Nissen fundoplication in “reflux-negative” gastroesophageal reflux disease

Nissen fundoplication in “reflux-negative” gastroesophageal reflux disease

A1218 AGA ABSTRACTS 5584 DETECTION OF DIFFERENT HEUCOBACTER SPECIES IN PATIENTS WITH OBSTRUCTIVE SQUAMOUS CELL CARCINOMA OF THE ESOPHAGUS IN SOUTH AF...

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A1218 AGA ABSTRACTS

5584 DETECTION OF DIFFERENT HEUCOBACTER SPECIES IN PATIENTS WITH OBSTRUCTIVE SQUAMOUS CELL CARCINOMA OF THE ESOPHAGUS IN SOUTH AFRICA. Ulrich Rm Bohr, Isidor Segal, Reidwaan Ally, Peter Malfertheiner, Ottovon-Guericke Univ, Magdeburg, Germany; Univ of the Witwatersrand, Johannesburg, South Africa. Background: In the past decades squamous cell carcinoma of the esophagus has become the most common cancer in certain African regions. The cause is unknown. Because of the frequent observation of a diffuse, largely nonulcerative esophagitis in these regions we hypothesized that an infectious agents may be involved in the pathogenesis of esophageal cancer in Africa. Methods: Nine South African and two German patients with stenosing squamous esophageal cancer were investigated. DNA was extracted from tumor and the surrounding non-lesional tissue. A new genusspecific PCR for selective detection of 16S-ribosomal RNA from all currently known Helicobacter species was used as a screening method. Positive results were confirmed by sequencing. In addition the resulting 16S-ribosomal RNA sequence enabled a species identification by means of computer aided sequence alignment. Results: Five of nine South African patients were Helicobacter positive. Four of them showed an amplification product in the tumor and in the surrounding tissue, one patient was positive only in the tumor localization. No Helicobacter infections were detected in both German patients. Sequence analysis of the amplification products revealed Helicobacter pylori in two of the five Helicobacter positive patients. Two other patients were infected by a new non-pylori Helicobacter. One patient had a simultaneous infection of two different Helicobacter species. There were no false positive amplification products. Discussion: This is the first report on a new Helicobacter species associated with squamous cell carcinoma of the esophagus in South Africa. A potential causal relation needs further investigation.

5585 GENDER DIFFERENCES IN AMPLITUDE OF CONTRACTION IN THE DISTAL ESOPHAGUS. Melissa Borthwick, Philip O. Katz, Donald O. Castell, Graduate Hosp, Philadelphia, PA. Gender differences in esophageal function identified in the literature include duration and velocity of contractions, esophageal length, amount of physiologic reflux, and pain threshold. Identification of other differences in motility may aid interpretation of manometry readings. Methods: Normal manometry was defined by a set of exclusion criteria: patient age less than 18 or greater than 70, achalasia, scleroderma, diffuse spasm, ineffective esophageal motility, nutcracker esophagus, double high pressure zone, UESP incoordination, hyper or hypotensive LES, hyper or hypotensive UES, incomplete relaxation of LES were excluded. Normal pH study was defined by % time pH below 4 upright <6.3 and supine <1.2. Eighty-six patients (47 females, 39 males) with normal manometry were divided by gender and compared in terms of patient age, resting LESP, residual LESP, duration and amplitude of contractions in the distal esophagus. Patients were subsequently subdivided into two groups: (1) normal motility, normal pH (2) normal motility, abnormal pH (reflux). Results: Gender differences in amplitude of contraction were observed before the patients were subdivided based on pH scores (women: 1]2.5 +1-4.9, men: 96.1 +1-4.9, mean +I-SEM, p=0.02). Subsequent t tests revealed no difference between patients with both normal motility and pH. However, gender differences were observed between the men and women with normal motility and reflux (women: ] 15.2 +1- 7.5, men: 91.5 +1- 8.5, p=0.0447). No other manometric differences were found. Conclusion: In patients with abnormal pH and normal motility, women have significantly higher amplitudes of contraction in the distal esophagus than do men. Clinical significance, if any, is uncertain but should be taken into account during evaluation of manometric studies.

5586 NISSEN FUNDOPLICATION IN "REFLUX-NEGATIVE" GASTROESOPHAGEAL REFLUX DISEASE. Eldert A. Boudesteijn, Janiek E. Bais, Koop Bosscha, Andre J. Smout, Hein G. Gooszen, GI Motility Unit UMC Utrecht, Utrecht, Netherlands. Patients with Gastroesophageal Reflux Disease and insufficient response to medical therapy, are potential candidates for anti-reflux surgery. Even without esophagitis there is no longer reluctance to propose surgery if symptoms are related to reflux. There is a subgroup of patients with severe reflux related symptoms, but with an overall reflux percentage within the normal range. Methods: We have analysed a subgroup of 9 such patients out of a consecutive group of 103 patients undergoing Nissen fundoplication. The relation between symptoms and reflux was assessed by the Symptom Association Probability(SAP). For calculating the SAP the 24hour pH signal was divided into consecutive 2-minute periods. These

GASTROENTEROLOGY Vol. 118, No.4

periods were evaluated for the occurrence of reflux. Fisher's exact test was then applied to calculate the probability (p value) that reflux and symptom episodes were unrelated. The SAP was calculated as (1.0-p)xlOO%. The Symptom Index (SI) was used in addition. Total percentage of time with pH below 4 was considered abnormal if exceeding 5.8%. Subjective effect of surgery was scored in combination with repeated pH monitoring at 3 months post-operatively. Results: Before operation: 9 patients were severely symptomatic (retrosternal pain: grade III), with esophagitis in 4, mean time pH<4 of 3.7% (:'::0.5),a mean number of symptom episodes of 9 (:'::2.6) and a mean number of reflux-related symptom episodes of 5 (:':: 1.5). All patients considered their operation successful (excellent: 6, good: 3 patients). Reflux time was reduced to 1.2%(:'::0.3) after surgery(p=0.004), the number of symptom episodes to 4 (:'::3.2)(p=0.02) and the number of reflux-related symptom episodes to 1(:'::0.2)(p=0.0l). The SAP was reduced from 99% to 22% (p=O.OOI), as was the SI from 73% to 7% (p=O.OOl). Parameters were scored as mean z SEM. Conclusions: Patients with so-called "reflux-negative" reflux disease not adequately responding to medical treatment are good candidates for anti-reflux surgery. The remaining symptoms are not related to acid reflux and do not interfere with the patients over-all judgement of the result of surgery.

5587 ACQUISTION OF HEUCOBACTER PYLORI (H.PYLORI)INFECTION IN BRITISH CHILDREN UNDER 3 YEARS OLD. Sarah A. Brennan, Jo L. Brough, Keith R. Neal, Robert P. Logan, Univ of Nottingham, Nottingham, United Kingdom; Div of Gastroenterology, Univ of Nottingham, Ng7 2uh, United Kingdom; Div of Public Health & Epidemiology Univ of Nottingham, Nottingham, United Kingdom; Div of Gastroenterology, Univ of Nottingham, Nottingham, United Kingdom. Introduction and background: In developed countries the adult prevalence of Hipylori infection is falling. However the incidence of infection in young children remains largely unknown and estimates vary widely(416%pa). This may be due to problems inherent with the detection of infection in young children or different populations studied. The HpSA R test is a novel sandwich ELISA which detects Hipylori antigens in faeces. Its accuracy is comparable to the l3C-UBT, but may be better suited for epidemiological studies in young children. AIMS:To measure the prevalence of Hipylori in children aged less than 3 years old and assess the utility of the HpSAR test for the detection of infection. Methods:Stool samples from nappies were collected from children < 3 years old attending social service provided nurseries in the deprived suburbs of Nottingham (pop 540,000). Stool samples for HpSA R sandwich ELISA were stored at -20DC and processed according to manufacturers instructions. 00 values of duplicate samples were determined automatically (+ve > 0.16) and confirmed visually. A self completed questionnaire detailing living conditions, personal/dental hygiene, early upbringing and antibiotic use were completed (SB). Data were categorised without knowledge of Hipylori status and a priori hypotheses tested using univariate analysis and logistic regression. Results:Parents of children (n=91) at 7 nurseries, were invited to participate. Completed questionnaires and stool samples were received from 53 children (mean age 1.9y, range 9-33 months, 60% boys). There were II stool samples without questionnaires and 16 refusals. Adequate breath samples to confirm infection could not be obtained from any of 7 children tested. Overall 5/53 were positive (prevalence = 9%, CI 1-17%). 00 values of +ve samples were 0.22, 0.94, 1.0, 0.89, 0.85. The mean (:'::sd) of the remaining samples was 0.07 (:'::0.014). Of the 5 positive children, 4 were boys, 2 were twins and 2 attended the same nursery. The estimated incidence of infection in children < 3 was 3.1%pa. Univariate analysis revealed no factors linked to infection. A nested case control study with 3 controls for each case is in progress. CONCLUSIONS:The prevalence of Hipylori infection in children less than 3 years old in urban Britain is 9%. The relatively high incidence in a developed country might suggest that falling prevalence may be due to spontaneous clearance of infection. The HpSA R test appears to be ideally suited for epidemiological studies in young children.

5588 DYSPLASIA-LIKE GASTRIC EPITHELIAL CHANGES SECONDARY TO CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER. Thomas P. Brien, Robert D. Odze, Brigham & Women's Hosp, Boston, MA. Background: We have noted that pre-operative chemoradiotherapy (chemrad) in patients with esophageal cancer may induce severely atypical gastric epithelial changes (AGEC) that mimic dysplasia and, as a result, may lead to overdiagnosis and unnecessary treatment, such as partial gastrectomy. Therefore, we evaluated the clinical, histologic and proliferative findings of 13 patients with dysplasia-like AGEC due to chernrad for esophageal cancer that were identified from a review of 216 consecutive