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PubMed2004

Symptom patterns in functional dyspepsia and irritable bowel syndrome: relationship to disturbances in gastric emptying and response to a nutrient challenge in consulters and non-consulters.

BACKGROUND: Our aim was to assess the relationship between gastric motor and sensory function and symptom patterns in community subjects and patients with functional dyspepsia (FD) or irritable bowel syndrome (IBS). METHODS: We recruited 291 asymptomatic blood donors, 151 symptomatic blood donors (recurrent abdominal pain or discomfort), and 40 patients with FD or IBS. Abdominal symptoms were assessed using the bowel disease questionnaire (BDQ) and, in addition, the most bothersome symptom complex identified (dysmotility-type, ulcer-type dyspepsia, or IBS). Gastric emptying time (GET (t(1/2), min)) was measured by (13)C-octanoic breath test and a nutrient challenge performed. Twenty randomly selected asymptomatic blood donors, 48 symptomatic blood donors (30 FD, 18 IBS), and 40 patients (23 FD, 17 IBS) had additional function testing. RESULTS: GET (t(1/2)) was significantly (p<0.05) longer in blood donors with FD symptoms (99 (6) min) and FD patients (110 (12) min) compared with asymptomatic controls (76.7 (7) min), but was not significant in IBS blood donors or patients. Overall, 25 of 48 blood donors with symptoms and 18 of 40 patients had slow gastric emptying. GET was most delayed in subjects with predominantly dysmotility-type symptoms (167 (36) min v controls; p<0.01). Symptom intensities after a nutrient challenge were significantly higher in FD patients and symptomatic blood donors compared with asymptomatic controls; 14 of 48 blood donors with symptoms and 16 of 40 patients had a symptom response to the nutrient challenge exceeding the response (mean (2SD)) of healthy asymptomatic controls. CONCLUSION: Gastric emptying and the global symptom response to a standardised nutrient challenge are abnormal in population based (non-health care seeking) subjects with dyspepsia.

Adolescent↗
PubMed1998

[The report 'Late termination of pregnancy: caution and assessment' by the consultant group Late Termination of Pregnancy. Consultant Group Late Termination of Pregnancy].

Late termination of pregnancy means terminating a pregnancy after 24 weeks or more following the detection of severe foetal abnormalities, with the aim of bringing about the death of the fetus. According to a recent document on 'Late pregnancy termination: caution and assessment' severe foetal anomalies can be divided into two categories: (a) abnormalities which would inevitably result in perinatal death; (b) abnormalities which lead to severe and irreversible functional disorders, although with a (limited) chance of survival; postnatal life-prolonging treatment only leads to continuation of a hopeless situation for the infant. Category I contravenes the rationale of article 82a of the Dutch Criminal Code which is aimed at providing legal protection for the unborn infant from the moment it becomes viable. Late pregnancy termination in this category should not be considered an offence. Late pregnancy termination regarding category 2 infants could be an offence. However, an appeal based on circumstances beyond the defendant's control, arising from a conflict of duties could lead to nolle prosequi. A case of late termination of pregnancy should be notified as a case of non natural death.

Abortion, Legal↗