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P.1.121: RESTING ENERGY EXPENDITURE IN TWO DIFFERENT CONDITIONS OF MALNUTRITION DUE TO GASTROENTERIC DISEASE
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Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264
lesions (38%); (ii) patients under 40 years old (31%); (iii) work overload at the endoscopy unit (23%); (iv) local custom (“biopsies are only obtained for research purposes”= 8%). When gastric mucosa biopsies were taken, the BiPs varied, as follows: antrum or corpus biopsy (38%); antrum and corpus biopsy (33%); 5 biopsies, including antral, angularis, and oxyntic mucosa (29%). Overall, the number of biopsies obtained was: <3 in 43% of case, 4 in 25% and ≥5 in 32%. All samples were sent to the pathologist in the same vial in 41% of cases (irrespective of the gastric site they came from); samples were distinguished according to their antral or oxyntic origin in 42% of cases; the antral, angulus and oxyntic mucosa samples were submitted separately, in the remaining 17% of cases. Conclusions: This survey documented a highly inconsistent approach to gastric biopsy procedures. The Italian scientific societies should endorse the international recommendations on gastric BiPs. Different staging systems have recently been proposed with a view to optimizing the histological assessment of gastritis (e.g. the OLGA system), all of which rely on clearly-defined BiPs. A national training program is warranted to promote the adoption of consistent gastric BiPs in routine GE-P.
P.1.121 RESTING ENERGY EXPENDITURE IN TWO DIFFERENT CONDITIONS OF MALNUTRITION DUE TO GASTROENTERIC DISEASE I. Grandone ∗ , M.C. Pagano, M. Marra, F. Vitale, L. Santarpia, F. Contaldo, F. Pasanisi Clinical Nutrition And Internal Medicine, Department Of Clinical And Experimental Medicine, Federico II University, Naples, Italy Background and aim: There are few studies concerning the possibility of metabolic adaption in two different conditions of malnutrition, due to neoplastic and non neoplastic disease. Aim: to evaluate possible differences in Resting Energy Expenditure (REE) in patients affected by two forms of malnutrition (weight loss>10% of usual weight), from gastroenteric cancer and from chronic Inflammatory Bowel Disease (IBD). Material and methods: We selected 37 malnourished patients, 18 affected by gastrointestinal cancer (Age = 48.1±17.3 years; Weight= 59.1±11.7 kg; BMI=19.9±2.2 kg/m2 ) and 19 with IBD (Age=34.4±15.7; Weight= 52.6±11.7; BMI=18.5±3.9). REE was measured by indirect calorimetry (Vmax 29N Sensor Medics). Fat Free Mass (FFM) and Fat Mass (FM) were estimated using Bioimpedance Analysis (BIA). Results: REE value was significantly higher in oncologic patients vs IBD patients (1747±246 kcal/d vs 1391±354 kcal/d) (p < 0.001). Absolute and percentage values of Body Composition had no significant differences in two groups (FFM cancer patients: 47.7±11.8 kg vs IBD: 43.6±9.kg; FM cancer patients: 19.6±8.6% vs IBD patients: 16.5±12.1%), and these data were confirmed by FFM correction (37.7±5.7 kcal/kg vs 32.8±8.5 kcal/kg). No statystical differences in Respiratory Quotient (RQ) values were founded. Conclusions: This preliminary study shows that malnourished patient affected by gastrointestinal cancer have higher REE values than IBD patients, both in absolute and in percentage values. More observations are needed to demonstrate the importance of a nutritional support adapted on the effective metabolic request in patients with neoplastic and non neoplastic gastroenteric disease.
P.1.122 AUTOIMMUNE CHRONIC ATROPHIC GASTRITIS AND HELICOBACTER PYLORI: PREVALENCE OF THE INFECTION AND GENETIC HETEROGENEITY S. Zanussi, G. Basaglia, M. Casarotto, R. Tedeschi, M. Fornasarig, S. Maiero, V. Canzonieri, V. De Re, P. De Paoli, R. Cannizzaro ∗ National Cancer Institute, Aviano, Italy Background and aim: Patients with autoimmune chronic atrophic gastritis
(AAG) show a high risk of precancerous lesions, displasia and carcinoids. Due to the cross-reactivity of anti-parietal cell antibodies with Helicobacter pylori (HP), it has been hypothesized a role of HP in triggering the autoimmune and carcinogenic process. The aims of the present work were to evaluate the relationship between HP infection and AAG, and to determine the genetic heterogeneity of Cag Pathogenicity Island in HP strains grown from gastric biopsies of patients with AAG. Material and methods: Eighteen patients with histological and/or functional diagnosis of AAG, determined by anti-parietal cell antibodies reactivity and/or GastroPanel, have been submitted to serological screening (HP IgG ELISA, Biohit), histology (from 2 antrus and 2 corpus biopsies) and colture for HP (N=32 gastric biopsies samples). Deletions for some virulence factors coding genes located in the HP Cag Pathogenicity Island (CagA, CagE e VirB11) were assessed by submitting to PCR 10-12 single colonies of HP, which well represent the genetic heterogeneity of the HP isolated strains. Results: An association between AAG and previous or active HP infection was shown in 10 patients (55.5%). Four patients (22.2%) had colture positive for HP and 12 (66.7%) showed a composite gastric microbiome. Four out of 5 HP strains showed low or no Cag Pathogenicity Island genetic heterogeneity: 1 strain had 92% e 2 strains had 100% of substrains deleted in 3 genes; 1 strain didn’t show any deletion. A higher heterogeneity was observed in the last strain: 80% of substrains were deleted in CagA, 60% in CagE e 40% in VirB11. Conclusions: HP showed an association with AAG in a large extent of cases. If compared to HP strains from other diseases (duodenal ulcer, non atrophic gastritis) HP isolated from AAG were less heterogeneous and deleted in important Cag Pathogenicity Island virulence factors. It could be interesting to establish if these strains result from a selection process within gastric atrophy or possess further characteristics useful in shaping a pathogenetic model of AAG.
P.1.123 LEVOFLOXACIN-CONTAINING QUADRUPLE CONCOMITANT THERAPY FOR ERADICATION OF H PYLORI INFECTION A.G. Gravina ∗ , A. Miranda, F. Micera, R. Zagaria, D. Napoletano, A. Federico, M. Romano Gastroenterologia And Ciranad, Seconda Università di Napoli, Napoli, Italy Background and aim: H. pylori eradication rates following triple therapies has substantially decreased. We have demonstrated that in an area of >15% prevalence of clarithromycin (CLA) and <5% prevalence of levofloxacin (LEV) resistant H. pylori strains, a LEV-containing sequential therapy (ST) is highly effective. Whether this is due to the sequential administration of the drugs is unknown. We hypothesized that concomitant administration of esomeprazole (ESO), amoxicillin (AMO), LEV, and tinidazole (TIN) (i.e. quadruple concomitant therapy (QCT) for 5 days might be as effective and safe as 10-day sequential administration of the same drugs). AIM: 1) to compare the efficacy of QCT and ST in the eradication of H. pylori infection in patients naïve to treatment; 2) to assess safety and cost effectiveness of QCT and ST. Material and methods: 82 consecutive naïve H. pylori-infected patients (41/group) were randomly assigned to QCT (i.e. ESO 40 mg bid + AMO 1 g bid + LEV 500 mg bid + TIN 500 mg bid for 5 days) or to ST (i.e. ESO 40 mg bid + AMO 1 g bid for 5 days followed by ESO 40 mg bid + LEV 500 mg bid + TIN 500 mg bid for 5 more days). Diagnosis of H. pylori infection was based on positivity to C13 Urea Breath Test (C13 UBT) or on positivity to both rapid urease test and histology in those patients who underwent endoscopy. Eradication was assessed by 13C UBT, 6 and 8 weeks after therapy. Incidence of adverse events was determined by interview at the end of therapy. Significance of differences was assessed by x2 test in the Per Protocol (PP) and Intention-to-Treat (ITT) analyses. Analysis of costs was performed for either regimen. Results: 1) 38/41 patients in the QCT and 40/41 patients in the ST group completed therapy; 2) eradication rate in the QCT was 37/38 (97.4%) in the PP analysis and 37/41 (90.2%) in the ITT analysis; 3) eradication rate in the ST group was 39/40 (97.5%) in the PP analysis and 39/41 (95.1%) in the ITT analysis; 4) this difference was not statistically significant; 5) no significant
Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264
lesions (38%); (ii) patients under 40 years old (31%); (iii) work overload at the endoscopy unit (23%); (iv) local custom (“biopsies are only obtained for research purposes”= 8%). When gastric mucosa biopsies were taken, the BiPs varied, as follows: antrum or corpus biopsy (38%); antrum and corpus biopsy (33%); 5 biopsies, including antral, angularis, and oxyntic mucosa (29%). Overall, the number of biopsies obtained was: <3 in 43% of case, 4 in 25% and ≥5 in 32%. All samples were sent to the pathologist in the same vial in 41% of cases (irrespective of the gastric site they came from); samples were distinguished according to their antral or oxyntic origin in 42% of cases; the antral, angulus and oxyntic mucosa samples were submitted separately, in the remaining 17% of cases. Conclusions: This survey documented a highly inconsistent approach to gastric biopsy procedures. The Italian scientific societies should endorse the international recommendations on gastric BiPs. Different staging systems have recently been proposed with a view to optimizing the histological assessment of gastritis (e.g. the OLGA system), all of which rely on clearly-defined BiPs. A national training program is warranted to promote the adoption of consistent gastric BiPs in routine GE-P.
P.1.121 RESTING ENERGY EXPENDITURE IN TWO DIFFERENT CONDITIONS OF MALNUTRITION DUE TO GASTROENTERIC DISEASE I. Grandone ∗ , M.C. Pagano, M. Marra, F. Vitale, L. Santarpia, F. Contaldo, F. Pasanisi Clinical Nutrition And Internal Medicine, Department Of Clinical And Experimental Medicine, Federico II University, Naples, Italy Background and aim: There are few studies concerning the possibility of metabolic adaption in two different conditions of malnutrition, due to neoplastic and non neoplastic disease. Aim: to evaluate possible differences in Resting Energy Expenditure (REE) in patients affected by two forms of malnutrition (weight loss>10% of usual weight), from gastroenteric cancer and from chronic Inflammatory Bowel Disease (IBD). Material and methods: We selected 37 malnourished patients, 18 affected by gastrointestinal cancer (Age = 48.1±17.3 years; Weight= 59.1±11.7 kg; BMI=19.9±2.2 kg/m2 ) and 19 with IBD (Age=34.4±15.7; Weight= 52.6±11.7; BMI=18.5±3.9). REE was measured by indirect calorimetry (Vmax 29N Sensor Medics). Fat Free Mass (FFM) and Fat Mass (FM) were estimated using Bioimpedance Analysis (BIA). Results: REE value was significantly higher in oncologic patients vs IBD patients (1747±246 kcal/d vs 1391±354 kcal/d) (p < 0.001). Absolute and percentage values of Body Composition had no significant differences in two groups (FFM cancer patients: 47.7±11.8 kg vs IBD: 43.6±9.kg; FM cancer patients: 19.6±8.6% vs IBD patients: 16.5±12.1%), and these data were confirmed by FFM correction (37.7±5.7 kcal/kg vs 32.8±8.5 kcal/kg). No statystical differences in Respiratory Quotient (RQ) values were founded. Conclusions: This preliminary study shows that malnourished patient affected by gastrointestinal cancer have higher REE values than IBD patients, both in absolute and in percentage values. More observations are needed to demonstrate the importance of a nutritional support adapted on the effective metabolic request in patients with neoplastic and non neoplastic gastroenteric disease.
P.1.122 AUTOIMMUNE CHRONIC ATROPHIC GASTRITIS AND HELICOBACTER PYLORI: PREVALENCE OF THE INFECTION AND GENETIC HETEROGENEITY S. Zanussi, G. Basaglia, M. Casarotto, R. Tedeschi, M. Fornasarig, S. Maiero, V. Canzonieri, V. De Re, P. De Paoli, R. Cannizzaro ∗ National Cancer Institute, Aviano, Italy Background and aim: Patients with autoimmune chronic atrophic gastritis
(AAG) show a high risk of precancerous lesions, displasia and carcinoids. Due to the cross-reactivity of anti-parietal cell antibodies with Helicobacter pylori (HP), it has been hypothesized a role of HP in triggering the autoimmune and carcinogenic process. The aims of the present work were to evaluate the relationship between HP infection and AAG, and to determine the genetic heterogeneity of Cag Pathogenicity Island in HP strains grown from gastric biopsies of patients with AAG. Material and methods: Eighteen patients with histological and/or functional diagnosis of AAG, determined by anti-parietal cell antibodies reactivity and/or GastroPanel, have been submitted to serological screening (HP IgG ELISA, Biohit), histology (from 2 antrus and 2 corpus biopsies) and colture for HP (N=32 gastric biopsies samples). Deletions for some virulence factors coding genes located in the HP Cag Pathogenicity Island (CagA, CagE e VirB11) were assessed by submitting to PCR 10-12 single colonies of HP, which well represent the genetic heterogeneity of the HP isolated strains. Results: An association between AAG and previous or active HP infection was shown in 10 patients (55.5%). Four patients (22.2%) had colture positive for HP and 12 (66.7%) showed a composite gastric microbiome. Four out of 5 HP strains showed low or no Cag Pathogenicity Island genetic heterogeneity: 1 strain had 92% e 2 strains had 100% of substrains deleted in 3 genes; 1 strain didn’t show any deletion. A higher heterogeneity was observed in the last strain: 80% of substrains were deleted in CagA, 60% in CagE e 40% in VirB11. Conclusions: HP showed an association with AAG in a large extent of cases. If compared to HP strains from other diseases (duodenal ulcer, non atrophic gastritis) HP isolated from AAG were less heterogeneous and deleted in important Cag Pathogenicity Island virulence factors. It could be interesting to establish if these strains result from a selection process within gastric atrophy or possess further characteristics useful in shaping a pathogenetic model of AAG.
P.1.123 LEVOFLOXACIN-CONTAINING QUADRUPLE CONCOMITANT THERAPY FOR ERADICATION OF H PYLORI INFECTION A.G. Gravina ∗ , A. Miranda, F. Micera, R. Zagaria, D. Napoletano, A. Federico, M. Romano Gastroenterologia And Ciranad, Seconda Università di Napoli, Napoli, Italy Background and aim: H. pylori eradication rates following triple therapies has substantially decreased. We have demonstrated that in an area of >15% prevalence of clarithromycin (CLA) and <5% prevalence of levofloxacin (LEV) resistant H. pylori strains, a LEV-containing sequential therapy (ST) is highly effective. Whether this is due to the sequential administration of the drugs is unknown. We hypothesized that concomitant administration of esomeprazole (ESO), amoxicillin (AMO), LEV, and tinidazole (TIN) (i.e. quadruple concomitant therapy (QCT) for 5 days might be as effective and safe as 10-day sequential administration of the same drugs). AIM: 1) to compare the efficacy of QCT and ST in the eradication of H. pylori infection in patients naïve to treatment; 2) to assess safety and cost effectiveness of QCT and ST. Material and methods: 82 consecutive naïve H. pylori-infected patients (41/group) were randomly assigned to QCT (i.e. ESO 40 mg bid + AMO 1 g bid + LEV 500 mg bid + TIN 500 mg bid for 5 days) or to ST (i.e. ESO 40 mg bid + AMO 1 g bid for 5 days followed by ESO 40 mg bid + LEV 500 mg bid + TIN 500 mg bid for 5 more days). Diagnosis of H. pylori infection was based on positivity to C13 Urea Breath Test (C13 UBT) or on positivity to both rapid urease test and histology in those patients who underwent endoscopy. Eradication was assessed by 13C UBT, 6 and 8 weeks after therapy. Incidence of adverse events was determined by interview at the end of therapy. Significance of differences was assessed by x2 test in the Per Protocol (PP) and Intention-to-Treat (ITT) analyses. Analysis of costs was performed for either regimen. Results: 1) 38/41 patients in the QCT and 40/41 patients in the ST group completed therapy; 2) eradication rate in the QCT was 37/38 (97.4%) in the PP analysis and 37/41 (90.2%) in the ITT analysis; 3) eradication rate in the ST group was 39/40 (97.5%) in the PP analysis and 39/41 (95.1%) in the ITT analysis; 4) this difference was not statistically significant; 5) no significant