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243 High-Resolution Esophageal Manometry Findings in Patients Using Chronic Opiates
median gastric cross sectional area and gastric empting were not altered by the LIFMA treatment. Conclusions: LIMFA therapy is effective in reducing symptoms in patients with FD
AGA Abstracts
243 High-Resolution Esophageal Manometry Findings in Patients Using Chronic Opiates Nicholas A. Piazza, Sarina Pasricha, Cary C. Cotton, Ryan D. Madanick Background: While the effect of chronic opiate use on intestinal motility is well established, the effect on esophageal motility remains poorly understood. Several studies have suggested opiate administration may induce dysmotility, however, there is a paucity of data on observed patterns seen during high-resolution esophageal manometry (HRM) in cohorts of patients with chronic oral opiate use. Aim: To assess differences in manometric study findings between patients on and off opiate therapy. Methods: We evaluated 101 consecutive patients at the University of North Carolina undergoing HRM from Nov 2014 - Mar 2015. Patients were grouped based on presence of an oral opiate on medication reconciliation prior to procedure. Integrated relaxation pressure (IRP), distal latency (DL), and contractile front velocity (CFV) measured during HRM were collected for comparison. Fisher's exact test was used for comparison of categorical variables and Wilcoxon rank-sum was used for continuous variables. Results: Of the 101 patients who underwent manometry, 21 had active opiate use. Evaluation of demographic data between patients using and not using opiates revealed no difference between sex or race. Patients on opiate therapy tended to be older (56 vs 51 years, p=0.03). Patients using opiates were more likely to have at least one abnormal finding of the three variables (IRP, DL, and CFV) assessed (57.1% vs 22.5%, p = 0.03). An increased IRP was the most common abnormal finding in the cohort using opiates (57.1% vs 21.3%, p = 0.002). The mean IRP was significantly greater in patients on an opiate (15.39 vs 10.63 mmHg, p=0.01). Increased CFV was also observed more frequently (9.5% vs 0.0%, p = 0.04). No significant difference was appreciated in incidence of decreased DL (4.8% vs 1.3%, p = 0.37). Conclusions: Chronic usage of oral opiates is associated with observable abnormalities on HRM, notably increased IRP and increased CFV. Clinicians should consider opiate use as a potential etiology or contributing factor to altered motility when assessing a patient with dysphagia. Comparison of Manometric and Demographic Characteristics between Patients Currently Using and not Using Opiate Analgesia.
Figure 1. FLIP topography classification algorithm and corresponding HRM/EPT motility diagnoses. Diagnoses above the red-line were considered major motor disorders.
241 Association of the HLA-DQB1-insertion in Idiopathic Achalasia and First Genotype-Phenotype (GxP) Study Using High-Resolution Manometry Data Zuzana Vackova, Stefan Niebisch, Jessica Becker, Nils Kosiol, Nicole Kreuser, Vitalia Schüller, Sophie Heinrichs, Timo Hess, Markus M. Nöthen, Ines Gockel, Julius Spicak, Johannes Schumacher, Jan Martinek Background: Idiopathic achalasia is a rare motility disorder of the esophagus with a lifetime prevalence of 1:10,000. The disease is characterized by impaired relaxation of the lower esophageal sphincter (LES) as well as disturbed esophageal peristalsis caused by degeneration of inhibitory neurons within the myenteric plexus. With the introduction of high-resolution manometry (HRM) and the Chicago classification, three clinically different types of achalasia can be distinguished: type I = 100% failed peristalsis, type II = panesophageal pressurization with ‡20% of swallows, type III = spastic contraction with ‡20% of swallows. On the etiological level, achalasia represents a multifactorial disorder with environmental and genetic factors being disease-associated. The strongest genetic risk variant identified so far represents a SNP rs28688207, which leads to an 8-amino-acid insertion in the HLA-DQB1 protein that forms together with HLA-DQA1 the HLA-DQ receptor placed on the surface of antigenpresenting cells. Aims and methods: The aim of our study was to replicate the role of rs28688207 in achalasia pathogenesis in an independent case-control sample from the Czech Republic (203 patients, 220 controls). In addition, we performed a genotype-phenotype (GxP) study to test whether rs28688207 is disease-associated to a particular HRM-subtype of achalasia. For this analysis we used a cohort of patients including cases from the Czech Republic and Germany with detailed HRM-data. From a total of 164 cases, 41 patients were diagnosed as achalasia type I, 109 as type II and 14 cases as type III according to the Chicago classification. Results: Genotyping of rs28688207 in the case-control sample yielded a strong achalasia-association (P = 1.22 x 10-04). The 8-amino-acid insertion in HLA-DQB1 was present in 9.1% of patients and in 2.7% of controls, which corresponds with the frequency seen in cases and controls from other countries in Central Europe. The GxP study revealed that rs28688207 is most prevalent in HRM-type I achalasia compared to type II and type III, although this was not statistically significant (P = 0.458). 12.2% of type I achalasia patients carried the HLA-DQB1-insertion, while only 9.6% of type II and 3.6% of type III cases were insertion carriers. Conclusions: The present study provides further evidence that the 8-amino-acid insertion in HLA-DQB1 plays a pivotal role in achalasia pathophysiology. In addition, the insertion is most frequent in HRM-type I achalasia patients. It might be due to a small sample size of patients with HRM-data, that despite the clear trend of increasing frequency of the insertion from type III to type I achalasia, this was not significant. Thus a larger number of patient samples with HRM data are needed in order to uncover whether the HLA-DQB1-insertion has an impact on achalasia also on the phenotypic level.
242 Low Frequency Magnetic Field (LIMFA) Treatment in Patients With Functional Dyspepsia Roda Enrico, Andrea Lisotti
*Fisher's exact test for categorical variables and Wilcoxon Rank-Sum for continuous variables. N, number; SD, standard deviation; CFV, contractile front velocity; DL, distal latency; IRP, integrated relaxation pressure.
Dyspepsia is defined by the Roma III criteria on functional gastrointestinal disorders as chronic or recurrent pain or discomfort centered in the upper abdomen. It has been estimated that as many as 25 to 40% of adults will experience dyspepsia in the five last year. The conventional medical therapy for functional dyspepsia (FD) has a limited efficacy. The aim of this prospective study was to provide evidence of the clinical benefit of the treatment of FD using a new instrument the low intensity magnetic field orthosystem. Methods: Twenty prospectively enrolled FD patients (9 males, 11 females) mean age 38+ 9 years were randomized to receive a 1 hour weekly treatment with LIMFA or shame treatment in a cross-over designed study that include a 2 week roll-in period, a 4 weeks treatment period and a 2week wash out period. All the patients followed the usual diet and physical activity. We evaluated the symptoms and their characteristics; a dyspeptic symptoms severity score as the sum of 8 dyspeptic symptoms (epigastric pain, postprandial fullness, upper abdominal bloating, early satiation, nausea, vomiting, epigastric burning; total global assessment) evaluated using a Likert scale was recorded; gastric empting was studied with a standardized ultrasound method. Results: LIMFA treatment significantly reduce the magnitude of symptoms (7.9+ 1.3 vs 12.6 + 1.6 for FD) As regards to the specific symptoms LIMFA significantly reduced upper abdominal bloating, postprandial sense of fullness compared to FD. The
AGA Abstracts
244 Additive Effect of Pathophysiological Mechanisms in Determining Symptom Severity in Functional Dyspepsia Jan F. Tack, Lukas Van Oudenhove, Hanne Vanheel, Florencia Carbone, Hans Törnblom, Olafur S. Palsson, Miranda A. van Tilburg, William E. Whitehead, Magnus Simren Background: Several pathophysiological mechanisms have been implicated in the pathogenesis of functional dyspepsia (FD) symptoms, including hypersensitivity to gastric distention (GD), impaired accommodation (GA) to a meal and delayed emptying (GE). Each of these mechanisms has been inconsistently associated with the severity of individual FD symptoms, and it is unclear whether they have additive effects on overall symptom severity. In addition, the recent Kyoto consensus proposed to consider a separate entity of H. pylori-associated dyspepsia (Sugano 2015). Aim: To study whether these pathophysiological disturbances exert an additive effect on symptom severity in FD. Methods: We included 483 patients fulfilling Rome II or III criteria for FD (74% women; mean age 40±0.6). We determined H. pylori status, solid and liquid GE (breath test), sensitivity to GD and GA (barostat).
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AGA Abstracts
243 High-Resolution Esophageal Manometry Findings in Patients Using Chronic Opiates Nicholas A. Piazza, Sarina Pasricha, Cary C. Cotton, Ryan D. Madanick Background: While the effect of chronic opiate use on intestinal motility is well established, the effect on esophageal motility remains poorly understood. Several studies have suggested opiate administration may induce dysmotility, however, there is a paucity of data on observed patterns seen during high-resolution esophageal manometry (HRM) in cohorts of patients with chronic oral opiate use. Aim: To assess differences in manometric study findings between patients on and off opiate therapy. Methods: We evaluated 101 consecutive patients at the University of North Carolina undergoing HRM from Nov 2014 - Mar 2015. Patients were grouped based on presence of an oral opiate on medication reconciliation prior to procedure. Integrated relaxation pressure (IRP), distal latency (DL), and contractile front velocity (CFV) measured during HRM were collected for comparison. Fisher's exact test was used for comparison of categorical variables and Wilcoxon rank-sum was used for continuous variables. Results: Of the 101 patients who underwent manometry, 21 had active opiate use. Evaluation of demographic data between patients using and not using opiates revealed no difference between sex or race. Patients on opiate therapy tended to be older (56 vs 51 years, p=0.03). Patients using opiates were more likely to have at least one abnormal finding of the three variables (IRP, DL, and CFV) assessed (57.1% vs 22.5%, p = 0.03). An increased IRP was the most common abnormal finding in the cohort using opiates (57.1% vs 21.3%, p = 0.002). The mean IRP was significantly greater in patients on an opiate (15.39 vs 10.63 mmHg, p=0.01). Increased CFV was also observed more frequently (9.5% vs 0.0%, p = 0.04). No significant difference was appreciated in incidence of decreased DL (4.8% vs 1.3%, p = 0.37). Conclusions: Chronic usage of oral opiates is associated with observable abnormalities on HRM, notably increased IRP and increased CFV. Clinicians should consider opiate use as a potential etiology or contributing factor to altered motility when assessing a patient with dysphagia. Comparison of Manometric and Demographic Characteristics between Patients Currently Using and not Using Opiate Analgesia.
Figure 1. FLIP topography classification algorithm and corresponding HRM/EPT motility diagnoses. Diagnoses above the red-line were considered major motor disorders.
241 Association of the HLA-DQB1-insertion in Idiopathic Achalasia and First Genotype-Phenotype (GxP) Study Using High-Resolution Manometry Data Zuzana Vackova, Stefan Niebisch, Jessica Becker, Nils Kosiol, Nicole Kreuser, Vitalia Schüller, Sophie Heinrichs, Timo Hess, Markus M. Nöthen, Ines Gockel, Julius Spicak, Johannes Schumacher, Jan Martinek Background: Idiopathic achalasia is a rare motility disorder of the esophagus with a lifetime prevalence of 1:10,000. The disease is characterized by impaired relaxation of the lower esophageal sphincter (LES) as well as disturbed esophageal peristalsis caused by degeneration of inhibitory neurons within the myenteric plexus. With the introduction of high-resolution manometry (HRM) and the Chicago classification, three clinically different types of achalasia can be distinguished: type I = 100% failed peristalsis, type II = panesophageal pressurization with ‡20% of swallows, type III = spastic contraction with ‡20% of swallows. On the etiological level, achalasia represents a multifactorial disorder with environmental and genetic factors being disease-associated. The strongest genetic risk variant identified so far represents a SNP rs28688207, which leads to an 8-amino-acid insertion in the HLA-DQB1 protein that forms together with HLA-DQA1 the HLA-DQ receptor placed on the surface of antigenpresenting cells. Aims and methods: The aim of our study was to replicate the role of rs28688207 in achalasia pathogenesis in an independent case-control sample from the Czech Republic (203 patients, 220 controls). In addition, we performed a genotype-phenotype (GxP) study to test whether rs28688207 is disease-associated to a particular HRM-subtype of achalasia. For this analysis we used a cohort of patients including cases from the Czech Republic and Germany with detailed HRM-data. From a total of 164 cases, 41 patients were diagnosed as achalasia type I, 109 as type II and 14 cases as type III according to the Chicago classification. Results: Genotyping of rs28688207 in the case-control sample yielded a strong achalasia-association (P = 1.22 x 10-04). The 8-amino-acid insertion in HLA-DQB1 was present in 9.1% of patients and in 2.7% of controls, which corresponds with the frequency seen in cases and controls from other countries in Central Europe. The GxP study revealed that rs28688207 is most prevalent in HRM-type I achalasia compared to type II and type III, although this was not statistically significant (P = 0.458). 12.2% of type I achalasia patients carried the HLA-DQB1-insertion, while only 9.6% of type II and 3.6% of type III cases were insertion carriers. Conclusions: The present study provides further evidence that the 8-amino-acid insertion in HLA-DQB1 plays a pivotal role in achalasia pathophysiology. In addition, the insertion is most frequent in HRM-type I achalasia patients. It might be due to a small sample size of patients with HRM-data, that despite the clear trend of increasing frequency of the insertion from type III to type I achalasia, this was not significant. Thus a larger number of patient samples with HRM data are needed in order to uncover whether the HLA-DQB1-insertion has an impact on achalasia also on the phenotypic level.
242 Low Frequency Magnetic Field (LIMFA) Treatment in Patients With Functional Dyspepsia Roda Enrico, Andrea Lisotti
*Fisher's exact test for categorical variables and Wilcoxon Rank-Sum for continuous variables. N, number; SD, standard deviation; CFV, contractile front velocity; DL, distal latency; IRP, integrated relaxation pressure.
Dyspepsia is defined by the Roma III criteria on functional gastrointestinal disorders as chronic or recurrent pain or discomfort centered in the upper abdomen. It has been estimated that as many as 25 to 40% of adults will experience dyspepsia in the five last year. The conventional medical therapy for functional dyspepsia (FD) has a limited efficacy. The aim of this prospective study was to provide evidence of the clinical benefit of the treatment of FD using a new instrument the low intensity magnetic field orthosystem. Methods: Twenty prospectively enrolled FD patients (9 males, 11 females) mean age 38+ 9 years were randomized to receive a 1 hour weekly treatment with LIMFA or shame treatment in a cross-over designed study that include a 2 week roll-in period, a 4 weeks treatment period and a 2week wash out period. All the patients followed the usual diet and physical activity. We evaluated the symptoms and their characteristics; a dyspeptic symptoms severity score as the sum of 8 dyspeptic symptoms (epigastric pain, postprandial fullness, upper abdominal bloating, early satiation, nausea, vomiting, epigastric burning; total global assessment) evaluated using a Likert scale was recorded; gastric empting was studied with a standardized ultrasound method. Results: LIMFA treatment significantly reduce the magnitude of symptoms (7.9+ 1.3 vs 12.6 + 1.6 for FD) As regards to the specific symptoms LIMFA significantly reduced upper abdominal bloating, postprandial sense of fullness compared to FD. The
AGA Abstracts
244 Additive Effect of Pathophysiological Mechanisms in Determining Symptom Severity in Functional Dyspepsia Jan F. Tack, Lukas Van Oudenhove, Hanne Vanheel, Florencia Carbone, Hans Törnblom, Olafur S. Palsson, Miranda A. van Tilburg, William E. Whitehead, Magnus Simren Background: Several pathophysiological mechanisms have been implicated in the pathogenesis of functional dyspepsia (FD) symptoms, including hypersensitivity to gastric distention (GD), impaired accommodation (GA) to a meal and delayed emptying (GE). Each of these mechanisms has been inconsistently associated with the severity of individual FD symptoms, and it is unclear whether they have additive effects on overall symptom severity. In addition, the recent Kyoto consensus proposed to consider a separate entity of H. pylori-associated dyspepsia (Sugano 2015). Aim: To study whether these pathophysiological disturbances exert an additive effect on symptom severity in FD. Methods: We included 483 patients fulfilling Rome II or III criteria for FD (74% women; mean age 40±0.6). We determined H. pylori status, solid and liquid GE (breath test), sensitivity to GD and GA (barostat).
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