Introduction

Cases of autochthonous Strongyloides stercoralis infection have been reported rarely in Northern Italy,. There are no reports from Southern Italy. Since S. stercoralis may harbor in dogs and other farm animals, we aimed to investigate the prevalence of such infestation in farm workers in Southern Italy.

Aims & Methods

Capillary blood samples were drawn from farm and doghouse workers in the county area of Bari (South Italy). Screening test was a commercial ELISA test (Strongyloides ratti by Bordier Affinity Products SA). Serology-positive patients were offered Ivermectin therapy, single dose of 200 ug/Kg. Patients underwent, at baseline and 4 months after therapy, clinical examination; severity of abdominal pain, diarrhea, skin rash, urticaria, asthma symptoms were estimates by a 10-point VAS scale. Stool consistency was classified according to the Bristol scale. Full blood count was also performed both at baseline and follow up. Data were expressed as median with interquartile range (IQR). Wilcoxon signed rank test was used for statistical analysis.

Results

Among 120 workers, 6 patients were serology- positive, with a prevalence of 5%. Two of them worked in doghouses. Abdominal pain was the most frequent symptom (3 patients, 50% cases), which resolved after therapy in all patients with VAS from 1 (IQR 0-5.8) to 0 (IQR 0-0), p=0.25. No variation in stool consistency was recorded (p=1). Two patients complained of urticaria, which totally resolved in one subject and improved in the other one. Asthma was referred bytwo patients, with full clearancein one of them. We observed a non statistically significant trend of eosinophil count reduction, from 190/mm³ (IQR 140-240) to 180/mm³ (IQR 150-220), p=0.14.

Conclusion

In our area, the prevalence of the parasitosis is low. Therapy may be helpful to reduce the severity of some symptoms such as abdominal pain, asthma and urticaria. A marginal effect on eosinophils has been observed.

Introduction

Idiopathic Sclerosing Mesenteritis (SM) is a rare fibroinflammatory disease of unknown etiology. The clinical course is generally benign, as has been demonstrated in retrospective studies and large case series.

Aims & Methods

To more accurately determine the natural history of patients with symptomatic SM and describe the clinical features of those with idiopathic SM, we performed a prospective cohort study. Inclusion criteria were adult patients with typical SM symptoms, after ruling out other causes of abdominal pain, who met the Coulier criteria in computed tomography scans for establishing SM diagnosis. We identified 58 patients with symptomatic SM. During the follow-up period, 3 patients were lost and excluded from the analysis. Most patients (95.7%) underwent upper and lower endoscopy and chest imaging to rule out co-existing cancer disease. Secondary SM cases were also excluded (n=5 had a co-existing cancer diagnosis within 6 months of SM diagnosis and n=4 had a pre-existing diagnosis of SM-related autoimmune disease at SM diagnosis). The final cohort of symptomatic idiopathic SM cases consisted of 46 patients. Data were collected prospectively at each site visit from January 2014 to January 2024. Descriptive statistics were used to summarize the results.

Results

In total, 46 patients with idiopathic SM were included, of whom 56.5% were females and 43.5% were males with a mean age at diagnosis of 62 years. Overweight or obese were 62.8%, and 37.2% had normal weight. SM was histologically confirmed in 13%. Features of IgG4-related disease were present in 21.7% with other organ involvement (13% pancreas, 10.9% bile ducts, 2.2% orbit, and 2.2% lymph nodes). Multiple organ involvement was observed in 6.5%. All patients who presented with an abdominal mass (8.7%) developed features similar to IgG4-related disease. Elevated serum IgG4 levels at diagnosis were found in 7 of 36 patients (19.4%). All patients presented with abdominal pain, followed by bloating (84.8%), nausea (43.5%), anorexia (39.1%), weight loss (37%), vomiting (30.4%), dyspepsia (19.6%), diarrhea (19.6%), constipation (13%), fever (8.7%), icterus (4.3%), early satiety (4.3%), sarcopenia (4.3%), and peripheral edema (2.2%). Hospitalization was required in 37%, and severe complications were observed in 30.4% [ileus (15.2%), acute pancreatitis (8.7%), acute cholangitis (8.7%), abdominal mass (8.7%), chronic pancreatitis (4.3%), mesenteric thrombosis (2.2%), and obstructive lymphadenopathy (2.2%)]. Surgical intervention was performed in 13%. During the disease course, most patients (84.8%) were treated with colchicine in combination or not with corticosteroids (54.3%), antiplatelets (50%), and low-molecular heparin (28.3%).

Conclusion

In this prospective cohort study, we observed an aggressive clinical course with severe intra-abdominal complications in a substantial proportion of patients with idiopathic SM (30.4%). Almost one in four patients (21.7%) manifested other organ involvement, identical to IgG4-related disease, indicating that some idiopathic SM cases could be part of the IgG4 disease spectrum. These observations suggest that idiopathic SM requires clinical vigilance similar to that applied to IgG4-related disease.

References

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Disclosure

No potential conflicts of interest

Introduction

Irritable bowel syndrome (IBS) and coeliac disease are common disorders that share overlapping symptoms. In this systematic review and meta-analysis, we aimed to provide up-to-date and comprehensive estimates of the prevalence of coeliac disease in patients with IBS.

Aims & Methods

We searched several databases through January 2025 for studies reporting the prevalence of coeliac disease in patients with IBS. Eligible studies used Rome III or Rome IV criteria for IBS diagnosis and used serological screening with tissue transglutaminase, endomysial antibodies, or deamidated gliadin peptide, and/or confirmatory duodenal biopsies for coeliac disease diagnosis. We used random-effects meta-analysis to estimate the pooled prevalence of seropositive and biopsy-proven coeliac disease with 95% confidence intervals (CI). We calculated pooled odds ratios (ORs) to compare the likelihood of coeliac disease between patients with IBS and controls.

Results

A total of 29 studies comprising 7,209 patients with IBS were included. The pooled seroprevalence of coeliac disease in patients with IBS was 6% (95% CI, 5% - 8%), and the pooled prevalence of biopsy-proven coeliac disease was 2% (95% CI, 2% - 3%). A significant proportion of seropositive patients (15%; 95% CI, 6% - 24%) did not undergo endoscopy and biopsy. Patients with IBS had significantly higher odds of a positive serology than controls (OR 4.42; 95% CI, 2.82 – 6.92). The odds of coeliac disease were similar across genders and IBS subtypes.

Conclusion

Coeliac disease is highly prevalent in patients with IBS, according to the Rome III and Rome IV criteria. A positive diagnosis of IBS should not be made without excluding coeliac disease.

Disclosure

MGS received speaker fees from Thermo Fisher. IA received speaker fees from PrecisionBiotics.

Clinical Case Summary

Background: Strongyloides stercoralis is a clinically inapparent chronic infection in an immunocompetent individual. However, infection by the same parasite in immunosuppressed individuals can lead to hyper infection syndrome and disseminated disease which have an alarmingly high case fatality rate. There have been only case reports of this disease. We here present a case series of Strongyloides stercoralis infection that were diagnosed in our institution.
Methods: We present 5 cases with strongyloidiasis, in immunosuppressed patients.
Results: Most common age group - 40 to 50 years with 90% males. Underlying comorbidities were diabetes, rheumatological disorders. Patients with rheumatological disorders were on steroids or immunomodulators. Most common presenting symptoms -abdominal pain(100%), vomiting(80%), fever(66%), diarrhoea(40%) and pedal edema/ascites(20%). Diagnosis of Strongyloidiasis by Upper GI scopy showing duodenal ulcers/ erosions/ fissuring, with biopsies showing larval and egg forms of the parasite in the duodenal mucosa in all patients. In 70% cases single stool examination failed to detect larva by conventional methods but stool routine micro yielded the diagnosis in one patient. All the patients were prescribed ivermectin and other supportive treatment. No mortality was seen in our study. In various published study the mortality rate for S. stercoralis hyperinfection was 87%, however none of the patients in our study succumb to the infection. This may be related to prompt starting of anti-helmenthic medications along with adequate medical and intensive care wherever needed.
Conclusion: Strongyloides Hyper infection syndrome if treated promptly with adequate medications can yield favorable results even in immunocompromised individuals. In contrast to the available literature suggesting high mortality in hyperinfection syndrome this case series did not record any mortality.

Disclosure

The authors have nothing to disclose

Introduction

Sarcopenia is associated with increased morbidity and mortality in IBD. The main objective of thisstudy was to prospectively evaluate sarcopenia by combining morphological and functional criteria inan outpatient IBD population.

Aims & Methods

In a prospective cohort study, we included all IBD patients admitted to the Day Hospital (DH) of ourdepartment between March 1st and 31st, 2023. Patients with short bowel syndrome were notincluded. Muscle mass was assessed using a Bodystat®1500MDD dual-frequency impedance meter,and muscle function was assessed by measuring handgrip strength, Carym® digital dynamometer. Pre-sarcopenia was defined by a handgrip measurement < 16 to 26, and myopenia was defined by anappendicular muscle mass index (AMMI) < 5.5 to 7 kg/m2 or a fat-free mass index (FFMI) < 15 to 17 inwomen or men. Sarcopenia was defined by the association of pre-sarcopenia and myopenia. Patientswere followed-up at 6 months to measure a composite criterion of disease activity combining one ofthe factors: FC > 250μg/g, endoscopic activity, therapeutic change, hospitalization, or IBD-relatedsurgery

Results

In total, 60 patients were included, median age 37 years (IQR 28-54), 55% women, with CD (52%) orUC (48%) diagnosed 9 years (4-17) ago, mostly in remission (67%, n=40). Patients with CD had ileocolic(48%), ileal (35%), or colonic (16%) involvement. Patients with UC had E1 (7%), E2 (41%), or E3 (52%)involvement. A history of digestive surgery linked to IBD was noted in 30% of cases. The biologicsadministered were infliximab (61%),vedolizumab (25%), or ustekinumab (14%). The BMI was 24 (21-27) and serum albumin was 41g/l (39-44). The prevalence of sarcopenia, pre-sarcopenia and myopeniawas 10%, 11% and 20%, respectively. Sarcopenic patients were significantly older (59 vs. 36 years,p=0.01), with older disease (20 vs. 8 years, p=0.003), and associated joint damage (40% vs. 2%,p=0.002) and tended to involve CD more frequently (80 vs. 49%, p=0.36). There was no significantdifference between biologics, BMI or albuminemia in sarcopenic patients, but vitamin D levels tendedto be lower (15 vs. 43, p=0.27). Myopenia was significantly associated with a history of surgery (67 vs.21%, p=0.004), a lower BMI (21 vs. 24, p=0.001) and a more active disease at M6 according to thecomposite criterion (50 vs. 21%, p=0.04 after adjustment for age, sex, and disease activity at baseline).Myopenia indices were strongly correlated with handgrip values(r=0.7, p<0.001)

Conclusion

In a prospective study of Day Hospital IBD patients, sarcopenia was identified by impedancemetry in11% and myopenia in 20% of cases, and associated with an increase in morbidity

Disclosure

No conflict of interest