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.

Abstract A wide variety of pieces of evidence has suggested that obesity is associated with a significant increase in the risk for gastroesophageal reflux disease (GERD) symptoms and its complications. The aim of this study was to evaluate the effect of weight loss on reflux symptoms in overweight/obese patients with proven GERD. We enrolled overweight/obese patients with typical GERD symptoms and erosive esophagitis. At baseline, patients underwent detailed reflux symptoms evaluation and anthropometric assessment, and were divided into two treatment groups: group A received proton pump inhibitor (PPI) and a personalized hypocaloric diet and aerobic exercise; and group B received PPI and a 'standard of care diet'. The dietetic treatment was considered effective if at least 10% of weight loss was achieved within 6 months. All patients were evaluated in terms of anthropometric data, GERD symptoms, and PPI use. In group A, mean body mass index (BMI) decreased from 30.3 ± 4.1 to 25.7 ± 3.1 (P 0.05), and mean weight decreased from 82.1 ± 16.9 kg to 69.9 ± 14.4 kg (P 0.05). In group B, there was no change in BMI and weight. Symptom perception decreased (P 0.05) in both groups during PPI therapy, but a higher improvement was recorded in group A. In group A, PPI therapy was completely discontinued in 27/50 of the patients, and halved in 16/50. Only 7/50 continued the same PPI dosage. In group B, 22/51 halved the therapy and 29/51 maintained full dosage of therapy, but none was able to discontinue PPI due to a symptom recurrence. Overall, weight loss of at least 10% is recommended in all patients with GERD in order to boost the effect of PPI on reflux symptom relief and to reduce chronic medication use. © 2014 International Society for Diseases of the Esophagus. GERD; erosive esophagitis; obesity; weight loss

Abstract: Background: CYP2D6 is a member of cytochrome P450 enzymes family which is involved in detoxification of a wide range of xenobiotics and drugs. Several genetic polymorphisms had been shown to affect its activity which may results in increased susceptibility to malignant disorders. Aim: to detect if there is specific cytochrome CYP2D6*4 genotype associated with hepatocellular carcinoma or hepatic cirrhosis among patients with hepatitis C. Method: CYP2D6*4 genotyping was performed by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). This study includes 23 patients with hepatic cirrhosis, 26 patients with HCC and normal 19 subjects with matched age and sex. Results: The frequency of (Extensive metabolizers) EM genotype (wild type) was higher in HCC cases compared to cirrhotic patients and controls (76.8% versus 39.1% and 63.2%).The frequency of (intermediate metabolizers) IM genotype (heterozygous variant) was higher in cirrhotic cases compared to HCC patients and controls (52.2% versus 15.4% and 26.3 %). On contrary, the frequency of (poor metabolizers) PM genotypes (homozygous variant) was the lowest among HCC patients in comparison to cirrhotic patients and controls (3.8% vs 8.7% and 10.5% respectively). Higher frequency of IM and PM genotypes were observed in patients more than 45 years old in cirrhotic and malignant patients. Frequency of IM and PM were significantly higher in males than females in HCC patients (p=0.000). Frequency of p allele was higher in males than females and in older patients than younger patients in the three groups. Conclusions: These data indicate that PM CYP2D6*4 genotype has no role in development of HCC and IM genotype may have a role in developing hepatic cirrhosis, while higher frequency of EM genotype may contribute to the progression of HCC in HCV-infected subjects [Sohair K. Sayed and Hala M. K. Imam. Study of the Association of CYP2D6*4 Polymorphism with the Susceptibility of HCV- Related Liver Cirrhosis and Liver Cancer. Life Sci J 2012;9(3):1571-1577] (ISSN:1097- 8135). http://www.lifesciencesite.com. 228

Abstract: Background: CYP2D6 is a member of cytochrome P450 enzymes family which is involved in detoxification of a wide range of xenobiotics and drugs. Several genetic polymorphisms had been shown to affect its activity which may results in increased susceptibility to malignant disorders. Aim: to detect if there is specific cytochrome CYP2D6*4 genotype associated with hepatocellular carcinoma or hepatic cirrhosis among patients with hepatitis C. Method: CYP2D6*4 genotyping was performed by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). This study includes 23 patients with hepatic cirrhosis, 26 patients with HCC and normal 19 subjects with matched age and sex. Results: The frequency of (Extensive metabolizers) EM genotype (wild type) was higher in HCC cases compared to cirrhotic patients and controls (76.8% versus 39.1% and 63.2%).The frequency of (intermediate metabolizers) IM genotype (heterozygous variant) was higher in cirrhotic cases compared to HCC patients and controls (52.2% versus 15.4% and 26.3 %). On contrary, the frequency of (poor metabolizers) PM genotypes (homozygous variant) was the lowest among HCC patients in comparison to cirrhotic patients and controls (3.8% vs 8.7% and 10.5% respectively). Higher frequency of IM and PM genotypes were observed in patients more than 45 years old in cirrhotic and malignant patients. Frequency of IM and PM were significantly higher in males than females in HCC patients (p=0.000). Frequency of p allele was higher in males than females and in older patients than younger patients in the three groups. Conclusions: These data indicate that PM CYP2D6*4 genotype has no role in development of HCC and IM genotype may have a role in developing hepatic cirrhosis, while higher frequency of EM genotype may contribute to the progression of HCC in HCV-infected subjects [Sohair K. Sayed and Hala M. K. Imam. Study of the Association of CYP2D6*4 Polymorphism with the Susceptibility of HCV- Related Liver Cirrhosis and Liver Cancer. Life Sci J 2012;9(3):1571-1577] (ISSN:1097- 8135). http://www.lifesciencesite.com. 228

Abstract Introduction: Surgical and locoregional therapies are different options in HCC treatment, several locoregional techniques are used. Purpose: This study aimed to assess the effectiveness of transarterial chemoembolization (TACE), radiofrequency ablation (RFA) and combined therapy, in HCC management. Materials and methods: The study was conducted at our University Hospital, from August 2011 to February 2013. It included 60 patients with HCC (40 males and 20 females, age ranged between 45 and 70 years). Patients were classified into 3 groups, group 1 treated with TACE, group 2 with RFA, and group 3 with both techniques. Response was assessed by triphasic CT and alpha fetoprotein. Patients were classified into good and poor responders after one and six months and one year. Patients’ survival and incidence of recurrence were recorded. Results: The percentage of good responders was greater with combined therapy than with TACE and RFA (90%, 70%, and 60% respectively). The overall survival was 75%and the recurrence free survival was 60% in TACE, 90%, and 45% in RFA and 95% and 90% in combined therapy respectively. Conclusion: Combined therapy is superior regarding good response, overall survival, and free recurrence survival than either TACE or RFA alone.

Abstract Introduction: Surgical and locoregional therapies are different options in HCC treatment, several locoregional techniques are used. Purpose: This study aimed to assess the effectiveness of transarterial chemoembolization (TACE), radiofrequency ablation (RFA) and combined therapy, in HCC management. Materials and methods: The study was conducted at our University Hospital, from August 2011 to February 2013. It included 60 patients with HCC (40 males and 20 females, age ranged between 45 and 70 years). Patients were classified into 3 groups, group 1 treated with TACE, group 2 with RFA, and group 3 with both techniques. Response was assessed by triphasic CT and alpha fetoprotein. Patients were classified into good and poor responders after one and six months and one year. Patients’ survival and incidence of recurrence were recorded. Results: The percentage of good responders was greater with combined therapy than with TACE and RFA (90%, 70%, and 60% respectively). The overall survival was 75%and the recurrence free survival was 60% in TACE, 90%, and 45% in RFA and 95% and 90% in combined therapy respectively. Conclusion: Combined therapy is superior regarding good response, overall survival, and free recurrence survival than either TACE or RFA alone.