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T1124 Gastroesophageal Reflux Disease: A Prospective Study Comparing a Symptom-Based Reflux Disease Questionnaire to BRAVO pH Capsule Monitoring
tissue. A catheter-free pH-monitoring probe placed 6 cm above the LES records acid levels for 48 hours. Results: 86 patients enrolled to date and underwent EGD. Mean age: 51.5 (33.7% female; 13.9% African-American). There were 8 failed BRAVO probe deployments and pH data is available for 89.5% of subjects. 47/86 (53.5%) had acid exposure that would be defined as significant defined by a Johnson-DeMeester (JD) score of 14.72 on either day 1 (36), day 2 (29), or both (17). Among these 46 patients, 21 (24.4%) had endoscopic and/ or histological evidence of reflux changes. There were 13 patients with either a normal JD score or no JD score due to failed deployment of the pH probe who also had endoscopic or histological evidence of acid reflux changes, either endoscopically or histologically. Thus, a total of 34/86 (39.5%) of patients without GERD symptoms had evidence of significant esophageal acid exposure. The positive and negative predictive values for JD score from day 2 were 41.4% (12/29) and 54.2% (26/48), respectively. In addition the prevalence of esophagitis and Barrett's esophagus were 26/86 (30.2%) and 8/86 (9.3%) respectively. There are no statistically significant relationships identified between acid exposure and BMI, sex, race, age, and ETOH/wk or coffee/day intake. It appears that an elevated JD score on day 1 or day 2 increases the odds of having reflux by 9.28% but that the overall correlation with symptoms or physiologic changes due to GERD is marginal. Conclusions: Our interim analysis indicates that significant esophageal acid exposure continues to be common in an asymptomatic population. Endoscopic or histological evidence of GERD is commonly seen in patients without GERD symptoms and reassessment of our current reference standards for pHmetry may be warranted.
Impedance-pH Characteristics of 47 Pre-Lung Transplantation Patients Alan Gunderson, Greg Nelligan, James D. Maloney, Eric A. Gaumnitz AIM: There is a recognized relationship between acid reflux and allograft dysfunction in the lung transplant population. The occurrence and effect of reflux is not known in the pretransplant population, although it has been speculated to occur more frequently and even play a role in progression of end-stage lung disease. With the development of ImpedancepH testing to identify both acid and non-acid reflux (NAR), we aimed to characterize reflux disease in the end-stage lung disease, pre-transplant population. METHODS: We performed a retrospective analysis of the multichannel intraluminal impedance-pH studies of 47 VA patients undergoing pre-lung transplant reflux evaluation. RESULTS: There was no significant difference in the acid exposure data between established normals and the pre-lung transplant patients who were either on or off acid suppression therapy; the average percent time of acid reflux for all patients on and off acid suppression was 1.27%, (normal BID PPI < 1.3%; p = 0.54). The combined average number of acid reflux events for those on and off acid suppressive medication was 15.6, which was no different from that expected on maximal PPI (normal BID PPI < 12 events; p =0.09). Impedance data demonstrated the mean percent of all reflux events reaching the proximal esophagus was increased in the study population (44% in study vs. 34% in normal; p = 0.00003). The mean bolus transit times (BTT) in both groups on and off of acid suppression were prolonged at 12.6 seconds in comparison with the normal median (median normal = 7.9 seconds; p < 0.00001). However, this was not statistically different from the upper limit of normal (95th percentile). Symptoms of laryngo-pharyngeal reflux (LPR) were more prevalent than classic GERD symptoms. The most common symptoms were cough (28%), belch (16%), and heartburn (14%); reflux episodes were predominantly silent and correlated (positive symptoms index) with belch only but not cough or heartburn. CONCLUSIONS: Despite normal reflux patterns in the distal esophagus, patients with end-stage lung disease have an increased frequency of NAR reaching the proximal esophagus and increased bolus contact time. This suggests that proximal reflux frequency is increased in the lung transplantation population despite normal distal reflux patterns and functions as a risk for lung damage by increasing the frequency of aspiration events.
T1124 Gastroesophageal Reflux Disease: A Prospective Study Comparing a SymptomBased Reflux Disease Questionnaire to BRAVO pH Capsule Monitoring Robert J. Chehade, Brian E. Lacy, Michael D. Crowell Purpose: The accurate diagnosis of gastroesophageal reflux (GERD) is problematic. The GERD-Q is a validated, 6-item questionnaire developed to identify patients with GERD. Prospective data comparing this questionnaire to 48-hour Bravo pH capsule is lacking. Aims: Prospectively evaluate the association between GERD-Q scores and parameters of 48-hr wireless pH recording. Methods: Consecutive patients referred for Bravo pH capsule testing were eligible for inclusion. Demographics, symptoms, type, dose and frequency of acid suppressants were obtained. The GERD-Q score was calculated as the sum of heartburn, regurgitation, upper abdominal pain, nausea, difficulty sleeping, and need for additional medication (total score 0-18). Bravo pH data was analyzed for Day 1, Day 2, and total. A pH < 4.0 for more than 5.3% of the 48-hour period was considered abnormal. Symptom association probability (SAP) scores were calculated and reported for Day 1, Day 2, and total. SAP scores > 95% were considered abnormal. Multivariate logistic regression models controlled for age, gender and BMI and were used to evaluate the association between amplified GERD-Q scores and abnormal esophageal acid reflux and SAP scores in patients studied either on or off PPI. Results: Bravo pH-metry was completed in 358 patients (age 51 ± 14 yrs; BMI = 29 ± 7 kg/m2; 72% Women; 97% Caucasian). The mean duration of symptoms was 89 ± 95 months. Capsules were placed with upper endoscopy (56%) or transorally (44%). The pH study was completed while on PPI in 50% of pts. Abnormal acid exposure was noted in 29/180 (16%) pts on PPI and 92/178 (52%) pts off PPI. Controlling for age, gender, and BMI, the odds of an abnormal study were 6.15 (95% CI, 3.66-10.36) times greater in pts studied off PPI. The mean GERD-Q score was 9.19 ± 4.31 in pts off PPI and 7.48 ± 4.51 in pts on PPI (p<0.01). In pts studied off PPI, the GERD-Q was associated with increased odds of an abnormal pH study (OR 1.08; 95% CI 1.01-1.16) and SAP (OR 1.19; 95%CI 1.08-1.31), but not in pts studied on PPI. The GERD-Q subscales regurgitation and more frequent use of extra medications were positively associated with an abnormal pH study (OR 1.41, 95% CI 1.03-1.93; OR 1.49, 95% CI 1.12-2.00, respectively) and SAP (OR 1.56, 95% CI 1.13-2.14; OR 1.43; 95% CI 1.06-1.94, respectively) in pts studied off PPI. Conclusions: Higher GERD-Q scores were predictive of an abnormal pH study in patients studied off PPI. Higher scores for regurgitation and the use of additional medications were most likely to predict an abnormal Bravo study. Additional prospective studies to confirm these results and to compare with endoscopic findings are required.
T1122 The National Survey of Prevalence of Gastroesophageal Reflux Disease in Russia Leonid B. Lazebnik, Dmitry S. Bordin, Antonina A. Masharova INTRODUCTION: The aim of the study was to assess the population-based prevalence of gastroesophageal reflux disease (GERD) in Russia and to report its characteristics gathered using the Mayo Clinic Questionnaire. AIMS & METHODS: We aimed to determine the prevalence and clinical spectrum of GERD in the urban population of 6 cities in different parts of Russia (St. Petersburg, Ryazan, Kazan, Kemerovo, Krasnoyarsk and Saransk). A previously validated reflux questionnaire developed at the Mayo Clinic was translated into Russian, culturally adapted and administered. Data was collected from 7812 randomly selected subjects greater than 18 years old with the assistance of the yellow pages. “Frequent symptoms” were defined as a major symptom (heartburn and/or regurgitation) occurring at least once a week or more. “Occasional symptoms” were defined as an episode of one of the major symptoms occurring less than once a week within the past 12 months. Patients were defined as having GERD if they reported frequent heartburn and/or regurgitation. RESULTS: The average prevalence of frequent and occasional GERD symptoms in Russia was 9% and 38.5% for heartburn and 7.6% and 35.3% for regurgitation respectively within the last 12 months. The average prevalence of GERD in Russia was 13.3% (11.3-14.3%). The prevalence of frequent heartburn decreased with age (r=-0.3); however, frequent regurgitation increased (r=0.7) with age. As a result, we found that prevalence of GERD increased with age. The average prevalence of GERD was statistically the same in men (12.5%) and in women (13.9%). This prevalence didn't change with age in men but did increase with age in elderly women to 24%. Frequent heartburn and regurgitation (GERD) were significantly associated with frequent belching (24.3%), chronic cough (22.9%), dyspepsia (19.8%), non-cardiac chest pain (15.1%), nausea (14.9%), hoarseness (11.4%), dysphagia (8.1%), odynophagia (7.3%) and constipation (37.8%). Alcohol consumption (prevalence of 60.4% among respondents) and smoking (prevalence of 25.4% among respondents) didn't yield any significant difference in subjects with frequent symptoms. Importantly, we also found that only 52.8% of subjects with frequent chest pain and 29.3% of respondents with frequent heartburn had seen a physician for these symptoms. CONCLUSION: This is the first population-based study on the prevalence of GERD using the Mayo Clinic Questionnaire for 7812 subjects in 6 cities located in different parts of Russia. The average prevalence of GERD in Russia proved to be 13.3%. We also found that respondents in most cases do not see a physician, despite frequency of associated symptoms.
T1125 The Usefulness of Narrow Band Imaging System With Magnifying Endoscopy in Evaluation of Patients With Laryngopharyngeal Reflux Disease Inchaya Sansak, Somchai Leelakusolvong, Varayu Prachayakul, Nonthalee Pausawasdi, Phunchai Charatcharoenwitthaya, Siwaporn P. Chainuvati, Supot Nimanong, Tawesak Tanwandee, Supot Pongprasobchai, Sataporn Manatsathit, Udom Kachintorn BACKGROUND: Esophageal mucosal injury in patients with laryngopharyngeal reflux disease (LPR) remains unclear. Conventional endoscope may be insensitive in detecting esophageal abnormality in patients with non-erosive reflux disease. Magnified-Narrow band imaging (NBI) endoscope system enhances visualization of microvasculature mucosal patterns and may overcome the limitation of conventional white light endoscope. AIM: To assess the abnormality of esophageal mucosa in patients with LPR using magnifying NBI endoscopy. METHODS: Patients diagnosed with LPR regardless of reflux symptoms were consecutively enrolled in the study. Proton pump inhibitors were discontinued for two weeks. Upper endoscopy was then performed using conventional white light endoscope followed by magnified-NBI endoscope and images were recorded. Tissue biopsies were obtained from lower, middle and upper esophagus. Within 1 week of endosocpy, 24 hour/pH with impedance monitoring test were performed to assess reflux pattern. RESULTS: 45 consecutive patients (mean age 47; 10 males, 35 females) were recruited. 62% (28/45) had abnormal vascular pattern of esophageal mucosa detected by magnified-NBI while 9% (4/45) found to have erosive esophagitis on conventional white light (p-value <0.05) endoscope. Among patients with abnormal magnified-NBI, 50% had dilatation or elongation of intrapapillarycapillary loops, and 50 % had tortuosity. The majority of abnormality was observed in the distal esophagus. 78% (35/45) of patients had abnormal impedance/24 hour pH monitoring. Of 28 patients with abnormal magnified-NBI, 22% had abnormal acid reflux, 22% had abnormal weak acid exposure, 40% had gas reflux, and 40% had mixed gas and liquid reflux detected on. Among patients with normal magnified NBI, 6% had abnormal acid
T1123 PH Monitoring in Asymptomatic Individuals and Its Endoscopic Correlates, an Update Todd La Rock, Ruben D. Acosta, Craig M. Womeldorph, Marjorie R. Piorkowski, Patrick E. Young, Brooks D. Cash Symptoms of gastroesophageal reflux (GERD) are present in a significant portion of the population. Prevalence of pathologic esophageal acid exposure without GERD symptoms is not known. Current pHmetry standards are based on naso-esophageal sensors and may not be the ideal standard. Implantable esophageal pH monitoring probes are being used to measure acid exposure and correlate it to the endoscopic and histologic appearance of the esophagus in asymptomatic patients. Methods: Routine colonoscopy patients complete a validated questionnaire (modified GERQ) to detect symptomatic GERD. Asymptomatic patients are invited to participate. Enrollees undergo a routine EGD with photographs of the gastroesophageal junction and measurement of the lower esophageal sphincter (LES) from the gums. Biopsies are taken of the distal esophagus and any abnormal appearing
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AGA Abstracts
AGA Abstracts
T1121
Impedance-pH Characteristics of 47 Pre-Lung Transplantation Patients Alan Gunderson, Greg Nelligan, James D. Maloney, Eric A. Gaumnitz AIM: There is a recognized relationship between acid reflux and allograft dysfunction in the lung transplant population. The occurrence and effect of reflux is not known in the pretransplant population, although it has been speculated to occur more frequently and even play a role in progression of end-stage lung disease. With the development of ImpedancepH testing to identify both acid and non-acid reflux (NAR), we aimed to characterize reflux disease in the end-stage lung disease, pre-transplant population. METHODS: We performed a retrospective analysis of the multichannel intraluminal impedance-pH studies of 47 VA patients undergoing pre-lung transplant reflux evaluation. RESULTS: There was no significant difference in the acid exposure data between established normals and the pre-lung transplant patients who were either on or off acid suppression therapy; the average percent time of acid reflux for all patients on and off acid suppression was 1.27%, (normal BID PPI < 1.3%; p = 0.54). The combined average number of acid reflux events for those on and off acid suppressive medication was 15.6, which was no different from that expected on maximal PPI (normal BID PPI < 12 events; p =0.09). Impedance data demonstrated the mean percent of all reflux events reaching the proximal esophagus was increased in the study population (44% in study vs. 34% in normal; p = 0.00003). The mean bolus transit times (BTT) in both groups on and off of acid suppression were prolonged at 12.6 seconds in comparison with the normal median (median normal = 7.9 seconds; p < 0.00001). However, this was not statistically different from the upper limit of normal (95th percentile). Symptoms of laryngo-pharyngeal reflux (LPR) were more prevalent than classic GERD symptoms. The most common symptoms were cough (28%), belch (16%), and heartburn (14%); reflux episodes were predominantly silent and correlated (positive symptoms index) with belch only but not cough or heartburn. CONCLUSIONS: Despite normal reflux patterns in the distal esophagus, patients with end-stage lung disease have an increased frequency of NAR reaching the proximal esophagus and increased bolus contact time. This suggests that proximal reflux frequency is increased in the lung transplantation population despite normal distal reflux patterns and functions as a risk for lung damage by increasing the frequency of aspiration events.
T1124 Gastroesophageal Reflux Disease: A Prospective Study Comparing a SymptomBased Reflux Disease Questionnaire to BRAVO pH Capsule Monitoring Robert J. Chehade, Brian E. Lacy, Michael D. Crowell Purpose: The accurate diagnosis of gastroesophageal reflux (GERD) is problematic. The GERD-Q is a validated, 6-item questionnaire developed to identify patients with GERD. Prospective data comparing this questionnaire to 48-hour Bravo pH capsule is lacking. Aims: Prospectively evaluate the association between GERD-Q scores and parameters of 48-hr wireless pH recording. Methods: Consecutive patients referred for Bravo pH capsule testing were eligible for inclusion. Demographics, symptoms, type, dose and frequency of acid suppressants were obtained. The GERD-Q score was calculated as the sum of heartburn, regurgitation, upper abdominal pain, nausea, difficulty sleeping, and need for additional medication (total score 0-18). Bravo pH data was analyzed for Day 1, Day 2, and total. A pH < 4.0 for more than 5.3% of the 48-hour period was considered abnormal. Symptom association probability (SAP) scores were calculated and reported for Day 1, Day 2, and total. SAP scores > 95% were considered abnormal. Multivariate logistic regression models controlled for age, gender and BMI and were used to evaluate the association between amplified GERD-Q scores and abnormal esophageal acid reflux and SAP scores in patients studied either on or off PPI. Results: Bravo pH-metry was completed in 358 patients (age 51 ± 14 yrs; BMI = 29 ± 7 kg/m2; 72% Women; 97% Caucasian). The mean duration of symptoms was 89 ± 95 months. Capsules were placed with upper endoscopy (56%) or transorally (44%). The pH study was completed while on PPI in 50% of pts. Abnormal acid exposure was noted in 29/180 (16%) pts on PPI and 92/178 (52%) pts off PPI. Controlling for age, gender, and BMI, the odds of an abnormal study were 6.15 (95% CI, 3.66-10.36) times greater in pts studied off PPI. The mean GERD-Q score was 9.19 ± 4.31 in pts off PPI and 7.48 ± 4.51 in pts on PPI (p<0.01). In pts studied off PPI, the GERD-Q was associated with increased odds of an abnormal pH study (OR 1.08; 95% CI 1.01-1.16) and SAP (OR 1.19; 95%CI 1.08-1.31), but not in pts studied on PPI. The GERD-Q subscales regurgitation and more frequent use of extra medications were positively associated with an abnormal pH study (OR 1.41, 95% CI 1.03-1.93; OR 1.49, 95% CI 1.12-2.00, respectively) and SAP (OR 1.56, 95% CI 1.13-2.14; OR 1.43; 95% CI 1.06-1.94, respectively) in pts studied off PPI. Conclusions: Higher GERD-Q scores were predictive of an abnormal pH study in patients studied off PPI. Higher scores for regurgitation and the use of additional medications were most likely to predict an abnormal Bravo study. Additional prospective studies to confirm these results and to compare with endoscopic findings are required.
T1122 The National Survey of Prevalence of Gastroesophageal Reflux Disease in Russia Leonid B. Lazebnik, Dmitry S. Bordin, Antonina A. Masharova INTRODUCTION: The aim of the study was to assess the population-based prevalence of gastroesophageal reflux disease (GERD) in Russia and to report its characteristics gathered using the Mayo Clinic Questionnaire. AIMS & METHODS: We aimed to determine the prevalence and clinical spectrum of GERD in the urban population of 6 cities in different parts of Russia (St. Petersburg, Ryazan, Kazan, Kemerovo, Krasnoyarsk and Saransk). A previously validated reflux questionnaire developed at the Mayo Clinic was translated into Russian, culturally adapted and administered. Data was collected from 7812 randomly selected subjects greater than 18 years old with the assistance of the yellow pages. “Frequent symptoms” were defined as a major symptom (heartburn and/or regurgitation) occurring at least once a week or more. “Occasional symptoms” were defined as an episode of one of the major symptoms occurring less than once a week within the past 12 months. Patients were defined as having GERD if they reported frequent heartburn and/or regurgitation. RESULTS: The average prevalence of frequent and occasional GERD symptoms in Russia was 9% and 38.5% for heartburn and 7.6% and 35.3% for regurgitation respectively within the last 12 months. The average prevalence of GERD in Russia was 13.3% (11.3-14.3%). The prevalence of frequent heartburn decreased with age (r=-0.3); however, frequent regurgitation increased (r=0.7) with age. As a result, we found that prevalence of GERD increased with age. The average prevalence of GERD was statistically the same in men (12.5%) and in women (13.9%). This prevalence didn't change with age in men but did increase with age in elderly women to 24%. Frequent heartburn and regurgitation (GERD) were significantly associated with frequent belching (24.3%), chronic cough (22.9%), dyspepsia (19.8%), non-cardiac chest pain (15.1%), nausea (14.9%), hoarseness (11.4%), dysphagia (8.1%), odynophagia (7.3%) and constipation (37.8%). Alcohol consumption (prevalence of 60.4% among respondents) and smoking (prevalence of 25.4% among respondents) didn't yield any significant difference in subjects with frequent symptoms. Importantly, we also found that only 52.8% of subjects with frequent chest pain and 29.3% of respondents with frequent heartburn had seen a physician for these symptoms. CONCLUSION: This is the first population-based study on the prevalence of GERD using the Mayo Clinic Questionnaire for 7812 subjects in 6 cities located in different parts of Russia. The average prevalence of GERD in Russia proved to be 13.3%. We also found that respondents in most cases do not see a physician, despite frequency of associated symptoms.
T1125 The Usefulness of Narrow Band Imaging System With Magnifying Endoscopy in Evaluation of Patients With Laryngopharyngeal Reflux Disease Inchaya Sansak, Somchai Leelakusolvong, Varayu Prachayakul, Nonthalee Pausawasdi, Phunchai Charatcharoenwitthaya, Siwaporn P. Chainuvati, Supot Nimanong, Tawesak Tanwandee, Supot Pongprasobchai, Sataporn Manatsathit, Udom Kachintorn BACKGROUND: Esophageal mucosal injury in patients with laryngopharyngeal reflux disease (LPR) remains unclear. Conventional endoscope may be insensitive in detecting esophageal abnormality in patients with non-erosive reflux disease. Magnified-Narrow band imaging (NBI) endoscope system enhances visualization of microvasculature mucosal patterns and may overcome the limitation of conventional white light endoscope. AIM: To assess the abnormality of esophageal mucosa in patients with LPR using magnifying NBI endoscopy. METHODS: Patients diagnosed with LPR regardless of reflux symptoms were consecutively enrolled in the study. Proton pump inhibitors were discontinued for two weeks. Upper endoscopy was then performed using conventional white light endoscope followed by magnified-NBI endoscope and images were recorded. Tissue biopsies were obtained from lower, middle and upper esophagus. Within 1 week of endosocpy, 24 hour/pH with impedance monitoring test were performed to assess reflux pattern. RESULTS: 45 consecutive patients (mean age 47; 10 males, 35 females) were recruited. 62% (28/45) had abnormal vascular pattern of esophageal mucosa detected by magnified-NBI while 9% (4/45) found to have erosive esophagitis on conventional white light (p-value <0.05) endoscope. Among patients with abnormal magnified-NBI, 50% had dilatation or elongation of intrapapillarycapillary loops, and 50 % had tortuosity. The majority of abnormality was observed in the distal esophagus. 78% (35/45) of patients had abnormal impedance/24 hour pH monitoring. Of 28 patients with abnormal magnified-NBI, 22% had abnormal acid reflux, 22% had abnormal weak acid exposure, 40% had gas reflux, and 40% had mixed gas and liquid reflux detected on. Among patients with normal magnified NBI, 6% had abnormal acid
T1123 PH Monitoring in Asymptomatic Individuals and Its Endoscopic Correlates, an Update Todd La Rock, Ruben D. Acosta, Craig M. Womeldorph, Marjorie R. Piorkowski, Patrick E. Young, Brooks D. Cash Symptoms of gastroesophageal reflux (GERD) are present in a significant portion of the population. Prevalence of pathologic esophageal acid exposure without GERD symptoms is not known. Current pHmetry standards are based on naso-esophageal sensors and may not be the ideal standard. Implantable esophageal pH monitoring probes are being used to measure acid exposure and correlate it to the endoscopic and histologic appearance of the esophagus in asymptomatic patients. Methods: Routine colonoscopy patients complete a validated questionnaire (modified GERQ) to detect symptomatic GERD. Asymptomatic patients are invited to participate. Enrollees undergo a routine EGD with photographs of the gastroesophageal junction and measurement of the lower esophageal sphincter (LES) from the gums. Biopsies are taken of the distal esophagus and any abnormal appearing
S-493
AGA Abstracts
AGA Abstracts
T1121