Introduction

The direct link between nutritional status and lung function, and survival in cystic fibrosis (CF) is unambiguous, so diet therapy for this disease is an important part of the treatment.

Aims & Methods

To study the influence of colostrum supplements in CF based on the evaluation of symptoms and values of antimicrobial peptides and proinflammatory cytokines.
A total of 56 children aged from 2 months to 3 years with cystic fibrosis were included. To make a diagnosis of CF we used determination of immunoreactive trypsin, sweat chlorides and genetic studies. Fecal calprotectin, fecal β-defensin 2 levels, as well as Il-1β values and antibody concentrations to cell permeability-increasing protein in serum were determined in patients. Colostrum was included in addition to basic therapy. The exclusion criteria were children with allergies to cow's milk protein, which made up 16 children. Colostrum was administered to 22 children according to the age dosages: up to 1 year -0.25 ml * 3 times a day, from 1 to 3 years - 0.5 ml * 3 times, 3-12 years - 1 ml * 3 times. The duration of use was 3 months. The control group consisted of 18 children on basic therapy.

Results

The cough with a discharge of viscous sputum which was observed in 36 children (90.0%) on admission to the hospital, remained in every fourth child after the basic therapy - 5 (27,7%, p<0.002). We registered a sixfold reduction of the number of patients with cough and viscous sputum - 3(13,6%, р<0.001) with modified therapy.
On the basic therapy protein-energy deficiency of a severe degree (-3SD) persisted in every fifth child - 4 (22,2%), moderate degree of protein-energy deficiency - in half of all patients - 9 (50%). On the modified therapy, the number of patients with protein-energy deficiency increased due to -2CO (27.7%) and -1CO (59.1%), while none of the patients had severe protein-energy deficiency.
After basic therapy, fatty stool was detected in 5 (27,8%, p<0.001), then in children of the second group this index reliably decreased by 7.3 times compared to the condition before admission (13.6%, p<0.001). In the first group children with polyfecalia recorded in 3 (16.7%, p<0.02 vs. admission), while in the second group the figure was 3.7 times less frequent (p<0.002).
The proinflammatory cytokine Il-1β had a fivefold excess at admission compared with control values. In the dynamics on the modified therapy the value of this index came to normal - 2,9+0,8 pg/ml, twofold excess was kept in the first group.
The level of antimicrobial peptides (fecal calprotectin and β-defensin) was significantly increased in comparison with reference values at admission. Fecal calprotectin decreased after 3 months on the basic therapy and was more pronounced in the group with modified therapy - 52,2±2,8 mcg/g, p<0,002, but they did not reach reference values, remaining three times higher than normal (p<0,001). A similar picture was observed in the estimation of β-defensin level. The most pronounced decrease (1,5 times) was observed in patients on the modified therapy - 72,1 ±3,6 ng/ml, p<0,001. Values in this group practically approached to the norm, which could not be said about the group with basic therapy (93,4±5,4 ng/ml, p<0,001).

Conclusion

The use of colostrum supplementation in the complex treatment of cystic fibrosis with basic therapy has a positive effect on the clinical course and reduces the activity of antimicrobial peptides and proinflammatory cytokines in children with cystic fibrosis.

Clinical Case Summary

A 78-year-old female with personal history of ischemic cardiomyopathy and atrial fibrillation was referred to a tertiary center due to iron deficiency anemia without clinical evidence of gastrointestinal bleeding. The patient required periodic erythrocyte transfusion and intravenous iron treatment. An upper and lower endoscopy was performed, yielding unremarkable findings.
In this context, the patient underwent capsule endoscopy which revealed an ileal polypoid ulcerated lesion close to a Meckel diverticulum. Subsequently, a double balloon retrograde enteroscopy was performed, with identification of a Meckel diverticulum without ulcers nor active bleeding. Furthermore, a 15-millimeter diameter polypoid lesion was also seen and removed using a diathermic snare after submucosa injection, clip and loop application. The histopathological report confirmed a pyogenic granuloma, also known as lobular capillary hemangioma. After lesion removal the patient experienced anemia resolution.
Pyogenic granuloma is a rare benign proliferation of capillary vessels, most commonly affecting the skin and oral mucosa, characterized by friable bright red papules. Nevertheless, gastrointestinal involvement can also occur. The high vascularization associated with these lesions justifies the presence of iron deficiency anemia due to gastrointestinal losses. This case highlights a rare small bowel pyogenic granuloma. Despite its association with iron deficiency anemia, the occurrence of a pyogenic granuloma in this context, particularly in the enteric mucosa, is uncommon. Nevertheless, recent studies suggest that this clinical entity may be underdiagnosed due to improper identification of inflammatory or hyperplastic polyps. Capsule endoscopy and device assisted enteroscopy were crucial in localizing and ensuring proper therapeutic management of this lesion, thereby solving the iron deficiency anemia.

References

1. Capsule endoscopy images with identification of the Meckel diverticulum and pyogenic granuloma
2. Device-assisted enteroscopy images with identification of the Meckel diverticulum and pyogenic granuloma
3. Histopathological sample of pyogenic granuloma

Introduction

Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD) is the most prevalent hepatic disorder worldwide. While histology remains the gold standard, a shift is evident in emerging studies favoring Magnetic Resonance Imaging Proton Density Fat Fraction (MRI-PDFF) over biopsy as a reliable alternative for steatosis assessment. Similarly, Controlled Attenuation Parameter (CAP) enables the noninvasive assessment of liver steatosis.

Aims & Methods

To assess the accuracy of CAP for MASLD diagnosis as defined by MRI-PDFF. We performed a cross-sectional, diagnostic accuracy study with prospectively collected data. We included consecutive adult participants with type 2 diabetes (T2D) and increased body mass index (BMI ≥25 kg/m²). We used receiver operating characteristic (ROC) curve analyses to assess the accuracy of CAP for diagnosing MASLD (MRI-PDFF ≥5%), and hepatic fat content (HFC) ≥10%. For each ROC analysis, we calculated the area under the ROC (AUROC) alongside 95% Confidence Intervals (CIs), and cutoffs for ruling out (sensitivity >90%) and ruling in (specificity >90%) the target condition. For each cutoff, we calculated the negative (NPV) and positive predictive values (PPV), as well as negative (LRn) and positive (LRp) likelihood ratios with their 95% CIs.

Results

We included 113 participants (58.4% males, mean age 59.6 years). Most participants (95.6%) had a BMI ≥30 kg/m². CAP measurements were performed with the M probe in 36.3% of the participants, and the remaining (63.7%) were scanned with the XL probe. MRI-PDFF values ranged from 1.9% to 37.8% covering the whole spectrum of steatosis. The prevalence of MASLD was 72.6%. The AUROC of CAP for MASLD diagnosis was 0.82 (0.74 to 0.89). The threshold for ruling out MASLD was 249 dB/m yielding a sensitivity (Sens) of 90.2% (81.7 to 95.7), specificity (Sp) 35.5% (19.2 to 54.6), LRp 1.40 (1.07 to 1.83), LRn 0.27 (0.12 to 0.62), PPV 78.7% (73.8 to 82.9) and NPV 57.9% (37.9 to 75.6). Similarly, the threshold for ruling in MASLD was 328 dB/m yielding a Sens, Sp, LRp, LRn, PPV and NPV of 47.6% (36.4 to 58.9), 90.3% (74.2 to 98.0), 4.91 (1.64 to 14.75) and 0.58 (0.46 to 0.74), 92.9% (81.2 to 97.5) and 39.4% (34.0 to 45.2), respectively. The AUROC of CAP for detecting HFC ≥10% was 0.81 (0.73 to 0.88). CAP thresholds for ruling out/in HFC ≥10% were 271 dB/m and 345 dB/m respectively. CAP measurements with IQR < 30 dB/ did not improve the accuracy of CAP for MASLD diagnosis

Conclusion

CAP has acceptable diagnostic accuracy in identifying patients with MRI-PDFF defined MASLD. Thresholds below 249 and 271 dB/m can be used to exclude MALSD and HFC ≥10% with adequate sensitivity. Similarly, CAP values over 328 and 345 dB/m can rule in MASLD and HFC ≥10% respectively.

Disclosure

This study was supported by the Hellenic Association for the Study and Education of Diabetes Mellitus

Introduction

Delayed bleeding (DB) is a possible adverse event following gastric endoscopic submucosal dissection (ESD). The Bleeding after ESD Trend from Japan (BEST-J) score was created as a risk prediction model for DB following gastric ESD, but is yet to be validated in non-Asiatic populations.

Aims & Methods

We aimed to apply and validate the BEST-J score on a European sample.
We have conducted a longitudinal study of all consecutive patients undergoing gastric ESD on a European Endoscopic Unit. DB was defined as a hemorrhage with clinical symptoms and confirmed by emergency endoscopy from the time of completion of ESD to 28 days after ESD.
BEST-J score (use of vitamin K antagonists +4, direct oral anticoagulants +4, aspirin or P2Y12R antagonists +2; withdrawing antithrombotic drugs -1; chronic kidney disease +3; multiple lesions +1; lesion ≥30mm +1; lesion in lower-third of the stomach +1) was calculated in each patient and confronted with the outcome (DB).

Results

Final sample included 161 patients, 102 (63.4%) male, with a mean age of 68±8 years. From these, 10 (6.2%) presented DB following ESD, with a median time to bleeding of 7 days (IQR 6.8).
According to BEST-J score, bleeding risk was low (0-1 points) in 111 (68.9%), intermediate (2 points) in 29 (18.0%), high (3-4 points) in 16 (9.9%) and very high (≥5 points) in 5 (3.1%) patients.
BEST-J score presented an excellent accuracy predicting DB in our sample, with an AUC=0.907 (95%CI=0.801-1.000; p<0.001). The optimal cut-off value to predict DB was a BEST-J score ≥3, which matches the cut-off value for high-risk of bleeding in the original investigation. This value had a sensitivity of 90% and specificity of 92%.

Conclusion

The BEST-J score still presents excellent accuracy in risk stratification for post-ESD bleeding in European individuals. Thus, this score may help to guide which patients benefit the most from prophylactic therapies following gastric ESD in this setting.