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Tu1741 Clinical Outcome of Diabetic Versus Idiopathic Gastroparesis Undergoing Gastric Electrical Stimulation
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Table 2 Descriptive Statistics of Predictors at Baseline
AGA Abstracts
Clinical Outcome of Diabetic Versus Idiopathic Gastroparesis Undergoing Gastric Electrical Stimulation Ammar Hassan, Abigail Stocker, Lindsay McElmurray, Karen Beatty, Michael G. Hughes, Christina Pinkston, Guy Brock, Hani Rashed, Archana Kedar, Thomas L. Abell Introduction: Gastric Electrical Stimulation (GES) is used for patients with both diabetic (DM) and idiopathic (ID) gastroparesis; but which patients benefit the most is still not clear. We compared a group of both DM and ID patients with the symptoms (Sx) of gastroparesis (Gp) to identify baseline predictive clinical outcome characteristics. We hypothesized that specific characteristics might predict short and long term outcomes of GES in patients with gastroparesis. Patients: 38 patients with the Sx of Gp, (12 m, 36 f, mean age 43.9 yrs; 19 with DM and 19 ID) were studied at baseline, after temporary (t) GES in a prospective study. Methods: Patients were evaluated by GI Sx using a standardized patient reported outcome (PRO) daily diary and solid/liquid GET at baseline, and after temporary gastric electrical stimulation tGES as previously described (GIE, 74(3): 496-503). Autonomic nervous system (ANS) evaluation was performed utilizing traditional autonomics plus electrogastrography (TRAD/EGG; ACEM, Sandhill Scientific, Inc.) and by heart rate variability (HRV; ANX 3.0 Autonomic Monitor, ANSAR Medical Technologies, Inc.). Results were compared by Wilcoxson 2 sample test for characteristics and baseline symptom measures related to outcome of tGES. Results: Improvement in PRO symptoms was seen in both diabetic and non-diabetic patients. Liquid and solid emptying at 1 hour improved after tGES in nondiabetic patients (Table 1). TRAD/EGG measures of the 30/15 ratio (P- value 0.001), total pulse amplitude at rest (p= 0.01), minimum heart rate (p = 0.03), and HRV measures of sympathetic modulation at baseline (p = 0.02), parasympathetic response to Valsalva (p = 0.03), sympathetic response to standing (p = 0.01), and parasympathetic response to standing (p=0.02) were significantly associated with improvement in gastroparetic symptoms following both temporary and permanent gastric stimulation (table 2). Conclusions: In this group of patients with the Sx of Gp, both DM and ID patients improved in GI Sx but gastric emptying improved more in ID patients. Both traditional autonomic testing including EGG, and heart rate variability, may help predict outcome of tGES. The physiologic findings reported here may have clinical usefulness in the optimal selection of patients for gastric electrical stimulation used for the treatment of patients with the symptoms of gastroparesis. Table 1 Mean Values at Baseline and after Temporary Stimulation
Tu1742 Gastric Fluid From Patients Receiving Proton Pump Inhibitors Triggers Increased Neutrophil Migration Across Lung Epithelial Monolayers Independently of pH Bryan Hurley, Rebecca Jugo, Nikki Johnston, Rachel Rosen Background: Patients with chronic lung disease are frequently prescribed proton pump inhibitors (PPIs) in an effort to reduce any lung inflammation related to aspiration of acidic gastric contents, despite a paucity of data to support efficacy of this common clinical practice. It is the goal of this study to determine the impact of gastric contents on neutrophil transepithelial migration from patients who were and were not taking PPIs. Methods: We prospectively collected gastric fluid from 28 patients (14 taking PPIs) undergoing endoscopy. After collection, the pH of gastric fluid was measured and each sample was normalized through addition of either NaOH or HCl into two separate groups; acidic (pH < 4) and neutral (pH 6-8). Gastric contents from each patient representing each pH group were applied to the apical surface of polarized lung epithelial cells grown on Transwell filters for 1 hour. Following treatment, lung epithelial monolayers were washed and neutrophils were applied to the basolateral surface. Neutrophil trans-epithelial migration was assessed based on the number of neutrophils measured in the apical well following incubation for 2 hours. Additional analyses were performed with application of human pepsin to the lung epithelial model. Results: Very few neutrophils migrated in response to lung epithelial monolayers pre-treated with buffer alone (either acidic or neutral). The mean pH, which did not reach statistical significance, of patient gastric contents on and off PPIs was 2.1±1.4 and 1.4±1.0, respectively (p=0.17). There was a significantly greater average neutrophil trans-epithelial migratory response following exposure of lung epithelial cells to gastric fluid from patients taking PPIs (6.1 ± 3.1 number of neutrophils x 104 ) compared to untreated patients (2.1 ± 2.6 number of neutrophils x 104, p=0.002) and this difference could not be explained by pH differences between treated and untreated patients as there were no significant differences in the pH at the time of sampling or the pH at the time of neutrophil migration. These differences in migrating neutrophils was not observed when pH neutral gastric samples were applied to lung epithelial cells. When 50 ug/ml pepsin alone was applied to the model, there were significant differences in neutrophil migration seen at pH 3 (10.4 ± 2.2 number of neutrophils x 104 ) compared to neutral pHs (2.3 ± 0.5 number of neutrophils x 104 , p=0.0004). Conclusions: Gastric fluid induces neutrophil migration across lung epithelial monolayers and appears to be more pronounced when fluid is derived from PPI treated patients irrespective of gastric fluid pH. Pepsin may play a role in neutrophil migration.
Tu1743 Evidence for Neuro-Immune Activation and Its Relationship to Abdominal Pain in Children With Irritable Bowel Syndrome (IBS) Robert Shulman, Lena Ohman, Magnus Simren, Mats Stridsberg, Margaret Heitkemper Background Granins are proteins found in secretory cells of the enteric, endocrine, and immune system and appear to regulate secretory vesicle formation/biogenesis with graninderived peptides affecting hormone release and immune function. Beta-defensins are constitutively expressed antimicrobial peptides present in epithelial cells of the gut and other tissues. Preliminary data have suggested that fecal concentrations of certain granins and beta-defensins are increased in adults with IBS compared to healthy controls (HC). Aims To determine if fecal concentrations of chromogranins A and B, secretogranins 2 and 3, and beta-defensin 2 are increased in children with IBS compared to HC and relate to abdominal pain symptoms.
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AGA Abstracts
Table 2 Descriptive Statistics of Predictors at Baseline
AGA Abstracts
Clinical Outcome of Diabetic Versus Idiopathic Gastroparesis Undergoing Gastric Electrical Stimulation Ammar Hassan, Abigail Stocker, Lindsay McElmurray, Karen Beatty, Michael G. Hughes, Christina Pinkston, Guy Brock, Hani Rashed, Archana Kedar, Thomas L. Abell Introduction: Gastric Electrical Stimulation (GES) is used for patients with both diabetic (DM) and idiopathic (ID) gastroparesis; but which patients benefit the most is still not clear. We compared a group of both DM and ID patients with the symptoms (Sx) of gastroparesis (Gp) to identify baseline predictive clinical outcome characteristics. We hypothesized that specific characteristics might predict short and long term outcomes of GES in patients with gastroparesis. Patients: 38 patients with the Sx of Gp, (12 m, 36 f, mean age 43.9 yrs; 19 with DM and 19 ID) were studied at baseline, after temporary (t) GES in a prospective study. Methods: Patients were evaluated by GI Sx using a standardized patient reported outcome (PRO) daily diary and solid/liquid GET at baseline, and after temporary gastric electrical stimulation tGES as previously described (GIE, 74(3): 496-503). Autonomic nervous system (ANS) evaluation was performed utilizing traditional autonomics plus electrogastrography (TRAD/EGG; ACEM, Sandhill Scientific, Inc.) and by heart rate variability (HRV; ANX 3.0 Autonomic Monitor, ANSAR Medical Technologies, Inc.). Results were compared by Wilcoxson 2 sample test for characteristics and baseline symptom measures related to outcome of tGES. Results: Improvement in PRO symptoms was seen in both diabetic and non-diabetic patients. Liquid and solid emptying at 1 hour improved after tGES in nondiabetic patients (Table 1). TRAD/EGG measures of the 30/15 ratio (P- value 0.001), total pulse amplitude at rest (p= 0.01), minimum heart rate (p = 0.03), and HRV measures of sympathetic modulation at baseline (p = 0.02), parasympathetic response to Valsalva (p = 0.03), sympathetic response to standing (p = 0.01), and parasympathetic response to standing (p=0.02) were significantly associated with improvement in gastroparetic symptoms following both temporary and permanent gastric stimulation (table 2). Conclusions: In this group of patients with the Sx of Gp, both DM and ID patients improved in GI Sx but gastric emptying improved more in ID patients. Both traditional autonomic testing including EGG, and heart rate variability, may help predict outcome of tGES. The physiologic findings reported here may have clinical usefulness in the optimal selection of patients for gastric electrical stimulation used for the treatment of patients with the symptoms of gastroparesis. Table 1 Mean Values at Baseline and after Temporary Stimulation
Tu1742 Gastric Fluid From Patients Receiving Proton Pump Inhibitors Triggers Increased Neutrophil Migration Across Lung Epithelial Monolayers Independently of pH Bryan Hurley, Rebecca Jugo, Nikki Johnston, Rachel Rosen Background: Patients with chronic lung disease are frequently prescribed proton pump inhibitors (PPIs) in an effort to reduce any lung inflammation related to aspiration of acidic gastric contents, despite a paucity of data to support efficacy of this common clinical practice. It is the goal of this study to determine the impact of gastric contents on neutrophil transepithelial migration from patients who were and were not taking PPIs. Methods: We prospectively collected gastric fluid from 28 patients (14 taking PPIs) undergoing endoscopy. After collection, the pH of gastric fluid was measured and each sample was normalized through addition of either NaOH or HCl into two separate groups; acidic (pH < 4) and neutral (pH 6-8). Gastric contents from each patient representing each pH group were applied to the apical surface of polarized lung epithelial cells grown on Transwell filters for 1 hour. Following treatment, lung epithelial monolayers were washed and neutrophils were applied to the basolateral surface. Neutrophil trans-epithelial migration was assessed based on the number of neutrophils measured in the apical well following incubation for 2 hours. Additional analyses were performed with application of human pepsin to the lung epithelial model. Results: Very few neutrophils migrated in response to lung epithelial monolayers pre-treated with buffer alone (either acidic or neutral). The mean pH, which did not reach statistical significance, of patient gastric contents on and off PPIs was 2.1±1.4 and 1.4±1.0, respectively (p=0.17). There was a significantly greater average neutrophil trans-epithelial migratory response following exposure of lung epithelial cells to gastric fluid from patients taking PPIs (6.1 ± 3.1 number of neutrophils x 104 ) compared to untreated patients (2.1 ± 2.6 number of neutrophils x 104, p=0.002) and this difference could not be explained by pH differences between treated and untreated patients as there were no significant differences in the pH at the time of sampling or the pH at the time of neutrophil migration. These differences in migrating neutrophils was not observed when pH neutral gastric samples were applied to lung epithelial cells. When 50 ug/ml pepsin alone was applied to the model, there were significant differences in neutrophil migration seen at pH 3 (10.4 ± 2.2 number of neutrophils x 104 ) compared to neutral pHs (2.3 ± 0.5 number of neutrophils x 104 , p=0.0004). Conclusions: Gastric fluid induces neutrophil migration across lung epithelial monolayers and appears to be more pronounced when fluid is derived from PPI treated patients irrespective of gastric fluid pH. Pepsin may play a role in neutrophil migration.
Tu1743 Evidence for Neuro-Immune Activation and Its Relationship to Abdominal Pain in Children With Irritable Bowel Syndrome (IBS) Robert Shulman, Lena Ohman, Magnus Simren, Mats Stridsberg, Margaret Heitkemper Background Granins are proteins found in secretory cells of the enteric, endocrine, and immune system and appear to regulate secretory vesicle formation/biogenesis with graninderived peptides affecting hormone release and immune function. Beta-defensins are constitutively expressed antimicrobial peptides present in epithelial cells of the gut and other tissues. Preliminary data have suggested that fecal concentrations of certain granins and beta-defensins are increased in adults with IBS compared to healthy controls (HC). Aims To determine if fecal concentrations of chromogranins A and B, secretogranins 2 and 3, and beta-defensin 2 are increased in children with IBS compared to HC and relate to abdominal pain symptoms.
S-931
AGA Abstracts