S. Emerenziani

Intercellular space diameters of the oesophageal epithelium in NERD patients: Head to head comparison between light and electron microscopy analysis

BACKGROUND Dilation of intercellular space diameters of oesophageal epithelium detected at transmission electron microscopy morphometry is a marker of tissue injury in non-erosive reflux disease patients. Semi-quantitative evaluation of intercellular space diameters using light microscopy seems to provide promising results. AIM/METHODS To comparatively evaluate intercellular space diameters in the same patients, by means of morphometry and semi-quantitative analysis, both on light microscopy and transmission electron microscopy microphotographs, biopsies were taken in 29 non-erosive reflux disease patients at distal and proximal oesophagus. Twelve asymptomatic controls underwent the same protocol. RESULTS Morphometric analysis on transmission electron microscopy microphotographs showed mean intercellular space diameter values of patients, at distal and proximal oesophagus, 3- and 2-fold, respectively, higher than those in controls (p<0.001). On light microscopy microphotographs, mean intercellular space diameter values of patients at distal oesophagus were higher than those in controls, an overlap between patients and controls being observed. The semi-quantitative score was positive in 79% of patients and in 25% of controls at distal esophagus. CONCLUSIONS Intercellular space diameter morphometric analysis at light microscopy is widely available, allows intercellular space diameter to be quantitatively measured with good sensitivity and specificity and could represent a useful tool in non-erosive reflux disease diagnosis. Despite satisfactory sensitivity, the semi-quantitative score at light microscopy is hampered by much lower specificity than transmission electron microscopy- and light microscopy-morphometry.

Nutritional status and bioelectrical phase angle assessment in adult Crohn disease patients receiving anti-TNFα therapy

BACKGROUND Altered body composition is frequently observed in Crohns disease (CD) patients. AIMS To investigate the nutritional status, and the effect of different therapeutic regimes in adult CD patients. METHODS Fat free mass (FFM) and BIA-derived phase angle (PhA) were assessed in 45 CD patients, 22 on conventional therapy (CT) and 23 on maintenance therapy with infliximab (MT). Nutritional status was also assessed in 12 CD patients before and following the induction protocol with infliximab. BIA data of CD patients were compared with those of 20 healthy asymptomatic volunteers. In CD patients C Reactive Protein (CRP) and albuminaemia dosage were obtained. RESULTS The mean values of PhA and of FFM were significantly lower in CT patients when compared with control group and MT patients. Following infliximab treatment FFM increased, although not significantly, while mean phase angle value significantly increased from 4.6±0.3 to 6.2±0.4 (p<0.05). CRP was significantly lower in MT patients compared to that in CT patients. CONCLUSION CD patients on conventional therapy showed a lower FFM and a lower mean phase angle score compared to those on infliximab therapy. Following infliximab treatment the mean phase angle score normalized. PhA is a reliable nutritional indicator in IBD patients and could be considered as an additional tool for assessing response to treatment.

P.19.3 ESOPHAGEAL HIGH RESOLUTION MANOMETRY FINDINGS DO NOT CORRELATE WITH CLEARANCE OF GASTRO-ESOPHAGEAL REFLUX IN GERD PATIENTS

Ineffective esophageal motility (IEM) has been observed in erosive and non-erosive reflux disease (NERD) patients and may account for delayed bolus transit and impaired esophageal reflux clearance. It has been demonstrated that conventional manometry findings cannot predict reflux clearance in GERD patients. High resolution manometry (HRM) allows an accurate analysis of esophageal motility. Distal contractile integral (DCI) integrates the length, contractile vigour, and duration of contraction of the first two segments of the distal esophagus. Aim: To assess the correlation between HRM findings and reflux clearance in GERD patients. Methods: Following a 3-week washout from PPI and/or H2 antagonists, HRM and 24-hour ambulatory multichannel pH-impedance (pH-MII) monitoring were performed in 37 consecutive GERD patients, with no evidence of hiatal hernia at endoscopy. Patients were analyzed in the supine position, a catheter with 36 solid state pressure sensors located at 1 cm intervals (MMS, HRIM, Enschede, The Netherlands) was used. Data were stored and analyzed using dedicated software. A total of 10 saline (5 ml) swallows, at 30sec intervals were analyzed in each subject. The pH-impedance assembly was positioned with the pH electrode at 5cm above the LES and impedance measuring segments at 3, 5, 7, 9, 15 and 17cm above LES (Sandhill Scientific, USA). Reflux episodes were classified according to standardized criteria. Mean reflux clearance time (RCT) and reflux exposure time (RET) were calculated using Bioview software analysis, after a manual analisys of each pH-MII tracing. DCI was calculated and correlated to RCT and RET values by means of linear regression analysis. HRM tracings were analyzed according to the Chicago classification. IEM was defined by the presence of hypothensive or absent peristaltic waves in >20% of deglutitions. Results: Of the 37 patients, 30 showed normal esophageal motility and 7 IEM. Mean DCI values were 1562 (95% CI, 1203-1921) mmHg*s−1*cm−1 in all patients and 182 (95% CI, 122-242) mmHg*s−1*cm−1 in the 7 patients with IEM (p<0.001). Mean RCT and RET were 12.2 sec. and 3.6% of total recording time in all 37 patients, 13.5 sec. and 6.5% in the 7 IEM patients. No correlation was found between DCI and mean RCT and RET (r= 0.3 and 0.25, respectively). Weak correlation was found between DCI and mean RCT in the subgroup of IEM patients (r= 0.65, p<0.05). Conclusions: failure of esophageal motility seems to play a weak role in the clearing of gastroesophageal reflux episodes. DCI is not correlated to impaired esophageal reflux clearing whose occurrence could depend on the balance between the magnitude of the motility weakness and of the flow resistance at esophago-gastric junction.

IN PPI-RESISTANT NERD PATIENTS, THERAPY FURTHER ENHANCES SENSITIVITY TO REMAINING ACIDIC REFLUX, WHICH IS ALSO INVOLVED IN PERCEPTION OF WEAKLY ACIDIC REFLUX EPISODES

BACKGROUND: The incidence of gastroesophageal reflux diseases has been reported to increase significantly in western populations in recent decades. However, data from Asian populations are still scarce. There is also a widespread notion that obesity may increase the risk of gastroesophageal reflux diseases. To provide additional data on prevalence of gastroesophageal reflux symptoms and investigate the association between obesity and abdominal obesity and gastroesophageal reflux symptoms, we performed this cross-sectional study in the Taizhou retiree cohort. METHODS: Taizhou cohort study phase II (retiree cohort) was started from December of 2007. A questionnaire about gastroesophageal reflux symptoms was added since September of 2008. After physical examination, the trained interviewers asked the participants whether or not they suffered with heartburn or acid regurgitation in the last 12 months, and if yes, the severity and frequency of the symptoms. Weight, height, waist and hip circumference were measured after questionnaire interview. Odds ratios (OR) with 95% confidence intervals (CI) were derived from logistic regression models. RESULTS: 3140 retiree aged 42 to 93 completed the questionnaire and physical examination. In total 67 (2.13%) reported the symptoms occurring at least once a week within the last 12 months before the interview. There was a tendency of decreasing prevalence of the symptoms with increasing age. For the age group 40-49, 50-59, 60-69, 70-79, and 80+, the prevalence rates were 4.41%, 2.62%, 2.05%, 1.41%, and 0.82%, respectively. Compared with subjects with normal weight, overweight subjects (BMI 25.1-27.9 kg/m2) had an age-adjusted OR of 1.60 (95%CI 0.71-3.62) of developing the symptoms and the corresponding ORwas 1.14 (95%CI 0.53-2.47) for obese subjects (BMI>28kg/m2). Similarly, waist to hip circumference ratio or waist alone did not show any significant association with the symptoms. There was also no significant association between gender, education, smoking habit, alcohol intake, tea and coffee and the occurrence of reflux symptoms. CONCLUSIONS: Compared with western populations, the prevalence of gastroesophageal reflux symptoms in this retiree cohort is low, and its occurrence is independent of obesity or abdominal obesity.