coefficients, and paired t-tests were computed to assess agreement betweenthe two modes of administration. Internal consistency reliability estimateswere computed by method of administration using Cronbach’s alpha. Scorestability based on patient understanding of GI anatomy was evaluatedthrough use of a human torso picture. During the S portion of datacollection, 50% of subjects referred to a labelled torso picture, while 50%had an unlabelled torso and were asked to label it.Results: The PAGI instruments demonstrated evidence of reliability acrossmethod of administration. For total scores, internal consistency reliabilitylevels were very high (PAGI-SYM: T: 0.95; S: 0.93; PAGI-QOL: T: 0.97;S: 0.97), exceeding the recommended level of 0.90 for applied research.Pearson correlations between T and S ranged from 0.44 to 0.76 for thePAGI-SYM subscales and 0.65 to 0.90 for the PAGI-QOL subscales. ICCswere similar, ranging from 0.42 to 0.77 for the PAGI-SYM and from 0.65to 0.89 for the PAGI-QOL. The ICCs and Pearson correlations for thePAGI-SYM total score were 0.90 and 0.92, respectively. The PAGI-QOLtotal score was 0.93 for both the ICC and Pearson correlations. There wereno statistically significant differences in mean scores related to the presenceof a torso picture, although only 50% of the group with the unlabelled torsopicture correctly identified the stomach and upper abdomen.Conclusions: The results of this study provide further evidence that thePAGI instruments are reliable condition-specific measures and that tele-phone interview is a viable option for the PAGI-SYM and PAGI-QOL inlongitudinal, prospective studies and clinical trials. Although subjects mayhave difficulty locating the stomach and upper abdomen, scores on thePAGI instruments are not affected.

897

Fecal occult blood testing in hospitalized patients: survey ofindications for FOBT and follow-up of positive resultsJohn T. Sweeney, MD1, Kevin B. Meyer, MD1 and John D. Long, MD1*.1Digestive Diseases, University of Cincinnati Medical Center,Cincinnati, OH.

Purpose: Use of fecal occult blood testing (FOBT) in hospitalized patientsis frequently employed beyond its indication for colorectal cancer screen-ing. A positive (�) FOBT indicates the need for gastrointestinal evaluationbut the compliance rate and diagnostic value of such an approach isunknown. We evaluated the indications for FOBT and management ofpositive results in hospitalized patients.Methods: Charts were reviewed on consecutive hospitalized patients, 71with (�) FOBT and 20 with (�) FOBT. FOBT was performed on spon-taneously passed stools. Reasons for admission, indications for FOBT, age,medications, hemoglobin levels, follow-up, and results of endoscopic test-ing were recorded.Results: Most patients (pts), 71/91 (78%), were admitted with non-gas-trointestinal (non-GI) diagnoses. Indications for FOBT are listed (Table).Acute anemia was defined as any decrease in hemoglobin during admissionwhich prompted FOBT (mean drop � 1.73 g, range: 0.3–4.7 g). Mean age� 58 years (range: 20–93 years). 30/71 (42%) of (�) pts and 14/20 (70%)of (�) pts were on antiplatelet or anticoagulant medications. 36/71 (51%)of pts with (�) FOBT underwent endoscopy: upper endoscopy (EGD),sigmoidoscopy (FS), or colonoscopy (CS). 35/71 (49%) of (�) pts did nothave endoscopy. Of those 35, 12/35 (34%) had an in-patient GI consulta-tion and/or an outpatient GI appointment. However, 23/35 (66%) had no GIevaluation (3 died during admission). 15/71 (21%) of (�) pts received CSor FS; 11/15 (73%) had findings that could cause a (�) FOBT (1/15 hadcolorectal adenocarcinoma). 33/71 (46%) of (�) pts received EGD. Ofthose, 23/33 (70%) had findings that could cause a (�) FOBT.Conclusions: The most common indication for FOBT testing in hospital-ized patients was to evaluate acute anemia in the absence of overt GIbleeding. When performed, endoscopy frequently identified a source ofblood loss, and EGD was employed more often than CS or FS. Compliancewith appropriate follow-up of a (�) FOBT was suboptimal, indicating thatmore education is needed regarding this clinical practice.

AcuteAnemia

OvertBleed

ChronicAnemia Miscellaneous

GISymptoms

FOBT (�) 45 (63%) 8 (11%) 6 (8%) 4 (6%)FOBT (�) 7 (35%) 0 (0%) 5 (25%) 6 (30%) 2 (10%)

898

Cost effectiveness and sensitivity of screening strategies forhepatocellular carcinoma and portal vein thrombosis in livertransplant candidatesMiriam Thomas, FACG, M.D.HF and Kimberly Brown, M.D.HF*.1Gastroenterology, Henry Ford Hospital, Detroit, MI, United States.

Purpose: Various screening strategies to determine the presence of hepa-tocellular carcinoma (HCC) and portal vein thrombosis (PVT) in patientsbeing evaluated for liver transplantation have been utilized. Our aim was todetermine the sensitivity, specificity and cost of various screening strate-gies in this population.Methods: 169 adult patients receiving their first liver transplant from 1/90to 1/99 were included. Data regarding pre transplant testing including alfafetoprotein (AFP), ultrasound with dopplers (US), cat scan (CT) andmagnetic resonance imaging (MRI) with respect to findings of HCC andPVT were recorded and analysed. Sensitivity and specificity of each testwas determined in detecting HCC and PVT using explant histology.Results: 169 patients, mean age 49 years, 60% male, 40% female wereincluded. HCC and PVT were found in 13 and 11 explants respectively.35% of patients had Hepatitis C (HCV) infection. Tumors were found morefrequently in patients with HCV (9) compared to patients without HCV (4)p � 0.015. Tumors were more common in males (11) vs females (2) p �0.08. The sensitivity of the MRI (86%) was significantly higher than AFP�20 ng/ml (27%), US (17%) and Cat scan (50%) for detecting HCC. Allmodalities were very specific with narrow confidence intervals. The costwas determined using the medicare reimbursement data. The combinedcost of detecting PVT with the US and doppler and HCC with the CT was$ 549.24 while that for the MRI was $489.61 and therefore the cost savingsis $59.63 per patient screened.Conclusions: 1. HCC appears to be more common in patients with HCVbeing evaluated for transplant compared with other patients. 2. AFP isinsensitive in detecting HCC in this population. 3. MRI is more sensitivein detecting HCC compared with CT and US and as sensitive as US lbdetecting PVT. 4. Strategies using MRI to detect HCC and PVT are lessexpensive when compared to CT combined with doppler US. 5. ScreeningMRI appears to be the most sensitive and cost effective method in screen-ing patients for HCC and PVT prior to transplant. 6. Given the increasedincidence of HCC in HCV patients, ongoing screening strategies for listedand waiting patients should be considered.

HCC PVTSensitivity Specificity Sensitivity Specificity

AFP�200� 25 % 99 %US 17 % 100 % 50 % 50 %CT 50 % 96 %MRI 86 % 93 % 50 % 94 %

899

Outcome of amyotropic lateral sclerosis patients receivingpercutaneous endoscopic gastrostomy tube placement underconscious sedationChristopher C. Thompson, M.D.1 and William A. Rowe, M.D.1*.1Gastroenterology, Pennsylvania State University College of Medicine,Hershey, PA, United States.

Purpose: Amyotropic lateral sclerosis (ALS) is the most common form ofprogressive motor neurodegeneration and often results in severe dysphagiarequiring other means of nutrition. The ALS patient’s diminished respira-tory function, thick abdominal wall due to accessory muscle hypertrophy,and generalized debility often introduce uncertainty into the decision about

S282 Abstracts AJG – Vol. 96, No. 9, Suppl., 2001