1003 Factors of Importance for Disease-Specific Quality of Life in Irritable Bowel Syndrome (IBS)

METHODS: Subjects were Rome+ IBS patients and healthy controls. The Early Trauma Inventory Self Report Short Form (ETI-SF) assessed for childhood trauma in four categories: general trauma, physical, sexual and emotional abuse. The Personal Health Questionnaire (PHQ-12) measured the severity of non-GI somatic symptoms. Anxiety, depression and trait anxiety were measured with validated questionnaires. Regression models were used to predict IBS and mediation effects.

RESULTS: Subjects were 233 IBS patients and 353 healthy controls (79.4% and 77.3% women). IBS was associated with slightly higher total ETI-SF scores [OR (95%CI): 1.1 (1.1-1.2)]. While all four categories were associated with IBS, general trauma [1.3 (1.21.4)] and emotional abuse [1.4 (1.3-1.6)] independently predicted IBS. The four items that were endorsed significantly more frequently in IBS than controls are listed in the table. State and trait anxiety, and depression were also associated with IBS (OR: 1.3, 1.4, 1.1), but controlling for these did not change the effect of ETI-SF on IBS. PHQ-12 was the strongest predictor of IBS [OR=2.0 (1.7-2.2)] and when added to the model, the effects of ETI-SF and psychological symptoms became non-significant, suggesting that factors associated with the presence of widespread non-GI symptoms mediate the relationship between childhood trauma or abuse and development of IBS.

CONCLUSIONS: Childhood trauma and abuse is associated with an increased vulnerability for multiple somatic symptoms of which IBS is one subset. Its relationship to IBS is independent, but likely related, to anxiety and depression. IBS does not have a unique relationship to childhood trauma and abuse, although adverse events focusing on the relationship between the child and parent or primary caregiver appear to be more prevalent in IBS than in healthy controls. Early traumatic events associated with IBS: prevalence and odds ratios

AGA Abstracts

Developing a Screening Questionnaire for Visceral Hypersensitivity Olafur S. Palsson, Marsha J. Turner, Steve Heymen, Stephan R. Weinland, Jane Tucker, Lenore Keck, William E. Whitehead Background and aims: Visceral pain sensitivity is influenced by psychological bias in perception reflected in the sensory decision theory index “B”. We sought to develop a noninvasive questionnaire to identify patients with visceral hyperalgesia by identifying questions correlated with the B index. Methods: 107 Rome III positive, clinically diagnosed IBS patients completed a barostat test of rectal pain sensitivity and the following questionnaires: Clinical symptoms of pain and bloating, Recent Physical Symptoms Questionnaire (RPSQ) somatization scale, Pennebaker Inventory of Limbic Languidness (PILL), Pain Vigilance and Awareness Questionnaire (PVAQ), Somatosensory Amplification Scale (SAS), Tellegen Absorption Scale, Visceral Sensitivity Index, and Dissociation, Anxiety, Depression, Sexual Abuse Trauma Index, and Sleep Disturbance subscales of the Trauma Symptoms Checklist 40. The B index and corrected pain threshold (subtracted pressure required to minimally inflate bag) were computed from barostat data. As planned a priori, we also pooled all 218 questions from all scales and used t-tests to identify items which separated the lowest from the highest third of B Index scores. The 26 non-redundant items so identified formed the Visceral Perception Bias Questionnaire (VPBQ), which was scored by summing individual items. Results: The sample was 79% females with average age of 37.2 years. The mean and range for the IOP-adjusted pain threshold was 15.9 (0-44) mmHg and for the B Index 3.3 (0.9-5.5). Clinical pain was not significantly correlated with the B Index or pain threshold, but bloating severity was correlated with pain threshold (-0.22, p<0.05). Conventionally computed scores for some questionnaires (RPSQ, Tellegen Absorption Scale, Dissociation scale, anxiety, depression, and sexual abuse) were significantly correlated with the B Index and pain threshold (PVAQ, Dissociation Scale); however, no correlation exceeded 0.27, which was not strong enough to permit identification of patients with low pain thresholds. The empirically derived VPBQ performed better: it correlated -0.31 with pain threshold and -0.48 with the B Index. A VPBQ score of 35 or higher (67th percentile) identified 51.5% of patients with pain thresholds below 12 mmHg and 64.5% of patients with B Index scores below 2.71 (most sensitive third of patients). Conclusion: The empirically derived VPBQ identified more than half of the most pain sensitive IBS patients, indicating that this is a promising approach. However, further refinement and testing in a new sample of subjects including healthy controls is needed. [Supported by a grant from Takeda Pharmaceuticals and R24 DK067674] 1001

1003

Psychological Distress is a Major Risk Factor for the Continuation of Functional Gastrointestinal Disorders (FGIDs) 12 Years Later in the General Population Natasha A. Koloski, Michael Jones, Jamshid S. Kalantar, Martin D. Weltman, Jessa Zaguirre, Nick Talley

Factors of Importance for Disease-Specific Quality of Life in Irritable Bowel Syndrome (IBS) Katarina Wilpart, Cecilia Grinsvall, Anette Lindh, Pernilla Jerlstad, Gisela Ringstrom, Magnus Simren

BACKGROUND: Although FGIDs are not life threatening, they generally are considered to persist life long. It is not yet clear what factors may be responsible for the persistence of these disorders over time. Very few prospective longitudinal studies have been conducted, and in particular it is unknown if psychological distress drives symptom persistence. AIMS: In a 12-year longitudinal, prospective, population-based follow-up cohort study, to determine if psychological factors are associated with the persistence of FGIDs. We hypothesized that those participants who reported a FGID and who had higher levels of psychological distress in 1997 will have an increased risk of continuing to meet criteria for a FGID in 2009. METHODS: Participants (n=1775) were a random population sample from Penrith, Australia who responded to a valid survey in 1997 and agreed to be contacted for future research. Of these n=1004 completed the 12-year follow-up survey (response rate = 64%). Among those followed 355 met Rome II criteria for a FGID diagnosis at baseline. The original and follow-up surveys included standardized questions allowing a Rome II diagnosis to be made for 18 FGIDs. Psychological distress (anxiety and depression) was measured with the valid Delusions Symptom States Inventory (DSSI). We also asked about medication use for stomach and bowel symptoms over the past 12 years. RESULTS: Of the 355 people who had a FGID in 1997, 70% (n=249) continued to meet criteria for a FGID at follow-up in 2009. The most common FGIDs that people with a FGID continued to have at follow-up were Functional Heartburn (FH 34%), Functional Bloating (FB 31%), Irritable Bowel Syndrome (IBS 17%), Functional Chest Pain (FCP 12%) and Functional Dyspepsia (FD 8%). Higher levels of baseline anxiety was a significant predictor of continuing to meet criteria for a FGID (OR per 5 point change in scores on the DSSI =1.41; 95%CI 1.01-1.96, P=.05), FH (OR=1.33; 95%CI 0.99-1.77, P=.05), FCP (OR=1.87; 95% 1.30-2.70, P=<0.001) and FB (OR=1.74; 95%CI 1.29-2.34, P.001). Only FCP (OR=1.85; 95%1.27-2.70, P=.001) and FB (OR=1.61; 95%CI1.17-2.22, P=.004) remained independent predictors after controlling for age, gender and medication use. Having higher levels of baseline depression was also a significant independent predictor of continuing to meet criteria for FCP (OR=2.07; 95%CI1.45-2.96, P=<0.001), FD (OR=1.56; 95%CI1.01-2.40, P=.05) and FB (OR=1.64; 95%CI1.19-2.25, P= .002) even after controlling for confounding factors. CONCLUSIONS: In a longitudinal cohort study, we found strong evidence that psychological distress is an independent risk factor for the long term persistence of some FGIDs.

Background: IBS has a significant impact on health-related quality of life (HRQOL), and both psychological and somatic symptoms are important explanatory variables for this. When measuring HRQOL, different dimensions of health are assessed. The relative importance of various disease-related factors for these different dimensions in IBS is unclear. Aim: To evaluate factors of importance for different dimensions of disease-specific QOL in IBS. Methods: We included 177 patients fulfilling the Rome III criteria for IBS (mean age 40 (19-72) years; 137 females), who completed the disease-specific IBSQOL questionnaire, which includes nine different dimensions (emotional, mental health, sleep, energy, physical functioning, food, social role, physical role and sexual relations). We also assessed the severity of IBS symptoms (IBS severity scoring system - IBS-SSS), somatisation (PHQ-15), general anxiety and depression (Hospital anxiety and depression (HAD) scale), and GIspecific anxiety (Visceral Sensitivity Index - VSI). Results: Disease-specific QOL in our cohort of patients was similar to previously published data from the US and UK (Hahn et Digestion 1999). With increasing severity of the IBS symptoms according to IBS-SSS a gradual reduction of all the nine QOL dimensions were seen (p<0.0001). Moreover, reduced QOL was also seen in patients with a symptom pattern compatible with a somatoform disorder (PHQ-15) (p<0.001), clinically significant anxiety (p<0.05 for 7/9 QOL dimensions) or depression (HAD) (p<0.05). By using standard, multiple, linear regression models factors independently associated with the nine different IBSQOL dimensions were determined. General and GIspecific anxiety were the only factors independently associated with the QOL dimensions emotional (R2=0.42) and mental health (R2=0.57). GI-specific anxiety was also together with severity of IBS symptoms independently associated with the QOL dimensions food (R2= 0.20) and social role (R2=0.44), and together with severity of IBS and somatic symptoms associated with energy (R2=0.41). IBS and somatic symptom severity were independent predictors of physical functioning (R2=0.28), whereas only IBS symptom severity was associated with sleep (R2=0.17), physical role (R2=0.24) and sexual relations (R2=0.22). Conclusion: General and GI-specific anxiety, as well as severity of GI and extraintestinal symptoms, are of importance for disease-specific QOL in IBS. These factors affect the dimensions of QOL in IBS differently, where the influence of psychological factors predominate for some dimensions, whereas GI and somatic severity are the main determinants for other dimensions.

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1004

The Effect of Childhood Trauma and Abuse on the Development of Irritable Bowel Syndrome is Mediated by Somatization Elizabeth J. Videlock, Emeran A. Mayer, Bruce D. Naliboff, Lin Chang

Severity of Cytomegalovirus Infection on Pathology Specimens is Associated With Colectomy Rates and Response to Antiviral Therapy in Inflammatory Bowel Disease Patients Minh Nguyen, Kara Bradford, Xiaolan Zhang, Peter Simpson, Stephan R. Targan, Eric A. Vasiliauskas, David Q. Shih

BACKGROUND: Childhood abuse and trauma have been shown to be associated with negative health outcomes and behaviors in the adult, including IBS and the presence of multiple somatic symptoms (somatization).

AIMS: 1) To determine if abuse or trauma before the age of 18 increases the risk of developing IBS; 2) To determine which types of trauma and abuse are most associated with IBS; 3) To evaluate the contribution of state and

AGA Abstracts

BACKGROUND: IBD patients have increased risk of GI manifestations of Cytomegalovirus (CMV) infection due to several factors, including use of immunosuppressive drugs, GI inflammation, malnutrition, and possible immune dysregulation. Relationships between CMV

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