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A randomized, crossover comparison of once daily pantoprazole versus omeprazole bid in the suppression of gastric acid in patients with GERD
AJG – September, Suppl., 2002
Abstracts
14
Expression of p27 in Barrett’s Esophagus and Adenocarcinoma History BM LGD HGD BAA
S5
Deep
Superficial
78% (29/37) 77% (27/35) 70% (30/43) 18% (6/33)(p ⬍ .0001)
84% (31/37) 83% (29/35) 79% (34/43) 18% (6/33) (p ⬍ .0001)
Conclusions: Loss of p27 may occur in some patients prior to the development of adenocarcinoma. P27 expression should be evaluated in a longitudinal trial to assess its prognostic significance. Patients who have high– grade dysplasia but do not express p27 may be at higher risk of progressing to cancer.
13 ASSOCIATION OF GASTROINTESTINAL (GI) DISORDERS AND SLEEP DISORDERS IN A POPULATION OF 1741 SUBJECTS Geoffrey S. Raymer, M.D., Helena F. Wrzos, M.D., Alexandros N. Vgontzas, M.D., Ann Ouyang, M.D. and Edward O. Bixler, Ph.D.*. Gastroenterology & Hepatology, Pennsylvania State University, Hershey, PA and Psychiatry, Pennsylvania State University, Hershey, PA. Purpose: Most studies that have examined the association between sleep disorders and GI disorders are based on subjects recruited with specific GI disorders studied in the sleep laboratory. The aim of this study was to define the relationships between GI and sleep disorders using a large database designed to determine the prevalence of sleep disorders in the general population. Methods: 12,219 women and 4,364 men (ages 20 –100) were interviewed by random survey via telephone. From these, 1000 women and 741 men were selected for further study based on the presence of risk factors for sleep disordered breathing. Each provided a structured history, had a physical exam and spent 1 night in the sleep lab. GI diagnoses were obtained directly from the exam and the history, which included GI–related questions, and indirectly from the medication list and symptoms. Sleep disorders were characterized as excessive daytime sleepiness (EDS) and insomnia (INS), with sub– categories of mild vs. moderate/severe for EDS and difficulty sleeping vs. insomnia for INS. Results: The GI diagnoses in the studied population were grouped into 7 categories, the most prevalent being acid peptic disorders (26.3%) and motility disorders (2.9%). The prevalence of each of the other 5 categories (liver disease, IBD, anatomic alterations, neoplasia, and other) was ⱕ1.1%. Acid peptic disorders were further divided into GERD, PUD & hiatal hernia (prevalence 24.3%, 3.3%, and 2.4% respectively). Significant relationships were found between GERD and EDS, GERD and INS, and PUD and INS as well as hiatal hernia and insomnia, motility disorders and moderate/severe EDS, and motility disorders and difficulty sleeping (See Figure 1).
INTRAVENOUS THEOPHYLLINE IN FUNCTIONAL CHEST PAIN–RANDOMIZED,DOUBLE BLIND STUDY Ranjit Mudipalli, Xing Zhao, M.D., Craig Utecht, R.N. and Satish S.C. Rao, M.D.*. Internal Medicine, Digestive Diseases Center, University of Iowa Health Care, Iowa City, IA. Purpose: To investigate if theophylline, an adenosine receptor antagonist, improves sensory thresholds and esophageal smooth muscle function in patients with functional chest pain of presumed esophageal origin. Methods: We performed balloon distention of the esophagus using impedance planimetry in patients with functional chest pain and otherwise normal cardiac and esophageal evaluation. Sixteen patients (M/F: 6/10; mean age⫽ 48) with hypersensitive (pain ⬍ 55 cm H2O) esophagus were randomized to receive either intravenous theophylline or placebo (double blind). Subsequently balloon distention was repeated. Sensory thresholds & biomechanics were assessed. Results: Eight patients each received theophylline or placebo. After theophylline infusion, median thresholds for discomfort, pre vs post⫽33 vs ⬎ 65 cm H2O) and pain (43 vs ⬎ 65 cm H2O) increased significantly (p⬍0.05) (figure). The mean theophylline serum concentration was 14.9 mcg/dl. After placebo infusion, thresholds for discomfort (pre vs post⫽ 30 vs 45 cm H2O) or pain (45 vs 55 cm H2O) were not significant (p⫽0.3). The mean cross –sectional area and circumferential wall tension increased significantly in those who received theophylline (table) but not in those who received placebo.
Biomechanical Properties before (pre) and after (post) IV theophylline Biomechanics Crossectional area (mm*mm) Wall tension (mm.cm H2O)
Pre (10) Post (10) Pre (20) Post (20) Pre (30) Post (30) 244
315*
343
409*
388
536*
173
192*
308
342*
437
516*
* P ⱖ 0.05.
Conclusions: Theophylline infusion improves esophageal hypersensitivity possibly by altering nociception and also by relaxing smooth muscle. This effect may be mediated by adenosine receptor antagonism. Theophylline may be useful in the treatment of functional chest pain.
15 A RANDOMIZED, CROSSOVER COMPARISON OF ONCE DAILY PANTOPRAZOLE VERSUS OMEPRAZOLE BID IN THE SUPPRESSION OF GASTRIC ACID IN PATIENTS WITH GERD David P. Jones, D.O. and Michael J. Rensch, M.D.*. Department of Gastroenterology, Brooke Army Medical Center, San Antonio, TX.
Conclusions: In a large population study focused on sleep disorders, GERD and motility disorders are associated with both EDS and INS; PUD and hiatal hernia are associated primarily with INS. Further investigation is warranted to understand the link between specific sleep and GI disorders.
Purpose: GERD is one of the most prevalent medical conditions seen in clinical practice today. Proton pump inhibiting (PPI) medications provide relief of GERD symptoms in a majority of patients but their effectiveness may decline after 18 hours. This effect may contribute to symptoms of nocturnal acid breakthrough (NAB). Our aim was to compare in a randomized and cross– over fashion the efficacy of two commonly used proton
S6
Abstracts
AJG – Vol. 97, No. 9, Suppl., 2002
pump inhibitors (pantoprazole and omeprazole) in their ability to sustain acid suppression in the both the stomach and esophagus over a 24 hour period Methods: Ten patients with symptomatic GERD and endoscopic evidence of Grade I–II esophagitis were studied. Ambulatory pH monitoring was performed with one electrode in the stomach and one electrode 5– cm above the lower esophageal border. All patients were randomized with respect to either starting 7 days of pantoprazole PO 40mg daily (group 1) or 7 days of omeprazole 20mg PO bid (group 2). A washout period while on therapy was observed for 7 days as patients in each group prior to crossover. Ambulatory pH studies were performed on study day 7 and 14. Results: Six patients completed the study; four withdrew due to discomfort of the pH probe. There was no significant difference in percentage of time the pH was above 4 between treatments (p ⫽ 0.082) or between treatment and order (p ⫽ 0.255) in gastric analysis. There was also no significant difference in percentage if time the pH was above 4 between treatments (p ⫽ 0.305) in esophageal analysis. Conclusions: There is no significant difference in acid suppression when comparing gastric pH and esophageal pH in patients with established GERD between omeprazole 20mg PO bid and pantoprazole 40 mg PO daily. This suggests potential improved compliance and cost savings with a once daily medication like pantoprazole with equivelant acid suppression.
under critical appraisal. Others reported that African Americans (AA) have much higher prevalence of HP than whites (W). Methods: We reviewed clinical records of Brooklyn veterans for GIM, BE and ESAC. Results: 1. In 5 years we diagnosed 174 male patients with GIM, 85 (49 %) were AA, 48 % were W. Age difference was NS: AA 69.4 (10.7) yr, x (1 SD), W 71.3 (9.8) yr. There was no difference in gastric inflammatory nodules and gastro– duodenal ulcer disease. 2. In 13 years there were 632 esophageal biopsies that revealed BE (with intestinal metaplasia) in 43 patients (6.8 %). Only 3 (7 %) of the BE patients were AA and they all had a very short segment of BE: 0.67 (1.15) cm compared with 4.5 (4.2) cm in W. 3. In 14 years we diagnosed 230 cases of esophageal cancer, 50 (22 %) were ESAC. Remarkably, less than 6 % of ESAC were AA, 94 % were W. Squamous cell ca distribution: 65 % AA, 31 % W, 4 % Hisp. Conclusions: HP, the main pathogenic factor for gastritis, GIM and gastric cancer affects our AA veterans as much as the W patients. Conceivably, a gastroduodenal dyspepsia would necessitate EGD with similar frequency in both ethnic groups. However, GERD–related BE and ESAC occur much less frequently in AA than in W. These findings in AA veterans in Brooklyn confirm other reports in natives of the sub–Saharan Africa. Research focused at these striking differences among ethnic groups may clarify the role of HP in GERD, BE and ESAC.
16
18
EVALUATION OF PATIENTS WITH ACHALASIA USING COMBINED MULTICHANNEL INTRALUMINAL IMPEDANCE AND ESOPHAGEAL MANOMETRY (MII/EM) Sajid Jalil, M.D., Radu I. Tutuian, M.D., Shirley Jamison, Lileeth Kong, R.N. and Donald O. Castell, M.D., MACG*. Division of Gastroenterology & Hepatology, Medical University of South Carolina, Charleston, SC.
WHERE DID THE LONG BARRETT’S ESOPHAGUS GO? Hashem B. El–Serag, M.D., M.P.H., Harindar Garewel, M.D., Ph.D. and Richard E. Sampliner, M.D.*. Medicine (GI and Oncology), Southern Arizona VA Healthcare System and the University of Arizona, Tucson, AZ and Gastroenterology and Health Services Research, Houston VA Medical Center and Baylor College of Medicine, Houston, TX.
Purpose: Multichannel intraluminal impedance (MII) is a new technique which uses resistance to alternating current across multiple electrodes to measure movement of bolus. It has been shown to be useful in evaluation of esophageal function testing in normal volunteers. A multi– center study recently (Gastro 2002; 122: A342) has established normal values from 48 healthy volunteers. The purpose of this study is to document esophageal bolus transport using MII/EM in patients with achalasia. Methods: Patients with history of dysphagia & established achalasia underwent esophageal function testing using MII/EM, with pressure transducers (P) placed 5cm, 10cm, 15cm & 20cm above LES and impedance channels (Z) located at same sites. Viscous boluses (total of 10 swallows) of applesauce consistency were used. Contraction amplitude, duration and onset of velocity were recorded along with bolus presence time in each segment & bolus transit time in the body of esophagus. Results: 12 patients (8 males: 4 females; mean age 59, range 37– 81 years) met the manometric criteria for the diagnosis of achalasia. MII showed complete absence of bolus movement with no bolus presence time and bolus transit times identified. Lack of impedance changes to bolus in these patients confirms retention of bolus within the esophagus. Conclusions: MII/EM detects absence of bolus movement within the esophagus in patients with achalasia. Further studies using MII/EM after treatment of achalasia are warranted.
Purpose: We have anecdotally noticed less frequent new diagnosis of patients with long segment Barrett’s esophagus (BE). Methods: A retrospective analysis of a prosepctively characterized large cohort of patients with documented BE diagnosed between 1981 and 2000 at the Tucson VAMC. We examined the temporal changes in the length of BE at the time of the diagnosis, as well as the frequency and the proportions of patients with ⬍1, ⱖ 3, ⱖ 5. Multivariate linear regression analyses were performed to examine the association between the year of diagnosis and the length of BE while adjusting for demographics, and the presence of intestinal metaplasia (IM) of the gastric cardia. Results: There were 366 patients diagnosed between 1982 and 2000 with BE – defined by the presence of salmon– colored mucosa in the lower end of the esophagus, and IM in biopsies taken from these areas on at least 2 endoscopic examinations. Of those, 352 had complete information on the length of BE; the average length was 4.5 cm (0.5–16 cm). The mean age at the time of the diagnosis was 61 years (27–90), and only 19 (5%) were women. There was a strong inverse correlation between the length of BE at the time of the diagnosis and the year of the diagnosis (correlation coefficient: – 0.32, p⬍0.0001). The frequency as well as the proportion of long BE (ⱖ 3 cm) and (ⱖ 5 cm) decreased over time from 60 (87%) and 40 (48%) in 1981– 85, to 41 (60%) and 25 (30%) in 1995–2000; p⬍0.0001. In the regression model, a more recent year of diagnosis was a strong predictor of a relatively shorter BE (PE⫽– 0.19, SE 0.03) and a R2 of 0.1 was calculated (i.e. 10% of the variation in the length of BE could be explained by the time of the diagnosis). This association persisted while adjusting for the age at the time of the diagnosis, ethnicity, gender, or the diagnosis of cardiac IM. When we excluded those with BE ⬍1 cm, the inverse correlation between the year of diagnosis and the length of BE persisted (– 0.23, p⫽0.0005). Conclusions: There has been a progressive decline in the length of newly diagnosed BE. This decline cannot be explained by changes in the demographic features, nor by the increasing emphasis on ultra short BE or IM of the gastric cardia. The role of prior therapy or more prompt presentation to endoscopy need to be explored.
17 UPPER GI DISORDERS IN THE MINORITY VETERANS Vlado Simko, M.D.*, Jorge Sotelo, M.D. and Sulaiman Azzeez, M.D. Medicine, Brooklyn Campus of VA NY Harbor Health Care System, Brooklyn, NY. Purpose: Helicobacter pylori (HP) is the most common cause of chronic active gastritis that may lead to gastric intestinal metaplasia (GIM) and gastric adenoca of the intestinal type. A preventive potential of HP to reduce GERD, Barretts esophagus (BE) and esophageal adenoca (ESAC) is
Abstracts
14
Expression of p27 in Barrett’s Esophagus and Adenocarcinoma History BM LGD HGD BAA
S5
Deep
Superficial
78% (29/37) 77% (27/35) 70% (30/43) 18% (6/33)(p ⬍ .0001)
84% (31/37) 83% (29/35) 79% (34/43) 18% (6/33) (p ⬍ .0001)
Conclusions: Loss of p27 may occur in some patients prior to the development of adenocarcinoma. P27 expression should be evaluated in a longitudinal trial to assess its prognostic significance. Patients who have high– grade dysplasia but do not express p27 may be at higher risk of progressing to cancer.
13 ASSOCIATION OF GASTROINTESTINAL (GI) DISORDERS AND SLEEP DISORDERS IN A POPULATION OF 1741 SUBJECTS Geoffrey S. Raymer, M.D., Helena F. Wrzos, M.D., Alexandros N. Vgontzas, M.D., Ann Ouyang, M.D. and Edward O. Bixler, Ph.D.*. Gastroenterology & Hepatology, Pennsylvania State University, Hershey, PA and Psychiatry, Pennsylvania State University, Hershey, PA. Purpose: Most studies that have examined the association between sleep disorders and GI disorders are based on subjects recruited with specific GI disorders studied in the sleep laboratory. The aim of this study was to define the relationships between GI and sleep disorders using a large database designed to determine the prevalence of sleep disorders in the general population. Methods: 12,219 women and 4,364 men (ages 20 –100) were interviewed by random survey via telephone. From these, 1000 women and 741 men were selected for further study based on the presence of risk factors for sleep disordered breathing. Each provided a structured history, had a physical exam and spent 1 night in the sleep lab. GI diagnoses were obtained directly from the exam and the history, which included GI–related questions, and indirectly from the medication list and symptoms. Sleep disorders were characterized as excessive daytime sleepiness (EDS) and insomnia (INS), with sub– categories of mild vs. moderate/severe for EDS and difficulty sleeping vs. insomnia for INS. Results: The GI diagnoses in the studied population were grouped into 7 categories, the most prevalent being acid peptic disorders (26.3%) and motility disorders (2.9%). The prevalence of each of the other 5 categories (liver disease, IBD, anatomic alterations, neoplasia, and other) was ⱕ1.1%. Acid peptic disorders were further divided into GERD, PUD & hiatal hernia (prevalence 24.3%, 3.3%, and 2.4% respectively). Significant relationships were found between GERD and EDS, GERD and INS, and PUD and INS as well as hiatal hernia and insomnia, motility disorders and moderate/severe EDS, and motility disorders and difficulty sleeping (See Figure 1).
INTRAVENOUS THEOPHYLLINE IN FUNCTIONAL CHEST PAIN–RANDOMIZED,DOUBLE BLIND STUDY Ranjit Mudipalli, Xing Zhao, M.D., Craig Utecht, R.N. and Satish S.C. Rao, M.D.*. Internal Medicine, Digestive Diseases Center, University of Iowa Health Care, Iowa City, IA. Purpose: To investigate if theophylline, an adenosine receptor antagonist, improves sensory thresholds and esophageal smooth muscle function in patients with functional chest pain of presumed esophageal origin. Methods: We performed balloon distention of the esophagus using impedance planimetry in patients with functional chest pain and otherwise normal cardiac and esophageal evaluation. Sixteen patients (M/F: 6/10; mean age⫽ 48) with hypersensitive (pain ⬍ 55 cm H2O) esophagus were randomized to receive either intravenous theophylline or placebo (double blind). Subsequently balloon distention was repeated. Sensory thresholds & biomechanics were assessed. Results: Eight patients each received theophylline or placebo. After theophylline infusion, median thresholds for discomfort, pre vs post⫽33 vs ⬎ 65 cm H2O) and pain (43 vs ⬎ 65 cm H2O) increased significantly (p⬍0.05) (figure). The mean theophylline serum concentration was 14.9 mcg/dl. After placebo infusion, thresholds for discomfort (pre vs post⫽ 30 vs 45 cm H2O) or pain (45 vs 55 cm H2O) were not significant (p⫽0.3). The mean cross –sectional area and circumferential wall tension increased significantly in those who received theophylline (table) but not in those who received placebo.
Biomechanical Properties before (pre) and after (post) IV theophylline Biomechanics Crossectional area (mm*mm) Wall tension (mm.cm H2O)
Pre (10) Post (10) Pre (20) Post (20) Pre (30) Post (30) 244
315*
343
409*
388
536*
173
192*
308
342*
437
516*
* P ⱖ 0.05.
Conclusions: Theophylline infusion improves esophageal hypersensitivity possibly by altering nociception and also by relaxing smooth muscle. This effect may be mediated by adenosine receptor antagonism. Theophylline may be useful in the treatment of functional chest pain.
15 A RANDOMIZED, CROSSOVER COMPARISON OF ONCE DAILY PANTOPRAZOLE VERSUS OMEPRAZOLE BID IN THE SUPPRESSION OF GASTRIC ACID IN PATIENTS WITH GERD David P. Jones, D.O. and Michael J. Rensch, M.D.*. Department of Gastroenterology, Brooke Army Medical Center, San Antonio, TX.
Conclusions: In a large population study focused on sleep disorders, GERD and motility disorders are associated with both EDS and INS; PUD and hiatal hernia are associated primarily with INS. Further investigation is warranted to understand the link between specific sleep and GI disorders.
Purpose: GERD is one of the most prevalent medical conditions seen in clinical practice today. Proton pump inhibiting (PPI) medications provide relief of GERD symptoms in a majority of patients but their effectiveness may decline after 18 hours. This effect may contribute to symptoms of nocturnal acid breakthrough (NAB). Our aim was to compare in a randomized and cross– over fashion the efficacy of two commonly used proton
S6
Abstracts
AJG – Vol. 97, No. 9, Suppl., 2002
pump inhibitors (pantoprazole and omeprazole) in their ability to sustain acid suppression in the both the stomach and esophagus over a 24 hour period Methods: Ten patients with symptomatic GERD and endoscopic evidence of Grade I–II esophagitis were studied. Ambulatory pH monitoring was performed with one electrode in the stomach and one electrode 5– cm above the lower esophageal border. All patients were randomized with respect to either starting 7 days of pantoprazole PO 40mg daily (group 1) or 7 days of omeprazole 20mg PO bid (group 2). A washout period while on therapy was observed for 7 days as patients in each group prior to crossover. Ambulatory pH studies were performed on study day 7 and 14. Results: Six patients completed the study; four withdrew due to discomfort of the pH probe. There was no significant difference in percentage of time the pH was above 4 between treatments (p ⫽ 0.082) or between treatment and order (p ⫽ 0.255) in gastric analysis. There was also no significant difference in percentage if time the pH was above 4 between treatments (p ⫽ 0.305) in esophageal analysis. Conclusions: There is no significant difference in acid suppression when comparing gastric pH and esophageal pH in patients with established GERD between omeprazole 20mg PO bid and pantoprazole 40 mg PO daily. This suggests potential improved compliance and cost savings with a once daily medication like pantoprazole with equivelant acid suppression.
under critical appraisal. Others reported that African Americans (AA) have much higher prevalence of HP than whites (W). Methods: We reviewed clinical records of Brooklyn veterans for GIM, BE and ESAC. Results: 1. In 5 years we diagnosed 174 male patients with GIM, 85 (49 %) were AA, 48 % were W. Age difference was NS: AA 69.4 (10.7) yr, x (1 SD), W 71.3 (9.8) yr. There was no difference in gastric inflammatory nodules and gastro– duodenal ulcer disease. 2. In 13 years there were 632 esophageal biopsies that revealed BE (with intestinal metaplasia) in 43 patients (6.8 %). Only 3 (7 %) of the BE patients were AA and they all had a very short segment of BE: 0.67 (1.15) cm compared with 4.5 (4.2) cm in W. 3. In 14 years we diagnosed 230 cases of esophageal cancer, 50 (22 %) were ESAC. Remarkably, less than 6 % of ESAC were AA, 94 % were W. Squamous cell ca distribution: 65 % AA, 31 % W, 4 % Hisp. Conclusions: HP, the main pathogenic factor for gastritis, GIM and gastric cancer affects our AA veterans as much as the W patients. Conceivably, a gastroduodenal dyspepsia would necessitate EGD with similar frequency in both ethnic groups. However, GERD–related BE and ESAC occur much less frequently in AA than in W. These findings in AA veterans in Brooklyn confirm other reports in natives of the sub–Saharan Africa. Research focused at these striking differences among ethnic groups may clarify the role of HP in GERD, BE and ESAC.
16
18
EVALUATION OF PATIENTS WITH ACHALASIA USING COMBINED MULTICHANNEL INTRALUMINAL IMPEDANCE AND ESOPHAGEAL MANOMETRY (MII/EM) Sajid Jalil, M.D., Radu I. Tutuian, M.D., Shirley Jamison, Lileeth Kong, R.N. and Donald O. Castell, M.D., MACG*. Division of Gastroenterology & Hepatology, Medical University of South Carolina, Charleston, SC.
WHERE DID THE LONG BARRETT’S ESOPHAGUS GO? Hashem B. El–Serag, M.D., M.P.H., Harindar Garewel, M.D., Ph.D. and Richard E. Sampliner, M.D.*. Medicine (GI and Oncology), Southern Arizona VA Healthcare System and the University of Arizona, Tucson, AZ and Gastroenterology and Health Services Research, Houston VA Medical Center and Baylor College of Medicine, Houston, TX.
Purpose: Multichannel intraluminal impedance (MII) is a new technique which uses resistance to alternating current across multiple electrodes to measure movement of bolus. It has been shown to be useful in evaluation of esophageal function testing in normal volunteers. A multi– center study recently (Gastro 2002; 122: A342) has established normal values from 48 healthy volunteers. The purpose of this study is to document esophageal bolus transport using MII/EM in patients with achalasia. Methods: Patients with history of dysphagia & established achalasia underwent esophageal function testing using MII/EM, with pressure transducers (P) placed 5cm, 10cm, 15cm & 20cm above LES and impedance channels (Z) located at same sites. Viscous boluses (total of 10 swallows) of applesauce consistency were used. Contraction amplitude, duration and onset of velocity were recorded along with bolus presence time in each segment & bolus transit time in the body of esophagus. Results: 12 patients (8 males: 4 females; mean age 59, range 37– 81 years) met the manometric criteria for the diagnosis of achalasia. MII showed complete absence of bolus movement with no bolus presence time and bolus transit times identified. Lack of impedance changes to bolus in these patients confirms retention of bolus within the esophagus. Conclusions: MII/EM detects absence of bolus movement within the esophagus in patients with achalasia. Further studies using MII/EM after treatment of achalasia are warranted.
Purpose: We have anecdotally noticed less frequent new diagnosis of patients with long segment Barrett’s esophagus (BE). Methods: A retrospective analysis of a prosepctively characterized large cohort of patients with documented BE diagnosed between 1981 and 2000 at the Tucson VAMC. We examined the temporal changes in the length of BE at the time of the diagnosis, as well as the frequency and the proportions of patients with ⬍1, ⱖ 3, ⱖ 5. Multivariate linear regression analyses were performed to examine the association between the year of diagnosis and the length of BE while adjusting for demographics, and the presence of intestinal metaplasia (IM) of the gastric cardia. Results: There were 366 patients diagnosed between 1982 and 2000 with BE – defined by the presence of salmon– colored mucosa in the lower end of the esophagus, and IM in biopsies taken from these areas on at least 2 endoscopic examinations. Of those, 352 had complete information on the length of BE; the average length was 4.5 cm (0.5–16 cm). The mean age at the time of the diagnosis was 61 years (27–90), and only 19 (5%) were women. There was a strong inverse correlation between the length of BE at the time of the diagnosis and the year of the diagnosis (correlation coefficient: – 0.32, p⬍0.0001). The frequency as well as the proportion of long BE (ⱖ 3 cm) and (ⱖ 5 cm) decreased over time from 60 (87%) and 40 (48%) in 1981– 85, to 41 (60%) and 25 (30%) in 1995–2000; p⬍0.0001. In the regression model, a more recent year of diagnosis was a strong predictor of a relatively shorter BE (PE⫽– 0.19, SE 0.03) and a R2 of 0.1 was calculated (i.e. 10% of the variation in the length of BE could be explained by the time of the diagnosis). This association persisted while adjusting for the age at the time of the diagnosis, ethnicity, gender, or the diagnosis of cardiac IM. When we excluded those with BE ⬍1 cm, the inverse correlation between the year of diagnosis and the length of BE persisted (– 0.23, p⫽0.0005). Conclusions: There has been a progressive decline in the length of newly diagnosed BE. This decline cannot be explained by changes in the demographic features, nor by the increasing emphasis on ultra short BE or IM of the gastric cardia. The role of prior therapy or more prompt presentation to endoscopy need to be explored.
17 UPPER GI DISORDERS IN THE MINORITY VETERANS Vlado Simko, M.D.*, Jorge Sotelo, M.D. and Sulaiman Azzeez, M.D. Medicine, Brooklyn Campus of VA NY Harbor Health Care System, Brooklyn, NY. Purpose: Helicobacter pylori (HP) is the most common cause of chronic active gastritis that may lead to gastric intestinal metaplasia (GIM) and gastric adenoca of the intestinal type. A preventive potential of HP to reduce GERD, Barretts esophagus (BE) and esophageal adenoca (ESAC) is