AG

AA

bst

ract

sM1835

Nighttime GERD: Prevalence, Symptom Intensity and Treatment Response to a4 Week Treatment with 40 Mg of Pantoprazole Magnesium O.D. a Report fromthe GERD Mexican Working GroupMiguel Morales-Arambula, Sergio R. Sobrino-Cossio, Jose-Antonio Vargas, Juan C. Lopez-Alvarenga, Julio-Cesar Soto-Perez, Aurelio López-Colombo, Oscar Teramoto-Matsubara,Yasmin Crespo, Armando Ramirez, Jorge Gonzalez, Antonio Orozco-Gamiz, Anthony G.Comuzzie, Luis H López-Salazar, Ramirez-Barba Ector

Background: Most nighttime GERD studies use the mere presence of symptoms. Focusingon symptom intensity instead, is probably more important to characterize the prevalenceof nighttime GERD (NTG) symptoms, its association with extraesophageal symptoms andresponse to a 4 week treatment with pantoprazole magnesium (PMg) 40 mg o.d. Material& Method: 4302 GERD patients (53.9% female) were included in a nationwide multicenterstudy. A total of 42.7% complained of NTG symptoms. Frequency of sleep disturbancesdue to GERD symptoms was registered at basal interview by using a 4 point-Likert scale toassess the intensity of GERD symptoms before and after treatment. By means of a Studentt test and chi-square contrast between NTG and non-NTG was made. Results: NTG grouppatients were slightly older (36.7±0.18 vs. 35.8±0.16, p<0.001) and had a higher BMI(29.4±0.85 vs. 27.6±0.45, p<0.057); no difference for gender was found. NTG group hadhigher basal symptom intensity scores for acid regurgitation (p<0.001), dysphagia (p<0.06),odynophagia (p<0.035), halitosis (p<0.036), sialorrhea (p<0.002), flatulence (p<0.016) andsome extraesophageal symptoms such as chest oppression (p<0.005), dispnea (p<0.001),chronic cough (p<0.001), hoarseness (p<0.001), and sleep disturbances (p<0.001) while,interestingly, no difference in heartburn intensity was found (p=0.44) between both groups.Male patients had higher scores for hoarseness (p<0.065), and chronic cough (p<0.060).Nighttime GERD group also had a higher risk of sleep disturbance such as waking up duringthe night: occasionally OR=4.4 [95%CI: 3.4, 5.8], frequent OR= 8.7 [95%CI: 6.6, 11.4],very frequent OR= 8.9 [95%CI: 6.4, 12.3]. Treatment improved symptom intensity for bothgroups (with and without NTG), nevertheless for the NTG group, chest oppression (p<0.014),odinophagia (p<0.053) and globus (p<0.019) had a better treatment response. Conclusion:NTG is a common finding among GERD patients who have an increased BMI with highfrequency of sleep disturbances. Symptom intensity evaluation increases the sensitivity fordetecting differences between GERD groups and its treatment implications. The presence-absence symptom approach for evaluating GERD, in itself, is limited. Evaluating the fre-quency, duration and especially the intensity of the symptoms gives a more completeunderstanding of the disease

M1836

Increased Serum Levels of IL-15 in Celiac Disease: A Role in the Loss ofPeripheral Immune Homeostasis?Mélika Ben Ahmed, Houda Sellami, Nadia Belhadj Hmida, Imen Monastiri, Asma Elbeldi,Yousr Galai, Rahma Sakkouhi, Nadine Cerf-Bensussan, Samira Blouza, Hechmi Louzir

Background: IL-15 is a proinflammatory cytokine overexpressed in the duodenal mucosaof celiac disease (CD) patients. IL-15 promotes the expansion and activation of intraepitheliallymphocyte leading to epithelial damage and in a subset of patients to lymphomagenesis.Moreover, IL-15 impairs the immunosuppressive effects of TGF-b and may thus contributeto the loss of oral tolerance. Aim: To investigate whether overexpression of IL-15 in sera ofCD patients might promote the loss of peripheral immune tolerance and trigger extraintestinalauto-immune diseases such as type 1 diabetes. Methods: Serum levels of IL-15 was measuredby ELISA in 40 patients with uncomplicated CD, 30 patients with type 1 diabetes and 10patients with both CD and type 1 diabetes. Thirty age-matched healthy individuals wereenrolled as controls. Results: Patients with type 1 diabetes did not exhibit elevated concentra-tions of IL-15. By contrast, serum levels of IL-15 were significantly increased in sera ofpatients with uncomplicated CD patients (4.9 pg/ml; 0.8 to 22.4 pg/ml) compared to controls(0.49 pg/ml; 0 to 2.79 pg/ml) (p<0.001). CD patients with type 1 diabetes had higher levelsof IL-15 than uncomplicated patients (6.23 pg/ml; 1.8 to 19.9 pg/ml) but the differencedid not reach statistical significance (p>0.05). Interestingly, among CD patients, serum levelsof IL-15 correlated with either disease activity and levels of antibodies anti-transglutaminase.Conclusion: Our data showing increased serum levels of IL-15 in CD patients indicate thatoverexpression of this cytokine is not restricted to the intestinal compartment and supportthe hypothesis of its possible implication in CD extraintestinal auto-immune complications

M1837

Schatzki's Ring and GERD: Association Between Esophageal Acid Exposureand Imaging FindingsShahin Ayazi, Jeffrey A. Hagen, Arzu Oezcelik, Joerg Zehetner, Emmanuele Abate, EhsanMalek, Weisheng Chen, James M. Halls, Greg Mogel, John C. Lipham, Farzaneh Banki,Steven R. DeMeester, Tom R. DeMeester

Introduction: A Schatzki's ring is a circular narrowing at the squamocolumnar junctionthat is thought to be related to Gastroesophageal Reflux Disease (GERD). The aim of thisstudy was to determine the prevalence of increased esophageal acid exposure in patientswith a Schatzki's ring. Material and Methods: Between 1997-2007, 190 patients were foundto have a Schatzki's ring by videoesophagogram. The study population included 85 patientswith no history of previous foregut surgery or esophageal dilatation, who had 24-hour pHmonitoring performed off of acid suppression therapy within 3 months of the videoesophago-gram. The frequencies of abnormal esophageal acid exposure for each individual componentand for the composite pH score were calculated. In those patients with a measured ringdiameter, the relationship between the composite pH score and the internal diameter of thering was assessed. Results: The study population consisted of 85 patients (67% male) witha median age of 52 years (IQR 44.5-64.0). The Schatzki's ring was associated with a hiatalhernia in 82 (97%) patients. Sixty eight percent had an abnormal composite pH score and64% had increased % total time < 4. In the remaining 27 patients with a normal compositepH score, at least one component of pH monitoring was abnormal in 20 (74%). Only 7

A-428AGA Abstracts

patients had no evidence of abnormal esophageal acid exposure. The diameter of the ringwas measured in 49 patients. Internal ring diameter was not significantly different in thosewith abnormal pH score compared to those with normal score (15.6, 15.1, p= 0.56). Inaddition, in those with an internal ring diameter of larger than 12 mm the abnormal acidexposure was not significantly different from those with a ring diameter ≤ 12 mm (69.4%vs. 69.2%, p=0.98). Conclusion: In the largest series reported to date of patients withSchatzki's ring diagnosed by videoesophagogram, we have shown that 92% have evidenceof abnormal acid exposure by at least one component of pH measurement. Sixty eightpercent of GERD patients who have Schatzki's ring have abnormal composite pH score, butthere is no correlation between ring diameter and the frequency of an abnormal pH score.

M1838

Heartburn and Regurgitation During Third Trimester of Pregnancy: the Effectof Fatty Acids IngestionValesca Dall'Alba, Fernando Fornari, Sidia M. Callegari-Jacques, Cláudio Krahe, Sergio G.Barros

Background: Heartburn and regurgitation are common symptoms in the third trimester ofpregnancy but the association with dietary components is unclear. Objectives: To investigatethe association of specific dietary components with heartburn and regurgitation in the thirdtrimester of pregnancy. Methods: Eighty-nine consecutive patients (aging 26 ± 6 years,gestational age 34 ± 4 weeks) were asked about frequency of heartburn and regurgitationin a low risk outpatient clinic. Antrophometric measurements and a 24-hour diet recordwere conducted by a dietitian. Patients with heartburn once a week or more were comparedto a control group with no heartburn. Results: Heartburn once a week or more was presentin 56 patients (aging 26 ± 6 years, gestational age 34 ± 4 weeks). The control group wascomposed by 20 patients (aging 26 ± 7 years, gestational age 32 ± 4 weeks). The averageamount of ingested polyunsaturated fatty acids was higher in patients with heartburn (11.2± 6.4 mg vs. 7.7 ± 3.5 mg; P = 0.022) after controlling for age, gain weight duringpregnancy, ingestion of caffeine and C vitamin, and total energetic intake. The ingestion ofmonounsaturated fatty acids was higher in patients with heartburn, however with a borderlinestatistical significance (16.1 ± 11 mg vs. 11.8 ± 6.5 mg; P = 0.061). No association wasobserved between the ingestion of saturated fatty acids and heartburn (P = 0.929) or anykind of fatty acids and regurgitation. Heartburn before pregnancy did not modify thesefindings. Conclusions: This study suggests that heartburn perception during the third trimes-ter of pregnancy is associated with the ingestion of fatty acids, particularly polyunsaturated.

M1839

Association Between Body Mass-Index and Increased Number of RefluxEpisodes Is Present in Females But Not MalesLubin F. Arevalo, Marcelo F. Vela, Neeraj Sharma, Amit Agrawal, Janice Freeman, DonaldO. Castell

Background.There is a known association between elevated BMI and GERD.The role ofgender in GERD is not clearly defined since available data from the literature are nothomogeneous. Recent studies have shown an association between rising BMI and worseningGERD symptoms and esophagitis in females. It has been hypothesized that higher estrogenconcentration may cause (a) decreased basal lower esophageal sphincter pressure, and (b)increased transient LES relaxations frequency due to higher plasma nitric oxide levels.Aim.Evaluate the association between BMI and (a) LES characteristics and (b) reflux mon-itoring parameters in males and females. Methods.All 54 males undergoing both esophagealmanometry and 24-hour impedance-pH reflux monitoring between August 2007 and Febru-ary 2008 for whom BMI was available were included.The last 54 consecutive females withsimilar data in that time period were included.We evaluated the association between BMI byGender and the following variables:(a)Manometric LES characteristics:resting pressure,totallength,intraabdominal length,(b)Impedance-pH monitoring results:number of reflux epis-odes (acid, nonacid, total).Association was evaluated by Pearson correlation. Results.108patients were included,50%F, mean ages 56.6 y(F)and 47.5 y(M),mean BMI:29.5,BMIrange:17-55.37% patients obese (BMI>30).Demographic characteristics and correlationsbetween BMI and evaluated variables shown in the table. Summary.There was a significantpositive correlation between increased BMI and total number of reflux episodes in females(r=0.387, p=0.004);this was not observed in males. BMI did not correlate with any LEScharacteristics in females or males. Conclusions.The positive correlation between BMI andtotal number of reflux episodes in females but not males, along with the lack of associationbetween BMI and basal LES characteristics regardless of gender, suggests that the increasedreflux in females may be due to TLESRs, possibly mediated by the higher estrogen concentra-tion in women.