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Esomeprazole provides highly effective acid control that is equally well maintained during sleep and active periods
AJG – September, Suppl., 2003
Methods: The charts of 112 patients (88 F, 24 M, 50 ⫾ 16 year old) referred to the motility center for evaluation of dysphagia were reviewed. All patients had previously undergone upper endoscopy to rule out mechanical obstruction. Patients underwent esophageal motility studies using a solid state manometry catheter. Esophageal body and lower esophageal sphincter (LES) function were evaluated in response to 5 food swallows (1 teaspoon of fruit cocktail) and 10 liquid swallows (5 cc water at 45 sec interval). All patients answered a series of questions to document the frequency, severity, and duration of their dysphagia prior to the motility study. Results: Half of the study population (50.9%) complained of severe dysphagia, 27.7% of mild dysphagia, and 18.8% had minimal symptoms. 27.7% of the study population had complaints of dysphagia for at least the last 48 months, and 12.5% for less than 6 months. 47.3% of the patients described their symptoms as located above the suprasternal notch, while 33% described their symptoms as below, and 18.8% had both upper and lower locations. No correlation was noted between the amplitude, the duration and propagation characteristics of esophageal body contractions and the severity and duration of the symptoms of dysphagia. Similarly, there was no relationship between the basal pressure and relaxation characteristics of the LES and the UES and the location of the dysphagia either. There was a trend for the percent of LES relaxation to be negatively correlated with the severity of symptoms during water swallows (p⫽0.06) but not during food swallows. Conclusions: In patients with dysphagia, symptoms of duration, frequency, intensity and location do not have any predictive value of esophageal body function during either liquid or solid swallows. Only the amplitude of the LES relaxation during water swallows may have a predictive value for symptom severity. A detailed history of the patients’ complaints may be taken, although this may not be beneficial in predicting manometry findings.
41 ESOMEPRAZOLE PROVIDES HIGHLY EFFECTIVE ACID CONTROL THAT IS EQUALLY WELL MAINTAINED DURING SLEEP AND ACTIVE PERIODS Philip O. Katz, M.D., FACG*, Donald O. Castell, M.D., Yusong Chen, Ph.D., Mark B. Sostek, M.D., FACG. Graduate Hospital, Philadelphia, PA; Medical University of South Carolina, Charleston, SC and AstraZeneca LP, Wilmington, DE. Purpose: Esomeprazole (Eso) 40mg once daily provides more effective acid control than standard healing doses of other FDA-approved PPIs.1 Highly effective acid control may be particularly critical during periods of sleep when nocturnal acid breakthrough can occur, possibly resulting in impaired quality of life and compromised treatment goals. The aim of this analysis was to determine the effect of 3 different dosing regimens of Eso on intragastric pH during sleep (supine) vs active (upright) periods. Methods: In this double-blind, 3-way crossover study, healthy volunteers were randomized to receive one of 3 dosing regimens of Eso (40mg once daily, 20mg twice daily, or 40mg twice daily) for 5 consecutive days. Following each 10- to 14- day washout phase, subjects received an alternate dosing regimen. On day 5 of each treatment period, intragastric pH was continuously measured using 24-hour ambulatory pH monitoring. Subjects were not permitted to lie down during active (daytime) periods of testing. The percentage of time that pH remained ⬎4.0 was assessed during sleep and active periods. Least-squares means were calculated for each treatment group and differences were assessed using ANOVA. Results: Data were evaluable for 25 of 29 subjects. The percentage of time during sleep and active periods that pH remained ⬎4.0 are presented (table). Within each dose group, Eso maintained pH ⬎4.0 for a similar percentage of time regardless of whether subjects were sleeping or active. Eso 40mg twice daily provided an intragastric pH ⬎4.0 for greater than 80% of the time during sleeping and active periods. All dose regimens were well tolerated.
Abstracts
S15
Eso Dose
% of Sleeping Period pH>4.0 (95% CI)
% of Active Period pH>4.0 (95% CI)
40 mg once daily 20 mg twice daily 40 mg twice daily
57.9 (49.0–66.9) 79.2 (70.5–87.9)* 83.7 (74.9–92.4)*
58.6 (51.9–65.3) 70.0 (63.5–76.6)† 81.0 (74.4–87.6)*
* pⱕ0.001 vs Eso 40 mg once daily; † pⱕ0.05 vs Eso 40 mg once daily.
Conclusions: Acid control with Eso is highly effective and is equally well maintained during sleep and active periods within each dosing regimen. Eso 40mg twice daily may provide more prolonged periods of acid inhibition for selected patients with refractory or hypersecretory disease who require the highest effective level of acid control. 1. Miner PB, et al. Gastroenterology 2003;124(4 Suppl 1):A-229.
42 HELICOBACTER PYLORI INFECTION AND BARRETT’S ESOPHAGUS: A META-ANALYSIS Chang-Cheng Wang, M.D., Yu-Hong Yuan, Ph.D., Richard H. Hunt, FACG*. McMaster University Medical Center, Hamilton, ON, Canada. Purpose: The majority of cancers of the lower esophagus are thought to arise in Barrett’s esophagus (BE). Helicobacter pylori (Hp) infection plays an aetiological role in gastric carcinogenesis, but any possible role in BE is still uncertain. To date, no meta-analysis on the prevalence of Hp infection in patients with BE has been performed. We aimed to analyze the relationship between Hp infection and BE. Methods: MEDLINE and PubMed searches of the English language literature for human studies were performed using keywords “Barrett’s esophagus” and “Helicobacter pylori” published to Dec. 2002. Recursive searches were performed on the references of all papers. Searches generated 96 citations, and 40 met inclusion criteria: studies reporting raw data on Hp infection and BE; Hp detected by histology and/or serology; studies conducted in adult populations. Exclusion criteria: studies without raw data for retrieval and duplicate publications. Results: 3866 patients with BE and 1916 controls (normal endoscopy) were identified. The prevalence of Hp infection in BE and controls was 32.0% (1239/3866) and 45.5% (871/1916) respectively (p⬍0.001). The prevalence of esophageal Hp infection 25.0% (413/1651) was significantly lower than that in stomach 37.3% (826/2215) respectively (p⬍0.001). The prevalence of esophageal Hp infection 25.0% (413/1651) was markedly lower than that in the gastric cardia 85.0% (35/40)(p⬍0.001), but there was no statistical difference in comparison with the prevalence of Hp infection in the gastric antrum 29.0% (176/606)(p⫽0.06) or the gastric corpus 33.7% (29/86)(p⫽0.09). The prevalence of Hp infection in the cardia 85% (35/40) was significantly higher than in the antrum 29.0% (176/606)(p⬍0.001) or the corpus 33.7% (29/86)(p⬍0.001). The prevalence of Hp infection in BE with carditis 85.0% (35/40) was markedly higher than that without carditis 13.8% (25/181)(p⬍0.001). There was no difference in the prevalence of Hp infection between SSBE 19.8% (21/106) and LSBE 20.4% (23/ 113)(p⫽0.95). The prevalence of CagA(⫹) strains and Hp infection in BE was 10.1% (13/129) and 32.0% (1239/3866) respectively (p⬍0.001). Conclusions: Hp infection and BE are inversely related which strongly suggest that Hp infection has no aetiological role in the pathogenesis of BE, especially with respect to CagA(⫹) strains. Hp infection at the cardia may protect against development of BE.
43 ACHALASIA IN THE ELDERLY; EVALUATION OF MANOMETRY AT PRESENTATION Kuldip S. Banwait, M.D., Susie Rivera, M.D., Anthony DiMarino, Jr., M.D., Sidney Cohen, M.D.*. Thomas Jefferson University, Philadelphia, PA.
Methods: The charts of 112 patients (88 F, 24 M, 50 ⫾ 16 year old) referred to the motility center for evaluation of dysphagia were reviewed. All patients had previously undergone upper endoscopy to rule out mechanical obstruction. Patients underwent esophageal motility studies using a solid state manometry catheter. Esophageal body and lower esophageal sphincter (LES) function were evaluated in response to 5 food swallows (1 teaspoon of fruit cocktail) and 10 liquid swallows (5 cc water at 45 sec interval). All patients answered a series of questions to document the frequency, severity, and duration of their dysphagia prior to the motility study. Results: Half of the study population (50.9%) complained of severe dysphagia, 27.7% of mild dysphagia, and 18.8% had minimal symptoms. 27.7% of the study population had complaints of dysphagia for at least the last 48 months, and 12.5% for less than 6 months. 47.3% of the patients described their symptoms as located above the suprasternal notch, while 33% described their symptoms as below, and 18.8% had both upper and lower locations. No correlation was noted between the amplitude, the duration and propagation characteristics of esophageal body contractions and the severity and duration of the symptoms of dysphagia. Similarly, there was no relationship between the basal pressure and relaxation characteristics of the LES and the UES and the location of the dysphagia either. There was a trend for the percent of LES relaxation to be negatively correlated with the severity of symptoms during water swallows (p⫽0.06) but not during food swallows. Conclusions: In patients with dysphagia, symptoms of duration, frequency, intensity and location do not have any predictive value of esophageal body function during either liquid or solid swallows. Only the amplitude of the LES relaxation during water swallows may have a predictive value for symptom severity. A detailed history of the patients’ complaints may be taken, although this may not be beneficial in predicting manometry findings.
41 ESOMEPRAZOLE PROVIDES HIGHLY EFFECTIVE ACID CONTROL THAT IS EQUALLY WELL MAINTAINED DURING SLEEP AND ACTIVE PERIODS Philip O. Katz, M.D., FACG*, Donald O. Castell, M.D., Yusong Chen, Ph.D., Mark B. Sostek, M.D., FACG. Graduate Hospital, Philadelphia, PA; Medical University of South Carolina, Charleston, SC and AstraZeneca LP, Wilmington, DE. Purpose: Esomeprazole (Eso) 40mg once daily provides more effective acid control than standard healing doses of other FDA-approved PPIs.1 Highly effective acid control may be particularly critical during periods of sleep when nocturnal acid breakthrough can occur, possibly resulting in impaired quality of life and compromised treatment goals. The aim of this analysis was to determine the effect of 3 different dosing regimens of Eso on intragastric pH during sleep (supine) vs active (upright) periods. Methods: In this double-blind, 3-way crossover study, healthy volunteers were randomized to receive one of 3 dosing regimens of Eso (40mg once daily, 20mg twice daily, or 40mg twice daily) for 5 consecutive days. Following each 10- to 14- day washout phase, subjects received an alternate dosing regimen. On day 5 of each treatment period, intragastric pH was continuously measured using 24-hour ambulatory pH monitoring. Subjects were not permitted to lie down during active (daytime) periods of testing. The percentage of time that pH remained ⬎4.0 was assessed during sleep and active periods. Least-squares means were calculated for each treatment group and differences were assessed using ANOVA. Results: Data were evaluable for 25 of 29 subjects. The percentage of time during sleep and active periods that pH remained ⬎4.0 are presented (table). Within each dose group, Eso maintained pH ⬎4.0 for a similar percentage of time regardless of whether subjects were sleeping or active. Eso 40mg twice daily provided an intragastric pH ⬎4.0 for greater than 80% of the time during sleeping and active periods. All dose regimens were well tolerated.
Abstracts
S15
Eso Dose
% of Sleeping Period pH>4.0 (95% CI)
% of Active Period pH>4.0 (95% CI)
40 mg once daily 20 mg twice daily 40 mg twice daily
57.9 (49.0–66.9) 79.2 (70.5–87.9)* 83.7 (74.9–92.4)*
58.6 (51.9–65.3) 70.0 (63.5–76.6)† 81.0 (74.4–87.6)*
* pⱕ0.001 vs Eso 40 mg once daily; † pⱕ0.05 vs Eso 40 mg once daily.
Conclusions: Acid control with Eso is highly effective and is equally well maintained during sleep and active periods within each dosing regimen. Eso 40mg twice daily may provide more prolonged periods of acid inhibition for selected patients with refractory or hypersecretory disease who require the highest effective level of acid control. 1. Miner PB, et al. Gastroenterology 2003;124(4 Suppl 1):A-229.
42 HELICOBACTER PYLORI INFECTION AND BARRETT’S ESOPHAGUS: A META-ANALYSIS Chang-Cheng Wang, M.D., Yu-Hong Yuan, Ph.D., Richard H. Hunt, FACG*. McMaster University Medical Center, Hamilton, ON, Canada. Purpose: The majority of cancers of the lower esophagus are thought to arise in Barrett’s esophagus (BE). Helicobacter pylori (Hp) infection plays an aetiological role in gastric carcinogenesis, but any possible role in BE is still uncertain. To date, no meta-analysis on the prevalence of Hp infection in patients with BE has been performed. We aimed to analyze the relationship between Hp infection and BE. Methods: MEDLINE and PubMed searches of the English language literature for human studies were performed using keywords “Barrett’s esophagus” and “Helicobacter pylori” published to Dec. 2002. Recursive searches were performed on the references of all papers. Searches generated 96 citations, and 40 met inclusion criteria: studies reporting raw data on Hp infection and BE; Hp detected by histology and/or serology; studies conducted in adult populations. Exclusion criteria: studies without raw data for retrieval and duplicate publications. Results: 3866 patients with BE and 1916 controls (normal endoscopy) were identified. The prevalence of Hp infection in BE and controls was 32.0% (1239/3866) and 45.5% (871/1916) respectively (p⬍0.001). The prevalence of esophageal Hp infection 25.0% (413/1651) was significantly lower than that in stomach 37.3% (826/2215) respectively (p⬍0.001). The prevalence of esophageal Hp infection 25.0% (413/1651) was markedly lower than that in the gastric cardia 85.0% (35/40)(p⬍0.001), but there was no statistical difference in comparison with the prevalence of Hp infection in the gastric antrum 29.0% (176/606)(p⫽0.06) or the gastric corpus 33.7% (29/86)(p⫽0.09). The prevalence of Hp infection in the cardia 85% (35/40) was significantly higher than in the antrum 29.0% (176/606)(p⬍0.001) or the corpus 33.7% (29/86)(p⬍0.001). The prevalence of Hp infection in BE with carditis 85.0% (35/40) was markedly higher than that without carditis 13.8% (25/181)(p⬍0.001). There was no difference in the prevalence of Hp infection between SSBE 19.8% (21/106) and LSBE 20.4% (23/ 113)(p⫽0.95). The prevalence of CagA(⫹) strains and Hp infection in BE was 10.1% (13/129) and 32.0% (1239/3866) respectively (p⬍0.001). Conclusions: Hp infection and BE are inversely related which strongly suggest that Hp infection has no aetiological role in the pathogenesis of BE, especially with respect to CagA(⫹) strains. Hp infection at the cardia may protect against development of BE.
43 ACHALASIA IN THE ELDERLY; EVALUATION OF MANOMETRY AT PRESENTATION Kuldip S. Banwait, M.D., Susie Rivera, M.D., Anthony DiMarino, Jr., M.D., Sidney Cohen, M.D.*. Thomas Jefferson University, Philadelphia, PA.