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e144
Abstracts of the 22
nd
National Congress of Digestive Diseases / Digestive and Liver Disease 48S2 (2016) e67–e231
inflammation. The positive effect of the eradicant Hp treatment may
also produce a reduction in serum levels of PGII.
The aim of the study was to assess the combined role of PGII and
anti IgG Hp antibodies (Hp abs) serum levels in the diagnosis of Hp-
related gastritis and in the follow-up after eradication.
Material and methods:
A total of 657 dyspeptic patients (M=219,
F=438, mean age=44.4±14.0 ys, range=18-86 ys) were evaluated.
PGII concentrations and Hp abs were determined via an ELISA test
(GastroPanel, Biohit Oyi, Helsinki, Finland) in fasting serum samples.
Patients affected by chronic atrophic gastritis were excluded from
the study. Patients in proton pump inhibitors (PPI) were included.
Results:
170 patients of 657 (25.9%) were Hp positive and 487 Hp
negative (74.1%). The table shows the result of age, PGII and Hp abs
in the four groups of patients.
Table 1
No PPI treatment
With PPI treatment
H pylori status
Age
PGII
IgG Hp Age
PGII
IgG Hp
Negative
38.4±10.8 5.8±2.5 6.5±10.4 42.4±13.4 8.4±4.2 7.1±8.7
Positive
39.1±10.8 12.9±6.7 90.3±24.5 43.7±14.0 17.3±12.1 83.5±30.8
Eradicated
45.6±13.3 5.8±1.6 30.7±31.3 55.1±13.1 8.1±4.1 24.0±23.2
(Hp-ve)
Non eradicated 54.2±13.2 12.4±3.8 86.5±30.7 52.9±13.5 19.9±14.4 81.8±36.5
(Hp+ve)
Conclusions:
The combined use of serum PGII (>10 ug/L) and Hp
abs (>=30 EIU) levels most accurately defines a picture of Hp-related
gastritis; the reduction of PGII concentrations under 10 ug/L as well
as Hp abs <30 EIU could be may be an aid in evaluating the efficacy
of eradication therapy.
P.04.4
THE SHOWER IS NOT WARM ENOUGH!
Padula D.*, Lenti M.V., De Quarti A., Miceli E., Corazza G.R.
Clinica Medica I IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
Background and aim:
A 30 years old Caucasian female, presented
with a 7 years history of nausea and non bloody hyperemesis 5 times
daily. She had multiple hospitalizations and emergency accesses
during the past years for intermittent abdominal pain, nausea and
vomiting and referred important weight loss (of about 15 Kg in the
last 3 years).
Material and methods:
An extensive medical workup had
demonstrated negative, including upper and lower endoscopy,
magnetic resonance enterography (jejunal thickening), PET scan,
push endoscopy. Moreover in the last three years she reported a
progressive increase of the systolic pressure, mean values over 160
mmHg, an ultrasound study of the renal arteries showed no arterial
obstruction.
Results:
At the admission to our Clinic the physical examination
showed increased levels of blood pressure (160/90mmHg), routinary
laboratory tests were unremarkable. She reported smoking one
cigarette daily and occasional alcohol use in social settings. No
family history of hypertension or gastrointestinal disorders was
declared.
During the first days of hospitalization she actually presented
an intractable vomit of whitish watery secretions associated to
abdominal pain and continuous nausea, antiemetics, including
metoclopramide and onsansetron, were not effective in relieving
the symptoms, she reported that the only strategy that could help
relieve her nausea was hot water, complaining that the hospital
showers were not warm enough. Her workups included: upper GI
with barium, gastric emptying studies (14C-octanoic acid gastric
emptying breath test), US abdomen, abdominal computerized
tomography; none of these investigations revealed pathology. After
a few days, the symptoms underwent to spontaneous relapse, in
those days she returned to normal bath habits.
Conclusions:
In order to exclude toxic ingestion other tests were
performed and showed the presence of cannabis in urine and blood
stools. She admitted smoking cannabis from at least 8 years.
The diagnosis of “cannabinoid hyperemesis syndrome” was made,
we recommend to quit smoking. On follow-up 6 months later,
she had remained free of cannabis use and she had no symptoms
of nausea, vomiting or compulsive bathing, moreover the blood
pressure levels returned normal.
P.04.5
PROGNOSIS OF GASTRIC GISTS BASED ON TUMOR SIZE
Togliani T.*, Mantovani N., Vitetta E., Savioli A., Troiano L., Pilati S.
S.S.D. di Endoscopia Digestiva, Azienda Ospedaliera Carlo Poma,
Mantova, Italy
Background and aim:
Gastric GISTs range from small benign lesions
to large metastatic tumors; EUS provides diagnostic and prognostic
information that help deciding between follow up or surgery. The
aim of this study was to establish the prognostic value of the size of
gastric GISTs.
Material and methods:
We retrospectively studied patients with
an EUS diagnosis of gastric GIST without metastases; we divided
them according to the initial size of the tumor: Group A (≤2 cm),
Group B (>2 cm). The clinical onset and the EUS characteristics were
recorded. For the prognostic evaluation one among these follow up
data was required: an EUS control after ≥6 months, the histologic
diagnosis in operated patients, or the documentation of a GIST-
related death.
Results:
Fifty-two patients were included. Group A was composed
of 24 patients. The onset was dyspepsia in 21 cases, anemia in 2,
a CT suspect of GIST in 1. EUS worrisome criteria (inhomogenicity,
irregular borders, enlarged lymph nodes, ulceration) were present
in 5 cases. After a mean of 45 months EUS controls showed no
changes in 19 patients and a little worsening (a mild enlargement
or the appearance of a second <1 cm GIST) in 4; 1 patient died after
GIST bleeding. No patients were operated. Group B was composed of
28 patients. The onset was dyspepsia in 11 cases, anemia in 1, upper
GI bleeding in 6, a CT suspect of GIST in 10. EUS worrisome criteria
other than size were present in 25 patients. In the 22 operated
patients histology revealed 4 GISTs with high mitotic rate, 13 GISTs
with low mitotic rate, 5 other benign tumors. Because of their poor
general condition, 6 patients were not operated: 3 showed no EUS
worsening during follow up, 3 died for GIST progression.
Conclusions:
In Group A and Group B an alarming onset was present
in 13% and 61%, other initial EUS worrisome criteria were visible in
21% and 89%, signs of a bad evolution (an EUS worsening during
follow up, a high risk histology after resection or a tumor-related
death) were seen in 21% and 32%, respectively. GISTs belonging to
Group A and B probably represent the same disease diagnosed in
different moments: ≤2 cm GISTs were accidentally found in younger
patients (mean age 59 years) while >2 cm GISTs were seen in older
subjects (mean age 69 years) in whom tumors had more time to
grow, becoming symptomatic. Thus, as a minority of small GISTs
showed a slow and late progression, these patients can initially
avoid surgery but a long EUS follow up is mandatory (e.g. every 1-2
years for at least 10 years).