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167 Anti-TNF Treatment for Extraintestinal Manifestations of Inflammatory Bowel Disease in the Swiss IBD Cohort Study
test (t test <0.9). Pre-test symptoms were similar between groups and were not predictive of test outcome. CONCLUSION: Approximately 1/3rdof patients with persistent GI symptoms have a positive breath test for either SIBO or carbohydrate intolerance (fructose, or lactose). Pretest symptoms did not appear to predict positive or negative test result. Breath tests are clinically useful and provide objective diagnosis of common GI problems. These findings should facilitate optimal clinical management. Breath tests should be adopted more widely in gastroenterology practice.
Anti-TNF Treatment for Extraintestinal Manifestations of Inflammatory Bowel Disease in the Swiss IBD Cohort Study Stephan R. Vavricka, Luc Biedermann, Gerhard Rogler, Ekaterina Safroneeva, Alain M. Schoepfer, Thomas Greuter, Michael Scharl Background: Extraintestinal manifestations (EIM) in inflammatory bowel disease (IBD) patients are frequently observed. However, little is known about the efficacy of anti-TNF treatment in EIM and current recommendations are largely based on expert opinions and case reports. We aimed to assess the effect of three anti-TNF agents (infliximab, adalimumab and certolizumab pegol) on the evolution of EIM. Methods: Data from the Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS) with 1,249 patients enrolled between January 2006 and March 2010 were analyzed. Results: Of the 366 patients with at least 1 EIM, 213 (58.2%) were ever treated with an anti-TNF, most of them with one anti-TNF agent (n= 147, 69.0%). Of these, 36.2% were male, 77.5% had Crohn's disease (CD), 18.8% ulcerative colitis (UC), and 2.8% indeterminate colitis (IC). Mean age at IBD diagnosis was 27.9 years (4.0-61.5) with a mean age of 44.4 years (20.5-78.2) at enrolment into the SIBDCS. The most frequently reported EIM were peripheral arthritis (75.6%), aphthous stomatitis (23.5%) and axial arthropathy/ankylosing spondylitis (21.6%). Infliximab was used in 63.2%, adalimumab in 22.4% and certolizumab pegol in 14.4% of patients. More than half of the patients showed a clinical response of the underlying EIM to anti-TNF therapy (54.5%). Under infliximab, peripheral arthritis had a clinical response rate of 77.6%, while aphthous stomatitis improved in 77.8%, uveitis in 66.7% and axial arthropathy in 59.1% of patients. Erythema nodosum showed a clinical response in 88.9% of patients. Improvement rates for the subcutaneous agents (adalimumab and certolizumab) were comparable. Only in 4.7% of patients (n=10), EIM presented under anti-TNF treatment for the first time with most of them (69.2%) showing an improvement under continued anti-TNF therapy. Conclusions: Anti-TNF therapy has a positive effect on most EIM. Occurrence of EIM under anti-TNF is seldom encountered and in only a minority a worsening of the underlying EIM can be observed. Anti-TNF agents are a valuable treatment for EIM.
170 Effectiveness of Curcuma Longa Linn Compared With Omeprazole on Treatment of Functional Dyspepsia Chaipichit Puttapitakpong, Jindarat Jearjesdakul Background: Functional dyspepsia was one of the common diseases in clinical practice. Current drug therapy is the main inhibitor of acid secretion. It was found that turmeric, one of the herbal medicine, can relieve symptom of dyspepsia. However, limited scientific evidences are available for the efficacy of turmeric. Objective: The purpose of this study was to evaluate the effectiveness of turmeric compared with omeprazole on treatment of functional dyspepsia Method: This study was a randomized, single-blind, controlled trial. All patients enrolled in this study had symptom of dyspepsia and underwent esophagogastroduodenoscopy which revealed no ulcer or lesion explain the symptoms. They were randomized into three groups to receive placebo, omeprazole or turmeric. The symptoms of dyspepsia were evaluated with questionnaire score (severity of dyspepsia assessment) at baseline, 2 and 6 weeks after treatment. Result: Thirty four patients were randomly assigned into 3 groups. Nine patients received placebo, 10 patients received omeprazole, 12 patients receive turmeric. Pain scores and other symptoms related with dyspepsia (burping, heartburn, bloating, nausea and bad breath) were decreased in all 3 groups those received placebo, omeprazole and turmeric. Pain scores at 6 weeks of treatment were significantly reduced from 31.1±1.91, 32.5±1.33, 31.82±1.6 to 12.7±8.76, 8.15±5.41, 10.55±5.15 in the placebo, omeprazole and turmeric groups respectively (p<0.05). However, there was no difference in reduction of pain scores between each group. Satisfaction scores at 6 weeks of treatment were significantly increased from 8.6±0.7, 8.23±0.73, 8.64±0.67 to 14.5±3.27, 16.38±3.31, 15.55±2 in placebo, omeprazole and turmeric groups respectively (p<0.05) without difference between each group. Conclusion: Turmeric can reduce symptoms of dyspepsia and increase satisfaction of treatment as effective as omeprazole and placebo. However, this study has a small population, so placebo also reduced the symptoms of dyspepsia. Difference in pain score, symptom score and satisfaction score between baseline, 2 and 6 weeks after treatment
168 Effects of Mirtazapine Combined With Standard Medical Treatment in Patients With Functional Dyspepsia Accompanying Psychological Distress: A Randomized, Double-Blind, Placebo-Controlled Trial Yaoyao Gong, Lin Lin BACKGROUND & AIMS: Functional dyspepsia (FD) is currently considered to be a biopsychosocial disorder. Mounting evidence shows that psychological distress is associated with FD. Previous in vitro studies have shown a potential role of the antidepressant mirtazapine in the treatment of FD. This study aimed to assess the effectiveness of mirtazapine in patients with FD and psychological distress. METHODS: Adult patients who met both diagnosis criteria for FD (diagnosed by gastroenterologists) and psychological distress (depression and/ or anxiety and/or somatization disorder, diagnosed by psychiatrists) were enrolled. Patients were randomly allocated to the control or experimental group. Standard medical treatment (omeprazole & mosapride) were administered in both the control and experimental groups. Besides standard therapy, patients in the experimental group received psychotherapy (mirtazapine), while those in the control group received placebo which is identical to mirtazapine. In both the control and experimental groups, patients were assessed at the same time, at baseline (T0) and at the end of 3 months of treatment (T1). Physicians involved in the recruitment and in the medical treatment were blinded to patients' randomization. We used Rome III criteria to evaluate FD symptoms (which were rated on a 7-point Likert scale) and the Symptom Checklist-90 (SCL-90) to determine status of depression, anxiety and somatization disorder. RESULTS: One hundred sixteen patients were enrolled; 48 and 55 participants completed treatment in the control and experimental group, respectively. After 3 months of treatment, the severity of FD symptoms, depression score, somatization disorder score and total SCL-90 score in the experimental group markedly improved in comparison to control group (P< .05). The anxiety score was not significantly improved in both groups. CONCLUSIONS: Mirtazapine combined with standard medical treatment were more effective than standard medical treatment in patients with FD accompanying psychological distress.
169 How Useful Are Breath Tests in the Diagnosis of SIBO or Carbohydrate Intolerance Mercedes Amieva-Balmori, Satish S. Rao, Enrique Coss-Adame
Pain score at baseline, 2 week and 6 week after treatment
BACKGROUND: Bloating, gas, fullness, nausea and diarrhea are commonin GI clinics, and often endoscopic and radiologic tests are negative in these patients. Can breath tests facilitate a diagnosis of small intestinal overgrowth (SIBO), and/or carbohydrate intolerance, and if so its clinically utility is not completely known. AIM: Assess the incremental diagnostic usefulness of glucose, fructose and lactose breath tests and the pre-test predictive value of gastrointestinal (GI) symptoms. METHODS:We recruited 1,000 patients from two tertiary care medical centers, with negative blood, endoscopy and radiology tests. All underwent completed validated questionnaires and glucose breath test (GBT) (75g), fructose breath test (FBT) (25g) and lactose breath test (LBT) (25g). Hydrogen (H2) and methane (CH4) levels were assessed. A positive test was defined as an increase in breath H2 levels of>20 particles per million (ppm) or CH4 levels of>15 ppm or combined H2 and CH4 of>15ppm over baseline. The frequency, duration and intensity of GI symptoms were assessed at baseline and during the test; also the correlation between symptoms and test results were analyzed. RESULTS: A total of 1,000 patients (M/F 2) with long standing GI symptoms were evaluated. We performed 2,047 breath tests,that included 733 GBT, 724 FBT and 590 LBT. Mean age was 49 (+17) years. 22.78% had a positive GBT compatible with (SIBO), 36.87% had a positive FBT indicating dietary fructose intolerance and 41.52% had a positive LBT. 41.1% of patients underwent all 3 tests, and of these 28.87% (356) were positive. Having a positive result with one breath test did not increase the probability of a positive result with another
171 Protease-Activated Receptor Expression in the Esophagus Is Associated With Esophageal Mucosal Integrity and Esophageal Motility Function Eikichi Ihara, Keita Fukaura, Kazumasa Muta, Yoshimasa Tanaka, Xiaopeng Bai, Tsutomu Iwasa, Akira Aso, Hirotada Akiho, Kazuhiko Nakamura Background: It was previously reported that the trypsin/protease-activated receptor 2 (PAR2) is involved in the pathogenesis of gastroesophageal reflux disease (GERD). We recently demonstrated that trypsin-PAR2 induced unique biphasic contraction and relaxation in porcine esophagus, which has physiological and/or pathophysiological roles in esophageal motility function. Although accumulated evidences have shown that PARs are critical in esophageal function, their precise characteristics and underlying mechanisms remain to be determined in the clinical setting. Objectives: This study was designed to investigate the association of esophageal-expressed PARs with esophageal motility and mucosal barrier function in humans. Patients and Methods: Twenty-one patients (12 women, nine men) with suspected esophageal motility disorder were assessed by high resolution manometry (Manoscan Z), with esophageal motility function evaluated by measuring distal contractile integral (DCI) and basal lower esophageal sphincter pressure (BLESP). Nineteen patients
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Anti-TNF Treatment for Extraintestinal Manifestations of Inflammatory Bowel Disease in the Swiss IBD Cohort Study Stephan R. Vavricka, Luc Biedermann, Gerhard Rogler, Ekaterina Safroneeva, Alain M. Schoepfer, Thomas Greuter, Michael Scharl Background: Extraintestinal manifestations (EIM) in inflammatory bowel disease (IBD) patients are frequently observed. However, little is known about the efficacy of anti-TNF treatment in EIM and current recommendations are largely based on expert opinions and case reports. We aimed to assess the effect of three anti-TNF agents (infliximab, adalimumab and certolizumab pegol) on the evolution of EIM. Methods: Data from the Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS) with 1,249 patients enrolled between January 2006 and March 2010 were analyzed. Results: Of the 366 patients with at least 1 EIM, 213 (58.2%) were ever treated with an anti-TNF, most of them with one anti-TNF agent (n= 147, 69.0%). Of these, 36.2% were male, 77.5% had Crohn's disease (CD), 18.8% ulcerative colitis (UC), and 2.8% indeterminate colitis (IC). Mean age at IBD diagnosis was 27.9 years (4.0-61.5) with a mean age of 44.4 years (20.5-78.2) at enrolment into the SIBDCS. The most frequently reported EIM were peripheral arthritis (75.6%), aphthous stomatitis (23.5%) and axial arthropathy/ankylosing spondylitis (21.6%). Infliximab was used in 63.2%, adalimumab in 22.4% and certolizumab pegol in 14.4% of patients. More than half of the patients showed a clinical response of the underlying EIM to anti-TNF therapy (54.5%). Under infliximab, peripheral arthritis had a clinical response rate of 77.6%, while aphthous stomatitis improved in 77.8%, uveitis in 66.7% and axial arthropathy in 59.1% of patients. Erythema nodosum showed a clinical response in 88.9% of patients. Improvement rates for the subcutaneous agents (adalimumab and certolizumab) were comparable. Only in 4.7% of patients (n=10), EIM presented under anti-TNF treatment for the first time with most of them (69.2%) showing an improvement under continued anti-TNF therapy. Conclusions: Anti-TNF therapy has a positive effect on most EIM. Occurrence of EIM under anti-TNF is seldom encountered and in only a minority a worsening of the underlying EIM can be observed. Anti-TNF agents are a valuable treatment for EIM.
170 Effectiveness of Curcuma Longa Linn Compared With Omeprazole on Treatment of Functional Dyspepsia Chaipichit Puttapitakpong, Jindarat Jearjesdakul Background: Functional dyspepsia was one of the common diseases in clinical practice. Current drug therapy is the main inhibitor of acid secretion. It was found that turmeric, one of the herbal medicine, can relieve symptom of dyspepsia. However, limited scientific evidences are available for the efficacy of turmeric. Objective: The purpose of this study was to evaluate the effectiveness of turmeric compared with omeprazole on treatment of functional dyspepsia Method: This study was a randomized, single-blind, controlled trial. All patients enrolled in this study had symptom of dyspepsia and underwent esophagogastroduodenoscopy which revealed no ulcer or lesion explain the symptoms. They were randomized into three groups to receive placebo, omeprazole or turmeric. The symptoms of dyspepsia were evaluated with questionnaire score (severity of dyspepsia assessment) at baseline, 2 and 6 weeks after treatment. Result: Thirty four patients were randomly assigned into 3 groups. Nine patients received placebo, 10 patients received omeprazole, 12 patients receive turmeric. Pain scores and other symptoms related with dyspepsia (burping, heartburn, bloating, nausea and bad breath) were decreased in all 3 groups those received placebo, omeprazole and turmeric. Pain scores at 6 weeks of treatment were significantly reduced from 31.1±1.91, 32.5±1.33, 31.82±1.6 to 12.7±8.76, 8.15±5.41, 10.55±5.15 in the placebo, omeprazole and turmeric groups respectively (p<0.05). However, there was no difference in reduction of pain scores between each group. Satisfaction scores at 6 weeks of treatment were significantly increased from 8.6±0.7, 8.23±0.73, 8.64±0.67 to 14.5±3.27, 16.38±3.31, 15.55±2 in placebo, omeprazole and turmeric groups respectively (p<0.05) without difference between each group. Conclusion: Turmeric can reduce symptoms of dyspepsia and increase satisfaction of treatment as effective as omeprazole and placebo. However, this study has a small population, so placebo also reduced the symptoms of dyspepsia. Difference in pain score, symptom score and satisfaction score between baseline, 2 and 6 weeks after treatment
168 Effects of Mirtazapine Combined With Standard Medical Treatment in Patients With Functional Dyspepsia Accompanying Psychological Distress: A Randomized, Double-Blind, Placebo-Controlled Trial Yaoyao Gong, Lin Lin BACKGROUND & AIMS: Functional dyspepsia (FD) is currently considered to be a biopsychosocial disorder. Mounting evidence shows that psychological distress is associated with FD. Previous in vitro studies have shown a potential role of the antidepressant mirtazapine in the treatment of FD. This study aimed to assess the effectiveness of mirtazapine in patients with FD and psychological distress. METHODS: Adult patients who met both diagnosis criteria for FD (diagnosed by gastroenterologists) and psychological distress (depression and/ or anxiety and/or somatization disorder, diagnosed by psychiatrists) were enrolled. Patients were randomly allocated to the control or experimental group. Standard medical treatment (omeprazole & mosapride) were administered in both the control and experimental groups. Besides standard therapy, patients in the experimental group received psychotherapy (mirtazapine), while those in the control group received placebo which is identical to mirtazapine. In both the control and experimental groups, patients were assessed at the same time, at baseline (T0) and at the end of 3 months of treatment (T1). Physicians involved in the recruitment and in the medical treatment were blinded to patients' randomization. We used Rome III criteria to evaluate FD symptoms (which were rated on a 7-point Likert scale) and the Symptom Checklist-90 (SCL-90) to determine status of depression, anxiety and somatization disorder. RESULTS: One hundred sixteen patients were enrolled; 48 and 55 participants completed treatment in the control and experimental group, respectively. After 3 months of treatment, the severity of FD symptoms, depression score, somatization disorder score and total SCL-90 score in the experimental group markedly improved in comparison to control group (P< .05). The anxiety score was not significantly improved in both groups. CONCLUSIONS: Mirtazapine combined with standard medical treatment were more effective than standard medical treatment in patients with FD accompanying psychological distress.
169 How Useful Are Breath Tests in the Diagnosis of SIBO or Carbohydrate Intolerance Mercedes Amieva-Balmori, Satish S. Rao, Enrique Coss-Adame
Pain score at baseline, 2 week and 6 week after treatment
BACKGROUND: Bloating, gas, fullness, nausea and diarrhea are commonin GI clinics, and often endoscopic and radiologic tests are negative in these patients. Can breath tests facilitate a diagnosis of small intestinal overgrowth (SIBO), and/or carbohydrate intolerance, and if so its clinically utility is not completely known. AIM: Assess the incremental diagnostic usefulness of glucose, fructose and lactose breath tests and the pre-test predictive value of gastrointestinal (GI) symptoms. METHODS:We recruited 1,000 patients from two tertiary care medical centers, with negative blood, endoscopy and radiology tests. All underwent completed validated questionnaires and glucose breath test (GBT) (75g), fructose breath test (FBT) (25g) and lactose breath test (LBT) (25g). Hydrogen (H2) and methane (CH4) levels were assessed. A positive test was defined as an increase in breath H2 levels of>20 particles per million (ppm) or CH4 levels of>15 ppm or combined H2 and CH4 of>15ppm over baseline. The frequency, duration and intensity of GI symptoms were assessed at baseline and during the test; also the correlation between symptoms and test results were analyzed. RESULTS: A total of 1,000 patients (M/F 2) with long standing GI symptoms were evaluated. We performed 2,047 breath tests,that included 733 GBT, 724 FBT and 590 LBT. Mean age was 49 (+17) years. 22.78% had a positive GBT compatible with (SIBO), 36.87% had a positive FBT indicating dietary fructose intolerance and 41.52% had a positive LBT. 41.1% of patients underwent all 3 tests, and of these 28.87% (356) were positive. Having a positive result with one breath test did not increase the probability of a positive result with another
171 Protease-Activated Receptor Expression in the Esophagus Is Associated With Esophageal Mucosal Integrity and Esophageal Motility Function Eikichi Ihara, Keita Fukaura, Kazumasa Muta, Yoshimasa Tanaka, Xiaopeng Bai, Tsutomu Iwasa, Akira Aso, Hirotada Akiho, Kazuhiko Nakamura Background: It was previously reported that the trypsin/protease-activated receptor 2 (PAR2) is involved in the pathogenesis of gastroesophageal reflux disease (GERD). We recently demonstrated that trypsin-PAR2 induced unique biphasic contraction and relaxation in porcine esophagus, which has physiological and/or pathophysiological roles in esophageal motility function. Although accumulated evidences have shown that PARs are critical in esophageal function, their precise characteristics and underlying mechanisms remain to be determined in the clinical setting. Objectives: This study was designed to investigate the association of esophageal-expressed PARs with esophageal motility and mucosal barrier function in humans. Patients and Methods: Twenty-one patients (12 women, nine men) with suspected esophageal motility disorder were assessed by high resolution manometry (Manoscan Z), with esophageal motility function evaluated by measuring distal contractile integral (DCI) and basal lower esophageal sphincter pressure (BLESP). Nineteen patients
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