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Biomedical subjects

W G Thompson

Publications and source records attributed to W G Thompson.

At least 37 records · Page 2Linked to original sources
PubMed1999

The road to Rome.

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Colonic Diseases, Functional↗
PubMed1997

Negative affect and the seeking of medical care in university students with irritable bowel syndrome: a preliminary study.

In a preliminary study using only self-report measures, university students completed questionnaires about their bowel symptoms and trait anxiety. Results showed that students with irritable bowel syndrome (IBS) reported higher trait anxiety than asymptomatic controls. Among the students with IBS, there were no significant differences in trait anxiety between those who had sought medical care for IBS mostly from a primary care physician, and those who had not sought care for IBS. Students who had sought medical care for IBS reported being more bothered by the symptoms and were more concerned about their meaning than those students who had not sought care. The results are compared to other research with IBS patients referred to specialist clinics, and a distinction is made between initial vs. continued care seeking for IBS.

Adolescent↗
PubMed1997

Gender differences in irritable bowel symptoms.

OBJECTIVE: Some data suggest that the Manning criteria for diagnosis of the irritable bowel syndrome (IBS) are less reliable in men. This research aims to detect gender differences in the prevalence of individual diagnostic criteria in IBS patients. DESIGN: One hundred and fifty-six IBS patients (26 males, 130 females) were asked about their bowel symptoms including the Manning and Rome criteria. RESULTS: In the IBS group, 90.4% fulfilled the Manning criteria (91.5% females, 84.6% males), and 68.6% the Rome criteria (70.8% females and 57.7% males). The three pain-related criteria (pain relieved by defecation, pain followed by change in stool frequency or stool consistency) were similarly present in males and females. However, mucus, feeling of incomplete evacuation, and distension were found in 86 (66.2%), 78 (60%) and 72 (55.4%) of the women, compared to 10 (38%), 7 (26.9%) and 9 (36.9%) of the men (P<0.009, P<0.002 and P=0.053, respectively). Scybala, which are among the Rome criteria, were also less prevalent in males (7.7% vs. 29.2% (P<0.03)). CONCLUSION: Among IBS patients, pain-related Manning symptoms are similar in men and women, but mucus, incomplete evacuation, distension and scybala are less common in men. Less reporting of these symptoms by men may account for reduced clinical reliability of the Manning or Rome criteria in men and their apparent low prevalence of IBS.

Adult↗
PubMed1997

Irritable bowel syndrome: the view from general practice.

OBJECTIVE: To determine the attributes of the irritable bowel syndrome (IBS) in general practice as perceived by the doctors. SUBJECTS AND METHODS: We administered a 93-item questionnaire about the terminology, diagnosis and treatment of the irritable bowel to 43 of 55 randomly selected general practitioners (28 men, 15 women). RESULTS: General practitioners were unfamiliar with the Manning criteria for the irritable bowel syndrome. Nevertheless, most of them diagnosed the irritable bowel with reasonable confidence and it is less troublesome to them than pelvic pain, headache or backache. Their main concern was excluding organic disease (63%) and 65% believed their patients shared this concern. Nevertheless, they ordered few tests and were often (72%) prepared to make the diagnosis on the initial visit. They estimated that they referred only 14% of IBS patients to specialists, in most cases (56%) because of an unsatisfied patient and in 35% because of an uncertain diagnosis. For treatment, most (77%) chose 'explanation and reassurance'. Virtually all employed drugs, usually several. CONCLUSION: General practitioners say they diagnose the irritable bowel syndrome with less difficulty than other common, painful disorders, but it would be helpful to find out exactly how they do so. Their confidence could be increased by use of diagnostic criteria. Patients referred to specialists are likely to be a minority of hard-to-satisfy people. The optimal approach to such patients should be developed by general practitioners and specialists together. Specialists should strive to satisfy the patient and confirm the diagnosis in the few that are referred. Drug usuage in the irritable bowel syndrome is more than is justified and should, in our view, be minimized.

Adult↗
PubMed1996

Contemporary English health care: what lessons can we learn from it?

Even though the United Kingdom has developed a reputation for lengthy patient queues, two-tier medicine and inadequate hospital facilities, its National Health Service (NHS) has some valuable attributes that are worth studying as Canada struggles to control its health care costs. Dr. Grant Thompson thinks the NHS focus on the GP as the entry point to health care and the resulting continuity of care, as well as a central medical record system, are successes that could be incorporated into Canada's medicare system.

Canada↗
PubMed1996

Irritable bowel syndrome.

The irritable bowel syndrome (IBS) is very common in the community. Psychosocial factors other than the gut symptoms themselves may contribute to the decision of a few to seek medical care. Examination of these not only suggests that the manifestation of symptoms is multifactorial, but also offers clues for management of individuals. There is evidence for both physical and psychological contributions to IBS symptoms and both together may induce illness behavior. In some, many factors may be present, in others apparently none, but the more factors at work, the more complex the treatment. Management should take advantage of the known features of the disease. Its prevalence, recognizable symptoms, and benign nature underpin the reassurance value of a positive diagnosis. Psychopathology or antecedent stressful life events may indicate psychological treatments. Although drugs are unproved in the global treatment of IBS, certain agents may benefit specific symptoms and use the placebo response to advantage. Patients having more difficulty treating symptoms need continuing care. A graded response to IBS complaints implies reassurance and drug-free management in primary care, with increments of psychosocial support, psychotherapy, and the specific use of drugs in nonresponders. The goal for intractable cases should be improved functioning rather than cure.

Colonic Diseases, Functional↗
PubMed1995

Dyspepsia: is a trial of therapy appropriate?

Dyspepsia is a common, benign condition that may be distinguished from gastroesophageal reflux, irritable bowel syndrome and pancreatobiliary, coronary or musculoskeletal disease by a careful history and physical examination. However, the presence or absence of a peptic ulcer in dyspepsia can be determined only by an endoscopic examination or a barium-contrast radiograph. Although the American College of Physicians has recommended trying drug therapy for patients with dyspepsia before diagnostic tests are done, new data support early diagnosis. Although therapy is initially cheaper than endoscopic examination, over a year the costs even out because most patients with dyspepsia eventually need an endoscopic examination, and many patients with nonulcer dyspepsia are given medication unnecessarily. Endoscopic examination, if available to general practitioners, is the most cost-effective approach to dyspepsia. An approach that does not include endoscopy lacks the opportunity to offer patients convincing reassurance that their illness is not serious, which is arguably the most important treatment in cases of nonulcer dyspepsia. Studies supporting the use of endoscopic examination predate the treatment of peptic ulcers with antibiotics, which makes an initial endoscopic examination to determine whether the patient has an ulcer even more important.

Anti-Ulcer Agents↗
PubMed1994

Clinical management of intractable constipation.

PURPOSE: To review current management of intractable constipation. DATA SOURCES: Original articles and reviews published in the English-language literature between 1965 and 1993 identified by MEDLINE search. Verbal feedback from attendees after presentation of the document as a clinical symposium at the 14th International Symposium on Gastrointestinal Motility in September 1993. STUDY SELECTION: Key words included constipation, epidemiology, colonic inertia, pseudo-obstruction, pelvic floor dysfunction, and results of therapeutic interventions, particularly the effects of biofeedback training and subtotal colectomy. RESULTS: In most patients, constipation is usually due to lack of dietary fiber and responds to simple measures to correct these factors, often without consulting a physician. In some, probably fewer than 10% of patients who consult their physicians, structural diseases of the colon and rectum, systemic disease, or medications that slow gut transit should be excluded, and regular exercise, dietary fiber, and an osmotic laxative prescribed. In a series of 277 highly selected patients from a tertiary referral center who had intractable constipation, only 29% had a definable abnormality; identification of abnormal transit facilitates selection of patients for further investigations identifying colonic inertia or pelvic floor dysfunction. CONCLUSION: An algorithmic approach can carefully select patients with intractable constipation for behavioral modification and biofeedback; the long-term outcome is excellent, with at least 75% success in several series. In a minority of patients with slow transit constipation unresponsive to medical treatment, subtotal colectomy with ileorectostomy is indicated and effective.

Algorithms↗
PubMed1994

Doubts about bran.

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Colonic Diseases, Functional↗
PubMed1994

Coffee: brew or bane?

Coffee is the most commonly used drug in the United States. The medical literature is conflicted regarding the harmful effects of coffee and caffeine. Because the articles that have appeared are so different, a formal meta-analysis is not the ideal way to summarize the data. However, this literature review suggests that coffee does not have an appreciable effect on hyperlipidemia, hypertension, ischemic heart disease, or cancer. The effects of decaffeinated coffee are much less well-defined, and there is little rationale for recommending that patients switch to decaffeinated coffee. A less appreciated problem with caffeine is that it may increase the risk of osteoporosis and hip fracture.

Caffeine↗
PubMed1994

Irritable bowel syndrome. Strategy for the family physician.

Irritable bowel syndrome is one of the most common reasons for disability and health care seeking. A sensible strategy for management incorporates a confident diagnosis based upon history, physical examination, and pertinent tests. The physician can then reassure the patient, offer dietary and stress management advice, and recommend bran to relieve constipation and to evoke the placebo response. Patients who do not respond could require supportive psychotherapy or a drug for the dominant symptom. A few require careful referral, but overall responsibility should remain with the primary physician.

Aftercare↗