PTU-151 Predictors For Coeliac Disease In Cases Of Lymphocytic Duodenosis

Abstract

Introduction Persistent GI symptoms and malnutrition have been associated with poorer quality of life in upper-GI cancer patients. This study aims to assess GI symptoms and nutritional status in patients undergoing modern treatment. Methods Patients with newly diagnosed upper-GI cancer were prospectively reviewed at the time of diagnosis and at 3- and 12-months following radical treatment. Nutritional assessment was performed using the patient-generated subjective global assessment (PG-SGA), which is considered the 'gold-standard' for nutritional assessment and has been validated in the oncology setting (score >= 4 intervention needed; score >= 9 critical intervention needed). The gastrointestinal symptom rating scale (GSRS) was used to evaluate the presence/absence and severity of 22 GI symptoms using a 4-point response scale. Total scores range from 0-66, where 0 = all symptoms absent and 66 = all symptoms severe. Results 61 males and 19 females, median age 66 (range 46-89) years were recruited (61% oesophageal, 33% gastric, 6% gastro-oesophageal junction tumours). Of these, 68 were reviewed at 3-months and 25 at 12-months. Mean (SD) body weight and body mass index (BMI) were 76.7 kg (17.4) and 26.7 kg/m2 (4.7) at baseline, 74.4 kg (14.8) and 25.9 kg/m2 (4.4) at 3-months and 72.1 kg (16.3) and 24.7 kg/m2 (4.4) at 12-months. There was a significant mean difference in weight (-2.0 kg, p = 0.002) and BMI (-0.56 kg/m2, p = 0.006) at 3-months compared to baseline. These reduced further by 12-months. Mean (SD) PG-SGA score at baseline 9.0 (6.3), 3-months 7.8 (5.6), and 12-months 7.4 (5.0) indicated that intervention was required. At baseline, 3- and 12-months 61%, 52% and 68% of patients respectively were considered moderately or severely malnourished. Mean (SD) total GSRS scores were 14.2 (10.8), 12.0 (9.4) and 15.5 (11.5) at baseline, 3- and 12-months respectively. The symptoms with the greatest increase in prevalence (% more patients) from baseline to 3-months (n = 68) were nausea (+24%), loose stool (+16%), urgency (+6%), flatulence (+6%) and early satiety (+6%). Those with the greatest decrease in prevalence (% less patients) during this time were difficulty swallowing (-24%), painful swallowing (-24%), regurgitation (-21%), belching (-15%) and acid reflux (-12%). Of the n = 25 followed up at 12-months, the most common symptoms reported were flatulence (76%), belching (72%), abdominal pain (68%), abdominal grumbling (56%) and early satiety (52%). Conclusion After treatment commences there is progressive weight loss over time. Troublesome GI symptoms persist at 12-months and may be contributing to this weight loss. Optimising nutritional status and controlling GI symptoms is required throughout the treatment pathway.