Long-term irritable bowel syndrome symptom control with reintroduction of selected FODMAPs

To investigate the long-term effect of dietary education on a low fermentable oligosaccharide, disaccharide and polyol (FODMAP) diet on irritable bowel syndrome (IBS) symptoms and quality of life (QoL). METHODSParticipants with IBS (Rome III) were randomized to two groups. Group I commenced a low FODMAP diet at baseline. At three months, group II, so far a comparator group, crossed over to a low FODMAP diet while group I started re-challenging foods. All patients completed the IBS SSS (IBS symptom severity scoring system, 0-500 points increasing with severity), IBS QoL questionnaire (0-100 increasing with QoL), a FODMAP specific food frequency questionnaire and provided a stool sample at baseline, three and six months for microbiome analysis. RESULTSFifty participants were enrolled into group I (n = 23) or group II (n = 27). Participants in both groups were similar in baseline values but with more men in group I. There was a significantly lower IBS SSS (275.6 ± 63.6 to 128.8 ± 82.5 vs 246.8 ± 71.1 to 203.6 ± 70.1) (P < 0.0002) and increased QoL (68.5 ± 18.0 to 83 ± 13.4 vs 72.9 ± 12.8 to 73.3 ± 14.4) (P < 0.0001) in group I vs group II at 3 mo. The reduced IBS SSS was sustained at 6 mo in group I (160 ± 102) and replicated in group II (124 ± 76). Fiber intake decreased on the low FODMAP diet (33 ± 17 g/d to 21 ± 8 g/d) (P < 0.01) and after re-introducing FODMAP containing foods increased again to 27 ± 9 g/d. There was no change seen in the intestinal microbiome when participants adopted a low FODMAP diet. CONCLUSIONThis study demonstrated that a reduction in FODMAPs improves symptoms in IBS and this improvement can be maintained while reintroducing FODMAPs.

Prevalence and knowledge of hepatitis C in a middle-aged population,Dunedin,New Zealand

AIM:To determine the prevalence of infection with hepatitis C virus(HCV) in those most at risk of advanced liver disease and to identify gaps in knowledge of HCV.METHODS: Questionnaires were mailed to randomly selected residents aged 40-59 to assess the extent of their general knowledge about HCV. The questionnaire assessed demographics, the extent of general knowledge about viral hepatitis, potential risks for infection and the prevalence of risk factors associated with increased progression of liver fibrosis. Anonymised residual laboratory blood samples from 40-59 years old people from Dunedin taken in hospital or in the community, were tested for HCV antibodies and alanine transaminase(ALT), aspartate transaminase(AST), gamma-glutamyl transpeptidase(GGT). Linear regression was performed to examine whether the demographics sex, age, socio-economic status, qualification level and occupation sector(categorical variables) were predictors of level of general knowledge about hepatitis. For the demographics that werefound to be significant predictors of score outcome, multiple regression analysis was used to determine independent effects. χ2 tests were used to compare our selected sample and our responder population demographics, to the demographics of the entire 40-59 years old population in Dunedin using the 2006 NZ census data. Exact confidence intervals for the proportion positive for HCV and HBV were calculated using the binomial distribution.RESULTS: The response rate to the mailed questionnaire was 431/1400(30.8%). On average 59.4% questions were answered correctly. Predictors for higher scores, indicating greater knowledge about symptoms and transmission included sex(female, P < 0.01), higher level of qualification(P < 0.000) and occupation sector(P < 0.000). Sharing intravenous drug utensils was a known risk factor for disease transmission(94.4%), but the sharing of common household items such as a toothbrush was not. 93% of the population were unaware that HCV infection can be asymptomatic. 25% did not know that treatment was available in New Zealand and of those who did know, only 40% assumed it was funded. Six hundred and eighty-two residual anonymised blood samples were tested for HCV antibodies, ALT, AST and GGT. The prevalence for HCV was 4.01%, 95%CI: 2.6%-5.8%. Liver function tests were not useful for identifying likelyhood of HCV infection.CONCLUSION: Prevalence of HCV in our population is high, and the majority have limited knowledge of HCV and its treatment.

Is the advantage of coronary bypass graft surgery over percutaneous coronary intervention in diabetic patients with severe multivessel disease influenced by the status of insulin requirement？

Several studies have shown that coronary artery bypass graft surgery （CABG） is superior to percutaneous coronary intervention （PCI） in patients with diabetes and multi-vessel disease. Whether this advantage of CABG over PCI is confined to diabetics who require insulin is unknown. We review the published literature comparing CABG with PCI in diabetics including 8 cohorts and 4,786 patients. There was a lower rate for all-cause mortality （Relative risk （RR）： 0.78, 95% confidence interval （CI）： 0.62-0.99）, and for major adverse cardiac and cerebrovascular events （MACCE, RR： 0.59, 95% CI： 0.47-0.75） for CABG compared to PCI. Composite outcome of mortality, myocardial infarction and stoke was similar between CABG and PCI （RR： 0.87, 95% CI： 0.54-1.42）. Visual inspection of the forest plots showed that in most analyses, the point estimates of the RR are similar between the insulin requiring group and non-insulin requiring group. On meta-regression, there was no interaction between status of insulin requirement and revascularization strategies （P 〉 0.05 for all）. The pre- sented data on the still unpublished analysis of the FREEDOM trial showed similar results. Thus, in the current era, CABG is superior to PCI with lower mortality and MACCE rates, but the state of insulin requirement had no effect on the outcomes from the two revascularization strategies.