Gastrin-17 (G-17) as a sensitive serological bio-marker for diagnosis of gastro-esophageal reflux disease (GERD) independently of H. pylori status

Abstracts

S54 ACCEPTED POSTERS PA.l REFLUX ESOPHAGITIS IN CHILDREN. THE ROLE OF ENDOSCOPY

G. Lombardi *,2, V. Rutigliano 3, G. Guaris0 4 , F. Michielutti 5, D. Falchetti 6, K. Pittschieler 7 , M. Brunero 8, C. Romano 9, P. Lerro 10, T. Sabbi 11, G. Pepe 12, G.L. de Angelis 13, D. De Venuto 14, F. Torroni IS, B. Ghidini 16, L. Dall'Oglio 17

20spedale uS.Santo", Pescara 3 Universitil degli Studi di Barl, Bari 4Universitil degli Studl, Padova 50spedale Civile, Negrar (VR) 6Universitil degli Studl, Brescia 70spedale Regionale, Bolzano 80spedale Civile, Novara 9Universitil degli Studl, Messina 10 Universitil degli Studl, Torino 11 Ospedale Civile, Viterbo l20spedale Civile, Gallipoli (IE) 13 Universitil degli Studl, Parma 14 Universitil degli Studl, Bari 150spedale Bambin Gesil, Roma 16 Universitil degli Studl, Parma 170spedale Bambin Gesil, Roma Background and aim: Endoscopic esophageal appearance of reflux esophagitis (RE) is not always correlated to symptoms and histology: phlogistic aspects or mucosal ulcers of distal esophagus can suggest RE, but they are not always correspondent to serious gastro-esophageal reflux. On the contrary, the histology becomes an important diagnostic part in the case of persistent eosinophilia after antireflux therapy. The aim of this multicentric study was to evaluate when upper endoscopy is necessary in the diagnosis of RE, defining the specific indications and giving the appropriate gUide-lines. Material and methods: 150 patients with a clinical diagnosis of Gastroesophageal Reflux Disease (GERD), 11 aged 0-1 months (medium 7,8) and 139 aged 1-18 years (medium 8,2), were recluited from 13 Centres in Italy; endoscopic and histologic esophagitis gradings were observed before and after therapy with Proton Pump Inhibitors (PP!). PPI treatment was for 3 months if the endoscopic grading was severe (3-4 of Henzel-Dent scoring), 2 months when less. Results: We found out that before therapy 45 children were symptomatic in spite of endoscopic grading (EG) 0; 42% of the children with EG 0-1 had severe histology; there was correspondence only when EG was higher. After therapy 62 children with EG 0 were still symptomatic. Conclusions: These results demonstrate that endoscopy is useful in GERD and that biopsy is very important. It is interesting to notice that the histological grading is often much worse than the endoscopic appearance, so that upper endoscopy and especially esophageal biopsies can help to discover severe and hidden RE. However, an appropriate clinical examination can drive to the use of endoscopy: this has been widely demonstrated in this study, where only 11 endoscopies were carried out in children with clinically suspected GERD under 1 year of age.

PA.2 GASTRIN-17 (G-17) AS A SENSITIVE SEROLOGICAL RIO-MARKER FOR DIAGNOSIS OF GASTRO-ESOPHAGEAL REFLUX DISEASE (GERD) INDEPENDENTLY OF H. PYLORI STATUS L.G. Cavallaro 1, A. Nouvenne 1, A. Maini 1, R. Merli 1, L. Fanigliulo 1, D. Basso 2, M. Plebani 2, V. Iori 1, G.M. Cavestro 1, M. Maino 1, G. Nervi 3, A. Franze 3, F. Di Mario *.1

lDip. Scienze Cliniche, Sezione Gastroenterologia, Universitil di Parma, Parma 2 Dip. Medicina lilboratorio, Universitil di Padova, Padova 30spedale Maggiore, U.O. Gastroenterologia, Parma Background and aim: The prevalence of GERD is 25% of the general population and is due to an excess of acid into the oesophagus. High basal acid output (BAa) can determine very low Gastrin 17 (G-17) levels due to the negative feedback relating antrum and corpus mucosa. Serum Pepsinogens I and II (sPGI and sPGIl) are surrogate markers of maximal acid output (MAO) and gastric inflammation respectively. Aim of the study is to evaluate G-17. spor and II levels in patients with GERD compared to patients with other acid-related disorders. Material and methods: 124 consecutive out-patients (60 M, mean age: 39 ± 9.4 years, range 21-59) with upper or symptoms and not under PPI treatment were enrolled. This population was divided, on the basis of upper GI endoscopy and gastric histology, predominant symptoms and medical history, into: 84 with GERD (42(17 Hp+ve) with Esophagitis (ERD); 42(19 Hp+ve) with Non Erosive Disease (NERD), 42 with Other Acid-related Disorders (6(5 Hp+ve) with Duodenal Ulcer (DU), 28(14 Hp+ve) with Gastritis (GAS) and 6(3Hp+ve) with Gastric Ulcer (GU)). In all patients H. pylori status was assessed and, a blood sample was taken to evaluate serum G-17 and sPGs levels (EIA, Biohit, Helsinki. Finland). Mann-Whitney U test was used to compare the means of serological parameters into the different clinical subgroups. Results: The mean of G-17 levels showed a marked decrease in group GERD vs Other acid-related disorders (GERD: 2±2, Other: 5±3 pmolll, p>O.OOl). No difference was found between ERD and NERD according to G-17 and sPGs. Notably all Hp+ve patients showed significantly increased sPGIl levels (Hp+ve15±4; Hp-ve 9±3 pmolll. p