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Sexual and Physical Abuse and Gastrointestinal Illness: Review and Recommendations

Douglas A. Drossman, MD; Nicholas J. Talley, MD; Jane Leserman, PhD; Kevin W. Olden, MD; and Marcelo A. Barreiro, MD, MSc
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From the University of North Carolina, Chapel Hill, North Carolina; the University of Sydney, Sydney, Australia; University of California, San Francisco, San Francisco, California; and United Medical Associates, Binghamton, New York. Acknowledgments: The authors thank Drs. William Whitehead, Robert Sandler, Ed Walker, and Wayne Katon for their critical review of the manuscript. Grant Support: By the Functional Brain-Gut Research Group of the American Gastroenterological Association. Requests for Reprints: Douglas A. Drossman, MD, Division of Digestive Diseases, 420 Burnett-Womack Building, CB #7080, University of North Carolina, Chapel Hill, NC 27599-7080. Current Author Addresses: Dr. Drossman: Division of Digestive Diseases, 420 Burnett-Womack Building, CB #7080, University of North Carolina, Chapel Hill, NC 27599-7080.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;123(10):782-794. doi:10.7326/0003-4819-123-10-199511150-00007
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Objectives: To summarize the existing data on abuse history and gastrointestinal illness, suggest a conceptual scheme to explain these associations, suggest ways to identify patients at risk, and provide information about mental health referral.

Data Sources: Review of the pertinent literature by clinicians and investigators at referral centers who are involved in the care of patients with complex gastrointestinal illness and who have experience in the diagnosis and care of patients with abuse history in these settings.

Study Selection: All research articles and observational data that addressed abuse history in gastroenterologic settings. Articles were identified through a MEDLINE search.

Data Extraction: Independent extraction by multiple observers.

Data Synthesis: On the basis of literature review and consensus, it was determined that abuse history is associated with gastrointestinal illness and psychological disturbance; appears more often among women, patients with functional gastrointestinal disorders, and patients seen in referral settings; is not usually known by the physician; and is associated with poorer adjustment to illness and adverse health outcome.


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Figure 2.
Conceptual scheme for relation of abuse history to psychosocial disturbance, gastrointestinal illness, and health care utilization.
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Figure 1.
Comparison of frequencies of sexual abuse history (for sexual exposure, contact abuse, and rape or incest) among health maintenance organization (HMO) members without bowel symptoms, with mild irritable bowel syndrome (IBS), or severe irritable bowel syndrome and patients seen at a university referral gastroenterology clinic[22, 33][7].

The progressive increase in frequency supports a relation of abuse history with the irritable bowel syndrome, its severity, and primary care compared with referral status. UNC equals University of North Carolina, Chapel Hill, North Carolina. (Reproduced with permission ).

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