- Email: [email protected]
Su1017 Prevalence of, and Risk Factors for, Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis
AGA Abstracts
were performed in the year 2009 on patients with complaints consistent with symptoms associated with functional and motility GI disorders. Of the total procedures, 257,625 (10%) upper GI endoscopies and 41,629 (3%) colonoscopies were repeat tests in the same patient. An additional 1.46 million (17%) CT Scans, 36,926 MRI tests (10%), 279,020 (9%) US were repeated in patients at a total cost of $874M. The total number of GI motility tests was 159,599; gastric emptying scintigraphy (102,078), gastroduodenal (2,209) and Anorectal manometry (25,124) and ROM(30,149). The total count of upper GI motility tests was 104,287 and total number of lower GI motility tests was 55,272 at a total cost of $89M. Conclusions: The number of repeat endoscopies far exceeds the number of UGI motility studies conducted among patients presenting with GI function/motility symptoms. Repeat radiologic tests conducted post initial endoscopy/colonoscopy also far exceeded the number of GI motility tests. AGA/ACG recommended management algorithms for patients presenting with upper and lower GI function/motility symptoms call for GI motility testing in refractory patients with negative endoscopy. Despite recommendations, clinical practice continues to administer either repeat endoscopy or alternate radiological testing presumably for continued rule out of alarm conditions more frequently than tests for evaluation of GI motility.
3. The median ileal intubation measure of 91% is the first report of such a rate. These type of data, once validated, may serve as potential benchmarks for the evaluation of pediatric endoscopists and might be considered in setting training goals. As the most common indications for colonoscopy in children are abdominal pain and diarrhea, ileal biopsy is often critical. 4. Measures of quality in adult GI practice are not directly applicable to children. Work needs to be directed to modifying them for pediatrics. Su1016 Effect of Gender on Prevalence and Subtype of Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis Rebecca M. Lovell, Alexander C. Ford Background and aims: It has always been assumed that irritable bowel syndrome (IBS) is more common in women. However, there has been no systematic review and meta-analysis that has synthesized data from all available studies to estimate prevalence of IBS according to gender. In addition, there has been no study that has investigated whether the presumed higher prevalence in women varies according to the way in which IBS is defined, and whether it holds true for all IBS subtypes. Methods: MEDLINE, EMBASE, and EMBASE Classic were searched through October 2011 for cross-sectional surveys reporting the prevalence of IBS. A recursive search of the bibliographies of identified articles was also conducted. There were no language restrictions. Eligible studies were population-based, recruited ≥50 adult (≥15 years) subjects, and were required to define IBS via the Manning or Rome I, II, or III criteria. Eligibility assessment and data extraction were conducted independently in a double-blind fashion by two investigators, with any discrepancies resolved by consensus. Data were extracted and pooled, with a random effects model, to estimate prevalence of IBS according to gender. An odds ratio (OR), with a 95% confidence interval (CI), was used to compare the female to male prevalence of IBS, as well as the prevalence of constipationpredominant (IBS-C), diarrhoea-predominant (IBS-D), and mixed-type (IBS-M) among women and men meeting criteria for IBS. Results: The search yielded 20 146 results, of which 390 studies appeared relevant and were retrieved for further assessment. There were 80 separate population-based studies that reported the prevalence of IBS according to the various criteria defined above. Of these, 55 studies reported IBS prevalence according to gender, with a pooled prevalence in women of 14.0% (95% CI 11.0-16.0%) compared with 8.9% (95% CI 7.3-10.5%) in men (OR 1.67; 95% CI 1.53-1.82). Prevalence was consistently higher when all definitions of IBS were considered (table). Nine studies, containing 63 827 participants, also reported the breakdown of IBS according to subtype for both genders. Prevalence of IBS-C was significantly higher in women with IBS compared with men (OR 2.38; 95% CI 1.45-3.92), IBS-D was less common in women with IBS compared with men (OR 0.45; 95% CI 0.32-0.65), while prevalence of IBS-M was not significantly different according to gender (OR 1.07; 95% CI 0.84-1.38). Conclusions: Prevalence of IBS was modestly increased in women, and this observation remained stable according to the various diagnostic criteria used. However, among individuals with IBS, women were more likely to have IBS-C than men, and less likely to have IBS-D. These data suggest that gender may influence IBS subtype.
Su1015 Para-Oesophageal Hernia Repair is Associated With Improvement in Respiratory Function and Quality of Life Priyantha Siriwardana, Keith Hattotuwa, Huw S. Jenkins, Adriana Rotundo, Cheuk Bong Tang, Michael Harvey, Sritharan S. Kadirkamanathan Background: Most patients with para-oesophageal hernia (PEH) are usually elderly and often present with symptoms of postprandial pain, vomiting, shortness of breath and anaemia. Most surgeons would recommend repairing PEH whenever they are encountered. However, significant levels of dyspnoea or respiratory dysfunction could have lead to concerns regarding individual patient suitability for repair. Aim of this study was to assess the effect of surgery on respiratory function and QoL in patients with giant PEH. Methods: 52 patients underwent surgery for giant PEH between January 1997 and October 2011. There were 31 males and the median age was 66(40 -88) year. General health (GH), physical function (PF), rolephysical(RP), bodily pain (BP) components of physical health as well as mental health components of the quality of life (QoL) measures were assessed with SF 36 questionnaire, before and after surgery (i.e. during the follow up at 6 weeks, 6 months and at 12 months). All patients who complained of shortness of breath had respiratory function assessment with pre- and postoperative spirometry, diffusion capacity, and dyspnoea index. Statistical analysis was done using Student's t test. Results: Most of the patients were either ASA grade III or IV (54%) and had either a Type III or a Type IV PEH (76%). Laparoscopic repair of PEH was performed in 30 patients and 5 (9%) patients had open conversion. Complications of both laparoscopic and open repair were minimal and mortality was zero. The median postoperative hospital stay was 3 (1-10) days for laparoscopic and 5 (9 -33) days for open repair. (p < 0.01). Significant improvement in spirometry levels were noted in mean forced expiratory volume in 1 second (FEV1) (pre-op, 1.57 liters; post-op, 2.11 liters; percent improvement, 34%), p < 0.0001; mean forced vital capacity (FVC) (pre-op, 1.74 liters; postop, 2.27 liters; percent improvement, 30%), p < 0.0001; mean percent predicted FEV1 (pre-op, 75 %; post-op, 85%), p < 0.0001; and mean percent predicted FVC (pre-op, 78%; post-op, 91%), p < 0.0001. An improvement trend was noted in diffusing capacity but it did not reach statistical significance. When hernias involved small bowel and or colon in addition to the stomach, percent improvement in FEV1 and FVC was more than those with stomach alone. Two patients who required home oxygen were able to discontinue therapy following surgery. Significant improvements in quality of life scores and dyspnoea index were documented. GH, PF, RP omponents of physical health and social function component of mental health had improved significantly following repair of PEH. Conclusions: Paraoesophageal hernia repair is safe in elderly patients and is associated with significant improvement in respiratory function and quality of life scores.
Su1017 Su1015a Prevalence of, and Risk Factors for, Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis Rebecca M. Lovell, Alexander C. Ford
Measuring Colonoscopy Quality in Pediatrics - One Large Center's Experience Esther J. Israel, Kristen E. Solemina, Evanthia P. Kartsagoulis Much has been written about the parameters which constitute a quality colonoscopy in the adult. These measurements are not necessarily applicable to children as indications and goals of colonoscopy differ in the two groups. The goal of this project was to create and evaluate a quality measures program for colonoscopy procedures in pediatric patients. METHODS: The documentation of 3 components, modified from adult criteria for a quality colonoscopy, were evaluated: 1. Pre-procedure risk assessment defined as ASA grade, history and physical performed with allergies reviewed, and patient/procedure ID and verification; 2. Quality of the bowel prep; and 3. Success of reaching the ileum. A composite measure of these 3 components was considered indicative of a "quality" colonoscopy. All colonoscopies performed by the pediatric gastroenterologists at one of our hospitals were included. Those procedures documented as being “aborted” or “difficult” were excluded. Also excluded were procedures where the intended goal was documented to be an area distal to the ileum. A query was designed in Provation to extract these measures. The hospital's Performance Analysis and Improvement Department measured the bundle monthly. A report listing performance for each individual MD with detail of the colonoscopies which did not meet the composite measure was reported to the physician monthly. RESULTS(FIG 1): Individual and group data for the first 3 quarters of 2011 were extracted. Colonoscopies performed by 18 physicians were evaluated. There was a range per physician of 5 to 89 eligible colonoscopies with a total of 474. Baseline composite measure rates (all 3 components met)of 52% and 46% were noted in 2009 and 2010, respectively. The rate increased to 79% by September 2011. Of the individual measures, the documentation of prep quality was most improved from 66% ('09-'10 mean) to 91%. An increase from 78% to 88% was noted in the documentation of reaching the ileum. Additionally, the range in 2011 for individual endoscopists for ileal intubation was 66% to 100%, with a median of 91%. CONCLUSIONS: 1. Measures of documentation, such as prep quality, are most easy to improve upon with proper training in documentation. 2. The measure seemingly related to the “skill” of the endoscopist, the ability to intubate the ileum, was harder to improve upon.
AGA Abstracts
Background and aims: Irritable bowel syndrome (IBS) is a common disorder. Prevalence varies between populations, and according to the criteria used to define its presence. There has been no systematic review and meta-analysis that has synthesized data from all available studies to estimate global prevalence and risk factors for the condition. Methods: MEDLINE, EMBASE, and EMBASE Classic were searched through October 2011 for cross-sectional surveys reporting prevalence of IBS. There were no language restrictions. Eligible studies were population-based, recruited ≥50 adult (≥15 years) subjects, and were required to define IBS via the Manning or Rome I, II, or III criteria, or according to a questionnaire. Eligibility assessment and data extraction were conducted independently in a double-blind fashion by two investigators, with discrepancies resolved by consensus. Prevalence of IBS was extracted for all studies, and according to criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, as well as odds ratios (OR), with 95% confidence intervals (CIs), were calculated. Results: The search yielded 20 146 results, of which 390 studies appeared relevant and were retrieved for assessment. There were 81 studies conducted in 80 separate populations eligible for inclusion. Pooled prevalence of IBS in all studies was 11.2% (95% CI 9.8-12.8%). IBS prevalence varied according to geographical region (see table), and according to criteria used to define it. Prevalence was greatest when ≥3 Manning criteria were used (14%; 95% CI 10.0-17.0%). Using the Rome I and Rome II criteria, it was 8.8% (95% CI 6.8-11.2%) and 9.4% (95% CI 7.8-11.1%) respectively. Prevalence was higher in women (OR 1.67; 95% CI 1.53-1.82), and lower in those aged 50 years or more compared with those aged less than 50 (OR 0.75; 95% CI 0.62-0.92). There was no effect of socioeconomic status, but only four studies reported these data. Conclusions: Prevalence of IBS varied from 7% to 21%, depending on country, and criteria used to define its presence. There was a modest increase in prevalence in women, and in those aged less than 50, but data on effect of socioeconomic status were sparse.
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Aim: In ulcerative colitis (UC), surgery is often recommended for patients who are not responding to conventional medical therapy.1 We estimated the prevalence of complications of colectomy in patients with UC, using meta-analysis of published studies. Methods: A systematic literature search in PubMed (through August 2011) was conducted for “ulcerative colitis” and the following: ileum, ileal, pouch-anal anastomosis, and complications. Studies with primary data collected from reports of complication rates associated with colectomy were analyzed. For complications with the highest prevalence, pooled averages across studies were estimated. The heterogeneity among studies was examined using the Cochran's Q-test to decide which model should be used (DerSimonian and Laird random-effects model with random effects applied on the logit scale if heterogeneity existed or fixed-effects model if no heterogeneity). Results: Pouchitis, chronic pouchitis, small bowel obstruction, small bowel obstruction requiring reoperation, and infertility in patients undergoing colectomy were analyzed using meta-analysis; the random-effects model was used for all estimates due to heterogeneity among studies. From 16 studies, the estimated prevalence of nonchronic pouchitis (≤3 episodes per year) was 28.4% (95% CI: 21.7-36.2%) (table). From 7 studies, the estimated prevalence of chronic pouchitis (≥4 episodes per year) was 10.9% (95% CI: 6.6-17.4%). From 2 studies that included infertility data, the prevalence of infertility after surgery was about 6 times the presurgery rate. From 15 studies, the estimated prevalence of small bowel obstruction was 17.8% (95% CI: 13.5-23.2%). From 7 studies, the estimated prevalence of small bowel obstruction requiring reoperation was 24.5% (95% CI: 14.937.5%). Conclusion: Patients with moderate to severe UC experienced substantial complications associated with colectomy. This suggested that alternative therapies might need to be considered before undergoing surgical intervention if conventional medical therapies failed. Reference: 1. Kornbluth A, et al. Am J Gastroenterol. 2010;105:501-23.
Su1018 Higher Polyp Detection Rate and Shorter Cecal Intubation Time With CapAssisted Colonoscopy (CAC): A Systematic Review and Meta-Analysis Sachin Wani, Srinivas Gaddam, Ajay Bansal, Matthew Hall, Prateek Sharma, Amit Rastogi Background: CAC has been shown to improve detection of polyps, adenomas, cecal intubation rates and decrease cecal intubation times. However, conflicting results have been reported with regards to these endpoints. Aims:To compare CAC with standard colonoscopy (SC) with respect to:(i) proportion of subjects detected with polyps, (ii) proportion of subjects detected with adenoma and advanced adenoma, and (iii)cecal intubation time. Methods:Studies were identified by searching Ovid MEDLINE, PubMed, and Cochrane Library database for studies published in English language between 1966 to October 2011 using a reproducible search strategy. References from retrieved articles and national meeting abstracts for past 3yrs were manually reviewed. Only prospective studies comparing CAC with SC in adult subjects were included. 2 reviewers independently scored identified studies for methodology and abstracted pertinent data. Pooling was conducted by random-effects model using MantelHaenszel method for dichotomous outcomes and inverse variance method for continuous outcomes. Cochran's Q-test with inverse variance weights and I2 test were used to assess heterogeneity. Outcomes measured were:(i)prevalence of polyps (number of subjects with polyps),(ii)prevalence of adenoma and advanced adenoma, and (iii)cecal intubation time. Results:14 studies met defined inclusion criteria (CAC-3172 and SC-3233 subjects). CAC detected a higher proportion of subjects with polyps [40% vs. 36%, OR 1.23 (95% CI 1.021.49), p=0.03]; with low heterogeneity (p=0.4, I2=2%) across 6 studies (CAC-970, SC1012) (Figure 1). There was no difference between the two groups with regards to proportion of subjects detected with adenomas [32% vs. 34%, OR 1.08 (95% CI 0.81-1.45), p=0.59], but significant heterogeneity (p<0.01, I2=72%) noted among the five studies with 3771 subjects (CAC-1972, SC-1799). Similarly, there was no difference between the two groups with regards to detection rates of advanced adenomas [10.7% vs. 12.4%, OR 0.9 (95% CI 0.57-1.4), p=0.63], with significant heterogeneity (p=0.04, I2=69%) noted across 3 studies with 2647 subjects (CAC-1316, SC-1331). CAC was associated with a shorter cecal intubation time [7.63 vs. 8.98 min, mean difference 0.88 (95% CI 0.35-1.42), p=0.001]; with significant heterogeneity (p<0.001, I2=84%) across the 13 studies included with 4984 subjects (CAC2473, SC-2511) (Figure 2). No complications attributable to CAC were noted in any of the studies. Conclusions:CAC is associated with improved polyp detection rate as well as shorter cecal intubation times. Although the adenoma detection rates were not different with CAC; given the heterogeneity of studies, more data are needed to make definite conclusions. CAC is a simple and efficient technique that has the potential to decrease the risk of interval colon cancer by improving the detection of polyps.
a b c
≤3 episodes per year. Random-effects model was used due to heterogeneity among studies. ≥4 episodes per year.
Su1020 Nonmelanoma Skin Cancers in Inflammatory Bowel Disease Patients Treated With Thiopurines: A Systematic Review and Meta-Analysis Nirav Thosani, Shivang Mehta, David S. Wolf, Andrew W. Dupont, Michael B. Fallon, Sushovan Guha Background and Aim: Inflammatory bowel disease (IBD) patients exposed to thiopurines are observed to have increased risk of lymphoma. The risk of extra-intestinal malignancies in inflammatory bowel disease (IBD) patients treated with thiopurines is unclear. Recently several studies suggested increased risk of nonmelanoma skin cancers (NMSC) in IBD patients exposed to thiopurines. The aim of this study was to assess the risk of NMSC in IBD patients exposed to thiopurines with a comprehensive meta-analytic approach. Patients and Methods: Relevant studies till October 2011 were identified by a search of MEDLINE and EMBASE database and Cochrane library, without restriction. We also reviewed the reference lists from the retrieved articles. We included population based cohort studies that reported odds ratio (OR) or hazard ratio (HR) with 95% confidence interval for the association between exposure to thiopurines in IBD patients and risk of nonmelanoma skin cancers. Two authors independently extracted data and assessed study quality. Study-specific ORs and HRs, depending on the study design were pooled using a random-effect model. Results: Five studies with a total of 100,809 IBD patients were included in the meta-analysis. Depending on the study design, 3 studies reported odds ratio based on multivariate analysis and 2 studies reported hazard ratio based on Cox-regression analysis. Based on the 3 studies with similar study design, the pooled OR for risk of NMSC with exposure to thiopurines in IBD patients was 2.31 (95% CI, 1.25 to 4.29) (Figure 1). Similarly based on the other 2 studies with similar study design the pooled HR for risk of NMSC with exposure to thiopurines in IBD patients was 2.14 (95% CI, 0.32 to 14.15). Significant heterogeneity was present between the studies (p=0.02). Due to different definition of exposure to thiopurines and inconsistent reporting in primary studies, we were not able to do further analysis on dose of exposure, duration of exposure, risk based on disease type (Ulcerative Colitis and Crohn's disease) and cancer type (Squamous cell carcinoma; SCC versus basal cell carcinoma; BSC). Conclusion: Exposure to thiopurines increases the risk of NMSC by 2 folds among individuals with IBD. However, as the current literature is heterogenous, more population based studies reporting outcomes in details for different dose, duration of exposure, and also specific to particular disease type (Ulcerative Colitis and Crohn's disease) and cancer type (SCC and BSC) are needed to confirm the 2-fold increased risk of NMSC found in this meta-analysis.
Prevalence of polyps
Cecal intubation time
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AGA Abstracts
AGA Abstracts
Complications Associated With Colectomy in Patients With Ulcerative Colitis Paul Leonard, Mei Yang, Jingdong Chao, Parvez Mulani
were performed in the year 2009 on patients with complaints consistent with symptoms associated with functional and motility GI disorders. Of the total procedures, 257,625 (10%) upper GI endoscopies and 41,629 (3%) colonoscopies were repeat tests in the same patient. An additional 1.46 million (17%) CT Scans, 36,926 MRI tests (10%), 279,020 (9%) US were repeated in patients at a total cost of $874M. The total number of GI motility tests was 159,599; gastric emptying scintigraphy (102,078), gastroduodenal (2,209) and Anorectal manometry (25,124) and ROM(30,149). The total count of upper GI motility tests was 104,287 and total number of lower GI motility tests was 55,272 at a total cost of $89M. Conclusions: The number of repeat endoscopies far exceeds the number of UGI motility studies conducted among patients presenting with GI function/motility symptoms. Repeat radiologic tests conducted post initial endoscopy/colonoscopy also far exceeded the number of GI motility tests. AGA/ACG recommended management algorithms for patients presenting with upper and lower GI function/motility symptoms call for GI motility testing in refractory patients with negative endoscopy. Despite recommendations, clinical practice continues to administer either repeat endoscopy or alternate radiological testing presumably for continued rule out of alarm conditions more frequently than tests for evaluation of GI motility.
3. The median ileal intubation measure of 91% is the first report of such a rate. These type of data, once validated, may serve as potential benchmarks for the evaluation of pediatric endoscopists and might be considered in setting training goals. As the most common indications for colonoscopy in children are abdominal pain and diarrhea, ileal biopsy is often critical. 4. Measures of quality in adult GI practice are not directly applicable to children. Work needs to be directed to modifying them for pediatrics. Su1016 Effect of Gender on Prevalence and Subtype of Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis Rebecca M. Lovell, Alexander C. Ford Background and aims: It has always been assumed that irritable bowel syndrome (IBS) is more common in women. However, there has been no systematic review and meta-analysis that has synthesized data from all available studies to estimate prevalence of IBS according to gender. In addition, there has been no study that has investigated whether the presumed higher prevalence in women varies according to the way in which IBS is defined, and whether it holds true for all IBS subtypes. Methods: MEDLINE, EMBASE, and EMBASE Classic were searched through October 2011 for cross-sectional surveys reporting the prevalence of IBS. A recursive search of the bibliographies of identified articles was also conducted. There were no language restrictions. Eligible studies were population-based, recruited ≥50 adult (≥15 years) subjects, and were required to define IBS via the Manning or Rome I, II, or III criteria. Eligibility assessment and data extraction were conducted independently in a double-blind fashion by two investigators, with any discrepancies resolved by consensus. Data were extracted and pooled, with a random effects model, to estimate prevalence of IBS according to gender. An odds ratio (OR), with a 95% confidence interval (CI), was used to compare the female to male prevalence of IBS, as well as the prevalence of constipationpredominant (IBS-C), diarrhoea-predominant (IBS-D), and mixed-type (IBS-M) among women and men meeting criteria for IBS. Results: The search yielded 20 146 results, of which 390 studies appeared relevant and were retrieved for further assessment. There were 80 separate population-based studies that reported the prevalence of IBS according to the various criteria defined above. Of these, 55 studies reported IBS prevalence according to gender, with a pooled prevalence in women of 14.0% (95% CI 11.0-16.0%) compared with 8.9% (95% CI 7.3-10.5%) in men (OR 1.67; 95% CI 1.53-1.82). Prevalence was consistently higher when all definitions of IBS were considered (table). Nine studies, containing 63 827 participants, also reported the breakdown of IBS according to subtype for both genders. Prevalence of IBS-C was significantly higher in women with IBS compared with men (OR 2.38; 95% CI 1.45-3.92), IBS-D was less common in women with IBS compared with men (OR 0.45; 95% CI 0.32-0.65), while prevalence of IBS-M was not significantly different according to gender (OR 1.07; 95% CI 0.84-1.38). Conclusions: Prevalence of IBS was modestly increased in women, and this observation remained stable according to the various diagnostic criteria used. However, among individuals with IBS, women were more likely to have IBS-C than men, and less likely to have IBS-D. These data suggest that gender may influence IBS subtype.
Su1015 Para-Oesophageal Hernia Repair is Associated With Improvement in Respiratory Function and Quality of Life Priyantha Siriwardana, Keith Hattotuwa, Huw S. Jenkins, Adriana Rotundo, Cheuk Bong Tang, Michael Harvey, Sritharan S. Kadirkamanathan Background: Most patients with para-oesophageal hernia (PEH) are usually elderly and often present with symptoms of postprandial pain, vomiting, shortness of breath and anaemia. Most surgeons would recommend repairing PEH whenever they are encountered. However, significant levels of dyspnoea or respiratory dysfunction could have lead to concerns regarding individual patient suitability for repair. Aim of this study was to assess the effect of surgery on respiratory function and QoL in patients with giant PEH. Methods: 52 patients underwent surgery for giant PEH between January 1997 and October 2011. There were 31 males and the median age was 66(40 -88) year. General health (GH), physical function (PF), rolephysical(RP), bodily pain (BP) components of physical health as well as mental health components of the quality of life (QoL) measures were assessed with SF 36 questionnaire, before and after surgery (i.e. during the follow up at 6 weeks, 6 months and at 12 months). All patients who complained of shortness of breath had respiratory function assessment with pre- and postoperative spirometry, diffusion capacity, and dyspnoea index. Statistical analysis was done using Student's t test. Results: Most of the patients were either ASA grade III or IV (54%) and had either a Type III or a Type IV PEH (76%). Laparoscopic repair of PEH was performed in 30 patients and 5 (9%) patients had open conversion. Complications of both laparoscopic and open repair were minimal and mortality was zero. The median postoperative hospital stay was 3 (1-10) days for laparoscopic and 5 (9 -33) days for open repair. (p < 0.01). Significant improvement in spirometry levels were noted in mean forced expiratory volume in 1 second (FEV1) (pre-op, 1.57 liters; post-op, 2.11 liters; percent improvement, 34%), p < 0.0001; mean forced vital capacity (FVC) (pre-op, 1.74 liters; postop, 2.27 liters; percent improvement, 30%), p < 0.0001; mean percent predicted FEV1 (pre-op, 75 %; post-op, 85%), p < 0.0001; and mean percent predicted FVC (pre-op, 78%; post-op, 91%), p < 0.0001. An improvement trend was noted in diffusing capacity but it did not reach statistical significance. When hernias involved small bowel and or colon in addition to the stomach, percent improvement in FEV1 and FVC was more than those with stomach alone. Two patients who required home oxygen were able to discontinue therapy following surgery. Significant improvements in quality of life scores and dyspnoea index were documented. GH, PF, RP omponents of physical health and social function component of mental health had improved significantly following repair of PEH. Conclusions: Paraoesophageal hernia repair is safe in elderly patients and is associated with significant improvement in respiratory function and quality of life scores.
Su1017 Su1015a Prevalence of, and Risk Factors for, Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis Rebecca M. Lovell, Alexander C. Ford
Measuring Colonoscopy Quality in Pediatrics - One Large Center's Experience Esther J. Israel, Kristen E. Solemina, Evanthia P. Kartsagoulis Much has been written about the parameters which constitute a quality colonoscopy in the adult. These measurements are not necessarily applicable to children as indications and goals of colonoscopy differ in the two groups. The goal of this project was to create and evaluate a quality measures program for colonoscopy procedures in pediatric patients. METHODS: The documentation of 3 components, modified from adult criteria for a quality colonoscopy, were evaluated: 1. Pre-procedure risk assessment defined as ASA grade, history and physical performed with allergies reviewed, and patient/procedure ID and verification; 2. Quality of the bowel prep; and 3. Success of reaching the ileum. A composite measure of these 3 components was considered indicative of a "quality" colonoscopy. All colonoscopies performed by the pediatric gastroenterologists at one of our hospitals were included. Those procedures documented as being “aborted” or “difficult” were excluded. Also excluded were procedures where the intended goal was documented to be an area distal to the ileum. A query was designed in Provation to extract these measures. The hospital's Performance Analysis and Improvement Department measured the bundle monthly. A report listing performance for each individual MD with detail of the colonoscopies which did not meet the composite measure was reported to the physician monthly. RESULTS(FIG 1): Individual and group data for the first 3 quarters of 2011 were extracted. Colonoscopies performed by 18 physicians were evaluated. There was a range per physician of 5 to 89 eligible colonoscopies with a total of 474. Baseline composite measure rates (all 3 components met)of 52% and 46% were noted in 2009 and 2010, respectively. The rate increased to 79% by September 2011. Of the individual measures, the documentation of prep quality was most improved from 66% ('09-'10 mean) to 91%. An increase from 78% to 88% was noted in the documentation of reaching the ileum. Additionally, the range in 2011 for individual endoscopists for ileal intubation was 66% to 100%, with a median of 91%. CONCLUSIONS: 1. Measures of documentation, such as prep quality, are most easy to improve upon with proper training in documentation. 2. The measure seemingly related to the “skill” of the endoscopist, the ability to intubate the ileum, was harder to improve upon.
AGA Abstracts
Background and aims: Irritable bowel syndrome (IBS) is a common disorder. Prevalence varies between populations, and according to the criteria used to define its presence. There has been no systematic review and meta-analysis that has synthesized data from all available studies to estimate global prevalence and risk factors for the condition. Methods: MEDLINE, EMBASE, and EMBASE Classic were searched through October 2011 for cross-sectional surveys reporting prevalence of IBS. There were no language restrictions. Eligible studies were population-based, recruited ≥50 adult (≥15 years) subjects, and were required to define IBS via the Manning or Rome I, II, or III criteria, or according to a questionnaire. Eligibility assessment and data extraction were conducted independently in a double-blind fashion by two investigators, with discrepancies resolved by consensus. Prevalence of IBS was extracted for all studies, and according to criteria used to define it. Pooled prevalence, according to study location and certain other characteristics, as well as odds ratios (OR), with 95% confidence intervals (CIs), were calculated. Results: The search yielded 20 146 results, of which 390 studies appeared relevant and were retrieved for assessment. There were 81 studies conducted in 80 separate populations eligible for inclusion. Pooled prevalence of IBS in all studies was 11.2% (95% CI 9.8-12.8%). IBS prevalence varied according to geographical region (see table), and according to criteria used to define it. Prevalence was greatest when ≥3 Manning criteria were used (14%; 95% CI 10.0-17.0%). Using the Rome I and Rome II criteria, it was 8.8% (95% CI 6.8-11.2%) and 9.4% (95% CI 7.8-11.1%) respectively. Prevalence was higher in women (OR 1.67; 95% CI 1.53-1.82), and lower in those aged 50 years or more compared with those aged less than 50 (OR 0.75; 95% CI 0.62-0.92). There was no effect of socioeconomic status, but only four studies reported these data. Conclusions: Prevalence of IBS varied from 7% to 21%, depending on country, and criteria used to define its presence. There was a modest increase in prevalence in women, and in those aged less than 50, but data on effect of socioeconomic status were sparse.
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Aim: In ulcerative colitis (UC), surgery is often recommended for patients who are not responding to conventional medical therapy.1 We estimated the prevalence of complications of colectomy in patients with UC, using meta-analysis of published studies. Methods: A systematic literature search in PubMed (through August 2011) was conducted for “ulcerative colitis” and the following: ileum, ileal, pouch-anal anastomosis, and complications. Studies with primary data collected from reports of complication rates associated with colectomy were analyzed. For complications with the highest prevalence, pooled averages across studies were estimated. The heterogeneity among studies was examined using the Cochran's Q-test to decide which model should be used (DerSimonian and Laird random-effects model with random effects applied on the logit scale if heterogeneity existed or fixed-effects model if no heterogeneity). Results: Pouchitis, chronic pouchitis, small bowel obstruction, small bowel obstruction requiring reoperation, and infertility in patients undergoing colectomy were analyzed using meta-analysis; the random-effects model was used for all estimates due to heterogeneity among studies. From 16 studies, the estimated prevalence of nonchronic pouchitis (≤3 episodes per year) was 28.4% (95% CI: 21.7-36.2%) (table). From 7 studies, the estimated prevalence of chronic pouchitis (≥4 episodes per year) was 10.9% (95% CI: 6.6-17.4%). From 2 studies that included infertility data, the prevalence of infertility after surgery was about 6 times the presurgery rate. From 15 studies, the estimated prevalence of small bowel obstruction was 17.8% (95% CI: 13.5-23.2%). From 7 studies, the estimated prevalence of small bowel obstruction requiring reoperation was 24.5% (95% CI: 14.937.5%). Conclusion: Patients with moderate to severe UC experienced substantial complications associated with colectomy. This suggested that alternative therapies might need to be considered before undergoing surgical intervention if conventional medical therapies failed. Reference: 1. Kornbluth A, et al. Am J Gastroenterol. 2010;105:501-23.
Su1018 Higher Polyp Detection Rate and Shorter Cecal Intubation Time With CapAssisted Colonoscopy (CAC): A Systematic Review and Meta-Analysis Sachin Wani, Srinivas Gaddam, Ajay Bansal, Matthew Hall, Prateek Sharma, Amit Rastogi Background: CAC has been shown to improve detection of polyps, adenomas, cecal intubation rates and decrease cecal intubation times. However, conflicting results have been reported with regards to these endpoints. Aims:To compare CAC with standard colonoscopy (SC) with respect to:(i) proportion of subjects detected with polyps, (ii) proportion of subjects detected with adenoma and advanced adenoma, and (iii)cecal intubation time. Methods:Studies were identified by searching Ovid MEDLINE, PubMed, and Cochrane Library database for studies published in English language between 1966 to October 2011 using a reproducible search strategy. References from retrieved articles and national meeting abstracts for past 3yrs were manually reviewed. Only prospective studies comparing CAC with SC in adult subjects were included. 2 reviewers independently scored identified studies for methodology and abstracted pertinent data. Pooling was conducted by random-effects model using MantelHaenszel method for dichotomous outcomes and inverse variance method for continuous outcomes. Cochran's Q-test with inverse variance weights and I2 test were used to assess heterogeneity. Outcomes measured were:(i)prevalence of polyps (number of subjects with polyps),(ii)prevalence of adenoma and advanced adenoma, and (iii)cecal intubation time. Results:14 studies met defined inclusion criteria (CAC-3172 and SC-3233 subjects). CAC detected a higher proportion of subjects with polyps [40% vs. 36%, OR 1.23 (95% CI 1.021.49), p=0.03]; with low heterogeneity (p=0.4, I2=2%) across 6 studies (CAC-970, SC1012) (Figure 1). There was no difference between the two groups with regards to proportion of subjects detected with adenomas [32% vs. 34%, OR 1.08 (95% CI 0.81-1.45), p=0.59], but significant heterogeneity (p<0.01, I2=72%) noted among the five studies with 3771 subjects (CAC-1972, SC-1799). Similarly, there was no difference between the two groups with regards to detection rates of advanced adenomas [10.7% vs. 12.4%, OR 0.9 (95% CI 0.57-1.4), p=0.63], with significant heterogeneity (p=0.04, I2=69%) noted across 3 studies with 2647 subjects (CAC-1316, SC-1331). CAC was associated with a shorter cecal intubation time [7.63 vs. 8.98 min, mean difference 0.88 (95% CI 0.35-1.42), p=0.001]; with significant heterogeneity (p<0.001, I2=84%) across the 13 studies included with 4984 subjects (CAC2473, SC-2511) (Figure 2). No complications attributable to CAC were noted in any of the studies. Conclusions:CAC is associated with improved polyp detection rate as well as shorter cecal intubation times. Although the adenoma detection rates were not different with CAC; given the heterogeneity of studies, more data are needed to make definite conclusions. CAC is a simple and efficient technique that has the potential to decrease the risk of interval colon cancer by improving the detection of polyps.
a b c
≤3 episodes per year. Random-effects model was used due to heterogeneity among studies. ≥4 episodes per year.
Su1020 Nonmelanoma Skin Cancers in Inflammatory Bowel Disease Patients Treated With Thiopurines: A Systematic Review and Meta-Analysis Nirav Thosani, Shivang Mehta, David S. Wolf, Andrew W. Dupont, Michael B. Fallon, Sushovan Guha Background and Aim: Inflammatory bowel disease (IBD) patients exposed to thiopurines are observed to have increased risk of lymphoma. The risk of extra-intestinal malignancies in inflammatory bowel disease (IBD) patients treated with thiopurines is unclear. Recently several studies suggested increased risk of nonmelanoma skin cancers (NMSC) in IBD patients exposed to thiopurines. The aim of this study was to assess the risk of NMSC in IBD patients exposed to thiopurines with a comprehensive meta-analytic approach. Patients and Methods: Relevant studies till October 2011 were identified by a search of MEDLINE and EMBASE database and Cochrane library, without restriction. We also reviewed the reference lists from the retrieved articles. We included population based cohort studies that reported odds ratio (OR) or hazard ratio (HR) with 95% confidence interval for the association between exposure to thiopurines in IBD patients and risk of nonmelanoma skin cancers. Two authors independently extracted data and assessed study quality. Study-specific ORs and HRs, depending on the study design were pooled using a random-effect model. Results: Five studies with a total of 100,809 IBD patients were included in the meta-analysis. Depending on the study design, 3 studies reported odds ratio based on multivariate analysis and 2 studies reported hazard ratio based on Cox-regression analysis. Based on the 3 studies with similar study design, the pooled OR for risk of NMSC with exposure to thiopurines in IBD patients was 2.31 (95% CI, 1.25 to 4.29) (Figure 1). Similarly based on the other 2 studies with similar study design the pooled HR for risk of NMSC with exposure to thiopurines in IBD patients was 2.14 (95% CI, 0.32 to 14.15). Significant heterogeneity was present between the studies (p=0.02). Due to different definition of exposure to thiopurines and inconsistent reporting in primary studies, we were not able to do further analysis on dose of exposure, duration of exposure, risk based on disease type (Ulcerative Colitis and Crohn's disease) and cancer type (Squamous cell carcinoma; SCC versus basal cell carcinoma; BSC). Conclusion: Exposure to thiopurines increases the risk of NMSC by 2 folds among individuals with IBD. However, as the current literature is heterogenous, more population based studies reporting outcomes in details for different dose, duration of exposure, and also specific to particular disease type (Ulcerative Colitis and Crohn's disease) and cancer type (SCC and BSC) are needed to confirm the 2-fold increased risk of NMSC found in this meta-analysis.
Prevalence of polyps
Cecal intubation time
S-401
AGA Abstracts
AGA Abstracts
Complications Associated With Colectomy in Patients With Ulcerative Colitis Paul Leonard, Mei Yang, Jingdong Chao, Parvez Mulani