Post-traumatic Stress Disorder Is Associated With Irritable Bowel Syndrome in African Americans.

BACKGROUND/AIMS: Psychosocial stressors likely play an important role in irritable bowel syndrome (IBS). The association between IBS and post-trau-matic stress disorder (PTSD) in non-minorities has been described. Our aim was to investigate the potential association between IBS and PTSD in an urban African American population. METHODS: Our institution maintains a longitudinal population-based survey of African Americans (AA). The survey utilizes a complex, stratified sampling design. The study group consisted of adult AA meeting Rome III criteria for IBS of any subtype. The 4-item Primary Care PTSD screener was administered; score of≥ 3 (range, 0-4) was considered positive for PTSD. Depression (Public Health Questionnaire-9 depression) and anxiety (generalized anxiety disorder-7) levels were measured using standardized scales. To assess quality of life, norm-based physical and mental component summary scores from the short-form 36 health survey ver-sion 2 were obtained. Descriptive and inferential statistics were calculated using Complex Sample Module of SPSS after weight-ing of the study sample. RESULTS: Four hundred nineteen subjects included corresponded to a weighted 21,264 (95% CI, 19,777-22,751) individuals. The preva-lence of IBS in our sample of urban AA was 8.2%. In multivariate regression analysis, female gender, age > 40, higher educa-tional attainment and divorce were independently associated with IBS. Those with IBS were considerably more likely to suffer from PTSD (OR, 4.54; 95% CI, 4.07-5.06). PTSD was independently associated with depression, anxiety, harmful drinking and substance abuse. CONCLUSIONS: In AA, PTSD is independently associated with IBS. PTSD has a significantly negative impact on physical and mental self-assess-ment of quality of life. Evaluation of minorities presenting with functional gastrointestinal disorders should include screening for PTSD.(J Neurogastroenterol Motil 2014;20:523-530).

Double balloon enteroscopy: effective and minimally invasive method for removal of retained video capsules.

BACKGROUND AND AIM: Prior case series document removal of retained video capsules predominantly via surgical intervention. Data on endoscopic removal of retained capsules are limited. Our aim was to describe an endoscopic method of retrieval using double balloon enteroscopy (DBE). METHODS: A retrospective case series examination found 10 patients who underwent DBE for retrieval of a retained video capsule at two large tertiary referral academic centers from May 2007 to June 2013. RESULTS: Mean age of patients was 64.9 ± 18.1 years (four females, six males). Five patients failed to pass the capsule as a result of an ileal or jejunal stricture (one patient with ulcerative colitis; four patients with Crohn's disease); two patients had a small bowel stricture as a result of non-steroidal anti-inflammatory drug enteropathy; one patient had intermittent partial small bowel obstruction without evidence of a stricture; one patient had an obstructing malignant jejunal mass and one patient had a small bowel stricture as a result of radiation enteritis. Endoscopic removal via DBE was successful in eight of 10 patients (80%). The remaining two patients underwent surgical removal of the retained capsule. The two failed cases of capsule retrieval were both patients with suspected ileal disease. CONCLUSIONS: The most common cause of capsule retention was underlying Crohn's disease. DBE is an effective and minimally invasive method of capsule retrieval, including those patients with ileal disease, which has not been previously described. DBE can prevent unnecessary surgery while providing endoscopic therapy of inflammatory strictures by dilation.

Predictors of colorectal cancer testing using the California Health Inventory Survey.

AIM: To identify key variables associated with colon cancer testing using the 2009 California Health Inventory Survey (CHIS). METHODS: The CHIS has been conducted biennially since 2001 using a two-stage, geographically stratified random-digit-dial sample design to produce a representative sample of the entire State. For this study we used survey data from 2001-2009 inclusive. We restricted our analysis to White, Black, and Hispanic/Latinos aged 50-80 years. Weighted data was used to calculate the proportion of participants who underwent some form of colon cancer testing (colonoscopy, flexible sigmoidoscopy or fecal occult blood testing) within the previous 5 years stratified by race/ethnicity. For inferential analysis, boot-strapping with replacement was performed on the weighted sample to attain variance estimates at the 95%CI. For mean differences among categories we used t-tests and for comparisons of categorical data we used Pearson's χ(2). Binary logistic regression was used to identify independent variables associated with undergoing some form of testing. Trend analysis was performed to determine rates of testing over the study period stratified by race. RESULTS: The CHIS database for 2009 had 30 857 unique respondents corresponding to a weighted sample size of 10.6 million Californians. Overall, 63.0% (63.0-63.1) underwent a colon cancer test within the previous 5 years; with 70.5% (70.5%-70.6%) of this subset having undergone colonoscopy. That is 44.5% (44.4%-44.5%) of all individuals 50-80 underwent colonoscopy. By multivariable regression, those tested were more likely to be male (OR = 1.06; 95%CI: 1.06-1.06), Black (OR = 1.30; 95%CI: 1.30-1.31), have a family member with colon cancer (OR = 1.71; 95%CI: 1.70-1.72), and have health insurance (OR = 2.71; 95%CI: 2.70-2.72). Progressive levels above the poverty line were also associated with receiving a test (100%-199%: 1.21; 1.20-1.21), (200%-299%:1.41; 1.40-1.42), (> 300:1.69; 1.68-1.70). The strongest variable was physician recommendation (OR = 3.90; 95%CI: 3.88-3.91). For the Hispanic/Latino group, additional variables associated with testing were success of physician-patient communication (OR = 2.44; 95%CI: 2.40-2.48) and naturalized citizenship status (OR = 1.91; 95%CI: 1.89-1.93). Trend analysis demonstrated increased colon cancer testing for all racial/ethnic subgroups from 2001-2009 although the rate remained considerably lower for the Hispanic/Latino subgroup. CONCLUSION: Using CHIS we identified California citizens most likely to undergo colon cancer testing. The strongest variable associated with testing for all groups was physician recommendation.

Ileocecal valve dysfunction in small intestinal bacterial overgrowth: a pilot study.

AIM: To explore whether patients with a defective ileocecal valve (ICV)/cecal distension reflex have small intestinal bacterial overgrowth. METHODS: Using a colonoscope, under conscious sedation, the ICV was intubated and the colonoscope was placed within the terminal ileum (TI). A manometry catheter with 4 pressure channels, spaced 1 cm apart, was passed through the biopsy channel of the colonoscope into the TI. The colonoscope was slowly withdrawn from the TI while the manometry catheter was advanced. The catheter was placed across the ICV so that at least one pressure port was within the TI, ICV and the cecum respectively. Pressures were continuously measured during air insufflation into the cecum, under direct endoscopic visualization, in 19 volunteers. Air was insufflated to a maximum of 40 mmHg to prevent barotrauma. All subjects underwent lactulose breath testing one month after the colonoscopy. The results of the breath tests were compared with the results of the pressures within the ICV during air insufflation. RESULTS: Nineteen subjects underwent colonoscopy with measurements of the ICV pressures after intubation of the ICV with a colonoscope. Initial baseline readings showed no statistical difference in the pressures of the TI and ICV, between subjects with positive lactulose breath tests and normal lactulose breath tests. The average peak ICV pressure during air insufflation into the cecum in subjects with normal lactulose breath tests was significantly higher than cecal pressures during air insufflation (49.33 ± 7.99 mmHg vs 16.40 ± 2.14 mmHg, P = 0.0011). The average percentage difference of the area under the pressure curve of the ICV from the cecum during air insufflations in subjects with normal lactulose breath tests was significantly higher (280.72% ± 43.29% vs 100% ± 0%, P = 0.0006). The average peak ICV pressure during air insufflation into the cecum in subjects with positive lactulose breath tests was not significantly different than cecal pressures during air insufflation 21.23 ± 3.52 mmHg vs 16.10 ± 3.39 mmHg. The average percentage difference of the area under the pressure curve of the ICV from the cecum during air insufflation was not significantly different 101.08% ± 7.96% vs 100% ± 0%. The total symptom score for subjects with normal lactulose breath tests and subjects with positive lactulose breath tests was not statistically different (13.30 ± 4.09 vs 24.14 ± 6.58). The ICV peak pressures during air insufflations were significantly higher in subjects with normal lactulose breath tests than in subjects with positive lactulose breath tests (P = 0.005). The average percent difference of the area under the pressure curve in the ICV from cecum was significantly higher in subjects with normal lactulose breath tests than in subjects with positive lactulose breath tests (P = 0.0012). Individuals with positive lactulose breath tests demonstrated symptom scores which were significantly higher for the following symptoms: not able to finish normal sized meal, feeling excessively full after meals, loss of appetite and bloating. CONCLUSION: Compared to normal, subjects with a positive lactulose breath test have a defective ICV cecal distension reflex. These subjects also more commonly have higher symptom scores.