Gastrointestinal Problems May Be Associated With Other Health Problems And Even Previously Experienced Abuse

Main Category: GastroIntestinal / Gastroenterology
Also Included In: Psychology / Psychiatry
Article Date: 12 Jun 2008 - 2:00 PDT

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People with recurrent gastrointestinal complaints often have other concurrent health problems, seek medical care more frequently, and experience lower quality of life than those without such complaints. Evidence also suggests that women with gastrointestinal complaints may have experienced various kinds of abuse earlier in life. This is shown in a doctoral dissertation by family physician Ture Ålander, who concludes that physicians should focus on the patient as a whole person rather than just on the patient's gastrointestinal complaints.

Approximately every third Swede has troublesome gastrointestinal symptoms that have no apparent physical explanation-a so-called functional gastrointestinal disorder. These disorders often cause substantial symptoms and great suffering, and medicine seldom helps. A new dissertation from the Swedish medical university Karolinska Institutet, Functional gastrointestinal disorders-co-morbidity and non-somatic aspects, shows that these complaints are often coupled with other psychological and physical disorders and even with having been a victim of abuse. Ålander, of the Center for Family and Community Medicine, hopes that his findings will cast new light on a group of patients for whom it is now difficult to provide effective treatment.

"The results support the idea that those of us who work in health care should have a holistic perspective when we meet patients with recurrent functional gastrointestinal complaints", says Dr Ålander. "This can mean establishing a relationship of trust and combining psychological treatment with medication. But research in this field is insufficient-much remains to be done before we can know with greater certainty which methods and medicines are most appropriate."

The study design is unique. Most previous studies were done on patients; this is the first such study in Sweden to focus on a general population. Researchers randomly selected 141 adult men and women in sthammar County who had long-term gastrointestinal complaints and 97 who had no history of such complaints. Participants answered questions about gastrointestinal symptoms and also about their general health, quality of life, medicines, previous negative life experiences, and earlier use of primary care.

It was previously known that many people who have these kinds of complaints try to manage them on their own; this dissertation shows that nearly a third have never sought help. The results also showed that people with gastrointestinal complaints who seek help at health care centers made approximately twice as many physician visits and calls to the centers as people without such problems. They also obtained more prescriptions and took considerably more painkillers. In addition, they more often had other concurrent health problems. For example, 80 percent said they felt tired, compared with 20 percent of those who were symptom-free. Those with recurrent gastrointestinal complaints also reported more headaches, back pain, depression, irritability, restlessness, and anxiety.

"We're not sure about cause and effect, but gastrointestinal problems can be a reaction to stress and also a part of other health problems, says Dr Ålander. "I found that there are many people who themselves link their stomach problems to their mood."

Another interesting finding was that 46 percent of women with recurrent gastrointestinal complaints said, that they had been the victim of some kind of physical, psychological, or sexual abuse earlier in life. The association was not as clear for men. "Although these results should be interpreted with caution, they may provide an important puzzle piece in consultations with some patients", says Dr Ålander.

The Center for Family and Community Medicine (CeFAM) is collaborative venture of Karolinska Institutet and the Stockholm County Council and the largest education, development, and research center in family medicine in the country and among the largest in Europe. Over 170 research and development projects are currently underway on topics such as diabetes, cardiovascular disease, cancer and heritability, psychological ill health, physical activity, gastrointestinal disorders, and health and quality of life in different neighborhoods.

http://www.ki.se

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