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Salivary prostaglandin E2 is less likely to contribute toesophagoprotection by saliva in humansTomasz Skoczylas, M.D., Cezary Poplawski, M.D., MarekMarcinkiewicz, M.D., Tomasz Zbroch, M.D., Richard W. McCallum,M.D. and Jerzy Sarosiek, M.D.*. 1GI Res. Lab., KUMC, Kansas City,KS.

Purpose: Salivary secretion exhibits its esophagoprotective properties bothin experimental animals and clinical scenario. An increase in the rate ofsalivary secretion during heartburn symptoms in patients with gastroesoph-ageal reflux disease (GERD), mediated by the esophago-salivary reflex, isalso a well established phenomenon. Salivary secretion stimulated bymastication exhibits a significantly enhanced protective potential (Gastro-enterology, 110:675-81, 1996). Little is known, however, regarding theinterrelationship between the rate of secretion of individual protectivefactors during stimulation by mastication and the esophago-salivary reflex.The aim of the study, therefore, was to explore the correlation between therate of secretion of salivary volume and bicarbonate (BIC), non-bicarbon-ate (NBIC), protein (P), glycoconjugate (GL), epidermal growth factor(EGF), transforming growth factor alpha (TGF alpha) and prostaglandin E2(PGE2) during stimulation by mastication or esophago-salivary reflex.Methods: The study was conducted in 33 asymptomatic volunteers (15Fand 18 M; mean age of 39). Salivary secretions were collected in basalconditions, during mastication, and stimulation by the esophago-salivaryreflex (evoked by intraesophageal HCI/pepsin, pH 2.1). Concentrations ofsalivary BIC and NBIC were measured by back-titration using TitraLab900 (Radiometer Am. Inc., OH), protein by Lowry, glycoconjugate byPAS, EGF, TGFa and PGE2 by radioimmunoassays (Amersham, ArlingtonHeights, IL). Spearman correlation coefficient was calculated using Sigma-Stat software (Jandel Sci. San Rafael, CA).Results: In saliva stimulated by mastication statistically significant corre-lation was found between salivary volume and BIC, NBIC, protein, gly-coconjugate, EGF, and TGFa output (P �0.01). In saliva stimulated byesophago-salivary reflex, statistically significant correlation was also foundbetween salivary volume and BIC, NBIC, protein, glycoconjugate, EGF,and TGFa output (P � 0.01). The rate of secretion of salivary PGE2 did notcorrelate with salivary volume both during stimulation by mastication andthe esophago-salivary reflex (P�0.10).Conclusions: 1) The parallel increase in the content of major salivarybuffers, protein, glycoconjugate, EGF, and TGF alpha, but not PGE2,during stimulation indicates that protective response within salivary glandsis synchronized and independent of PGE2 generation. 2) PGE2 generatedwithin salivary glands is less likely to play a significant role in salivaryesophagoprotection.

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Retrospective assessment of glucagon in esophageal food impactionsThomas C Sodeman MD1 and Todd H Baron MD1*. 1Gastroenterologyand Hepatology, Mayo Clinic, Rochester, MN, United States.

Purpose: Esophageal food impactions account for a significant number ofemergent endoscopies. Glucagon is considered an effective therapy todislodge impactions and obviate the need for endoscopy. However, themedical literature supporting its use consists mostly of case reports con-cerning its efficacy. AIM: To assess the efficacy of glucagon in the settingof acute food impactions.Methods: The records of all patients presenting to the emergency roomwith esophageal food impactions were reviewed from 1975 to 2000. Thesuccess of Glucagon was defined as relief of obstruction obviating the needfor endoscopy.Results: Over the 25 year period, 222 patients were seen for food impac-tion (average age 59.51 � 22.81, 62.16% male). Of these, 106 patientsreceived glucagon, which led to clinical resolution of the impaction in 10(10.4%). 116 patients did not receive glucagon. Of this group, 20 sponta-neously passed their bolus (20.8%). Although the glucagon and non-

glucagon groups differed significantly in age (53.2 � 23.3 vs. 65.2 � 20.8years), they had a similar Body Mass Indices (BMI) (27.5 � 4.70 vs. 27.6� 5.54) and sex ratio (62.2% male vs. 62.0% male). The duration ofimpaction prior to presentation was not different (7.15 � 8.57 vs. 11.11 �17.28 hours). Of those patients responding to Glucagon, there was nodifference in age, sex, BMI, duration of impaction, or occurrence of a priorfood impaction. Likewise, in those who spontaneously passed their foodbolus without Glucagon, there was no difference in age, sex, prior impac-tions or BMI, although there was a significantly lower duration in time ofimpaction (3.26 � 5.83 vs. 12.44 � 18.23 hours) in the patients who didnot receive glucagon but spontaneously passed their bolus. There was asignificant difference in the dose of glucagon used between responders andnon-responders (1.0 � 0 vs. 1.14 � 0.49 mg).Conclusions: 1. Glucagon may hinder the passage of an impacted foodbolus rather than promote passage. 2. In the patients who clinically re-sponded, a smaller dose of glucagon (1 mg) may be more effective thanlarger doses. 3. Further investigation of glucagon for food impaction via arandomized trial is warranted to determine an optimal dose and optimalpatient characteristics, before the routine use of glucagon in food impac-tions can be recommended.

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Profile of GERD: Attitudes toward the disease and theirmanagement strategies (care seeking behavior and knowledge of lifestyle modifications)Ramesh Srinivasan1, Radu I Tutuian1, Marcelo F Vela1, T Isaac2, IGalaria2, June Castell1, Philip O Katz1* and Donald O Castell1.1Medicine, Graduate Hospital, Philadelphia, PA, United States; and2Medicine, Thomas Jefferson University, Philadelphia, PA, UnitedStates.

Purpose: To assess in an urban population: 1) attitudes about the disease,2) care seeking behavior, 3) knowledge of lifestyle modifications for relief.Methods: A sample from Philadelphia (410 subjects, with demographicscomparable to the Philadelphia 1990 census) filled an 84-item in-personquestionnaire regarding heartburn.Results: 70% of the total population considered heartburn (HB) a seriousmedical condition. This percentage remains the same regardless of gender,race or age, however rises to 85% if the individuals have been previouslydiagnosed with GERD. Related questions showed similar results. Wouldseek medical attention (Total 80%, Dx GERD 84%) MD could help (Total83%, Dx GERD 81%) HB education needed (Total 70%, Dx GERD 81%)Care seeking behavior again is not affected by gender, race or age.

Total Dx GERD

Would visit MD for HB �2x wk 66% 74%Would visit MD for severe HB 86% 97%Would visit HB clinic for severe HB 41% 45%Have discussed their symptoms with MD 23% 57%Would ask about surgery for severe HB 28% 32%Take prescription medication 12% 52%Take over the counter (OTC) medication 42% 58%

While 71% of the total population believe there are medication and/or othertreatments available they are not using, a much smaller percent are awareof life style modifications they can make to alleviate their symptoms.65-83% were aware that elimination of alcohol, fat, chocolate and smokingwould be of benefit but less that 40% (39-22%) were aware of the benefitsof loose clothing, not lying down after meals and raising the head of thebed.Conclusions: The majority of the population believes heartburn is a seriousmedical problem that requires medical attention. Over 50% of the total takesome form of medication (42% OTC) and those diagnosed with GERD areabout 1/2 prescription and 1/2 OTC medication. Almost 1/3 of the subjectswould consider surgery. With the exception of dietary modifications mostpeople are not aware of things they can do to alleviate their symptoms.

S38 Abstracts AJG – Vol. 96, No. 9, Suppl., 2001