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sreduction in their mean GERD scores (6 to 5.2) and QOL measures except for the parameterof inability to eat/drink certain foods that improved significantly (reduction in mean score2.9 + 4.5, p < 0.05). Conclusions: GERD is highly prevalent (up to 50%) in obese, non-health seeking individuals as compared to historic controls (10-20% prevalence in the generalpopulation). Acid reflux symptoms have a significant impact on their QOL. The impact ofweight loss on symptom resolution and QOL needs further evaluationTable . Baseline QOL measures in subjects with and without GERD symptoms

Mo1057

Gas-Related Symptoms After Anti-Reflux SurgeryBoudewijn F. Kessing, Joris A. Broeders, Nikki Vinke, Marlies P. Schijven, Eric Hazebroek,Ivo A. Broeders, Albert J. Bredenoord, Andreas J. Smout

Background: Anti-reflux surgery decreases the ability to belch thereby preventing gastric airventing. Gas-related complaints after anti-reflux surgery are frequent but it is not knownwhat determines the severity of these complaints. We aimed to assess the impact of gas-related complaints on surgical outcome. Furthermore, we aimed to determine whether theseverity of gas-related complaints after anti-reflux surgery is associated with increased pre-operative swallowing of air and/or belching or a more impaired ability to belch after surgery.Methods: We included 52 patients who underwent anti-reflux surgery (24 Toupet fundoplic-ation, 28 Nissen fundoplication). Patients reported the presence and severity of bloating,flatulence and an inability to belch after a median of 27 months using a 3-point scale andtheir impact on quality of life and satisfaction with surgical outcome was assessed. Thenumber of air swallows and belches before and after surgery was assessed using 24-houresophageal impedance monitoring. Results: Severe bloating and flatulence was associatedwith a decreased score for the physical component of the quality-of-life. Patients felt thatthe result of their operation was affected negatively by gas-related symptoms by flatulencein 19%, by bloating in 15% and by an inability to belch in 6%. Notably, 9% of the patientswould not opt for surgery again because of gas-related complaints. The prevalence of severeflatulence was higher in patients who underwent Nissen fundoplication than in those whohad a Toupet fundoplication (57% vs 25%, p<0.05) but the prevalences of severe bloating(13% vs 25%) and the inability to belch (13% vs 11%) were not significantly different.Anti-reflux surgery decreased the total number of belches (from 60 (49-79) to 12 (5-35),p<0.001) but did not affect the number of air swallows (378 (260-523) vs 360 (249-495)).The severity of gas-related complaints was neither associated with the number of pre-operative air swallows and/or belches, nor with the magnitude of the post-operative decreasein the number of belches. Conclusion: Gas-related symptoms are associated with decreasedquality-of-life and reduced satisfaction with surgical outcome. The severity of gas-relatedcomplaints is not determined by the number of pre-operative air swallows or a more severeimpairment of the ability to belch after surgery. Pre-operative predictors of postoperativegas-related symptoms could therefore not be identified.

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Laparoscopic Thal Fundoplication: A 10-15 Year Prospective Follow-up StudyFemke A. Mauritz, Maud Y. van Herwaarden-Lindeboom, Roderick Houwen, KathelijnFischer, Peter D. Siersema, David C. van der Zee

INTRODUCTION: Gastroesophageal reflux disease (GERD) is a major healthcare problemin infants and children. Antireflux surgery (ARS) is reserved for pediatric patients with severeGERD resistant to long-term medical treatment. Studies on short-term outcome of ARS inthis group have shown good to excellent results; however, long-term follow-up studies arescarce, retrospective and have not used objective measurements. AIM: To evaluate long-term (10-15 years) efficacy of ARS in a prospectively followed cohort of pediatric GERDpatients. METHODS: For symptom assessment, patients or caretakers were asked to fill outa reflux specific questionnaire before, 3-4 months, 5 years and 10-15 years after ARS.Twenty-four-hour pH monitoring was performed at three different time points: before, 3-4 months after and 10-15 years after ARS. Disease-free-survival was analyzed using theKaplan-Meier method. All other outcomes are presented in absolute values. RESULTS:Between 1993 and 1998, a laparoscopic anterior, partial fundoplication (Thal) was performedin 61 children (aged 1 month - 18 years; 27 males) with GERD. Neurologic impairmentwas present in 43% of patients. Seventeen patients were lost-to-follow-up (14 had diedunrelated to ARS surgery and 3 had emigrated). Median follow-up was 13 years (range 10-15). All remaining 44 patients completed the reflux specific questionnaire. At 3-4 monthsafter ARS 49/61 (80%) of patients were completely free of reflux symptoms, at 5 years 54/61 (89%) patients were free of symptoms and at 10-15 years 38/44 (86%) patients. Evaluatingremaining patients per time point showed a low recurrence of reflux symptoms. However,taking into account patients lost-to-follow-up using the disease-free-survival analysis, only66% of patients were symptom free 10-15 years after ARS. Twenty-four-hour pH monitoringwas not performed in 12 patients due to patient refusal (n= 8), comorbidities (n=3) or agastric bypass (n=1). At 3-4 months after ARS 24-hour pH monitoring was still pathologicalin 11/61 (18%) patients and at 10-15-years 11/32 (38%) had pathological reflux. In 6/62patients (10%), all with symptoms and pathological reflux, redo ARS was performed, withgood results with regard to symptoms in all but one. Treatment in the other 5 patients withpathological reflux consisted of conservative treatment, which was effective in treatingsymptoms. Postoperative dysphagia after initial ARS was 4.8% after short-term and 4.4%

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after long-term follow-up. CONCLUSION: As gastro-esophageal reflux still persists or recursin 34% of children 10-15-years after laparoscopic Thal fundoplication and recurrence ofdisease as measured by pathological 24-hour pH monitoring is seen in up to 38% in patientsover time, it is important to closely follow-up these children to make a timely diagnosis inthose with a recurrence of gastroesophageal reflux.

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Rectal Prolapse and Anorexia Nervosa: About 24 CasesSophie Marjoux, Boubekeur Bennadji, Vincent De Parades, Henri Mosnier, PatrickAtienza, Xavier Barth, Yves Francois, Jean Luc Faucheron, Sabine Roman, Francois Mion,Henri Damon

Introduction. Complete rectal prolapse (RP) is uncommon in young subjects. Its pathophysi-ology remains unclear. Cystic fibrosis, some parasitosises and collagen congenital abnormalit-ies are known to be associated with RP in young subjects as well as anorexia nervosa (AN).Our aim was to characterize patients with complete RP in a context of AN and to comparethem with patients without AN. Patients and methods. From 1998 to 2011, we includedretrospectively women who were referred in two tertiary centers for anal incontinence (AI)or dyschezia and who presented clinical complete RP associated with current or past historyof AN. Demographic and clinical data were collected. Patients underwent anorectal manome-try and anal endosonography. Data were compared with a group of women with completeRP and absence of AN referred within the same period. Results. Twenty-four women withAN and complete RP (AN) consulted in our institutions. They were compared with 42women with complete RP without AN (controls). Demographics and significant previoushistory are presented in Table 1. AI was less frequent in AN than in control (67% vs 90%,p<0.05); stress urinary incontinence was not statistically different (13% vs 32%, p=0.24).Constipation was observed in 92% of AN patients vs 85% in controls (p=0.35). Grade 1cystocele was present in 3 cases in AN (12%), vs 16 cases of Grade 1 cystocele (38%) and9 cases of grade 2 or 3 in controls (21%). At manometry, anal sphincter was hypotensiveat rest (mean pressure < 70 cmH2O) in 82% AN vs 100% of controls. Squeezing analpressure and duration were also low in the two groups (mean amplitude 42 vs 40 cmH2O(p=0.81) and mean duration 16 vs 17 seconds (p=0.55) in AN and controls respectively).Defects of the internal and external anal sphincters or combined defects were found in 40%of cases in the two groups (anal ultrasound). RP surgery was always indicated in bothgroups. Laparoscopic rectopexy was preferentially performed. Conclusion. Patients with RPin a context of AN were younger and presented less obstetrical and surgical past historythan patients without AN. This suggests a specific physiopathology of RP associated with AN.Abdominal hyper pressure induced by vomiting, laxatives and enemas abuse, constipation andphysical hyperactivity, combined with abnormalities of conjunctive and muscular tissuessecondary to weight loss might contribute to pelvic abnormalities in AN. Further studiesare required to determine RP prevalence in AN, natural history and recurrence after surgery.Significant demographic and past history differences between AN and control women

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Electrical Stimulation Therapy (EST) of the Lower Esophageal Sphincter(LES) is Successful in Treating GERD in Proton Pump Inhibitors (PPI)Incomplete Responders - Post-Hoc Analysis of Open-Label Prospective TrialLeonardo Rodriguez, Patricia Rodriguez, Beatriz Gomez, Juan C. Ayala, Jorge Saba,Alberto Perez Castilla, Galvao Neto Manoel, Edy E. Soffer

Background: A prospective open-label human trial of LES -EST in patients with GERD hasshown improvement in patients' symptoms and GERD-HRQL, esophageal acid exposureand LES pressure (Am J Gastro 2011; 106: S6). Aims: This is a post-hoc analysis of theprospective open-label trial to evaluate the effect of LES-EST in a subgroup of patients thatwere incomplete responders to PPI therapy. Methods: GERD patients with incompleteresponse to PPI therapy defined as off-PPI GERD HRQL >20 and on-PPI GERD-HRQL >/=6 were included in this post-hoc analysis. Inclusion criteria for the trial were: basal LESend-expiratory pressures (EEP) of 5-15 mmHg, % 24 hour esophageal pH<4.0 for >5%,hiatal hernia < 3cm and esophagitis < LA Grade D. Bipolar stitch electrodes were laparo-scopically placed in the LES and an implantable pulse generator (EndoStim®LES Stimulator,EndoStim BV, The Hague, The Netherlands) was placed subcutaneously in the anteriorabdominal wall. EST at 20Hz, 215usec, 3-8mAmp in 30 minutes sessions was deliveredstarting on day 1 post-implant. The sessions were delivered pre-meal and at night. Patientswere evaluated using GERD-HRQL, symptom diaries and SF-12 at baseline and every monthfor 6 months thereafter, and underwent esophageal pH at 0, 1, 3 and 6 months and highresolution manometry testing at 0, 1 and 3 months. LES-EST sessions were optimized basedon residual symptoms at follow-up. Results: Fifteen [mean age (sd) 53.2 (10.1) years; 7men] out of 24 GERD patients enrolled in the trial had incomplete response to PPI's. Allhave completed their 6 month evaluation on LES-EST, and their data are the basis forthis analysis. LES-EST resulted in a significant and sustained improvement in symptoms,esophageal acid exposure and LES pressures (Table). Optimization in LES-EST resulted infurther improvement in both GERD-HRQL (p=0.1) and esophageal pH (p=0.07) betweenmonth 3 and 6 though the difference was not significant. At baseline, on-PPI therapy 33%patient reported nocturnal heartburn symptom “bothersome” compared to 0% (p=0.04) at