faktor resiko kolonoskopi

8/16/2019 faktor resiko kolonoskopi

1/10


2/10

"'() *a+tor( ,or %emorr-o'

3rant 1


3/10

"'() *a+tor( ,or %emorr-o',rom In(t'tut'onal "e8'eB 4oar

re8'eB.


4/10

Stu Populat'on

#ll tr'al part'+'pant( B-o +omplete t-e ba(el'ne 8'('t Bere 'n+lue. # re(ear+- a(('(tant

tra'ne 'n ata ab(tra+t'on an bl'ne to t-e epo(ure 8ar'able( ab(tra+te ata ,rom t-e ual

','n +olono(+op report(. $a(e( Bere part'+'pant( reporte to -a8e -emorr-o'( +ontrol(

Bere (ubje+t( B't- no ment'on o, -emorr-o'(. Ea+- part'+'pant -a an 'nta)e 8'('t ,or t-e

parC ent (tu B't-'n 120 a( a,ter t-e +olono(+op. &-e 'nta)e 8'('t +olle+te 'n,ormat'on onemorap-'+(! 'et! boBel -ab't(! p-('+al a+t'8't! (mo)'n -'(tor! al+o-ol u(e! pre(+r'pt'on

an o8er t-e +ounter me'+at'on u(e. D'etar 'n,ormat'on Ba( +olle+te u('n t-e 4lo+) 4r'e,

2000 *oo *reuen+ ue(t'onna're! a (em'Cuant'tat'8e ,oo ,reuen+ ue(t'onna're B't-

F0 ,oo 'tem(.M

4oBel mo8ement ,reuen+ Ba( a((e((e B't- t-e ue(t'on QIn t-e pa(t ear! on a8erae!

-oB man boBel mo8ement( ' ou -a8e per a or per Bee)MR 4oBel -ab't( Bere

,urt-er e8aluate b 'nu'r'n B-at per+ent o, t-e t'me a part'+'pant -a to (tra'n ur'n a

boBel mo8ement! -a a ,eel'n o, 'n+omplete boBel e8a+uat'on! or -a -ar or lump

(tool(.

&Bo e,'n't'on( o, +on(t'pat'on Bere u(e. &-e ,'r(t e,'n't'on Ba( ba(e on "ome I

$r'ter'a F! 7M an Ba( e,'ne a( -a8'n tBo or more o, t-e ,olloB'n: 1@ (tra'n'n ur'n a

boBel mo8ement 2 or more o, t-e t'me! 2@ a ,eel'n o, 'n+omplete boBel e8a+uat'on 2 omore o, t-e t'me! 3@ -a8'n -ar or lump (tool( 2 or more o, t-e t'me! an/or 5@ report'n

,eBer t-an t-ree boBel mo8ement( per Bee). &-e (e+on e,'n't'on Ba( ,reuen+ ba(e an

Ba( e,'ne a( ,eBer t-an t-ree boBel mo8ement( per Bee) on a8erae.

P-('+al a+t'8't Ba( mea(ure u('n t-e 8al'ate Internat'onal P-('+al #+t'8't ue(t'on

na're!M an (ummar'6e a( metabol'+ eu'8alent(. Seentar be-a8'or Ba( a((e((e B't- t-e

ue(t'on! QDur'n t-e la(t 7 a(! -oB mu+- t'me ' ou u(uall (pen ('tt'n on a Bee)

aR %e'-t an Be'-t Bere e't-er mea(ure ?70 an 72.3! re(pe+t'8el@ or +olle+te b

(el,Creport ?29.F an 25! re(pe+t'8el@ at t-'( 8'('t.

"eular u(e o, a(p'r'n or NS#IDS Ba( e,'ne a( one or more a( o, u(e per Bee).

Smo)'n Ba( +ateor'6e a( ne8er! ,ormer an +urrent. #l+o-ol u(e Ba( a((e((e B't- number

o, al+oC -ol'+ r'n)( per a o8er t-e la(t ear. Prenan+ -'(tor Ba( a((e((e B't- t-e

ue(t'on(Q%oB man t'me( -a8e ou been prenantR an Q%oB man l'8e b'rt-( -a8e ou -aR

Stat'(t'+al #nal('(

ean( an (tanar e8'at'on( Bere reporte ,or +ont'nuou( 8ar'able(! me'an( ,or ()eBe

'(tr'but'on( o, +ont'nuou( 8ar'able(! an proport'on( ,or +ateor'+al ata. $-ara+ter'(t'+(

Bere +ompare u('n a 2 (ample tCte(t or Pear(onH( +-'C(uare te(t. D'etar ata! al+o-ol u(e!

p-('+al a+t'8't an (eentar be-a8'or Bere +on8erte 'nto uart'le( ,or anal(e(. ult'8ar'C

able anal(e( Bere per,orme u('n lo'(t'+ rere(('on to e(t'mate o( rat'o( an 9 +on,'C

en+e 'nter8al( B-'le aju(t'n ,or ae! (e an +on(t'pat'on ?B-en appropr'ate@. Inta)e o,

total 'etar ,'ber Ba( aju(te ,or total +alor'+ 'nta)e u('n rere(('on re('ual(.9M #ll te(t(

o, ('n','+an+e Bere tBoCta'le an pC8alue( T0.0 Bere +on('ere ('n','+ant. &-e anal('(

Ba( per,orme u('n S#S 9.2 ?S#S! $ar! Nort- $arol'na@.

"e(ult(

Our anal('( 'n+lue 2!13 enrolle (tu part'+'pant(. O, t-e(e! 1!075 ?3@ -a -emorC

r-o'( note 'n t-e'r +olono(+op report. Part'+'pant( B't- -emorr-o'( Bere more l')el to be

oler! nonCB-'te! an le(( eu+ate t-an t-o(e B't-out. &-e reporte ,eBer m'nute( ('tt'n on

a Bee)a an Bere more l')el to meet +r'ter'a ,or +on(t'pat'on t-an +ontrol( ?&able 1@. &-ere

Ba( no (tat'(t'+all ('n','+ant ',,eren+e amon Bomen 'n t-e mean number o, total prenanC

+'e( ?2.7 U 1. 8er(u( 2. U 1.@ or l'8e b'rt-( ?2.5 U 1.5 8er(u( 2.5 U 1.3@.


5/10

&able 1. Populat'on $-ara+ter'(t'+(.

%emorr-o'( No %emorr -o'(

n J 1!075 n J 1!739

#e! 0ear(! mean U SD .7 U 7.2 7.F U F.7

Se! n ?@

ale F5F ?F0@ 1!09 ?F3@

*emale 52 ?50@ F55 ?37@

"a+e! n ?@

G-'te 53 ?5@ 1!55 ?7@

NonCB-'te 17 ?1F@ 215 ?13@

Eu+at'on! ear(! mean U SD 11.2 U 3.1 11.F U 2.

4I! )/m2! mean U SD 29.1 U . 29.2 U .2

NS#ID u(e ? 1 a/Bee)@! n ?@ 257 ?23@ 53F ?2@

#(p'r'n u(e ? 1 a/Bee)@! n ?@ 551 ?51@ F7 ?50@

Smo)'n (tatu(! n ?@

Ne8er 5 ?1@ 911 ?2@

*ormer / O++a('onal 50 ?3@ F1 ?37@

$urrent 117 ?11@ 177 ?10@Da'l al+o-ol u(e! r'n)(/a! mean U SD 0.77 U 1.1 0.71 U 1.0

&otal ener 'nta)e! )+al/a! mean U SD 179 U 7 17 U 7

&otal 'etar Vber! ram(/a! mean U SD 15.9 U 7.1 1.1 U F.

Supplemental Vber! n ?@ 9 ?@ 99 ?F@

P-('+al a+t'8't per Bee)! E&S! mean U SD 512 U 39 523 U 390F

Seentar be-a8'or! m'nute( ('tt'n on Bee)a! mean U SD 370 U 19 397 U 19F

$on(t'pat'on! "ome eVn't'on! n ?@ 127 ?12@ 15 ?@

$on(t'pat'on! ,reuen+ eVn't'on! n ?@ 21 ?2@ 25 ?1@

Smptom( o, +on(t'pat'on! n ?@

Stra'n B't- boBel mo8ement! 2 13F ?13@ 151 ?@

In+omplete boBel empt ,eel'n! 2 13 ?13@ 17F ?10@

%ar or lump (tool! 2 175 ?1F@ 230 ?13@

4oBel mo8ement( per Bee)! mean U SD 9.0 U 5. 9.0 U 5.9

Laat'8e u(e/la(t ear! n ?@ 3 ?@ 139 ?@

#bbre8'at'on(: SD! (tanar e8'at'on 4I! bo ma(( 'ne NS#ID! non(tero'al

ant'C'nWammator ru E&! metabol'+ eu'8alent ta()

S'n'V+an+e at t-e pT0.0 '( 'n'+ate B't- a

T0.01 B't-

an T.001 B't-

o':10.1371/journal.pone.0139100.t001

# reater proport'on o, -emorr-o' +a(e( met +r'ter'a ,or +on(t'pat'on e,'ne b "ome I

t-an +ontrol( ?12 8er(u( ! p J 0.002 O" 1.53! 9 $I 1.11! 1.F@ ?&able( 1 an [email protected]'m'lar proport'on( o, +a(e( an +ontrol( reporte laat'8e u(e ? 8er(u( ! p J 0. O"

0.93! 9 $I 0.70! 1.25@@ ?&able( 1@.

ore +a(e( t-an +ontrol( reporte (tra'n'n ur'n boBel mo8ement( ?13 8er(u( !

pT0.0001 O" 1.! 9 $I 1.23! 2.03@! 'n+omplete boBel empt'n ur'n e,e+at'on ?13 8er

(u( 10! p J 0.05 O" 1.27! 9 $I 1.00! 1.F1@ an -ar (tool( ?1F 8er(u( 13! p J 0.03 O"

1.2! 9 $I 1.03! 1.@ ?&able( 1 an 2@. %oBe8er! ,reuent boBel mo8ement( Bere not a((oC

+'ate B't- an 'n+rea(e r'(). $ompare to part'+'pant( -a8'n 7 boBel mo8ement( per

Bee)!


6/10

&able 2. #((e((ment o, $on(t'pat'on an "elate S0mptom( a( "'() *a+tor( ,or %emorr-o'(.

n O" ?9 $I@1

$on(t'pat'on! "ome I eVn't'on

No 251 re,erent

Xe( 272 1.53 ?1.11 K 1.F@

$on(t'pat'on! ,reuen+eVn't'on

3 4oBel mo8ement( per Bee) 27F re,erent

T3 4oBel mo8ement( per Bee) 5 1.52 ?0.7 K 2.@

Stra'n ur'n boBel mo8ement

Le(( t-an 2 o, t-e t'me 225 re,erent

2 or more o, t-e t'me 277 1. ?1.23 K 2.03@

*eel'n o, 'n+omplete boBel mo8ement


2 or more o, t-e t'me 311 1.27 ?1.00 K 1.F1@

%ar or lump (tool


2 or more o, t-e t'me 505 1.2 ?1.03 K 1.@

1

#ju(te ,or (e an a/e

o':10.1371/journal.pone.0139100.t002

ne't-er part'+'pant( -a8'n K15 boBel mo8ement( per Bee) ?O" 0.97! 9 $I 0.0! 1.17@

nor part'+'pant( -a8'n 1 or more mo8ement( per Bee) ?O" 1.22! 9 $I 0.7! 1.70@ -a an

'n+rea(e o( o, -emorr-o'(.

&-ere Ba( no (tat'(t'+all ('n','+ant ',,eren+e betBeen t-e +a(e( an t-e +ontrol( 'n mean

'etar ,'ber 'nta)e ?15.9 ram( 8er(u( 1.1 ram( per a! p J 0.F@ or 'n reporte

(upplemental ,'ber 'nta)e ? 8er(u( F! p J 0.@ ?&able 1@. Nonet-ele((! -'- total 'etar

,'ber 'nta)e trene toBar( an a((o+'at'on B't- a reu+e r'() o, -emorr-o'( ?O" 0.0! 9

$I 0.F5!

1.01@ 'n a +ompar'(on o, t-e -'-e(t uart'le o, ,'ber 'nta)e ?mean 25. ram(/a@ to t-e

loBC e(t ?mean 7.9 ram(/a p ,or tren o8er uart'le( J 0.03@ ?&able 3@. O, t-e ,'ber

(ubtpe(!

&able 3. #((e((ment o, #+t'8't an D'etar *'ber a( "'() *a+tor( ,or %emorr -o'(.

uart'le

1 2 3 5 p ,or tren

P-('+al a+t'8't

O" ?9 $I@1

re,erent 0.92 ?0.75K1.1@ 0.9F ?0.7K1.19@ 0.3 ?0.FFK1.03@ 0.1

Seentar be-a8'or

O" ?9 $I@1

re,erent 0.9 ?0.72K1.09@ 0.2 ?0.FFK1.02@ 0.0 ?0.FK0.9@ 0.02

&otal 'etar Vber! /a

O" ?9 $I@1

re,erent 0.F ?0.F9K1.0@ 0.1 ?0.FK1.02@ 0.0 ?0.F5K1.01@ 0.03

4ean Vber! /a

O" ?9 $I@1

re,erent 1.00 ?0.0K1.2@ 0. ?0.70K1.10@ 1.0 ?0.FK1.3@ 0.95

ra'n Vber! /a

O" ?9 $I@1

re,erent 0.90 ?0.72K1.13@ 1.00 ?0.0K1.2@ 0.7 ?0.F2K0.9@ 0.1

*ru't an 8eetable Vber! /a

O" ?9 $I@1

re,erent 0.90 ?0.71K1.12@ 0. ?0.70K1.11@ 0.7 ?0.F9K1.09@ 0.1

1#ju(te ,or (e an a/e

o':10.1371/journal.pone.0139100.t003


7/10

&able 5. #((e((ment o, NS#IDS! #S#! 4I an Smo)'n/ a( "'() *a+tor( ,or %emorr -o'(.

n O" ?9 $I@

NS#ID (e1

Ne8er / NonC"eular (er 2!127 re,erent

"eular u(er F3 0.90 ?0.7 K 1.07

#(p'r'n (e

1

Ne8er / NonC"eular (er 1!F5 re,erent

"eular u(er 1!12 1.02 ?0.7 K 1.20

4I1

Normal F10 re,erent

O8erBe'-t 1!132 0.9 ?0.72 K 1.09

Obe(e 1!0F3 0.F ?0.70 K 1.0F

$'arette (mo)'n1

Ne8er 1!59 re,erent

E8er 1!33 1.0 ?0.90 K 1.22

#bbre8'at'on(: 4I! bo ma(( 'ne NS#ID! non(tero'al ant'C'nWammator ru1

#ju(te ,or (e an a/e

o':10.1371/journal.pone.0139100.t005

-'- ra'n ,'ber 'nta)e Ba( a((o+'ate B't- a reu+e r'() ?O" ,or uart'le 5 8(. uart'le

1 J 0.7! 9 $I 0.F2! 0.9! p ,or tren o8er uart'le( 0.1@ ?&able 3@. Ge ,oun no

a((o+'at'on( betBeen 'nta)e o, bean ,'ber or ,ru't/8eetable ,'ber an t-e pre(en+e o

-emorr-o'( ?&able 3@. #ju(tment ,or +on(t'pat'on ' not +-ane t-e(e e(t'mate

('n','+antl ?ata not (-oBn@.

In'8'ual( B't- t-e -'-e(t uart'le o, (eentar be-a8'or ?mean FF m'nute(/a@ -a a

loBer r'() o, -emorr-o'( t-an t-o(e 'n t-e loBe(t uart'le ?mean 17F m'nute(/a@ ?O"

0.0!

9 $I 0.FK0.9 p ,or tren J 0.02@ ?&able 3@. In +ontra(t! ne't-er p-('+al a+t'8't nor

be'n o8erBe'-t or obe(e Ba( a((o+'ate B't- 'n+rea(e r'() ?&able( 3 an 5@. #l+o-ol!

(mo)'n! NS#ID an a(p'r'n u(e Bere not a((o+'ate B't- -emorr-o'( ?&able 5@. &-ere Ba(

al(o no a((o+'at'on betBeen ra8''t or number o, l'8e b'rt-( an r'() 'n Bomen ?&able @.

D'(+u(('on

('n +olono(+op ata ,rom a lare +l'n'+al tr'al re+or'n eta'le 'n,ormat'on about boBel

-ab't(! 'et! bo ma(( 'ne! an per(onal -ab't(! Be ,oun t-at +on(t'pat'on Ba( a((o+'ate

B't- 'n+rea(e r'() o, -a8'n -emorr-o'(. ore (pe+','+all! (tra'n'n ur'n boBel mo8eC

ment(! a ,eel'n o, 'n+omplete boBel mo8ement(! an -a8'n -ar or lump (tool( at lea(t

2

&able . #((e((ment o, ra8''t an Number o, L'8e 4'rt-( a( "'() *a+tor( ,or %emorr-o'(.

ra8''t

Null'ra8'a 1 2 3 5

n 107 122 22 277 22

O" ?9 $I@1

re,erent 0.7 ?0.1K1.5@ 0.97 ?0.F1K1.2@ 1.1 ?0.73K1.0@ 0.75 ?0.57 K 1.17@

Number o, L'8e 4'rt-(

Null'ra8'a 1 2 3 5

n 107 1F 32 230 152

O" ?9 $I@1

re,erent 1.0 ?0.F5K1.75@ 0.97 ?0.F3K1.0@ 0. ?0.3K1.3F@ 0.F ?0.1 K 1.55@

1#ju(te ,or a/e

o':10.1371/journal.pone.0139100.t00


8/10

o, t-e t'me Bere all a((o+'ate B't- an 'n+rea(e r'(). # 'et -'- 'n ra'n ,'ber Ba(

a((o+'ate B't- a reu+e r'() o, -emorr-o'( e8en a,ter aju(t'n ,or +on(t'pat'on. $ontrar

to epe+taC t'on(! -oBe8er! Be ,oun t-at ,reuent boBel mo8ement( an ra8''t Bere not

a((o+'ate B't- -emorr-o'(! B-'le (eentar be-a8'or Ba( a((o+'ate B't- a reu+e r'().

&oba++o u(e! al+o-ol u(e! nonCa(p'r'n NS#ID u(e! a(p'r'n u(e! p-('+al a+t'8't! an bo

ma(( 'ne Bere not a((o+'ate B't- r'().

&-ere -a8e been ,eB r'orou( (tu'e( o, +on(t'pat'on a( a r'() ,a+tor ,or -emorr-o'(.

o-an(on an Sonnenber10M +ompare t-e ep'em'olo o, -emorr-o'( an +on(t'pat'on

'n a (tu t-at ut'l'6e (e8eral nat'onal (ur8e(. &-e ,oun t-at! 'n +ontra(t B't-

-emorr-o'(! +on(t'pat'on Ba( more +ommon B't- 'n+rea('n ae! amon bla+)(! an amon

t-o(e B't- loB (o+'oe+onom'+ (tatu( an le(( eu+at'on. In ,olloB up to t-'( report! Del+o et al

11M publ'(-e

a +a(eC+ontrol (tu u('n am'n'(trat'8e ata an ,oun t-at +oe( ,or +on(t'pat'on Bere

a((oC +'ate B't- an 'n+rea(e r'() o, +oe( ,or -emorr-o' '(ea(e.

o-an(on an Sonnenber later publ'(-e a +a(eC+ontrol (tu o, 32 8eteran( B-o unerC

Bent pro+to(+op.3M Ne't-er +on(t'pat'on e,'ne b obje+t'8e +r'ter'a ?(tool ,reuen+ or

+on('(ten+ or (tra'n'n to e,e+ate@ nor (ubje+t'8e +r'ter'a Ba( a((o+'ate B't- t-e pre(en+e o,

-emorr-o'(. "'(( et al.12M publ'(-e a +ro((C(e+t'onal (tu o, 97F part'+'pant( B-o -a a

+olono(+op an ,oun t-at +on(t'pat'on Ba( a((o+'ate B't- an 'n+rea(e r'() o,

-emorr-o'(. n,ortunatel! t-e'r roup ' not aju(t ,or +on,oun'n 8ar'able(

&-ere -a8e been ,eB (tu'e( o, (tra'n'n B't- e,e+at'on an -emorr-o'(. o-ann((on an

Sonnenber13Mpubl'(-e a +a(e +ontrol (tu o, 100 pat'ent( B-o part'+'pate 'n a ranomC

'6e (tu o, -emorr-o'e+tom B-o Bere +ompare to 100 populat'on +ontrol( an 100 -o(C

p'tal +ontrol( Pat'ent( B't- -emorr-o'( Bere more l')el to report e+e(('8e (tra'n'n an a

,eel'n o, 'n+omplete empt'n but t-ere Ba( no ',,eren+e amon t-e roup( 'n boBel mo8eC

ment ,reuen+. $ontrol( ' not -a8e an anore+tal eam! ra'('n t-e po(('b'l't o,

a(mptomC at'+ -emorr-o'( 'n t-e +ontrol roup.

Se8eral tr'al( -a8e ,oun t-at 'etar ,'ber '( an e,,e+t'8e treatment ,or (mptomat'+

-emorC r-o'(.15M Ge ,oun t-at a 'et -'- 'n ra'n ,'ber Ba( a((o+'ate B't- a reu+e r'()

o, -emC orr-o'(. Ge -pot-e('6e t-at a -'- ,'ber 'et reu+e( t-e r'() o, +on(t'pat'on!B-'+- '( a((o+'ate B't- -emorr-o'(. Surpr'('nl! t-e a((o+'at'on betBeen -'- ,'ber 'nta)e

an reu+e r'() o, -emorr-o'( -el e8en a,ter aju(tment ,or +on(t'pat'on.

# (ubje+t'8e report o, 'arr-ea Ba( a((o+'ate B't- an 'n+rea(e r'() o, -emorr-o'( 'n a

('nle +a(eC+ontrol (tu.3M &-e (ame (tu ,oun no a((o+'at'on betBeen ,reuent or

Bater (tool( an -emorr-o'(. Ge al(o ,oun no a((o+'at'on betBeen more ,reuent boBel

mo8eC ment( an -emorr-o'(.

%emorr-o'( +ommonl +ompl'+ate prenan+. #n e(t'mate o, prenant Bomen 'n

t-e'r (e+on an t-'r tr'me(ter -a8e -emorr-o'(. G-et-er a -'(tor o, prenan+ or l'8e

b'rt-( (ub(euentl 'n+rea(e( t-e r'() o, -emorr-o'( ,olloB'n prenan+ '( le(( Bell unerC

(too. &-e +urrent ob(tetr'+ l'terature pre'+t( t-at -emorr-o'( rere(( po(tpartum! but o

not re(ol8e +ompletel.1M 4ot- t-e (tu b "'(( et al2M an our (tu ,oun no

a((o+'at'on betBeen ra8''t an -emorr-o'(! B-'+- (ue(t( t-at -emorr-o'( re(ol8e po(tpartum.

Obe('t Ba( a((o+'ate B't- -emorr-o'( 'n tBo o, t-e a,orement'one (tu'e( 2! 3M but

not 'n t-e pre(ent (tu. De(p'te t-e B'e(prea bel'e, t-at ('tt'n ,or lon per'o( '( a r'()

,a+C tor ,or -emorr-o'(! Be ,oun t-at (eentar be-a8'or Ba( a((o+'ate B't- a reu+e r'()

SeC entar be-a8'or Ba( one +omponent o, t-e Internat'onal P-('+al #+t'8't ue(t'onna're

but t-ere Ba( no 'n'+at'on t-at total p-('+al a+t'8't per (e Ba( a((o+'ate B't- -emorr-o'(

In +ontra(t to pr'or Bor)! our anal('( Ba( per,orme u('n a lare! BellC+-ara+ter'6e popC

ulat'on t-at -a a +omplete +olono(+op ,or t-e purpo(e o, +olore+tal (+reen'n or aenoma

(ur8e'llan+e. Ge ut'l'6e a BellCa++epte e,'n't'on o, +on(t'pat'on!1FM an +on,oun'n


9/10

8ar'able( Bere 'n+lue 'n our moel(. Ge al(o 'n+lue 'n our anal('( a ,reuen+Cba(e

e,'C n't'on o, +on(t'pat'on an a((e((e t-e (mptom( o, +on(t'pat'on 'nepenentl. G-'le

Be ,oun no (tat'(t'+all ('n','+ant a((o+'at'on betBeen -emorr-o'( an +on(t'pat'on e,'ne

b ,reuen+! (tool ,reuen+ '( t-ou-t to be a poor mea(ure o, +on(t'pat'on.17M

&-ere are l'm'tat'on( to our (tu. &-'( '( a +ro((C(e+t'onal (tu o, 'n'8'ual( B't- a

re+ent -'(tor o, +olore+tal aenoma( an '( t-ere,ore not repre(entat'8e o, t-e eneral

populat'on. # eta'le eam an report'n o, t-e anore+tum Ba( not reu're 'n t-e +l'n'+al

tr'al! alt-ou- man eno(+op'(t( +on('er a eta'le eam o, t-e re+tum an anal +anal to be

(tanar o, +are.1M *urt-ermore! an eam'nat'on B't- an ano(+ope '( t-e ol (tanar ,or

'ano('n -emorr-o'( an e+e(( a'r 'n(u,,lat'on ur'n retro,le'on o, t-e +olono(+op ma

-a8e re(ulte 'n ,al(e neat'8e re(ult(. oreo8er! Be ' not -a8e an 'n,ormat'on about t-e

rae

or tpe o, -emorr-o'(. It '( rea((ur'n t-at t-e pre8alen+e o, -emorr-o'( 'n our populat'on

?3@ '( ('m'lar to pre8alen+e e(t'mate( 'n ('m'lar populat'on( [email protected]

&-e pre(ent (tu eam'ne a number o, r'() ,a+tor( t-at -a8e been +la(('+all a((o+'ate

B't- -emorr-o'(! (pe+','+all: loBC,'ber 'et! (tra'n'n B't- e,e+at'on! +on(t'pat'on! 'arr-ea

ra8''t! an (eentar be-a8'or. In a lare! BellC+-ara+ter'6e populat'on! onl t-ree o, t-e(e

(' r'() ,a+tor( Bere (upporte b t-e ata. Our Bor) (upport( t-e +ommon B'(om t-at a

loBC,'ber 'et! (tra'n'n B't- e,e+at'on an +on(t'pat'on are a((o+'ate B't- an 'n+rea(e

r'() o, -emorr-o'(. %oBe8er! +ontrar to epe+tat'on! 'arr-ea an ra8''t Bere not

a((o+'ate B't- -emorr-o'(! an (eentar be-a8'or Ba( a((o+'ate B't- a reu+e r'().

#ut-or $ontr'but'on(

$on+e'8e an e('ne t-e eper'ment(: #*P "SS # "S4 $* D# EL4 #4. #nal6e t-e

ata: #*P "SS # "S4 $* D# EL4 #4. Grote t-e paper: #*P "SS # "S4 $* D#

EL4 #4.

"e,eren+e(1. an6 "#. &-e e8aluat'on an treatment o, -emorr-o'(: a u'e ,or t-e a(troenterolo'(t. $l'n'+al

a(troenterolo an -epatolo: t-e o,,'+'al +l'n'+al pra+t'+e journal o, t-e #mer'+an a(troenter olo'C+al #((o+'at'on. 2013 11?F@:93KF03. Epub 2013/01/22. o': 10.101F/j.+ -.2012.12.020 PID:

2333322 0.

2. "'(( S! Ge'(er *#! S+-Bame'(

F. G-'te-ea GE $S! $ora66'ar ' E! et al. "eport o, an 'nternat'onal Bor)(-op on manaement o, +on(t'C

pat'on. a(troenterolo Internat'onal. 1991 5?3@:99 K113.

7. Dro((man D#. &-e *un+t'onal a(tro'nte(t'nal '(orer(: 'ano('(! pat-op-('olo! an treatment: amult'nat'onal +on(enu(. 1(t e. 4o(ton: L'ttle! 4roBn 1995. '! 370 p. p.

. $ra' $L! ar(-all #L! Sjo(trom ! 4auman #E! 4oot- L! #'n(Bort- 4E! et al. Internat'onal p-('+ala+t'8't ue(t'onna're: 12C+ountr rel'ab'l't an 8al''t. e S+' Sport( Eer+. 2003 3?@:131 K9.

Epub 2003/0/0F. o': 10.1259/0 1 .SS.000 0 07925.F1 5 3.*4 PID: 12900F 9 5.

9. G'llett G! Stamp,er . &otal ener 'nta)e: 'mpl'+at'on( ,or ep'em'olo'+ anal0(e(. #m Ep'em'ol.

19F 125?1@:17K27. Epub 19F/07/01. PID: 3212F 1.

10. o-an(on *! Sonnenber #. &-e pre8alen+e o, -emorr-o'( an +-ron'+ +on(t'pat'on. #n ep'em'oC

lo'+ (tu. a(troenterolo. 1990 9?2@:30KF. Epub 1990/02/01. PID: 22939 2.

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11. Del+o *! Sonnenber #. #((o+'at'on( betBeen -emorr-o'( an ot-er 'a/no(e(. D'(ea(e( o, t-e+olon an re+tum. 199 51?12@:135K51 '(+u(('on 51K2. Epub 199/12/22. PID: 9F033 .

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1. #8(ar #*!

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