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Differences of Influencing Factors of PPI and Placebo Responder in Functional Dyspepsia: Clinical Advantage of Effect on Suppression of Acid With Rabeprazole in Functional Dyspepsia (the CAESAR Study)
AGA Abstracts
catheter were positioned in the proximal stomach. After a stabilization period a nutrient drink (Nutridrink; 1.5 kcal ml-1) was intragastrically infused at 60 ml min-1, the subjects were unaware of the infusion speed. The subjects scored satiation until maximum, when the experiment ended. IGP was presented as change from baseline (median ± 95% confidence interval). Results were compared using a t-test. Results: HV drank significantly more than FD patients 843 (799-1063) vs. 321 (170-646) ml respectively (p=0.0001), in 7 patients the maximally ingested volume was lower than the lowest confidence interval in HV (see figure, interrupted lines indicate lower confidence intervals). In all subjects the IGP decreased initially to gradually recover thereafter. Although as a group the maximum IGP decrease in HV (3.4 (2.3-4.3) mmHg) was not different from FD patients (2.1 (1.2-3.6) mmHg), the nadir pressure in 4 patients was outside the lower confidence intervals in HV (see figure). Conclusions: This pilot study indicates that IGP during intragastric nutrient drink infusion represents a method to objectively discriminate FD patients with impaired nutrient tolerance and/or gastric accommodation.
reflux in placebo had significant influence on decrease response. In EPS score responder, the same factors in PPI had significant impact on increase response and in placebo on decrease response. However, the strength of hunger pain and EPS score in both PPI and placebo had significant impacts on increase response. There were no symptom factors influencing PDS score responder (PPI:36.7%:18/49 , placebo:32.7%:16/49). Conclusions There might be differences of influencing factors of PPI and placebo responder in functional dyspepsia such as symptoms associated with pain and reflux. However, it may be difficult to predict placebo response, since the strength of hunger pain and EPS score in both PPI and placebo had impacts on increase response in EPS score responder.
Tu2074 Smoking Increases the Risk of Onset of the Epigastric Pain Syndrome in Males and Worsens the Symptoms of Postprandial Distress Syndrome in Females Sawako Okada, Hidekazu Suzuki, Juntaro Matsuzaki, Yasushi Fukushima, Keiko Asakura, Toru Takebayashi, Hitoshi Tsugawa, Kenro Hirata, Seiichiro Fukuhara, Toshifumi Hibi
Tu2072 The Relationship Between Functional Dyspepsia and SCN5A Mutation Suggesting Na+ Channelopathy - A Pilot Study Jie-Hyun Kim, Kwang Hyun Kim, Young Hoon Youn, Hyojin Park, Sang In Lee
Background. Smoking had often been indicated as one of the risk factors for the development of functional dyspepsia (FD)(Am J Gastroenterol. 99: 2210, 2004). Furthermore, it has been reported that placebo has less pronounced effect in smoking FD patients than in nonsmoking FD patients(Neurogastroenterol Motil. 21: 370, 2009). However, it has not ever been shown whether there might be a difference in the influence of smoking on the severity of FD between males and females. The present study is designed to investigate the relation of smoking to the onset of FD, especially from the viewpoint of any gender-related difference. Methods. The web survey, comprising items of the Gastrointestinal Symptom Rating Scale (GSRS), the Rome III criteria for the diagnosis of FD, and items to determine the demographic characteristics of the patients, including the smoking history, were sent to 177,615 subjects who were 20 years old or older and less than 70 years old, and had provided consent and registered for participation in clinical research programs at the Tokyo Station Center Building Clinic, over five days from July 31, 2008. We categorized those patients who fulfilled the Rome III criteria and had no positive findings on esophagogastroduodenoscopy into the FD group and those who did not fulfilled the diagnostic criteria for FD into the non-FD group. In addition, those who smoked one or more cigarettes in a day were classified as “smoker”, and those who did not smoke as “non-smoker”. Then, factor analysis and cluster analysis were conducted. Results. A total of 8,039 subjects (male 3,463; female 4,576; mean age 40.8) completed the survey; of these, 563 subjects fulfilled the diagnostic criteria for FD. In all, 30.4% of the patients in the FD group and 25.4% of the patients in the non-FD group were smokers. Among the males, FD patients, especially those who were classified as having epigastric pain syndrome (EPS), tended to smoke more as compared to the nonFD patients (OR 2.95, 95%CI 1.83-4.77). Among the females, no relationship was noted between the absence of FD and the prevalence of smoking. In terms of the GSRS score, which reflects the severity of the gastrointestinal symptoms, only female FD patients who smoked, especially those who were classified as having postprandial distress syndrome (PDS), had higher scores of acid reflux (β=0.23, p<0.001), abdominal pain (β=0.19, p=0.001), diarrhea (β=0.17, p=0.003) and constipation (β=0.16, p=0.006) than non-smoking female FD patients. Conclusion. The influence of smoking on the manifestation of the dyspeptic syndrome differes between men and women. In men, smoking influenced the risk of onset of EPS, but did not worsen the symptoms. On the other hand, there was no relation between smoking and the onset of FD in women, although smoking was a risk factor for the deterioration of PDS symptoms.
Background/Aims: Abnormality of gastric myoelectrical rhythm is suggested one of the mechanisms in functional dyspepsia (FD). SCN5A encodes the cardiac-specific Nav1.5 sodium channel, and Brugada syndrome is a cardiac conduction disorder associated with SCN5A mutation. The SCN5A-encoded Nav1.5 channel was also found on gastrointestinal smooth muscle and interstitial cells of Cajal. Thus, we investigated the relationship between FD and SCN 5A mutation to evaluate sodium channelopathy in FD. Methods: Patients with Brugada syndrome or FD were examined according to upper endoscopy, electrogastrography (EGG), FD symptom questionnaire based on Rome III criteria, and genetic testing for SCN5A mutation. Symptoms scales of FD and EGG findings were analyzed according to SCN 5A mutation. Results: An SCN5A mutation was noted in 75.0% patients of Brugada syndrome. 33.3% of the patients with SCN5A mutation in Brugada syndrome reported the symptoms compatible with FD. An SCN5A mutation was observed in 7.7% of the patients with FD. The EGG findings were not significantly different between the patients with and without an SCN5A mutation. Decreased postprandial power ratio was observed in 50.0% of the patients with SCN5A mutation. Postprandial tachygastria and bradygastria were noted in 50.0% and 25.0% of the patients with SCN5A mutation, respectively. Conclusion: About 30.0% of the patients with SCN5A mutation reported dyspeptic symptoms, and 7.7% of the patients diagnosed with FD had an SCN5A mutation. The relationship between FD and Na+ channelopathy should be elucidated by large-scaled study. Tu2073 Differences of Influencing Factors of PPI and Placebo Responder in Functional Dyspepsia: Clinical Advantage of Effect on Suppression of Acid With Rabeprazole in Functional Dyspepsia (the CAESAR Study) Kazunari Tominaga, Hidekazu Suzuki, Eiji Umegaki, Hiroaki Kusunoki, Naoki Tomotsugu, Kazuhide Higuchi, Ken Haruma, Toshifumi Hibi, Tetsuo Arakawa, the CAESAR study Group Background & Aim We gave the first report in Japan on the efficacy of PPI, Rabeprazole (RPZ) in Functional Dyspepsia (FD) derived from double-blind randomized placebo-controlled study (the Caesar study) (DDWAGA2010). Since the placebo response is great for FD patients in general, we investigated the effective factors for RPZ- or placebo-response in this study. Methods On hundred fifteen subjects with FD, diagnosed by the Rome III criteria, were randomly assigned to 4 weeks of either RPZ 10mg/day (Age 50.7±17.3, male/ female:13/ 36) or placebo (Age 49.6±16.7, male/ female:18/31). Severity of gastrointestinal symptoms was assessed using the Gastrointestinal Symptoms Rating Scale (GSRS). With GSRS, FD scores were calculated by summing scores of two symptoms (epigastric pain and hunger pain) of epigastric pain syndrome (EPS) and scores of two symptoms (nausea and satiety) of postprandial distress syndrome (PDS). Definition for responders is improvement rate ≧50% of FD, EPS, and PDS scores after 4-week administration. Background factors (age, sex, BMI, H. pylori infection, each GSRS score) for responders were analyzed by univariate analysis and the odds ratio was calculated. Results There were no significant factors having the effect of PPI and placebo on symptom improvement in age, sex, BMI, and H pylori infection. Factors influencing FD and EPS score responder are the following. In FD score responder, the strength of symptoms associated with pain, FD and EPS score in PPI had significant influence on increase response while the strength of symptoms associated with
AGA Abstracts
Tu2075 Diagnostic Yield of Upper Endoscopy in Transplant Recipients Juan E. Pizzala, Maria Dolores Matoso, Salomon L. Algranati, Nora Cristina C. Imperiali, Alvaro R. Talamazzi, Victor H. Abecia, Marina Cariello, Cesar A. Mombelli, Pierangelo A. Mauricio, Paula A. Carrillo, Diego A. Jiménez Larriva, Diego H. Giunta, Maria Giordanini, Silvia R. Groppa, Graciela Estela Bohbouth, Carlos A. Macías Gomez, Juan A. De Paula Introduction: Gastrointestinal symptoms are common among patients who underwent kidney and kidney/pancreas transplantation. Besides the usual causes, patient's symptoms in these cases may be related with immunosuppressive therapy and/or be associated with opportunistic infections (OI). Upper endoscopy is nearly used as a rutine tool in the diagnosis work up of disorders with clinical implication. Aim: To evaluate the diagnostic yield of upper endoscopy in this population, to describe the endoscopic findings and to assess the clinical endoscopic correlation. Methods: Two hundred eighteen computerized clinical records of
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catheter were positioned in the proximal stomach. After a stabilization period a nutrient drink (Nutridrink; 1.5 kcal ml-1) was intragastrically infused at 60 ml min-1, the subjects were unaware of the infusion speed. The subjects scored satiation until maximum, when the experiment ended. IGP was presented as change from baseline (median ± 95% confidence interval). Results were compared using a t-test. Results: HV drank significantly more than FD patients 843 (799-1063) vs. 321 (170-646) ml respectively (p=0.0001), in 7 patients the maximally ingested volume was lower than the lowest confidence interval in HV (see figure, interrupted lines indicate lower confidence intervals). In all subjects the IGP decreased initially to gradually recover thereafter. Although as a group the maximum IGP decrease in HV (3.4 (2.3-4.3) mmHg) was not different from FD patients (2.1 (1.2-3.6) mmHg), the nadir pressure in 4 patients was outside the lower confidence intervals in HV (see figure). Conclusions: This pilot study indicates that IGP during intragastric nutrient drink infusion represents a method to objectively discriminate FD patients with impaired nutrient tolerance and/or gastric accommodation.
reflux in placebo had significant influence on decrease response. In EPS score responder, the same factors in PPI had significant impact on increase response and in placebo on decrease response. However, the strength of hunger pain and EPS score in both PPI and placebo had significant impacts on increase response. There were no symptom factors influencing PDS score responder (PPI:36.7%:18/49 , placebo:32.7%:16/49). Conclusions There might be differences of influencing factors of PPI and placebo responder in functional dyspepsia such as symptoms associated with pain and reflux. However, it may be difficult to predict placebo response, since the strength of hunger pain and EPS score in both PPI and placebo had impacts on increase response in EPS score responder.
Tu2074 Smoking Increases the Risk of Onset of the Epigastric Pain Syndrome in Males and Worsens the Symptoms of Postprandial Distress Syndrome in Females Sawako Okada, Hidekazu Suzuki, Juntaro Matsuzaki, Yasushi Fukushima, Keiko Asakura, Toru Takebayashi, Hitoshi Tsugawa, Kenro Hirata, Seiichiro Fukuhara, Toshifumi Hibi
Tu2072 The Relationship Between Functional Dyspepsia and SCN5A Mutation Suggesting Na+ Channelopathy - A Pilot Study Jie-Hyun Kim, Kwang Hyun Kim, Young Hoon Youn, Hyojin Park, Sang In Lee
Background. Smoking had often been indicated as one of the risk factors for the development of functional dyspepsia (FD)(Am J Gastroenterol. 99: 2210, 2004). Furthermore, it has been reported that placebo has less pronounced effect in smoking FD patients than in nonsmoking FD patients(Neurogastroenterol Motil. 21: 370, 2009). However, it has not ever been shown whether there might be a difference in the influence of smoking on the severity of FD between males and females. The present study is designed to investigate the relation of smoking to the onset of FD, especially from the viewpoint of any gender-related difference. Methods. The web survey, comprising items of the Gastrointestinal Symptom Rating Scale (GSRS), the Rome III criteria for the diagnosis of FD, and items to determine the demographic characteristics of the patients, including the smoking history, were sent to 177,615 subjects who were 20 years old or older and less than 70 years old, and had provided consent and registered for participation in clinical research programs at the Tokyo Station Center Building Clinic, over five days from July 31, 2008. We categorized those patients who fulfilled the Rome III criteria and had no positive findings on esophagogastroduodenoscopy into the FD group and those who did not fulfilled the diagnostic criteria for FD into the non-FD group. In addition, those who smoked one or more cigarettes in a day were classified as “smoker”, and those who did not smoke as “non-smoker”. Then, factor analysis and cluster analysis were conducted. Results. A total of 8,039 subjects (male 3,463; female 4,576; mean age 40.8) completed the survey; of these, 563 subjects fulfilled the diagnostic criteria for FD. In all, 30.4% of the patients in the FD group and 25.4% of the patients in the non-FD group were smokers. Among the males, FD patients, especially those who were classified as having epigastric pain syndrome (EPS), tended to smoke more as compared to the nonFD patients (OR 2.95, 95%CI 1.83-4.77). Among the females, no relationship was noted between the absence of FD and the prevalence of smoking. In terms of the GSRS score, which reflects the severity of the gastrointestinal symptoms, only female FD patients who smoked, especially those who were classified as having postprandial distress syndrome (PDS), had higher scores of acid reflux (β=0.23, p<0.001), abdominal pain (β=0.19, p=0.001), diarrhea (β=0.17, p=0.003) and constipation (β=0.16, p=0.006) than non-smoking female FD patients. Conclusion. The influence of smoking on the manifestation of the dyspeptic syndrome differes between men and women. In men, smoking influenced the risk of onset of EPS, but did not worsen the symptoms. On the other hand, there was no relation between smoking and the onset of FD in women, although smoking was a risk factor for the deterioration of PDS symptoms.
Background/Aims: Abnormality of gastric myoelectrical rhythm is suggested one of the mechanisms in functional dyspepsia (FD). SCN5A encodes the cardiac-specific Nav1.5 sodium channel, and Brugada syndrome is a cardiac conduction disorder associated with SCN5A mutation. The SCN5A-encoded Nav1.5 channel was also found on gastrointestinal smooth muscle and interstitial cells of Cajal. Thus, we investigated the relationship between FD and SCN 5A mutation to evaluate sodium channelopathy in FD. Methods: Patients with Brugada syndrome or FD were examined according to upper endoscopy, electrogastrography (EGG), FD symptom questionnaire based on Rome III criteria, and genetic testing for SCN5A mutation. Symptoms scales of FD and EGG findings were analyzed according to SCN 5A mutation. Results: An SCN5A mutation was noted in 75.0% patients of Brugada syndrome. 33.3% of the patients with SCN5A mutation in Brugada syndrome reported the symptoms compatible with FD. An SCN5A mutation was observed in 7.7% of the patients with FD. The EGG findings were not significantly different between the patients with and without an SCN5A mutation. Decreased postprandial power ratio was observed in 50.0% of the patients with SCN5A mutation. Postprandial tachygastria and bradygastria were noted in 50.0% and 25.0% of the patients with SCN5A mutation, respectively. Conclusion: About 30.0% of the patients with SCN5A mutation reported dyspeptic symptoms, and 7.7% of the patients diagnosed with FD had an SCN5A mutation. The relationship between FD and Na+ channelopathy should be elucidated by large-scaled study. Tu2073 Differences of Influencing Factors of PPI and Placebo Responder in Functional Dyspepsia: Clinical Advantage of Effect on Suppression of Acid With Rabeprazole in Functional Dyspepsia (the CAESAR Study) Kazunari Tominaga, Hidekazu Suzuki, Eiji Umegaki, Hiroaki Kusunoki, Naoki Tomotsugu, Kazuhide Higuchi, Ken Haruma, Toshifumi Hibi, Tetsuo Arakawa, the CAESAR study Group Background & Aim We gave the first report in Japan on the efficacy of PPI, Rabeprazole (RPZ) in Functional Dyspepsia (FD) derived from double-blind randomized placebo-controlled study (the Caesar study) (DDWAGA2010). Since the placebo response is great for FD patients in general, we investigated the effective factors for RPZ- or placebo-response in this study. Methods On hundred fifteen subjects with FD, diagnosed by the Rome III criteria, were randomly assigned to 4 weeks of either RPZ 10mg/day (Age 50.7±17.3, male/ female:13/ 36) or placebo (Age 49.6±16.7, male/ female:18/31). Severity of gastrointestinal symptoms was assessed using the Gastrointestinal Symptoms Rating Scale (GSRS). With GSRS, FD scores were calculated by summing scores of two symptoms (epigastric pain and hunger pain) of epigastric pain syndrome (EPS) and scores of two symptoms (nausea and satiety) of postprandial distress syndrome (PDS). Definition for responders is improvement rate ≧50% of FD, EPS, and PDS scores after 4-week administration. Background factors (age, sex, BMI, H. pylori infection, each GSRS score) for responders were analyzed by univariate analysis and the odds ratio was calculated. Results There were no significant factors having the effect of PPI and placebo on symptom improvement in age, sex, BMI, and H pylori infection. Factors influencing FD and EPS score responder are the following. In FD score responder, the strength of symptoms associated with pain, FD and EPS score in PPI had significant influence on increase response while the strength of symptoms associated with
AGA Abstracts
Tu2075 Diagnostic Yield of Upper Endoscopy in Transplant Recipients Juan E. Pizzala, Maria Dolores Matoso, Salomon L. Algranati, Nora Cristina C. Imperiali, Alvaro R. Talamazzi, Victor H. Abecia, Marina Cariello, Cesar A. Mombelli, Pierangelo A. Mauricio, Paula A. Carrillo, Diego A. Jiménez Larriva, Diego H. Giunta, Maria Giordanini, Silvia R. Groppa, Graciela Estela Bohbouth, Carlos A. Macías Gomez, Juan A. De Paula Introduction: Gastrointestinal symptoms are common among patients who underwent kidney and kidney/pancreas transplantation. Besides the usual causes, patient's symptoms in these cases may be related with immunosuppressive therapy and/or be associated with opportunistic infections (OI). Upper endoscopy is nearly used as a rutine tool in the diagnosis work up of disorders with clinical implication. Aim: To evaluate the diagnostic yield of upper endoscopy in this population, to describe the endoscopic findings and to assess the clinical endoscopic correlation. Methods: Two hundred eighteen computerized clinical records of
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