Orocecal time is prolonged in some patients with chronic constipation

AJG – September, Suppl., 2002

Abstracts

positive (ACG 2001). AIM: 1) To determine the role of telomerase in differentiating normal bile ducts from cholangiocarcinoma in surgical resection specimens. 2) To determine the feasability of telomerase enzyme detection with ERCP brush cytology in patients with biliary strictures. Methods: Surgical specimens from 10 pts with cholangiocarcinoma and 10 pts with normal bile ducts were compiled. All patients underwent telomerase enzyme immunostaining, which has been previously described. (DDW 2001). In addition, ERCP brush cytology from 7 patients with biliary strictures were assessed for telomerase enzyme. 4 patients progressed to cholangiocarcinoma or were diagnosed with cholangiocarcinoma (Progressors) and 3 patients had benign biliary epithelium (Non– progressors). Telomerase expression was graded as positive (nuclear telomerase present) and negative (nuclear telomerase absent). Results: Patients Cholangiocarcinoma Benign Bile Duct

14 13

Telomerase Positive 14 0

Telomerase Negative 0 13

*1) Telomerase differentiates benign bile duct epithelium from cholangiocarcinoma (p⬍0.001). 2) In the patients whose ERCP brush cytology was examined, all 4 Progressors to Cancer were telomerase positive, while all 3 Non–Progressors to Cancer were telomerase negative. 3) Demographic (age, sex, preceding PSC history, h/o colorectal neoplasia, h/o ulcerative colitis) and tumor associated characteristics (tumor stage and location) did not affect the level of telomerase expression. Conclusions: 1) Positive telomerase expression differentiates cholangiocarcinoma from benign bile duct epithelium, a novel finding. 2)Telomerse enzyme assay may be used in ERCP brush cytology from biliary strictures to differentiate cholangiocarcinoma from benign biliary epithelium. This finding is the first description ever using the telomerase immunostaining assay and represents a major breakthrough in the possibility of screening for cancer and diagnosing cancer in patients with biliary strictures. 3) Telomerase enzyme immunostaining merits further evaluation as a method to screen and diagnose cholangiocarcinoma in biliary strictures.

SMALL INTESTINE/UNCLASSIFIED 226 OROCECAL TIME IS PROLONGED IN SOME PATIENTS WITH CHRONIC CONSTIPATION Nirmal S. Mann, FACG*, Joseph W. Leung, FACG and Donald Lum, M.D. Gastroenterology, VANCHCS, Univ. of California, Davis, Martinez, CA. Purpose: We have previously reported that oro– cecal time (OCT) in healthy male volunteers determined by lactulose H2 breath test was 55 ⫹ 3.7 minutes (HepatoGastroenterol 45:1023, 1998). In the treatment of chronic constipation new agents which affect small bowel motility are being developed. We wanted to determine the frequency of prolonged OCT in patients with chronic constipation and also to see if fasting breath hydrogen (FBH) could predict prolongation of OCT in these patients. Methods: The study was approved by IRB and informed consent was obtained. Only male veteran patients were recruited. Chronic constipation was defined when one of these criteria were met (a) two or less BM/week (b) straining at stool more than 25% of the time (c) hard stools more than 25% of the time (d) feeling of incomplete evacuation more than 25% of the time. Patients with diabetes mellitus, other endocrine disorders, h/o abd, surgery or those on GI motility affecting drugs, neurologic disorders and with known malignancy were excluded. After an overnight fast baseline FBH was measured using EC 60 gastrolyzer (Bedfont Scientific; Medford, NJ) which has a sealed electrochemical sensor specific for H2. Lactulose 10 GM was given orally and breath H2 was measured every 5 minutes for 120 minutes. OCT was defined as a point in time when breath H2 increased at least 5 ppm above the baseline and this increase was sustained for two subsequent readings. Prolonged OCT was considered to be present when

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OCT was 1.5 times compared to healthy controls; thus an OCT of 80 minutes or longer was considered prolonged. Results: There were 45 patients. 14/45 (30.2%) were found to have a prolonged OCT. The FBH in these 14 patients 20 ⫹ 6 (range 3–32) ppm was significantly higher compared to those patients whose OCT was not prolonged 13 ⫹ 8 (range 2–20) ppm (t–test; p ⬍ 0.05). Conclusions: In 30.2% of patients with chronic constipation OCT is significantly prolonged. High FBH may predict those patients with constipation who are likely to have prolonged OCT. The mechanism for prolonged OCT is not known. Inhibitory coloenteric and cologastric reflexes may be responsible. Colonic distention in patients with constipation causes tachygastria (Gastroenterology 108:A635, 1995).

227 PRIMARY SMALL BOWEL ADENO CARCINOMA DIAGNOSED BY M2A CAPSUL ENDOSCOPY Vijaypal Arya, M.D.*, Vipin Gupta, M.D. and Mayuri Patni, M.D. Vijay Arya MDPC, Middle Village, NY and Division of Gastroenterology, Wyckoff Heights Medical Center, Brooklyn, NY. Introduction: – M2A capsule endoscopy has emerged as a fascinating and promising tool for the work up of small bowel pathologies. The diagnosis of small bowel Adeno– carcinoma is usually delayed, either because lesion was missed on small bowel series or was not reached by enteroscopy. The following case report describe diagnosis of small bowel Adenocarcinoma by capsule endoscopy after extensive negative work up Case Report:– C.B A 78 year old African American female Jehovah’s witness with out significant PMH presented with anemia unexplained by EGD, Colonoscopy, CT, small bowel series and MRI. Patient was taking procreate and iron supplement for anemia. Her presenting complaints were weight loss, generalized weakness and abdominal discomfort. Physical Exam was significant for positive hem occult stool. She was self referred to us for capsule endoscopy. Given imaging Capsule was ingested by the patient. The images were recorded for 8 hours, subsequently reviewed. At 161 minutes past ingestion time a lesion was seen in small bowel. It was an ulcerated mass with shoulder effects partially obstructing the lumen of small bowel with retain food and fluid, although, Clinically Patient did not have vomiting, abdominal distention or other signs of small bowel obstruction .No bleeding was found at the site of lesion. Patient underwent surgery and lesion was found non resectable. Biopsy was done which revealed Aden carcinoma of small bowel. palliative gastrojejunostomy was done and chemo therapy was offered Conclusion: – Capsule endoscopy has the highest sensitivity in detection of small bowel cancer. In conclusion elderly patients with history of weight loss, anemia and obscure GI bleeding with negative extensive work– up; The Capsule endoscopy is must to rule out small bowel pathology.

228 ANATOMY AND PHYSIOLOGY OF GI TRACT ON M2A CAPSULE ENDOSCOPY Vijay Arya, M.D.*, Vipin Gupta, M.D. and Mayuri Patni, M.D. Albertson, NY. Purpose: To recognize anatomical landmarks in GI tract and assessment of GI motility by M2A capsule endoscopy. Methods: Capsule endoscopy was performed on 5 patients (4 female and 1 male), in age range of 18 to 72 years. Indication of the procedure was obscure GI bleeding in 2 patients while in other 3 patients the capsule endoscopy was done to rule out– Inflammatory bowel disease .The video images were reviewed and landmarks were identified Results: The findings were as follows. The capsule entered in the duodenum in 43 to 120 minutes (average 74.4 minutes), which corresponds to normal physiology. The duodenal bulb was identified by same landmarks as on endoscopy. The ampulla of vater could not be identified in any patient. Passage of capsule through small intestine took from 106 to 324