Digestive and Liver Disease - Volume 48 - Supplement 2 - February 2016

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Abstracts of the 22nd National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231 e115
OC.12 Miscellanea 2
OC.12.1
ARE BASELINE IMPEDANCE LEVELS ASSESSED DURING
ESOPHAGEAL IMPEDANCE MANOMETRY HELPFUL IN
DISCRIMINATING PATIENTS WITH GASTROESOPHAGEAL REFLUX
DISEASE FROM THOSE WITHOUT? A PILOT STUDY
Furnari M.*2, Moscatelli A.2, Marabotto E.2, De Bortoli N.1,
Martinuci I.1, Savarino E.3, Zentilin P. 2, Savarino V. 2
1Division of Gastroenterology, Department of Internal Medicine,
University of Pisa, Pisa, Italy, 2 Departement of Internal Medicine,
Gastroenterology Unit, University of Genoa, Genoa, Italy, 3Division
of Gastroenterology, Department of Surgery, Oncology and
Gastroenterology, University of Padua, Padua, Italy
Background and aim: Previous studies by means of 24h impedance-
pHmonitoring (MII-pH) highlighted the correlationbetweenbaseline
impedance levels (BI) and integrity of the esophageal mucosa
and the possibility to use this parameter to discriminate between
subtypes of GERD. No previous studies investigated the possibility
to achieve similar results by using impedance-manometry, a test
requiring shorter time and providing further data about esophageal
motility. We aimed to measure BI during manometric assessment
and to correlate them with those obtained at MII-pH monitoring.
Material and methods: Consecutive patients with typical reflux
symptoms underwent upper endoscopy and multiple biopsies were
taken at Z-line and 2 cm above it to assess presence and severity
of microscopic esophagitis. Within 3 days from endoscopy, patients
underwent esophageal imp-manometry and imp-pH testing off-
therapy. We evaluated BI values for at least 30 seconds during
impedance manometry, expressed as mean value over 3 intervals of
10 secs each. BI at 3 and 5cm above the LES, was assessed on MII-pH
recording during the overnight rest, for at least 30 minutes. Twenty
healthy volunteers (HVs) who underwent the same procedures were
also used as controls.
Results: We included 38 patients (M/F 17/11; BMI 27; age 46)
classified according to endoscopy and MII-pH as: 8 grade A
erosive esophagitis (EE), 10 non-erosive reflux disease (NERD), 10
hypersensitive esophagus (HE) and 10 with functional heartburn
(FH). Twenty HVs [11F/9M; BMI 24; mean age 44] were included. BI
values during impedance-manometry were lower in patients with
GERD (2290; 95%CI: 1518-3476) than in those without (FH/HVs;
3677, 95%CI: 2648-5074; p<0.05). AUC 0.797; Sens 71.4 Spec 92.3;
cut off ≤3159Ω. BI levels were lower in patients with ME than those
without (2178 vs 3328; p<0.05). AUC 0.724; Sens 65.4 Spec 78.6;
cut off ≤3353Ω. Although BI levels progressively decreased with the
increasing severity of mucosal damage (EE<NERD<HE), a statistical
significance was not reached. Finally, BI values assessed during
manometry showed a positive correlation with BI levels assessed
during MII-pH monitoring (r=0.37).
Conclusions: Baseline impedance levels measured during esopha­
geal impedance-manometry have been associated to the diagnosis
of GERD in patients with typical reflux symptoms. In patients with
limited compliance this may represent an alternative method in
order to investigate GERD. Due to the complexity of this disorder,
miscellaneous manifestations and inconstant benefit of treatment,
MII-pH study remains crucial in the management of patients
referred to tertiary centers.
OC.12.2
HLA TESTING IN ADULT-ONSET CELIAC DESEASE: RELATIONSHIP
WITH CLINICAL PRESENTATION AND MUCOSAL DAMAGE
Morreale G.C.*2, Cappello M.2, Arini A.2, Scorsone A.1, Provenzano V.1,
Cutrera S.3, Almasio P.2
1UO Diabetologia e Medicina Interna, PO Civico- Partinico ASP6,
Partinico, Italy, 2Gastroenterology Section - Di.Bi.Mis- University of
Palermo, Palermo, Italy, 3CLADIBIOR clinical pathology, University of
Palermo-Italy, Palermo, Italy
Background and aim: Genetic predisposition plays a key role in
celiac disease (CD). Indeed, CD is strongly associated with specific
HLA class II genes known as HLA-DQ2 and HLA-DQ8 located on
chromosome 6p21.
Our aim was to assess the relationship between HLA phenotypes
and clinical, serological and histological characteristics in a
homogeneous cohort of patients with adult-onset CD, diagnosed in
two referral centers from Sicily.
Material and methods: Age at diagnosis, clinical presentation
(classical, atypical, silent), serological markers – anti - tissue
transglutaminase antibodies (tTGA) and antiendomysium antibodies
(EMA), degree of mucosal damage according to Marsh-Oberhuber
classification, were registered on a shared database. HLA-DR
and DQ alleles were performed on genomic DNA extracted from
peripheral blood lymphocytes by PCR. According to HLA phenotype,
patients were divided into three groups: HLA-DQ2 (homozygous
or heterozygous for DQ2), HLA-DQ2-DQ8 and HLA-DQ8 (DQ8
homozygous or heterozygous). Data were analyzed by SPSS 13.0.
Results: 309 patients with CD were consecutively diagnosed
between January 2004 and August 2014. 132 patients were tested for
HLA-DQ2/DQ8. Most patients expressed HLA-DQ2 (56.9%), followed
by HLA-DQ8 (31.8%) and HLA-DQ2 / DQ8 (11.3%). 82,6% were females.
Mean age was 39,21±14,7 (range 12-80). 59,85% presented as classic
CD (C-CD), 26,51% showed an atypical presentation (A-CD), 13,6% had
silent disease ((S-CD). 16,6% of patients had a previous diagnosis of
autoimmune disease. There was no relationship between phenotype
and sex. HLA-DQ2 was related to an earlier age of onset (38,3±14,6)
compared with HLA-DQ8 (p<0.05). There was no relationship
between clinical presentation and genotype, but in HLA-DQ2 / DQ8
patients, levels of hemoglobin and ferritin were lower (p<0,05).
Genotype did not influence the presence of autoimmune disorders.
Serological markers (EMA and TGA) were significantly associated
with DQ2 (p=0,05). No significant difference was observed in the
three HLA- groups concerning the degree of mucosal damage.
Conclusions: The most frequent HLA haplotype in this sicilian
population with CD is HLA-DQ2. However, the prevalence of HLA-
DQ8 was greater than expected, according with rates reported in
other Mediterranean series. Patients with HLA-DQ2 alone or in
combination with DQ8 have a more aggressive clinical presentation
with lower levels of hemoglobin and ferritin and higher levels
of TTGA and EMA. HLA genotype is not related to severity of
histological damage. Our results suggest that HLA testing has not
only a diagnostic role, but could predict disease course.
OC.12.3
SUSTAINED IMPROVEMENT OF A CASE WITH REFRACTORY
CELIAC DISEASE (RCD) BY SERIAL INFUSIONS OF AUTOLOGOUS
BONE MARROW-DERIVED MESENCHYMAL STEM CELLS
Ciccocioppo R.*1, Gallia A.1, Avanzini M.A.2, Cangemi G.C.1, Racca F.1,
Picone C.3, Vanoli A.4, Strada E.1, Biagi F.1, Bergamaschi G.1,
Maccario R.2, Corazza G.R.1
11Clinica Medica I; Fondazione IRCCS Policlinico San Matteo,
Università di Pavia; Italia., Pavia, Italy, 22Cell Factory e Laboratori
Ricerca Onco-Ematologia Pediatrica; Fondazione IRCCS Policlinico