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A1216 AGA ABSTRACTS GASTROENTEROLOGY Vol. 118, No.4 5577 ASSOCIATION OF FAMILY HISTORY OF GASTRIC CANCER, INTESTINAL METAPLASIA AND HIGH GASTRIC JUICE AM- MONIA IN PATIENTS WITH HELICOBACTER PYLORI INFEC- TION. Premysl Bercik, Elena F. Verdu, Marek Ferkl, Manfred Stolte, Yoshio Wakatsuki, David Armstrong, Miroslav Zavoral, Postgrad Inst of Gastro- enterol, Cent Military Hosp, Prague, Czech Republic; Institute of Pathol- ogy, Clin Bayreuth, Bayreuth, Germany; Div of Gastroenterology, Kyoto Vniv, Kyoto, Japan; Div of Gastroenterology, McMaster Univ, Hamilton, Canada. Background: Although Helicobacter pylori (Hp) is recognized to be a gastric carcinogen, the roles played by genetic, host and bacterial factors in 5576 EARLY ENDOSCOPY AS THE ADEQUATE DIAGNOSTICAL AP- PROACH FOR CLASSIFICATION OF CORROSIVE INJURIES OF THE OESOPHAGUS AND STOMACH. Laszlo Bene, Geza Korosi, A. Dakhlaoni, Gabor Zacher, Tamas Berenyi, M. Karteszi, Peterfy S utcai Korhaz, Budapest, Hungary. In accordance with the recently accepted view that endoscopy,best per- formed 12 to 24 h after acids and alkali ingestion in all symptomatic patients, documents the anatomic site and often the severity of the injury, we evaluated the diagnostical advantage of this procedure in all our patients with corrosive injuries in the last two years. Methods: Upper panendoscopy was performed within 6 to 24 h in 125 patients hospitalized in an emergency to our departments with alkali In=48/, acids In=641 or other agents In= 131 injury. Chest and abdomined x-rays and routine laboratory values were also obtained to evaluate for aspiration,perforation and organ disfunction. Results: By classifying the severity of the injuries through endoscopy as being mild, moderate and sevier we obtained the following distribution of our patients: mild moderate sevier Alkali 24 14 10 Acids 20 14 30 Conclusion: Early endoscopy in patients with corrosive injuries seems to be an important diagnostical procedure predicting the outcome of the case and determining the classification of the patients in considered to be more precize that regarding almost all the patients as sevier case indicated by the clinical symptoms. 5575 DUODENAL ULCER, BODY MASS AND SMOKING ARE STRONG PREDICTORS OF .:i 13 C0 2 IN A LARGE SERIES OFHE· LICOBACTER PYLORI POSITIVE SUBJECTS (LOIANO·MONG· HIDORO STUDY). Franco Bazzoli, Domenico Palli, Rocco M. Zagari, Giovanna Masala, Paolo Pozzato, Gianni Nicolini, Stefania Fossi, Luca De Luca, Debora Berretti, Luigi Ricciardiello, Davide Festi, Enrico Roda, Stefania Maltoni, Lorenzo Fuccio, Cristina Martuzzi, Univ of Bologna, Bologna, Italy; Epidemiology Unit, CSPO, Florence, Italy; Univ of Chieti, Chieti, Italy. Helicobacter pylori (Hp) infection has been related to different patholog- ical manifestations ranging from ?astritis to peptic ulcer, lymphoma and cancer. The 13C urea breath teste 3C-UBT)is supposed to correlate with bacterial density, a determinant of mucosal inflammation. We have previ- ously reported (Gastroenterology 1997,4,A68 I-II-III) preliminary results of a large cross sectional study on prevalence of Hp infection in Loiano- Monghidoro, a rural area near Bologna, Italy, assessed by 13C-VBT. Aim: to evaluate differences in 8 13COzexcretion in relation to past history of peptic ulcer and individual characteristics. Methods: 1,533 subjects ac- cepted to be evaluated in relation to their Hp status by the 13C-UBT. A standardized questionnaire for socio-demographic and life style factors was also administred. For 1,079 subjects reliable information on weight and height was available and body surface area was estimated. Results: Out of 1,079 participants with anthropometric measures, 791(73.3%; 438 males, 353 females) resulted positive for Hp infection (8 13COzexcretion > than 5). We observed that mean 8 13CO zwas significantly higher in females (28.5) than in males (25.8). Current smokers had significantly lower values (21.9) than ex smokers (25.3) and non smokers (28.5). Subjects reporting a personal history of duodenal ulcer tended to have a higher mean excretion (31.2) than subjects with no history of peptic disease (26.6) or with a history of gastric ulcer (27.1) (NS). A multivariate analysis (including terms for sex, age, weight, smoking and duodenal ulcer) showed a negative association of 8 13COzexcretion with weight (p=0.006), current smoking (p=O.OOOI) and a positive association with duodenal ulcer (p=0.02); no association with sex, age, and gastric ulcer persisted in this multivariate analysis. Body surface area had the same effect of weight. Conclusions: Observed differences in 8 13COzexcretion were due to the effect of few significant predictors: body mass (either measured as weight or body surface), current smoking and duodenal ulcer. Heavier subjects and smok- ers have significantly lower values, while in contrast duodenal ulcer pa- tients have significantly hi§her 8 13COzexcretion. These results suggest that in the evaluation of 8 I COzexcretion anthropometric measures (body mass) and information on smoking status should be considered. alkali acids mild 24 20 moderate 14 14 sevier 10 30 the progression from H. pylori (Hp) gastritis to gastric cancer (GC) are unknown. Aim: To investigate the relationship between gastric concentra- tions of ammonia (NH 3) produced by Hp and a family history (FH) of Gc. Methods: Patients undergoing upper GJ. endoscopy were interviewed to identify those with (FH+) and without (FH-) a FH of GC in 1st and 2nd degree relatives. Relatives of GC patients (FH-t-] were also invited to participate. Hp infection (Hp+) was diagnosed by Rapid Urease Test and by histology. Hp density, gastritis and intestinal metaplasia (1M) were scored in antral and corpus biopsies (modified Sydney classification). Gastric [NH 3 J in aspirates obtained at endoscopy was measured using an NH 3sensitive electrode. Serum was obtained for Hp serology and cagA status (ELISA). Results: Table shows median values; Fisher s Exact Test & Mann Whitney V Test. Summary: Hp infected patients with a FH of GC have a higher prevalence of 1M and a higher gastric [NH 3 J than infected patients without a FH of GC. This appears to be unrelated to age, Hp density and CagA status. Conclusions: Ammonia may playa role in the pathogenesis of a potentially pre-malignant lesion (intestinal metaplasia) in Hp-infected patients. Measurement of intra-gastric [NH 3 J may be a useful screening tool for Hp-infected individuals who are at risk of gastric cancer. Supported by Czech Grant Agency No. 4306-2 IGA MZ CR. Hp+/FH+ Hp+IFH. H/tIFH· Nol age (yrs) 18(51.5) 26(54) 46 (51) Hpdensity 25 2.5 CagA+ve 9/18 (50%) 11/26 (42%) 1M '5/18 (27%) 1/26(4%) 0/46 (0%) [NH31 '5.5mM 3.1 mM 1.3mM ('p<0.05= Hp+/FH+vs Hp+/FH-) 5578 WHAT PROPORTION OF DYSPEPTIC PATIENTS HAVING H.PYLORI BREATH TEST SUBSEQUENTLY UNDERGO ENDOS- COPY? Kalpesh Besherdas, Jude Oben, Eric Beck, Robin Vicary, Voi Shim Wong, Whittington Hosp, London, United Kingdom. Background H.pylori (HP) testing in young patients with uncomplicated dyspepsia has been recommended. A test and treat strategy for dyspeptics positive for HP is recommended by the AGA and, reassurance 1 symptom- atic treatment in those who test negative. Aims To assess the rates of re-referral for upper OJ endoscopy (OGD) and outpatient (OPD) atten- dance in uncomplicated dyspeptic patients following assessment of HP status. Methods Between August 1997 and July 1998, 190 patients under 50 years of age (83 males; aged 17 to 50, mean age 34yrs) with uncom- plicated dyspepsia (without alarm symptoms) referred from primary care to gastroenterology underwent HP urea breath test (VBT). Primary care physicians were informed of the results of UBT and recommended eradi- cation therapy if positive, and if negative advised symptomatic treatment with an acid suppressant +1- a prokinetic. The patients were analysed for subsequent attendance at OGD or OPD up to the present time (September 1999). Results HP was present in 93 of 190 patients. 20 of 190 (10.5%) patients subsequently were re-referred and underwent OGD for continuing dyspeptic symptoms and a further 6 seen in OPD but not endoscoped as they have been judged to have uncomplicated GORD. 12 of 20 patients endoscoped were initially infected with HP. At time of OGD all patients were negative on CLO test. Findings at OGD were normal (9), hiatus hernia (6), gastritis (4) and duodenitis (I). No case of peptic ulcer disease or gastric cancer has been identified. Conclusions In this group of dyspeptic patients, adopting a test and treat policy after initial analysis of HP : I) 10.5% require were re-referred for subsequent OGD, 2) findings in those endoscoped were normal or minimal. A test and treat strategy for H.pylori in uncomplicated dyspeptics saves endoscopies and outpatient consulta- tions. 5579 EARLY ASSESSMENT OF INTRAGASTRIC PH AND ESOPHA· GEAL ACID EXPOSURE IN HEALTHY SUBJECTS TREATED WITH OMEPRAZOLE (10 AND 20 MG) AND LANSOPRAZOLE (15 AND 30 MG). Valerie Bicheler, Hicham Gharib, Sophie Monat, Frank Zerbib, Stanislas Bruley des Varannes, Jean-Paul Galmiche, HNRC and INSERM-IFR26, Nantes Cedex 01, France. Background: In gastro-esophageal reflux disease, the time to onset of acid suppression with proton pump inhibitors (PPls) is an important factor with respect to the speed of symptoms relief. However, few studies have investigated the early effects of PPls, especially at low dosages, on both gastric acid pH and esophageal acid exposure. This study aimed at a comparison of the effect of3-day therapy with lansoprazole (15 and 30 mg) and omeprazole (10 and 20 mg). Methods: Two groups of 12 H. pylori- negative healthy subjects (sex ratio = I) received in a randomized, double- blind, three-way crossover design, either placebo, lansoprazole 15 mg (LAN 15) and omeprazole 10 mg (OME 10) (Group I), or placebo, lansoprazole 30 mg (LAN 30) and omeprazole 20 mg (OME 20) (Group II) for 3 days. Twenty four-h intraesophageal and intragastric acidity were measured with an ambulatory pH recording system on the 3rd day of treatment. The results are shown on the table. Group I : There was no

Association of family history of gastric cancer, intestinal metaplasia and high gastric juice ammonia in patients with Helicobacter pylori infection

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Page 1: Association of family history of gastric cancer, intestinal metaplasia and high gastric juice ammonia in patients with Helicobacter pylori infection

A1216 AGA ABSTRACTS GASTROENTEROLOGY Vol. 118, No.4

5577ASSOCIATION OF FAMILY HISTORY OF GASTRIC CANCER,INTESTINAL METAPLASIA AND HIGH GASTRIC JUICE AM­MONIA IN PATIENTS WITH HELICOBACTER PYLORI INFEC­TION.Premysl Bercik, Elena F. Verdu, Marek Ferkl, Manfred Stolte, YoshioWakatsuki, David Armstrong, Miroslav Zavoral, Postgrad Inst of Gastro­enterol, Cent Military Hosp, Prague, Czech Republic; Institute of Pathol­ogy, Clin Bayreuth, Bayreuth, Germany; Div of Gastroenterology, KyotoVniv, Kyoto, Japan; Div of Gastroenterology, McMaster Univ, Hamilton,Canada.

Background: Although Helicobacter pylori (Hp) is recognized to be agastric carcinogen, the roles played by genetic, host and bacterial factors in

5576

EARLY ENDOSCOPY AS THE ADEQUATE DIAGNOSTICAL AP­PROACH FOR CLASSIFICATION OF CORROSIVE INJURIES OFTHE OESOPHAGUS AND STOMACH.Laszlo Bene, Geza Korosi, A. Dakhlaoni, Gabor Zacher, Tamas Berenyi,M. Karteszi, Peterfy S utcai Korhaz, Budapest, Hungary.

In accordance with the recently accepted view that endoscopy,best per­formed 12 to 24 h after acids and alkali ingestion in all symptomaticpatients, documents the anatomic site and often the severity of the injury,we evaluated the diagnostical advantage of this procedure in all ourpatients with corrosive injuries in the last two years. Methods: Upperpanendoscopy was performed within 6 to 24 h in 125 patients hospitalizedin an emergency to our departments with alkali In=48/, acids In=641 orother agents In= 131 injury. Chest and abdomined x-rays and routinelaboratory values were also obtained to evaluate for aspiration,perforationand organ disfunction. Results: By classifying the severity of the injuriesthrough endoscopy as being mild, moderate and sevier we obtained thefollowing distribution of our patients: mild moderate sevier Alkali 24 14 10Acids 20 14 30 Conclusion: Early endoscopy in patients with corrosiveinjuries seems to be an important diagnostical procedure predicting theoutcome of the case and determining the classification of the patients inconsidered to be more precize that regarding almost all the patients assevier case indicated by the clinical symptoms.

5575DUODENAL ULCER, BODY MASS AND SMOKING ARESTRONG PREDICTORS OF .:i13C0 2IN A LARGE SERIES OFHE·LICOBACTER PYLORI POSITIVE SUBJECTS (LOIANO·MONG·HIDORO STUDY).Franco Bazzoli, Domenico Palli, Rocco M. Zagari, Giovanna Masala,Paolo Pozzato, Gianni Nicolini, Stefania Fossi, Luca De Luca, DeboraBerretti, Luigi Ricciardiello, Davide Festi, Enrico Roda, Stefania Maltoni,Lorenzo Fuccio, Cristina Martuzzi, Univ of Bologna, Bologna, Italy;Epidemiology Unit, CSPO, Florence, Italy; Univ of Chieti, Chieti, Italy.

Helicobacter pylori (Hp) infection has been related to different patholog­ical manifestations ranging from ?astritis to peptic ulcer, lymphoma andcancer. The 13C urea breath teste 3C-UBT)is supposed to correlate withbacterial density, a determinant of mucosal inflammation. We have previ­ously reported (Gastroenterology 1997,4,A68 I-II-III) preliminary resultsof a large cross sectional study on prevalence of Hp infection in Loiano­Monghidoro, a rural area near Bologna, Italy, assessed by 13C-VBT. Aim:to evaluate differences in 8 13COzexcretion in relation to past history ofpeptic ulcer and individual characteristics. Methods: 1,533 subjects ac­cepted to be evaluated in relation to their Hp status by the 13C-UBT. Astandardized questionnaire for socio-demographic and life style factors wasalso administred. For 1,079 subjects reliable information on weight andheight was available and body surface area was estimated. Results: Out of1,079 participants with anthropometric measures, 791(73.3%; 438 males,353 females) resulted positive for Hp infection (8 13COzexcretion > than5). We observed that mean 813CO

zwas significantly higher in females(28.5) than in males (25.8). Current smokers had significantly lower values(21.9) than ex smokers (25.3) and non smokers (28.5). Subjects reportinga personal history of duodenal ulcer tended to have a higher mean excretion(31.2) than subjects with no history of peptic disease (26.6) or with ahistory of gastric ulcer (27.1) (NS). A multivariate analysis (includingterms for sex, age, weight, smoking and duodenal ulcer) showed a negativeassociation of 8 13COzexcretion with weight (p=0.006), current smoking(p=O.OOOI) and a positive association with duodenal ulcer (p=0.02); noassociation with sex, age, and gastric ulcer persisted in this multivariateanalysis. Body surface area had the same effect of weight. Conclusions:Observed differences in 8 13COzexcretion were due to the effect of fewsignificant predictors: body mass (either measured as weight or bodysurface), current smoking and duodenal ulcer. Heavier subjects and smok­ers have significantly lower values, while in contrast duodenal ulcer pa­tients have significantly hi§her 8 13COzexcretion. These results suggestthat in the evaluation of 8 I COzexcretion anthropometric measures (bodymass) and information on smoking status should be considered.

alkali

acids

mild

24

20

moderate

14

14

sevier

10

30

the progression from H. pylori (Hp) gastritis to gastric cancer (GC) areunknown. Aim: To investigate the relationship between gastric concentra­tions of ammonia (NH3) produced by Hp and a family history (FH) of Gc.Methods: Patients undergoing upper GJ. endoscopy were interviewed toidentify those with (FH+) and without (FH-) a FH of GC in 1st and 2nddegree relatives. Relatives of GC patients (FH-t-] were also invited toparticipate. Hp infection (Hp+) was diagnosed by Rapid Urease Test andby histology. Hp density, gastritis and intestinal metaplasia (1M) werescored in antral and corpus biopsies (modified Sydney classification).Gastric [NH3J in aspirates obtained at endoscopy was measured using anNH3sensitive electrode. Serum was obtained for Hp serology and cagAstatus (ELISA). Results: Table shows median values; Fisher s Exact Test& Mann Whitney V Test. Summary: Hp infected patients with a FH of GChave a higher prevalence of 1M and a higher gastric [NH3J than infectedpatients without a FH of GC. This appears to be unrelated to age, Hpdensity and CagA status. Conclusions: Ammonia may playa role in thepathogenesis of a potentially pre-malignant lesion (intestinal metaplasia) inHp-infected patients. Measurement of intra-gastric [NH3J may be a usefulscreening tool for Hp-infected individuals who are at risk of gastric cancer.Supported by Czech Grant Agency No. 4306-2 IGA MZ CR.

Hp+/FH+ Hp+IFH. H/tIFH·

Nol age (yrs) 18(51.5) 26(54) 46 (51)Hpdensity 25 2.5CagA+ve 9/18 (50%) 11/26 (42%)1M '5/18 (27%) 1/26(4%) 0/46 (0%)[NH31 '5.5mM 3.1 mM 1.3mM

('p<0.05= Hp+/FH+vs Hp+/FH-)

5578WHAT PROPORTION OF DYSPEPTIC PATIENTS HAVINGH.PYLORI BREATH TEST SUBSEQUENTLY UNDERGO ENDOS­COPY?Kalpesh Besherdas, Jude Oben, Eric Beck, Robin Vicary, Voi Shim Wong,Whittington Hosp, London, United Kingdom.

Background H.pylori (HP) testing in young patients with uncomplicateddyspepsia has been recommended. A test and treat strategy for dyspepticspositive for HP is recommended by the AGA and, reassurance 1symptom­atic treatment in those who test negative. Aims To assess the rates ofre-referral for upper OJ endoscopy (OGD) and outpatient (OPD) atten­dance in uncomplicated dyspeptic patients following assessment of HPstatus. Methods Between August 1997 and July 1998, 190 patients under50 years of age (83 males; aged 17 to 50, mean age 34yrs) with uncom­plicated dyspepsia (without alarm symptoms) referred from primary care togastroenterology underwent HP urea breath test (VBT). Primary carephysicians were informed of the results of UBT and recommended eradi­cation therapy if positive, and if negative advised symptomatic treatmentwith an acid suppressant +1- a prokinetic. The patients were analysed forsubsequent attendance at OGD or OPD up to the present time (September1999). Results HP was present in 93 of 190 patients. 20 of 190 (10.5%)patients subsequently were re-referred and underwent OGD for continuingdyspeptic symptoms and a further 6 seen in OPD but not endoscoped asthey have been judged to have uncomplicated GORD. 12 of 20 patientsendoscoped were initially infected with HP. At time of OGD all patientswere negative on CLO test. Findings at OGD were normal (9), hiatushernia (6), gastritis (4) and duodenitis (I). No case of peptic ulcer diseaseor gastric cancer has been identified. Conclusions In this group of dyspepticpatients, adopting a test and treat policy after initial analysis of HP : I)10.5% require were re-referred for subsequent OGD, 2) findings in thoseendoscoped were normal or minimal. A test and treat strategy for H.pyloriin uncomplicated dyspeptics saves endoscopies and outpatient consulta­tions.

5579EARLY ASSESSMENT OF INTRAGASTRIC PH AND ESOPHA·GEAL ACID EXPOSURE IN HEALTHY SUBJECTS TREATEDWITH OMEPRAZOLE (10 AND 20 MG) AND LANSOPRAZOLE(15 AND 30 MG).Valerie Bicheler, Hicham Gharib, Sophie Monat, Frank Zerbib, StanislasBruley des Varannes, Jean-Paul Galmiche, HNRC and INSERM-IFR26,Nantes Cedex 01, France.

Background: In gastro-esophageal reflux disease, the time to onset of acidsuppression with proton pump inhibitors (PPls) is an important factor withrespect to the speed of symptoms relief. However, few studies haveinvestigated the early effects of PPls, especially at low dosages, on bothgastric acid pH and esophageal acid exposure. This study aimed at acomparison of the effect of3-day therapy with lansoprazole (15 and 30 mg)and omeprazole (10 and 20 mg). Methods: Two groups of 12 H. pylori­negative healthy subjects (sex ratio= I) received in a randomized, double­blind, three-way crossover design, either placebo, lansoprazole 15 mg(LAN 15) and omeprazole 10 mg (OME 10) (Group I), or placebo,lansoprazole 30 mg (LAN 30) and omeprazole 20 mg (OME 20) (Group II)for 3 days. Twenty four-h intraesophageal and intragastric acidity weremeasured with an ambulatory pH recording system on the 3rd day oftreatment. The results are shown on the table. Group I : There was no