Comparison of treatment outcome measures for irritable bowel syndrome.

We have examined the relations among three common treatment outcome measures in irritable bowel syndrome (IBS): end of treatment global ratings by a physician, end of treatment patient global ratings, and measures derived from a daily symptom diary completed by the patient. Eighty-four IBS patients (53 female, 31 male) participated in a randomized controlled evaluation of three psychological treatment conditions for IBS. Treatment outcome measures from this trial (Blanchard et al., 1992) were used in the present methodological study. Physician global ratings were significantly correlated with patient global ratings (r = .45, p < .01). Both of these global ratings also correlated significantly with a composite score from patient diary ratings. Multiple regression analyses revealed that reductions in bloating and constipation account for 18% of the variance in patient global ratings. Global ratings at end of treatment by either patient or physician were only partially related to symptom relief as measured by a daily diary.

Fish oil dietary supplementation for prevention of indomethacin induced gastric and small bowel toxicity in healthy volunteers.

OBJECTIVE: To determine if N-3 fatty acid (fish oil) dietary supplements could favorably alter indomethacin induced gastric and small bowel toxicity related to use of nonsteroidal antiinflammatory drugs (NSAID). METHODS: Healthy volunteers consumed 8 g of N-3 fatty acids for 16 weeks, while controls consumed corn oil. Subjects ingested indomethacin 50 mg tid between Weeks 12 and 16. Upper gastrointestinal (GI) endoscopy with biopsies and Cr-EDTA swallows were performed at Week 12 and again at Week 16. Biopsy specimens were graded for inflammation and endoscopic scores were recorded. RESULTS: No significant differences were seen between groups in any study variable, although the direction of change favored the fish oil subjects for inflammation scores in both the stomach and duodenum (fish oil subjects -0.50 +/- 1.2 stomach, -0.28 +/- 0.97 duodenum; and corn oil subjects +0.10 +/- 0.84 stomach, +0.20 +/- 0.79 duodenum; p = 0.086). Direction of change in stomach inflammation showed a trend favoring fish oil (p = 0.056 by chi square). CONCLUSION: Although no significant differences were seen between groups, the changes observed in inflammation suggest a possible benefit of fish oil in the amelioration of NSAID induced GI inflammation.

Psychological aspects of irritable bowel syndrome: comparisons with inflammatory bowel disease and nonpatient controls.

Patients with irritable bowel syndrome (IBS) (n = 121) were compared to 46 patients with inflammatory bowel disease (IBD), and to 45 nonpatient controls on a variety of psychological tests and on symptomatology. The most consistent finding was the ordering of group psychological test means such that, on 11 of 14 measures, IBS patients scored higher than IBD patients, who in turn scored higher than the nonpatient controls. The two patient groups differed significantly only on measures of anxiety with the IBS patients scoring significantly higher on all three measures. IBS patients also reported significantly more severity of abdominal pain than the IBD patients; while IBD patients reported more episodes of diarrhea, they did not rate them as significantly more severe than did the IBS patients. Various other parameters of the IBS population are also explored and implications for treatment and future study are discussed.

Prediction of outcome from cognitive-behavioral treatment of irritable bowel syndrome.

The presence of a diagnosable Axis I psychiatric disorder predicted significantly (P less than 0.001) lower likelihood of significant improvement among 90 irritable bowel syndrome patients given cognitive and behavioral treatments to help the disorder. Other psychological tests, including the MMPI, BDI, STAI, as well as demographic variables, failed to yield significant prediction.

Two controlled evaluations of multicomponent psychological treatment of irritable bowel syndrome.

We report two controlled comparisons of a previously validated multicomponent (relaxation, thermal biofeedback, and cognitive therapy) treatment for irritable bowel syndrome (IBS) to an ostensible attention-placebo control (pseudo-meditation and EEG alpha suppression biofeedback) and to a symptom-monitoring control. In Study 1 (n = 10 per condition) there were nonsignificant trends for the multicomponent treatment to be superior to the attention-placebo condition. In Study 2 (n = 30 per condition), we found no advantage for the multicomponent treatment over the attention-placebo condition. Subjects in both treatment conditions showed significant reductions in GI symptoms, as measured by daily symptom diaries, and significant reductions in trait anxiety and depression. The GI symptom reductions held up over a 6 month follow-up. Possible explanations for the results are explored.