AG

AA

bst

ract

sM1260

Effect of Cyclically Long-Term Treatment With Mesalamine in Patients WithSymptomatic Uncomplicated Diverticular Disease (SUDD): A 5 Years Follow-up StudyMargherita Curlo, Luigi Gatta, Paola Soriani, Andrea Iori, Alberto Pilotto, CarmeloScarpignato, Giulia M. Cavestro, Dino Vaira, Angelo Franzé, Francesco Di Mario

Background: In the last years, mesalamine has been proposed as long-term treatment inpatients with diverticular disease in prevention of complications such as diverticulitis. Themajority of studies were based on an intermittent schedule of treatment, namely ten daysevery month, usually at the dosage of 800 mg b.i.d. AIM: To evaluate and follow-up 5clinical variables (lower abdominal pain, tenesmus, diarrhea, meteorism, not well-being),in a cohort of patients with SUDD taking 800 mg of mesalamine b.i.d for 10 days everymonth for 5 years. Methods: 67 consecutive patients (42 M, mean age: 64 years, range 48-86) affected by SUDD, diagnosed by colonoscopy or Rx barium enema, and takingmesalamine800 mg b.i.d for 10 days every month were followed-up with a clinical assessment every12 months for a period of 5 years. Lower abdominal pain, tenesmus, diarrhoea, meteorism,not well-being, were scored on a 4 point scale (from 0 to 3). The Global Symptomatic Score(GSS) was the sum of all symptom scores. Results: 15 out of 67 patients dropped-out duringthe follow-up (9 for prior complications, 3 for recurrence of serious chronic disease, 3 foroccurrence of neoplasia), and 2 died for cardiovascular disease. At baseline the lowerabdominal pain had a median value of 1 (25th= 0; 75th = 2), tenesmus a median value of0 (25th= 0; 75th = 1), diarrhoea a median value of 0 (25th= 0; 75th = 2), meteorism amedian value of 2 (25th= 0; 75th = 2), not well-being a median value of 1 (25th= 0; 75th =2), and the GSS had a median value of 5 (25th= 3; 75th = 6). The GSS significantly decreasedafter 12 months, 24, 36, 48 and 60 months (p < 0.0001). After 60 months the GSS had amedian value of 0 (25th= 0; 75th = 2). All symptoms but meteorism, showed a similarsignificant decrease during the follow-up period. Conclusion: Long-term regimen of intermit-tent therapy with 800 mg of mesalamine b.i.d seems able to improve symptoms in patientsaffected by SUDD.

M1261

Recurrence of Diverticulitis in Patients With Symptomatic UncomplicatedDiverticular Disease (SUDD) Treated Cyclically With Mesalamine: Result of aFollow-up StudyMargherita Curlo, Luigi Gatta, Loredana Guida, Paola Soriani, Angelo Franzé, AlbertoPilotto, Marilisa Franceschi, Carmelo Scarpignato, Dino Vaira, Cinzia Papadia, FrancescoDi Mario

Background: In the last years, mesalamine has been proposed as long-term treatment inpatients with diverticular disease in prevention of complications such as diverticulitis. Themajority of studies were based on an intermittent schedule of treatment, namely ten daysevery month, usually at the dosage of 800 mg b.i.d. AIM: to compare the recurrence ofdiverticulitis occurring during a 5 year-followup in a population of patients affected byuncomplicated diverticular disease, taking either 800 mg of mesalamine b.i.d for 10 daysevery month or no mesalamine. Methods: 67 consecutive patients (42 M,mean age: 64 years,range 48-86) affected by SUDD, diagnosed by colonoscopy or Rx barium enema,werefollowed-up with a clinical assessment every 12 months for a period of 5 years. All patientin thisgroup were requested to assume mesalamine 800 mg b.i.d for 10 days every month.A control group of 82 subjects (39M, mean age 73 years, range 66-94) allocated in aninstitution for elderly with the same picture of SUDD, and taking no specific therapy wasalso followed-up in the same period. Results: In the mesalazine group, 15 out of 67 patientsdropped-out during the follow-up (9 for prior complications, 3 for recurrence of seriouschronic disease, 3 for occurrence of neoplasia), and 2 died for cardiovascular disease. Atthe end of the follow-up only 2 out of 50 patients (4%; 95% CI: 1.1% to 13.5%) experienceddiverticulitis (2 episodes in one subject and 1 in the other). In the control group, 7 patientsdied (4 for cardiovascular diseases, 2 for neoplasia lung and stomach and one for an accident),and 8 out of 75 patients (11%; 95% CI: 5.5% to 20%) experienced at least 1 episode ofacute diverticulitis (3 episodes in one subject, 2 episodes in 3 subjects, 1 episode in 4 patients).4 patients also underwent a successfully colonic resection for this reason. Conclusions: Long-term regimen of intermittent therapy with 800 mg of mesalamine b.i.d lead to a reductionof episodes of acute diverticulitis in a population of patients affected by diverticular disease.

M1262

Baseline Symptoms in Patients With Symptomatic Uncomplicated DiverticularDisease (SUDD)Luigi Gatta, M. Curlo, Paola Soriani, Andrea Iori, Loredana Guida, Dino Vaira, AlbertoPilotto, Carmelo Scarpignato, Giulia M. Cavestro, Cinzia Papadia, Angelo Franzé,Francesco Di Mario

Introduction: Colonic diverticular disease is a wide-ranging condition that runs the spectrumfrom asymptomatic to severe and complicated disease. By definition there are no symptomsin the asymptomatic or development stages. When symptoms develop, they maybe variedand numerous and depend on the extent of the pathology and visceral perceptions. Fewstudies evaluated symptoms in patients with symptomatic uncomplicated diverticular disease(SUDD). Aim: to assess the type and prevalence of symptoms in a cohort of patients affectedby SUDD. Methods: 384 consecutive patients (216 female, median age: 68 years; 25th: 63years; 75th: 75 years) affected by SUDD, diagnosed by colonoscopy or Rx barium enema,were assessed evaluating the following symptoms: pain/discomfort in the upper abdomen,pain/discomfort in the lower abdomen, bloating, feeling of incomplete evacuation, diarrhoea,abdominal tenderness, fever, not well being, nausea, vomiting, dysuria, and rectal bleeding.Each was scored on a 4 point scale (from 0 to 3). The Global Symptomatic Score (GSS)was the sum of all symptom scores (range 0-36). Results: The first more frequent symptomwas bloating (87.73%), reported as moderate by most of the patients (34.73%); the secondmore frequent symptom was pain/discomfort in the lower abdomen (80.68%), reported asmoderate by most of the patients (34.46%); the third was abdominal tenderness (65.27%),

S-366AGA Abstracts

reported as mild by most of the patients (37.60%); the fourth was feeling of incompleteevacuation (63.45%), reported as mild by most of the patients (32.11%). The most severesymptom reported by this cohort of patients was bloating (25.59%) followed by pain/discomfort in the lower abdomen (21.15%). Considering sex, more female than male com-plained of pain/discomfort in the upper abdomen (51% vs. 36%; p = 0.03), bloating (91%vs. 84%; p = 0.04) and not well being (45% vs. 33%; p = 0.02).%). The GSS had a medianvalue of 9 (25th: 6-75th: 11). Women had a slightly but significant higher GSS valuescompare to men (median value: 9 [25th: 6-75th: 12] vs. 8 [25th: 5-75th: 11]; p = 0.007).Conclusions: SUDD in this cohort of patients is mainly characterized by bloating, pain/discomfort in the lower abdomen, abdominal tenderness and feeling of incomplete evacu-ation, with an intensity ranging from mild to moderate. However these symptoms can overlapwith IBS. More detailed studies are demanded to better explore and differentiate patientswith SUDD from those complaining IBS.

M1263

Hepatic Al Amyloidosis - A 10-Year Experience at the United KingdomNational Amyloidosis Centre (NAC)Prayman Sattianayagam, Simon D. Gibbs, Ashutosh D. Wechalekar, Helen J. Lachmann,Janet A. Gilbertson, Hawkins N. Philip, Julian D. Gillmore

Background: AL amyloidosis is a disorder characterised by deposition of an abnormal proteinin a fibrillary conformation in tissues. The amyloidogenic precursor proteins are serum freelight chains secreted by abnormal plasma cells, which form amyloid in organs. The mainclinical manifestations include proteinuric renal failure, an amyloid cardiomyopathy andneuropathy. Treatment is with chemotherapy to eliminate the underlying plasma cell dyscra-sia. Aims and Methods: A hepatic presentation of AL amyloidosis is relatively unusual. Weaim to report the phenotype and outcome of the largest reported series of new patientsdiagnosed with AL amyloidosis on liver histology. Consecutive patients were evaluated atthe NAC between 2000 and 2009. In all cases amyloid was diagnosed unexpectedly by liverbiopsy. Serum amyloid P component (SAP) scintigraphy was used to quantify whole bodyamyloid load and organ involvement by amyloid was classified according to consensuscriteria (Gertz MA et al. Am J Hematol (79), 319-328, 2005). Results: 87 cases (56 male)were identified. Median (range) age at diagnosis was 60 (29-84) years and median (range)time from symptoms to diagnosis was 0.66 years (0-2.9). All cases presented with hepatomeg-aly and deranged liver function tests (see table). 59% cases had a normal bilirubin. 90%cases had a large total body amyloid load with both hepatic and splenic amyloid on SAPscintigraphy. 86% cases had evidence of extra-hepatic amyloid, as assessed by consensuscriteria (74% renal amyloid, 47% cardiac involvement, 20% autonomic neuropathy and 8%peripheral neuropathy). 51% cases had 2 or more extra-hepatic organs involved. 69% caseswere fit enough for chemotherapy. Median survival by Kaplan-Meier analysis from a biopsydiagnosis of amyloidwas 1.2 years. Liver transplantation (LTx) for liver failure was undertakenin 5 cases. 1- and 5-year survival from LTx was 40 and 20% respectively when performedin conjunction with chemotherapy in 4 cases. Conclusions: AL amyloidosis with a dominanthepatic presentation has a poor prognosis. The liver function tests are typically those ofcholestasis and often there is no hyperbilirubinaemia. There is commonly a large total bodyamyloid load with extra-hepatic organ involvement by the time of diagnosis and thereforeLTx, in view of donor shortages, probably does not have a role in this condition.

M1264

Proton Pump Inhibitor use is Associated With the Development of a BroadRange of Infections in CirrhosisJasmohan S. Bajaj, Manhal M. Tannous, Zoeb Bootwala, Arun J. Sanyal, Douglas M.Heuman

Cirrhotics are predisposed to a broad range of infections. Proton pump inhibitors (PPI)allow small intestinal bacterial overgrowth and affect immune function, and may increaseinfection risk in cirrhosis. Aim: to determine the relationship between PPI use and risk ofdevelopment of first infection in cirrhosis. Methods: We conducted a retrospective reviewof cirrhotics seen in our tertiary care center over 5 yrs. The outcome was development ofthe first infection that required an ER visit or hospitalization. Patients followed for < 1 year,those with incomplete medication history, HIV infection and organ transplant were excluded.The details of the first infectious episode, outpatient PPI use and its indication were recorded.Results: The study population included 373 cirrhotics whose age averaged 58±8yrs andMELD was 11±5 . 95% were men and the etiology of cirrhosis was 62% HCV and 20%alcoholic cirrhosis. 182 (49%) were treated with PPI during the study period. DM waspresent in 113 (29%) pts. 153 (41%) experienced an initial infection during the periodunder review. The majority of infections were skin/soft tissue (29%), urinary (24%) &respiratory (21%). Fewer than one quarter of initial infections were enteric (10%), SBP (6%)or bacteremia (6%). PPI use was significantly more common in patients who experiencedthe first infection than in those who did not (Table p=0.00001). In infected patients, meanduration of PPI use prior to infection was 25±23 months. In the 104 patients receiving PPIwho developed infection, a valid evidence-based indication for PPI at the time of infectioncould be identified in only 30%. Patients who developed their first infection also had higherprevalence of diabetes and mean MELD score than those without infections. On multivariateanalysis, the only 2 factors associated with development of the first infections were PPI use(OR: 2.97, CI:1.9-4.7) and MELD score (OR:1.07, CI:1.02-1.13). Patients who experiencedinfection had a higher likelihood of transplant/death on follow-up compared to those without