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Su1276 A Novel Method to Identify Fat Malabsorption: The Serum Vitamin A Test
presentations on a gluten containing diet and 58 were known celiac disease patients on a gluten free diet but with poor compliance. IgAD was present in 5 patients. Ability to flag IgAD sera was assessed by analysis of 27 IgAD patient sera. Specificity was calculated from 124 unselected consecutive disease control sera, comprising rheumatoid arthritis (29), inflammatory arthritis (24), other connective tissue disease or autoimmune disease (70), and other inflammation (1). Interference by high IgA in the IgA kit was assessed by analysis of 35 sera with increased IgA levels (range 310 to 3700 mg/dL) including 8 from patients with an IgA monoclonal gammopathy. 234 unselected consecutive sera for celiac screening were run prospectively in parallel with the Eurospital tTG-IgA ELISA assay. All assays were performed according to the kit manufacturers' recommendations. Manufacturer recommended cut-off of .15.0 U/mL defined positivity in all assays. Results: All IgAD sera were identified by a BioPlex® 2200 System alert flag. None of 209 sera without IgAD were flagged. Screening with tTG-IgA and adding tTG-IgG when IgAD was identified, gave clinical sensitivity of 100% for celiac disease. Amongst the high IgA sera there were no false positive tTG-IgA and one false positive DGP-IgA (22 U/mL, total IgA 410 mg/dL). Specificity was 100% for tTG-IgA & tTG-IgG, and 98% & 97% for DGP-IgA & DGP-IgG respectively. Conclusions: Use of the BioPlex® 2200 Celiac IgA and Celiac IgG kits in a standard protocol gave excellent sensitivity and specificity with highly effective detection of IgAD and little evidence of interference from high IgA levels. The ability to detect IgAD without prescreening with a separate IgA assay should have a significant beneficial impact on laboratory workflow. *in development. Observed Total CV:
and good clinical condition, small bowel enteroscopy should be considered a pre operative requirement.
A Novel Method to Identify Fat Malabsorption: The Serum Vitamin A Test Rajveer Hundal, Kevin P. Rioux, Valerian Dias, Tanis Fenton, Pam Crotty, Maitreyi Raman Introduction: Chronic diarrhea is a common clinical presentation, and discerning malabsorption from other causes of diarrhea is often very challenging. The 72-hr fecal fat test (FFT) is a standard means of assessing fat malabsorption in the clinical lab, but it is cumbersome for the patient and fraught with limitations. As demonstrated previously, the absorption of fat soluble vitamins such as Vitamin A parallel the absorption of dietary fats and can serve as an alternative marker of malabsorption. A pilot study was conducted to assess serum vitamin A levels as a measure of intestinal fat malabsorption following oral administration of vitamin A. Methods: Using a case-control study design, Vitamin A, retinyl palmitate (50,000 IU) was administered to both subjects with clinically suspected fat malabsorption and healthy controls after a 14-hour overnight fast along with a standardized breakfast containing 20 to 26 g of fat. Serial blood samples were drawn to measure retinyl esters in serum at baseline, and 3, 4, 5, 6 and 7 hours after vitamin A ingestion. All subjects completed a 72-hour stool for fecal fat while consuming 100g of fat daily for two days prior to and during the stool collection. Serum retinol and retinyl-palmitate levels were assayed by reversed-phase HPLC method. For retinyl-palmitate the detection limit was 0.02 mg/L. Results: Three cases with malabsorption confirmed by FFT and three controls were included. The average (+/- SD) retinyl palmitate area under the curve was not different for cases and controls (0.88 + 0.41 vs. 0.80 + 0.24, p=0.88). However, serum levels of retinyl esters were significantly greater for the controls (Md = 0.38, Interquartile range (IQR) = 0.23, 0.53) than the cases (Md = 0.03, IQR = 0.02, 0.17) at 6 hours (p = 0.0495). Conclusion: We have shown that serum retinyl esters may be a useful marker of intestinal fat malabsorption. Compared with the FFT, the serum Vitamin A test may be easier and more acceptable for patients. While encouraging, we are currently recruiting patients to expand on our promising pilot data.
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Clinical Utility of Less Invasive Treatments Including Sclerotherapy With Alta and Pph for Prolapsing Internal Hemorrhoids: Comparison With Hemorrhoidectomy Yukihiko Tokunaga, Hirokazu Sasaki
Inhibitory Effect of Eupatilin Isolated From Artemisia Princeps on NSAID Induced Small Intestinal Mucosal Injury in the Rat Hyun Jeong Lee, Jin Il Kim, Dae Young Cheung, Tae Ho Kim, Byung-Wook Kim, Sung Soo Kim, Se Hyun Cho
Backgrounds: For prolasing internal hemorrhoids, less invasive treatments such as sclerotherapy using aluminum potassium sulphate / tannic acid (ALTA), and procedure for prolapse and hemorrhoids (PPH) have been introduced recently. We compared the results of ALTA and PPH with conventional hemorrhoidectomy. Methods: Between January 2006 and December 2009, We performed conventional hemorrhoidectomy in 547 pantients, ALTA in 1150 patients, and PPH in 183 patients with second- and third-degree internal hemorrhoids according to the Goligher's classification. Results: The operation duration was significantly longer (p,0.01) in LE (43±5 min) (m±SD) than in ALTA (13±2 min). Volume of ALTA injected into a hemorrhoid was 7.3±2.2mL. Post operative pain, which needed intravenous injection of pain killer, occurred in 76 cases (14%) in LE and 19 cases (1.7%) in ALTA (p,0.01). ALTA could be performed on an outpatient basis without any severe complication such as abscess, ulcer, and stenosis. Hospital stays were 6.7±2.0 days for hemorrhoidectomy, and 4.1±1.5 days for PPH. The dissapearnace rates of prolapse were 100% in hemorroidectomy, 96% in ALTA, and 99% in PPH respectively. Conclusions: Conventional hemorrhoidectomy would be indicated for alomost all cases of prolapsing internal hemorroids. However, it needs hospitalization, being accompanied with post-operative pain. ALTA is feasible on an outpatient basis without any severe pain or complication. PPH is an useful alternative treatment with shorter period of hospitalization and less pain compared to hemorrhoidectomy. Less invasive treatments would be useful and should be performed in appropriate cases, paying attention to avoid complications.
Background/Aims: This study aimed to reveal the mucosal protective effect of the eupatilin isolated from Artemisia princeps on the rat small intestine. Methods: Twenty-four pathogen free Sprague-Dawley rats were divided into four groups: one group without any control; another with indomethacin control; a third with eupatilin 30 mg/kg; the fourth with eupatilin 60 mg/kg. The rats given the intragastric route at the eupatilin for six days before indomethacin treatment. These were given indomethacin 200 mg/kg and sacrificed two days later. The effects of eupatilin were evaluated on macroscopic, histologic injury, inflammatory markers, plasma prostaglandin E2(PGE2), plasma tumor necrosis factor alpha(TNFα), tissue myeloperoxidase(MPO) were measured by enzyme-linked immunosorbent assays. Results: The mean number of damage per rat was 5.5 for the indomethacin control group, 2.5 for the low dose eupatilin group, 1 for the high dose eupatilin group. The area of mucosal defect in a rat small intestine was 12.5±8.04 mm2 for indomethacin control group, 3.5±2.07 mm2 for low dose eupatilin group, 1.0±0.63 mm2 for high dose eupatilin group. Three rats with ulceration were observed and three rats with erosion were observed in the indomethacin control group. Four rats with ulceration were observed and two rats with erosion were observed in the low dose eupatilin group. One rat with ulceration was observed and three rats with erosion were observed in the high dose eupatilin group. Five rats were observed to have less than ten neutrophils and one rat was observed to have more than ten ones in the indomethacin control group. Five rats were observed to have less than ten neutrophils and one rat was observed to have more than ten ones in the indomethacin control group. Four rats were observed to have less than ten neutrophils and two rat was observed to have more than ten ones in the low dose eupatilin group. Four rats were observed to have less than ten neutrophils and one rat was observed to have more than ten ones in the high dose eupatilin group. Indomethacin decrease basal PGE2 (P,0.002), but PGE2 were not modified by eupatilin (P=0.394, P=0.132). TNFα of indomethacin control group were 29.47±5.37 pg/ml. TNF α level induced by indomethacin was significantly reduced by low dose eupatilin ( P,0.001) or high dose eupatilin (P,0.001). MPO of indomethacin control group were 8.3±4.43 U/ L. MPO induced by indomethacin was significantly reduced by low dose eupatilin ( P,0.013). Conclusion: The study could conclude that eupatilin in rat small intestinal of models significantly decreased the macroscopic damage, plasma TNF α and tissue MPO, whereas eupatilin slightly affected the infiltration of tissue neutrophil and plasma PGE2. These suggests that eupatilin can be used as a mucosal protective agent in the small intestinal injury by the indomethacin.
Su1275 Preoperative Diagnosis of Small Bowel Tumors by Double Balloon Enteroscopy; A Single-Center Experience Johannes A. Brouwer, Lodewijk J. Schelfhout, Erwin van der Harst, Muhammed Hadithi BACKGROUND: Small bowel tumors (SBT) account for only 2% of all gastro-intestinal tumors. Until recently the pre operative diagnosis of these rare tumors was not possible. The advancement of small bowel diagnostic methods including double balloon enteroscopy (DBE) has changed this practice. This study was to evaluate the diagnostic and therapeutic impact of DBE on small-bowel tumors. METHODS: A review was conducted in the medical data of 167 patients who had undergone DBE over a 3-year period. RESULTS: Fourteen patients (9.3%) were diagnosed with SBT [8 males; median age 56 years (range 43-74)]. Indications for DBE were occult gastro-intestinal bleeding (n=10), abdominal pain (n=3) and small bowel obstruction (n=1). Endoscopic findings included the presence of mass (n= 10), strictures (n=8), submucosal swelling with central ulceration (n=4). Biopsies and tattooing could be performed in all cases. The pathological examination of resected tumors confirmed the biopsy results revealing the diagnosis of primary adenocarcinoma (n=10), carcinoid (n=3) and gastrointestinal stromal tumor (GIST, n=1). GIST was found in jejunum and all carcinoids were located in ileum. All patients with carcinoid and GIST had localized tumors that were resected successfully with good prognosis. Adenocarcinomas were located in the proximal jejunum. Two patients with adenocarcinoma had metastases at time of diagnosis and underwent palliative surgery. One had locally advanced stage that operation was withheld. Two of seven patients who underwent explorative laparotomy had peritoneal metastases and five were successfully resected. After median follow up of 19 months (range 1-29 months) 2 patients with adenocarcinoma died and three developed recurrence after resection. CONCLUSIONS: DBE is valuable in establishing the histological diagnosis, determining the localization and further management of SBT. In patients suspected with SBT
Su1278 Tolerability, Compliance, and Feasibility of a Split Dose PEG-Based Bowel Preparation for Colonoscopy Among Hospitalized Patients Dennis Yang, Robert J. Summerlee, Brian Rajca, Jonathan B. Williamson, Dennis Collins, Shahnaz Sultan The success of colonoscopy as a screening or diagnostic test is highly dependent on bowel prep quality and the ability to adequately visualize the colon. Suboptimal bowel prep results in missed pathology, prolonged procedure times, increased risk of procedure-associated complications, and ultimately higher costs to the health care system. Hospitalized patients have higher rates of suboptimal preps as compared to outpatients undergoing colonoscopy. Bowel preparation with split dose bowel lavage, as opposed to full dose, is associated with better bowel prep scores and importantly, higher rates of compliance. Among inpatients,
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AGA Abstracts
AGA Abstracts
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and good clinical condition, small bowel enteroscopy should be considered a pre operative requirement.
A Novel Method to Identify Fat Malabsorption: The Serum Vitamin A Test Rajveer Hundal, Kevin P. Rioux, Valerian Dias, Tanis Fenton, Pam Crotty, Maitreyi Raman Introduction: Chronic diarrhea is a common clinical presentation, and discerning malabsorption from other causes of diarrhea is often very challenging. The 72-hr fecal fat test (FFT) is a standard means of assessing fat malabsorption in the clinical lab, but it is cumbersome for the patient and fraught with limitations. As demonstrated previously, the absorption of fat soluble vitamins such as Vitamin A parallel the absorption of dietary fats and can serve as an alternative marker of malabsorption. A pilot study was conducted to assess serum vitamin A levels as a measure of intestinal fat malabsorption following oral administration of vitamin A. Methods: Using a case-control study design, Vitamin A, retinyl palmitate (50,000 IU) was administered to both subjects with clinically suspected fat malabsorption and healthy controls after a 14-hour overnight fast along with a standardized breakfast containing 20 to 26 g of fat. Serial blood samples were drawn to measure retinyl esters in serum at baseline, and 3, 4, 5, 6 and 7 hours after vitamin A ingestion. All subjects completed a 72-hour stool for fecal fat while consuming 100g of fat daily for two days prior to and during the stool collection. Serum retinol and retinyl-palmitate levels were assayed by reversed-phase HPLC method. For retinyl-palmitate the detection limit was 0.02 mg/L. Results: Three cases with malabsorption confirmed by FFT and three controls were included. The average (+/- SD) retinyl palmitate area under the curve was not different for cases and controls (0.88 + 0.41 vs. 0.80 + 0.24, p=0.88). However, serum levels of retinyl esters were significantly greater for the controls (Md = 0.38, Interquartile range (IQR) = 0.23, 0.53) than the cases (Md = 0.03, IQR = 0.02, 0.17) at 6 hours (p = 0.0495). Conclusion: We have shown that serum retinyl esters may be a useful marker of intestinal fat malabsorption. Compared with the FFT, the serum Vitamin A test may be easier and more acceptable for patients. While encouraging, we are currently recruiting patients to expand on our promising pilot data.
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Clinical Utility of Less Invasive Treatments Including Sclerotherapy With Alta and Pph for Prolapsing Internal Hemorrhoids: Comparison With Hemorrhoidectomy Yukihiko Tokunaga, Hirokazu Sasaki
Inhibitory Effect of Eupatilin Isolated From Artemisia Princeps on NSAID Induced Small Intestinal Mucosal Injury in the Rat Hyun Jeong Lee, Jin Il Kim, Dae Young Cheung, Tae Ho Kim, Byung-Wook Kim, Sung Soo Kim, Se Hyun Cho
Backgrounds: For prolasing internal hemorrhoids, less invasive treatments such as sclerotherapy using aluminum potassium sulphate / tannic acid (ALTA), and procedure for prolapse and hemorrhoids (PPH) have been introduced recently. We compared the results of ALTA and PPH with conventional hemorrhoidectomy. Methods: Between January 2006 and December 2009, We performed conventional hemorrhoidectomy in 547 pantients, ALTA in 1150 patients, and PPH in 183 patients with second- and third-degree internal hemorrhoids according to the Goligher's classification. Results: The operation duration was significantly longer (p,0.01) in LE (43±5 min) (m±SD) than in ALTA (13±2 min). Volume of ALTA injected into a hemorrhoid was 7.3±2.2mL. Post operative pain, which needed intravenous injection of pain killer, occurred in 76 cases (14%) in LE and 19 cases (1.7%) in ALTA (p,0.01). ALTA could be performed on an outpatient basis without any severe complication such as abscess, ulcer, and stenosis. Hospital stays were 6.7±2.0 days for hemorrhoidectomy, and 4.1±1.5 days for PPH. The dissapearnace rates of prolapse were 100% in hemorroidectomy, 96% in ALTA, and 99% in PPH respectively. Conclusions: Conventional hemorrhoidectomy would be indicated for alomost all cases of prolapsing internal hemorroids. However, it needs hospitalization, being accompanied with post-operative pain. ALTA is feasible on an outpatient basis without any severe pain or complication. PPH is an useful alternative treatment with shorter period of hospitalization and less pain compared to hemorrhoidectomy. Less invasive treatments would be useful and should be performed in appropriate cases, paying attention to avoid complications.
Background/Aims: This study aimed to reveal the mucosal protective effect of the eupatilin isolated from Artemisia princeps on the rat small intestine. Methods: Twenty-four pathogen free Sprague-Dawley rats were divided into four groups: one group without any control; another with indomethacin control; a third with eupatilin 30 mg/kg; the fourth with eupatilin 60 mg/kg. The rats given the intragastric route at the eupatilin for six days before indomethacin treatment. These were given indomethacin 200 mg/kg and sacrificed two days later. The effects of eupatilin were evaluated on macroscopic, histologic injury, inflammatory markers, plasma prostaglandin E2(PGE2), plasma tumor necrosis factor alpha(TNFα), tissue myeloperoxidase(MPO) were measured by enzyme-linked immunosorbent assays. Results: The mean number of damage per rat was 5.5 for the indomethacin control group, 2.5 for the low dose eupatilin group, 1 for the high dose eupatilin group. The area of mucosal defect in a rat small intestine was 12.5±8.04 mm2 for indomethacin control group, 3.5±2.07 mm2 for low dose eupatilin group, 1.0±0.63 mm2 for high dose eupatilin group. Three rats with ulceration were observed and three rats with erosion were observed in the indomethacin control group. Four rats with ulceration were observed and two rats with erosion were observed in the low dose eupatilin group. One rat with ulceration was observed and three rats with erosion were observed in the high dose eupatilin group. Five rats were observed to have less than ten neutrophils and one rat was observed to have more than ten ones in the indomethacin control group. Five rats were observed to have less than ten neutrophils and one rat was observed to have more than ten ones in the indomethacin control group. Four rats were observed to have less than ten neutrophils and two rat was observed to have more than ten ones in the low dose eupatilin group. Four rats were observed to have less than ten neutrophils and one rat was observed to have more than ten ones in the high dose eupatilin group. Indomethacin decrease basal PGE2 (P,0.002), but PGE2 were not modified by eupatilin (P=0.394, P=0.132). TNFα of indomethacin control group were 29.47±5.37 pg/ml. TNF α level induced by indomethacin was significantly reduced by low dose eupatilin ( P,0.001) or high dose eupatilin (P,0.001). MPO of indomethacin control group were 8.3±4.43 U/ L. MPO induced by indomethacin was significantly reduced by low dose eupatilin ( P,0.013). Conclusion: The study could conclude that eupatilin in rat small intestinal of models significantly decreased the macroscopic damage, plasma TNF α and tissue MPO, whereas eupatilin slightly affected the infiltration of tissue neutrophil and plasma PGE2. These suggests that eupatilin can be used as a mucosal protective agent in the small intestinal injury by the indomethacin.
Su1275 Preoperative Diagnosis of Small Bowel Tumors by Double Balloon Enteroscopy; A Single-Center Experience Johannes A. Brouwer, Lodewijk J. Schelfhout, Erwin van der Harst, Muhammed Hadithi BACKGROUND: Small bowel tumors (SBT) account for only 2% of all gastro-intestinal tumors. Until recently the pre operative diagnosis of these rare tumors was not possible. The advancement of small bowel diagnostic methods including double balloon enteroscopy (DBE) has changed this practice. This study was to evaluate the diagnostic and therapeutic impact of DBE on small-bowel tumors. METHODS: A review was conducted in the medical data of 167 patients who had undergone DBE over a 3-year period. RESULTS: Fourteen patients (9.3%) were diagnosed with SBT [8 males; median age 56 years (range 43-74)]. Indications for DBE were occult gastro-intestinal bleeding (n=10), abdominal pain (n=3) and small bowel obstruction (n=1). Endoscopic findings included the presence of mass (n= 10), strictures (n=8), submucosal swelling with central ulceration (n=4). Biopsies and tattooing could be performed in all cases. The pathological examination of resected tumors confirmed the biopsy results revealing the diagnosis of primary adenocarcinoma (n=10), carcinoid (n=3) and gastrointestinal stromal tumor (GIST, n=1). GIST was found in jejunum and all carcinoids were located in ileum. All patients with carcinoid and GIST had localized tumors that were resected successfully with good prognosis. Adenocarcinomas were located in the proximal jejunum. Two patients with adenocarcinoma had metastases at time of diagnosis and underwent palliative surgery. One had locally advanced stage that operation was withheld. Two of seven patients who underwent explorative laparotomy had peritoneal metastases and five were successfully resected. After median follow up of 19 months (range 1-29 months) 2 patients with adenocarcinoma died and three developed recurrence after resection. CONCLUSIONS: DBE is valuable in establishing the histological diagnosis, determining the localization and further management of SBT. In patients suspected with SBT
Su1278 Tolerability, Compliance, and Feasibility of a Split Dose PEG-Based Bowel Preparation for Colonoscopy Among Hospitalized Patients Dennis Yang, Robert J. Summerlee, Brian Rajca, Jonathan B. Williamson, Dennis Collins, Shahnaz Sultan The success of colonoscopy as a screening or diagnostic test is highly dependent on bowel prep quality and the ability to adequately visualize the colon. Suboptimal bowel prep results in missed pathology, prolonged procedure times, increased risk of procedure-associated complications, and ultimately higher costs to the health care system. Hospitalized patients have higher rates of suboptimal preps as compared to outpatients undergoing colonoscopy. Bowel preparation with split dose bowel lavage, as opposed to full dose, is associated with better bowel prep scores and importantly, higher rates of compliance. Among inpatients,
S-445
AGA Abstracts
AGA Abstracts
Su1276