Examination of the effects of breath hydrogen and methane levels on the EC/IR II

<p>Fifty patients undergoing hydrogen and methane breath testing at Cedars-Sinai GI Motility Lab were recruited, and consented to having their breath tested for alcohol using the EC/IR II (Intoximeters, Inc., St. Louis). The subjects gave multiple breath samples for alcohol analysis during this controlled study. All subjects had hydrogen in their breath ranging from 1 to 176 parts per million (ppm). Methane was also present in some patients’ breath samples (0–107 ppm). In all cases, except for one subject that admitted to heavy drinking the night before, breath alcohol results were 0.000 g/210 L. Based on these findings, breath hydrogen and methane do not have any impact on breath alcohol results with the EC/IR II.</p

Cutoffs for anti-CdtB and anti-vinculin for the diagnosis of D-IBS vs. IBD.

<p>^a positive likelihood ratio</p><p>^b negative likelihood ratio</p><p>Cutoffs for anti-CdtB and anti-vinculin for the diagnosis of D-IBS vs. IBD.</p

Development and Validation of a Biomarker for Diarrhea-Predominant Irritable Bowel Syndrome in Human Subjects

<div><p>Diarrhea-predominant irritable bowel syndrome (IBS) is diagnosed through clinical criteria after excluding “organic” conditions, and can be precipitated by acute gastroenteritis. Cytolethal distending toxin B (CdtB) is produced by bacteria that cause acute gastroenteritis, and a post-infectious animal model demonstrates that host antibodies to CdtB cross-react with vinculin in the host gut, producing an IBS-like phenotype. Therefore, we assessed circulating anti-CdtB and anti-vinculin antibodies as biomarkers for D-IBS in human subjects. Subjects with D-IBS based on Rome criteria (n=2375) were recruited from a large-scale multicenter clinical trial for D-IBS (TARGET 3). Subjects with inflammatory bowel disease (IBD) (n=142), subjects with celiac disease (n=121), and healthy controls (n=43) were obtained for comparison. Subjects with IBD and celiac disease were recruited based on the presence of intestinal complaints and histologic confirmation of chronic inflammatory changes in the colon or small intestine. Subjects with celiac disease were also required to have an elevated tTG and biopsy. All subjects were aged between 18 and 65 years. Plasma levels of anti-CdtB and anti-vinculin antibodies were determined by ELISA, and compared between groups. Anti-CdtB titers were significantly higher in D-IBS subjects compared to IBD, healthy controls and celiac disease (P<0.001). Anti-vinculin titers were also significantly higher in IBS (P<0.001) compared to the other groups. The area-under-the-receiver operating curves (AUCs) were 0.81 and 0.62 for diagnosis of D-IBS against IBD for anti-CdtB and anti-vinculin, respectively. Both tests were less specific in differentiating IBS from celiac disease. Optimization demonstrated that for anti-CdtB (optical density≥2.80) the specificity, sensitivity and likelihood ratio were 91.6%, 43.7 and 5.2, respectively, and for anti-vinculin (OD≥1.68) were 83.8%, 32.6 and 2.0, respectively. These results confirm that anti-CdtB and anti-vinculin antibodies are elevated in D-IBS compared to non-IBS subjects. These biomarkers may be especially helpful in distinguishing D-IBS from IBD in the workup of chronic diarrhea.</p></div

Receiver operator curve (ROC) comparing anti-CdtB and anti-vinculin levels in D-IBS subjects and IBD subjects.

<p>CI, confidence interval.</p

Comparison of optical density (OD) for the anti-CdtB antibody among the groups.

<p>Titers were higher in IBS subjects when compared to any other group (<i>P</i><0.001). Titers were also higher in subjects with celiac disease when compared to healthy controls and IBD subjects (<i>P</i><0.001). Dots represent outlier subjects beyond the whisker plot.</p

Cutoffs for anti-CdtB and anti-vinculin for the diagnosis of D-IBS vs. IBD.

<p>^a positive likelihood ratio</p><p>^b negative likelihood ratio</p><p>Cutoffs for anti-CdtB and anti-vinculin for the diagnosis of D-IBS vs. IBD.</p

Patient demographics.

<p>^aValues are given as mean ± standard deviation</p><p>^b Crohn’s disease</p><p>^c ulcerative colitis</p><p>Patient demographics.</p

Past and future burden of inflammatory bowel diseases based on modeling of population-based data

BACKGROUND & AIMS: Inflammatory bowel diseases (IBDs) exist worldwide, with high prevalence in North America. IBD is complex and costly, and its increasing prevalence places a greater stress on health care systems. We aimed to determine the past current, and future prevalences of IBD in Canada. METHODS: We performed a retrospective cohort study using population-based health administrative data from Alberta (2002–2015), British Columbia (1997– 2014), Manitoba (1990–2013), Nova Scotia (1996–2009), Ontario (1999–2014), Quebec (2001–2008), and Saskatchewan (1998–2016). Autoregressive integrated moving average regression was applied, and prevalence, with 95% prediction intervals (PIs), was forecasted to 2030. Average annual percentage change, with 95% confidence intervals, was assessed with log binomial regression. RESULTS: In 2018, the prevalence of IBD in Canada was estimated at 725 per 100,000 (95% PI 716–735) and annual average percent change was estimated at 2.86% (95% confidence interval 2.80%–2.92%). The prevalence in 2030 was forecasted to be 981 per 100,000 (95% PI 963–999): 159 per 100,000 (95% PI 133–185) in children, 1118 per 100,000 (95% PI 1069–1168) in adults, and 1370 per 100,000 (95% PI 1312–1429) in the elderly. In 2018, 267,983 Canadians (95% PI 264,579–271,387) were estimated to be living with IBD, which was forecasted to increase to 402,853 (95% PI 395,466–410,240) by 2030. CONCLUSION: Forecasting prevalence will allow health policy makers to develop policy that is necessary to address the challenges faced by health systems in providing high-quality and cost-effective care