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Gallbladder (GB) motility is important for gallstone (GS) clearance and recurrence afte extracorporeal shock-wave lithotripsy (ESWL)
A34
Abstracts
/Netherlands
Journal
therefore be at increased risk for atrophic gastritis during acid-suppressive therapy. We prospectively investigated the relation between Hp and atrophic gastritis during omeprazole maintenance therapy. Methods: 105 subjects (56 men, age at initial visit 62 (16-83) years) were continuously treated for a mean 5 years (3-6) with 20-40 mg omeprazole o.d. for reflex oesophagitis. All subjects underwent gastroscopy with biopsy sampling preentry and at annual follow-up. Gastric corpus biopsy specimens of both the pre-entry and the last visit were assessed by one pathologist according to the Sydney classification. The Hp status of each patient was assessed by silver-stained histological slides. Results: 46 patients were HP-negative; no new infections were noted during follow-up. Pre-entry, they all had no (n = 39) or only mildly active gastritis (n = 7) gastritis. After 5 years, only 2/46 (4%) had active corpus gastritis. 59 patients were HP-positive; pre-entry corpus gastritis activity scores were: negative (n = 24; 41%) mild (n = 25; 42%), moderate to severe (n = 10; 17%). After 5 years these scores were: negative (n = 11; 19%), mild (n = 18; 30%) moderate to severe (n = 30; 51%). Thus, both the prevalence (p= 0.007; Fisher exact) and the severity of active gastritis (p < 0.001; Student t-test) significantly increased. Development of atrophic gastritis was noted in 2/46 (4%) HP-negative patients and 18/59 (30%) HP-positive patients (p < 0.001; Fisher exact, OR 9.89; 2.2-45.2). In the HP-negative subgroup, prevalence of ECL cell hyperplasia was 8% and remained unchanged. In the HP-positive, ECL cell hyperplasia increased from 15 to 30% (p = 0.04; Fisher exact). Development of ECL cell hyperplasia was closely associated with Hp infection (p = 0.004; Fisher exact, OR 4.72; 1.47-15.1). Conclusions: During long-term acid-suppressive therapy, a persistent increase in corpus inflammation with substantive development of atrophic gastritis and ECL cell hyperplasia was observed in HP-positive patients, but not in HP-negative patients. We therefore recommend that Hp eradication be considered at the beginning of acid-suppressive maintenance therapy. Gallbladder (GB) motility is important for gallstone (GS) clearance and recurrence after extracorporeal shock-wave litbotripsy (ESWL). P. Portincasa ‘x2, K.J. van Erpecum ‘, P. van de Meeberg t, G.P. van Berge Henegouwen ‘. ’ Department of Gastroenterology, de Clinica Medica I, Bari
University University
Hospital Utrecht; 2 Istituto Medical School, Bari, Italy.
ESWL is an effective treatment in selected gallstone patients, but recurrence is a major drawback, particularly for patients with initially multiple stones. We examined several factors potentially influencing the risk of recurrence in 83 patients (66F, 17M) with complete stone clearance (confirmed by 2 consecutive ultrasound) after ESWL+ bile salt therapy (UDCA+ CDCA 7-8 mg kg/day each) for solitary (n = 55) or multiple (2-10 stones, n = 28) radiolucent GS. Median followup after clearance was 36 (range 4.5-67) months. GB motility was studied in a representative subgroup of 47 patients and 20 controls (sonographic determinations of fasting GB volume
of Medicine
47 (1995)
AI -A42
and then after 2815 kJ meal every 10 min for 2 h). Independent factors (Cox Proportional Hazard Analysis) for speed of GS clearance were initial GS size/number (6.5 f 0.8 vs. 12.7 + 1.7 months in solitary and multiple GS, resp.), effectiveness of fragmentation (I or > 5 mm after ESWL) and residual postprandial GB volume ( 5 or > 6 ml) (p < 0.002). Neither age, sex nor body size influenced GS clearance rate. GS recurrence was seen in 29 patients after 28.6+ 2.6 months (median 26, range 9-57 months). Recurrence rates by actuarial analysis at 1, 2, 3, 4 years were: 14, 23, 35, 45% (solitary GS) and 20, 42, 47, 56% (multiple GS) (p = 0.1). Patients with or without recurrence had similar age, sex, initial GS size, % on NSAIDs and sex female hormones. However, biliary pain was more frequent with recurrence (55 vs. 13%, p = 0.001). GB motility was impaired in GS patients, compared to controls. Patients with recurrence had a larger fasting (n = 17, 31.3k2.8 ml vs. n = 30, 24.2& 1.5 ml, p < 0.05) and postprandial residual GB volume (9.5 + 1.3 vs. 6.1+0.6 ml, p < 0.05) than patients with no recurrence or controls. When residual GB volume was small ( _C6 ml), actuarial recurrence rate at 4 years was lower (45 vs. 78% for residual volume > 6 ml; log-rank test, p = 0.0215). Conclusions: (1) GS clearance rate after ESWL is mainly dictated by GS number, size, effective fragmentation and effective GB emptying. (2) Recurrence rate is lower in patients with solitary than multiple stones but might be higher than previously reported after 3-4 years. GS recurrence is strongly associated with biliary pain and impaired GB emptying (residual volume > 6 ml). Gallbladder motility in patients with pancreatic insufficiency. H.A.J. Gielkens, E.H. Eddes, J. Vecht, C.B.H.W. Lamers, A.A.M. Masclee. Departments of Gastroenterology-Hepatology and Surgery,
University
Hospital,
Leiden,
Netherlands.
Cholecystokinin (CCK) is the major hormonal regulator of postprandial gallbladder contraction. In patients with pancreatic insufficiency (PI) meal-stimulated endogenous CCK secretion may be impaired. We have investigated whether meal-induced gallbladder contraction is affected in patients with pancreatic insufficiency. Gallbladder volumes, measured with ultrasonography, and plasma CCK levels (RIA) were determined at regular intervals of 15 min for 120 min after oral ingestion of a meal (475 kCal). Fourteen patients with pancreatic insufficiency due to chronic pancreatitis (12 male; age 35-63 yr; faecal fat excretion 15-48 g/24 h; normal < 7 g/24 h) were studied and 15 healthy subjects (10 male; age 19-57 yr) served as controls. Results: Fasting gallbladder volumes were significantly increased in patients with PI compared to controls (46+5 vs. 30 f 2 cm3; p < 0.05). Meal-induced gallbladder contraction was significantly reduced in patients with PI compared to controls: at 60 min 34+ 5 vs. 63 +4% (p < 0.01) and at 120 min 25 +5 vs. 68+5% (p < 0.01). The resting gallbladder volume at 120 min was significantly (p < 0.01) larger in patients with PI (33f4 cm3) than in controls (9+ 1 cm3). Postprandial CCK secretion was significantly (p < 0.01) reduced in the patients compared to controls (78+ 14 vs. 154+ 14
Abstracts
/Netherlands
Journal
therefore be at increased risk for atrophic gastritis during acid-suppressive therapy. We prospectively investigated the relation between Hp and atrophic gastritis during omeprazole maintenance therapy. Methods: 105 subjects (56 men, age at initial visit 62 (16-83) years) were continuously treated for a mean 5 years (3-6) with 20-40 mg omeprazole o.d. for reflex oesophagitis. All subjects underwent gastroscopy with biopsy sampling preentry and at annual follow-up. Gastric corpus biopsy specimens of both the pre-entry and the last visit were assessed by one pathologist according to the Sydney classification. The Hp status of each patient was assessed by silver-stained histological slides. Results: 46 patients were HP-negative; no new infections were noted during follow-up. Pre-entry, they all had no (n = 39) or only mildly active gastritis (n = 7) gastritis. After 5 years, only 2/46 (4%) had active corpus gastritis. 59 patients were HP-positive; pre-entry corpus gastritis activity scores were: negative (n = 24; 41%) mild (n = 25; 42%), moderate to severe (n = 10; 17%). After 5 years these scores were: negative (n = 11; 19%), mild (n = 18; 30%) moderate to severe (n = 30; 51%). Thus, both the prevalence (p= 0.007; Fisher exact) and the severity of active gastritis (p < 0.001; Student t-test) significantly increased. Development of atrophic gastritis was noted in 2/46 (4%) HP-negative patients and 18/59 (30%) HP-positive patients (p < 0.001; Fisher exact, OR 9.89; 2.2-45.2). In the HP-negative subgroup, prevalence of ECL cell hyperplasia was 8% and remained unchanged. In the HP-positive, ECL cell hyperplasia increased from 15 to 30% (p = 0.04; Fisher exact). Development of ECL cell hyperplasia was closely associated with Hp infection (p = 0.004; Fisher exact, OR 4.72; 1.47-15.1). Conclusions: During long-term acid-suppressive therapy, a persistent increase in corpus inflammation with substantive development of atrophic gastritis and ECL cell hyperplasia was observed in HP-positive patients, but not in HP-negative patients. We therefore recommend that Hp eradication be considered at the beginning of acid-suppressive maintenance therapy. Gallbladder (GB) motility is important for gallstone (GS) clearance and recurrence after extracorporeal shock-wave litbotripsy (ESWL). P. Portincasa ‘x2, K.J. van Erpecum ‘, P. van de Meeberg t, G.P. van Berge Henegouwen ‘. ’ Department of Gastroenterology, de Clinica Medica I, Bari
University University
Hospital Utrecht; 2 Istituto Medical School, Bari, Italy.
ESWL is an effective treatment in selected gallstone patients, but recurrence is a major drawback, particularly for patients with initially multiple stones. We examined several factors potentially influencing the risk of recurrence in 83 patients (66F, 17M) with complete stone clearance (confirmed by 2 consecutive ultrasound) after ESWL+ bile salt therapy (UDCA+ CDCA 7-8 mg kg/day each) for solitary (n = 55) or multiple (2-10 stones, n = 28) radiolucent GS. Median followup after clearance was 36 (range 4.5-67) months. GB motility was studied in a representative subgroup of 47 patients and 20 controls (sonographic determinations of fasting GB volume
of Medicine
47 (1995)
AI -A42
and then after 2815 kJ meal every 10 min for 2 h). Independent factors (Cox Proportional Hazard Analysis) for speed of GS clearance were initial GS size/number (6.5 f 0.8 vs. 12.7 + 1.7 months in solitary and multiple GS, resp.), effectiveness of fragmentation (I or > 5 mm after ESWL) and residual postprandial GB volume ( 5 or > 6 ml) (p < 0.002). Neither age, sex nor body size influenced GS clearance rate. GS recurrence was seen in 29 patients after 28.6+ 2.6 months (median 26, range 9-57 months). Recurrence rates by actuarial analysis at 1, 2, 3, 4 years were: 14, 23, 35, 45% (solitary GS) and 20, 42, 47, 56% (multiple GS) (p = 0.1). Patients with or without recurrence had similar age, sex, initial GS size, % on NSAIDs and sex female hormones. However, biliary pain was more frequent with recurrence (55 vs. 13%, p = 0.001). GB motility was impaired in GS patients, compared to controls. Patients with recurrence had a larger fasting (n = 17, 31.3k2.8 ml vs. n = 30, 24.2& 1.5 ml, p < 0.05) and postprandial residual GB volume (9.5 + 1.3 vs. 6.1+0.6 ml, p < 0.05) than patients with no recurrence or controls. When residual GB volume was small ( _C6 ml), actuarial recurrence rate at 4 years was lower (45 vs. 78% for residual volume > 6 ml; log-rank test, p = 0.0215). Conclusions: (1) GS clearance rate after ESWL is mainly dictated by GS number, size, effective fragmentation and effective GB emptying. (2) Recurrence rate is lower in patients with solitary than multiple stones but might be higher than previously reported after 3-4 years. GS recurrence is strongly associated with biliary pain and impaired GB emptying (residual volume > 6 ml). Gallbladder motility in patients with pancreatic insufficiency. H.A.J. Gielkens, E.H. Eddes, J. Vecht, C.B.H.W. Lamers, A.A.M. Masclee. Departments of Gastroenterology-Hepatology and Surgery,
University
Hospital,
Leiden,
Netherlands.
Cholecystokinin (CCK) is the major hormonal regulator of postprandial gallbladder contraction. In patients with pancreatic insufficiency (PI) meal-stimulated endogenous CCK secretion may be impaired. We have investigated whether meal-induced gallbladder contraction is affected in patients with pancreatic insufficiency. Gallbladder volumes, measured with ultrasonography, and plasma CCK levels (RIA) were determined at regular intervals of 15 min for 120 min after oral ingestion of a meal (475 kCal). Fourteen patients with pancreatic insufficiency due to chronic pancreatitis (12 male; age 35-63 yr; faecal fat excretion 15-48 g/24 h; normal < 7 g/24 h) were studied and 15 healthy subjects (10 male; age 19-57 yr) served as controls. Results: Fasting gallbladder volumes were significantly increased in patients with PI compared to controls (46+5 vs. 30 f 2 cm3; p < 0.05). Meal-induced gallbladder contraction was significantly reduced in patients with PI compared to controls: at 60 min 34+ 5 vs. 63 +4% (p < 0.01) and at 120 min 25 +5 vs. 68+5% (p < 0.01). The resting gallbladder volume at 120 min was significantly (p < 0.01) larger in patients with PI (33f4 cm3) than in controls (9+ 1 cm3). Postprandial CCK secretion was significantly (p < 0.01) reduced in the patients compared to controls (78+ 14 vs. 154+ 14