M1237 Gastrointestinal Symptoms and Quality of Life in Patients with END-Stage Renal Disease Undergoing Treatment By Hemodialysis

III criteria (mean age 41 (19-72) years; 104 feamles) attending an outpatient clinic specialized in functional GI disorders. The patients completed validated questionnaires to assess IBS symptoms (IBS severity scoring system - IBS-SSS), stool form and frequency (Bristol Stool Form Scale), somatization (PHQ-15), anxiety and depression (Hospital anxiety and depression (HAD) scale), and GI-specific anxiety (Visceral Sensitivity Index - VSI). The presence of a somatoform disorder, anxiety and/or depression and the severity of IBS symptoms were evaluated using available cut-off levels (PHQ-15, HAD, IBS-SSS). Results: Severe IBS symptoms were reported by 73 patients, whereas 49 had moderate and 13 mild symptoms. Suspected somatoform disorder was seen in 72 patients (54%), whereas 29 (22%) and 10 patients (7%) had clinically significant anxiety or depression, respectively. The most commonly reported extraintestinal symptoms were fatigue, sleeping problems, headache and musculoskeletal pain. More severe IBS symptoms were seen in patients with somatoform disorder (IBS-SSS 359±63 vs. 241±74 (mean±SD); p<0.0001), depression (373±80 vs. 300±90; p<0.05) and in patients with IBS-D (p<0.01). The IBS symptom severity was univariately associated with the scores on PHQ-15 (r=0.54; p<0.0001), VSI (r=0.42; p<0.0001), HAD anxiety (r=0.25; p<0.01) and depression (r=0.32; p<0.0001). Also when excluding GI symptoms from PHQ-15 (i.e. PHQ-12) an association with IBS-SSS was seen (r=0.43; p<0.0001). Gender, age, stool form and frequency were not correlated with IBS symptom severity. In a standard, multiple, linear regression model only somatization (PHQ15; p<0.001) and GI-specific anxiety (VSI; p<0.01) were found to be independently associated with IBS symptom severity and explained 41% of the variance in IBS-SSS. This was also true when excluding the GI symptoms from PHQ-15. Conclusion: GI-specific anxiety and somatization seem to be important determinants for IBS symptom severity. This should be taken into account when managing these patients in clinical practice.

Gastrointestinal Symptoms and Quality of Life in Patients with END-Stage Renal Disease Undergoing Treatment By Hemodialysis Chang Hwan Choi, Sung Jin Park, Hye Ryung Sul, Hyun Woong Lee, Hyung Joon Kim, Jae Hyuk Do, Sae Kyung Chang, Soo Hyun Kim, Dong Jin Oh, Seok Hee Yoo Aims: Gastrointestinal (GI) symptoms are said to be common in patients with end-stage renal disease (ESRD) and there are reports of prevalence rates as high as 79%. The aims of this study were to determine the prevalence of gastrointestinal symptoms and quality of life in patients with ESRD undergoing hemodialysis (HD) treatment in South Korea. Patients and Methods: A total of 109 patients with ESRD undergoing HD in Chung-Ang University Hospital were asked to complete a locally validated GERD questionnaire (heartburn or acid regurgitation at least once a week) and Rome III questionnaire for functional dyspepsia (FD), irritable bowel syndrome (IBS), and functional constipation (FC). The same questionnaire was also administered to age- and gender-matched 500 health check-up subjects without renal failure as controls. Patients on HD and health check-up subjects also completed the Beck's Depression Scale and the SF-36 questionnaire for health related quality of life (HRQOL). Results: The mean age (56.2±13.9 in HD vs 54.1±13.8 in controls) and sex ratio (M:F; 1.6:1 in HD vs 1.4:1 in controls) were not different between the two groups. The symptoms consistent with GERD, FC, and Depression were more common in patients with HD (13.8%, 31.2%, and 25.0%) than in controls (7.4%, 12.0%, and 8.3%) (p<0.01). The frequencies of FD and IBS were not different between in patients with HD (31.2% and 7.3%) and in controls (24.2% and 8.2%). The patients with HD were more likely to have nausea, vomiting, sense of incomplete of evacuation and straining. However, loose stool was more common in controls and the frequencies of the other symptoms such as dysphasia, odynophasia, globus, early satiation, postprandial fullness, epigastric pain, abdominal discomfort were not different between the two groups. The overall mean values of SF-36 (62.1±17.1 in HD vs 76.6±17.0 in controls) as well as each score of 5 domains among 8 domains of SF-36 (physical functioning, social functioning, role physical, vitality, and general health) were significantly lower in patients with HD than in controls. Among patients with HD, the overall mean values and each score of SF-36 domains were similar regardless of gastrointestinal symptoms, but were significantly reduced in patients with depression compared those in patients without depression. Conclusions: In patients with ESRD undergoing HD, GERD, FC, and depression were more common and HRQOL significantly reduced compared with health check-up subjects without renal failure. Among ESRD patients with HD, HRQOL appeared not to be related to GI symptoms but to depression.

M1240 Who Drops Out from Cognitive Behavior Therapy (CBT) for IBS?: Results of An NIH Randomized Clinical Trial Jeffrey M. Lackner, Susan S. Krasner, Brian Quigley, Gregory D. Gudleski, Leonard A. Katz, Cathrine Powell, Praveen K. Sampath, Michael D. Sitrin Background and Aims: Although CBT is regarded as an empirically validated treatment for IBS (Mayer, 2008), a significant proportion (20-35%) of patients drop out before treatment ends. Premature dropout is an important but largely neglected topic of study because it has implications for research (e.g. reducing statistical power, limited generality of results), clinical practice, and service delivery. Understanding factors contributing to attrition can help clinicians identify patients at risk for poor outcome and intervene to engage patients better in treatment. Our aim was to identify characteristics of more severely affected IBS patients who prematurely dropped out of a brief regimen of CBT conducted during an NIH clinical trial. Method: Analyses were conducted using clinically relevant variables collected from questionnaires at baseline including age, gender, bowel type, extraintestinal symptoms, negative pain beliefs (pain “catastrophizing”; CSQ), pain severity (SF 36), perceptions of controllability over IBS (locus of control [LOC], self efficacy), motivation (TSRQ), perceived stress (PSS), fear of arousal symptoms (ASI), and IBS severity (IBSSSS). Subjects included 82 Rome II diagnosed IBS patients (11 M; 71 F). Results: Of 77 patients randomized to CBT, 21 (22%) dropped out prematurely. Among drop outs, 71% had IBS-D, while among treatment completers only 44% had IBS-D, χ2 (n=77, df = 2) = 4.39, p < .05, d = +.49 (95% CI +.03 / +.94). The most clearly significant predictor of premature termination was IBS-LOC beliefs as measured with the IBS-LOC scale (Lackner et al., 2005). Drop outs during treatment (M = 95.90, sd= 19.56) were more likely to perceive IBS symptoms as unrelated to their behavior and therefore beyond their control (M = 86.12, sd= 13.66), d = +.62 (95% CI +.11 / +1.13). Detailed analysis of patients status on IBS-LOC subscales suggested that those who dropped out before treatment were more likely to attribute their symptoms to luck, fate, or chance events outside their control (M = 42.80, sd = 6.64) than those who remained in treatment (M = 31.80, sd = 8.65), d = +1.29 (95% CI +.35 / +2.24). Similarly, those who dropped out during treatment were more likely to attribute their symptoms to chance events (M = 35.23, sd = 8.60) than treatment completers, d = +.41 (95% CI -.09 / +.91). Conclusion: Notwithstanding the small sample size, data suggest that predominant bowel type and attributions regarding the cause of symptoms may influence whether patients benefit from CBT for IBS. Findings underscore the impact of central processes (e.g., patient beliefs) on treatment outcome. (Supported by NIH/NIDDK grant 67878)

M1238 The Severity of Diarrhea and Constipation Are Important in Examining Gender Differences in IBS Herman Jeremy, Venkata B. Pokkunuri, Mark Pimentel A significant gender disparity has been observed in patients with irritable bowel syndrome (IBS) with females outnumbering males. This is especially true in constipation predominant IBS (C-IBS). However, there is little or no data examining gender differences based on a graduated severity of constipation or diarrhea. In a large prospective dataset, we examined the gender differences across a wide range of diarrhea and constipation severity among IBS subjects. Methods: Consecutive Rome I positive IBS subjects were given a questionnaire to rate their constipation (C) and diarrhea (D) according to their perceived severity in past week using a visual analogue scale from 0-5. C-IBS was determined to be present if severity of C>D. If D>C, subjects were considered D-IBS. The severity of C and D were examined separately between men and women. To further categorize their symptoms, subjects were then divided based the difference between C severity and D (C-D) creating a range from -5 to +5. For each of the 11 C-D groups, the female:male ratio was determined. Gender proportions were examined across diarrhea, constipation and C-D severity. Results: 429 subjects completed a questionnaire. More women presented with IBS (325 female subjects and 104 males) and thus more women had D-IBS (118 women and 60 men) and C-IBS (135 women and 27 men) than men. Assuming presentation to clinic was equal between men and women, more men suffered with D-IBS than women (57.7% of men and 36.3% of women, P<0.0001). The opposite was seen in C-IBS (P<0.01). In the group as a whole, the ratio of women to men appeared to increase with greater severity of constipation (R= 0.94, P<0.017) but not diarrhea. Among men only, there was a correlation with the severity of diarrhea (R=0.93, P<0.05) and inverse correlation with constipation severity (R=-0.9, P<0.05). The difference between C and D evaluated the purity of constipation alone compared to diarrhea. In this comparison, a proportional increase in women was seen in patients with more constipation compared to diarrhea (R=0.89, P<0.001). Using this C-D concept, women were up to 9 times more likely to have severe constipation proportional to diarrhea. Although in this study women were more likely to describe higher severity scores, these did not negate the gradation of constipation prevalence in women and diarrhea prevalence in men. Conclusion: The severity of constipation dictates the prevalence of women compared to men. Although D-IBS is more common in women, men are more likely to have severe DIBS. Also, a greater degree of constipation was related to a higher proportion of women.

M1241 Language Analysis and Psychological Correlates in Irritable Bowel Syndrome and Inflammatory Bowel Disease Lisa B. VanWagner, Laurie Keefer, Tiffany H. Taft, Jason R. Bratten, Jennifer L. Zinke, Michael P. Jones BACKGROUND: Although physiologically different, Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD) are chronic digestive disorders with many shared symptoms. Similarities between these conditions, including exacerbation with stress, may lead to the expression of similar illness experiences. Comparative studies have been limited by selfreport measures that provide quantitative, single-dimension data. AIM: To apply qualitative written language analysis to identify similarities and differences between these groups with respect to cognitive processes and psychological characteristics not previously captured via self-report. METHODS: 13 IBS, 13 IBD and 13 age-matched Healthy Control (HC) patients were recruited through an outpatient gastroenterology clinic and via word-of-mouth. Following a standard written emotional disclosure protocol, subjects wrote for 20 minutes about their experience during a shared national tragedy, 9/11/01. Using the Linguistic Inquiry and Word Count (LIWC) program, writing samples were analyzed and sorted into 70 linguistic areas. ANOVA with post-hoc Schefé tests identified differences between groups. For nonnormally distributed data, Kruskal-Wallis tests were used. RESULTS: Subjects wrote an average of 649.1 ± 236.7 words per entry with no differences between groups. Nine of 75 variables analyzed yielded significant results with a large effect size (d>0.8). Psychological process differed among the groups (x2=6.97, p<0.05): IBS used more negative emotion and less optimism words (e.g. certainty, pride) than IBD/HC. IBS patients referenced words

M1239 Gastrointestinal-Specific Anxiety and Somatization Are Important Determinants for Symptom Severity in Irritable Bowel Syndrome Jenny Gunnarsson, Iris Posserud, Gisela Ringstrom, Anette Lindh, Hasse Abrahamsson, Magnus Simren Background: Psychosocial factors are considered to be of great importance for symptom perception in irritable bowel syndrome (IBS). However, even though general anxiety and depression are common in IBS, it is not present in the majority of patients. Recently, GIspecific anxiety (Labus et al APT 2004) and the presence of somatization (North et al CGH 2004) have been proposed to be of greater relevance for symptom severity in IBS. Aim: To assess the relative importance of psychosocial factors, somatization and GI-specific anxiety for IBS symptom severity. Methods: We included 135 IBS patients according to the Rome

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AGA Abstracts

AGA Abstracts

M1237