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PA.55 SMALL INTESTINAL BACTERIAL OVERGROWTH RECURRENCE AFTER ANTIBIOTIC THERAPY
Abstracts / Digestive and Liver Disease 40S (2008), S1–S195 Medtronic); endoscopic signs of chronic gastritis; histological signs of chronic gastritis and absence of Helicobacter pylori infection. All pts enrolled underwent glucose breath test (GBT) under standard conditions to detect SIBO. Diagnosis of SIBO was based on the occurrence of a peak of H2 values more than 12 ppm above the basal value after 50 gr glucose ingestion. According to the inclusion criteria, 34 pts (19 F; 15 M; mean age 55±5) were enrolled. Besides, 38 healthy volunteers were used as control group. Results: 21 out of the 34 pts (62%) enrolled showed a positive GBT. One subject among control group (2.6%) had a pathological GBT. Difference between the two groups was statistically significant. Moreover, pts with DGR and GBT positive test showed a significantly higher prevalence of heartburn, bloating and diarrhoea. Conclusions: Preliminary results of this study show a high prevalence of SIBO in patients affected by alkaline reactive gastritis for DGR post-cholecystectomy. SIBO presence seems to be related to part of symptoms pattern complained by patients in the post-surgical period. Alkaline gastritis, reducing the efficacy of the gastric acid barrier, may favour bacterial overgrowth into the upper portion of the small bowel. Besides, SIBO has been associated to a disruption of normal GI motor events (MMCs) that could contribute to DGR pathogenesis. # C. Small bowel diseases 3. Other malabsorption syndromes
PA.54 INDEPENDENCY IN SHORT BOWEL SYNDROME: A LONG-TERM STUDY ON 108 PATIENTS I. Vantini ∗ , L. Benini, F. De Iorio, F. Tomba, M. Toaiari, D. Cusumano, L. Peraro, C. Pravadelli Dpt. Gastroenteorlogy-University of Verona, Verona Background and aim: Chronic intestinal failure secondary to short bowel syndrome (SBS) reduces life expectancy and needs long-term parenteral nutrition. About 50% of SBS patients reach nutritional independency. QOL can be affected in SBS and living activities and work attendance can be compromised. Aim of this study was to assess the independency (nutritional, daily life activities, earning capacity and reasons of retirement) in patients with SBS, and factors influencing independency. Material and methods: 108 consecutive SBS patients were followed for an average of 38 (SE 5.3) months. Nutritional independency, daily activities, work and retirement were registered Results: Nutritional independency influenced survival rate (93% in patients who reached nutritional independency, 70% in those on longterm home artificial nutrition). Length of remnant intestine affected nutritional independency, t attained in 63.7% and 58.8% of SBS with remnant intestine > 100 cm and colon in continuity and without colon in continuity respectively, but in 20% and 0 patients with intestine length < 50 cm with and without colon in continuity respectively. Mean age of independent patients at onset of SBS was 57 year(SE 2.62) and 63.4 (SE 1.70) in non-independent(P=NS). 61.1% of patients were independent in daily activities and in managing nutrition. Artificial nutrition was more frequent in patients non-independent in life activities (85.7%) than in independent ones (22.7%) (p<0.001). 27.7% of SBS patients remained at work (mean age 34.6, SE 3.77 years at SBS onset). In patients retired for disability the values were 51.7 (SE 4.93), 68.82 (SE 3.15) and 10.53 (SE 2.43) respectively (P<0.05). 40% of independent patients took to working, 22.7% received invalidity, whereas in nonindependent patients invalidity was recognized in 64.3% of the cases. Artificial nutrition, daily activitiesm non-independency and retirement for invalidity were correlated with irreversible intestinal failure. Family support in daily activities was often sufficient in independent and younger patients.Non-independent patients, though at home, needed nursing support for managing comprehensive care. Conclusions: Nutritional independency, correlated with the length of remnant intestine, strongly influence the global patient’s independency,
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work, vocations and daily activities. These variables should be seriously considered in long-term management of SBS and in assessing care outcome. # C. Small bowel diseases 3. Other malabsorption syndromes
PA.55 SMALL INTESTINAL BACTERIAL OVERGROWTH RECURRENCE AFTER ANTIBIOTIC THERAPY E.C. Lauritano ∗ , M. Gabrielli, E. Scarpellini, A. Lupascu, M.L. Novi, S. Sottili, G. Vitale, V. Cesario, M. Serricchio, G. Cammarota, G. Gasbarrini, A. Gasbarrini UCSC, Roma Background and aim: Current treatment for small intestinal bacterial overgrowth (SIBO) is based on courses of broad spectrum antibiotics. No data concerning SIBO recurrence are available. The aims of the present study were to investigate SIBO recurrence as assessed by glucose breath test (GBT) after antibiotic treatment and conditions associated to SIBO recurrence. Material and methods: Eighty (80) consecutive patients affected by SIBO and decontaminated by rifaximin (1200 mg per day for 1 week) were enrolled. Diagnosis of SIBO was based on GBT. GBT was reassessed at 3, 6, and 9 months after decontamination. GBT positivity recurrence, predisposing conditions and gastrointestinal symptoms were evaluated. Results: Ten (10/80, 12.6%), 22 (22/80, 27.5%) and 35 (35/80, 43.7%) patients showed positivity to GBT at 3, 6 and 9 months after successful antibiotic decontamination, respectively. At multivariate analysis, older age (OR 1.09, 95% CI 1.02-1.16), history of appendectomy (OR 5.9, 95% CI 1.45-24.19) and chronic use of proton pump inhibitors (OR 3.52, 95% CI 1.07-11.64) were significantly associated to GBT positivity recurrence. All gastrointestinal symptoms significantly increased at 3, 6 and 9 months in patients with evidence of GBT positivity recurrence. Conclusions: GBT positivity recurrence rate was high after antibiotic decontamination. Older age, history of appendectomy and chronic use of proton pump inhibitors were associated with GBT positivity recurrence. Patients with evidence of GBT positivity recurrence showed gastrointestinal symptoms relapse thus suggesting SIBO recurrence. Cyclic courses of non-absorbable antibiotics could be necessary in order to prevent SIBO recurrence. # C. Small bowel diseases 3. Other malabsorption syndromes
PA.56 THE VON HERBAY CLASSIFICATION APPLIED TO ITALIAN PATIENTS WITH WHIPPLE’S DISEASE F. Biagi ∗ ,1 , A. Marchese 1 , L. Trotta 1 , P.I. Bianchi 1 , O. Luinetti 2 , V. Villanacci 3 , G.R. Corazza 4 1 Coeliac Centre, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia; 2 Pathologic Anatomy Service, Fondazione IRCCS Policlinico San Matteo, Pavia; 3 2nd Pathology Department, Spedali Civili, Brescia; 4 University of Pavia, Pavia
Background and aim: Whipple’s disease (WD) is a chronic systemic condition due to Tropherima Wipplei (TW) that in the vast majority of cases affects the small intestine. PAS positive macrophages in the duodenal biopsy are the classical hallmarks for its diagnosis. Although PCR is nowadays required to both confirm the diagnosis and follow up the patients, a few years ago a classification of WD based on the morphological pattern of PAS positive macrophages was proposed. Most interestingly, the morphological modifications of PAS positive macrophages parallel the intestinal response to therapy [1]. Aims: To apply this classification to our group of patients with WD.
PA.54 INDEPENDENCY IN SHORT BOWEL SYNDROME: A LONG-TERM STUDY ON 108 PATIENTS I. Vantini ∗ , L. Benini, F. De Iorio, F. Tomba, M. Toaiari, D. Cusumano, L. Peraro, C. Pravadelli Dpt. Gastroenteorlogy-University of Verona, Verona Background and aim: Chronic intestinal failure secondary to short bowel syndrome (SBS) reduces life expectancy and needs long-term parenteral nutrition. About 50% of SBS patients reach nutritional independency. QOL can be affected in SBS and living activities and work attendance can be compromised. Aim of this study was to assess the independency (nutritional, daily life activities, earning capacity and reasons of retirement) in patients with SBS, and factors influencing independency. Material and methods: 108 consecutive SBS patients were followed for an average of 38 (SE 5.3) months. Nutritional independency, daily activities, work and retirement were registered Results: Nutritional independency influenced survival rate (93% in patients who reached nutritional independency, 70% in those on longterm home artificial nutrition). Length of remnant intestine affected nutritional independency, t attained in 63.7% and 58.8% of SBS with remnant intestine > 100 cm and colon in continuity and without colon in continuity respectively, but in 20% and 0 patients with intestine length < 50 cm with and without colon in continuity respectively. Mean age of independent patients at onset of SBS was 57 year(SE 2.62) and 63.4 (SE 1.70) in non-independent(P=NS). 61.1% of patients were independent in daily activities and in managing nutrition. Artificial nutrition was more frequent in patients non-independent in life activities (85.7%) than in independent ones (22.7%) (p<0.001). 27.7% of SBS patients remained at work (mean age 34.6, SE 3.77 years at SBS onset). In patients retired for disability the values were 51.7 (SE 4.93), 68.82 (SE 3.15) and 10.53 (SE 2.43) respectively (P<0.05). 40% of independent patients took to working, 22.7% received invalidity, whereas in nonindependent patients invalidity was recognized in 64.3% of the cases. Artificial nutrition, daily activitiesm non-independency and retirement for invalidity were correlated with irreversible intestinal failure. Family support in daily activities was often sufficient in independent and younger patients.Non-independent patients, though at home, needed nursing support for managing comprehensive care. Conclusions: Nutritional independency, correlated with the length of remnant intestine, strongly influence the global patient’s independency,
S95
work, vocations and daily activities. These variables should be seriously considered in long-term management of SBS and in assessing care outcome. # C. Small bowel diseases 3. Other malabsorption syndromes
PA.55 SMALL INTESTINAL BACTERIAL OVERGROWTH RECURRENCE AFTER ANTIBIOTIC THERAPY E.C. Lauritano ∗ , M. Gabrielli, E. Scarpellini, A. Lupascu, M.L. Novi, S. Sottili, G. Vitale, V. Cesario, M. Serricchio, G. Cammarota, G. Gasbarrini, A. Gasbarrini UCSC, Roma Background and aim: Current treatment for small intestinal bacterial overgrowth (SIBO) is based on courses of broad spectrum antibiotics. No data concerning SIBO recurrence are available. The aims of the present study were to investigate SIBO recurrence as assessed by glucose breath test (GBT) after antibiotic treatment and conditions associated to SIBO recurrence. Material and methods: Eighty (80) consecutive patients affected by SIBO and decontaminated by rifaximin (1200 mg per day for 1 week) were enrolled. Diagnosis of SIBO was based on GBT. GBT was reassessed at 3, 6, and 9 months after decontamination. GBT positivity recurrence, predisposing conditions and gastrointestinal symptoms were evaluated. Results: Ten (10/80, 12.6%), 22 (22/80, 27.5%) and 35 (35/80, 43.7%) patients showed positivity to GBT at 3, 6 and 9 months after successful antibiotic decontamination, respectively. At multivariate analysis, older age (OR 1.09, 95% CI 1.02-1.16), history of appendectomy (OR 5.9, 95% CI 1.45-24.19) and chronic use of proton pump inhibitors (OR 3.52, 95% CI 1.07-11.64) were significantly associated to GBT positivity recurrence. All gastrointestinal symptoms significantly increased at 3, 6 and 9 months in patients with evidence of GBT positivity recurrence. Conclusions: GBT positivity recurrence rate was high after antibiotic decontamination. Older age, history of appendectomy and chronic use of proton pump inhibitors were associated with GBT positivity recurrence. Patients with evidence of GBT positivity recurrence showed gastrointestinal symptoms relapse thus suggesting SIBO recurrence. Cyclic courses of non-absorbable antibiotics could be necessary in order to prevent SIBO recurrence. # C. Small bowel diseases 3. Other malabsorption syndromes
PA.56 THE VON HERBAY CLASSIFICATION APPLIED TO ITALIAN PATIENTS WITH WHIPPLE’S DISEASE F. Biagi ∗ ,1 , A. Marchese 1 , L. Trotta 1 , P.I. Bianchi 1 , O. Luinetti 2 , V. Villanacci 3 , G.R. Corazza 4 1 Coeliac Centre, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia; 2 Pathologic Anatomy Service, Fondazione IRCCS Policlinico San Matteo, Pavia; 3 2nd Pathology Department, Spedali Civili, Brescia; 4 University of Pavia, Pavia
Background and aim: Whipple’s disease (WD) is a chronic systemic condition due to Tropherima Wipplei (TW) that in the vast majority of cases affects the small intestine. PAS positive macrophages in the duodenal biopsy are the classical hallmarks for its diagnosis. Although PCR is nowadays required to both confirm the diagnosis and follow up the patients, a few years ago a classification of WD based on the morphological pattern of PAS positive macrophages was proposed. Most interestingly, the morphological modifications of PAS positive macrophages parallel the intestinal response to therapy [1]. Aims: To apply this classification to our group of patients with WD.