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Mo1877 The Comparison of Gastrointestinal Symptoms in Patients With Helicobacter pylori-Associated Dyspepsia and Functional Dyspepsia
Results: A total of 2,042 patients with a mean age of 50.3±13.8 years were included and 66% were female. Of these, 543 (26.6%) patients were infected by H. pylori and the remaining 1,499 patients were classified as having FD. Both groups of patients were similar with regard to age, gender, body mass index, smoking habit and alcohol used. The duration of the disease estimated from the onset of clinical symptoms to the time of endoscopy in individuals with H. pylori-associated dyspepsia was shorter than those with FD [16±28 vs. 20±37 months, p=.02]. Using the Rome III criteria, no significant differences were found between the symptom patterns of H. pylori-associated dyspepsia and FD categorized as epigastric pain syndrome (68.5% vs. 68.5%, p=.7), postprandial distress syndrome (8.7% vs. 9.2%, p=.9) and overlap condition (22.8% vs.22.3%, p=.9). Concomitant heartburn (10.9% vs. 13.2%, p=.2), bloating (43.0% vs. 42.7%, p=.9) and diarrhea (8.3% vs. 7.2%, p=.4) were also not significantly different between H. pylori-associated dyspepsia and FD. The prevalence of constipation tend to be often occurred in subjects with H. pylori-associated dyspepsia but the difference did not reach statistical significance (22.6% vs. 19.1%, p=.09). The frequency of irritable bowel syndrome among H. pylori-associated dyspepsia and FD was 6.7% and 8.5%, respectively (p=.2). Conclusion: Our data show that the gastrointestinal symptoms among patients with H. pylori-associated dyspepsia and FD are not significantly different. Thus, other novel markers rather than symptomatology should be used to determine the effect of H. pylori infection in the pathogenesis of FD.
Mo1876
Mo1878
Prevalence of Significant Endoscopic Findings in Dyspeptic Patients With Alarm Features: A Prospective Study Pitiya Roongpoovapatr, Amporn Atsawarungruangkit, Disaya Chavalitdhamrong, Chalermrat Bunchorntavakul
Psychological Status and Relationship Between Psychological Problems and Disease's Symptoms Among Functional Dyspepsia Patients Aliye Soylu, Ejder A. Yildirim Objectives: Gastrointestinal complaints are common amongst patients with psychological problems. Incidence and severity of mental health problems among functional dyspepsia (FD) patients, and relationship between FD symptoms and psychological problems are investigated. Study design: Ninety-five FD patients (76F/19M) according to Rome III criteria were included in the study. They were assessed with Personality Type Inventory, General Health Questionnaire (GHQ-28) and Beck Anxiety Inventory (BAI). Somatic anxiety scores (SoAS) and subjective anxiety scores (SuAS) of Beck Anxiety Inventory (BAI) and four subscales (A, B, C, D) of GHQ-28 were evaluated. Duration, intensity of dyspeptic, refluxlike and epigastric pain symptoms, medicine use and its duration were scored and compared with GHQ and BAI scores. Results: Of the 95 patients; 62.1% had dyspepsia, 81.1% had acid reflux and 96.8% had epigastric pain. Dyspesia severity was mild in 18.6%, moderate in 42.4% and severe in 39%. Epigastric pain severity was mild in 17.6%, moderate in 35.1% and severe in 47.4%. B type personality was predominant among those with epigastric pain over 1 year. The women had higher BAI, SuAS and SoAS scores (p ,0.01). Those with ≤1 year of reflux symptoms had higher BAI and SuAS scores compared to those with ,1 year of reflux complaint and no-reflux group. SuAS and SoAS scores had a positive correlation with reflux scores and (p ,0.01). According to GHQ-0011, 63.2% of the patients had mental health problems. Psychological problems were more prevalent among women (%71.1; p,0.01). There was a positive correlation between GHQ-0011 scores and epigastric pain severity (p,0.05). Psychological problems were significantly more prevalent among moderate and severe epigastric pain group compared to mild and no-symptom group. 72.6% of the patients used PPI, 7.4% used antacids and 4.2% used H2RA and 15.8% did not use any gastric medication. The medication use pattern varied among patients; 29.5% used ondemand, 4.2% used several times a week and 50.5% used regularly every day. Conclusion: Symptoms overlap among FD patients and psychological problems are very high. Psychological problems and anxiety are more common among women. Epigastric pain is more prevalent among A type personality and the pain intensity increases as psychological problems increase. It seems that reflux intensifies anxiety and as duration of the reflux increases anxiety decrease. Collaboration with psychiatry professionals should be considered in order to reduce improper gastric medication use.
Background: Dyspepsia is common in clinical practice. Esophagogastroduodenoscopy (EGD) is generally recommended in dyspeptic patients with alarm features (AF) including (I) age ≥55 years, (II) evidence of gastrointestinal blood loss, (III) unexplained weight loss, (IV) dysphagia, and (V) persistent vomiting. The predictive value of AF remains unclear. Aims: To evaluate EGD findings in dyspeptic patients with AF and to assess the diagnostic role of abdominal ultrasonography (US) in endoscopy-negative dyspeptic patients with AF. Methods: Between July 2011 and September 2012, consecutive dyspeptic patients were evaluated for the presence of AF. EGD was performed in 143 dyspeptic patients with AF. Significant EGD findings were defined as any lesion(s) other than normal and non-erosive gastritis. Patients with known malignancy, previous gastric surgery and prior EGD were excluded. We retrospectively collected EGD findings among dyspeptic patients without AF who underwent EGD during the same period of time to compare with the study population. Abdominal US was performed in all endoscopic negative patients. Results: Peptic ulcers and erosive gastroduodenitis were found in 23.1% and 46.9% of 143 dyspeptic patients with AF, respectively. Tumors were encountered in 5.6% (CA esophagus 1, CA stomach 4, gastric lymphoma 1, GIST 1, metastatic squamous cell CA 1). Rapid urease test was positive in 84/137 patients (61.3%). Significant EGD findings were found in 108/143 of patients; which is significantly higher than AF-negative dyspeptic controls. (75.5% vs 21.3%, p ,0.001). EGD findings in relation to each AF were summarized in the Table. Among the 5 AF, persistent vomiting seems to have the highest predictive value, especially for peptic ulcer (71%). In those 34 patients with negative EGD, US was normal in 41.2% and positive in 58.8% (fatty liver 9, gallstones 7, lymphadenopathy 1, cirrhosis 1, hemangioma 1, ovarian cyst 1) Conclusions: The presence of AF in dyspeptic patients has high predictive value for significant EGD lesions with highest predictive value with persistent vomiting. The most commonly found lesion was erosive gastroduodenitis. Further evaluation by US in EGDnegative dyspeptic patients with AF has limited utility. EGD findings in relation to each alarm feature
Mo1879 Analysis of C825T Polymorphism of the G-Protein Beta-3 Subunit Gene and Its Association With Dyspeptic Symptoms in Brazilian Patients With Functional Dyspepsia Andre C. Wortmann, Daniel Simon, Luiz E. Mazzoleni, Vanessa C. Jacovas, Guilherme B. Sander, Tobias C. Milbradt, Laura R. De Bona, Carlos F. Francesconi, Vagner R. Lunge, Themis R. Silveira BACKGROUND: Functional dyspepsia (FD) is characterized by upper gastrointestinal symptoms in the absence of any know specific structural cause. According to Rome III consensus, dyspeptic patients may be classified in two categories: postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). The role of genetic factors in the susceptibility to the disease is not well established. Nevertheless, recent findings suggest a possible association between C825T polymorphism of the G-protein beta-3 subunit gene (GNB3) and FD. Significant association between homozygous 825C allele of GNB3 protein and dyspepsia was reported from Germany, Japan and the USA. The aim of the present study was to evaluate the association of C825T polymorphism with dyspeptic symptoms in Brazilian patients. METHODS: Study sample was comprised by 303 functional dyspeptics (Rome III criteria) infected by Helicobacter pylori. Informed consent was obtained from all subjects, and the study protocol was approved by the institution's human research committee. Peripheral blood samples were used for DNA extraction, followed by PCR amplification. C825T polymorphism of GNB3 gene was analyzed by restriction fragment length polymorphism with the enzyme BsaJI; the digested PCR products were analyzed by polyacrylamide gel electrophoresis. Dyspeptic symptoms (upper abdominal pain, nausea/vomiting, abdominal bloating and early satiety) were scored according to a previously structured and validated questionnaire (PADYQ; Sander et al. Dig Dis Sci 2004, 49:1822-9). RESULTS: According to the predominant symptoms, patients were classified into categories of FD: 152 (50.2%) as DPS, and 151 (49.8%) as EPS. GNB3 genotype frequencies were: 128 (42.2%) CC, 130 (42.9%) CT, and 45 (14.9%) TT. There were no statistically significant differences in genotype or allele frequencies between FD categories. Higher PADYQ scores on abdominal bloating/ early satiety were observed in patients with CC GNB3 genotype (128 patients, mean score
A=age .55 years; B=GI blood loss; C=weight loss; D=dysphagia; E=persistent vomiting Mo1877 The Comparison of Gastrointestinal Symptoms in Patients With Helicobacter pylori-Associated Dyspepsia and Functional Dyspepsia Uayporn Siriyuyuen, Phunchai Charatcharoenwitthaya, Nonthalee Pausawasdi, Monthira Maneerattanaporn, Somchai Leelakusolvong, Udom Kachintorn Background/Aims: The role of Helicobacter pylori (H. pylori ) infection in the pathogenesis of functional dyspepsia (FD) is controversial. Several investigators suggest that H. pyloriassociated dyspepsia should be considered a different disease entity from FD. Our study was conducted to assess the differences in gastrointestinal symptoms between patients with FD who have H. pylori infection and those without infection. Methods: Retrospective review of medical records and endoscopic findings of 3,309 patients aged ≥18 years presenting with dyspepsia based on the Rome III criteria undergone upper endoscopy with H. pylori assessment. The infection is documented if urease test was positive or a microorganism was identified on the gastric biopsy. A total of 1,267 patients who had erosive esophagitis (n= 323), peptic ulcer (n=202), erosive gastroduodenitis (n=493), malignancies (n=14), used either anti-platelets or non-steroidal anti-inflammatory drugs (n=541) were excluded.
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AGA Abstracts
AGA Abstracts
61 years, range: 48 - 72 years) were considered in the study. All fulfilled the following criteria: a) eradication H. pylori successfully proved by at least two test (UBT or HpSA and by histology); b) cure administered before 1999 (mean follow-up of 15 years, range 12 20 years); c) availability of records symptomatological pattern before the eradication therapy; d) proved persistence of negative H. pylori status between january 2011 and january 2012, assessed by gastropanel (both PGII and anti-HP antibodies normal); e) availability of new assessment of dyspeptic symptoms by means of a structurated interview by using a visual analogic scale based on six scored symptoms (0 to 3) namely: nausea, bloating, post-prandial fullness, epigastric pain, regurgitation, heartburn; f) no previous diagnosis of peptic ulcer; g) age, 50 years at the time of the H. pylori eradication. RESULTS: Hundred and nine patients experienced same symptoms after the 15 years period of follow-up, while a group of 32 (19 males) remained asymptomatic. In the group of the symptomatic patients, 45 referred two symptoms or more (17 nausea, 11 fullness, 10 bloating, 2 epigastric pain); it's noteworthy that 24 patients experienced typical GERD symptoms like hearthburn or regurgitation. CONCLUSION: Dyspepsia is currently considered a multifactorial long-life clinical condition; over 75% of patients 15 years after Hp cure experienced currently dyspeptic symptoms. Further studies might be encouraged in better define the profile of asymptomatic patients after a very long follow-up from the Hp eradication, to try to identify factor involved in a more favourable prognostic outcome.
Mo1876
Mo1878
Prevalence of Significant Endoscopic Findings in Dyspeptic Patients With Alarm Features: A Prospective Study Pitiya Roongpoovapatr, Amporn Atsawarungruangkit, Disaya Chavalitdhamrong, Chalermrat Bunchorntavakul
Psychological Status and Relationship Between Psychological Problems and Disease's Symptoms Among Functional Dyspepsia Patients Aliye Soylu, Ejder A. Yildirim Objectives: Gastrointestinal complaints are common amongst patients with psychological problems. Incidence and severity of mental health problems among functional dyspepsia (FD) patients, and relationship between FD symptoms and psychological problems are investigated. Study design: Ninety-five FD patients (76F/19M) according to Rome III criteria were included in the study. They were assessed with Personality Type Inventory, General Health Questionnaire (GHQ-28) and Beck Anxiety Inventory (BAI). Somatic anxiety scores (SoAS) and subjective anxiety scores (SuAS) of Beck Anxiety Inventory (BAI) and four subscales (A, B, C, D) of GHQ-28 were evaluated. Duration, intensity of dyspeptic, refluxlike and epigastric pain symptoms, medicine use and its duration were scored and compared with GHQ and BAI scores. Results: Of the 95 patients; 62.1% had dyspepsia, 81.1% had acid reflux and 96.8% had epigastric pain. Dyspesia severity was mild in 18.6%, moderate in 42.4% and severe in 39%. Epigastric pain severity was mild in 17.6%, moderate in 35.1% and severe in 47.4%. B type personality was predominant among those with epigastric pain over 1 year. The women had higher BAI, SuAS and SoAS scores (p ,0.01). Those with ≤1 year of reflux symptoms had higher BAI and SuAS scores compared to those with ,1 year of reflux complaint and no-reflux group. SuAS and SoAS scores had a positive correlation with reflux scores and (p ,0.01). According to GHQ-0011, 63.2% of the patients had mental health problems. Psychological problems were more prevalent among women (%71.1; p,0.01). There was a positive correlation between GHQ-0011 scores and epigastric pain severity (p,0.05). Psychological problems were significantly more prevalent among moderate and severe epigastric pain group compared to mild and no-symptom group. 72.6% of the patients used PPI, 7.4% used antacids and 4.2% used H2RA and 15.8% did not use any gastric medication. The medication use pattern varied among patients; 29.5% used ondemand, 4.2% used several times a week and 50.5% used regularly every day. Conclusion: Symptoms overlap among FD patients and psychological problems are very high. Psychological problems and anxiety are more common among women. Epigastric pain is more prevalent among A type personality and the pain intensity increases as psychological problems increase. It seems that reflux intensifies anxiety and as duration of the reflux increases anxiety decrease. Collaboration with psychiatry professionals should be considered in order to reduce improper gastric medication use.
Background: Dyspepsia is common in clinical practice. Esophagogastroduodenoscopy (EGD) is generally recommended in dyspeptic patients with alarm features (AF) including (I) age ≥55 years, (II) evidence of gastrointestinal blood loss, (III) unexplained weight loss, (IV) dysphagia, and (V) persistent vomiting. The predictive value of AF remains unclear. Aims: To evaluate EGD findings in dyspeptic patients with AF and to assess the diagnostic role of abdominal ultrasonography (US) in endoscopy-negative dyspeptic patients with AF. Methods: Between July 2011 and September 2012, consecutive dyspeptic patients were evaluated for the presence of AF. EGD was performed in 143 dyspeptic patients with AF. Significant EGD findings were defined as any lesion(s) other than normal and non-erosive gastritis. Patients with known malignancy, previous gastric surgery and prior EGD were excluded. We retrospectively collected EGD findings among dyspeptic patients without AF who underwent EGD during the same period of time to compare with the study population. Abdominal US was performed in all endoscopic negative patients. Results: Peptic ulcers and erosive gastroduodenitis were found in 23.1% and 46.9% of 143 dyspeptic patients with AF, respectively. Tumors were encountered in 5.6% (CA esophagus 1, CA stomach 4, gastric lymphoma 1, GIST 1, metastatic squamous cell CA 1). Rapid urease test was positive in 84/137 patients (61.3%). Significant EGD findings were found in 108/143 of patients; which is significantly higher than AF-negative dyspeptic controls. (75.5% vs 21.3%, p ,0.001). EGD findings in relation to each AF were summarized in the Table. Among the 5 AF, persistent vomiting seems to have the highest predictive value, especially for peptic ulcer (71%). In those 34 patients with negative EGD, US was normal in 41.2% and positive in 58.8% (fatty liver 9, gallstones 7, lymphadenopathy 1, cirrhosis 1, hemangioma 1, ovarian cyst 1) Conclusions: The presence of AF in dyspeptic patients has high predictive value for significant EGD lesions with highest predictive value with persistent vomiting. The most commonly found lesion was erosive gastroduodenitis. Further evaluation by US in EGDnegative dyspeptic patients with AF has limited utility. EGD findings in relation to each alarm feature
Mo1879 Analysis of C825T Polymorphism of the G-Protein Beta-3 Subunit Gene and Its Association With Dyspeptic Symptoms in Brazilian Patients With Functional Dyspepsia Andre C. Wortmann, Daniel Simon, Luiz E. Mazzoleni, Vanessa C. Jacovas, Guilherme B. Sander, Tobias C. Milbradt, Laura R. De Bona, Carlos F. Francesconi, Vagner R. Lunge, Themis R. Silveira BACKGROUND: Functional dyspepsia (FD) is characterized by upper gastrointestinal symptoms in the absence of any know specific structural cause. According to Rome III consensus, dyspeptic patients may be classified in two categories: postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). The role of genetic factors in the susceptibility to the disease is not well established. Nevertheless, recent findings suggest a possible association between C825T polymorphism of the G-protein beta-3 subunit gene (GNB3) and FD. Significant association between homozygous 825C allele of GNB3 protein and dyspepsia was reported from Germany, Japan and the USA. The aim of the present study was to evaluate the association of C825T polymorphism with dyspeptic symptoms in Brazilian patients. METHODS: Study sample was comprised by 303 functional dyspeptics (Rome III criteria) infected by Helicobacter pylori. Informed consent was obtained from all subjects, and the study protocol was approved by the institution's human research committee. Peripheral blood samples were used for DNA extraction, followed by PCR amplification. C825T polymorphism of GNB3 gene was analyzed by restriction fragment length polymorphism with the enzyme BsaJI; the digested PCR products were analyzed by polyacrylamide gel electrophoresis. Dyspeptic symptoms (upper abdominal pain, nausea/vomiting, abdominal bloating and early satiety) were scored according to a previously structured and validated questionnaire (PADYQ; Sander et al. Dig Dis Sci 2004, 49:1822-9). RESULTS: According to the predominant symptoms, patients were classified into categories of FD: 152 (50.2%) as DPS, and 151 (49.8%) as EPS. GNB3 genotype frequencies were: 128 (42.2%) CC, 130 (42.9%) CT, and 45 (14.9%) TT. There were no statistically significant differences in genotype or allele frequencies between FD categories. Higher PADYQ scores on abdominal bloating/ early satiety were observed in patients with CC GNB3 genotype (128 patients, mean score
A=age .55 years; B=GI blood loss; C=weight loss; D=dysphagia; E=persistent vomiting Mo1877 The Comparison of Gastrointestinal Symptoms in Patients With Helicobacter pylori-Associated Dyspepsia and Functional Dyspepsia Uayporn Siriyuyuen, Phunchai Charatcharoenwitthaya, Nonthalee Pausawasdi, Monthira Maneerattanaporn, Somchai Leelakusolvong, Udom Kachintorn Background/Aims: The role of Helicobacter pylori (H. pylori ) infection in the pathogenesis of functional dyspepsia (FD) is controversial. Several investigators suggest that H. pyloriassociated dyspepsia should be considered a different disease entity from FD. Our study was conducted to assess the differences in gastrointestinal symptoms between patients with FD who have H. pylori infection and those without infection. Methods: Retrospective review of medical records and endoscopic findings of 3,309 patients aged ≥18 years presenting with dyspepsia based on the Rome III criteria undergone upper endoscopy with H. pylori assessment. The infection is documented if urease test was positive or a microorganism was identified on the gastric biopsy. A total of 1,267 patients who had erosive esophagitis (n= 323), peptic ulcer (n=202), erosive gastroduodenitis (n=493), malignancies (n=14), used either anti-platelets or non-steroidal anti-inflammatory drugs (n=541) were excluded.
S-681
AGA Abstracts
AGA Abstracts
61 years, range: 48 - 72 years) were considered in the study. All fulfilled the following criteria: a) eradication H. pylori successfully proved by at least two test (UBT or HpSA and by histology); b) cure administered before 1999 (mean follow-up of 15 years, range 12 20 years); c) availability of records symptomatological pattern before the eradication therapy; d) proved persistence of negative H. pylori status between january 2011 and january 2012, assessed by gastropanel (both PGII and anti-HP antibodies normal); e) availability of new assessment of dyspeptic symptoms by means of a structurated interview by using a visual analogic scale based on six scored symptoms (0 to 3) namely: nausea, bloating, post-prandial fullness, epigastric pain, regurgitation, heartburn; f) no previous diagnosis of peptic ulcer; g) age, 50 years at the time of the H. pylori eradication. RESULTS: Hundred and nine patients experienced same symptoms after the 15 years period of follow-up, while a group of 32 (19 males) remained asymptomatic. In the group of the symptomatic patients, 45 referred two symptoms or more (17 nausea, 11 fullness, 10 bloating, 2 epigastric pain); it's noteworthy that 24 patients experienced typical GERD symptoms like hearthburn or regurgitation. CONCLUSION: Dyspepsia is currently considered a multifactorial long-life clinical condition; over 75% of patients 15 years after Hp cure experienced currently dyspeptic symptoms. Further studies might be encouraged in better define the profile of asymptomatic patients after a very long follow-up from the Hp eradication, to try to identify factor involved in a more favourable prognostic outcome.