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P.1.226: GIANT GASTRIC GIST: A RARE CASE REPORT
Abstracts of the XVII National Congress of Digestive Diseases / Digestive and Liver Disease 43S (2011) S115–S264 and in those with BMI >25 (0.34±0.12 vs 0.60±0.09) (all p<0.05); abdominal bloating improved in males (2.6±1.4 cm vs 1.6±0.6, p<0.05), in patients <45 y (2.7±2.2 vs 1.7±1.1, p<0.01) and in those with BMI <25 (2.9±2.2 vs 1.8±1.1, p<0.05). An improvement in the number of perceived IE/day in patients with a BMI =25 (0.6±0.35 vs 0.4±0.3, p<0.05) was also found. In addition, a decreased needing of laxatives/enemas was recorded in females (0.14±0.12 vs 0.07±0.09, p<0.05), in patients <45 y (0.13±0.12 vs 0.06±0.08, p<0.01) and in subjects with BMI<25 (0.13±0.12 vs 0.07±0.09, p<0.05). CCT significantly decreased at the end of study regardless of gender (males: 48±8 hrs vs 39±6; females: 45±8 vs 39±7) and of BMI (<25: 46±8 vs 39±7; =25: 47±7 vs 39±8), (all p<0.05). BS improved in all patient subgroups. Conclusions: Demographic parameters such as age, BMI and gender seem to determine a different response to PHGG intake in constipated IBS patients.
P.1.226 GIANT GASTRIC GIST: A RARE CASE REPORT A. Calogero ∗ , R. De Falco, F. Piantadosi, M. Sannino, M. Nunziante, E. Antonaki, M. Cirillo, M. Cappiello, N. Gennarelli, L. Asciore Gastrointestinal Surgery-University Of Naples “Federico II”, Naples, Italy Background and aim: The GISTs are the most common mesenchymal cancer of the gastrointestinal tract. They originate from the myenteric ganglion cells,termed the interstitial Cajal cells. The 95% of the GISTs shows expression of the membrane receptor protein CD 117 with a tyrosine kinase activity c-kit. They may be benign or malignant (30%) and occur in every part of the gastrointestinal tract, however the stomach is the most common localization (39-70%).The radical surgery is the best treatment (survival rate between 40 and 55%). Recent studies have shown that therapy with Imatinib mesylate is effective in the treatment of metastatic and unresectable tumors. The molecular target are the mutations of c-kit gene. Material and methods: M.K., male, 53 years old, from about one month fever and right hypochondrial pain resistant to medical treatment. Preoperative examination: palpable mass in right abdomen, painful with regular margins and surface. Investigation: blood test, neoplastic markers, digestive endoscopy were negative; USS has shown giant solid lesion of about 20 cm and CT releaved voluminose eteroplastic lesion of 26 cm. diameter with contrast enhancement. Explorative laparotomy: reddish bulky mass, irregular, very vascularized with a peduncle arising from anterior gastric wall; resection en-block with a part of gastric wall. No postoperative complication occurs, discharge in eighth day. Histology: mass size of 27x16x9cm and mitotix index 3-5 X 50 HPF compatible with diagnosis of GIST (immunochemistry positive for CD117, CD34 and MSA). The patient was referred to oncologist for adjuvant therapy with Imatinib. At current follow-up (36months) the patient is alive without recurrence. Results: Defining the prognosis of the GISTs is difficult since even small tumors (<2 cm) can have a metastatic potential. The parameters to be considerated are: size, mitotic index, age>50 years, histological differentation, necrosis, origin (GISTs of gastric wall have a better prognosis). Conclusions: The GISTs are rare neoplasms with variable prognosis; the mitotic index and size of cancer seem to be the principal parameters to define the biological aggressiveness. The elective therapy is surgical. The metastatic and unoperable gist can be treated with Imatinib. We propose to direct adjuvant therapy to those patients in whow has made ro resection but with greater risk of malignancy (size >5cm, mitotic activity >10hpf, necrosis, breaking cancer during surgical manoeuvres).
P.1.227 IS COLONOSCOPY REALLY MANDATORY IN CLINICAL PRACTICE AFTER STREPTOCOCCUS BOVIS BACTEREMIA? S. Segato, M. Parravicini ∗ , M. Montanari, L. Rotabacchetta, S. Piana, G. Bisso Azienda Ospedaliero Universitaria Macchi, Varese, Italy Background and aim: Streptococcus bovis (SB) is a group D non-
S223
enterococcal Streptococcus; an association between SB bacteremia (SBB) and colorectal cancer (CC)/adenomatous polyps (AP) has been established. The knowledge however about the true pathophysiologic mechanism is lacking and adenomatous polyps are frequent in general population over 50. The aim of the study was to investigate the prevalence of CC/AP in SBB patients. Material and methods: The study was made on 26 consecutive patients (8 women, 18 men, medium age at diagnosis 63.3 yrs, range 49-78 yrs) who had positive hemocolture for SB (Group A). Complete colonoscopy and biopsies or polipectomy were performed in all patients. In the same way colonoscopy was made on 26 consecutive asymptomatic patients (6 women, 20 men, medium age 58.1 yrs range 49-69) as a control group (Group B). Data were analysed by Fisher’s exact test. Results: In Group A 14 patients (53.8%) had neoplastic lesions (12 AP =46.1% and 2 CC = 7.7%); in Group B 8 patients had AP (30.7%). No patient had CC. No statistical significance was found between the two groups (p=0.16). Conclusions: The study was made on small groups of patients and the medium age of Control Group was 5 years lower than Group A. Even though the reasons of the association between SB infection and colon neoplasia (in particular with non ulcerated lesions) are still not clear and the differences between the two groups aren’t statistically significative, the detection rate of CC or AP in SBB patients is higher than expected. Colonoscopy should be recommended after the diagnosis of SBB.
P.1.228 DO SYMPTOMS OF LACTOSE INTOLERANCE REVEAL A SOMATOFORM DISORDER? C. Tomba ∗ ,1 , A.R. Baldassarri 2 , M. Coletta 1 , B. Cesana 3 , G. Basilisco 2 1 Scuola di Specializzazione In Gastroenterologia Ed Endoscopia Digestiva, Università degli Studi di Milano, Milano, Italy; 2 Irccs Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy; 3 Dipartimento di Statistica, Università di Brescia, Brescia, Italy
Background and aim: Symptoms of lactose intolerance are often attributed to lactose malabsorption and treated with elimination diets that increase the risk of calcium deficiency. However, psychological factors may play a role in altered symptom perception. The aim of the study was to assess the relationship between the symptoms of lactose intolerance during a lactose hydrogen breath test and the psychological profiles of patients with and without lactose malabsorption. Material and methods: One hundred and two consecutive patients (77 females; median age 36 years) underwent a 15 g-lactose hydrogen breath test because of suspected lactose malabsorption. The patients recorded the presence and severity of symptoms of lactose intolerance (pain, nausea, bloating, borborygmi, flatulence) during the test on 10 cm visual analogue scales. A psychological symptom checklist (SCL-90R) assessed the severity of somatisation, anxiety, depression, and the global severity index (GSI). Lactose intolerance was defined as an overall severity of >7 cm, and a normalised SCL-90R cut-off score of 63 identified cases of significant psychopathology. Lactose malabsorption was defined as a >10 ppm increase in baseline breath hydrogen in the three hours after lactose ingestion. Non-parametric tests were used for the univariate analysis; the multivariate analysis included the presence/absence of lactose malabsorption and significant psychopathology. Data are mean values ± SD. Results: Lactose malabsorption and intolerance were diagnosed in 33% and 29% of the patients. The two conditions were not associated (P=0.64) and the severity of intolerance was not significantly higher in the patients with malabsorption (5.37±8.42 vs 4.71±5.81; P=0.97). Univariate analysis revealed that the intolerant patients showed significantly greater somatisation (64±9.16 vs 57.99±7.38; P=0.0009), anxiety (59.67±7.6 vs 56.14±7.04; P=0.04) and GSI (60.07±8.08 vs 56.19±7.48; P=0.02). Multivariate analysis showed that altered somatisation significantly increased the risk of intolerance (odds ratio 4.184; 1.704-10.309), whereas the effects of the other psychological variables and the presence of lactose malabsorption were not significant.
P.1.226 GIANT GASTRIC GIST: A RARE CASE REPORT A. Calogero ∗ , R. De Falco, F. Piantadosi, M. Sannino, M. Nunziante, E. Antonaki, M. Cirillo, M. Cappiello, N. Gennarelli, L. Asciore Gastrointestinal Surgery-University Of Naples “Federico II”, Naples, Italy Background and aim: The GISTs are the most common mesenchymal cancer of the gastrointestinal tract. They originate from the myenteric ganglion cells,termed the interstitial Cajal cells. The 95% of the GISTs shows expression of the membrane receptor protein CD 117 with a tyrosine kinase activity c-kit. They may be benign or malignant (30%) and occur in every part of the gastrointestinal tract, however the stomach is the most common localization (39-70%).The radical surgery is the best treatment (survival rate between 40 and 55%). Recent studies have shown that therapy with Imatinib mesylate is effective in the treatment of metastatic and unresectable tumors. The molecular target are the mutations of c-kit gene. Material and methods: M.K., male, 53 years old, from about one month fever and right hypochondrial pain resistant to medical treatment. Preoperative examination: palpable mass in right abdomen, painful with regular margins and surface. Investigation: blood test, neoplastic markers, digestive endoscopy were negative; USS has shown giant solid lesion of about 20 cm and CT releaved voluminose eteroplastic lesion of 26 cm. diameter with contrast enhancement. Explorative laparotomy: reddish bulky mass, irregular, very vascularized with a peduncle arising from anterior gastric wall; resection en-block with a part of gastric wall. No postoperative complication occurs, discharge in eighth day. Histology: mass size of 27x16x9cm and mitotix index 3-5 X 50 HPF compatible with diagnosis of GIST (immunochemistry positive for CD117, CD34 and MSA). The patient was referred to oncologist for adjuvant therapy with Imatinib. At current follow-up (36months) the patient is alive without recurrence. Results: Defining the prognosis of the GISTs is difficult since even small tumors (<2 cm) can have a metastatic potential. The parameters to be considerated are: size, mitotic index, age>50 years, histological differentation, necrosis, origin (GISTs of gastric wall have a better prognosis). Conclusions: The GISTs are rare neoplasms with variable prognosis; the mitotic index and size of cancer seem to be the principal parameters to define the biological aggressiveness. The elective therapy is surgical. The metastatic and unoperable gist can be treated with Imatinib. We propose to direct adjuvant therapy to those patients in whow has made ro resection but with greater risk of malignancy (size >5cm, mitotic activity >10hpf, necrosis, breaking cancer during surgical manoeuvres).
P.1.227 IS COLONOSCOPY REALLY MANDATORY IN CLINICAL PRACTICE AFTER STREPTOCOCCUS BOVIS BACTEREMIA? S. Segato, M. Parravicini ∗ , M. Montanari, L. Rotabacchetta, S. Piana, G. Bisso Azienda Ospedaliero Universitaria Macchi, Varese, Italy Background and aim: Streptococcus bovis (SB) is a group D non-
S223
enterococcal Streptococcus; an association between SB bacteremia (SBB) and colorectal cancer (CC)/adenomatous polyps (AP) has been established. The knowledge however about the true pathophysiologic mechanism is lacking and adenomatous polyps are frequent in general population over 50. The aim of the study was to investigate the prevalence of CC/AP in SBB patients. Material and methods: The study was made on 26 consecutive patients (8 women, 18 men, medium age at diagnosis 63.3 yrs, range 49-78 yrs) who had positive hemocolture for SB (Group A). Complete colonoscopy and biopsies or polipectomy were performed in all patients. In the same way colonoscopy was made on 26 consecutive asymptomatic patients (6 women, 20 men, medium age 58.1 yrs range 49-69) as a control group (Group B). Data were analysed by Fisher’s exact test. Results: In Group A 14 patients (53.8%) had neoplastic lesions (12 AP =46.1% and 2 CC = 7.7%); in Group B 8 patients had AP (30.7%). No patient had CC. No statistical significance was found between the two groups (p=0.16). Conclusions: The study was made on small groups of patients and the medium age of Control Group was 5 years lower than Group A. Even though the reasons of the association between SB infection and colon neoplasia (in particular with non ulcerated lesions) are still not clear and the differences between the two groups aren’t statistically significative, the detection rate of CC or AP in SBB patients is higher than expected. Colonoscopy should be recommended after the diagnosis of SBB.
P.1.228 DO SYMPTOMS OF LACTOSE INTOLERANCE REVEAL A SOMATOFORM DISORDER? C. Tomba ∗ ,1 , A.R. Baldassarri 2 , M. Coletta 1 , B. Cesana 3 , G. Basilisco 2 1 Scuola di Specializzazione In Gastroenterologia Ed Endoscopia Digestiva, Università degli Studi di Milano, Milano, Italy; 2 Irccs Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy; 3 Dipartimento di Statistica, Università di Brescia, Brescia, Italy
Background and aim: Symptoms of lactose intolerance are often attributed to lactose malabsorption and treated with elimination diets that increase the risk of calcium deficiency. However, psychological factors may play a role in altered symptom perception. The aim of the study was to assess the relationship between the symptoms of lactose intolerance during a lactose hydrogen breath test and the psychological profiles of patients with and without lactose malabsorption. Material and methods: One hundred and two consecutive patients (77 females; median age 36 years) underwent a 15 g-lactose hydrogen breath test because of suspected lactose malabsorption. The patients recorded the presence and severity of symptoms of lactose intolerance (pain, nausea, bloating, borborygmi, flatulence) during the test on 10 cm visual analogue scales. A psychological symptom checklist (SCL-90R) assessed the severity of somatisation, anxiety, depression, and the global severity index (GSI). Lactose intolerance was defined as an overall severity of >7 cm, and a normalised SCL-90R cut-off score of 63 identified cases of significant psychopathology. Lactose malabsorption was defined as a >10 ppm increase in baseline breath hydrogen in the three hours after lactose ingestion. Non-parametric tests were used for the univariate analysis; the multivariate analysis included the presence/absence of lactose malabsorption and significant psychopathology. Data are mean values ± SD. Results: Lactose malabsorption and intolerance were diagnosed in 33% and 29% of the patients. The two conditions were not associated (P=0.64) and the severity of intolerance was not significantly higher in the patients with malabsorption (5.37±8.42 vs 4.71±5.81; P=0.97). Univariate analysis revealed that the intolerant patients showed significantly greater somatisation (64±9.16 vs 57.99±7.38; P=0.0009), anxiety (59.67±7.6 vs 56.14±7.04; P=0.04) and GSI (60.07±8.08 vs 56.19±7.48; P=0.02). Multivariate analysis showed that altered somatisation significantly increased the risk of intolerance (odds ratio 4.184; 1.704-10.309), whereas the effects of the other psychological variables and the presence of lactose malabsorption were not significant.