Introduction

EUS-guided gastroenterostomy(EUS-GE) with lumen-apposing metal stent(LAMS) has emerged as a mini-invasive, effective and safe alternative to surgical gastrojejunostomy and endoluminal stenting to treat malignant gastric outlet obstruction(MGOO).Currently, intra-abdominal carcinomatosis represents a relative contraindication to this procedure, due to a possible higher risk of clinical failure.

Aims & Methods

The primary aim was to compare clinical success of EUS-GE in patients (pts) with MGOO with vs without concomitant intra-abdominal carcinomatosis.Secondary aims was to compare between the same subgroups of pts the clinical and procedural characteristics, the technical success rate and long-term outcomes.All pts undergoing EUS-GE for MGOO at our institution from Jun.2018 to Dec.2024 were retrospectively enrolled.Technical success was defined as successfully establishing EUS-GE and clinical success as oral diet tolerance without re-intervention for 14 days after the procedure. Inclusion criteria: 1)age>18 years; 2)MGOO; 3)complete clinical records. Exclusion criterium:missing data. Intra-abdominal carcinomatosis was defined according to CT/MRI imaging. Adverse events (AEs) recorded and classified (AGREE). Obstructive symptoms graded according to the GOOSS score. Data expressed as median [range], comparisons by the Student-t-test, Mann-Whitney-u test and X² test as appropriate.

Results

EUS-GE for MGOO was performed in 74 pts (36 [48.6%] males, age 71 [30-92]), with ECOG performance status ≥2 in 29(39.2%). Obstructive symptoms were reported by 72(97.3%) pts (GOOSS: 1 [0-3]). Intra-abdominal carcinomatosis was present in 29(39.2%) pts. Ascites was more frequent in pts with vs without carcinomatosis (19[65.5%] vs 12[26.7%], p=0.02). Other clinical characteristics were comparable between groups.All EUS-GE were performed in deep sedation. LAMS included Axios and Spaxus (Axios: 37[82.2%] vs 25[86.2%],p=0.89). 20mm LAMS were used in a comparable proportion of pts with vs without carcinomatosis (25[86.2%] vs 37[83.2%], p=0.89). Technical success rates and procedural time did not differ between groups (28[96.6%] vs 43[95.6%],p=0.69; 33[16-85] vs 40[20-106],p=0.52). Overall, 9 misdeployments were observed (carcinomatosis: 3[10.3%] vs no-carcinomatosis: 6[13.3%], p=0.98). AEs were 4 (19.8%) and 9 (20%) in pts with vs without carcinomatosis (p=0.71), all grade III. Time to refeeding (days) was comparable between groups (1[1-5] vs 1[1-5], p=0.96), while hospital stay (days) was longer in patients with carcinomatosis (8[2-18] vs 4[2-15],p=0.0009). Clinical success rate did not differ in pts with vs without carcinomatosis (25[86.2%] vs 43[95.6%],p=0.31). All 6 failures were due to malignancy progression. Median follow-up duration was 51[21-622] days. During follow-up, 27(93.1%) pts with and 38(84.4%) without carcinomatosis died(p=0.45). Median survival (days) and oral diet toleration until last follow-up/death were comparable between pts with vs without carcinomatosis (42[21-398] vs 66[26-622],p=0.07; 26[89.6%] vs 42[93.3%],p=0.89). Oncological treatments were resumed in 11(37.9%) pts with and 23(51.1%)without carcinomatosis (p=0.38). Rehospitalization rate for any cause was comparable in both groups (14[48.3%] vs 26[57.7%],p=0.57), requiring reintervention in 1case.

Conclusion

In our study population high technical and clinical success rates of EUS-GE were comparable in pts with and without intra-abdominal carcinomatosis. The major outcomes were comparable between these 2 subgroups of pts, suggesting the long-term efficacy of this procedure also in those with more advanced malignancy.

Introduction

STW 5, a herbal medicinal product with well characterized pharmacological action, has been shown in several RTCs to be an effective treatment in disorders of the gut-brain interaction (DGBI) as functional dyspepsia (FD) [1, 2]. The aim of the present study was to examine whether changes in gut microbiota induced in an experimental model of FD could be prevented by STW 5.

Aims & Methods

FD was induced in rats by subjecting them to neonatal maternal separation followed by subjecting them to restraint stress for 90 minutes/day for one week. During that week, one group (8 animals) was treated with the liquid form of STW 5 (5 ml/Kg) and one with its vehicle at the same dose level. Animals were sacrificed 24 h after the last drug administration. Fecal samples were taken from the cecum. Genomic DNA was isolated and changes in selected bacterial phyla and genera were assessed using quantitative Real Time-PCR (qPCR). The main phyla studied under the influence of stress in the model were the Bacteroidetes, Firmicutes, Fusibacterium and Actinobacteria.

Results

FD led to a 50% drop in the Lactobacilli population but to a two-fold rise in Proteobacteria abundance but did not affect significantly the changes in Bacteroidetes. Furthermore, the Methanobrevibacter population was raised more than two-fold while the genomic DNA concentration in Bifidobacterium dropped from ca. 3 ng/g feces to nearly nil.

Conclusion

In general, STW 5 tended to ameliorate and protect against the changes induced by the stress model. The results lend further support to the use of STW 5 in FD and IBS by providing evidence that it acts at least in part through influencing beneficially the changes in intestinal microbiota induced by stress. Taken together, the findings shed more light on mechanisms involved in the therapeutic action of STW 5 in gastro-intestinal disorders.

References

1. Malfertheiner P. STW 5 (Iberogast) Therapy in Gastrointestinal Functional Disorders. Dig Dis. 2017, 35 Suppl 1: 25-29
2. Allescher H-D, Burgell R, Malfertheiner P, Mearin F. Multi-target Treatment for Irritable Bowel Syndrome with STW 5: Pharmacological Modes of Action. Gastrointest Liver Dis. 2020;29: 227-233

Disclosure

OK and HA-K are empolyees of Steigerwald Arzneimittelwerk GmbH, Darmstadt, Germany. MTK has been obtaining travel support and speakers fees from Steigerwald Arzneimittelwerk GmbH, Darmstadt, Germany.

Introduction

Small intestinal bacterial overgrowth (SIBO) is a frequent condition characterized by an abnormal increase in the bacterial population in the small intestine. It is associated with digestive disorders, metabolic disturbances, and an elevated cardiovascular risk in patients with dyslipidemia. Emerging evidence suggests that SIBO may aggravate lipid metabolism abnormalities by disrupting the gut microbiota.

Aims & Methods

The aim of the study was to determine the prevalence of SIBO among patients with dyslipidemia and evaluate the impact of SIBO-targeted therapy on lipid metabolism correction. The study included 342 patients with dyslipidemia. SIBO was diagnosed via hydrogen breath testing. Patients received a combined therapy with rifaximin (400 mg TID for 14 days) followed by Saccharomyces boulardii CNCM I-745 (250 mg BID for 14 days). Clinical symptoms, lipid profiles (total cholesterol, triglycerides, LDL-C, HDL-C), apolipoprotein levels (ApoA1, ApoB), and homocysteine were assessed before and after treatment.

Results

SIBO was detected in 45.3% of patients with dyslipidemia. Combined therapy significantly reduced the prevalence of SIBO to 18% and alleviated clinical symptoms such as abdominal pain, bloating, meteorism, and stool disturbances. Notably, therapy led to significant improvements in lipid profiles: reductions in total cholesterol, LDL-C, triglycerides, ApoB, and homocysteine levels, alongside increases in HDL-C and ApoA1. These improvements were comparable between patients receiving statin therapy and those not receiving it.

Conclusion

SIBO is highly prevalent in patients with dyslipidemia and may contribute to lipid metabolism disorders and cardiovascular risk. Targeted therapy with rifaximin and S. boulardii effectively reduces SIBO prevalence, improves gut symptoms, and enhances lipid parameters. Integrating SIBO treatment into dyslipidemia management strategies offers promising new therapeutic opportunities for cardiovascular risk reduction.