Katherine Roeser

Gastric Electrical Stimulation Improves Outcomes of Patients With Gastroparesis for up to 10 Years

BACKGROUND & AIMS We assessed the long-term clinical outcomes of gastric electrical stimulation (GES) therapy with Enterra (Enterra Therapy System; Medtronic, Minneapolis, MN) in a large cohort of patients with severe gastroparesis. METHODS Gastroparesis patients (n=221; 142 diabetic, 48 idiopathic, and 31 postsurgical) treated with Enterra (Medtronic) for 1-11 years were retrospectively assessed; 188 had follow-up visits and data were collected for at least 1 year (mean 56 months, range 12-131 months). Total symptom scores (TSSs), gastric emptying, nutritional status, weight, hospitalizations, use of prokinetic and/or antiemetic medications, levels of HbA1c levels (in diabetic patients), and adverse events were evaluated at the beginning of the study (baseline) and during the follow-up period. RESULTS TSS, hospitalization days, and use of medications were significantly reduced among all patients (P<.05). More patients with diabetic (58%) and postsurgical gastroparesis (53%) had a greater than 50% reduction in TSS than those with idiopathic disease (48%; P=.32). Weight significantly increased among all groups, and 89% of J-tubes could be removed. At end of the follow-up period, all etiological groups had similar, abnormal delays in mean gastric retention. Thirteen patients (7%) had their devices removed because of infection at the pulse generator site. CONCLUSIONS GES therapy significantly improved subjective and objective parameters in patients with severe gastroparesis; efficacy was sustained for up to 10 years and was accompanied by good safety and tolerance profiles. Patients with diabetic or postsurgical gastroparesis benefited more than those with idiopathic disease.

Restorative Impact of Rabeprazole on Gastric Mucus and Mucin Production Impairment During Naproxen Administration: Its Potential Clinical Significance

Rabeprazole augments gastric mucus and mucin production in humans. However, its potential restorative impact on gastric mucus and mucin production impairment, resulting from administration of naproxen, remained to be explored. Therefore, we measured the content of mucus and mucin in gastric juice (GJ) before and after administration of naproxen with rabeprazole or placebo. The study was approved by HSC at KUMC and conducted in 21 asymptomatic, H. pylori–negative volunteers in a double-blind, placebo-controlled, crossover design. The content of gastric mucus in GJ, after exhaustive dialysis and complete lyophilization, was assessed gravimetrically, whereas the content of mucin was measured after its purification with equilibrium density-gradient ultracentrifugation in CsCl. Gastric mucus secretion during administration of naproxen with placebo declined significantly both in basal (by 44%; P < 0.001) and in pentagastrin-stimulated (by 35%; P < 0.001) conditions. Coadministration of rabeprazole significantly restored the naproxen-induced impairment in mucus production in basal conditions (by 47%; P < 0.01) and by 22% during stimulation with pentagastrin. Gastric mucin secretion during naproxen/placebo administration also declined significantly in both basal (by 39%; P < 0.01) and stimulated (by 49%; P = 0.003) conditions. Rabeprazole also significantly restored the naproxen-induced decline of gastric mucin output during pentagastrin-stimulated conditions (by 67%; P = 0.003) and by 40% in basal conditions (P = 0.05). The restorative capacity of rabeprazole on the quantitative impairment of gastric mucus and mucin during administration of naproxen may translate into a clinical benefit of protection of the upper alimentary tract from NSAID-related mucosal injury.

847 Effect of Multi-Point Gastric Electrical Pacing (MGP) On Symptoms, Gastric Emptying and Electrical Activity in Diabetic Gastroparesis

other sites (incidental TICs) were excluded from this analysis. Daily fiber & abstinence from ASA & NSAIDs were recommended. Outcomes were analyzed for PRES vs. DEF subgroups & by baseline treatment groups (MED, ENDO, SURG) post-60 days after initial diagnosis & treatment. Data were recorded on standard forms by research coordinators & SAS was used for data management & analysis. RESULTS: Patients were similar in all demographics, except for more RBCs & ENDO treatments in the DEF group. The mean age was 72 yrs, 29% were female, 16% took anticoagulants & all had co-morbidities. 43 pts (37.7%) had definitive & 71 pts (62.3 %) presumptive TIC Bleeds. Mean F/U was 1195±77 days. Compliance with fiber & ASA/NSAIDs was low. The rates of rebleeds & other TIC COMPL for DEF (N=43) vs. PRES (N=71); & MED (N=74), ENDO (N=32) & SURG (N=8) are shown in the Table. No differences were significant (p> 0.05). The cumulative death rate was 16.7% & no one died of TIC bleed or TIC-COMPL. CONCLUSIONS: For patients with documented diverticular hemorrhage followed long-term: 1. Rebleeding rates were low, but as likely to be from TICs as other GI sites. 2. No one died of TIC bleeds or TIC complications, which were also very rare. 3. There were no significant outcome differences after medical, endoscopic, or surgical therapies. Based upon these data, the recommendation of surgery for an index diverticular bleed should be revised. Partially supported by NIH grants (K24DK002650) & CURE (P30-DK040301) Human Studies Core.

Narcotic Bowel Syndrome: Under Recognized Diagnosis Resulting in Over-Utilization of Healthcare Resources

Introduction: The UK National Cancer Plan (2000) introduced a ‘two week’ waiting time standard for investigating suspected malignancy and guidance to encourage early diagnosis. Improved access to elective (ELECT) investigation should reduce the need for emergency (EMERG) admission. This study examined route of diagnosis and outcomes for oesophagogastric cancer (OGC), both locally and nationally. Methods: Local OGC cases were audited for 2-year periods before (“Pre”: July 97-June 99) and after (“Post”: Jan 01-Dec 02) service re-design, collecting details of demographics, tumour type, stage, dates of referral, diagnosis, treatment and survival. Within a project funded by the NHS Information Centre, we developed novel linkage algorithms to analyse Hospital Episode Statistics for England (20068) and methods to track OGC care chronologically, selecting only incident cases with a valid pathway of coded diagnostic and therapeutic interventions. External linkage to death registry established date of death and 2-year survival. Results: LOCAL DATA: n=333 cases (Pre, n=152; Post, n=181). No change in % of patients diagnosed via EMERG route after service re-design (Pre: 30.9% v Post: 31.5%; p=0.981), nor any change in age, symptom or tumour profile of EMERG cases. Local EMERG cases were older than ELEC (75 v 68 yrs; p<0.0001), less likely to have potentially curative treatment (13.5% v 40%; p<0.0001) and had poorer 3 yr survival (10.6% v 22.2%, p=0.013). EMERG cases with dysphagia and/or weight loss had lower 3 year survival than those with other presenting features (p=0.035). NATIONAL DATA We identified 33,115 patients with OGC, of whom 26,097 (79%) met study criteria. Of these, 7,082 (27%) were EMERG and 19,015 ELEC (73%). EMERG cases were older (74 yrs v 70 yrs; p<0.001), less likely to undergo surgery (516 [2%] v 3,780 [14.5%], p<0.001) and had poorer 2 yr survival (19.6% v 32.9%, p<0.001). The % of EMERG cases varied widely between cancer networks (22% to 40%). Conclusion: Findings are consistent with a recent report by the UKNational Cancer Intelligence Network suggesting that a quarter of major cancers are diagnosed via the EMERG route. Our national linkage study suggests 27% of new OGC cases in England are diagnosed as EMERG and this mode of presentation predicts a poor outcome, confirmed by detailed local audit. Although EMERG admission is unavoidable for some cases, the observed variation across the country suggests possible unresolved inequalities in patient access. Monitoring of this candidate indicator could assess the impact of new initiatives to promote earlier elective diagnosis.

Can Gastrointestinal Clinical Presentation Predict Gastroparesis: Results From a Tertiary Referral Center

Background: Gastroparesis can have varied clinical presentation. There are no well defined clinical parameters for predicting gastroparesis in patients presentingwith different gastrointestinal symptoms. Aims: To assess clinical predictors of gastroparesis in a large cohort of patients undergoing gastric emptying test Methods: A retrospective chart review of patients referred to our tertiary care center with presumed diagnosis of gastroparesis and various combinations of abdominal symptoms (nausea, vomiting, abdominal pain, bloating, post parandial fullness and early satiety) were included. All patients underwent a standardized 4-hrs scintigraphic gastric emptying test (GET) consisting of low-fat (2%) isotope labeled egg beaters meal of 250 kcal at our center. Patient demographics, medical/surgical history, drug use (affecting gastric/GI motility), proton pump inhibitor (PPI) use, endoscopic findings and results of hydrogen breath test were noted. Patients with previous history of gastric or small bowel resection, IBD, significant co-morbidities (end stage liver, kidney disease) were excluded. A univariate analysis was performed using Fishers exact to evaluate predictors of gastroparesis, variables with a significance (p<0.05) were further evaluated using a multivariate logistic regressions model to identify independent predictors for gastroparesis. Results: 217 patients (mean age 46 yrs, 77% females, 83% Caucasians, average BMI 29 kg/m2, 18% smoker and 32% alcohol use history) were included. The frequency of gastrointestinal symptoms were: nausea 70%, abdominal pain 54%, vomiting 45%, bloating 34%, early satiety 14%, constipation 35%, and associated heart burn or acid reflux 40% and weight loss 30%. Diabetes mellitus (DM type 1 and 2) were present in 25% patients, 30 % had cholecystectomy history and 37% carried a diagnosis of depression. A total of 42% (92) patients had DGE (mild = 53%, moderate = 31%, severe = 16%) and of these 33% had diabetic gastroparesis and rest had idiopathic gastroparesis. In univariate analysis presence of nausea, DM, chronic use of PPIs were significant predictors for delayed gastric emptying (DGE), however, in multivariate analysis there was no independent clinical variable that predicted DGE, Table 1. Similarly, in patients with DM no clinical predictors for presence of DGE were identified. The number of patients with moderate and severe delay in gastric emptying was comparable between diabetic gastroparesis and idiopathic gastroparesis patients: moderate 30% vs. 31% and severe 16% vs. 18 %, respectively. Conclusion: In a large cohort of patients presenting with varied gastrointestinal symptoms, there was no independent clinical factor that predicted gastroparesis. Future RCTs are needed to confirm these findings. Clinical parameters in patients with delayed and normal gastric emptying

W1182 Does Small Intestinal Bacterial Overgrowth Affect pH Readings as Recorded by Wireless Motility Capsule Technology in the GI Tract

584] where P0 was a normal exam, P1 a finding of questionable relevance, and P2 a findings of significant clinical relevance (including blood in the lumen). We classified findings as normal examination, AVMs, blood in the lumen without a source visualized, ulcerations, strictures, red spots, definite mass, submucosal lesion, abnormal mucosa, and other findings. If more than one lesion was found on the examination, we classified the study using the most significant clinical lesion. We determined location of the finding as proximal or distal small bowel based on small bowel transit time. We did not consider gastritis or duodenitis as significant findings. Results: We enrolled 624 VCE studies, 119 performed on inpatients, and 505 as outpatient exams. Data is shown in the Table. Gastric transit time, gastric capsule retention, and incomplete small bowel studies were more likely to occur in inpatients. Inpatient studies were more likely to reveal significant lesions including AVMs and blood. Conclusions: There were more incomplete studies on inpatients despite a higher rate of endoscopic placement. Despite the incomplete study rate, there was a higher diagnostic yield. Comparison of Inpatient and Outpatient VCE Studies

Restorative impact of rabeprazole on gastric mucus production impairment during Naprosyn administration: its potential clinical significance

Restorative impact of rabeprazole on gastric mucus production impairment during Naprosyn administration: its potential clinical significance

Profoundly diminished gastric mucus production during Naprosyn administration as a potential factor contributing to mucosal injury

Profoundly diminished gastric mucus production during Naprosyn administration as a potential factor contributing to mucosal injury