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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
e95
OC.07 UPPER GI
OC.07.1
REFRACTORY PATIENTS WITH NON-ACID REFLUX DISEASE AND
THOSE WITH EROSIVE AND NON-EROSIVE REFLUX DISEASE HAVE
SIMILAR RESPONSE TO ANTI-REFLUX SURGICAL THERAPY
Savarino E.*
2
, Marabotto E.
1
, Furnari M.
1
, Zentilin P.
1
, De Bortoli N.
3
,
Marchi S.
3
, Camerini G.
4
, Savarino V.
1
1
Division of Gastroenterology, Department of Internal Medicine,
University of Genoa, Genoa, 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
Division of Surgery,
Department of Surgery, University of Genoa, Genoa, Italy
Background and aim:
Recent studies clearly demonstrated the
increased diagnostic yield of impedance-pH monitoring thanks
to its ability to correlate gastro-esophageal reflux disease (GERD)
symptoms with both acid and/or non-acid reflux episodes. However,
data about the clinical usefulness of this additional diagnostic yield
are poor. We aimed to assess whether refractory GERD patients
classified by means of endoscopy and impedance-pH as affected
by non-acid reflux disease (NARD), erosive and non-erosive reflux
disease (ERD and NERD) may equally benefit from anti-reflux
surgery.
Material and methods:
Consecutive patients with persisting
heartburn and/or regurgitation despite 8 weeks of PPI therapy,
were prospectively enrolled in this open label trial. All patients
underwent endoscopy and impedance-pH off-therapy. We measured
esophageal acid exposure time (AET), reflux episodes (acid/non-
acid) and symptom-reflux association. Then, patients with ERD
(endoscopy+), NERD (endoscopy-, AET>4.2% and/or SAP/SI+ for
acid reflux) and NARD (endoscopy-, AET<4.2% and SAP/SI+ for non-
acid reflux or both kind of reflux) underwent laparoscopic Nissen
fundoplication (LNF). Before and at 1, 6 and 12 months after LNF,
reflux symptoms and quality of life were assessed using validated
questionnaires. Endoscopy and impedance–pH was repeated 1 year
after surgery. Surgical treatment failure was considered in case
of: persisting typical reflux symptoms and/or objective evidence
of GERD (esophagitis at upper endoscopy, abnormal AET and/or
number of refluxes, positive symptom association) and/or poor
quality of life.
Results:
Out of sixty-five refractory patients, forty-eight (24F/24M;
mean age 49; 14 ERD, 22 NERD and 12 NARD) were included. At 1
year follow-up, LNF had similar pathophysiological effects in all
groups. Indeed, percentage of patients with abnormal AET (ERD 93%
vs 7%, NERD 71% vs 0%) and/or increased number of reflux episodes
(ERD 93% vs 0%, NERD 86% vs 0%, NARD 83% vs. 0%), mean AET (ERD
12.9% vs 1.8%, NERD 6.1% vs 0.7, NARD 0.7% vs 0.4%) and median
number of total (ERD 100 vs 6, NERD 73 vs 9, NARD 72 vs 10), acid
and non-acid refluxes significantly decreased (in all cases, p<0.01).
As to the surgical outcome, the percentage of patients with resolved
or markedly improved typical symptoms at 12 months after LNF was
similar among groups (ERD 93% vs. NERD 82% vs NARD 83%, p=ns).
Quality of life similarly improved in all groups (p=ns). Finally, the
percentage of failure and/or adverse events did not differ among the
groups (ERD 21% vs. NERD 23% vs NARD 17%, p=ns).
Conclusions:
Our data show that LNF was a safe and effective
procedure in relieving typical reflux symptoms in PPI-refractory
patients identified as affected by ERD, NERD and NARD, by means of
endoscopy and impedance-pH monitoring. Therefore, impedance-
pH testing allowed a more clear identification of refractory patients
whose symptoms are related to reflux, thus improving their
management and outcome.
OC.07.2
FUNCTIONAL HEARTBURN OVERLAPS WITH IRRITABLE BOWEL
SYNDROME MORE OFTEN THAN GERD. DEVELOPMENT OF
PREDICTIVE MODELS WITH NOMOGRAMS
De Bortoli N.*
1
, Frazzoni L.
2
, Savarino E.V.
3
, Martinucci I.
1
,
Frazzoni M.
4
, Tolone S.
5
, Marabotto E.
6
, Furnari M.
6
, Bodini G.
6
,
Fuccio L.
2
, Bellini M.
1
, Savarino V.
6
, Marchi S.
1
1
University of Pisa, Pisa, Italy,
2
University of Bologna, Bologna, Italy,
3
University of Padua, Padua, Italy,
4
Baggiovara Hospital, Modena,
Italy,
5
Second University of Naples, Naples, Italy,
6
University of Genoa,
Genoa, Italy
Background and aim:
Gastroesophageal reflux disease (GERD)
and irritable bowel syndrome (IBS) are gastrointestinal disorders
affecting a large part of the general population, with relevant impact
on quality of life and health care costs. We aimed to evaluate the
prevalence of irritable bowel syndrome (IBS) in patients with reflux
symptoms as distinguished into gastroesophageal reflux disease
(GERD) and functional heartburn (FH) on the basis of multichannel
intraluminal impedance (MII)-pH monitoring. We also aimed to
develop a predictive model for FH.
Material and methods:
Patients underwent a structured interview
based on questionnaires for GERD, IBS, anxiety and depression. Upper
GI endoscopy and 24h MII-pH monitoring were performed in all cases.
In patients with IBS, fecal calprotectin was measured and colonoscopy
was scheduled for values >100 mg/Kg to exclude organic disease.
Multivariate logistic regression analysis was performed to identify
independent risk factors for FH and to develop predictive models.
Results:
Of the 701 patients with heartburn who entered the study,
458 (65%) had GERD whereas 243 (35%) had FH. IBS was found in
143/458 (31%) GERD but in 187/243 (77%) FH patients (P <0.001). At
multivariate analysis IBS, anxiety, and smoking resulted independent
risk factors for FH whereas hiatal hernia resulted protective. Two
predictive models, based on clinical only (ISAC) or clinical and
endoscopic characteristics (ISAA-HH) were developed: the area
under the ROC curve did not differ between ISAC (0.861, 95% CI
0.833-0.890) and ISAA-HH (0.872, 95%CI 0.844-0.899) (P =0.110).
Fig. 1.
Nomogram derived from the ISAA-HH (IBS, Smoking, Anxiety, Age, Hiatal hernia,
H. pylori positivity) predictivemodel. Each independent variable corresponds to an axis;
in order to obtain the corresponding score, the position on the axis must be reported
perpendicularly on the “Points axis” at the top of the figure (e.g., anxiety diagnosis
corresponds to 100 points). This passage has to be repeated for all the variables. Then,
the total predictive score is obtained by summing all the single scores, and must be
reported on the “Total points” axis. The position has to be perpendicularly reported on
the “Predicted FH probability” axis to obtain the predicted probability of FH diagnosis.