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Clinical Gastroenterology and Hepatology
Volume 5, Issue 9, September 2007, Pages 1059-1064
doi:10.1016/j.cgh.2007.04.028
Copyright © 2007 AGA Institute Published by Elsevier Ltd.
Medical Presentation of Constipation From Childhood to Early Adulthood: A Population-Based Cohort Study
Denesh K. Chitkara, , , Nicholas J. Talley‡, G. Richard Locke III‡, Amy L. Weaver§, Slavica K. Katusic§, Heiko De Schepper‡ and Mary Jo Rucker
Background & Aims: Constipation is a common disorder in children and adults, but the role of gender and early life risk factors remains undefined. The aims of the study were as follows: (1) to estimate the incidence of medical presentation for constipation in a population-based birth cohort, and (2) to examine factors associated with constipation presentation from childhood to adulthood.
Methods: A birth cohort of all children born between 1976 and 1982 to mothers who were residents of Rochester, Minnesota, and who remained in the community until age 5 was used for this study. Medical visits for constipation were identified by diagnoses codes and chart review. Subjects were followed up based on their diagnoses accumulated while younger than 21 years old, and 80% of subjects remained in the area until 18 years of age.
Results: Of 5299 birth cohort members without constipation presentation before age 5, the overall age- and sex-adjusted incidence was 3.9 per 1000 person-years. A higher incidence for constipation in females occurred beginning at 13 years to early adulthood (rate ratio, 2.6 for 13–16 y and 4.2 for 17 to <21 y). Children with a diagnosis for constipation at younger than 5 years of age had a significantly higher incidence for subsequent medical visits for constipation through adolescence and early adulthood compared with the incidence rate of children without an early medical presentation (rate ratio, 4.5 for 5–8 y, 2.5 for 9–12 y, and 3.9 for 17–20 y).
Conclusions: Early medical presentation and female sex influence incident and repeat medical visits for constipation from childhood to early adulthood.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7GGW-4P5YK6F-1&_user=10&_coverDate=09%2F30%2F2007&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=317be6cbdd8c8dfa61789a841cbe1ce3
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Hepatogastroenterology. 2007 Jul-Aug;54(77):1403-6.
Factors affecting the technical difficulty of colonoscopy.
Oh SY, Sohn CI, Sung IK, Park DI, Kang MS, Yoo TW, Park JH, Kim HJ, Cho YK, Jeon WK, Kim BI.
Department of Internal Medicine, Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine, Seoul, Korea.
BACKGROUND/AIMS: Colonoscopy is a standard diagnostic tool for screening and surveillance of diseases affecting the colon. Colonoscopy may be painful for patients and difficult for the endoscopist. The aim of this study was to identify the factors affecting the technical difficulty of a colonoscopic examination and to predict potential difficult patients who will undergo colonoscopy.
METHODOLOGY: A total of 646 outpatients were consecutively included in this study. Patient's age and gender, body mass index (BMI), prior surgical history, and the duration and symptoms of irritable bowel syndrome (IBS) were recorded before the procedure. The quality of bowel preparation, the difficulty of examination reported by the colonoscopist, the degree of patient pain, the degree of pain as reported by an observer, cecal intubation time andcolonoscopic findings were assessed after the procedure.
RESULTS: We evaluated the difficulty of colonoscopy by cecal intubation time. Advanced age (>50 years), female gender, low BMI (< or = 23 Kg/m2), poor bowel preparation, prior surgical history, patient pain and the presence of IBS were associated with prolonged cecal intubation time. A multivariate logistic regression analysis demonstrated that advanced age, female gender, low BMI, poor bowel preparation and patient pain were independent factors related to prolonged cecal intubation time.
CONCLUSIONS: In patients with advanced age, female gender and low BMI, information that colonoscopy may be difficult and painful should be provided. If a colonoscopy is not absolutely indicated, barium enema or CT colonography may be performed as alternative diagnostic modalities.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17708264&ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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Rev Gastroenterol Mex. 2007 Jan-Mar;72(1):29-33.
Association of depression and anxiety in patients with irritable bowel syndrome
Cruz Ruíz MA, Ortíz Herrera RB, Muñiz Jurado D, Padierna Luna JL.
Gastroenterólogo adscrito Hospital General de Zona 4 IMSS, Celaya, Gto.
INTRODUCTION: The irritable bowel syndrome (SII) is characterized by alterations of intestinal motility and visceral sensibility, without organic cause. Is associated a psychiatric alterations and somatic symptoms in 80%, the anxiety or depression precede or is concomitants with gastrointestinal symptoms.
OBJECTIVE: To determine association between depression or anxiety on the basis of DSM-IV criteria and Scale of Hamilton in patients with criteria of Rome II.
DESIGN: A total one hundred patients were randomized in two groups: Hamilton for anxiety (n = 50) and DSM-IV for depression (n = 50), is correlated bi-variables (Pearson) in a descriptive and transversal study.
RESULTS: The female gender represented 76% (n = 76), the relation F/ M; 4:1, the age average 49.7 years (R 18-89). Group DSM-IV in 62% (n = 31) had depression and 54% (n = 27) were women. The group Hamilton in 58% (n = 29) presented anxiety and 50% were women (n = 25). The correlation of Pearson (P < 0.1) for the female with anxiety was of P < 0.05 and in depression of P < 0.01, using an IC 95%.
CONCLUSIONS: The manifestation of anxiety or depression appears in more of 50%, affects in greater proportion the female, reason why antidepressing therapy must be contemplated in the handling of the SII.
PMID: 17685197 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17685197&ordinalpos=10&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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World J Gastroenterol. 2007 Jul 21;13(27):3699-704.
Abnormal endogenous pain modulation and somatic and visceral hypersensitivity in female patients with irritable bowel syndrome.
Wilder-Smith CH, Robert-Yap J.
Brain-Gut Research Group, Bubenbergplatz 11, CH-3011 Berne, Switzerland.
AIM: To investigate the role of endogenous pain modulatory mechanisms in the central sensitization implicated by the visceral hypersensitivity demonstrated in patients with irritable bowel syndrome (IBS). Dysfunction of modulatory mechanisms would be expected to also result in changes of somatic sensory function.
METHODS: Endogenous pain modulatory mechanisms were assessed using heterotopic stimulation and somatic and visceral sensory testing in IBS. Pain intensities (visual analogue scale, VAS 0-100) during suprathreshold rectal distension with a barostat, cold pressor stimulation of the foot and during both stimuli simultaneously (heterotopic stimulation) were recorded in 40 female patients with IBS and 20 female healthy controls.
RESULTS: Rectal hypersensitivity (defined by 95% CI of controls) was seen in 21 (53%), somatic hypersensitivity in 22 (55%) and both rectal and somatic hypersensitivity in 14 of these IBS patients. Heterotopic stimulation decreased rectal pain intensity by 6 (-11 to -1) in controls, but increased rectal pain by 2 (-3 to +6) in all IBS patients (P < 0.05) and by 8 (-2 to +19) in IBS patients with somatic and visceral hypersensitivity (P < 0.02).
CONCLUSION: A majority of IBS patients had abnormal endogenous pain modulation and somatic hypersensitivity as evidence of central sensitization.
PMID: 17659729 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17659729&ordinalpos=23&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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Urology. 2007 Jul;70(1):16-8.
Prevalence of pelvic floor dysfunction in patients with interstitial cystitis.
Peters KM, Carrico DJ, Kalinowski SE, Ibrahim IA, Diokno AC.
Ministrelli Program for Urology Research and Education, Department of Urology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA.
OBJECTIVES: To evaluate the prevalence of pelvic floor dysfunction in women with interstitial cystitis (IC).
METHODS: Women with IC and pelvic pain were referred to the Beaumont Women's Initiative for Pelvic Pain and Sexual Health program. A comprehensive patient history and pelvic examination were completed by a certified women's health nurse practitioner.
RESULTS: Seventy women with a mean age of 45 years were evaluated. Of these 70 women 87% had levator pain consistent with pelvic floor dysfunction. The mean levator pain score was 4.48 out of 10. Nearly two thirds of these women (64%) had their pain for 5 years or more, whereas one quarter (24%) had their pain for 1 to 3 years. Half of the women reported irritable bowel syndrome, and more than one third (36%) reported urge urinary incontinence.
CONCLUSIONS: Women with IC may have pelvic floor dysfunction, as noted in this population in which 87% had levator pain upon examination. If pelvic floor dysfunction is diagnosed in IC patients, then therapy targeting the pelvic floor musculature may be considered as part of a multimodality approach to treating IC.
PMID: 17656199 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17656199&ordinalpos=24&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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J Korean Med Sci. 2007 Oct;22(5):851-4.
Irritable Bowel Syndrome Is More Common in Women Regardless of the Menstrual Phase: A Rome II-based Survey.
Lee SY, Kim JH, Sung IK, Park HS, Jin CJ, Choe WH, Kwon SY, Lee CH, Choi KW.
Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
Functional gastrointestinal disorders are more common in women in relation to the fluctuations of female sex hormones. We tried to know the gender-related differences in the prevalence of irritable bowel syndrome and gastrointestinal symptoms according to the menstrual phase.
A total of 253 women before menopause and 252 men below age 50 were examined by a gastroenterologist after completing the questionnaire. Blood tests, endoscopic procedures, and imaging studies were done, if needed. Women were subclassified into three groups according to their menst- ruation period; menstrual phase, proliferative phase, and secretory phase.
Finally, 179 men and 193 women were analyzed. Irritable bowel syndrome was more frequently noticed in women than in men (p=0.01). The diarrhea-dominant type was more common in men, while constipation-dominant or alternating types were more common in women (p<0.001). Of 193 women, there was no significant difference in their gastrointestinal symptoms according to their menstrual phase.
Regardless of the menstrual phase, gastrointestinal symptoms are more frequent in women. Physicians should consider different symptomatic manifestations between men and women should be considered when evaluating functional gastrointestinal disorders.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17982234&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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Am J Gastroenterol. 1998 Oct;93(10):1867-72.
The menstrual cycle and its effect on inflammatory bowel disease and irritable bowel syndrome: a prevalence study.
Kane SV, Sable K, Hanauer SB.
Department of Medicine, University of Chicago, Illinois 60637, USA.
OBJECTIVE: Female patients with bowel disease commonly report worsening symptoms in relation to the menstrual cycle. Our aim was to determine the nature of gastrointestinal symptoms correlating with the menstrual cycle in women with inflammatory and irritable bowel disease.
METHODS: This was a retrospective study involving 49 women with ulcerative colitis (UC), 49 women with Crohn's disease (CD), 46 women with irritable bowel syndrome (IBS), and 90 healthy community controls. Participants were interviewed using a questionnaire including information regarding general health, medication history, pregnancy, as well as premenstrual and menstrual symptoms. Chi2 testing and logistic regression modeling were used to test for differences in frequencies between groups and for risk analysis.
RESULTS: Premenstrual symptoms were reported by 93% of all women but statistically more often by patients with CD (p < 0.01). CD patients were also more likely to report increased gastrointestinal symptoms during menstruation ( < 0.01), diarrhea being the symptom reported most often. All disease groups had a cyclical pattern to their bowel habits significantly more than controls (p=0.01). Cyclical symptoms included diarrhea, abdominal pain, and constipation. Logistic regression revealed an odds ratio (OR) of 1.1 (95% CI 0.9-1.2) for experiencing bowel symptoms during the premenstrual and menstrual phases and an OR of 2.0 (95% CI 1.2-3.2) for experiencing a cyclical pattern in bowel habit changes in women with bowel disease.
CONCLUSION: The prevalence of menstrually related symptoms is high, and appears to affect bowel patterns. The physiological and clinical effects of the menstrual cycle should be taken into consideration when assessing for disease activity.
PMID: 9772046 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=9772046&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus
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Acupunct Med. 2008 Mar;26(1):33-45.
Is it all about sex? Acupuncture for the treatment of pain from a biological and gender perspective.
Lund I, Lundeberg T.
Pain is a unique personal experience showing variability where gender and sex related effects might contribute. The mechanisms underlying the differences between women and men are currently unknown but are likely to be complex and involving interactions between biological, sociocultural and psychological aspects.
In women, painful experimental stimuli are generally reported to produce a greater intensity of pain than in men. Clinical pain is often reported with higher severity and frequency, longer duration, and present in a greater number of body regions in women than in men.
Women are also more likely to experience a number of painful conditions such as fibromyalgia, temporomandibular dysfunction, migraine, rheumatoid arthritis and irritable bowel syndrome. With regard to biological factors, quantitative as well as qualitative differences in the endogenous pain inhibitory systems have been implicated, as well as an influence of gonadal hormones. Psychosocial factors like sex role beliefs, pain coping strategies, and pain related expectancies may also contribute to the differences.
Being exposed to repeated painful visceral events (eg menses, labour) during life may contribute to an increased sensitivity to, and greater prevalence of, pain among women. When assessing the outcome of pharmacological and non-pharmacological therapies in pain treatment, the factors of gender and sex should be taken into account as the response to an intervention may differ.
Preferably, treatment recommendations should be based on studies using both women and men as the norm. Due to variability in results, findings from animal studies and experiments in healthy subjects should be interpreted with care.
PMID: 18356797 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/18356797?ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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Twin Res Hum Genet. 2008 Apr;11(2):197-203.
No evidence of sex differences in heritability of irritable bowel syndrome in Swedish twins.
Svedberg P, Johansson S, Wallander MA, Pedersen NL.
1 Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Abstract Studies have shown that familial aggregation is of importance for abdominal symptoms including irritable bowel syndrome and there are a few reports of a moderate heritability for irritable bowel syndrome.
Sex differences in prevalence and incidence of irritable bowel syndrome have been demonstrated however less is known about sex differences in heritability. The objective was to investigate whether there were sex differences in heritability of irritable bowel syndrome while accounting for different prevalences among women and men in different age groups.
A sample of 45,750 Swedish twins, whereof 16,961 were complete twin pairs, participated in a telephone interview. The sample was divided into three age groups (40-54, 55-64 and 65 years and older) and the diagnosis of irritable bowel syndrome was operationally defined with a number of disorder specific symptoms.
Standard biometrical model fitting analyses were conducted using raw ordinal data from same-sex and opposite-sex twins. The prevalence of irritable bowel syndrome was greater among women than men and more prevalent at younger ages (e.g., women 10.3%, men 6.3% at ages 40-54 years vs. women 6.1%, men 4% at ages over 65 years).
The heritability of the disorder was approximately 25% in all age groups. We found no evidence for sex differences in heritability in any of the age groups, however, models allowing prevalences of irritable bowel syndrome to differ between sexes and age groups fitted best.
PMID: 18361721 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/pubmed/18361721?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
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Biol Psychol. 2010 Mar 1.
Gender-related differences in prepulse inhibition of startle in irritable bowel syndrome (IBS).
Kilpatrick LA, Ornitz E, Ibrahimovic H, Treanor M, Craske M, Nazarian M, Mayer EA, Naliboff BD.
Center for Neurobiology of Stress, David Geffen School of Medicine, UCLA, United States; Department of Medicine and Physiology, Division of Digestive Diseases, David Geffen School of Medicine, UCLA, United States.
Alterations in central networks involved in the regulation of arousal, attention, and cognition may be critical for irritable bowel syndrome (IBS) symptom maintenance and exacerbation.
Differential sensitivities in these networks may underlie sex differences noted in IBS. The current study examined prepulse inhibition (PPI), a measure of sensorimotor gating, in male and female IBS patients.
Relationships between PPI and symptom severity were examined, as well as potential menstrual status effects.
Compared to healthy controls, male IBS patients had significantly reduced PPI; whereas female IBS patients (particularly naturally cycling women) had significantly enhanced PPI suggesting hypervigilance.
Considering previously demonstrated sex-related differences in perceptual and brain imaging findings in IBS patients, the current findings suggest that different neurobiological mechanisms underlie symptom presentation in male and female IBS patients.
Compromised filtering of information in male IBS patients may be due to compromised top down (prefrontal, midcingulate) control mechanisms while increased attention to threat due to increased limbic and paralimbic circuits may be characteristic of female IBS patients. Copyright © 2010. Published by Elsevier B.V.
PMID: 20193731 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/20193731
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