Abstracts 65 ANXIETY BUT NOT DEPRESSION DECREASES IN CELIAC PATIENTS AFI’ER ONE-YEAR GLUTEN-FREE DIET. G. Addolorato, E. Capristo, G. Ghittoni, C. Valeri. R. Mascianh, A. Scarfone, G. Valemini, C. Ancona, G. Gasbarrini Institute of Internal Medicine, Catholic University of Rome, Italy. Background. Several neurological and psychiatric illnesses are present in coeliac disease (CD). Among them, a high prevalence of anxiety and depression has been reported in untreated CD patients. A gluten-free diet (GFD) represents the most important treatment of CD patients. However the role of GFD on psychological disorders is still poorly known since at present there are no longitudinal study on this topic. Aim. The aim of this study was to evaluate state and trait anxiety and depression in adult CD patients before and after one year of GFD. Methods. A total of 35 CD patients were studied before and after one year of GFD and were compared to 59 healthy controls matched for gender, age and soc~o- economic status. State and trait anxiety were assessed by the STAI test; depression was assessed by the modified version of the SDS Zung self- rating depression scale (M-SDS). The tests were administered before (TO) and after one year of GFD (Tl). Results: At TO CD patients showed high levels of state anxiety in a significantly higher percentage compared to controls (71.4% vs 23.7%; p-zO.0001) while there was no significant difference in trait anxiety between groups (25.7% vs 15.2%; p:ns); the percentage of subjects with depression was significantly higher in the CD erouo than in controls (57.1% vs 9.6%: ocO.COO1). At Tl a sianificant D~--r decrease in the percent& of state anxieiy’was foudd in CD pat& (TO: 71.4% vs Tl: 25.7%; p<O.OOl), while there were no significant changes in the percentage of trait anxiety (TO: 25.7% vs Tl: 17.1%; p:ns) or depression (TO: 57.1.% vs Tl: 45.7%; p:ns) which was still present in a significantly higher percentage in treated CD compared to controls (p<O.OOOl). Conclusions: In CD patients anxiety is present in a predominantly reactive form, probably due to the presence of the symptoms, and it decrease after GFD. Depression is present in a higher percentage in CD patients and could be related both Lo the symptomatology and to the malabsorption of the nutrients acting on the neuronal oroduction of monoamine. One war of GFD fails to significantly affect depressive symptoms. The presence of depression after GFD could be related Lo the reduction in quality of life in CD patients partly due to dietary restrictions, and could suggest that these patients may need psychological support. 66 APPROPRIATE USE OF UPPER GASTROINTESTINAL ENDGS- COPY: COMPARATIVE PROSPECTIVE STUDY USING GUIDE- LINES OF AMERICAN SOCIETY OF GASTROINTESTINAL EN- WSCOPY AND EUROPEAN PANEL ON THE APPROPRIATENESS OF GASTROINTESTINAL ENDOSCOPY A Mamaw*, R.Man, GCondorelli, A Cabana,C Favara, G Trama, A.Russo Surgical Endoscapy - University of C&&a; *Division of Surgery - University of BACKGROUND Several studies have investigated the appropriate use of upper gastrointestinal endoscnpy (LOGE) following the American Society of gastrointestinal endoscopy (ASGE) guideline. Recently more detailed criteria have been developed by European Panel on Appropriateness of Gastrointestinal Endoscopy (EPAGE)“‘, but they are not yet validated. AUI. To compare the appropriateness of referrals for UGE in an open ac- cess endoscoov unit. usinn the ASGE and EPAGE criteria. METHODS.‘& &ou&d consecutive outpatients (496 Ml504 F; mean age 54.9, range 18-79) referred to our endoscopy unit by general practitio- ners from March to November 1999 were included in the study. The refer- ral indications were compared with the ASGE and EPAGE guidelines and with endoscopic diagnosis. Endoscopic findings, that had therapeutic or prognostic consequences, were classified as clinical relevant. RESULTS. Most UGE were motivated by dyspepsia (45%) or gastro- esophageal reflux symptoms (36%). Using ASGE criteria 63% of UGE were judged inappropriate and only 31 % appropriate. The probability of finding a clinical relevant lesion was significantly higher in UGE rated as appropriate (58 %) than in those rated as inappropriate (44 %) @<O.OOl). Using EPAGE criteria only 28% of UGE ware judged while 71% were appropriate; 1% of the indications were uncertain. The probability of finding a clinical relevant lesion was significantly higher in UGE rated as anorooriate 163 %) that in those rated as inaoorooriate (49 %) CD< 0.0011. ~~N&us~oN%‘I~ oar opm access endo&p; unit ;sing’&GE g&- lines, 63% of outpatients were referred for inappropriate reasons while following the EPAGE criteria only 28% of UGE were inappropriate. In our opinion more specific criteria, above all regarding dyspepsia or r&lox symptoms included in EPAGE guidelines can explain the lower rate of inappropiate endowpies. (‘I J -J Gonvers et al Endoscopy 1999; 3 I:572 67 A MULTIDISCIPLINARY OUTPATIENTS CLINIC FOR COLORECTAL DISEASES V Stialiano, M Coamelli, M De Sands, F Graz~ano. D .ASSISI, V Casale, S Giunta , C Garuii, E Santoro and M Crespt Regina Elena Cancer Institute, Rome Italy BACKGROUND Colorectal cancer (CRC) is one of the learlmg causes of death for neoplasms in Western counmes. ldentificatmn and removal of all adenomas detected is the most Important measure to improve prognosis and reduce mortality In addition, the role of follow up m patients already treated for colorectal cancer 1s to detect any recurrence or metachronous lesmns at an early stage. AIM With the aim to offer to the pop&Ion and to patients m surveillance after treatment a prompt and efficient care, an “ad hoc” OutpatIent Chmc was established MATERIAL AND METHODS The new entm. where the coiorectal cancer screening program and the follow up for treated patients IS performed, 1s named Colorectal Multidisaplinq Outpatxnts Clinic. The screening program subjects enrolled are volunteers Informed by the AlGO screening campaign ads and other educational matenal, focused on the importance of early detechon and on how death and morbidity can be prevented or reduced by detectmg and removmg adenomas Moreover the Importance of family history, predisposmg conditions and other risk factors IS emphasized These subjects, after a gasuoenterological consultation, follow a screening program mcludmg FOBT, Colonoscopy and, if necessary, a Double Contrast Barmm Enema. Pawnts already treated for colorectal cancer are sobmIned to a strict follow up protocol provldmg swgul consultation, serological markers, ultrasonography and endoscopy at regular timings. Patients are also adwed on the opportunity to screen the first degree relatives RESULTS: The mnovative aspects of tlus mitiative are: a) the unification of screemng, diagnosis and follow up wthm the same medical team; b) the fact that all the required procedures are performed in the same or shortly followmg days, c) to antrcipate the waiting hst for adnnssion and care when necessary Thus Initiative was started four months ago and the acceptance by the public and patients seems very favorable. CONCLUSIONS: We are conwnced that public awareness towards the problem of CRC screemng and early diagnosis must find m the health care network dedicated medical surgical Umts where a comprehensive care is delivered. 68 CURRENT KNOWLEDGE ON H.PYLORl AND INDICATIONS FOR ENDOSCOPY: IS IT POSSIBLE TO REDUCE THE ENDOSCOPIC WORKLOAD? S.Mosca, GManes, C.DeNucci, S.Picascia, A.Bove, E.Riccio, L.Amitrano, PV Rocco, A.Balzano, Gruppo Campano H.pylori. Cardarelli Hospital, Napoli Italy Discovery of H.pylori (Hp) has dramatically changed the diagnosis and treatment of peptic disease. Both the NIH and Maastricht comensus conferences reported the guidelines to optimize the management of the infection in the clinical practice. In spite of the wide dissemination of knowledge about Hp, a large number of endoscopy performed in the open access services are not indicated. Patients: All patients who underwent endoscopy for problems strictly related to peptic disease, i.e. dyspeptic symptoms of different types, history of peptic ulcer, control after treatment were prospectively considered during one week in 21 endoscopic services of Campania. The following data were recorded: age, sex, symptoms, history of peptic ulcer with regard lo previous endoscopy or radiographic examinations and treatment, endoscopic diagnosis, and Hp status. Indication to endoscopy was evaluated by two investigators (GM and SM) onaware of the endoscopic findings according to Maastricht guidelines and current medical knowledge. Results: 706 patients were considered (age: mean 47 years, range 15-86; 387 M, 319 F). 316 pts presented with reflux symptoms, 330 with dyspeptic symptoms of different types, 38 with alarm symptoms, 22 with atypical symptoms. Endoscopy was normal in 346 cases (49%); DU was found in 219 cases, GU in 39, esophagitis in 82 and gastric cancer in 6 cases. All pts with cancer were older than 45 and 4 of them presented with alarm symptoms. In 398 cases (56.4%) endoscopy was considered not indicated: in 250 patients with a previous endoscopic or radiologic diagnosis of ulcer without changing of symptoms; in 38 patients to confirm eradication; in 110 patients younger than 45 with dyspepsia without alarm symptoms. Conelasioa: a large number of endoscopic examinations are not indicated and could be avoided following the guidelines of the Maastricht consensw and current medical knowledge. In order to reduce the. endoscopic workload and optimize the treatment of Hp infection, strategies for educating physician should be pursued. All3