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Mo1334 Comparative Study to Assess the Outcome of Percutaneous Catheter Drainage Versus Combination of Percutaneous Catheter Drainage and Endoscopic Therapy in Fluid Collections Following Acute Pancreatitis
AGA Abstracts
studies suggest PPI use is associated with weight gain, and other studies found PPI use impairs weight loss after gastric bypass surgery, possibly by altering the gut microbiota and influencing energy extraction. The effect of PPIs on energy intake, energy extraction, or energy expenditure is unknown. Obese patients with GERD are often instructed to lose weight, but there is little data on energy intake, diet composition, or physical activity patterns of PPI users compared to PPI non-users. The aims of this study were to investigate whether differences in energy intake, diet composition, or physical activity patterns exist for PPI users compared to non-users that would influence body weight. Methods: Our data are from the National Health and Nutrition Examination Survey (NHANES), a complex multistage probability sample of the U.S. civilian population. We used data on 2479 eligible adults aged 20-74y in the 2005-2006 NHANES. Medication use was ascertained during an inperson interview. Energy intake (kcal/day) and diet composition were obtained by dietary recall. Confounding variables were included in multivariate regression models assessing energy intake, physical activity, and weight change (including age, gender, race/ethnicity, education, being overweight or obese, diabetes medications, and total number of medications). Appropriate survey commands were used. Results: PPI users were older (52.8y vs 42.8y; p <0.001), more likely to be obese (45.4% vs 30.6%; p=0.008), and were taking more non-acid suppressing medications (4.0 vs 1.2; p<0.001) compared to non-users. PPI users consumed a slightly higher proportion of calories from fat (34.5% vs 33.2%; p=0.02) with a similar proportion of calories from carbohydrates, protein, and alcohol compared to PPI non-users. Daily energy intake was similar between PPI users and non-users (p=0.42). PPI users rated themselves as being as physically active as their age/gender-matched peers and had nearly identical frequencies of walking, biking, and engaging in moderate/vigorous physical activity compared to non-users. PPI users were less likely to have participated in muscle-strengthening activities within the previous 30 days (OR 0.53; 95% CI: 0.29-0.96). Male PPI users had a significant increase in self-reported weight (of 1.5 ± 0.6 kg; p=0.028) over the previous year, while female PPI users had a non-significant increase in weight (of 0.4 ± 1.1 kg; p=0.7). Conclusions: PPI use may lead to weight gain, possibly due to differences in energy extraction as energy intake and physical activity were similar between PPI users and non-users.
Mo1333 Adiposity Is Associated With Alterations Within the Brain Reward System in Adult Subjects Claudia P. Sanmiguel, Arpana Gupta, Jennifer S. Labus, Kristen Coveleskie, Iordanis Karagiannidis, Mher Alaverdyan, Cody Ashe-McNalley, Jean Stains, Suzanne R. Smith, Kirsten Tillisch, Lin Chang, Emeran A. Mayer Structural and functional brain changes have been identified in obese subjects, but the mechanisms underlying these changes are incompletely understood. Increased cytokine production by visceral adipose tissue (VAT) may play a role in triggering regional inflammatory changes within the brain. Aims: We hypothesized that: 1) The morphology of reward network regions differs between obese/overweight [O/O] and lean 2) Morphometric changes are related to VAT and proinflammatory adipokines. Methods: 37 adult subjects (age:24.1±6yrs, 26 females) without history of diabetes, neurological, cardiovascular or psychiatric disorders underwent structural brain MRIs. Subjects were divided into 22 lean subjects (BMI: 21.8±1.7) and 15 O/O subjects (BMI: 29±4.9). Freesurfer analysis yielded 165 regions with 4 gray matter (GM) metrics (volume; cortical thickness; surface area; mean curvature). Adipokines were measured in serum using magnetic bead-based multiplex assay. VAT was measured using DEXA scans. Associations between morphometric measures and adipokines, BMI, waist-hip ratio (WHR), and VAT were explored using Pearson correlations. General linear models were constructed to examine interactions of obesity with adipokines on gray matter changes Results: 1) GM properties were positively correlated with BMI in the insula (INS) and posterior cingulate cortex (CC), and negatively in orbital gyrus (OFG). VAT was positively associated with INS and precentral gyrus GM properties. Increased WHR was related to higher INS grey matter properties and low nucleus accumbens (NAcc) volume. Females tended to have larger INS volumes than men and smaller CC volumes. 2) Measures of adiposity (BMI, VAT and WHR) were negatively correlated with Adiponectin. Pro-inflammatory adipokines were associated with GM changes: a) CMP-1: positive correlations with CC, INS, amygdala (AMYG) and post-central gyrus (PostCG); b) IL-6 and IL-8: negative correlation with INS, and c) TNF-α: positive association with postCG and precuneus. 3) Higher BMI tended to be associated with lower volumes in parahippocampal gyrus (F=5.8, p=0.02), INS (F=3.4, p=0.02) and OFG (F=12.8, p=0.001). Adiponectin was positively associated OFG volumes (F=6.7, p=0.01) and there was an interaction effect between BMI and Adiponectin (F=6.153, p=.019). Conclusion: Increased adiposity was associated with lower volumes at parahippocampal gyrus, INS and OFG. Adiponectin, an "anti-inflammatory" adipokine was negatively correlated with obesity and associated with greater OFG volumes. Adipokines correlated with altered morphology in the reward system regions that could lead to abnormal top-down regulation of eating behaviors. Although current findings are enticing for a possible association between an obesity-related pro-inflammatory environment and brain morphometric changes, a larger sample is needed to confirm these associations.
Mo1332 Upper Gastrointestinal System Endoscopic Findings in Obese Patients Ahmet Danalioglu, Yusuf Kayar, Birol Baysal, Ali T. Ince, Hakan Senturk Background: Obesity is an epidemic situation and its incidence continues to increase worldwide. Some endoscopic findings are more common in obese patients. Aim: Endoscopically evaluate the upper gastrointestinal system findings in obese patients. Methods: An upper gastrointestinal system endoscopy was performed in all patients hospitalized for bariatric surgery. Relevant endoscopic findings were recorded and biopsies from antrum, incisura and pylorus were taken by two experienced gastroenterologist. Gastroesophageal sphincter incompetency (GSI) was classified according to Hill classification. Age, gender, body mass index (BMI) and Helicobacter Pylori (HP) were considered. The patients were divided to into normal (Group I) and abnormal group (Group II) in terms of existence of abnormal endoscopic findings. Results: Total 129 patients were enrolled into study. Of these, 93 (%73,2) were female and mean age was 38,9±12,5 (range: 16-68). Abnormal endoscopic findings and HP were detected in 79% and 44% of patients, respectively. In group II, patients were older, BMI higher and HP more prevalent (all statistically significant). Diabetes mellitus (%36.2), hypertension (%35.4) and dyslipidemia (%36.2) were the most common comorbidities. Multiple comorbidities were more common in group II. GSI in total group was observed in a rate of 45.6% (Hill A %7.9, B %25.2, C %11 and D %2.4). and groups were similar. Conclusion: Endoscopic findings are more frequent in obese than in non-obese patients and these findings increases with severity of obesity and age. HP infection is less common in obese patients comparing to non-obese population but more common in endoscopically abnormal obese patients comparing to normal ones. Table I. Abnormal Endoscopic Findings in Total Group
Mo1334 Comparative Study to Assess the Outcome of Percutaneous Catheter Drainage Versus Combination of Percutaneous Catheter Drainage and Endoscopic Therapy in Fluid Collections Following Acute Pancreatitis Arun AC, Ajay Gulati, Vikas Gupta, Thakur D. Yadav, Pradeep K. Siddappa, Manish Manrai, Saroj K. Sinha, Rakesh Kochhar Objectives: To compare the outcomes of percutaneous catheter drainage (PCD) versus combination of PCD and endoscopic therapy in management of fluid collections in acute pancreatitis (AP). Material and methods: In this retrospective and prospective study between July 2010 and June 2014, we evaluated the outcome of patients with acute fluid collections following acute pancreatitis who had undergone PCD alone (group 1) and PCD combined with endoscopic therapy (group 2) . There was no significant difference in the etiology of acute pancreatitis, sex distribution and severity of acute pancreatitis between the two groups. Indications for PCD were symptomatic collections, size more than 6 cm, infected collections, persistent organ failure. Indications for endoscopic therapy were disrupted pancreatic duct in those with fluid collections and collections abutting stomach or duodenum which persist even after PCD. During analysis of data, continuous variables were compared using the student t test. Dichotomous variables were compared using Chi square test. Outcome measures studied were resolution of fluid collections, need for surgery and mortality. Results: Out of the 154 patients (89 retrospective and 65 prospective), 119 were in group 1 and 35 in group 2. Patients in group 2 received endoscopic therapy apart from PCD which included pancreatic sphincterotomy alone (n=11), pancreatic stenting (n=16), nasocystic drainage with endoscopic necrosectomy (n=6), endoscopic cystogastrostomy with pancreatic stenting (n=2). Fluid collections resolved in 57 patients (47.89%) in group 1 and 27 patients (77.14%) in group 2 (p=0.002). Thirty five patients (29.41%) required surgery in group 1, while only 5 patients (14.28%) required surgery in group 2 (p=0.07). The mortality rate was 39.49% (n=47) in group 1 and 8.5% (n=3) in group 2 (p=0.006). Conclusion : Resolution of fluid collections, requirement of surgery and mortality were significantly low in patients undergoing endoscopic therapy along with PCD when compared to patients undergoing PCD alone.
Table II. Comparing of Groups
Mo1335 Impact of Characteristics of Acute Fluid Collections on the Course and Outcome of Acute Pancreatitis Narendra Dhaka, Munish Ashat, Pradeep K. Siddappa, Jayanta Samanta, Vikas Gupta, Thakur D. Yadav, Ajay Gulati, Saroj K. Sinha, Rakesh Kochhar Aims: To evaluate the impact of various characteristics (number, location and size) of fluid collections on course and outcome of patients of acute pancreatitis (AP). Methods : 195 patients with AP who had acute fluid collections in and around pancreas on initial imaging were divided on the basis of collections: number (single versus multiple), size (≤5 cm versus >5cm) and location {pancreatic (A), peripancreatic (B), both (C), peripancreatic with distant(D) and at all sites(E)}. Outcome variables studied were hospital stay, ICU stay, need for ventilator and ICU care, need for pigtail drainage, surgery and mortality. Results:
AGA Abstracts
S-674
studies suggest PPI use is associated with weight gain, and other studies found PPI use impairs weight loss after gastric bypass surgery, possibly by altering the gut microbiota and influencing energy extraction. The effect of PPIs on energy intake, energy extraction, or energy expenditure is unknown. Obese patients with GERD are often instructed to lose weight, but there is little data on energy intake, diet composition, or physical activity patterns of PPI users compared to PPI non-users. The aims of this study were to investigate whether differences in energy intake, diet composition, or physical activity patterns exist for PPI users compared to non-users that would influence body weight. Methods: Our data are from the National Health and Nutrition Examination Survey (NHANES), a complex multistage probability sample of the U.S. civilian population. We used data on 2479 eligible adults aged 20-74y in the 2005-2006 NHANES. Medication use was ascertained during an inperson interview. Energy intake (kcal/day) and diet composition were obtained by dietary recall. Confounding variables were included in multivariate regression models assessing energy intake, physical activity, and weight change (including age, gender, race/ethnicity, education, being overweight or obese, diabetes medications, and total number of medications). Appropriate survey commands were used. Results: PPI users were older (52.8y vs 42.8y; p <0.001), more likely to be obese (45.4% vs 30.6%; p=0.008), and were taking more non-acid suppressing medications (4.0 vs 1.2; p<0.001) compared to non-users. PPI users consumed a slightly higher proportion of calories from fat (34.5% vs 33.2%; p=0.02) with a similar proportion of calories from carbohydrates, protein, and alcohol compared to PPI non-users. Daily energy intake was similar between PPI users and non-users (p=0.42). PPI users rated themselves as being as physically active as their age/gender-matched peers and had nearly identical frequencies of walking, biking, and engaging in moderate/vigorous physical activity compared to non-users. PPI users were less likely to have participated in muscle-strengthening activities within the previous 30 days (OR 0.53; 95% CI: 0.29-0.96). Male PPI users had a significant increase in self-reported weight (of 1.5 ± 0.6 kg; p=0.028) over the previous year, while female PPI users had a non-significant increase in weight (of 0.4 ± 1.1 kg; p=0.7). Conclusions: PPI use may lead to weight gain, possibly due to differences in energy extraction as energy intake and physical activity were similar between PPI users and non-users.
Mo1333 Adiposity Is Associated With Alterations Within the Brain Reward System in Adult Subjects Claudia P. Sanmiguel, Arpana Gupta, Jennifer S. Labus, Kristen Coveleskie, Iordanis Karagiannidis, Mher Alaverdyan, Cody Ashe-McNalley, Jean Stains, Suzanne R. Smith, Kirsten Tillisch, Lin Chang, Emeran A. Mayer Structural and functional brain changes have been identified in obese subjects, but the mechanisms underlying these changes are incompletely understood. Increased cytokine production by visceral adipose tissue (VAT) may play a role in triggering regional inflammatory changes within the brain. Aims: We hypothesized that: 1) The morphology of reward network regions differs between obese/overweight [O/O] and lean 2) Morphometric changes are related to VAT and proinflammatory adipokines. Methods: 37 adult subjects (age:24.1±6yrs, 26 females) without history of diabetes, neurological, cardiovascular or psychiatric disorders underwent structural brain MRIs. Subjects were divided into 22 lean subjects (BMI: 21.8±1.7) and 15 O/O subjects (BMI: 29±4.9). Freesurfer analysis yielded 165 regions with 4 gray matter (GM) metrics (volume; cortical thickness; surface area; mean curvature). Adipokines were measured in serum using magnetic bead-based multiplex assay. VAT was measured using DEXA scans. Associations between morphometric measures and adipokines, BMI, waist-hip ratio (WHR), and VAT were explored using Pearson correlations. General linear models were constructed to examine interactions of obesity with adipokines on gray matter changes Results: 1) GM properties were positively correlated with BMI in the insula (INS) and posterior cingulate cortex (CC), and negatively in orbital gyrus (OFG). VAT was positively associated with INS and precentral gyrus GM properties. Increased WHR was related to higher INS grey matter properties and low nucleus accumbens (NAcc) volume. Females tended to have larger INS volumes than men and smaller CC volumes. 2) Measures of adiposity (BMI, VAT and WHR) were negatively correlated with Adiponectin. Pro-inflammatory adipokines were associated with GM changes: a) CMP-1: positive correlations with CC, INS, amygdala (AMYG) and post-central gyrus (PostCG); b) IL-6 and IL-8: negative correlation with INS, and c) TNF-α: positive association with postCG and precuneus. 3) Higher BMI tended to be associated with lower volumes in parahippocampal gyrus (F=5.8, p=0.02), INS (F=3.4, p=0.02) and OFG (F=12.8, p=0.001). Adiponectin was positively associated OFG volumes (F=6.7, p=0.01) and there was an interaction effect between BMI and Adiponectin (F=6.153, p=.019). Conclusion: Increased adiposity was associated with lower volumes at parahippocampal gyrus, INS and OFG. Adiponectin, an "anti-inflammatory" adipokine was negatively correlated with obesity and associated with greater OFG volumes. Adipokines correlated with altered morphology in the reward system regions that could lead to abnormal top-down regulation of eating behaviors. Although current findings are enticing for a possible association between an obesity-related pro-inflammatory environment and brain morphometric changes, a larger sample is needed to confirm these associations.
Mo1332 Upper Gastrointestinal System Endoscopic Findings in Obese Patients Ahmet Danalioglu, Yusuf Kayar, Birol Baysal, Ali T. Ince, Hakan Senturk Background: Obesity is an epidemic situation and its incidence continues to increase worldwide. Some endoscopic findings are more common in obese patients. Aim: Endoscopically evaluate the upper gastrointestinal system findings in obese patients. Methods: An upper gastrointestinal system endoscopy was performed in all patients hospitalized for bariatric surgery. Relevant endoscopic findings were recorded and biopsies from antrum, incisura and pylorus were taken by two experienced gastroenterologist. Gastroesophageal sphincter incompetency (GSI) was classified according to Hill classification. Age, gender, body mass index (BMI) and Helicobacter Pylori (HP) were considered. The patients were divided to into normal (Group I) and abnormal group (Group II) in terms of existence of abnormal endoscopic findings. Results: Total 129 patients were enrolled into study. Of these, 93 (%73,2) were female and mean age was 38,9±12,5 (range: 16-68). Abnormal endoscopic findings and HP were detected in 79% and 44% of patients, respectively. In group II, patients were older, BMI higher and HP more prevalent (all statistically significant). Diabetes mellitus (%36.2), hypertension (%35.4) and dyslipidemia (%36.2) were the most common comorbidities. Multiple comorbidities were more common in group II. GSI in total group was observed in a rate of 45.6% (Hill A %7.9, B %25.2, C %11 and D %2.4). and groups were similar. Conclusion: Endoscopic findings are more frequent in obese than in non-obese patients and these findings increases with severity of obesity and age. HP infection is less common in obese patients comparing to non-obese population but more common in endoscopically abnormal obese patients comparing to normal ones. Table I. Abnormal Endoscopic Findings in Total Group
Mo1334 Comparative Study to Assess the Outcome of Percutaneous Catheter Drainage Versus Combination of Percutaneous Catheter Drainage and Endoscopic Therapy in Fluid Collections Following Acute Pancreatitis Arun AC, Ajay Gulati, Vikas Gupta, Thakur D. Yadav, Pradeep K. Siddappa, Manish Manrai, Saroj K. Sinha, Rakesh Kochhar Objectives: To compare the outcomes of percutaneous catheter drainage (PCD) versus combination of PCD and endoscopic therapy in management of fluid collections in acute pancreatitis (AP). Material and methods: In this retrospective and prospective study between July 2010 and June 2014, we evaluated the outcome of patients with acute fluid collections following acute pancreatitis who had undergone PCD alone (group 1) and PCD combined with endoscopic therapy (group 2) . There was no significant difference in the etiology of acute pancreatitis, sex distribution and severity of acute pancreatitis between the two groups. Indications for PCD were symptomatic collections, size more than 6 cm, infected collections, persistent organ failure. Indications for endoscopic therapy were disrupted pancreatic duct in those with fluid collections and collections abutting stomach or duodenum which persist even after PCD. During analysis of data, continuous variables were compared using the student t test. Dichotomous variables were compared using Chi square test. Outcome measures studied were resolution of fluid collections, need for surgery and mortality. Results: Out of the 154 patients (89 retrospective and 65 prospective), 119 were in group 1 and 35 in group 2. Patients in group 2 received endoscopic therapy apart from PCD which included pancreatic sphincterotomy alone (n=11), pancreatic stenting (n=16), nasocystic drainage with endoscopic necrosectomy (n=6), endoscopic cystogastrostomy with pancreatic stenting (n=2). Fluid collections resolved in 57 patients (47.89%) in group 1 and 27 patients (77.14%) in group 2 (p=0.002). Thirty five patients (29.41%) required surgery in group 1, while only 5 patients (14.28%) required surgery in group 2 (p=0.07). The mortality rate was 39.49% (n=47) in group 1 and 8.5% (n=3) in group 2 (p=0.006). Conclusion : Resolution of fluid collections, requirement of surgery and mortality were significantly low in patients undergoing endoscopic therapy along with PCD when compared to patients undergoing PCD alone.
Table II. Comparing of Groups
Mo1335 Impact of Characteristics of Acute Fluid Collections on the Course and Outcome of Acute Pancreatitis Narendra Dhaka, Munish Ashat, Pradeep K. Siddappa, Jayanta Samanta, Vikas Gupta, Thakur D. Yadav, Ajay Gulati, Saroj K. Sinha, Rakesh Kochhar Aims: To evaluate the impact of various characteristics (number, location and size) of fluid collections on course and outcome of patients of acute pancreatitis (AP). Methods : 195 patients with AP who had acute fluid collections in and around pancreas on initial imaging were divided on the basis of collections: number (single versus multiple), size (≤5 cm versus >5cm) and location {pancreatic (A), peripancreatic (B), both (C), peripancreatic with distant(D) and at all sites(E)}. Outcome variables studied were hospital stay, ICU stay, need for ventilator and ICU care, need for pigtail drainage, surgery and mortality. Results:
AGA Abstracts
S-674