S24 Abstracts - 91_ Mt 21-42 ASSISTED ENDOSCOPY %60 50 f------- 40 f------- ROUTINE ENDOSCOPY per 100 patients per 100 patients 15,-----------------,20,000 ._--H---+·0l-___i 12,OOO EGDS+ Histo!ogy+ Ureasetesl __ lJ; :000 EGDS+ Pepsinogen + Gastrin + IgGtoHp Figure 2 EGOS + Mt21-42+ Histology 31_ 51_ c f----- AGOM Adeno-Ca detected detected AGOM Adeno-Ca detected detected Figure 1 10 20 30 f--------i!' Abstract OC2.1.6 - Figs. 1 and 2 hypochlorhydria); b) a retrospective multicenter study (to assess the oc- currence of AGOM and gastric adenocarcinoma in routine endoscopic activity; it regarded 17907 patients and involved 10 endoscopic Italian units); c) a cost analysis (to estimate the cost of conventional tests for AGOM and Hp infection and to evaluate the potential of Mt 21-42 as cost-effective approach for the diagnosis of these two conditions). Results: The main results of the study are summarized in figure 1 and 2 (*P<O.OOI). Conclusions: 1) AGOM represents an insidious and risky condition that often goes undetected in current clinical practice; this is also confirmed by the small gap between AGOM and gastric cancer. 2) The conventional methods for AGOM are limited by a low sensitivity. 3) Mt 21-42 seems to be a valid and useful tool; it resulted to be the most accurate and economical method for the diagnosis of the main risk factors for gastric cancer (AGOM and H. pylori infection). OC2.2.t COST-EFFECTIVENESS OF DIFFERENT DIAGNOSTIC STRATEGIES TO ASSESS GERD IN PATIENTS WITH UNEXPLAINED CHRONIC PERSISTENT COUGH IN ITALY F. Baldi I, C. Cavoli 1, S. Ghersi 2, L. Mantovani 3, F. Torresan I, E. Roda l 1Policlinico Sant Orsola Malpighi, Bologna 20spedale Maggiore, Bologna 3 Universitil di Milano, Milano Background and aim: Chronic persistent cough (CPC) is a common and disabling disorder and GERD is considered to be the third leading cause of CPC, after asthma and nasal problems. Therefore patients with unexplained CPC usually undergo a stepwise evaluation to establish the existence of a reflux disease.To identify the most cost-effective diagnostic approach to assess GERD in patients with unexplained CPC. Material and methods: Direct and indirect costs associated with six diagnostic strategies using 24-h esophageal pH-metry (pH-metry), esophago-gastroduodenoscopy (EGD), and the PPI-test (lansoprazole 30 mg/bid for 4 weeks) in different sequences, were evaluated using a decision tree model. If the first test was positive, the diagnostic work up was stopped, if negative the patient proceeded to the second test, and so on. Clinical data from an observational prospective trial conducted in 51 patients with unexplained CPC were used in the economic model. Results: All six strategies had the same clinical effectiveness (40 out of 51 pts had a positive diagnosis of GERD, that is 78.4%). The diagnostic work-up with the lowest cost per diagnosed case was the PPI-test fol- lowed by pH-metry and then EGD with a total cost of €262.54 (direct € 177.77, indirect € 84.76). The cost-effectiveness ratios of all other strategies were higher, ranging from +€ 56.96 (+22%) to +€ 138.88 (+53%) [see Table]. Conclusions: This study shows that the lowest cost is the strategy where PPI-test is performed as first investigation. Implementation of this diagnostic work-up may lead to cost savings in the management of patients with CPC. OC2.2.2 RELATIONSHIP BETWEEN GASTROESOPHAGEAL REFLUX SYMPTOMS AND ESOPHAGITIS IN THE GENERAL POPULATION: RESULTS FROM THE LOIANO-MONGHIDORO STUDY R.M. Zagari *,1, S. Damian I, M.L. Bianchi I, L. Ceroni I, L. Fuccio 1, P. Pozzat0 2 , M. Wallander 3 , S. Johansson 4, E. Roda I, F. Bazzoli 1 1Department of Internal Medicine and Gastroenterology, University of Bologna, Bologna 20spedale di Bentivoglio, Bentivoglio (BO) 3Department of Public Health and Caring Science, University of Uppsala, Upssala (Sweden) 4 Section of Preventive Cardiology, University of Gothenburg, Gothenburg (Sweden) Background and aim: Gastroesophageal reflux disease (GERD) is characterized by typical symptoms of heartburn and regurgitation, and/or endoscopically evident lesions such as esophagitis. The rela- tionship between symptoms and endoscopic findings in the general population is unclear, as endoscopic data are usually obtained only in selected subgroups. Our study aimed to establish the relationship between endoscopic findings and reflux symptoms in a representative sample of the general population. Material and methods: We approached a representative sample of 1533 adults from two Italian villages (Loiano and Monghidoro) between 2000 and 2004 to undergo symptom assessment and gastrointestinal endoscopy. Endoscopic findings were assessed using the Savary-Miller classification. We recorded the frequency of heartburn and regurgitation Abstract OC2.2.1 - Table 1. Effectiveness of diagnostic strategies in 51 patient with CPC Diagnostic strategy I test Positive pts II test Positive pts III test Positive pts Cost-effectiveness (Total cost - Euro) A EGD 6 pH-metry 22 PPJ-test 12 401.42 B pH-metry 28 EGD 0 PPJ-test 12 354.54 C PPJ-test 25 EGD 3 pH-metry 12 374.08 D PPJ-test 25 pH-metry 15 EGD 0 262.54 E EGD 6 PPJ-test 22 pH-metry 12 345.42 F pH-metry 28 PPJ-test 12 EGD 0 319.50