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Biomedical subjects

D A Drossman

Publications and source records attributed to D A Drossman.

At least 91 records · Page 5Linked to original sources
PubMed1989

Health-related quality of life in inflammatory bowel disease. Functional status and patient worries and concerns.

The assessment of health-related quality of life may be an adjunct to understanding the chronic illness experience and its effects on health outcomes. In this study, we evaluated health-related quality of life of 150 patients with inflammatory bowel disease (63 ulcerative colitis, 87 Crohn's disease). We used a standardized measure, the Sickness Impact Profile, and a questionnaire we developed that elicits and prioritizes the disease-related worries and concerns of patients with IBD. Our preliminary data indicate that: (1) IBD patients experience moderate functional impairment more in the social and psychological than in the physical dimensions; (2) Crohn's disease patients report psychosocial dysfunction to a greater degree than ulcerative colitis patients; (3) IBD patients report greatest concerns about having surgery, degree of energy, and body image issues such as having an ostomy bag; and (4) functional status and patient concerns correlate better with other measures of health status and previous health care utilization than the physician's rating of disease activity. We believe that questionnaires measuring health-related quality of life (HRQOL) can be used in research and patient care to extend the clinical assessment of patients with IBD. Further work is needed to determine the role of HRQOL relative to disease activity and other physician-based assessments in predicting health outcomes.

Adult↗
PubMed1989

Irritable bowel syndrome.

Irritable bowel syndrome is characterized by bowel irregularity (constipation and/or diarrhea), gaseous distention and abdominal pain. Symptoms usually occur in response to various biological and environmental factors. The diagnosis is made by identifying certain clinical features in association with a negative medical evaluation. Since specific treatment is not available, the patient must be helped to adapt to this chronic or recurrent disorder.

Adult↗
PubMed1988

Psychosocial factors in the irritable bowel syndrome. A multivariate study of patients and nonpatients with irritable bowel syndrome.

In this multivariate analysis of the irritable bowel syndrome (IBS) we describe the symptomatic and psychologic features of the condition and their possible contributions to health care seeking. We studied 72 IBS patients, 82 persons with IBS who had not sought medical treatment, and 84 normal subjects. All subjects received complete medical evaluation, diary card assessment of abdominal pain and stool habit, and standard psychologic tests of pain, personality, mood, stressful life events, illness behavior, and social support. Pain and diarrhea were the most important symptoms associated with patient status. When controlling for these symptoms we found that (a) IBS patients have a higher proportion of abnormal personality patterns, greater illness behaviors, and lower positive stressful life event scores than IBS nonpatients (p less than 0.001) and normals (p less than 0.001); (b) IBS nonpatients, although psychologically intermediate between patients and normals, are not different from normals (p less than 0.21); and (c) IBS nonpatients have higher coping capabilities, experience illness as less disruptive to life, and tend to exhibit less psychologic denial than patients. These factors may contribute to "wellness behaviors" among people with chronic bowel symptoms. We conclude that the psychologic factors previously attributed to the IBS are associated with patient status rather than to the disorder per se. These factors may interact with physiologic disturbances in the bowel to determine how the illness is experienced and acted upon.

Adult↗
PubMed1987

Bowel habits in young adults not seeking health care.

In order to determine bowel patterns and perceptions of diarrhea and constipation in young adults not seeking health care, we surveyed 1128 young adults about their bowel habits. The mean number of stools varied by race and sex. Whites reported more frequent stools than nonwhites (7.8 vs 6.0 stools per week, P less than 0.0001) and men reported more frequent stools than women (9.2 vs 6.7 stools per week, P less than 0.0001). Milk and coffee consumption differed by race and sex, but did not account for the differences in stool frequency. Subjects were asked to estimate the percentage of the time their stools were normal or abnormal. The median value for normal was 85% of the time; only 3.6% of subjects reported diarrhea greater than 25% of the time, and only 7.3% reported constipation greater than 25% of the time. Subjects most commonly defined constipation as straining and hard stools and diarrhea as loose/watery stools and urgency. Investigators should use race- and sex-specific norms to study individuals who have patterns which deviate from the usual. Investigators and clinicians must also consider definitions used by their subjects.

Adult↗
PubMed1987

Recollection of childhood events in adults with irritable bowel syndrome.

We examined retrospectively premorbid factors that might relate to the development of irritable bowel syndrome (IBS). We administered a semistructural interview to adult IBS patients, adults with symptoms of IBS who had not visited a doctor (nonpatients), and asymptomatic normals. Patients with IBS differed from nonpatients by reporting more severe bowel problems, more frequent doctor visits in childhood, and more pain associated with current bowel symptoms. These factors may contribute to the tendency of people with bowel symptoms to seek medical care. More patients, and in most cases nonpatients with IBS, reported poorer general health and headaches, stomachaches, and bowel complaints during childhood. They also showed evidence for greater parental attention to illness with more frequent school absences and doctor visits than normal subjects. Loss and separation during childhood, and in the current family, and conflicted or dependent maternal relationships were also more frequently reported among patients and nonpatients. These factors may contribute to the development of IBS.

Adult↗
PubMed1986

Urgency and fecal soiling in people with bowel dysfunction.

The frequency of urgency and fecal soiling in the population and among people with irritable bowel syndrome (IBS), and the association of these symptoms with health care seeking is unknown. Among 1128 students and hospital employees that we surveyed, urgency was reported in 14.4%, fecal soiling in 5.3%, and diarrhea in 9.0%. Most persons with fecal soiling did not report urgency or diarrhea. Although bowel dysfunction compatible with IBS was present in 20% (227), only 29% of this group (65) had seen a physician for bowel complaints. People with bowel dysfunction were more likely to be women, to take laxatives, and to have rectal urgency. Fecal soiling was more likely among those with bowel dysfunction who had been to the doctor, and included almost half of the men in this group. There was no difference in the frequency of diarrhea reported among those with bowel dysfunction regardless of whether they had been to the doctor. These data suggest fecal soiling may influence people with bowel dysfunction to go to the doctor. Physiological studies are needed to determine if anal sphincter dysfunction is a component of IBS.

Cathartics↗
PubMed1984

Hepatobiliary disease that precedes ulcerative colitis.

There is a variable temporal relationship between the presenting symptoms of inflammatory bowel disease and associated hepatic disease: hepatobiliary disease may precede, occur with, or occur many years after the onset of the bowel disease. We describe six patients in whom hepatobiliary disease of initially obscure origin preceded the development of inflammatory bowel disease. The colitis which subsequently developed in these patients was symptomatically mild. In our series, there was a high prevalence of sclerosing cholangitis. We conclude that in patients with chronic hepatobiliary disease of obscure origin, evaluation should include detailed questioning about bowel symptoms and routine sigmoidoscopy to screen for subclinical colitis. If a diagnosis of colitis is made in such a patient, endoscopic retrograde cholangiography may be indicated to evaluate the biliary tree for sclerosing cholangitis.

Adolescent↗