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Background & Aims Functional dyspepsia (FD) is associated with anxiety but it is not clear if one causes the other. We investigated whether anxiety and depression precede the onset of FD (based on the modified Rome III criteria) and gastroesophageal reflux symptoms (GERS) in a population-based follow-up study. Methods Participants from the Kalixanda study (n = 3000), randomly selected from the national population register of Sweden, were given the validated Abdominal Symptom Questionnaire 1998–2001; 1000 of these participants then were selected randomly to undergo esophagogastroduodenoscopy and were given the Abdominal Symptom Questionnaire along with the Hospital Anxiety and Depression Scale questionnaire. All eligible subjects who underwent endoscopy (n = 887) were invited to participate in a follow-up study in June–August 2010 and were given the same questionnaires. Data were analyzed by logistic regression. Results Of the 703 subjects who completed the follow-up questionnaires (79.3%); 110 were found to have FD at baseline (15.6%) and 93 at the follow-up examination (13.3%); 48 of these were new cases of FD. GERS without organic disease was reported by 273 individuals (38.8%) at baseline and by 280 at follow-up examination (39.8%); 93 cases were new. Major anxiety was associated with FD at the follow-up evaluation (odds ratio [OR], 6.30; 99% confidence interval [CI], 1.64–24.16). Anxiety was associated with postprandial distress syndrome at baseline (OR, 4.83; 99% CI, 1.24–18.76) and at the follow-up examination (OR, 8.12; 99% CI, 2.13–30.85), but not with epigastric pain syndrome. Anxiety at baseline was associated with new-onset FD at the follow-up examination (OR, 7.61; 99% CI, 1.21–47.73), but not with GERS. Conclusions In a study of the Swedish population, anxiety at baseline, but not depression, increased the risk for development of FD by 7.6-fold in the next 10 years. Anxiety did not affect risk for GERS. [ABSTRACT FROM AUTHOR]

Background & Aims: Gastroesophageal reflux is common in infants during their first year of life, especially in those born preterm or small for gestational age (SGA). We assessed whether being born preterm or SGA increased the risk of developing Barrett's esophagus (BE) in adulthood. Methods: We performed a population-based case-control study of patients with BE (cases) that were diagnosed at 2 Swedish hospitals from January 1, 1986, through December 31, 2005. We identified the birth hospital of the cases; data on perinatal characteristics such as gestational age at birth and birth weight were collected from original birth records. We also obtained and collected information on the 3 singleton live births, of the same sex, born after each case at the same maternity ward (controls). In total, we analyzed data from 331 cases and 852 matched controls. We used conditional logistic regression to determine odds ratios (ORs), determined 95% confidence intervals (CIs), and adjusted for potential confounding factors. Results: Compared with infants born with a normal birth weight (3000–3999 g), infants with low birth weight (<2500 g) were at increased risk of BE (adjusted OR, 8.22; 95% CI, 2.83–23.88). This was mainly due to an effect of SGA rather than preterm birth. Specifically, compared with infants with normal birth weight for gestational age (25th–75th percentiles), the odds of BE among very SGA infants (<3rd percentile) was nearly tripled (adjusted OR, 2.95; 95% CI, 1.35–6.44). Conclusions: On the basis of a population-based study of patients with BE in Sweden, infants born SGA have a 3-fold increase in risk for developing BE as adults, compared with infants of normal birth weight for gestational age. [Copyright &y& Elsevier]

Gastro-oesophageal reflux disease (GORD) occurs when reflux of gastric contents causes troublesome symptoms and/or complications (the Montreal definition). GORD is a common condition with a substantial economical burden to the community and it has a significant negative effect on health-related quality of life (HRQoL) while endoscopic findings like erosive oesophagitis per se seem to correlate badly with the experienced HRQoL. The prevalence of GORD varies over the world for unknown reasons, but genetic differences, difference in the Helicobacter pylori prevalence and life style factors like obesity might influence. The prevalence is lowest in East Asia (2.5-9.4%) and higher in Mid (7.6-19.4%) and Western Asia (12.5-27.6%). The highest population-based prevalence is reported from Europe (23.7%) and the US (28.8%). GORD seems to be fairly stable over time both in terms of symptoms and erosive oesophagitis, but the prevalence seems to be increasing both in Asia and in the West. [ABSTRACT FROM AUTHOR]

Background & Aims: The Rome III criteria for functional dyspepsia have been changed to include 2 distinct syndromes: postprandial distress syndrome and epigastric pain syndrome. We investigated risk factors for functional dyspepsia among the functional dyspepsia subgroups defined by the Rome III criteria. Methods: We performed a cross-sectional population-based study in a primary care setting (the Kalixanda study). A random sample (n = 2860) of the adult population from 2 northern Swedish municipalities (n = 21,610) was surveyed using a validated postal questionnaire to assess gastrointestinal symptoms (response rate, 74.2%; n = 2122). A randomly selected subgroup (n = 1001) of responders was invited to undergo an esophagogastroduodenoscopy (participation rate, 73.3%) including biopsy specimen collection, Helicobacter pylori culture and serology, and symptom assessments. Results: Of the 1001 subjects examined by endoscopy, 202 (20.2%; 95% confidence interval [CI], 17.7–22.7) were classified as having uninvestigated dyspepsia and 157 (15.7%; 95% CI, 13.4–18.0) as having functional dyspepsia. Major anxiety (Hospital Anxiety and Depression Scale score ≥11) was associated with uninvestigated dyspepsia (odds ratio [OR], 3.01; 95% CI, 1.39–6.54), as was obesity (body mass index ≥30 kg/m2) (OR, 1.86; 95% CI, 1.15–3.01). Major anxiety was associated with functional dyspepsia and postprandial distress syndrome (OR of 2.56 [95% CI, 1.06–6.19] and 4.35 [95% CI, 1.81–10.46], respectively), as was use of nonsteroidal anti-inflammatory drugs (OR, 2.49 [95% CI, 1.29–4.78] and 2.75 [95% CI, 1.38–5.50], respectively). Depression was not associated with any dyspepsia group. Conclusions: Anxiety but not depression is linked to uninvestigated dyspepsia, functional dyspepsia, and postprandial distress syndrome but not to epigastric pain syndrome. [Copyright &y& Elsevier]

Background & Aims: Functional abnormalities of the duodenum have been observed in non-ulcer dyspepsia. We aimed to identify whether eosinophils in the upper gastrointestinal tract are a biomarker for non-ulcer dyspepsia. Methods: A random sample of an adult Swedish population (n = 1001; mean age, 54 y; 51% female) underwent upper endoscopy. Non-ulcer dyspepsia cases (n = 51, Rome II) and randomly selected controls (n = 48) were identified. Two blinded independent observers assessed the gastroduodenal eosinophil counts. Eosinophils were quantified by counting the number per 5 high-power fields at each of 5 sites (cardia, body, antrum, D1 duodenal bulb, and D2 second portion of duodenum), and total counts were summed over the 5 fields at each site. Results: The odds ratio for non-ulcer dyspepsia (vs asymptomatic controls) in subjects with high duodenal bulb eosinophil counts (median, ≥22, relative to <22) was 11.7 (95% confidence interval, 3.9–34.9), adjusting for age, sex, and H pylori; similar results were observed in D2 (odds ratio = 7.3; 95% confidence interval, 2.9–18.1). A significant association with the number of eosinophil clusters was detected in the duodenum, with higher values in non-ulcer dyspepsia (P < .01). By immunostaining with major basic protein antibody in a subset of duodenal biopsy specimens, eosinophil degranulation was observed in non-ulcer dyspepsia (7 of 15 vs 0 of 5 controls; P = .11). Gastric eosinophil counts were overall not significantly increased in non-ulcer dyspepsia vs controls. Early satiety was associated with eosinophilia in D1 (P = .01) and D2 (P = .02), adjusting for age, sex, and H pylori. Conclusions: Duodenal eosinophilia may characterize a subset of adults with non-ulcer dyspepsia. [Copyright &y& Elsevier]

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Background & Aims: Barrett’s esophagus (BE) is associated with esophageal adenocarcinoma, the incidence of which has been increasing dramatically. The prevalence of BE in the general population is uncertain because upper endoscopy is required for diagnosis. This study aimed to determine the prevalence of BE and possible associated risk factors in an adult Swedish population. Methods: A random sample (n = 3000) of the adult population (n = 21,610) in 2 municipalities was surveyed using a validated gastrointestinal symptom questionnaire (response rate, 74%); a random subsample (n = 1000; mean age, 53.5 years; 51% female) underwent upper endoscopy. Endoscopic signs suggestive of columnar-lined esophagus (CLE) were defined as mucosal tongues or an upward shift of the squamocolumnar junction. BE was diagnosed when specialized intestinal metaplasia was detected histologically in suspected CLE. Results: BE was present in 16 subjects (1.6%; 95% confidence interval, 0.8–2.4): 5 with a long segment and 11 with a short segment. Overall, 40% reported reflux symptoms and 15.5% showed esophagitis; 103 (10%) had suspected CLE, and 12 (1.2%) had a visible segment ≥2 cm. The prevalence of BE in those with reflux symptoms was 2.3% and in those without reflux symptoms was 1.2% (P = .18). In those with esophagitis, the prevalence was 2.6%; in those without, the prevalence was 1.4% (P = .32). Alcohol (P = .04) and smoking (P = .047) were independent risk factors for BE. Conclusions: BE was found in 1.6% of the general Swedish population. Alcohol and smoking were significant risk factors. [Copyright &y& Elsevier]

There is controversy about whether psychological factors (anxiety and depression) increase health care seeking by patients with irritable bowel syndrome (IBS). We investigated whether psychological factors increase health care seeking by patients with IBS and the effects of extragastrointestinal (extra-GI) symptoms. We performed a population-based prospective study of health care use over a 12-year period in Sweden. From 2002 through 2006, 1244 subjects were selected randomly for an examination by a gastroenterologist and to complete questionnaires, including the Rome II modular questionnaire. Psychological factors were measured with the valid Hospital Anxiety and Depression scale and extra-GI symptoms were measured with a symptom checklist. Responses from 1159 subjects (57% female; mean age, 48.65 y) were matched with health records in 2016 (164 were classified as having IBS based on Rome II criteria). The overall association between depression or anxiety and health care use varied in subjects with and without IBS at baseline. The presence of extra-GI symptoms strengthened the relationship between anxiety and depression and prospective psychiatric visits for subjects with IBS and without IBS (incidence rate ratio, 1.14–1.26). Extra-GI symptoms did not alter the association of anxiety or depression with use of GI or extra-GI health care. In a population-based study in Sweden, we found that individuals with high baseline anxiety or depression were more likely to seek psychiatric health care, but not GI or extra-GI health care, in the presence of extra-GI symptoms at baseline. Patients with IBS might benefit from more thorough assessments that examine extra-GI and psychological symptoms, to reduce health care utilization. [ABSTRACT FROM AUTHOR]

Background & Aims Symptomatic uncomplicated diverticular disease is considered to be a discreet clinical entity distinct from irritable bowel syndrome (IBS), but population-based data are unavailable. We aimed to investigate the prevalence and location of diverticulosis in the general population, and its association with colonic symptoms and mental health. We propose that individuals with diverticulosis would report more constipation and IBS. Methods We performed a population-based study of randomly selected adults born in Sweden (age, 18–70 y; 57.2% women); 745 received a gastroenterology consultation, completed validated abdominal symptom and mental health questionnaires, and were examined by colonoscopy. Logistic regression was used to calculate the associations between diverticulosis and age, sex, gastrointestinal symptoms, anxiety, depression, and self-rated health. Results Among the 742 participants (54.6% women), 130 (17.5%) had diverticulosis. Age was the strongest predictor of diverticulosis ( P < .001), and diverticulosis was rare in participants younger than 40 years (0.7%). All participants with diverticulosis had sigmoid involvement. Participants with diverticulosis were more likely to report loose stools (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.20–2.96), urgency (OR, 1.64; 95% CI, 1.02–2.63), passing mucus (OR, 2.26; 95% CI, 1.08–4.72), and a high stool frequency (OR, 2.02; 95% CI, 1.11–3.65). Diverticulosis was associated with abdominal pain (OR, 2.10; 95% CI, 1.01–4.36; P = .047) and diarrhea-predominant IBS (OR, 9.55; 95% CI, 1.08–84.08; P = .04) in participants older than 60 years. The presence of anxiety and depression and self-rated health were similar in participants with and without diverticulosis. Conclusions The prevalence of diverticulosis is age-dependent. Diverticulosis is associated with diarrhea in subjects across all age ranges. In subjects older than age 60, diverticulosis is associated with abdominal pain and diarrhea-predominant IBS. [ABSTRACT FROM AUTHOR]

Background & Aims: This systematic review assesses findings of endoscopic surveys in the general population with regard to gastroesophageal reflux disease (GERD). Methods: Systematic searches were conducted in PubMed and EMBASE. Authors were contacted for additional, unpublished data. Results: Data on 61,281 individuals were included from 3 general population studies (Kalixanda study [Sweden], Loiano–Monghidoro study [Italy], SILC study [China]) and 8 health-check studies (Japan, n = 1; China, n = 1; Taiwan, n = 4; Korea, n = 2). The prevalence of reflux esophagitis was 15.5% (Kalixanda), 11.8% (Loiano–Monghidoro), and 6.4% (SILC); it ranged from 3.4% to 8.5% in health-check studies in Japan, China, and Korea (n = 4), but was higher (mean, 15.6%; range, 9.0%–24.6%; n = 4) in Taiwan. Hiatus hernia prevalence was 23.9% (Kalixanda), 43.0% (Loiano–Monghidoro), and 0.7% (SILC), and 0.8%–19.5% in health-check studies (n = 7). For endoscopically suspected esophageal metaplasia (ESEM), the prevalence was 10.3% (Kalixanda), 3.6% (Loiano–Monghidoro), and 1.8% (SILC), and 0.0%–3.4% in health-check studies (n = 4). The prevalence of reflux esophagitis among individuals without symptom-defined GERD was 12.1% (Kalixanda), 8.6% (Loiano–Monghidoro), 6.1% (SILC), and 1.6%–22.8% (health-check studies; n = 6). For individuals without symptom-defined GERD, the prevalence of ESEM was 9.4% (Kalixanda), 2.8% (Loiano–Monghidoro), and 1.8% (SILC). Conclusions: The prevalence of reflux esophagitis is higher in Sweden and Italy than in China, Korea, and Japan, but is within the range reported in Taiwan. Hiatus hernia and ESEM are generally more prevalent in Europe than in Asia. A considerable proportion of individuals without symptom-defined GERD has reflux esophagitis or ESEM. [ABSTRACT FROM AUTHOR]