Geographic variation in the use of gastrointestinal procedures in medicare beneficiaries

(7/10) showed a significant reduction in pain and symptom scores. However, the placebo treated group (SBT negative) had only 18% of subjects (2/11) with reduced pain and syraptom scores. Conclusions: The SBT can identify elderly patients with SIBO who can then be given appropriate antibiotic therapy leading to a reduction of symptoms and a better quality of life.

illness. Eligible persons were contacted and requested to complete a symptom questionnaire and to undergo upper endoscopy or to share results of any endoscopic examination performed within the 12 months preceding the interview date. Medical records were reviewed in detail. Results A total 189 potentially eligible persons satisfied inclusion and exclusion criteria and were contacted; 9 were deceased, and 5 were ineligible. Of the remaining 175, 117 (66%) refused, and 59 (34%) completed the questionnaire. Fourteen of these (24%) had upper endoscopy. The mean age of the 59 participants was 20; 78% were Caucasian, and 58% were female. The mean age at which GERD was documented was 5 years. Most participants 44/59 (75%) had either heartburn or regurgitation reported within the past 12 months; an additional 3 were asymptomatic but taking either H2RA or PPI; 13/59 (22%) reported frequent symptoms (greater than once a week). In a sensitivity analyses in which all nonrespondents (175) were assumed to be free of symptoms, the prevalence of any GERD symptoms, or frequent GERD symptoms was 25% and 7%, respectively. Overall, 16 (27%) were taking either H2RA or PP[ and eighteen patients underwent fundoplication (of those 5 were taking H2RA or PP1). Those who underwent endoscopy were younger, had a younger age of onset, and were more likely to be taking H2RA or PPI than those who did not undergo endoscopy. On endoscopy, three patients had mild erosive esophagitis, and two had columnar-lined epithelium, which on histological examination revealed gastric fundic glands but no intestinal metaplasia. Conclusions A significant proportion of subjects who had GERD as children and were otherwise normal, continue to have GERD symptoms or signs as adults and use anti-secretory medications. Childhood GERD should be considered as a risk factor for adulthood GERD. Prospective studies are needed to further elaborate the clinical course of childhood GERD.

$1172 SOCIOECONOMIC BURDEN OF DIGESTIVE DISORDERS IN CANADA: A RETROSPECTIVE AND DESCRIPTIVE ANALYSIS Jia-Qing Huang, E Jan Irvine, Richard H Hunt Background: Digestive disorders (DD) have a major impact on health and socioeconomic status in the USA as evidenced by the recent Burden of Gastrointestinal (GI) Diseases study published by the American Gastroenterological Association. Aim: to collate information on the epidemiology and burden of DD in Canada. Methods: A retrospective, descriptive study was conducted by applying appropriate principles of literature search, data gathering and analysis to integrate data from all possible sources. Results: In the fiscal year 2000/2001, the total number of discharges from acute-care hospitalizations was 2,889,586. Of these, 11.1% were for DD, ranking third after cardiovascular diseases, pregnancy and childbirth. The total number of hospitalization days was 1,781.091, with an average of 5.5 days per G1 admission, somewhat lower than the overall average stay (7.2 days). The hospitalization rate for DD for men was 1,013 per 100,000 and 980 per 100,000 for women. An estimated 136,900 new cases of cancer and 66,200 cancer deaths occurred in Canada in 2002, with the number of new cancers of the digestive system being the highest (28,000 new cases) among all organ systems and resulting in the second highest cancer deaths (14,300) only after lung cancer. The potential years of life lost (PYLL) due to GI cancers were 158,000, accounting for 17% of all PYLL associated with cancers. The overall PYLL due to DD in Canada is 2.4 per 1000 person-years, higher than AIDS and diabetes. Functional GI disorders based on the Rome II criteria are common in Canada with an estimated prevalence of 62%. Over 2 million Canadians suffer from irritable bowel syndrome (IBS), costing over $1 billion per year for the management of IBS alone. About 40% of Canadian adults have dyspepsia, with a likelihood of nsmg OTC medications 16.5 times and working days-lost 9 times higher than those without symptoms, respectively. The overall current economic data for DD in Canada are not available. However, data estimated in 1997 suggest that the annual direct costs were $3.32 billion (equivalent to $3.77 billion in 2002 dollars, valued at a constant inflation rate of 2.55%/y). Conclusions: Digestive disorders are common in Canada and have a major socioeconomic impact. Relative to the commonality of epidemiology of DD in Canada, government, industrial and public awareness of the social and economic burden needs to be increased. DD should have a higher priority for health resource and research funding allocation.

Sl175 Association Between Typical and Atypical Symptoms of Gastroesophageal Reflux: A Population-Based Study in Spain Enrique Rey, Cristina Moreno, Fernando Rodriguez-Artalejo, Giles R. Locke Ill, Manuel Diaz-Rubio BACKGROUND: Association between typical and atypical symptoms of gastroesophageal reflux (GER) has received little attention in population-based studies. AIM: To evaluate the association between typical and atypical symptoms of GER in the general population of Spain. MATERIAL AND METHODS: A phone interview was conducted with 2500 persons between 40 and 79 years of age selected at random from the general population of the whole country. Interview was done using a validated questionnaire(GERQ); a spanish version was previously validated. GERQ includes questions regarding typical GER symptoms and several atypical symptoms, both gastrointestinal (chest pain, dysphagia, eructation, early satiety) and non-gastrointestinal (globus, hoarseness, hiccups and asthma). We analysed the annual prevalence of each atypical symptom in subjects with and without typical symptoms in the last year. Associations between each atypical symptom and the reporting of typical GER symptoms were calculated by logistic regression using three separate models. Model 1(M1) adjusting by age and gender, Model 2(M2) adjusting for M1 covariates and body mass index, coffee use, alcohol consumption and psychosomatic symptom score and Model 3(M3) adjusting for M2 covariates and the presence of each of the other atypical symptoms RESULTS: Results are shown in table, which include the prevalence (C195%) of each atypical symptoms in people without (N= 1709) and with typical GER symptoms (N=791), and the OR (CI95%) in the three models CONCLUSION: Many atypical symptoms are clearly associated with typical symptoms of GER on a population basis. However, for hoarseness, hiccups and asthma the association seems to be explained by other factors or ahematively they may be associated to silent reflux.

81173 Geographic Variation in the Use of Gastrointestinal Procedures in Medicare Beneficiaries Gregory S. Cooper, Siran M. Koroukian Background: Geographic variation in utilization has been demonstrated for numerous surgical procedures, especially when alternative diagnostic and treatment options are available. However, regional variation has not been well described for endoscopic and radiographic procedures of the gastrointestinal tract. Methods: All Medicare claims for fecal ocuh blood testing (FOBT), flexible sigmoidoscopy (FS), colonoscopy (CY), barium enema (BE), esophagogastroduodenoscopy (EGD) and upper G[ series (UGI) from 1997-1999 were identified from hospital outpatient and physician-supplier files. Patients were excluded if they were < 65 years, and only months in which a patient was enrolled in fee-for-service (FFS) plans were included. A yearly and three-year average state-level age-, gender- and race-adjnsted rate per 100,000 FFS months was calculated for each procedure. State-level correlations were determined using Spearman coefficients. Results: The three-year average rates among 50 states (median and interquartile range) were: FOBT 1211 (1062 to 1677), FS 256 (209 to 298), CY 523 (487 to 557), BE 184 (156 to 209), EGD 407 (356 to 439) and UGI 232 (210 to 247). Single year rates for a given procedure were very highly correlated among individual states (i.e., r >- 0.9, p<0.0001). The state-level correlations among different procedures were less consistent. However, there were strong associations at the state level between rates of CY and EGD (r = 0.73, p<0.0001) and BE and UGI (r = 0.71, p<0.0001), as well as an inverse association between EGD and FS (r-0.53, p = 0.0004). The change in state-level procedure rates was compared between 1997 and 1999. Use of FOBT and FS remained relatively constant in all states (FOBT median and interquartile range + 1.5%, 3.7% to 6.6%; FS + 5.1%, -3.7% to + 6.6%) but CY consistently increased (25.0%, 21.2% to 28.1%) and BE consistently decreased (-20.9%, -17.4% to -23.2%). Conclusions: As with other interventions, there was geographic variation in the use of gastrointestinal procedures. States with higher rates of CY also had higher rates of EGD, and those with higher rates of BE also had higher rates of UGI. Given the associations in a given state between the use of individual endoscopic and radiographic procedures, the findings suggest that local practice patterns may influence the choice of intervention.

Chest Pain

22(19.124.9)

7.9 (6,6-0.2)

3.1 (2.4-4.0)

2.4 (1.8-3.2)

1,9 (1,4-2.5)

I)ysphagla

16.419) (13,9-

5 (3,9-6)

3.5 (2.6.4,7)

2.6 (1.9-3.6)

1,5 (1.0-2.1)

37.5(34,2-

12.6(11.1-

4.4 (3,6.5.5)

3.8 (3.0-4,7)

2,4 (1.9.3.1)

F_adySatiety Glob~ Hoartene~ Hiccups

Asthma

40.9

14.2)

27.7(24,6. 10.1 (8.6. 30.8 11.5) 20.7(17.9. 4.3(3,4-5.3) 23,6 33.6 (30,3- 23.5 (21.536.9 25.5) 14.3(11,6- 6.6(5.4-7.8) 16,7

9,4 (7.411.5

5.3 (4.3.6.4)

M1-OR(C195%) M2,OR(C195%) M3.OR(C195%)

3,2(2.5-4,1)

2.5(2.0-3.3)

1,6(1.2-2.1)

5.6(4.1-7.6)

4.4(3.2-6,1)

2,0(1.4-3.0)

1.6 (1.3-1.9)

1.4 (1,1-1,7)

1.0 (0.8-1,3)

2.1 (1.6-2.8)

1,7(1,3-2,3)

1.1 (0.7-1.5)

1.9 (1.4-2.7)

1.4 (1,0-2,1)

1.1 (0.6.1.7)

$1176 Brazilian National Surveillance on Heartburn Joaquim F. P. Moraes-Filho, Decio Chinzon, Jaime N. Eisig, Flavio Quilici, Schlioma Zaterka OBJECTIVES : Heartburn is related to gastroesophageal reflux disease(GERD). The frequency of the symptom is directly related to the possibility of GERD to be present. A national inquire was conducted in 22 Brazilian large cities evaluating the prevalence of heartburn in Brazil. METHODS : The study encompassing 13,959 individuals ( aged 16-91). The foflowmg questions were proposed : 1. Have you ever felt a burning sensation ? 2. If yes, was it located only in the chest (chest burning) or began in the upper belly and roise up to the chest (epigastric burning)? When heartburn was present, the persons were requested to answer its duration and weekly frequency. GERD was considered present when people refered ->1 episodes of heartburn/week for more than 4 weeks. RESULTS : Prevalence of GERD (heartburn at least once a week) was observed in 1651/13,959 (11.8%) of the studied population.

The Clinical Course of GERD from Childhood to Adulthood Hashem B. EI-Serag, Mark Gilger, Junaia Carter, Linda Rabeneck Background The clinical course and progression in adulthood of gastroesophageal reflux disease (GERD) in children without comorbid illness (neurological deficits, congenital esophageal anomalies, chronic obstructive airway conditions) is unknown. Methods We identified a cohort of individuals diagnosed with GERD in childhood (GERD-related ICD-9 codes and a documented upper endoscopy) during 1990-95 at Texas Children Hospital. Only children expected to be older than 10 by 2001 were included. We excluded patients with cerebral palsy, mental retardation, esophageal anomalies, cystic fibrosis, or other severe comorbid

Abstracts

Wlfftout GERS

Eructation

$1174

AGA

With OERS

A-166