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sReceiver Operator Curve (AUC): Primary Outcome (Bleeding Interventions)

Receiver Operator Curve (AUC): Secondary Outcome (Repeat Bleeding and Death)

1083

Gastric Volume Responses and Emptying After a Large Liquid Nutrient Mealin Functional Dyspepsia and Health Assessed by Non-Invasive GastricScintigraphy (GS) and Magnetic Resonance Imaging (MRI): A Pilot Study toIdentify Candidate BiomarkersEmily Tucker, Helen L. Parker, Caroline L. Hoad, Nicola Hudders, Alan C. Perkins,Patricia E. Blackshaw, Luca Marciani, Carolyn Costigan, Penny A. Gowland, Mark R. Fox

Dyspeptic symptoms are very common in clinical practice; however, current investigationsof gastric function by GS rarely explain symptoms or guide effective treatment (KaramanolisGastro 2006, Pasricha CGH 2011). This lack of clinically relevant information may bebecause: (1) Current test meals are small (~200ml) and may not be sufficient to triggerdyspeptic symptoms or dysfunction. (2) GS measurements of gastric emptying half time(T50) and retention at 2 or 4 hoursmay not be directly associatedwith underlying pathophysi-ology. By contrast, MRI studies (Fruehauf NGM 2008) suggest that gastric volume changeafter a large meal may identify impaired accommodation in functional dyspepsia (FDs). AIM:GS and MRI with a large liquid test meal were applied to identify candidate biomarkersthat distinguish FDs from healthy volunteers (HVs). METHODS: FDs with postprandialdistress by Rome III criteria and without disease on endoscopy or 24hr pH-studies wererecruited. Results were compared to age and sex matched HVs from a prospectively collectedcohort. Maximum tolerated volume (MTV) was assessed by nutrient drink test (0.75kcal/ml@40ml/min). Participants were then randomized to GS and MRI with 400ml liquidtest meal (0.75kcal/ml@40ml/min) on two separate test days. Only directly comparablemeasurements of gastric content volume after meal ingestion were analyzed: Gastric contentsvolume after meal ingestion (GCV0), GE half-time [T50], maximum GErate and GErate@T50[ml/min]. RESULTS: FDs (n=8; 7 female) were each compared to those of 3 matched HVs(n=24). HVs weighed more than FDs (p<0.018) and NDT MTV was greater (median 960(IQR750-1330) v. 480(±400-760)ml, p=0.015). With GS, HVs had higher GCV0 than FDs(345(333-358) v. 325(310-350)ml; p=0.052), T50 (48(39-56) v. 52(44-54)min; p=0.710)and maximum GErate (4.8(3.7-6.0)ml/min v. 4.4(3.9-6.6)ml/min; p=0.810) were similarbut GErate@T50 was faster (3.5(3.0-4.2)ml/min v. 2.7(2.1-3.1)ml/min; p=0.012). With MRI,compared to GS, measurements of GCV and T50 were larger (p<0.001), and GErate wasslower (p=0.012); however there were no significant differences between HVs and FDs.CONCLUSIONS: FD patients are characterized by an abnormal gastric response to a large,liquid nutrient meal that was detected by GS but not MRI. Rapid early emptying (reducedGCV0) is followed by slow late emptying (slow GErate@T50). These GS measurements, butnot T50, are candidate biomarkers in FD. MRI measurements of GCV that includes residualvolume, meal and secretions do not provide the same information. These findings areconsistent with the hypothesis that impaired accommodation during gastric filling in FDleads to rapid nutrient delivery to the small bowel and powerful neuro-hormonal feedbackthat slows subsequent emptying. Ongoing studies will assess the association of GS and MRImeasurements with postprandial symptoms.

S-194AGA Abstracts

Dynamic gastric volume change after a 400ml liquid nutrrient test meal (representative GSdata from FDs and matched HV). Note rapid early emptying during gastric filling (reducedGCV0) is followed by slow late emptying (slow GErate@T50).

1084

Unclear Abdominal Discomfort - Pivotal Role of Fructose Malabsorption andLactose IntoleranceMiriam Goebel-Stengel, Andreas Stengel, Marco Schmidtmann, Ivo R. van der Voort,Hubert Monnikes

Background: Carbohydrate malabsorption can lead to increasing end-expiratory hydrogen(H2) concentrations and often causes gastrointestinal symptoms. It seems to be frequent inpatients with functional gastrointestinal disorders and also in the general population, butthere is a lack of comparative studies in large study populations. Aims: To investigate theprevalence of carbohydrate malabsorption by means of hydrogen breath test in a large cohortof patients who sought healthcare because of their gastrointestinal discomfort includingsymptoms like bloating, pain or changes in bowel habits. Abdominal symptoms were evalu-ated by our in-house standardized symptom questionnaire. Methods: 2390 patients (meanage: 49.6 yrs, 806 male, 1584 female) with abdominal discomfort underwent combined H2breath testing with 50g of lactose and fructose. Subjects with a pathologic early rise in bothtests were additionally tested with 50g of glucose. Subjects with pathologic 50g fructosebreath hydrogen values underwent another test after a 25g fructose load. The breath testsfollowed standard protocols. Concurrent abdominal symptoms under the carbohydrate loadwere documented. The population was investigated regarding prevalence of carbohydratemalabsorption, correlation of symptoms with a significant H2 increase and prevalence ofsmall intestinal bacterial overgrowth (SIBO). Results: 35.5% of all patients with unclearabdominal discomfort were lactose intolerant while 76.1% showed fructose malabsorption.A combined carbohydrate malabsorption was found in 34.7%. The comparison of maximalH2 concentrations in the breath test with 50g fructose showed that subjects with pathologicH2 breath test with 25g fructose, classified as severe fructose malabsorbers, exhaled signific-antly higher H2 concentrations than patients with negative H2 breath test with 25 g fructose,defined as moderate fructose malabsorbers (P < 0.001). An additional glucose breath testwas performed in subjects with an early H2 increase in the lactose and fructose breath test(n = 576). Of these, 103 patients showed an early significant H2 increase after the glucoseload, indicative of SIBO in 4.3% of the whole study population. Patients with SIBO weresignificantly older than patients without SIBO (P < 0.001). Conclusions: This is the largeststudy cohort presentingwith abdominal discomfort describing the prevalence of carbohydratemalabsorption which is a frequent but under-estimated condition in this patient population.Studying the prevalence of carbohydrate malabsorption in the normal population withoutabdominal symptoms and elimination diet trials will determine the relevance of these findingsin daily life. Diagnosis of carbohydrate malabsorption can be easily confirmed by H2 breathtest which should be more often utilized.

1085

Improvement of Quality of Life and Symptoms After Gastric ElectricalStimulation in Children With Gastroparesis and Functional DyspepsiaPeter L. Lu, Steven Teich, Carlo Di Lorenzo, Jaya Punati, Beth Skaggs, Maya Alhajj, HayatMousa

Background: Gastric Electrical Stimulation (GES) has been shown to provide significantand sustained symptomatic improvement in adults with gastroparesis (GP) and functionaldyspepsia (FD). Data in children is limited. Our aim is to evaluate the effect of GES onsymptoms and quality of life for pediatric patients with GP and FD. Methods and Patients:Twenty-four patients (16 F, median 15y, range 4-19) were treated with GES for GP and/or FD at Nationwide Children's Hospital after a median of 24 months of symptoms (3mo-14y). At baseline, 46% (11/24) required tube feeds and 25% (6/24) parenteral nutrition.Sixty percent (12/20) had documented delayed gastric emptying. The PedsQL GI SymptomsModule (PedsQL) was completed for 18/24 patients both pre- and 2-30 months post-GES(median 8mo). Patients also completed the Symptom Monitor Worksheet (SMW) pre- andpost-GES after a median of 6 months (range 1-20mo). Global health and patient satisfactionwere assessed. Data was compared using the paired t-test and Wilcoxon signed-rank test.Results: Significant improvements were seen inmultiple areas based on the PedsQL, includingstomach pain and upset (p<0.01), food/drink limits (p<0.01), heartburn/reflux (p<0.01)and gas/bloating (p<0.01). Improvement was also seen in patient worry (p<0.01), medicationtolerance (p<0.05) and constipation (p<0.05). A decrease was found in combined symptomseverity and frequency based on SMW (p<0.01). Improvements were made in all categories,including vomiting (p<0.01), nausea (p<0.01), early satiety (p<0.01), bloating (p<0.01),