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HISTOLOGICAL PROGRESSION IN AUTOIMMUNE GASTRITIS
S86
Abstracts / Digestive and Liver Disease 41S (2009), S1–S167
they could be part of familial adenomatous polyposis (FAP) or sporadic. Sporadic FGS are sometimes associated with use of proton pump inhibithor (PPI). Gastric cancer has been reported in FAP, even arising from FGP. The neoplastic potential of sporadic FGP is considered poor considered the rare association with dysplasia; however longitudinal studies are lacking. Material and methods: For every FGP patient, age, gender, PPI use and Hp status are recorded. Attempt to achieve complete eradication of polyps with endoscopic polypectomy is proposed to all patients with 10 or less polyps. Follow up is made to control recurrence, or, if eradication od all polyps is not feasible, to control the development of displasia through endoscopy and biopsy every year. PPI discontinuation was encorauged. Polyps were classified for size and number (counted to 10, 10-20, 20-30, more than 30). Concomitant endoscopic feature are recorded. We have prospectively evaluated 21 patients with endoscopically ascertained FGP (14 female, mean age 53,3, range 36-75). Total amount of follow up is 701 months/patient, mean 33 months, range 3-65 months. Results were compared with incidence data on gastric cancer in Italy. Results: During follow up two patients developed mild dysplasia, not confirmed in subseguent follow up. No patients developed gastric cancer. Development of displasia was not associated with PPI use, number or dimension of polyps, and Hp status. In Italy it could be expected one case of gastric cancer every 2000 persons/year (50/100000/year). Difference is not statistically significative. Conclusions: As far as we know, this is the first study of follow up in sporadic FGP. The risk of gastric cancer is, if one, very low. Dysplasia may affect sporadic FGP, but its further degenerative potential seems to be low. Given the low gastric cancer rate in Italy, comparision is difficult and therefore these data need confirmation with larger studies. # B. Gastric diseases 5. Pre-cancerous lesions
P.29 COMBINED USE OF INTRINSIC FACTOR AND PARIETAL CELL AUTOANTIBODIES ARE USEFUL FOR THE DIAGNOSIS OF AUTOIMMUNE GASTRITIS E. Lahner ∗ ,1 , G.L. Norman 2 , L. Vannella 1 , C. Pozzessere 1 , G. Delle Fave 1 , B. Annibale 1 1 Digestive and Liver Disease, University Sapienza, Ospedale Sant’Andrea, Roma; 2 Inova Diagnostics Inc, San Diego, USA
Background and aim: Atrophic body gastritis (ABG) is an autoimmune condition eventually manifesting itself as pernicious anemia (PA). Parietal cell (PCA) and intrinsic factor autoantibodies (IFA) are considered characteristic of these conditions. Aim: Recent studies on IFA and PCA frequency in biopsy-proven ABG patients with respect to cobalamin deficiency are lacking. We addressed this issue employing new ELISA-based-assays. Material and methods: Sera from 165 patients with histologicallydiagnosed ABG and 113 controls were tested for IFA and PCA by ELISA (INOVA Diagnostics, San Diego). 81 ABG patients had cobalamin deficiency and macrocytic anemia (Group 1-PA), 36 cobalamin deficiency without macrocytic anemia (Group 2), and 48 had normal cobalamin levels (Group 3). Results: IFA were detected in 44/165 ABG patients (27% sensitivity) and 0/113 controls (100% specificity). PCA were detected in 134 ABG patients (81% sensitivity) and 11 controls (90% specificity). In Group 1, IFA demonstrated 37% sensitivity and 100% specificity, while PCA showed 81% sensitivity and 90% specificity. Combining IFA and PCA increased the sensitivity to 61% in all ABG patients and to 73% in Group 1, while maintaining 100% specificity. Conclusions: IFA are 100% specific for biopsy-proven ABG and occurred in 27% of patients. PCA occurred in 81% of ABG patients and 10% of controls. Combining IFA and PCA significantly increases their diagnostic performance for ABG and PA, yielding a 73% sensitivity for
PA. The non-invasive combined assessment of PCA and IFA may be useful to select patients at risk of autoimmune gastritis to be confirmed by gastroscopic-histologic examination. # B. Gastric diseases 5. Pre-cancerous lesions
P.30 IS GASTROPANEL USEFUL IN THE DIAGNOSIS OF ATROPHIC GASTRITIS FROM A SERUM SAMPLE? E. Masci 1 , E. Viale 2 , B. Mangiavillano 1 , M.C. Petrone 2 , P.A. Testoni 2 1 Dept.
of Gastrointestinal Endoscopy, University San Paolo Hospital, Milano; 2 Division of Gastroenterology, H San Raffaele, Milano Background and aim: Atrophic gastritis is a clinically relevant disease that is usually diagnosed with endoscopy and biopsies from gastric antrum and corpus. GastroPanel (Biohit, Helsinki, Finland) is a serum test kit that measures Helicobacter pylori antibodies (HPABs), pepsinogens I and II and gastrin 17, which reflect the degree of atrophic gastritis. The aim of the present study was to evaluate whether patients with histologic diagnosis of atrophic gastritis can be detected nonendoscopically by means of the non-invasive test ‘Gastropanel’. The second endpoint was to analyze if the serum test was able to discern mild from severe atrophic gastritis. Material and methods: The serological panel was evaluated in patients with mild or severe atrophic gastritis. All patients previously underwent gastroscopy with biopsies of the gastric antrum and body. Levels of pepsinogen I and II, gastrin-17, and HPABs were determined through a specific EIA test in fasting serum samples. Data were assessed by BIOHIT Gastrosoft. The gastropanel accuracy was evaluated and histology was considered the gold standard. Results: We enrolled 47 patients (24 males, mean age 52±9). Gastropanel test was positive in 39 patients (39/47), the sensitivity and accuracy were 82.9%. Patients with severe atrophic gastritis were 30 (63.8%, group A), the others had mild atrophic gastritis (group B). In group A gastropanel was positive in 86.7% (26/30); in group B the serum test was positive in 76.5% (13/17). Sensitivity was 86.7%. Positive predictive value was 66.7% and negative predicitive value was 50%. The Gastropanel would not have detected 4 of the 30 cases of severe atrophic gastritis. Conclusions: Gastropanel is a useful noninvasive method for the diagnosis of atrophic gastritis that could be recommended as a screening method to select patients that should be referred for upper GI endoscopy; however in our series the specificity to discriminate severe from mild atrophic gastritis has poor performance, further studies with larger series are needed to understand if serological test is a useful tool also in this subgroup of patients. # B. Gastric diseases 5. Pre-cancerous lesions
P.31 HISTOLOGICAL PROGRESSION IN AUTOIMMUNE GASTRITIS S. Segato 1 , M. Parravicini 1 , M. Montanari 1 , C. Capella 2 1 Gastroenterologia Azienda Ospedaliera Macchi, Varese; 2 Anatomia Patologica Azienda Ospedaliera Macchi, Varese
Background and aim: Autoimmune gastritis (AG) is a corpusrestricted chronic atrophic gastritis associated with circulating serum antibodies; AG patients may be at increased risk for hyperplastic (HP) or adenomatous polyps (AP),carcinoma (GC) and endocrine tumors (ET). The aim of the study was to carry out a retrospective analysis of the histological evolution of AG in a series of patients followed for a long period.
Abstracts / Digestive and Liver Disease 41S (2009), S1–S167 Material and methods: The study was made on 20 patients (13 women, 7 men, mean age at diagnosis 54.4 yrs, range 40-70 yrs) who were positive for anti-parietal antibodies and/or had histological features compatible with AG and total atrophy of gastric glands. Endoscopy and biopsies were repeated almost every two years. Data on therapy for H pylori were incomplete and were not evaluated. Patients were followed-up for an average time of 155 months (range 120-180). Results: At 10 years or more after the diagnosis all patients were alive. No patient had adenomatoid ECL hyperplasia, endocrine tumor or gastric cancer. 2 patients (10%), at the 14th year of follow-up, showed gastric low grade dysplasia. 3 patients (15%) had hyperplastic polyps. Conclusions: AG is a progressive disease; the progression rate is very low. Advanced histologic lesions are uncommon in a long follow up period. There are insufficient data to suggest definite endoscopic surveillance including biopsies in these patients. # B. Gastric diseases 5. Pre-cancerous lesions
P.32 CAN ADVANCED ENDOSCOPY DETECT FOCAL LESIONS IN PATIENTS WITH GASTRIC DYSPLASIA AFTER RANDOM BIOPSIES? A. Simone, A. Casadei, I. Manzi, L. Saragoni, P. Morgagni, E. Ricci Ospedale Morgagni Pierantoni, Forlì Background and aim: Few study have evaluated the correlation between convenctional endoscopy and histological findings, but results seem poor so that many authors have proposed in high risk patients a lot of random biopsies to detect gastric dysplasia. In the last years advanced endoscopy (chromoendoscpy, FICE and zoom endoscopy) has been proposed for detection of minimal changes in gastric mucosa and focal lesions with dysplastic changes. Material and methods: From 2003 to 2008 we have studied 39 patients, (21 women and 18 man), mean age 75 years (range 50-87), affected from early gastric cancer (EGC) or gastric high grade dysplasia. Fourteen of them were referred from other institution to our Unit for histological findings of high grade dysplasia in random biopsies at convenctional endoscopy, without identification of focal lesion. All patients underwent upper endoscopy with chromoscopic analysis using indigo carmine, computed virtual chromoendoscopy (FICE) and zoom endoscopy. The mocosal lesion detected by advanced endoscopy were described by Paris classification and histologically by Vienna classification. Results: Advanced endoscopy has identified focal lesions in all patients. Lesions were classified as follows: 7IIa-IIc, 5 IIa, 1 IIc, 1 Is. Thirteen lesions were located in gastric antrum, one in gastric body and mean diameter was 1.6 cm (range 1-3). Lesions were resected en-block and histological findings were early gastric cancer (EGC) in 8 patients and high grade dyspalsia in the others. Six patients were referred to surgery according to Japanese guide lines. Conclusions: In our experience advanced endoscopy employing indigo carmine and FICE chromoendoscopy plus magnifyng vision has been effective for identification of focal dysplastic lesions. # B. Gastric diseases 5. Pre-cancerous lesions
P.33 IN VIVO HISTOPATHOLOGY WITH PORTABLE CONFOCAL MINIPROBES ENDOMICROSCOPY IN THE DIAGNOSIS OF CELIAC DISEASE (CD) E. Dabizzi ∗ , R. Manta, H. Bertani, M. Manno, A. Mussetto, P. Trande, R. Conigliaro Nuovo Ospedale Civile S. Agostino Estense di Baggiovara, Modena Background and aim: Endoscopic duodenal biopsy is still critical in
S87
the diagnosis of CD, but often sampling errors and poor quality specimens may generate false-negative results. Confocal endomicroscopy (CEM) allows an in vivo histologic assessment of the mucosal layer during routine endoscopy. Aim: To evaluate the application of CEM in the diagnosis of CD and the potential benefit in the management of patients. Material and methods: CEM (Cell-vizio, Mauna Kea Technologies, Paris, France), using portable confocal mini probes (Type Z, Type MiniO) was performed in 12 patients (8 F/4 M; mean age: 31 yrs; range 19-44 yrs) underwent an upper gastointestinal endoscopy for either suspected CD or malabsorption symptoms. Endoscopy was performed under conscious sedation (i.v. meperidine and midazolam) with standard video gastroscopes (Pentax EG 2970 F, Pentax, Tokyo, Japan). We used endovenous fluorescein dye (2,5-5 mL), to enhance the diagnostic power of CEM. Real time video sequences were digitally recorded. Multiple biopsies were taken from the same examined area. All stored sequences were put into a random order and assessed by a gastroenterologist blinded to any histopathological data. Biopsies were analized by experts pathologists blinded to CEM data, too. Traditional histology was considered as the gold standard. Villous atrophy (VA) (presence of 5 or fewerblunt-shaped villi seen on superficial scans) and crypt hypertrophy (CH) (>1 crypt on imaging of the deep mucosa) were defined as CEM features of CD. Results: The patient’s clinical-pathological characteristics are shown in the table. PTS 1 2 3 4 5 6 7 8 9 10 11 12
SEX
AGE
EMA*/tTGA†
Endoscopy#
CEM
Histology
F F M F M F F F F M F M
19 31 19 39 25 27 35 23 42 26 44 36
+ + + – + + – + + – + –
4 1-2 2 2 1-3 1 1 3 4 1 2-3 1-4
VA+CH VA+CH VA+CH Normal VA+CH VA VA+CH VA+CH Normal Normal VA+CH VA+CH
3a 3b 3a Normal 3b 1 3b 3b 1 Normal 3b 3b
*EMA: Endomisium antibodies; † tTGA: tissue Transglutaminase Antibodies. # Endoscopy: 1) Reduction of duodenal folds; 2) Scalloping of folds; 3) Mosaic pattern; 4) Nodularity of the mucosa.
Comparing the CEM data with histology, we can assess a sensibility of 90%, a specificity of 100%, and an accuracy of 92%. Conclusions: This is our preliminary experience with CEM applied to the diagnosis of CD. It allows a real time in vivo histological improving histology itself, reducing the number of biopsy, guiding a better tissue sampling. # C. Small bowel diseases 1. Celiac disease
P.34 USEFULNESS OF ANTIBODIES TO DEAMIDATED GLIADIN PEPTIDES (DGP) IN COELIAC DISEASE (CD) R. Ciccocioppo ∗ ,1 , M. De Amici 1 , M. Valli 2 , G. Mantegna 1 , G. Zanellati 2 , E. Betti 1 , C. Alvisi 1 , G.R. Corazza 1 1 Fondazione
IRCCS Policlinico San Matteo, Pavia; 2 Università degli
Studi, Pavia Background and aim: Antibodies reactive with DGP have been recently shown to be more sensitive and specific than conventional anti-gliadin antibodies and comparable to anti-transglutaminase and anti-endomysium testing in diagnosing CD. Based on these observations, we evaluated the prevalence and accuracy of these antibodies in CD. Material and methods: The study population included 86 adult subjects of both sexes grouped as follows: 18 anti-endomysium positive
Abstracts / Digestive and Liver Disease 41S (2009), S1–S167
they could be part of familial adenomatous polyposis (FAP) or sporadic. Sporadic FGS are sometimes associated with use of proton pump inhibithor (PPI). Gastric cancer has been reported in FAP, even arising from FGP. The neoplastic potential of sporadic FGP is considered poor considered the rare association with dysplasia; however longitudinal studies are lacking. Material and methods: For every FGP patient, age, gender, PPI use and Hp status are recorded. Attempt to achieve complete eradication of polyps with endoscopic polypectomy is proposed to all patients with 10 or less polyps. Follow up is made to control recurrence, or, if eradication od all polyps is not feasible, to control the development of displasia through endoscopy and biopsy every year. PPI discontinuation was encorauged. Polyps were classified for size and number (counted to 10, 10-20, 20-30, more than 30). Concomitant endoscopic feature are recorded. We have prospectively evaluated 21 patients with endoscopically ascertained FGP (14 female, mean age 53,3, range 36-75). Total amount of follow up is 701 months/patient, mean 33 months, range 3-65 months. Results were compared with incidence data on gastric cancer in Italy. Results: During follow up two patients developed mild dysplasia, not confirmed in subseguent follow up. No patients developed gastric cancer. Development of displasia was not associated with PPI use, number or dimension of polyps, and Hp status. In Italy it could be expected one case of gastric cancer every 2000 persons/year (50/100000/year). Difference is not statistically significative. Conclusions: As far as we know, this is the first study of follow up in sporadic FGP. The risk of gastric cancer is, if one, very low. Dysplasia may affect sporadic FGP, but its further degenerative potential seems to be low. Given the low gastric cancer rate in Italy, comparision is difficult and therefore these data need confirmation with larger studies. # B. Gastric diseases 5. Pre-cancerous lesions
P.29 COMBINED USE OF INTRINSIC FACTOR AND PARIETAL CELL AUTOANTIBODIES ARE USEFUL FOR THE DIAGNOSIS OF AUTOIMMUNE GASTRITIS E. Lahner ∗ ,1 , G.L. Norman 2 , L. Vannella 1 , C. Pozzessere 1 , G. Delle Fave 1 , B. Annibale 1 1 Digestive and Liver Disease, University Sapienza, Ospedale Sant’Andrea, Roma; 2 Inova Diagnostics Inc, San Diego, USA
Background and aim: Atrophic body gastritis (ABG) is an autoimmune condition eventually manifesting itself as pernicious anemia (PA). Parietal cell (PCA) and intrinsic factor autoantibodies (IFA) are considered characteristic of these conditions. Aim: Recent studies on IFA and PCA frequency in biopsy-proven ABG patients with respect to cobalamin deficiency are lacking. We addressed this issue employing new ELISA-based-assays. Material and methods: Sera from 165 patients with histologicallydiagnosed ABG and 113 controls were tested for IFA and PCA by ELISA (INOVA Diagnostics, San Diego). 81 ABG patients had cobalamin deficiency and macrocytic anemia (Group 1-PA), 36 cobalamin deficiency without macrocytic anemia (Group 2), and 48 had normal cobalamin levels (Group 3). Results: IFA were detected in 44/165 ABG patients (27% sensitivity) and 0/113 controls (100% specificity). PCA were detected in 134 ABG patients (81% sensitivity) and 11 controls (90% specificity). In Group 1, IFA demonstrated 37% sensitivity and 100% specificity, while PCA showed 81% sensitivity and 90% specificity. Combining IFA and PCA increased the sensitivity to 61% in all ABG patients and to 73% in Group 1, while maintaining 100% specificity. Conclusions: IFA are 100% specific for biopsy-proven ABG and occurred in 27% of patients. PCA occurred in 81% of ABG patients and 10% of controls. Combining IFA and PCA significantly increases their diagnostic performance for ABG and PA, yielding a 73% sensitivity for
PA. The non-invasive combined assessment of PCA and IFA may be useful to select patients at risk of autoimmune gastritis to be confirmed by gastroscopic-histologic examination. # B. Gastric diseases 5. Pre-cancerous lesions
P.30 IS GASTROPANEL USEFUL IN THE DIAGNOSIS OF ATROPHIC GASTRITIS FROM A SERUM SAMPLE? E. Masci 1 , E. Viale 2 , B. Mangiavillano 1 , M.C. Petrone 2 , P.A. Testoni 2 1 Dept.
of Gastrointestinal Endoscopy, University San Paolo Hospital, Milano; 2 Division of Gastroenterology, H San Raffaele, Milano Background and aim: Atrophic gastritis is a clinically relevant disease that is usually diagnosed with endoscopy and biopsies from gastric antrum and corpus. GastroPanel (Biohit, Helsinki, Finland) is a serum test kit that measures Helicobacter pylori antibodies (HPABs), pepsinogens I and II and gastrin 17, which reflect the degree of atrophic gastritis. The aim of the present study was to evaluate whether patients with histologic diagnosis of atrophic gastritis can be detected nonendoscopically by means of the non-invasive test ‘Gastropanel’. The second endpoint was to analyze if the serum test was able to discern mild from severe atrophic gastritis. Material and methods: The serological panel was evaluated in patients with mild or severe atrophic gastritis. All patients previously underwent gastroscopy with biopsies of the gastric antrum and body. Levels of pepsinogen I and II, gastrin-17, and HPABs were determined through a specific EIA test in fasting serum samples. Data were assessed by BIOHIT Gastrosoft. The gastropanel accuracy was evaluated and histology was considered the gold standard. Results: We enrolled 47 patients (24 males, mean age 52±9). Gastropanel test was positive in 39 patients (39/47), the sensitivity and accuracy were 82.9%. Patients with severe atrophic gastritis were 30 (63.8%, group A), the others had mild atrophic gastritis (group B). In group A gastropanel was positive in 86.7% (26/30); in group B the serum test was positive in 76.5% (13/17). Sensitivity was 86.7%. Positive predictive value was 66.7% and negative predicitive value was 50%. The Gastropanel would not have detected 4 of the 30 cases of severe atrophic gastritis. Conclusions: Gastropanel is a useful noninvasive method for the diagnosis of atrophic gastritis that could be recommended as a screening method to select patients that should be referred for upper GI endoscopy; however in our series the specificity to discriminate severe from mild atrophic gastritis has poor performance, further studies with larger series are needed to understand if serological test is a useful tool also in this subgroup of patients. # B. Gastric diseases 5. Pre-cancerous lesions
P.31 HISTOLOGICAL PROGRESSION IN AUTOIMMUNE GASTRITIS S. Segato 1 , M. Parravicini 1 , M. Montanari 1 , C. Capella 2 1 Gastroenterologia Azienda Ospedaliera Macchi, Varese; 2 Anatomia Patologica Azienda Ospedaliera Macchi, Varese
Background and aim: Autoimmune gastritis (AG) is a corpusrestricted chronic atrophic gastritis associated with circulating serum antibodies; AG patients may be at increased risk for hyperplastic (HP) or adenomatous polyps (AP),carcinoma (GC) and endocrine tumors (ET). The aim of the study was to carry out a retrospective analysis of the histological evolution of AG in a series of patients followed for a long period.
Abstracts / Digestive and Liver Disease 41S (2009), S1–S167 Material and methods: The study was made on 20 patients (13 women, 7 men, mean age at diagnosis 54.4 yrs, range 40-70 yrs) who were positive for anti-parietal antibodies and/or had histological features compatible with AG and total atrophy of gastric glands. Endoscopy and biopsies were repeated almost every two years. Data on therapy for H pylori were incomplete and were not evaluated. Patients were followed-up for an average time of 155 months (range 120-180). Results: At 10 years or more after the diagnosis all patients were alive. No patient had adenomatoid ECL hyperplasia, endocrine tumor or gastric cancer. 2 patients (10%), at the 14th year of follow-up, showed gastric low grade dysplasia. 3 patients (15%) had hyperplastic polyps. Conclusions: AG is a progressive disease; the progression rate is very low. Advanced histologic lesions are uncommon in a long follow up period. There are insufficient data to suggest definite endoscopic surveillance including biopsies in these patients. # B. Gastric diseases 5. Pre-cancerous lesions
P.32 CAN ADVANCED ENDOSCOPY DETECT FOCAL LESIONS IN PATIENTS WITH GASTRIC DYSPLASIA AFTER RANDOM BIOPSIES? A. Simone, A. Casadei, I. Manzi, L. Saragoni, P. Morgagni, E. Ricci Ospedale Morgagni Pierantoni, Forlì Background and aim: Few study have evaluated the correlation between convenctional endoscopy and histological findings, but results seem poor so that many authors have proposed in high risk patients a lot of random biopsies to detect gastric dysplasia. In the last years advanced endoscopy (chromoendoscpy, FICE and zoom endoscopy) has been proposed for detection of minimal changes in gastric mucosa and focal lesions with dysplastic changes. Material and methods: From 2003 to 2008 we have studied 39 patients, (21 women and 18 man), mean age 75 years (range 50-87), affected from early gastric cancer (EGC) or gastric high grade dysplasia. Fourteen of them were referred from other institution to our Unit for histological findings of high grade dysplasia in random biopsies at convenctional endoscopy, without identification of focal lesion. All patients underwent upper endoscopy with chromoscopic analysis using indigo carmine, computed virtual chromoendoscopy (FICE) and zoom endoscopy. The mocosal lesion detected by advanced endoscopy were described by Paris classification and histologically by Vienna classification. Results: Advanced endoscopy has identified focal lesions in all patients. Lesions were classified as follows: 7IIa-IIc, 5 IIa, 1 IIc, 1 Is. Thirteen lesions were located in gastric antrum, one in gastric body and mean diameter was 1.6 cm (range 1-3). Lesions were resected en-block and histological findings were early gastric cancer (EGC) in 8 patients and high grade dyspalsia in the others. Six patients were referred to surgery according to Japanese guide lines. Conclusions: In our experience advanced endoscopy employing indigo carmine and FICE chromoendoscopy plus magnifyng vision has been effective for identification of focal dysplastic lesions. # B. Gastric diseases 5. Pre-cancerous lesions
P.33 IN VIVO HISTOPATHOLOGY WITH PORTABLE CONFOCAL MINIPROBES ENDOMICROSCOPY IN THE DIAGNOSIS OF CELIAC DISEASE (CD) E. Dabizzi ∗ , R. Manta, H. Bertani, M. Manno, A. Mussetto, P. Trande, R. Conigliaro Nuovo Ospedale Civile S. Agostino Estense di Baggiovara, Modena Background and aim: Endoscopic duodenal biopsy is still critical in
S87
the diagnosis of CD, but often sampling errors and poor quality specimens may generate false-negative results. Confocal endomicroscopy (CEM) allows an in vivo histologic assessment of the mucosal layer during routine endoscopy. Aim: To evaluate the application of CEM in the diagnosis of CD and the potential benefit in the management of patients. Material and methods: CEM (Cell-vizio, Mauna Kea Technologies, Paris, France), using portable confocal mini probes (Type Z, Type MiniO) was performed in 12 patients (8 F/4 M; mean age: 31 yrs; range 19-44 yrs) underwent an upper gastointestinal endoscopy for either suspected CD or malabsorption symptoms. Endoscopy was performed under conscious sedation (i.v. meperidine and midazolam) with standard video gastroscopes (Pentax EG 2970 F, Pentax, Tokyo, Japan). We used endovenous fluorescein dye (2,5-5 mL), to enhance the diagnostic power of CEM. Real time video sequences were digitally recorded. Multiple biopsies were taken from the same examined area. All stored sequences were put into a random order and assessed by a gastroenterologist blinded to any histopathological data. Biopsies were analized by experts pathologists blinded to CEM data, too. Traditional histology was considered as the gold standard. Villous atrophy (VA) (presence of 5 or fewerblunt-shaped villi seen on superficial scans) and crypt hypertrophy (CH) (>1 crypt on imaging of the deep mucosa) were defined as CEM features of CD. Results: The patient’s clinical-pathological characteristics are shown in the table. PTS 1 2 3 4 5 6 7 8 9 10 11 12
SEX
AGE
EMA*/tTGA†
Endoscopy#
CEM
Histology
F F M F M F F F F M F M
19 31 19 39 25 27 35 23 42 26 44 36
+ + + – + + – + + – + –
4 1-2 2 2 1-3 1 1 3 4 1 2-3 1-4
VA+CH VA+CH VA+CH Normal VA+CH VA VA+CH VA+CH Normal Normal VA+CH VA+CH
3a 3b 3a Normal 3b 1 3b 3b 1 Normal 3b 3b
*EMA: Endomisium antibodies; † tTGA: tissue Transglutaminase Antibodies. # Endoscopy: 1) Reduction of duodenal folds; 2) Scalloping of folds; 3) Mosaic pattern; 4) Nodularity of the mucosa.
Comparing the CEM data with histology, we can assess a sensibility of 90%, a specificity of 100%, and an accuracy of 92%. Conclusions: This is our preliminary experience with CEM applied to the diagnosis of CD. It allows a real time in vivo histological improving histology itself, reducing the number of biopsy, guiding a better tissue sampling. # C. Small bowel diseases 1. Celiac disease
P.34 USEFULNESS OF ANTIBODIES TO DEAMIDATED GLIADIN PEPTIDES (DGP) IN COELIAC DISEASE (CD) R. Ciccocioppo ∗ ,1 , M. De Amici 1 , M. Valli 2 , G. Mantegna 1 , G. Zanellati 2 , E. Betti 1 , C. Alvisi 1 , G.R. Corazza 1 1 Fondazione
IRCCS Policlinico San Matteo, Pavia; 2 Università degli
Studi, Pavia Background and aim: Antibodies reactive with DGP have been recently shown to be more sensitive and specific than conventional anti-gliadin antibodies and comparable to anti-transglutaminase and anti-endomysium testing in diagnosing CD. Based on these observations, we evaluated the prevalence and accuracy of these antibodies in CD. Material and methods: The study population included 86 adult subjects of both sexes grouped as follows: 18 anti-endomysium positive