A1320 AGA ABSTRACTS GASTROENTEROLOGY Vol. 118, No.4

6021DOES SURGERY FOR ACHALASIA IMPROVE ESOPHAGEALBODY MOTILITY?Grzegorz T. Wallner, PrzemysJaw Madro, Jerzy Melko, Andrzej Dab­rowski, Wojciech P. Polkowski, Med Acad in Lublin, Lublin, Poland.

Improvement of the esophageal body motility after surgery for achalasiaseems to be controversial. The prospective study was undertaken to assessthe motility of the body of the esophagus following the cardiomyotomywith Nissen-Rossetti fundoplication for achalasia. The study was carriedout in 36 consecutive patients (12 males, 24 females; age range: 18-77,mean: 45.6). Three-fold solid state for manometry and double-channel forpH-metry catheters in the body of the esophagus were used before and afterthe operation (follow up time range: 4-60, mean: 20 months). Completerelief of dysphagia and/or pyrosis after the operation were observed in28/36 (78%) and in 32/36 (89%) of patients, respectively. Improvement ofcontrast passage, without retention, and decrease in the diameter of theesophagus, were observed on barium swallow and on endoscopy in 26/36(72%) of patients. There was no patients with pathological gastro-esoph­ageal reflux on pH-metry after the operation. Results of esophageal bodymanometry before and after the operation are presented in the table.Conclusions: Cardiomyotomy with antireflux procedure improves peristal­tic contractibility of the body of the esophagus, but effective motilityremains disabled after the operation.

Esophageal body manometry before and after theoperation.

6019PEPTIC ULCER BLEEDING IN THE ELDERLY:ROLES OF HEL·ICOBACTER PYLORI AND NON-STEROIDAL ANTI·INFLAM­MATORY DRUGS.Carlos Alfredo Waldbaum, Saul Salom Berman, Ana Cabanne, Hosp deClfnicas, Buenos Aires, Argentina; Hosp Durand, Buenos Aires, Argen­tina; Hosp Carlos Bonorino Udaondo, Buenos Aires, Argentina.

Background:It is now established that most peptic ulcers are caused by H.pylori infection or consume of non-steroidal anti-inflamatory drugs(NSAIDs).Whether both together are worse than one alone is somethingthat is quite unknown. Aim:To study the etiology factors of the bleedingpeptic ulcer in the elderly. Material and Methods: Between April 1998 andJune 1999 84 patients(42 males,42 females with mean age 74.59 years)ad­mined with peptic ulcer bleeding or developed this during the admissionfor others disease were evaluated. All the patients underwent upper gas­trointestinal endoscopy during the first 12 hours of the initial bleeding. H.pylori infection was detected by rapid ureasa test (Hp Fast) on corpus andantral biopsy and confirmed by histology on antral and corpus biopsy. Drugusage by cases and an exhaustive interrogatory was carried out to detectprevious personal of family upper gastrointestinal bleeding and was estab­lished by using a questionnaire. Results:The incidence of the consumptionof DAINEs and H.pylori infection are summarized in the following table:Conclusion: The use of DAINEs was the main cause of bleeding pepticulcer in this group. The infection of H. pylori alone was not a frequentetiology of bleeding ulcer in this study. The most percentage of uppergastrointestinal bleeding was present in the group of patients with DAINEsconsume and concomitantly infection of H. pylori. The aspirina and thediclofenac were the DAINEs of more consumption Percentage (%j Before operation Afteroperation pvalue

The incidence ofconsumption ofDAINEs and H. pylori infection

%consumpt %DAINEs and HP infections %patients

Peristaltic contractionsPeristaltic sequencesEffective peristaltic sequencesContractions> 25mm Hg

3.27 ±3.05256±2361.57 ±3.3743.3 +18.5

9.87 ±5.4954.2 ±22.81.72 ±2.7850.4 +18.6

< 0.001< 0.0010.8560.128

6020ARE ALL FIVE BIOPSY SITES OF THE UPDATED SYDNEYSYSTEM ESSENTIAL TO ASSESS GASTRITIS?Marjorie M. Walker, Julian P. Teare, Rupert Negus, Alexandra J. Rice,Vicky Loh, Mark R. Thursz, ICSM, St Mary's Campus, London, UnitedKingdom; St Mary's Hosp, London, United Kingdom.

Aim: Endoscopy and pathology workloads are increasing. In this labora­tory gastric biopsies account for 14% of surgical pathology and are risingby 4% per year. The updated Sydney system for classification and gradingof gastritis (Am J Surg Pathol 1996; 20:1161-1181) recommends fivegastric biopsy sites, one each from the middle antrum (within 2 - 3 cm fromthe pylorus on the lesser (AI) and greater curvatures (A2), two from thebody, lesser curve (Bl) and the greater curve (B2) approximately 8 emfrom the cardia and one from the incisura angularis(lA). To take fivebiopsies is time consuming for the endoscopist and also for the pathologistto review. This study aims to determine if all five sites are necessary for anaccurate appraisal of gastric pathology in the absence of a visible lesion atendoscopy. Patients and Methods: 91 patients, 40 males, median age 58years (range 21 - 88 years), presenting for upper gastrointestinal endoscopyhad 5 sites biopsied according to the updated Sydney protocol. Biopsieswere placed on a cellulose acetate strip, routinely processed, stained withH&E and Giminez stain to identify H. pylori and graded for gastricpathology by the Sydney system. Results were analysed for concordance ofdiagnosis by sites and to determine whether all five biopsies were essentialto assess gastric pathology or if there was an optimal site in the antrumand/or body. Results: The sensitivity of endoscopy to assess gastritis was43% with a specificity of 98%. Concordance between both antral and bodybiopsy sites for nature of gastritis - H. pylori associated (36%), chemicallreactive/ reflux (32%), other (20%) and normal (9%) - was good (>95%).No additional information regarding gastritis was gained from biopsy ofthe incisura angularis. Intestinal metaplasia (1M) was found with greatestprevalence in Al (16.4% all biopsies) and B2 (10.9%). However if onlythese two sites are biopsied, 1M will be missed in 6.3% of cases relative tothe full Sydney protocol. The overall prevalence of 1M in this study was19% from analysis of biopsies of all sites, but to note was not identified inany patient under the age of 40 years (15% of endoscopies). Conclusions:Where histological assessment is required in the absence of a visible lesiontwo biopsies, one from the roof of the antrum (A1) and one from the bodyon the greater curve (B2), are adequate. However, if 1M is consideredclinically important then the full 5 site protocol is necessary.

H.pylori. DAINEs­H. pylori. DAINEs.H.pylori - DAINEs.H.pylori - DAINEs-

7,14%66,66%23,80%4,76%

values expressed asmean ±SD

6022THE INFLUENCE OF H. PYLORI INFECTION ON MUCOSALCELL PROLIFERATION ANDITS POSSmLE ROLE IN GASTRICCARCINOGENESIS.Casmir Wambura, Nobuo Aoyama, Toshiyuki Sakai, Takahiro Ikemura,Daisuke Shirasaka, Masanori Sakashita, Kohei Kuroda, Shuji Maekawa,Takashi Inoue, Shigeyuki Ebara, Masaki Miyamoto, Masato Kasuga, KobeUniv Sch of Med, Kobe, Japan.

Background: Several epidemiological studies have established a strongassociation between H. pylori infection and gastric cancer. Despite ad­vances in the subject, the mechanism by which H. pylori is involved ingastric carcinogenesis is unclear. Objective: We evaluated the influence ofH. pylori infection on gastric cell proliferation. Subjects and Methodology:Gastric mucosal biopsy specimens were obtained from 67 Subjects withnon-ulcer dyspepsia (NUD, 34 H. pylori positive, 33 H. pylori negative)and 29 H. pylori positive subjects with gastric cancer. Epithelial cellproliferation was determined by immunohistochemical technique utilizingKi-67. Gastritis was evaluated and graded according to Updated SydneySystem. H. pylori infection status was confirmed by culture, histology andanti H. pylori antibody. Results: Proliferation Labeling Index in corpusgreater curvature increased significantly in H. pylori positive than in H.pylori negative NUD subjects regardless of age (p < 0.05). Above the ageof 60 years, gastric cancer patients had significantly higher PLI than H.pylori positive NUD subjects in antrum (p < 0.05). Moreover, at this agegroup, gastric cancer subjects had significantly higher PLI than H. pylorinegative NUD in all gastric sites (p < 0.05). PLI was not influenced byageing except in H. pylori positive NUD subjects below the age of 60years, in corpus greater curvature (p < 0.05). The degree of activityshowed a significant influence on cell proliferation in antrum of H. pylorinegative NUD (p = 0.0303). However, PLI was not influenced by neitherthe degree of inflammation nor the severity of glandular atrophy. Conclu­sion: From these results, we concluded that H. pylori significantly inducesgastric cell hyper-proliferation, which seems to be an important step ingastric carcinogenesis.

6023THE RELATIONSHIP BETWEEN SYMPTOMS AND REFLUX EP·ISODES FOLLOWING TREATMENT WITH SODIUM ALGI­NATE, RANITIDlNE, OMEPRAZOLE AND WATER.Neena Washington, Margaret A. Parker, Sarah J. Jackson, Debbie Bush,Jeff Wright, Jane Bryan, Peter W. Dettmar, Sarah L. Little, Jackie Turner,Univ Hosp, Nottingham, United Kingdom; Reckitt & Colman ProductsLtd, Hull, United Kingdom; II Mendip Drive, Reading, United Kingdom.

The occurrence of symptoms ('oesophageal': heartburn, acid reflux, regur­gitation; 'gastric': nausea, epigastric discomfort; 'all': oesophageal, gastric,wind/flatulence and 'other') was noted during a 4-hour study period duringwhich measurements of oesophageal and intragastric pH were made in 16subjects suffering from occasional reflux symptoms who were given treat­ment with sodium alginate (SA, 20ml), ranitidine (RAN, 75mg), omepra­zole (OM, lOmg) and control (water, 50ml) following tailored reflux­inducing meals in a single-centre, open, randomised, four-period crossover