Clinical and manometric features of the hypoplastic esophagus

o1 rabbit esophageal epithelium were mounted in Ussing chambers and exposed luminally for 1 hr to Ringer soJution, pH 7.4, or to Ringer containing aJendronate (lOmg/ml) while monitoring the transepithelial potential difference (PD). short circuit current (Isc) and electrical resistance (R). RESULTS:(means_+SEand n=5-8/group). Alendronate in a time-dependent manner significantly increased PD and Isc (54_+6% and 64+-7% vs control of -10-+3% and 15-+2% respectively) while producing a minimal reduction in R (7+_1% vs control of 5_+2%). This rise in PD and Isc was not due to extra sodium liberated into the luminal bath from the drug (sodium-alendronate). Further, the increase in PD and Isc was compfate~yabolished in tissues pretreated serosally with ouabain, an inhibitor of basolateral membrane Na*,K +ATPase, or whose luminal bath was acidified to pH 2.0, the latter a means for blocking the apical membrane Na+ channel in esophagealepithelium. CONCLUSION:These results suggest that alendronate: a) does not damage the esophagus by direct alteration of its epithelial permeability barrier, b) has a direct stimuiatory effect on net ion (likely Na*) transport across the epithelium and c) stimulates net ion transport by increasing cation (Na') permeability through apical membrane cation channels in esophagealepithelium. It is unclear whether this change in ion transport by aiendronate plays a role in the pathogenesis of esophageal injury.

1268 Electronic Database For Assessment and Prediction of Outcome idler IntenmMion For Upper GI Haemorrhage. Fortunato D. Castillo, St Bartholomew's and the Royal London Sob of Medicine, London United Kingdom; Sean G. Nugent, Mark Appleyard, Louise F. Langmaad, Matthew Guinane Background: The management of acute upper gastrointestinal haemorrhage (UGIH) is aided by the assessmentof clinical and endoscopic parameters.Accurate scoring of these parameters allows for the prediction and outcome of endoscopic therapy. Aim: We developedan electronic database based on the published data on management of upper GI haemorrhage,which could be used to assess the risk of rebleeding and the outcome of intervention and which could be incorporated into existing endoscopy software packages, thus facilitating Clinical audit. Methods: We designed a user-friendly electronic database, which requires the endoscopist to select options based on the patient s clinical status and endoscopy findings. The database then automatically calculates the Rockall score passed on this information and also provides the endoscopist with the predicted likelihood of rebleedingwithout intervention. The endoscopy findings can also be entered and based on the presence or absence of stigmata the database will automatically calculate the probability of rebleeding. The database also contains a review of the published data on the outcomes of the various endoscopic modalities available for upper GI haemorrhage. The endoscopist can select a mndality of intervention and see the current published data on risk of further bleeding, surgery and sundvat. Results: This is a simple to use database, which can easily be, accessed from existing endoscopy software packages but has the additional clinical informal/on to help assess UGIHand accurately predict outcome based on the published literature. The database also records the clinical details of all the UGIH and can be used to determine the endoscopy units outcomes after endoscopic intervention. Conclusion: We hope others will find this a helpful software utility to aid in the assessment of UGIH; prediction of outcome of endoscopic therapy based on the published data and also provide an electronic database for further research or clinical audit of an endoscopy units activity.

1269

1270 Axial Asymmetry in the Lower Esophageal Sphincter: Comparison Between Patients With Achalasia of the Esophagusand Normal Subjects Jianmin Liu, Univ of CA San Diego and San Diego VAMC, San Diego, CA; James L. Puckett, Univ of CA, San Diego, San Diego, CA; Nonko Pehlivanov, Ravinder K. Mittal, Univ of CA San Diego and San Diego VAMC, San Diego, CA There are conflicting data on the LES muscle thickness in patients with achalasia compared to normal subjects. Using high frequency intraluminal ultrasound (HFIUS) we found an axial asymmetry in the muscle thickness of normal subjects with the thickest muscle in the center. Previous studies on LES muscle thickness in achaiasia did not take into account the axial asymmatry. AIM: To compare the muscle thickness and axial asymmetry in patient with aohalasia and normal subject using HFIUS. METHODS: 10 normal subjects and 20 patients with achalasia were studied. Simultaneous recordings of the LES pressure(by a side hole) and HFIUS images (using a 20 MHz, 2 mm diameter HFIUS probe) were performed using a station pull through technique. Measurements were made every 0.5 cm along the length of the LES. The HFIUS image of the LES at each level was digitized and the thickness of the muscuiaris propria (circular and longitudinal muscle) and the corresponding LES pressure was measured using an image analysis software. RESULTS:The muscle thickness in achalasia is significantly greater than normal subjects along the entire length of the LES. Normal subjects show an axial asymmetry with the peak thickness at the center of the LES. On the other hand patients with achalasia have the thickest muscle at the upper end of the LES. Normal subjects show a good correlation between the muscle thickness and LES pressure. This correlation was absent in schalasia patients. CONCLUSIONS: Axial muscle distribution in the LES is different in patient with achalasia compared to normal subjects. The temporal correlation between muscle thickness and pressure seen in normal subjects is absent in achalasiapatients. Levd

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1271

Clinical And Manometric Features Of The HypopfasticEsophagus Duff M. Bruce, Cedric G. Bremner, James E. Huprich, Christopher G. Streets, Farzaneh Banki, Nagammapudur S. Balaji, Peter F. Crookes, Jeffrey A. Hagen, Michael A. Kline, Rndney J. Mason, Jeffrey H. Peters, Tom R. DeMeester, Univ of Southern CA, Los Angeles, CA

Background:The hypoplastic esophagus syndrome describes symptomatic, diffuse narrowing of the esophagus, which cannot be attributed to acquired diseases (gastro-esophageal reflux, caustic ingestion, eosinophilic esophagitis or mucosal inflammation). The etiology of this rare condition is unknown and descriptions of clinical presentation and esophageal physiological characteristics are rare. Objective: The aim of this study was to describe clinical aspects and manometric assessment of the hypoplastic esophagus. Methods: Eight suspected patients were identified in a lO-year period. Esophagealdiameters, corrected for magnification, were measured on an upper-GI series oblique view taken in the prone position. The patient was asked to drink barium as rapidly as possible. Patients, with dysphagia, an esophagealdiameter less than 20mm and with no evidence of acquired diseases were included in the diagnosis. The esophageal diameters of 10 asymptomatic control patients were measured in the same way, for reference. The data are presented as medians and ranges. Results: Six of the 8 patients were male. Oysphagia for solids began at a median age of 11(0 -31) years. All had diffuse narrowing on video-esophagram. The median maximum esophageal diameter was 14 (12-20) mm, which was smaller than that of age-matchad normals (25.5 (22-32) ram). Two patients had radiologicat evidence of small hiatus herniae. Segmental esophageal contraction amplitudes lay at the lower end of normal values. Median pressures were 50, 61, 63 and 43 mmHg at 20, 15, 10 and 5 cm above the lower esophageal high-pressure zone (LEHPZ), respectively. Two of the patients had more than 20% simultaneous contractions of an esophageal segment. LEHPZ overall length was 2.6 (1-4) cm, intra-abdominal length 1.6 (0.6-2.8) cm and pressure 12.8 (3.6-24.4) mmHg. Ambulatory 24hour-pH studies were undertaken in 6 patients and showed no evidence of abnormal distal esophagealacid exposure. All patients were treated by dilatation under general anaesthesia, to a median size of 51(36-60) French. This was difficult in all and caused linear mucosel tears in 5. Follow up is available in 5/8 at 1 - 48 months. Three patients are symptom free 1-20 months after dilatation and two have persistent dysphagia. Conclusion: This paper defines the anatomical and functional characteristics of patients with hypoplastic esophagus. Whilst dilatation may help some, persistent dysphagia may warrant consideration of esophageal replacement in others.

Fundiu Gland Polyps and Chronic PPI Treatment: A Prospective Study. Ann Reekmans, Naegels Serge, Hendrik Reynaert, Daniel Urbain, Univ Hosp Free Univ Brussels (AZ-VUB), Brussels Belgium Background & Aim: Fundic gland polyps (FGP) were first described in patients with familial polyposis coil Later, FGP were also reported to occur sporadically in gastric oxyntic mucosa in patients without polyposis coli syndrome. FGP are composed of normal-appearing fundic glands with an increased number of chief and parietal cells. Previous small retrospective studies suggested a role for proton pump inhibitors (PPI) in the development of FGP. The aim of this prospective study was compare the prevalence of FGP in patients on chronic (at least 1 year) PPI therapy and a control population. Methods: For 6 months all patients presenting to our endoscopy unit for a variety of reasons were evaluatedfor the presence of FGP.All polyps were processed for routine histologic examination. Biopsies were also examined for the presence of H. Pylori (HP) and in patients with polyps, serum gastrin was measured. Statistical analysis was performed using Statview 5.0. The presence or absence of FGP and HP in different groups was compared by chi-square (x2)test and Fisher' s exact test. Studentt test was used to compare gastrin levels in patients with and without FGP (mean + / SEMi. Results: A total of 2981 patients eligible for analysis underwent endoscopy. In 27 patients (0.9%) FGP were identified. FGP occurred in 20 female and in 7 male patients: X2 = 5.06; Fisher' s exact P = 0.03. 115 (3.8%) Patients received long term treatment with PPI (group 1) and 2866 (96.2%) did not (group 2). Observed frequency of FGP was 7.8 % in group 1 vs. to 0,6 % in group 2: x 2 = 60.8; Fisher' s exact P< 0.0001. In group 1, no differences were found between the presence of FGP and gender [13.0 % in female and 4.3 % in male: X2 = 2.8 (NS)] and between the FGP and HP [7.5% in HP negative vs. 0 % in HP positive patients: X2 = 0.73 (NS)J. Serum gastrin levels were not statistically significantly different in patients with FGP (145 + / - 26 ng/L) and without FGP (164 + / - 14 ng/L)(NS). In group 2, FGP tended to occur more frequently in females (0.9%) than in males (0.3%): x 2 = 4.44 (Fisher' s exact P =0. 055). Conclusions: In this prospective study, FGP occurred more frequently in females and in patients chronically treated with PPI. No clear relationship between the presence of FGP and serum gastrin levels or the presence of HP was obsemed. These results are in agreement with findings in previous non-prospective studies.

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