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Gastric PH may not be an accurate indicator of gastric acidity
S66
Abstracts
205 Is there a shift in symptomatology in patients after laparoscopic Nissen fundoplication? Moneera Haque1, Nonko Pehlivanov2, Michael Moncure3, Kahdi Udobi3, Ed Childs3, Irena Sarosiek2 and Richard McCallum2*. 1 School of Medicine, University of Kansas Medical Center, Kansas City, KS, United States; 2 Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States; and 3 Surgery, University of Kansas Medical Center, Kansas City, KS, United States. Purpose: To evaluate how the laparoscopic Nissen fundoplication (LNF) changes the symptomatology of patients with gastroesophageal reflux disease (GERD). Methods: Twenty-two patients (M 6, F 16, mean age 44.6 ⫾ 11.4 years) who required LNF for GERD also underwent preoperative screening with 24-hour esophageal pH monitoring, esophageal motility test, and endoscopy, were included in the study. Nineteen (86%) of the patients responded to a questionnaire in regards to their subjective GERD/dyspeptic symptoms assessment before and within 6 months after the surgery. The survey included questions about the following symptoms: heartburn, regurgitation, dysphagia, extraesophageal manifestations of GERD, ability to vomit, nausea, abdominal bloating, ability to belch, epigastric pain, fullness, early satiety, diarrhea/constipation. Body weight was compared as well. Eight (44%) patients were studied pre- and postoperatively with gastric scintigraphy for gastric emptying time (GET) of solids for 4 hours. Results: There was significant weight loss after LNF from mean weight of 191.9 ⫾47.7 lb before to 171.8 ⫾40.4 lb within 6 months after the surgery, P ⫽ 0002. The majority of patients, 17 (89%), were very satisfied with the outcome, and rated the operation ⬎90% successful. The chief GERDrelated complaints present preoperatively in all 19 patients before LNF, were alleviated afterwards in 18 (95%) patients for heartburn, and 15 (79%) patients for regurgitation, P⬍0.05. However, 17/19 (89%) of the patients complained of fullness post-LNF while only 8/19 (42%) had it before, P ⫽ 0.003. The prevalence of early satiety increased from 5/19 (26%) to 17/19 (89%) pre- and postoperatively, respectively, P ⫽ 0.0001. Gastric retention for solids at 4 hours exceeded the normal value of ⱕ10% in both, pre- and postoperative investigations (mean⫾SE): 19.6 ⫾6.1% and 30.0 ⫾14.8%, respectively, P ⫽ 0.69. Gastric retention did not differ significantly at any of the four hours of the test. Two patients (25%) had normal GET pre- and postoperatively, 2 (25%) remained delayed, whilst 3 (37%) had delayed GET only before, and 1 (13%) only after surgery. Conclusions: 1) Laparoscopic Nissen fundoplication is a very effective treatment for patients with symptomatic GERD; 2) However, symptoms suggesting functional dyspepsia are prevalent post-LNP: some were present pre-LPN and now enhanced, while the majority (2/3) were new after surgery, and 3) Preliminary data suggest that these dyspeptic symptoms cannot be attributed to delayed gastric emptying.
206 Antimicrobial therapy for H. pylori versus acid suppressive therapy for prevention of rebleeding in peptic ulcer disease—a meta-analysis Sidney Peykar, Simmy Bank, Senthil Nachimuthu and Pankaj Singh*. 1 Gastroenterology, North Shore-LIJ Health System, New Hyde Park, NY, United States. Purpose: To evaluate whether Helicobacter pylori eradication reduces rebleeding in patients with recent upper gastrointestinal hemorrhage from peptic ulcer disease. Methods: We reviewed the literature sytematically, for prospective controlled trials of Helicobacter pylori eradication versus acid suppressive therapy, for prevention of rebleeding in patients who have recently bled from peptic ulcer disease. Relative risk was used to study the measure of association in this meta-analysis. The Breslow-Day method was used to treat for homogeneity under the null hypothesis that the relative risk were consistent across the studies and the corrected Mantel Haenszel Chi-square
AJG – Vol. 96, No. 9, Suppl., 2001
test was used to test whether relative risk differed systematically from a value of 1. Results: Five controlled trials (four randomized) were identified. 206 patients were treated for H. pylori eradication and 152 patients with acid suppressive therapy. Statistical tests failed to detect heterogeneity between studies for rebleeding (p ⫽ 0.38). All major outcomes were based on fixed effect model. Random effect model produced clearly identical results. Rebleeding was significantly lower in the H. pylori eradication group as compared to patients who recieved acid suppressive therapy(relative risk 0.28, 95%CI [0.13 to 0.59]; p ⫽ 0.0006). Pooled rebleeding rates were 0.4% in the eradication group as compared to 21% in the acid suppressive group; Absolute Risk Reduction ⫽ 19% [95%CI ⫽ 9%, 30%]; Number Needed to Treat ⫽ 5 [95%CI ⫽ 3, 11]. Conclusions: Helicobacter pylori eradication reduces rebleeding rate by 20% in patients who have recently bled from peptic ulcer disease. For every five patients treated with anti-microbial therapy, one rebleeding episode is prevented. 207 Gastric PH may not be an accurate indicator of gastric acidity Vijaya Pratha, MD1*, Robyn Karlstadt, MD2, Richard B. Lynn, MD2, James R. Lane, PharmD1 and Daniel L. Hogan, PhD1. 1Clinical Applications Laboratories (CAL), San Diego, CA, United States; and 2 Wyeth-Wyerst Pharmaceuticals, St. Davids, PA, United States. Purpose: Acid in the gastric refluxate is a key contributor to mucosal injury in GERD. Hence, quantification of “gastric acidity” is a logical measure of efficacy of medical therapy in GERD. In theory, the most accurate predictor of “acid load” to the esophagus is gastric acid output (GAO). Intragastric pH monitoring studies are frequently used to assess the efficacy of proton pump inhibitor therapy in reducing esophageal acid exposure. The purpose of this study was to establish the accuracy of intragastric pH monitoring as a predictor of GAO and potential esophageal acid load. Methods: Thirty-five healthy subjects (13 female, 22 male) were dosed (single dose, double-blind) with either placebo, pantoprazole 40 mg PO or omeprazole 20 mg PO (1:4:4 randomization; study remains blinded). At the time of dosing, gastric acid secretion was stimulated with a continuous infusion of pentagastrin (1 mcg/kg/h IV) for 24 hours. Beginning 2 hours after dosing and continuing for 22 hours, gastric acid was continuously aspirated by automatic suction and volumes collected in 30-minute periods. Gastric sample pH was measured with a combination electrode, and [H⫹] determined by titration to pH 7.0. Gastric acid output was then calculated as GAO⫽[H⫹]ⴱgastric volume. Statistical analysis was performed independent of placebo or PPI therapy. Results: Intragastric pH ranged from 0.8 –7.6 while the range for GAO was 0.0 –30.1mEq/30 min. Whereas GAO correlated significantly with gastric pH (median r ⫽ ⫺0.61, p⬍0.001), gastric volume had a significantly greater association with GAO (r ⫽ 0.78). Conclusions: Variations in GAO are dependent on the variation in the volume of the gastric aspirate. Measurement of gastric pH alone may not be a precise predictor of gastric acidity and potential esophageal acid load. 208 Management of H. pylori infection in Hungary Laszlo Pronai, MD, Laszlo Schandl, MD, Ferenc Szalay, FACG and Zsolt Tulassay, FACG*. 12ndDept Internal Medicine, Semmelweis University, Budapest, Hungary; 22nd Dept Internal Medicine, Semmelweis University, Budapest, Hungary; 31st Dept Internal Medicine, Semmelweis University, Budapest, Hungary; and 42nd Dept Internal Medicine, Semmelweis University, Budapest, Hungary. Purpose: The aim of the study was to assess the current practice of H. pylori related diseases in Hungary. Methods: A questionnaire has been sent to 1160 medical members of the Hungarian Society of Gastroenterology which of 791 (68,2%) has been returned.
Abstracts
205 Is there a shift in symptomatology in patients after laparoscopic Nissen fundoplication? Moneera Haque1, Nonko Pehlivanov2, Michael Moncure3, Kahdi Udobi3, Ed Childs3, Irena Sarosiek2 and Richard McCallum2*. 1 School of Medicine, University of Kansas Medical Center, Kansas City, KS, United States; 2 Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States; and 3 Surgery, University of Kansas Medical Center, Kansas City, KS, United States. Purpose: To evaluate how the laparoscopic Nissen fundoplication (LNF) changes the symptomatology of patients with gastroesophageal reflux disease (GERD). Methods: Twenty-two patients (M 6, F 16, mean age 44.6 ⫾ 11.4 years) who required LNF for GERD also underwent preoperative screening with 24-hour esophageal pH monitoring, esophageal motility test, and endoscopy, were included in the study. Nineteen (86%) of the patients responded to a questionnaire in regards to their subjective GERD/dyspeptic symptoms assessment before and within 6 months after the surgery. The survey included questions about the following symptoms: heartburn, regurgitation, dysphagia, extraesophageal manifestations of GERD, ability to vomit, nausea, abdominal bloating, ability to belch, epigastric pain, fullness, early satiety, diarrhea/constipation. Body weight was compared as well. Eight (44%) patients were studied pre- and postoperatively with gastric scintigraphy for gastric emptying time (GET) of solids for 4 hours. Results: There was significant weight loss after LNF from mean weight of 191.9 ⫾47.7 lb before to 171.8 ⫾40.4 lb within 6 months after the surgery, P ⫽ 0002. The majority of patients, 17 (89%), were very satisfied with the outcome, and rated the operation ⬎90% successful. The chief GERDrelated complaints present preoperatively in all 19 patients before LNF, were alleviated afterwards in 18 (95%) patients for heartburn, and 15 (79%) patients for regurgitation, P⬍0.05. However, 17/19 (89%) of the patients complained of fullness post-LNF while only 8/19 (42%) had it before, P ⫽ 0.003. The prevalence of early satiety increased from 5/19 (26%) to 17/19 (89%) pre- and postoperatively, respectively, P ⫽ 0.0001. Gastric retention for solids at 4 hours exceeded the normal value of ⱕ10% in both, pre- and postoperative investigations (mean⫾SE): 19.6 ⫾6.1% and 30.0 ⫾14.8%, respectively, P ⫽ 0.69. Gastric retention did not differ significantly at any of the four hours of the test. Two patients (25%) had normal GET pre- and postoperatively, 2 (25%) remained delayed, whilst 3 (37%) had delayed GET only before, and 1 (13%) only after surgery. Conclusions: 1) Laparoscopic Nissen fundoplication is a very effective treatment for patients with symptomatic GERD; 2) However, symptoms suggesting functional dyspepsia are prevalent post-LNP: some were present pre-LPN and now enhanced, while the majority (2/3) were new after surgery, and 3) Preliminary data suggest that these dyspeptic symptoms cannot be attributed to delayed gastric emptying.
206 Antimicrobial therapy for H. pylori versus acid suppressive therapy for prevention of rebleeding in peptic ulcer disease—a meta-analysis Sidney Peykar, Simmy Bank, Senthil Nachimuthu and Pankaj Singh*. 1 Gastroenterology, North Shore-LIJ Health System, New Hyde Park, NY, United States. Purpose: To evaluate whether Helicobacter pylori eradication reduces rebleeding in patients with recent upper gastrointestinal hemorrhage from peptic ulcer disease. Methods: We reviewed the literature sytematically, for prospective controlled trials of Helicobacter pylori eradication versus acid suppressive therapy, for prevention of rebleeding in patients who have recently bled from peptic ulcer disease. Relative risk was used to study the measure of association in this meta-analysis. The Breslow-Day method was used to treat for homogeneity under the null hypothesis that the relative risk were consistent across the studies and the corrected Mantel Haenszel Chi-square
AJG – Vol. 96, No. 9, Suppl., 2001
test was used to test whether relative risk differed systematically from a value of 1. Results: Five controlled trials (four randomized) were identified. 206 patients were treated for H. pylori eradication and 152 patients with acid suppressive therapy. Statistical tests failed to detect heterogeneity between studies for rebleeding (p ⫽ 0.38). All major outcomes were based on fixed effect model. Random effect model produced clearly identical results. Rebleeding was significantly lower in the H. pylori eradication group as compared to patients who recieved acid suppressive therapy(relative risk 0.28, 95%CI [0.13 to 0.59]; p ⫽ 0.0006). Pooled rebleeding rates were 0.4% in the eradication group as compared to 21% in the acid suppressive group; Absolute Risk Reduction ⫽ 19% [95%CI ⫽ 9%, 30%]; Number Needed to Treat ⫽ 5 [95%CI ⫽ 3, 11]. Conclusions: Helicobacter pylori eradication reduces rebleeding rate by 20% in patients who have recently bled from peptic ulcer disease. For every five patients treated with anti-microbial therapy, one rebleeding episode is prevented. 207 Gastric PH may not be an accurate indicator of gastric acidity Vijaya Pratha, MD1*, Robyn Karlstadt, MD2, Richard B. Lynn, MD2, James R. Lane, PharmD1 and Daniel L. Hogan, PhD1. 1Clinical Applications Laboratories (CAL), San Diego, CA, United States; and 2 Wyeth-Wyerst Pharmaceuticals, St. Davids, PA, United States. Purpose: Acid in the gastric refluxate is a key contributor to mucosal injury in GERD. Hence, quantification of “gastric acidity” is a logical measure of efficacy of medical therapy in GERD. In theory, the most accurate predictor of “acid load” to the esophagus is gastric acid output (GAO). Intragastric pH monitoring studies are frequently used to assess the efficacy of proton pump inhibitor therapy in reducing esophageal acid exposure. The purpose of this study was to establish the accuracy of intragastric pH monitoring as a predictor of GAO and potential esophageal acid load. Methods: Thirty-five healthy subjects (13 female, 22 male) were dosed (single dose, double-blind) with either placebo, pantoprazole 40 mg PO or omeprazole 20 mg PO (1:4:4 randomization; study remains blinded). At the time of dosing, gastric acid secretion was stimulated with a continuous infusion of pentagastrin (1 mcg/kg/h IV) for 24 hours. Beginning 2 hours after dosing and continuing for 22 hours, gastric acid was continuously aspirated by automatic suction and volumes collected in 30-minute periods. Gastric sample pH was measured with a combination electrode, and [H⫹] determined by titration to pH 7.0. Gastric acid output was then calculated as GAO⫽[H⫹]ⴱgastric volume. Statistical analysis was performed independent of placebo or PPI therapy. Results: Intragastric pH ranged from 0.8 –7.6 while the range for GAO was 0.0 –30.1mEq/30 min. Whereas GAO correlated significantly with gastric pH (median r ⫽ ⫺0.61, p⬍0.001), gastric volume had a significantly greater association with GAO (r ⫽ 0.78). Conclusions: Variations in GAO are dependent on the variation in the volume of the gastric aspirate. Measurement of gastric pH alone may not be a precise predictor of gastric acidity and potential esophageal acid load. 208 Management of H. pylori infection in Hungary Laszlo Pronai, MD, Laszlo Schandl, MD, Ferenc Szalay, FACG and Zsolt Tulassay, FACG*. 12ndDept Internal Medicine, Semmelweis University, Budapest, Hungary; 22nd Dept Internal Medicine, Semmelweis University, Budapest, Hungary; 31st Dept Internal Medicine, Semmelweis University, Budapest, Hungary; and 42nd Dept Internal Medicine, Semmelweis University, Budapest, Hungary. Purpose: The aim of the study was to assess the current practice of H. pylori related diseases in Hungary. Methods: A questionnaire has been sent to 1160 medical members of the Hungarian Society of Gastroenterology which of 791 (68,2%) has been returned.