LIVER AND G-I TRACT s59

Causes of HOS

n=26(%)

Post-operative 16(61) Jejunstomy (5 150cm) 5(19) Long-tam (>hmonths post op) 4(16) Intemittent Obstruction l(4)

fluids and 3/4 long-&m patients had been dialysed. 5 (19%) were initially heated with parentera nutrition, on oral intake and Octreotide. 3/5 jejun- stomy patients were convelted to oral/enteral nutrition/fluid. 21 (81%) were treated with oral fluid restriction (0.5-l.OL/day) a glucose-electrolyte solu- tion (Na 9Ommol/I), Loperamide (+/- Codeine Phosphate) and Omeprazole. 12 (46%) were discharge home without pxenteral fluids. 402 were readmit- ted with dehydration due to non compliance with the fluid restriction. 1002 required oral magnesium oxide, one of these also needed regular parentera magnesium.

outcome

n=26(%)

Stoma Reversal Died Resolved 52weeks Continuing UnkIKWn Other

WV 6(23)* 5(19) 5(19) 74) l(4)

* 2 died within 30 days

Conclusions: Hypotonic fluid restriction, administration of a glucose- electrolyte solution with anti-diarrhoeal drugs prevents dehydration occur- ring and the need for parentera fluids in pt with a HOS.

219-P. A RESEARCH CONCERNING THE IMPORTANCE OF BCAA’S IN PATIENTS WITH LIVER CIRRHOSIS

B. Demtiel’, S. Mercanligilz, S. Disibeyaz3, F. Nisanci4, F. Celik’ ‘Nutrition and Dietetic, Marmara University Hospital, Istanbul, 2Nutrition and Dietetic, Hacettepe Uni., 3 Gastroenterology, 4Nutrition and Dietetic, Yuksek Ihtisas Hospital, Ankara, ‘Pediatry, Dicle Uni., Diyarbakir, Turkey

Rationale: The study was conducted to observe the effect in treatment of increase BCAA in the diets of patients with liver cirrhosis. Method: The study was taxied out among 13 patients classified as having liver cirrhosis of viral etiology, between the ages of 35-71 at the Y ksek fitisas Hospital Gastroenterology clinic between the yexs of 2000-2001. At the beginning, after 15 days treatment a diet designed for chronic liver disease (treatment I) and followed by a treatment an addition of enteral products riched of BCAAs for 1 month (treatment II);a total of 3 periods values obtained from patients for anthropometric measurements (weight, BMI, TST, MAMC) and urea, creatinine, AST, ALT, ALP, protein, albumin, bilirubin, Na, K, prealbumin, CRP, ammoniac, Hb, PT, BCAA and AAA levels in the blood. Results: The biochemical parameters of prealbumin, total bilirubin and ammoniac levels between all 3 periods wele found to be statictically signif- icant (piO.OS).Decreasing of PT between Initial - treatment II period were statistically significant (piO.05). The mean values of BCAA I AAA ratios of patients at the periods are; At the Begining BCAA/AAA XfSD= 0.539f0.254, at Treatment I BCAA/AAA XfSD=0.587f0.292, at Treatment II BCAA/AAA XfSD=1.222*0.949.

Biochemical findings of patients at the periods (~13)

Biochemical Parameteres Periods X&SD

Amoniac (mgldl) Amoniac (mgldl) Amoniac (mgldl) PI (xc) PI (xc) PI (xc)

Begining 110.X6&50.03 Treatment I 90.67&32.X9 Treatment II 67.90&26.66

Begining 17.36&2.466 Treatment I 16.29&2.612 Treatment II 15.46&2.203

Conclusions: Adding of BCAAs to the diets of chronic liver disease patients can increase in blood BCAA/AAA ratio and decrease in blood ammoniac levels, thus result in improving the prognosis of the disesase.

220-P. NUTRITIONAL SUPPORT [NS] AND SURGICAL TREATMENT [ST] OF POSTOPERATORY GASTROINTESTINAL FISTULAE [POGF]

M.E. Ferreyra, M.C. Oca a, R. Cervantes Nutritional Support Unit of General Surgery Department, Rebagliati Hospital, Lima, Peru

Rationale: To evaluate the survival/mortality after [ST] of [POGF] follow- ing a protocol of management of [POGF] as the mortality has been reported as high as of 22% amongst such patients Method: A prospective 1Cyear study (1988-2002) is reported. Patients were tleated by the same surgical nutrition team when either on [NS] and at surgery, so that the decisions could be as uniform as possible. All of them were operated on for persistent [POGF] Results: 41 patients (septic and non septic) out of 532 with fistulae were included. Survival was of 90.2%(37/41). Fistulae origins were: 24/41 small bowel, 9/41 large bowel, 1141 gastric, 7/41 mixed. 7/41 foreign bodies associated with development of [POGF] Malnutrition rate was of 87.09% for patients operated on immediately after a period of [NS]: 31/41 75.6%(31/41) required [NS] either enteral or parentera until just before [ST]. 7/41 required only Total Enteral Nutrition (TEN) for 42 +/- 22.54 (X+/- 1SD) days, 21/41 required only Total Pxenteral Nutrition (TPN) for 47.61 +/- 47.95 days, 3/41 TEN+TPN (sequentially) for 49.33 +/- 24.78 days, 5/41 wele on either TEN or TPN that finished some time before [ST], 5/41 had no [NS] Death cause in 4/41 was multiple organic failure [MOF] Conclusions: 1) Adherence to a protocol in order to manage [POGF] is use- ful to lower mortality rates after [ST]. 2) Some high output (>500ml/24h) distal ileal [POGF] may be managed with Total Enteral Nutrition. 3) If Surgical Treatment has to be undertaken, it has to be done by a Highly Mo- tivated Surgical Team as [POGF] may be extremely challenging as [MOF] will be the main cause of death if treatment fails. 4) Nutritional repletion through Nutritional Support is a key element of interdisciplinary treatment of [POGF]

221-P. MEASUREMENT OF GASTRIC EMPTYING DURING CONTINUOUS NASOGASTRIC INFUSION OF ENTERAL FEED

C.T. Soulsby’, M.K. Khela’, E. Yazaki’, D.F. Evans’, .I. Powell-Tuck’ ‘Human Nutrition, ’ Gastroenterology, Bar& and the London School of Medicine, London, United Kingdom

Rationale: The gold standard for measuring gastric emptying (GE) is gamma scintigraphy (GS). However GS does not measure gastric secre- tions and exposes subjects to radiation. Electric impedance tomographic spectroscopy (EITS) is non-invasive, non-isotopic and measures emptying of both feed and gastric secretions. Our aim was to compare EITS with GS in volunteers. Method: GE was measured simultaneously by EITS and GS in 10 fasted, acid suppressed volunteers. Enteral feed was labelled with 99MTc-Tin col- loid and 5g NaCl to increase resistivity. An initial bolus of 1OOmls was given to identify the region of interest (ROI) representing the stomach, followed by continuous nasogastric infusion of lOOml/h for 4hrs. GE curves were obtained by plotting changes in resistivity (EITS) or no of counts (GS) in the ROI with time. Results: GE curves were obtained in 10 EITS but only 8 GS studies due to failure to identify the ROI. As GE half time could not be used as feed was administered as a continuous infusion, anza under the curve was com- pxed and showed agreement in gastric emptying patterns in all 8 subjects. However, the relationship between EIT and GS was not linear and there was no relationship between the maximum (p=O.27) and minimum (p=O.24) volumes measured by each method. Conclusions: As EITS and GS measure different components of gastric