Anne Line Engsbro

The epidemiology of irritable bowel syndrome in Denmark. A population-based survey in adults ≤50 years of age

Abstract Objective. Our aims were to investigate the prevalence and subtype distribution of irritable bowel syndrome (IBS) according to the Rome III criteria in Denmark, to describe the difference in symptom reporting between those with gastrointestinal (GI) symptoms not fulfilling Rome III for IBS compared to those classified as IBS, and furthermore to describe the proportion of consulters and formally diagnosed subjects. Material and methods. A web-based survey was carried out in January 2010. Questionnaires were emailed to a web panel (n = 19,567) representative of the general Danish population aged 18–50 years on gender, age, and geography. IBS and subtypes were estimated by the Rome III criteria. Results. Of 6112 responders, 979 (16%) fulfilled the Rome III criteria for IBS and had no organic diagnosis likely to explain their symptoms. Subtypes were: mixed IBS 36%, IBS with diarrhea 33%, IBS with constipation 18%, and unsubtyped IBS 11%. Those with GI symptoms, not fulfilling Rome III for IBS, had symptoms very similar to those classified as IBS, but symptoms were less frequent and of shorter duration. Of IBS subjects, 180/978 (18.4%) had consulted a doctor for GI symptoms within the past 3 months, but only 7.9% were diagnosed with IBS. Conclusion. Symptoms compatible with IBS according to Rome III are highly prevalent in Denmark. A high proportion of sufferers are undiagnosed.

Patients suspected of irritable bowel syndrome--cross-sectional study exploring the sensitivity of Rome III criteria in primary care.

OBJECTIVES:The Rome III criteria for irritable bowel syndrome (IBS) are recommended by guidelines to help identify the syndrome. The majority of IBS patients are managed in primary care, where a pragmatic approach to diagnosis is usually adopted, using clinical judgment and knowledge about the patient. Many general practitioners (GPs) have no or limited knowledge of the diagnostic criteria, few use them, and many consider IBS a diagnosis of exclusion. The aim of this study is to explore the sensitivity of the Rome III criteria in relation to a GP-based clinical diagnosis of IBS, to identify differences between Rome III-positive and -negative patients, and to describe the agreement between the various symptom-based criteria.METHODS:Patients aged 18–50 years, presenting in primary care with gastrointestinal complaints and identified as IBS patients by their GP, were referred for enrollment. The Manning and Rome I–III criteria were evaluated through interviews and patients completed the questionnaires The Gastrointestinal Symptom Rating Scale (GSRS)/The Gastrointestinal Symptom Rating Scale modified for use in patients with IBS (GSRS-IBS), Short Form 36, Irritable Bowel Syndrome Quality of Life measurement, Work Productivity and Activity Impairment questionnaire—irritable bowel version, and a questionnaire on use of health-care resources.RESULTS:A total of 604 patients were referred and 499 were included (mean age 32.8 (s.d. 9.5) years, 75% were female). The Rome III criteria were fulfilled by 376 patients (sensitivity 0.75, 95% CI 71–79%). Rome III-positive patients more frequently reported disturbed defecation, had a higher symptom burden, and lower disease-specific health-related quality of life compared with Rome III-negative patients. The various symptom-based criteria identified slightly different subpopulations with the highest agreement between the Rome II and III criteria.CONCLUSIONS:The Rome III criteria identified three in four patients labeled with IBS in primary care. The relevance of the Rome III for IBS in primary care is supported.

Treatment of Dientamoeba fragilis in Patients with Irritable Bowel Syndrome

The role of Dientamoeba fragilis in irritable bowel syndrome (IBS) is incompletely known. We aimed to investigate whether eradication of D. fragilis alleviates symptoms in IBS. Twenty-five D. fragilis-positive IBS patients were treated with Metronidazole (MZ) or Tetracycline. The patients were mostly female (89%), and mean age (SD) was 35.1 (8.2) years. Microbiological response, evaluated 2 weeks post-treatment, was observed in 15 of 25 patients (60%), all by MZ. Clinical response, defined as adequate relief of symptoms, was observed in 7 of 22 patients (32%), all by MZ. In a logistic regression analysis, we found no significant association between clinical and microbiological response. This case study did not support our hypothesis of a simple association between D. fragilis and IBS. Some D. fragilis-infections were insufficiently treated by MZ. Further studies into the prevalence and effect of eradication of D. fragilis in IBS and into efficient treatments of D. fragilis are warranted.

Prevalence, incidence, and risk factors of intestinal parasites in Danish primary care patients with irritable bowel syndrome

Abstract The gut microbiota may be involved in the aetiopathogenesis of irritable bowel syndrome (IBS). We studied the role of intestinal parasites by describing the epidemiology and risk factors for infection in primary care patients aged 18–50 y with IBS. One hundred and thirty-eight patients at baseline and 78/116 patients returning 1 y later, submitted faecal samples that were examined by microscopy, culture for Blastocystis, and real-time PCR for Dientamoeba fragilis, Entamoeba (dispar and histolytica), Cryptosporidium spp., and Giardia intestinalis. Overall, 42–45% of patients harboured intestinal parasites (baseline and follow-up, respectively): D. fragilis carriage was 35–41%; Blastocystis 14–20%. Incidence rates for D. fragilis and Blastocystis were 10 and 4 per 100 person-y, respectively. Blastocystis carriage increased the odds for carrying D. fragilis. Clinical comparisons showed D. fragilis to be associated with a low frequency of defecation. Further, D. fragilis was associated with having children aged 5–18 y and Blastocystis with increasing age.

Blastocystis: To Treat or Not to Treat … But How?

TO THE EDITOR—In their recent paper, Coyle et al [1] recommend metronidazole as the drug of choice for Blastocystis eradication. We have come across multiple cases where high-dose metronidazole treatment does not eliminate Blastocystis from the intestine. In fact, it appears that no single drug is capable of eradicating Blastocystis [2]. Here, we present an example of an intractable Blastocystis infection despite multiple courses of antibiotic intervention. A 36-year-old female presented with a 9-month history of abdominal pain, diarrhea, and bloating. Blood tests and a sigmoidoscopy with biopsies were normal, and she was diagnosed with irritable bowel syndrome (IBS) according to Rome III criteria [3]. Fecal samples revealed Blastocystis sp. subtype 9 (ST9) and Dientamoeba fragilis. During a period of almost 3 years, she sequentially received antimicrobial treatment (Table 1). Clinical and microbiological effect was systematically evaluated 2weeks after treatment. Although the patient was cleared of D. fragilis, none of these treatments successfully eliminated Blastocystis ST9, which was repeatedly isolated from her feces, nor did they alleviate her gastrointestinal symptoms. No further treatment options are available in general in Denmark. The mechanisms leading to Blastocystis eradication are unclear. Using molecular diagnostics, we have come to realize that the parasite colonizes a substantial proportion of any given population [4]. With such a high rate of colonization, we must anticipate that we are all exposed to Blastocystis regularly, and therefore the factors influencing successful Blastocystis colonization should be explored [4]. Metagenomic studies have led to advances in the understanding of the structure and function of the human intestinal microbiome [5, 6], whereas nonprokaryotic organisms remain much less studied. If Blastocystis colonization is dependent on the composition of the bacterial flora as suggested recently [4], it is striking that the parasite could be sustained throughout the many different courses of antimicrobial treatment in this IBS patient. Eradication of Blastocystis may happen directly (protistostatic or protistocidal effect) or indirectly (due to perturbations of the intestinal flora). In this case eradication failed, and our study adds to the string of papers

Antibiotics: a risk factor for irritable bowel syndrome in a population-based cohort

Abstract Objectives: Use of antibiotics affects the composition of the gut microbiome. The microbiome is thought to play a role in development of irritable bowel syndrome (IBS), but antibiotics as a possible risk factor for IBS has not been clarified. We aimed to explore if antibiotics is a risk factor for IBS by investigating use of antibiotics and development of IBS in a cohort from the Danish background population. Materials and Methods: An internet-based web panel representative of the Danish background population was invited to participate in a survey regarding the epidemiology of IBS in 2010, 2011 and 2013. A questionnaire based on the Rome III criteria for IBS were answered at all three occasions. In 2013, a question regarding use of antibiotics in the past year was included. Results: In 2013, use of antibiotics was reported by 22.4% (624/2781) of the population. A higher proportion of individuals with IBS reported use of antibiotics compared with asymptomatic controls [29.0% (155/534) vs. 17.9% (212/1,184), p < .01]. For asymptomatic respondents in 2010 and 2011 (n = 1004), the relative risk of IBS in 2013 related with use of antibiotics was 1.9 [95% confidence interval (CI): 1.1–3.1]. Adjusting for sex by logistic regression, development of IBS was predicted by use of antibiotics with an odds ratio of 1.8 (95% CI: 1.0–3.2). Conclusions: Antibiotics is a risk factor for IBS in asymptomatic individuals. Possible mechanisms should be investigated in future studies.

Patients with suspected irritable bowel syndrome in primary care - Demogra: - Demographic and clinical characteristics

Book List of content Invited Speaker Abstracts 28 Free paper abstracts 45 Nurse programme invited speaker abstracts 61 Nurse programme oral presentation abstracts 64 Poster presentation abstracts 66 Postgraduate course abstracts 87 Session Chair abstracts 90 Author Index 91 Invited Speaker abstracts Interventional oncology in liver metastases Sat 1 Vogl, Thomas University Hospital of Frankfurt, Frankfurt, Germany Minimal-invasive therapies for tumor treatment in solid organs like liver or lung are based on different intravascular techniques (e.g. transarterial chemoembolization (TACE)) or thermal techniques (e.g. laser-induced thermotherapy (LITT)). In contrast to systemic chemotherapy local chemotherapy can be injected in the tumor area in a concentration up to 100 times higher with fewer side effects. Besides, selective ischemia and tumor starvation are caused by embolizing the branches of the hepatic artery. Under local anaesthesia the femoral artery is punctured in the inguinal region followed by insertion of a femoral sheath. The latter allows free exchange of catheters without vessel wall injury while bleeding is prevented. After identifying the hepatic artery the catheter is advanced into the aorta. A small catheter is passed through the hepatic artery into the tumor-supplying artery and chemoembolization is locally injected in the tumor followed by an embolizing material. After removing catheters/sheath, a small suture is prepared to prevent bleeding at the puncture site. The patient is then observed for 4-6h during which complications can be diagnosed and treated. To monitor treatment success and rule out complications, unenhanced CT is performed post procedure. Typically 2-3 TACE sessions in 4-week intervals are necessary. Tumor response is determined 4 weeks later by MRI. LITT is a minimal-invasive technique for local tumor destruction in solid organs using laser light. The laser (Nd:YAG laser (1,064nm)) is exactly targeted on the tissue volume. Due to the comparably high penetrability of photons and complication-free transfer of energy through guide-light, laser of near-infrared region (NIR) is used. The energy is applied to the target tissue using special laser applicators. Laser light energy is absorbed, which causes heating and thus coagulation of the tumor tissue. To benefi t from the advantages of the effect and accuracy of the therapy, all factors contributing to the therapy success must be fi ne-tuned by calculating duration and output of the laser. Depending on size, number and location of the lesion more laser applicators and more cycles of therapy may be required. In practice a temperature of about 60-110°C is achieved in the tumor tissue. Challenges in combating the obesity epidemic Inv 01 Sorensen, Thorkild IA Bispebjerg University Hospital, Institute of Preventive Medicine, Copenhagen, Denmark Background: An obesity epidemic has developed worldwide, even in less developed and poor countries. The epidemic creates a new serious burden to the health of the populations because of its concurrent psychosocial and somatic handicaps and the increased risk of a broad panel of diseases, including type 2 diabetes, hypertension, cardiovascular diseases, some cancers, NAFLD, gallstones and osteoarthitis as prominent ones. The more severe the obesity, the higher is the mortality; it is now expected that the overall life expectations of the populations most affected may decline in the near future. There is therefore a very strong demand to fi nd ways to combat the epidemic. Methods: While it is impossible to solve the health problems induced by the epidemic by treatment of those already obese with the tools currently available for clinical use (behavioural modifi cations, restrictions in caloric intake, antiobesity drugs, bariatric surgery), a critical review of the evidence for what has caused the epidemic is needed to fi nd ways of preventing development of obesity. If these causes are still operating in maintaining already developed obesity and if they are reversible, this undertaking may also provide treatment targets. Results: The obesity epidemic is obviously caused by some changes in the environment, which may interact with or

M1328 IBS Subtype Stability Evaluated Prospectively. Results From a Randomized Trial

Guidelines recommend treatment based on irritable bowel syndrome (IBS) subtype. Different criteria are used for subtyping and agreement between these and stability of subtypes over time remain poorly investigated. METHOD: Rome II IBS-patients were included in a randomized, placebo-controlled trial of probiotics. Patients scored all defecations according to Bristol Stool Form Scale (BSFS) for 10 weeks. Probiotics had no effect on stool pattern over placebo, thus data were pooled and stability of subtypes over time was analyzed. Rome III subtype based on 1, 2, or 3 week recordings of BSFS was compared. Subtype pattern (1 week evaluation) was determined for each patient. Rome II subtype was determined retrospectively at entry. RESULTS: 57 patients (75% female, median age 54, range 28-67 yr) were included. Rome III subtypes at week 1-2 and 9-10 were: IBS-C 21% vs. 26%, IBSD 35% vs. 30%, IBS-M 7% vs. 5% and IBS-U 32% vs. 32%, p>0,2 for all . 14/57 patients (25%) had the same Rome III-subtype each week; the rest changed between 2, 3, or 4 subtypes. 40/57 (70%) had a dominant subtype (same subtype >60% of time). A total of 169 shifts between subtypes were seen when determined for single weeks. Most shifts were from IBS-C to IBS-M (26)/or to IBS-U (40) and from IBS-D to IBS-M (23)/or -U (53). 20 shifts between IBS-C and D were seen in 13/57 patients (23%). No factors were associated with being stable or having a dominant subtype: sex, age, level of bowel disturbance at entry, average bowel frequency, Rome II or -III subtype (at entry), symptom severity, HRQOL (SF-36) or time since first diagnosis of IBS. Rome II subtype at entry showed fair agreement with Rome III subtype week 1 (kappa=0.26), week 1-2 (kappa=0.29) and for week 1-3 (kappa=0.34). Agreement between Rome III-subtypes week 1 and week 10 was fair (kappa= 0.34), for week 1-2 and week 9-10 moderate (kappa=0.51) and for week 1-3 and 8-10 fair (kappa=0.39). CONCLUSION: Distribution of Rome III subgroups was stable over time, but patients shift between subtypes and only 25% were completely stable. No predictors of subtype stability were found. Our data shows a tendency for better agreement over time and between Rome II and Rome III when subtype is based on a 2-week evaluation, which is therefore recommended. Subtypes according to Rome III