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Magnetic resonance imaging (MRI) assessment of gastric emptying and antral motility in clinical practice: Preliminary results on patients
A392 AGA ABSTRACTS
GASTROENTEROLOGY Vol. 118, No.4
2055
2057
ABNORMAL P53 IMMUNOHISTOCHEMISTRY IS ASSOCIATED WITH COLORECTAL CANCER-RELATED DEATH IN PATIENTS WITH ULCERATIVE COLITIS. William M. Bauer, John Goldblum, Lisa Rybicki, Bret A. Lashner, Cleveland Clin Fdn, Cleveland, OH. Background: Established predictors of risk for developing colorectal cancer (CRC) in patients with ulcerative colitis (UC) include duration and extent of disease, abnormal p53 immunohistochemistry (p53+), and primary sclerosing cholangitis (PSC). Variables which may predict CRCrelated death in UC-associated cancers (UCAC) have not been investigated. Aim: To determine what factors may predict CRC-related death in UCAe. Methods: A historical cohort study of all 75 UCAC patients between 1978-1997 was performed. Survival curves were adjusted to assess risk factors associated with CRC-related death. Proportional hazards modeling determined relative risk (RR) estimate, 95% confidence interval (CI) and adjusted for possible confounders. Results: 50.7% of all tumors were p53+. 38.5% of patients with PSC had p53+ tumors. p53+ tumors were associated with CRC-related death (RR 3.73, 95% CI 1.22-11.43) (Figure). Most of the increased mortality was due to a worse Dukes' stage among p53+ patients. PSC patients who had p53+ tumors had a particularly high mortality with 3/5 patients having CRC-related death compared with 1/8 with p53- cancer. Prednisone was associated with a 78.6% lO-year survival compared with 27.9% in those not taking prednisone (p
DEVELOPMENT OF GASTRIC EMPTYING IN HEALTHY CHILDREN. Mieke L. Van Den Driessche, Yvo Ghoos, Gigi A. Veereman-Wauters, Pediatric Gastroenterology, Univ Hospitals Leuven, Leuven, Belgium; Lab Digestion-Absorption, Univ Hospitals Leuven, Leuven, Belgium. Introduction : The l3C octanoic acid breath test is a reliable, safe and non-invasive method for assessing gastric emptying, enabling us to study healthy children. Aim: The aim of this study is to describe development of gastric emptying and to establish reference values in the pediatric population. Patients and methods : A l3C octanoic acid breath test has been performed in 367 healthy children after informed consent. Ages ranged from 1-17 yrs (mean 8,5 yrs), weights varied from 9 to 75 kg (mean 30 kg) and lengths from 70 to 184 cm (mean 134 em). The population was normally distributed \normal probability plot). After collection of breath samples at baseline, a 3Clabeled testmeal was ingested. Standardization of testmeals is essential since octanoic acid needs to be incorporated in the liquid or solid phase of the meal. We have tested various testmeals earlier and used chocolate milk for liquid emptying and a 250 kcal pancake (with freezedried l3C octanoic acid labeled egg yolk) for solid emptying. Breath samples were taken every 15 min for 4 hrs. l3C02 was analyzed by isotope ratio mass spectrometry and data were expressed as halfemptying time (t l12) and gastric emptying coefficient (GEC). Results : Multivariate regression analysis (SAS) resulted in an optimal regression model for tl/ 2 and GEe. Age (p <0,005), sex (p
Results: PplX fluorescence intensity peak at635 nm Tissuelype
Mean ± SE
pvs. HGD
HGD low.grade or indeftnite dysplasia non·dysplastlc Barrett's gastric mucosa squamous epithelium
0.71±0.20 0.1S±0.04 0.11±0.02 0.09±0.02 0.16±0.03
004 002 0.02 0.03
7 23 23 29 16
2056 MAGNETIC RESONANCE IMAGING (MRI) ASSESSMENT OF GASTRIC EMPTYING AND ANTRAL MOTILITY IN CLINICAL PRACTICE: PRELIMINARY RESULTS ON PATIENTS. Luca Marciani, Robin C. Spiller, Penny A. Gowland, Jeff Wright, Rachel J. Moore, Paul Young, Magnetic Resonance Ctr, Univ of Nottingham, Nottingham, United Kingdom; Div of Gastroenterology, Univ Hosp, Nottingham, United Kingdom; Surg, Univ Hosp, Nottingham, United Kingdom. Investigations of disordered gastric motility and emptying are often disappointing. Scintigraphy lacks spatial definition while manometry is often poorly tolerated. Aims: To show that ultra-fast MRI examination of gastric function is well tolerated by patients and provides information about both emptying and antral motility. Methods: 4 fasted patients ingested 500 ml of low (0.06 Pas) viscosity polysaccharide nutrient (1350 kJ of lipids and carbohydrates) meal. Single-shot echo-planar images (EPI) were acquired in 130 ms at 0.5 T. Following meal ingestion 72 volume sets (5 slices every 3 s) across the antrum were acquired to assess antral motility using a in-house developed semi-automated analysis. After that transverse rapid multislice volume sets were acquired every 15 min to measure the half gastric emptying time (T50%) and reconstruct three-dimensional anatomic pictures of the stomach. Patients sat upright in between scanning. All suffered from nausea and vomiting, underlying disorders were: patient 1 visceral ganglionitis, patient 2 bronchial carcinoma, patient 3 & 4 nonulcer dyspepsia. Results: (see Table, mean±SEM) The procedure was well tolerated. Delayed emptying was demonstrated with antral hypomotility in patient 3 but normal motility in patient 1. Conclusion: EPI can noninvasively detect abnormalities of both gastric emptying & motility without irradiation or discomfort. Although currently expensive ultra-fast MRI will soon be widely available and may well be preferred for the greater detail it provides. Half gastric emptying time T50% and antral contraction frequency and velocity forthe four patients and thecontrol group. T"",(mln)
Contraction frequency (mln-')
Contraction velocity (mmls)
67±9 62 134'"
3.0±0.1 3.0 2.9 2.6*""'/I'
34'
2.7-
1.5±0.1 1.6 1.7 1.0'" 3.0'"
Controls (n=12) Pstlent 1 Patient 2 Pstlent 3 Patient 4 'p<0.004: "p
1OS"
2058 GASTRIC EMPTYING IN PERITONEAL DIALYSIS PATIENTS: GLUCOSE VERSUS ICODEXTRIN. Renaat Schoonjans, Bruno Van Vlem, Wim Van Biesen, Wouter Vandamme, Norbert Lameire, Martine MP De Vos, Univ Hosp, Gent, Belgium. Nutritional status is a major determinant of outcome in peritoneal dialysis patients. A factor probably related to malnutrition is the resorption of glucose during the dwell time, leading to a feeling of saturation and decreased food and protein intake. It has been shown in a previous study of our group that the gastric emptying is delayed during the presence of dialysate in the abdomen. This study investigates whether this is due to a volume effect or to a glucose absorption effect. Methods: In II PD patients, gastric emptying was assessed by the l3C-octanoic acid breath test. Each of the patients was tested twice on consecutive days, in a cross-over protocol, during a 4-hour dwell with 2 litres of once 1,36% glucose (Dianeal", Baxter Healthcare), and once polyglucose (Extraneal'", Baxter Healthcare). The n4fht dwell before the test with 1;36% glucose solution, a 2,27% Dianeal was used, and before the test with the polyglucose solution , an Extraneal" was used. This was done to avoid cross-over effects of glucose of volume from the night dwell to the test dwell. Results: the gastric emptying coefficient (GEC) was 2,86±(range 2,24-3,55) and 3,11±0,38 (range 2,43-3,63) in the glucose and polyglucose group respectively (p=0,028). the gastric emptying rate, expressed as the half time T I 12, was 130,5±54,2 and 96,9±33,4 minutes respectively (p=0,02). In conclusion: Gastric emptying in CAPD patients is more delayed during a dwell with 1,36% glucose solution than with a polyglucose solution. Gastric emptying during a dwell with polyglucose is not different from that of patients with an empty abdomen. The delayed gastric emptying observed in CAPD patients with filled abdomen is thus not due to volume, but to absorption of glucose.
GASTROENTEROLOGY Vol. 118, No.4
2055
2057
ABNORMAL P53 IMMUNOHISTOCHEMISTRY IS ASSOCIATED WITH COLORECTAL CANCER-RELATED DEATH IN PATIENTS WITH ULCERATIVE COLITIS. William M. Bauer, John Goldblum, Lisa Rybicki, Bret A. Lashner, Cleveland Clin Fdn, Cleveland, OH. Background: Established predictors of risk for developing colorectal cancer (CRC) in patients with ulcerative colitis (UC) include duration and extent of disease, abnormal p53 immunohistochemistry (p53+), and primary sclerosing cholangitis (PSC). Variables which may predict CRCrelated death in UC-associated cancers (UCAC) have not been investigated. Aim: To determine what factors may predict CRC-related death in UCAe. Methods: A historical cohort study of all 75 UCAC patients between 1978-1997 was performed. Survival curves were adjusted to assess risk factors associated with CRC-related death. Proportional hazards modeling determined relative risk (RR) estimate, 95% confidence interval (CI) and adjusted for possible confounders. Results: 50.7% of all tumors were p53+. 38.5% of patients with PSC had p53+ tumors. p53+ tumors were associated with CRC-related death (RR 3.73, 95% CI 1.22-11.43) (Figure). Most of the increased mortality was due to a worse Dukes' stage among p53+ patients. PSC patients who had p53+ tumors had a particularly high mortality with 3/5 patients having CRC-related death compared with 1/8 with p53- cancer. Prednisone was associated with a 78.6% lO-year survival compared with 27.9% in those not taking prednisone (p
DEVELOPMENT OF GASTRIC EMPTYING IN HEALTHY CHILDREN. Mieke L. Van Den Driessche, Yvo Ghoos, Gigi A. Veereman-Wauters, Pediatric Gastroenterology, Univ Hospitals Leuven, Leuven, Belgium; Lab Digestion-Absorption, Univ Hospitals Leuven, Leuven, Belgium. Introduction : The l3C octanoic acid breath test is a reliable, safe and non-invasive method for assessing gastric emptying, enabling us to study healthy children. Aim: The aim of this study is to describe development of gastric emptying and to establish reference values in the pediatric population. Patients and methods : A l3C octanoic acid breath test has been performed in 367 healthy children after informed consent. Ages ranged from 1-17 yrs (mean 8,5 yrs), weights varied from 9 to 75 kg (mean 30 kg) and lengths from 70 to 184 cm (mean 134 em). The population was normally distributed \normal probability plot). After collection of breath samples at baseline, a 3Clabeled testmeal was ingested. Standardization of testmeals is essential since octanoic acid needs to be incorporated in the liquid or solid phase of the meal. We have tested various testmeals earlier and used chocolate milk for liquid emptying and a 250 kcal pancake (with freezedried l3C octanoic acid labeled egg yolk) for solid emptying. Breath samples were taken every 15 min for 4 hrs. l3C02 was analyzed by isotope ratio mass spectrometry and data were expressed as halfemptying time (t l12) and gastric emptying coefficient (GEC). Results : Multivariate regression analysis (SAS) resulted in an optimal regression model for tl/ 2 and GEe. Age (p <0,005), sex (p
Results: PplX fluorescence intensity peak at635 nm Tissuelype
Mean ± SE
pvs. HGD
HGD low.grade or indeftnite dysplasia non·dysplastlc Barrett's gastric mucosa squamous epithelium
0.71±0.20 0.1S±0.04 0.11±0.02 0.09±0.02 0.16±0.03
004 002 0.02 0.03
7 23 23 29 16
2056 MAGNETIC RESONANCE IMAGING (MRI) ASSESSMENT OF GASTRIC EMPTYING AND ANTRAL MOTILITY IN CLINICAL PRACTICE: PRELIMINARY RESULTS ON PATIENTS. Luca Marciani, Robin C. Spiller, Penny A. Gowland, Jeff Wright, Rachel J. Moore, Paul Young, Magnetic Resonance Ctr, Univ of Nottingham, Nottingham, United Kingdom; Div of Gastroenterology, Univ Hosp, Nottingham, United Kingdom; Surg, Univ Hosp, Nottingham, United Kingdom. Investigations of disordered gastric motility and emptying are often disappointing. Scintigraphy lacks spatial definition while manometry is often poorly tolerated. Aims: To show that ultra-fast MRI examination of gastric function is well tolerated by patients and provides information about both emptying and antral motility. Methods: 4 fasted patients ingested 500 ml of low (0.06 Pas) viscosity polysaccharide nutrient (1350 kJ of lipids and carbohydrates) meal. Single-shot echo-planar images (EPI) were acquired in 130 ms at 0.5 T. Following meal ingestion 72 volume sets (5 slices every 3 s) across the antrum were acquired to assess antral motility using a in-house developed semi-automated analysis. After that transverse rapid multislice volume sets were acquired every 15 min to measure the half gastric emptying time (T50%) and reconstruct three-dimensional anatomic pictures of the stomach. Patients sat upright in between scanning. All suffered from nausea and vomiting, underlying disorders were: patient 1 visceral ganglionitis, patient 2 bronchial carcinoma, patient 3 & 4 nonulcer dyspepsia. Results: (see Table, mean±SEM) The procedure was well tolerated. Delayed emptying was demonstrated with antral hypomotility in patient 3 but normal motility in patient 1. Conclusion: EPI can noninvasively detect abnormalities of both gastric emptying & motility without irradiation or discomfort. Although currently expensive ultra-fast MRI will soon be widely available and may well be preferred for the greater detail it provides. Half gastric emptying time T50% and antral contraction frequency and velocity forthe four patients and thecontrol group. T"",(mln)
Contraction frequency (mln-')
Contraction velocity (mmls)
67±9 62 134'"
3.0±0.1 3.0 2.9 2.6*""'/I'
34'
2.7-
1.5±0.1 1.6 1.7 1.0'" 3.0'"
Controls (n=12) Pstlent 1 Patient 2 Pstlent 3 Patient 4 'p<0.004: "p
1OS"
2058 GASTRIC EMPTYING IN PERITONEAL DIALYSIS PATIENTS: GLUCOSE VERSUS ICODEXTRIN. Renaat Schoonjans, Bruno Van Vlem, Wim Van Biesen, Wouter Vandamme, Norbert Lameire, Martine MP De Vos, Univ Hosp, Gent, Belgium. Nutritional status is a major determinant of outcome in peritoneal dialysis patients. A factor probably related to malnutrition is the resorption of glucose during the dwell time, leading to a feeling of saturation and decreased food and protein intake. It has been shown in a previous study of our group that the gastric emptying is delayed during the presence of dialysate in the abdomen. This study investigates whether this is due to a volume effect or to a glucose absorption effect. Methods: In II PD patients, gastric emptying was assessed by the l3C-octanoic acid breath test. Each of the patients was tested twice on consecutive days, in a cross-over protocol, during a 4-hour dwell with 2 litres of once 1,36% glucose (Dianeal", Baxter Healthcare), and once polyglucose (Extraneal'", Baxter Healthcare). The n4fht dwell before the test with 1;36% glucose solution, a 2,27% Dianeal was used, and before the test with the polyglucose solution , an Extraneal" was used. This was done to avoid cross-over effects of glucose of volume from the night dwell to the test dwell. Results: the gastric emptying coefficient (GEC) was 2,86±(range 2,24-3,55) and 3,11±0,38 (range 2,43-3,63) in the glucose and polyglucose group respectively (p=0,028). the gastric emptying rate, expressed as the half time T I 12, was 130,5±54,2 and 96,9±33,4 minutes respectively (p=0,02). In conclusion: Gastric emptying in CAPD patients is more delayed during a dwell with 1,36% glucose solution than with a polyglucose solution. Gastric emptying during a dwell with polyglucose is not different from that of patients with an empty abdomen. The delayed gastric emptying observed in CAPD patients with filled abdomen is thus not due to volume, but to absorption of glucose.