Brief Article
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World J Gastroenterol. Jul 7, 2013; 19(25): 3990-3995
Published online Jul 7, 2013. doi: 10.3748/wjg.v19.i25.3990
A prospective study evaluating emotional disturbance in subjects undergoing defecating proctography
Amit S Kashyap, Divyanshoo R Kohli, Arnold Raizon, Kevin W Olden
Amit S Kashyap, Divyanshoo R Kohli, Department of Medicine, Washington Hospital Center, Washington, DC 20010, United States
Arnold Raizon, Department of Radiology, Washington Hospital Center, Washington, DC 2002, United States
Kevin W Olden, Division of Gastroenterology, Washington Hospital Center, Washington, DC 2002, United States
Kevin W Olden, Department of Internal Medicine, St. Josephs Medical Center Phoenix, Phoenix, AZ 85013, United States
Author contributions: Kashyap AS contributed to the data acquisition; Kohli DR contributed to the statistical analysis, manuscript preparation; Raizon A performed single contrast defecating proctography and interpreted images; Olden KW contributed to the study concept and design, supervision of project, critical revision of manuscript; Kashyap AS and Kohli DR contributed equally to the study.
Correspondence to: Divyanshoo R Kohli, MD, Department of Medicine, Washington Hospital Center, 110 Irving St NW, Room 2A-50, Washington, DC 20010, United States. kohli015@gmail.com
Telephone: +1-202-8772835 Fax: +1-202-8778288
Received: January 26, 2013
Revised: April 20, 2013
Accepted: May 8, 2013
Published online: July 7, 2013
Processing time: 161 Days and 10.7 Hours
Abstract

AIM: To investigate the prevalence of psychiatric illness in association with functional gastrointestinal disorders using defecating proctography (DP) and validated questionnaires.

METHODS: We prospectively evaluated 45 subjects referred for DP using hospital anxiety and depression scale (HADS), state trait anxiety inventory (STAI), patient health questionnaire 15-item somatic symptom severity scale (PHQ-15), validated questionnaires for sexual or physical abuse; post-traumatic stress disorder questionnaire (PTSD) and ROME-III questionnaires for gastrointestinal complaints. DP results were considered negative if levator ani function was normal, rectoceles (if any) were < 4 cm and there was no evidence of intussusception, rectal prolapse, or other anatomic abnormality demonstrated. Subjects were subsequently divided into those with structural defects seen on DP (DP positive group) and those with a normal defecography study (DP negative group).

RESULTS: Forty five subjects were included in the study of which 20 subjects were classified as DP negative (44.4%). There was a striking prevalence of a history of sexual abuse in DP negative group compared to the DP positive group (n = 9, 5 respectively; P = 0.036). Further, subjects in the DP negative group scored significantly higher on the HADS anxiety (6.60 ± 1.00 vs 4.72 ± 0.40, P = 0.04) and depression scales (5.72 ± 1.00 vs 3.25 ± 0.46, P = 0.01). This correlated well with significantly higher scores on the STAI state anxiety scale (42.75 ± 3.16 vs 35.6 ± 2.00, P = 0.027), PHQ-15 questionnaire (13.15 ± 0.82 vs 10.76 ± 0.97, P = 0.038) and prevalence of PTSD (20% vs 4%, P = 0.045) among DP negative subjects. There was no difference between the groups in terms of STAI trait anxiety.

CONCLUSION: The findings of this prospective study demonstrate a significantly high degree of psychiatric ailments in patients with negative findings on DP who should be appropriately screened for a history of sexual abuse and symptoms of psychosocial distress.

Keywords: Functional gastrointestinal disorders; Sexual abuse; Defecating proctography; Post-traumatic stress disorder questionnaire

Core tip: In this study, we used validated questionnaires in consort with defecating proctography and demonstrated that subjects undergoing defecating proctography who met ROME III criteria for functional constipation have a high prevalence of psychiatric disorders and a significant history of sexual abuse. We also found an association between post-traumatic stress disorder questionnaire, anxiety, history of sexual abuse and functional constipation. Taken together, these findings suggest that a very detailed history about psychiatric co-morbidities and traumatic experiences must be taken in selected patients complaining of constipation.