Introduction

This study assessed typical symptoms (abdominal pain, bloating, diarrhoea, nausea, tiredness) in patients with celiac disease (CeD) following a gluten-free diet (GFD) and evaluated the association between symptom severity and quality of life (QoL) to address limited data in this area.

Aims & Methods

In the Virtual Celiac Symptoms Study (NCT05309330), patients reported daily symptoms using the Celiac Disease Symptom Diary 2.1^© (CDSD 2.1^©) over 12 weeks and completed patient-reported outcome measures (PROMs), with 7-day look-back, at specified timepoints, including the Impact of Celiac Disease Symptoms Questionnaire (ICDSQ) and the Patient Global Impression of Severity (PGI-S) measure. Spearman’s correlation coefficient (SCC) and generalized linear regression evaluated associations between symptom severity and QoL PROM scores and mean differences were adjusted for key demographics.

Results

In total, 480 participants completed the study (mean [standard deviation] age: 31 [15] years, 81.7% female, 93.8% White). For all CeD symptoms measured, there was a positive linear association between CDSD 2.1^© symptom severity and PROM scores (p <0.001). The SCC between symptom severity and PROMs was 0.45–0.62 (PGI-S) and 0.33–0.56 (ICDSQ). The strongest correlations between gastrointestinal symptom severity (abdominal pain, bloating, diarrhoea, and nausea) and PROMs were between PGI-S score and abdominal pain (SCC: 0.62) and bloating (SCC: 0.59). Patients with severe/very severe abdominal pain versus none had mean (95% confidence interval [CI]) 63.1% (53.2–73.6) and 217.5% (165.1–280.2) greater PGI-S and ICDSQ scores, respectively.

Conclusion

The results indicate that higher symptom severity is strongly associated with worse QoL in patients with CeD following a GFD and that CDSD 2.1^© assesses patient-relevant symptom severity in CeD.

Disclosure

MA, NC, DAL, SG and RS are employees and shareholders of Takeda. LMM was an employee of Takeda at the time of the study. JRM and SS are employees of Analysis Group, Inc., which received research support from Takeda Development Center Americas, Inc. DA has served as a consultant for Takeda Pharmaceuticals and Ironwood Pharmaceuticals. MG is an employee of the Celiac Disease Foundation, which received financial support from Takeda Development Center Americas, Inc. EL serves as a consultant for Takeda Pharmaceuticals and is an author for UpToDate (celiac section) for which he receives royalties.

Introduction

Diet is an essential regulator of brain function, evidenced by longstanding associations between nutrient intake and neuronal function, synaptic plasticity, and neurotransmitter release. Recent studies have suggested that diet may impact mental health and cognition and even convey susceptibility to neurogenerative disease. However, there is little related neuroimaging evidence to date.

Aims & Methods

Our aim was to delineate the association between diet, brain structure and function. We studied 518 healthy participants from the Cambridge Centre for Aging and Neuroscience (CAM-Can) repository (261 male and 257 female, mean age 53 ± .79 years). Participants were clustered via their self-reported dietary intakes using K-means clustering. Resting-state functional, white matter tractography, and grey matter volumetry networks conditional to dietary cluster were analysed using network-based statistics, controlling for participant age and sex as nuisance covariates. Relevant clinical data comprising BMI and Hospital Anxiety and Depression Score (HADS) were compared between diet clusters using Welch’s t-test.

Results

Four distinct dietary intake patterns were identified: balanced, meat-predominant, vegetarian, and raw vegetable-predominant diets. Specific dietary types – balanced, meat-predominant and vegetarian – were associated with increased functional, grey matter or white matter connectivity between regions comprising the bilateral insula, frontomedial cortex (FMC) and bilateral anterior cingulate cortex (ACC) (p<0.04). A balanced diet was associated with significantly increased functional, structural, and white matter connectivity between frontal brain regions, including the orbitofrontal cortex (OFC), superior frontal gyri (SFG), and FMC (p=0.04) when compared to other diet clusters. A balanced diet was associated with a significantly reduced depression score (HADS-D) (p=0.03), compared to a meat-predominant one. The meat-predominant diet cluster was correlated with increased structural connectivity at the bilateral ACC (p=0.03) and significantly increased BMI (p=0.01), when compared to vegetarian diets.

Conclusion

In the largest study of its kind, we reveal the structural and functional connectomic brain associations of diet. Notably, the set of brain regions implicated have broader established roles across interoception, emotion, memory, reward and addiction. Our findings imply a possible physiological correlate for diet-induced changes in behaviour, weight, mood, and cognition previously observed in the literature, and pave the way for future research.

References

1.Zhang R, Zhang B, Shen C, Sahakian BJ, Li Z, Zhang W, et al. Associations of dietary patterns with brain health from behavioral, neuroimaging, biochemical and genetic analyses. Nat Ment Health. 2024 Apr 1;1–18.
2.Gaynor AM, Varangis E, Song S, Gazes Y, Noofoory D, Babukutty RS, et al. Diet moderates the effect of resting state functional connectivity on cognitive function. Sci Rep. 2022 Sep 27;12(1):16080.
3.Jensen DEA, Leoni V, Klein-Flügge MC, Ebmeier KP, Suri S. Associations of dietary markers with brain volume and connectivity: A systematic review of MRI studies. Ageing Res Rev. 2021 Sep 1;70:101360.
4.Rolls ET, Feng R, Cheng W, Feng J. Orbitofrontal cortex connectivity is associated with food reward and body weight in humans. Soc Cogn Affect Neurosci. 2023 Jan 1;18(1):nsab083.
5.Tan HE, Sisti AC, Jin H, Vignovich M, Villavicencio M, Tsang KS, et al. The gut–brain axis mediates sugar preference. Nature. 2020 Apr;580(7804):511–6.
6.Rolls ET. Functions of the anterior insula in taste, autonomic, and related functions. Brain Cogn. 2016 Dec 1;110:4–19.
7.Frank S, Kullmann S, Veit R. Food related processes in the insular cortex. Front Hum Neurosci. 2013 Aug 23;7:499.

Disclosure

No conflicts of interest.

Introduction

There is a close relationship between the rise in obesity and the increase in consumption of sugar-sweetened beverages. According to a report by the World Health Organization (WHO), about 18% of children and adolescents worldwide are affected by overweight or obesity. Sweet beverage consumption is particularly high in this age group. The WHO recommends reducing sugar intake to prevent and treat obesity. Reduction of sugar intake can be achieved through partial substitution with alternative sweeteners. Erythritol is a naturally occurring non-caloric bulk sweetener. Unlike sugar, erythritol does not affect plasma glucose and insulin concentrations yet stimulates the release of gastrointestinal satiation hormones.

Aims & Methods

This study aimed to evaluate the impact of daily erythritol versus sucrose intake over 5 weeks on parameters of glycemic control, food intake and gastrointestinal symptoms in healthy adolescents.
In this randomized, double-blind, parallel trial, 30 healthy, lean adolescents (15 per group: mean ± SD; age: 16.9 ± 1.5 years; BMI: 20.9 ± 1.8 kg/m²) were included. For a duration of 5 weeks, they received a daily total of 36 g of erythritol (divided into two portions of 18 g in 150 mL tap water; ERY), or 25 g of sucrose (divided into two portions of 12.5 g in 150 mL tap water; SUC). During the week before and the last week of intervention, food intake was assessed by food records. Before and after the intervention period, an oral glucose tolerance test was carried out and blood samples were collected at fixed time points to measure plasma glucose and insulin. Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and Homeostatic Model Assessment of Insulin Sensitivity (HOMA-%S)) were calculated. The Gastrointestinal Symptom Rating Scale (GSRS) was applied to assess gastrointestinal symptoms at 3 timepoints (before, during week 3, and after the intervention).

Results

In the erythritol-group, parameters of glycemic control were not significantly different in response to the intervention. In the sucrose-group Cmax for blood glucose was not significantly different but Cmax for blood insulin (PRE_SUC: 91.67 ± 33.71 mIU/L vs. POST_SUC: 127.38 ± 68.24 mIU/L; p = 0.030) and HOMA-IR (PRE_SUC: 1.79 ± 0.74 vs. POST_SUC: 2.51 ± 0.74; p < 0.001) were significantly increased, while HOMA-%S (PRE_SUC: 70.5 ± 47.3 vs. POST_SUC: 43.2 ± 12.5; p = 0.016) was significantly reduced after the intervention period. In the erythritol-group, total sugar intake (PRE_ERY: 90.3 ± 34.0 g vs. POST_ERY: 71.0 ± 36.0 g; p = 0.034) and total carbohydrate intake (PRE_ERY: 256.8 ± 54.8 g vs. POST_ERY: 211.1 ± 71.0 g; p = 0.038) were significantly reduced after the intervention period, while total caloric intake (PRE_ERY: 2113.7 ± 495.4 kcal vs. POST_ERY: 1855.1 ± 495.7 kcal; p = 0.068) showed a trend of reduction. In the sucrose-group, total sugar intake (PRE_SUC: 75.4 ± 31.2 g vs. POST_SUC: 92.4 ± 24.7 g; p = 0.073) showed a trend of increase after the intervention period, while total carbohydrate and total caloric intakes were not significantly different. The total score of GSRS was not significantly different between the groups but increased significantly over time in both groups (p = 0.045).

Conclusion

Daily erythritol intake in healthy, lean adolescents over 5 weeks did not affect parameters of glycemic control but led to a significant reduction of total carbohydrate and total sugar intake. In contrast, the sucrose intervention resulted in a significant increase in maximum insulin concentration and HOMA-IR, along with a significant decrease in HOMA-%S.

Introduction

The only effective treatment for celiac disease (CD) is lifelong compliance with a gluten-free diet. Lactobacilli and Bifidobacterium spp. may play a role in the breakdown of gluten. Ithas been demonstrated that Lactobacilli can detoxify gliadin peptides after partial digestion by human proteases. These findings could suggest the use of probiotics as complementary therapy for CD.

Aims & Methods

We designed a study to determine the potential effect of a combination of Lactobacillus (acidophilus HA-122, casei HA-108) and Bifidobacterium bifidum HA-132 on perception of symptoms and on the inflammatory-immunological markers in patients with active CD.
25 adult patients were randomized to receive bid of a probiotic combination of Lactobacilus and Biffidobacter for six weeks (13 pts) va a placebo group (12 pts) while being on gluten-free diet. Laboratory studies included routine blood tests, CD specific antibodies, determination of IL-1b, IL-6 and TNF-alpha. CD serology and duodenal histology were performed at baseline, at the end of treatment and at 30 days after therapy. Histological damage in intestinal biopsy samples was graded according to the Marsh modified classification. At baseline and follow-up visit, patients completed the Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. Histological damage in intestinal biopsy samples was graded according to the Marsh modified classification.

Results

25 pacients, 13 in the probiotic associated arm, 12 in the placebo arm, with median age of 40, BMI 21.2, 18 with symptomatic CD (equal distribuited) and 7 with sublinical CD (4 in the probiotic arm, 9 in the placebo arm). Baseline serology: IGA tTG 1986.6 (group A) vs 1507.1 (placebo group). Baseline hystology (Marsh classification)- Marsh 3a 1 pacient in probiotic group, 2 in the placebo arm. 5 pts Mars 3b3 in group A and 2 in the placebo arm and 17 pts Marsh 3c (9 pts probiotic, 8 pts placebo). IELs density (mean range) was 44.5 in the first group vs 42.5
After treatment: clinical aleviation of indigestion and diareea (p=0.002), constipation (p=0. 0396), gastro-esophageal reflux (p=0.0493) and abdominal pain (p=0.0378)-superior in the probiotic associated treatment.
Serologic parameters: IgA tTG 0,96 in the probiotic arm vs 1,16 in the placebo (p=0.048), IgA EMA 1,05 vs 0,97 (p=0.028), IgG DGP 0,91 vs 1,12 (p=0.21).
Improvement of the inflamatory status: decrease of IL-1b, IL 6 and TNF-a was superior in the probiotic associated group (p=0.071, p=0.083, p=0.078).
Regarding the histologic response: IELs 0,83 vs 1.07 in the placebo arm (p=0.049).

Conclusion

Tests and the lymphocyte infiltrates in the mucosal biopsy specimen in uur study suggests that prebiotic/probiotic treatment may improve symptoms and serology in celiac disease.

Disclosure

I don t have any conflict of interest to declare

Introduction

Since the global emergence of the COVID-19 pandemic in Spring 2020, numerous bariatric units worldwide have indefinitely postponed elective weight loss procedures, responding to the heightened risk profile associated with obesity during viral infections. Concomitantly, lockdown measures have led to significant lifestyle changes, notably reductions in physical activity and increases in food consumption, collectively contributing to weight gain in various populations. Intragastric balloons, recognized as effective means for initiating weight loss or serving as an interim solution before bariatric surgery, require upper endoscopy for insertion and removal. These procedures have faced significant disruptions due to the pandemic-driven reallocation of medical resources, including anesthesiologists and endoscopic services.

Aims & Methods

This study aims to evaluate the feasibility and safety of employing the Allurion Elipse® gastric balloon, an innovative device designed for administration without anesthesia or endoscopic guidance. This device could potentially reduce patient risk and conserve valuable hospital resources in times of medical crisis. A selected group of obese patients, as determined by our multidisciplinary bariatric team, were administered an encapsulated pill balloon, which, once ingested, expands with 550mL of fluid under the direct supervision of a gastroenterologist. Placement accuracy was confirmed through X-ray imaging. Alongside the physical intervention, patients received comprehensive support, including a customized diet plan, access to a digital health application connected to a weighing scale for remote monitoring, and regular virtual follow-ups. The primary measure of clinical efficacy was the percentage of total body weight loss (%TBWL).

Results

The study included seventeen consecutive patients (11 females, 6 males) with a mean age of 43.7 ± 9.9 years. These individuals had a mean weight of 104.21 ± 21.72 kilograms and a mean BMI of 36.11 ± 4.7 kg/m2. The balloon positioning procedures were efficiently completed in 20 to 30 minutes without technical complications. Most patients reported transient nausea and vomiting. However, these symptoms were manageable and did not lead to any severe adverse events. Only one patient required early balloon removal due to intolerance. After eight months of the procedure, with the balloon passing naturally four months prior, two patients reported a %TBWL of 19.8. The average %TBWL recorded at the four-month mark was 13%, and the weekly check-in compliance rate was 62%.

Conclusion

The COVID-19 pandemic has drastically impacted the availability and functionality of bariatric and endoscopic services, prompting the need for alternative methods that simplify and expedite the weight loss process. Although limited, the available data support the Allurion Program with the Elipse Balloon as a non-invasive, secure, and effective method to manage obesity. It facilitates rapid and sustainable weight loss, enables continuous remote support, and minimizes the impact on patients and the already strained health systems. This method represents a valuable alternative to traditional approaches, particularly during healthcare resource constraints.

References

Tønnesen CJ, et al. A novel intragastric balloon for treatment of obesity and type 2 diabetes. A two-center pilot trial. Scand J Gastroenterol. 2022
Mauro A., et al. A Comprehensive Review on Bariatric Endoscopy: Where We Are Now and Where We Are Going. Medicina (Kaunas). 2023
Navarra, G, et al. Bariatric surgery and the COVID-19 pandemic: SICOB recommendations on how to perform surgery during the outbreak and when to resume the activities in phase 2 of lockdown. Updates Surg. 2020
Vargas EJ, et al. Single Fluid-Filled Intragastric Balloon Safe and Effective for Inducing Weight Loss in a Real-World Population. Clin Gastroenterol Hepatol. 2018
Kumar N, et al. The Influence of the Orbera Intragastric Balloon Filling Volumes on Weight Loss, Tolerability, and Adverse Events: a Systematic Review and Meta-Analysis. Obes Surg. 2017

Introduction

Malabsorption syndrome encompasses a spectrum of gastrointestinal disorders characterized by impaired absorption of nutrients, leading to various clinical manifestations. Endoscopic and histological evaluations play crucial roles in diagnosing underlying etiologies, including celiac disease.

Aims & Methods

This retrospective study aimed to analyze the clinical presentation, endoscopic findings, and histological yield in patients with malabsorption syndrome, focusing on the subset exhibiting villous atrophy to investigate the prevalence of celiac disease. We conducted a retrospective analysis of 100 patients with malabsorption syndrome who underwent endoscopic evaluation between January 1, 2023, and December 31, 2023. Clinical data, endoscopic findings, and histological results were collected and analyzed.

Results

Among the 100 patients, 60 were males and 40 were females. Common presenting symptoms included fatigue (33 patients), recurrent mouth ulcers (15 patients), bloating (12 patients), diarrhea (24 patients), and abdominal discomfort (16 patients). Endoscopic findings revealed normal mucosa in 34 patients, decreased height of duodenal folds in 24, and fissured mucosa in 42. Histological analysis showed increased intraepithelial lymphocytes in 36 patients, crypt hyperplasia with increased intraepithelial lymphocytes in 20, partial villous atrophy in 22, subtotal villous atrophy in 12, and total villous atrophy in 10 patients. Giardia was detected in histological specimens from 4 patients with partial villous atrophy. Interestingly, only 12 patients had positive celiac serology despite a substantial number exhibiting villous atrophy on histological examination.

Conclusion