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Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
e97
GERD were associated with a better %TWL% at 5 years. (p<0.001 and
p=0.03) (Table1).
Conclusions:
LSG is an effective procedure at long-term, with good
weight loss outcomes. Age at surgery and presence of postoperative
GERD symptoms could play a role in the long term weight outcomes.
OC.07.5
GASTROINTESTINAL SYMPTOMS AND DYSPEPSIA IN
AUTOIMMUNE GASTRITIS: AN OVERLOOKED OCCURRENCE
Carabotti M.*, Lahner E., Esposito G., Sacchi M.C., Severi C.,
Annibale B.
University “Sapienza”, Roma, Italy
Background and aim:
Autoimmune gastritis (AG) is characterized
by loss of the oxyntic glands with consequent hypochlorhydria,
presence of gastric autoantibodies (anti-parietal cell and/or anti-
intrinsic factor) and, in a later stage, pernicious anemia. Traditionally,
AG is considered a silent disease, however scanty data on the pattern
of gastrointestinal of symptoms are available. Aim of this study is to
assess the occurrence and pattern of symptoms in AG patients.
Material and methods:
Gastrointestinal symptoms of 379 AG
patients, [70.2% female, median age 55 years (range 17-83)], with
(53.6%) or without (46.4%) pernicious anemia, were systematically
assessed and retrospectively classified following Rome III Criteria.
The anemia pattern, positivity to gastric autoantibodies, Helicobacter
pylori infection, and concomitant autoimmune disease were
evaluated. Univariate analyses were performed by Mann–Whitney
and Fisher’s exact tests for categorical and continuous variables
and odds ratio (OR) and 95% confidence intervals (CIs) were used
to describe associations and were obtained by logistic regression
analysis. Two-tailed p values < 0.05 were considered statistically
significant.
Results:
Two hundred fifteen patients (56.7%) complained of
gastrointestinal symptoms, 69.8% of them had exclusively upper
symptoms, 15.8% only lower and 14.4% concomitant upper and lower
symptoms. Among upper GI symptoms, 60.2% reported dyspepsia
subtype post-prandial distress syndrome (PDS), 3.8% dyspepsia
subtype epigastric pain syndrome (EPS), 7.2% overlap between
PDS and EPS, 7.2% gastro-esophageal reflux disease (GERD), 17.7%
GERD and dyspepsia, and 3.8% nausea. Logistic regression analysis
showed that age <55 years [OR 1.6 (CI:1-2.5)], absence of smoking
habit [OR 2.2 (CI: 1.2-4)] and absence of anemia [OR 3.1 (CI:1.5-
6.4)] were independent factors associated to dyspepsia, whereas
positivity to gastric autoantibodies, Helicobacter pylori infection,
and concomitant autoimmune disease were not associated.
Conclusions:
This study shows that AG is a condition which in more
than half of cases is associated with GI symptoms, mainly dyspepsia,
revisiting the concept of a silent disease.
OC.07.6
SERUM BIOMARKERS CAN IDENTIFY PATIENTS WITH
AUTOIMMUNE AND H.PYLORI-RELATED ATROPHIC GASTRITIS
AND DIFFERENTIATE THOSE WITH ADVANCED GASTRIC CHANGES
Maddalo G.*, Orlando C., Fassan M., Basso D., Rugge M., Farinati F.
Università degli Studi di Padova, Padova, Italy
Background and aim:
Autoimmune atrophic gastritis (AAG) and
multifocal H.pylori-related atrophic gastritis (MAG) are precancerous
condition at risk for adenocarcinoma and gastric carcinoid (AAG).
The OLGA staging (Operative Link for Gastritis Assessment) has
been validated in MAG as well as in AAG. Our aim was to assess
whether the determination of simple serum biomarkers allows
the prediction of MAG and AAG, the identification of patients with
advanced disease and the risk of carcinoid in AAG.
Material and methods:
189 patients with AAG, 157 with MAG
and 38 controls (C) underwent endoscopy with at least 5 biopsies
(Sydney system) and blood tests (ELISA for Gastrin, PGI and PGII).
Statistics included Kolmogorov-Smirnov, Kruskall-Wallis, ROC
curves, multivariate and discriminant analysis.
Results:
Median values of PgI, PgI/PgII and gastrin in AAG, MAG and
C were significantly different (p<0.0001 for all comparisons). Same
was true for Gastrin/PgI, a new parameter, introduced considering
the inverse behaviour of gastrin and PgI in AAG. Cut-offs, AUCs and
accuracy (ACC) for the various parameters are reported in the Table.
The cut-offs selected (ROC curves) showed high sensitivity,
specificity, PPV, NPV and overall ACC. The distribution of the
parameters in AAG according to the OLGA staging was significantly
different (stages 0-I vs II-III/IV, p<0.0005 for each). The cut-off for
gastrin/PgI was the same between C and AAG and AAG and MAG. In
AAG, PgI and gastrin/PgI levels were different in the various stages of
ECL hyperplasia (linear, micronodular, nodular, carcinoid, p<0.01 for
both). Nodular hyperplasia and carcinoid aggregated in OLGA II-III-
IV. A multivariate analysis identified PgI/PgII and gastrin as
independent predictors of the diagnosis. Discriminant Analysis
demonstrated a patients correct allocation in 80% of the cases (62.5
of C, 60% of MAG, 85% of AAG).
Conclusions:
PgI/PgII ratio and gastrin differentiate C from
patients harboring AAG or MAG, thus confirming the role of
their determination in sorting out patients that should undergo
endoscopy. Gastrin/PgI, even though not selected in the multivariate
analysis, is a promising biomarker.
OC.07.7
INSULIN-MEDIATED ESOPHAGEAL ADENOCARCINOMA
DEVELOPMENT RELATED TO CHRONIC DUODENUM-ESOPHAGEAL
REFLUX IN A HYPERINSULINEMIC AND NON-OBESE MURINE
MODEL
Arcidiacono D.*
1
, Dedja A.
2
, Giacometti C.
3
, Antonello A.
1
, Fassan M.
4
,
Dall’Olmo L.
5
, Cassaro M.
3
, Rugge M.
4
, Battaglia G.
1
, Alberti A.
6
,
Realdon S.
1
1
Digestive Endoscopy Unit, Veneto Institute of Oncology (IOV –
I.R.C.S.S.), Padua, Italy,
2
Department of Cardiac, Thoracic and Vascular
Sciences, University of Padua, Padua, Italy,
3
Anatomic Pathology Unit,
ULSS 15, Alta Padovana, Camposampiero, Padua, Italy,
4
Department
of Medicine, Surgical Pathology & Cytopathology Unit, University
of Padua, Padua, Italy,
5
Surgical Oncology Unit, Veneto Institute of
Oncology (IOV-I.R.C.C.S.), Padua, Italy,
6
Department of Molecular
Medicine, University of Padua, Padua, Italy
Background and aim:
Esophageal adenocarcinoma (EAC) is a cancer
with a rapidly increasing incidence in the western countries. Barrett’s
esophagus (BE), its main risk factor and precancerous lesion, related
to gastro-duodenum-esophageal reflux disease (GERD), has seen a
comparable increase in its incidence as well. Several studies showed
that central obesity has a strong correlation with both, EAC and BE
onset.
Central obesity is characterized by various hormonal and metabolic
changes related to the underlying insulin resistance. Insulin
resistance is characterized by compensatory hyperinsulinemia that
could have a proliferative and possibly a pro-carcinogenic effect on