Why do patients with gastroesophageal reflux disease (GERD) have a poor health-related quality of life (HRQL)?

0.08 to 0.21. Conclusions: Non-obese male patients without a HH appear more likely to achieve HB resolution after acid suppression therapy in non-erosive reflux disease.Young non-obese females with a HH were least likely to respond. Supported by a grant from AstraZeneca LP, Wayne, PA.

2160 Placement of Hypopharynoeal pH Sensor Does Not Have to be Precise to Detect Esophagopharynoeal Reflux (EPR) William B. Evans,Abdul Jabber, Welby Winstead, Jeff W. Allen, Mark A. Wilson, Stephanie A. Carl, John M. We, Univ of Louisville, Louisville, KY

Leading Predictorsof Heartburn Resolution in 717 US Patients with Non,Erosive Reflux Disease DemographicVariables

E40

E20

P

Mule, Age • 50, BMI • 30, No HH Mule,Age • 50, BMI < 30, No HH Mule,Age • 50, BMI • 30, HH Male, Age • 50, BMI < 30, HH Mule, Age _<50, BMI • 30, No HH

0.508 0.483 0.468 0.443 0.410

0.540 0.515 0.500 0.475 0.441

0.213 0.197 0.t 87 0.173 0.154

Precise placement of the distal esophageal pH sensor at 5 cm above lower esophageal sphincter (LES) is important to diagnose GERD. Acid exposure differs considerably if pH sensor location varies a few cm. HypopharyngealpH tesflng at 2 cm above upper esophageal sphincter (UES) has been advocated to diagnose EPR. The pH sensor can be placed by manometry or by direct visualization, but if is difficult to put it in the precise position above UES. Geographicrelationship between pH sensor and UES is not constant becauseof pharyngeal cavity size, UES movement, and sensor displacement with swallowing. AIM: To determine if the location of hypopharyngealpH sensor is critical to diagnose EPR. Methods: Pts with laryngealcomplaints suggestiveof EPRwere enrolled prospectively.Proximal margin of UES was located by manometry. Pts underwent24-hr pH testing using a custom designed, quadruple-sensor pH catheter to monitor hypopharynx (3, 2 and 1 cm above UES) and proximal esophagus, pH artifacts were excluded by predefined criteria. Number of reflux episode, acid exposuretime, and % time pH<4 were comparedamong the 3 hypopharyngeal pH sensors. EPR was diagnosed if hypopharyngealreflux episodes >3. Results: 20 pts were enrolled. Resultsare shown in table. Numberof reflux episodesdiffered slightly but significantly among the 3 closely-spacedhypopharyngealsensors in total and upright periods. Acid exposure and % time pH<4 did not vary. 13 pts had EPR by pH test. Location of pH sensors did not alter the diagnosis in any pt. Conclusions: 1) Placement of hypopharyngealpH sensor does not have to be precise to detect EPR. 2) Amount of reflux is small in EPR, and effects of pH sensor displacement is minimal.

2158 Why Do Patients with Gaslreesophageal Reflux Disease (GERD) Rave a Poor HealthRelated Quality of Life (HROL)? Nicholas J. Talley, Dept of Medicine, Univ of Sydney, Nepean Hosp, Penrifb Australia; Ola Junghard, Ingela K. Wiklund, AstraZeneca R&D Molndal, Moelndal Sweden Background: A poor HRQL in patients with GERD has been shown across many studies. Objectives:To better understandwhy the symptoms of heartburnand acid regurgitation affect people'slives. Methods: The validated,disease-specificQuality of Life in Reflux and Dyspepsia questionnaire was completed at baselineand after 2 and 4 weeks of treatment by 984 male and female patients, aged 18-80 years, with an endoscopicallyverified diagnosis of symptomatic GERD included in two clinical trials. The response to each item in the QOLRAD was analyzed to show the proportion of patients reporting that beartbum or acid regurgitation affected them < during the past week. Change score correlations linking relief of reflux symptoms to improvement in aspects of HRQL were also calculated. Results: Before treatment the most pronounced dysfunction related to eat/drink problems, i.e. heartburn induced by food/drinks (81%) or by eating food one does not tolerate (61%), avoiding certain food/drinks (61%), having to eat less than usual (45%), or inability to eat what one likes (55%); sleep problems such as difficulty getting a good night sleep (49%), trouble getting to sleep (39%), and failing to wake up rested (42%); lack of vitality, i.e. feeling unwell (58%), tired or worn out (54%), lack of energy (41%); emotional problems, i.e. frustration (55%), irritability (55%), worry about health (47%), distress (45%), anxiety (40%). Daffy activities were affected in approximately 20% of patients although as many as 44% avoided bending over because of heartburn. After 2 weeks of treatment with esomeprazole all complaints were reducedto between 8% (feeling distressed) to 19% (heartburn induced food/drink problems). The 4-week results were similar. Relief of reflux symptoms at 2 weeks was correlated with improvement in eating/drinking problems (r=O.5O), vitality (r=0.46), well-being (r = 0.43), and sleep quality (r = 0.38), all p-values <0.0001. Conclusions: Heartburn disrupts a range of important aspects of life including eating and drinking habits, sleep quality, vitality, well-being and daily activities. With effective treatment such problems can promptly be resolved, suggesting effective acid suppression is important in improving HROL in patients with GERO.

HypopharyngealpH data (median & range) Total # of reflex episode* Total acid exposure (rain) Total % time pl-1<4(%) UpdgM # of reflux episodes Supine# of reflux episode

3 cm Above UES

2 ¢m Above UES

1 ¢m Above UES

t 1 (0-59) 2 (0-23) 0.2 (0-1.7) 6.5 (0-52) 0 (0-17)

14 (0-74) 2.5 (0-25) 0.2 (0-1.9) 11 (0-71) O(0-25)

17 (0-84) 3 (0-22) 0.2 (0-1.7) 13.5 (0-80) 1 (0-45)

*p
2161 Non-Acid Gastroesophageal Reflex Daniel Sitrim, K U Leuven, Leaven Belgium; Richard H. Holloway, Royal Adelaide Hosp, Adelaide Australia; Jiri Silny, Helmholtz Institute, Aachen Germany; Jan Tack, Jozef Janssens, K U Leuven, Leuven Belgium Gastmesophageal reflux that acidifies the esophagealmucosa to pH below 4.0 (traditional acid reflux) may provoke symptoms and esophagitis. Minor acid reflux events with pH drops above4.0 can ~11 inducesymptoms, lutraluminal electricalimpedance(IEI) allows for detection of non-acid liquid reflux. Recentstudies in infants using pH-impedaocefound a high prevalence of non-acid reflux in babies with respiratory symptoms. We aimed to characterize non-acid reflux in healthy adults and patients with GERD.Methods: Ambulatory 24-hour pH-impedance recordings were performed in 30 patients with GERD and 26 healthy controls. In 24 of the patients a Bilitec device was added to the ambulatory setup to measure bile reflux. Subjects received 3 semiliquid meals (400 ml; 600 Kcal) and were allowed free movement. After appropriate synchronization, pH, impedance and Bilitec data were displayed together and analyzedvisually. Non-acid reflux was defined as an orally progressing drop in IEI in at least 3 measuring segments (liquid reflux) with a pH drop of less than 1 unit. Bile reflux was defined as an increase in esophagealbilirubin absorbance > 0.14 longer than lOs. Results: The rate of non-acid reflux was similar in patients with GERD (11(8-16)/24h) and normals (13(8.5-19)/24h). Non-acid reflux constituted one third of all reflux events in both groups. It was very frequent early after the meals (40% of reflux events) and in recumbent position (40-60% of reflux events). Half of non-acid reflux episodes were pure liquid, compared to 17-30% with acid reflux. In patients with GERD, only 13/321 (4%) non-acid reflux events were classifiedas bile reflux. The majority (75%) of bile reflux events(n = 118) were associated with acid reflux (46% with pH below 4 and 29% with pH above 4). Only 25 % of bile reflux episodes were non-acid. The proximal extent of non-acid reflux was higher in patients with GERD than in controls, but it was significantly lower than that of acid reflux. The volume clearance of non acid reflux was significantly faster than that of acid reflux (13.7s (10-18) vs. 27s (16-53), p
2159 Benign And Malignant Laryngeal Lesions In Patients With Different Type Of Surgical Resection Of The Stomach. Rossella Cianci, Giovanni Cammarota, Antonio Gasbarrini, Jacopo Galli, StefaniaAgoetino, Fahiola Arsncio, Ping Piro77i,Antonio Martino, Maurizio Maurizi, GiuseppeFedeli, Giovanni Gasbarrini, Catholic Univ, Rome Italy Background/Aim: In recent years, some studies have shown a relative high incidence of otolaryngological manifestations in patients with GERD. We investigated the presence of esophageal and laryngeal lesions in patients with a previous surgical resection, who were therefore exposed to alkaline duodenal reflux. 11Patients and Methods: 40 patients (pts) (28M, mean age 65.92-+9.92; 12F, mean age 57.83-+13.84) were consecutivelyrecruited, all of them have a previous surgical resection, performed in 9/40 pts <10 years ago, in 13/40 pts 10<20 yrs, in 18/40 pts >20 yrs. The type of anastomosis observed in this patients was: 26 Billroth II (BII), 8 Billroth I (BI), 4 total gastrectomy (TG), 2 Roux en Y (RY). After informed consent,all of patients underwentanamnesticevaluationof esophagealand laryngeal findings and symptoms, of alchool intake and tobacco's use, EGDscopywith biopsy, indirect laryngoscopy or, in case of need, videolaryngoscopywith biopsy. Results: The anamnestic evluation have shown that 7/40 (17.5%) pts (5 with BII, 2 with TG) underwent cordectomy because of a squamocellular carcinoma of the larynx within 3 years previous this study; indirect laryngoscopy have shown: 4 (10%) pts with leucoplakia (all with BII), 8 (20%) pts with vocal cord edema,6 (15%) pts with posterior laryngitis, 8 (20%) pts with interarytenoid area edema, only 7 (17.5%) pts have no laryngeal lesions (3 BI, 1 BII, 1 RY). These data show a statistically significant increased incidence of neoplastic findings in those patients with a Billroth II resectionand total gastrectomy(p20 years ago. Discussion and Conclusions:The reflux of duodenalcontents into the esophagus can cause not only Barrett s esophagus and subsequent adenocarcinoma.The same mechanism can be hypotbizedfor laryngeal lesions in those patients with chronic reflux of duodenal contents. Obviously, severalyears are required to developmentof this damage.So, we consider the lesions of larynx as a long term complication of surgical resection.

2162 MulUchaeeel Intraluminal impedance (MII): Accuracy in detecting fasting reflux events (RE) compared to pH probe and manometry Steven S. Shay, Steven Bomeii, Joel E. Richter, ClevelandClin Fdn, Cleveland,OH Introduction. MII detects flow of gastric contents into the esophagusby measuring changes in impedance, and can distinguish liquid from gas reflux, it has been proposed as a new GERD test. Aim. To determine the accuracy of MII in detecting RE's in comparison to two standard GERD methods, pH probe and manometry, used simultaneously to maximize RE detection. Methods. Patients (n = 10) with both 1) severeendoscopic GERD(> grade 2) and 2) >10 RE's during routine esophagealmanometry (Man-RE, also termed "common cavity": increased intraesophagealpressurethat persists until decreasedby an esophagealcontraction) were compared to 10 normal volunteers. Simultaneous manometry (7 sites: esophagus (4),

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