165

LONG-TERM FOLLOW UP OF CARDIA INTESTINALMETAPLASIA (CIM) AND CARDIA DYSPLASIAChristian Clark, M.D., Prateek Sharma, M.D., Daniela Mitreva, M.D.,S.F. Jafri, M.D., S. Mathur, M.D., Allan P. Weston, M.D.*. VAMC,Kansas City, MO and University of Kansas School of Medicine, KansasCity, KS.

Purpose: Esophageal adenoCA develops over a period of years fromchronic GERD through a well-delineated, sequential step-wise pathway.This tumor shares many demographic and clinical features of GEJ/cardiaadenoCA. It is unclear if CIM and dysplasia are histologic precursor lesionsfor GEJ/Cardia cancer.Aim: The purpose of this study was to characterize histologic changeswithin the cardia in a cohort of patients with known CIM or cardiadysplasia followed prospectively long-term.Methods: An electronic database of over 1000 pts in whom cardia bx havebeen obtained has been assimilated. Cardia bx (4) were taken from theanatomic cardia. The junction of tubular esophagus and saccular cardia wasdetermined by well described endoscopic techniques. Cardia bx were fixedin formalin or Bouins solution, embedded in paraffin, step-serial sectioned,and stained with either HE/Alcian blue pH2.5 or PAS/Alcian blue pH 2.5stains. Grading of cardia histology per modified Sydney scoring classifi-cation. From this database, pts in whom CIM was initially ID and who havesubsequently undergone at least one f/u EGD 1 or more yrs later wasexamined. Cardia histology on most recent bx was compared in a blindedfashion to intial cardia bx. Cardia LGD and HGD readings requiredindependent confirmation by a 2nd pathologist. Hp status was determinedbased upon 4 antral and 2 body bx using either a modified Giemsa stain orSteiner’s Silver stain.Results: Of 1050 pts with cardia bx, 125 pts had CIM ID with 52 of thesepts having histologic f/u of at least 1year. All pts were males except onewith a mean age of 65.1�11.5. Race — white:black:other – 43:6:3. LGDwas noted in 11 (22%) pts and HGD in 1 (2%). Grading of Cardia IMinitially 1 in 13 (25%), 2 in 38 (73%) and 3 in 1 (2%). Hp was noted in only21 pts (41%). Length of f/u ranges from 1 to 9 years (3.5�2.2 yrs). Duringthis f/u, 7 Hp� pts were tx; 44 pts were tx with PPIs and 8 with H2blockers. Cardia IM grade remained unchanged in 21 pts (40%), worsenedin 8 (15%) and improved in 23 (44%) [with 20 of these pts harboring noCIM]. The incidence of cardia LGD was 4%. Cardia HGD persisted duringf/u. Cardia LGD resolved in 8 and persisted in 3.Conclusions: Incidence of Cardia dysplasia is low and the vast majority ofCIM pts had either stable or marked improvement of CIM during f/u.Improvement in CIM was significantly correlated with those pts tx withPPIs.

166

EFFECT OF PROSTOGLANDIN INHIBITION WITHKETOROLAC ON GASTRIC ACTIVITY AND DYSPEPTICSYMPTOMS IN PATIENTS WITH DYSPEPTIC SYMPTOMSHrair P. Simonian, M.D., Henry P. Parkman, M.D., FACG*. TempleUniversity School of Medicine, Philadelphia, PA.

Purpose: Gastric myoelectric abnormalities are found in up to 40% ofpatients with functional dyspepsia. Electrogastrography (EGG) providesinformation on the frequency and regularity of gastric myoelectric activity.The prostaglandin inhibitor indomethacin has been suggested to convertgastric tachygastria to a normal rhythm. The aim of this study was todetermine if intravenous administration of the nonsteroidal antiinflamma-tory agent (prostaglandin inhibitor) ketorolac (Toradol) can improve gastricdysrhythmias and improve symptoms in patients with refractory dyspepsia.Methods: Twelve normal subjects (3 males, 9 females. Mean age: 32�3years) and 22 dyspeptic patients (5 males, 17 females. Mean age: 37�3years) were studied. Multichannel EGG recording was used to assessgastric slow wave frequency, regularity, and coupling. Fasting multichan-nel EGG (Medtronic Polygraf ID EGG system) was recorded for 60

minutes, followed by ingestion of an egg sandwich meal with 4 oz. oforange juice and postprandial EGG recording for 120 minutes. This wasfollowed by placebo injection of normal saline, followed in 15 minutes byketorolac 15 mg IV. EGG recording was obtained for another 60 minutes.Symptoms were assessed throughout the study.Results: In the normal subjects, IV ketorolac had no effect on the EGGparameters of dominant frequency and in the percent time in the normal2–4 cpm rhythm. However, there was a decrease in the power of thedominant frequency decreased from 48�2 dB to 46�2 (p�0.05) and adecrease in the average percent slow wave coupling decreased from 77�4to 73�4% (p�0.06). In the 22 dyspeptic patients overall, there was nosignificant changes in the EGG parameters. Interestingly, 7 of the 22patients had a decrease in symptoms (primarily nausea, abdominal pain,and bloating) after ketorolac administration from a symptom score of 10�2to 8�1 (p�0.05). In these patients, there was a decrease in the EGGdominant frequency from 3.2�0.1 to 2.8�0.1 (p�0.05) and an increase inthe power of the dominant frequency from 42�2 to 44�2 (p�0.07). In the15 patients that did not have symptom improvement with IV ketorolac,there were no significant EGG changes.Conclusions: In some patients with refractory dyspepsia, intravenous ke-torolac administration can improve symptoms and affect gastric myoelec-tric activity. This suggests that prostaglandin inhibition may be helpful insome dyspeptic patients with abnormal gastric myoelectric activity.

167

DELAYED GASTRIC EMPTYING IN GASTROESOPHAGEALREFLUX DISEASE: REASSESSMENT WITH NEWMETHODOLOGIES AND CLINICAL CORRELATIONSDaniel Buckles, M.D., Irene Sarosiek, M.D., Celia Gonzalez,Chris McMillin, Richard McCallum, M.D.*. Kansas UniveresityMedical Center, Kansas City, KS and Kansas University MedicalCenter, Kansas City, KS.

Purpose: Previous studies have shown that patients with GERD haveslower rates of gastric emptying than controls, but the prevalence hasdiffered due to variations in methodology. The recent establishment ofinternational control values for scintigraphic gastric emptying assessmentmakes standardization of this technique possible (Tougas, et al). It wouldalso be useful to know if specific gastrointestinal symptoms predicteddelayed gastric emptying in GERD and if the prevalence of delayedemptying is altered by anti-reflux surgery.Methods: Forty-nine patients (mean age 42.9 years, range 24–65 years, 35women 14 men) who were diagnosed with GERD in the previous twelvemonths were given a standardized 280 kcal 99Tc-labeled low fat meal (eggbeater). Percent intragastric residual content was recorded at baseline andat hourly intervals for 240 minutes by scintigraphy. Patients were alsoasked about the presence of dyspepsia (bloating, postprandial discomfort orbelching, or early satiety), dysphagia, or regurgitation. Gastric emptyingtimes were also performed before and after laparoscopic Nissen fundopli-cation surgery on 16 patients with documented GERD.Results: Sixteen patients (33%) had intragastric residual contents greaterthan the 95th percentile (�40%) at 120 minutes, and thirteen (26%) hadabnormal results at 240 minutes (�6%). Diabetic patients accounted foronly 4 patients with delayed 120 minute gastric emptying and 5 withdelayed 240 minute emptying. Dyspepsia was present in all patients.Regurgitation and dysphagia were common (present in approximately 80%and 40% of patients, respectively) and the prevalence of these symptomsdid not differ between patients with normal versus delayed gastric empty-ing. Six out of 16 patients (37.5%) had delayed gastric emptying prior tofundoplication surgery and the prevalence was unchanged post-surgically.Also, mean 240 minute intragastric residual was not significantly differentafter surgery when compared with before surgery (19.75% vs 11.94%).Conclusions: Using standardized techniques: 1. Delayed gastric emptyingis common in patients presenting with GERD at both 120 and 240 minutesafter ingestion of a solid meal; 2. Symptomatology alone is not a usefulpredictor of this pathophysiology; and 3. Contrary to previous studies,

S58 Abstracts AJG – Vol. 98, No. 9, Suppl., 2003