S698 Abstracts
or gastric outlet obstruction. Their symptoms included anorexia, bloating, nausea, vomiting, and post 1220
prandial fullness. None of the patients were on Prokinetic drugs or Erythromycin. Age— Ranged from
29—85 years Sex— 38% (8) were males62% (13) were females Race— all Caucasians After endoscopy, all
patients were given 1 capsule of Zygluten with each meal for two weeks and their symptoms were assessed
for, either marked improvement or no improvement.
Results: Out of 21 patients enrolled in the trial, 14 (66.7%) showed marked improved symptoms and
7(33.3%) showed no improvement of symptoms. No side effects were reported.
Conclusion: Zygluten was found to be helpful in alleviating the symptoms of Diabetic Gastroparesis
symptoms in majority of patients when given with meals. Findings from this study should be elaborated
with a larger perspective study.
1219
Clinichopathological and Endoscopic Features of Helicobacter pylori—Negative Early Gastric
Cancer
Hiroya Ueyama, MD, PhD, Kohei Matsumoto, MD, PhD, Kenshi Matsumoto, MD, PhD, Atsushi Ikeda,
MD, Noboru Yatagai, MD, Yoichi Akazawa, MD, PhD, Hiroyuki Komori, MD, Kentaro Izumi, MD,
Kumiko Ueda, MD, PhD, Mariko Hojo, MD, PhD, Takashi Yao, MD, PhD, Akihito Nagahara, MD, PhD.
Juntendo University School of Medicine, Bunkyo—Ku, Tokyo, Japan
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Introduction: Helicobacter pylori (Hp) leads to chronic gastritis and eventually causes gastric cancer.
Recently, several studies have shown the existence of a small number of Hp—negative gastric cancers
(HPNGC). With the decline of the Hp infection rate, the HPNGC should increases. However, the clin-
ichopathological and endoscopic features of HPNGC are still unclear. The aim of this study is to clarify
the characteristics of HPNGC.
Methods: We analyzed 628 lesions of early gastric cancer that underwent endoscopic resection at our
hospital from April 2009 to June 2017, retrospectively. Thirty—five HPNGC cases (38 lesions, 6.1%)
were enrolled in this study, and evaluated clinichopathologically. Hp—negative status was defined as the
fulfillment of all the following criteria: no eradication history, no mucosal atrophy in endoscopic and
pathological findings, negative rapid urease test or urease breathe test or serum Hp—immunoglobulin
G test or stool antigen.
Results: In HPNGC (n=38), the frequency according to the histology was as follows: gastric adenocarci-
noma of fundic gland type (GAFG) / gastrointestinal phenotype of well—differentiated adenocarcinoma
(GI—WDA) / gastric phenotype of WDA (G—WDA) / signet—ring cell carcinoma (Sig) = 23(60.5%) /
7(18.5%) / 1(2.5%) / 7(18.5%). GAFG was presented as a whitish elevated lesion in the upper to middle
part of the stomach. Although GAFGs exhibited submucosal invasion despite the small size of the lesions,
neither lymphatic nor venous invasion was observed. GI—WDA presented as a reddish lesion in the
lower part of the stomach. G—WDA presented as a whitish elevated lesion in the upper part of the
stomach. Sig presented as a whitish flat or depressed lesion in the middle to lower part of the stomach.
In magnifying endoscopy simple diagnostic algorithm for gastric cancer (MESDA—G) diagnosis, WDA
was diagnosed as a cancer, GAFG and Sig were diagnosed as non—cancer.
Conclusion: HPNGC has distinct endoscopic and clinicopathological features by each histological type
and may be classified into 3 types; 1. Whitish elevated lesion in the upper or middle part of the stomach
(GAFG and G—WDA), 2. Reddish lesion in the lower part of the stomach (GI—WDA), 3. Whitish
flat or depressed lesion in the middle or lower part of the stomach (sig). Early detection of HPNGC
enables minimally invasive treatment which preserves the patient’s quality of life. Endoscopists should
fully understand the characteristics and endoscopic findings of HPNGC.
1219  Figure 1
The American Journal of Gastroenterology
Reflux Symptoms in Patients With Gastroparesis: Prevalence, Severity, and Correlation With Gas-
troparesis Symptoms and Gastric Retention
Presidential Poster Award
Asad Jehangir, MD1, Henry P. Parkman, MD2. 1. Reading Hospital — Tower Health, Reading, PA; 2.
Temple University Hospital, Philadelphia, PA
Introduction: Gastroparesis (Gp) patients often experience gastroesophageal reflux symptoms. How the
severity of reflux symptoms correlates with the severity of Gp symptoms and gastric retention on gastric
emptying scintigraphy (GES) is not known. The aims of this study were to: 1) Determine the prevalence
and severity of reflux symptoms in patients with Gp and its subtypes; 2) Correlate the severity of reflux
symptoms to the severity of symptoms of Gp and delay in gastric emptying.
Methods: Patients referred to our academic center with symptoms suggestive of Gp from July 2013 to
May 2018 filled out the Patient Assessment of Gastrointestinal Symptoms (PAGI—SYM), and question-
naires on demographics and medication use. They underwent 4—hour GES.
Results: Out of 755 patients, 445 had delayed gastric emptying (83.1% females) including 238 patients
with idiopathic gastroparesis (IGp), 123 with diabetic gastroparesis (DGp), 51 with atypical gastroparesis
(AGp), and 33 with post—surgical gastroparesis (PSGp) (Table 1). Gp patients had a Gastroparesis Car-
dinal Symptom Index (GCSI) total score of 3.2±0.1 (mean±SEM), and heartburn/regurgitation subscale
score of 2.0±0.1 (Table 2). 26.3% of all Gp patients had moderate to very severe heartburn/regurgitation
symptoms. Patients with PSGp and AGp reported more severe reflux symptoms compared to IGp patients.
Heartburn/regurgitation subscale had moderate correlation with GSCI total score (r=0.57, p<0.01), nau-
sea/vomiting, postprandial fullness/early satiety (PPF/ES) and upper abdominal pain (AP) subscales
(Table 3). Heartburn/regurgitation subscale had weak correlation with bloating and lower AP subscales,
with weak correlation with 4—hour (r=0.13, p=0.01) and no significant correlation with 2—hour gastric
retention. DGp patients had the strongest correlation of heartburn/regurgitation subscale with GCSI total
score and all PAGI—SYM subscales, except PPF/ES subscale. Nearly two thirds (62.9%) of all Gp patients
were taking proton pump inhibitors, while a minority (12.1%) were on histamine—2 blockers.
Conclusion: A fourth of Gp patients experience moderate to very severe reflux symptoms. The reflux
symptoms are more severe in PSGp and AGp patients. The severity of reflux symptoms in Gp patients
has moderate correlation with symptoms of gastroparesis and weak correlation with 4—hour gastric
retention. Assessment of the severity of reflux in Gp patients is important to effectively manage their
symptoms.
1221
Efficacy and Safety of Trans—Oral Incisionless Fundoplication Performed by Gastroenterologists
Ali Raza, MD1, Marc Catalano, MD1, Erik F. Rahimi, MD1, Hani A Zamil, MD2, Bijun S. Kannadath,
MBBS, MS3, Julie Guider, MD1, Reena V. Chokshi, MD4, Brooks D. Cash, MD, FACG1, Todd Wilson,
MD1, Erik Wilson, MD1, Nirav Thosani, MD2. 1. University of Texas Health Science Center at Houston,
Houston, TX; 2. University of Texas Health Science Center at Houston / McGovern Medical School,
Houston, TX; 3. University of Arizona College of Medicine, Phoenix, AZ; 4. UT Health — McGovern
Medical School, Houston, TX
Introduction: Transoral incisionless fundoplication (TIF) is an emerging technology for the management
of symptomatic gastroesophageal reflux (GER) in select patients. The procedure is typically performed in
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