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M1846 Postprandial Reflux Patterns in Healthy Volunteers (HV) and Patients with Gastro-Esophageal Refux Disease (GERD)
M1844
range 25-70), 20 EE patients (A, B esophagitis LA classification) (7 F, median age 43.5 yrs, range 26-69), 20 BE patients (5 F, median age 59 yrs, range 29-73). All patients underwent upper endoscopy, esophageal manometry and MII-pH study, while HV only the last two examinations. During the 24-hour study, patients and HV ate three standard meals and their composition has been already reported. Total % time < pH 4, median bolus clearance time (MBCT), mean acid clearance time (MACT), median number of acid and non-acid refluxes and liquid, mixed and gas refluxes were assessed. Results. They are reported in the table (values are expressed as median and 25th - 75th percentiles): Conclusion: Our findings show that acid, liquid and mixed refluxes prevail in the first postprandial hour in EE and BE patients in comparison with HV. NERD patients present a higher exposure to acid compared with controls, but the difference is not significant and the physical characteristics are normal.
AGA Abstracts
Salivary Epidermal Growth Factor: A Novel Factor in the Pathophysiology of Gastroesophageal Reflux Disease Haruka Fujinami, Takahiko Kudo, Toshiro Sugiyama Background and Aims: Impaired salivary secretion has been reported to cause abnormal acid clearance from the esophagus in gastroesophageal reflux disease (GERD). However, few studies have explained the differences between nonerosive reflux disease (NERD) and erosive esophagitis (EE) with respect to salivary secretion. We have already reported that a noninvasive salivary functional test, modified glucose clearance test, which enabled the distinction between NERD and EE (Aliment Pharmacol & Ther 2008). According to our report, glucose clearance of EE was significantly lower than that of NERD. Saliva has important functions not only to clear gastric acid but also to regenerate esophageal mucosa by epidermal growth factor (EGF). The purpose of this study was to examine the relation between pathophysiology of GERD and the amount of salivary EGF (sEGF) produced. Subjects and Methods: Twenty patients with heartburn (10 NERD and 10 EE) and 10 healthy volunteers were enrolled in this study after an informed consent was obtained from them. Salivary volume was measured by gum test, and the sEGF concentration in the saliva produced by these patients was determined using a commercially available ELISA kit (Quantikine®, R&D systems). To elucidate the differences among the NERD and EE and control groups, salivary volume (mL/ min), sEGF concentration (pg/mL), and sEGF production (pg/min) were measured. sEGF production was calculated as salivary volume multiplied by sEGF concentration. Results: Salivary volume and sEGF concentration were not statistically different among the study groups. However the sEGF production was significantly lower in the EE group than in the NERD and control groups (Table 1). Conclusions: These results suggest that a decrease in sEGF production may be a cause of erosive esophagitis. Table 1: sEGF in the NERD and EE groups
Statistical analysis: A p< 0.05 HV vs EE, HV vs BE, NERD vs BE b p < 0.05 HV vs EE, HV vs BE, NERD vs EE, NERD vs BE c p < 0.05 HV vs EE, HV vs BE, NERD vs BE d p < 0.05 HV vs EE, HV vs BE, NERD vs EE f p < 0.05 HV vs EE, HV vs BE, NERD vs BE M1847 Influence of Low-Proof Alcoholic Beverages On Duodeno-Gastro-Esophageal Reflux in Health and GERD Holger Seidl, Felix Gundling, Thomas Schmidt, Wolfgang Schepp, Christian Pehl
*Compared with the control group N.S.; not significant
Background: Both high- and low-proof alcoholic beverages are known to increase acidic gastro-esophageal-reflux (GER) and elevate the risk of NERD and esophagitis. Moreover, Duodeno-GER (DGER), containing bile acids, was shown to harmfully alter the esophageal mucosa, alone and synergistic with HCl and pepsin - being a potential mechanism in carcinogenesis. Aim: To establish DGER-monitoring with Bilitech 2000 in the presence of beer, white, rose and red wine and to assess the influx of these low-proof beverages on DGER in health and GERD. Methods: Bilitech 2000 readings for beer, white, rose and red wine were obtained pure and mixed with bile. On four separate occasions DGER monitoring and pH-Metrie was performed in 12 healthy subjects and 9 patients with known GERD. With each monitoring subjects received a standardized meal and a quantitiy of either water, beer, white or rose wine in a random order . All patients underwent gastroscopy for a grading of GERD. Results: Bilitech 2000 was found to be feasible in presence of beer, white wine and rose wine using a cut-off of 0.25. However, readings in the presence of red wine were misleading, therefore red wine was not included in the clinical part. In good accordance with previous results, all investigated alcoholic beverages triggered significantly increased acidic GER, especially consumption of white wine, both in health and GERD. Nevertheless, no relevant DGER was found after consumption of the low-proof alcoholic beverages. Conclusion: Bilitech 2000 can be used for DGER monitoring in combination with alcoholic beverages, except with red wine. Effects of low-proof alcoholic beverages on GER were confirmed. No correlation between consumption of these beverages and DGER was found. GER and DGER after consumption of low-proof alcoholic beverages
M1845 High Prevalence of Reflux Symptoms in Obese Individuals Mandeep Singh, Debra K. Sullivan, Ajay Bansal, Sachin B. Wani, Vikas Singh, Amit Rastogi, Joseph E. Donnelly, Bryan K. Smith, Prateek Sharma Background: Both obesity & gastroesophageal reflux disease (GERD) have risen in epidemic proportions in the U.S. suggesting a causal association. Several surveys have suggested that reflux symptoms (encountered on a weekly basis) are common & reported by at least 810% of the adult US population; however, the prevalence of reflux symptoms in obese individuals is not known. Aim: To evaluate the prevalence of reflux symptoms (heartburn and/or regurgitation) in a cohort of obese subjects enrolled in a weight loss program. Methods: In an ongoing prospective weight loss study, participants were asked to complete a validated GERD questionnaire [reflux disease questionnaire (RDQ)]. The RDQ comprises of 12 questions; 6 each related to reflux symptom frequency & severity. In addition, demographic information, use of acid suppressive medications, BMI & waist circumference (WC) were recorded at study enrollment. The overall prevalence of reflux symptoms was assessed by calculating the frequency of subjects with at least weekly heartburn (HB) and/ or regurgitation (RG) (as reported in the RDQ). BMI & WC were compared between subjects with & without reflux symptoms using the χ2 test. Results: To date, a total of 122 subjects have been enrolled ; all subjects completed the validated GERD questionnaire. Cohort's mean age was 45 years (range: 18 -64); 75% females and 82% Caucasians, the mean BMI was 36.6 (range: 27 - 46.5) and the mean WC was 102.6 cm (range: 79 - 141). The majority of the subjects had a BMI > 35 (60%) and WC > 100 (67%). 45 subjects (37%) had at least weekly HB &/or RG. RG [n= 31 (25%)] was reported more frequently than HB [n=27 (22%)] and 18/37 subjects (40%) had moderate-severe symptoms. The mean BMI and WC in subjects with reflux symptoms was 36.0 (range 28 to 46.5) and 104.8 cm (range 84 to 142) respectively. No significant association was observed between different BMI quartiles and the presence of reflux symptoms (p<0.05); however, a trend was noted for an association between reflux symptoms and increasing WC (prevalence: 28% with WC≤100 & 44% with >100 cm; p= 0.09). Only 6 subjects were using acid suppressive medications. Conclusions: This study demonstrates that the prevalence of reflux symptoms in obese subjects, is approximately 40%. This prevalence in obese subjects appears to be higher than that reported in the general population. Despite experiencing weekly symptoms, the majority of these subjects were not taking acid suppressive therapy. Obese individuals, therefore, should be actively queried regarding the presence of reflux symptoms. Randomized controlled trials are needed to study the impact of weight loss on reflux symptoms.
* fraction of whole monitoring interval of one hour in %, median (range). p-values white wine vs. water p<0.001, rose wine vs. water p<0.01, beer vs water p<0.01, white wine vs rose wine p<0.05, white wine vs beer p<0.01 M1848 Nonacid Reflux Is Able to Determine Microscopic Esophagitis in Non-Erosive Reflux Disease (NERD) Patients Edoardo Savarino, Patrizia Zentilin, Luca Mastracci, Lorenzo Gemignani, Andrea Parodi, Elisa Marabotto, Giorgio Sammito, Paola Ceppa, Roberto Fiocca, Vincenzo Savarino Introduction: Acid reflux has been shown to be able to induce microscopic esophagitis in non-erosive reflux disease (NERD) patients. There are no data on the role of nonacid reflux in causing the same histological alteration. Aim: To assess whether nonacid reflux can provoke microscopic esophagitis in NERD patients. Methods: We evaluated 35 consecutive patients with NERD (20F, median age 47; range 40-71 yrs) while off-PPI therapy. During the upper GI endoscopy multiple biopsies were taken at the Z-line, 2 and 4 cm above it. Microscopic esophagitis was identified by necrosis/erosion, neutrophil/eosinophil intraepithelial infiltration, basal cell hyperplasia, elongation of papillae, dilation of intercellular spaces and a score (range: 0-2) was given for each lesion. In agreement with previous studies a cut-off value of 2 was considered for diagnosing a microscopic esophagitis 1. Within 3 days of endoscopy, patients underwent a multichannel intraluminal impedance and pH (MII-pH) testing using a standardized Mediterranean diet. We measured distal esophageal acid exposure time (AET) and number of impedance-detected reflux episodes (acid, nonacid) 2 . Results: Out of 35 NERD patients, 15 (43%) had an abnormal esophageal AET. Among these, 10 (29%) patients had microscopic esophagitis in agreement with our histological score (score>2). The remaining twenty (57%) patients had normal distal esophageal AET,
M1846 Postprandial Reflux Patterns in Healthy Volunteers (HV) and Patients with Gastro-Esophageal Refux Disease (GERD) Patrizia Zentilin, Edoardo Savarino, Giorgio Sammito, Marzio Frazzoni, Vincenzo Savarino The postprandial increase of GER reflux results from an increase in the rate of transient lower esophageal sphincter relaxations which occur more frequently after the ingestion of a meal which induces gastric distention. Few data exist on the differences between HV and GERD patients in the postprandial periods. Aim of this study was to evaluate reflux patterns among HV, non erosive reflux disease (NERD) patients, erosive esophagitis (EE) patients and Barrett esophagus (BE) in the first postprandial hour using combined multichannel intraluminal impedance and pH (MII-pH). Methods. We studied 20 HV (8 F, median age 25 yrs, range 22-69), 20 NERD patients with typical symptoms (11 F, median age 49.5 yrs,
AGA Abstracts
A-430
range 25-70), 20 EE patients (A, B esophagitis LA classification) (7 F, median age 43.5 yrs, range 26-69), 20 BE patients (5 F, median age 59 yrs, range 29-73). All patients underwent upper endoscopy, esophageal manometry and MII-pH study, while HV only the last two examinations. During the 24-hour study, patients and HV ate three standard meals and their composition has been already reported. Total % time < pH 4, median bolus clearance time (MBCT), mean acid clearance time (MACT), median number of acid and non-acid refluxes and liquid, mixed and gas refluxes were assessed. Results. They are reported in the table (values are expressed as median and 25th - 75th percentiles): Conclusion: Our findings show that acid, liquid and mixed refluxes prevail in the first postprandial hour in EE and BE patients in comparison with HV. NERD patients present a higher exposure to acid compared with controls, but the difference is not significant and the physical characteristics are normal.
AGA Abstracts
Salivary Epidermal Growth Factor: A Novel Factor in the Pathophysiology of Gastroesophageal Reflux Disease Haruka Fujinami, Takahiko Kudo, Toshiro Sugiyama Background and Aims: Impaired salivary secretion has been reported to cause abnormal acid clearance from the esophagus in gastroesophageal reflux disease (GERD). However, few studies have explained the differences between nonerosive reflux disease (NERD) and erosive esophagitis (EE) with respect to salivary secretion. We have already reported that a noninvasive salivary functional test, modified glucose clearance test, which enabled the distinction between NERD and EE (Aliment Pharmacol & Ther 2008). According to our report, glucose clearance of EE was significantly lower than that of NERD. Saliva has important functions not only to clear gastric acid but also to regenerate esophageal mucosa by epidermal growth factor (EGF). The purpose of this study was to examine the relation between pathophysiology of GERD and the amount of salivary EGF (sEGF) produced. Subjects and Methods: Twenty patients with heartburn (10 NERD and 10 EE) and 10 healthy volunteers were enrolled in this study after an informed consent was obtained from them. Salivary volume was measured by gum test, and the sEGF concentration in the saliva produced by these patients was determined using a commercially available ELISA kit (Quantikine®, R&D systems). To elucidate the differences among the NERD and EE and control groups, salivary volume (mL/ min), sEGF concentration (pg/mL), and sEGF production (pg/min) were measured. sEGF production was calculated as salivary volume multiplied by sEGF concentration. Results: Salivary volume and sEGF concentration were not statistically different among the study groups. However the sEGF production was significantly lower in the EE group than in the NERD and control groups (Table 1). Conclusions: These results suggest that a decrease in sEGF production may be a cause of erosive esophagitis. Table 1: sEGF in the NERD and EE groups
Statistical analysis: A p< 0.05 HV vs EE, HV vs BE, NERD vs BE b p < 0.05 HV vs EE, HV vs BE, NERD vs EE, NERD vs BE c p < 0.05 HV vs EE, HV vs BE, NERD vs BE d p < 0.05 HV vs EE, HV vs BE, NERD vs EE f p < 0.05 HV vs EE, HV vs BE, NERD vs BE M1847 Influence of Low-Proof Alcoholic Beverages On Duodeno-Gastro-Esophageal Reflux in Health and GERD Holger Seidl, Felix Gundling, Thomas Schmidt, Wolfgang Schepp, Christian Pehl
*Compared with the control group N.S.; not significant
Background: Both high- and low-proof alcoholic beverages are known to increase acidic gastro-esophageal-reflux (GER) and elevate the risk of NERD and esophagitis. Moreover, Duodeno-GER (DGER), containing bile acids, was shown to harmfully alter the esophageal mucosa, alone and synergistic with HCl and pepsin - being a potential mechanism in carcinogenesis. Aim: To establish DGER-monitoring with Bilitech 2000 in the presence of beer, white, rose and red wine and to assess the influx of these low-proof beverages on DGER in health and GERD. Methods: Bilitech 2000 readings for beer, white, rose and red wine were obtained pure and mixed with bile. On four separate occasions DGER monitoring and pH-Metrie was performed in 12 healthy subjects and 9 patients with known GERD. With each monitoring subjects received a standardized meal and a quantitiy of either water, beer, white or rose wine in a random order . All patients underwent gastroscopy for a grading of GERD. Results: Bilitech 2000 was found to be feasible in presence of beer, white wine and rose wine using a cut-off of 0.25. However, readings in the presence of red wine were misleading, therefore red wine was not included in the clinical part. In good accordance with previous results, all investigated alcoholic beverages triggered significantly increased acidic GER, especially consumption of white wine, both in health and GERD. Nevertheless, no relevant DGER was found after consumption of the low-proof alcoholic beverages. Conclusion: Bilitech 2000 can be used for DGER monitoring in combination with alcoholic beverages, except with red wine. Effects of low-proof alcoholic beverages on GER were confirmed. No correlation between consumption of these beverages and DGER was found. GER and DGER after consumption of low-proof alcoholic beverages
M1845 High Prevalence of Reflux Symptoms in Obese Individuals Mandeep Singh, Debra K. Sullivan, Ajay Bansal, Sachin B. Wani, Vikas Singh, Amit Rastogi, Joseph E. Donnelly, Bryan K. Smith, Prateek Sharma Background: Both obesity & gastroesophageal reflux disease (GERD) have risen in epidemic proportions in the U.S. suggesting a causal association. Several surveys have suggested that reflux symptoms (encountered on a weekly basis) are common & reported by at least 810% of the adult US population; however, the prevalence of reflux symptoms in obese individuals is not known. Aim: To evaluate the prevalence of reflux symptoms (heartburn and/or regurgitation) in a cohort of obese subjects enrolled in a weight loss program. Methods: In an ongoing prospective weight loss study, participants were asked to complete a validated GERD questionnaire [reflux disease questionnaire (RDQ)]. The RDQ comprises of 12 questions; 6 each related to reflux symptom frequency & severity. In addition, demographic information, use of acid suppressive medications, BMI & waist circumference (WC) were recorded at study enrollment. The overall prevalence of reflux symptoms was assessed by calculating the frequency of subjects with at least weekly heartburn (HB) and/ or regurgitation (RG) (as reported in the RDQ). BMI & WC were compared between subjects with & without reflux symptoms using the χ2 test. Results: To date, a total of 122 subjects have been enrolled ; all subjects completed the validated GERD questionnaire. Cohort's mean age was 45 years (range: 18 -64); 75% females and 82% Caucasians, the mean BMI was 36.6 (range: 27 - 46.5) and the mean WC was 102.6 cm (range: 79 - 141). The majority of the subjects had a BMI > 35 (60%) and WC > 100 (67%). 45 subjects (37%) had at least weekly HB &/or RG. RG [n= 31 (25%)] was reported more frequently than HB [n=27 (22%)] and 18/37 subjects (40%) had moderate-severe symptoms. The mean BMI and WC in subjects with reflux symptoms was 36.0 (range 28 to 46.5) and 104.8 cm (range 84 to 142) respectively. No significant association was observed between different BMI quartiles and the presence of reflux symptoms (p<0.05); however, a trend was noted for an association between reflux symptoms and increasing WC (prevalence: 28% with WC≤100 & 44% with >100 cm; p= 0.09). Only 6 subjects were using acid suppressive medications. Conclusions: This study demonstrates that the prevalence of reflux symptoms in obese subjects, is approximately 40%. This prevalence in obese subjects appears to be higher than that reported in the general population. Despite experiencing weekly symptoms, the majority of these subjects were not taking acid suppressive therapy. Obese individuals, therefore, should be actively queried regarding the presence of reflux symptoms. Randomized controlled trials are needed to study the impact of weight loss on reflux symptoms.
* fraction of whole monitoring interval of one hour in %, median (range). p-values white wine vs. water p<0.001, rose wine vs. water p<0.01, beer vs water p<0.01, white wine vs rose wine p<0.05, white wine vs beer p<0.01 M1848 Nonacid Reflux Is Able to Determine Microscopic Esophagitis in Non-Erosive Reflux Disease (NERD) Patients Edoardo Savarino, Patrizia Zentilin, Luca Mastracci, Lorenzo Gemignani, Andrea Parodi, Elisa Marabotto, Giorgio Sammito, Paola Ceppa, Roberto Fiocca, Vincenzo Savarino Introduction: Acid reflux has been shown to be able to induce microscopic esophagitis in non-erosive reflux disease (NERD) patients. There are no data on the role of nonacid reflux in causing the same histological alteration. Aim: To assess whether nonacid reflux can provoke microscopic esophagitis in NERD patients. Methods: We evaluated 35 consecutive patients with NERD (20F, median age 47; range 40-71 yrs) while off-PPI therapy. During the upper GI endoscopy multiple biopsies were taken at the Z-line, 2 and 4 cm above it. Microscopic esophagitis was identified by necrosis/erosion, neutrophil/eosinophil intraepithelial infiltration, basal cell hyperplasia, elongation of papillae, dilation of intercellular spaces and a score (range: 0-2) was given for each lesion. In agreement with previous studies a cut-off value of 2 was considered for diagnosing a microscopic esophagitis 1. Within 3 days of endoscopy, patients underwent a multichannel intraluminal impedance and pH (MII-pH) testing using a standardized Mediterranean diet. We measured distal esophageal acid exposure time (AET) and number of impedance-detected reflux episodes (acid, nonacid) 2 . Results: Out of 35 NERD patients, 15 (43%) had an abnormal esophageal AET. Among these, 10 (29%) patients had microscopic esophagitis in agreement with our histological score (score>2). The remaining twenty (57%) patients had normal distal esophageal AET,
M1846 Postprandial Reflux Patterns in Healthy Volunteers (HV) and Patients with Gastro-Esophageal Refux Disease (GERD) Patrizia Zentilin, Edoardo Savarino, Giorgio Sammito, Marzio Frazzoni, Vincenzo Savarino The postprandial increase of GER reflux results from an increase in the rate of transient lower esophageal sphincter relaxations which occur more frequently after the ingestion of a meal which induces gastric distention. Few data exist on the differences between HV and GERD patients in the postprandial periods. Aim of this study was to evaluate reflux patterns among HV, non erosive reflux disease (NERD) patients, erosive esophagitis (EE) patients and Barrett esophagus (BE) in the first postprandial hour using combined multichannel intraluminal impedance and pH (MII-pH). Methods. We studied 20 HV (8 F, median age 25 yrs, range 22-69), 20 NERD patients with typical symptoms (11 F, median age 49.5 yrs,
AGA Abstracts
A-430