[Psychometric Evaluation of the Union Physio-Psycho-Social Assessment Questionnaire].

Objective To validate the Union Physio-Psycho-Social Assessment Questionnaire(UPPSAQ-70)and test its validity and reliability.Methods From April,2013 to July,2018,patients were asked to finish the computer evaluation of UPPSAQ-70 and Symptom Checklist 90(SCL-90)in Peking Union Medical College Hospital(PUMCH).Confirmatory factor analysis(CFA)was conducted on the SPSS 17.0,and the number of fixed factors was 8 factors and 3 factors.Amos 23.0 was used to verify the original 8-factor model,8-factor revision model,3-factor model,3-factor revision model,and single-factor model.Each factor of SCL-90 was used as the calibration standard to calculate the correlation coefficient between factors.The retest reliability was tested by the outpatients in PUMCH in July,2018.Results Exploratory factor analysis indicated that the 8-factor revised model included:depression,anxiety and fatigue,sleep,physical discomfort,sexual function,happiness and satisfaction,hypochondria,and social anxiety.The 3 factors revised model included that:psychological,physiological and social dimension.Confirmatory factor analysis indicated that the 8-factor modified model was superior to the 3-factor model and the single-factor model: χ 2=10 410.4,df=1862,RMSEA=0.07,CFI=0.753,and NFI=0.715.With SCL-90 as the standard criteria,except the low correlation coefficient between emotional scale and depression(r=0.600)and anxiety(r=0.520),the correlation coefficients of other symptoms were below 0.5.The chronbach's α between each factor and total score of UPPSAQ-70 was between 0.823 and 0.904,and the Chronbach's α coefficient of the whole scale was between 0.954 and 0.956 after each item was deleted.The retest reliability of the scale of 32 participants Chronbach's α was 0.847.Each item of the scale measured between one week was significantly correlated(P<0.05). Conclusion UPPSAQ-70 is a good scale for evaluating overall health status and is especially feasible in general hospitals.

Temperature can influence gastric accommodation and sensitivity in functional dyspepsia with epigastric pain syndrome.

BACKGROUND: Functional dyspepsia-epigastric pain syndrome (FD-EPS) is characterized pathophysiologically by visceral hypersensitivity, but the effect of the temperature stimulation on gastric function has been seldom studied. AIM: The purpose of this study was to investigate the effects of liquid nutrients at different temperatures on the gastric accommodation, sensitivity, and gastric-wall compliance of healthy subjects (HS) and FD-EPS patients. METHODS: Ten FD-EPS patients (Roma III criteria) and ten HS were recruited into the study. Intragastric pressure (IGP) and gastric perfusion were measured and compared following the administration of liquid nutrients at 37 °C on day 1 and at 8 °C on day 2. RESULTS: Seven patients developed abdominal discomfort or abdominal pain after being given cold liquid nutrient. The administration of liquid nutrient at 8 °C resulted in an increase of IGP in HS (P=0.044), a significant decrease in gastric perfusion (P<0.0001), a marked increase in IGP (P=0.015), and a dramatic reduction in gastric wall compliance (P=0.012) in patients compared to the effects of liquid nutrient at 37 °C. In addition, IGP in patients was lower than that in HS at 37 °C liquid nutrient (P=0.036), and the gastric perfusion volume in patients at maximal satiety was also significantly reduced at 8 °C liquid nutrient compared with HS (P=0.017). CONCLUSIONS: Cold stimulation can increase the IGP in HS and FD-EPS patients, elevate the visceral sensitivity and reduce the gastric volume of FD-EPS patients. FD-EPS patients who are sensitive to cold may develop epigastric discomfort or pain.

[Therapeutic mechanism of diaphragm training at different periods in patients with gastroesophageal reflux disease].

OBJECTIVE: To explore the effects of postprandial diaphragm training (DT) on esophageal acid exposure, esophageal motility and proximal gastric volume at different postprandial periods in patients with gastroesophageal reflux disease (GERD). METHODS: Thirty GERD patients and 9 healthy subjects (HS) with matched demographic characteristics were enrolled from June 2005 to June 2006 at Peking Union Medical College Hospital. Esophageal manometry with a Dent sleeve catheter and simultaneous esophageal pH monitoring were recorded in a 30-min fasting period and a 120-min postprandial period. The GERD patients were divided into 3 groups: 9 patients received diaphragm training at 1(st) hour after meal (group DT1 h) and another 10 at 2(nd) hour after meal (group DT2 h) whereas no diaphragm training after meal in 11 (group NDT). Ultrasonic imaging of proximal gastric volume was undertaken at 0, 30, 60, 90 and 120 min after meal. RESULTS: (1) The percentage time with pH<4 in group DT1 h was lower than that in group NDT in the 120-min postprandial period (0.2% (0-4.1%), 6.6% (2.2%-18.2%), P < 0.05) and no significant difference of esophageal acid exposure was observed between groups DT2 h and NDT (3.7% (0.1%-17.8%), 6.6% (2.2%-18.2%), P > 0.05) . (2) Esophagogastric junction (EGJ) and crural diaphragm pressures at the 1(st) hour after meal in group DT1 h were both significantly higher than those in group NDT during diaphragm training ((44.4 ± 8.1) vs(16.2 ± 4.5) mm Hg, (38.2 ± 4.2) vs (9.8 ± 4.5) mm Hg, 1 mm Hg = 0.133 kPa, both P < 0.05). EGJ and crural diaphragm pressures at the 2(nd) hour after meal in group DT2 h were significantly higher than those in group N-DT during diaphragm training ((53.2 ± 7.5) vs (14.0 ± 3.7) mm Hg, (48.2 ± 6.3) vs (8.9 ± 2.7) mm Hg, both P < 0.05). There was no change of lower esophageal sphincter pressure (all P > 0.05). (3) After test meal, the groups DT1 h, DT2 h and N-DT had similar proximal stomach volume (all P > 0.05). CONCLUSIONS: Diaphragm training at the 1(st) hour after meal might reduce the 120-min postprandial esophageal acid exposure in GERD patients. The reduction in esophageal acid exposure may result from enhanced antireflux barrier of EGJ function. Therefore postprandial diaphragm training provides a new approach to conservative treatment of GERD.

[Symptomatic features and psychosocial factors in patients with belching disorders].

OBJECTIVE: To explore the symptomatic features and psychosocial factors in patients with belching disorders. METHODS: At Peking Union Medical College Hospital Outpatient Clinic from September 2010 to January 2011, 21 consecutive patients with repetitive belching were profiled by symptom questionnaires, including general demographics, spectrum of symptoms, disease course, predisposing factors, previous treatment, psychosocial factors, mental status and personality traits, etc. Pearson's correlation analysis and exact probability were used. RESULTS: Among them, 20 patients fulfilled the Rome III criteria of belching disorders. There were 5 males and 15 females with an age range of (49 ± 10) years. Among them, the belching patterns were daily (n = 18), meal-related (n = 16), spontaneous (n = 15), controllable (n = 16) and symptomatic overlapping (n = 17). The most common symptoms were functional dyspepsia (FD) (n = 13) and gastroesophageal reflux disease (GERD) (n = 11). Sixteen patients experienced mental stimulation/negative events and 13 patients were related to family tension, work stress and overwork. There were 12 patients with anxiety and/or depression and 8 with neurotic personality. The number of overlapping symptoms was related to anxiety states (r = 0.47, t = 2.14, P < 0.05). But the severity of belching was unrelated to with or without depression and anxiety state (P = 0.096). CONCLUSIONS: There are a variety of clinical manifestations in patients with belching disorders. Belching disorders is often related to emotional change and environmental stress and accompanied by abnormal mental and personality characteristics. Belching may be an abnormal behavior reaction to gastrointestinal discomfort symptoms. The psychological and social factors probably play an important role in the pathogenesis of belching disorders.

[Multi-centered stratified clinical studies for psychological and sleeping status in patients with chronic constipation in China].

OBJECTIVE: To survey the emotional and sleeping status of patients with chronic constipation (CC) and analyze the relationship between psychological status and constipated symptoms. METHODS: From January 2009 to April 2010, 5 centers and 25 stratified hospitals were selected as the representatives of different regions of mainland China. The CC questionnaires including constipated symptoms, emotional and sleeping status, previous treatments and self-reported impact of constipation on health status, etc. Questionnaires were completed by well-trained physicians or investigators during face-to-face interviews. CC was diagnosed in accordance with the Rome III criteria. RESULTS: A total of 909 valid questionnaires analyzed. There were 258 males and 651 females with a mean age of (49 ± 19) years. 41.5% (377 cases) reported "tense feelings" and 38.3% (348 cases) "felt downcast" over the past 3 months. The patients feeling tense and(or) downcast "frequently" and "most of time" were around 11.3% (103 cases) and 9.4% (85 cases). And 43.8% (398 cases) patients reported sleeping disorders over the past 3 months. Regional differences existed in the comorbidities of psychological and sleeping disorders in CC patients, especially in those from tertiary hospitals. And it was the highest in Beijing area for tense feelings and downcast. The sleeping disorders were the most common in the patients from secondary hospitals, of which 66.1% (37/56) and 65.0% (39/60) were from Wuhan and Xi'an respectively. They were higher than Beijing and Guangzhou (39.7% (23/58), 29.0% (9/31), all P = 0.001). The patients from rural primary clinics suffered more sleeping disorders than those from urban primary cares (P = 0.026). About 35.0% (318 cases) and 28.4% (258 cases) patients reported their constipation was related with emotional and sleeping disorders. The comorbidities of psychological and sleeping disorders were more common in severe constipated patients than mild and moderate counterparts and resulted in more hospital visits (both P = 0.000). CONCLUSIONS: The CC patients often have the comorbidities of psychological and sleeping disorders with regional differences. The patients from the hospitals at various levels may present different spectrums of comorbidities of psychological and sleeping disorders. And the severity of CC influences the moods, sleeps and hospital visits.

[Clinical application of high resolution manometry for examining esophageal function in neonates].

OBJECTIVE: To examine the esophageal function of neonates by high resolution manometry (HRM), and to provide preliminary data for research on the esophageal function of neonates. METHODS: Esophageal HRM was performed on neonates using a solid-state pressure measurement system with 36 circumference sensors arranged at intervals of 0.75 cm, and ManoView software was used to analyze esophageal peristalsis pattern. RESULTS: Esophageal HRM was performed successfully in 11 neonates, and 126 occurrences of complete esophageal peristalsis were recorded. Complete esophageal peristalsis with pressure increase was recorded in some neonates but most neonates showed a different esophageal peristalsis pattern compared with adults. Some neonates had no relaxation of the upper esophageal sphincter (UES) when pharyngeal muscles contracted in swallowing, some neonates had multiple swallowing without esophageal peristalsis and some neonates had relatively low pressure of esophageal peristalsis. Full-term infants could have relatively low UES pressure and esophageal sphincter (LES) pressure but some preterm infants showed relatively high UES pressure and LES pressure. Longitudinal contraction of the whole esophagus and elevation of LES after swallowing were recorded in some neonates. CONCLUSIONS: Esophageal HRM is safe and tolerable for neonates. HRM shows that esophageal peristalsis after swallowing may not occur or may be incomplete in neonates. The esophageal function of neonates has not yet been developed completely, with large individual differences in esophageal peristalsis. Large sample data are needed for further analysis and research on the esophageal function of neonates.

Are bowel symptoms and psychosocial features different in irritable bowel syndrome patients with abdominal discomfort compared to abdominal pain?

BACKGROUND: The Rome IV criteria eliminated abdominal discomfort for irritable bowel syndrome (IBS), which was previously included in Rome III. There are questions as to whether IBS patients with abdominal discomfort (seen in Rome III but not Rome IV) are different from those with abdominal pain (Rome IV). AIM: To compare bowel symptoms and psychosocial features in IBS patients diagnosed with Rome III criteria with abdominal discomfort, abdominal pain, and pain & discomfort. METHODS: We studied IBS patients meeting Rome III criteria. We administered the IBS symptom questionnaire, psychological status, and IBS quality of life. Patients were classified according to the predominant abdominal symptom associated with defecation into an only pain group, only discomfort group, and pain & discomfort group. We compared bowel symptoms, extraintestinal symptoms, IBS quality of life, psychological status and healthcare-seeking behaviors, and efficacy among the three groups. Finally, we tested risk factors for symptom reporting in IBS patients. RESULTS: Of the 367 Rome III IBS patients enrolled, 33.8% (124 cases) failed to meet Rome IV criteria for an IBS diagnosis. There were no meaningful differences between the pain group (n = 233) and the discomfort group (n = 83) for the following: (1) Frequency of defecatory abdominal pain or discomfort; (2) Bowel habits; (3) Coexisting extragastrointestinal pain; (4) Comorbid anxiety and depression; and (5) IBS quality of life scores except more patients in the discomfort group reported mild symptom than the pain group (22.9% vs 9.0%). There is a significant tendency for patients to report their defecatory and non-defecatory abdominal symptom as pain alone, or discomfort alone, or pain & discomfort (all P < 0.001). CONCLUSION: IBS patients with abdominal discomfort have similar bowel symptoms and psychosocial features to those with abdominal pain. IBS symptoms manifesting abdominal pain or discomfort may primarily be due to different sensation and reporting experience.

[Evaluation of gastric sensitivity and accommodation by simultaneous determination of intra-gastric pressure in liquid load test].

OBJECTIVE: To extensively evaluate the method of simultaneous determination of intra-gastric pressure (IGP) in liquid load test (LLT) in healthy subjects (HS) and patients with functional dyspepsia (FD). METHODS: Forty HS and 67 FD patients (Rome III criteria) were recruited. All subjects were surveyed with regards to demographic characteristics, features of FD symptom spectrum and psychological status (Zung anxiety and depression scale). And the test of simultaneous determination of IGP in LLT was conducted. Finally all the data were collected and analyzed. RESULTS: HS group: no statistical difference was found in IGP divided by gender, age and body mass index (P > 0.05). The coefficient of variation of IGP at 15.3% was less than that of maximal intake volume (MIV). Twice repeated studies showed quite similar results and the linear interclass correlation coefficient of IGP was 0.806 (P = 0.002). As to the range of normal value from HS, the proportion of gastric hypersensitivity accounted for 35.0% and impaired accommodation for 25.0%. FD group: no statistical difference was found in IGP and MIV divided by gender, age and FD symptom subtype (P > 0.05). FD patients with abnormal psychological status had a lower IGP (4.2 +/- 1.2 mm Hg vs 4.8 +/- 1.1 mm Hg, P = 0.042) and MIV (450 +/- 138 ml vs 526 +/- 121 ml, P = 0.034) than those with normal status. IGP was not related to epigastric pain, epigastric burning, postprandial fullness or early satiation (F = 1.635, P = 0.190). Early satiation was significantly related to MIV (F = 4.682, P = 0.031; correlation coefficient was -6.8, P = 0.033). No statistical difference was found in gastric compliance among HS, all FD patients, patients with hypersensitivity or impaired accommodation (P > 0.05). The test had an excellent safety and tolerability. CONCLUSIONS: The method of simultaneous determination of IGP in LLT can differentiate gastric hypersensitivity from impaired accommodation. And it has an excellent feasibility, safety and reliability.

[Multi-channel electrogastrography and autonomic nervous system function in patients with non-erosive reflux disease and reflux esophagitis].

OBJECTIVE: To investigate the gastric myoelectrical activity and autonomic nervous system (ANS) function in patients with non-erosive reflux disease (NERD) and reflux esophagitis (RE). METHODS: 42 patients with gastroesophageal reflux disease (GERD), 21 with NERD and 21 with RE, and 20 healthy volunteers (controls) underwent multi-channel electrogastrography (MEGG) and electrocardiography simultaneously for 30 min in the fasting state and 60 min after a standard test meal. The MEGG parameters included dominant frequency (DF), dominant power (DP), normal percentage of 2 - 4 times/min gastric slow waves (N%), and percentage of slow wave coupling (%SWC). ANS was determined according to power spectra analysis of heart rate variability (HRV) which was conducted by using electrocardiogram recording, including the parameters of sympathetic activity, vagal activity, and sympathovagal balance ratio so as to evaluate the ANS function. RESULTS: The DF levels of the NERD and RE patients and healthy volunteers after test meal were all significantly higher than those in fasting state (all P < 0.05). The %SWC levels of the 3 groups after test meal were all significantly lower than those when fasting (all P < 0.05), and the %SWC level of the NERD patients was significantly lower than that of the healthy volunteers in fasting state [70.5% (40.6% - 81.9%, 76.3% (66.4% - 91.4%), P < 0.05]. Test meal significantly increased the sympathetic activity and sympathovagal balance ratio of the NERD and RE patients and healthy volunteers (all P < 0.05), and the vagal activity levels of the 3 groups after test meal were all significantly lower than those when fasting (all P < 0.01). The sympathovagal balance ratio of the NERD group was significantly lower than that of RE group after meal [1.4 (0.8 - 2.5), 2.2 (1.3 - 4.4), P < 0.05]. CONCLUSION: The spatial regularity of gastric slow waves and ANS function in NERD patients are significantly different from those in RE patients.

[Value of computed tomographic colonography in analyzing mechanism of defecation in healthy subjects].

OBJECTIVE: To establish the methodology of 3-dimensional CT reconstruction of colon and rectum in evaluating anorectum and pelvic floor function. METHODS: 19 healthy volunteers, 8 males and 11 females, aged 42.8, received both defecography and 3-dimensional CT reconstruction of colon and rectum. Relevant parameters were compared between the two methods. RESULTS: (1) CT reconstruction showed that the average value of anorectal angle (ARA) was (101 +/- 13) degrees when resting, (83 +/- 12) degrees when squeezing, and (124 +/- 13) degrees when defecating;the average values of the distance between the upper part of anal canal and the pubococcygeal line (DUAC) was (10 +/- 6) mm when resting, -2(-8 - 3) mm when squeezing, and (27 +/- 11) mm when defecating; and the average value of the anal canal length (ACL) was (29 +/- 7) mm when resting, (39 +/- 8) mm when squeezing, and (22 +/- 5) mm when defecating. The change trends of ARA, DUAC, and ACL during squeezing and defecating in CT reconstruction were the same as those in defecography. (2) No significant differences were found in ARA and ACL measured by the two methods; but the DUAC values measured by defecography when resting, squeezing, and defecating were (31 +/- 11)mm, 18(-1 - 26) mm, and (50 +/- 12) mm respectively, all significantly longer those measured by CT reconstruction (all P < 0.01). (3) During defecation, the value changes of ARA was not significantly correlated between these 2 methods (r = 0.315, 0.361, both P > 0.05). CONCLUSION: 3-dimensional CT reconstruction of colon and rectum is helpful in evaluation of anorectum and pelvic floor function.

[Investigation of female chronic constipation: a multi-center cross-sectional clinical study].

OBJECTIVE: To analyze the characteristics of female chronic constipation (CC), contributing factors of severe constipation and the correlation between female CC and pelvic floor dysfunction (PFD) so as to provide references for the diagnosis and treatment of female CC. METHODS: Five hundred and sixty-one CC outpatients meeting Rome III criteria at clinics of gastroenterology from ten Beijing hospitals were recruited during March-May 2007. After data input and verification, formulated the standard of severe CC. RESULTS: The peak age of CC onset was 20 - 29 years in female patients while 60 - 69 years in male patients. F:M = 3.04:1. A wide range of CC symptoms were present and straining was the most common one (381, 76%). However, a significant difference between females and males was shown in defecation by manually pelvic floor supporting (female 26/69, 38%, male 3/20, 15% in manual assisted defecation, P < 0.05) and urinary incontinence when coughing (female 95/422, 22.5%, male 13/139, 9.4%, P < 0.01). Severity of CC, its manifestations and pelvic floor dysfunction were closely correlated with frequencies of pregnancy and delivery. CONCLUSION: Owing to anatomic features of female pelvic floor and physiological nature of pregnancy and delivery, the early onset of CC in female patients should attract sufficient attention of multi-disciplinary clinicians.

[Long-term impact on quality of life in patients with gastroesophageal reflux disease after 52-week rabeprazole treatment].

OBJECTIVE: To investigate the longitudinal changes in quality of life (QoL) for gastroesophageal reflux disease (GERD) treated with 52-week rabeprazole over a period of 2-3 years. METHODS: A multi-center, open-label and randomized 52-week rabeprazole trial was conducted in 67 eosinophilic esophagitis (EE) and 31 non-erosive reflux disease (NERD) patients. The follow-up period is 2-3 years after the treatment. Their QoL were evaluated using SF-36 Health Survey Questionnaire and GERD-HRQL scale. The results were compared with those acquired before and after a 52-week proton pump inhibitor (PPI) treatment. RESULTS: (1) Both EE and NERD patients improved significantly according to GERD-HRQL scale in scores of reflux symptoms as well as overall satisfaction (12.5 vs 3.5, 20.0 vs 14.0, both P < 0.01) versus the pre-therapy baseline. (2) Both EE and NERD patients had no significant difference in the scale of GERD-HRQL (2.0 vs 3.5, 5.0 vs 4.0, both P > 0.05) and most major domains of SF-36 questionnaire versus the post-therapy baseline (53 +/- 17 vs 61 +/- 17, t = -2.143, P = 0.035). (3) The NERD patients had a higher score of reflux symptoms than the EE patients according to the GERD-HRQL Scale (14.0 vs 3.5, Z = 2.377, P = 0.017), however there were no significant differences between NERD and EE in 8 major domains of SF-36 questionnaire (P > 0.05). CONCLUSION: Long-term and low-dose PPI treatment achieves improvement both in reflux symptoms and QoL in GERD patients and such effects last a long time. At follow-ups, the reflux symptoms of NERD patients are more severe than EE patients. However, the overall QoL has shown little differences between these two subtypes.

Effects of enteral and parenteral nutrition on gastroenteric hormones and gastric motility after subtotal gastrectomy.

OBJECTIVE: To investigate the effects of enteral nutrition (EN) and parenteral nutrition (PN) on gastric motility and gastroenteric hormones after subtotal gastrectomy. METHODS: Forty-one patients underwent gastrectomy were randomly divided into EN group (n = 20) and PN group (n = 21). From the first postoperative day to the seventh day, patients received either EN (EN group) or PN (PN group) with isocaloric (84.9 kJ x kg(-1) x d(-1)) and isonitrogenous (0.11 g x kg(-1) x d(-1)) intake. Serum gastrin (GAS), plasma motilin (MTL), and plasma cholecystokinin (CCK) were measured on preoperative day, the first and seventh postoperative day. Electrogastrography (EGG) was measured on preoperative day and the seventh postoperative day. RESULTS: Compared with preoperation, blood GAS, MTL, and CCK levels of 41 patients decreased significantly on the first day after subtotal gastrectomy (P < 0.001), but returned to the preoperative levels one week later. EGG after gastrectomy showed that gastric basal electrical rhythm was significantly restrained (P < 0. 001). On the seventh day after subtotal gastrectomy, plasma MTL and CCK levels in EN group were higher than those in PN group (P < 0.05). There was no difference in GAS level between two groups. EGG in EN group was better than that in PN group postoperatively. CONCLUSIONS: The levels of gastroenteritic hormones and the gastric motility decrease significantly after subtotal gastrectomy. In contrast with PN, EN can accelerate the recovery of MTL, CCK, and gastric motility after subtotal gastrectomy.

[Changes of serum gastrin, plasma motilin, and gastric motility in gastric cancer patients after subtotal gastrectomy].

OBJECTIVE: To study the change of the serum gastrin (GAS) and plasma motilin (MTL) levels as well as the gastric motility in gastric cancer patients after subtotal gastrectomy. METHODS: We used radioimmunoassay method to detect the levels of serum GAS and plasma MTL in 39 healthy volunteers (control group) and 39 gastric cancer patients before and after gastrectomy (gastric cancer group). Electrogastrography (EGG) was measured at the same time points. RESULTS: The levels of serum GAS and plasma MTL in gastric cancer group before operation were significantly higher than those in control group (P = 0.000), and the levels of serum GAS and plasma MTL in gastric cancer stage II patients were also significantly higher than those in stage III patients (P <0.05). The levels of serum GAS and plasma MTL in gastric cancer group significantly decreased on the first post-operative day (P = 0.000), but returned to the pre-operative levels on the seventh post-operative day. The incidence of the abnormity of gastric motility in gastric cancer group on the seventh post-operative day was significantly higher than the pre-operation incidence (89.7% vs. 43.6%; chi2 = 18.692, P <0.01). CONCLUSIONS: The levels of serum GAS and plasma MTL transiently decreased in gastric cancer patients. Subtotal gastrectomy could affect the gastric motility in gastric cancer patients.

Illness Perception of Patients with Functional Gastrointestinal Disorders.

OBJECTIVE: To investigate the illness perception characteristics of Chinese patients with functional gastrointestinal disorders (FGID), and the mediating role between symptoms, psychopathology, and clinical outcomes. METHODS: Six illness groups from four outpatient departments of a general hospital in China were recruited, including the FGID patient group. The modified and validated Chinese version of the illness perception questionnaire-revised was utilized, which contained three sections: symptom identity, illness representation, and causes. The 12-item short-form health survey was utilized to reflect the physical and mental health-related quality of life (HRQoL). The Toronto alexithymia scale was used to measure the severity of alexithymia. Additional behavioral outcome about the frequency of doctor visits in the past 12 months was measured. Pathway analyses with multiple-group comparisons were conducted to test the mediating role of illness perception. RESULTS: Overall, 600 patients were recruited. The illness perceptions of FGID patients were characterized as with broad non-gastrointestinal symptoms (6.8 ± 4.2), a negative illness representation (more chronic course, worse consequences, lower personal and treatment control, lower illness coherence, and heavier emotional distress), and high numbers of psychological and culture-specific attributions. Fit indices of the three hypothesized path models (for physical and mental HRQoL and doctor-visit frequency, respectively) supported the mediating role of illness perceptions. For example, the severity of alexithymia and non-gastrointestinal symptoms had significant negative effect on mental quality of life through both direct (standardized effect: -0.085 and -0.233) and indirect (standardized effect: -0.045 and -0.231) influence via subscales of consequences, emotional representation, and psychological and risk factor attributions. Multi-group confirmatory factor analysis showed similar psychometric properties for FGID patients and the other disease group. CONCLUSION: The management of FGID patients should take into consideration dysfunctional illness perceptions, non-gastrointestinal symptoms, and emotion regulation.

Effect of high-fat, standard, and functional food meals on esophageal and gastric pH in patients with gastroesophageal reflux disease and healthy subjects.

OBJECTIVES: To investigate the effects of different test meals on esophageal and intragastric pH in patients with gastroesophageal reflux disease (GERD) and healthy subjects and to demonstrate the relationship between esophageal acid exposure (EAE) and gastric pH. METHODS: We enrolled patients with reflux esophagitis (RE; n = 15), nonerosive reflux disease (NERD; n = 12) and healthy subjects (n = 10). Four pH electrodes were used to monitor the pH of the distal esophagus, upper border of the lower esophageal sphincter, gastric fundus, and gastric body for 26 hours. Isocaloric and isovolumetric high-fat, standard, and functional meals were supplied randomly to the participants. The EAE and gastric acidity of each meal in fasting and postprandial states were compared. RESULTS: High-fat meals significantly increased postprandial EAE in patients with RE and NERD. EAE was higher after a high-fat meal than after a standard or functional food meals at the fourth hour postprandially in patients with RE (P < 0.05). Patients with NERD reported fewer symptoms after a functional food meal than after high-fat and standard meals (0 [interquartile range {IQR} 0-1] vs 1 [IQR 0-2] vs 3 [IQR 1-4], P = 0.014). Compared with high-fat and standard meals, functional food meal significantly decreased gastric acidity in patients with RE. EAE was significantly related to gastric acidity in patients with RE. CONCLUSIONS: High-fat meals increased EAE in patients with RE and NERD. Functional food could serve as adjuvant therapy in GERD patients. EAE was related to gastric acidity in RE patients.

A randomized, double-blind, placebo-controlled trial assessing the efficacy and safety of tegaserod in patients from China with chronic constipation.

AIM: To evaluate the efficacy and safety of tegaserod, 6 mg twice daily (b.i.d.), in men and women with chronic constipation (CC) from China. METHODS: This was a multicenter, double-blind, placebo-controlled study. Following a 2-wk treatment-free baseline period, patients were randomized to receive either tegaserod (6 mg b.i.d.) or placebo (b.i.d.) for 4 wk. An analysis of covariance with repeated measures was used to determine the overall effect of treatment for the primary efficacy variable; the change from baseline in the number of complete spontaneous bowel movements (CSBMs) during the 4-wk treatment period. Secondary efficacy endpoints included other measures of response in terms of CSBMs, and patients' daily and weekly assessment of bowel habits. Safety was also assessed, based on the incidence and severity of adverse events (AEs). RESULTS: A total of 607 patients were randomized to receive either tegaserod (n = 304) or placebo (n = 303). Tegaserod treatment resulted in a rapid and significant increase from baseline in the adjusted mean number of CSBMs per week over wk 1-4 compared with placebo (1.39 vs 0.91, P = 0.0002). A statistically significant difference in favor of tegaserod was also observed for a mean increase > or = 1 CSBM/wk over wk 1-4 (47.7% vs 35.0%, tegaserod vs placebo, respectively, P = 0.0018) and for the absolute number of > or = 3 CSBMs/wk over wk 1-4 (25.0% vs 14.5%, tegaserod vs placebo, respectively, P = 0.0021). Improvements in other symptoms of CC were also seen in the tegaserod group, including improved stool form and reduced straining. In addition, more patients in the tegaserod group reported satisfactory relief from their constipation symptoms. The frequency and severity of AEs was comparable between tegaserod and placebo groups, with the exception of a greater incidence of diarrhea in patients receiving tegaserod (3.6%) compared with placebo (1.7%). CONCLUSION: Tegaserod treatment improved multiple symptoms of CC and was associated with a favorable safety profile.

[Effect of combined drug treatment on megacolon with severe constipation].

OBJECTIVE: To assess the effectiveness of combined drug treatment on megacolon complicated by severe constipation. METHODS: Ten patients with megacolon confirmed by barium enema examination, 4 males and 6 females, aged 38 (15 - 66), with a mean course of 10 years (2 weeks - 23 years), all complicated by severe constipation and 5 cases with colonic obstruction confirmed by X-ray examination, 1 being diagnosed as with Hirschsprung' disease, 3 secondary to chronic constipation, 1 with diabetes mellitus, 1 with a history of anorectal malformation, 4 with colonic pseudo-obstruction, and 4 with colonic pseudo-obstruction, were treated with combined conservative therapy including tegaserod (6 mg 2/d), polyethylene glycol (PEG) 4000 (20 - 40 g/d), and liuweianxiao (traditional Chinese medicine, 5 # 3/d). Colon enema was used in the first week if necessary. Follow-up was conducted for 1 - 7 months. The major clinical data included bowel symptoms, complications and adverse effects. RESULTS: After 1 - 2 weeks of treatment, properties of feces, defecation times, defecation difficulty, and abdominal symptoms, and X-ray findings were all notably improved. No relapse of colonic obstruction was found. The 5 patients with colonic obstruction all showed release. Regarding adverse effect, mild diarrhea was found in 2 cases and was relieved when the dosage was decreased. CONCLUSION: Combined drug treatment including tegaserod, PEG 4000 and traditional Chinese medicine is effective in treating megacolon with severe constipation and may help avoid surgical treatment.