Gastrointestinal-specific anxiety: an important factor for severity of GI symptoms and quality of life in IBS.

BACKGROUND: Gastrointestinal (GI)-specific anxiety (GSA) has been proposed to influence symptom severity and quality of life (QOL) in patients with irritable bowel syndrome (IBS). The Visceral Sensitivity Index (VSI) is a recently developed, reliable and valid measure of GSA. Our aim was to evaluate the association between GSA, GI symptom severity, and QOL in IBS patients. METHODS: Sixty healthy subjects and 306 patients fulfilling the Rome II criteria for IBS were studied. Demographic and disease-related factors were assessed. Patients completed VSI and GI Symptom Rating Scale (GSRS) and questionnaires to determine psychological symptom severity (Hospital Anxiety and Depression Scale), QOL (Short form 36), and presence of functional GI disorders (Rome II Modular Questionnaire). KEY RESULTS: Compared with healthy subjects, patients with IBS had more severe GSA (34.7 +/- 16.9 vs. 2.2 +/- 4.4 [mean +/- standard deviation]; P < 0.0001). In the IBS group, more severe GSA was seen in patients with more severe GI symptoms (P < 0.0001), general anxiety (P < 0.0001) and depression (P < 0.0001), and with lower socioeconomic status (P < 0.05). In a regression analysis, GSA was the strongest predictor for GI symptom severity (GSRS total score), followed by number of Rome II diagnoses, presence of meal-related IBS symptoms, and gender (R(2) = 0.34). Gastrointestinal-specific anxiety was also, together with general anxiety, depression, socioeconomic status, and gender, found to be independently associated with mental QOL (R(2) = 0.62). CONCLUSIONS & INFERENCES: Gastrointestinal-specific anxiety seems to be an important factor for GI symptom severity and QOL in patients with IBS.

Effect of profound acid suppression in functional dyspepsia: a double-blind, randomized, placebo-controlled trial.

BACKGROUND: Functional dyspepsia (FD) is defined as persistent or recurrent pain/discomfort centred in the upper abdomen, where no structural explanation for the symptoms is found. The role of drug treatment remains controversial. The aim in this study was to evaluate the effect of omeprazole 20 mg twice daily (b.i.d) and to test methods for symptom assessment. METHODS: 197 patients fulfilling the criteria for FD were randomly allocated to double-blind treatment with omeprazole 20 mg b.i.d (n = 100) or placebo (n = 97) for 14 days. Patients with a known gastrointestinal disorder or with main symptoms indicating gastro-oesophageal reflux disease or irritable bowel syndrome were excluded. Helicobacter pylori testing and 24-h intra-oesophageal 24-h pH-metry were performed before randomization. The patients recorded dyspeptic symptoms on diary cards. RESULTS: A stringent endpoint, 'complete symptom relief on the last day of treatment', was the primary efficacy variable. For the APT cohort, this was achieved in 29.0% and 17.7% on omeprazole and placebo, respectively (95% CI of difference (11.3%): -0.4%-23.0%, P = 0.057). Similar figures in the PP cohort were 31.0% and 15.5%, respectively (95% Cl of difference (15.5%): 3.2%-27.7%, P = 0.018). The benefit of omeprazole in the PP cohort was confirmed by secondary endpoints such as, no dyspeptic symptoms on the last 2 days of treatment and overall treatment response. H. pylori status and the level of oesophageal acid exposure did not significantly influence the response to therapy. CONCLUSION: A subset of patients with FD will respond to therapy with omeprazole.

Does endoscopy have a positive impact on quality of life in dyspepsia?

BACKGROUND: It is unclear whether normal endoscopy results in patients investigated for dyspepsia has therapeutic value. Therefore the aim of this study was to evaluate the effect of the endoscopy on quality of life and dyspeptic symptoms. METHODS: One hundred ninety-six symptomatic patients (85 men and 111 women, mean age 42.9 years), who were receiving no treatment, were investigated before and 1 week after endoscopy with the use of a battery of validated questionnaires. RESULTS: Before endoscopy the health-related quality of life was compromised in comparison with a normal population, but 1 week after a negative endoscopy it is increased to a level which was close to the normal range despite no major change in symptoms. Physical activity and sleep scores improved significantly after endoscopy. CONCLUSION: The present results suggest that a negative endoscopy improves quality of life in the short-term in patients with dyspepsia, even though symptoms may persist.