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e192
Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
and polyols - FODMAPs) have been shown, but is unclear if such
diet modification could impact adequate nutrient intake. Aim of the
present study was to evaluated the effect of a low FODMAPs diet
on symptoms, quality of life and nutrient intake in patients with
irritable bowel syndrome.
Material and methods:
29 IBS pts (21-67 yrs, 24 females)
underwent nutritional evaluation and counseling: T0 instruction
for low FODMAPs diet, symptoms and quality of life evaluation; T1,
instruction for reinsering previously withdrawn food, symptoms and
quality of life evaluation; T2 symptoms and quality of life evaluation.
Patients completed an alimentary diary during the entire duration
of the study.
Results:
Low-FODMAPS diet was well tolerated by the majority of
patients, althoughwas judged frustrating and boring. 9 patients (31%)
interrupted the study (3 worsening of symptoms, 2 no beneficial
effect, 3 no compliance), while 61% completed the protocol.
During low FODMAPS diet significant amelioration of intestinal and
extraintestinal symptoms was observed, except for constipation:
abdominal symptoms overall [T0 5.9±2.2 vs t1 3.2±2.5 M± DS, p
0.001], discomfort [t0 7.7±1.4 vs t1 3.3±2.5; P 0.000], pain [T0 5.7±2.9
vs t1 2.8±2.6; p 0.001], bloating [t0 7.1±1.7 vs t1 3.3±2.3; p 0.000],
diarrhea [t0 4.7± 3.2 vs t1 2.1±2.2; p 0.003], urinary symptoms [t0
2.0±2.2 vs t1 0.7±1.3; p 0.003], fatigue [t0 5.6±3.1 vs t1 3.6±3.2; p
0.003], headache [t0 3.8± 3.0 vs t1 2.0±2.2; p 0.008], constipation
[t0 3.3± 2.7 vs t1 2.6±2.2; p 0.147]. A persistent amelioration of
symptoms was also observed after dietician-guided reintroduction
of previously withdrawn foods and in some patients after.
Furthermore, quality of life improvement in both physical and
mental environment was observed (respectively [PCS-12 t0 43.5; t1
48.2; t2 47.7. MCS-12 t0 39.3, t1 45.4, 48.9]).
However, alimentary diaries showed, during low FODMAPs diet,
reduced intake of fibers, calcium, folate, vit D compared to suggested
levels.
Conclusions:
Low FODMPAS-diet ameliorates both intestinal and
extraintestinal symptoms and quality of life in IBS patients. However,
since it could be associated with inadequate intake of several
nutrients, nutritional counseling and follow-up are recommended.
P.13.9
A PREDICTIVE ROLE OF ANORECTAL MANOMETRIC DIAGNOSIS OF
CHRONIC REFRACTORY CONSTIPATION
Goffredo F.*
1
, D’Alba L.
2
, Zirizzotti G.
1
, Gervasi C.A.
3
, Paolantonio P.
2
,
Tammaro L.
2
, Giannelli C.
1
1
Azienda Ospedaliera S.Camillo-Forlanini, Roma, Italy,
2
Azienda
Ospedaliera S.Giovanni-Addolorata, Roma, Italy,
3
Roma, Italy
Background and aim:
Anorectal Manometry (AM), fundamental
in the correct diagnosis of patients with Chronic Refractory
Constipation (CRC), is described as a test operator-dependent. The
aim of this study was to evaluate the predictive value and sensitivity
of the AM and the Ballon Expulsion Test (BET) in the diagnosis
of CRC, comparing the experience of two Centers of Digestive
Pathophysiology of second level.
Material and methods:
From September 2014 to September 2015
they were submitted in total in the two Centers in AM, 187 patients
with CRC, following criteria Roma III. Among these, 164 were
performed to complete a diagnostic imaging exam: 84 TransPerineal
Ultrasonography (S.Camillo Hospital) and 80 patients defecated-
NMR (S.Giovanni-Addolorata Hospital). After AM, the doctor
performer, on the basis of the results associated with the medical
examination thorough history and the Digital Rectal Exploration,
expressed a suspected diagnosis which was then compared with the
result of the Imaging exam not known previously.
Results:
A) patients with CRC secondary to pelvic floor dyssynergia
(TEP and phase straining altered, paradoxical contraction of the
pubo-rectal muscle) is forecasted to 41/164 (25%) and then it has
been confirmed in 38/41 = 92% sensitivity, accuracy 92.6%;
B) patients with SCR secondary to anorectal anatomical changes
(prolapse, intussusception, rectocele, descending perineum etc)
without dyssynergia (normal phase of straining, alteration of the
TEP, squeeze and sensitivity thresholds) is forecasted to 98/164
(60%) and then it has been confirmed in 90/98 = 91% sensitivity,
accuracy 91.8;
C) patients with dyssynergia and anorectal anatomical changes (all
changes described above) is forecasted to 25/164 (15%) and then it
has been confirmed in 23/25 = 92% sensitivity, accuracy 92%.
Conclusions:
This study demonstrates that the AM performed in
Centres diagnostic of a second level is not an examination operator-
dependent and it has a predictive value with high sensitivity, and
accuracy greater than 90% in the diagnosis of patients with SCR.
P.13.10
NON-ELECTIVE SURGERY FOR ACUTE COMPLICATED
DIVERTICULITIS. PRIMARY RESECTION-ANASTOMOSIS OR
HARTMANN’S PROCEDURE? A SYSTEMATIC REVIEW AND META-
ANALYSIS
Lorusso D., Giliberti A.*, Bianco M., Leandro G.
Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital,
Castellana Grotte, Italy
Background and aim:
The use of Primary Resection-Anastomosis
with or without protective ileostomy (PRA) or Hartmann’s Procedure
(HP) in the surgery of complicated acute diverticulitis is still an open
question. The latest published meta-analyses were limited to the
most severe stages (Hinchey III and IV).
Our systematic review aimed to compare PRA with the HP in all
non-elective surgical patients with complicated acute diverticulitis
(perforation or obstruction).
Material and methods:
A computerized literature search was
performed on Medline databases until July 2014. The studies
included in the meta-analysis were 24 with a total of 4,062 patients.
Study outcomes included postoperative surgical complications,
reintervention, 30-day mortality, overall mortality as well as the
length of stay as secondary outcome. The pooled effects were
estimated using a fixed effect model or random effect model based
on the heterogeneity test. Results were expressed as odds ratio
(OR) and 95% confidence interval (CI) for dichotomous outcomes
and as mean difference (MD) with 95% CI for continuous outcomes.
Subgroup analyses by study type were performed.
Results:
The PRA group had a lower rate of postoperative surgical
complications (OR=0.525, 95% CI 0.387-0.713), reintervention
(OR=0.688, 95% CI 0.525-0.902), 30-day mortality (OR=0.389, 95% CI
0.259-0.586), overall mortality (OR=0.467, 95% CI 0.272-0.803) and
length of stay (MD=9.129, 95% CI 2.391-15.867) compared to the HP
group.
Conclusions:
Our meta-analysis shows that the PRA technique
is better than HP for all considered outcomes. Due to the high
variability of the included studies, further randomized controlled
trials would be required to confirm these results.
P.13.11
KAPLAN-MEIER CUMULATIVE SURVIVAL CURVES: A SIX YEAR
EXPERIENCE OF A LARGE VOLUME COLONOSCOPY COLORECTAL
CANCER SCREENING CENTER
Pontarolo N.*
1
, Merlo F.
1
, Rosa-rizzotto E.
1
, Guido E.
1
, Caroli D.
1
,
Lomele M.
2
, Cappellesso R.
2
, Rugge M.
2
, Mammano E.
1
, Pilati P.
1
,
De Lazzari F.
1
1
Ospedale S. Antonio, Padova, Italy,
2
Azienda Ospedaliera, Padova, Italy