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A simple modified 13c-urea breath test: transnasal breath sample collection method
AJG – September, Suppl., 2002
be safely dilated upto a diameter of 12 mm with a balloon. Other 2 were dilated upto 15 mm. One patient required laparoscopic strictureplasty after 2 sessions of dilatation. Other 3 patients required dilatation on 2, 3 and 8 sessions respectively, before lasting relief was achieved. The last mentioned patient needed sequential Savary dilatations upto a diameter of 18 mm. Conclusions: Anastomotic strictures are a rare complication of laparoscopic Roux– en–Y gastric bypass surgery. They present 3– 4 weeks post– surgery. 2 of our 5 patients with such strictures required repeat surgery, one of whom restenosed. The other 3 and the one restenosed patient could effectively be managed with repeated endoscopic dilatations. 165 A SIMPLE MODIFIED 13C–UREA BREATH TEST: TRANSNASAL BREATH SAMPLE COLLECTION METHOD Yoshihisa Urita, Yoshinori Kikuchi, Kazuo Hike, Naotaka Torii, Eiko Kanda, Masahiko Sasajima and Kazumasa Miki*. First Department of Internal Medicine, Toho University, Tokyo, Tokyo, Japan. Purpose: 13C– urea breath test (UBT) has become the most convenient non–invasive method for the diagnosis of the presence of Helicobacter pylori (H.pylori) infection. The main disadvantage of the UBT is possible interference by urease activity not related to H.pylori, as there is bacterial flora in the mouth and the intestine. In order to eliminate the problem of false positive results in early breath samples, due to urease–producing bacteria other than H.pylori, some modifications of the UBT have been suggested, such as mouth washing, or supplying 13C– urea as a rapid– release tablet. In the present study, we design the most simple modification of the UBT. Methods: Seventy–two patients were enrolled in the present study, including 47 females and 25 males, with a mean age of 60.3 years. After overnight fasting, 100 ml tap water and 100mg 13C– urea solution were used. Breath samoles were collected at baseline and at 1, 3, 5, 10, 20, and 30 minutes after administration, through the mouth and the nose at each time–point. 13C is measured as the 13C–12C ratio and is expressed as delta over baseline. Results: In H.pylori negative 35 patients, the mean values of breath samples for excess delta 13CO2 collected through the nose at 1,3,5,10,20,30 minutes after administration of 100mg of 13C– urea were 0.2, 0.1, 0.1, 0.1, 0.1, 0.1 pre mil, respestively. Those collected throuth the mouth at 1,3,5,10,20,30 minutes were 4.1, 2.5, 1.4, 0.6, 0.3, 0.2 per mil, respestively. In 37 infected patients, the mean values of breath samples for excess delta 13CO2 collected through the nose at 1,3,5,10,20,30 minutes were 16.2, 10.5, 14.5, 20.5, 26.3, 28.4 per mil, and those collected throuth the mouth at 1,3,5,10,20,30 minutes were 1.4, 8.2, 10.4, 20.2, 25.6, 28.1 per mil, respestively. Conclusions: The simple modification, such as transnasal collection of breath samples, provide a easy way of avoiding false–positive readings, due to urease–producing bacteria in the mouth. 166 NON–HELICOBACTER PYLORI, NON–NSAID PEPTIC ULCER DISEASE: A TERTIARY CARE EXPERIENCE Leon S. Maratchi, M.D., Amar Deshpande, M.D., Umaprasanna S. Karnam, M.D. and Jeffrey B. Raskin, M.D., F.A.C.P., FACG*. Division of Gastroenterology, University of Miami School of Medicine/Jackson Memorial Hospital, Miami, FL. Purpose: To study the incidence of H. pylori–negative peptic ulcer disease in NSAID–naive patients at a tertiary care referral center in the United States. Methods: Over a one year period (January to December 2000), all patients who were found to have either a gastric or duodenal ulcer by EGD were assessed for H. pylori status by histologic examination (hematoxylin & eosin stain or Giemsa stain) and biopsy urease test. The medical records and patients’ history were carefully reviewed for a documented positive
Abstracts
S55
history of NSAID/aspirin usage, defined as ingestion of at least one dose per week in the month preceding the endoscopy. Results: A total of 85 patients (42 males, 43 females) were included in the study and were divided into four subgroups: those with H. pylori–positive ulcers (group I), those with NSAID usage (group II), those with both H. pylori positivity and NSAID usage (group III), and those with neither (group IV). In group I, dyspepsia and bleeding were the indication for EGD in equal numbers of patients, while in all other groups bleeding was twice as common as dyspepsia. Thirty–seven percent of the patients had H. pylori ulcers (group I), 12% of the patients had NSAID use only (group II). Twenty–five percent of the study group was positive for H. pylori and had documented NSAID usage (group III), 27% of the patients had non–H. pylori, non–NSAID ulcers (group IV). The mean ages (in years) of the patients in the four subgroups were as follows: H. pylori 49, NSAID 54, H. pylori and NSAID 52, non–H. pylori, non–NSAID 50. In terms of comorbidities, hypertension was found in 29% of patients in group I, 60% in group II, 38% in group III, and 13% in group IV. Tobacco and alcohol use was found in 32% and 29% respectively in group I, 40% and 10% in group II, 19% and 14% in group III, and 48% and 39% in group IV. There were no statistically significant differences between the groups in demographics and overall comorbidites. Conclusions: 1.The majority of gastroduodenal ulcers are the result of either H. pylori infection (37%), NSAID ingestion (12%) or both (25%). 2. Twenty–three percent had no evidence of H. pylori infection nor a history of NSAID ingestion. The high incidence of non–H. pylori, non– NSAID ulcer could be due to underestimation of NSAID usage or low background prevalence of H. pylori infection in this population.
167 BARRETT’S ESOPHAGUS IS MORE COMMON IN NON–FAP PATIENTS WITH FUNDIC GLAND POLYPS INDEPENDENT OF AGE AND PROTON PUMP INHIBITOR THERAPY Thomas M. Attard, M.D., Lysette Stamato and Carmen Cuffari, M.D.*. Pediatrics, University of Nebraska Medical Center, Omaha, NE and Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, MD. Purpose: Although Fundic Gland Polyps (FGP) are considered benign lesions of the gastric epithelium, in patients with Familial Adenomatous Polyposis (FAP), they have been known to harbor dysplasia. The association of FGP with other upper gastrointestinal metaplastic or dysplastic lesions is unclear; an association with Barretts esophagus (BE) has been ascribed to concomitant proton pump inhibitor (ppi) therapy, but this mechanism has recently been disputed (Am J Gastroenterol 1997;92(10): 1858). Aim: To investigate the clinical, endoscopic – histopathologic findings on upper endoscopy (EGD) in patients with FGP. Methods: An electronic database analysis was used to identify patients who underwent EGD and were diagnosed with FGP at our institution between 1990 – 2001. Patients with FAP were further investigated through chart review. Histology reports and demographic data were subsequently entered into a dedicated database for analysis. Results: In total, 347 (169M) patients with FGP and an adjusted racial background of (W:AA) 2.7:1, were accrued into the database. The mean age (SD) at endoscopy was 57.2 (16.0) years. BE was present in 14% of all patients and in 28% of cases wherein the esophagus was biopsied. None of the patients with FAP had BE. Most patients with BE were Caucasian (47/49). No statistically significant differences in the mean age was noted in non–FAP patients with FGP with and without BE, nor did a greater proportion of patients with BE harbor histologic changes characteristic of chronic ppi use (“tombstone cells”). Among the 24 patients with FAP, 18 (17F) had dysplastic changes in their FGP. APC mutation analysis results were available in only 6 patients with FAP. Five had mutations localized between codon 1030 – 1309. Conclusions: BE is more common in patients with sporadic FGPs than the published incidence in patients undergoing routine EGD. A conceptual framework for this association based on advanced age and concomitant ppi
be safely dilated upto a diameter of 12 mm with a balloon. Other 2 were dilated upto 15 mm. One patient required laparoscopic strictureplasty after 2 sessions of dilatation. Other 3 patients required dilatation on 2, 3 and 8 sessions respectively, before lasting relief was achieved. The last mentioned patient needed sequential Savary dilatations upto a diameter of 18 mm. Conclusions: Anastomotic strictures are a rare complication of laparoscopic Roux– en–Y gastric bypass surgery. They present 3– 4 weeks post– surgery. 2 of our 5 patients with such strictures required repeat surgery, one of whom restenosed. The other 3 and the one restenosed patient could effectively be managed with repeated endoscopic dilatations. 165 A SIMPLE MODIFIED 13C–UREA BREATH TEST: TRANSNASAL BREATH SAMPLE COLLECTION METHOD Yoshihisa Urita, Yoshinori Kikuchi, Kazuo Hike, Naotaka Torii, Eiko Kanda, Masahiko Sasajima and Kazumasa Miki*. First Department of Internal Medicine, Toho University, Tokyo, Tokyo, Japan. Purpose: 13C– urea breath test (UBT) has become the most convenient non–invasive method for the diagnosis of the presence of Helicobacter pylori (H.pylori) infection. The main disadvantage of the UBT is possible interference by urease activity not related to H.pylori, as there is bacterial flora in the mouth and the intestine. In order to eliminate the problem of false positive results in early breath samples, due to urease–producing bacteria other than H.pylori, some modifications of the UBT have been suggested, such as mouth washing, or supplying 13C– urea as a rapid– release tablet. In the present study, we design the most simple modification of the UBT. Methods: Seventy–two patients were enrolled in the present study, including 47 females and 25 males, with a mean age of 60.3 years. After overnight fasting, 100 ml tap water and 100mg 13C– urea solution were used. Breath samoles were collected at baseline and at 1, 3, 5, 10, 20, and 30 minutes after administration, through the mouth and the nose at each time–point. 13C is measured as the 13C–12C ratio and is expressed as delta over baseline. Results: In H.pylori negative 35 patients, the mean values of breath samples for excess delta 13CO2 collected through the nose at 1,3,5,10,20,30 minutes after administration of 100mg of 13C– urea were 0.2, 0.1, 0.1, 0.1, 0.1, 0.1 pre mil, respestively. Those collected throuth the mouth at 1,3,5,10,20,30 minutes were 4.1, 2.5, 1.4, 0.6, 0.3, 0.2 per mil, respestively. In 37 infected patients, the mean values of breath samples for excess delta 13CO2 collected through the nose at 1,3,5,10,20,30 minutes were 16.2, 10.5, 14.5, 20.5, 26.3, 28.4 per mil, and those collected throuth the mouth at 1,3,5,10,20,30 minutes were 1.4, 8.2, 10.4, 20.2, 25.6, 28.1 per mil, respestively. Conclusions: The simple modification, such as transnasal collection of breath samples, provide a easy way of avoiding false–positive readings, due to urease–producing bacteria in the mouth. 166 NON–HELICOBACTER PYLORI, NON–NSAID PEPTIC ULCER DISEASE: A TERTIARY CARE EXPERIENCE Leon S. Maratchi, M.D., Amar Deshpande, M.D., Umaprasanna S. Karnam, M.D. and Jeffrey B. Raskin, M.D., F.A.C.P., FACG*. Division of Gastroenterology, University of Miami School of Medicine/Jackson Memorial Hospital, Miami, FL. Purpose: To study the incidence of H. pylori–negative peptic ulcer disease in NSAID–naive patients at a tertiary care referral center in the United States. Methods: Over a one year period (January to December 2000), all patients who were found to have either a gastric or duodenal ulcer by EGD were assessed for H. pylori status by histologic examination (hematoxylin & eosin stain or Giemsa stain) and biopsy urease test. The medical records and patients’ history were carefully reviewed for a documented positive
Abstracts
S55
history of NSAID/aspirin usage, defined as ingestion of at least one dose per week in the month preceding the endoscopy. Results: A total of 85 patients (42 males, 43 females) were included in the study and were divided into four subgroups: those with H. pylori–positive ulcers (group I), those with NSAID usage (group II), those with both H. pylori positivity and NSAID usage (group III), and those with neither (group IV). In group I, dyspepsia and bleeding were the indication for EGD in equal numbers of patients, while in all other groups bleeding was twice as common as dyspepsia. Thirty–seven percent of the patients had H. pylori ulcers (group I), 12% of the patients had NSAID use only (group II). Twenty–five percent of the study group was positive for H. pylori and had documented NSAID usage (group III), 27% of the patients had non–H. pylori, non–NSAID ulcers (group IV). The mean ages (in years) of the patients in the four subgroups were as follows: H. pylori 49, NSAID 54, H. pylori and NSAID 52, non–H. pylori, non–NSAID 50. In terms of comorbidities, hypertension was found in 29% of patients in group I, 60% in group II, 38% in group III, and 13% in group IV. Tobacco and alcohol use was found in 32% and 29% respectively in group I, 40% and 10% in group II, 19% and 14% in group III, and 48% and 39% in group IV. There were no statistically significant differences between the groups in demographics and overall comorbidites. Conclusions: 1.The majority of gastroduodenal ulcers are the result of either H. pylori infection (37%), NSAID ingestion (12%) or both (25%). 2. Twenty–three percent had no evidence of H. pylori infection nor a history of NSAID ingestion. The high incidence of non–H. pylori, non– NSAID ulcer could be due to underestimation of NSAID usage or low background prevalence of H. pylori infection in this population.
167 BARRETT’S ESOPHAGUS IS MORE COMMON IN NON–FAP PATIENTS WITH FUNDIC GLAND POLYPS INDEPENDENT OF AGE AND PROTON PUMP INHIBITOR THERAPY Thomas M. Attard, M.D., Lysette Stamato and Carmen Cuffari, M.D.*. Pediatrics, University of Nebraska Medical Center, Omaha, NE and Pediatrics, The Johns Hopkins Medical Institutions, Baltimore, MD. Purpose: Although Fundic Gland Polyps (FGP) are considered benign lesions of the gastric epithelium, in patients with Familial Adenomatous Polyposis (FAP), they have been known to harbor dysplasia. The association of FGP with other upper gastrointestinal metaplastic or dysplastic lesions is unclear; an association with Barretts esophagus (BE) has been ascribed to concomitant proton pump inhibitor (ppi) therapy, but this mechanism has recently been disputed (Am J Gastroenterol 1997;92(10): 1858). Aim: To investigate the clinical, endoscopic – histopathologic findings on upper endoscopy (EGD) in patients with FGP. Methods: An electronic database analysis was used to identify patients who underwent EGD and were diagnosed with FGP at our institution between 1990 – 2001. Patients with FAP were further investigated through chart review. Histology reports and demographic data were subsequently entered into a dedicated database for analysis. Results: In total, 347 (169M) patients with FGP and an adjusted racial background of (W:AA) 2.7:1, were accrued into the database. The mean age (SD) at endoscopy was 57.2 (16.0) years. BE was present in 14% of all patients and in 28% of cases wherein the esophagus was biopsied. None of the patients with FAP had BE. Most patients with BE were Caucasian (47/49). No statistically significant differences in the mean age was noted in non–FAP patients with FGP with and without BE, nor did a greater proportion of patients with BE harbor histologic changes characteristic of chronic ppi use (“tombstone cells”). Among the 24 patients with FAP, 18 (17F) had dysplastic changes in their FGP. APC mutation analysis results were available in only 6 patients with FAP. Five had mutations localized between codon 1030 – 1309. Conclusions: BE is more common in patients with sporadic FGPs than the published incidence in patients undergoing routine EGD. A conceptual framework for this association based on advanced age and concomitant ppi