Introduction

The Helicobacter pylori (H. pylori) infection is a common problem (prevalence of 32.7% in 2023) in the North-Western Federal District, comprising one-tenth of Russia, where primary resistance rates of clarithromycin and levofloxacin are >15%.¹ The eradication rates remain low and do not reach the threshold value of 95% (eradication rate of 86.8% in 2023). ² There is limited information regarding the best approach for H. pylori infection management.

Aims & Methods

The study was conducted in the North-Western Federal District during 2023-2025. Individuals (n=145) who underwent ¹³C-UBT (¹³С-urea breath test) was conducted in the prospective randomized clinical trial. Patients were randomly allocated to two eradication groups: high-dose dual therapy for 14 days (esomeprazole 40 mg and amoxicillin 1000 mg three times daily) and optimized high-dose dual therapy for 14 days (esomeprazole 40 mg, amoxicillin 1000 mg, rebamipide 100 mg three times daily). The modified intention-to-treat (mITT) effectiveness, safety, and adherence were analyzed for the regimens. The secondary endpoints were adverse effects and patient compliance. Eradication was confirmed by a ¹³C-UBT 4-6 weeks after therapy.

Results

Among all included individuals (mean age 46.27±14.21; 67.6% of whom were female), there were 91.7% (n=133) of primary “naïve” patients (who had had no history of prior eradication therapy). The proportion of treated patients was 8.3% (n=12). The high-dose dual therapy PPI-amoxicillin did not provided encouraging mITT results - 87.5%, 21/24, 95%CI 69.0-95.7; the inclusion of patients in this group was stopped due to unacceptable cure rates. Whereas the higher was reported with optimized eradication regimen with rebamipide (96.3%, 105/109, 95%CI 90.9-98.6 for treatment-naïve and 91.7%, 11/12, 95%CI 64.9-98.5 for treated patients). The adverse event rates were 37.5% in the PPI-amoxicillin group and 19.8% in the PPI-amoxicillin-rebamipide group (р=0.211). The most common were a diarrhea (25% and 12.4% respectively), bloating (25% and 3.5% respectively), abdominal pain (20.8% and 10.7% respectively). Good adherence, defined as > 90% of drug intake, were similar between the two groups (100% of cases).

Conclusion

In the North-Western region of Russia, the fourteen-day optimized high-dose dual therapy with PPI-amoxicillin-rebamipide provided encouraging results (over 90% cure rates) and had the lower incidence rate of side effects (19.8%) suggesting as an alternative for H. pylori rescue treatment in the local region.

References

1. Simanenkov VI, Zakharova NV, Zhebrun AB, et al. Resistance of Helicobacter pylori to antimicrobial preparations by the results of bacteriologic testing. Attending Physician. 2015;4:10 (In Russ.)].
2. Bakulina NV, Tikhonov SV, Savilova IV, Zharkov AV, Ponomarenko VA. Dynamics of the prevalence of Helicobacter pylori infection from 2015 to 2023. Herald of North-Western State Medical University named after I.I. Mechnikov. 2023;15(3):41–51. DOI: https://doi.org/10.17816/mechnikov623259

Introduction

Early identification of severe acute pancreatitis (SAP) enables the prompt initiation of aggressive resuscitation strategies and improves patient outcomes. The aim of the present study is to assess the clinical differences between patients with SAP and those with mild or moderate acute pancreatitis, as well as the distribution of organ failure in severe cases.

Aims & Methods

A retrospective analysis was conducted on a prospective database comprising a cohort of 526 patients with acute pancreatitis, consecutively included from March 2017 to June 2019 at a tertiary care hospital. All included patients underwent systematic blood testing at admission and at 48 hours. Clinical management adhered to current clinical practice guidelines. Diagnosis and classification were based on the revised 2012 Atlanta classification. The analysis included the need for antibiotic therapy, development of local complications, organ failure patterns, and infectious complications

Results

	Mild/Moderately severe AP (n = 399 / 90.7%)	Severe AP (n = 41 / 9.3%)	p-value
Necrotizing pancreatitis	8 (2.1%)	13 (34.2%)	0.001 **
Infected necrosis	4 (1%)	6 (16.2%)	0.001 **
Antibiotic therapy	129 (32.9%)	29 (74.4%)	0.001 **
Extrapancreatic infection	35 (12.5%)	10 (28.6%)	0.011 **
Mortality	2 (0.5%)	18 (43.9%)	0.001 **
Cholangitis	145 (36.3%)	18 (43.9%)	0.340
ICU admission	3 (0.3%)	12 (29.3%)	0.001 **
SIRS at admission	56 (14.1%)	26 (63.4%)	0.001 **
SIRS at 48 hours	17 (4.3%)	22 (55%)	0.001 **

Table 1 summarizes the clinical characteristics and outcomes associated with severe acute pancreatitis (SAP). Regarding infectious complications, patients with SAP showed higher rates of infected necrosis and extrapancreatic infections, although no significant differences were observed in the incidence of acute cholangitis. Patients with SAP were more likely to develop necrotizing pancreatitis and local complications. Moreover, they accounted for the vast majority of ICU admissions and deaths. In terms of persistent organ failure, renal failure was the most frequent (80%), followed by respiratory failure (45%). A high proportion of patients who developed SAP presented with SIRS at admission (64%) and at 48 hours (55%).

Conclusion

Early identification of severe acute pancreatitis (SAP) is not always straightforward and requires close monitoring. Nevertheless, recognizing these patients is critical, as prognosis is intrinsically linked to the timeliness of diagnosis and the implementation of supportive measures necessary to maintain organ stability.
Patients with SAP are at higher risk of developing organ failure. In our cohort, we observed increased use of antibiotic therapy among SAP patients, likely due to the higher incidence of infected necrosis and extrapancreatic infections. Conversely, the incidence of acute cholangitis, based on the 2018 Tokyo criteria, was similar between SAP and mild/moderate AP cases.
Regarding organ failure, renal failure was the most frequent in our cohort, although other series have reported respiratory failure as the most common. The presence of SIRS at admission and at 48 hours was associated with subsequent development of SAP; however, a significant number of patients with SIRS did not ultimately develop a severe course. Its predictive value may be enhanced when combined with other prognostic factors.

References

1. Banks, P. A., Bollen, T. L., Dervenis, C., Gooszen, H. G., Johnson, C. D., Sarr, M. G., Tsiotos, G. G., & Vege, S. S. (2013). Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut, 62(1), 102–111.
2. Garg, P. K., & Singh, V. P. (2019). Organ Failure Due to Systemic Injury in Acute Pancreatitis. Gastroenterology, 156(7), 2008–2023.
3. Pezzilli, R., Zerbi, A., Campra, D., Capurso, G., Golfieri, R., Arcidiacono, P. G., Billi, P., Butturini, G., Calculli, L., Cannizzaro, R., Carrara, S., Crippa, S., De Gaudio, R., De Rai, P., Frulloni, L., Mazza, E., Mutignani, M., Pagano, N., Rabitti, P., & Balzano, G. (2015). Consensus guidelines on severe acute pancreatitis. Digestive and Liver Disease, 47(7), 532–543

Introduction

Familial adenomatous polyposis (FAP) is a hereditary syndrome caused by a pathogenic variant in the APC gene, responsible for 1–2% of colorectal cancers (CRC) and associated with a near 100% lifetime CRC risk. Prophylactic colectomy or proctocolectomy reduces CRC incidence and mortality but does not eliminate the risk of rectal or pouch cancer (2–24%). The ESGE recommends endoscopic surveillance every 1–2 years, taking into account the number, size, and histological features of the polyps. However, these recommendations are mainly based on expert opinions, with limited current evidence available to optimize surveillance guidelines and define endoscopic quality standards.

Aims & Methods

To analyze the quality parameters of endoscopic surveillance and their association with the development of advanced neoplasia in the rectal remnant or reservoir among familial adenomatous polyposis (FAP) patients after prophylactic (procto)colectomy.
A retrospective observational study was conducted including FAP patients who underwent prophylactic colectomy or proctocolectomy and were registered between 1983 and 2022 at the Hospital Clínic de Barcelona. Numerical variables were analyzed using the Mann-Whitney U test, and categorical variables were evaluated with the Chi-square test. Logistic regression was performed to identify independent variables associated with the development of advanced neoplasia.

Results

Of the 85 eligible patients, 61 (64% women; median age, 53 years [range, 39–59]) met the inclusion criteria. Seven patients (11.5%) were diagnosed with advanced neoplasia (AN), of whom six had ileorectal anastomosis and one had ileoanal pouch anastomosis. Of these seven patients, three (43%) developed cancer, while four (57%) presented advanced adenomas in the rectal remnant or reservoir. Patients with AN underwent lower-quality endoscopic procedures compared to those without AN: the use of high-definition endoscopes was 42.9% vs. 94.4% (p=0.002), retroflexion was performed in 14.2% vs. 68.5% (p=0.005), adequate bowel preparation was achieved in 42.8% vs. 87% (p=0.004), procedures were performed in a dedicated endoscopy program in 28.5% vs. 79.6% (p=0.004), and the mean number of polyps removed was 1.1 ± 0.9 vs. 3.4 ± 4.2 (p=0.001), respectively. In the multivariable analysis, the only independent variable associated with the development of advanced neoplasia was the non-use of high-definition endoscopes.

Conclusion

The development of advanced neoplasia is associated with lower quality in endoscopic surveillance parameters among FAP patients who underwent prophylactic (procto)colectomy. These findings highlight the need to establish specific quality indicators to optimize endoscopic surveillance in this high-risk population.
In light of these preliminary findings, the study has been expanded to a European multicenter phase and is currently in the patient recruitment stage.