1. Healthcare

Journal of
Neurogastroenterology and Motility
February, 2015
Volume 21 Supplement 2
February 6, 2015
Official Journal of
Indian Motility and Functional Disease Association
Japanese Society of Neurogastroenterology and Motility
Chinese Society of Gastrointestinal Motility
Korean Society of Neurogastroenterology and Motility
Thai Neurogastroenterology and Motility Society
10:30-11:20
Session I: Esophageal disorder
11:20-12:10
Session II: Lower GI disorder
12:30-13:20
Session III: Post-infectious bowel dysfunction
Doctor, I have heartburn and dysphagia but the disease is yet undiagnosed
Constipation, bloating but no abdominal pain: Do I have IBS or something else?
Chronic small volume diarrhoea, abdominal pain and bloating after
an episode of acute gastroenteritis: Are we missing something?
13:20-14:10Lunch
14:10-15:10
Session IV: A patient with GERD with nocturnal symptoms while on PPI
Doctor, I am on PPI for GERD but continue to have symptoms at night
15:10-15:40
15:40-16:10
16:10-16:30 16:50-18:50 17:00-18:30
19:00-20:00 Session V: Pathophysiology of functional bowel disease:
Looking beyond the conventional
Session VI: An overview of therapy of IBS for clinicians
Session VII: Role of endoscopy in gastrointestinal motility disorders
Session VIII: Covidien dinner Symposium/workshop on technique and interpretation of manometry
Technical review on small intestinal bacterial overgrowth in IBS for
Indian SIBO IBS Task Force Members only
J Neurogastroenterology & Motility Editorial Board Meeting at the
Board Room of Hyatt Regency hotel for Editorial Board Members only
JNM Journal of Neurogastroenterology and Motility
JNM
Session I: State of the art lecture & selected oral paper session
Session II: Symposium on motor dysphagia
Session III: Rome-ANMA symposium
Tea Break (Presidential Poster Round by the judges; presenters must be present near the posters)
Session IV: Asian FGID symposium
Session V: Abbott Lunch Symposium: Chronic Constipation: East meets West in India
Lunch and poster round session
Session VI: Functional dyspepsia symposium
Session VII: Symposium on GERD
Session I: Presidential papers selected for oral presentation
Session II: Constipation symposium
Session III: ANMA-JNM symposium
Session IV: Gut-Microbiota symposium
Session V: Menarini Lunch Symposium: IBS and Pain
Lunch and poster round session
Session VI: Faecal incontinence symposium
Session VII: Megatrend in IBS
Session VIII: Micro-organic basis of IBS: Diet and inflammation
Session IX: Micro-organic basis of IBS: Microbiota-related
Session X: Valedictory function
February 2015
08:00-08:40 08:40:10:05 10:05-11:05 11:05-12:25
12:25-13:15 13:15-14:05
14:05-15:00 15:00-16:05 16:15-17:10 17:10-18:15 18:15-18:30 Vol. 21, Suppl. 2
South East Asia Gastro-Neuro Motility Association
Taiwan Neurogastroenterology and Motility Society
Asian Neurogastroenterology and Motility Association
February 8, 2015
JNM
Journal of
Neurogastroenterology
and Motility
th
February 6-8, 2015
Hyatt Regency Hotel,
Gurgaon, Delhi, India
Themes:
Neurogastroenterology &
Motility: From Science to
Application/Motiltiy Master Class
(Supported by an unrestricted educational grant from Eisai)
Session VIII: Therapeutics in functional bowel disease and motility disorders
Session IX: Symposium on FBD in children
Inaugural function and dinner
Impact factor 2.698
Biennial Congress of
the Asian Neurogastroenterology and
Motility Association in Conjunction With
3rd Biennial Conference of the Indian
Motility and Functional Diseases Association
February 7, 2015
08:00-08:30 08:30-09:40 09:40-11:05 11:05-11:30
11:30-12:30 12:30-14:15 13:25-14:15
14:15-15:30 15:45-17:00 17:15-18:15 18:15-18:55 20:00 onward pISSN: 2093-0879
eISSN: 2093-0887
www.jnmjournal.org
Organized by
Asian Neurogastroenterology & Motility Association
Indian Motility & Functional Diseases Association
Endorsed by
Indian Society of Gastroenterology
The Rome Foundation
www.anmaindia.in
Organizing Secretariat
Department of Gastroenterology
Sanjay Gandhi Postgraduate Institute of Medical Sciences
Lucknow, India
2015
February Volume 21 Supplement 2
‣‣ ANMA
Program
2015 India
4th Biennial Congress of the Asian Neurogastroenterology and Motility Association
3rd Biennial Conference of Indian Motility and Functional Diseases Association
February 6th, 2015
Motility Master Class (Supported by an unrestricted educational grant from Abbott Established Pharmaceuticals, Global HQ)
Moderators: Dr. Nitesh Pratap, Dr. Samir Mohindra
10:30-11:20
Session I: Esophageal disorder
Doctor, I have heartburn and dysphagia but the disease is yet undiagnosed
Chair: Prof. Hidekazu Suzuki, Prof. Faruque Ahmed
40 mins
Case presentation
Analysis
Prof. Ching-Liang Lu
Investigations: technique & interpretation
Management
11:10-11:20
11:20-12:10
Dr. Abhai Verma
Prof. Uday C Ghoshal
Prof. Joon Seong Lee
Question answer session
Session II: Lower GI disorder
Constipation, bloating but no abdominal pain: Do I have IBS or something else?
Chair: Prof. Young-Tae Bak, Prof. Rakesh Tandon
40 mins
Case presentation
Analysis
Dr. Suvadip Chatterjee
Prof. Yeong Yeh Lee
Investigations: technique & interpretation
Management
Prof. Justin Wu
Prof. Ari Fahrial Syam
12:00-12:10
Question answer session
12:10-12:30
Tea Break
Moderators: Dr. Abhai Verma, Dr. Akash Shukla
12:30-13:20
Session III: Post-infectious bowel dysfunction
Chronic small volume diarrhoea, abdominal pain and bloating after an episode of acute
gastroenteritis: Are we missing something?
Chair: Prof. Usha Dutta, Dr. Karmabir Chakraborty
40 mins
Case presentation
Analysis
Dr. Golam Kibria
Prof. Kok-Ann Gwee
Investigations
Dr. Sanjeev Sachdeva
Management
Prof. VA Saraswat
13:10-13:20
Question answer session
13:20-14:10
Lunch Break
Indian Motility & Functional Diseases Association (IMFDA) Gorverning Council
Meeting for IMFDA GC Members at the Board Room of Hyatt Regency Hotel
Program
Moderators: Dr. Rakesh Kalapala, Dr. Ashish Sethi
14:10-15:10
Session IV: A patient with GERD with nocturnal symptoms while on PPI
Doctor, I am on PPI for GERD but continue to have symptoms at night
Chair: Prof. Kentaro Sugano, Prof. Philip Abraham
40 mins
Case presentation
Dr. Maneesh Paliwal
Analysis
Prof. Shobna Bhatia
Investigations: technique & interpretation
Dr. Nitesh Pratap
Management
14:50-15:00
15:00-15:10
Prof. Mahmud Hasan
Frequency, factors associated and clinical implication of nocturnal
acid breakthrough in patients with GERD: A review of literature
Prof. Deng-Chyang Wu
Question answer session
Moderators: Dr. Sanjeev Sachdeva, Dr. Sanjeev Khanna
15:10-15:40
Session V: Pathophysiology of functional bowel disease: Looking beyond the conventional
Chair: Prof. Minhu Chen, Prof. BS Ramakrishna
15:10-15:35
Sensitivity and perception in IBS: hypersensitivity or hyper-vigilance?
15:35-15:40
Question answer session
15:40-16:10
Prof. Ami Sperber
Session VI: An overview of therapy of IBS for clinicians
Chair: Prof. Giovanni Barbara, Prof. SP Mishra
15:40-16:05
Pharmacotherapy of IBS: A clinician's perspective
16:05-16:10
Question answer session
16:10-16:30
Prof. Sutep Gonlachanvit
Session VII: Role of endoscopy in gastrointestinal motility disorders
Chair: Prof. Hiroto Miwa, Prof. VA Saraswat, Dr. Samir Mohindra
16:10-16:25
Overview of application of current endoscopic technology
in diagnosis and therapy of GI motility disorders
16:25-16:30
Question answer session
16:30-16:50
Tea Break
Prof. Rakesh Kochhar
Moderators: Dr. Rajesh Sainani, Dr. Manoj Sharma
16:50-18:50
Session VIII: Covidien dinner Symposium/workshop on technique and interpretation of
manometry
Chair: Prof. Sanjiv Mahadeva, Dr. Abhai Verma, Prof. Shobna Bhatia
16:50-17:50
Esophageal manometry
Prof. Justin Wu
Chair: Prof. William Whitehead, Dr. Asha Misra
17:50-18:50
Anorectal manometry
19:00-19:30
J Neurogastroenterology & Motility Editorial Board Meeting for
Editorial Board Members at the Board Room of Hyatt Regency Hotel
19:30-20:30
Technical review on small intestinal bacterial overgrowth in IBS for
Indian SIBO IBS Task Force Members only at the Board Room of Hyatt Regency Hotel
20:30-22:00
Dinner
Prof. Uday C Ghoshal
Program
February 7th, 2015
Moderators: Dr. Asha Misra, Dr. Suvadip Chatterjee
08:00-08:30
Session I: State of the art lecture & selected oral paper session
Chair: Dr. Jane Campos, Dr. Pardeep Kumar
08:00-08:20
Role of the GI tract in the control of food intake
08:20-08:30
An Epidemiological Study on Esophageal Symptoms by Rome III
Criteria in an Asian Rural Population: Prevalence and Risk Factors
(Selected oral paper)
Authors: Mohammed Masudur Rahman, Uday C Ghoshal, Md. Golam Kibria,
AHM Rowshon, Faruque Ahmed, Nigar Sultana, Mahmud Hasan
Presenting author: AHM Rowshon
08:30-09:40
Prof. Jan Tack
Session II: Symposium on motor dysphagia
Chair: Prof. Xiaohua Hou, Prof. V Jayanthi
08:30-08:45
Spectrum of disorders associated with motor dysphagia
08:45-09:00
High resolution esophageal manometry in diagnosis of
motor dysphagia using Chicago classification: A new horizon
Prof. Young-Tae Bak
Dr. Rajesh Sainani
09:00-09:15
Management of Achalasia cardia: The past, the present and the future
09:15-09:30
Question answer session
09:30-09:40
Effect of peroral esophageal myotomy on
esophageal dynamics in achalasia patients
(Selected oral presentation)
(10 mins =
7 + 3)
Prof. Joon Seong Lee
Authors: Hu Yue, Lu Bin, Li Meng, Chu Li
Presenting author: Hu Yue
Moderators: Dr. Arun Khanduri, Dr. Sunil Baran Das Chakraborty
09:40-11:05
Session III: Rome-ANMA symposium
Chair: Prof. Douglas Drossman, Prof. Sutep Gonlachanvit
09:40-09:50
Rome Foundation: its mission organization and activity
09:50-10:10
The Rome process for development of diagnostic criteria and
management algorithm in FGID: An overview
10:10-10:30
Global issues in FGID: How do regional epidemiological
differences may affect diagnosis and management?
Prof. Douglas Drossman
Prof. William E Whitehead
Prof. Ami Sperber
10:30-10:50
Rome IV system on multi-dimensional clinical profile (MDCP) in FGID:
How will it benefit patient management in future?
Prof. Douglas Drossman
10:50-11:05
Question answer session
11:05-11:30
Tea Break (Presidential Poster Round by the judges;
presenters must be present near the posters)
Program
Moderators: Dr. Sunil Dadhich, Dr. Sujit Choudhury
11:30-12:30
Session IV: Asian FGID symposium
Chair: Prof. Kok-Ann Gwee, Prof. Ching-Liang Lu
11:30-11:40
Translation and validation of Asian Rome III questionnaires
11:40-11:50
Translation and validation of Bengali Rome III questionnaires Dr. Mohammed Masudur Rahman
11:50-12:05
Report on Asian Lower FGID
Prof. Uday C Ghoshal
12:05-12:20
Report on Asian Upper FGID
Prof. Justin Wu
12:20-12:30
Question answer session
12:30-14:15
Dr. Nitesh Pratap
Session V: Abbott Lunch Symposium: Chronic Constipation: East meets West in India
Chair: Prof. Varghese Thomas, Prof. Uday C Ghoshal
12:30-12:35
Opening remarks
12:35-12:55
Diagnosis and treatment of chronic constipation - an European perspective
12:55-13:15
Management of Chronic Constipation in Asian and Indian perspective
13:15-13:25
Question answer session
13:25-14:15
Lunch and poster round session
Prof. Jan Tack
Prof. Kok-Ann Gwee
Moderators: Dr. Omesh Goyal, Dr. SK Tyagi
14:15-15:45
Session VI: Functional dyspepsia symposium
Chair: Prof. Nayoung Kim, Dr. Rupesh Chaturvedi, Dr. TS Chandrasekhar
14:15-14:30
Epidemiology of FD: East versus West
14:30-14:45
Management of FD: Still a challenge
14:45-15:00
H. pylori in FD: The controversy and the consensus
Prof. Kentaro Sugano
15:00-15:15
FD and GERD overlap: Implication in diagnosis and management
Prof. Ching-Liang Lu
15:15-15:30
FD and IBS overlap: Implication in diagnosis and management
15:30-15:45
Question answer session
15:45-17:00
Prof. Sanjiv Mahadeva
Prof. Michio Hongo
Prof. Govind Makharia
Session VII: Symposium on GERD (Supported by an unrestricted educational grant from Eisai)
Chair: Prof. Sutep Gonlachanvit, Dr. Chetan Bhatt
15:45-16:00
Diagnosis of GERD: The recent advances
16:00-16:15
Therapeutic approach to GERD: Pharmacological options
16:15-16:30
Future trends in management of GERD
16:30-16:45
On-demand treatment of GERD: Worth or worthless?
16:45-17:00
Question answer session
17:00-17:15
Tea Break
Prof. Xiaohua Hou
Prof. Shobna Bhatia
Dr. Rupa Banerjee
Prof. Sutep Gonlachanvit
Program
Moderators: Dr. Mahesh Gupta, Dr. Umang Rathi
17:15-18:15
Session VIII: Therapeutics in functional bowel disease and motility disorders
Chair: Prof. Sanjiv Mahadeva, Prof. Rakesh Kochhar, Prof. Om Prakash Singh
17:15-17:27
Serotonin and its modulators in management of FBD
17:27-17:39
Psychotropic drugs in management of FBD
17:39-17:51
Prokinetics in management of FGIDs
17:51-18:03
Antispasmodic in management of FBD
17:03-18:15
Question answer session
18:15-18:55
Prof. Hiroto Miwa
Prof. Douglas Drossman
Prof. EM Quigley
Prof. Giovanni Barbara
Session IX: Symposium on FBD in children
Chair: Prof. Shaman Rajindrajith, Prof. Kaustav Nayek
18:15-18:25
Functional dyspepsia in children
Prof. Shaman Rajindrajith
18:25-18:35
Spectrum of chronic constipation in children
18:35-18:45
Hirschsprung's disease in children: diagnosis and management
18:45-18:55
Question answer session
18:15-19:30
ANMA Governing Council Meeting for ANMA GC Members only at
the Board Room of Hyatt Regency Hotel
Prof. SK Yachha
Dr. Anshu Srivastava
20:00 Onward Inaugural function and dinner
February 8th, 2015
08:00-08:40
Session I: Presidential papers selected for oral presentation
(5 min for each presentation, 2 min for Q&A)
Moderators: Dr. Seshadri, Dr. Nitin J Joshi
08:40-10:05
Session II: Constipation symposium
Chair: Prof. Joon Seong Lee, Dr. Ari Fahrial Syam, Prof. Adarsh Chaudhary
08:40-08:55
Management of refractory chronic constipation : A clinician's perspective
08:55-09:10
Functional constipation and IBS-C: Are thes different entities?
09:10-09:25
Diagnostic work-up of refractory chronic constipation
09:25-09:40
ANMA chronic constipation tool
09:40-09:55
Surgery in chronic constipation
09:55-10:05
Question answer session
10:05-11:05
Prof. Minhu Chen
Prof. Philip Abraham
Dr. Sanjeev Sachdeva
Prof. Yeong Yeh Lee
Prof. Ashok Kumar
Session III: ANMA-JNM symposium
Chair: Prof. Nayoung Kim, Prof. G Choudhuri, Prof. Tamal Ghosh
10:05-10:25
Major publications in FGID and Neurogastroenterology from the West
10:25-10:45
Major publications in FGID and Neurogastroenterology from the East
Prof. Hidekazu Suzuki
Prof. Nayoung Kim
Program
10:45-10:55
Question answer session
10:55-11:05
Tea Break
Moderators: Dr. Rupesh Chaturvedi, Dr. Sanjay Jain
11:05-12:25
Session IV: Gut-Microbiota symposium
Chair: Prof. Hyojin Park, Dr. Dipanker Ghosh
11:05-11:20
Evaluation of Gut microbiota: Culture, genome and metabolome
11:20-11:35
Dysbiosis and Functional bowel disease: The new kid on the block
11:35-11:50
Microbiome, enteroendocrine signalling and brain function:
Spreading beyond the gut
11:50-12:05
Dr. Ujjala Ghoshal
Prof. BS Ramakrishna
Prof. Giovanni Barbara
Therapeutic modulation of Gut-microbiota: antibiotic,
probiotic and fecal transplantation
Prof. EM Quigley
12:05-12:15
Question answer session
12:15-12:25
Recurrence of Small Intestinal Bacterial Overgrowth (SIBO) after successful
antibiotic therapy in patients with Irritable bowel syndrome (IBS): Frequency and Predictors
(Selected oral presentation)
Authors: Alok Sangam, Ashok Dalal, K Arivarasan,
Sanjeev Sachdeva, AS Puri
Presenting author: Alok Sangam
(10 mins =
7 + 3)
12:25-14:05
Session V: Menarini Lunch Symposium: IBS and Pain
Chair: Dr. VG Mohan Prasad, Prof. Uday C Ghoshal
12:25-12:45
Pathogenesis of Pain in IBS: The current understanding
Prof. Kok-Ann Gwee
12:45-13:05
Management of pain predominant IBS: A Clinician's perspective
13:05-13:15
Question answer session
13:15-14:05
Lunch and poster round session
Prof. Giovanni Barbara
Moderators: Dr. Sanjeev Sachdeva, Dr. AHM Rowshon
14:05-15:00
Session VI: Faecal incontinence symposium
Chair: Prof. Robin Spiller, Dr. Ajay Kumar
14:05-14:20
Investigating fecal incontinence: How much and why?
14:20-14:35
Fecal incontinence: Pathophysiology and non-surgical treatment
14:35-14:50
Surgical management of FI
14:50-15:00
Question answer session
15:00-16:05
Dr. Kasaya Tantiphlachiva
Prof. William E Whitehead
Prof. Abhijit Chandra
Session VII: Megatrend in IBS
Chair: Prof. EM Quigley, Prof. Ami D. Sperber
15:00-15:15
Current perspective in IBS including its micro-organic basis
Prof. Kok-Ann Gwee
15:15-15:30
Low-FODMAP diet in management of IBS: Is there light at
the end of tunnel
Prof. Sutep Gonlachanvit
15:30-15:45
15:45-15:55
Mechanism of symptom improvement by dietary manipulation in
IBS including non-celiac gluten intolerance: Digging into the depth
Question answer session
Prof. Robin Spiller
15:55-16:05
(10 mins =
7 + 3)
16:05-16:15
Program
Abnormal intestinal permeability induced by acute stress: Interaction of
gut microbiota and adrenal gland (Selected oral presentation)
Authors: An-Ni Tsai, Ching-Liang Lu
Presenting author: An-Ni Tsai
Tea Break
Moderators: Dr. Dipankar Ghosh, Dr. Atul Sharma
16:15-17:10
Session VIII: Micro-organic basis of IBS: Diet and inflammation
Chair: Prof. Kok-Ann Gwee, Prof. AS Puri
16:15-16:30
Pathophysiological significance of mucosal permeability in IBS -possible
involvement of microbiota
Prof. Hiroto Miwa
16:30-16:45
Lactose intolerance and IBS: East versus West
Prof. Minhu Chen
16:45-17:00
IBS in patients with IBD: functional organic dichotomy revisited
Prof. Vineet Ahuja
17:00-17:10
Question answer session
17:10-18:15
Session IX: Micro-organic basis of IBS: Microbiota- related
Chair: Prof. Michio Hongo, Prof. VG Mohan Prasad
17:10-17:25
Methanogens, methane and constipation
17:25-17:40
PI-IBS: Challenging the functional basis of IBS
17:40-17:55
SIBO in IBS: The old wine in a new glass
17:55-18:05
Question answer session
18:05-18:15
Patients with irritable bowel syndrome, particularly constipation-predominant
type have more Methanobrevibacter smithii, which is associated with
higher methane production on lactulose hydrogen breath test (Selected oral presentation)
Authors: Ratnakar Shukla, Ujjala Ghoshal, Deepakshi Srivastava,
Tapan N Dhole, Uday C Ghoshal
Presenting author: Ratnakar Shukla
(10 mins =
7 + 3)
18:15-18:30
Prof. Hyojin Park
Prof. Robin Spiller
Prof. Uday C Ghoshal
Session X: Valedictory function
Chair: Prof. Sutep Gonlachanvit
18:15-18:30
Valedictory function
Prof. Uday C Ghoshal, Dr. Sanjeev Sachdeva, Dr. Dipankar Ghosh
Contact address: Prof. Uday C Ghoshal, President, Organizing Committee,
Dept. of Gastroenterology, SGPGI, Lucknow 226014, India ([email protected])
ANMA 2015 India
ANMA
The 4th Biennial Congress of Asian Neurogastroenterology and Motility Association
Selected Oral Presentations
23. Recurrence of Small Intestinal Bacterial Overgrowth After Successful Antibiotic Therapy in
Patients With Irritable Bowel Syndrome: Frequency and Predictors
S3
34. Effect of Peroral Esophageal Myotomy on Esophageal Dynamics in Achalasia Patients
S3
64. Patients With Irritable Bowel Syndrome, Particularly Constipation-predominant Type Have
More Methanobrevibacter smithii, Which Is Associated With Higher Methane Production on
Lactulose Hydrogen Breath Test
S4
82. An Epidemiological Study on Esophageal Symptoms by Rome III Criteria in an Asian Rural
Population: Prevalence and Risk Factors
S4
111. Abnormal Intestinal Permeability Induced by Acute Stress: Interaction of Gut Microbiota and
Adrenal Gland
S5
Selected Presidential Poster Presentations
4. New High-resolution Anorectal Manometry Parameter for Fecal Incontinence on the Basis of
a 3-dimensional Integrated Pressurized Volume of Spatiotemporal Plot: Comparison Between
the Female Patients With Fecal Incontinence and Asymptomatic Normal Control
S9
8. Fecal Evacuation Disorder Among Patients With Solitary Rectal Ulcer Syndrome:
A Case-control Study
S10
12. Effect of Biofeedback Therapy on Anorectal Physiological Parameters Among Patients With
Fecal Evacuation Disorder
S10
13. Influence of Obesity on the Prevalence of Laryngopharyngeal Reflux Disease
S11
22. Clinical Validation of c-PDR: Methodology for Accurate Non-invasive Detection of
Helicobacter pylori Infection
S11
24. Relationship Between Sub-classification of Functional Dyspepsia and Gastric Emptying
S12
26. Corticotropin-releasing Factor Impairs Tight Junctions by Mediating F-actin in Irritable Bowel
Syndrome
S13
32. The Effect of 5-Hydroxytryptamine 4 Receptor Agonist, YKP10811 on Postoperative Ileus in
Guinea Pig
S13
39. Reduction of Hydrogen Sulfide Synthesis Enzymes in Esophagus of Patients With Achalasia
S14
41. Long-term Outcome of Peroral Endoscopic Myotomy in Achalasia Cardia Based on The Sub
Types
S14
63. Genetic Chararecterization of Cryptosporidia in Patients With Hematological Malignancies and
Human Immunodeficiency Virus Infection
S15
66. Reduction of Breath Methane Using Rifaximin Shortens Colon Transit Time and Improves
Constipation: A Randomized Double-blind Placebo Controlled Trial
S15
78. Frequency and Risk Factors of Dyspepsia in a Rural Indian Population
S16
79. Does Chronicity Impact on The Severity of Functional Dyspepsia Symptoms?
S17
81. An Epidemiological Study on Functional Constipation by Rome III Criteria in an Asian Rural
Population: Overlap With Functional Dyspepsia and Psychological Stress
S18
83. Development, Translation and Validation of Enhanced Asian Rome 3 Questionnaires for
Diagnosis of Functional Bowel Diseases in Major Asian Languages: A Rome Foundation-Asian
Neurogastroenterology and Motility Association Working Team Report
S18
84. The Change in the Interstitial Cells of Cajal and Neuronal Nitric Oxide Synthase With Aging
in the Stomach of F344 Rat
S19
87. The Effects of YH12852 on the Experimental Model of Postoperative Ileus in Guinea Pig
S20
102. Treatment With Proton Pump Inhibitors Only Neutralizes Gastric Acid, but Rarely Effective in
Preventing Gastroesophageal Reflux: Preliminary Report of an Ongoing Study
S20
115. Gastrointestinal Manifestations of Systemic Sclerosis: Clinical and Investigative Study of 50
Patients
S21
Selected Poster Presentations
2. Composite Antropyloric Valve and Gracilis Muscle Transposition for Total Anorectal
Reconstruction: A Preliminary Report
S25
5. Clinical and Manometry Profile of Patients With Fecal Incontinence
S25
7. High-resolution Manometric Profile of Patients With Solitary Rectal Ulcer Syndrome
S26
9. Utility of High-resolution Anorectal Manometry in Children With Chronic Constipation
S27
10. Characteristics of Anorectal Dysfunction in Patients With Solitary Rectal Ulcer Syndrome:
Assessment by High-resolution Manometry
S27
11. Profile of Anorectal Manometry in Patients With Dyssynergic Defecation
S28
14. Endoscopic Management of Sphincter of Oddi Dysfunction: A Single Center Experience From
India
S28
16. Elevated Somatosensory Glutamate-Glutamine Levels in Functional Dyspepsia: Preliminary
Magnetic Resonance Spectroscopy Findings
S29
17. Gut Bacterial Infection Does Not Affect Experience-specific Memory
S29
18. Modulation of Gut-Brain Axis and Tryptophan Metabolism by Bacteria Associated With Small
Intestinal Bacterial Overgrowth-Irritable Bowel Syndrome
S30
19. Prevalence of Fructose Malabsorption in Patients With Irritable Bowel Syndrome After
Excluding Small Intestinal Bacterial Overgrowth
S30
21. Non-invasive Diagnosis of Small Intestinal Bacterial Overgrowth in Diarrhea-predominant
13
12
Irritable Bowel Syndrome Patients Using High-precision Stable CO2/ CO2 Isotope Ratios in
Exhaled Breath
S31
27. Gut-directed Hypnotherapy Is Superior to Drug Therapy in the Management of
Diarrhea-predominant Irritable Bowel Syndrome: A Randomized Controlled Study
S32
28. Psychological and Dietary Factors Exacerbate Symptoms of Irritable Bowel Syndrome
S32
29. Different Distribution and Changes in the Interstitial Cells of Cajal and Neuronal Nitric
Oxide Synthase With Age in the Proximal and Distal Colon of F344 Rat
S33
30. Brain-derived Neurotrophic Factor Induce the Plasticity of the Structure and the Function on
the Mice Colon Smooth Muscle Cells
S33
31. Brain-derived Neurotrophic Factor Contribute to Regulation of the Intestine Motility in
Functional Constipation
S34
33. Searching for a Definition for Refractory Constipation
S34
13. The Evaluation of Peroral Esophageal Myotomy for Achalasia
S35
37. Correlation Between High-resolution Manometry Metrics and Symptoms, Symptomatic
Outcomes of Peroral Esophageal Myotomy in Achalasia
S35
38. Study on Effects of Electrical Stimulation on Rabbit Esophageal Body Motility In Vivo
S36
40. Effectiveness of N-acetylcysteine on the Treatment of Achalasia
S37
43. Symptomatic and Manometric Spectrum of Esophageal Motility Disorders in a Tertiary Care
Institute in Northern India
S37
44. The Safety of Gastrointestinal Endoscopist Directed Flexible Endoscopic Evaluation of
Swallowing Study Is the Patient With Oropharyngeal Dysphagia
S38
45. Spectrum of Esophageal Motility Disorders on High-resolution Esophageal Manometry in
Children
S38
47. Surgery for Achalasia Cardia: One Time Treatment Modality in Develping Countries
S39
48. Multichannel Intraluminal Impedance-pH Monitoring Confirms Less Than 2.5 Hours
Dinner-bedtime Interval, Obesity Were Associated With Nocturnal Gastroesophageal Reflux
Other Than Age and Gender
S39
50. Efficacy and Safety of Pneumatic Dilatation for Achalasia
S40
51. Esophageal Motility in Patients With Corrosive Esophageal Stricture
S40
52. Classic and Vigorous Achalasia: Change From One Form to Another
S41
53. Etiological Spectrum of Motor Dysphagia as per Chicago Classification: Experience at a
Tertiary Center in Central India
S41
54. Esophageal Motility Abnormalities and the Influence on Esophageal Acid Exposure in
Patients With Gastroesophageal Reflux Disease
S42
55. Utility of Esophageal Manometry in Diagnosing Pediatric Gastrointestinal Motility Disorders
S42
57. Corticotropin-releasing Factor Changes the Phenotype and Function of Mouse Mesenteric
Lymph Nodes Dendritic Cells
S43
58. Characteristics of Mouse Mesenteric Lymph Nodes Dendritic Cells and Their Ability to
Secrete Corticotropin Releasing Factor
S43
59. Quantitative Determination of Selected fecal Microbiota in Patients With Irritable Bowel
Syndrome and Healthy Controls: An Evidence of Dysbiosis
S44
60. Markers of Gastric Acid Secretion (Pepsinogens and Gastrin-17) and Inflammatory Response
(IL-8) are Associated With Functional Dyspepsia Particularly in Absence of Helicobacter pylori
Infection
S44
61. Metronidazole-resistant Helicobacter pylori Is More Prevalent in Patients With Dyspepsia
S45
67. Constipation in India Differs From West by Both Stool Frequency and Form
S45
68. Impact of Memory Function in Patients With Irritable Bowel Syndrome
S46
69. Laparoscopic Ventral Mesh Rectopexy for Complete Rectal Prolapse: Intermediate-term
Results From a Tertiary Care Institute
S46
70. Functional Dyspepsia Is Associated With GN3 C825T Polymorphism: A Case-control Study
S47
72. The Aaccuracy of Symptom Recall in Elderly Patients With Functional Constipation
S47
73. Comparison of Rome III Diagnostic Criteria Versus Simple Symptom Based Approach in
Patients With Gastrointestinal Symptoms Presented at the General Medicine Clinic
S48
74. Profile of Patients With Common Functional Gastrointestinal Disorders Attending Out-patient
Clinic of a Medical College in Eastern India
S49
75. Prevalence of Anxiety and Depression in Irritable Bowel Syndrome
S49
76. Food Habit and Its Relation With Irritable Bowel Syndrome in North East Part Of Bangladesh
S50
77. Prevalence of Irritable Bowel Syndrome, Migraine and Co-existing Irritable Bowel
Syndrome-Migraine in Medical Students
S50
80. Defecation Frequency and Stool Form in a Rural Community in Bangladesh
S51
86. Long Pulse Gastric Electrical Stimulation Promotes Renovation of Interstitial Cells of Cajal
Related to Smooth Muscle Cells in the Stomach of Diabetic Rats
S51
90. A Disintegrin and Metalloproteases Expression in Functional Dyspepsia Patients With
Helicobacter pylori Infection
S52
92. Melatonin Protects Esophageal Epithelial Barrier via Suppressing the Transcription, Expression
and Activity of Myosin Light Chain Kinase Through ERK1/2 Signal Transduction
S52
93. Meta-analysis: The effect of Helicobacter pylori Eradication Therapy on The Development of
Gastroesophageal Reflux Disease
S53
95. Effects of Acupuncture on Esophageal Motility in Patients With Refractory Gastroesophageal
Reflux Disease
S53
97. Upper Esophageal Sphincter Function During Transient Lower Esophageal Sphincter
Relaxations in Gastroesophageal Reflux Disease Patients: Based on Impedance-High
Resolution Manometry Results
S54
99. Is There Any Correlation Between Gastroesophageal Reflux Disease and Atrial Fibrillation?
S54
100. Predictors of Long-term Proton Pump Inhibitor Use in Patients With Suspected
Laryngopharyngeal Reflux Who Responded to Proton Pump Inhibitor Therapy
S55
101. Non-cardiac Chest Pain With Normal Endoscopy: Role of Manometry and pH Recording in
Indian Setting
S55
103. Symptoms and Quality of Life in Patients With Gastroesophageal Reflux Disease and
Therapeutic Response to Rabeprazole
S56
104. Foods Reproducing Typical Gastroesophageal Reflux Disease Symptoms in Korea
S56
105. An Open Label, Non-randomized, Prospective Comparison of the Efficacy of Ilaprazole and
Esomeprazole in the Treatment of Gastroesophageal Reflux Disease
S57
106. Effect of Non Absorbable Antibiotic, Rifaximin in Patients With Irritable Bowel Syndrome: A
Single Centre Study
S58
108. Effect of DA-9701 on Visceral Pain in Rats
S58
109. Toll Like Receptors 4 and 5 but Not 2 mRNAs Are Over-Expressed in Colonic Biopsy Among
Patients With Irritable Bowel Syndrome
S59
110. Up-Regulations of Gastric TRPV Receptors and Decreased Serum Concentration of BDNF in
Patients with Functional Dyspepsia
S59
112. Regulation of Esophageal Epithelial-derived Cytokines by IL-33
S60
113. Prevalence and Symptoms Correlation of Lactose Intolerance in North East Part of
Bangladesh
S60
114. Gastrointestinal Motility Disturbances In Patients With Celiac Disease
S61
116. Motility Disturbances in Achalasia Cardia Are Wide Spread in Gastrointestinal Tract
S61
117. Intestinal Microsporidiosis in Renal Transplant Recipients: Prevalence, Predictors of
Occurrence and Genetic Characterization
S62
118. Polymorphisms of Toll Like Receptor 4 (Thr399Ile and Asp299Gly) and Toll Like Receptor 2
(196-174 Deletion) in Cryptosporidium Infection
S62
119. Translation and Validation of Enhanced Asian Rome 3 Questionnaires in Bengali Language
for Diagnosis of Functional Gastrointestinal Disorders
S63
120. Virulence Factors of Helicobactor pylori Among Patients With Functional Dyspepsia and
Peptic Ulcer in the Community: A Study by cagA and vacA Genotyping
S63
121. Characteristics of Neural Immunoreactive Staining of Serum Anti-enteric Neuronal Antibodies
in Patients With Irritable Bowel Syndrome and Its Clinical Significance
S64
122. Mitochondrial Neurogastrointestinal Encephalopathy: An Unusual Cause of Intestinal
Obstruction
S64
123. Effects of Postprandial Coffee Intake on the Rate of Gastric Emptying of Liquid and Solid
13
Meals: A Crossover Study Using C Breath Test
S65
124. Prevalence and Self-Recognition of Sonstipation in Japanese Population
S65
125. The Value of High Resolution Manometry in Patients Presenting With Gastroesophageal
Reflux Disease Symptoms With Normal Endoscopy and Negative 24 Hour pH-Impedance
Study
S66
126. pH Probe Placement in Children: Arithmetic Calculations Much Inferior to Esophageal
High-resolution Manometry
S66
127. Characteristics of Esophageal pH-Impedence Monitoring in Non-erosive Reflux Disease
Patients On and Off Protein Pump Inhibitor Therapy
S67
128. Characteristics of Multichannel Impedence With pH Metry in Refractory Gastroesophageal
Reflux Disease Patients On and Off Proton Pump Inhibitor Therapy in Indian Population
S67
129. Orocecal Transit Time in Gastrointestinal Diseases in Indian Patients
S68
131. Small Intestinal Bacterial Overgrowth and Orocecal Transit Time in Cirrhosis and
Non-cirrhotic Portal Hypertension
S68
132. Effects of Activin A on Duodenum of Denervated Rats: Roles of Myenteric Plexus, Interstitial
Cells of cajal and Smooth Muscle Cells
S69
133. Lactobacillus plantarum PS128 Ameliorated 5-Hydroxytrytophan-induced Visceral
Hypersensitivity in Rats
S69
134. Expression of Transient Receptor Potential Vanilloid Type 1 Receptors and
Electrophysiological Characteristics of Colon-specific Dorsal Root Ganglion Neurons in a Rat
Model of Colonic Visceral Hypersensitivity
S70
135. Perforation Following Pneumatic Dilation of Achalasia Cardia: A Retrospective Review of 11
Patients
S70
136. Vitamin-D Deficiency is Associated With Gallbladder Stasis Among Pregnant Women　S71
137. Vitamin D Supplementation Improves Gallbladder Ejection Fraction in Patients With
Gallstones
S71
138. Chicago Classification Parameters for Upright and Supine Position in Gastroesophageal
Disease: A Preliminary Report
S72
139. Relation Between Transition Zone and Distal Breaks in Symptomatic Gastroesophageal Reflux
Disease and Dysphagia: A Preliminary Report
S72
ANMA 2015 India
Selected Oral Presentations
ANMA 2015 India
Selected Oral Presentation
No. 23
No. 34
Recurrence of Small Intestinal Bacterial
Overgrowth After Successful Antibiotic
Therapy in Patients With Irritable Bowel
Syndrome: Frequency and Predictors
Effect of Peroral Esophageal Myotomy on
Esophageal Dynamics in Achalasia Patients
Hu Yue, Lu Bin, Li Meng, and Chu Li
First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou,
China
Alok Sangam, Ashok Dalal, K Arivarasan, Sanjeev Sachdeva, and A S
Puri
Department of Gastroenterology, GB Pant Hospital, New Delhi, India
Background/Aims: To investigate the effect of peroral esophageal
myotomy (POEM) on esophageal dynamics in patients with achalasia.
Methods: From January 2012 to March 2014, a total of 35 patients
with achalasia received POEM at Endoscopic Center in the First
Affiliated Hospital of Zhejiang Chinese Medical University. Esophageal dynamics of all patients were evaluated by high-resolution manometry (HRM) system preoperatively and one months after peroral
endoscopic myotomy (POEM) the test was repeated. The characteristic of esophageal motility of the two tests were compared.
Results: After POEM, lower esophagus sphincter resting pressure
(LESP) decreased from 28.94 ± 18.70 to 16.02 ± 5.46 mmHg (P
＜ 0.001) and descend rate was 44.6%. 4-second integrated relaxation
pressure (4sIRP) decreased from 27.182 ± 14.636 to 12.222 ± 6.75
mmHg (P ＜ 0.001). LESP decreased from 23.000 ± 18.55 to 12.22
± 6.75% (P ＜ 0.05). Intrabolus pressure (IBP) decreased from
11.02 0± 5.36 to 4.91 ± 4.55 mmHg (P ＜ 0.001). Distal contractile
integral decreased from 2103.43 ± 1960.86 to 810.90 ± 1308.50
mmHg (P ＜ 0.05). Esophageal body distal amplitude (average
measurements at 3 cm and 7 cm above the lower esophageal sphincter)
decreased from 26.21 ± 19.11 to 19.23 ± 9.74 mmHg (P ＜ 0.05).
The variation value of Eckhard score between pre- and post-POEM
was correlation with the decline of 4s-IRP (r = 0.372, P = 0.036).
After POEM, a small segment of proximal esophageal peristalsis appeared in 2 patients but was below normal level.
Conclusions: POEM can improve esophagogastric junction relaxation and affect esophageal body contraction in patients with achalasia,
but can not restore normal esophageal peristalsis.
Background/Aims: Small intestinal bacterial overgrowth (SIBO)
has been implicated in pathogenesis of irritable bowel syndrome
(IBS). Rifaximin has emerged as a promising therapy for IBS, acting
primarily via eradication of SIBO. There is very limited data concerning recurrence of SIBO after successful antibiotic therapy. We aimed
to study frequency and predictors of recurrence of SIBO in patients
with IBS after successful treatment with rifaximin.
Methods: The study included 78 consecutive patients with IBS
(without constipation) affected by SIBO who were successfully treated
with oral rifaximin therapy (550 mg three times daily for 2 weeks).
SIBO was diagnosed on the basis of glucose hydrogen breath test
(GHBT) using 100 gm of glucose after an overnight fast. Patients
were retested for GHBT at 3 and 6 months after documentation of
GHBT normalization. Frequency and predictors of recurrence of
GHBT positivity were evaluated.
Results: Of 78 patients, 47 (60.3%) were males. Median age of
study subjects was 39 (19-74) years. Fourteen (14/78, 17.9%) and 31
(31/78, 39.7%) patients had recurrence of GHBT positivity at 3 and 6
months, respectively after successful rifaximin therapy. At univariate
analysis, age ＞ 60 years, chronic use of proton pump inhibitors (PPIs),
peak breath hydrogen concentration prior to rifaximin therapy of ＞ 25
ppm, Bristol stool form score ≥ 5, stool frequency ＞ 14/week, and abdominal bloating at presentation were associated with recurrence of
GHBT positivity. At multivariate analysis, chronic use of PPIs (OR,
4.28; 95% CI, 1.29-14.13), older age (OR, 5.17; 95% CI,
1.46-18.29) and Bristol stool form score ≥ 5 (OR, 3.43; 95% CI,
1.05-11.17) were independent predictors of recurrence of SIBO.
Conclusions: Recurrence of GHBT positivity was observed in substantial proportion of patients with IBS at 6 months after successful
treatment with rifaximin. Chronic use of PPIs, older age, and higher
Bristol stool form score were associated with recurrence of SIBO in
patients with IBS without constipation.
S3
ANMA 2015 India
Selected Oral Presentation
No. 64
No. 82
Patients With Irritable Bowel Syndrome,
Particularly Constipation-predominant Type
Have More Methanobrevibacter smithii,
Which Is Associated With Higher Methane
Production on Lactulose Hydrogen Breath
Test
An Epidemiological Study on Esophageal
Symptoms by Rome III Criteria in an Asian
Rural Population: Prevalence and Risk
Factors
1
1
1
Mohammed Masudur Rahman, Uday C Ghoshal, Md. Golam Kibria,
2
3
AHM Rowshon, Faruque Ahmed, Nigar Sultana, and Mahmud Hasan
1
Dhaka Medical College, Dhaka, Bangladesh; 2Sanjay Gandhi
Postgraduate Institute of Medical Sciences, Lucknow, India;
Shaheed Suhrawardy Medical College, Dhaka, Bangladesh; and
3
Bangladesh Medical Research Council, Dhaka, Bangladesh
2
Ratnakar Shukla, Ujjala Ghoshal, Deepakshi Srivastava, Tapan N
1
2
Dhole, and Uday C Ghoshal
Departments of 1Microbiology and 2Gastroenterology, Sanjay Gandhi Post
Graduate Institute of Medical Sciences, Lucknow, India
Background/Aims: Though community studies on gastroesophageal reflux disease are available, data on other functional esophageal
symptoms are scanty in Asia. Accordingly, we undertook such a study
in a rural Bangladeshi community.
Methods: In a door-to-door survey, adult population (＞ 18 years)
living in four villages in Bangladesh were interviewed by trained personnel using Bengali translated and validated Enhanced Asian Rome
III and general health questionnaire 28 (GHQ-28).
Results: Common esophageal symptoms among 3351 subjects (age
40.41 ± 16.04 years, 1924 [57.4%] female) surveyed included: heartburn (n = 428, 12.8%), globus (n = 49, 1.5%), functional chest pain
(n = 41, 1.2%), and dysphagia (n = 26, 0.8%). 524/3361 (15.6%)
had at least one functional esophageal symptom (FES). FES were
commoner among female than male (338/1924 [17.6%] vs 186/1427
[13%]; P ＜ 0.0001), married than unmarried (438/2678 [16.4%] vs
41/424 [9.7%]; P = 0.001), Muslim than Hindu (382/2220 [17.2%]
vs 140/1126 [12.4%]; P ＜ 0.0001), low (less than 6733 taka per
month) than higher income family (182/984 [18.5%] vs 342/2026
[14.4%], P = 0.004). GHQ-28 score was higher among subjects
with FES than those without (0.94 ± 2.64 vs. 0.4 ± 1.49; P = 0.000)
and subjects with EFS more often had high score (＞ 5) than those
without (36/521 [6.9%] vs 74/2809 [2.6%], P ＜ 0.000).
Conclusions: Sixteen percent people in rural Bangladesh had at
least one functional esophageal symptom, heartburn being the most
common; other symptoms like globus, functional chest pain, and dysphagia were uncommon. Female gender, marriage, Muslims religion,
and low income were the risk factors for EFS on univariate analysis.
Psychological distress as evidenced by high GHQ-28 score was higher among subjects with EFS.
Background/Aims: Since Methanobrevibacter smithii (M. Smithii)
produces methane in the gut, which delays gut transit resulting in constipation and constipation-predominant irritable bowel syndrome
(IBS-C), we evaluated quantity of M. smithii in patients with IBS and
healthy controls (HC) and its relationship with levels of breath methane on lactulose hydrogen breath test (LHBT).
Methods: Quantitative real-time PCR (qPCR) was performed in
fecal samples of 47 patients with IBS (Rome III) and 30 HC for M.
smithii. LHBT was performed in 25 of these patients with IBS and 10
HC. Fasting breath methane level ≥ 10 ppm or increase by ≥ 10
ppm above basal after 10-g lactulose ingestion was diagnostic of methane-producer.
Results: Of 47 patients with IBS, 20 had IBS-C, 20 had diarrhea
(IBS-D), and 7 could not be sub-typed (IBS-U). Number of copies of
16S rRNA of M. smithii was higher among patients with IBS than
HC (Log10 4.9, IQR [3.2-6.2] vs 1.9 [0.0-3.3], P ＜ 0.001), particularly among IBS-C than IBS-D (Log10 5.7 [5.1-6.5] vs 3.4
[0.6-6.0], P ＜ 0.001). Of 25 patients who underwent LHBT, 8/12
(67%) with IBS-C were methane-producer compared with 3/13
(23%) with IBS-D (P = 0.047). Quantity of 16S rRNA of M. smithii
was higher among methane-producers than non-producers (Log10
6.3 [5.6-7.4] vs 4.0 [1.8-5.8], P ＜ 0.001). Area under curve for
breath methane had positive correlation with number of copies of M.
smithii among methane producers (Spearman correlation coefficient R
= 0.81, P = 0.003).
Conclusions: Patients with IBS, particularly constipation-predominant, had higher quantity of 16S rRNA of M. smithii than HC.
Breath methane levels on LHBT correlated with quantity of 16S
rRNA of M. smithii.
S4
ANMA 2015 India
Selected Oral Presentation
No. 111
Abnormal Intestinal Permeability Induced by
Acute Stress: Interaction of Gut Microbiota
and Adrenal Gland
An-Ni Tsai and Ching-Liang Lu
Institute of Brain Science, National Yang-Ming University, Taipei
Background/Aims: Acute and chronic stress increase gut permeability, which lead to visceral hypersensitivity and bacterial translocation. The phenomenon may be accounted for the symptoms attack in
the patients with irritable bowel syndrome (IBS) or inflammatory
bowel disease. Increased gut permeability would also facilitate an increased serum level of circulating endotoxin and promote systemic inflammation through Toll like receptor4 (TLR-4). TLR-4 is a major
mediator in the crosstalk between the innate immune system and the
endocrine stress response. Probiotics has been shown to be beneficial
for clinical symptoms in IBS patients. Therefore, we first aimed to investigate the impact of acute stress on intestinal permeability and immune-adrenal responses. Secondly, the biological effects of probiotic
treatment on intestinal permeability after acute stress were evaluated.
Methods: Water avoidance stress was applied as the acute stress
model. Measurement intestinal permeability was performed by loading FITC-dextran into small intestine. FITC-dextran concentration
was determined from portal vein at 2 hours, 4 hours and 6 hours after
water avoidance stress. The protein expression level of TLR4 in adrenal cortex after stress was examined by Western blot. Administrate
9
single-dose of Lacidofil (3 × 10 CFU/mL saline) or Lactobacillus casei
9
(5 × 10 CFU/mL saline) was given through oral gavage immediately after the acute stress.
Results: Acute stress led to increased intestinal permeability evidenced by elevated portal concentration of FITC-dextran, which
peaked at 6 hours after the stress (P ＜ 0.05). Circulating endotoxin
leaking from gut were significantly increased at 2 hours after acute
stress (P ＜ 0.05). The time course in the changes of plasma corticosterone and TLR-4 expression in adrenal cortex after stress paralleled
with the changes in FITC-dextran concentration, suggestive of a regulatory roles of cortisol and TLR-4 in intestinal permeability. A single-dose of Lacidofil, but not Lactobacillus casei, immediately after
WAS reversed the changes in FITC-dextran concentration (intestinal
permeability).
Conclusions: Acute stress would induce increased intestinal permeability, which might be resulted from the interaction between the immunological responses from gut microbiota and the stress-related endocrine response. Probiotics can reverse the acute stress-induced
changes in intestinal permeability. The beneficial effect of probiotics in
stress-induced alteration in intestinal permeability is strain-specific.
S5
ANMA 2015 India
Selected Presidential Poster Presentations
ANMA 2015 India
Selected Presidential Poster Presentation
squeezing showed a significant difference between FI and asymptomatic normal control. Pressurization through the lower anal canal during squeezing maneuver of HRAM might have a key role in determining between continence and incontinence. A prospectively
well-designed study based on large numbers of subjects may be warranted to validate its clinical meaning.
No. 4
New High-resolution Anorectal Manometry
Parameter for Fecal Incontinence on the
Basis of a 3-dimensional Integrated
Pressurized Volume of Spatiotemporal Plot:
Comparison Between the Female Patients
With Fecal Incontinence and Asymptomatic
Normal Control
1
2
1
Kee Wook Jung, Segyeong Joo, Seung-Jae Myung, Dong-Hoon
1
1
1
1
1
Yang, In Ja Yoon, So Young Seo, Hyun Sook Koo, Hyo Jeong Lee,
1
1
1
Ji-Beom Kim, Jong Wook Kim, Soo Kyung Park, Sang Hyoung Park,1
1
1
1
Kyung Jo Kim, Byong Duk Ye, Jeong-Sik Byeon, and Hwoon-Yong
1
Jung
Departments of 1Gastroenterology and 2Biomedical Engineering, Asan
Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Background/Aims: The conventional anorectal manometry and its
parameters in fecal incontinence (FI) have been controversial in the
discrimination between patients with FI and asymptomatic normal
control. Previously, we reported that integrated pressurized volume
(IPV) during balloon expulsion, based on the spatiotemporal plot of a
high-resolution anorectal manometry (HRAM), was highly correlated with the success of balloon expulsion test in constipated patients.
We aimed to develop new parameters in HRAM using IPV in discriminating between FI and asymptomatic normal control.
Methods: From August to November 2013, female patients complaining FI were prospectively enrolled using a validated FI
questionnaire. Asymptomatic normal female control more than 50
years old were prospectively enrolled after exclusion of Rome III
questionnaires. All of the enrolled patients underwent HRAM using
circumferential sensors with 23 channels in 6-cm lengths. Resting and
squeezing pressures were then converted to ASCII files and analyzed
using a MATLAB program. A 3-dimensional IPV was plotted after
transforming the data to a cubic spline interpolation followed by resampling the manometry position at 0.1-cm intervals.
Results: After exclusion of overflow FI, 12 patients with FI (mean
age 71 ± 6 years) were enrolled. Their conventional and new manometric parameters were compared with 6 asymptomatic normal control
(mean age 54 ± 2 years). When compared regarding conventional manometry profiles, there was no significant difference between 2 groups.
However, the IPV of lower 2 cm anal canal during squeezing showed a
lower tendency in FI group than asymptomatic normal control (395.3 ±
137.3 mmHg · cm · sec in FI vs 578.5 ± 201.7 mmHg · cm · sec in
control, P = 0.050). Moreover, the IPV of lower 1 cm anal canal during squeezing was significantly lower in FI group than asymptomatic
normal control (466.9 ± 165.8 mmHg · cm · sec in FI vs 697.3 ±
243.6 mmHg · cm · sec in control, P = 0.030).
Conclusions: The newly developed IPV of anal canal during
S9
ANMA 2015 India
Selected Presidential Poster Presentation
No. 8
No. 12
Fecal Evacuation Disorder Among Patients
With Solitary Rectal Ulcer Syndrome:
A Case-control Study
Effect of Biofeedback Therapy on Anorectal
Physiological Parameters Among Patients
With Fecal Evacuation Disorder
Atul Sharma, Asha Mishra, and Uday C Ghoshal
Abhai Verma, Asha Misra, and Uday C Ghoshal
Department of Gastroenetrology, Sanjay gandhi Post Graduate Institute of
Medical Sciences, Lucknow, India
Department of Gastroenetrology, Sanjay gandhi Post Graduate Institute of
Medical Sciences, Lucknow, India
Background/Aims: Data on frequency of fecal evacuation disorder
(FED) among patients with solitary rectal ulcer syndrome (SRUS),
hitherto an enigmatic condition, are scanty. Moreover, most such
studies had limitations due to small sample size and lack of inclusion
of healthy controls (HC).
Methods: Forty patients with SRUS underwent symptom assessments, sigmoidoscopy, anorectal manometry, defecography, and balloon expulsion test (BET); endoscopic ultrasound (EUS) of anal
sphincter complex was performed in a subgroup. Physiological tests
(anorectal manometry and BET) were also performed in 19 HC.
Results: Patients with SRUS (26/40 male, age 37 [18-80] years)
more often had FED than HC (10/19 male, age 43 [25-72] years) as
shown by weight needed to expel the balloon (300 [0-700] g vs 100
[0-400] g; P = 0.006), a trend towards abnormal BET (need of > 200
g weight for expulsion) (21/40 [53%] vs 5/19 [26%], P = 0.058) and
impaired anal relaxation (14/40 [35%] vs 2/19 [10.5%]; P = 0.040).
Using Rome III criteria, most patients with SRUS reported having
chronic constipation (36/40 [90%]) in spite of having normal (Bristol
stool type IV, 21/40 [53%]) and diarrheal (types V, VI, and VII; 6/40
[20%]) stool forms (Asian classification). 17/40 [43%] patients with
SRUS had functional defecation disorder (Rome III criteria).
Patients with SRUS with abnormal BET had thicker internal anal
sphincter than those without (3.4 [3.9-7] mm vs 2.8 [2-4] mm; P =
0.010).
Conclusions: FED was commoner among patients with SRUS as
evidenced by abnormal BET and sphincter relaxation. Those with abnormal BET had thicker internal sphincter on EUS than those
without.
Background/Aims: Fecal evacuation disorders (FED) are common among patients with chronic constipation presenting to tertiary
care centers. Though biofeedback therapy is effective in relieving
symptoms in these patients, there is limited data on improvement in
physiological parameters after such treatment. Therefore, we evaluated efficacy of biofeedback in improving anorectal physiological parameters among patients with FED.
Methods: Consecutive patients with FED (diagnosed in symptomatic patients based on defecography, balloon expulsion test [BET],
and anorectal manometry) referred to Gastrointestinal Pathophysiology and Motility Laboratory of a large university hospital from August
2012 to July 2014 were included. Anorectal manometry parameters
such as basal and squeeze pressures, residual sphincter pressure during attempted defecation and balloon expulsion test parameters were
evaluated before and after biofeedback therapy (2 sessions per day for
2 weeks).
Results: Of 29 patients (median age 48 years, range 19-76, 24
[82%] male), defecography and BET and was abnormal in 22/26
(84%) and 25/29 (86%). Pre and post-biofeedback manometric parameters (median and range) were as follows: basal pressure 75
(52-128) vs 67 (53-102), P = 0.045; squeeze pressure 146 (75-248)
vs 140 (81-246); P = 0.900; residual anal sphincter pressure during
attempted defecation 106 (52-148) vs 85 (37-182); P = 0.020; weight
needed to expel intra-rectal balloon during BET 500 (0-700) vs 200
(0-700); P = 0.010. Dyssenergia and BET got corrected in 19/29
(65%) and 14/25 (56%) patients after biofeedback.
Conclusions: Successful biofeedback therapy improves anorectal
physiological parameters.
S10
ANMA 2015 India
Selected Presidential Poster Presentation
No. 13
No. 22
Influence of Obesity on the Prevalence of
Laryngopharyngeal Reflux Disease
Clinical Validation of c-PDR: Methodology for
Accurate Non-invasive Detection of
Helicobacter pylori Infection
Cheol Woong Choi, Hyung Wook Kim, Dae Hwan Kang, Su Bum Park,
Su Jin Kim, Hyeong Seok Nam, Dong Ku Kang, and Ja Jun Goo
1
2
2
Suman Som, Sunil B Daschakraboty, Sujit Chaudhuri, and Manik
1
Pradhana
Department of Internal Medicine, Pusan National University Yangsan
Hospital, Yangsan, Gyeongsangnamdo, Korea
1
Department of Chemical, Biological and Macromolecular Sciences, S.N.
Bose National Center for Basic Sciences, Salt Lake, India; and 2Department
of Gastroenterology, AMRI Hospital, Salt Lake, India
Background/Aims: Laryngopharyngeal reflux disease (LPRD) is a
variant of Gastroesophageal reflux disease (GERD) that affects the
larynx and pharynx. The aim of this study was to examine the association between obesity and LPRD as well as GERD.
Methods: We conducted a cross-sectional study of consecutive patients undergoing ambulatory 24-hour dual-probe pH monitoring
from July 2003 to December 2006. The association between body
mass index (BMI) and parameters about LPRD was examined in
univariate and multivariate analyses.
Results: A total of 769 patients (307 men and 462 women; mean
age 50.7 years) were finally enrolled. Most variables showing GERD
was higher in the obese patients than the patients with normal BMI.
There was no difference in all the variables showing LPRD according
to the BMI. After adjustment for age, sex, alcohol intake and smoking, obese patients demonstrated an about 2-fold increase in risk of
GERD compared with patients with normal BMI (OR, 1.9; 95 CI,
1.3-2.9), but overweight patients did not demonstrate increased risk of
GERD (OR, 1.2; 95 CI, 0.8-1.7). Both obese patients and overweight
patients did not demonstrated increased risk of LPRD compared with
patients with normal BMI (OR, 1.1; 95 CI, 0.8-1.7; and OR, 0.9; 95
CI, 0.6-1.3, respectively).
Conclusions: Obesity is not associated with LPRD while it is associated with GERD.
Background/Aims: Helicobacter pylori is a common and important
human pathogen and the primary cause of peptic ulcer disease and
gastric cancer. Currently H. pylori infection is detected by both invasive and non-invasive way but the diagnostic accuracy is not up to
13
the mark. To set up an optimal diagnostic cut-off value of C-urea
breath test to detect H. pylori infection and evaluate a novel c-PDR
methodology to overcome of inconclusive grey zone.
Methods: All 83 subjects first underwent upper-gastrointestinal
endoscopy followed by rapid urease test and histopathology and depending on these results we classified 49 subjects as H. pylori positive
and 34 negative. After an overnight fast patients are taken 4 gm of citric acid in 200 ml water solution and 10 minute after ingestion of the
test meal a baseline exhaled breath sample was collected and thereafter
13
an oral dose of 75 mg C-Urea dissolved in 50 ml water was given
and breath samples were collected upto 90 minute for 15 minute intervals and analysed by laser based high precisional cavity enhanced
spectroscopy.
13
Results: We studied the excretion kinetics of C isotope enrichment (expressed as δDOB13C ‰) of exhaled breath samples and
found maximum enrichment around 30 minute of H. pylori positive
patients, it is due to the acid mediated stimulated urease enzyme activity and maximum acidification happened within 30 minute but no
such significant isotopic enrichment observed for H. pylori negative
individuals. Using Receiver Operating Characteristic (ROC) curve
13
an optimal diagnostic cut-off value, δDOB C ‰ = 3.14 was determined at 30 minute exhibiting 89.16% accuracy. Now to overcome
13
grey zone problem we explore percentage dose of C recovered per
13
hour, ie, C-PDR (%/hr) and cumulative percentage dose of 13C recovered, ie, c-PDR (%) in exhaled breath samples for the present
13
C-UBT. We further explored the diagnostic accuracy of 13C-UBT
by constructing ROC curve using c-PDR (%) values and an optimal
cut-off value was estimated to be c-PDR = 1.47 (%) at 60 minute, exhibiting 100% diagnostic sensitivity , 100% specificity and 100% ac13
curacy of C-UBT for detection of H. pylori infection. We also eluci13
date the gastric emptying process of present C-UBT for H. pylori
positive patients. The maximal emptying rate found at 36 minute and
half empting time of present 13C-UBT was found at 45 minute.
Conclusions: The present study exhibiting the importance of
S11
ANMA 2015 India
Selected Presidential Poster Presentation
c-PDR methodology to overcome of grey zone problem in 13C-UBT
for accurate determination of infection without any risk of diagnostic
errors and making it sufficiently robust and novel method for an accurate and fast non-invasive diagnosis of H. pylori infection for large
scale screening purposes.
No. 24
Relationship Between Sub-classification of
Functional Dyspepsia and Gastric Emptying
1
2
1
Tatsuhiro Masaoka, Juntaro Matsuzaki, Hideki Mori, Kentaro
1
1
1
1
Tanaka, Yurika Ichikawa, Hikari Kohmoto, Takahiro Komori, Koji
Togawa,1 Ichiro Mizushima,1 Toshihiro Nishizawa,3 Eisuke Iwasaki,4
5
1
1
Tohru Mizushima, Takanori Kanai, and Hidekazu Suzuki
1
Division of Gastroenterology and Hepatology, Department of Internal
2
Medicine, Center for Preventive Medicine, Division of Research and
3
4
Development for Minimally Invasive Treatment, Cancer Center, Center
for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio
5
University, Tokyo, Japan; and Department of Analytical Chemistry,
Faculty of Pharmacy, Keio University, Tokyo, Japan
Background/Aims: Functional dyspepsia (FD) is sub-classified to
post-prandial distress syndrome (PDS) and epigastric pain syndrome
(EPS) by Rome III criteria. However, a cohort of FD patients who
1
overlap EPS and PDS is reported. Moreover, role of delayed gastric
emptying in pathogenesis of FD is considered to be limited. The aim
of this study was to investigate relationship between sub-classification
of functional dyspepsia and gastric emptying.
Methods: The 58 FD patients who fulfilled Rome III criteria at a
single tertiary care center from December 2012 to August 2014 and
39 healthy volunteers as a control group were enrolled this study.
Patients and control group were measured gastric emptying using
13
C-acetate breath test. The point of maximum gastric emptying
(Tmax) was evaluated. Because average Tmax in control group was 43.2
± 16.1 minutes, we defined Tmax more than 60 minutes as delayed
gastric emptying.
Results: The 58 FD patients were sub-classified into an EPS group
(n = 9, 15.5%), PDS group (n = 14, 24.1%), and EPS + PDS
group (n = 35, 60.3%). Compared with control group, Tmax in EPS
group and PDS group did not changed. However, Tmax in EPS +
PDS group was significantly delayed. Moreover, compared with control group, ratio of patients who presented delayed gastric emptying in
EPS group and PDS group did not changed. However it in EPS +
PDS group was significantly high.
Conclusions: FD patients who had both of EPS and PDS symptoms presented delayed gastric emptying.
Reference
1. Matsuzaki J, Suzuki H, Asakura K, et al. Classification of functional dyspepsia based on concomitant bowel symptoms. Neurogastroenterol Motil 2012;24:325-e164.
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Selected Presidential Poster Presentation
No. 26
No. 32
Corticotropin-releasing Factor Impairs Tight
Junctions by Mediating F-actin in Irritable
Bowel Syndrome
The Effect of 5-Hydroxytryptamine 4 Receptor
Agonist, YKP10811 on Postoperative Ileus in
Guinea Pig
Li Meng, Lu Bin, Wang Xiaoteng, and Hu Yue
Yoo Jin Lee, Young Hoon Youn, Zahid Hanssen, Min Joo Im, and Hyojin
Park
First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou,
China
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei
University College of Medicine, Seoul, Korea
Background/Aims: Corticotropin-releasing factor (CRF) plays an
important role in the establishment of irritable bowel syndrome (IBS).
Increased colonic paracellular permeability mainly regulated by tight
junctions (TJs) is associated with IBS-like symptoms. The present
study aimed at determining the effect of CRF on TJs.
Methods: IBS rat model was established by acute restraint stress
which underwent abdominal withdrawal reflex to evaluate visceral
sensitivity. According to experiments, Double-labeling immunofluorescence and Western-blot were used to determine the ultrastructure and expression of F-actin, claudin-1, and zonula occludens-1 (ZO-1) in colon mucosa. In vitro, T84 cells were treated with
different concentration of CRF. Double-labeling immunofluorescence was used to determine the expression of CRF-R1/R2 on the surface of T84, Western-blot and QPCR were used to analyze the effect
of CRF on the expression of F-actin, claudin-1, and ZO-1.
Results: In animal experiment, visceral sensitivity was significantly
higher in IBS group. The expression of F-actin in colonic mucosa
were higher than those in control group, while the expression of claudin-1 and ZO-1 were relatively lower. F-actin filament dissolution and
condensation accompanied by redistribution and/or fragmentation of
ZO-1 and claudin-1 were detected by double-labeling immunofluorescence. CRF receptors (CRF1 and CRF2) exist on the surface of
T84. 10 nM CRF caused a significant rise of F-actin, which were associated with a marked reduction of ZO-1.
Conclusions: Our findings indicate that CRF may induce colon
epithelial barrier dysfunction through changes in TJ proteins by mediating F-actin. These findings might provide new insights for the pathophysiology of IBS and clinical treatment.
Background/Aims: Postoperative ileus (POI) is defined as inhibition of gastrointestinal (GI) motility after abdominal surgery that
is associated with patient’s morbidity and prolonged hospitalization.
YKP10811 (SK biopharmaceuticals, Daejeon, South Korea) is selective 5-hydroxytryptamine 4 (5-HT4) receptor agonist which is
known to have an intestinal prokinetic activity. The aim of this study
was to investigate the effects of 5-HT4 receptor agonists including
YKP10811 and prucalopride on a POI model of guinea pig.
Methods: The experimental of POI in adult male guinea pigs was
created by laparotomy, gentle manipulation of the cecum for 60 seconds, and closure by suture. Upper GI transit was measured by the
migration of charcoal from the pylorus to the most distal part. Colonic
transit was indirectly assessed via measurement of weight and numbers of fecal expulsion every hour for 5 hours after administration of
various doses of YKP10811 and prucalopride.
Results: Charcoal transit assay showed that both YKP10811 and
prucalopride can significantly accelerate delayed in upper GI transit in
a dose-dependent manner. In fecal pellet output assay, the number
and weight of fecal pallets were slightly increased by prucalopride
(dose above 10 mg/kg) and YKP10811 (dose of 1- and 3-mg/kg).
Conclusions: Both prucalopride and YKP10811seems to have beneficial effects to hasten upper and lower GI transit in the POI model.
YKP10811 might be used as a potential therapeutic drug for POI.
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ANMA 2015 India
Selected Presidential Poster Presentation
No. 39
No. 41
Reduction of Hydrogen Sulfide Synthesis
Enzymes in Esophagus of Patients With
Achalasia
Long-term Outcome of Peroral Endoscopic
Myotomy in Achalasia Cardia Based on The
Sub Types
Lili Zhang, Wei Zhao, Zhongqing Zheng, Tao Wang, Chunshan Zhao,
Guojian Zhou, Hong Jin, and Bangmao Wang
Rakesh Kalapala, Pankaj Shrimal, Mohan Ramchandani, Santosh
Darisetty, and D Nageshwar Reddy
Department of Digestive Diseases, General Hospital, Tianjin Medical
University, Tianjin, China
Department of Medical Gastroenterology, Asian Institute of
Gastroenterology, Hyderabad, India
Background/Aims: The etiology of achalasia was not clear, and
there was considerable evidence that the lower esophageal sphincter
(LES) dysfunction was due to lack of inhibitory transmitter. Recent
studies suggested that hydrogen sulfide (H2S) may act as an inhibitory
transmitter in gastrointestinal tract. The aim of the study was to investigate whether the synthesis of endogenous H2S was altered in LES
and other parts of esophagus of achalasia patients undergoing peroral
endoscopic myotomy (POEM).
Methods: Tissue samples in cardia, LES, 2 cm above LES, and 4
cm above LES were obtained from achalasia patients undergoing
POEM. And tissue samples in LES from esophageal neoplasia patients undergoing esophagomyotomy were also obtained as controls.
The expression of cystathionine--synthase (CBS) and cystathionine-lyase (CSE) in LES were compared between achalasia patients and
esophageal neoplasia patients by immunohistochemical staining. In
addition, the expression of CBS and CSE were also compared among
the different parts of esophagus in patients with achalasia.
Results: Both CBS and CSE could be detected in biopsy from
achalasia patients and controls. Compared with controls, the expression of CBS and CSE in LES of achalasia patients was significantly reduced (P < 0.05). There was significant difference between the number of CBS and or CSE positive cells in different parts
of esophagus in achalasia patients (P < 0.05).
Conclusions: H2S synthesis enzymes, existed in human esophagus
and the expression of CBS and CSE was reduced in patients with
achalasia.
Background/Aims: Achalasia cardia (AC) is a primary esophageal
motility disorder commonly treated with endoscopic pneumatic dilatation or surgical myotomy. Peroral endoscopic myotomy (POEM) is a
safe and effective treatment for AC with significant symptom relief
and improvement in objective outcome.
Methods: Fifty-one patients with AC (Type I/II/III) who underwent POEM at our institute between March 2013 and April 2014
were included. Pre and post operative symptoms were quantified by
Eckardt’s score. Objective tests (High-resolution manometry and
timed barium esophagogram) were done pre and post operatively at 6
months.
Results: Male: female = 31:20, mean age 70 ± 38 years, SD 14.5.
The pre and post POEM values at 6 months are as follows: mean procedure time is 112 minutes. Eckardt’s score: mean-7.3/0.62, SD-1.87/
0.63, P < 0.001. HRM: integrated relaxation pressure: mean-18.5/
9.86, SD-2.48/2.14, P < 0.001. Lower esophageal sphincter pressure: mean-46.9/23.2, SD-21.0/14.6, P < 0.001. All patients had improvement on timed barium esophagogram post POEM. Type II and
III had a better outcome with POEM compared to type I patients.
Conclusions: POEM is feasible, safe and effective technique for
treatment of AC. This is the first study to describe the outcome and efficiency of POEM based on types of AC.
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ANMA 2015 India
Selected Presidential Poster Presentation
No. 63
No. 66
Genetic Chararecterization of Cryptosporidia
in Patients With Hematological Malignancies
and Human Immunodeficiency Virus
Infection
Reduction of Breath Methane Using
Rifaximin Shortens Colon Transit Time and
Improves Constipation: A Randomized
Double-blind Placebo Controlled Trial
1
1
1
1
Ujjala Ghoshal, Prabhat Ranjan, Asmita Dey, V Misra, Bikas
2
3
4
Agarwal, S Nityanand, and Uday C Ghoshal
Uday C Ghoshal, Deepakshi Srivastava, and Asha Misra
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of
Medical Sciences, Lucknow, India
Departments of 1Microbiology, 2Immunology, 3Hematology, and
4
Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical
Sciences, Lucknow, India
Background/Aims: High methane by the methanogenic flora in the
gut may reduce gut transit causing chronic constipation (CC).
Reducing methane with antibiotic directed against methanogens may
accelerate colon transit improving CC. Accordingly, we studied the effect of treatment with non-absorbable antibiotic, rifaximin, on patients
with slow transit CC associated with high methane production.
Methods: Bristol stool forms, frequency, colon transit time (CTT;
20 markers each at 0, 12, and 24 hours, radiograph at 36 and 60
hours) and breath methane (lactulose hydrogen breath test [LHBT])
were evaluated in 23 patients with CC (Rome III); frequency of methane production was compared with 68 non-constipating irritable bowel
syndrome. Methane producing CC (basal breath methane > 10 parts
per million (PPM) and/or post-lactulose rise > 10 PPM above basal)
were randomized (double-blind) to receive either rifaximin or placebo
(thrice daily for 14 days). Bristol stool forms, frequency, breath methane and CTT were recorded after treatment.
Results: Patients with CC more often tended to be methane producers (13/23 [56.5%] vs 25/68 [36.5%]; P = 0.070) and had higher area under curve (AUC) for methane (2415 [435-23580] vs 1335
[0-6562.5], P = 0.021) than non-constipating IBS. Eight out of thirteen (61.5%) methane producers and 5/10 (50%) methane non-producers had abnormal CTT (markers retained at 36 hours: 53 [0-60]
vs 19 [8-56], P = 0.062; at 60 hours: 16 [0-57] vs 13 [3-56], P =
0.877). Of 13 methane producers, 6 (46.2%) were randomized to receive rifaximin and 7 (53.8%) to placebo. After 1 month, AUC for
methane was lower among patients on rifaximin (6697.5 [1777.523580] vs 2617.5 [562.5-19867.5], P = 0.005) than those on placebo (3945 [2415-12952.5] vs 3720 [502.5-9210, P = 0.118). CTT
normalized in 4/6 (66.7%) on rifaximin (markers retained at 36 hours:
54 [44-57] vs 36 [23-60], P = 0.05; at 60 hours: 45 [3-57] vs
14[11-51], P = 0.090) but did not normalize in anyone on placebo (P
= 0.020) (markers retained at 36 hours: 31 [0-60] vs 25 [0-45], P =
0.078; at 60 hours: 6 [0-54] vs 12 [0-28], P = 0.200). Weekly stool
frequency (before treatment: 3 [1-9] vs after treatment: 7 [1-14], P
= 0.05) and forms (type 1: 2/6 [33.3%], type 2: 1/6 [16.6%], type 3:
3/6 [50%] vs type 1: 1/6 [16.6%], type 3: 3/6 [50%], type 4: 1/6
[16.6%], type 5: 1/6 [16.6%]) improved with rifaximin than with placebo (7 [3-21] vs 7 [1-14], P = 0.080 and type 1: 1/7 [14.3%], type
BackgroundAims: Cryptosporidiosis is a protozoan parasitic disease that commonly causes diarrhea in immunocompromised patients.
Till date, there is no study on genotyping of cryptosporidium from patients with hematological malignancies (HM). Therefore, we aimed to
study, (1) frequency of cryptosporidiosis in patients with HM and human immunodeficiency virus (HIV). (2) genetic characterization of
cryptosporidium in HM and HIV patients.
Methods: Eight hundred and ten stool samples of 301 patients
were examined by stool microscopy using modified acid fast staining
and Enzyme linked immunosorbent assay was performed to detect
their specific antigen. Polymerase chain reaction coupled with restriction fragment length polymorphism (RFLP) was used for the species
detection.
Results: Twenty-four of 301 (8%) patients were positive for cryptosporidium infection by kinyoun staining of which 19/177 (10.7%)
were HIV patients and 5/124 (4%) were HM patients. Cryptosporidium was more often detected in patients with diarrhea than those without diarrhea (17/112 [15.2%]; 7/189 [3.7%], P = 0.002). Infected
patients presented with acute diarrhea (> 3 loose stools per day for <
2 weeks; 4/24 [16.6%]), chronic diarrhea (> 4 loose stools per day >
4 weeks; 7/24 [29%]), persistent diarrhea (> 3 loose stools per day
for 2-4 weeks, 6/24 [25%]), abdominal pain 8/24 (33.3%), vomiting
10/24 (41.6%) and fever 18/24 (75%). Based on RFLP analysis,
18/24 (75%) samples were identified as Cryptosporidium hominis and
6/24 (25%) as Cryptosporidium parvum.
Conclusions: Cryptosporidiosis is not uncommon in HM and immunocompromised patients. Most of them were presented with
diarrhea. And the most prevalent species causing cryptosporidiosis is
Cryptosporidium hominis.
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ANMA 2015 India
Selected Presidential Poster Presentation
2: 1/7 [14.3%], type 3: 1/7 [14.3%], type 4: 4/7 [57.1%] vs type 1:
1/7 [14.3%], type 2: 2/7 [28.6%], type 3: 1/7 [14.3%], type 4: 3/7
[42.8%]).
Conclusions: Rifaximin improves constipation by reducing breath
methane and reducing colon transit.
No. 78
Frequency and Risk Factors of Dyspepsia in
a Rural Indian Population
Uday C Ghoshal and Rajan Singh
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of
Medical Sciences, Lucknow, India
Background/Aims: Since community studies, scarce in India,
would give the best estimates on prevalence of dyspepsia, we undertook such a study in a rural Indian population.
Methods: In a house-to-house survey by a trained interviewer using a translated-validated Rome III and hospital anxiety and depression questionnaires, information about demography, socio-economic
parameters, diet and symptoms were collected.
Results: Of 5415 (2011 census) subjects from 3 villages (Chhataura,
Bastibandgawn, and Molanapur, Jaunpur District, UP), 3426 ≥ 18
years were invited to participate of whom 2876 (84%) participated;
2774 participants (age 38.5 ± 18 years, 1573 [56.7%] male) providing complete data were analyzed. Socio-economically (Prasad classification), 14% were in upper, 16% upper-middle, 21% lower-middle,
25% upper-lower, and 24% in lower classes. 2331/2774 (84%) subjects were vegetarian (no food of animal origin), 305 (11%) lacto-vegetarian (vegetarian with cow’s milk), and 138 (5%) non-vegetarian
(foods of animal origin). 528 (19%) subjects met Rome III criteria for
dyspepsia; 49/528 (9%) had epigastric pain, 141 (27%) post-prandial
distress syndromes (EPS and PDS) and 338 (64%) EPS-PDS
overlap. On univariate analysis, high intake of aerated drink (OR, 1.4;
95% CI, 1.2-1.7; P < 0.001), tea/coffee (OR, 1.5; 95% CI, 1.1-1.8; P
= 0.004), disturbed sleep (OR, 4.7; 95% CI, 3.8-5.8; P < 0.001) and
anxiety (feeling of tension and wound up: 460/528 (87%) vs 1468/
2246 (65%), worry: 451 (85%) vs 1270 (56%), panic attacks: 401
(76%) vs 1058 (47%), feeling of something awful: 375 (71%) vs 930
(41%), P < 0.01) were associated with dyspepsia.
Conclusions: One-fifth people in rural India had dyspepsia, particularly EPS-PDS overlap; risk factors included high intake of aerated
drinks, tea/coffee, disturbed sleep and anxiety.
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ANMA 2015 India
Selected Presidential Poster Presentation
history, there appeared to be significant differences in symptom severity. Patients with more frequent symptoms appear to suffer more severe symptoms. Comparing first time and referral attenders, there was
significant difference in severity of epigastric pain/burning. Future
clinical trials of FD, should take into account patients’ symptom
chronicity.
No. 79
Does Chronicity Impact on The Severity of
Functional Dyspepsia Symptoms?
1
2
1
Xiao R Gong, Kok-Ann Gwee, Minhu Chen, and William E
3
Whitehead ; Rome ANMA Working Team
1
Department of Gastroenterology and Hepatology, The First Affiliated
Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China;
2
Department of Medicine, Yong Loo Lin School of Medicine, National
University of Singapore, Singapore; and 3Department of Gastroenterology,
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Background/Aims: Patients with functional gastrointestinal disorders are defined as having chronic symptoms, and the current Rome
criteria requires patients to have symptom onset at least 6 months
before. An early study of IBS suggests that patients with 6 months
symptoms have more severe symptoms than those who are first time
attenders. Aim of this study is to assess the impact of chronicity on severity of functional dyspepsia (FD) symptoms.
Methods: Patients presented with dyspepsia symptoms such as
postprandial fullness and epigastric pain or burning in last 3 month or
longer were enrolled to evaluate the severity of symptoms (1, very
mild, 2 mild; 3, moderate; 4, severe; and 5, very severe). The frequency of symptoms (1, less than one day a month; 2, one day a
month; 3, two to three days a month; 4, one day a week; 5, more than
one day a week, and 6 every day) and previous treatment were also
recorded. Patients with no treatment before were classified as first attender, thus those had previous treatment were referral patients.
Results: A total of 993 patients (415 male, 578 female) with epigastric pain or burning were enrolled, including less than 6 months (n
= 302, 30.4%) and 6 month or longer (n = 691, 69.6%). There were
significant correlation between the duration and severity of symptoms
2
(Linear by linear χ = 35.003, P < 0.001). There was also significant
correlation between frequency and severity of symptoms. (Linear by
2
linear χ = 117.334, P < 0.001; rs = 0.338, P = 0.029). Among
those patients, 163 (16.4%) were first time attenders and 830 (83.6%)
were referral attenders. The severity of symptoms was significantly
different between the 2 groups (Z = −2.188, P = 0.029). Similarly,
a total of 963 patients (384 male, 579 female) with postprandial fullness were enrolled, including less than 6 months (n = 280, 29.1%)
and 6 month or longer (n = 683, 70.9%). There was significant correlation between the duration and severity of symptoms (Linear by linear
2
χ = 42.559. P < 0.001; rs = 0.204, P = 0.031). There was also significant correlation between frequency and severity of symptoms.
2
(Linear by linear χ = 74.169, P < 0.001; rs = 0.269, P = 0.031).
However, the severity of symptoms was not significantly different between first time attenders (n = 163, 16.8%) and referral attenders
(800, 83.1%) (Z = −1.026, P = 0.305) in patients with fullness.
Conclusions: Comparing patients with < 6 months and ≥ 6 months
S17
ANMA 2015 India
Selected Presidential Poster Presentation
No. 81
No. 83
An Epidemiological Study on Functional
Constipation by Rome III Criteria in an Asian
Rural Population: Overlap With Functional
Dyspepsia and Psychological Stress
Development, Translation and Validation of
Enhanced Asian Rome 3 Questionnaires for
Diagnosis of Functional Bowel Diseases in
Major Asian Languages: A Rome
Foundation-Asian Neurogastroenterology
and Motility Association Working Team
Report
1
2
1
Mohammed M Rahman, Uday C Ghoshal, Md. Golam Kibria, Faruque
1
3
1
4
Ahmed, AHM Rowshon, Nigar Sultana, and Mahmud Hasan
1
Dhaka Medical College, Dhaka, Bangladesh; 2Sanjay Gandhi Postgraduate
Institute of Medical Sciences, Lucknow, India; 3Shaheed Suhrawardy
Medical College, Dhaka, Bangladesh; and 4Bangladesh Medical Research
Council, Dhaka, Bangladesh
Uday C Ghoshal, Kok-Ann Gwee, Minhu Chen, Xiao R Gong, Nitesh
Pratap, Xiaohua Hou, Ari F Syam, Murdani Abdullah, Young-Tae Bak,
Myung-Gyu Choi, Sutep Gonlachanvit, Andrew S B Chua, Kuck-Meng
Chong, Kewin T H Siah, Ching-Liang Lu, and Lisho Xiong
Asian Neurogastroenterology and Motility Association and Rome
Foundation Working Team
Background/Aims: As epidemiological studies on functional constipation (FC) are scanty in Asia, we undertook such a study in a rural
Bangladeshi community.
Methods: In a door-to-door survey, adult subjects (＞ 18 years)
living in four villages in Bangladesh (Charcharia, Chatia, and Churain
of Dhaka District; Kharrah of Munshiganj district) were interviewed
by trained personnel using Bengali translated and validated Enhanced
Asian Rome III and General Health Questionnaire 28 (GHQ28). A
binary method was used to categorize responses (none and sometimes
as 0 and often or almost always as 1).
Results: 3351/3559 subjects (94.15%, age 40.41 ± 16.04 years;
1924, 57.4% female) responded. 35/3351 (1.04%) fulfilled Rome III
criteria for FC. FC was commoner among female than male (28/1924,
1.5% vs 7/1427, 0.5%, P = 0.004) and among subjects 55 years or older than younger (13/710, 1.8% vs 22/2636, 0.8%; P = 0.035). FC was
commoner among lower family income group (≤ 6733 taka/month,
Kuppuswami) than higher (20/984, 2% vs 15/2367, 0.6%; P = 0.001)
and lower education (≤ 5 standard vs more: 20/1798, 1.1% vs.
10/1553, 0.6%; P = 0.040). Common symptoms among FC subjects
were: straining (21/35, 60%), incomplete evacuation (14/35, 40%),
anorectal obstruction (12/35, 34.2%), manual maneuvers (8/35, 22.8%)
and lumpy or hard stool (Bristol type I and II; 7/ 35, 20%). Only 4/35
(11.4%) subjects with FC passed less than stools/ week. 20/35(57.1%)
subjects with FC had associated uninvestigated dyspepsia, all of whom
had post-prandial distress syndrome (PDS). GHQ-28 score was higher
among subjects with FC than those without (2.63 ± 4.53 vs 0.49 ±
1.67; P = 0.009) and was more often abnormal (≥ 5: 9/35, 25.7% vs
101/3295, 3.1%, P = 0.000).
Conclusions: FC, though not prevalent, was commoner among female, older age, low income and lesser educated group in rural
Bangladeshi population. FC subjects had higher psychological stress
and overlap with PDS. A stool frequency of less than 3 per week was
uncommon and only 20% had Bristol stool type I and II stool.
Background/Aims: The development-processes by regional socio-cultural adaptation of an Enhanced Asian Rome III Questionnaire (EAR3Q), a cultural adaptation of the Rome III Diagnostic
Questionnaire (R3DQ), and its translation-validation in Asian languages are presented. As English is not the first language for most
Asians, translation-validation of EAR3Q is essential. Hence, we
aimed to culturally adapt the R3DQ to develop EAR3Q and linguistically validate it to show that the EAR3Q was able to allocate diagnosis
according to Rome III criteria.
Methods: After EAR3Q was developed by Asian experts by consensus, it was translated into Chinese, Hindi-Telugu, Indonesian,
Korean and Thai, following Rome Foundation guidelines; these were
then validated on native subjects (healthy [HS, n = 60], and patients
with irritable bowel syndrome [IBS, n = 59], functional dyspepsia
[FD, n = 53], and functional constipation [FC, n = 61]) diagnosed
by clinicians using Rome III criteria, negative alarm features and
investigations.
Results: Experts noted words for constipation, bloating, fullness,
and heartburn, posed difficulty. The English back-translated questionnaires demonstrated concordance with the original EAR3Q.
Sensitivity and specificity of the questionnaires were high to diagnose
respective functional gastrointestinal disorders (FGIDs) (gold standard: clinical diagnoses) in most except Korean and Indonesian languages. Questionnaires often uncovered overlapping FGIDs. Test-retest
agreement (Kappa) values of the translated questionnaires were high
(0.7-1.0) except in Korean (0.3-0.5) and Indonesian (0.1-0.4) languages at the initial and 2-week follow-up visit.
Conclusions: Though Chinese, Hindi, and Telugu translations
performed well, Korean and Indonesian versions did not. Questionnaires often uncovered overlapping FGIDs, which were quite common.
S18
ANMA 2015 India
Selected Presidential Poster Presentation
crease in the 2-year age rat group compared to the 6- and 31-week-old
age group (P < 0.005).
Conclusions: As increased age, the decrease of the density and activity of ICC and nNOS were found in the stomach. These morphologic and molecular expression changes might explain the alteration of
the gastric accommodation with aging process. The barostat experiment is undergoing.
No. 84
The Change in the Interstitial Cells of Cajal
and Neuronal Nitric Oxide Synthase With
Aging in the Stomach of F344 Rat
1,2
1
1
1
Nayoung Kim, Yong Hwan Kwon, Ju Yup Lee, Yoon Jin Choi, Kichul
1
1
1
1
Yoon, Cheol Min Shin, Ryoung Hee Nam, Ji Hyung Suh, Ji Hyun
2
2
1,2
Park, Bokyung Kim, and Dong Ho Lee
1
Department of Internal medicine, Seoul National University Bundang
2
Hospital, Seongnam, Gyeonggi-do, Korea; and Department of Internal
Medicine and Liver Research Institute, Seoul National University College of
Medicine, Seoul, Korea
Background/Aims: Interstitial cells of Cajal (ICC) and neuronal
nitric oxide (nNOS) are known to play an important role for gastric
accommodation in the stomach. However, the change of the structure
and function with aging is not well established in this organ. Thus, we
evaluated the change of ICC and nNOS immunoreactive cells in the
stomach of F344 rat in four different age groups using immunohistochemistry (IHC) and molecular analysis.
Methods: The stomach of Fisher 344 rats at 4 different ages (6-,
31-, 74-week, and 2-year of age) were studied (each group, n = 6).
The immunoreactivity of c-Kit and neuronal nitric oxide synthase
(nNOS) were quantified after immunohistochemistry (IHC). The
c-Kit, nNOS, and stem cell factor (ligand of Kit) mRNA were measured by real-time PCR. C-Kit and nNOS protein were assessed by
Western blot.
Results: The proportion of c-Kit-positive area of 31-week (P =
0.014), 74-week (P = 0.015), and 2-year (P = 0.005) old rat were
significantly decreased compared to 6-week old rat in smooth muscle
barrier. In myenteric plexus (MP) layer, the proportion of c-Kit positive area of 74-week and 2-year old rat were significantly declined
compared to younger age group (P < 0.005). The proportion of
nNOS-positive neuronal cell per total neuronal cell was decreased
with aging in smooth muscle barrier, circular muscle, and MP layer
(74-week and 2-year vs 6-and 31-week in SMB layer, P = 0.005; 31and 74-week vs 6-week in circular muscle layer, P < 0.005; 2-year vs
6-, 31-, and 74-week, P < 0.005, P =0.019, and P = 0.030; 31-,
74-week, and 2-year vs 6-week in MP layer, P < 0.005). c-kit mRNA
expression significantly decreased in the 74-week and 2-year-old rats
compared to the 6- (P < 0.05) and 31-week-old rats (P < 0.005).
nNOS mRNA expression showed significant decrease in the 74-week
compared to the 6- (P = 0.005) and 31-week-old age (P = 0.020).
Similarly, stem cell factor mRNA expression of 74-week-old and
2-year-old age rats was significantly lower than that of 6- (P < 0.005)
and 31-week-old age (P < 0.005), respectively. The expression of
c-Kit protein of stomach showed significant decrease in the 2-year-old
age rat group compared to the other aged rat group (P < 0.005) and
the expression of nNOS protein of stomach showed significant deS19
ANMA 2015 India
Selected Presidential Poster Presentation
No. 87
No. 102
The Effects of YH12852 on the Experimental
Model of Postoperative Ileus in Guinea Pig
Treatment With Proton Pump Inhibitors Only
Neutralizes Gastric Acid, but Rarely Effective
in Preventing Gastroesophageal Reflux:
Preliminary Report of an Ongoing Study
Zahid Hussain, Lee Young Ju, and Hyojin Park
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei
University College of Medicine, Seoul, Korea
Arun Karyampudi, Rajan Singh, Vivek A Saraswat, Asha Misra, and
Uday C Ghoshal
Department of Gastroenterology, Sanjay Gandhi Post-Graduate Institute of
Medical Sciences, Lucknow, India
Background/Aims: Postoperative ileus (POI) is the transient impairment of gastrointestinal (GI) motility that develops as a consequence of almost every abdominal surgical procedure. The disruption of normal coordinated propulsive motor activity of the GI
tract lasts for 2-4 days for conventional surgery, but decrease to as little
as ≤ 2 days in the case of laparoscopic surgery. Several studies indicate that POI can lead to significant increase in patient morbidity
and hospitalization costs. The aim of this study was to evaluate the effect of new drug YH12852, 5-hydroxytryptamine-4 receptor agonists
on the experimental model of post-operative ileus in guinea pig.
Methods: Adult male Hartley guinea pigs were used to create experimental model of POI. The guinea pig was anaesthetized by intraperitoneal injection of pentobarbital sodium. Laparotomy was done
followed by evisceration and gentle manipulation of the cecum using
wet gauze for 60 seconds and closure by suture. After operation, the
guinea pigs were treated with different doses (1, 3, 10, and 30 mg/kg)
of YH12852 through orogastric cannula. The restoration of upper GI
transit was measured using migration of charcoal mixture from the pylorus to the most distal point of migration. The lower GI or colonic
transit was indirectly measured in non-fasted guinea pig using fecal
pellet output assay. Different doses of YH 12852 were administered
1.5 hours after the anesthesia. The number of fecal pellets and weight
were measured and recorded in 1 hour increment for 5 hours.
Results: Charcoal transit assay showed that YH12852 accelerate
delayed upper GI transit in a dose dependent manner. The percentage
of charcoal transit after administration of 1, 3, and 10 mg/kg dose of
YH12852 was 28.8, 45.0, and 53.3 (cm) respectively. The highest acceleration of GI charcoal migration was achieved at concentration of
10 mg/kg. The highest dose of 30 mg/kg leads to receptor desensitization and hence decreases in the percentage of charcoal migration compare to 10 mg/kg (48.4 vs 53.3). Similarly, the fecal pellet output assay
showed significant effect in accelerating colonic motility at concentration of 10 mg/kg in POI model.
Conclusions: This study demonstrated very clearly that the oral administration of YH 12852, 5-hydroxytryptamine-4 receptor agonists
restored the delayed upper as well as lower GI transit in a dose dependent manner on experimental model of POI in guinea pig. This
drug may serve as a useful candidate for examination in a clinical trial
of POI.
Background/Aims: Proton pump inhibitors (PPIs) are widely used
in treatment of gastroesophageal reflux disease (GERD), a common
condition. Based on resolution of heartburn, PPIs have been widely
claimed to be highly effective in treatment of GERD. There is limited
data on frequency of non-acid volume reflux in patients with GERD
while on treatment with PPI particularly in India using 24-hour impedance pH-metry. Hence we present findings from such an ongoing
study.
Methods: Fourteen patients with GERD underwent 24-hour impedance pH monitoring while on PPI (omeprazole 20 mg once daily
and ilaprazole 10 mg once daily, n = 7 patients each) to evaluate mean
gastric pH, % time gastric pH below 4, mean esophageal pH, % time
esophageal pH below 4, % time non-acid gastroesophageal liquid reflux and frequency of diagnosis of abnormal gastroesophageal reflux
on pH-metry and impedance monitoring.
Results: Of 14 patients (median age 42 years old, range 22 to 63,
50% male) median of mean gastric pH was 3.46, range 0.69 to 5.53,
median of % time of gastric pH below 4 was 61.0%, range 10.7 to 98.3
and median of mean esophageal pH was 6.09, range 5.38 to 6.81.
During 24-hour pH-metry, of 14 patients, 3 (21%) had abnormal
24-hour pH-metry (% time esophageal pH below 4 above 4.1%).
During 24-hour impedance monitoring, of 14 patients, 11 (78.6%)
had abnormal volume reflux (% time liquid reflux above 1.3%).
Conclusions: Though PPI therapy is associated with lack of abnormal esophageal acidification, non-acidic liquid gastroesophageal reflux
was present in as high as 78% patients. This suggests need for additional therapeutic options to prevent occurrence of non-acidic volume
reflux.
S20
ANMA 2015 India
Selected Presidential Poster Presentation
No. 115
Gastrointestinal Manifestations of Systemic
Sclerosis: Clinical and Investigative Study of
50 Patients
1
2
2
1
M B Adarsh, Rakesh Kochhar, Saroj K Sinha, Shefali K Sharma, Anish
3
2
2
1
Bhattacharya, Satyavati Rana, J Samanta, and Surjit Singh
Departments of 1Internal Medicine, 2Gastroenterology and 3Nuclear
medicine, Postgraduate Institute of Medical Education and Research
(PGIMER), Chandigarh, India
Background/Aims: Systemic Sclerosis (SSc) is known to involve
the gastrointestinal (GI) system and can lead to multitude of problems
predominantly affecting the GI motility.
Methods: It was a prospective, observational, single centre study of
50 consecutive patients with SSc who presented to our rheumatology
clinic. Clinical profile of all the patients was noted. Thirty-five patients
underwent esophagogastroduodenoscopy, 31 underwent esophageal
manometry, 37 underwent lactulose breath test to assess orocecal
transit time and glucose breath test for detecting small intestinal bacterial overgrowth (SIBO) and 36 underwent gastric emptying scintigraphy to measure gastric emptying time.
Results: Skin manifestations were seen in all patients and gastrointestinal involvement was seen in 98% of patients, with common
symptoms being regurgitation (78%) and heartburn (76%). In esophagogastroduodenoscopy, esophagitis was seen in 30, of which 3 had
candidiasis and 1 had herpes simplex virus esophagitis. Two patients
had gastric antral vascular ectasia. Hiatus hernia was noted in 10
patients. Mean lower esophageal sphincter pressure was 16.1 ± 12.7
mmHg with hypotensive sphinctre in 12 patients. Esophageal peristaltic abnormalities (aperistalsis or ineffective peristalsis) were observed in 90% of 31 patients. Gastric emptying was delayed in 10/36
patients. Orocecal transit time was prolonged in 23/37 patients whereas SIBO was noted in 7/37.
Conclusions: The GI involvement is common in SSc with esophagus being the most commonly affected. Motility abnormalities make
them prone for super added infections esp. Infectious esophagitis and
SIBO as observed in the study and should be investigated.
S21
ANMA 2015 India
Selected Poster Presentations
ANMA 2015 India
Selected Poster Presentation
No. 2
No. 5
Composite Antropyloric Valve and Gracilis
Muscle Transposition for Total Anorectal
Reconstruction: A Preliminary Report
Clinical and Manometry Profile of Patients
With Fecal Incontinence
1
2
1
Seshadri Venkatesh Parthasarathy, Preethi Mahalingam,
Piramanayagam Paramasivan, Ubal Dhus, Bharath Kumar Mookiah,
Revathy Marimuthu Shanmugam, Usha Srinivas, Natarajan Murugan,
Hariharan Muthuswamy, Shanthi Vijayaraghavan, Prem Kumar
Karunakaran, Sarojini Ashok Parameswaran, Mohan Arumugam
Thiravia, and Kallipatti Ramasami Palaniswamy
1
Abhijit Chandra, Brajesh Mishra, Saket Kumar, Vishal Gupta, Manoj
3
1
1
4
4
Srivastava, Noushif M, Sunil K Singh, Misra A Uday C Ghoshal, and
5
Pradeep K Srivastava
1
2
3
Departments of Surgical Gastroenterology, Plastic Surgery, Surgical
5
Oncology, and Radiotherapy, King George’s Medical University,
4
Lucknow, India; and Department of Gastroenterology, Sanjay Gandhi
Post-Graduate Institute of Medical Sciences, Lucknow, India
Department of Gastroenterology, Apollo Hospitals, Chennai, India
Background/Aims: Fecal incontinence is associated with significant impairment of quality of life. Apart from obvious cases, a considerable proportion is under-recognized. Careful clinical history, digital rectal examination and anorectal high-resolution manometry
(HRM) can unearth sphincter dysfunction. We aimed to study the
clinical profile and HRM findings in patients with symptoms of fecal
incontinence at a tertiary referral center, seen over a period of eight
months.
Methods: All patients referred to our motility lab with history suggestive of fecal incontinence, were included. A detailed history with
emphasis on obstetric history and peri-anal/spinal surgeries, was taken; this was followed by physical examination including digital rectal
examination. All patients underwent anorectal HRM (16 channel water perfusion) at our motility lab. Basal and squeeze pressures were
recorded. Patients with low squeeze (less than twice that of basal pressures) were diagnosed to have external anal sphincter dysfunction
(EASD), and those with low basal (less than 40 mmHg) and low
squeeze pressures were diagnosed to have combined (internal and external) anal sphincter dysfunction (CASD). The findings on anorectal
endoscopic ultrasonography (EUS) in patients who underwent the
same were recorded. Fifty patients without symptoms suggestive of
sphincter dysfunction and with normal anorectal HRM, were taken as
controls. SPSS version 16 was used for statistical analysis.
Results: A total of 41 patients were included in the study. Thirty
(73.2%) patients were female with mean age of 41.9 ± 9.5 years and
11 were males (26.8%) with mean age of 49.9 ± 13.3 years. The most
common symptom was urge incontinence (97.6%) followed by fecal
urgency (63.4%) and straining at stools (31.7%). In addition, 29.3%
of patients had complained of fecal soiling and 19.5% had resorted to
digital maneuvers for defecation. Out of 28 parous women, 12 had
history of prolonged delivery (42.9%), 8 had instrument/assisted delivery (28.5%) and 10 had episiotomies (35.7%); four of these women
had undergone pelvic floor repair surgeries. Among the women, other
relevant surgeries were fistulectomy and spinal surgery. Among the 11
male patients, 6 (54.5%) had undergone peri-anal surgeries (hemorrhoidectomy, fistulectomy, anal stenosis correction, and rectopexy). On
HRM, the mean basal anal sphincter pressure was 43.4 mmHg and
Backgournd/Aims: Technique and initial outcome of perineal antropyloric valve transposition to restructure an irreparably damaged or
an excised anorectal sphincter has been reported previously. Use of
antropyloric valve for total anorectal reconstruction had reasonable
outcomes but lacked voluntary control. We hereby report the initial results of patients who underwent gracilis muscle wrapping around the
transposed antropyloric valve in an attempt to improve voluntary fecal
control.
Methods: This study was conducted at a single tertiary care
institution. Eight adult patients (7 males and 1 female) with a mean
age of 37 years (range 19-50 years) underwent this procedure. Seven
patients already had prior anorectal reconstruction with transposed antropyloric valve and one patient with severely damaged anal sphincter
complex underwent single stage composite antropylorus transposition
with gracilis muscle wrap. The primary outcome measures were anatomical integrity and functional status of the composite graft in the
perineum.
Results: This procedure was performed in 8 patients. No operative
mortality or serious procedure-related morbidity occurred in any
patient. The median postoperative resting pressure was 29 mmHg
(range 22-38 mmHg) and squeeze pressure was 72.5 mmHg (range
45-267 mmHg). Improvement in the squeeze pressures was clearly
evident following surgery, though it couldn't reach the level of statistical significance (P = 0.070). The St. Mark’s hospital incontinence
scores significantly improved in all patients and varied between 7 and
9 (P = 0.004). On personal interviews, all patients who underwent
this procedure were pleased with result of their surgery. A longer follow-up with a larger sample size is required and quality of life data has
not been evaluated in this study.
Conclusions: Gracilis muscle wrapping around perineally transposed antropyloric valve improves the voluntary control and overall
functional outcomes in a selected group of patients with end-stage fecal incontinence, requiring anal replacement.
S25
ANMA 2015 India
Selected Poster Presentation
mean squeeze pressures was 64.4 mmHg. EASD was diagnosed in 22
(53.7%) patients, while CASD in 19 (46.3%). Mean basal and
squeeze pressures in patients with EASD were 55.55 mmHg and 80.6
mmHg and in patients with CASD, were 29.42 mmHg and 45.75
mmHg respectively. The mean basal sphincter pressure of normal
controls was 64.5 mmHg and the mean squeeze pressure was 147
mmHg. The mean basal and squeeze pressure of all patients with incontinence (EASD + CASD) was significantly less than that of controls (P ＜ 0.001 both). Three patients had undergone anorectal endoscopic ultrasonography; external anal sphincter defect was confirmed
in 2 patients while combined defect was seen in 1 patient.
Conclusions: Urge incontinence and fecal urgency are important
symptoms of anal sphincter dysfunction, which would have been otherwise managed as diarrhea-predominant irritable bowel syndrome
(IBS-D). Prolonged vaginal/assisted deliveries and perianal surgical
interventions are important causes for development of anal sphincter
damage, and hence a careful history is important. Anorectal HRM
helps in the diagnosis of anal sphincter dysfunction and to offer appropriate therapy.
No. 7
High-resolution Manometric Profile of
Patients With Solitary Rectal Ulcer Syndrome
Preethi Mahalingam, Seshadri Venkatesh Parthasarathy,
Piramanayagam Paramasivan, Ubal Dhus, Prem Kumar Karunakaran,
Revathy Marimuthu Shanmugam, Hariharan Muthuswamy, Sarojini
Ashok Parameswaran, Usha Srinivas, Mohan Arumugam Thiravia,
Natarajan Murugan, Bharat Kumar Mookiah, and Kallipatti
Ramaswamy Palaniswamy
Department of Gastroenterology, Apollo Hospitals, Chennai, India
Background/Aims: Solitary rectal ulcer syndrome (SRUS) is
postulated to be outcome of a combination of pelvic floor dysfunction,
obstructed defecation and rectal mucosal ischemia. Symptoms suggestive of dyssynergic defecation are frequently noted in patients with
SRUS, if quizzed closely. There are very few studies which have
looked into the prevalence of dyssynergic defecation in patients with
SRUS. We aimed to study the prevalence of dyssynergic defecation in
patients with biopsy proven SRUS, at our tertiary care centre.
Methods: Patients, who were diagnosed to have SRUS based on
colonoscopy and confirmed on biopsy, over the last 8 month period,
were taken as cases. All patients underwent ano-rectal high-resolution
manometry (HRM; 16 channel water perfusion) at our motility Lab.
Basal anal sphincter pressures and squeeze pressures were measured;
the pattern of pressure change on straining and at attempted balloon
expulsion was noted. Dyssynergic defecation was diagnosed when patients had absent/inadequate relaxation or paradoxical increase of anal
sphincter pressures, in response to straining and balloon expulsion
with inability to expel 50 cc balloon and were classified into 3 types.
Fifty patients with normal colonoscopy and normal ano-rectal manometry served as controls. All patients who had dyssynergic defecation
were suggested bio-feedback therapy. SPSS version 16 was used for
statistical analysis.
Results: A total of 21 patients with biopsy proven SRUS were
studied. Mean age was 20.5 years and 61.9% were females. 90.5 % of
patients had sense of incomplete evacuation and strained at stools, 85.7
% resorted to digital evacuation of stools. Peri-rectal bleeding was seen
in 87% and pain on defecation in 47.6%. On colonoscopy 13/21
(61.9%) had ulcers, 7/21 (33.3%) had rectal erosions and/or erythema
and 1/21 (4.7%) had polypoidal mucosa. 71.4% (15/21) of patients
had dyssynergic defecation on HRM. The mean basal pressure in patients was 66 mmHg and mean squeeze pressure was 146.3 mmHg;
the values when compared with those of normal controls (64.5 and 147
mmHg respectively), was not statistically significant (P = 0.601 and
P = 0.925 respectively). High anal dyssynergic pattern was seen in all
patients. Of all the patients only 2 patients came for biofeedback
therapy.
Conclusions: The prevalence of dyssynergic defecation is 71.4% in
patients with SRUS which is higher than in general population. The
basal anal sphincter pressures of these patients are not significantly
higher than in normal controls. All patients with SRUS would benefit
from ano-rectal HRM.
S26
ANMA 2015 India
Selected Poster Presentation
No. 9
No. 10
Utility of High-resolution Anorectal
Manometry in Children With Chronic
Constipation
Characteristics of Anorectal Dysfunction in
Patients With Solitary Rectal Ulcer Syndrome:
Assessment by High-resolution Manometry
Jaya Agarwal, Rakesh Kalpala, Santosh Darisetty, and D Nageshwar
Reddy
Alok Sangam, Ashok Dalal, K Arivarasan, Sanjeev Sachdeva, and AS
Puri
Asian Institute of Gastroenterology, Somajiguda, Hyderabad, India
Department of Gastroenterology, GB Pant Hospital, New Delhi, India
Background/Aim: Solitary rectal ulcer syndrome (SRUS) is an uncommon chronic benign disorder associated with typical histological
features and disturbed defecatory behavior. There is scanty data regarding high-resolution manometric characteristics of this enigmatic
anomaly. We aimed to evaluate the clinical profile and manometric
features in patients with SRUS.
Methods: Twenty-nine patients with biopsy proven SRUS underwent symptom assessment, anorectal high-resolution manometry
(HRM) and balloon expulsion test (BET). Fourteen healthy controls
(HC) also underwent anorectal physiological tests. HRM was performed using 16-channel anorectal manometry catheter perfused with
water using a pneumatically activated manometric pump. Analysis was
done using Trace software.
Results: Median age of patients (31 years, range 16-47 years) was
comparable to controls (32 years, 18-49 years) (P = 0.410). Patient
group was similar to HC in gender distribution (female 18/29
[62.1%] vs 9/14 [64.3%], P = 0.880). The median duration of
symptoms at presentation in patients with SRUS was 3 (1-7) years.
The symptoms at presentation included rectal bleeding (28/29
[96.6%]), constipation (27/29 [93.1%]), straining at defecation
(24/29 [82.8%]), feeling of incomplete evacuation (19/29 [65.5%]),
digitation to evacuate stools (10/29 [34.5%]), passage of mucus in
stools (8/29 [27.6%]), abdominal bloating (6/29 [20.7%]), and tenesmus (5/29 [17.2%]). Anal resting and squeeze pressures were similar in the two study groups, and all the study subjects had normal recto-anal inhibitory reflex (RAIR). Rectal sensory thresholds were lower
in patients as compared to HC (P＜ 0.02). During attempted defecation, dyssynergia was observed in 17/29 (58.6%) patients with SRUS
(P ＜ 0.001). Prolonged balloon expulsion time (＞ 1 minute) was
more frequent in the patient group as compared to controls (19/29 vs
1/14, P ＜ 0.001).
Conclusions: Rectal bleeding, constipation and straining at defecation were the most frequent symptoms in patients with SRUS. Rectal
hypersensitivity, dyssynergic defecation and prolonged balloon expulsion time were the salient abnormalities observed on anorectal
physiological testing in SRUS.
Background/Aims: Childhood constipation is a common problem
accounting for 30% of visits to pediatric gastroenterologist. Only
5-10% of patients has organic cause, with Hirschprung disease (HD)
as the major one. Anorectal manometry (ARM) is a non-invasive tool
to demonstrate recto-anal inhibitory reflex, which is absent in children
with HD. There is scant literature on utility of ARM in management
of chronic constipation in young children.Aim: The aim of the present
study was to evaluate the role of high resolution ARM in young children ≤ 5 years of age with constipation at a tertiary care referral
centre.
Methods: Consecutive patients ≤ 5 years of age who underwent
anorectal manometry for chronic constipation from August 2012 to
August 2014 were identified. Demographic data, manometry findings
and subsequent outcome were recorded.
Results: A total of one hundred and thirty seven cases (mean age 3
± 1.2 years, 80 [58.3%] boys] were evaluated. Barium enema done
elsewhere was reported as suspicious for HD in 40/137 (29%) cases.
The mean basal resting pressure was measured 55 ± 20 mm Hg with
no difference observed with respect to gender or final diagnosis. Of
these 137 cases, 12 (8.7%) had absent rectal anal inhibitory reflex suggestive of HD. Of them, 10/12 cases had absent ganglion cells on rectal biopsy confirming diagnosis of HD and subsequently underwent
surgery. All ARM procedures were done under midazolam sedation
with no intra or post procedure adverse events.
Conclusions: High definition ARM is reliable and safe tool in
management of chronic constipation in young children.
S27
ANMA 2015 India
Selected Poster Presentation
No. 11
No. 14
Profile of Anorectal Manometry in Patients
With Dyssynergic Defecation
Endoscopic Management of Sphincter of
Oddi Dysfunction: A Single Center
Experience From India
Akash Shukla, Megha Meshram, Prashant Dhore, and Shobna Bhatia
1
Department of Gastroenterology, Seth G S Medical College and K E M
Hospital, Mumbai, India
Background/Aims: Dyssynergic defecation (DD) is a frequently
encountered problem in procedure. The clinical features do not often
correlate with anorectal manometry (ARM) findings. No data are
available from India on the ARM findings in patient with dyssynergic
defecation. We prospectively evaluated the ARM findings in patients
with DD and their correlation to symptoms.
Methods: Sixty conservative patients (43 male, mean age 36.5
years) with dyssynergic defecation were diagnosed by symptoms of obstructed defecation and normal sigmoidoscopy included in the study.
Anorectal manometry was performed using Water perfusion (Trace
1.2, Australia) system. Baseline/squeeze sphincter pressures and rectal
balloon expulsion were carried out. Based on manometric abnormalities, patients were classified as having Type I-IV dyssynergia. Those
patients who could not expel balloon with 50 g weight within one minute were considered as abnormal.
Results: Mean age of women was higher (42.5 vs. 36.5 years, P =
0.016. Median frequency of stools was 1/day (range 0.1-8). 10 patients had stool frequency ＜ 1/day. 6 patients had ＜ 3 bowel movements/week. Mean sphincter pressure was 58.8 (14.8) mmHg and
squeeze pressure was 113.1(60.0) mmHg. Balloon expulsion was abnormal in 51 patients, and in all patients with bowel frequency ＜
3/week. Baseline and squeeze pressures were highest in patients with
Type I DD (P = 0.039). None of the symptoms correlated with type
of DD.
Conclusions: Type 1 is the commonest type of defecatory disorder.
Only 1 patient with type II was found in our series. Clinical symptoms
were not useful for predicting abnormal balloon expulsion test.
1
2
1
3
S K Sinha, J Samanta, A Bhatachraya, R Prasada, A Lal, P K
1
1
1
Siddappa, N Berry, and R Kochhar
Departments of 1Gastroenterology, 2Nuclear Medicine, and
3
Radiodiagnosis, PGIMER, Chandigarh, India
Background/Aims: Sphincter of Oddi dysfunction (SOD) leads to
pancreatobiliary pain, cholestasis, and/or pancreatitis. Management
with endoscopic sphincterotomy (ERCP-ES) has been reported mostly from developed countries. The aim of this study was to evaluated the
outcome of SOD patients treated with ERCP-ES.
Methods: Study included all patients presenting with features of
“presumptive” SOD according to modified Milwaukee classification
between April 2012 and July 2014. All these symptomatic patients had
estimation of pancreatic enzymes and alkaline phosphatase, CT scan
and MRI of abdomen. SOD was confirmed by hepatobiliary scintigraphy scan (Sostre score). Patients were treated with endoscopic
sphincterotomy (biliary and pancreatic).
Results: Eleven patients (7 males, age 36.9 ± 13.5 years) were seen
during study period. Five patients (45.5%) had chronic pain abdomen
while 6 (54.5%) had history of recurrent acute pancreatitis. Mean
Sostre score was 7.3 ± 1. Three (27.3%) were opium addicts. While
common bile duct was dilated in all 3, pancreatic duct was dilated in 2
patients. All patients underwent pancreatic and biliary sphincterotomy, pancreatic stent (5 Fr) was placed in 4 (36.4%). Five (45.5%)
developed post ERCP pancreatitis (PEP)−2 (18.2%) were moderately severe, rest were mild and all improved with conservative
management. During a median follow up of 6 months, 2 (18.2%) patients had recurrence of symptoms.
Conclusions: SOD can be effectively managed with ERCP with
endoscopic sphincterotomy but is commonly associated with post
ERCP pancreatitis.
S28
ANMA 2015 India
Selected Poster Presentation
No. 16
No. 17
Elevated Somatosensory Glutamate-Glutamine
Levels in Functional Dyspepsia: Preliminary
Magnetic Resonance Spectroscopy Findings
Gut Bacterial Infection Does Not Affect
Experience-specific Memory
1
Arthur D P Mak, J C Y Wu, D K Yeung, D F Wang, W C W Chu, Y
Chan, F Fang, S Lee, and L C W Lam
Institute of Digestive Diseases, Department of Radiology and Department
of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR,
China
1,2
Cheng-Che Hung, Chia-Fen Tsai,
1,5
Lu
3,4
Ying-Chieh Tsai,
and Ching-Liang
National Yang-Ming University
Background/Aims: In post-prandial distress syndrome (FD-PDS),
brain imaging has shown elevated resting activity and impaired structural connectivity between regions involved in homeostatic-interoceptive processes (insula, somatosensory cortex [SSC]) and descending sensory modulation (pregenual anterior cingulate cortex [pgACC]).
Excitatory glutamatergic transmission may underlie these changes,
but has not been studied on FD-PDS. The aim of this study was to
compare the glutamate-glutamine (Glx) concentration of the left insula, SSC and bilateral pgACC between FD-PDS female patients and
healthy controls, and assess their correlation with dyspeptic, anxiety
and depressive variables.
Methods: Adult FD-PDS (Rome III) female patients and
age-matched healthy controls were recruited for proton magnetic resonance spectroscopy (1H-MRS). We excluded gastroesophageal reflux
disease, irritable bowel syndome, severe medical or psychiatric illnesses, Helicobacter pylori infection, substance abuse, use of psychotropic drugs, NSAID or proton pump inhibitor or drugs affecting gut
motility, and presence of metal in the body. 1H-MRS was done with
voxels in bilateral pgACC, left Insula, and left SSC. Relative metabolic concentrations of Glx to total creatine + phosphocreatine (Cr +
PCr) were computed for cases with chronic recurrent multifocal osteomyelitis (CRMO) ≤ 20%. A standardized questionnaire measured
dyspeptic symptom severity (0-4). Depressive (Montgomery Åsberg
Depression Rating Scale [MADRS]) and anxiety (Hamilton Anxiety
Rating Scale [HAM-A]) symptoms were rated by a trained clinician
interviewer.
Results: Eighteen FD-PDS (mean age 44.94 ± 9.47 years) female
patients were matched with 18 healthy female controls (mean age
44.94 ± 9.86 years). Mean duration of FD-PDS was 11.19 years.
FD-PDS subjects had elevated global dyspeptic symptom (0.94 vs
0.32, P ＜ 0.001), HAM-A (17.89 vs 2.17, P ＜ 0.001) and
MADRS (5.17 vs 0.56, P = 0.020). FD-PDS subjects had significantly elevated Glx/Cr + PCr in the SSC (17 FD-PDS vs 18 controls included, 1.77 ± 0.22 vs 1.60 ± 0.14, P = 0.020, Cohen’s D =
0.920). No significant differences were observed in the insula or
pgACC. In FD-PDS subjects, SSC Glx/Cr + PCr significantly correlated with dyspeptic illness duration (r = 0.580, P = 0.020) but not
global dyspeptic symptom severity, HAM-A or MADRS scores. In
multivariate analysis, HAM-A but not MADRS scores abolished significance of the between-group differences in Glx/Cr + PCr.
Conclusions: Increased excitatory glutamatergic transmission in
the left somatosensory cortex was found in FD-PDS, apparently
mediated by anxiety and chronicity of dyspepsia.
Background/Aims: Gut bacterial infection has been reported to impair
1
memory upon pre-exposure to stress. However, the underlying neuronal
mechanisms behind the memory changes are still poorly defined. We tested the hypothesis that gut bacterial infection with stress would affect the
neuronal activation in hippocampus upon memory re-exposure.
Methods: Evironmental enrichment (EE) was used as a model of
contextual experience memory stimuli. The mice were re-exposed to
the EE context 4 weeks after the first EE exposure. Experience-specific memory to EE was measured by colocalizaiton of immediately
early gene (c-fos, markers for neuronal activity) and BrdU (markers
for neurogenesis) in the neurons (NeuN) of dendate gyrus (DG) in
hippocampus. The effects of Citrobacter rodentium infection with or
without stress on this specific contextual memory were examined.
Results: (1) EE significantly enhanced hippocampal neurogenesis
+
+
(increased numbers of BrdU /NeuN cells, P ＜ 0.01) in the DG
neurons. (2) Re-exposure to the contextual of the same EE condition
for 2.5 to 4 hours would not only significantly induced neural activity
+
+
(c-fos /NeuN ; P ＜ 0.001) but also retrieved an experience-specific
memory (BrdU+/c-fos+/NeuN+; P ＜ 0.05). This phenomenon indicated an enhanced response to a contextual experience memory. (3)
+
+
+
The cell counts of BrdU /c-fos /NeuN did not change after C. rodentium infection in combination, no matter with or without stress.
Conclusions: Gut bacterial infection, independent of stress, did not
to affect the experience-specific contextual memory encoded in adult
neurogenesis of hippocampus, suggesting a relatively stable encoding
in adult-born neurons during EE-related memory recall.
Reference
1. Gareau MG, Wine E, Rodrigues DM, et al. Bacterial infection
causes stress-induced memory dysfunction in mice. Gut 2011;
60: 307-317
S29
ANMA 2015 India
Selected Poster Presentation
No. 18
No. 19
Modulation of Gut-Brain Axis and Tryptophan
Metabolism by Bacteria Associated With
Small Intestinal Bacterial Overgrowth-Irritable
Bowel Syndrome
Prevalence of Fructose Malabsorption in
Patients With Irritable Bowel Syndrome After
Excluding Small Intestinal Bacterial
Overgrowth
Pallavi Lahiri and Dipankar Ghosh
Kee Wook Jung
Center for Molecular Medicine, Jawaharlal Nehru University, ArunaAsaf Ali
Marg, New Delhi, India
Department of Gastroenterology, Asan Medical Center, University of Ulsan
College of Medicine, Seoul, Korea
Background/Aims: The mammalian tryptophan metabolism generates many intermediates with potent neurological properties and diverse functions. At least one of these intermediates, serotonin (5-HT)
is accepted as a fundamental determinant of gut health and disease
(irritable bowel syndrome [IBS]). However, it is increasingly evident
that other tryptophan metabolic intermediates produced both by the
host and gut microbiome, may play more subtle yet physiologically
significant roles in bidirectional communication in the gut-brain axis.
Methods: Using co-culture models on intestinal Caco-2 cells and
Mass Spectrometry based metabolomics, we demonstrate that specific
species of bacteria often reported in small intestinal bacterial overgrowth (SIBO) mediated irritable bowel syndrome (IBS), dysregulate
the host tryptophan pathway.
Results: The SIBO bacteria modulate production of 5-HT, kynurenine, kynurenic acid, 3-hydroxykynurenine, or quinolinic acid in the
colonized epithelial microenvironment. The latter 2 exhibit potent
neurotoxic properties. SIBO bacteria also actively modulate host epithelial innate immunity and defensin production.
Conclusions: Together these present new insights in the mechanism of SIBO-IBS pathophysiology.
Background/Aims: Fructose malabsorption (FM) mimics the
symptoms of irritable bowel syndrome (IBS), and its prevalence has
rapidly increased because of the frequent use of fructose in food
products. However, diagnosing FM in IBS is challenging because of
its overlap with small intestinal bacterial overgrowth (SIBO) and the
differences among fructose dosage cutoffs that distinguish between
FM and normalcy, especially in Asian individuals, in hydrogen breath
testing (HBT). We assessed the prevalence of FM by comparing patients with IBS with asymptomatic control individuals after excluding
SIBO using the glucose HBT. We also evaluated the effective fructose dosage for HBT. In addition, we assessed the differences between
the dietary habits of patients with IBS and asymptomatic control
individuals.
Methods: From December 2011 until November 2012, patients
with IBS were identified using the Rome III questionnaire, and the
asymptomatic control individuals were prospectively enrolled in the
study. Dietary habits were determined using the food frequency questionnaire and responses were analyzed using a computer-aided nutritional analysis program. After excluding SIBO using the 75-g glucose
HBT, the enrolled participants were tested using both the 15- and
25-g fructose HBTs, with an interval of at least 1 week.
Results: After excluding SIBO-positive patients and those that
dropped out of the study during follow-up (n = 18), 35 patients with
IBS (male:female [M:F] = 16:19, mean age 43 ± 14 years) and 35
asymptomatic control individuals (M:F = 18:17, mean age 38 ± 11
years) were enrolled in the study. The 15-g fructose HBT yielded positive results in seven of the 35 (20.0%) patients with IBS and in 2 of 35
(5.7%) asymptomatic control individuals (P = 0.070). The 25-g fructose HBT yielded positive results in 16 of the 35 (45.7%) patients with
IBS and in eight of the 35 (22.9%) asymptomatic control individuals
(P = 0.040). CAN analysis of the FFQ responses showed no significant differences between the 2 groups in relation to total calorie intakes, and protein, lipid, carbohydrate, and fructose consumption.
However, patients with IBS showed a significantly higher mean fiber
intake than that of the control individuals (21.24 ± 11.35 g in patients
with IBS vs 15.87 ± 7.07 g in asymptomatic control individuals, P =
0.040).
Conclusions: Use of the 25-g fructose HBT enabled identification
of FM in a significantly higher percentage of SIBO-negative patients
with IBS than in asymptomatic control individuals, suggesting that
FM is closely correlated with IBS. Education regarding dietary control of foods containing fructose may be useful for the management of
patients with IBS.
S30
ANMA 2015 India
Selected Poster Presentation
13
DOB C‰
values with the profiles of IBS-D patients presenting positive SIBO, indicating HBT often fails to diagnose of SIBO, when
patients harbouring possibly “non-hydrogen-production” bacteria or
hydrogen consuming bacteria in the small intestine. Moreover, when
an individual is just at the acute onset of SIBO or falls within the
13
"grey-zone," the significant level of the statistical analysis of δDOB
C‰ measurements was more robust (P ＜ 0.001) compared to the
statistical level of histamine H2 measurements (P = 0.240). Finally,
the prevalence of SIBO in IBS-D patients from India was found to be
45.7%, suggesting a close association between IBS-D patients and
SIBO syndrome.
13
Conclusions: These findings demonstrate that C-GBT is a clinically valid and sufficiently robust alternative non-invasive diagnostic
methodology for the accurate evaluation of SIBO in IBS-D patients
and is superior to the widely used HBT.
No. 21
Non-invasive Diagnosis of Small Intestinal
Bacterial Overgrowth in
Diarrhea-predominant Irritable Bowel
Syndrome Patients Using High-precision
Stable 13CO2/12CO2 Isotope Ratios in Exhaled
Breath
1
2
2
Gourab Dutta Banik, Sunil B Daschakraboty, Sujit Chaudhuri, and
1
Manik Pradhan
1
Department of Chemical, Biological and Macromolecular Sciences, S.N.
Bose National Center for Basic Sciences, Salt Lake, Kolkata, India; and
2
Department of Gastroenterology, AMRI Hospital, Salt Lake, Kolka, India
Background/Aims: At present, Hydrogen breath tests (HBT) are
widely used for diagnosis of small intestinal bacterial overgrowth
(SIBO) in patients with irritable bowel syndrome (IBS). However the
conclusions drawn from the studies are controversial and several discrepancies exist in the results as there are numerous intrinsic drawbacks, limitations and pitfalls. The aim of our study was therefore
13
13
3-fold: (1) to develop an alternative C-glucose breath test ( C-GBT)
13
12
methodology by measuring high-precision CO2/ CO2 stable isotope
ratios in exhaled breath using an optical cavity-enhanced CO2 isotope
analyzer to accurately diagnose SIBO in IBS patients, (2) to evaluate
13
the clinical efficacy of C-GBT for "non-hydrogen-production" individuals and during the preclinical phase or at the acute onset of
SIBO and finally, and (3) to explore the prevalence of SIBO in diarrhea-predominant IBS (IBS-D) patients from India and their poten13
tial link assessed by C-GBT.
Methods: A total number of 118 IBS-D patients with suspected
SIBO diagnosed according to Rome III criteria were selected for
13
C-GBT. Patients ingested the test meal containing 50 mg 13C enriched glucose with 50 g normal glucose dissolved in 250 mL of water.
Concentration of hydrogen levels (ppm) and high precision
13
CO2/12CO2 isotope ratio in exhaled breath were measured in every
15 minutes intervals for 180 minutes.
13
Results: In the first series of experiments, the excretion of CO2
13
isotopic enrichment, expressed in delta-over-baseline (δDOB) C‰, in
exhaled breath samples depleted more in case of IBS-D individuals (n
= 25) with suspected SIBO (positive HBT) compared to the IBS-D
patients (n = 53) without SIBO (negative HBT). We obtained that
13
there were statistically significant differences of the δDOB C‰ values
13
(P ＜ 0.001) and cumulative percentage dose of C-recovered (P ＜
0.001) at 45 minutes in breath samples between positive and negative
SIBO patients, suggesting 13C-GBT is an alternative diagnostic tool
13
for detection of SIBO. An optimal diagnostic cut-off level of δDOB
C‰ ≤ 5.47‰ at 45 minutes is indicative of positive SIBO. In the
second series of experiment, a group of (n = 20) IBS-D individual
whose HBTs are negative followed the similar excretion profiles of δ
S31
ANMA 2015 India
Selected Poster Presentation
No. 27
No. 28
Gut-directed Hypnotherapy Is Superior to
Drug Therapy in the Management of
Diarrhea-predominant Irritable Bowel
Syndrome: A Randomized Controlled Study
Psychological and Dietary Factors Exacerbate
Symptoms of Irritable Bowel Syndrome
Sivaprasad Punnaveetil and Varghese Thomas
Department of Gastroenterology, Government Medical College,
Kozhikode, Calicut, India
Sandeep Kunhikannan and Varghese Thomas
Department of Gastroenterology, Government Medical College,
Kozhikode, Kerala, India
Background/Aims: Irritable bowel syndrome (IBS) is a chronic
disorder without any definite cure. Many treatment options are available, which of all are not satisfactory. We studied the efficacy of placebo, amitriptyline, loperamide, and gut-directed hypnotherapy in diarrhea-predominant IBS (IBS-D) in a randomized controlled trial.
Methods: Seventy-three consecutive patients with IBS-D (Rome
III) criteria were studied. They received therapy for 6 weeks with either placebo (Group A), amitriptyline 10 mg (Group B), loperamide 2
mg (Group C), or GHT (Group D). Reassessment of pain, bowel frequency, general well being, toilet time per week and quality of life
(QOL) were done at 3 weeks, 6 weeks, and 3 months.
Results: The baseline characteristics were similar in all groups.
Regarding abdominal pain and general well being, short-term benefit
was observed in all groups except group A, while long-term benefit
was observed only in group D. Average stool frequency was found to
be significantly reduced in group D (P = 0.003). Compared to placebo, total toilet time spent for defecation was found to be reduced in all
groups. At 6 weeks, the change in QOL was statistically significant in
group B and C as against placebo; but this effect was not seen at 3
months. Long-term efficacy and sustained improvement in QOL was
observed only in Group D at 3 months (P = 0.004).
Conclusions: Gut-directed hypnotherapy is more effective than
medical therapy in IBS-D patients. Both loperamide and amitriptyline
provided significant relief of symptoms initially and there were no statistically significant difference in the benefits obtained between these
drugs.
S32
Background/Aims: Irritable bowel syndrome (IBS) is a chronic
disorder lasting for many years, but very often the patients seek medical care when they experience exacerbation of symptoms. We analyzed
the role of various psychological and dietary factors in the exacerbation
of symptoms of IBS.
Methods: One hundred consecutive patients with IBS who satisfied the Rome III criteria were enrolled in this cross-sectional study.
Patients were evaluated to rule out organic causes. Detailed dietary
history was obtained and a questionnaire containing the presumptive
stressful life events scale (PSLES) and the hospital anxiety and depression scale (HADS) was utilized.
Results: Mean age of the cohort was 30.74 ± 9.31 years. The male
to female ratio was 68:32. 62% patients had diarrhea-predominant
IBS, 28% had mixed IBS, and 10% had constipation-predominant
IBS. Mean stool frequency of diarrhea-predominant IBS patients was
4.5/day versus 1.9/week for constipation-predominant IBS. Mean
PSLES score of the patients was 262.21 ± 143.86, indicating high
level of stress. Moderate to high scores for anxiety and depression
were documented. Higher scores of PSLES, HADS-Anxiety, and
HADS-Depression were associated with increased stool frequency.
However statistical significance was achieved only for HADS-A
scores (P = 0.050). Mean PSLES and HADS-D scores were significantly higher for patients with psychiatric illness (P = 0.007 and P
= 0.027 respectively). Majority of subjects (96%) consumed a spicy
diet and 67 (69.8%) subjects reported subjective symptomatic improvement after reducing the spices in their diet.
Conclusions: High levels of stress, anxiety and depression were
noted in patients suffering from IBS. Majority of patients noted relief
of symptoms on reduction of spices in their diet.
ANMA 2015 India
Selected Poster Presentation
No. 29
No. 30
Different Distribution and Changes in the
Interstitial Cells of Cajal and Neuronal Nitric
Oxide Synthase With Age in the Proximal
and Distal Colon of F344 Rat
Brain-derived Neurotrophic Factor Induce the
Plasticity of the Structure and the Function
on the Mice Colon Smooth Muscle Cells
Nayoung Kim
Qilu Hospital, Shandong Province, China
Department of Internal Medicine, Seoul National University Bundang
Hospital
Jing Cao
Background/Aims: Brain-derived neurotrophic factor (BDNF) is
one member of neurotrophin family of proteins which is known for its
effect of neuronal survival, differentiation, migration, and synaptic
plasticity in central and peripheral neurons. Some studies have shown
that exogenous BDNF stimulate human gut motility in health and
constipation. Recently, the positive role of BDNF in gastrointestinal
motility has drawn increasing attentions. A mount of studies have
shown that BDNF could induce the plasticity of enteric neurons to affect the construction of colon but the study whether BDNF could
work on the smooth muscle cells directly is limited. The aim of the
present study was to investigate the effects of BDNF on the plasticity
of the structure and the function of the mice colon smooth muscle
cells.
Methods: First, the electron microscopy was used to investigate
muscular alterations in BDNF+/− mice controlled with BDNF+/+
mice, and the alpha smooth muscle actin (-SMA) which has been
manifested to be related with the contraction of the smooth muscle was
measured by Western blotting. Second, the primary mice smooth
muscle cells were cultured, and the immunofluorescence staining was
used to exam the expression of the high-affinity receptor of BDNF,
tropomyosin-related kinase B (TrkB) receptor. Third, BDNF and
TrkB antagonists (k252a) was used to intervene the mice smooth
muscle cells. The alteration of the mice smooth muscle cells structure
was examined by the electron microscopy, the expression of the TrkB
receptor, phospholipase C (PLC), and -SMA was examined by
Western blotting. Finally Intracellular Ca2+concentration ([Ca2+]i)
changes in myenteric neurons were monitored using Fluo-3.
Results: First, electron microscopy showed ultrastructural damage
on the smooth muscle cells of BDNF+/− mice. The cellular borders of
SMCs were characterized by multiple bulbous protrusions; the cell
bodies contained less myofilaments; and the interstitial gaps between
adjacent smooth muscle cells were focally widened. The levels of the
-SMA in BDNF+/− mice colon was obviously less than the control
group. Second, the colon smooth muscle cells expressed TrkB receptors, which was first time in the world to indicate BDNF could directly mediate the colon smooth muscle cell plasticity by TrkB signal
pathway. Third, BDNF could cause the ultrastructural alteration of
the colon smooth muscle cells, which is similar to the tissue mentioned
above. And the TrkB-PLC signal pathway proteins have changed under the effect of BDNF. Finally, BDNF could cause the [Ca2+]i increasing than the control, and K252a could suppress this phenomenon.
Conclusions: BDNF induce the plasticity of the structure and the
function on the mice colon smooth muscle cells by TrkB-PLC signal
pathway, and then can affect the contraction of the smooth muscle
cells.
Background/Aims: The disorder of motility such as constipation is
a common problem in the elderly. However, the time-course of the effect of aging on colon is not well established. We aimed to investigate
the difference of proximal and distal colon and the effect of aging between these two areas of colon in F344 rats.
Methods: The morphologic changes of colonic smooth muscle
were quantitatively measured using the image analysis system in F344
rats at 4 different ages (6-, 31-, 74-week, and 2-year-old) in the proximal and distal colon (each, n = 6). The immunoreactivity of c-Kit
and neuronal nitric oxide synthase (nNOS) in proximal and distal colon were also quantified. Furthermore, for functional study electrical
field stimulation (EFS) to circular muscle strips of proximal and distal
colon in organ bath was performed in young (31-week) and aged
(74-week) F344 rats.
Results: The intramuscular fat accumulation significantly increased with age after 31-week-old in both proximal and distal colon.
In terms of nNOS distribution the immunoreactivity was significantly
higher in the proximal colon than in the distal colon in the submucosal
border, circular muscle, myenteric plexus, and longitudinal muscle after 31 weeks (P ＜ 0.05). c-Kit distribution was significantly higher in
the distal colon than in the distal colon in the all ages (P ＜ 0.05). c-Kit
and nNOS immunoreactivity significantly declined with age (P ＜
0.05). However, the declination of the c-Kit immunoreactivity was
more prominent in distal colon than in proximal colon, but that of
nNOS was reverse. During the contractile recording, the spontaneous
contractile response in resting state was significantly decreased in distal colon (31 weeks, 6.30 ± 3.16 mN vs 84 weeks, 3.77 ± 2.08 mN)
but not in the proximal colon (young, 12.65 ± 7.95 mN vs senescent,
9.14 ± 4.05 mN). Under the non-adrenergic non-cholinergic
(atropine + phentolamine) condition, the relaxation was not inhibited
by apamin but by L-NG-Nitroarginine methyl ester (L-NAME) (P
= 0.000) in the distal colon.
Conclusions: There was a difference in terms of density of nNOS
and c-Kit between proximal and distal colon. The relative different decrease of interstitial cell of Cajal and nNOS (+) neuronal cells depending on proximal and distal colon in the aged rat might affect intestinal contraction, which could be related with frequent constipation
in the elderly. Further molecular study is undergoing.
S33
ANMA 2015 India
Selected Poster Presentation
No. 31
No. 33
Brain-derived Neurotrophic Factor Contribute
to Regulation of the Intestine Motility in
Functional Constipation
Searching for a Definition for Refractory
Constipation　Tengfei Wang, Xiuli Zuo, Hongbo Ren, Yanbo Yu, Feixue Chen, Han
Liu, Chao Liu, Qiujie Zhao, and Yanqing Li
1
Qilu Hospital of Shandong University, Jinan, Shandong, China
1
1
2
Alex Y S Soh, Kewin T H Siah, and Kok-Ann Gwee Department of Gastroenterolgy and Hepatology, National University
2
Health System, Singapore; and Department of Medicine, Yong Loo Lin
School of Medicine, National University of Singapore, Singapore
Background/Aims: Patients with severe chronic constipation are
usually selected for treatments such as biofeedback and surgery if they
fail medical treatment. We hypothesise that the definition of refractory
constipation is poorly defined, variable and the medical treatment applied may not even have proven efficacy.
Methods: We carried out a systematic review of the literature using
text word searches on Pubmed, EMBASE and Cochrane for studies
that were carried out in the last 10 years. The following search terms
were used: Constipation AND (Refractory OR Failed OR Colectomy
OR Biofeedback). All abstracts were reviewed and all relevant full
texts were retrieved. Studies relating to secondary constipation, faecal
incontinence, pediatric studies or studies where the definition for constipation was not mentioned, were excluded. Only those studies reporting chronic constipation or functional constipation were selected.
These studies were further scrutinized on how failed medical treatment was defined.
Results: PubMed, Cochrane, and EMBASE revealed 99, 24, and
4 results respectively. We excluded 91 studies. 36 relevant studies
were reviewed. There was no unifying criterion used to define refractory constipation. We found that refractory constipation was defined in many ways. Some papers used the Rome criteria, or modifications of it, with duration of symptoms ranging from 6 months to 5
years. Some studies also required patients to have failed interventions
such as fiber, laxatives, and enemas, while others required patients to
undergo investigations such as colonic transit test, imaging or
manometry. Only one study described the dose, frequency, and duration of medications tried before being considered as having failed
treatment.
Conclusions: Refractory constipation is ill-defined with very little
studies providing specific details on pharmacological agent, dose and
dosing frequency. A large number of studies applied the response to
fibre treatment, but given that it is largely ineffective in severe constipation, this is an inappropriate criterion. There is an urgent need to
define a validated criterion for refractory constipation.
Background/Aims: The manifestations of functional constipation
(FC) have the common ground of abnormal gastrointestinal motility
and intestinal smooth muscle reconstruction. Brain-derived neurotrophic factor (BDNF) is a membership of neurotropic factor family,
which is confirmed to express not only in CNS but also in intestinal
nerve plexus and mucosa. In FC patients, the expression of BDNF is
reduced compared with the healthy ones. A couple of confirmatory
clinical trials have shown the effect of combination human BDNF in
promoting the intestine motility and elevating defecation frequents. In
this research we investigated the effect of BDNF on intestine smooth
muscle cells and its cellular mechanism.
Methods: We isolated the primary myenteric neurons rapidly from
−/+
knockout C57/BL mice (n = 10, 4 weeks)
distal colon of BDNF
and wild-type mice (n = 10, 4 weeks), and cultured the neurons with
primary intestinal smooth muscle cells as stable co-culture cellular
-8
system. Separating this system into group A (treated with 10 M
-6
BDNF, 10 minutes), group B (10 M K252a pretreatment, 30 minutes) and the control group (0.9% NS treatment). Calcium imaging
was used to record the cytoplasmic Ca2+ concentration in smooth
muscles, and electrophysiological recording in whole cell mode helped
to shown ion flux and the excitability change.
Results: The primary myenteric neuron-smooth muscle cells
co-culture system could maintain the morphological stability and
physiological activity at 16-24 hours. (1) In calcium imaging recording, there was an increasing calcium transient in the group A SM cells
of knockout mice (F/F0, P < 0.05, n = 6) and wild-type group
2+
(F/F0, P < 0.05, n = 9). Meanwhile the range of Ca concentrate
change was greater in knockout mice than wild-type ones (P < 0.05).
These calcium transient could be suppressed by BDNF-trkB signal
-6
inhibitor K252a (n = 15, P < 0.05, 10 M). (2) In all electrophysiological recording, the patched cell was initially held at a -40 mV
command potential. In group A, we captured inward current (46 ±
-8
15 pA, P < 0.05, n = 9, 10 M BDNF) after treatment at 60 seconds, which could also be suppressed by K252a in group B.
Conclusions: BDNF and its downstream signal pathway appear to
2+
regulate the activity and Ca release of intestinal smooth muscle. It
could explain part of the pathogenesis of functional constipation.
S34
ANMA 2015 India
Selected Poster Presentation
No. 35
No. 37
The Evaluation of Peroral Esophageal
Myotomy for Achalasia
Correlation Between High-resolution
Manometry Metrics and Symptoms,
Symptomatic Outcomes of Peroral
Esophageal Myotomy in Achalasia　Hu Yue, Lu Bin, Li Meng, and Chu Li First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou,
China
Yu-Rong Tang, Mei-Feng Wang, Chen Xie, Liu-Qin Jiang, Rui-Hua Shi,
and Lin Lin　Department of Gastroenterology, the First Affiliated Hospital of Nanjing
Medical University, Nanjing, China
Background/Aims: To investigate the effect of peroral esophageal
myotomy (POEM) on esophageal dynamics in patients with achalasia.
Methods: From January 2012 to March 2014, a total of 35 patients
with achalasia received POEM at Endoscopic Center in the First
Affiliated Hospital of Zhejiang Chinese Medical University.
Esophageal dynamics of all patients were evaluated by high-resolution
manometry system preoperatively and one months after POEM the
test was repeated. The characteristic of esophageal motility of the two
tests were compared.
Results: After POEM, lower esophagus sphincter resting pressure
(LESP) decreased from 28.94 ± 18.70 to 16.02 ± 5.46 mmHg (P
＜ 0.001) and descend rate was 44.6%. Four-second integrated relaxation pressure (4s-IRP) decreased from 27.18 ± 14.63 to 12.22 ±
6.75 mmHg (P ＜ 0.001). Lower esophagus sphincter resting pressure (LESRR) decreased from 23.00 ± 18.55 to 12.22 ± 6.75% (P
＜ 0.05). Intrabolus pressure decreased from 11.02 ± 5.36 to 4.90 ±
4.55 mmHg (P ＜ 0.001). Distal contractile integral decreased from
2103.43 ± 1960.86 to 810.90 ± 1308.50 mmHg (P ＜ 0.05).
Esophageal body distal amplitude (average measurements at 3 cm and
7 cm above the lower esophageal sphincter) decreased from 26.21 ±
19.11 to 19.23 ± 9.74 mmHg (P ＜ 0.05). The variation value of
Eckhard score between pre- and post-POEM was correlation with the
decline of 4s-IRP (r = 0.372, P = 0.036). After POEM, a small segment of proximal esophageal peristalsis appeared in two patients but
was below normal level.
Conclusions: POEM can improve esophagogastric junction relaxation and affect esophageal body contraction in patients with achalasia,
but can not restore normal esophageal peristalsis.
Bckground/Aims: Achalasia is an esophageal motility disorder
characterized by failure of both esophagogastric junction relaxation
and esophageal body peristalsis. High-resolution manometry (HRM)
has improved the accuracy of manometry in detecting achalasia and
defined clinically relevant subtypes. Peroral esophageal myotomy
(POEM) is a novel endoscopic operation performed for the treatment
of achalasia. This study investigated whether HRM metrics correlate
with achalasia symptoms and symptomatic outcomes of POEM.
Methods: Thirty patients with achalasia without previous surgery,
and who underwent HRM were enrolled. Twenty-five patients were
treated with POEM, and 12 patients repeat HRM 3 months after
POEM. All of the patients enrolled at the beginning were asked to
complete questionnaires that determined Eckardt scores at baseline,
and symptoms of patients who treated with POEM were followed up
about 6 months after surgery. Pearson correlation was used to assess
the relationship of HRM metrics and Eckardt Scores at baseline,
HRM metrics at baseline and symptomatic outcomes of POEM,
HRM metrics changes, and Eckardt Score changes after POEM.
Results: Thirteen type I, 16 type II, and 1 type III achalasia patients were enrolled. At baseline, Eckardt scores and HRM metrics
(integrated relaxation pressure [IRP], lower esophageal sphincter
[LES] relaxation rate, LES length) were similar between type I and
type II achalasia except mean distal esophageal pressure in swallows (P
= 0.000), and panesophageal pressurization rate in type II achalasia
was raged from 20% to 100%. IRP was positively correlated with total
Eckardt scores (P = 0.016), regurgitation (P = 0.048), and weight
loss (P = 0.000) in all achalasia patients. And it was correlated with
weight loss in type I achalasia (P = 0.000). No correlation was found
between Eckardt scores and other HRM metrics. Twenty-five patients (10 patients with type I and 15 patients with type II achalasia)
were treated with POEM, and their total Eckardt scores and scores of
each symptom were decreased after surgery (vs before POEM, all P
＜ 0.05). Eckardt scores changes (Eckardt scores before POEM minus Eckardt scores after POEM) were no difference between type I
and type II achalasia. Eckardt scores and weight loss changes were
positively correlated with IRP at baseline (all P ＜ 0.05), and no correlation was found between other HRM metrics at baseline and
S35
ANMA 2015 India
Selected Poster Presentation
Eckardt scores changes. Twelve patients (4 patients with type I and 8
patients with type II achalasia) underwent HRM after POME, IRP
was changed significantly after POEM (vs before POEM, P =
0.005), and so were mean distal esophageal pressure changes in type II
achalasia (vs before POEM, P = 0.010). IRP changes (IRP before
POEM minus IRP after POEM) were positively correlated with
Eckardt scores changes (P = 0.029).
Conclusions: IRP correlates with symptoms and symptomatic outcomes of POEM in achalasia patients. HRM is an effective way to assess the severity of achalasia, and can be used to predict the efficacy of
POEM.
No. 38
Study on Effects of Electrical Stimulation on
Rabbit Esophageal Body Motility In Vivo　Lili Zhang, Wei Zhao, Chunshan Zhao, Hong Jin, Qi Yao, Guojian Zhou,
Xiaoxuan Xu, and Bangmao Wang　Department of Digestive Diseases, General Hospital, Tianjin Medical
University, Tianjin, China
Background/Aims: Abnormal esophageal motility was a prominent
mechanism for achalasia. Though there have been many methods to
relax lower esophageal sphincter (LES), the effective method to regain
peristalsis of esophagus still lack. Experiments have confirmed that
electric stimulation (ES) could induce contraction of smooth muscle.
While, if ES could induce peristalsis of esophagus was uncertain. The
aim of this study was to analyze the effects of ES on rabbit esophageal
motility and the related mechanism in vivo.
Methods: The study was performed on 12 rabbits. After anesthesia, esophagus was exposed and one pair of electrodes was implanted on esophageal subserosa in lower segment of esophagus, then
the electrodes were connected to an electrical stimulator. The electrical
stimulation signal was bipolar rectangular voltage trains, lasting for
3.0 seconds, with different current (1.0, 3.0, 5.0, and 10.0 mA), and
frequency (10.0, 20.0, and 50.0 Hz). The amplitude and scope of
esophageal contraction was recognized by the High-resolution manometry system. The effect of ES was tested under anesthesia and following intravenous administration of atropine (0.05 mg/kg), phentolamine (0.05 mg/kg), and L-NAME (50 mg/kg).
Results: ES induced an esophageal contraction on the stimulated
site. (1) From the current of 3.0 mA the contraction of esophagus
could be recognized, the most high pressure increased was 48.5 ± 1.3
mmHg with the frequency 50.0 Hz; with current 5.0 mA and frequency 50.0 Hz, the most high pressure increased was 49.1 ± 2.5
mmHg; with current 10.0 mA and frequency 50.0 Hz, the most high
pressure increased was 50.7 ± 2.4 mmHg, the difference was significant (P = 0.002). (2) The latency period between ES and contraction of esophagus was 50.0 ± 10.0 msec. The length of latency period was not influenced by stimulation parameters. (3) The esophageal
contraction caused by electrical stimulation was restricted to the stimulated point (the scope was 2.0 ± 0.2 cm, not influenced by stimulation
parameters). (4) During ES, atropine, phentolamine, and L-NAME
had no effect on the amplitude of esophageal contraction induced by
ES.
Conclusions: ES could induce esophageal contraction on the
stimulated site in vivo, following a quite short latency period, and this
effect was not mediated by neurotransmitters. The amplitude of
esophageal contraction was current and frequency dependent.
S36
ANMA 2015 India
Selected Poster Presentation
No. 40
No. 43
Effectiveness of N-acetylcysteine on the
Treatment of Achalasia
Symptomatic and Manometric Spectrum of
Esophageal Motility Disorders in a Tertiary
Care Institute in Northern India　Wei Zhao, Lili Zhang, Hong Jin, Lanlan Wu, and Bangmao Wang　Department of Digestive Diseases, General Hospital, Tianjin Medical
University, Tianjin, China
Background/Aims: Achalasia still lack effective treatments.
Especially, traditional medication was considered to be unsatisfactory.
Was there other medication which could help to cure achalasia? This
paper was to report a clinical finding, that N-acetylcysteine (NAC)
might be able to relieve symptoms of achalasia and reduce lower
esophageal sphincter pressure (LESP).
Methods: Eight patients with Achalasia (M:F = 5:3, age 43.2 ±
10.5 years) who take NAC (Flumucil effervescent tablet, 200 mg
tid)for the treatment of cough with phlegm were under observation.
The NAC treatment lasted for 2 weeks. The observation lasted for 4
weeks including NAC treatment period and the following 2 weeks.
During the observation, any other medication, especially traditional
medication for achalasia, such as nifedipine and isosorbide mononitrate, was abandoned, and all the patients were asked to keep their
previous diet and life style. The symptoms of achalasia were evaluated
by Eckardt score before treatment, at the end of the second week and
at the end of the fourth week. At the same time, high-resolustion
esophageal monometry were also taken, and the relaxation function of
lower esophageal sphincter (LES) was evaluated by 4-second integrated relaxation pressure (4s-IRP).
Results: At the end of NAC treatment, all patients reported an obvious relief of achalsia symptoms (Eckardt score: 10.2 ± 3.5 vs 6.4 ±
2.6, P = 0.001), and, interestingly, LESP were also reduced significantly (4s-IRP: 20.4 ± 6.2 mmHg vs10.4 ± 4.3 mmHg, P =
0.001). During the period, no side effects were observed. But, at the
end of the fourth week, there was a relapse both in achalasia symptoms
(Eckardt score: 9.2 ± 4.1 vs 6.4 ± 2.6, P = 0.001) and in LESP
(4s-IRP: 16.7 ± 4.4 mmHg vs 10.4 ± 4.3 mmHg, P = 0.001) compared with that at the end of second week.
Conclusions: NAC might relieve symptoms of achalasia. This effect might be relevant with the reduced LESP. But the mechanism
was still not clear.
Omesh Goyal, Monika Bansal, Ajit Sood, Varun Mehta, Sandeep S
Sidhu, and Rajoo S Chhina　Department of Gastroenterology, DMC and Hospital, Ludhiana, India
Background/Aims: Data on the spectrum of esophageal motility
disorders in Indian population is scarce. We aimed to study the symptomatic and manometric profile of patients with suspected esophageal
motility disorders.
Methods: Consecutive patients with esophageal symptoms and
normal esophago-gastro-duodenoscopy referred for esophageal manometry from 2010 to 2014 were included. High-resolution esophageal
manometry was performed with 22-channel water-perfusion system
(MMS). Chicago classification was used to classify motility disorders.
Results: Of the 304 patients studied (mean age 43.6 years, 61%
males), 161 presented with dysphagia, 122 with retro-sternal discomfort/pain and 22 with regurgitation. Out of the patients with dysphagia, 35.4% had weak peristalsis with large/small breaks, 27.3% had
achalasia cardia (AC), 8.7% had rapid contractions with normal latency, 6.2% had frequent failed peristalsis, 4.3% had diffuse esophageal spasm (DES), 0.6% had nut-cracker esophagus while 12.8%
had normal manometry. Of the patients with retro-sternal discomfort,
40.2% had weak peristalsis with large/small breaks, 8.2% had rapid
contractions with normal latency, 6.6% had AC, 4.1% had frequent
failed peristalsis while 39.3% had normal manometry. Duration of
dysphagia at presentation was longer in AC patients than those with
weak peristalsis (34.8 ± 33.5 months vs 16.4 ± 18.3 months, P =
0.052). Associated regurgitation and bolus obstruction were more frequent in patients with AC than those with weak peristalsis.
Conclusions: Dysphagia was the commonest esophageal symptom
followed by retro-sternal discomfort/pain at our centre. Among dysphagia patients, weak peristalsis was the commonest high-resolution
manometry finding followed by AC. Weak peristalsis was also the
commonest finding among patients with retro-sternal discomfort/pain, followed by rapid contractions.
S37
ANMA 2015 India
Selected Poster Presentation
No. 44
No. 45
The Safety of Gastrointestinal Endoscopist
Directed Flexible Endoscopic Evaluation of
Swallowing Study Is the Patient With
Oropharyngeal Dysphagia Spectrum of Esophageal Motility Disorders
on High-resolution Esophageal Manometry
in Children
1,2
1
1
Anshu Srivastava, Amrita Mathias, Surender Kumar Yachha, and Ujjal
Poddar
1
Tae Hee Lee, Joon Seong Lee, Yong Sub Lee, Jun-Hyung Cho,
1,2
1
3
1
Seong Ran Jeon, Hyun Gun Kim, Su Jin Hong, Jin-Oh Kim, and
Joo Young Cho1 Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate
Institute of Medical Sciences, Lucknow, India
1
Institute for Digestive Research, Digestive Disease Center,
2
Soonchunhyang University Seoul Hospital, Seoul, Korea; Nutritional
Support Team, Soonchunhyang University Seoul Hospital, Seoul, Koea;
3
and Department of Internal Medicine, Soonchunhyang University College
of Medicine, Bucheon, Korea
Background/Aims: To study the safety of gastrointestinal endoscopist directed flexible endoscopic evaluation of swallowing study
(FEES).
Methods: All persons undergoing FEES were prospectively
evaluated. A flexible fiberoptic endoscope (XP260 gastroscope) was
passed transnasally (without topical anesthesia or nasal constriction)
into the more patent nostril. Nasopharyngeal and laryngeal anatomy
was first evaluated. Laryngopharyngeal sensory and motor function
was then assessed, followed by a comprehensive swallowing
evaluation. Six parameters were prospectively evaluated. These included the failure of FEES, airway compromise, epistaxis, change in
heart rate, level of discomfort, and vasovagal syncope. Descriptive statistics were calculated.
Results: A total 303 examinations were performed during the study
period. The failures of FEES occurred in 5 patients (0.2%) due to
high risk of aspiration or poor cooperation. After exclusion of failed
examinations, mild epistaxis occurred in 22 examinations (7.3%) and
there was no case of vasovagal syncope. There was one episode (0.3%)
of decreased oxygen saturation below 90%, the patient recovered soon
by supportive therapy with oxygen supply. There was no statistically
significant difference between the average pretest and post-test heart
rates; no patients became symptomatically bradycardic or tachycardic.
The discomfort ratings were as follows; 128 examinations (43.0%) rated the overall discomfort of the test as none, 150 examinations (50.3%)
as mild, 18 examinations (6.0%) as moderate, and 2 (0.7%) examinations were described as severe discomfort.
Conclusions: Flexible endoscopic evaluation of swallowing is a safe,
well-tolerated procedure to objectively evaluate patients with dysphagia when performed by an experienced gastrointestinal endoscopist.
S38
Background/Aims: Esophageal pressure topography (EPT) based
Chicago classification is the standard for characterization of esophageal motility disorders (EMD) in adults. There is limited data regarding its applicability in children. We evaluated the spectrum of
EMD by EPT based diagnosis in children.
Methods: Forty-seven children (27 boys, median age 14 [6-18]
years) underwent esophageal high-resolution manometry (MMS)
with a 22 channel Dent sleeve water perfusion catheter. EPT metrics
were derived for 10 liquid swallows and Chicago classification was
applied.
Results: Of the 47 children, 32 (68%) had a normal study and 15
(32%) had a motility disorder (achalasia-11, hypotensive lower esophageal sphincter [LES]-2, frequent failed peristalsis-1, and weak peristalsis with large peristaltic defects-1). Type I achalasia was present in
6 (55%) and type II in 5 (45%) cases. Pan-esophageal pressurization
(＞ 30 mmHg) was present in 50 % (30-100) swallows in type II
achalasia. The basal LES and 4-second integrated relaxation pressure
was 20 (11-60) and 31 (15.2-55) mmHg respectively. Dysphagia (11
[100%]) was the most common symptom followed by regurgitation (9
[82%]), weight loss (7 [64%]), and chest pain (3 [27%]). Barium
swallow and esophagogastroscopy were also suggestive of achalasia in
these cases. Two patients with peristaltic dysfunction had extrahepatic
portal vein obstruction (EHPVO) with persistent dysphagia despite
adequate dilatation of the post-sclerotherapy stricture. Both patients
with hypotensive LES had reflux disease and presented with vomiting.
Conclusions: EPT is a useful technique to diagnose EMD in
children. Achalasia is the most common disorder, with type I and II
being equally frequent
ANMA 2015 India
Selected Poster Presentation
No. 47
No. 48
Surgery for Achalasia Cardia: One Time
Treatment Modality in Develping Countries
Multichannel Intraluminal Impedance-pH
Monitoring Confirms Less Than 2.5 Hours
Dinner-bedtime Interval, Obesity Were
Associated With Nocturnal Gastroesophageal
Reflux Other Than Age and Gender
Abhijit Chandra, Vishal Gupta, Saket Kumar, Ajeet P Maurya, Hunaid
Hatimi, and Rahul
Department of Surgical Gastroenterology, King George's Medical
University, Lucknow, India
Nian Yuanyuan, Wang Xueqin, Wu Jing, Cheng Yan, and Zhang Jun
Division of Gastroenterology, The Second Affiliated Hospital of Xi'an
Jiaotong University, Xi'an, China
Background/Aims: Two main treatment modalities for achalasia
cardia are laparoscopic Heller's myotomy (LHM) and endoscopic
balloon dilation. Here we present our experience of LHM as the first
line one time treatment for achalasia.
Methods: Hospital data from January 2009 to December 2013 was
analyzed. Preoperative assessment included esophagogastroduodenoscopy, barium swallow and manometry.
Results: Thirty-five patients (male 19, median age 31 years, range
12-65) underwent LHM. All patients had dysphagia (median duration 48 months [range 1-240]) and 8 (22.8%) had chest pain. Four
(11%) patients had recurrent achalasia. Most of the patients (80%)
came from rural areas and 68.5% were ≤ 40 years of age.
Fundoplication (mostly Toupet's) was added in all except 4 patients (1
megaesophagus, 1 left lobe hepatomegaly, 2 post-surgical recurrent
achalasia). Median operative time was 180 minutes (range 120-300)
with one conversion (due to mucosal injury). Intraoperative complication included mucosal injury (n = 2) and pleural breach (n = 3).
Median postoperative stay was 7 days (range 4-27) with a morbidity of
5.7% (leak 1, subphrenic collection 1). One patient died postoperatively due to myocardial infarction. With a median follow-up of
9.5 months (range 1-47 months), 4 (11.4%) patients had recurrent
dysphagia, and 3 (8.5%) had gastroesophageal reflux. Most of the patients (6/8) had relief in chest pain.
Conclusions: Predominance of rural patients, young (＜ 40 years)
patients, and males in this study suggest LHM may be the first line
treatment for achalasia in developing countries like India where predominant population is rural that prefer one time treatment.
Background/Aims: To assess nocturnal reflux parameters by multichannel intraluminal impedance-pH (MII-pH) monitoring in gastroesophageal reflux disease (GERD) patients with nocturnal gastroesophageal reflux (nGER), in order to find the influences of gender,
age, body mass index (BMI), and dinner-bedtime interval on the
nGER.
Methods: One hundred and thirty suspected GERD patients with
typical symptoms underwent 24-hour MII-pH monitoring. When
patients had pathological gastroesophageal reflux, we cut out the impedance and pH information of evening duration (from the end of of
last evening meal, to the start of breakfast). Ninety-seven patients (46
males, average ages 51.27 ± 12.15 years) with nGER were included,
and they were subgrouped according the gender, age, BMI, and dinner-bedtime interval respectively. Data between groups were analyzed
using SPSS17.0 software.
Results: One hundred and thirty suspected GERD patients had
accepted 24-hour MII-pH monitoring, 74.62% (97/130) of them had
nGER, 18.56% (18/97) patients had reflux symptoms. Ninety-seven
patients were subgrouped on the basis of different dinner-bedtime interval (2, 3, and 4 hours) respectively, reflux parameters quantifying
nGEJ such as %time ＜ 4, numbers of reflux episodes, and numbers
of long reflux episodes, had no difference between groups. Then patients were subdivided as patients with dinner-bedtime interval ＜ 2.5
hours and patients with dinner-bedtime interval ≥ 2.5 hours, it is
found that patients with time interval less than 2.5 hours had higher
figures in %time ＜ 4 and duration of the longest reflux episode, had
more acid refluxes, weakly acidic refluxes, liquid refluxes, mixed refluxes, gas refluxes, and lower nadir pH. All of them had significant
differences. Obese (BMI ≥ 25) GERD patients had higher %time
pH ＜ 4, numbers of reflux episodes and duration of the longest reflux episode in nocturnal period than GERD patients with normal
BMI. There were no differences between GERD patients with low
BMI, normal BMI, and over-weight. Although nocturnal volume
clearance time were longer in female GERD patients than male, and
also were longer in elder GERD patients than younger, but other reflux parameters were no statistically different between groups.
Conclusions: Less than 2.5 hours dinner-bedtime interval, obesity
(BMI ≥ 25) were associated with nGER, gender and age had no influences on the nGER, but female patients and elder patients had lower esophageal clearance. This study comprehensively analyzed the influences of dinner-bedtime interval, firstly and objectively indicated
dinner-bedtime interval ≥ 2.5 hours could reduce nocturnal reflux.
S39
ANMA 2015 India
Selected Poster Presentation
No. 50
No. 51
Efficacy and Safety of Pneumatic Dilatation
for Achalasia
Esophageal Motility in Patients With
Corrosive Esophageal Stricture
Cheol Woong Choi, Hyung Wook Kim, Dae Hwan Kang, Su Bum Park,
Su Jin Kim, Hyeong Seok Nam, Dong Ku Kang, and Ja Jun Goo
S K Sinha, B Nagi, N Berry, PK Sidappa, K Singh, and R Kochhar
Department of Internal Medicine, Pusan National University Yangsan
Hospital, Yangsan, Gyeongsangnamdo, Korea
Department of Gastroenterology, Post Graduate Institute of Medical
Education and Research, Chandigarh, India
Background/Aims: To study the esophageal motility in patients
with chronic corrosive stricture.
Methods: This prospective study included patients with chronic
corrosive stricture of esophagus who were on stricture dilatation
programme. Patients were included at least 6 months after intake of
corrosive substance. Patients who were not willing to participate in
study were excluded. Clinical details of each patient were recorded.
Each patient underwent esophageal manometry by station pull
through technique. Manometric studies were performed on a water
perfused system from MMS.
Results: The study included 18 patients (14 males, 77.8%) with
mean age of 34.9 ± 11.5 years. Sites of esophageal stricture were as
follows: upper third in 3 patients, middle third in 9 patients, lower
third in 4 patients, and at multiple level in 2 patients. Resting lower
esophageal sphincter (LES) pressure was low in 4 patients, three of
them had stricture in middle third and one had multiple strictures.
LES relaxation was normal all patients. Peristaltic waves were present
in all patients. In patients with upper third stricture, the wave form in
upper third showed normal pattern in 1 and bizarre pattern in 2
patients. In the middle third of esophagus, wave form was normal in 1,
bizarre in 1 and of low amplitude in 1 patient. Same pattern of wave
form was seen in lower third of esophagus. In patients with middle
third stricture, the wave form in upper third showed normal pattern in
4 and bizarre pattern in 1 and reduced amplitude in 4 patients. The
wave form in middle third showed normal pattern in 2 and bizarre pattern in 3 and reduced amplitude in 4 patients. The wave form in lower
third showed normal pattern in 4 and bizarre pattern in 1 and reduced
amplitude in 4 patients. In patients with lower third stricture, motility
in upper and middle third was normal in all patients. The wave form in
lower third showed normal pattern in 1, bizarre pattern in 2 and reduced amplitude in 1 patient. Out of 2 patients with multiple level
strictures, one had bizarre wave form in whole esophagus; the other
patient had reduced wave amplitude in whole esophagus.
Conclusions: Most patients with corrosive stricture of esophagus
have altered esophageal motility. Such motility disturbances are not restricted to stricture segment only.
Backgraund/Aims: Pneumatic balloon dilation is a most safe and
effective nonsurgical treatment to relieve functional obstruction of the
gastroesophageal junction in achalasia. In this retrospective study, we
reported a 4-years’ experience with pneumatic dilation treatment in
patients with primary achalasia, and determined whether previously
described predictors of outcome remain significant after endoscopic
dilation. Our aim was to determine the safety and the short and
long-term efficacy of pneumatic dilatation.
Methods: Between August 2009 to October 2013, 16 patients consecutive patients with primary symptomatic achalasia (diagnosed by
endoscopy, clinical presentation, barium esophagogram, and manometry) who received pneumatic balloon dilation. It was reviewed retrospectively on single center experience. Six males and ten females
were included and their average age was 47.7 ± 21.9. Mean age at
time of diagnosis years was 43.2 ± 21.9. Remission was assessed by a
structured interview and a previous symptoms score.
Results: Symptoms were dysphagia (n = 16, 100%), regurgitation
(n = 13, 81.3%), chest pain (n = 3, 18.0%), and weight loss (n = 2,
12.5%). The median number of dilatations was 1.9 ± 1.6. A total of
31 dilations were performed in 16 patients; 8 patients (50%) underwent a single dilation, 5 patients (31.3%) required a second procedure,
and 2 patients (12.5%) underwent over third procedure. Five patients
were required a second pocedure within a median of 16.7 months
(range 4-36 months), and 2 patients (12.5 %) underwent a third procedure within a median of 36 months. The mean duration of symptoms prior to treatment was 15.0 ± 13 months. Symptom score at
baseline,1 and 12 months after dilation. Post dilatation major complication (perforation and bleeding) was none.
Conclusions: Pneumatic dilatation is an effective procedure in the
treatment of primary achalasia during the short- and long-term period.
Treatment evaluation can possibly be made objectively with radiographic and manometric alterations of esophagus that occurred after
pneumatic dilatation.
S40
ANMA 2015 India
Selected Poster Presentation
No. 52
No. 53
Classic and Vigorous Achalasia: Change From
One Form to Another
Etiological Spectrum of Motor Dysphagia as
per Chicago Classification: Experience at a
Tertiary Center in Central India
1
1
2
1
1
1
S K Sinha, B Nagi, A Lal, S S Rana, D K Bhasin, R Kochhar, J
1
1
Samanta, and K Singh
Mayank Jain, Sandip Ware, Amit Bundiwal, Shohini Sircar, and Ajay
K Jain
Departments of 1Gastroenterology and 2Radiodiagnosis, Post Graduate
Institute of Medical Education and Research, Chandigarh, India
Department of Gastroenterology Choithram Hospital and Research Center,
Indore, India
Background/Aims: To study changes in esophageal motility pattern in patients with achalasia cardia during follow-up.
Methods: This prospective study included consecutive patients
with achalasia cardia. Achalasia cardia was diagnosed on the basis of
history of dysphagia, typical appearance on barium swallow and esophageal manometry findings of incomplete relaxation of lower esophageal sphincter (LES) and absence of peristalsis in esophageal body.
Patients unwilling to participate were excluded. Patients were treated
with pneumatic balloon dilatation using Rigiflex balloon or surgical
cardiomyotomy. Balloon dilatation was repeated after 4-8 weeks if
there was residual dysphagia. Esophageal manometry was repeated
within a month of dilatation or surgery and then once in 3-6 months.
Manometric criteria for the diagnosis of classic achalasia was incomplete relaxation of LES (residual pressure ＞ 8 mmHg) and absence of peristalsis in esophageal body with contraction amplitudes ＜
40 mmHg. When esophageal contractions had amplitude ＞ 40
mmHg, it was classified as vigorous achalasia.
Results: The study included 67 patients (38 males, 56.7%) with
mean age of 37.9 ± 14.8 years. Mean duration of follow up was 12.9
± 21.6 months. Fourteen patients (20.9%) got lost to follow-up after
single manometry examination. Out of remaining 53 patients, 44
(83%) patients (24 males) had classic achalasia cardia on initial manometric study and 9 (17%) patients (7 males) had vigorous achalasia.
Demographic profile of patients with classic achalasia did not differ
significantly from those with vigorous achalasia. Out of 44 patients
with classic achalasia, 2 patients (4.5%) showed change in pattern of
esophageal motility to vigorous achalasia. Out of 9 patients with vigorous achalasia cardia, 3 (33.3%) showed change in motility pattern to
classic achalasia.
Conclusions: Classic and vigorous achalasia cardia are not exclusive
groups and change from one form to another occurs in a subset of
patients.
Background/Aims: The aim of the present study was to analyse the
demographic, symptomatic and manometric profile of patients with
motor dysphagia at a tertiary referral center in Central India using the
recent Chicago classification.
Methods: This is a retrospective analysis of data. The records of all
patients who underwent high-resolution esophageal manometry for
suspected motor dysphagia from March 2012 to March 2014 were
analysed. Motor dysphagia was defined as dysphagia for solids and/or
liquids of more than one month duration with normal endoscopic
examination. The manometry study was done in right lateral position
using 16 channel water perfusion systems (Ready Stock, Australia).
Reporting was done by a single observer. The data was analysed for
age, sex, symptoms, and manometric findings.
Results: A total of 70 patients formed the study group. The mean
age was 43.1 years and thirty nine were males. The major symptoms
reported were dysphagia for solids (90%), dysphagia for liquids
(75.7%), regurgitation (47.1%), chest pain (31.4%), weight loss
(31.4%), and respiratory complaints (5%). The etiological causes for
motor dysphagia, based on High-resolution manometry findings,
were as follows: achalsia cardia (40), distal esophageal spasm (6), hypertensive peristalsis (5), scleroderma esophagus (5), non specific dysmotility (5), hypotensive LES (4), frequently failed peristalsis (1),
weak peristalsis with small (1) and large defects (2), and cricopharangeal achalasia (1).Type I achalsia was the commonest form (21/40)
followed by type II (15/40), and type III (4/40) variants.
Conclusions: Majority of patients with motor dysphagia present
with dysphagia for solids and liquids. Regurgitation, chest pain, and
weight loss are seen in one third of the patients. Achalsia cardia is the
commonest cause of motor dysphagia. Type 1 achalsia was the most
common variant of achalsia in our study.
S41
ANMA 2015 India
Selected Poster Presentation
No. 54
No. 55
Esophageal Motility Abnormalities and the
Influence on Esophageal Acid Exposure in
Patients With Gastroesophageal Reflux
Disease
Utility of Esophageal Manometry in
Diagnosing Pediatric Gastrointestinal Motility
Disorders
Maneesh Paliwal, Sakshi Karkra, Rajesh Puri, Neelam Mohan, and
Randhir Sud
Yuantao Hou, Xiaohong Sun, Xiaoqing Li, Zhifeng Wang, Liming Zhu,
Huijun Shu, Guijun Fei, Meiyun Ke, and Xiucai Fang
Department of Pediatric Gastroenterology, Hepatology and Liver
Transplantation, Medanta Institute of Digestive and Hepatobiliary
Sciences, Gurgaon, Haryana, India
Department of Gastroenterology, Peking Union Medical College Hospital,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, China
Background/Aims: Esophageal manometry has evolved from a research tool to a diagnostic modality with wide availability. It is an excellent tool to define the integrity of peristalsis and esophagogastric
junction function. The utility of esophageal manometry in clinical
practice is to accurately define normal and abnormal esophageal motor
function and accordingly to delineate a treatment plan based on motor
abnormalities. Objective of this study was to determine the usefulness
of esophageal manometry in establishing a diagnosis in children with
recurrent vomiting, dysphagia, and chest pain.
Methods: We analyzed our data of pediatric population defined as
less than 18 years of age from march 2013 till September 2014.
Esophageal manometry was done using 22 channel water perfusion
high-resolution esophageal manometry catheter (Solar HRM). The
procedure was done without sedation on all the patients. The results
were analyzed using computer software based on Chicago classification.
Results: HRM was done on 19 subjects (15 males) with a mean
age of 14.1 years. Underlying diseases were as follows; 10 had recurrent vomiting, 8 dysphagia and one chest pain. In 3 of the 4 (79%)
patients who had clinical history of Rumination syndrome on the basis
of Rome III criteria , the postprandial manometry showed an esophageal pressure pattern compatible with rumination. All had an amplitude ＞ 30 mmHg from baseline in abdomen and esophagus. Three
out of remaining seven in the same group had low baseline lower
esophageal sphincter pressure and were evaluated further for gastroesophageal reflux disease (Subsequently proven on 24 hour esophageal
impedance-pH analysis) while rest were normal. Five of the eight
(62.5%) patients in dysphagia group had type II achalasia with mean
lower esophageal sphincter pressure of 43 mmHg, with mean
Integrated relaxation pressure of 20 mmHg and no peristaltic activity.
One patient with dysphagia had distal esophageal spasm, while other 2
patients had normal manometry pattern. Patient with chest pain had
normal study.
Conclusions: Esophageal manometry is a useful modality in pediatric subjects with persistent vomiting and dysphagia. Rumination syndrome and achalasia in childhood can be accurately diagnosed using
Chicago classification.
Background/Aims: To study the characteristics of esophageal motility abnormalities in patients with gastroesophageal reflux disease
(GERD) and their influences on esophageal acid exposure.
Methods: We enrolled 15 reflux esophagitis (RE) patients and 12
non-erosive reflux disease (NERD) patients with typical reflux symptoms, and 10 healthy subjects (HS) as controls. All subjects underwent esophageal manometry and esophageal 26 hours pH monitoring,
and 3 kinds of standardized meals are applied during the pH
monitoring.
Results: The abnormalities of esophageal motility in GERD patients are mainly presented as decreases of lower esophageal sphincter
pressure (LESP) and distal esophageal body pressure compared with
HS. We divided GERD patients into 3 groups according to their
esophageal motility abnormalities: (1) LESP decrease group (n =
16), (2) ineffective esophageal motivation (IEM) + LESP decrease
group (n = 7), (3) IEM group (n = 3), one NERD patient has normal esophageal motility. In RE and NERD patients, the proportion of
3 subtypes of esophageal motility abnormalities' has significant difference (P = 0.017). All patients in IEM + LESP decrease group are
with RE, their total number of acid exposure ([144.14 ± 153.64] vs
[51.06 ± 36.14], P = 0.023) and the total acid exposure time ([14.54
± 13.25%] vs [5.13 ± 4.78%], P = 0.017], the acid exposure time
in fasting ([2.93 ± 2.46%] vs [0.65 ± 1.16%], P = 0.014) are higher than LESP decrease group.
Conclusions: Esophageal motility abnormalities in GERD patients
are characterized by LESP and IEM in distal esophagus. Decrease of
LESP and IEM were associated with enhanced esophageal acid exposure, which might explain the occurrence of esophageal mucosa
damage in RE patients.
S42
ANMA 2015 India
Selected Poster Presentation
No. 57
No. 58
Corticotropin-releasing Factor Changes the
Phenotype and Function of Mouse
Mesenteric Lymph Nodes Dendritic Cells
Characteristics of Mouse Mesenteric Lymph
Nodes Dendritic Cells and Their Ability to
Secrete Corticotropin Releasing Factor
Wang Xiaoteng, Lu Bin, Li Meng, and Hu Yue
Wang Xiaoteng, Lu Bin, Li Meng, and Hu Yue
First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou,
China
First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou,
China
Background/Aims: Dendritic cells (DCs) significantly contribute
to the pathology of several chronic inflammatory autoimmune
disorders. However, little is known of the contribution of corticotropin-releasing factor (CRF) to intestinal DCs. In this study, we try
to investigate the role of CRF in the change of intestinal dendritic cell
phenotype and function.
Methods: The mice mesenteric lymph nodes dendritic cells
(MLNDCs) were obtained by the technique of magnetic bead
sorting. Expression of CRF receptor 1 (CRF1)/CRF2 on the surface
of MLNDCs were determined by double-labeling immunofluorescence and polymerase chain reaction. Then, MLNDCs were
exposed to CRF with or without the presence of CRF1 and CRF2 receptor antagonists, the expression of surface molecules (MHC I and
MHC II) and co-stimulatory molecules (CD80 and CD86) were tested by the technique of flow cytometry and Western blot, the capacity
to stimulate T cells was evaluated by mixed lymphocyte reaction
(MLR).
Results: Both the CRF receptors (CRF1 and CRF2) exist on the
surface of MLNDCs. CRF could increase the expression of CD86
and MHC II of MLNDCs as well as the capacity to stimulate T cells.
MLNDCs treated with CRF1 receptor antagonist had less-activated
phenotype characterized with lowered surface expression of MHC II,
CD86, and consequently had reduced capacity to stimulate T cells,
while MLNDCs treated with CRF2 receptor antagonist showed an
opposite result.
Conclusions: Our findings suggest that CRF could change the
phenotype and function of mouse intestinal DCs by acting on CRF1
and CRF2 receptors directly. The pathway of CRF1 and CRF2 receptors show opposite effects.
Background/Aims: To study the phenotype and function of mouse
mesenteric lymph nodes dendritic cells (MLNDCs) and their ability
to secrete corticotrophin releasing factor (CRF)
Methods: The mice mesenteric lymph nodes dendritic cells were
obtained by the technique of magnetic bead sorting and cultured with
or without lipopolysaccharide (LPS). Then the expression of surface
molecules (MHC I and MHC II) and co-stimulatory molecules
(CD80 and CD86) were analyzed by flow cytometry. The capacity to
stimulate T cells was evaluated by mixed lymphocyte reaction (MLR).
The enterogenous production of CRF in MLNDCs was determined
by PCR and western blot, the expression of CRF receptor 1
(CRF1)/CRF2 on the surface of MLNDCs were determined by double-labeling immunofluorescence.
Results: Fresh isolated MLNDCs express high level of MHC II
and had the ability to attract and stimulate CD4+/CD8+ T cell
proliferation. LPS could not change the phenotype and function of
MLNDCs. MLNDCs had high level of CRF mRNA transcription
and protein expression. Immunofluorescence assay showed that both
the CRF receptors (CRF1 and CRF2) exist on the surface of
MLNDCs.
Conclusions: Mouse MLNDCs are in a mature state and can produce high level of CRF. And this finding indicate that MLNDCs
maybe an important source of peripheral CRF.
S43
ANMA 2015 India
Selected Poster Presentation
No. 59
No. 60
Quantitative Determination of Selected fecal
Microbiota in Patients With Irritable Bowel
Syndrome and Healthy Controls: An Evidence
of Dysbiosis
Markers of Gastric Acid Secretion
(Pepsinogens and Gastrin-17) and
Inflammatory Response (IL-8) are Associated
With Functional Dyspepsia Particularly in
Absence of Helicobacter pylori Infection
1
1
2
Ratnakar Shukla, Ujjala Ghoshal, Vikas Agarwal, Tapan N Dhole,
3
and Uday C Ghoshal
1
Departments of 1Microbiology, 2Immunology, and 3Gastroenterology,
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Sushil Kumar and Uday C Ghoshal
Background/Aims: Dysbiosis may play role in irritable bowel syndrome (IBS), hitherto an enigmatic disorder. We evaluated selected
fecal microbes in IBS patients and healthy controls (HC).
Methods: Fecal 16S rRNA copy number of selected bacteria was
studied using qPCR in 47 patients with IBS (Rome III) and 30 HC.
Results: Of 47 patients, 20 had constipation-predominant IBS
(IBS-C), 20 diarrhea-predominant IBS (IBS-D), and 7 un-classified
IBS (IBS-U). Relative difference in 16S rRNA copy number of
Bifidobacterium (P = 0.040) was lower while Ruminococcus productus-Clostridium coccoides (P = 0.020), Veillonella (P ＜ 0.01),
Bacteroides thetaiotamicron (P ＜ 0.001), Pseudomonas aeruginosa (P ＜
0.001), and gram-negative bacteria (P ＜ 0.01) higher among IBS patients than HC. Number of Lactobacillus (P ＜ 0.01) was lower while
Bacteroides thetaiotamicron (P ＜ 0.001) and segmented filamentous
bacteria (SFB, P = 0.010) was higher among IBS-D than IBS-C.
Numbers of Bacteroides thetaiotamicron (P ＜ 0.001), Pseudomonas aeruginosa (P ＜ 0.001), and gram-negative bacteria (P ＜ 0.01) were
higher among IBS-C and IBS-D than HC. Quantity of SFB was
higher among IBS-D (P ＜ 0.001) and lower among IBS-C (P ＜
0.01) than HC. Number of Veillonella species was higher among
IBS-C than HC (P ＜ 0.01). Pseudomonas aeruginosa was frequently
detected among IBS than HC (46/47 [97.9%] vs 10/30 [33.3%], P
＜ 0.001). Higher number of Bacteroides thetaiotamicron, Clostridium
coccoides, Pseudomonas aeruginosa, gram-negative and SFB was associated with visible abdominal distension and Clostridium coccoides and
gram-negative bacteria with bloating. Microbial flora was different
among IBS than HC on principal component analysis.
Conclusions: Fecal microbiota was different among IBS than HC
and different sub-types were associated with different microbiota.
Pseudomonas aeruginosa was more frequent and higher in number
among IBS patients.
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of
Medical Sciences, Lucknow, India
Background/Aims: Circulating levels of pepsinogen (PG), gastrin-17 (G-17) are known serological marker of gastric acid secretion;
Helicobacter pylori infection is known to alter acid secretion, which may
be influenced by pro-inflammatory cytokines (eg, IL-8) through degree and severity of gastritis. Since altered acid secretion may be associated with functional dyspepsia (FD), we undertook this study.
Methods: Serum levels of PG-I, PG-II, PG-I/PG-II ratio, G-17,
IL-8, and anti-H. pylori IgG were estimated (ELISA) among 60 subjects with FD (Rome III criteria and normal endoscopy) and healthy
controls (HC).
Results: Age (mean ± SD: 48.2 ± 10.4 vs 51.7 ± 12.1), gender
(male: 41 [68.3%] vs 40 [66.7%]) and H. pylori sero-positivity (44
[73.3%] vs 37 [61.7%]) were comparable among patients with FD
and HC. Serum PG-I (median [range]: 76.1[5.3-199.2] vs 106.4
[29.4-225.0], P = 0.040) and PG-I/PG-II (5.6 [0.5-66.4] vs 9.8
[1.8-28.8], P = 0.005) were lower but serum G-17 (12.1 [0.2-42.9]
vs 7.3 [0.6-73.3], P = 0.045), and IL-8 (55.1 [4.2-318.9] vs 26.3
[4.7-277.6], P = 0.02) were higher among FD than HC, though
PG-II was comparable. FD patients without H. pylori infection also
had lower serum PG-I (72.9 [26.1-192.4] vs 113.8 [29.4-225.0], P
= 0.003), PG-I/PG-II (5.4 [1.0-66.3] vs 8.4 [3.6-28.8], P =
0.001), and higher G-17 (17.1 [1.9-42.9] vs 5.0 [0.9-73.3], P =
0.048), and IL-8 (29.5 [8.1-163.9] vs 18.9 [4.7-101.9], P = 0.030)
levels than HC, though the serum levels were comparable among H.
pylori sero-positive subjects with FD and HC.
Conclusions: Circulating levels of PG-1 and PG-I/PG-II were
lower but G-17 and IL-8 were higher among patient with FD than
HC, particularly those without H. pylori infection, suggesting that acid
secretion may be higher among patients with FD without H. pylori infection than HC.
S44
ANMA 2015 India
Selected Poster Presentation
No. 61
No. 67
Metronidazole-resistant Helicobacter pylori Is
More Prevalent in Patients With Dyspepsia
Constipation in India Differs From West by
Both Stool Frequency and Form
1
2
3
Juntaro Matsuzaki, Hideki Mori, Hitoshi Tsugawa, Tatsuhiro
2
2
2
2
Masaoka, Sawako Miyoshi, Seiichiro Fukuhara, Takanori Kanai, and
Hidekazu Suzuki2
Gautam Ray and P. Manju Bhargav
B R Singh Hospital, Kolkata, West Bengal, India
1
Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan;
Division of Gastroenterology and Hepatology, Department of Internal
Medicine, Keio University School of Medicine, Tokyo, Japan; and
3
Department of Biochemistry and Integrative Medical Biology, Keio
University, Tokyo, Japan
2
Background/Aims: Helicobactor pylori infection is thought to be one
of the causes of dyspepsia symptoms. The aim of this study is to determine the characteristics of H. pylori strains associated with the presence of dyspepsia.
Methods: Patients who have failed H. pylori eradication treatment
with metronidazole-contained triple regimen were enrolled. H. pylori
was isolated from these gastric biopsy specimens, and the minimum
inhibitory concentrations (MICs) of metronidazole, clarithromycin
and amoxicillin were evaluated. The mutations of reactive oxygen species (ROS)-scavenging enzymes, such as AhpC and NapA, in H. pylori were also investigated. The presence of dyspepsia symptoms is diagnosed based on the definition of functional dyspepsia in the Rome III
criteria.
Results: Twenty-eight patients with dyspepsia and 81 patients
without dyspepsia were enrolled. Metronidazole-resistant H. pylori
(MIC ≥ 8 g/mL) was more prevalent in patients with dyspepsia
(89% in dyspepsia, 72% in non-dyspepsia, P = 0.060). The MIC levels of metronidazole were higher in patients with both postprandial
distress symptoms (PDS) and epigastric pain symptoms (EPS) than
patients with EPS alone among dyspepsia patients (35.5 g/mL vs
20.0 g/mL, P = 0.050). Among H. pylori strains isolated from patients with both PDS and EPS, the combination of AhpC mutations
(A126S and I140V) and NapA mutation (I73L) was commonly
observed.
Conclusions: Metronidazole-resistance of H. pylori was associated
with the presence of dyspepsia. H. pylori eradication therapy might be
more effective for patients with dyspepsia in Asia than in Europe,
since metronidazole-resistant H. pylori is more prevalent in Asia. The
mutations of AhpC and NapA would be useful markers for the risk of
dyspepsia.
S45
Background/Aims: There is paucity of data regarding stool frequency and form in Indian patients complaining of constipation which
are needed for its definition.
Methods: In a prospective study 186 consecutive patients consulting doctor for their complaint of constipation completed a questionnaire containing Rome III criteria points of functional constipation and constipation predominant irritable bowel syndrome.
Organic bowel diseases were excluded by further history taking, physical examination and appropriate investigations. Patients were asked to
report their predominant stool form according to the Bristol stool
chart. The data was then compared with the existing Indian population data.
Results: Stool type 1-3 according to Bristol stool form scale was the
predominant type present in 92.1% and conformed to Asian criteria of
constipation. Twenty-eight percent had normal stool frequency by
Indian standard (ie, at least 1 motion/day) and most others (51.5%) reported a frequency of 3-4/week. Subjective feeling was at variance with
observed rate and only 35.4% had constipation by Western criteria
(less than 3 motions/week). Feeling of incomplete evacuation was
universal. Most patients of functional constipation were elderly with
comorbidities. Only 3.2% had colonic cancer.
Conclusions: Asian criteria for constipation based on stool form
holds in Indian patients but frequency needs to be defined (＜
5/week) and the subjective feeling of incomplete evacuation should be
given due weightage in any definition of constipation in Indian
context.
ANMA 2015 India
Selected Poster Presentation
No. 68
No. 69
Impact of Memory Function in Patients With
Irritable Bowel Syndrome
Laparoscopic Ventral Mesh Rectopexy for
Complete Rectal Prolapse: Intermediate-term
Results From a Tertiary Care Institute
Pei-Yi Liu and Ching-Liang Lu
National Yang-Ming University, Taipei, Taiwan
Abhijit Chandra, Vishal Gupta, Vivek Gupta, Saket Kumar, Rahul, and
Hunaid Hatimi
Department of Surgical Gastroenterology, King George's Medical
University, Lucknow, India
Background/Aims: Chronic pain has been recognized as a public
health priority and is often associated with memory and concentration
difficulties.1 (Brain 2013; 136, 815-827). The patients with irritable
bowel syndrome (IBS) are characterized by chronic and recurrent abdominal pain. Whether there is any memory dysfunction exists in the
IBS patients remain unclear. The aim of this study was to explore the
memory function in IBS patients using questionnaire survey.
Methods: Twenty-three IBS patients, 26 age- and education-matched
controls were enrolled. Demographic data as well as hospital anxiety
and depression scale (HADS), Pain Catastrophizing Scale (PCS),
IBS Quality-of-Life questionnaire (IBS-QOL) and meta-memory in
adulthood (MIA) questionnaire were assessed. In MIA questionnaire, which assessed beliefs about four aspects of memory function including memory capacity, knowledge, locus, and strategy.
Result: IBS patients showed significantly higher levels HADS,
PCS and IBS-QoL than control group. (all P ＜ 0.05) Among the 4
aspects of MIA questionnaire, IBS patients reported lower memory
capacity (56.8 ± 1.2 vs 53.4 ± 1.4, P = 0.05) and strategy (69.5 ±
1.9 vs 61.9 ± 2.0, P = 0.01) than control group, while memory
knowledge and locus showed similar levels as the controls. PCS scores
in IBS patients were negatively correlated with memory capacity (r =
−0.391, P = 0.03).
Conclusions: Memory impairment may be a common, but neglected, component of IBS. Chronic visceral pain may lead to parahippocampal dysfunction and contribute to memory impairment in
IBS patients. Further elucidation of the neural dysconnection underlying the memory dysfunction may provide a better understanding of
pathophysiology of IBS.
Reference
1. Vachon-Presseau E, Roy M, Martel MO, et al. The stress model of chronic pain: evidence from basal cortisol and hippocampal
structure and function in humans. Brain 2013;136(Pt 3):815827.
Background/Aims: Rectal prolapse is a debilitating condition that
greatly impairs the quality of life. Multitude of surgical interventions
has been developed for it’s management but the ideal treatment still remains far-fetched. We hereby report the intermediate-term outcomes
of patients who underwent laparoscopic ventral mesh rectopexy for
complete rectal prolapse.
Methods: This study was conducted at a single tertiary care
institution. Fifteen patients (7 males and 8 females) with a median age
of 38 years (range 15-68 years) underwent laparoscopic ventral mesh
rectopexy for complete rectal prolapse. Seven of these patients had associated fecal incontinence of varying degree. Four patients had complains of chronic constipation in the pre-operative period. Vault prolapse was present in 2 patients and one had coexisting inguinal hernia.
The primary outcome measures were correction of anatomical defect
and bowel dysfunction following the surgery and also detection of de
novo functional problem in the follow-up.
Results: The procedure was performed in 15 patients. All rectopexy
procedures were done laparoscopically. Patients were followed-up for
a median duration of 22 months (range 4-54 months). No peri-operative mortality occurred. One patient required re-exploration in the
post-operative period due to inadvertent injury of the small bowel. No
mesh-related complication was encountered. Till the last follow-up no
recurrence was reported in any of the patient. All patients reported better bowel function and improved continence after the procedure. None
of the patient had new onset of constipation or fecal incontinence following surgery. On personal interviews, all patients who underwent
this procedure were satisfied with result of their surgery.
Conclusions: Laparoscopic ventral mesh rectopexy appears to be a
safe and effective alternative for the management of complete rectal
prolapse. Lower recurrence rates, positive effect on functional bowel
dysfunction and minimal complication makes this procedure “ideal”
for management of rectal prolapse.
S46
ANMA 2015 India
Selected Poster Presentation
No. 70
No. 72
Functional Dyspepsia Is Associated With
GN3 C825T Polymorphism: A Case-control
Study
The Aaccuracy of Symptom Recall in Elderly
Patients With Functional Constipation
1
2
Wenjuan Fan, Haiwei Xin, Shaomei Han, Jin Wang, Ying Ba, Jun Zhang,
Shi Liu, and Xiucai Fang
1
Rajan Singh, Balraj Mittal, and Uday C Ghoshal
1
Department of Gastroenterology, Peking Union Medical College Hospital,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, China
2
Departments of Gastroenterology and Genetics, Sanjay Gandhi
Postgraduate Institute of Medical Sciences, Lucknow, India
Background/Aims: Functional dyspepsia (FD) is characterized by
epigastric pain, burning, early satiety and post-prandial fullness in absence of organic or metabolic causes. Gastrointestinal (GI) motor abnormalities and altered visceral sensation have been considered as major pathophysiological mechanisms involved in FD. G-protein beta-3
subunit gene (GN3), C825T polymorphism alters intra-cellular signal transduction, which may lead to motor or sensory abnormalities of
the GI tract. Therefore, we evaluated the role of this polymorphism in
patients with FD as compared to healthy controls (HC).
Methods: Two hundred thirty-seven consecutive patients with FD
(Rome III) and 250 HC were genotyped for GN3 C825T polymorphism (PCR-RFLP). Patients with FD were sub-classified into
epigastric pain syndrome (EPS), postprandial distress syndrome
(PDS), and EPS-PDS overlap.
Results: Patients with FD (173 [73%] male, age 38 ± 12 years)
were comparable with HC (195 [78%] male, age 37 ± 12 years) with
respect to age and gender. Twenty-six of 237 (11%) had EPS, 55
(23.2%) PDS, and 156 (65.8%) EPS-PDS overlap. Among 237 patients with FD, TT genotype (associated with increased intra-cellular
signal transduction) of GN3 C825T polymorphism was commoner
among patients than HC (26 [11%] vs 12 [4.8%], P = 0.014; OR,
2.47; 95% CI, 1.2-5.1). However, genotypes distribution was comparable among patients with different subtypes of FD (P = 0.800).
Conclusions: TT genotype of GN3 C825T is commoner among
patients with FD, suggesting that increased signal transduction associated with this genotype may be important in its pathophysiology.
Background/Aims: The accuracy of symptom recall might influence the diagnosis of functional gastrointestinal disorders, including
functional constipation (FC). The aim of this study is to evaluate the
accuracy of the symptom recall in elderly patients with FC and its potential influence factors.
Methods: Patients were ≥ 60 years old, met Rome Ⅲ-FC diagnostic criteria and had excluded organic diseases. At the beginning of
the study, all subjects reported the duration of constipation, the frequency and severity of constipated symptoms during the past 3
months (recall symptoms), and then they take 2 weeks’ diary (diary
symptoms). Symptom score was evaluated by the independent investigators. Patients were divided as mild, moderate or severe constipation
group according to overall symptom score and subtyped into slow
transit, defecation disorder, mixed and normal transit constipation
based on the main symptoms, gastrointestinal transit time and anorectal manometry. The consistency of recalled symptoms and diary
symptoms were analyzed.
Results: One hundred and fifteen patients (55 males and 60 females) were enrolled from June, 2010 to October, 2012. The overall
score of recall and diary symptoms are 27.57 ± 7.37 and 26.09 ±
7.59, respectively (P ＜ 0.001). The recall symptom score has a correlation with diary symptoms (according to the severity of constipation,
2
χ test, к = 0.725, P ＜ 0.001), and each recall symptom score has a
correlation with diary symptoms (к ＞ 0.75, P ＜ 0.001). Gender,
age, labor intensity, and economic situation (all P ＜ 0.05) but not education level, duration, and severity of constipation, subtype of FC (all
P ＞ 0.05) influenced the accuracy of symptom recall. Female patients
recalled severity of hard stools more accurately than male patients (P
= 0.046). There is significant difference in recalled accuracy in numbers of defecations per week and sensation of anorectal obstruction
among different age group (P ＜ 0.05). Patients with good economic
condition presented more accurate recall for frequency of hard stools
than patients with lower income (P = 0.020).
Conclusions: The accuracy of symptom recall in elderly patients
with FC is acceptable even though gender, age, labor intensity and
economic situation might influence the accuracy of some constipated
symptom recall.
S47
ANMA 2015 India
Selected Poster Presentation
52.5%), abdominal discomfort (105 patients, 24.0%), incomplete
bowel movement (31 patients, 7.1%), abdominal bloating (29 patients,
6.6%), straining (16 patients, 3.7%), fecal urgency (14 patients,
3.2%), heartburn (7 patients, 1.6%), and other symptoms (6 patients,
1.3%). The QOL of patients who could report the most bothersome
were lower than healthy volunteers in both met and unmet the Rome
III criteria (Table). All domains of QOL were not different between
the patients who met and unmet Rome III criteria. The anxiety and
depression scores were similar (8.0 ± 3.8 and 6.7 ± 2.5 vs 8.2 ± 4.5
and 7.2 ± 3.3) in these 2 FGID groups but significantly greater than
healthy subjects (3.7 ± 2.7 and 3.4 ± 2.5, P ＜ 0.001); the proportion
of patients with anxiety and/or depression in the patients who met
(186/310) and unmet (73/128) the Rome III criteria was also similar
but significantly greater than healthy volunteers (15/120, P ＜ 0.001).
Conclusions: When approach to patients who present with any gastrointestinal symptoms using the Rome III criteria, the diagnosis
could not be made in 29% of the patients but the symptom based diagnosis could be made in 100% of the patients. In addition, patients who
had any bothersome symptoms both met and unmet Rome III criteria
had similarly lower QOL and higher co-morbid anxiety and/or depression compared to healthy subjects. This study suggests that symptom based approach is likely to be more appropriate than Rome III criteria for approaching patients with any gastrointestinal symptoms in
clinical practice. Clinical practice guideline should base on the most
bothersome symptom instead of the Rome III criteria.
No. 73
Comparison of Rome III Diagnostic Criteria
Versus Simple Symptom Based Approach in
Patients With Gastrointestinal Symptoms
Presented at the General Medicine Clinic　Kessarin Thanapirom, Tanisa Patcharatrakul, and Sutep Gonlachanvit　GI motility Research Unit, Faculty of Medicine, King Chulalongkorn
Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
Background/Aims: Rome III criteria have been used as standard
tools for diagnosis of functional gastrointestinal disorders (FGIDs).
However, the Rome III criteria have not been employed in most daily
clinical practice. The aims of this study were to compare: (1) the proportion of patients who met the Rome III diagnostic criteria vs. symptom based diagnostic criteria, (2) the quality of life (QOL) in patients
who met the Rome III criteria vs symptom based criteria in relative to
healthy subjects, and (3) the proportion of co-morbid anxiety and depression in patients who met the Rome III vs symptom based criteria.
Methods: Four hundred and thirty-eight patients (age 48 ± 13
years, 321 female) with any gastrointestinal symptoms without alarm
features presented at General medicine Clinic, King Chulalongkorn
Memorial hospital were invited to complete a Thai validated version of
the FBDR3 questionnaire, the 36-item short form general health survey (SF-36), the hospital anxiety and depression scales (HADS)
questionnaire. Symptom base diagnosis was based on the most bothersome symptom reported by the patients.
Results: Three hundred and ten patients (70.8%) met Rome III diagnostic criteria (173 FD, 16 IBS, 74 FD + IBS, 27 functional constipation, and 20 other FGIDs) and 128 patients (29.2 %) unmet the
Rome III diagnostic criteria. The reasons for unmet Rome III diagnostic criteria were symptom duration (108 and 3 patients experienced
symptom duration 1-3 and 3-6 months, respectively) and incomplete
symptom criteria (17 patients). All patients (100%) could report the
most bothersome symptom including abdominal pain (230 patients,
Table. Quality of Life in Patients Who Met and Unmet the Rome III Criteria Compare With Healthy Volunteer
Met Rome III criteria (n = 310) Unmet Rome III criteria (n = 128)
Physical functioning
Role physical
Bodily pain
General health
Vitality
Social Functioning
Role emotional
Mental Health
Health transition
76.7 ± 29.5
76.6 ± 28.6
b
49.5 ± 22.3
b
53.6 ± 21.4
b
49.6 ± 19.8
b
60.5 ± 21.9
b
73.5 ± 26.2
b
60.5 ± 20.1
b
48.8 ± 24.3
72.9 ± 28.3
77.4 ± 23.7
b
51.6 ± 21.5
b
54.6 ± 17.8
b
58.9 ± 19.6
b
72.2 ± 24.1
b
72.2 ± 24.1
a
60.6 ± 16.1
b
49.8 ± 22.7
a
P ＜ 0.05 vs healthy volunteers, bP ＜ 0.005 vs healthy volunteers.
S48
Healthy volunteers (n = 120)
74.6 ± 19.8
78.1 ± 22.1
73.3 ± 24.6
65.4 ± 17.2
61.2 ± 16.9
74.4 ± 19.1
82.1 ± 16.1
65.9 ± 18.0
71.5 ± 19.5
ANMA 2015 India
Selected Poster Presentation
No. 74
No. 75
Profile of Patients With Common Functional
Gastrointestinal Disorders Attending
Out-patient Clinic of a Medical College in
Eastern India
Prevalence of Anxiety and Depression in
Irritable Bowel Syndrome
1
2
Om Prakash Singh
Department of Psychiatry, Nil Ratan Sircar Medical College, Kolkata, India
2
Kaustav Nayek, Rajan Singh, and Uday C Ghoshal
1
Burdwan Medical College, Burdwan, West Bengal, India; and
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of
Medical Sciences, Lucknow, India
2
The main objective of the study was to find out the prevalence of
depression and anxiety in patients with irritable bowel syndrome.
Thirty patients diagnosed of irritable bowel syndrome as per Rome III
criteria and giving informed consent were assessed with Hamilton
Rating Scale for Depression and Hamilton Rating Scale for Anxiety.
Thirty age and sex matched healthy controls were also assessed using
the same instruments. The results and discussion will be presented at
the time of presentation
Background/Aims: Though functional gastrointestinal disorders
are common reasons for out-patient visit, there is scanty date on profile
of these patients from India.
Methods: Consecutive patients with functional gastrointestinal disorders (FGIDs) attending out-patient clinic of a medical college of
eastern India were interviewed using a translated-validated Bengali
questionnaires. Dyspepsia and irritable bowel syndrome (IBS) was defined according to Rome III criteria. Questionnaire also included the
information about demography, socio-economic parameters, diet and
psychological-comorbidity.
Results: Of 1157 patients enrolled (age 31.2 ± 16 years, 673
[58.2%] male), 12.7% were in upper class, 11.5% upper middle, 8.5%
lower middle, 14.5% upper lower, and 52.8% lower classes (Prasad socio-economic classification). Fifty-four of 1157 (4.7%) patients were
vegetarian, 15 (1.3%) lacto-vegetarian, and 1088 (94%) non-vegetarian. Three-hundred forty of 1157 (29.4%) had dyspepsia, 98/1157
(8.5%) IBS, and 337/1157 (29.1%) dyspepsia-IBS overlap. In patients with dyspepsia, 76/677 (11.2%) had epigastric pain syndrome
(EPS), 269 (39.8%) post-prandial distress syndrome (PDS) and 332
(49%) EPS-PDS overlap. Tobacco chewing (OR, 2.0; 95%
CI,1.5-2.8; P ＜ 0.001), high intake of tea/coffee (OR, 1.5; 95% CI,
1.1-2.0, P = 0.003), disturbed sleep (OR, 1.8; 95% CI, 1.4-2.3; P ＜
0.001) and anxiety (feeling of tension and wound up: 342/677 [50%]
vs 168/480 [35%], worry: 414 (61%) vs 210 [43%], panic attacks:
448 [66%] vs 220 [45%], feeling of something awful: 308 [45%] vs
93 [19%], all P ＜ 0.01) were associated with dyspepsia univariate
analysis.
Conclusions: Dyspepsia, particularly EPS-PDS overlap, was common in out-patient clinic; IBS overlap was also common among them.
High intake of tea/coffee, tobacco chewing, disturbed sleep, and anxiety were associated with dyspepsia on univariate analysis.
S49
ANMA 2015 India
Selected Poster Presentation
No. 76
No. 77
Food Habit and Its Relation With Irritable
Bowel Syndrome in North East Part Of
Bangladesh
Prevalence of Irritable Bowel Syndrome,
Migraine and Co-existing Irritable Bowel
Syndrome-Migraine in Medical Students
Madhusudan Saha, Irin Parveen, Bimal Chandra Shil, Md Masudur
Rahman Khan, and Md Jahangir Alam
Irin Perveen, Rukhsana Parvin, Madhusudan Saha, Md. Shafiqul
4
2
5
Bari, Md. Nazmul Huda, and Mridul K Ghosh
North East Medical College, Sylhet, Bangladesh
Departments of 1Gastroenterology and 2Medicine, Enam Medical College,
Dhaka, Bangladesh; 3Department of Gastroenterology, North East Medical
College, Sylhet, Bangladesh; 4Department of Medicine, Sylhet MAG
Osmani Medical College, Sylhet, Bangladesh; and 5UChicago Research
Bangladesh, Dhaka, Bangladesh
1
Background/Aims: Approximately two-third of subjects with irritable bowel syndrome (IBS) relates their symptoms to their intake of
food. This study was designed to see any relation of specific food items
with IBS in North East part of Bangladesh.
Methods: By randomized sampling method, subjects were selected
in and around City corporation area of Sylhet district. People were interviewed from door to door with preformed questionnaire for IBS
and food habit. Data was analyzed using SPSS 16.
Results: Total 1900 (male 901, 47.4% and female 999, 52.6%) persons, age ranging from 15-92 years (mean 34.74 years), were
interviewed. Prevalence of IBS was found 14.2%. IBS was more in
older people (41.35 vs 33.65, P = 0.000), low education group
(16.3% vs 7.9%, P = 0.000) and lower socioeconomic group (18.5%
vs 9.2%, P = 0.000). House wives (15.0%), day laborer (17.8%), and
farmers (16.9%) were more vulnerable to IBS. Among the food factors IBS was found more in those who consume spice regularly
(18,8% vs 9.2%, P = 0.000) and in those who did not consume meat
(18.7% vs 7.9%, P = 0.000), milk(16.8% vs 9.1%, P = 0.000), pulse
(22.4% vs 10.5%, P = 0.000), fruit (17.8% vs 11.2%, P = 0.000) and
tea (20.1% vs 12.7%, P = 0.000) frequently. Vegetables, wheat,
smoking and chewing tobacco were not found to have significant associations with IBS. In multivariate analysis infrequent intake of meat
(OR, 1.722; P = 0.002) and tea (OR, 1.735; P = 0.001) were found
as important associated factors for IBS.
Conclusions: Food factors found to have relations with IBS.
Regular intake of tea and meat was found to have important negative
associations with IBS symptoms.
2
3
Background/Aims: Irritable bowel syndrome (IBS) and migraine
frequently co-exist. Stress is a major contributing factor for both. The
study aimed to evaluate the prevalence of migraine, IBS and co-existing IBS and migraine among medical students.
Methods: This questionnaire-based study was conducted among
the students of 4 medical colleges. Migraine was defined according to
International Headache Society criteria (IHS) while IBS by both
Asian criteria and Rome III criteria.
Results: A total of 293 students (mean age 21.09 years with SD
2.24 years) volunteered in the study (Male 177); 140 from private institutions and 153 from Government institutions. Fourteen (4.8%, 11
male, 3 female, P = 0.175) students met the criteria for IBS with comparable prevalence among preclinical and clinical (4.2% vs.5.3%, P =
0.787) students from both private and government institutions (2.1%
vs. 7.2%, P = 0.055). IBS-D was the most prevalent subtype (n = 8,
M = 6)), next common was IBS-M (n = 4, M = 3). Feeling of incomplete evacuation (n = 10), frequent motion (n = 7), straining (n
= 7) and bloating (n = 7) were more prevalent symptoms besides abdominal pain relieved by defecation (n = 11). Fifty percent (n = 7)
consider their bowel habit as normal. Among the 221 (75.4%) students with headache, only 83 (37.6%) had frequent attacks. Fiftyone
(17.4%, 20 male and 31 female, P = 0.001) met the IHS criteria for
migraine, with comparable prevalence among preclinical and clinical
students (16.2% vs. 18.5%, P = 0.645). Ninety percent (n = 46) migraineurs had accompanying aura. Common triggers were stress (n =
43), lack of sleep (n = 42), and daily life events. Thirty-four (66.6%)
migraine patients suffered frequent attacks and 12 (23.5%) had migraine-associated frequent disability. Headache was highly prevalent
in IBS (n = 10, 71.4%) but only two female students with IBS-D
(14.3%) had concomitant IBS and migraine.
Conclusions: IBS and concomitant migraine - IBS prevalence was
found to be low in our medical students, but migraine prevalence corresponds to other countries as well as in medical students.
S50
ANMA 2015 India
Selected Poster Presentation
No. 80
No. 86
Defecation Frequency and Stool Form in a
Rural Community in Bangladesh
Long Pulse Gastric Electrical Stimulation
Promotes Renovation of Interstitial Cells of
Cajal Related to Smooth Muscle Cells in the
Stomach of Diabetic Rats
1
1
Md. Golam Kibria, Mohammed Masudur Rahman, Uday Chand
2
1
1
1
Ghoshal, Faruque Ahmed, Nigar Sultana, Mahfuza Akhter, Mahmud
Hasan3
Yan Chen, Hai Li, and Shi Liu
1
Departments of Gastroenterology, Dhaka Medical College and Hospital,
2
Dhaka, Bangladesh; Sanjay Gandhi Postgraduate Institute of Medical
3
Sciences, Lucknow, India; and Bangladesh Medical Research Council,
Dhaka, Bangladesh
Division of Gastroenterology, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan, China
Background/Aims: Loss of interstitial cells of Cajal (ICC) has been
confirmed in the stomach of diabetic patients, which leads to kinds of
gastrointestinal motility disorders. Long pulse gastric electrical stimulation (GES) has been proved to improve gastric motility, but the
mechanism is not completely understood. The aim of this study was to
investigate the effect of long pulse GES on ICC and the related mechanism in diabetic rats.
Methods: Male SD rats were randomized into the control, diabetic
rats (DM), diabetic rats with sham GES (DM+SGES), diabetic rats
with GES group (DM + GES1: 5.5 cpm, 100 msec, 4 mA; DM +
GES2: 5.5 cpm, 300 msec, 4 mA; DM + GES3: 5.5 cpm, 550 msec,
2 mA). GES was performed 30 minutes everyday for 6 weeks.
Mechanical contraction of gastric antrum was explored by organ bath
technique. Western blot and RT-PCR were employed to demonstrate
the expression of c-kit, a-SMA, and myosin 11 in gastric antrum. The
distribution of ICC and smooth muscle cells (SMC) were identified
by immunolabeling for c-kit and a-SMA. The ultrastructural alterations of ICC and SMC were reflected by transmission electron
microscopy.
Results: (1) In DM group, contractions of gastric antrum circular
strips were severely weakened, while long pulse GES strengthened the
attenuated contractions. (2) Both western blot analysis and RT-PCR
suggested that the expression of c-kit was reduced apparently in DM
group, but was obviously upregulated in GES group. Whereas the expression of a-SMA was not changed dramatically in each group, the
expression of myosin 11 was decreased in DM group and markedly
increased in GES group. (3) In DM group, c-kit positive cells distributed among SMC were significantly decreased. However, c-kit+
cell in GES group were rich both in muscular and intermuscular layer.
(4) In contrast to the control group, the ultrastructural alterations of
ICC and SMC in DM group were significantly destroyed. However,
GES improved the ultrastructural alterations of ICC and SMC.
Conclusions: Long pulse GES promoted the renovation of interstitial cells of Cajal, which may be related to smooth muscle cells in the
stomach of diabetic rats.
Background/Aims: Stool form and frequency, which are important
to define constipation and diarrhea, may vary in different population.
Data on stool form and frequency among Asian population are scanty.
Accordingly, we undertook such a study in a rural Bangladeshi population.
Methods: A door-to-door survey was conducted by trained interviewers among all the adults (＞ 18 years) living in a village (Charcharia,
Dhaka District) in Bangladesh using a translated validated Bengali
questionnaire. Data on demographic variables, stool form (Bristol
stool scale [BSS]) and frequency were collected.
Results: Of 1021 subjects invited in the study, 817 (80.0%, age
40.13 ± 15.53 years, 517 [63%] female) responded. Stool frequency
was 9 ± 3.7 per week (median 7, range 0-28). Daily stool frequency
was at least once a day in 747 (91.4%); 252 of these 747 (33.7%) subjects passed two to three stools a day. Weekly stool frequency was lesser among female compared to male (8.67 ± 3.5 vs 9.56 ± 3.9, P=
0.001). Only 6 (0.7%) subjects reported a stool frequency less than 3
times per week. Four (0.5%) subjects passed more than 21 times per
week. Of 797 subjects who reported data on predominant stool types
(BSS), these were: type IV 446 (55.9%), III 204 (25.6%), II 66
(8.3%), I 8 (1%), V 38 (4.8%), VI 28 (3.5%), and VII 07 (0.9%).
Conclusions: Most people in Bangladeshi rural community passed
more than one stool a day with a median frequency of seven per week.
Common stool forms were Bristol type IV and III. Stool frequency
was lower among female.
S51
ANMA 2015 India
Selected Poster Presentation
No. 90
No. 92
A Disintegrin and Metalloproteases
Expression in Functional Dyspepsia Patients
With Helicobacter pylori Infection
Melatonin Protects Esophageal Epithelial
Barrier via Suppressing the Transcription,
Expression and Activity of Myosin Light Chain
Kinase Through ERK1/2 Signal Transduction
1
1
1
Jahanarah Khatoon, Kashi Nath Prasad, Ravi Prakash Rai, Narendra
2
3
Krishnani, and Uday Chand Ghoshal
Departments of 1Microbiology, 2Pathology, and 3Gastroenterology, Sanjay
Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
Jiacheng Tan, Ying Wang, Xiaomeng Sun, Ting Yu, and Lin Lin
Background/Aims: Helicobacter pylori infection is an important risk
factor for development of various gastroduodenal pathologies including gastric cancer (GC). The bacterial-epithelial cell interactions may
be critical in gastric pathogenesis. A disintegrin and metalloproteases
(ADAMs), family of membrane anchored glycoproteins are thought
to be responsible for ectodomain shedding of many membrane proteins like growth factor (EGFR), TNF-, cytokine, cytokine-receptors, etc. This ADAMs- mediated ectodomain shedding is likely to
have a key role in inflammatory and pathological states. The objectives
of this study was to detect- to detect the expression of ADAMs 10 and
17 in presence of H. pylori in patients of functional dyspepsia (FD).
Methods: A total of 80 patients with functional dyspepsia (H. pyori
positive 36 and H. pyori negative 44) patients were included in this
study. Further, RNA was extracted from gastric biopsies and expression of ADAMs 10 and 17 were examined by quantitative real
time PCR.
Results: Present study revealed that the expression of ADAM17
was significantly higher (5.11 ± 4.00 vs 2.29 ± 2.85, P = 0.040),
whereas the expression of ADAM10 tended to be higher (3.70 ± 6.24
vs 2.07 ± 2.50, P = 0.075) in patients with H. pylori infection.
Conclusions: The study showed that in human gastric mucosal expressions ADAMs 10 and 17 were higher in patients with H. pylori
infection. Further studies are needed to explore the exact role of
ADAMs expression and functions of its various domains in pathogenesis of gastro-duodenal diseases in presence of H. pylori.
Department of Gastroenterology, the First Affiliated Hospital of Nanjing
Medical University, Nanjing, China
Background/Aims: Dilated intercellular spaces (DIS) is a pathogenesis of gastroesophageal reflux disease (GERD). Myosin light
chain kinase (MLCK) plays a role in maintaining epithelial cells
morphology. Melatonin (MLT) protects esophageal mucosa against
various types of injury, but its mechanism remains unclear. This study
aimed to investigate the effects of melatonin on the esophageal epithelial barrier.
Methods: Intercellular spaces in the esophageal epithelium of
GERD patients were evaluated by transmission electron microscopy
(TEM). The barrier function of Het-1A monolayer was investigated
by measuring the transepithelial resistance (TER) and the paracellular
permeation of FITC-dextran. The MLCK mRNA was measured by
real-time PCR. The activity of MLCK was represented by the phosphorylation of MLC. The expression and phosphorylation of MLCK,
MLC, and extracellular signal-regulated kinase (ERK) were examined by using western blotting.
Results: Intercellular spaces of the esophageal epithelium were dilated significantly in GERD patients. The expression and activity of
MLCK as well as the phosphorylation of ERK were increased in the
esophageal epithelium. The increase in the expression and activity of
MLCK were strongly correlated with dilated intercellular spaces.
Upon acid treatment, the permeability of Het-1A monolayer was
increased. The transcription, expression and activity of MLCK as well
as the phosphorylation of ERK were up-regulated. When Het-1A
monolayer was pretreated with melatonin and PD98059 (an inhibitor
of ERK) before acid incubation, the permeability was decreased as
well as the expression and phosphorylation of MLCK and ERK.
Conclusion: Melatonin protected the esophageal epithelial barrier
function via suppressing the transcription, expression and activity of
MLCK through ERK1/2 signal transduction. These findings provided a better understanding of potential clinical application of melatonin in GERD treatment.
S52
ANMA 2015 India
Selected Poster Presentation
No. 93
No. 95
Meta-analysis: The effect of Helicobacter
pylori Eradication Therapy on The
Development of Gastroesophageal Reflux
Disease
Effects of Acupuncture on Esophageal
Motility in Patients With Refractory
Gastroesophageal Reflux Disease
Jiacheng Tan
Department of Gastroenterology, Ruijin Hospital, Shanghai Jiaotong
University School of Medicine, Shanghai, China
Tang Yuming, Lin Han, Yao Weiyan, and Yuan Yaozong
Department of Gastroenterology, the First Affiliated Hospital of Nanjing
Medical University, China
Background/Aims: To investigate the effects of acupuncture on
improvement of esophageal motility disorder in patients with refractory gastroesophageal reflux disease (GERD).
Methods: Forty patients with refractory GERD from the outpatient department of gastroenterology in Ruijin Hospital were included in this study from September 2012 to March 2014. The patients were evenly divided into the treatment group and the control
group. High resolution esophageal impedance manometry was conducted in patients. After the manometry, patients of the control group
lay for 30 minutes and patients of the treatment group received acupuncture at the selected points: Neiguan, Gongsun, and Zusanli for
30 minutes. Then all the patients underwent high resolution esophageal impedance manometry again. ManoView ESO 3.0 software was
used for analysis. The parameters included lower esophageal sphincter
(LES) pressure , swallowing peristalsis defect, LES residual pressure,
LES length, upper esophageal sphincter pressure, distal wave amplitude, peristalsis duration time, starting speed of peristalsis wave, speed
of edge contraction, and integration of the peristaltic waves. Chi-square
test and t test were performed for data analysis.
Results: The percentage of normal swallows of the treatment group
before and after treatment was 56.0% (112/200) and 74.0% (148/200),
while the percentage of delayed esophageal emptying was 31.5%
(63/200) and 11.5% (23/200) and the differences were statistically sig2
nificant (χ = 14.242 and 23.700, both P = 0.05). The LES resting
pressure of the treatment group before and after treatment was 20.4 ±
11.0 mmHg (1 mmHg = 0.133 kPa) and 19.8 ± 11.3 mmHg. The
length of LES was 2.3 ± 0.6 cm and 2.5±0.6 cm. The distal esophageal peristaltic amplitude were 67.4 ± 21.2 mmHg and 53.5±18.1
mmHg, and the differences were statistically significant (t = 5.519,
6.580, and 6.881, all P = 0.050). While, before and after lying down,
there were significant differences in the length of LES (2.2 ± 0.6 cm
vs 3.3 ± 0.8 cm) and upper esophageal sphincter resting pressure
(60.2 ± 21.9 cm vs 41.1 ± 16.8 mmHg) (t = 2.530 and 6.652, both
P = 0.050).
Conclusions: Acupuncture can help increase the LES resting pressure and the length of LES, improve the overall peristaltic pressure
and completeness of esophageal somatic part, and increase the percentage of normal swallows of patients with refractory GERD.
Background/Aims: It is uncertain whether the Helicobacter pylori
eradication therapy makes a role in the progression of gastroesophageal reflux disease (GERD).
Methods: A meta-analysis was undertaken to investigate the effect
of H. pylori eradication therapy on the development of GERD.
Results: Overall, 16 cohort studies were included. We demonstrated that H. pylori eradication had no significant effect on the occurrence of GERD in these cohort studies (OR, 0.87; 95% CI,
2
0.66-1.14; I = 32.4%; P = 0.103).
Conclusions: In general, H. pylori eradication has no significant effect on the development of GERD in the long term. However, eradication therapy should be cosidered. Because H. pylori infection is acknowledged to be a major cause of acute and chronic gastritis and peptic ulcer diseases, and has been established as a definite etiological factor for gastric cancer.
S53
ANMA 2015 India
Selected Poster Presentation
No. 97
No. 99
Upper Esophageal Sphincter Function During
Transient Lower Esophageal Sphincter
Relaxations in Gastroesophageal Reflux
Disease Patients: Based on Impedance-High
Resolution Manometry Results
Is There Any Correlation Between
Gastroesophageal Reflux Disease and Atrial
Fibrillation?
Jae Jin Hwang, Dong Ho Lee, Ae-Ra Lee, Yong Hwan Kwon, Yeon Sang
Jeong, Hyun Joo Lee, KiChul Yoon, Hyuk Yoon, Cheol Min Shin, Young
Soo Park, and Nayoung Kim
Jingzhi Zhang, Xuelian Xiang, Xiaoping Xie, and Xiaohua Hou
Department of Internal Medicine, Seoul National University Bundang
Hospital, Seongnam, Gyeonggi-do, Korea
Division of Gastroenterology, Union Hospital of Tongji Medical College,
Huazhong University of Science and Technology
Background/Aims: Recent studies have reported an association between Gastroesophageal reflux disease (GERD) and atrial fibrillation
(AF). The objective of the present study was to determine the association of GERD with AF.
Methods: In this retrospective study, patients with newly diagnosed with GERD or AF were classified into two groups. The patients diagnosed as new GERD with the presence of AF were assigned
to the GERD group (n = 129), and those diagnosed as new AF with
the presence of GERD were assigned to the AF group (n = 134). The
risk factors of 2 groups were then correlated respectively.
Results: In univariate and multivariate analyses, age, alcohol, underlying chronic obstructive pulmonary disease, coronary artery disease, thyrotoxicosis, use of angiotensin-converting enzyme inhibitor,
B-blocker, and warfarin were related to the incidence of GERD in the
GERD group (P ＜ 0.05). In the AF group, chronic obstructive pulmonary disease and proton pump inhibitors were related to the incidence of new AF (P ＜ 0.01). The presence of AF was found to increase the risk of GERD (RR, 1.37; 95% CI, 1.33-1.47; P = 0.004),
and conversely, the presence of GERD was determined to increase the
risk of AF (RR, 1.12; 95% CI, 1.08-1.19; P = 0.005).
Conclusions: There was a significantly strong association between
GERD and AF. The presence of GERD or AF increased the risk of
diagnosis of the other. Further, large prospective and cohort studies
will be required to better establish the association of GERD with AF.
S54
ANMA 2015 India
Selected Poster Presentation
No. 100
No. 101
Predictors of Long-term Proton Pump
Inhibitor Use in Patients With Suspected
Laryngopharyngeal Reflux Who Responded
to Proton Pump Inhibitor Therapy
Non-cardiac Chest Pain With Normal
Endoscopy: Role of Manometry and pH
Recording in Indian Setting
Han-Chung Lien, Chen-Chi Wang, Chi-Sen Chang, Wen-Miin Liang,
Jeng-Yuan Hsu, and Hong-Zen Yeh
Choithram Hospital and Research Centre, Indore, India
Mayank Jain
Han-Chung Lien, Division of Gastroenterology, Taichung Veterans
General Hospital, Taichung, Taiwan; Department of Internal Medicine,
National Yang-Ming University, Taipei, Taiwan; and Department of Public
Health, China Medical University and Hospital, Taichung, Taiwan
Background/Aims: Laryngopharyngeal reflux (LPR) is a chronic
relapsing disease. The long-term outcome is unknown. We aimed to
find the predictors of long-term proton pump inhibitors (PPIs) users
among initial responders for LPR symptoms.
Methods: A total of 51 subjects with predominant laryngeal symptoms suggestive of LPR who responded to a 12-week twice daily esomeprazole therapy between 2006 and 2009 were enrolled. We followed up symptoms and PPIs use periodically. Factors associated with
requirement of long-term PPIs use more than 1 year after initial diagnosis were analyzed.
Results: Two subjects were excluded from analysis because of concern about the safety of long-term PPI use. The median follow-up period for the remaining 49 subjects were 5 years. Thirty one (63%) of
subjects remained symptomatic for larynx. Thirty-five (71%) of subjects required long-term PPIs therapy (twice daily in 2, once daily in
11, and on-demand in 22). The pre-treatment excessive distal esophageal acid exposure (71.4% vs 14.3%, P ＜ 0.001), pharyngeal acid
exposure (42.9% vs 7.1%, P = 0.02), either of above parameters
(85.7% vs 14.3%, P ＜ 0.001), and the presence of reflux esophagitis
(31.4% vs 0.0%, P = 0.020) but not typical reflux symptoms (65.7%
vs 64.3%) predicted the long-term PPIs use.
Conclusions: The majority of patients with suspected LPR who responded to initial PPI therapy remained symptomatic and still required PPI therapy for median follow-up of 5 years after diagnosis.
Approximate 27% of subjects still required regular PPI therapy at
least once daily. The baseline pH test and reflux esophagitis, but not
typical reflux symptoms were predictive factors of those who required
long-term PPI therapy.
S55
Background/Aims: To determine the common endoscopic and
manometric changes noted in patients presenting with non-cardiac
chest pain (NCCP) and to identify role of manometry and pH recording in Indian patients.
Methods: The study was done at Choithram Hospital and
Research Centre, Indore. The study duration was from October 2011
to October 2013. All patients who had significant retrosternal chest
pain and whose cardiology evaluation was negative (normal ECG,
TMT, and/or 2D-echo, angiography in selected cases) formed the
study group. Upper gastrointestinal endoscopy was done in all
patients. If normal, they were subjected to high resolution esophageal
manometry. Reporting was done as per Chicago classification.
24-hour pH recording was done as and when required.
Results: A total of 126 patients (mean age of 45.4 years, 84 males,
42 females) formed the study group. Two thirds of the patients had
abnormalities in the esophagoduodenoscopy. In the remaining 42 patients, esophageal manometry was done. The findings included normal manometry (22), type 3 achalsia cardia (2), nutcracker esophagus
(2), diffuse esophageal spasm (4), and hypotensive lower esophageal
sphincter with weak peristalsis (12).Twenty hour pH recording was
done in 24 patients out of 34 patients who had no characteristic dysmotility pattern. In 16 patients, acidic reflux with good symptom correlation was noted. In the other 8, 6 had significant acidic reflux with
poor symptom correlation and 2 had no significant acidic reflux.
Conclusion: Two thirds of patients with NCCP have endoscopic
findings. In patients with non cardiac chest pain and normal endoscopy, manometric evaluation and 24-hour pH recording help to establish diagnosis in majority of the cases. Hence, in resource limited
countries like India, I would like to recommend manometry and pH
recording in only patients who have normal endoscopies.
ANMA 2015 India
Selected Poster Presentation
No. 103
No. 104
Symptoms and Quality of Life in Patients
With Gastroesophageal Reflux Disease and
Therapeutic Response to Rabeprazole
Foods Reproducing Typical
Gastroesophageal Reflux Disease Symptoms
in Korea
Dashatwar PD, Nitesh Pratap, Sharat Reddy Putta, and Nagarjuna
Yarlagadda
Yong Jeoung, Jung Wan Choe, Moon Kyung Joo, Hyo Jung Kim, Beom
Jae Lee, Jong-Jae Park, Jae Seon Kim, and Young-Tae Bak
Department of Gastroenterology, Krishna Institute of Medical Sciences,
Karad, Maharashtra, India
Department of Gastroenterology, Korea University Guro Hospital, Seoul,
Korea
Background/Aims: Gastroesophgeal reflux disease (GERD) is a
one of the commonest GI disorders with a great impact on quality of
life of GERD patients. Health-related quality of life (HRQL) is
emerging as an important factor in selecting treatment options and in
assessing the outcome of different treatment strategies. Studies suggest that rabeprazole is one of the most potent drugs in the treatment
of GERD with excellent safety profile. Quantification of real-life outcomes of treatment of GERD with rabeprazole using questionnaire
based indices.
Methods: Fifty-two consecutive patients with symptoms suggestive of GERD were evaluated with endoscopy. The cases were classified into either erosive esophagitis or non-erosive esophagitis. All such
patients were enrolled in the study and before starting rabeprazole
treatment HRQLI and Reflux severity index (RSI) were calculated.
Patients were reassessed with same questionnaires after 45 days of
therapy. Paired t test was used to determine the P-value.
Results: Mean scores of pre-treatment HRQLI and RSI for patients were 26.72 ± 8.29 and 29.72 ± 7.72 respectively. After 45 days
of treatment HRQLI and RSI showed significant decline to 12.10 ±
5.35 and 12.47 ± 4.31 (P ＜ 0.001) respectively. Treatment with rabeprazole showed significant improvement in epigastric pain, regurgitation, and quality of sleep.
Conclusion: Rabeprazole demonstrated excellent efficacy in controlling GERD symptoms.
Background/Aims: Limitation of quality of life in gastroesophageal
reflux disease (GERD) patients is mainly due to their subjective
symptoms, not complications. Several specific foods, including dietary
fat, chocolate, mints, coffee, spicy foods, citrus fruits, and tomatoes,
have been known to be precipitate GERD symptoms and the GERD
patients are usually advised to avoid such foods. Avoiding such foods
may be important in keeping the patients in silent state after medications, although it may not be helpful to induce the healing of
GERD. However, foods consumed daily are quite variable according
to the regions, cultures, etc. Therefore, dietary advices should be based
on local experiences. This study was done to elucidate what kind of
foods may be responsible to induce typical GERD symptoms in
Korean patients in daily life.
Methods: Korean patients having typical GERD symptoms
(heartburn or regurgitation) at least once a week were asked to mark
all food items that induced their typical GERD symptoms for the last
3 months from a food list containing 152 typical foods consumed daily
in Korea. If they had any symptom-inducing food(s) but could not
find it (or them) on the list, they were instructed to add it (or them) to
the list. The accused food items were categorized into 2 groups;
“frequent” if any food induced symptom(s) in half or more occasions
of consumptions and “occasional” if it induced symptom(s) in less
than half occasions. In addition, they were asked to delete all uncertain
foods from the list because they had not taken such food for the last 3
months. Foods inducing typical GERD symptom(s) in 50% or more
patients of the group were regarded as meaningful. All patients underwent upper gastrointestinal endoscopy and ambulatory pH
(with/without impedance) monitoring, and they were divided into 2
groups according to the results; “GERD” if either study revealed evidence of GERD and “possible GERD” if both studies were negative.
Results: One hundred and twenty-six patients (51 GERD and 75
possible GERD) were enrolled. Nineteen (37.3%) of GERD patients
and 17 (22.7%) of possible GERD patients indicated specific food
items inducing their typical GERD symptoms. In GERD group (n =
19), foods frequently inducing typical GERD symptoms were hot spicy stew, rice cake, ramen noodle, fried food, and topokki (stir-fried
spicy rice cake). Foods frequently or occasionally inducing symptoms
were hot spicy stew, ramen noodle, fried food, rice cake, biscuit, bread,
S56
ANMA 2015 India
Selected Poster Presentation
sujebi (clear soup with dumplings), topokki, hamburger, doughnut,
chanpon noodle, jajangmyeon (noodle with salty black soybean sauce),
alcoholic beverage, Fanta, pizza, mandarin, plain noodle, orange,
mandarin juice, and milk. In possible GERD group (n = 17), foods
frequently inducing typical GERD symptoms were hot spicy stew, fried food, doughnut, bread, ramen noodle, coffee, pizza, topokki, rice
cake, chanpon noodle, and hotdog. Foods frequently or occasionally
inducing symptoms were fried foods, hot spicy stew, topokki, bread,
pizza, rice cake, coffee, doughnut, ramen noodle, hotdog, cola, orange
juice, chanpon noodle, alcoholic beverage, orange, hamburger, jajangmyeon, sujebi, dumpling, red bean, green tea, and rice cake soup.
In all confirmed or possible GERD patients (n = 36), foods frequently inducing typical GERD symptoms were hot spicy stew, rice
cake, ramen noodle, fried food, bread, and topokki. Foods frequently
or occasionally inducing symptoms were hot spicy stew, fried food, ramen noodle, rice cake, bread, topokki, pizza, doughnut, coffee, sujebi,
chanpon noodle, hamburger, alcoholic beverage, jajangmyeon, orange, biscuit, cola, orange juice, and plain noodle.
Conclusions: Hot spicy stew, rice cake, ramen noodle, fried food,
and topokki are foods frequently reproducing typical GERD symptoms in Korea. The list of food items reproducing typical GERD
symptoms in Asian countries is needed to be revised substantially from
that of the Western literature based on the local experiences.
No. 105
An Open Label, Non-randomized,
Prospective Comparison of the Efficacy of
Ilaprazole and Esomeprazole in the
Treatment of Gastroesophageal Reflux
Disease
Ayesha Siddiqua, Madiha Ahmed, Nitesh Pratap, Dashatwar PD, and
Sharat Reddy Putta
Department of Gastroenterology, Krishna Institue of Medical Sciences,
Karad, Maharashtra, India
Background/Aims: Proton pump inhibitors (PPIs) are widely used
for the treatment of gastroesophageal reflux disease (GERD). The
available PPIs differ somewhat in their pharmacokinetics and clinical
properties, but whether these differences are of clinical relevance is a
matter of debate. Esomeprazole, the S-isomer of omeprazole, has established pharmacological and clinical benefits beyond those seen with
the racemic parent compound - omeprazole. Preclinical studies have
found ilaprazole to be significantly effective in treatment of reflux oesophagitis and suppression of gastric secretion in a dose-dependent
manner; the drug also has a broad dose range and safety feature. Till
date only one clinical study on patients with GERD has shown its potency in suppressing gastric acid secretion. To compare the efficacy of
esomeprazole and ilaprazole with regards times to first response after
treatment and complete clinical remission of symptoms.
Methods: Esomeprazole 40 mg once daily (qd) (Neksium; n =
15) and ilaprzole 10 mg qd (Adiza; n = 15) were administered to consecutive patients with signs and symptoms suggestive of GERD, irrespective of endoscopic findings of erosive or non-erosive reflux
disease. Patients were followed up for minimum period of 4 weeks and
time to of heartburn after administration of either drug and the time to
the complete symptomatic remission, if any, were noted with the help
of a questionnaire.
Results: All patients had symptomatic remission at the end of four
week period. Difference in time to relief of heartburn was statistically
insignificant for both PPIs (esomeprazole [4.072 ± 0.753] hours and
ilaprazole [4.129 ± 0.731] hours, P = 0.836). Likewise, time to
complete clinical remission was similar for both the drugs
(esomeprazole [6.867 ± 4.422] hours and ilaprazole [6.267 ±
4.480] days, P = 0.736).
Conclusions: Ilaprazole 10 mg qd for 4 weeks is effective therapy
for GERD, and it was equivalent to esomeprazole 40 mg daily in
terms of time to initial symptom relief and complete symptomatic
remission.
S57
ANMA 2015 India
Selected Poster Presentation
No. 106
No. 108
Effect of Non Absorbable Antibiotic,
Rifaximin in Patients With Irritable Bowel
Syndrome: A Single Centre Study
Effect of DA-9701 on Visceral Pain in Rats
Dae Sung Lee
Department of Gastroenterology, Internal medicine, Sungkyunkwan
University Kangbuk Samsung Hospital, Seoul, Korea
Ramesh M, Bhagyalekshmi N, and J Xavier Ignatius
MES Medical College, Perinthalmanna, Malapuram, Kerala, India
Background/Aims: DA-9701 is a compound extracted from Corydalis
Tuber and Pharbitidis Semen. It promotes gastric emptying and facilitates gastric accommodation. It has antiacetylcholine-esterase, antibutylcholine-esterase, antiallergic activity and antinociceptive activity.
Mechanisms of analgesic effect of DA-9701 are by 5-hydroxytryptamine agonist/antagonist and D2 agonist. It is used for the treatment
of functional dyspepsia. The heterogeneous symptom and multiple
causes of functional dyspepsia have resulted in multiple drug target
strategies for its treatment. In this study, we examined the antinociceptive effect of DA-9701 using intraperitoneal acetic acid injection in rat model.
Methods: After injection of acetic acid to intraperitoneal cavity,
writhing behavior was checked as response to the pain. Writhing test is
the most common behavior test for visceral pain in animal model.
Intraperitoneal injection of acetic acid solution was used to make visceral pain. Ten milligram per body weight (kg), 0.6% solution of acetic acid was injected to intraperitoneal cavity of rat. DA-9701 was dissolved in saline and injected to intraperitoneum. Two different dose of
DA-9701 was injected to each study group, 3 and 10 mg/kg, respectively.
Writhing behavior was checked every 5 minutes. Saline was injected to
the control group instead of acetic acid.
Results: Eight rats were tested at each study group. Ten milligram
per kilogram of DA-9701 makes decreased writhing behavior compared with other 2 groups in rats. P value of 10 mg/kg of DA-9701
compared with other 2 groups was 0.001 and 0.021, respectively, at 0
to 5 and 30 to 35 minutes. P value was 0.152 and 0.113 at 10 to 15 and
20 to 25 minutes, respectively. There is difference in number of writhing behaviors induced by acetic acid between saline and DA-9701 injected rats.
Conclusions: DA-9701 is effective in visceral pain induced by inflammation or irritation of abdominal cavity. But further study is
needed to evaluate DA-9701 effect.
Background/Aims: Irritable bowel syndrome (IBS) is the most
common functional bowel disease having a great impact on quality of
life. Recent studies suggest the role of infective etiology. Recently
there are many studies addressing the role of rifaximin in IBS, however there are no such studies available from India. In this study we are
demonstrating the effect of rifaximin, a non absorbable antibiotic, in
IBS. Our objective is to assess the efficacy and safety of short course of
rifaximin in IBS patients without constipation.
Methods: This randomized controlled study was carried out in a
tertiary care hospital in Kerala. Study period was 12 months. IBS was
diagnosed using Rome III criteria. Patients were divided into treatment group and placebo group using simple systematic randomization.
Treatment group received rifaximin 400 mg thrice daily for a period of
2 weeks and all patients were subsequently followed up to one week. In
addition to clinical and laboratory parameters patients subjective feeling of well being also recorded before treatment, end of the treatment
and at the end of 1 week the follow up period. Subjective feeling of improvement in global IBS symptoms, bloating score, pain score, and
overall score was used in final analysis. Analysis was done using SPSS
version 16.
Results: A total of 149 patients were analyzed; 75 patients in rifaximin group and 74 patients in control group. Baseline characteristics
were comparable in both groups. There was a significant reduction in
global IBS symptoms in rifaximin arm when compared to control
group (68% vs 39.1%, P ＜ 0.001). Assessment at the end of 2 weeks
therapy rifaximin provided significant improvement in the following
IBS related symptom scores (bloating score, pain score, and overall
score). Improvement in consistency of stool and stool frequency was
also observed in rifaximin arm compared to control arm. The improvement which was obtained at the end of the treatment was sustained for one week of follow up period. There were no significant differences in laboratory parameters between 2 groups after treatment.
No major adverse effect was reported during study and minor adverse
effects were comparable in both groups.
Conclusions: A 2 weeks course of rifaximin in IBS patients provided significant improvement in global IBS symptoms. Patients who
received rifaximin had improvement in IBS related scores; such as
bloating score, pain score, and overall score. No major adverse effect
was reported in the study. Minor adverse effects were comparable in
both rifaximin and control group.
S58
ANMA 2015 India
Selected Poster Presentation
No. 109
No. 110
Toll Like Receptors 4 and 5 but Not 2 mRNAs
Are Over-Expressed in Colonic Biopsy Among
Patients With Irritable Bowel Syndrome
Up-Regulations of Gastric TRPV Receptors
and Decreased Serum Concentration of
BDNF in Patients with Functional Dyspepsia
1
1
2
Ujjala Ghoshal, Ratnakar Shukla, Vikas Agarwal, Tapan N Dhole,
3
and Uday C Ghoshal
1
Departments of 1Microbiology, 2Immunology, and 3Gastroenterology,
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Cynthia K Y Cheung, Lin Lin Lan, Yawen Chan, and Justin C Y Wu
Institute of Digestive Disease, The Chinese University of Hong Kong, Hong
Kong, China
Background/Aims: Immune activation has been implicated in the
mechanism of post-infectious functional dyspepsia (FD). However,
the role of immune activation in FD patients without infection remains
unclear. To compare the gastric mucosal and serum expression of
brain-derived neurotropic factor (BDNF), transforming growth factor beta (TGF-) families, and transient receptor potential vanilloid
type (TRPV) families between FD patients and healthy controls.
Methods: Consecutive adult FD patients (Rome III) with no recent history of gastroenteritis and age-and-sex matched asymptomatic
healthy controls were recruited for upper endoscopy. Subjects with
gastroesophageal reflux disease and irritable bowel syndrome as predominant symptoms, diabetes mellitus, current or previous Helicobacter
pylori infection, psychiatric illness and recent use of NSAID or proton
pump inhibitors were excluded. Serum and mucosal biopsies from the
gastric corpus were obtained for quantitative assay of mRNA TRPV1,
TRPV2, and TGF-1 by real time-polymerase chain reaction. Serum
concentrations of TGF- families and BDNF were analyzed using
immunoassay. The gastric mucosal inflammation was evaluated using
Sydney classification. The associations between these assays and dyspeptic symptoms were evaluated.
Results: Forty-five (M:F = 8:37, mean age 35.9 [9.1]) FD patients were matched with 23 healthy controls (M:F = 8:15, mean age
36.6 [10.2]] respectively. FD patients had postprandial distress syndrome as predominant sub-type (postprandial distress syndrome: 43,
epigastric pain syndrome: 2). There was no significant difference in
the median inflammation score between FD patients and controls
(FD: 0 (0-1) vs Control: 0 (0-1), P = 0.540). However, FD patients
had significantly higher mRNA expression of gastric TRPV1 (FD:
0.008 ± 0.002, control: 0.003 ± 0.001, P = 0.030), TRPV2 (FD:
0.006 ± 0.001, control: 0.002 ± 0.001, P = 0.010) and a trend of increased gastric TGF-1 (FD: 0.013 ± 0.003, control: 0.005 ±
0.002, P = 0.070) compared to controls. The serum concentration of
BDNF (FD: 240.7 ± 11.0, control: 389.6 ± 22.7, P ＜ 0.001) were
significantly lower in FD patients. Serum TGF-1 and TGF-2 concentrations were significantly correlated with symptoms of belching (R
= 0.441, P = 0.010) and vomiting (R = 0.378, P = 0.040) in FD
patients.
Conclusions: Despite the absence of gastric mucosal inflammation,
up-regulations of gastric mucosal TRPV1, TRPV2, TGF-1, and
down-regulation of serum BDNF were observed in FD patients. The
immune activation is associated with symptoms of belching and
vomiting. These findings suggest that mucosal immune activation also
contributes to the development of FD in those without history of
infection.
Background/Aims: Evidence of low grade inflammation, increased
intestinal permeability and altered host-microbial interactions suggests
that innate immune response may play an imperative role in the pathogenesis of Irritable bowel syndrome (IBS), hitherto an enigmatic
disorder. Since toll like receptors (TLR)s are important component of
innate immune system. We aimed of study TLR-2, TLR-4, and
TLR-5 expression in colonic biopsies among patients with IBS.
Methods: Quantitative real-time polymerase chain reaction was
used to determine the relative expression of mRNA of TLRs in colonic biopsy samples in 47 patients with IBS (Rome III criteria) and 30
controls.
Results: Of 47 patients with IBS (comparable in age and gender
with controls), 20 had constipation (IBS-C), 20 had diarrhea (IBS-D)
predominant IBS; the syndrome could not be sub-typed (IBS-U) in 7
using Rome III criteria. Relative expression of TLR-4 and TLR-5
was up-regulated in patients with IBS compared to controls (TLR-4:
[0.15 ± 0.06] vs [0.002 ± 0.001], P ＜ 0.001; TLR-5: [3.14
±1.02] vs [0.05 ± 0.17], P ＜ 0.001). Expression of TLR-4 and
TLR-5 was higher both among IBS-C and IBS-D as compared to
controls (P ＜ 0.001). Expression of TLR-2, however, was comparable ([0.06 ± 0.006) vs [0.05 ± 0.010], P = 0.089).
Conclusions: Up-regulations of TLR-4 and TLR-5 in colonic biopsies among patients with IBS may suggest that innate immune response may play a potential role in the pathophysiology of IBS.
S59
ANMA 2015 India
Selected Poster Presentation
No. 112
No. 113
Regulation of Esophageal Epithelial-derived
Cytokines by IL-33
Prevalence and Symptoms Correlation of
Lactose Intolerance in North East Part of
Bangladesh
Katsuyuki Tozawa, Tadayuki Oshima, Jing Shan, Takahisa Yamasaki,
Takashi Kondo, Tomoaki Kono, Fumihiko Toyoshima, Hisatomo
Ikehara, Yoshio Ohda, Toshihiko Tomita, Hirokazu Fukui, Jiro Watari,
and Hiroto Miwa
Division of Gastroenterology, Department of Internal Medicine, Hyogo
College of Medicine, Nishinomiya, Japan
Madhusudan Saha, Shasanka Saha, Bimal Chandra Shil, Irin Parveen,
Monojit Majumder, and Ranjit Kumar Banik
North East Medical College, Sylhet, Bangladesh
Background/Aims: This study was designed to see the prevalence
of lactose intolerance and symptom correlation following oral lactose
tolerance test in healthy adult volunteers in the north east part of
Bangladesh.
Methods: apparently healthy volunteers underwent oral lactose tolerance test after overnight fasting. Blood glucose was measured at 0
hour and 30 minutes after 25 g oral lactose load. Failure to rise blood
glucose level ≥ 1.1 mmol/dL at 30 minutes after lactose intake from
fasting level was taken as lactose malabsorption ie, lactose intolerance.
Results: A total 174 volunteers (male 126, female 48) with mean
age 35.03 years participated in this study. Lactose intolerance was
found among 83.9% (male 105, female 41). Symptoms mostly experienced by the lactose malabsorbers were diarrhea (n = 84, 57.53%),
borborygmi (n = 81, 55.47%), abdominal pain (n = 39, 26.71%),
and flatulence (n = 27, 18.49%).
Conclusions: Lactose intolerance among healthy adults of North
East part of Bangladesh is as common as in many countries in Asia including China and Malaysia. But it is higher than that of Europeans
and also that of south Indians. Diarrhoea, borborygmi, abdominal
pain, and flatulence are most common symptoms associated with lactose malabsorption.
Background/Aims: IL-33 is a tissue-derived cytokine constitutively
expressed in epithelial cells and plays a role in sensing damage caused
by inflammatory diseases. We recently reported IL-33 in the esophageal mucosa is up-regulated in reflux esophagitis patients. However,
the regulation of cytokines by IL-33 has not been examined.
Accordingly, we examined the function of IL-33 in esophageal epithelial cells using normal esophageal squamous epithelial cells.
Methods: Cytokines produced from esophageal biopsy specimen
was determined by Bio-Plex system. Using an in vitro stratified normal esophageal squamous epithelial model, IL-33 production was assessed by western blotting and immunofluorescence staining.
Cytokines produced by the cell layers after stimulations were measured by ELISA and Bio-Plex system. Pharmacological inhibitors
were used to examine the regulation of cytokine productions by IFN. IL-33 siRNA was used to examine the function in esophageal epithelial cells.
Results: Esophageal biopsy specimen produced IL-8 and IL-6.
IFNg induced nuclear IL-33 expression and IL-33 mRNA dose and
time dependent manner in stratified esophageal epithelial cell model.
Furthermore, IFN- induced IL-8 and IL-6 release from the cell
layers. IFN--induced IL-33 protein up-regulation in the cell layers
was through Janus-activated kinase (JAK) and p38 mictogen-activated protein kinase (MAPK) activation, but not through
protein kinase A (PKA). IFN--induced IL-8 and IL-6 release was
JAK, p38MAPK, and STAT1 dependent. IFN--induced IL-8 and
IL-6 are regulated by IL-33.
Conclusions: Esophageal epithelial nuclear IL-33 is up-regulated
by IFN- and inflammatory cytokines production from these cells is
regulated by IL-33.
S60
ANMA 2015 India
Selected Poster Presentation
No. 114
No. 116
Gastrointestinal Motility Disturbances In
Patients With Celiac Disease
Motility Disturbances in Achalasia Cardia Are
Wide Spread in Gastrointestinal Tract
1
2
3
1
1
S K Sinha, H Sinha, A Bhattacharya, S V Rana, K K Prasad, C K
1
1
1
1
1
Nain, R Kochhar, R Prasada, D K Bhasin, and K Singh
A Miglani, S K Sinha, BR Mittal, DK Bhasin, B Nagi, R Kochhar, HS
Dhaliwal, and K Singh
Departments of 1Gastroenterology, 2Internal Medicine, and 3Nuclear
Medicine, Post Graduate Institute of Medical Education and Research,
Chandigarh, India
Departments of Gastronetorlogy and Nuclear Medicine, Post Graduate
Institute of Medical Education and Research, Chandigarhg, India
Background/Aims: In achalasia cardia, motility disturbances have
been assumed to be confined to esophagus. However, losses of inhibitory ganglia into the proximal stomach and degenerative changes
in ganglia of vagal dorsal motor nucleus have been reported. As whole
of gastrointestinal tract (GIT) is supplied by vagus nerve, the motility
disturbances may be widespread in GIT.
Methods: This propective study included 20 patients of treated
Achalasia cardia (post pneumatic dialtation and grade 0-1 dysphagia).
Gastric emptying time for solids was measured by scintigraphic meth99m
od using Tc sulphur colloid. Small intestinal transit time (SITT)
was also measured by scintigraphic method. Ultrasound of gall bladder (GB) was done at baseline and after fatty meals (30 minutes and
60 minutes) to measure gall bladder ejection fraction.
Results: In these 20 patients (13 males, age 36.9 ± 10.4 years)
mean duration of dysphagia was 38.6 + 32.3 months. Gastric emptying T1/2 for solids and percentage emptying at 60 minutes were 87.4 +
47.1 minutes and 41.4 + 17.7% respectively. SITT measured by scintigraphic study was 4.6 + 1.56 hous. 35% patients had prolonged gastric emptying T 1/2 for solids (normal ＜ 80 minutes) and 65% patients had reduced percentage gastric emptying at one hour (45%).
Prolonged SITT (＞ 3.5 hours) was found in 75%. Mean GBEF at
30 and 60 minutes were 50.7 + 21.4 and 46.5 + 29.4% respectively.
40% patients had static GB (GBEF ＜ 40%) and 20% had poor contractility of GB (GBEF 40-60%).
Conclusions: In Achalasia cardia, altered gastric emptying, prolonged SITT and reduced GBEF was seen in most of the patients.
Thus, GIT motility disturbances seem to be widespred among patients with Achalasia cadia.
Background/Aims: Some of the symptoms of celiac disease patients
suggest disturbances in gastrointestinal (GI) motility. In celiac disease, pathology mainly involves the epithelium and lamina propria.
Involvement of muscle layer has not been clearly defined. The gut motility is primarily determined by muscularis propria and nervous system (enteric, autonomic, and central). There is paucity of data on motility changes in patients with celiac disease. To study esophageal, gastric and small intestinal motility in untreated cases of celiac disease
Methods: This prospective study included untreated consecutive
cases of celiac disease. Patients with any of following were excluded:
unwillingness to participate, intake of antibiotics or drugs affecting GI
motility in preceding 2 weeks, co-morbid illnesses affecting GI motility and pregnancy or lactation. Esophageal motility was studied by
esophageal manometry performed by station pull through. Gastric
motility was studied scintigraphically by measuring the rate of empty99m
ing of solid meal. Patients were given 2 Idlis labeled with Tc sulphur colloid. Segmental dynamic images were acquired in supine position with a gamma camera for 1 hour @ 1 minute/frame. Standard
software was used to calculate % emptying at 60 minutes and T1/2.
Orocecal transit time was measured by lactulose hydrogen breath test.
Breath hydrogen was measured using Quintron SC Microanalyser.
After collecting fasting breath samples, 10 grams of lactulose was given orally. End expiratory breath samples were collected every 15 minutes for 180 minutes. Time taken for a sustained rise in breath hydrogen by ＞ 10 ppm was taken as oro-cecal transit time.
Results: Out of 56 new cases of celiac disease seen during the study
period, 44 (21 males [47.7%]), age 28.1 ± 13.4 years) were included
and 12 excluded. Esophageal manometry was performed in 38 cases
and showed normal motility in 24 (63.2%), isolated hypertensive lower
esophageal sphincter (LES) in 2 (5.3%), nut cracker esophagus in 1
(2.6%), nut cracker esophagus with hypertensive LES in 2 (5.3%),
hypertensive LES with non-specific esophageal dysmotility in 3
(6.8%), and non-specific esophageal dysmotility with normal LES in
6 patients (15.8%). Gastric emptying for solids was found to be delayed in 13 out of 32 patients (40.6%). Orocecal transit time was prolonged in 25 out of 33 patients (75.8%).
Conclusions: Esophageal, gastric, and small intestinal motility disturbances are common in untreated patients of celiac disease.
S61
ANMA 2015 India
Selected Poster Presentation
No. 117
No. 118
Intestinal Microsporidiosis in Renal
Transplant Recipients: Prevalence, Predictors
of Occurrence and Genetic Characterization
Polymorphisms of Toll Like Receptor 4
(Thr399Ile and Asp299Gly) and Toll Like
Receptor 2 (196-174 Deletion) in
Cryptosporidium Infection
1
1
1
2
Sonali Khanduja, Ujjala Ghoshal, Tapan N Dhole, Raj K Sharma, and
3
Uday C Ghoshal
1
2
1
1
2
3
Asmita Dey, Ujjala Ghoshal, Vikas Agarwal, Uday C Ghoshal, Tapan
1
4
N Dhole, and Raj K Sharma
3
Departments of Microbiology, Nephrology, and Gastroenterology,
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road,
Lucknow, India
Departments of 1Microbiology, 2Immunology, 3Gastroenterology, and
4
Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences,
Lucknow, India
Background/Aims: Intestinal microsporidiosis, which occurs in
immunocompromised states such as acquired immunodeficiency syndrome, has rarely been studied in patients with renal transplantation
(RT) on immunosuppressive therapy.
Methods: Three hundred and twenty-four consecutive RT recipients on immunosuppressive treatment and 170 healthy subjects were
evaluated for intestinalmicrosporidiosis and other parasites using
modified trichrome staining, wet mount using normal saline and iodine staining and polymerase chain reaction (PCR). Clinical, demographic and laboratory parameters associated with occurrence of intestinal microsporidiosis were studied using univariate and multivariate analysis. The species of microsporidia were studied using
PCR-RFLP.
Results: Of 324 RT recipients initially screened, 52 were excluded
from final analysis due to incomplete data. Patients with RT (n = 272,
age 42 ± 12.54 years, 222 [81.6%] male) more often had microsporidiosis than healthy subjects by modified trichrome stain and
PCR (n = 170, age 33.8 ± 6.7 years, 123 [72.3%] male) (16/272
[5.8%] vs 0/170 [0.0%], P ＜ 0.001). Patients with intestinal microsporidiosis were younger (33.9 ± 9 years vs 42.3 ± 12.6 years; P =
0.009), had diarrhoea more often (13/16 [81%] vs 123/256 [48%]; P
= 0.020), which was longer in duration (47.5 [25-90] days vs 12
[7-18] days; P ＜ 0.001) and had associated giardiasis (2/16 [12.5%]
vs 2/256 [0.8%]; P = 0.018). Younger age, presence of diarrhoea and
associated giardiasis were significant on multivariate analysis.
Enterocytozoon bieneusi were isolated in 15/16 (93%) patients with intestinal microsporidiosis.
Conclusions: Intestinal microsporidiosis occurs frequently in patients with RT on immunosuppressive treatment, particularly among
younger patients with longer diarrhoea duration and associated
giardiasis. E. bieneusi is the major species identified among these
patients.
Background/Aims: Enteric parasite Cryptosporidium causes voluminous diarrhoea, prolonged symptoms and recurrences in immunocompromised patients, while in immunocompetent patients infection resolves in few weeks. Variation in the host genetic factors,
leading to impaired immune mechanisms might cause this differential
manifestation. Toll-like receptors (TLR) 2/4 specifically recognize
lipopolysaccharide motifs on surfaces of microorganisms. Polymorphism
in TLR genes has resulted in abnormal host-pathogen interaction due
to variation in TLR proteins. Thus, we aimed to study the relationship
between TLR 2/4 polymorphism and cryptosporidiosis.
Methods: Two hundred and twenty-two immunocompromised
(154 renal transplant recipients and 68 HIV positive patients) and 200
healthy subjects (HS) were evaluated for TLR2 196_174del, TLR4
Asp299Gly and Thr399Ile polymorphisms by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP).
Three stool samples were collected from each patient for microscopy
and EDTA-blood samples were taken for TLR PCR-RFLP.
Results: Sixty-two out of 222 immunocompromised patients and
none of the HS were positive for Cryptosporidium. Logistic regression
analysis was performed between genotype and allele distributions of
the Cryptosporidium positive group and the 2 control groups, ig, immunocompromised patients without cryptosporidiosis and HS. It revealed no significant association between TLR2 196_174 del,
TLR4_299, and TLR_399 heterozygote and homozygote states and
occurrence of cryptosporidiosis in our population.
Conclusions: This is the first study to investigate the role of TLR
gene polymorphisms for susceptibility to Cryptosporidium. This study
also confirmed the low frequency of the three polymorphisms in our
population, as observed in other studies. Although, no significant association was found, studies comprising of very large population from
independent geographical/ ethnic groups might decipher the involvement of these polymorphisms with the infection.
S62
ANMA 2015 India
Selected Poster Presentation
No. 119
No. 120
Translation and Validation of Enhanced Asian
Rome 3 Questionnaires in Bengali Language
for Diagnosis of Functional Gastrointestinal
Disorders
Virulence Factors of Helicobactor pylori
Among Patients With Functional Dyspepsia
and Peptic Ulcer in the Community: A Study
by cagA and vacA Genotyping
1
2
Mohammed Masudur Rahman, Uday C Ghoshal, AHM Rowshon,
1
1
4
Faruque Ahmed, Md. Golam Kibria, Mahmud Hasan, Kok-Ann
Gwee,5 and William Whitehead6
1
2
3
1
3
DMCH, Dhaka, Bangladesh; SGPGIMS, Lucknow, India; ShSMCH,
4
5
Bangladesh; BMRC, Bangladesh; National University of Singapore,
6
Singapore; and University of North Carolina at Chapel Hill, NC, USA
2
3
Mohammed Masudur Rahman, Uday C Ghoshal, Shamsun Nahar,
4
1
1
Mian Mashhud Ahmad, Md. Golam Kibria, Faruque Ahmed, AHM
Rowshon,5 Nigar Sultana,1 Abdullah yousuf,5 and Mahmud Hasan6
1
Background/Aims: Since functional gastrointestinal disorders
(FGIDs) are diagnosed by symptom-based criteria and socio-cultural
and linguistic factors may influence symptom reporting, cultural adaptation of the questionnaire and its translation and validation is
important. Hence, we translated and validated the Enhanced Asian
Rome 3 questionnaire (EAR3Q) in Bengali.
Methods: From May 2011 to February 2012, the EAR3Q was
translated in Bengali as per guideline from the Rome Foundation.
The translated questionnaire was validated on a prospective samples of
Bengali speaking healthy subjects (HS, n = 10), and patients with
functional dyspepsia (FD, n = 20), irritable bowel syndrome (IBS, n
= 20), and functional constipation (FC, n = 10) diagnosed by clinicians using Rome 3 criteria. The subjects were asked to fill-up the
questionnaire again after two weeks, to check for its reliability.
Results: During translation, the original and backward translated
English versions of the questionnaire demonstrated high concordance.
The median age of the patients with FD, IBS, FC, and HS were 30
(range 18-42), 30 (18-65), 35 (18-70), and 27 (18-42) years,
respectively. Agreement (kappa values) between clinical and translated
questionnaire-based diagnosis at initial and at 2 weeks follow-up visits
for FD, IBS, FC, and HS were 1.0, 1.0, 0.9, and 1.0, and 1.0, 1.0,
1.0, and 1.0, respectively. Bengali questionnaire detected considerable
overlap symptoms of FD among patients with IBS, IBS among patients with FD and FD among patients with FC, which were not detected by the clinicians.
Conclusions: We successfully translated and validated the EAR3Q
in Bengali. We believe that this translated questionnaire will be useful
for clinical evaluation and research among Bengali speaking population.
2
Dhaka Medical College, Dhaka, Bangladesh; Sanjay Gandhi Postgraduate
3
Institute of Medical Sciences, Lucknow, India; ICDDR, B Dhaka,
4
5
Bangladesh; Apollo Hospitals, Dhaka, Bangladesh; Shaheed Suhrawardy
6
Medical College, Dhaka, Bangladesh; and BMRC, Dhaka, Bangladesh
Background/Aims: Though the role of Helicobactor pylori in peptic
ulcer (PU) is well-established, its role in functional dyspepsia (FD) is
controversial. Hence, we undertook a study in a Bangladeshi rural
community to evaluate the virulence-associated genes of H. pylori
(cagA, vacA, and specifically the vacA allelic variants) among patients
with FD as compared to PU with a hypothesis that H. pylori may be as
virulent among these patients as compared to those with PU.
Methods: H. pylori was identified and genotyped using multiplex
polymerase chain reaction on antral biopsies among dyspeptic subjects
(diagnosed using Rome III criteria) while door-to-door survey in a rural community in Bangladesh.
Results: Of 268 dyspeptic subjects, 190 (71%) had FD and 78
(29%) had PU (active PU and ulcer in remission). H. pylori was detected as commonly among patients with FD as those with PU
(170/190 [89.5%] vs 74/78 [95%]; P = 0.238). H. pylori infected patients with PU had higher frequency of cagA positivity than those with
FD (52/74 [70.36 %] vs 74/170 [43.5%] P = 0.000). Among the
patients with FD and PU, The frequency of vacA genotypes s1m1,
s1m2, s2m1, and s2m2 among patients with FD and PU was 66/170
(38.8%) vs 48/74 (64.9%) (P = 0.000); 48/170 (28.2%) vs 15/74
(20.3%) (P = 0.207); 6/170 (3.5%) vs 1/74 (1.4%) (P = 0.678) and
7/170 (4.1%) vs 1/74 (1.4%) (P = 0.441), respectively.
Conclusions: These data suggest that patients with PU in the community had more virulent H. pylori compared to those with FD. These
data contradict some of the earlier studies that suggested that in hyper-endemic areas such as India and Bangladesh frequency of virulent
strains of H. pylori is comparable among patients with FD and PU in
hospital-based studies.
S63
ANMA 2015 India
Selected Poster Presentation
No. 121
No. 122
Characteristics of Neural Immunoreactive
Staining of Serum Anti-enteric Neuronal
Antibodies in Patients With Irritable Bowel
Syndrome and Its Clinical Significance
Mitochondrial Neurogastrointestinal
Encephalopathy: An Unusual Cause of
Intestinal Obstruction
1
1
2
Arun Karyampudi, Abhai Verma, Kausik Mandal, Priyanka
2
2
2
1
Srivastava, Dhanya Lakshmi, Shubha R Phadke, Vivek A Saraswat,
1
and Uday C Ghoshal
Lingling Chen, Guijun Fei, Ping Wen, Chengdang Wang, Haiwei Xin,
and Xiucai Fang
1
2
Departments of Gastroenterology and Medical Genetics, Sanjay Gandhi
Post-Graduate Institute of Medical Sciences, Lucknow, India
Department of Gastroenterology, Peking Union Medical College Hospital,
Chinese Academy of Medical Sciences and Peking Union Medical College,
Beijing, China
Background/Aims: Mitochondrial neurogastrointestinal encephalopathy (MNGIE), an autosomal recessive disorder, is characterized
by gastrointestinal dysmotility, cachexia, extra-ocular muscle weakness, peripheral neuropathy, leucoencephalopathy, and acquired mitochondrial DNA abnormalities in various tissues. It is caused by mutation in thymidine phosphorylase (TYMP) gene causing depletion of
the enzyme activity.
Methods: A 16-year-old emaciated male presented with recurrent
vomiting and loose stools since 9 years of age. His illness remained undiagnosed for seven years in spite of multiple consultations and investigations to find out a mechanical cause for intestinal obstruction that
failed. He received anti-tubercular drugs (ATD) with a misdiagnosis
of intestinal tuberculosis and homoeopathic treatment. His body mass
2
index was 7.1 kg/m and had visible intestinal peristalsis. He had ptosis, external ophthalmoplegia and diminished deep tendon reflexes.
Stomach and duodenum were hugely dilated with features of superior
mesenteric artery syndrome on CT scan.
Results: Esophageal manometry and radionuclide gastric emptying
showed abnormal motility of esophagus and stomach. Cerebral MRI
and nerve conduction studies showed diffuse leucoencephalopathy
and axonal and demyelinating polyneuropathy. Diagnosis of MNGIE
was confirmed by identification of 2 novel mutations in the TYMP
gene. Though allogenic stem cell transplantation is the only effective
treatment but the literature on this is limited. He received nasojejunal
tube feeding, prokinetics, rifaximin for small intestinal bacterial overgrowth, ATD for associated pulmonary tuberculosis, and Co-enzyme
Q 10. He improved (BMI 12 at 4-mo).
Conclusions: MNGIE is rare and may present with gastroparesis
and intestinal pseudo-obstruction. High index of suspicion is required
for an early diagnosis.
Background/Aims: The aim of the study is to investigate the characteristics of neural immunoreactive straining of serum anti-enteric
neuronal antibodies in irritable bowel syndrome (IBS) patients, to analyze the relationship between the antibodies and clinical symptoms.
Methods: IBS patients met the Rome III criteria were enrolled,
and had been excluded the organic diseases by laboratory examinations and colonoscopy. Indirect immunofluorescence (IIF) was used
to detect the sera anti-enteric neuronal antibodies with the substrate of
enteric submucosal plexus of guinea pig. The immune reactivity (IR)
stains were read and graded by 2 independent investigators in blinded
manner. The bowel symptoms and defecation-related symptoms of patients with positive staining and negative staining were compared.
Results: A total of 139 IBS patients were enrolled. The positive rate
of serum anti-enteric neuronal antibodies in IBS patients was 84.9%,
which is significantly higher than in healthy controls (n = 86, 7.0%, P
＜ 0.001). Among 118 IBS sera with positive immune reactivity,
26.3% of them presented as strongly positive staining (+++), 51.7%
as positive (++), 22.0% as weakly positive (+). Several IR staining
patterns were observed: positive staining only within cytoplasm in 81
sera, purely nucleus staining in 2 cases, purely nuclear membrane
staining in 2 cases, both cytoplasm and nuclear membrane staining in
30 cases, and both cytoplasm and nucleus staining in 3 cases. All of 6
positive healthy control sera showed cytoplasm staining only. The anti-enteric neuronal antibodies negative staining group and positive
staining group in IBS patients have no significant differences in age,
gender and disease duration. IBS patients in positive staining group
are more commonly associated with bowel urgency comparing with
patients in negative staining group (87.3% vs 57.1%, P = 0.002).
Compared with patients with negative and week positive IR, more patients with higher intensity IR have higher intestinal symptoms scores
(＞ 10 scores), frequent abdominal pain in non-defecation period, and
severe abdominal pain/discomfort before defecation (58.8% vs 38.1%,
P = 0.028; 91.7% vs 60.0%, P = 0.04; 24.7% vs 9.5%, P = 0.043,
respectively).
Conclusions: In our study, the positive rate of sera anti-enteric neuronal antibodies in IBS patients was higher than in the healthy
controls. IBS patients with positive or higher staining intensity of anti-enteric neuronal antibodies presented more severe bowel symptoms
than the patients with negative and weakly positive staining，suggesting that the anti-enteric neuronal antibodies might cause or aggravate
bowel symptoms by affecting enteric nervous system. Anti-enteric
neuronal antibodies may play a role in the pathogenesis of IBS, which
have the potentiality to be a biomarker for IBS.
S64
ANMA 2015 India
Selected Poster Presentation
No. 123
No. 124
Effects of Postprandial Coffee Intake on the
Rate of Gastric Emptying of Liquid and Solid
Meals: A Crossover Study Using 13C Breath
Test
Prevalence and Self-Recognition of
Sonstipation in Japanese Population
Fumihiko Toyoshima, Toshihiko Tomita, Akio Tamura, Takahisa
Yamasaki, Takashi Kondo, Tomoaki Kono, Katsuyuki Tozawa, Hisatomo
Ikehara, Yoshio Ohda, Tadayuki Oshima, Hirokazu Fukui, Jiro Watari
and Hiroto Miwa
Kenji Kanoshima, Takashi Nonaka, Yumi Inou, Shiori Uchiyama, Mizue
Matsuura, Takuma Higurashi, Hiroshi Iida, Tomonori Ida, Hiroki Endo,
Masahiko Inamori, Kusakabe, Shin Maeda, and Atsushi Nakajima
Hyogo College of Medicine, Nishinomiya, Japan
Background/Aims: Constipation is a common symptom. Most patients recognize constipation by one or more symptoms, such as hard
stools, infrequent stools (typically fewer than 3 per week), the need for
excessive straining, a sense of incomplete bowel evacuation. However,
there is no international consensus definition of constipation so far.
The aim of study was (1) to assess self-recognition of constipation in
Japanese population and (2) to examine the prevalence of constipation
using the criteria of Japanese society of internal medicine.
Methods: An internet questionnaire survey of 5155 adult members
of the general public in Japan who were screened for constipation using the criteria of Japanese society of internal medicine was conducted.
The definition of constipation identified it as an inability to evacuate
stool completely and spontaneously three or more times per week.
Questionnaire including self-recognition of constipation, frequency of
defecation, interval, form, management were also obtained.
Results: Adult of the general public in Japan who recognize themselves as constipation were found in 28.4%, among them 50.7% think
them constipated in 20’s women. However, the prevalence of constipation was found only in 10.1% using the criteria of Japanese society
of internal medicine. Interestingly, subjects who regard constipation as
disease were seen only in 48.8%. The management of constipation in
Japanese population was as follows; intake of liquid (52.2%), reservation of sleeping time (39.7%), and only 7.9% take some medicines
(including OTC) for constipation.
Conclusions: There is a discrepancy in the prevalence of constipation between by self-recognition and that defined using the criteria of Japanese society of internal medicine.
Background/Aims: Coffee is one of the most popular beverages
worldwide, however, few studies have examined the effects of coffee
on the gastrointestinal system. The aim of this study was to determine
whether there was a correlation between coffee intake and gastric emp13
tying of liquid and solid meals using C breath test.
Methods: Six healthy volunteers participated in this randomized,
two-way crossover study. The subjects fasted overnight and were randomly assigned to receive 190 mL black coffee following ingestion of
the liquid test meal (200 kcal per 200 mL) labelled with 100 mg
13
C-acetate, or the liquid test meal alone. Under both conditions, gastric emptying was monitored for 4 hours after administration of the
13
test meal by the C breath test performed continually using the
BreathID system. Liquid gastric emptying was estimated by the values of T1/2 and Tlag, using Oridion Research Software. Moreover, other 6 healthy volunteers were randomly assigned to receive 190 mL
black coffee or 190 mL water following ingestion of the solid test meal
13
(a pancake, 350 kcal) labelled with 100 mg C-octanoic acid after an
overnight fast. Under both conditions, breath samples were collected
for 150 minutes following the meal ingestion using air bags. Solid gastric emptying was estimated by the values of Tmax. The above parameters between the coffee intake and the control were compared
statistically.
Results: In the coffee intake after ingestion of the liquid test meal,
significant differences compared with the control condition were
found in T1/2 (median 105.7 [range 85.7-123.1] minutes vs 121.3
[107.2-134.0.0] minutes; P = 0.023) and Tlag (median 49.5
[21.0-68.5] minutes vs 65.6 [49.8-87.6] minutes; P = 0.046].
Whereas, no significant difference in the Tmax was observed between
the coffee intake and the control after ingestion of the solid test meal
(median 82.5 (50.0-105.0) minutes vs 60.0 [40-150] minutes; P =
0.528).
Conclusions: This study showed that postprandial coffee intake
significantly enhances gastric emptying of a liquid meal, not a solid
meal.
S65
ANMA 2015 India
Selected Poster Presentation
No. 125
No. 126
The Value of High Resolution Manometry in
Patients Presenting With Gastroesophageal
Reflux Disease Symptoms With Normal
Endoscopy and Negative 24 Hour
pH-Impedance Study
pH Probe Placement in Children: Arithmetic
Calculations Much Inferior to Esophageal
High-resolution Manometry
Alex Yu Sen Soh, Kewin Tien Ho Siah, Chin O Ho, Ho Khek Yu, and
Reuben K Wong
Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate
Institute of Medical Sciences, Lucknow, India
Anshu Srivastava, Amrita Mathias, Rohan Malik, Surender K Yachha,
and Ujjal Poddar
Department of Gastroenterology and Hepatology, National University
Hospital, Singapore, Singapore
Background/Aims: Precise definition of lower esophageal sphincter (LES) by high-resolution manometry (HRM) helps in correct
placement of the pH probe. Various arithmetic calculations are used to
predict esophageal length (EL) for pH placement in children. This
study determined the validity of these formulae to predict EL in comparison to HRM.
Methods: Sixty-three children (40 boys, age 12.5 ± 3.1 years) underwent esophageal HRM by a 22channel water perfusion system
(MMS) to determine LES position and EL was calculated using upper border of LES as reference point. The patients height, EL by
Strobel’s formula (SF) and by the new formula (NF) proposed by
1
Moreau et al was recorded. Patients with scoliosis, neurological impairment and esophageal surgery were excluded. Formula calculated
EL was compared with HRM measured values.
Results: The mean EL on HRM was 35.3 ± 3.5 cm and the LES
length was 2.4 ± 0.5 cm. The height ranged from 88.0-171.4 cm,
with a significant correlation between the child’s height and EL by
HRM (r = 0.857, r2 = 0.730; new equation: EL = 0.2 × height +
6.587; P ＜ 0.001). Calculated EL by SF was 41.3 ± 3.8 cm, significantly more than HRM values (difference 5.9 ± 2.0 cm; P ＜
0.001). Similarly, NF also overestimated the EL in comparison to
HRM (38.2 ± 3.3, difference 3.0 ± 0.55 cm; P ＜ 0.001). NF was
significantly better than SF in predicting EL.
Conclusions: HRM should be the preferred method for pH catheter placement in children. Arithmetic calculations based on height of
the child significantly overestimate EL, with SF performing poorer
than the NF.
Reference
1. Moreau B, Kambites S, Lévesque D. Esophageal length: esophageal manometry remains superior to mathematical equations. J
Pediatr Gastroenterol Nutr 2013;57:236-239.
Background/Aims: The number of patients presenting with gastroesophageal reflux disease (GERD) related symptoms are increasing in
Asia. Currently GERD patients with negative endoscopy are divided
to non-erosive reflux disease or functional heartburn according to
ROME III criteria after 24-hour pH-Impedance and proton pump
inhibitor treatment. We aim to investigate the value of high-resolution
manometry (HRM) in GERD patients with normal endoscopic findings and negative 24 hour pH-Impedance test.
Methods: Consecutive patients referred to the motility laboratory
were invited to participate in the study. Inclusion criteria were patients
with GERD related symptoms, normal endoscopic findings and negative dysphagia. Both 24 hour pH-Impedance study and HRM study
were carried out. Biophysical, social and GERD Quality of Life data
were also collected.
Results: We recruited 101 patients (54 males, 47 females) with a
mean age of 49.0 (SD 15.4). Nineteen patients had positive 24 hour
pH-Impedance test, 26.3% of them had positive HRM findings (4
weak peristalsis and 1 esophagogastric junction outflow obstruction).
43% with negative 24 hour pH-Impedance (35 out of 82 patients) had
positive HRM findings. Majority had weak peristalsis (19 patients),
however, 6 had esophagogastric junction outflow obstruction, 4 had
nutcracker esophagus, 3 had Type II Achalasia, and 2 had absent
peristalsis. Presenting symptoms were not able to differentiate between
positive and negative findings in both 24 hour pH-Impedance and
HRM tests.
Conclusions: GERD patients with normal endoscopy and negative
24 hour pH-Impedance may benefit from HRM evaluation.
S66
ANMA 2015 India
Selected Poster Presentation
No. 127
No. 128
Characteristics of Esophageal pH-Impedence
Monitoring in Non-erosive Reflux Disease
Patients On and Off Protein Pump Inhibitor
Therapy
Characteristics of Multichannel Impedence
With pH Metry in Refractory
Gastroesophageal Reflux Disease Patients
On and Off Proton Pump Inhibitor Therapy
in Indian Population
Rakesh Kalapala, Jaya Agarwal, and D Nageshwar Reddy
Rakesh Kalapala, Jaya Agarwal, and D Nageshwar Reddy
Department of Gastroenterology, Asian Institute of Gastroenterology,
Hyderabad, India
Department of Gastroenterology, Asian Institute of Gastroenterology,
Hyderabad, India
Background/Aims: Non-erosive reflux disease (NERD) is the
common form of presentation of gastroesophageal reflux disease
(GERD). About 50% of patients with typical GERD symptoms have
normal endoscopy findings. Both acidic and non-acidic refluxes contribute to symptomatology in these group of patients. We aimed to
evaluate the characteristics of impedence-pH monitoring in non-erosive reflux disease (NERD) patients who are on and off PPI therapy.
Methods: Forty-eight patients with symptoms of reflux disease and
normal endoscopy findings were included in the study. The patients
were divided into 2 groups: proton pump inhibitor (PPI) (+) group
(on PPI therapy for more than 4 weeks) and PPI (-) group (off PPI
therapy for more than 4 weeks). All these patients underwent 24-hour
pH with impedance monitoring after informed consent. Twenty-one
patients were in PPI (+) group and 27 were in PPI (-) group. The
acidic, nonacidic reflux events, proximal and distal extent of the reflux
including the median bolus clearance time were recorded. The symptom index (SI) and symptom association probability (SAP) were also
noted.
Results: Mean age were 42 and 44.7, and M:F ratio were 13:8 and
25:2 in PPI (+) and (-) groups, respectively. There was no significant
statistical difference in any of the variables in both groups. Multivariate
logistic regression analysis showed odds ratio ＞ 1 in acid supine reflux, non-acidic supine and total reflux, SAP (heart burn), deMeester
score, proximal and distal reflux episodes supine, and symptom correlation (heart burn and belch) with 95% confident interval.
Conclusions: Twenty-four-hour impedence-pH monitoring in patients with NERD who are on and off PPI therapy does not show any
significant difference in assessment of relationship between symptoms
and reflux episodes and also other variables like reflux episode activity
and bolus exposure. However, the odds ratio in the above mentioned
variables can be proposed as the risk factors in patients with NERD
but need a large population study to propose the same.
Background/Aims: Gastroesophageal reflux disease (GERD) is a
common condition affecting a large population. Traditionally GERD
has been associated with acidic refluxes. The regular 24-hour pH metry can detect acidic reflux only. The 24-hour multichannel intraluminal impedence with pH metry (MII-pH) enables monitoring of
both acidic and non-acidic reflux episodes including the extent of each
episode into the esophagus. The variations of these reflux episodes in
patients with and without proton pump inhibitor (PPI) therapy have
not been evaluated. To assess the reflux patterns of GERD patients
who are on and off PPI therapy with combined MII-pH.
Methods: One hundred twenty patients (75 M , 45 F) with symptoms of reflux disease and erosive esophagitis on endoscopy were
included. Subjects on PPI therapy for more than 4 weeks were included in the PPI (+) group. The subjects without any PPI therapy
for at least 4 weeks prior to the study were included in the PPI (−)
group. These underwent MII-pH after informed consent.
Twenty-two patients were in PPI (+) group and and 28 were in PPI
(−) group. The acidic, nonacidic reflux events, proximal and distal
extent of the reflux including the median bolus clearance time were
recorded. The Symptom index (SI) and Symptom association probability (SAP) were also noted.
Results: Mean age and M:F ratio of both groups was similar. Acid
reflux events (upright and supine), the composite deMeester score
and the proximal extent of the refluxes was significantly higher in the
PPI (−) group (P ＜ 0.001).The majority of refluxes in the subjects
on PPI (+) group were supine and non-acidic type. The SI, SAP, and
median bolus clearance did not demonstrate statistical significance between the 2 groups. Logistic regression analysis showed odds ratio ＞
1 in non-acidic supine reflux, SAP (belch), SI (heartburn), and distal
extent reflux events with 95% confident interval for subjects in the
PPI (−) group.
Conclusions: The study demonstrates that persistent symptoms in
subjects of the PPI (+) group of GERD are possibly related to
non-acidic refluxes predominantly in the supine position. This increased frequency of supine non-acid reflux events reflects an increased exposure of distal esophagus to gastric and duodenal
secretions. These non-acid refluxes are not detectable with traditional
esophageal pH metry alone and hence MII-pH metry may be mandatory for patients with refractory GERD symptoms.
S67
ANMA 2015 India
Selected Poster Presentation
No. 129
No. 131
Orocecal Transit Time in Gastrointestinal
Diseases in Indian Patients
Small Intestinal Bacterial Overgrowth and
Orocecal Transit Time in Cirrhosis and
Non-cirrhotic Portal Hypertension
Satya V Rana
S K Sinha, S V Rana, D K Bhasin, U Dutta, HS Dhaliwal, K Singh, and
R Kochhar
Department of Gastroenterology, Post Graduate Institute of Medical
Education and Research, Chandigarh, India
Department of Gastroenterology, Post Graduate Institute of Medical
Education and Research, Chandigarh, India
Background/Aims: Orocecal transit time (OCTT) is one of main
determinants of gastrointestinal motility. While marked-isotopes scintigraphy is gold standard in its determination in clinical frame, breath
tests are cheap, well-tolerated and non-invasive alternatives. Gastroenterologists have shown great interest in simple and non-invasive methods of assessing gut transit. Secondly, rate of passage of barium during
small bowel radiology is unreliable and lacks correlation with
symptoms. Therefore, Lactulose hydrogen breath test was used to
measure orocecal transit time in different gastrointestinal diseases such
as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD),
gall stones, etc.
Methods: For this method, adult patients of IBS, IBD, gall stones,
and 100 apparently healthy age and sex matched subjects were instructed to consume low fiber diet 3 days before test. Fasting end expiratory breath was taken .Then 15 mL lactulose syrup containing 10
g lactulose was given to patients and controls to drink and end expiratory breath was taken after every 10 minutes up to 4 hours.
Subjects were instructed not to sleep, exert and smoke during test.
Time taken for rise ＞ 10 ppm in hydrogen concentration over fasting
value was considered as orocecal transit time.
Results: It was observed that the age range of patients and controls
was 18 to 65 years. Results of orocecal transit time in different gastrointestinal diseases and controls will be presented. Mean of orocecal
transit time of controls was 90.5 minutes while of IBS patients 98.7
minutes, of IBD patients 145.9 minutes and of gall stone patients
128.6 minutes.
Conclusions: It was observed that the orocecal transit was significantly delayed in IBD and gall stone patients as compared to controls but no significant change in patients with IBS.
Background/Aims: Motility disturbances in achalasia cardia are
not restricted to esophagus only. We have reported delayed liquid gastric emptying in achalasia cardia earlier. The aim of study was to measure the small intestinal transit time in patients with achalasia cardia
Methods: This prospective study included patients with achalasia
cardia diagnosed on the basis of barium swallow findings and esophageal manometry. Informed consent was obtained from each patient.
Small bowel transit time was measured by lactulose hydrogen breath
test. The test was performed in each patient after overnight fast by instilling 10 g of lactulose just beyond the pylorus during index esophagogastroduodenoscopy examination. Breath hydrogen was measured
at base line and then every 15 minutes for 180 minutes or more. Time
taken for rise in breath hydrogen by more than 5 ppm was taken as
small intestinal transit time. Patients with a history of intake of drugs
like antibiotics, prokinetics, lactulose, histamine H2 receptor antagonist, and proton pump inhibitor in preceding 4 weeks were excluded.
Results: The study included 27 patients (17 males, 10 females).
Mean age was 37.9 ± 13.5 years. The mean small intestinal transit
time was 81.7 ± 41.7 minutes. However, 7 out of 27 patients (25.9%)
had small intestinal transit time of 105 minutes or more (which is the
upper limit for the orocecal transit time in our laboratory).
Conclusions: Abnormality of small intestinal transit is common in
patients with achalasia cardia.
S68
ANMA 2015 India
Selected Poster Presentation
No. 132
No. 133
Effects of Activin A on Duodenum of
Denervated Rats: Roles of Myenteric Plexus,
Interstitial Cells of cajal and Smooth Muscle
Cells
Lactobacillus plantarum PS128 Ameliorated
5-Hydroxytrytophan-induced Visceral
Hypersensitivity in Rats
1,2,3
4,5
4
1,2
Yen-Po Wang,
Chien-Chen Wu, Wen-Jian Tzeng, Pei-Yi Liu,
4,5
1,2
Ying-Chieh Tsai, and Ching-Liang Lu
Yue Yu, Dan Xue, and Yan Yang
1
Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan;
Division of Gastroenterology, Taipei Veterans General Hospital, Taipei,
Taiwan; 3Endoscopy Center for Diagnosis and Treatment, Taipei Veterans
General Hospital, Taipei, Taiwan
Division of Gastroenterology, Affiliated Provincial Hospital, Anhui Medical
University, Hefei, China
2
Background/Aims: Studies have demonstrated that loss or damage
of enteric neurons can lead to various gastrointestinal motility disorders, and the myenteric plexus plays an important role in the regulation of gastrointestinal motility. Benzalkonium chloride (BAC), a
kind of cationic disincrustant, can damage enteric nerve tissue at certain concentrations. Activin A, also called neuronal survival factor, can
provide neuroprotective and anti-inflammatory effects, and is helpful
for repair of stromal cells. But few reports describe the neuroprotective
and promoting effects of activin A on the survival of enteric neurons,
intestitial cells of Cajal (ICC) and smooth muscle cells (SMCs). The
aim of study was explore the effect of activin A on duodenl myenteric
plexus, ICC and slow waves of SMCs.
Methods: All Sprague-Dawley male rats were divided randomly
into 3 groups: control, denervated, and Activin A-treated group. The
duodenum of denervated group rats was wrapped around by cotton
wool soaked in 0.9% saline containing 0.5% BAC for 30 minutes.
Then the peritoneum and treated area were flushed with 0.9% saline
several times .The activin A-treated group were injected with activin A
(0.005 mg/mL) 10 mL/kg/day for 2 weeks via tail vain. After 2 weeks,
neurons, and ICCs in duodenal myenteric plexus were counted by immunohistochemistry staining. Changes of protein gene product 9.5
(PGP9.5) in duodenum were determined by western blotting. The
slow waves of SMCs were recorded by intracellular recording.
Results: The number of neurons (PGP9.5), c-kit, and the quantity
of PGP9.5 protein of activin A-treated group increased significantly
compared with denervated group (all P ＜ 0.01), but they were decreased significantly compared with the control group (all P ＜ 0.01).
The amplitude of slow waves in duodenal smooth muscle in the activin
A-treated group was significantly higher than that in the denervated
group (13.80 ± 5.39 vs 6.90 ± 2.12, P ＜ 0.05), but the frequency
was not significantly changed (26.50 ± 1.28 vs 26.60 ± 1.69, P ＞
0.05). The frequency and amplitude of slow waves in duodenal
smooth muscle in the activin A-treated group were significantly lower
than those in the control group (20.50 ± 3.72 vs 6.90 ± 2.12, P ＜
0.05; 26.50 ± 1.28 vs 35.00 ± 1.20, P ＜ 0.05).
Conclutions: The duodenum was denervated significantly after application of BAC for 2 weeks. The ICCs and slow waves of SMCs also
changed obviously. Activin A can protect enteric neurons and promote
them survive and is also helpful for repairing ICCs and improving the
slow waves of SMCs. This provided evidence for the treatment of gastrointestinal disorders related to enteric neurons in the future.
Background/Aimds: Irritable bowel syndrome (IBS) is a common
functional gastrointestinal disorder characterized by abdominal pain
and alterations in bowel habits. IBS symptoms would not only impair
their quality of life, but also bring substantial economic burden to the
society. Visceral hypersensitivity (VH) is commonly observed in patients with IBS and has been suggested to play a pathogenic role in development of IBS symptoms. Current treatment of IBS is still unsatisfactory and probiotics may serve as a promising option for the IBS
treatment. The aim of study was identify the potential anti-nociceptic
effect of Lactobacillus plantarum PS128 in a rat model with VH, mimicking IBS symptoms.
Methods: Lactobacillus plantarum PS128 (109 colony-forming unit
in 0.2 mL saline/rat/day) or placebo (0.2 mL saline/rat/day) were fed
to male Sprague-Dawley rats for 14 days. 5-Hydroxytryptophan
(5-HTP) was injected subcutaneously into awake rats to induce VH at
day 0 and day14. Colorectal distension (CRD) with simultaneous
electromyography recording was done 30 minutes before and 30 minutes after 5-HTP injection. Spinal substance P level was measured at
14 days after finishing CRD test.
Results: The visceromotor reflex (VMR) was statistically significantly higher after 5-HTP administration (P ＜ 0.05). Oral administration of PS128 for 14 days successfully reversed the 5-HTP-induced VH. The VMR differences between baseline and after 5-HTP
administration was statistically higher in PS128 group compared with
placebo group (P ＜ 0.05). Rats fed with placebo were found to have a
significantly increased spinal level of substance P, an important excitatory neurotransmitter, after 5-HTP injection followed by CRD.
Administration of PS128 could reverse spinal substance P level after
5-HTP-sensitization and CRD.
Conclusions: PS128 would ameliorate the 5-HTP-induced VH,
which may go through the substance P-containing neural pathway in
spinal cord.
S69
ANMA 2015 India
Selected Poster Presentation
No. 134
No. 135
Expression of Transient Receptor Potential
Vanilloid Type 1 Receptors and
Electrophysiological Characteristics of
Colon-specific Dorsal Root Ganglion Neurons
in a Rat Model of Colonic Visceral
Hypersensitivity
Perforation Following Pneumatic Dilation of
Achalasia Cardia: A Retrospective Review of
11 Patients
Nakul Morakhia, Uday C Ghoshal, Abhai Verma, Samir Mohindra, and
Vivek A Saraswat
Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of
Medical Sciences, Lucknow, India
Yue Yu, Lili Yuan, Nan Jiang, Fengqin Chen, Qiaomin Wang, and
Liecheng Wang
Department of Gastroenterology, Affiliated Provincial Hospital, Anhui
Medical University, Hefei, China
Background/Aims: To investigate the expression of transient receptor potential vanilloid type 1 (TRPV1) receptors and electrophysiological characteristics of the colon-specific dorsal root ganglion
(DRG) neurons in a rat model of colonic visceral hypersensitivity
(CVH).
Methods: CVH was induced by colorectal injection of acetic acid
(AA) in 10-day-old rats, colon-specific DRG neurons were retrogradely labeled by injection of DiI (1,1'-Dioctadecyl-3,3,3',3'Tetramethylindocarbocyanine Perchlorate) into the colon wall. Expression of TRPV1 receptors was determined by immunofluorescence staining and electrophysiological characteristics were measured using
whole patch clamp techniques.
Results: Compared to the controls, the expression of TRPV1 receptors in the colon-specific DRG neurons was significantly higher (P
＜ 0.01) and the frequency of Aps (P ＜ 0.01).
Conclusions: These data suggest that there is a close relationship
between visceral hypersensitivity and increased expression of TRPV1
receptors and excitability in colon-specific DRG neurons which is
conducive to provide an effective target to treat visceral hypersensitivity.
S70
Background/Aims: Pneumatic dilation (PD) is an effective treatment of achalasia; 1-30% patients undergoing PD have esophageal
perforation (EP), which may require surgery. Data on frequency, profile and outcome of EP are not widely reported.
Methods: Records of patients undergoing PD for achalasia during
a 16.5 year period (April 1998 to September 2014) were retrospectively reviewed.
Results: Eleven (median age 43 years, range 27-74, male 5 [45%])
of 455 (2.4%) PD sessions, on 414 patients (2.6%), had EP. Seven
and 4 patients had type 1 and 2 achalasia, respectively. Median resting
lower esophageal sphincter (LES) pressures was 43 mmHg (range
16-60). The size pneumatic balloon used for PD were 30 mm (n = 6),
35 mm (n = 4), and 40 mm (n = 1). Ten out of 11 EP occurred during the first and only 1 during second PD. Chest radiograph done in 6
patients revealed pneumomediastinum in 3 (50%) but computerized
tomographic scan of chest done in 5 revealed pneumomediastinum in
all. Contrast radiograph using gastrograffin revealed perforation in
7/9 (78%) patients in whom it was performed. Seven patients needed
surgical treatment (all had contrast leak), 1 was managed successfully
with self-expandable covered metal stent and 3 (1 had contrast leak)
improved with conservative treatment. At surgery, median length of
the perforation was 3 cm (range 2-5); sites of perforation were: the left
lateral wall in 4, left antero-lateral wall in 2, and posterior wall in 1.
Conclusions: EP perforation occurs in 2.4% PD, most often in the
first session. Effective management of this dreaded complication is
usually associated with good outcome.
ANMA 2015 India
Selected Poster Presentation
No. 136
No. 137
Vitamin-D Deficiency is Associated With
Gallbladder Stasis Among Pregnant Women　Vitamin D Supplementation Improves
Gallbladder Ejection Fraction in Patients With
Gallstones　Rimpi Singla, Usha Dutta, Neelam Aggarwal, Sanjay Kumar Bhadada,
Rakesh Kochhar, Lakhbir K. Dhaliwal　Gayathri Petluri, Usha Dutta, Anish Bhattacharya, Sanjay Bhadada, and
Kartar Singh
Departments of Gastroenterology, Obstetrics and Gynecology, and
Endocrinology, Postgraduate Institute of Medical Education and Research,
Chandigarh, India
Departments of Gastroenterology, Obstetrics and Gynecology, and
Endocrinology, Postgraduate Institute of Medical Education and Research,
Chandigarh, India
Background/Aims: Pregnant women are at an increased risk for
gallbladder (GB) stasis, an important risk factor for gallstones (GS).
In non-pregnant women, we found that Vitamin-D deficiency (VDD)
was associated with GB stasis, which improves on supplementation.
Revalence of VDD and its relationship to GB stasis among pregnant
women is not known.
Methods: Prospective study conducted at a tertiary care center.
Consecutive healthy pregnant women (12-16 weeks gestation) were
enrolled. Serum 25 (OH) Vitamin-D was estimated and levels ＜ 20
ng/mL was considered as VDD. Risk factors and clinical features of
VDD were assessed. Gallbladder ejection fraction (GBEF) was assessed by ultrasound after a standard fatty meal and ＜ 40% was defined as stasis. Statistical analysis was performed to assess relationship
of GB stasis and vitamin-D levels and identify factors associated with
VDD.
Results: Median serum vitamin-D in 304 women studied was 7.9
ng/mL (interquartile range [IQR] 5.7, 12). VDD afflicted 92% of
them. Women with VDD, more often had GB stasis than those with
normal Vitamin-D (20% [56/280] vs 0% [0/24]; P = 0.015).
Women with VDD, had lower GBEF compared to those with normal
Vitamin-D (53.7 ± 17% vs 59 ± 10%; P = 0.026). GBEF showed a
positive correlation with vitamin-D levels (r = 0.117; P = 0.042).
Risk factors for low vitamin-D levels were urban residence (P =
0.001); lower sun-exposure time (P = 0.005); limited skin exposure
(P ＜ 0.001); higher BMI (P = 0.050) and higher socioeconomic
status (P = 0.020). Vitamin-D levels was associated with low serum
calcium ( = 0.457; P ＜ 0.001).
Conclusions: Vitamin D deficiency is highly prevalent among pregnant Indian women. It is associated with GB stasis and lower GBEF.
The risk factors for VDD were reduced sun exposure and urban
lifestyle.
Background/Aims: Vitamin D deficiency (VDD) is associated with
poor skeletal muscle function, which improves on Vitamin D supplementation (VDS). Effect of VDD and VDS on gallbladder muscle
function is not known. To study the relationship of VDD and gallbladder ejection fraction (GBEF) and determine the effect of VDS on
GBEF in patients with gallstones (GS).
Methods: Prospective study at a tertiary center in North-India.
Patients with symptomatic GS (n = 91) were evaluated for their demographic and clinical profile. 25-OH Vitamin-D levels was assessed
using chemiluminiscence assay and categorized as deficient (＜ 20
ng/mL), insufficient (20-30 ng/mL), and sufficient (＞ 30 ng/mL).
GBEF was estimated using cholescintigraphy and classified as
non-functional (0%), static (＜ 40%), and normal GBEF (≥ 40%).
GBEF was reassessed in those with functioning GB’s 2 weeks after a
single dose of intramuscular Vitamin-D (600 000 IU).
Results: Patients with GS (mean age of 48 ± 13 years, 78% F, 86%
multiple GS). The mean Vitamin-D levels were 14 ± 7.5 ng/mL Of
them, 75 (82.4%) were deficient, 12 (13.2%) insufficient and only 4
(4.4%) had sufficient Vitamin-D levels. Among the 91 patients, GB
was non-functional in 13 (14%), static in 15 (16%), and normal in 63
(70%). VDS resulted in resolution of GB stasis in all (100%) of those
with stasis (n = 15); with a overall median increase of 17% (interquartile range [IQR] 9.6, 44.4) in GBEF. GBEF increased from 52 ±
16.3% at baseline to 62.7 ± 13.8% after VDS (P = 0.001).
Conclusions: Most patients (95%) with GS had Vitamin-D deficiency or insufficiency. Vitamin-D supplementation resulted in significant improvement in GBEF and resulted in resolution of GB stasis
in all those with stasis.
S71
ANMA 2015 India
Selected Poster Presentation
No. 138
No. 139
Chicago Classification Parameters for Upright
and Supine Position in Gastroesophageal
Disease: A Preliminary Report Relation Between Transition Zone and Distal
Breaks in Symptomatic Gastroesophageal
Reflux Disease and Dysphagia: A Preliminary
Report
Srinivas M, Vijaya Srinivasan, and Jayanthi V　Srinivas M and Jayanthi V
Department of Gastroenterology, Global Health City, Chennai, India
Department of Gastroenterology, Global Health City, Chennai, China
Background/Aims: We observed that there were some differences
in interpretation by Chicago classification (CC) in high-resolution
esophageal manometry (HREM) done in upright and supine postures among patients with dysphagia and gastroesophageal reflux disease (GERD). We therefore aimed to evaluate the differences in CC
parameters for liquid swallows (atleast 5 × 5 mL water) in both positions for patients with GERD retrospectively.
Methods: Swallows of 21 patients (excluding achalasia on
HREM) with GERD tested in upright and supine position (16-channel water perfused catheter) were analysed for peristaltic breaks
(S1and S2 + S3), distal latency (DL), contractile front velocity, integrated relaxation pressure (IRP), and distal contractile integral
(DCI). Comparison was made between values for each parameter by
test posture. Statistical analyses: Wilcoxon signed rank test; P ＜ 0.05
significant.
Results: Three hundred and eighty swallows were analysed
(divided equally between both postures) (Table). Overall, most parameters had mean values, irrespective of posture, within the normal
CC range. The IRP (8.8 ± 4.5 vs 11.68 ± 9.47; P ＜ 0.03) and DCI
(1071.9 ± 982.05 vs 1325.02 ± 1026; P ＜ 0.01) were significantly
lower in upright compared to supine values. All the other parameters
were similar in both postures. The large standard deviation for DCI
was probably due to small sample size.
Conclusions: Most parameters in our study were normal by CC
values irrespective of posture suggesting the need to standardise normal values in the Indian context. Despite this, lower IRP and DCI
among the upright refluxers suggests greater retrograde propulsion in
them.
Background/Aims: Peristaltic breaks in high-resolution esophageal
manometry (HREM) occur in both proximal and distal segments.
These may exaggerate the transition zone (TZ) contributing to gastroesophageal reflux disease (GERD) and dysphagia. Study the relationship between segment breaks in GERD and dysphagia by test posture.
Methods: Excluding achalasia and post-fundoplication, 112 adult
HREM (minimum 5 × 5 mL water swallows, 16-channel water perfused catheter) evaluations for dysphagia and GERD in supine/upright postures were analysed retrospectively. The TZ and distal break
(DB) lengths were classified as no (＜ 2 cm), small (2-5), and large
(＞ 5). The TZ break was correlated with DB by indication and posture using Mann Whitney U test to compare absence and presence of
DB in various TZ categories between postures.
Results: In GERD, about 50% had TZ breaks irrespective of posture with DB in 36% of them. Even in absence of TZ breaks, 7/42
(16.6%) had DB, especially in upright posture (P ＜ 0.01). In dysphagia, unlike GERD, upright posture was associated with more TZ
breaks than supine (48% vs 23%) and DB occurred only in “presence”
of small TZ breaks (4/9 vs 0/2 supine, P = 0.050). DB did not occur
in “absence” of TZ breaks in either posture.
Conclusions: TZ breaks occurred in both GERD and dysphagia
(Table). More breaks occurred in the latter in upright posture. Both
TZ breaks and DB were common in upright position for both indications, suggesting that upright HREM may be better for assessing
dysphagia and GERD.
Table. Comparison of Various High-resolution Esophageal Manometry Parameters Between Upright and Supine Postures in Gastroesophageal Reflux Disease
Parameter
Upright
Supine
P-value
S1
S2 + S3
DL
CFV
IRP
DCI
2.8 ± 4.7
2.1 ± 5.9
5.4 ± 0.9
9.2 ± 2.9
8.8 ± 4.5
1071.9 ± 982.0
2.5 ± 4.5
2.5 ± 8.6
5.5 ± 0.8
10.3 ± 2.5
11.7 ± 9.5
1325.0 ± 1026.0
0.778
0.318
0.056
0.165
0.029
0.001
S, segment of contractile; DL, distal latency; CFV, contractile front velocity;
IRP, integrated relaxation pressure; DCI, distal contractile integral.
S72
ANMA 2015 India
Selected Poster Presentation
Table. Transition Zone Correlation With Distal Breaks in Dysphagia and Gastroesophageal Reflux Disease
Distal break (N)
< 2 cm/2-5 cm/> 5 cm
TZ break (N)
Indication (Supine/Upright)
Size (cm)
Supine
Upright
Supine
Upright
Dysphagia (13/21)
Supine: 8 men (median 51 yr), Upright : 11 men (median 53 yr)
<2
2-5
>5
10 (77%)
2 (15%)
1 (8%)
11 (52%)
9 (43%)
1 (5%)
10/0/0
2/0/0
0/0/1
10/1/0
4/1/4
0/1/0
GERD (35/43)
Supine: 25 men (median 39 yr), Upright: 32 men (median 39 yr)
<2
2-5
>5
20 (57%)
10 (29%)
5 (14%)
22 (51%)
12 (28%)
9 (21%)
19/1/0
7/3/0
2/0/3
16/5/1
8/1/3
3/0/6
GERD, gastroesophageal reflux disease.
S73
ANMA 2015 India
Author Index
A
Abdullah, Murdani
No. 83
Adarsh, M B
No. 115
Agarwal, Bikas
No. 63
Agarwal, Jaya
No. 9, 127, 128
Agarwal, Vikas
No. 59, 109, 118
Aggarwal, Neelam
No. 136
Ahmad, Mian Mashhud
No. 120
Ahmed, Faruque
No. 80, 81, 82,
119, 120
Ahmed, Madiha
No. 105
Akhter, Mahfuza
No. 80
Alam, Md Jahangir
No. 76
Arivarasan, K
No. 10, 23
B
Ba, Ying
No. 72
Bak, Young-Tae
No. 83, 104
Banik, Gourab Dutta
No. 21
Banik, Ranjit Kumar
No. 113
Bansal, Monika
No. 43
Bari, Md. Shafiqul
No. 77
Berry, N
No. 14, 51
Bhadada, Sanjay Kumar
No. 136
Bhadada, Sanjay
No. 137
Bhargav, Gautam Ray P. Manju
No. 67
Bhasin, D K
No. 52, 114, 116, 131
Bhatachraya, A
No. 14
Bhatia, Shobna
No. 11
Bhattacharya, Anish
No. 115
Bhattacharya, Anish
No. 137
Bhattacharya, A
No. 114
Bin, Lu
No. 26, 34, 35, 57, 58
Bundiwal, Amit
No. 53
Byeon, Jeong-Sik
No. 4
C
Cao, Jing
Chan, Yawen
Chan, Y
Chandra, Abhijit
Chang, Chi-Sen
Chao Liu
Chaudhuri, Sujit
Chen, Fengqin
No. 30
No. 110
No. 16
No. 2, 47, 69
No. 100
No. 31
No. 21, 22
No. 134
Author Index
Chen, Lingling
Chen, Minhu
Chen, Yan
Cheung, Cynthia K Y
Chhina, Rajoo S
Cho, Joo Young
Cho, Jun-Hyung
Choe, Jung Wan
Choi, Cheol Woong
Choi, Myung-Gyu
Choi, Yoon Jin
Chong, Kuck-Meng
Chu, W C W
Chua, Andrew S B
No. 121
No. 79, 83
No. 86
No. 110
No. 43
No. 44
No. 44
No. 104
No. 13, 50
No. 83
No. 84
No. 83
No. 16
No. 83
D
Dalal, Ashok
Darisetty, Santosh
Daschakraboty, Sunil B
Dey, Asmita
Dhaliwal, HS
Dhaliwal, Lakhbir K.
Dhole, Tapan N
Dhore, Prashant
Dhus, Ubal
Dutta, U
Dutta, Usha
Dutta, Usha
No. 10, 23
No. 9, 41
No. 21, 22
No. 63, 118
No. 116, 131
No. 136
No. 59, 64,
109, 117, 118
No. 11
No. 5, 7
No. 131
No. 136
No. 137
E
Endo, Hiroki
No. 123
F
Fan, Wenjuan
Fang, F
Fang, Xiucai
Fei, Guijun
Feixue Chen
Fukuhara, Seiichiro
Fukui, Hirokazu
No. 72
No. 16
No. 54, 72, 121
No. 54, 121
No. 31
No. 61
No. 112, 124
G
Ghosh, Mridul K
Ghosh, Pallavi Lahiri Dipankar
Ghoshal, Misra A4 Uday C
Ghoshal, Sushil Kumar Uday C
74
No. 77
No. 18
No. 2
No. 60
Ghoshal, Uday Chand
No. 80, 90
Ghoshal, Uday C
No. 8, 59, 63, 64,
66, 70, 74, 81, 82, 83, 102, 109,
117, 118, 119, 12, 120, 122, 135
Ghoshal, Ujjala
No. 59, 63, 64,
109, 117, 118
Gong, Xiao R
No. 79, 83
Gonlachanvit, Sutep
No. 73, 83
Goo, Ja Jun
No. 13, 50
Goyal, Omesh
No. 43
Gupta, Vishal
No. 2, 47, 69
Gupta, Vivek
No. 69
Gwee, Kok-Ann
No. 33, 79, 83, 119
H
Han Liu
Han, Lin
Han, Shaomei
Hanssen, Zahid
Hasan, Mahmud
Hatimi, Hunaid
Higurashi, Takuma
Ho, Chin O
Hong, Su Jin
Hongbo Ren
Hou, Xiaohua
Hou, Yuantao
Hsu, Jeng-Yuan
Huda, Md. Nazmul
Hung, Cheng-Che
Hussain, Zahid
Hwang, Jae Jin
No. 31
No. 95
No. 72
No. 32
No. 80, 81, 82,
119, 120
No. 47, 69
No. 123
No. 125
No. 44
No. 31
No. 83, 97
No. 54
No. 100
No. 77
No. 17
No. 87
No. 99
I
Ichikawa, Yurika
Ida, Tomonori
Ignatius, J Xavier
Iida, Hiroshi
Ikehara, Hisatomo
Im, Min Joo
Inamori, Masahiko
Inou, Yumi
Iwasaki, Eisuke
No. 24
No. 123
No. 106
No. 123
No. 112, 124
No. 32
No. 123
No. 123
No. 24
J
Jain, Ajay K
No. 53
ANMA 2015 India
Jain, Mayank
Jeon, Seong Ran
Jeong, Yeon Sang
Jeoung, Yong
Jiang, Liu-Qin
Jiang, Nan
Jin, Hong
Jing, Wu
Joo, Moon Kyung
Joo, Segyeong
Ju, Lee Young
Jun, Zhang
Jung, Hwoon-Yong
Jung, Kee Wook
No. 53, 101
No. 44
No. 99
No. 104
No. 37
No. 134
No. 38, 39, 40
No. 48
No. 104
No. 4
No. 87
No. 48
No. 4
No. 4, 19
K
Kalapala, Rakesh
No. 41, 127, 128
Kalpala, Rakesh
No. 9
Kanai, Takanori
No. 24, 61
Kang, Dae Hwan
No. 13, 50
Kang, Dong Ku
No. 13, 50
Kanoshima, Kenji
No. 123
Karkra, Sakshi
No. 55
Karunakaran, Prem Kumar
No. 5, 7
Karyampudi, Arun
No. 102, 122
Ke, Meiyun
No. 54
Khan, Md Masudur Rahman
No. 76
Khanduja, Sonali
No. 117
Khatoon, Jahanarah
No. 90
Kibria, Md. Golam
No. 80, 81, 82,
119, 120
Kim, Bokyung
No. 84
Kim, Hyo Jung
No. 104
Kim, Hyun Gun
No. 44
Kim, Hyung Wook
No. 13, 50
Kim, Jae Seon
No. 104
Kim, Ji-Beom
No. 4
Kim, Jin-Oh
No. 44
Kim, Jong Wook
No. 4
Kim, Kyung Jo
No. 4
Kim, Nayoung
No. 29, 84, 99
Kim, Su Jin
No. 13, 50
Kochhar, Rakesh
No. 115, 136
Kochhar, R
No. 14, 51, 52,
114, 116, 131
Kohmoto, Hikari
No. 24
Komori, Takahiro
No. 24
Author Index
Kondo, Takashi
Kono, Tomoaki
Koo, Hyun Sook
Krishnani, Narendra
Kumar, Saket
Kusakabe
Kwon, Yong Hwan
No. 112, 124
No. 112, 124
No. 4
No. 90
No. 2, 47, 69
No. 123
No. 84, 99
L
Lakshmi, Dhanya
No. 122
Lal, A
No. 14, 52
Lam, L C W
No. 16
Lan, Lin Lin
No. 110
Lee, Ae-Ra
No. 99
Lee, Beom Jae
No. 104
Lee, Dae Sung
No. 108
Lee, Dong Ho
No. 84, 99
Lee, Hyo Jeong
No. 4
Lee, Hyun Joo
No. 99
Lee, Joon Seong
No. 44
Lee, Ju Yup
No. 84
Lee, S
No. 16
Lee, Tae Hee
No. 44
Lee, Yong Sub
No. 44
Lee, Yoo Jin
No. 32
Li, Chu
No. 34, 35
Li, Hai
No. 86
Li, Xiaoqing
No. 54
Liang, Wen-Miin
No. 100
Lien, Han-Chung
No. 100
Lin, Lin
No. 37, 92
Liu, Pei-Yi
No. 133
Liu, Shi
No. 72, 86
Lu, Ching-Liang
No. 17, 83, 133
Lu, Pei-Yi Liu Ching-Liang
No. 68
M
M, Noushif
M, Ramesh
M, Srinivas
Maeda, Shin
Mahalingam, Preethi
Majumder, Monojit
Mak, Arthur D P
Malik, Rohan
Mandal, Kausik
Masaoka, Tatsuhiro
No. 2
No. 106
No. 138
No. 123
No. 5, 7
No. 113
No. 16
No. 126
No. 122
No. 24, 61
75
Mathias, Amrita
No. 45, 126
Matsuura, Mizue
No. 123
Matsuzaki, Juntaro
No. 24, 61
Maurya, Ajeet P
No. 47
Mehta, Varun
No. 43
Meng, Li
No. 26, 34, 35, 57, 58
Meshram, Megha
No. 11
Miglani, A
No. 116
Mishra, Asha
No. 8
Mishra, Brajesh
No. 2
Misra, Asha
No. 12, 66, 102
Misra, V
No. 63
Mittal, Balraj
No. 70
Mittal, BR
No. 116
Miwa, Hiroto
No. 112
Miwa, Jiro Watari Hiroto
No. 124
Miyoshi, Sawako
No. 61
Mizushima, Ichiro
No. 24
Mizushima, Tohru
No. 24
Mohan, Neelam
No. 55
Mohindra, Samir
No. 135
Mookiah, Bharat Kumar
No. 7
Mookiah, Bharath Kumar
No. 5
Morakhia, Nakul
No. 135
Mori, Hideki
No. 24, 61
Murugan, Natarajan
No. 5, 7
Muthuswamy, Hariharan
No. 5, 7
Myung, Seung-Jae
No. 4
N
N, Bhagyalekshmi
Nagi, B
Nahar, Shamsun
Nain, C K
Nakajima, Atsushi
Nam, Hyeong Seok
Nam, Ryoung Hee
Nayek, Kaustav
Nishizawa, Toshihiro
Nityanand, S
Nonaka, Takashi
No. 106
No. 51, 52, 116
No. 120
No. 114
No. 123
No. 13, 50
No. 84
No. 74
No. 24
No. 63
No. 123
O
Ohda, Yoshio
Oshima, Tadayuki
No. 112, 124
No. 112, 124
ANMA 2015 India
P
Palaniswamy, Kallipatti Ramasami
No. 5
Palaniswamy, Kallipatti Ramaswamy No. 7
Paliwal, Maneesh
No. 55
Paramasivan, Piramanayagam
No. 5, 7
Parameswaran, Sarojini Ashok
No. 5, 7
Park, Hyojin
No. 32, 87
Park, Ji Hyun
No. 84
Park, Jong-Jae
No. 104
Park, Sang Hyoung
No. 4
Park, Soo Kyung
No. 4
Park, Su Bum
No. 13, 50
Park, Young Soo
No. 99
Parthasarathy, Seshadri Venkatesh No. 5, 7
Parveen, Irin
No. 113, 76
Parvin, Rukhsana
No. 77
Patcharatrakul, Tanisa
No. 73
PD, Dashatwar
No. 103, 105
Perveen, Irin
No. 77
Petluri, Gayathri
No. 137
Phadke, Shubha R
No. 122
Poddar, Ujjal
No. 45, 126
Pradhan, Manik
No. 21
Pradhana, Manik
No. 22
Prasad, K K
No. 114
Prasad, Kashi Nath
No. 90
Prasada, R
No. 14, 114
Pratap, Nitesh
No. 83, 103, 105
Puri, A S
No. 23
Puri, AS
No. 10
Puri, Rajesh
No. 55
Putta, Sharat Reddy
No. 103, 105
Q
Qiujie Zhao
No. 31
R
Rahman, Mohammed Masudur
No. 80,
82, 119, 120
Rahman, Mohammed M
No. 81
Rahul
No. 47, 69
Rai, Ravi Prakash
No. 90
Ramchandani, Mohan
No. 41
Rana, S S
No. 52
Rana, S V
No. 114, 131
Rana, Satya V
No. 129
Author Index
Rana, Satyavati
Ranjan, Prabhat
Reddy, D Nageshwar
No. 115
No. 63
No. 9, 41,
127, 128
Rome ANMA Working Team
No. 79
Rowshon, AHM
No. 81, 82,
119, 120
S
Sachdeva, Sanjeev
No. 10, 23
Saha, Madhusudan
No. 76, 77, 113
Saha, Shasanka
No. 113
Samanta, J
No. 14, 52, 115
Sangam, Alok
No. 10, 23
Saraswat, Vivek A
No. 102, 122, 135
Seo, So Young
No. 4
Shan, Jing
No. 112
Shanmugam, Revathy Marimuthu No. 5, 7
Sharma, Atul
No. 8
Sharma, Raj K
No. 117, 118
Sharma, Shefali K
No. 115
Shi, Rui-Hua
No. 37
Shil, Bimal Chandra
No. 76, 113
Shin, Cheol Min
No. 84, 99
Shrimal, Pankaj
No. 41
Shu, Huijun
No. 54
Shukla, Akash
No. 11
Shukla, Ratnakar
No. 59, 64, 109
Siah, Kewin T H
No. 33, 83
Siah, Kewin Tien Ho
No. 125
Sidappa, PK
No. 51
Siddappa, P K
No. 14
Siddiqua, Ayesha
No. 105
Sidhu, Sandeep S
No. 43
Singh, Kartar
No. 137
Singh, K
No. 51, 52,
114, 116, 131
Singh, Om Prakash
No. 75
Singh, Rajan
No. 70, 74, 102
Singh, Sunil K
No. 2
Singh, Surjit
No. 115
Singh, Uday C Ghoshal Rajan
No. 78
Singla, Rimpi
No. 136
Sinha, H
No. 114
Sinha, S K
No. 14, 51, 52,
114, 116, 131
Sinha, Saroj K
No. 115
76
Sircar, Shohini
Soh, Alex Y S
Soh, Alex Yu Sen
Som, Suman
Sood, Ajit
Srinivas, Usha
Srinivasan, Vijaya
Srivastava, Anshu
Srivastava, Deepakshi
Srivastava, Manoj
Srivastava, Pradeep K
Srivastava, Priyanka
Sud, Randhir
Suh, Ji Hyung
Sultana, Nigar
Sun, Xiaohong
Sun, Xiaomeng
Suzuki, Hidekazu
Syam, Ari F
No. 53
No. 33
No. 125
No. 22
No. 43
No. 5, 7
No. 138
No. 45, 126
No. 64, 66
No. 2
No. 2
No. 122
No. 55
No. 84
No. 80, 81, 82, 120
No. 54
No. 92
No. 24, 61
No. 83
T
Tamura, Akio
No. 124
Tan, Jiacheng
No. 92, 93
Tanaka, Kentaro
No. 24
Tang, Yu-Rong
No. 37
Thanapirom, Kessarin
No. 73
Thiravia, Mohan Arumugam
No. 5, 7
Thomas, Sandeep
Kunhikannan Varghese
No. 27
Thomas, Sivaprasad
Punnaveetil Varghese
No. 28
Togawa, Koji
No. 24
Tomita, Toshihiko
No. 112, 124
Toyoshima, Fumihiko
No. 112, 124
Tozawa, Katsuyuki
No. 112, 124
Tsai, An-Ni
No. 111
Tsai, Chia-Fen
No. 17
Tsai, Ying-Chieh
No. 17, 133
Tsugawa, Hitoshi
No. 61
Tzeng, Wen-Jian
No. 133
U
Uchiyama, Shiori
No. 123
V
V, Jayanthi
V, Srinivas M Jayanthi
No. 138
No. 139
ANMA 2015 India
Verma, Abhai
Vijayaraghavan, Shanthi
No. 12, 122, 135
No. 5
W
Wang, Bangmao
Wang, Chen-Chi
Wang, Chengdang
Wang, D F
Wang, Jin
Wang, Liecheng
Wang, Mei-Feng
Wang, Qiaomin
Wang, Tao
Wang, Tengfei
Wang, Yen-Po
Wang, Ying
Wang, Zhifeng
Ware, Sandip
Watari, Jiro
Weiyan, Yao
Wen, Ping
Whitehead, William E
Whitehead, William
Wong, Reuben K
Wu, Chien-Chen
Wu, J C Y
Author Index
Wu, Justin C Y
Wu, Lanlan
No. 110
No. 40
X
No. 38, 39, 40
No. 100
No. 121
No. 16
No. 72
No. 134
No. 37
No. 134
No. 39
No. 31
No. 133
No. 92
No. 54
No. 53
No. 112
No. 95
No. 121
No. 79
No. 119
No. 125
No. 133
No. 16
Xiang, Xuelian
Xiaoteng, Wang
Xie, Chen
Xie, Xiaoping
Xin, Haiwei
Xiong, Lisho
Xiuli Zuo
Xu, Xiaoxuan
Xue, Dan
Xueqin, Wang
No. 97
No. 26, 57, 58
No. 37
No. 97
No. 72, 121
No. 83
No. 31
No. 38
No. 132
No. 48
Y
Yachha, Surender K
Yachha, Surender Kumar
Yamasaki, Takahisa
Yan, Cheng
Yanbo Yu
Yang, Dong-Hoon
Yang, Yan
Yanqing Li
Yao, Qi
Yaozong, Yuan
77
No. 126
No. 45
No. 112, 124
No. 48
No. 31
No. 4
No. 132
No. 31
No. 38
No. 95
Yarlagadda, Nagarjuna
No. 103
Ye, Byong Duk
No. 4
Yeh, Hong-Zen
No. 100
Yeung, D K
No. 16
Yoon, Hyuk
No. 99
Yoon, In Ja
No. 4
Yoon, Kichul
No. 84, 99
Youn, Young Hoon
No. 32
yousuf, Abdullah
No. 120
Yu, Ho Khek
No. 125
Yu, Ting
No. 92
Yu, Yue
No. 132, 134
Yuan, Lili
No. 134
Yuanyuan, Nian
No. 48
Yue, Hu
No. 26, 34, 35, 57, 58
Yuming, Tang
No. 95
Z
Zhang, Jingzhi
Zhang, Jun
Zhang, Lili
Zhao, Chunshan
Zhao, Wei
Zheng, Zhongqing
Zhou, Guojian
Zhu, Liming
No. 97
No. 72
No. 38, 39, 40
No. 38, 39
No. 38, 39, 40
No. 39
No. 38, 39
No. 54
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Journal of
Neurogastroenterology and Motility
February, 2015
Volume 21 Supplement 2
February 6, 2015
10:30-11:20
Japanese Society of Neurogastroenterology and Motility
Taiwan Neurogastroenterology and Motility Society
South East Asia Gastro-Neuro Motility Association
12:30-13:20
Session II: Lower GI disorder
Constipation, bloating but no abdominal pain: Do I have IBS or something else?
Session III: Post-infectious bowel dysfunction
Chronic small volume diarrhoea, abdominal pain and bloating after
an episode of acute gastroenteritis: Are we missing something?
Doctor, I am on PPI for GERD but continue to have symptoms at night
13:20-14:10
14:10-15:10
15:10-15:40
15:40-16:10
16:10-16:30 16:50-18:50 19:00-19:30
19:30-20:30
20:30-22:00 Lunch
Indian Motility & Functional Diseases Association (IMFDA) Governing
Council Meeting for IMFDA GC Members only
Session IV: A patient with GERD with nocturnal symptoms while on PPI
Session V: Pathophysiology of functional bowel disease:
Looking beyond the conventional
Session VI: An overview of therapy of IBS for clinicians
Session VII: Role of endoscopy in gastrointestinal motility disorders
Session VIII: Covidien dinner Symposium/workshop on technique and interpretation of manometry
J Neurogastroenterology & Motility Editorial Board Meeting
for Editorial Board Members only
Technical review on small intestinal bacterial overgrowth in IBS
for Indian SIBO IBS Task Force Members only
Dinner
February 7, 2015
08:00-08:30 08:30-09:40 09:40-11:05 11:05-11:30
11:30-12:30 12:30-14:15 13:25-14:15
14:15-15:30 15:45-17:00 17:15-18:15 18:15-18:55 18:15-19:30 20:00 onward Session I: State of the art lecture & selected oral paper session
Session II: Symposium on motor dysphagia
Session III: Rome-ANMA symposium
Tea break
JNM
Journal of
Neurogastroenterology
and Motility
th
February 6-8, 2015
Hyatt Regency Hotel,
Gurgaon, Delhi, India
(Presidential Poster Round by the judges; presenters must be present near the posters)
Session IV: Asian FGID symposium
Session V: Abbott Lunch Symposium: Chronic Constipation: East meets West in India
Lunch and poster round session
Session VI: Functional dyspepsia symposium
Session VII: Symposium on GERD (Supported by an unrestricted
educational grant from Eisai)
Session VIII: Therapeutics in functional bowel disease and motility disorders
Session IX: Symposium on FBD in children
ANMA Governing Council Meeting for ANMA GC Members
Inaugural function and dinner
February 8, 2015
08:00-08:40 08:40:10:05 10:05-11:05 11:05-12:25
12:25-13:15 13:15-14:05
14:05-15:00 15:00-16:05 16:15-17:10 17:10-18:15 18:15-18:30 Impact factor 2.698
Biennial Congress of
the Asian Neurogastroenterology and
Motility Association in Conjunction With
3rd Biennial Conference of the Indian
Motility and Functional Diseases Association
Session I: Presidential papers selected for oral presentation
Session II: Constipation symposium
Session III: ANMA-JNM symposium
Session IV: Gut-Microbiota symposium
Session V: Menarini Lunch Symposium: IBS and Pain
Lunch and poster round session
Session VI: Faecal incontinence symposium
Session VII: Megatrend in IBS
Session VIII: Micro-organic basis of IBS: Diet and inflammation
Session IX: Micro-organic basis of IBS: Microbiota-related
Session X: Valedictory function
Themes:
Neurogastroenterology &
Motility: From Science to
Application/Motiltiy Master Class
February 2015
Official Journal of
Indian Motility and Functional Disease Association
Asian Neurogastroenterology and Motility Association
11:20-12:10
Session I: Esophageal disorder
Doctor, I have heartburn and dysphagia but the disease is yet undiagnosed
Vol. 21, Suppl. 2
Korean Society of Neurogastroenterology and Motility
Chinese Society of Gastrointestinal Motility
Thai Neurogastroenterology and Motility Society
JNM Journal of Neurogastroenterology and Motility
JNM
pISSN: 2093-0879
eISSN: 2093-0887
www.jnmjournal.org
Organized by
Asian Neurogastroenterology & Motility Association
Indian Motility & Functional Diseases Association
Endorsed by
Indian Society of Gastroenterology
The Rome Foundation
www.anmaindia.in
Organizing Secretariat
Department of Gastroenterology
Sanjay Gandhi Postgraduate Institute of Medical Sciences
Lucknow, India
2015
February Volume 21 Supplement 2