*Data are shown as mean±SD

W1017

How Do IBD Patients Search for Information on Their Disease? FindingsWithin a National Clinical Cohort StudyValérie Pittet, Christelle Despont-Gros, Bernard Burnand, Florian Froehlich, PascalJuillerat, John-Paul Vader

Introduction Inflammatory bowel disease (IBD) is a chronic condition affecting relativelyyoung patients. It is unclear how these patients search for information on their disease. Thegoal of this survey was therefore to consider patient input in order to develop a specificwebsite by identifying relevant target information more precisely. Methods The Swiss Inflam-matory Bowel Disease Cohort (SIBDC) started in Nov. 2006 and has enrolled nearly 1600patients in university centers, regional hospitals and private practices. Two short question-naires were sent to all the patients in the cohort. The first, a short one-page questionnaire,was used to identify current information resources used by patients to gather informationabout disease. The second was a narrative questionnaire, used to identify which kind ofspecific information patients were seeking. The questionnaire was divided into 4 parts, eachfocusing on a different phase of disease history: 1st symptoms, time of diagnosis, worseningof disease and disease remission. Results Questionnaires were sent to the 1566 IBD patientsenrolled in the cohort from Nov. 2006 to Sep. 2009. 64 were excluded (wrong address).681 patients (45%) replied. The characteristics of those who responded were quite similarto the whole cohort. Information sources consulted to gather information on their diseasewere: gastroenterologist (90%), internet (67%), family doctor (38%), books (30%), TV (17%)and patient associations (13%). 586 (86%) patients accessed the internet at home or atwork, 60% having access on a daily basis. The information currently sought by patients onwebsites was advances in research (37%), therapies (especially adverse effects of therapyand alternative medicine) (25%) and daily disease management tips (15%). Patients soughtinformation at the time of their initial symptoms, mainly through physicians or the internet;48% were satisfied with what they found. 80% of patients sought information just afterinitial diagnosis, 74% during flares or complications and 65% in periods of remission. Themain information topic consulted during relapses concerned therapies (41% of patients whoare seeking information); during periods of disease remission it was mostly linked to advancesin research (44%). Conclusion This survey performed in a large national IBD cohort reportsfor the first time on how patients look for information on their chronic disease. Gastroenterol-ogists and the internet are the main sources of information. These results will facilitate thecreation of an information website tailored to patients' needs.

W1018

Relationship Between the Location of Colonic Diverticulosis and the VisceralFat Accumulation. Crucial Role of the Visceral Fat Accumulation for theFormation of Left Sided Colonic DiverticulosisSeitaro Watanabe, Masahiko Inamori, Atsushi Nakajima

[background]The prevalence of colonic diverticulosis in routine clinical practice has increasedremarkably in industrialized countries, including Japan. Diverticular hemorrhage and diver-ticulitis is an urgent clinical task. However, the pathogenesis underlying the developmentof colonic diverticulosis is still unclear, direct evidence needs to be collected before developingmethods to prevent diverticulosis. Originally, colonic diverticula were located predominantlyon the right side in patients in Japan, in contrast to those in Europe and the United States.However, the prevalence of left-sided diverticula has been increasing recently, and the precisereason is unknown. Westernized food habit has been pointed out as one of the factors.Changes in the food habit are closely related to the lifestyle, therefore, we analyzed thecorrelation between the location of colonic diverticula and lifestyle-related factors (BMI,DM, HT, HL, etc) suspected to be involved in the shift of the predominant location of colonicdiverticula to the left side.[method]In a total of 271 patients who underwent abdominal CTand colonoscopy, 48 patients(17.7%) who were diagnosed as having colonic diverticulosisby colonoscopy were included in this study. [results]The numbers of subjects with right-sided diverticula, left-sided diverticula and bilateral diverticula were 22(45.8%), 10(20.8%),and 16(33.3%), respectively. The mean visceral fat areas in the patients with right-sided,left-sided and bilateral diverticula were 82.5cm2, 101.6cm2 and 126.6cm2, respectively,with the differences among the three groups being significant. There was also a significantdifference in the visceral fat area between the patients with right-sided and bilateral diverticula.There were no significant differences among the three patient groups in relation to otherfactors, including humoral factors (leptin, adiponectin, and HOMAR), subcutaneous fat area,age, or sex distribution. [conclusion]The location of colonic diverticula was correlated withthe visceral fat area, and the findings suggest that left-sided and bilateral diverticulosis maybe lifestyle-related diseases. This raises the possibility that diet and exercise therapy may be

S-633 AGA Abstracts

effective in the prevention of left-sided diverticulosis. In future, we propose to undertakepatient education based on evidence, and discuss whether such therapies will be effectivein preventing not only the onset of diverticulosis, but also that of diverticular hemorrhageand diverticulitis.

W1019

Changes in Prevalence of Upper Gastrointestinal Disease Detected atEndoscopy - From the Age of Peptic Ulcers and Gastric Cancer to the Age ofReflux EsophagitisMasaki Miyamoto, Takeshi Okamoto, Ken Haruma

Background: In Japan, Helicobacter pylori (Hp) infection rate is higher than for Westerncountries, the incidences of gastric cancer (GCa) and peptic ulcer (PU) are also high. Inrecent years, with Westernisation of diet and declining Hp infection, an increase in refluxesophagitis (RE) has been reported. However, detailed clinical studies of how upper gastroin-testinal (UGI) disease is changing are extremely rare. Aim: The aim of this study was toevaluate changes in the incidence of UGI disease at a hospital and to forecast the futuretrend of UGI disease in Japan. Subjects and methods: We examined records for 9,620patients (66.3±15.1 years, male 5,738) attending the only hospital in Town A, a rural townwith little population movement in Japan (8,018 persons, January 2008), for UGI endoscopyover a period of 12 years. We investigated changes in the frequency of UGI disease. Thefrequency was calculated as the ratio of endoscopic diagnosis against all endoscopic examina-tions each year (801±81.5 cases/year). The frequency in the survey initial year of 1997 wasused as the baseline. Results: 1) Changes in the frequency of UGI disease Compared to1997 (12.2%), GU was found to decline significantly (2008: 3.1%, p<0.05) from 2001(8.2%). Compared to 1997 (5.5%), RE increased significantly (p<0.05) from 2005 (10.4%).Mild RE (Los Angeles (LA) grade A, B) in particular increased significantly from 2002(3.5%→6.1%, p<0.05). The distribution of endoscopic diagnoses in 1997 was highest forPU at 31.5% (106/337) while gastroesophageal reflux disease (GERD: RE + NERD) was14.2%, but in 2008 GERD was highest at 38.0% (68/179), while PU declined to 10.6%,showing a significant reversal (p<0.05). The incidence of GCa declined from 1.2% to 0.3%,but no significance was found. Conclusions: Compared to Western countries, Japan has ahigh rate of PU, against a background of a high rate of Hp infection. This survey showedthat the current situation in Japan is rather that there is a high frequency of GERD similarto Western countries, especially mild RE.

W1020

Adult-Onset Autoimmune Enteropathy (AIE): the Kansas UniversityExperienceSavio Reddymasu, Mojtaba S. Olyaee, Scott Grisolano, Tuba Esfandyari

Background: Adult-onset Autoimmune enteropathy (AIE) is a rare disease manifested bychronic protracted diarrhea, weight loss and malabsorption. The hallmark of the AIE issmall bowel villous atrophy, no response to Gluten free diet or other dietary exclusions andpredisposition to autoimmunity such as circulating anti-enterocyte antibodies. Aims: Weaim to describe the clinical features, diagnosis and management of adult patients diagnosedwith AIE at the Kansas University. We also aim to propose diagnostic criteria for adult-onset autoimmune enteropathy, based on the review of literature on all reported cases ofAIE. Findings: Total of 6 adult patients was diagnosed with AIE at the Kansas Universityfrom January 2006 to December 2009, median age 63 years. All patients were Caucasians,with majority being female (83%). All patients had chronic significant diarrhea, with amedian duration of 9months, not responding to anti-diarrhea medications andwere evaluatedfor common and uncommon causes of chronic diarrhea, such as infectious, inflammatoryor pancreatic diseases, neuroendocrine tumors, lymphoma. 50% of patients were initiallydiagnosed as celiac disease based on small bowel histologic findings, but all were negativefor celiac serology and did not respond to a trial of Gluten free diet. All patients Anti-enterocyte antibodies were negative in 2 patients (pending in one patient). All patients hadother associated autoimmune disorders, including 2 patients with common variable immunedeficiency. All patients had dramatic response to corticosteroids, with significant improve-ment or resolution of diarrhea within the first week of treatment. Conclusion: Based on theclinical features, treatment and outcome of our patients and comparison with other reportedcases of patients with AIE, we propose the following criteria for diagnosis of adult-onsetAIE. 1 Chronic significant diarrhea (> 6 weeks duration), not responding to anti-diarrheamedications 2 Villous blunting in small bowel histology 3 Exclusion of other causes ofvillous atrophy including celiac disease, common variable immune deficiency, refractory

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ssprue and intestinal lymphoma. 4 Anti-enterocyte antibodies and/or rapid response to cortico-steroid treatment (prednisone 40 mg, PO, daily for 7 days) The rapid response to corticos-teroid treatment is a useful criterion in diagnosing AIE, while awaiting the result of anti-enterocyte antibodies. We do not recommend malnutrition to be a diagnostic criterion, aswith more awareness, patients are expected to be diagnosed earlier. The presence of otherautoimmune antibodies or diseases is supportive but not necessary in making the diagnosisof AIE.

W1021

Adherence to Evidenced-Based Guideline for the Prescription of NonsteroidalAnti-Inflammatory Drugs in Japanese PatientsHidetaka Tsumura, Tsuyoshi Fujita, Isamu Tamura, Yoshinori Morita, Tsuyoshi Sanuki,Masaru Yoshida, Takashi Toyonaga, Hidekazu Mukai, Hideto Inokuchi, Hiromu Kutsumi,Takeshi Azuma

Objective Recently, guidelines for the treatment and prevention of non-steroidal anti-inflam-matory drugs (NSAIDs) induced ulcers were established. Our aim was to assess the currentadherence to the guidelines, and the incidence of gastric mucosal lesions caused by NSAIDsin Japanese patients. Methods This study included 254 NSAIDs users (128 regular and 126on-demand users) who underwent upper gastrointestinal endoscopy. The patients werecharacterized as high-risk based on the following: Age 65 years or older, history of pepticulcers, concurrent use of corticosteroids or anticoagulants, high-dose NSAIDs use. Adherencewas defined as the prescription of NSAIDs with proton pump inhibitors (PPIs), prostaglandinanalogues (PAs), or high-dose histamine 2 receptor antagonists (H2RAs) in high-risk NSAIDsuser. The severity of gastric mucosal lesions was evaluated using the modified LANZA score(MLS). Results Seventy-nine (61.7%) of the regular NSAIDs users and 65 (51.6%) of theon-demand NSAIDs users met our definition of high-risk patients. Adherence in the regularNSAIDs users and on-demand NSAIDs users was 25(31.7%) and 16(24.6%), respectively.The incidence of gastric mucosal lesions (MLS≧1) was significantly higher in the nonadher-ence group than in the adherence group for both regular NSAIDs users (59.3% vs 28.0%P=0.01) and on-demand NSAIDs users (63.3% vs 25.0% P=0.01). Gastric ulcers in theregular NSAIDs users were more frequently observed in the nonadherence group than inthe adherence group (29.6% vs 4.0% P<0.01). Conclusion Adherence to the guidelines waslow. Nonadherence was found to be associated with a high prevalence of NSAIDs inducedgastric mucosal lesions.

W1022

Diverticulosis: Clinical Predictors. A Retrospective Case-Control StudyMaryam Khorrami, Muhammad F. Azrak, Steven Keilin

Objective: To examine clinical factors associated with colonic diverticulosis in adults.Methods: Retrospective case control study of patients presented to Emory University Hospitaland Clinics for colonoscopy between 8/1/2007 and 1/31/2008. We restricted inclusion topatients who had complete colonoscopy and had complete data on the studied variables.346 patients with diverticulosis were included. 346 patients who did not have diverticulosiswere randomly selected as a control group. Variables such as age, race, gender, BMI andco-morbid conditions were collected. Wald Chi-Square method was used to calculate unad-justed odds ratios with 95% confidence intervals. Student T test was used to compare meansof continuous variables. We used logistic regression model to calculate the adjusted oddsratios. Results: Diverticulosis was significantly more prevalent with increased age, withincrease in BMI, White race, hypertension and dyslipidemia (Table 1). Four significantpredictors of diverticulosis were found by the logistic regression model: Age, BMI, Whiterace and hypertension. BMI showedmodest but significant increase in the risk of diverticulosis(3% more likely to have diverticlusosis with each unit increase in BMI). Conclusion: HTNand increased weight are treatable clinical factors that are associated with increased risk ofdiverticulosis. With the obesity epidemic and aging population in US, diverticulosis maybecome more prevalent. Further studies are needed to further confirm these associations.Characteristics of the study sample and significant unadjusted OR's of diverticulosis withthe study variables

Statistically significant adjusted OR's of diverticulosis

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W1023

Heartburn Symptoms are Stronger Than Dyspepsia Symptoms in MotivatingGeneral Population to Seek Medical AttentionMotoyasu Kusano, Kazuma Fujimoto

It is unclear whether reflux or dyspepsia symptoms provide stronger motivation for thepopulation to seek medical attention. We developed the frequency scale for symptoms ofGERD (FSSG), a GERD-specific questionnaire. FSSG contained 12 questions according tosymptom in Japanese GERD patients, 7 reflux related symptoms and 5 dyspepsia relatedsymptoms. The cutoff in FSSGwas set at 8 points for GERD. (Sensitivity:62%, specificity:59%,accuracy :60%, Kusano et al, J Gastroenterol, 2004). We surveyed members of the generalpopulation using the FSSG over the internet, classifying respondents with mainly reflux(GERD) symptoms or upper gastrointestinal symptoms (UGI), and compared the 2 groups.Methods and Subjects: We created a homepage that users were able to access by enteringonly two key words; ‘reflux' and ‘heartburn'. The FSSG was used to assess respondents'symptoms. Other questions included: 1) the presence of UGI; 2) recognition of disease bysymptoms 3) history of presentation for medical attention for treatment of symptoms. Atotal of 15,814 subjects (age: 20-70, male/female: 8,165/7,649), who visited the homepageand answered all questions during the surveillance period from January to February 2008,were enrolled. The diagnosis of GERD was made on the basis of an FSSG score ≥8, andUGI with an FSSG score ≥1. Results: 1. The rate of medical consultation was 9.2% (1449/14365). The rate of not seeking medical attention despite having UGI, non-consulting UGIwas 82.5% (4666/5659), and the rate of not seeking medical attention despite having GERDsymptoms, non-consulting GERD, was 70.5% (2301/3625). 2. For respondents with GERD,the rate of medical consultation increased significantly as the number of positive responsesto the 3 reflux questions related to heartburn increased (P<0.0001). The rate of medicalconsultation did not increase as the number of positive responses to the 3 dyspepsia questionsrelated to abdominal fullness and bloating increased. 3. We calculated odds ratios for seekingmedical attention with multivariate analysis. This showed that the number of positiveresponses to questions related to heartburn was a significant factor (odds ratio 1.5, P=0.0001), but the number of positive responses to questions related to dyspepsia did notyield a significant odds ratio. Other significant factors were age≥60 (odds ratio 2.2,P<0.0001), FSSG score≥8 (odds ratio 1.5, P<0.0001), and awareness of disease (odds ratio6.1, P<0.0001), although gender was not a significant factor. Conclusions: Our resultsindicate that reflux symptoms such as heartburn are stronger than dyspepsia symptoms inmotivating patients to seek medical attention.

W1024

Knowledge and Attitudes of Junior Medical Doctors Towards Gastric CancerBoon Bee George Goh, Damien M. Tan, Yu Tien Wang, Khoon-Lin Ling

Background: Gastric cancer (GC) is the 4th most common cancer globally and accounts forthe second most common cause of cancer related death. It remains the 5th most commoncancer among Singapore males with age standardized incidence rate of 14.4 per 100,000per year. As doctors play an important part in persuading patients to undergo screening,and as screening may have an important role in diagnosing early GC, we sought to determinethe knowledge and attitudes of interns and residents towards GC and GC screening. Aims:To ascertain knowledge and attitudes of interns and residents in a tertiary Singapore hospitaltowards GC. Methods: Self-administered questionnaires regarding knowledge and attitudesto gastric cancer and screening were distributed to a cohort of junior doctors (JD) in SingaporeGeneral Hospital between April 2009 to November 2009. Results: There were a total of 104JD. 82.5% of JD felt that GC is common in Singapore. 94.2%, 98.1%, 83.7%, 91.3%, 60.6%and 89.4% of JD correctly identified smoking, Helicobacter pylori, older age, family historyof GC, Chinese race and male gender as risk factors respectively. However, only slightlymore than a third of JD realized high salt diet (34.3%) and low vegetable/fruit intake (36.5%)were also risk factors for GC. Majority of JD (95.1%) knew that GC can be asymptomaticbut if detected early is potentially curable (97.1%). 96% of JD felt that GC was best diagnosedby endoscopy and the best time to diagnose it was when asymptomatic (84%). However,only 52% of the JD cohort would be willing to undergo screening gastroscopy. For thosewilling to pay for screening gastroscopy, the mean cost they were willing to pay was US$175.85% of JD were more willing to undergo gastroscopy if tested positive for Helicobacter pylori.Conclusion: JD were generally knowledgeable in most important aspects with regards torisk factors, symptoms and management of GC. However, JD were less aware of dietary riskfactors for GC. JD were ambivalent about screening gastroscopy despite knowing that GCis common in Singapore and can be asymptomatic. Should a population based GC screeningprogram be introduced in Singapore, this ambivalence of doctors towards GC screeningmay result in a lower take-up rate for screening in a population.

W1025

Positive Gastric Cancer Association With Wood Stove (fogón) use in CentralAmerica, Independent of H. pylori InfectionJean Paul Higuero Sevilla, Ricardo Dominguez, Christopher F. Martin, Paris Heidt,Douglas R. Morgan

AIMS. Gastric cancer is the second-leading cause of cancer mortality worldwide, with highincidence in Asia and the mountainous pacific rim of Latin America. Exposure to woodburning and wood stove cooking (fogón) has been linked to a variety of cancers, includingupper aerodigestive tract, cervical, and gastric and esophageal cancers. The potential fogón- H. pylori (Hp) interaction is uninvestigated. Our aim was to investigate the association ofgastric cancer to exposure to fogón use in western Honduras. This mountainous region isidentified as a region of high incidence. (ASRs: 35.9 males and 14.5 females, per 106 peryear, 2002-08). METHODS. We conducted a prospective, population-based case-controlstudy in western Honduras. Incident gastric cancer cases were evaluated at the time ofdiagnosis. Household interviews were conducted for the population-based controls in villagesin the region. Village size was accounted for by noting populations of less than or greaterthan 25,000 inhabitants. (All villages had populations < 50,000). A standardized health