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Quality of Life Impairment in Community Subjects with Functional DyspepsiaDefined According to the ROME III CriteriaPertti Aro, Jukka Ronkainen, Tom Storskrubb, Elisabeth Bolling-Sternevald, Nicholas J.Talley, Lars Agreus

Background and aims: Major changes were made in the Rome III criteria for functionaldyspepsia where two distinct syndromes were postulated, postprandial distress syndrome(PDS) and epigastric pain syndrome (EPS). Our aim in a general population sample was toexplore if quality of life, using the validated SF-36, is impaired in functional dyspepsia andamong functional dyspepsia subgroups defined according to the Rome III definition. Method:A random sample (n=2,860) of the adult population of two northern Swedish municipalities(n=21,610) was surveyed using a validated questionnaire assessing gastrointestinal symptoms(ASQ) and the SF-36 for quality of life with the 8 standard domains Physical Functioning(PF), Role-Physical (RP), Bodily Pain (BP), General Health (GH), Mental Health (MH), Vitality(VT), Social Functioning (SF) and Role Emotional (RE). A random sub-sample (n=1,001)of the responders was invited to undergo an esophagogastroduodenoscopy (participationrate 73.3%). The mean values of SF-36 domains in different dyspepsia categories werecalculated. Multivariate logistic regression analysis, adjusting with age and sex, was used toanalyze associations of different dyspepsia groups with dichotomized SF-36 domains. Results:SF-36 data were available in 999 of the 1,001 subjects endoscoped. 202 (20.2%) wereclassified as uninvestigated dyspepsia (UID) and 157 (15.7%) as functional dyspepsia (FD);52 (5.2%) reported epigastric pain syndrome and 122 individuals (12.2%) had postprandialdistress syndrome. FD was significantly associated with low scores in every SF-36 domain(all p≤0.01); EPS was associated only with worse Bodily Pain (p<0.05) but PDS wasassociated with impairment in all domains (all p ≤ 0.01). Symptomatic peptic ulcer disease(PUD) impaired quality of life significantly more than FD only in domain RP (p<0.05).Conclusions: Functional dyspepsia appears to seriously impair quality of life in adult non-patients, and PDS is associated with more quality of life impairment than EPS.Table. SF-36 domain scores in different dyspepsia groups

UID = Un-investigated dyspepsia FD = Functional dyspepsia EPS = Epigastric pain syndromePDS = Postprandial distress syndrome PUD = Peptic ulcer disease

S1216

Bone Mineral Density and Bone Turnover Markers in Patients withInflammatory Bowel DiseaseSeong-Eun Kim, Sung-Ae Jung, Ki-Nam Shim, Hye-Kyung Jung, Ji Min Jung, Min-JungKang, Hyun Joo Song, Tae Hun Kim, Kwon Yoo, Il-Hwan Moon

Background/Aims : The aim of this study was to investigate the prevalence and the pathophysi-ology of osteopenia and osteoporosis in Korean IBD patients. Methods: The BMD wasdetermined by dual-energy X-ray absorptiometry at the lumbar spine and femoral neck in26 IBD patients (22 men and 4 women, mean age 31.3±9.9 years), 14 with Crohn's diseaseand 12 with ulcerative colitis. Osteopenia and osteoporosis were defined according to theWHO guidelines. Bone turnover was assessed by measuring serum osteocalcin and ALP forbone formation, and serum calcium and deoxypyridinoline for bone resorption. Clinicalcharacteristics including the duration of disease, cumulative corticosteroid doses, and bodymass index were compared between the patients with decreased BMD and normal BMD.Results: Osteopenia was present in 40% of the patients, and osteoporosis in 10% of thepatients at either lumbar spine or femoral neck. Deoxypyridinoline levels were significantlyhigher in the patients with decreased BMD than in patients with normal BMD (p = 0.02),but osteocalcin, ALP and calcium levels were not significantly different between two groups.Body mass indexes in patients with decreased BMD were significantly lower than in patientswith normal BMD (p=0.02). However, there was no significant difference in other clinicalparameters between two groups. Conclusion: Decreased BMD is not rare in IBD patients inKorea and increased bone resorption may be the mechanism responsible for bone loss.Whether BMD should be determined in all IBD patients and antiresorptive therapy is effectiveto prevent and treat IBD-associated osteoporosis remained for the next larger study.

S1217

Long-Term Response of Ileal Crohn's Strictures to Balloon Dilation: TheImpact of the Length of the StricturesThomas Mueller, Bernhard Rieder, Albrecht Pfeiffer

BACKGROUND: Endoscopic balloon dilation is an effective and safe treatment of Crohn'ssymptomatic strictures. While strictures of the colon and the ileocolonic anastomosis hada long-term response after dilation, we recently demonstrated that 42% of our patients withde novo strictures of the terminal ileum required surgery. The aim of the present study wasto evaluate the role of the length of the ileal strictures and the necessity of repeated balloondilations in the need of surgery. MATERIAL AND METHODS: Between Oct. 1999 and June2008, 30 patients (12 males, 18 females, 40 (20-71) years) underwent 45 ballon dilationsfor 39 symptomatic de novo strictures of the terminal ileum. Hydrostatic through the scopeballoons were used with a diameter of 18 mm on inflation (Microvasive Rigiflex Ballons,Boston Scientific, Boston, MA, USA). Prior to endoscopy all patients received a sonographic

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and radiologic assessement (small bowel enteroclysis or MRI) to exclude intestinal fistulasand to measure the length of the strictures. RESULTS (median, range, Mann-Whitney test):13 out of the 30 patients (43%) had to be operated on within a median period of 1,5 (0-20) months because of recurrent strictures. 17 patients (57%) are free of symptoms duringa median observation period of 44 (1-103) months. In the patients who underwent surgery,the ileal strictures were significantly (p = 0.006) longer (7.5, 1-25 cm) compared with thenon-operated patients (2.5, 1-25 cm). The number of dilations was not significantly (p =0,65) different between both patient groups (2, 0-3 versus 1, 1-3 dilations). CONCLUSION:The present data suggest that not the frequency of dilations but the length of de novostrictures of the terminal ileum is predictive of the need of surgery. Therefore, patients withlong ileal Crohn's strictures should be early regarded as candidates for surgery.

S1218

Somatostatin Analogues Are Effective Rescue Therapy for Chronic Bleedingfrom Gastrointestinal Angiodysplasia: A Meta-Analysis of Prospective CohortStudiesCollin Brown, Venkataraman Subramanian, Shajan Peter, C. Mel Wilcox

Background: Treatment of patients with bleeding gastrointestinal (GI) angiodysplasia's is achallenging clinical problem. The results from studies detailing endoscopic ormedical therapyfor angiodysplastic lesions have been mixed. Somatostatin analogues have shown somepromise in mitigating the clinical impact of these difficult to treat lesions. We aimed toreview the available literature and provide pooled estimates of clinical efficacy of somatostatinanalogues in treating patients with GI angiodysplasia. Methods: We searched electronicdatabases (Pubmed, Embase, Web of Science and Zetoc) for full journal articles publishedafter 1990 reporting on response rates to somatostatin analogue therapy in patients withbleeding gastrointestinal angiodysplasia. We selected studies which reported prospectivelyon more than 10 patients. The primary outcome was a clinical response to treatment definedas either a stable haemoglobin (Hb) level or no further gastrointestinal bleeding. Secondaryoutcomes were a reduction in transfusion requirements after treatment and improvementin Hb levels after treatment. We hand searched the reference lists of all retrieved articles,then carried out fixed effects meta-analysis, and checked for bias using Harbord-Egger'smethod. We also calculated Cochran's Q and the I2 statistic to assess for heterogeneity.Results: Three prospective cohort studies totalling 60 patients were included in the meta-analysis. The use of a somatostatin analogue was associated with pooled clinical responserate of 76% (95% CI 64-85%). The heterogeneity between the studies was low (Cochran'sQ was 0.68 (p=0.7) and I2 was 0%). 2 studies involving 30 patients provided data onchanges in Hb and transfusion requirements. A fixed effect inverse variance standardizedmean difference (SMD) meta analysis was done for both Hb and transfusion requirementsbefore and after treatment. The pooled SMD for Hb was 2.5 (95% CI 1.8-3.2) favouringtherapy and the pooled SMD for transfusions was -0.79 (95% CI -1.32, -0.26) also favouringtherapy with somatostatin analogues. Heterogeneity was low for both, the I2 was 36% and0% respectively and Cochrans Q was 1.56 (p=0.21) and 0.0 (p=0.96) respectively. Conclu-sions: For patients with refractory bleeding from gastrointestinal angiodysplasia, the use ofa somatostatin analogue leads to a clinical response in around 75% of patients, improvesHb by 2.5 gm% and reduces transfusion requirements by 0.79 units per patient.

S1219

Evaluation of a New Sclerotherapy with Alta for Prolapsing InternalHemorrhoids: Comparison with HemorrhoidectomyYukihiko Tokunaga, Hirokazu Sasaki, Tohru Saito

Backgrounds: For prolasing internal hemorrhoids, a less invasive treatment such as sclerother-apy using aluminum potassium sulphate/tannic acid (ALTA) has been introduced recently.We compared the results of ALTA with conventional hemorrhoidectomy of ligation andexcision (LE). Methods: Between January 2006 and December 2007, We performed LE in331 patients, ALTA in 565 patients with second- and third-degree internal hemorrhoidsaccording to the Goligher's classification. Results: Volume of ALTA injected into a hemorrhoidwas 7.1±2.1 (m±SD) mL and a total of 14.3±4.5 mL in a patient . The operation durationwas significantly longer (p<0.01) in LE (43±5 min) than in ALTA (13±2 min). Post operativepain, which needed intravenous injection of pain killer, occurred in 51 cases (15%) in LEand 7 cases (1.2%) in ALTA (p<0.01). ALTA could be performed on an outpatient basiswithout any severe complication such as abscess, ulcer, and stenosis. Hospital stays were6.8±2.0 days for LE. Postoperative bleeding requiring surgical hemostasis occurred in 3cases (0.9%) in LE. The disappearance rates of prolapse were 100% in LE and 96.1% inALTA respectively. Discussion: Conventional hemorrhoidectomy would be indicated foralmost all cases of prolapsing internal hemorrhoids. However, it needs hospitalization, beingaccompanied with post-operative pain in most cases. ALTA is feasible on an outpatient basiswithout any severe pain or complication, being favored withmost patients. The disappearancerate of prolapse in ALTA was comparable in LE. Conclusions: A less invasive treatment ofsclerotherapy with ALTA is feasible on an outpatient basis and would be an useful alternativetreatment for prolapsing internal hemorrhoids.

S1220

Complementary and Alternative Medicine (CAM) Use in Children withFunctional Abdominal Pain (FAP) and Irritable Bowel Syndrome (IBS) Differsin Tertiary vs. Primary Care and Is Related to Mother's View of ChildDisabilityErica Weidler, Mariella Lane, Danita I. Czyzewski, Robert J. Shulman

Background: We sought to determine if CAM use was greater in children in tertiary vs.primary care and whether child or parent report of pain characteristics, and/or child andmother's psychological characteristics differed between those who did/did not use CAM.Design/Methods: We identified children 7-10 years of age with FAP or IBS using PediatricRome II criteria. Children were managed solely in primary care by their pediatrician (PED,

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