Upper Gastrointestinal Diseases Research Articles

Elevated Faecal Calprotectin in Patients with a Normal Colonoscopy: Does It Matter in Clinical Practice? A Retrospective Observational Study

Introduction: Faecal calprotectin (FC) is commonly used as a diagnostic tool for patients with gastrointestinal (GI) symptoms. However, there is uncertainty in daily clinical practice how to interpret an elevated FC in patients with a normal colonoscopy. We investigated if patients with a normal colonoscopy but with an elevated FC more often were diagnosed with a GI disease in a 3-year follow-up period. Methods: Patients referred for colonoscopy (n = 1,263) to the Umeå University Hospital endoscopy unit between 2007 and 2013 performed a FC test (CALPRO^®) on the day before bowel preparation. A medical chart review was performed on all patients who had normal findings on their colonoscopy (n = 585, median age 64 years). Results: Thirty-four percent of the patients (n = 202) with normal colonoscopy had elevated FC (>50 μg/g), and these patients were more frequently diagnosed with upper GI disease during the follow-up period than patients with normal FC levels (9.9 vs. 4.7%; p = 0.015). The upper GI diseases were mainly benign (i.e., gastritis). In a binary logistic regression analysis controlling for age, gender, nonsteroid anti-inflammatory drug use, and proton-pump inhibitor use, there was no difference for a new diagnosis of upper GI disease in the follow-up period (multivariate OR 1.70; 95% CI: 0.77–3.74). There was no difference in a new diagnosis of lower GI disease (6.4 vs. 5.2%; p = 0.545) or cardiovascular disease/death (multivariate OR 1.68; 95% CI: 0.83–3.42) in the follow-up period between patients with elevated versus normal FC levels. Conclusions: In patients with a normal colonoscopy, a simultaneously measured increased FC level was not associated with an increased risk for significant GI disease during a follow-up period of 3 years.

Helicobacter pylori infection a risk for upper gastrointestinal diseases among patients in North Central Nigeria

Background: Since the discovery of the Upper Gastrointestinal (UGI) fiber optic endoscope machine in 1868 and following the discovery of Helicobacter pylori (H- Pylori) infection and its association with most gastroduodenal diseases in 1983 by Robin Warren and Barry Marshal, Our knowledge of diagnosis and treatment of most UGI diseases has significantly improved. Aim: The study aimed to establish the presence of H. pylori as a risk factor for common UGI disease as confirmed by UGI endoscopy and the pattern of findings in UGI endoscopy. Methodology: This study is a descriptive cross-sectional study that was carried out at the Endoscopy Unit of Jos University Teaching Hospital. A total of 260 patients referred for UGI endoscopy from August 2013 to April 2014 were recruited and investigated for H. pylori from the biopsy specimens taken during UGI endoscopy. The diagnosis of H. pylori was made by histology. Result: A total of 260 patients were studied, 159 (61.2%) males and 101 (38.8%) females. H. pylori were present in 169 (65%) and absent in 91 (35%). More females had H. pylori compared to males (67.3% and 63.5%). The common endoscopic findings were present in the stomach. Gastritis 57 (21.9%) was the most common abnormality seen in the stomach, while gastroesophageal reflux disease was the most commonly seen in the esophagus and duodenal ulcer in the duodenum. Conclusion: There is a positive correlation between H. pylori infection with endoscopic abnormalities seen among patients.

Role of Artificial Intelligence in Upper Gastrointestinal Diseases: Present and Future

There has been extensive research and progress in the medical application of Artificial Intelligence (AI) technology. Radiologic and endoscopic diagnosis based on image analysis has been one of the main areas of focus. In the field of Gastrointestinal (GI) endoscopy, AI has been applied to gastroscopy, capsule endoscopy, and colonoscopy. There are relatively fewer studies in which AI is applied to upper GI diseases, and analysis has mainly focused on the detection of esophageal or gastric neoplasms in upper GI endoscopy. AI is also used to assess the depth of cancer invasion, detect Helicobacter pylori (H. pylori) infection, and diagnose the characteristics of subepithelial lesions. In the near future, AI is expected to expand to the field of disease treatment.

Characteristics and predictors of postoperative outcome of Crohn disease patients requiring abdominal surgery: a series of 1 048 cases from a single inflammatory bowel disease centre

Objective: To examine the clinical characteristics, the potential relative factors for postoperative abdominal septic complications, and prognosis factors of surgical recurrence of Crohn disease (CD) patients after the first surgery. Methods: All the CD patients from Department of General Surgery, Jinling Hospital, Medical School of Nanjing University who had undergone at least one abdominal surgery from January 2007 to December 2017 were included for retrospective analysis. Hospital records were reviewed for information on clinical characteristics. Relative factors of postoperative abdominal septic complications were accessed by Logistic regression models, and prognosis factors of surgical recurrence were accessed by Cox proportional hazards regression models. Results: There were 1 048 patients included (733 males and 315 females), accounting for 1 513 operations. The age was 31(17) years and the length of resected small bowel was 30.0(40.0) cm at the first resection, 20.0(35.0) cm at the second resection, and 20.0(23.5) cm at the third resection. The length of resected small bowel was 25.0(40.0) cm at any resection. At the first abdominal surgery, 70.99%(744/1 048) patients were aged between 17 and 40 years, 66.98%(702/1 048) patients had ileocolonic disease, and 60.40%(633/1 048) patients had penetrating behavior. Penetrating behavior (OR=8.594, 95%CI: 3.397 to 21.740, P<0.01) and current smoking status (OR=2.671, 95%CI: 1.044 to 6.832, P=0.040) were significantly associated with an increased risk of postoperative septic complications, whereas staged operation (OR=0.360, 95%CI: 0.184 to 0.707, P=0.003) was associated with a decreased risk. Male gender (HR=1.500, 95%CI: 1.128 to 1.995, P=0.005), upper gastrointestinal disease (HR=1.526, 95%CI: 1.033 to 2.255, P=0.034), penetrating behavior (HR=1.506, 95%CI: 1.132 to 2.003, P=0.005) and emergency surgery (HR=1.812, 95%CI: 1.375 to 2.387, P<0.01) were significantly associated with an increased risk of postoperative surgical recurrence, whereas staged operation (HR=0.361, 95%CI: 0.227 to 0.574, P<0.01) was significantly associated with a decreased risk. Conclusions: In this cohort of CD patients receiving abdominal surgery from an inflammatory bowel disease center, the median age was 31 years and the median length of resected small bowel was 30 cm, at first resection. Patients who have risk factors of adverse postoperative outcome may be benefited from staged surgical approach.

Comparison of endoscopic and pathological findings of the upper gastrointestinal tract in transplant candidate patients undergoing hemodialysis or peritoneal dialysis treatment: a review of literature

BackgroundDyspepsia is a common disorder in kidney transplant recipients, and the risk of post-transplant complications is increased in candidates with upper gastrointestinal disease. We evaluated gastrointestinal lesions of kidney transplant candidates on dialysis.MethodsIn this study, endoscopic and pathological findings in hemodialysis (HD) and peritoneal dialysis (PD) patients with gastrointestinal symptoms on the waiting list were compared.ResultsThe most common non-ulcerous lesions in the endoscopic examination were gastritis (62.3%), erosive gastritis (38.7%), duodenal erosion or duodenitis (18.9%) and esophagitis (13.2%). The ulcerous lesion was present in only 3 patients. Gastroesophageal reflux disease, ulcerated lesion and non-ulcerated lesion rates were similar in both dialysis groups. Histopathological examination revealed Helicobacter pylori (HP) positivity in 28.3% of patients. HP positivity rate was significantly higher in PD patients than in HD patients (38.7% vs. 13.6%, p = 0.046). Chronic gastritis (75.5%) was the most common pathological finding. HP positivity rate was 37.5% in patients with chronic gastritis, but HP was negative in patients without chronic gastritis. In multivariate analysis, male gender, urea and albumin levels were associated with the presence of pathological chronic gastritis. The presence of gastritis, total cholesterol and ferritin levels were found significant for HP positivity. A total cholesterol > 243 mg/dL was significantly related to an increased risk of the presence of HP positivity.ConclusionsGastrointestinal lesions and HP infection are common in dialysis patients. Dialysis modality may affect the frequency of some lesions. It may be useful to have an endoscopic examination before entering the transplant waiting list for all candidates.

Effect of Acid Suppressants on the Risk of COVID-19: A Propensity Score-Matched Study Using UK Biobank

Effect of Acid Suppressants on the Risk of COVID-19: A Propensity Score-Matched Study Using UK Biobank

Defining Endpoints and Biomarkers in Inflammatory Bowel Disease: Moving the Needle Through Clinical Trial Design

Defining Endpoints and Biomarkers in Inflammatory Bowel Disease: Moving the Needle Through Clinical Trial Design

Comparison of Dietary Habit, Lifestyle, Health Attitude and Self-efficacy by Upper Gastrointestinal Disease among Group Mental Health Care Facilities with Chronic Schizophrenia

Comparison of Dietary Habit, Lifestyle, Health Attitude and Self-efficacy by Upper Gastrointestinal Disease among Group Mental Health Care Facilities with Chronic Schizophrenia

Risk factors for precancerous lesions of esophageal squamous cell carcinoma in high-risk areas of rural China: A population-based screening study.

Although many studies in China have found that environmental or lifestyle factors are major contributors to the etiology of esophageal cancer, most of the patients in the above studies are in the middle and late stages, the early-stage patients account for a small proportion. To clarify the risk/protective factors contributing to early lesions, we conducted the present cross-sectional study.A total of 2925 healthy controls and 402 patients with esophageal precancerous lesions were included in our study by endoscopic examination. Information on risk/protective factors was collected by personal interview, and unconditional logistic regression was used to determine adjusted odds ratios (AORs) by the maximum-likelihood method.Smoking >20 pack-years (AOR = 1.48), duration of drinking >30 years (AOR = 1.40), alcohol consumption >100 mL/d (AOR = 1.44), gastroesophageal reflux disease (AOR = 1.75), esophagitis (AOR = 1.25), a family history of esophageal cancer (AOR = 1.92), or stomach cancer (AOR = 1.92) were significant risk factors for esophageal precancerous lesions. There was a negative correlation between abdominal obesity and early esophageal cancer and precancerous lesions (AOR = 0.75). In addition, we found that there was a synergistic effect between a family history of esophageal cancer and drinking (AOR = 3.00) and smoking (AOR = 2.90).Lifestyle risk factors, genetic factors, and upper gastrointestinal diseases are associated with the development of esophageal precancerous lesions. These results highlight the need for primary prevention to reduce the future burden of cancer and other chronic diseases in high-risk areas of rural China.

Clinical consequences of controversies in gastric physiology

Studies on the regulation of gastric acid secretion started more than 100 years ago at an early phase of experimental physiology. In nearly the whole last century there were disputes about the interpretation of the findings: the interaction between the three principle gastric acid secretagogues acetylcholine, gastrin and histamine, the cell producing the relevant histamine which turned out to be the ECL cell, the ability of the ECL cell to divide and thus develop into tumours, the classification of gastric carcinomas and the mechanism for Helicobacter pylori carcinogenesis. The elucidation of the central role of the ECL cell and thus its main regulator, gastrin, solve all these controversies, and gives a solid base for handling upper gastrointestinal diseases.

P1719GASTRODUODENAL LESIONS AND HELICOBACTER PYLORI INFECTION IN ASYMPTOMATIC RENAL TRANSPLANT CANDIDATES

Abstract Background and Aims Patients suffering from end stage renal disease usually cope with many problems due to their lengthy illness and its complications. Renal transplantation is the most effective therapeutic strategy in these patients. One of the post transplantation complications is gastrointestinal bleeding due to peptic ulcers and other upper gastrointestinal diseases which can affect the morbidity and mortality of these patients. The present research aims to shed lights on prevalence of gastrointestinal lesions and Helicobacter pylori infection using upper endoscopy in asymptomatic candidates for renal transplantation. Method The present cross-sectional research was performed on renal transplant candidates suffering chronic renal failure referred to Montaserie organ transplantation center in the time period of January 2016, to January 2018. Eighty five ESRD patients, 45 male and 40 female, mean age 39.09 ± 11.09 years, enrolled in the study. Hypertension and diabetes were the most common causes of kidney failure in the patients. In the present research about 90.6% of patients had been on chronic dialysis,. Mean duration of vintage time on dialysis was 20.46 ±16.12 months, and hemodialysis (87%) was the most common dialysis method. Including criteria were patients candidature for renal transplant and consent for involvement in the research. Excluding criteria were patients with apparent dyspeptic symptoms, patients with known upper gastrointestinal diseases, and patients who have been using PPIs (proton pump inhibitors), NSAIDs(non-steroid anti-inflammatory drug), H2 blockers or antibiotics over the past two weeks preceding the enrollment in study . Patients who met criteria underwent endoscopy and were classified according to endoscopic findings, Helicobacter pylori infection and pathologic findings. Chi-square statistics was used for evaluating the correlation between categorical endoscopic or pathologic findings with categorical demographic and dialysis characteristics parameters. The Statistical Package for the Social Sciences software (SPSS version 20.0, SPSS Inc., Chicago, IL, USA) was used for data analyses. A P &amp;lt;0.05 was considered significant. Results Sixty two patients (72%) had significant endoscopic findings; erosive gastroduodenitis (32.5%) was the most common findings. There was not a significant correlation between endoscopic findings and: age (p = 0.5), cause of renal failure (p-value = 0.9), dialysis type (p-value = 0.08), gender (p-value = 0.9), infection with H. Pylori (p-value = 0.2) and mean duration of vintage dialysis time (p = 0.4).All the patients with significant endoscopic findings, had also significant abnormal pathologic findings on endoscopic obtained biopsied samples. Helicobacter pylori infection was seen in, 36 patient(42%)s. Significant association between H. Pylori infection and abnormal pathology was found (p=0.04) . Conclusion Asymptomatic gastrointestinal lesions and Helicobacter pylori infection are prevalent in renal transplant candidates, so routine upper endoscopy in these patients is strongly recommended.

1111 SECOND-GENERATION MAGNETICALLY CONTROLLED CAPSULE GASTROSCOPY FOR BETTER DIAGNOSIS OF UPPER GASTROINTESTINAL TRACT: A RANDOMIZED CONTROLLED CLINICAL TRIAL

Compared to conventional endoscopy, magnetically controlled capsule gastroscopy (MCCG) can be further optimized in gastric examination time and complete visualization of upper gastrointestinal (UGI) mucosa. The second-generation MCCG (MCCG-2) was developed with higher image resolution and adaptive frame rate, and we aimed to evaluate its clinical availability for UGI examination in this study. Consecutive patients undergoing MCCG examination between May to June 2019 were prospectively enrolled and randomized to swallow the first-generation MCCG (MCCG-1) or MCCG-2 in a 1:1 ratio. The main outcomes included visualization of the esophagus and duodenum, operation related parameters, image quality, maneuverability, detection of lesions, as well as safety evaluation. Eighty patients were enrolled. In MCCG-2 group, frames captured for esophageal mucosa and Z-line were 171.00 and 2.00, significantly increased from those in MCCG-1 group with 97.00 and 0.00 (P=0.002 and 0.028). The gastric examination time was shortened from 7.78±0.97 min to 5.27±0.74 min (P<0.001), with the total running time of capsule extended from 702.83 min to 1001.99 min (P<0.001). MCCG-2 also greatly improved the image quality (P<0.001) and maneuverability (P<0.01). No statistical difference existed in the detection of lesions between the two groups, and no adverse events occurred. MCCG-2 showed better performance in mucosal visualization, examination duration and maneuverability, making better diagnosis of UGI diseases a possibility.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

ISDE guidance statement: management of upper gastrointestinal endoscopy and surgery in COVID-19 outbreak

SUMMARYThis is an official guidance statement of The International Society of the Diseases of the Esophagus (ISDE) to address all the operators involved in management of patients affected by upper gastrointestinal diseases during COVID-19 pandemic. This guidance is based on the best available evidence to date and will be updated as new evidence becomes available.

Association Between Acid-Suppressive Agents' Use and Risk of Hepatocellular Carcinoma.

Background:Acid-suppressive agents (ASAs), which are mostly used in patients with upper gastrointestinal diseases (UGIDs), may influence the risk of hepatocellular carcinoma (HCC).Methods:A population-based retrospective cohort study was conducted. Patients with UGID who used ASAs and those who did not receive ASAs were identified. Patients without UGIDs were randomly selected and matched (comparison group). All groups were followed up for 6 years. A Cox proportional hazard model was used to estimate the risk of HCC among the different groups.Results:Patients with UGID who used ASAs had a significantly elevated HCC risk (adjusted hazard ratio [HR] 1.53; 95% confidence interval [CI], 1.32-1.76] compared to those who did not use ASAs. Patients with UGID who used more than 540 defined daily doses of ASAs had a significantly higher risk of HCC (adjusted HR 2.04; 95% CI, 1.62-2.58). Moreover, the dose effect on HCC risk exhibited a significant increasing trend (P < .01). Furthermore, patients with UGID who did not use ASAs had a significantly elevated HCC risk (adjusted HR 1.94; 95% CI, 1.59-2.36) compared to the comparison group.Conclusion:The use of ASAs increased the risk of HCC in patients with UGIDs, and the effect of ASAs was dose dependent. In addition, UGIDs alone increased the risk of HCC.

An Experimental Bacteriostasis of the Banxiaxiexin Decoction and 7 Kinds of Single Taste Traditional Chinese Medicine on Helicobacter Pylori Resistant Strains in Vitro

Objectives: To research experimental bacteriostasis on the Banxiaxiexin decoction and 7 kinds of single taste Traditional Chinese Medicine (TCM) for Helicobacter pylori resistant strains in vitro. Methods: Collecting specimens of gastric mucosa in patients with upper gastrointestinal disease, separated and identified 8 strains of Hp resistant strains, the E-test methods of metronidazole and clarithromycin, drug resistance status of amoxicillin, selected eight strains of clinical drug resistance strains; Using liquid dilution method to determine the Banxiaxiexin decoction and 7 kinds of single Chinese medicine clinical drug-resistant strains of 8 strains of antibacterial effect in vitro. Results: Banxiaxiexin decoction MIC is 0.31 mg/ml, MIC of Radix scutellariae is 0.09 mg/ml, Rhizoma coptidis MIC 0. 16 mg/ml, Glycyrrhizin realness MIC 0. 31 mg/ml, Ginseng MIC 0. 75 mg/ml, there are four of seven kinds of single taste Traditional Chinese Medicine of TCM has bacteriostatic action, the order of antibacterial strength: Scutellaria baicalensis&gt;Coptis chinesis&gt;Glycyrrhizin realness &gt;Ginseng, three kinds of Pinellia, Jujube and dry Zingibe in vitro for H. P ylori no inhibition, the method of MIC with liquid dilution in this decoction were determined, the decoction of resistant isolates average MIC isolates was 0.20±0.09mg/ml, the results showed that this decoction have stronger antibacterial effect on eight kinds of drug resistant strains in vitro. Banxiaxiexin decoction and 4kinds of single taste TCM have stronger antibacterial effect on drug resistant strains in vitro. Conclusion: Banxiaxiexin decoction and 4 kinds of single TCM have strong bacteriostatic effect on the bacteria resistance of Helicobacter pylori strains in vitro, therefore, we suggest that this decoction could be used as an effective method in the treatment of resistant HP associated gastritis.

An Experimental Bacteriostasis of the Banxiaxiexin Decoction and 7 Kinds of Single Taste Traditional Chinese Medicine on Helicobacter Pylori Resistant Strains in Vitro

Objectives: To research experimental bacteriostasis on the Banxiaxiexin decoction and 7 kinds of single taste Traditional Chinese Medicine (TCM) for Helicobacter pylori resistant strains in vitro. Methods: Collecting specimens of gastric mucosa in patients with upper gastrointestinal disease, separated and identified 8 strains of Hp resistant strains, the E-test methods of metronidazole and clarithromycin, drug resistance status of amoxicillin, selected eight strains of clinical drug resistance strains; Using liquid dilution method to determine the Banxiaxiexin decoction and 7 kinds of single Chinese medicine clinical drug-resistant strains of 8 strains of antibacterial effect in vitro. Results: Banxiaxiexin decoction MIC is 0.31 mg/ml, MIC of Radix scutellariae is 0.09 mg/ml, Rhizoma coptidis MIC 0. 16 mg/ml, Glycyrrhizin realness MIC 0. 31 mg/ml, Ginseng MIC 0. 75 mg/ml, there are four of seven kinds of single taste Traditional Chinese Medicine of TCM has bacteriostatic action, the order of antibacterial strength: Scutellaria baicalensis>Coptis chinesis>Glycyrrhizin realness >Ginseng, three kinds of Pinellia, Jujube and dry Zingibe in vitro for H. P ylori no inhibition, the method of MIC with liquid dilution in this decoction were determined, the decoction of resistant isolates average MIC isolates was 0.20±0.09mg/ml, the results showed that this decoction have stronger antibacterial effect on eight kinds of drug resistant strains in vitro. Banxiaxiexin decoction and 4kinds of single taste TCM have stronger antibacterial effect on drug resistant strains in vitro. Conclusion: Banxiaxiexin decoction and 4 kinds of single TCM have strong bacteriostatic effect on the bacteria resistance of Helicobacter pylori strains in vitro, therefore, we suggest that this decoction could be used as an effective method in the treatment of resistant HP associated gastritis.

Comparison of surgical payer costs and implication on the healthcare expenses between laparoscopic magnetic sphincter augmentation (MSA) and laparoscopic Nissen fundoplication (LNF) in a large healthcare system

IntroductionMagnetic sphincter augmentation (MSA) is a promising antireflux surgical treatment. The cost associated with the device may be perceived as a drawback by payers, which may limit the adoption of this technique. There are limited data regarding the cost of MSA in the management of reflux disease. The aims of the study were to report the clinical outcome and quality of life measures in patients after MSA and to compare the pharmaceutical and procedure payer costs and the disease-related and overall expense of MSA compared to laparoscopic Nissen fundoplication (LNF) from a payer perspective.Methods and proceduresThis prospective observational study was performed in conjunction with the region’s largest health insurance company. Data were collected on patients who underwent MSA over a 2-year period beginning in September 2015 at the study network hospitals. The LNF comparison group was procured from members’ claims data of the payer. Inclusion was predicated by patients having continuous coverage during study period. The total procedural reimbursement and the disease-related and overall medical claims submitted up to 12 months prior to surgery and up to 12 months following surgery were obtained. The payer reimbursement data are presented as allowed cost per member per month (PMPM). These values were then compared between groups.ResultsThere were 195 patients who underwent MSA and 1131 that had LNF. MSA results in comparable symptom control, PPI elimination rate, and quality of life measures compared to values reported for LNF in the literature. The median (IQR) reimbursement of surgery was $13,522 (13,195–14,439) for those who underwent MSA and $13,388 (9951–16,261) for patients with LNF, p = 0.02. In patients who underwent MSA, the median reimbursement related to the upper gastrointestinal disease was $ 305 PMPM, at 12 months prior to surgery and $ 104 at 12 months after surgery, representing 66% decrease in cost. These values were $ 233 PMPM and $126 PMPM for patients who underwent LNF, representing a 46% decrease (p = 0.0001). At 12 months following surgery, the reimbursement for overall medical expenses had decreased by 10.7% in the MSA group and 1.4% in the LNF group when compared to the preoperative baseline reimbursement. The reimbursement for PPI use after surgery showed a 95% decrease in the MSA group and 90% among LNF group when compared to the preoperative baseline (p = 0.10).ConclusionWhen compared with LNF, MSA results in a reduction of disease-related expenses for the payer in the year following surgery. While MSA is associated with a higher procedural payer cost compared to LNF, payer costs may offset due to reduction in the expenses after surgery.

1013-P: Effect of Upper Gastrointestinal Disease on the Pharmacokinetics of Oral Semaglutide in Subjects with Type 2 Diabetes

The GLP-1 analog semaglutide has been co-formulated with the absorption enhancer sodium N-(8-[2-hydroxybenzoyl] amino) caprylate (SNAC) to allow oral administration. Since oral semaglutide is absorbed in the stomach, the effect of upper gastrointestinal disease (UGD) on exposure to oral semaglutide has been investigated in an open-label, parallel-group trial (NCT02877355). Subjects aged 18-80 years with T2D and with UGD (N=36; chronic gastritis [n=5], gastroesophageal reflux disease [GERD; n=8] or both [n=23]) or without UGD (N=19) received oral semaglutide 3 mg once-daily for 5 days followed by 7 mg for 5 days. Key endpoints were area under the semaglutide plasma concentration-time curve (AUC) (primary) and maximum semaglutide plasma concentration (Cmax) from 0-24 h after the 10th dose. Semaglutide exposure was not statistically significantly different in subjects with vs. without UGD (Figure; estimated group ratios with/without UGD [95% CI] AUC: 1.18 [0.80; 1.75]and Cmax: 1.16 [0.77; 1.76]). Time to maximum plasma concentration and half-life of semaglutide were similar in subjects with vs. without UGD. Oral semaglutide was well tolerated. All adverse events (AEs) were mild or moderate with no withdrawals due to AEs. In conclusion, no significant difference in exposure to oral semaglutide in subjects with vs. without UGD was found; hence, no dose adjustment is expected to be required. Disclosure J.J. Meier: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp &amp; Dohme Corp., Novo Nordisk A/S, Sanofi. C. Granhall: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. U. Hoevelmann: None. A. Navarria: Employee; Self; Novo Nordisk A/S. Employee; Spouse/Partner; Novo Nordisk A/S. L. Plum-Moerschel: None. C. Ramesh: None. A. Tannapfel: None. C. Kapitza: Research Support; Self; ADOCIA, Biocon, Boehringer Ingelheim Pharmaceuticals, Inc., Dance Biopharm Holdings Inc., Eli Lilly and Company, Gan &amp; Lee Pharmaceuticals, MedImmune, Mylan, Nestlé, Nordic Bioscience, Novo Nordisk A/S, Poxel SA, Sanofi-Aventis, Wockhardt, Xeris Pharmaceuticals, Inc., Zealand Pharma A/S. Funding Novo Nordisk A/S

DOZ047.75: Ectopic pancreas in children with esophageal atresia: not an incidental association

Abstract Aim of the Study Ectopic pancreas (EP) is pancreatic tissue lacking vascular or anatomic connection with the main body of the pancreas. Incidence in the general population ranges between 0.15% and 5.2%, and it is most commonly located in the stomach. It is usually asymptomatic, but it can lead to intestinal occlusion, bleeding, or malignant degeneration. After a patient with esophageal atresia (EA) debuted with a symptomatic EP, we aimed to determine EP incidence in our series of EA patients. Method Prospective single center review (2016–2018) was performed of children with upper gastrointestinal diseases who underwent diagnostic or therapeutic esophagogastroduodenoscopy (EGD). Patients were divided according to main diagnosis and gastric EP was actively searched for in every case. Results EGD was performed in 192 patients and the main diagnoses were EA in 53 (27.60%), eosinophilic esophagitis in 37 (19.27%), celiac disease in 23 (11.97%), and other upper gastrointestinal disorders in 79 (41.14%). EP was found in 7 cases (4 ♂/3 ♀), all of them in the EA group (7/53, 13.2%). Out of the 7, 4 had type III EA and in every case the EP was found at a prepyloric location. One patient debuted with hematemesis, so surgical excision was performed. Since the remaining 6 are asymptomatic, conservative treatment has been proposed. PE was not found in any of the other groups (P &lt; 0.05). Conclusion In this series, the incidence of EP in children with EA was higher (13.2%) than the one found in other groups (0%) or in the general population (0.15%–5.2%). These findings suggest that there is an association between EP and EA. Ectopic pancreas should be ruled out in every patient with esophageal atresia due to its potential morbidity, and when found, long-term follow-up is advisable.

Clinicopathological features of duodenal bulb biopsies and their relationship with upper gastrointestinal diseases

AimTo assess the prevalence of the lesions in duodenal bulb mucosa and the relationship between duodenal lesions and upper gastrointestinal diseases, including helicobacter pylori infection. MethodsClinical, endoscopic and pathological data of the cases with duodenal bulb and gastric mucosal biopsy from January 2005 to May 2017 were analyzed retrospectively. ResultsA total of 3540 patients were enrolled. The biopsy from protuberant lesions with endoscopic morphology are mostly duodenal gastric heterotopia or adenoma. The biopsy from duodenal ulcers are often observed in inflammatory changes and gastric metaplasia.Patients with gastric heterotopia had a significantly lower prevalence of chronic atrophic gastritis, intestinal metaplasia, and gastric ulcer; and much higher prevalence of gastroesophageal reflux disease and gastric fundic polyps.Patients with gastric metaplasia had been positively associated with gastroesophageal reflux disease, and negatively associated with gastric fundic polyps.There were positive correlation between helicobacter pylori infection and duodenal active inflammation, Brunner gland hyperplasia, gastric metaplasia and duodenal ulcer. However, Patients with gastric heterotopia in bulb had been negatively associated with helicobacter pylori infection. ConclusionsThe mucosa lesions in duodenal bulb were associated with concurrent gastric fundic gland polyps, gastroesophageal reflux disease, duodenal ulcer, and helicobacter pylori infection.