patients with normal manometry showed more than 1 simultaneous con-traction in the proximal esophagus.Conclusions: Simultaneous contractions (spasms) in DES patients areexclusively found in the distal smooth muscle segment. These findingssuggest that DES should be re–named as “Distal” Esophageal Spasm.

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HEALTH CARE SEEKING BEHAVIOUR OFGASTROESOPHAGEAL REFLUX DISEASE (GERD) IN ANURBAN POPULATION IN PAKISTANNadim Jafri, Shahid Manzoor, Asif Jalil, Faraz Hashmi and Syed W.Jafri, M.D.,F.R.C.G.*. Department of Medicine, Sind Medical College,Karachi, Sind, Pakistan and Gastroenterology Section, Department ofMedicine, Aga Khan University, Karachi, Sind, Pakistan.

Purpose: Pakistan has a population of over 150 million. Epidemiologicalstudies on different diseases are lacking. GERD is a common universalproblem, but its prevalence is unknown in Pakistan. The aim of this studywas to investigate the prevalence of gastroesophageal reflux disease, thepattern of symptoms associated with GERD and the health care seekingbehavior in subjects in an urban population in Pakistan.Methods: This was an observational study to diagnose GERD. A total of336 persons � 15 yrs old were interviewed using a predesigned question-naire modified from the American College of Gastroenterology (ACG)questionnaire. The urban population was from the southern city of Karachi.Results: A response of 84.0% yielded 336 questionnaires for analysis.Mean age of the surveyed sample was 23.1 �/–6.25 yr. In total, 188(55.95%) were men, and 148 (44.05%) were women. Using the ACGcriteria, the overall prevalence was 25.6% (17.9% in men and 7.7% inwomen). Age was not found to influence the prevalence in either sex.Symptoms frequently experienced were uncomfortable feeling behind thebreastbone moving upward from the stomach (50.0%), burning sensation inthe back of the throat (48.8%) and a bitter, acid taste in the back of themouth (58.1%). 76.7% experienced this immediately after the meal. Ex-tra–GI symptoms associated with heartburn in descending order were sorethroat (30.2%), frequent throat clearing (20.9%), cough (12.8%), hoarse-ness of voice (8.1%), allergies (7.0%) and asthma (5.8%). Food mostcommonly associated with heartburn was spicy foods (65.1%) and fried orfatty foods (61.6%). (75.6%) experienced these feelings more than twice aweek. 84.9% felt that antacids only provided temporary relief in theirsymptoms. 31.4% were taking prescription medication to treat their heart-burn but were still experiencing symptoms, however only 1.2% had actu-ally consulted a physician regarding their condition. Age, sex, and numberof symptoms did not influence health care seeking behavior.Conclusions: Gastroesophageal Reflux Disease is a common problem in theurban population of Pakistan. The prevalence is similar to most other countries.Health seeking behavior was found in only a small minority of subjects.

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LOW YIELD OF SCREENING FOR BARRETT’S ESOPHAGUSIN PATIENTS WITH A HISTORY OF GASTROESOPHAGEALREFLUX IN A UNIVERSITY HOSPITAL SETTINGNabeel Khan, M.D., Bernardo Ruiz, M.D. and Luis A. Balart, M.D.*.Louisiana State University, New Orleans, LA.

Purpose: Barrett’s esophagus has been reported to develop in 6–14% ofindividuals with gastroesophageal reflux(GER). There is considerable con-troversy regarding performing a screening upper endoscopy in this subsetof patients. Our aim was to identify the prevalence of Barrett’s esophagusin a setting of GER in our patient population and thus evaluate the need forscreening and aid in better utilization of resources.Methods: All adult patients with a long standing history of GER and whohad not undergone a previous endoscopy were screened for Barrett’sesophagus by an upper endoscopy during a one year time interval betweenNovember 2000 and October 2001.Results: One hundred and twenty patients were endoscoped. The agerange was 25–78 with a mean age of 50 years. There were 71(59%)

African–Americans, 40(33%) Caucasian, 8(7%) Hispanic and 1(0.83%)Asian. There were 84(70%) females and 36(30%) males. We found only1(0.83%) case of Barretts esophagus in a Caucasian male. There were 3(2.5%)other cases of intestinal metaplasia at the esophagogastric junction.Conclusions: The prevalence of barrett’s esophagus in our subset ofpatients was extremely low � 1%. In light of the above data we do not thinkit to be either cost effective or adequate utilization of resources to performa screening upper endoscopy in our subset of patients with a history of GERand probably it should be limited to Caucasian males.

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ENDOLUMINAL GASTROPLICATION AS AN EFFECTIVETREATMENT FOR GERDMohammed S. Uddin, M.D. and Fatema S. Uddin*. El Paso, TX.

Purpose: The selective application of Endoluminal Gastroplication as anoutpatient procedure for the treatment of gastroesophageal reflux disease(GERD) offers encouraging results for both patients and physicians.Methods: A total of 20 patients between the ages of 29 and 60 yearswere treated for GERD using the Bard EndoCinch system. Patients wereselected on the basis of the history of heartburn, regurgitation, andtherapeutic response supported by pH and motility studies. Other non-specific symptoms including epigastric pain (or discomfort), nausea,and coughing spells were noted. The occurrence of daily heartburn ofmoderate to severe intensity (on a scale of 1 to 10) was reported by18/20 patients, while 2/20 had occasional heartburn of moderate inten-sity, and 9/20 had frequent regurgitation. Most patients had symptomsof more than three years duration. All patients experienced good re-sponse to anti–reflux therapy. All patients were medication– dependent.Motility studies were performed on 16/20 patients and 15/20 had a pHstudy. All patients had low LES pressure (normal 14 –32mm Hg).Exclusion criteria were history of Barrett’s esophagus, dysphagia, classIII or IV airway obstruction, esophageal stricture, grade III or IVesophagitis, hiatal hernia greater than 2 cm, esophageal varices, previ-ous history of fundiplication, and obesity (BMI � 40 (kg/m2)). Allpatients were followed up with at two week, one month, three month,and six month intervals. A record of symptoms, medication intake, andweight change was maintained and comparisons were made.Results: Post–operative symptom changes and patient feedback demon-strated procedural efficacy. There was 100% recovery from regurgitation(9/9 patients), 13/20 patients reported no heartburn, and only 7/20 hadoccasional (up to once a week) mild heartburn needing PRN PPI/OTCdrugs. All patients were satisfied with the procedure and were happy to beable to eat without restriction. Weight gain was reported in 12/20 patients,some with significant gains (�10 pounds in 3 months).Conclusions: Endoluminal Gastroplication (done with Bard EndocinchSystem) is safe and effectively controls GERD symptoms. It reduces thenecessity of medication dramatically and allows patients to have the free-dom of enjoying diet without modification.

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PROSPECTIVE CONTROLLED EVALUATION OF PHTESTING, LARYNGOSCOPY AND LARYNGOPHARYNGEALSENSORY TESTING (LPST) SHOWS A SPECIFIC POSTERIORINTER–ARYTENOID NEUROPATHY IN PROXIMAL GERD (P–GERD). LPST IMPROVES LARYNGOSCOPY DIAGNOSTICYIELD IN PGERDV. Alin Botoman, M.D.*, Kendall L. Hanft, M.D., Susan M. Breno,C.C.R.C., Dawn Vickers, R.N., Frank C. Astor, M.D., Irys B. Caristo,C.C.R.C., Gilberto O. Alemar, M.D., Sheshir Sheth, M.D. and GregoryF. Bonner, M.D. Dept of Gastroenterology, Cleveland Clinic Florida,Weston, FL and Dept of Otolaryngology, Cleveland Clinic Florida,Weston, FL.

Purpose: Proximal GERD (P–GERD) is associated with hoarseness, andcough. LPST tests, with air, sensation and involuntary laryngeal–closurereflex (LCR) in stroke patients(pts) with dysphagia. We studied the role of

S11AJG – September, Suppl., 2002 Abstracts