Effect of Comestibles on Symptoms of Interstitial Cystitis

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1 Effect of Comestibles on Symptoms of Interstitial Cystitis

2 Background Interstitial cystitis “pelvic pain, pressure, or discomfort related to the bladder, typically associated with persistent urge to void or urinary frequency, in the absence of infection or other pathology” Rev Urol 2007 Spring;9(2):81

3 Definition National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) 1988 consensus definition European Society for the Study of IC-PBS (ESSIC) consensus meeting Washington, DC, Consensus Group on Interstitial Cystitis-Painful Bladder Syndrome (IC-PBS)

4 Prevalence In NHANES III, the prevalence was 470 per 100,000 population, including 60 per 100,000 men and 850 per 100,000 women. This equals approximately 83,000 men and 1.2 million women across the U.S. American Urological Association (AUA) Guideline (2011)

5 More than 180 therapies are used to treat PBS/IC with no single modality successful for all patients. Rovner E, et al: Urology 2000; 56: 940.

6 Factors such as stress, medication, allergic reactions, sexual intercourse, hormonal changes and diet may exacerbate bladder symptoms. Barbara Shorter, et al; J Urol Jul;178(1):

7 Literature reviewd on “Effect of Comestibles on Symptoms of Interstitial Cystitis”
Study Study design Method No. patients Significant Results Weak point Koziol JA, 1993 Case-series 374 acidic, alcoholic or carbonated beverages, and coffee or tea increased interstitial cystitis pain in more than 50% of the patients. Only records of symptoms Bade JJ, et al 1997 Cross-sectional Verbal interview 16 none of the IC patients were aware of any possible dietary measures in relation to their IC symptoms Compared to normal population less calories and fat more fibers fewer consumers of coffee more consumers of (herbal) tea orange juice consumption not significant Only the dietary habits of the BPS population Barbara Shorter, et al; 2007 Questionnaires; postage paid envelope; no identifying information and data 104/327 (32%) NIDDK criteria, symptoms with ICSI and PUF All patients had been examined and diagnosed with IC by a single physician at a suburban medical center. 90.2% indicated that the consumption of certain foods or beverages caused symptom exacerbation. most bothersome comestibles were coffee, tea, soda, alcoholic beverages, citrus fruits and juices, artificial sweeteners and hot pepper. Renee Bassaly, et al; 2011 Web-based questionnaire 598 95.8% of the participants answered that certain foods and beverages affected their IC/BPS symptoms. Worse: citrus fruits, tomatoes, coffee, tea, carbonated and alcoholic beverages, spicy foods, artificial sweeteners, and vitamin C Better: calcium glycerophosphate, sodium bicarbonate  Selection bias, perceptions at website, accuracy of BPS diagnosis Tettamanti G, et al; 2011 Case-control Web-based survey, female twins (After 2–5 months, 100 twins were contacted again to assess test-retest reliability.) 9349 Symptoms with ICSI Tea consumption was associated with an increased risk for BPS Coffee consumption was not a risk factor for BPS Former, and current smoking, were both associated with a higher risk of BPS (co-twin control analysis suggested that the association between smoking and BPS was confounded by familial factors) “Occurrence of BPS”, not exacerbation of BPS

8 Gap Specific diet really induce exacerbation of BPS ?
esp. in Taiwanese / Asians ? Taiwanese / Asians have the same “high risk comestibles” as the western society? Age or BPS scores of BPS patients related to possibility of “high risk comestibles”?

9 Significance The only Taiwanese / Asian data in the world
Determine some diets really induce exacerbation of BPS Answer what diets cause Taiwanese exacerbation of BPS Analysis relationship between “Age or BPS scores of BPS patients” and “high risk comestibles”

10 Methods 藉由一份通過驗證的問卷，統整約30項國外已 知可能會惡化間質性膀胱炎的食物，訪談大林 慈濟醫院婦產科患有間質性膀胱炎的婦女。
採病例對照研究、立意取樣收集100位，自2013 年9月始，達研究目標樣本為止。 間質性膀胱炎病人回婦產科許鈞碩醫師門診追蹤 時，經由許鈞碩醫師進行知情同意，之後進行電 話問卷。

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16 預期結果

17 Odds ratio 危險對比值 (odds ratio) = (暴露組中得病人數與 未得病人數之比值) / (非暴露組中得病人數與未 得病人數之比值)

18 吃特定食物會比不吃還要容易惡化間質性膀胱炎嗎？
吃特定食品會造成症狀惡化的危險對比值 (odds ratio) = (較頻繁地暴露在特定食物中且症狀分數較高的病人數，與較頻繁地暴露在特定食物中且症狀分數較低的病人數之比值) (較不常暴露在特定食物中且症狀分數較高的病人數，與較不常暴露在特定食物中且症狀分數較低的病人數之比值)

19 年紀越大越有可能飲食中暗藏會惡化膀胱症狀的食物嗎？
年紀大小和"可能有會惡化膀胱症狀食物的潛質"的危險對比值 (odds ratio) = (年紀較大且有任何食物會惡化症狀的病人數，與年紀較大且無任何食物會惡化症狀的病人數之比值) (年紀較小且有任何食物會惡化症狀的病人數，與年紀較小且無任何食物會惡化症狀的病人數之比值))

20 症狀越嚴重，越有可能飲食中暗藏會惡化膀胱症狀的食物嗎？
症狀分數和"可能有會惡化膀胱症狀食物的潛質"的危險對比值 (odds ratio) = (症狀分數較高且有任何食物會惡化症狀的病人數，與症狀分數較高且無任何食物會惡化症狀的病人數之比值)/ (症狀分數較低且有任何食物會惡化症狀的病人數，與症狀分數較低且無任何食物會惡化症狀的病人數之比值)

21 台灣間質性膀胱炎病人應避免的食物 …

22 Thanks for your attention!