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Influence of age and gender on gastric acid secretion using integrated acidity (IA)
S40
Abstracts
AJG – Vol. 97, No. 9, Suppl., 2002
gastrointestinal barium studies. Of 336 investigated patients, 90 patients (27%) had gastro– duodenal ulcers, 76 patients (23%) erosive esophagitis, cancer of esophagus 14 patients (4%), cancer of stomach 10 patients (3%), cancer of pancreas 7 patients (2%). Group I Group I Group II Group II Group III Group III AS (ⴙ) AS (–) AS (ⴙ) AS (–) AS (ⴙ) AS (–) Number of 100 46 80 40 55 Patients Normal Study 20 (20%) 36 (78%) 12 (15%) 29 (72%) 6 (11%) Lesions Detected 80 (80%) 10 (22%) 68 (85%) 11 (27%) 49 (89%)
15 10 (67%) 5 (33%)
Conclusions: Our study suggests that early endoscopy appears to increase diagnostic yield and may be beneficial in the elderly minority patients with dyspepsia accompanied by alarm symptoms. Further, prospective randomized population– based studies are necessary. Results of endoscopic and radiological evaluations in 336 investigated patients in relation to age and presence (⫹) or absence (–) of alarm symptoms (AS) 119 INFLUENCE OF AGE AND GENDER ON GASTRIC ACID SECRETION USING INTEGRATED ACIDITY (IA) Grace L. Shih, M.D., Colleen Brensinger, M.S., David Katzka, M.D., FACG and David Metz*. Gastroenterology, UPHS, Philadelphia, PA. Purpose: To measure IA as a function of age and gender from ambulatory 24 hour pH studies. Methods: Of 976 patients studied between 1994 and 2001, 229 studies ⬍16 hrs duration, with poor grounding, with pH ⬍0.5 or ⬎7.0 for ⬎20% time, or with no demographic data were excluded. The remaining 747 studies were exported into SAS (Cary, NC) for analysis. Basal integrated acidity (BIA) was defined as IA between midnight and 8 am when no meals were consumed. Daytime and nocturnal IA/hr were measured from 8 am to 8 pm and 8 pm to 8 am. Postprandial IA (PIA) was measured for two hours after the largest meal peak in each patient. IA was expressed as mmolxh/L (Am. J Gastro 2001, 96:1363). Wilcoxon, Kruskal–Wallis tests with Bonferroni adjusted p–values and Spearman correlation coefficient were calculated. Results: There were 126 patients aged ⬍ 35 yrs (74F/52M), 297 aged 35– 49 yrs (196F/101M), 218 aged 50 – 64 yrs (148F/70M) and 106 aged ⬎65 yrs (59F/47M). Gender distribution was similar between groups (2⫽6.64,3 df, p⫽0.084). Men and women had similar mean gastric pH (2.96 ⫾1.36 F; 3.00 ⫾1.40 M; p⫽0.74), BIA (335.9⫾323.5 vs 379.1⫾340.9 mmolxh/L, p⫽0.15), daytime IA (31.0 ⫾29.4 vs 30.5 ⫾28.3 mmol/L, p⫽0.97) and nocturnal IA (39.1⫾36.2 vs 41.6 ⫾37.2 mmol/L, p⫽0.49), and PIA (36.2⫾54.1 vs 33.8 ⫾51.5 mmolxh/L, p⫽0.51). Mean gastric pH and daytime IA did not differ between age groups, but BIA, nocturnal IA, and PIA did (see table). Patients aged ⬍35 yrs had a higher nocturnal IA and BIA than those aged 50 – 64 yrs (p⫽0.022, p⫽0.0036, respectively), and higher PIA than those aged 35– 49 yrs (p⫽0.026) and 50 – 64 yrs (p⫽0.0072). None of the parameters studied had a linear association with age (Spearman cofficients, see table). <35 yrs 35–49 yrs 50–64 yrs >65 yrs p Spearman (n ⴝ 126) (n ⴝ 297) (n ⴝ 218) (n ⴝ 106) value coefficient Mean pH (⫾SD) 2.73 (1.22) BIA 426.7 (mmol ⫻ h/L) (345.2) Daytime IA 32.2 (mmol/L) (28.5) Nocturnal IA 46.3 (mmol/L) (37.3) PIA 45.9 (mmol ⫻ h/L) (59.0)
2.85 (1.27) 360.3 (326.5) 30.2 (27.4) 40.2 (35.7) 32.8 (49.5)
3.17 (1.46) 303.4 (317.8) 29.6 (29.4) 35.4 (34.9) 28.9 (44.0)
3.17 (1.56) 347.1 (339.8) 34.0 (33.0) 42.6 (40.5) 43.1 (65.7)
0.071
0.103
0.0039 –0.121 0.54
–0.042
0.030
–0.089
0.0085 –0.117
Conclusions: Gastric acid secretion is unaffected by gender. Although differences in BIA, PIA, and nocturnal IA were seen, none of the parameters of gastric acid secretion changed with age overall.
120 ENDOSCOPIC BAND LIGATION OF GASTRIC VARICES: A CASE SERIES Vaman S. Jakribettuu, M.D., Peter C. McNally, D.O.*, William Brown, M.D., Sharon Bahrych, P.A.–C. and Neil Toribara, M.D. Section of Gastroenterology, University of Colorado Health Sciences Center, Denver, CO. Purpose: To evaluate if management of gastric varices via endoscopic band ligation is feasible. Methods: Band ligation of the gastric varices was performed using Saeed’s six–shooter with a retroflexed endoscope. Banding was repeated every 2–3 weeks until the varices were obliterated. Results: Nine patients (8 men, 1 woman, Mean age 46 years) with upper gastrointestinal bleeding (GIB) secondary to gastric varices underwent band ligation. In all patients, the etiology of portal hypertension was cirrhosis. Four had Child’s A, 2 Child’s B, and 3 Child’s C cirrhosis. The cause of cirrhosis was alcohol ingestion alone in 4, alcohol and hepatitis C together in 3 and hepatitis B alone in 1. One patient had metastatic hepatocellular carcinoma (HCC) and another was HIV positive. Seven of the patients had gastroesophageal varices type 1 (GEV1) and 2 had type 2 (GEV2). Active GIB from gastric varices was noted in 2 patients. Five others had cherry red spots on the gastric varices. Two other patients had large gastric varices without stigmata of bleeding. A mean of 4 bands (range 2– 6) was placed on the gastric varices. Active bleeding in the two patients was controlled by band ligation. No complications were associated with the procedure. Early repeat GIB (ⱕ 7 days) occurred in one patient with Child’s C cirrhosis. This patient underwent repeat endoscopy with sclerotherapy but died 3 days later from progressive liver failure and GIB. The other 8 patients did not have early repeat GIB. One patient without repeat GIB underwent elective TIPS procedure 2 weeks after the initial endoscopy. Two patients (including the one with HCC) had late repeat GIB at 4 and 6 weeks respectively but refused further endoscopy. The other 5 patients have not had further GIB. All 8 patients without repeat early GIB are alive at a median of 3 months after the initial gastric variceal banding. Conclusions: Endoscopic band ligation of gastric varices may be a viable alternative to TIPS in the management of bleeding gastric varices
121 RISK FACTORS FOR BLEEDING IN GASTRIC ANTRAL VASCULAR ECTASIA Khondker K. Islam, M.D., Marlyn C. Ciesla, M.D., Rana Sokhi, M.D., Kapil Mehta, M.D., Michael Klamut, M.D. and Sohrab Mobarhan, M.D.*. Department of Medicine, Loyola University Medical Center, Maywood, IL. Purpose: Gastric antral vascular ectasia (GAVE) is a rare cause of gastrointestinal bleeding. This condition is seen more frequently in patients with renal failure, COPD, aortic stenosis, scleroderma and cirrhosis of liver. As most of the patients were asymptomatic, this observational study was done to define the risk factors for bleeding in a group of patients presented with GAVE. Methods: Retrospective analysis was done in a group of patients who were presented with anemia, melena or abdominal discomfort requiring upper endoscopy. Results: Six patients were included in this study who were found to have GAVE in upper endoscopy. Out of six patients, five were female and one was male. Age ranges from 53 to 79 years with a mean age of 68. Only one patient was found to have renal insufficiency. H. pylori infection was found in two patients (33%). Three out of six patients (50%) were using NSAIDS before the clinical presentation of gastrointestinal bleeding. All of them using NSAIDS were presented with melena. Out of six patients, four (66%) of them received blood transfusion. Mean blood transfusion requirement was 3 units of PRBC. All these patients were treated with Argon Plasma Coagulator (APC) . The mean improvement of hemoglobin was noted to be 2.68 mg/l.
Abstracts
AJG – Vol. 97, No. 9, Suppl., 2002
gastrointestinal barium studies. Of 336 investigated patients, 90 patients (27%) had gastro– duodenal ulcers, 76 patients (23%) erosive esophagitis, cancer of esophagus 14 patients (4%), cancer of stomach 10 patients (3%), cancer of pancreas 7 patients (2%). Group I Group I Group II Group II Group III Group III AS (ⴙ) AS (–) AS (ⴙ) AS (–) AS (ⴙ) AS (–) Number of 100 46 80 40 55 Patients Normal Study 20 (20%) 36 (78%) 12 (15%) 29 (72%) 6 (11%) Lesions Detected 80 (80%) 10 (22%) 68 (85%) 11 (27%) 49 (89%)
15 10 (67%) 5 (33%)
Conclusions: Our study suggests that early endoscopy appears to increase diagnostic yield and may be beneficial in the elderly minority patients with dyspepsia accompanied by alarm symptoms. Further, prospective randomized population– based studies are necessary. Results of endoscopic and radiological evaluations in 336 investigated patients in relation to age and presence (⫹) or absence (–) of alarm symptoms (AS) 119 INFLUENCE OF AGE AND GENDER ON GASTRIC ACID SECRETION USING INTEGRATED ACIDITY (IA) Grace L. Shih, M.D., Colleen Brensinger, M.S., David Katzka, M.D., FACG and David Metz*. Gastroenterology, UPHS, Philadelphia, PA. Purpose: To measure IA as a function of age and gender from ambulatory 24 hour pH studies. Methods: Of 976 patients studied between 1994 and 2001, 229 studies ⬍16 hrs duration, with poor grounding, with pH ⬍0.5 or ⬎7.0 for ⬎20% time, or with no demographic data were excluded. The remaining 747 studies were exported into SAS (Cary, NC) for analysis. Basal integrated acidity (BIA) was defined as IA between midnight and 8 am when no meals were consumed. Daytime and nocturnal IA/hr were measured from 8 am to 8 pm and 8 pm to 8 am. Postprandial IA (PIA) was measured for two hours after the largest meal peak in each patient. IA was expressed as mmolxh/L (Am. J Gastro 2001, 96:1363). Wilcoxon, Kruskal–Wallis tests with Bonferroni adjusted p–values and Spearman correlation coefficient were calculated. Results: There were 126 patients aged ⬍ 35 yrs (74F/52M), 297 aged 35– 49 yrs (196F/101M), 218 aged 50 – 64 yrs (148F/70M) and 106 aged ⬎65 yrs (59F/47M). Gender distribution was similar between groups (2⫽6.64,3 df, p⫽0.084). Men and women had similar mean gastric pH (2.96 ⫾1.36 F; 3.00 ⫾1.40 M; p⫽0.74), BIA (335.9⫾323.5 vs 379.1⫾340.9 mmolxh/L, p⫽0.15), daytime IA (31.0 ⫾29.4 vs 30.5 ⫾28.3 mmol/L, p⫽0.97) and nocturnal IA (39.1⫾36.2 vs 41.6 ⫾37.2 mmol/L, p⫽0.49), and PIA (36.2⫾54.1 vs 33.8 ⫾51.5 mmolxh/L, p⫽0.51). Mean gastric pH and daytime IA did not differ between age groups, but BIA, nocturnal IA, and PIA did (see table). Patients aged ⬍35 yrs had a higher nocturnal IA and BIA than those aged 50 – 64 yrs (p⫽0.022, p⫽0.0036, respectively), and higher PIA than those aged 35– 49 yrs (p⫽0.026) and 50 – 64 yrs (p⫽0.0072). None of the parameters studied had a linear association with age (Spearman cofficients, see table). <35 yrs 35–49 yrs 50–64 yrs >65 yrs p Spearman (n ⴝ 126) (n ⴝ 297) (n ⴝ 218) (n ⴝ 106) value coefficient Mean pH (⫾SD) 2.73 (1.22) BIA 426.7 (mmol ⫻ h/L) (345.2) Daytime IA 32.2 (mmol/L) (28.5) Nocturnal IA 46.3 (mmol/L) (37.3) PIA 45.9 (mmol ⫻ h/L) (59.0)
2.85 (1.27) 360.3 (326.5) 30.2 (27.4) 40.2 (35.7) 32.8 (49.5)
3.17 (1.46) 303.4 (317.8) 29.6 (29.4) 35.4 (34.9) 28.9 (44.0)
3.17 (1.56) 347.1 (339.8) 34.0 (33.0) 42.6 (40.5) 43.1 (65.7)
0.071
0.103
0.0039 –0.121 0.54
–0.042
0.030
–0.089
0.0085 –0.117
Conclusions: Gastric acid secretion is unaffected by gender. Although differences in BIA, PIA, and nocturnal IA were seen, none of the parameters of gastric acid secretion changed with age overall.
120 ENDOSCOPIC BAND LIGATION OF GASTRIC VARICES: A CASE SERIES Vaman S. Jakribettuu, M.D., Peter C. McNally, D.O.*, William Brown, M.D., Sharon Bahrych, P.A.–C. and Neil Toribara, M.D. Section of Gastroenterology, University of Colorado Health Sciences Center, Denver, CO. Purpose: To evaluate if management of gastric varices via endoscopic band ligation is feasible. Methods: Band ligation of the gastric varices was performed using Saeed’s six–shooter with a retroflexed endoscope. Banding was repeated every 2–3 weeks until the varices were obliterated. Results: Nine patients (8 men, 1 woman, Mean age 46 years) with upper gastrointestinal bleeding (GIB) secondary to gastric varices underwent band ligation. In all patients, the etiology of portal hypertension was cirrhosis. Four had Child’s A, 2 Child’s B, and 3 Child’s C cirrhosis. The cause of cirrhosis was alcohol ingestion alone in 4, alcohol and hepatitis C together in 3 and hepatitis B alone in 1. One patient had metastatic hepatocellular carcinoma (HCC) and another was HIV positive. Seven of the patients had gastroesophageal varices type 1 (GEV1) and 2 had type 2 (GEV2). Active GIB from gastric varices was noted in 2 patients. Five others had cherry red spots on the gastric varices. Two other patients had large gastric varices without stigmata of bleeding. A mean of 4 bands (range 2– 6) was placed on the gastric varices. Active bleeding in the two patients was controlled by band ligation. No complications were associated with the procedure. Early repeat GIB (ⱕ 7 days) occurred in one patient with Child’s C cirrhosis. This patient underwent repeat endoscopy with sclerotherapy but died 3 days later from progressive liver failure and GIB. The other 8 patients did not have early repeat GIB. One patient without repeat GIB underwent elective TIPS procedure 2 weeks after the initial endoscopy. Two patients (including the one with HCC) had late repeat GIB at 4 and 6 weeks respectively but refused further endoscopy. The other 5 patients have not had further GIB. All 8 patients without repeat early GIB are alive at a median of 3 months after the initial gastric variceal banding. Conclusions: Endoscopic band ligation of gastric varices may be a viable alternative to TIPS in the management of bleeding gastric varices
121 RISK FACTORS FOR BLEEDING IN GASTRIC ANTRAL VASCULAR ECTASIA Khondker K. Islam, M.D., Marlyn C. Ciesla, M.D., Rana Sokhi, M.D., Kapil Mehta, M.D., Michael Klamut, M.D. and Sohrab Mobarhan, M.D.*. Department of Medicine, Loyola University Medical Center, Maywood, IL. Purpose: Gastric antral vascular ectasia (GAVE) is a rare cause of gastrointestinal bleeding. This condition is seen more frequently in patients with renal failure, COPD, aortic stenosis, scleroderma and cirrhosis of liver. As most of the patients were asymptomatic, this observational study was done to define the risk factors for bleeding in a group of patients presented with GAVE. Methods: Retrospective analysis was done in a group of patients who were presented with anemia, melena or abdominal discomfort requiring upper endoscopy. Results: Six patients were included in this study who were found to have GAVE in upper endoscopy. Out of six patients, five were female and one was male. Age ranges from 53 to 79 years with a mean age of 68. Only one patient was found to have renal insufficiency. H. pylori infection was found in two patients (33%). Three out of six patients (50%) were using NSAIDS before the clinical presentation of gastrointestinal bleeding. All of them using NSAIDS were presented with melena. Out of six patients, four (66%) of them received blood transfusion. Mean blood transfusion requirement was 3 units of PRBC. All these patients were treated with Argon Plasma Coagulator (APC) . The mean improvement of hemoglobin was noted to be 2.68 mg/l.