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

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

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.