Conventional catheter-based systems used for ambulatory esophageal pH monitoring have been reported to affect patient behavior. As physical activity has been associated with gastroesophageal reflux disease (GERD), there is a risk that abnormal behavior will degrade the value of this diagnostic investigation and consequent management strategies. The aim of this study was to quantify the effect of conventional pH monitoring on behavior and to investigate the temporal association between activity and reflux. A total of 20 patients listed for 24 hours pH monitoring underwent activity monitoring using a lightweight ear-worn accelerometer (e-AR sensor, Imperial College London) 2 days prior to, and during their investigation. PH was measured and recorded using a conventional nasogastric catheter and waist-worn receiver. Daily activity levels, including subject-specific activity intensity quartiles, were calculated and compared. Physical activity was added to the standard pH output to supplement interpretation. Average patient activity levels decreased by 26.5% during pH monitoring (range -4.5 to 51.0%, P = 0.036). High-intensity activity decreased by 24.4% (range -4.0 to 75.6%, P = 0.036), and restful activity increased on average by 34% although this failed to reach statistical significance (-24.0 to 289.2%, P = 0.161). Some patients exhibited consistent associations between bouts of activity and acidic episodes. The results of this study support the previously reported reduction in activity during ambulatory esophageal pH monitoring, with the added reliability of objective data. In the absence of more pervasive pH monitoring systems (e.g. wireless), quantifying activity changes in the setting of activity-induced reflux might guide the physicians' interpretation of patient DeMeester scores resulting in more appropriate management of GERD.

Conclusion This data supports the previous findings that the BO lesion length of greater than 3 cm is associated with the presence of IM. Furthermore, the odds of having IM are significantly reduced in patients from the Indian sub-continent. Ethnicity should thus be taken into account in the future risk stratification of BO patients and requires further study. REFERENCE1 Kang et al. Diverticular disease of the colon: ethnic differences in frequency. Aliment. Pharmacol. Ther.

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BSG abstracts efficacy of detection of Barrett's related cancer through screening within the Imperial College NHS Trust. Methods We retrospectively analysed endoscopy and pathology reports of all patients who received an endoscopy for Barrett's oesophagus within a 5 year period from 2007 to 2012. Patients presenting with established dysplasia or adenocarcinoma were excluded and only those with confirmed Barrett's oesophagus were considered. The surveillance regime in this period was in accordance with the British Society of Gastroenterology guidelines. All endoscopies were conducted by Imperial College NHS gastroenterologists within Imperial Trust sites. Results Over 54 months 326 patients underwent endoscopic surveillance of Barrett's oesophagus with a mean follow-up of 36 months. 73 (22%) patients stopped surveillance in this period. Early Adenocarcinoma and High Grade Dysplasia was reported in 2 (0.6%) and 3 (0.9%) patients respectfully. Providing a 0.2% progression to adenocarcinoma per year and a 0.5% progression to High Grade Dysplasia or cancer per year. This gave a cancer incidence in Barrett's oesophagus of 1 per 492 patient years of surveillance. All three of the HGD patients underwent endoscopic therapy and have successfully eradicated dysplasia and Barrett's. Both cancer patients were unsuitable for endoscopic therapy. 1 received surgical treatment and 1 received radiotherapy. Conclusion The risk of progression to cancer is lower than previously anticipated. We estimate the cost of a single surveillance endoscopy at £400, thus surveillance costs are £124,000 per cancer diagnosis. The mean age of adenocarcinoma diagnosis through surveillance is 68.1(2) and with average male life expectancy of 78, the cost of diagnosis is approximately £12,400 per year saved. This assumes all cancers detected via surveillance are curable and does not account for any subsequent treatment or follow-up costs, therefore this is likely to be a fractiont of the true cost. NICE state that £20,000-£30,000 is a cost-effective range per quality adjusted life year saved. In light of this we recommend a more stratified, cost effective screening programme be considered.

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