- Email: [email protected]
26 OC Oesophageal structure by alendronate: A case report
25 P
27 P
MAfNTENANCE MC DAILY STUDY A Pdono Dept
of
THERAPY IN ELDERLY
OF REFLC’X ESOPHAGITIS PATIENTS A DOUBLE-BLIND,
WITH PANTOPKAZOLE PLACEBO-COAXROLLED
20
LAPAROSCOPIC F Rebecchl,
on behalf Genatncr.
of the ‘-Aging San Borrolo
and Amd-Related Horp&al,
V~cenza.
Dweases
Study
Group”
Department
RtPAlR C Cnaccone of Surgery
OF GIANT R Campac!, U”l\ers”y
HIATAL. M
HERNIA
WHICH
ThCHNlQUE’
Monno
of Turin
Italy lntroduclio” Thw study analyzes the results of laparorcopw repair of gmnt hmtal hernm and describes addnctlonal techmcal aspens that have evolved dung the apphcat~o” ofthtr tech”m”e Mate”& and Methods From October 1991 to December 2001 391 patmnts underwent laparoscopic 360 ’ fondophcatto” for garroesophageal reflux disease (CERD) Among them 53 patients (31 females and 22 m&s, wfh a mea” age of 56 years) u”den*ent electwe laparorcopic repair of large hmtai herma We defined a large himal hernra as either a hiaral hernia measuring at least 6-8 cm I” lenght at nreooerat~e endoscoov. or hemiatio” of at least half ofrhe stomach anto the thorax, hete&“ed by preop&tive contrast radiographic study. intaoperatively the distance between crura should exceed 5 cm I” our initial experience from October I991 to December 1995 13 pattents with giant esophageal emm were repaired by laparoscopic primary closure ofthe hiatus with interrupted, “““absorbable sutures Subsequently we modified the procedure and in 35 parents we used a ” te~io” free “ technique, the hmtal defect was repmred with a polypropylene mesh fixed to the diaphragm I” 21 patients. with a Gore-Tex mesh I” 4 patients and with a mixed mesh (polypropylene + Gore-Tex) I” 10 patrents More recently we performed the Colbs-N~sse” techmque in 5 patents Results There was no mortabty and there were no conversions to open surgery or ~“traoperative complication The hernia recurred I” IO/l 3 (77%) patients treated without mesh in 7121 (33%) panents treated wth polypropylene mesh, t” 414 (100%) patients treated wth Gore-Tex mesh and I” l/IO (10%) patients treated with mixed mesh No recurrences were observed m the group of patients treated with the Colbs-Ntsse” technique
lntroducuo” Esopbagms IS a more severe dnsease I” elderly patients than in young-adult rubJems, however no placebo-controlled chmc~l trials have been yet published a” the efficacy of a mamtenance therapy molder sub,ects wth esophagms The mm ofthe stud, was to evahmte the efficacy of pantoprawle m preventing recurrence of esophagitis I” elderlv subiects Methods 133 oatients sned 65 veers and over iM= 67. F=66. mea” age=?2 9 y&s, range = 65.93)‘with docimentei heabng of e,o&e esdphagitis afler 8 weeks of panfoprazole 40 mg duly were included in the study All patients were treated wth pantoprarole 20 mglday for 6 months (open phase), thereafter, cured patients were randomized to receive pantoprarole 20 mg duly or placebo for the followmg 6 months (double-blind phase) Chn~cal evaluanons were performed every 2 months while endorcopy was repeated after 6 and I2 months and,“, whenever symptoms suggested a relapse of esoohamtts. Results Ooen ohase 133 oatients were included. 15,133 droooed out from the study kcer 6 months ok pantoprazole i0 mg dally the healmg rates of es&agitis were 92 4%(95%CI-87 6-97 2) and 82%(95%Cl=75 4-88 5) by PP and ITT analyses The presence of reflux symptoms (heartburR acid regurgntio” and chest-pain) were slgmficantlv rssocmed wtth the relapse of erophagms (p-0 OOOI), hmtus hernia, H pylon mfectton. concomitant diseases and concomitant treatments did not Double-blmd phase 105 pattents were included 49 patiems were treated with pantopruole 20 mg dally and 56 with placebo 121105 oattents droooed out from the stud” A,Ier 12 months the PP and I’fT heal,“= rates of esopbagitis were’&penively 95 1%(9~%Cf=88 5-100) and 79 6°%(950%CI=68 3:90 9) I” the Lreatmem group versus 32 7% (95”%C,=,9 9-45 4, and 30 4%(95%CI=18 3-42 4, m the placebo group (p+ OWI) The Absolute Risk Reduction of relapse with pantopraroie 20 mg dally versus placebo was 49 2%. the “umber of pauents who needed to be treated I” orda to gain a reduct~o” of one relapse of erophagttis (NnT) w&s 2 Conclusion I” the elderly. pantopruole 20 mg dally was highly effective to maintain healing of esophagius, dtscontlnumg actwe treatment after 6 months ts associated with a significant increase in the relapse rates
Conclusions Laparoswpx management of gwt himal hem,a IS a” altemarwe treatment to open surgery offering all the advantages of a minimally “waswe approach together with excellent visuahation of hmtal region The problem such as I” open approach is fo achieve a durable repair Tension free techniques seem to be supenor I” terms of long term success but M ideal technique and a” tdeal mesh are solI fo be identified Altematwe technique, such es the Coilis-Nissen procedure. should be conajdered pertularty I” patients with short esophagus
- 26 OC
OESOPHAGEAL G G”lio”l*. F ‘medlcma
28 OP
- STRICTURE BY ALENDRONATE Lamanna*, G Macarn^
Jest. ~ch”~ca
dt gasrroenterologm
unwers~ta
A CASE
REPORT
H PYLOR, INFECTION DOES NOT PROTECT FROM GASTROESOPWAGEAL REFLUX DISEASE AND DE”!ZLOPMENT OF BARRETT’S ESOPHAGUS M
dl ancona
“ore’,
*Isututo
BACKGROLIND Ale”dro”ate,a” amlnobtphosphonate and a selective tnhtbttor of osteoclast-medtated bone resorpoonwed to weat osteoporosis in postmenopausal women and Paxa’s disease of bo”e.has recentlv bee” reoorted to cause o~~asmnallv oesoohamur. even severe METHODS We dewbe.” case oia” old woman 78 years oli, ,,&g f&m 4 years IO mg/d of alendronate continually. presented for severe disphagya and weight loss more of IO kgs RESULTS Endoscopy showed stricture ofproxlmal oesophagus wfh co”“ue”t eros,o”s and errudate, b,opsms excluded mebgnancy and infectwe dtseases I” P second examinatlo&was performed a balloon dilatatto” of stricture and prescribed therapy with PPI and sucralfate wth good cb”,cal results, obvmusiy the ale”d&“ate was supped A” e”doscopY performed 3 and 6 months later documented the persntence of mild oesophagitis but resolutlo” of stnct”re CONCLUSIONS Alendronate represents a “sk fanor for severe oesophagms, expecmlly I” elderly patients, the selection of patients, recommendations to take alendronate wth a” adeguate amount ofwater and the tnformation ofpossibility of oesopbageal symptoms. can improve patiem care
L Manas’. dl Cbnica
E Maragkudakis’,
Medica.
Unwers~ti
R Mele’, dl Sassan
G Leandro^,
“TRCCS
G Realdl’
S De Belhs,
Castellana
Grone,
Bar1
Background The inmdence of gastroesophageal reflux due&se (GERD) and esophageal adenocarmnoma have increased in recent years If was suggested that the H pylon Infectton mav “rotect nnceotible indivnduals From develooinz GERD and its cam”lications. The urn of our study was to evaluate the relationship amb”g-H pylon infection i”d presence of GERD subtypes and development metaplasia of Barrett, dyspiasm or carcinoma I” the esophagus Methods All patients undergot” upper endoscopy and posmve for typmhl GERD symptoms such as heartburn and regurgitation and/or wth esophagms were enrolled I” the study Symptoms were recorded in a detmled questionnaire Patients wth peptic “Ice, were excluded from the study H pylori status was assessed by histology and rapld orease testing of gastric biopsws Esophagus ofBarrett was dmgnored on the basis of endoscopy features and histology examination The study cohort was subgrouped in Group A patrents wtth typical symptoms of GERD plus erorwe esophagitis at the endoscopy &wary-Muller classification), Group B patients wxth typical symptoms without eroswe esophagitls, and Group C patients with erosive esophagitls without health”,” or regurgltatio” Results A total of 901 patients were enrolled The prevalence of H pylon tnfectlo” was 42% (I 511357) ,n Group A, 44% (1401316) m po”p B and 39% (871224) in Group C (p = N S) 12 paoems (I 3%) were postlive for esophagw of Barren, and more specdically 4 pattents I” the Group A (2 Hp p&2 Hp neg), 6 patients in the Group B (3 Hp pad3 Hp “eg). and 2 pattents I” the Group C (Hp pos), complicated by mdd dysplarm I” 5 cases No one cancer of the esophagus was observed Conclusion Our data show that patents wthout and wth H pylon can develop esophagus ofBanett suggestzng that H pylon 1s not proten,vc I” Ihe development of gasfroesophageal reflux duease I
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A4
27 P
MAfNTENANCE MC DAILY STUDY A Pdono Dept
of
THERAPY IN ELDERLY
OF REFLC’X ESOPHAGITIS PATIENTS A DOUBLE-BLIND,
WITH PANTOPKAZOLE PLACEBO-COAXROLLED
20
LAPAROSCOPIC F Rebecchl,
on behalf Genatncr.
of the ‘-Aging San Borrolo
and Amd-Related Horp&al,
V~cenza.
Dweases
Study
Group”
Department
RtPAlR C Cnaccone of Surgery
OF GIANT R Campac!, U”l\ers”y
HIATAL. M
HERNIA
WHICH
ThCHNlQUE’
Monno
of Turin
Italy lntroduclio” Thw study analyzes the results of laparorcopw repair of gmnt hmtal hernm and describes addnctlonal techmcal aspens that have evolved dung the apphcat~o” ofthtr tech”m”e Mate”& and Methods From October 1991 to December 2001 391 patmnts underwent laparoscopic 360 ’ fondophcatto” for garroesophageal reflux disease (CERD) Among them 53 patients (31 females and 22 m&s, wfh a mea” age of 56 years) u”den*ent electwe laparorcopic repair of large hmtai herma We defined a large himal hernra as either a hiaral hernia measuring at least 6-8 cm I” lenght at nreooerat~e endoscoov. or hemiatio” of at least half ofrhe stomach anto the thorax, hete&“ed by preop&tive contrast radiographic study. intaoperatively the distance between crura should exceed 5 cm I” our initial experience from October I991 to December 1995 13 pattents with giant esophageal emm were repaired by laparoscopic primary closure ofthe hiatus with interrupted, “““absorbable sutures Subsequently we modified the procedure and in 35 parents we used a ” te~io” free “ technique, the hmtal defect was repmred with a polypropylene mesh fixed to the diaphragm I” 21 patients. with a Gore-Tex mesh I” 4 patients and with a mixed mesh (polypropylene + Gore-Tex) I” 10 patrents More recently we performed the Colbs-N~sse” techmque in 5 patents Results There was no mortabty and there were no conversions to open surgery or ~“traoperative complication The hernia recurred I” IO/l 3 (77%) patients treated without mesh in 7121 (33%) panents treated wth polypropylene mesh, t” 414 (100%) patients treated wth Gore-Tex mesh and I” l/IO (10%) patients treated with mixed mesh No recurrences were observed m the group of patients treated with the Colbs-Ntsse” technique
lntroducuo” Esopbagms IS a more severe dnsease I” elderly patients than in young-adult rubJems, however no placebo-controlled chmc~l trials have been yet published a” the efficacy of a mamtenance therapy molder sub,ects wth esophagms The mm ofthe stud, was to evahmte the efficacy of pantoprawle m preventing recurrence of esophagitis I” elderlv subiects Methods 133 oatients sned 65 veers and over iM= 67. F=66. mea” age=?2 9 y&s, range = 65.93)‘with docimentei heabng of e,o&e esdphagitis afler 8 weeks of panfoprazole 40 mg duly were included in the study All patients were treated wth pantoprarole 20 mglday for 6 months (open phase), thereafter, cured patients were randomized to receive pantoprarole 20 mg duly or placebo for the followmg 6 months (double-blind phase) Chn~cal evaluanons were performed every 2 months while endorcopy was repeated after 6 and I2 months and,“, whenever symptoms suggested a relapse of esoohamtts. Results Ooen ohase 133 oatients were included. 15,133 droooed out from the study kcer 6 months ok pantoprazole i0 mg dally the healmg rates of es&agitis were 92 4%(95%CI-87 6-97 2) and 82%(95%Cl=75 4-88 5) by PP and ITT analyses The presence of reflux symptoms (heartburR acid regurgntio” and chest-pain) were slgmficantlv rssocmed wtth the relapse of erophagms (p-0 OOOI), hmtus hernia, H pylon mfectton. concomitant diseases and concomitant treatments did not Double-blmd phase 105 pattents were included 49 patiems were treated with pantopruole 20 mg dally and 56 with placebo 121105 oattents droooed out from the stud” A,Ier 12 months the PP and I’fT heal,“= rates of esopbagitis were’&penively 95 1%(9~%Cf=88 5-100) and 79 6°%(950%CI=68 3:90 9) I” the Lreatmem group versus 32 7% (95”%C,=,9 9-45 4, and 30 4%(95%CI=18 3-42 4, m the placebo group (p+ OWI) The Absolute Risk Reduction of relapse with pantopraroie 20 mg dally versus placebo was 49 2%. the “umber of pauents who needed to be treated I” orda to gain a reduct~o” of one relapse of erophagttis (NnT) w&s 2 Conclusion I” the elderly. pantopruole 20 mg dally was highly effective to maintain healing of esophagius, dtscontlnumg actwe treatment after 6 months ts associated with a significant increase in the relapse rates
Conclusions Laparoswpx management of gwt himal hem,a IS a” altemarwe treatment to open surgery offering all the advantages of a minimally “waswe approach together with excellent visuahation of hmtal region The problem such as I” open approach is fo achieve a durable repair Tension free techniques seem to be supenor I” terms of long term success but M ideal technique and a” tdeal mesh are solI fo be identified Altematwe technique, such es the Coilis-Nissen procedure. should be conajdered pertularty I” patients with short esophagus
- 26 OC
OESOPHAGEAL G G”lio”l*. F ‘medlcma
28 OP
- STRICTURE BY ALENDRONATE Lamanna*, G Macarn^
Jest. ~ch”~ca
dt gasrroenterologm
unwers~ta
A CASE
REPORT
H PYLOR, INFECTION DOES NOT PROTECT FROM GASTROESOPWAGEAL REFLUX DISEASE AND DE”!ZLOPMENT OF BARRETT’S ESOPHAGUS M
dl ancona
“ore’,
*Isututo
BACKGROLIND Ale”dro”ate,a” amlnobtphosphonate and a selective tnhtbttor of osteoclast-medtated bone resorpoonwed to weat osteoporosis in postmenopausal women and Paxa’s disease of bo”e.has recentlv bee” reoorted to cause o~~asmnallv oesoohamur. even severe METHODS We dewbe.” case oia” old woman 78 years oli, ,,&g f&m 4 years IO mg/d of alendronate continually. presented for severe disphagya and weight loss more of IO kgs RESULTS Endoscopy showed stricture ofproxlmal oesophagus wfh co”“ue”t eros,o”s and errudate, b,opsms excluded mebgnancy and infectwe dtseases I” P second examinatlo&was performed a balloon dilatatto” of stricture and prescribed therapy with PPI and sucralfate wth good cb”,cal results, obvmusiy the ale”d&“ate was supped A” e”doscopY performed 3 and 6 months later documented the persntence of mild oesophagitis but resolutlo” of stnct”re CONCLUSIONS Alendronate represents a “sk fanor for severe oesophagms, expecmlly I” elderly patients, the selection of patients, recommendations to take alendronate wth a” adeguate amount ofwater and the tnformation ofpossibility of oesopbageal symptoms. can improve patiem care
L Manas’. dl Cbnica
E Maragkudakis’,
Medica.
Unwers~ti
R Mele’, dl Sassan
G Leandro^,
“TRCCS
G Realdl’
S De Belhs,
Castellana
Grone,
Bar1
Background The inmdence of gastroesophageal reflux due&se (GERD) and esophageal adenocarmnoma have increased in recent years If was suggested that the H pylon Infectton mav “rotect nnceotible indivnduals From develooinz GERD and its cam”lications. The urn of our study was to evaluate the relationship amb”g-H pylon infection i”d presence of GERD subtypes and development metaplasia of Barrett, dyspiasm or carcinoma I” the esophagus Methods All patients undergot” upper endoscopy and posmve for typmhl GERD symptoms such as heartburn and regurgitation and/or wth esophagms were enrolled I” the study Symptoms were recorded in a detmled questionnaire Patients wth peptic “Ice, were excluded from the study H pylori status was assessed by histology and rapld orease testing of gastric biopsws Esophagus ofBarrett was dmgnored on the basis of endoscopy features and histology examination The study cohort was subgrouped in Group A patrents wtth typical symptoms of GERD plus erorwe esophagitis at the endoscopy &wary-Muller classification), Group B patients wxth typical symptoms without eroswe esophagitls, and Group C patients with erosive esophagitls without health”,” or regurgltatio” Results A total of 901 patients were enrolled The prevalence of H pylon tnfectlo” was 42% (I 511357) ,n Group A, 44% (1401316) m po”p B and 39% (871224) in Group C (p = N S) 12 paoems (I 3%) were postlive for esophagw of Barren, and more specdically 4 pattents I” the Group A (2 Hp p&2 Hp neg), 6 patients in the Group B (3 Hp pad3 Hp “eg). and 2 pattents I” the Group C (Hp pos), complicated by mdd dysplarm I” 5 cases No one cancer of the esophagus was observed Conclusion Our data show that patents wthout and wth H pylon can develop esophagus ofBanett suggestzng that H pylon 1s not proten,vc I” Ihe development of gasfroesophageal reflux duease I
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A4