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Tu1798 High Resolution Manometry Profile in Patients Before and After Fundoplication
AGA Abstracts
subjects responded to the web survey. After excluding individuals with malignancies or peptic ulcers, individuals without GERD symptoms, as well as those who were unemployed, 711 participants with GERD symptoms (44.3 ± 11.8 y, 66% men and 34% women), consisting of those who had not been prescribed medication to treat GERD symptoms (n = 343) and those who had been prescribed medication (n = 368), were included in the study. These participants reported a mean (± SD) loss of work productivity of 9.5 ± 12.7 h/wk, absenteeism of 0.55 ± 2.7 h/wk, and presenteeism of 8.9 ± 11.9 h/wk. Reduced productivity due to GERD symptoms while at work was 22%, reduced productivity while doing regular daily activities was 26%, and economic loss estimated by work productivity impairment was US$ 208 ± 302/wk. Increased symptom frequency and GerdQ score, and decreased satisfaction levels with medication were significantly associated with greater loss of work productivity (table, p , 0.001). By multiple regression analysis, loss of work productivity was significantly associated with the frequency of GERD symptoms (4-7 d/wk, β = 0.275 and p , 0.001; 2-3 d/wk, β = 0.286 and p , 0.001; 1 d/wk, β = 0.133 and p=0.031) and with the GerdQ score (β = 0.231 and p , 0.001). Conclusion: Increased GERD symptom frequency and GerdQ score, and decreased satisfaction with medication prescribed to treat GERD were significantly associated with reduced work productivity in a Japanese population, highlighting the economic impact of unmet medical needs for GERD. Loss of work productivity, the frequency and severity of GERD symptom, and satisfaction with medication
Tu1799 Autofluorescence Imaging Videoendoscopy Predicts Acid Reflux in Patients With Gastroesophageal Reflux Disease Weifeng Wang, Noriya Uedo, Yunsheng Yang, Lihua Peng, Juan Wang, Huihui Li, Xiaoxiao Wang Background: Endoscopic detection of non-erosive reflux disease (NERD) remains challenging. Although autofluorescence imaging (AFI) can identify indistinct mucosal lesions, its ability to diagnose gastroesophageal reflux disease (GERD) has not been determined. We therefore evaluated the ability of AFI endoscopy to detect mucosal changes associated with acid reflux. Methods: This prospective observational trial was conducted at two tertiary referral centres, the Chinese PLA General Hospital in Beijing, China and the Osaka Medical Center for Cancer and Cardiovascular Diseases in Osaka, Japan. We assessed 95 subjects consisting of men and women, aged 18-75 years, with heartburn and/or regurgitation lasting more than 1 month before screening. Patients were excluded if they had any known esophageal disease or disorder other than erosive esophagitis(EE); an active or healing gastroduodenal ulcer (except scars); a past history of esophageal or gastric surgery; clinically significant heart, lung, liver or kidney disease; or pregnancy. They were administered GerdQ questionnaires. Ambulatory 24-hour pH/impedance was monitored and endoscopy with white light imaging (WLI) and AFI was performed. Erosive esophagitis(EE) on WLI was determined using the Los Angeles classification. The normal esophageal mucosa appeared green on AFI. The appearance of a longitudinal purple line longer than 1cm on AFI endoscopy was defined as positive for GERD. Each patient's endoscopic findings were assessed independently by two endoscopists and the agreement of the two endoscopists was evaluated using Kappa statistics. Results: 82 subjects were included. Of the 34 patients with negative pH/impedance findings, 33 was normal on WLI except one with EE and18 were normal on AFI(Figure 1A). Of the 48 patients with positive pH/impedance findings, 38 was normal on WLI except 10 with EE and 37 showed positive AFI manifestations indicating the presence of GERD(Figure 1B). The sensitivity and accuracy of AFI (77% and 67%, respectively) in detecting GERD were higher than those of WLI (20% and 52%, respectively), although the specificity of AFI (53%) was lower than that of WLI (97%) (Table 1). Inter-observer reliability analysis of AFI findings indicated substantial agreement (Kappa = 0.63, p=0.000). Multivariate analysis showed that positive AFI findings significantly correlated with pH/impedance results (odds ratio [OR]=0.242, 95% confidence interval [CI] 0.087-0.673, p=0.007). Conclusion: AFI can detect esophageal mucosal changes related to acid reflux, invisible on conventional WLI, in patients with NERD, suggesting that AFI endoscopy may be effective in the endoscopic diagnosis of GERD. Table 1 Diagnostic parameters of WLI, GerdQ, and AFI in the diagnosis of GERD
* p,0.001 for trend (Spearman) Tu1798 High Resolution Manometry Profile in Patients Before and After Fundoplication Antoni Stadnicki, Katarzyna Bilnik, Józef Kurek, Ewa Klimacka-Nawrot Background/aims: It is defective knowledge related to the application of high resolution manometry (HRM) for the evaluation of the effect fundoplication. The aim of this study is to assess prospectively lower esophago - gastric junction and esophageal peristalsis by HRM in patients with gastroesophageal reflux disease (GERD) before and after laparoscopic Nissen fundoplication. Material and methods: HRM was performed in 25 patients with GERD before fundoplication (preoperative group) and at least 3 months after surgery (postoperative group). The manometric protocol included 10 consecutive swallows of 10 ml of water. Data analysis was done with esophageal pressure topography according to the Chicago Classification Results. In the postoperative group the mean basal LES pressure as well as the minimal basal LES pressure was significantly higher than in the preoperative group. Integrated relaxation pressure (IRP) was also significantly higher in the postoperative group as compared with the preoperative group. IRP values were within the reference range in both examined groups (, 15 mm Hg) except one patients in postoperative group. Before fundoplicatin 11 patients had hiatal hernia, but non after surgery. It was found significant increase of intrabolus pressure (IBP MAX) and decrease of contractile front velocity (CFV) in the postoperative group as compared with preoperative group. Distal contractile integral (DCI) was significantly higher in postoperarative group, however based on DCI threshold (450 mmHg/s/cm) it was observed only trend from ineffective to effective esophageal motility (p=0,07). In addition, double-peaked waves were more frequent in the postoperative than in the preoperative group. Early dysphagia was observed in 8 of 25 patients after fundoplication. The data were shown in table. Conclusions. HRM is valuable tool related to LES characteristic of GERD patients before after fundoplication. Fundoplication establishes antireflux barrier by increasing LES pressure and correcting hiatal hernia. Moderate increased of IRP may contribute to motility disorders and pressurization in some patients after fundoplication.
WLI: White light imaging GerdQ: GerdQ questionnaires AFI: Autofluorescence imaging PPV: Positive predictive value NPV: Negative predictive value
Figure 1. Normal and abnormal images of the distal esophagus on AFI. (A) AFI showing a normal green colour pattern. (B) AFI showing the appearance of purple colour lines in a patient diagnosed as NERD. AFI: Autofluorescence imaging
AGA Abstracts
S-848
subjects responded to the web survey. After excluding individuals with malignancies or peptic ulcers, individuals without GERD symptoms, as well as those who were unemployed, 711 participants with GERD symptoms (44.3 ± 11.8 y, 66% men and 34% women), consisting of those who had not been prescribed medication to treat GERD symptoms (n = 343) and those who had been prescribed medication (n = 368), were included in the study. These participants reported a mean (± SD) loss of work productivity of 9.5 ± 12.7 h/wk, absenteeism of 0.55 ± 2.7 h/wk, and presenteeism of 8.9 ± 11.9 h/wk. Reduced productivity due to GERD symptoms while at work was 22%, reduced productivity while doing regular daily activities was 26%, and economic loss estimated by work productivity impairment was US$ 208 ± 302/wk. Increased symptom frequency and GerdQ score, and decreased satisfaction levels with medication were significantly associated with greater loss of work productivity (table, p , 0.001). By multiple regression analysis, loss of work productivity was significantly associated with the frequency of GERD symptoms (4-7 d/wk, β = 0.275 and p , 0.001; 2-3 d/wk, β = 0.286 and p , 0.001; 1 d/wk, β = 0.133 and p=0.031) and with the GerdQ score (β = 0.231 and p , 0.001). Conclusion: Increased GERD symptom frequency and GerdQ score, and decreased satisfaction with medication prescribed to treat GERD were significantly associated with reduced work productivity in a Japanese population, highlighting the economic impact of unmet medical needs for GERD. Loss of work productivity, the frequency and severity of GERD symptom, and satisfaction with medication
Tu1799 Autofluorescence Imaging Videoendoscopy Predicts Acid Reflux in Patients With Gastroesophageal Reflux Disease Weifeng Wang, Noriya Uedo, Yunsheng Yang, Lihua Peng, Juan Wang, Huihui Li, Xiaoxiao Wang Background: Endoscopic detection of non-erosive reflux disease (NERD) remains challenging. Although autofluorescence imaging (AFI) can identify indistinct mucosal lesions, its ability to diagnose gastroesophageal reflux disease (GERD) has not been determined. We therefore evaluated the ability of AFI endoscopy to detect mucosal changes associated with acid reflux. Methods: This prospective observational trial was conducted at two tertiary referral centres, the Chinese PLA General Hospital in Beijing, China and the Osaka Medical Center for Cancer and Cardiovascular Diseases in Osaka, Japan. We assessed 95 subjects consisting of men and women, aged 18-75 years, with heartburn and/or regurgitation lasting more than 1 month before screening. Patients were excluded if they had any known esophageal disease or disorder other than erosive esophagitis(EE); an active or healing gastroduodenal ulcer (except scars); a past history of esophageal or gastric surgery; clinically significant heart, lung, liver or kidney disease; or pregnancy. They were administered GerdQ questionnaires. Ambulatory 24-hour pH/impedance was monitored and endoscopy with white light imaging (WLI) and AFI was performed. Erosive esophagitis(EE) on WLI was determined using the Los Angeles classification. The normal esophageal mucosa appeared green on AFI. The appearance of a longitudinal purple line longer than 1cm on AFI endoscopy was defined as positive for GERD. Each patient's endoscopic findings were assessed independently by two endoscopists and the agreement of the two endoscopists was evaluated using Kappa statistics. Results: 82 subjects were included. Of the 34 patients with negative pH/impedance findings, 33 was normal on WLI except one with EE and18 were normal on AFI(Figure 1A). Of the 48 patients with positive pH/impedance findings, 38 was normal on WLI except 10 with EE and 37 showed positive AFI manifestations indicating the presence of GERD(Figure 1B). The sensitivity and accuracy of AFI (77% and 67%, respectively) in detecting GERD were higher than those of WLI (20% and 52%, respectively), although the specificity of AFI (53%) was lower than that of WLI (97%) (Table 1). Inter-observer reliability analysis of AFI findings indicated substantial agreement (Kappa = 0.63, p=0.000). Multivariate analysis showed that positive AFI findings significantly correlated with pH/impedance results (odds ratio [OR]=0.242, 95% confidence interval [CI] 0.087-0.673, p=0.007). Conclusion: AFI can detect esophageal mucosal changes related to acid reflux, invisible on conventional WLI, in patients with NERD, suggesting that AFI endoscopy may be effective in the endoscopic diagnosis of GERD. Table 1 Diagnostic parameters of WLI, GerdQ, and AFI in the diagnosis of GERD
* p,0.001 for trend (Spearman) Tu1798 High Resolution Manometry Profile in Patients Before and After Fundoplication Antoni Stadnicki, Katarzyna Bilnik, Józef Kurek, Ewa Klimacka-Nawrot Background/aims: It is defective knowledge related to the application of high resolution manometry (HRM) for the evaluation of the effect fundoplication. The aim of this study is to assess prospectively lower esophago - gastric junction and esophageal peristalsis by HRM in patients with gastroesophageal reflux disease (GERD) before and after laparoscopic Nissen fundoplication. Material and methods: HRM was performed in 25 patients with GERD before fundoplication (preoperative group) and at least 3 months after surgery (postoperative group). The manometric protocol included 10 consecutive swallows of 10 ml of water. Data analysis was done with esophageal pressure topography according to the Chicago Classification Results. In the postoperative group the mean basal LES pressure as well as the minimal basal LES pressure was significantly higher than in the preoperative group. Integrated relaxation pressure (IRP) was also significantly higher in the postoperative group as compared with the preoperative group. IRP values were within the reference range in both examined groups (, 15 mm Hg) except one patients in postoperative group. Before fundoplicatin 11 patients had hiatal hernia, but non after surgery. It was found significant increase of intrabolus pressure (IBP MAX) and decrease of contractile front velocity (CFV) in the postoperative group as compared with preoperative group. Distal contractile integral (DCI) was significantly higher in postoperarative group, however based on DCI threshold (450 mmHg/s/cm) it was observed only trend from ineffective to effective esophageal motility (p=0,07). In addition, double-peaked waves were more frequent in the postoperative than in the preoperative group. Early dysphagia was observed in 8 of 25 patients after fundoplication. The data were shown in table. Conclusions. HRM is valuable tool related to LES characteristic of GERD patients before after fundoplication. Fundoplication establishes antireflux barrier by increasing LES pressure and correcting hiatal hernia. Moderate increased of IRP may contribute to motility disorders and pressurization in some patients after fundoplication.
WLI: White light imaging GerdQ: GerdQ questionnaires AFI: Autofluorescence imaging PPV: Positive predictive value NPV: Negative predictive value
Figure 1. Normal and abnormal images of the distal esophagus on AFI. (A) AFI showing a normal green colour pattern. (B) AFI showing the appearance of purple colour lines in a patient diagnosed as NERD. AFI: Autofluorescence imaging
AGA Abstracts
S-848