S1938 Ambulatory Esophageal pH-Impedance Reflux Monitoring: A Comparison Between Antimony, ISFET and Glass pH Electrodes

Abstract

Background and Aims: Studies describe adverse pulmonary effects in those who responded to the World Trade Center (WTC) disaster in New York City,with mention of aerodigestive symptoms (sx) described as GERD. Little is known about the mechanism of gastrointestinal sx in the WTC-exposed populations. The WTC Environmental Health Center (WTCEHC) was established to respond to health issues related to the attack on 9/11/01 and serves those exposed to WTC dust or fumes, including local residents, workers, and clean-up workers. We now report biopsy findings of post 9/11 refractory GERD-like sx. Methods: Participants were self-referred for medical sx and WTC exposure within the year after 9/11/2001. A standardized questionnaire was administered, including questions assessing the presence of heartburn and/or “acid indigestion.” Patients with sx were treated with proton pump inhibitors (PPIs); those with refractory sx were referred to a single gastroenterologist. Endoscopic results from patients evaluated between 1/11/07 and 10/23/08 are analyzed. Results: 160 patients were referred for endoscopy for refractory GERD-like symptoms. 33 patients whose sx resolved before their appointment were not endoscoped. 18 patients did not attend their appointment. 109 patients underwent endoscopy (mean age of 49.8, 48.6% male). 41.3% were white, 11.0% black, 8.3% Asian, 0.9% Native American, and 40% were undeclared. 64.2% of patients were Hispanic. Many patients (58.7%) had an income <15K. Visible abnormalities were seen on endoscopic evaluation in most patients (94.5%). On biopsy, 49.5% had reflux esophagitis, 44% had chronic inactive gastritis (CIG) and 43.1% had chronic active gastritis (CAG). 40% had evidence of infection with Helicobacter pylori (HP). CIG and CAG were associated with HP (P<0.0001) and Asian race (p=0.02). In patients who were HP negative, many had CIG (63.5%), CAG (19.1%), and reflux esophagitis (21.7%). Conclusions: GERD-like sx in a WTC exposed population were associated with gastritis as well as reflux esophagitis. Although we identified a high frequency of HP in our population, in patients without HP, gastritis remained common. The high frequency of HP in our population is most likely due to the country of origin of our patients. Further studies are ongoing to characterize the esophageal disease through pH testing and manometry. Biopsy and EGD results