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Gastroesophageal reflux disease (GERD) is among the commonest of gastro-intestinal disorders and the costs of management worldwide are considerable. GERD symptoms impair quality of life and in a minority of subjects, there is a risk of significant morbidity due to complications including strictures and extra-esophageal manifestations. There is also a significant mortality related to the risk of esophageal adenocarcinoma. Although the absolute risk is low in any individual, the incidence of this cancer is rising in Western populations, particularly among Caucasian males over 50 years of age. Therefore, the goals of GERD therapy are to relieve symptoms, restore quality of life, heal esophagitis if present and reduce complications in the most cost-effective manner. Medical therapy is the mainstay of treatment for most patients with surgery appropriate for a well selected minority. Newer endoscopic techniques are currently under evaluation. A direct comparison of the benefits and drawbacks of all modalities of treatment is limited by the lack of quality comparative data, the different interests of the providers of therapy and also by the complementary rather than competing nature of these alternatives.

BACKGROUND & AIMS: The incidences of the inflammatory bowel diseases (IBDs) Crohn’s disease (CD) and ulcerative colitis (UC) are increasing, indicating gene–environment interactions. Migrants from low-IBDprevalence countries to a high-prevalence country may help identify the relative contribution of environmental risk factors compared with native Caucasians. METHODS: This prospective case–control study evaluated IBD environmental risk factors of Middle Eastern migrants (MEM) in Australia compared with matched Caucasian IBD subjects, MEM controls, Caucasian controls, and controls in the Middle East using adjusted odds ratios (aOR). RESULTS: A total of 795 subjects were recruited: 154 MEM cases (75 CD; 79 UC), 153 MEM controls, 162 Caucasian cases (85 CD; 77 UC), 173 Caucasian controls, and 153 controls in Lebanon. Smoking increased CD risk in MEM and Caucasians and reduced UC risk in Caucasians (aOR, 0.77; 95% CI, 0.41–0.98) but not MEM (aOR, 1.45; 95% CI, 0.80–2.62). Antibiotic use reduced the risk of MEM CD (aOR, 0.27; 95% CI, 0.11–0.67) and UC (aOR, 0.38; 95% CI, 0.18–0.80), but increased the risk in Caucasians (CD: aOR, 5.24; 95% CI, 2.13–12.90; and UC: aOR, 6.82; 95% CI, 2.67–17.38). Most hygiene markers (rural dwelling, pet ownership, pet feeding, and farm animal contact) reduced CD and UC risk in MEM (P < .05). In contrast, in Caucasians these hygiene markers lacked significance. Other significant risk factors include IBD family history, appendectomy, tonsillectomy, and breastfeeding. CONCLUSIONS: Differential IBD environmental risk factors exist between migrants and native Caucasians, indicating a dynamic interplay between environmental factors and IBD risk for immigrants that is distinct to those factors most relevant in native Caucasians.

overall accuracy of 88% with a sensitivity of 81%. Conclusion: Molecular testing is a valuable test in the diagnostic evaluation of indeterminate strictures. DNA mutational profiling increases the diagnostic yield of malignant biliary strictures when combined with brush cytology. Our data suggests that both FISH and mutational analysis can be used as second line diagnostic modality. Future studies will need to focus on evaluating the order in which these adjunct tests need to be performed. Combined diagnostic performance of firstand/or second-line testing AB398 GASTR Diagnostic Test OINTESTINA % Accuracy L ENDOSC % Sensitivity OPY Vol % Specificity

Mo1376 Biliary Endoprosthesis: a Retrospective Analysis of Biliary Stent Related Late Complications Marie Ooi*, Santosh Sanagapalli, Ken Liu, Gavin Barr, James L. Cowlishaw, Rupert W. Leong, Peter Katelaris Gastroenterology, Concord Hospital, Sydney, NSW, Australia Biliary endoprosthesis: Biliary endoprosthesis: A retrospective analysis of biliary stent related late complications. Background: Biliary sepsis may occur following placement of biliary stents either due to stent dysfunction or delay in scheduled interval stent exchange. Causes of stent dysfunction include stent occlusion by debris or tumour ingrowth, stentmigration and stent fracture. Thechoice of stent typedependson the life expectancy of the patient. According to the European Society of Gastroenterology guidelines, plastic stents are cost effective if estimated life expectancy is!4 months while self-expandable metallic stents (SEMS) are preferred if life expectancy exceeds 4 months.Aims: Toassess the frequency and causesof late (after 30days) complications of biliary stenting. Methods: We retrospectively analysed patients presenting with complications related to biliary stents over a 4-year period (Jan 2010-Dec 2013). Data collected included demographics, co-morbidities, indication for stent insertion and stent type(s). Primary outcome was stent related complications. Results: Of 699 patients who had ERCP (58% female, median age 73 yr ; interquartile age range 67-78 yr), 269 had biliary stents inserted, 141 for malignant biliary strictures (Group 1) and 128 for benign biliary disease (Group 2). In Group 1, 118 (84%) had initial palliation of biliary obstruction with a plastic stent while 23 (16%) had a SEMS. In Group 2, a majority (nZ118, 92%) had plastic stents and 10 (8%) had a SEMS. A total of 68 patients (25%) had stent related complications, of which 58 (22%) presented with obstructive jaundice or cholangitis due to occluded stents (13.5 2.9 stents/ yr). Other complications included cholecystitis (nZ3), liver abscess (nZ1), stent migration (nZ5), and stent fracture (nZ1). In Group 1, plastic stents had an OR 4.3 (95% CI 1.85-10.02; p!0.01) for stent occlusion compared to SEMS. In malignant biliary strictures, the time to stent occlusion for plastic, bare metal stents and covered metal stents were 2.1, 6.6 and 11.9 months, respectively. For Group 2, all 23 occluded stents occurred with plastic stents in patients lost to follow up with a mean stent patency of 24.9 months, whilst no stent occlusion occurred with covered SEMS. Conclusion: For malignant strictures, plastic stents had a significantly higher rate of occlusion and a lower duration of stent patency compared to SEMS. For benign biliary disease, all occluded stents were due to stents inadvertently left in situ for longer than recommended. A stent registry database is recommended to record all patients with biliary stents to ensure prophylactic stent exchange occurs at a timely interval to reduce the risk of biliary sepsis related to stent occlusion. For malignant strictures, earlier stent revision (! 2 months) should be considered if a plastic stent was inserted.

Diarrhoea is the most common illness affecting travellers to developing countries. Our study was designed to compare the efficacy of a single 500 mg dose of ciprofloxacin with placebo for treatment of acute diarrhoea in travellers. British troops who were within their first 8 weeks of deployment in Belize and who presented within 24 h of the onset of diarrhoea, were randomized to receive either ciprofloxacin 500 mg or placebo. Every subject recorded the number and consistency of stools and presence of any other associated symptoms for 72 h or until recovery. Of 88 subjects enrolled, 83 were evaluable, of whom 45 received ciprofloxacin and 38 placebo. Groups did not differ with regard to duration or severity of diarrhoea at randomisation. Mean (SE) duration of diarrhoea, as assessed by time to the last liquid and last unformed stool, was reduced from 50.4 (4.5) h and 53.5 (4.4) h, respectively, in the placebo group to 20.9 (3.4) h and 24.8 (3.8) h in those receiving ciprofloxacin (p < 0.0001). Mean number of liquid stools was reduced from 11.4 (1.2) in the placebo group to 5.0 (0.7) in the ciprofloxacin-treated group (p < 0.0001). The cumulative percentages of subjects with no unformed stool after 24 h, 48 h, and 72 h were, respectively, 64%, 82%, and 93% in the ciprofloxacin group and 11%, 42%, and 79% in the placebo group (p < 0.0001, p < 0.001, and not significant, respectively). A single 500 mg dose of ciprofloxacin was an effective empirical treatment for reducing the duration and severity of diarrhoea in travellers. The regimen should maximise compliance and reduce the cost and duration of therapy.

diacetate (DCF-DA) was used to detect the generation of intracellular ROS (especially H2O2). When the cells were exposed to IL-1beta (2.5, 5, 10, 25, 50 ng/mL) medium for 18 hours, cell viability did not show any change. We found that QGC did not reduce COX-2 expression induced by IL-1beta (25 ng/mL, 18 hrs), which plays an important role in inflammatory condition. However, QGC significantly inhibited the production of intracellular ROS induced by IL-1beta (25 ng/mL, 30 min). IL-1beta induced the activation of ERK, p38 MAPK and IB, and the nuclear translocation of NFkB, which were reversed by ROS scavenger Nactetylcysteine (NAC) and QGC, not by NADPH oxidase inhibitor diphenyleneiodonium (DPI). We also found that pretreatment of cells with ERK inhibitor PD98059, p38 MAPK inhibitor SB202190, NAC and QGC significantly attenuated the nuclear translocation of NFkB and the activation of IB induced by IL-1beta. Taken together, IL-1beta increases production of intracellular ROS and expression of COX-2, while it does not affect cell viability. QGC has a scavenger effect on cytokine-induced ROS production, thereby preventing its downstream events, the nuclear translocation of NFkB and the activation of IB, mediating by the activation of ERK and p38 MAPK, although QGC does not inhibit IL-1beta-stimulated COX-2 expression in feline esophageal epithelial cells.

Most cases of fulminant hepatic failure (FHF) are related to viral hepatitis or to drugs and toxins. With improvement in supportive intensive care, the overall survival has increased, but specific forms of temporary hepatic support pending hepatic regeneration have been disappointing. With the widespread availability of orthotopic liver transplantation, this has become a viable option for those patients with FHF who are unlikely to survive with conservative treatment, although patient selection and timing of transplantation still presents a clinical dilemma.