Mucosal Pathology Research Articles

Details Unfold: The Endoplasmic Reticulum Stress Response in Intestinal Inflammation and Cancer

Details Unfold: The Endoplasmic Reticulum Stress Response in Intestinal Inflammation and Cancer

A retrospective analysis of oral and maxillofacial pathology in an Australian adult population

The prevalence of oral and maxillofacial pathology has not previously been reported in the Australian adult population. This study aimed to audit a large pathology service to provide insight into the prevalence of head and neck pathologies. Written records of a major Australian oral pathology service were imported into an electronic database. Age, gender and histological diagnosis were assessed. Prevalence of histological diagnoses as a percentage of the major diagnostic categories and of the whole sample were calculated, as well as gender predilections and mean age of presentation of disease. A total of 6344 oral pathology specimens, collected from adults aged 17 years and over were included in the analysis. Mucosal pathology was the most common pathology (37.2%), followed by odontogenic cysts (16.3%) and dental pathology (14.5%). The three most common histological diagnoses were fibrous hyperplasia (15.2%), chronic periapical granuloma (9.6%) and radicular cyst (9.5%). The male:female ratio of the entire sample was 0.74. This is the first study to describe the prevalence of oral and maxillofacial pathology among adult patients in an Australian population. The trends seen in this study are repeated in studies from other parts of the world, and are of diagnostic importance.

A retrospective analysis of oral and maxillofacial pathology in an Australian paediatric population.

The prevalence of oral and maxillofacial pathology has not previously been reported in the Australian paediatric population. This study aimed to audit a large pathology service to provide insight into the prevalence of oral and maxillofacial pathology. Written records of a major Australian oral pathology service were imported into an electronic database. Age, gender and histological diagnosis were assessed. Prevalence of histological diagnoses as a percentage of the major diagnostic categories and of the whole sample were calculated, as well as gender predilections and mean age of presentation of disease. A total of 1305 oral pathology specimens, collected from paediatric patients aged 16 and under were included in the analysis. The most common pathology was dental pathology (24.4%), followed by odontogenic cysts (18.5%) and mucosal pathology (17.0%). The most frequently encountered lesion was the dentigerous cyst (9.4%), followed by fibrous hyperplasia (8.3%), radicular cyst (5.2%) and chronic periapical granuloma (5.2%). In the paediatric population, dental pathology and specifically, the dentigerous cyst is the most common pathology type sent for histopathology, suggesting a high prevalence of pathology of dental origin occurring in Australian children.

Su1740 The Diagnostic Yield of Upper Endoscopy in Children: Do Symptoms Matter?

prospective data collection using a standard computerized report generator and central registry (PEDS-CORI) to examine factors affecting examination of the ileum during colonoscopies performed in 14 pediatric centers between Jan 2000 and Dec 2011. Procedures with and without examination of the ileum were compared with regards to demographic and clinical features in practices with more than 100 colonoscopy procedures during the study period. Results: We analyzed 21, 807 colonoscopy procedures performed in patients with mean age of 11.9 (SD 4.8). Overall, 15,130 (69%) of colonoscopies included examination of the ileum. Patients in which the ileum was not examined were younger, had higher ASA class, and were more likely to have procedures performed under intravenous sedation. Procedures done under general anesthesia were associated with intubation rate of 76%, while other sedation types (intravenous sedation) had a significantly lower intubation rate of 63% ( p!0.001). Procedures done in male patients achieved an intubation rate of 68%, significantly lower than the 71% rate seen in female patients ( p!0.001). The presence of a fellow was not associated with ileal intubation (pZ0.072). Colonoscopies done with an adequate bowel prep reported a higher rate of intubation than those without (94% vs. 82%; p!0.001). Of the 21, 807 reports received during the study period, 56% did not document bowel prep quality, 31% did not include duration of procedure, and 12.7% did not include ASA classification. Conclusions: Approximately, 30% of colonoscopy procedures in children did not include complete examination (i.e., reach the ileum). Several factors including age, sedation method, ASA class, and quality of bowel prep are associated with examination of the terminal ileum during colonoscopy in children. Su1740 The Diagnostic Yield of Upper Endoscopy in Children: Do Symptoms Matter? Barra Alabd Alrazzak, Deborah Preston, Yoram Elitsur* Pediatrics, Gastroenterology, Marshall University, Huntington, WV; Pediatrics, Gastroenterology, Marshall University, Huntington, WV Introduction: Upper endoscopic (EGD) procedure in children is a common diagnostic tool for children with various abdominal symptoms. The diagnostic value of EGD in regards to positive histology and its association with symptoms has not been adequately investigated. Previous reports suggested that in up to 62% of diagnostic EGD, no histologic abnormalities are found. (Hyams JS. JPGN 2000). Aim: to evaluate the correlation between symptoms and histology in children who undergo the first diagnostic upper endoscopy procedure at our gastroenterology clinic. Method: A retrospective chart review of all children who had their first diagnostic upper endoscopy procedure, between 2006 and 2011, was performed. Demographic, clinical symptoms and histology were collected. Mucosal biopsies from the esophagus, stomach and small intestine were available in all patients irrespective of the tissue appearance. Children with the diagnosis of chronic recurrent abdominal pain were excluded from the study. Results: A total of 728 endoscopy charts were reviewed. Male/Female ratio and mean age were 1.12:1.0, and 11.5 years, respectively. The most common presenting symptom in our cohort was abdominal pain (64%) followed by N&V (23%), FTT (6.4%), GI bleed (6%), and dysphagia (5.6%). The most common pathologic finding was gastritis (56%) followed by esophagitis (37%), duodenitis (11%), EoE (10%), and H. pylori-associated gastritis (2%) (Table 1). In 260 (36%) procedures, no pathology was found in either of the organs (esophagus, stomach, duodenum). The sensitivity and specificity to detect mucosal pathology for any symptom ranged between 5668% and 3440%, respectively, with no significant differences among the symptoms (Table 2). Conclusion: In over a third of our EGD’s no mucosal pathology was found. The accuracy rate to detect pathology was approximately 80% for abdominal pain but was below 50% for all other presenting symptoms. With increasing cost of endoscopic procedures, calculation of cost analysis is needed in order to assess the diagnostic yield of this procedure in children with various GI symptoms. Table 1. Presenting symptoms and histology

Su1512 Learning Curve in Mucosal Healing (MH) and Inflammatory Activity Assessment by Using the Newly Validated Erlangen IBD-Mh Score for Confocal LASER Endomicroscopy

Confocal laser endomicroscopy (CLE) is a modern imaging technique that enables real time histology in vivo, during endoscopy, providing new insights of mucosal pathology. Monitoring histological activity to assess MH is important in evaluating the therapy response and management of inflammatory bowel diseases (IBD). Our group has recently validated an endomicroscopic mucosal healing score (eIBD-MHs), which has to be interpreted by skilled endoscopists.

Prevalence of oral and oropharyngeal human papillomavirus in a sample of South African men: a pilot study.

Human papillomavirus (HPV) infection is well known to be associated with head and neck cancers (HNCs). HPV-associated HNCs are related to sexual behaviour, particularly the lifetime number of oral sex partners, but the epidemiology of oral and oropharyngeal HPV in South African men has not yet been studied. To determine the oral and oropharyngeal HPV strain prevalence and associated factors in a selected male population in Pretoria, South Africa (SA). Male factory workers were recruited. Oral rinse and gargle samples were tested for 37 HPV types using the Linear Array HPV Genotyping Test (Roche Molecular Systems). A questionnaire was used to obtain information regarding age, medical conditions, substance and alcohol use and sexual behaviour. HIV testing was optional. The HPV prevalence was 5.6% among men (N=125) aged 17 - 64 years. High-risk HPV (hrHPV) types 16 and 68 were found in two men. Oral sex seemed to be an uncommon practice in the majority of respondents, but the two respondents with hrHPV did practise oral sex. There was a statistically significant association between HPV infection and an increased number of sexual partners (p=0.027), but not between HPV and substance use, HIV status or clinical mucosal pathology. The prevalence of oral and oropharyngeal HPV was lower than reported in other countries. An association between oral HPV and having multiple sexual partners was found. A larger nationwide study would give a more representative view of the burden of oral and oropharyngeal HPV infection in SA.

Dental prosthetist experience with oral mucosal screening and referral.

This study aimed to investigate dental prosthetists' experiences with screening and referral for suspicious oral mucosal pathology. Questionnaires regarding oral mucosal screening and referral were mailed to 300 randomly selected dental prosthetists in Australia for selfcompletion. Non-responders were sent replacement questionnaires up to three times, according to the Dillman method. A total of 179 prosthetists returned completed questionnaires resulting in a response rate of 64.9% after excluding 24 due to incorrectly listed addresses. Most participants reported that they checked all new patients for oral mucosal pathology (99.4%) and most reported that they checked all recall patients for mucosal pathology (86%). Most participants had detected a suspicious lesion (86%) and most had referred for a suspicious lesion (77.3%). Australian dental prosthetists appear motivated to perform oral mucosal screening and will refer suspicious oral mucosal pathology when detected.

Sinonazal Bölge Aanatomik Varyasyonlarının Paranazal Sinüs Enfeksiyonları İle İlişkisi

Purpose: The aim of this study was to examine the frequency of anatomical variations of thesinonasal region detected by Computed Tomography (CT) and, to investigate their roles onparanasal sinus infections.Methods: In this study, coronal section CT images of 120 patients who were admitted to ourhospital’s Ear, Nose and Throat Clinic with sinonasal complaints between January 2012 andNovember 2012 were retrospectively reviewed. Sinonasal anatomical variations detected by CTimaging and their relationships with the mucosal pathologies of paranasal sunuses were alsoinvestigated.Results: On paranasal CT imaging, major variations in order of their frequency were Aggernasi cells (47.5%), concha bullosa (34.2%), septum deviation (31.2%), septum pneumatization(24.5%) and paradoxical middle concha (17.5%). Of these cases, 55% were associated withmucosal pathologies and maxillary sinuses were the most frequently involved sinus. Paradoxicalmiddle concha, Agger nasi cell, septum pneumatization and septum deviation were frequentlyencountered with mucoperiosteal pathologies whereas Onodi and Haller cell seemed to associatesinus pathologies less commonly.Conclusion: Sinonasal anatomic variations are closely related with occurrence of paranasalsinus infection. CT is the most effective diagnostic tool for evaluation of these variations.Considering and reporting of these variations are important because preoperative identificationof these anatomic variations gives advantage to the surgeon for choosing the operation type aswell as clarify the reason of the sinonasal complaints

The role and application of exfoliative cytology in the diagnosis of oral mucosa pathology - contemporary knowledge with review of the literature.

On the basis of the current available literature, the authors have presented a short description of cytological examination and its application in the oral mucosa disease diagnostic process. Furthermore, the advantages and disadvantages of this method are described. The available diagnostic tools used for oral smears were reviewed as well as more and more often available methods which aim at making the diagnosis process more accurate and more favorable for patients. Oral cytology analysis may, in the near future, be a very useful examination for patients in terms of diagnostics and monitoring, not only during the treatment but also afterwards. The authors would like to demonstrate what a beneficial tool this cytological examination could be as a fast and cheap cancer prophylactic test. This opinion is based on the fact that this cytological method has significantly improved the detection of uterine cervical cancer during a gynecological examination since the introduction of the Papanicolau technique in the 40s.

Does Eosinophilic Inflammation Affect the Outcome of Endoscopic Sinus Surgery in Chronic Rhinosinusitis in Koreans?

The implication of eosinophilic inflammation in chronic rhinosinusitis (CRS) has not been sufficiently studied in Asians. The aim of this study was to evaluate the relationship between eosinophilic inflammation in sinonasal tissues and the surgical outcome of functional endoscopic sinus surgery (FESS) in Koreans. A retrospective review of medical records was performed for 347 patients who had undergone bilateral FESS. During FESS, nasal polyp (NP) or sinonasal pathological mucosa was obtained and histopathological analyses were performed. For analyses of surgical outcomes, 173 patients whose follow-up was >12 months were included. The sinonasal cavity was evaluated by endoscopic examination at the last follow-up using a Lund-Kennedy endoscopic scoring system. Of 347 patients whose tissues were histologically evaluated, 250 (72%) had noneosinophilic CRS. The patients were categorized into four groups according to the presence of NP and eosinophilic inflammation. Of 173 patients, 43 patients (24.9%) had eosinophilic CRS with NP, 15 (8.7%) had eosinophilic CRS without NP, 74 (42.7%) had noneosinophilic CRS with NP, and 41 (23.7%) had noneosinophilic CRS without NP. There were no statistically significant differences in prevalence of allergic rhinitis and asthma and in their preoperative Lund-Mackay scores among four groups. Also, there was no statistically significant difference in the postoperative Lund-Kennedy score between eosinophilic and noneosinophilic CRS groups. The results suggest that eosinophilic inflammation in CRS may not be related to the surgical outcome in Koreans.

Esophageal Eosinophilia and Gastric Mucosal Pathology: Is There a Link?

Purpose: We have previously reported an inverse relationship between eosinophilic esophagitis (EoE) and H. pylori infection. The present study tests the hypothesis that other gastric conditions likely related to H. pylori infection might also be less common in EoE patients, and that conditions unrelated to H. pylori infection would be independent of esophageal eosinophilia. Methods: We used the Miraca Life Sciences database to extract histopathologic, demographic, and clinical information from all patients with esophageal and gastric biopsies obtained between 1.2008 and 6.2012; those with upper GI cancer or esophageal surgery were excluded. Patients were stratified in 5 groups based on the numbers of eosinophils per high-power field (eos/HPF) in their esophageal squamous mucosa (<15, the controls; 15 to 45; 46 to 60; 61 to 75; and > 75). The prevalence of common gastric histopathologic diagnoses was determined according to the updated Sydney System: normal mucosa, H. pylori gastritis, chronic inactive gastritis (CIG), reactive gastropathy (RG), intestinal metaplasia (IM), and atrophic gastritis (AIG). Results: Of the 212,982 unique patients with both esophageal and gastric biopsies, 204,525 had <15 eos/HPF in the esophageal epithelium (median age 57 years [yrs]; 68.5% F), and 8,457 had ≥15 eos/HPF (median age 45 y; 37.8% F). A normal gastric mucosa was significantly more common in patients with EoE than in patients with <15 eos/HPF (23% vs. 18%; odds ratio [OR] 1.35; 95% CI 1.28 - 1.42; p<.0001; see Figure 1). H. pylori gastritis and, as expected, its associated conditions (CIG and IM), were inversely related to EoE. Reactive gastropathy, damage likely caused by NSAIDs or bile reflux, had an inverse relationship with EoE (12% vs. 16%; OR 0.70; 95% CI 0.66 - 0.75; p<.0001). AIG, an autoimmune condition whose etiologic relationship with H. pylori is uncertain, had the strongest inverse association with EoE (0.4% versus 0.1%; OR 0.36; 95% CI 0.20 - 0.65; p<.001).FigureConclusion: This study confirms the inverse relationship between EoE and H. pylori and its sequelae. Conditions that are clearly unrelated (RG) or uncertainly linked to H. pylori (AIG) were also less likely in patients with EoE. While selection bias and age may play a role in these findings, the possibility that the reduced acid reflux (due to hypo- or achlorhydria) in patients with AIG may limit eosinophilic infiltration in the esophageal mucosa may warrant further investigation.

Stem cell–directed therapies in pancreatic cancer

Gut microbiota-derived metabolites are involved in intestinal inflammation, which can affect the development of atherosclerotic plaques. Previous studies have shown that oat fiber can delay the progression of atherosclerosis via improving lipid metabolism. The aim of this study was to evaluate how oat fiber acted on gut microbiota-derived metabolites, inhibited intestinal inflammation, and protected the intestinal mucosal barrier.Male low-density lipoprotein receptor knock-out (LDLR–/–) mice were fed a high-fat/cholesterol diet with or without oat fiber for 14 wk. Histopathology of the aorta was detected by Oil Red O staining, and the small intestine mucosal pathology was measured through hematoxylin and eosin staining. Non-targeted metabolomics of feces was performed using liquid chromatography-mass spectrometry. Western blot method was used to assess the relative levels of the proteins involved in the toll-like receptor (TLR)4 signal pathway and intestinal mucosal barrier in interest tissues.Pathologically, oat fiber reversed the increment of the atherosclerotic lesion and ameliorated intestinal mucosal barrier in LDLR–/– mice. Oat fiber regulated the levels of gut microbiota-derived metabolites along with a decrease in isobutyrylcarnitine, valerylcarnitine, 1-methylguanosine, and 2-methylguanosine, and an increase in l-tyrosine and niacinamide. Notably, oat fiber blocked the TLR4 signal pathway and decreased the expression of nuclear factor-κB p65 in both the aorta and gut tissues. Also, oat fiber raised the expression of tight junction proteins including ZO-1 and occludin.Taken together, the present study revealed that oat fiber feeding effectively attenuated the development of atherosclerosis, at least partly via affecting gut microbiota-derived metabolites, inhibiting the intestinal inflammatory response, and maintaining the integrity of the intestinal mucosal barrier.

Renewed Attention for Overtube-Assisted Colonoscopy to Prevent Incomplete Endoscopic Examination of the Colon

Colonoscopy is the standard examination to detect mucosal pathology in the colon. However, failure to complete colonoscopy may reach more than 10% in population-based endoscopy practices. The reasons for incomplete conventional colonoscopy are diverse and result in missed diagnosis of colonic polyps and carcinoma. Recent endoscopic developments have shown that the use of specialized overtubes may help to reach the cecum in the case of a difficult colonoscopy, even with less discomfort. Several types of overtubes are currently available, whereas other types are being developed and clinically evaluated. The current review highlights the development of overtubes for colonoscopy and the available clinical data on overtube-assisted colonoscopy in the case of incomplete conventional colonoscopy. Data were derived from a PubMed search through November 2012. Available clinical literature data on recent developments in overtube-assisted colonoscopy were studied. A descriptive comparison was made of currently available endoscopy systems used for overtube-assisted colonoscopy. The primary outcomes measured were the feasibility and safety of different endoscopy systems to perform overtube-assisted colonoscopy. Several overtube-assisted colonoscopy systems have recently been developed to complete colonoscopy in the case of difficult conventional colonoscopy. Literature data show excellent feasibility to reach the cecum with very low complication rates and good patient tolerance for the different overtube systems. The majority of available studies are uncontrolled case series describing 7 to 110 patients undergoing overtube-assisted colonoscopy with only 1 direct comparison between 2 overtube systems. Overtube-assisted colonoscopy has been shown to be useful in performing colonoscopy by increasing the cecal intubation rate and patient tolerance and by decreasing the need for sedation. There is no standardized superior overtube system at this moment.

Ghost cells transformation of oral epithelium in irritational fibroma and oral submucous fibrosis: A pathogenetic viewpoint

ObjectiveIt was proposed that ghost cells (GCs) are formed as a result of metaplasia caused due to reduction in oxygen supply. Hence, identification of GC like features in irritational fibroma and oral submucous fibrosis (OSMF) is carried out where reduction in oxygen supply to the overlying epithelium is expected due to fibrosis and hyalinization in the stroma. Materials and methodWe retrospectively analyzed 113 cases of irritational fibroma and 55 cases of OSMF. The epithelium of each lesion was carefully searched for GC like features. ResultsFive cases (4.43%) of irritational fibroma and 2 OSMF cases (3.63%) showed GC transformation of spinous and basal cells of epithelium. The surface keratinized layers were absolutely normal. No differences were seen in the degree of fibrosis between GC cases and non-GC cases. The stroma showed patent vascular spaces just beneath the basement membrane in all the cases. ConclusionGC transformation of oral epithelium in irritational fibroma and OSMF is not reported in the literature till date. Patent vascular spaces are seen in the histopathological examination which goes against the hypothesis. Hence, alternate hypothesis of mucin induced GC transformation has been proposed for mucosal pathologies.

Comparison of magnetic resonance enterography, capsule endoscopy and gastrointestinal radiography of children with small bowel Crohn’s disease

The aim of this study was to compare magnetic resonance enterography (MRE) findings with those of video capsule endoscopy (VCE) or conventional gastrointestinal radiography (CGR) in pediatric patients with small bowel Crohn’s disease. A total of 55 cases of small bowel Crohn’s disease that were diagnosed through clinical, laboratory, surgical and histopathological findings were reviewed. Prior to the examination, children suspected of having other types of diseases of the small intestinal were identified. The pulse sequences included coronal T2-true-fast imaging with steady-state precession (TrueFISP) images, navigation axial and coronal T1-weighted images, T2-weighted fat-suppressed images and coronal fat-suppressed three-dimensional gradient-echo images, immediately followed by contrast-enhanced axial and coronal T1-weighted fat-suppressed images. Findings from MRE were compared with those of VCE (n=39) and CGR (n=37). MRE results exhibited a number of features characteristic to small bowel Crohn’s disease, including wall thickening, mesenteric fibrofatty changes and mesenteric vasculature changes. VCE, MRE and CGR demonstrated sensitivities of 94.6, 85.7 and 71.1% with specificities of 72.7, 70 and 40%; accuracies of 89.6, 82.2 and 61.1%; positive predictive values of 92.1, 90.9 and 59.6%; and negative predictive values of 80, 58.3 and 40%, respectively. VCE depicted mucosal pathologies missed by MRE in three patients. MRE revealed 83 extraenteric findings in 55 patients and CGR was able to show the dynamic evolution of the gastrointestinal function. MRE is a simple, safe, non-invasive and effective method for evaluating small bowel Crohn’s disease. VCE allows visualization and readily characterizes subtle mucosal lesions missed by MRE, whereas MRE yields additional mural, perienteric and extraenteric information. However, oral barium CGR utilizes radiation, which is not suitable for repeated use in children.

Tu1323 Gender Differences - Analysis of 6704 Colonoscopies Over 5 Years Reveals Lower Caecal Intubation Rates in Female Patients

Colonoscopy is the gold standard assessment for large bowel mucosal pathology, but a complete examination is an essential requirement. Lower caecal intubation rates (CIR) in female patients versus male patients have been shown in the literature (1-3). Several theories are mooted for this difference such as female patients undergoing previous hysterectomy (1), low BMI (2) and the suggestion that female patients have longer colons (3).The published papers on this subject are mostly over 10 years old and colonoscopy practice has changed dramatically over the last decade in the UK.

The Acid Pocket: A Target for Treatment in Reflux Disease?

The nadir esophageal pH of reflux observed during pH monitoring in the postprandial period is often more acidic than the concomitant intragastric pH. This paradox prompted the discovery of the "acid pocket", an area of unbuffered gastric acid that accumulates in the proximal stomach after meals and serves as the reservoir for acid reflux in healthy individuals and gastroesophageal reflux disease (GERD) patients. However, there are differentiating features between these populations in the size and position of the acid pocket, with GERD patients predisposed to upward migration of the proximal margin onto the esophageal mucosa, particularly when supine. This upward migration of acid, sometimes referred to as an "acid film", likely contributes to mucosal pathology in the region of the squamocolumnar junction. Furthermore, movement of the acid pocket itself to a supradiaphragmatic location with hiatus hernia increases the propensity for acid reflux by all conventional mechanisms. Consequently, the acid pocket is an attractive target for GERD therapy. It may be targeted in a global way with proton pump inhibitors that attenuate acid pocket development, or with alginate/antacid combinations that colocalize with the acid pocket and displace it distally, thereby demonstrating the potential for selective targeting of the acid pocket in GERD.

708 Upper Endoscopy Prior to Bariatric Surgery: Do Visual Findings Accurately Predict Mucosal and Anatomical Pathology?

708 Upper Endoscopy Prior to Bariatric Surgery: Do Visual Findings Accurately Predict Mucosal and Anatomical Pathology?

Su1873 Eosinophilic Esophagitis in Patients Presenting With Dysphagia–a Prospective Analysis

Introduction Eosinophilic oesophagitis (EO) is a chronic relapsing,immune/antigen mediated disease of the oesophagus with rapidly increasing incidence and prevalence; however EO often remains under-diagnosed. Early detection and appropriate therapy improves quality of life and may prevent development of chronic oesophageal changes. A diagnosis can only be made when a dense eosinophilia is confirmed on histology in the context of typical symptoms (e.g.solid food dysphagia) 1 .We prospectively assessed the prevalence of EO in patients presenting to endoscopy at a tertiary referral centre with solid food dysphagia over 2 years. Methods Between Jan 2010 and Dec 2011,746 patients with dysphagia (including food bolus obstruction)had high definition white light endoscopy performed. Patient demographics,symptomatology,endoscopic and histological findings were recorded.EO was defined as the presence of > 15 eosinophils per high power field Results Patients with oesophageal malignancy (n = 65),barrett’s oesophagus(n = 48) and post-oesophageal surgery complications (n = 16) were excluded. Of the 628 remaining patients,388(62%) (254 male; mean age 59; range 18–88) had mid-oesophageal biopsies taken.23/388 (5.9%)were diagnosed with EO 19 male; mean age 40; range 26–56).Endoscopy showed mucosal pathology in 12/23 (52%)patients with confirmed EO; oesophagitis (n = 3),red furrows (n = 3),distal narrowing (n = 2),corrugated rings (n = 2),mucosal tear (n = 1) and white exudates (n = 1).250 of the remaining patients had grade A or B oesophagitis. Overall 17 patients had food bolus obstruction.11/17 patients had biopsies taken and 5/11(46%) showed histological evidence of EO.4/5 patients with bolus obstruction had distal oesophagitis on endoscopy but EO was confirmed following ≥4 mid-oesophageal biopsies. There was a trend towards those with EO having had a greater number of biopsies taken (mean 6.14; range 2–12) compared to those without EO (mean 5.02; range 2–8; p = 0.082).28% and 51% had ≤3 and ≤4 biopsies collected respectively. The mean (±SD) number of eosinophils/hpf in the EO group was 64.3 (51.3). Conclusion Mid-oesophageal biopsies can diagnose EO in at least 1 in 16 cases of patients with unexplained solid food dysphagia.However,1/3 of patients in whom EO should have been considered (including 6 with food bolus obstruction)did not have biopsies collected.Furthermore, 1/4 had less than the recommended minimum 4 mid-oesophageal biopsies. In summary, our experience has shown that EO detection is likely to improve further if all patients with symptoms conducive with EO (e.g.solid food dysphagia) routinely trigger an EO biopsy protocol of ≥4 from the mid-oesophagus regardless of endoscopic findings. Disclosure of Interest None Declared Reference Liacouras CA, Furuta GT et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011; 128(1):3–20 e6.

Pathologic tumor and normal mucosa responses after hyperfractionated versus hypofractionated preoperative radiotherapy for rectal cancer.

556 Background: The aim of the study is to assess radiation-induced tumor and normal mucosa responses in patients who underwent preoperative radiotherapy according to two different fractionation protocols. This research constitutes one of the secondary endpoints of a prospective randomized trial. Methods: Pathological samples after preoperative radiotherapy and surgery were obtained from 106 patients: 50 were treated with hypofractionation 39 Gy in 3.0 Gy per fraction (HYPO) and 56 with accelerated hyperfractionation 42 Gy given in two daily fractions of 1.5 Gy with a minimal interfraction interval of 6 hours (HART). This sample represents approximately 30% of an overall trial size. Over 50 pathological features were assessed for each sample including tumor/nodal response, normal mucosa and cellular matrix response, ulceration and morphology of tumor cells. The observed grades of responses in HYPO vs. HART were compared using U Mann-Whitney test. Results: The primary tumor downstaging was observed in 41% vs. 35% of the patients treated with HYPO and HART respectively, the difference was not significant (p=0.5). By contrast, a trend towards improved nodal response among the patients treated with HYPO was recorded, with 94% achieving complete or major nodal response, compared to 73% in HART (p=0.03). Mucosal atrophy and edema were significantly higher in HYPO (p=0.003 and p=0.02, respectively). A trend for increased mucosal inflammation was also recorded in HYPO (p=0.06). Tumor/nodal responses were not significantly influenced by time-interval radiotherapy-surgery (below or above the median of 11 days), however, more cellular injury to normal mucosa (atrophy, ulceration) was observed at short RT-surgery intervals (p=0.01). Conclusions: Radiation-induced tumor and normal mucosa responses differ significantly according to fractionation schedule, with more mucosa injury observed in HYPO. Pathological responses of mucosa are also influenced by time-interval radiotherapy-surgery.