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Background-Abdominal bloating and visible distention are common yet poorly understood symptoms. Epidemiological data distinguishing visible distention from bloating are not available. We aimed to evaluate the prevalence and potential risk factors for abdominal bloating and visible distention separately in a representative US population, and their association with other functional gastrointestinal disorders (FGIDs).

Background Dysphagia is considered an alarm symptom but detailed population-based data on dysphagia are lacking. We aimed to estimate in a representative US Caucasian population the prevalence of dysphagia and potential risk factors. Methods A modified version of the previously validated Bowel Disease Questionnaire was mailed to a population based cohort (n=7640) of Olmsted County, MN. Dysphagia was measured by one validated question “In the last year, how often have you had difficulty swallowing (a feeling that food sticks in your throat or chest)?” The medical records were reviewed for organic causes of dysphagia. The associations of reported frequency of dysphagia with potential risk factors were assessed using logistic regression models. Results The sex-specific, age-adjusted (US White 2000) prevalence for dysphagia experienced at least weekly was 3.0 % (95% CI: 2.2, 3.7) in females and 3.0 % (95% CI: 2.0, 4.0) in males. Those with frequent heartburn [OR=5.9 (4.0, 8.6)] and acid regurgitation [OR=10.6 (6.8, 16.6)] were significantly more likely to report frequent dysphagia. PPI use was significantly associated with frequent (3.1, 95% CI 2.2, 4.4) and infrequent dysphagia (1.5, 955 CI 1.3, 1.8). GERD was the most common diagnosis in those reporting dysphagia on the medical record; other organic explanations were rare and only found in the frequent dysphagia group. Conclusions Frequent dysphagia is not rare in the community (3%), occurs in both women and men across all adult age groups, and is most likely to indicate underlying GERD.

Dyspepsia is common in the general population, and despite a paucity of data, smoking, alcohol, and analgesics are believed to be important risk factors. Dyspepsia was significantly more common in younger subjects and females. Adjusting for age and gender, paracetamol (odds ratio (OR)=2*2), aspirin (OR=1-8), and smoking (OR=1.5), but not alcohol (OR=0-9), were associated with dyspepsia (all p<0 05). When non-gastrointestinal somatic complaints were included in the logistic models, however, these environmental factors were no longer significant (OR=1-3, 1.1, 1-2 and 0*9, respectively).Similar results were obtained when ulcer-like, dysmotility-like, and reflux-like dyspepsia were considered separately. The results were not significantly changed when subjects with a history of ulcer disease were included in the analyses. Smoking, alcohol, and analgesics may not therefore be important risk factors for dyspepsia in the community.

Summary BACKGROUND Proton pump inhibitors (PPI) are inconsistently associated with osteoporotic fractures. Barrett’s oesophagus patients are treated with high PPI doses for prolonged periods, but there is limited data on the incidence of osteoporosis and fractures in them. AIM In this study, we aimed to estimate the incidence of (and risk factors for) low bone mass (osteoporosis and/or osteopenia) related fractures in a population-based Barrett’s oesophagus cohort. METHODS All subjects with Barrett’s oesophagus and a diagnosis of osteoporosis and fractures were identified using Rochester Epidemiology Project (REP) resources. The incidence rates of all and osteoporotic fractures in these subjects were compared to an age- and gender similar population in Olmsted County to determine standardized incidence ratios (SIR). Predictors were assessed using Cox proportional hazards models. RESULTS Five hundred and twenty-one patients were included [median (IQR) age 61(52, 72) years; three hundred ninety-eight (76%) men] of whom one hundred thirteen (21.7%) had fractures, and forty-six (8.8%) had osteoporotic fractures. The incidence of all fractures and osteoporotic fractures was comparable to that of an age- and gender- matched population (SIR 1.09; 95% CI 0.92–1.29: SIR 1.05; 95% CI 0.85–1.29). PPI use, dose or duration of use was not associated with osteoporotic fracture risk (HR 0.87; 95% CI 0.12–6.39). Independent risk factors for osteoporotic fractures included older age, female gender and higher co-morbidity index. CONCLUSIONS The incidence of osteoporotic fractures was not increased in Barrett’s oesophagus patients compared to the general population. Additionally, PPI use was not associated with increased fracture risk regardless of the duration of therapy or dose.