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Su1081 Which Is the Best Cut-off to Define Ineffective Esophageal Motility?
by the Chicago group, using 10 liquid swallows of 5 mL of water. We used the classification criteria of Chicago v3.0 and EGJ was classified into the 3 suggested subtypes: type I, type II and type III. BMI was calculated and patients were classified into: 1) normal (BMI <25), 2) overweight (BMI 25 to 29.9) and 3) obesity (BMI> 30). Results: Of the 174 patients, 102 were women (59%) and the mean age was 45.8 ± 15 years (range 18-83). Sixty-three (36.2%) had a normal BMI, 73 (42%) overweight and 38 (21.8%) obesity. Ninety-three patients (53.4%) had a EGJ type I, 49 (28.2%) type II and 32 (18.4%) a type III. Of the 38 patients with obesity, 66% (n = 25) had obesity grade I, 26% (n = 10) obesity grade II and 8% (n = 3) obesity grade III. There was a statistically significant difference between mean BMI according to the different types of union; the mean BMI was 25.9 ± 5 in type I, 27 ± 4 in type II and 29.2 ± 4 in type III (p = 0.005). Likewise, a statistically significant correlation between BMI and type of union (correlation coefficient 0.65, p = 0.02) was found. 85% of patients with type III were overweight or obese compared to 55% of patients with type I (p = 0.023, Figure). The odds ratio for overweight and obesity associated with a type III EGJ was 3.59 (1.3-9.87). There was no difference between the prevalence of type III union and 3 different degrees of obesity (50% vs 25% vs 25%, p = 0.12) Conclusions: Overweight and obese patients have a higher frequency of EGJ morphology that suggest the presence of HH. According to this study, having a higher BMI is considered a risk factor for HH diagnosed by HRM.
Su1081 Which Is the Best Cut-off to Define Ineffective Esophageal Motility? Nicola de Bortoli, Salvatore Tolone, Irene Martinucci, Marzio Frazzoni, Leonardo Frazzoni, Manuele Furnari, Salvatore Russo, Lorenzo Bertani, Lidia Surace, Massimo Bellini, Vincenzo Savarino, Santino Marchi, Edoardo Savarino
Su1083 Effect of a Carbonated Beverage on Transient Lower Esophageal Sphincter Relaxations (TLESR). A Study in Healthy Volunteers Mercedes Amieva-Balmori, Paulo Cesar Gomez-Castaños, Shareni Galvez-Rios, Ana D. Cano Contreras, Olivia Rascon Sosa, Enrique Perez-Luna, Federico B. Roesch Dietlen, Arturo Meixueiro, Jose M. Remes Troche
Background and Aims: The last version (3.0) of Chicago Classification took an arbitrary decision and defined ineffective esophageal motility (IEM) when 50% or more wet swallows (WS) result failed (DCI<100 mmHg/cm/s) or weak (100
Introduction: There is evidence that the consumption of carbonated beverages ("soda") can induce and / or increase the symptoms associated with gastroesophageal reflux disease. Our group previously demonstrated that the consumption of carbonated beverages induces a greater number of episodes of non-acid reflux. TLESRs are mainly triggered by the proximal stomach distension and in some cases are associated with retrograde escape of gas form the stomach into the esophagus, causing gastric belching ("belching reflex"). The effect of consumption of carbonated drinks on TLESRs is not known. Aim To evaluate the effect of consumption of a carbonated beverage during a standard meal on TLESRs and esophageal symptoms. Material and Methods: High resolution esophageal manometry (HREM) with Impedance was performed in 20 healthy volunteers in two consecutive days. With the patient fasting, sitting at 90 °, a 36 sensors probe (Hand Scan-Z, Sierra Scientific) was placed and the standard Chicago protocol was performed (10swallows of 5ml water). Then, the volunteers ate a standardized breakfast accompanied with 250ml of fresh fruit smoothie (strawberry) on day one, and the next day, the same protocol was repeated but the drink was a 250ml carbonated beverage (Coca Cola). Recoding time was 90 minutes after finish of the breakfast and it was analyzed using the Manoview, Software. We analyze and quantified the number of TLESR, the % of TLESR associated with belching, # of gastric belching and supragastric belching after each breakfast (day 1 and day 2). TLESR was defined according to these criteria (Roman S, et al DDW 2015): a) presence of a spontaneous fall of LES pressure in the absence of 4 seconds before swallowing or 2 seconds after the start of relaxation; b) inhibition of diaphragmatic crura. A comparative analysis between the results obtained with each breakfast was performed. Results: We included 20 healthy controls, 13 women and 6 men (mean age 32 ± 12 years, BMI 25. 3 ± 3.1). The carbonated beverage intake increased the number and percentage of inducing belching TLESR (p <0.05), # of belching (p <0.05) and % of supragastric belching (p <0.05) (see Table). There was no difference regarding the number of reflux detected by impedance and heartburn among the 2 breakfasts evaluated. Conclusions: Carbonated beverage consumption increases the number of TLESR associated to belching and most of these are gastric. Excessive gastric belching may be a co-factor in the perception of symptomatic GERD. Based on these results it is advisable to avoid drinking carbonated beverages with food in subjects suffering from belching.
Su1082 Types of Esophagogastric Junction (EGJ) According to Chicago Classification and Its Relationship With Body Mass Index (BMI) Paulo Cesar Gomez-Castaños, Marina Nuñez-Floriano, Mercedes Amieva-Balmori, Enrique Perez-Luna, Shareni Galvez-Rios, Job Reyes-Huerta, Jose M. Remes Troche Background: Esophageal high-resolution manometry (HRM) allows a better topographical evaluation of the esophagogastric junction (EGJ) and its two major components, the lower esophageal sphincter (LES) and the crural diaphragm (CD). It has been shown that the HRM has high sensitivity and specificity (92% and 95%) for the diagnosis of hiatal hernia (HH). According to the Chicago classification v3.0 the EJG is categorized in 3 types (I,II,III), with type III morphology being a hallmark for HH. Previous studies have reported that a body mass index (BMI) >25 is a risk factor for HH. However, no previous studies have evaluated the relationship between the types of EGJ and BMI using HRM. Aim: To evaluate whether there is an association between the types of EGJ and BMI, trying to establish whether overweight and obesity are associated with the increased probability of HH. Materials and methods: We evaluated all the consecutive patients referred for HRM (n = 174) in our Laboratory, from January 2014 to May 2015. All patients underwent a HRM using a 36 solid state sensors probe (Given Imaging, Yoqneam, Israel) following the protocol established
S-463
AGA Abstracts
AGA Abstracts
endoscopy-negative patients with heartburnand compare the characteristics of reflux episodes and minimal changes of esophageal mucosa between NERD and FH. Methods:This is a retrospective cohort study of patients with heartburn in our Endoscopy Unit. A prospectively maintained database of MII-pH and endoscopy performance from Jan 2010 to Dec 2014 was assessed. Patients without any mucosal break at white light endoscopy and abnormal esophageal acid exposure at 24-h MII-pH were determined NERD. FH was defined as without any mucosal break at white light endoscopy, normal oesophageal acid exposure and negative symptom reflux association analysis (symptom index (SI) <50%, symptom association probability (SAP) <95%) at 24-h MII-pH monitoring. Six endoscopic criteria were used for assessing minimal changes in the esophagogastric junction: erythema, edema, irregular or blurring of the Z-line, friability, and white mucosal turbidity. Presence of at least one of the minimal changes was considered positive HRE performance. Results:A total of 126 consecutive patients with heartburn negative were found no esophagealmucosal erosions in white light endoscopy. Of them, 35 patients were with increased acid exposure time (AET) and SAP/ SI + (NERD) (19 males 46%, 46.7±12.5 year, range 33- 58 years), 12 were with normal AET and SAP/SI - (FH) (6 males, 50 %, 45.3±13.4 year, range 32- 61 years). When compared to FH, NERD patients had a significantly increased number of total and acid reflux episodes (p < 0.01), but had similar number of weakly acidic reflux and gas episodes (p < 0.01). The rate of proximal reflux episodes in NERD was higher than in FH (51.4% vs 25%, p < 0.01). Irregular or blurring of the Z-line and white mucosal turbidity were the most common endoscopic findings of minimal changes in this study. The frequency of minimal changes was higher in the NERD group than that in the FH group (62.9% and 16.7%, respectively) (P= 0.008). The combinations of increased reflux episodes and minimal changes had a specificity of 95 % in the diagnosis of NERD patients from those with heartburn. Conclusions:There is large overlap of NERD and FH in patients with heartburn andconventional endoscopy -negative. The combinations of 24-h MII-pH monitoring and HRE could distinguish patients with NERD from those with FH.
Su1081 Which Is the Best Cut-off to Define Ineffective Esophageal Motility? Nicola de Bortoli, Salvatore Tolone, Irene Martinucci, Marzio Frazzoni, Leonardo Frazzoni, Manuele Furnari, Salvatore Russo, Lorenzo Bertani, Lidia Surace, Massimo Bellini, Vincenzo Savarino, Santino Marchi, Edoardo Savarino
Su1083 Effect of a Carbonated Beverage on Transient Lower Esophageal Sphincter Relaxations (TLESR). A Study in Healthy Volunteers Mercedes Amieva-Balmori, Paulo Cesar Gomez-Castaños, Shareni Galvez-Rios, Ana D. Cano Contreras, Olivia Rascon Sosa, Enrique Perez-Luna, Federico B. Roesch Dietlen, Arturo Meixueiro, Jose M. Remes Troche
Background and Aims: The last version (3.0) of Chicago Classification took an arbitrary decision and defined ineffective esophageal motility (IEM) when 50% or more wet swallows (WS) result failed (DCI<100 mmHg/cm/s) or weak (100
Introduction: There is evidence that the consumption of carbonated beverages ("soda") can induce and / or increase the symptoms associated with gastroesophageal reflux disease. Our group previously demonstrated that the consumption of carbonated beverages induces a greater number of episodes of non-acid reflux. TLESRs are mainly triggered by the proximal stomach distension and in some cases are associated with retrograde escape of gas form the stomach into the esophagus, causing gastric belching ("belching reflex"). The effect of consumption of carbonated drinks on TLESRs is not known. Aim To evaluate the effect of consumption of a carbonated beverage during a standard meal on TLESRs and esophageal symptoms. Material and Methods: High resolution esophageal manometry (HREM) with Impedance was performed in 20 healthy volunteers in two consecutive days. With the patient fasting, sitting at 90 °, a 36 sensors probe (Hand Scan-Z, Sierra Scientific) was placed and the standard Chicago protocol was performed (10swallows of 5ml water). Then, the volunteers ate a standardized breakfast accompanied with 250ml of fresh fruit smoothie (strawberry) on day one, and the next day, the same protocol was repeated but the drink was a 250ml carbonated beverage (Coca Cola). Recoding time was 90 minutes after finish of the breakfast and it was analyzed using the Manoview, Software. We analyze and quantified the number of TLESR, the % of TLESR associated with belching, # of gastric belching and supragastric belching after each breakfast (day 1 and day 2). TLESR was defined according to these criteria (Roman S, et al DDW 2015): a) presence of a spontaneous fall of LES pressure in the absence of 4 seconds before swallowing or 2 seconds after the start of relaxation; b) inhibition of diaphragmatic crura. A comparative analysis between the results obtained with each breakfast was performed. Results: We included 20 healthy controls, 13 women and 6 men (mean age 32 ± 12 years, BMI 25. 3 ± 3.1). The carbonated beverage intake increased the number and percentage of inducing belching TLESR (p <0.05), # of belching (p <0.05) and % of supragastric belching (p <0.05) (see Table). There was no difference regarding the number of reflux detected by impedance and heartburn among the 2 breakfasts evaluated. Conclusions: Carbonated beverage consumption increases the number of TLESR associated to belching and most of these are gastric. Excessive gastric belching may be a co-factor in the perception of symptomatic GERD. Based on these results it is advisable to avoid drinking carbonated beverages with food in subjects suffering from belching.
Su1082 Types of Esophagogastric Junction (EGJ) According to Chicago Classification and Its Relationship With Body Mass Index (BMI) Paulo Cesar Gomez-Castaños, Marina Nuñez-Floriano, Mercedes Amieva-Balmori, Enrique Perez-Luna, Shareni Galvez-Rios, Job Reyes-Huerta, Jose M. Remes Troche Background: Esophageal high-resolution manometry (HRM) allows a better topographical evaluation of the esophagogastric junction (EGJ) and its two major components, the lower esophageal sphincter (LES) and the crural diaphragm (CD). It has been shown that the HRM has high sensitivity and specificity (92% and 95%) for the diagnosis of hiatal hernia (HH). According to the Chicago classification v3.0 the EJG is categorized in 3 types (I,II,III), with type III morphology being a hallmark for HH. Previous studies have reported that a body mass index (BMI) >25 is a risk factor for HH. However, no previous studies have evaluated the relationship between the types of EGJ and BMI using HRM. Aim: To evaluate whether there is an association between the types of EGJ and BMI, trying to establish whether overweight and obesity are associated with the increased probability of HH. Materials and methods: We evaluated all the consecutive patients referred for HRM (n = 174) in our Laboratory, from January 2014 to May 2015. All patients underwent a HRM using a 36 solid state sensors probe (Given Imaging, Yoqneam, Israel) following the protocol established
S-463
AGA Abstracts
AGA Abstracts
endoscopy-negative patients with heartburnand compare the characteristics of reflux episodes and minimal changes of esophageal mucosa between NERD and FH. Methods:This is a retrospective cohort study of patients with heartburn in our Endoscopy Unit. A prospectively maintained database of MII-pH and endoscopy performance from Jan 2010 to Dec 2014 was assessed. Patients without any mucosal break at white light endoscopy and abnormal esophageal acid exposure at 24-h MII-pH were determined NERD. FH was defined as without any mucosal break at white light endoscopy, normal oesophageal acid exposure and negative symptom reflux association analysis (symptom index (SI) <50%, symptom association probability (SAP) <95%) at 24-h MII-pH monitoring. Six endoscopic criteria were used for assessing minimal changes in the esophagogastric junction: erythema, edema, irregular or blurring of the Z-line, friability, and white mucosal turbidity. Presence of at least one of the minimal changes was considered positive HRE performance. Results:A total of 126 consecutive patients with heartburn negative were found no esophagealmucosal erosions in white light endoscopy. Of them, 35 patients were with increased acid exposure time (AET) and SAP/ SI + (NERD) (19 males 46%, 46.7±12.5 year, range 33- 58 years), 12 were with normal AET and SAP/SI - (FH) (6 males, 50 %, 45.3±13.4 year, range 32- 61 years). When compared to FH, NERD patients had a significantly increased number of total and acid reflux episodes (p < 0.01), but had similar number of weakly acidic reflux and gas episodes (p < 0.01). The rate of proximal reflux episodes in NERD was higher than in FH (51.4% vs 25%, p < 0.01). Irregular or blurring of the Z-line and white mucosal turbidity were the most common endoscopic findings of minimal changes in this study. The frequency of minimal changes was higher in the NERD group than that in the FH group (62.9% and 16.7%, respectively) (P= 0.008). The combinations of increased reflux episodes and minimal changes had a specificity of 95 % in the diagnosis of NERD patients from those with heartburn. Conclusions:There is large overlap of NERD and FH in patients with heartburn andconventional endoscopy -negative. The combinations of 24-h MII-pH monitoring and HRE could distinguish patients with NERD from those with FH.