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Sa1424 Quality of Life in Patients With Gastroparesis: the Impact of Gastroparesis Symptoms and Psychological Factors
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symptoms (p=0.01) and depression (p=0.002) were independently associated with QOL, and not gastroparesis symptoms (p=0.9), anxiety (p=0.1), LOC (p=0.3), gastric retention (2 hours; p=0.8, 4 hours; p=0.9), and demographic factors. CONCLUSIONS: Patients with severe symptoms of gastroparesis have more somatic symptoms and worse QOL than patients with mild gastroparesis. Somatic symptoms and depression appear to be the major determinants of reduced QOL in gastroparesis. Thus, somatization and depression are important contributors to the overall burden of gastroparesis.
AGA Abstracts
Visceral Perception in Anorexia Nervosa Patients and Its Relation to Actual Stomach Volumes Sena Kuyumcu, Dieter Menne, Oliver Goetze, Peter Boesiger, Michael Fried, Gabriella Milos, Werner Schwizer, Andreas Steingoetter Background: Patients with Anorexia Nervosa (AN) often complain about gastrointestinal symptoms after food intake. These complaints are relevant confounders during re-feeding therapy. It is not clear, if symptoms originate from disturbed interoceptive awareness or altered gastrointestinal afferent signals. We assessed visceral perception related to food intake by visual analogue scales (VAS) as a function of gastric volumes and compared results to data from healthy volunteers (HC). Methods: 33 individuals participated in this study: 17 HC (BMI 21.8±1.8 kg*m2; age 24.5±6.2 y) and 16 AN (BMI 14.3±1.2 kg*m2; age 21.6±3.8 y). Visceral perception was recorded at regular intervals during the 360 min study period. Participants were asked to rate their perception of hunger, fullness, nausea, bloating, abdominal pain, desire to eat and amount desired to eat from 0 to 10. Before and over 120 min after ingestion of a 400 kcal muffin, stomach volumes (SV) were non-invasively measured by MRI (1.5T Achieva, Philips Healthcare) using a standard protocol. AUC of nausea, bloating and pain scales were compared between groups by Mann-Whitney test and are presented as median (interquartile range). For correlation of VAS and MRI volume data, ordinal logistic regression was used and data are presented as log-odds ratio LOR [95% CI]. Correlations between scale ratings were derived using Spearman`s rank test. Results: Fullness started at lower SV (LOR 15.3 [8.6 to 22]) and had a less steep increase (LOR -0.03 [-0.04 to -0.01]) in AN. Hunger was constantly rated lower in AN and in contrast to HC was not related to SV (AN: LOR 0.00 [-0.01 to 0.01], HC: LOR -0.028 [-0.043 to -0.014]). Bloating, nausea and pain were perpetually rated higher in AN: 142.5(7.5-675) vs 0(0-22.5), 112.5(0-465) vs 0(0-11.3) and 75 (0-174) vs 0(0), all p<0.03. In addition, neither of these scales was related to any of the gastric volume data for both groups. Both groups showed correlations between scales only for hunger and desire to eat or amount desired to eat (AN: ρ=0.8 or 0.74, HC: ρ=0.88 or 0.86). No correlation was detected between any other scales. Summary& Conclusion: AN patients were less hungry and more full compared to HC. Postprandial fullness was related to SV in HC and AN, however showed different volume dependency (Figure 1). Hunger was only related to SV in HC. This confirms the abnormal attribution towards hunger feelings in AN. All scale rates, except those for hunger, proposed an increased visceral perception of AN patients. Both groups had a similar understanding of terms used in the VAS confirmed by the identical correlation pattern between the scale ratings. Therefore our data confirms that rather the misidentification of interoceptive signals as morbid symptoms, than altered gastric afferent signals, explain postprandial complaints in patients with anorexia nervosa.
Sa1425 Assessment of White Matter Tract Integrity of Brain in Cyclic Vomiting Syndrome by Diffusion Tensor Imaging Shahryar Ahmad, Erica A. Samuel, Rob Siewiec, Anna Patel, Arash Babaei, Thangam Venkatesan, Benson T. Massey, Reza Shaker Background: Cyclic vomiting syndrome (CVS) is a functional disorder characterized by recurrent episodes of vomiting and abdominal pain interspersed with symptom-free intervals. CVS is frequently associated with autonomic dysfunction and migraine headaches with no structural or functional abnormalities in the gastrointestinal tract. These features suggest the possibility that CVS may represent abnormal CNS function, possibly as a result of disturbed cerebral blood flow. Such changes have the potential to alter CNS structure, as has been observed in other functional disorders. Diffusion tensor imaging has emerged as a promising tool to evaluate the white matter tract integrity of the brain. Objective: The objective of the current study was to determine if there are any underlying white matter changes in adult patients with CVS as compared to healthy subjects. Methods: We recruited 10 righthanded patients with CVS and 10 age and sex matched healthy volunteers. The age of CVS patients ranged from 18-58 years with most patients being on tricyclic antidepressants (TCA's).GE 3.0T system was used for whole brain imaging.T1 weighted anatomical scans (SPGR) preceded DTI scans which were performed with dual spin echo protocol. Tensor was acquired with diffusion sensitizing gradient orientations along 32 directions (b=1000) along with one scan without diffusion weighing (b=0). Functional MRI of brain (FMRIB) software library FSL v4.1 was employed to process and analyze raw DTI data. FDT v2.0 of FMRIB was used to correct for eddy-current distortions. BET v2.1 was used for brain mask generation and subsequently FDT v2.0 was used to fit the tensor and compute the various measures of diffusivity of whole brain including Fractional anisotropy (FA), Mean diffusivity (MD) as well as Axial & Radial Diffusivities (AD, RD). FA target image from TBSS v1.2 was used for alignment & registration of all FA images to standard space. FA images were projected on mean FA skeleton and this was subsequently fed into voxel-wise statistics. Data for AD, RD & MD were also generated by applying FA nonlinear registration to these parametric images. Two sampled t test was used to compare these values between patients and controls using randomize v2.1 of FSL. Results: FA maps did not reveal any statistically significant difference between the two groups. Similarly other diffusivity measures including mean diffusivity, radial diffusivity and axial diffusivity did not show any statistical difference between the two groups. Conclusion: Patients with CVS in the inter-episodic phase show no detectable differences in white matter tract integrity compared to healthy subjects. Additional studies are warranted in newly diagnosed CVS patients naïve to TCA therapy.
Sa1426 Transabdominal Ultrasound to Evaluate the Gastroesophageal Junction in Normal Volunteers and Patients With GERD Anil K. Vegesna, Samuel Weissman, Anand Patel, Kian Makipour, Larry S. Miller
Sa1424 Quality of Life in Patients With Gastroparesis: the Impact of Gastroparesis Symptoms and Psychological Factors Monik Kowalczyk, Alexandra N. Modiri, Henry P. Parkman
PURPOSE: To evaluate the mechanics of swallowing at the gastroesophageal junction (GEJ) using transabdominal ultrasound (TAU). METHODS: TAU of the GEJ was performed on 13 normal volunteers and 2 patients with GERD, during swallows of 5ccs of water. The GEJ was imaged while the distance and speed of mucosal movement was measured during bolus transit. RESULTS: In normal volunteers, the layers of the esophageal and gastric wall, including the mucosa and muscularis propria, are clearly imaged during bolus transit. The mucosa starts to move proximally an average 1.75+/-0.26 seconds after the initiation of the swallow and slides over the muscularis propria for an average of 1.25 seconds before the muscularis propria starts to move at 3 seconds after the initiation of the swallow (1.75sec.+/0.26 vs. 3.00sec.+/-0.37, p<0.012). The total distance the mucosa moves forward on the lesser curve side is significantly greater than the total movement of muscularis propria in the forward direction (13.97mm+/-1.38 vs. 8.91mm+/-1.02, p<0.007). The average velocity of the mucosa moving in the forward direction is significantly greater than the average velocity of the muscularis propria moving in the forward direction (5.82mm+/-0.47 vs 3.65mm+/-0.35 p<0.001). The mucosa on the greater and lesser curve, as well as the muscularis propria, start to move backwards (back toward the stomach) at the same time point (7.72 +/-0.36 sec. for the mucosa vs. 7.66 +/-0.33sec. for the muscularis propria, p= .915). However the total backwards distance moved by the mucosa on the lesser curve was significantly greater than the total backwards movement of the muscularis propria (13.37mm+/-1.14 vs. 6.86mm+/-0.66, p<0.00007). The average velocity of the mucosa in the backwards direction was significantly greater than the average velocity of the muscularis propria in the backwards direction (7.41mm/sec+/-1.14 vs 4.02mm/sec. +/-0.84, p<0.027). The mucosa showed two temporal areas of acceleration. The first acceleration of the mucosa was completely independent of the acceleration of the muscularis propria. The second acceleration coincides with the acceleration of the muscularis propria. The angle between the esophagus and gastric wall along the lesser curvature changed from 140.85° to a maximum of 152.85°. There was no mucosal movement observed in the GERD subjects. CONCLUSION:
BACKGROUND: Gastroparesis has a significant negative impact on patient's quality of life (QOL). Coexisting psychological problems may contribute to the burden of gastroparesis. Limited information exists about psychological dysfunction in gastroparesis. AIMS: The aims of this study were to; 1) Compare psychological factors in mild and severe gastroparesis; 2) Evaluate which factors are predictive of QOL. METHODS: Newly referred patients with gastroparesis completed the following questionnaires: Gastroparesis Cardinal Symptom Index (GCSI), Patient Assessment of Upper Gastrointestinal Disorders QOL (PAGI-QOL), Hospital Anxiety and Depression Scale (HADS), and demographic profile. Somatic symptoms were assessed with Patient Health Questionnaire-15 (PHQ). Patient's locus of control (LOC) was evaluated with Multidimensional Health LOC. LOC is an extent to which individuals believe that they can control events that affect them. One's LOC can be internal (belief that one controls their life), chance (belief that higher power controls their life), others (belief that other people control their life). RESULTS: 84 patients with gastroparesis with documented delayed gastric emptying (Mean age of 42.7±1.6 years, 82.1% females, 27.3% diabetic) participated in the study. Patients with severe gastroparesis symptoms (GCSI≥3) had more somatic symptoms compared to patients with mild gastroparesis (GCSI<3) (PHQ 14.6±0.7 vs. 11.8±0.9, p=0.02), but had similar anxiety (HADS-Anxiety 8.2±0.7 vs. 8.9±0.8, p=0.5), depression (HADS-Depression 6.9±0.6 vs. 7.0±0.6, p=0.9), and LOC (Internal-LOC 21.3±0.9 vs. 21.7±1.3, p=0.8; Chance-LOC 17.5±0.7 vs. 17.4±1.3, p=0.9; Other-LOC 18.7±0.8 vs. 19.5±1.3, p=0.6) scores. Patients with severe gastroparesis had worse QOL compared to patients with mild gastroparesis (PAGI-QOL 2.2±0.1 vs. 2.8±0.2, p=0.02). There were no differences between patients with severe gastroparesis compared to mild gastroparesis with respect to demographic characteristics, gastric retention at 2 hours (53.6±3.7 vs. 47.7±5.7, p=0.37), and 4 hours (25.5±2.8 vs. 23.3±3.5, p=0.63). In multivariate analysis, somatic
AGA Abstracts
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symptoms (p=0.01) and depression (p=0.002) were independently associated with QOL, and not gastroparesis symptoms (p=0.9), anxiety (p=0.1), LOC (p=0.3), gastric retention (2 hours; p=0.8, 4 hours; p=0.9), and demographic factors. CONCLUSIONS: Patients with severe symptoms of gastroparesis have more somatic symptoms and worse QOL than patients with mild gastroparesis. Somatic symptoms and depression appear to be the major determinants of reduced QOL in gastroparesis. Thus, somatization and depression are important contributors to the overall burden of gastroparesis.
AGA Abstracts
Visceral Perception in Anorexia Nervosa Patients and Its Relation to Actual Stomach Volumes Sena Kuyumcu, Dieter Menne, Oliver Goetze, Peter Boesiger, Michael Fried, Gabriella Milos, Werner Schwizer, Andreas Steingoetter Background: Patients with Anorexia Nervosa (AN) often complain about gastrointestinal symptoms after food intake. These complaints are relevant confounders during re-feeding therapy. It is not clear, if symptoms originate from disturbed interoceptive awareness or altered gastrointestinal afferent signals. We assessed visceral perception related to food intake by visual analogue scales (VAS) as a function of gastric volumes and compared results to data from healthy volunteers (HC). Methods: 33 individuals participated in this study: 17 HC (BMI 21.8±1.8 kg*m2; age 24.5±6.2 y) and 16 AN (BMI 14.3±1.2 kg*m2; age 21.6±3.8 y). Visceral perception was recorded at regular intervals during the 360 min study period. Participants were asked to rate their perception of hunger, fullness, nausea, bloating, abdominal pain, desire to eat and amount desired to eat from 0 to 10. Before and over 120 min after ingestion of a 400 kcal muffin, stomach volumes (SV) were non-invasively measured by MRI (1.5T Achieva, Philips Healthcare) using a standard protocol. AUC of nausea, bloating and pain scales were compared between groups by Mann-Whitney test and are presented as median (interquartile range). For correlation of VAS and MRI volume data, ordinal logistic regression was used and data are presented as log-odds ratio LOR [95% CI]. Correlations between scale ratings were derived using Spearman`s rank test. Results: Fullness started at lower SV (LOR 15.3 [8.6 to 22]) and had a less steep increase (LOR -0.03 [-0.04 to -0.01]) in AN. Hunger was constantly rated lower in AN and in contrast to HC was not related to SV (AN: LOR 0.00 [-0.01 to 0.01], HC: LOR -0.028 [-0.043 to -0.014]). Bloating, nausea and pain were perpetually rated higher in AN: 142.5(7.5-675) vs 0(0-22.5), 112.5(0-465) vs 0(0-11.3) and 75 (0-174) vs 0(0), all p<0.03. In addition, neither of these scales was related to any of the gastric volume data for both groups. Both groups showed correlations between scales only for hunger and desire to eat or amount desired to eat (AN: ρ=0.8 or 0.74, HC: ρ=0.88 or 0.86). No correlation was detected between any other scales. Summary& Conclusion: AN patients were less hungry and more full compared to HC. Postprandial fullness was related to SV in HC and AN, however showed different volume dependency (Figure 1). Hunger was only related to SV in HC. This confirms the abnormal attribution towards hunger feelings in AN. All scale rates, except those for hunger, proposed an increased visceral perception of AN patients. Both groups had a similar understanding of terms used in the VAS confirmed by the identical correlation pattern between the scale ratings. Therefore our data confirms that rather the misidentification of interoceptive signals as morbid symptoms, than altered gastric afferent signals, explain postprandial complaints in patients with anorexia nervosa.
Sa1425 Assessment of White Matter Tract Integrity of Brain in Cyclic Vomiting Syndrome by Diffusion Tensor Imaging Shahryar Ahmad, Erica A. Samuel, Rob Siewiec, Anna Patel, Arash Babaei, Thangam Venkatesan, Benson T. Massey, Reza Shaker Background: Cyclic vomiting syndrome (CVS) is a functional disorder characterized by recurrent episodes of vomiting and abdominal pain interspersed with symptom-free intervals. CVS is frequently associated with autonomic dysfunction and migraine headaches with no structural or functional abnormalities in the gastrointestinal tract. These features suggest the possibility that CVS may represent abnormal CNS function, possibly as a result of disturbed cerebral blood flow. Such changes have the potential to alter CNS structure, as has been observed in other functional disorders. Diffusion tensor imaging has emerged as a promising tool to evaluate the white matter tract integrity of the brain. Objective: The objective of the current study was to determine if there are any underlying white matter changes in adult patients with CVS as compared to healthy subjects. Methods: We recruited 10 righthanded patients with CVS and 10 age and sex matched healthy volunteers. The age of CVS patients ranged from 18-58 years with most patients being on tricyclic antidepressants (TCA's).GE 3.0T system was used for whole brain imaging.T1 weighted anatomical scans (SPGR) preceded DTI scans which were performed with dual spin echo protocol. Tensor was acquired with diffusion sensitizing gradient orientations along 32 directions (b=1000) along with one scan without diffusion weighing (b=0). Functional MRI of brain (FMRIB) software library FSL v4.1 was employed to process and analyze raw DTI data. FDT v2.0 of FMRIB was used to correct for eddy-current distortions. BET v2.1 was used for brain mask generation and subsequently FDT v2.0 was used to fit the tensor and compute the various measures of diffusivity of whole brain including Fractional anisotropy (FA), Mean diffusivity (MD) as well as Axial & Radial Diffusivities (AD, RD). FA target image from TBSS v1.2 was used for alignment & registration of all FA images to standard space. FA images were projected on mean FA skeleton and this was subsequently fed into voxel-wise statistics. Data for AD, RD & MD were also generated by applying FA nonlinear registration to these parametric images. Two sampled t test was used to compare these values between patients and controls using randomize v2.1 of FSL. Results: FA maps did not reveal any statistically significant difference between the two groups. Similarly other diffusivity measures including mean diffusivity, radial diffusivity and axial diffusivity did not show any statistical difference between the two groups. Conclusion: Patients with CVS in the inter-episodic phase show no detectable differences in white matter tract integrity compared to healthy subjects. Additional studies are warranted in newly diagnosed CVS patients naïve to TCA therapy.
Sa1426 Transabdominal Ultrasound to Evaluate the Gastroesophageal Junction in Normal Volunteers and Patients With GERD Anil K. Vegesna, Samuel Weissman, Anand Patel, Kian Makipour, Larry S. Miller
Sa1424 Quality of Life in Patients With Gastroparesis: the Impact of Gastroparesis Symptoms and Psychological Factors Monik Kowalczyk, Alexandra N. Modiri, Henry P. Parkman
PURPOSE: To evaluate the mechanics of swallowing at the gastroesophageal junction (GEJ) using transabdominal ultrasound (TAU). METHODS: TAU of the GEJ was performed on 13 normal volunteers and 2 patients with GERD, during swallows of 5ccs of water. The GEJ was imaged while the distance and speed of mucosal movement was measured during bolus transit. RESULTS: In normal volunteers, the layers of the esophageal and gastric wall, including the mucosa and muscularis propria, are clearly imaged during bolus transit. The mucosa starts to move proximally an average 1.75+/-0.26 seconds after the initiation of the swallow and slides over the muscularis propria for an average of 1.25 seconds before the muscularis propria starts to move at 3 seconds after the initiation of the swallow (1.75sec.+/0.26 vs. 3.00sec.+/-0.37, p<0.012). The total distance the mucosa moves forward on the lesser curve side is significantly greater than the total movement of muscularis propria in the forward direction (13.97mm+/-1.38 vs. 8.91mm+/-1.02, p<0.007). The average velocity of the mucosa moving in the forward direction is significantly greater than the average velocity of the muscularis propria moving in the forward direction (5.82mm+/-0.47 vs 3.65mm+/-0.35 p<0.001). The mucosa on the greater and lesser curve, as well as the muscularis propria, start to move backwards (back toward the stomach) at the same time point (7.72 +/-0.36 sec. for the mucosa vs. 7.66 +/-0.33sec. for the muscularis propria, p= .915). However the total backwards distance moved by the mucosa on the lesser curve was significantly greater than the total backwards movement of the muscularis propria (13.37mm+/-1.14 vs. 6.86mm+/-0.66, p<0.00007). The average velocity of the mucosa in the backwards direction was significantly greater than the average velocity of the muscularis propria in the backwards direction (7.41mm/sec+/-1.14 vs 4.02mm/sec. +/-0.84, p<0.027). The mucosa showed two temporal areas of acceleration. The first acceleration of the mucosa was completely independent of the acceleration of the muscularis propria. The second acceleration coincides with the acceleration of the muscularis propria. The angle between the esophagus and gastric wall along the lesser curvature changed from 140.85° to a maximum of 152.85°. There was no mucosal movement observed in the GERD subjects. CONCLUSION:
BACKGROUND: Gastroparesis has a significant negative impact on patient's quality of life (QOL). Coexisting psychological problems may contribute to the burden of gastroparesis. Limited information exists about psychological dysfunction in gastroparesis. AIMS: The aims of this study were to; 1) Compare psychological factors in mild and severe gastroparesis; 2) Evaluate which factors are predictive of QOL. METHODS: Newly referred patients with gastroparesis completed the following questionnaires: Gastroparesis Cardinal Symptom Index (GCSI), Patient Assessment of Upper Gastrointestinal Disorders QOL (PAGI-QOL), Hospital Anxiety and Depression Scale (HADS), and demographic profile. Somatic symptoms were assessed with Patient Health Questionnaire-15 (PHQ). Patient's locus of control (LOC) was evaluated with Multidimensional Health LOC. LOC is an extent to which individuals believe that they can control events that affect them. One's LOC can be internal (belief that one controls their life), chance (belief that higher power controls their life), others (belief that other people control their life). RESULTS: 84 patients with gastroparesis with documented delayed gastric emptying (Mean age of 42.7±1.6 years, 82.1% females, 27.3% diabetic) participated in the study. Patients with severe gastroparesis symptoms (GCSI≥3) had more somatic symptoms compared to patients with mild gastroparesis (GCSI<3) (PHQ 14.6±0.7 vs. 11.8±0.9, p=0.02), but had similar anxiety (HADS-Anxiety 8.2±0.7 vs. 8.9±0.8, p=0.5), depression (HADS-Depression 6.9±0.6 vs. 7.0±0.6, p=0.9), and LOC (Internal-LOC 21.3±0.9 vs. 21.7±1.3, p=0.8; Chance-LOC 17.5±0.7 vs. 17.4±1.3, p=0.9; Other-LOC 18.7±0.8 vs. 19.5±1.3, p=0.6) scores. Patients with severe gastroparesis had worse QOL compared to patients with mild gastroparesis (PAGI-QOL 2.2±0.1 vs. 2.8±0.2, p=0.02). There were no differences between patients with severe gastroparesis compared to mild gastroparesis with respect to demographic characteristics, gastric retention at 2 hours (53.6±3.7 vs. 47.7±5.7, p=0.37), and 4 hours (25.5±2.8 vs. 23.3±3.5, p=0.63). In multivariate analysis, somatic
AGA Abstracts
S-302