Correlation between percentage of lower esophageal sphincter relaxation and response of technetium...
1
822 HYPNOSIS HOME TREATMENT FOR IRRITABLE BOWEL SYNDROME (IBS): EXPLORATORY STUDY Olafur S. Palsson, Psy.D., William E. Whitehead, Ph.D.*, Marsha J. Turner, MEd. University of North Carolina, Chapel Hill, NC. Purpose: Gut-directed hypnosis often improves IBS, but its reliance on specialized therapists and the costs of multiple treatment visits keep it unavailable to most patients. We previously found in two studies (Dig Dis Sci 2002;47:2605–2614) that a standardized protocol using verbatim hyp- nosis scripts improves all central IBS symptoms in the majority of treated patients. This study aimed to assess the effectiveness of a previously standardized hypnosis protocol in reducing IBS symptoms and improving quality of life (QOL) and psychological well-being, when used at home without a therapist, compared to standard medical treatment. Methods: Nineteen IBS patients (Rome II criteria physician diagnosis; mean age 43.1 years; 15 females) completed a 3-month hypnosis home treatment course via audio compact disc recordings (7 biweekly 30 – 40 min. sessions plus daily 13 min. session). All instructions and symptom assessments were completed through mail and the internet, and included the validated IBS Severity Index (IBSS; Aliment Pharmacol Ther 1997; 11:395– 402), Brief Symptom Inventory -18 (BSI-18; NCS Pearson, Inc.) and IBS-QOL (Dig Dis Sci 1998;43:400 –11) before and after treatment, and IBSS and IBS-QOL at 3- and 6-month follow-up. Controls were 57 Rome II IBS patients from a separate study, age and gender matched (3 to1 matching) and identical in mean IBS severity to the hypnosis subjects. The controls completed the same outcome measures as the hypnosis subjects 6 months apart but received only standard medical care. Results: Ten of 19 hypnosis subjects (53%) responded to treatment by 3-month follow-up (judged by a stringent criterion of 50% reduction in IBS symptom severity) vs. 15/57 (26%) of controls (Chi-square p.05). Hypnosis subjects improved more in their QOL scores compared to con- trols (p.0001). Anxiety scores, but not other psychological variables, were higher in hypnosis non-responders than in responders prior to treat- ment, and predicted poor outcome: 1/7 anxious (BSI anxiety score 5) vs. 9/12 non-anxious subjects were responders. BSI somatization improved in hypnosis responders (p.05), but no BSI changes were seen in non-responders or controls. All treatment responders remained improved at 6-month follow-up. Conclusions: These preliminary findings suggest that hypnosis audio home treatment may be useful in IBS management, perhaps doubling the pro- portion of patients improving across 6 months, and warrants further re- search in light of its low cost and wide potential applicability. It mostly benefits non-anxious patients. 823 CORRELATION BETWEEN PERCENTAGE OF LOWER ESOPHAGEAL SPHINCTER RELAXATION AND RESPONSE OF TECHNETIUM ESOPHAGEAL TRANSIT TIME TO ISORDIL IN IDIOPATHIC ACHALASIA Leonel Rodriguez, M.D., Marc Fiorillo, M.D., Lawrence Brandt, M.D., Aaron Tokayer, M.D.* Montefiore Medical Center, Bronx, NY. Purpose: Achalasia is an uncommon esophageal motor disorder, best characterized by manometric findings of aperistalsis of the body of the esophagus and incomplete relaxation of the lower esophageal sphincter (LES) on swallowing. Others have used the technetium esophageal transit time (tETT) as an alternative or correlative method for evaluating achalasia. We used isordil to enhance the accuracy of the tETT. The aim of this study was to determine the correlation between the percentage of LES relaxation and the percentage of change on tETT before and after the use of isordil. Methods: This study included 31 patients with newly diagnosed idiopathic achalasia who underwent clinical evaluation and esophageal manometry by which the percentage of LES relaxation was established. The patients then underwent a tETT with water at baseline. A tETT was repeated after the administration of 5 mg of isordil. The percentage of response to isordil was assessed by the difference in time between the two tETT studies performed. Results: A total of 31 patients were studied (18 female and 13 male), with a mean age of 49.3 yr (range 20 – 88 yr). The mean percentage of LES relaxation was 44.52 % and the mean percentage of tETT response to isordil was 49.23%. Data were analyzed in a two-tailed correlation study, showing a positive correlation between the percentage of LES relaxation and the percentage of improvement of tETT after isordil; Pearson’s cor- relation coefficient was 0.452 and p0.011. Conclusions: Our study showed that the tETT response to isordil correlates with the percentage of LES relaxation, and could be used as an adjunct to the evaluation of patients with achalasia. Further studies are needed to evaluate its role in predicting the response of achalasia to medical therapy and interventional treatments. 824 ROME II FUNCTIONAL VOMITING IS NOT ASSOCIATED WITH PSYCHOLOGICAL DISTURBANCE Kevin Olden, M.D., FACG, Teresa Radam, Michael Crowell, Ph.D., FACG* Mayo Clinic Scottsdale, Scottsdale, AZ. Purpose: Functional vomiting (FV) is a poorly understood disorder. Di- agnostic criteria have been proposed by the Rome II working teams. However, the relationship between psychological disturbance and FV by Rome II criteria has never been systematically studied. The purpose of this study is to determine the presence of psychologic disturbance as measured by the SCL-90-R in patients presenting with FV by Rome II criteria compared to historic controls and patients with vomiting due to structural abnormalities (SA). Methods: Forty-nine subjects seen for FV were studied. All subjects had negative EGD, SBPT, BE, Head imaging, HCG (females) and abdominal CT. All patients completed the Rome II bowel disease questionnaire to exclude other functional bowel disorders and to confirm the diagnosis of FV. All subjects (N49) as well as 13 controls with SA induced vomiting completed the SCL-90-R, a validated measure of psychological distress. Results: SCL-90-R scores normalized to historic controls were elevated for the somatization (T-score 71 19 vs 65 24) and depression (67 22 vs 61 22). These subscales were elevated in both the FV and the SA patients. Subjects with FV did not differ significantly from those with structural vomiting on any of the 9 subscales or the global symptom index of the SCL-90-R. Conclusions: FV by Rome II criteria was not associated with psychologic disturbance compared to patients with structural causes of chronic vomit- ing. Patients with chronic vomiting (3 mo) due either to structural or functional etiologies had a tendency to have elevated scores on the som- atization and the depression scales of the SCL-90-R compared to historic controls used to validate the SCL-90-R but these elevations were not statistically significant. The term functional vomiting as proposed by the Rome working teams would seem to be preferable to the older, technically incorrect term “psychogenic vomiting.” 825 PREVALENCE OF GI RELATED SURGICAL PROCEDURES AMONG MEDICAID ELIGIBLE PATIENTS WITH AND WITHOUT IRRITABLE BOWEL SYNDROME Rahul Ganguly, Ph.D., Victoria Barghout, M.S.P.H., Sandhya Pannicker, B.Pharm., Bradley C. Martin, Ph.D.* The University of Mississippi, Oxford, MS; Novartis Pharmaceutical Corporation, East Hanover, NJ and The University of Georgia, Athens, GA. Purpose: To estimate the prevalence of GI related surgical procedures among Medicaid eligible IBS patients and compare it with a matched group not having IBS. S274 Abstracts AJG – Vol. 98, No. 9, Suppl., 2003
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Transcript of Correlation between percentage of lower esophageal sphincter relaxation and response of technetium...
822
HYPNOSIS HOME TREATMENT FOR IRRITABLE BOWELSYNDROME (IBS): EXPLORATORY STUDYOlafur S. Palsson, Psy.D., William E. Whitehead, Ph.D.*,Marsha J. Turner, MEd. University of North Carolina, Chapel Hill,NC.
Purpose: Gut-directed hypnosis often improves IBS, but its reliance onspecialized therapists and the costs of multiple treatment visits keep itunavailable to most patients. We previously found in two studies (Dig DisSci 2002;47:2605–2614) that a standardized protocol using verbatim hyp-nosis scripts improves all central IBS symptoms in the majority of treatedpatients. This study aimed to assess the effectiveness of a previouslystandardized hypnosis protocol in reducing IBS symptoms and improvingquality of life (QOL) and psychological well-being, when used at homewithout a therapist, compared to standard medical treatment.Methods: Nineteen IBS patients (Rome II criteria � physician diagnosis;mean age 43.1 years; 15 females) completed a 3-month hypnosis hometreatment course via audio compact disc recordings (7 biweekly 30–40min. sessions plus daily 13 min. session). All instructions and symptomassessments were completed through mail and the internet, and includedthe validated IBS Severity Index (IBSS; Aliment Pharmacol Ther 1997;11:395–402), Brief Symptom Inventory -18 (BSI-18; NCS Pearson, Inc.)and IBS-QOL (Dig Dis Sci 1998;43:400–11) before and after treatment,and IBSS and IBS-QOL at 3- and 6-month follow-up. Controls were 57Rome II IBS patients from a separate study, age and gender matched (3 to1matching) and identical in mean IBS severity to the hypnosis subjects. Thecontrols completed the same outcome measures as the hypnosis subjects 6months apart but received only standard medical care.Results: Ten of 19 hypnosis subjects (53%) responded to treatment by3-month follow-up (judged by a stringent criterion of �� 50% reduction inIBS symptom severity) vs. 15/57 (26%) of controls (Chi-square p�.05).Hypnosis subjects improved more in their QOL scores compared to con-trols (p�.0001). Anxiety scores, but not other psychological variables,were higher in hypnosis non-responders than in responders prior to treat-ment, and predicted poor outcome: 1/7 anxious (BSI anxiety score �� 5)vs. 9/12 non-anxious subjects were responders. BSI somatization improvedin hypnosis responders (p�.�05), but no BSI changes were seen innon-responders or controls. All treatment responders remained improved at6-month follow-up.Conclusions: These preliminary findings suggest that hypnosis audio hometreatment may be useful in IBS management, perhaps doubling the pro-portion of patients improving across 6 months, and warrants further re-search in light of its low cost and wide potential applicability. It mostlybenefits non-anxious patients.
823
CORRELATION BETWEEN PERCENTAGE OF LOWERESOPHAGEAL SPHINCTER RELAXATION AND RESPONSEOF TECHNETIUM ESOPHAGEAL TRANSIT TIME TOISORDIL IN IDIOPATHIC ACHALASIALeonel Rodriguez, M.D., Marc Fiorillo, M.D., Lawrence Brandt, M.D.,Aaron Tokayer, M.D.* Montefiore Medical Center, Bronx, NY.
Purpose: Achalasia is an uncommon esophageal motor disorder, bestcharacterized by manometric findings of aperistalsis of the body of theesophagus and incomplete relaxation of the lower esophageal sphincter(LES) on swallowing. Others have used the technetium esophageal transittime (tETT) as an alternative or correlative method for evaluating achalasia.We used isordil to enhance the accuracy of the tETT. The aim of this studywas to determine the correlation between the percentage of LES relaxationand the percentage of change on tETT before and after the use of isordil.Methods: This study included 31 patients with newly diagnosed idiopathicachalasia who underwent clinical evaluation and esophageal manometry bywhich the percentage of LES relaxation was established. The patients thenunderwent a tETT with water at baseline. A tETT was repeated after the
administration of 5 mg of isordil. The percentage of response to isordil wasassessed by the difference in time between the two tETT studies performed.Results: A total of 31 patients were studied (18 female and 13 male), witha mean age of 49.3 yr (range 20–88 yr). The mean percentage of LESrelaxation was 44.52 % and the mean percentage of tETT response toisordil was 49.23%. Data were analyzed in a two-tailed correlation study,showing a positive correlation between the percentage of LES relaxationand the percentage of improvement of tETT after isordil; Pearson’s cor-relation coefficient was 0.452 and p�0.011.Conclusions: Our study showed that the tETT response to isordil correlateswith the percentage of LES relaxation, and could be used as an adjunct tothe evaluation of patients with achalasia. Further studies are needed toevaluate its role in predicting the response of achalasia to medical therapyand interventional treatments.
824
ROME II FUNCTIONAL VOMITING IS NOT ASSOCIATEDWITH PSYCHOLOGICAL DISTURBANCEKevin Olden, M.D., FACG, Teresa Radam,Michael Crowell, Ph.D., FACG* Mayo Clinic Scottsdale, Scottsdale,AZ.
Purpose: Functional vomiting (FV) is a poorly understood disorder. Di-agnostic criteria have been proposed by the Rome II working teams.However, the relationship between psychological disturbance and FV byRome II criteria has never been systematically studied. The purpose of thisstudy is to determine the presence of psychologic disturbance as measuredby the SCL-90-R in patients presenting with FV by Rome II criteriacompared to historic controls and patients with vomiting due to structuralabnormalities (SA).Methods: Forty-nine subjects seen for FV were studied. All subjects hadnegative EGD, SBPT, BE, Head imaging, HCG (females) and abdominalCT. All patients completed the Rome II bowel disease questionnaire toexclude other functional bowel disorders and to confirm the diagnosis ofFV. All subjects (N�49) as well as 13 controls with SA induced vomitingcompleted the SCL-90-R, a validated measure of psychological distress.Results: SCL-90-R scores normalized to historic controls were elevated forthe somatization (T-score � 71 � 19 vs 65 � 24) and depression (67 � 22vs 61 � 22). These subscales were elevated in both the FV and the SApatients. Subjects with FV did not differ significantly from those withstructural vomiting on any of the 9 subscales or the global symptom indexof the SCL-90-R.Conclusions: FV by Rome II criteria was not associated with psychologicdisturbance compared to patients with structural causes of chronic vomit-ing. Patients with chronic vomiting (�3 mo) due either to structural orfunctional etiologies had a tendency to have elevated scores on the som-atization and the depression scales of the SCL-90-R compared to historiccontrols used to validate the SCL-90-R but these elevations were notstatistically significant. The term functional vomiting as proposed by theRome working teams would seem to be preferable to the older, technicallyincorrect term “psychogenic vomiting.”
825
PREVALENCE OF GI RELATED SURGICAL PROCEDURESAMONG MEDICAID ELIGIBLE PATIENTS WITH ANDWITHOUT IRRITABLE BOWEL SYNDROMERahul Ganguly, Ph.D., Victoria Barghout, M.S.P.H.,Sandhya Pannicker, B.Pharm., Bradley C. Martin, Ph.D.* TheUniversity of Mississippi, Oxford, MS; Novartis PharmaceuticalCorporation, East Hanover, NJ and The University of Georgia, Athens,GA.
Purpose: To estimate the prevalence of GI related surgical proceduresamong Medicaid eligible IBS patients and compare it with a matched groupnot having IBS.
S274 Abstracts AJG – Vol. 98, No. 9, Suppl., 2003
