Hector J. Maldonado

Prevalence of Gastroesophageal Reflux Disease in Patients with Extraesophageal Symptoms Referred from Otolaryngology, Allergy, and Cardiology Practices: A Prospective Study

Aim: To investigate the prevalence of gastroesophageal reflux disease (GERD) as well as the clinical, endoscopic, and manometric characteristics in 57 adult patients with otolaryngeal symptoms, asthma, or noncardiac chest pain referred from specialized services. Methods: The following evaluations were performed: (1) upper endoscopy, (2) 24-hour ambulatory esophageal pH monitoring, and (3) esophageal manometry. The prevalence of GERD was determined, and demographic, clinical, endoscopic, and manometric characteristics of patients with or without GERD were evaluated. Results: Thirty-four out of 57 patients (60%) had GERD. The 95% confidence interval ranged from 48 to 72%. There was no statistical difference between patients with or without GERD regarding gender, age, or time of evolution of symptoms. Cough was more frequent in the subjects with GERD (75 vs. 25%, p<0.05). Nevertheless, cough was observed in only 53% of the patients with GERD. Patients suffering from laryngitis had a greater proximal and distal esophageal acid exposure time than those without. Conclusions: The prevalence of GERD was 60%. There is not a definite demographic or clinical profile that permits us to distinguish between patients with and without GERD among those with ear, nose, and throat and pulmonary symptoms or chest pain.

Endoscopic injection of botulinum toxin in the gastric antrum for the treatment of obesity: Results of a pilot study

OBJECTIVES The aim of this study was to observe the effects of endoscopic injections of botulinum toxin (BT) in the gastric antrum on body weight and gastric emptying in obese patients. PATIENTS AND METHODS Obese patients were selected for the study. By endoscopy, 100 U of BT type A was injected into the prepyloric antral gastric wall. Before and after treatment body weight and solid gastric emptying were evaluated. RESULTS Twelve patients were included into this study. Four and twelve weeks after the treatment median values of body weight and gastric emptying did not show significant changes compared to baseline values: body weight: (- 0.5 kg and - 1.0 kg respectively, P > 0.05) and gastric retention for solids at 90 min (+ 4.5% and +10.5% respectively, P > 0.05). Abnormal gastric emptying (solid gastric retention at 90 min > 50%) was observed in 22% of patients after 4 weeks and in 25% after 12 weeks. CONCLUSIONS BT injected into the gastric antrum does not seem to significantly reduce body weight or delay gastric emptying in obese patients.

Impact of therapeutic interventions induced by capsule endoscopy on long term outcome in chronic obscure GI bleeding.

BACKGROUND The diagnostic yield and the clinical impact of capsule endoscopy (CE) in obscure gastrointestinal bleeding (OGIB) are well known. The aim of this study was to determine the impact of therapeutic interventions induced by CE findings on long term outcome. PATIENTS AND METHODS Patients with chronic OGIB referred to our center from September 2003 to June 2005 for CE were included. Treatment of intestinal lesions was prescribed according to the clinical characteristics of patients and the nature of the lesions. RESULTS Forty patients were included, 18 females and 22 males. Median age was 54 yrs (range: 5-87) with a median follow-up of 13 months (range: 6-22). The diagnostic yield of CE was 75% (30/40). From 30 patients with positive CE, 16 received treatment (Group I) and 14 did not (Group II). Thus clinical impact was 40%. Ten patients had negative CE (Group III). During follow-up, bleeding recurrence was observed in only 1 patient from Group I (6%), 5 from Group II (36%) and 1 from Group III (10%). There were only significant differences between Group I vs Group II (P=0.002). CONCLUSIONS CE results had a favorable influence in patient outcome allowing for specific treatment as they showed significantly reduced recurrent bleeding.

Mo1976 Plasma Levels Cytokine Imbalance in Compensated Cirrhotic Patients With Impaired Glucose Tolerance and Diabetes Mellitus. A Prospective Study

Background and Aims: To define if there is an imbalance in plasma levels of some proinflammatory, fibrogenic and antifibrogenic cytokines of patients with liver cirrhosis (LC) and impaired glucose tolerance (IGT) or Diabetes Mellitus (DM) . Methods: We studied 54 patients with compensated LC who had normal fasting plasma glucose (FPG) levels. An oral glucose tolerance test (OGTT) was carried out:18 patients were normal, 18 had IGT, and 18 had DM. Plasma levels of the following cytokines were measured: TNF-α, Soluble Tumor Necrosis Factor Receptor 1 (sTNF-R1), Leptin, TGF-β1, and Hepatocyte Growth Factor (HGF). Also, fasting plasma insulin (FPI) levels were measured and HOMA2-IR was calculated. Results were compared with those of a control group of 18 patients without liver disease or DM. Data were expressed as medians and interquartile ranges. Intergroup comparison was performed using non parametric tests. Results:. Patients with IGT and DM had significantly higher sTNF-R1 (p = 0.0043 and 0.0045 respectively) (Figure 1) and significantly lower TGF-β1 (p = 0.001 and 0.001 respectively) (Figure 2) compared to controls. Leptin , HGF, and TNF-α showed no significant differences among cirrhotic patient and controls. Correlations between sTNF-R1 and HOMA2-IR and between leptin and HOMA2-IR were found. Conclusions: IGT and DM were associated to an imbalance of sTNF-R1 and TGFβ1 in cirrhotic patients. At the same time sTNF-R1and leptin correlated with IR. These findings may suggest that sTNF-R1 might be implicated in the development of DM or in the deterioration of liver function in cirrhotic patients with DM.

T1950 Use of Proton Pump Inhibitors On Admission Is a Protective Factor for Three Day-Mortality in Non-Variceal Bleeding (NVB)

ever, compared to patients undergoing delayed endoscopy, those with early endoscopy had a lower initial blood pressure (p=0.06), lower platelet count (p=0.008), higher transfusion requirement (p=0.04), and were more likely to be managed in the ICU (p<0.0001) and have varices (p=0.009). That is, patients undergoing early endoscopy had more severe illness vs. those receiving delayed endoscopy. In logistic regression adjusting for these and other confounders, performance of early endoscopy was associated with an 85% reduction in mortality (OR=0.15; CI=0.04-0.71).Conclusion: Performance of early endoscopy is a surrogate marker for bleeding severity. When adjusting for systematic differences between patients receiving early vs. delayed endoscopy, performance of early endoscopy in this cohort was associated with a striking reduction in mortality. These data provide additional support to the argument that early endoscopy should be standard of care in acute GI hemorrhage.

T1949 Clinical Features and Risk Factors for Three-Day Mortality in Elderly Patients with Non Variceal Bleeding

ever, compared to patients undergoing delayed endoscopy, those with early endoscopy had a lower initial blood pressure (p=0.06), lower platelet count (p=0.008), higher transfusion requirement (p=0.04), and were more likely to be managed in the ICU (p<0.0001) and have varices (p=0.009). That is, patients undergoing early endoscopy had more severe illness vs. those receiving delayed endoscopy. In logistic regression adjusting for these and other confounders, performance of early endoscopy was associated with an 85% reduction in mortality (OR=0.15; CI=0.04-0.71).Conclusion: Performance of early endoscopy is a surrogate marker for bleeding severity. When adjusting for systematic differences between patients receiving early vs. delayed endoscopy, performance of early endoscopy in this cohort was associated with a striking reduction in mortality. These data provide additional support to the argument that early endoscopy should be standard of care in acute GI hemorrhage.