S44 Abstracts
116 European RCT with eradication rates of 174/218 (80%; 95% CI=74%-85%)
Gastric Polyps: Where Do We Stand?
Anibal Ferreira, MD, João Soares, MD, Ana Caetano, MD, Carla Rolanda, MD,
PhD, Artur Machado, MD, Raquel Gonçalves, MD. Gastroenterology, Hospital
São Marcos, Braga, Portugal.
Purpose: 1-4% of patients undergoing upper GI endoscopy have gastric
polyps. These lesions may be true epithelial polyps, heterotopias, lymphoid tis-
sue, or stromal lesions. Hyperplastic polyps are the most frequently encoun-
tered and occur in both sexes, being more common in the seventh decade of
life. The objective was to describe the endoscopic and histopathological char-
acteristics of gastric polyps and establish connections with demographic crite-
ria of our population.
Methods: Retrospective analysis of a total of 106 polyps removed with
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polypectomy snare in the years 2008 and 2009, using endoscopy reports
and histopathology results of the lesions. Epidemiologic data was obtained
from patient files and was statistically processed with Excel 2007® and SPSS
(v16.0)®.
Results: 80.2% were hyperplastic, 9.4% true adenomas, and 5.7% were fun-
dic glands. Hyperplastic polyps average size was 11.5 mm with preferential
location in the antrum (52.9%). Most adenomas were sessile (80%) and were
located preferentially in the body (50%), with an average size of 8.9 mm (60% of
those showed high-grade dysplasia). The majority of individuals were infected
with Helicobacter pylori and less than a third was medicated with a PPI at the
time of polypectomy. There were no major differences between sexes and age
distribution. The authors also present the results of univariate and multivariate
analysis of epidemiological associations.
Conclusion: Most polyps were hyperplastic, confirming the association with
areas of high prevalence of Helicobacter pylori infection.2 The small number
of adenomas limits statistical results, but clearly a large portion of them had
high grade dysplasia in relation with other epidemiological aspects of our
population.
117
Quadruple Therapy Using a 3-in-1 Capsule of Bismuth Subcitrate Potas-
sium, Metronidazole, and Tetracycline with Omeprazole Compared to
Triple Therapy for the Eradication of Helicobacter pylori
2010 Presidential Poster
Paul Moayyedi, MB, ChB,1 Franco Bazzoli, MD,2 Francis Megraud, MD,3
Monique Giguere, PhD4. 1. McMaster University, Hamilton, ON, Canada;
2. Universita di Bologna, Bologna, Italy; 3. Universite Victor Segalen Bordeaux
2, Bordeaux, France; 4. Axcan Pharma, Inc., Mont-Sant-Hilaire, QC, Canada.
Purpose: Although proton pump inhibitor triple therapy is recommended
as first line treatment of H. pylori, eradication rates <80% have been recently
reported. Bismuth containing quadruple therapy is an alternative. The efficacy
of these 2 approaches was evaluated by re-analyzing 2 randomized controlled
trials (RCTs).
Methods: One N. American RCT comparing omeprazole plus a 3-in-1
capsule of bismuth subcitrate potassium, metronidazole, and tetracy-
cline (OBTM) vs. omeprazole, amoxicillin and clarithromycin (OAC)
each given for 10 days was combined with a European RCT compar-
ing OBTM (10 days) vs. OAC (7 days). Both RCTs evaluated therapy in
patients with upper GI symptoms, positive 13C urea breath test (UBT),
a rapid urease test with at least 1 positive test from histology and cul-
ture. H. pylori eradication was confirmed by 2 negative UBTs 6 and
10 weeks post therapy. The impact of sex, age, race, presence of pep-
tic ulcer disease (PUD), duration of OAC therapy, and pretreatment
H. pylori clarithromycin and metronidazole resistance was evaluated on
efficacy in univariate and multivariate analyses. All data were analyzed
on an intention to treat basis.
Results: 299 patients were enrolled in the N. American RCT with eradica-
tion rates in OBMT arm of 126/147 (86%; 95% CI=79%-91%) and 122/152
(80%; 95% CI=73%-86%) in OAC arm. 440 patients were enrolled in the
The American Journal of GASTROENTEROLOGY
with 10d OBTM and 123/222 (55%; 95% CI=49%-62%) with 7d OAC.
There were no predictors of treatment failure in OBTM arms in univariate
or multivariate analysis including H. pylori metronidazole resistant strains
(81% versus 86%, p=0.23). OAC was less successful in patients without
PUD vs. those with PUD (eradication rate 60% vs. 77% respectively;
p=0.003), in those taking 7d vs. 10d of therapy (80% vs. 55%; p<0.0001)
and in clarithromycin resistant strains (12% vs. 78%, p<0.0001). These
factors remained significant in a logistic regression model adjusting for all
factors outlined above. In a logistic regression model combining OBTM
and OAC groups adjusting for all factors plus an interaction term for clar-
ithromycin resistance and treatment regimen, clarithromycin resistance
(p=0.004) was an independent predictor of treatment failure whereas
therapy with OBTM was an independent predictor of treatment success
(p=0.003).
Conclusion: OBTM appears less susceptible to influence of H. pylori resistance
to antibiotics and other factors in determining efficacy and overall may be a
better first line choice in the treatment of H. pylori infection.
Disclosure: Dr Moayyedi, Advisory Board Member, Axcan Pharma; Dr Bazzolo,
Advisory Board Member, Axcan Pharma; Prof Megraud, Advisory Board Mem-
ber and Dr Giguere, Employee, Axcan Pharma.
This research was supported by an industry grant from Axcan Pharma.
118
Effect of Yoga (Shankh Prakshalana) on Liquid Gastric Emptying Pattern
Measured By Real Time Ultrasound
Vijaypal Arya, MD,1 Ashok Valluri, MD, MS, MPH,1 Jitin Patel, MS,1 Jeffery
Fischbein, MD,2 Larissa Davidowa, RDMS2. 1. Vijaypal Arya MD PC, Middle
Village, NY; 2. Wyckoff Heights Medical Center, Brooklyn, NY.
Purpose: Originated in India, more than 2500 years ago, Yoga is now in wide-
spread practice throughout the United States. Shankh Prakshalana is a Yogic
process intended to clean the bowel using lukewarm saline water and specific
sets of yoga postures (Asanas). Using this Yogic method to clean the colon, we
reported the efficacy similar to Polyethylene glycol based colon prep with an
average prep time of 101 minutes. We postulate that Yoga postures in Shankh
Prakshalana, modify the gastric configuration and gastric emptying leading to
faster gastric emptying and faster colon lavage.
Methods: After six hours of fasting, gastric emptying pattern analysis
was done in 10 (5 males, 5 females) healthy volunteers. The protocol was
approved by IRB at WHMC. All ultrasound measurements were done by a
well trained technician. The volunteers drank 480 mL of lukewarm saline
in a bolus form (1-2 minutes). Gastric antral ultrasounds were done - Base-
line, immediately after intake and at 10, 20 and 30 minutes interval. On a
different day, the process was repeated with Asanas performed in between
intervals. Return to the baseline surface area and/or appearance of gas
shadow in the antrum were used as a secondary guideline for complete
emptying. The results were expressed as percentage change in the surface
area of gastric antrum from antral surface area measured at immediately
after intake.
Results: The percentage decrease in the surface area of gastric antrum at 10, 20
and 30 minutes from immediately after intake were - (minus) 1.44, 32.83, 51.14
without Asanas and 23.47, 42.26, 58.69 with Asanas. The major difference in
gastric antral surface area was evident at first 10 minutes - increased in non
Yoga group as compared to decrease in the Yoga group. Gastric emptying pat-
terns in males was faster than females. One patient showed paradoxical effect
and is not included in this analysis.
Conclusion: The Yoga allowed normal saline to pass gastric antrum
without accumulation, leading to faster emptying. Bolus intake of normal
saline itself makes the gastric emptying process faster (first order kinet-
ics) and it was further enhanced by these Asanas. This may explain the
faster colon preparation in bolus lukewarm saline Yogic method of colon
cleaning.
VOLUME 105 | SUPPLEMENT 1 | OCTOBER 2010 www.amjgastro.com

Disclosure: Dr Vijaypal Arya - President, Vikalp Inc.; Ashok Valluri - Employee,
Vijaypal Arya MD PC. Jiten Patel - Employee, Vijaypal Arya MD PC.
119
Excitatory Effects of Mirtazapine on Gastric and Colonic Motility
Jiande Chen, PhD,1 Jieyun Yin, MD,1 Jun Song, PhD,1 Xiaohong Xu, MS2.
1. University of Texas Medical Branch, Galveston, TX; 2. Veterans Research and
Education Foundation, Oklahoma City, OK.
Purpose: Mirtazapine (Mirt.) is an antidepressant commonly used in
the clinical practice for irritable bowel syndrome. Our previous studies
reported that mirt. reduced visceral hypersensitivity in rodent model of
colonic sensitization. However, the effect of mirt. on gastrointestinal motil-
ity is unknown. The aims of this study were to investigate the effects of mirt.
on gastrointestinal motility including solid gastric emptying, antral con-
tractions, small intestinal contractions, small intestinal transit and colonic
transit in dogs.
Methods: Eleven dogs were used in this study, 6 of the dogs were chroni-
cally implanted with two cannulas, one was located at the duodenum and
the other at the ascending colon; 5 of the dogs were implanted with one
gastric cannula for measuring antral contractions. Each of the motility tests
was performed in 2 randomized sessions (control, mirtazapine 45 mg/kg).
Two additional sessions were included for the gastric emptying experi-
ment: rectal distention (RD) and mirt. plus RD. RD was accomplished with
120 ml balloon distension during 60 min to 90 min after a test meal, mirt.
was administered 90 minutes before the study. The solid gastric emptying
was assessed by collecting the gastric chyme every 15 or 30 min from the
duodenal cannula for 3 hours after feeding 375 g solid food; the phenol
red solution was injected through the duodenal cannula immediately after
the food ingestion, small intestinal transit was assessed by the first appear-
ance of phenol red collected from the colonic cannula. The antral and small
intestinal contractions were measured by manometry. Colonic transit was
assessed by counting the numbers of radiopaque markers from abdominal
X-ray films at different time points (2, 4, 6 hours after inserting the markers
via the colon cannula).
Results: 1) Mirt. accelerated gastric emptying during the entire 3 hours
in normal dogs, the gastric emptying was increased from 25.6±6.5% to
43.0±5.5% at 60 min (P < 0.01), 53.1±5.8% to 73.4±5.7% at 120 min (P=0.02)
and 68.9±6.3% to 81.1±6.1% (P=0.03) at 180 min. Moreover, mirt. acceler-
ated delayed gastric emptying induced by RD from 45 min to 180 min after
the meal (P < 0.04). 2) Mirt. enhanced antral contractions from 12.5±1.9 to
22.5±4.6 (P=0.06). 3) No significant changes were noted on the small intesti-
nal contractions and transit with mirt. (P > 0.1). 4). Mirt. accelerated colonic
transit at 2 and 4 hours but not 6 hours. The geometric center was increased
from 1.9±0.6 to 3.0±0.5, 3.9±0.5 to 4.7±0.1 at 2 and 4 hours respectively
(P=0,04 vs. corresponding control).
Conclusion: Mirt. improves gastric and colonic motility and may have a thera-
peutic potential for gastrointestinal motility disorders.
© 2010 by the American College of Gastroenterology
Abstracts S45
120
Altered Postprandial Gastric and Autonomic Functions in Obese Subjects
2010 Presidential Poster
Dennis Chen, BS,2 Xiaohong Xu, MS,1 Jiande Chen, PhD3. 1. Veterans Research
and Education Foundation, Oklahoma City, OK; 2. University of Texas Health
Science Center, San Antonio, TX; 3. University of Texas Medical Branch,
Galveston, TX.
Purpose: Obesity is an eating disorder but it is unclear whether the responses
of gastric and autonomic functions to food ingestion are altered in obese. The
aims of this study were to investigate gastric myoelectrical activity (GMA) and
autonomic functions in obese subjects and to compare their responses to dif-
ferent meals with lean subjects.
Methods: The study was performed in 12 healthy lean and 12 healthy obese
subjects. GMA was measured using electrogastrography and autonomic func-
tions were assessed using spectral analysis of heart rate variability derived from
the electrocardiogram. The recordings were made in two sessions each com-
posed of a 30-min fasting period and a 30-min period after a fatty soup or
protein soup (160cal from fat or protein).
Results: 1) The obese showed enhanced responses to both soups. The percent-
age of normal slow waves was reduced with the fatty soup in lean (73.9±5.3%
vs. 59.7±6.0%, P<0.02) but not in obese (68.9±5.1% vs. 67.7±4.8%, P>0.3); The
power of gastric slow waves was not altered with the protein soup in the lean
but increased in the obese (34.3±2.9 dB vs. 30.8±2.5 dB, P<0.05). 2) Auto-
nomic functions were altered in obese subjects in both fasting and fed states.
The obese showed a reduced vagal activity (0.45±0.05 vs. 0.58±0.03, P<0.04),
and increased sympathetic activity (0.55±0.05 vs. 0.42±0.03, P<0.04) and sym-
pathovagal balance (1.59±0.27 vs. 0.78±0.10) in the fasting state, and a com-
plete absence of normal postprandial autonomic responses to the test meal.
Conclusion: The findings on gastric slow waves demonstrate that obese sub-
jects are more receptive to fatty meals and more responsive to protein meals.
Obese subjects have impaired autonomic functions in both fasting and fed
states. The alterations in gastric and autonomic functions may contribute to
eating disorders in obese subjects.
121
Dual Therapy: Nitazoxanide and Sucralfate for the Treatment of
Helicobacter pylori
William Stuppy, MD. Private Practice, Los Angeles, CA.
Purpose: In the United States the incidence of Helicobacter pylori (HP) infec-
tion has been estimated to be as high as 40% of the general population. While
most infections may be deemed sub-clinical, HP is classified as a type 1
carcinogen by the WHO and is the primary cause for gastric cancer, peptic
ulcers, and gastritis. Most treatment regimens incorporate 3 or 4 drugs with
at least two antibiotics and an anti-secretory agent. However, these regimens
can be cumbersome and difficult to tolerate. Furthermore, in clinical practice
few routinely achieve eradication rates exceeding 90%. Nitazoxanide is a thia-
zolide antibiotic that has previously been shown to be effective in a variety of
HP combination regimens. Sucralfate is a cytoprotective agent that has dem-
onstrated activity against HP and has been reported to enhance the effects
of other antibiotics. The purpose of this paper is to update an earlier report
(AJG 2009;104(S3):S55) of the efficacy of a simple, novel HP regimen utilizing
nitazoxanide and sucralfate.
Methods: Patients with a positive salivary antibody test for HP (Diag-
nos-Techs, Inc., Kent, WA) were eligible for treatment. Eligible patients
were apprised of various treatment options and consented to the regimen.
All patients were treated with nitazoxanide 1 g twice daily and sucralfate
1 g twice daily for 14 days. The use of gastric acid suppressants was not
allowed. Follow-up testing for the continued presence of salivary HP anti-
bodies was made one to six months after the end of therapy. Previous stud-
ies have compared the utility of salivary testing versus stool antigen (AJG
2009;104(S3):S59).
Results: The study enrolled 50 patients, 11 of which had failed already on
a standard initial regimen; mean age 45 years, 30/20 males/females and a
The American Journal of GASTROENTEROLOGY