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Characteristics of pancreatic diseases in the elderly
T1677
See Table) Cortc/usions: lneffi,cteve Esophageal Motility is bigbly prevalent in patients with GERD, young and old, and is not influenced by the aging process,
Novel Age-Associated Alteration of IL-6 levels in the Gastrointestinal Tract During Sepsis Hiroshi Saito, Jacalyn N. Johnson, B. Mark Evers
Comparison of 4 Groups Motility Dx
GERD § Groupl,N=~P 60 years 46 (76.6%)*
GERD * GERDGELID Group2,n=36~ Gmup3,n=36~ Group4,n=30:~ 40 years 60 years 40 years 17 (47.2%)* 3 (8.3%) 3 (10%)
Aged patients with sepsis have a significantly higher morbidity and mortality compared with younger patients. Previously, we have demonstrated elevated and prolonged expression of the inflammatory cytokme, interleukin-6 (IL-6), in the heart of aged mice compared with young during endotoxic stress. However, the inflammatory response of the GI tract has not been analyzed with aging. Thus, we analyzed repression of Ik-6 in the GI tract of aged versus young mice with endotoxemia. Methods. Young (4-ran) and aged (24-mo) male C57BIJ6 mice were injected with bacterial endotoxin lipopolysaccharide (LPS, 1.5 mg/kg, i p ) or saline (control), and body weight was measured lbr 7 day's (n = 4-5 mice/group) For IL-6 analysis, mice were sacrificed 6 h after injection, and the cymkine levels in serum and various tissues (stomach, pancreas, small bowel, and colon) were measnred by EL1SA. IL-6 mRNA levels were measured by RT-PCR. Results. After LPS iniection, none of young mice died, however 43% of the aged mice died Body weights of young mice were reduced 11% by 2 day's and recovered to near normal within 4 days. The aged mice lost 19% body weight with recovery to control weights requiring 7 days or longer. IL-6 levels were elevated m all tissues examined after I_PS injection. The induced IL-6 level in the serum, stomach, pancreas, small bowel, and colon of aged mice was 46-, 24-, 12-, 92-, and 34-told higher, respectively, compared with levels in young mice The mRNA levels tbr Ih-6 significantly increased with LPS injection in both age groups, and the increased mRNA levels were only sligbtly higher in the aged than the young mice. Conclusions. The age-associated increase in IL-6 suggests that the endotoxemiam~ediated intlammatory responses in the GI tissues are enhanced with aging. Increased IL-6 levels may be causally related to the delayed weight recovery of aged mice. The significant age-associated difference in lL-6 protein levels, in contrast to the modest difference in mRNA leveIs, raises a possibility that IL-6 production or stability is post4ranscriptionally altered with aging.
Ineffective motility (IEM) _Normal m ~ l ~ _ _ _ _ ~ l A % }.... 15 {41:6%) _ 26 (72.2%) !9 {63.~_)___ *p = <.001 pa~ts with IEM with GERDcompared to thosewithoutGERDp=.396for groups accordingto IEM and age
11675 The Ettect of Aging on Neurogenic Bowel Dysfunction after Spinal Cord Injury Noel R Fajardo lan Mark G. Gampon, William A. Bauman, Mark A. Korsten Background: Neurogenic bowel dysfunction (NBD) has a negative impact on the quality of hie afier spina] cord itljnIT (SCI) Adwmces in health care of individuals with SCI has increased file expectancy However, normal aging is associated with an increased number of gastrointestinal morbidities, the aim of the present study was to assess the effect of aging on the bowel fimction of indivldnals with SCI Methods: A survey tool was designed and validated. "the domaius include: demography, level and age of iNury, pre- and post- SCI bowel complaints, p m and post- SCI bowel habits, and bowel satisfaction scale Tlae survey was sent to approxintately 1000 members of the Eastern Paralyzed Veterans Association. Analysis: Phe survey pool was divided into pre-determined levels for: age, years of injury, and levels ofiNury "1heparameters observed across these categories were: bc)wel complaints scot'(" (BCS), bowel habit score (BHS), and bmvel satiat)ction score (BSS) The BCS is a sum of the complaints characteristic of NBD: constipation, diarrhea, [ecal incontinence, rectal bleeding, and fecal impaction. 1he BEg is ~be descriptive bowel care pattern, which includes bowel care/week and minutes/fiowel care The BSS is a nameric scale (I-5: l=highly dissatisfied, 5 = highly satisfied) &signed to determine satisfaction with present bowelfunction. The ANOVA, t-test, and Chi-squam were used to determine ditference between means. Results: The response rate was 34.3% after six weeks, Of these responses, 158 met the criteria for analysis, (95% males; mean age (yrs) 56 -+ l, range 22 - 85; mean age of injury (yrs) 21 7~ l, sange 1 - 57; levels of SCI: C2-C6=77, T1-T6=28, T7-T12=41, LIL5 = 12) BCS BHS, and BSS were not significantly"different across age groups and years of iNury levels ('f2t4e). Across kve[s of St), individuals with higher cord lesions tend to have tbwer (39 +- 02 vs 4 8 • 04, p
AGE (yrs.) BCS BOWEL CARE/WEEK M~JBOWEL CARE <30 1 5 54 3140 2 4 90 41-50 2 4 84 51-60 2 4 78 61-70 2 4 96 11-80 2 5 60 >80 1 4 60 YEARS OF INJURY <15 2 4 78 1640 2 4 96 31.45 2 4 60 >45 2 3 66
T1678 Characteristics Of Pancreatic Diseases In The Elderly Temmi Kamisawa, Takeo Arakawa, Hitoshi Nakaiima Background/Aim: As the numbers of elderly patients continue to increase, so does the incidence of pancreatitis and pancreatic carcinoma. Few detailed studies have been examined the characteristics of pancreatic diseases in the elderly'. To determine the optimal therapy for the elderly patients with pancreatic diseases, we examined their dmicopathologicaI features. Methods: Clinical and histological features of pancreatic carcinoma, acute pancreatitis, and chronic pancreatitis in patients 70 yr of age or older on diagnosis (n= 186, 55, 26) were compared with those in patients aged 69 yr or less (n= 333, 170, 121). Results: In pancreatic carcinoma, the male : female ratio peaked at 1:0.3 in patients under 49 yr old hilt grad~aallydecreased to ]:1.2 in those aged over 80 yr Them was no significant difference between the two groups as to the therapentic interventions used, but the rate of palliative therapy only was significandy greater in tbe elderly (43% vs. 14%) There were no significant differences in the resectability, prognosis, location, or histology"of the minor. Hematogenous and lymphogenous metastases were detected at autopsy in 68 and 61% of patients older than 70, and in 82 and 80% of the younger group. In acute pancrcatitis, alcoholic pancmatitis was vely rate (2% vs 21%), and severe pancreatitis was more frequent (25% vs 12%) in the elderly. In chronic pancreatitis, alcoholic pancreatitis was not common (19% vs. 84%), and idiopathic (34% vs 3%) and autoimmune pancreatitis (31% vs. 6%) increased in the elderly Chronic pancreatitis occurred predominantly in males in bofh groups. There were no significant differences in the incidence of calcification of the pancreas and accompanied diabetes, but those who developed chronic pancreatitis in the elderly were more likely, to be painless (74% vs. 29%). Average age of death was 79 yr and major causes of death were malignancy and malabsorption. Conclusions: The decreased sex ratio in aging might suggest a protective efl~'ct of estrogen in pancreatic carcinoma. I_ymphogenous as weU as hematogenous metastases were significantly less fi'equent in the elderly patients with pancreatic carcinoma, although local invasion was comparable. Alcohol was a much less common cause of pancreatitis in the elderly'. Idiopathic and autoimmnne pancrcatitis, which were sometimes difficult to differentiate from pancreatic carcinoma, frequently occurred in the elderly'. In examination of the elderly patients with pancreatic diseases, it is necessary to understand these clinicopatbological features.
BSS 2 3 3 3 2 2 3 3 3 2 2
T1676 Differential Ef|t'cts of Aging on Cell Proliferation and Beta Catenin Expression in Murine Small and Large Intestinal Epithelia Pdtoda A Reddix, Clorinda C Johnson
T1679
Background: Preneoplastic hyperproldi2ratwe changes in intestinal cD~pt epithelia has been well documented during aging in various mammalian species including humans, However, the mufine intestine is unique in that only colonic epithelial cell growth is enhanced while small intestinal epitbelial proliferation i.s unahered or declines. Recent studies have shown that the Wnt/P,eta Catenin signaling pathway is important in the regulation of epithelial cell growth. Activatmn of this pathway stimulates cell pmlitemtion, Aim: To determine whether segmental differences in epithelial cell proliferation wttbin aged murine intestine are associated with changes in epithelial beta catenin expression. Methods: Mucosal scrapings and whole thickness sections were prepared tram distal jejmm~/ileal segments excised fiom young, 3-4 month (n= 3) and aged, 20-24 month (n= 3) C57BU6 mice. Morphological changes were examined in wboie thickness sections using hemotoxyfin and eosin staining. Western blot analyses was used to detect age-related changes in profiierating cell nuclear antigen (PCNA), beta cateinn and gb/cogen s~thase kmase (GSK)- 3 alpha and beta expression, Results: l-f ~r E staimng showed no differences in the cD-pt epithelial regions within the small intestine of both age groups: however, the crypt proliferative zone was greater in coloinc tissue trom aged mice Simdarly, PCNA (36 kDa) and beta catenin (94 kDa) levels were nnafiered in the small intestine, wbile both were upregulated in colonic tissues from aged micro Ebe leveIs ot GSK-3 alpha (45 kDa) and beta (47 kDa) lsot?)rms were similar in both age groups Conclusion: The ~esults suggest that ditfierential eftects of aging on crypt epithcliaI cell growlh m murine intestine may be due to segmental differences in beta catenm expression and signaling activity Support ka, BOR HEF (2000-05)-04.
AGA Abstracts
Hyperplastic Polyps of the Gastric Antrum in Patients with Gastrointestinal Blood Loss Eric Ward, Massimo Raimondo Background and Aims: The histology and distributimr of gastric polyps have been well described. However, the significance of hyTerplastic polyps of the gastric antram in anemic patients with suspected gastrointestinal bleeding has not been determined. The aims of this study were to evaluate the prevalence and prognosis of such polyps in this patients' group, Methods: We reviewed clinical records and esophagogastroduodenoscopies of patients referred to our endoscopy lab fi'om 11/1999 to 11/2002 for the evaluation of iron deficiency anemia, Demographic and clinical details were also recorded. Results: 897 upper endoscopies were reviewed. Six patients (0.7%) were fimnd to have hFperplastic polyps in the gastric antrum. The mean age of these patients was 69 years (range 63-76) and the male: female ratio w-as 5:1 Multiple antral polyps were present in 2 cases. The largest polyp measured 2.5 cm. Histological confirmation was obtained in all 6 patients, Malignancy was not present in any submitted specimen, including those polyps, which were completely removed by snare polypectomy None of the patients had evidence for Hdicobacter pylon refection One of the patients reported melena, but the rest were asyTnptomatic. All patients were anemic (raean serum hemoglobin 9.2 mg/dl), and 5 had documented iron deficiency. The anemia resolved in one patient without further intervention. In two patients other potential bleeding sources were also discovered, including vascular malformations and colon polyps
A-546
See Table) Cortc/usions: lneffi,cteve Esophageal Motility is bigbly prevalent in patients with GERD, young and old, and is not influenced by the aging process,
Novel Age-Associated Alteration of IL-6 levels in the Gastrointestinal Tract During Sepsis Hiroshi Saito, Jacalyn N. Johnson, B. Mark Evers
Comparison of 4 Groups Motility Dx
GERD § Groupl,N=~P 60 years 46 (76.6%)*
GERD * GERDGELID Group2,n=36~ Gmup3,n=36~ Group4,n=30:~ 40 years 60 years 40 years 17 (47.2%)* 3 (8.3%) 3 (10%)
Aged patients with sepsis have a significantly higher morbidity and mortality compared with younger patients. Previously, we have demonstrated elevated and prolonged expression of the inflammatory cytokme, interleukin-6 (IL-6), in the heart of aged mice compared with young during endotoxic stress. However, the inflammatory response of the GI tract has not been analyzed with aging. Thus, we analyzed repression of Ik-6 in the GI tract of aged versus young mice with endotoxemia. Methods. Young (4-ran) and aged (24-mo) male C57BIJ6 mice were injected with bacterial endotoxin lipopolysaccharide (LPS, 1.5 mg/kg, i p ) or saline (control), and body weight was measured lbr 7 day's (n = 4-5 mice/group) For IL-6 analysis, mice were sacrificed 6 h after injection, and the cymkine levels in serum and various tissues (stomach, pancreas, small bowel, and colon) were measnred by EL1SA. IL-6 mRNA levels were measured by RT-PCR. Results. After LPS iniection, none of young mice died, however 43% of the aged mice died Body weights of young mice were reduced 11% by 2 day's and recovered to near normal within 4 days. The aged mice lost 19% body weight with recovery to control weights requiring 7 days or longer. IL-6 levels were elevated m all tissues examined after I_PS injection. The induced IL-6 level in the serum, stomach, pancreas, small bowel, and colon of aged mice was 46-, 24-, 12-, 92-, and 34-told higher, respectively, compared with levels in young mice The mRNA levels tbr Ih-6 significantly increased with LPS injection in both age groups, and the increased mRNA levels were only sligbtly higher in the aged than the young mice. Conclusions. The age-associated increase in IL-6 suggests that the endotoxemiam~ediated intlammatory responses in the GI tissues are enhanced with aging. Increased IL-6 levels may be causally related to the delayed weight recovery of aged mice. The significant age-associated difference in lL-6 protein levels, in contrast to the modest difference in mRNA leveIs, raises a possibility that IL-6 production or stability is post4ranscriptionally altered with aging.
Ineffective motility (IEM) _Normal m ~ l ~ _ _ _ _ ~ l A % }.... 15 {41:6%) _ 26 (72.2%) !9 {63.~_)___ *p = <.001 pa~ts with IEM with GERDcompared to thosewithoutGERDp=.396for groups accordingto IEM and age
11675 The Ettect of Aging on Neurogenic Bowel Dysfunction after Spinal Cord Injury Noel R Fajardo lan Mark G. Gampon, William A. Bauman, Mark A. Korsten Background: Neurogenic bowel dysfunction (NBD) has a negative impact on the quality of hie afier spina] cord itljnIT (SCI) Adwmces in health care of individuals with SCI has increased file expectancy However, normal aging is associated with an increased number of gastrointestinal morbidities, the aim of the present study was to assess the effect of aging on the bowel fimction of indivldnals with SCI Methods: A survey tool was designed and validated. "the domaius include: demography, level and age of iNury, pre- and post- SCI bowel complaints, p m and post- SCI bowel habits, and bowel satisfaction scale Tlae survey was sent to approxintately 1000 members of the Eastern Paralyzed Veterans Association. Analysis: Phe survey pool was divided into pre-determined levels for: age, years of injury, and levels ofiNury "1heparameters observed across these categories were: bc)wel complaints scot'(" (BCS), bowel habit score (BHS), and bmvel satiat)ction score (BSS) The BCS is a sum of the complaints characteristic of NBD: constipation, diarrhea, [ecal incontinence, rectal bleeding, and fecal impaction. 1he BEg is ~be descriptive bowel care pattern, which includes bowel care/week and minutes/fiowel care The BSS is a nameric scale (I-5: l=highly dissatisfied, 5 = highly satisfied) &signed to determine satisfaction with present bowelfunction. The ANOVA, t-test, and Chi-squam were used to determine ditference between means. Results: The response rate was 34.3% after six weeks, Of these responses, 158 met the criteria for analysis, (95% males; mean age (yrs) 56 -+ l, range 22 - 85; mean age of injury (yrs) 21 7~ l, sange 1 - 57; levels of SCI: C2-C6=77, T1-T6=28, T7-T12=41, LIL5 = 12) BCS BHS, and BSS were not significantly"different across age groups and years of iNury levels ('f2t4e). Across kve[s of St), individuals with higher cord lesions tend to have tbwer (39 +- 02 vs 4 8 • 04, p
AGE (yrs.) BCS BOWEL CARE/WEEK M~JBOWEL CARE <30 1 5 54 3140 2 4 90 41-50 2 4 84 51-60 2 4 78 61-70 2 4 96 11-80 2 5 60 >80 1 4 60 YEARS OF INJURY <15 2 4 78 1640 2 4 96 31.45 2 4 60 >45 2 3 66
T1678 Characteristics Of Pancreatic Diseases In The Elderly Temmi Kamisawa, Takeo Arakawa, Hitoshi Nakaiima Background/Aim: As the numbers of elderly patients continue to increase, so does the incidence of pancreatitis and pancreatic carcinoma. Few detailed studies have been examined the characteristics of pancreatic diseases in the elderly'. To determine the optimal therapy for the elderly patients with pancreatic diseases, we examined their dmicopathologicaI features. Methods: Clinical and histological features of pancreatic carcinoma, acute pancreatitis, and chronic pancreatitis in patients 70 yr of age or older on diagnosis (n= 186, 55, 26) were compared with those in patients aged 69 yr or less (n= 333, 170, 121). Results: In pancreatic carcinoma, the male : female ratio peaked at 1:0.3 in patients under 49 yr old hilt grad~aallydecreased to ]:1.2 in those aged over 80 yr Them was no significant difference between the two groups as to the therapentic interventions used, but the rate of palliative therapy only was significandy greater in tbe elderly (43% vs. 14%) There were no significant differences in the resectability, prognosis, location, or histology"of the minor. Hematogenous and lymphogenous metastases were detected at autopsy in 68 and 61% of patients older than 70, and in 82 and 80% of the younger group. In acute pancrcatitis, alcoholic pancmatitis was vely rate (2% vs 21%), and severe pancreatitis was more frequent (25% vs 12%) in the elderly. In chronic pancreatitis, alcoholic pancreatitis was not common (19% vs. 84%), and idiopathic (34% vs 3%) and autoimmune pancreatitis (31% vs. 6%) increased in the elderly Chronic pancreatitis occurred predominantly in males in bofh groups. There were no significant differences in the incidence of calcification of the pancreas and accompanied diabetes, but those who developed chronic pancreatitis in the elderly were more likely, to be painless (74% vs. 29%). Average age of death was 79 yr and major causes of death were malignancy and malabsorption. Conclusions: The decreased sex ratio in aging might suggest a protective efl~'ct of estrogen in pancreatic carcinoma. I_ymphogenous as weU as hematogenous metastases were significantly less fi'equent in the elderly patients with pancreatic carcinoma, although local invasion was comparable. Alcohol was a much less common cause of pancreatitis in the elderly'. Idiopathic and autoimmnne pancrcatitis, which were sometimes difficult to differentiate from pancreatic carcinoma, frequently occurred in the elderly'. In examination of the elderly patients with pancreatic diseases, it is necessary to understand these clinicopatbological features.
BSS 2 3 3 3 2 2 3 3 3 2 2
T1676 Differential Ef|t'cts of Aging on Cell Proliferation and Beta Catenin Expression in Murine Small and Large Intestinal Epithelia Pdtoda A Reddix, Clorinda C Johnson
T1679
Background: Preneoplastic hyperproldi2ratwe changes in intestinal cD~pt epithelia has been well documented during aging in various mammalian species including humans, However, the mufine intestine is unique in that only colonic epithelial cell growth is enhanced while small intestinal epitbelial proliferation i.s unahered or declines. Recent studies have shown that the Wnt/P,eta Catenin signaling pathway is important in the regulation of epithelial cell growth. Activatmn of this pathway stimulates cell pmlitemtion, Aim: To determine whether segmental differences in epithelial cell proliferation wttbin aged murine intestine are associated with changes in epithelial beta catenin expression. Methods: Mucosal scrapings and whole thickness sections were prepared tram distal jejmm~/ileal segments excised fiom young, 3-4 month (n= 3) and aged, 20-24 month (n= 3) C57BU6 mice. Morphological changes were examined in wboie thickness sections using hemotoxyfin and eosin staining. Western blot analyses was used to detect age-related changes in profiierating cell nuclear antigen (PCNA), beta cateinn and gb/cogen s~thase kmase (GSK)- 3 alpha and beta expression, Results: l-f ~r E staimng showed no differences in the cD-pt epithelial regions within the small intestine of both age groups: however, the crypt proliferative zone was greater in coloinc tissue trom aged mice Simdarly, PCNA (36 kDa) and beta catenin (94 kDa) levels were nnafiered in the small intestine, wbile both were upregulated in colonic tissues from aged micro Ebe leveIs ot GSK-3 alpha (45 kDa) and beta (47 kDa) lsot?)rms were similar in both age groups Conclusion: The ~esults suggest that ditfierential eftects of aging on crypt epithcliaI cell growlh m murine intestine may be due to segmental differences in beta catenm expression and signaling activity Support ka, BOR HEF (2000-05)-04.
AGA Abstracts
Hyperplastic Polyps of the Gastric Antrum in Patients with Gastrointestinal Blood Loss Eric Ward, Massimo Raimondo Background and Aims: The histology and distributimr of gastric polyps have been well described. However, the significance of hyTerplastic polyps of the gastric antram in anemic patients with suspected gastrointestinal bleeding has not been determined. The aims of this study were to evaluate the prevalence and prognosis of such polyps in this patients' group, Methods: We reviewed clinical records and esophagogastroduodenoscopies of patients referred to our endoscopy lab fi'om 11/1999 to 11/2002 for the evaluation of iron deficiency anemia, Demographic and clinical details were also recorded. Results: 897 upper endoscopies were reviewed. Six patients (0.7%) were fimnd to have hFperplastic polyps in the gastric antrum. The mean age of these patients was 69 years (range 63-76) and the male: female ratio w-as 5:1 Multiple antral polyps were present in 2 cases. The largest polyp measured 2.5 cm. Histological confirmation was obtained in all 6 patients, Malignancy was not present in any submitted specimen, including those polyps, which were completely removed by snare polypectomy None of the patients had evidence for Hdicobacter pylon refection One of the patients reported melena, but the rest were asyTnptomatic. All patients were anemic (raean serum hemoglobin 9.2 mg/dl), and 5 had documented iron deficiency. The anemia resolved in one patient without further intervention. In two patients other potential bleeding sources were also discovered, including vascular malformations and colon polyps
A-546