Use of laboratory tests to predict helicobacter pylori in patients with Gastric Intestinal Metaplasia

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  • groups. (17% Group 1, 19% Group 2, 16% Group 3). In addition, a subsetanalysis showed no differences in the location of ulcers, whether gastric orduodenal.Conclusions: We conclude that emotional stress does not cause an increasein the prevalence of asymptomatic ulcers found during upper endoscopy.This study provides evidence that emotional stress following major cata-strophic events does not lead to the development of peptic ulcer disease.

    128ELECTROGASTROGRAM AND WATER LOAD TEST (WLT)RESULTS DIFFERENTIATE PATIENTS WITH BLOATING ORNAUSEA SYMPTOMSGeoffrey S. Raymer, M.D., Lihua Xu, M.D. and Kenneth L. Koch,M.D.*. Division of Gastroenterology & Hepatology, Pennsylvania StateUniversity, Hershey, PA.

    Purpose: The pathophysiology of chronic bloating remains poorly under-stood in many patients with functional dyspepsia. The aim of this study wasto compare A) electrogastrogram (EGG) results and B) WLT results inpatients with predominant bloating with patients with predominant nauseasymptoms.Methods: 30 pts. (22 women, 8 men, ages 1680 yrs.) with unexplainednausea or bloating based on review of visual analog scale (VAS) scoreswere studied. Patients underwent EGG and WLT using a standard protocol.EGGs were recorded with electrodes placed on the epigastrium and theoverall clinical diagnosis and percent distribution of EGG power in 4frequency ranges (12.5 cpm bradygastria, 2.53.7 cpm normal, 3.710.0 cpm tachygastria, and 1015 cpm duodenal/respiratory range)were determined. Symptoms were assessed at baseline, 10 and 30 min. afteringestion of water until full using a 0 300 mm VAS.Results: Baseline bloating score was 16824 and increased to 2518 and23112 at 10 and 30 min. after the WLT in the bloating patients. Nauseapredominant patients had bloating scores 20 after the WLT (p0.01 vs.bloating patients). Bloating patients ingested significantly more water dur-ing the WLT compared with the nausea patients (54148 ml vs. 36758ml, p0.03). Bloating patients had significantly more bradygastria activitycompared with the nausea patients (ANOVA, p0.012), and the differ-ences in % bradygastria activity were significant at baseline (5214 vs.3913, p0.02) and approached significance at 30 min. (p0.057) afterthe WLT. The % 3cpm and tachygastria activity were not significantlydifferent in the two groups. Bloating patients had significantly less duo-denal/respiration activity (33 vs. 75, p0.02) than the nausea predom-inant patients at baseline. The EGG clinical diagnoses in the bloatingpatients were: 5 normal EGGs, 3 tachygastrias, 4 bradygastrias, and 3mixed dysrhythmias, whereas the diagnoses in the nausea patients were: 11normal EGGs, 3 tachygastria and 1 bradygastria.Conclusions: 1) Bloating symptoms were associated with A) increasedbradygastria activity, B) increased water load volume ingested, and C)more abnormal EGG diagnoses compared with the nausea predominantpatients; and 2) EGG patterns and the WLT differentiated selected patientswith chronic bloating or chronic nausea symptoms.

    129GASTRIC ANTRAL METAPLASIA AND ITS ASSOCIATIONWITH BARRETTS ESOPHAGUS AND H. PYLORI INFECTIONKhondker K. Islam, M.D.*, Marlyn C. Ciesla, M.D., Steve Creech, M.S.,Kapil Mehta, M.D., Rana Sokhi, M.D. and Sohrab Mobarhan, M.D.Medicine, Loyola University Medical Center, Maywood, IL andCardinal Bernadin Cancer Center, Loyola University Medical Center,Maywood, IL.

    Purpose: Gastric antral metaplasia is an occasional histologic finding whenbiopsies are taken for H. pylori infection. Identification of H. pylori isinfrequent in areas of intestinal metaplasia. This retrospective study wasdone to identify the association of gastric antral metaplasia with H. pyloriinfection and Barretts esophagus.

    Methods: We performed a chart review to identify patients that had antralmetaplasia resulting in 532 patients, which constitute the study sample. Wereport descriptive statistics for demographic variables. We used the twosample ttest to compare age between groups defined by binary variables.We used the Chisquare or Fishers exact test as appropriate to evaluateassociations among categorical variables.Results: Out of 532 patients, 276 (52%) of the patients were male. Theaverage age was 69 years and the range was 1 to 97. Ninety eight (18%)of the patients were tested positive for H. pylori , 137 (26%) were testednegative and 297 (56%) were not tested for H. pylori. Ninety three (18%)of the patients had Barretts esophagus, 134 (25%) were tested negative and305 (57%) were not tested for Barretts esophagus. Fifteen (3%) patientswere tested positive for both H. pylori and Barretts esophagus and 51pa-tients (10%) were tested negative for both. Age was not statisticallydifferent between groups defined by gender, H. pylori status or Barrettsesophagus. A greater percentage of males (48%) than females (35%) weretested positive for H. pylori (P0.063). There was no difference in inci-dence of Barretts esophagus between males and females. H. pylori positivepatients had a greater percentage of Barretts esophagus (37%) than H.pylori negative patients (15%) (P0.012).Conclusions: Barretts esophagus and H. pylori infection were signifi-cantly higher in patient populations with antral interstitial metaplasia.Higher incidence of gastric antral metaplasia is noted in elderly patientgroup (age 75 Y). Combination of Barretts esophagus and gastric antralmetaplasia is more marked in female with relatively higher age than male( 60 y Vs 60 Y). H. pylori infection was more seen in male population.Antral biopsy might be taken in pateints with Barretts esophagus if if H.pylori infection or antral metaplasia is suspected.

    130

    USE OF LABORATORY TESTS TO PREDICT HELICOBACTERPYLORI IN PATIENTS WITH GASTRIC INTESTINALMETAPLASIAVlado Simko, M.D.,Ph.D.*, Cristina SeminoMora, M.D.,Ph.D.,Fredrick Oni, M.D. and Andre Dubois, M.D.,Ph.D. Medicine, BrooklynCampus, VA NY Harbor HCS, Brooklyn, NY and GastroenterologyResearch, Uniformed Services University HCS, Bethesda, MD.

    Purpose: Gastric intestinal metaplasia (GIM) preceeding dysplasia andneoplasia has been causally linked with the Helicobacter pylori (HP). Thereis uncertainty about the predictive value for HP diagnosis with routine lightmicroscopy combined with a rapid urease test, when gastric biopsies arelimited in number and location. An HP breath test (BT) may more accu-rately represent an integrated response to HP urease.Methods: Eighteen male veterans aged 73 (9), mean (1 SD), range 59 81years who had previously documented GIM, were tested for HP by gastricbiopsies from the antrum, incisura at lesser curvature and 1 cm distal tocardia using light microscopy (Giemsa) and a CLOtest (Ballard MedicalProducts). All patients had a C13 BT (Meretek Diagnostics Inc) with p.o.PranactinCitric solution after 10 days absence of PPI and antibiotics.These routine tests were compared with results obtained using (1) formalinfixed biopsies (Genta Robason method or in situ hybridization for thevirulence gene cagA); (2) culture; and (3) quantitative RTPCR for HP16SrRNA.Results: In routine clinical testing light microscopy was positive for HP in1/18 patients, CLOtest in 1/18, BT in 3/18. Using a combined predictivepower of Genta stain, cagA, HP culture and RTPCR, 15/18 patients wereHP positive. Proportion of HP positive results: Genta 14/18, cagA 14/18,culture 3/18 and RTPCR 11/18.Conclusions: Routine clinical tests for HP using light microscopy andCLOtest from multiple sites combined with a BT, missed HP in 12/18patients. Given the association between HP and GIM, the premalignantpotential of GIM, serious consideration should be given to agressiveeradication of HP in patients with GIM, even if routine clinical tests arenegative for this organism.

    S43AJG September, Suppl., 2002 Abstracts

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