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e170
Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
Results:
Male were more represented in groups C (60%), D (75%), E
(75%) (p=0.03), whereas mean age was similar in all groups (p=0.57).
Erosive esophagitis was more represented in groups C (70%), D
(50%), E (50%) (p=0.018). Acid exposure time increased progressively
from group A to E (A 4.3[IQR 5.6]; B 8.2[8.4]; C 9[5.7]; D 9.1[11.3];
E 10.2[7.4]; p=0.014). Total number of reflux events was higher in
C and D groups (A 45.3[IQR 20.7]; B 49[85]; C 96[71]; D 80[37.5];
E 57.5[76.7]; p=0.008). Mean DCI during WS, DCI-MRS and MRS/
WS ratio were progressively lower from A to E group (p<0.001 with
ANOVA). The Bonferroni test showed significant differences between
A, B, C, versus D and E (p<0.001). Details are reported in table 1.
Conclusions:
Data on GERD evidence at impedance-pH monitoring
demonstrated that IEM should be considered as clinically relevant
when the frequency of failed or weak WS is ≥60%.
P.08.14
A PROSPECTIVE APPLICATION OF THE ESPGHAN GUIDELINES IN A
SYMPTOMATIC ADULT POPULATION
Efthymakis K.*, Serio M., D’Amato D., Milano A., Laterza F.,
Bonitatibus A., Neri M.
Department of Medicine and Ageing Sciences, “G.D’Annunzio”
University and Foundation, Chieti, Italy
Background and aim:
Current adult guidelines require histological
confirmation of celiac disease (CD). However, recent pediatric
guidelines have proposed algorithms to reduce the need for biopsy
in genetically susceptible symptomatic children. We explore
the applicability of the current ESPGHAN criteria and assess the
accuracy of serology in detecting villous atrophy in a prospective
cohort of symptomatic adults.
Material and methods:
We recruited 234 consecutive symptomatic
adults (mean age=33.9ys) showing EMA positivity and genetic
susceptibility. All patients underwent upper endoscopy with
multiple biopsy sampling in the duodenum. Histological lesions
were graded according to the Corazza-Villanacci classification and
considered diagnostic for grades>B. Anti-tTG titers were assessed
with 12 different assays; one ELISA kit (specified Upper Limit of
Normal=3.5U/ml) was used in 141 subjects (60.3%), while a second
one in 59 (25.2%, ULN=9.9U/ml). Accuracy of anti-tTG testing and
optimal cut-off levels were determined by means of a ROC curve.
Performance was also calculated for a cut-off 10 times ULN.
Results:
Mean anti-tTG levels at inclusion were 71.1±4.4U/ml, while
mean adjusted levels (anti-tTG/ULN) were 14.8±0.9 times ULN
(mean±SE). Among the 234 patients,21 (9%) showed no atrophy;
partial and total atrophy were present in 85 (36.3%) and 128 (54.7%)
respectively. Anti-tTG levels significantly correlated to the degree
of villous atrophy (p<0.001; rs=0.397, p<0.001). AUC proved a fair
diagnostic accuracy both for unadjusted and adjusted anti-tTG
levels (respectively 0.803, 0.807; p<0.01). For the ESPGHAN criterion
of anti-tTG=10 times ULN, a positive predictive value (PPV) of 97.7%
was calculated (sensitivity=59.2%, specificity=86.9%). The optimal
cut-off for adjusted anti-tTG levels was 16 times ULN, with a PPV
of 98.9% (sensitivity=41.2%, specificity=95.7%). Considering different
assays, results were puzzling; although in the first one PPV (=97.14%)
seemed to peak at 50U/ml (14.3 times ULN), the second assay proved
considerably more predictive: for a cut-off=37.3U/ml (3.7 times
ULN) it showed a superior PPV=100% (sensitivity 53.1%, specificity
100%). This persisted after standardization (cut-offs -0.14 vs -1.2).
Conclusions:
In adult symptomatic patients with EMA positivity and
genetic susceptibility, anti-tTG titers predict severity of duodenal
atrophy. Multiples of ELISA cut-off values can be applied to diagnose
CD in a subset of adult patients. Measured values are assay-specific,
intrinsically difficult to compare and not scale-dependent in our
study. Thus, ESPGHAN criteria can be applied in adults but are
sub-optimal for the purpose of achieving uniform prediction of
atrophy. Our findings could prove useful when assessing equivocal
histological cases, and could help in guiding patient follow-up.
P.08.15
INCREASED INTRA-BOLUS PRESSURE IS ASSOCIATED WITH NON-
CARDIAC CHEST PAIN AND NEGATIVE ENDOSCOPY – A STUDY
USING HIGH-RESOLUTION MANOMETRY
Della Coletta M.*
2
, Galeazzi F.
2
, Marabotto E.
3
, De Bortoli N.
4
,
Marchi S.
4
, Tolone S.
5
, Savarino V.
3
, Savarino E.
1
1
Reparto di Gastroenterologia, Dipartimento di Chirurgia, Oncologia
e Gastroenterologia, Università di Padova, Padova, Italy,
2
Divisione
di Gastroenterologia, Dipartimento di Chirurgia, Oncologia e
Gastroenterologia, Università di Padova, Padova, Italy,
3
Divisione di
Gastroenterologia, Dipartimento di Medicina Interna, Università di
Genova, Genova, Italy,
4
Divisione di Gastroenterologia, Dipartimento di
Medicina Interna, Università di Pisa, Pisa, Italy,
5
Divisione di Chirurgia
Generale e Bariatrica, Dipartimento di Chirurgia, Seconda Università
di Napoli, Napoli, Italy
Background and aim:
High Resolution Manometry (HRM) is
currently considered the gold standard to assess esophageal
peristalsis and esophago-gastric junction (EGJ) function. Indeed,
with the use of this technology novel validated metrics have been
developed to define esophageal motility abnormalities. In particular,
the intrabolus pressure (IBP) has been initially regarded as an
indirect measure of bolus transit trough the EGJ, although the last
iteration of Chicago Classification lacks of its adoption because of
the paucity of data in this regard. We aimed to investigate whether
patients with non-cardiac chestpain (NCCP) and reflux-related
heartburn (RH) may present different IBP values and which is its
pathophysiological role.
Material andmethods:
We included consecutive patients with NCCP
or RH as stand-alone symptom, referring to our motility laboratory.
Patientswithgastro-intestinal surgery, achalasiaor sclerodermawere
excluded. All patients underwent esophagogastroduodenoscopy
(EGDS) and HRM with 5-min baseline recording and 10 single
water swallows. The diagnostic criteria agreed with the Chicago
Classification vers. 2. Data were expressed as mean and standard
deviation. A t-test and x2 analysis were performed to compare data.
A p-value < 0.05 was considered statistically significant.
Results:
Between March 2014 and March 2015, we included 24
patients (9 Male, 56±15 years) with NCCP and 47 patients (50±13
years; 19 M) with RH. No differences in terms of age, sex, BMI,
manometry patterns and esophagogastric junction morphologies
were found between the two groups (p=ns). Patients with NCCP
had a mean IBP higher than patients with RH (18.6±6.7 vs. 14.1±4.7;
p=0.02). Mean DCI (79±36 vs. 82±35; p=0.7) and resting pressure
(30±12vs. 22±11; p=0.06) were similar between the two groups
groups. Only 1/24 patients (4%) of the NCCP patients had endoscopic
evidence of GERD, while in RH group the number was higher (13/47;
28%; p=0.02).
Conclusions:
The IBP is the only HRM metric that differed between
patients with NCCP and those with RH supporting its diagnostic
usefulness in distinguishing them and suggesting that NCCP
elicitation can be more related to reduced distal oesophageal
compliance as a whole (i.e. abnormal bolus transit and EGJ
dysfunction) rather than abnormal vigor of peristalsis. Finally,
an increased IBP well correlated with a negative endoscopy, thus
reflecting a potential role of IBP in contrasting reflux occurrence.