Jose M. Remes Troche

Tu2027 Topography and Characterization of Anal Ultraslow Waves (AUSWs) in Patients With Proctalgia Fugax. a Study Using High-Definition Anorectal Manometry (HDM).

Ano-rectal disorders are quite common in the general population. Although they are not life threatening conditions they do represent a certain social stigma and a reduced quality of life for the sufferer. The ano-rectal region is a continuously active area integrating the effects of smooth and striated muscle sphincters. The underlying physiology of muscle function contributing to ano-rectal competence is still poorly understood and there is room for a much better understanding so that treatments can improve. In this work we inserted a cylindrically shaped, liquid filled bag (7.5 cm long), mounted on a catheter into the anus and positioned it straddling the ano-rectal region in 20 healthy volunteers (10 females). A series of volume-controlled distensions (40ml/min to 40ml) were carried out and data on 16 cross-sectional area measurements at 5 mm apart and bag pressure were recorded. Provocative tests using squeeze and cough at bag volumes of 20, 30 and 40ml were also carried out. Results indicated that the procedure was safe and well tolerated. Ramp distension showed that the female ano-rectal sphincter requires a higher pressure (mean, 11mmHg) to open than in males (mean, 5mmHg) (P 0.05). The geometric profile during distensions showed almost the same pattern in all volunteers with proximal and distal narrow bands at low degrees of distension and shortening of the narrow zone at higher degrees of distension (figure1). Interindividual differences were observed in the behaviour of the external anal sphincter and the puborectal muscle during squeeze. However, during cough their behaviour was quite similar. This distensibility technique provided an important new way of studying the anal canal and hence may have a role in testing sphincter competence in patients with incontinence and anorectal dysfunction.

Tu1195 The Effect of Tadalafil on Esophageal Motor Function

Background: Recently it has been described that 5-phosphodiesterase (5-PDE) inhibitors produce esophageal smooth muscle relaxation through the increase and extension of the inhibitory activity of cGMP. Some studies have shown that sildenafil alters LES function, amplitude and velocity of esophageal peristaltic contractions but not induce gastro-oesophageal reflux. Tadalafil is a 5-PDE inhibitor that has a half-life of 18 hours and its plasma clearance can take up to 72 hours. Thus, in this study we hypothesize that tadalafil induce a sustained and prolonged effect in esophageal motor function. Objective: To evaluate the effect of a single dose of 20 mgs of tadalafil on esophageal motility and the lower esophageal sphincter in healthy volunteers and patients with spastic disorders of the esophagus. Materials and Methods: In this study, we included 10 healthy volunteers (6 men, mean age 27.5 years) and 10 patients (6 with type II achalasia, 2 with type III achalasia and 2 with hypertensive peristalsis [5 men, mean age 45 years]). At baseline, in all subjects a highresolution manometry (Given, Yoqneam, Israel) was performed. Baseline HRM included 10 swallows of 5ml of NaCl; then all subjects received 20 mgs of tadalafil (Cialis, LillyICOS, Washington, U.S.) and the catheter was left in place 2 hours. At 15, 30, 45, 60 and 120 minutes after the tadalafil dose, 5 swallows of 5 ml were performed. Blood pressure and heart rate was recorded continuously. 24 hours and 48 hours after de tadalafil dose, all subjects return to the lab to repeat HRM. We measure LES and esophageal motility function according to the Chicago II classification parameters. Results: In controls, 60 minutes after tadalafil administration a decrease in basal resting pressure of the LES was recorded (18.8 ± 4 mmHg ,p = 0.019) and this decrease was progressive at, 2 hours, 24 and 48 hours (Figure 1). The lowest point of pressure was reached after 48 hours. The pressure reduction was observed in all but one subject. The average amplitude of esophageal contraction significantly decreased in all 3 segments after 45 minutes of the administration of tadalafil, and its recovery began at 48 hours (Figure 2 p ,0.05). Similar findings were recorded in 8 of the 10 patients. In addition, 6 patients reported improvement of dysphagia at 24 and 48 hours, and in threes case this improvement lasted up to 72 hours. In all cases there were not cardiovascular effects with the administration of tadalafil. The most common side adverse effect reported was mild headache. Conclusions: Tadalafil is a 5-PDE that induce a prolonged and sustained effect on esophageal contractions, is well tolerated and it could be a promising drug in the management of esophageal motor disorders.

M1337 Irritable Bowel Syndrome (IBS) Among Caregivers of Chronically Ill Patients: Prevalence, Quality of Life (QOL) and Association With Psychological Stress

were conducted. Results: A total of 15.6M patients with AP were identified (10.1% children, 89.9% adults) with 516.6M total consultations (12.4% children, 87.6% adults). Children demonstrated a non-linear trend in APCs (R2 = 0.030) and a quadratic trend was found to be the best fit (polynomial; R2 = 1.000; Figure 1). This indicates a seasonal pattern in APC among children but not adults (linear; R2 = 0.621). The trend in seasonal variation of APCs among children stratified by age and gender was consistent with the overall child population. Conclusions: Abdominal pain consultations in children are less common during summer months while APC among adults do not vary during the year. Factors involved in the pathogenesis of AP in adults and children may differ.