J-Y Kang

Systematic review: worldwide variation in the frequency of coeliac disease and changes over time

Coeliac disease (CD), originally thought to be largely confined to Northern Europe and Australasia and uncommon in North America and the Middle East, is now recognised to be equally common in all these countries. It is still thought to be rare in the Orient and Sub‐Saharan Africa.

The global prevalence of IBS in adults remains elusive due to the heterogeneity of studies: a Rome Foundation working team literature review

Objectives The global prevalence of IBS is difficult to ascertain, particularly in light of the heterogeneity of published epidemiological studies. The aim was to conduct a literature review, by experts from around the world, of community-based studies on IBS prevalence. Design Searches were conducted using predetermined search terms and eligibility criteria, including papers in all languages. Pooled prevalence rates were calculated by combining separate population survey prevalence estimates to generate an overall combined meta-prevalence estimate. The heterogeneity of studies was assessed. Results 1451 papers were returned and 83, including 288 103 participants in 41 countries, met inclusion criteria. The mean prevalence among individual countries ranged from 1.1% in France and Iran to 35.5% in Mexico. There was significant variance in pooled regional prevalence rates ranging from 17.5% (95% CI 16.9% to 18.2%) in Latin America, 9.6% (9.5% to 9.8%) in Asia, 7.1% (8.0% to 8.3%) in North America/Europe/Australia/New Zealand, to 5.8% (5.6% to 6.0%) in the Middle East and Africa. There was a significant degree of heterogeneity with the percentage of residual variation due to heterogeneity at 99.9%. Conclusions The main finding is the extent of methodological variance in the studies reviewed and the degree of heterogeneity among them. Based on this, we concluded that publication of a single pooled global prevalence rate, which is easily calculated, would not be appropriate or contributory. Furthermore, we believe that future studies should focus on regional and cross-cultural differences that are more likely to shed light on pathophysiology.

Systematic review: does gastro‐oesophageal reflux disease progress?

Gastro‐oesophageal reflux disease affects approximately 20% of western populations. Barretts oesophagus, associated with severe gastro‐oesophageal reflux disease, is premalignant and regular endoscopic surveillance is generally performed. In contrast, mild gastro‐oesophageal reflux disease is thought not to progress and is not generally subjected to endoscopic follow‐up.

Conducting multinational, cross-cultural research in the functional gastrointestinal disorders: issues and recommendations. A Rome Foundation working team report

Cross‐cultural, multinational research can advance the field of functional gastrointestinal disorders (FGIDs). Cross‐cultural comparative research can make a significant contribution in areas such as epidemiology, genetics, psychosocial modulators, symptom reporting and interpretation, extra‐intestinal co‐morbidity, diagnosis and treatment, determinants of disease severity, health care utilisation, and health‐related quality of life, all issues that can be affected by geographical region, culture, ethnicity and race.

Uncomplicated diverticular disease is not a common cause of colonic symptoms

Background  Colonic diverticular disease is common among older individuals whereas colonic symptoms, such as those of irritable bowel syndrome, are frequent in the general population.

Effects of eosinophilic oesophagitis on quality of life in an adult UK population: a case control study

Eosinophilic oesophagitis (EoE) is a chronic immune-mediated esophageal disease, characterized by symptoms related to esophageal dysfunction and histologically by eosinophil predominant inflammation. Current evidence for an adverse impact on quality of life (QoL) is conflicting and there are no data from a UK population regarding QoL. We conducted a prospective cross-sectional observational study using the Short Form-36 Health Survey, Hospital Dysphagia/Odynophagia Questionnaire, and the EoE Adult Quality of Life Questionnaire to assess QoL and severity of dysphagia in EoE patients, compared to age and gender matched healthy control subjects. Data were also collected on comorbidity and medication use. Eighty-eight subjects were recruited (44 patients). Patients had higher rates of antihistamine and topical (swallowed) corticosteroid use. Physical QoL did not differ between patients and controls, although patients did report a statistically significant lower mental QoL, with small absolute magnitude of difference. Patients reported higher dysphagia scores and these were negatively correlated with both physical and mental QoL. Higher rates of dysphagia and medication use in patients may among other things account for lower mental QoL. However, a higher rate of dysphagia in patients is not associated with a reduced physical QoL. Our findings are of clinical value, particularly when a new diagnosis of EoE is made, as clinicians can reassure patients that their general physical health should not be greatly affected by the diagnosis. Moreover, it may also be useful for patients to be aware that EoE may have an impact on their mental health, but this effect is likely to be small. We therefore advocate education and reassurance in this respect for all patients at diagnosis.

Risk of gastric carcinoma in patients with atrophic gastritis and intestinal metaplasia

We read with interest the study of Whiting et al ( Gut2002;50:378–81 [OpenUrl][1][Abstract/FREE Full Text][2] ) in which they reported an 11% risk of development of malignancy among patients with atrophic gastritis and intestinal metaplasia over a 10 year period. We agree with their conclusion that their findings should be further evaluated in larger studies, as confirmation of a high risk of malignancy would have important implications for clinical practice. We would however like to raise two issues. Firstly, in Whiting’s study, biopsies were taken only when there was macroscopic abnormality. These patients may … [1]: {openurl}?query=rft.jtitle%253DGut%26rft.stitle%253DGut%26rft.issn%253D0017-5749%26rft.aulast%253DWhiting%26rft.auinit1%253DJ%2BL%26rft.volume%253D50%26rft.issue%253D3%26rft.spage%253D378%26rft.epage%253D381%26rft.atitle%253DThe%2Blong%2Bterm%2Bresults%2Bof%2Bendoscopic%2Bsurveillance%2Bof%2Bpremalignant%2Bgastric%2Blesions%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fgut.50.3.378%26rft_id%253Dinfo%253Apmid%252F11839718%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=gutjnl&resid=50/3/378&atom=%2Fgutjnl%2F51%2F6%2F899.1.atom

PWE-070 Perspectives And Attitudes To Colonoscopy In Patients With Inflammatory Bowel Disease

Introduction Visualisation of mucosa at ileocolonoscopy (IC) remains the gold standard in the assessment of mucosal healing (MH) in patients with inflammatory bowel disease (IBD). MH is evolving as a key endpoint in assessing response to therapy. This will invariably mean an increased endoscopic burden on these patients. We aimed to investigate IBD patients’ perspectives on this, as well as their tolerance of IC. Methods Consecutive patients attending IBD clinic between September and December 2013 were questioned on their experience of IC. Data on sex, age, disease type (Crohn’s (CD) or ulcerative colitis (UC)), duration of illness, and no. of IC was obtained. They were asked to grade various components of the IC experience (concerns about complications, bowel preparation, disruption to life, procedure discomfort, travel to hospital) on a standardised tolerance scale from 1–5. They were also asked to qualitatively rate their overall experience of IC (not unpleasant/neither unpleasant nor pleasant/bearable/unpleasant/very unpleasant). Finally, they were asked how often they would be prepared to undertake IC in the future. Results 98 patients responded (46% male). Mean age was 43.2 years. 33 had UC, 50 had CD, and 11 were unsure of diagnosis. Mean no. IC was 3.7. 62% had a disease duration >5 years, with only 4% diagnosed in the previous year. Mean tolerance scores for the group were: concerns about complications 2.6, bowel preparation 3.0, disruption to life 2.4, discomfort during procedure 3.0, travel to/from hospital 1.7. Comparisons between patient subgroups CD versus UC, age ≥55 years versus age <55 years, ≥4 IC versus <4 IC, and diagnosis ≥5 years versus diagnosis <5 years, revealed no significant differences in scores. However, comparison between sexes showed females were more worried about the procedure than males (3.0 vs. 2.1, p = 0.02), were less tolerant of bowel preparation (3.5 vs. 2.3, p < 0.001), experienced more disruption to their lives (2.9 vs. 1.9, p < 0.001) and were more troubled by travel concerns (2.0 vs. 1.4, p = 0.02). The majority of the patients felt IC was bearable (53%) with only 13% describing it as very unpleasant. 55% would have the procedure as frequently as required if their physician felt it appropriate. 7% would only have IC every 5 years. Conclusion Bowel preparation and procedural discomfort are the most bothersome aspects of IC amongst IBD patients. There are clear differences in tolerance between female and male patients, and these results should prompt endoscopy units to find ways of improving patient acceptability. This could be provided in the form of a pre-test telephone consultation. A minority of patients were reluctant to increase their frequency of IC, which may be relevant in the monitoring of MH in their future management. Disclosure of Interest None Declared.

PTH-073 Social Media use by Inflammatory Bowel Disease and Viral Hepatitis Patients and Potential Application for Healthcare

Introduction Currently, inflammatory bowel disease (IBD) and viral hepatitis management involve regular visits to hospital clinics. This requires frequent time taken out of work and family life to attend. This study investigates patients’ current social media use and attitude toward the potential role social media could have in reducing their hospital visits. Methods Over a one month period (November 2012), IBD and hepatitis B and C patients attending the Gastroenterology and Hepatology Outpatient Departments of St. George’s Hospital were identified. Convenience sampling was used; all IBD and hepatitis B and C patients encountered in these clinics were asked to participate. Patients were asked to complete a questionnaire, gathering information about their disease, current use of social media and their views about social media in the management of their disease Results 180 patients participated in the study: 95 patients were male and 85 were female. The combined mean age was 38.9 years (range of 15–85 years). 112 patients had IBD and 68 had viral hepatitis. The mean age for the IBD patients was 39 years (range 16–85 years) and the mean age for the hepatitis patients was 38.6 years (range 15–63 years). 46 (43.75%) of the IBD patients and 49 (72%) of the hepatitis patients were male. In our study, 82.1% of the IBD and 72.1% of the viral hepatitis patients used one or more social networking site. Facebook was the most popular site. 29.5% of the IBD and 33.8% of the viral hepatitis patients used social media for support with their illness. 80.4% of the IBD patients and 72.9% of the viral hepatitis patients said they would be happy with some form of social media interaction by healthcare professionals. 84.8% of the IBD patients and 72.1% of the viral hepatitis patients were in favour of a specific social media website for their disease. Conclusion A large proportion of patients with IBD and viral hepatitis already use social networking sites. This study suggests that the majority of both IBD and viral hepatitis patients would welcome the use of social media as part of their illness management. There are already some social media sites that have been setup for these patient groups. Increasing the awareness of these sites and further research investigating the integration of social media into the current management of both these patient groups is needed. Disclosure of Interest None Declared.