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NUTRITIONAL ASSESSMENT IN HEAD AND NECK CANCER PATIENTS
Abstracts / Digestive and Liver Disease 41S (2009), S1–S167 P.242 NUTRITIONAL ASSESSMENT IN HEAD AND NECK CANCER PATIENTS D. Assisi ∗ , L. Sanchez Mete, I. Schiavetto, A. Grassi, R. Lapenta, V. Stigliano, B. Belverde, G. Viceconte Polo Oncologico Istituto Regina Elena, Roma Background and aim: Nutritional problems of head and neck cancer patients have long been recognized. Patients may be malnourished because of the disease and/or adverse effects of treatment Therefore, in these patient, nutritional assessment (NA) and support are likely to become increasingly important. The aim of our study was to evaluate nutritional status and intervention required in head and neck cancer patients, during or after radiotherapy (RT), chemotherapy (CT) or combined treatment. Material and methods: Head and neck cancer patients, which referred to our nutritional team, were retrospectively evaluated. Parameters assessed were: anthropometry, biochemical status, clinical signs and symptoms of nutritional deficiencies, cancer stage and treatment. Nutritional Status (NS) was defined by weight loss (WL) percentage, Body Mass index (BMI) and lymphocyte count/mm3 . Results: We selected 55 patients: NA revealed malnutrition in 81,8% of patients (mean WL: 15,5%), normal NS in 16,3% and obesity in 1,8% of patients. NA was performed during RT, CT or combined treatment in 18 patients (group A) and at a mean-time of 8,8 months (range 1-12 months) from treatment in 17 patients (group B). For the group A, NA revealed good NS in 5,5%; slight malnutrition in 22,2%; moderate in 38,8%; severe in 33,3% of patients; for the group B, good NS in 17,6%, slight malnutrition in 11,7%; moderate in 29,4% and severe in 41,2% of patients. Among the 55 patients enrolled, 38 (69%) required Enteral Nutrition (EN): 26 placed percutaneous endoscopic gastrostomy (PEG) and 12 placed naso-gastric tube (NG) prevalence in the group B patients. Conclusions: Slight and moderate malnutrition were prevalent in the group A than in the group B. In the group B, severe malnutrition increases, probably because nutritional intervention was performed too late. Early NA allows to perform an adequate and timely nutritional intervention with EN or oral supplementation, reducing malnutrition related to oncological treatment. # U. Obesity and Nutrition
P.243 NON-ULCER-DYSPEPSIA (NUD) AND AMINOTRANSFERASES (AST/ALT) ELEVATION IN A COHORT OF OBESE PATIENTS (PTS): A PRELIMINARY REPORT G. Franchina 1 , G. Dardanoni 2 , E. Gorgone 1 , A. Maringhini ∗ ,1 1 Arnas Civico, Palermo; 2 Osservatorio Epidemiologico Regione Sicilia, Palermo
Background and aim: A relationship between BMI, gastrointestinal reflux symptoms and hepatic steatosis is well known. Aim of this prospective study is to investigate non ulcer dyspepsia symptoms and any increase of aminotransferases (AST/ALT) without any clinical significant hepatic disease in a cohort of obese patients and their relationship with BMI/waist circumference. Material and methods: All obese patients (pts.) consecutively visited in our unity were investigated about: 1) non ulcer dyspepsia symptoms (episodic epigastria pain and/or associated with bloating, distension and eructation which is precipitated by the ingestion of food); 2) any increase in AST/ALT (endoscopic or barium X-rays; ultrasound, laboratory, imaging and histology when clinically useful). All pts. were exhaustively evaluated to exclude any relevant organic gastrointestinal or liver disease.
S165
Results: We enrolled 161 patients male = 51, female n = 110; age 47.3 +SD 14.2. Two patients were excluded for HCV infections, one pt. was excluded for history of duodenal ulcer. We failed to find any significant relationship between BMI/waist circumference and non ulcer dyspepsia in female or male at any age (BMI in dyspeptic vs non: 37.72±6.25 vs 36.82±6.57 p=0.83). WC in dyspeptic vs non (110.39±10.89 vs 112.76±13.86; p=1.07). Pts. with any increase of ALT have a significant larger WC (114.88±10.89 vs. 110.68±13.72 p=0.0476, Students’ test). A non significant test for a higher BMI was found (38.85±5.6 vs 36.78±6.58 p=0.0722 Students’ t test). We failed to find any relevant association between AST and obesity. Conclusions: Non ulcer dyspepsia is not related to the obesity level. WC more than BMI is related to increasing ALT, probably due to hepatic steatosis. We need to have larger sample but WC may be no reliable than BMI to test the risk for hepatic steatosis and or steatohepatitis. # U. Obesity and Nutrition
P.244 DEGREE OF BOWEL CLEANSING FOR COLONOSCOPY: A RANDOMISED STUDY OF HIGH VS. LOW DOSE OF PEG AND SPLIT VS. NON-SPLIT REGIMEN R. Marmo ∗ ,1 , G. Rotondano 2 , G. Riccio 1 , A. Marone 1 , E. Gregorio 1 , G. D’Alvano 1 , N. Procaccio 1 , F. Spanò 1 , C. Marmo 3 1 P.O.L.Curto, Polla; 2 P.O. Maresca, Torre Del Greco; 3 Servizio Civile, Polla
Background and aim: Inadequate bowel preparation at colonoscopy can result in missed lesions, cancelled procedures, increased procedural time, and a potential increase in complication and missing rates. To evaluate the degree of colon cleansing in patients undergoing colonoscopy comparing low vs. standard PEG volume and two different intake regimens (split vs. non split); to identify predictors of poor bowel cleansing Material and methods: All patients scheduled for colonoscopy were eligible. Exclusion criteria indicated by the manufacturers. Patients were randomised (stratified, blocked random allocation) to 4 different prep regimens according to the dose (PEG + ascorbic acid 2L vs. PEG 4L) and to timing of intake (split, i.e. 1/2 dose the afternoon before and 1/2 dose the morning of the examination vs. non-split, i.e. full dose the afternoon before the day of exam). Blinded assessment was provided. Quality of bowel cleansing was recorded separately for each colonic segment, with a 1 (poor) to 4 (excellent) scale. Overall assessment resulted from the sum of the individual scores. Continuous data were compared with ANOVA or non parametric tests. Categorical variables were tested using corrected χ2 . Both ITT and PP analyses were run. Multiple logistic regression model was used to identify independent predictors of the degree of bowel cleansing. Results: 200 patients were enrolled (115 M, mean age 56.5 yrs).No difference was noted between 2L vs. 4L PEG (mean Rank 97.6 vs.102.1, p=0.58), independently of the modality of intake. The split prep provided the best bowel cleansing (mean Rank 107.6 vs. 86.7, p<0.01), independently of the volume. Among split intakers, the highest quality of bowel cleansing was observed for colonoscopy performed within 4 hrs of the end of prep p<0.01). Poor prep requiring repeat procedure occurred in 26 cases (13%). Independent predictors of poor preparation were male gender (OR 3.87 [1.37-10.9], p<0.01) and non-split regimen (OR 3.37 [1.42-7.98], p<0.006). These two predictors alone had a 71% accuracy in predicting poor bowel preparation. Conclusions: Low-dose and high-dose PEG solutions have similar efficacy in cleansing the colon. Split intake regimen is associated with a significantly better colon cleansing. The highest quality of colon prep is found when colonoscopy is performed within 4 hours of the end of split regimen # X. E.B.M. 3. RCT
P.243 NON-ULCER-DYSPEPSIA (NUD) AND AMINOTRANSFERASES (AST/ALT) ELEVATION IN A COHORT OF OBESE PATIENTS (PTS): A PRELIMINARY REPORT G. Franchina 1 , G. Dardanoni 2 , E. Gorgone 1 , A. Maringhini ∗ ,1 1 Arnas Civico, Palermo; 2 Osservatorio Epidemiologico Regione Sicilia, Palermo
Background and aim: A relationship between BMI, gastrointestinal reflux symptoms and hepatic steatosis is well known. Aim of this prospective study is to investigate non ulcer dyspepsia symptoms and any increase of aminotransferases (AST/ALT) without any clinical significant hepatic disease in a cohort of obese patients and their relationship with BMI/waist circumference. Material and methods: All obese patients (pts.) consecutively visited in our unity were investigated about: 1) non ulcer dyspepsia symptoms (episodic epigastria pain and/or associated with bloating, distension and eructation which is precipitated by the ingestion of food); 2) any increase in AST/ALT (endoscopic or barium X-rays; ultrasound, laboratory, imaging and histology when clinically useful). All pts. were exhaustively evaluated to exclude any relevant organic gastrointestinal or liver disease.
S165
Results: We enrolled 161 patients male = 51, female n = 110; age 47.3 +SD 14.2. Two patients were excluded for HCV infections, one pt. was excluded for history of duodenal ulcer. We failed to find any significant relationship between BMI/waist circumference and non ulcer dyspepsia in female or male at any age (BMI in dyspeptic vs non: 37.72±6.25 vs 36.82±6.57 p=0.83). WC in dyspeptic vs non (110.39±10.89 vs 112.76±13.86; p=1.07). Pts. with any increase of ALT have a significant larger WC (114.88±10.89 vs. 110.68±13.72 p=0.0476, Students’ test). A non significant test for a higher BMI was found (38.85±5.6 vs 36.78±6.58 p=0.0722 Students’ t test). We failed to find any relevant association between AST and obesity. Conclusions: Non ulcer dyspepsia is not related to the obesity level. WC more than BMI is related to increasing ALT, probably due to hepatic steatosis. We need to have larger sample but WC may be no reliable than BMI to test the risk for hepatic steatosis and or steatohepatitis. # U. Obesity and Nutrition
P.244 DEGREE OF BOWEL CLEANSING FOR COLONOSCOPY: A RANDOMISED STUDY OF HIGH VS. LOW DOSE OF PEG AND SPLIT VS. NON-SPLIT REGIMEN R. Marmo ∗ ,1 , G. Rotondano 2 , G. Riccio 1 , A. Marone 1 , E. Gregorio 1 , G. D’Alvano 1 , N. Procaccio 1 , F. Spanò 1 , C. Marmo 3 1 P.O.L.Curto, Polla; 2 P.O. Maresca, Torre Del Greco; 3 Servizio Civile, Polla
Background and aim: Inadequate bowel preparation at colonoscopy can result in missed lesions, cancelled procedures, increased procedural time, and a potential increase in complication and missing rates. To evaluate the degree of colon cleansing in patients undergoing colonoscopy comparing low vs. standard PEG volume and two different intake regimens (split vs. non split); to identify predictors of poor bowel cleansing Material and methods: All patients scheduled for colonoscopy were eligible. Exclusion criteria indicated by the manufacturers. Patients were randomised (stratified, blocked random allocation) to 4 different prep regimens according to the dose (PEG + ascorbic acid 2L vs. PEG 4L) and to timing of intake (split, i.e. 1/2 dose the afternoon before and 1/2 dose the morning of the examination vs. non-split, i.e. full dose the afternoon before the day of exam). Blinded assessment was provided. Quality of bowel cleansing was recorded separately for each colonic segment, with a 1 (poor) to 4 (excellent) scale. Overall assessment resulted from the sum of the individual scores. Continuous data were compared with ANOVA or non parametric tests. Categorical variables were tested using corrected χ2 . Both ITT and PP analyses were run. Multiple logistic regression model was used to identify independent predictors of the degree of bowel cleansing. Results: 200 patients were enrolled (115 M, mean age 56.5 yrs).No difference was noted between 2L vs. 4L PEG (mean Rank 97.6 vs.102.1, p=0.58), independently of the modality of intake. The split prep provided the best bowel cleansing (mean Rank 107.6 vs. 86.7, p<0.01), independently of the volume. Among split intakers, the highest quality of bowel cleansing was observed for colonoscopy performed within 4 hrs of the end of prep p<0.01). Poor prep requiring repeat procedure occurred in 26 cases (13%). Independent predictors of poor preparation were male gender (OR 3.87 [1.37-10.9], p<0.01) and non-split regimen (OR 3.37 [1.42-7.98], p<0.006). These two predictors alone had a 71% accuracy in predicting poor bowel preparation. Conclusions: Low-dose and high-dose PEG solutions have similar efficacy in cleansing the colon. Split intake regimen is associated with a significantly better colon cleansing. The highest quality of colon prep is found when colonoscopy is performed within 4 hours of the end of split regimen # X. E.B.M. 3. RCT