Symptoms and dietary practices of irritable bowel syndrome patients compared to controls: results of a USA national survey.

BACKGROUND: Little is known regarding the dietary behaviors and epidemiology of irritable bowel syndrome (IBS) patients in the USA. METHODS: This was an IRB-approved cross-sectional survey conducted via a secured online server (SurveyMonkey®). A representative sample of the US population was queried regarding demographics, gastrointestinal (GI) symptoms, treatments and dietary practices. Of 1718 respondents, 161 reported IBS. These were compared to 1116 subjects reporting no GI diagnosis (controls). RESULTS: Overall, 9% reported a diagnosis of IBS. When compared to controls, IBS patients were more likely over 45 years (P<0.001) and female (P<0.001). IBS patients more frequently noted abdominal pain, constipation, diarrhea, gas/bloating and GERD/heartburn (all P<0.001) than controls. Regarding therapeutic measures, IBS patients were more likely to cite food avoidance, over-the-counter remedies, probiotics, consultation with doctor/dietitian, and prescriptions (all P<0.001). However, they were less likely to believe their strategies were effective. While the majority of subjects believed food contributed to their symptoms, those with IBS listed more dietary triggers. IBS patients were more likely to follow a dietary 'plan' with 21% citing lactose-free, 17% gluten-free and 9% low-FODMAP (all P<0.001). Nevertheless, 47% with IBS denied following any dietary plans. A minority, (24%), of IBS patients was aware of the low-FODMAP diet. CONCLUSIONS: In this US survey, IBS was reported by 9% of the population, most often females over 45 years. IBS patients were more likely to implement therapeutic strategies and cite food triggers, yet few were aware of the low-FODMAP diet. Outreach programs could improve awareness of this substantiated intervention.

Covered Esophageal Stenting Is Effective for Symptomatic Gastric Lumen Narrowing and Related Complications Following Laparoscopic Sleeve Gastrectomy.

BACKGROUND AND STUDY AIMS: Laparoscopic sleeve gastrectomy (LSG) is gaining popularity in treating morbid obesity. Prior studies showed a 3.5% risk of gastric sleeve stenosis (GSS). There is no consensus on how to treat these patients, and the role of endoscopic therapy has been addressed in only a few studies. We aim to assess the efficacy and safety of endoscopic stenting in the management of GSS following LSG. PATIENTS AND METHODS: Retrospective data were reviewed from July 2009 to November 2013. Patients were referred for endoscopic therapy for symptoms or imaging findings suggestive of gastric leak or narrowing following LSG. Endoscopic therapy included the use of fully covered self-expanding esophageal metal stents (FCSEMS) in addition to over-the-scope clip system (OTSC) when necessary. RESULTS: All 27 patients were females with mean age of 40 years; six patients were excluded from the study. Major symptom was nausea and vomiting in 57% of the patients. Five of 21 patients had concomitant leaks. All 21 patients underwent FCSEMS placement, and four out of five patients (80%) with concomitant leak had OTSC. The success rate in both groups for resolution of stricture and leak was 100%, and no surgical intervention was required. There were no immediate or delayed complications of endoscopic therapy. Median follow-up of 6 months was available for 20/21 patients. Among patients with gastric leak, 80% had resolution of their symptoms compared with 93% of patients with GSS. CONCLUSIONS: Endoscopic therapy for LSG-related GSS or leaks with FCSEMS is highly effective and safe.