Introduction

Eosinophilic esophagitis (EoE) is a chronic disease characterized by eosinophil-predominant inflammation of the esophagus. Due to his progressive condition, it may evolve to fibrostenotic disease if a treatment is not prescribed. When stricture is already present, the standard therapeutic strategy is represented by endoscopic dilatation, but the use of topical steroids as a first-line approach is gradually being considered.

Aims & Methods

The aim of the study is to evaluate endoscopic modification of esophageal stenosis after induction therapy with budesonide orodispersible tablets (BOT). To date, these data have not been studied yet. A retrospective study was conducted to include all EoE patients in BOT therapy followed in our center. Data on demographics, clinical characteristics, prevalence and endoscopic features of stenosis before BOT medication were evaluated. After induction BOT treatment (1 mg twice a day), endoscopic and histological findings were studied, with attention to modification, intended by total remission, improvement (stricture passed by standard gastroscope) or stability of stenosis. Concomitant treatment with proton-pump inhibitors (PPI) was reviewed.

Results

A total of 93 EoE patients in BOT therapy were evaluated. 22 patients (24%) presented esophageal stenosis localized in 7 patients (32%) in cervical esophagus, in 4 patients (18%) in mid esophagus and in 11 patients (50%) in distal esophagus. After induction treatment, 8 patients (36%) reported total remission of stenosis, 7 patients (32%) improvement and 2 patients (9%) stability, 5 patients (23%) have not already performed gastroscopy at time of analysis. All patients (100%) with fibrostenotic disease reached total histologic remission (0 eosinophil/HPF) on gastroscopy after BOT induction therapy. Concomitant treatment with PPI was reported in 6 patients (28%), while 15 patients (72%) were not taking this medication.

Conclusion

Esophageal strictures in EoE are a well-known complication of disease. Our results show that stenosis may be modified by BOT induction therapy with a total remission or improvement in diameter in most of patients. This data could be explained by the inflammatory component of some stenosis, which respond to medical therapy with budesonide. Consistent with the already established efficacy of BOT, all patients achieved total histologic remission. On the contrary, concomitant treatment with PPI didn’t show an additional role in ameliorating fibrostenotic picture, but further studies are needed.

Introduction

Endoscopic retrograde cholangiopancreatography (ERCP) poses a risk of patient-to-patient transmission of multidrug-resistant organisms (MDROs) via contaminated duodenoscopes. The prevalence of MDRO carriage in ERCP patients is unknown but crucial for assessing this risk and to determine the impact and choice of targeted infection prevention measures.

Aims & Methods

The aim of this study was to measure MDRO prevalence in ERCP patients across four countries. This observational study included adults undergoing ERCP in the Netherlands, India, Italy, and the United States. Pre-procedural rectal and throat-nose swabs were collected for MDRO detection. Patient- and procedure-related data were systematically collected. Risk factors for MDRO carriage were determined through multivariate logistic regression analysis.

Results

Of 1244 patients, 462 (37.1%) carried an MDRO. Extended-spectrum beta-lactamase-producing Enterobacterales were most common (337/1244, 27.1%), followed by carbapenemase-producing Enterobacterales (94/1244, 7.6%). MDRO prevalence exhibited significant geographical variation, highest in India (83.1%) and lowest in the Netherlands (10.8%), with intermediate rates in Italy (31.6%) and the United States (20.1%). Additionally, MDRO types varied substantially across countries. Pre-procedural MDRO carriage was significantly associated with chronic lung disease (aOR 1.75, 95% CI 1.07–2.86, P = 0.025), congestive heart failure (aOR 2.20, 95% CI 1.33–3.64, P = 0.002), and prior penicillin use (aOR 1.66, 95% CI 1.05–2.63, P = 0.031).

Conclusion

Patients undergoing ERCP have a moderate to high prevalence of MDRO carriage, with significant variation in prevalence, species, and resistance mechanisms across countries. High MDRO prevalence increases the risk of duodenoscope contamination by MDRO and subsequent patient-to-patient transmission via these contaminated endoscopes. Pre-procedural screening could enable targeted infection prevention measures, including enhanced reprocessing or the use of single-use duodenoscopes, to reduce the risk of future duodenoscope-related MDRO outbreaks.

Disclosure

This study was supported by an unrestricted research grant from Boston Scientific and received material support from Copan Italia SpA. The study was investigator-initiated, and neither Boston Scientific nor Copan Italia had any role in the design of the study protocol, data analysis, interpretation of results, or preparation of the abstract.

Introduction

Duodenoscopes have been implicated in patient-to-patient transmission of multidrug-resistant organisms (MDROs). Current gastrointestinal MDRO surveillance relies primarily on rectal screening, yet the duodenum is the primary site of duodenoscope exposure to MDRO. This study evaluated the predictive value of rectal and throat-nose screening for detecting MDROs in duodenal fluid as a marker of duodenoscope contamination risk.

Aims & Methods

The aim of this study was to evaluate the predictive value of rectal and throat-nose screening for detecting MDROs in duodenal fluid as a marker of duodenoscope contamination risk. This study was conducted at two tertiary care centers in India and the Netherlands. Adult patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) were included. Rectal swabs, throat-nose swabs, and duodenal aspirates were collected and analyzed for MDROs. The detected MDROs were compared using species identification, antibiotic susceptibility patterns, and whole-genome sequencing.

Results

A total of 512 participants were included: 339 from the Netherlands and 173 from India. Rectal MDRO carriage was observed in 33.8% (173/512), throat-nose carriage in 0.2% (1/512), and duodenal carriage in 22.9% (117/512). Due to the low prevalence of carriage in the nose or throat, only the predictive value efficacy of rectal screening was assessed. Rectal screening showed a sensitivity of 38.5% for genetically related strains in duodenal fluid. For detecting any duodenal MDRO, rectal screening demonstrated a sensitivity of 90.6%, specificity of 83.0%, a positive predictive value (PPV) of 61.3%, and a negative predictive value (NPV) of 96.7%.

Conclusion

Rectal screening is unreliable for detecting strain-specific duodenal MDROs. While effective in identifying non-carriers, it overestimates true duodenal MDRO carriage. Thus, utility of rectal screening in guiding infection prevention strategies for duodenoscope contamination is greater in regions with low MDRO prevalence.

Disclosure

This study was supported by an unrestricted research grant from Boston Scientific and received material support from Copan Italia SpA. The study was investigator-initiated, and neither Boston Scientific nor Copan Italia had any role in the design of the study protocol, data analysis, interpretation of results, or preparation of the abstract.

Introduction

The primary treatment goals of gastroesophageal reflux disease (GERD) include resolving symptoms, preventing complications and symptom relapses, and healing erosive oesophagitis.^{1, 2} Heartburn and regurgitation are frequent and typical symptoms of GERD. Vonoprazan, a potassium-competitive acid blocker, is approved in China for the treatment of reflux oesophagitis.^{3, 4} However, there is a paucity of real-world data assessing the relief of typical daily symptoms achieved with vonoprazan in adult Chinese patients.

Aims & Methods

VIEW (NCT04501627) was a multicentre, single-arm, prospective, observational, real-world study conducted in China. Patients received 20 mg vonoprazan, orally, once daily for 4 weeks (8 weeks for insufficient healing). This post hoc subgroup analysis conducted in enrolled patients with GERD assessed changes in symptom scores for all-day or night-time heartburn and/or regurgitation during the first 14 days of treatment. A mixed-effects model for repeated measures assessed statistical differences in symptom scores from baseline for each day; least-squares mean (LSM) and its 95% confidence interval are reported (negative values indicate improvement).

Results

Among the 2214 patients included in the effectiveness analysis population of the GERD group, 86.7% were aged <65 years[A.G.1] and 60.8% were male. The LSM change in symptom scores from baseline demonstrated a significant improvement from day 1 of treatment in all-day heartburn and/or regurgitation, daytime heartburn or regurgitation, and night‑time heartburn or regurgitation (Table). Significant improvement continued to be observed on day 14 and throughout all previous days of treatment.

Conclusion

Vonoprazan provided rapid (from day 1), significant and durable symptom relief in patients with GERD.

Table: Improvement in symptom scores^a from baseline to day 14 of vonoprazan treatment (effectiveness analysis population; MMRM analysis)

References

1. Antunes C, Aleem A and Curtis SA. StatPearls. Treasure Island (FL), 2023.
2. Heidelbaugh JJ, Nostrant TT, Kim C, et al. Am Fam Physician 2003; 68: 1311-1318.
3. Xiao Y, Lu Y, Yang H, et al. Am J Gastroenterol 2023; 118: S345-S345.
4. Oshima T and Miwa H. J Neurogastroenterol Motil 2018; 24: 334-344.

Disclosure

This study was funded by Takeda (China) International Trading Co. Ltd. Yinglian Xiao, Dekui Zhang and Jianyong Chen have no conflicts of interest. Kailun Liang and Li Xie are Takeda employees and hold Takeda stock options. Minhu Chen received speaker honoraria from Takeda China, AstraZeneca China, Xian Janssen and Eisai China.

Introduction

Graves’ disease (GD) and ulcerative colitis (UC) are two distinct autoimmune disorders with increasing evidence of shared pathophysiological mechanisms. While previous epidemiological studies have reported a higher risk of IBD among individuals with GD, the association between GD and UC specifically remains controversial. In particular, the causal direction, genetic liability, and molecular mediators underlying this relationship are not well defined.

Aims & Methods

We conducted a multi-layered investigation to clarify the relationship between GD and UC. First, a large-scale prospective analysis using the UK Biobank cohort was performed to assess the association between GD and subsequent UC risk, with adjustments for demographic, lifestyle, and clinical covariates utilizing COX proportional hazard models. Second, two-sample Mendelian randomization (MR) analyses were conducted using publicly available genome-wide association study (GWAS) datasets to infer potential causal links. Finally, we performed protein mediation analysis integrating plasma proteomic data to identify potential intermediate proteins and pathways mediating the effect of GD on UC.

Results

Observational analysis revealed that patients with GD had a significantly elevated risk of developing UC. Stratified analysis further revealed that this association was more pronounced among male and obese individuals. The association remained significant even after adjusting for key covariates including medication use, psychological disorders, air pollution exposure, and sunlight exposure. Genetic-level analysis using Mendelian randomization confirmed a potential causal relationship between AITD and UC. This association was independently validated in MR sensitivity analyses. Through mediation analysis based on plasma proteomic data, 28 UC-related proteins were identified as potential mediators of the AITD–UC relationship. Among them, proteins such as Arachidonate 15-lipoxygenase B (ALOX15B) were significantly enriched in the high-risk group. Collectively, six pathways likely represent the core signaling axes through which GD promotes UC pathogenesis, highlighting potential targets for mechanistic and therapeutic exploration.

Conclusion

This study provides robust clinical, genetic, and molecular evidence for a link from GD to UC, mediated through specific immunopathogenic proteins and pathways. These findings offer novel insights into shared autoimmunity and may inform biomarker-driven strategies for early identification and targeted prevention of UC in patients with GD.

References

Ferrari SM. The association of other autoimmune diseases in patients with Graves' disease (with or without ophthalmopathy): Review of the literature and report of a large series. Autoimmun Rev. 2019 Mar;18(3):287-292.
Ordás I. Ulcerative colitis. Lancet. 2012 Nov 3;380(9853):1606-19.
Xian W. Graves Disease and Inflammatory Bowel Disease: A Bidirectional Mendelian Randomization. J Clin Endocrinol Metab. 2023 Apr 13;108(5):1075-1083.
Burisch J. Incidence of Immune-Mediated Inflammatory Diseases Among Patients With Inflammatory Bowel Diseases in Denmark. Clin Gastroenterol Hepatol. 2019 Dec;17(13):2704-2712.e3.

Disclosure

The authors declare no conflicts of interest.