We explored the comorbidity between panic attacks (PA), whose symptoms can include gastrointestinal discomfort, and gastrointestinal disorders (GD). Structural equation modeling was used to analyze data from 1,874 MZ and 1,498 DZ male–male twin pairs from the Vietnam Era Twin Registry. PA and GD were associated (relative risk for GD = 2). The percentage of liability due to genetic factors was estimated to be 37% for PA and 31% for GD. There was significant correlation between the genetic risk factors for PA and GD (estimated r = .55, 95% CI of 34% to 82%) and no evidence of correlation between the environmental causes of PA and GD. Therefore, PA and GD comorbidity can be explained by overlapping genetic factors and not overlapping environmental factors. Although these data cannot identify a biological pathway for such a shared liability, it suggests the presence of GD may be informative for genetic studies of panic.

PAR-2 (protease-activated receptor 2), a G-protein-coupled receptor activated by certain serine proteases such as trypsin and tryptase, is now considered a physiologically important molecule and also a novel target for drug development. PAR-2 is widely distributed in the mammalian body, especially throughout the alimentary system. PAR-2 plays various roles in the alimentary, circulatory, respiratory and neuronal systems. In the gastric mucosa, PAR-2 modulates multiple functions and exerts mucosal cytoprotection mainly by activating sensory neurons. Thus, PAR-2 would appear to be a therapeutic target for treatment of gastric mucosal injury. Agonists and/or antagonists for PAR-2 might also be applicable to the clinical treatment of patients with inflammatory diseases in other organs.

Little is known about the value patients, physicians, and payers place on intangible attributes of care. Differences in valuations among these groups and misperceptions of value of intangible attributes to other groups can contribute to conflicts about treatment recommendations or coverage decisions. We surveyed patients, physicians, and managed care executives to assess their willingness to pay (WTP) for diagnostic certainty for peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD). To determine if patients, physicians, and payers accurately perceive each other's valuations of diagnostic certainty, participants were also asked to estimate the WTP of each of the other types of respondents. Patients were most likely, and executives least likely, to value diagnostic certainty. For PUD, 84% of patients, 61% of physicians, and 43% of executives expressed a positive WTP. Median WTP was low for all three groups ($1–9 for patients and physicians; $0 for payers). Physicians and executives both correctly predicted patient WTP. For GERD, 87% of patients, 52% of physicians, and 29% of executives expressed a positive WTP. Executives underestimated patient WTP. For both diseases, physicians' WTP was overestimated by patients and underestimated by executives. The inconsistency in the value that patients, physicians, and managed care executives place on diagnostic certainty indicates the potential for conflict over practice guidelines or access to services. WTP surveys can provide information to aid in anticipating and addressing areas of disagreement.

Adipose tissue levels of linoleic acid were determined from biopsies of subcutaneous abdominal fat of normal healthy controls (n 40) and from two patient groups with endoscopically evaluated non-ulcer dyspepsia (n 40) or peptic ulcer disease (n 38). The level (g/100 g) of adipose tissue linoleic acid in the normal healthy controls (15·0 (sd 4·1)) was significantly (P < 0·05) greater than that in patients with non-ulcer dyspepsia (12·8 (sd 3·5)) and in patients with peptic ulcer disease (11·7 (sd 2·7)). A dietary history revealed a lower intake of linoleic acid and a significantly (P < 0·05) lower intake of dietary fibre (g/d) for both the non-ulcer dyspepsia (15·9 (sd 6·2)) and peptic ulcer disease (15·2 (sd 7·8)) patients compared with normal healthy controls (20·2 (sd 11·2)). Adipose tissue linoleic acid tended to increase with indices of increasing socioeconomic status, although the differences between patient and controls were not confounded by socioeconomic status. Patients with dyspepsia reported more foods causing symptoms (onion, fried foods, alcohol, citrus fruits and spices) and more foods giving relief (milk, bread) compared with control orthopaedic patients.