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Obesity Increases the Risk of Gastrointestinal Bleeding in Men
was performed using Mann-Whitney U test. Results: The mean CDAI, PMS and CES-D scale were 97.2 (0-324), 1.2 (0-8) and 5.2 (0-17), respectively. The proportion of the patients who showed depressive psychological status was 25.2% (29/115). Disease activity was positively correlated with CES-D scale in both CD and UC patients (CD: r=0.51, p<.0001, UC: r=0.54, p<.0001). When these patients were followed-up, there was no change for disease activity between first and second visit in both depressive and non-depressive patients (depressive CD; 148.0 vs 135.6, p=0.87, non-depressive CD; 68.5 vs 72.2, p=0.49, depressive UC; 2.5 vs 1.6, p=0.22 and non-depressive UC; 0.76 vs 0.78, p=1.0). When remissive patients were selected, depressive patients, but not non-depressive patients, worsened disease activity in CD patients (75.6 vs 111.2, p=0.02), whereas non-depressive patients, but not depressive patients, worsened disease activity in UC patients (0.26 vs 0.67, p=0.003). Conclusion: Disease activity was associated with psychologic stress in IBD patients. There was no change for disease activity both CD and UC patients. In remissive patients, depressive psychological status was associated with worsened disease activity in CD patients. Depressive psychological status may predict future disease exacerbation in remissive CD patients.
Tu1697 ASSOCIATION BETWEEN LOWER AIR PRESSURE AND THE ONSET OF ISCHEMIC COLITIS: A NOVEL METEOROLOGICAL ASPECT Takefumi Kimura, Naoki Tanaka Background and Aim: Ischemic colitis (IC) most often affects the elderly. Pro-arteriosclerotic factors, such as hypertension and smoking, and cardiovascular disease are regarded as major contributors to IC. Although a possible link between certain cerebrocardiovascular disorders and meteorological phenomena has been reported, the relationship between IC onset and weather changes remains uninvestigated. This study examined whether specific meteorological factors were associated with the occurrence of IC. Methods: We retrospectively enrolled 303 patients who had been diagnosed as having IC between January 2003 and June 2010 at Suwa Red Cross Hospital in Suwa, Japan. The meteorological data of the days on which IC patients visited our hospital (IC+ days) were compared with those of the days on which IC patients did not (IC- days). Results: Univariate analysis revealed that IC+ days had significantly lower air pressure (P<0.001), depressed air pressure from the previous day (P<0.001), and fewer daylight hours (P<0.001) as well as higher air temperature (P=0.017), air humidity (P=0.004), wind velocity (P<0.001), and rainfall (P=0.012) as compared with IC- days. Multivariate logistic regression analysis demonstrated that air pressure (odds ratio: 0.935, P<0.001) and change in air pressure from the previous day (odds ratio: 0.934, P<0.001) were significantly related with IC onset. Conclusions: Lower air pressure and decrease in air pressure from the previous day are possible novel risk factors for IC development.
Tu1701 FATIGUE IS NOT ASSOCIATED WITH VITAMIN D DEFICIENCY IN IBD PATIENTS Svein O. Frigstad, Marte Lie Høivik, Jorgen Jahnsen, Milada C. Smastuen, Tore Grimstad, Ingrid P. Berset, Gert Huppertz-Hauss, Øystein Hovde, Roald Torp, Tomm Bernklev, Bjorn Moum, Lars-Petter Jelsness-Jørgensen Background: Fatigue is common in inflammatory bowel diseases (IBD) with a prevalence of 44-86 % in active disease and 22-41% in remission. In addition to disease activity, sleep disturbance, anemia, pain and depression all seem to be related to fatigue. However, the influence of vitamin D deficiency on fatigue is unclear. The aim of this study was to investigate if fatigue was associated with vitamin D deficiency in patients with IBD. Methods: Participants were recruited from nine hospitals in the southeastern and western regions of Norway to participate in a multicentre cross sectional study from March 2013 to April 2014. Clinical and epidemiological data were collected by interview, from laboratory tests and medical records. The Fatigue questionnaire (FQ) and Multidimensional Fatigue Inventory (MFI-20) were used to measure fatigue. Disease activity was assessed by clinical indices (Harvey Bradshaw index and simple clinical colitis activity index), C-reactive protein and faecal calprotectin. Vitamin D deficiency was defined as a 25-OH-D concentration < 50 nmol/l. The possible association between fatigue and vitamin D deficiency was investigated using Pearson Correlation coefficient for continuous variables and Students T-test for categorical variables. Results: In total, 405 patients were available for the analyses, 227 (56%) with CD and 178 (44 %) with UC. There were no significant differences between UC and CD patients regarding age or gender, but CD patients had significantly longer disease duration (median 11 vs. 6 years). Almost 50% (199/405) of the patients had vitamin D deficiency. Substantial fatigue was found in 48 % (194/405) and chronic fatigue in 29 % (116/405). No significant correlation between total fatigue and vitamin D levels was observed, and no significant associations were found between fatigue dimensional scores and vitamin D deficiency. In addition, no significant differences in mean vitamin D levels among patients with substantial fatigue (p=0.21) or chronic fatigue (p=0.96), and patients without fatigue, were found. Conclusions: In this study, no significant associations between fatigue and vitamin D deficiency were observed in IBD patients.
Tu1699 OBESITY INCREASES THE RISK OF GASTROINTESTINAL BLEEDING IN MEN Lisa L. Strate, Amit D. Joshi, Prashant Singh, Sorbarikor Piawah, Matthew R. Boylan, Andrew T. Chan Background: The existing literature regarding obesity and risk of gastrointestinal bleeding (GIB) is sparse and pertains to specific sources of bleeding. We assessed the risk of GIB associated with body mass index (BMI), waist circumference and waist-to-hip ratio in a large prospective cohort of men. Methods: We studied 46,884 men in the Health Professional follow-up Study (HPFS) who were aged 40-75 years at baseline in 1986. We reviewed medical records from men who indicated GIB requiring hospitalization and/or blood transfusion on biennial questionnaires from 2006-2012. Weight and height were updated every 2 years, and waist and hip circumference were collected in 1987. We used Cox proportional hazards regression to calculate the hazard ratios (HR) and 95% CI adjusting for age, study year, physical activity, regular aspirin and nonsteroidal anti-inflammatory drug use, alcohol and smoking. Results: We documented 302 episodes of GIB during a 26-year follow up period with a cumulative follow up of 893,359 person-years. After adjustment for other potential risk factors, men with a BMI ≥ 30 had a multivariate HR of 2.65 (95% CI 1.51-4.65; p for trend < 0.001) for overall GIB when compared with men with a BMI of 21-22.9. BMI appeared to be more strongly related to lower GIB (multivariate HR 2.69, 95% CI 1.056.91) than upper GIB (multivariate HR 2.03, 95% CI 0.93-5.43). Waist circumference was associated with risk of overall GIB (multivariate HR 1.31, 95% CI 0.90-1.90; p for trend = 0.04) and lower GIB (multivariate HR 1.63, 95% CI 0.91-2.93; p for trend=0.04) in lowhigh comparisons. Men in the highest quintile of waist-to-hip ratio were at increased risk of lower GIB when compared to those in the lowest quintile (multivariate HR 2.18, 95% CI 1.07-4.45; p for trend=0.05). Waist-to-hip ratio was not associated with overall or upper GIB. Conclusions: In this large prospective study, obesity as well as measures of central obesity were associated with an increased risk of GIB, particularly lower GIB.
Tu1702 THE INFLUENCE OF METEOROLOGICAL FACTORS ON THE INCIDENCE OF ACUTE UPPER GASTROINTESTINAL HEMORRHAGE Florian Prechter, Martin Bürger, Thomas Lehmann, Carsten Schmidt, Andreas Stallmach Background: It is a frequently mentioned glimpse by experienced endoscopists that environmental factors and in particular changing weather conditions might influence the probability of acute upper gastrointestinal bleeding (uGIB). Various studies have examined seasonal variation in uGIB with inconclusive results. Furthermore, there have been several reports on the effect of meteorological factors on various bleeding-associated diseases, ranging from epistaxis to intracerebral hemorrhage. The aim of this study was to investigate the association between the incidence of uGIB and various meteorological parameters. Patients and Methods: We retrospectively included all patients with uGIB diagnosed between January 2013 and October 2016. Patients were categorized according to the source of the bleeding (table 1). The following parameters were correlated with the occurrence of uGIB: Temperature (minimum, maximum, range, change from previous day), Air pressure (absolute and change from previous day), wind speed, precipitation, humidity, and solar irradiance. Firstly, the entire group of bleeding episodes was associated with weather conditions. Secondly, due to the different pathophysiology of bleeding sources, we also performed a subgroup analysis for variceal as well as peptic ulcer bleeding. Meteorological data were obtained from the closest meteorological station (Jena University of Applied Sciences). Event rates were modeled as a function of weather conditions using Poisson regression. Results: During the study period, 2,862 gastroscopies were performed because of clinically suspected uGIB. In 1,056 patients (36.9%) recent or actual bleeding was confirmed. In 572 patients (54.2%) endoscopic therapy was applied (Table 1). With respect to all sources of bleeding we did not find a significant influence of meteorological conditions on the incidence of uGIB (table 2). No such association has been found in patients requiring endoscopic therapy or (according to the pre-specified subgroup analyses) in patients with peptic ulcer bleeding. However, in patients with variceal bleeding we identified a statistically highly significant association with the change in temperature relative to the day before (p=0.007, Incidence rate ratio (IRR) = 1.179 per degree centigrade). Discussion: Our study does not support the correlation of meteorological conditions with the frequency of uGIB from a wide variety of different sources. However, we found a statistically significant and clinically relevant increase of variceal bleeding episodes along with an increase in temperature relative to the prior day. While there have been reports on the effect of the absolute temperature on various disease courses, the effects of changing weather conditions have not yet been investigated sufficiently and require further elucidation.
Tu1700 DEPRESSIVE PSYCHOLOGICAL STATUS IS ASSOCIATED WITH DISEASE EXACERBATION IN REMISSIVE CROHN'S DISEASE PATIENTS: A PROSPECTIVE OBSERVATIONAL STUDY Manabu Araki, Hideki Iijima, Takeo Yoshihara, Shuko Iwatani, Toshio Yamaguchi, Shoichiro Kawai, Satoshi Hiyama, Takahiro Inoue, Shinichiro Shinzaki, Tetsuo Takehara Background: Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are refractory diseases and the course is suggested to be associated with environmental factors. Although psychologic stress has been shown to be associated with disease course, it is unclear whether depressive psychological status is the cause or consequence of IBD exacerbation. In this study, we aimed to clarify the association between depressive mood and disease course in IBD. Methods: This was a single-center prospective observational study. A total of 135 IBD patients (63 CD patients, 72 UC patients) were enrolled. All patients were Japanese and data were collected using medical records and questionnaires from patients from December 2015 to August 2016. We evaluated the association between clinical disease activity and depressive psychological status, and the patients' disease activity at the visit of 2-4 months later was evaluated. We assessed disease activity by using Crohn's disease activity index (CDAI) in CD patients and partial Mayo score (PMS) in UC patients, and evaluated mental state by using 11-item short form of Central for Epidemiologic Depression (CES-D) scale. Active disease was defined as CDAI ≥ 150 or PMS ≥ 2. A depressive psychological status was defined as CES-D scale ≥ 7. Statistical analysis
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AGA Abstracts
AGA Abstracts
people with high school (OR: 4.14, 95% CI: 1.88-9.10, p=0.001) or college (OR: 5.00, 95% CI: 2.53-9.91, p<0.001) education level and higher income level (OR: 2.07, 95% CI: 1.064.02, p=0.033) were significantly associated with higher prevalence of concurrent PPI and antacid use. Conclusion: A significant number of people in the US who are taking prescription PPI are also taking supplemental antacid for additional antacid measures, especially those with higher education or higher income level. Clinicians who prescribe PPI should be aware that patients may under-report inadequate symptom control with PPI or take supplemental antacid on their own.
Tu1697 ASSOCIATION BETWEEN LOWER AIR PRESSURE AND THE ONSET OF ISCHEMIC COLITIS: A NOVEL METEOROLOGICAL ASPECT Takefumi Kimura, Naoki Tanaka Background and Aim: Ischemic colitis (IC) most often affects the elderly. Pro-arteriosclerotic factors, such as hypertension and smoking, and cardiovascular disease are regarded as major contributors to IC. Although a possible link between certain cerebrocardiovascular disorders and meteorological phenomena has been reported, the relationship between IC onset and weather changes remains uninvestigated. This study examined whether specific meteorological factors were associated with the occurrence of IC. Methods: We retrospectively enrolled 303 patients who had been diagnosed as having IC between January 2003 and June 2010 at Suwa Red Cross Hospital in Suwa, Japan. The meteorological data of the days on which IC patients visited our hospital (IC+ days) were compared with those of the days on which IC patients did not (IC- days). Results: Univariate analysis revealed that IC+ days had significantly lower air pressure (P<0.001), depressed air pressure from the previous day (P<0.001), and fewer daylight hours (P<0.001) as well as higher air temperature (P=0.017), air humidity (P=0.004), wind velocity (P<0.001), and rainfall (P=0.012) as compared with IC- days. Multivariate logistic regression analysis demonstrated that air pressure (odds ratio: 0.935, P<0.001) and change in air pressure from the previous day (odds ratio: 0.934, P<0.001) were significantly related with IC onset. Conclusions: Lower air pressure and decrease in air pressure from the previous day are possible novel risk factors for IC development.
Tu1701 FATIGUE IS NOT ASSOCIATED WITH VITAMIN D DEFICIENCY IN IBD PATIENTS Svein O. Frigstad, Marte Lie Høivik, Jorgen Jahnsen, Milada C. Smastuen, Tore Grimstad, Ingrid P. Berset, Gert Huppertz-Hauss, Øystein Hovde, Roald Torp, Tomm Bernklev, Bjorn Moum, Lars-Petter Jelsness-Jørgensen Background: Fatigue is common in inflammatory bowel diseases (IBD) with a prevalence of 44-86 % in active disease and 22-41% in remission. In addition to disease activity, sleep disturbance, anemia, pain and depression all seem to be related to fatigue. However, the influence of vitamin D deficiency on fatigue is unclear. The aim of this study was to investigate if fatigue was associated with vitamin D deficiency in patients with IBD. Methods: Participants were recruited from nine hospitals in the southeastern and western regions of Norway to participate in a multicentre cross sectional study from March 2013 to April 2014. Clinical and epidemiological data were collected by interview, from laboratory tests and medical records. The Fatigue questionnaire (FQ) and Multidimensional Fatigue Inventory (MFI-20) were used to measure fatigue. Disease activity was assessed by clinical indices (Harvey Bradshaw index and simple clinical colitis activity index), C-reactive protein and faecal calprotectin. Vitamin D deficiency was defined as a 25-OH-D concentration < 50 nmol/l. The possible association between fatigue and vitamin D deficiency was investigated using Pearson Correlation coefficient for continuous variables and Students T-test for categorical variables. Results: In total, 405 patients were available for the analyses, 227 (56%) with CD and 178 (44 %) with UC. There were no significant differences between UC and CD patients regarding age or gender, but CD patients had significantly longer disease duration (median 11 vs. 6 years). Almost 50% (199/405) of the patients had vitamin D deficiency. Substantial fatigue was found in 48 % (194/405) and chronic fatigue in 29 % (116/405). No significant correlation between total fatigue and vitamin D levels was observed, and no significant associations were found between fatigue dimensional scores and vitamin D deficiency. In addition, no significant differences in mean vitamin D levels among patients with substantial fatigue (p=0.21) or chronic fatigue (p=0.96), and patients without fatigue, were found. Conclusions: In this study, no significant associations between fatigue and vitamin D deficiency were observed in IBD patients.
Tu1699 OBESITY INCREASES THE RISK OF GASTROINTESTINAL BLEEDING IN MEN Lisa L. Strate, Amit D. Joshi, Prashant Singh, Sorbarikor Piawah, Matthew R. Boylan, Andrew T. Chan Background: The existing literature regarding obesity and risk of gastrointestinal bleeding (GIB) is sparse and pertains to specific sources of bleeding. We assessed the risk of GIB associated with body mass index (BMI), waist circumference and waist-to-hip ratio in a large prospective cohort of men. Methods: We studied 46,884 men in the Health Professional follow-up Study (HPFS) who were aged 40-75 years at baseline in 1986. We reviewed medical records from men who indicated GIB requiring hospitalization and/or blood transfusion on biennial questionnaires from 2006-2012. Weight and height were updated every 2 years, and waist and hip circumference were collected in 1987. We used Cox proportional hazards regression to calculate the hazard ratios (HR) and 95% CI adjusting for age, study year, physical activity, regular aspirin and nonsteroidal anti-inflammatory drug use, alcohol and smoking. Results: We documented 302 episodes of GIB during a 26-year follow up period with a cumulative follow up of 893,359 person-years. After adjustment for other potential risk factors, men with a BMI ≥ 30 had a multivariate HR of 2.65 (95% CI 1.51-4.65; p for trend < 0.001) for overall GIB when compared with men with a BMI of 21-22.9. BMI appeared to be more strongly related to lower GIB (multivariate HR 2.69, 95% CI 1.056.91) than upper GIB (multivariate HR 2.03, 95% CI 0.93-5.43). Waist circumference was associated with risk of overall GIB (multivariate HR 1.31, 95% CI 0.90-1.90; p for trend = 0.04) and lower GIB (multivariate HR 1.63, 95% CI 0.91-2.93; p for trend=0.04) in lowhigh comparisons. Men in the highest quintile of waist-to-hip ratio were at increased risk of lower GIB when compared to those in the lowest quintile (multivariate HR 2.18, 95% CI 1.07-4.45; p for trend=0.05). Waist-to-hip ratio was not associated with overall or upper GIB. Conclusions: In this large prospective study, obesity as well as measures of central obesity were associated with an increased risk of GIB, particularly lower GIB.
Tu1702 THE INFLUENCE OF METEOROLOGICAL FACTORS ON THE INCIDENCE OF ACUTE UPPER GASTROINTESTINAL HEMORRHAGE Florian Prechter, Martin Bürger, Thomas Lehmann, Carsten Schmidt, Andreas Stallmach Background: It is a frequently mentioned glimpse by experienced endoscopists that environmental factors and in particular changing weather conditions might influence the probability of acute upper gastrointestinal bleeding (uGIB). Various studies have examined seasonal variation in uGIB with inconclusive results. Furthermore, there have been several reports on the effect of meteorological factors on various bleeding-associated diseases, ranging from epistaxis to intracerebral hemorrhage. The aim of this study was to investigate the association between the incidence of uGIB and various meteorological parameters. Patients and Methods: We retrospectively included all patients with uGIB diagnosed between January 2013 and October 2016. Patients were categorized according to the source of the bleeding (table 1). The following parameters were correlated with the occurrence of uGIB: Temperature (minimum, maximum, range, change from previous day), Air pressure (absolute and change from previous day), wind speed, precipitation, humidity, and solar irradiance. Firstly, the entire group of bleeding episodes was associated with weather conditions. Secondly, due to the different pathophysiology of bleeding sources, we also performed a subgroup analysis for variceal as well as peptic ulcer bleeding. Meteorological data were obtained from the closest meteorological station (Jena University of Applied Sciences). Event rates were modeled as a function of weather conditions using Poisson regression. Results: During the study period, 2,862 gastroscopies were performed because of clinically suspected uGIB. In 1,056 patients (36.9%) recent or actual bleeding was confirmed. In 572 patients (54.2%) endoscopic therapy was applied (Table 1). With respect to all sources of bleeding we did not find a significant influence of meteorological conditions on the incidence of uGIB (table 2). No such association has been found in patients requiring endoscopic therapy or (according to the pre-specified subgroup analyses) in patients with peptic ulcer bleeding. However, in patients with variceal bleeding we identified a statistically highly significant association with the change in temperature relative to the day before (p=0.007, Incidence rate ratio (IRR) = 1.179 per degree centigrade). Discussion: Our study does not support the correlation of meteorological conditions with the frequency of uGIB from a wide variety of different sources. However, we found a statistically significant and clinically relevant increase of variceal bleeding episodes along with an increase in temperature relative to the prior day. While there have been reports on the effect of the absolute temperature on various disease courses, the effects of changing weather conditions have not yet been investigated sufficiently and require further elucidation.
Tu1700 DEPRESSIVE PSYCHOLOGICAL STATUS IS ASSOCIATED WITH DISEASE EXACERBATION IN REMISSIVE CROHN'S DISEASE PATIENTS: A PROSPECTIVE OBSERVATIONAL STUDY Manabu Araki, Hideki Iijima, Takeo Yoshihara, Shuko Iwatani, Toshio Yamaguchi, Shoichiro Kawai, Satoshi Hiyama, Takahiro Inoue, Shinichiro Shinzaki, Tetsuo Takehara Background: Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are refractory diseases and the course is suggested to be associated with environmental factors. Although psychologic stress has been shown to be associated with disease course, it is unclear whether depressive psychological status is the cause or consequence of IBD exacerbation. In this study, we aimed to clarify the association between depressive mood and disease course in IBD. Methods: This was a single-center prospective observational study. A total of 135 IBD patients (63 CD patients, 72 UC patients) were enrolled. All patients were Japanese and data were collected using medical records and questionnaires from patients from December 2015 to August 2016. We evaluated the association between clinical disease activity and depressive psychological status, and the patients' disease activity at the visit of 2-4 months later was evaluated. We assessed disease activity by using Crohn's disease activity index (CDAI) in CD patients and partial Mayo score (PMS) in UC patients, and evaluated mental state by using 11-item short form of Central for Epidemiologic Depression (CES-D) scale. Active disease was defined as CDAI ≥ 150 or PMS ≥ 2. A depressive psychological status was defined as CES-D scale ≥ 7. Statistical analysis
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AGA Abstracts
AGA Abstracts
people with high school (OR: 4.14, 95% CI: 1.88-9.10, p=0.001) or college (OR: 5.00, 95% CI: 2.53-9.91, p<0.001) education level and higher income level (OR: 2.07, 95% CI: 1.064.02, p=0.033) were significantly associated with higher prevalence of concurrent PPI and antacid use. Conclusion: A significant number of people in the US who are taking prescription PPI are also taking supplemental antacid for additional antacid measures, especially those with higher education or higher income level. Clinicians who prescribe PPI should be aware that patients may under-report inadequate symptom control with PPI or take supplemental antacid on their own.