Showing papers by "Jane M. Andrews published in 2009"

Fear and fertility in inflammatory bowel disease: a mismatch of perception and reality affects family planning decisions.

Abstract: BACKGROUND: Smaller family size and voluntary childlessness has been reported in IBD; however the disease-related reasons for this from a patient viewpoint are not described. The aims were to 1) determine whether IBD patients perceptions of the issues surrounding IBD pregnancy and childbearing influence their reproductive behavior and 2) describe these specific perceptions and concerns related to fertility and pregnancy. METHODS: All contactable subjects between 18-50 years of age from a hospital-based IBD database were surveyed by postal questionnaire. Data were obtained regarding age gender IBD diagnosis and treatment body image and sexual relationships as well as both objective and subjective data regarding fertility and pregnancy. Comparisons were made to community norms where data were available. Contingency tables with Fishers exact test were used. RESULTS: Of 365 subjects 255 responded (70%). The mean age was 35.5 years overall 34.7 years for women. In all 34% of participants were male 127 had Crohns disease (CD) 85 ulcerative colitis (UC) and 5 indeterminate colitis (IC). The average fertility rate was no different between women with CD and UC (1.0 and 1.2 births/woman respectively; P = 0.553) compared with 1.81 for all Australian women. Although 42.7% of IBD patients reported a fear of infertility patients only sought medical fertility advice at the same rate as the general population. Fear of infertility was most evident in women those with CD and those reporting previous surgery. Specific patient concerns which appear to have decreased patients family size included IBD heritability the risk of congenital abnormalities and medication teratogenicity. CONCLUSIONS: The unusually high response rate indicates the centrality of reproductive issues to IBD patients. "Voluntary" childlessness in this group appears to result from concerns about adverse reproductive outcomes that may not be justified. Patients require accurate counseling addressing fertility and pregnancy outcomes in IBD to assist in their decision making.

Systematic review: does concurrent therapy with 5-ASA and immunomodulators in inflammatory bowel disease improve outcomes?

Abstract: Summary Background With greater use of immunomodulators in inflammatory bowel disease (IBD), it is uncertain whether concurrent therapy with both 5-aminosalicylic acid [5-ASA, mesalazine (mesalamine)] and an immunomodulator is necessary. Aim To determine whether concurrent therapy with both 5-ASA and immunomodulator(s) improves outcomes in IBD. Methods Systematic review with search terms ‘azathioprine, 6-mercaptopurine, thiopurine(s), 5 aminosalicylic acid, mesalazine, inflammatory bowel disease, ulcerative colitis, Crohn’s disease, immunosuppressant(s), immunomodulator and methotrexate’ in November 2007 to identify clinical trials on concurrent 5-ASA and immunomodulator therapy. Results Two small controlled studies were found. Neither showed a benefit on disease control beyond immunomodulator monotherapy. Potential pharmacological interactions exist between 5-ASA and thiopurines. Whilst circumstantial, epidemiological and laboratory evidence suggests that 5-ASA may assist colorectal cancer (CRC) chemoprevention, it may simply be via anti-inflammatory effects. With changes in practice, ethical issues and the long lead-time needed to demonstrate or disprove an effect, no clinical studies can/will directly answer this. The costs of avoiding one CRC in IBD may be as low as 153 times the annual cost of 5-ASA therapy. Conclusions It is unclear whether concurrent 5-ASA and immunomodulator therapy improves outcomes of disease control, drug toxicity or compliance. Concurrent therapy of 5-ASA and immunomodulators may decrease CRC risk at ‘acceptable’ cost.

Age and gender affect likely manometric diagnosis: Audit of a tertiary referral hospital clinical esophageal manometry service

Abstract: BACKGROUND AND AIM: Awareness of patient demographics, common diagnoses and associations between these may improve the use and interpretation of manometric investigations. The aim of the present study therefore was to determine whether age and/or gender affect manometric diagnosis in a clinical motility service. METHODS: An audit of all 452 clinical manometry reports issued from December 2003 to July 2005 with respect to age, gender and diagnosis was carried out. Patients were divided by age (17-24 years n = 14, 25-44 years n = 87, 45-64 years n = 216 and >or=65 years n = 135), and gender and data compared using contingency tables. RESULTS: Women were more commonly referred overall (59%) and in each age bracket except <25 years (64% male). Men were more likely to have 'hypotensive' motor problems P = 0.01. With aging, normal motor function became less common (P = 0.013), with non-specific motor disorder, ineffective/hypotensive peristalsis and 'achalasia-like' conditions each more common (individual P = NS). Increasing age showed a trend for increased spastic motor disorders (P = 0.06). Gender did not, however, influence whether motility was abnormal (P = 0.5), spastic (P = 0.7) or whether a non-specific motor disorder was present (P = 0.1). In the total cohort, the principal manometric diagnoses were: non-specific motor disorder 33%, normal motility 29%, low basal lower esophageal sphincter pressure 18%, hypotensive/ineffective peristalsis 10%, achalasia/achalasia-like 6%, diffuse esophageal spasm 3% and other 1%. CONCLUSIONS: Aging leads to increasing esophageal motor abnormalities. Men and women have similar rates of dysfunction, although 'low-pressure problems' were more common in men.

Management of Reflux Symptoms with Over-the-Counter Proton Pump Inhibitors: Issues and Proposed Guidelines

Abstract: Background: Symptoms of gastroesophageal reflux are widely prevalent There is a continuum between subjects with mild reflux symptoms and those severely affected by gastroesophageal

Psychogastroenterology: a call for psychological input in Australian gastroenterology clinics

Abstract: Gastroenterologists should be able to refer patients directly to psychologists with full Medicare reimbursement. Psychological comorbidities are frequently seen in patients with gastrointestinal conditions. However, time pressure and lack of expertise in non-medical therapies of psychological problems prevent gastroenterologists from initiating psychological treatment although such treatment may improve patients' outcomes and reduce health-care utilization. Psychologists are needed as part of the multidisciplinary team in gastroenterology clinics in Australia to take the leading role in the psychological management of those patients by contributing to screening, faster diagnosis and treatment of depression and anxiety disorders in particular.

Psychogastroenterology: a call for psychological input in Australian gastroenterology clinics

Abstract: Gastroenterologists should be able to refer patients directly to psychologists with full Medicare reimbursement. Psychological comorbidities are frequently seen in patients with gastrointestinal conditions. However, time pressure and lack of expertise in non-medical therapies of psychological problems prevent gastroenterologists from initiating psychological treatment although such treatment may improve patients' outcomes and reduce health-care utilization. Psychologists are needed as part of the multidisciplinary team in gastroenterology clinics in Australia to take the leading role in the psychological management of those patients by contributing to screening, faster diagnosis and treatment of depression and anxiety disorders in particular.

Does doctors' knowledge of inflammatory bowel disease patients' psychological status affect patients' clinical outcomes: a pilot randomized controlled trial.

Abstract: Mikocka-Walus, Antonina A.; Turnbull, Deborah A.; Andrews, Jane M.; Moulding, Nicole T.; Wilson, Ian G. and Holtmann, Gerald

BRIEF COMMUNICATION Do We Know What Patients Want? The Doctor-Patient Communication Gap in Functional Gastrointestinal Disorders

Abstract: BACKGROUND & AIMS: Understanding patients’ expectations at initial consultation for functional gastrointestinal disorders (FGIDs) might influence future health care utilization. Ideally, patients and doctors would have a common understanding of the issues involved. We sought to investigate this with matched questionnaires. METHODS: Patients’ needs/ expectations/understanding were compared with gastroenterologists’ and general practitioners’ awareness of these. Patients were followed up to investigate satisfaction with and outcomes of specialist consultation. RESULTS: Specialists underestimated the number and severity of patients’ symptoms (in 43% and 41%, respectively), and patients and specialists had quite discordant views on what treatment would best suit their symptoms. Strikingly, only 1 of 13 patients available for follow-up agreed with or accepted the functional diagnosis, despite all being diagnosed by a specialist as having an FGID. CONCLUSIONS: In FGIDs there is a communication gap between patients and gastroenterologists. Importantly, at follow-up, patients do not acknowledge their FGID diagnosis. This communication gap and lack of acceptance of a functional diagnosis are likely to influence future management and health care utilization.