Introduction

Capsule panendoscopy is increasingly used in Crohn's disease (CD), particularly in patients with extensive small bowel and colonic involvement. It offers a non-invasive, one-step evaluation of both segments, making it appealing for disease monitoring and treatment response. However, there is a need for validated scoring systems that objectively assess inflammatory activity in both the small bowel and the colon.

Aims & Methods

The aim of this study was to externally validate the Eliakim Score (Elk-S), developed to assess mucosal inflammation in CD by capsule panendoscopy. Patients referred for PillCam™ Crohn's examination at our institution were selected, and procedure data were collected retrospectively to calculate the Elk-S.

Results

A total of 72 patients were included, 62.5% female, with a mean age of 42±15 years. In 52 (72.2%) individuals, the indication for the procedure was suspected CD. Among them, the diagnosis was rejected in 38 cases, while in 14 cases, the diagnosis was established. There was a significant difference in mean Elk-S between the two groups (5.3±1.5 vs. 21.8±5.3, respectively; p<0.001). Capsule panendoscopy was used to evaluate inflammatory activity in 20 (27.8%) patients with CD. Treatment remained unchanged in 10 cases, while therapy was intensified in 10 patients, and there was a significant difference in mean Elk-S between the two groups (2.2±0.5 vs. 17.1±2, respectively; p<0.001). The Elk-S demonstrated an area under the ROC curve of 0.979 for the diagnosis of CD and 0.875 for predicting therapeutic escalation. An Elk-S ≥ 7 (Table 1) had a Sensitivity, Specificity, Negative Predictive Value, and Positive Predictive Value of 100%, 89.5%, 100%, 77.8%, respectively, for the diagnosis of CD. To determine the need for therapeutic intensification in patients with established CD, the same cut-off value showed a Sensitivity, Specificity, Negative Predictive Value, and Positive Predictive Value of 90%, 70%, 87.5%, 75%, respectively.

Conclusion

The Elk-S exhibited high accuracy in establishing the diagnosis of CD and was equally useful in predicting the need for therapeutic intensification in cases of established CD. The present study represents the first external validation of the Elk-S, demonstrating its effectiveness for assessing inflammatory activity via capsule panendoscopy of both the small bowel and colon.

References

Eliakim R, Yablecovitch D, Lahat A, et al. A novel PillCam Crohn’s capsule score (Eliakim score) for quantification of mucosal inflammation in Crohn’s disease. United Eur Gastroenterol J. 2020;8(5):544-551. doi:10.1177/2050640620913368

Introduction

Irritable bowel syndrome (IBS) is considered a disorder of the altered microbiota-gut-brain axis, where gut dysbiosis and impaired central nervous system processing play important roles. The latter, in the form of depression, anxiety, and gastrointestinal-specific anxiety (GSA), frequently coexist and exacerbate IBS. Probiotics might be a promising therapeutic approach to treat IBS and coexisting depression, anxiety, and GSA.

Aims & Methods

The aim of the trial was to compare the impact of standard care combined with multi-strain probiotics with standard care alone on depression, anxiety, and visceral sensitivity in patients with diarrheal IBS (IBS-D). It was a 12-week randomized trial that included 108 patients with IBS-D that were divided into 2 groups: a control group (n = 51) receiving only standard care (diet, peppermint oil) and an experimental group (n = 57) receiving a combination of standard care (diet, peppermint oil) and the study probiotic (based on Lactobacillus, Streptococcus, Bifidobacterium, and Saccharomyces boulardii strains). Patient Health Questionnaire-9 (PHQ-9) and Beck’s Depression Inventory (BDI) were used to assess depression; the Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression; and the Visceral Sensitivity Index (VSI) was used to assess GSA.

Results

Baseline data were not different between the study groups (p> 0.05). After 12 weeks of treatment, PHQ-9, BDI, and anxiety subscale of HADS were not different between the study groups (p> 0.05), while the central tendency of the depression subscale of HADS in the control group was higher (3 (2-4)) than in the experimental group (3 (2-3)), p = 0.046. VSI was higher in the control group (31±5) compared to the experimental group (29±5.7), p = 0.032, after 12 weeks of trial.

Conclusion

In patients with IBS, additional prescribing of a multi-strain probiotic led to a decrease in depression according to HADS, as well as a reduction in GSA and visceral sensitivity assessed by VSI compared to IBS standard care alone.

Introduction

Common variable immunodeficiency (CVID) is the most prevalent primary immune deficiency. Two-thirds of CVID patients present concomitant autoimmune disorders, including gastrointestinal autoimmune disease, other than being at risk for gastric cancer.

Aims & Methods

We aimed to assess the prevalence of autoimmune gastrointestinal manifestation in patients with CVID and to evaluate the diagnostic yield of EGDS for the screening of gastric pre-neoplastic lesions in a prospective cohort of patients with CVID. From June 2020 to June 2022, we prospectively enrolled patients with CVID diagnoses from a tertiary referral center. At enrollment, patients underwent a gastroenterological screening consisting of clinical evaluation and laboratory tests for the screening of autoimmune gastrointestinal disease. Moreover, all patients were proposed to undergo an esophagogastroduodenoscopy (EGD) regardless of the presence of GI symptoms to rule out pre-neoplastic gastric lesions and upper gastrointestinal disease in the presence of clinical suspicion. Patients with lower GI symptoms were proposed for colonoscopy.

Results

We included 94 patients with CVID, of whom 58 (61.7%) were females, with a mean age of 44.3 years old [standard deviation (SD) 16.3]. Overall, 12 patients (12.8%) were diagnosed with one or more gastrointestinal autoimmune diseases. Eight patients (8.5%) had ongoing therapy with intravenous immunoglobulin, while 24 (25.5%) with subcutaneous immunoglobulin. Four patients (4.3%) had a previous celiac disease diagnosis, with a negative serology at screening, and only 1 (1.1%) patient had evidence of villous atrophy and duodenal inflammation at the time of EGD. Three (3.2%) patients were diagnosed with autoimmune atrophic gastritis with negative serology and evidence at biopsies taken during EGD of atrophic gastritis. One patient (1.1%) was diagnosed with ulcerative colitis, one patient (1.1%) with Crohn’s disease, and 5 patients (5.3%) with autoimmune hepatitis. Sixteen (16, 17%) patients reported inhalant allergy, 5 (5.3%) reported food allergy, and 26 (27.7%) reported drug-related allergy. Eleven (11.7) patients reported previous Helicobacter pylori (HP) infection, while only 1 (1.1%) patient was diagnosed with an ongoing HP infection. Fifty-eight patients underwent EGD, with endoscopic evidence of esophagitis in 8 patients (13.8%), gastritis in 45 (77.6%), and duodenal atrophy/inflammation in 23 (39.7%), of whom 41.4% had histological evidence of duodenal lymphocytosis. No patient was diagnosed with gastric cancer. Twenty-three patients underwent colonoscopy according to clinical indication, which showed at biopsy sampling ileal nodular follicular hyperplasia in 2 patients (8.7%), microscopic (lymphocytic) colitis in 2 patients (8.7%), ulcerative colitis in 1 (4.3%) and Crohn's disease in 1 (4.3%).

Conclusion

Celiac disease, atrophic gastritis, and autoimmune hepatitis were the most common gastrointestinal autoimmune overlaps of patients with CVID. Autoimmune gastrointestinal diseases in patients with CVID may pose a particular diagnostic challenge since autoantibodies are often absent. Five percent of CVID patients screened with EGD was found with a gastric pre-neoplastic lesion. Further data are needed to define the optimal timing of endoscopic follow-up of these patients for the screening of pre-neoplastic and neoplastic lesions.

Disclosure

Served as an advisory board member for EG Pharma
Received lecture grants from AlfaSigma, Bromatech, Echosens, Ferring, Mayoly Spindler and Schwabe Pharma.

Introduction

Helicobacter pylori (H. pylori) antibiotic resistances are the leading cause for unsuccessful eradication therapy. After one or more failures, the chance of encountering secondary antibiotic resistances increases. The aim of this study was to characterize genotypic secondary resistances in a cohort of Southern Italy H. pylori patients with at least one previous failure.

Aims & Methods

Patients with at least one previous eradication failure collected stool samples by a dedicated kit (THD fecal testTM) and bacterial DNA was extracted and amplified by RT-PCR. Resistance to clarithromycin, amoxicillin, metronidazole, levofloxacin and tetracycline was assessed by high-resolution melting curve.

Results

We enrolled 50 patients. The 72% failed one previous antibiotic course, the 16% two, the 10% three and the 2% four. The rate of secondary antibiotic resistance was 16% for clarithromycin, 18% for metronidazole, 14% for amoxicillin, 14% for levofloxacin and 2% for tetracycline. Multi-resistance was detected in 9 patients (18%) and double resistance to clarithromycin + metronidazole was the most common one (n = 5). Among patients with a previous failure to an amoxicillin-containing regimen, amoxicillin resistance was found in 4 out of 20 (20%). Among patients with a previous failure to a clarithromycin-containing regimen, resistance to such antibiotic was detected in 6 out of 19 (31.6%). Among patients with a previous failure to a metronidazole-containing regimen (n = 21), metronidazole resistance was found in 3 cases (14.3%). A failed levofloxacin-based therapy was given in 3 patients, but in none of them resistance was found (0%). Finally, among patients with a previous failure to a tetracycline-containing therapy, resistance to such antibiotic was detected in 1 out of 12 (8.3%)

Conclusion

In conclusion, our data seem to show that, despite secondary resistances are not so high, a resistance to clarithromycin could be very likely related to previous exposure to this antibiotic.