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The prevalence of functional gastrointestinal symptoms in male patients with posttraumatic stress disorder (PTSD)
April 1995
• THE PREVALENCE OF FUNCTIONAL GASTROINTESTINAL SYMPTOMS IN MALE PATIENTS WITH POSTTRAUMATIC STRESS DISORDER (PTSD). R. Fass, B. Kagan, S. Fullerton, E.A. Mayer. CURE: VA/UCLA Gastroenteric Biology Canter/Neuroenteric Biology Group, Depts. of Medicine and Psychiatry, UCLA and West LAVA Medical Center, Los Angeles, CA 90073. State-dependent memory modulation involving central noradrenergic control centers (Locus Coeruleus) may play a role in the etiology of chronic symptoms in patients with a history of traumatic combat exposure, or sexual abuse (BritJ.Psych. 152:164,1988). Functional bowel symptoms are common in patients with a history of sexual abuse. In the current study, we wanted to determine the prevalence of functional gastrointestinal symptoms in male patients with Vietnam combat-related PTSD. METHODS: We prospectively evaluated 28 inpatients, who fulfilled the DSM 3 criteria for PTSD, using a modified Talley bowel symptom questionnaire, at a major VA PTSD unit. All the patients were males and post Vietnam war veterans. RESULTS: The mean age was 47 (range 42-53). 17 (6I%) of the patients reported functional gastrointestinal symptoms. There was no difference in perceived PTSD severity between patients with and without bowel symptoms.The perceived mean duration of gastrointestial symptoms was 12 years (range 10-13 years). The distribution of IBS, NUD and IBS+NUD was 35%, 41%, 24% respectively. The majority of patients (40%) with IBS and NUD reported alternating bowel movements rather then diarrhea or constipation predominance. 82% of the patients with 1BS and NUD reported sleeping disturbances vs. 64% of the non-IBS patients (N.S.). 83% of patients reported awakening from bowel symptoms. 67% of the IHS and 86°,%NUD patients reported sexual dysfunction, the vast majority due to decrease sexual drive. CONCLUSIONS: IBS and NUD symptoms are present in the majority of male PTSD patients. These findings suggest that the neurophysiological changes indentified in PTSD patients may also play a role in the etiology of functional gastrointestinal symptoms.
Motility and Nerve-Gut Interactions
A597
IMPROVED GASTRIC FUNCTION FOLLOWING PANCREASKIDNEY TRANSPLANT. R.L. Faust and R.L. Camp. D i v i s i o n of Gastroenterology, U n i v e r s i t y of California-Davis, Sacramento, CA. G a s t r o p a r e s i s (GP) is a common complication of end stage diabetes mellitus and may be a s s o c i a t e d with significant morbidity. To determine w h e t h e r GP improves following a combined p a n c r e a s - k i d n e y (PK) transplant, we studied all patients t r a n s p l a n t e d at the U n i v e r s i t y of California, Davis from January 1991 to D e c e m b e r 1994. METHODS: Patient symptoms were scored as m i l d (n=10), m o d e r a t e (n=5), or severe (n=2) depending on their frequency, intensity, and requirement for medication. Symptom scores were compared before and after transplant and a paired t-test analysis performed. Follow up ranged from 2-46 months (mean 18 months). RESULTS: 31 patients underwent PK transplantation. 21 patients (68%) had symptoms of GP prior to transplant. Four patients were excluded because of death or transplant failure within one month of operation, leaving a study group of 17. 5 of 17 patients had complete resolution of symptoms following transplant and no longer required p r o k i n e t i c agents. Symptom score significantly improved for the group as a whole (mean 1.5 vs. 1.2, p=0.01). Patients with m i l d symptoms of GP were s i g n i f i c a n t l y more likely to show improvement (p=0.0004). There was no difference in the d u r a t i o n of diabetes between patients that did and did not improve. CONCLUSIONS: i) Significant clinical improvement in gastroparetic symptoms can be seen following combined PK transplant. 2) Patients with milder pretransplant symptoms are more likely to improve. Further study is w a r r a n t e d to confirm these associations.
• THE EFFECTS OF INTRADUODENAL CARBOHYDRATE ON GASTRIC M O T O R AND SENSORY RESPONSES TO GASTRIC DISTENSION. Christine Feinle., Roberta Barbera, David Grundy* and Nicholas W. Read, Centre for Human Nutrition, Northern General Hospital, and Department of Biomedical Sciences*, The University of Sheffield, Sheffield, U.K.
EFFECTS OF ISOCALORIC DUODENAL CARBOHYDRATE AND LIPID ON GASTRIC MOTOR AND SENSORY RESPONSES TO GASTRIC DISTENSION. Christine Feinle, David Grundy and Nicholas W. Read, Centre for Human Nutrition, Northern General Hospital, and Dept. of Biomedical Sciences*, The University of Sheffield, Sheffield, U.K.
Intraluminal glucose has been shown to slow gastric emptying, reduce gastric tone and antral phasic activity. Lipid exhibits the same effects on the stomach and, in addition, can change the quality of the sensations during gastric distension from epigastric pressure and pain into sensations that more closely resemble those experienced after a meal with subsequent progression into nausea. The AIM of this study was to compare the motor and sensory responses to gastric distension during intraduodenal infusion of carbohydrate solutions of varying energy content controlled for osmolality and to investigate the hypothesis that any changes in gastric sensory responses are causally related to alterations in gastric motility. METHODS: In 10 healthy subjects (5 males, 5 females, 22-40 years old) the stomach was repeatedly distended with air (rate: 100 ml/min), while the duodenum was perfused with 0.9% saline (IS), 5% saline (HS, 1700 mosmol), glucose (GL, 1700 mosmol, 1 kcal/ml) or maltedextrin* (MD, 1600 mosmol, 2 kcal/ml). Intragastric pressure was monitored throughout. Subjects rated sensations experienced during distensions (fullness, discomfort, nausea) on visual analogue scales. Sham distensions were carded out to verify the subjects' reports. RESULTS: Gastric tone was similar during HS, GL and MD infusions, but significantly reduced compared with IS (p<0.05). Phasic contractile activity was gradually and significantly decreased: IS > HS, GL > MD (p<0.05). During HS, GL and MD infusions, sensations of fullness and discomfort during gastric distensions were reported at significantly higher gastric volumes than during IS (p<0.05). Only MD significantly changed the quality of the sensation of fullness during distension to a sensation that was often described as more satiating as opposed to a sensation of epigastric pressure with the other infusions. No significant reports were made during sham distensions. CONCLUSION: As the effects of HS, GL and MD on gastric motor responses during distensions were very similar, but only MD changed the quality of fullness into a more "meal-like" sensation, we conclude that gastric sensory responses are not directly related to changes in gastric motility. * C*Pur 01934 was a very generous gift from Cerestar GmbH, IG'efeld,Germany.
Both carbohydrates and lipid relax the proximal stomach and reduce antral contractility. We also found that both nutrients can change the quality of sensations experienced during gastric distensions from epigastric pressure and pain into more meal-like sensations and nausea at higher levels of distensions. The __AIMSof this study were to compare the effects of both nutrients with each other and to investigate the hypothesis that isocaloric nutrient solutions exhibit similar effects on gastric motility and visceral sensitivity. METHODS: 10 healthy subjects (5 males, 5 females, 22-40 years) were studied on three occasions, during which the duodenum was perfused with either isotonic saline (IS) or isocaloric (2 kcal/ml) solutions of maltodextrin* (MD) or Intralipid (IL) at a rate of 1 ml/min, while a flaccid bag positioned in the proximal stomach was repeatedly distended with air at a rate of 100 ml/min. Intragastric pressure was monitored throughout. Subjects rated sensations experienced during distensions (fullness, discomfort, nausea) on visual analogue scales. Sham distensions were carried out to verify the subjects' reports. RESULTS: Although MD and IL reduced intragastric pressure to a similar degree compared with the saline control (p<0.05), the sensory thresholds for fullness and discomfort (expressed as ml of air in the bag) were increased only during MD infusion (p<0.05). During IS, fullness and discomfort during distensions were described by the subjects as epigastric pressure and pain, respectively. Infusion of MD and IL changed fullness into a more "meal-like" sensation in 67 % and 78 % of distensions, respectively (MD vs. IL, p=0.18). Discomfort was reported as nausea in 78 % of distensions during 1L, but only in 33 % of distensions during MD. These differences were statistically significant (p<0.05). No reports were made during sham distensions. CONCLUSION: Although MD and IL have similar effects on gastric motility, their effects on gastric sensory responses to gastric distension vary. Therefore, we conclude that the energy content of the solutions is not the only factor that determines meal-like fullness and/or nausea and the thresholds at which these sensations occur. * C*Pur 01934 was a generous gift from Cerestar GmbH, Krefeld, Germany.
• THE PREVALENCE OF FUNCTIONAL GASTROINTESTINAL SYMPTOMS IN MALE PATIENTS WITH POSTTRAUMATIC STRESS DISORDER (PTSD). R. Fass, B. Kagan, S. Fullerton, E.A. Mayer. CURE: VA/UCLA Gastroenteric Biology Canter/Neuroenteric Biology Group, Depts. of Medicine and Psychiatry, UCLA and West LAVA Medical Center, Los Angeles, CA 90073. State-dependent memory modulation involving central noradrenergic control centers (Locus Coeruleus) may play a role in the etiology of chronic symptoms in patients with a history of traumatic combat exposure, or sexual abuse (BritJ.Psych. 152:164,1988). Functional bowel symptoms are common in patients with a history of sexual abuse. In the current study, we wanted to determine the prevalence of functional gastrointestinal symptoms in male patients with Vietnam combat-related PTSD. METHODS: We prospectively evaluated 28 inpatients, who fulfilled the DSM 3 criteria for PTSD, using a modified Talley bowel symptom questionnaire, at a major VA PTSD unit. All the patients were males and post Vietnam war veterans. RESULTS: The mean age was 47 (range 42-53). 17 (6I%) of the patients reported functional gastrointestinal symptoms. There was no difference in perceived PTSD severity between patients with and without bowel symptoms.The perceived mean duration of gastrointestial symptoms was 12 years (range 10-13 years). The distribution of IBS, NUD and IBS+NUD was 35%, 41%, 24% respectively. The majority of patients (40%) with IBS and NUD reported alternating bowel movements rather then diarrhea or constipation predominance. 82% of the patients with 1BS and NUD reported sleeping disturbances vs. 64% of the non-IBS patients (N.S.). 83% of patients reported awakening from bowel symptoms. 67% of the IHS and 86°,%NUD patients reported sexual dysfunction, the vast majority due to decrease sexual drive. CONCLUSIONS: IBS and NUD symptoms are present in the majority of male PTSD patients. These findings suggest that the neurophysiological changes indentified in PTSD patients may also play a role in the etiology of functional gastrointestinal symptoms.
Motility and Nerve-Gut Interactions
A597
IMPROVED GASTRIC FUNCTION FOLLOWING PANCREASKIDNEY TRANSPLANT. R.L. Faust and R.L. Camp. D i v i s i o n of Gastroenterology, U n i v e r s i t y of California-Davis, Sacramento, CA. G a s t r o p a r e s i s (GP) is a common complication of end stage diabetes mellitus and may be a s s o c i a t e d with significant morbidity. To determine w h e t h e r GP improves following a combined p a n c r e a s - k i d n e y (PK) transplant, we studied all patients t r a n s p l a n t e d at the U n i v e r s i t y of California, Davis from January 1991 to D e c e m b e r 1994. METHODS: Patient symptoms were scored as m i l d (n=10), m o d e r a t e (n=5), or severe (n=2) depending on their frequency, intensity, and requirement for medication. Symptom scores were compared before and after transplant and a paired t-test analysis performed. Follow up ranged from 2-46 months (mean 18 months). RESULTS: 31 patients underwent PK transplantation. 21 patients (68%) had symptoms of GP prior to transplant. Four patients were excluded because of death or transplant failure within one month of operation, leaving a study group of 17. 5 of 17 patients had complete resolution of symptoms following transplant and no longer required p r o k i n e t i c agents. Symptom score significantly improved for the group as a whole (mean 1.5 vs. 1.2, p=0.01). Patients with m i l d symptoms of GP were s i g n i f i c a n t l y more likely to show improvement (p=0.0004). There was no difference in the d u r a t i o n of diabetes between patients that did and did not improve. CONCLUSIONS: i) Significant clinical improvement in gastroparetic symptoms can be seen following combined PK transplant. 2) Patients with milder pretransplant symptoms are more likely to improve. Further study is w a r r a n t e d to confirm these associations.
• THE EFFECTS OF INTRADUODENAL CARBOHYDRATE ON GASTRIC M O T O R AND SENSORY RESPONSES TO GASTRIC DISTENSION. Christine Feinle., Roberta Barbera, David Grundy* and Nicholas W. Read, Centre for Human Nutrition, Northern General Hospital, and Department of Biomedical Sciences*, The University of Sheffield, Sheffield, U.K.
EFFECTS OF ISOCALORIC DUODENAL CARBOHYDRATE AND LIPID ON GASTRIC MOTOR AND SENSORY RESPONSES TO GASTRIC DISTENSION. Christine Feinle, David Grundy and Nicholas W. Read, Centre for Human Nutrition, Northern General Hospital, and Dept. of Biomedical Sciences*, The University of Sheffield, Sheffield, U.K.
Intraluminal glucose has been shown to slow gastric emptying, reduce gastric tone and antral phasic activity. Lipid exhibits the same effects on the stomach and, in addition, can change the quality of the sensations during gastric distension from epigastric pressure and pain into sensations that more closely resemble those experienced after a meal with subsequent progression into nausea. The AIM of this study was to compare the motor and sensory responses to gastric distension during intraduodenal infusion of carbohydrate solutions of varying energy content controlled for osmolality and to investigate the hypothesis that any changes in gastric sensory responses are causally related to alterations in gastric motility. METHODS: In 10 healthy subjects (5 males, 5 females, 22-40 years old) the stomach was repeatedly distended with air (rate: 100 ml/min), while the duodenum was perfused with 0.9% saline (IS), 5% saline (HS, 1700 mosmol), glucose (GL, 1700 mosmol, 1 kcal/ml) or maltedextrin* (MD, 1600 mosmol, 2 kcal/ml). Intragastric pressure was monitored throughout. Subjects rated sensations experienced during distensions (fullness, discomfort, nausea) on visual analogue scales. Sham distensions were carded out to verify the subjects' reports. RESULTS: Gastric tone was similar during HS, GL and MD infusions, but significantly reduced compared with IS (p<0.05). Phasic contractile activity was gradually and significantly decreased: IS > HS, GL > MD (p<0.05). During HS, GL and MD infusions, sensations of fullness and discomfort during gastric distensions were reported at significantly higher gastric volumes than during IS (p<0.05). Only MD significantly changed the quality of the sensation of fullness during distension to a sensation that was often described as more satiating as opposed to a sensation of epigastric pressure with the other infusions. No significant reports were made during sham distensions. CONCLUSION: As the effects of HS, GL and MD on gastric motor responses during distensions were very similar, but only MD changed the quality of fullness into a more "meal-like" sensation, we conclude that gastric sensory responses are not directly related to changes in gastric motility. * C*Pur 01934 was a very generous gift from Cerestar GmbH, IG'efeld,Germany.
Both carbohydrates and lipid relax the proximal stomach and reduce antral contractility. We also found that both nutrients can change the quality of sensations experienced during gastric distensions from epigastric pressure and pain into more meal-like sensations and nausea at higher levels of distensions. The __AIMSof this study were to compare the effects of both nutrients with each other and to investigate the hypothesis that isocaloric nutrient solutions exhibit similar effects on gastric motility and visceral sensitivity. METHODS: 10 healthy subjects (5 males, 5 females, 22-40 years) were studied on three occasions, during which the duodenum was perfused with either isotonic saline (IS) or isocaloric (2 kcal/ml) solutions of maltodextrin* (MD) or Intralipid (IL) at a rate of 1 ml/min, while a flaccid bag positioned in the proximal stomach was repeatedly distended with air at a rate of 100 ml/min. Intragastric pressure was monitored throughout. Subjects rated sensations experienced during distensions (fullness, discomfort, nausea) on visual analogue scales. Sham distensions were carried out to verify the subjects' reports. RESULTS: Although MD and IL reduced intragastric pressure to a similar degree compared with the saline control (p<0.05), the sensory thresholds for fullness and discomfort (expressed as ml of air in the bag) were increased only during MD infusion (p<0.05). During IS, fullness and discomfort during distensions were described by the subjects as epigastric pressure and pain, respectively. Infusion of MD and IL changed fullness into a more "meal-like" sensation in 67 % and 78 % of distensions, respectively (MD vs. IL, p=0.18). Discomfort was reported as nausea in 78 % of distensions during 1L, but only in 33 % of distensions during MD. These differences were statistically significant (p<0.05). No reports were made during sham distensions. CONCLUSION: Although MD and IL have similar effects on gastric motility, their effects on gastric sensory responses to gastric distension vary. Therefore, we conclude that the energy content of the solutions is not the only factor that determines meal-like fullness and/or nausea and the thresholds at which these sensations occur. * C*Pur 01934 was a generous gift from Cerestar GmbH, Krefeld, Germany.