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Biomedical subjects

I Wilhelmsen

Publications and source records attributed to I Wilhelmsen.

At least 19 recordsLinked to original sources
PubMed2004

Comorbidity of irritable bowel syndrome in general practice: a striking feature with clinical implications.

BACKGROUND: Somatic comorbid symptoms might identify irritable bowel syndrome patients with different aetiologies and needs of treatment. AIMS: To measure comorbid symptoms in patients with irritable bowel syndrome in general practice, and to explore characteristics of patients with low, intermediate and high somatic comorbidity. METHODS: Prospective study of 208 of 278 consecutive patients with irritable bowel syndrome (Rome II) in nine general practices. Questionnaires assessed 22 comorbid symptoms (subjective health complaint inventory), psychosocial factors including psychological distress (Symptom Check list-10) and quality of life (Short form-12). Subjective health complaint data from 1240 adults (controls) constituted a reference material. Patients with low, intermediate and high somatic comorbidity were identified by a somatic comorbidity score (17 subjective health complaint items). Health care seeking was assessed after 6-9 months. RESULTS: Patients with irritable bowel syndrome (67% females, mean age 50, s.d. 16) reported 20 of 22 comorbid symptoms significantly more frequent than controls (odds ratios = 2-7, P < 0.001). The somatic comorbidity score correlated with psychological distress (R = 0.46, P < 0.001). Patients with high somatic comorbidity reported higher levels of mood disorder, health anxiety, neuroticism, adverse life events and reduced quality of life and increased health care seeking when compared to those with low and intermediate somatic comorbidity (P-values < 0.05). CONCLUSIONS: Our findings support the hypothesis that structured assessment of comorbid somatic symptoms might identify subgroups with different aetiology and needs of treatment.

Adult↗
PubMed2004

Reduced relapse rate in duodenal ulcer disease leads to normalization of psychological distress: twelve-year follow-up.

BACKGROUND: The aim of this study was to elucidate the relationship between duodenal ulcer (DU) disease and psychological symptoms. METHODS: Sixty-four Helicobacter pylori-positive patients with frequently relapsing DUs (patient group 1) were compared with 78 control subjects without dyspepsia, starting 2 years before and ending 10 years after eradication of H. pylori. Seven non-relapsing and untreated patients (patient group 2) were also followed-up. RESULTS: The relapse rate was reduced from 100% per year in the two years before anti-H. pylori treatment to 0.3% per year after treatment in patient group 1. The reinfection rate was 0.7% per year. Anxiety and neuroticism were high at inclusion, but had normalized at the 10-year follow-up in relapse-free patients. There was no increase of gastro-oesophageal reflux symptoms during the 10 years after H. pylori eradication. CONCLUSIONS: Normalization of anxiety and neuroticism following cure of DU disease supports the view that the increased anxiety and neuroticism are consequences, and not causes, of the disease.

Adolescent↗
PubMed1999

On demand therapy of reflux oesophagitis--a prospective study of symptoms, patient satisfaction and quality of life.

BACKGROUND: In patients with low-grade reflux oesophagitis adequate symptom control is the aim of treatment. Effervescent tablets alleviate heartburn more rapidly than ordinary tablets. AIM: To investigate symptom control, patient satisfaction, health-related quality of life and disease progress when ranitidine 150 mg effervescent tablets were offered as on demand treatment. We also wanted to investigate whether any biological or psycho-social factor could predict patient satisfaction. METHOD: Consecutive patients with endoscopically verified reflux oesophagitis grade I-II were followed up for 12 months. 24 h pH-metry, disease history, symptoms and several psycho-social factors were registered at baseline and 12 months follow-up. RESULTS: Eighty-one patients were included. Mean age was 50.7 years (range 21-82), 63% were men. Mean tablet consumption was 1.21 per day (range 7-1016 tablets/year). At the 1-year follow-up discomfort resulting from reflux symptoms was significantly reduced (P<0.001), and the patients' social and vocational life improved. Eighty-four percentage of the patients were satisfied with the treatment. 24 h pH-metry or number of reflux episodes did not change. We did not find any factors able to predict patient satisfaction. CONCLUSIONS: On demand therapy with ranitidine effervescent tablets was well accepted by the majority of patients with reflux oesophagitis grade I. Even though the number of reflux episodes did not change, the patients experienced less discomfort due to reflux symptoms, and their social and vocational life was better. There was no significant progression of the disorder during the 1-year follow-up. No predictive factor for patient satisfaction was found.

Adult↗
PubMed1999

The psychologic effect of attending a screening program for colorectal polyps.

BACKGROUND: Participation in screening programs for malignant disease may have negative psychologic health effects that could outweigh the beneficial effects of the screening itself. The present study was designed to investigate the psychologic effect of attending a screening program for detection and removal of colorectal adenomas, which are precursors to colorectal cancer. METHOD: In 1983 a prospective. controlled screening study using flexible sigmoidoscopy to detect adenomas was started in Telemark County, Norway. Four hundred individuals were enrolled as a screening group and 399 as a control group. In 1996 survivors in both groups were invited to have a colonoscopic screening examination for detection and removal of polyps. Four hundred and fifty-one individuals (71%) attended; their mean age was 67.2 years (range, 63-72 years), and 48% were women. Fourteen days and 3 and 17 months after the examination the attendees received by mail a questionnaire composed of Goldberg's General Health Questionnaire (GHQ-28) and the Hospital Anxiety and Depression Scale (HADS). The questionnaire was also mailed to an age- and sex-matched group not enrolled in the endoscopic screening study. Four hundred and nine (95%), 395 (92%), and 389 (91%), respectively, returned the questionnaire. Of the controls 314 (70%) returned filled-in questionnaires. RESULTS: The scores for both GHQ-28 and HADS were lower, indicating a lower level of psychiatric morbidity among those attending the examination in 1996 than among the controls. There was a trend towards higher scores with increasing time after the examination in the screened group. CONCLUSION: During the first 17 months after screening the attendees, as a group, did not appear to have developed untoward psychologic effects as judged by HADS and GHQ questionnaires.

Anxiety↗
PubMed1996

[Cognitive therapy of subjective somatic symptoms].

In this article we present a model for the interaction between physical, psychological and social factors in the production of subjective somatic complaints, which is the most common reason for visiting a doctor. Especially if the patient has subjective somatic symptoms for which there is no apparent organic reason it may be important to motivate the patient to examine all the different factors that contribute to the vicious circle he/she often enters into. The following elements of this circle are explained: Physical (symptoms, signs, findings), beliefs (thoughts, cognitive processes and cognitive schemas), feelings (emotions), behaviour (all we say and do) and the so-called X-factor, which represents everything we do not know. The model might help us in our relationship to the patients, and can be used both in connection with known somatic disease and with conditions with a multifactorial genesis, like somatoform disorders.

Cognitive Behavioral Therapy↗
PubMed1996

Impaired accommodation of proximal stomach to a meal in functional dyspepsia.

In patients with functional dyspepsia, scanning by a novel ultrasonographic method was carried out to investigate postprandial accommodation of the proximal stomach. Twenty patients with functional dyspepsia and 20 controls were scanned fasting in a sitting position after drinking 500 ml meat soup. Images were recorded up to 25 min after the ingestion period using an ultrasound sector scanner with a 3.25-MHz transducer. The area in a sagittal section and the maximal diameter in a oblique frontal section were chosen as the main variables for calculating the emptying fraction of the proximal stomach, defined as: (aV2.5min - aVactual/aV2.5min. All subjects were asked to score total symptoms (1-9) provoked by the meal. From 7.5 to 25 min after the ingestion period the patients exhibited both smaller area in the sagittal section (P < 0.018) and shorter diameter in the frontal section (P < 0.046) compared with the healthy controls, and they suffered more symptoms in response to the meal (P = 0.002). Dyspeptic patients revealed higher emptying fractions (P = 0.0005, ANOVA), and H. pylori status did not influence the emptying fractions. Diagnostic sensitivity of the method at 20 min postprandially was 70% and the specificity was 65%. Patients with functional dyspepsia have impaired accommodation of the proximal stomach to a meal, temporarily related to symptom induction.

Adult↗
PubMed1996

Bismuth therapy for Helicobacter pylori infection. A review of five years experience at a university hospital in Norway.

BACKGROUND: Eradication of H. pylori cures peptic ulcer disease. Bismuth and antibiotics in various combinations were tested at a single university hospital. METHODS: The standard treatment was bismuth subnitrate, metronidazole and oxytetracycline. A positive biopsy urease test was the main inclusion criterium, whereas a negative 14C-urea breath test performed at least four weeks after cessation of therapy was the main indicator of cured infection, and performed later for reinfection. In separate studies we tested the absorption of bismuth subnitrate compared to other bismuth preparations, what aspects of bismuth-based triple therapy are most important to obtain maximum eradication, what can be done to decrease side effects, and the reliability of diagnostic methods. RESULTS: The absorption of bismuth from bismuth subnitrate was very low. More than 90% cure rates were usually obtained. Including metronidazole in the regimen increased side effects but was crucial for effectiveness. Spiramycine could replaced oxytetracycline without substantial loss of effectiveness. Effectiveness was decreased if the patients had recently used metronidazole. Aluminium containing antacids and chlorhexidine were not very useful. Side effects were frequent, up to 60%, but usually mild and very few patients withdrew from treatment. Adding ranitidine to the regimen reduced abdominal pain. 14C-urea breath test was the "gold standard" and the specificity of the biopsy urease test in diagnosing H. pylori infection was high. CONCLUSIONS: Bismuth combination therapy combines high effectiveness with acceptable side effects and low cost. Biopsy urease test and urea breath test are reliable indicators of H. pylori infection.

Antacids↗
PubMed1996

Quality of life and Helicobacter pylori eradication.

BACKGROUND: It has convincingly been shown that relapses of duodenal ulcers are significantly reduced after eradication of Helicobacter pylori. The aim of this study was to examine the long-term effect of bacteria eradication on Quality of Life (QOL) and subjective somatic symptoms. METHODS: Seventy-four Helicobacter pylori-positive patients with recurrent duodenal ulcer disease were treated with triple treatment. Relapses, H. pylori status, QOL and subjective somatic symptoms were registered at yearly intervals for 4 years. RESULTS: Preliminary results show that the patients were more satisfied with the healthcare system, had better sexual relationships and less psychological distress up to 3 years after eradication of the bacteria. They also had fewer symptoms of exhaustion and less stomach discomfort than before triple treatment. CONCLUSION: Long-term follow-up of patients after eradication of H. pylori shows that QOL is improved and feeling of exhaustion and stomach discomfort reduced.

Adult↗
PubMed1995

Discriminant analysis of factors distinguishing patients with functional dyspepsia from patients with duodenal ulcer. Significance of somatization.

Patients with duodenal ulcer or functional dyspepsia do not differ on dyspeptic symptoms. The aim of the present study was to test the hypothesis that functional dyspepsia and duodenal ulcer are two different diagnostic entities by examining the discriminating power of several anamnestic, biological, and psychosocial variables. Ninety-four patients with duodenal ulcer and 86 patients with functional dyspepsia were included. Anamnestic data, global assessment, Helicobacter pylori status, blood group, Lewisa+ phenotype, and several measures of psychological distress and somatic complaints were registered. Compared to patients with functional dyspepsia, the duodenal ulcer patients were more often infected by Helicobacter pylori and had their stomach discomfort more often relieved by eating. Compared to patients with duodenal ulcer, patients with functional dyspepsia had higher scores of depression, trait anxiety, general psychopathology and different somatic complaints (called somatization). They were also less satisfied with the health care system, their disorder had a greater negative impact on their quality of life, and their global assessment of own health was poorer. Discriminant analysis including age, smoking, Helicobacter pylori status, global assessment, and somatic complaint classified 86.1% of the patients correctly (77.9% of the patients with functional dyspepsia and 93.6% of the patients with duodenal ulcer). It is concluded that duodenal ulcer and functional dyspepsia are two separate diagnostic entities. Patients with duodenal ulcer are older, smoke more often, and almost all are infected with Helicobacter pylori, while patients with functional dyspepsia are characterized by somatization and a negative assessment of their own health.

Adult↗
PubMed1995

Spiramycin in triple therapy of Helicobacter pylori-associated peptic ulcer disease. An open pilot study with 12-month follow-up.

BACKGROUND: Spiramycin (Rovamycin) is a well-established macrolide antibiotic with good anti-Helicobacter pylori activity in vitro. It is acid-stable and found in high concentration in various body fluids and cells after oral administration. Its anti-H. pylori activity in vivo has not yet been tested. METHODS: Twenty-five consecutive patients with endoscopically verified peptic ulcer and a positive biopsy urease test were given spiramycin tables 1.5 MIU instead of oxytetracycline 500 mg q.d.s. in our triple therapy regimen with bismuth subnitrate suspension 10 mL (150 mg bismuth subnitrate) q.d.s. and metronidazole 400 mg t.d.s. for 10 days. Bismuth was taken between meals and spiramycin and metronidazole with meals. Re-endoscopy and 14C-urea breath test were performed 4 weeks after completion of therapy. Those who were H. pylori negative according to the breath test returned for 1-year follow-up. RESULTS: Per protocol analysis at 4 weeks showed that 21 out of 23 patients were H. pylori negative and had healed ulcers. These 21 patients were persistingly H. pylori negative and had no ulcers at 1-year follow-up. H. pylori eradication and ulcer healing rates were thus 91.3%; 95% confidence interval from 72.0% to 98.9%. Side-effects limiting daily activity were significantly less frequent than we have experienced previously using oxytetracycline in triple therapy. CONCLUSIONS: Spiramycin appears to be an alternative to tetracycline in the triple therapy of H. pylori infection. Further studies to position spiramycin as an anti-H. pylori drug are warranted.

Adult↗
PubMed1995

Life events and stress in patients with functional dyspepsia compared with patients with duodenal ulcer and healthy controls.

BACKGROUND: Life events and stress may be important for functional dyspepsia and duodenal ulcer. METHODS: The perception of life events in the preceding 6 months was recorded in 100 patients with functional dyspepsia, 100 patients with duodenal ulcer, and 100 healthy controls. In addition, psychologic and social factors were assessed. RESULTS: Patients with functional dyspepsia experienced significantly more life events than patients with duodenal ulcer and healthy controls. The difference in life events between the groups was due to the difference in stressful life events. The patients with functional dyspepsia had higher levels of state-trait anxiety, general psychopathology, and depression than patients with duodenal ulcer and healthy controls. CONCLUSION: Patients with functional dyspepsia had higher scores on negative life events than patients with duodenal ulcer and healthy controls. This may be causally related to the higher levels of anxiety, depression, and general psychopathology in these patients.

Adult↗
PubMed1995

Quality of life in upper gastrointestinal disorders.

BACKGROUND: There is increased interest in the concept 'quality of life'. Available instruments are defined and discussed, with special emphasis on reliability and validity. Research on quality of life in patients with upper gastrointestinal disorders is reviewed, and our own results presented. METHODS: The Psychosocial Adjustment to Illness Scale was used to compare 100 patients with functional dyspepsia and 100 patients with duodenal ulcer in a cross-sectional study, and to monitor the quality of life of 74 duodenal ulcer patients in a longitudinal phase. RESULTS: The quality of life of patients with functional dyspepsia was more negatively affected than that of patients with duodenal ulcer. After half of the patients had received short-term cognitive psychotherapy and all had received prophylactic H2-blocker treatment after ulcer relapse, quality of life improved in both the treatment group and the control group. Seventy-four patients with recurrent duodenal ulcers reported higher satisfaction with the health care system, improved sexual relationship, and less psychological distress one year after cure of the ulcer disease by the eradication of Helicobacter pylori compared to before. CONCLUSIONS: Reliable and valid instruments are available to measure quality of life, and will probably gain increased importance in future medical research. In patients with recurrent duodenal ulcer disease, quality of life improves with the eradication of Helicobacter pylori.

Adolescent↗
PubMed1995

What are the real problems for patients with functional dyspepsia?

BACKGROUND: Patients with functional dyspepsia (FD) have more complaints than just the dyspepsia. METHOD: One hundred FD patients were assessed with regard to psychologic, medical, and social factors, before randomization, in a study of cognitive therapy. They were asked to list their main problem areas or 'target complaints'. RESULTS: Dyspepsia was the third most frequent target complaint (26 patients), and anxiety was the most frequent one (65 patients). Patients identifying dyspepsia as a target complaint differed from the other FD patients in several aspects. They had significantly more dyspeptic symptoms (p < 0.05) and scored significantly higher on multiple somatic complaints (p = 0.001), depression (p = 0.025), general psychopathology (p = 0.043), the global assessment scale (p = 0.001), and the General Health Questionnaire (p = 0.040). However, they did not have more somatic predisposing factors like consumption of alcohol and coffee or infection with Helicobacter pylori than the patients with other target complaints. CONCLUSIONS: Anxiety and not dyspepsia was the most frequent target complaint, and patients who identified dyspepsia as a target complaint did not have more somatic predisposing factors.

Adult↗
PubMed1994

[10 days of triple treatment of Helicobacter pylori infection and peptic ulcer. Status after treatment of 4 weeks and of one year].

We treated 143 Helicobacter pylori positive ulcer patients (duodenal ulcer 81, gastric ulcer 24, pyloric ulcer nine, previous duodenal ulcer 27, others two) with a ten days regimen of bismuth subnitrate, oxytetracycline and metronidazole. Four weeks after cessation of treatment the 14C-urea breath test showed that the infection was eradicated in 133 out of 140 patients (95%). The ulcer had healed in 129 (97%) of the H. pylori negative patients. Status at one year after treatment showed that 121 (98.4%) of 123 patients who had become H. pylori negative had remained negative. None of the H. pylori negative patients experienced ulcer relapse. The results show that the treatment is effective and that the rate of recurrence of H. pylori during the first year is very low.

Adult↗