studies

930A AASLD ABSTRACTS HEPATOLOGY, October, 2015
therapeutic procedure to improve liver function as well as to
attenuate hepatic encephalopathy through increase of portal
venous flows in cirrhotic patients with porto-systemic shunts.
Disclosures:
Satoshi Mochida - Grant/Research Support: Chugai, MSD, Tioray Medical,
BMS; Speaking and Teaching: MSD, Toray Medical, BMS, Tanabe Mitsubishi
The following authors have nothing to disclose: Manabu Nakazawa, Yukinori
Imai, Satsuki Ando, Kayoko Sugawara, Mie Inao, Nobuaki Nakayama
1475
Six-week administration of lactulose in patients with cirrhosis
does not alter the gut bacterial flora
Amit Goel 1 , Aditya N. Sarangi 2 , Ankur Singh 1 , S. Avani 1 , Rakesh
Aggarwal 1,2 ; 1 Gastroenterology, Sanjay Gandhi Postgraduate
Institute of Medical Sciences, Lucknow, India; 2 Biomedical informatics
Center, Sanjay Gandhi Postgraduate Institute of Medical
Sciences, Lucknow, India
Background: Benefit of lactulose in hepatic encephalopathy
(HE) may be mediated, at least partially, by alterations in gut
flora. However, data on change in gut flora post-lactulose are
sparse. We therefore studied gut microbial composition in
patients with liver cirrhosis (LC) and the effect of 6 weeks of
lactulose use on it, using next-generation sequencing. Methods:
30 patients with LC (male 22; median [range] age: 42 [29-65]
y; body mass index 22.7 [17.3-32.3] Kg/m 2 ) of any cause
or severity but no prior history of HE, and 18 healthy controls
(HC; male 14; 45 [24-67] y; 23.3 [20.0-25.0] Kg/m 2 ) were
enrolled. Persons with gastrointestinal symptoms, or recent (preceding
6 weeks) use of lactulose or another drug affecting
gut motility or flora were excluded. A morning stool specimen
was collected from each subject; 19 patients also provided
a follow-up specimen after 6 weeks of lactulose intake. A
cDNA library for V3 region of bacterial 16S rRNA from each
stool was subjected to paired-end Illumina sequencing, and
abundances of various bacterial operational taxonomic units
(OTUs) were determined. Relationship of specimens with each
other was studied using principal co-ordinate analysis (PCoA).
Abundances of various OTUs, and indices of α and β diversity
were compared between groups using t-test with Bonferroni
correction; data before and after lactulose were compared
using tests for paired data. Results: The 67 specimens yielded a
median (range) of 504,182 (171,799-1,267,206) high-quality
reads. In PCoA, gut flora from LC clustered separately from
HC and showed lower diversity (Chao 1 index: 1975 vs 2802;
observed species: 1082 vs 1485; Shannon index: 4.8 vs 5.6;
p=0.0001 each). Median abundances of major phyla (Bacteroidetes
[75.2% vs 67.2%], Firmicutes [17.5% vs 18.4%]
and Proteobacteria [6.6% vs 8.3%]) were similar in LC and
HC; however, Lentisphaerae [0% vs 0.01%], Cyanobacteria
[0.01% vs 0.52%] and Tenericutes [0.01% vs 0.05%] were
less abundant in LC than HC (p0.005%
of all the bacterial sequences had comparable abundances
before and after lactulose. The pre- and post-lactulose specimens
showed no separation on PCoA, and had similar α diversity
indices (Chao 1: 2755 vs 2788; observed species 1732
vs 1761; Shannon index: 4.9 vs 4.9; all p=ns). Conclusion:
Gut flora in LC differs from healthy persons. However, administration
of lactulose for 6 weeks did not produce a discernible
change in gut flora in patients with LC, suggesting that alteration
in gut flora may play a minor role in improving HE.
Disclosures:
The following authors have nothing to disclose: Amit Goel, Aditya N. Sarangi,
Ankur Singh, S. Avani, Rakesh Aggarwal
1476
Erectile Dysfunction in patients with cirrhosis
Sergio Maimone 1 , Giovanni Oliva 1,2 , Antonino Di Benedetto 2 ,
Roberto Filomia 1,2 , Gaia Caccamo 1 , Carlo Saitta 1 , Irene Cacciola
1,2 , Giovanni Squadrito 1,3 , Giovanni Raimondo 1,2 ; 1 Division
of Clinical and Molecular Hepatology, Universitary Hospital of
Messina, Messina, Italy; 2 Department of Clinical and Experimental
Medicine, University Hospital of Messina, Messina, Italy; 3 Department
of Human Pathology, University Hospital of Messina, Messina,
Italy
BACKGROUND AND AIMS - Erectile dysfunction (ED) is a clinical
disorder frequently observed in men suffering from several
chronic diseases as diabetes, obesity, metabolic syndrome,
cardiovascular diseases. There is little information, however,
about ED in patients with advanced chronic liver disease. Aims
of our study were to evaluate the prevalence of ED in cirrhotic
patients and to investigate clinical and biochemical factors
possibly associated with ED occurrence in these patients.
PATIENTS AND METHODS - We prospectively analyzed 147
consecutive cirrhotic patients (mean age 61.5± 15.5 years) 99
of whom were in class A and 48 in class B of Child-Pugh (CP).
Physical examination, electrocardiography, biochemistry as
well as serum levels of thyroid stimulating hormone (TSH), total
testosterone (TT), free testosterone (FTT), sex hormon binding
globulin (SHBG), and prolattin (PRL) were evaluated in each
patient. Known ED risk factors such as smoking habit, alcohol
abuse, diabetes, cardiovascular diseases (i.e., hypertensive
cardiovascular disease, ischemic heart disease), depression,
hypogonadism, treatment with diuretics and beta blockers
were evaluated as well. All patients completed the following
questionnaires: International Index of Erectile Function (IIEF)
scale (that classifies ED into 4 categories: absent, mild, moderate
and severe), Self-rating Anxiety Scale (SAS) (that evaluates
grades of depression), and ANDROTEST (that assesses
the presence of hypogonadism jointly to serum level of FTT).
Data processing and statistical analysis were performed by
SPSS software. RESULTS - ED was revealed in 86/147 (58.5%)
patients, 31 (36%) of whom had mild, 7 (8.1%) moderate and
48 (55.9%) severe ED. No statistically significant differences
were found when patients with and those without ED were
compared for age, smoking habit, alcohol consumption, ethiology
of liver disease, concomitant arterial hypertension, therapy
with diuretics and beta blockers, depression, thyroid and sexual
hormone profiles. In analogy, SAS test and ANDROTEST
provided similar results in the two groups. On the contrary,
at univariate logistic regression analysis ED was significantly
associated with CP class B (p=0.04), presence of diabetes
(p=0.04), and cardiovascular diseases (p=0.01). However,
only presence of cardiovascular disease maintained the significant
association with ED occurrence at the multivariate logistic
regression analysis (OR 3.7, CI 95%1.06-13.44, p=0.03).
CONCLUSIONS - Erectile dysfunction affects the majority of
patients with cirrhosis and it is significantly associated with
cardiovascular diseases in these patients.
Disclosures:
Giovanni Raimondo - Speaking and Teaching: BMS, Gilead, Roche, Merck,
Janssen, Bayer, MSD
The following authors have nothing to disclose: Sergio Maimone, Giovanni
Oliva, Antonino Di Benedetto, Roberto Filomia, Gaia Caccamo, Carlo Saitta,
Irene Cacciola, Giovanni Squadrito