Introduction

Colon capsule endoscopy (CCE) may be recommended as a screening test for individuals under the age of 50 with low familial risk, diagnosed with irritable bowel syndrome (IBS) but lacking alarming symptoms and showing no fecal immunochemical test (FIT) positivity.

Aims & Methods

In the present study, our aim was to assess the efficacy, feasibility and acceptance of CCE in IBS patients with low risk of CRC, and our secondary aim was to assess polyp detection rates, transit times, cleanliness level and patient satisfaction. From April 2022 to April 2024, we conducted a prospective study at our institution involving 196 patients with IBS under the age of 50 (130 (66%) males, 66 (44%) females). We applied first in the literature, the recently developed colon capsule endoscopy technology of the Anx Robotics (USA) Navicam dual-camera CCE for this comprehensive assessment. The new first generation Navicam CCE measures 31mm in length and 11.6mm in diameter, weighing approximately 3 grams. The two cameras operate at adaptive frame rate of 0.5 to 16 pic/sec, with adaptive focus of 0-30 mm, providing an image resolution of 480x480 pixels. The minimum battery time is 12h, and this is a fully functional panenteric capsule. Colonoscopy under anaesthesia was offered to all patients, and after detailed information and signing the consent form, they chose CCE as the first examination method. We identified and addressed the incomplete cases, recorded capsule transit times, and calculated the polyp detection rates. If polyps were detected, patients underwent subsequent colonoscopy with Propofol sedation for polyp removal and histological analysis.

Results

Out of the total cases, 8.7% (n=17) were incomplete. The average colon and total transit time was 201.95 and 360.55 mins, respectively. Our study revealed a remarkable 14.8% (n=29) polyp detection rate (PDR) among the participants. PDR varied across age groups (18-30yo: 12.5%, 31-40yo: 14.04%, 41-50yo: 17.39%). Polyp sizes were categorized as <5mm (n=20), 5-7mm (n=6), and >7mm (n=3). The majority of polyps were located in the sigmoid colon (n=12), followed by the unspecified left colon (n=10) and the right colon (n=7). Subsequent colonoscopy due to positive CCE performed in all patients and detected an additional 6 small polyps (<3mm). In 4 cases, colonoscopy yielded negative results. However, upon conducting a back-to-back colonoscopy all of the previously undetected polyps were eventually found. Histology results revealed one high-grade dysplastic polyp. The average cleanliness level of the colon was assessed using the CCE Cleansing Score (CC-CLEAR). For the coecum, the right and left colon, the average scores were 5.5-7-8, respectively. Impressively, 95% of participants reported high tolerance, and 91% of respondents expressed a preference for CCCE as the next screening procedure too and colonoscopy only after a positive CCE result.

Conclusion

Navicam colon capsule endoscopy emerges as a useful and feasible screening tool, demonstrating unparalleled promise in detecting polyps among asymptomatic individuals. Its polyp detection rate, cost-effectiveness, patient-friendly nature, and agreement with colonoscopy findings position it as a potent complementary method for advancing colorectal screening in low CRC risk individuals.

Introduction

Nearly 25% of patients are diagnosed with Inflammatory Bowel Disease (IBD) under 18 years old of age. To date, there are no transition models established and recommended in IBD setting, so each center tends to develop a transition model based on its own needs and experience.

Aims & Methods

To compare the effectiveness on transition readiness and quality of life of two different modes of transition, one based on sending the subject to a first gastroenterological visit in the clinic with the support of a clinical report prepared by the pediatrician (letter-based transition) and the other one characterized by combined visits in the presence of both the pediatrician and adult gastroenterologist (combined-visit- based transition).
From 2018 to 2021, patients diagnosed with IBD, aged between 16 and 19 years, and followed at the Paediatric Gastroenterology and Hepatology Unit of the Azienda Ospedale Università Padova, were randomized to the letter-based transition or the combined- visits-based transition. The transition readiness was verified using the Transition Readiness Assessment Questionnaire (TRAQ), whilst the quality of life was analysed using the Pediatric Quality of Life Inventory TM at the start of the study, at six months and after one year.

Results

The final sample analyzed consisted of 40 patients, 22 assigned to the letter-based group (10 males, mean age 18.6 ± 0.4) and 18 to the combined-visits groups (10 males, mean age 18.6 ± 0.5) with similar age and sex distribution. Twenty-one and 18 reached T2, respectively, and 17 in both groups reached T3. The clinical activity and calprotectin value did not change along the study in both groups (p >0.05). Three azathioprine and 4 anti-TNF therapy were stopped after transition. The TRAQ questionnaire improved significantly during the study both in the letter-based group (from 72.1 ± 12.46 to 82.35 ± 5.88, p 0.002) and in the combined-visits group (from 66.52 ± 15.06 to 76.0 ± 12.83, p 0.008). No significant change was observed in patients' perceived quality of life along the study in the letter-based group (from 83.9±8 to 86.2 ± 9.54, p = 0.17) while it improved in the combined-visits group (from 82.5 ± 8.23 to 89.1 ± 7.63, p <0.05).

Conclusion

Our data suggest that both transition models are able to obtain a marked improvement in transition readiness, while the quality of life improves only in the combined-visits transition. Therefore, despite the letter-based transition approach is a good option interms of costs and time sparing, the combined-visits process should be preferable when possible to improve both transition readiness and quality of life.

Introduction

Multiple sclerosis (MS) is a chronic, immune-mediated demyelinating disease of the central nervous system (CNS) affecting young adults, with a female preponderance.¹ A large number of evidences indicate that the gut-brain axis is involved in the pathophysiology of neurodegenerative diseases, including MS. In addition to symptoms caused by CNS pathology, the majority of MS patients frequently exhibit functional gastrointestinal (GI) disorders, such as constipation, dysphagia, dyspepsia, fecal incontinence, and dysbiosis.² Novel findings in both MS patients and animal models propose the ENS as the first site of origin of MS, due to its interaction with microbial-derived factors and immune responses.^3,4

Aims & Methods

Aim: The aim of the present study, supported by a BINC-Genève grant, was to investigate the effect of cuprizone-mediated demyelination on the structural and functional integrity of the ENS.
Methods: Female C57/Bl6 (3±1 weeks old; N=18/group) mice were fed with standard diet (SHAM) or with standard diet supplemented with 0.25% (w/w) cuprizone for 4 weeks (CPZ). Animal health status was monitored by recording body weight daily. In SHAM and CPZ-treated mice changes in recognition memory and locomotor activity were evaluated using the novel object recognition, open field, beam walking tests. At the end of the behavioral tests, animals sacrificed by cervical dislocation and analyzed for changes in gut function. GI transit was assessed by measuring the distribution of nonabsorbable-FITC-labeled dextran throughout the GI tract. Changes in contractility were recorded in ileum segments following: i) 60 mM KCl; ii) cumulative addition of carbachol (CCh; 0.1-100 μM); iii) electric field stimulation (EFS, 0-40 Hz). The distribution of neuronal (HuC/D, ChAT) and glial (S100β, PLP1) markers was determined by immunohistochemistry and confocal microscopy in longitudinal-muscle-myenteric plexus whole-mount ileum preparations. Expression of myelin-related genes was analyzed by RT-qPCR in ileal tissue samples.

Results

CPZ administration led to weight loss (-20%) and caused a delayed GI transit (p<0.001), associated to deficits in recognition memory and locomotor activity. In vitro contractility studies showed reduced frequency and amplitude of contractions in CPZ mice (-10% and -35.3%, respectively; p<0.05). CPZ treatment determined changes in receptor- and not-receptor mediated excitatory responses (-28% of Emax to CCh and -33% of contraction to KCl, respectively; p<0.01) together with reduced EFS-induced contractions (-24.5% at 40 Hz; p<0.01). In the myenteric plexus of CPZ mice, we found marked alterations in glial cells distribution, accompanied by a significant reduction of the number of HuC/D⁺ neurons (-15%; p<0.01), and disrupted cholinergic network (-30% in ChAT immunoreactivity; p<0.01). Significant changes in myelin-related genes expression (MOG, MBP, PLP1) were found in ileal tissues of CPZ compared to SHAM mice.

Conclusion

Our findings show that cuprizone determines small intestine dysmotility and altered myenteric neuro-glial plasticity within the ENS of female mice. Further studies are warranted to assess the mechanisms that lead to the onset and spread of neurodegeneration within the gut, from the gut to the brain, and vice versa.

References

REFERENCES:
¹Cloake NC, et al. J Clin Med. 2018;7:342
²Levinthal DJ,et al. Mult Scler Int. 2013;2013:319201
³Wunsch M, et al. Acta Neuropathol. 2017;134:281-295
⁴Parodi B, Kerlero de Rosbo N. Front Immunol. 2021;12:718220