BACKGROUND/AIMS: Dietary therapy is increasingly used to manage gastrointestinal (GI) symptoms in patients with irritable bowel syndrome (IBS). We aim to gauge United States gastroenterologists’ perceptions of dietary therapies for IBS. METHODS: We distributed a 22-question survey to members of the American College of Gastroenterology. The survey was developed by gastroenterologists and survey methodologists. We collected information pertaining to demographics, providers’ interpretation of their patients’ views on dietary therapy, and gastroenterologists’ perceptions on dietary therapy, and nutritional counseling in IBS. RESULTS: One thousand five hundred and sixty-two (14%) surveys were collected. Nearly 60% of participants reported that patients commonly associate food with GI symptoms. IBS patients most commonly use a trial and error approach followed by a lactose-free and gluten-free diet, and rarely use a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet on their own. Over half of providers recommend diet therapy to > 75% of IBS patients and most commonly recommend a low FODMAP diet. Only 21% of gastroenterologists commonly refer IBS patients to registered dietitians, and only 30% use GI dietitians. Female providers were more likely than males to recommend dietary changes as the primary mode of therapy (OR, 1.43 [1.09–1.88]; P = 0.009). CONCLUSIONS: Our national survey identified enthusiasm for diet treatment of IBS. While patients infrequently tried a low FODMAP diet on their own, GI providers commonly recommended this diet. Only a minority of GI providers refer their IBS patients to a registered dietitian for nutrition counseling and few refer patients to dietitians with specialized GI training. Female providers were more enthusiastic about diet therapies than males.
Counseling ; Demography ; Diet ; Diet Therapy ; Diet, Gluten-Free ; Disaccharides ; Female ; Gastroenterology ; Humans ; Irritable Bowel Syndrome ; Male ; Monosaccharides ; Nutritionists ; Oligosaccharides ; United States

STUDY DESIGN: Prospective, prognostic study, level II evidence. PURPOSE: To define the normal change in the creatine kinase (CK) levels in patients undergoing prone or supine lumbar or cervical spine surgery and to determine if positioning influences the postoperative changes in the CK levels. OVERVIEW OF LITERATURE: Spine surgery is one of the most commonly performed and fastest growing areas of surgery in the United States. Thus, the various possible complications need to be understood, and risk factors for these complications need to be mitigated. One of the rare complications, reported in the literature as small case series and case reports, is rhabdomyolysis, diagnosed by high CK levels. Thus far, very few studies have examined the rise in CK levels following spine surgery, and to our knowledge, none has assessed the potential association of surgical positioning and the rise in CK levels. METHODS: We retrospectively analyzed 94 patients. We obtained their preoperative CK levels, and re-assessed their CK levels at postoperative day (POD) 1, 2, and 3, as well as at their 2-week follow-up. The data were analyzed with respect to the spine level and positioning to determine if positioning had any effect on the postoperative rise in the CK level. RESULTS: Total 94 consecutive patients were enrolled in this study. The average preoperative CK level was 179.64, and the average CK level was 847.04 on POD 1. Prone positioning showed a greater rise in the CK levels following surgery than the supine positioning. In a similar manner, lumbar procedures led to a larger rise in the CK levels than cervical surgery. Prone/lumbar surgery showed the largest increase among all groups. Finally, revision surgery and instrumentation both increased the postoperative CK levels. CONCLUSIONS: This study demonstrated that positioning can affect the postoperative CK level rise, with patients undergoing prone/lumbar surgery showing the greatest rise in the postoperative CK levels. This rise, however, may be related to paraspinal muscle damage, rather than the positioning itself.
Creatine Kinase ; Creatine ; Follow-Up Studies ; Humans ; Paraspinal Muscles ; Prospective Studies ; Retrospective Studies ; Rhabdomyolysis ; Risk Factors ; Spine ; United States

OBJECTIVETo evaluate the feature of experimental endplate fracture in lumbar spine and its related factors.

METHODSNineteen cadaveric lumbar motion segments aged 48 - 77 years were compressed by overload to fracture the endplate and dissected into isolated vertebrae to evaluate feature of their endplate failure. Before and after failure of endplate, radiographic tests were taken on every motion segment. The bone mineral density (BMD), bone mineral content (BMC) of the vertebral body and endplate were tested respectively before endplate fracture.

RESULTSAmong 19 motion segments, 16 were fractured and accounted for 84.2% of all and fracture featured as stellate, step, depression and intrusion. Fracture concentrated on the center or anterior of superior endplate of the inferior vertebrae in one motion segment. Failure load of endplate was positively correlated with BMD, BMC of vertebral endplate. Within one vertebral body, the BMD and BMC of its superior endplate was markedly less than that of inferior endplate, on the other hand, the difference of BMD and BMC of endplate around one disc was opposite.

CONCLUSIONSFractures usually concentrate on the center or anterior part of superior endplate of one vertebrae and are hard to be identified by conventional radiographic examination. Failure load of endplate is positively correlated with BMD, BMC of vertebral body and endplate. There might be certain relationship between feature of fracture and severity of disc degeneration.

Aged ; Bone Density ; Cadaver ; Female ; Fractures, Stress ; diagnostic imaging ; pathology ; Humans ; Intervertebral Disc ; diagnostic imaging ; pathology ; Lumbar Vertebrae ; diagnostic imaging ; injuries ; pathology ; Male ; Middle Aged ; Radiography ; Spinal Fractures ; diagnostic imaging ; pathology