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Understanding Gastrointestinal Distress: A Framework for Clinical Practice

Spiegel, Brennan M R MD, MSHS1,2,3,4,5,6; Khanna, Dinesh MD, MS7; Bolus, Roger PhD1,6; Agarwal, Nikhil MD6; Khanna, Puja MD, MPH7; Chang, Lin MD1,2,5,6

American Journal of Gastroenterology: March 2011 - Volume 106 - Issue 3 - p 380–385
doi: 10.1038/ajg.2010.383
THE RED SECTION
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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.

1Department of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA

2Division of Digestive Diseases, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA

3Department of Health Services, UCLA School of Public Health, University of California, Los Angeles, California, USA

4CURE: Digestive Diseases Research Center, University of California, Los Angeles, California, USA

5Center for Neurobiology of Stress, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA

6UCLA/VA Center for Outcomes Research and Education, Los Angeles, California, USA

7Division of Rheumatology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA

Correspondence: Brennan M.R. Spiegel, MD, MSHS, Department of Gastroenterology, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Building 115, Room 215, Los Angeles, California 90073, USA. E-mail: bspiegel@mednet.ulca.edu

© The American College of Gastroenterology 2011. All Rights Reserved.
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