होम Gastroenterology 839 Development of Irritable Bowel Syndrome Symptoms in Quiescent Inflammatory Bowel Disease:...

839 Development of Irritable Bowel Syndrome Symptoms in Quiescent Inflammatory Bowel Disease: Significant Association With Presence of Psychiatric Illness and Early Onset IBD

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यह पुस्तक आपको कितनी अच्छी लगी?
फ़ाइल की गुणवत्ता क्या है?
पुस्तक की गुणवत्ता का मूल्यांकन करने के लिए यह पुस्तक डाउनलोड करें
डाउनलोड की गई फ़ाइलों की गुणवत्ता क्या है?
May, 2013
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आप पुस्तक समीक्षा लिख सकते हैं और अपना अनुभव साझा कर सकते हैं. पढ़ूी हुई पुस्तकों के बारे में आपकी राय जानने में अन्य पाठकों को दिलचस्पी होगी. भले ही आपको किताब पसंद हो या न हो, अगर आप इसके बारे में ईमानदारी से और विस्तार से बताएँगे, तो लोग अपने लिए नई रुचिकर पुस्तकें खोज पाएँगे.
were included (n=849). Charts were reviewed for clinical parameters. We performed a
genome-wide association study (GWAS) using Illumina OmniExpress, comparing patients
with and without perianal disease (n=780). Serum was analyzed by ELISA for anti-Saccharomyces cerevisiae (ASCA), anti-outer membrane porin C (anti-OmpC), anti-Cbir1, and antiPseudomonas fluorescens (anti-I2). Data analysis was undertaken using univariate logistic
regression for clinical and serologic data (statistical significance at p ,0.001). Multivariate
regression was used for GWAS data, with principal components/disease location as covariates.
We report single nucleotide polymorphisms (SNPs) that reached p=10E-6. Results: Perianal
disease was documented in 35% (n=297). Perianal disease was associated with colonic and
ileocolonic disease locations (p,0.0001), as well as with upper GI (p=0.0006) and rectal
disease (p,0.0001). Anti-OmpC was significantly more prevalent among individuals with
perianal disease (p, 0.0001). Two statistically significant SNPs were identified. One was a
SNP at chromosome 8q24 (rs6470545, p=9x10E-6), which is 200 kilobases upstream from
the proto-oncogene MYC, and near a colon cancer locus (rs6983267) known to control
MYC expression. Three nearby SNPs (rs10091329, rs6470537, rs6470552) in close linkage
disequilibrium (r2 .0.8) had p-values of 10E-5. Another SNP on chromosome 8 in a gene
desert was also associated with perianal disease (rs10092418, p=8x10E-6). Conclusions:
We report novel genetic and serologic associations with perianal disease in a large cohort
of Crohn's disease patients. The association between perianal disease and a locus near MYC,
which encodes a transcription factor with broad activity in cell proliferation, apoptosis, and
differentiation, suggests novel mechanisms in the development of perianal disease. Replication
will be important to confirm findings and direct further investigation into this unique Crohn's
disease phenotype. *Dr. Weizman and Dr. Murdoch contributed equally to this study.; 


Aim: We compared medical utilization and associated direct costs of privately insured US
employees with ulcerative colitis (UC) and common comorbid conditions to employees with
UC alone. Methods: Employed patients18-65 years old with ≥2 UC diagnoses (International
Classification of Diseases, Ninth Revision [ICD-9]: 556.xx) were selected from Truven Health
MarketScan® Commercial Claims and Encounters Databases (1/1/2000-12/31/2010). Comorbidities identified during the 1-year baseline period prior to a randomly chosen UC diagnosis
date (index date) included: autoimmune disease, pulmonary disease, diabetes, hypertension,
malignancy, psychiatric disorders, and heart disease. Medical resource utilization (overnight
hospitalizations, emergency department [ED] visits, hospital day visits, and physician outpatient visits) and associated costs during the 1-year period following the index date were
compared for patients with .1 comorbidity vs. those without. A multivariate analysis
compared direct costs adjusting for age, sex, and Charlson score. Analyses were also performed for a subgroup of patients with moderate to severe UC (UC hospitalization or use
of systemic corticosteroids, immunosuppressants, or biologics). Results: 10,264 UC patients
with .1 common comorbidity at baseline and 12,604 UC patients with no common comorbidity at baseline were included. Medical resource utilization was significantly greater in the
group with comorbidities vs. without (0.33 vs. 0.18 ED visits; 0.34 vs. 0.16 overnight
hospitalizations; 4.32 vs. 2.22 hospital day visits; 14.63 vs. 8.31 outpatient visits). Direct
costs were also significantly higher for the comorbidity group (table). In the moderate to
severe patients, employees with comorbidities (N=1,849) vs. those without (N=1,956) had
significantly higher medical resource usage (0.46 vs. 0.22 ED visits; 0.48 vs. 0.27 overnight
hospitalizations; 5.11 vs. 2.81 hospital day visits; 16.62 vs. 9.37 outpatient visits) and greater
direct costs (table). Conclusions: Employed UC patients with comorbidities had greater
use of medical resources and higher medical costs, especially in moderate to severe UC.
Treatment strategies for patients with UC should take into account comorbidities.
Annual Health Care Costs (2010 US$) of Comorbidities in UC Patients

Development of Irritable Bowel Syndrome Symptoms in Quiescent
Inflammatory Bowel Disease: Significant Association With Presence of
Psychiatric Illness and Early Onset IBD
Mark Radigan, Corinne Guilday, Alexis Visotcky, Benson T. Massey, Daniel Stein, Amar S.
Naik, Nanda Venu, Susan Skaros, Kari Best, Lilani P. Perera
Inflammatory bowel disease (IBD; Crohn's disease, CD & Ulcerative colitis, UC) and irritable
bowel syndrome (IBS) have overlapping symptoms. Few prevalence studies of IBS in quiescent
IBD have used colonoscopy to confirm inactive disease and few have been prospective.
Aims: To establish the prevalence of IBS in quiescent IBD and determine predictors of risk
for developing IBS in this group of IBD patients (pts). We hypothesized that quiescent IBD
pts with IBS would have higher healthcare utilization and higher rates of anxiety/depression
than quiescent IBD pts without IBS. Methods: This was a prospective cohort study at a single
tertiary care IBD center. 96 pts with colonoscopy-confirmed quiescent disease consented and
completed the Irritable Bowel Syndrome Symptoms Survey (IBSSS), Rome III Criteria for
IBS Survey (Rome III), and the Hospital Anxiety and Depression Scale (HADS). Data on
gender, race, age at diagnosis, disease duration, disease phenotype, disease extent, smoking
history, psychiatric history, Short Inflammatory Bowel Disease Questionnaire (SIBDQ) score,
Harvey-Bradshaw Index/Ulcerative Colitis Disease Activity Index (HBI/UCDAI) and IBD
medications were collected. Logistic regression models and Fisher's exact test were used for
data analysis. Results: 36% (28/77) and 37% (7/19) of quiescent CD and UC pts, respectively,
met diagnostic criteria for IBS. Psychiatric diagnosis (OR 3.53 95% CI 1.221-10.204) and
earlier onset of IBD (OR 1.056 95% CI 1.015-1.096), were associated with development of
IBS. Pt gender, race, IBD subtype, IBD phenotype, IBD extent, duration of IBD, medication
use, and smoking history showed no significant association with development of IBS. Patients
fulfilling IBS criteria had higher HADS anxiety and depression scores. Worse SIBDQ scores
(p=,0.0001), and HBI/UCDAI scores (p=0.005) were seen in pts with IBS which was driven
by persistent symptoms. Over the 12 month observation period, only patients fulfilling IBS
criteria had subsequent hospitalization or surgery. Conclusions: The prevalence of IBS in
quiescent IBD was higher than reported rates in the general population and was similar to
previous studies. Development of IBS in quiescent IBD was associated with previous psychiatric diagnosis and earlier onset of disease with significantly worse HRQoL and disease activity
scores. Quiescent IBD pts with IBS had significantly more anxiety and depression and higher
healthcare utilization rates than those without IBS. Therefore a high index of suspicion of
IBS in quiescent IBD patients with persistent symptoms by healthcare providers is important
to prevent unnecessary interventions in this subgroup of patients.

Ambulance and durable medical equipment services. bWilcoxon rank sum test. cGeneralised
linear regression model.

Quantitative Assessment of Fecal Primary and Secondary Bile Acids in Health
and Irritable Bowel Syndrome (IBS) With Diarrhea or Constipation
Andrea Shin, Priya Vijayvargiya, Irene A. Busciglio, Alan R. Zinsmeister, Alan J. Lueke,
Amy K. Saenger, Adam Girtman, Michael Camilleri
Background: Total fecal bile acids (BAs) are increased in patients with diarrhea-predominant
irritable bowel syndrome (IBS-D) and functional diarrhea. Hypothesis: Secretory BAs are
decreased in patients with constipation-predominant IBS (IBS-C) and increased in IBS-D.
Aims: To perform a quantitative assessment of total, primary and secondary fecal BAs in
health and IBS, and to assess the relationships between 1° and 2° BA profiles and phenotypes.
Methods: In a prospective study, we enrolled 30 healthy volunteers (HV), 31 patients with
IBS-D, and 30 patients with IBS-C from within a 150 mile radius of Rochester, MN. Functional
gastrointestinal disease was defined by Rome III criteria. Patients received a 100g fat diet
and provided a 48h stool collection. In stool samples, we measured total and individual
BAs [cholic (CA), chenodeoxycholic (CDCA), deoxycholic (DCA), lithocholic (LCA), and
ursodeoxycholic (UDCA) acids] by HPLC/tandem mass spectrometry. The univariate associations of BAs with symptom phenotype were assessed using the Kruskal-Wallis test. Results:
There was a significant correlation in the overall group between fecal fat and fecal total BAs
(r=0.48, p,0.001). Fecal fat and fecal total BAs were significantly associated with group,
with lower fecal fat and BAs in IBS-C [respectively p=0.013 and p=0.2, not signficant (NS)].
Total fecal BAs and fat were numerically higher in IBS-D (but both p=NS) relative to controls.
Secretory primary BAs were significantly associated with group, being higher in IBS-D
compared to healthy controls [CA (p=0.0014), CDCA (p=0.0007)]. Conversely, the secretory
BAs, CDCA and DCA, were lower in IBS-C (p=0.015 and 0.025 respectively). The nonsecretory secondary BA, LCA, was significantly higher in IBS-C (p=0.020). Associations with
group for UDCA (p,0.001) were of unclear significance, given the mean ,2.2% total
excretion in all groups. Conclusions: Secretory primary BAs are increased in IBS-D and
decreased in IBS-C. In IBS-C, the predominant fecal BA is the non-secretory LCA. Measurements of individual primary and secondary BAs rather than total fecal BAs appear necessary
to identify changes in BAs in patients with bowel dysfunction in IBS. Funding: NIH DK92179

Table 1: Patient characteristics; Mean (SD); I/S/P = inflammation/structuring/penetrating;
Bio/Imm+Bio/Imm/Other = biologics only, immunomodulators and biologics, immunomodulators only, other or no medications; CRP = C-reactive protein; ESR = erythrocyte sedimentation rate; * in the year following remission of IBD.


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