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Tu1428 Using the Rome III Criteria to Diagnose Functional Gastrointestinal Disorders: One Is the Loneliest Number
AGA Abstracts
GIBS score ≥ 3 (normal <3). 12 patients had ANS assessment performed of which 10 (83%) had abnormal adrenergic response, 5 (42%) had abnormal cholinergic response and 10 (83%) had abnormal EGG. Full Thickness Gastric biopsy was performed in 18 patients. Average number of interstitial cells of Cajal (ICC) as determined by CD117 was 2.07 (normal: 5-6), and only 2 patients had normal levels of ICC. However, 14/18 patients had evidence of immune cells in gastric biopsy, as determined by CD68, at an average of 6.6 immune cells/patient. Median number of neuronal fibers as determined by S100 was 8.55 (Normal: >15). 24 patients had placement of temporary GES followed by a permanent GES. This subgroup of patients (n=23, data missing for 1 patient) showed a good response in symptoms to temporary GES with a p-value of <0.00001 for total symptoms score or TSS but a lack of response to permanent GES with a p-value of 0.73 for TSS (table 1). In contrast, a reference group of consecutive patients, show good response to both temporary and permanent GES (table 2). This lack of response to permanent GES may be a marker of neuromuscular disorder in patients with neuromuscular abnormalities. Conclusions: In the group of patients who are drug and/or device refractory, a wide variety of neuromuscular abnormalities are detected. Application of neuro-muscular laboratory evaluation to larger groups of patients with the symptoms of gastroparesis may be warranted. Table 1: GES in neuromuscular patients. n=23
criteria for one FGID and 10.9% met criteria for 2 FGID diagnoses. 64.6% of patients had 3 or more FGID diagnoses. The highest number of FGID diagnoses was 12 in one patient. The most common diagnosis was irritable bowel syndrome in 48.6% of patients. In the 318 patients with IBS, 29.6% of them also met criteria for functional dyspepsia. Of the 120 patients with functional dyspepsia, all of them also met criteria for post-prandial distress syndrome, whereas only 4% met criteria for epigastric pain syndrome. Conclusion: FGIDs are a group of highly prevalent conditions that lead to significant patient and healthcare burden. Diagnosing patients with FGIDs is important so that appropriate investigation can be performed and specific treatment can be recommended. The Rome criteria are an important tool in the diagnosis of FGIDs. However, they often do not lead to a singular diagnosis, and the majority of patients are classified into multiple diagnostic categories. In particular, IBS and functional dyspepsia overlap the most. Clinicians and researchers should be aware of the high likelihood of multiple FGID diagnoses and the practical limitations they may impose. Tu1429 Is Proton Pump Inhibitor Use Associated With Delayed Gastric Emptying in Functional Dyspepsia Subjects? Ann E. Almazar, Yuri A. Saito, Giles Locke, Michael Camilleri, Duane D. Burton, Ernest P. Bouras, Colin W. Howden, Brian E. Lacy, John K. DiBaise, Charlene M. Prather, Bincy Abraham, Hashem B. El-Serag, Paul Moayyedi, Linda M. Herrick, Lawrence A. Szarka, Frank A. Hamilton, Katherine E. Tilkes, Cathy D. Schleck, Alan R. Zinsmeister, Nicholas J. Talley Background: Proton pump inhibitors (PPIs) are commonly prescribed for both gastroesophageal reflux disease (GERD) and functional dyspepsia (FD). Approximately one-third of FD patients have delayed gastric emptying. Prior studies of PPIs and gastric emptying of caloriecontaining liquids have shown a variable effect: delayed gastric emptying or no effect on gastric emptying. It is unknown whether PPI use, with decreased gastric secretions, could be associated with slower gastric emptying. Aim: To evaluate whether gastric emptying (GE) time differs between FD patients on PPI compared to no PPI. Methods: This study used baseline data from the Functional Dyspepsia Treatment Trial (FDTT), a 12-week, multicenter, randomized, double blind, placebo-controlled trial evaluating the efficacy of antidepressants on FD symptoms. Subjects were required to meet Rome II criteria for FD. Subjects were excluded if they had erosive esophagitis, predominant heartburn or acid regurgitation, and those who have had an adequate response to anti-secretory therapy. Gastric emptying (GE) was measured by scintigraphy after an overnight fast, applying a standardized meal. Subjects completed questionnaires including the Symptom Somatic Checklist (SSC), Hospital Anxiety and Depression Scale (HADS). The univariate association between PPI use and each of the individual characteristics and GE measures was assessed using a chi square test, rank sum test, or 2-sample t-test as warranted. Results: There were 292 subjects randomized: mean age was 44, 219 (75%) were female, 250 (86%) were Caucasian, while 207 (70%) had dysmotility-like FD and 88 (30%) had ulcer-like FD. PPI and GE data was available for 288 (99%): 63(22%) were taking a PPI and 225(78%) were not. Data and comparisons are summarized in the Table. PPI use was associated with age and gender with those not taking a PPI being younger and female. PPI therapy was also associated with gastric emptying being slower at 1 hr (23.5 (2.0) v. 26.9 (1.1), p=0.06) and 2 hours (48.0 (2.5) v. 58.0 (1.4), p<0.001), but not 4 hours (N.S.). GE t½ was longer for those on PPIs (126 (6) v. 114 (3), p=0.03). The proportion with delayed gastric emptying at 4 hours was not associated with PPI use. Conclusions: This analysis showed that early gastric emptying at 1 and 2 hours is slower, and GE t½ is longer, in FD patients taking a PPI. PPI use was not associated with GE at 4 hours.
Table 2: GES in a reference group, n=81
Tu1428 Using the Rome III Criteria to Diagnose Functional Gastrointestinal Disorders: One Is the Loneliest Number Nikhil Agarwal, Richard E. Shaw, Mimi S. Lin, William J. Snape Background: The Rome criteria were developed to help classify functional gastrointestinal disorders (FGIDs). FGIDs do not typically have anatomic abnormalities on standard diagnostic testing, and therefore the diagnosis is usually made on symptoms alone. The most recent iteration, the Rome III criteria, classifies FGIDs into functional esophageal disorders, functional gastroduodenal disorders, functional bowel disorders, functional abdominal pain syndrome, functional gallbladder and sphincter of Oddi disorders and functional anorectal disorders. Although the Rome III criteria helps clinicians unify patients' symptoms into a class of FGIDs, the ability to make a singular diagnosis is often difficult, and patients often have more than one FGID as the cause of this symptom. Aims: The aim of this study was to determine the frequencies of different FGIDs in a cohort of patients and determined the presence of overlapping syndromes. Methods: We performed a prospective study of patients presenting to our motility clinic for evaluation of digestive symptoms. Patients were given the Rome III questionnaire on a scan form at the time of their initial consultation. Forms were scanned into a database and scored based on standard Rome III criteria, producing a major diagnosis for each patient. The frequency of diagnoses was calculated using the IBM/ SPSS statistical software. Results: A total of 654 patients presented to our motility clinic between January 1, 2012 and October 30, 2013 and completed the Rome III questionnaire. 9.5% of the patients did not meet criteria for any FGID diagnosis. Only 15% met diagnostic
AGA Abstracts
SSC=Symptom Somatic Checklist, BMI=Body Mass Index, HADS=Hospital Anxiety and Depression Scale #From CRF &=Rank sum test, §=Chi Square test, α=2-sample t-test +Delayed GE <84% emptying at 4 hours
S-888
GIBS score ≥ 3 (normal <3). 12 patients had ANS assessment performed of which 10 (83%) had abnormal adrenergic response, 5 (42%) had abnormal cholinergic response and 10 (83%) had abnormal EGG. Full Thickness Gastric biopsy was performed in 18 patients. Average number of interstitial cells of Cajal (ICC) as determined by CD117 was 2.07 (normal: 5-6), and only 2 patients had normal levels of ICC. However, 14/18 patients had evidence of immune cells in gastric biopsy, as determined by CD68, at an average of 6.6 immune cells/patient. Median number of neuronal fibers as determined by S100 was 8.55 (Normal: >15). 24 patients had placement of temporary GES followed by a permanent GES. This subgroup of patients (n=23, data missing for 1 patient) showed a good response in symptoms to temporary GES with a p-value of <0.00001 for total symptoms score or TSS but a lack of response to permanent GES with a p-value of 0.73 for TSS (table 1). In contrast, a reference group of consecutive patients, show good response to both temporary and permanent GES (table 2). This lack of response to permanent GES may be a marker of neuromuscular disorder in patients with neuromuscular abnormalities. Conclusions: In the group of patients who are drug and/or device refractory, a wide variety of neuromuscular abnormalities are detected. Application of neuro-muscular laboratory evaluation to larger groups of patients with the symptoms of gastroparesis may be warranted. Table 1: GES in neuromuscular patients. n=23
criteria for one FGID and 10.9% met criteria for 2 FGID diagnoses. 64.6% of patients had 3 or more FGID diagnoses. The highest number of FGID diagnoses was 12 in one patient. The most common diagnosis was irritable bowel syndrome in 48.6% of patients. In the 318 patients with IBS, 29.6% of them also met criteria for functional dyspepsia. Of the 120 patients with functional dyspepsia, all of them also met criteria for post-prandial distress syndrome, whereas only 4% met criteria for epigastric pain syndrome. Conclusion: FGIDs are a group of highly prevalent conditions that lead to significant patient and healthcare burden. Diagnosing patients with FGIDs is important so that appropriate investigation can be performed and specific treatment can be recommended. The Rome criteria are an important tool in the diagnosis of FGIDs. However, they often do not lead to a singular diagnosis, and the majority of patients are classified into multiple diagnostic categories. In particular, IBS and functional dyspepsia overlap the most. Clinicians and researchers should be aware of the high likelihood of multiple FGID diagnoses and the practical limitations they may impose. Tu1429 Is Proton Pump Inhibitor Use Associated With Delayed Gastric Emptying in Functional Dyspepsia Subjects? Ann E. Almazar, Yuri A. Saito, Giles Locke, Michael Camilleri, Duane D. Burton, Ernest P. Bouras, Colin W. Howden, Brian E. Lacy, John K. DiBaise, Charlene M. Prather, Bincy Abraham, Hashem B. El-Serag, Paul Moayyedi, Linda M. Herrick, Lawrence A. Szarka, Frank A. Hamilton, Katherine E. Tilkes, Cathy D. Schleck, Alan R. Zinsmeister, Nicholas J. Talley Background: Proton pump inhibitors (PPIs) are commonly prescribed for both gastroesophageal reflux disease (GERD) and functional dyspepsia (FD). Approximately one-third of FD patients have delayed gastric emptying. Prior studies of PPIs and gastric emptying of caloriecontaining liquids have shown a variable effect: delayed gastric emptying or no effect on gastric emptying. It is unknown whether PPI use, with decreased gastric secretions, could be associated with slower gastric emptying. Aim: To evaluate whether gastric emptying (GE) time differs between FD patients on PPI compared to no PPI. Methods: This study used baseline data from the Functional Dyspepsia Treatment Trial (FDTT), a 12-week, multicenter, randomized, double blind, placebo-controlled trial evaluating the efficacy of antidepressants on FD symptoms. Subjects were required to meet Rome II criteria for FD. Subjects were excluded if they had erosive esophagitis, predominant heartburn or acid regurgitation, and those who have had an adequate response to anti-secretory therapy. Gastric emptying (GE) was measured by scintigraphy after an overnight fast, applying a standardized meal. Subjects completed questionnaires including the Symptom Somatic Checklist (SSC), Hospital Anxiety and Depression Scale (HADS). The univariate association between PPI use and each of the individual characteristics and GE measures was assessed using a chi square test, rank sum test, or 2-sample t-test as warranted. Results: There were 292 subjects randomized: mean age was 44, 219 (75%) were female, 250 (86%) were Caucasian, while 207 (70%) had dysmotility-like FD and 88 (30%) had ulcer-like FD. PPI and GE data was available for 288 (99%): 63(22%) were taking a PPI and 225(78%) were not. Data and comparisons are summarized in the Table. PPI use was associated with age and gender with those not taking a PPI being younger and female. PPI therapy was also associated with gastric emptying being slower at 1 hr (23.5 (2.0) v. 26.9 (1.1), p=0.06) and 2 hours (48.0 (2.5) v. 58.0 (1.4), p<0.001), but not 4 hours (N.S.). GE t½ was longer for those on PPIs (126 (6) v. 114 (3), p=0.03). The proportion with delayed gastric emptying at 4 hours was not associated with PPI use. Conclusions: This analysis showed that early gastric emptying at 1 and 2 hours is slower, and GE t½ is longer, in FD patients taking a PPI. PPI use was not associated with GE at 4 hours.
Table 2: GES in a reference group, n=81
Tu1428 Using the Rome III Criteria to Diagnose Functional Gastrointestinal Disorders: One Is the Loneliest Number Nikhil Agarwal, Richard E. Shaw, Mimi S. Lin, William J. Snape Background: The Rome criteria were developed to help classify functional gastrointestinal disorders (FGIDs). FGIDs do not typically have anatomic abnormalities on standard diagnostic testing, and therefore the diagnosis is usually made on symptoms alone. The most recent iteration, the Rome III criteria, classifies FGIDs into functional esophageal disorders, functional gastroduodenal disorders, functional bowel disorders, functional abdominal pain syndrome, functional gallbladder and sphincter of Oddi disorders and functional anorectal disorders. Although the Rome III criteria helps clinicians unify patients' symptoms into a class of FGIDs, the ability to make a singular diagnosis is often difficult, and patients often have more than one FGID as the cause of this symptom. Aims: The aim of this study was to determine the frequencies of different FGIDs in a cohort of patients and determined the presence of overlapping syndromes. Methods: We performed a prospective study of patients presenting to our motility clinic for evaluation of digestive symptoms. Patients were given the Rome III questionnaire on a scan form at the time of their initial consultation. Forms were scanned into a database and scored based on standard Rome III criteria, producing a major diagnosis for each patient. The frequency of diagnoses was calculated using the IBM/ SPSS statistical software. Results: A total of 654 patients presented to our motility clinic between January 1, 2012 and October 30, 2013 and completed the Rome III questionnaire. 9.5% of the patients did not meet criteria for any FGID diagnosis. Only 15% met diagnostic
AGA Abstracts
SSC=Symptom Somatic Checklist, BMI=Body Mass Index, HADS=Hospital Anxiety and Depression Scale #From CRF &=Rank sum test, §=Chi Square test, α=2-sample t-test +Delayed GE <84% emptying at 4 hours
S-888