Barium Enema

We used the data of the Korean National Cancer Screening Survey (KNCSS), an annual, nationwide, population-based survey of cancer screening rates in Korea, from 2004 to 2018 [4 (link)]. To ensure that the survey participants were nationally representative, KNCSS employed a stratified, multistage sampling design based on resident registration population according to geographical area, age, and sex. The methods used for sampling were described in previous studies [3 (link),4 (link)].
The data were collected through face-to-face interviews conducted by a professional research agency, except in 2004, when data were collected via computer-assisted telephone interviews. Subjects were recruited through door-to-door contact, and at least three attempts to contact each household were made. One person was selected from each household. All study participants were provided with sufficient explanation and they agreed to participate in the survey.
Our target population, derived from the NCSP protocols in Korea, was composed of cancer-free men and women aged ≥ 40 and ≥ 30 years, respectively, during the years 2004–2018. In addition, from 2014, we also conducted survey about cervical cancer screening in women aged 20–29 years, as the recipients of the national cervical cancer screening program was expanded to women in their age of 20s from 2015. Because they were not eligible for other kinds of cancer screening, those data were only used for cervical cancer screening rates with recommendation, either when calculating them separately (i.e., subgroup analysis by age) or when integrating them with screening rates for women aged ≥ 30 years (i.e. calculating the screening rates, including women in their 20s), from 2014.
The KNCSS explored experience with screening for five types of cancer (i.e., stomach, liver, colorectal, breast, and cervical cancer) and sociodemographic characteristics, including educational level, household income, marital status, residential area, and type of health insurance, using a structured questionnaire. Among the questionnaire, major questions asking the interviewee’s cancer screening experiences provided in Supplementary Material. The questions included were, “Have you ever undergone (cancer type) screening?” and “Which screening method have you experienced?” For the interval between screenings, the question was, “When did you last undergo (cancer type) screening with this method?”
Two types of cancer screening rates were measured in this study. Lifetime screening was defined as ever having undergone a screening test during the lifetime. Meanwhile, screening rate with recommendation category was assigned to participants who had undergone screening tests according to the NCSP procedures and intervals (Table 1). However, for colorectal cancer screening, respondents who underwent colonoscopy, double-contrast barium enema, or fecal occult blood test (FOBT) within 5, 5, and 1 year, respectively, before 2009, and within 10, 5, and 1 year, respectively, after 2009 were considered to have undergone screening with recommendation.
We determined the lifetime screening rates and the screening rates with recommendations for each cancer. The latter rates were also calculated with reference to age and sex. However, the liver cancer screening rate was excluded from subgroup analysis because an inadequate number of individuals in the high-risk group rendered the results unreliable (95% confidence interval was wide). We used the survey sample weights to develop non-biased estimates of the descriptive data. Trends in screening rates of both types were estimated using Joinpoint regression [5 ], and the results were summarized as an annual percentage change (APC) using a linear model on the raw values of each screening rate. A logarithmic transformation on screening rate was not performed, and a maximum number of two joinpoints was applied in the analysis. However, we adopted 1 joinpoint option for every analysis, for the unity, which showed the best model fit in most of the cases. Statistical analyses were performed using SAS ver. 9.4 (SAS Institute Inc., Cary, NC) and Joinpoint ver. 4.8.0.1 (National Cancer Institute, Bethesda, MD) software.

As in our prior 2 trials, potential participants with IBS were recruited through general advertisement (flyers, newspapers, public radio, posters on city busses, and targeted mailings to GI clinic patients) in a metropolitan area in the Pacific Northwest (United States). Interested adults were screened over the phone. Eligibility was assessed across the 5-week baseline assessment (initial interview and 4-week diary). During the last 2 weeks of this assessment period, preselected candidate biomarkers were obtained. The criteria for inclusion specified men and women 18–70 years of age. In addition, participants had to have a history of IBS symptoms for at least 6 months prior to their IBS diagnosis and for at least 6 months after their diagnosis by a healthcare provider. They had to meet the Rome-III research criteria.17 Adults age 50 or older had to have a negative colonoscopy, sigmoidoscopy, abdominal ultrasonography, or barium enema. Anyone with a “red flag” symptom (eg, lost 10 lbs without trying, blood in stool - except blood due to hemorrhoids) was referred to their healthcare provider for further evaluation (eg, colonoscopy).
Potential participants were excluded if they were taking the following medications: antibiotics, corticosteroids, daily use of anticholinergics, tricyclic antidepressants, calcium-channel blockers; had a medical history of abdominal surgery (except appendectomy, Cae-sarian section, tubal ligation, laparoscopic cholecystectomy, hysterectomy, or abdominal wall hernia repair); organic GI disease, celiac disease, or a moderate to severe pain condition (eg, low back pain and fibromyalgia); diabetes, current mental health disorders (psychosis, bipolar disorder, or moderate to severe depressive episodes, recent suicide attempt or drug or alcohol abuse or dependence); cardiac valve or conduction defects, immune-compromised disorders (eg, autoimmune conditions) or women who were pregnant, breast feeding, or planning to get pregnant in the next year (Figure).

Inclusion criteria were patients aged 18 years or older who underwent a lactulose hydrogen-methane breath test to assess SIBO. Exclusion criteria were patients who 1) had taken antibiotics, H2 receptor antagonists, proton pump inhibitors, probiotics, or medications that affect gastrointestinal motility within the last month; 2) had undergone vagotomy; 3) had a history of gastrointestinal surgery; 4) had a colonoscopy, barium enema, or any other test with a bowel preparation within one week; 5) had postprandial hypoglycemia; 6) were diagnosed with irritable bowel syndrome, inflammatory bowel disease, or chronic pancreatitis.

In total, 53 patients with CC were consecutively recruited from the Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, between September 2017 and September 2019. The patients were diagnosed based on the Rome III criteria for CC.^{28 (link)} In all, 31 healthy participants were also recruited from the physical examination center of the same institution and assigned to a healthy control (HC) group. The frequency of spontaneous bowel movements of healthy participants should be more than 3 times per week. Individuals who were pregnant, those who had a history of abuse, and those were on drugs that could affect defecation (e.g. antidepressants, spasmolytics, and opioids, but not hypnotics) were excluded. Subjects with a history of antibiotic treatment or intentional probiotic consumption 1 month prior to starting this study were also excluded. The other exclusion criteria were the presence of structural diseases (e.g. tumor, rectocele, and intussusception) based on colonoscopic or barium enema findings); chronic conditions; and previous gastrointestinal surgery. The reporting of this study conforms to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.^{29 (link)}