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Seventy patients with non-stenosing Crohn's disease were randomly assigned to follow a low residue diet or a normal Italian diet for a mean of 29 months. The two groups were comparable at the onset in various measures of disease severity and diet. Patients complied well with the diet prescriptions, the low residue group eating a mean of 8.1 portions a week of fibre containing foods and the liberalized group a mean of 26.6 portions (p less than 0.005). There was no difference in outcome between the two groups, including symptoms, need for hospitalisation, need for surgery, new complications, nutritional status, or postoperative recurrence. Eighty six per cent of patients eating ad libitum and 65% of patients who avoided roughage eliminated one or more permitted foods because of subjective intolerance. Lifting of dietary restrictions, which results in a more appetizing and nutritious diet, does not cause symptomatic deterioration or precipitate intestinal obstruction in Crohn's disease. [ABSTRACT FROM PUBLISHER]

Background & Aims: There is controversy over whether psychological stress contributes to development of peptic ulcers. We collected data on features of life stress and ulcer risk factors from a defined population in Denmark and compared these with findings of confirmed ulcers during the next 11-12 years., Methods: We collected blood samples and psychological, social, behavioral, and medical data in 1982-1983 from a population-based sample of 3379 Danish adults without a history of ulcer participating in the World Health Organization's MONICA study. A 0- to 10-point stress index scale was used to measure stress on the basis of concrete life stressors and perceived distress. Surviving eligible participants were reinterviewed in 1987-1988 (n = 2809) and 1993-1994 (n = 2410). Ulcer was diagnosed only for patients with a distinct breach in the mucosa. All diagnoses were confirmed by review of radiologic and endoscopic reports. Additional cases of ulcer were detected in a search of all 3379 subjects in the Danish National Patient Register., Results: Seventy-six subjects were diagnosed with ulcer. On the basis of the stress index scale, ulcer incidence was significantly higher among subjects in the highest tertile of stress scores (3.5%) than the lowest tertile (1.6%) (adjusted odds ratio, 2.2; 95% confidence interval [CI], 1.2-3.9; P < .01). The per-point odds ratio for the stress index (1.19; 95% CI, 1.09-1.31; P < .001) was unaffected after adjusting for the presence of immunoglobulin G antibodies against Helicobacter pylori in stored sera, alcohol consumption, or sleep duration but lower after adjusting for socioeconomic status (1.17; 95% CI, 1.07-1.29; P < .001) and still lower after further adjustments for smoking, use of nonsteroidal anti-inflammatory drugs, and lack of exercise (1.11; 95% CI, 1.01-1.23; P = .04). The risk for ulcer related to stress was similar among subjects who were H pylori seropositive, those who were H pylori seronegative, and those exposed to neither H pylori nor nonsteroidal anti-inflammatory drugs. On multivariable analysis, stress, socioeconomic status, smoking, H pylori infection, and use of nonsteroidal anti-inflammatory drugs were independent predictors of ulcer., Conclusions: In a prospective study of a population-based Danish cohort, psychological stress increased the incidence of peptic ulcer, in part by influencing health risk behaviors. Stress had similar effects on ulcers associated with H pylori infection and those unrelated to either H pylori or use of nonsteroidal anti-inflammatory drugs., (Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.)

The prevailing concept of peptic ulcer etiology has swung over entirely in just a few years from the psychological to the infectious, yet the rich literature documenting an association between psychosocial factors and ulcer is not invalidated by the discovery of Helicobacter pylori. Physical and psychological stressors interact to induce ulcers in animal models, concrete life difficulties and subjective distress predict the development of ulcers in prospective cohorts, shared catastrophes such as war and earthquakes lead to surges in hospitalizations for complicated ulcers, and stress or anxiety can worsen ulcer course. Many known ulcer risk factors, including smoking, nonsteroidal anti-inflammatory drug use, heavy drinking, loss of sleep and skipping breakfast, can increase under stress; the association of low socioeconomic status with ulcer is also accounted for in part by psychosocial factors. Among possible physiological mechanisms, stress may induce gastric hypersecretion, reduce acid buffering in the stomach and the duodenum, impair gastroduodenal blood flow, and affect healing or inflammation through psychoneuroimmunological mechanisms. Psychosocial factors seem to be particularly prominent among idiopathic or complicated ulcers, but they are probably operative in run of the mill H pylori disease as well, either through additive effects or by facilitating the spread of the organism across the pylorus, while gastrointestinal damage by nonsteroidal anti-inflammatory drugs can also be potentiated by stress. Although the clinical importance of peptic ulcer is fading along with the millennium, due to secular trends and new therapies, it remains worthy of study as a splendid example of the biopsychosocial model.

Five years' experience of student attachment to a Cape Town general practice as part of a community medicine 'block' is described. The students found the proceedings valuable and specially mentioned that the holistic approach to patient care, continuing care and the importance of the doctor-patient relationship were issues which they had become aware of for the first time--in sharp contrast to their experience of patient care in the teaching hospital situation. Nearly all the students complained that the time allotted to their attachment and to general practice as a whole was far too short. Various aspects of attachment are discussed, e.g. the doctor's approach, the handling of students' anxieties and the doctor-student relationship. Certain inferences are drawn concerning overall undergraduate medical training.

'Psychosomatic families' are characterized by 'enmeshment', over-protectiveness, rigidity, and a marked inability to resolve conflicts. A psychosomatically ill child may help the parents to avoid facing the conflicts in their relationship by apparently focusing all their attention on the child. The general practitioner can help such families by utilizing the principles of family therapy.

Five months' experience of a Balint group composed of 5th year medical students and a general practitioner facilitator is reported. The students found that the group helped to fill a big gap in their current training, i.e. in the area of the doctor-patient relationship. It is now widely accepted that understanding and skills in the psychological aspects of general practice are of great importance, not only because of the high incidence of such problems but because of the role of psychological factors in physical illness. For example, studies have demonstrated that the single most important factor determining the extent of patient compliance with the doctor's instructions for treatment is the quality of the doctor-patient relationship.

Much of the general practitioner's work is concerned with emotional problems, yet his undergraduate training does not equip him adequately for this purpose. Four theories of personality, each of which has contributed to modern psychotherapeutic practice, are reviewed, with specific reference to their formulations on the causation and treatment of anxiety, and the application of each of these viewpoints to specific problems in general practice. Finally, a plea is made for much greater provision for the teaching of psychology (especially therapeutic psychology) in the undergraduate medical curriculum.

A further year's experience of a Balint group composed of undergraduate medical students (having completed their final year in 1981) and a general practitioner facilitator is reported. The students found that the extra year of participation in the group had increased their understanding of and effectiveness in their relationships with patients. The implications of this experience for undergraduate training are discussed.

Chronic illness, whether physical or mental, has a profound psychological effect on the affected individuals and their families. It is necessary for the general practitioner to have a good grasp of these aspects of the care of such patients and their families, not only in order to be of assistance in alleviating the emotional stresses which chronic illness places on them, but also so as to ensure maximal compliance with the treatment regimen of the illness itself. Studies have demonstrated that the most important factor determining patient compliance is the quality of the doctor-patient relationship. Special mention is made of the 'illness solution' in families and the ways in which the general practitioner can deal with this situation.

Three years' experience as members of a group composed predominantly of general practitioners, and constituted to discuss psychological problems encountered in general practice, is reported. Without exception, present and past members found the experience valuable, and particular mention was made of members' increased insight into their own reactions in the doctor-patient relationship. It is hoped that the experience of this group will encourage general practitioners in other centres which do not already have such a group to consider forming similar groups.

The background to, initiation of and development of Balint work in the RSA over the past decade is described and discussed. Special reference is made to the establishment of Balint groups in various centres. The formation of the South African Balint Society, its activities and its place in the South African medical scene as well as in the international Balint Federation are also dealt with. Finally, some comments are made regarding the future of the Balint movement in this country.