Introduction

There is limited evidence regarding how the dosage of each individual drug affects the effectiveness of the different first-line bismuth-based quadruple therapy regimens.

Aims & Methods

To analyse the effectiveness of first-line bismuth quadruple regimens according to the dosage of the different drugs used. Prospective, non-interventional registry of the clinical practice of European gastroenterologists on the management of H. pylori infection (Hp-EuReg) between 2013 and 2024. Only first-line bismuth quadruple regimens with more than 100 cases were included, and effectiveness was analysed by modified intention-to-treat (mITT) based on the different dosages.

Results

A total of 10,767 first-line records were analysed (Table 1). The clarithromycin-amoxicillin-bismuth (CAB) quadruple regimen showed effectiveness >90% regardless of the daily dose of bismuth, using A and C at standard doses. The tetracycline-metronidazole-bismuth (TMB) quadruple regimen achieved effectiveness >90% with T doses of at least 1,500 mg/day, M 1,500 mg/day, and bismuth at least 480 mg/day, with no improvement seen when the bismuth dose was increased further. The amoxicillin-metronidazole-bismuth (AMB) quadruple regimen showed mITT >90% with A at 2,000 mg/day, M at least 1,000 mg/day, and bismuth at 480 mg/day, without relevant improvement when increasing the M dose. The clarithromycin-metronidazole-bismuth (CMB) regimen showed mITT ≥90% with M doses of 800 mg/day or higher, C 1,000 mg/day, and bismuth 480 mg/day, with no improvement seen with higher daily doses of bismuth. In the amoxicillin-levofloxacin-bismuth (ALB) quadruple therapy, mITT was >90% across all regimens, with no differences observed when increasing the L dose above 500 mg/day. The rest of the regimens studied did not reach mITT >90%.

Conclusion

Several first-line bismuth quadruple regimens (CAB, TMB, AMB, CMB, and ALB) are highly effective (>90%) in clinical practice in Europe. Increasing the daily dose of bismuth above 480 mg did not yield additional benefit, supporting the use of standard bismuth dosages in routine management.

Disclosure

Dr. Javier P. Gisbert has served as a speaker, a consultant and advisory member for or has received research funding from Mayoly, Allergan, Diasorin, Biocodex, Juvisé and Richen. Dr. Olga P. Nyssen has served as a speaker or has received research funding from Mayoly, Allergan, Diasorin, Biocodex, Juvisé and Richen. Dr. Samuel J. Martínez-Domínguez has served as a speaker for Juvisé. Dr. Ángel Lanas has served as a speaker for Juvisé. The remaining authors declare no conflicts 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

Crohn’s disease (CD) complicated with intra-abdominal abscess often requires surgical intervention. Image guided percutaneous drainage (PD) can help to avoid surgical interventions, however there is limited evidence on the optimal management after PD.

Aims & Methods

Our study aimed to analyze the long-term outcomes of CD complicated with intra-abdominal abscess after intervention. In this multicenter, interational retrospective trial penetrating CD patients with simplex intra-abdominal abscess were enrolled and followed until 12-24 months. Baseline was the day of the first detection of abdominal abscess. Patients with urgent resection were excluded. Patients were grouped based on elective surgical need during follow-up after a successful PD, while the control group consisted of patients who underwent resection without PD. Primary outcome was the abscess recurrence, while stoma rate, post procedural complications rate (<30 days), need for re-drainage and postoperative luminal recurrence were analyzed as secondary outcomes.

Results

A total of 151 CD patients from 9 countries were recruited and 86/151 patients had PD due to simplex abdominal abscess (Table 1.). Abscess recurrence rates were similar (12.8% vs. 7.7%, p=0.231). Need for re-drainage was more common amongst PD patients (OR=0.088, 95% CI=0.011-0.682), while hospital admission need was more frequent in control patients (OR=2.56, 95% CI=1.22-5.37). Postoperative luminal recurrence, new stoma, and biological treatment escalation needs were similar between groups based on PD. Surgical complications were coupled with increased odds in patients without prior PD (OR=3.3, 95% CI=1.09-10.0), septic complications, perforation and new fistula formation were reported the most, while PD associated complication did not occur. Higher baseline diameter of the abscess increased the odds for postoperative recurrence (OR=1.05, 95% CI=1.02-1.08) and new biological treatment initiation (OR=0.98, 95% CI=0.96-0.98). Elective resection was delayed after PD compared to control (24 vs 10 week, p=0.003). Time until resection increased the odds for redrainage (OR=1.03, 95% CI 1.01-1.05), and outcome was worse exceeding 17 weeks.

Conclusion

The size of the abscess determines the outcomes, while surgical treatment alone may be associated with post-procedural complications. PD may delay resection; however, this delay can necessitate re-drainage.

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.