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Background & Aims The epidemiology of gastroparesis is unknown. We aimed to determine the incidence, prevalence, and outcome of gastroparesis in the community. Methods Using the Rochester Epidemiology Project, a medical records linkage system in Olmsted County, Minnesota, we identified county residents with potential gastroparesis. The complete medical records were reviewed by a gastroenterologist. Three diagnostic definitions were used: (1) definite gastroparesis, delayed gastric emptying by standard scintigraphy and typical symptoms for more than 3 months; (2) probable gastroparesis, typical symptoms and food retention on endoscopy or upper gastrointestinal study; (3) possible gastroparesis, typical symptoms alone or delayed gastric emptying by scintigraphy without gastrointestinal symptoms. Poisson regression was used to assess the association of incidence rates with age, sex, and calendar period. Results Among 3604 potential cases of gastroparesis, 83 met diagnostic criteria for definite gastroparesis, 127 definite plus probable gastroparesis, and 222 any of the 3 definitions of gastroparesis. The age-adjusted (to the 2000 US white population) incidence per 100,000 person-years of definite gastroparesis for the years 1996–2006 was 2.4 (95% confidence interval [CI], 1.2–3.8) for men and 9.8 (95% CI, 7.5–12.1) for women. The age-adjusted prevalence of definite gastroparesis per 100,000 persons on January 1, 2007, was 9.6 (95% CI, 1.8–17.4) for men and 37.8 (95% CI, 23.3–52.4) for women. Overall survival was significantly lower than the age- and sex-specific expected survival computed from the Minnesota white population ( P Conclusions Gastroparesis is an uncommon condition in the community but is associated with a poor outcome.

Background & Aims: The optimal management of bleeding peptic ulcer with adherent clot is controversial and may include endoscopic therapy or medical therapy. Methods: We searched MEDLINE, BIOSIS, EMBASE, and the Cochrane Library to identify all randomized controlled trials comparing the 2 interventions. Outcomes evaluated in the meta-analysis were recurrent bleeding, need for surgical intervention, length of hospitalization, transfusion requirement, and mortality. Results: Six studies were identified that included 240 patients from the United States, Hong Kong, South Korea, and Spain. Patients in the endoscopic therapy group underwent endoscopic clot removal and treatment of the underlying lesion with thermal energy, electrocoagulation, and/or injection of sclerosants. Rebleeding occurred in 5 of 61 (8.2%) patients in the endoscopic therapy group, compared with 21 of 85 (24.7%) in the medical therapy group (P = .01), for a pooled relative risk of 0.35 (95% confidence interval, 0.14–0.83; number needed to treat, 6.3). There was no difference between endoscopic therapy and medical therapy in length of hospital stay (mean, 6.8 vs 5.6 days; P = .27), transfusion requirement (mean, 3.0 vs 2.8 units of packed red blood cells; P = .75), or mortality (9.8% vs 7%; P = .54). Patients in the endoscopic therapy group were less likely to undergo surgery (pooled relative risk, 0.43; 95% confidence interval, 0.19–0.98; number needed to treat, 13.3); however, this outcome became nonsignificant when only peer-reviewed studies were considered. Conclusions: Endoscopic therapy is superior to medical therapy for preventing recurrent hemorrhage in patients with bleeding peptic ulcers and adherent clots. The interventions are comparable with respect to the need for surgical intervention, length of hospital stay, transfusion requirement, and mortality.

BACKGROUND: Colitis describes inflammation in the colon and is classified into defined diseases: inflammatory bowel disease (IBD), microscopic colitis, iatrogenic colitis, ischemic colitis, and infectious colitis. Accurate classification helps guide management, but this is often difficult. Nonspecific colitis, or also known as atypical colitis, describes the cases that do not show characteristic features of a specific colitis. The clinical significance of nonspecific colitis is unclear as there are limited studies. Notteghem et al. (1993) showed that out of 104 patients with nonspecific colitis, 52.3% had another episode within 3 years and 54% were diagnosed with ulcerative colitis, 33% with Crohn's, and 13% remained unclassified, suggesting that nonspecific colitis could potentially be undiagnosed IBD. PURPOSE: The objective of this study is to understand their clinical course by examining subsequent colonoscopies and determining if any presenting symptom can predict subsequent diagnosis. METHODS: Patients who had colonoscopies from 1/2004-12/2006 with biopsies showing nonspecific colitis were enrolled in this retrospective observational study. The inclusion criteria are biopsies from colonoscopies showing nonspecific colitis, follow up with a physician for at least one year, and no previous diagnosis of a specific colitis based on history or biopsy. A chart review of the electronic record was done from the time of colonoscopy until current time or the last note. RESULTS: 101 patients were included in the study with a mean follow-up period of 5.09 years. The most common indications for colonoscopy were diarrhea (44.6%), abdominal pain (29.7%), blood in stool (36.6%), and anemia (7.9%). 50.5% of patients had at least one subsequent colonoscopy with 68.6% of them with normal biopsies, 33.3% with nonspecific biopsies, and 15.7% with biopsies consistent with IBD. No presenting symptom was predictive of subsequent biopsies with IBD, such as abdominal pain (OR, 2.4, 95% CI, 0.57-10.5, p = 0.23) or blood in stool (OR, 3.2, 95% CI, 0.7114.2, p = 0.13). 19 out of 101 patients with nonspecific colitis biopsies were treated for IBD given symptoms (18.8%), and 6 out of the 19 patients had subsequent biopsies showing IBD (31.6%). CONCLUSIONS: 50.5% of patients who have biopsies with nonspecific colitis had a subsequent colonoscopy, and 68.6% of subsequent colonoscopies were normal while 15.7% had IBD. Therefore, although most commonly nonspecific colitis is self-limited colitis, there is a portion that are undiagnosed IBD. In fact, 18.8% of patients with nonspecific colitis were empirically treated for IBD given symptoms, and 31.6% of these patients showed IBD on subsequent colonoscopies.

Introduction: Functional dyspepsia (FD) is a common unexplained disorder; abnormalities of duodenal function (e.g. duodeno-gastric reflex abnormalities) have been observed. Increased eosinophil counts in the 1st portion of duodenum have also been reported in FD, and in turn this finding has been associated with early satiety[1]; duodenal eosinophilia may be a biomarker for FD. We aimed to evaluate if duodenal eosinophilia is a biomarker for FD in adults. Methods: A case-control study using the endoscopy database at a major tertiary referral center; consecutive patients undergoing endoscopy and duodenal biopsies (2nd portion) were enrolled. An extensive chart review identified patients with FD by Rome criteria (n=126). Controls were chosen patients with iron deficiency (n= 52), gastroesophageal reflux (n= 4) and constipation (n=1). Information regarding any abuse (yes/no) and life stress (scaled one to five; values > 4 scored as major stress) was obtained. Quantification of the number of eosinophils /high power field (HPF) in 5 HPFs was performed by a single experienced GI histopathologist blinded to diagnosis, chart review and endoscopy. Results: Eosinophil counts were not significantly associated with case-control status after adjusting for age, gender and other potential confounders. The median eosinophil count in cases was 10.9/hpf vs. 8.0/hpf in controls (OR=1.07, 95% CI 0.96-1.3). Taking a normal eosinophil cut-off score as 15 or higher based on population-based normal data [1], there was a numerically greater proportion of subjects with abnormal eosinophil counts in FD cases (38.3%) vs. controls (25.9%) but this was not statistically significant (p=0.11). A total of 27 patients complained of early satiety in the FD group while none of the controls did. Of these 27 patients, 10 had abnormal eosinophil counts and 17 had normal eosinophil counts; there was not an association between early satiety and eosinophil count (p=0.62). FD and eosinophil counts were not associated with a history of asthma, hay fever or nasal polyps (all p>0.64, Wilcoxon rank sum test). Conclusions:We did not detect a significant association between duodenal eosinophilia and FD. Limitations include the lack of biopsies from the 1st portion of duodenum where the yield of eosinophils may be higher [1] and the likely heterogeneous nature of FD. [1]Clin Gastroenterol Hepatol. 2007;5:1175-83.

Introduction: We previously utilized an administrative dataset, created for the purpose of recording diagnoses and visit/test charges at patient encounters, to identify that just 22% of over 20,000 screen eligible patients in the safety-net health system serving Fort Worth, Texas were up to date with colorectal cancer(CRC) screening(Gupta ‘09). While this study suggested that administrative data may be used to efficiently assess screening, the validity this approach has not been extensively studied. Further, test indication(screening vs. nonscreening), and the quality of test performance are not discernible from administrative data, which do not serve as a complete medical record. Understanding the validity of test use measurements, and quality of test use are critical for optimizing screening. We hypothesized that while administrative coding would be accurate for test use capture, many tests would be for non-screening indications, and further, that direct chart review would provide insight into test performance quality. Primary aims: 1) Determine validity of using administrative data coding for CRC test completion to measure screening test use, and 2) Evaluate test performance quality. Methods: Test use was determined by administrative coding for: 1) Fecal occult blood test(FOBT), 2) Barium enema, 3) Sigmoidoscopy, 3) Colonoscopy(COLO), or 5) No screening over a 5-year period(Gupta CEBP, DDW ‘09). 100 subjects from each category were randomly selected for medical chart abstraction, which served as the validation gold standard. A tool validated for determining accuracy of Medicare screening test claims data(Schenck ‘07) was adapted to abstract test indication(screening vs. sign/symptom evaluation), presence of test completion, and quality parameters. Agreement was estimated by the Kappa(κ) statistic. Descriptive statistics were used to characterize test indication and quality. Results: Agreement between the administrative database and chart abstraction was almost perfect for FOBT(κ=0.83, 95%CI:0.75-0.90) and COLO(κ=0.91, 95%CI:0.85-0.96), and fair for sigmoidoscopy(κ=0.39, 95%CI:0.28-0.49) and barium enema(κ=0.21, 95%CI:0.12-0.29). 40% of tests were for the indication of screening. Test quality, and record of quality parameters were variable. For example, among subjects with positive FOBT, follow-up COLO was noted as recommended for 46%, and bowel preparation quality and cecal intubation were undocumented for 42% and 17% of COLO, respectively. Conclusions: Administrative data have validity for CRC test completion measurement. For assessment of test indication and quality, medical chart review, or implementation of alternate data systems are required.

Background and aims: Major changes were made in the Rome III criteria for functional dyspepsia where two distinct syndromes were postulated, postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). Our aim in a general population sample was to explore if quality of life, using the validated SF-36, is impaired in functional dyspepsia and among functional dyspepsia subgroups defined according to the Rome III definition. Method: A random sample (n=2,860) of the adult population of two northern Swedish municipalities (n=21,610) was surveyed using a validated questionnaire assessing gastrointestinal symptoms (ASQ) and the SF-36 for quality of life with the 8 standard domains Physical Functioning (PF), Role-Physical (RP), Bodily Pain (BP), General Health (GH), Mental Health (MH), Vitality (VT), Social Functioning (SF) and Role Emotional (RE). A random sub-sample (n=1,001) of the responders was invited to undergo an esophagogastroduodenoscopy (participation rate 73.3%). The mean values of SF-36 domains in different dyspepsia categories were calculated. Multivariate logistic regression analysis, adjusting with age and sex, was used to analyze associations of different dyspepsia groups with dichotomized SF-36 domains. Results: SF-36 data were available in 999 of the 1,001 subjects endoscoped. 202 (20.2%) were classified as uninvestigated dyspepsia (UID) and 157 (15.7%) as functional dyspepsia (FD); 52 (5.2%) reported epigastric pain syndrome and 122 individuals (12.2%) had postprandial distress syndrome. FD was significantly associated with low scores in every SF-36 domain (all p≤0.01); EPS was associated only with worse Bodily Pain (p

Introduction: Nonacid reflux has been shown to be able in inducing reflux symptoms in gastroesophageal reflux disease (GERD) patients. Non-erosive reflux disease (NERD) and erosive esophagitis (EE) are the most frequent phenotypic presentations of GERD. Aim: To evaluate symptom association probability (SAP) in patients with NERD and EE. Methods: We evaluated 44 patients with EE (26M, median age 48; range 23-73 yrs), 173 with NERD (67M, median age 49; range 18-78 yrs) and 48 controls (22M, median age 44; range 2277) using multichannel intraluminal impedance and pH while off-PPI therapy. All patients had typical reflux symptoms. We measured distal esophageal acid exposure time (AET), number of impedance-detected reflux episodes (acid, nonacid) and symptom association probability (SAP; positive if ≥95%). Results: Symptom-reflux association with SAP in EE and NERD patients is shown in the Figure below. Out of 35 (75%) EE patients with an abnormal AET, 33 (75%) had a positive SAP. Twenty-seven (61%) patients had a positive SAP for acid reflux only, 2 (5%) for nonacid reflux only and 4 (9%) for both. Among the 8 (18%) patients with a normal AET and a positive SAP, 3 (7%) had a positive SAP for nonacid reflux only, 2 (5%) for acid reflux only and 3 (7%) for both. Out of 72 (42%) NERD patients with an abnormal AET, 64 (37%) had positive SAP. Fifty-two (31%) patients had a positive SAP for acid reflux only, 8 (5%) for nonacid reflux only and 6 (3%) for both. Among the 101 (58%) patients with a normal AET, 59 (34%) had a positive SAP. Twentytwo (13%) patients had a positive SAP for nonacid reflux only, 23 (13%) for acid reflux only and 14 (8%) for both. Conclusions: Nonacid reflux clearly contributes to provoke reflux symptoms in both NERD and EE patients. The increased percentage of NERD patients whose symptoms are related to nonacid reflux could be due to the higher sensitivity of these patients to stimuli different from acid.

Background Typical symptoms of gastroesophageal reflux disease (GERD) are heartburn and regurgitation. Extraesophageal (EE) symptoms such as cough and throat clearing are less commonly associated with GERD but represent a common presenting symptom for reflux testing. Proximal extent of refluxate into the larynx or even the lungs is proposed as a potential mechanism for EE symptoms. Aim We tested the hypothesis that EE symptoms are more frequently associated with proximal esophageal reflux than typical symptoms. Methods A blinded assessment was rigorously applied. Themultichannel intraluminal impedance-pH (MII-pH) tracings analyzed for this study were edited by one of the investigators so that none of the symptom markers were visible and the reflux associated symptoms reviewed were simply marked as symptom 1-5 for each patient. 815 consecutive MII-pH reports were reviewed to identify 40 patients with at least 5 symptom events preceded by a reflux episode, thus a total of 50 reflux related events in each of 4 symptom groups: cough, throat clearing, heartburn, and regurgitation. A second investigator blindly analyzed all 200 episodes by reporting the extent of the refluxate at 7, 9, 15, and 17 cm above the LES. Results The percentage of symptom related reflux extending proximally to 17 cm above the LES is similar among all four symptom types (Figure 1). At least 50% of all symptoms were associated with proximal reflux to 17 cm above the LES, with the numerically highest being regurgitation (60%). There is no significant difference between any of the values. Conslusion This study confirms the frequent association of proximal reflux with GERDrelated symptoms previously identified. However, as opposed to common beliefs, our data indicate that EE GERD-related symptoms are not more frequently associated with proximal reflux than typical GERD symptoms. Both EE and esophageal symptoms are associated with reflux to 17cm at least 50% of the time.

Assessment of a Korean Gastrointestinal Symptom Rating Scale (KGSRS) for Measuring Quality of Life in Patients with GERD Hye-kyung Jung, Ki-Nam Shim, Tae Hun Kim, Sung-Ae Jung, Sun Young Yi, Doe-Young Kim, Kwon Yoo, Ilhwan Moon Background: As the incidence of gastro-esophageal reflux (GERD) is increasing in Asian countries, the appropriate assessment of the symptom severity, quality of life, and their response to treatment, has become increasingly important in these regions. Patients with GERD also complain of other GI symptoms, representing heterogeneity. Therefore, developing appropriate GI symptom questionnaire will be a key element in performing clinical trials in this particular setting. Our objective was to develop and validate a questionnaire about health related quality of life (HRQOL) in relation to GI symptoms in patients with GERD. Method: Sixty eight, consecutive patients with GERD at the ambulatory clinic of a tertiary care center and 216 healthy subjects were enrolled in the study. GERD was defined by the presence of typical GERD symptoms, heartburn and acid regurgitation which occur twice or more than per week, regardless of whether they were associated with endoscopic erosive changes (ERD) or not (NERD). All subjects had endoscopy and filled up two kinds of self-reported questionnaires: modified Korean form of GI rating scale (KGSRS), a newly developed instrument, and KSF-36 health survey (Korean version of Medical Outcomes Study Short Form), a conventional one. KGSRS consisted of 16 questionnaires; each question was scored on a 5-point scale of symptom severity and included symptom frequency. Results: Internal consistency reliabilities for the KGSRS scales ranged from 0.58 to 0.84. There was a significant correlation between the KGSRS and KSF-36 scale scores (Spearman’s r Z 0.62, p!0.05). There were statistically significant differences between patients with GERD and healthy controls in the mean KGSRS scale scores (p!0.05) and 5 out of 8 items in KSF-36 (p!0.05). The patients with NERD showed similar decrease of QOL compared to those with ERD. However, patients with NERD showed more prevalent decrease of QOL in individual items such as abdominal pain, dyspepsia and constipation than those with ERD. Conclusion: KGSRS seems to be able to be used as a test of good reliability and validity in discriminating symptom severity and frequency in patients with GERD. It is noteworthy that the QOL of patients with NERD was similarly decreased with patients with ERD, however, decreased QOL in relation to individual symptoms such as abdominal pain, dyspepsia and constipation was more prevalent than those with ERD. M1281 Endoscopic Screening for Varices in Cirrhotics: Data From a National Endoscopic Database (the CORI Project) Mary Kovalak, Jeremy Lake, Nora Mattek, David Lieberman, Glenn Eisen, Atif Zaman Purpose: The current American College of Gastroenterology (ACG) guidelines for primary prophylaxis of variceal hemorrhage in cirrhotics recommend screening for varices with upper endoscopy (EGD). The national screening pattern of endoscopists is not known. Patient characteristics associated with the finding of varices on screening endoscopy are not fully established. Aim: Evaluate national endoscopic practice patterns and factors associated with finding varices on screening endoscopy using a national endoscopic database. Methods: Endoscopic reports generated by the Clinical Outcomes Research Initiative (CORI) repository were analyzed to determine the annual variation and findings of screening upper endoscopies between 1/1/2000 and 12/31/2003. Results: Data from 69 CORI practices (44 community/16 academic/9 Veterans Affairs Medical Center (VAMC)) was evaluated. A total of 1688 of 172,854 EGDs (9.8 per 1,000 EGDs) were performed for the purpose of screening for varices. Overall, there was a linear increase in annual proportion of screening EGDs performed. A significantly greater proportion of variceal screening EGDs are performed in academic centers (28.3 per 1,000 EGDs) compared to VAMC (10.8 per 1,000 EGDs) and community (5.3 per 1,000 EGDs). Among screening EGDs (n Z 1688), 881 (52.2%) yielded varices. Varices were found more often in Child-Pugh class B/C (71.9%) compared to ChildPugh class A (42.7%) patients. Of those with varices found, patients with Child-Pugh class B/C were more likely to have large varices (vs. small/med sized) than patients with Child-Pugh class A (p Z 0.02). Among procedures with an etiology reported (78%), patients with alcohol as an etiology of cirrhosis were significantly more likely (!.001) to have varices found than those who did not. Conclusions: The data shows 1) The proportion of EGDs performed for variceal screening has increased between 2000 and 2003. 2) A higher proportion of EGDs are performed for variceal screening in academic centers compared to VAMC and community. 3) Varices were found more frequently in Child-Pugh classes B and C and in patients with cirrhosis due to alcohol. 4) Patients with Child-Pugh class B/C were more likely to have large varices than patients with Child-Pugh class A.