e-poster presentations - a1)...

E-Poster Presentations - A1)Esophagus

# P-0059 Antitumor effect of telmisartan on thecell proliferation and tumor growth in humanesophageal adenocarcinomaAuthors: SHINTARO FUJIHARA[1];ASAHIRO MORISHITA[2]; TOMOKO TADOKORO[2];TAIGA CHIYO[2]; NORIKO NISHIYAMA[2];KIYOHITO KATO[2]; AKIRA YOSHITAKE[1];HIDEKI KOBARA[2]; HIROHITO MORI[2];AKIHIRO DEGUCHI[1]; TSUTOMU MASAKI[1]Affiliation: [1]Departments of Gastroenterology, Kagawa RousaiHospital, and [2]Departments of Gastroenterology and Neurology,Faculty of Medicine, Kagawa University, Japan

Background: Angiotensin II type 1 (AT1) receptor blocker (ARB),telmisartan, is a widely used antihypertensive drug. It inhibits cancer cellproliferation, but the mechanisms by which telmisartan affects various can-cers, including esophageal adenocarcinoma (EAC), remain unknown.Methods: The aim of the present study was to evaluate the antitumor ef-fects of telmisartan on human EAC cell proliferation in vitro and in vivo.We studied the effects of telmisartan on human esophageal adenocarci-noma (EAC) cells using the cell lines OE19, OE33, and SKGT-4. Results:Telmisartan inhibited the proliferation in the EAC cell lines, OE19, OE33,and SKGT-4 in a time and dose-dependent manner. It induced cell-cyclearrest at the G0/G1 phase, which was accompanied by an obvious activationof the AMP-activated kinase pathway and a decreased activation of mam-malian target of rapamycin (mTOR) and p70S6 kinase. Telmisartan treat-ment led to remarkable decrease of cyclin D1, cyclin E, and other cell-cycle-related proteins. In our in vivo study, intraperitoneal injection oftelmisartan led to a remarkable reduction in tumor growth in mice bearingxenografts derived from the OE19 cells. Furthermore, miRNA expressionwas markedly altered by telmisartan in vitro and in vivo. Among thesemicroRNAs, miR-301a-3p was significantly down-regulated, and it mayregulate the phosphorylation of AMPKα through the AMPKα/mTOR sig-naling pathway to control cell proliferation in EAC cells. Conclusion:Telmisartan suppress human EAC cell proliferation and tumor growth byinducing cell-cycle arrest via the AMPK/mTOR pathway. Keywords:esophageal adenocarcinoma, angiotensin II type 1 receptor blockers,AT1, angiotensin II type 1, AMP-activated protein kinase, microRNA.

# P-0066 The interaction between esophagealsquamous cell carcinoma and adipose tissue inadipose tissue-based organotypic cultureAuthors: ATSUSHI NAKAYAMA[1,2]; YASUHISA SAKATA[1];TAKAHIRO YUKIMOTO[1]; TAKASHI AKUTAGAWA[1,2];RYO NAKANO[1]; SHUJI TODA[2]; KAZUMA FUIMOTO[1]Affiliations: [1]Department of Internal Medicine and GastrointestinalEndoscopy; and [2]Department of Pathology and Microbiology, Faculty ofMedicine, Saga University, Japan

Background: Esophageal squamous cell carcinoma (ESCC) developswithin squamous epithelial layer and progressively invades into submuco-sal to subadventitial layers. Given that abundant adipose tissue exists in the

subadventitia, adipose tissue seems critical for the progression of ESCC.However, their interaction is unknown. Aim:We aimed to address an inter-action between ESCC and adipose tissue in vitro. Methods: ESCC cells(EC-GI-10 and TE-9) were cultured on rat or human subcutaneous adiposetissue-embedded or non-embedded collagen gel. Culture assembly was an-alyzed by electron microscopy, immunohistochemistry, Western blot,ELISA, and small-interfering RNA (siRNA) transfection, in terms of cellsurvival, growth, differentiation, and invasion. Results: Adipose tissue pro-moted the expression of the growth markers, Ki-67 antigen in the cancercell types, whereas it inhibited that of the apoptosis marker, cleavedcaspase-3. Adipose tissue accelerated the invasion of TE-9 cells into thegel, increased with matrix metalloproteinase (MMP)-9 in the culture me-dium. Adipose tissue promoted the expression of mitogen-activated proteinkinase (MAPK) and phosphoinositide 3-kinase-AKT (PI3K-AKT) path-ways and insulin-like growth factor-1 receptor (IGF-1R) in the cell types,while it decreased that of human epidermal growth factor receptor 2(HER2). Cancer cell types in turn decreased IGF-1, adiponectin, leptin,and registin production in AT. IGF-1 promoted the growth of cancer celltypes, while IGF-1R inhibitor (picropodophyllin) enhanced the apoptosis.TE-9 cells treated with IGF-1R siRNA transfection could not reproducethe adipose tissue-induced phenomena above. Moreover, ESCC cellsinhibited the regeneration of adipose tissue. Conclusion: Adipose tissuemay influence the progression of ESCC with the increasedgrowth/invasion and the decreased apoptosis through IGF-1R up-regulation. Adipose tissue may adversely affect the HER2-targeted ther-apy. ESCC cells may affect adipokine production of adipose tissue. Wehave shown for the first time that the strong interaction between ESCCcells and adipose tissue.

# P-0116 A pilot study comparing first week initialclinical response to dual delayed-releasedexlansoprazole 60mg and esomeprazole 40mg intreating gastroesophageal reflux disease grades aand BAuthors: CHIH-MING LIANG[1]; PIN-I HSU[2];CHAO-HUNG KUO[3]; WEI-CHEN TAI[1];KENG-LIANG WU[1]; YAO-KUANG WANG[3];JIUNN-WEI WANG[3]; DENG-CHYANG WU[3];SENG-KEE CHUAH[1]Affiliations: [1]Kaohsiung Chang Gung Memorial Hospital and ChangGung University College of Medicine, and [2]Kaohsiung VeteransGeneral Hospital; and [3]Kaohsiung Medical University Hospital, Taiwan

Background: Rapid onset of proton-pump inhibitors in achieving fastsymptom relief is an unmet need for gastroesophageal reflux disease(GERD), but there is no report on short-term clinical response comparingdexlansoprazole 60 mg to esomeprazole 40 mg. This study aims to com-pare the 7-day clinical responses between the two drugs. Methods: We en-rolled 175 adult GERD subjects, randomized them in 1:1 ratio todexlansoprazole (n = 88) and esomeprazole (n = 87) for the intention-to-treat analysis. Primary endpoints were complete symptom resolution rate(CSR) like heartburn, epigastric pain, or acid regurgitation in days 1, 3,and 7. Results: Thirteen patients were lost to follow up leaving 81 patientsin each group for per-protocolanalysis. At days 1, 3, and 7 post-dose, CSRfor dexlansoprazole and esomeprazole was 25.9% vs. 28.4%, P = .724,33.3% vs. 32.1%, P = .867, 51.9% vs. 48.1%, P = .637, respectively. Insubgroup analysis, female patients attained higher CSR in dexlansoprazolegroup compared to esomeprazole group at day 3 (38.3% vs. 18.4%,P = .046) and an increase trend at day 7 (55.3% vs. 36.8%, P = .09). Inesomeprazole group, female was a negative predictive factor for CSR inpost-dose day 1 (OR, �1.249 ± 0.543; 95% CI: 0.287 [0.099–0.832],P = .022) and day 3 (OR, �1.254 ± 0.519; 95% CI: 0.285 [0.103–

doi:10.1111/jgh.13874

46 Journal of Gastroenterology and Hepatology 2017; 32 (Suppl. 3): 46–60

Editorial material and organization © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

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0.789], P = .016). Conclusion: This study suggested that symptom relieffor GERD was higher in female patients who received single dosedexlansoprazole at day 3 and a trend of increased CSR at day 7.

# P-0121 Response rate and predictors of responseto dexlansoprazole in patients withlaryngopharyngeal refluxAuthors: XI-HSUAN LIN[1,2]; JIING-CHYUAN LUO[1,2,3];MING-CHIH HOU[1,2,3]Affiliations: [1]Department of Medicine, National Yang-MingUniversity, School of Medicine, and [3]Endoscopic Center forDiagnosis and Therapy, Taipei Veterans General Hospital, Taipei,Taiwan; and [2]Division of Gastroenterology and Hepatology, Departmentof Medicine

Background: The study evaluated the response rate and predictors of theresponse in patients with laryngopharyngeal reflux (LPR) receiving anew dual delayed release proton-pump inhibitor (PPI) therapy.Methods: Patients who had LPR symptoms (cough, hoarseness, and globussensation) with a reflux symptom index (RSI) score ≥13 with or withouttypical symptoms (heartburn or acid regurgitation) or non-cardiac chestpain (NCCP) were enrolled. The age, sex, body mass index (BMI), pres-ence of typical gastroesophageal reflux disease (GERD) symptoms, erosiveesophagitis (EE), and questionnaire GerdQ were recorded. The responserate was defined as more than a 50% reduction in symptom scores after2-month therapy with dexlasoprazole 60 mg once daily. Multivariate logis-tic regressions were performed to evaluate the predictors of PPI responsefor cough, hoarseness, globus sensation, and NCCP, respectively.Results: After 2 months of dexlasoprazole therapy in the 132 eligible pa-tients, we noted the following response rates: 81% heartburn, 80% acid re-gurgitation, 73% cough, 42% hoarseness, 61% globus, and 72% NCCP.Multivariate logistic regression analysis showed that presence of EE andGerdQ score ≥8 were independent predictors in patients with cough. ABMI <25 was an independent predictor for patients with hoarseness andglobus, respectively. The presence of heartburn or acid regurgitation andno referral from otolaryngologist were independent predictors for patientswith NCCP.Conclusion: There is a higher response rate for LPR in patients taking a 2-month dual delayed release PPI, dexlansoprazole. Cough associated withEE or GerdQ ≥8, hoarseness or globus associated with BMI <25, andNCCP associated with heartburn or acid regurgitation may response todexlansoprazole therapy.

# P-0127 A pilot study comparing first week initialclinical response to dual delayed-releasedexlansoprazole 60mg and esomeprazole 40mg intreating gastroesophageal reflux disease grades aand BAuthors: CHIH-MING LIANG[1]; PIN-I HSU[2];CHAO-HUNG KUO[3]; WEI-CHEN TAI[1];KENG-LIANG WU[1]; YAO-KUANG WANG[3];JIUNN-WEI WANG[3]; DENG-CHYANG WU[3];SENG-KEE CHUAH[1]Affiliations: [1]Kaohsiung Chang Gung Memorial Hospital and ChangGung University College of Medicine, and [2]Kaohsiung VeteransGeneral Hospital; and [3]Kaohsiung Medical University Hospital, Taiwan

Background: Rapid onset of proton-pump inhibitors in achieving fastsymptom relief is an unmet need for gastroesophageal reflux disease(GERD), but there is no report on short-term clinical response comparing

dexlansoprazole 60 mg to esomeprazole 40 mg. This study aims to com-pare the 7-day clinical responses between the two drugs. Methods: We en-rolled 175 adult GERD subjects, randomized them in 1:1 ratio todexlansoprazole (n = 88) and esomeprazole (n = 87) for the intention-to-treat analysis. Primary endpoints were complete symptom resolution rate(CSR) like heartburn, epigastric pain, or acid regurgitation in days 1, 3,and 7. Results: Thirteen patients were lost to follow up leaving 81 patientsin each group for per-protocol analysis. At days 1, 3, and 7 post-dose, CSRfor dexlansoprazole and esomeprazole was 25.9% vs. 28.4%, P = .724,33.3% vs. 32.1%, P = .867, 51.9% vs. 48.1%, P = .637, respectively. Insubgroup analysis, female patients attained higher CSR in dexlansoprazolegroup compared to esomeprazole group at day 3 (38.3% vs. 18.4%,P = .046) and an increase trend at day 7 (55.3% vs. 36.8%, P = .09). Inesomeprazole group, female was a negative predictive factor for CSR inpost-dose day 1 (OR, �1.249 ± 0.543; 95% CI: 0.287 [0.099–0.832],P = .022) and day 3 (OR, �1.254 ± 0.519; 95% CI: 0.285 [0.103–0.789], P = .016). Conclusion: This study suggested that symptom relieffor GERD was higher in female patients who received single dosedexlansoprazole at day 3 and a trend of increased CSR at day 7.

# P-0201 Diagnostic trends and clinicalcharacteristics of eosinophilic esophagitis: AKorean, single-center database studyAuthor: GA HEE KIMAffiliation: Department of Health Promotion Medicine, EwhaWomans University School of Medicine, Ewha Medical ResearchInstitute

Background and Aim: The prevalence of eosinophilic esophagitis (EoE) isreportedly increasing in Western countries. However, its prevalence in Ko-rea remains unknown. We investigated the diagnostic trends and clinicalcharacteristics of EoE in Korea. Methods: Using an endoscopic databasemaintained at a tertiary care center, we retrospectively reviewed the biopsyreports regarding 18 399 biopsy specimens collected from all patients whounderwent esophagogastroduodenoscopy and esophageal biopsy at this fa-cility between 2006 and 2014. The presence of more than 15 eosinophilsper high-power field with symptoms related to esophageal dysfunctionwas considered to indicate EoE. Results: A total of 37 patients (male:fe-male ratio, 29:8; mean age, 44.0 ± 13 years) were diagnosed with EoE.These patients presented with dysphagia (21.6%), epigastric pain(21.6%), heartburn (24.3%), and other symptoms (32.4%). Typical endo-scopic appearance of EoE was noted in 33 (89.1%) cases and included lin-ear furrows in 24 cases (64.8%), ringed esophagus in 10 cases (27.0%), andwhite exudates in 11 cases (29.7%). The median eosinophilic count was25.0 per high-power field (interquartile range = 20.0–70.0). Notable histo-pathological findings included eosinophilic microabscesses in 21 cases(56.7%). Utilizing the Cochran–Armitage trend test, the diagnosis rate ofEoE was found to have increased from 2006 and to 2014 (P-value for trend<0.001 by the Cochran–Armitage trend test). Conclusions: The number ofpatients with EoE appears to have increased significantly over the 9-yearperiod investigated, while the number of endoscopic investigations in-creased only marginally. Greater awareness of EoE and the role of esoph-ageal biopsies should be considered. Key-words: eosinophilic esophagitis,endoscopy, dysphagia

E-Poster Presentations - A1) Esophagus

47Journal of Gastroenterology and Hepatology 2017; 32 (Suppl. 3): 46–60



# P-0211 Rumination syndrome in atypicalgastro-oesophageal reflux diseases (GORD): Therole of high-resolution manometry (HRM)—A casereport from an Asian tertiary hospital (Singapore)Authors: ZHEN XI JOEL LEE; TZE WEI CHRISTOPHER CHIAAffiliation: Department of Gastroenterology and Hepatology, TanTock Seng Hospital, Singapore

Background/Aim: Rumination syndrome (RS) is a functional gastroduode-nal disorder of unknown etiology characterized by persistent or recurrentregurgitation of recently ingested food into the mouth, typically not pre-ceded by retching and nausea. Difficulties in making the diagnosis maybe caused by the lack of awareness of this entity among physicians and sig-nificant overlap with GORD symptoms. We highlight here a case of rumi-nation syndrome in a middle-aged man who had been labeled chronicallyas refractory GORD in which HRM suggested an alternative diagnosis.Case Description: A 63-year-old man with a history of anxiety disorderwas seen for reflux symptoms. History revealed persistent regurgitationsymptoms for the past 15 years. He denied heartburn symptoms and hadseen multiple physicians and was told to have GORD. His symptoms didnot improve with proton-pump inhibitors (PPI) and dietary advice. He re-ported intermittent regurgitation of undigested food contents that did nottaste acidic or sour. These episodes usually occurred within 10–15 minutesof food intake with eventual expulsion of the food contents. Gastroscopyrevealed erosive esophagitis (Los Angeles Grade B). HRM was performedwhich showed several “R” wave consistent with RS that was characterizedby simultaneous pressure waves arising from the gastric cavity(>30 mmHg) throughout the recording particularly during the multiplerapid swallows (water) and solid food challenge (biscuits). Thereafter, thepatient was referred to the physiotherapist for diaphragmatic breathing.He was also given a short trial of PPI for 3 months for healing of the esoph-agitis seen. His symptoms improved dramatically. Conclusion: Rumina-tion syndrome is an under-diagnosed condition in adults especially withsymptoms suggestive of GORD. Careful history taking can suggest possi-ble diagnosis. In cases of atypical GORD, role of HRM can help to clinchthe diagnosis and alter further management.

# P-0212 Rare case of primary esophagealmelanoma in a female—A case report from anAsian tertiary hospital (Singapore)Authors: ZHEN XI JOEL LEE; CHUNG KING CHIAAffiliation: Department of Gastroenterology and Hepatology, TanTock Seng Hospital, Singapore

Background/Aim: Primary malignant melanoma of the esophagus is a rareand aggressive tumor. It has an incidence of 0.2% of all esophageal neo-plasms. Up to 40.9% of patients have metastases at diagnosis.1 Worldwide,less than 300 cases have been published with a male:female ratio of 2:1.There is no known risk factor for this malignancy.2 Locally, there has been3 case reports published thus far.3–5 We highlight here a case of primaryesophageal melanoma in an elderly female who presented with dysphagia.Case Description (Methods and Results): A 78-year-old lady was referredfrom the general practitioner to the gastroenterology clinic for progressivedysphagia of 3-month duration. She had complained of the sensation offood stuck in her “mid-chest” with loss of weight. She had a significantfamily history of malignancy in her siblings. Computed tomography (CT)of the thorax, abdomen, and pelvis showed a focal mural thickening inthe mid-esophagus with no suspicious intra-abdominal mass seen. Gastros-copy revealed a nodule in the mid-esophagus. Multiple biopsies weretaken. Histology of the esophageal nodule confirmed malignant melanomawith positive Melan A staining. Full skin survey was unremarkable. A

body PET (positron emission tomography)/CT scan showedfludeoxyglucose (FDG) uptake in the upper-mid esophagus in keeping withthe biopsy proven malignant melanoma. Endoscopy ultrasound showed a16-mm submucosal lesion arising from the muscularis mucosae (MM)layer. There was no enlarged lymph node in the vicinity. Fine needle aspi-ration (FNA) confirmed malignant melanoma. Thereafter, the patientunderwent a transhiatal esophagectomy. There were no post-operativecomplications, and she remains well. Conclusion: Having made a diagno-sis of esophageal melanoma, one should always hunt meticulously for aprimary lesion to exclude metastasis. A comprehensive history and physi-cal examination is therefore mandatory. Early radical surgical excision of-fers the best survival outcomes.

References:

1 Sabanathan S et al. Am. J. Gastroenterol. 1989; 84:1475–812 Charu Jora et al. Indian J Nucl Med 2015; 30(2):162–43 Yirong Sim et al. Asian Journal of Surgery 2015; 38:236–84 Khek YH et al. Nature Clin Practice Gastrol & Hepatol 2007; 4:171–45 Leong QM et al. Biomed Central 2008; 1:28

# P-0248 Rodent models of Barrett’s esophagusand esophageal adenocarcinoma: Thechemo-preventive effect of parthenolide, a herbalnuclear factor-κB inhibitorAuthors: KATSUNOBU OYAMA; SACHIO FUSHIDA;JUN KINOSHITA; TOMOHARU MIYASHITA;HIDEHIRO TAJIMA; HIROYUKI TAKAMURA;ITASU NINOMIYA; TETSUO OHTAAffiliation: Department of Gastroenterological Surgery, Graduateschool of Medical Science, Kanazawa University, Japan

Background: Esophageal adenocarcinoma (EAC) is a rising cancer. Long-standing inflammatory condition caused by gastroesophageal reflux in-duces Barrett esophagus (BE) and EAC. Rats underwent surgical proce-dure that causes the direct flow back of duodenal contents into theesophagus generate BE and EAC. We have investigated this surgically pre-pared rat carcinogenesis model. In first experiment, we made same modelusing mouse. We examined the difference of histological changes of mousemodel compared with rat model. Second experiment was conducted to in-vestigate the chemo-prevention effect for BE and EAC of parthenolide, aherbal nuclear factor (NF)-κB inhibitor. NF-kB involved in several stepsof inflammatory and carcinogenic process. Methods: We operated fiftymice and fifteen rats to make carcinogenesis model. For second experi-ments, twenty of fifty mouse models take experimental chow containingparthenolide from one to forty weeks after surgery. Forty weeks after sur-gery, the resected esophagus of rodent models were evaluated histologi-cally. Results: In first experiments, seventeen of thirty mice and twelveof fifteen rats were alive until forty weeks after surgery. The incidence ofBE in mouse models and rat models was 71% (12/17) and 92% (11/12), re-spectively. The incidence of ADC in mouse models and rat models was29% (5/17) and 75% (9/12), respectively. The histological changes weregentle and limited in small extent in mouse models compared with ratmodels. No metastases were found in both models. In second experiments,thirteen of twenty rats alive until forty weeks after surgery. The incidenceof BE and ADC were 69% (9/13) and 15% (2/13) in mouse models withchow containing parthenolide. Conclusion: BE and ADC were inducedin both of mouse and rat models. Parthenolide tended to suppress the ex-pression of BE and ADC.





# P-0262 Decreased serum level of microRNA-381is correlated with poor prognosis of patients withesophageal squamous cell carcinomaAuthors: SUNA ZHOU; JUN LIANG; QIUJU SHAO;DONGJIE HEAffiliation: Department of Radiotherapy, Tangdu Hospital, FourthMilitary Medical University, Xi’an, China

Aim: In our previous study, microRNA(miR)-381 could enhance the radio-sensitivity of ESCC cells. And miR-381 could be detected in both ESCCtissues and patients’ serum. Circulating microRNAs have momentous clin-ical relevance as prognostic biomarkers and have been correlated with dis-ease progression in many solid tumors. In further study, we try to evaluatethe expression level of miR-381 and to investigate the potential usefulnessof this molecule as a biomarker for prognosis in ESCC. Methods: Real-time PCR was performed to examine the amount of miR-381 in serum inESCC patients and healthy controls. The prognostic implications of serummiR-381 level in human ESCC were further evaluated. Results: Expres-sion levels of miR-381 in ESCC patients’ serum were significantly lowerthan in healthy controls (P < 0.01). Moreover, lower serum miR-381 levelmore frequently occurred in ESCC patients with advanced tumor–node–metastasis, advanced T and N stages (both P < 0.05), and poor tumor dif-ferentiation (P = 0.01). The Kaplan–Meier curve showed that lower miR-381 expression was closely associated with worse overall survival (OS)and disease-free survival (DFS) of patients with ESCC (both P < 0.01),and the serum level of miR-381 was found to be an independent prognosticfactor for both OS and DFS (both P = 0.01) by further multivariate analy-sis. Conclusion: Decreased expression of miR-381 was closely associatedwith malignant progression and poor prognosis in ESCC patients. There-fore, the amount of miR-381 in serum may become a potential predictorfor the clinical outcome of ESCC patients.

# P-0268 Comparison of treatment efficacybetween vonoprazan and esomeprazole forimprovement of symptoms in patients with erosivegastritisAuthors: CHISE KANO; HIROSHI YAMASHITA;AKIHIKO OKADAAffiliation:Department of Gastroenterology and Hepatology, OsakafuSaiseikai Nakatsu Hospital, Osaka, Japan

Background: Vonoprazan is reported to provide more potent and fast-acting gastric acid suppressive effects compared with proton-pump inhibi-tors (PPIs). However, no data exist regarding the efficacy of vonoprazanfor symptomatic improvement compared with PPIs. Methods: Patientswith mucosal break diagnosed using endoscopy and reflux symptoms(heartburn or regurgitation) exceeding moderate grade defined accordingto the Global Overall Severity(GOS) scale were randomized to receive20 mg of vonoprazan or esomeprazole. Patients were instructed to com-plete descriptive questionnaires every week for 4 weeks. The primary end-point was comparing the percentage of patients in each treatment groupachieving complete symptom relief during each week. Results: Followingrandomization, eleven patients received vonoprazan (mean age: 53.4, LA-AB/CD: 10/1), and 7 patients received esomeprazole (mean age: 62.8, LA-AB/CD: 6/1). The percentages of patients achieving complete symptom re-lief in vonoprazan and esomeprazole groups were 36.3 and 14.2 at 1 week(P = 0.63), 36.3 and 28.5 at 2 weeks (P = 0.86), and 54.5 and 28.5 at3 weeks (P = 0.55), respectively. The percentages of patients achievingcomplete heartburn relief in the vonoprazan and esomeprazole groups were36.3 and 14.2 at 1 week (P = 0.63), 36.3 and 28.5 at 2 weeks (P = 0.86),54.5 and 28.5 at 3 weeks (P = 0.55), and 45.4 and 28.5 at 4 weeks

(P = 0.82), respectively; percentages achieving complete regurgitation re-lief were 45.4 and 16.6 at 1 week (P = 0.51), 63.6 and 66.6 at 2 weeks(P = 0.68), 72.7 and 50.0 at 3 weeks (P = 0.94), and 54.5 and 83.3 at4 weeks (P = 0.51). Conclusion: Vonoprazan treatment produced in-creased rates of complete symptom relief for both heartburn and regurgita-tion at 1 week. Therefore, vonoprazan treatment may be a useful strategyfor early complete symptom relief.

# P-0276 Prognostic role of CDKL3 expression inpatients with esophageal squamous cellcarcinomaAuthors: SUNA ZHOU[1]; WENGUANG YE[2]; JUN LIANG[1];QIUJU SHAO[1]Affiliation: Departments of [1]Radiotherapy, [2]Gastroenterology,Tangdu Hospital, Fourth Military Medical University, Xi’an, China

Aim: To investigate the clinicopathological features and prognostic impli-cations of CDKL3 status in esophageal squamous cell carcinomas(ESCCs). Methods: All patients with ESCC (n = 60) underwent surgicalresection at Tangdu Hospital of Fourth Military Medical University be-tween 2012 and 2014. A tissue microarray was constructed using cores ob-tained from representative tumor areas of formalin-fixed, paraffin-embedded tissue blocks. The level of CDKL3 was examined by immuno-histochemistry. The Kaplan–Meier method was used to construct survivalcurves. Univariate and multivariate Cox proportional hazard regressionmodels were performed to identify associations with outcome variables.Results: Patients with CDKL3 over-expression (≥40% or 50% as cut-offvalue) were correlated with worse DFS and OS by multivariate analysis.The prognostic impact was not consistent in the patients with stages Iand II (36, 60.0%) and stages III and IV (24, 40%), or with lymph nodemetastasis (29, 48.3%). In patients with stages I and II disease, CDKL3 ex-pression (≥30%, 40%, or 50%) was associated with worse DFS and OSupon multivariate analysis. In patients without lymph node metastasis,CDKL3 expression (≥20%, 30%, 40%, or 50%) was associated withshorter DFS and OS in univariate or multivariate analysis. However,CDKL3 expression was not correlated with prognosis in patients withstages III and IV disease or with lymph node metastasis. Conclusion:CDKL3 expression acted as an independent favorable predictor in ESCCpatients with stages I and II disease or without lymph node metastasis,not in stages III and IV or lymph node metastasis.

# P-0292 SPAG5 is a potential prognostic markerand promotes proliferation and invasion inesophageal squamous cell carcinomaAuthors: MINGXIN ZHANG[1]; MANLI CUI[1];LINGMIN ZHANG[2]; JINGJIE WANG[1]; SUNA ZHOU[3]Affiliations: [1]Department of Gastroenterology, [2]Department ofRadiotherapy, Tangdu Hospital, Fourth Military Medical University,Xi’an 710038; [3]Department of Anesthesiology, First Affiliated Hospital,Xi'an Jiaotong University, Xi’an 710061

Background: SPAG5 was found as a prognostic biomarker in breast andcervical cancer, but its expression, clinic value, and function in esophagealsquamous cell carcinoma (ESCC) was unclear.Methods: First, SPAG5 ex-pression was analyzed in ESCC cell lines and tumor tissues. Then, its rela-tionship with clinicopathological factors and survival were analyzed.Further, the effect of SPAG5 on cell proliferation, apoptosis, and metasta-sis was examined in vitro by modulating expression of SPAG5 throughspecific shRNA. Last, the potential mechanisms were also investigatedby antibody microarray. Results: SPAG5 was up-regulated in ESCC, and





expression of SPAG5 was correlated with tumor differentiation and lymphnode metastasis. Univariate and multivariate analyses indicated that highSPAG5 expression might be a poor prognostic factor. Further studies dem-onstrated that inhibition of SPAG5 expression inhibited proliferation by in-ducing apoptosis and repressed invasion. Then, it was found that Rap1bshRNA decreased expression of proteins related to EMT and apoptosispathways Conclusion: SPAG5 is a potential prognostic marker and pro-motes proliferation and invasion in ESCC.

# P-0307 Endovascular stent graft for esophagealcancer involving the thoracic aorta: Treatment orprophylaxis for fetal hemorrhage—Review of 5experimental casesAuthors: RAI SHIMOYAMA[1]; HIDEMITSU OGINO[1];NAOKO ISOGAI[1]; YUKI IKEGAYA[1]; JUN KAWACHI[1];KATSUNORI MIYAKE[1]; AKIKO SASAKI[2];SHINNOSUKE TOKORO[2]; CHIKAMASA ICHICHIDA[2];HIDETO EGASHIRA[2]Affiliations: [1]Department of General Surgery; and [2]Gastroenterology Medicine Center, Shonan Kamakura General Hospital,Japan

Background: In patients with advanced esophageal cancer involving tho-racic aorta, aortoesophageal fistula is a rare complication but causes lethalhemorrhage. Efficacy of thoracic endovascular aortic repair (TEVAR) byhandmade stent graft for aortoesophageal fistula is already reported. In2008, commercially based stent graft was approved in Japan, and emergentor urgent TEVER for aortoesophageal fistula became possible. To investi-gate efficacy and safety of TEVAR for esophageal cancer with aortic inva-sion including aortoseohapgeal fistula, retrospective review was planned.Methods: We conducted retrospective chart review of the patients treatedwith TEVAR for advanced esophageal cancer with aortic invasion betweenApril 2008 and December 2016 at Shonan Kamakura General Hospital. Ef-ficacy and safety were analyzed. Results: Five cases were treated withTEVAR. Commercially available GORE® TAG® thoracic aortic stent-graft system was used in all cases. Two patients ware male, and 3 were fe-male; median age was 75 years (67–76), and all the stages were UICC IIIC.Three cases were emergent for hematemesis, and 2 cases were prophylac-tic. Major complication of procedure was none. The median survival was115 days (43–507); two cases were dead from intrathoracic or retroperito-neal hemorrhage from aortic rupture. One case was dead from disease pro-gression, and other 2 cases were alive. Conclusion: For patients withadvanced esophageal cancer involving aorta, it is possible to prevent hem-orrhagic death from aortoesophageal fistula in a short term by TEVAR.The risk of stent-graft infection is high and may cause death from aorticrupture. Further study is needed for long-time survival.

# P-0319 Etiology and risk factors forgastroesophageal reflux disease and its subtypes:Results from a large cross-sectional studyAuthors: JI MIN CHOI; CHANGHYUN LEE; YOO MIN HAN;GOH EUN CHUNG; SU JIN CHUNG; JOO SUNG KIMAffiliation: Department of Internal Medicine, Healthcare ResearchInstitute, Seoul National University Hospital Healthcare SystemGangnam Center, Seoul, South Korea

Background: Gastroesophageal reflux disease (GERD) can be divided intoerosive reflux disease (ERD) and non-ERD (NERD) depending on thepresence of mucosal damage in endoscopy. We evaluated the prevalenceand risk factor of GERD and its subtypes in the Korean population.

Methods: Subjects who underwent upper gastrointestinal endoscopy forhealth screening from August 2015 to September 2016 were included.Prevalence, demographics, endoscopy results, and accompanying dyspep-sia symptoms were retrospectively investigated in GERD subjects. This re-search has been approved by an ethical committee. Results: Of the total10 607 subjects who underwent upper gastrointestinal endoscopy andsymptom questionnaire, 729 (6.9%) had GERD: ERD (n = 315, 3.0%)and NERD (n = 414, 3.9%). Compared to subjects without reflux, numberof male, BMI, and proportion of current smoker were significantly higher,and H. pylori infection rate was significantly lower in ERD group. On mul-tivariate analysis, male, higher BMI, and negative H. pylori status were in-dependent risk factors for ERD. In NERD group, number of male, level ofeducation, and proportion of excessive alcohol consumers were lower thanthat of no reflux group. Multivariate analysis showed that the subjects inNERD group had significantly lower educational level and lower alcoholconsumption. Overlap between GERD and functional dyspepsia was foundin 20.6% of GERD subjects: The proportion of subjects with pure epigas-tric pain syndrome (EPS) was higher in both subgroups of GERD than innormal group, whereas that with pure postprandial distress syndrome(PDS) was higher only in NERD group. EPS-PDS overlap was more prev-alent in ERD group. Conclusions: GERD is present in 6.9% of the Koreanpopulation. Male, higher BMI, and H. pylori negative status were associ-ated with ERD. Lower education level and less alcohol consumption wererelated with NERD. There was considerable overlap between GERD andfunctional dyspepsia in the Korean general population.

# P-0335 Management of caustic consumptioninjuries—A multidisciplinary effort for asuccessful outcomeAuthors: BHARAT KUMAR NARA; T V ADITYA CHOWDARY;S THIRUNAVUKKARASU; K RAVINDRANATHAffiliation: Surgical Gastroenterology And Minimal Access Surgery,Gleaneagles Global Hospital

Introduction: Ingestion of corrosive substances results in severe damage ofupper aerodigestive system and is still a major cause of concern in India.Injuries depend on the type of substance, quality, quantity, and the inten-tion. Corrosive agents produce extensive damage to gastrointestinal tract,which may result in death in the acute phase or may result in long-termsequelae. We describe the experience of our department in treating suchinjuries. Methods: All corrosive injury patients, acute and late, presentedto the Department of Surgical Gastroenterology from January 2009 to June2016, are included in this retrospective study. Results: Between January2009 and June 2016, 55 patients were admitted with history of corrosiveagent consumption. Twenty-three patients had only mild mucosal injuryand were treated conservatively and required no further intervention. Threerequired emergency total gastrectomy with a cervical esophagostomy ofwhom only one survived. Twenty-four patients underwent repeatedesophageal dilatations for strictures. One of them had a spontaneousduodenal perforation and succumbed. Seventeen patients responded verywell to the dilatation protocol. Six patients underwent surgery forcomplication/failure of endoscopic dilatation. Five patients presented latewith well-established strictures with poor nutrition and underwent a feed-ing jejunostomy with a reconstructive procedure at a later date. A total of11 patients underwent a reconstructive procedure, 7 underwent a colonicpull through, and 4 underwent a Bilroth II distal gastrectomy. Conclusion:Corrosive injury of upper gastrointestinal tract is a complex condition,requiring an intensive approach and multidisciplinary management. Main-tenance of nutrition is essential for a good outcome. The native esophagusshould be salvaged whenever possible. Meticulous intra-operativetechnique and ensuring good vascular supply of the conduit are the corner-stones of successful outcome.





# P-0351 The sex-specific lag in incidence ofsymptomatic Barrett’s esophagus—A UKprospective cohort study (EPIC-Norfolk)Authors: STEPHEN LAM[1,2]; LEO ALEXANDRE[1,2];ROBERT LUBEN[3]; MAX YATES[1]; EDWARD CHEONG[1];JAMES KANG[1,2]; LASZLO IGALI[1]; ANDREW HART[2]Affiliation: [1]Norfolk and Norwich University Hospital NHS Trust,Colney Lane, Norwich, NR4 7UY, [2]Norwich Medical School,University of East Anglia, Norwich, NR4 7TJ [3]Strangeways ResearchLaboratory, Worts Causeway, Cambridge, CB1 8RN, UK

Background: The marked male predominance in patients with esophagealadenocarcinoma cannot be explained by known current risk factors. Thelower incidence in women may be explained by a later age of onset ofBarrett’s esophagus due to the protective effects of premenopausal hor-mones. In laboratory studies, estrogen has demonstrated anti-inflammatoryproperties, which may prevent the inflammatory-driven metaplastic processassociated with Barrett’s disease. Aims: To investigate in a large prospec-tive cohort study, the peak age of incidence of symptomatic Barrett’sesophagus according to sex. Methods: A total of 30 445 men and womenwere recruited into the EPIC–Norfolk study between 1993 and 1997 andfollowed up until 2015 to identify incident cases of symptomatic Barrett’sdisease diagnosed using esophagogastroscopy. The crude sex-specific inci-dences were calculated according to age categories with 5-year cut-pointsand standardized (using the whole population) to calculate age-standardized incidence rates (ASRs). Results: Two hundred thirty-five par-ticipants developed Barrett’s esophagus (68% men) during a mean follow-up of 17.6 years (SD 4.5), totalling 525 724 person-years. The peak inci-dence in men was at age 55–60 years (ASR 7.4/1000), whereas in women,it was 65–70 years (ASR 4.1/1000). In the 55–60 year category, the ASRratio between men and women was 4:1, but equivalent (1:1) in the65–70 year category, demonstrating an approximate 10-year disease lagin women. Conclusion: These findings are consistent with the hypothesisthat high estrogen levels before the menopause may protect againstBarrett’s esophagus, creating a lag in female incidence. This may explainthe striking gender difference in esophageal adenocarcinoma, where, dueto the long duration of the metaplastic–dysplastic sequence, women arelikely die from other competing causes before the onset of esophageal can-cer. Further evaluation of the potential protective effects of estrogen againstesophageal adenocarcinoma is warranted.

# P-0352 Does physical activity protect against thedevelopment of gastroesophageal reflux disease,Barrett’s esophagus, and esophagealadenocarcinoma? A review of the literature with ameta-analysisAuthors: STEPHEN LAM[1,2]; ANDREW HART[2]Affiliation: [1]Norfolk and Norwich University Hospital NHS Trust,Colney Lane, Norwich, NR4 7UY, [2]Norwich Medical School,University of East Anglia, Norwich, NR4 7TJ, UK

Background: Physical activity affects the functioning of the gastrointesti-nal system through both local and systemic effects and may play an impor-tant role in reducing the risk of developing esophageal adenocarcinoma.This review assesses the epidemiological evidence for the relationship be-tween physical activity and the development of gastroesophageal refluxdisease (GORD), Barrett’s esophagus, and esophageal adenocarcinoma.Methods: A search of PubMed, Medline, Embase, and CINHAL was con-ducted from their inceptions to March 25, 2017, for observational studiesthat examined associations between recreational and/or occupational levelsof physical activity and the risk of GORD, Barrett’s esophagus, and

esophageal adenocarcinoma. Furthermore, GORD was examined using ameta-analysis. Results: Seven studies were included (2 cohort and 5case–control). For GORD, there were 3 case–control studies with 10 200cases among 78 034 participants, with a pooled estimated OR of 0.67(95% CI 0.57–0.78) for high vs. low levels of recreational physical activity.In Barrett’s esophagus, there was a single case–control study, whichreported no association, OR 1.19 (95% CI 0.81–1.73). For esophagealadenocarcinoma, there were 3 studies (2 prospective cohort and 1 case con-trol) with 666 cases among 910 376 participants. The largest cohort studyreported an inverse association for high vs. low levels of recreational phys-ical activity, RR 0.68, 95% CI 0.48–0.96. The remaining studies reportedno associations with either occupational or combined recreational andoccupational activity. Heterogeneity in the measurement of exposure(recreational, occupational, and both) made a pooled estimate for esopha-geal adenocarcinoma inappropriate. Conclusion: Although limited, thereis some evidence that higher levels of recreational physical activity mayreduce the risk of both GORD and esophageal adenocarcinoma, but furtherlarge cohort studies examining the type, intensity, and duration of activitiesthat may be beneficial are needed.

# P-0354 Normative Chicago 3.0 metrics forhigh-resolution esophageal manometry (InSIGHTultima®) in healthy Malay population and effectson metrics with different provocative swallowsand positionsAuthors: MOHD RIDZUAN MOHD SAID[1];WONG ZHIQIN[1]; RAFIZ ABDUL RANI[2];RAJA AFFENDI RAJA ALI[1]; CHAI SOON NGIU[1];YEONG YEH LEE[3]Affiliation: [1]Unit Gastroenterology, Department of Medicine, TheNational University of Malaysia, and [2]Unit Gastroenterology,Department of Medicine, Universiti Teknologi MARA, Kuala Lumpur,[3]School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu,Malaysia

Background: The study of esophageal function has significant advance-ment with availability of high-resolution manometry (HRM). We aimedto determine normative metrics among healthy Malay volunteers and toevaluate effects of provocative swallows in various positions. Method:We conducted a cross-sectional study of 50 healthy Malay adult volunteersusing the InSIGHT Ultima® system (Diversatek, Highlands Ranch, USA).HRM metrics (95 percentile) were analyzed using the Chicago Classifica-tion version 3.0 following completion of swallowing protocols consistingof liquid, viscous, and solid materials in recumbent and standing positions.Result: Normative metrics in the recumbent position for integrated relaxa-tion pressure (IRP) 4 s, distal contractile integral (DCI), distal latency (DL),and length of peristaltic break (PB) were 17 mmHg (median 9, range 7–12), 2633 mmHg s�1 cm�1 (median 856, range 501–1525), 8.5 s (median6.4, range 5.7–7.3), and 7 cm (median 2, range 0–3), respectively. Signif-icant delay of DL was observed with viscous vs. liquid swallows (median7.5 s vs. 6.4 s, P < 0.01). More distinctive changes in metrics wereobserved with solid materials vs. liquid swallows including increment ofDCI (median 1098 vs. 856, P < 0.05), prolonged DL (median 8.2 vs.6.4 s, P < 0.01) but shorter breaks (median 0 vs. 1.4 cm, P < 0.01).Shifting from recumbent to standing position caused a significant reductionin IRP 4 s (median 9 vs. 7 mmHg, P < 0.05) but not with other metrics. Instanding position, a significant delay of DL was observed with solid vs.viscous swallows (median 8.0 vs. 7.5 s, P < 0.01). Conclusion: We estab-lish normative metrics for HRM with InSIGHT Ultima® system in theMalay population. Variations in metrics exist with different provocativeswallows and positions. Normative parameters for different populationsshould be pursued if HRM studies are performed in these situations.





# P-0360 Single pneumatic dilation (PD) inachalasia: Outcomes from a tertiary referral centerin AsiaAuthors: JONATHAN KUANG; CHRISTOPHER CHIA;CHUAH KHOON BENGAffiliation: Department of Gastroenterology and Hepatology, TanTock Seng Hospital, Singapore

Background: Achalasia is a rare esophageal motility disorder with debili-tating symptoms that can impact on a patient’s quality of life. Conventionaltreatments include graded PD or laparoscopic Heller myotomy (LHM). Pa-tients who undergo PD may be subjected to repeated dilations to achievesymptom control. In this study, we looked at the number of pneumatic di-lations and balloon size required to achieve symptom control in a group ofAsian patients with achalasia. We also looked at patients who had under-gone LHM and their symptoms post-surgery. Methods: In this retrospec-tive pilot study, a total of 11 Asian patients with achalasia diagnosed byhigh resolution manometry (HRM) were studied. Symptoms were assessedby using the Eckardt scores pre- and post-intervention. Treatment was con-sidered successful if the Eckardt score was 3 or less. Patients were followedup for at least 9 months. Results: Of the 11 patients, 27% had Type I acha-lasia with mean integrated relaxation pressure (IRP) of 27.2 mmHg, and73% had Type II achalasia with a mean IRP of 22.9 mmHg. There werenone with Type III achalasia. Seventy-eight percent who underwent PDhad successful treatment after just one session. Three of these patientshad Type 1 achalasia, and 4 of these patients had Type 2 achalasia. Allof the dilations were performed using a 30-mm balloon size. Of the 2 pa-tients with suboptimal treatment response to PD, one previously had aLHM with subsequent recurrence of symptoms after 2 years, and the otherdefaulted follow-up. In our cohort, only 3 patients underwent LHM, ofwhich 67% had good response to treatment post-surgery. Conclusion:Our findings show that in a cohort of Asian patients with achalasia, onesession of PD using a 30-mm balloon is sufficient to achieve a goodtreatment response without undergoing the conventional graded dilatorapproach.

# P-0370 Normative values of water-perfusedesophageal high-resolution impedancemanometry in the Chinese populationAuthors: PING-HUEI TSENG; CHIEN-CHUAN CHEN;YI-CHIA LEE; HSIU-PO WANG; MING-SHIANG WUAffiliation: Department of Internal Medicine, National TaiwanUniversity Hospital, Taipei, Taiwan

Background/Aims: Combined esophageal high-resolution impedance ma-nometry (HRIM) measures multiple pressures and bolus transit simulta-neously and allows detailed assessment of esophageal motility. Currently,no normative values for the water-perfused HRIM system are available inthe Chinese population. Therefore, we aim to establish the normal refer-ence values of the water-perfused HRIM in the Chinese population.Methods: Seventy healthy volunteers were enrolled. After an overnightfast, all subjects underwent a HRIM study with 22 water-perfused pressuresensors and eight impedance channels. Ten 5-ml liquid swallows of salineat 30-s intervals were obtained. Parameters including distal contractile inte-gral (DCI), distal contraction latency (DL), lower esophageal sphincter(LES) basal pressure and 4-s integrated relaxation pressure (IRP-4 s), andpercentage of complete bolus transit were calculated. The esophageal bodycontraction vigor was evaluated with Chicago Classification version 3.0.Normal values based on the 5th or 95th percentile were established.Results: All participants finished the study and tolerated the HRIM proce-dure well. After excluding 4 subjects with absent contractility in all ten

saline swallows, 66 subjects (34 male, mean age 41.9, range 21–64) wereanalyzed. The upper normal limit (95th percentile) of IRP-4 s was20 mmHg. Female subjects had significantly higher upper normal limit ofIRP-4 s than male subjects (21 vs. 15 mmHg, P = 0.001). The 5th–95thpercentile range was 99.4–2185.6 mmHg·s�1·cm�1 for DCI, 6.2–11.3 sfor DL, and 50–100% for percentage of complete bolus transit, respec-tively. Conclusion: We establish the normative values for the water-perfused HRIM system in the Chinese population. Gender may affect themajor parameter of LES relaxation pressure and thus should be taken intoaccount when interpreting the HRIM results.

# P-0434 Prevalence of extraesophagealsymptoms in Chinese patients withgastroesophageal reflux disease (GERD): Amulticenter questionnaire-based study in ChinaAuthors: DUOWU ZOU; YU BAIAffiliation: Changhai Hospital

Objectives: Extraesophageal symptoms (EES) are presented in manyGERD patients. The studys aim is to investigate the prevalence of EESin Chinese patients with GERD. Methods: This questionnaire-based studywas conducted in 50 hospitals in China between June and November 2016.Outpatients diagnosed with GERD were recruited for study. Thesymptoms-based questionnaire consisting of GerdQ questions and EESquestions was filled out during the visit. Results: Three thousand nine hun-dred seventy-seven questionnaires were collected in this study totally. Theprevalence of EES was 20.8%. The most prevalent EES was globuspharyngeus (45.4%), followed by epigastric burning (28.3%), chest pain(15.1%), dysphagia (14.1%), and hoarseness (10.6%). Of patients withEES, 67.9% had sleep disturbance, and 42.4% had taken additional medi-cation for heartburn and/or regurgitation. Conclusions: The EES is verycommon in Chinese patients with GERD. The improvement on QOL im-pairment should be considered more in management of GERD patientswith EES in China. Keywords: Extraesophageal symptom, Gastroesopha-geal reflux, Prevalence.

# P-0502 A randomized open-label clinical trial tocompare efficacy of Gaviscon advance and antacidalone in post-supper suppression of acid pocket,gastroesophageal reflux, and symptoms amongobese participantsAuthors: MOHD ADLI DERAMAN[1];MUHAMMAD ILHAM ABDUL HAFIDZ[2];RONA MARIE LAWENKO[3]; ZHENG FEEI MA[1];MUNG SEONG WONG[1];CHANDRAMOULI ANNAMALAI[2]; CATHAL COYLE[4];YEONG YEH LEE[1]Affiliations: [1]School of Medical Sciences, Universiti Sains Malaysia,Kota Bharu, [2]Faculty of Medicine, Universiti Teknologi MARA,Sungai Buloh, Malaysia; [3]De La Salle Health Sciences Institute,Dasmarinas, Cavite, Philippines; and [4]Reckitt Benckiser, Slough, UK

Background: Heavy-size snacks during supper may cause nighttime gas-troesophageal reflux (GER) especially among obese individuals. The aimwas to compare efficacy of Gaviscon Advance (Reckitt Benckiser, UK)and antacid alone in post-supper suppression of acid-pocket, GER, andsymptoms among obese participants. Methods: Consented obese partici-pants underwent 48 h of wireless pH-metry (Bravo capsule, Medtronic,USA) placed at cardia (acid pocket) alongside pH-impedance probe





(MMS, The Netherlands) with pH sensor 5 cm above lower esophagealsphincter (LES). Snacks (two burgers and 250-mL drink) were given at10:00 PM for two nights. Participants were randomized to single adminis-tration of either Gaviscon Advance or antacid in an open-label fashion onthe second night, 10 min after snacks. The pH at cardia and 5 cm aboveLES, frequency of acid refluxes (pH < 4), and symptoms were measuredevery 10 min after supper for 1 h. Results: (Fig. ) Eighteen participants(mean age 33.5 and BMI 32.8 kg/m2) entered the trial, with nine partici-pants each group. Significant pH suppression of acid pocket was observedwith Gaviscon Advance vs. antacid (median pH difference 2.7, P = 0.008).The frequency of acid refluxes was also less after Gaviscon Advance vs.antacid (median difference 2.2, P = 0.03), although no significant differ-ence in pH of GER was observed between the two groups. Symptoms(heartburn and regurgitation) were not different between the two groups(all P > 0.05). Conclusion: Gaviscon Advance is more efficacious thanantacid in post-supper suppression of acid pocket and frequency of GERwith similar pH suppression of GER and symptoms in obesity. Acknowl-edgement: This study is supported by a research grant from ReckittBenckiser (M) Sdn. Bhd.

# P-0537 Successful conservative treatment forspontaneous esophageal rupture (Boerhaavesyndrome): A case reportAuthors: KODAI SHINZATO[1]; HIDETSUGU NAKAZATO[1];SHOGO KINJO[1]; TAKESHI TOMIYAMA[1];SHINJI NAGAMINE[1]; TAKEHIKO TOMORI[1];JUNMIYAGI[1]; SEIJI NAGAYOSHI[1]; YASUSHI OMINE[1];HIDEAKI SASAKI[2]; TETSUHIRO MIYARA[3]Affiliations: [1]Department of Surgery, and [2]Department ofEmergency medicine; and [3]Department of Radiology, Okinawa RedCross Hospital, Japan

Introduction: Spontaneous esophageal rupture (Boerhaave syndrome) israre and has a highly mortality rate. Late diagnosis and treatment can befatal. Presentation of Case: The patient was a 48-year-old male who had

vomited and developed chest pain after drinking alcohol. He was trans-ferred to our hospital 12 hours after the symptoms occurred. The chest painwas exacerbated by deep breathing. He had a fever with a body tempera-ture (BT) of 38.1 °C, and his oxygen saturation level was 94% (in roomair). His blood pressure was stable. His white blood cell count and C-reactive protein level were slightly abnormal. Computed tomography(CT) showed mediastinal emphysema and that the left wall of the loweresophagus had ruptured. Contrast-enhanced esophagography revealed theleakage of contrast media into the mediastinum, but the media did not passinto the intrathoracic cavity. The patient was diagnosed with spontaneousesophageal rupture. Conservative therapy, involving intravenous broad-spectrum antibiotics, an intravenous proton pump inhibitor, nasogastrictube drainage, and total parenteral nutrition, was administered. The pa-tient’s physical improved, and his BT dropped below 37 °C. On postoper-ative day (POD) 15, follow-up contrast-enhanced esophagography showedno leakage of contrast media. However, CT revealed an abscess near to theleft side of the lower esophagus. After confirming that the abscess had re-duced in size, oral intake was started on POD 22. The patient wasdischarged from hospital on POD 39. Conclusion: We experienced a caseof spontaneous esophageal rupture (Boerhaave syndrome) that was suc-cessfully treated with conservative treatment.

# P-0542 Long-term outcome of acute corrosiveingestion (ACI): A prospective single-center studyAuthors: SUDIPTA DHAR CHOWDHURY;C BHARATH KUMAR; SREEKAR DEVARAKONDA;SOUMYA KANTI GHATAK; REUBEN T KURIEN;DEEPU DAVID; AJ JOSEPHAffiliation: Department of Gastroenterology, Christian MedicalCollege, Vellore, India

Introduction: Acute corrosive ingestion (ACI) is a serious medical prob-lem in South Asia and accounts for a number of hospital admissions.ACI causes significant mortality and morbidity. This study was aimed atassessing the long-term outcomes of high grade (Zargar’s grade ≥ 2A)

Figure 1 Illustration of results of one participant from each group (antacid vs. Gaviscon Advance) during days 1 and 2 of concomitant Bravo capsuleplaced at cardia and pH-impedance probe placed at 5 cm above lower esophageal sphincter (LES).





ACI. Materials and Methods: The present study was conducted in theDepartment of Gastroenterology at Christian Medical College, Vellore,between January 2008 and December 2014. All patients with ACI weremanaged as per protocol that included gastroscopy (within 24 hours ofingestion), feeding tube placement, and high-dose PPI. We included allpatients ≥15 years with high-grade ACI. Patients in whom gastroscopycould not be done (delay in presentation) or was done at another hospitalwere excluded. Results: During the study period, 112 patients presentedwith ACI; of them, 82 were included. Mean age was 36.5 ± 15.5 years,and 53% were females. In 70%, the intent of ingestion was suicidal.Among the 82 patients, 11 were lost to follow-up. The median follow-up period was 31 months (range 2–72 m) during which 12 (16.9%) pa-tients expired (73% related to ACI). Among those alive 16 (27%) weresymptomatic, with dysphagia, regurgitation, chest pain, or weight loss.Barium swallow was done in 43 (73%) patients, and strictures were notedin 21 (36%). The site of stricture was esophageal in 11 (53%), stomachin 8 (38%), or both in 2 (9%). Esophageal stricture rate was 100% in pa-tients with Grade IIIB, 27% (6/22) in Grade IIIA injury, 19% (5/27) inGrade IIB injury, and nil in patients with Grade IIA injury. Stricture instomach developed in 25% (2/8) with Grade IIIB injury, 25% (6/24)Grade IIIA injury, 10%(1/10) with IIB injury, and 20% (1/5) with IIAinjury. Conclusions: Acute corrosive ingestion is associated withsignificant morbidity and mortality. High-grade injury is associated withpoor outcomes.

# P-0566 Prediction of concurrentchemo-radiotherapy response in esophagealcancer using primary 3D cell cultureAuthors: SU YOUN NAM; SEUNG JIN LEE;SEONG WOO JEON; YONG HWAN KWON;HYUN SUK LEE; JIN SUNAffiliation: Gastroenterology, Kyungpook National University MedicalCenter, Daegu, South Korea

Background: Even if concurrent chemo-radiotherapy (CCRT) is one oftreatment modality for localized advanced or advanced esophageal cancer,prediction factors of CCRT response have been limited. Primary three-dimensional (3D) cultured cells have evident advantages in providing morephysiologically relevant and predictive data for in vivo tests. Method: Pri-mary 3D cell culture (spheroid) was performed using tumor tissuesacquired from esophageal cancer before 1st CCRT. After 7 days cultured,same-sized spheroids were collected and were treated with 5-FU, and 5-Gyradiotherapy was provided. After 6 days, primary cultured cells werestained, and fluorescent images were captured. Clinical response wasassessed before 5th cycle CCRT. Clinical response was classified as com-plete remission (CR), partial remission (PR), and disease progression (PD).

Results: A total of 17 esophageal cancer patients were enrolled. Finalsuccess rate of primary 3D cell culture was 76% (13/17). A total of10 persons were followed up more than 4 cycles of CCRT and were an-alyzed. Clinical CR was observed in 6 persons, and two persons showedclinical PR (n = 3) or PD (n = 1). Live activity was noted in less than20% of primary 3D cultured cells in patients with all patients with clin-ical CR. Conclusions: Primary 3D cell culture from esophageal cancerwas successfully set up for the first time. It takes 2 weeks to evaluateCCRT response in primary 3D culture from tissue acquirement. A highagreement between clinical response and response in primary 3Dcultured cell was observed. The evaluation of CCRT response in primary3D cultured cell will provide a good predictor of clinical CCRTresponse. Grant: This work was supported by Kyungpook NationalUniversity Hospital.

# P-0575 Normative values for 24-hour ambulatorymultichannel intraluminal impedance and pHmonitoring (ZepHr®) in healthy Malay cohortAuthors: MOHD RIDZUAN MOHD SAID[1];WONG ZHIQIN[1]; RAFIZ ABDUL RANI[2];RAJA AFFENDI RAJA ALI[1]; CHAI SOON NGIU[1];YEONG YEH LEE[3]Affiliation: [1]Unit Gastroenterology, Department of Medicine, TheNational University of Malaysia, and [2]Unit Gastroenterology,Department of Medicine, Universiti Teknologi MARA, Kuala Lumpur,[3]School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu,Malaysia

Background: A 24-hour ambulatory multichannel intraluminal imped-ance and pH (MII-pH) monitoring is increasingly available in Asia, butnormative data for Asians are lacking. We aimed to determine normativemetrics for MII-pH monitoring in healthy Malay cohort. Method: Thiswas a cross-sectional study of 50 healthy Malay adults using the ZepHr®system (Diversatek, Highlands Ranch, USA). Normative metrics (95 per-centile) and Johnson–DeMeester composition score were determined.Gastroesophageal refluxes were categorized into acidic, weakly acidic,and weakly alkaline. Result: Normative Johnson–DeMeester score was30 (median 3.9, interquartile range 1–6.7), and the upper threshold of fre-quency values for acidic, weakly acidic, weakly alkaline, and totalrefluxes were 60, 43, 18, and 86, respectively. Comparison of refluxtypes and their frequencies in different population is shown in Table 1.In healthy Malays, refluxes were predominantly weakly acidic(n = 1517) but also higher occurrence of weakly alkaline refluxes(n = 203). Conclusion: We establish normative values for 24-hour ambu-latory MII-pH monitoring with the ZepHr system in the Malaypopulation.

Table 1 Comparison of reflux types and their frequencies across different populations

— Malay Chinese Belgian–French American

Total reflux, n Median (IQR) 45.5 (35–70) 40 (31–53) 44 (25–58) 30 (16–45)95th percentiles 86 75 75 73

Acidic reflux, n Median (IQR) 17 (8–31) 22 (7–36) 22 (10–35) 18 (7–31)95th percentiles 60.0 54 50 55

Weakly acidic reflux, n Median (IQR) 20 (13–32) 16 (10–24) 11 (5–18) 9 (6–15)95th percentiles 43 40 33 26

Weakly alkaline reflux, n Median (IQR) 2 (0–4) 0 (0–1) 3 (1–7) 0 (0–0)95th percentiles 18 4 15 1

IQR, interquartile range.





# P-0597 The prognostic significance ofpreoperative neutrophil-to-lymphocyte ratio afterneoadjuvant chemotherapy for esophagealsquamous cell carcinomaAuthors: MOYURU YAMADA; KOJI TANAKA;TOMOKI MAKINO; MAKOTO YAMASAKI;YASUHIRO MIYAZAKI; TSUYOSHI TAKAHASI;YUKINORI KUROKAWA; KIYOKAZU NAKAJIMA;MASAKI MORI; YUICHIRO DOKIAffiliation: Department of Gastroenterological surgery, OsakaUniversity Graduate School of Medicine, Japan

Background/Aims: Recently, neutrophil-to-lymphocyte ratio (NLR) hasbeen reported as a good predictive marker of prognosis in various can-cers. However, it remains unclear the significance of NLR of patientswith esophageal squamous cell carcinoma (ESCC) who receive neoadju-vant chemotherapy (NAC). The aim of this study is comparing NLRbefore and after NAC to investigate their clinical values as predictorsof safety and response to chemotherapy and survival. Methods: FromJanuary 2010 to April 2012, 135 patients with ESCC who receivedNAC of fluorouracil, adriamycin, and cisplatin (ACF) or docetaxel, cis-platin, and 5-fluorouracil (DCF) followed by surgical resection in ourhospital were retrospectively investigated. We analyzed the associationbetween NLR of both pre- and post-NAC and side effects, response tochemotherapy, and overall survival (OS). Results: One hundred seven-teen patients were male, and 18 patients were female. The median agewas 67 (range 35–83). Seventy and 65 patients received ACF andDCF, respectively. The median NLR of pre-NAC was 2.7(range 0.9–12.7) and that of post-NAC was 2.1 (range 0.5–11.4). NLR of bothpre- and post-NAC was not associated with side effects and response.OS of patients with higher NLR of post-NAC (>3.0, n = 31) was signif-icantly poorer than that of patients with lower NLR (<3.0, n = 104)(P = 0.01). Conclusion: NLR after chemotherapy may have a betterprognostic value for patients with ESCC undergoing NAC.

# P-0602 Sengstaken-Blakemore tube malpositionwith esophageal ruptureAuthors: YOEN YOUNG CHUAH[1,2]; PING I HSU[1];WEN CHI CHEN[1]; HUAY MIN HUANG[1];WEI-CHIH SUN[1]; SUNG SHUO KAO[1]Affiliation: [1]Department of Gastroenterology and Hepatology,Kaohsiung Veterans General Hospital, Kaohsiung, [2]Department ofGastroenterology and Hepatology, Ping Tung Christian Hospital, PingTung, Taiwan

Introduction: Acute variceal bleeding is a life-threatening complicationamong cirrhotic patient. Endoscopic band ligation and vasoactive medica-tions are the mainstay treatment for active variceal bleeding. However,Sengstaken–Blakemore (SB) tube indwelling serves as an effective tempo-rizing measure used in hemostasis of variceal bleeding when primary ther-apies fail. Yet, it has some complications with esophageal rupture as themost lethal one. Case Description: A 60-year-old man with hepatitis C cir-rhosis was scheduled for elective ligation of esophageal varices after his re-cent acute variceal bleeding. Four esophageal varices of one form 2 andthree form 1 with red whale sign were found endoscopically. Whenperforming variceal ligation, one active oozing bleeding was seen fromone of the ligated varices during the procedure. Further attempted ligationsfailed to achieve hemostasis. SB tube was subsequently applied. Patienthad a prominent acute sharp pain when the gastric balloon of SB tubewas being inflated. Chest roentgenogram reconfirmation was made afterthe procedure, and an ovoid shape balloon was seen above diaphragm

(Fig. 1). Malposition of gastric balloon at esophagus was highly suspected.Therefore, immediate deflation with readjustment of SB tube position wasperformed. Patient was seen to have a drastic relief of pain. Anotherepisode of persistent epigastric pain accompanied with subcutaneousemphysema occurred in the next day. Computed tomography of chestfurther uncovered esophageal rupture with pneumo-mediastinum. Familyopted for conservative treatment when surgical intervention was suggested.Patient expired 1 week later after an episode of massive hematemesis inintensive care unit.

# P-0665 Validation of the Korean version of theGerdQ questionnaire for diagnosis ofgastro-esophageal reflux disease (GerdQ in KoreanGERD)Authors: KEE WOOK JUNG[1]; YANG WON MIN[2];KYOUNG SUP HONG[3]; HEE JUNG SON[2];DOYEON KIM[1]; JUNGBOK LEE[4]; OH-YOUNG LEE[5]Affiliations: [1]Department of Gastroenterology, Asan MedicalCenter, [2]Department of Gastroenterology, SamsungMedical Center,Sungkyunkwan University School of Medicine, and [5]Department ofGastroenterology, Hanyang University School of Medicine; and [3]Department of Internal Medicine, Seoul National University College ofMedicine, and [4]Department of Clinical Epidemiology and Biostatistics,Asan Medical Center, Seoul, South Korea

Background: The incidence of gastro-esophageal reflux disease (GERD) israpidly increasing in Asian countries including Korea. However, no singleideal test is available to confirm the diagnosis. GerdQ has been used in thediagnosis of GERD in Western countries. However, its Korean version has

Figure 1 CXR of chest showed malposition of SB tube(arrow) abovediaphragm.





not yet been validated. Moreover, its ideal cut-off value in determiningGERD in the Korean population has not been clearly defined. Therefore,we aimed to assess the diagnostic accuracy of the Korean version of GerdQand to its reproducibility and concurrent validity. Methods: After repeatedtranslations and backward translations, the Korean version of GerdQ wasprepared. Patients with symptoms suggestive of GERD were asked to an-swer to the GerdQ at their first visit. A second GerdQ questionnaire wasthen administered to the patients when they visited for their subsequent ap-pointment for upper endoscopy, which was at least 2 weeks after the firstvisit. The final questionnaire was provided after proton pump inhibitor(PPI) treatment. Reflux esophagitis or pathological acid exposure was usedas diagnostic references for GERD. The diagnostic accuracy of the GerdQfor GERD with regard to symptom response to PPI therapy was assessed.Results: A total of 149 patients (52 male and 97 female) with a mean ageof 52.6 ± 14.6 years were enrolled. A GerdQ cutoff of 7 was found to thebest balance with regard to sensitivity (64.6% [95% CI: 55.0–73.2]) andspecificity (69.4% [95% CI: 51.7–83.1]). The intraclass correlation coeffi-cient of two subsequently measured GerdQ scores was 0.65 (95% CI0.52–0.75). Moreover, GerdQ had a high-positive predictive value (86.9%[95% CI: 77.4–93.0]), but a low negative predictive value (38.5% [95%CI: 26.9–51.4]) for GERD. Conclusions: The Korean version of GerdQ isa useful complementary tool for the diagnosis of GERD in primary careof Korea. Moreover, the relatively lower cutoff represents milder GERDsymptoms in Korean patients than those in patients in Western countries.

# P-0674 A phase 4, open-label study in patientsfrom Asia with gastroesophageal reflux disease(GERD) treated with dexlansoprazoleAuthors: JUSTIN CHE-YUENWU[1]; BOR-SHYANG SHEU[2];MING- SHIANG WU[3]; YONG-CHAN LEE[4];MYUNG-GYU CHOI[5]Affiliations: [1]Department of Medicine and Therapeutics, Prince ofWales Hospital, Hong Kong, China; [2]Department of Internal Medicine,National Cheng Kung University Hospital, Tainan City and [3]Department ofInternal Medicine, National Taiwan University Hospital, Taipei City, Taiwan;and [4]Division of Gastroenterology, Department of Internal Medicine,Yonsei University Severance Hospital, Sinchon-dong and [5]Department ofInternal Medicine, The Catholic University of Korea, Seoul, South Korea

Background: This phase 4 study, sponsored by Takeda, evaluated theefficacy and safety of dexlansoprazole MR (modified release), a dual

delayed-release formulation, in Asian subjects with non-erosive reflux dis-ease (NERD) and erosive esophagitis (EE). Methods: Subjects aged≥20 years with persistent typical GERD symptoms for at least 6 monthsunderwent endoscopy. Based on endoscopic findings, they were randomlyassigned to either dexlansoprazole MR 30 mg once daily (QD) for 4 weeks(NERD group) or dexlansoprazole MR 60 mg QD for 8 weeks (EE group).The primary endpoint was the percentage of days that subjects did not ex-perience any 24-hour heartburn or acid regurgitation. Results: Four hun-dred forty-five subjects were screened from Hong Kong, South Korea,and Taiwan, of whom 208 were enrolled in the NERD group (meanage: 53.6 years, male: 34.6%) and 88 in the EE group (mean age:51.7 years, male: 55.7%). Over the treatment period, the median percent-age of days that subjects did not experience any 24-hour heartburn oracid regurgitation was 26.92% and 65.45% in the NERD and EE groups,respectively. The median percentage of days that subjects did not experi-ence any nighttime heartburn or acid regurgitation in the NERD and EEgroups was 59.26% and 83.33%, respectively (Table ). The treatment waswell tolerated with low incidence of adverse events (AEs) related tostudy drug in NERD and EE groups—6.7% and 5.7%, respectively.Conclusions: In Asian patients with GERD, treatment withdexlansoprazole MR indicated a favorable efficacy and safety profile inrelieving heartburn and acid regurgitation symptoms.

# P-0703 Spectrum of esophageal motilitydisorders using high-resolution manometry at atertiary referral centerAuthors: VINOD GUPTA; RAJIV BAIJAL; RAKESH TANDONAffiliation: Pushpawati Singhania Research Institute (PSRI) andHospital, New Delhi, India

Background: Esophageal motility disorders are attributable to neuromus-cular dysfunction of the esophagus, presenting as dysphagia, chest pain,or heartburn. We aimed to study the clinical and manometric profile ofesophageal motility disorders and to identify the various etiologies of mo-tor dysphagia at our center. Methods: This study was a prospective cross-sectional study done at PSRI Hospital. Adult patients with motor dysphagiareferred to the GI Motility Laboratory from 2015 to 2017 were analyzed.All patients were evaluated for symptoms such as dysphagia, regurgitation,chest pain, heartburn, bolus obstruction, globus sensation, respiratorysymptoms, and weight loss. Eckardt scoring was done for achalasia.High-resolution manometry was done in supine position using 16-channel

Table 1

Data category Parameter NERD EEClinical endpoints N 207 (4 weeks) 87 (8 weeks)

Percent (%) of days without heartburn and/or acid regurgitation — —

% days without 24-hour heartburn or acid regurgitation—median (range) 26.92 (0.0–100.0) 65.45 (0.0–100.0)% days without 24-hour heartburn—median (range) 53.85 (0.0–100.0) 81.97 (0.0–100.0)% days without 24-hour acid regurgitation—median (range) 75.00 (0.0–100.0) 88.46 (0.0–100.0)% days without nighttime heartburn or acid regurgitation—median (range) 59.26 (0.0–100.0) 83.33 (0.0–100.0)% days without nighttime heartburn—median (range) 73.08 (0.0–100.0) 92.73 (0.0–100.0)% days without nighttime acid regurgitation—median (range) 88.00 (0.0–100.0) 92.59 (0.0–100.0)

Adverse events N 208 88Number of subjects (%)—treatment emergent adverse events (TEAEs) 35 (16.8) 31 (35.2)

Related 14 (6.7) 5 (5.7)Leading to study drug discontinuation 6 (2.9) 3 (3.4)

Number of subjects (%)—serious TEAEs 0 (0) 2 (2.3)Related 0 (0) 1 (1.1)Leading to study drug discontinuation 0 (0) 1 (1.1)





water perfusion system (model: KANGAROOJEF). Basal LES pressurewas recorded for 1 minute. Esophageal peristalsis was recorded for tenswallows of 5 ml water each. Analysis was done using Chicago classifica-tion version 3. Results: One hundred seventeen patients formed the studygroup (mean age 43.7 years, 34% females). The main symptoms at presen-tation were dysphagia (44, 37.6%), regurgitation (31, 26.4%), weight loss(8, 6.8%), chest pain (15, 12.8%), vomiting (7, 5.9%), and retrosternalburning (10, 8.5%). The manometric profile showed the following abnor-malities: achalasia cardia (24 cases [Type I—2, Type II—7, and Type III—15], 20.5%) with mean Eckardt score of 4.79 (range 1–6), ineffectiveesophageal motility (23, 19.6%), distal esophageal spasm (3, 2.5%), hyper-tensive peristalsis (2, 1.7%), and esophago-gastric junction outflowobstruction (3, 2.5%). Conclusion: In this study, achalasia cardia was themost common cause of motor dysphagia followed closely by ineffectiveesophageal motility. Type III was the most common type of achalasia.

# P-0721 Wireless electrical stimulation formanaging gastroesophageal reflux disease in therabbit modelAuthors: MIN WANG; LILI ZHAO; ZHINING FAN

Background and Aim: Electrical stimulation of lower esophageal sphinc-ter (LES) has been approved to increase LES pressure (LESP) and com-mercially treat gastroesophageal reflux disease (GERD). Endostim™-likeactive appliance was efficient but needs reoperation for replacing thebattery part. Therefore, one novel passive LES stimulation system wasinvented and evaluated here in rabbits. Methods: Different fromEndostim™, wireless power technology was firstly applied in the im-planted part. The LES stimulation could be easily self-controlled andpowered by external system. No need for reoperation or implantationreplacement. In order to evaluate its efficacy and safety, GERD rabbitmodel was created by balloon dilation and applied to optimize stimulat-ing parameters. Body weight, food intake, and LESP were recorded inthe experimental course. Results: A total of 12 rabbits (male, 3–4 kg)were successfully applied for equipment implantation. LES stimulationwas delivered at 20 Hz, 215 μs, and 3–8 mA in multiple 30-minute ses-sions. The muscle contraction phenomenon was obviously observed dur-ing the surgery in the stimulation group (6 rabbits). The mean LESP wasincreased significantly in stimulation group than sham group (stimulationgroup: 9.25 ± 1.24 mmHg vs 13.99 ± 1.28 mmHg, P < 0.05; sham con-trol group: 9.00 ± 1.22 mmHg vs 9.23 ± 1.27 mmHg, P = 0.267). Afteroperation, the body weight initially decreased but recovered after 1 week.No serious implantation or stimulation-related adverse effects werereported in the 2-month follow-up. Conclusion: Electric stimulation rep-resents the perspective approach for treating GERD in clinics. This

novel wireless LES stimulation system was also safe and effective fortreating GERD rabbits. After implantation, its passive medical strategywill benefit patients and keep the long-term efficacy for clinical GERDmanagement.

# P-0809 The association betweengastroesophageal reflux disease and insulinsensitivityAuthors: LARAS BUDIYANI[1]; DYAH PURNAMASARI[2];MARCELLUS SIMADIBRATA[3]; MURDANI ABDULLAH[3];SUHARKO SOEBARDI[2]Affiliation: [1]Department of Internal Medicine Faculty of MedicineUniversitas Indonesia, [2]Endocrine Metabolic Division Department ofInternal Medicine Faculty of Medicine Universitas Indonesia, and [3]Gastroenterology Division Department of Internal Medicine Faculty ofMedicine Universitas Indonesia

Background: Reduced insulin sensitivity or insulin resistance may mani-fest as metabolic syndrome that carries a high risk for cardiovascularevents. Although controversial, insulin resistance had been reported tohave a significant relationship to the severity of gastroesophageal refluxdisease (GERD). Differences in subjects’ characteristics and measurementused in previous studies encourage the need to assign the study inIndonesia to set a better prevention towards metabolic syndrome and man-agement of GERD. Aim: To learn the association between the severity ofgastroesophageal reflux disease and insulin sensitivity. Methods: We con-ducted a cross-sectional study of 84 adult patients with GERD symptoms.The subjects were recruited consecutively between January 2017 and April2017 at Cipto Mangunkusumo National Hospital in Jakarta. GERDQ ques-tionnaire was used for subject recruitment. Homeostatic model assessmentinsulin resistance (HOMA-IR) index was used to evaluate insulin sensitiv-ity. Esophageal erosions were diagnosed using upper gastrointestinal en-doscopy. Results: The median of HOMA-IR in all subjects was 1.46(0.32–13.85). Through endoscopic examination, we found that 48(57.1%) people did not have esophageal erosion and the other 36(42.9%) people had erosive esophagitis. Using Mann–Whitney test, wefound that the erosive esophagitis was associated with lower insulin sensi-tivity (P = 0.015). HOMA-IR index was higher in esophagitis patients thanin non-erosive patients, with the median of 1.74 (0.35–13.85) and 1.21(0.32–10.78), respectively. Conclusion: The severity of GERD, based onesophageal erosion, is negatively associated with insulin sensitivity. Key-words GERD severity, insulin sensitivity, HOMA-IR.

Figure 1 Changes of mean LESP after operation. There was significant improvement of LESP in stimulation group.





# P-0815 Efficacy of chemotherapy for head andneck cancer on synchronous superficialesophageal cancerAuthors: YOSHIKI TSUJII; YOSHITO HAYASHI;RYOTARO UEMA; TAKANORI INOUE; KEIICHI KIMURA;AKIHIKO SAKATANI; SHUNSUKE YOSHII; KENGO NAGAI;HIDEKI IIJIMA; TETSUO TAKEHARAAffiliation: Department of Gastroenterology and Hepatology, OsakaUniversity Graduate School of Medicine, Suita, Japan

Background: Esophageal cancer (EC) and head and neck (H&N) cancerfrequently coexist simultaneously. When chemoradiotherapy (CRT) forH&N cancer is preceded, post-chemotherapy outcomes for synchronousEC remain unknown. Methods: A total of 18 patients with synchronoussuperficial EC lesions received CRT for advanced H&N cancer fromJune 2009 to June 2016 in Osaka University Hospital, and the clinicalcourse of them was retrospectively investigated. The endpoints were ef-ficacy of the chemotherapy against synchronous EC and outcomes of thesubsequent treatment. Results: We found 20 synchronous superficial EClesions in 18 patients (16 male; median age, 67.5 [range 56–79] years).Details of H&N cancer were as follows: oral 1/oropharyngeal4/hypopharyngeal 9/larynx 4 cases and stage II 2/III 7/IV 9 cases. Re-garding CRT, radiation therapy of 66 to 70 Gy was performed onlyfor H&N region concurrently with chemotherapy (docetaxel alone, 1;docetaxel plus cisplatin, 17 (5 cases additionally received TPF [combina-tion of docetaxel, cisplatin, and 5-FU] therapy). The initial average tu-mor size of EC was 30 (range 10–80) mm, and the initial invasiondepth was EP-LPM 13/MM-SM1 3/SM2 or deeper 4. On endoscopic ex-amination conducted after median 4 (range 0–7) months after CRT, 4EC lesions disappeared (originally EP-LPM: 3; SM2: 1), and 5 lesionshad shrunk (originally EP-LPM: 3; MM-SM1: 1; SM2: 1; and invasiondepth of all lesions became EP-LPM). The other 11 lesions were stablewith no progression. Endoscopic submucosal dissection for 11 lesions,CRT for 3 lesions, and surgery for 2 lesions were performed. Conclu-sion: Subsequent treatment against superficial EC after CRT for H&Ncancer is considered a reasonable management. Chemotherapy forH&N cancer was effective for 45% of synchronous superficial EC.

# P-0822 Life-threatening acute dysphagia as anearly manifestation of dermatomyositisAuthors: YEO HYUNG KIM; KYOUNG MIN KWON;JUNG SOO LEEAffiliation: Department of Rehabilitation Medicine, College ofMedicine, The Catholic University of Korea, Seoul, Republic of Korea

Introduction: Dysphagia is a known complication of dermatomyositisduring the course of the disease, usually attributed to muscular involve-ment. We report a case of a patient with dermatomyositis who developedlife-threatening sudden onset dysphagia as an early manifestation of dis-ease and showed a delayed response to intravenous immunoglobulins andrehabilitation therapy. Case report: At 1 month after diagnosing dermato-myositis and starting treatment, a 53-year-old male complained of asudden inability to swallow solid foods, liquids, and even saliva. A com-puted tomography scan of the larynx, an esophagogastroduodenoscopy,and brain magnetic resonance imaging was unremarkable. Avideofluoroscopic swallowing study revealed inadequate pharyngeal con-traction with aspiration. Decreased upper esophageal sphincter relaxationwas observed, but it was not a direct cause of dysphagia but a secondarychange due to decreased contraction of the pharynx. Treatment withmethylprednisolone failed, and therapy with IVIG was applied. At6 weeks after IVIG therapy, he could swallow saliva again. At 4 months

from the onset of dysphagia, he showed normal swallowing function.During the course of medical treatment for life-threatening dysphagia,he continued with rehabilitative dysphagia therapy. Conclusion: A der-matomyositis patient with acute onset life-threatening dysphagia recov-ered after 4 months with extensive medical and rehabilitation support,and dysphagia did not recur for subsequent 2 years. Intractable acute oro-pharyngeal dysphagia in myopathy can be reversible.

# P-0835 Construction of esophageal squamouscell carcinoma-specific transcriptional regulatorynetworks revealed co-activation of four genesAuthors: LI MIN; YU ZHAO; SHENGTAO ZHU;SHUILONG GUO; SHUTIAN ZHANGAffiliation: Department of Gastroenterology, Beijing FriendshipHospital, Capital Medical University, National Clinical Research Centerfor Digestive Disease, Beijing, 100050, P. R. China

Background: Many studies revealed genetic and molecular characteristicsof esophageal squamous cell carcinoma (ESCC). However, studies system-atically investigated transcriptional regulatory network of ESCC are ab-sent. Methods: Using paired ESCC and adjacent normal tissues (NC), weevaluated expression level of all genes by microarray assays. Then we in-tegrated motif data of transcription factors (TFs) in JASPAR databaseand constructed networks between TFs and their targets by Passing Attri-butes between Networks for Data Assimilation (PANDA) method.Hypergeometric distribution model was applied to analyze target profilesimilarity and find co-activation effects using both TF-targets networksdata and different expression data. Expression level of four co-targetedgenes was also validated by qPCR. Results: We identified 1116 up-regulated genes and 1301 down-regulated genes in ESCC compared withNC. Additionally, we identified 16 970 ESCC-specific edges and 9307NC-specific edges in TF-targets regulatory networks. Among all 131 TFsincluded in this study, 17 were found repressed and 5 were found activatedin ESCC. We revealed that 16 genes were co-targeted by 4 TFs (SPIB,MZF1, MAFG, and NFE2L1) in ESCC, among which ENO2, MPO,NDST1, and CDH9 were validated by qPCR in an independent ESCC co-hort. Conclusions: We constructed TF-targets regulatory networks in bothESCC and NC tissues and found SPIB, MZF1, MAFG, and NFE2L1 co-activated in ESCC. Our findings would give a distinctive insight into stud-ies of ESCC carcinogenesis mechanism.

# P-0939 Idiopathic esophagitis in animmunocompromised patient: A case reportAuthor: CARLA JANE CONCEPCION O MAGNOAffiliation:Medical Resident, Department of Medicine, St. Luke’sMedical Center—Global City

Background: There has been an increasing incidence of HIV-infected indi-viduals worldwide and locally. Along with its increasing number, there isalso an increasing incidence of HIV-related infections or illnesses such ascytomegalovirus (CMV) and varicella zoster virus (VZV). Objective: Thispaper aims to present a case of a 36-year-old Filipino male presenting witha chief complaint of difficulty of breathing. Discussion: This patient hasbeen treated as having atypical pneumonia and fungal infection, but stillhad worsening of symptoms. An upper endoscopy with biopsy was doneshowing esophageal lesions that is grossly similar with lesions of CMVesophagitis. However, biopsy results showed otherwise. The patient hasbeen diagnosed with idiopathic esophagitis, which is a diagnosis of exclu-sion and can mimic other esophageal infections. The etiology for idiopathicesophagitis is still uncertain, but it can be attributed to high viremia,





inflammatory cytokines, and altered GI immunopathophysiology. Treat-ment involves the use of prednisone and anti-retroviral therapy. Conclu-sion: Among patients with esophagitis not responding to therapy, anendoscopy with biopsy can be done to help in the diagnosis and propertreatment.

# P-0994 Effects of mosapride in patients withminor disorders of esophageal peristalsis usinghigh-resolution manometryAuthors: SUNG EUN KIM; MOO IN PARK; SEUN JA PARK;WON MOON; JAE HYUN KIM; KYOUNGWON JUNGAffiliation: Department of Internal Medicine, Kosin University Collegeof Medicine, Busan, South Korea

Background/Aims: Minor disorders of peristalsis are frequently observedesophageal motility, which may be shown dysphagia or reflux symptoms.Unfortunately, therapeutic options for minor peristaltic disorders are lim-ited, and the role of prokinetics has been controversial so far. This studyinvestigated the efficacy of mosapride in patients with minor peristaltic dis-orders. Methods: A total of 10 patients with esophageal symptoms, whowere diagnosed as minor disorders of peristalsis by gastroscopy andhigh-resolution manometry (HRM) using the Chicago Classification v3.0,were prospectively enrolled. Patients received mosapride 30 mg daily for2 weeks. Symptoms assessment including abbreviated version of the WorldHealth Organization quality of life scale (WHOQOL-BREF) and the HRMstudy was performed before treatment and after 2 weeks. Results: Com-plete response (≥80%), satisfactory response (≥50%), partial response(<50%), and refractory response rates were 20.0%, 60.0%, 10.0%, and10.0%, respectively. Overall response rate (complete + satisfactory) was80.0%, and overall score of WHOQOL-BREF was significantly increasedafter treatment (6.2 ± 1.1 to 6.9 ± 1.1, P = 0.025). In the HRM metrics,lower esophageal sphincter (LES) respiratory mean pressure was signifi-cantly increased after treatment (13.5 ± 8.4 mmHg to 17.0 ± 8.7 mmHg,P = 0.014). The values of LES length, LES residual pressure, effectiveswallows, and distal contractile integral were increased after treatment;however, there was no significant difference before and after treatment.Conclusions: Mosapride improved overall symptoms and increased LESrespiratory mean pressure with presenting a tendency to increase LES con-traction and esophageal motility in patients with minor peristaltic disorders.However, further large-scale studies are needed to identify the effect ofmosapride. Key words: Esophageal motility disorders; High-resolution ma-nometry; Mosapride; Esophageal sphincter, lower; Symptom assessment.

# P-0995 The role of early endoscopy in themanagement of post-esophagectomy patientsAuthors: MAN HIM MATRIX FUNG; IAN YU HONG WONG;TSZ TING LAW; KWAN KIT CHAN; CLAUDIA WONG;DANIEL KING HUNG TONG; FION SIU YIN CHAN;SIMON LAWAffiliation: Department of Surgery, Queen Mary Hospital, Universityof Hong Kong

Background: Major complications after esophagectomy include anasto-motic leak, ischemic conduit, conduit mal-rotation, and delayed gastricemptying. Accurate and timely detection of complications is challenging.Upper endoscopy is increasingly used to detect and manage complications.This study looks into the indications, timing, and accuracy of early post-operative upper endoscopy in the diagnosis of the above complications.Different endoscopic therapeutic procedures were also investigated.Method: Records of all patients who underwent esophagectomy between

January 2014 and December 2016 in a tertiary referral center werereviewed. Early post-operative upper endoscopy was defined as upper en-doscopy performed within the same admission. Results: A total of 114 pa-tients underwent esophagectomy. Forty-four patients (38.6%) had earlypost-operative upper endoscopy. The most common indications were atrialfibrillation (33.3%), sinus tachycardia (17.9%), and fever (17.9%). Fifteenout of these 44 patients (34.1%) had abnormal findings. Upper endoscopydetected 7 anastomotic leaks *(Sn: 70.0%, Sp: 100%, PPV: 100%, andNPV: 92.3%), 3 ischemic conduits *(Sn: 100%, Sp: 100%, PPV 100%,and NPV 100%), 2 conduit mal-rotation, and 3 delayed gastric emptying.Contrast study and computed tomography had inferior sensitivity and spec-ificity for anastomotic leaks. No complications from endoscopy were re-ported. The post-operative day of diagnosis of ischemic conduit was ondays 1, 2, and 5. The median post-operative day for diagnosis of anasto-motic leak was 9.5 (4–27). Feeding tube/decompression tube insertion(n = 20) and stenting (n = 3) were the most performed endoscopic thera-peutic procedures. There was no in-hospital mortality. The two patientswho had conduit malrotation required re-exploration, while the three withdelayed gastric emptying were treated conservatively. Conclusion: Earlypost-operative upper endoscopy is safe, sensitive, and specific in the diag-nosis of anastomotic leak and ischemic conduit. Appropriate timing andcareful case selection may reduce unnecessary endoscopies. *Sn = sensitiv-ity; Sp = specificity; PPV = positive predictive value; NPV = negativepredictive value.

# P-1049 The effect of esophageal acid exposureon NMDA receptor subunits expression and D-serine in prefrontal cortex and hippocampusAuthors: WEIFANG ZHANG; KUN WANG; XIN WANG;LIPING DUANAffiliation: Department of Gastroenterology, Peking University ThirdHospital, China

Background: The N-methyl-D-aspartate receptor (NMDAR) and D-serinemay mediate the neural plasticity, which may develop following nocicep-tive emotional experience in prefrontal cortex (PFC) and hippocampus.However, whether the neural plasticity participates in the mechanism ofesophageal visceral hypersensitivity is little known. Therefore, we aimedto investigate the neural molecular alterations after acid exposure.Methods: All rats were exposed to esophageal acid or saline at postnataldays 7–15 (P7), and most rats underwent acute exposure again at adult time(P60). All rats were randomly distributed to 5 groups, including P7S, P7H,P7H + P60H, P7H + P60S, P7S + P60H (H: 0.1 N HCL infusion; S: sa-line). The tissue harvest was conducted at P60. We examined the expres-sion of NMDAR subunits, c-fos, serine racemase (SR) and D-serine inPFC, dorsal (DH), and ventral hippocampus (VH). Results: In PFC, com-pared with adult saline treatment (AS: P7H + P60H and P7S + P60Hgroup) and without adult treatment(A�: P7S and P7H group), adult acidexposure (AH) increased the expression of NR1 (P = 0.052, P = 0.298),NR2B (P = 0.035, P = 0.045), and SR (P = 0.022, P = 0.017) significantly.In VH, compared with A�, AH caused increasing expression of NR2B(P = 0.012) and NR1 (P = 0.024) significantly. In PFC, the expression ofSR in the P7S + P60H group was obviously higher than that of othergroups (P = 0.008). In DH, there was statistical significance on the levelof c-fos between the P7S + P60H group and other groups (P = 0.008). InPFC, the LC–MS analysis results that D-serine decreased in AH(P = 0.000) and AS (P = 0.042) group, comparing with A� group.Conclusion: Those long-term and transitional molecular alterations inPFC and hippocampus may mediate the development of acid exposurerelated esophageal visceral hypersensitivity.





# P-1050 The psychological characteristics ofreflux hypersensitivity—A pilot study based onSCL-90 questionnaire and 24-h pH-impedancemonitoringAuthors: KUN WANG; ZHIJIE XU; YING GE; ZHIWEI XIA;KUNLUN WANG; LIPING DUANAffiliation: Department Of Gastroenterology, Peking University ThirdHospital

Aims: Reflux hypersensitivity (RHV) was lately defined by Rome IVworkshop. The aim of this study was to assess the psychological character-istics of RHV. Methods: Patients who underwent 24-h pH-impedancemonitoring were screened from January 1, 2011 to November 31, 2015.Patients with heartburn or chest pain ≥2 days/week for more than 6 monthswere enrolled. All subjects fulfilled the SCL-90 questionnaire, underwentgastroscopy, and underwent HRM test to exclude organic diseases of mainmotility disorders. The patients were diagnosed respectively as non-erosivereflux disease (NERD), functional heartburn (FH), and RHV according to

ROME IV criteria. Results: Two-hundred thirty-one patients were enrolledincluding NERD (48.25 ± 1.18 years, M:F = 55:52), 92 FH(48.30 ± 1.27 years, M:F = 9:83), and 32 RHV (48.41 ± 2.36 years, M:F = 4:28). Twenty-eight HVs (47.21 ± 2.27, M:F = 8:20) were enrolledas controls. NERD presented higher acid exposure time (pH > 4.2) thanthose of FH, RHV, and HV. The acid reflux and weakly acid reflux wereboth higher in NERD than that in FH, RHV, and HV (P< 0.001). The totalscores of SCL-90 of each group of patients were significantly higher thanHV (NERD:HV, 133.15 ± 3.68 vs. 108.61 ± 4.51, P = 0.004; FH:HV,133.15 ± 3.68 vs. 108.61 ± 4.51, P = 0.003; RHV:HV, 142.67 ± 8.91 vs.108.61 ± 4.51, P = 0.002). RHV patients presented higher compulsive factorscore than FH (1.85 ± 0.16 vs. 1.58 ± 0.06, P = 0.047) and HV (1.85 ± 0.16vs. 1.37 ± 0.09, P = 0.004). The patients of NERD, FH, and RHV presentedsignificantly higher depression, anxiety, and hostile factor scores than thoseof HV (P < 0.05). Conclusions: NERD, RHV, and FH patients showedhigher scores than HVs in total and most factors of SCL-90. Furtherly,RHV patients presented higher compulsive score than FH, NERD, andHVs. The role of senseless thought, impulse, and act of compulsive behaviorin the pathogenesis of RHV needs to be studied furtherly.





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