About
380
Publications
18,135
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
26,431
Citations
Publications
Publications (380)
Irritable bowel syndrome (IBS) is a common long-term illness that affects around 14% of the UK population. Most patients with IBS are managed in primary care and frequently seek help for continuing symptoms, yet IBS does not come under the Quality and Outcomes Framework. Nurse practitioners play an important role in helping people to manage their l...
A multidisciplinary panel of health professionals come together to share their experience in treating chronic gastrointestinal symptoms
Nick Read and Lystra Rampersad-Smith provide an overview of irritable bowel syndrome (IBS) and discuss the practice nurse's role in treating it
Experiments were carried out to determine the range of human colonic bacteria that could ferment the viscous polysaccharide, guar gum, and to seek evidence for collaboration between different strains of colonic bacteria. Single strains of a variety of species of bacteria isolated from human faeces were incubated with guar gum. Only seven of the 57...
This study aimed to assess the relationship between somatisation and outcome in patients with severe irritable bowel syndrome (IBS).
Two hundred fifty-seven patients with severe IBS included in a randomised controlled trial were assessed at baseline and divided into four quartiles on the basis of their somatisation score. The patients were randomis...
Intraduodenal acid has been shown to delay gastric emptying. We have investigated the effect of infusing hydrochloric acid into the duodenum on the motor activity of the gastric antrum, pylorus, and duodenum in 18 healthy volunteers. Pressures in the gastric antrum, pylorus, and duodenum and the pH in the antrum and duodenum were recorded in respon...
Abstract Studies in the dog have shown that when equicaloric nutrients are infused into the distal small intestine, glucose is the most potent inhibitor of proximal small intestinal motility. Studies in man and rat have shown lipid to be the most potent inhibitor of gastrointestinal motility, but the nutrients were not infused at equicaloric loads....
The influence of duodenal infusion of bile acid at a concentration similar to that in the common bile-duct (50 mmol/1) on antroduodenal motility, duodenogastric reflux, gastric and duodenal secretion was studied in 10 healthy volunteers. Intraluminal pressures were recorded in the antrum and the first and second parts of the duodenum. Gastric and d...
We have previously reported improved health-related quality of life in patients with severe irritable bowel syndrome (IBS) following psychological treatments. In this paper, we examine whether this improvement was associated with improvement in psychological symptoms and was confined to those patients who had concurrent psychiatric disorder.
Two hu...
Irritable bowel syndrome often leads to impaired functioning.
To assess the contribution of psychiatric disorders to impaired outcome in severe irritable bowel syndrome.
Patients with severe irritable bowel syndrome entering a psychological treatment trial (n=257) were interviewed using the Schedules for Clinical Assessment in Neuropsychiatry. Outc...
We assessed the effect of reported sexual abuse on symptom severity and health-related quality of life in patients with severe irritable bowel syndrome (IBS) undergoing psychological treatments.
IBS patients entering a treatment trial who reported prior sexual abuse were compared with the remainder in terms of symptom severity and health-related qu...
Reduced tolerance to rectal distension has been regarded as a biological marker for irritable bowel syndrome (IBS), but longitudinal studies are few. This study determined whether change in tolerance to rectal distension after psychological treatments was associated with: 1) change in abdominal pain; 2) change in psychological symptoms; 3) a report...
We previously showed that oral administration of a liquid soup preload was associated with a slower rate of gastric emptying and suppressed appetite more compared with intragastric administration of the same soup [Appetite 31(1998)377]. The present study was designed to investigate whether these results could be explained by the cephalic stimulatio...
Psychosocial factors have been examined in functional bowel disorders (FBD), including irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC). Abnormal illness behaviour (AIB) has been investigated in IBS patients as evidence of underlying psychological distress and as influencing health-care-seeking behaviour. Health locus of con...
Irritable bowel syndrome (IBS) is a heterogeneous condition which is diagnosed according to specific bowel symptom clusters. The aim of the present study was to identify subgroups of IBS subjects using measures of rectal sensitivity and psychological symptoms, in addition to bowel symptoms. Such groupings, which cross conventional diagnostic approa...
Background and aims: Chronic bowel disturbances resembling irritable bowel syndrome (IBS) develop in approximately 25% of patients after an episode of infectious diarrhoea. Although we have previously shown that psychosocial factors operating at the time of, or prior to, the acute illness appear to predict the development of post-infectious IBS (PI...
Sequential patients, aged 18-50, admitted to an Infectious Diseases Unit of a large teaching hospital with an acute infection, completed validated psychometric questionnaires on admission and were followed up at three monthly intervals for 12 months. 34% of patients available for follow-up remained symptomatic at 3 months, but by 6 months and for t...
Psychotherapy and antidepressants are effective in patients with severe irritable bowel syndrome (IBS), but the cost-effectiveness of either treatment in routine practice has not been established.
Patients with severe IBS were randomly allocated to receive 8 sessions of individual psychotherapy, 20 mg daily of the specific serotonin reuptake inhibi...
It has long been known that stress affects both the stomach and colon, as shown by the very high prevalence of gastrointestinal symptoms among patients with psychiatric illness. The source may be limbic or peripheral, involving encoded memories or physiological changes. It is important to realise that physical symptoms such as those of functional d...
Previous research suggests that sufferers of irritable bowel syndrome (IBS) report a greater prevalence of sexually and physically abusive experiences than patients with organic gastrointestinal disorders and non-patient populations. This has led to suppositions that previous abusive experiences might predispose to the development of functional gas...
To investigate whether oral factors stimulated by the presence of sucrose in the mouth are involved in the suppression of appetite following sucrose ingestion.
Ten male and 10 female healthy volunteers participated in four experimental conditions designed to provide differing levels of oro-sensory stimulation. Appetite and energy intake from a test...
Previous work has shown that the gastric emptying rate in animals and humans can adapt due to previous dietary intake. The present study investigated whether adaptation in gastric emptying rate due to consumption of a high-fat diet (HFD) is nutrient specific in humans. Gastric emptying of high-fat and high-carbohydrate test meals was measured (usin...
To investigate mechanisms by which specific sugars affect feeding behaviour.
In an initial study, gastric emptying rate and appetite were measured following ingestion of lemon flavoured solutions of sucrose, maltose (2160 kJ, 575 ml) and water control (67 kJ, 575 ml) given in randomised order on separate days to six male volunteers. In a second stu...
Changes in diet can alter gastric and small intestinal (SI) motility. The effects of a vegetarian diet on fasting SI motility are unknown.
Manometric studies were performed in 9 lacto-ovo vegetarians (7 women) and 9 omnivores (7 women) of similar age and body mass index. On each study day, manometry was used to assess SI motility for 5 h, or 3 comp...
The irritable bowel syndrome (IBS) may lead to considerable impairment of health-related quality of life and high health care costs. It is not clear whether these poor outcomes directly result from severe bowel symptoms or reflect a coexisting psychiatric disorder.
To determine whether bowel symptom severity and psychological symptoms directly infl...
This study was conducted to determine whether and under what circumstances exercise causes nausea. Twelve healthy volunteers (20-37 years), including six athletes, participated in the study. Subjects were studied on seven occasions. Each subject performed low and high-intensity exercise without eating, immediately after eating a beef patty and 60 m...
Consumer interest in diet and nutritional supplements is increasing dramatically. Patients and members of the public are seeking advice from health professionals, nutritionists and food scientists. This book is designed to meet the needs of those professionals who are called upon to advise patients and the general public. It provides also a valuabl...
Dietary fat intake is related to the degree of obesity, but the specific mechanisms by which fats regulate food intake in humans are unclear. We compared food intake suppression, plasma triglyceride appearance, and cholecystokinin (CCK) response after intestinal infusion of oils enriched with C18 fatty acids of increasing unsaturation.
Food intake...
This chapter describes a psychoanalytical understanding of how disease may result from the impact of psychosocial stresses on a fragile and vulnerable personality structure. This is then compared with recent neuroendocrinological concepts of mind-body disease. Where appropriate, integration is attempted. This chapter has deliberately chosen the mod...
The aim of this chapter is to provide a clear and balanced account of the role of the various forms of psychotherapy in the irritable bowel syndrome (IBS). It commences with an account of the philosophical basis for psychotherapy, attempting to integrate the concepts of autonomic arousal, repression, conversion and a developmental disorder of think...
To investigate the effects of fat and carbohydrate on appetite, food intake and gastric emptying with and without the influence of orosensory factors, a group of nine healthy, fasted male subjects took part in two separate paired experiments involving high-fat and high-carbohydrate radiolabelled soup preloads. In the first experiment subjects recei...
Dyspepsia and irritable bowel syndrome are suitable conditions for assessment of quality of life. Their similarities justify the elaboration of a single specific questionnaire for the two conditions.
To examine the process leading to the validation of the psychometric properties of the functional digestive disorders quality of life questionnaire (F...
Both psychological and physiological disturbances have been implicated in the aetiopathogenesis of irritable bowel syndrome (IBS).
To investigate how the psychological factors act, and the involvement of infective and physiological factors.
Consecutive patients hospitalised for gastroenteritis reported life events for the previous 12 months, and pa...
To investigate gastric emptying and intestinal transit of pelleted pancreatin in relation to food boluses.
Dual isotope scintigraphy combined with breath hydrogen sampling was used to track the concurrent gastric emptying and intestinal transit of 111indium labelled microspheres and a 99mtechnetium labelled tin colloid test meal. Twelve pancreatic...
To investigate the contribution of oral, gastric and intestinal factors in the control of appetitc, 425 ml (400 kcal) tomato soup was administered either orally, intragastrically (covertly and overtly) or intraduodenally (overtly) to nine healthy, fasted, male volunteers. Ratings of fullness, hunger and desire to eat were recorded over a period of...
Our previous study demonstrated that meals, particularly when rich in fat, significantly reduced the pain induced by the cold pressor stimulus in healthy human subjects. To determine the mechanisms involved, the aim of this study was to bypass the taste and cognitive component of food and to investigate the scope of these analgesic effects with dir...
The relation between gastrointestinal incretin hormones in the control of insulin release and short-term satiety by intestinal carbohydrate was investigated in 8 fasted, healthy male volunteers. Insulin, gastric inhibitory polypeptide (GIP), glucagon-like peptide 1 (GLP-1), and appetite ratings were measured during, and food intake was measured aft...
Previous studies in humans and animals have shown that the presence of lipid in the small intestine can reduce food intake. Studies that have combined intraduodenal lipid infusions with gastric distension produced a greater reduction in food intake than when these two stimuli were separated. In this study, subjects received duodenal lipid (Intralip...
Effects of recent food ingestion on daytime sleepiness were assessed in 16 subjects (8 men and 8 women) who were each studied on two occasions, 28 days apart. On each occasion, subjects ate a high-fat low-carbohydrate (CHO) (fat/CHO energy ratio 54:41) meal and an isoenergetic low-fat high-CHO meal (fat/CHO energy ratio 7:88) 4 h apart in a counter...
The effects of gastric infusions of fat and carbohydrate on physiological and psychological measures were compared using a within subject design in 9 healthy subjects (6 males). Each subject received isovolaemic rapid gastric infusions of sucrose solution (100% energy carbohydrate), lipid emulsion (100% energy fat, 20% Intralipid), and a non-nutrie...
Previous studies using meal preloads have indicated that carbohydrate has a greater satiating power than fat. To investigate the effects of macronutrients on ingestion and satiety, without the influence of meal design and orosensory factors, two groups of ten healthy, fasted male volunteers took part in two separate experiments involving rapid dire...
The effects on mood of reducing dietary fat while keeping the energy constant were examined in ten male and ten female healthy volunteers aged between 20 and 37 years. Each volunteer consumed a diet containing 41% energy as fat for 1 month. For the second month half of the subjects changed to a low-fat diet (25% energy from fat) and the remainder c...
Peripheral kappa receptor agonists may provide a new therapeutic approach for the treatment of functional dyspepsia.
To evaluate, in a large multicentre trial, the use of the kappa receptor agonist fedotozine to improve symptoms associated with functional dyspepsia.
Two or more of the following persistent symptoms were required for inclusion: epiga...
The pathogenesis of anorectal dysfunction, which occurs frequently in patients with diabetes mellitus, is poorly defined. Recent studies indicate that changes in the blood glucose concentration have a major reversible effect on gastrointestinal motor function.
To determine the effects of physiological changes in blood glucose and hyperglycaemia on...
To study in healthy subjects the relationship between gastric sensations/perception and motility during gastric distension and the effects of duodenal nutrients, a flaccid gastric bag was distended in the proximal stomach with air at 100 ml/min while the duodenum was perfused (1 ml/min) with isotonic saline, hypertonic saline, glucose (1 kcal/ml),...
Previous studies have demonstrated that feelings of sleepiness increase after ingestion of a fat-rich meal. The aim of the study was to test the hypothesis that postprandial sleepiness is mediated by cholecystokinin (CCK) acting on CCK-A receptors. A double-blind crossover study was conducted. Twelve male volunteers ate a high-fat morning meal [54%...
The aim of this study was to investigate if food could reduce pain perception in a group of 16 healthy human volunteers (8 male and 8 female), and to explore the differential effects of macronutrient composition on the response to cold-induced pain. All subjects underwent the cold pressor test (CPT) on 3 occasions in a counterbalanced order, before...
Paired studies were conducted in 18 healthy volunteers (9 men, 9 women) to investigate whether differences in mood and daytime sleepiness induced by high-fat-low-carbohydrate (CHO) and low-fat-high-CHO morning meals were associated with specific hormonal responses. Plasma insulin concentrations were significantly higher after low-fat-high-CHO meals...
To compare the effects of aspartame-sweetened and sucrose-sweetened soft drinks on food intake and appetite ratings of female restrained eaters.
Fourteen female students, shown to have eating restraint.
Subjects were given four drinks (330 ml) of aspartame-sweetened lemonade, sucrose-sweetened lemonade and carbonated mineral water on three separate...
Loperamide improves anorectal function in patients with chronic diarrhoea. We wished to investigate whether the prodrug loperamide oxide has similar effects.
Eleven patients with chronic diarrhoea and faecal incontinence participated in a randomized, placebo-controlled, double-blind, crossover study of the effects of loperamide oxide (4 mg twice da...
The involvement of 5-hydroxytryptamine3 (5-HT3) receptors in gastric motor and sensory responses to distension and duodenal lipid was investigated. Subjects were studied on four occasions during which isotonic saline or 20% Intralipid (2 kcal/ml) was infused intraduodenally (1 ml/min) while the proximal stomach was distended with air (100 ml/min)....
The pathophysiology of faecal incontinence in diabetes mellitus is poorly understood. The study was designed to document the anorectal dysfunctions in diabetic patients with faecal incontinence.
Multiport anorectal manometry and electromyography were done in 11 diabetic patients with faecal incontinence and in 20 healthy controls.
Basal and squeeze...
The role of endogenous cholecystokinin (CCK) in the regulation of gastric emptying remains controversial. We therefore studied the effect of the CCK-A receptor antagonist loxiglumide on gastric emptying of a high-caloric solid-liquid meal in humans. Gastric emptying was assessed in eight volunteers using intravenous loxiglumide or placebo in a rand...
To investigate the mechanisms by which intestinal carbohydrate affects eating behavior, seven fasted, healthy male volunteers received intraduodenal infusions of glucose or saline over a 90-min period while blood glucose levels were matched by use of intravenous glucose and saline infusions. A second study examined the effect of intraduodenal gluco...
Paired studies testing the effects of lower energy high-fat, low-CHO meals (3181 kJ, fat:CHO energy ratio 54:41) and higher energy low-fat, high-CHO meals (3599 kJ, fat:CHO energy ratio 7:88) were conducted in 18 healthy males. The meals were eaten at 1030 h by group A (nine subjects) and 1230 h by group B (nine subjects). Subjective lassitude incr...
The combination of duodenal lipid and gastric distention induces meal-like fullness followed by nausea in healthy subjects. The aim of this study was to assess the role of cholecystokinin (CCK) A receptors in these changes using a CCK-A antagonist loxiglumide.
Twelve healthy subjects were studied on four occasions, during which either 0.9% saline o...
Recent observations indicate that gastric emptying may be influenced by patterns of previous nutrient intake. The aims of this study were to determine the effects of a high glucose diet on gastric emptying of glucose and fructose, and the impact of any changes in gastric emptying on plasma concentrations of glucose, insulin and gastric inhibitory p...
Although previous studies have shown that psychological disturbances are frequently associated with the irritable bowel syndrome (IBS), the relation was not necessarily cause and effect. The development of chronic bowel symptoms resembling IBS after an episode of acute gastroenteritis has allowed us to examine prospectively the role of psychologica...
Vection and fat delay gastric emptying and can induce nausea. Therefore, we studied the interaction between vection and fat on the production of nausea and the relationship between the severity of symptoms and changes in gastric emptying. Twelve healthy males consumed two liquid test meals, a zero-fat and a high-fat meal. Nausea was induced by seat...
Patients with functional dyspepsia exhibit increased sensitivity to gastric distension (mechanoreceptors) and to meals rich in fat (chemoreceptors). The aim of this study was to test whether these patients were abnormally sensitive to intraduodenal lipid, and whether this stimulus altered gastric mechanosensitivity.
Experiments were conducted on 10...
Intraduodenal lipid infusion induces symptoms and increases sensitivity to gastric distension in patients with functional dyspepsia. To test whether these effects are specific for lipid, we compared the effects of intraduodenal infusions of either lipid or glucose on symptoms and gastric sensory and motor responses to gastric distension. Eighteen d...
To investigate the relative potency of short-term control mechanisms for carbohydrate satiety, ten fasted, healthy male volunteers consumed a 250-ml, 30% glucose drink with and without the addition of guar gum (2%). Gastric emptying, hunger and fullness ratings and blood glucose and insulin levels were monitored over the following 3 h and energy in...
The effects of intraduodenal and dietary lipid on alertness, mood and performance in a task requiring sustained attention were investigated in two studies. The first experiment compared the effect of duodenal infusion of either 100 g/l Intralipid (8.36 kJ/min) or isotonic saline (9 g NaCl/l) in paired studies carried out on two non-consecutive days...
In a multicenter study of patients with painful functional bowel disorders (FBD), we compared the demographic, health status, and diagnostic features of patients with FBD and developed a functional bowel disorder severity index (FBDSI) for research and clinical care. Two hundred seventy patients with FBD in the United States, England, and Canada we...
A second family with hereditary proctalgia fugax and internal anal sphincter hypertrophy associated with constipation is described. Anorectal ultrasonography, manometry, and sensory tests were conducted in two symptomatic and one asymptomatic subjects within the same family and further clinical information was obtained from other family members. Th...
Background/aims:
The implantation of spinal stimulators to facilitate defecation in patients with complete spinal transection involves division of the posterior sacral nerve roots. The aim of this study was to investigate the role of spinal reflexes in anorectal function.
Methods:
Anorectal manometry and electromyography were performed in 14 pat...
To examine the hypothesis that nausea during vection arises directly from an underlying alteration in gastric motility.
The simultaneous application of vection and assessment of gastric emptying of a liquid, non-nutrient test meal allowed the examination of the interaction between changes in gastric motility and symptoms.
Studies were conducted in...
We summarize the prevalence and causes of constipation and incontinence in an elderly, drawing particular attention to the roles of immobility, dietary fiber, and dehydration. The physiology of fecal impaction is described in detail, and neurological and mechanical causes (rectal prolapse, rectocele, and hemorrhoids) of constipation are discussed....
A case study reporting the efficacy of oral vancomycin in a patient with chronic idiopathic constipation prompted this prospective trial of oral vancomycin in eight female patients (aged 21-61 years) with severe constipation resistant to the action of dietary fibre.
The trial was divided into two consecutive 14-day periods. During the first period,...
Twelve male subjects took part in a study to investigate the effects of overfeeding a high-fat diet (19.17 MJ/d; 58% energy from fat) for 2 weeks on plasma cholecystokinin (CCK) levels, food intake, and subjective feelings of hunger and fullness. Before and after the diet, subjects completed a 2-week weighed dietary inventory, formal measurements o...
In a multicenter study of patients with painful functional bowel disorders (FBD), we compared the demographic, health status, and diagnostic features of patients with FBD and developed a functional bowel disorder severity index (FBDSI) for research and clinical care. Two hundred seventy patients with FBD in the United States, England, and Canada we...
The gut is a long tube; food goes down it and across it. Its purpose is to process the food that is consumed in order to optimize absorption of nutrients. It works rather like the reverse of an assembly line in a manufacturing plant with different regions of the gastrointestinal tube specialized sequentially for storage, acid digestion, alkaline di...
The aim of this paper was to investigate the effects of the CCK, a receptor antagonist loxiglumide on food intake, hunger and fullness in humans. A double blind, placebo controlled, cross-over test was carried out, with subjects taking one loxiglumide or one placebo tablet three times a day, 15 min before main meals or at comparable intervals. The...
