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Patients With Extra-Esophageal Symptoms, Compared to NERD Patients With Typical Symptoms and Healthy Volunteers, Are Characterized by a Higher Number of Reflux Episodes and Higher Proportion of Weakly Acidic and Mixed Reflux
Sa1213 LTx Patients With Increased Gastroesophageal Reflux Have Increased CD8+ Effector T Cells in BAL Veerle Mertens, Kathleen Blondeau, Ans Pauwels, Ricard Farré, Bart M. Vanaudenaerde, Robin Vos, Dirk E. Van Raemdonck, Geert M. Verleden, Lieven Dupont, Daniel Sifrim
*p< 0.05 Sa1215
Gastroesophageal reflux (GER) and aspiration of gastric contents have been labeled as risk factors for the development of BOS and surgical correction of GER by gastric fundoplication may be associated with increased freedom from BOS. The mechanisms underlying this relationship remains insufficiently elucidated. The aim of our study was to compare differential cell count and T/B cell characteristics of broncho-alveolar lavage (BAL) cells between LTX patients with and without abnormal GER. Methods GER was assessed using 24hrs impedance-pH monitoring, 1 year after LTx. BAL samples were obtained at the same time, cell count was performed and samples were analyzed by means of fluorescence immunophenotyping for the presence of CD8+ & CD4+ cells. Patients were considered to have increased GER if they had either an increased total number of reflux events (n>75), increased esophageal acid exposure (>5.0%) or increased bolus exposure (>2.0%). Results 52 patients were recruited (40 SSLTx, 11 SLTx, 1 HLTx, 52% female; mean (±SD) age 50.4 ± 12.1 years). 36% (19/52) of LTx patients had increased reflux. BAL characteristics of patients with and without GER are listed in the Table. Patients with increased GER had elevated levels of CD8+ cells as compared to patients with normal GER [64.2 (56.2-79.0) vs 51.8 (41.3-69.0); p=0.0089]. The ratio CD4+/CD8+ was significantly reduced in patients with increased GER [0.3(0.1-0.4) vs 0.5(0.25-1.1); p=0.0024]. Conclusion Pathological GER is associated with an increased frequency of potentially injurious effector CD8 cells in the BAL of lung transplant recipients.
Gastric Cardia Mucosa Not More Common in Those With GERD or Barrett's Esophagus Patrick E. Young, Adam Deising, Philip R. Taylor, Sean Hussey, Brooks D. Cash Background: Controversy exists as to whether histologically distinct gastric cardia mucosa is a naturally occurring phenomenon or a pathologic reaction to noxious stimuli, particularly acid. Aim: To determine if histologically distinct cardiac mucosa was more prevalent in patients with Barrett's Esophagus (BE), gastroesophageal reflux disease (GERD) or both when compared to patients without these conditions. Methods: A single gastrointestinal pathologist reviewed samples from 447 taken from the proximal stomach within 1cm of the gastroesophageal junction (GEJ) as part of a larger study. The GEJ was defined as the site where the gastric folds terminated. BE was defined as histologically confirmed intestinal metaplasia on endoscopic biopsies of a columnar lined esophagus. Biopsies were taken with large capacity forceps. GERD diagnosis was based on positive GERQ questionnaire or endoscopic evidence of erosive esophagitis. Groups were compared using the Chi-Square test with 2 degrees of freedom. Results: Four hundred and forty-seven patient samples were examined. Two hundred thirty seven had either active or prior BE, 237 had GERD without BE, and 60 had neither (non-GERD). There was no significant difference in the prevalence of cardiac mucosa in those with BE (6% P=0.086 vs. non-GERD), GERD (8.9%, P=0.301 vs. non-GERD), or neither (13.3%). The odds ratios for having cardiac mucosa (vs. non-GERD patients) were 0.42 (CI 0.15 - 1.13) for those with current Barrett's, 0.66 (CI 0.23 - 1.86) for those with a history of Barrett's, and 0.63 (CI 0.27 - 1.51) for those with GERD alone. Models which adjusted for age, gender, BMI, smoking, or alcohol use individually did not substantively alter the results, nor did models in which all 5 covariates were simultaneously used to adjust the ORs for the presence of gastric cardia-specific mucosa in BE or GERD patients. Conclusions: In our patent sample, there was no statistically significant difference in the presence of cardiac mucosa between those with GERD or Barrett's and those without. In fact, there was a trend toward an increase in cardiac mucosa in patients with neither Barrett's nor GERD. This suggests that cardiac mucosa is not a response to excessive acid in the proximal stomach as has been previously proposed.
Table *p<0.05 Sa1214 Table 1: Distribution of histology (oxyntic and gastric cardia-specific mucosa) by diagnosis group (BE, GERD, Non-GERD
Patients With Extra-Esophageal Symptoms, Compared to NERD Patients With Typical Symptoms and Healthy Volunteers, Are Characterized by a Higher Number of Reflux Episodes and Higher Proportion of Weakly Acidic and Mixed Reflux Mentore Ribolsi, Paola Balestrieri, Sara Emerenziani, Maria Chiara Addarii, Fabio Greco, Manuele Casale, Fabrizio Salvinelli, Fabio Pace, Michele Cicala Background and aims: Although extra-esophageal symptoms are present in >30% of GERD patients, the role of gastric refluxate still remains unclear. In patients with extra-esophageal symptoms, pH monitoring is often in the normal range and the response to PPI therapy is poor. Few data are currently available concerning the chemical, physical and dynamic properties of reflux in these patients when compared to those in patients with typical or combined typical and atypical symptoms, as well as concerning the predictive value of esophageal multichannel impedance-pH (MI-pH) monitoring for the PPI response. Methods: Of consecutive patients not showing erosive esophagitis, 61 (F 36; mean age 41 yrs, range 22-68) presenting with extra-esophageal, suspected GERD-related symptoms (EE group, hoarseness n. 56, globus n. 12, chronic cough n. 12 and dysphonia, n. 16) underwent, following a 3-week pharmacological washout, ambulatory MI-pH, following stationary manometry. Patients filled out a structurized questionnaire with symptom score. 32 of the 61 EE presented only extra-esophageal symptoms (EE only), the remaining 29 patients also presented typical GERD symptoms (EE+T). 36 of the 61 EE had not shown a satisfactory response to 8 weeks double dose PPI therapy (<50% improvement). MI-pH findings were compared to those obtained in 54 NERD patients with typical symptoms responding to PPI (F 31; mean age 44 yrs, range 25-67) and to normal values reported in an Italian population of healthy volunteers (HV). Data are expressed as median and 25th-75th percentile values. Results: 19/61 EE (31%) and 24/54 NERD (44%) patients presented pathological acid exposure time (AET) (mean ± SD, 7.9 ± 1.2 vs 8.4 ± 1.9). AET was positive in 10/33 patients
Table 2: Odds ratios (95% confidence intervals) for presence of gastric cardia-specific mucosa in BE and GERD patients compared to Non-GERD patients Sa1216 The Pattern of Gastroesophageal Reflux in Patients With and Without Nighttime Heartburn William C. Orr, Suanne Goodrich, Stacy Wright BACKGROUND AND AIMS: It has been estimated that approximately 70% of individuals who complain of heartburn also report nighttime heartburn. It is not known whether individuals with daytime versus nighttime heartburn have different patterns of gastroesophageal reflux (GER). The aims of this study were to assess daytime and nighttime GER as well as sleep quality in patients with exclusively daytime heartburn compared to those with both daytime and nighttime complaints. METHODS: Subjects included 25 individuals who complained of both daytime and nighttime heartburn (at least 2 nights per week), and 13
S-255
AGA Abstracts
AGA Abstracts
of the EE only group and in 9/30 patients of EE+T group. AET was positive in 13/36 PPI non responder and 6/25 responder patients. Findings of MI-pH are shown in the table. The total reflux number and the proportions of weakly acidic, mixed and proximal reflux did not differ between EE patients (PPI responders and non-responders). Conclusions: Patients with extra-esophageal symptoms, compared to NERD patients with typical symptoms and HV, are characterized by a higher number of reflux episodes and higher proportion of weakly acidic and mixed refluxes. Although this reflux pattern could explain the reduced response to PPI treatment, MI-pH findings do not seem to predict the PPI response in this group of patients.
*p< 0.05 Sa1215
Gastroesophageal reflux (GER) and aspiration of gastric contents have been labeled as risk factors for the development of BOS and surgical correction of GER by gastric fundoplication may be associated with increased freedom from BOS. The mechanisms underlying this relationship remains insufficiently elucidated. The aim of our study was to compare differential cell count and T/B cell characteristics of broncho-alveolar lavage (BAL) cells between LTX patients with and without abnormal GER. Methods GER was assessed using 24hrs impedance-pH monitoring, 1 year after LTx. BAL samples were obtained at the same time, cell count was performed and samples were analyzed by means of fluorescence immunophenotyping for the presence of CD8+ & CD4+ cells. Patients were considered to have increased GER if they had either an increased total number of reflux events (n>75), increased esophageal acid exposure (>5.0%) or increased bolus exposure (>2.0%). Results 52 patients were recruited (40 SSLTx, 11 SLTx, 1 HLTx, 52% female; mean (±SD) age 50.4 ± 12.1 years). 36% (19/52) of LTx patients had increased reflux. BAL characteristics of patients with and without GER are listed in the Table. Patients with increased GER had elevated levels of CD8+ cells as compared to patients with normal GER [64.2 (56.2-79.0) vs 51.8 (41.3-69.0); p=0.0089]. The ratio CD4+/CD8+ was significantly reduced in patients with increased GER [0.3(0.1-0.4) vs 0.5(0.25-1.1); p=0.0024]. Conclusion Pathological GER is associated with an increased frequency of potentially injurious effector CD8 cells in the BAL of lung transplant recipients.
Gastric Cardia Mucosa Not More Common in Those With GERD or Barrett's Esophagus Patrick E. Young, Adam Deising, Philip R. Taylor, Sean Hussey, Brooks D. Cash Background: Controversy exists as to whether histologically distinct gastric cardia mucosa is a naturally occurring phenomenon or a pathologic reaction to noxious stimuli, particularly acid. Aim: To determine if histologically distinct cardiac mucosa was more prevalent in patients with Barrett's Esophagus (BE), gastroesophageal reflux disease (GERD) or both when compared to patients without these conditions. Methods: A single gastrointestinal pathologist reviewed samples from 447 taken from the proximal stomach within 1cm of the gastroesophageal junction (GEJ) as part of a larger study. The GEJ was defined as the site where the gastric folds terminated. BE was defined as histologically confirmed intestinal metaplasia on endoscopic biopsies of a columnar lined esophagus. Biopsies were taken with large capacity forceps. GERD diagnosis was based on positive GERQ questionnaire or endoscopic evidence of erosive esophagitis. Groups were compared using the Chi-Square test with 2 degrees of freedom. Results: Four hundred and forty-seven patient samples were examined. Two hundred thirty seven had either active or prior BE, 237 had GERD without BE, and 60 had neither (non-GERD). There was no significant difference in the prevalence of cardiac mucosa in those with BE (6% P=0.086 vs. non-GERD), GERD (8.9%, P=0.301 vs. non-GERD), or neither (13.3%). The odds ratios for having cardiac mucosa (vs. non-GERD patients) were 0.42 (CI 0.15 - 1.13) for those with current Barrett's, 0.66 (CI 0.23 - 1.86) for those with a history of Barrett's, and 0.63 (CI 0.27 - 1.51) for those with GERD alone. Models which adjusted for age, gender, BMI, smoking, or alcohol use individually did not substantively alter the results, nor did models in which all 5 covariates were simultaneously used to adjust the ORs for the presence of gastric cardia-specific mucosa in BE or GERD patients. Conclusions: In our patent sample, there was no statistically significant difference in the presence of cardiac mucosa between those with GERD or Barrett's and those without. In fact, there was a trend toward an increase in cardiac mucosa in patients with neither Barrett's nor GERD. This suggests that cardiac mucosa is not a response to excessive acid in the proximal stomach as has been previously proposed.
Table *p<0.05 Sa1214 Table 1: Distribution of histology (oxyntic and gastric cardia-specific mucosa) by diagnosis group (BE, GERD, Non-GERD
Patients With Extra-Esophageal Symptoms, Compared to NERD Patients With Typical Symptoms and Healthy Volunteers, Are Characterized by a Higher Number of Reflux Episodes and Higher Proportion of Weakly Acidic and Mixed Reflux Mentore Ribolsi, Paola Balestrieri, Sara Emerenziani, Maria Chiara Addarii, Fabio Greco, Manuele Casale, Fabrizio Salvinelli, Fabio Pace, Michele Cicala Background and aims: Although extra-esophageal symptoms are present in >30% of GERD patients, the role of gastric refluxate still remains unclear. In patients with extra-esophageal symptoms, pH monitoring is often in the normal range and the response to PPI therapy is poor. Few data are currently available concerning the chemical, physical and dynamic properties of reflux in these patients when compared to those in patients with typical or combined typical and atypical symptoms, as well as concerning the predictive value of esophageal multichannel impedance-pH (MI-pH) monitoring for the PPI response. Methods: Of consecutive patients not showing erosive esophagitis, 61 (F 36; mean age 41 yrs, range 22-68) presenting with extra-esophageal, suspected GERD-related symptoms (EE group, hoarseness n. 56, globus n. 12, chronic cough n. 12 and dysphonia, n. 16) underwent, following a 3-week pharmacological washout, ambulatory MI-pH, following stationary manometry. Patients filled out a structurized questionnaire with symptom score. 32 of the 61 EE presented only extra-esophageal symptoms (EE only), the remaining 29 patients also presented typical GERD symptoms (EE+T). 36 of the 61 EE had not shown a satisfactory response to 8 weeks double dose PPI therapy (<50% improvement). MI-pH findings were compared to those obtained in 54 NERD patients with typical symptoms responding to PPI (F 31; mean age 44 yrs, range 25-67) and to normal values reported in an Italian population of healthy volunteers (HV). Data are expressed as median and 25th-75th percentile values. Results: 19/61 EE (31%) and 24/54 NERD (44%) patients presented pathological acid exposure time (AET) (mean ± SD, 7.9 ± 1.2 vs 8.4 ± 1.9). AET was positive in 10/33 patients
Table 2: Odds ratios (95% confidence intervals) for presence of gastric cardia-specific mucosa in BE and GERD patients compared to Non-GERD patients Sa1216 The Pattern of Gastroesophageal Reflux in Patients With and Without Nighttime Heartburn William C. Orr, Suanne Goodrich, Stacy Wright BACKGROUND AND AIMS: It has been estimated that approximately 70% of individuals who complain of heartburn also report nighttime heartburn. It is not known whether individuals with daytime versus nighttime heartburn have different patterns of gastroesophageal reflux (GER). The aims of this study were to assess daytime and nighttime GER as well as sleep quality in patients with exclusively daytime heartburn compared to those with both daytime and nighttime complaints. METHODS: Subjects included 25 individuals who complained of both daytime and nighttime heartburn (at least 2 nights per week), and 13
S-255
AGA Abstracts
AGA Abstracts
of the EE only group and in 9/30 patients of EE+T group. AET was positive in 13/36 PPI non responder and 6/25 responder patients. Findings of MI-pH are shown in the table. The total reflux number and the proportions of weakly acidic, mixed and proximal reflux did not differ between EE patients (PPI responders and non-responders). Conclusions: Patients with extra-esophageal symptoms, compared to NERD patients with typical symptoms and HV, are characterized by a higher number of reflux episodes and higher proportion of weakly acidic and mixed refluxes. Although this reflux pattern could explain the reduced response to PPI treatment, MI-pH findings do not seem to predict the PPI response in this group of patients.