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44.4% in 15 Hz group (p0.480). One patient had numbness/
tingling in the right arm in 5 Hz group.
Conclusions In this interim analysis, repetitive translumbar and
transsacral magnetic stimulation appears safe, and at 1 Hz fre-
quency showed significant superiority when compared to
higher frequencies for the treatment of FI. This non-invasive
neuromodulation modality offers promise as a novel treatment
approach for FI.
Abstract OWE-030 Table 1 Summary of results
1 Hz 5 Hz 15 Hz
Baseline Post-
Treat
Baseline Post-
Treat
Baseline Post-
Treat
FI episodes/Wk 7.1±2.7 2.0±1.3* 10.6
±4.5
9.1±3.7 5.0±2.5 2.3±0.8*
Responder rate
(%)
88.9%]25% 44.4%
FISI score d(%) 34.6±18.4 12.0±4.9 17.6±16.1
Considerable or
Complete relief
66.7% 37.5% 44.4%
Mild or
Unchanged
33.3% 62.5% 44.4%
Worse 0 0 11.1%
Bold = *p<0.05 vs baseline; ]vs 5Hz
OWE-031 OESOPHAGEAL APERISTALSIS IS UNDER
INVESTIGATED IN THOSE WITHOUT ACHALASIA OR
REFLUX
1
Mr Pierfrancesco Visaggi*,
2
Hajir Ibraheim,
2
Terry Wong,
2
Jafar Jafari,
2
Jason Dunn,
2
Sebastian Zeki.
1
University of Pisa, Pisa, Italy;
2
Dept Gastroenterology, St Thomas‘Hospital,
London, UK
10.1136/gutjnl-2018-BSGAbstracts.419
Introduction Oesophageal aperistalsis (OA) is the absence of
oesophageal motility with water swallows at high-resolution
manometry (HRM). The main causes are achalasia and reflux
although in many patients no cause is found, therefore we
aimed to investigate the number of patients with an identifi-
able cause of OA and the number of patients in whom the
most common aetiologies have been determined. There is no
consensus for the investigation of OA without achalasia; this
will depend on how common the underlying aetiology is.
Methods We examined the reports of patients who had HRM at
Guy’s and St. Thomas’NHS Trust from January 2008 to July
2017. 492 patients had OA as per the Chicago Classification
2014; achalasia was defined as an integrated relaxation pressure
(IRP) of >15 mmHg or IRP 12–15 mmHg and a barium swallow
or other imaging or a previous myotomy for achalasia was identi-
fied. For those without achalasia, Gastroesophageal reflux disease
(GORD) was defined according to any pH study off PPI. Patients
without GORD or achalasia were classified as non-achalasia, non-
reflux aperistalsis (NANRA). Non-achalasia patients without a pH
study were excluded (n35). The electronic patient record of
NANRA patients was consulted to look for evidence of autoim-
mune disorders (AD), eosinophilic oesophagitis (EoE) or previous
oesophageal surgery.
Results Among 457 included patients we defined three catego-
ries: 183 (40%) had achalasia, 185 (41%) had GORD and 89
(19%) had NANRA.
Of the 89 NANRA patients, 29% had an AD including
Systemic Lupus Erythematosus, Scleroderma, Sjögren syndrome
and Antisynthetase syndrome (n25, M:F 3:7, average
age 48). One had Myotonic Dystrophy (n1); 11% (n10)
had hypersensitive oesophagus; 6% (n5) had surgery for
atresia, oesophageal spasm, or gastric cancer; 2% (n2) had
EoE and in 2% (n2) of patients AD screen and EoE screen
were normal. The remaining 50% of NANRA patients (n44)
had an unknown cause but incomplete investigations (no
screen for AD: 97.7%; no biopsy: 67.4%).
Conclusions 1.The principal cause of OA is achalasia; it
shouldn’t be dismissed as a cause even if the IRP
is <15 mmHg as 6.5% (n12) of patients with achalasia and
OA had IRP <15 mmHg but typical radiological findings.
2.GORD is present in 41% of patients but it is unclear
whether it is a cause or effect of OA, therefore the finding of
GORD should not stop further investigation.
3.Patients with OA are under investigated for AD and EoE.
50% of patients with NANRA had incomplete investigations
potentially losing the opportunity to identify other aetiologies.
It is unclear whether NANRA patients should be routinely
tested for AD or for EoE, or whether this should be done
only in selected cases.
OWE-032 A RANDOMISED PLACEBO-CONTROLLED TRIAL OF A
MULTI-STRAIN PROBIOTIC FORMULATION. (BIO-KULT
®
)
IN THE MANAGEMENT OF IBS-D
Shamsuddin Ishaque*, Sheikh Mohammed Khosruzzaman, Dewan Saifuddin Ahmed,
Mukesh Prasad Sah, Malwina Naghibi*. Bangabandhu Sheikh Mujib Medical University
(BSMMU), Dhaka, Bangladesh
10.1136/gutjnl-2018-BSGAbstracts.420
Introduction Increasing evidence supports the viewpoint that
alterations in the diversity and function of gastrointestinal bac-
teria contributes to IBS, and that increasing the mass of bene-
ficial species, by consuming probiotics, may lower pathogenic
bacteria numbers and help alleviate symptoms.
Methods In this double-blind trial, a total of 360 adult
patients with moderate-to-severe symptomatic diarrhoeapredo-
minant IBS (IBS-D) were randomised to receive either treat-
ment with the multi-strain probiotic Bio-Kult (14 different
bacterial strains) or placebo for 16 weeks. The primary out-
come measure was change in abdominal pain. The secondary
outcomes included frequency of bowel motions, overall change
in IBS-severity scoring system (IBS-SSS) and IBS specific qual-
ity of life (IBS-QoL).
Results In comparison to placebo, treatment with probiotics
significantly alleviated the severity of abdominal pain in
patients with IBS-D: 69% reduction for probiotic versus 47%
for placebo (p<0.001), equating to a 145 point reduction on
the IBS-SSS. The level of patients rating their symptoms as
moderate-to-severe was reduced from 100% at baseline to
14% in the multi-strain probiotic group by follow-up (month
5) versus 48% for placebo (p<0.001). In addition, the num-
ber of bowel motions per day from month 2 onwards was
significantly reduced in the probiotic group compared with
the placebo group (p<0.05). In addition to relieving symp-
toms, the probiotic markedly improved all dimensions of qual-
ity of life in the 34-item IBS-QoL questionnaire. No serious
adverse events were reported.
Conclusions The multi-strain probiotic was associated with signifi-
cant improvement in symptoms in IBS-D patients, and was well-
Abstracts
A210 Gut 2018;67(Suppl 1):A1–A304
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