Age-stratified Prevalence and Hospitalization Rates of ED Visits with a GI Disease

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Association of Doxycyline Use With the Development of Acute and ChronicGastrointestinal Illness in Australians Deployed AbroadThomas W. Lee, Lahiru Russell, Min F. Deng, Peter R. Gibson

Background: The risks for chronic gastrointestinal illness (GI) when relocated short-term toother countries and when taking antibiotic prophylaxis in areas where malaria is endemicare unknown. A cluster of Australian Federal Police officers returning from overseas dutyreported acute and chronic GI illnesses and some were diagnosed with inflammatory boweldisease. Aims: To examine the associations of deployment to developed or developingcountries and exposure to doxycycline with the new onset of acute GI illness, functionalbowel disorder (FBD) and inflammatory bowel disease (IBD). Methods: A cross-sectionalweb-based survey of all current and past members of the Australian Federal Police Associationwas undertaken. Independent predictors of gastrointestinal illness were examined by logisticregression analysis relative to those not deployed without exposure to doxycycline. Results:Of 1300 respondents (response rate 34%), 133 were excluded due to pre-existing chronicGI illness. Median age range was 36 to 45 years old with male predominance. 590 hadepisodes of overseas deployment for a median duration of 6.5 (range 0.1-149) months. 18(3%) of those not deployed took doxycycline compared with 171 (30%) of those deployed.Those deployed abroad vs those not deployed reported gastroenteritis in 9.7% vs 0.7%(P<0.001), FBD in 4.7% vs 2.3% (P<0.001) and IBD 1.7% vs 1.4% (p=ns). Results of themultivariate analyses are shown in the table below. Conclusions: Being deployed abroadrather than doxycycline exposure is a risk factor for acute GI illness. The use of doxycyclinein those deployed overseas is associated with the onset of FBD and possibly IBD. Doxycyclineas a risk factor for chronic gastrointestinal illness warrants a prospective larger scale study.

a Estimated Odd's Ratio [95% confidence intervals]

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Gastroesophageal Reflux Disease (GERD) is Strongly Associated WithPsychological Disorders in the General Population: A Community-Based StudyJustin C. Wu, Arthur D. Mak, Yawen Chan, Adley Tsang, Joseph J. Sung, Francis K. L.Chan, Sing Lee

BACKGROUND: The association between GERD and psychological disorders is uncertainand there is a lack of data from population-based studies. AIM: To determine the associationbetween GERD and psychological disorders in the community. METHODS: A randomtelephone survey of the general population aged 15-65 years was conducted. In the telephoneinterview, the participants were invited to complete a validated structured diagnostic ques-tionnaire for GERD based on Montreal definition, functional dyspepsia based on Rome IIIcriteria, generalized anxiety disorder (GAD) and major depressive disorder (MDD) basedon DSM-IV criteria, respectively. RESULTS: 2011 participants (M: 937, F: 1074; cooperationrate: 65.4%) completed the interview. The prevalence of GERD and FD symptoms was 4.2%(N=84) and 8.0% (N=161), respectively. The 12-month prevalence of GAD and MDD was3.8% (N=77) and 12.4% (n=249), respectively. Compared to participants with no GERD/FD symptoms, GERD+ participants had significantly higher prevalence of both GAD andMDD whereas the prevalence of psychological disorders was highest among those with bothGERD and FD symptoms (Table). Concomitant GAD and MDD were also more prevalentin GERD+ participants compared to GERD/FD negative participants (6.1% Vs 2.1%, p=0.01). The frequency of GERD symptoms was correlated with the prevalence of GAD butnot MDD. Using multivariate analysis, both GAD (OR: 3.0, 95% CI: 2.3-5.5, p<0.001) anddepression (OR: 3.4, 95% CI: 2.5-5.3, p<0.001) were independent factors associated withGERD in the community. CONCLUSION: In the general population, GERD is stronglyassociated with psychological disorders. Concomitant FD and frequent GERD symptomsare associated with higher risk of psychological comorbidity.

S-725 AGA Abstracts

Prevalence of GAD and MDD in different groups of participants

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Clostridium difficile Infection in a Pediatric PopulationKathryn T. Chen, Daniel Stephens, Eric P. Anderson, Robert Acton, Daniel Saltzman,Donavon J. Hess

Introduction: Clostridium difficile infection in the pediatric population is uncommon. Theincidence of C. difficile associated disease (CDAD) in the adult population has doubled inthe past decade, with increasing morbidity and mortality; however, little research has beenperformed in the pediatric population. We characterize C. difficile infection in the pediatricpopulation, with emphasis on the surgical population. Methods: The records of 231 patientsat a University children's hospital, birth to 18 years of age, with an associated diagnosis ofCDAD between January 1, 2002 and December 31, 2008 were reviewed. The diagnosis ofCDAD was confirmed by associated diarrhea and either positive stool culture or toxin assay.Results: The incidence of CDAD more than doubled from 2.5 per 1,000 hospitalizations to5.8 per 1,000 hospitalizations over the duration of our study period. There were no fatalitiesor surgical interventions directly associated with CDAD. Eighty-four percent of patientsreceived antibiotics within 2 months of diagnosis. Fifty-two percent of patients underwentoperative intervention within two months of diagnosis and, of these, 6% received no otherantibiotics other than pre-operative antibiotics; the remainder were either on chronic antibi-otics for immunosuppressive states or had been treated for infectious disease. Fifty-sevenpercent of operative patients were immunosuppressed. The most commonly associatedprocedures included bone marrow biopsies and line placement for myelodysplastic diseases(40%) followed by renal transplant (11%). Conclusion: The incidence of pediatric CDADin our institution has doubled in the past decade, but in contrast to adult populations, wasnot associated with death or operative intervention. A substantial number of CDAD caseswere associated with previous operative procedures, particularly in immunosuppressedpatients and those who received prior antibiotics.

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Prevalence Changes, Incidence and Spontaneous Loss of GastroesophagealReflux Symptoms in a Population-Based Setting. The Nord-TrøNdelag HealthStudyEivind Ness-Jensen, Anna P. Lindam, Jesper Lagergren, Kristian Hveem

Background & aims: The changes in occurrence of gastroesophageal reflux symptoms (GERS)in the general population remains unsettled. This study aimed to determine the changes inprevalence of GERS, and the incidence and spontaneous loss of GERS. Methods: The studywas conducted within the Nord-Trøndelag Health Study (HUNT), a series of population-based health surveys conducted in Nord-Trøndelag County, Norway. The study base encom-passed all adults from 20 years of age resident in Nord-Trøndelag County, and the participantsreported their degree of GERS during the previous 12 months. In HUNT 2 (1995-1997),58,869 persons participated (63% of the invited) and in HUNT 3 (2006-2009), 44,997persons participated (48% of the invited). Of these, 29,610 persons were prospectivelyfollowed up for an average of 11 years from HUNT 2 to HUNT 3. Results: Between 1995-1997 and 2006-2009, the prevalence of any and severe GERS increased from 31.4% to 40.9%and from 5.4% to 6.7%, respectively. The prevalence of GERS increased with increasing age,in particular for females. The average annual incidence of any and severe GERS was 2.6%and 0.2%, respectively. Females, but not males, had an increasing incidence of GERS withincreasing age. The average annual loss of any and severe GERS, not due to antirefluxmedication, was 2.1% and 1.1%, respectively. The loss of GERS decreased with increasingage. Conclusions: The prevalence of GERS increased between 1995-1997 and 2006-2009.The average annual incidence of severe GERS was 0.2%, while the corresponding non-medicated loss was 1.1%. The prevalence, incidence and loss of GERS were influenced bysex and age.

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ROME III Criteria for Functional Gastrointestinal Disorders: Too MuchOverlap to Be Useful?Alexander C. Ford, David G. Morgan, Paul Moayyedi

Introduction: Functional gastrointestinal (GI) symptoms are common. The Rome III classifica-tion of these symptoms into mutually exclusive disorders attempts to improve the homogen-eity of patients recruited into clinical trials from secondary and tertiary care. Previousinvestigators have reported significant degrees of overlap between some of these conditions,but no study has examined this issue in its entirety. Methods: This was a cross-sectionalsurvey of consecutive new patients consulting a Gastroenterologist at two tertiary care centres.All individuals were provided with the self-administered, validated, Rome III diagnosticquestionnaire for the adult functional GI disorders. We scored completed questionnairesaccording to the algorithm devised by the authors, but suspended the mutual exclusivitybetween various syndromes, such as dyspepsia, irritable bowel syndrome, and functionalconstipation, required by the questionnaire in order to examine the degree of overlap betweenthem. Results: A total of 1822 patients completed the questionnaire. There were 1253(68.8%) who met criteria for at least one of the functional GI disorders, and 880 (70.2%)of these patients met criteria for more than one disorder when the mutual exclusivity wassuspended. The degree of overlap between the various disorders varied between 3% and86%, and was greatest for functional vomiting and chronic idiopathic nausea (Table). Conclu-sions: The degree of overlap between the various Rome III diagnostic was variable but largein some cases. The magnitude of this overlap was of remarkably similar magnitude in

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