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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
was performed during therapy whereas ENT examination and nasal
cytology were performed at the end of treatment.
Results:
Of the 20 patients with NARNE, 14 (70%) resulted to have
pathological basal pH-Impedance values and 6 (30%) resulted to
have normal basal values. PH-impedance performed during PPI
treatment showed the normalization of the number of refluxes
(< 48) and pH values (< 4.2) in nine (64.3%) out of the 14 patients
with positive pH-Impedance at enrollment. Ph-Impedance during
treatment continued to be pathological in 3 (21.4%) patients with
a pathological number of refluxes (2 with acid pH, 1 with normal
pH values). Two (14,3%) subjects experienced improvement in
symptoms and showed the normalization of nasal cytology but
refused to repeat the pH-Impedance during therapy. Seven (77.8%)
out of 9 patients with normal ph-Impedance values under treatment
showed the simultaneous normalization of nasal cytology whereas
two (22,2%) subjects did not show any significant improvement at
nasal cytology.
Conclusions:
Our study showed a possible causal effect association
between GERD and NARNE. Treatment with high dose of oral PPI
for 8 weeks seemed to be effective in improving symptoms and in
reducing nasal inflammation in a significant number of patients
with NARNE. Larger studies are needed to confirm our data.
P.08.9
CORRELATION BETWEEN HIGH RESOLUTION MANOMETRY
PARAMETERS AND SYMPTOMS IN TREATED ACHALASIA PATIENTS
Pesce M.*, Esposito D., Maione F., Gennarelli N., Cargiolli M.,
De Palma G.D., Cuomo R., Sarnelli G.
Federico II University, Naples, Italy
Background and aim:
HRM is the gold standard study to follow up
achalasia patients after treatment However, discrepancies between
residual achalasia-related symptoms and HRM parameters may
occur, thus drifting therapeutic choices in subsets of achalasia
patients. Being more physiologic, it has been claimed that a HRM in
the upright position may better reflect the clinical condition of these
patients. We aimed to examine the effects of body position on HRM
parameters and whether they are related to symptoms’ persistence.
Material andmethods:
40 achalasia patients (20M, mean age 41 ± 12
ys) were treated with pneumatic dilation according to standardized
protocol. In all patients a standardized questionnaire assessing
the frequency and the intensity of achalasia-related symptoms
(dysphagia for solids and liquids graded from 0: absent to 9: at each
meal and precluding daily activities) was administered before and 6
months after pneumatic dilation. A HRM study was performed at the
same time points, both in supine and sitting position with at least 10
single 5-mL swallows performed for each series.
Results:
In all patients, a significant improvement of dysphagia
severity for both solids and liquids was achieved after dilation
(1±1.5 vs 6.7±2.2 and 0.6±1.1 vs 5.2±3.2 respectively; all p<0,001).
A significant reduction in terms of LES pressure, IRP4 and bolus
clearance rate was observed in the sitting as compared to the
supine position (32±13 vs 25,4±17 mmHg; 19,8±9,5 vs 14,8±10
and 67,5±36 vs 47,8±43%; respectively, all p<0.05). However, none
of the examined values showed a significant correlation with the
persistence of dysphagia for solids or liquids both in the upright and
supine position.
Conclusions:
Here we showed that, despite body position
significantly affects HRM parameters, none of these appears to
significantly correlate with symptoms’ persistence in treated
achalasia patients. HRM study, per se, may not predict the clinical
outcome of these patients and a number of variables (namely
achalasia subtypes, age, sex, presence of megaesophagus) may
account for residual symptoms in treated achalasia patients.
P.08.10
ESOPHAGOGASTRIC JUNCTION MORPHOLOGY ASSESSMENT BY
HIGH RESOLUTION MANOMETRY IN OBESE PATIENTS CANDIDATE
TO BARIATRIC SURGERY
Tolone S.*
1
, Savarino E.
2
, De Bortoli N.
3
, Frazzoni M.
4
, Furnari M.
5
,
Bosco A.
1
, Pirozzi R.
1
, Parisi S.
1
, Bondanese M.
1
, Jannelli G.
1
, Carlea N.
1
,
Ferrara F.
1
, Savarino V.
5
, Docimo L.
1
1
Division of Surgery, Department of Surgery, Second University of
Naples, Naples, Italy,
2
Division of Gastroenterology, Department
of Surgery, Oncology and Gastroenterology, University of Padua,
Padua, Italy,
3
Division of Gastroenterology, Department of Internal
Medicine, University of Pisa, Pisa, Italy,
4
Digestive Pathophysiology
Unit and Digestive Endoscopy Unit, Baggiovara Hospital, Modena,
Italy,
5
Division of Gastroenterology, Department of Internal Medicine,
University of Genoa, Genoa, Italy
Background and aim:
Obesity is a strong independent risk factor
of gastroesophageal reflux disease (GERD) symptoms and hiatal
hernia development. Pure restrictive bariatric surgery should not be
indicated in case of hiatal hernia and GERD. However it is unclear
what is the real incidence of disruption of esophagogastric junction
(EGJ) in patients candidate to bariatric surgery. Actually, high
resolution manometry (HRM) can provide accurate information
about EGJ morphology. Aim of this study was to describe the EGJ
morphology determined by HRM in obese patients candidate to
bariatric surgery and to verify if different EGJ morphologies are
associated to GERD-related symptoms presence.
Material and methods:
All patients underwent a standardized
questionnaire for symptom presence and severity, upper endoscopy,
high resolution manometry (HRM). EGJ was classified as: Type I, no
separation between the lower esophageal sphincter (LES) and crural
diaphragm (CD); Type II, minimal separation (>1 and <2 cm); Type
III, >2 cm separation.
Results:
One hundred thirty-eight obese (BMI>35) subjects were
studied. Ninety-eight obese patients referred at least one GERD-
related symptom, whereas 40 subjects were symptom-free.
According to HRM features, EGJ Type I morphology was documented
in 51 (36.9%) patients, Type II in 48 (34.8%) and Type III in 39 (28.3%).
EGJ Type III subjects were more frequently associated to Symptoms
than EGJ Type I (38/39, 97.4%, vs. 21/59, 41.1% p<0.001).
Conclusions:
Obese subjects candidate to bariatric surgery have
a high risk of disruption of EGJ morphology. In particular, obese
patients with hiatal hernia often refer pre-operative presence
of GERD symptoms. Testing obese patients with HRM before
undergoing bariatric surgery, especially for restrictive procedures,
can be useful for assessing presence of hiatal hernia.
P.08.11
THE POSITION WITHIN THE OESOPHAGEAL CIRCUMFERENCE
PREDICTS DYSPLASIA IN SHORT SEGMENT BARRETT’S
ESOPHAGUS: A 7-YEAR RETROSPECTIVE SERIES OF 341 LESIONS
Bibbò S.
1
, Ianiro G.*
1
, Arciuolo D.
3
, Ricci R.
3
, Petruzziello L.
2
,
Spada C.
2
, Riccioni M.E.
2
, Larghi A.
2
, Dibitetto F.
1
, Monelli E.
1
,
Gasbarrini A.
1
, Costamagna G.
2
, Cammarota G.
1
1
Internal Medicine, Gastroenterology and Liver Unit - Catholic
University of Rome, Rome, Italy,
2
Endoscopy Unit - Catholic University
of Rome, Rome, Italy,
3
Histopathology Unit - Catholic University of
Rome, Rome, Italy
Background and aim:
A careful endoscopic surveillance of Barrett’s
esophagus (BE) is essential to prevent esophageal cancer. The aim
of this study is to identify the preferred location of short BE and its
associated dysplasia within the esophageal circumference.
Material and methods:
We retrospectively reviewed a prospectively
maintained database of patients with non-circumferential, short-