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spatients screened and 38% of total invalid patients). This subgroup analysis also had asignificant decrease (p = 0.01) from 21% in 2003 to 15% in 2006. Discussion: The twostudies reviewed a large number of charts and allowed liberal criteria for classifying PPI useas appropriate. Although we showed a significant decrease in the number of invalid patientsbeing prescribed a PPI, both studies still demonstrated substantial inappropriate use (47%and 39%, respectively). Subgroup analysis revealed that 46% and 38%, respectively, ofpatients receiving a PPI >age 70 were inappropriately prescribed. However, we need additionaleducation for the majority of the patients younger than 70, for whom there was no significantdecrease. This data is promising because education alone may contribute to a decrease inpoly-pharmacy in the elderly population and overall cost for the health care system.

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Medical Management of Inflammatory Bowel Disease; Patterns of InfliximabUse Amongst Canadian GastroenterologistsJennifer Jones, Remo Panaccione, Margaret Russell, Robert J. Hilsden

Background: The last decade has been characterized by an increase in the number of biologicalagents available to treat inflammatory bowel disease (IBD). Infliximab was approved byHealth Canada for the treatment of Crohn's disease (CD) in 2001 and for ulcerative colitis(UC) in 2006. However, little is known of physician's perceptions and practices in usingInfliximab. Objectives: To describe how Canadian gastroenterologists' use and perceptionsof Infliximab to treat refractory inflammatory bowel disease (IBD) and to identify factorswhich may influence a gastroenterologist's decision to initiate Infliximab therapy. Methods:A postal questionnaire was distributed to all practicing clinicians captured in the 2007membership of the Canadian Association of Gastroenterology (CAG). Each physician wascontacted up to a maximum of three times. Results: 336/466 responded (72%). 292 (63percent) of respondents had completed questionnaires in full. The majority of respondentswere between the ages of 30 and 59 years. 80 percent indicated that IBD patients comprisedless than 30% of their clinical practice. Most prescribed Infliximab at an initial dose of 5mg per kilogram (97%), prescribed loading doses at 0, 2 and 6 weeks (88%), pre-medicatedwith corticosteroids (74%), administered maintenance infusions at 8 week intervals (89%),co-administered immunosuppressive agents (81%) and continued Infliximab “indefinitely”,as long as effective and well tolerated (76%). Most (> 70 percent) gastroenterologists identifiedlack of insurance coverage and provincial funding criteria as important barriers to prescribingInfliximab. Conclusions: Most Canadian gastroenterologists exhibit similar practice patternswith respect to the use of Infliximab for induction and maintenance therapy of IBD. Commonbarriers were identified with respect to the initiation of Infliximab therapy. The developmentof more targeted educational programs are needed which address Infliximab-related risk aswell as specific aspects of IBD patient care.

S1057

How Thoroughly Is Diarrhoea Investigated in Secondary Care?Asma Fikree, Toyah Singh, Raymond D'Souza, Niall van Someren, Kalpesh Besherdas

Introduction: Chronic diarrhoea (CD) is one of the most common reasons for referral to agastroenterology clinic. The British Society of Gastroenterology (BSG) has produced guide-lines for the investigation of CD. This includes checking basic blood tests (including fullblood count (FBC), calcium (Ca), liver function tests (LFTs), haematinics and thyroidfunctions tests(TFTs), coeliac serology (TTG) and then lower gastrointestinal endoscopy(LGIE). Aim: The aim of this study was to ascertain how tightly published guidelines areadhered to in performing initial blood tests for CD. Method: A retrospective single centrestudy (associate teaching hospital) of patients undergoing LGIE for CD was performed. Datafor patients undergoing LGIE for CD over a 2 year period (Jul 05 - Jul 07) were obtainedfrom endoscopy software the hospital pathology system. Results: 283 patients (age 16-92)had a LGIE over the two year period. 4 patients of the 283 (4.9%) had a full set of bloodtests. 35 patients (12.4%) had no blood tests. 248 patients did have one or more bloodtests set out in the guidelines. Of these, 16 (6.4%) had no FBC, 22 (8.9%) had no U+Es,29 (11.7%) had no LFTs. 155 patients (62.5%) had a CRP, 157 patients (63%) had TFTs,76 (30.6%) had a Ca level, 95 (38%) had ferritin, 84 (34%) had B12 and folate levels. 73patients (29%) had a full haematinics screen. Only 28 patients (11.3%) had anti-tissuetransglutaminase levels. 206 patients (83%) had a very basic blood screen including FBC,U+Es and LFTs. 18 patients (6.3%) had no specific endoscopic diagnosis. Of the 265patients who had an endoscopic diagnosis, 174 (66%) had a normal endoscopy, 15.8% haddiverticulosis, 6% had colorectal polyps, 6% had ulcerative colitis and 1.5% had colorectalcancer. Conclusion: In this study, only 4.9% of patients who have a LGIE for CD have acomplete set blood investigation. The study demonstrates that the BSG guidelines for theinitial investigation of CD with screening blood tests are poorly implemented. Significanttreatable pathology to account for CD, such as coeliac disease and thyroid disorders, maybe missed as a result of not performing a basic blood screen. In addition, LGIE may beperformed unnecessarily, as if screening blood tests were to be performed may indicatesmall bowel or pancreatic investigations rather colonic imaging. Using a blood test Proformamay help standardise the investigation of CD and ensure a more thorough set of initialinvestigations is done. Reference: Guidelines for the investigation of chronic diarrhoea, 2ndedition. Thomas et al, GUT 2003 (52): v1-v15

S1058

Hepatitis A and B Immunization Practices Among Community Physicians ofChronic Hepatitis C PatientsYasmin Metz, Ketan Kulkarni, Maya Gambarin-Gelwan, Ira M. Jacobson

PURPOSE: We sought to determine if chronic hepatitis C (CHC) patients are being appropri-ately vaccinated in the community in accordance with AASLD practice guidelines (StraderDB et al. Hepatology 2004; 39: 1147-71). METHODS: Patients with CHC initially seen inour hepatology practice between 7/06-7/07 were identified. Subjects were either self-referred,referred by their primary care provider or gastroenterologist. Charts were reviewed to

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ascertain date of diagnosis, demographic data, hepatitis serologies and stage of liver disease.Screening colonoscopy status in age-appropriate subjects was also reviewed to assess compli-ance with another recommended preventive health measure. Patients were only includedin the final analysis if they had well-compensated liver disease and had known CHC for atleast one year prior to referral to permit time for immunization. RESULTS: One hundredand fifteen consecutive new CHC referrals were identified. 89 of them had been diagnosedat least one year prior to referral with a mean of 6.6±4 years. 41 patients (46%, n=89) wereHAV IgG +, suggesting either prior vaccination or natural immunity. Among 86 patientsfor whom complete HBV serologies were available, 50 (58%) had serum markers of pastHBV infection or vaccination (isolated HBcAb+ n=5, HBsAb+ n=45). Of 66 patients over50 years old for whom colonoscopy history was documented, 43 (65%) had a screeningcolonoscopy within 5 years. Prior studies have shown the prevalence of natural immunityto HAV and HBV among CHC patients is 38% and 59%, respectively (Siddiqui F et al. AmJ Gastroenterol 2001; 96: 858-63). There was no difference between the prevalence ofimmunity to HAV (p=0.13) or HBV (p=0.91) among our population when compared to theexpected prevalence of natural immunity. The prevalence of colonoscopy screening wasgreater than that of immunity to HAV (p=0.02) but not for HBV (p= 0.41). CONCLUSION:The prevalence of immunity to HAV and HBV among our CHC patients was similar to theprevalence of natural immunity previously reported. Since the immunogenicity of HAV andHBV vaccinations is high in patients with well-compensated disease, ineffective seroconver-sion could only account for a small percentage of unvaccinated subjects. Hence, immunityto HAV and HBV in our population of HCV-infected subjects was not adequately ensuredby referring physicians. Patients were more likely to have undergone colonoscopy than haveimmunity to HAV. Greater awareness is needed among physicians so that immunizationagainst HAV and HBV becomes part of routine health maintenance for CHC patients.

S1059

Intravenous PPI Ordering Pattern in a Computerized Physician Order EntrySystem: Factors Affecting Inappropriate UsageAugustin Nguyen, Flavio Habal

Background and Aims: Intravenous (IV) proton pump inhibitor (PPI) use is widely acceptedin treatment of suspected upper gastrointestinal bleeding (UGIB) or in patients who cannottolerate oral medications (ie. NPO) but require PPI for other reasons. Various rates ofinappropriate utilization of IV PPI and factors associated with inappropriate use have beenreported previously. Hospital computerized physician order entry (CPOE) systems are widelyregarded as the technical solution to medication ordering errors. The aim was to determinethe rate of inappropriate usage of IV PPI and determine any factors associated with improperuse in an institution with an established CPOE system. Methods: In a prospective studyover 2 month period, all patients who had computer generated orders for IV PPI duringtheir hospital visit (inpatient, emergency room, or elective post-operatively) were reviewedwithin 48 hours of initiation of the order, for indication, appropriateness of dose, andinvolvement GI service. Indications for use were divided into 3 categories: suspected/knownUGIB, NPO, or other indications. A very liberal accepted appropriate dosing for suspectedUGIB was used; including a standard regimen of a bolus followed by continuous IV infusionof PPI or any IV intermittent dose. Accepted dosing for NPO status included any IVintermittent dose but not continuous IV drips. Results: Over the study period, a total of101 patients had computer-generated orders for IV PPI as part of their medical treatment.Of the total, 69 patients (68.3%) received IV PPI for possible UGIB, and of these, 16 (23.2%)had IV PPI ordered inappropriately. IV PPI for NPO status was ordered in 18 (17.8% oftotal) patients and of these, 11 (61.1%) patients had inappropriate usage. Other indicationswere identified in 14 (13.9% of total) patients, all of whom are considered inappropriate.Overall, the rate of inappropriate usage was 39.6% (40/101), with the majority of inappropri-ate use in the non-UGIB categories (25/41). Factors that appear to be associated withinappropriate use were non-UGIB (combined NPO and other indications), orders generatedafter business hours, and orders generated by surgical subspecialties. Age and gender didnot affect appropriateness of IV PPI use. Conclusion: In the setting of computerized physicianorder entry, despite a liberal acceptance of indications, inappropriate use of IV PPI remainsunacceptably high. The factors associated with inappropriate ordering practices includeorders generated after hours and those generated by surgical subspecialties.

S1060

Gender-Related Differences in Quality of Life Perception in InflammatoryBowel DiseaseZuzana Zelinkova, Judith E. Baars, Tineke Markus, E. J. Kuipers, Christien J. van derWoude

INTRODUCTION: Clinical practice shows that gender-related issues in inflammatory boweldisease (IBD) are of great importance. Previous reports showed that female gender is anindependent predictor of decreased quality of life. However, no data are available on thegender-specific character of the disease-related quality of life perception. AIMS & METHODS:The aim of the study was to assess gender-related differences in quality of life perceptionin IBD patients. Between December 2006 and January 2007, a patient empowerment studyhas been performed as a patients-initiated study in cooperation with Dutch Patients' Crohn'sand Colitis association (CCUVN). All patients willing to participate completed an onlinequestionnaire consisting of multiple-choice questions on the CCUVN website. Differencesbetween males and females perception of particular quality of life influencing factors wereanalyzed statistically by chi-square test. RESULTS: In total 1067 (Crohn's disease/ulcerativecolitis, 617/450) patients, mainly females (703 females/364 males, 66%/34%) replied. Signi-ficantly more females (F) than males (M) found that the disease limited them in everydayactivities (53% F vs. 45% M, p=0.014). Only 9% of participating female patients vs. 19%of males almost never experienced disease-related limitations. Significantly more femalesthan males encountered serious limitations in professional life such as work (42% F vs.33% M, p=0.015) and study (36% F vs. 19% M, p<0.001). Furthermore, the disease waslimiting more females than males in family life (31% F vs. 21% M, p=0.002), social life(35% F vs. 23% M, p<0.001) and sport (44% F vs. 34% M, p=0.004). No differences inthe impact of disease on these activities were observed with regards to the type of the disease.

Finally, as a result of the disease, significantly less female then male patients (44% and 55%,respectively; p=0.002) found that they were able to meet their daily expectations withregards to work or study, household, family and social activities. CONCLUSION: Femaleinflammatory bowel disease patients experience more frequently the negative impact of thedisease on the quality of life. Furthermore, there are important gender-related differencesin the perception of particular factors influencing the quality of life.

S1061

Does a Pre-Transplant Diagnosis of GERD Increase the Risk of Acute Rejectionin Lung Transplant RecipientsChristopher C. Canale, Kristen Hilden, Fatima Gangotena, John C. Fang, Barbara Cahill,Kathryn A. Peterson

Introduction: There is a high prevalence of gastroesophageal reflux (GER) amongst lungtransplant recipients. It is not known how a pre-transplant diagnosis of GER impacts post-transplant allograft function. Aim: To determine whether a pre-transplant diagnosis ofGERD increases the risk of acute rejection (AR) after lung transplantation (LT). Methods:A retrospective chart review was performed on all University of Utah lung transplantsperformed 01/1996 - 02/2007. Patients were diagnosed with GERD if they had evidence ofesophagitis or a physician-diagnosis of GERD prior to LT. Surveillance bronchoscopy withlavage and biopsy was performed on a regular basis in the first two years after LT. AR wasdiagnosed by transbronchial biopsy. CMV infection was diagnosed by a positive shell vialassay and/ or culture of lavage fluid. Results: A total of 94 patients were studied. The meanpatient age was 55.4 years (26-74). Indications for transplant included COPD (n=58),pulmonary fibrosis (n=11), pulmonary hypertension (n=8), cystic fibrosis (n=8), and other(n=9). Of the 94 patients evaluated, 35 (37%) carried a pre-transplant diagnosis of GERand 25/35 (71%) experienced AR. The number of overall AR episodes were 49/94 (52%).Univariate analysis revealed that pre-transplant GERD was significantly associated with ARpost-transplant. Patients without GERD were 3.22 times more likely to remain AR free (p=0.01). A subset analysis looking at the prevalence of CMV infection in those with andwithout pre-transplant GERD did not alter the results. Importantly, on multivariate analysis,controlling for age, gender, diagnosis, transplant type, BMI, and GERD, GERD was the onlyvariable found to increase the odds of AR (p=0.005). Conclusions: There is a significantincrease of AR in LT recipients who carry a pre-transplant diagnosis of GER. Prospectivestudies should be performed to determine whether these patients would benefit from concom-itant fundoplication at the time of transplant.

S1062

Sleep Disturbance Associated with Gastro-Oesophageal Reflux Disease(GORD): Frequency and Evolution with Treatment According to PatientsGuillaume Cadiot, Pierre-henri Delaage, Caroline Fabry, Philippe Barthelemy

Introduction The aim of this study carried out in general practice was to evaluate thefrequency of sleep disturbances associated with GORD in reflux patients and to analyse theevolution of GORD symptoms and of sleep disturbances one month after treatment accordingto patients. Materials and methods This was an observational study carried out by 1983GPs. Each doctor completed a register during a period of two weeks for all the GORDpatients over 18 YO seen consecutively. For the first two patients on the register who hadhad at least one nocturnal GORD symptom with GORD-related sleep disturbances over thepast week and who had not been treated by proton pump inhibitor (PPI) or H2 receptorantagonist during the previous fortnight, a detailed symptomatic evaluation was carried outby the physician before treatment and by the patient before and after one month of treatment.Results Between September 2006 and March 2007, 33391 patients were included in theregister (age=52±16, male=52%, first episode=23%). Among these, 19313 (62%) presentedsleep disorders. The frequency of sleep disturbances was once a week for 25% of patientsand more than once a week for 37% of them. Multivariate analysis showed that the factorssignificantly associated with sleep disturbances were nocturnal heartburn (OR=9.0; CI 95%=8.38-9.71), nocturnal cough (OR=7.8; 7.15-8.59), nocturnal acid regurgitation (OR = 5.3;4.94-5.80), hypnotics use (O=1.5; 1.40-1.65), daytime acid regurgitation (OR=1.4; 1.26-1.45), the current episode being the first episode of GOR (OR=0.8; 0.77-0.91) and age >50 years vs age < 50 years (OR=1.1; 1.06-1.22). Among the 3.269 participants with sleepdisturbances and for whom a complete questionnaire had been filled in by the physician,2,876 initial and final self-evaluation questionnaires were analysed. The initial treatmentwas a PPI in 99% of cases, either alone or associated with another treatment. After onemonth of treatment, the patients observed a significant reduction in the frequency andintensity of the nocturnal symptoms. The scores for the four sleep rating scales (time takento fall asleep, duration of sleep, quality of sleep and morning sleepiness) significantlyimproved under treatment. With treatment, the number of patients who woke up at nightdecreased from 89% to 18% and the mean number of nights with interrupted sleep decreasedfrom 3.8 to 1.8 per week. Conclusion This study showed that 62% of the patients seen ingeneral practice who suffer from symptomatic GORD have associated sleep disturbance.Treatment with PPI improves nocturnal GORD symptoms, sleep rating scales and reducesthe number of nights with sleep interruption by half.

S1063

The Effect of Esomeprazole 20 Mg Twice Daily Versus Placebo On Acousticand Perception Parameters of the Voice in Patients Diagnosed with GERD-Related Posterior Laryngitis (GPL)Tomas Navarro-Rodriguez, Julie Barkmeier-Kraemer, Kent Wilson, Marcia R. Willis, NorthNoelck, Jeannette Powers, Ronnie Fass

Background: Control studies investigating outcomes of posterior laryngitis associated withGERD treated with proton pump inhibitors report no improvement in laryngeal appearanceor reflux symptoms with the exception of hoarseness and throat clearing. Unfortunately,none of these studies addressed acoustic parameters to address changes in vocal function.

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Aims: To determine the effect of esomeprazole vs. placebo on voice parameters in patientsdiagnosed with GPL. Methods: Forty-one individuals diagnosed by an otolaryngologist ashaving GPL participated. All subjects completed the Laryngopharyngeal Reflux Quality ofLife (LPR-QOL) and underwent vocal function testing including acoustic recordings of thevoice during sustained and connected speech and videostroboscopic examination. Upperendoscopic examination of the esophagus and dual-probe 24-hour esophageal pH monitorwere also completed. After baseline testing, participants were randomly assigned to eitherplacebo or esomeprazole (20 mg) twice daily for 12 weeks. Both capsules were identical toensure that participants and investigators were blind to condition. Upon completion of thestudy, acoustic measures, the LPR-QOL, and videostroboscopic examinations were repeated.Reflux Severity Scores were obtained during randomized presentations of paired open andclosed laryngeal images from baseline and post-treatment stroboscopy sessions. An otolaryng-ologist and speech-language pathologist, who were not associated with the study, performedthese ratings. Results: Sixty percent of the patients had either abnormal acid exposure and/or erosive esophagitis. Both groups were similar for age (65 years) and BMI (28). Male/female ratio was 11:6 for placebo and 13:11 for esomeprazole. As seen in Table 1, LPR-QOL scores were significantly different between the two groups at baseline (P<0.003);however, no difference was found between groups for treatment response. In addition, noneof the voice parameters changed from baseline to post-treatment. Conclusions: Perceivedgains from treatment by participants were unrelated to esomeprazole and unsupported byvoice measures. Voice measures are not predictive of PPI response in patients with GPL.Pre- and post-treatment measures

S1064

Development of Acid Exposure, Symptoms and Laryngeal Findings in HealthySubjects: A More Than 10-Years Follow-Up StudyRiitta Ylitalo Moller, Olle Andersson, Caterina A. Finizia, Magnus Ruth

Gastroesophageal reflux disease (GERD) is a complex condition presenting with both eso-phageal and extraesophageal manifestations. Despite the high prevalence in the generalpopulation there are few studies with systematic evaluation of long-term development ofboth esophageal and laryngopharyngeal reflux (LPR) in previously healthy persons. Aims:To evaluate1) whether acid exposure (AE) in the esophagus or pharynx increases over time;2) to which extent observed AE relates to the development of esophageal and airwaysymptoms as well as laryngeal pathology. Methods: Forty adult symptomfree persons (mean43 yrs, range 23-64) earlier included in a normative pH monitoring study were traced. Aftera mean follow-up period of 14 years, 24 of the subjects (mean 57 yrs, range 38-76) completedvideolaryngoscopy, station pull-through manometry, 24-hour dual-probe pH monitoring(probe location: 2cm proximal to UES and 5cm proximal to LES high pressure zones) and2 symptom questionnaires. pH recordings were checked manually to exclude artefacts.Laryngoscopic recordings from the follow-up were copied to a separate S-VHS tape in arandom order and 2 ENT doctors blinded for the data evaluated the new videotape. Results:Of the 24 subjects, 5 (21%) had pathological esophageal AE at baseline and 8 (33%) atfollow-up (p=.23). The number of esophageal reflux episodes (p=0.24) and the total timeof pH<4 (p=0.71) remained unchanged. LPR occurred in 15 (63%) subjects (1-10 episodes)at baseline and in 8 (33%) subjects (1-4 episodes) at follow-up (p=.04). Of the subjectswith pathological esophageal AE, 4 (80%) had LPR at baseline and 4 (50%) at follow-up.The Body Mass Index (BMI) increased significantly (p< 0.001) during this follow-up time.Heartburn and regurgitation developed in 8 (33%) (p= 0.008) and 11 (46%) (p=0.001) ofthe 24 subjects, respectively, while airway symptoms were reported by 10 (42%) at thefollow-up. The most common symptoms were throat clearing, excessive phlegm and daytimecough, in that order. The esophageal, or airway symptoms, or combination of them weresimilar among persons with and without pathological AE and with and without LPR. Laryngealpathology was found in 9 of 23 (39%) subjects: 5 (22%) had posterior laryngitis and 4(17%) chronic laryngitis. There was no significant difference (p>.01) in esophageal orpharyngeal AE at baseline or follow-up between those with laryngeal abnormalities andthose without. Conclusions: Esophageal and pharyngeal AE is relatively stable over time inpreviously symptomfree, healthy volunteers. The increase in both esophageal and airwaysymptoms as well as laryngeal pathology is not related to increased AE.

S1065

Correlation Between Pulmonary Fibrosis and GERD in Scleroderma (SSc)Patients: Studies Using 24-Hour Ambulatory Intraluminal pH-Impedance (MII-pH)Edoardo Savarino, Marco Bazzica, Massimo Ghio, Patrizia Zentilin, Daniel Pohl, RaduTutuian, Vincenzo Savarino

Introduction: GI tract and lung involvement are the most frequent manifestations of SScdisease. Recently, GER is suspected to be a contributing factor in the pathogenesis ofidiopathic pulmonary fibrosis. Aim: To evaluate the role of GERD in pulmonary fibrosis inSSc patients using MII-pH testing. Methods: We evaluated 24 consecutive SSc patients (ACR

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