Introduction

Вasic anatomical and functional unit of the epithelial barrier of the small intestine is enterocyte, which plays a key role in assimilation processes nutrients. Therefore, understanding the processes of structure regeneration mucous membrane of the small intestine in celiac disease is of paramount importance meaning.

Aims & Methods

To study the effect of permeability markers (I-FABP of blood serum and fecal zonulin) in patients with celiac disease with atrophy of the mucous membrane of the small intestine.
151 patients with celiac disease was examined: the median (Me) age of those examined was 42 years (Q25-Q75: 30–56 years) (25 (16.6%) men; women - 126 (83.4%). Depending on adherence to AGD, patients were divided into 3 groups: Group I-newly diagnosed patients without AGD (n=58); Group II- patients who do not strictly adhere to AGD (n=38); Group III- patients carefully observing AGD for periods from 6 months to 15 years (n=55). Also serum Fatty-Acid-Binding Protein-I - 1-FABP and zonulin in feces were studied. The reference values for zonulin in feces were 83.15 ng/ml. Reference values for I-FABP determined in the control group are 845 pg/ml.

Results

A significant increase in the level of I-FABP (Me 2045 pg/ml (1690–2350)) in group I compared to the control group (p <0.01). High rates were observed in patients of group I, and averaged 111.6 ng/ml (103.1–124), which was significantly higher than in the control group (p <0.01). The highest levels of I-FABP were observed in patients with the most severe degree of atrophy (Marsh III (A-C)). The level of I-FABP was significantly different from the control depending on the degree of villous atrophy: with atrophy corresponding to Marsh IIIA - median: 1310 pg/ml, (1212-1461 pg/ml), with atrophy corresponding to Marsh IIIB - median: 2090 pg/ml ml, (1812-2322 pg/ml), and for atrophy corresponding to Marsh IIIC - median: 2058 pg/ml, (1858-2678 pg/ml). The highest levels of fecal zonulin were found in patients with the most severe atrophy (Marsh III (A-C)). As follows from the presented data, the level of zonulin was significantly different from the control depending on the degree of villous atrophy: with partial atrophy (Marsh IIIA) - median: 97.5 ng/ml, (90-105 ng/ml), with subtotal atrophy (Marsh IIIB) ) - median: 107 ng/ml, (96.5-117 ng/ml), and with total (Marsh IIIC) - median: 113.7 ng/ml, (104-128.8 ng/ml).

Conclusion

The average values of I-FABP and zonulin correlated with the degree of mucosa atrophy (p<0.01). Each of the studied non-invasive markers of intestinal permeability (serum I-FABP and fecal zonulin) reflects its own level and degree of damage to the STC in patients with celiac disease and can be used in clinical practice to assess ongoing structural changes in STC during a gluten-free diet.

Disclosure

The authors declare that there is no conflict of interest.

Introduction

Managing patients with severe irritable bowel syndrome (IBS) has significant challenges for practicing physicians due to the condition's refractoriness to standard therapy and the lack of clinical remission. The prevalence of IBS reaches 9–21% among the adult working population and is associated with a low quality of life. According to various sources, visceral hypersensitivity (VHS) plays a key role in the pathogenesis of IBS.

Aims & Methods

The aim is to show the relationship between clinical symptoms, the visceral sensitivity index, and the visceral sensitivity threshold in patients with severe IBS-D.
A total of 84 patients with severe IBS-D, according to the Rome IV criteria, were examined. The median (Me) patient age was 32 (25; 37.2) years, with a disease duration of 5 (4; 6) years. Pain syndrome was assessed using the VAS scale in points (pts.), the level of visceral sensitivity index (VSI) using the J. Labus questionnaire reflecting gastrointestinal anxiety (pts.), and the visceral sensitivity threshold (VST) was studied via balloon dilatation test (BDT) (ml). Statistical analysis was conducted using non-parametric methods (Statistica 12). Quantitative data were described using Me and interquartile ranges (Q1 – Q3). Differences were considered statistically significant at p < 0.05.

Results

Before treatment, all patients showed a high level of pain syndrome - 9 (8; 9) pts. on VAS, and level of gastrointestinal anxiety at 71.00 (63; 75) according to the J. Labus questionnaire. BDT data revealed a low VST (first threshold—urge to defecate): 34.00 (27; 43.5) mm Hg. After examination, patients were randomly divided into two equal groups. The first group received the SNRI antidepressant (duloxetine) 60 mg/day, while the second group received trimebutine maleate 600 mg/day for 8 weeks, followed by assessment of therapy effectiveness. In the first group, SNRI therapy showed positive dynamics: a decrease of pain levels (from 9 (9 - 10) to 2 (1.75 - 3), p < 0.01*), an increase in VST (from 34.0 (29.75, 45.0) to 92.0 (86.0, 123.0), p < 0.01*), and a reduction in gastrointestinal anxiety (from 56.50 (47.50 – 68.00) to 12.00 (10.00 – 19.25), p < 0.01*). No significant positive changes were achieved in the second group. After the treatment, the overall group showed an inverse correlation between abdominal pain (VAS) and VST (BDT data) (ρ = -0.772; p < 0.01), and between gastrointestinal anxiety (VSI by J. Labus) and VST (BDT data) (ρ = -0.782; p < 0.001).

Conclusion

The effectiveness of therapy in the first group of patients was associated with the severe course of IBS, characterized by high gastrointestinal anxiety, abdominal pain, and low VST. In the overall group, post-treatment correlation analysis revealed a connection between the severity of clinical presentation and VST levels (BDT). Balloon dilatation test allows an objective assessment of IBS severity and therapeutic effectiveness. The treatment of choice for severe IBS-D is the SNRI duloxetine, which acts on the pain center and patients' emotional status.

Introduction

Acute pancreatitis (AP) during pregnancy is a rare but potentially life-threatening condition for both mother and fetus. The most common cause is gallstone disease, followed by hypertriglyceridemia and, less frequently, alcohol use. The physiological changes of pregnancy can mask the clinical presentation, delaying diagnosis and intervention. This review aims to synthesize current evidence on the diagnosis, management, and maternal-fetal outcomes of AP in pregnancy, with special attention to the role and timing of cholecystectomy during an acute episode.

Aims & Methods

A comprehensive literature search was conducted using PubMed, Scopus, and the Cochrane Library for studies published between 2000 and 2024. Inclusion criteria involved clinical trials, cohort studies, systematic reviews, and relevant guidelines discussing AP in pregnancy and cholecystectomy

Results

​The majority of AP cases in pregnancy occur in the third trimester or early postpartum period. Gallstones account for 65–100% of cases. Conservative management remains the first-line approach, particularly in the first trimester. However, recurrence rates up to 70% with conservative therapy alone have prompted a reevaluation of surgical timing. Recent studies support the safety of cholecystectomy during the second trimester and even during stabilized mild to moderate AP. In the third trimester, ERCP with endoscopic biliary sphincterotomy is preferred, with cholecystectomy deferred postpartum. Multidisciplinary management has significantly improved maternal and neonatal outcomes in recent years.

Conclusion

Acute pancreatitis in pregnancy remains a rare but serious condition requiring timely diagnosis and multidisciplinary care. Recent innovations support the safety and efficacy of cholecystectomy laparascopyce during the second trimester and even in selected stabilized cases of mild acute pancreatitis. Personalized management strategies based on gestational age and disease severity, along with minimally invasive techniques like ERCP, offer improved maternal and fetal outcomes.
Laparascopi Colecystectomy prevens the recurrent acute pancreatitis and other complications billiaris.
No differenc in the intra and postoperative complications during and after pregnancy.

References

1. Forsmark CE, Vege SS, Wilcox CM. Acute pancreatitis. N Engl J Med. 2016;375(20):1972–81.
2. Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(9):1400–15.
3. Yokoe M, Takada T, Mayumi T, et al. Japanese guidelines for the management of acute pancreatitis: JPN Guidelines 2015. J Hepatobiliary Pancreat Sci. 2
4. Rosing DK, de Virgilio C. Early cholecystectomy for mild gallstone pancreatitis: time for a paradigm shift
   

Disclosure

Taibe Haziri
*University Clinical Center University of Kosovo*

Introduction

​Pancreatic fibrosis (PF), a pathological hallmark of chronic pancreatitis, serves as a critical mediator in the progression of numerous pancreatic disorders. Early identification of fibrotic changes presents a strategic opportunity to intervene in disease pathways, potentially curbing the advancement of pancreatic pathologies. It makes research of non-invasive radiological PF assessment perspective.

Aims & Methods

Aim of our study was to evaluate the possibility of multidetector computed tomography (MDCT) post-processing parameters in PF grade assessment.
Methods. Results of contrast-enhanced 128-row MDCT from 165 patients (mean age 57.9±13.5) who underwent surgery from April 2022 to February 2024 due to pancreatic tumors and advanced chronic pancreatitis were analyzed. We calculated contrast enhancement ratio (CR) between venous phase (VP) and non-contrast MDCT, and normalized CR (NCR) during the pancreatic phase (PP) and VP, also we measured pancreas attenuation during MDCT examination. PF morphological grade was assessed according to Klöppel & Maillet’s scoring system [1] and scaled into three grades: mild, moderate and severe PF.
This study was conducted within the healthcare research project “Assessment of pancreatic fibrosis as a prognostic factor for its diseases course” funded by Autonomous non-profit organization "Moscow Center for Innovative Technologies in Healthcare" administered by the Moscow Healthcare Department.

Results

The values of post-processing CT results were compared in groups with different degrees of PF. Mean CR were significantly higher (p=0.001) in patients with severe PF (CR 1.16±0.65 HU) than in patients with mild PF (CR 0.78±0.31 HU). CR significant increase (p=0.03) was found in patients with signs of inflammatory changes in the pancreas tissue (CR 1.14±0.6 HU) than in those without them (CR 0.81±0.3 HU). There were no significant differences between the NCRPP and NCRVP, and the degree of PF, which we had shown in publications of our preliminary results. We suppose the main reason of this fact is study groups enlargement as well as measurement technique improvement, led to results clarification.

Conclusion

The CR value increased in patients with severe degree of PF and decreased in patients with mild PF. Also, there was a significant relation between CR increase and presence of early signs of pancreatic inflammatory changes. Thus, there was a relationship between MDCT postprocessing results and morphological signs of PF, which can be used for pancreatic fibrosis non-invasive diagnosis and identification of additional signs of early chronic pancreatitis.

References

1. Esposito I, Hruban RH, Verbeke C, et al. Guidelines on the histopathology of chronic pancreatitis. Recommendations from the working group for the international consensus guidelines for chronic pancreatitis in collaboration with the International Association of Pancreatology, the American Pancreatic Association, the Japan Pancreas Society, and the European Pancreatic Club. Pancreatology. 2020;20(4):586-593. doi:10.1016/j.pan.2020.04.009

Clinical Case Summary

Aims: We report 3 cases of new inflammatory bowel disease (IBD) which occurred in multiple sclerosis (MS) patients undergoing ocrelizumab therapy over last year in Irish Teaching Hospital setting.
Background: Ocrelizumab, a monoclonal antibody targeting CD20-positive B cells, is an established treatment for MS. While it is generally well-tolerated, emerging reports suggest a possible link to gastrointestinal complications, including IBD.
Methods: Three MS patients presented after starting ocrelizumab with gastrointestinal symptoms suggestive of inflammatory bowel disease. They were fast-tracked for endoscopic evaluation by an experienced gastroenterologist specializing in IBD. Diagnosis was based on clinical presentation, endoscopic findings, and histological analysis. Data regarding symptom onset, disease severity, colitis grade, inflammation distribution, and treatment response were assessed.
Results: A temporal relationship was observed between ocrelizumab initiation and IBD onset in all three cases, with symptoms emerging after 4-6 infusions. Reported symptoms included diarrhoea, nausea, urgency, and abdominal pain. Faecal calprotectin levels at time of referral ranged from 900 to 1800 µg/g. Endoscopy confirmed mild colitis and terminal ileitis, while histology revealed active colitis with cryptitis, acute terminal ileitis, or normal colon findings. Treatment with steroids, Mesalazine, and antibiotics led to symptom resolution in all cases. Discontinuing ocrelizumab resulted in recovery within 4-6 weeks, with no relapse over an average follow-up of two months.
Conclusion: These cases suggest a potential association between ocrelizumab and IBD onset or exacerbation in MS patients. Symptom resolution upon drug withdrawal supports a possible causal relationship. Clinicians should be aware of this risk to facilitate early detection, management, and patient education.

References

https://journals.lww.com/acgcr/Fulltext/2022/01000/Severe_Ocrelizumab_Induced_Enterocolitis_Treated.31.aspx
https://pubmed.ncbi.nlm.nih.gov/32198886/

Disclosure

No Conflict of Interest

Introduction

Pancreatic pseudocyst (PPC) is a well defined local complication of pancreatitis. It has been reported in 8-41% of patients with history of pancreatitis in children¹. In past, surgical technique was treatment of choice for PPC drainage², however with advancements in endoscopic interventions, endoscopic ultrasound (EUS) guided PPC drainage is preferred in present era. Limited literature is available for EUS guided PPC drainage in pediatrics, owing to structure of echo-endoscope due to its rigid tip³, need of anesthesia and endoscopic skills. This study is one of the largest retrospective data⁴ in which we have shared experience of last 10 years for EUS guided PPC drainage from a tertiary care center of Pakistan.

Aims & Methods

This study aimed to evaluate the safety of EUS-guided PPC drainage in a large paediatric cohort (≤18 years) in Karachi, Pakistan, and assess technical and clinical success.
We retrospectively reviewed the charts of patients ≤18 years who underwent EUS-guided PPC drainage from 2015 to 2024 at the Sindh Institute of Advanced Gastroenterology, a tertiary care centre in Karachi, Pakistan. Data collected include patient demographics, aetiology of pancreatitis, PPC characteristics, procedural details, and outcomes. Technical success was defined as successful stent placement across the cyst gastrostomy. Clinical success included PPC resolution and symptom improvement.

Results

28 patients were referred for EUS-guided PPC drainage, 7 patients had no symptoms when presented, so 21 patients underwent EUS-guided PPC drainage. All patients were given general anesthesia by a pediatric anesthetist, and the airway was secured by endotracheal intubation to avoid the risk of aspiration. out of 21 patients,11 were male, with ages ranging from 6 to 18 years (Mean age 14.00± 3.25 years). 11 patients underwent EUS-guided complete aspiration of pseudocyst, with average pseudocyst size of 4.27 X3.93 cm, ranged from 2X1.2cm to 6.7 x5.6 cm. 10 patients underwent EUS-guided pseudocyst drainage via stent placement. The average size of PPC in this group was 8.39 X 8.02 cm, ranged from 6 X5 cm to 14X10cm. 8 pseudocysts were located along the pancreatic body region, 8 were located along the head and neck, and 5 were located near the tail region. Two Double pig tail plastic stents (DPPS) of 7fr 4cm were placed in 9 patients and 7fr 6cm in one patient transmurally into the cyst-gastrostomy tract, whereas LAMS hot axios 10x20 mm was placed in one patient only. One of the patients had a recurrence of pseudocyst with symptoms after 3 months, hence needing repeat pseudocyst drainage. One patient had displacement of DPPS. None of the patients developed major complications.

Conclusion

Endoscopy guided pancreatic pseudocyst drainage is safe and effective in pediatric population, however this procedure should be done by trained and experienced endoscopists under general anesthesia by pediatric anesthetist and EUS guided technique should be preferred over conventional technique of PPC drainage.

References

1.Park, A., Latif, S.U., Shah, A.U., Tian, J., Werlin, S., Hsiao, A., Pashankar, D., Bhandari, V., Nagar, A. and Husain, S.Z. (2009), Changing Referral Trends of Acute Pancreatitis in Children: A 12-year Single-center Analysis. Journal of Pediatric Gastroenterology and Nutrition, 49: 316-322. https://doi.org/10.1097/MPG.0b013e31818d7db3
2.Szakó L, Mátrai P, Hegyi P, Pécsi D, Gyöngyi Z, Csupor D, Bajor J, Erőss B, Mikó A, Szakács Z, Dobszai D. Endoscopic and surgical drainage for pancreatic fluid collections are better than percutaneous drainage: Meta-analysis. Pancreatology. 2020 Jan 1;20(1):132-41
3.Thomson M, Tringali A, Dumonceau JM, Tavares M, Tabbers MM, Furlano R, Spaander M, Hassan C, Tzvinikos C, Ijsselstijn H, Viala J. Paediatric gastrointestinal endoscopy: European society for paediatric gastroenterology hepatology and nutrition and European society of gastrointestinal endoscopy guidelines. Journal of pediatric gastroenterology and nutrition. 2017 Jan 1;64(1):133-53
4.Nabi Z, Talukdar R, Lakhtakia S, Reddy DN. Outcomes of Endoscopic Drainage in Children with Pancreatic Fluid Collections: A Systematic Review and Meta-Analysis. Pediatr Gastroenterol Hepatol Nutr. 2022 May;25(3):251-262. doi: 10.5223/pghn.2022.25.3.251. Epub 2022 May 9. PMID: 35611379; PMCID: PMC9110851.