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P.10.11 SYMPTOMS ASSOCIATED TO WEAKLY ACIDIC REFLUX AND ESOPHAGEAL MOTILITY ABNORMALITIES ARE COMMON FINDINGS IN PATIENTS WITH NCCP NON-RESPONDING TO PPI THERAPY
Abstracts of the 18th National Congress of Digestive Diseases / Digestive and Liver Disease 44S (2012) S55–S220 Conclusions: Laryngoscopic findings have a low specificity to diagnose LPR. Only a complete pathophysiological study of the esophagus can identify whether laryngeal lesions are due to GERD.
P.10.10 SCCA-IGM DETERMINATION IN BARRETT’S ESOPHAGUS AND ESOPHAGEAL CANCER MIGHT REGULATE ENDOSCOPIC FOLLOW-UP SCHEDULE V. Zorzetto ∗ ,1 , G. Maddalo 1 , M. Rugge 2 , P. Parente 4 , G. Zaninotto 1 , A. Ruol 1 , A. Biasiolo 3 , L. Zanatta 1 , F. Farinati 1 1 Dipartimento
di Scienze Chirurgiche e Gastroenterologiche, Università di Padova, Padova, Italy; 2 Dipartimento di Scienze Medico Diagnostiche e Terapie Speciali, Università di Padova, Padova, Italy; 3 Dipartimento di Medicina Clinica e Sperimentale, Università di Padova, Padova, Italy; 4 Anatomia Patologica, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy Background and aim: Esophageal cancer (EC) is the sixth cause of cancer death in the world. The only well known precursor of esophageal adenocarcinoma (EA) is Barrett’s esophagus (BE) and endoscopy is the only approach to prevention; the importance of a potential biomarker to screen EC in the general population, or modulate surveillance timing, is consequently clear. Squamous cell carcinoma antigen (SCCA), first isolated from squamous cell carcinoma (SCC) of the uterine cervix, is expressed at elevated levels in a number of gastrointestinal (GI) and non GI cancers. It has been shown that immunocomplexed SCCA-IgM presents higher sensitivity than non-complexed one. Aim: To test SCCA-IgM in 135 pts with BE (53), EA (51) or squamous cell carcinomas (SCC 31) and in controls (CON, 57 blood donors). Material and methods: All histological data were reviewed by a single experienced pathologist (MR), endoscopic classification was based on the Prague system and SCCA-IgM levels were determined by ELISA (Xeptagen, Marghera-Italy). Results: Mean values of SCCA-IgM were significantly higher in all pts than in CON (p<0.0001): CON 70 AU/mL, EA 140 AU/mL, SCC 113 AU/mL and BE 109 AU/mL (with no difference between long and short Barrett and a trend, though not statistically significant, between Barrett with (130 AU/mL) and without dysplasia (101 AU/mL)). EC overall showed higher levels of SCCA-IgM than EB, but the difference was not statistically significant (BE SCCA-IgM mean value 109 AU/mL, EC 130 AU/mL; p=0.09). When patients (pts) with BE at higher risk of progression (Short BE+dysplasia and long BE +/- dysplasia) were considered, this sub-group had SCCA-IgM levels significantly higher than pts at lower risk (short Barrett with no dysplasia) (118 vs 102 AU/ml; p=0.03). Sensitivity and specificity for BE were 45% and 76%, respectively, with a positive and negative predictive value of 70% and 53%. Conclusions: Pts with EC have higher SCCA-IgM levels than pts with BE and controls. SCCA-IgM determination apparently enables the identification of a sub-group of pts with BE at higher risk of progression to esophageal adenocarcinoma to whom a stricter endoscopic follow up should be devoted, leaving, on the contrary, pts with lower SCCA-IgM levels to a looser schedule of endoscopic controls.
S151
Endoscopia Digestiva, Ospedale Bellaria, Bologna, Italy; 3 Fisiopatologia Digestiva, Nuovo Ospedale S. Agostino, Modena, Italy; 4 Division of Gastroenterology, Department of Internal Medicine, University of Pisa, Pisa, Italy; 5 Gastroenterology Unit, “Bolognini” Hospital, Seriate, Italy; 6 Division of Gastroenterology, Ospedale San Giuseppe, Milano, Italy; 7 Department of Medicine, Irccs S. Matteo Hospital, University of Pavia, Pavia, Italy; 8 Struttura Semplice di Fisiopatologia Digestiva, Azienda Ospedaliera G. Brotzu, Cagliari, Italy; 9 Department of Clinical and Experimental Medicine, Postgraduate School of Gastroenterology, University of Ferrara, Ferrara, Italy; 10 Gastroenterology Unit, “Santa Maria Del Parato” Hospital, Feltre, Italy; 11 Division of Gastroenterology, Department of Surgery and Gastroenterology, University of Padua, Padua, Italy Background and aim: Proton pump inhibitor (PPI) therapy has been demonstrated to be less effective on symptom relief in patients with non-cardiac chest-pain (NCCP) than in those with heartburn. Data on the potential causes of this reduced response rate are lacking. Aim: To assess the frequency of esophageal motility abnormalities and reflux disease in NCCP non-responders patients. Material and methods: Consecutive NCCP patients non-responders to PPI (<50%) underwent manometry and impedance-pH testing (MII-pH) while on or off-therapy. Manometric pattern was defined according to international criteria as Normal peristalsis (NP), Ineffective Esophageal Motility (IEM), Distal Esophageal Spasm (DES), Nutcracker Esophagus (NE). We also measured esophageal acid exposure time (AET; % pH<4), reflux episodes (acid/weakly acidic) and symptom-reflux association using both symptom association probability (SAP+ if = 95%) and symptom index (SI+ if = 50%). Results: Ninety-seven NCCP patients (55F/42M) were enrolled. At manometry testing, NP was found in 62 (64%) patients, 23 (24%) had DES, 9 (9%) had NE and 3 (3%) had IEM. As to MII-pH monitoring (44 on- and 53 patients off-PPI), we found 13 (13%) patients with an abnormal AET, although 4 (4%) of them were on-PPI. Out of the remaining 84 (87%) patients, 8 (8%) had a positive SAP/SI to acid reflux only, 31 (32%) to weakly acidic reflux only and 11 (11%) to both acid and weakly acidic reflux (4 patient were positive considering both refluxes as a whole). Thirty-four (35%) patients had no association between reflux and symptoms and out of them 23 (23%) had NP (i.e. functional chest-pain). Thus, at manometry testing 35 (36%) patients had esophageal motility abnormalities, while at MII-pH monitoring 13 (13%) had acid GERD, 8 (8%) had SI/SAP+ to acid (i.e. hypersensitive esophagus to acid), 31 (32%) had SI/SAP+ to weakly acidic (i.e. weakly acidic GERD) and 11 (11%) had SI/SAP+ to both reflux (i.e. mixed GERD). Conclusions: Symptoms related to weakly acidic reflux and esophageal motility abnormalities are very common in NCCP patients non-responding to PPI therapy and may be responsible for the persistence of symptoms in the majority of these patients.
P.10.12 ARE PPI RESPONDER PATIENTS ALWAYS CONFIRMED AS GERD PATIENTS? A MII-PH STUDY N. De Bortoli ∗ ,1 , I. Martinucci 1 , E. Savarino 2 , V. Bolognesi 1 , V. Ussia 1 , L. Bertani 1 , C. Racale 1 , A. Frattino 1 , M. Bellini 1 , S. Marchi 1 1 Gastroenterology
Unit - University of Pisa, Pisa, Italy; 2 Gastroenterology Unit - University of Padova, Padova, Italy
P.10.11 SYMPTOMS ASSOCIATED TO WEAKLY ACIDIC REFLUX AND ESOPHAGEAL MOTILITY ABNORMALITIES ARE COMMON FINDINGS IN PATIENTS WITH NCCP NON-RESPONDING TO PPI THERAPY E. Savarino ∗ ,11 , P. Zentilin 1 , D. Lo Cuoco 2 , M. Frazzoni 3 , N. De Bortoli 4 , I. Martinucci 4 , V. Casini 5 , F. Pace 5 , R. Barbera 6 , M. Bergonzi 7 , M. Di Stefano 7 , F. Oppia 8 , P. Usai Satta 8 , G. Ricci 9 , M. De Bona 10 , M. De Boni 10 , G.C. Sturniolo 11 , V. Savarino 1 1 Division
of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy; 2 Unità di Operativa di Gastroenterologia Ed
Background and aim: The typical gastroesophageal reflux disease (GERD) is defined by the presence of troublesome heartburn and/or regurgitation, without the need for diagnostic testing. Consistently with this notion, empiric proton pump inhibitor (PPI) therapy is used in diagnosing GERD as ex adiuvantibus criteria. Apparently, patients with well controlled symptoms under PPI therapy undergo pathophysiological investigations less frequently. However, heartburn can also have non reflux-related causes, corresponding to the definition of functional heartburn (FH). The aim was to evaluate whether patients with reflux symptoms, who well respond to PPI therapy, are always considered within the spectrum of GERD after undergoing a multichannel intraluminal impedance and pH study (MII-pH).
P.10.10 SCCA-IGM DETERMINATION IN BARRETT’S ESOPHAGUS AND ESOPHAGEAL CANCER MIGHT REGULATE ENDOSCOPIC FOLLOW-UP SCHEDULE V. Zorzetto ∗ ,1 , G. Maddalo 1 , M. Rugge 2 , P. Parente 4 , G. Zaninotto 1 , A. Ruol 1 , A. Biasiolo 3 , L. Zanatta 1 , F. Farinati 1 1 Dipartimento
di Scienze Chirurgiche e Gastroenterologiche, Università di Padova, Padova, Italy; 2 Dipartimento di Scienze Medico Diagnostiche e Terapie Speciali, Università di Padova, Padova, Italy; 3 Dipartimento di Medicina Clinica e Sperimentale, Università di Padova, Padova, Italy; 4 Anatomia Patologica, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy Background and aim: Esophageal cancer (EC) is the sixth cause of cancer death in the world. The only well known precursor of esophageal adenocarcinoma (EA) is Barrett’s esophagus (BE) and endoscopy is the only approach to prevention; the importance of a potential biomarker to screen EC in the general population, or modulate surveillance timing, is consequently clear. Squamous cell carcinoma antigen (SCCA), first isolated from squamous cell carcinoma (SCC) of the uterine cervix, is expressed at elevated levels in a number of gastrointestinal (GI) and non GI cancers. It has been shown that immunocomplexed SCCA-IgM presents higher sensitivity than non-complexed one. Aim: To test SCCA-IgM in 135 pts with BE (53), EA (51) or squamous cell carcinomas (SCC 31) and in controls (CON, 57 blood donors). Material and methods: All histological data were reviewed by a single experienced pathologist (MR), endoscopic classification was based on the Prague system and SCCA-IgM levels were determined by ELISA (Xeptagen, Marghera-Italy). Results: Mean values of SCCA-IgM were significantly higher in all pts than in CON (p<0.0001): CON 70 AU/mL, EA 140 AU/mL, SCC 113 AU/mL and BE 109 AU/mL (with no difference between long and short Barrett and a trend, though not statistically significant, between Barrett with (130 AU/mL) and without dysplasia (101 AU/mL)). EC overall showed higher levels of SCCA-IgM than EB, but the difference was not statistically significant (BE SCCA-IgM mean value 109 AU/mL, EC 130 AU/mL; p=0.09). When patients (pts) with BE at higher risk of progression (Short BE+dysplasia and long BE +/- dysplasia) were considered, this sub-group had SCCA-IgM levels significantly higher than pts at lower risk (short Barrett with no dysplasia) (118 vs 102 AU/ml; p=0.03). Sensitivity and specificity for BE were 45% and 76%, respectively, with a positive and negative predictive value of 70% and 53%. Conclusions: Pts with EC have higher SCCA-IgM levels than pts with BE and controls. SCCA-IgM determination apparently enables the identification of a sub-group of pts with BE at higher risk of progression to esophageal adenocarcinoma to whom a stricter endoscopic follow up should be devoted, leaving, on the contrary, pts with lower SCCA-IgM levels to a looser schedule of endoscopic controls.
S151
Endoscopia Digestiva, Ospedale Bellaria, Bologna, Italy; 3 Fisiopatologia Digestiva, Nuovo Ospedale S. Agostino, Modena, Italy; 4 Division of Gastroenterology, Department of Internal Medicine, University of Pisa, Pisa, Italy; 5 Gastroenterology Unit, “Bolognini” Hospital, Seriate, Italy; 6 Division of Gastroenterology, Ospedale San Giuseppe, Milano, Italy; 7 Department of Medicine, Irccs S. Matteo Hospital, University of Pavia, Pavia, Italy; 8 Struttura Semplice di Fisiopatologia Digestiva, Azienda Ospedaliera G. Brotzu, Cagliari, Italy; 9 Department of Clinical and Experimental Medicine, Postgraduate School of Gastroenterology, University of Ferrara, Ferrara, Italy; 10 Gastroenterology Unit, “Santa Maria Del Parato” Hospital, Feltre, Italy; 11 Division of Gastroenterology, Department of Surgery and Gastroenterology, University of Padua, Padua, Italy Background and aim: Proton pump inhibitor (PPI) therapy has been demonstrated to be less effective on symptom relief in patients with non-cardiac chest-pain (NCCP) than in those with heartburn. Data on the potential causes of this reduced response rate are lacking. Aim: To assess the frequency of esophageal motility abnormalities and reflux disease in NCCP non-responders patients. Material and methods: Consecutive NCCP patients non-responders to PPI (<50%) underwent manometry and impedance-pH testing (MII-pH) while on or off-therapy. Manometric pattern was defined according to international criteria as Normal peristalsis (NP), Ineffective Esophageal Motility (IEM), Distal Esophageal Spasm (DES), Nutcracker Esophagus (NE). We also measured esophageal acid exposure time (AET; % pH<4), reflux episodes (acid/weakly acidic) and symptom-reflux association using both symptom association probability (SAP+ if = 95%) and symptom index (SI+ if = 50%). Results: Ninety-seven NCCP patients (55F/42M) were enrolled. At manometry testing, NP was found in 62 (64%) patients, 23 (24%) had DES, 9 (9%) had NE and 3 (3%) had IEM. As to MII-pH monitoring (44 on- and 53 patients off-PPI), we found 13 (13%) patients with an abnormal AET, although 4 (4%) of them were on-PPI. Out of the remaining 84 (87%) patients, 8 (8%) had a positive SAP/SI to acid reflux only, 31 (32%) to weakly acidic reflux only and 11 (11%) to both acid and weakly acidic reflux (4 patient were positive considering both refluxes as a whole). Thirty-four (35%) patients had no association between reflux and symptoms and out of them 23 (23%) had NP (i.e. functional chest-pain). Thus, at manometry testing 35 (36%) patients had esophageal motility abnormalities, while at MII-pH monitoring 13 (13%) had acid GERD, 8 (8%) had SI/SAP+ to acid (i.e. hypersensitive esophagus to acid), 31 (32%) had SI/SAP+ to weakly acidic (i.e. weakly acidic GERD) and 11 (11%) had SI/SAP+ to both reflux (i.e. mixed GERD). Conclusions: Symptoms related to weakly acidic reflux and esophageal motility abnormalities are very common in NCCP patients non-responding to PPI therapy and may be responsible for the persistence of symptoms in the majority of these patients.
P.10.12 ARE PPI RESPONDER PATIENTS ALWAYS CONFIRMED AS GERD PATIENTS? A MII-PH STUDY N. De Bortoli ∗ ,1 , I. Martinucci 1 , E. Savarino 2 , V. Bolognesi 1 , V. Ussia 1 , L. Bertani 1 , C. Racale 1 , A. Frattino 1 , M. Bellini 1 , S. Marchi 1 1 Gastroenterology
Unit - University of Pisa, Pisa, Italy; 2 Gastroenterology Unit - University of Padova, Padova, Italy
P.10.11 SYMPTOMS ASSOCIATED TO WEAKLY ACIDIC REFLUX AND ESOPHAGEAL MOTILITY ABNORMALITIES ARE COMMON FINDINGS IN PATIENTS WITH NCCP NON-RESPONDING TO PPI THERAPY E. Savarino ∗ ,11 , P. Zentilin 1 , D. Lo Cuoco 2 , M. Frazzoni 3 , N. De Bortoli 4 , I. Martinucci 4 , V. Casini 5 , F. Pace 5 , R. Barbera 6 , M. Bergonzi 7 , M. Di Stefano 7 , F. Oppia 8 , P. Usai Satta 8 , G. Ricci 9 , M. De Bona 10 , M. De Boni 10 , G.C. Sturniolo 11 , V. Savarino 1 1 Division
of Gastroenterology, Department of Internal Medicine, University of Genoa, Genoa, Italy; 2 Unità di Operativa di Gastroenterologia Ed
Background and aim: The typical gastroesophageal reflux disease (GERD) is defined by the presence of troublesome heartburn and/or regurgitation, without the need for diagnostic testing. Consistently with this notion, empiric proton pump inhibitor (PPI) therapy is used in diagnosing GERD as ex adiuvantibus criteria. Apparently, patients with well controlled symptoms under PPI therapy undergo pathophysiological investigations less frequently. However, heartburn can also have non reflux-related causes, corresponding to the definition of functional heartburn (FH). The aim was to evaluate whether patients with reflux symptoms, who well respond to PPI therapy, are always considered within the spectrum of GERD after undergoing a multichannel intraluminal impedance and pH study (MII-pH).