Tu1841 Efficacy of Combined Treatment Using Helicobacter pylori Eradication Therapy Plus Antidepressant by Comparison With Eradication Therapy in Patients With Functional Dyspepsia: A Randomized Trial

AGA Abstracts

range [IQR] 37-56; male 51%). The population was comprised of diverse races (White 41%, Black 44%, Hispanic 6%, Asian 1%, Other/Unknown 9%), and insurance status (Private 19%, Medicare 19%, Medicaid 20%, Self-pay/other 42%). At time of admission, 12% of patients met criteria for SIRS, 54% had elevation in a liver chemistry to suggest an alcohol or biliary etiology. During hospitalization, 27% required the intensive care unit and a minority (4%) of patients underwent ERCP by median hospital day 2 (IQR 2-4) or CCY (15%) by median hospital day 4 (IQR 3-6). Median length of stay was 5 days (IQR 3-8), with inpatient and 30-day mortality of 2% each. Hispanic/Other patients were more likely to be younger, of female sex, have higher median ALT levels at presentation, and undergo same-stay CCY (table). There were no significant differences across race groups in patients meeting SIRS criteria, receiving enteral feeding/total parenteral nutrition, ICU stay or undergoing same-stay ERCP (table). On subgroup analysis of patients with any elevation in ALT (n=1114), Hispanic/Other patients (41%) were more likely than White (20%) and Black (14%) patients to receive CCY alone (p<0.001) or both ERCP/CCY (3% vs. 1% vs. 2%, p= 0.04). On multinomial regression analysis using White race as the reference group, Hispanic/ Other race was associated with greater likelihood of receiving CCY (relative odds 1.8, 95% CI 1.1-2.7). Conclusion: In a large cohort from an urban medical center, patients of different races with AP present with similar acuity and have comparable same-stay and 30-day mortality. Rates of same-stay ERCP and CCY are low across all races. Hispanic/Other race is associated with higher rates of biliary pancreatitis, as defined by greater elevations in liver chemistries and use of same-stay ERCP and CCY. Comparison of patient characteristics, admission criteria and interventions performed between difference races

± 0.46 vs. -1.79 ± 0.74 mmHg, p < 0.001; WAS vs. WAS + ILG; 0.71 ± 0.66 vs. -1.57 ± 0.51 mmHg, p < 0.05; L-NNA vs. L-NNA + ILG: -0.33 ± 0.76 vs. -1.37 ± 0.84 mmHg, p < 0.05). SB215505 also exhibited similar effects for improving inhibition of gastric accommodation. Conclusions: Experimentally derived inhibition of gastric accommodation was mediated by 5-HT2BR and improved by RKT via 5-HT2BR antagonism. Tu1840 Ameliorating Effects and Mechanisms of Transcutaneous Electroacupuncture at ST36 on Impairment in Postprandial Gastric Slow Waves Induced by Cold Stress in Healthy Subjects Nina Zhang, Geng-Qing Song, Jianfeng Chen, Lin Lin, Jieyun Yin, Jiande Chen AIM: Stress has long been documented to alter gastrointestinal motility. The effects of electroacupuncture (EA) on stress and gastric motility are relatively well known; however, whether EA has an ameliorating effect on stress-induced dysmotility remained unclear. The aim of this study was to investigate the effects and mechanisms of needleless transcutaneous EA (TEA) on stress-induced impairment in gastric slow waves. METHODS: Ten healthy volunteers (3F, aged 25-30 years) were involved in a four-session study (control, cold stress, stress+TEA and stress+sham-TEA). The control session was composed of one 30-min baseline recording in the fasting state and two 30-min recordings after a standard test meal. Cold stress was performed during the first 30-min period after the meal. The protocol of the other two sessions was the same as the stress session except that the volunteers were subjected to 30-min TEA at ST36 or sham-TEA initiated 10 min before cold stress and finished at the end of cold stress. Surface electrogastrograpy was used to assess gastric slow waves and electrocardiogram was recorded for the assessment of autonomic function using spectral analysis of heart rate variability. RESULTS: 1) TEA showed a preventive effect on cold stressinduced impairment in gastric slow waves. Cold stress decreased the percentage of normal 2-4 cycle/min slow waves (87±4% vs 71±7%, P<0.01). TEA at ST36, but not sham-TEA, normalized slow waves to 86±3% (P=0.03 vs. stress; P=0.44 vs. control), attributed to the suppression of gastric dysrhythmia: bradygastria reduced from 14±4% to 6±2% and tachygastria reduced from 10±3% to 7±2%. The instability coefficient of the dominant frequency was increased with cold stress (P<0.001) and this increase was ameliorated with TEA (P<0.05 vs. stress). 2) Postprandially, there was a decrease in vagal activity assessed from spectral analysis of heart rate variability in both control (P=0.004) and stress (P=0.002) sessions; this decrease was however prevented with TEA. The vagal activity in the postprandial session was higher with TEA than that sham-TEA (0.61±0.05 vs 0.47±0.05, P<0.05). Similarly, there was a postprandial increase in LF/HF ratio in both control (P=0.01) and stress (P=0.002) sessions and this increase was suppressed with TEA. CONCLUSION: TEA at ST36 is able to improve stress-induced impairment in gastric slow waves possibly mediated via the vagal mechanism. Tu1841 Efficacy of Combined Treatment Using Helicobacter pylori Eradication Therapy Plus Antidepressant by Comparison With Eradication Therapy in Patients With Functional Dyspepsia: A Randomized Trial Anatoliy Svintsitskyy, Iryna Korendovych, Viktor Korendovych Background: To date trials didn't fully resolve the question of efficacious treatment in functional dyspepsia (FD). Most of them report effects of antisecretory drugs, prokinetics, eradication of H. pylory. Antidepressants seems to be effective, as they reduce signs of anxiety and depression (A and D), which are thought to aggravate the symptoms in functional pathology, have central analgesic effect, improve sleep and have local effect on gastrointestinal tract. Objective: to assess the superiority of combined treatment using eradication therapy (ET) plus antidepressant by comparison with ET for patients with FD. Methods: In this randomized superiority trial adult patients (18 - 65 years) with confirmed diagnosis of FD were eligible to participate. Exclusion criteria: the presence of "red flag" signs and other comorbidities that could explain the symptoms. All patients were tested for H. pilory using two methods (rapid urease test and by morphological examination). To assess the presence of A and D Hamilton Anxiety and Depression Rating Scales were used. To assess quality of life, patients filled in WHOQOL-BREF questionnaire. To allocate patients randomly a numbered series of sealed envelopes containing group assignments were used. Patients of the first group were prescribed ET according to the Maastricht 4 ( 2010) plus escitalopram as follows: initial dose - 5 mg/day for the first two weeks of treatment; depending on individual response the dose could be increased to 10 mg/day. The second group received only ET for 10 days. Patients were assessed on the 14th day and after 1 month of treatment. The superiority was shown if there was more lasting decrease in symptoms severity, reduced A and D levels, improved functional health and quality of life of patients. Results: Of 75 randomized patients 43 were allocated to the first group and 32 to the second one. The groups were statistically comparable in age and sex. H. pylori was detected in all 75 patients. Treatment results showed reduction of dyspeptic symptoms such as postprandial heaviness and epigastric pain on the 14th day in both groups (1group-90.6%, 2group-75.0%), however symptoms recurrence occurred in a significant percent of the second group patients within the next 2 weeks (53.1%, P=0.0001). Comparing the levels of A and D before and after the treatment, there was a significant decrease in A and D in the first group compared to the second one (P < 0.001). The analysis of the questionnaire WHOQOL-BREF showed that patients of the first group recorded significantly higher improvement of quality of life (P < 0.001). Conclusion: The combination of ET plus antidepressant demonstrates clinical and statistical superiority to ET only showing more lasting symptoms regression, improved psychological and functional health and quality of life of patients.

Tu1839 Improvement Effect of Rikkunshito Mediated by Serotonin 2B Receptor Antagonism in Inhibition of Gastric Accommodation Hiroto Miwa, Junichi Koseki, Takahisa Yamasaki, Fumihiko Toyoshima, Hisatomo Ikehara, Tomohisa Hattori, Yoshio Kase, Tadayuki Oshima Background and Aims: Gastric accommodation is a response associated with relaxation of the gastric fundus following ingestion of a meal. Rikkunshito (RKT), a traditional Japanese medicine, induces proximal stomach relaxation in conscious dogs (Furukawa et al., Auton Neurosci; 2013). However, the effect of RKT on impaired gastric accommodation and its mechanism of action remain to be elucidated. Recently, flavonoids included in RKT were reported to antagonize serotonin (5-HT) 2B receptor (5-HT2BR), which induces smooth muscle contraction in the gastric fundus (Takeda et al., Gastroenterology; 2008). The present study examined the effects of RKT on stress and nitric oxide synthase inhibitor-induced inhibition of gastric accommodation and the association with 5-HT2BR antagonism as the mechanism of action using conscious guinea pigs. Methods: A polyethylene bag was inserted through the distal part of the gastric body and placed in the proximal stomach of 5-weekold male Hartley guinea pigs. These animals were submitted daily to 1 h of water-avoidance stress (WAS) for 2 consecutive days. Gastric accommodation was measured as follows: air (6 mL) was injected into the polyethylene bag at a flow rate of 2 mL/min and intrabag pressure at baseline was recorded for 1 min. Immediately after WAS, a liquid meal (4 mL, 1.7 kcal) was administered orally, and air (6 mL) was again injected into the bag. Intrabag pressure was then recorded for 1 min six times at 5-min intervals. L-NNA (nitric oxide synthase inhibitor; 10 mg/kg) was administered orally 60 min before the liquid meal. RKT (250-1000 mg/kg), RKT components (0.25-5 mg/kg), and SB215505 (5-HT2BR antagonist; 1, 6 mg/kg) were administered orally 30 min before the liquid meal. Results: In the control group, intrabag pressure was significantly decreased from 5 to 20 min after administration of liquid meal compared with basal levels, indicating induction of gastric accommodation. Conversely, gastric accommodation was significantly inhibited by WAS or administration of L-NNA. RKT and isoriquiritigenin (ILG), which exerts 5-HT2BR antagonism, improved inhibition of gastric accommodation by WAS or administration of L-NNA (WAS vs. WAS + RKT: 1.28 ± 0.76 vs. -1.84 ± 0.88 mmHg, p < 0.001; L-NNA vs. L-NNA + RKT: -0.16

AGA Abstracts

S-852