Sa1879 A Model to Assess the Risk for ASA/NSAID-Related Ulcer Bleeding for the Individual Patient Based on the Number of Risk Factors

Abstract

Background and goals: Recently we observed patients with chronic liver diseases (CLD) (n= 16) and chronic reflux symptoms (CRS) (n=38) that developed gastric polyps (GPs) while undergoing repeated esophagogastroduodenoscopy (EGD). The indications for repeated EGD were: persistent reflux symptoms (CRS patients) and monitoring of esophageal varices development (CLD patients). Herewith we identify risk factors for GP development and estimate the gastric polyp development time (GPDT). Methods: Data was retrospectively analyzed. GPDT was defined as days, since the first gastroscopy until polyp discovery. The presence of portal hypertension (PHT) in CLD patients was determined by the presence of esophageal varices with or without gastric varices. Results: CLD patients developed more hyperplastic gastric polyps (HGPs) than CRS patients (p= 0.021). CLD patients with PHT developed HGPs at a younger age (p=0.023) and had a tendency for a shorter GPDT than CLD patients without PHT: mean GPDT was 1184 ±787 days (for CLD patients with PHT) vs.2634 ±2345 days (for CLD patients without PHT). In order to further study the effect of PHT on the GPDT, Kaplan-Meier curves, indicating the individual GPDT, for all patients with HGPs, from the CRS and CLD groups, were constructed. A trend for shorter GPDT for CLD patients with PHT was demonstrated (Figure 1). In the CLD patients (irrespective to the presence PHT), a positive correlation between the GPDT and age was found; the older the patient, the longer the GPDT (p=0.014). In patients with CLD, Ki-67 labeling index values of HGPs were independent to the presence PHT, the patient's gender, to infection with Helicobacter Pylori and to PPI exposure. However, a negative correlation between the patient's age and the Ki-67 values was found; the younger the patient, the higher the Ki-67 value (p= 0.042).The histopathology features that were previously reported to be specific for GP tissue in patients with PHT were not detected more often in the CLD patients with HGPs, irrespective to the presence or absence of PHT. Conclusions: Compared to CRS patients, CLD patients with PHT, appear to develop HGPs at a greater number, at a younger age and in a shorter GPDT.