Deamidated gliadin peptide antibodies have recently been suggested as reliable tools for celiac disease (CD) diagnosis. We compared their utility for diagnosis CD in comparison to the routinely used anti-endomysial, and anti-tissue transglutaminase antibodies. We studied 65 patients (17 men, 48 women; age range, 17– 63 years) who underwent intestinal biopsy because of clinical suspicion of small-bowel disorders. Serum samples were obtained at the time of biopsy for measuring IgA and IgG anti–tissue transglutaminase (tTG), IgA and IgG anti–deamidated gliadin peptide (DGP) by ELISA and IgA anti-endomesial antibody (EmA) by indirect immunoflouresce. Characterization of patients was based on histological criteria (Marsh type II lesion or greater). Biopsy revealed that 14 patients had positive criteria for CD. The remaining 51 negative patients were used as controls. Assay sensitivity and specificity for diagnosing celiac disease were 85.7% and 92.2% for IgA and 92.9 and 100% for IgG antibodies to DGP respectively. Serum IgA and IgG DGP, IgA and IgG -tTG and IgA EmA were significantly higher in CD patients than in control group (P= 0.000). None of the controls was positive for IgG DGP or IgA -EmA, but 4 of 51 (7.8 %) were positive for IgA- DGP, 6 of 51 (11.8 %) were positive for IgA anti-tTG, and 2 of 51 (3.9%) were positive for IgG anti-tTG. IgG-DGP has the best sensitivity (92.9%), specificity (100%), positive predictive value (100%), and negative predictive value (96.2%). In conclusion, the DGP antibodies tests, alone or in combination with the tTG antibodies, are useful tools for screening purposes and with better patient acceptance than intestinal biopsy.

Deamidated gliadin peptide antibodies have recently been suggested as reliable tools for celiac disease (CD) diagnosis. We compared their utility for diagnosis CD in comparison to the routinely used anti-endomysial, and anti-tissue transglutaminase antibodies. We studied 65 patients (17 men, 48 women; age range, 17– 63 years) who underwent intestinal biopsy because of clinical suspicion of small-bowel disorders. Serum samples were obtained at the time of biopsy for measuring IgA and IgG anti–tissue transglutaminase (tTG), IgA and IgG anti–deamidated gliadin peptide (DGP) by ELISA and IgA anti-endomesial antibody (EmA) by indirect immunoflouresce. Characterization of patients was based on histological criteria (Marsh type II lesion or greater). Biopsy revealed that 14 patients had positive criteria for CD. The remaining 51 negative patients were used as controls. Assay sensitivity and specificity for diagnosing celiac disease were 85.7% and 92.2% for IgA and 92.9 and 100% for IgG antibodies to DGP respectively. Serum IgA and IgG DGP, IgA and IgG -tTG and IgA EmA were significantly higher in CD patients than in control group (P= 0.000). None of the controls was positive for IgG DGP or IgA -EmA, but 4 of 51 (7.8 %) were positive for IgA- DGP, 6 of 51 (11.8 %) were positive for IgA anti-tTG, and 2 of 51 (3.9%) were positive for IgG anti-tTG. IgG-DGP has the best sensitivity (92.9%), specificity (100%), positive predictive value (100%), and negative predictive value (96.2%). In conclusion, the DGP antibodies tests, alone or in combination with the tTG antibodies, are useful tools for screening purposes and with better patient acceptance than intestinal biopsy.

Deamidated gliadin peptide antibodies have recently been suggested as reliable tools for celiac disease (CD) diagnosis. We compared their utility for diagnosis CD in comparison to the routinely used anti-endomysial, and anti-tissue transglutaminase antibodies. We studied 65 patients (17 men, 48 women; age range, 17– 63 years) who underwent intestinal biopsy because of clinical suspicion of small-bowel disorders. Serum samples were obtained at the time of biopsy for measuring IgA and IgG anti–tissue transglutaminase (tTG), IgA and IgG anti–deamidated gliadin peptide (DGP) by ELISA and IgA anti-endomesial antibody (EmA) by indirect immunoflouresce. Characterization of patients was based on histological criteria (Marsh type II lesion or greater). Biopsy revealed that 14 patients had positive criteria for CD. The remaining 51 negative patients were used as controls. Assay sensitivity and specificity for diagnosing celiac disease were 85.7% and 92.2% for IgA and 92.9 and 100% for IgG antibodies to DGP respectively. Serum IgA and IgG DGP, IgA and IgG -tTG and IgA EmA were significantly higher in CD patients than in control group (P= 0.000). None of the controls was positive for IgG DGP or IgA -EmA, but 4 of 51 (7.8 %) were positive for IgA- DGP, 6 of 51 (11.8 %) were positive for IgA anti-tTG, and 2 of 51 (3.9%) were positive for IgG anti-tTG. IgG-DGP has the best sensitivity (92.9%), specificity (100%), positive predictive value (100%), and negative predictive value (96.2%). In conclusion, the DGP antibodies tests, alone or in combination with the tTG antibodies, are useful tools for screening purposes and with better patient acceptance than intestinal biopsy.

Deamidated gliadin peptide antibodies have recently been suggested as reliable tools for celiac disease (CD) diagnosis. We compared their utility for diagnosis CD in comparison to the routinely used anti-endomysial, and anti-tissue transglutaminase antibodies. We studied 65 patients (17 men, 48 women; age range, 17– 63 years) who underwent intestinal biopsy because of clinical suspicion of small-bowel disorders. Serum samples were obtained at the time of biopsy for measuring IgA and IgG anti–tissue transglutaminase (tTG), IgA and IgG anti–deamidated gliadin peptide (DGP) by ELISA and IgA anti-endomesial antibody (EmA) by indirect immunoflouresce. Characterization of patients was based on histological criteria (Marsh type II lesion or greater). Biopsy revealed that 14 patients had positive criteria for CD. The remaining 51 negative patients were used as controls. Assay sensitivity and specificity for diagnosing celiac disease were 85.7% and 92.2% for IgA and 92.9 and 100% for IgG antibodies to DGP respectively. Serum IgA and IgG DGP, IgA and IgG -tTG and IgA EmA were significantly higher in CD patients than in control group (P= 0.000). None of the controls was positive for IgG DGP or IgA -EmA, but 4 of 51 (7.8 %) were positive for IgA- DGP, 6 of 51 (11.8 %) were positive for IgA anti-tTG, and 2 of 51 (3.9%) were positive for IgG anti-tTG. IgG-DGP has the best sensitivity (92.9%), specificity (100%), positive predictive value (100%), and negative predictive value (96.2%). In conclusion, the DGP antibodies tests, alone or in combination with the tTG antibodies, are useful tools for screening purposes and with better patient acceptance than intestinal biopsy.

We aimed to model esophageal bolus transit based on esophageal pressure topography (EPT) landmarks, concurrent intrabolus pressure (IBP), and esophageal diameter as defined with fluoroscopy. Ten healthy subjects were studied with high-resolution impedance manometry and videofluoroscopy. Data from four 5-ml barium swallows (2 upright, 2 supine) in each subject were analyzed. EPT landmarks were utilized to divide bolus transit into four phases: phase I, upper esophageal sphincter (UES) opening; phase II, UES closure to the transition zone (TZ); phase III, TZ to contractile deceleration point (CDP); and phase IV, CDP to completion of bolus emptying. IBP and esophageal diameter were analyzed to define functional differences among phases. IBP exhibited distinct changes during the four phases of bolus transit. Phase I was associated with filling via passive dilatation of the esophagus and IBP reflective of intrathoracic pressure. Phase II was associated with auxotonic relaxation and compartmentalization of the bolus distal to the TZ. During phase III, IBP exhibited a slow increase with loss of volume related to peristalsis (auxotonic contraction) and passive dilatation in the distal esophagus. Phase IV was associated with the highest IBP and exhibited isometric contraction during periods of nonemptying and auxotonic contraction during emptying. IBP may be used as a marker of esophageal wall state during the four phases of esophageal bolus transit. Thus abnormalities in IBP may identify subtypes of esophageal disease attributable to abnormal distensibility or neuromuscular dysfunction.

SSc_GIT 2.0 is a validated disease-specific HRQOL instrument for evaluation of GIT-related activity and severity in systemic sclerosis (SSc). Aim: We studied HRM in SSc patients and the correlation of findings to the UCLA SSc_GIT 2.0 scores. Methods: Forty SSc patients administered UCLA SSc GIT 2.0 that includes multi-item scales: reflux, distention, diarrhea, fecal soiling, constipation, emotional well-being, social functioning, and total GIT score. Twenty out of 40 patients underwent esophageal HRM study (Solar GI MMS). HRM studies were analyzed for LES resting and residual pressures, esophageal amplitude and peristalsis integrity, duration and velocity of distal esophageal contraction, and UES resting and residual pressures. HRM data were compared with 15 healthy volunteers. Stepwise multiple linear regression analysis was done to test if HRM parameters could predict UCLA SSc_GIT 2.0 variables. Results: Forty patients (32 females), mean age 46 +/- 7 years, mean disease duration 9.3 +/- 7 years, reported upper (85.7%) and lower GI symptoms (75%), while 5% reported no symptoms. 31 patients had diffuse cutaneous systemic sclerosis (dcSSc), and 9 had limited cutaneous systemic sclerosis (LcSSc). Mean (SD) score of UCLA SSc_GIT 2.0 items for those who underwent HRM were as follow: reflux 1.2 +/- 0.8, distention 1.6 +/- 1.2, fecal soiling 0.3 +/- 0.9, diarrhea 0.8 +/- 1, social 1 +/- 1, emotional 1 +/- 1.1, constipation 0.5 +/- 0.9, and total GIT score 0.9 +/- 0.6. LES resting pressure and distal esophageal amplitude were significantly lower in SSc patients than control (table 1). Main manometric findings were decrease LES resting pressure (40%), aperistalsis (40%), small and large peristaltic breaks in mid and distal esophagus (55%), and low amplitude of proximal esophagus (25%) of patients. While, normal manometric findings were found in (15%) of SSc patients. Regression analyses showed distal esophageal amplitude and LES resting pressure negatively correlated with reflux score (r= -0.64; p= 0.001 and r= -0.46; p= 0.019 respectively), and total GIT score (r= -0.54; p= 0.007 and r=-0.42; p=0.03 respectively). While LES resting pressure only had negative correlation with diarrhea score (r= -0.062 p=0.002). No correlation was found between other HRM parameters and symptoms score. Conclusion: LES resting pressure and distal esophageal amplitude correlate with the UCLA SSc_GIT 2.0 questionnaire, and can be a predictor of the GIT affection in SSc. HRM parameters among SSc patients and control.

Abstract BACKGROUND: Genesis of persistent gastro-esophageal reflux symptoms despite proton pump inhibitor (PPI) therapy is not fully understood. We aimed at determining reflux patterns on 24-h pH-impedance monitoring performed on PPI and correlating impedance patterns and symptom occurrence in PPI non-responders. METHODS: Seventy-eight PPI non-responder patients underwent 24-h pH-impedance monitoring on PPI. Reflux impedance characterization included gastric and supragastric belches and proximal extent of reflux. Symptoms were considered associated with reflux if occurring within 5 min after a reflux event. Patients were classified into three groups: persistent acid reflux (acid esophageal exposure [AET] >5% of time), reflux sensitivity (AET 5%, symptom index [SI] ≥50%), and functional symptoms (AET 5%, SI 50%). Dominant impedance pattern was determined for each patient. KEY RESULTS: Seven patients (9%) had persistent acid reflux, 28 (36%) reflux sensitivity, and 43 (55%) functional symptoms. A total of 4296 reflux events were identified (median per patient 45 [range 4-221]). Although liquid reflux was the most common pattern in all groups, patients with reflux sensitivity and functional symptoms had much more variability in their pattern profile with a large proportion being associated with gastric and supragastric belching. Only 417 reflux events (9.7%) were associated with symptoms. Reflux with a supragastric component and proximal extent were more likely to be associated with symptoms. CONCLUSIONS & INFERENCES: The impedance reflux profile in PPI non-responders was heterogeneous and the majority of reflux events were not associated with symptoms. Thus, the treatment of PPI non-responders should focus on mechanisms beyond reflux, such as visceral hypersensitivity and hypervigilance.

This study aimed to develop and validate a method to measure bolus flow time (BFT) through the esophagogastric junction (EGJ) using a highresolution impedance-manometry (HRIM) sleeve. Ten healthy subjects were studied with concurrent HRIM and videofluoroscopy; another 15 controls were studied with HRIM alone. HRIM studies were performed using a 4.2-mm-outer diameter assembly with 36 pressure sensors at 1-cm intervals and 18 impedance segments at 2-cm intervals (Given Imaging, Los Angeles, CA). HRIM and fluoroscopic data from four barium swallows, two in the supine and two in the upright position, were analyzed to create a customized MATLAB program to calculate BFT using a HRIM sleeve comprising three sensors positioned at the crural diaphragm. Bolus transit through the EGJ measured during blinded review of fluoroscopy was almost identical to BFT calculated with the HRIM sleeve, with the nadir impedance deflection point used as the signature of bolus presence. Good correlation existed between videofluoroscopy for measurement of upper sphincter relaxation to beginning of flow [R  0.97, P  0.001 (supine) and R  0.77, P  0.01 (upright)] and time to end of flow [R  0.95, P  0.001 (supine) and R  0.82, P  0.01 (upright)]. The medians and interquartile ranges (IQR) of flow time though the EGJ in 15 healthy subjects calculated using the virtual sleeve were 3.5 s (IQR 2.3–3.9 s) in the supine position and 3.2 s (IQR 2.3–3.6 s) in the upright position. BFT is a new metric that provides important information about bolus transit through the EGJ. An assessment of BFT will determine when the EGJ is open and will also provide a useful method to accurately assess trans-EGJ pressure gradients during flow.

Abstract BACKGROUND AND OBJECTIVE: The addition of fine-needle aspiration (FNA) to different imaging modalities has raised the accuracy for diagnosis of cystic pancreatic lesions. We aim to differentiate benign from neoplastic pancreatic cysts by evaluating cyst fluid carcinoembryonic antigen (CEA), carbohydrate antigen (CA19-9), and amylase levels and cytopathological examination, including mucin stain. PATIENTS AND METHODS: This prospective study included 77 patients with pancreatic cystic lesions. Ultrasound-FNA (US-FNA) or endoscopic ultrasound-FNA (EUS-FNA) was done according to the accessibility of the lesion. The aspirated specimens were subjected to cytopathological examination (including mucin staining), tumor markers (CEA, CA19-9), and amylase level. RESULTS: Cyst CEA value of 279 or more showed high statistical significance in differentiating mucinous from nonmucinous lesions with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 73%, 60%, 50%, 80%, and 65%, respectively. Cyst amylase could differentiate between neoplastic and nonneoplastic cysts at a level of 1043 with sensitivity of 58%, specificity of 75%, PPV of 73%, NPV of 60%, and accuracy of 66%. CA19-9 could not differentiate between neoplastic and nonneoplastic cysts. Mucin examination showed a sensitivity of 85%, specificity of 95%, PPV of 92%, NPV of 91%, and accuracy of 91% in differentiating mucinous from non-mucinous lesions. Cytopathological examination showed a sensitivity of 81%, specificity of 94%, PPV of 94%, NPV of 83%, and accuracy of 88%. CONCLUSION: US or EUS-FNA with analysis of cyst CEA level, CA19-9, amylase, mucin stain, and cytopathological examination increases the diagnostic accuracy of cystic pancreatic lesions.

Abstract BACKGROUND AND OBJECTIVE: The addition of fine-needle aspiration (FNA) to different imaging modalities has raised the accuracy for diagnosis of cystic pancreatic lesions. We aim to differentiate benign from neoplastic pancreatic cysts by evaluating cyst fluid carcinoembryonic antigen (CEA), carbohydrate antigen (CA19-9), and amylase levels and cytopathological examination, including mucin stain. PATIENTS AND METHODS: This prospective study included 77 patients with pancreatic cystic lesions. Ultrasound-FNA (US-FNA) or endoscopic ultrasound-FNA (EUS-FNA) was done according to the accessibility of the lesion. The aspirated specimens were subjected to cytopathological examination (including mucin staining), tumor markers (CEA, CA19-9), and amylase level. RESULTS: Cyst CEA value of 279 or more showed high statistical significance in differentiating mucinous from nonmucinous lesions with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 73%, 60%, 50%, 80%, and 65%, respectively. Cyst amylase could differentiate between neoplastic and nonneoplastic cysts at a level of 1043 with sensitivity of 58%, specificity of 75%, PPV of 73%, NPV of 60%, and accuracy of 66%. CA19-9 could not differentiate between neoplastic and nonneoplastic cysts. Mucin examination showed a sensitivity of 85%, specificity of 95%, PPV of 92%, NPV of 91%, and accuracy of 91% in differentiating mucinous from non-mucinous lesions. Cytopathological examination showed a sensitivity of 81%, specificity of 94%, PPV of 94%, NPV of 83%, and accuracy of 88%. CONCLUSION: US or EUS-FNA with analysis of cyst CEA level, CA19-9, amylase, mucin stain, and cytopathological examination increases the diagnostic accuracy of cystic pancreatic lesions.