Introduction

Eosinophilic esophagitis is a chronic, immune-mediated inflammatory disease of esophagus characterized by a significant mucosal eosinophilia. However, the definite cause of this disease remains unknown. One of the most probable etiology factors is an abnormal response of immune system to various types of ingested food. Therefore, one of the treatment options is the so called 6-food elimination diet. This diet represents a therapeutic method of choice especially in patients who could not be treated by standard immunosuppressive medications such as corticosteroids. The 6 food groups that are mostly associated with food allergies are: eggs, dairy products, seafood/shellfish, nuts, wheat, and soy. Although widely used, there is surprisingly lack of data evaluating its effect on metabolomic profile of the patients and their well-being despite its strict dietary regime.

Aims & Methods

The aim of this study was to evaluate possible changes in metabolomic and anthropometric parameters in healthy individuals pre and after 4 weeks of elimination diet.
We performed a prospective single center study on healthy volunteers (age >18 years). For metabolomic analysis of blood plasma and urine the method of NMR (Nuclear Magnetic Resonance) was used. Anthropometric analysis was performed by bioelectrical impedance. All volunteers also filled validated questionnaires considering various aspects of patient well-being (WHOQOL-BREF, PROMIS-10 and PHQ-15). The statistical analysis was processed by unparametric tests (Mann-Whitney U-test) for comparison of equality of medians and unparametric paired Wilcoxon-signed-rank test.

Results

Fifteen (15) healthy volunteers without any previous dietary restrictions participated in this study (12 women with median age 35,5 years and 3 men with median age 41 years). Evaluation of blood plasma metabolomic profile shows significant increase of acetate, succinate, creatine, and creatinine at the end of the four weeks period of the course of the diet. The urine metabolomic profile shows significant decrease of dimethylamine. Importantly, no statistically significant changes were observed in the levels of essential aminoacids. No relevant differences were observed considering anthropometric parameters (BMI, percentage of fat and muscle mass) and in the questionnaires assessing quality of life.

Conclusion

The results of presented study shows that the 6-food elimination diet have only minor effect on the metabolomic profile of healthy volunteers. This further suggest its good safety profile for the treatment of eosinophilic esophagitis. In addition, presented data point out that this diet does not significantly lower the quality of life of patients which could result to good adherence to the diet in short term course.

Introduction

Gastroparesis (GP) is defined as symptomatic delayed gastric emptying. The most frequent etiologies are diabetes mellitus, after esophageal or gastric surgery and about a third of patients have idiopathic GP. The gastric emptying study by using a scintigraphy scintigraphy (GES) is considered as a principal diagnostic method. Endoscopic pyloromyotomy (G-POEM) is a method improving symptoms in about 60-70% of patients with GP. Its effect on gastric emptying remains controversial.

Aims & Methods

We performed a retrospective single-center analysis to assess the clinical efficicacy of G-POEM based on GES parameters. Between 2016 – 2024, a total of 72 patients with GP (confirmed by scintigraphy) underwent G-POEM and were later invited for clinical as well as scintigraphic assessment after 3, 12 and 36 months. Of these patients, 4 were excluded for missing data, incomplete follow-up data or non-standard testing meal. GES was always performed using the standardized 4 hours protocol with the standard testing meal mixed with 99Tc-DTPA. For this study, all GES were reanalyzed and the following parameters were established : residual activity after 2 hours, residual activity after 4 hours, biological halftimes of ingested activity and proximal-to-distal count ratio for time 0 (PDCR0).

Results

Mean value of GCSI before G-POEM was 3.1 and decreased to 1.6, 1.0 and 0.7 after 3, 12 and 36 months. Median value of GES after 2 hours was 60.2% before G-POEM and 38%, 32.6% and 24.2% after 3, 12 and 36 months. Median value of GES after 4 hours was 21.9% before G-POEM and 7.8%, 6.5% and 3.9% after 3, 12 and 36 months. Correlation index was weakly positive for GCSI and GES after 4 hours only for the first follow-up visit and negative for all remaining visits.
The residual activity after 2 hours and residual activity after 4 hours decreased after G-POEM during all follow-up visits (p<0,001). Mean decrease of residual activity after 4 hours was 12.89%, 15.13% and 6.7% after 3, 12 and 36 months.
Biological halftime also decreased after the procedure with statistically significant results with the mean halftime before G-POEM being 150 min and 86 min, 78.4 min and 65.8 min after 3, 12 and 36 months.
There was a difference between the diabetic and non-diabetic groups, with higher residual activity after 2 hours [median 29.6% before G-POEM, 9.0% after 3 months (p<0.001) and 11.0% after 12 months (p=0.005)] and 4 hours [median 64.8% before G-POEM, 39.4% after 3 months (p<0.001) and 37.7% after 12 months (p=0.012)] respectively in patients with diabetes.
The predictive value of PDCR0 for treatment success after G-POEM was only calculated for the first follow-up visit but was not statistically proved (p=0,712).

Conclusion

In our group of patients there is a weak correlation between the decrease of GCSI and GES early after G-POEM. The decrease in GES parameters tends to be lower in patients with diabetes compared to non-diabetic patients. Based on our data, predicting clinical success of G-POEM using PDCR0 cannot be recommended.

Introduction

Despite being a frequent step in clinical practice, there is little real world evidence supporting the benefit of optimizing mesalamine in ulcerative colitis (UC) patients who have a mild to moderate flare. The aim of this study was to assess the role of optimizing 5-ASA in patients in clinical remission (CR) who suffer clinical relapse.

Aims & Methods

Patients in CR who developed a mild to moderate flare treated with 5-ASA optimization from 2015 to 2023 were included. Patients under immunosuppression were excluded, as well as flares treated with oral or topical corticosteroids (CS). The primary outcome was corticosteroid-free clinical remission (CFCR) at six months. Secondary outcomes were need for CS at six months and deep remission (DR) defined as fecal calprotectin <250 ug/g or Mayo endoscopic score of 0.

Results

From 908 UC patients screened, 116 flares met the inclusion criteria. The average disease duration was 9.1±7.0 years. The majority were under oral therapy (91%), 6% topical therapy and the remainder combined therapy. Most flares were mild (81.9%). Optimization of 5-ASA recaptured CR in 72.4% and 37.1% of those were in DR at six months. Around 15% required CS at six months. The absence of a flare in the previous year (OR 13.5; p<0.01) and lower PRO-2 score (OR 2.07; p=0.020) were identified as predictive factors for CFCR at six months, as well as both DR and need for CS at six months. Non-extensive UC (E1/E2) was also a predictive factor for DR and need for CS at six months (p<0.05). The type or formulation of 5-ASA (granules vs tablet), pre-flare or optimized 5-ASA dose were not associated with primary or secondary outcomes.

Conclusion

Optimizing 5-ASA therapy recaptured CR in a significant number of patients. Those with extensive UC, previous flares and with higher symptom burden should be closely monitored.

Disclosure

The authors declare that there are no conflicts of interest related to this study.