Archive
Delay to celiac disease diagnosis and its implications for health-related quality of life
Delay to celiac disease diagnosis and its implications for health-related quality of life
Source: BMC Gastroenterology
Background
To determine how the delay in diagnosing celiac disease (CD) has developed during recent decades and how this affects the burden of disease in terms of health-related quality of life (HRQoL), and also to consider differences with respect to sex and age.
Methods
In collaboration with the Swedish Society for Coeliacs, a questionnaire was sent to 1,560 randomly selected members, divided in equal-sized age- and sex strata, and 1,031 (66%) responded. HRQoL was measured with the EQ-5D descriptive system and was then translated to quality-adjusted life year (QALY) scores. A general population survey was used as comparison.
Results
The mean delay to diagnosis from the first symptoms was 9.7 years, and from the first doctor visit it was 5.8 years. The delay has been reduced over time for some age groups, but is still quite long. The mean QALY score during the year prior to initiated treatment was 0.66; it improved after diagnosis and treatment to 0.86, and was then better than that of a general population (0.79).
Conclusions
The delay from first symptoms to CD diagnosis is unacceptably long for many persons. Untreated CD results in poor HRQoL, which improves to the level of the general population if diagnosed and treated. By shortening the diagnostic delay it is possible to reduce this unnecessary burden of disease. Increased awareness of CD as a common health problem is needed, and active case finding should be intensified. Mass screening for CD might be an option in the future.
Notes from the Field: Outbreak of Salmonellosis Associated with Pet Turtle Exposures — United States, 2011
Notes from the Field: Outbreak of Salmonellosis Associated with Pet Turtle Exposures — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)
CDC is collaborating with the Pennsylvania State Health Department in an ongoing investigation of an outbreak of human Salmonella enterica serotype Paratyphi B var. L (+) tartrate + infections associated with pet turtle exposures. Turtles have long been recognized as sources of human Salmonella infections and are a particular risk to young children (1). Although the sale or distribution of small turtles (those with carapace lengths <4 inches [<10.2 cm]) has been prohibited in the United States since 1975 (with exceptions for scientific or educational purposes) (2), they are still available for illegal purchase through transient vendors on the street, at flea markets, and at fairs.
During August 5, 2010–September 26, 2011, a total of 132 cases of human Salmonella Paratyphi B var. L (+) tartrate + infection were reported in 18 states. The median age of patients was 6 years (range: <1–75 years), 66% were aged <10 years, and 63% were female. No deaths were reported. Of the 56 patients interviewed, 36 (64%) reported turtle exposure. For 15 patients who could recall the type of turtle contacted, 14 identified turtles too small to be legally traded. Five samples of turtle tank water from patient homes tested positive for the outbreak strain (four from Pennsylvania and one from South Carolina). Investigation to trace the source of these turtles is difficult because the vendors are transient. These cases illustrate that small turtles remain a source of human Salmonella infections, especially for young children.
Although many reptiles carry Salmonella, small turtles pose a greater risk to young children because they are perceived as safe pets, are small enough to be placed in the mouth, and can be handled as toys. Despite a 30-year ban on small turtles, this ongoing outbreak suggests that ban enforcement efforts, as well as public education efforts, have not been fully successful and should be examined. In 2010, in response to a 2007 lawsuit filed by the Independent Turtle Farmers of Louisiana, Inc. seeking to overturn the ban, a federal district court upheld the Food and Drug Administration's authority to enforce the ban (3). Regulating the sale of small turtles likely remains the most effective public health action to prevent turtle-associated salmonellosis (4,5).
New Guides Compare Benefits and Risks of GERD Treatments
New Guides Compare Benefits and Risks of GERD Treatments
Source: Agency for Healthcare Research and Quality
New plain-language publications from the U.S. Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ) compare the benefits and risks of treatments for gastroesophageal reflux disease (GERD), a digestive condition that affects millions of Americans and can be treated with medications or surgery. The publications are based on an updated evidence report also released today.
The report concluded that established drug-based therapy is effective. It also concluded that a type of surgical treatment known as laparoscopic fundoplication is at least as effective as drug-based medical treatment for some patients, but also had a higher risk of serious side effects. Another surgical treatment using an endoscopic variation of fundoplication also has been used to treat GERD, but AHRQ’s analysis found there is not enough evidence to compare this type of surgery’s effectiveness with other treatments.
GERD affects as many as 4 percent of Americans, making it one of the most common conditions in the United States. Those who have GERD can spend a significant amount of money on treatments—estimated at $3,355 annually per patient, the report noted. Approximately two-thirds of these costs are related to prescription drugs, but it is commonly recognized that some drugs used to treat GERD, such as proton pump inhibitors (PPIs), are overused, according to the report.
“Because it affects so many Americans, GERD is an important disease both in terms of public health and cost,” said AHRQ Director Carolyn M. Clancy, M.D. “These new publications will help patients and their clinicians work together to find the best treatment option based on patient preferences and needs.”
The AHRQ report found that PPIs tend to be more effective than other drugs, but comparisons show few consistent differences between PPI types or dosages. PPIs cause some side effects, such as diarrhea and headaches, but these were generally not serious.
+ Management Strategies for Gastroesophageal Reflux Disease: An Update
Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians
Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians
Source: British Medical Journal
Objective To examine the associations of a vegetarian diet and dietary fibre intake with risk of diverticular disease.
Design Prospective cohort study.
Setting The EPIC-Oxford study, a cohort of mainly health conscious participants recruited from around the United Kingdom.
Participants 47,033 men and women living in England or Scotland of whom 15 459 (33%) reported consuming a vegetarian diet.
Main outcome measures Diet group was assessed at baseline; intake of dietary fibre was estimated from a 130 item validated food frequency questionnaire. Cases of diverticular disease were identified through linkage with hospital records and death certificates. Hazard ratios and 95% confidence intervals for the risk of diverticular disease by diet group and fifths of intake of dietary fibre were estimated with multivariate Cox proportional hazards regression models.
Results After a mean follow-up time of 11.6 years, there were 812 cases of diverticular disease (806 admissions to hospital and six deaths). After adjustment for confounding variables, vegetarians had a 31% lower risk (relative risk 0.69, 95% confidence interval 0.55 to 0.86) of diverticular disease compared with meat eaters. The cumulative probability of admission to hospital or death from diverticular disease between the ages of 50 and 70 for meat eaters was 4.4% compared with 3.0% for vegetarians. There was also an inverse association with dietary fibre intake; participants in the highest fifth (≥25.5 g/day for women and ≥26.1 g/day for men) had a 41% lower risk (0.59, 0.46 to 0.78; P<0.001 trend) compared with those in the lowest fifth (<14 g/day for both women and men). After mutual adjustment, both a vegetarian diet and a higher intake of fibre were significantly associated with a lower risk of diverticular disease.
Conclusions Consuming a vegetarian diet and a high intake of dietary fibre were both associated with a lower risk of admission to hospital or death from diverticular disease.
Vital Signs: Colorectal Cancer Screening, Incidence, and Mortality — United States, 2002–2010
Vital Signs: Colorectal Cancer Screening, Incidence, and Mortality — United States, 2002–2010
Source: Morbidity and Mortality Weekly Report (CDC)
Background: Screening lowers colorectal cancer (CRC) incidence and mortality. CRC is preventable through the removal of premalignant polyps and is curable if diagnosed early. Increased CRC screening and reduced CRC incidence and mortality are among the Healthy People 2020 objectives.
Methods: CRC screening data are reported using information from 2002–2010 Behavioral Risk Factor Surveillance System surveys. State-specific CRC incidence and mortality data were drawn from the United States Cancer Statistics. Annual percentage changes (APCs) in incidence and death rates from 2003 to 2007 were calculated by state.
Results: From 2002 to 2010, the percentage of persons aged 50–75 years who were adequately screened for colorectal cancer increased from 52.3% to 65.4%. In 2007, CRC incidence ranged from 34.3 per 100,000 population in Utah to 56.9 in North Dakota; death rates ranged from 12.3 per 100,000 in Utah to 21.1 in the District of Columbia (DC). From 2003 to 2007, CRC incidence declined significantly in 35 states, and mortality declined in 49 states and DC, with APCs ranging from 1.0% per year in Alabama to 6.3% per year in Rhode Island.
Conclusions: CRC incidence and mortality have declined in recent years throughout the United States, and CRC screening has increased.
Implications for Public Health Practice: Continued declines in incidence and mortality are expected as past and current public health emphasis on the importance of CRC screening become evident with the increase in screening. To ensure these gains continue, CRC screening should be accessible and used as recommended by all eligible persons in the United States.
FDA approves treatment for Clostridium difficile infection
FDA approves treatment for Clostridium difficile infection
Source: U.S. Food and Drug Administration
The U.S. Food and Drug Administration today approved Dificid (fidaxomicin) tablets for the treatment of Clostridium difficile-associated diarrhea (CDAD).
Clostridium difficile (C. difficile) is a bacterium that can cause diarrhea and lead to colitis, other serious intestinal conditions, and death in severe cases. C. difficile bacteria are found in the stool of an infected person, and others can become infected if they touch items or surfaces contaminated with the bacteria or spores and then touch their mouths.
The safety and efficacy of Dificid were demonstrated in two trials that included 564 patients with CDAD that compared Dificid with vancomycin, a common antibiotic used to treat CDAD. The clinical response was similar in the Dificid group compared with the vancomycin group in both studies. In some patients with CDAD, symptoms can return. In the Dificid trials, a greater number of patients treated with Dificid had a sustained cure three weeks after treatment ended versus those patients treated with vancomycin.
USDA Revises Recommended Cooking Temperature for All Whole Cuts of Meat, Including Pork, to 145 °F
USDA Revises Recommended Cooking Temperature for All Whole Cuts of Meat, Including Pork, to 145 °F
Source: U.S. Department of Agriculture
The U.S. Department of Agriculture (USDA) is updating its recommendation for safely cooking pork, steaks, roasts, and chops. USDA recommends cooking all whole cuts of meat to 145 °F as measured with a food thermometer placed in the thickest part of the meat, then allowing the meat to rest for three minutes before carving or consuming.
This change does not apply to ground meats, including ground beef, veal, lamb, and pork, which should be cooked to 160 °F and do not require a rest time. The safe cooking temperature for all poultry products, including ground chicken and turkey, remains at 165 °F.
“With a single temperature for all whole cuts of meat and uniform 3 minute stand time, we believe it will be much easier for consumers to remember and result in safer food preparation,” said Under Secretary Elisabeth Hagen. “Now there will only be 3 numbers to remember: 145 for whole meats, 160 for ground meats and 165 for all poultry.”
USDA is lowering the recommended safe cooking temperature for whole cuts of pork from 160 °F to 145 °F and adding a three-minute rest time. The safe temperature for cuts of beef, veal, and lamb remains unchanged at 145 °F, but the department is adding a three-minute rest time as part of its cooking recommendations. Cooking raw pork, steaks, roasts, and chops to 145 °F with the addition of a three-minute rest time will result in a product that is both microbiologically safe and at its best quality.
Laparoscopic Antireflux Surgery vs Esomeprazole Treatment for Chronic GERD
Laparoscopic Antireflux Surgery vs Esomeprazole Treatment for Chronic GERD
Source: Journal of the American Medical Association
This multicenter clinical trial demonstrated that with contemporary antireflux therapy for GERD, either by drug-induced acid suppression with esomeprazole or by LARS, most patients achieve and remain in remission at 5 years.
NCCAM Clinical Digest: Irritable Bowel Syndrome and CAM
NCCAM Clinical Digest: Irritable Bowel Syndrome and CAM
Source: National Center for Complementary and Alternative Medicine
Irritable bowel syndrome (IBS) is a chronic disorder that interferes with the normal functions of the colon. IBS is characterized by symptoms such as abdominal pain, cramping, bloating, constipation, and diarrhea. IBS is challenging to study because its symptoms vary and may disappear for long periods, and because people with IBS tend to respond well to placebos.
This issue summarizes research on some of the most popular complementary and alternative medicine (CAM) therapies people try to treat symptoms of IBS. Overall, although there is some emerging evidence suggesting that some CAM therapies may be helpful for IBS, there have been few large well-designed studies, and most of the studies have had methodological flaws. Systematic reviews generally conclude that more well-designed studies are needed to firmly establish whether CAM therapies are helpful treatments for IBS.
Safety of Probiotics Used to Reduce Risk and Prevent or Treat Disease
Safety of Probiotics Used to Reduce Risk and Prevent or Treat Disease
Source: Agency for Healthcare Research and Quality
Objectives: To catalog what is known about the safety of interventions containing Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and/or Bacillus strains used as probiotic agents in research to reduce the risk of, prevent, or treat disease.
Data Sources: We searched 12 electronic databases, references of included studies, and pertinent reviews for studies addressing the safety of probiotics from database inception to August 2010 without language restriction.
Review Methods: We identified intervention studies on probiotics that reported the presence or absence of adverse health outcomes in human participants, without restriction by study design, participant type, or clinical field. We investigated the quantity, quality, and nature of adverse events.
Results: The search identified 11,977 publications, of which 622 studies were included in the review. In 235 studies, only nonspecific safety statements were made (“well tolerated”); the remaining 387 studies reported the presence or absence of specific adverse events. Interventions and adverse events were poorly documented.
+ Full Report (PDF)
Updated Norovirus Outbreak Management and Disease Prevention Guidelines
Updated Norovirus Outbreak Management and Disease Prevention Guidelines
Source: Morbidity and Mortality Weekly Report (CDC)
Noroviruses are the most common cause of epidemic gastroenteritis, responsible for at least 50% of all gastroenteritis outbreaks worldwide, and a major cause of foodborne illness. In the United States, approximately 21 million illnesses attributable to norovirus are estimated to occur annually. Since 2001, when the most recent norovirus recommendations were published (CDC. “Norwalk-like viruses.” Public health consequences and outbreak management. MMWR 2001;50[No. RR-9]), substantial advances have been made in norovirus epidemiology, immunology, diagnostic methods, and infection control. As molecular diagnostic techniques have improved in performance and become more widely available, detection and reporting of norovirus outbreaks have increased. Although the inability to culture human noroviruses in vitro has hampered progress, assessment of the performance of disinfectants has been facilitated by the discovery of new, cultivable surrogates for human noroviruses. In addition, the periodic emergence of epidemic strains (from genogroup II type 4, GII.4) and outbreaks in specific populations (e.g., the elderly in nursing homes) have been characterized. This report reviews these recent advances and provides guidelines for outbreak management and disease prevention. These recommendations are intended for use by public health professionals investigating outbreaks of acute gastroenteritis, including state and local health authorities, as well as academic and research institutions.
Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity
Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity
Source: BMC MedicineBackground
Celiac disease (CD) is an autoimmune enteropathy triggered by the ingestion of gluten. Gluten-sensitive individuals (GS) cannot tolerate gluten and may develop gastrointestinal symptoms similar to those in CD, but the overall clinical picture is generally less severe and is not accompanied by the concurrence of tissue transglutaminase autoantibodies or autoimmune comorbidities. By studying and comparing mucosal expression of genes associated with intestinal barrier function, as well as innate and adaptive immunity in CD compared with GS, we sought to better understand the similarities and differences between these two gluten-associated disorders.Methods
CD, GS and healthy, gluten-tolerant individuals were enrolled in this study. Intestinal permeability was evaluated using a lactulose and mannitol probe, and mucosal biopsy specimens were collected to study the expression of genes involved in barrier function and immunity.Results
Unlike CD, GS is not associated with increased intestinal permeability. In fact, this was significantly reduced in GS compared with controls (P = 0.0308), paralleled by significantly increased expression of claudin (CLDN) 4 (P = 0.0286). Relative to controls, adaptive immunity markers interleukin (IL)-6 (P = 0.0124) and IL-21 (P = 0.0572) were expressed at higher levels in CD but not in GS, while expression of the innate immunity marker Toll-like receptor (TLR) 2 was increased in GS but not in CD (P = 0.0295). Finally, expression of the T-regulatory cell marker FOXP3 was significantly reduced in GS relative to controls (P = 0.0325) and CD patients (P = 0.0293).Conclusions
This study shows that the two gluten-associated disorders, CD and GS, are different clinical entities, and it contributes to the characterization of GS as a condition associated with prevalent gluten-induced activation of innate, rather than adaptive, immune responses in the absence of detectable changes in mucosal barrier function.+ Full Paper (PDF)
