April 1995 Esophageal, Gastric, and Duodenal Disorders A257

Q PROSPECTIVE EVALUATION OF A NON-ENDOSCOPIC METHOD FOR DETECTING HELICOBACTER PYLORI. A.P. Weston, D.R. Campbell, D.H. McGregor, W.F. Makdisi, R. Cherian, A. Dixon, W. Bartholomew. VAMC Kansas City, MO & Univ. of Kansas Medical Center, Kansas City, KS. This prospective study was designed to evaluate the sensitivity and specificity of blindly brushing gastric mucosa to detect Helicobacter pylori (Hp). Blind brushings (BB) of gastric mucosa were obtained by placing a modified NG tube into the stomach and then inserting a protected brush through it. The brush was blindly extended in the stomach and two different brushes were used to obtain specimens. Material from the first brush was smeared onto a glass slide for Giemsa staining (GS) and the brush itself was then placed in carbowax for cytospin and subsequent GS of the sediment. The second brush was placed in a CLOtest chamber. After obtaining the two brushings, upper endoscopy was performed and at least 9 biopsies were obtained from the stomach; greater curve (3), antrum (3) and gastric brushing site (3). At each site, 2 biopsies were taken for histology/GS and 1 for CLOtest. RESULTS: BB were successful in 50 of 52 patients. The presence or absence of Hp was based on GS gastric biopsies. Hp was found on at least 1 of the gastric biopsy specimens in 24 of these patients. Sensitivity and specificity were determined for the brush site alone and the brush site compared to the rest of the stomach, since Hp infection can be patchy.

Sensitivity/Specificity* Based Upon GS Gastric Biopsies From

Blind Brushings Brush Site All Sites GS smear 81%/82% 64%/83% GS cytospin sediment 46%/96% 36%/100% CLOtest of brush itself 73%/92% 62%/100%

CLOtest of brush site bx** 88%/93% 74%/100% * equivocal results excluded from analysis - cytospin (5), smear (5) ** Brush site identified in 47 patients CONCLUSIONS: BB of the gastric mucosa is a viable method to detect Hp. BB has high specificity, good sensitivity, is simple to perform, is inexpensive, and results are available within hours. Hp detection can be enhanced by sampling more than one gastric site by brushing or biopsy.

PROSPECTIVE STUDY OF SHORT SEGMENT BARRETT'S: PREVALENCE, ASSOCIATED ENDOSCOPIC AND HISTOLOGIC LESIONS. A.P. Weston, P. Krmvotich. W. Makdisi, R. Cherian, D. McGregor, A. Dixon. VAMC Kansas City, Mo & Univ. Kansas Medical Center, Kansas City, KS.

The diagnosis of Barrett's esophagus is unequivocally established when specialized epithelium (intestinal metaplasia [IM]) is present anywhere in the tubular esophagus, regardless of its length. Short segment Barrett's (SSB) was defined as the presence of short extensions or patches of red mucosa lying less than 2 cm above the gastroesophageal junction containing specialized columnar epithelium. Little is known about SSB. AIM: To prospectively study SSB to determine; 1) its prevalence, 2) its clinical and endoscopic presentation, and 3) its association with Helicobacter pylori (Hp) and gastric IM. METItODS: All patients undergoing EGD by any of the authors over a 8 week period were scrutinized for SSB. Multiple esophageal biopsies from suspicious areas were taken to check for IM. Biopsies were also taken from the antrum and body to check for Hp (modified Giemsa stain) and gastric IM. RESULTS: 138 EGD were performed in 119 patients (108 patients single EGD, 11 others > 2 EGD). 26 patients had biopsies for possible SSB.

Features of Patients Screened for SSB + SSB - SSB p value

N 12 14 Gender 12 Male 14 Male Age (yrs) 68.3+6.7 53.7+14 0.003 Hx GERD 8 (67%) 13 (93%) 0.091 Hiatal Hernia 8 (67%) 13 (93%) 0.091 Gastric IM 5 (42%) 1 (7.1%) 0.037 Hp + 7 (58%) 12 (86%) 0.117 Dysplasia 0 (0%) NA Adenocarcinoma 0 (0%) 0 (0%)

CONCLUSIONS: Overall prevalence of SSB was 9.2%. SSB was not associated with Hp. SSB may be associated with gastric IM or this association may simply reflect the fact that SSB+ patients were significantly older.

• URINE IgG SEROLOGY TO DETECT GASTRIC HELICOBACTER PYLORI: COMPARISON TO SERUM IgG AND IgA SEROLOGY AND GIEMSA STAINED GASTRIC BIOPSIES. A.P. Weston, D.R. Campbell, W. Bartholomew, W.F. Makdisi, A. Kester, R. Cherian, D.H. McGregor, A. Dixon. VAMC Kansas City, MO & Univ. of Kansas Medical Center, Kansas City, KS. A number of nonendoseopic tests have been developed to simplify the detection of Helicobacter pylori (Hp) including serum serologic testing and urea breath testing. AIM: To prospectively evaluate the sensitivity (sens) and specificity (spec) of a new urine serologic kit (DAKO ELISA kit) in the detection of gastric Hp. METHODS. Subjects not eligible for this study included those with a history of previous gastric surgery or recent use (within 4 weeks) of bismuth or antibiotics. At EGD at least 6 biopsies (bx) were obtained from the stomach; 3 from the antrum and 3 from the greater curve (mid-distal body). Two bx from each site were for histology (modified Giemsa stain) and 1 was for CLOtest. Immediately following EGD, both urine and serum were collected for serologic analysis (all serologic kits provided by DAKO used ELISA to detect Hp antibodies). Determination of sens and spec of each serologic test was based upon Giemsa stained gastric bx. RESULTS: 50 patients entered the study, 24 of whom were colonized with Hp.

Test Sens%* Spec%* Equivocal (n)* Urine IgG 70 85% 1 Serum IgG 96 54% 0 Serum IgA 70 61% 4

p < 0.03 for sens U-IgG:S-IgG & S-IgG:S-IgA p < 0.03 for spec U-IgG:S-IgG & U-IgG:S-IgA

• equivocal results were excluded from sens/spec analysis Concordance between urine IgG and serum IgG results was 63%, urine IgG and serum IgA 64%, and serum IgG and serum IgA 80%. CONCLUSIONS: Urine ELISA IgG testing was significantly less sensitive than serum IgG for detecting Hp colonization, but it was significantly more specific. Serum serologic testing specificity may have been lowered by the inability to distinguish active from remote Hp infection. Factors responsible for the better specificity obtained from urine serologic testing warrant further study.

SYMPTOM PERCEPTION IN GASTROESOPHAGEAL REFLUX DISEASE IS DEPENDENT ON SPATIOTEMPORAL REFLUX CHARACTERISTICS. B.L.A.M. Weusten, L.M.A. Akkermans, G.P. vanBerge-Henegouwen, and A.J.P.M. Smout. Depts. of Gastro- enterology and Surgery, University Hospital, Utrecht, The Netherlands.

Gastroesophageal reflux disease (GERD) is a common disorder. The mechanisms responsible for the development of reflux symptoms are poorly understood. Recent technological developments have made it possible to measure intraluminal pH at multiple esophageal sites simultaneously. We performed 5-channel esophageal pH metry (3, 6, 9, 12, and 15 cm above the upper border of the LES) in 18 symptomatic GERD patients (6 female, 12 male; age 21-73 yr), in order to identify differences in spatiotemporal reflux characteristics (proximal extent and duration of reflux episodes, ascending velocity of the refluxate) between symptomatic and asymptomatic reflux episodes, and to assess the influence of different pH sensor positions on the yield of symptom analysis. In all patients, the median proximal extent, the median duration at the most distal sensor and the median ascending velocity of the refluxate were assessed for symptomatic and asymptomatic reflux episodes separately. Additionally, the Symptom Association Probability (SAP) was calculated for each esophageal level. Median episode duration (at 3 cm above the LES) was longer and the proximal extent was higher in symptomatic than in asymptomatic reflux episodes (P=0.006 and P=0.01). A significant correlation was found between the duration (at 3 cm) and the extent of the reflux episodes (P<0.01). No significant differences were found in ascending velocities between symptomatic and asymptomatic reflux episodes. The SAP decreased significantly (P<0.05) from distal to proximal, but no significant differences were found between distal and proximal esophageal levels for the proportion of patients with positive (>95%) SAP values. Conclusion: The perception of reflux symptoms depends on the duration of acid exposure episodes and on the proximal extent of the refluxate. Small changes in pH sensor position do not significantly influence the yield of symptom analysis.