Ileocecal valve dysfunction in small intestinal bacterial overgrowth: A pilot study

AIM: To explore whether patients with a defective ileocecal valve (ICV)/cecal distension reflex have small intestinal bacterial overgrowth. METHODS: Using a colonoscope, under conscious sedation, the ICV was intubated and the colonoscope was placed within the terminal ileum (TI). A manometry catheter with 4 pressure channels, spaced 1 cm apart, was passed through the biopsy channel of the colonoscope into the TI. The colonoscope was slowly withdrawn from the TI while the manometry catheter was advanced. The catheter was placed across the ICV so that at least one pressure port was within the TI, ICV and the cecum respectively. Pressures were continuously measured during air insufflation into the cecum, under direct endoscopic visualization, in 19 volunteers. Air was insufflated to a maximum of 40 mmHg to prevent barotrauma. All subjects underwent lactulose breath testing one month after the colonoscopy. The results of the breath tests were compared with the results of the pressures within the ICV during air insufflation. RESULTS: Nineteen subjects underwent colonoscopy with measurements of the ICV pressures after intubation of the ICV with a colonoscope. Initial baseline readings showed no statistical difference in the pressures of the TI and ICV, between subjects with positive lactulose breath tests and normal lactulose breath tests. The average peak ICV pressure during air insufflation into the cecum in subjects with normal lactu-lose breath tests was significantly higher than cecal pressures during air insufflation (49.33 ± 7.99 mmHg vs 16.40 ± 2.14 mmHg, P = 0.0011). The average percentage difference of the area under the pressure curve of the ICV from the cecum during air insufflations in subjects with normal lactulose breath tests was significantly higher (280.72% ± 43.29% vs 100% ± 0%, P = 0.0006). The average peak ICV pressure during air insufflation into the cecum in subjects with positive lactulose breath tests was not significantly different than cecal pressures during air insufflation 21.23 ± 3.52 mmHg vs 16.10 ± 3.39 mmHg. The average percentage difference of the area under the pressure curve of the ICV from the cecum during air insufflation was not significantly different 101.08% ± 7.96% vs 100% ± 0%. The total symptom score for subjects with normal lactulose breath tests and subjects with positive lactu-lose breath tests was not statistically different (13.30 ± 4.09 vs 24.14 ± 6.58). The ICV peak pressures during air insufflations were significantly higher in subjects with normal lactulose breath tests than in subjects with positive lactulose breath tests (P = 0.005). The average percent difference of the area under the pressure curve in the ICV from cecum was significantly higher in subjects with normal lactulose breath tests than in subjects with positive lactulose breath tests (P = 0.0012). Individuals with positive lactulose breath tests demonstrated symptom scores which were significantly higher for the following symptoms: not able to finish normal sized meal, feeling excessively full after meals, loss of appetite and bloating. CONCLUSION: Compared to normal, subjects with a positive lactulose breath test have a defective ICV cecal distension reflex. These subjects also more commonly have higher symptom scores.

Predictors of colorectal cancer testing using the California Health Inventory Survey

AIM:To identify key variables associated with colon cancer testing using the 2009 California Health Inventory Survey(CHIS).METHODS:The CHIS has been conducted biennially since 2001 using a two-stage,geographically stratified random-digit-dial sample design to produce a representative sample of the entire State.For this study we used survey data from 2001-2009 inclusive.We restricted our analysis to White,Black,and Hispanic/Latinos aged 50-80 years.Weighted data was used to calculate the proportion of participants who underwent some form of colon cancer testing(colonoscopy,flexible sigmoidoscopy or fecal occult blood testing) within the previous 5 years stratified by race/ethnicity.For inferential analysis,boot-strapping with replacement was performed on the weighted sample to attain variance estimates at the 95%CI.For mean differences among categories we used t-tests and for comparisons of categorical data we used Pearson's χ 2.Binary logistic regression was used to identify independent variables associated with undergoing some form of testing.Trend analysis was performed to determine rates of testing over the study period stratified by race.RESULTS:The CHIS database for 2009 had 30 857 unique respondents corresponding to a weighted sample size of 10.6 million Californians.Overall,63.0%(63.0-63.1) underwent a colon cancer test within the previous 5 years;with 70.5%(70.5%-70.6%) of this subset having undergone colonoscopy.That is 44.5%(44.4%-44.5%) of all individuals 50-80 underwent colonoscopy.By multivariable regression,those tested were more likely to be male(OR = 1.06;95%CI:1.06-1.06),Black(OR = 1.30;95%CI:1.30-1.31),have a family member with colon cancer(OR = 1.71;95%CI:1.70-1.72),and have health insurance(OR = 2.71;95%CI:2.70-2.72).Progressive levels above the poverty line were also associated with receiving a test(100%-199%:1.21;1.20-1.21),(200%-299%:1.41;1.40-1.42),(> 300:1.69;1.68-1.70).The strongest variable was physician recommendation(OR = 3.90;95%CI:3.88-3.91).For the Hispanic/Latino group,additional variables associated with testing were success of physician-patient communication(OR = 2.44;95%CI:2.40-2.48) and naturalized citizenship status(OR = 1.91;95%CI:1.89-1.93).Trend analysis demonstrated increased colon cancer testing for all racial/ethnic subgroups from 2001-2009 although the rate remained considerably lower for the Hispanic/Latino subgroup.CONCLUSION:Using CHIS we identified California citizens most likely to undergo colon cancer testing.The strongest variable associated with testing for all groups was physician recommendation.