Introduction

Systemic sclerosis (SSc) is an autoimmune connective tissue disease characterized by vasculopathy and fibrosis. The gastrointestinal tract is one of the most frequently involved systems, manifesting as hypomotility of the affected segments. As SSc survival rates increase, digestive manifestations are becoming more important for the comprehensive management of affected patients.

Aims & Methods

Objective: To analyze the prevalence of digestive symptoms and dysmotility of the gastrointestinal tract in patients with systemic sclerosis and to assess their impact on the quality of life.
Methods: Cross-sectional study in a cohort of active patients with SSc, performed between January and July 2022. Digestive symptoms were evaluated by standardized questionnaires (UCLA-GIT 2.0 and a motility symptoms questionnaire). Health-related QoL was evaluated using the SF-36 questionnaire. Demographic, clinical-immunological data and results of examinations (upper endoscopy, esophageal manometry, gastric emptying scintigraphy, intestinal manometry, and CT scans) were collected from clinical records.

Results

183 patients with SSc participated in the study (age 59±12 years, 103 (55%) patients had limited cutaneous SSc, 43 (24%) diffuse SSc, and 37 (21%) sine-sclerosis SSc). 139 (77%) patients reported having at least one moderate digestive symptom (>1 day/week). The prevalence of digestive symptoms correlated negatively with overall quality of life measured by SF-36 (r= -0.503, IC -0.615 to -0.397, p=<0.001). Gastrointestinal motility assessments detected esophageal motor abnormalities in 67/123 (55%) patients, gastroparesis in 18/31 (58%) patients (mild n=6, moderate n=5, severe n=7), small bowel dysmotility by manometry in 6/6 (100%) (neuropathic n=1, myopathic n=5), and dilated small bowel loops by CT scan in 6/65 (9.2%) patients. Severe gastrointestinal involvement (gastroparesis and/or small bowel dysmotility, n=21, 11%), was associated with older age at SSc onset (45 ± 9 vs. 36 ± 14 years; p=0.012), the diffuse subtype (57% vs 18%; p=0.001), myositis (24% vs. 3%, p=0.011), tendon friction rubs (29% vs 3%, p=0.003) and with erosive esophagitis (10% vs. 57%, p=0.001). Patients with severe gastrointestinal involvement had a higher digestive burden, measured by UCLA GIT 2.0 score (1.05 ± 0.63 vs 0.62 ± 0.51; p=0.043) mainly due to reflux subscore (1.07 ± 0.63 vs 0.58 ± 0.61; p=0.001) and bloating subscore (1.85 ± 0.78 vs 1.23 ± 0.94; p=0.001)

Conclusion

Patients with SSc present a high prevalence of digestive symptoms and objective gastrointestinal dysmotility that negatively influence their quality of life. SSC patients with severe gastrointestinal dysmotility may represent a different disease phenotype.

References

Denton CP, De Lorenzis E, Roblin E, Goldman N, Alcacer-Pitarch B, Blamont E, Buch M, Carulli M, Cotton C, Del Galdo F, Derrett-Smith E, Douglas K, Farrington S, Fligelstone K, Gompels L, Griffiths B, Herrick A, Hughes M, Pain C, Pantano G, Pauling J, Prabu A, O'Donoghue N, Renzoni E, Royle J, Samaranayaka M, Spierings J, Tynan A, Warburton L, Ong V. Management of systemic sclerosis: British Society for Rheumatology guideline scope. Rheumatol Adv Pract. 2023 Mar 14;7(1):rkad022. doi: 10.1093/rap/rkad022.
McMahan ZH, Kulkarni S, Chen J, Chen JZ, Xavier RJ, Pasricha PJ, Khanna D. Systemic sclerosis gastrointestinal dysmotility: risk factors, pathophysiology, diagnosis and management. Nat Rev Rheumatol. 2023 Mar;19(3):166-181. doi: 10.1038/s41584-022-00900-6.

Disclosure

Nothing to disclouse

Introduction

The Maastricht VI/Florence Consensus recommends eradication of all Helicobacter pylori (Hp) infections. However, retreatment strategies after therapeutic failure remain inconsistent.

Aims & Methods

To evaluate the reasons and associated factors for non-retreatment after a failure of Hp eradication treatment.
Systematic, prospective, multicenter, non-interventional registry of clinical practice by European gastroenterologists on the management of Hp infection (Hp-EuReg). Patients who failed eradication treatment between 2013-2024 and were registered in AEG-REDCap were analysed and categorised into two groups: retreatment (control group) and non-retreatment. Reasons for no retreatment were also classified according to either the medical or the patient perspective. Multivariate logistic regression was conducted to identify factors associated with no retreatment from both the patient and medical perspectives, each compared with the control group.

Results

Overall, 6,904 patients were evaluated; 950 (14%) were not retreated: 41% due to a medical decision, 50% due to a patient decision, and 9% due to other reasons. The most frequent reasons for no retreatment were: previous poor tolerance, unclear indication, multiple prior eradication attempts, and previous non-compliance. From the medical perspective, factors significantly associated with no retreatment were: age ≥ 71 years (OR 1.49; 95% CI 1.04-2.13), previous non-compliance (OR 4.27; 95% CI 2.64-6.93), number of previous attempts (OR 2.07-9.25; 95% CI from 1.57-2.73 to 6.15-13.93) and previous treatment discontinuation due to adverse events (OR 2.06; 95% CI 1.19-3.56). From the patient perspective, the factors significantly associated with no retreatment included: being male (OR 1.34; 95% CI 1.10-1.63), having undergone two to four previous eradication attempts (OR 1.69-3.60; 95% CI from 1.16-2.44 to 1.75-7.41) and previous non-compliance (OR 10.04; 95% CI 7.37-13.68).

Conclusion

A significant proportion (14%) of European patients are not retreated after Hp eradication failure. Key barriers include advanced age, a history of poor treatment adherence, and multiple prior eradication failures. The decision to avoid re-treatment was frequently driven by patient-related factors, although medical reasons also played a relevant role, highlighting the importance of shared decision-making and enhanced patient education.

References

1. Gisbert JP, Alcedo J, Amador J, Bujanda L, Calvet X, Castro-Fernández M, et al. V Spanish Consensus Conference on Helicobacter pylori infection treatment. Gastroenterol Hepatol Engl Ed. mayo de 2022;45(5):392-417.
2. 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. septiembre de 2022;71(9):1724-62.
3. Banks M, Graham D, Jansen M, Gotoda T, Coda S, Di Pietro M, et al. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut. septiembre de 2019;68(9):1545-75.

Disclosure

Olga P. Nyssen has served as a speaker or has received research funding from Allergan, Mayoly Spindler, Richen, Biocodex and Juvisé.
Javier P. Gisbert has served as speaker, consultant, and advisory member for or has received research funding from Mayoly, Allergan/Abbvie, Diasorin, Richen, Juvisé, Biocodex.
The remaining authors declare no conflicts of interest.

Introduction

Incidental inflammation of the terminal ileum is not uncommon in individuals who are submitted to screening colonoscopy. It is mostly mild and considered to have a benign course without the need for immunosuppressive therapy used for moderate Crohn’s disease. In the light of recent literature highlighting the effectiveness of early treatment of Crohn’s Disease we sought to determine the natural course of asymptomatic terminal ileitis in our pool of individuals who underwent screening (ileo)colonoscopy, and in particular which patients ended up being treated with biologics in real life , as well as any baseline factors.

Aims & Methods

We included individuals from the endoscopic database with asymptomatic terminal (Crohn’s) ileitis in the last 5 years: we only included those with recorded endoscopic images available for endoscopic assessment with the SES-CD score and biopsies compatible with Inflammatory Bowel Disease (IBD) without a history of significant NSAID consumption. We recorded baseline characteristics (age, gender, smoking status, IBD family history, extra-intestinal autoimmunity), endoscopic severity, degree of histologic inflammation and biomarkers of inflammation (C-RP, Fecal Calprotectin). Finally we went through the Greek Prescription Database to find out the ones that were prescribed with biologics, steroids or had IBD-related surgery or hospitalization. We used point-biserial correlation, Pearson correlation, chi-square test to establish any variable correlations.

Results

We included 46 individuals : 28 women, 18 men with a median age of 55.8 years and a median follow up of 46.8 months. Nine of them were smokers (19.5%) and 10 (21.7%) had elevated C-RP (>0.5 mg/dL) and/or Fecal Calprotectin (>250 μg/mg). Steroids were used in 11 patients (23.9%) and only 1 had IBD-related surgery. Patients that received biologic therapy at some time-point amounted to 15 (32.6%): 9 with adalimumab (60%), 5 with ustekinumab (33.3%) and 1 patient received upadacitinib (concomitant rheumatoid arthritis). No factor other than an initial SES-CD score > 4 displayed statistically significant correlation with the future use of biologic therapy (p-bc=0,4214, p=0,0032). Interestingly enough most of the patients to eventually receive biologic therapy showed some kind of endoscopically visible ileocecal valve inflammation.

Conclusion

In this carefully selected but with a real life follow up group of patients with incidental asymptomatic terminal (Crohn’s) ileitis a rather surprising one third of patients was eventually treated with biologic therapy during a median period of a 4-year follow up. Only baseline endoscopic severity (SES CD score >4) predicted the use of biologic therapy (mostly adalimumab or ustekinumab). All those patients had moderate disease and uneventful disease course. We need more studies to determine the (endoscopic?) threshold for biologic therapy or the right non-invasive tool (intestinal ultrasound?) to monitor these individuals in order to prevent over (or under)treatment.

References

Jellyana Peraza, Marco Emilio Kaper, Andre Bargas, Iris Kim, Manasi Agrawal, Lone Larsen, Henrik Albaek Jacobsen, Tine Jess, Jean-Frederic Colombel, Joana Torres, Ryan C. Ungaro, Ashwin N. Ananthakrishnan. A Simple Endoscopic Score for Crohn's Disease (SES-CD) ≥ 7 Predicts Disease Progression. Alimentary Pharmacology and Therapeutics 2025. Mar;61(6):1011-1018. doi: 10.1111/apt.18492. Epub 2025 Jan 5.PMID: 39757503.

Introduction

The rising number of patients with intraductal papillary mucinous neoplasms (IPMNs) in countries with aging populations in the near future is predictable considering that the incidence of pancreatic cystic tumors is positively correlated with patient age and that IPMNs occur most frequently among multifocal pancreatic cystic tumors. Although the majority of IPMNs detected incidentally through various imaging tests have a tumor diameter ≤10 mm and are thus deemed low-risk for carcinogenesis, the possibility of malignant transformation persists. Thus, such IPMNs are subject to periodic follow-up diagnostic imaging. Therefore, an appropriate surveillance system must be established to effectively and efficiently identify cases of IPMN-related malignant transformation, which develops only in few IPMN cases, under the constraints of limited national healthcare funding.

Aims & Methods

In the current study, we analyzed the clinical background observed at initial patient presentation that affect long-term prognosis and tried to narrow the population for whom continued evaluation is inevitable. The study included 1645 patients with IPMNs (776 men and 869 women) treated at our hospital since 2010. We examined the types and timing of medical intervention (surgical resection or pancreatic carcinogenesis) selected mainly in terms of worrisome features (WF) as advocated by the international guidelines (Pancreatology, 2024:24;255–70) for IPMN treatment. Statistical analysis was performed using the chi-square test, log-rank test, and Cox proportional hazards model, with statistical significance set at α = 0.05.

Results

During the entire observation period, 123 patients (7.5%) had IPMN-derived carcinoma (IPMN-DC), whereas 41 patients (2.5%) had concomitant pancreatic ductal adenocarcinoma (PDAC), which required medical intervention. The proportion of cases with c-Stage I, II, III, and IV (UICC 8th edition) at the time of diagnosis were 52.0%, 43.9%, 0.8%, and 3.3%, respectively, for IPMN-DC and 39.0%, 31.7%, 9.8%, and 19.5%, respectively for PDAC. A significantly higher proportion of PDAC cases were diagnosed with an advanced disease stage that developed earlier in time. Factors with significantly shorter time for IPMN-DC medical intervention were: maximum cyst diameter ≥30 mm, non-branched type, main pancreatic duct diameter ≥5 mm, and septal nodal structure for IPMN-DC. For PDAC, these factors were maximum cyst diameter ≥30 mm, main duct type, main pancreatic duct diameter ≥5 mm, septal nodal structure, cyst enlargement (≥2.5 mm/year), and abnormally high levels of CA19-9. Both groups could be significantly stratified by the number of WFs. However, the difference was more distinct in IPMN-DC, whereas <1% (9/1190) medical intervention from the group with 0 WFs was noted in PDAC. Relative risk (hazard ratio, HR) analysis of WF in which proportional hazard was maintained revealed that the presence of septal nodular structure (HR 5.2), maximum cyst diameter ≥30 mm (HR 3.3), and main pancreatic duct diameter ≥5 mm (HR 2.6) were significant factors for IPMN-DC, whereas abnormally high CA19-9 levels (HR 5.0) and septal nodular structure (HR 4.8) were significant for PDAC. Conversely, a significantly higher percentage of patients who exhibited these factors at initial presentation also later developed IPMN-DC or PDAC.

Conclusion

Ten percent of IPMN cases will develop IPMN-DC or PDAC, thereby requiring careful follow-up, especially in cases with septal nodules, abnormally high CA19-9 levels, and cysts with a maximum diameter of ≥30 mm.

Introduction

H.pylori infection is widespread in the world and affects about 41% of the world's population. H. pylori causes chronic gastritis. However, the development of atrophic gastritis is associated both with the duration of the disease and, possibly, with the presence of virulence factors of H.pylori. CagA is one of the most significant virulence factors of H.pylori.

Aims & Methods

The aim of the study is to determine the influence of the presence antibodies to CagA virulence factor of H. pylori on the development of atrophic gastritis according to the OLGA system.
Methods: 221 H. pylori-positive patients (69 men and 152 women) were examined in A.S. Loginov Moscow Clinical Scientific Center as part of the study on the prevalence of H. pylori in Moscow (Grant of the Moscow Center for Innovative Technologies in Healthcare, 0903-1/22). The mean age of the patients was 49.80 ± 13.66 years (from 20 to 73 years). The presence of H.pylori infection was confirmed by a ¹³C-urea breath test. All patients underwent endoscopy with morphological examination by the OLGA system and serological determination of total antibodies to CagA antigen («Vector-Best», Russia, the normal level is < 0.41 conventional unit (c.u.)). All patients were divided into 5 groups based on the OLGA system gastritis stage (from stage 0 to IV stage). The mean age of patients in the groups was 43.33, 46.52, 53.87, 56.76, and 56.86 years respectively.

Results

Results are presented in Table 1. Total antibodies to CagA virulence factor were detected in 57.47% of patients (127 of 221 patients). The proportion of CagA-positive patients was higher in groups with atrophic gastritis and was rising with increasing stage of atrophy (maximum at stage IV - 85.7%) [Kendall’s correlation coefficient (K.c.c.) is 0.247 (p<0.01)]. The trend is noted that the mean age of patients increases in groups from 0 to IV stage of atrophy according to OLGA system, the K.c.c. is 0.282 (p<0.01). Groups with II, III and IV stages of atrophy were comparable in age, but proportion of CagA-positive patients reached a maximum at stage IV of atrophy - 85.7%.

Table 1: Frequency of detection CagA-positive patients and mean age of patients in groups with different stage of atrophic gastritis according to the OLGA system

Conclusion

We found positive relationship between the presence of antibodies to CagA antigen and the atrophy stage of the OLGA system in H. pylori gastritis patients.

Disclosure

This study is part of the study on the prevalence of H. pylori in Moscow (Grant of the Moscow Center for Innovative Technologies in Healthcare, 0903-1/22).

Introduction

Diabetes is a known risk factor for pancreatic cancer (PC), potentially mediated by mechanisms such as hyperinsulinemia, insulin resistance, chronic inflammation, and hyperglycemia. Prediabetes shared many of these pathophysiological features; however, its association with PC remains inconclusive.

Aims & Methods

We aimed to evaluate the association between prediabetes and risk of PC and to determine whether changes in glycemic status modify the subsequent PC risk. This retrospective cohort study used data from a territory-wide electronic healthcare database. Adults (≥18 years) with at least one hemoglobin A1c (HbA1c) or fasting glucose (FG) measurement between January 2007 and December 2022 were included. Baseline glycemic status was classified as: (1) normoglycemia (HbA1c <5.7% or FG <5.6 mmol/L), (2) prediabetes (HbA1c 5.7-6.4% or FG 5.6-6.9 mmol/L), or (3) diabetes (HbA1c ≥6.5% or FG ≥7 mmol/L). The index date was the date of first recorded HbA1c or FG. Patients were followed until PC, pancreatectomy, death, or study end date (December 31, 2022). Exclusion criteria included prior PC, immunoglobulin G4-related disease, and type 1 diabetes. To minimize reverse causality between diabetes and PC, individuals with PC diagnosed within two years of the index date or with less than two years of follow-up were excluded. The primary outcome was incident PC. Covariates included demographic factors, body mass index, smoking status, alcohol use disease, metabolic and cardiovascular comorbidities, diabetes-related complications, and concomitant medications (including aspirin, non-steroidal anti-inflammatory drugs [NSAIDs] statins, and antidiabetic agents). Adjusted hazard ratios (aHRs) were estimated using multivariable Cox regression. Among individuals with normoglycemia or prediabetes at baseline, glycemic trajectories over the first 2 years were categorized as: (1) persistent normoglycemia, (2) reversion from prediabetes to normoglycemia, (3) persistent prediabetes, and (4) progression from prediabetes to diabetes, with PC risk evaluated accordingly.

Results

A total of 1,977,149 individuals were included (median age:55.3 [IQR:45.0-65.0] years; 44.5% male), with 1,295,290 (65.5%) classified as normoglycemia, 469,236 (23.7%) as prediabetes, and 212,623 (10.8%) as diabetes at baseline. Over a median follow-up of 8.8 (IQR:5.4-11.6) years, PC developed in 1,419 (1.26/10,000 person-years) normoglycemic, 859 (2.19/10,000 person-years) prediabetic, and 551 (2.92/10,000 person-years) diabetic individuals. The 14-year cumulative PC incidence among three groups was shown in Figure 1 (log-rank P <0.001). Compared with normoglycemia, prediabetes and diabetes were associated with 27% (aHR:1.27; 95%CI:1.17-1.39) and 56% (aHR:1.56; 95%CI:1.40-1.75) higher PC risk, respectively. Each 1% increase in HbA1c was associated with an 11% increased risk (aHR:1.11; 95%CI:1.07–1.15). At year 2, of those with prediabetes at baseline, 68,268 (14.5%) progressed to diabetes, 81,122 (17.3%) reverted to normoglycemia, and 319,846 (68.2%) remained prediabetic. Among normoglycemics, 81,122 (6.3%) remained persistently normoglycemic. Compared with persistent normoglycemia, PC risk was higher in persistent prediabetes (aHR:1.37; 95%CI:1.22-1.53) and prediabetes progressing to diabetes (aHR:2.22; 95%CI:1.91-2.59), but not in those reverting to normoglycemia (aHR:1.17; 95%CI:0.96-1.42).

Conclusion

Prediabetes was independently associated with an increased risk of PC compared with normoglycemia. Early intervention to revert prediabetes to normoglycemia may be a modifiable oncopreventive strategy to reduce PC risk.