M1052 Short-Term Faecal Incontinence After 3rd/4th Degree Tear Is Uncommon
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AGA Abstracts M1052 Short-Term Faecal Incontinence After 3rd/4th Degree Tear Is Uncommon Kumaran Thiruppathy, Richard Cohen, Stuart A. Taylor, Adeel A. Bajwa, Anton V. Emmanuel Introduction: Reported rates of short- and long-term faecal continence after 3rd/4th degree obstetric tears vary widely from approximately 10 to 25%. The risk of faecal incontinence (FI) is related to the degree of disruption to anal sphincters is related to women's subsequent. We hypothesised that the wide range of rates of incontinence may relate to variations in the degree of actual damage sustained, and how well this damage is repaired. Methods : Consecutive women with clinically diagnosed 3rd/4th degree (sphincter involving) obstetric tears were referred for anorectal assessment 3 months post-partum. They completed the Wexner incontinence score, and underwent endoanal ultrasound and anorectal physiology. Comparison was made between women with radiologically confirmed 3rd/4th degree tears and those whose injury did not actually involve the sphincter (ie 1st/2nd degree tears). Results : 101 patients with a clinically diagnosed 3rd/4th degree tear were seen, 49 (49%) were primiparous. Ultrasound revealed that 32/101(32%) had no evidence of sphincter injury (1st/2nd degree tear). Of the 69 with sphincter involvement, 59 (86%) had an intact repair and 14% (10/69) had persisting sphincter defects. Thirty-three of 69 (48%) of 3rd/ 4th degree tears occurred with primiparous. While 34% of women with 1st/2nd degree tears reported FI, 61% with 3rd/4th degree tears were incontinent (p=0.01 chi-squared). A persistent sphincter defect was associated with significantly higher Wexner scores compared to those with well repaired sphincters (11.4 vs 2.9 respectively, p<0.003). Anal manometry: resting pressure was similar in both 3rd/4th and 1st/2nd degree tear groups (59 vs 65mmHg, p=0.13). Squeeze pressure (external sphincter function) was lower in 3rd/4th than 1st/2nd degree tear groups (57 vs 73mmHg, p=0.003). Rectal distension sensitivity and anorectal electrosensitivity was similar in both groups. Conclusions : One-third of patients with suspected 3rd/4th degree tears had normal anal sphincters, indicating a large over-diagnosis rate in labour ward. Where there was damage, sphincter repairs were successfully repaired in 86% of cases, and patients with intact repairs were significantly less symptomatic than those with persisting defects. In the absence of sphincter injury women one-third of women suffer with FI, possibly related to sphincter weakness rather than sensory change. M1053 Bone Health Quality Improvement in a Tertiary GI/Hepatology Clinic Millie Long, Lisa M. Gangarosa, Robert Sandler Objectives: We assessed the efficacy of a patient and provider bone health knowledge improvement intervention in a tertiary care GI/Hepatology clinic. We determined character- istics associated with recommendation of bone health measures (DEXA scan, calcium, vitamin D, bisphosphonate, weight-bearing exercise or smoking cessation). Methods: We adminis- tered a comprehensive patient questionnaire on glucocorticoid use and physician bone health recommendations. A basic knowledge improvement intervention targeting both patients and providers was performed over a 3 month period. Repeat questionnaires were then collected. Improvement was assessed via Pearson's chi square statistic. Predictive multiple logistic regression modeling determined factors associated with recommendation of bone health measures. Variables were eliminated via likelihood ratio test. Predictive ability of the model was measured via a Hosmer-Lemeshow goodness of fit test. Results: A total of 552/615 surveys were returned in the pre-intervention phase (89.8%). A total of 725/1000 surveys were returned in the post-intervention phase (72.5%). The overall prevalence of glucocort- icoid use in the tertiary GI/Hepatology clinic was 12.9%. Bone health recommendation to at-risk patients was unchanged with the intervention (63.0% vs.55.4%, p=0.42). Predictive modeling showed the strongest predictor of bone health recommendation to be autoimmune hepatitis (OR 6.60, 95% CI 3.13-13.90), followed by inflammatory bowel disease (OR 6.06, 95%CI 3.92-9.38), liver disease (OR 3.70, 95% CI 2.45-5.59), current smoking (OR 3.31, 95% CI 2.32-4.73) and history of osteoporosis/osteopenia (OR 2.72, 95% CI 1.83-4.03). Goodness of fit testing demonstrated appropriate fit to the model (p=0.20). Conclusions: A basic knowledge improvement intervention was not effective in improving bone health recommendations by gastroenterologists and hepatologists. Patient characteristics such as autoimmune hepatitis, inflammatory bowel disease, other liver disease, smoking and history of osteoporosis/osteopenia were predictive of bone health recommendation. Important risk factors such as previous fragility fracture, reduced BMI, age and current glucocorticoid use were not predictive. Further improvement in implementation of bone health recommenda- tions by gastroenterologists and hepatologists is necessary. Future quality improvement initiatives should focus on barriers other than knowledge in implementing bone health care. M1054 Impact of Anal Incontinence Severity On Functional Status Measured By the Fecal Incontinence Quality of Life Scale (FIQOL) Sailajah Janarthanan, Stephanie L. Hansel, Sarah Umar, Lucinda A. Harris, Tisha N. Lunsford, Michael P. Jones, Michael D. Crowell The severity of anal incontinence (AI) has been shown to be inversely related to functional status and quality of life (QoL). The Fecal Incontinence Severity Index (FISI) provides a validated measure of the severity of AI based on frequency and type of incontinence. However, the type of AI may impact functional status and be influenced by other covariates. We aimed to explore the associations between functional status measured by FIQOL and the frequency of incontinence measured by FISI while controlling for potential confounders. METHODS: Consecutive AI patients (n=82) from a prospective clinical cohort completed the FISI and FIQOL. The FIQOL is a validated questionnaire composed of 29 items forming 4 scales: Lifestyle, Coping/Behavior, Depression/Self-Perception, and Embarrassment. Lower scores are associated with lower functional status. The FISI queries patients on the frequency and type of incontinence (flatus, mucus, liquid or solid) on a 6-point scale scored as never to ≥ 2/day. Both the unweighted (0-20) and patient-derived weighted (0-61) FISI score was evaluated using linear regression models and hierarchical, stepwise multiple regression modes. RESULTS: Females (n=70) and males (n=12) were not statistically different in age A-328 AGA Abstracts (67±12 yrs) or BMI (27.69±6.75 kg/m2). Females tended to have a higher mean FISI score compared to males (11.7±4.5 vs. 9.25±3.19, p=0.16). Linear regression on unweighted FISI scores showed increased age to be associated with higher FIQOL Lifestyle scores (r=0.24, p=0.03), whereas increased BMI was associated with lower perceived QoL (r= -0.22, p= 0.02). Multiple regression of FIQOL Lifestyle by FISI type resulted in a significant model that only included frequency of liquid incontinence (beta= -0.32, p=0.003; R 2 =0.20, p= 0.003). Adding a measure of depression significantly improved the regression model for Lifestyle (beta= -0.45, p<0.001; R 2 =0.31, p=0.003). Evaluation of patient-derived weighted scores did not significantly change the models. FIQOL Embarrassment was negatively associ- ated with both gas (beta= -0.31, p=0.001) and liquid (beta= -0.27, p=0.006) incontinence, and positively associated with age (beta=0.34, p=0.008; R 2 =0.30, p=0.006). The addition of depression also significantly improved the model for Embarrassment (beta= -0.52, p<0.001; R 2 =0.49, p=0.02). CONCLUSION: Clinically meaningful associations were found between patient's functional status measured by the FIQOL and the frequency and type of incontinence symptoms. The impact of AI on QoL was most negatively influenced by comorbid depression. These findings may help clinicians better identify effective interventions in patients with anal incontinence. M1055 Short Bowel Patients Treated for Two Years with Native Glucagon-Like Peptide 2 (GLP-2): Compliance, Safety and Effects On Quality of Life Palle B. Jeppesen, Ida B. Gottschalck, Jens J. Holst, Per B. Mortensen Compliance and safety was evaluated in 11 patients (3 female, 8 male; 47±11 years; remnant small bowel 157±66 cm; 2 with a colon; 4 receiving parenteral nutrition and 3 receiving parenteral fluids and electrolytes exclusively) offered GLP-2, 400mg TID s.c., for two years intermitted by an 8-week washout period. In addition, longitudinal changes in quality of life were evaluated every 13th week by the Sickness Impact Profile (SIP), Visual Analog Scale (VAS), Short Form 36 (SF 36), and the Inflammatory Bowel Disease Questionnaire (IBDQ). Results; Three patients did not complete the study. One experienced abdominal pain and choose to discontinue GLP-treatment; one patient with Crohns disease had a fibrostenotic lesion requiring surgery, and one was excluded by the investigator due to lack of feedback from the patient. Compliance was >93% in all patients. Surveillance of standard laboratory tests obtained during GLP-2 treatment did not raise concerns. The positive effects of GLP-2 on SIP and VAS-scores are presented in the table. Regarding SF 36, mental function and well-being was significantly better at week 13 and 52 of the first year and during weeks 13, 26 and 52 of the second year of GLP-2 treatment compared to baseline (p<0.05). No changes were seen regarding limitation based on physical function, physical pain, general well being, energy, social function, or limitations based on mental function. Numerically, the overall IBDQ scores were significantly better at all treatment points during the two years of GLP-2 treatment (p=0.007), but the post hoc pair-wise test of differences between admission periods and the baseline period were negative. Conclusion: The favorable safety profile, high compliance, and positive trends in measures of quality of life over two years of GLP-2 treatment indicates, that the reduction in fecal wet weight excretion around 1000 gram per day and a reduction in the need for hyperphagia in the same magnitude (reported elsewhere) is desirable from a patients perspective and outdo the discomforts of three daily injections. * ~ p<0.05, Compared to Baseline by Dunnett's test. § ~ p<0.05, §§ ~ p<0.01, §§§ ~ p<0.001, compared to baseline by Chi-square, alternatively Fisher exact test. M1056 Peptic Ulcer Disease: What Did Change in Turkey? Askin Yazici, Filiz Akyuz, Halim Issever, Binnur Pinarbasi, Kadir Demir, Sadakat Ozdil, Fatih Besisik, Gungor Boztas, Zeynel A. Mungan, Sabahattin Kaymakoglu In recent years, mortality from peptic ulcer disease is decreased in the world. It had been attributed to eradication of H. pylori and improvement of social-sanitory conditions. However, H. pylori still remains the most common reason of peptic ulcer. We aimed to evaluate the prevalence of H. pylori, the distribution in peptic ulcer in Turkey. Material-Methods:Between January 1985-December 2006, the patients which were performed upper gastrointestinal system endoscopy were retrospectively analyzed. Data included patients' demographic char- acteristics, presence of ulcer, its location and rapid urease test/histopathological examinations. The study period was divided into four groups with respect to the years following as;1985- 1990, 1991-1995, 1996-2000, 2001-2006. Results:Total 38034 gastroscopy were evaluated. Mean age of patients 46.6±15.6 years and 49.1% of them were male. Overall gastric ulcer rate and duodenal ulcer rate were 6.2% and 14.3%, respectively. Peptic ulcer rates are significantly higher in males (4% vs 7.5% and 10% vs 18.4% gastric and duodenal ulcer, females and males respectively,p<0.05). Gastric ulcer rates significantly higher in older age and significantly decreased in last ten years(p<0.05). H. pylori positivity rate was %48(in 9462 cases after 1990). There was no statistically different between gender (males 50.2%, females 47%). The gastric and duodenal ulcer prevalence was decreased and following results were obtained with respect to years, 9.6%, 6.3%, 4.8%, 5.7% (p<0.05); 19.8%, 20.3%, 14.6%, 8.9% (p<0.05), respectively. H. pylori positivity rates regarding the years were 67.2%,
Transcript of M1052 Short-Term Faecal Incontinence After 3rd/4th Degree Tear Is Uncommon
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sM1052
Short-Term Faecal Incontinence After 3rd/4th Degree Tear Is UncommonKumaran Thiruppathy, Richard Cohen, Stuart A. Taylor, Adeel A. Bajwa, Anton V.Emmanuel
Introduction: Reported rates of short- and long-term faecal continence after 3rd/4th degreeobstetric tears vary widely from approximately 10 to 25%. The risk of faecal incontinence(FI) is related to the degree of disruption to anal sphincters is related to women's subsequent.We hypothesised that the wide range of rates of incontinence may relate to variations inthe degree of actual damage sustained, and how well this damage is repaired. Methods :Consecutive women with clinically diagnosed 3rd/4th degree (sphincter involving) obstetrictears were referred for anorectal assessment 3 months post-partum. They completed theWexner incontinence score, and underwent endoanal ultrasound and anorectal physiology.Comparison was made between women with radiologically confirmed 3rd/4th degree tearsand those whose injury did not actually involve the sphincter (ie 1st/2nd degree tears).Results : 101 patients with a clinically diagnosed 3rd/4th degree tear were seen, 49 (49%)were primiparous. Ultrasound revealed that 32/101(32%) had no evidence of sphincterinjury (1st/2nd degree tear). Of the 69 with sphincter involvement, 59 (86%) had an intactrepair and 14% (10/69) had persisting sphincter defects. Thirty-three of 69 (48%) of 3rd/4th degree tears occurred with primiparous. While 34% of women with 1st/2nd degreetears reported FI, 61% with 3rd/4th degree tears were incontinent (p=0.01 chi-squared). Apersistent sphincter defect was associated with significantly higher Wexner scores comparedto those with well repaired sphincters (11.4 vs 2.9 respectively, p<0.003). Anal manometry:resting pressure was similar in both 3rd/4th and 1st/2nd degree tear groups (59 vs 65mmHg,p=0.13). Squeeze pressure (external sphincter function) was lower in 3rd/4th than 1st/2nddegree tear groups (57 vs 73mmHg, p=0.003). Rectal distension sensitivity and anorectalelectrosensitivity was similar in both groups. Conclusions : One-third of patients withsuspected 3rd/4th degree tears had normal anal sphincters, indicating a large over-diagnosisrate in labour ward. Where there was damage, sphincter repairs were successfully repairedin 86% of cases, and patients with intact repairs were significantly less symptomatic thanthose with persisting defects. In the absence of sphincter injury women one-third of womensuffer with FI, possibly related to sphincter weakness rather than sensory change.
M1053
Bone Health Quality Improvement in a Tertiary GI/Hepatology ClinicMillie Long, Lisa M. Gangarosa, Robert Sandler
Objectives: We assessed the efficacy of a patient and provider bone health knowledgeimprovement intervention in a tertiary care GI/Hepatology clinic. We determined character-istics associated with recommendation of bone health measures (DEXA scan, calcium, vitaminD, bisphosphonate, weight-bearing exercise or smoking cessation). Methods: We adminis-tered a comprehensive patient questionnaire on glucocorticoid use and physician bone healthrecommendations. A basic knowledge improvement intervention targeting both patients andproviders was performed over a 3 month period. Repeat questionnaires were then collected.Improvement was assessed via Pearson's chi square statistic. Predictive multiple logisticregression modeling determined factors associated with recommendation of bone healthmeasures. Variables were eliminated via likelihood ratio test. Predictive ability of the modelwas measured via a Hosmer-Lemeshow goodness of fit test. Results: A total of 552/615surveys were returned in the pre-intervention phase (89.8%). A total of 725/1000 surveyswere returned in the post-intervention phase (72.5%). The overall prevalence of glucocort-icoid use in the tertiary GI/Hepatology clinic was 12.9%. Bone health recommendation toat-risk patients was unchanged with the intervention (63.0% vs.55.4%, p=0.42). Predictivemodeling showed the strongest predictor of bone health recommendation to be autoimmunehepatitis (OR 6.60, 95% CI 3.13-13.90), followed by inflammatory bowel disease (OR 6.06,95%CI 3.92-9.38), liver disease (OR 3.70, 95% CI 2.45-5.59), current smoking (OR 3.31,95% CI 2.32-4.73) and history of osteoporosis/osteopenia (OR 2.72, 95% CI 1.83-4.03).Goodness of fit testing demonstrated appropriate fit to the model (p=0.20). Conclusions: Abasic knowledge improvement intervention was not effective in improving bone healthrecommendations by gastroenterologists and hepatologists. Patient characteristics such asautoimmune hepatitis, inflammatory bowel disease, other liver disease, smoking and historyof osteoporosis/osteopenia were predictive of bone health recommendation. Important riskfactors such as previous fragility fracture, reduced BMI, age and current glucocorticoid usewere not predictive. Further improvement in implementation of bone health recommenda-tions by gastroenterologists and hepatologists is necessary. Future quality improvementinitiatives should focus on barriers other than knowledge in implementing bone health care.
M1054
Impact of Anal Incontinence Severity On Functional Status Measured By theFecal Incontinence Quality of Life Scale (FIQOL)Sailajah Janarthanan, Stephanie L. Hansel, Sarah Umar, Lucinda A. Harris, Tisha N.Lunsford, Michael P. Jones, Michael D. Crowell
The severity of anal incontinence (AI) has been shown to be inversely related to functionalstatus and quality of life (QoL). The Fecal Incontinence Severity Index (FISI) provides avalidated measure of the severity of AI based on frequency and type of incontinence. However,the type of AI may impact functional status and be influenced by other covariates. We aimedto explore the associations between functional status measured by FIQOL and the frequencyof incontinence measured by FISI while controlling for potential confounders. METHODS:Consecutive AI patients (n=82) from a prospective clinical cohort completed the FISI andFIQOL. The FIQOL is a validated questionnaire composed of 29 items forming 4 scales:Lifestyle, Coping/Behavior, Depression/Self-Perception, and Embarrassment. Lower scoresare associated with lower functional status. The FISI queries patients on the frequency andtype of incontinence (flatus, mucus, liquid or solid) on a 6-point scale scored as never to≥ 2/day. Both the unweighted (0-20) and patient-derived weighted (0-61) FISI score wasevaluated using linear regression models and hierarchical, stepwise multiple regressionmodes. RESULTS: Females (n=70) and males (n=12) were not statistically different in age
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A-328AGA Abstracts
(67±12 yrs) or BMI (27.69±6.75 kg/m2). Females tended to have a higher mean FISI scorecompared to males (11.7±4.5 vs. 9.25±3.19, p=0.16). Linear regression on unweighted FISIscores showed increased age to be associated with higher FIQOL Lifestyle scores (r=0.24,p=0.03), whereas increased BMI was associated with lower perceived QoL (r= -0.22, p=0.02). Multiple regression of FIQOL Lifestyle by FISI type resulted in a significant modelthat only included frequency of liquid incontinence (beta= -0.32, p=0.003; R2=0.20, p=0.003). Adding a measure of depression significantly improved the regression model forLifestyle (beta= -0.45, p<0.001; R2=0.31, p=0.003). Evaluation of patient-derived weightedscores did not significantly change the models. FIQOL Embarrassment was negatively associ-ated with both gas (beta= -0.31, p=0.001) and liquid (beta= -0.27, p=0.006) incontinence,and positively associated with age (beta=0.34, p=0.008; R2=0.30, p=0.006). The additionof depression also significantly improved the model for Embarrassment (beta= -0.52, p<0.001;R2=0.49, p=0.02). CONCLUSION: Clinically meaningful associations were found betweenpatient's functional status measured by the FIQOL and the frequency and type of incontinencesymptoms. The impact of AI on QoL was most negatively influenced by comorbid depression.These findings may help clinicians better identify effective interventions in patients withanal incontinence.
M1055
Short Bowel Patients Treated for Two Years with Native Glucagon-Like Peptide2 (GLP-2): Compliance, Safety and Effects On Quality of LifePalle B. Jeppesen, Ida B. Gottschalck, Jens J. Holst, Per B. Mortensen
Compliance and safety was evaluated in 11 patients (3 female, 8 male; 47±11 years; remnantsmall bowel 157±66 cm; 2 with a colon; 4 receiving parenteral nutrition and 3 receivingparenteral fluids and electrolytes exclusively) offered GLP-2, 400mg TID s.c., for two yearsintermitted by an 8-week washout period. In addition, longitudinal changes in quality oflife were evaluated every 13th week by the Sickness Impact Profile (SIP), Visual AnalogScale (VAS), Short Form 36 (SF 36), and the Inflammatory Bowel Disease Questionnaire(IBDQ). Results; Three patients did not complete the study. One experienced abdominalpain and choose to discontinue GLP-treatment; one patient with Crohns disease had afibrostenotic lesion requiring surgery, and one was excluded by the investigator due to lackof feedback from the patient. Compliance was >93% in all patients. Surveillance of standardlaboratory tests obtained during GLP-2 treatment did not raise concerns. The positive effectsof GLP-2 on SIP and VAS-scores are presented in the table. Regarding SF 36, mental functionand well-being was significantly better at week 13 and 52 of the first year and during weeks13, 26 and 52 of the second year of GLP-2 treatment compared to baseline (p<0.05). Nochanges were seen regarding limitation based on physical function, physical pain, generalwell being, energy, social function, or limitations based on mental function. Numerically,the overall IBDQ scores were significantly better at all treatment points during the two years ofGLP-2 treatment (p=0.007), but the post hoc pair-wise test of differences between admissionperiods and the baseline period were negative. Conclusion: The favorable safety profile, highcompliance, and positive trends in measures of quality of life over two years of GLP-2treatment indicates, that the reduction in fecal wet weight excretion around 1000 gram perday and a reduction in the need for hyperphagia in the same magnitude (reported elsewhere)is desirable from a patients perspective and outdo the discomforts of three daily injections.
* ~ p<0.05, Compared to Baseline by Dunnett's test. § ~ p<0.05, §§ ~ p<0.01, §§§ ~p<0.001, compared to baseline by Chi-square, alternatively Fisher exact test.
M1056
Peptic Ulcer Disease: What Did Change in Turkey?Askin Yazici, Filiz Akyuz, Halim Issever, Binnur Pinarbasi, Kadir Demir, Sadakat Ozdil,Fatih Besisik, Gungor Boztas, Zeynel A. Mungan, Sabahattin Kaymakoglu
In recent years, mortality from peptic ulcer disease is decreased in the world. It had beenattributed to eradication of H. pylori and improvement of social-sanitory conditions. However,H. pylori still remains the most common reason of peptic ulcer. We aimed to evaluate theprevalence of H. pylori, the distribution in peptic ulcer in Turkey. Material-Methods:BetweenJanuary 1985-December 2006, the patients which were performed upper gastrointestinalsystem endoscopy were retrospectively analyzed. Data included patients' demographic char-acteristics, presence of ulcer, its location and rapid urease test/histopathological examinations.The study period was divided into four groups with respect to the years following as;1985-1990, 1991-1995, 1996-2000, 2001-2006. Results:Total 38034 gastroscopy were evaluated.Mean age of patients 46.6±15.6 years and 49.1% of them were male. Overall gastric ulcerrate and duodenal ulcer rate were 6.2% and 14.3%, respectively. Peptic ulcer rates aresignificantly higher in males (4% vs 7.5% and 10% vs 18.4% gastric and duodenal ulcer,females and males respectively,p<0.05). Gastric ulcer rates significantly higher in older ageand significantly decreased in last ten years(p<0.05). H. pylori positivity rate was %48(in9462 cases after 1990). There was no statistically different between gender (males 50.2%,females 47%). The gastric and duodenal ulcer prevalence was decreased and following resultswere obtained with respect to years, 9.6%, 6.3%, 4.8%, 5.7% (p<0.05); 19.8%, 20.3%,14.6%, 8.9% (p<0.05), respectively. H. pylori positivity rates regarding the years were 67.2%,
