transplant has become a life saving treatment with excellent long-termrehabilitation for patients with irreversible intestinal failure.

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6-Thioguanine levels versus white blood cell counts in guiding 6-mercaptopurine and azathioprine therapyJP Achkar, MD, T Stevens, MD, A Brzezinski, MD, FACG, D Seidner,MD, FACG, B Lashner, MD, FACG. Cleveland Clinic Foundation,Cleveland, OH.

Purpose: A recently published study demonstrated that serum 6-thiogua-nine levels (6-TG).235 pmol/83 108 RBCs correlated with clinicalresponse in pediatric patients with inflammatory bowel disease (IBD). Ouraim was to assess the association between 6-TG, white blood cell counts(WBC), and clinical response in adult IBD patients.Methods: 45 patients with IBD who were on stable doses of six-mercap-topurine (6-MP) or azathioprine (AZA) for at least 3 months were evalu-ated. 6-TG levels and WBC were measured as part of routine clinical care.Patients were classified as responders (N5 19), non-responders (N5 18),or in continued remission (N5 8) based on clinical criteria.Results:

Responders Non-Responders P-value

Median 6-TG 302 179 0.0046-TG . 235 16 (84%) 8 (44%) 0.026-TG . 260 15 (79%) 5 (28%) 0.006Median WBC 4.9 7.0 0.02WBC , 5.0 10/18 (56%) 4/14 (29%) 0.2Median 6-MP dose 1.50 mg/kg 0.95 mg/kg 0.03Median AZA dose 1.60 mg/kg 1.65 mg/kg 0.3

Maximal difference between responders and non-responders was seen at6-TG levels.260. There was a significant inverse correlation between6-TG level and WBC (Spearman correlation coefficient5 20.35; P50.03) but no relationship was found between drug dose and 6-TG levels(Spearman correlation coefficient5 0.11; P5 0.5).

Conclusions: 1.6-TG levels are associated with clinical response and, inour population, maximal differentiation between responders and non-re-sponders is seen at 6-TG levels. 260.2. 6-TG levels appear to be betterpredictors of clinical response than leukopenia.3. Measurement of 6-TGlevels is helpful in tailoring therapy with 6-MP and AZA especially innon-responders.

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Foeniculum vulgare therapy in irritable bowel syndromeHassan Amjad, MD, HA Jafary, MD. Beckley, WV.

IBS is a chronic disorder with stomach pain, bloating and abnormal bowelmovements, often refractory to conventional treatment with pts having afeeling of poor quality of life. Herbal therapy with Foeniculum vulgare(Fennel seed), offers new therapeutic modality. IBS is 2nd important causeof work absenteeism after common colds and affects 9.4% of Americans.Conventional therapy consists of high fiber diet antispasmodics like hyo-cyamine and dicyclomine which benefit some pts however, the majorityremain symptomatic. They have more frequent visits to hospitals, physi-cians, more abdominal surgeries, procedures and dependence on analge-sics.

IBS is not a new disease and similar functional bowel dysfunctions weretreated with FV seeds in the ancient writing of AVICENNA and RHAZES,and in medieval English herbal remedies. Five pts with IBS meeting Romecriteria, who were poor responders to available therapies were selected forFV treatment. These pts were given special sugar coated 4 FV seeds tochew and swallow after meals for one week then increasing gradually the

dose to 8–12 seeds three times a day. Following IBS activity markers, wereused for comparison before and after therapy. Frequency and regularity ofBMS, number of visits to medical provider, abdominal pain and spasm,excessive bloating and dependence on pain medicine. After 2 weeks oftherapy, there were marked improvement with less abdominal cramps, lessdependence on laxative, Imodium, analgesics and less visits to physicians.Pts felt that they had more control of their social life. Fennel seeds extractcontain essential oils like trans—trans-anethole and fechone which exhibitits spasmolytic effect through plant based Ca Channel blocker. It has alsoestrogenic and psychodelic adrenalin like effect.

Fennel seeds should be considered as a useful adjunctive therapeuticmodality in refractory cases of IBS. It effectively controls many symptomsof IBS with significant overall improvement in quality of life.

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The effect of abdominal palpation on gastrointestinal sounds (GIS)in healthy subjects: A quantitative investigation using computerizedanalysisTerence L Angtuaco, Jennifer Evans, Laura Harrell, Hussein A Mansy,Richard H Sandler*. Rush University, Chicago, IL.

Purpose: To determine whether gastrointestinal sounds are altered whenabdominal palpation is performed before auscultation. Although it has longbeen taught that auscultation of the abdomen should precede palpation inorder not to affect gastrointestinal sounds, there is no evidence in theliterature supporting this teaching.Methods: We enrolled 40 healthy subjects in the study. A single investi-gator applied moderately firm abdominal palpation to each of the nineabdominal regions for a total of one minute. We placed a three-sensorcustom harness on each subject’s abdomen and recorded pre- and post-palpation gastrointestinal sounds (GIS) for 10 minutes each on an analogaudio tape recorder. Our previous experience in 220 subjects showed theGIS spectrum to lie within the 100–1000 Hz acoustic bandwidth; hence,signals were high- and low-band pass filtered at these frequencies anddigitized at 4096 Hz. We used custom software to identify the number ofGIS event per minute, characterizing separately their duration (millisec-onds), dominant frequency (“pitch” in Hz) and amplitude (millivolts).Results:There were no significant differences in the number of GIS eventsper minute, duration, dominant frequency and amplitude between pre- andpost-palpation recordings. The findings from all three sensors were con-sistent.Conclusions:Abdominal palpation before auscultation does not influencegastrointestinal sounds in healthy subjects. If these findings are confirmedin patients with gastrointestinal illnesses, auscultation need not precedeabdominal palpation during physical examination.

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Endoscopic ultrasound assisted resection of duodenal non-ampullaryadenomasMohammed Barawi, Frank Gress, Alan Lipp, Steve Geier, JamesGrendell*. State University of New York, Stony Brook, NY.

Purpose: Non-ampullary duodenal adenomas are rare. There is limiteddata in the literature regarding endoscopic management. The purpose of thestudy is to report our own experience with the endoscopic management ofsuch lesions.Methods: Eight consecutive patients (5M/3F) with a mean age of 68 years(range 60–84) were referred to our institution for endoscopic managementof non-ampullary duodenal polypoid lesions. These were sessile lesions,measuring 1–4 cm (mean 2.3 cm). The pathology of these lesions weretubular adenoma (5), tubulovillous adenoma (2) and one villous adenomawith high grade dysplasia. EUS was performed on all lesions to determinedepth of invasion. All lesions were superficial with no involvement beyond

2491AJG – September, 2000 Abstracts