pts), dyspepsia (2 pts) and anemia (2 pts). Endoscopic findings in the duodenum werenormal (8 pts), showed scalloping/atrophy (4 pts), congestion/edema (1 pt), mild nodularity(1 pt) and was unknown for 4 patients. Associations with other gastrointestinal diseasesincluded collagenous gastritis (1 pt), lymphocytic gastritis (2 pts), collagenous colitis (1 pt),chronic gastritis (4 pts), reactive gastropathy (1 pt), erosive gastritis (1 pt) and high gradeT cell lymphoma of esophagus (1 pt). Three patients had a personal history of celiac sprue.No duodenal pathology follow-up was available in 14 of 18 cases. Of the four cases withduodenal biopsy follow-up, one case of CS persisted at 9 months although duodenal biopsyat 20 months was normal. One patient's biopsy was normal after 10 months. One patientshowed peptic duodenopathy at 12 months, but no evidence of celiac or CS. One patientshowed evidence of celiac sprue at 22 months, but had no increase of subepithelial collagen.Conclusion: This nationwide study indicates that CS has a female predominance, randomgeographical distribution and usually occurs above the age of 50. Clinical symptoms arevaried and the endoscopic appearance is often normal or shows atrophy or scalloping.Limited follow-up data suggests that histologic features of CS are reversible.

T1086

Stress Ulcer Prophylaxis out of Intensive Care Setting: Prospective Evaluationof a Common PracticeEdna N. Mendez Hernandez, Gilberto Herrera Quiñones, Carlos I. Felix Saguchi Garcia,Nadia C. Arias Peña, Alberto Ibarra Moedano, Rommel Z. Carranco Salas, Andrea S.Ochoa De la Paz, Ivannia Preciado, Manuel J. Avendaño Reyes, Ricardo Flores Rendon

BACKGROUND:The use of antisecretory therapy(AST)has been specifically recommendedfor some ICU patients,but they have been frequently prescribed outside of this settingwithout justified assessments,having great economic impact. PURPOSE:Determining thefrequency of inappropriate use of AST,factors associated with this practice and trends relatingto its use in a prospective fashion. METHODS:Prospective evaluation of patients consecutivelyadmitted to internal medicine and surgery departments at the general hospital of specialtiesof the mexican institute of social security (a second level-teaching hospital at Mexicali,Mex-ico)in a 30-day period.Variables evaluated were:Gender,age,specialty,length of stay (LOS),re-ason for prophylaxis,type of antisecretory medication and dosification.Variables are expressedas means,medians and standard deviation,comparisons with X square test and Fisher exacttest,95% confidence intervals were calculated.We excluded patients under 18 and thosewhose conditions justified the use of AST(i e Peptic ulcer disease,GERD).Criteria for prophy-laxis was published in Am JHealth-Syst Pharm 1999,56:347-79 and we added the criterionof coagulopathy,defined as platelets less than 50,000 or INR> 2.5. RESULTS:In April 2009,a total of 821 pts of whom 803 (97.8%)were treated with AST as stress ulcer prophylaxis,were prospectively evaluated.Age 54.8 ±19,M/F 412/409,LOS 6.9 ±6.5 days.Five hundredand twentyone patients at Internal Medicine(internists 130,gastroenterologists 76, cardiolog-ists 64,nephrologists 56,neurologists 46,Pneumologists 30 and others 119 pts),and 300 atsurgery (General 147,neurosurgery 19,urology 12,and others 132 pts).A total of 178 (21.6%)pts had the correct indication of prophylactic AST of which 53(29.7%)used ster-oids,37(20.8%) had history of peptic ulcer disease,24(13.5%) coagulopathy and others(36%).The prophylactic drugs used were omeprazole 389, rantidine 393 and both 20.Surgerydepartment prescribe more frequently AST prophylaxis (OR 5.6,1.98-15.9 CI95% p =0.001)than internal medicine.Surgical specialties prescribed omeprazole in bigger proportion(OR 2.16; 1.49-3.1 CI95%, p <0.001)than medical specialties.The proportion of wrongdosification of AST (omeprazole or ranitidine)was higher in the specialties of internalmedicine(OR 1.36, 1.002-1.863 CI 95%, p=0.029);patients who received prophylaxis without indica-tion criteria for AST received 11.6 +10 unnecessary doses during the stay. CONCLU-SIONS:The use of antisecretory therapy is alarmingly common in our clinical practice,thiscould have a high economic impact as well as adverse effects;it is important to teach thestandards of care to lowering costs.

T1087

Assessment of Serum Pepsinogens Using Commercial ELISA Test Kit forPredicting Histology in a Chinese Population With Intermediate Cancer RiskFock Kwong Ming, Dhamodaran Subbiah, Tiing Leong Ang, Eng Kiong Teo, Song Lu,Jessica Tan, Kieron B. Lim

Introduction: A low serum pepsinogen I (PGI) level and a low pepsinogen I/ pepsinogen II(PGI /PGII) ratio are serologic markers for atrophic gastritis of the gastric corpus and fundus.These tests can be used as surrogate markers for the diagnosis of subjects with atrophicgastritis who have increased risk for gastric cancer and may then benefit from endoscopicevaluation. The usefulness of commercial ELISA kits for the detection of serum pepsinogenhas not been well studied in Asian population. The present study was carried out to examinethe utility of commercially available serum pepsinogen ELISA kit in predicting gastric atrophyin a Chinese population with intermediate gastric cancer risk. Materials and Methods: Weanalysed 393 sera collected from patients with known gastric diseases. Serum PGI and PGIIlevels were determined by ELISA kit (BIOHIT, Finland). A low serum pepsinogen I of <25ug/l and PGI / PGII ratio of <3 were considered significant based on the manufacturer'scriteria. The results of the serum pepsinogens were then correlated with the known histologyof the gastric corpus. Chi-square and Fisher's exact test were used and a p value of <0.005 was statistically significant. ROC analysis was performed to assess the sensitivity andspecificity of the manufacturer's serum pepsinogen cut-offs. Results: Among subjects withgastric atrophy, the prevalence of low PGI was 20.6%, while in subjects without gastricatrophy, the prevalence of low PGI was only 1.7% (p < 0.001). In the presence of gastricatrophy, a low PGI/ PGII ratio was present in 41.2%; in the absence of gastric atrophy, theprevalence of low PGI/ PGII ratio was 8.1% (p < 0.001). When ROC analysis was performed,the AUC for PGI was 0.491 (95% CI: 0.374 - 0.608), while that for PGI/ PGII ratio was0.262 (95% CI: 0.159 - 0.366). Using a cut-off value of PGI <25 ug/l and PGI/PGII ratioof <3, the performance of the test kit for predicting gastric atrophy was not significant.Conclusion: It appears from our study that the commercial serum pepsinogen ELISA kitwith recommended PGI levels and PGI/PGII ratio seems to be less significant in predictingthe presence of gastric atrophy in a Chinese population with intermediate gastric cancerrisk. This could be due to high levels of PGI detected compared to PGII in Chinese population.

S-485 AGA Abstracts

T1088

Relationship Between Upper-GI Symptoms and Duodenal Acidity During AcidInfusion Into StomachTakashi Tanimura, Kyoichi Adachi, Kenji Furuta, Shunji Ohara, Terumi Morita, KenjiKoshino, Yoshikazu Kinoshita

Background and Aim: Several recent studies have demonstrated the relationship betweenduodenal acidity and occurrence of functional dyspepsia (FD) symptoms. This study wasperformed to investigate that relationship during acid infusion into the stomach. Methods:We studied 6 healthy volunteers (3 females) with no history of GI disorders or upper gastro-intestinal symptoms. To evaluate duodenal acidity, we used Bravo pH capsules (Medtronic;Minneapolis, MN). All subjects underwent an upper endoscopic examination and a calibratedBravo pH capsule 5 cm in length attached to a nylon thread was inserted into the stomachunder endoscopic guidance. The thread was attached to the lesser curvature of the antrum(approximately 1 cm from the oral side of the pyloric ring) using an endoscopic hemoclipand the capsule was introduced into the duodenum. Acid and pure water infusions intothe stomach were randomly performed after overnight fasting at 24 and 48 hours afterattachment of the capsule. A 5-fr ED tube was inserted transnasally into the stomach, afterchecking that the capsule was correctly positioned in the duodenal second portion underX-ray fluoroscopy guidance. Thereafter, 300 mL of hydrochloric acid at a concentration of0.1 mol/L (30 mL/minute for 10 minutes) or the same volume of water was infused intothe stomach via the ED tube. The type and severity of several upper gastro-intestinalsymptoms were assessed by each subject using a 10-cm visual analogue scale every 2 minutesfor up to 30 minutes. The area under the severity scale time curve and percentage of timewith symptoms during the 30-minute examination period were calculated. Results: Severalupper gastro-intestinal symptoms were more severe during acid infusion as compared withwater infusion (acid vs. water: epigastric heavy feeling, 29.1±12.0 vs. 2.7±1.4; epigastricdull pain, 8.8±4.9 vs. 0.7±0.7 cm x minutes/30 minutes). Also, the percentage of time atwhich duodenal pH was below 4.0 was significantly longer during the acid test than withwater infusion (61.4±6.1% vs. 24.8±6.5 %). When the relationship between the severity ofsymptoms and duodenal pH below 4.0 was investigated using the results of 12 infusiontests, epigastric heavy feeling in the stomach was not correlated with duodenal pH below4.0. On the other hand, epigastric dull pain in the stomach was well-correlated with thepercentage of time duodenal pH was below 4.0 (p=0.046). Conclusion: Our results showedthat acid infusion into the stomach can provoke both postprandial distress-like and epigastricpain-like symptoms. In addition, the occurrence of epigastric pain may be highly influencedby intra-luminal duodenal pH levels.

T1089

Symptomatic Uncomplicated Peptic Ulcer Disease: True Peptic Ulcer orFunctional Dyspepsia?Montri Gururatsakul, Jane M. Andrews, Gerald Holtmann, Nick Talley, Richard H.Holloway

Background: We have previously reported lower sensory thresholds and delayed gastricemptying in patients with uncomplicated peptic ulcer (uPUD) compared to both patientswith bleeding peptic ulcer (BPU) and healthy controls (1, 2), features more typically associatedwith functional dyspepsia (FD). Thus we hypothesised that after ulcer healing and H.pylori eradication patients with uPUD are more likely to have ongoing dyspeptic symptomscompared to patients with BPU. Methods: Questionnaires to evaluate gastrointestinal symp-toms and psychological co-morbidities (BDQ, GIS, NDI, HADS) were sent to all patients12 months after treatment of endoscopically confirmed PUD. At baseline and after 12months the proportion of patients with and without upper gastrointestinal symptoms, andpsychological co-morbidity(ies) were calculated. Comparison were made between groupsand between time-points using contingency tables with a p<0.05 regarded as significant.Results: 16 patients with uPUD and 28 BPU completed the questionnaires and were availablefor analysis. At the time of diagnosis, 14/16 patients with uPUD presented with dyspepsiacompared with only 6/28 patients with BPU (p<0.001). After 12 months, 9/14 symptomaticuPUD and 6/6 originally symptomatic BPU reported persistent symptoms, whereas symptomshad resolved in 5 uPUD. New symptoms did not develop in any patient asymptomatic afterhealing. Thus a greater proportion (9/16) of patients with uPUD had persistent symptomsthan patients with BPU (6/28, p=0.02). At diagnosis, when patients were divided intosymptomatic vs asymptomatic ulcer, patients with dyspeptic symptoms were significantlyyounger than asymptomatic patients (mean 57 vs 67 yrs, p=0.004). After 12 months followup, patients with persistent symptoms remained significantly younger than symptom-freepatients (57 vs 65, p=0.018), and reported significantly higher anxiety (9.2±1.4 vs 3.8±0.6,p=0.002) and depression score (7.2±1.1 vs 3±0.6, p=0.003) and impaired quality of lifeaffected by dyspeptic symptoms (p<0.001). Conclusions: Most (>60%) patients with dys-peptic symptoms prior to the diagnosis of PUD continue to have dyspeptic symptoms 12months after ulcer healing and H. pylori eradication. Patients with persistent dyspepticsymptoms have higher level of anxiety and depression score than patients without symptoms.The data suggest that most patients with symptomatic PUD have concomitant FD, whichmay have lead to the diagnostic endoscopy being performed that probably prevented thedevelopment of a life threatening ulcer bleed. 1.Gururatsakul M, et al. Gastroenterology2007: p212:A43 2.Gururatsakul M, et al. Gastroenterology 2008: p134:A75

T1090

Impact of Postprandial Walking on Gastric Emptying of Solid Assessed by13C Octanoate Breath Test - Assessments Using the Wagner-Nelson MethodTakatsugu Yamamoto, Koichiro Abe, Kengo Hattori, Taro Ishii, Yasushi Kuyama, MasakiSanaka

Background: 13C octanoate breath test has currently been accepted as a simple and noninvas-ive method for assessing gastric emptying of solids. However, the results show differencewith those obtained by scintigraphy. Our previous researches show that the Wagner-Nelson

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