1050 Which Non-Invasive Disease Activity Index Should Be Used in Ulcerative Colitis? A Systematic Head-to-Head Psychometric Comparison Dan Turner, Cynthia H. Seow, Mark S. Silverberg, Gordon R. Greenberg, Anne M. Griffiths, A. Hillary Steinhart Background: Several non-invasive indices are available to measure disease activity in ulcerative colitis (UC), but sparse evidence exists to guide their use. We aimed to systematically compare the psychometric properties of all existing indices and to determine cutoff scores that correspond to remission and response. Methods: In this prospective longitudinal study, 86 adults with UC were recruited (52% males, mean age 37.6 ± 13.7 years, median disease duration 6.6 (2.1-13.1) years). Items from the following indices were scored: Mayo score, Rachmilewitz, Lichtiger, Seo, Pediatric UC Activity Index (PUCAI), Partial Powell-Tuck, Endoscopic-Clinical Correlation Index (ECCI), Beattie, and Walmsley (SCCAI). Physician global assessment, colonoscopic score, blood tests and the Mayo score were used to assess construct and discriminative validity. Follow-up evaluation of 61 patients was used to assess test-retest reliability and responsiveness. Results: The PUCAI and Walmsley indices ranked the best for each of the four psychometric properties evaluated. For construct validity, the average correlation for the five included constructs were r=0.79 and r=0.80 for the PUCAI and Walmsley respectively (both p<0.001); discriminative validity AUC=0.95 (95% CI, 0.90- 0.99) and AUC=0.93 (95% CI, 0.87-0.98); test-retest reliability ICC=0.89 (95%CI, 0.76- 0.95) and ICC=0.94 (95% CI, 0.86-0.97) and responsiveness AUC=0.84 (95% CI, 0.72- 0.96) and AUC=0.86 (95%CI, 0.74-0.99) respectively. The partial Mayo score ranked well on three of the four properties evaluated: construct validity r=0.79 (p<0.001); discriminative validity AUC=0.95 (95% CI, 0.90-0.99); and responsiveness AUC=0.84 (95%CI, 0.72-0.96). However, this index demonstrated inferior test-retest reliability ICC=0.82 (95% CI, 0.60- 0.92). The Rachmilewitz index showed good validity (construct validity r=0.81 (p<0.001); discriminative validity AUC 0.92 (95% CI, 0.87-0.98) and reliability ICC=0.89 (95% CI, 0.76-0.95) but inferior responsiveness AUC=0.74 (95%CI, 0.58-0.90). Cutoff scores that define clinical-endoscopic remission and response were determined using ROC curve analysis for all instruments and were broadly similar to those cutoffs that had been empirically derived and used with each of the instruments. Conclusion: The Walmsley, PUCAI and partial Mayo are valid, reliable and responsive non-invasive indices to assess disease activity in adult UC. Given their robust psychometric properties, these instruments may permit less frequent endoscopic assessment in clinical practice and in research. 1051 Assessment of Wireless Capsule Endoscopy in Patients with Ulcerative Colitis David T. Rubin, Marc Schwartz, Jami A. Rothe, Bonnie L. Surma, Sam Gavzy, Alana P. Bunnag, Andrew S. Ross Background: Approximately 10-15% of patients with colitis are classified as indeterminate due to mixed features at diagnosis or during subsequent treatment and follow-up. In addition, some patients thought to have UC develop Crohn's disease (CD) after surgery. Wireless capsule endoscopy (WCE) provides a highly sensitive examination of the small bowel, and has been shown to have superior yield in known or suspected CD, but has not been studied prospectively in UC. Objective: The aim of this prospective study was to determine the prevalence of small bowel findings with WCE in adult patients with a clinical diagnosis of UC. Methods: Patients with clinical, endoscopic and histologic evidence of UC and no evidence of terminal ileitis (by ileoscopy or radiographic study) underwent WCE. Disease activity was assessed using the Simple Clinical Colitis Activity Index (SCCAI) and serologic testing with Serology 7 (Prometheus Laboratories, San Diego, CA) was performed. Two experienced examiners blinded to patient history independently assessed the WCE findings. Discrepancies were resolved by meeting and review. Small bowel findings were converted to Lewis Scores (<135 is “normal”), and compared to SCCAI and serology results. Results: Thirty-six patients met screening criteria and participated in the study. 19 (53%) were male, and 24 (67%) were non-smokers, 7 (19%) ex-smokers and 5 smokers < 1ppd. Patients were median 43y old (range: 18-78y), with median age of onset 29y (12-54y) and median duration of disease 10y (0-37y). Twenty-four patients had pancolitis, 11 had left-sided disease and 1 had proctitis. The median SCCAI score was 5 (1-13) and 14 patients (39%) had score > 7. Median small bowel transit time was 199.5 min (65-374 min). Serology 7 predicted UC in 13 patients, CD in 12 patients and no IBD in 11 patients. No patient had an abnormal Lewis Score (mean score=1.2 (SD 5)), but 2 patients had a single pinpoint erosion (serology predicted UC) and 1 patient (with prior negative ileoscopy) had an ileal ulcer <1/4 of the lumen (serology predicted CD). SCCAI did not correlate with these findings and review of individual titers did not change this assessment. Conclusions: In this series of well-defined adult UC patients with various degrees of clinical activity, WCE and Lewis Scoring did not identify small bowel findings of significance and did not change the diagnosis in 97% of these patients. In this cohort of patients, the sensitivity of Serology 7 for UC was only 37%. These findings have important clinical implications for diagnosis and management decisions. 1052 Abnormal Counts of Small Bowel Bacteria or Abnormal Lactulose Hydrogen Breath Test in Irritable Bowel Syndrome: Relevance for Symptoms? Iris Posserud, Per-Ove Stotzer, Hasse Abrahamsson, Magnus Simren Abnormal lactulose hydrogen breath tests (LHBT) indicating abnormal counts of small bowel bacteria are proposed to be common in irritable bowel syndrome (IBS). In a recent study, culture verified small intestinal bacterial overgrowth (SIBO) was rare in IBS, but a proportion of patients had mildly increased counts of small bowel bacteria compared with controls (Posserud et al. Gut 2007). However, the clinical importance of abnormal counts of small bowel bacteria as indicated by LHBT or culture remains unclear. AIM: Assess the relevance of abnormal counts of small bowel bacteria and symptoms in IBS. METHODS: Jejunal cultures were obtained from 126 IBS patients (mean age 36 years; 92 females). Another 80 IBS patients (mean age 40 years; 63 females) underwent a LHBT. All patients completed validated questionnaires assessing IBS symptoms and stool consistency and frequency. SIBO A-161 AGA Abstracts was defined as ≥10 5 colonic bacteria/ml fluid and mildly increased bacteria was defined as >5x10 3 bacteria/ml or ≥5x10 3 colonic bacteria/ml (Posserud et al. Gut 2007). For the LHBT a double peak pattern or a >20 ppm H 2 rise within 90 min was considered abnormal (Pimentel et al. Am J G 2003). RESULTS: SIBO was found in 4 patients (3%), whereas ≥5x10 3 colonic bacteria/ml was seen in 11 patients (9%), and >5x10 3 bacteria/ml in 32 patients (25%). No significant differences in symptoms were reported by patients with and without SIBO. Patients with >5x10 3 bacteria/ml had looser stools (4.6±1.1 vs 4.0±1.2; p<.05) and tended to have less severe abdominal pain (3.1±0.8 vs 3.5±1.1; p=.05) than patients with normal small bowel bacterial counts. Having ≥5x10 3 colonic bacteria/ml was associated with more severe dyspeptic symptoms (3.3±1.7 vs 2.2±1.2; p<.05). The LHBT of 5 patients (6%) showed a double peak pattern, whereas 34 patients (43%) had a single H 2 increase within 90 min. A LHBT with a double peak pattern was not associated with any specific symptoms. Patients with a H 2 rise within 90 min reported more severe symptoms of diarrhea (4.6±1.4 vs 3.2±1.6; p<.05) and looser stools (5.1±0.9 vs 4.0±0.9; p<.05) compared to patients with a normal LHBT. Overall symptom severity was not different in patients with normal and abnormal LHBTs. CONCLUSIONS: We found no clear associations between symptoms or symptom severity and culture verified SIBO, mildly increased small bowel bacteria or abnormal LHBT. A H2 rise within 90 min was associated with looser stools and more severe symptoms of diarrhea, possibly as a consequence of faster small bowel transit in these patients. Thus, the clinical importance of abnormal small bowel bacterial counts in IBS patients is questionable. 1053 Risk Exposures for Functional Dyspepsia Versus IBS in Latin America: A Population-Based Study in Nicaragua Edgar M. Peña, Loreto Cortes, Rodolfo Pena, Paris . Heidt, Douglas Morgan BACKGROUND: Risk factors for functional dyspepsia (FD) are uninvestigated in Latin America. The University of Nicaragua (UNAN) maintains a population-based epidemiology surveillance system for western Nicaragua, encompassing 24% (11,000 homes) of the region's population (200,000). As the only Latin American member of the INDEPTH network (global network of developing nation surveillance systems), UNAN can uniquely conduct population- based investigations in the Latino population. We have demonstrated an association between IBS and psychosocial risk exposures (domestic violence, war trauma) in this population. The aim of the study was to delineate the epidemiology of FD in this Latino population. METHODS: We conducted a population-based, cross-sectional survey in western Nicaragua. A random sample was chosen utilizing the UNAN population surveillance system. The validated Spanish Rome II Modular Questionnaire (R2MQ) was used for the identification of FD cases for comparison with random healthy controls. The validated Spanish Conflict Tactics Scales assessed domestic violence and sexual abuse. The war trauma instrument for exposures in the Sandinista Revolution, was previously validated in Nicaragua, with assess- ment of physical or psychological abuse, witnessed executions, and economic loss. Household socioeconomic status was assessed with a regionally validated poverty index [Renzi1993], which was calculated with the United Nation's unsatisfied basic needs measurement, based on housing, sanitation, education, unemployment. Mantel-Haensztel summary ORs were calculated, controlled for age and gender. RESULTS: In this population-based survey of randomly selected subjects (n=1624), the overall prevalence of FD was 10.3%. This preval- ence is higher than reported in western populations, but consistent with clinical experience. As in the case of IBS in this population, exposure to war trauma was a risk factor for FD, OR 2.0 (95%CI, 1.15-3.5). Poverty did not increase the risk of FD, OR 1.1 (95%CI, 0.78- 1.7). In contrast to a positive association in IBS, domestic violence was not a risk factor for FD overall, OR 1.1 (95%CI, 0.68-1.8), or among females, OR 0.98 (95%CI, 0.55-1.7). CONCLUSIONS War trauma is an independent risk factor for functional dyspepsia, as for IBS, among Latinos in Nicaragua. Poverty and domestic violence do not appear to be independently associated. FUNDING: Rome Foundation. 1054 Prevalence of Small Intestinal Bacterial Overgrowth in Irritable Bowel Syndrome: Systematic Review and Meta-Analysis Alexander C. Ford, Nicholas J. Talley, Brennan M. Spiegel, Paul Moayyedi Introduction: Small intestinal bacterial overgrowth (SIBO) may explain symptoms in indi- viduals with irritable bowel syndrome (IBS). A high prevalence of SIBO in IBS has been reported. As a result, treatment of IBS with antibiotics has been advocated. However, study data are conflicting. Methods: We conducted a systematic review and meta-analysis to examine this issue. MEDLINE and EMBASE were searched up to November 2008 to identify case series and case-control studies reporting on prevalence of SIBO, according to various diagnostic tests, in unselected adults (> 16 years) meeting diagnostic criteria for IBS. Propor- tion of individuals with a presumptive diagnosis of IBS testing positive using lactulose, glucose, or sucrose hydrogen breath tests, or jejunal aspirate and culture, were combined for case series and case-control studies to give a pooled prevalence of SIBO, according to the test used, in subjects meeting diagnostic criteria for IBS. In addition, for case-control studies data were pooled for cases and controls, regardless of test used, and pooled prevalence of SIBO was compared between the two with an odds ratio (OR) and 95% confidence interval (CI). All data were pooled using a random effects model. Results: The search identified 2542 studies. Of these 16 appeared eligible and were evaluated. Eleven studies, containing 1778 subjects with symptoms suggestive of IBS met eligibility criteria. Six were case-control studies using healthy members of the general population, or healthy relatives, as controls. Prevalence of SIBO, according to various tests, is reported in the table. When data were pooled for cases meeting diagnostic criteria for IBS compared to controls, regardless of the test used, the OR for SIBO in IBS was 3.6 (95% CI 1.0-12.4, I2 = 83%). Conclusions: Prevalence of SIBO in individuals meeting diagnostic criteria for IBS appeared high, but there was a large degree of heterogeneity between studies, and no statistically significant increase in cases compared with controls. When jejunal aspirate and culture, the gold- standard for the diagnosis of SIBO, was used prevalence was only 4%. These data suggest a definite role for SIBO in IBS is debatable. AGA Abstracts