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Cross-cultural comparison of quality of life in irritable bowel syndrome (IBS)
4073
4075
Racial Differences in the Impact of Irritable Bowel Syndrome (IBS) on HealthRelated Quality of Life (HRQOL) lan M. Gralnek, VA Greater Los Angeles Hesithcare System, Los Angeles, CA; non D. Hays, UCLA Sch of Medicine, Los Angeles, CA; Amy Kilbourne, VA Pittsburgh Healthcare System, Pittsburgh, PA; Emeran A. Mayer, UCLA Sch of Medicine, Los Angeles, CA
Long-term Outcomeof EndoscopicDrainage of Pancreatic Psoudocysts Ojuna L. Cahen, Marco J. Bruno, Erik Aj Rauws, Paul Fockens, Jacques Ghm Bergman, Guido N.J. Tytgat, Kess Huibregtse, Acad Medical Ctr, Amsterdam Netherlands Background: Nowadays,endoscopic drainage is often used as the initial treatment modality to relief symptomatic pancreatic pseudocysts.Although short-term results are reported to be excellent, studies on long-term outcome are lacking. Methods: All patients who underwent endoscopic drainage of pancreatic pseudocysts between 1983-1999 in our hospital were included in this retrospective study. Patient charts were reviewed and long-term follow up data were obtained by written questionnaire.Outcome measureswere: complication rate, cyst resolution, favourable symptomatic response and recurrence rate. Results: 92 patients were included (mean age 49 yr, 66 male). A total of 106 cysts were drained with a mean size of 8 cm (range 2-20 cm). 52 were located in the head of the pancreas, 30 in the body and 24 in the tail. Drainage was performed transgastrically in 39% of cases, transpapillary in 30%,trsnsduodenally in 22% and via muliple routes in 9%. Technical success rate of endoscopic drainagewas 96%. One patient died a month after the procedurebecauseof decompensated liver cirrhosis after he had developeda midazolaminduced respiratoryfailure, amounting to a procedure related mortality rate of 1%. Procedure related complications occurred in 22 patients (24%)and stent relatedcomplications in 13 (14%). In 11 patients complicationswere minor and no further treatment was needed.Additional interventionaltreatment was required in 24 patients (26%); 13 cases were managed endoscopically, 2 percutaneously and 10 required surgery (gastrocystostomy in 8, tail resection in 2). Two of these patients had acute necrotising pancreatitis and died after a protractive disease course, due to pneumonia and MOF respectively. A causal relationship between these deaths and endoscopic intervention can neither be proven nor excluded.Completeresolution of the cyst was accomplished in 54 patients (59%). In the remaining 41% in whom cyst resolution was partial, only 7 patients (8%) requiredadditional (surgical) treatment for persisting symptoms. During a medianfollow up of 33 months (range 0-208) 19 patients developeda new cyst, 15 of which were located at the original drainagesite. Only 11/19 were symptomatic and required reinterventionbecause of complaints; 5 were managedendoscopically,one peroutaneoustyand 5 surgically. Conclusions: Endoscopic drainage seems a safe and effective treatment modality for symptomatic pseudocysts. Even after long-term follow up only a few patients develop a recurrence or a new symptomatic pseudocyst.
Comparativedata on HRQOLby race has not previously been reported for IBS patients (pts). Purpose: To compare HRQOLof white & non-white IBS pts with one another & with pts with other chronic disease. Methods: The SF-36, a self-report HRQOL measure, has 8 multi-item scales each ranging from 0-100 (higher scores indicate better HRQOL): physical functioning (PF),role limitations - physical (RP), bodily pain (BP), general health perceptions (GH), emotional well-being (EW), role limitations - emotional (RE), energy (EG), & social functioning (SF). SF-36 scores of white (n = 707) & non-white (n = 166) IBS pts were compared in multivariate regression models, adjusting for age & gender. Scores for non-white pts were also compared with the general US population, GERD, diabetes, depression, & end-stage renal disease pts. Results: Mean age of the non-white & white IBS pts were 43 & 46 yrs, respectively; 71% & 66% were female. Non-white IBS pts reported significantly worse PF and ~ than white IBS pts (p = 0.04 & 0.03). Non-white IBS pts also scored worse on HRQOL than the general US population & GERD pts (see Table); they scored better than ESRD pts on PF, RP & GH but worse on EW. Conclusions: This study provides evidencethat non-white IBS pts have worse HRQOL than white IBS pts. Non-white IBS pts also report worse HRQOLthan the general US population & GERDpts. These data provide new insights into the impact of IBS by race. 8F.36 Scale
IB8 n=t66
US Pop n=2474
GERD n =516
DM n=541
DEP n=502
ESRD n=165
PF RP BP GH EW RE EG SF
77 52 53 52 61 62 42 60
85* 82* 75* 72* 74* 82* 61' 83*
80 72* 58 68" 71" 78* 57* 79*
68 57 69 56 77 76 56 82
72 44 59 53 46* 78* 40 57
52* 33* 59 44* 70* 60 46 64
4070
meanSF-36scalescores * p < 0.05comparedwith non-whiteIBS pts
Morpho-Funstionat Evaluation Of Chronic PancraatHis In Early Phases With MRCholanoiopancraatooraphyAlter Secratin Stimulation, italo De Vitis, Cristiano Spada, Dept of Internal Medicine, Rome Italy; Riccardo Manfredi, Dept of Radiology, Rome Italy; Giuseppa Pirozzi, tulsa Guidi, Giuseppa Fedeli, Giovanni Gnsparrini, Dept of Internal Medicine, Rome Italy
4074 Cress-Culthral Comparison of Quality of Life in Irritable Bowel Syndrome (IBS) Paul Enck, Oept of Gen Surg, Univ of Tuebingen, Tuebingen Germany; Sihylle Klosterhalfen, Institute of Medical Psychology, Univ of Duesseldorf, Duesseldorf Germany; Monika Behrens, GlaxoWelcomeGermany, Hamburg Germany
Introduction: Chronic pancreatitis is an inflammatory disease rather difficult to diagnose in its early phases.The aim of our study is to verify the usefulness and the efficiency of MRCP after secretin stimulation in revealingthe initial lesions of chronic pancreatitis. Methods: 73 patients with suspect of chronic pancrestitis (hyperamylasaemiaand/or hypedipesaemiaand/ or abdominal pain) were studied. The routine examinations, the glucose curve (75g), and abdominal ECO-scanand an EGDSwere carried out in all cases. 22 patients that showed no alterations,exceptabdominalpainand/or hyperamylasemiaand/or hypedipaseemia,underwent MRCP alter secretin stimulation, and a new score based on the duodenalfitting was assigned with the following grading: GO(absenceof secretion); G1 (fluid only in the bulb); G2 (inferior duodenal curve); 63 (beyond the inferior duodenal curve). Results: The images given by MRCPafter secretinstimulation were confident of chronic pancreatitisin 21/22 (95%) patients. The overall radiological aspect was of an early pancreatic involvement: 5 (24%) had only minimal changes, 7 (33%) were in stage to, 5 ~24%) were in stage Ib, 3 (14%) in stage it, 1 (5%) in stage Ifi and none in stages IV-V, according to Cromer classification of chronic pancrestitis. Furthermore, 20 (91%) were in G3, 2 (9%) in G2 and none were in GI/GO. Conclusions: kl our 22 case study the MRCP after secretin stimulation was useful to point out 21 eases of illness of which 17 in the initial phase. So, MRCP can be a usefull, non iovasive diagnostic tool in the study of the initial phases of chronic pancreatitis.
Cross cultural comparison of Quality-of-Life(GOt)in IBS patients has not been undertaken. Methods: QOL was assessed in subjects with IBS-associated symptoms recruited from a population survey in Germany (GE). Respondersmatching Rome II criteria(n = 158) or were IBS-like (n = 390) were given the SF-36 and an IBS specific OUt test (IBSQOL), and were compared IBS patients in the US and UK. Results: a) Rome II-type IBS subjects were lower in GOt on all scales and subscales as IBS-like subjects for both tests. In 3 of the SF-36 scales (physical functioning, emotional functioning, pain) and in all but 2 of the IBSQOL scales (food, sexuality) these differences were significant (p<.05). b) German IBS and IBSlike subjects were higher on all QOL scores than their American counterpartsfor all subscales of both tests, followed by the UK patients (Fig.l). The GE-US comparison was significant tor 3 SF-36 scales (physical role, emotional functioning, social functioning), and all but 2 IBSQOL scales (emotional, sleep), c) The GE-UKcomparison was significant (p<.05) on all subscales of both tests, d) As reported previously (Hahn et al. 1999), the US and UK sample significantly (p<.01) differed in all but 1 (social functioning) SF-36 scale and on 4 IBSQOL subscales (sleep, energy, physical role, and sexuality). Conclusion: Two patterns of differences were observed betweencountries: an overall lower/higher QOL profile which may reflect symptom severity and/or recruitment mode, and specific higher/lower scores on individual test scales reflecting cultural differences.
4077 The Use of EndoscopicUltrasound in Diagnosing Chronic Pancreatitis in Patients with Unexplained Pancreatic-Type Pain and a History of Acute PancreatiUs. Melanie Belanger,Joseph Romagnuolo,Josee Parent, Montreal Gen Hosp, Montreal Canada
100 ---4-- GE: R e i n
90
- * - GE: Rest
•
BACKGROUND:The prevalenceof chronic pancreatitis (DP) in patients presenting with an attack of acute pancreatiUsis unknown and variableacross populations.Endoscopicultrasound (EUS) is emerging as the most sensitive test to detect early CP. AIM: To determine the prevalenceof CP by EUS in patients with pancreatic-typeepisodesof pain and a past history of acute pancreafitis. METHODS:Aretrospective analysis of patients who underwent EUS at the Montreal General Hospital from 97/08/01 to 00/08/01 and had a documented history of acute pancreafifis (amylaseand/or lipase >5 times the upper limit of normal and/or typical CT/MRI findings) and ongoing pancreatic-typepain, for -> 3 months. Patientswere excluded if prior ultrasound, CT, MRI, MRCP or ERCPdiagnosed CP, if a pancreatic mass was found, or if steatorrhea was present. Presence of CP was defined as the presence of -> 4 EUS criterias of CP. Otherfactors were sought from chart review (seetable below). 95% Confidence Intervals (CI)were calculated and the Fisher Exact test was used to compare proportions. RESULTS: 19 patients were included, 15 of whom were female (79%). Mean age was 42.5 +/-18.0 (SD) years. Six patient~ (32%; 95%C1: 11-53%) met the EUS criteria for CP. Of these, 5 were female (83%), and mean age was 40.7 years. The table below summarizesthe prevalence of clinical factors in EUS-positive and EUS-negative patients (no statisticallly significant differences). CONCLUSIONS:CP is prevalent in patients with pancreatic-typepain and a past history of acute pancreatitis.Since it cannot be predictedeasily on clinical grounds, EUS is indicated as a diagnostic test in these patients.
80 70 60 50 40' 30 Phys Func
Phys Role
pain
General VitaUy health
Soc Role
Emot Role
Mental health
A-759
4075
Racial Differences in the Impact of Irritable Bowel Syndrome (IBS) on HealthRelated Quality of Life (HRQOL) lan M. Gralnek, VA Greater Los Angeles Hesithcare System, Los Angeles, CA; non D. Hays, UCLA Sch of Medicine, Los Angeles, CA; Amy Kilbourne, VA Pittsburgh Healthcare System, Pittsburgh, PA; Emeran A. Mayer, UCLA Sch of Medicine, Los Angeles, CA
Long-term Outcomeof EndoscopicDrainage of Pancreatic Psoudocysts Ojuna L. Cahen, Marco J. Bruno, Erik Aj Rauws, Paul Fockens, Jacques Ghm Bergman, Guido N.J. Tytgat, Kess Huibregtse, Acad Medical Ctr, Amsterdam Netherlands Background: Nowadays,endoscopic drainage is often used as the initial treatment modality to relief symptomatic pancreatic pseudocysts.Although short-term results are reported to be excellent, studies on long-term outcome are lacking. Methods: All patients who underwent endoscopic drainage of pancreatic pseudocysts between 1983-1999 in our hospital were included in this retrospective study. Patient charts were reviewed and long-term follow up data were obtained by written questionnaire.Outcome measureswere: complication rate, cyst resolution, favourable symptomatic response and recurrence rate. Results: 92 patients were included (mean age 49 yr, 66 male). A total of 106 cysts were drained with a mean size of 8 cm (range 2-20 cm). 52 were located in the head of the pancreas, 30 in the body and 24 in the tail. Drainage was performed transgastrically in 39% of cases, transpapillary in 30%,trsnsduodenally in 22% and via muliple routes in 9%. Technical success rate of endoscopic drainagewas 96%. One patient died a month after the procedurebecauseof decompensated liver cirrhosis after he had developeda midazolaminduced respiratoryfailure, amounting to a procedure related mortality rate of 1%. Procedure related complications occurred in 22 patients (24%)and stent relatedcomplications in 13 (14%). In 11 patients complicationswere minor and no further treatment was needed.Additional interventionaltreatment was required in 24 patients (26%); 13 cases were managed endoscopically, 2 percutaneously and 10 required surgery (gastrocystostomy in 8, tail resection in 2). Two of these patients had acute necrotising pancreatitis and died after a protractive disease course, due to pneumonia and MOF respectively. A causal relationship between these deaths and endoscopic intervention can neither be proven nor excluded.Completeresolution of the cyst was accomplished in 54 patients (59%). In the remaining 41% in whom cyst resolution was partial, only 7 patients (8%) requiredadditional (surgical) treatment for persisting symptoms. During a medianfollow up of 33 months (range 0-208) 19 patients developeda new cyst, 15 of which were located at the original drainagesite. Only 11/19 were symptomatic and required reinterventionbecause of complaints; 5 were managedendoscopically,one peroutaneoustyand 5 surgically. Conclusions: Endoscopic drainage seems a safe and effective treatment modality for symptomatic pseudocysts. Even after long-term follow up only a few patients develop a recurrence or a new symptomatic pseudocyst.
Comparativedata on HRQOLby race has not previously been reported for IBS patients (pts). Purpose: To compare HRQOLof white & non-white IBS pts with one another & with pts with other chronic disease. Methods: The SF-36, a self-report HRQOL measure, has 8 multi-item scales each ranging from 0-100 (higher scores indicate better HRQOL): physical functioning (PF),role limitations - physical (RP), bodily pain (BP), general health perceptions (GH), emotional well-being (EW), role limitations - emotional (RE), energy (EG), & social functioning (SF). SF-36 scores of white (n = 707) & non-white (n = 166) IBS pts were compared in multivariate regression models, adjusting for age & gender. Scores for non-white pts were also compared with the general US population, GERD, diabetes, depression, & end-stage renal disease pts. Results: Mean age of the non-white & white IBS pts were 43 & 46 yrs, respectively; 71% & 66% were female. Non-white IBS pts reported significantly worse PF and ~ than white IBS pts (p = 0.04 & 0.03). Non-white IBS pts also scored worse on HRQOL than the general US population & GERD pts (see Table); they scored better than ESRD pts on PF, RP & GH but worse on EW. Conclusions: This study provides evidencethat non-white IBS pts have worse HRQOL than white IBS pts. Non-white IBS pts also report worse HRQOLthan the general US population & GERDpts. These data provide new insights into the impact of IBS by race. 8F.36 Scale
IB8 n=t66
US Pop n=2474
GERD n =516
DM n=541
DEP n=502
ESRD n=165
PF RP BP GH EW RE EG SF
77 52 53 52 61 62 42 60
85* 82* 75* 72* 74* 82* 61' 83*
80 72* 58 68" 71" 78* 57* 79*
68 57 69 56 77 76 56 82
72 44 59 53 46* 78* 40 57
52* 33* 59 44* 70* 60 46 64
4070
meanSF-36scalescores * p < 0.05comparedwith non-whiteIBS pts
Morpho-Funstionat Evaluation Of Chronic PancraatHis In Early Phases With MRCholanoiopancraatooraphyAlter Secratin Stimulation, italo De Vitis, Cristiano Spada, Dept of Internal Medicine, Rome Italy; Riccardo Manfredi, Dept of Radiology, Rome Italy; Giuseppa Pirozzi, tulsa Guidi, Giuseppa Fedeli, Giovanni Gnsparrini, Dept of Internal Medicine, Rome Italy
4074 Cress-Culthral Comparison of Quality of Life in Irritable Bowel Syndrome (IBS) Paul Enck, Oept of Gen Surg, Univ of Tuebingen, Tuebingen Germany; Sihylle Klosterhalfen, Institute of Medical Psychology, Univ of Duesseldorf, Duesseldorf Germany; Monika Behrens, GlaxoWelcomeGermany, Hamburg Germany
Introduction: Chronic pancreatitis is an inflammatory disease rather difficult to diagnose in its early phases.The aim of our study is to verify the usefulness and the efficiency of MRCP after secretin stimulation in revealingthe initial lesions of chronic pancreatitis. Methods: 73 patients with suspect of chronic pancrestitis (hyperamylasaemiaand/or hypedipesaemiaand/ or abdominal pain) were studied. The routine examinations, the glucose curve (75g), and abdominal ECO-scanand an EGDSwere carried out in all cases. 22 patients that showed no alterations,exceptabdominalpainand/or hyperamylasemiaand/or hypedipaseemia,underwent MRCP alter secretin stimulation, and a new score based on the duodenalfitting was assigned with the following grading: GO(absenceof secretion); G1 (fluid only in the bulb); G2 (inferior duodenal curve); 63 (beyond the inferior duodenal curve). Results: The images given by MRCPafter secretinstimulation were confident of chronic pancreatitisin 21/22 (95%) patients. The overall radiological aspect was of an early pancreatic involvement: 5 (24%) had only minimal changes, 7 (33%) were in stage to, 5 ~24%) were in stage Ib, 3 (14%) in stage it, 1 (5%) in stage Ifi and none in stages IV-V, according to Cromer classification of chronic pancrestitis. Furthermore, 20 (91%) were in G3, 2 (9%) in G2 and none were in GI/GO. Conclusions: kl our 22 case study the MRCP after secretin stimulation was useful to point out 21 eases of illness of which 17 in the initial phase. So, MRCP can be a usefull, non iovasive diagnostic tool in the study of the initial phases of chronic pancreatitis.
Cross cultural comparison of Quality-of-Life(GOt)in IBS patients has not been undertaken. Methods: QOL was assessed in subjects with IBS-associated symptoms recruited from a population survey in Germany (GE). Respondersmatching Rome II criteria(n = 158) or were IBS-like (n = 390) were given the SF-36 and an IBS specific OUt test (IBSQOL), and were compared IBS patients in the US and UK. Results: a) Rome II-type IBS subjects were lower in GOt on all scales and subscales as IBS-like subjects for both tests. In 3 of the SF-36 scales (physical functioning, emotional functioning, pain) and in all but 2 of the IBSQOL scales (food, sexuality) these differences were significant (p<.05). b) German IBS and IBSlike subjects were higher on all QOL scores than their American counterpartsfor all subscales of both tests, followed by the UK patients (Fig.l). The GE-US comparison was significant tor 3 SF-36 scales (physical role, emotional functioning, social functioning), and all but 2 IBSQOL scales (emotional, sleep), c) The GE-UKcomparison was significant (p<.05) on all subscales of both tests, d) As reported previously (Hahn et al. 1999), the US and UK sample significantly (p<.01) differed in all but 1 (social functioning) SF-36 scale and on 4 IBSQOL subscales (sleep, energy, physical role, and sexuality). Conclusion: Two patterns of differences were observed betweencountries: an overall lower/higher QOL profile which may reflect symptom severity and/or recruitment mode, and specific higher/lower scores on individual test scales reflecting cultural differences.
4077 The Use of EndoscopicUltrasound in Diagnosing Chronic Pancreatitis in Patients with Unexplained Pancreatic-Type Pain and a History of Acute PancreatiUs. Melanie Belanger,Joseph Romagnuolo,Josee Parent, Montreal Gen Hosp, Montreal Canada
100 ---4-- GE: R e i n
90
- * - GE: Rest
•
BACKGROUND:The prevalenceof chronic pancreatitis (DP) in patients presenting with an attack of acute pancreatiUsis unknown and variableacross populations.Endoscopicultrasound (EUS) is emerging as the most sensitive test to detect early CP. AIM: To determine the prevalenceof CP by EUS in patients with pancreatic-typeepisodesof pain and a past history of acute pancreafitis. METHODS:Aretrospective analysis of patients who underwent EUS at the Montreal General Hospital from 97/08/01 to 00/08/01 and had a documented history of acute pancreafifis (amylaseand/or lipase >5 times the upper limit of normal and/or typical CT/MRI findings) and ongoing pancreatic-typepain, for -> 3 months. Patientswere excluded if prior ultrasound, CT, MRI, MRCP or ERCPdiagnosed CP, if a pancreatic mass was found, or if steatorrhea was present. Presence of CP was defined as the presence of -> 4 EUS criterias of CP. Otherfactors were sought from chart review (seetable below). 95% Confidence Intervals (CI)were calculated and the Fisher Exact test was used to compare proportions. RESULTS: 19 patients were included, 15 of whom were female (79%). Mean age was 42.5 +/-18.0 (SD) years. Six patient~ (32%; 95%C1: 11-53%) met the EUS criteria for CP. Of these, 5 were female (83%), and mean age was 40.7 years. The table below summarizesthe prevalence of clinical factors in EUS-positive and EUS-negative patients (no statisticallly significant differences). CONCLUSIONS:CP is prevalent in patients with pancreatic-typepain and a past history of acute pancreatitis.Since it cannot be predictedeasily on clinical grounds, EUS is indicated as a diagnostic test in these patients.
80 70 60 50 40' 30 Phys Func
Phys Role
pain
General VitaUy health
Soc Role
Emot Role
Mental health
A-759