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Association between body mass index and irritable bowel syndrome in the young Japanese population: a cross-sectional study. Int J Colorectal Dis 2022; 37:2357-2363. [PMID: 36264423 DOI: 10.1007/s00384-022-04267-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The association between body mass index (BMI) and irritable bowel syndrome (IBS) has been inconsistent in the Asian population. Also, no evidence regarding this issue in the young population exists. The aim of the present study is to investigate the association between BMI and IBS based on the Rome III criteria in young Japanese people. METHODS This study was a cross-sectional study consisted of 8923 Japanese university students. The definition of IBS was based on the Rome III criteria. BMI was divided into four categories (quartiles) on the basis of the study subjects' distribution (lowest, low, moderate, and high [reference]). The definition of lean, normal, and overweight was BMI < 18.5 kg/m2, 18.5 ≤ BMI < 25 kg/m2 (reference), and 25 ≤ BMI kg/m2, respectively. Age, sex, drinking, smoking, exercise habit, anemia, and sports injury were selected a priori as potential confounding factors. RESULTS The prevalence of IBS was 6.5%, with females having a significantly higher prevalence than males (6.0% vs. 7.2%, p = 0.029). In females, being overweight was independently positively associated with IBS after adjustment (adjusted odds ratio [OR]: 1.81 [95% confidence interval (CI): 1.13-2.79]). In contrast, in males, no association between being lean or overweight and IBS was found. CONCLUSIONS Among the young Japanese population, being overweight might be independently positively associated with prevalence of IBS in females but not in males.
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Abstract
Patients with obesity who present with gastroesophageal reflux disease (GERD) require a nuanced approach. Those with lower body mass index (BMI) (less than 33) can be counseled on weight loss, and if successful may be approached with laparoscopic fundoplication. Those who are unable to achieve weight loss or those who present with a BMI greater than or equal to 35 should proceed with laparoscopic Roux-en-Y gastric bypass (LRYGB). Conversion to LRYGB from sleeve gastrectomy is a safe and effective way to manage GERD after sleeve gastrectomy.
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Analysis of Emergency Department Visits and Unplanned Readmission After Bariatric Surgery: An Experience From a Tertiary Referral Center. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2021; 32:107-113. [PMID: 34653112 DOI: 10.1097/sle.0000000000001011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/12/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Bariatric surgery is the most effective treatment of morbid obesity. As the number of bariatric procedures performed has increased, visits to the emergency department (ED) and readmissions have subsequently increased. The present study aimed to assess the rates and indications for of ED visits and readmission after bariatric surgery and to identify the predictors of hospital readmission. PATIENTS AND METHODS This was a retrospective cohort study on patients who underwent bariatric surgery from January 2018 to April 2020. The percentage of ED visits and unplanned readmission was estimated and the indications and management of each were analyzed. The association of age, sex, body mass index, and type of procedure with readmission was assessed. RESULTS Of 582 patients who underwent bariatric surgery in the study period, 204 (35%) required ED visits, and 42 (7.2%) required readmission. The mean age of patients was 33 years, and the mean body mass index was 43 kg/m2. The most common indication for ED visits was abdominal pain (41.2%). In all, 64.8% of ED visits and 43% of readmissions were unrelated to bariatric surgery complications. A total of 94.1% of patients who required ED visits and 71.4% of readmitted patients were managed conservatively. The most common procedure followed by readmission was laparoscopic sleeve gastrectomy (50%) then one-anastomosis gastric bypass (21.4%). Age, sex, body mass index, and procedure type were not significantly associated with higher readmission. CONCLUSIONS The rates of ED visits and readmission in our cohort were 35% and 7.2%, respectively. Most cases of ED visits were not related to adverse effects of bariatric surgery and the majority of which were managed conservatively.
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Pogodina AV, Romanitsa AI, Rychkova LV. Obesity and functional bowel disorders: are they linked? OBESITY AND METABOLISM 2021. [DOI: 10.14341/omet12706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Obesity and functional bowel disease (FBD) are affecting a large number of people worldwide. They have psychosocial consequences and associated with considerable healthcare resource use. The purpose of this review was a comprehensive study of the relationship between obesity and FBD, as well as mechanisms to explain this relationship. An analysis of the literature provides strong evidence of a link between obesity and diarrhea, but there is currently insufficient data to speak confidently about the link between obesity and irritable bowel syndrome. Most studies suggest that adult obesity is not associated or negatively associated with constipation. The association of obesity with diarrhea is most convincingly explained through diet, eating behavior, changes in the metabolism of bile acids, accelerated colonic transit, altered intestinal microbiota and associated inflammation and increased intestinal permeability. Medicines taken by patients, as well as non-alcoholic fatty liver disease, can play their own role.Planning and conducting studies, including longitudinal ones, based on valid diagnostic criteria and taking into account the widest possible range of confounders, will allow a deeper study of the problem of comorbidity of obesity and FBD. This will help optimize the treatment of these diseases.
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Affiliation(s)
- A. V. Pogodina
- Scientific Center for Family Health and Human Reproduction Problems
| | - A. I. Romanitsa
- Scientific Center for Family Health and Human Reproduction Problems
| | - L. V. Rychkova
- Scientific Center for Family Health and Human Reproduction Problems
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Tandon A, Akbari K, Dempster N, Child E, Gillies R, Sgromo B. Meta-Analysis of Gastrointestinal Quality of Life After Laparoscopic Sleeve Gastrectomy or Laparoscopic Roux-en-Y Gastric Bypass. Bariatr Surg Pract Patient Care 2021. [DOI: 10.1089/bari.2020.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ashutosh Tandon
- Department of Bariatric Surgery, Churchill Hospital, Oxford, United Kingdom
| | - Khalid Akbari
- Department of Bariatric Surgery, Churchill Hospital, Oxford, United Kingdom
| | - Niall Dempster
- Department of Bariatric Surgery, Churchill Hospital, Oxford, United Kingdom
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, United Kingdom
| | - Emma Child
- Knowledge & Evidence Services, Warrington and Halton Hospitals, Warrington, United Kingdom
| | - Richard Gillies
- Department of Bariatric Surgery, Churchill Hospital, Oxford, United Kingdom
| | - Bruno Sgromo
- Department of Bariatric Surgery, Churchill Hospital, Oxford, United Kingdom
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Slagter N, Hopman J, Altenburg AG, de Heide LJM, Jutte EH, Kaijser MA, Damen SL, van Beek AP, Emous M. Applying an Anti-reflux Suture in the One Anastomosis Gastric Bypass to Prevent Biliary Reflux: a Long-Term Observational Study. Obes Surg 2021; 31:2144-2152. [PMID: 33496931 DOI: 10.1007/s11695-021-05238-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The one anastomosis gastric bypass (OAGB) is an effective treatment to induce sustained weight loss in morbidly obese patients. Concerns remain regarding the development of reflux. The aim of this study was to investigate the effect of an "anti-reflux suture" as anti-reflux modification to prevent reflux. METHOD This is a single-center retrospective cohort study of patients who underwent a primary OAGB at the Center Obesity North-Netherlands (CON) between January 2015 and December 2016. Reflux was defined as symptoms of acid/bilious regurgitation or pyrosis. This was consequently asked and reported at each follow-up visit. Outcomes of patients with an anti-reflux suture were compared to those without. RESULTS In 414 (59%) of the 703 included patients, an anti-reflux suture was applied. Follow-up at 3 years was 74%. The incidence of reflux did not differ between patients with or without an anti-reflux suture (57 versus 56%, respectively; P = 0.9). The presence of an anti-reflux suture was significantly associated with a lower incidence of conversion to Roux-en-Y gastric bypass (RYGB) for reflux (OR 0.56, 95%CI 0.34-0.91). Patients preoperatively diagnosed with gastroesophageal reflux disease (GERD) were 5.2 times more likely to need a conversion to RYGB for reflux (95%CI 2.7-10.1). CONCLUSION The presence of preoperative GERD should be weighted heavily in the decision to perform an OAGB as this is a major risk factor for conversion surgery due to reflux. The anti-reflux suture might be a valuable addition to the procedure of the OAGB because it results in fewer conversion surgeries for reflux.
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Affiliation(s)
- Nienke Slagter
- Center for Obesity Northern-Netherlands (CON), Medical Center Leeuwarden, Leeuwarden, the Netherlands.
| | - Jonne Hopman
- Center for Obesity Northern-Netherlands (CON), Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Anna G Altenburg
- Center for Obesity Northern-Netherlands (CON), Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Loek J M de Heide
- Center for Obesity Northern-Netherlands (CON), Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Ewoud H Jutte
- Center for Obesity Northern-Netherlands (CON), Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Mirjam A Kaijser
- Center for Obesity Northern-Netherlands (CON), Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - Stefan L Damen
- Center for Obesity Northern-Netherlands (CON), Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - André P van Beek
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marloes Emous
- Center for Obesity Northern-Netherlands (CON), Medical Center Leeuwarden, Leeuwarden, the Netherlands
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Pugliese G, Muscogiuri G, Barrea L, Laudisio D, Savastano S, Colao A. Irritable bowel syndrome: a new therapeutic target when treating obesity? Hormones (Athens) 2019; 18:395-399. [PMID: 31228102 DOI: 10.1007/s42000-019-00113-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/30/2019] [Indexed: 02/07/2023]
Abstract
There is accumulating evidence showing that obesity is due not merely to increased food intake, but could have a more complex pathophysiology possibly originating from the gut. Due to its microbiological, hormonal, and nutritional aspects, the gut could represent a starting point for the treatment of weight excess. Obesity is associated with a change of microbiota composition that not only could increase the calorie extraction from food but also could create a functional derangement resulting in irritable bowel syndrome (IBS). Several mechanisms have been postulated to explain this association, such as specific foods that are poorly absorbed, i.e., carbohydrates and lipids, as well as conditions of psychological stress which could stimulate colonic hypersensitivity giving rise to IBS symptoms. Another factor involved in this link could be the subclinical inflammation typical of obesity, characterized by the release of inflammatory mediators that can irritate intestinal nerve endings. The change of levels of some anorexigenic hormones, as well as the alterations of the gut microbiota with the reduction of the bacteroides/Firmicutes ratio, could also contribute to the pathogenesis of IBS related to obesity. Thus, the aim of this manuscript is to review the current evidence on the association between obesity and IBS while providing physiopathological hypotheses that may explain this link. Further, we will report the effect of weight loss on IBS symptoms, highlighting the importance of an accurate assessment of gut function in obese patients.
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Affiliation(s)
- Gabriella Pugliese
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University Federico II, Via Sergio Pansini, 5, I-80131, Naples, Italy
| | - Giovanna Muscogiuri
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University Federico II, Via Sergio Pansini, 5, I-80131, Naples, Italy.
| | - Luigi Barrea
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University Federico II, Via Sergio Pansini, 5, I-80131, Naples, Italy
| | - Daniela Laudisio
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University Federico II, Via Sergio Pansini, 5, I-80131, Naples, Italy
| | - Silvia Savastano
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University Federico II, Via Sergio Pansini, 5, I-80131, Naples, Italy
| | - Annamaria Colao
- Endocrinology Unit, Department of Clinical Medicine and Surgery, University Federico II, Via Sergio Pansini, 5, I-80131, Naples, Italy
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Tartamella F, Ziccarelli A, Cecchini S, Ferro M, Riccò M, Baldini E, Mancini R, Anselmino M, Marchesi F. Abdominal pain and internal hernias after Roux-en-Y Gastric Bypass: are we dealing with the tip of an iceberg? ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:251-258. [PMID: 31125004 PMCID: PMC6776200 DOI: 10.23750/abm.v90i2.7145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/06/2018] [Indexed: 01/28/2023]
Abstract
Background: Abdominal pain is the most frequent cause of hospital admission after Roux-en-y gastric bypass (RYGB). Among numerous possible underlying causes, internal hernias represent one of the most peculiar and insidious conditions, setting challenging diagnostic and therapeutic problems for the surgeon. The aim of this study is to analyze aspecific abdominal pain incidence and characteristics after RYGB, discriminating peculiar aspects suggestive of internal hernias. Methods: 13 patients submitted to internal hernia repair after laparoscopic antecolic RYGB and a group of 49 controls (non-complicated RYGB) have been assessed using a specific questionnaire. Overall aspecific abdominal pain incidence and characteristics have been analysed. Typical pain traits and predisposing conditions for internal hernias have been investigated. Results: 33% of controls reported aspecific abdominal pain after RYGB, mainly early postprandial, deep, remittent, colicky, located in the upper left abdomen. 77% of the case patients reported prodromal episodes of pain similar to the controls. The only significant differences between prodromal and acute episodes were pain intensity and quality (continuous). Excess weight lost at 3 months significantly correlated with internal hernia occurrence (p: 0.002). Conclusions: Based on abdominal pain characteristics, we can reasonably postulate the presence of remittent bowel torsions (remittent internal hernia) in many patients after antecolic RYGB, only occasionally complicating. Therapeutic management of these cases remains controversial, being laparoscopic exploration a reasonable option when symptomatology is suggestive.(www.actabiomedica.it)
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Affiliation(s)
- Francesco Tartamella
- Dipartimento di Medicina e Chirurgia, sezione di Clinica Chirurgica Generale, Università degli studi di Parma.
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9
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Akhondi N, Memar Montazerin S, Soltani S, Saneei P, Hassanzadeh Keshteli A, Esmaillzadeh A, Adibi P. General and abdominal obesity in relation to the prevalence of irritable bowel syndrome. Neurogastroenterol Motil 2019; 31:e13549. [PMID: 30657237 DOI: 10.1111/nmo.13549] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 12/17/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Earlier studies on the obesity-IBS association have mostly been reported from Western nations, and limited data are available in this regard from developing countries. This study was performed to examine the association of general and abdominal obesity with Irritable bowel syndrome (IBS) in a Middle Eastern population. METHODS In this cross-sectional study, 4763 Iranian adults participated. Data on self-reported anthropometric measurements were collected, and BMI was calculated. Overweight and obesity were defined as 25 ≤ BMI < 30 and BMI ≥ 30 kg/m2 , respectively. Also, we used WC measurements to define the three categories of normal (<94 cm in men <80 cm in women), abdominal overweight (94 ≤ WC < 102 in men and 80 ≤ WC < 88 in women), and abdominal obesity (WC ≥ 102 cm in men and WC ≥ 88 cm in women). Assessment of different GI symptoms including those related to IBS was done using a validated Persian version of the Rome III questionnaire. IBS was defined as the presence of recurrent abdominal pain or discomfort at least sometimes in the last 3 months associated with 2 or more of the following features: improvement with defecation, pain onset associated with a change in frequency of stool, and pain onset associated with a change in form (appearance) of stool. KEY RESULTS Irritable bowel syndrome was more prevalent among individuals with abdominal obesity compared with normal subjects (23.8% vs 19%). Neither in crude nor in adjusted models, we found any significant association between overweight and obesity and IBS [for overweight: OR: 0.95, 95% CI: 0.66-1.36 and for obesity: OR: 1.06, 95% CI: 0.85-1.31]. We observed a significant positive association between abdominally overweight and IBS in crude model (OR: 1.31, 95% CI: 1.09-1.60); however, this association became non-significant after adjustment for potential confounders (OR: 1.09, 95% CI: 0.82-1.44). Across BMI categories, neither in crude nor in adjusted models, we did not find any significant association between overweight (OR: 0.89, 95% CI: 0.62-1.27), obesity (OR: 1.05, 95% CI: 0.58-1.87), and abdominal pain severity. Abdominal overweight (OR: 0.96, 95% CI: 0.65-1.40) and obesity (OR: 1.61, 95% CI: 0.67-1.63) were not associated with abdominal pain severity. CONCLUSIONS AND INFERENCES It is concluded that general or abdominal obesity was not associated with odds of IBS. Future longitudinal studies are needed to clarify the association between obesity and IBS.
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Affiliation(s)
- Negin Akhondi
- Isfahan Medical Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sahar Memar Montazerin
- Isfahan Medical Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sanaz Soltani
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvane Saneei
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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10
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Santucci NR, Hyman PE. Do Functional Gastrointestinal Disorders Affect Growth and Nutrition? J Pediatr 2018; 199:9-10. [PMID: 29731354 DOI: 10.1016/j.jpeds.2018.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 04/04/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Neha R Santucci
- Pediatric Gastroenterology, Hepatology and Nutrition University of Cincinnati Cincinnati Children's Hospital Medical Center Cincinnati, Ohio.
| | - Paul E Hyman
- Pediatric Gastroenterology, Hepatology and Nutrition Louisiana State University Health Sciences Center Children's Hospital of New Orleans New Orleans, Louisiana
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11
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Funaki Y, Kaneko H, Kawamura Y, Yoshimine T, Tamura Y, Izawa S, Ebi M, Ogasawara N, Sasaki M, Kasugai K. Impact of Comorbid Irritable Bowel Syndrome on Treatment Outcome in Non-Erosive Reflux Disease on Long-Term Proton Pump Inhibitor in Japan. Digestion 2018. [PMID: 28641289 DOI: 10.1159/000477801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS Irritable bowel syndrome (IBS) frequently coexists with non-erosive reflux disease (NERD). Efficacy of long-term proton pump inhibitor (PPI) treatment on NERD with or without IBS is controversial. The impact of comorbid IBS in NERD on quality of life (QOL) remains uncertain. We verified the hypothesis that NERD patients with IBS symptoms demonstrated poor responses to long-term PPI treatments, deteriorated QOL, and high frequency of psychological deviations in Japan. METHODS In all, 141 NERD patients who had been taking PPIs for more than 6 months were enrolled and analyzed. Patient profiles were assessed by GerdQ, IBS Severity Index (IBSSI-J)/Gastrointestinal Symptoms Rating Scale (GSRS)/SF-8, and Hospital Anxiety and Depression Scale (HADS). RESULTS IBS existed in 37 out of 141 NERD patients. Patients with IBS (the positive-IBS group) demonstrated significantly higher frequencies of extant reflux symptoms than those without IBS (64.9 vs. 40.4%). In the positive-IBS group, 40.5% were classified as middle grade by IBSSI-J. The SF-8 and GSRS scores in this group were significantly lower than those without IBS (the negative-IBS group). Prevalence of depression and anxiety by HADS in the positive-IBS group was significantly higher than that in the negative-IBS group. CONCLUSION These results proved the hypothesis that considering comorbid IBS among NERD patients on long-term PPI seems recommended in Japan.
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Affiliation(s)
- Yasushi Funaki
- Department of Gastroenterology, Division of Internal Medicine, Aichi Medical University School of Medicine, Aichi, Japan
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D’Silva M, Bhasker AG, Kantharia NS, Lakdawala M. High-Percentage Pathological Findings in Obese Patients Suggest that Esophago-gastro-duodenoscopy Should Be Made Mandatory Prior to Bariatric Surgery. Obes Surg 2018; 28:2753-2759. [DOI: 10.1007/s11695-018-3230-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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13
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Aasbrenn M, Lydersen S, Farup PG. A Conservative Weight Loss Intervention Relieves Bowel Symptoms in Morbidly Obese Subjects with Irritable Bowel Syndrome: A Prospective Cohort Study. J Obes 2018; 2018:3732753. [PMID: 29686892 PMCID: PMC5852871 DOI: 10.1155/2018/3732753] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/18/2017] [Accepted: 12/26/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is common in subjects with morbid obesity; the effect of weight loss programs on bowel symptoms is largely unknown. METHODS This prospective cohort study explored bowel symptoms, health scores, and biomarkers in subjects with morbid obesity during a six-month-long conservative weight loss intervention. Bowel symptoms were assessed with IBS-severity scoring system (IBS-SSS) and Gastrointestinal Symptom Rating Scale-IBS. Changes in all variables and associations between the changes in bowel symptoms and the other variables were analysed. RESULTS Eighty-eight subjects (81% females) were included. Body mass index was reduced from 42.0 (3.6) to 38.7 (3.5) (p < 0.001). IBS-SSS was reduced from 116 (104) to 81 (84) (p=0.001). In all, 19 out of 25 variables improved significantly. In subjects with and without IBS at inclusion, the improvement in IBS-SSS was 88 (95% CI 55 to 121) and 10 (95% CI -9 to 29), respectively. Improved bowel symptoms were associated with improved subjective well-being, sense of humour, and vitamin D and negatively associated with reduced body mass index. CONCLUSION Body mass index and health scores improved during a conservative weight loss intervention. Subjects with IBS before the intervention had a clinically significant improvement in bowel symptoms.
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Affiliation(s)
- Martin Aasbrenn
- Department of Surgery, Innlandet Hospital Trust, Gjøvik, Norway
- Unit for Applied Clinical Research, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Per G. Farup
- Unit for Applied Clinical Research, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
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Chen J, Mackenzie J, Zhai Y, O'Loughlin J, Kholer R, Morrow E, Glasgow R, Volckmann E, Ibele A. Preventing Returns to the Emergency Department FollowingBariatric Surgery. Obes Surg 2017; 27:1986-1992. [PMID: 28283919 DOI: 10.1007/s11695-017-2624-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Unnecessary emergency department (ED) visits following bariatric surgery represent a significant source of inefficient resource utilization. This study aimed to identify potential strategies aimed at preventing unnecessary returns to the ED following bariatric surgery. The study was conducted in University Hospital, USA. METHODS The electronic medical records of all patients who underwent bariatric surgery at our institution between January 2011 and October 2015 were retrospectively reviewed. Information regarding procedure, gender, age, preoperative BMI, obesity-related comorbid conditions, postoperative length of stay (LOS), and reasons for ED visits within 90 days of surgery were obtained. Six practitioners (four attending surgeons, one resident physician, and one physician assistant) independently reviewed patient chief complaint and clinical findings at the time of ED returns. Reasons for ED return were scored as either preventable or non-preventable. "Preventable" denoted that an ED return could potentially be avoided by means of a system change in our bariatric practice. RESULTS Our institution performed 361 bariatric procedures during the study period. Of these, 65 patients had 91 ED visits, 23 of which resulted in readmissions, and two of which required operative interventions. The ≤90-day all-cause postoperative ED visit rate was 18% (n = 65). Of the 91 ED visits, 47% were deemed preventable (n = 43). The most common preventable reasons for ED returns were nausea, vomiting, dehydration (NVD) (27.9%), postoperative pain (25.6%), wound evaluations (20.9%), and compliance issues (14%). CONCLUSIONS Postoperative ED visits following bariatric surgery are prevalent and costly. Many of these visits are potentially preventable. Implementing outpatient strategies to address these causes will likely attenuate inefficient resource utilization.
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Affiliation(s)
- Jennwood Chen
- Department of General Surgery, University of Utah Program in Personalized Health, National Center for Advancing Translational Sciences of the National Institutes of Health, UL1TR001067, Salt Lake City, USA.
| | - Justin Mackenzie
- Department of Psychology, University of Utah and Affiliated Hospitals, Salt Lake City, UT, USA
| | - Yan Zhai
- Department of General Surgery, University of Utah Program in Personalized Health, National Center for Advancing Translational Sciences of the National Institutes of Health, UL1TR001067, Salt Lake City, USA
| | - James O'Loughlin
- Department of General Surgery, University of Utah Program in Personalized Health, National Center for Advancing Translational Sciences of the National Institutes of Health, UL1TR001067, Salt Lake City, USA
| | - Rebecca Kholer
- Department of General Surgery, University of Utah Program in Personalized Health, National Center for Advancing Translational Sciences of the National Institutes of Health, UL1TR001067, Salt Lake City, USA
| | - Ellen Morrow
- Department of General Surgery, University of Utah Program in Personalized Health, National Center for Advancing Translational Sciences of the National Institutes of Health, UL1TR001067, Salt Lake City, USA
| | - Robert Glasgow
- Department of General Surgery, University of Utah Program in Personalized Health, National Center for Advancing Translational Sciences of the National Institutes of Health, UL1TR001067, Salt Lake City, USA
| | - Eric Volckmann
- Department of General Surgery, University of Utah Program in Personalized Health, National Center for Advancing Translational Sciences of the National Institutes of Health, UL1TR001067, Salt Lake City, USA
| | - Anna Ibele
- Department of General Surgery, University of Utah Program in Personalized Health, National Center for Advancing Translational Sciences of the National Institutes of Health, UL1TR001067, Salt Lake City, USA
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Abdominal imaging post bariatric surgery: predictors, usage and utility. Surg Obes Relat Dis 2017; 13:1327-1336. [DOI: 10.1016/j.soard.2017.04.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 03/16/2017] [Accepted: 04/27/2017] [Indexed: 11/27/2022]
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Aasbrenn M, Høgestøl I, Eribe I, Kristinsson J, Lydersen S, Mala T, Farup PG. Prevalence and predictors of irritable bowel syndrome in patients with morbid obesity: a cross-sectional study. BMC OBESITY 2017; 4:22. [PMID: 28680646 PMCID: PMC5490229 DOI: 10.1186/s40608-017-0159-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 06/22/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Irritable bowel syndrome has been reported as more common in patients with morbid obesity than in the general population. The reason for this association is unknown. The aims of this study were to study the prevalence of irritable bowel syndrome and other functional bowel disorders in patients with morbid obesity, and to search for predictors of irritable bowel syndrome. METHODS Patients opting for bariatric surgery at two obesity centers in South-Eastern Norway were included. Functional bowel disorders were diagnosed according to the Rome III criteria. Predictors were evaluated in a multivariable logistic regression analysis with irritable bowel syndrome as the dependent variable. RESULTS A total of 350 (58%) out of 603 consecutive patients were included. The prevalence rates of irritable bowel syndrome at the two centers were 17/211 (8%) and 37/139 (27%) respectively. High low-density lipoprotein (OR 2.10; 95% CI 1.34-3.29), self-reported psychiatric disorders (OR 2.39; 95% CI 1.12-5.08) and center (OR 5.22; 95% CI 2.48-10.99) were independent predictors of irritable bowel syndrome. CONCLUSIONS At one of the two obesity centers, the prevalence of irritable bowel syndrome was threefold higher than in the general population in the same region. The high prevalence appears to be related to dietary differences or altered absorption or metabolism of fat. Attention to irritable bowel syndrome is important in the care of patients with morbid obesity.
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Affiliation(s)
- Martin Aasbrenn
- Department of Surgery, Innlandet Hospital Trust, Kyrre Grepps gate 11, N-2819 Gjøvik, Norway.,Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingvild Høgestøl
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Inger Eribe
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jon Kristinsson
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tom Mala
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Per G Farup
- Unit for Applied Clinical Research, Department of Cancer Research and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Research, Innlandet Hospital Trust, Brumunddal, Norway
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18
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Eslick GD, Howell SC, Talley NJ. Dysmotility Symptoms Are Independently Associated With Weight Change: A Population-based Study of Australian Adults. J Neurogastroenterol Motil 2015; 21:603-11. [PMID: 26424045 PMCID: PMC4622143 DOI: 10.5056/jnm14124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 04/16/2015] [Accepted: 07/16/2015] [Indexed: 01/12/2023] Open
Abstract
Background/Aims Weight loss is a recognized alarm symptom for organic gastrointestinal (GI) disease, yet the association between weight change (loss or gain) and specific GI symptoms remains poorly described. We assess the associations between GI symptoms and weight change in a population-based sample of Australian adults. Methods The prevalence of 26 GI symptoms was determined by a postal survey to 5000 residents in western Sydney, Australia (60% response rate). These were classified a priori into 5 symptom groups–abdominal pain, esophageal symptoms, dysmotility symptoms, diarrhea and constipation. Weight change was measured by two items which assessed weight loss and weight gain. Clinically relevant weight change was defined as a loss or gain of 3 or more kilograms in the past 3 months. Results Prevalence estimates for clinically relevant weight loss and gain in the past 3 months were 10.3% and 8.1%, respectively. When the 5 symptom groups were evaluated simultaneously, the dysmotility symptoms of fullness after meals emerged as a predictor of both weight loss (OR, 1.57; 95% CI, 1.32–1.88; P < 0.001) and weight gain (OR, 0.85; 95% CI, 0.72–0.99; P = 0.040), which also included bloating (OR, 1.64; 95% CI 1.46–1.84; P < 0.001). The associations remained significant following adjustment for socio-economic status, body mass index, and eating behaviors. Conclusions Specific dysmotility symptoms are independently predictive of both weight loss and weight gain. Different pathogenic mechanisms may be involved.
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Affiliation(s)
- Guy D Eslick
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Medicine, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Stuart C Howell
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Medicine, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia
| | - Nicholas J Talley
- Department of Medicine, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia.,Faculty of Health, The University of Newcastle, Callaghan, New South Wales, Australia
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Prevalence and relationship between gastrointestinal symptoms among individuals of different body mass index: A population-based study. Obes Res Clin Pract 2015; 10:143-50. [PMID: 26142872 DOI: 10.1016/j.orcp.2015.05.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 05/27/2015] [Accepted: 05/29/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Obesity has been identified as a potential risk factor for gastrointestinal (GI) symptoms, although the data from community samples remain sparse. We assess the associations between GI symptoms and obesity in a population-based sample of Australian adults. METHOD The prevalence of 26 GI symptoms was determined by a validated postal questionnaire which was sent to 5000 randomly selected residents. The response rate was 60%. GI symptoms were classified into six broader symptom groups based on the Rome II Criteria - abdominal pain, esophageal symptoms, dysmotility symptoms, diarrhea, vomiting, and constipation. Obesity was defined according to body mass index using self-reported height and weight. RESULTS The prevalence of obesity (BMI≥30kg/m(2)) was 25.1%; 36.1% were overweight. There were significant and positive univariate associations between obesity and abdominal pain (OR=1.75; 95% CI: 1.39-2.21), esophageal symptoms (OR=1.74; 95% CI: 1.36-2.22), dysmotility symptoms (OR=1.43; 95% CI: 1.16-1.77) and diarrhea (OR=2.01; 95% CI: 1.65-2.45). The adjustment for socioeconomic characteristics and eating behaviors had minimal effect on the associations for abdominal pain (OR=1.34; 95% CI: 1.01-1.79), esophageal symptoms (OR=1.35; 95% CI: 1.03-1.78), and diarrhea (OR=1.86; 95% CI: 1.49-2.31); however, the association between obesity and dysmotility symptoms became non-significant. Obesity was not related to constipation. CONCLUSION Obesity is an independent risk factor for abdominal pain, esophageal symptoms and diarrhea, but is not associated with dysmotility symptoms or constipation.
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21
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The role of endoscopy in the bariatric surgery patient. Gastrointest Endosc 2015; 81:1063-72. [PMID: 25733126 DOI: 10.1016/j.gie.2014.09.044] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/11/2014] [Indexed: 12/22/2022]
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Abstract
Obesity in children has become a global pandemic during the last decade. Recent studies have reported an association between obesity and functional gastrointestinal (GI) disorders. In addition, obesity is also becoming increasingly recognized at diagnosis of organic GI diseases such as celiac disease and inflammatory bowel disease. An awareness of all possible complications and associations of obesity by the practicing physician is crucial to provide comprehensive care to obese children. This article reviews the present data on the association between obesity and various common GI disorders. The possible mechanisms and the clinical significance of this association are also discussed.
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Affiliation(s)
- Uma P Phatak
- Division of Pediatric Gastroenterology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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[Upper endoscopy findings in obese morbid patients candidates for bariatric surgery]. GASTROENTEROLOGIA Y HEPATOLOGIA 2015; 38:426-30. [PMID: 25709107 DOI: 10.1016/j.gastrohep.2015.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/03/2015] [Accepted: 01/12/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Body mass index has been associated with the presence and severity of various gastrointestinal symptoms. The aim of the study was to analyze the endoscopic findings and gastric histology of morbidly obese candidates for bariatric surgery. METHODS We retrospectively included patients undergoing bariatric surgery at the Hospital de León from March 2005 to April 2013. The findings of upper gastrointestinal endoscopy and antral histology were collected. The relationship of body mass index (BMI) with gastroscopy findings and the presence of Helicobacter pylori were assessed. RESULTS A total of 194 patients were included. An abnormality on endoscopy or antral biopsy was found in 48.7% and 78.9% of the patients, respectively. Three patients had gastric peptic ulcer, and consequently the intervention was postponed until healing. H.pylori infection was found in 63.9% of the patients. The presence of H.pylori and endoscopic findings were not related to BMI. CONCLUSION Gastroesophageal disease is common in morbidly obese patients and approximately half of the patients had some kind of alteration on endoscopy. Gastroscopy and H.pylori testing prior to surgery is required to rule out disease that could delay or contraindicate surgery.
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Varndell W, Elliott D, Fry M. Emergency nurses practices in assessing and administering continuous intravenous sedation for critically ill adult patients: a retrospective record review'. Int Emerg Nurs 2014; 23:81-8. [PMID: 25449551 DOI: 10.1016/j.ienj.2014.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/16/2014] [Accepted: 09/17/2014] [Indexed: 10/24/2022]
Abstract
AIM To generate an initial profile of emergency nurses' practices in and factors influencing the assessment and administration of continuous intravenous sedation and analgesia for critically ill mechanically ventilated adult patients. BACKGROUND Emergency nurses are relied upon to assess and manage critically ill patients, some of whom require continuous intravenous sedation. Balancing sedation is a highly complex activity. There is however little evidence relating to how emergency nurses manage continuous intravenous analgesia and sedation for the critically ill intubated patients. DESIGN Descriptive study. METHOD A 12-month retrospective medical record review was undertaken from January to December 2009 of patients (>16 years) administered continuous intravenous sedation in ED. RESULTS Fifty-five patients received ongoing intravenous sedation within the ED during a median length of stay of 3.4 h. Assessment of patient depth/quality of sedation and pain-relief varied and were rarely documented. Adverse events were documented, majority (16%) drug administration related. Thematic analysis identified three themes: 'Maintaining sedation', 'Directionless-directions', and 'Navigating the balance'. CONCLUSION Emergency nurses provide continuity of patient care and optimisation of analgesia and sedation for critically ill sedated patients. The safety and effectiveness of continuous intravenous sedation for the critically ill adult patient in ED are dependent on the expertise and decision-making abilities of the nurse.
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Affiliation(s)
- Wayne Varndell
- Prince of Wales Hospital Emergency Department, Faculty of Health, University of Technology, Sydney, Australia.
| | - Doug Elliott
- Faculty of Health, University of Technology, Sydney, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology, Sydney, Australia
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Combining laparoscopic giant paraesophageal hernia repair with sleeve gastrectomy in obese patients. Surg Endosc 2014; 29:1115-22. [DOI: 10.1007/s00464-014-3771-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 07/15/2014] [Indexed: 02/07/2023]
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26
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Prevalence of functional gastrointestinal disorders in obese and overweight children. Int J Obes (Lond) 2014; 38:1324-7. [PMID: 24781857 DOI: 10.1038/ijo.2014.67] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/20/2014] [Accepted: 04/02/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To compare the prevalence of functional gastrointestinal disorders such as functional constipation (FC), functional abdominal pain (FAP), functional abdominal pain syndrome (FAPS) and irritable bowel syndrome (IBS) between a large cohort of healthy obese/overweight children and normal-weight children. METHODS Healthy children between the ages of 4 and 18 years were eligible for recruitment from the Yale Pediatric Primary Care clinic, Yale Adolescent clinic and a local private practice in Orange, CT, USA. Study subjects or their parents were interviewed using a questionnaire based on the ROME III standardized criteria for diagnosing functional gastrointestinal disorders. Medical records were reviewed to collect information about age, gender, height, weight, body mass index (BMI), ethnicity and chronic medical conditions. Children were classified into obese, overweight and normal-weight based on their BMI for age and gender. Data were analyzed to compare the prevalence of FC, FAP, FAPS and IBS between obese/overweight children and normal-weight children. RESULTS A total of 450 children (45% males) were recruited. There were 191 (42%) obese/overweight children and 259 (58%) normal-weight children. FAPS (odds ratio (OR) =2.1, 95% confidence interval (CI): 1.21-3.64, P=0.007), FC (OR=1.83, 95% CI: 1.12-2.98, P=0.01), and IBS (OR=2.59, 95% CI: 1.40-4.79, P=0.003) were significantly more prevalent in the obese/overweight children than in the normal-weight children. Of the obese/overweight children, 47% had at least one functional gastrointestinal disorder compared with 27% of the normal-weight children (P⩽0.001). Only 36% of the children with functional gastrointestinal disorders sought medical attention for their symptoms. CONCLUSIONS Obese/overweight children have a higher prevalence of functional gastrointestinal disorders than normal-weight children. Almost half of the obese/overweight children had at least one functional gastrointestinal disorder.
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Eidy M, Pazouki A, Raygan F, Ariyazand Y, Pishgahroudsari M, Jesmi F. Functional abdominal pain syndrome in morbidly obese patients following laparoscopic gastric bypass surgery. ARCHIVES OF TRAUMA RESEARCH 2014; 3:e13110. [PMID: 25032167 PMCID: PMC4080767 DOI: 10.5812/atr.13110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 07/31/2013] [Accepted: 09/25/2013] [Indexed: 01/01/2023]
Abstract
Background: Roux-en-Y gastric bypass surgery (RYGBP) is one of the most common bariatric surgeries, which is being performed using various techniques like gastrojejunostomy by hand swen, linear or circular stapler. Abdominal pain is a common complaint following laparoscopic gastric bypass procedure (LGBP), which has different aetiologies, such as overeating, adhesion, internal herniation, bile reflux and many more. In this study LGBP was performed in an ante-colic ante-gastric pattern in a double loop manner and the prevalence and distribution of pain in morbidly obese patients undergoing LGBP was assessed. Objectives: The aim of this study was to analyze the distribution and frequency of post LGBP pain in morbidly obese patients. Patients and Methods: This study was performed on 190 morbidly obese patients referred to Hazrat Rasoul Hospital in Tehran. After LGBP, pain was measured in the following intervals: 24 hours, one week and one month after the operation. Before the operation onset, 2 mg Keflin and 5000 IU subcutaneous heparin were administered as prophylaxis. LGBP was performed using five ports including: one 11 mm port was placed 15-20 cm far from the xiphoid, one 12-mm port in mid-clavicular line at the level of camera port, one 5-mm port in subcostal area in ante-axillary region in the left, another 5-mm port in the right mid-clavicular area and a 5-mm port in sub-xyphoid. All operations were done by the same team. Staple was used for all anastomoses and hand sewn technique to close the staple insertion site. The mesenteric defect was left open and no effort was made to repair it. Results: The results of this study showed that 99.94 % of the patients had complains of pain in the first 24 hours of post operation, about 60% after one week and 29.5 % still had pain after one month. In addition, left upper quadrant (LUQ) was found to be the most prevalent site for the pain in 53.7% of the patients in the first 24 hours, 59.6% after one week and 16.8% after one month (except for obscure pain) with a significance of < 0.05. Conclusions: In this study, the authors analyzed the location and disturbance level of pain after LGBP, which could serve as a cornerstone for further researches. The authors suggest that long-term follow-up (for more than a year after operation) should be considered in future studies and also the relationship between the drainage site and pain should be investigated.
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Affiliation(s)
- Mohammad Eidy
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Minimally Invasive Surgery Research Centre, Iran University of Medical Sciences, Tehran, IR Iran
| | - Abdolreza Pazouki
- Minimally Invasive Surgery Research Centre, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Abdolreza Pazouki, Minimally Invasive Surgery Research Centre, Hazrat Rasoul Hospital, Iran University of Medical Sciences, Tehran, IR Iran. Tel/Fax: + 98-2166555447, E-mail:
| | - Fahimeh Raygan
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Yazdan Ariyazand
- Minimally Invasive Surgery Research Centre, Iran University of Medical Sciences, Tehran, IR Iran
| | | | - Fatemeh Jesmi
- Minimally Invasive Surgery Research Centre, Iran University of Medical Sciences, Tehran, IR Iran
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Abstract
Weight loss is a recognized alarm symptom for organic gastrointestinal (GI) disease, yet the association between obesity and specific GI symptoms remains poorly described. A meta-analysis was conducted to determine which GI symptoms predominate among obese individuals. A search of the literature using the databases MEDLINE, EMBASE PubMed and Current Contents (1950 - November 2011) was conducted. All studies assessing GI symptoms and increasing body mass index (BMI)/obesity were included. English and non-English articles were searched. A random effect model of the studies was undertaken. Overall, significant associations between GI symptoms and increasing BMI were found for upper abdominal pain (odds ratio [OR] = 2.65, 95% confidence interval [CI]: 1.23-5.72), gastroesophageal reflux (OR = 1.89, 95% CI: 1.70-2.09), diarrhoea (OR = 1.45, 95% CI: 1.26-1.64), chest pain/heartburn (OR = 1.74, 95% CI: 1.49-2.04), vomiting (OR = 1.76, 95% CI: 1.28-2.41), retching (OR = 1.33, 95% CI: 1.01-1.74) and incomplete evacuation (OR = 1.32, 95% CI: 1.03-1.71). However, no significant associations were found for all abdominal pain, lower abdominal pain, bloating, constipation/hard stools, fecal incontinence, nausea and anal blockage. Several key GI symptoms are associated with increasing BMI and obesity. In addition, there were a number of other GI symptoms that had no relationship with obesity. A greater knowledge of the GI symptoms associated with obesity along with the physiology will be important in the clinical management of these patients.
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Affiliation(s)
- G D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia.
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Greenstein AJ, O'Rourke RW. Abdominal pain after gastric bypass: suspects and solutions. Am J Surg 2011; 201:819-27. [PMID: 21333269 DOI: 10.1016/j.amjsurg.2010.05.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 05/21/2010] [Accepted: 05/21/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastric bypass remains the mainstay of surgical therapy for obesity. Abdominal pain after gastric bypass is common and accounts for up to half of all postoperative complaints and emergency room visits. This article reviews the most important causes of abdominal pain specific to gastric bypass and discusses management considerations. METHODS The current surgical literature was reviewed using PubMed, with a focus on abdominal pain after gastric bypass and the known pathologies that underlie its pathogenesis. RESULTS The etiologies of abdominal pain after gastric bypass are diverse. A thorough understanding of their pathogenesis impacts favorably on clinical outcomes. CONCLUSIONS The differential diagnosis for abdominal pain after gastric bypass is large and includes benign and life-threatening entities. Its diverse causes require a broad evaluation that should be directed by history and clinical presentation. In the absence of a clear diagnosis, the threshold for surgical exploration in patients with abdominal pain after gastric bypass should be low.
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Affiliation(s)
- Alexander J Greenstein
- Department of Surgery, Oregon Health and Science University, Portland, OR 97239-3098, USA
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Eslick GD. Prevalence and epidemiology of gastrointestinal symptoms among normal weight, overweight, obese and extremely obese individuals. Gastroenterol Clin North Am 2010; 39:9-22. [PMID: 20202575 DOI: 10.1016/j.gtc.2009.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Until recently, the epidemiology of gastrointestinal (GI) symptoms had not been adequately studied in relation to increasing body mass index. To date there are only a few studies in the literature, and thus the relationship between obesity and specific GI symptoms is poorly understood. Future studies that incorporate different ethnicities from varied geographic locations are urgently required. A greater understanding of how GI symptoms are related to obesity and the physiology will be important in the clinical management of these patients.
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Affiliation(s)
- Guy D Eslick
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
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Ballem N, Yellumahanthi K, Wolfe M, Wesley MM, Clements RH. Gastrointestinal symptom improvement after Roux-en-Y gastric bypass: long-term analysis. Surg Obes Relat Dis 2009; 5:553-8. [DOI: 10.1016/j.soard.2008.11.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2008] [Revised: 10/17/2008] [Accepted: 11/23/2008] [Indexed: 12/22/2022]
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Merchant AM, Cook MW, Srinivasan J, Davis SS, Sweeney JF, Lin E. Comparison between Laparoscopic Paraesophageal Hernia Repair with Sleeve Gastrectomy and Paraesophageal Hernia Repair Alone in Morbidly Obese Patients. Am Surg 2009. [DOI: 10.1177/000313480907500716] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treatment options for morbidly obese patients with complications from large paraesophageal hernias (PEH) are limited. Simple repair of the PEH has a high recurrence rate and may be associated with poor gastric function. We compared a series of patients who underwent repair of large PEH plus gastrostomy tube gastropexy (PEH-GT) with PEH plus sleeve gastrectomy (PEHSG). Retrospective review of patients undergoing PEH-SG and patients with PEH-GT was performed. We assessed symptoms of delayed gastric emptying and reflux postoperatively. In selected patients, gastric-emptying studies and upper gastrointestinal contrast studies were also obtained. All patients with large PEH were repaired laparoscopically with sac resection, primary crural closure using pledgeted sutures, and biologic patch onlay. SG for patients undergoing concomitant weight loss surgery (PEH-SG) was performed with linear endoscopic staplers and staple line reinforcement. Patients undergoing PEH repair alone had a gastrostomy tube gastropexy (PEH-GT). Patients had intraoperative endoscopic evaluation and postoperative contrast swallow studies. In a 12-month period, five patients underwent laparoscopic PEH-SG; two of five had previous antireflux surgery and one of five with a previous diagnosis of delayed gastric emptying. Postoperatively, two patients undergoing PEH-SG had readmission for dehydration and odynophagia. Six-month follow-up body mass index was 32 kg/m2 for the PEH-SG group with no hernia recurrence and complete resolution of gastroesophageal reflux disorder symptoms. Six patients underwent PEH-GT, one for acute incarceration and anemia and four with previous antireflux surgery. Follow up at 8 months demonstrated one recurrence, four of six had severe delayed gastric emptying and reflux, three of six had additional hospitalization for poor oral intake, and three of six underwent reoperation for delayed gastric emptying. There were no perforations, leaks, or deaths in either group. Combined laparoscopic PEH-SG is a clinically reasonable option for patients with morbid obesity with minimal additional risks and decreased incidence of delayed gastric emptying, reflux, and reoperation.
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Affiliation(s)
- Aziz M. Merchant
- Department of Surgery, Emory Endosurgery Unit, Emory University, Atlanta, Georgia
| | - Michael W. Cook
- Department of Surgery, Emory Endosurgery Unit, Emory University, Atlanta, Georgia
| | - Jahnavi Srinivasan
- Department of Surgery, Emory Endosurgery Unit, Emory University, Atlanta, Georgia
| | - S. Scott Davis
- Department of Surgery, Emory Endosurgery Unit, Emory University, Atlanta, Georgia
| | - John F. Sweeney
- Department of Surgery, Emory Endosurgery Unit, Emory University, Atlanta, Georgia
| | - Edward Lin
- Department of Surgery, Emory Endosurgery Unit, Emory University, Atlanta, Georgia
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Obesity is related to multiple functional abdominal diseases. J Pediatr 2009; 154:444-6. [PMID: 19874760 DOI: 10.1016/j.jpeds.2008.09.053] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 09/03/2008] [Accepted: 09/29/2008] [Indexed: 12/13/2022]
Abstract
Analysis of the body mass index of pediatric patients with gastrointestinal complaints as a whole and by disease subgroup revealed a greater percentage of obese patients with constipation, gastroesophageal reflux, irritable bowel syndrome, encopresis, and functional abdominal pain compared with local and New Jersey control populations.
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Anderson MA, Gan SI, Fanelli RD, Baron TH, Banerjee S, Cash BD, Dominitz JA, Harrison ME, Ikenberry SO, Jagannath SB, Lichtenstein DR, Shen B, Lee KK, Van Guilder T, Stewart LE. Role of endoscopy in the bariatric surgery patient. Gastrointest Endosc 2008; 68:1-10. [PMID: 18577471 DOI: 10.1016/j.gie.2008.01.028] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 01/16/2008] [Indexed: 12/13/2022]
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35
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Nelson LG, Gonzalez R, Haines K, Gallagher SF, Murr MM. Amelioration of Gastroesophageal Reflux Symptoms following Roux-en-Y Gastric Bypass for Clinically Significant Obesity. Am Surg 2005. [DOI: 10.1177/000313480507101109] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Symptoms of gastroesophageal reflux disease (GERD) are frequent in patients with clinically significant obesity and are reported to improve after Roux- en-Y gastric bypass (RYGB). The purpose of this study is to determine timing and duration of improvement of GERD symptoms in patients undergoing RYGB. Prospectively collected data from patients who underwent RYGB from January 1998 to August 2004 were analyzed. Patients answered a standardized questionnaire pre- and postoperatively inquiring about frequency of GERD symptoms (none, one episode/week, one episode/day, more than one episode/day) and medication use. Of 606 patients undergoing RYGB, 239 patients (39%) reported GERD symptoms preoperatively (mean age 43 ± 1 years; body mass index 51 ± 1 kg/m2). Of these, 89 per cent of patients reported improved at 3 months post-op and 94 per cent of patients 9 months post-op ( P < 0.001). Medication usage decreased from 30 per cent to 3 per cent by 3 months and 5 per cent beyond 9 months ( P < 0.001). Percentage of excess weight loss was 18 ± 1 per cent and 75 ± 2 per cent at 3 and 9 months, respectively. Symptoms of GERD significantly improve and use of antireflux medications is reduced after RYGB independent of weight loss. RYGB may be the treatment of choice for GERD in obese patients.
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Affiliation(s)
- Lana G. Nelson
- Department of Surgery, Interdisciplinary Obesity Treatment Group, University of South Florida Health Sciences Center, Tampa, Florida
| | - Rodrigo Gonzalez
- Department of Surgery, Interdisciplinary Obesity Treatment Group, University of South Florida Health Sciences Center, Tampa, Florida
| | - Krista Haines
- Department of Surgery, Interdisciplinary Obesity Treatment Group, University of South Florida Health Sciences Center, Tampa, Florida
| | - Scott F. Gallagher
- Department of Surgery, Interdisciplinary Obesity Treatment Group, University of South Florida Health Sciences Center, Tampa, Florida
| | - Michel M. Murr
- Department of Surgery, Interdisciplinary Obesity Treatment Group, University of South Florida Health Sciences Center, Tampa, Florida
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Kim HN, Vorona RD, Winn MP, Doviak M, Johnson DA, Ware JC. Symptoms of gastro-oesophageal reflux disease and the severity of obstructive sleep apnoea syndrome are not related in sleep disorders center patients. Aliment Pharmacol Ther 2005; 21:1127-33. [PMID: 15854175 DOI: 10.1111/j.1365-2036.2005.02447.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Studies suggest obstructive sleep apnea syndrome (OSAS) frequently manifests in patients with gastroesophageal reflux disease (GERD) and that there may be a causal relationship. AIM To determine the relationship between OSAS and symptoms of GERD. METHODS Consecutive patients referred to the Sleep Disorders Center (SDC) 18 years and older with polysomnographically defined OSAS were evaluated prospectively for GERD using a validated symptoms questionnaire. The GERD and OSAS relationship was assessed by 1) determining frequency of GERD in patients with and without OSAS; 2) ascertaining the relationship between OSAS severity categories and presence of GERD; 3) examining GERD score in relation to those factors that might affect both GERD and OSAS, e.g. obesity. RESULTS One thousand and twenty-three SDC patients met entry criteria. Amongst participants, GERD was common (29% of women and 17% of males) and OSAS extremely common (58% of women and 80% of males). GERD score did not correlate with OSAS variables. The severity of OSAS did not influence the prevalence of GERD. CONCLUSION In a large group of patients referred to a sleep disorders center, there was no relationship between OSAS and GERD symptoms. Also, there was no relationship between the severity of OSAS and the likelihood of GERD symptoms.
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Affiliation(s)
- H-N Kim
- Department of Internal Medicine, University of Virginia, Charlottesville, VA, USA
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Orr WC, Heading R, Johnson LF, Kryger M. Review article: sleep and its relationship to gastro-oesophageal reflux. Aliment Pharmacol Ther 2004; 20 Suppl 9:39-46. [PMID: 15527463 DOI: 10.1111/j.1365-2036.2004.02239.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gastro-oesophageal reflux disease (GERD) is among the most common gastrointestinal conditions in the USA. For most symptomatic patients, reflux events occur during both daytime and night-time hours. Whereas daytime reflux events tend to be frequent but brief, reflux events that occur during sleep are comparatively less frequent but significantly longer. Longer oesophageal acid-clearance and acid-mucosal contact times during sleep are at least partly due to several physiological changes associated with sleep, including dramatic declines in saliva production and frequency of swallowing, decreased conscious perception of heartburn and consequent arousal and clearance behaviours, and slower gastric emptying. Obstructive sleep apnea syndrome and obesity seem to predispose some patients to nocturnal GERD, and the presence of either of these conditions may help to identify patients with symptoms consistent with GERD. Recognition and treatment of night-time GERD are important because it can be associated with decreased quality of life (including sleep disruption) and increased risk of serious oesophageal and respiratory complications.
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Affiliation(s)
- W C Orr
- Lynn Health Science Institute, Oklahoma City, Oklahoma 73112, USA.
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Talley NJ, Quan C, Jones MP, Horowitz M. Association of upper and lower gastrointestinal tract symptoms with body mass index in an Australian cohort. Neurogastroenterol Motil 2004; 16:413-9. [PMID: 15305996 DOI: 10.1111/j.1365-2982.2004.00530.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Food modulates gastrointestinal (GI) function and GI symptoms could alter food intake, but it is not established whether or not obese people experience more or less GI symptoms. We aimed at evaluating the association between body mass index (BMI) and specific GI symptoms in the community. Population-based random samples from Sydney, Australia (n = 777) completed a validated questionnaire. The association of each GI symptom with BMI (kg m(-2)) categories was assessed using logistic regression analysis adjusting for potential confounders. The prevalence of obesity (BMI > or =30 kg m(-2)) was 22%. There were univariate associations (adjusting for age, sex, education level, alcohol and smoking) between increased BMI category and heartburn (OR = 1.9, 95% CI 1.4, 2.5), acid regurgitation (OR = 2.1, 95% CI 1.4, 2.9), increased bloating (OR = 1.3, 95%CI 1.1, 1.6), increased stool frequency (OR = 1.4, 95% CI 1.1, 1.7), loose and watery stools (OR = 1.5, 95% CI 1.1, 2.0) and upper abdominal pain (OR = 1.3, 95% CI 1.03, 1.6). Early satiety was associated with a lower BMI category but this was not significant after adjustment (OR = 0.8, 95% CI 0.6, 1.1). Lower abdominal pain, postprandial fullness, nausea and vomiting were not associated with BMI category. In a regression model adjusting for sex, education, smoking, alcohol and all GI symptoms, older age, less early satiety and increased stool frequency and heartburn were all independently associated with increasing BMI (all P < 0.01). Heartburn and diarrhoea were associated with increased BMI, while early satiety was associated with a lower BMI in this population.
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Affiliation(s)
- N J Talley
- Clinical Enteric Neuroscience Translational and Epidemiological Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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