- Email: [email protected]
Results of long-term gastric electrical stimulation (GES) for treatment of gastroparesis refractory to standard medical therapy
S46
Abstracts
classified as Barrett’s Esophagus. Our research captured both long (ⱖ3cm) segment BE and short segment (⬍3cm) BE. At Mayo Clinic Rochester, patients consulting the Gastroenterology and Hepatology, Medical Oncology and Thoracic Surgery Division, with a diagnosis of BE and/or esophageal ACA were identified, and asked to list first-degree relatives. Patient demographics, clinical information, and a validated Reflux Symptoms Questionnaire (RSQ) were collected. Medical release was received and BE diagnosis was confirmed by review of slides and endoscopic reports from all relatives endoscoped in the past. Relatives not previously investigated were asked to present for endoscopy. At other collaborating Institutions, primary physicians referred high prevalence BE families. Results: To date, 462 families were identified. 246 of 462 (53%) BE index patients agreed to participate, listing all first degree relatives. 961 of 1490 (65%) adult living relatives completed RSQ’s and medical release forms after one contact. 120 outside endoscopy reports and pathology slides were reviewed. 244 patients were scoped at Mayo. 39 of 246 (16%) families have been identified as having multiple occurrences of BE or BE with ACA. Among the 246 participating families, 28 had 2 members with BE, 9 families had 3 members, and 2 families had 4 or more members with BE. Conclusions: Barrett’s Esophagus aggregates in families. This group effort is the first step towards genetic linkage analysis aimed at localizing susceptibility loci in familial Barrett’s Esophagus.
141 A post-genomic strategy for the positional cloning of the gene for Severe pediatric GERD Fen Ze Hu, M.S., Robert A. Preston, Ph.D., Sandra Johnson, B.S., Azad Ahmed, M.D., John Gladitz, Ph.D., and J. Christopher Post, M.D. Allegheny Singer Research Institute, Pittsburgh, PA, United States. A strategy has been developed and implemented based upon the availability of the complete human genomic sequence to positionally clone the gene for pediatric GERD. We had previously mapped a gene for pediatric GERD to a 9 cM region on chromosome 13q14, but analyses of several potential candidate genes within this region failed to identify any mutations that could be etiologically associated with the disease. Thus, a positional cloning approach was developed for the entire linkage region. Prior to the availability of the human genome sequence, a 9 cM region would have been considered much too large for a brute-force positional cloning approach. However, utilizing the annotated human genomic DNA databases we were able to determine that the linkage region was actually only 6 cM suggesting a higher than average rate of meiotic crossover in thus region than would be expected. We have identified 21 genes (composed of 151 exons); 19 spliced ESTs; and 88 unspliced ESTs within the linkage region. To identify which of these genes contains GERD-specific mutations we have developed a four phase approach. The first phase is the identification of all exons for all known genes and ESTs followed sequentially by an analysis of: 2) the 3⬘ untranslated regions (3⬘ UTRs); 3) the introns; and finally 4) the promoter regions. For each of the four phases the initial step is PCRsequencing primer design, followed by quality control of the primers, and optimization for each primer pair that fails QC. During the course of this study we have developed efficient high throughput methods for each of these laboratory parameters and have, through incremental process development, increased our success rate for primer QC on the first pass from 70 to over 90%. Systems have been developed that permit in 2 days the: 1) the QC analysis of 100 primer pairs; and the optimization of 50 primer pairs that are evaluated under 12 conditions. Next each of the validated primer pairs are used in the PCR-sequencing of 5 affected persons, 1 from each of five GERD families and three controls with current throughput of 108 independent sequences/day. Heterozygote screening of the DNA sequence data for all of the known gene and EST exons is nearly complete and primers have been developed for all of the 3⬘UTRs. It is anticipated that all known, and in silico-identified genes will be evaluated in their entirety within the next six months which should yield the gene for severe pediatric GER.
AJG – Vol. 96, No. 9, Suppl., 2001
STOMACH 142 Gastric electrical stimulation improves both GI symptoms and gastric emptying in patients with post-surgical gastroparesis Thomas L Abell1*, Jean Luo2, Guy Voeller2, Derrick Beech 2, Hossein Amiri2 and Paula Eaton2. 1U of TN, Memphis, TN, United States; and 2 U of AR, Little Rock, AR, United States. Purpose: Post surgical gastroparesis patients unresponsive to medications remain one of the most difficult groups of patients with gastric motor disorders. Although some patients appear to improve over time, others do not, and often do not respond to antiemetic and prokinetic medications. Gastric Electrical Stimulation (GES) has shown promise for patients with idiopathic and diabetic gastroparesis. To investigate its clinical usefullness, we have applied gastric electrical stimulation for a group of patients with surgery-related gastric motor disorders. Methods: We studied 9 patients, a subset of the GEMS and WAVESS trials, 2m, 7f, mean age 42 yrs, who had ‘surgery-related’ gastroparesis, of long duration (mean 5.8 years). These patients had a variety gastrointestinal surgical procedures, such as gastrojejunostomy, partial gastrectomy, Nissen fundoplication, vagotomy, and pyloroplasty; 3 pts had symptoms, which had predated their surgery. Patients were evaluated for symptoms by Total Symptom Score (TSS:nausea, vomiting, bloating, abdominal pain and anorexia), weekly vomiting frequency (WVF) and gastric emptying (GET) at baseline, 3, 6, and 12 months post gastric electrical stimulation device implantation. GES stimulation electrodes were placed in the distal stomach remnant, and the device (Itrel, Medtronic), was programmed for high frequency, low energy settings as previously reported(GE 112(4) A735, 1997). Results were compared by paired t-tests and were reported as mean ⫾SE. Results: All patients noted a significant reduction in TSS and WVF, and an improvement in 2hrs solid GET. Baseline
3 Months
6 Months
12 Months
TSS
40.3 ⫾ 2.2
WVF
24.1 ⫾ 11.4
GET (2 hr solid)
69.5 ⫾ 12.5
19.8 ⫾ 4.6 (p ⬍ 0.002) 6.9 ⫾ 5.0 (p ⬍ 0.05) 66.5 ⫾ 16.7 (p ⬎ 0.3)
10.1 ⫾ 3.4 (p ⬍ 0.001) 0.4 ⫾ 0.3 (p ⬍ 0.05) 50.0 ⫾ 16.1 (p ⫽ 0.218)
22.6 ⫾ 5.7 (p ⬍ 0.05) 4.3 ⫾ 2.7 (p ⬍ 0.05) 52.5 ⫾ 11.8 (p ⫽ 0.155)
Conclusions: We conclude that in this group of surgery-related, or postsurgical, gastroparesis patients, gastric electrical stimulation shows significant improvement in both total GI symptoms and vomiting frequency, with an improvement in gastric emptying, all of which are sustained over time. GES deserves further investigation in controlled trials in pts with postsurgical gastric motor disorders. Supported in part by Medtronic.
143 Results of long-term gastric electrical stimulation (GES) for treatment of gastroparesis refractory to standard medical therapy Richard McCallum, MD1*, Irene Sarosiek, MD1, Zhiyue Lin, PhD1, Jameson Forster, MD1, Thomas Abell, MD2, Hani Rashed, PhD4, Paula Eaton, RN3, Lesa Gann, RoN2 and Warren Starkebaum, PhD3. 1 University of Kansas, Kansas City, KS; 2University of Arkansas, Little Rock, AR; 3Medtronic, Inc., Minneapolis, MN; and 4University of Tennessee, Memphis, TN. Purpose: The objective of this study was to evaluate the long-term efficacy of high frequency gastric electrical stimulation for gastroparesis (GP) in an open label Compassionate Use Electrical Stimulation Study (CUESS). Preliminary results at 6 and 12 months are reported here. Methods: 48 patients with chronic GP were enrolled from 2 centers [22 diabetic (8M, 14F), 19 idiopathic (2M, 17F), and 7 post surgical (1M, 6F)]; mean overall age was 40.8 years. Entry criteria were ⱖ 7 episodes/week of
AJG – September, Suppl., 2001
Abstracts
vomiting or nausea, delayed gastric emptying (GET) at 4 hours determined by standardized scintigraphic techniques, and refractoriness to prokinetic and antiemetic therapy. Chronic high frequency GES therapy was administered for 12 months via electrodes implanted by laparotomy in the muscle wall of the antrum 10 cm from the pylorus and connected to an implanted stimulator placed in the abdominal wall (frequency ⫽ 0.2 Hz, intensity ⫽ 5 mA, pulse width ⫽ 330 msec). At 6-month intervals, GI symptoms were assessed by symptom interview (5 point scale, 0 – 4) and quality of life (QOL) was evaluated using the SF-36 questionnaire. Results: Results (mean ⫾ std err) are shown in table below. Vomiting and nausea severity scores were significantly improved at 6 and 12 months compared to baseline scores. Physical and Mental Component Summary (PCS and MCS) QOL scores also improved significantly at 6 months. Gastric retention was not improved. Key therapy-related complications were infections (4X) at the implant site resulting in surgical removal of the device in one patient. Conclusions: Chronic high frequency GES therapy significantly improved GI symptoms (nausea and vomiting) and QOL in diabetic, idiopathic, and post gastric-surgery GP patients with an acceptable safety profile. These data together with an earlier report (GE 120(5):A98), indicate that GET represents a major advance in treating medically refractory gastroparesis. .
Vomiting Severity Nausea Severity PCS MCS GET (%) 2 hr GET (%) 4 hr * p ⬍.05 vs baseline
Baseline (48)
6 Months (n)
12 Months (n)
3.1 ⫾ .18 3.6 ⫾ .09 23.5 ⫾ 1.06 36.6 ⫾ 1.63 63.8 ⫾ 3.6 38.1 ⫾ 3.9
0.9* ⫾ .29 (19) 1.8* ⫾ .33 (19) 32.7* ⫾ 3.0 (16) 50.4* ⫾ 3.2 (16) 60.7 ⫾ 7.5 (15) 32.9 ⫾ 7.4 (15)
1.4* ⫾ .54 (10) 1.7* ⫾ .54 (10) 27.0 ⫾ 4.8 (7) 46.8 ⫾ 3.0 (7) 85.5 ⫾ 4.6 (6) 59.8 ⫾ 8.9 (6)
144 Evaluation of gastric emptying in portal hypertensive patients using ultrasonography Ayman Y Abdel-Rahim MD, Hisham I Makhzangy MD, Magdy M Mourad MD and Abul Dahab M El-Sahly MD*. 1Department of Tropical Medicine, Gastrointesinal Endoscopy & Liver Unit, Cairo University, Cairo, Egypt; and 2Pathology Department, Cairo University, Cairo, Egypt. Purpose: The aim of this study was to investigate the rate of gastric emptying of portal hypertensive patients and whether alterations in gastric emptying are related to portal hypertensive gastropathy and various clinical, sonographic, endoscopic and histopathologic parameters. Methods: One hundred patients with portal hypertension due to schistosomal hepatic fibrosis (14), cirrhosis (70), or both (16) in addition to 20 age and sex mathched healthy controls were enrolled in this study. The gastric emptying time (GET) was measured by ultrasonography using a liquid meal. Results: The GET was significantly delayed in portal hypertensive patients compared to controls (54.07 ⫾ 32.53 Vs 24.45 ⫾ 12.73 min, p ⬍ 0.05). This delay in GET in portal hypertensive patients seems to be related to the degree of hepatocellular dysfunction: the GET was significantly longer in ascitic than non-ascitic patients (67.67 ⫾ 32.75 Vs 49.26 ⫾ 31.53 min, p ⬍ 0.05) and in patients with shrunken livers compared to those with normal sized livers (72 ⫾ 40.65 Vs 43.66 ⫾ 28.98 min p ⬍ 0.05) and in patients with Child’s grade B & C patients compared to grade A patients (68.44 ⫾ 35.97 Vs 50.54 ⫾ 32.12 min, p ⬍ 0.05). No significant difference in GET was observed between the different grades of endoscopic portal hypertensive gastropathy and between those with portal hypertensive gastropathy and normal gastric mucosa. However, the GET was significantly delayed in patients with histologic congestive gastropathy comapred to those with histologic gastritis (58.26 ⫾ 33.95 Vs 39.78 ⫾ 17.77, p ⬍ 0.05).
S47
Conclusions: Gastric emptying is delayed in portal hypertensive patients and this delay seems to be related to the severity of liver disease and the presence of histologic congestive gastropathy. 145 Silent peptic ulcer disease in the elderly patients Abbasi J. Akhtar, MD, FACG*. 1Internal Medicine, King-Drew Medical Center, Los Angeles, California, United States. Purpose: Precise pathogenesis of pain in peptic ulcer disease (PUD) is incompletely understood. Sometimes the first manifestation of PUD may be one of its complications, such as bleeding or perforation. This study was conducted, at an inner city community teaching hospital, to determine frequency of painless PUD in the elderly population and its comparison with the younger age group. Methods: Records of 390 patients, 29 to 95 years of age with endoscopic and/or radiological diagnosis of PUD were reviewed retrospectively. Presence or absence of pain, and use of non-steroidal anti-inflammatory drugs (NSAIDs) were recorded. Patients were stratified according to the age group and sex: 29 – 65 yrs (Group I), 168 patients (98 males, 70 females), 66 – 80 yrs (Group II) 130 patients (70 males, 60 females) and 80 –95 yrs (Group III) 92 patients (47 males, 45 females). Frequency of pain in PUD was determined and the data were analyzed. Results: Endoscopy was performed in 360 patients (92%). In 30 patients (8%), the diagnosis was made by upper gastrointestinal barium studies. Patient characteristics, regarding absence of pain are shown in the following table.
Male Female NSAID
Group I
Group II
Group III
16 (10%) 12 (7%) 15 (9%)
26 (20%) 31 (24%) 35 (27%)
23 (25%) 28 (30%) 39 (42%)
Conclusions: Our study confirms earlier observations that painless PUD is common in the elderly, its incidence increases with aging in both sexes, more so in women. NSAIDs consumption significantly increases the incidence of painless PUD. 146 Laparoscopy significantly shortens length of stay in patients undergoing placement of gastric electrical stimulators for gastroparesis Stepahanie Granger2, James Barnes2, Amar Al-Juburi1, Guy Voeller3, Derrick Beech3, Hosein Amiri3 and Thomas L Abell1*. 1Department of Medicine, The University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States; 2Department of Surgery, The University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States; and 3Department of Surgery, UT-Memphis, Memphis, Tennessee, United States. Purpose: Placement of Gastric Electrical Stimulators (GES) for the symptoms of Gastroparesis(GP) has been performed by laparotomy, with varying hospital stays; the introduction of laparascopy offers the potential for shorter hospitalizations. We compared the operative times (OT) and length of stays (LOS) of 7 consecutive patients (pts) undergoing laparoscopic GES placement (OSCOPY), matched with pts undergoing GES placement by laparotomy (OTOMY). Methods: OT and LOS were determined for 7 consecutive pts (1m 6f mean age 37.7 yrs) undergoing OSCOPY for a GES device, an implantable neuromuscular stimulator (Medtronic Itrel 3) programmed as follows: 330 microsec, 12 bpm, with 5 mAmp of current. Gastric serosal electrodes were placed near the body-antral junction and the device was placed in a subcutaneous pocket. Pts had GP etiologies of: 2 DM, 1 post-surgical and 4 idiopathic disease, and were compared with 7 patients undergoing laparotomy (OTOMY) for a device, matched for primary diagnosis, surgical history, and overall degree of illness with an ADAPS score, which quantify
Abstracts
classified as Barrett’s Esophagus. Our research captured both long (ⱖ3cm) segment BE and short segment (⬍3cm) BE. At Mayo Clinic Rochester, patients consulting the Gastroenterology and Hepatology, Medical Oncology and Thoracic Surgery Division, with a diagnosis of BE and/or esophageal ACA were identified, and asked to list first-degree relatives. Patient demographics, clinical information, and a validated Reflux Symptoms Questionnaire (RSQ) were collected. Medical release was received and BE diagnosis was confirmed by review of slides and endoscopic reports from all relatives endoscoped in the past. Relatives not previously investigated were asked to present for endoscopy. At other collaborating Institutions, primary physicians referred high prevalence BE families. Results: To date, 462 families were identified. 246 of 462 (53%) BE index patients agreed to participate, listing all first degree relatives. 961 of 1490 (65%) adult living relatives completed RSQ’s and medical release forms after one contact. 120 outside endoscopy reports and pathology slides were reviewed. 244 patients were scoped at Mayo. 39 of 246 (16%) families have been identified as having multiple occurrences of BE or BE with ACA. Among the 246 participating families, 28 had 2 members with BE, 9 families had 3 members, and 2 families had 4 or more members with BE. Conclusions: Barrett’s Esophagus aggregates in families. This group effort is the first step towards genetic linkage analysis aimed at localizing susceptibility loci in familial Barrett’s Esophagus.
141 A post-genomic strategy for the positional cloning of the gene for Severe pediatric GERD Fen Ze Hu, M.S., Robert A. Preston, Ph.D., Sandra Johnson, B.S., Azad Ahmed, M.D., John Gladitz, Ph.D., and J. Christopher Post, M.D. Allegheny Singer Research Institute, Pittsburgh, PA, United States. A strategy has been developed and implemented based upon the availability of the complete human genomic sequence to positionally clone the gene for pediatric GERD. We had previously mapped a gene for pediatric GERD to a 9 cM region on chromosome 13q14, but analyses of several potential candidate genes within this region failed to identify any mutations that could be etiologically associated with the disease. Thus, a positional cloning approach was developed for the entire linkage region. Prior to the availability of the human genome sequence, a 9 cM region would have been considered much too large for a brute-force positional cloning approach. However, utilizing the annotated human genomic DNA databases we were able to determine that the linkage region was actually only 6 cM suggesting a higher than average rate of meiotic crossover in thus region than would be expected. We have identified 21 genes (composed of 151 exons); 19 spliced ESTs; and 88 unspliced ESTs within the linkage region. To identify which of these genes contains GERD-specific mutations we have developed a four phase approach. The first phase is the identification of all exons for all known genes and ESTs followed sequentially by an analysis of: 2) the 3⬘ untranslated regions (3⬘ UTRs); 3) the introns; and finally 4) the promoter regions. For each of the four phases the initial step is PCRsequencing primer design, followed by quality control of the primers, and optimization for each primer pair that fails QC. During the course of this study we have developed efficient high throughput methods for each of these laboratory parameters and have, through incremental process development, increased our success rate for primer QC on the first pass from 70 to over 90%. Systems have been developed that permit in 2 days the: 1) the QC analysis of 100 primer pairs; and the optimization of 50 primer pairs that are evaluated under 12 conditions. Next each of the validated primer pairs are used in the PCR-sequencing of 5 affected persons, 1 from each of five GERD families and three controls with current throughput of 108 independent sequences/day. Heterozygote screening of the DNA sequence data for all of the known gene and EST exons is nearly complete and primers have been developed for all of the 3⬘UTRs. It is anticipated that all known, and in silico-identified genes will be evaluated in their entirety within the next six months which should yield the gene for severe pediatric GER.
AJG – Vol. 96, No. 9, Suppl., 2001
STOMACH 142 Gastric electrical stimulation improves both GI symptoms and gastric emptying in patients with post-surgical gastroparesis Thomas L Abell1*, Jean Luo2, Guy Voeller2, Derrick Beech 2, Hossein Amiri2 and Paula Eaton2. 1U of TN, Memphis, TN, United States; and 2 U of AR, Little Rock, AR, United States. Purpose: Post surgical gastroparesis patients unresponsive to medications remain one of the most difficult groups of patients with gastric motor disorders. Although some patients appear to improve over time, others do not, and often do not respond to antiemetic and prokinetic medications. Gastric Electrical Stimulation (GES) has shown promise for patients with idiopathic and diabetic gastroparesis. To investigate its clinical usefullness, we have applied gastric electrical stimulation for a group of patients with surgery-related gastric motor disorders. Methods: We studied 9 patients, a subset of the GEMS and WAVESS trials, 2m, 7f, mean age 42 yrs, who had ‘surgery-related’ gastroparesis, of long duration (mean 5.8 years). These patients had a variety gastrointestinal surgical procedures, such as gastrojejunostomy, partial gastrectomy, Nissen fundoplication, vagotomy, and pyloroplasty; 3 pts had symptoms, which had predated their surgery. Patients were evaluated for symptoms by Total Symptom Score (TSS:nausea, vomiting, bloating, abdominal pain and anorexia), weekly vomiting frequency (WVF) and gastric emptying (GET) at baseline, 3, 6, and 12 months post gastric electrical stimulation device implantation. GES stimulation electrodes were placed in the distal stomach remnant, and the device (Itrel, Medtronic), was programmed for high frequency, low energy settings as previously reported(GE 112(4) A735, 1997). Results were compared by paired t-tests and were reported as mean ⫾SE. Results: All patients noted a significant reduction in TSS and WVF, and an improvement in 2hrs solid GET. Baseline
3 Months
6 Months
12 Months
TSS
40.3 ⫾ 2.2
WVF
24.1 ⫾ 11.4
GET (2 hr solid)
69.5 ⫾ 12.5
19.8 ⫾ 4.6 (p ⬍ 0.002) 6.9 ⫾ 5.0 (p ⬍ 0.05) 66.5 ⫾ 16.7 (p ⬎ 0.3)
10.1 ⫾ 3.4 (p ⬍ 0.001) 0.4 ⫾ 0.3 (p ⬍ 0.05) 50.0 ⫾ 16.1 (p ⫽ 0.218)
22.6 ⫾ 5.7 (p ⬍ 0.05) 4.3 ⫾ 2.7 (p ⬍ 0.05) 52.5 ⫾ 11.8 (p ⫽ 0.155)
Conclusions: We conclude that in this group of surgery-related, or postsurgical, gastroparesis patients, gastric electrical stimulation shows significant improvement in both total GI symptoms and vomiting frequency, with an improvement in gastric emptying, all of which are sustained over time. GES deserves further investigation in controlled trials in pts with postsurgical gastric motor disorders. Supported in part by Medtronic.
143 Results of long-term gastric electrical stimulation (GES) for treatment of gastroparesis refractory to standard medical therapy Richard McCallum, MD1*, Irene Sarosiek, MD1, Zhiyue Lin, PhD1, Jameson Forster, MD1, Thomas Abell, MD2, Hani Rashed, PhD4, Paula Eaton, RN3, Lesa Gann, RoN2 and Warren Starkebaum, PhD3. 1 University of Kansas, Kansas City, KS; 2University of Arkansas, Little Rock, AR; 3Medtronic, Inc., Minneapolis, MN; and 4University of Tennessee, Memphis, TN. Purpose: The objective of this study was to evaluate the long-term efficacy of high frequency gastric electrical stimulation for gastroparesis (GP) in an open label Compassionate Use Electrical Stimulation Study (CUESS). Preliminary results at 6 and 12 months are reported here. Methods: 48 patients with chronic GP were enrolled from 2 centers [22 diabetic (8M, 14F), 19 idiopathic (2M, 17F), and 7 post surgical (1M, 6F)]; mean overall age was 40.8 years. Entry criteria were ⱖ 7 episodes/week of
AJG – September, Suppl., 2001
Abstracts
vomiting or nausea, delayed gastric emptying (GET) at 4 hours determined by standardized scintigraphic techniques, and refractoriness to prokinetic and antiemetic therapy. Chronic high frequency GES therapy was administered for 12 months via electrodes implanted by laparotomy in the muscle wall of the antrum 10 cm from the pylorus and connected to an implanted stimulator placed in the abdominal wall (frequency ⫽ 0.2 Hz, intensity ⫽ 5 mA, pulse width ⫽ 330 msec). At 6-month intervals, GI symptoms were assessed by symptom interview (5 point scale, 0 – 4) and quality of life (QOL) was evaluated using the SF-36 questionnaire. Results: Results (mean ⫾ std err) are shown in table below. Vomiting and nausea severity scores were significantly improved at 6 and 12 months compared to baseline scores. Physical and Mental Component Summary (PCS and MCS) QOL scores also improved significantly at 6 months. Gastric retention was not improved. Key therapy-related complications were infections (4X) at the implant site resulting in surgical removal of the device in one patient. Conclusions: Chronic high frequency GES therapy significantly improved GI symptoms (nausea and vomiting) and QOL in diabetic, idiopathic, and post gastric-surgery GP patients with an acceptable safety profile. These data together with an earlier report (GE 120(5):A98), indicate that GET represents a major advance in treating medically refractory gastroparesis. .
Vomiting Severity Nausea Severity PCS MCS GET (%) 2 hr GET (%) 4 hr * p ⬍.05 vs baseline
Baseline (48)
6 Months (n)
12 Months (n)
3.1 ⫾ .18 3.6 ⫾ .09 23.5 ⫾ 1.06 36.6 ⫾ 1.63 63.8 ⫾ 3.6 38.1 ⫾ 3.9
0.9* ⫾ .29 (19) 1.8* ⫾ .33 (19) 32.7* ⫾ 3.0 (16) 50.4* ⫾ 3.2 (16) 60.7 ⫾ 7.5 (15) 32.9 ⫾ 7.4 (15)
1.4* ⫾ .54 (10) 1.7* ⫾ .54 (10) 27.0 ⫾ 4.8 (7) 46.8 ⫾ 3.0 (7) 85.5 ⫾ 4.6 (6) 59.8 ⫾ 8.9 (6)
144 Evaluation of gastric emptying in portal hypertensive patients using ultrasonography Ayman Y Abdel-Rahim MD, Hisham I Makhzangy MD, Magdy M Mourad MD and Abul Dahab M El-Sahly MD*. 1Department of Tropical Medicine, Gastrointesinal Endoscopy & Liver Unit, Cairo University, Cairo, Egypt; and 2Pathology Department, Cairo University, Cairo, Egypt. Purpose: The aim of this study was to investigate the rate of gastric emptying of portal hypertensive patients and whether alterations in gastric emptying are related to portal hypertensive gastropathy and various clinical, sonographic, endoscopic and histopathologic parameters. Methods: One hundred patients with portal hypertension due to schistosomal hepatic fibrosis (14), cirrhosis (70), or both (16) in addition to 20 age and sex mathched healthy controls were enrolled in this study. The gastric emptying time (GET) was measured by ultrasonography using a liquid meal. Results: The GET was significantly delayed in portal hypertensive patients compared to controls (54.07 ⫾ 32.53 Vs 24.45 ⫾ 12.73 min, p ⬍ 0.05). This delay in GET in portal hypertensive patients seems to be related to the degree of hepatocellular dysfunction: the GET was significantly longer in ascitic than non-ascitic patients (67.67 ⫾ 32.75 Vs 49.26 ⫾ 31.53 min, p ⬍ 0.05) and in patients with shrunken livers compared to those with normal sized livers (72 ⫾ 40.65 Vs 43.66 ⫾ 28.98 min p ⬍ 0.05) and in patients with Child’s grade B & C patients compared to grade A patients (68.44 ⫾ 35.97 Vs 50.54 ⫾ 32.12 min, p ⬍ 0.05). No significant difference in GET was observed between the different grades of endoscopic portal hypertensive gastropathy and between those with portal hypertensive gastropathy and normal gastric mucosa. However, the GET was significantly delayed in patients with histologic congestive gastropathy comapred to those with histologic gastritis (58.26 ⫾ 33.95 Vs 39.78 ⫾ 17.77, p ⬍ 0.05).
S47
Conclusions: Gastric emptying is delayed in portal hypertensive patients and this delay seems to be related to the severity of liver disease and the presence of histologic congestive gastropathy. 145 Silent peptic ulcer disease in the elderly patients Abbasi J. Akhtar, MD, FACG*. 1Internal Medicine, King-Drew Medical Center, Los Angeles, California, United States. Purpose: Precise pathogenesis of pain in peptic ulcer disease (PUD) is incompletely understood. Sometimes the first manifestation of PUD may be one of its complications, such as bleeding or perforation. This study was conducted, at an inner city community teaching hospital, to determine frequency of painless PUD in the elderly population and its comparison with the younger age group. Methods: Records of 390 patients, 29 to 95 years of age with endoscopic and/or radiological diagnosis of PUD were reviewed retrospectively. Presence or absence of pain, and use of non-steroidal anti-inflammatory drugs (NSAIDs) were recorded. Patients were stratified according to the age group and sex: 29 – 65 yrs (Group I), 168 patients (98 males, 70 females), 66 – 80 yrs (Group II) 130 patients (70 males, 60 females) and 80 –95 yrs (Group III) 92 patients (47 males, 45 females). Frequency of pain in PUD was determined and the data were analyzed. Results: Endoscopy was performed in 360 patients (92%). In 30 patients (8%), the diagnosis was made by upper gastrointestinal barium studies. Patient characteristics, regarding absence of pain are shown in the following table.
Male Female NSAID
Group I
Group II
Group III
16 (10%) 12 (7%) 15 (9%)
26 (20%) 31 (24%) 35 (27%)
23 (25%) 28 (30%) 39 (42%)
Conclusions: Our study confirms earlier observations that painless PUD is common in the elderly, its incidence increases with aging in both sexes, more so in women. NSAIDs consumption significantly increases the incidence of painless PUD. 146 Laparoscopy significantly shortens length of stay in patients undergoing placement of gastric electrical stimulators for gastroparesis Stepahanie Granger2, James Barnes2, Amar Al-Juburi1, Guy Voeller3, Derrick Beech3, Hosein Amiri3 and Thomas L Abell1*. 1Department of Medicine, The University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States; 2Department of Surgery, The University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States; and 3Department of Surgery, UT-Memphis, Memphis, Tennessee, United States. Purpose: Placement of Gastric Electrical Stimulators (GES) for the symptoms of Gastroparesis(GP) has been performed by laparotomy, with varying hospital stays; the introduction of laparascopy offers the potential for shorter hospitalizations. We compared the operative times (OT) and length of stays (LOS) of 7 consecutive patients (pts) undergoing laparoscopic GES placement (OSCOPY), matched with pts undergoing GES placement by laparotomy (OTOMY). Methods: OT and LOS were determined for 7 consecutive pts (1m 6f mean age 37.7 yrs) undergoing OSCOPY for a GES device, an implantable neuromuscular stimulator (Medtronic Itrel 3) programmed as follows: 330 microsec, 12 bpm, with 5 mAmp of current. Gastric serosal electrodes were placed near the body-antral junction and the device was placed in a subcutaneous pocket. Pts had GP etiologies of: 2 DM, 1 post-surgical and 4 idiopathic disease, and were compared with 7 patients undergoing laparotomy (OTOMY) for a device, matched for primary diagnosis, surgical history, and overall degree of illness with an ADAPS score, which quantify