- Email: [email protected]
Esophageal Foreign Body Impaction Presenting to the Emergency Department: Time Trends, Utilization and Treatment Modalities
AGA Abstracts
secretion was significantly inhibited by atropine and famotidine, respectively. Acute intragastric administration of capsaicin significantly and dose-dependently attenuated basal acid secretion in awaken mice, yet BCTC by itself was not affected basal acid secretion. Pretreatment of a TRPV1 blocker BCTC was significantly reversed the attenuation of basal acid secretion in response to capsaicin. In addition, gastric mucosal application of capsaicin (0.33-3.3 mg/ml) significantly increased in GMBF in a dose-dependent manner in urethaneanesthetized mice, which is completely inhibited by mucosal co-application of BCTC (0.6 mg/ml). When the mucosa was exposed to capsaicin (3.3 mg/ml) repeatedly, this response showed a marked tachyphylaxis. CONCLUSION: These results suggested that acute effect of capsaicin inhibited acid secretion and increased in GMBF through activation of TRPV1expressing neurons. It is assumed that ingestion of some diets contain capsaicin regulates gastric acid secretion and GMBF lead to modify functional dyspeptic symptoms acutely.
growth factors and heat shock proteins (HSP) in ethanol-induced gastric ulcers in rats Methods: 8 week-old 56 Sprague-Dawley rats were randomly divided into EsomeprazoleSr(ES) group and control groups according to administration dosage (30, 100 mg/kg), and were subjected to oral administration of 2ml of 100% ethanol to induce gastric mucosal damage. Rats were sacrificed 1 hour later and the stomach was removed. And we obtained pathologic ulcer indexes. After that tissue samples were ground with tissue buffer and lysed by sonication and centrifuged. Western blot analysis was used to evaluate factors such as cytokines, growth factors, DNA repair enzyme, heat shock proteins (HSP) between ES group and control group. Results: Pathological ulcer indexes in the ES group were significantly lower as compared to the control group. Inflammatory cytokine (IL-6, IL-8, TNF-α) levels were also decreased after ES administration, whereas growth factors PDGF-B and NGF were significantly increased in accordance with ES dosage levels. Furthermore, HSP 70 and 78 showed significantly elevated levels in accordance with ES dosage levels. Conclusion: In the rat model, ES administration improved the ethanol-induced ulcers, and showed antiinflammatory properties and mucosal protective effects via inflammatory cytokine reduction and growth factors expression increases, respectively. Furthermore, ES had cytoprotective effects through the increasing HSP.
Tu1063 MUC5AC and MUC6 Expression Remains Unchanged in H. pylori/NSAIDNegative Gastric Ulcer (Idiopathic Ulcer) Yaron Niv, Doron Boltin, Alex Vilkin, Zohar Levi
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Introduction: The incidence of idiopathic ulcer (IU) is increasing. IU has unique clinical and endoscopic features, and is associated with more bleeding complications and a higher mortality. Alterations in gastric mucin secretion may play a role in the pathogenesis of IUs. We aimed to investigate whether IUs are associated with altered mucin expression, compared to H. pylori or NSAID induced ulcers. Methods: All cases of non-malignant gastric ulcers were revised. We randomly selected patients with H. pylori, NSAID, combined H. pylori and NSAID and patients with H. pylori/NSAID-negative gastric ulcer. Paraffin embedded tissue was obtained and sections of the mucosa from the ulcer margins were stained immunohistochemically for MUC5AC and MUC6. Results: 59 patients were included, 31 males (52.5%), mean age 72.1±9.53 y, 14 patients in the H. pylori, 16 in the NSAID, 15 in the combined and 14 in the H. pylori/NSAID-negative group. MUC 5AC was expressed strongly on the surface epithelium (57 cases, 96.6%) and neck glands (56 cases, 94.9%) but not in the deep glands. MUC 6 was expressed in the deep glands (47, 79.7%) but not in the surface epithelium (0 cases) or neck glands (1, 1.7%). The pattern of MUC5AC and MUC 6 expression in IU margins was not different from the expression in ulcers associated with H. pylori (p= 0.98 & p=0.46), NSAID (p=0.94 & p=0.50), or combined H. pylori and NSAID (p=0.56 & p=0.14, respectively). Conclusion: There appears to be no change in mucin expression in IU compared with ulcers associated with H. pylori or NSAID use.
A Retrospective Observational Analysis of Food Bolus Impaction (FBI) Presentations Within Regional Australia (Rural North Queensland) Rozemary Karamatic, Jenine Lawlor, John Croese, Gillian Mahy Food bolus impaction (FBI) is frequently encountered within endoscopic practice. Factors that contribute to this other than eosinophilic oesophagitis (EO) have not been well characterised within the Australian context. The incidence may vary according to diet, lifestyle and geographic factors. The aim of this study was to retrospectively analyse consecutive cases of oesophageal FBI to determine the epidemiology, aetiology, management and complications of FBI presentations within our region. Methods: We performed a retrospective review of consecutive adult cases of endoscopically managed FBI from 1 January 2005 until 31 December 2009 at the Townsville and Mater Hospitals (Townsville, Queensland (QLD)). Our centre is the sole regional referral centre for North Qld. Cases were identified by analysis of emergency department records, endoscopy databases, coding search results and private practice data. Inclusion criteria were clinical presentation and history consistent with FBI with subsequent gastroscopy for management of that FBI. The study was approved by the Townsville Hospital Human Research Ethics Committee. Results: There were a total of 108 patients presenting with FBI. The estimated incidence rate has been increasing and the average is 9 episodes per 100,000. The Aboriginal and Torres Strait Islander incidence was estimated at 19.2 per 100,000. The median age of men was 55 years (range 13-82) and women 56.5 years (range 16-94) (p=0.25). The male to female ratio was 2.38:1 (p<0.05). Patients were more likely to present during the warmer months although this trend was not significant. Remoteness was associated with FBI. The type of food bolus was predominantly meat (n=88, 81.5%) - the majority with steak (n=34, 31%). Two thirds (60.2%) of procedures in public hospitals were managed with conscious sedation using an average of 5mg midazolam and 100mcg fentanyl. The most common endoscopic management of FBI was the push technique (43.1%). Complications included: oesophageal perforation (n=1, 1%); bleeding (n=2, 2%), requirement for general anaesthetic (n=5, 4.6%). A significant proportion of patients had underlying oesophageal disease (n=88, 81.5%), particularly EO (n=24, 22.2%). Glucagon administration prior to endoscopy showed a trend towards effectiveness but this was not statistically significant. Summary: Our data suggest that FBI is a common occurrence within this regional/rural district and occurs more commonly in males than females. There appeared to be an association with season and type of food ingested which may reflect the northern Australian lifestyle. As in previously published series, glucagon administration did not appear effective for the management of FBIs and the majority of cases were safely managed using the push technique with conscious sedation.
Tu1064 Proton Pump Inhibitors Increase the Incidence of Bone Fractures in Hepatitis C Patients Michael Mello, Rick Weideman, Byron L. Cryer, Bert Little, Geri Brown Background: While proton pump inhibitors (PPI) are a known risk factor for bone fractures, the incidence of bone fractures in a population with chronic hepatitis C viral (HCV) infection with or without PPI exposure has not been explored. Methods: A retrospective cohort study of the incidence of bone fractures over 10 years from 1/1/2000 through 9/30/2010 in 9437 HCV antibody positive veterans in the Dallas VA Hepatitis C Registry was performed. The primary study endpoint was incidence of new bone fractures per patient-years (pt-yrs) of study in PPI users compared to non-PPI users. All new non-traumatic bone fractures occurring during the 10 yr period, excluding skull fractures, were included and were first identified using the relevant ICD-9 code. Each potential fracture was confirmed by detailed review of the electronic health record of all patients identified with bone fractures. Only fractures with radiographic evidence of new bone fractures were included. PPI use was defined as those taking a PPI for ≥ 360 days. Pt-yrs of exposure for PPI users began on the first PPI prescription date and pt-yrs of exposure for non-PPI users began with first date of any nonPPI prescription following the initial study evaluation period date (1/1/2000). For both HCV groups (PPI and non-PPI users), the final date of patients' study duration was defined by end of PPI exposure, bone fracture occurrence, death or end of study evaluation period (9/ 30/2010). Exclusion criteria included those with prescriptions for calcium, vitamin D, corticosteroids, carbamazapine, rifampin, rifaximin, bisphosphonates, LHRH agonists, interferon, ribavirin, loop or thiazide diuretics for ≥ 30 days. Statistical differences in fracture incidence (fractures/pt-yrs) between chronic HCV PPI and non-PPI users were determined by multivariate regression analysis. Results: Our cohort was 97.3% male with a mean age of 49.7 years. 2205 patients (23.4%) were long-term (≥ 360 days) PPI users. There were no differences in race between our two groups. Bone fractures occurred in 337 patients over the 10 yr period. Unadjusted bone fracture incidences were 12.5/1000 pt-yrs vs. 4.3/ 1000 pt-yrs in PPI and non-PPI users, respectively. After adjusting for differences in age, gender and race between groups, the hazard ratio was 3.86 [(2.26-6.59) 95% C.I., p < 0.01]. Conclusions: In patients with chronic HCV, use of PPI for more than 1 year increased the risk of new bone fractures by more than 3-fold. Since our study cohort is predominantly male, we speculate that the risk of bone fractures in females with HCV and long-term PPI use could be even higher.
Tu1067 Esophageal Foreign Body Impaction Presenting to the Emergency Department: Time Trends, Utilization and Treatment Modalities Sarah L. Sperry, Seth D. Crockett, C. B. Miller, Nicholas J. Shaheen, Evan S. Dellon Background: Esophageal foreign body impaction (EFBI) often results in presentation to an emergency department (ED). Characteristics of ED service utilization, treatment choices and related time trends for EFBI patients are not well described. Aim: To assess ED utilization and characteristics for patients with EFBI, with a focus on time of presentation, type of impaction, medical therapy and time to therapeutic procedure. Method: Cases of EFBI from 2005 to 2009 were identified by querying the University of North Carolina Hospital's billing database (2005-2009), clinical database (2006-2009), and endoscopy database (2005-2009) for all records with ICD-9 code “935.1- foreign body in the esophagus.” Charts were reviewed to confirm EFBI and to extract all pertinent data related to the ED visit, including time of presentation, length of ED stay, diagnostic work-up, medications administered, and time to therapeutic procedure. Results: Of the 479 cases of EFBI that were identified, 318 subjects presented to the ED (58% male, 66% Caucasian, mean age 32 ± 30 yrs). There were 47 EFBIs in the ED in 2005, 75 in 2006, 57 in 2007, 69 in 2008 and 70 in 2009. 188 (59%) were food impactions, 92 (29%) were coin impactions and 38 (12%) were other items or were unspecified. A total of 107 (34%) patients received a medication to treat EFBI, the most common of which were glucagon (70%) and nitroglycerin (52%), but this was only effective in 9% of those patients. 261 (82%) subjects underwent a procedure and 162 (51%) were admitted to the hospital. Procedures included EGD (62%), ENT-performed laryngoscopy or esophagoscopy (43%), or multiple procedures (5%). No significant relationship was observed between delivery of ED medications and likelihood of undergoing a procedure or between ED arrival time and delivery of medications. Contrary to our hypothesis, there was also no relationship between ED arrival time and time-to-procedure, or between ED arrival time and total time in ED. The time-to-procedure was shorter in patients who received EFBI medications compared to those who did not (8 hrs vs. 11 hrs; p<0.04), likely because the majority of patients with coin or battery impactions were children who did not receive medications and who received general anesthesia for their procedure. Patients with
Tu1065 The Effects of Esomeprazole Strontium on Inflammatory Cytokines, Growth Factors and Heat Shock Proteins in Ethanol Induced Gastric Animal Model Hyuk Soon Choi, Yoon Tae Jeen, Bora Keum, Yong Sik Kim, Hong Sik Lee, Hoon Jai Chun, Chang Duck Kim, Ho Sang Ryu, Sung Chul Park, Ji-Youn Lim, Donggeun Sul Background: Esomeprazole strontium (ES) is a new proton pump inhibitor, and is composed of 4 molecules of water bound to the strontium salt of S-omeprazole. This S-omeprazole strontrium tetrahydrate is a novel material changed salt that improves on the insoluble properties of magnesium trihydrate, which was developed in Korea (Hanmi Pharm. Co. Ltd). However, there are currently no systematic studies that investigate its effect of cellular damage and repair. This study investigates the effects of ES on inflammatory cytokines,
AGA Abstracts
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non-food impactions were more likely to undergo a procedure than those with a food impaction (90% vs. 79%; p=0.007). Conclusions: The majority of patients with EFBI at our institution between 2005 and 2009 presented to the ED. Medical management was largely ineffective, and a therapeutic procedure was required to clear the EFBI in most patients. Time of ED arrival made no difference in time-to-procedure, indicating that GI and ENT specialists recognize and address the urgency of treating EFBI regardless of time of day.
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Background: H. pylori infection is considered to cause the vast majority of cases of active and chronic gastritis. However, a recent study reported a large proportion (30-75%) of H. pylori-negative gastritis. We prospectively investigated the presence of active and chronic gastritis in H. pylori-negative individuals, considering potential influence of proton pump inhibitors (PPI). Methods: Esophagogastroduodenoscopy was performed in individuals between 40 and 79 years consecutively referred for elective endoscopy at a single large Veterans Affairs Medical Center. Patients with liver, lung, colon, breast, esophageal or stomach cancer were excluded. Gastric mapping biopsies were taken from all patients from 7 gastric sites (2 antrum, 4 corpus, 1 cardia). Features of active and chronic gastritis and gastric atrophy were identified and graded using the Updated Sydney System and OLGA stage, respectively. Two expert GI pathologists reviewed and scored all slides. To be considered as H. pylori-negative, an individual had to fulfill all three criteria: i) a negative triple staining of gastric mucosa in all 7 sites (hematoxylin and eosin, alcian blue at pH 2.5, and a modified silver stain), ii) a negative H. pylori culture iii) and a negative IgG H. pylori serology (HMCAP ELISA). Participants completed a questionnaire regarding lifestyle factors and PPI Use. Results: A total of 496 individuals were enrolled of whom 200 (40.3%) were found to have active or chronic gastritis of any degree in at least one of the seven gastric locations. Out of these 200 individuals, 40 (20.0%) tested negative for H. pylori using all three methods; most of these cases (30, 75.0%) had features of chronic gastritis, 5 (12.5%) had an active gastritis, and 5 (12.5%) had signs of both. Approximately one third of the H. pylori-negative gastritis cases was present in antrum and corpus sites (12), one third in a corpus site only (14), and one third in an antral site only (14); none was present in the cardia alone. Atrophy was present in 19 individuals (as represented by OLGA stage ≥1, median=1). Patients with H. pylori-negative gastritis were less likely to be current smokers (11.1% and 37.2% respectively; p<0.01), or current alcohol drinkers (35.1% and 51.1%; p=0.14) compared to the 160 patients with H. pylori-positive gastritis, while ever using PPIs was more frequent but not statistically significant (67.5% and 52.5%; p=0.08). Conclusions: A considerable proportion (20%) of patients with histologic gastritis were H. pylori-negative. While PPI use is a potential risk factor, the cause or clinical implications of this entity is not known. Characteristics of individuals with gastritis in the study population
Tu1068 The Birth Cohort Effect and Helicobacter pylori: Evidence for Stabilized Colonization Rates in Childhood in a Developed Country Caroline M. den Hoed, Anne Marie J. Vila, Guillermo I. Perez-Perez, Martin J. Blaser, Johan C. de Jongste, Ernst J. Kuipers Background: The prevalence of Helicobacter pylori (Hp) has, in developed countries, declined over the last decades. The increasing prevalence with age is presumably due to a birthcohort effect, with decreasing infection rates in subsequent generations. Research in 1978 and 1993 in 6 to 8 year old Dutch children showed a decline in prevalence of Hp from 19% in 1978 to 9% in 1993. Knowledge about birth-cohort-related Hp prevalence is relevant as a predictor for the future incidence of Hp-associated conditions. We assessed the prevalence of H. pylori in 551 Dutch children of native Dutch parents in 2005 and 2006. Aim: The aim of this study was to investigate whether the birth-cohort effect of H. pylori demonstrated in 1978 and 1993, has continued in the next 12 years. Methods: Anti-Hp IgG antibodies as well as anti-CagA IgG antibodies were determined in serum samples of Dutch children aged 7-9 years collected in 2005 and 2006, the PIAMA cohort. This cohort consisted of 551 children, but 6 were excluded because they were twins (n=545). The Hp and CagA antibodies were determined with ELISAs that have been extensively validated in children, with a sensitivity 94% for Hp colonization and 92.5% for colonization with a CagA-positive strain. Optical density ratio (ODR) values were calculated for each serum sample in relation to reference sera, with an ODR >1.0 positive for Hp and ODR>0.35 for CagA. All assays were performed at least in duplicate. ANOVA and X2 were used to determine consistency of test results over time and between researchers. Results: Of the 545 children (M/F 245/ 300, aged 7-9 years) the majority were of Dutch descent (91.5%); the others were either from Caucasian (2.5%), non-Caucasian (3%), or unknown (1.8%) descent. An Hp positivity rate of 9% was demonstrated (95% CI 6.6-11.4%). The prevalence of CagA antibodies was remarkably low [0.9% (95% CI 0.1-1.6%)]. No differences were demonstrated in Hp and CagA prevalence in relation to gender or ethnicity (p>0.05). We previously demonstrated a decrease in Hp rates in 6-8 year olds from 19% in 1978 to 9% in 1993, but no further decrease was demonstrated in this study. Conclusion: The prevalence of Hp in childhood has remained stable in the Netherlands from 1993 to 2005, suggesting a stabilization of the previous decreasing trend in subsequent birth cohorts. This finding may be due to stabilization in determinants such as family size, housing, and hygienic conditions. If confirmed in other populations in developed countries, it implies that colonization with Hp will remain common in the coming decades. Remarkably however, the rate of colonization with CagA-positive Hp strains has become very low, consistent with prior observations that CagA-positive strains are disappearing in Western countries. Tu1069 Birth-Cohort Patterns of Gastric Cancer and Peptic Ulcer Among Nonwhites in the United States. Amnon Sonnenberg Aims: The aim of the study was to follow the long-term time trends of mortality from gastric cancer, gastric and duodenal ulcer in the United States. It was hypothesized that the time trends among different ethnic groups would be shaped by similar birth-cohort patterns. Methods: Mortality data were retrieved from electronic records and published reports of the US National Center for Health Statistics. Ulcer and cancer data were available for the time periods 1923-2006 and 1930-2006, respectively. The historic populations of the US stratified by age, sex and race were retrieved from electronic records of the US Census Bureau. Age-specific death rates were calculated for consecutive 10-year periods and 10year age groups, stratified by sex and race. They were plotted against the period of death as period-age contours and against the period of birth as cohort-age contours. The time trends were also summarized as standardized cohort mortality ratios. Results: Between 1930 and 2006 1,440,221 people died from gastric cancer in the United States. During the same time period 287,186 people died from gastric ulcer and 234,908 people from duodenal ulcer. The age-specific death rates increased among birth-cohorts born during the 19th century and then declined in subsequent cohorts born during the 20th century. The occurrence of such birth-cohort patterns was observed in gastric cancer and both ulcer types. It occurred similarly in whites and nonwhites, as well as men and women. In all ethnic groups alike, the initial rise in mortality from gastric cancer and gastric ulcer preceded the rise of duodenal ulcer by 10-20 years. The two time lags between gastric cancer and gastric ulcer and between gastric and duodenal ulcer were most pronounced in whites. In nonwhites, the rise of gastric cancer occurred later than in whites and coincided with that of gastric ulcer. The initial rise in mortality from gastric cancer was more evident in nonwhites than whites. Conclusions: The birth-cohort pattern has been a ubiquitous phenomenon shaping the time trends of H. pylori-related disease similarly among different ethnic groups. During the 19th century, changes in diet or hygiene may have initially resulted in a decline of gastrointestinal infections by other organisms that in the past had kept any concomitant infection by H. pylori suppressed. As such suppression decreased the occurrence of H. pylorirelated diagnoses first increased. Subsequently, further improvements in hygiene during the 20th century must have also decreased H. pylori infection in the general population with a concomitant decline of mortality from gastric cancer, gastric and duodenal ulcer.
* Numbers might not add up due to missing data ** Negative on staining, culture and serology. † Positive on at least one of staining, culture or serology. Tu1071 Atrophic Gastritis and Salt Intake Hiroyuki Suto, Ikumi Yoshida, Akiyo Yamakawa, Kazuya Ohfuji, Takashi Ohno, Shinsuke Matsunaga, Satoko Satomi, Masahiro Ohtani, Soshoku Lee, Tomoyuki Nemoto, Yukinao Yamazaki, Takuji Kato, Takeshi Azuma Background and aim: Recently some reported that high salt intake is a risk factor of gastric cancer. However the relationship between atrophic gastritis and salt intake has not been well clarified yet. We investigated the relationship between the urinary sodium to creatinine ratio and the serum pepsinogen (PG) I/II ratio, which are the representative markers of salt intake and atrophic gastritis, respectively. Methods: We screened 331 employees (age range 30-55 years, mean age 43.6 years) of an industrial corporation for H. pylori infection with the 13C-urea breath test. Of these subjects, 99 were H. pylori-positive and 232 wereH. pylorinegative. They were examined the serum PG I, the serum PG II, the urinary sodium concentration and the urinary creatinine concentration in the early morning urine during two consecutive years. The relationship between the PG I/II ratio and the urinary sodium to creatinine ratio was investigated. The PG I/II ratio was classified into two groups in H. pylori-positive subjects: PG I/II ratio ≦3.0 and PG I/II ratio >3.0 was considered as atrophic gastritis (AG) group and non-AG group, respectively. Results: There was no significant difference between H. pylori-positive and H. pylori-negative subjects in the urinary sodium to creatinine ratio. The urinary sodium to creatinine ratio was significantly negatively correlated with the serum PG I/II ratio (p<0.05, coefficient of correlation=-0.23) in H. pyloripositive subjects in the second year. The urinary sodium to creatinine ratios in the AG group were significantly higher than those in non-AG group in the first year (p<0.01, AG: 15.0±1.6, non-AG: 11.9±0.8) and the second year (p<0.01, AG: 16.5±2.1, non-AG: 12.5±0.9). There was no significant correlation between the urinary sodium to creatinine ratio and the PG I/
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AGA Abstracts
The Prevalence of Helicobacter pylori-Negative Gastritis Helena Nordenstedt, Jennifer R. Kramer, Massimo Rugge, Gordana Verstovsek, Stephanie Fitzgerald, Rhiannon Dodge, Abeer Alsarraj, Yasser H. Shaib, Maria E. Velez, Neena S. Abraham, Bhupinderjit S. Anand, Rhonda A. Cole, David Graham, Hashem El-Serag
secretion was significantly inhibited by atropine and famotidine, respectively. Acute intragastric administration of capsaicin significantly and dose-dependently attenuated basal acid secretion in awaken mice, yet BCTC by itself was not affected basal acid secretion. Pretreatment of a TRPV1 blocker BCTC was significantly reversed the attenuation of basal acid secretion in response to capsaicin. In addition, gastric mucosal application of capsaicin (0.33-3.3 mg/ml) significantly increased in GMBF in a dose-dependent manner in urethaneanesthetized mice, which is completely inhibited by mucosal co-application of BCTC (0.6 mg/ml). When the mucosa was exposed to capsaicin (3.3 mg/ml) repeatedly, this response showed a marked tachyphylaxis. CONCLUSION: These results suggested that acute effect of capsaicin inhibited acid secretion and increased in GMBF through activation of TRPV1expressing neurons. It is assumed that ingestion of some diets contain capsaicin regulates gastric acid secretion and GMBF lead to modify functional dyspeptic symptoms acutely.
growth factors and heat shock proteins (HSP) in ethanol-induced gastric ulcers in rats Methods: 8 week-old 56 Sprague-Dawley rats were randomly divided into EsomeprazoleSr(ES) group and control groups according to administration dosage (30, 100 mg/kg), and were subjected to oral administration of 2ml of 100% ethanol to induce gastric mucosal damage. Rats were sacrificed 1 hour later and the stomach was removed. And we obtained pathologic ulcer indexes. After that tissue samples were ground with tissue buffer and lysed by sonication and centrifuged. Western blot analysis was used to evaluate factors such as cytokines, growth factors, DNA repair enzyme, heat shock proteins (HSP) between ES group and control group. Results: Pathological ulcer indexes in the ES group were significantly lower as compared to the control group. Inflammatory cytokine (IL-6, IL-8, TNF-α) levels were also decreased after ES administration, whereas growth factors PDGF-B and NGF were significantly increased in accordance with ES dosage levels. Furthermore, HSP 70 and 78 showed significantly elevated levels in accordance with ES dosage levels. Conclusion: In the rat model, ES administration improved the ethanol-induced ulcers, and showed antiinflammatory properties and mucosal protective effects via inflammatory cytokine reduction and growth factors expression increases, respectively. Furthermore, ES had cytoprotective effects through the increasing HSP.
Tu1063 MUC5AC and MUC6 Expression Remains Unchanged in H. pylori/NSAIDNegative Gastric Ulcer (Idiopathic Ulcer) Yaron Niv, Doron Boltin, Alex Vilkin, Zohar Levi
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Introduction: The incidence of idiopathic ulcer (IU) is increasing. IU has unique clinical and endoscopic features, and is associated with more bleeding complications and a higher mortality. Alterations in gastric mucin secretion may play a role in the pathogenesis of IUs. We aimed to investigate whether IUs are associated with altered mucin expression, compared to H. pylori or NSAID induced ulcers. Methods: All cases of non-malignant gastric ulcers were revised. We randomly selected patients with H. pylori, NSAID, combined H. pylori and NSAID and patients with H. pylori/NSAID-negative gastric ulcer. Paraffin embedded tissue was obtained and sections of the mucosa from the ulcer margins were stained immunohistochemically for MUC5AC and MUC6. Results: 59 patients were included, 31 males (52.5%), mean age 72.1±9.53 y, 14 patients in the H. pylori, 16 in the NSAID, 15 in the combined and 14 in the H. pylori/NSAID-negative group. MUC 5AC was expressed strongly on the surface epithelium (57 cases, 96.6%) and neck glands (56 cases, 94.9%) but not in the deep glands. MUC 6 was expressed in the deep glands (47, 79.7%) but not in the surface epithelium (0 cases) or neck glands (1, 1.7%). The pattern of MUC5AC and MUC 6 expression in IU margins was not different from the expression in ulcers associated with H. pylori (p= 0.98 & p=0.46), NSAID (p=0.94 & p=0.50), or combined H. pylori and NSAID (p=0.56 & p=0.14, respectively). Conclusion: There appears to be no change in mucin expression in IU compared with ulcers associated with H. pylori or NSAID use.
A Retrospective Observational Analysis of Food Bolus Impaction (FBI) Presentations Within Regional Australia (Rural North Queensland) Rozemary Karamatic, Jenine Lawlor, John Croese, Gillian Mahy Food bolus impaction (FBI) is frequently encountered within endoscopic practice. Factors that contribute to this other than eosinophilic oesophagitis (EO) have not been well characterised within the Australian context. The incidence may vary according to diet, lifestyle and geographic factors. The aim of this study was to retrospectively analyse consecutive cases of oesophageal FBI to determine the epidemiology, aetiology, management and complications of FBI presentations within our region. Methods: We performed a retrospective review of consecutive adult cases of endoscopically managed FBI from 1 January 2005 until 31 December 2009 at the Townsville and Mater Hospitals (Townsville, Queensland (QLD)). Our centre is the sole regional referral centre for North Qld. Cases were identified by analysis of emergency department records, endoscopy databases, coding search results and private practice data. Inclusion criteria were clinical presentation and history consistent with FBI with subsequent gastroscopy for management of that FBI. The study was approved by the Townsville Hospital Human Research Ethics Committee. Results: There were a total of 108 patients presenting with FBI. The estimated incidence rate has been increasing and the average is 9 episodes per 100,000. The Aboriginal and Torres Strait Islander incidence was estimated at 19.2 per 100,000. The median age of men was 55 years (range 13-82) and women 56.5 years (range 16-94) (p=0.25). The male to female ratio was 2.38:1 (p<0.05). Patients were more likely to present during the warmer months although this trend was not significant. Remoteness was associated with FBI. The type of food bolus was predominantly meat (n=88, 81.5%) - the majority with steak (n=34, 31%). Two thirds (60.2%) of procedures in public hospitals were managed with conscious sedation using an average of 5mg midazolam and 100mcg fentanyl. The most common endoscopic management of FBI was the push technique (43.1%). Complications included: oesophageal perforation (n=1, 1%); bleeding (n=2, 2%), requirement for general anaesthetic (n=5, 4.6%). A significant proportion of patients had underlying oesophageal disease (n=88, 81.5%), particularly EO (n=24, 22.2%). Glucagon administration prior to endoscopy showed a trend towards effectiveness but this was not statistically significant. Summary: Our data suggest that FBI is a common occurrence within this regional/rural district and occurs more commonly in males than females. There appeared to be an association with season and type of food ingested which may reflect the northern Australian lifestyle. As in previously published series, glucagon administration did not appear effective for the management of FBIs and the majority of cases were safely managed using the push technique with conscious sedation.
Tu1064 Proton Pump Inhibitors Increase the Incidence of Bone Fractures in Hepatitis C Patients Michael Mello, Rick Weideman, Byron L. Cryer, Bert Little, Geri Brown Background: While proton pump inhibitors (PPI) are a known risk factor for bone fractures, the incidence of bone fractures in a population with chronic hepatitis C viral (HCV) infection with or without PPI exposure has not been explored. Methods: A retrospective cohort study of the incidence of bone fractures over 10 years from 1/1/2000 through 9/30/2010 in 9437 HCV antibody positive veterans in the Dallas VA Hepatitis C Registry was performed. The primary study endpoint was incidence of new bone fractures per patient-years (pt-yrs) of study in PPI users compared to non-PPI users. All new non-traumatic bone fractures occurring during the 10 yr period, excluding skull fractures, were included and were first identified using the relevant ICD-9 code. Each potential fracture was confirmed by detailed review of the electronic health record of all patients identified with bone fractures. Only fractures with radiographic evidence of new bone fractures were included. PPI use was defined as those taking a PPI for ≥ 360 days. Pt-yrs of exposure for PPI users began on the first PPI prescription date and pt-yrs of exposure for non-PPI users began with first date of any nonPPI prescription following the initial study evaluation period date (1/1/2000). For both HCV groups (PPI and non-PPI users), the final date of patients' study duration was defined by end of PPI exposure, bone fracture occurrence, death or end of study evaluation period (9/ 30/2010). Exclusion criteria included those with prescriptions for calcium, vitamin D, corticosteroids, carbamazapine, rifampin, rifaximin, bisphosphonates, LHRH agonists, interferon, ribavirin, loop or thiazide diuretics for ≥ 30 days. Statistical differences in fracture incidence (fractures/pt-yrs) between chronic HCV PPI and non-PPI users were determined by multivariate regression analysis. Results: Our cohort was 97.3% male with a mean age of 49.7 years. 2205 patients (23.4%) were long-term (≥ 360 days) PPI users. There were no differences in race between our two groups. Bone fractures occurred in 337 patients over the 10 yr period. Unadjusted bone fracture incidences were 12.5/1000 pt-yrs vs. 4.3/ 1000 pt-yrs in PPI and non-PPI users, respectively. After adjusting for differences in age, gender and race between groups, the hazard ratio was 3.86 [(2.26-6.59) 95% C.I., p < 0.01]. Conclusions: In patients with chronic HCV, use of PPI for more than 1 year increased the risk of new bone fractures by more than 3-fold. Since our study cohort is predominantly male, we speculate that the risk of bone fractures in females with HCV and long-term PPI use could be even higher.
Tu1067 Esophageal Foreign Body Impaction Presenting to the Emergency Department: Time Trends, Utilization and Treatment Modalities Sarah L. Sperry, Seth D. Crockett, C. B. Miller, Nicholas J. Shaheen, Evan S. Dellon Background: Esophageal foreign body impaction (EFBI) often results in presentation to an emergency department (ED). Characteristics of ED service utilization, treatment choices and related time trends for EFBI patients are not well described. Aim: To assess ED utilization and characteristics for patients with EFBI, with a focus on time of presentation, type of impaction, medical therapy and time to therapeutic procedure. Method: Cases of EFBI from 2005 to 2009 were identified by querying the University of North Carolina Hospital's billing database (2005-2009), clinical database (2006-2009), and endoscopy database (2005-2009) for all records with ICD-9 code “935.1- foreign body in the esophagus.” Charts were reviewed to confirm EFBI and to extract all pertinent data related to the ED visit, including time of presentation, length of ED stay, diagnostic work-up, medications administered, and time to therapeutic procedure. Results: Of the 479 cases of EFBI that were identified, 318 subjects presented to the ED (58% male, 66% Caucasian, mean age 32 ± 30 yrs). There were 47 EFBIs in the ED in 2005, 75 in 2006, 57 in 2007, 69 in 2008 and 70 in 2009. 188 (59%) were food impactions, 92 (29%) were coin impactions and 38 (12%) were other items or were unspecified. A total of 107 (34%) patients received a medication to treat EFBI, the most common of which were glucagon (70%) and nitroglycerin (52%), but this was only effective in 9% of those patients. 261 (82%) subjects underwent a procedure and 162 (51%) were admitted to the hospital. Procedures included EGD (62%), ENT-performed laryngoscopy or esophagoscopy (43%), or multiple procedures (5%). No significant relationship was observed between delivery of ED medications and likelihood of undergoing a procedure or between ED arrival time and delivery of medications. Contrary to our hypothesis, there was also no relationship between ED arrival time and time-to-procedure, or between ED arrival time and total time in ED. The time-to-procedure was shorter in patients who received EFBI medications compared to those who did not (8 hrs vs. 11 hrs; p<0.04), likely because the majority of patients with coin or battery impactions were children who did not receive medications and who received general anesthesia for their procedure. Patients with
Tu1065 The Effects of Esomeprazole Strontium on Inflammatory Cytokines, Growth Factors and Heat Shock Proteins in Ethanol Induced Gastric Animal Model Hyuk Soon Choi, Yoon Tae Jeen, Bora Keum, Yong Sik Kim, Hong Sik Lee, Hoon Jai Chun, Chang Duck Kim, Ho Sang Ryu, Sung Chul Park, Ji-Youn Lim, Donggeun Sul Background: Esomeprazole strontium (ES) is a new proton pump inhibitor, and is composed of 4 molecules of water bound to the strontium salt of S-omeprazole. This S-omeprazole strontrium tetrahydrate is a novel material changed salt that improves on the insoluble properties of magnesium trihydrate, which was developed in Korea (Hanmi Pharm. Co. Ltd). However, there are currently no systematic studies that investigate its effect of cellular damage and repair. This study investigates the effects of ES on inflammatory cytokines,
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non-food impactions were more likely to undergo a procedure than those with a food impaction (90% vs. 79%; p=0.007). Conclusions: The majority of patients with EFBI at our institution between 2005 and 2009 presented to the ED. Medical management was largely ineffective, and a therapeutic procedure was required to clear the EFBI in most patients. Time of ED arrival made no difference in time-to-procedure, indicating that GI and ENT specialists recognize and address the urgency of treating EFBI regardless of time of day.
Tu1070
Background: H. pylori infection is considered to cause the vast majority of cases of active and chronic gastritis. However, a recent study reported a large proportion (30-75%) of H. pylori-negative gastritis. We prospectively investigated the presence of active and chronic gastritis in H. pylori-negative individuals, considering potential influence of proton pump inhibitors (PPI). Methods: Esophagogastroduodenoscopy was performed in individuals between 40 and 79 years consecutively referred for elective endoscopy at a single large Veterans Affairs Medical Center. Patients with liver, lung, colon, breast, esophageal or stomach cancer were excluded. Gastric mapping biopsies were taken from all patients from 7 gastric sites (2 antrum, 4 corpus, 1 cardia). Features of active and chronic gastritis and gastric atrophy were identified and graded using the Updated Sydney System and OLGA stage, respectively. Two expert GI pathologists reviewed and scored all slides. To be considered as H. pylori-negative, an individual had to fulfill all three criteria: i) a negative triple staining of gastric mucosa in all 7 sites (hematoxylin and eosin, alcian blue at pH 2.5, and a modified silver stain), ii) a negative H. pylori culture iii) and a negative IgG H. pylori serology (HMCAP ELISA). Participants completed a questionnaire regarding lifestyle factors and PPI Use. Results: A total of 496 individuals were enrolled of whom 200 (40.3%) were found to have active or chronic gastritis of any degree in at least one of the seven gastric locations. Out of these 200 individuals, 40 (20.0%) tested negative for H. pylori using all three methods; most of these cases (30, 75.0%) had features of chronic gastritis, 5 (12.5%) had an active gastritis, and 5 (12.5%) had signs of both. Approximately one third of the H. pylori-negative gastritis cases was present in antrum and corpus sites (12), one third in a corpus site only (14), and one third in an antral site only (14); none was present in the cardia alone. Atrophy was present in 19 individuals (as represented by OLGA stage ≥1, median=1). Patients with H. pylori-negative gastritis were less likely to be current smokers (11.1% and 37.2% respectively; p<0.01), or current alcohol drinkers (35.1% and 51.1%; p=0.14) compared to the 160 patients with H. pylori-positive gastritis, while ever using PPIs was more frequent but not statistically significant (67.5% and 52.5%; p=0.08). Conclusions: A considerable proportion (20%) of patients with histologic gastritis were H. pylori-negative. While PPI use is a potential risk factor, the cause or clinical implications of this entity is not known. Characteristics of individuals with gastritis in the study population
Tu1068 The Birth Cohort Effect and Helicobacter pylori: Evidence for Stabilized Colonization Rates in Childhood in a Developed Country Caroline M. den Hoed, Anne Marie J. Vila, Guillermo I. Perez-Perez, Martin J. Blaser, Johan C. de Jongste, Ernst J. Kuipers Background: The prevalence of Helicobacter pylori (Hp) has, in developed countries, declined over the last decades. The increasing prevalence with age is presumably due to a birthcohort effect, with decreasing infection rates in subsequent generations. Research in 1978 and 1993 in 6 to 8 year old Dutch children showed a decline in prevalence of Hp from 19% in 1978 to 9% in 1993. Knowledge about birth-cohort-related Hp prevalence is relevant as a predictor for the future incidence of Hp-associated conditions. We assessed the prevalence of H. pylori in 551 Dutch children of native Dutch parents in 2005 and 2006. Aim: The aim of this study was to investigate whether the birth-cohort effect of H. pylori demonstrated in 1978 and 1993, has continued in the next 12 years. Methods: Anti-Hp IgG antibodies as well as anti-CagA IgG antibodies were determined in serum samples of Dutch children aged 7-9 years collected in 2005 and 2006, the PIAMA cohort. This cohort consisted of 551 children, but 6 were excluded because they were twins (n=545). The Hp and CagA antibodies were determined with ELISAs that have been extensively validated in children, with a sensitivity 94% for Hp colonization and 92.5% for colonization with a CagA-positive strain. Optical density ratio (ODR) values were calculated for each serum sample in relation to reference sera, with an ODR >1.0 positive for Hp and ODR>0.35 for CagA. All assays were performed at least in duplicate. ANOVA and X2 were used to determine consistency of test results over time and between researchers. Results: Of the 545 children (M/F 245/ 300, aged 7-9 years) the majority were of Dutch descent (91.5%); the others were either from Caucasian (2.5%), non-Caucasian (3%), or unknown (1.8%) descent. An Hp positivity rate of 9% was demonstrated (95% CI 6.6-11.4%). The prevalence of CagA antibodies was remarkably low [0.9% (95% CI 0.1-1.6%)]. No differences were demonstrated in Hp and CagA prevalence in relation to gender or ethnicity (p>0.05). We previously demonstrated a decrease in Hp rates in 6-8 year olds from 19% in 1978 to 9% in 1993, but no further decrease was demonstrated in this study. Conclusion: The prevalence of Hp in childhood has remained stable in the Netherlands from 1993 to 2005, suggesting a stabilization of the previous decreasing trend in subsequent birth cohorts. This finding may be due to stabilization in determinants such as family size, housing, and hygienic conditions. If confirmed in other populations in developed countries, it implies that colonization with Hp will remain common in the coming decades. Remarkably however, the rate of colonization with CagA-positive Hp strains has become very low, consistent with prior observations that CagA-positive strains are disappearing in Western countries. Tu1069 Birth-Cohort Patterns of Gastric Cancer and Peptic Ulcer Among Nonwhites in the United States. Amnon Sonnenberg Aims: The aim of the study was to follow the long-term time trends of mortality from gastric cancer, gastric and duodenal ulcer in the United States. It was hypothesized that the time trends among different ethnic groups would be shaped by similar birth-cohort patterns. Methods: Mortality data were retrieved from electronic records and published reports of the US National Center for Health Statistics. Ulcer and cancer data were available for the time periods 1923-2006 and 1930-2006, respectively. The historic populations of the US stratified by age, sex and race were retrieved from electronic records of the US Census Bureau. Age-specific death rates were calculated for consecutive 10-year periods and 10year age groups, stratified by sex and race. They were plotted against the period of death as period-age contours and against the period of birth as cohort-age contours. The time trends were also summarized as standardized cohort mortality ratios. Results: Between 1930 and 2006 1,440,221 people died from gastric cancer in the United States. During the same time period 287,186 people died from gastric ulcer and 234,908 people from duodenal ulcer. The age-specific death rates increased among birth-cohorts born during the 19th century and then declined in subsequent cohorts born during the 20th century. The occurrence of such birth-cohort patterns was observed in gastric cancer and both ulcer types. It occurred similarly in whites and nonwhites, as well as men and women. In all ethnic groups alike, the initial rise in mortality from gastric cancer and gastric ulcer preceded the rise of duodenal ulcer by 10-20 years. The two time lags between gastric cancer and gastric ulcer and between gastric and duodenal ulcer were most pronounced in whites. In nonwhites, the rise of gastric cancer occurred later than in whites and coincided with that of gastric ulcer. The initial rise in mortality from gastric cancer was more evident in nonwhites than whites. Conclusions: The birth-cohort pattern has been a ubiquitous phenomenon shaping the time trends of H. pylori-related disease similarly among different ethnic groups. During the 19th century, changes in diet or hygiene may have initially resulted in a decline of gastrointestinal infections by other organisms that in the past had kept any concomitant infection by H. pylori suppressed. As such suppression decreased the occurrence of H. pylorirelated diagnoses first increased. Subsequently, further improvements in hygiene during the 20th century must have also decreased H. pylori infection in the general population with a concomitant decline of mortality from gastric cancer, gastric and duodenal ulcer.
* Numbers might not add up due to missing data ** Negative on staining, culture and serology. † Positive on at least one of staining, culture or serology. Tu1071 Atrophic Gastritis and Salt Intake Hiroyuki Suto, Ikumi Yoshida, Akiyo Yamakawa, Kazuya Ohfuji, Takashi Ohno, Shinsuke Matsunaga, Satoko Satomi, Masahiro Ohtani, Soshoku Lee, Tomoyuki Nemoto, Yukinao Yamazaki, Takuji Kato, Takeshi Azuma Background and aim: Recently some reported that high salt intake is a risk factor of gastric cancer. However the relationship between atrophic gastritis and salt intake has not been well clarified yet. We investigated the relationship between the urinary sodium to creatinine ratio and the serum pepsinogen (PG) I/II ratio, which are the representative markers of salt intake and atrophic gastritis, respectively. Methods: We screened 331 employees (age range 30-55 years, mean age 43.6 years) of an industrial corporation for H. pylori infection with the 13C-urea breath test. Of these subjects, 99 were H. pylori-positive and 232 wereH. pylorinegative. They were examined the serum PG I, the serum PG II, the urinary sodium concentration and the urinary creatinine concentration in the early morning urine during two consecutive years. The relationship between the PG I/II ratio and the urinary sodium to creatinine ratio was investigated. The PG I/II ratio was classified into two groups in H. pylori-positive subjects: PG I/II ratio ≦3.0 and PG I/II ratio >3.0 was considered as atrophic gastritis (AG) group and non-AG group, respectively. Results: There was no significant difference between H. pylori-positive and H. pylori-negative subjects in the urinary sodium to creatinine ratio. The urinary sodium to creatinine ratio was significantly negatively correlated with the serum PG I/II ratio (p<0.05, coefficient of correlation=-0.23) in H. pyloripositive subjects in the second year. The urinary sodium to creatinine ratios in the AG group were significantly higher than those in non-AG group in the first year (p<0.01, AG: 15.0±1.6, non-AG: 11.9±0.8) and the second year (p<0.01, AG: 16.5±2.1, non-AG: 12.5±0.9). There was no significant correlation between the urinary sodium to creatinine ratio and the PG I/
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The Prevalence of Helicobacter pylori-Negative Gastritis Helena Nordenstedt, Jennifer R. Kramer, Massimo Rugge, Gordana Verstovsek, Stephanie Fitzgerald, Rhiannon Dodge, Abeer Alsarraj, Yasser H. Shaib, Maria E. Velez, Neena S. Abraham, Bhupinderjit S. Anand, Rhonda A. Cole, David Graham, Hashem El-Serag