Introduction

The role of eosinophils in unexplained gastrointestinal diseases is an area of increasing interest. However, there remains a lack of quality data available to determine the relationship between eosinophilic oesophagitis (EoE) and DGBIs (e.g., functional dyspepsia (FD), associated with duodenal eosinophilia). Several other gastrointestinal diseases are also characterised by an increased number of tissue eosinophils, including gastro-oesophageal reflux, inflammatory bowel disease and rumination syndrome. Risk factors for EoE still remain to be clearly defined in large population-based studies. The aim of this study was to determine the relationship between EoE and DGBIs as well as other potential risk factors for EoE, and mortality in EoE.

Aims & Methods

General practice electronic medical records were sourced from the United Kingdom (UK) via The Health Improvement Network which collates and cleans records from across the UK. EoE was identified through Read codes. DGBIs were similarly identified via Read codes and the first date of first record of each was noted.

Results

A total of 1.274 million unique patients were available for analysis. There were 389 EoE cases (0.03%) from the cohort, with age at first diagnoses being mean 21 years (SD=18), and 74% female.
Statistically significant univariate risk factors for EoE included female sex (OR: 3.69, 95%CI: 2.94-4.63), Crohn’s disease (OR: 3.85, 95%CI: 1.44-10.31), Helicobacter pylori infection (OR: 3.35, 95%CI: 1.84-6.10), gluten sensitivity (OR: 10.59, 95%CI: 1.48-75.59), allergy (OR: 2.99, 95%CI: 2.37-3.78), reflux (OR: 3.05, 95%CI: 2.43-3.83), GI Infection (OR: 2.07, 95%CI: 1.55-2.77), asthma (OR: 2.97, 95%CI: 2.37-3.72), rhinitis (OR: 2.46, 95%CI: 1.94-3.12), antibiotics (OR: 2.79, 95%CI: 1.74-4.48), and proton pump inhibitors (PPIs) (OR: 11.78, 95%CI: 8.02-17.31). Significant factors that had a reduced risk were IBS (OR: 0.36, 95%CI: 0.23-0.56) and FD (OR: 0.74, 95%CI: 0.57-0.97).
We conducted three separate multiple logistic regression models. The first consisted of all univariate risk factors of which the following were independent: female sex (OR: 4.10, 95%CI: 3.27-5.15), H. pylori (OR: 2.48, 95%CI: 1.35-4.56), gluten sensitivity (OR: 9.10, 95%CI: 1.25-66.46), allergy (OR: 1.74, 95%CI: 1.36-2.21), reflux (OR: 1.63, 95%CI: 1.28-2.07), asthma (OR: 1.72, 95%CI: 1.36-2.17), and prior PPI use to diagnosis of EoE (OR: 13.29, 95%CI: 10.27-17.20). Independent factors that reduced risk were IBS (OR: 0.19, 95%CI: 0.12-0.30) and FD (OR: 0.22, 95%CI: 0.17-0.30). ROC/AUC 0.86 (95%CI: 0.84-0.88).
Second model assessed IBS and FD (adjusting for sex, age at first contact, anxiety, and depression): both IBS and FD remained statistically significant and less likely to be associated with EoE (IBS OR: 0.35, 95%CI: 0.22-0.54; FD OR: 0.74, 95%CI: 0.56-0.97). ROC/AUC 0.79 (95%CI: 0.77-0.81).
Final model assessed mortality (adjusting for sex/ age at first contact): mortality (OR: 0.15, 95%CI: 0.03-0.59) was less likely in EoE. ROC/AUC 0.78 (95%CI: 0.76-0.81).

Conclusion

Individuals with EoE were less likely to have DGBIs (IBS and FD), whereas they were more likely to have other gastrointestinal diseases (e.g. gluten sensitivity, reflux, H. pylori). They were more likely to have had allergies and asthma and much more likely to have used PPIs before diagnosis of EoE. Mortality is not increased.

Disclosure

GD Eslick, MP Jones, MM Walker have no conflicts of interest. Nicholas J. Talley is supported by funding from the National Health and Medical Research Council (NHMRC) to the Centre for Research Excellence in Digestive Health and he holds an NHMRC Investigator grant. Dr Talley reports nonfinancial support from Norgine (2021) (IBS interest group); reports research grants from Allakos, Astra Zeneca; personal fees from Allakos (eosinophilic disease) (2021), Bayer (IBS) (2020), Planet Innovation (Gas capsule IBS) (2020), twoXAR Viscera Labs, (USA 2021) (IBS-diarrhea), Dr Falk Pharma (2020) (eosinophilic esophagitis), Sanofi-Aventis, Glutagen (2020) (celiac disease), IsoThrive (2021) (esophageal microbiome), BluMaiden (microbiome advisory board) (2021), Rose Pharma (IBS) (2021), Intrinsic Medicine (2022) (human milk oligosaccharide), Comvita Mānuka Honey (2021) (digestive health), Astra Zeneca (2022), and Glaxo (2022) outside the submitted work. In addition, Dr Talley has a patent on Nepean Dyspepsia Index (NDI) 1998 and Biomarkers of IBS licensed, a patent on Licensing Questionnaires Talley Bowel Disease Questionnaire licensed to Mayo/Talley, a patent on Nestec European Patent licensed, a Singapore Provisional Patent “Microbiota Modulation of BDNF Tissue Repair Pathway” issued, and “Diagnostic marker for functional gastrointestinal disorders,” Australian Provisional Patent Application 2021901692. Committees: NHMRC member, Asia Pacific Association of Medical Journal Editors, Rome V Working Team Member (gastroduodenal committee), International Plausibility Project co-chair (Rome Foundation funded), COVID-19 vaccine forum member (by invitation only). Community groups: advisory board, International Foundation for Functional GI Disorders and ausEE Inc. Editorial: Mayo Clinic Proceedings (Associate Editor), UpToDate (section editor), Precision and Future Medicine, Sungkyunkwan University School of Medicine, South Korea (Journal of Cell Press).

Introduction

Chronic hepatitis, primarily caused by HBV, HCV, or HDV infections, remains a silent yet progressive condition leading to advanced hepatic fibrosis and cirrhosis. Non-invasive assessment tools, such as the FIB-4 score, play a crucial role in early-stage risk stratification. Emerging evidence suggests a potential interaction between gut microbiota alterations-particularly Small Intestinal Bacterial Overgrowth (SIBO)-and liver function, mediated through the gut-liver axis.

Aims & Methods

Aim: To evaluate the association between SIBO status and FIB-4 scores among patients with chronic hepatitis, and to assess whether SIBO positivity serves as an independent marker of hepatic fibrosis severity.
Methods: We retrospectively analyzed clinical and biochemical data from 122 patients with confirmed viral hepatitis. Parameters included age, gender, liver enzyme levels (ALT, AST, ALP, GGT), SIBO breath test results, and viral titers. FIB-4 scores were calculated using standard formulas. Patients were grouped based on SIBO status (positive vs. negative). Boxplot analysis and correlation metrics were used to visualize and quantify associations.

Results

Patients with SIBO positivity exhibited significantly higher median FIB-4 scores (1.87) compared to those who were SIBO-negative (1.23), (p < 0.05). The boxplot analysis underscored a wider interquartile range and rightward skew in SIBO-positive individuals. A moderate positive correlation (Spearman's rho = 0.41) was observed between viral titers and FIB-4 levels, indicating a synergistic impact of microbial overgrowth and viral load on liver fibrosis progression.

Conclusion

SIBO positivity appears to correlate with elevated FIB-4 scores in chronic hepatitis patients, suggesting microbial dysbiosis as a potential contributor to fibrotic burden. Incorporating gut health assessment into routine liver disease screening may enhance early detection of high-risk individuals. Further prospective studies are recommended to explore causality and therapeutic modulation of the gut-liver axis.

Introduction

Advances in non-celiac wheat sensitivity (NCWS) have proved that it should be considered a protean condition in which several potential triggers [e.g. gluten, wheat amylase-trypsin inhibitors, etc.] might determine an intestinal mucosal damage with increased permeability and exposure of foods/microbial peptides to immune cells (1,2), resulting in both a local and systemic inflammatory activation responsible for its gastrointestinal and extraintestinal manifestations (3,4). Up to 75% of NCWS subjects complain of multiple foods hypersensitivities (MFH) (5). These patients usually have clinical, immunological and histological features similar to wheat allergy patients, although without positive gluten/wheat IgE assays, allowing to hypothesize the existence of a non-IgE mediated hypersensitivity. In addition, several studies have reported an association between atopic diseases and NCWS.

Aims & Methods

This study aimed to define the presence and features of atopic diseases and other hypersensitivities (primarily food allergies/intolerances) in NCWS compared with celiac disease (CD) and irritable bowel syndrome/functional dyspepsia (IBS/FD) and to analyze a possible correlation between these diseases and NCWS clinical manifestations. This retrospective, multicenter study included NCWS patients diagnosed by double-blind placebo-controlled challenge with wheat. Their clinical, laboratory and histology data at diagnosis (i.e. before the start of a wheat-free diet) were analyzed and compared to control subjects with CD and IBS/FD. Specific allergology data, other than clinical/laboratory features typical of NCWS, were collected and analyzed: family and personal history of atopic diseases, type of allergens responsible, positivity of skin prick tests (SPT), patch tests and total and food-specific IgE.

Results

Atopic disease prevalence was higher in NCWS (32.8%) than in CD (19.3%) and IBS/FD (21.5%) (P=.001 for both). Similarly, NCWS subjects had a higher frequency of MFH (39.8%) and self-reported milk intolerance (SRMI) (65.9%) compared to the controls (P <.001 for both). Allergic asthma, either alone (P=.03) or associated with allergic rhinitis (P=.005), was more prevalent in NCWS compared to IBS/FD, which was more often associated with allergic conjunctivitis (P=.004) or allergic rhinitis alone (P=.02). Graminaceae hypersensitivity and nickel allergic contact dermatitis (Ni-ACD) were more frequent in patients with NCWS (70.1% and 17.8%) vs both CD (48.7% and 9.4%, P=.03 and P=.01, respectively) and IBS/FD (50.8% and 6.7%, P=.01 and P<.001, respectively). On multiple logistic regression analysis, a coexistent atopic disease (OR 1.481), MFH (OR 3.882) and SRMI (OR 2.259) were associated with the NCWS diagnosis. NCWS subjects with atopy compared to those without more frequently had Ni-ACD (P<.001) and SRMI (P=.03), positive patch test (P<.001), SPT for foods (P=0.001) and both total and food-specific serum IgE (P=.02 and P=.002, respectively). On multiple logistic regression analysis, positivity to patch test (OR 2.955), SPT for foods (OR 5.799), and food-specific serum IgE (OR 3.101) were confirmed as differentiating the 2 subgroups.

Conclusion

NCWS subjects have a higher frequency of atopic disease, MFH and SRMI compared to both CD and IBS/FD ones. These conditions could be expression of an underlying hypersensitivity milieu characterizing NCWS and might be of support in the differential diagnosis between NCWS and functional gastrointestinal disorders, if inserted into a broader diagnostic panel.

References

1) Zevallos VF, Raker V, Tenzer S, Jimenez-Calvente C, Ashfaq-Khan M, Rüssel N, et al. Nutritional Wheat Amylase-Trypsin Inhibitors Promote Intestinal Inflammation via Activation of Myeloid Cells. Gastroenterology. 2017;152:1100-1113.e12.
2) Uhde M, Ajamian M, Caio G, De Giorgio R, Indart A, Green PH, et al. Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease. Gut. 2016;65:1930–7.
3) Volta U, De Giorgio R, Caio G, Uhde M, Manfredini R, Alaedini A. Nonceliac Wheat Sensitivity. Gastroenterol Clin North Am. 2019;48:165–82.
4) Catassi C, Elli L, Bonaz B, Bouma G, Carroccio A, Castillejo G, et al. Diagnosis of Non-Celiac Gluten Sensitivity (NCGS): The Salerno Experts’ Criteria. Nutrients. 2015;7:4966–77.
5) Carroccio A, Mansueto P, Iacono G, Soresi M, D’Alcamo A, Cavataio F, et al. Non-Celiac Wheat Sensitivity Diagnosed by Double-Blind Placebo-Controlled Challenge: Exploring a New Clinical Entity. American Journal of Gastroenterology. 2012;107:1898–906.

Disclosure

This study is funded by the European Union - Next Generation EU, Mission 4, Component 1 CUP B53D23031860001, Project Code: P2022Z9RZY_001.

Introduction

Studies have shown that most foreign body (FB) pass without the need for intervention (1).
European Society of Gastrointestinal Endoscopy (ESGE) recommends urgent endoscopic retrieval of high-risk objects such as sharp, blunt (magnets, button batteries) and long objects,(2) but decision regarding endoscopic retrieval is often taken ‘case by case’ with variation in clinical practice.

Aims & Methods

We set out to evaluate and compare outcomes in cases where FB ingestion was managed conservatively versus cases where an attempt at gastroscopy (OGD) retrieval was undertaken.
This was a retrospective cohort analysis performed in a large tertiary centre reviewing FB ingestion presentations between January 2020 to December 2024. Cases were identified using an electronic coding system and adults (aged 18 and above) were included. Food impaction cases were excluded. Data analysis included demographics, early warning score (EWS) at presentation, prior FB ingestion and intervention episodes. FB type was categorised as blunt, long (5cm or more), sharp and other. Location of FB in the gastro-intestinal tract at presentation was documented where possible. For analysis, groups were categorised to those who had OGD versus those conservatively managed (no OGD).
Outcomes were categorised as eventful (defined as requiring surgical intervention for retrieval or complications such as perforation, obstruction, hemorrhage, foreign body migration through the digestive wall or death) or uneventful, defined as foreign body passing through spontaneously. Length of hospital stay (LOS) was also compared between both groups.
Chi squared, Man Whitney U and Kruskal-Wallis test were used for statistical evaluation. P value of less than 0.05 is considered significant.

Results

A total of 119 presentations were analysed (n=73 Females n=46 Males) with a median age of 38 years. Median EWS at presentation was 1. Location of FB identified at presentation were as follows; oesophagus n=11, stomach n=72, beyond n=27, radiolucent n=9.
Categories of FB, comparison between groups (OGD versus no OGD) and outcome is summarised in table 1.
Overall, 0.08% (n=7 for OGD and n=3 for no OGD respectively) of presentations had an eventful outcome. There is no significant difference observed in the number of eventful outcomes between the OGD and no OGD group (p=0.282). There is no significant difference in LOS (days) between the two groups (OGD group median = 3 days IQR 3 versus no OGD; median = 2 days IQR 4, p 0.198)
Eventful outcome occurred in all categories of FB (blunt n=3, sharp n=3, long n=3, other n=1) and location (oesophagus n=2, stomach n=7, beyond n=1).
There is a trend that those who had intervention previously for FB ingestion will have had more overall presentations (Kruskall-Wallis p=0.044).

Table 1 - Category of foreign body, OGD performed, outcomes and comparison.

Conclusion

Our study observed an overall low eventful outcome following foreign body ingestion presentation. There is no significant difference in outcomes and LOS between patients who had OGD versus those managed conservatively.

References

1. Tambakis G, Schildkraut T, Delaney I, Gilmore R, Loebenstein M, Taylor A, Holt B, Tsoi EH, Cameron G, Demediuk B, Miller A, Connell W, Wright E, Thompson A, Holmes J. Management of foreign body ingestion in adults: Time to STOP and rethink endoscopy. Endosc Int Open. 2023 Dec 12;11(12):E1161-E1167. doi: 10.1055/a-2201-6928. PMID: 38094028; PMCID: PMC10715904.
2. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) clinical guidelines. http://dx.doi.org/ 10.1055/s-0042-100456 Published online: 0.0.2016 Endoscopy 2016; 48: 1–8 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0013-726X