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Gastrointestinal electrical stimulation (GES) can be performed safely with endoscopically placed electrodes
S56
Abstracts
acidity and secretion during the postprandial period when esophageal reflux of gastric acid is most likely to occur. 173 Gastrointestinal electrical stimulation (GES) can be performed safely with endoscopically placed electrodes Amit Goyal1, Sandeep Khurana1, Sandeep Bhragava1 and Abell L Thomas1* 1Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States. Purpose: Gastrointestinal electrical stimulation (GES) has been shown to decrease nausea and vomiting (Am J Gastro abstract 2000) leading to its approval as a humanitarian device. GES for diabetic and idiopathic gastroparesis (GP) involves surgically implanted electrodes placed into the stomach wall via laparotomy or laparoscopy connected to a subcutaneously placed device. However, the usefulness of GES in patients with other types of GP, such as post-surgical GP is unknown; likewise the placement of stimulating electrodes by endoscopy has not been reported. We report the use of GES for 2 patients with post-surgical gastroparesis using endoscopically placed electrodes plus an external GES device (Itrel 3–7424, Medtronics). Methods: Two patients, 21 and 40 year old females, both of whom had post-surgical gastroparesis with an average of 49 months duration, were refractory to all medical treatment. A bipolar temporary screw-in cardiac pacing electrode (Medtronic 6416 –200) was passed through the 7F biopsy channel of a gastroscope and placed through the gastric mucosa using a corkscrew motion. The scope was then withdrawn keeping the lead in place and a rotating clip device (Olympus HX-5LR-1) was used to attach the electrode to the gastric mucosa using clips (Olympus HX-600 – 090). The electrodes were connected to the external GES device using low energy and high frequency stimulation (Am J Gastro above). Standardized symptom assessment and a low fat gastric emptying test (Am J Gastro 2000; 95: 1456 – 62) were performed before and during GES. Results: Over a period of 3 months, a total of 8 procedures in two patients were performed for placement of electrical stimulating leads. The leads stayed in place for an average of 8 days with the average impedance of 722 ohms (ideal ⬍800). The average number of weekly vomiting episodes decreased from 24/wk prior to GES to none/wk with GES. During GES, the percentage of the meal retained on gastric emptying test (GET) decreased at one hour from 100% to 63% in one patient. The other patient vomited the meal during the baseline GET but was able to retain the meal without vomiting during GES. There were no complications associated with any of the procedures. Conclusions: GES can be safely performed using endoscopically placed electrodes for short-term use in patients with post-surgical gastroparesis. Temporary electrical stimulation may help in selecting patients for the placement of permanent GES device. Study support in part was provided by Medtronics and Olympus. 174 Helicobacter pylori genotypes in duodenal ulcer and non-ulcer dyspepsia cases in Hyderabad (India) Mohammed Aejaz Habeeb, Rekha M Thippavazzula, Ayesha Alvi M, Aleem Ahmed Khan, Niyaz Ahmed N and Chittoor Mohammed Habibullah*. 1Centre For Liver Diseases, Deccan College of Medical Sciences, Hyderabad, Andhra Pradesh, India; and 2Centre for DNA Fingerprinting & Diagnostics, CDFD, Hyderabad, Andhra Pradesh, India. Purpose: The aim of the study was to investigate the cagA and vacA subtypes in Indian (Hyderabad) H.pylori isolates and to assess the relationship between genotypes of isolates and clinical features. Two major virulence factors encoded by the cytotoxin-associated gene (cagA) and the vacuolating cytotoxin (vacA) gene of Helicobacter pylori are known to be associated with gastroduodenal pathologic condition. Genetic differences have been identified between the vacA alleles, two families of alleles in the
AJG – Vol. 96, No. 9, Suppl., 2001
mid region, m1 and m2, and three families of alleles in the signal sequence s1a, s1b, and s2. In total, any H.pylori strain could have one to six possibilities and among them s2m2 are non-toxic, s1/m1 are high toxic producers, and s2/m2 have a bimodal distribution. Methods: A total of 102 H.pylori positive patients with peptic ulcer disease or other H.pylori related disease were studied for vacA genotypes and the presence of cagA gene by PCR Results: In 50 (91%) of 55 duodenal ulcer patients were of type s1 (s1m1 ⫽ 45; s1m2 ⫽ 5;s2m2 ⫽ 5), similarily 25(63%) of 40 non-ulcer dyspepsia patients were type s1 (s1m1 ⫽ 25; s1m2 ⫽ 11; s2m2 ⫽ 4). The presence of the cagA gene was closely associated with the vac s1 genotype, and was found in 85% of patients with s1m1 and s1m2 genotypes. The cagA gene, which is a marker for duodenal ulceration, was found in 87% of duodenal ulcer patients and 55% of non-ulcer patients. Conclusions: Our study shows that most (91%) H.pylori strains among patients with ulcers possess the vacA s1/m1 and cagA gene. Determination of vacA genotypes and cagA gene may contribute to the potential clinical identification of patients at different levels of risk.
175 Role of H. pylori flagellar genes (FlaA and FlaB) in colonization and pathogenesis Mohammed Aejaz Habeeb, Ayesha Alvi M, Aleem Ahmed Khan, Rekha T M, Niyaz Ahmed N and Chittoor Mohammed Habibullah*. 1Centre For Liver Diseases, Deccan College of Medical Sciences, Hyderabad, Andhra Pradesh, India; and 2Centre For DNA Fingerprinting & Diagnostic, CDFD, Hyderabad, Andhra Pradesh, India. Purpose: H.pylori is now accepted to be the causative agent of chronic active gastritis in humans. Studies investigating the essential role of Flagellum in colonization of human gastrointestinal tract have shown an strong relation between virulence or colonization and motility of the bacteria. In case of H.pylori, flagellar motility is regulated by FlaA & FlaB genes. FlaA mutants produce truncated flagella and retain little motility. Mutants lacking both FlaA and FlaB are aflagellate and non-motile. Invivo the role of these flagellum in colonization and pathogenesis is not yet known. Present study was undertaken in order to know the invivo role of flagellin in colonization and pathogenesis of duodenal ulcer and non-ulcer dyspepsia. Methods: DNA extracted from the bacteria were further used for amplifying 1.5 Kb FlaA & 1.6Kb FlaB (Eaton et al 1996). The gastric biopsies were subjected to histopathological studies like localization of H.pylori & degree of inflammation. The bacteria cultured from gastric biopsies were checked for their in-vitro motility. Macroscopically the colony morphology was classified as 1) spreading 2) granular. PCR Conditions: Reaction was programmed for 35 cycles of 94°C-1min, 55°C-1min,72°C-2min with final extension at 72°C for 6min. The amplified products were visualized on 1% agarose gel. Results: A total of 110 genomic DNA screened for the presence of FlaA and FlaB genes. Results showed that 62 clinical isolates were found positive for both FlaA and FlaB genes. 48 of these clinical isolates were belonged to duodenal ulcer subjects and only 12 (out of 62) represents from non ulcer dyspepsia subjects. 53 out of 62 subjects positive for both FlaA and FlaB genes had severe from of Gastritis and only 9 had acute gastritis. Invitro motility data showed 93% of FlaA and FlaB positive isolates with spreading type of colonies (highly motile) and only 7 had granular colonies (less motile). Conclusions: The study showed that both the flagellin genes (FlaA & FlaB) are necessary for motility and pathogenesis.
176 Satiety testing (ST): Water is the way to go S Hoffman, CC Ebert and MP Jones Northwestern University Medical School Chicago, IL.
Abstracts
acidity and secretion during the postprandial period when esophageal reflux of gastric acid is most likely to occur. 173 Gastrointestinal electrical stimulation (GES) can be performed safely with endoscopically placed electrodes Amit Goyal1, Sandeep Khurana1, Sandeep Bhragava1 and Abell L Thomas1* 1Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States. Purpose: Gastrointestinal electrical stimulation (GES) has been shown to decrease nausea and vomiting (Am J Gastro abstract 2000) leading to its approval as a humanitarian device. GES for diabetic and idiopathic gastroparesis (GP) involves surgically implanted electrodes placed into the stomach wall via laparotomy or laparoscopy connected to a subcutaneously placed device. However, the usefulness of GES in patients with other types of GP, such as post-surgical GP is unknown; likewise the placement of stimulating electrodes by endoscopy has not been reported. We report the use of GES for 2 patients with post-surgical gastroparesis using endoscopically placed electrodes plus an external GES device (Itrel 3–7424, Medtronics). Methods: Two patients, 21 and 40 year old females, both of whom had post-surgical gastroparesis with an average of 49 months duration, were refractory to all medical treatment. A bipolar temporary screw-in cardiac pacing electrode (Medtronic 6416 –200) was passed through the 7F biopsy channel of a gastroscope and placed through the gastric mucosa using a corkscrew motion. The scope was then withdrawn keeping the lead in place and a rotating clip device (Olympus HX-5LR-1) was used to attach the electrode to the gastric mucosa using clips (Olympus HX-600 – 090). The electrodes were connected to the external GES device using low energy and high frequency stimulation (Am J Gastro above). Standardized symptom assessment and a low fat gastric emptying test (Am J Gastro 2000; 95: 1456 – 62) were performed before and during GES. Results: Over a period of 3 months, a total of 8 procedures in two patients were performed for placement of electrical stimulating leads. The leads stayed in place for an average of 8 days with the average impedance of 722 ohms (ideal ⬍800). The average number of weekly vomiting episodes decreased from 24/wk prior to GES to none/wk with GES. During GES, the percentage of the meal retained on gastric emptying test (GET) decreased at one hour from 100% to 63% in one patient. The other patient vomited the meal during the baseline GET but was able to retain the meal without vomiting during GES. There were no complications associated with any of the procedures. Conclusions: GES can be safely performed using endoscopically placed electrodes for short-term use in patients with post-surgical gastroparesis. Temporary electrical stimulation may help in selecting patients for the placement of permanent GES device. Study support in part was provided by Medtronics and Olympus. 174 Helicobacter pylori genotypes in duodenal ulcer and non-ulcer dyspepsia cases in Hyderabad (India) Mohammed Aejaz Habeeb, Rekha M Thippavazzula, Ayesha Alvi M, Aleem Ahmed Khan, Niyaz Ahmed N and Chittoor Mohammed Habibullah*. 1Centre For Liver Diseases, Deccan College of Medical Sciences, Hyderabad, Andhra Pradesh, India; and 2Centre for DNA Fingerprinting & Diagnostics, CDFD, Hyderabad, Andhra Pradesh, India. Purpose: The aim of the study was to investigate the cagA and vacA subtypes in Indian (Hyderabad) H.pylori isolates and to assess the relationship between genotypes of isolates and clinical features. Two major virulence factors encoded by the cytotoxin-associated gene (cagA) and the vacuolating cytotoxin (vacA) gene of Helicobacter pylori are known to be associated with gastroduodenal pathologic condition. Genetic differences have been identified between the vacA alleles, two families of alleles in the
AJG – Vol. 96, No. 9, Suppl., 2001
mid region, m1 and m2, and three families of alleles in the signal sequence s1a, s1b, and s2. In total, any H.pylori strain could have one to six possibilities and among them s2m2 are non-toxic, s1/m1 are high toxic producers, and s2/m2 have a bimodal distribution. Methods: A total of 102 H.pylori positive patients with peptic ulcer disease or other H.pylori related disease were studied for vacA genotypes and the presence of cagA gene by PCR Results: In 50 (91%) of 55 duodenal ulcer patients were of type s1 (s1m1 ⫽ 45; s1m2 ⫽ 5;s2m2 ⫽ 5), similarily 25(63%) of 40 non-ulcer dyspepsia patients were type s1 (s1m1 ⫽ 25; s1m2 ⫽ 11; s2m2 ⫽ 4). The presence of the cagA gene was closely associated with the vac s1 genotype, and was found in 85% of patients with s1m1 and s1m2 genotypes. The cagA gene, which is a marker for duodenal ulceration, was found in 87% of duodenal ulcer patients and 55% of non-ulcer patients. Conclusions: Our study shows that most (91%) H.pylori strains among patients with ulcers possess the vacA s1/m1 and cagA gene. Determination of vacA genotypes and cagA gene may contribute to the potential clinical identification of patients at different levels of risk.
175 Role of H. pylori flagellar genes (FlaA and FlaB) in colonization and pathogenesis Mohammed Aejaz Habeeb, Ayesha Alvi M, Aleem Ahmed Khan, Rekha T M, Niyaz Ahmed N and Chittoor Mohammed Habibullah*. 1Centre For Liver Diseases, Deccan College of Medical Sciences, Hyderabad, Andhra Pradesh, India; and 2Centre For DNA Fingerprinting & Diagnostic, CDFD, Hyderabad, Andhra Pradesh, India. Purpose: H.pylori is now accepted to be the causative agent of chronic active gastritis in humans. Studies investigating the essential role of Flagellum in colonization of human gastrointestinal tract have shown an strong relation between virulence or colonization and motility of the bacteria. In case of H.pylori, flagellar motility is regulated by FlaA & FlaB genes. FlaA mutants produce truncated flagella and retain little motility. Mutants lacking both FlaA and FlaB are aflagellate and non-motile. Invivo the role of these flagellum in colonization and pathogenesis is not yet known. Present study was undertaken in order to know the invivo role of flagellin in colonization and pathogenesis of duodenal ulcer and non-ulcer dyspepsia. Methods: DNA extracted from the bacteria were further used for amplifying 1.5 Kb FlaA & 1.6Kb FlaB (Eaton et al 1996). The gastric biopsies were subjected to histopathological studies like localization of H.pylori & degree of inflammation. The bacteria cultured from gastric biopsies were checked for their in-vitro motility. Macroscopically the colony morphology was classified as 1) spreading 2) granular. PCR Conditions: Reaction was programmed for 35 cycles of 94°C-1min, 55°C-1min,72°C-2min with final extension at 72°C for 6min. The amplified products were visualized on 1% agarose gel. Results: A total of 110 genomic DNA screened for the presence of FlaA and FlaB genes. Results showed that 62 clinical isolates were found positive for both FlaA and FlaB genes. 48 of these clinical isolates were belonged to duodenal ulcer subjects and only 12 (out of 62) represents from non ulcer dyspepsia subjects. 53 out of 62 subjects positive for both FlaA and FlaB genes had severe from of Gastritis and only 9 had acute gastritis. Invitro motility data showed 93% of FlaA and FlaB positive isolates with spreading type of colonies (highly motile) and only 7 had granular colonies (less motile). Conclusions: The study showed that both the flagellin genes (FlaA & FlaB) are necessary for motility and pathogenesis.
176 Satiety testing (ST): Water is the way to go S Hoffman, CC Ebert and MP Jones Northwestern University Medical School Chicago, IL.