circumference was a strong risk factor both for OSAS and GERD; 40.2±3.7 for primarysnoring vs. 43.8±3.9 for severe OSAS in both gender (p<0.0001). CONCLUSION: In thislarge cohort study the prevalence of GERD significantly increased in patients with OSASrecruited from secondary and tertiary referral centers compared to the general population(23%) but not to primary snoring. The severity of OSAS was not related with the prevalenceof GERD. The prevalence of GERD increased with BMI in female and it was stabile in menafter BMI>25. It was shown that obesity and neck circumference but not OSAS wereindependent risk factors for GERD in women patients. An independent risk factor couldnot identify in male patients except for neck circumference. The major therapeutic goalshould focus to lose weight in patients with OSAS and GERD especially in women.

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Continuous Positive Airway Pressure Does Not Decrease GastroesophagealReflux in Patients With Obstructive Sleep Apnea SyndromeRukiye Vardar, Mehmet S. Tasbakan, Ozen K. Basoglu, Esra Yildirim, Serhat Bor

AIM & BACKGROUND: Gastroesophageal reflux disease (GERD) is common in patientswith Obstructive Sleep Apnea Syndrome (OSAS). Studies have shown that treatment withnasal Continuous Positive Airway Pressure (CPAP) decreases esophageal acid exposure. Theaims of this study were to examine the relationship between OSAS and GERD, and theeffect of CPAP on GERD. METHODS: The study population included 61 patients with severeOSAS (apnea-hypopnea index (AHI)>30/h) and was compared with 11 patients withoutOSAS (primary snoring; AHI<5/h) as a control group. All patients were undertaken esophagealmanometry to identify the upper limit of lower esophageal sphincter followed by the MII-pH catheter was placed (MMS Ohmega, The Netherland). In addition, 11 OSAS patientswere re-evaluated with 24 h MII-pH monitoring at least 3 months of therapy with CPAP.All impedance tracings were analysed by the same author who was blinded to the patients.Demographic-anthropometric features, polysomnographic evaluation and results of 24 hMII-pH recording were compared. RESULTS: Mean age of OSAS patients was 55±11 years,13 patients were women (21%), whereas control group was younger (43.8±10) (p=0,005).Both groups were similar with respect to gender, body mass index, circumferences of waistand hip. BMI None of the patients was in the normal level of BMI, they were either overweight(24.6%) or obese. According to the results of 24 h MII-pH, pathologic findings were detectedat 49% (30/61) in patients with OSAS and 36% (4/11) without OSAS (p=0.464). Twentyfive patients (40%) defined heartburn and/or acid regurgitation at least once a week in OSASgroup. As expected, results of 24 h MII pH monitoring were significantly pathologic inpatients with GERD symptoms (17/25 vs 11/36) (p=0.004). There was no difference in 24h MII pH monitoring results in terms of CPAP therapy. CONCLUSIONS: The prevalenceof GERD symptoms was higher in OSAS patients than general population, but similar toprimary snoring subjects. Similar with those results the prevalence of GERD detected with24h pH-MII was 49% in patients with OSAS and not different than primary snoring subjects.Besides, CPAP therapy did not decrease gastroesophageal reflux in patients with OSAS. SinceBMI was higher in all patients and the esophageal exposure of refluxate was similar betweensevere OSAS and primary snoring, OSAS by it self might not be responsible in this highprevalence of GERD and results might be explain with obesity.

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Significant Temporal Association Between Gastroesophageal Acid RefluxEvents and Obstructive Sleep Apnea. Results of the Pilot Swap Study -Synchronous Wireless pH-Metery and Ambulatory PolysomnographyTomer Adar, Shimon Shteingart, Derora Katz, Eran Goldin, Kalman Paz

Introduction Gastroesophageal reflux disease may be exacerbated at nighttime. In severecases, reflux content may affect large segments of the esophagus, up to the larynx. Obstructivesleep apnea (OSA) is major cause of morbidity. Evaluating this association was difficult untilrecently as both tests required special settings and manipulations. Synchronous wireless pH-metry and ambulatory plysomnography testing in the comfort of the patients' home allowsthis question to be addressed in a truly physiological setting Aims This study aims to evaluatethe temporal association between gastroesophageal acid reflux events and respiratory sleepdisorders. Methods Consenting patients with known PPI dependant GERD underwent ambu-latory wireless pH-metery (off PPI) for 2 days using the Bravo capsule [Given imaging,Israel] implanted to the lower esophagus. During this period, an overnight ambulatorypolysomnography test using a WatchPat instrument [Itamar, Israel] was synchronouslyperformed over two consecutive nights . The results of both studies were correlated, toidentify the respiratory events which occurred during reflux events. Results Simultaneoustesting was achieved in 9 patients (17 nights total), with a mean age, weight and BMI of47.4 years, 79 kg and 26.49 respectively, F/M ratio was 2/7. The study group had a mean64.9 reflux events per day. Mean respiratory distress index (RDI), apnea hypopnea index(AHI) and oxygen desaturation index (ODI) were 101, 71.4 and 32.8 respectively, of which10.3%, 10.2% and 10.6% were simultaneous with reflux events. A strong correlation wasfound between fraction of time the pH was <4 in the supine position and RDI, ODI andAHI which occurred with simultaneous reflux event (r = 0.9, 0.89 and 0.88 respectively).When using a cut-off of 15% of RDI events occurring with simultaneous reflux, 2 distinctgroups could be identified - low and high reflux association, with a significant increasednumber of supine reflux events 33 and 2.2 (p<0.01) and an increased fraction of respiratoryevents associated with reflux (31.9 vs. 0.4, 34.2 vs. 0 and 32.4 vs. 0.2 for RDI, ODI andAHI respectively, p≤0.01). This difference was significant despite no significant differencein BMI or Epworth scale (27.2 vs. 28.7 and 12.2 vs. 10.7 respectively) Conclusion In thisfirst ever simultaneous study we have demonstrated the association of respiratory sleepdisorders and GERD. Using a cut-off of 15% association of RDI with reflux allows identifica-tion of low and high association patterns. This interpretation demonstrated that in certaincases there can be up to 33% association between GERD and respiratory sleep disorders.This study, though small, is pivotal in demonstrating this strong temporal association betweenreflux events and OSA.

S-857 AGA Abstracts

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Prevalence and Distribution of Gastro-Esophageal Reflux (GER) TypeSymptoms in Premature Infants: Categorization Based on the Severity of AcidReflux IndexAlecia Wagner, Xiaoyu Gao, Sudarshan Jadcherla

BACKGROUND: Symptom association with GER is an important consideration in the evalua-tion and management of GER disease (GERD). Unfortunately, the distinction between GERand GERD is not entirely clear, as many cardiorespiratory - aerodigestive events (CRE),sensory symptoms, and physical symptoms have multiple confounding etiologies. Therefore,modification of esophageal acidification with acid suppressive agents as an empiric therapeutictarget for GERD type of symptoms is controversial and can be potentially dangerous inneonates. Thus, the presence of excessive symptoms as a manifestation of disease in thesetting of GERD requires further clarification. The current study was undertaken to determineif GER precedes symptoms or if GER succeeds symptoms in convalescing premature infants.AIMS: To establish the prevalence, distribution and type of symptoms based on severity ofAcid Reflux Index (ARI) in infants evaluated for GERD type of symptoms. METHODS: 117infants (born at 30.8 ± 0.5 wks gestation; 59 males) were evaluated at 44.8 ± 0.82 wkspostmenstrual age (PMA) with 24-h pH-impedance (Ohmega, MMS) methods. Meal periodswere excluded from the analysis. A trained nurse assistant who was blinded to the pH-Impedance recordings scored symptoms in real time as they occurred. Symptom associationswere analyzed and stratified based on reflux severity. Recordings were scored in 2-minepochs. Symptom index (SI) and symptom sensitivity index (SSI) were calculated for GERevents preceding symptoms and GER events succeeding symptoms. Symptoms were furthergrouped into: Cardiorespiratory-aerodigestive symptoms (cough, bradycardia, tachycardia,desaturation, sneezing, gagging), sensory symptoms (emesis, flushing, grimace, grunting,),and physical symptoms (arching, irritability). RESULTS: A total of 6471 reflux events wereanalyzed from 2222 hours of recordings. Symptom analysis was stratified by the severity ofacid reflux index and comparisons were made between GER preceding symptoms versusGER succeeding symptoms for SI* and SSI§ (Table 1). CONCLUSIONS: Symptom indexincreases with increasing severity of acid GER events in either category (i.e. GER precedingand succeeding symptoms). Thus, magnitude of esophageal acidification may contribute toincreased sensitization. Symptom sensitivity index decreases with increasing severity of acidGER events in either category. This finding may be related to volume or spatio-temporalcharacteristics of refluxate. GER events succeeding symptoms are more frequent than GERevents preceding symptoms. Symptoms may increase the pressure gradient and modifyupper and lower esophageal sphincter protective functions. Therapeutic targets to modifysymptoms mimicking GERD can therefore several. *Supported in part by 2RO1DK068158 (Jadcherla)Table 1. Reflux Index Severity Correlation with Symptom Analysis

Data are stated as median (IQR) or mean ± SEM. CRE- Cardiorespiratory-aerodigestiveevents. ‡ ≥ 3 RI ≤ 7 versus RI > 7 and † RI < 3 versus RI > 7, with P <0.05. RI < 3 versus≥ 3 RI ≤ 7 was not significant. * SI preceding versus succeeding, with P < 0.05 and § SSIpreceding versus succeeding, with P< 0.01

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Histological Marker of Chronic Reflux Laryngitis in RatsDaisuke Asaoka, Akihito Nagahara, Yuji Shimada, Mariko Hojo, Sumio Watanabe

Background: Reflux laryngitis is regarded as one of the extraesophageal syndrome of gastro-esophageal reflux disease(GERD), however the histological marker of the pseudostratifiedciliated epithelium in reflux laryngitis has been unknown. This study aimed to investigatethe histological marker in chronic reflux laryngitis model in rats. Methods: A rat chronicreflux esophago-laryngitis model(CREL model)(n=5) was induced by modifying the previousmethod(Asaoka D et al. Dig Dis Sci. 2010). Control model(n=3) was induced by shamoperation. Control and CREL model rats were sacrificed on the day 28 after the operationand 28 day survival rate was measured. After the esophagus and larynx were resected, theratio of occurrence of reflux esophagitis and the total ulcer area(mm2) were measured in the

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