrointestinal hormones did not differ in the various periods studied. CONCLUSIONS: Our study shows that, despite evident dyspeptic symptoms, there were no significant alterations in gastric emptying or orocecal transit time during the first trimester of pregnancy. Conversely, in the third trimester, orocecal transit time was significantly longer.

Criterion-related validity of the diagnostic criteria for psychosomatic research for alexithymia in patients with functional gastrointestinal disorders.

BACKGROUND: Because of criticism made against psychiatric assessment of somatization, alternative Diagnostic Criteria for Psychosomatic Research (DCPR) have been proposed by an international group of psychosomatic investigators. One of these criteria concerns the alexithymia construct. The main aim of the present study was to investigate the criterion-related validity of the DCPR for alexithymia syndrome (DCPR-A). A secondary aim was to explore the relationship between alexithymia and depressed mood. METHOD: The study included 190 consecutive outpatients with functional gastrointestinal disorders. Alexithymia was assessed by means of the DCPR-A and the 20-item Toronto Alexithymia Scale (TAS-20). Depressed mood was assessed on the basis of the Depression subscale of the Hospital Anxiety and Depression Scale (HDS) and the DSM-IV criteria. RESULTS: The sensitivity of the DCPR-A together with the TAS-20 was 70.2%, specificity was 81.6%, positive predictive power 88.9%, negative predictive power 66.0% and overall hit rate 46.8%. DCPR-A positives scored significantly higher than DCPR-A negatives on the TAS-20 scores (t = 9.86, p < 0.001). The TAS-20 was not associated with any measure of depression, while the DCPR-A was significantly associated with the HDS and DSM-IV criteria. CONCLUSIONS: The DCPR-A had adequate sensitivity, specificity and accuracy, thus proving that the criterion has good validity. The differences in association found between alexithymia and depression suggest that they may be due to differences in the methods of investigation rather than to the constructs per se.

Assessing somatization in functional gastrointestinal disorders: integration of different criteria.

BACKGROUND: Psychiatric assessment of somatization (the tendency to experience and communicate psychological distress in the form of physical symptoms and to seek medical help for them) currently rests on DSM criteria. An alternative diagnostic and conceptual framework has been proposed by an international group of psychosomatic investigators. The aim of this study was to compare these new criteria (Diagnostic Criteria for Psychosomatic Research, DCPR) with DSM-IV in a population where a high prevalence of psychosocial problems is expected (functional gastrointestinal disorders, FGID). METHOD: One hundred and ninety consecutive patients with FGID in a tertiary care center were assessed according to DSM-IV and DCPR criteria. RESULTS: The number of the 12 DCPR diagnoses was almost double that of DSM diagnoses. Only 9% of the patients were not identified by DCPR criteria, whereas this occurred in 25% of patients using DSM criteria. While patients who were given a DSM diagnosis frequently had additional DCPR diagnoses, many patients with DCPR syndromes did not fulfill any DSM criteria. Four DCPR syndromes appared to be particularly frequent and accounted for almost three quarters of the total diagnoses (alexithymia, persistent somatization, functional symptoms secondary to a psychiatric disorder, demoralization). CONCLUSIONS: The joint use of DSM and DCPR criteria was found to improve the identification of psychological factors in FGID. The results may pave the way for changes in DSM classification of somatoform disorders.

Alexithymia and functional gastrointestinal disorders. A comparison with inflammatory bowel disease.

BACKGROUND: Although the alexithymia construct was derived from observations of patients with classical psychosomatic diseases, empirical studies have found only a moderate association between alexithymia and inflammatory bowel disease (IBD). Indeed, there is some evidence that alexithymia may be associated more strongly with functional somatic symptoms than with the psychosomatic diseases. The present study examined the relationship between alexithymia and functional gastrointestinal disorders (FGIDs) in a group of 121 FGID patients, and compared the results with findings from a group of 116 IBD patients and a group of 112 healthy subjects. METHOD: The subjects completed the 20-item Toronto Alexithymia Scale and the Hospital Anxiety and Depression Scale. RESULTS: The FGID group was significantly more alexithymic than the IBD group, and the two gastrointestinal groups were more alexithymic than the normal healthy group. These differences remained even after controlling for the influence of education, gender, anxiety, depression and gastrointestinal symptoms. CONCLUSIONS: The finding of a high rate of alexithymia (66%) in the group of FGID patients is consistent with the propensity of these patients to somatization and to high levels of poorly differentiated psychological distress.

Functional gastrointestinal disorders and eating disorders. Relevance of the association in clinical management.

BACKGROUND: As functional gastrointestinal disorders (FGID) are common in eating disorder patients, we aimed to assess past eating disorders in patients referred for current FGID. METHODS: One hundred and twenty-seven consecutive FGID outpatients and 163 patients with gallstone disease (GD) were enrolled. All patients were interviewed to detect GI symptoms (by means of the GI Symptom Rating Scale), lifetime eating disorders (on the basis of DSM-IV criteria), and current psychologic distress (on the Hospital Anxiety and Depression Scale). RESULTS: Past eating disorders were significantly more prevalent in FGID (15.7%) than in GD patients (3.1%) (chi-square = 14.6, P < 0.001). FGID patients with past eating disorders were significantly younger, more educated, more psychologically distressed, more dyspeptic, and more were women than FGID patients without past eating disorders. CONCLUSIONS: This study confirms the previously found association between functional GI symptoms and eating disorders and shows that functional GI symptoms may still persist even after the recovery from eating disorders, particularly in psychologically distressed patients.

Hypolactasia and metabolic changes in post-menopausal women.

OBJECTIVES: The aims of the study were to evaluate the prevalence of hypolactasia in a group of post-menopausal women in Southern Italy, and to relate hypolactasia to possible changes occurring in biochemical indicators of carbohydrate and fat metabolism as well as in biochemical markers of bone metabolism. METHODS: Fifty post-menopausal women entered the study. Lactose malabsorbers were identified by breath hydrogen test. The kinetics of D-xylose was evaluated by a graphic-mathematical analysis after oral administration of a solution of 10 g of D-xylose in water. Serum glucose, insulin, C-peptide, cholesterol and triglycerides were assayed by commercial kits. The evaluation of dietary habits and physical activities was performed by a questionnaire. The assessment of bone turnover was obtained by measuring osteocalcin, serum alkaline phosphatase, calcium, phosphorus, and urinary hydroxyproline and urinary calcium expressed as a ratio or urinary creatinine. RESULTS: Twenty-six of 50 women showed hypolactasia. Significant differences were found in serum levels of insulin, glucose, and triglycerides, which were lower in malabsorbers than lactose absorbers, and in HDL-cholesterol levels which were higher in the first group than in the second. As regards bone turnover, dietary habits or lactose intake, there were no significant differences between the two groups. CONCLUSIONS: The significant differences found in serum levels of glucose, triglycerides, and HDL-cholesterol between lactose absorbers and malabsorbers may be imputable to the low or absent lactase activity which does not allow the whole amount of lactose in the small bowel of malabsorbers to be metabolized. Moreover, changes in lactose absorbing capacity of intestinal mucosa did not modify the intake of milk or its by-products in malabsorbers as demonstrated by the analysis of food.