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Prevalence of irritable bowel syndrome according to the Rome criteria in a Vietnamese population
AJG – September, 2000
because the patient’s PCP recommended it. The next most important reasons were having a family member of friend with colon cancer, or that they believed in health maintenance. Of the 263 patients who did not undergo screening FS on the day of the questionnaire, 166 (63%) had had a prior FS or colonoscopy, and this was the most common reason for not having the FS done on the day of screening. Of the 97 patients who had not had a prior FS, not being recommended by their PCP was the most important reason. Concern about pain and discomfort associated with the procedure was next most important. Conclusions: Patients attending a cancer-screening clinic are presumably health conscious. Slightly over half of those surveyed had undergone a previous FS, but of those without a prior FS, less than a third were having FS that day. Physician’s recommendations, or lack of, was the most important influence for having a screening FS in this study population.
492 Prevalence of irritable bowel syndrome according to the Rome criteria in a Vietnamese population Zuckerman MD FACG MJ, Nguyen MD G, Ho MD H, Nguyen MD L, Gregory PhD GG. Texas Tech University HSC and University of Texas, El Paso USA and Cho Ray Hospital, Ho Chi Minh City, Vietnam. Prevalence estimates for irritable bowel syndrome (IBS) from surveys among American and European adults are 14 –24% of women and 5–19% of men and only a minority seek health care. There are few studies of bowel patterns in Asian countries. We conducted a survey of a nonpatient population in Ho Chi Minh City, Vietnam to determine bowel patterns and whether sex-related differences exist in the prevalence of bowel dysfunction. A forced-choice, self-report questionnaire was distributed to 560 predominantly health care workers, as well as patient relatives, at Cho Ray Hospital and returned by 233 (response rate of 41.6%). Results were analyzed for men and women using Student’s T-test for continuous variables and chi square test for categorical variables. Subjects were 60.2% female with a mean age of 30.7 years. Overall perception of health was excellent/very good in 14.5%, good in 54.6%, and fair/poor in 30.8% (males 17.4%, 51.1%, 31.5% vs. females 12.6%, 57.0%, 30.4%, p ⫽ NS). The mean number of stools reported per week was 6.4 (males 6.5 vs. females 6.4, p ⫽ NS) and ranged between 3 and 21 stools per week in 94.8%. The frequency of IBS-type symptoms (using Rome I criteria) was 6.1% (males 5.4% vs. females 6.7%, p ⫽ NS). Of the subjects with IBS-type symptoms, 4/14 (28.6%) had seen a physician for bowel symptoms. There were no gender differences in reported infrequent stool (12.1%), frequent stool (12.6%), hard stool (20.1%), loose stool (5.4%), straining (15.6%), incomplete emptying (16.5%), and bloating (11.2%), but urgency (10.7%) (males 16.1% vs. females 6.9%, p ⬍ 0.05) and mucus (3.6%) (males 7.5% vs. females 0.8%, p ⬍ 0.01) were more frequent in males. In conclusion, this survey of a nonpatient population in Vietnam showed that there were no significant differences between sexes in either stool frequency or the prevalence of IBS, unlike previous studies from the United States. The prevalence of IBS in Vietnam may be in the lower range of reported data, possibly in part related to the use of the more restrictive Rome criteria.
493 Comparison of surveillance colonoscopy in patients with and without a family history of colon cancer or polyps Zwas MD FACG Felice, Brown PA-C James H, Berken MD FACG Clifford, Bonheim MD FACG Nelson. Yale University School of Medicine, Greenwich, CT, United States. Purpose: Colonoscopy (CS) is generally recommended for people with a family history of colon cancer or polyps (FHCC), whereas people with no
Abstracts
2555
family history (NFHCC) are given the option of flexible sigmoidoscopy and stool guaiacs, barium enema, or CS. We compared the diagnostic yield of CS in FHCC versus NFHCC. Methods: All CS performed for initial colon cancer screening in asymptomatic patients from March 21 to May 24, 2000 by 3 gastroenterologists in a community hospital were evaluated. The patients’ age, sex, presence or absence of family history (defined as one or more first degree relative(s) with colon cancer or polyps) were noted. Polyps were described by size, number, location, and pathology. When documenting size of polyps, for statistical analysis, the largest polyp was noted. Polyps were deemed either from the splenic flexure (SF) and distally or proximal to the SF. Results: 152 asymptomatic patients underwent first time screening CS. 55 (37 female, 18 male) had FHCC, 97 (58 female, 39 male) had NFHCC. Average age of FHCC was 52.7 (range 36 to 81), NFHCC was 58.3 (range 32 to 77). The average age of those undergoing CS with FHCC was younger (P ⬎ 0.0009). 16 FHCC patients had adenomatous polyps; 25 NFHCC patients had adenomatous polyps. This was not statistically significant (P ⬎ 0.65). There was no statistical difference in location or size of polyps in either group. Most polyps were ⬍5 mm, but 6 NFHCC and 4 FHCC had polyps ⬎10 mm. One NFHCC had a Duke’s A colon cancer above the SF. 13 NFHCC and 8 FHCC patients had polyps located exclusively proximal to the SF. Conclusions: In our study, patients with or without a family history of colon cancer or polyps had a similar prevalence of adenomatous polyps proximal to the SF, as well as throughout the colon. We feel patients with NFHCC should be given similar screening recommendations for colon cancer as those patients with FHCC.
494 Antiendomysium antibodies for screening, diagnosis and control of the diet in celiac Brazilian patients Kotze LMS, Utiyama SRR, Nisihara RM, Mocelin V, Amarante HMS. Federal & Pontifical Catholic University of Parana, Curitiba, Parana, Brazil. Purpose: Data in the literature shows high specificity of the antiendomysial antibodies (EmA IgA) in celiac disease (CD). The scarcity of Brazilian reports concerning this subject have motivated this work. Methods: A wide clinical and serological study was performed by investigating the presence of these antibodies in 392 individuals in southern Brazil. Indirect immunofluorescence using human umbilical cord as substrate was employed and the total levels of IgA were determined by Turbidimetry. The study comprised 57 celiac patients (18 at diagnosis, 24 who adhered to a gluten-free diet and 15 with great or slight transgression of the diet), 115 relatives of celiac patients (39 families), 94 patients with other gastrointestinal diseases and 126 healthy individuals of the population. Results: The results evidenced 100% of positivity for the recently diagnosed patients and in those consuming gluten, in contrast to the patients who kept obedient the diet (0%). In the control group one individual was positive, but refused to undergo a biopsy. In the group of other gastrointestinal diseases, one positive patient presented ulcerative colitis. Down’s syndrome, epilepsy and the intestinal biopsy was diagnostic of CD. These data showed 99.3% of specificity. Eighteen relatives were positive for EmA IgA (15.65%) and the correlation with the healthy population revealed statistical significance (p ⬍ 0.0001). In 7, an intestinal biopsy was performed (one with total villous atrophy and 6 with minor alterations in the mucosal architecture, but all with a high number of intraepithelial lymphocytes). Conclusions: The method revealed 100% of sensitivity and 99.3% of specificity. Because it is not an invasive method it can be used for the screening of atypical and latent forms of CD to avoid seriate biopsies and to control the adherence to a gluten-free diet with implications in the prevention of malignancy in CD.
because the patient’s PCP recommended it. The next most important reasons were having a family member of friend with colon cancer, or that they believed in health maintenance. Of the 263 patients who did not undergo screening FS on the day of the questionnaire, 166 (63%) had had a prior FS or colonoscopy, and this was the most common reason for not having the FS done on the day of screening. Of the 97 patients who had not had a prior FS, not being recommended by their PCP was the most important reason. Concern about pain and discomfort associated with the procedure was next most important. Conclusions: Patients attending a cancer-screening clinic are presumably health conscious. Slightly over half of those surveyed had undergone a previous FS, but of those without a prior FS, less than a third were having FS that day. Physician’s recommendations, or lack of, was the most important influence for having a screening FS in this study population.
492 Prevalence of irritable bowel syndrome according to the Rome criteria in a Vietnamese population Zuckerman MD FACG MJ, Nguyen MD G, Ho MD H, Nguyen MD L, Gregory PhD GG. Texas Tech University HSC and University of Texas, El Paso USA and Cho Ray Hospital, Ho Chi Minh City, Vietnam. Prevalence estimates for irritable bowel syndrome (IBS) from surveys among American and European adults are 14 –24% of women and 5–19% of men and only a minority seek health care. There are few studies of bowel patterns in Asian countries. We conducted a survey of a nonpatient population in Ho Chi Minh City, Vietnam to determine bowel patterns and whether sex-related differences exist in the prevalence of bowel dysfunction. A forced-choice, self-report questionnaire was distributed to 560 predominantly health care workers, as well as patient relatives, at Cho Ray Hospital and returned by 233 (response rate of 41.6%). Results were analyzed for men and women using Student’s T-test for continuous variables and chi square test for categorical variables. Subjects were 60.2% female with a mean age of 30.7 years. Overall perception of health was excellent/very good in 14.5%, good in 54.6%, and fair/poor in 30.8% (males 17.4%, 51.1%, 31.5% vs. females 12.6%, 57.0%, 30.4%, p ⫽ NS). The mean number of stools reported per week was 6.4 (males 6.5 vs. females 6.4, p ⫽ NS) and ranged between 3 and 21 stools per week in 94.8%. The frequency of IBS-type symptoms (using Rome I criteria) was 6.1% (males 5.4% vs. females 6.7%, p ⫽ NS). Of the subjects with IBS-type symptoms, 4/14 (28.6%) had seen a physician for bowel symptoms. There were no gender differences in reported infrequent stool (12.1%), frequent stool (12.6%), hard stool (20.1%), loose stool (5.4%), straining (15.6%), incomplete emptying (16.5%), and bloating (11.2%), but urgency (10.7%) (males 16.1% vs. females 6.9%, p ⬍ 0.05) and mucus (3.6%) (males 7.5% vs. females 0.8%, p ⬍ 0.01) were more frequent in males. In conclusion, this survey of a nonpatient population in Vietnam showed that there were no significant differences between sexes in either stool frequency or the prevalence of IBS, unlike previous studies from the United States. The prevalence of IBS in Vietnam may be in the lower range of reported data, possibly in part related to the use of the more restrictive Rome criteria.
493 Comparison of surveillance colonoscopy in patients with and without a family history of colon cancer or polyps Zwas MD FACG Felice, Brown PA-C James H, Berken MD FACG Clifford, Bonheim MD FACG Nelson. Yale University School of Medicine, Greenwich, CT, United States. Purpose: Colonoscopy (CS) is generally recommended for people with a family history of colon cancer or polyps (FHCC), whereas people with no
Abstracts
2555
family history (NFHCC) are given the option of flexible sigmoidoscopy and stool guaiacs, barium enema, or CS. We compared the diagnostic yield of CS in FHCC versus NFHCC. Methods: All CS performed for initial colon cancer screening in asymptomatic patients from March 21 to May 24, 2000 by 3 gastroenterologists in a community hospital were evaluated. The patients’ age, sex, presence or absence of family history (defined as one or more first degree relative(s) with colon cancer or polyps) were noted. Polyps were described by size, number, location, and pathology. When documenting size of polyps, for statistical analysis, the largest polyp was noted. Polyps were deemed either from the splenic flexure (SF) and distally or proximal to the SF. Results: 152 asymptomatic patients underwent first time screening CS. 55 (37 female, 18 male) had FHCC, 97 (58 female, 39 male) had NFHCC. Average age of FHCC was 52.7 (range 36 to 81), NFHCC was 58.3 (range 32 to 77). The average age of those undergoing CS with FHCC was younger (P ⬎ 0.0009). 16 FHCC patients had adenomatous polyps; 25 NFHCC patients had adenomatous polyps. This was not statistically significant (P ⬎ 0.65). There was no statistical difference in location or size of polyps in either group. Most polyps were ⬍5 mm, but 6 NFHCC and 4 FHCC had polyps ⬎10 mm. One NFHCC had a Duke’s A colon cancer above the SF. 13 NFHCC and 8 FHCC patients had polyps located exclusively proximal to the SF. Conclusions: In our study, patients with or without a family history of colon cancer or polyps had a similar prevalence of adenomatous polyps proximal to the SF, as well as throughout the colon. We feel patients with NFHCC should be given similar screening recommendations for colon cancer as those patients with FHCC.
494 Antiendomysium antibodies for screening, diagnosis and control of the diet in celiac Brazilian patients Kotze LMS, Utiyama SRR, Nisihara RM, Mocelin V, Amarante HMS. Federal & Pontifical Catholic University of Parana, Curitiba, Parana, Brazil. Purpose: Data in the literature shows high specificity of the antiendomysial antibodies (EmA IgA) in celiac disease (CD). The scarcity of Brazilian reports concerning this subject have motivated this work. Methods: A wide clinical and serological study was performed by investigating the presence of these antibodies in 392 individuals in southern Brazil. Indirect immunofluorescence using human umbilical cord as substrate was employed and the total levels of IgA were determined by Turbidimetry. The study comprised 57 celiac patients (18 at diagnosis, 24 who adhered to a gluten-free diet and 15 with great or slight transgression of the diet), 115 relatives of celiac patients (39 families), 94 patients with other gastrointestinal diseases and 126 healthy individuals of the population. Results: The results evidenced 100% of positivity for the recently diagnosed patients and in those consuming gluten, in contrast to the patients who kept obedient the diet (0%). In the control group one individual was positive, but refused to undergo a biopsy. In the group of other gastrointestinal diseases, one positive patient presented ulcerative colitis. Down’s syndrome, epilepsy and the intestinal biopsy was diagnostic of CD. These data showed 99.3% of specificity. Eighteen relatives were positive for EmA IgA (15.65%) and the correlation with the healthy population revealed statistical significance (p ⬍ 0.0001). In 7, an intestinal biopsy was performed (one with total villous atrophy and 6 with minor alterations in the mucosal architecture, but all with a high number of intraepithelial lymphocytes). Conclusions: The method revealed 100% of sensitivity and 99.3% of specificity. Because it is not an invasive method it can be used for the screening of atypical and latent forms of CD to avoid seriate biopsies and to control the adherence to a gluten-free diet with implications in the prevention of malignancy in CD.