Childhood gastroesophageal reflux(GER) symptoms in adult patients with ger symptoms

A480 AGA ABSTRACTS

GASTROENTEROLOGY Vol. 118, No.4

2595 RE-OPERATION FOLLOWING LAPAROSCOPIC FUNDOPLICA· TION. Thomas C. Dehn, Garett Smith, Jane M. Stratford, Royal Berkshire Hosp, Reading, United Kingdom. Aim: To ascertain the rate and cause of re-operation in patients undergoing laparoscopic fundoplication (LF). Method: Prospective data collection on a palm-top computer. Results: Between 4/1193 and 30/10/99, 230 consecutive patients, age 38 (10 - 82 years) underwent LF. 15 (6.5%) required re-operation at between 4 hours and 78 months ( 8 from the first fifty cases and 5 from the second fifty). Details of re-operated cases are in the table below. Conclusion: Wrap herniation and dysphagia were preventable by altering surgical technique. Other complications and the need for reoperation were not predictable. Re-operation is technically demanding and may not be achieved Iaparoscopically.

total 94.6% ~2.9%, upright 93.4% ~3.5%, and supine 96.1% ~3.3%. Conclusions: ) Gastric fundus is the optimal location to position pH electrode when measuring gastric acidity. 2) Gastric fundus pH values are highly reproducible 3) In healthy subjects, gastric fundus pH remains < 4 greater than 90% of time.

Details ofre-operated cases following laparoscopic fundoplication.

Indication for reoperation

N

Case No.

Time post·op (months)

Laparoscopic re·operation?

Mediastinal wrap herniation Intractable dysphagia Gas bloat Wrap disruption Ca·in·situ Haemorrhage Caecal volvulus Wrap perforation

6 2 2 1 1 1 1 1

1,2,3,16,30,86 1,20 69,177 84 12 71 48 205

0,5-78 6,2 12,10 27 14 0 0,5 0,125

0/6 0/6 2/2 1/1 0/1 0/1 0/1 011

2596 THE GASTRIC CARDIA IN GASTRO·ESOPHAGEAL REFLUX DISEASE. Hala M. EI-Zimaity, Vino J. Verghese, Jacqueline Ramchatesingh, David Y. Graham, VAMC and Baylor Coil of Medicine, Houston, TX. Background: There have been conflicting reports concerning the usefulness of cardia biopsies in screening for Barrett s in patients with GERO. AIM: To define the histopathological changes in the gastric cardia of patients with and without GERO. Methods: Topographically mapped gastric biopsy specimens were obtained from patients with GERD and from controls. Biopsies were scored on a visual analog scale of 0 to 5 for H. pylori, intestinal metaplasia, pancreatic metaplasia, foveolar hyperplasia, and active inflammation. The presence or absence of cardiac glands was recorded. In most cases, a lesser curve antral biopsy and a greater curve corpus biopsy were also taken for culture. All cases were confirmed as H. pylori positive or negative based on the consistency of these tests. Results: 65 GERD patients and 71 controls were examined. Intestinal metaplasia was present in cardia biopsies of 10 patients with GERD (15%) as compared to II controls (16%) (p = n.s.). Only 2 GERD patients (3%) with intestinal metaplasia in the cardia had no evidence of exposure to H. pylori. Intestinal metaplasia was not found in the cardia of those with long segment Barrett s. Carditis was strongly associated with active H. pylori infection (p
2597 AMBULATORY GASTRIC PH MONITORING - PROPER PROBE PLACEMENT AND NORMAL VALUES. William K. Fackler, Michael Fredrick Vaezi, Joel E. Richter, Cleveland Clin Fdn, Cleveland, OH. Background:Monitoring ambulatory gastric pH in pts with gastroesophageal reflux disease (GERD) is gaining popularity, especially in those with difficult to manage symptoms. To date, the optimal positioning of the gastric probe is neither standardized nor validated. Purpose: To identify the region most representative of gastric pH, evaluate reproducibility of gastric pH in this region, and define the normal gastric pH values in healthy subjects. Methods: LES identified manometrically in all subjects. 24 hour ambulatory pH monitoring performed with 2 simultaneous, dual electrode pH probes. One electrode located 5 cm proximal and the other 10 em distal to LES in gastric fundus. Second pH probe placed under fluoroscopic guidance: one electrode in antrum and other 10 cm proximal in gastric body. Reproducibility of pH tracings from most acidic gastric region assessed using two simultaneous, dual electrode pH probes positioned in same gastric vicinity. Normal data calculated based on gastric pH values from 20 healthy subjects. All probe locations confirmed by fluoroscopy after placement and prior to removal. Results: Based on 5 subjects, mean % total time pH<4: fundus 92.2%; body 90.1%, and antrum 54.6% (Figure 1). Antral pH was markedly influenced by nighttime alkaline tide. pH values from the fundus were highly reproducible (linear regression p=O.OO4, i2=0.96) in a separate series of 5 subjects. Normal values (mean ~95'hpercentile) for % time gastric pH<4 in fundus in 20 normal subjects:

Fundus

Body

Antrum

2598 CHILDHOOD GASTROESOPHAGEAL REFLUX (GER) SYMPTOMS IN ADULT PATIENTS WITH GER SYMPTOMS. Mark 1. Feiler, Benjamin D. Gold, John G. Hunter, C. Daniel Smith, 1. Patrick Waring, Emory Univ Sch of Medicine, Atlanta, GA. Introduction: The natural history of childhood-acquired GER is unknown. Aim: To determine the frequency of childhood reflux symptoms in adult patients with and without gastroesophageal reflux symptoms. Methods: Patients seen in the Outpatient GI Clinics and Swallowing Clinics from 9/1199 to 11123/99 were surveyed. Patients were asked about symptoms related to GER as infants and children (i.e., spitting up, abdominal or chest pain, abdominal or chest burning, dysphagia, failure to thrive, or asthma). Patients were categorized as adult refluxers or non- refluxers. Comparisons were made using X-square analysis. Results: 400 patients responded, 225 had adult reflux, 154 were non-refluxers, 21 patients claimed to not know. 141 of the 225 refluxers had at least one childhood symptom compared to 54 of the 154 non-refluxers (p
Spitup-infant Abdomlchest pain Abdomlchest bum Dysphagia Underweight Asthma MedforGERD Surgery forGERD

Refluxers N=225

Non·Reflux N=l54

p

23(8,8%) 48(21,3%) 67(29.7%) 52 (23,1%) 47(20,1%) 50(22,2%) 31 (13,7%) 10(4.4%)

6(38%) 17(110%) 14(g,O%) 20(12,9%) 18(11.6%) 9(5,8%) 3(1,9%) 0(0%)

.02 <.01 <.001 ,01 ,02 <001 <,001 <,01

2599 ASSOCIATION BETWEEN DUODENOGASTRIC AND DUODENOGASTROESOPHAGEAL REFLUX. Martin Fein, Karl H. Fuchs, Joern Maroske, Stefan M. Freys, Harald Tigges, Arnulf Thiede, Dept of Surg, Wuerzburg, Germany. Purpose: In the past, duodenogastric (DGR) has been assessed by aspiration, pH-monitoring, or scintigraphy. Bilirubin monitoring allows long term measurements of one component of DGR. It has been widely applied for the quantification of duodenogastroesophageal reflux (DGER). The aim of this study was to relate gastric to esophageal bilirubin exposure. Methods: 24-hour gastric bilirubin monitoring was performed in 312 patients (197 m, 115 f; age 51 ~ 14y) with symptoms offoregut disease. Of these, 273 had simultaneous esophageal bilirubin monitoring. All patients had endoscopy, esophageal manometry and 24-hour pH monitoring. Bilirubin exposure was measured as the percentage total time above an absorbance threshold of 0.25 in the stomach and 0.14 in the esophagus. Probe position in the stomach was 5 em below the lower border of the LES. Previous surgery was gastric resection (BI or BII) in 18, cholecystectomy in 22, and other operations on the foregut in 22 patients. GERD documented by an increased esophageal acid exposure (score > 14,7) or the presence of esophagitis was present in 186 patients (Barrett s n=39, esophagitis n= 104, no esophagitis n=43) compared to 86 patients with normal acid exposure and no esophagitis. Results: Gastric bilirubin exposure was highest following gastric resection (57.2 ~ 27.3%, p