Introduction

Gastric polyps represent an abnormal proliferation of the gastric mucosa. Chronic atrophic autoimmune gastritis (CAAG) targets parietal cells and results in hypo-achlorhydria and hypergastrinemia, which exerts a proliferative effect on the gastric mucosa.

Aims & Methods

We investigate the incidence of gastric polyps in CAAG patients in a single-center retrospective study examining patients with confirmed CAAG from January 1990 until June 2022. Demographic, clinical, biochemical, and serological data were collected for each included patient. The histopathological characteristics of the detected polyps were recorded.

Results

A total of 176 CAAG patients were included. Eighty-nine (50.5%) had 163 incidental polyps. Seventy-six patients (85%) had 130 non-endocrine lesions, among which 118 (90.7%) were inflammatory, 6 (4.6%) adenomatous, and 4 (3%) fundic; 33 patients (37%) had gastric neuroendocrine neoplasms (gNENs), and 21 (23.6%) both; one had MALToma and one gastric adenocarcinoma. Higher circulating lev- els of gastrin and chromogranin A were observed among patients with polyps (median 668 vs 893 pg/ml p = 0.0237, 146 vs 207 ng/ml p = 0.0027, respectively).

Conclusion

​CAAG implies a high incidence of gNENs and exocrine lesions. Gastrin plays a possible trophic role on the mucosa. Further evidence is needed to validate its predictive role for increased polyp risk in CAAG.

Introduction

Nonalcoholic fatty liver disease (NAFLD) is the most common hepatic disorder worldwide. The therapeutic landscape in NAFLD is rapidly evolving, with several agents under investigation. The use of noninvasive biomarkers is highlighted in recent guidelines

Aims & Methods

To assess the comparative efficacy of pharmacologic interventions in patients with NAFLD based on magnetic resonance imaging (MRI) biomarkers. We searched Medline, Embase and CENTRAL up to January 2023. We included randomized controlled trials (RCTs) with > 12 weeks of intervention. Eligible trials assessed the efficacy of pharmacologic interventions in patients with NAFLD diagnosed by liver biopsy or MRI. The primary outcome was absolute reduction in liver fat content (LFC) as assessed by means of either MRI–Proton Density Fat Fraction or MR-Spectroscopy. Secondary efficacy outcome was absolute reduction in liver stiffness (LS) assessed by MR-Elastography. We performed random-effects frequentist network meta-analyses to estimate mean differences (MD) with 95% confidence intervals (CIs). We ranked treatments based on P-scores.

Results

Thirty RCTs (2,511 participants) contributed data in the network meta-analysis. Among drug classes, thiazolidinediones (MD -7.4%; 95% CI -11.4 to -3.3), fibroblast growth factor (FGF) analogues (-5.8%; -8.8 to -2.8), glucagon-like peptide-1 receptor agonists (GLP1-RAs) (-4.3%; -7.5 to -1.1), farnesoid X receptor (FXR) agonists (-3.6%; -7.1 to -0.05), and combination treatment with vitamin E plus thiazolidinediones (-11%; -18.3 to -3.6) were more efficacious compared to placebo regarding absolute reduction of LFC. Vitamin E plus thiazolidinedione co-administration (P-score 0.90) was ranked as the most efficacious treatment followed by GLP1-RA-based combinations, thiazolidinedione (0.77) and vitamin E monotherapy (0.69). In terms of individual agents, efruxifermin, aldafermin, semaglutide, liraglutide, pioglitazone, vitamin E, tropifexor and resmetirom were superior to placebo with MDs ranging from -13.5% for efruxifermin to -4.0% for liraglutide. Combination treatments with semaglutide, and vitamin E plus pioglitazone were also superior to placebo. Based on P scores, Efruxifermin (0.97) was the most efficacious agent followed by vitamin E plus pioglitazone (0.91) and semaglutide-based combination therapies. All interventions were equally efficacious to placebo for LS reduction.

Conclusion

Pioglitazone and semaglutide are the most efficacious glucose-lowering agents for LFC reduction in patients with NALFD. Among non-glucose-lowering agents, efruxifermin, vitamin E and tropifexor can lead to significant steatosis reduction. Combination treatments, from different drugs classes seem promising for the management of NAFLD. Although no treatment was superior to placebo for LS reduction, duration of included trials was too small to draw firm conclusions.

Disclosure

Tsapas and E. Sinakos have received research support from Boehringer Ingelheim. E. Sinakos has participated in clinical trials funded by Novo Nordisk

Clinical Case Summary

A 21-years old male developed a perianal abscess and he undertook an ileocolonoscopy which showed right colon substenosis with ulcerations and deformation of the ileo-cecal valve. Stenosis histological samples were compatible with IBD-U (granulation tissue, chronic inflammatory infiltration and some cryptes with lowered mucous secretion). The MRI-enterography, showed thickening of distal ileum, ileo-cecal valve and cecum. A diagnosis of Crohn’s disease was made and the patient started adalimumab. The patient experienced recurring subocclusive crisis, thus another ileocolonoscopy was performed showing a scarring stenosis of proximal right colon, which could not be overcome by paediatric instrument. The patient underwent ileo-colonic resection. The surgical sample showed ileo-cecal valve circumferential stenosis and an occluding diaphragm between cecum and ascendent colon. Histologically the valve and the colonic wall had thickening and raising of only submucous membrane; mucosa was characterized by linfoplasmacellular inflammation with eosinophils granulocytes, architecture distortion and Paneth metaplasia. These features were compatible with colopathy with formation of fibrosus intraluminal diaphragm, namely diaphragm disease. The use of NSAIDs was investigated, but the patient took them just occasionally. Therefore, there was not a clear correlation between the use of NSAIDs and the diaphragm formation. At the ileocolonscopy performed six months after surgery, the ileal-colonic anastomosis appeared wide, slightly hyperaemic and without lesions. No more subocclusive crisis occurred.
Diaphragm disease is a rare colopathy associated with a long-term use of NSAIDs with a range of presentations and symptoms as abdominal pain, anemia, diarrhea, weight loss and constipation. The treatment is based on discontinuation of NSAIDs and eventually surgery. This clinical case shows a rare and challenging differential diagnosis of IBD.

Introduction

In patients with Helicobacter pylori (HP) infection, superficial gastritis proceeds to atrophic gastritis in about half of the patients. Although, it usualy involves the antrum, it can also proceed to the corpus with sometimes neuroendocrine cell hyperlasia and chromogranin A antibody positivity, like in classic autoimmune gastritis.

Aims & Methods

The aim of our study was to determine the frequence of HP infection in autoimmune atrophic gastritis and its characteristics
A retrospective study was conducted over patients with autoimmune atrophic gastritis diagnosed in the gastroenterology department in Mohamed taher maamouri hospital between January 2019 and December 2021. Clinical, biological, endoscopic and pathology features were abstracted from medical records.

Results

A total of 31 patients were included in this study. The sex ratio M/F was 0.8 and the mean age was 56 years [28- 82 years]. The average haemoglobin level was 9,9 g/dl and the average mean corpuscular volume was 95,6 fL. Serum markers were available in 13 patients. Intrinsic factor antibodies were positive in five patient and anti-parietal cell antibodies in 11 patients. Pathology findings of fundal biopsies showed mild atrophy in 16,1% patients, moderate in 48,4% and severe in 35,5% with presence of intestinal metaplasia in 90,3%. The antrum was atrophic in one patient and antral intestinal metaplasia was detected in 11 patients (35,5%). HP infection was diagnosed in 23 patients (74,2%). The presence of HP infection was correlated with the severity of anaemia (p= 0.048). No correlation was found between HP infection and the degree of atrophy or the presence of intestinal metaplasia (p= 0.35 et 0.38 respectively).

Conclusion

Our study showed the presence of HP in 74.2% of patients with autoimmune atrophic gastritis , which may support the inplication of HP infection in the development of autoimmune gastritis. The presence of HP infection was correlated with the severity of anaemia, hence the importance of HP eradication treatment.