Somatosensory amplification (SSA) and alexithymia (AL) in functional dyspepsia (FD)

significant differences between the groups. At binary logistic regression, number of GP visits last two years (OR 3.45 and CI 147:8.06) and health anxiety (OR 1.12 and CI 1.04:121) were significant independent predictors of outcome. No difference was found between groups for neuroticism, quality of life, sex, age or duration of symptoms. CONCLUSION: [BS patients with persisting substantial complaints at 6-9 months follow-up have higher psychological distress at baseline than those with minor or no complaints. Higher levels of health ar~xiety and more frequent visits to the GP last two years predict substantial abdominal compfaints at followmp. Further research is needed to see if these factors enables us to identity" patients likely to benefit from cognitive behavioural treatment

Variable r~rted at 9first visit GP visits 2 yrs (0,1~,

:,5)

Health anxiety

(m~nISD) r

Mood disorder (mean/SD) Sub~ health

Su~complalr~s at f~ up {n:l 11

Minor or no complaints at follow up (n=29)

Statistics

27/70/11

18/10/1

p=0.02

27,1 (8.5)

22,2 (6.4)

p < 0,01

1.9 (0,6)

1,5 (0.5)

p< 0.01

28.1 (13,0)

21,6 (10,7)

p= 0,02

T1423 Changes in Childhood Recurrent Abdominal Pain and Parental Responses with Cognitive Behavior Therapy Rona L Levy, Michelle D Garner, Dennis L. Christie, Star: F. Whitsett, WiUiam E. Whitehead, Lynn S. Walker, Andrew D Feld Pre~%us research by our group has shown that modding (having a mother with irritabk bowel s>mdrome) and encouragement of illness behavior by mother is associated with increased abdominal pain and thnctional disability. (Gastroenterol, 2002). However, no studies have demonstrated a relationship between changes m modeling and parental response and symptom change. Aims: Demonstrate that a cognitive behavior therapy (CBT) intervention focusmg on parental response and modefiug results in (1) a decrease m encouragement of illness behavior by parents; and (2) a decrease in abdominal pain and other G1 symptoms from baseline to post-treatment and follow-up. Methods: Eleven children referred from a tertiary care climc who met Apley's criteria for RAP were treated with three sessions of CBT. Questionnaires given at baseline, end of treatment, and follow-up 1-3 momhs later included the Pain Response Inventory, the Pain Beliefs Inventor}* (PBI), and validated measures of parental response to children's GI symptoms. The design was a time-series one in which each subject served as his/her own control. Results: (1) Comparing baseline to end of treatment, there was a sigmficam decrease in encouragement of illness heha~ior by parents and a sigrfificant decrease in the child's tendency to catastrophize about abdominal pain. The child's attributions of how serious abdominal pain symptoms were also tended to decrease by d:e end of treannent (t(9) = 2.18, p = .06). (2) There was a sigmficant decrease in all GI syanptoms reported by the child from baseline to end of treatment (t(8)=2.71, p < 0 3 ) and also baseline to foflow-up (t(7)= 2.51, p = .04). The PBI scale for frequency of abdominal pain decreased from baseline to end of treatment (t(9)=2.48, p = .04) and from baseline to follow-up (t(7)= 4.26, p = .004). Conclusions: CBT decreased the encouragement of illness behavior by parents as intended, and it decreased the tendency of children to catastmphize about pain. This was associated with a significant reduction in GI symptoms overall and specifically with the frequency of abdominal pain. Future research v-ill include a large randomized contrulled trial.
T1421 Patients and Non-Consulters with Irritable Bowel Syndrome (IBS) are more likely than Subjects without IBS to Report that their Parents had a History of Bowel Problems Motoyori Kanazawa, Yuka Endo, William E, Whitehead, Michiko Kano, Manabu Satake, Taisnke Nomnm, Michio Hongo, Shin Fukudo Backgruund and kuns: It has been reported that heredity and scvzial learning comribute to the development of irritable boa'el syndrome (1BS) in the Us The aims of this study were (1) to confirm that Japanese subjects with IBS are morn likely' to have parents with a history of bowel problems, and (2) to determine whether parental history of bowel problems is associated with greater psychological distress. Methods: A convenience sample of 417 adult subjects (200 females and 217 males, mean age 36+-1 years) who had not consulted gastrointestinal specialists at Tobokn Unwersity Hospital in Sendal, Japan, was recruited from the urban community. These subjects were classified as non-consulters with IBS if they met Rome U diagnostic criteria, or otherwise as non-lBS subjects. An additional 56 patients who had consulted for IBS at Tohoku University Hospital were recruited (29 iemales and 27 males, mean age 33 + -2 years). All subjects completed the Gastrointestinal Symptoms Rating Scale (GSRS), the State-Trait Amciety Inventory (STAI), the Self-Rating Depression scale (SDS), the Perceived Stress Scale (PSS), and the SF-36. Data analysis consisted of Chi Square to compare proportions and two-way analysis of variance (ANOVA) to assess the impact of 1BS diagnosis and parental history of bowel problems. Results: 14.2% (155% of females and 12.9% of males) in the community sample met the criteria for IBS diagnosis. Significantly more IBS patients (33.9%) and IBS non-consulters (27,1%) had a family history of bowel problems compared to nonqBS subjects (13.1%, p<.001). Two-way ANOVA showed a significantly greater impact of 1BS diagnosis on all of the gastrointestinal symptoms, state and trait anxiety, depression, perceived stress, and the SF-36 quality of life scales except physical fi.mctioning The two-way ANOVA also showed that parental history, was associated with a significantly greater impact on the symptoms of indigestion, diarrhea, cmLstipation, state and trait anxiety, and the SF-36 scales for bodily pain, social functioning, and role emotional. Conclusions: A parental history of bowel synptoms is a significant risk factor for development of IBS in Japan, as was reported for the U.S. Moreover, patients with a family history of bowel problems show more psychological distress than other patients. The design of the study does not allow us to distinguish the effects of heredity from the effects of social learning. [Supported by RO1 DK3t369 ]

T1424 A Perception of the Irritable Bowel Syndrome (IBS) from Physicians and Pharmacist in South Australia (SA) Eldon Shaffer, Fengxiao Li, Peter Bampton, Robert Hilsden, Lloyd Sutherland Patients with IBS, a chronic disease that generally' lacks a clear has:s or effective treatment, have a reputation as being time-consuming and difficult to manage. Aim: This study examined how 3 types of physicians (MD) and pharmacists (Pharm) iu Australia perceive IBS. Methods: A structured questionnaire (45 items/MD & 36/Pbarm) was mailed to all gastroenterologists (GI, n = 52) and general internists (G1M, n = 34), plus a random sample of general practitioners (GP, n = 151) and Pbarm (n = 139) in SA. The snrvey examined their knowledge, perception and attitude towards 1BS. Comparisons made separately between the 3 MD groups and between GP and Pharm used g 2 tests with Holm's step-down procedure for multiple comparisons. Results: Response rates were high: 88% G[, 73% G1M, 76% GP & 71% Pharm, with appropriate age and sex distributions. Most G1 (64%) t'eh their knowledge of IBS was very good, vs 4% G1M, 20% GP & 5% Pharm (p<0.001). Most (68-86%) felt IBS was functional iNS). More Pharrn (36%) vs MDs (9-20%) considered IBS structural (12=0.02). All groups considered 1BS to be gruel"ally more physical (70-80%) than psychological (3863%). Amongst MDs, GI were more aware of the possible association between IBS and physical (61% vs 26% & 30%, p=0,043) or sex abuse (73% vs 22% & 26%, p<0.001), Most G1 (74%) felt that any of the consensus criteria could be used to diagnose IBS, vs 17% GlM~,and 1% GP (p<0.001). The MDs ranked the frequency of altered bowel habit in order: alternating diarrhea-constipation, diarrhea and constipation; Pharm considered diarrhea most common. Only a few Pharm (< 6%) and MDs (<2%, NS) tdt currently available medications to be effective for all IBS symptoms; therapy for specific symptoms fared better (73-93%), All 4 groups felt IBS patients able to cope with life (67-80%); few labeled them as neurotic (7-16%) or demanding (11-23%). Only 39% GI, 29% G1M, 13% GP and 7% PHM believed that 1BSpatients overused health resources (NS). The biggest problems for MDs was providing a sufficient explanation (44-73%) and managing patient expectations (79-100%). Conclusion: Differences exist in knowledge and perception of IBS between these 4 health professionals in SA. This variation likely reflects the medical uncertainties of IBS and different training backgrounds of the 4 groups. The findings in Australia are rather similar to an equivalent survey in Alberta, likely a reflection of comparable practice and education. In both countries, health care professionals have a rather positive attitude to IBS,

T1422 A Multi-Center Randomized Trial of Cognitive-Behavioral Treatment (CBT) vs. Education (EDU) in Moderate to Severe Functional Bowel Disorder (FBD) Douglas A Drossman, brenda Toner, William Whitehead, N:cholas Diamant, Christine Dalton, Shdagh Emmort, Val Proffitt, Donna Akman, Karen Frusciante, Kimberly Meyer, Carlar Blackman, Yuming Hu, Huanguang Jia, Zbiming Li, Caroljm Morns, Gab' Koch, Shrikant Bangdiwala Backgrmmd: Although patients with FBD may benefit from psychological treatments, previous studies are small in scope and methodologically limited. Aim: As part of a study of antidepressam and psychological treatment of 431 patients with FBD (1BS, Functional Abdominal Pare Syndrome, painful cortstipatinn, unspecihed FBD) we report the results ot a 12-week trial of CBT vs. EDU, and secondarily, treatment benefit among clinically meaningful subgroups. Methods: Participants (N = 215) from UNC and Toronto with FBD with moderate to severe symptoms at least 2 daywXveek were randomized 2:1 to CBT or EDU. Clinical response by intention to treat and per protocol was assessed by a linear composite score (Satisfaction with treatment and McGill Pain Questionnaires, Global Well-being, and IBS-QOL), where each of the component ,scales were ranked withm site using modihed ridit scores. Responder rotes were determined by an averaged Satisfaction with Treatment Score of >3.5 (0-5 range). Results: CBT was more eflective than EDU (p=0.0001) with a response rate of 70% vs, 37% (P<0.0001) and a Number Needed to Treat (NNT) of 3.1. These results held in the per protocd analysis aher 21% (18% CBT, 29% EDU) dropped out. Clinical response was best gauged by the Satisfaction with Treatment questionnaire Ancillary analyses showed CBT was effective for patients with moderate or severe FBD, and with or without abuse h:story, but was not different from EDU for patients with severe depression (BDl>16). Conclusions: For patients with moderate to severe FBD, 12-week CBT is eflective over EDU regardless of symptom severity or abuse status, but is not as effective fbr patients with severe depression Supported by NIH Grant RO1DK49334.

AGA Abstracts

T1425 Somatosensory Amplification (SSA) and Alexithymia (AL) in Functional Dyspepsia (FD) Michael P. Jones, Ann Schettler, Michael D. Crowell Introduction and Aims: SSA occurs when nonadverse sensations are perceived as intense and disturbing. AL is difficulty' distinguishing between emotions and bodily sensations. Both may be assoc with functional symptoms but neither has been studied in FD. Methods: 43 pts with FD by Rome II criteria and 38 ctrls were studied. SSA was measured using Barsky's Somatosensory Amplification Scale (SSAS) and AL measured with the Toronto Alexlthymaia Scale (TAS). Subjects also completed a validated dyspepsia symptom measure, the Nepean Dyspepsia Index (NDI), Psychological General Well-Being Index (PGWB) and S}ulptom Cbecklist-90R (SCL90R). Data were expressed as mean-+ SE, Results: FD had higher scores than ctr[s for SSAS (29-+ 1 vs 26 4-1; p=0.02) and TAS (42-+ 2 vs 37 +-1; p=0.04). TAS subscales for Externally Oriented Thinking (EOT) and Difficulty Describing Feelings (DDF) did not differ between FD and ctrls but FD had higher scores for Difl]culty Identifying Feelings (DIF)(13 +_ 1 vs 11 -+ 1;p=0,02). In FD, SSAS and TAS were not correlated. SSAS, AL and DIF all significantly corrdated with PGWB and

A-530

SCL90R global symptom index(see Table) SSAS and DIE also correlated significantly with NDI. SSAS was significantly assoc with SCL90R subscale scores for somatization and anxiety. AL and DIF were positively assoc with heightened interpersonal sensitivity and depression and DIF was also assoc vAth somatization and anxiety. SSAS did not correlate with specific dyspeptic symptoms. AL correlated significantly with chest burning (r=0.5), abdominal burning (r = 0.44) and regurgitation (r = 0.6) DIF was significantly assoc with nausea (r=0.51), abdominal d~omfbrt (r=0.5), postprandial fullness (r=0.48), regurgitatinn (r = 0.48), abdominal pain (r = 047) and abdominal burning (r = 0.43). No significant assoc existed for DDF and EOT. Conclusions: SSA and AL (especially DIF) are perceptual and emotional styles assoc with symptom perception and perhaps symptom generation in FD. Both SSA and AL are associated with decreased QOL. SSA is assoc with aruxiety and somatization but no specific symptom. AL and DIF are assc.c with depression, heiglltened interpersonal sensitivity and several dyspeptic symptoms. DIF is the parameter most strongly' assoc with symptoms and psychosocial correlates in FD

PGWB NDI 8CL~R somatizatlon (SCLgOR) anxiety (SCLgOR) (SCL~R) I_E,te~ersonal ~m$1tlvi~ (SCLg0R) 'p
$SAS -0.42" 0.31" 0.36" 043* 0.35' 0.2~ 0.31

TAS -0.34' 0.15 0.3' 0.16 0.29 03~ 0.46*

TAS-~F -0.55* 0.3Z 0.53* 0.4* 04G* 056' 0.57* T1428

T1426

Fatigue and Subjective Sleeping Difficulties are More Prominent in Functional Disorders Than in Organic Gastrointestinal Diseases Magnus Simren, .Jan Svedlund, Ins Posserud, jessica Fennander, Einar S. Bjomsson, Hasse Abrahamsson

Women Are Different - Also in Response to Nausea Siby'lle Klosterhalfen, Sandra Kellermam'~, Ursula Smckhorst, Paul Enck

Nausea symptoms are tiequently as~iated with gender, but this has never been proven t0r vestibularly induced experimental nausea We report here the post-hoc results of an experimental study on conditioned nausea and the protective effects of a beha;qoral intervention Methods: Twenty-tour healthy vohmteers (12/12 males/femaks, 26.2 },ears) screened lot high susceptibility to body rotation were exposed to 2 x 1 min body rotation (120degrees! sec with nausea-enforcing head movements) for 4 consecute clays and always at the same time of the day, while nausea symptom ratings (SR) on a stand_ardized 7-symptom scale and saliva cortisol samples were taken at baseline, immediately post rotation and 15 and 30 rain later. Daily afier rotation, tim overall nausea profile (NP) was measured according to Mnth et al. 1996. Data were compared w~flfin and across days and between gender by muhilactorial ANOVAs; correlations were computed as Pearsons rank correlatio~ks. Results: I) Overall rotation sigmficantly increased SR (F = 12.65, p<.001) irrespective oI days and gender, bul women reported significantly higher s~lptmns following rotation, and did habituate sigmficantly less as compared to men across the four days (ANOVA, stress x days x gender, F = 2 . 5 5 p=.001). 2) In the NP, all subseales (sorck~tic, gastrointestinal, and emotional) decreased with each day (F=6.29, p = .001), but in men this elfk:ct was significantly stronger especially in the emotional subscale while women stayed high on this scale (F = 46, p = 0 0 5 ) 3) Saliva cor~isol was significantly higher in women as compared to men especially on days 1 aud 2 ( F = 3 4 8 p < 04), hut decreased independendly of gender siginficantly b'om day i to day 4 (F = 4.23, p = 008). 4) Cortisol levels did not correlate w[fh SR at the same or the following day this was true for all [bur days. 5) SR following rotation did signifieant]y correlate with baseline nausea ratings on the subsequent day: from day 1 to day 2: r = .51; clay 2 to day 3: r = 83; day 3 to day 4: r = .82 (all p<.01) indicating "antlkipatory" (condinoned) nausea; tins effects was stronger in women (kom day 2 to day 3: r = 79; and tnam day 3 to day 4, r = .93), than in men (only day 2 to day 3: r = .74) (all p< 01). Conclusion: Gender dflterences in the respon~ to nausea-provoking body rotation are evident: women respond stronger, habituate less, and are more prone to conditioned nausea than men This eft>cts is associated with higher stress hormone release, but the exact relationship between cortisol and nausea remains obscure (Supported by grants from DFG, KL 811/2, and the Wellcome Trust)

Fatigue and poor sleep quality are common in patients with functional gastrointestinal (GI) disorders (Simren et al Scand J Gastroentero] 2001; Fuss et al Am J Gastroenterol 2000). 'vu this is specific for functinnal G1 disorders or is present also in organic GI diseases is not clear. METHODS: We invited 600 consecutive patients attending a university-based GI outpatient clinic to participate in the study They completed validated questionnaires assessing deep quality (USi-25) and the impact of fatigue on quality of life (Ratigue Impact Scale (FIS)). They also completed the Hospital Anxiety and Depression (HAD) scale and rated their GI symptoms using the Gastrointestinal Symptom Rating Scale (GSRS) 434 patients agreed to participate, 35 were later excluded due to severe non-GI diseases For the analyses we divided the material into 2 groups: patients with hmctional GI disorders (FG1D) and organic GI diseases (OGID) (mainly inflammatory bowel disease) RESULTS: Completed questionnaires were evaluated in 112 patients with FGID (86 temales mean age 41 (20-73) years) and 287 with OGID (159 fema]es; mean age 46 (20-83) years). Both groups demonstrated high degree of fatigue assessed wi(h FIS. Compared with OGID, patients with FGID had more severe cogintiw" (18 (1.0) vs. 15 (06) (mean (SEM)) p=0.02) and psychosocial fatigue (35 (2.0) vs. 29 (1.1); p=0.005), whereas physical l;~tigue was shnflar (18 (1.1) vs. 16 (07); N8). Accordingly, the total FIS score was higher in patients with FGID than OGID (71 (3.8) vs. 60 (22); p ~ 0.01). 'v\hth increasing severity of gastrointestinal symptoms, there was a clear increase in the severity of fatigue (p<0.0001). Fatigue was more severe in patients with anxiety (p
T1429 Psychological Features Are the Main Predictors of Functional Gastrointestinal Disorders in Patients with Eating Disorders Catherine M. Boyd, Suzanne Abraham, John E. Kellow

T1427 IBS Diagnosis and a History of Abuse Have Synergistic Effects on the Perigenual Cingulate Activation in Response to Rectal Distention Yehuda Ringd, Douglas A. Drossman, Jane l.x:serman, Weili Lin Hui Liu, Brent A. Vogt, William E. Whitehead

Background: Gastrointestinal symptoms in patients with eating disorders are well recogr~ised and usually occur in the absence of structural gastrointestinal disease. Despite this, the spectrum and predictors of specihc functional gastrointestinal disorders (FGIDs) docmnented using standardized and validated questionnaires have received little attention Aim: To describe the prevalence and type of FGIDs in patients attending an eating disorder unit and to determine the relation of illness history', eating disorder diagnosis and behaviours, and psychological k*atures, with the type and number of FGID present. Methods: 74 consecutive female eating disorder unit inpatients (anorexia nervosa 46%, bufimia nervosa 22%, nonspecific eating disorder 27%, no cun~nt eating disorder 5% mean age 21yrs; BMI 17.8; duration of illness 5 1 yrs), completed the Rome II modular questionnaire and a range of other validated sell-report questionnaires detaiiing illness history (e.g. age; duration of illness; current, lowest and highest BMI), eating and exercise behaviour (binge eating, self-induced vomiting, laxative abuse, resmcting, exeessive exercising), and psychoIogical features. Results: 96% of the sample satisfied criteria for at least one FG1D. The most common FGIDs were irritabIe boa, el syndrome ([BS, 55%), functional heartburn (FH, 55%), functional dysphagm (FDys, 23%), functional constipation (FC; 23%) and functional anorectai pain disorder (FAno; 23%). Trait anxiety, asceticism (tendency for seltLdenial) and an ab~nce of binge eating were significant predictors of 1BS. Predictors of FH were higher somatization and a diagnosis of bufimia nervosa. FDdys was predicted by an increase in trait anxiety. FC was predicted by younger age and a decrease in intm?ersoual sensitivity'. An increase in age predicted the presence of FAun. The predictor of three or mm~ coexistent FG1D syndrnmes

Patients with irritable bowel syndror~m (IBS) when compared to healthy controls dilter in the ACC respon~ to rectal &stention (Naliboff 2001 ; Mertz 2000). We have shown (Ringel 2002) that when compared to controls, subjects with a history of abuse, subjects with 1BS, aml subjects with both IBS and abuse have greater activation of perigenual ACC (pACC) in response to painful rectal distension. Aim: To assess whether IBS diagnosis and a history of abu~ have a synergistic effect on pACC activation. Methods: We studied 15 right-banded kmale subjects (5 subjects in each of the 3 noted groups). FMRI images and subjective rating of pain (on a 0-5 scale) were obtained dunng ba~sehne, 15 mmHg (non-painflal) and 50mmHg (painful) distension. Statistical parametric mapping (SPM) analysis was used to identify activation differences between IBS combined w~th abuse, 1BS alone, and abuse alone. Results: In respome to painful (50mmHg) rectal distention, IBS combined with abuse was associated with siginficantly hgher pACC activation then 1BS alone (Z = 3.8, p<0.03) (left figure) and abuse alone (Z=4.0, p<0.03) (right figure). In addition IBS/abuse patients scored sigmflcantly higher on pain compared to IBS and abuse alone (4.75 vs 3.17 vs. 3.3, p<0.05 respectively). Conclusions: 1BS diagnosis and a history of abuse have synergistic e[t?ct on the pACC activation, a region that is involved in the all, clive component of pain processing; this is associated with greater pain reporting. These findings may explain the greater emotional response, pain behaviors psychological difficuhies and poorer outcome in patients with a history of abuse

A-531

AGA Abstracts