Ji Min Jung

Primary esophageal adenoid cystic carcinoma.

Adenoid cystic carcinoma (ACC) is common in the salivary glands but rare in the esophagus. Routine esophagogastroscopy performed in a 54-year-old woman as part of a medical check-up revealed a submucosal tumor (1.5x1.0 cm) at the mid-esophagus. Endoscopic ultrasonography revealed a lesion with mixed echogenicity in the submucosal layer. The submucosal mass was removed by incisional endoscopic enucleation, and pathological analysis revealed epithelial cells with small hyperchromatic angular nuclei in tubular and cribriform patterns. The lesion was pathologically confirmed as an ACC of the esophagus.

S1032 Favorable Factors for Survival in Elderly Patients with Colorectal Cancer

Background & Aims: Endoscopic submucosal dissection (ESD) has been developed for en bloc resection of gastric tumors. It can be desirable to use this novel endoluminal surgery for colorectal tumors. Methods: ESD was performed on 196 consecutive cases of mucosal or slight submucosally invasive neoplasms, which were diagnosed preoperatively. The therapeutic efficacy, technical feasibility, operation time, safety and clinical outcomes were assessed. Results: The target lesions consisted of 140 adenocarcinoma, 43 adenoma and 13 carcinoid tumor. There were 31, 34, 28, 16, 23 and 64 neoplasms in the caecum, ascending, transverse, descending and sigmoid colon, and rectum, respectively. The mean size of the neoplasms was 23.8 mm (maximum, 65mm). The mean operation time was 50 minutes (maximum, 130 min). The rate of en bloc resection was 82.6% (162/196), and that of en bloc resection with lateral/basal margins (RO resection) was 81.1% (159/196). Eleven lesions (5.6%) were histologically considered to be at substantial risk for nodal metastasis after ESD (8 were surgically resected and 3 were followed-up with no recurrent tumors). Obvious perforation related to ESD occurred in 12 (6.1%) patients. No one needed blood transfusion or had a complication of problematic bleeding. Multiple-piece resections of mucosal carcinoma, which were successfully followed-up by colonoscopy, have not been associated with locally recurrent tumors so far. No nodal or distant metastasis was detected in 140 patients with noninvasive or invasive carcinoma to date. Conclusions: ESD was found to be feasible for treatment of superficial colorectal tumors with promising results.

S1909 Gender Specific Risk Factors for Reflux Esophagitis in Asia: Role of Age, Body Mass Index, Metabolic Syndrome and Menopause

Introduction: Nonacid reflux has been shown to be able in inducing reflux symptoms in gastroesophageal reflux disease (GERD) patients. Non-erosive reflux disease (NERD) and erosive esophagitis (EE) are the most frequent phenotypic presentations of GERD. Aim: To evaluate symptom association probability (SAP) in patients with NERD and EE. Methods: We evaluated 44 patients with EE (26M, median age 48; range 23-73 yrs), 173 with NERD (67M, median age 49; range 18-78 yrs) and 48 controls (22M, median age 44; range 2277) using multichannel intraluminal impedance and pH while off-PPI therapy. All patients had typical reflux symptoms. We measured distal esophageal acid exposure time (AET), number of impedance-detected reflux episodes (acid, nonacid) and symptom association probability (SAP; positive if ≥95%). Results: Symptom-reflux association with SAP in EE and NERD patients is shown in the Figure below. Out of 35 (75%) EE patients with an abnormal AET, 33 (75%) had a positive SAP. Twenty-seven (61%) patients had a positive SAP for acid reflux only, 2 (5%) for nonacid reflux only and 4 (9%) for both. Among the 8 (18%) patients with a normal AET and a positive SAP, 3 (7%) had a positive SAP for nonacid reflux only, 2 (5%) for acid reflux only and 3 (7%) for both. Out of 72 (42%) NERD patients with an abnormal AET, 64 (37%) had positive SAP. Fifty-two (31%) patients had a positive SAP for acid reflux only, 8 (5%) for nonacid reflux only and 6 (3%) for both. Among the 101 (58%) patients with a normal AET, 59 (34%) had a positive SAP. Twentytwo (13%) patients had a positive SAP for nonacid reflux only, 23 (13%) for acid reflux only and 14 (8%) for both. Conclusions: Nonacid reflux clearly contributes to provoke reflux symptoms in both NERD and EE patients. The increased percentage of NERD patients whose symptoms are related to nonacid reflux could be due to the higher sensitivity of these patients to stimuli different from acid.

S1216 Bone Mineral Density and Bone Turnover Markers in Patients with Inflammatory Bowel Disease

Background and aims: Major changes were made in the Rome III criteria for functional dyspepsia where two distinct syndromes were postulated, postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS). Our aim in a general population sample was to explore if quality of life, using the validated SF-36, is impaired in functional dyspepsia and among functional dyspepsia subgroups defined according to the Rome III definition. Method: A random sample (n=2,860) of the adult population of two northern Swedish municipalities (n=21,610) was surveyed using a validated questionnaire assessing gastrointestinal symptoms (ASQ) and the SF-36 for quality of life with the 8 standard domains Physical Functioning (PF), Role-Physical (RP), Bodily Pain (BP), General Health (GH), Mental Health (MH), Vitality (VT), Social Functioning (SF) and Role Emotional (RE). A random sub-sample (n=1,001) of the responders was invited to undergo an esophagogastroduodenoscopy (participation rate 73.3%). The mean values of SF-36 domains in different dyspepsia categories were calculated. Multivariate logistic regression analysis, adjusting with age and sex, was used to analyze associations of different dyspepsia groups with dichotomized SF-36 domains. Results: SF-36 data were available in 999 of the 1,001 subjects endoscoped. 202 (20.2%) were classified as uninvestigated dyspepsia (UID) and 157 (15.7%) as functional dyspepsia (FD); 52 (5.2%) reported epigastric pain syndrome and 122 individuals (12.2%) had postprandial distress syndrome. FD was significantly associated with low scores in every SF-36 domain (all p≤0.01); EPS was associated only with worse Bodily Pain (p<0.05) but PDS was associated with impairment in all domains (all p ≤ 0.01). Symptomatic peptic ulcer disease (PUD) impaired quality of life significantly more than FD only in domain RP (p<0.05). Conclusions: Functional dyspepsia appears to seriously impair quality of life in adult nonpatients, and PDS is associated with more quality of life impairment than EPS. Table. SF-36 domain scores in different dyspepsia groups

W1837 Stress and Fatigue in Reflux Esophagitis

Background Typical symptoms of gastroesophageal reflux disease (GERD) are heartburn and regurgitation. Extraesophageal (EE) symptoms such as cough and throat clearing are less commonly associated with GERD but represent a common presenting symptom for reflux testing. Proximal extent of refluxate into the larynx or even the lungs is proposed as a potential mechanism for EE symptoms. Aim We tested the hypothesis that EE symptoms are more frequently associated with proximal esophageal reflux than typical symptoms. Methods A blinded assessment was rigorously applied. Themultichannel intraluminal impedance-pH (MII-pH) tracings analyzed for this study were edited by one of the investigators so that none of the symptom markers were visible and the reflux associated symptoms reviewed were simply marked as symptom 1-5 for each patient. 815 consecutive MII-pH reports were reviewed to identify 40 patients with at least 5 symptom events preceded by a reflux episode, thus a total of 50 reflux related events in each of 4 symptom groups: cough, throat clearing, heartburn, and regurgitation. A second investigator blindly analyzed all 200 episodes by reporting the extent of the refluxate at 7, 9, 15, and 17 cm above the LES. Results The percentage of symptom related reflux extending proximally to 17 cm above the LES is similar among all four symptom types (Figure 1). At least 50% of all symptoms were associated with proximal reflux to 17 cm above the LES, with the numerically highest being regurgitation (60%). There is no significant difference between any of the values. Conslusion This study confirms the frequent association of proximal reflux with GERDrelated symptoms previously identified. However, as opposed to common beliefs, our data indicate that EE GERD-related symptoms are not more frequently associated with proximal reflux than typical GERD symptoms. Both EE and esophageal symptoms are associated with reflux to 17cm at least 50% of the time.