Objectives:The low FODMAPs diet has emerged as an option for the treatment of irritable bowel syndrome (IBS). One major challenge of this diet is that it is very restrictive, and compliance is usually low. Preliminary findings suggest an association between eating disorder (ED) and the risk of developing IBS. The primary aim of the study is to assess the correlation between compliance to low FODMAPs diet and risk of eating disorder behaviours among an irritable bowel syndrome cohort. Methods:We report a single centre study in the IBS patient population at University College London Hospital (UCLH). 233 patients (186 female) who commenced a low FODMAPs group programme for IBS (Rome III or IV). Self-reported diet adherence at the end of the 6week programme was measured. At baseline, participants completed the SCOFF questionnaire (a validated 5-item screening tool for EDs), the validated HADS questionnaire and the validated IBS-symptom severity score (IBS-SSS). Results:The SCOFF questionnaire identified 54 (23%) patients at an increased risk of ED behaviour. Overall, 95 (41%) participants were diet-adherent at 6 weeks, with significantly greater adherence in identified ED individuals (57%). The highest adherence rate (51%) was in the IBS-D subtype and the lowest rate (10%) in IBS-C. There was no significant relationship between IBS symptom severity and either adherence or ED severity. Conclusion:In our IBS patient cohort greater adherence to a low FODMAPs diet is associated with eating disorder behaviour. The implications of our study are for clinicians to have a high index of suspicion of EDs in IBS patients, but also that low FODMAPs dietary advice to the general IBS population should be couched alongside psychological support.

Background Adenoma/polyp detection rates are considered to be among the most important quality indicators of colonoscopy and are key measures of a quality procedure. However, they are designed for use in the screening setting and are not amenable to other colonoscopy indications. Little is known about their significance in other colonoscopy indications. We aimed to evaluate the impact of the various indications on polyp detection rate (PDR). Methods This was a retrospective, single-center study. Electronic reports of index colonoscopy procedures with adequate bowel preparation over a 10-year period were reviewed. Patients were divided into 7 groups based on the study indication. PDR was determined for each group and was compared to that of a control group, the screening indication group. Adjustment was made for potential confounders such as age, sex, and procedural setting. Results A total of 13,054 patients were considered suitable for the study. PDR was greatest in the positive fecal occult blood test group, with a value of 33.1% (P<0.01). Overall, the remaining groups showed similar PDRs compared with screening (22.1% vs. 20.4%; P=0.15). This trend persisted in a multivariate analysis, which showed the odds ratio in the positive fecal occult blood test group to be significantly higher, with a value of 1.955 (1.759-2.172, P<0.001) compared with the screening group. Conclusion PDR was highest for the positive fecal occult blood test indication, but was not affected significantly by most indications. Further randomized studies are warranted to confirm these findings and help calculate recommended thresholds for “overall” PDR.

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