Introduction

Disorders of the gut brain interaction (DGBI) describe a range of chronic, debilitating gastrointestinal symptoms, including irritable bowel syndrome (IBS). Whilst DGBI can be responsive to first-line dietary therapy, in South Australia, tertiary care service models are typically gastroenterologist-led with on-referral to a dietitian. To address the increasing demand of DGBI care on a tertiary outpatient gastroenterology service, a new dietitian-led DGBI service model utilising intestinal ultrasound performed by a gastroenterologist was developed.

Aims & Methods

The aim of the study was to investigate the clinical outcomes, cost of service delivery, and activity-based funding (ABF) generated by a dietitian-led DGBI model of care. This prospective study between September 2022 and October 2024 included patients with DGBI and no high-risk clinical features. Patient reported outcome measures were assessed with validated IBS-symptom severity score (IBS-SSS). The per patient episode of care costs were calculated including staffing, both medical and allied health, investigations ordered, emergency department presentations and hospital admissions. ABF is an Australian commonwealth government funding model that allocates government funding to healthcare providers based on the volume and complexity of health care services delivered. ABF was calculated using 2023 National Weighted Activity Units (NWAU) ($5797.00) multiplied by the allied health specialist interventions price weight (0.567). Descriptive and inferential statistics were used to analyse demographics, clinical outcomes and costing presented ($AUD).

Results

Fifty-six of one-hundred and sixty-eight patients participated in this study. The median age was 30 years (interquartile range (IQR 25-37)) and 42/56 (75%) were female. There were 3 (IQR 1-4) occasions of service per episode of care. There was a 98.8-point (95% CI 68-6-128.1) reduction the IBS-SSS scores (p<0.001). The cost per patient episode of care cost was $286.25 (IQR 221.25-351.87). The ABF funding generated was $1064.66 (IQR 656.00-1640.00). Each $1 invested into the clinic returned $2.58 in ABF funding to the health service.

Conclusion

A dietitian-led DGBI clinic utilising intestinal ultrasound delivers improvement in patient reported outcome measures and positive financial return on investment.

Disclosure

Nil

Introduction

Gastric adenocarcinoma (GAC) is the the sixth most common cancer worldwide. It is estimated that 54% of cases are preventable; yet, its prognosis remains poor, with 1-year and 5-year survival rates being just 48% and 22%, respectively. GastroPanel (Biohit Oyj; Helsinki, Finland) is an ELISA kit that measures pepsinogen I (PGI); pepsinogen II (PGII); gastrin-17 (G-17); and Helicobacter pylori IgG antibodies (Hp IgG). PGI and the PGI/PGII ratio correlate inversely with the severity of chronic atrophic gastritis (AG). Proximal open patterns (O1–O3) of Kimura and Takemoto classification of atrophic gastritis are associated with higher risk of developing gastric neoplasm. The aim of this study was to assess GastroPanel performance in the identification of moderate to severe AG in dyspepsia.

Aims & Methods

In this UK, single-centre, prospective diagnostic accuracy study, 324 patients [56.8% (n=184) female; median age 57 years (range 39–92 years)] were recruited for gastroscopy with biopsy and histology according to the updated Sydney System (USS). Blood (plasma) samples were collected for GastroPanel analysis. Paired samples were obtained from 268 patients [56.3% (n=151) female; median age=57 (range 39–92 years)]. Patients with type 2 diabetes were enrolled in a separate group. GastroPanel results were interpreted using the GastroSoft app (Biohit) for all patients.

Results

Overall agreement between GastroPanel and the USS classification was 90% (95% CI=86.7 to 93.8%), with a weighted kappa (κw) of 0.828 (95% CI=0.781 to 0.865). In receiver operating characteristics (ROC) curve analysis, using moderate/severe atrophic gastritis of the corpus (AGC2+) as the endpoint, AUC=0.840 (95% CI 0.630 to 1.000) and 0.960 (95% CI 0.907 to 1.000) for PGI and the PGI/PGII ratio, respectively.

Conclusion

GastroPanel is a reliable dyspepsia triage test distinguishing patients who can be safely treated conservatively from those with moderate to severe proximal (corpus) atrophic gastritis at high risk of developing GAC. A new proposed clinical pathway for dyspepsia might include the GastroPanel.

Disclosure

No conflict of interest to disclose

Introduction

The definition of actionable GERD according to the Lyon v2.0 Consensus in patients with inconclusive diagnosis of GERD (acide exposure time [AET] that ranges among 4 and 6%) requires adjunctive metrics such as mean nocturnal baseline impedance (MNBI), total number of reflux events and reflux/symptom association (RSA) indices.

Aims & Methods

The aim of this study was to identify patients most likely to have a positive metrics on prolonged 96 hours wireless pH monitoring (PWPM) among patients with inconclusive AET values on 24 hours pH-impedance monitoring (MII-pH) off PPI. Secondary aim was to identify other MII-pH parameters predictive of GERD diagnosis.
This was a retrospective study that collected a series of patients with typical GERD presentation. All patients underwent:

• Endoscopy, to exclude the presence of erosive esophagitis (grade B or higher according to Los Angeles classification);
• Esophageal HRM to rule out motility disorders and calculate: esophago-gastric junction contractile integral (EGJ-CI), esophagogastric junction (EGJ) morphology, and Milan Score.
• MII-pH monitoring to assess AET values, total reflux events, MNBI, RSA and Lyon Score.
• PWPM performed for 96 hours within 1 month after MII-pH.
• Treatment (PPI) response was evaluated with VAS scale during follow-up.

Patients were categorized into 2 different groups: those with vs. without conclusive GERD on PWPM. MII-pH and HRM parameters were compared between the two groups.

Results

51 consecutive patients (24 female; median age 51yrs) were included: 15 patients (8 female, 49yrs, BMI 22.8) had non-conclusive PWPM for GERD (negative), while GERD was confirmed (positive) in 36 patients (16 female, 53yrs, BMI 26.8). There were no significant demographic differences. Prevalence of heartburn and regurgitation were comparable in both groups. Patients with confirmed GERD were more likely to respond to PPI treatment (positive 69% vs negative 59%, p=0.014).
Patients with confirmed GERD on PWPM had a higher AET (p<0.001), total reflux events (p < 0.001), and lower MNBI (p < 0.001) on MII-pH; lower EGJCI, and higher prevalence of hiatal hernia (p<0.001) on HRM; higher Milan SCORE (p < 0.001), and higher Lyon Score (p<0.01) compared to negative PWPM. See Table 1.

	Negative PWPM 96h (15)	Positive PWPM 96h (36)	P
PPI response (VAS)	59 (39, 69)	59 (39, 69)	0.014
Hiatal Hernia	0 (0%)	18 (50%)	<0.001
EGJ-CI	63 (46, 87)	20 (11, 30)	<0.001
MILAN SCORE	48 (42, 53)	196 (173, 234)	<0.001
AET (MIIpH)	1.60 (1.10, 2.90)	5.20 (3.75, 5.85)	<0.001
N REFLUX	25 (19, 29)	44 (36, 54)	<0.001
Symptom Index (+)	0 (0%)	10 (28%)	0.024
MNBI	2871 (2269, 3165)	1055 (910, 1247)	<0.001
LYON SCORE	1.00 (0.00, 2.00)	5.00 (3.00, 6.00)	<0.001

ROC analysis showed that MNBI is the strongest predictor of GERD (AUC 1.0), followed by the Milan (AUC 0.99, Sens 100%, Spec 93%) and Lyon Scores (AUC 0.97, Sens 80%, Spec 100%), total number of reflux events (AUC 0.9, Sens 86%, Spec 93%)
A subgroup of 13 patients (7 female) with an AET<4% but MNBI values <1500 Ohms on MII-pH, all (100%) were confirmed as having GERD on 96h PWPM.

Conclusion

We demonstrate that a low MNBI value on MII-pH is the strongest predicting factor of conclusive GERD diagnosis in patients with borderline or normal AET values. A sub-group of patients with AET <4% but very low MNBI (<1500 Ohms) on MII-pH showed conclusive GERD during subsequent 96 hour PWPM, establishing its longitudinal role in confirming reflux disease.

Disclosure

Conference Speech: Reckitt Benckiser; Malesci; Dr Falk, PharmaLine, AlfaSigma, Sanofi-Genzyme.
Advisory Board: Dr Falk; Astra Zeneca; Sanofi Genzyme, AlfaSigma
Research grant: Dr Falk; Sanofi Genzyme