BALTIMORE – The use of hormonal contraception among women with epilepsy may significantly increase their rate of seizure activity, according to the findings of a Web-based survey of women aged 18 to 47 years with the neurological condition.

Seizures while using contraceptives were reported by 18% of women using hormonal contraceptives, compared with 3% of those using nonhormonal contraceptives, according to the study’s lead investigator Kristen M. Fowler, R.N., of Beth Israel Deaconess Medical Center, Boston.

When antiepileptic drugs (AEDs) were not used, 24% of women using hormonal contraceptives reported an increase in seizure frequency, compared with 7% of women using nonhormonal contraceptives.

Seizure exacerbation with hormonal contraceptives differed among the AEDs used, Ms. Fowler said at the annual meeting of the American Epilepsy Society, where she presented her findings from the first 300 women who responded to a Web-based survey, called the Epilepsy Birth Control Registry.

Valproate showed the greatest seizure exacerbation when used in conjunction with hormonal contraceptives. Seizure exacerbation while taking valproate occurred in 44% of women using hormonal contraceptives, compared with 8% of women who were using nonhormonal contraceptives.

In general, glucuronidated AEDs and enzyme-inducing AEDs were associated with significantly greater seizure exacerbation than nonenzyme-inducing AEDs, especially when women were using hormonal contraception, Ms. Fowler found.

In a related analysis that looked more broadly at contraceptive choices among the same group of surveyed women, 72% of the women reported using contraception. Among those women, the most common choices were oral contraceptives (23%), male condoms (23%), intrauterine devices (12%), and withdrawal (10%).

"Although contraception is an important consideration for women of reproductive age, there has been little investigation of contraceptive practices in women with epilepsy," said Kaitlyn Cahill, also at Beth Israel Deaconess Medical Center.

The top three considerations when making contraceptive choices were AED interaction (57%), efficacy (53%), and convenience (45%). Only about 3% of the women mentioned cost as a most important consideration in choosing contraception.

A subgroup of 178 women was considered high risk because they were potentially fertile and sexually active. Of these women, 68% used highly effective contraceptive methods: 44% used hormonal contraception, 16% used IUDs, and 8% relied on a tubal ligation or vasectomy.

Hormonal contraception varied according to insurance coverage status (53% with insurance used it vs. 29% without).

Only 28% of the women reported consulting their neurologist before selecting a contraceptive method.

The retrospective design of both studies limited the conclusion that could be drawn. "Prospective investigations are needed to determine whether these findings represent important seizure safety issues or reporting biases," they concluded.

The studies were supported in part by the Epilepsy Foundation. The researchers had no financial conflicts to disclose.

BALTIMORE – The use of hormonal contraception among women with epilepsy may significantly increase their rate of seizure activity, according to the findings of a Web-based survey of women aged 18 to 47 years with the neurological condition.

Seizures while using contraceptives were reported by 18% of women using hormonal contraceptives, compared with 3% of those using nonhormonal contraceptives, according to the study’s lead investigator Kristen M. Fowler, R.N., of Beth Israel Deaconess Medical Center, Boston.

When antiepileptic drugs (AEDs) were not used, 24% of women using hormonal contraceptives reported an increase in seizure frequency, compared with 7% of women using nonhormonal contraceptives.

Seizure exacerbation with hormonal contraceptives differed among the AEDs used, Ms. Fowler said at the annual meeting of the American Epilepsy Society, where she presented her findings from the first 300 women who responded to a Web-based survey, called the Epilepsy Birth Control Registry.

Valproate showed the greatest seizure exacerbation when used in conjunction with hormonal contraceptives. Seizure exacerbation while taking valproate occurred in 44% of women using hormonal contraceptives, compared with 8% of women who were using nonhormonal contraceptives.

In general, glucuronidated AEDs and enzyme-inducing AEDs were associated with significantly greater seizure exacerbation than nonenzyme-inducing AEDs, especially when women were using hormonal contraception, Ms. Fowler found.

In a related analysis that looked more broadly at contraceptive choices among the same group of surveyed women, 72% of the women reported using contraception. Among those women, the most common choices were oral contraceptives (23%), male condoms (23%), intrauterine devices (12%), and withdrawal (10%).

"Although contraception is an important consideration for women of reproductive age, there has been little investigation of contraceptive practices in women with epilepsy," said Kaitlyn Cahill, also at Beth Israel Deaconess Medical Center.

The top three considerations when making contraceptive choices were AED interaction (57%), efficacy (53%), and convenience (45%). Only about 3% of the women mentioned cost as a most important consideration in choosing contraception.

A subgroup of 178 women was considered high risk because they were potentially fertile and sexually active. Of these women, 68% used highly effective contraceptive methods: 44% used hormonal contraception, 16% used IUDs, and 8% relied on a tubal ligation or vasectomy.

Hormonal contraception varied according to insurance coverage status (53% with insurance used it vs. 29% without).

Only 28% of the women reported consulting their neurologist before selecting a contraceptive method.

The retrospective design of both studies limited the conclusion that could be drawn. "Prospective investigations are needed to determine whether these findings represent important seizure safety issues or reporting biases," they concluded.

The studies were supported in part by the Epilepsy Foundation. The researchers had no financial conflicts to disclose.

BALTIMORE – The use of hormonal contraception among women with epilepsy may significantly increase their rate of seizure activity, according to the findings of a Web-based survey of women aged 18 to 47 years with the neurological condition.

Seizures while using contraceptives were reported by 18% of women using hormonal contraceptives, compared with 3% of those using nonhormonal contraceptives, according to the study’s lead investigator Kristen M. Fowler, R.N., of Beth Israel Deaconess Medical Center, Boston.

When antiepileptic drugs (AEDs) were not used, 24% of women using hormonal contraceptives reported an increase in seizure frequency, compared with 7% of women using nonhormonal contraceptives.

Seizure exacerbation with hormonal contraceptives differed among the AEDs used, Ms. Fowler said at the annual meeting of the American Epilepsy Society, where she presented her findings from the first 300 women who responded to a Web-based survey, called the Epilepsy Birth Control Registry.

Valproate showed the greatest seizure exacerbation when used in conjunction with hormonal contraceptives. Seizure exacerbation while taking valproate occurred in 44% of women using hormonal contraceptives, compared with 8% of women who were using nonhormonal contraceptives.

In general, glucuronidated AEDs and enzyme-inducing AEDs were associated with significantly greater seizure exacerbation than nonenzyme-inducing AEDs, especially when women were using hormonal contraception, Ms. Fowler found.

In a related analysis that looked more broadly at contraceptive choices among the same group of surveyed women, 72% of the women reported using contraception. Among those women, the most common choices were oral contraceptives (23%), male condoms (23%), intrauterine devices (12%), and withdrawal (10%).

"Although contraception is an important consideration for women of reproductive age, there has been little investigation of contraceptive practices in women with epilepsy," said Kaitlyn Cahill, also at Beth Israel Deaconess Medical Center.

The top three considerations when making contraceptive choices were AED interaction (57%), efficacy (53%), and convenience (45%). Only about 3% of the women mentioned cost as a most important consideration in choosing contraception.

A subgroup of 178 women was considered high risk because they were potentially fertile and sexually active. Of these women, 68% used highly effective contraceptive methods: 44% used hormonal contraception, 16% used IUDs, and 8% relied on a tubal ligation or vasectomy.

Hormonal contraception varied according to insurance coverage status (53% with insurance used it vs. 29% without).

Only 28% of the women reported consulting their neurologist before selecting a contraceptive method.

The retrospective design of both studies limited the conclusion that could be drawn. "Prospective investigations are needed to determine whether these findings represent important seizure safety issues or reporting biases," they concluded.

The studies were supported in part by the Epilepsy Foundation. The researchers had no financial conflicts to disclose.

Daily cigarette smoking and binge drinking among American teenagers declined over the past year, but the use of marijuana and the abuse of prescription drugs remain a problem, data from the 2011 Monitoring the Future survey have shown.

The National Institute on Drug Abuse (NIDA) announced the survey findings Dec. 14 at a press conference.

The survey found that daily cigarette use, which peaked in the mid- to late 1990s, continued to drop in the past year; 2.4% of 8th graders, 5.5% of 10th graders, and 10.3% of 12th graders reported daily smoking. However, the decline in smoking has slowed in recent years, the researchers said in a press release. "These levels remain too high given the significant morbidity and mortality associated with tobacco use," they said.

Alcohol use, particularly binge drinking, declined significantly among all three age groups over the last 5 years, to a 2011 prevalence of 6.4% of 8th graders, 14.7% of 10th graders, and 21.6% of 12th graders. Binge drinking was defined as five or more drinks in a row in the last 2 weeks.

The use of marijuana among teens climbed in 2011 for the fourth straight year, the survey found. In 2011, 12.5% of 8th graders, 28.8% of 10th graders, and 36.4% of 12th graders reported past-year use of marijuana. These numbers were not significantly different from the 2010 rates. However, the 5-year trends show increases in daily, current, and past-year marijuana use by 10th and 12th graders. The increases might be attributable, in part, to a decline in the perceived risk associated with marijuana use, the researchers suggested. For example, more high school seniors reported marijuana use than smoking cigarettes in the past 30 days (22.6% vs. 18.7%).

The use of marijuana among teens climbed in 2011 for the fourth straight year, the survey found.

In addition, the 2011 survey included first-time data on the use of synthetic marijuana, called K2 or "spice," among high school seniors. About 11.4% of high school seniors reported using spice during the past year. Earlier this year, the Drug Enforcement Administration declared many of the chemicals used in such products as schedule I drugs and deemed them unsafe for at least a year. In addition, at least 18 states have banned synthetic marijuana. "Next year’s results should tell us a lot more about how successful these new control efforts are," Lloyd D. Johnston, Ph.D., research scientist at the Institute for Social Research at the University of Michigan and lead investigator of the survey, said in a statement. "We know that the great majority of those who have used synthetic marijuana also used medical marijuana during the year, as well as a number of other drugs."

Prescription and over-the-counter (OTC) medications account for most of the drugs abused by 12th grade students in the past year. Nonmedical use of OxyContin remained stable across grades 8, 10, and 12, and amphetamine use increased among 12th graders, to 8.2% in 2011 from 6.6% in 2010. Nonmedical use of Vicodin remained stable among seniors, but declined among 10th graders, from 7.7% in 2010 to 5.9% in 2011.

In response to the persistent trends in prescription drug abuse, NIDA unveiled its PEERx campaign, a prevention effort that seeks to educate young people about the dangers of prescription drug use in an engaging way. The teen-friendly site features a "mixer" that shows teens what can happen if they combine prescription drugs with different activities. For example, the equation "Hot Date plus Adderall" equals a photo of a frustrated girl who comments: "He took some Adderall and got more into the video game than into me. Some date!" The site also explains the science behind drug abuse, and includes interactive videos that allow teens to make different choices about illicit use of prescription drugs in various situations (such as taking a stimulant the night before a big test) and view the possible outcomes.

The annual Monitoring the Future survey tracks annual drug abuse trends among U.S. teenagers via responses from 8th, 10th, and 12th grade students to questions about drug use, including attitudes and perceived risks. About 47,000 students participated in the 2011 survey. The lead investigators are all affiliated with the University of Michigan’s Institute for Social Research.

Daily cigarette smoking and binge drinking among American teenagers declined over the past year, but the use of marijuana and the abuse of prescription drugs remain a problem, data from the 2011 Monitoring the Future survey have shown.

The National Institute on Drug Abuse (NIDA) announced the survey findings Dec. 14 at a press conference.

The survey found that daily cigarette use, which peaked in the mid- to late 1990s, continued to drop in the past year; 2.4% of 8th graders, 5.5% of 10th graders, and 10.3% of 12th graders reported daily smoking. However, the decline in smoking has slowed in recent years, the researchers said in a press release. "These levels remain too high given the significant morbidity and mortality associated with tobacco use," they said.

Alcohol use, particularly binge drinking, declined significantly among all three age groups over the last 5 years, to a 2011 prevalence of 6.4% of 8th graders, 14.7% of 10th graders, and 21.6% of 12th graders. Binge drinking was defined as five or more drinks in a row in the last 2 weeks.

The use of marijuana among teens climbed in 2011 for the fourth straight year, the survey found. In 2011, 12.5% of 8th graders, 28.8% of 10th graders, and 36.4% of 12th graders reported past-year use of marijuana. These numbers were not significantly different from the 2010 rates. However, the 5-year trends show increases in daily, current, and past-year marijuana use by 10th and 12th graders. The increases might be attributable, in part, to a decline in the perceived risk associated with marijuana use, the researchers suggested. For example, more high school seniors reported marijuana use than smoking cigarettes in the past 30 days (22.6% vs. 18.7%).

The use of marijuana among teens climbed in 2011 for the fourth straight year, the survey found.

In addition, the 2011 survey included first-time data on the use of synthetic marijuana, called K2 or "spice," among high school seniors. About 11.4% of high school seniors reported using spice during the past year. Earlier this year, the Drug Enforcement Administration declared many of the chemicals used in such products as schedule I drugs and deemed them unsafe for at least a year. In addition, at least 18 states have banned synthetic marijuana. "Next year’s results should tell us a lot more about how successful these new control efforts are," Lloyd D. Johnston, Ph.D., research scientist at the Institute for Social Research at the University of Michigan and lead investigator of the survey, said in a statement. "We know that the great majority of those who have used synthetic marijuana also used medical marijuana during the year, as well as a number of other drugs."

Prescription and over-the-counter (OTC) medications account for most of the drugs abused by 12th grade students in the past year. Nonmedical use of OxyContin remained stable across grades 8, 10, and 12, and amphetamine use increased among 12th graders, to 8.2% in 2011 from 6.6% in 2010. Nonmedical use of Vicodin remained stable among seniors, but declined among 10th graders, from 7.7% in 2010 to 5.9% in 2011.

In response to the persistent trends in prescription drug abuse, NIDA unveiled its PEERx campaign, a prevention effort that seeks to educate young people about the dangers of prescription drug use in an engaging way. The teen-friendly site features a "mixer" that shows teens what can happen if they combine prescription drugs with different activities. For example, the equation "Hot Date plus Adderall" equals a photo of a frustrated girl who comments: "He took some Adderall and got more into the video game than into me. Some date!" The site also explains the science behind drug abuse, and includes interactive videos that allow teens to make different choices about illicit use of prescription drugs in various situations (such as taking a stimulant the night before a big test) and view the possible outcomes.

The annual Monitoring the Future survey tracks annual drug abuse trends among U.S. teenagers via responses from 8th, 10th, and 12th grade students to questions about drug use, including attitudes and perceived risks. About 47,000 students participated in the 2011 survey. The lead investigators are all affiliated with the University of Michigan’s Institute for Social Research.

Daily cigarette smoking and binge drinking among American teenagers declined over the past year, but the use of marijuana and the abuse of prescription drugs remain a problem, data from the 2011 Monitoring the Future survey have shown.

The National Institute on Drug Abuse (NIDA) announced the survey findings Dec. 14 at a press conference.

The survey found that daily cigarette use, which peaked in the mid- to late 1990s, continued to drop in the past year; 2.4% of 8th graders, 5.5% of 10th graders, and 10.3% of 12th graders reported daily smoking. However, the decline in smoking has slowed in recent years, the researchers said in a press release. "These levels remain too high given the significant morbidity and mortality associated with tobacco use," they said.

Alcohol use, particularly binge drinking, declined significantly among all three age groups over the last 5 years, to a 2011 prevalence of 6.4% of 8th graders, 14.7% of 10th graders, and 21.6% of 12th graders. Binge drinking was defined as five or more drinks in a row in the last 2 weeks.

The use of marijuana among teens climbed in 2011 for the fourth straight year, the survey found. In 2011, 12.5% of 8th graders, 28.8% of 10th graders, and 36.4% of 12th graders reported past-year use of marijuana. These numbers were not significantly different from the 2010 rates. However, the 5-year trends show increases in daily, current, and past-year marijuana use by 10th and 12th graders. The increases might be attributable, in part, to a decline in the perceived risk associated with marijuana use, the researchers suggested. For example, more high school seniors reported marijuana use than smoking cigarettes in the past 30 days (22.6% vs. 18.7%).

The use of marijuana among teens climbed in 2011 for the fourth straight year, the survey found.

In addition, the 2011 survey included first-time data on the use of synthetic marijuana, called K2 or "spice," among high school seniors. About 11.4% of high school seniors reported using spice during the past year. Earlier this year, the Drug Enforcement Administration declared many of the chemicals used in such products as schedule I drugs and deemed them unsafe for at least a year. In addition, at least 18 states have banned synthetic marijuana. "Next year’s results should tell us a lot more about how successful these new control efforts are," Lloyd D. Johnston, Ph.D., research scientist at the Institute for Social Research at the University of Michigan and lead investigator of the survey, said in a statement. "We know that the great majority of those who have used synthetic marijuana also used medical marijuana during the year, as well as a number of other drugs."

Prescription and over-the-counter (OTC) medications account for most of the drugs abused by 12th grade students in the past year. Nonmedical use of OxyContin remained stable across grades 8, 10, and 12, and amphetamine use increased among 12th graders, to 8.2% in 2011 from 6.6% in 2010. Nonmedical use of Vicodin remained stable among seniors, but declined among 10th graders, from 7.7% in 2010 to 5.9% in 2011.

In response to the persistent trends in prescription drug abuse, NIDA unveiled its PEERx campaign, a prevention effort that seeks to educate young people about the dangers of prescription drug use in an engaging way. The teen-friendly site features a "mixer" that shows teens what can happen if they combine prescription drugs with different activities. For example, the equation "Hot Date plus Adderall" equals a photo of a frustrated girl who comments: "He took some Adderall and got more into the video game than into me. Some date!" The site also explains the science behind drug abuse, and includes interactive videos that allow teens to make different choices about illicit use of prescription drugs in various situations (such as taking a stimulant the night before a big test) and view the possible outcomes.

The annual Monitoring the Future survey tracks annual drug abuse trends among U.S. teenagers via responses from 8th, 10th, and 12th grade students to questions about drug use, including attitudes and perceived risks. About 47,000 students participated in the 2011 survey. The lead investigators are all affiliated with the University of Michigan’s Institute for Social Research.

Information about the relative risks of knee OA as a result of sports participation is essential to help develop prevention strategies and shape public health messages, said Jeffrey Driban, Ph.D., who presented the findings at the annual meeting of the American College of Rheumatology.

Dr. Driban and his colleagues at Tufts Medical Center in Boston analyzed 16 studies that identified OA rates in elite and recreational athletes participating in a range of sports including running, soccer, and wrestling. In general, the prevalence of knee OA was 8.4% among the 3,192 athletes of any level, compared with 9.1% among the 3,485 nonathletes, Dr. Driban said.

However, the risk of knee OA is sport-specific, Dr. Driban said. Compared with nonathletes, soccer players at elite and nonelite levels were at increased risk of knee OA (relative risk, 4.4), as were elite athletes competing in distance running (3.2), weight lifting (6.4), and wrestling (3.7). Elite athletes were defined as those competing at the national, Olympic, or professional level; nonelite athletes were those competing at the recreational or scholastic level.

The results were limited by the lack of adequate data on women and injury histories for the study participants. However, the data are encouraging and suggest that knee OA risk generally is not elevated for most recreational athletes, said Dr. Driban.

"For individuals who are interested in pursuing the health benefits of physical activity, sports participation can be a healthy way of getting those benefits," Dr. Driban emphasized.

However, anyone who is especially concerned about reducing their risk for OA should opt for low-impact, noncontact sports, he said. Elite athletes in high-risk sports can take steps to reduce their risk, such as treating injuries promptly and maintaining a healthy weight and lifestyle when they retire from competition, he added.

Dr. Driban reported having no financial conflicts of interest.

Information about the relative risks of knee OA as a result of sports participation is essential to help develop prevention strategies and shape public health messages, said Jeffrey Driban, Ph.D., who presented the findings at the annual meeting of the American College of Rheumatology.

Dr. Driban and his colleagues at Tufts Medical Center in Boston analyzed 16 studies that identified OA rates in elite and recreational athletes participating in a range of sports including running, soccer, and wrestling. In general, the prevalence of knee OA was 8.4% among the 3,192 athletes of any level, compared with 9.1% among the 3,485 nonathletes, Dr. Driban said.

However, the risk of knee OA is sport-specific, Dr. Driban said. Compared with nonathletes, soccer players at elite and nonelite levels were at increased risk of knee OA (relative risk, 4.4), as were elite athletes competing in distance running (3.2), weight lifting (6.4), and wrestling (3.7). Elite athletes were defined as those competing at the national, Olympic, or professional level; nonelite athletes were those competing at the recreational or scholastic level.

The results were limited by the lack of adequate data on women and injury histories for the study participants. However, the data are encouraging and suggest that knee OA risk generally is not elevated for most recreational athletes, said Dr. Driban.

"For individuals who are interested in pursuing the health benefits of physical activity, sports participation can be a healthy way of getting those benefits," Dr. Driban emphasized.

However, anyone who is especially concerned about reducing their risk for OA should opt for low-impact, noncontact sports, he said. Elite athletes in high-risk sports can take steps to reduce their risk, such as treating injuries promptly and maintaining a healthy weight and lifestyle when they retire from competition, he added.

Dr. Driban reported having no financial conflicts of interest.

Information about the relative risks of knee OA as a result of sports participation is essential to help develop prevention strategies and shape public health messages, said Jeffrey Driban, Ph.D., who presented the findings at the annual meeting of the American College of Rheumatology.

Dr. Driban and his colleagues at Tufts Medical Center in Boston analyzed 16 studies that identified OA rates in elite and recreational athletes participating in a range of sports including running, soccer, and wrestling. In general, the prevalence of knee OA was 8.4% among the 3,192 athletes of any level, compared with 9.1% among the 3,485 nonathletes, Dr. Driban said.

However, the risk of knee OA is sport-specific, Dr. Driban said. Compared with nonathletes, soccer players at elite and nonelite levels were at increased risk of knee OA (relative risk, 4.4), as were elite athletes competing in distance running (3.2), weight lifting (6.4), and wrestling (3.7). Elite athletes were defined as those competing at the national, Olympic, or professional level; nonelite athletes were those competing at the recreational or scholastic level.

The results were limited by the lack of adequate data on women and injury histories for the study participants. However, the data are encouraging and suggest that knee OA risk generally is not elevated for most recreational athletes, said Dr. Driban.

"For individuals who are interested in pursuing the health benefits of physical activity, sports participation can be a healthy way of getting those benefits," Dr. Driban emphasized.

However, anyone who is especially concerned about reducing their risk for OA should opt for low-impact, noncontact sports, he said. Elite athletes in high-risk sports can take steps to reduce their risk, such as treating injuries promptly and maintaining a healthy weight and lifestyle when they retire from competition, he added.

Dr. Driban reported having no financial conflicts of interest.

In 2009, the prevalence of no physical activity was 53% higher in adults with arthritis than those without, based on the latest data from the Behavioral Risk Factor Surveillance System. The findings were published online in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report on Dec. 8.

From 2002 to 2008, the percentage of all adults in the United States who reported no physical activity stagnated at 25%, regardless of their arthritis status. The growing subset of adults with arthritis who tend to be sedentary because of their barriers to activity may have contributed to that stagnation, according to the CDC researchers.

"Further reduction in the prevalence of no leisure-time physical activity (LTPA) among all adults might be hindered by population subgroups that have exceptionally high rates of no LTPA, such as adults with arthritis," the researchers noted.

The researchers reviewed data from 432,607 adults aged 18 years and older who responded to telephone surveys. The study population included respondents from all 50 states, the District of Columbia, and all U.S. territories (MMWR 2011;60:1641-45).

Adults with arthritis accounted for at least 20% of all adults reporting no LTPA in each state, ranging from 21% in Minnesota to 43% in Tennessee.

Survey respondents were defined as "no LTPA" if they answered no to the question, "During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?"

Survey respondents were defined as having arthritis if they answered yes to the question, "Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?"

© Diana Hirsch/iStockphoto.com

The findings are not surprising, given the disease-specific barriers to physical activity experienced by people with arthritis, the researchers wrote.

"However, these barriers can be addressed through targeted health communication messages; increased access to arthritis-appropriate, individually adapted behavior change programs; and relevant policy and environmental changes," they added.

The study results were limited by several factors, included the use of self-reports and the lack of including household, occupational, or transportation-related activities as LTPA.

The findings, however, support data from previous studies showing increased rates of physical inactivity in adults with arthritis, and they highlight the need to target these individuals with physical activity promotion initiatives that are arthritis specific, the researchers noted.

"Health care providers and public health physical activity practitioners should counsel arthritis patients regarding the benefits of physical activity and refer them to physical or occupational therapy if indicated or to locally available arthritis-appropriate physical activity programs," they said.

The study was conducted by the Centers for Disease Control and Prevention.

In 2009, the prevalence of no physical activity was 53% higher in adults with arthritis than those without, based on the latest data from the Behavioral Risk Factor Surveillance System. The findings were published online in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report on Dec. 8.

From 2002 to 2008, the percentage of all adults in the United States who reported no physical activity stagnated at 25%, regardless of their arthritis status. The growing subset of adults with arthritis who tend to be sedentary because of their barriers to activity may have contributed to that stagnation, according to the CDC researchers.

"Further reduction in the prevalence of no leisure-time physical activity (LTPA) among all adults might be hindered by population subgroups that have exceptionally high rates of no LTPA, such as adults with arthritis," the researchers noted.

The researchers reviewed data from 432,607 adults aged 18 years and older who responded to telephone surveys. The study population included respondents from all 50 states, the District of Columbia, and all U.S. territories (MMWR 2011;60:1641-45).

Adults with arthritis accounted for at least 20% of all adults reporting no LTPA in each state, ranging from 21% in Minnesota to 43% in Tennessee.

Survey respondents were defined as "no LTPA" if they answered no to the question, "During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?"

Survey respondents were defined as having arthritis if they answered yes to the question, "Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?"

© Diana Hirsch/iStockphoto.com

The findings are not surprising, given the disease-specific barriers to physical activity experienced by people with arthritis, the researchers wrote.

"However, these barriers can be addressed through targeted health communication messages; increased access to arthritis-appropriate, individually adapted behavior change programs; and relevant policy and environmental changes," they added.

The study results were limited by several factors, included the use of self-reports and the lack of including household, occupational, or transportation-related activities as LTPA.

The findings, however, support data from previous studies showing increased rates of physical inactivity in adults with arthritis, and they highlight the need to target these individuals with physical activity promotion initiatives that are arthritis specific, the researchers noted.

"Health care providers and public health physical activity practitioners should counsel arthritis patients regarding the benefits of physical activity and refer them to physical or occupational therapy if indicated or to locally available arthritis-appropriate physical activity programs," they said.

The study was conducted by the Centers for Disease Control and Prevention.

In 2009, the prevalence of no physical activity was 53% higher in adults with arthritis than those without, based on the latest data from the Behavioral Risk Factor Surveillance System. The findings were published online in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report on Dec. 8.

From 2002 to 2008, the percentage of all adults in the United States who reported no physical activity stagnated at 25%, regardless of their arthritis status. The growing subset of adults with arthritis who tend to be sedentary because of their barriers to activity may have contributed to that stagnation, according to the CDC researchers.

"Further reduction in the prevalence of no leisure-time physical activity (LTPA) among all adults might be hindered by population subgroups that have exceptionally high rates of no LTPA, such as adults with arthritis," the researchers noted.

The researchers reviewed data from 432,607 adults aged 18 years and older who responded to telephone surveys. The study population included respondents from all 50 states, the District of Columbia, and all U.S. territories (MMWR 2011;60:1641-45).

Adults with arthritis accounted for at least 20% of all adults reporting no LTPA in each state, ranging from 21% in Minnesota to 43% in Tennessee.

Survey respondents were defined as "no LTPA" if they answered no to the question, "During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?"

Survey respondents were defined as having arthritis if they answered yes to the question, "Have you ever been told by a doctor or other health professional that you have some form of arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia?"

© Diana Hirsch/iStockphoto.com

The findings are not surprising, given the disease-specific barriers to physical activity experienced by people with arthritis, the researchers wrote.

"However, these barriers can be addressed through targeted health communication messages; increased access to arthritis-appropriate, individually adapted behavior change programs; and relevant policy and environmental changes," they added.

The study results were limited by several factors, included the use of self-reports and the lack of including household, occupational, or transportation-related activities as LTPA.

The findings, however, support data from previous studies showing increased rates of physical inactivity in adults with arthritis, and they highlight the need to target these individuals with physical activity promotion initiatives that are arthritis specific, the researchers noted.

"Health care providers and public health physical activity practitioners should counsel arthritis patients regarding the benefits of physical activity and refer them to physical or occupational therapy if indicated or to locally available arthritis-appropriate physical activity programs," they said.

The study was conducted by the Centers for Disease Control and Prevention.

NATIONAL HARBOR, MD. – Colonoscopy led to significant reductions in colorectal cancers located in both the distal colon and proximal colon, based on a large analysis of Medicare data from 1998 to 2002.

The finding that colonoscopy provided protection in the proximal colon is important because "several recent studies [have] yielded mixed results on the protective effect of colonoscopy in the proximal colon," said Dr. Yize Wang of the Mayo Clinic in Jacksonville, Fla.

To assess the impact of colonoscopy and flexible sigmoidoscopy on colorectal cancer risk, Dr. Wang and colleagues analyzed cancer rates in adults aged 67 to 80 years. The study group included 12,266 patients who had an outpatient colonoscopy, 6,402 who underwent sigmoidoscopy, and 41,410 individuals who did not have a screening procedure and served as controls.

Patients with inflammatory bowel disease, a history of polyps, or a history of colorectal cancer were excluded. The study patients were followed until the end of 2005, or until a diagnosis of colorectal cancer, or death.

A total of 58 colorectal cancers (CRCs) were diagnosed in the colonoscopy group during the follow-up period, compared to 66 CRCs in the patients who underwent flexible sigmoidoscopy and 634 CRCs in the control group.

In a multivariate analysis, colonoscopy was associated with a significant 73% reduction of distal colorectal cancer (hazard ratio, 0.27) and a significant 54% reduction of proximal colorectal cancer (HR, 0.46), compared with unscreened controls.

Sigmoidoscopy was associated with a significant 60% reduction of distal colorectal cancer (HR, 0.40), but no significant reduction in proximal colorectal cancer, compared to unscreened controls; this was expected because the procedure does not examine the entire colon.

A total of 771 (12%) of the patients who first underwent sigmoidoscopy went on to have a colonoscopy within 12 months. When the investigators excluded data from these patients, who had sigmoidoscopy followed by colonoscopy, the study results on cancer risk were essentially unchanged.

The findings were limited by the retrospective nature of the study, as well as the confounding effect of the diagnostic procedure chosen and the selection bias in the use of screening endoscopy, Dr. Wang said.

In addition, the study "does not reflect recent advancements in endoscopy equipment and techniques," he noted.

However, the results from this large study population confirm that colonoscopy remains the preferred screening test for colorectal cancer, said Dr. Wang.

The study was funded by a research grant from the American College of Gastroenterology. The researchers said they had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – Colonoscopy led to significant reductions in colorectal cancers located in both the distal colon and proximal colon, based on a large analysis of Medicare data from 1998 to 2002.

The finding that colonoscopy provided protection in the proximal colon is important because "several recent studies [have] yielded mixed results on the protective effect of colonoscopy in the proximal colon," said Dr. Yize Wang of the Mayo Clinic in Jacksonville, Fla.

To assess the impact of colonoscopy and flexible sigmoidoscopy on colorectal cancer risk, Dr. Wang and colleagues analyzed cancer rates in adults aged 67 to 80 years. The study group included 12,266 patients who had an outpatient colonoscopy, 6,402 who underwent sigmoidoscopy, and 41,410 individuals who did not have a screening procedure and served as controls.

Patients with inflammatory bowel disease, a history of polyps, or a history of colorectal cancer were excluded. The study patients were followed until the end of 2005, or until a diagnosis of colorectal cancer, or death.

A total of 58 colorectal cancers (CRCs) were diagnosed in the colonoscopy group during the follow-up period, compared to 66 CRCs in the patients who underwent flexible sigmoidoscopy and 634 CRCs in the control group.

In a multivariate analysis, colonoscopy was associated with a significant 73% reduction of distal colorectal cancer (hazard ratio, 0.27) and a significant 54% reduction of proximal colorectal cancer (HR, 0.46), compared with unscreened controls.

Sigmoidoscopy was associated with a significant 60% reduction of distal colorectal cancer (HR, 0.40), but no significant reduction in proximal colorectal cancer, compared to unscreened controls; this was expected because the procedure does not examine the entire colon.

A total of 771 (12%) of the patients who first underwent sigmoidoscopy went on to have a colonoscopy within 12 months. When the investigators excluded data from these patients, who had sigmoidoscopy followed by colonoscopy, the study results on cancer risk were essentially unchanged.

The findings were limited by the retrospective nature of the study, as well as the confounding effect of the diagnostic procedure chosen and the selection bias in the use of screening endoscopy, Dr. Wang said.

In addition, the study "does not reflect recent advancements in endoscopy equipment and techniques," he noted.

However, the results from this large study population confirm that colonoscopy remains the preferred screening test for colorectal cancer, said Dr. Wang.

The study was funded by a research grant from the American College of Gastroenterology. The researchers said they had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – Colonoscopy led to significant reductions in colorectal cancers located in both the distal colon and proximal colon, based on a large analysis of Medicare data from 1998 to 2002.

The finding that colonoscopy provided protection in the proximal colon is important because "several recent studies [have] yielded mixed results on the protective effect of colonoscopy in the proximal colon," said Dr. Yize Wang of the Mayo Clinic in Jacksonville, Fla.

To assess the impact of colonoscopy and flexible sigmoidoscopy on colorectal cancer risk, Dr. Wang and colleagues analyzed cancer rates in adults aged 67 to 80 years. The study group included 12,266 patients who had an outpatient colonoscopy, 6,402 who underwent sigmoidoscopy, and 41,410 individuals who did not have a screening procedure and served as controls.

Patients with inflammatory bowel disease, a history of polyps, or a history of colorectal cancer were excluded. The study patients were followed until the end of 2005, or until a diagnosis of colorectal cancer, or death.

A total of 58 colorectal cancers (CRCs) were diagnosed in the colonoscopy group during the follow-up period, compared to 66 CRCs in the patients who underwent flexible sigmoidoscopy and 634 CRCs in the control group.

In a multivariate analysis, colonoscopy was associated with a significant 73% reduction of distal colorectal cancer (hazard ratio, 0.27) and a significant 54% reduction of proximal colorectal cancer (HR, 0.46), compared with unscreened controls.

Sigmoidoscopy was associated with a significant 60% reduction of distal colorectal cancer (HR, 0.40), but no significant reduction in proximal colorectal cancer, compared to unscreened controls; this was expected because the procedure does not examine the entire colon.

A total of 771 (12%) of the patients who first underwent sigmoidoscopy went on to have a colonoscopy within 12 months. When the investigators excluded data from these patients, who had sigmoidoscopy followed by colonoscopy, the study results on cancer risk were essentially unchanged.

The findings were limited by the retrospective nature of the study, as well as the confounding effect of the diagnostic procedure chosen and the selection bias in the use of screening endoscopy, Dr. Wang said.

In addition, the study "does not reflect recent advancements in endoscopy equipment and techniques," he noted.

However, the results from this large study population confirm that colonoscopy remains the preferred screening test for colorectal cancer, said Dr. Wang.

The study was funded by a research grant from the American College of Gastroenterology. The researchers said they had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – Coronary artery disease was significantly more prevalent in patients with hepatitis C virus infection, compared with control subjects, based on a retrospective review. The findings were presented at the annual meeting of the American College of Gastroenterology.

"An association of coronary artery disease [CAD] with hepatitis C has been suggested, but definitive data are still lacking," said Dr. Sanjaya Satapathy, who conducted the study while at Long Island Jewish Medical Center in New Hyde Park, N.Y.

To estimate the prevalence of CAD in hepatitis C patients, Dr. Satapathy and his colleagues reviewed data from 934 individuals with hepatitis C infection who were seen at a single center between May 2002 and December 2008. Of these patients, 63 had undergone coronary angiography. The investigators compared their data with data from 63 matched controls without hepatitis C.

Overall severity of CAD according to the combined Reardon severity score was significantly greater in the hepatitis C virus (HCV) group than in the controls (6.3 vs. 2.6, respectively), suggesting that being HCV-positive increases the severity of, or risk for, CAD, Dr. Satapathy said.

The researchers defined CAD in two different ways for their analysis. CAD defined as stenosis greater than 50% was found in 44 of the HCV cases (70%) compared with 30 controls (48%). CAD defined as stenosis greater than 75% was found in 42 patients with hepatitis C (67%) compared with 29 controls (46%).

In addition, the prevalence of multivessel coronary artery disease was significantly higher in the HCV patients compared with the controls (57% vs. 16%, respectively). The prevalence of single-vessel involvement was greater in the control group.

"HCV seropositive status is a strong predictor for CAD," Dr. Satapathy said. However, "HCV patients are more likely to remain undertreated with antiplatelet and lipid-lowering agents," he noted.

The study was limited by the retrospective design and small sample size, said Dr. Satapathy. However, the findings suggest that CAD is significantly more common and severe in HCV-positive patients, and this should be considered by clinicians treating these patients, he said.

Dr. Satapathy said he had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – Coronary artery disease was significantly more prevalent in patients with hepatitis C virus infection, compared with control subjects, based on a retrospective review. The findings were presented at the annual meeting of the American College of Gastroenterology.

"An association of coronary artery disease [CAD] with hepatitis C has been suggested, but definitive data are still lacking," said Dr. Sanjaya Satapathy, who conducted the study while at Long Island Jewish Medical Center in New Hyde Park, N.Y.

To estimate the prevalence of CAD in hepatitis C patients, Dr. Satapathy and his colleagues reviewed data from 934 individuals with hepatitis C infection who were seen at a single center between May 2002 and December 2008. Of these patients, 63 had undergone coronary angiography. The investigators compared their data with data from 63 matched controls without hepatitis C.

Overall severity of CAD according to the combined Reardon severity score was significantly greater in the hepatitis C virus (HCV) group than in the controls (6.3 vs. 2.6, respectively), suggesting that being HCV-positive increases the severity of, or risk for, CAD, Dr. Satapathy said.

The researchers defined CAD in two different ways for their analysis. CAD defined as stenosis greater than 50% was found in 44 of the HCV cases (70%) compared with 30 controls (48%). CAD defined as stenosis greater than 75% was found in 42 patients with hepatitis C (67%) compared with 29 controls (46%).

In addition, the prevalence of multivessel coronary artery disease was significantly higher in the HCV patients compared with the controls (57% vs. 16%, respectively). The prevalence of single-vessel involvement was greater in the control group.

"HCV seropositive status is a strong predictor for CAD," Dr. Satapathy said. However, "HCV patients are more likely to remain undertreated with antiplatelet and lipid-lowering agents," he noted.

The study was limited by the retrospective design and small sample size, said Dr. Satapathy. However, the findings suggest that CAD is significantly more common and severe in HCV-positive patients, and this should be considered by clinicians treating these patients, he said.

Dr. Satapathy said he had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – Coronary artery disease was significantly more prevalent in patients with hepatitis C virus infection, compared with control subjects, based on a retrospective review. The findings were presented at the annual meeting of the American College of Gastroenterology.

"An association of coronary artery disease [CAD] with hepatitis C has been suggested, but definitive data are still lacking," said Dr. Sanjaya Satapathy, who conducted the study while at Long Island Jewish Medical Center in New Hyde Park, N.Y.

To estimate the prevalence of CAD in hepatitis C patients, Dr. Satapathy and his colleagues reviewed data from 934 individuals with hepatitis C infection who were seen at a single center between May 2002 and December 2008. Of these patients, 63 had undergone coronary angiography. The investigators compared their data with data from 63 matched controls without hepatitis C.

Overall severity of CAD according to the combined Reardon severity score was significantly greater in the hepatitis C virus (HCV) group than in the controls (6.3 vs. 2.6, respectively), suggesting that being HCV-positive increases the severity of, or risk for, CAD, Dr. Satapathy said.

The researchers defined CAD in two different ways for their analysis. CAD defined as stenosis greater than 50% was found in 44 of the HCV cases (70%) compared with 30 controls (48%). CAD defined as stenosis greater than 75% was found in 42 patients with hepatitis C (67%) compared with 29 controls (46%).

In addition, the prevalence of multivessel coronary artery disease was significantly higher in the HCV patients compared with the controls (57% vs. 16%, respectively). The prevalence of single-vessel involvement was greater in the control group.

"HCV seropositive status is a strong predictor for CAD," Dr. Satapathy said. However, "HCV patients are more likely to remain undertreated with antiplatelet and lipid-lowering agents," he noted.

The study was limited by the retrospective design and small sample size, said Dr. Satapathy. However, the findings suggest that CAD is significantly more common and severe in HCV-positive patients, and this should be considered by clinicians treating these patients, he said.

Dr. Satapathy said he had no financial conflicts to disclose.

NATIONAL HARBOR, MD. – "Food is what patients blame for their gastrointestinal symptoms," Dr. Peter Gibson said at the annual meeting of the American College of Gastroenterology.

And patients with functional GI disorders may be on the right track, according to Dr. Gibson, professor of medicine at Monash University in Victoria, Australia. He presented a novel dietary treatment that is not well known in the United States but appears promising as a strategy for managing irritable bowel syndrome (IBS) and other functional GI problems.

(c) Christian Pedant/fotolia.com

Dr. Gibson also said that physicians who want to help their patients manage their symptoms need to understand how foods can interact with the enteric nervous system, which controls most GI functions.

More specifically, certain types of sugars found in many foods are rapidly absorbed and fermented, drawing liquid into the GI tract, which can cause distension and trigger the symptoms of IBS, such as bloating and pain, he said.

The novel dietary approach is known by the acronym FODMAP, which stands for the types of sugars suspected of causing symptoms: fermentable sugars, oligosaccharides, disaccharides, monosaccharides, and polyols (such as sorbitol or mannitol). Thus the regimen designed to reduce symptoms is called a low-FODMAP diet, said Dr. Gibson.

Data are limited, but in theory, a low-FODMAP diet causes less distension of the intestinal lumen and thereby reduces IBS symptoms. His colleague, Susan Shepherd, Ph.D., who is a dietitian, has developed a list of foods that should be included, and others to exclude, when following such a diet.

In a recent study, 82 IBS patients were randomized to receive either standard dietary advice (39 people) or instruction on following a low-FODMAP diet (43 people); the patients were meeting with a dietitian on an outpatient basis (J. Hum. Nutr. Diet 2011;24:487-95).

Composite IBS symptom scores showed that significantly more patients in the low-FODMAP group had overall improvement in their symptoms, compared with the standard care group (86% vs. 49%). In addition, significantly more low-FODMAP patients reported improvements in bloating (82%), abdominal pain (85%), and flatulence (87%), compared with the standard care group (49%, 61%, and 50%, respectively).

More research is needed, but the data support the potential effectiveness of a low-FODMAP diet, Dr. Gibson said.

Some examples of foods to include as part of a low-FODMAP diet are bananas, blueberries, lettuce, potatoes, gluten-free bread or cereal products, rice, oats, hard cheeses, lactose-free milk, sugar, molasses, and most artificial sweeteners with names that do not end in "ol."*

Foods to eliminate when following a low-FODMAP diet include apples, pears, canned fruit in natural juice, high-fructose corn syrup, cows’ milk (which contains lactose), soft cheese, broccoli, cabbage, pasta, bread, or baked goods made from wheat or rye, mushrooms, and sweeteners ending in "ol," such as sorbitol.

A potential limitation of using the low-FODMAP diet is that it requires collaboration with a dietitian who is familiar with the diet, Dr. Gibson noted, and the diet is relatively unknown in the United States.

However, it may catch on, Dr. William D. Chey said in an interview at the meeting. Dr. Chey is a professor of internal medicine and director of the gastrointestinal physiology laboratory at the University of Michigan in Ann Arbor; he is also one of the two editors in chief of the American Journal of Gastroenterology.

"I think doctors are hungry for non-medical interventions" for IBS patients, Dr. Chey said. Although the diet is restrictive, many IBS patients are already on such restricted diets that the low-FODMAP diet actually broadens their food choices, which may promote adherence, he added.

More details about the low-FODMAP diet, including a complete list of foods and a database of knowledgeable dietitians, are available at ibsgroup.org/ibs-diet.

Dr. Gibson said he had no relevant financial disclosures. Dr. Chey has served as a consultant for multiple companies including AstraZeneca, Johnson & Johnson, Salix, and Takeda.

Correction: An earlier version of this story incorrectly named a few items on list of foods that may be consumed on the low-FODMAP diet. The error has been corrected.

NATIONAL HARBOR, MD. – "Food is what patients blame for their gastrointestinal symptoms," Dr. Peter Gibson said at the annual meeting of the American College of Gastroenterology.

And patients with functional GI disorders may be on the right track, according to Dr. Gibson, professor of medicine at Monash University in Victoria, Australia. He presented a novel dietary treatment that is not well known in the United States but appears promising as a strategy for managing irritable bowel syndrome (IBS) and other functional GI problems.

(c) Christian Pedant/fotolia.com

Dr. Gibson also said that physicians who want to help their patients manage their symptoms need to understand how foods can interact with the enteric nervous system, which controls most GI functions.

More specifically, certain types of sugars found in many foods are rapidly absorbed and fermented, drawing liquid into the GI tract, which can cause distension and trigger the symptoms of IBS, such as bloating and pain, he said.

The novel dietary approach is known by the acronym FODMAP, which stands for the types of sugars suspected of causing symptoms: fermentable sugars, oligosaccharides, disaccharides, monosaccharides, and polyols (such as sorbitol or mannitol). Thus the regimen designed to reduce symptoms is called a low-FODMAP diet, said Dr. Gibson.

Data are limited, but in theory, a low-FODMAP diet causes less distension of the intestinal lumen and thereby reduces IBS symptoms. His colleague, Susan Shepherd, Ph.D., who is a dietitian, has developed a list of foods that should be included, and others to exclude, when following such a diet.

In a recent study, 82 IBS patients were randomized to receive either standard dietary advice (39 people) or instruction on following a low-FODMAP diet (43 people); the patients were meeting with a dietitian on an outpatient basis (J. Hum. Nutr. Diet 2011;24:487-95).

Composite IBS symptom scores showed that significantly more patients in the low-FODMAP group had overall improvement in their symptoms, compared with the standard care group (86% vs. 49%). In addition, significantly more low-FODMAP patients reported improvements in bloating (82%), abdominal pain (85%), and flatulence (87%), compared with the standard care group (49%, 61%, and 50%, respectively).

More research is needed, but the data support the potential effectiveness of a low-FODMAP diet, Dr. Gibson said.

Some examples of foods to include as part of a low-FODMAP diet are bananas, blueberries, lettuce, potatoes, gluten-free bread or cereal products, rice, oats, hard cheeses, lactose-free milk, sugar, molasses, and most artificial sweeteners with names that do not end in "ol."*

Foods to eliminate when following a low-FODMAP diet include apples, pears, canned fruit in natural juice, high-fructose corn syrup, cows’ milk (which contains lactose), soft cheese, broccoli, cabbage, pasta, bread, or baked goods made from wheat or rye, mushrooms, and sweeteners ending in "ol," such as sorbitol.

A potential limitation of using the low-FODMAP diet is that it requires collaboration with a dietitian who is familiar with the diet, Dr. Gibson noted, and the diet is relatively unknown in the United States.

However, it may catch on, Dr. William D. Chey said in an interview at the meeting. Dr. Chey is a professor of internal medicine and director of the gastrointestinal physiology laboratory at the University of Michigan in Ann Arbor; he is also one of the two editors in chief of the American Journal of Gastroenterology.

"I think doctors are hungry for non-medical interventions" for IBS patients, Dr. Chey said. Although the diet is restrictive, many IBS patients are already on such restricted diets that the low-FODMAP diet actually broadens their food choices, which may promote adherence, he added.

More details about the low-FODMAP diet, including a complete list of foods and a database of knowledgeable dietitians, are available at ibsgroup.org/ibs-diet.

Dr. Gibson said he had no relevant financial disclosures. Dr. Chey has served as a consultant for multiple companies including AstraZeneca, Johnson & Johnson, Salix, and Takeda.

Correction: An earlier version of this story incorrectly named a few items on list of foods that may be consumed on the low-FODMAP diet. The error has been corrected.

NATIONAL HARBOR, MD. – "Food is what patients blame for their gastrointestinal symptoms," Dr. Peter Gibson said at the annual meeting of the American College of Gastroenterology.

And patients with functional GI disorders may be on the right track, according to Dr. Gibson, professor of medicine at Monash University in Victoria, Australia. He presented a novel dietary treatment that is not well known in the United States but appears promising as a strategy for managing irritable bowel syndrome (IBS) and other functional GI problems.

(c) Christian Pedant/fotolia.com

Dr. Gibson also said that physicians who want to help their patients manage their symptoms need to understand how foods can interact with the enteric nervous system, which controls most GI functions.

More specifically, certain types of sugars found in many foods are rapidly absorbed and fermented, drawing liquid into the GI tract, which can cause distension and trigger the symptoms of IBS, such as bloating and pain, he said.

The novel dietary approach is known by the acronym FODMAP, which stands for the types of sugars suspected of causing symptoms: fermentable sugars, oligosaccharides, disaccharides, monosaccharides, and polyols (such as sorbitol or mannitol). Thus the regimen designed to reduce symptoms is called a low-FODMAP diet, said Dr. Gibson.

Data are limited, but in theory, a low-FODMAP diet causes less distension of the intestinal lumen and thereby reduces IBS symptoms. His colleague, Susan Shepherd, Ph.D., who is a dietitian, has developed a list of foods that should be included, and others to exclude, when following such a diet.

In a recent study, 82 IBS patients were randomized to receive either standard dietary advice (39 people) or instruction on following a low-FODMAP diet (43 people); the patients were meeting with a dietitian on an outpatient basis (J. Hum. Nutr. Diet 2011;24:487-95).

Composite IBS symptom scores showed that significantly more patients in the low-FODMAP group had overall improvement in their symptoms, compared with the standard care group (86% vs. 49%). In addition, significantly more low-FODMAP patients reported improvements in bloating (82%), abdominal pain (85%), and flatulence (87%), compared with the standard care group (49%, 61%, and 50%, respectively).

More research is needed, but the data support the potential effectiveness of a low-FODMAP diet, Dr. Gibson said.

Some examples of foods to include as part of a low-FODMAP diet are bananas, blueberries, lettuce, potatoes, gluten-free bread or cereal products, rice, oats, hard cheeses, lactose-free milk, sugar, molasses, and most artificial sweeteners with names that do not end in "ol."*

Foods to eliminate when following a low-FODMAP diet include apples, pears, canned fruit in natural juice, high-fructose corn syrup, cows’ milk (which contains lactose), soft cheese, broccoli, cabbage, pasta, bread, or baked goods made from wheat or rye, mushrooms, and sweeteners ending in "ol," such as sorbitol.

A potential limitation of using the low-FODMAP diet is that it requires collaboration with a dietitian who is familiar with the diet, Dr. Gibson noted, and the diet is relatively unknown in the United States.

However, it may catch on, Dr. William D. Chey said in an interview at the meeting. Dr. Chey is a professor of internal medicine and director of the gastrointestinal physiology laboratory at the University of Michigan in Ann Arbor; he is also one of the two editors in chief of the American Journal of Gastroenterology.

"I think doctors are hungry for non-medical interventions" for IBS patients, Dr. Chey said. Although the diet is restrictive, many IBS patients are already on such restricted diets that the low-FODMAP diet actually broadens their food choices, which may promote adherence, he added.

More details about the low-FODMAP diet, including a complete list of foods and a database of knowledgeable dietitians, are available at ibsgroup.org/ibs-diet.

Dr. Gibson said he had no relevant financial disclosures. Dr. Chey has served as a consultant for multiple companies including AstraZeneca, Johnson & Johnson, Salix, and Takeda.

Correction: An earlier version of this story incorrectly named a few items on list of foods that may be consumed on the low-FODMAP diet. The error has been corrected.

Despite the Food and Drug Administration’s finding that Plan B One-Step, an emergency contraceptive, is safe, effective, and should be approved for nonprescription use by all women of childbearing potential, the drug remains unavailable without a prescription for those under 17 years old.

Dr. Margaret Hamburg, FDA Commissioner, announced her agency’s analysis and finding Dec. 7, but noted that Health and Human Services Secretary Kathleen Sebelius had overruled the decision.

In a memo, Ms. Sebelius disagreed with the FDA’s decision to extend approval of Plan B One-Step for nonprescription use by all women of childbearing potential based on her stated concern that the studies submitted to the FDA do not include data on girls of all ages who would be granted nonprescription access to the drug.

"It is commonly understood that there are significant cognitive and behavioral differences between older adolescent girls and the youngest girls of reproductive age, which I believe are relevant to making this determination as to non-prescription availability of this product for all ages," she said.

Plan B One-Step, a 1.5-mg levonorgestrel tablet, was first approved by the FDA in 2006 for use without a prescription by females aged 17 years and older, and by prescription only for girls younger than 17 years. The pill has been shown to reduce the chance of pregnancy after unprotected sex.

In February 2011, drug manufacturer Teva Pharmaceuticals appealed to the FDA to lift the prescription-only requirement for females younger than 17 years, triggering a review of the evidence by the FDA Center for Drug Evaluation and Research.

"Based on the information submitted to the agency, [the Center for Drug Evaluation and Research] determined that the product was safe and effective in adolescent females, that adolescent females understood the product was not for routine use, and that the product would not protect them against sexually transmitted diseases," Dr. Hamburg said in her statement. "Additionally, the data supported a finding that adolescent females could use Plan B One-Step properly without the intervention of a health care provider."

However, because of the HHS secretary’s objection, the FDA has issued a response letter to Teva stating that Plan B One-Step is not approved without a prescription for females younger than 17 years.

The product will remain on the market and available to females of all ages, with no prescription necessary for females aged 17 years and older.

Despite the Food and Drug Administration’s finding that Plan B One-Step, an emergency contraceptive, is safe, effective, and should be approved for nonprescription use by all women of childbearing potential, the drug remains unavailable without a prescription for those under 17 years old.

Dr. Margaret Hamburg, FDA Commissioner, announced her agency’s analysis and finding Dec. 7, but noted that Health and Human Services Secretary Kathleen Sebelius had overruled the decision.

In a memo, Ms. Sebelius disagreed with the FDA’s decision to extend approval of Plan B One-Step for nonprescription use by all women of childbearing potential based on her stated concern that the studies submitted to the FDA do not include data on girls of all ages who would be granted nonprescription access to the drug.

"It is commonly understood that there are significant cognitive and behavioral differences between older adolescent girls and the youngest girls of reproductive age, which I believe are relevant to making this determination as to non-prescription availability of this product for all ages," she said.

Plan B One-Step, a 1.5-mg levonorgestrel tablet, was first approved by the FDA in 2006 for use without a prescription by females aged 17 years and older, and by prescription only for girls younger than 17 years. The pill has been shown to reduce the chance of pregnancy after unprotected sex.

In February 2011, drug manufacturer Teva Pharmaceuticals appealed to the FDA to lift the prescription-only requirement for females younger than 17 years, triggering a review of the evidence by the FDA Center for Drug Evaluation and Research.

"Based on the information submitted to the agency, [the Center for Drug Evaluation and Research] determined that the product was safe and effective in adolescent females, that adolescent females understood the product was not for routine use, and that the product would not protect them against sexually transmitted diseases," Dr. Hamburg said in her statement. "Additionally, the data supported a finding that adolescent females could use Plan B One-Step properly without the intervention of a health care provider."

However, because of the HHS secretary’s objection, the FDA has issued a response letter to Teva stating that Plan B One-Step is not approved without a prescription for females younger than 17 years.

The product will remain on the market and available to females of all ages, with no prescription necessary for females aged 17 years and older.

Despite the Food and Drug Administration’s finding that Plan B One-Step, an emergency contraceptive, is safe, effective, and should be approved for nonprescription use by all women of childbearing potential, the drug remains unavailable without a prescription for those under 17 years old.

Dr. Margaret Hamburg, FDA Commissioner, announced her agency’s analysis and finding Dec. 7, but noted that Health and Human Services Secretary Kathleen Sebelius had overruled the decision.

In a memo, Ms. Sebelius disagreed with the FDA’s decision to extend approval of Plan B One-Step for nonprescription use by all women of childbearing potential based on her stated concern that the studies submitted to the FDA do not include data on girls of all ages who would be granted nonprescription access to the drug.

"It is commonly understood that there are significant cognitive and behavioral differences between older adolescent girls and the youngest girls of reproductive age, which I believe are relevant to making this determination as to non-prescription availability of this product for all ages," she said.

Plan B One-Step, a 1.5-mg levonorgestrel tablet, was first approved by the FDA in 2006 for use without a prescription by females aged 17 years and older, and by prescription only for girls younger than 17 years. The pill has been shown to reduce the chance of pregnancy after unprotected sex.

In February 2011, drug manufacturer Teva Pharmaceuticals appealed to the FDA to lift the prescription-only requirement for females younger than 17 years, triggering a review of the evidence by the FDA Center for Drug Evaluation and Research.

"Based on the information submitted to the agency, [the Center for Drug Evaluation and Research] determined that the product was safe and effective in adolescent females, that adolescent females understood the product was not for routine use, and that the product would not protect them against sexually transmitted diseases," Dr. Hamburg said in her statement. "Additionally, the data supported a finding that adolescent females could use Plan B One-Step properly without the intervention of a health care provider."

However, because of the HHS secretary’s objection, the FDA has issued a response letter to Teva stating that Plan B One-Step is not approved without a prescription for females younger than 17 years.

The product will remain on the market and available to females of all ages, with no prescription necessary for females aged 17 years and older.

NATIONAL HARBOR, MD. – Patients with short-segment Barrett’s esophagus who had additional ablative therapies after endoscopic mucosal resection had no significant improvement in recurrence or mortality rates, compared with patients who did not have additional therapies.

The study of 213 patients was presented at the annual meeting of the American College of Gastroenterology.

"Endoscopic mucosal resection and ablative therapies are now widely used to remove and ablate the Barrett’s mucosa," said Dr. Jianmin Tian of the Mayo Clinic in Rochester, Minn.

However, it is unclear whether additional ablative therapies after endoscopic mucosal resection (EMR) can improve outcomes for patients with short-segment Barrett’s esophagus (SSBE), defined as Barrett’s esophagus less than 3 cm.

To assess the value of additional ablation, Dr. Tian and colleagues conducted a retrospective cohort study of 213 adults with SSBE who were treated in a tertiary referral center. The study population included 93 patients who underwent EMR and 120 patients who underwent EMR plus additional ablative therapies.

The additional ablative therapies included radiofrequency ablation, photodynamic therapy, multipolar/bipolar electrocautery, cryotherapy, and argon plasma coagulation.

The recurrence rate was not significantly different in the EMR-only group, compared with the EMR-plus-ablation group (10% vs. 12%), after control for age, sex, Charlson comorbidity index, and specific condition (either intestinal metaplasia or dysplasia), Dr. Tian said. Similarly, the mortality rate was not significantly different between the two groups (15% vs. 18%, respectively).

The study included patients with SSBE and high-grade dysplasia or early esophageal cancer who had achieved complete remission of their dysplasia or intestinal metaplasia. Patients with a history of esophagectomy were excluded. Recurrence was defined as finding dysplasia or early esophageal cancer after two consecutive negative esophagogastroduodenoscopy exams with complete response.

The findings suggest that ablation of the gastroesophageal junction may not reduce recurrence, said Dr. Tian. The study was limited by its retrospective design and small size. But the study’s strengths include a relatively long follow-up period, the inclusion of two consecutive negative esophagogastroduodenoscopy exams, and systematic surveillance biopsies from the esophagus and the gastroesophageal junction, he noted.

Areas for further research include validation of the study findings in a randomized, controlled trial; data collection from patients with long-segment Barrett’s esophagus; and investigation of the clinical significance of recurrence at the gastroesophageal junction, Dr. Tian said.

Dr. Tian had no financial conflicts to disclose. Several study coauthors disclosed financial relationships with companies including Olympus, Fujinon, and Barrx.

NATIONAL HARBOR, MD. – Patients with short-segment Barrett’s esophagus who had additional ablative therapies after endoscopic mucosal resection had no significant improvement in recurrence or mortality rates, compared with patients who did not have additional therapies.

The study of 213 patients was presented at the annual meeting of the American College of Gastroenterology.

"Endoscopic mucosal resection and ablative therapies are now widely used to remove and ablate the Barrett’s mucosa," said Dr. Jianmin Tian of the Mayo Clinic in Rochester, Minn.

However, it is unclear whether additional ablative therapies after endoscopic mucosal resection (EMR) can improve outcomes for patients with short-segment Barrett’s esophagus (SSBE), defined as Barrett’s esophagus less than 3 cm.

To assess the value of additional ablation, Dr. Tian and colleagues conducted a retrospective cohort study of 213 adults with SSBE who were treated in a tertiary referral center. The study population included 93 patients who underwent EMR and 120 patients who underwent EMR plus additional ablative therapies.

The additional ablative therapies included radiofrequency ablation, photodynamic therapy, multipolar/bipolar electrocautery, cryotherapy, and argon plasma coagulation.

The recurrence rate was not significantly different in the EMR-only group, compared with the EMR-plus-ablation group (10% vs. 12%), after control for age, sex, Charlson comorbidity index, and specific condition (either intestinal metaplasia or dysplasia), Dr. Tian said. Similarly, the mortality rate was not significantly different between the two groups (15% vs. 18%, respectively).

The study included patients with SSBE and high-grade dysplasia or early esophageal cancer who had achieved complete remission of their dysplasia or intestinal metaplasia. Patients with a history of esophagectomy were excluded. Recurrence was defined as finding dysplasia or early esophageal cancer after two consecutive negative esophagogastroduodenoscopy exams with complete response.

The findings suggest that ablation of the gastroesophageal junction may not reduce recurrence, said Dr. Tian. The study was limited by its retrospective design and small size. But the study’s strengths include a relatively long follow-up period, the inclusion of two consecutive negative esophagogastroduodenoscopy exams, and systematic surveillance biopsies from the esophagus and the gastroesophageal junction, he noted.

Areas for further research include validation of the study findings in a randomized, controlled trial; data collection from patients with long-segment Barrett’s esophagus; and investigation of the clinical significance of recurrence at the gastroesophageal junction, Dr. Tian said.

Dr. Tian had no financial conflicts to disclose. Several study coauthors disclosed financial relationships with companies including Olympus, Fujinon, and Barrx.

NATIONAL HARBOR, MD. – Patients with short-segment Barrett’s esophagus who had additional ablative therapies after endoscopic mucosal resection had no significant improvement in recurrence or mortality rates, compared with patients who did not have additional therapies.

The study of 213 patients was presented at the annual meeting of the American College of Gastroenterology.

"Endoscopic mucosal resection and ablative therapies are now widely used to remove and ablate the Barrett’s mucosa," said Dr. Jianmin Tian of the Mayo Clinic in Rochester, Minn.

However, it is unclear whether additional ablative therapies after endoscopic mucosal resection (EMR) can improve outcomes for patients with short-segment Barrett’s esophagus (SSBE), defined as Barrett’s esophagus less than 3 cm.

To assess the value of additional ablation, Dr. Tian and colleagues conducted a retrospective cohort study of 213 adults with SSBE who were treated in a tertiary referral center. The study population included 93 patients who underwent EMR and 120 patients who underwent EMR plus additional ablative therapies.

The additional ablative therapies included radiofrequency ablation, photodynamic therapy, multipolar/bipolar electrocautery, cryotherapy, and argon plasma coagulation.

The recurrence rate was not significantly different in the EMR-only group, compared with the EMR-plus-ablation group (10% vs. 12%), after control for age, sex, Charlson comorbidity index, and specific condition (either intestinal metaplasia or dysplasia), Dr. Tian said. Similarly, the mortality rate was not significantly different between the two groups (15% vs. 18%, respectively).

The study included patients with SSBE and high-grade dysplasia or early esophageal cancer who had achieved complete remission of their dysplasia or intestinal metaplasia. Patients with a history of esophagectomy were excluded. Recurrence was defined as finding dysplasia or early esophageal cancer after two consecutive negative esophagogastroduodenoscopy exams with complete response.

The findings suggest that ablation of the gastroesophageal junction may not reduce recurrence, said Dr. Tian. The study was limited by its retrospective design and small size. But the study’s strengths include a relatively long follow-up period, the inclusion of two consecutive negative esophagogastroduodenoscopy exams, and systematic surveillance biopsies from the esophagus and the gastroesophageal junction, he noted.

Areas for further research include validation of the study findings in a randomized, controlled trial; data collection from patients with long-segment Barrett’s esophagus; and investigation of the clinical significance of recurrence at the gastroesophageal junction, Dr. Tian said.

Dr. Tian had no financial conflicts to disclose. Several study coauthors disclosed financial relationships with companies including Olympus, Fujinon, and Barrx.

Epilepsy, like other chronic medical conditions, leaves affected individuals feeling out of control and isolated, says Shelly Stoll, MPH, of the University of Michigan.

Ms. Stoll, along with colleagues at the university and the Epilepsy Foundation of Michigan, developed a program for individuals with epilepsy (IWE) to improve their self-care.

Photo Credit: Lidingo

The researchers conducted a pilot study of their intervention and presented the results at the annual meeting of the American Epilepsy Society in Baltimore, Md.

The 21 study participants were epilepsy patients aged 21 years and older. They completed telephone interviews at baseline and four months after completing the 6-week intervention.

The FOCUS intervention includes five elements:

-Figure out the problem or issue.

-Observe your routine.

-Choose a change goal.

-Undertake a change strategy.

-Study the results and select a reward.

The intervention included a day-long workshop followed by weekly telephone calls with a coach, some of which were conference calls with other patients.

Although this intervention didn’t reduce the frequency of seizures, the patients showed significant improvement from baseline in terms of quality of life and positive well-being.

The researchers admitted that the study is small and the findings preliminary, but the results merit a larger study with a longer time frame. Ideally, patients who participated in this study will continue to benefit. The researchers quoted one satisfied patient, who said, “I plan to keep moving forward, empowering and taking my life into my hands regardless of how epilepsy has tried to conquer me.”

The study was supported by the Centers for Disease Control and Prevention and the Managing Epilepsy Well network.

(On Twitter @hsplete)

^{(Photo courtesy of Lidingo via wikimedia commons (creative commons attribution share-alike license)}

Epilepsy, like other chronic medical conditions, leaves affected individuals feeling out of control and isolated, says Shelly Stoll, MPH, of the University of Michigan.

Ms. Stoll, along with colleagues at the university and the Epilepsy Foundation of Michigan, developed a program for individuals with epilepsy (IWE) to improve their self-care.

Photo Credit: Lidingo

The researchers conducted a pilot study of their intervention and presented the results at the annual meeting of the American Epilepsy Society in Baltimore, Md.

The 21 study participants were epilepsy patients aged 21 years and older. They completed telephone interviews at baseline and four months after completing the 6-week intervention.

The FOCUS intervention includes five elements:

-Figure out the problem or issue.

-Observe your routine.

-Choose a change goal.

-Undertake a change strategy.

-Study the results and select a reward.

The intervention included a day-long workshop followed by weekly telephone calls with a coach, some of which were conference calls with other patients.

Although this intervention didn’t reduce the frequency of seizures, the patients showed significant improvement from baseline in terms of quality of life and positive well-being.

The researchers admitted that the study is small and the findings preliminary, but the results merit a larger study with a longer time frame. Ideally, patients who participated in this study will continue to benefit. The researchers quoted one satisfied patient, who said, “I plan to keep moving forward, empowering and taking my life into my hands regardless of how epilepsy has tried to conquer me.”

The study was supported by the Centers for Disease Control and Prevention and the Managing Epilepsy Well network.

(On Twitter @hsplete)

^{(Photo courtesy of Lidingo via wikimedia commons (creative commons attribution share-alike license)}

Epilepsy, like other chronic medical conditions, leaves affected individuals feeling out of control and isolated, says Shelly Stoll, MPH, of the University of Michigan.

Ms. Stoll, along with colleagues at the university and the Epilepsy Foundation of Michigan, developed a program for individuals with epilepsy (IWE) to improve their self-care.

Photo Credit: Lidingo

The researchers conducted a pilot study of their intervention and presented the results at the annual meeting of the American Epilepsy Society in Baltimore, Md.

The 21 study participants were epilepsy patients aged 21 years and older. They completed telephone interviews at baseline and four months after completing the 6-week intervention.

The FOCUS intervention includes five elements:

-Figure out the problem or issue.

-Observe your routine.

-Choose a change goal.

-Undertake a change strategy.

-Study the results and select a reward.

The intervention included a day-long workshop followed by weekly telephone calls with a coach, some of which were conference calls with other patients.

Although this intervention didn’t reduce the frequency of seizures, the patients showed significant improvement from baseline in terms of quality of life and positive well-being.

The researchers admitted that the study is small and the findings preliminary, but the results merit a larger study with a longer time frame. Ideally, patients who participated in this study will continue to benefit. The researchers quoted one satisfied patient, who said, “I plan to keep moving forward, empowering and taking my life into my hands regardless of how epilepsy has tried to conquer me.”

The study was supported by the Centers for Disease Control and Prevention and the Managing Epilepsy Well network.

(On Twitter @hsplete)

^{(Photo courtesy of Lidingo via wikimedia commons (creative commons attribution share-alike license)}