| Understanding gastrointestinal distress: a framework for clinical practice. | |
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MedLine Citation:
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PMID: 21378758 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Brennan M R Spiegel; Dinesh Khanna; Roger Bolus; Nikhil Agarwal; Puja Khanna; Lin Chang |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: The American journal of gastroenterology Volume: 106 ISSN: 1572-0241 ISO Abbreviation: Am. J. Gastroenterol. Publication Date: 2011 Mar |
Date Detail:
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Created Date: 2011-03-07 Completed Date: 2011-04-28 Revised Date: 2011-06-06 |
Medline Journal Info:
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Nlm Unique ID: 0421030 Medline TA: Am J Gastroenterol Country: United States |
Other Details:
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Languages: eng Pagination: 380-5 Citation Subset: IM |
Affiliation:
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Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA. bspiegel@mednet.ulca.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Abdominal Pain
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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:
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AR052177/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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