Post-traumatic Stress Disorder Is Associated With Irritable Bowel Syndrome in African Americans.

BACKGROUND/AIMS: Psychosocial stressors likely play an important role in irritable bowel syndrome (IBS). The association between IBS and post-trau-matic stress disorder (PTSD) in non-minorities has been described. Our aim was to investigate the potential association between IBS and PTSD in an urban African American population. METHODS: Our institution maintains a longitudinal population-based survey of African Americans (AA). The survey utilizes a complex, stratified sampling design. The study group consisted of adult AA meeting Rome III criteria for IBS of any subtype. The 4-item Primary Care PTSD screener was administered; score of≥ 3 (range, 0-4) was considered positive for PTSD. Depression (Public Health Questionnaire-9 depression) and anxiety (generalized anxiety disorder-7) levels were measured using standardized scales. To assess quality of life, norm-based physical and mental component summary scores from the short-form 36 health survey ver-sion 2 were obtained. Descriptive and inferential statistics were calculated using Complex Sample Module of SPSS after weight-ing of the study sample. RESULTS: Four hundred nineteen subjects included corresponded to a weighted 21,264 (95% CI, 19,777-22,751) individuals. The preva-lence of IBS in our sample of urban AA was 8.2%. In multivariate regression analysis, female gender, age > 40, higher educa-tional attainment and divorce were independently associated with IBS. Those with IBS were considerably more likely to suffer from PTSD (OR, 4.54; 95% CI, 4.07-5.06). PTSD was independently associated with depression, anxiety, harmful drinking and substance abuse. CONCLUSIONS: In AA, PTSD is independently associated with IBS. PTSD has a significantly negative impact on physical and mental self-assess-ment of quality of life. Evaluation of minorities presenting with functional gastrointestinal disorders should include screening for PTSD.(J Neurogastroenterol Motil 2014;20:523-530).

The impact of functional constipation on quality of life of middle-aged Black Americans: a prospective case-control study.

PURPOSE: To quantify the impact of constipation on health-related quality of life (HRQoL) in Black Americans. METHODS: Case-control design. Black subjects referred for colon cancer screening with a Bristol Stool Score of 3-5 for >75% of bowel movements served as controls. Frequency-matched functional constipation subjects had to fulfill Rome III criteria. Both groups completed demographic and health surveys. Short Form-36 assessed HRQoL. RESULTS: We recruited 102 constipated patients and 100 controls. The groups were well matched demographically. After adjustment for comorbidities, SF-36 scores for vitality, bodily pain, social functioning, and role-emotional were significantly lower in constipated patients. Unadjusted physical and mental component summary scores (PCS and MCS) were significantly higher in the control group (47.1 ± 10.6 vs. 43.3 ± 8.6; P = 0.005 and 50.6 ± 12.4 vs. 43.4 ± 11.8; P < 0.001, respectively). After adjustment for comorbidities, PCS differences were no longer significant (P = 0.54); however, MCS differences were significant (P = 0.004). Marginal mean scores for the MCS for controls and constipated subjects were 49.9 ± 1.2 and 43.6 ± 1.2, respectively. The presence of a comorbidity was independently associated with PCS (P < 0.001) and MCS (P = 0.026) results. CONCLUSIONS: Functional constipation has a significant impact on HRQoL in middle-aged Black Americans, particularly in regard to mental well-being.

Botulinum toxin A for the treatment of delayed gastric emptying.

BACKGROUND: Observational data suggest that intrapyloric injection of botulinum toxin A (BoTN/A) reduces symptoms and accelerates gastric emptying in idiopathic and diabetic gastroparesis. Our purpose was to determine whether botulinum toxin improves symptoms to a significantly greater extent than placebo. An additional objective was to determine whether there is an acceleration of gastric emptying after injection. METHODS: A single-institution, randomized, double-blind, placebo-controlled trial* was done. Eligible patients had a Gastroparesis Cardinal Symptom Index score > or = 27 with randomization to intrapyloric botulinum toxin, 200 U (units), or saline placebo. Reassessment of symptoms and repeat gastric emptying scan at 1-month follow-up were done. RESULTS: Thirty-two patients were randomized to botulinum toxin (N = 16) and placebo (N = 16). At 1-month follow-up, 37.5% randomized to botulinum toxin and 56.3% randomized to placebo achieved improvement as defined by this study. There were no identifiable clinical predictors of response. The botulinum toxin group demonstrated improvement in gastric emptying; however, this was not superior to placebo. No serious adverse events were attributable to botulinum toxin. CONCLUSIONS: Intrapyloric injection of botulinum toxin improves gastric emptying in patients with gastroparesis, although this benefit was not superior to placebo at 1 month. Also, in comparison to placebo, symptoms do not improve significantly by 1 month after injection. Overall, we are unable to recommend botulinum toxin therapy for widespread use in the treatment of delayed gastric emptying until more data are available.