Introduction

Patients with Crohn’s disease (CD) are at risk of progressing from inflammatory to stricturing and penetrating phenotypes. The influence of the type of remission on phenotype progression has not been adequately evaluated.

Aims & Methods

Retrospective cohort study including surgically naïve CD patients with inflammatory or stricturing phenotype evaluated concomitantly by magnetic resonance enterography and colonoscopy. The degree of remission was correlated with the risk of progressing to stricturing and penetrating phenotypes.

Results

381 CD patients were included, 21.8% with transmural remission, 21.3% with isolated endoscopic remission, 10.5% with isolated radiologic remission, and 46.5% without remission. Patients with transmural remission presented the lowest rates of phenotype progression (1.2%), with a significant difference compared to isolated endoscopic remission (18.3%, P≤ 0.001), isolated radiologic remission (17.5%, P=0.002), and no remission (36.9%, P≤0.001). In multivariate regression analysis, transmural remission (OR 0.023 95%CI 0.003-0.171, P<0.001), isolated radiologic remission (OR 0.342 95%CI 0.141-0.826, P=0.017), and isolated endoscopic remission (OR 0.441 95%CI 0.220-0.881, P=0.020) resulted in lower rates of phenotype progression compared to no remission.
Figure 1 presents the Kaplan-Meier estimates of remaining free of penetrating complication (upper curve) and free of stricturing and/or penetrating complication (lower curve) after the baseline assessment in patients with no remission (A), isolated endoscopic remission (B), isolated radiologic remission (C), and transmural remission (D).

Conclusion

The degree of intestinal remission correlates with the risk of phenotype progression. Patients with transmural remission are at the lowest risk of progressing to stricturing and penetrating phenotypes.

Introduction

Recent developments in diagnostic imaging have increased the detection rate of lymphoma, for which a clear, histopathological diagnosis is critical for the subsequent choice of therapeutic regimen. Over the past decade, endoscopic ultrasound-guided fine needle aspiration/biopsy (EUS-FNA/B) has become widely-used means of tissue collection. However the open lymph node biopsy has conventionally been used to diagnose lymphoma histologically, and the evidence backing the use of EUS-FNA/B for this purpose is still limited.

Aims & Methods

The present study aimed to compare the performance of EUS-FNA/B and the open biopsy for diagnosing lymphoma by retrospectively analyzing 1113 patients with 1224 lesions who underwent either of the two methods at the study center between 2012 and 2024. The patients’ background, pathological diagnosis, procedural factors, and complications were evaluated. The performance of the open biopsy was compared with that of EUS-FNAB in diagnosing lymphoma in accordance with the 5^th edition of the World Health Organization classification of hematolymphoid tumours ¹⁾ (WHO classification).

Results

An open biopsy was performed for 943 lesions, 621 of which were malignant lymphomas, with the face, head, neck, axilla or groin, limb, and other areas being the site of 46, 556, 96, 225, 4, and 16 lesions, respectively. EUS-FNAB was performed for 281 lesions, 82 of which were malignant lymphomas, with the intra-abdominal area, mediastinum, and rectum being the site of 270, 10, and 1 lesion, respectively. The needle gauge used for FNA was 19G, 22G, and 25G in 1, 143, and 36 lesions, respectively, while and the needle gauge for FNB was 20G, 22G, and 25G in 3, 74, and 3 lesions, respectively. The mean number of punctures was 2.3 (range 1-9). EUS-FNAB involved significantly fewer, procedural complications than the open biopsy (14/943 vs 0/281; p=0.04). According to the WHO classification, the diagnostic performance (95% confidence interval) of the open biopsy has sensitivity 93.4 % (91.1-95.2), specificity 100.0 % (98.3-100.0), positive predictive value 100.0 % (99.0-100.0), and negative predictive value 88.7 % (85.0-91.8). The diagnostic performance (95% confidence interval) of EUS-FNAB according to the same classification has sensitivity 79.3 % (68.9-87.4), specificity 100.0 % (97.2-100.0), positive predictive value 100 % (91.8-100.0), and negative predictive value 92.1 % (87.7-95.3 %). Between the groups, there was no significant difference in the proportion of lesions for which immunostaining was able to be performed (615/621 vs 80/82; p = 0.24). The positive diagnosis rate was significantly higher for the open biopsy (580/621 vs 27/40; p < 0.001) but did not differ significantly for the EUS-FNB (580/621 vs 38/42; p = 0.52). Univariate and multivariate analyses found that needle type (FNB needle) was a procedural factor in EUS (needle type, gauge, number of punctures, stroke length) contributing to the diagnosis of lymphoma (odds ratio: 3.83; p = 0.037).

Conclusion

EUS was less complicated than the open biopsy as means of collecting tissue for histologically diagnosing lymphoma, and EUS-FNB had a positive diagnosis rate comparable to that of the open biopsy.

References

1. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Myeloid and Histiocytic/Dendritic Neoplasms. Leukemia. 2022 Jul;36(7):1703-1719.

Introduction

Budesonide orodispersible tablet (BOT) is the only approved topical steroid available in Europe for the induction and maintenance of remission in patients with eosinophilic esophagitis (EoE). Available randomized controlled trials have demonstrated that, following induction of histological remission with BOT 1mg twice daily (bid), patients can be maintained in remission with BOT 0.5mg bid. It is currently unknown whether a dose of 1mg once daily (od) has comparable efficacy to 0.5mg bid.

Aims & Methods

In this prospective study conducted at two tertiary referral centers for EoE, we enrolled consecutive patients with EoE undergoing clinical, endoscopic, and histologic re-assessment while on maintenance treatment for EoE with BOT 0.5mg bid or BOT 1mg od. All included patients had achieved histological remission (i.e., <15 eosinophils/high-power field, eos/HPF) following induction of remission with BOT 1mg bid. At the end of the induction of remission period (T0), all patients were assessed using the dysphagia symptom questionnaire (DSQ), the EoE endoscopic reference score (EREFS), and peak eosinophil counts (PEC). At re-assessment while on maintenance treatment (T1), all patients underwent 1) assessment of dysphagia and adaptive behaviors with the DSQ and the Pisa EoE Adaptation Questionnaire v1.0 (PiEAQ). Clinical remission was defined as DSQ not increasing >30% compared to T0. 2) upper endoscopy (EGDS) with assessment of EREFS score and at least six esophageal biopsies, and 3) histological assessment using the EoE Histology Scoring System (EoEHSS). In addition, a comprehensive global assessment of clinical, endoscopic, and histologic findings was performed using the validated index of severity for EoE (I-SEE score). Kruskal-Wallis Rank Sum Test and Pearson’s Chi-squared were used for comparisons. Significance threshold was p<0.05.

Results

Fifty-six patients were included (46 males and 10 females). Following histological remission with BOT 1mg bid, 28 (50%) initiated maintenance treatment with BOT 1mg od and 28 (50%) with BOT 0.5 bid. At the end of induction of remission (T0), the two groups had achieved similar outcomes, with comparable median DSQ [0 (0-28) vs 0 (0-28)], EREFS [1 (0-2) vs 1 (0-1)], and PEC [1 (0-7) vs 1.5 (0-4)] (all p>0.3) (Table 1). At the end of the maintenance treatment (T1), the two groups had been taking maintenance treatment for a comparable duration [20 weeks (12 – 36) vs 20 weeks (12 – 32; p=0.7). Persistent histological and clinical remission at T1 was present in 86% of BOT 1mg od versus 93% of BOT 0.5 bid (p=0.7). In addition, EREFS scores were comparable between groups at T1 [1 (0-2) vs 1 (0-2), p=0.8]. Similarly, the EoEHSS stage and grade was comparable between groups, as was the PiEAQ score [1.5 (0.75-2) vs 0.5 (0-2); p=0.06], and the I-SEE score [ 3 (2-4) vs 3 (2-4); p=0.5] (Table 2).

Conclusion

Persistent clinical endoscopic, and histological remission was maintained in most patients treated either with BOT 1mg od or BOT 0.5mg bid for a median of 20 weeks, indicating that the total daily dose of BOT 1mg may be more important that the frequency of administration, at least in the short term.

Disclosure

Speaker or Consultancy for Apogee Therapeutics, Alfasigma, Dr Falk Pharma, Sanofi, Malesci, JB Pharmaceuticals

Introduction

Incidence of sporadic ductal pancreatic adenocarcinoma (PDAC) in the Czech Republic is the third highest in Europe (23.1/100,000 population). New-onset diabetes mellitus with weight loss (> 5% within < 6 months) in patients over sixty can be an early sign of PDAC. New-onset diabetes mellitus was recorded in 12.2% subjects three years prior to the diagnosis of PDAC (in the 60-74+ age group:13.8%) in the Czech Republic in the period 2017-2021 [ref. 1].

Aims & Methods

The aim of this study was to evaluate the standardized incidence ratio (SIR) of PDAC in patients with diabetes mellitus with and without previous history of any other malignancy within a 12-year period.
Methods: The analysis was based on individual population data from the Czech National Registry of Reimbursed Health Services, the National Cancer Registry, and the Death Certificate Information System in the period 2010 - 2021. Patients were divided into two groups: the first one included subjects with diabetes mellitus who had a history of any malignancy prior to the diagnosis of diabetes (follow-up 865,956 person-years); the second cohort consisted of people with diabetes mellitus who had no history of malignancy prior to the diagnosis of diabetes (7,971,090 person-years). The calculated person-years at risk were stratified by sex, age and time periods (2010-2013; 2014-2017; 2018-2021). Subgroup analyses were performed considering follow-up and age at diagnosis of diabetes. The first report of any antidiabetic drug (ATC group A10) was the determinant for the diagnosis of diabetes mellitus in a particular individual. SIR was calculated as the ratio of observed to expected (estimated from incidence in the general population) cases of PDAC.

Results

Selected SIRs stratified according to age and follow-up are displayed in Table 1.
A significantly higher risk of PDAC in diabetes mellitus with a history of previous malignant diseases (compared to the general population) was found for the following: head and neck cancer (SIR 2.54), gastric cancer (2.12), colorectal cancer (1.38), laryngeal cancer (2,51), malignant melanoma (1.65), breast cancer (1.61), cervical cancer (2.22), uterine cancer (1.72), prostate cancer (1.59), testicular cancer (3.1), kidney cancer (1.75), urinary bladder cancer (1.74), thyroid cancer (2.13), Hodgkin lymphoma (2.74), non-Hodgkin lymphoma (2.15) and leukaemias (1.93).

Table 1
Risk of PDAC in diabetes mellitus

Conclusion

Risk of PDAC in patients with diabetes mellitus was higher in subjects with a history of various malignant diseases compared to those with no previous history of any malignancy. Particular attention should be paid to new-onset diabetes (diagnosis made within one last year). History of a malignancy, as an important risk factor for PDAC, should be taken into account when surveilling patients with diabetes mellitus.

Funding: Research projects MO1012 (DZVRO) and MH CZ-DRO (UHHK, 00179906).

References

Ref. 1: UEG Journal 2024; 12 (Suppl S8): 565.

Disclosure

There is conflict of interest.

Introduction

Recent evidence supports diagnosing coeliac disease without biopsy in patients with significantly elevated tissue transglutaminase (IgA-tTG) antibodies. However, the implementation of this no-biopsy approach relies on accurate and consistent serological testing across laboratories. In this nationwide survey, we aimed to evaluate the availability and variability of coeliac disease testing across the United Kingdom.

Aims & Methods

We conducted a cross-sectional telephone survey of biomedical scientists and laboratory managers from NHS trusts and health boards across England, Wales, Scotland, and Northern Ireland. Data collected included assay types, reporting methods, upper limit of normal (ULN) thresholds, turnaround times, total IgA testing, the availability of anti-endomysial antibodies (EMA),

Results

A total of 356 sites were approached, with a 96% response rate (n=342). Of responding sites, 177 performed coeliac serology tests in-house, while 165 transferred samples externally. Among sites performing tests, 12 different tTG assays were identified, with considerable variability in ULN thresholds ranging from 3 to 30 IU/mL, even within laboratories using the same assays. The median turnaround time for IgA-tTG results was 7 days (range 1–21 days). Only 43% of laboratories routinely measured total IgA when IgA-tTG was requested. EMA testing was available in 83% of laboratories.

Conclusion

Significant variability exists in coeliac serology testing across UK laboratories which poses a challenge for the implementation of the no-biopsy approach in clinical practice. Efforts to standardise serological testing are urgently needed. Until such standardisation is achieved, local assay validation remains critical.

Disclosure

MGS and HAP received speaker fees from Thermo Fisher.