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Mo1294 Body Dissatisfaction and Disordered Eating in GI Patients: A Comparison of Functional Bowel Disorders, Inflammatory Bowel Disorders, and Esophageal Disorders
Mo1295
AGA Abstracts
Histamine Intolerance Syndrome Is a Differential Diagnosis for Irritable Bowel Syndrome Miriam Goebel-Stengel, Matthias Robert, Andreas Stengel, Hubert Monnikes Background: Histamine intolerance syndrome (HIS) is a non-immunologically mediated reaction towards oral intake of histamine-containing food products and gastrointestinal (GI) symptoms are common. Aim: Pilot study to determine the prevalence of HIS in patients with irritable bowel syndrome (IBS)-like symptoms, main complaints and possible predictors. Methods: 27 patients (24 female, 3 men, age 23-70 years) with IBS-like complaints were exposed to an oral histamine challenge (15, 25, 50, 100 mg). GI symptoms were assessed by a questionnaire of 36 symptoms (Figure 1; frequency rated on a scale from 0 to 4 where 0=never and 4=always, intensity rated on a scale from 0 to 5 where 0=no complaints and 5=very strong complaints). Serum diaminoxidase (DAO, normal range: 14-33 U/ml) was determined prior to and the urinary histamine metabolite methylhistamine was determined before and after challenge (range <6.5μg/mmol). Results: DAO levels were below normal range in 19/27 (70%) patients (as a possible correlate for HIS). Furthermore, DAO was correlated positively with the symptoms ‘acidic reflux' (r=0.41, P=0.03), ‘upper abdominal pain' (r=0.44, P=0.02) and ‘sleep disturbances' (r=0.40, P=0.04). 20/27 patients (74%) were symptomatic following the oral histamine challenge and presented with typical symptoms. The most common symptoms described by the patients as bothersome in daily life were ‘bloating' (90%), ‘dysthymia' and ‘flatus' (85%), ‘symptom-based anxiety' (80%), ‘nausea', ‘fullness', ‘epigastric pain' (65% each) and ‘sleep disturbances' (60%). In 14/20 (70%) of the patients with positive challenge, the DAO levels were below normal range. DAO levels were only positively correlated with ‘sleep disturbances' (r=0.52, P=0.02). The increase in postexposition urinary methyl histamine excretion was positively correlated with ‘nausea' (r= 0.54, P=0.01). Conclusion: The histamine intolerance syndrome can present with various intestinal symptoms and should be considered as a differential diagnosis in patients with IBS-like symptoms. Serum DAO and urinary methyl histamine do not suffice to diagnose HIS because they are only sporadically correlated with the symptoms. Thus, an oral histamine challenge remains the gold standard for the diagnosis.
Mo1294 Body Dissatisfaction and Disordered Eating in GI Patients: A Comparison of Functional Bowel Disorders, Inflammatory Bowel Disorders, and Esophageal Disorders Ashley Rolnik, Sarah W. Kinsinger, Laurie Keefer Background: It is clinically important for GEs to identify patients with or at risk for eating disorders. Food restriction is common in patients with GI conditions and it is often difficult to determine when such restriction rises to the level of eating disorder pathology. Body dissatisfaction is both a diagnostic criterion and an important risk factor for most eating disorders but is rarely considered in GI practices. We examined body image and eating behavior in 3 GI patient populations: functional bowel disorders (FBD), inflammatory bowel diseases (IBD), and esophageal disorders (ESO). We hypothesized that body dissatisfaction would differentiate GI patient groups and predict disordered eating. Methods: GI patients presenting to an academic medical center GI practice completed demographic information, the body dissatisfaction scale of the Eating Disorder Inventory-3 and the Eating Attitudes Test. The body dissatisfaction scale assesses discontent with the size and shape of different areas of the body through statements such as "I think that my thighs are too large." The EAT-26 consists of three subscales: dieting (e.g., food restriction), bulimia/food preoccupation (e.g., purging behaviors and/or having excessive thoughts about food intake), and oral control (e.g., pressure to eat from others and/or specific habits such as eating slowly). Sample items include "I am preoccupied with the thought of fat on my body" and "I like my stomach to be empty." One-way Anova and t-tests were performed to identify differences between groups. Regression analyses were used to determine the role of body dissatisfaction on eating behavior. Results: 31 patients completed the survey, mean age 44.23(16.26), n=31, 81% Female, mean BMI 24.97(5.92). ANOVA compared the effect of GI group (FBD, IBD, ESO) on body dissatisfaction and disordered eating [Table 1]. There was a main effect for GI group on body dissatisfaction (F(2, 27) = 4.94, p = .02) and a trend towards disordered eating (F(2, 27) = 2.57, p = .096) by group. Body dissatisfaction was significantly higher in IBD than ESO. FBD did not significantly differ from either group. Disordered eating was significantly higher in FBD than ESO. IBD group did not differ. Body dissatisfaction significantly predicted dieting (b = .41; p = .04) and bulimia/food preoccupation ((b = .47; p = .01) but not oral control (b = .23; p = .22) on EAT-26. Conclusions: Body dissatisfaction and disordered eating appear to vary by GI patient group. IBD patients tend to be the most at-risk for body dissatisfaction, which may potentially be due to visible signs of illness or medication side effects. FBD group was more likely to endorse disordered eating. Body dissatisfaction predicted dieting as well as bulimia/food preoccupation and may serve as a useful tool to identify GI patients at risk for disordered eating. The Effect of GI Patient Group on Body Dissatisfaction and Disordered Eating
Mo1296 Proton Pump Inhibitors (PPIs) Are Associated With the Onset of Bowel Symptoms Especially Those Relate to Diarrhea Max J. Schmulson, Alberto Frati Background: PPIs are considered safe medications in general with only a few mild and scarce adverse events. However, the long-term usage of PPIs has been related to bowel symptoms and SIBO.1-4 Aims: To investigate the prevalence of bowel symptoms in Mexican patients that receive PPIs. Methods: Two-thousand gastroenterologists (GIs) throughout Mexico were invited to survey any patient undergoing PPI treatment. At the end of 2013, the questionnaires were delivered to those who accepted to participate (N=215/36 cities). The questionnaire inquired about the PPI used/time, intestinal symptoms, temporal relation between them, Rome III criteria for IBS, prescribed treatments for the symptoms and patients satisfaction. Surveys took place between October-2013 and March-2014 during the clinical visit. The study was approved by an Ethics Committee. Results: 1851 patients were surveyed (F: 58%, age: 47±11 ). Frequency of PPIs were omeprazole: 40%, pantoprazole: 24%, esomeprazole: 15%, dexlansoprazole: 7%, lansoprazole: 6%, others: 8 for gastritis: 48.8%, GERD: 38.5%, other 12.7%. Length of treatment was 1-3 months in 56.9% and more than 13 months in 11.9%. Of them, 92% reported at least one bowel symptom including abdominal pain/discomfort: 88%, bloating: 81%, flatulence: 57%. In ~54% these symptoms started before the PPI treatment. Bowel habit abnormalities were reported by 84% of which diarrhearelated symptoms began after the PPIs in ~56.6% (p<0.0001) while constipation-related symptoms were present before PPIs in ~63.6% (p<0.01) . Also, 67.5% fulfilled criteria for IBS (before PPIs: 52.4%, after: 47.6%) with no differences according to IBS-subtype. Frequency of symptoms differed according to PPIs (omeprazole: 87.8%, pantoprazole: 89.4%, esomperazole: 89.5%, lansoprazole: 90.3%, dexlansoprazole: 72.9%, (p<0.05). Physicians indicated treatments for the intestinal symptoms included antispasmodics: 55%, prokinetics: 26%, antiflatulent agents: 22%, antibiotics: 31% (rifaximin: 82%). Accordingly, a satisfactory response was reported by 62%, 55%, 60% and 72% of the patients respectively, (p<0.00001). Conclusions: Bowel-related symptoms are very common among patients receiving PPIs and half fulfill criteria for IBS. Although in more than half these symptoms are present before the PPIs, diarrhea-related symptoms seem to be triggered by them. Prospective studies are warranted to confirm these results and to determine if PPI-intestinal symptoms are related to changes in the intestinal microbiota. 1Lombardo L et al. ClinGastroenterolHepatol 2010; 2 Choung R et al. Neurogastroenterol Motil 2013; 3Jacobs C et al. AlimentPharmacolTher 2013; 4Lo W-K, Chan W. ClinGastroenterolHepatol 2013. This study was funded by Alfa Wasserman SA de CV, Mexico.
AGA Abstracts
S-664
AGA Abstracts
Histamine Intolerance Syndrome Is a Differential Diagnosis for Irritable Bowel Syndrome Miriam Goebel-Stengel, Matthias Robert, Andreas Stengel, Hubert Monnikes Background: Histamine intolerance syndrome (HIS) is a non-immunologically mediated reaction towards oral intake of histamine-containing food products and gastrointestinal (GI) symptoms are common. Aim: Pilot study to determine the prevalence of HIS in patients with irritable bowel syndrome (IBS)-like symptoms, main complaints and possible predictors. Methods: 27 patients (24 female, 3 men, age 23-70 years) with IBS-like complaints were exposed to an oral histamine challenge (15, 25, 50, 100 mg). GI symptoms were assessed by a questionnaire of 36 symptoms (Figure 1; frequency rated on a scale from 0 to 4 where 0=never and 4=always, intensity rated on a scale from 0 to 5 where 0=no complaints and 5=very strong complaints). Serum diaminoxidase (DAO, normal range: 14-33 U/ml) was determined prior to and the urinary histamine metabolite methylhistamine was determined before and after challenge (range <6.5μg/mmol). Results: DAO levels were below normal range in 19/27 (70%) patients (as a possible correlate for HIS). Furthermore, DAO was correlated positively with the symptoms ‘acidic reflux' (r=0.41, P=0.03), ‘upper abdominal pain' (r=0.44, P=0.02) and ‘sleep disturbances' (r=0.40, P=0.04). 20/27 patients (74%) were symptomatic following the oral histamine challenge and presented with typical symptoms. The most common symptoms described by the patients as bothersome in daily life were ‘bloating' (90%), ‘dysthymia' and ‘flatus' (85%), ‘symptom-based anxiety' (80%), ‘nausea', ‘fullness', ‘epigastric pain' (65% each) and ‘sleep disturbances' (60%). In 14/20 (70%) of the patients with positive challenge, the DAO levels were below normal range. DAO levels were only positively correlated with ‘sleep disturbances' (r=0.52, P=0.02). The increase in postexposition urinary methyl histamine excretion was positively correlated with ‘nausea' (r= 0.54, P=0.01). Conclusion: The histamine intolerance syndrome can present with various intestinal symptoms and should be considered as a differential diagnosis in patients with IBS-like symptoms. Serum DAO and urinary methyl histamine do not suffice to diagnose HIS because they are only sporadically correlated with the symptoms. Thus, an oral histamine challenge remains the gold standard for the diagnosis.
Mo1294 Body Dissatisfaction and Disordered Eating in GI Patients: A Comparison of Functional Bowel Disorders, Inflammatory Bowel Disorders, and Esophageal Disorders Ashley Rolnik, Sarah W. Kinsinger, Laurie Keefer Background: It is clinically important for GEs to identify patients with or at risk for eating disorders. Food restriction is common in patients with GI conditions and it is often difficult to determine when such restriction rises to the level of eating disorder pathology. Body dissatisfaction is both a diagnostic criterion and an important risk factor for most eating disorders but is rarely considered in GI practices. We examined body image and eating behavior in 3 GI patient populations: functional bowel disorders (FBD), inflammatory bowel diseases (IBD), and esophageal disorders (ESO). We hypothesized that body dissatisfaction would differentiate GI patient groups and predict disordered eating. Methods: GI patients presenting to an academic medical center GI practice completed demographic information, the body dissatisfaction scale of the Eating Disorder Inventory-3 and the Eating Attitudes Test. The body dissatisfaction scale assesses discontent with the size and shape of different areas of the body through statements such as "I think that my thighs are too large." The EAT-26 consists of three subscales: dieting (e.g., food restriction), bulimia/food preoccupation (e.g., purging behaviors and/or having excessive thoughts about food intake), and oral control (e.g., pressure to eat from others and/or specific habits such as eating slowly). Sample items include "I am preoccupied with the thought of fat on my body" and "I like my stomach to be empty." One-way Anova and t-tests were performed to identify differences between groups. Regression analyses were used to determine the role of body dissatisfaction on eating behavior. Results: 31 patients completed the survey, mean age 44.23(16.26), n=31, 81% Female, mean BMI 24.97(5.92). ANOVA compared the effect of GI group (FBD, IBD, ESO) on body dissatisfaction and disordered eating [Table 1]. There was a main effect for GI group on body dissatisfaction (F(2, 27) = 4.94, p = .02) and a trend towards disordered eating (F(2, 27) = 2.57, p = .096) by group. Body dissatisfaction was significantly higher in IBD than ESO. FBD did not significantly differ from either group. Disordered eating was significantly higher in FBD than ESO. IBD group did not differ. Body dissatisfaction significantly predicted dieting (b = .41; p = .04) and bulimia/food preoccupation ((b = .47; p = .01) but not oral control (b = .23; p = .22) on EAT-26. Conclusions: Body dissatisfaction and disordered eating appear to vary by GI patient group. IBD patients tend to be the most at-risk for body dissatisfaction, which may potentially be due to visible signs of illness or medication side effects. FBD group was more likely to endorse disordered eating. Body dissatisfaction predicted dieting as well as bulimia/food preoccupation and may serve as a useful tool to identify GI patients at risk for disordered eating. The Effect of GI Patient Group on Body Dissatisfaction and Disordered Eating
Mo1296 Proton Pump Inhibitors (PPIs) Are Associated With the Onset of Bowel Symptoms Especially Those Relate to Diarrhea Max J. Schmulson, Alberto Frati Background: PPIs are considered safe medications in general with only a few mild and scarce adverse events. However, the long-term usage of PPIs has been related to bowel symptoms and SIBO.1-4 Aims: To investigate the prevalence of bowel symptoms in Mexican patients that receive PPIs. Methods: Two-thousand gastroenterologists (GIs) throughout Mexico were invited to survey any patient undergoing PPI treatment. At the end of 2013, the questionnaires were delivered to those who accepted to participate (N=215/36 cities). The questionnaire inquired about the PPI used/time, intestinal symptoms, temporal relation between them, Rome III criteria for IBS, prescribed treatments for the symptoms and patients satisfaction. Surveys took place between October-2013 and March-2014 during the clinical visit. The study was approved by an Ethics Committee. Results: 1851 patients were surveyed (F: 58%, age: 47±11 ). Frequency of PPIs were omeprazole: 40%, pantoprazole: 24%, esomeprazole: 15%, dexlansoprazole: 7%, lansoprazole: 6%, others: 8 for gastritis: 48.8%, GERD: 38.5%, other 12.7%. Length of treatment was 1-3 months in 56.9% and more than 13 months in 11.9%. Of them, 92% reported at least one bowel symptom including abdominal pain/discomfort: 88%, bloating: 81%, flatulence: 57%. In ~54% these symptoms started before the PPI treatment. Bowel habit abnormalities were reported by 84% of which diarrhearelated symptoms began after the PPIs in ~56.6% (p<0.0001) while constipation-related symptoms were present before PPIs in ~63.6% (p<0.01) . Also, 67.5% fulfilled criteria for IBS (before PPIs: 52.4%, after: 47.6%) with no differences according to IBS-subtype. Frequency of symptoms differed according to PPIs (omeprazole: 87.8%, pantoprazole: 89.4%, esomperazole: 89.5%, lansoprazole: 90.3%, dexlansoprazole: 72.9%, (p<0.05). Physicians indicated treatments for the intestinal symptoms included antispasmodics: 55%, prokinetics: 26%, antiflatulent agents: 22%, antibiotics: 31% (rifaximin: 82%). Accordingly, a satisfactory response was reported by 62%, 55%, 60% and 72% of the patients respectively, (p<0.00001). Conclusions: Bowel-related symptoms are very common among patients receiving PPIs and half fulfill criteria for IBS. Although in more than half these symptoms are present before the PPIs, diarrhea-related symptoms seem to be triggered by them. Prospective studies are warranted to confirm these results and to determine if PPI-intestinal symptoms are related to changes in the intestinal microbiota. 1Lombardo L et al. ClinGastroenterolHepatol 2010; 2 Choung R et al. Neurogastroenterol Motil 2013; 3Jacobs C et al. AlimentPharmacolTher 2013; 4Lo W-K, Chan W. ClinGastroenterolHepatol 2013. This study was funded by Alfa Wasserman SA de CV, Mexico.
AGA Abstracts
S-664