Background Mean nocturnal baseline impedance (MNBI), a novel pH-impedance metric, may be a surrogate marker of reflux burden. Aim To assess the predictive value of MNBI on symptomatic outcomes after antireflux therapy. Methods In this prospective observational cohort study, pH-impedance studies performed over a 5-year period were reviewed. Baseline impedance was extracted from 6 channels at three stable nocturnal 10-min time periods, and averaged to yield MNBI. Distal and proximal esophageal MNBI values were calculated by averaging MNBI values at 3, 5, 7, and 9 cm, and 15 and 17 cm, respectively. Symptomatic outcomes were measured as changes in global symptom severity (GSS, rated on 100-mm visual analog scales) on prospective follow-up after medical or surgical antireflux therapy. Univariate and multivariate analyses assessed the predictive value of MNBI on symptomatic outcomes. Results Of 266 patients, 135 (50.8%) were tested off PPI therapy and formed the study cohort (52.1±1.1 yrs, 63.7% F). The 59 with elevated acid exposure time (AET) had lower composite and distal MNBI values than those with physiologic AET (p<0.0001), but similar proximal MNBI (p=0.62). Linear AET negatively correlated with distal MNBI, both individually and collectively (Pearson's r=−0.5, p<0.001), but not proximal MNBI (Pearson's r=0, p=0.72). After prospective follow-up (94 patients followed for 3.1±0.2 yrs), univariate and multivariate regression models showed that distal MNBI, but not proximal MNBI, was independently predictive of linear GSS improvement. Conclusions Distal esophageal MNBI negatively correlates with AET and, when assessed off PPI therapy, is independently predictive of symptomatic improvement following antireflux therapy.

Background/AimsBreaks in the peristaltic contour on esophageal high-resolution manometry (HRM) may be associated with bolus retention in the esophagus. We evaluated the relationship between peristaltic breaks and esophageal symptoms, reflux exposure, and symptom outcomes in a prospective patient cohort.MethodsTwo hundred and eighteen patients (53.2 ± 0.9 years, 68.3% female) undergoing both pH-impedance testing and HRM over a 5–year period were prospectively evaluated. Demographics, symptom presentation, acid exposure time, symptom association probability, and symptom burden scores were collected. Outcomes were assessed on follow-up using changes in symptom scores. Presence of long breaks (≥ 5 cm) on HRM was assessed by a blinded author. Relationships between breaks, reflux parameters, presenting symptoms, and outcomes were assessed.ResultsPatients with long breaks were more likely to have cough as a presenting symptom than those without (43.4% vs 28.6%, P = 0.024); statistical differences were not demonstrated with other symptoms (P ≥ 0.3). Numbers of swallows with long breaks were higher in patients with cough compared to those without (2.4 ± 0.3 vs 1.6 ± 0.2, P = 0.021); differences were not found with other symptoms (P ≥ 0.4). Long breaks were not associated with age, gender, race, reflux burden, symptom association, or changes in symptom metrics (P ≥ 0.1 for all comparisons). Among patients with cough, the presence of long breaks predicted suboptimal symptom improvement with antireflux therapy (P = 0.018); this difference did not hold true for other symptoms (P ≥ 0.2).ConclusionsLong breaks in esophageal peristaltic integrity are associated with cough. The presence of long breaks is associated with suboptimal benefit from antireflux therapy.

SUMMARY Background The Chicago Classification (CC) uses high-resolution manometry (HRM) software tools to designate esophageal motor diagnoses. We evaluated changes in diagnostic designations between two CC versions, and determined motor patterns not identified by either version. Methods In this observational cohort study of consecutive patients undergoing esophageal HRM over a 6-year period, proportions meeting CC 2.0 and 3.0 criteria were segregated into esophageal outflow obstruction, hypermotility, and hypomotility disorders. Contraction wave abnormalities (CWA), and ‘normal’ cohorts were recorded. Symptom burden was characterized using dominant symptom intensity and global symptom severity. Motor diagnoses, presenting symptoms, and symptom burden were compared between CC 2.0 and 3.0, and in cohorts not meeting CC diagnoses. Results Of 2569 eligible studies, 49.9% met CC 2.0 criteria, but only 40.3% met CC 3.0 criteria (p<0.0001). Between CC 2.0 and 3.0, 82.8% of diagnoses were concordant. Discordance resulted from decreasing proportions of hypermotility (4.4%) and hypomotility (9.0%) disorders, and increase in ‘normal’ designations (13.0%); esophageal outflow obstruction showed the least variation between CC versions. Symptom burden was higher with CC 3.0 diagnoses (p≤0.005) but not with CC 2.0 diagnoses (p≥0.1). Within ‘normal’ cohorts for both CC versions, CWA were associated with higher likelihood of esophageal symptoms, especially dysphagia, regurgitation, and heartburn, compared to truly normal studies (p≤0.02 for each comparison). Conclusions Despite lower sensitivity, CC 3.0 identifies esophageal motor disorders with higher symptom burden compared to CC 2.0. CWA, which are associated with both transit and perceptive symptoms, are not well identified by either version.

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17044 Background: Approximately 10% of patients (pts) with lung cancer do not have a history of tobacco smoking. The clinical presentation and outcomes of pts with LCINS have not been well characterized in the Western population. Methods: We reviewed our institutional tumor registry to identify patients with lung cancer from 1992 to 2002. Data regarding tobacco smoking, stage, histology and survival were collected. Results: Of the 5417 consecutive pts diagnosed with lung cancer, 254 were determined to be never-smokers with confirmed pathologic diagnosis of non-small cell lung cancer (NSCLC). The table below describes the patient demographics. The five-year survival for the entire population with LCINS was 22.56%, with 37 pts surviving beyond five years. The median overall survival for women was 21.08 months (95% CI 14.03–23.37) and for men 13.5 months (95% CI 8.5–32.492); p = 0.73. Among the different histologic subtypes, broncho-alveolar carcinoma was associated with better median overall survival of 61.67 months (p < 0.0001). The median overall survival by TNM stage: I (71 months), II (32 months), III (15 months), and IV (6 months). Conclusions: 1. LCINS affects predominantly women. 2. Adenocarcinoma is the most common histological type. 3. Brain and bone are the most common sites of metastases. [Table: see text] No significant financial relationships to disclose.

18555 Background: Lung cancer is the most common cause of cancer related death in the United States. Non-small cell lung cancer (NSCLC) accounts for over 80% of all new cases of lung cancer. Lung cancer is a disease of the elderly. There are only limited data available on NSCLC in octogenarians. Methods: From our institutional tumor registry, we identified all patients with NSCLC from 1995 to 2002 who were 80 years or older at the time of initial presentation. Data regarding overall stage, histology, date and extent of surgery, and co-morbidities were analyzed. Co-morbidity determination was based on the Adult Co-morbidity Evaluation (ACE-27) test, which ranges from 0 to 3 depending on severity of co-existing conditions. Results: At the time of initial presentation with NSCLC, 236 pts were 80 years or older. The distribution of stages were: stage I in 93 pts (39.5%), stage II in 15 pts (6.5%), stage III in 66 pts (28%) and stage IV in 62 pts (26%). Of the 236 patients the co-morbidity score was known for 223 pts. The distribution of the known scores was: 0, 39 pts (17.5%); 1, 79 pts (35%); 2, 68 pts (30.5%); and 3, 37 pts (17%). Only 35 patients in this cohort underwent surgery. Conclusions: 1. Despite a high proportion (46%) of early stage NSCLC, only a few elderly patients 80 years or older undergo surgical resection, likely because of co-morbid conditions. 2. Innovative non-surgical local modalities of therapy need to be studied in this population. No significant financial relationships to disclose.

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