agement is considered safe for the patient without significant complica-tions.

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APPENDICEAL ORIFICE POLYPFredrick A. Oni, M.D., Vlado Simko, M.D.* and Gerald Fruchter, M.D.Medicine, Gastroenterology Section (111c), VA NY Harbor HCS,Brooklyn, NY.

Purpose: The risks involved in performing colonoscopy in general is wellknown even greater is the risk of therapeutic interventions such as polypec-tomy especially in the cecum without adequate identification of the landmarks such as the appendiceal orifice and the ileo–cecal valve.Case: A 54 yo male with no significant family history of colorectal cancerwas refered by his Primary care physician for colonoscopy followingbarium enema ordered for evaluation of fecal occult blood positive thatrevealed a colon polyp.

Colonoscopy performed revealed multiple polyps which were removedexcept one polyp arising from the appendiceal orifice which was biopsied,all specimens revealed tubular adenoma. Surgical consult was obtained buta right hemicolectomy was advised which the patient refused hence a repeatcolonoscopy was done and the polyp was snared, histology again revealedadenomatous polyp.Conclusion: Barium enema should never be used as an investigative ordiagnostic tool in a patient with stool hemocult positive and certainly notin an average risk patient for colorectal cancer unless the patient refusedcolonoscopy.

The need for any surgical procedure more than a simple appendectomyin this case, with the known histology, is arguably questionable.

To reduce the risk of perforation in the cecum, the deflation/inflationtechnique must be used judiciously to dislodge an intussuscepted appendixthat mimicks a polyp.

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DOES INCREASED AWARENESS ABOUT COLON CANCERIMPLY BETTER COMPLIANCE FOR COLONOSCOPYSantosh Reddy, M.D., Jeffrey Nestler, M.D. and Shyam Varadarajulu,M.D.*. Medicine, Marshfield Clinic, Marshfield, WI; Medicine,Hartford Hospital, Hartford, CT and Gastroenterology, MedicalUniversity of South Carolina, Charleston, SC.

Purpose: The success of any screening program depends ultimately onpatients’ compliance. The aim of this study was to determine if compliancefor colonoscopy (CS) has improved with increased awareness about colo-rectal cancer (CRC)in recent years.Methods: This was a retrospective study of all patients scheduled for CSover 6–month (January–June) periods in 1996 and 2000. Only patientsscheduled for CRC screening and undergoing CS for the first time wereincluded. All patients scheduled for CS were reminded the day before bytelephone call. All patients who failed to keep up their appointment for CSwere considered noncompliant except for those who cancelled and resched-uled their procedures within 15 months or underwent the procedure as aninpatient in the ensuing 15 months.Results: A total of 1582 CS were performed in 1996. Thirty–four pa-tients(2.1%) were noncompliant at the end of 15 months and had not hadtheir procedures done even after 5 yrs when this study was undertaken. Twopatients who failed to keep up their appointment had their CS done laterwithin 1 yr as inpatients. Twenty–seven patients who had cancelled and 3who were initially considered noncompliant rescheduled and underwenttheir CS within 6 months. In 2000, 2240 CS were performed. Forty–ninepatients (2.1%) scheduled for CS were noncompliant and remained so after15 months. Thirty–three patients who had cancelled and 32 who wereinitially considered noncompliant rescheduled and underwent their CSwithin 1 yr.Conclusions: While the number of colonoscopic examinations has in-creased by 41% over a 4 yr period, the rate of noncompliance has remained

same. The results suggest that while awareness for CRC has improved,compliance with colonoscopy has not. The noncompliance rate is relativelylow, but, if the figures can be projected to the large population at risk forCRC, thousands of scheduled patients are failing to be screened by CSbecause of issues other than lack of awareness of CRC. It is possible tospeculate that better patient education, and possibly reassurance, aboutunique aspects of CS such as bowel preparation and preservation of dignitymay further improve compliance rates.

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FASTING BREATH HYDROGEN IS HIGHER IN PATIENTSWITH CHRONIC CONSTIPATION COMPARED TO CONTROLSAND CORRELATES WITH SEVERITY OF CONSTIPATIONNirmal S. Mann, FACG*, Joseph W. Leung, FACG and Donald Lum,M.D. Gastroenterology, VANCHCS, Univ. of California, Davis,Martinez, CA.

Purpose: We have previously reported that the mean fasting breath hy-drogen (FBH) in adult healthy males is 3.0 parts per million (ppm); range1–6 ppm. Breath hydrogen reflects the fermentative production of H2 bythe colonic bacteria.Aim: To determine if patients with chronic constipation compared tocontrols have higher FBH and if FBH correlated with the severity ofconstipation; prolonged colonic stasis may produce more hydrogen.Methods: The study was approved by IRB and informed consent wasobtained. Only male veteran patients were recruited. Patients with diabetesmellitus, other endocrine, neurologic disorders, or with h/o abd. Surgery orthose on medications which would affect bowel motility were excluded.Also patients with known malignancy were excluded. The severity ofconstipation was graded as follows.

Two or less BM/week: 2 pointsStraining more than 25% of time: 1 pointHard stools more than 25% of time: 1 pointFeeling of incomplete evacuation more than 25% of time: 1 pointTotal 5 pointsAfter an overnight fast FBH was measured using a EC60 gastrolyzer

(Bedfont Scientific; Medford NJ) which has a sealed electrochemicalsensor specific for H2. The results reported are mean � standard error ofthe mean (S.E.M.); t–test was used and a p value of � .05 was consideredsignificant.Results: There were 45 patients; the mean age was 58 years (range 29–78).Group A consisted of 14 patients whose constipation severity score 3.8 �0.2 (range 2–5) was significantly higher than those of Group B 2.4 � 0.1(range 1–5). The age of group A patients 60 years (range 32–78) was notsignificantly different from B patients 56 years (range 29–74). The meanFBH of group A patients 20 � 6 (range 3–32) ppm was significantly higherthan group B 13 � 8 (range 2–20) ppm. The mean FBH of these 45 patientswith chronic constipation (mean constipation severity score 3.1 � 0.2) was17 � 4 ppm was higher compared to normal healthy controls 3.0 � 0.5ppm.Conclusions: FBH in patients with chronic constipation is higher com-pared to controls and correlates with severity of constipation. This may bedue to colonic stasis and increased fermentative production of H2 inconstipated patients.

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IDIOPATHIC COLITIS FOLLOWING CARDIACTRANSPLANTATION: TWO PEDIATRIC CASESGhassan Wahbeh, M.D., Vera Hupertz, M.D.* and Maryanne Kichuk–Chrisant, M.D. Pediatric Gastroenterology & Nutrition and PediatricCardiology, The Cleveland Clinic Foundation, Cleveland, OH.

Purpose: Pediatric patients who receive a heart transplant may have avariety of gastrointestinal symptoms. Many are attributed to commonmedication side effects, common pediatric pathogens and opportunisticinfections secondary to immunosuppression. We describe two cases where

S106 Abstracts AJG – Vol. 97, No. 9, Suppl., 2002