Gastrointestinal symptoms are still common in a general Western population.

BACKGROUND: Results from studies conducted in the late 1980s and early 1990 s showed that gastrointestinal symptoms were common among the general population. Meanwhile, lifestyle habits have changed and important treatment options have been introduced. This might have influenced symptom prevalence. METHODS: This study aimed to describe the current prevalence of upper and lower gastrointestinal symptoms within the general population. For this purpose, a demographically representative sample of the Dutch population within the city of Nijmegen and surrounding areas was selected after careful comparison with demographic figures from a government demographic database. Participants were invited to fill in a valid self-report questionnaire about gastrointestinal symptoms and prevalence figures were calculated. RESULTS: A total of 5000 questionnaires was sent and 1616 (32%) were returned. Of these, 839 (52%) subjects reported having had upper (43%) or lower (38%) gastrointestinal symptoms in the past four weeks. The most prevalent individual symptoms reported were flatulence (47%), abdominal rumbling (40%), bloating (37%), alternating solid and loose stools (31%), belching (25%) and postprandial fullness (25%). People who smoked or used a proton pump inhibitor had an increased risk for reporting upper as well as lower gastrointestinal symptoms (OR 1.99; 95% CI 1.56 to 2.55, and OR 1.37; 95% CI 1.01 to 1.75, respectively for smoking; and OR 3.17; 95% CI 2.17 to 4.72, and OR 2.14; 95% CI 1.49 to 3.08, respectively for PPIs). CONCLUSION: Both upper and lower gastrointestinal symptoms are very common in a representative sample of a general Western population.

Meta-analysis: a functional polymorphism in the gene encoding for activity of the serotonin transporter protein is not associated with the irritable bowel syndrome.

BACKGROUND: Serotonin is associated with symptoms of the irritable bowel syndrome, its action is terminated by the serotonin transporter protein. AIM: To assess the association between a functional polymorphism in the gene encoding for activity of the serotonin transporter protein and the irritable bowel syndrome. METHODS: Meta-analysis of studies identified through a Medline, PubMed and Web of Science search, describing the prevalence of a polymorphism in the serotonin transporter gene creating long and short alleles. RESULTS: Eight eligible studies described a total of 1034 patients with the irritable bowel syndrome, and 1377 healthy controls. Presence of the short allele is not associated with an increased risk for the irritable bowel syndrome: OR 1.0; 95% CI: 0.7-1.4 for homozygous subjects, and OR 1.0; 95% CI: 0.8-1.2 for homozygous subjects and heterozygotes together. Although Caucasians and Asians had diverging genotypic frequencies, no association with the shot allele and irritable bowel syndrome was observed in subgroups: Asians OR 1.2; 95% CI: 0.9-1.6 and OR 1.1; 95% CI: 0.2-5.9; Caucasians OR 0.9; 95% CI: 0.5-1.7 and OR 0.9; 95% CI: 0.7-1.2, respectively, for homozygous subjects alone and for homozygous subjects and heterozygotes together. CONCLUSION: A genetic polymorphism in the gene encoding for activity of the serotonin transporter protein is not associated with the irritable bowel.

Is there any association between referral indications for open-access upper gastrointestinal endoscopy and endoscopic findings?

BACKGROUND AND STUDY AIM: The total number of upper gastrointestinal endoscopies is increasing, and despite guidelines for endoscopy referral for general practitioners, the proportion of patients found to have no endoscopic abnormalities is still up to 60% (and increasing). The aim of this study was to assess the association between general practitioners' referral indications and endoscopic findings. PATIENTS AND METHODS: General practitioners of patients referred for an open-access endoscopy between January 2002 and December 2004 were asked to specify the reason for referral on a specially designed form. The relative frequency of patients actually having an endoscopic abnormality was assessed for each referral indication. RESULTS: A total of 1298 people were included in the study. A relevant endoscopic abnormality was found in 48% of patients. Patients with an endoscopic abnormality were not more often referred with "alarm" symptoms or failure of empirical treatment than patients without an abnormal endoscopic finding (31% with an endoscopic abnormality vs. 30% without an endoscopic abnormality had alarm symptoms; 57% of people in both groups experienced failure of empirical treatment). Referral with alarm symptoms had a positive predictive value of 4% for cancer (prevalence 2%; P < 0.01), and referral with reflux-like symptoms had a positive predictive value of 33% for finding reflux esophagitis (prevalence 22%; P < 0.01). CONCLUSIONS: General practitioners' referral indications for open-access endoscopy did not add any relevant predictive value for endoscopic findings in comparison with what might have been expected from overall prevalence. Only alarm symptoms slightly increased the probability of finding cancer and only reflux-like symptoms slightly increased the probability of finding reflux esophagitis.

Anxiety, depression and psychotropic medication use in patients with persistent upper and lower gastrointestinal symptoms.

BACKGROUND: Limited information is available about anxiety, depression and psychotropic medication use in patients referred for gastrointestinal endoscopy. AIM: To determine anxiety and depression and its association with endoscopic findings in a representative sample of patients with persistent gastrointestinal symptoms prior to endoscopy. METHODS: Patients referred to the hospital for endoscopy between February 2002 and February 2004 were asked to score anxiety and depression on the Hospital Anxiety and Depression Scale 2 weeks prior to endoscopy. Information about endoscopic diagnoses was obtained from medical files. RESULTS: A total of 1298 subjects was studied (600 upper gastrointestinal endoscopies and 698 lower gastrointestinal endoscopies). Patients referred for upper gastrointestinal endoscopy used most psychotropic agents (24%; odds ratio = 3.1; 95% confidence interval = 2.3-4.2), especially patients with an organic abnormality when compared with patients without an organic abnormality (42% versus 8%; odds ratio = 8.6; 95% confidence interval = 5.4-14.0). Patients with colonic polyps were more anxious (odds ratio = 1.7; 95% confidence interval = 1.0-2.9) and depressed (odds ratio = 1.8; 95% confidence interval = 1.1-3.1) than other patients referred for lower gastrointestinal endoscopy. CONCLUSIONS: There is no difference in anxiety nor depression between patients with and without organic abnormalities at endoscopy. Patients with colonic polyps are more anxious and depressed than other patients referred for lower gastrointestinal endoscopy. Psychotropic medication use is highest among patients with an organic abnormality in the proximal gastrointestinal tract.