Introduction

Qualitative research in healthcare consists of studies using a variety of methodological approaches to gain in-depth insights into patients' and practitioners' experiences, perceptions, and social dynamics, particularly in relation to clinical interventions and their real-world acceptability and efficacy. There is growing concern regarding the underrepresentation of qualitative research in clinical journals,¹ including Gastroenterology with less than 0.1% of published articles in the top 10 Gastroenterology journals classed as utilising qualitative methods.²

Aims & Methods

In this piece of research, we seek to gain a deeper understanding of the nature of qualitative research published in the top 20 Gastroenterology and Hepatology journals, and identify if there is a relationship between journals' SCImago journal rank indicator, a measure of scientific influence that accounts for both citations and the prestige of the journals where the citations originate, and the number of qualitative articles published in these journals over a 20-year period. We conducted a comprehensive PubMed search in April 2023, using a validated search strategy³ that encompassed a combination of terms, including "interview," "qualitative," and "experience," to identify qualitative studies, including those employing mixed methods, excluding reviews, published between 2002 and 2022 in the top 20 GI journals ranked according to their SCImago score. We used simple descriptive statistics to quantify the scope of the included articles, their provenance and the types of qualitative analytical methods used. We used Pearson's correlation coefficient to calculate the existence of any relationship between SCImago Journal rank indicator and the number of qualitative articles published per journal.

Results

We identified 68 journal articles (median 1 per journal, Q1=0, Q3=5, range = 0-17) that used qualitative methods for both data collection and, published in the top 20 GI journals over a 20 year period, making up less than 0.0008% of all published primary studies in these journals. Most focused on inflammatory bowel disease (n=30,44%) and liver transplant (n=16,24%), and were conducted in the USA (n=33, 49%) and the UK (n=12,18%). Most participants in the qualitative studies were patients (n=49,72%) and clinicians (n=25,37%). The main methods used for data collection were semi-structured interviews (n=51,75%) and focus groups (n=17,25%). Thematic analysis was the most common qualitative data analytical method used (n=36, 53%). There was a weak, non-significant correlation (r(18)=-0.19, p=0.43) between SCImago journal rank indicator and the percentage of published qualitative articles.

Conclusion

Our analysis indicates that qualitative research remains notably underrepresented in the top 20 GI journals in the last two decades. A majority of the published qualitative studies centred on inflammatory bowel disease and liver transplant, were primarily from the USA and the UK, and frequently used similar qualitative data collection and analytical methods. Although no apparent relationship between SCImago rank, and percentage of articles published that used qualitative methods was found, the lack of such articles in the top 20 GI journals suggests a potential bias against qualitative research by reviewers and editors or reluctance by researchers to submit qualitative articles to clinical GI journals. Expanding the visibility of qualitative research in GI journals can enhance our understanding of patients' and practitioners' experiences and contribute to more comprehensive and patient-centred care in GI medicine.

References

1. Greenhalgh T, Annandale E et al. An open letter to The BMJ editors on qualitative research. Bmj. 2016 Feb 10;352.
2. Peerally MF, Mohanan V, Verma A, et al. PTU-85 Playing Hide and Seek: Qualitative research and Gastroenterology. Gut 2021;70:A209-A210.
3. Booth A. Searching for qualitative research for inclusion in systematic reviews: a structured methodological review. Systematic reviews. 2016 Dec;5(1):1-23.

Disclosure

Nil to declare

Introduction

With the improvement of endoscopic resection techniques, there has been recent interest in real-time in vivo characterization of polyp histology. Of all the new imaging technologies for characterizing polyp histology, narrow-band imaging (NBI) has been the most extensively studied and is easy to feasible. Correct histological prediction allows determining the optimal endoscopic technique for resection of lesions with the achievement of R0 resection. The NBI International Colorectal Endoscopic Classification (NICE) and the Japanese NBI Expert Team (JNET) classification are mostly used to predict the depth of invasion. However, the effectiveness of diagnostics using NBI in clinical practice is variable and is associated with low sensitivity for superficial invasive carcinoma.

Aims & Methods

Primary aim was to determine and compare the diagnostic accuracy of NICE and JNET classifications in predicting histology in community practice. Secondary aim was to determine the positive predictive value (PPV) for the NICE and JNET classification.
In this single-center prospective study we have included 211 patients aged 18–75 years (130 men, 62%; 81 women, 38%; mean age 60 years) who underwent colonoscopies with endoscopic resection of advanced colorectal neoplasia (defined by size lesions ≥ 10 mm). The NICE and JNET classifications were used for each lesion. The results were compared with the final histopathological finding to determine and compare NICE and JNET classification accuracy.

Results

257 lesions were analyzed including 8 (3.1 %) hyperplastic polyps, 47 (18.3 %) sessile serrated polyps, 152 (59.1 %) adenomas with low grade dysplasia, 36 (14.0 %) high-grade adenomas, 12 (4,7 %) intramucosal carcinomas, 1 (0.4 %) T1sm1 carcinoma and 1 (0.4 %) T2 carcinoma. A total of 199 lesions (77.4 %) were correctly classified according to the JNET classification and 241 lesions (93.8 %) were correctly classified according to the NICE classification. The PPV for NICE 1 lesion was 95.9 %, NICE 2 97.0 % and NICE 3 22.0 %. The PPV for JNET 1 lesions was 95.9 %, JNET 2A 83.0 %, JNET 2B 52.2 % and JNET 3 22.5 %.

Conclusion

The NICE classification was associated with a higher proportion of correctly classified lesions (93.8 %) compared to the JNET classification (77.4 %). However, NBI virtual chromoendoscopy shows a low PPV for HGD adenomas, intramucosal carcinomas and T1sm1 carcinomas (NICE 2 22.1 %, JNET 2B 52.2 %). Therefore, additional investigations in these lesions are still required with magnifying chromoendoscopy prior a final decision of endoscopic therapy. Improvement of predictive accuracy of these lesions and determining the limiting factors will be the subject of further investigation.
Supported by program projects of the Ministry of Health of the Czech Republic with reg. no. NV18-08-00246, NU22-08-00424, MO1012 and Cooperatio.

References

Kobayashi S et al. Diagnostic yield of the Japan NBI Expert Team (JNET) classification for endoscopic diagnosis of superficial colorectal neoplasms in a large-scale clinical practice database. United European Gastroenterology Journal 2019;7(7):914- 923.
Hayashi N et al. Endoscopic prediction of deep submucosal invasive carcinoma: validation of the narrow-band imaging international colorectal endoscopic (NICE) classification. Gastrointest Endosc 2013;78:625–632.
Sano Y et al. Narrow-band imaging (NBI) magnifying endoscopic classification of colorectal tumors proposed by the Japan NBI Expert Team. Dig Endosc 2016;28:526–533.
Wang Y et al. Diagnostic performance of narrow-band imaging international colorectal endoscopic and Japanese narrow-band imaging expert team classification systems for colorectal cancer and precancerous lesions. World J Gastrointest Oncol 2021;13(1):58-68.

Clinical Case Summary

A 66-year-old woman with no significant pathological history is admitted for etiologic assessment of anemia. It is an iron deficiency microcytic anemia with hemoglobin at 9.8g/dL. An upper digestive endoscopy showed multiple fundic polypoid lesions of variable size measuring more than 10mm, including a subcardial lesion measuring 20mm, with the presence of other antrals centimetrics polypoids lesions. The anatomopathological examination of the lesions is in favor of ECL (enterochromaffin like) cell carcinoids. Fundic biopsy revealed fundic atrophy consistent with Biermer’s disease. The biological assessment showed a collapsed vitamin B12 level with the presence of anti parietal cell antibodies. The treatment is based on injectable iron infusions, vitamin B12 injections and taking proton pump inhibitors. supracentimetric polypoid lesions were resected endoscopically with regular endoscopic control of other small lesions.
Gastric neuroendocrine tumors form a heterogeneous group, very largely dominated by tumors derived from so-called enterochromaffin-like (ECL) cells, endocrine cells specialized in the secretion of histamine and located within the fundic mucosa, at the deep part of the glands . The vast majority of ECL cell tumors occur in a context of hypergastrinemia. It is most often a hypergastrinemia secondary to achlorhydria induced by chronic atrophic gastritis affecting the fundic mucosa (especially in the context of Biermer’s disease). Endoscopically, gastric neuroendocrine tumors appear as multiple small polypoid lesions of less than 1 cm in size. Therapeutically, simple monitoring is recommended for ECLomas < 1 cm in size. In case of size > 1 cm, an endoscopic mucosectomy is sufficient if the submucosa is undamaged. Otherwise, ECLomas are treated by local resection associated with antrectomy.
(Included Images: Fig 1 and 2 : An upper digestive endoscopy showed multiple fundic polypoid lesions of variable size measuring more than 10mm, including a subcardial lesion measuring 20mm)

Introduction

H.pylori infection is common in developing countries leading to of high prevalences of peptic ulcers and gastric cancer. However, the diagnostic tests such as rapid urease test or urease breath test requires facilities and patients need to go to medical sites, which raise a more and more need for non-invasive and convenient tests appropriate to community.

Aims & Methods

A cross-sectional study was conducted at the Institute of Gastroenterology and Hepatology, Hanoi, Vietnam to compare the H.pylori determination results of the qualitative detection of 2 antibodies specific to FliD and CagA with the rapid urease test and urease breath test in Vietnamese patients with upper gastrointestinal symptoms. Patients over 18 years old with upper GI symptoms and no prior history of treated peptic ulcers or H.pylori eradication were invited to participate in the study. Patients were indicated with upper GI endoscopy and three methods to diagnose H.pylori infection: Rapid Urease Test (RUT), Urease Breath Test (UBT), and qualitative detection of 2 antibodies specific to FliD and CagA (Pylori Duotect). Pylori Duotect is considered positive if either antibody for FliD and CagA are positive. The parameters for evaluating the diagnostic accuracy of Pylori Duotect include sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV). Patients are considered H.pylori positive if both RUT and UBT are positive.

Results

From December 1, 2023, to April 20, 2024, 189 patients were recruited for the research. The mean age were 45.8 years old (min-max: 18-76 years old), 40.7% were female. The most common symptom of patients was epigastric pain (46.6%). There were 172 patients (91%) with gastritis, 27 patients (14.3%) with gastric ulcers and 16 (8.5%) with duodenal ulcers. Using the Pylori Duotect test, 50.8% of the patients were positive, in which 39.6% were positive with FliD and 86.5% were positive with CagA. Based on RUT and UBT results, 31.2% of patients were diagnosed with H. pylori infection. Pylori DuoTect’s sensitivity, specificity, PPV, and NPV were 81.4%, 63.8%, 50.5%, and 88.3%, respectively.

Conclusion

The Pylori DuoTect test had low sensitivity and specificity in diagnosis H. pylori infection in patients with upper gastrointestinal symptoms.

Introduction

Obscure gastrointestinal bleeding (OGIB) is defined as gastrointestinal bleeding of unknown origin that persists or recurs despite a negative finding from an initial bidirectional endoscopy. According to recent guidelines, capsule endoscopy was recommended first in overt OGIB, but it is unclear when it is appropriate to perform capsule endoscopy in overt OGIB patients.

Aims & Methods

We aimed to analyze clinical outcomes with regard to the timing of capsule endoscopy in overt OGIB patients. We conducted a single-center retrospective study enrolling patients who had undergone capsule endoscopy for overt OGIB between February 2010 to December 2021. We included hospitalized patients who underwent capsule endoscopy for overt OGIB after negative bidirectional endoscopy. We investigated the diagnostic yield of capsule endoscopy, rebleeding rate, length of hospital stay, initial hemoglobin, and the amount of blood transfusion with regard to the timing of capsule endoscopy.

Results

A total of 118 patients underwent capsule endoscopy to assess overt OGIB. The diagnostic yields in the groups that underwent capsule endoscopy < 48h and > 48h from the last overt OGIB were 50.0% and 22.0%, respectively (P=0.017). Rebleeding rate and the length of hospital stay were not significantly different between the two groups. Initial hemoglobin level in the group who underwent capsule endoscopy > 48h group was lower than in the < 48h group (8.8±3.0 vs. 10.7±3.7, P=0.015).

Conclusion

Performing capsule endoscopy within 48 hours from the last overt OGIB resulted in a higher diagnostic yield. Performing capsule endoscopy within 48 hours may improve the clinical outcomes of patients with overt OGIB.

Introduction

Sexual health is a major determining factor in the quality of life and psycho-emotional development of every individual, and may be affected by chronic diseases as inflammatory bowel disease (IBD). The aim of this study is to measure the impact of the disease on patient’s sexual desire.

Aims & Methods

Cross-sectional descriptive study in which 107 patients over 18 years old anonymously undertook the Sexual Desire Inventory (SDI) survey validated in Spanish between the months of March and April 2022. The SDI consists in a questionnaire composed by 13 items that evaluate both dyadic (items 1-9) and solitary (items 10-13) sexual desire, measured from 1 to 8 with a total score of 101. Specifically, items 9 and 13 asked about patient’s sexual desire compared to their peers. Furthermore, they were also asked if they believed their disease affected their sexual desire and to what extent. Sociodemographic data and general information about their disease were collected as well.

Results

107 questionnaires were analyzed. Mean age was 47.21 years (± 13.54), 57.01% male. 39.01% of patients suffered from ulcerative colitis (UC), 59.81% from Crohn´s disease (CD). The average total score in the SDI of 52.99 out of 101 points. There is not a validated threshold to catalogue a reply as normal, considering that the higher the score, the greater the desire. When compared patients with UC and CD, their responses did not show statistically significant differences. Other variables that could have an impact on sexual desire as perianal disease or previous surgery were analyzed, again not showing differences with the overall average. When divided between dyadic and solitary sexual desire, results were constantly higher on dyadic answers (mean 4.6 vs 3.9), with statistically significant difference (p=0.03). However, when compared questions 1 to 8 (regarding dyadic sexual desire) with question 9 (compared to their peers), and questions 10 to 12 (regarding solitary sexual desire) with question 13 (compared to their peers), it did not showed differences. When asked whether they believed their disease affected their sexual desire, 41.12% (44) replied affirmatively, being women 24 of them. From those 44 patients, the average score on the degree to which their desire is affected of 5.43 out of 8, without differences between UC and CU. 38% of the 31 patients with perianal disease agreed with the affirmation as well, with a score of 6.16 out of 8. Patients who answered yes to this question tended to have lower score on the SDI, being statistically significant when compared to the answers on question 13 (p=0.05).

Conclusion

Sexual health is a complex issue which involves a great number of variables. Most statistically significative differences were seen regarding individual sexual desire, being impaired with respect to dyadic desire. There is a remarkable number of patients who felt their disease impaired their sexual desire, seeing a higher proportion between women. Moreover, for the ones affected, it was to a large extent. It is an issue that needs further studies, especially because its impact on quality of life and the lack of quality evidence in this area.

References

1. Ortega V, Zubeidat I, Sierra JC. Further examination of measurement properties of Spanish version of the Sexual Desire Inventory with undergraduates and adolescent students. Psychol Rep. 2006 Aug;99(1):147-65. doi: 10.2466/pr0.99.1.147-165. PMID: 17037461.
2. Spector IP, Carey MP, Steinberg L. The sexual desire inventory: development, factor structure, and evidence of reliability. J Sex Marital Ther. 1996 Fall;22(3):175-90. doi: 10.1080/00926239608414655. PMID: 8880651

Introduction

Inflammatory bowel disease (IBD) is an auto-immune disease comprising Crohn's disease (CD), ulcerative colitis (UC) and colitis-type unclassified (IBD-U). Studies have shown that diet plays an important role in the development and course of IBD.
To improve assessment of dietary intake in the IBD population, our research group recently developed the Groningen IBD Nutritional Questionnaires (GINQ-FFQ), a food frequency questionnaire designed to assess dietary intake of 218 food items using 121 questions in patients with IBD over the previous month. This questionnaire needs to be validated.

Aims & Methods

This study aims to test the reliability and relative construct validity of the GINQ-FFQ.
In total 143 patients (CD N=79, UC N=57, IBD-U N=7); median age 50 [IQR: 38,6]) of the 1000IBD cohort completed both the GINQ-FFQ and a 3-Day Food Diary (3FD).
Intake from the GINQ-FFQ was calculated using the FFQ-Tool^TM , which was linked to the Dutch food composition database (NEVO). Intake from the 3FD was calculated using a Dutch nutritional calculation tool (Evry, version 2.3.7.0), that converts food consumption into nutrient intake using the same NEVO database.
Nutritional data with implausible energy intake (over- and underreporting) were excluded.
Spearman’s rho was performed to assess the correlation between nutrients of the GINQ-FFQ and 3FD (using 0.20-0.49 acceptable and ≥0.50 good outcome). A Bland-Altman (B&A) plot was performed to visualise level of agreement for energy intake (kcal).

Results

For macronutrients Spearman’s rho varied between 0.39 and 0.63; For micronutrients between 0.20 and 0.51 (Table 1).
B&A plot for kcal showed good agreement (mean difference of -84.87, limits of agreement [-1358, 1188]).

Conclusion

Compared to a 3FD, the GINQ-FFQ is an acceptable dietary assessment tool.

References

1. Abraham C, Cho JH. Inflammatory bowel disease. N. Engl. J. Med. 361, 2066–2078 (2009)
2. Lewis JD, Abreu MT. Diet as a trigger or therapy for inflammatory bowel diseases. Gastroenterology 152, 398–414.e6 (2017)
3. Ananthakrishnan AN, Bernstein CN, Iliopoulos D, Macpherson A, Neurath MF, Ali RAR, Vavricka SR, Fiocchi C. Environmental triggers in IBD: A review of progress and evidence. Nat. Rev. Gastroenterol. Hepatol.2018,15, 39–49.
4. Peters V, Alizadeh BZ, de Vries JH, Dijkstra G, Campmans-Kuijpers MJ. Nutritional Assessment in Inflammatory Bowel Disease (IBD)—Development of the Groningen IBD Nutritional Questionnaires (GINQ). Nutrients. 2019 Nov 12;11(11):2739.
5. Imhann F, Van der Velde KJ, Barbieri R, et al. The 1000IBD project: multi-omics data of 1000 inflammatory bowel disease patients; data release 1. BMC Gastroenterol 2019;19:5.
6. Molag M. Towards transparent development of food frequency questionnaires: scientific basis of the Dutch FFQ-TOOL tm: a computer system to generate, apply and process FFQs. Wageningen University and Research, 2010.
7. Rijksinstituut voor Volksgezondheid en Milieu. Dutch Food Composition Database. https://www.rivm.nl/en/dutch-food-composition-database
8. Black A. Critical evaluation of energy intake using the Goldberg cut-off for energy intake: basal metabolic rate. A practical guide to its calculation, use and limitations. International Journal of Obesity. 2000 Sep 24;24(9):1119–30.

Disclosure

GD received speakersfee from: Abbvie, Janssen-Cilag, Takeda, Janssen, Pfizer not related to this work.