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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
e169
segment, histologically proven BE who underwent upper endoscopy
between January 2008 and February 2015 at our Endoscopy Center.
In the case of multiple metaplastic lesions, each tongue was counted
individually. The circumferential locations of BE lesions and
associated-BE dysplasia lesions were identified as on a clock face
and their distributions in the 4 quadrants were compared.
Results:
Of a total 435 BE patients, 184 (42%) short-BE patients
were eligible for the study purpose. Multiple short BE lesions were
diagnosed in 110 (60%) of 184 subjects, for a total amount of 341
metaplastic areas. Short BE lesions were more frequently observed
in the posterior wall of esophagus (38.5%), compared with right
wall (28.6%), anterior wall (22.4%), or left wall (10.5%) (P<0.0001).
Twenty eight (8%) of total 341 metaplasic areas were associated with
dysplasia, and 1 (0.3%) with adenocarcinoma. Dysplastic lesions
were more common in the posterior wall (39.3%) than, respectively,
in the anterior wall (35.8%), in the right wall (21.4%), in the left wall
(3.5%) (P= 0.03).
Conclusions:
Our results show the posterior wall of esophagus as the
preferential location of both short BE and associated-BE dysplasia.
Should our findings be confirmed by further, larger experiences,
they should be taken into account for the development of future
surveillance protocols of Barrett’s esophagus.
P.08.12
GERDQ QUESTIONNAIRE DISTINGUISHES PROTON PUMP
INHIBITOR-RESPONSIVE ESOPHAGEAL EOSINOPHILIA FROM
EOSINOPHILIC ESOPHAGITIS PATIENTS
Bartolo O.*
1
, De Cassan C.
1
, Galeazzi F.
1
, Tolone S.
1
, Salvador R.
2
,
Sturniolo G.C.
1
, Costantini M.
2
, Savarino E.
1
1
Division of Gastroenterology, Department of Surgery, Oncology and
Gastroenterology, University of Padua, Padua, Italy,
2
U.O. Clinica
Chirurgica 3, Department of Surgery, Oncology and Gastroenterology,
University of Padua, Padua, Italy
Background and aim:
Current studies failed to observe clinical
features able to distinguish Eosinophilic Esophagitis (EoE) from
Proton Pump Inhibitor-response esophageal eosinophilia (PPI-REE).
However, these investigations did not systematically assess reflux
symptoms. Recently, GerdQ questionnaire has been validated for the
diagnosis of gastro-oesophageal reflux disease (GERD). We aimed
to apply GerdQ questionnaire in patients with EoE and PPI-REE to
assess whether a prospective and systematic evaluation of reflux
symptoms may be helpful to distinguish patients with PPI-REE from
those with EoE.
Material and methods:
Consecutive patients diagnosed with EoE
and PPI-REE according to international criteria [a) presence of at
least one typical symptom of esophageal dysfunction; b) at least
15 eosinophils per high-power field at mid/proximal esophagus; c)
persisting or nor of eosinophils at mid/proximal esophagus after an
8-week PPI trial] prospectively completed a specific GERD-related
questionnaire (GERDQ). GerdQ questionnaire is a simple and self-
administered questionnaire including six items. A cut-off value
higher ≥ 9 (range of 0–18) was considered diagnostic for GERD. For
comparisons, a group of 27 patients with proven reflux disease was
used.
Results:
Fifty-two consecutive patients with histologically-detected
eosinophilic infiltration were enrolled. At the follow-up endoscopy
plus biopsy, after 8 weeks treatment with twice-daily PPI, thirty-
five (67%) patients were identified as having EoE, whereas 17
(33%) patients were diagnosed with PPI-REE. The two cohorts had
similar dysphagia for solids (EoE 74% vs. PPI-REE 76%, p=1.000),
bolus impaction (66% vs. 70%, p=1.000) and chestpain (20% vs.
41%, p=0.1810), but different heartburn (26% vs. 58%, p=0.0315)
and regurgitation (17% vs. 47%, p=0.0429). The overall GerdQ score
was statistically lower in EoE vs. PPI-REE [1 (0-6) vs. 8 (2.5-11.25),
p=0.004]. When compared to control patients with GERD, both EoE
and PPI-REE patients showed increased rate in dysphagia parameters,
whereas EoE individuals reported less frequently heartburn (26%
vs. 85%, p<0.001), regurgitation (17% vs. 74%, p<0.001) and overall
GerdQ scores [1 (0-6) vs. 8 (6-12), p= 0.001] than control patients
with GERD. In contrast, no difference was found comparing PPI-REE
and control patients with GERD for heartburn, regurgitation and
overall GerdQ score (p=0.0754, p=0.1083 and p=1.000, respectively).
Two EoE patients (6%), 8 PPI-REE patients (47%) and 15 control
patients with GERD (55%) had a total score equal or above 9 (EoE
vs. PPI-REE p=0.0010, EoE vs. GERD p<0.001 and PPI-REE vs. GERD
p= 0.7577).
Conclusions:
GerdQ is a useful complementary tool to distinguish
patients with PPI-REE from those with EoE. The implementation
of GerdQ could reduce the need for more aggressive therapies
(i.e. topical steroids and specialised diets) and improve resource
utilisation.
P.08.13
WHICH IS THE BEST CUT-OFF TO DEFINE INEFFECTIVE
ESOPHAGEAL MOTILITY?
De Bortoli N.*
1
, Tolone S.
2
, Martinucci I.
1
, Frazzoni M.
3
, Furnari M.
4
,
Russo S.
1
, Bertani L.
1
, Surace L.
1
, Giannotti S.
1
, Savarino V.
4
, Marchi S.
1
,
Savarino E.V.
5
1
University of Pisa, Pisa, Italy,
2
Second University of Naples, Naples,
Italy,
3
Baggiovara New Hospital, Modena, Italy,
4
University of Genoa,
Genoa, Italy,
5
University of Padua, Padua, Italy
Background and aim:
The last version (3.0) of Chicago Classification
took an arbitrary decision and defined ineffective esophageal
motility (IEM) when 50% or more wet swallows (WS) result failed
(DCI<100 mmHg/cm/s) or weak (100<DCI<450 mmHg/cm/s) during
standard manometric protocol. The aim of this study was to compare
patients with different frequency of failed/weak WS, provocative
test (MRS, 3ml x 5times in 10sec) and MRS/WS ratio to better define
the IEM diagnosis.
Material and methods:
We retrospectively evaluated 59 outpatients
who underwent: upper endoscopy, high resolution manometry
(HRM) with 5-min baseline recording, 10 single water swallows of
5mL each, and 1 MRS in supine position, and 24-h impedance and
pH monitoring for unresponsive heartburn. We excluded patients
with achalasia, scleroderma, absent peristalsis and prior surgery.
MRS/WS ratio was calculated according to medical literature. All
patients were sub-grouped based on the percentage of failed/weak
WS as follows: a) ≤30%; b) 40%; c) 50%; d) 60% and e) ≥ 70% failed
or weak WS.
All data were expressed in median and IQR. ANOVA with Bonferroni
test has been applied for statistical analysis.
Table 1
The main HRM results and statistical analysis (ANOVA and Bonferroni Test)
Percentage of failed swallows
Group A Group B Group C Group D Group E
(17)
(9)
(10)
(8)
(8)
≤30% 40%
50%
60% ≥70%
p
Mean age
44.5
43.2
51.3
39.8
47.1
0.57
a
(IQR)
(16.2)
(16.8)
(7.2)
(13.6)
(18.1)
DCI mean
1255.5 1466 1153
598
284 0.0001
b
(IQR)
(577.8)
(623.5)
(577)
(582)
(235)
DCI-MRS
1653 1578 1241
472
119 0.0001
b
(IQR)
(541.8)
(502)
(828)
(507)
(221)
MRS/WS ratio
1.3
1.1
1.1
0.6
0.5 0.0001
b
(IQR)
(0.6)
(0.2)
(0.3)
(0.6)
(0.3)
a
P > 0.05 for all pairwise comparisons
b
P<0.001 between A vs D; A vs E; B vs D; B vs E; C vs D and C vs E