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Development of a Core Outcome Set for Infant Colic
Mo1685 LOW-FODMAP DIET RESULTED EFFECTIVE IN RELIEVING ESOPHAGEAL AND INTESTINAL SYMPTOMS IN PATIENTS WITH PATHOPHYSIOLOGICAL CHARACTERISTICS OF FUNCTIONAL HEARTBURN AND A PROSPECTIVE, INTERVENTIONAL STUDY Nicola de Bortoli, Giada Guidi, Katia Nardi, Alessandra Stella, Salvatore Tolone, Marzio Frazzoni, Leonardo Frazzoni, Lorenzo Fuccio, Massimo Bellini, Vincenzo Savarino, Santino Marchi, Edoardo V. Savarino Background and aims: Recently, low-FODMAP diet has been proposed as potential treatment in patients with irritable bowel syndrome (IBS) given its high efficacy in symptoms relief. Recent data showed that IBS frequently overlap with functional heartburn (FH) and functional dyspepsia. The aim of this study was to evaluate the efficacy of low-FODMAP diet in reducing heartburn in patients with FH and no pathophysiological evidence of gastroesophageal reflux (GERD) compared to patients with non-erosive reflux disease (NERD). As secondary, aim we investigated the reduction of lower gastrointestinal symptoms in both groups. Patients and Methods: we enrolled patients with heartburn and negative upper endoscopy who were scheduled for upper pathophysiological tests (esophageal manometry and impedance and pH monitoring, MII-pH) at Gastroenterology Unit in University of Pisa. We excluded patients older than 75 and younger than 18, those with primary esophageal motor disorders and with previous abdominal surgery. Medical history, voluptuary habits and response to proton pump inhibitor (PPI) treatment were recorded. By means of MII-pH we splitted patients in two populations: NERD group (abnormal esophageal acid exposure or number of refluxes) and FH group (normal esophageal acid exposure and number of reflux, no symptom-reflux correlation and no heartburn relief during PPI treatment). All enrolled patients were evaluated with validated questionnaires (Likert and VAS) to evaluate heartburn occurrence pre- and post a nutritional approach with low-FODMAP diet for 6 weeks. Results: we included 31 patients (20 female; mean age 49.1 yrs; mean BMI 24.4) into the study. NERD group was composed by 13 patients (6 female; mean age 48.7 yrs; mean BMI 25.7). FH group was composed by 18 patients (11 female; mean age 50.9 yrs; mean BMI 23.9). All patients showed symptom improvement regarding bloating, abdominal pain and stools composition (p<0.001) after low-FODMAP diet. Moreover, we observed a very important improvement of heartburn in the FH group (from 8.4±2.5 to 2.3±1.1; p<0.001 on VAS scale) compared to the NERD group (7.2±2.2 a 6.9±1.9; p=0.624 on VAS). Conclusion: even if this is a pilot study, our results showed that a low-FODMAP diet was able to reduce heartburn perception in patients with FH and who did not obtain any symptom relief after PPI treatment. Larger prospective randomized controlled trial is mandatory to further explore these findings. abdominal symptoms perception pre- and post- low-FODMAP diet in NERD and FH groups
Mo1683 DEVELOPMENT OF A CORE OUTCOME SET FOR INFANT COLIC Nina Steutel, Marc A. Benninga, Miranda Langendam, Judith Korterink, Flavia Indrio, Hania Szajewska, Merit Tabbers Background: Infant colic (IC) is a common functional gastrointestinal disorder with a prevalence of 5 - 25%. The unknown etiology results in a wide variety in interventions and use of heterogeneous outcome measures across therapeutic trials. Our aim was to develop a core outcome set (COS) for IC to facilitate and improve evidence synthesis. Methods: The COS was developed using the Delphi technique. First, healthcare professionals and parents of infants with IC were asked to list up to 5 outcomes they considered relevant in the treatment of IC. Outcomes mentioned by >10% of participants were forwarded to a shortlist. In the second round, outcomes on this shortlist were rated and prioritized. The final COS was defined in a face-to-face expert meeting of pediatricians. Results: 49% of invited stakeholders (133 healthcare professionals and 55 parents) completed both Delphi rounds. Duration of crying, family stress, sleeping time of infant, quality of life (of family), discomfort of infant and hospital admission/duration were rated as most important outcomes in IC, framing the final COS. Conclusions: The use of this COS should serve as a minimum of outcomes to be measured and reported. This will benefit evidence synthesis, by enhancing homogeneity of outcomes, and enable evaluation of success in therapeutic trials on IC. Researchers are strongly encouraged to use this COS when setting up a clinical trial on IC.
Mo1684 NUTRITIONAL HABITS AND FODMAPS IN RELATION TO GASTROINTESTINAL ISSUES OF ENDURANCE ATHLETES Lauren Killian, Soo-Yeun Lee Gastrointestinal (GI) issues have been shown to be prevalent among endurance athletes and can significantly impair performance during training and competition. The distribution and characteristics of these symptoms are analogous to those in patients with irritable bowel syndrome (IBS). Recent studies have shown IBS symptom improvement upon implementation of a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). No studies have evaluated the nutritional intake of U.S. endurance athletes for FODMAPs in relation to GI symptoms. Objective: The objective of this study was to examine the nutritional habits of endurance athletes from a FODMAP perspective to determine the association between FODMAPs and athletes' GI distress. Methods: A 92-item online questionnaire on endurance athlete nutritional habits and lower GI symptom frequency was previously validated. The questionnaire was completed between December 2015 and November 2016 by 373 athletes in the U.S. completing a marathon, ultra-marathon, halfdistance triathlon, or full-distance triathlon within that calendar year. Results: Only 0.8% of athletes reported following a low FODMAP diet in everyday life. Of the typical pre-race dinners reported, 85.9% included a potentially high FODMAP source, while 62.2% specifically mentioned a high FODMAP food (e.g. pasta, pizza, bread). For a typical pre-race breakfast, 83.8% of athletes reported potentially high FODMAP foods, with 54.3% reporting a wheat-type breakfast food (e.g. bagel, toast). Potentially high FODMAP food intake at these meals, however, was not significantly correlated with frequency of various GI symptoms. Other potentially high FODMAP foods reported were sports nutrition products such as sports drinks, gels, energy bars, or homemade products, which include ingredients like fructose, honey, sugar alcohols, and fruit. The frequency of non-caffeinated sports drink consumption during competition was positively correlated with defecation and diarrhea during competition (p=.028 and .037, respectively). Gel or gummy consumption prior to competition was positively correlated with post-competition defecation (p=.048). Homemade product use prior to and during competition was positively correlated with various GI symptoms both during and post-competition (p<.05). Of those reporting homemade products, 57.5% were potentially high in FODMAPs (e.g. sandwiches or bars with dried fruit or honey). Conclusions: Endurance athletes commonly consume potentially high FODMAP foods. While there are some correlations between these foods and GI symptoms, it is likely that, as in the general population and patients with IBS, certain individuals have differing degrees of sensitivity. Testing of FODMAP levels in popular sports nutrition products is recommended to more accurately identify the FODMAP intake of endurance athletes.
BSC= Bristol Stool Classification; *statistically significant (p<0.05)
Mo1686 FACTORS THAT PREDICT INTESTINAL RESECTION IN PATIENTS WITH ACUTE MESENTERIC ISCHEMIA David Mossad, Drew Triplett, Ronald J. Markert, Sangeeta Agrawal Introduction Acute mesenteric ischemia (AMI) is a serious and urgent condition. Morbidity and mortality in these patients are significant, with intestinal resection at times being a major intervention. The purpose of this study was to evaluate patient demographics, comorbidity burden, and hospital characteristics in patients with AMI undergoing bowel resection. Methods We used ICD-9 diagnosis codes from the 2001-2010 National Hospital Discharge Survey to identify cases of AMI. ICD-9 procedure codes were then used to identify patients who underwent bowel resection. Comparisons on demographics, comorbidities, hospital length of stay (LOS), and selected health system characteristics were made between those who underwent bowel resection and those who did not. SPSS was used for chi-square and t test analysis at alpha = 0.05. Results Among 3,441 cases of AMI, 1,393 underwent bowel resection and 2,048 did not. The resection group was similar in age (64.4 vs 65.7 years, p=0.11) but had a longer LOS (18.0 vs 7.9 days, p<0.001). Males were more likely to undergo resection (43.1% of males vs 38.9% of females, p=0.015). No differences were seen in resection rate based on race (p=0.55). Patients with hypertension (25.5% vs 44.8%, p<0.001), coronary artery disease (CAD) (28.5% vs 41.6%, p<0.001), and diabetes (30.3% vs 41.5%, p<0.001) had lower resection rates. Patients who suffered acute kidney injury (AKI) (51.4% vs 38.6%, p<0.001), and sepsis (61.3% vs 38.9%, p<0.001) during their hospitalization were more likely to undergo resection. Those undergoing surgery were more often discharged to a short term (37.9%) or long term (58.6%) care facility compared to going directly home (32.4%) (p<0.001). Patients needing resection had a higher mortality
S-751
AGA Abstracts
AGA Abstracts
our aim was to develop a core outcome set (COS) for FC for children 0-1 year and 1-18 years. Methods: This COS was developed using a Delphi technique. As first step, HCPs, parents of children with FC and patients aged ≥12-18 years were asked to list up to 5 outcomes they considered relevant in the treatment of FC. Outcomes mentioned by >10% of participants were included in a shortlist. In the next step, outcomes on this shortlist were rated and prioritized by HCPs, parents and patients. Outcomes with the highest scores were included in a draft COS. In a face-to-face expert meeting, the final COS was determined. Results: The first step was completed by 109 HCPs, 165 parents and 50 children. Fifty HCPs, 80 parents and 50 children completed the subsequent step. The response rate was between 63 and 100% in both steps. The final COS for all ages consisted of: defecation frequency, stool consistency, painful defecation, quality of life, side-effects, fecal incontinence, abdominal pain and school attendance. Conclusion: The use of a COS for FC will decrease study heterogeneity and improve comparability of studies. Therefore, researchers are recommended to use this COS in future therapeutic trials on childhood FC.
Mo1683 DEVELOPMENT OF A CORE OUTCOME SET FOR INFANT COLIC Nina Steutel, Marc A. Benninga, Miranda Langendam, Judith Korterink, Flavia Indrio, Hania Szajewska, Merit Tabbers Background: Infant colic (IC) is a common functional gastrointestinal disorder with a prevalence of 5 - 25%. The unknown etiology results in a wide variety in interventions and use of heterogeneous outcome measures across therapeutic trials. Our aim was to develop a core outcome set (COS) for IC to facilitate and improve evidence synthesis. Methods: The COS was developed using the Delphi technique. First, healthcare professionals and parents of infants with IC were asked to list up to 5 outcomes they considered relevant in the treatment of IC. Outcomes mentioned by >10% of participants were forwarded to a shortlist. In the second round, outcomes on this shortlist were rated and prioritized. The final COS was defined in a face-to-face expert meeting of pediatricians. Results: 49% of invited stakeholders (133 healthcare professionals and 55 parents) completed both Delphi rounds. Duration of crying, family stress, sleeping time of infant, quality of life (of family), discomfort of infant and hospital admission/duration were rated as most important outcomes in IC, framing the final COS. Conclusions: The use of this COS should serve as a minimum of outcomes to be measured and reported. This will benefit evidence synthesis, by enhancing homogeneity of outcomes, and enable evaluation of success in therapeutic trials on IC. Researchers are strongly encouraged to use this COS when setting up a clinical trial on IC.
Mo1684 NUTRITIONAL HABITS AND FODMAPS IN RELATION TO GASTROINTESTINAL ISSUES OF ENDURANCE ATHLETES Lauren Killian, Soo-Yeun Lee Gastrointestinal (GI) issues have been shown to be prevalent among endurance athletes and can significantly impair performance during training and competition. The distribution and characteristics of these symptoms are analogous to those in patients with irritable bowel syndrome (IBS). Recent studies have shown IBS symptom improvement upon implementation of a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). No studies have evaluated the nutritional intake of U.S. endurance athletes for FODMAPs in relation to GI symptoms. Objective: The objective of this study was to examine the nutritional habits of endurance athletes from a FODMAP perspective to determine the association between FODMAPs and athletes' GI distress. Methods: A 92-item online questionnaire on endurance athlete nutritional habits and lower GI symptom frequency was previously validated. The questionnaire was completed between December 2015 and November 2016 by 373 athletes in the U.S. completing a marathon, ultra-marathon, halfdistance triathlon, or full-distance triathlon within that calendar year. Results: Only 0.8% of athletes reported following a low FODMAP diet in everyday life. Of the typical pre-race dinners reported, 85.9% included a potentially high FODMAP source, while 62.2% specifically mentioned a high FODMAP food (e.g. pasta, pizza, bread). For a typical pre-race breakfast, 83.8% of athletes reported potentially high FODMAP foods, with 54.3% reporting a wheat-type breakfast food (e.g. bagel, toast). Potentially high FODMAP food intake at these meals, however, was not significantly correlated with frequency of various GI symptoms. Other potentially high FODMAP foods reported were sports nutrition products such as sports drinks, gels, energy bars, or homemade products, which include ingredients like fructose, honey, sugar alcohols, and fruit. The frequency of non-caffeinated sports drink consumption during competition was positively correlated with defecation and diarrhea during competition (p=.028 and .037, respectively). Gel or gummy consumption prior to competition was positively correlated with post-competition defecation (p=.048). Homemade product use prior to and during competition was positively correlated with various GI symptoms both during and post-competition (p<.05). Of those reporting homemade products, 57.5% were potentially high in FODMAPs (e.g. sandwiches or bars with dried fruit or honey). Conclusions: Endurance athletes commonly consume potentially high FODMAP foods. While there are some correlations between these foods and GI symptoms, it is likely that, as in the general population and patients with IBS, certain individuals have differing degrees of sensitivity. Testing of FODMAP levels in popular sports nutrition products is recommended to more accurately identify the FODMAP intake of endurance athletes.
BSC= Bristol Stool Classification; *statistically significant (p<0.05)
Mo1686 FACTORS THAT PREDICT INTESTINAL RESECTION IN PATIENTS WITH ACUTE MESENTERIC ISCHEMIA David Mossad, Drew Triplett, Ronald J. Markert, Sangeeta Agrawal Introduction Acute mesenteric ischemia (AMI) is a serious and urgent condition. Morbidity and mortality in these patients are significant, with intestinal resection at times being a major intervention. The purpose of this study was to evaluate patient demographics, comorbidity burden, and hospital characteristics in patients with AMI undergoing bowel resection. Methods We used ICD-9 diagnosis codes from the 2001-2010 National Hospital Discharge Survey to identify cases of AMI. ICD-9 procedure codes were then used to identify patients who underwent bowel resection. Comparisons on demographics, comorbidities, hospital length of stay (LOS), and selected health system characteristics were made between those who underwent bowel resection and those who did not. SPSS was used for chi-square and t test analysis at alpha = 0.05. Results Among 3,441 cases of AMI, 1,393 underwent bowel resection and 2,048 did not. The resection group was similar in age (64.4 vs 65.7 years, p=0.11) but had a longer LOS (18.0 vs 7.9 days, p<0.001). Males were more likely to undergo resection (43.1% of males vs 38.9% of females, p=0.015). No differences were seen in resection rate based on race (p=0.55). Patients with hypertension (25.5% vs 44.8%, p<0.001), coronary artery disease (CAD) (28.5% vs 41.6%, p<0.001), and diabetes (30.3% vs 41.5%, p<0.001) had lower resection rates. Patients who suffered acute kidney injury (AKI) (51.4% vs 38.6%, p<0.001), and sepsis (61.3% vs 38.9%, p<0.001) during their hospitalization were more likely to undergo resection. Those undergoing surgery were more often discharged to a short term (37.9%) or long term (58.6%) care facility compared to going directly home (32.4%) (p<0.001). Patients needing resection had a higher mortality
S-751
AGA Abstracts
AGA Abstracts
our aim was to develop a core outcome set (COS) for FC for children 0-1 year and 1-18 years. Methods: This COS was developed using a Delphi technique. As first step, HCPs, parents of children with FC and patients aged ≥12-18 years were asked to list up to 5 outcomes they considered relevant in the treatment of FC. Outcomes mentioned by >10% of participants were included in a shortlist. In the next step, outcomes on this shortlist were rated and prioritized by HCPs, parents and patients. Outcomes with the highest scores were included in a draft COS. In a face-to-face expert meeting, the final COS was determined. Results: The first step was completed by 109 HCPs, 165 parents and 50 children. Fifty HCPs, 80 parents and 50 children completed the subsequent step. The response rate was between 63 and 100% in both steps. The final COS for all ages consisted of: defecation frequency, stool consistency, painful defecation, quality of life, side-effects, fecal incontinence, abdominal pain and school attendance. Conclusion: The use of a COS for FC will decrease study heterogeneity and improve comparability of studies. Therefore, researchers are recommended to use this COS in future therapeutic trials on childhood FC.