Introduction

Although national guidance on the management of Helicobacter pylori (H. pylori) infection in the UK is reviewed regularly, the recommendations on treatment and follow-up are not aligned with guidance in the rest of Europe. This is mainly due to the issue that there are no up to date data available on H. pylori prevalence or primary resistance to drugs usually used in eradication regimens.

Aims & Methods

Aim of this study was to analyse the current UK practice on H. pylori management to highlight areas that warrant improvement. UK data collected at AEG-REDCap e-CRF until January 2025 from the European Registry on H. pylori management (Hp-EuReg) were analysed. Modified intention-to-treat (mITT) and per protocol (PP) analyses were performed and the Fisher’s exact test was used for comparison of categorical data (significance for p<0.05).

Results

Data on 462 patients from 3 different centres across the UK was analysed. The mean age of the patients was 55 years (SD 16 years). The indication to test for H. pylori was non-investigated dyspepsia in 47%, dyspepsia with normal endoscopy in 21%, iron deficiency anaemia in 10%, duodenal ulcer in 9.7%, gastric ulcer in 6.9%, and gastric preneoplastic conditions in 1.3%. Of the 257 patients for whom data on regular concurrent medication was available, 222 (87%) took proton pump inhibitors (PPI) daily. Standard triple therapy regimens were given in 97.6% with 90.9% of these having undergone a 7-day regimen, 1.7% a 10-day regimen and 7.4% a 14-day regimen. Most commonly prescribed regimens were amoxicillin-clarithromycin-PPI (75.5%), amoxicillin-metronidazole-PPI (11.1%) and clarithromycin-metronidazole-PPI (9.1%). In the majority of cases, PPI was prescribed at low dose (76%); standard dose was given in 21%, and high dose in 3% of patients. The incidence of at least one adverse event due to treatment was reported in 31% of cases. Tests to confirm eradication success were done in 85% of patients, with practice varying between the different sites (p<0.001). This was also confirmed for the length of prescribed treatment (p<0.001) and the PPI dose used (p<0.001). Eradication was successful in 71% in the mITT analysis, and in 71% of the PP analysis. Patients treated for 7 days showed treatment success in 70% in the mITT analysis, and 69.4% in the PP analysis, compared to 93% (both mITT and PP) in those treated for 14 days (p<0.01). Adverse events were associated with reduced eradication treatment success (mITT: 62 vs 76%; PP: 63 vs 76%; p<0.01). The effect was more pronounced for compliance, with only 5 patients having reported not to have completed >90% of their course of treatment (PP: 29% vs 80%, p<0.05). Second-line treatment was documented for 109 patients, with 20 different regimens having been prescribed. The overall mITT success of second-line treatment was 48.5%.

Conclusion

Clarithromycin-based triple therapy remains the standard in the UK, despite a treatment failure of ≈30%. While adherence to national British or European guidelines on treatment duration and PPI dosage varies by centre, this does not uniformly affect treatment success. Despite British guidance advocating to assess treatment success based on symptom response, eradication was confirmed in the majority of patients. A review of national guidance on H. pylori management in the UK is required, along with efforts to generate national data on prevalence and resistance patterns.

Disclosure

JB: Advisory fee by Flynn Pharma LTD UK and Juvise Pharmaceuticals France
OPN: Speaker fee or research funding from Allergan, Mayoly Spindler, Richen, Biocodex and Juvisé.
JPG: Speaker or consultancy fees, advisory board member or research funding form Mayoly, Allergan/Abbvie, Diasorin, Richen, Juvisé, Biocodex.
IB, MCS, ACC, PP, LM, FM, COM, and PP have no conflict of interest to declare.

Introduction

Helicobacter pylori (H. pylori) is a well-recognized gastric carcinogen. However, whether this infection is related to colorectal polyps and colorectal cancer remains debatable. Data from some recent studies have indicated a significant association between H. pylori infection and the development of colorectal polyps or cancer. Potential effects of H. pylori on the colorectal mucosa include the induction of inflammatory responses, alteration of gut flora, and the release of toxins.
The aim was to investigate the association between H.pylori infection and colorectal polyps.

Aims & Methods

We retrospectively included patients diagnosed with colorectal polyps who underwent H. pylori testing between September 2024 and March 2025. Patients with incomplete colonoscopies were excluded. Demographic, clinical, and endoscopic data were subsequently collected. Polyp subtypes and dysplasia grades were extracted from histopathology reports. Screening for H. pylori infection was performed on gastric biopsies. Patients were divided into two groups: Group 1 (H. pylori-negative) and Group 2 (H. pylori-positive). The number, size, location, and pathological type of colorectal polyps were compared between the two groups.

Results

One hundred thirty patients were included, with a male-to-female sex ratio of 3.2. The mean age was 56.3 ± 11.23 years. The main comorbidities were diabetes (33.1%), dyslipidemia (26.9%), and hypertension (25.4%). The locations of colorectal polyps varied: 18.5% in the rectum, 17.7% in the sigmoid colon, 8.5% in the left colon, 7.7% in the transverse colon, 16.9% in the right colon, and 30.8% of patients had polyps in multiple locations. A total of 219 polyps were identified, with a mean of 2.16 polyps per patient and a mean size of 5.9 mm (range: 2–30 mm).
Histopathological examination revealed predominantly hyperplastic polyps (36.9%), low-grade dysplastic adenomas (48.5%), high-grade dysplastic adenomas (7.7%), and adenocarcinomas (6.9%). The prevalence of H. pylori infection was 31.5%.
Statistical analyses showed that the H. pylori-positive group had a significantly higher proportion of colorectal polyps with sizes ≥10 mm (55.6% vs. 44.4%, p = 0.027) and multiple polyps (≥5) (56.3% vs. 43.8%, p = 0.04) compared to the H. pylori-negative group. However, neither dysplasia grading nor polyp localization was significantly associated with H. pylori infection.

Conclusion

In our study, H. pylori infection was associated with an increased risk of large and multiple colorectal polyps. Further studies are needed to confirm these findings and to better understand the impact of H. pylori eradication on the occurrence of colorectal polyps, as well as its tumorigenic effects on the colorectal mucosa.

Introduction

Autism Spectrum Disorder (ASD) is closely associated with gut-brain axis dysfunction[1]. Fecal microbiota transplantation (FMT) may alleviate gastrointestinal and behavioral symptoms in ASD children by remodeling gut microbiota[2], yet the key functional bacterial strains underlying FMT-mediated neurobehavioral regulation remain unidentified.

Aims & Methods

This study aims to systematically evaluate FMT efficacy through a cohort study, combined with metagenomic analysis to investigate the dynamic patterns of microbiota colonization in ASD children. We will thoroughly identify core bacterial strains and analyze the relationship between their colonization patterns and therapeutic outcomes. The children aged 0-18 years meeting the diagnostic criteria for ASD were included in this study. The clinical data of recipients was collected before FMT, alongside questionnaire surveys and fecal sample collection. Pre-FMT assessments were conducted by pediatric psychologists using standardized scales. Donor feces were extracted via standardized protocols, and 100 mL of donor microbiota suspension was administered into the jejunum or ileum via colonoscopy or nasojejunal tube once every other day, total three sessions. Post-FMT fecal samples were collected from recipients at 1, 2, 4, 12, and 24 weeks for metagenomic analysis at species and strain levels. At 12 and 24 weeks post-FMT, the same psychologists reevaluated recipients using assessment scales, while parents completed follow-up questionnaires to document clinical outcomes. Finally, correlation analysis was conducted between laboratory data and clinical outcomes.

Results

A total of age-matched healthy pediatric donors (86 fecal samples) and 52 ASD children (351 fecal samples) were included. Results revealed that 69.2% of ASD children exhibited gastrointestinal (GI) symptoms (e.g., constipation or diarrhea), 58.3% had one or more food protein allergies, and 78.5% experienced sleep disturbances (<8 hours/day). Post-FMT, GI symptoms improved most significantly: 80% of recipients showed at least one grade reduction in Gastrointestinal Symptom Rating Scale (GSRS) scores, while 60% demonstrated improvements in autism-related behavioral traits, including reduced emotional dysregulation/negativity and enhanced sensory responsiveness. Clinical improvements became more pronounced over time. Metagenomic analysis demonstrated a significant increase in gut microbiota diversity and structural remodeling in recipients, with microbial profiles converging toward donor compositions. Correlation analysis identified donor-derived Bacteroidetes and Bacillota phyla as closely associated with clinical improvements.

Conclusion

FMT can significantly and 'long-term' reconstruct the gut microbiota of children with autism, effectively alleviating concurrent symptoms such as gastrointestinal disorders. Successful colonization of Bacteroidetes and Bacillota from donor sources is closely related to clinical improvement.

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.
2.Dossaji Z, Khattak A, Tun KM, Hsu M, Batra K, Hong AS. Efficacy of Fecal Microbiota Transplant on Behavioral and Gastrointestinal Symptoms in Pediatric Autism: A Systematic Review. Microorganisms. 2023 Mar 22;11(3):806.

Introduction

Helicobacter pylori (H. pylori) remains a significant global pathogen, implicated in chronic gastritis, peptic ulcer disease, and gastric cancer. Over the past two decades, escalating resistance to key antibiotics—particularly clarithromycin, levofloxacin, and metronidazole—has reduced the effectiveness of standard triple therapies, with eradication rates falling below 70%. Refractory H. pylori infection, defined in this study as persistent infection after three or more failed eradication regimens, presents a growing therapeutic challenge. The absence of standardised rescue protocols and limited access to antibiotic susceptibility testing in many regions further complicates treatment. Innovative empirical strategies, especially those using agents with low resistance profiles, are urgently needed.

Aims & Methods

This real-world, prospective observational study aimed to evaluate the efficacy of a Modified Concomitant Therapy (MCT) regimen for the eradication of refractory H. pylori. Adults aged ≥18 years with confirmed H. pylori infection persisting after at least three previous treatment attempts were recruited from a gastroenterology centre in Bogotá, Colombia, between January and November 2023.

The MCT protocol included:

• Esomeprazole 40 mg, twice daily (before breakfast and dinner)
• Furazolidone 100 mg, every 8 hours
• Amoxicillin 875 mg every 8 hours (in patients <70 kg) or 1 g every 8 hours (in ≥70 kg)
• Tetracycline 500 mg, every 6 hours

Patients were counselled about the therapeutic difficulty and potential adverse effects. The treatment duration was 14 days. Eradication was assessed 6–8 weeks post-therapy using histological evaluation with haematoxylin-eosin and Giemsa staining. This choice was based on prior discordance between breath test results (often negative) and biopsy (positive). Effectiveness was analysed both by modified intention-to-treat (mITT) and per-protocol (PP) methods.

Results

A total of 30 patients were enrolled (mean age: 45 ± 6 years; range: 28–63).

• mITT eradication rate: 27/30 (90%, 95% CI: 72.3–97.4)
• PP eradication rate: 25/27 (92.5%, 95% CI: 76.3–97.9)

Adverse events were reported in 8 patients:

• Nausea (30%)
• Headache (33%)
• Diarrhoea (16%)
• Constipation (10%)

Three patients discontinued treatment prematurely between days 10 and 12. No severe adverse events or hospitalisations occurred. The major limiting factor for broader enrolment was intermittent availability of tetracycline.

Conclusion

This study demonstrates that Modified Concomitant Therapy represents a promising and effective option for the eradication of refractory H. pylori infection in real-world settings. With an eradication rate exceeding 90% and manageable adverse effects, MCT using furazolidone, amoxicillin, tetracycline, and high-dose PPI constitutes a rational empirical rescue strategy in regions where antibiotic resistance testing is unavailable and first-line therapies have failed. Further multicentre studies with larger cohorts are warranted to confirm these findings and assess long-term outcomes. The development of accessible tetracycline formulations would enhance implementation.

References

1. Malfertheiner P, Megraud F, Rokkas T, Gisbert JP, Liou JM, Schulz C, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022 Jan;71(1):172–95. doi:10.1136/gutjnl-2021-325210.
2. Graham DY, Lee YC, Wu MS. Rational Helicobacter pylori therapy: evidence-based medicine rather than medicine-based evidence. Clin Gastroenterol Hepatol. 2014 Feb;12(2):177–86.e3. doi:10.1016/j.cgh.2013.06.020.
3. Liou JM, Chen CC, Chang CY, Chen MJ, Fang YJ, Lee JY, et al. Sequential versus triple therapy for the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. Lancet. 2013 Feb 16;381(9862):205–13. doi:10.1016/S0140-6736(12)61455-0.

Introduction

Acute biliary pancreatitis (ABP) has been shown to be associated with increasing incidence and health-care costs, and possibly higher mortality than other etiologies. Despite the existence of various scoring systems, early and accurate risk stratification remains difficult. Due to heterogeneity of populations, focusing on one etiology might reveal important insights concerning predictors of outcome.

Aims & Methods

We conducted a retrospective, multicenter cohort study including all patients admitted with ABP between 2018 and 2021 at two hospitals. Epidemiological, clinical, and outcome data were analyzed. The main clinical outcome of interest was a hierarchical composite endpoint of five mutually exclusive clinical states: (i) death (90-day all-cause mortality), (ii) severe AP and/or admission to the intensive care unit (ICU), (iii) endoscopic, interventional radiological, or surgical interventions, (iv) moderately-severe AP, (v) mild AP. Univariable logistic regression identified parameters associated with worse outcomes, which were then tested in multivariable models. Emphasis was placed on early availability and clinical practicality of predictors. We aimed to stratify patients into outcome trajectories reflecting both health impact and healthcare resource utilization.

Results

Out of 569 total acute pancreatitis cases, 217 (38.1%) patients had ABP (mean age 65.9 ±17.4 years; median length of stay (LOS) 7 days, IQR 4;11) Mild, moderately-severe, and severe disease occurred in 62.2%, 30.0%, and 7.8% of patients. All-cause 90-day mortality was 2.3%. Several parameters were significantly (p<0.05) associated with worse outcomes, including BISAP and the Charlson comorbidity index (CCI) (p<0.001). Individually, BISAP and CCI classified patients reasonably, however, wide prognostic uncertainty persisted. When combining BISAP and CCI (BISAP-C), 5 discrete risk groups were identified, ranging from low (group 1, BISAP 0-2 & CCI 0-2) to very-high risk (group 5, BISAP 3-5 & CCI ≥6) (see Table 1). The prevalence of severe outcomes (i–iii) increased across these strata: 2.4% (Group 1), 9.5% (Group 2), 27.3% (Group 3), 60% (Group 4), and 62.5% (Group 5), with LOS also significantly longer in higher-risk groups (p<0.001). Mortality was 50% in group 5, while, importantly, 97.6% of patients in group 1 experienced mild-to-moderate AP without ICU admission, persistent organ dysfunction, surgical or endoscopic interventions, and no fatality, supporting potential early discharge. This also occurred in 90.5% of group 2. Notably, Groups 1 and 2 together comprised nearly 80% of the cohort.

Conclusion

Comorbidity seems to play a major role concerning worse outcomes in ABP. The combination of CCI and BISAP (BISAP-C), both comprised of early-on and easily available parameters, offers improved early prognostic discrimination and may provide tailored, individualized management and healthcare resource utilization.

Introduction

Tissue acoustic properties, such as sound speed, attenuation, and impedance, are closely associated with its mechanical characteristics. Acoustic microscopy, which employs high-frequency ultrasound ranging from several tens of MHz to several GHz, enables the quantitative evaluation of these acoustic properties. Understanding the acoustic properties of biological tissues may offer new insights into disease pathology. Furthermore, because clinical ultrasound images depend on tissue acoustic properties, understanding them could improve the interpretation of echogenic patterns and contribute to developing new diagnostic approaches. Although acoustic microscopy has been applied to cardiovascular and cutaneous tissues in medical research, studies focusing on the liver, particularly hepatic tumours, remain limited.

Aims & Methods

This study aimed to quantify sound speed in hepatocellular carcinoma (HCC)—the most common primary liver tumour—and to examine its relationship with histopathological features. Histopathological classification followed World Health Organization criteria, including histological grade (well, moderately, and poorly differentiated) and histological growth pattern (trabecular, pseudoglandular, and solid). Tissue sound speed was measured using a scanning acoustic microscope (AMS-50SI; Honda Electronics Co., Ltd.) with an 80 MHz transducer. Regions of interest were identified on haematoxylin and eosin-stained slides. Serial 10 μm-thick sections were prepared from formalin-fixed, paraffin-embedded tissue blocks and rehydrated for measurement. Differences in sound speed among histological categories were compared, and statistical analysis was conducted to assess significance. A p-value of < 0.05 was considered significant. This study was approved by the institutional review board, and written informed consent was obtained.

Results

Tissue sound speed was measured at 66 sites from 51 patients. Histological grading identified 22 well, 41 moderately, and 3 poorly differentiated cases. Median sound speeds were 1584.0 m/s, 1595.9 m/s, and 1550.1 m/s, respectively. Poorly differentiated HCC showed significantly lower sound speed than the other grades (p = 0.021). Growth patterns included 50 trabecular, 10 pseudoglandular, and 6 solid cases, with median sound speeds of 1595.9 m/s, 1586.0 m/s, and 1563.6 m/s, respectively. The trabecular pattern tended to exhibit higher sound speed than the solid pattern (p = 0.063). Tissues with abundant fat or glycogen (n = 16) had significantly lower sound speeds than those without (p = 0.002). After excluding these cases, which could act as potential confounding factors, sound speed in poorly differentiated HCC remained significantly lower (p = 0.016), and higher values in the trabecular pattern persisted. Additionally, the pseudoglandular pattern showed greater variability in sound speed than the trabecular pattern.

Conclusion

Variations in acoustic properties among histological subtypes of HCC may contribute to developing novel quantitative assessments in ultrasound imaging and pathological diagnosis.

Disclosure

Kazuto Kobayashi, a co-author, has reported a relationship with Honda Electronics Co., Ltd. that includes: employment.

Introduction

The global prevalence of Helicobacter pylori (HP) infection is almost 43% and affects almost 18% of Italians [1, 2]. The literature describes several endoscopic signs detectable during upper-GI endoscopy that may predict HP status [3]; however, in clinical practice, random biopsies according to the Sydney system are still widely used for its determination.

Aims & Methods

The aim of our study is to investigate the role of Regular arrangement of collecting venules (RAC) assessment, during upper-GI endoscopies, for predicting HP status. We conducted a monocentric prospective study including patients who underwent upper-GI endoscopy for any indications from August 2024 to February 2025. Upper-GI endoscopies were performed according to standard of care [4], with high-definition scopes and after adequate cleaning [5]. Exclusion criteria were autoimmune gastritis, antibiotics within the previous 4 weeks, gastric surgery, previous endoscopic submucosal resection, upper-GI neoplasms, age <18 years, severe liver/kidney disease and previous known HP infection. Every procedure was performed by 6 endoscopists trained in recognition of all typical endoscopic signs of healthy stomach or HP infection: RAC, fundic gland polyps, linear streaks, hematin spots and diffuse redness prior to data collection. HP infection was investigated by histological evaluation by bioptic sampling, obtained according to the Sydney criteria.

Results

From 429 enrolled patients, 244 patients were included, according to inclusion criteria (M 124, 50.8%, median age 54.9, IQR 41.9-65.0). The prevalence of H. pylori infection was 15.5% (38/244). The presence of RAC in both greater and lesser curvature was observed in 63.1% (154/244) of cases, gland polyps in 19.6% (48/244), linear streaks in 15.5% (38/244), hematin spots in 15.9% (39/244) and diffuse redness in 9% (22/244). The presence of RAC, gland polyps and diffuse redness were significantly associated with higher prevalence of HP infection (p<0.001). The best performance was obtained from the presence of RAC in both greater and lesser curvature (AUROC 0.808, p<0.001) with a sensitivity (SEN), specificity (SPE), NPV and PPV respectively of 82.7% (64.2-94.1), 78.8% (72.3-84.4), 96,2% (92-98.3) and 40.8% (33.3-48.7). At multivariate analysis it confirmed to be related to HP-negative status (p=0.01, OR 0.04 95%CI: 0.005-0.481). Lastly, the presence of RAC showed a higher performance in males (AUROC 0.836, SEN 86.6% 59.5-98.3, SPE 80.6% 71.4-87.9, NPV 97.1% 90.3-99.2, PPV 44.1% 33.4-55.3) and in young patients (AUROC 0.846, SEN 80% 51.9-95.6, SPE 89.2% 81.1-94.7, NPV 96.2% 90.1-98.6, PPV 56.7% 40.9-71.3). As expected, the presence of RAC required a very short observation time (29.3 ± 11.0 versus 34.7 ± 11.7 seconds; p=0,001).

Conclusion

The presence of RAC in both the greater and lesser curvatures is the most important and reliable indicator of HP-negative status, and the time required for the evaluation is minimal. Our findings may represent a first step toward avoiding unnecessary random biopsies, promoting a more accurate endoscopic examination focused on the careful assessment of the gastric mucosa

References

1. Chen YC, et al. Global Prevalence of Helicobacter pylori Infection and Incidence of Gastric Cancer Between 1980 and 2022. Gastroenterology, 2024
2. Zullo A, et al. Upper Endoscopy in Patients with Extra-Oesophageal Reflux Symptoms: A Multicentre Study. GE Port J Gastroenterol, 2020
3. Seo JY, et al. Predicting Helicobacter pylori infection from endoscopic features. Korean J Intern Med, 2024
4. Bisschops R, et al. Performance measures for upper gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative. Endoscopy, 2016
5. Manfredi G, et al. Premedication with simethicone and N-acetylcysteine for improving mucosal visibility during upper gastrointestinal endoscopy in a Western population. Endosc Int Open, 2021