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Tu2078 The Effect of Lubiprostone on Regional Alimentary Tract Transit Times Measured by Wireless Motility Capsule in Patients With Chronic Constipation
AGA Abstracts
psychological symptoms and quality of life. Methods: We included 197 IBS patients (mean age 35 (18-72) years; 142 females) referred to our outpatient clinic. The patients completed a food questionnaire where they specified symptoms from 56 different food items or food groups relevant to food intolerance/allergy. The patients also completed questionnaires to assess depression and anxiety (HAD), GI-specific anxiety (VSI), IBS symptoms (IBS-SSS), somatic symptoms (PHQ-15), and quality of life (IBSQOL). Results: Eighty-four percent of the studied population reported symptoms related to at least one of the food items surveyed. Symptoms related to intake of food items with incompletely absorbed carbohydrates were noted in 139 (71%) patients; the most common were dairy products (49%), beans/lentils (36%), apple (28%), flour (24%), and plum (23%). Fifty-six percent experienced GI symptoms from foods rich in biogenic amines, such as wine/beer (31%), salami (22%), and cheese (20%). Histamine-releasing foods, such as pork (28%), chocolate (17%) and orange (17%), were also considered to cause symptoms in IBS patients. GI symptoms were also frequently reported after intake of fried and fatty foods (52%). With increasing IBS symptom severity patients reported more food items responsible for their GI symptoms (p=0.004), and this was also found in patients with more severe somatic symptoms (p ,0.0001). Women tended to report more foods causing symptoms than men (p=0.06). A high number of food items causing GI symptoms was also associated with reduced quality of life and this was significant for the following domains: sleep (r=-0.25; p=0.001), energy (r=-0.21; p=0.005), food (r=0.29; p,0.001), and social role (r=-0.24; p=0.001). However, the number of food items reported to provoke GI symptoms was unrelated to IBS subgroup, anxiety, depression or GI-specific anxiety. Conclusion: The majority of IBS patients consider that certain food items are important for their GI symptoms. This is especially true for foods containing incompletely absorbed carbohydrates and fat, but also histamine-releasing food items and foods rich in biogenic amines seem to be relevant. Perceived food intolerance is associated with high symptom burden and reduced quality of life. Improving management of food intolerance in IBS has the potential to reduce symptom burden and improve quality of life. Tu2080 Prolonged Orocecal Transit Time in Irritable Bowel Syndrome: Investigation of the Relationships With Clinical Features, Psychological Distress and Small Intestinal Bacterial Overgrowth Cristiane K. Nagasako, Sônia L. Lorena, Célia R. Pavan, Maria A. Mesquita Ns = not significant
Background: Studies on small intestinal transit in irritable bowel syndrome (IBS) have reported contradictory results. Aims: To determine the orocecal transit time (OCTT) in patients with irritable bowel syndrome and its association with clinical features, psychological distress and small intestinal bacterial overgrowth (SIBO). Subjects and Methods: Seventythree consecutive patients with the diagnosis of IBS based on Rome III criteria (females: 61, age: 50 ± 10 years) participated in this study. All patients completed a questionnaire for intestinal symptoms and underwent the lactulose hydrogen breath test (LBT) to determine OCTT and the glucose breath test (GBT) to assess the occurrence of SIBO. The control group for the LBT was composed of 24 healthy volunteers. The GBT test was considered positive for SIBO if there was a rise in breath hydrogen ≥ 12 ppm above the basal value at 120 min, following the ingestion of 50g glucose. The presence of anxiety and depression was assessed by the Hospital Anxiety and Depression (HAD) scale. Results: 34 patients (46%) were classified as IBS with diarrhea, 25 (34%) as IBS with constipation and 14 (19%) as mixed IBS. Anxiety and/or depression were observed in 55 (75,3%) patients. There was a statistically significant increase in OCTT values in IBS patients (80 ± 39 min) in comparison with controls (54 ± 17 min; p= 0.02). Individual analysis showed that OCTT was above the upper limit (mean + 2SD: 88 min) in 23 patients (31.5%). There was no association between OCTT values and IBS subtypes, symptoms of bloating and distension, or anxiety and depression scores (p.0.05). Eleven patients (15%) had a positive GBT suggestive of SIBO. Eight of them (72%) complained of diarrhea. SIBO was identified in 30% of patients with prolonged OCTT and in 8.3% of those with OCTT values within the normal range of the test (p=0.05). Conclusions: Small bowel transit may be delayed in about one-third of IBS patients. This abnormality seems to be equally distributed among IBS subtypes and may contribute to the development of SIBO in these patients.
Tu2078 The Effect of Lubiprostone on Regional Alimentary Tract Transit Times Measured by Wireless Motility Capsule in Patients With Chronic Constipation Irene Sarosiek, Alicia Alvarez, Roberta Romero, Yvette Gomez, Natalia Vega, Richard W. McCallum, Jerzy Sarosiek Introduction: Lubiprostone, a selective type 2 chloride channel (ClC-2) activator, induces a chloride-rich intestinal fluid secretion which diminishes viscoelasticity of luminal contents and increases lubrication. These effects have led to increased stool frequency and relief of symptoms in patients with chronic constipation (CC). While radionuclide studies have indicated acceleration in colon transit, the impact of lubiprostone on transit times in specific regions of the gut has not been clarified. These measurements can now be achieved by the novel wireless motility capsule (WMC) technology in patients with CC. Our aim was to investigate the effects of lubiprostone on gastric emptying (GET), small bowel (SBTT), colon (CTT) and small/large bowel (SLBTT) transit times assessed by WMC in CC (Rome III) patients. Methods: Twenty nine female patients with CC, mean age 38 (19-64) mean weight 167 lbs (111-305) were tested with WMC before treatment and on day number 8 after receiving 24 mcg BID of lubiprostone. GET was calculated from the time WMC was ingested until the point at which there was an abrupt and sustained increase in pH of more than 2 units from the gastric pH to an absolute pH of .6.0. SBTT was defined as the elapsed time from capsule leaving the stomach until capsule arrived at the cecum. This was determined by a sudden drop of pH .1 unit, for longer than 1 h, which was preceded by a gradual, sustained rise in pH as the capsule passes through the distal small bowel. CTT was defined as the time interval between the point of entry into the cecum and the exit of WMC from the body. SLBTT includes SBTT and CTT. Statistical analysis, using Mann-Whitney Rank Sum Test was performed using Sigma-Stat software. Results are presented as Median with 25-75 percentiles range. Results: After administration of lubiprostone gastric emptying was slowed by 14.5% to 4.02h (2.27-8.82) versus 3.51h (2.38-12.83) at baseline (P=0.913); SBTT was significantly accelerated by 12.2% to 4.03h (3.13-4.49) when compared with 4.59 h (4.00-6.32) at baseline (P=0.010) and CTT was accelerated by 10.1% to 35.1h (22.66-47.99) vs 39.05h (22.61-63.39) before treatment ( P=0.328). The comparison of SLBTT before and after therapy with lubiprostone showed 18.9% reduction of this regional transit time with median being 46.24h (30.97-80.47) at baseline and 37.55h (24.49-54.21) while on medication (P=0.128). Conclusions: 1) During treatment with lubiprostone the acceleration of SBTT is more pronounced that colon transit in CC patients. 2) This implies that type 2 chloride channel activation within the small bowel does affect small intestine motility patterns in patients with chronic constipation. 3) The very modest delay in gastric emptying was not accompanied by clinically relevant nausea and is unlikely to explain the nausea side effect profile of lubiprostone.
Tu2081 Clinical, Manometric, and Radiographic Evidence of Diffuse Gastrointestinal Dysmotility in the Postural Orthostatic Tachycardia Syndrome (POTS) Robert J. Huang, Carlene Chun, Karen Friday, George Triadafilopoulos Background/Aims: Postural orthostatic tachycardia syndrome (POTS) is a rare condition of dysautonomia characterized by symptoms of orthostasis coupled with inappropriate tachycardia. Gastrointestinal complaints in POTS patients are common and disturbing but not well characterized. We conducted a clinical, manometric, and radiographic assessment of a cohort of patients with POTS presenting with gastrointestinal symptoms to a tertiary referral center. Methods: We studied 12 patients with POTS (1 man and 11 women; age range 18-54, mean 32) who presented with gastrointestinal symptoms to a tertiary Cardiology referral center. Symptoms were quantified using a previously validated symptom questionnaire. Depending on the nature of their symptoms, patients then underwent gastroduodenal manometry (GDM), anorectal manometry (ARM), gastric emptying studies (GES), and colonic transit time studies (CTT). Patients were then treated with a symptom-targeted approach and reevaluated 6 months after treatment. Results: All patients underwent either gastroduodenal manometry (n=8) or anorectal manometry (n=7), with very high prevalence of abnormalities suggesting neuropathy (Table 1). Five patients underwent CTT, of which four (80%) showed delayed colonic transit. Five patients underwent GES, of which three patients (60%) demonstrated delayed gastric emptying. The two most prevalent and severe symptoms, constipation and bloating, demonstrated the greatest improvement in symptom scores (46% and 33% reduction, respectively) following six months of treatment (Figure 1). Conclusion: All POTS patients referred for motility testing demonstrated at least one abnormality suggestive of gastrointestinal dysautonomia. Treatment for the gastrointestinal symptoms in POTS can be effective, especially in cases of constipation and bloating. Prevalence of gastroduodenal and anorectal manometric abnormalities in POTS patients
Tu2079 Food-Related Gastrointestinal Symptoms in IBS Are Common and Associated With More Severe Symptoms and Reduced Quality of Life. Lena Böhn, Stine Störsrud, Hans Törnblom, Ulf J. Bengtsson, Magnus Simren Background: Despite the fact that food and diet are central issues, which concern patients with IBS, the current understanding about the association between the intake of certain foods/food groups and the gastrointestinal (GI) symptom pattern, psychological symptoms and quality of life is poor. Aims: To determine which food groups and specific food items IBS patients report causing GI symptoms, and to investigate the association with GI and
AGA Abstracts
S-922
psychological symptoms and quality of life. Methods: We included 197 IBS patients (mean age 35 (18-72) years; 142 females) referred to our outpatient clinic. The patients completed a food questionnaire where they specified symptoms from 56 different food items or food groups relevant to food intolerance/allergy. The patients also completed questionnaires to assess depression and anxiety (HAD), GI-specific anxiety (VSI), IBS symptoms (IBS-SSS), somatic symptoms (PHQ-15), and quality of life (IBSQOL). Results: Eighty-four percent of the studied population reported symptoms related to at least one of the food items surveyed. Symptoms related to intake of food items with incompletely absorbed carbohydrates were noted in 139 (71%) patients; the most common were dairy products (49%), beans/lentils (36%), apple (28%), flour (24%), and plum (23%). Fifty-six percent experienced GI symptoms from foods rich in biogenic amines, such as wine/beer (31%), salami (22%), and cheese (20%). Histamine-releasing foods, such as pork (28%), chocolate (17%) and orange (17%), were also considered to cause symptoms in IBS patients. GI symptoms were also frequently reported after intake of fried and fatty foods (52%). With increasing IBS symptom severity patients reported more food items responsible for their GI symptoms (p=0.004), and this was also found in patients with more severe somatic symptoms (p ,0.0001). Women tended to report more foods causing symptoms than men (p=0.06). A high number of food items causing GI symptoms was also associated with reduced quality of life and this was significant for the following domains: sleep (r=-0.25; p=0.001), energy (r=-0.21; p=0.005), food (r=0.29; p,0.001), and social role (r=-0.24; p=0.001). However, the number of food items reported to provoke GI symptoms was unrelated to IBS subgroup, anxiety, depression or GI-specific anxiety. Conclusion: The majority of IBS patients consider that certain food items are important for their GI symptoms. This is especially true for foods containing incompletely absorbed carbohydrates and fat, but also histamine-releasing food items and foods rich in biogenic amines seem to be relevant. Perceived food intolerance is associated with high symptom burden and reduced quality of life. Improving management of food intolerance in IBS has the potential to reduce symptom burden and improve quality of life. Tu2080 Prolonged Orocecal Transit Time in Irritable Bowel Syndrome: Investigation of the Relationships With Clinical Features, Psychological Distress and Small Intestinal Bacterial Overgrowth Cristiane K. Nagasako, Sônia L. Lorena, Célia R. Pavan, Maria A. Mesquita Ns = not significant
Background: Studies on small intestinal transit in irritable bowel syndrome (IBS) have reported contradictory results. Aims: To determine the orocecal transit time (OCTT) in patients with irritable bowel syndrome and its association with clinical features, psychological distress and small intestinal bacterial overgrowth (SIBO). Subjects and Methods: Seventythree consecutive patients with the diagnosis of IBS based on Rome III criteria (females: 61, age: 50 ± 10 years) participated in this study. All patients completed a questionnaire for intestinal symptoms and underwent the lactulose hydrogen breath test (LBT) to determine OCTT and the glucose breath test (GBT) to assess the occurrence of SIBO. The control group for the LBT was composed of 24 healthy volunteers. The GBT test was considered positive for SIBO if there was a rise in breath hydrogen ≥ 12 ppm above the basal value at 120 min, following the ingestion of 50g glucose. The presence of anxiety and depression was assessed by the Hospital Anxiety and Depression (HAD) scale. Results: 34 patients (46%) were classified as IBS with diarrhea, 25 (34%) as IBS with constipation and 14 (19%) as mixed IBS. Anxiety and/or depression were observed in 55 (75,3%) patients. There was a statistically significant increase in OCTT values in IBS patients (80 ± 39 min) in comparison with controls (54 ± 17 min; p= 0.02). Individual analysis showed that OCTT was above the upper limit (mean + 2SD: 88 min) in 23 patients (31.5%). There was no association between OCTT values and IBS subtypes, symptoms of bloating and distension, or anxiety and depression scores (p.0.05). Eleven patients (15%) had a positive GBT suggestive of SIBO. Eight of them (72%) complained of diarrhea. SIBO was identified in 30% of patients with prolonged OCTT and in 8.3% of those with OCTT values within the normal range of the test (p=0.05). Conclusions: Small bowel transit may be delayed in about one-third of IBS patients. This abnormality seems to be equally distributed among IBS subtypes and may contribute to the development of SIBO in these patients.
Tu2078 The Effect of Lubiprostone on Regional Alimentary Tract Transit Times Measured by Wireless Motility Capsule in Patients With Chronic Constipation Irene Sarosiek, Alicia Alvarez, Roberta Romero, Yvette Gomez, Natalia Vega, Richard W. McCallum, Jerzy Sarosiek Introduction: Lubiprostone, a selective type 2 chloride channel (ClC-2) activator, induces a chloride-rich intestinal fluid secretion which diminishes viscoelasticity of luminal contents and increases lubrication. These effects have led to increased stool frequency and relief of symptoms in patients with chronic constipation (CC). While radionuclide studies have indicated acceleration in colon transit, the impact of lubiprostone on transit times in specific regions of the gut has not been clarified. These measurements can now be achieved by the novel wireless motility capsule (WMC) technology in patients with CC. Our aim was to investigate the effects of lubiprostone on gastric emptying (GET), small bowel (SBTT), colon (CTT) and small/large bowel (SLBTT) transit times assessed by WMC in CC (Rome III) patients. Methods: Twenty nine female patients with CC, mean age 38 (19-64) mean weight 167 lbs (111-305) were tested with WMC before treatment and on day number 8 after receiving 24 mcg BID of lubiprostone. GET was calculated from the time WMC was ingested until the point at which there was an abrupt and sustained increase in pH of more than 2 units from the gastric pH to an absolute pH of .6.0. SBTT was defined as the elapsed time from capsule leaving the stomach until capsule arrived at the cecum. This was determined by a sudden drop of pH .1 unit, for longer than 1 h, which was preceded by a gradual, sustained rise in pH as the capsule passes through the distal small bowel. CTT was defined as the time interval between the point of entry into the cecum and the exit of WMC from the body. SLBTT includes SBTT and CTT. Statistical analysis, using Mann-Whitney Rank Sum Test was performed using Sigma-Stat software. Results are presented as Median with 25-75 percentiles range. Results: After administration of lubiprostone gastric emptying was slowed by 14.5% to 4.02h (2.27-8.82) versus 3.51h (2.38-12.83) at baseline (P=0.913); SBTT was significantly accelerated by 12.2% to 4.03h (3.13-4.49) when compared with 4.59 h (4.00-6.32) at baseline (P=0.010) and CTT was accelerated by 10.1% to 35.1h (22.66-47.99) vs 39.05h (22.61-63.39) before treatment ( P=0.328). The comparison of SLBTT before and after therapy with lubiprostone showed 18.9% reduction of this regional transit time with median being 46.24h (30.97-80.47) at baseline and 37.55h (24.49-54.21) while on medication (P=0.128). Conclusions: 1) During treatment with lubiprostone the acceleration of SBTT is more pronounced that colon transit in CC patients. 2) This implies that type 2 chloride channel activation within the small bowel does affect small intestine motility patterns in patients with chronic constipation. 3) The very modest delay in gastric emptying was not accompanied by clinically relevant nausea and is unlikely to explain the nausea side effect profile of lubiprostone.
Tu2081 Clinical, Manometric, and Radiographic Evidence of Diffuse Gastrointestinal Dysmotility in the Postural Orthostatic Tachycardia Syndrome (POTS) Robert J. Huang, Carlene Chun, Karen Friday, George Triadafilopoulos Background/Aims: Postural orthostatic tachycardia syndrome (POTS) is a rare condition of dysautonomia characterized by symptoms of orthostasis coupled with inappropriate tachycardia. Gastrointestinal complaints in POTS patients are common and disturbing but not well characterized. We conducted a clinical, manometric, and radiographic assessment of a cohort of patients with POTS presenting with gastrointestinal symptoms to a tertiary referral center. Methods: We studied 12 patients with POTS (1 man and 11 women; age range 18-54, mean 32) who presented with gastrointestinal symptoms to a tertiary Cardiology referral center. Symptoms were quantified using a previously validated symptom questionnaire. Depending on the nature of their symptoms, patients then underwent gastroduodenal manometry (GDM), anorectal manometry (ARM), gastric emptying studies (GES), and colonic transit time studies (CTT). Patients were then treated with a symptom-targeted approach and reevaluated 6 months after treatment. Results: All patients underwent either gastroduodenal manometry (n=8) or anorectal manometry (n=7), with very high prevalence of abnormalities suggesting neuropathy (Table 1). Five patients underwent CTT, of which four (80%) showed delayed colonic transit. Five patients underwent GES, of which three patients (60%) demonstrated delayed gastric emptying. The two most prevalent and severe symptoms, constipation and bloating, demonstrated the greatest improvement in symptom scores (46% and 33% reduction, respectively) following six months of treatment (Figure 1). Conclusion: All POTS patients referred for motility testing demonstrated at least one abnormality suggestive of gastrointestinal dysautonomia. Treatment for the gastrointestinal symptoms in POTS can be effective, especially in cases of constipation and bloating. Prevalence of gastroduodenal and anorectal manometric abnormalities in POTS patients
Tu2079 Food-Related Gastrointestinal Symptoms in IBS Are Common and Associated With More Severe Symptoms and Reduced Quality of Life. Lena Böhn, Stine Störsrud, Hans Törnblom, Ulf J. Bengtsson, Magnus Simren Background: Despite the fact that food and diet are central issues, which concern patients with IBS, the current understanding about the association between the intake of certain foods/food groups and the gastrointestinal (GI) symptom pattern, psychological symptoms and quality of life is poor. Aims: To determine which food groups and specific food items IBS patients report causing GI symptoms, and to investigate the association with GI and
AGA Abstracts
S-922