Introduction

Fecal microbiota transplantation (FMT) is becoming an increasingly used procedure in the treatment of gastrointestinal diseases. In this summary, we present our experience of FMT in hematological indications and patients.

Aims & Methods

From January 2023 to January 2024, 15 FMT procedures in 7 patients were performed. The transplant was prepared by standard technique from a healthy donor at the Department of Microbiology. Hematology team was responsible for selecting patients with adequate FMT indication. Procedure was performed with standard gastroscope in 6 patients by transplantation into the distal duodenum, and in one patient by a colonoscope in the large bowel.

Results

Patient 1: acute GVHD and recurrent CD colitis after alogenic bone marrow transplantation (BMT) due to acute T-lymphoblastic leukemia. Application of FMT was done from caecum to rectum in a dose of 200 ml with complete symptom resolution and CD negativization Patient 2: alogenic BMT for MDS with development of severe small intestine GVHD refractory to standard immunosuppression. Two FMT performed with transplantation into the distal duodenum (200 ml in three weeks apart). Although relatively good clinical recovery was observed after 6-8 weeks, patient died 4 months later due to respiratory insufficiency and sepsis.
Patient 3 and 4. patients with AML in preparation for BMT. Due to repeated stool isolate of Pseudomonas aeruginosa, FMT was performed with the application of 200 ml of transplant (2 weeks apart) to the duodenum for the purpose of intestinal decolonization. Two weeks after FMT, the stool cultures showed a physiological flora and a planned BMT was performed. Patient 5 and 6: patients with alloBMT due to primary myelofibrosis who developed intestinal GVHD and CD colitis. 200 ml of transplant was applied (3 weeks aparat) to the duodenum. The condition improved quickly and in further follow-up CD toxin was negative with partial improvement of GVHD symptoms (one patient required additonal photopheresis). Patient 7: patient with AML in whom multidrug-resistant Enterococcus faecium has been isolated in coprocultures on several occasions during chemotherapy. Prior to the planned BMT, FMT was performed with the aim of intestinal decontamination with the application of 200 ml (2 weeks apart) of transplant to the distal duodenum. Stool analysis 2 weeks after FMT indicated physiological flora and a planned BMT was performed

Conclusion

Our experience indicates that FMT is a useful method in the treatment of GI pathology (GVHD, decontamination of the intestine before BMT and treatment of CD colitis) in hematological patients.

Introduction

Although the overall incidence of colorectal cancer (CRC) has declined in individuals over 50 years of age, CRC in young adults (CRCYA) continues to rise. Previous studies suggest that CRCYA is associated with worse prognosis, primarily due to a higher proportion of advanced-stage disease at diagnosis. Accordingly, early detection and resection of young-onset adenomas (YOAs), the precursor lesions of CRCYA, is critical for prevention. This study aimed to characterize the clinicopathological features associated with YOAs.

Aims & Methods

We retrospectively analyzed patients who underwent colonoscopic polypectomy at our institution between January and June 2020. Neoplastic polyps were evaluated for size, histology, morphology, and anatomical distribution. Comparisons were made between patients aged ≤50 years (YOA group, n = 89) and those aged >50 years (elder group, n = 432).

Results

A total of 958 neoplastic adenomas from 521 patients were analyzed—138 in the YOA group and 820 in the elder group. No significant differences were found in gender distribution, mean polyp size, or morphology. However, elder patients had more neoplastic polyps per person than younger patients (1.90 ± 1.31 vs. 1.54 ± 0.88; p = 0.014).
With regard to anatomical distribution, adenomas in the YOA group were more often located in the left-sided colon compared to those in the elder group (63.3% vs. 45.4%; p < 0.001).
Although the prevalence of advanced adenomas—defined as polyps ≥10 mm, with villous histology, or high-grade dysplasia—was also comparable between both groups. (19.4% vs. 19.9%; p = 0.523), histologically high-risk neoplastic lesions (villous adenoma, high-grade dysplasia, carcinoma in situ, and adenocarcinoma) were more frequent in the elder group (15.7% vs. 7.2%). In contrast, sessile serrated adenomas (SSAs) were more common in the YOA group (23.9% vs. 9.8%; p < 0.001).

Conclusion

While CRC remains more prevalent among older individuals, the comparable prevalence of advanced adenomas between younger and older adults raises concern for early carcinogenesis in young populations. Distinct histological features were observed: SSAs were more frequent in younger adults. Moreover, YOAs were predominantly located in the distal colon. These findings emphasize the need for tailored screening strategies and proactive endoscopic surveillance in younger adults. Future prospective studies are warranted to further clarify the epidemiology and risk profiles of YOAs.

Introduction

Functional and organic bowel diseases in children often present with gastrointestinal (GI) symptoms, yet systematic data on symptom profiles at first presentation limited. Functional bowel disorders (FBD) are common and often require costly and invasive diagnostic procedures. The Pediatric Structured Assessment of Gastrointestinal Symptoms (pSAGIS) is a validated tool that facilitates structured and standardized symptom assessment in pediatric outpatient settings (1).

Aims & Methods

We aimed to compare GI symptoms at first presentation in children with subsequently diagnosed functional (FD), any organic bowel disease (aOD), and specifically inflammatory bowel disease (IBD) using the pSAGIS. The diagnosis of FD was based on the Rome IV criteria (2). From 2016 and 2023, 1550 children completed the pSAGIS questionnaire at their first outpatient visit at St. Anna Children’s Hospital, Vienna. The tool assesses 21 GI symptoms (five grades, from no problem (0) to very severe (4)), grouped into five domains: abdominal pain, dyspepsia, diarrhea, constipation, and dysphagia/nausea. Symptom severity scores (0–12 to 20, depending on the number of items in each domain) were analyzed using median ± SD; p < 0.05 was considered significant.

Results

Of all patients (n=1550), 17.7% (n=274) were excluded due to non-gastroenterological diagnoses. 28.7% (n=445) were diagnosed with FD and 53.6% (n=831) with aOD, including 7.2% (n=111) with IBD. The number of symptoms rated as present (mild to very severe) was 6.4±3.0 SD (FD) vs. 4.8±2.9 SD (aOD) vs. 4.3±2.5 SD (IBD) (FD vs. aOD and vs. IBD: p<0.001). The number of symptoms rated as moderate to very severe was 4.3±3.7 SD (FD) vs. 2.2±3.2 SD (aOD) vs. 2.0±3.1 SD (IBD) FD vs. aOD and vs. IBD: p<0.001).

Symptom scores in all five domains were significantly higher in the functional group:

Conclusion

Children with functional bowel disorders report significantly higher symptom burden at first presentation compared to those with organic disease, including IBD. In addition to its role in long-term monitoring of treatment outcomes, pSAGIS may support early symptom-based differentiation. This could support more targeted diagnostic pathways and inform timely therapeutic decisions in pediatric gastroenterology.

References

(1) Hammer J et al, JPGN 2023; (2) Hyams JS et al, Gastroenterology 2016.

Introduction

The quantitative fecal immunochemical test (FIT) is widely used for colorectal cancer (CRC) screening. While the association between FIT concentration and the risk of advanced colorectal neoplasia (ACN) detection is well established, the predictive performance of current-round FIT concentration alone has limitations. Identifying additional predictive factors could enhance screening. For individuals with a prior colonoscopy, colonoscopy findings and quality metrics may serve as such factors.1 For those who did not undergo colonoscopy due to a negative FIT in the previous round, alternative predictors should be explored. We hypothesized that prior-round FIT concentration could serve as a potential predictor.

Aims & Methods

We aimed to investigate whether prior-round negative FIT concentration could predict CRC and ACN detection by conducting a cross-sectional analysis of data from the FIT arm of the SCREESCO, a nationwide randomized controlled trial on CRC screening in Sweden.1,2 A sample of the Swedish population aged 60 years was randomly assigned to one of three arms: the once-colonoscopy arm, FIT arm, or control arm. Individuals in the FIT arm were invited to undergo two rounds of quantitative FIT screening in the first and third years. A highly sensitive method was used to assess FIT positivity, with a cut-off concentration of ≥10 μg Hb/g feces. We estimated the detection rates of CRC and ACN in second-round colonoscopy based on first-round FIT concentration. Binary regression models were used to assess whether first-round FIT concentration was associated with CRC and ACN detection in the second round. The models included participant characteristics such as sex, body mass index, and smoking status, and second-round FIT concentration, in addition to first-round FIT concentration.

Results

A total of 1,991 individuals were included, with a median FIT concentration of 2.2 μg Hb/g feces (interquartile range: 0.4–4.6) in the first round and 21.8 (13.4–50.8) in the second round. CRC and ACN were detected during second-round colonoscopy in 23 (1.2%) and 267 (13.4%) individuals, respectively. Individuals with first-round FIT concentration of 0–1.9, 2.0–5.9, and 6.0–9.9 μg Hb/g feces had second-round CRC detection rates of 0.8%, 0.9%, and 2.6%, respectively, and ACN detection rates of 9.7%, 12.5%, and 15.9%, respectively. A higher first-round FIT concentration was associated with an increased risk of CRC (risk ratio per unit increase 1.27; 95% confidence interval 1.10–1.47) and ACN (1.08; 1.04–1.12) detection in the second round, after adjusting for the second-round FIT concentration and participant characteristics. For a fixed second-round FIT concentration, the absolute risk of second-round ACN detection increased with higher first-round FIT concentration. For instance, in a nonsmoking or ex-smoking male with a second-round FIT concentration of 20 µg Hb/g feces, the risk increased from 10.0% at < 0.2 µg Hb/g feces in the first round to 14.9% at 5 µg Hb/g feces and 19.6% at 9.9 µg Hb/g feces.

Conclusion

First-round negative FIT concentration is predictive of CRC and ACN detection in the second screening round. Even an increase in low levels of the FIT concentration is associated with future detection of these neoplasms. Incorporating first-round FIT concentration alongside second-round FIT concentration may enhance risk stratification in CRC screening, leading to more efficient use of colonoscopy resources.

References

1. Sekiguchi M, Westerberg M, Löwbeer C, Forsberg A. Gastrointest Endosc. 2025 Feb 4. doi: 10.1016/j.gie.2025.01.037. Epub ahead of print.
2. Forsberg A, Westerberg M, et al. Lancet Gastroenterol Hepatol. 20227: 513-21. doi: 10.1016/S2468-1253(21)00473-8.

Clinical Case Summary

Background: Alcoholic liver disease (ALD) is a major health concern, ranging from hepatic steatosis and alcoholic hepatitis (AH) to cirrhosis, and can progress to acute liver failure (ALF). Extrahepatic manifestations of AH include gastrointestinal bleeding, peripheral neuropathy, and alcoholic cardiomyopathy. However, the association between alcoholic hepatitis and acute inflammatory demyelinating polyneuropathy (AIDP) is rare and scarcely reported.
Case Presentation: A 35-year-old chronic alcoholic female with hypothyroidism presented with jaundice (bilirubin 13.3 mg/dL) and hepatomegaly. Two weeks later, she developed ascending lower limb weakness, absent reflexes, and reduced muscle power (right leg 3+/5, left leg 2/5). Nerve conduction studies were suggestive of demyelinating pathology. Lab workup revealed elevated AST (134 IU/L), ALT (31 IU/L), INR (1.9), and thiamine deficiency (23.7 μg/L). Other potential differentials, including viral hepatitis and autoimmune hepatitis, were ruled out based on negative serology for HBsAg, HCV, CMV, and autoimmune markers (ANA, anti-LKM antibodies). Despite thiamine supplementation and IV immunoglobulin (IVIG) therapy (0.4 g/kg/day for 5 days), the patient showed limited motor improvement. Progressive liver failure and sepsis led to death.
Conclusion: The pathophysiology of AIDP in the context of AH remains unclear but may involve immune dysregulation due to alcohol’s toxic effects on the nervous system. Early detection of AIDP in patients with AH is crucial, as these patients are at risk of respiratory failure and permanent neurological deficits. Although IVIG therapy may offer some improvement, the prognosis remains poor in cases complicated by severe liver failure. This case highlights the importance of recognizing and managing complications like AIDP in patients with AH.

Introduction

Early detection of gastric neoplasms remains challenging, even with enhanced endoscopic imaging. Photodynamic endoscopic imaging (PEI) with 5-aminolevulinic acid (5-ALA) is a novel diagnostic approach that exploits tumor-selective fluorescence. After oral administration, 5-ALA is converted via the heme biosynthesis pathway to protoporphyrin IX (PpIX), which accumulates in neoplastic cells and emits red fluorescence under violet-blue excitation. We developed specialized endoscope prototypes (first-generation prototype using a 410 nm laser, second-generation prototype with an enhanced 410 nm laser, and third-generation prototype employing a high-intensity LED light source) to visualize PpIX fluorescence in the stomach. These successive devices improved image brightness and enabled more objective tumor detection.

Aims & Methods

In this exploratory study at Tottori University Hospital, 54 patients with 60 early-stage gastric lesions (gastric adenomas or early gastric carcinomas) were examined. Patients received oral 5-ALA (20 mg/kg) three hours before endoscopy. PEI was performed using the prototype systems (excitation at 410 nm and detection of ~635 nm red fluorescence). Lesions were identified by their red fluorescent contrast against surrounding mucosa. After the procedure, patients were protected from strong light for 24 hours to prevent photosensitivity. Key outcomes were the fluorescence detection rate of known tumors, discovery of any additional lesions, and safety (adverse events).

Results

The overall fluorescence detection rate was 85.0% (51/60 lesions). PEI newly identified 11 synchronous lesions in 8 patients (14.8%). Among lesions with fluorescence, histological types included tubular adenocarcinoma and adenoma (tub/sig/adenoma: 49/0/13). All signet ring cell carcinomas (5/5) were fluorescence-negative. Among 12 post-H. pylori eradication gastric cancers, 11 (91.6%) exhibited detectable fluorescence. Adverse events included transient elevations in liver enzymes (9 cases), mild hypotension (1 case), and low-grade fever (1 case), all resolving spontaneously. No phototoxic reactions were observed under light-shielding protocols.

Conclusion

Oral 5-ALA-mediated photodynamic endoscopic imaging is a feasible and effective technique for objective visualization of early-stage gastric tumors. This method provides bright tumor-specific fluorescence in gastric adenomas and differentiated early cancers, enhancing lesion contrast and aiding detection. Although diffuse-type (signet ring cell) carcinoma may evade fluorescence due to limited PpIX accumulation, the overall ability of 5-ALA-PEI to highlight tumors could significantly augment current endoscopic screening practices. This emerging molecular imaging approach offers endoscopists a valuable tool for identifying gastric neoplasms, and ongoing device refinements may further improve sensitivity for subtle lesions.

Disclosure

Hiroki Kurumi and Yuichiro Ikebuchi declare no conflict of interest. Hajime Isomoto received research funding from FUJIFILM Corporation.

Clinical Case Summary

Background: Percutaneous endoscopic gastrostomy (PEG) tubes are commonly used for long-term enteral nutrition in critically or chronically ill patients [1]. Buried bumper syndrome (BBS), a rare but serious complication, occurs when the internal bumper migrates along the stoma tract, leading to tissue ischemia, infection, and potential tube dysfunction [2,3]. BBS typically manifests around 18 months post-placement, with acute presentations exceptionally rare [4]. This case highlights an unusual early onset of BBS, emphasizing the importance of vigilant post-procedural care [5].
Case report: An 83-year-old male with multiple comorbidities, including progressive oropharyngeal dysphagia following cervical spine surgery, underwent PEG tube placement for enteral nutrition. Postoperatively, mild oozing was managed by tightening the bumper. Twelve days later, erythema and pressure necrosis were noted due to excessive tightness, prompting loosening. Three weeks post-placement, localized cellulitis developed and was treated with antibiotics. Two months postoperatively, the PEG tube became dysfunctional, and endoscopic evaluation revealed a partially buried bumper. A minimally invasive surgical approach, assisted endoscopically, was performed to extract the bumper and replace the tube with a balloon G-tube. The revised PEG tube functioned effectively, with no recurrence of complications.
Conclusion: This case underscores the importance of early recognition and management of BBS, even in the acute postoperative period [4,7]. Minimally invasive techniques, combined with proper bumper positioning and patient education, are crucial for preventing and managing this complication [3,6]. Vigilant monitoring of PEG sites and timely intervention can significantly reduce morbidity and improve outcomes in patients with BBS [2,7].

References

1. Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: Techniques, problems and solutions. World J Gastroenterol. 2014;20(26):8505–24.
2. Cyrany J, Rejchrt S, Kopacova M, Bures J. Buried bumper syndrome: A complication of percutaneous endoscopic gastrostomy. World J Gastroenterol. 2016;22(2):618–27.
3. Pérez R, De La Serna C. Buried bumper syndrome: A critical analysis of endoscopic release techniques. World J Gastrointest Endosc. 2019;11(9):611–7.
4. Pinho J, Libânio D, Pimentel-Nunes P, Dinis-Ribeiro M. The challenging acute buried bumper syndrome: A case report. GE Port J Gastroenterol. 2018;25(3):151–4.
5. Satiya J, Marcus A. The buried bumper syndrome: A catastrophic complication of percutaneous endoscopic gastrostomy. Cureus. 2019;11(3):e4275.
6. Maly O, Bichard P. Endoscopic management of buried bumper syndrome using a guidewire and external traction: a novel technique. Acta Gastro-Enterol Belg. 2023;86(1):13–6.
7. Venu RP, Brown RD, Pastika BJ, Erikson LW. The buried bumper syndrome: a simple management approach in two patients. Gastrointest Endosc. 2002;56(4):582–4.

Disclosure

Dear Editors,
I, Evelyn Inga, hereby declare that I have no financial, professional, or personal conflicts of interest.
I affirm that I have no affiliations, financial interests, personal relationships, or commitments that could influence my impartiality in reviewing, conducting, or overseeing our study. Additionally, I confirm that I will uphold the highest ethical standards in compliance with institutional and federal regulations.
If any potential conflict arises, I will promptly disclose it to the United European Gastroenterology Association. Please let me know if any further documentation is required.
Sincerely,
Evelyn Inga, MD