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LONG-TERM FOLLOW UP OF CARDIA INTESTINALMETAPLASIA (CIM) AND CARDIA DYSPLASIAChristian Clark, M.D., Prateek Sharma, M.D., Daniela Mitreva, M.D.,S.F. Jafri, M.D., S. Mathur, M.D., Allan P. Weston, M.D.*. VAMC,Kansas City, MO and University of Kansas School of Medicine, KansasCity, KS.

Purpose: Esophageal adenoCA develops over a period of years fromchronic GERD through a well-delineated, sequential step-wise pathway.This tumor shares many demographic and clinical features of GEJ/cardiaadenoCA. It is unclear if CIM and dysplasia are histologic precursor lesionsfor GEJ/Cardia cancer.Aim: The purpose of this study was to characterize histologic changeswithin the cardia in a cohort of patients with known CIM or cardiadysplasia followed prospectively long-term.Methods: An electronic database of over 1000 pts in whom cardia bx havebeen obtained has been assimilated. Cardia bx (4) were taken from theanatomic cardia. The junction of tubular esophagus and saccular cardia wasdetermined by well described endoscopic techniques. Cardia bx were fixedin formalin or Bouins solution, embedded in paraffin, step-serial sectioned,and stained with either HE/Alcian blue pH2.5 or PAS/Alcian blue pH 2.5stains. Grading of cardia histology per modified Sydney scoring classifi-cation. From this database, pts in whom CIM was initially ID and who havesubsequently undergone at least one f/u EGD 1 or more yrs later wasexamined. Cardia histology on most recent bx was compared in a blindedfashion to intial cardia bx. Cardia LGD and HGD readings requiredindependent confirmation by a 2nd pathologist. Hp status was determinedbased upon 4 antral and 2 body bx using either a modified Giemsa stain orSteiner’s Silver stain.Results: Of 1050 pts with cardia bx, 125 pts had CIM ID with 52 of thesepts having histologic f/u of at least 1year. All pts were males except onewith a mean age of 65.1�11.5. Race — white:black:other – 43:6:3. LGDwas noted in 11 (22%) pts and HGD in 1 (2%). Grading of Cardia IMinitially 1 in 13 (25%), 2 in 38 (73%) and 3 in 1 (2%). Hp was noted in only21 pts (41%). Length of f/u ranges from 1 to 9 years (3.5�2.2 yrs). Duringthis f/u, 7 Hp� pts were tx; 44 pts were tx with PPIs and 8 with H2blockers. Cardia IM grade remained unchanged in 21 pts (40%), worsenedin 8 (15%) and improved in 23 (44%) [with 20 of these pts harboring noCIM]. The incidence of cardia LGD was 4%. Cardia HGD persisted duringf/u. Cardia LGD resolved in 8 and persisted in 3.Conclusions: Incidence of Cardia dysplasia is low and the vast majority ofCIM pts had either stable or marked improvement of CIM during f/u.Improvement in CIM was significantly correlated with those pts tx withPPIs.

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EFFECT OF PROSTOGLANDIN INHIBITION WITHKETOROLAC ON GASTRIC ACTIVITY AND DYSPEPTICSYMPTOMS IN PATIENTS WITH DYSPEPTIC SYMPTOMSHrair P. Simonian, M.D., Henry P. Parkman, M.D., FACG*. TempleUniversity School of Medicine, Philadelphia, PA.

Purpose: Gastric myoelectric abnormalities are found in up to 40% ofpatients with functional dyspepsia. Electrogastrography (EGG) providesinformation on the frequency and regularity of gastric myoelectric activity.The prostaglandin inhibitor indomethacin has been suggested to convertgastric tachygastria to a normal rhythm. The aim of this study was todetermine if intravenous administration of the nonsteroidal antiinflamma-tory agent (prostaglandin inhibitor) ketorolac (Toradol) can improve gastricdysrhythmias and improve symptoms in patients with refractory dyspepsia.Methods: Twelve normal subjects (3 males, 9 females. Mean age: 32�3years) and 22 dyspeptic patients (5 males, 17 females. Mean age: 37�3years) were studied. Multichannel EGG recording was used to assessgastric slow wave frequency, regularity, and coupling. Fasting multichan-nel EGG (Medtronic Polygraf ID EGG system) was recorded for 60

minutes, followed by ingestion of an egg sandwich meal with 4 oz. oforange juice and postprandial EGG recording for 120 minutes. This wasfollowed by placebo injection of normal saline, followed in 15 minutes byketorolac 15 mg IV. EGG recording was obtained for another 60 minutes.Symptoms were assessed throughout the study.Results: In the normal subjects, IV ketorolac had no effect on the EGGparameters of dominant frequency and in the percent time in the normal2–4 cpm rhythm. However, there was a decrease in the power of thedominant frequency decreased from 48�2 dB to 46�2 (p�0.05) and adecrease in the average percent slow wave coupling decreased from 77�4to 73�4% (p�0.06). In the 22 dyspeptic patients overall, there was nosignificant changes in the EGG parameters. Interestingly, 7 of the 22patients had a decrease in symptoms (primarily nausea, abdominal pain,and bloating) after ketorolac administration from a symptom score of 10�2to 8�1 (p�0.05). In these patients, there was a decrease in the EGGdominant frequency from 3.2�0.1 to 2.8�0.1 (p�0.05) and an increase inthe power of the dominant frequency from 42�2 to 44�2 (p�0.07). In the15 patients that did not have symptom improvement with IV ketorolac,there were no significant EGG changes.Conclusions: In some patients with refractory dyspepsia, intravenous ke-torolac administration can improve symptoms and affect gastric myoelec-tric activity. This suggests that prostaglandin inhibition may be helpful insome dyspeptic patients with abnormal gastric myoelectric activity.

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DELAYED GASTRIC EMPTYING IN GASTROESOPHAGEALREFLUX DISEASE: REASSESSMENT WITH NEWMETHODOLOGIES AND CLINICAL CORRELATIONSDaniel Buckles, M.D., Irene Sarosiek, M.D., Celia Gonzalez,Chris McMillin, Richard McCallum, M.D.*. Kansas UniveresityMedical Center, Kansas City, KS and Kansas University MedicalCenter, Kansas City, KS.

Purpose: Previous studies have shown that patients with GERD haveslower rates of gastric emptying than controls, but the prevalence hasdiffered due to variations in methodology. The recent establishment ofinternational control values for scintigraphic gastric emptying assessmentmakes standardization of this technique possible (Tougas, et al). It wouldalso be useful to know if specific gastrointestinal symptoms predicteddelayed gastric emptying in GERD and if the prevalence of delayedemptying is altered by anti-reflux surgery.Methods: Forty-nine patients (mean age 42.9 years, range 24–65 years, 35women 14 men) who were diagnosed with GERD in the previous twelvemonths were given a standardized 280 kcal 99Tc-labeled low fat meal (eggbeater). Percent intragastric residual content was recorded at baseline andat hourly intervals for 240 minutes by scintigraphy. Patients were alsoasked about the presence of dyspepsia (bloating, postprandial discomfort orbelching, or early satiety), dysphagia, or regurgitation. Gastric emptyingtimes were also performed before and after laparoscopic Nissen fundopli-cation surgery on 16 patients with documented GERD.Results: Sixteen patients (33%) had intragastric residual contents greaterthan the 95th percentile (�40%) at 120 minutes, and thirteen (26%) hadabnormal results at 240 minutes (�6%). Diabetic patients accounted foronly 4 patients with delayed 120 minute gastric emptying and 5 withdelayed 240 minute emptying. Dyspepsia was present in all patients.Regurgitation and dysphagia were common (present in approximately 80%and 40% of patients, respectively) and the prevalence of these symptomsdid not differ between patients with normal versus delayed gastric empty-ing. Six out of 16 patients (37.5%) had delayed gastric emptying prior tofundoplication surgery and the prevalence was unchanged post-surgically.Also, mean 240 minute intragastric residual was not significantly differentafter surgery when compared with before surgery (19.75% vs 11.94%).Conclusions: Using standardized techniques: 1. Delayed gastric emptyingis common in patients presenting with GERD at both 120 and 240 minutesafter ingestion of a solid meal; 2. Symptomatology alone is not a usefulpredictor of this pathophysiology; and 3. Contrary to previous studies,

S58 Abstracts AJG – Vol. 98, No. 9, Suppl., 2003

gastric emptying does not accelerate after anti-reflux surgery and delayedemptying remains after fundoplication.

168

HOPE AS A PREDICTOR OF ANXIETY AND DEPRESSIVESYMPTOMS IN PATIENTS RECEIVING THE GASTRICPACEMAKER FOR GASTROPARESIS: A LONGITUDINALSTUDYStacy Parenteau, Sheryle Gallant, Irene Sarosiek, M.D.*,Richard McCallum, M.D. University of Kansas Medical Center, KansasCity, KS.

Purpose: The patients in this study have proven to be refractory tomedications for gastroparesis (GP), thus requiring the surgical implantationof a gastric electrical stimulator.Goals: 1) To determine if pre-surgery hope level predicts levels of depres-sive symptoms and anxiety at 3 and 6 months post surgery; 2) To comparelevels of hope, depressive symptoms, and anxiety across three differentsubgroups of GP patients: diabetic, idiopathic, and post-surgical patients.Methods: Twenty-four participants (mean age � 35. 5, 88.2% female)have been recruited to date. Patients were asked to fill out the BeckDepression Inventory-II, the State Anxiety Inventory (SAI), and the StateHope Scale (SHS). The study consists of two baseline assessments (the firstapproximately two weeks prior to surgery, the second while in the hospitalawaiting surgery) and 3 and 6 month follow-ups. First baseline data wasgathered to show that depressive symptoms and anxiety levels were notmerely the result of being in a hospital awaiting surgery.Results: (See Table)

Differencesin AnxietyLevels atSecondBaseline Diabetic Idiopathic

Differencesin AnxietyLevels at6 months Diabetic Idiopathic

M 56.00 45.86 M 42.83 31.5SD 10.24 12.21 SD 8.84 4.8N 11 7 N 6 4Mean Difference 10.14 Mean Difference 11.33Significance Level p�.08 Significance Level p � .05

Conclusions: 1) Hope was a negative predictor of depressive symptomsapproaching statistical significance at 3 months (p � 0.09); 2) Individualswith a high degree of hope prior to surgery experience less depressivesymptoms and anxiety after implantation, and vice versa; 3) Diabetic GPpatients experienced a greater degree of anxiety than the idiopathic patientsat both baseline and 6 months, possibly indicating an increased concernregarding their diabetic condition, even if their gastroparetic condition isalleviated.

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ANALYSIS OF RADIOGRAPHIC STUDIES USED TOEVALUATE COMPLICATIONS AFTER LAPAROSCOPICROUX-EN-Y GASTRIC BYPASSJames T. McCormick, D.O., Pavlos K. Papasavas, M.D.,Christopher G. Pastor, B.S., H. Scott Beasley, M.D.,Philip F. Caushaj, M.D., Daniel J. Gagne, M.D.*. Temple UniversitySchool of Medicine Clinical Campus at the Western PennsylvaniaHospital, Pittsburgh, PA.

Purpose: The most commonly occurring complications after laparoscopicRoux-en-Y gastric bypass (LRYGB) are anastomotic stricture, intestinalobstruction and anastomotic leak. Patients who present with these compli-cations undergo radiologic studies as part of their evaluation. We investi-gated the utility of computed tomography (CT), upper gastrointestinalseries (UGI), and plain abdominal x-rays (AXR).Methods: This study was a retrospective review of 190 patients whounderwent LRYGB during September 1999 to September 2001. We ana-

lyzed patients who developed complications and were studied with CT,UGI, and/or AXR. Patients were grouped according to the clinical diag-nosis (obstruction, stricture or leak). The radiologic impressions werecompared with final diagnoses. Pre- and post-test probability of diseasepresence was determined.Results: Twenty-three patients developed postoperative symptoms thatprompted 49 radiographic studies. UGI was best when ordered for strictureor leak and CT was best when ordered for obstruction. Pre-test probabilitieswere 63, 67 and 78% respectively, each resulting in a post-test probabilityof disease presence of 100% if the test was positive and 0% if the test wasnegative. UGI did not perform well when ordered for obstruction yieldinga 67% probability of disease presence if the test was negative.Conclusions: Radiographic studies following LRYGB are highly specificbut their sensitivity is determined by matching the appropriate study to theclinical presentation. UGI is the best study to obtain for patients whopresent with suspected stricture or anastomotic leak. CT is the radiologicstudy of choice when intestinal obstruction is suspected.

PANCREATIC/BILIARY

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ENDOSONOGRAPHY (EUS) FOR BILIARY MICROLITHIASISIN ACADEMIC AND PRIVATE PRACTICE SETTINGSJames E. Dill, M.D.*, Bobbie P. Dill, B.S.N., R.N., C. North AdamsRegional Hospital, North Adams, MA.

Purpose: Endosonography (EUS) is being increasingly utilized for ideo-pathic, acute recurrent pancreatitis as well as unexplained upper abdominalpain/gallbladder disease. The purpose of the present study was to acertainthe utilization of EUS for the diagnosis of microlithiasis in both private andacademic settings.Methods: A brief survey was developed with questions about the use ofEUS for ideopathic, acute recurrent pancreatitis and unexplained upperabdominal pain/gallbladder disease. A third question was whether theendosonographer would reccomend cholecystectomy if microlithiasis wasfound on those patients with gallbladders in situ. the final question con-cerned the endosonographer’s annual EUS case volume. The surveys weremailed to 50 private practice sites and E-mailed to 23 physicians listed asEUS training directors.Results: Seventeen surveys were returned from the private practice sitesand there were 15 responses to the E-mailed survey, one from a physicianwho is presently in private practice. The results are tabulated below: 1 EUSfor ideopathic pancreatitis . Total- 26/32 (81%), Private Practice- 13/18(72%) , Academic 13/14 (93%). 2. EUS utilization for unexplained upperabdominal pain/gallbladder disease. Total- 21/32 (66%) , Private Practice-11/18 (61%) , Academic- 10/14 (71%). 3. Surgery reccomended for mi-crolithiasis. Total- 24/32 (75%), Private Practice- 13/18 (72%) , Academic-11/14 (79%).Conclusions: 1. 26/32 (81%) of the respondents utilize EUS for ideopathic,acute recurrent pancreatitis. 2. 21/32 (66%) of the respondents utilize EUSfor unexplained upper abdominal pain /gallbladder disease. 3. 24/32 (75%)of the respondents reccomend cholecystectomy with the finding of micro-lithiasis in appropriate patients with the above conditions. 4. Endosonog-raphy has become an important diagnostic modality for biliary microlithi-asis.

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A RARE ASSOCIATION OF SCLEROSING CHOLANGITIS ANDADVANCED NON-SMALL CELL LUNG CANCERKrishna Pachipala, M.D., Sara Mitchell, M.D., Suresh Nair, M.D.,Michael Komar, M.D.*. Geisinger Medical Center, Danville, PA.

Introduction: Primary sclerosing cholangitis is commonly associated withIBD. Cholangiographic changes similar to those seen in primary sclerosingcholangitis is seen in variety of other conditions like operative trauma,

S59AJG – September, Suppl., 2003 Abstracts