W M Gonsalkorale

University Hospital Of South Manchester NHS Foundation Trust, Manchester, England, United Kingdom

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Publications (14)98.33 Total impact

  • Wendy M Gonsalkorale
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    ABSTRACT: This article describes the particular approach of using hypnosis as an adjunct to treating irritable bowel syndrome, developed within the Department of Medicine at the University Hospital of South Manchester, UK, since the 1980s. Patients receive up to 12 sessions over a 3-month period, and the majority of patients achieve marked improvement in symptoms and quality of life, an effect that is usually sustained. The therapy has a "gut-directed" framework that aims to teach patients the necessary hypnotic skills to control gut function and reduce symptoms, such as hand warmth on the abdomen and imagery. Other interventions based on particular lifestyle and psychological factors commonly found to influence symptoms are also included as appropriate for the individual patient.
    International Journal of Clinical and Experimental Hypnosis 02/2006; 54(1):27-50.
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    Wendy M Gonsalkorale, Peter J Whorwell
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    ABSTRACT: There is accumulating and compelling evidence that hypnotherapy is an effective treatment for irritable bowel syndrome. Recently, studies have shown that hypnotherapy has beneficial effects that are long lasting, with most patients maintaining improvement, and with decreased consultation and medication needs in the long term. The particular gut directed approach used, which is aimed at normalizing and controlling gut function, is also described. While the mechanisms of how hypnotherapy brings about its therapeutic effect are not fully known, changes in colonic motility and rectal sensitivity have been demonstrated, although changes in central processing and psychological effects may also play a role.
    European Journal of Gastroenterology & Hepatology 02/2005; 17(1):15-20. · 1.92 Impact Factor
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    Wendy M Gonsalkorale, Brenda B Toner, Peter J Whorwell
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    ABSTRACT: Impaired quality of life and psychological distress are common in irritable bowel syndrome (IBS) and may be associated with unhelpful cognitions. Hypnotherapy (HT) is effective in improving both symptoms and quality of life in patients with IBS, and this study was designed to determine whether this improvement is reflected in cognitive change using a validated scale recently developed for use in such patients. A total of 78 IBS patients completed a validated symptom-scoring questionnaire, the Hospital Anxiety and Depression (HAD) Scale and the Cognitive Scale for Functional Bowel Disorders (FBDs), before and after 12 sessions of gut-focused HT. HT resulted in improvement of symptoms, quality of life and scores for anxiety and depression (all P's<.001). IBS-related cognitions also improved, with reduction in the total cognitive score (TCS; P<.001) and all component themes related to bowel function (all P<.001). Cognitions were related to symptom severity because the most abnormal cognitive scores were observed in patients with the highest symptom scores (P<.001). Furthermore, a reduction in symptom score following treatment correlated with an improvement in the cognitive score (P<.001). Regression analysis confirmed that the cognitive score had independence from the other scores and did not serve solely as a proxy for symptom improvement. This study shows that symptom improvement in IBS with HT is associated with cognitive change. It also represents an initial step in unravelling the many possible mechanisms by which treatments such as HT might bring about improvement.
    Journal of Psychosomatic Research 03/2004; 56(3):271-8. · 3.27 Impact Factor
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    W M Gonsalkorale, V Miller, A Afzal, P J Whorwell
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    ABSTRACT: There is now good evidence from several sources that hypnotherapy can relieve the symptoms of irritable bowel syndrome in the short term. However, there is no long term data on its benefits and this information is essential before the technique can be widely recommended. This study aimed to answer this question. 204 patients prospectively completed questionnaires scoring symptoms, quality of life, anxiety, and depression before, immediately after, and up to six years following hypnotherapy. All subjects also subjectively assessed the effects of hypnotherapy retrospectively in order to define their "responder status". 71% of patients initially responded to therapy. Of these, 81% maintained their improvement over time while the majority of the remaining 19% claimed that deterioration of symptoms had only been slight. With respect to symptom scores, all items at follow up were significantly improved on pre-hypnotherapy levels (p<0.001) and showed little change from post-hypnotherapy values. There were no significant differences in the symptom scores between patients assessed at 1, 2, 3, 4, or 5+ years following treatment. Quality of life and anxiety or depression scores were similarly still significantly improved at follow up (p<0.001) but did show some deterioration. Patients also reported a reduction in consultation rates and medication use following the completion of hypnotherapy. This study demonstrates that the beneficial effects of hypnotherapy appear to last at least five years. Thus it is a viable therapeutic option for the treatment of irritable bowel syndrome.
    Gut 11/2003; 52(11):1623-9. · 10.73 Impact Factor
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    ABSTRACT: We have previously shown that hypnotherapy alters rectal sensitivity in some patients with irritable bowel syndrome. However, this previous study used incremental volume distension of a latex balloon, which might be susceptible to subject response bias and might compromise the assessment of compliance. In addition, the study group was symptomatically rather than physiologically defined. To assess the effect of hypnotherapy on rectal sensitivity in hypersensitive, hyposensitive and normally sensitive irritable bowel syndrome patients using a distension technique (barostat) that addresses these technical issues. Twenty-three irritable bowel syndrome (Rome I) patients (aged 24-72 years) were assessed before and after 12 weeks of hypnotherapy in terms of rectal sensitivity, symptomatology, anxiety and depression. Normal values for sensitivity were established in 17 healthy volunteers (aged 20-55 years). Compared with controls, 10 patients were hypersensitive, seven hyposensitive and six normally sensitive before treatment. Following hypnotherapy, the mean pain sensory threshold increased in the hypersensitive group (P = 0.04) and decreased in the hyposensitive group, although the latter failed to reach statistical significance (P = 0.19). Normal sensory perception was unchanged. Sensory improvement in the hypersensitive patients tended to correlate with a reduction in abdominal pain (r = 0.714, P = 0.07). Hypnotherapy improves abnormal sensory perception in irritable bowel syndrome, leaving normal sensation unchanged.
    Alimentary Pharmacology & Therapeutics 04/2003; 17(5):635-42. · 4.55 Impact Factor
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    ABSTRACT: Inflammation may play a role in the pathogenesis of irritable bowel syndrome in some individuals, such as in those who develop symptoms following a dysenteric illness. Persisting inflammation, resulting from an imbalance of cytokines regulating the inflammatory response, is one possible mechanism. As the elaboration of cytokines is under genetic control, this study was designed to establish whether there might be a genetic predisposition to an altered pattern of anti-inflammatory cytokine production in patients with irritable bowel syndrome. A total of 230 unselected patients with irritable bowel syndrome and 450 healthy, ethnically matched controls were studied. DNA was extracted from peripheral blood leucocytes of subjects. Allele and genotype frequencies were determined for the anti-inflammatory cytokine interleukin 10 at the site (-1082) concerned with production in lymphocytes. Transforming growth factor beta(1) (codons 10 and 25) genotypes were also examined in a smaller group of subjects. Patients with irritable bowel syndrome had significantly reduced frequencies of the high producer genotype for interleukin 10 than controls (21% v 32%; p=0.003). There was no apparent relationship with any particular bowel habit subtype. Genotypes for transforming growth factor beta(1) were not altered. These preliminary results suggest that at least some patients with irritable bowel syndrome may be genetically predisposed to produce lower amounts of the anti-inflammatory cytokine interleukin 10. This lends some support to the hypothesis that there may be an inflammatory or genetic component in some cases of this condition and that further studies in specific irritable bowel syndrome subgroups are justified.
    Gut 02/2003; 52(1):91-3. · 10.73 Impact Factor
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    Wendy M Gonsalkorale, Lesley A Houghton, Peter J Whorwell
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    ABSTRACT: Hypnotherapy has been shown to be effective in the treatment of irritable bowel syndrome in a number of previous research studies. This has led to the establishment of the first unit in the United Kingdom staffed by six therapists that provides this treatment as a clinical service. This study presents an audit on the first 250 unselected patients treated, and these large numbers have also allowed analysis of data in terms of a variety of other factors, such as gender and bowel habit type, that might affect outcome. Patients underwent 12 sessions of hypnotherapy over a 3-month period and were required to practice techniques in between sessions. At the beginning and end of the course of treatment, patients completed questionnaires to score bowel and extracolonic symptoms, quality of life, and anxiety and depression, allowing comparisons to be made. Marked improvement was seen in all symptom measures, quality of life, and anxiety and depression (all ps < 0.001), in keeping with previous studies. All subgroups of patients appeared to do equally well, with the notable exception of males with diarrhea, who improved far less than other patients (p < 0.001). No factors, such as anxiety and depression or other prehypnotherapy variables, could explain this lack of improvement. This study clearly demonstrates that hypnotherapy remains an extremely effective treatment for irritable bowel syndrome and should prove more cost-effective as new, more expensive drugs come on to the market. It may be less useful in males with diarrhea-predominant bowel habit, a finding that may have pathophysiological implications.
    The American Journal of Gastroenterology 05/2002; 97(4):954-61. · 9.21 Impact Factor
  • Gastroenterology 04/2000; 118(4). · 12.82 Impact Factor
  • Gastroenterology 01/2000; 118(4). · 12.82 Impact Factor
  • Gastroenterology 01/2000; 118(4). · 12.82 Impact Factor
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    ABSTRACT: Interleukin-10 (IL-10) is an anti-inflammatory cytokine. Its production in humans is under genetic control, and genotype defines high or low producers of this cytokine. This study addresses the hypothesis that idiopathic inflammatory bowel disease (IBD) patients are more likely to have the low IL-10 producer genotype and phenotype. DNA was extracted from blood cells of patients with Crohn's disease (CD) or with ulcerative colitis (UC) for IL-10 genotyping. The frequency of the high IL-10 producer allele (-1082*G) was decreased in the whole IBD group (41% vs. 51%, P = 0.03) and in the UC patients compared with normal controls (37% vs. 51%; P = 0.04). Hence, there appears to be an association between the IL-10 genotypes and IBD. This suggests that individuals genetically predisposed to produce less IL-10 are at a higher risk of developing IBD, in particular, UC.
    Tissue Antigens 11/1999; 54(4):386-90. · 2.93 Impact Factor
  • Gastroenterology 01/1998; 114. · 12.82 Impact Factor
  • W M Gonsalkorale, M J Dascombe, I V Hutchinson
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    ABSTRACT: The effects of adrenocorticotropic hormone (ACTH) (10(-6) to 1 U/ml) on T-lymphocyte proliferation and function were studied in the rat mixed lymphocyte reaction (MLR). ACTH produced a modest increase in lymphocyte proliferation on day 3 in lymph node (LN) cells and on day 5 in spleen cells. In addition, LN MLR cells, activated in the presence of ACTH, showed a higher proliferative response to restimulation on day 5 and on day 11 of the primary culture. Cytotoxic activity and the number of IL-2R- cells were increased in ACTH-treated LN MLR cultures in experiments where control MLR levels were low. ACTH also overcame the generation of low levels of suppressor activity in spleen MLR cells. These findings indicate that ACTH could play a role in increasing the priming of T-lymphocytes and enhancing, in particular, suboptimal primary responses.
    International Journal of Immunopharmacology 04/1995; 17(3):197-206.
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    W M Gonsalkorale, M J Dascombe, I V Hutchinson
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    ABSTRACT: The effects of increasing the level of cyclic AMP (cAMP) activity on lymphocyte proliferation in the rat mixed lymphocyte reaction (MLR) were investigated. Dibutyryl cAMP (dbcAMP) and prostaglandin E2 (PGE2) produced a dose-dependent reduction in proliferation in the lymph node (LN) MLR, but produced a substantial increase in proliferation in the spleen MLR at the lower concentrations used (10(-5)-10(-4) M dbcAMP; 10(-7)-10(-6) M PGE2). Enhancement of proliferation was dependent on the presence of macrophages and was probably due to inhibition of macrophage activation. This was based on the following findings: (1) spleen MLR proliferation was lower than that in the LN MLR; (2) depletion of spleen macrophages increased proliferation in the spleen MLR and addition of these macrophages to the LN MLR reduced proliferation; (3) macrophage depletion from the spleen MLR abolished the proliferation-enhancing effect of dbcAMP. In conclusion, cAMP enhances lymphocyte proliferation in this system, apparently as a consequence of suppressing the inhibitory influence of macrophages.
    Immunology 01/1994; 80(4):611-6. · 3.71 Impact Factor

Publication Stats

743 Citations
98.33 Total Impact Points

Institutions

  • 1999–2006
    • University Hospital Of South Manchester NHS Foundation Trust
      Manchester, England, United Kingdom
  • 1994–1999
    • The University of Manchester
      Manchester, England, United Kingdom