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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
e167
Conclusions:
Our data showed that HRiM was able to discriminate
Barrett mucosa from normal esophageal epithelium. Considering
that HRiM is the reference standard to assess EGJ position and
borders, this technique might become a useful tool combined with
endoscopic examination to assess more precisely BE length.
P.08.6
THE IMPACT OF RHINOLOGIC EVALUATION ON PATIENTS WITH
SUSPECTED SUPRAESOPHAGEAL REFLUX DISEASE
Torresan F.*
1
, Ioannou A.
2
, Schiavon P.
1
, Mancini M.
2
, Cimatti M.C.
2
,
Pirodda A.
2
, Bazzoli F.
2
1
Ospedale Sant’Orsola-Malpighi, Bologna, Italy,
2
Università di Bologna,
Bologna, Italy
Background and aim:
Supraesophageal reflux disease (SERD),
defined as reflux proximal to the upper esophageal sphincter,
is a common cause of morbidity of the upper aerodigestive tract,
including rhinitis, laryngitis, cough, postnasal drip, and throat
clearing. There are no unequivocal criteria that reliably demonstrate
a causal link between acid reflux and laryngeal symptoms. Results
of esophageal pH-testing and response to proton pump inhibition
therapy are variable. It is likely that some patients are mistakenly
diagnosed with SERD and investigation of the other causes of
laryngeal symptoms, including rhinitis, should be considered.
Aim:
To evaluate the impact of the rhinologic evaluation on patients with
suspected supraesophageal reflux disease.
Material and methods:
Between January 2014 and September
2015 fifty-five patients (28 F) referred to our unit for suspected
reflux disease with supraesophageal manifestations and a history
of a ENT visit suggesting a suspected reflux cause, were enrolled. An
esophageal manometric study and a 24 hour pH-Impedance study
were performed in our G.I motility lab and a rhinomanometry, a skin
prick test and a nasal cytology were performed in our ENT unit.
Results:
Of the 55 patients with suspected SERD, 33 (60%) resulted
to have pathological basal pH-Impedance values and 22 (40%)
resulted with normal basal values. Of the patients with pathological
pH-Impedance, 14 (42,4%) were diagnosed with non allergic rhinitis
(NAR), 11 (33,3%) with allergic rhinitis (AR), 2 (6,1%) with both AR and
NAR, 1 (3%) with negative rhinologic evaluation whereas 5 (15,2%)
were affected of other rhinological pathologies such us sinusitis and
sinus polyposis. Of the patients with a normal pH-Impedance, 11
(50%) resulted to have NAR, 9 (41%) AR, 1 (4,5%) NAR and AR and 1
(4,5%) resulted to have a negative rhinologic evaluation.
Conclusions:
Our study showed that 40% of the ENT evaluated
patients with suggested reflux related ENT symptoms resulted with
a normal pH-Impedance. Many patients had associated rhinologic
pathologies (allergic and non allergic). There is no statistical
correlation between patients affected by rhinologic pathologies
and ph-Impedance results. We have concluded that in patients with
suspected SERD is necessary a rhinologic evaluation for the frequent
and occasional association of rhinitis.
P.08.7
THE USE OF NON-ABLATIVE RF ENERGY (STRETTA) FOR THE
TREATMENT OF GERD, WHAT HAPPENS A DECADE LATER
Dughera L.*, Catalano G., Cisarò F., Cassolino P.
AO Città della Salute e della Scienza, Torino, Italy
Background and aim:
To date, the Stretta procedure (Mederi
Therapeutics Inc., Greenwich, CT, USA), which applies thermal
radiofrequency energy to the LES, still remains an available technique
for endoscopic treatment of GERD, with documented effectiveness
on patient symptom control, quality of life (QoL), oesophageal acid
exposure, and LES pressure. From June 2002 to July 2015 a cohort of
158 patients were consecutively treated with the Stretta procedure
for GERD; 51 patients (32 females, 19 males) reached to date a ten
year follow-up. Primary end point of the study was to verify the
durability and efficacy of the procedure at this time.
Material and methods:
The primary outcomes of the study were
heartburn score, GERD health-related QoL score (HRQL) and general
quality of life, using the medical outcome 36-item Short-Form
Health Survey (SF-36); GERD HRQL improvement was evaluated as a
continuous variable and as a dichotomous variable (responder versus
nonresponder). Response was a >50% improvement compared with
baseline values. The secondary outcome was the need of medication
use.
Results:
Out of 158 patients treated with Stretta from June 2002
toJuly 2015, 98 did not reach at the date of the objective of 10 years of
follow-up and nine patients were lost to follow-up. In seven patients
the RF treatment lost its efficacy. There here was a significant
decrease in both heartburn and GERD HRQL scores as well as a
significant increase of QoL scores (mental SF-36 and physical SF-36)
and 35 patients out of 51 (68,6%) were completely off PPIs.
Conclusions:
The results of our further follow-up study after 10 years
confirms the data published by Noar in late 2014 and further sustain
the concept that Stretta might represent a viable treatment option
for selected patients with symptomatic mild to moderate GERD; this
suggestion has been recently stated by the SAGES Guidelines in 2013
and by the ASGE Guidelines in 2015 ; nowadays it seems reasonable
to recommend Stretta, specially to the younger GERD sufferers, as
a “bridge therapy” between the continuous medical treatment and
the optimal timing for laparoscopic fundoplication.
P.08.8
CAUSAL EFFECT ASSOCIATION BETWEEN GASTROESOPHAGEAL
REFLUX DISEASE AND NONALLERGIC RHINITIS WITH
NEUTROPHILS
Torresan F.*
1
, Ioannou A.
2
, Schiavon P.
3
, Mancini M.
2
, Cimatti M.C.
2
,
Pirodda A.
2
, Bazzoli F.
2
1
Ospedale Sant’Orsola-Malpighi, Bologna, Italy,
2
Università di Bologna,
Bologna, Italy,
3
Italy
Background and aim:
The role of GERD in causing extra-esophageal
symptoms, such as laryngitis, asthma, chest pain and cough is
increasingly recognized with renewed interest. Nonallergic rhinitis
(NAR) is defined as a compound of nasal symptoms in the absence
of an allergic etiology and it is frequently observed in the clinical
practice. Nasal cytology allows to identify the different NAR sub-
types on the basis of the particular inflammatory cell infiltrate:
nonallergic rhinitis with neutrophils (NARNE), NAR with eosinophils
(NARES), NAR with mast cells (NARMA) and NAR with eosinophils
and mast cells (NARESMA). To date, there are no data about the
role of the reflux in rhinitis and in particular in the forms with
neutrophils (NARNE).
Aim:
To evaluate the possible association
between gastroesophageal reflux disease and nonallergic rhinitis
with neutrophils (NARNE).
Material and methods:
Between October 2013 and September 2015
thirty-five patients referred to our ENT unit for nasal symptomps
such as rhinorrhea, sneezing, and postnasal dripwere enrolled. Visual
analogue scale (VAS) for nasal obstruction and other NAR symptoms,
rhinomanometry, skin prick test and nasal cytology were performed.
Exclusion criteria were ambient irritant exposure and/or a positive
skin prick test. Of the 35 subjects with NAR, 20 (13F/7M, median
age 48 years) showed the presence of neutrophils (neutrophils >
50% with absent spores and bacteria) at nasal cytology (NARNE) and
were selected to perform a 24 hour pH-Impedance. Patients with a
24 hour pH-Impedance positive for GERD were treated with a high
dose of oral PPI (40 mg x 2/day) for 8 weeks. A second ph-Impedance