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Ulrik Fredrik Malt - One of the best experts on this subject based on the ideXlab platform.
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personality and physical symptoms in nonpsychiatric patients with Functional Gastrointestinal Disorder
Journal of Psychosomatic Research, 2001Co-Authors: Lars Tanum, Ulrik Fredrik MaltAbstract:Abstract Objective: We investigated the relationship between personality and reported pain and somatic distress in patients with Functional Gastrointestinal Disorder (FGD) without psychopathology. Methods: Fifty-six patients and 55 controls completed Buss–Durkee Hostility Inventory (BDHI), NEO Personality Inventory (NEO-PI), Eysenck Personality Questionnaire (EPQ: N+L scales), and Giessener Physical Complaints Checklist (GBB). Patients also completed McGill Pain Questionnaire (MPQ) and Visual Analogue Scale (VAS) for abdominal pain and target symptom (abdominal distress). Results: Patients displayed significantly higher levels of neuroticism and covert aggression than controls. Number of words chosen (NWC) to describe pain and sensory pain index (MPQ), but not pain intensity on VAS, were predicted by indirect aggression — and less so by neuroticism — in females and covert aggression in males (stepwise regression model). Patients reported far more extraintestinal somatic complaints than controls. Conclusion: Out of nine dimensions of hostility and five dimensions of personality, only neuroticism and concealed aggression are increased in FGD patients without psychiatric comorbidity compared with healthy controls. These personality traits influence pain reports and should be taken into account when evaluating and treating patients with FGD. Neuroticism and concealed aggression are most likely markers of vulnerability to FGD and not merely reflections of being chronic ill or explained by sample bias secondary to illness behavior.
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personality traits predict treatment outcome with an antidepressant in patients with Functional Gastrointestinal Disorder
Scandinavian Journal of Gastroenterology, 2000Co-Authors: Lars Tanum, Ulrik Fredrik MaltAbstract:Background: We investigated the relationship between personality traits and response to treatment with the tetracyclic antidepressant mianserin or placebo in patients with Functional Gastrointestinal Disorder (FGD) without psychopathology. Methods: Forty-eight patients completed the Buss-Durkee Hostility Inventory, Neuroticism Extroversion Openness -Personality Inventory (NEO-PI), and Eysenck Personality Questionnaire (EPQ), neuroticism + lie subscales, before they were consecutively allocated to a 7-week double-blind treatment study with mianserin or placebo. Treatment response to pain and target symptoms were recorded daily with the Visual Analogue Scale and Clinical Global Improvement Scale at every visit. Results: A low level of neuroticism and little concealed aggressiveness predicted treatment outcome with the antidepressant drug mianserin in non-psychiatric patients with FGD. Inversely, moderate to high neuroticism and marked concealed aggressiveness predicted poor response to treatment. These find...
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fenfluramine challenge test predicts outcome in pharmacological treatment of patients with Functional Gastrointestinal Disorder
Journal of Psychosomatic Research, 1999Co-Authors: Lars Tanum, Kari Bratveitjohansen, Ulrik Fredrik MaltAbstract:Abstract We investigated if response to the fenfluramine challenge test could predict outcome in 47 nonpsychiatric patients with chronic Functional Gastrointestinal Disorder (FGD) treated with mianserin, a drug closely related to mirtazepine, or placebo. Sixty milligrams of fenfluramine was given orally in the morning on nonfasting basis. Serum cortisol (COR) and prolactin (PRL) were analyzed at baseline, and after 120, 180, and 240 minutes. Patients were then randomized into a 7-week double-blind treatment trial with mianserin or placebo. Response to treatment with mianserin (76% vs.18% for placebo) was closely linked to a high increase in PRL and COR following a fenfluramine challenge test (positive predictive power=72%). Adding length of illness history increased both positive and negative predictive power to 92%. Our results indicate that the fenfluramine challenge test may be a potentially useful tool to identify nonpsychiatric subjects with FGD, who will most likely respond to treatment with a combined α2 and 5HT-2 and -3 antagonist.
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fenfluramine and idiopathic pain a serotonergic study in non psychiatric patients with Functional Gastrointestinal Disorder
Scandinavian Journal of Gastroenterology, 1998Co-Authors: Lars Tanum, Kari Bratveitjohansen, Ulrik Fredrik MaltAbstract:Background: We investigated prolactin and cortisol response to fenfluramine in non-psychiatric patients with chronic Functional Gastrointestinal Disorder (FGD). Methods: Sixty milligrams fenfluramine was given orally to 55 subjects without any DSM-III axis-1 psychopathology and 29 healthy control subjects matched for sex and age. Serum cortisol and prolactin levels were analysed at base line and after 120, 180, and 240 min. Results: Fenfluramine challenge induced an increase in mean prolactin and cortisol serum values in both patients and controls. Female patients showed lower base-line values of prolactin and higher delta values of cortisol than controls. Male patients and controls showed very uniform values for all variables. Length of illness history influenced delta cortisol values in both sexes. Conclusions: The cortisol and prolactin responses to fenfluramine suggest a psychobiologic gender difference with a possible stress-induced central serotonergic dysfunction in female patients but not in male ...
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a new pharmacologic treatment of Functional Gastrointestinal Disorder a double blind placebo controlled study with mianserin
Scandinavian Journal of Gastroenterology, 1996Co-Authors: Lars Tanum, Ulrik Fredrik MaltAbstract:Background: The efficacy of unselected monoamine reuptake inhibitors (tricyclic antidepressants) in the treatment of patients with Functional Gastrointestinal Disorders (FGD) has not been convincingly demonstrated. We investigated the efficacy of an antidepressant (mianserin) with a different receptor profile (combined 5-hydroxytryptamine-2 + 3 and alpha-2 antagonist) in FGD. Methods: After excluding patients with psychopathology and initial placebo responders from the study, eligible patients (n = 49) were randomized to 7 weeks of double-blind treatment with either mianserin, 120 mg/day, or placebo. Efficacy was assessed by using observer-completed ratings, the Global Improvement Scale, and patient self-ratings, Visual Analog Scale, and Disability Scales. Results: Patients taking mianserin reported less abdominal pain, symptoms of abdominal distress, and Functional disability than those given placebo (p < 0.001). The efficacy was significant across different lengths of illness periods and types of functi...
Stephen P. Pereira - One of the best experts on this subject based on the ideXlab platform.
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Systematic review: sphincter of Oddi dysfunction – non‐invasive diagnostic methods and long‐term outcome after endoscopic sphincterotomy
Alimentary pharmacology & therapeutics, 2006Co-Authors: S N Sgouros, Stephen P. PereiraAbstract:Summary Background Sphincter of Oddi dysfunction is a benign, Functional Gastrointestinal Disorder for which invasive endoscopic therapy with potential complications is often recommended. Aims To review the available evidence regarding the diagnostic accuracy of non-invasive methods that have been used to establish the diagnosis and to estimate the long-term outcome after endoscopic sphincterotomy. Methods A systematic review of English language articles and abstracts containing relevant terms was performed. Results Non-invasive diagnostic methods are limited by their low sensitivity and specificity, especially in patients with Type III sphincter of Oddi dysfunction. Secretin-stimulated magnetic resonance cholangiopancreatography appears to be useful in excluding other potential causes of symptoms, and morphine-provocated hepatobiliary scintigraphy also warrants further study. Approximately 85%, 69% and 37%, of patients with biliary Types I, II and III sphincter of Oddi dysfunction, respectively, experience sustained benefit after endoscopic sphincterotomy. In pancreatic sphincter of Oddi dysfunction, approximately 75% of patients report symptomatic improvement after pancreatic sphincterotomy, but the studies have been non-controlled and heterogeneous. Conclusions Patients with suspected sphincter of Oddi dysfunction, particularly those with biliary Type III, should be carefully evaluated before considering sphincter of Oddi manometry and endoscopic sphincterotomy. Further controlled trials are needed to justify the invasive management of patients with biliary Type III and pancreatic sphincter of Oddi dysfunction.
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systematic review sphincter of oddi dysfunction non invasive diagnostic methods and long term outcome after endoscopic sphincterotomy
Alimentary Pharmacology & Therapeutics, 2006Co-Authors: S N Sgouros, Stephen P. PereiraAbstract:Summary Background Sphincter of Oddi dysfunction is a benign, Functional Gastrointestinal Disorder for which invasive endoscopic therapy with potential complications is often recommended. Aims To review the available evidence regarding the diagnostic accuracy of non-invasive methods that have been used to establish the diagnosis and to estimate the long-term outcome after endoscopic sphincterotomy. Methods A systematic review of English language articles and abstracts containing relevant terms was performed. Results Non-invasive diagnostic methods are limited by their low sensitivity and specificity, especially in patients with Type III sphincter of Oddi dysfunction. Secretin-stimulated magnetic resonance cholangiopancreatography appears to be useful in excluding other potential causes of symptoms, and morphine-provocated hepatobiliary scintigraphy also warrants further study. Approximately 85%, 69% and 37%, of patients with biliary Types I, II and III sphincter of Oddi dysfunction, respectively, experience sustained benefit after endoscopic sphincterotomy. In pancreatic sphincter of Oddi dysfunction, approximately 75% of patients report symptomatic improvement after pancreatic sphincterotomy, but the studies have been non-controlled and heterogeneous. Conclusions Patients with suspected sphincter of Oddi dysfunction, particularly those with biliary Type III, should be carefully evaluated before considering sphincter of Oddi manometry and endoscopic sphincterotomy. Further controlled trials are needed to justify the invasive management of patients with biliary Type III and pancreatic sphincter of Oddi dysfunction.
Lars Tanum - One of the best experts on this subject based on the ideXlab platform.
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personality and physical symptoms in nonpsychiatric patients with Functional Gastrointestinal Disorder
Journal of Psychosomatic Research, 2001Co-Authors: Lars Tanum, Ulrik Fredrik MaltAbstract:Abstract Objective: We investigated the relationship between personality and reported pain and somatic distress in patients with Functional Gastrointestinal Disorder (FGD) without psychopathology. Methods: Fifty-six patients and 55 controls completed Buss–Durkee Hostility Inventory (BDHI), NEO Personality Inventory (NEO-PI), Eysenck Personality Questionnaire (EPQ: N+L scales), and Giessener Physical Complaints Checklist (GBB). Patients also completed McGill Pain Questionnaire (MPQ) and Visual Analogue Scale (VAS) for abdominal pain and target symptom (abdominal distress). Results: Patients displayed significantly higher levels of neuroticism and covert aggression than controls. Number of words chosen (NWC) to describe pain and sensory pain index (MPQ), but not pain intensity on VAS, were predicted by indirect aggression — and less so by neuroticism — in females and covert aggression in males (stepwise regression model). Patients reported far more extraintestinal somatic complaints than controls. Conclusion: Out of nine dimensions of hostility and five dimensions of personality, only neuroticism and concealed aggression are increased in FGD patients without psychiatric comorbidity compared with healthy controls. These personality traits influence pain reports and should be taken into account when evaluating and treating patients with FGD. Neuroticism and concealed aggression are most likely markers of vulnerability to FGD and not merely reflections of being chronic ill or explained by sample bias secondary to illness behavior.
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personality traits predict treatment outcome with an antidepressant in patients with Functional Gastrointestinal Disorder
Scandinavian Journal of Gastroenterology, 2000Co-Authors: Lars Tanum, Ulrik Fredrik MaltAbstract:Background: We investigated the relationship between personality traits and response to treatment with the tetracyclic antidepressant mianserin or placebo in patients with Functional Gastrointestinal Disorder (FGD) without psychopathology. Methods: Forty-eight patients completed the Buss-Durkee Hostility Inventory, Neuroticism Extroversion Openness -Personality Inventory (NEO-PI), and Eysenck Personality Questionnaire (EPQ), neuroticism + lie subscales, before they were consecutively allocated to a 7-week double-blind treatment study with mianserin or placebo. Treatment response to pain and target symptoms were recorded daily with the Visual Analogue Scale and Clinical Global Improvement Scale at every visit. Results: A low level of neuroticism and little concealed aggressiveness predicted treatment outcome with the antidepressant drug mianserin in non-psychiatric patients with FGD. Inversely, moderate to high neuroticism and marked concealed aggressiveness predicted poor response to treatment. These find...
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fenfluramine challenge test predicts outcome in pharmacological treatment of patients with Functional Gastrointestinal Disorder
Journal of Psychosomatic Research, 1999Co-Authors: Lars Tanum, Kari Bratveitjohansen, Ulrik Fredrik MaltAbstract:Abstract We investigated if response to the fenfluramine challenge test could predict outcome in 47 nonpsychiatric patients with chronic Functional Gastrointestinal Disorder (FGD) treated with mianserin, a drug closely related to mirtazepine, or placebo. Sixty milligrams of fenfluramine was given orally in the morning on nonfasting basis. Serum cortisol (COR) and prolactin (PRL) were analyzed at baseline, and after 120, 180, and 240 minutes. Patients were then randomized into a 7-week double-blind treatment trial with mianserin or placebo. Response to treatment with mianserin (76% vs.18% for placebo) was closely linked to a high increase in PRL and COR following a fenfluramine challenge test (positive predictive power=72%). Adding length of illness history increased both positive and negative predictive power to 92%. Our results indicate that the fenfluramine challenge test may be a potentially useful tool to identify nonpsychiatric subjects with FGD, who will most likely respond to treatment with a combined α2 and 5HT-2 and -3 antagonist.
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fenfluramine and idiopathic pain a serotonergic study in non psychiatric patients with Functional Gastrointestinal Disorder
Scandinavian Journal of Gastroenterology, 1998Co-Authors: Lars Tanum, Kari Bratveitjohansen, Ulrik Fredrik MaltAbstract:Background: We investigated prolactin and cortisol response to fenfluramine in non-psychiatric patients with chronic Functional Gastrointestinal Disorder (FGD). Methods: Sixty milligrams fenfluramine was given orally to 55 subjects without any DSM-III axis-1 psychopathology and 29 healthy control subjects matched for sex and age. Serum cortisol and prolactin levels were analysed at base line and after 120, 180, and 240 min. Results: Fenfluramine challenge induced an increase in mean prolactin and cortisol serum values in both patients and controls. Female patients showed lower base-line values of prolactin and higher delta values of cortisol than controls. Male patients and controls showed very uniform values for all variables. Length of illness history influenced delta cortisol values in both sexes. Conclusions: The cortisol and prolactin responses to fenfluramine suggest a psychobiologic gender difference with a possible stress-induced central serotonergic dysfunction in female patients but not in male ...
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a new pharmacologic treatment of Functional Gastrointestinal Disorder a double blind placebo controlled study with mianserin
Scandinavian Journal of Gastroenterology, 1996Co-Authors: Lars Tanum, Ulrik Fredrik MaltAbstract:Background: The efficacy of unselected monoamine reuptake inhibitors (tricyclic antidepressants) in the treatment of patients with Functional Gastrointestinal Disorders (FGD) has not been convincingly demonstrated. We investigated the efficacy of an antidepressant (mianserin) with a different receptor profile (combined 5-hydroxytryptamine-2 + 3 and alpha-2 antagonist) in FGD. Methods: After excluding patients with psychopathology and initial placebo responders from the study, eligible patients (n = 49) were randomized to 7 weeks of double-blind treatment with either mianserin, 120 mg/day, or placebo. Efficacy was assessed by using observer-completed ratings, the Global Improvement Scale, and patient self-ratings, Visual Analog Scale, and Disability Scales. Results: Patients taking mianserin reported less abdominal pain, symptoms of abdominal distress, and Functional disability than those given placebo (p < 0.001). The efficacy was significant across different lengths of illness periods and types of functi...
William E Whitehead - One of the best experts on this subject based on the ideXlab platform.
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rome foundation asian working team report asian Functional Gastrointestinal Disorder symptom clusters
Gut, 2018Co-Authors: Kewin Tien Ho Siah, Xiaorong Gong, Xi Jessie Yang, William E Whitehead, Minhu Chen, Xiaohua Hou, Nitesh Pratap, Uday C Ghoshal, Ari Fahrial Syam, Murdani AbdullahAbstract:Objective Functional Gastrointestinal Disorders (FGIDs) are diagnosed by the presence of a characteristic set of symptoms. However, the current criteria-based diagnostic approach is to some extent subjective and largely derived from observations in English-speaking Western patients. We aimed to identify latent symptom clusters in Asian patients with FGID. Design 1805 consecutive unselected patients with FGID who presented for primary or secondary care to 11 centres across Asia completed a cultural and linguistic adaptation of the Rome III Diagnostic Questionnaire that was translated to the local languages. Principal components factor analysis with varimax rotation was used to identify symptom clusters. Results Nine symptom clusters were identified, consisting of two oesophageal factors (F6: globus, odynophagia and dysphagia; F9: chest pain and heartburn), two gastroduodenal factors (F5: bloating, fullness, belching and flatulence; F8 regurgitation, nausea and vomiting), three bowel factors (F2: abdominal pain and diarrhoea; F3: meal-related bowel symptoms; F7: upper abdominal pain and constipation) and two anorectal factors (F1: anorectal pain and constipation; F4: diarrhoea, urgency and incontinence). Conclusion We found that the broad categorisation used both in clinical practice and in the Rome system, that is, broad anatomical divisions, and certain diagnoses with long historical records, that is, IBS with diarrhoea, and chronic constipation, are still valid in our Asian societies. In addition, we found a bowel symptom cluster with meal trigger and a gas cluster that suggests a different emphasis in our populations. Future studies to compare a non-Asian cohort and to match to putative pathophysiology will help to verify our findings.
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psychological treatments in Functional Gastrointestinal Disorders a primer for the gastroenterologist
Clinical Gastroenterology and Hepatology, 2013Co-Authors: Olafur S Palsson, William E WhiteheadAbstract:The Functional Gastrointestinal Disorders (FGIDs) often show inadequate response to usual medical care. Psychological treatments can help improve Functional Gastrointestinal Disorder patient outcomes, and such treatment should be considered for patients who have moderate or severe symptoms after 3–6 months of medical care and those whose symptoms are clearly exacerbated by stress or emotional symptoms. Effective psychological treatments, which are based on multiple randomized controlled trials, include cognitive behavioral therapy and hypnosis for irritable bowel syndrome and pediatric Functional abdominal pain, cognitive behavioral therapy for Functional chest pain, and biofeedback for dyssynergic constipation in adults. Successful referral by the gastroenterologist for psychological treatment is facilitated by educating the patient about the rationale for such treatment, reassurance about the diagnosis and continuation of medical care, firm doctor-patient therapeutic alliance, and identification of and communication with an appropriate psychological services provider.
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Definition of a responder in clinical trials for Functional Gastrointestinal Disorders: report on a symposium.
Gut, 1999Co-Authors: William E Whitehead, E Corazziari, R Prizont, J R Senior, W G Thompson, S J O Veldhuyzen Van ZantenAbstract:On 10 and 11 September 1998, about 125 participants met at a symposium in Vienna, Austria, with the goal of determining whether a consensus could be developed on the definition of responders in clinical trials in the Functional Gastrointestinal Disorders. Present at this meeting were representatives of the Food and Drug Administration (FDA) (Robert Prizont, MD, and John Senior, MD*), a representative of the Japanese International Motility Society (Kei Matsueda, MD, PhD), academic investigators from around the world, and representatives of several pharmaceutical companies currently engaged in the development of therapeutic compounds for the Functional Gastrointestinal Disorders. The discussion centered primarily on the irritable bowel syndrome (IBS), the Functional Gastrointestinal Disorder for which there is the largest development program underway. However, the discussion also addressed the measurement of outcomes in Functional constipation. This conference was sponsored by the Multinational Working Teams to Develop Diagnostic Criteria for Functional Gastrointestinal Disorders (MWT). Over a two year period, the executive committee of the MWT held a series of informal meetings with representatives of the FDA, and on one occasion, with a representative of the European Agency for the Evaluation of Medicinal Products. During these meetings, representatives of the regulatory groups indicated that there was a need for a more broad-based consensus on the best ways of defining responders in clinical trials. The MWT organized this conference …
Nicholas J. Talley - One of the best experts on this subject based on the ideXlab platform.
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the alignment of dietary intake and symptom reporting capture periods in studies assessing associations between food and Functional Gastrointestinal Disorder symptoms a systematic review
Nutrients, 2019Co-Authors: Kerith Duncanson, Tracy Burrows, Simon Keely, Michael D Potter, Gayatri Das, Marjorie M Walker, Nicholas J. TalleyAbstract:Food ingestion is heavily implicated in inducing symptoms of irritable bowel syndrome (IBS) and Functional dyspepsia (FD), which affect over one-third of adults in developed countries. The primary aim of this paper was to assess the alignment of dietary assessment and symptom-reporting capture periods in diet-related studies on IBS or FD in adults. Secondary aims were to compare the degree of alignment, validity of symptom-reporting tools and reported significant associations between food ingestion and symptoms. A five-database systematic literature search resulted in 40 included studies, from which data were extracted and collated. The food/diet and symptom capture periods matched exactly in 60% (n = 24/40) of studies, overlapped in 30% (n = 12/40) of studies and were not aligned in 10% (n = 4/40) of studies. Only 30% (n = 12/40) of studies that reported a significant association between food and global Gastrointestinal symptoms used a validated symptom-reporting tool. Of the thirty (75%) studies that reported at least one significant association between individual Gastrointestinal symptoms and dietary intake, only four (13%) used a validated symptom tool. Guidelines to ensure that validated symptom-reporting tools are matched with fit-for-purpose dietary assessment methods are needed to minimise discrepancies in the alignment of food and symptom tools, in order to progress Functional Gastrointestinal Disorder research.
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identification and validation of Functional Gastrointestinal Disorder subtypes using latent class analysis a population based study
Scandinavian Journal of Gastroenterology, 2018Co-Authors: Alan R Zinsmeister, Linda M Herrick, Yuri Saito A Loftus, Cathy D Schleck, Nicholas J. TalleyAbstract:Objective: Attempts to categorize distinct Functional Gastrointestinal Disorders based on reported symptoms continue but symptoms frequently overlap. The study objective was to use latent class ana...
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Functional nausea and vomiting.
Australian family physician, 2007Co-Authors: Nicholas J. TalleyAbstract:BACKGROUND There is a group of patients who have unexplained chronic nausea and/or vomiting. In the past these patients were labelled as having psychogenic vomiting. However, there is little evidence that such a condition exists. Rather, these patients usually have a Functional Gastrointestinal Disorder (Functional nausea and vomiting). OBJECTIVE This article describes the three important syndromes in adults that clinicians need to recognise: cyclic vomiting syndrome, Functional vomiting, and chronic idiopathic nausea. DISCUSSION Cyclic vomiting syndrome presents with stereotypical episodes of acute nausea and vomiting that may be severe. Patients are generally well between attacks. Cannabis use can cause a similar syndrome. Patients may respond to antimigraine therapy or low dose tricyclic antidepressant treatment. Functional vomiting is rare and presents with more frequent vomiting episodes. Rumination needs to be distinguished from Functional vomiting by careful history taking. Tricyclic antidepressants are also useful in Functional vomiting whether or not there is associated depression. Chronic idiopathic nausea refers to patients with bothersome nausea occurring several times a week usually not associated with vomiting. Its treatment is poorly defined but a trial of antidepressant therapy anecdotally can be helpful.
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aerophagia in children characterization of a Functional Gastrointestinal Disorder
Neurogastroenterology and Motility, 2005Co-Authors: Denesh K Chitkara, Albert J Bredenoord, M Wang, M J Rucker, Nicholas J. TalleyAbstract:The purpose of this study was to describe presenting symptoms, diagnostic testing, treatments and outcomes in a group of children with a diagnosis of aerophagia. A computerized diagnostic index was used to identify all children between the age of 1 and 17 years diagnosed with aerophagia at a tertiary care medical centre between 1975 and 2003. Individual medical charts were abstracted for information on the demographics, clinical features, co-morbid diagnoses, diagnostic work up and treatment of children with aerophagia. Information on presenting symptoms was also collected for a group of children who were retrospectively classified as having Functional dyspepsia for comparison (n = 40). Forty-five children had a diagnosis of aerophagia. The mean duration of symptoms in children with aerophagia was 16 +/- 5 months. The most common Gastrointestinal symptoms were abdominal pain, distention and frequent belching. Children with Functional dyspepsia had a higher prevalence of nausea, vomiting, abdominal pain and unintentional weight loss compared to children with aerophagia (all P < 0.05). In conclusion, aerophagia is a Disorder that is diagnosed in neurologically normal males and females, who can experience prolonged symptoms. Although many children with aerophagia present with upper Gastrointestinal symptoms, the Disorder appears to be distinct from Functional dyspepsia.
