Tu1149 Increased Inspiratory LES Pressure in Systemic Scleroderma: A Positive Add-on to LES Function?

Tu1149 Increased Inspiratory LES Pressure in Systemic Scleroderma: A Positive Add-on to LES Function?

with CO showed a trend towards having more frequent GER symptoms (OR 1.6, 95%CI 0.7-3.3) as well as a trend towards being diagnosed more likely with E...

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with CO showed a trend towards having more frequent GER symptoms (OR 1.6, 95%CI 0.7-3.3) as well as a trend towards being diagnosed more likely with EI (OR 1.8, 95%CI, 0.8-4.3). The presence of GER symptoms was found to be a risk factor for EI (OR 2.1, 95%CI 0.96-4.8). No significant difference was observed in the prevalence of EI between individuals with (16%) and without (14%) CO. Waist circumference was found to correlate with BMI (rho 0.812, 0.75-1) Conclusion: The overall prevalence of EI in subjects with cenral obesity in the population is 16%. A substantial proportion of these patients (60%) are asymptomatic for reflux symptoms raising the possibility of an alternate fat modulated pathway influencing esophageal injury.

Flowsheet for patients enrolled in the study Tu1149 Tu1151

Increased Inspiratory LES Pressure in Systemic Scleroderma: A Positive Addon to LES Function? Miguel Angelo N. Souza, Nelson S. Matias, Maria Amélia D. Gadelha, Ricardo Oliveira, Armênio A. Santos

Racial Differences in Prevalence of Hiatal Hernia and Esophageal Mucosal Injury: Results From a Large Prospective GERD Cohort Benjamin R. Alsop, Neil Gupta, Gokulakrishnan Balasubramanian, Sachin Wani, Srinivas Gaddam, April D. Higbee, Tracy Shipe, Mandeep Singh, Harathi Yandrapu, Maria Giacchino, Amit Rastogi, Ajay Bansal, Prateek Sharma

Systemic involvement in scleroderma includes esophageal smooth muscle and LES. However, it is not known if the crural part of the antireflux barrier is involved. We aim to evalute the inspiratory LES pressure in systemic scleroderma (SS). Herein, we consider controlled inspiratory LES pressure a surrogate for crural diaphragm strength. METHODS. After local ethical committee approval, we studied 8 SS volunteers (average age: 40.1y, 1 male, 6 with absent distal esophageal peristalsis and 2 with distal hypotensive peristalsis, 6 with exertion dyspnea, 7 with tomographic pulmonary involvement), and 5 healthy controls (C) (average age: 24.8y, 1 male). High resolution manometry with a 36-channel solid-state catheter (ManoScanZ, Sierra Inc, USA) was performed. Contour analysis was used to measure mean and expiratory LES pressure (mmHg), and inspiratory diaphragmatic lowering (cm). Tracings analysis was used to measure LES pressure increase after respiratory sinus arrhythmia maneuver (5-second inspiration and 5-second expiration, Prsa), and after forced inspiration under controlled resistance of 12 cmH2O (Pth12) and 24 cmH2O (Pth24) (Threshold®IMT, Philips Respironics, USA). A frequency-based symptom score was attributed for heartburn and regurgitation (1-less than once a week, 2- once a week, 3-two to 4 times a week, 4more than 5 times a week). Pressures were referenced to gastric pressure. Maneuver pressures are shown as raw data (mmHg), and normalized to age-1 in order to account for the negative relationship between age and muscle strength (mmHg x year). Data are presented in mean and SEM, and analyzed as appropriate. RESULTS. All SS patients presented heartburn at least twice a week. Six SS presented regurgitation, and five had esophageal intermittent dysphagia. SS patients had lower mean LES pressure (19.7 ± 2.8 mmHg versus 32.5 ± 24.8 mmHg, p=0.031). Expiratory LES pressure was even lower in SS (8.5 ± 1.7 mmHg versus 22.5 ± 5.1 mmHg, p=0.01). However, all maneuver pressures (particularly Prsa) were nonsignificantly higher in SS (Prsa: 142.6 ± 9.4 mmHg versus 104.3 ± 17.6 mmHg, p=0.058; Pth12: 140.8 ± 13.6 mmHg versus 111.9 ± 9.2 mmHg, p=0.154; Pth24: 141.2 ± 15.1 mmHg versus 120.4 ± 12.2 mmHg, p=0.357). Diaphragmatic lowering in SS was similar to controls (SS: 2.2 ± 0.4 cm versus C: 2.8 ± 0.2 cm, p=0.242). Maneuver pressures normalized to age1 (mmHg x year) unveiled a significantly higher inspiratory LES pressure in SS (Prsa: 5711 ± 536.9 versus 2610 ± 492.8, p=0.002; Pth12: 5655 ± 674.8 versus 2794 ± 349.1, p=0.009; Pth24: 5678 ± 758.5 versus 3021 ± 431.9, p=0.026). CONCLUSIONS. Mean and expiratory LES pressures are reduced in SS. However, maneuver-controlled inspiratory LES pressure is increased in SS. The latter finding may be a positive add-on to an overall deficient LES in SS.

Background:Compared to Caucasians, African Americans (AA) appear to be at a lower risk for the development of complicated GERD, including Barrett's esophagus (BE). However, the degree to which AA may be protected and the reasons for this have not yet been characterized. Aims:In a large prospective cohort of patients referred for upper endoscopy, to compare: (1) prevalence of esophageal mucosal injury (erosive esophagitis (EE) and BE), (2) prevalence of hiatal hernia, and (3) GERD symptom profiles between AA and Caucasians. Methods:Consecutive patients presenting for index endoscopic evaluation of GERD symptoms, abdominal pain, or anemia were asked to complete a validated questionnaire (GERQ) about their symptoms. Demographic data, family history, medication use, co-morbid conditions, and EGD findings were systematically recorded. To compare AA to Caucasians, univariate analyses were performed using a chi square test for categorical variables and an unpaired t-test for continuous variables. Odds ratios for endoscopic findings of EE, BE, and hiatal hernia were calculated after adjusting for age, gender, presence of weekly GERD symptoms, and body mass index (BMI). Results:Of the entire cohort of 1086 patients, 162 (15%) were African-American, 858 (79%) were male, and the mean age was 57.7 years (SD 12.7). Compared to Caucasians, the duration of both heartburn and regurgitation was significantly shorter in AA, although the frequency and severity of GERD symptoms were similar between the 2 groups. At endoscopy, AA were less likely to have hiatal hernia (40.4% vs. 49.7%, p=0.03) or BE (2.5% vs. 16.0%, p<0.001). Similarly, there was a difference in the grade of EE between the two groups, where AA tended to have a lower EE grade (LA classification). The prevalence of diabetes mellitus, hypertension, NSAID or aspirin use, smoking, and the use of PPI and H2A did not differ by race. On multivariate analysis, after adjusting for cofounding variables, AAs were significantly less likely to have hiatal hernia or esophageal mucosal injury (Table). Conclusions:The results of this prospective cohort study demonstrate that African Americans with chronic GERD are at a significantly lower risk for esophageal mucosal injury and BE. This finding could be related to the significantly lower prevalence of hiatal hernia among AAs. These results emphasize the need for a tailored approach to the management of GERD and screening strategies for BE in African Americans. Tu1152 Small Bowel Tumors Discovered During Double Balloon Enteroscopy (DBE): Analysis of Large Prospectively Collected Database Mihir K. Patel, Victoria Gomez, Ali Lankarani, Mark E. Stark, Frank Lukens

Tu1150 Influence of Central Obesity on Esophageal Injury: A Population Based Study Cadman Leggett, Emmanuel C. Gorospe, Kelly T. Dunagan, David A. Katzka, Magdalen A. Clemens, Ganapathy A. Prasad

Background: The reported prevalence of small bowel tumors is low and there is limited data describing their characteristics. The information regarding the use of double balloon enteroscopy (DBE) in the diagnosis of small bowel tumors (benign or malignant) is scarce. Aim: To determine the diagnostic yield of DBE in detection of small bowel tumors. Methods: We reviewed our large prospectively collected DBE database from 2006 to 2011. The patients who found to have small bowel tumor during DBE were included in our study analysis. Patients Demographics along with DBE procedure indication, findings and complications were recorded. The diagnostic yield of DBE procedure in detection of small bowel tumors was calculated by frequency statistics. Results: A total of 1218 DBE procedure were performed from 2006 to 2011 at our tertiary referral center. Out of these, small bowel tumors were found in 83 patients (62.5% male) who underwent 88 DBE procedures (48 antegrade and 40 retrograde approaches). The prevalence of small bowel tumors among the patients undergoing DBE procedure for various indications was found to be 9.8%. The most common indication was suspected mass in previously abnormal imaging studies (see Table). Small bowel tumors were located more commonly in the ileum 60.2% (n=53) in comparison with the Jejunum 39.8% (n=35). Biopsies obtained during procedure confirmed the pathologic diagnosis of malignant lesion in 50.6% (n=42) patients, benign lesions in 48.2% (n=40) patients and inconclusive lesion in 1.2% (n=1) patients who underwent these procedures. Among 83 patients, 73.5% (n=61) patients underwent capsule endoscopy prior to DBE procedure. Among them, 91.8% (n=56) of the patients had abnormal capsule endoscopic findings that raised the concern of small bowel mass or polypoidal lesion. Conclusion: The prevalence of small bowel tumor is low in patients undergoing DBE procedure. The DBE

Background: Gastroesophageal reflux (GER) may lead to esophageal injury (EI) in the form of erosive esophagitis (EE) and Barrett's esophagus (BE). Central obesity (CO) is associated with EI, likely through both mechanical and metabolic factors. The prevalence of EI in a broad population of centrally obese patients is unknown. Aim: To assess the prevalence of esophageal injury in subjects with CO in the general population. Methods: A random sample of Olmsted County residents (age >50 years) selected using the Rochester Epidemiology Project database were mailed a validated gastrointestinal questionnaire that characterized reflux symptoms. Asymptomatic individuals were identified by absent or mild reflux symptoms that occurred less than once weekly. Participants with upper endoscopy within the last 10 years or known BE were excluded. Participants were stratified by age, gender and reflux symptoms and randomized to undergo unsedated transnasal endoscopy, capsule endoscopy or sedated upper endoscopy. Esophageal injury was defined by the presence of EE or BE. Anthropometric measurements were obtained at time of endoscopy using standard techniques. CO was defined as waist circumference of ≥102 cm in men and ≥88 cm in women. Results: 123 subjects with a median age of 69 years of whom 54% were female and 99% were Caucasian were studied. 52 (42%) were centrally obese (18% males and 24% females). 71 (58%) were asymptomatic for reflux symptoms as per above criteria. 36 (30%) had evidence of esophageal injury overall with 6 (17%) BE cases and 30(83%) EE cases (LA grade A+B in 25(83%), LA grade C+D in 2 (6%)). Prevalence of EI in those with and without CO was 15 % vs 14% (p=0.12). Compared to subjects without CO, individuals

S-759

AGA Abstracts

AGA Abstracts

(TGs) and fasting plasma glucose (FPG). MetS was diagnosed using criteria from the Japanese society for the study of obesity (JASSO) (waist circumference ≥85 cm in men, ≥90 cm in women plus at least two of following, TGs ≥150 mg/dl and/or HDL cholesterol <40 mmHg, systolic BP ≥140 mmHg and/or diastolic BP ≥85 mmHg, FPG ≥110 mg/dl). Symptoms were classified as reflux-like, dysmotility-like, or ulcer-like. Statistical calculation was performed using Student's t and Weltch's t test ,chi-square test, and logistic regression analysis. Results: The incidence of MetS was significantly higher in the CS group than the control group: in males (55.4% vs. 36.7%, p<0.001), females (36.6% vs. 1.6%, p<0.001), and total (50.4% vs. 29.7%, p<0.001). Males with CS, compared to controls, had significantly higher BMI (25.8±3.2 vs. 24.0±2.7 kg/m2, p<0.0001), waist circumference (89.0±8.6 vs. 84.7±7.6 cm, p<0.001), LDL cholesterol (133.14±76.7 vs. 122.0±31.0 mg/dl, p<0.05), TGs (154.9±110.8 vs. 134.7±83.0 mg/dl, p<0.05), and lower HDL cholesterol (50.7±11.8 vs. 55.1±16.7 mg/dl, p<0.001). Females with CS, compared to controls, had significantly higher BMI (27.3±4.8 vs. 22.1±3.7 kg/m2, p<0.0001), waist circumference (87.7±13.0 vs. 79.4±10.2 cm, p<0.0001), systolic BP (121.3±16.4 vs. 112.6±18.4 mmHg, p=0.0017), diastolic BP (74.5±12.2 vs. 69.0±10.9 mmHg, p=0.0034),and FPG <110 mg/dl. (97.6±10.5 vs. 93.4±9.1 mmHg, p<,0.01) According to multivariate analysis, CS was an independent risk factor for reflux symptoms (odds ratio: 3.98, 95%; CI: 1.80-8.83, p<0.001). Additionally, BMI (odds ratio: 3.55, 95%; CI: 2.45-5.17, p<0.0001) was an independent risk factor for CS. Conclusion: CS correlates with MetS, and CS is a risk factor for reflux symptoms. This study suggests MetS-related visceral obesity causes upper GI symptoms via cascade stomach.