Document Detail


Understanding gastrointestinal distress: a framework for clinical practice.
MedLine Citation:
PMID:  21378758     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We describe a framework to help clinicians think about health-related quality of life in their gastrointestinal (GI) patients. We introduce "GI distress" as a clinically relevant concept and explain how it may result from physical symptoms, cognitions, and emotions. The GI distress framework suggests that providers should divide GI physical symptoms into four categories: pain, gas/bloat, altered defecation, and foregut symptoms. We describe how these physical symptoms can be amplified by maladaptive cognitions, including external locus of control, catastrophizing, and anticipation anxiety. We suggest determining the level of embarrassment from GI symptoms and asking about stigmatization. GI patients may also harbor emotional distress from their illness and may exhibit visceral anxiety marked by hypervigilance, fear, and avoidance of GI sensations. Look for signs of devitalization, indicated by inappropriate fatigue. When appropriate, screen for suicidal ideations. Finally, we provide a list of high-yield questions to screen for these maladaptive cognitions and emotions, and explain how the GI distress framework can be used in clinical practice.
Authors:
Brennan M R Spiegel; Dinesh Khanna; Roger Bolus; Nikhil Agarwal; Puja Khanna; Lin Chang
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  106     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-07     Completed Date:  2011-04-28     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  380-5     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Abdominal Pain / etiology
Anxiety / complications*
Catastrophization / etiology
Cognition
Constipation / etiology
Diarrhea / etiology
Emotions
Fear
Fecal Incontinence / etiology
Gastrointestinal Diseases / physiopathology,  psychology*
Gastrointestinal Tract / physiopathology*
Health Status
Humans
Internal-External Control
Mass Screening
Quality of Life
Questionnaires
Stereotyping
Stress, Psychological / complications*,  etiology*
Grant Support
ID/Acronym/Agency:
AR052177/AR/NIAMS NIH HHS; U01 AR057936/AR/NIAMS NIH HHS; U01 AR057936-01/AR/NIAMS NIH HHS; U01 AR057936A/AR/NIAMS NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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