Introduction

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing public health concern, with projections indicating that over half of the global population could be affected by 2040. MASLD is strongly linked to cardiometabolic risk factors and can progress to advanced liver diseases such as fibrosis, cirrhosis, and hepatocellular carcinoma. It is characterized by lipid accumulation within hepatocytes, leading to oxidative stress and inflammation. Gilbert’s syndrome (GS), a benign hereditary condition marked by elevated unconjugated bilirubin, is known for its antioxidant and anti-inflammatory properties. These properties have been associated with a reduced risk of several cardiometabolic conditions, raising the question of whether GS may influence the progression or severity of liver disease in MASLD.

Aims & Methods

This study aimed to investigate the potential relationship between GS and MASLD, focusing specifically on the impact of bilirubin’s effects on liver fibrosis and disease severity. A retrospective cohort study was conducted at Nawaloka Hospital, Colombo, Sri Lanka. Medical records from January 2022 to December 2024 were reviewed to extract sociodemographic, anthropometric, and biochemical data. Liver fibrosis was assessed using Fibro Scan® 502. Data analysis was performed using SPSS version 28, employing univariate analyses including t-tests, chi-square tests, and simple linear regression. A P-value <0.05 was considered statistically significant.

Results

A total of 180 patients with MASLD were included, of whom 36 were identified as having GS (defined by total bilirubin >1 mg/dL with elevated unconjugated bilirubin) and 144 without. No statistically significant difference in liver stiffness measurements (LSM) was observed between patients with and without GS (P = 0.8919). GS was not significantly associated with the presence or severity of liver fibrosis. Increasing age (P = 0.0278), body mass index (BMI) (P = 0.0330), and blood sugar levels (P = 0.0257) were positively associated with liver fibrosis. Demographic and clinical characteristics of the participants are summarized in Table 1.

Conclusion

There was no difference in the presence of fibrosis in MASLD patients with GS without GS in our population. This is in keeping with the view that GS is a benign condition. The significant associations of age, BMI, and blood sugar with increased fibrosis are well documented.

Introduction

Idiopathic gastroparesis (IG) remains a challenging condition, with few effective therapeutic options available. Despite recent European and international consensuses, some management modalities are still different in the French practice (1).

Aims & Methods

We aimed to develop French recommendations on the diagnosis and management of IG in adults and paediatric patients, highlighting the similarities and differences with recent consensuses. A Delphi process was conducted among a panel of 16 French neurogastroenterology experts, including gastroenterologists and paediatricians. A first list of statements was drafted with a literature summary. After revisions and clarifications, 3 voting rounds were conducted and consensus statements were identified (defined as ≥ 80% agreement).

Results

Consensus was reached for 39 out of 46 statements. Definition and diagnostic modalities were similar to recent guidelines. IG was defined as symptoms associated with delayed gastric emptying (GE), in the absence of a mechanical obstruction. The panel agreed that nausea and vomiting are cardinal symptoms, with postprandial distress symptoms frequently overlapping. Variable presentations according to age were highlighted in paediatric patients.
Delayed GE can be confirmed by either scintigraphy or a GE breath test, using a solid meal, and a 4-hour measurement. Food retention at endoscopy was not considered a diagnostic criterion. Pyloric EndoFlip was not considered a diagnostic or pretherapeutic tool. A blood test and screening for Helicobacter pylori were supported before diagnosing IG.
Regarding the management, like in recent guidelines, the panel supported a first-line therapy using dietary advice and dopamine antagonists (metoclopramide or domperidone). The panel supported the efficacy of intravenous erythromycin, but not oral erythromycin. Agreement on the efficacy of other drugs, including prucalopride, antiemetics, or neuromodulators, was not reached. The use of nutritional support was recommended if deemed necessary for refractory vomiting and malnutrition, with enteral post-pyloric nutrition recommended as the first option.
The consensus supported different strategies for the management of refractory gastroparesis. Stopping opioids, or drugs inducing delayed GE, and the treatment of associated constipation were recommended before considering more invasive procedures. The efficacy of pyloric toxin injection was not agreed upon. Gastric endoscopic pyloromyotomy and gastric electrical stimulation were considered effective therapies for refractory IG. Finally, surgical procedures were not supported.

Conclusion

This consensus shows that the diagnostic modalities for IG are similar in France as compared to international guidelines, but highlights differences in the management of refractory gastroparesis, supporting endoscopic pyloromyotomy or the implantation of gastric electrical stimulation.

References

1. Schol J, Wauters L, Dickman R, Drug V, Mulak A, Serra J, et al. United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis. United European Gastroenterol J. 2021 Apr;9(3):287–306.
2. Schol J, Huang IH, Carbone F, Fernandez LMB, Gourcerol G, Ho V, et al. Rome Foundation and international neurogastroenterology and motility societies’ consensus on idiopathic gastroparesis. Lancet Gastroenterol Hepatol. 2025 Jan;10(1):68–81.

Disclosure

HS received lecture fees from Enterra Medical, and Viatris.

Introduction

Microplastic particles (MPs) have previously been confirmed to be found in the human body and are suspected to lead to systemic health effects (1). One biological matrix in which MPs have been detected is human faeces (2). While there is growing evidence suggesting potential impacts on the gut microbiome from animal (3) and in-vitro/ex-vivo studies (4), studies investigating this relationship in the human are still lacking.

Aims & Methods

This pilot study aimed to investigate the impact of short-term plastic reduction on the gastrointestinal tract of healthy participants, focussing on MP presence and gut microbial composition.
Sixty healthy volunteers participated by providing two stool samples: one prior to and one after a seven-day intervention during which they actively minimized plastic exposure. To facilitate the reduction, participants were provided with plastic-free alternatives (e.g., glass water bottles, wooden kitchen utensils, plastic-free dental care products, tin lunch boxes), together with instructions on how to avoid plastic-packaged goods and find alternatives. Dietary habits and plastic contact were recorded using detailed questionnaires to assess behavioural changes and identify potential sources of exposure. Stool samples were analysed using 16S rRNA gene sequencing for changes in microbial diversity and potential differential taxa. Additionally the samples were frozen at –80°C for future MP quantification, where method development is ongoing.

Results

Fifty-five participants completed the study, with an average self-reported success rate of 76% in adhering to the intervention. Forty percent of participants fully avoided plastic packaging, while 56% achieved partial avoidance. Participants noted challenges, particularly in avoiding plastic in meat and dairy products and during restaurant visits. Despite these obstacles, 92.7% expressed a lasting commitment to reducing plastic use post-intervention, with many reporting intentions to continue purchasing fresh products, reduce fast food intake, and adopt sustainable household practices, especially replacing plastic utensils. Initial microbiome analysis revealed no significant changes in alpha or beta diversity following reduced plastic exposure; however, differential abundance analysis identified potential specific taxa shifts. One species each within the genera Clostridium, Ruminococcus, and Blautia showed reduced abundance post-intervention, while species from the genera Bacteroides and Anaerostipes were associated with increased abundance after plastic fasting.

Conclusion

A short-term reduction in plastic exposure is feasible and can effectively raise awareness and promote long-term behavioural change in plastic consumption habits. However, no significant changes in gut microbial diversity were observed within the study period, with only shifts in a limited number of species visible. Due to the stability of the gut microbial composition, longer changes in plastic exposure might be necessary to trigger stronger effects.

References

(1) Prata, J. C., da Costa, J. P., Lopes, I., Duarte, A. C., & Rocha-Santos, T. (2020). Environmental exposure to microplastics: An overview on possible human health effects. The Science of the total environment, 702, 134455. https://doi.org/10.1016/j.scitotenv.2019.134455
(2) Schwabl, P., Köppel, S., Königshofer, P., Bucsics, T., Trauner, M., Reiberger, T., & Liebmann, B. (2019). Detection of Various Microplastics in Human Stool: A Prospective Case Series. Annals of internal medicine, 171(7), 453–457. https://doi.org/10.7326/M19-0618
(3) Hirt, N., & Body-Malapel, M. (2020). Immunotoxicity and intestinal effects of nano- and microplastics: a review of the literature. Particle and fibre toxicology, 17(1), 57. https://doi.org/10.1186/s12989-020-00387-7
(4) Tamargo, A., Molinero, N., Reinosa, J. J., Alcolea-Rodriguez, V., Portela, R., Bañares, M. A., Fernández, J. F., & Moreno-Arribas, M. V. (2022). PET microplastics affect human gut microbiota communities during simulated gastrointestinal digestion, first evidence of plausible polymer biodegradation during human digestion. Scientific reports, 12(1), 528. https://doi.org/10.1038/s41598-021-04489-w