Rok Seon Choung

The Incidence, Prevalence, and Outcomes of Patients With Gastroparesis in Olmsted County, Minnesota, From 1996 to 2006

BACKGROUND & AIMS The epidemiology of gastroparesis is unknown. We aimed to determine the incidence, prevalence, and outcome of gastroparesis in the community. METHODS Using the Rochester Epidemiology Project, a medical records linkage system in Olmsted County, Minnesota, we identified county residents with potential gastroparesis. The complete medical records were reviewed by a gastroenterologist. Three diagnostic definitions were used: (1) definite gastroparesis, delayed gastric emptying by standard scintigraphy and typical symptoms for more than 3 months; (2) probable gastroparesis, typical symptoms and food retention on endoscopy or upper gastrointestinal study; (3) possible gastroparesis, typical symptoms alone or delayed gastric emptying by scintigraphy without gastrointestinal symptoms. Poisson regression was used to assess the association of incidence rates with age, sex, and calendar period. RESULTS Among 3604 potential cases of gastroparesis, 83 met diagnostic criteria for definite gastroparesis, 127 definite plus probable gastroparesis, and 222 any of the 3 definitions of gastroparesis. The age-adjusted (to the 2000 US white population) incidence per 100,000 person-years of definite gastroparesis for the years 1996-2006 was 2.4 (95% confidence interval [CI], 1.2-3.8) for men and 9.8 (95% CI, 7.5-12.1) for women. The age-adjusted prevalence of definite gastroparesis per 100,000 persons on January 1, 2007, was 9.6 (95% CI, 1.8-17.4) for men and 37.8 (95% CI, 23.3-52.4) for women. Overall survival was significantly lower than the age- and sex-specific expected survival computed from the Minnesota white population (P<.05). CONCLUSIONS Gastroparesis is an uncommon condition in the community but is associated with a poor outcome.

Epidemiology of IBS

Irritable bowel syndrome (IBS) is a common functional gastrointestinal (GI) disorder. Because not everyone needs to seek care, population-based studies are needed to truly understand the epidemiology of IBS. About 10% of the population has IBS at any one time and about 200 people per 100,000 will receive an initial diagnosis of IBS over the course of a year. IBS patients are more frequently younger in age, and a female predominance has been observed in Western countries and tertiary care settings. IBS patients commonly report overlapping upper GI, as well as a variety of non-GI, complaints.

Diarrhea-Predominant Irritable Bowel Syndrome Is Associated With Diverticular Disease: A Population-Based Study

OBJECTIVES:A subset of patients with colonic diverticular disease have chronic gastrointestinal symptoms, and some have a clinical diagnosis of irritable bowel syndrome (IBS), but whether IBS and diverticular disease are linked is uncertain. We aimed to evaluate this association in the community.METHODS:A population-based, cross-sectional survey was conducted by mailing a valid symptom questionnaire to the eligible residents of Olmsted County, MN, aged 30–95 years. Colonic diverticular disease (diverticulosis and diverticulitis) was ascertained through a review of the complete medical history of all responders. Subjects with at least one relevant test (colonoscopy, computed tomography (CT) scan, CT colonography, or barium enema) were included. IBS was defined using Rome II criteria.RESULTS:Among 2,267 eligible respondents, there were 1,712 subjects who had undergone colon testing (76%): 919 women (54%); mean (±s.d.) age 65 (±11 years). Colonic diverticular disease was identified in 44.4% (95% confidence interval (CI) 42.1–46.8) of the subject. IBS was reported by 8.8% (95% CI 6.9–11.0) of men and 17.0% (95% CI 14.6–19.6) of women. After adjusting for age and gender, the presence of IBS was associated with an increased odds for diverticulosis (odds ratio (OR) =1.8, 95% CI 1.3–2.4) but not diverticulitis (OR=1.7, 95% CI 0.9–3.2). In those 65 years of age or older, the presence of IBS was associated with a ninefold higher odds for diverticulosis (OR=9.4, 95% CI 5.8–15.1). Relative to the non-IBS subgroup, diarrhea-predominant IBS and mixed IBS were significantly associated with an increased odds for diverticular disease (OR=1.9, 95% CI 1.1–3.2; OR=2.6, 95% CI 1.0–6.4, respectively).CONCLUSIONS:There is a significantly increased odds for colonic diverticulosis in subjects with IBS (relative to those without IBS). These results suggest that IBS and colonic diverticular disease may be connected.

Psychosocial Distress and Somatic Symptoms in Community Subjects With Irritable Bowel Syndrome: A Psychological Component Is the Rule

OBJECTIVES:Psychosocial factors may drive people with irritable bowel syndrome (IBS) to seek health care, but whether psychological factors are causally linked to IBS is controversial. One hypothesis is that IBS is a heterogeneous syndrome comprising two distinct conditions, one psychological and the other biological. However, it is unclear how many people with IBS in the community have little somatization and minimal psychosocial distress. The aim of our study was to estimate the proportion of people with IBS in a representative US community, who have low levels of somatic and psychological symptoms.METHODS:The cohort comprised subjects from three randomly selected population studies from Olmsted County, Minnesota. All of them filled out a validated gastrointestinal (GI) symptom questionnaire, the Symptom Checklist-90-R (SCL-90-R), and the Somatic Symptom Checklist (SSC) comprising 11 somatic complaint items. Logistic regression models were used to evaluate the associations between somatic symptoms/psychosocial factors and IBS, adjusting for age and gender.RESULTS:Of the 501 eligible subjects, 461 (92%) provided complete data (mean age=56 years, 49% female). IBS (Rome II criteria) was associated with both higher SSC and Global Severity Index (GSI of SCL-90-R) scores. Among subjects with high (75th percentile) SSC scores, 43% reported IBS vs. 10% of those with low (<25th percentile) SSC scores. Among those with high (60) GSI scores, 23% reported IBS vs. 6% with low (<40) GSI scores. Specifically, none of the IBS subjects had both low SSC and low GSI scores.CONCLUSIONS:Psychological factors and somatization are strongly associated with IBS in the community. However, IBS may not be related to low psychological distress and/or somatization.

Functional Dyspepsia Impacts Absenteeism and Direct and Indirect Costs

BACKGROUND & AIMS Functional dyspepsia (FD) is a common morbid condition but data are limited on the direct and indirect costs for employees with FD or on its impact on productivity. Few data on absenteeism and no objective information are available. This study aimed to assess the impact of FD on costs and effects on absenteeism and work output (productivity). METHODS We performed a retrospective analysis of payroll data and adjudicated health insurance medical and prescription claims collected over a 4-year study period (January 1, 2001 to December 31, 2004) from more than 300,000 employees. Data from employees with and without (controls) FD were compared using 2-part regression techniques. Outcome measures included medical (total and by place of service) and prescription costs, absenteeism, and objectively measured productivity output. RESULTS Employees with FD (N = 1669) had greater average annual medical and prescription drug costs and indirect costs (owing to sick leave and short- and long-term disability absences) than controls (N = 274,206). Compared with controls, the FD employees incurred costs that were

Risk of gastroparesis in subjects with type 1 and 2 diabetes in the general population.

5138 greater and had greater costs for each place of service (all P < .0001). The employees with FD had an additional 0.83 absence days per year and produced 12% fewer units per hour than controls (both P < .05). CONCLUSIONS Employees with FD have greater costs at all places of service and lower productivity than employees without FD.

Do distinct dyspepsia subgroups exist in the community? A population-based study.

OBJECTIVES:In patients with diabetes mellitus (DM) and upper gastrointestinal symptoms, a diagnosis of diabetic gastroparesis is often considered, but population-based data on the epidemiology of diabetic gastroparesis are lacking. We aimed to estimate the frequency of and risk factors for gastroparesis among community subjects with DM.METHODS:In this population-based, historical cohort study, the medical records linkage system of the Rochester Epidemiology Project was used to identify 227 Olmsted County, MN residents with type 1 DM in 1995, a random sample of 360 residents with type 2 DM, and an age- and sex-stratified random sample of 639 nondiabetic residents. Using defined diagnostic criteria, we estimated the subsequent risk of developing gastroparesis in each group through 2006. The risk in DM, compared with frequency-matched community controls, was assessed by Cox proportional hazards modeling.RESULTS:The cumulative proportions developing gastroparesis over a 10-year time period were 5.2% in type 1 DM, 1.0% in type 2 DM, and 0.2% in controls. The age- and gender-adjusted hazard ratios (HRs) for gastroparesis (relative to controls) was 33 (95% confidence interval (CI): 4.0, 274) in type 1 DM and 7.5 (95% CI: 0.8, 68) in type 2 DM. The risk of gastroparesis in type 1 DM was significantly greater than in type 2 DM (HR: 4.4 (1.1, 17)). Heartburn (HR: 6.6 (1.7, 25)) at baseline was associated with diabetic gastroparesis in type 1 DM.CONCLUSIONS:Gastroparesis is relatively uncommon in patients with DM, although an increased risk for gastroparesis was observed in type 1 DM.

Clinical predictors of small intestinal bacterial overgrowth by duodenal aspirate culture

BACKGROUND: The heterogeneity of the dyspepsia symptom complex is well known. Several attempts to classify dyspepsia into subgroups have been proposed as a basis for diagnosis and therapy, but data are conflicting. We postulated that dyspepsia comprises three distinct subsets, characterized by pain, early satiety, or nausea/vomiting. We aimed to identify these subsets of dyspepsia: “frequent upper abdominal pain (UAP),” “early satiety (ES),” and “nausea/vomiting (NV).”METHODS: A population-based, cross-sectional survey study was conducted by mailing a valid questionnaire to an age- and gender-stratified random sample of residents of Olmsted County, MN, aged 20–94 yr (response rate 55%). Dyspepsia and irritable bowel syndrome (IBS) prevalence were estimated by Rome II criteria; gastroesophageal reflux (GERD) by weekly or more frequent heartburn or acid regurgitation. Dyspepsia subgroups were categorized based on a priori defined symptoms.RESULTS: The prevalence (95% CI) of dyspepsia was 15% (14, 17). Of 351 dyspeptic subjects, 51% (46, 56) reported UAP, 21% (16, 25) NV, and 47% (42, 52) ES. The overlap of the subgroups was significantly less than expected by chance. Among the three groups, the subjects were similar in age, educational level, IBS status, and overall symptom severity. A high somatic symptom checklist score and those with GERD were associated with greater odds for reporting combination symptoms compared with the upper abdominal pain subgroup of dyspepsia or the early satiety subgroup of dyspepsia, respectively.CONCLUSION: Distinct subgroups of uninvestigated dyspepsia do exist in the general population, suggesting that separate evaluation and treatment strategies are needed.

Cumulative incidence of chronic constipation: A population-based study 1988-2003

Aliment Pharmacol Ther 2011; 33: 1059–1067

A shift in the clinical spectrum of eosinophilic gastroenteritis toward the mucosal disease type

Aim  To estimate the cumulative incidence of chronic constipation and evaluate potential risk factors.