`Slitiplement to Slitiplement to
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`April 1997 Volume 112 • Number 4 April 1997 Volume 112 • Number 4
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`Digestive Disease Week Digestive Disease Week
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`and the and the
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`97th Annual Meeting of the American 97th Annual Meeting of the American
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`Gastroenterological Association Gastroenterological Association
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`May 11-14, 1997, Washington, D.C. May 11-14, 1997, Washington, D.C.
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`EI Program of the Annual Meeting of the American EI Program of the Annual Meeting of the American
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`Gastroenterological Association, the American Association Gastroenterological Association, the American Association
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`for the Study of Liver Diseases, the Gastroenterology for the Study of Liver Diseases, the Gastroenterology
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`Research Group, the Society for Surgery of the Alimentary Research Group, the Society for Surgery of the Alimentary
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`Tract, and the American Society for Gastrointestinal Tract, and the American Society for Gastrointestinal
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`Endoscopy Endoscopy
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`EI Abstracts of Papers Submitted to the American EI Abstracts of Papers Submitted to the American
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`Gastroenterological Association Gastroenterological Association
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`El Abstracts of Papers Submitted to the American Association El Abstracts of Papers Submitted to the American Association
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`for the Study of Liver Diseases for the Study of Liver Diseases
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`El Abstracts of Papers Submitted to the Society for Surgery El Abstracts of Papers Submitted to the Society for Surgery
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`of the Alimentary Tract of the Alimentary Tract
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`Official Journal of the American Gastroenterological Association Official Journal of the American Gastroenterological Association
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`Gastroenterolo (cid:9)Gastroenterolo (cid:9)
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`9 9
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`Volume 112 Volume 112
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`No. 4 No. 4
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`April 1997 April 1997
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`P1 (cid:9)P1 (cid:9)
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`Al (cid:9)Al (cid:9)
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`Al (cid:9)Al (cid:9)
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`Program of the Annual Meeting of the American Program of the Annual Meeting of the American
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`Gastroenterological Association, the American Association for Gastroenterological Association, the American Association for
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`the Study of Liver Diseases, the Gastroenterology Research the Study of Liver Diseases, the Gastroenterology Research
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`Group, the Society for Surgery of the Alimentary Tract, and the Group, the Society for Surgery of the Alimentary Tract, and the
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`American Society for Gastrointestinal Endoscopy American Society for Gastrointestinal Endoscopy
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`Abstracts of Papers Submitted to the American Abstracts of Papers Submitted to the American
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`Gastroenterological Association Gastroenterological Association
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`Clinical Practice Clinical Practice
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`A51. (cid:9)A51. (cid:9)
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`Esophageal, Gastric, and Duodenal Disorders Esophageal, Gastric, and Duodenal Disorders
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`A333 (cid:9)A333 (cid:9)
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`A424 (cid:9)A424 (cid:9)
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`A497 (cid:9)A497 (cid:9)
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`A530 (cid:9)A530 (cid:9)
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`A691 (cid:9)A691 (cid:9)
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`A859 (cid:9)A859 (cid:9)
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`A918 (cid:9)A918 (cid:9)
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`A1129 (cid:9)A1129 (cid:9)
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`A1205 (cid:9)A1205 (cid:9)
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`A1426 (cid:9)A1426 (cid:9)
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`Intestinal Disorders Intestinal Disorders
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`Pancreatic Disorders Pancreatic Disorders
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`13 diary Disorders 13 diary Disorders
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`Gastrointestinal Oncology Gastrointestinal Oncology
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`Motility and Nerve-Gut Interactions Motility and Nerve-Gut Interactions
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`Growth, Development, and Nutrition Growth, Development, and Nutrition
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`Immunology, Microbiology, and Inflammatory Disorders Immunology, Microbiology, and Inflammatory Disorders
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`Hormones, Transmitters, Growth Factors, and Their Receptors Hormones, Transmitters, Growth Factors, and Their Receptors
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`Abstracts of Papers Submitted to the American Association for Abstracts of Papers Submitted to the American Association for
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`the Study of Liver Diseases the Study of Liver Diseases
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`Abstracts of Papers Submitted to the Society for Surgery of the Abstracts of Papers Submitted to the Society for Surgery of the
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`Alimentary Tract Alimentary Tract
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`A1488 (cid:9)A1488 (cid:9)
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`Author Index Author Index
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`A1558 (cid:9)A1558 (cid:9)
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`Suhject Index Suhject Index
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`A1665 (cid:9)A1665 (cid:9)
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`Disclosure Index Disclosure Index
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`GAsta0ENTERoLoor (ISSN 0016-5085) is published monthly (semimonthly in April) in two indexed volumes per year by W. B. Saunders Company.. GAsta0ENTERoLoor (ISSN 0016-5085) is published monthly (semimonthly in April) in two indexed volumes per year by W. B. Saunders Company..
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`A1078 AGA ABSTRACTS A1078 AGA ABSTRACTS
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`GASTROENTEROLOGY, Vol 112, Pk. 4 GASTROENTEROLOGY, Vol 112, Pk. 4
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`• NEUROENDOCRINE CELL EXPRESSION IN TCR ALPHk-• NEUROENDOCRINE CELL EXPRESSION IN TCR ALPHk-
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`MICE. D. Rubin, H. Zhang, R. Lorenz and M. Peters. Departments of MICE. D. Rubin, H. Zhang, R. Lorenz and M. Peters. Departments of
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`Medicine and Pathology, Washington University School of Medicine, Medicine and Pathology, Washington University School of Medicine,
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`St Louis MO- St Louis MO-
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`Mice lacking T cell receptor alpha chain knockout mice (TCRet4) Mice lacking T cell receptor alpha chain knockout mice (TCRet4)
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`develop inflammation of the colon. We have studied the effect of this develop inflammation of the colon. We have studied the effect of this
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`imflaoimation on markers of epithelial cell differentiation. Using imflaoimation on markers of epithelial cell differentiation. Using
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`innnunohistochernical techniques, we studied both neuroendocrine innnunohistochernical techniques, we studied both neuroendocrine
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`(neurotensin. (NT), CCK, GLP-1. PYY, gastrin and 5HT), epithelial (neurotensin. (NT), CCK, GLP-1. PYY, gastrin and 5HT), epithelial
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`(L-FABP, I-FABP) and immune (LCA, IgA, E220 and CD8) Bell (L-FABP, I-FABP) and immune (LCA, IgA, E220 and CD8) Bell
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`markers. Colons were compared in normal B6 and murine TCR le4" markers. Colons were compared in normal B6 and murine TCR le4"
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`mice aged 8-11 months, 3 TCR ci mice had clinical evidence of IBD mice aged 8-11 months, 3 TCR ci mice had clinical evidence of IBD
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`(weight loss or bloody stool). All TCR (cid:9)(weight loss or bloody stool). All TCR (cid:9)
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`mice had histologic mice had histologic
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`evidence of inflammation with increased in LCA+. CDS+. B220 + and evidence of inflammation with increased in LCA+. CDS+. B220 + and
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`igA+ cells, The epithelial response is shown in the table-. igA+ cells, The epithelial response is shown in the table-.
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`GLP-1 PYY GLP-1 PYY
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`Gastrin CCK Gastrin CCK
`NT NT
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`5HT 5HT
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`61±7 61±7
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`46±7 46±7
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`54±17 340 54±17 340
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`24±4 24±4
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`106±23 106±23
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`NB6 NB6
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`61±14 61±14
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`10±3. 10±3.
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`17-±6" 430 17-±6" 430
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`8±31 8±31
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`TCR ce 128±22 TCR ce 128±22
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`P<0 05eximpared to control. P<0 05eximpared to control.
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`1-FABP expression was present in control cecurn but not in TCR ce-1-FABP expression was present in control cecurn but not in TCR ce-
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`cecum. I-FABP expression was unchanged. In summary, there is a cecum. I-FABP expression was unchanged. In summary, there is a
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`decrease in the number of several enteroendocrine cell types (gastrin, decrease in the number of several enteroendocrine cell types (gastrin,
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`CCK and NT) in the inflamed colon of TCR ere' mice_ This appears to CCK and NT) in the inflamed colon of TCR ere' mice_ This appears to
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`be a specific response to inflammation, since the expression of only a be a specific response to inflammation, since the expression of only a
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`subset of these cells was altered, and the epithelium was intact by subset of these cells was altered, and the epithelium was intact by
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`histologic analysis. In conclusion, the inflammatory response in TCR histologic analysis. In conclusion, the inflammatory response in TCR
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`cc.'" colon has a marked effect on differentiation of a specific cc.'" colon has a marked effect on differentiation of a specific
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`subpopulation of enteroendocrine cells, prior to loss of integrity of the subpopulation of enteroendocrine cells, prior to loss of integrity of the
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`epithelium. epithelium.
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`lb CLINICAL CHARACTER'S-TICS AT DIAGNOSIS IN 724 SMOKERS lb CLINICAL CHARACTER'S-TICS AT DIAGNOSIS IN 724 SMOKERS
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`AND 633 NON-SMOKERS WITH INFLAMMATORY BOWEL DISEASE: AND 633 NON-SMOKERS WITH INFLAMMATORY BOWEL DISEASE:
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`RESULTS or THE EUROPEAN COLLABORATIVE STUDY 014 1BD. RESULTS or THE EUROPEAN COLLABORATIVE STUDY 014 1BD.
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`Russel, A Volovics, Ee.Schoon, S.Shivananda, R.W. Stockbridgger on Russel, A Volovics, Ee.Schoon, S.Shivananda, R.W. Stockbridgger on
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`behalf of the European, Collaborative Study Group. behalf of the European, Collaborative Study Group.
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`In Crohn's disease (CD) smoking is associated with an impaired In Crohn's disease (CD) smoking is associated with an impaired
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`prognosis; in active ulcerative colitis (UC) treatment with nicotine improves prognosis; in active ulcerative colitis (UC) treatment with nicotine improves
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`disease activity suggesting a beneficial effect of smoking. There is little disease activity suggesting a beneficial effect of smoking. There is little
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`knowledge on differences between smokers and non-smokers at time of knowledge on differences between smokers and non-smokers at time of
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`diagnosis of MD. The aim of our study was to compare disease location and diagnosis of MD. The aim of our study was to compare disease location and
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`other clinical !course at presentation in smokers and non-smokers in a large other clinical !course at presentation in smokers and non-smokers in a large
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`inception cohort of newly diagnosed patients with [BD across Europe and inception cohort of newly diagnosed patients with [BD across Europe and
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`secondly to compare clinical outcome after one year of disease duration. secondly to compare clinical outcome after one year of disease duration.
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`Logistic regression was used to investigate a possible relationship between Logistic regression was used to investigate a possible relationship between
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`clinical characteristics and smoking,. Resides the variable smoking, oral clinical characteristics and smoking,. Resides the variable smoking, oral
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`contraceptive use, family history, extraintestinal complications. anal disease, contraceptive use, family history, extraintestinal complications. anal disease,
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`age at diagnosis. and gender were analysed as independent variables. age at diagnosis. and gender were analysed as independent variables.
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`Results: 447 incident patients with CD (48% male, median age at Results: 447 incident patients with CD (48% male, median age at
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`diagnosis: 30 (15-84) years) and 915 with UC (56% male, median age at diagnosis: 30 (15-84) years) and 915 with UC (56% male, median age at
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`diagnosis: 39 (15-89) years) were included, Smoking at time of diagnosis was diagnosis: 39 (15-89) years) were included, Smoking at time of diagnosis was
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`observed more frequently in CD (43%) than in UC (16°%) (p<0.01). On the observed more frequently in CD (43%) than in UC (16°%) (p<0.01). On the
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`contrary, the percentage of ex-smokers was higher in UC (34%) than in CD contrary, the percentage of ex-smokers was higher in UC (34%) than in CD
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`(11 ae) (p<0.01). Significantly more smokers with CD had snail bowel (11 ae) (p<0.01). Significantly more smokers with CD had snail bowel
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`involvement compared to non-smokers (pellet), whereas no interaction was involvement compared to non-smokers (pellet), whereas no interaction was
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`found with the other variables. In SSC, disease location was not associated with found with the other variables. In SSC, disease location was not associated with
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`smoking. With the exception of weight loss, which symptom was observed smoking. With the exception of weight loss, which symptom was observed
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`more frequently in both UC and CD smokers (p<0.01), none of the other more frequently in both UC and CD smokers (p<0.01), none of the other
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`clinical features was related to smoking status at diageosis. clinical features was related to smoking status at diageosis.
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`Summary and conclusions: Smoking influences disease location in CD, Summary and conclusions: Smoking influences disease location in CD,
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`but not UC. In CD as well as in UC weight loss is associated with smoking. but not UC. In CD as well as in UC weight loss is associated with smoking.
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`Epidemiologic findings such as the negative correlation between smoking and Epidemiologic findings such as the negative correlation between smoking and
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`UC and our findings on disease Location in CD may reflect a protective role of UC and our findings on disease Location in CD may reflect a protective role of
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`smoking to colonic inflammation in both disease entities. The reported smoking to colonic inflammation in both disease entities. The reported
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`increased use of immunosuppressives and the higher resection rates in increased use of immunosuppressives and the higher resection rates in
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`smokers compared to non-sneakers with CD are possibly related to differences smokers compared to non-sneakers with CD are possibly related to differences
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`in disease location, already present at diagnosis. This will be investigated in a in disease location, already present at diagnosis. This will be investigated in a
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`follow-up study in the same cohort. follow-up study in the same cohort.
`
`
`• RETREATMENT WITH ANTI-TNF-m CHIMERIC ANTIBODY (cA2) • RETREATMENT WITH ANTI-TNF-m CHIMERIC ANTIBODY (cA2)
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`EFFECTIVELY MAINTAINS cA2-INDUCED REMISSION IN EFFECTIVELY MAINTAINS cA2-INDUCED REMISSION IN
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`CROHN'S DISEASE.. Rutsteerts' G. D'HaensI, SIH van Deventer', CROHN'S DISEASE.. Rutsteerts' G. D'HaensI, SIH van Deventer',
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`DH Presents,L. Mayer, SB Hanauer4, TAJ Braakmati', KL DeWoody', DH Presents,L. Mayer, SB Hanauer4, TAJ Braakmati', KL DeWoody',
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`TF Schaible', SR Targan', and the Crohn's 1:e ease cA2 Study Group. TF Schaible', SR Targan', and the Crohn's 1:e ease cA2 Study Group.
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`Academisch Ziekenhuis Gasthuisberg, Leuven, BELL Aeademisch Academisch Ziekenhuis Gasthuisberg, Leuven, BELL Aeademisch
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`Me Tisch Centrum. Amsterdam, NC, Mt. Sinai Med Ctr, New York, Me Tisch Centrum. Amsterdam, NC, Mt. Sinai Med Ctr, New York,
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`NV; Univ. of Chicago, Chicago, 10; Centocor, Inc, Malvern, PA', NV; Univ. of Chicago, Chicago, 10; Centocor, Inc, Malvern, PA',
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`Cedars Sinai Med Ctr, Los Angeles, CAa. Cedars Sinai Med Ctr, Los Angeles, CAa.
`
`
`TNF-ct is a proinflammatory cytokine which plays a pivotal part in TNF-ct is a proinflammatory cytokine which plays a pivotal part in
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`inflammation in Crohn's disease. In a multicenter, placebo-controlled, inflammation in Crohn's disease. In a multicenter, placebo-controlled,
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`double-blind, randomized trial, a single iv infusion of a chimeric double-blind, randomized trial, a single iv infusion of a chimeric
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`(mouse/human) anti-TNFect antibody (cA2, infliximab) rapidly induced a (mouse/human) anti-TNFect antibody (cA2, infliximab) rapidly induced a
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`clinical reponse (e 70 point decrease in CDAI) in 65% of patients with clinical reponse (e 70 point decrease in CDAI) in 65% of patients with
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`severe Crohn's disease, with the majority of these patients achieving severe Crohn's disease, with the majority of these patients achieving
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`clinical remission (CDAk150). The 73 patients (35M/35F, mean age clinical remission (CDAk150). The 73 patients (35M/35F, mean age
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`37±11) who had a clinical response at 8 weeks following an initial cA2 37±11) who had a clinical response at 8 weeks following an initial cA2
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`infusion were then randomized at 12 weeks to receive 4 blinded infusion were then randomized at 12 weeks to receive 4 blinded
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`retreatments with cA2 10 mg/kg (cA2 + cA2x4) or with placebo (cA2 + retreatments with cA2 10 mg/kg (cA2 + cA2x4) or with placebo (cA2 +
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`plx4) at weeks (w) 12, 20, 28 and 36. CDAI, IBDQ and CRP were plx4) at weeks (w) 12, 20, 28 and 36. CDAI, IBDQ and CRP were
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`measured at 4-week intervals through 48w. Result;;: Proportion of pis measured at 4-week intervals through 48w. Result;;: Proportion of pis
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`achieving a clinical response and clinical remission; median CDAI, IBDQ achieving a clinical response and clinical remission; median CDAI, IBDQ
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`and CRP at baseline (Ow), prior to first retreatrnent at 12w and at 44w (8 and CRP at baseline (Ow), prior to first retreatrnent at 12w and at 44w (8
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`weeks after last retreatosent) were: weeks after last retreatosent) were:
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`CRP (my/1i I) CRP (my/1i I)
`
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`IS (cid:9)IS (cid:9)
`CDAI (cid:9)CDAI (cid:9)
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`Clio Resit (cid:9)Clio Resit (cid:9)
`Remission (cid:9)Remission (cid:9)
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`cA2+ cA2+ cA2+ eA2+-cA2+ cA2+ cA2+ cA2+ eA2+-cA2+
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`cA2+ eA2+ eA2+ cA/+ (cid:9)cA2+ eA2+ eA2+ cA/+ (cid:9)
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`cA2a 4 plx4 cA2x4 cA2a 4 plx4 cA2x4
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`Time plx4 cA2x4 plx4 cA2x4 plx4 cA2x4 (cid:9)Time plx4 cA2x4 plx4 cA2x4 plx4 cA2x4 (cid:9)
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`(cid:9) come- (cid:9) come-
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`TO TB TO TB
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`74% 74% 43% 40% 170 175 (cid:9)74% 74% 43% 40% 170 175 (cid:9)
`168 166 0.4 0.5 168 166 0.4 0.5
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`44w (cid:9) 35% 66%* 21% 51%. 193 1 1 S' 148 175 4 0.7 0.5 44w (cid:9) 35% 66%* 21% 51%. 193 1 1 S' 148 175 4 0.7 0.5
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`*p<0.05, *pee. vs cA2 + pl x4 *p<0.05, *pee. vs cA2 + pl x4
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`Retreatment with cA2 sustained the initial cA2 treatment benefit at a high Retreatment with cA2 sustained the initial cA2 treatment benefit at a high
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`level through 44w, whereas the initial cA2 treatment benefit declined over level through 44w, whereas the initial cA2 treatment benefit declined over
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`time with placebo retreatment. Retreatment with cA2 was generally well-time with placebo retreatment. Retreatment with cA2 was generally well-
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`tolerated; 6 patients discontinued treatment associated with an adverse tolerated; 6 patients discontinued treatment associated with an adverse
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`event. We conclude that a retreattnent regimen of 10 mg/kg cA2 every 8 event. We conclude that a retreattnent regimen of 10 mg/kg cA2 every 8
`
`weeks is effective in maintaining disease remission following an initial weeks is effective in maintaining disease remission following an initial
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`treatment with cA2- treatment with cA2-
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`ID SUBTYPES OF MEDICAL INTRACTABILITY AS AN INDICATION FOR ID SUBTYPES OF MEDICAL INTRACTABILITY AS AN INDICATION FOR
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`TOTAL COLECTOMY IN ULCERATIVE COLITIS. Daniel (cid:9)TOTAL COLECTOMY IN ULCERATIVE COLITIS. Daniel (cid:9)
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`Sadowski Sadowski
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`LA.Singh, W.Paul 2ekriewski, Division of Oastreepterology. University of LA.Singh, W.Paul 2ekriewski, Division of Oastreepterology. University of
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`Alberta , Edmonton, Alberta. Alberta , Edmonton, Alberta.
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`Background: Medical intractability is the most common indication for total Background: Medical intractability is the most common indication for total
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`colectomy (TC) in patients with ulcerative colitis (UC). Several distinct patterns of colectomy (TC) in patients with ulcerative colitis (UC). Several distinct patterns of
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`medical intractability can he recognized clinical/y. To date, the subtypes of medical medical intractability can he recognized clinical/y. To date, the subtypes of medical
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`intractability have not been examined in the setting of ulcerative colitis. intractability have not been examined in the setting of ulcerative colitis.
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`Objective: To determine which subtype of medical intractability is the most Objective: To determine which subtype of medical intractability is the most
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`common in patients with refractory ulcerative colitis undergoing total colectomy. common in patients with refractory ulcerative colitis undergoing total colectomy.
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`Methods: All patients undergoing TC in the Edmonton metropolitan area from Methods: All patients undergoing TC in the Edmonton metropolitan area from
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`1955.R5 were identified using ICI3-9 diagnostic codes. Retrieved cases were 1955.R5 were identified using ICI3-9 diagnostic codes. Retrieved cases were
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`reviewed independently by all authors to determine the indication For TC. The reviewed independently by all authors to determine the indication For TC. The
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`medical intractability subtype was determined by using the following criteria which medical intractability subtype was determined by using the following criteria which
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`were set a pricer : I) Primary medical failure: failure of the first attack of UC to were set a pricer : I) Primary medical failure: failure of the first attack of UC to
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`respond to maximal medical therapy, 2) Incomplete response: failure of subsequent respond to maximal medical therapy, 2) Incomplete response: failure of subsequent
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`attacks of UC to respond to maximum medical therapy, 3) Steroid dependent attacks of UC to respond to maximum medical therapy, 3) Steroid dependent
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`response: UC responds to therapy but steroids cannot be weaned, 5) Submaximal response: UC responds to therapy but steroids cannot be weaned, 5) Submaximal
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`therapy: patients are prescribed sub-therapeutic doses of drugs, 6) Non compliance, therapy: patients are prescribed sub-therapeutic doses of drugs, 6) Non compliance,
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`7) !Erogenic: side effects of drugs require discontinuation of therapy, 8) Crescendo 7) !Erogenic: side effects of drugs require discontinuation of therapy, 8) Crescendo
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`flare; Severe single terminal flare which does not respond to therapy. flare; Severe single terminal flare which does not respond to therapy.
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`Ramie: i09 cases met inclusion criteria. As in previous studies, medical Ramie: i09 cases met inclusion criteria. As in previous studies, medical
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`intractability was the most common indication for TC_ incomplete response was the intractability was the most common indication for TC_ incomplete response was the
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`predominant subtype of medical intractability. Corticosteroids were used as the predominant subtype of medical intractability. Corticosteroids were used as the
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`mainstay of therapy in this group ( 43144 cases). Six patients were prescribed other mainstay of therapy in this group ( 43144 cases). Six patients were prescribed other
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`iMM.3,4q.prrrc-S51,C medication (axathioprine). iMM.3,4q.prrrc-S51,C medication (axathioprine).
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`Total Indications for Surgery (a.=J 09) Mgr:lima intractability Subtype to73.1. Total Indications for Surgery (a.=J 09) Mgr:lima intractability Subtype to73.1.
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`78(71.5%) 78(71.5%)
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`Incomplete Response Incomplete Response
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`Medical Intractability Medical Intractability
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`49( 62.8%) 49( 62.8%)
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`reeesiaa. reeesiaa.
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`Toxic Megacolon Toxic Megacolon
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`Steroid Dependent Steroid Dependent
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`11(14.150 11(14.150
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`DysplasirsiCancer DysplasirsiCancer
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`10(9.2%) 10(9.2%)
`
`Primary Medical Failure Primary Medical Failure
`
`7(9.0%) 7(9.0%)
`
`Incomes Diagnosis Incomes Diagnosis
`
`7(6_496) 7(6_496)
`
`Crescendo Flare Crescendo Flare
`
`6(7.7%) 6(7.7%)
`
`Intractable Bleeding Intractable Bleeding
`
`2(1.8%) 2(1.8%)
`
`Frequent Relapses Frequent Relapses
`
`3(3.3%) 3(3.3%)
`
`Colon Perforation Colon Perforation
`
`2(1 .$%) 2(1 .$%)
`
`Non-compliance Non-compliance
`
`1(1.3%) 1(1.3%)
`
`Nitrogen ic Nitrogen ic
`
`1(1.3%) 1(1.3%)
`
`Conclusions: Incomplete response to adequate doses of steroids represents the most Conclusions: Incomplete response to adequate doses of steroids represents the most
`
`common subtype of medical intractability in our series. These results suggest that common subtype of medical intractability in our series. These results suggest that
`
`the use of perste immunOSupprcssivc medication such as asathioprine may reduce the use of perste immunOSupprcssivc medication such as asathioprine may reduce
`
`the requirement for total colectomy in patients with severe ulcerative the requirement for total colectomy in patients with severe ulcerative
`
`Ex. 1024 - Page 3
`
`(cid:9)
`(cid:9)
`