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M1200 Effect of Pharyngeal Stimulus on Upper Esophageal Sphincter (UES) and Lower Esophageal Sphincter (LES) During Development in Human Pre-Term Infants
AGA Abstracts
system. Diverticular disease was defined as presence of two or more diverticula during endoscopy. CRLs were categorized into adenomatous and serrated lesions. Results A total of 2,310 patients (mean age 58.4 yrs, range 18-93 yrs and 46.1% males) were included. Seventy-nine % of patients were referred due to symptoms, while 20.7% for screening or surveillance indications. In the total population, 37% (n=855) had diverticular disease, of which 77% (n=658) left-sided, 2% (n=16) right-sided and 21% (n=181) generalized. Endoscopic signs of diverticulitis were found in 9.0% (n=77) of the patients with diverticular disease. Of all patients, 27% (n=619) had at least one adenoma and 13% (n=307) at least one serrated lesion. In patients with diverticular disease vs. those without, adenomas were found in 26.8% vs. 17.5% (p<0.001), serrated lesions in 9.5% vs. 6.2% (p=0.004) and both lesions combined in 7.0% vs. 5.2% (p=0.08) of patients, respectively. Multiple logistic regression analysis with interactions, showed that the relationship between diverticular disease and CRLs was affected by age (p<0.001). Presence of diverticular disease was associated with increased risk for CRLs in patients aged <70 yrs (OR 2.2, 95% CI 1.7-3.0, p<0.001), while this was not found in patients aged ≥70 yrs. Noteworthy, the association between diverticular disease and risk for CRLs gradually increased with younger age, as follows: OR 3.0 (95% CI 2.1-4.3, p<0.001) for age <60 yrs, OR 4.5 (95% CI 2.8-7.0, p<0.001) for age <50 yrs and OR 6.6 (95% CI 3.8-11.6, p<0.001) for age <40 yrs. Conclusion We found an age-dependent association between diverticular disease and colorectal lesions. In younger patients diverticular disease is an independent risk factor for simultaneous presence of colorectal lesions, while this is not the case in patients aged 70 yrs or more.
*Air vs. Water P < 0.01 Table 2: Effect of water (volumes) on PRS and LESRR
*P < 0.03 Time-1 vs. Time-2 PRS - Pharyngeal Reflexive Swallowing LESRR - Lower Esophageal Relaxation Response
M1199
M1201
Atorvastatin Induces Apoptosis In Vitro and Slows Growth of Tumor Xenografts but Does Not Reduce Polyp Initiation Emina Huang, Laura A. Johnson, Kathryn A. Eaton, Mark Hynes, Joseph Carpentino, Peter D. Higgins
Comparison of Red Flags and Associated Factors in Pediatric Functional Abdominal Pain and Crohn's Disease Angela Majeskie, Manu R. Sood, Adrian Miranda Introduction: Symptom based criteria have been developed for the diagnosis of functional abdominal pain (FAP). Red flags serve as a warning that the pain may be related to a disease that warrants further work-up. There are no pediatric studies comparing the prevalence of red flags in children presenting with abdominal pain who are diagnosed with FAP or Crohn's disease (CD). Family history of functional GI disorders (FGIDs) and stressors may also contribute to symptom generation in children with FAP. Aim: To evaluate the prevalence of red flags, familial association and early life and social stressors in children with FAP or CD. Methods: 181 FAP and 128 CD patients prospectively completed a detailed demographic, history and symptom questionnaire. The data were analyzed retrospectively using student t test and chi square analysis. Results: The mean (SD) age at presentation for FAP was 11.9 yrs (3.5) vs. 13.1 yrs (3) for CD. There were more females in the FAP group than CD (124 (69%) vs. 52 (40%); p<0.001). The mean duration of symptoms at presentation was 15.7 vs. 10.6 months in FAP and CD, respectively (p<0.01). Periumbilical pain was reported in 40% of FAP patients compared to 6% in CD (p<0.0001). Social stressors were identified by 25% of parents of children with FAP vs. 5% with CD (p<0.0001). Prevalence of red flags, family history of functional disorders and early life stressors are shown in Table 1.Conclusion: Female gender, family history of FGID, as well as early life and social stressors may contribute to the development of FAP. Up to 50% of patients with FAP have one or more red flags. Our data suggests that some of the red flags commonly used for symptom based diagnosis of FAP may need to be revised. Table 1
Despite the availability of effective surveillance for colorectal cancer with colonoscopy, relatively few at-risk individuals utilize this option. Colon cancer chemoprevention might be a more acceptable alternative. Some epidemiologic studies have suggested statins may have chemopreventive effects on colorectal cancer without the risks of nonsteroidal antiinflammatory drugs, but other epidemiologic studies have found no effect of statins. We tested the efficacy of atorvastatin in inducing apoptosis In Vitro, in preventing polyp formation in the min mouse, and in preventing xenograft tumor growth in nude mice. Results: Atorvastatin rapidly induces apoptosis in the HCT116 colon cancer cell line In Vitro, and this effect is reversible with mevalonate and geranylgeranyl pyrophosphate, but less so with farnesyl pyrophosphate. Atorvastatin chow was ineffective in reducing polyp initiation in the min mouse model, with no significant effect on polyp number. Atorvastatin was effective in greatly slowing the growth of HCT116 colon cancer cell xenografts in nude mice (p=0.008). Further, this reduction was associated with increased levels of apoptosis. Conclusions: Atorvastatin can induce apoptosis In Vitro, through mevalonate and prenylation pathways. Atorvastatin, while not effective in preventing polyp initiation in the Min mouse model, was very effective in slowing tumor propagation in a nude mouse model. Consistent with In Vitro findings, increased apoptosis was associated with decreased tumor growth. Statins may have a chemopreventive benefit by slowing tumor growth, rather than preventing tumor initiation. M1200 Effect of Pharyngeal Stimulus on Upper Esophageal Sphincter (UES) and Lower Esophageal Sphincter (LES) During Development in Human Pre-Term Infants Sudarshan R. Jadcherla, Vanessa N. Parks, Juan Peng, Soledad A. Fernandez, Reza Shaker BACKGROUND AND AIMS: Dysphagia is a common problem in neonatal ICU and requires long term tube feeding. The sensory and motor aspects of the pharyngeal reflexes that favor airway protection or peristalsis during maturation are unclear. We characterized the maturational changes in pharyngeal reflexive swallow (PRS) and LES relaxation response (LESRR) evoked upon pharyngeal stimulation. METHODS: We recorded pharyngo-esophageal motility using a micromanometric pneumohydraulic water perfusion system, a specially designed catheter assembly (Dentsleeve) with 4-sideports, UES sleeve, and a pharyngeal infusion port in 10 healthy neonates (28 ± 0.7 wk gestation). Enterally fed healthy infants were studied twice at 34 ± 0.8 wks (Time-1, 1.6 ± 0.1kg) and again at 38 ± 1.7 wks (Time-2, 2.4 ± 0.2 kg) corrected age. Graded volumes (0.1, 0.3, 0.5 ml) of air (125 infusions) and sterile water (123 infusions) were given via the pharyngeal infusion port, and motor characteristics of PRS and LESRR were identified. Mixed models were applied and data shown as mean ± SE or %. RESULTS: Threshold volume for air was variable, and for water was 0.2 ± 0.1ml at Time-1 and 0.1 ± 0 ml at Time-2 (P=NS). Multiple PRS responses were noted with graded water stimulus at Time-1 (71% vs. 11%, water vs. air, p < 0.002) and at Time-2 (75% vs. 21%, water vs. air, P < 0.04). Effect of stimulus in provoking PRS and LESRR reflex relationships are shown in the tables. CONCLUSIONS: 1. Frequency recruitment of PRS and LESRR increase with maturation. Water is a better medium to evoke swallowing reflexes. 2. Frequency recruitment of esophageal peristalsis facilitating PRS and LESRR increases with increment in water volumes at both stages of maturation. 3. Changes in aerodigestive protective reflexes may represent differences in the modulation of excitatory and inhibitory pathways during maturation. *Supported by NIHRO1 DK 068158 Table 1: Effect on stimulus on PRS and LESRR
n.s. not significant M1202 Children's Reliability Using a Modified Bristol Stool Scale to Indicate Stool Form Mariella Lane, Danita I. Czyzewski, Norah Vasen, Bruno P. Chumpitazi, Robert Shulman Background: Stool form and changes in form are important diagnostic symptoms in both gastroenterology practice and research. However, patient descriptions of stool form may be subjective and objective measurements of stool form are not well developed. Self-report of stool form in pediatric patients may be uniquely important given that caregivers often do not observe stools. However, procuring accurate descriptions from children may be particularly challenging without an objective tool. Therefore, we sought to determine the ability of children of various ages to reliably use a modified Bristol Stool Form Scale (MBSFS) to indicate stool form. Methods: The original Bristol Stool Form Scale was modified to reduce the number of discriminations children were required to make from seven to five choices (types 3 and 5 omitted). Our prior evaluation of this modified BSFS indicated a high degree
S-353
AGA Abstracts
system. Diverticular disease was defined as presence of two or more diverticula during endoscopy. CRLs were categorized into adenomatous and serrated lesions. Results A total of 2,310 patients (mean age 58.4 yrs, range 18-93 yrs and 46.1% males) were included. Seventy-nine % of patients were referred due to symptoms, while 20.7% for screening or surveillance indications. In the total population, 37% (n=855) had diverticular disease, of which 77% (n=658) left-sided, 2% (n=16) right-sided and 21% (n=181) generalized. Endoscopic signs of diverticulitis were found in 9.0% (n=77) of the patients with diverticular disease. Of all patients, 27% (n=619) had at least one adenoma and 13% (n=307) at least one serrated lesion. In patients with diverticular disease vs. those without, adenomas were found in 26.8% vs. 17.5% (p<0.001), serrated lesions in 9.5% vs. 6.2% (p=0.004) and both lesions combined in 7.0% vs. 5.2% (p=0.08) of patients, respectively. Multiple logistic regression analysis with interactions, showed that the relationship between diverticular disease and CRLs was affected by age (p<0.001). Presence of diverticular disease was associated with increased risk for CRLs in patients aged <70 yrs (OR 2.2, 95% CI 1.7-3.0, p<0.001), while this was not found in patients aged ≥70 yrs. Noteworthy, the association between diverticular disease and risk for CRLs gradually increased with younger age, as follows: OR 3.0 (95% CI 2.1-4.3, p<0.001) for age <60 yrs, OR 4.5 (95% CI 2.8-7.0, p<0.001) for age <50 yrs and OR 6.6 (95% CI 3.8-11.6, p<0.001) for age <40 yrs. Conclusion We found an age-dependent association between diverticular disease and colorectal lesions. In younger patients diverticular disease is an independent risk factor for simultaneous presence of colorectal lesions, while this is not the case in patients aged 70 yrs or more.
*Air vs. Water P < 0.01 Table 2: Effect of water (volumes) on PRS and LESRR
*P < 0.03 Time-1 vs. Time-2 PRS - Pharyngeal Reflexive Swallowing LESRR - Lower Esophageal Relaxation Response
M1199
M1201
Atorvastatin Induces Apoptosis In Vitro and Slows Growth of Tumor Xenografts but Does Not Reduce Polyp Initiation Emina Huang, Laura A. Johnson, Kathryn A. Eaton, Mark Hynes, Joseph Carpentino, Peter D. Higgins
Comparison of Red Flags and Associated Factors in Pediatric Functional Abdominal Pain and Crohn's Disease Angela Majeskie, Manu R. Sood, Adrian Miranda Introduction: Symptom based criteria have been developed for the diagnosis of functional abdominal pain (FAP). Red flags serve as a warning that the pain may be related to a disease that warrants further work-up. There are no pediatric studies comparing the prevalence of red flags in children presenting with abdominal pain who are diagnosed with FAP or Crohn's disease (CD). Family history of functional GI disorders (FGIDs) and stressors may also contribute to symptom generation in children with FAP. Aim: To evaluate the prevalence of red flags, familial association and early life and social stressors in children with FAP or CD. Methods: 181 FAP and 128 CD patients prospectively completed a detailed demographic, history and symptom questionnaire. The data were analyzed retrospectively using student t test and chi square analysis. Results: The mean (SD) age at presentation for FAP was 11.9 yrs (3.5) vs. 13.1 yrs (3) for CD. There were more females in the FAP group than CD (124 (69%) vs. 52 (40%); p<0.001). The mean duration of symptoms at presentation was 15.7 vs. 10.6 months in FAP and CD, respectively (p<0.01). Periumbilical pain was reported in 40% of FAP patients compared to 6% in CD (p<0.0001). Social stressors were identified by 25% of parents of children with FAP vs. 5% with CD (p<0.0001). Prevalence of red flags, family history of functional disorders and early life stressors are shown in Table 1.Conclusion: Female gender, family history of FGID, as well as early life and social stressors may contribute to the development of FAP. Up to 50% of patients with FAP have one or more red flags. Our data suggests that some of the red flags commonly used for symptom based diagnosis of FAP may need to be revised. Table 1
Despite the availability of effective surveillance for colorectal cancer with colonoscopy, relatively few at-risk individuals utilize this option. Colon cancer chemoprevention might be a more acceptable alternative. Some epidemiologic studies have suggested statins may have chemopreventive effects on colorectal cancer without the risks of nonsteroidal antiinflammatory drugs, but other epidemiologic studies have found no effect of statins. We tested the efficacy of atorvastatin in inducing apoptosis In Vitro, in preventing polyp formation in the min mouse, and in preventing xenograft tumor growth in nude mice. Results: Atorvastatin rapidly induces apoptosis in the HCT116 colon cancer cell line In Vitro, and this effect is reversible with mevalonate and geranylgeranyl pyrophosphate, but less so with farnesyl pyrophosphate. Atorvastatin chow was ineffective in reducing polyp initiation in the min mouse model, with no significant effect on polyp number. Atorvastatin was effective in greatly slowing the growth of HCT116 colon cancer cell xenografts in nude mice (p=0.008). Further, this reduction was associated with increased levels of apoptosis. Conclusions: Atorvastatin can induce apoptosis In Vitro, through mevalonate and prenylation pathways. Atorvastatin, while not effective in preventing polyp initiation in the Min mouse model, was very effective in slowing tumor propagation in a nude mouse model. Consistent with In Vitro findings, increased apoptosis was associated with decreased tumor growth. Statins may have a chemopreventive benefit by slowing tumor growth, rather than preventing tumor initiation. M1200 Effect of Pharyngeal Stimulus on Upper Esophageal Sphincter (UES) and Lower Esophageal Sphincter (LES) During Development in Human Pre-Term Infants Sudarshan R. Jadcherla, Vanessa N. Parks, Juan Peng, Soledad A. Fernandez, Reza Shaker BACKGROUND AND AIMS: Dysphagia is a common problem in neonatal ICU and requires long term tube feeding. The sensory and motor aspects of the pharyngeal reflexes that favor airway protection or peristalsis during maturation are unclear. We characterized the maturational changes in pharyngeal reflexive swallow (PRS) and LES relaxation response (LESRR) evoked upon pharyngeal stimulation. METHODS: We recorded pharyngo-esophageal motility using a micromanometric pneumohydraulic water perfusion system, a specially designed catheter assembly (Dentsleeve) with 4-sideports, UES sleeve, and a pharyngeal infusion port in 10 healthy neonates (28 ± 0.7 wk gestation). Enterally fed healthy infants were studied twice at 34 ± 0.8 wks (Time-1, 1.6 ± 0.1kg) and again at 38 ± 1.7 wks (Time-2, 2.4 ± 0.2 kg) corrected age. Graded volumes (0.1, 0.3, 0.5 ml) of air (125 infusions) and sterile water (123 infusions) were given via the pharyngeal infusion port, and motor characteristics of PRS and LESRR were identified. Mixed models were applied and data shown as mean ± SE or %. RESULTS: Threshold volume for air was variable, and for water was 0.2 ± 0.1ml at Time-1 and 0.1 ± 0 ml at Time-2 (P=NS). Multiple PRS responses were noted with graded water stimulus at Time-1 (71% vs. 11%, water vs. air, p < 0.002) and at Time-2 (75% vs. 21%, water vs. air, P < 0.04). Effect of stimulus in provoking PRS and LESRR reflex relationships are shown in the tables. CONCLUSIONS: 1. Frequency recruitment of PRS and LESRR increase with maturation. Water is a better medium to evoke swallowing reflexes. 2. Frequency recruitment of esophageal peristalsis facilitating PRS and LESRR increases with increment in water volumes at both stages of maturation. 3. Changes in aerodigestive protective reflexes may represent differences in the modulation of excitatory and inhibitory pathways during maturation. *Supported by NIHRO1 DK 068158 Table 1: Effect on stimulus on PRS and LESRR
n.s. not significant M1202 Children's Reliability Using a Modified Bristol Stool Scale to Indicate Stool Form Mariella Lane, Danita I. Czyzewski, Norah Vasen, Bruno P. Chumpitazi, Robert Shulman Background: Stool form and changes in form are important diagnostic symptoms in both gastroenterology practice and research. However, patient descriptions of stool form may be subjective and objective measurements of stool form are not well developed. Self-report of stool form in pediatric patients may be uniquely important given that caregivers often do not observe stools. However, procuring accurate descriptions from children may be particularly challenging without an objective tool. Therefore, we sought to determine the ability of children of various ages to reliably use a modified Bristol Stool Form Scale (MBSFS) to indicate stool form. Methods: The original Bristol Stool Form Scale was modified to reduce the number of discriminations children were required to make from seven to five choices (types 3 and 5 omitted). Our prior evaluation of this modified BSFS indicated a high degree
S-353
AGA Abstracts