Tu1034 Clostridium difficile Infection in a Pediatric Population Kathryn T. Chen, Daniel Stephens, Eric P. Anderson, Robert Acton, Daniel Saltzman, Donavon J. Hess Introduction: Clostridium difficile infection in the pediatric population is uncommon. The incidence of C. difficile associated disease (CDAD) in the adult population has doubled in the past decade, with increasing morbidity and mortality; however, little research has been performed in the pediatric population. We characterize C. difficile infection in the pediatric population, with emphasis on the surgical population. Methods: The records of 231 patients at a University children's hospital, birth to 18 years of age, with an associated diagnosis of CDAD between January 1, 2002 and December 31, 2008 were reviewed. The diagnosis of CDAD was confirmed by associated diarrhea and either positive stool culture or toxin assay. Results: The incidence of CDAD more than doubled from 2.5 per 1,000 hospitalizations to 5.8 per 1,000 hospitalizations over the duration of our study period. There were no fatalities or surgical interventions directly associated with CDAD. Eighty-four percent of patients received antibiotics within 2 months of diagnosis. Fifty-two percent of patients underwent operative intervention within two months of diagnosis and, of these, 6% received no other antibiotics other than pre-operative antibiotics; the remainder were either on chronic antibiotics for immunosuppressive states or had been treated for infectious disease. Fifty-seven percent of operative patients were immunosuppressed. The most commonly associated procedures included bone marrow biopsies and line placement for myelodysplastic diseases (40%) followed by renal transplant (11%). Conclusion: The incidence of pediatric CDAD in our institution has doubled in the past decade, but in contrast to adult populations, was not associated with death or operative intervention. A substantial number of CDAD cases were associated with previous operative procedures, particularly in immunosuppressed patients and those who received prior antibiotics.
Age-stratified Prevalence and Hospitalization Rates of ED Visits with a GI Disease Tu1032 Association of Doxycyline Use With the Development of Acute and Chronic Gastrointestinal Illness in Australians Deployed Abroad Thomas W. Lee, Lahiru Russell, Min F. Deng, Peter R. Gibson Background: The risks for chronic gastrointestinal illness (GI) when relocated short-term to other countries and when taking antibiotic prophylaxis in areas where malaria is endemic are unknown. A cluster of Australian Federal Police officers returning from overseas duty reported acute and chronic GI illnesses and some were diagnosed with inflammatory bowel disease. Aims: To examine the associations of deployment to developed or developing countries and exposure to doxycycline with the new onset of acute GI illness, functional bowel disorder (FBD) and inflammatory bowel disease (IBD). Methods: A cross-sectional web-based survey of all current and past members of the Australian Federal Police Association was undertaken. Independent predictors of gastrointestinal illness were examined by logistic regression analysis relative to those not deployed without exposure to doxycycline. Results: Of 1300 respondents (response rate 34%), 133 were excluded due to pre-existing chronic GI illness. Median age range was 36 to 45 years old with male predominance. 590 had episodes of overseas deployment for a median duration of 6.5 (range 0.1-149) months. 18 (3%) of those not deployed took doxycycline compared with 171 (30%) of those deployed. Those deployed abroad vs those not deployed reported gastroenteritis in 9.7% vs 0.7% (P<0.001), FBD in 4.7% vs 2.3% (P<0.001) and IBD 1.7% vs 1.4% (p=ns). Results of the multivariate analyses are shown in the table below. Conclusions: Being deployed abroad rather than doxycycline exposure is a risk factor for acute GI illness. The use of doxycycline in those deployed overseas is associated with the onset of FBD and possibly IBD. Doxycycline as a risk factor for chronic gastrointestinal illness warrants a prospective larger scale study.
Tu1035 Prevalence Changes, Incidence and Spontaneous Loss of Gastroesophageal Reflux Symptoms in a Population-Based Setting. The Nord-TrøNdelag Health Study Eivind Ness-Jensen, Anna P. Lindam, Jesper Lagergren, Kristian Hveem Background & aims: The changes in occurrence of gastroesophageal reflux symptoms (GERS) in the general population remains unsettled. This study aimed to determine the changes in prevalence of GERS, and the incidence and spontaneous loss of GERS. Methods: The study was conducted within the Nord-Trøndelag Health Study (HUNT), a series of populationbased health surveys conducted in Nord-Trøndelag County, Norway. The study base encompassed all adults from 20 years of age resident in Nord-Trøndelag County, and the participants reported their degree of GERS during the previous 12 months. In HUNT 2 (1995-1997), 58,869 persons participated (63% of the invited) and in HUNT 3 (2006-2009), 44,997 persons participated (48% of the invited). Of these, 29,610 persons were prospectively followed up for an average of 11 years from HUNT 2 to HUNT 3. Results: Between 19951997 and 2006-2009, the prevalence of any and severe GERS increased from 31.4% to 40.9% and from 5.4% to 6.7%, respectively. The prevalence of GERS increased with increasing age, in particular for females. The average annual incidence of any and severe GERS was 2.6% and 0.2%, respectively. Females, but not males, had an increasing incidence of GERS with increasing age. The average annual loss of any and severe GERS, not due to antireflux medication, was 2.1% and 1.1%, respectively. The loss of GERS decreased with increasing age. Conclusions: The prevalence of GERS increased between 1995-1997 and 2006-2009. The average annual incidence of severe GERS was 0.2%, while the corresponding nonmedicated loss was 1.1%. The prevalence, incidence and loss of GERS were influenced by sex and age.
a Estimated Odd's Ratio [95% confidence intervals] Tu1033 Gastroesophageal Reflux Disease (GERD) is Strongly Associated With Psychological Disorders in the General Population: A Community-Based Study Justin C. Wu, Arthur D. Mak, Yawen Chan, Adley Tsang, Joseph J. Sung, Francis K. L. Chan, Sing Lee
Tu1036 ROME III Criteria for Functional Gastrointestinal Disorders: Too Much Overlap to Be Useful? Alexander C. Ford, David G. Morgan, Paul Moayyedi
BACKGROUND: The association between GERD and psychological disorders is uncertain and there is a lack of data from population-based studies. AIM: To determine the association between GERD and psychological disorders in the community. METHODS: A random telephone survey of the general population aged 15-65 years was conducted. In the telephone interview, the participants were invited to complete a validated structured diagnostic questionnaire for GERD based on Montreal definition, functional dyspepsia based on Rome III criteria, generalized anxiety disorder (GAD) and major depressive disorder (MDD) based on DSM-IV criteria, respectively. RESULTS: 2011 participants (M: 937, F: 1074; cooperation rate: 65.4%) completed the interview. The prevalence of GERD and FD symptoms was 4.2% (N=84) and 8.0% (N=161), respectively. The 12-month prevalence of GAD and MDD was 3.8% (N=77) and 12.4% (n=249), respectively. Compared to participants with no GERD/ FD symptoms, GERD+ participants had significantly higher prevalence of both GAD and MDD whereas the prevalence of psychological disorders was highest among those with both GERD and FD symptoms (Table). Concomitant GAD and MDD were also more prevalent in GERD+ participants compared to GERD/FD negative participants (6.1% Vs 2.1%, p= 0.01). The frequency of GERD symptoms was correlated with the prevalence of GAD but not MDD. Using multivariate analysis, both GAD (OR: 3.0, 95% CI: 2.3-5.5, p<0.001) and depression (OR: 3.4, 95% CI: 2.5-5.3, p<0.001) were independent factors associated with GERD in the community. CONCLUSION: In the general population, GERD is strongly associated with psychological disorders. Concomitant FD and frequent GERD symptoms are associated with higher risk of psychological comorbidity.
Introduction: Functional gastrointestinal (GI) symptoms are common. The Rome III classification of these symptoms into mutually exclusive disorders attempts to improve the homogeneity of patients recruited into clinical trials from secondary and tertiary care. Previous investigators have reported significant degrees of overlap between some of these conditions, but no study has examined this issue in its entirety. Methods: This was a cross-sectional survey of consecutive new patients consulting a Gastroenterologist at two tertiary care centres. All individuals were provided with the self-administered, validated, Rome III diagnostic questionnaire for the adult functional GI disorders. We scored completed questionnaires according to the algorithm devised by the authors, but suspended the mutual exclusivity between various syndromes, such as dyspepsia, irritable bowel syndrome, and functional constipation, required by the questionnaire in order to examine the degree of overlap between them. Results: A total of 1822 patients completed the questionnaire. There were 1253 (68.8%) who met criteria for at least one of the functional GI disorders, and 880 (70.2%) of these patients met criteria for more than one disorder when the mutual exclusivity was suspended. The degree of overlap between the various disorders varied between 3% and 86%, and was greatest for functional vomiting and chronic idiopathic nausea (Table). Conclusions: The degree of overlap between the various Rome III diagnostic was variable but large in some cases. The magnitude of this overlap was of remarkably similar magnitude in
S-725
AGA Abstracts
AGA Abstracts
Prevalence of GAD and MDD in different groups of participants