Introduction

Ileocecal resection (ICR) is the most common surgical procedure for ileal Crohn's disease (CD). Data is growing to suggest ICR in localized disease as a first-line treatment instead of biologics to maintain long-term remission. However, removal of the ileocecal valve has a detrimental effect on bowel transit and disabling symptoms may occur after surgery. We aimed to assess the impact of a primary ICR on the daily symptoms of patients with CD.

Aims & Methods

All patients who underwent a primary ileocecal resection at the Saint-Antoine Hospital between January 2017 and December 2022 were included. Patients were followed up with post-operative visits before and after Rutgeerts score assessment. Patients' daily symptoms were recorded using a dedicated database (SUVIMIC), the routine software used at the Saint-Antoine Hospital that includes assessment of patient reported outcomes.

Results

Between 2017 and 2022, 110 patients underwent primary ICR for CD in relapse at the Saint-Antoine Hospital. The median disease duration at surgery was 6 years (IQR 1–11). The indications for surgery were fistulizing CD phenotype for 62 patients (56.4%) and strictures for 40 patients (36.4%). Only 7 patients (6.4%) had inflammatory phenotype at the time of first ICR. The median time to Rutgeerts Score assessment was 7 months showing 75 patients (68.2%) in remission defined as a score of i0, i1, i2a and 35 patients (31.8%) in relapse with a score of i2b to i4. Patients' daily symptoms reported at endoscopic assessment (6 – 12 months after surgery) are shown in Table 1. According to disease activity, the prevalence of diarrhea, defined as liquid stools, was 58.7% in patients in remission and 54.3% in patients in relapse. The prevalence of fecal urgency was 22.7% and 25.7%, respectively. Fecal incontinence was present in one patient in remission and three patients in relapse. According to the length of the resected small bowel, liquid stools were observed in 61.7% of patients with short resections (≤ 20 cm), 45.7% of patients with resections between 21 - 40 cm and 76.5% of patients with long resections (≥ 41 cm). Fecal urgency was present in 25.5%, 13.0% and 47.1% respectively. Furthermore, the prevalence of abdominal pain was 31.8% and of fatigue 34.5% in the whole cohort.

Table 1. Daily symptoms of patients after primary ileocecal resection at endoscopic assessment

Conclusion

The prevalence of digestive symptoms after primary ICR for CD is high, especially diarrhea and fecal urgency, even in patients in remission. Primary ICR for CD is an effective treatment for achieving long-term remission, but removal of the ileocecal valve leads to irreversible changes in bowel transit, which must be considered before proposing surgery.

Introduction

Helicobacter pylori (H. pylori) is the most widespread infection globally and the main cause of chronic gastritis, peptic ulcer disease, and gastric cancer. Its eradication is primarily managed in primary care. Assessing real-world clinical management practices of H. pylori infection and their adherence to clinical guidelines is essential to inform and optimize treatment strategies.

Aims & Methods

To assess the current H. pylori management strategies followed in Primary Care, we conducted an epidemiological cohort study using data from BIFAP, a Spanish healthcare database containing real-world data on the clinical practice of Primary Care physicians.
Patients aged ≥18 years with a recorded H. pylori infection between January 1, 2003, and June 30, 2023, and a prescription for infection treatment were selected. Two algorithms were developed: one to identify potential cases of H. pylori infection, based on ICD-9/10, and SNOMED CT codes, supplemented by clue words; and another to detect prescribed treatment patterns, constructed from guideline-based recommendations compiled from Spanish and European Consensus Conferences between 1997 and 2022, encompassing 19 possible combinations. A validation process was conducted to confirm the accuracy of infection records through manual review of a random sample of electronic health records. Treatment prescriptions were validated based on active ingredients recorded. We analysed the treatment prevalence stratified by clinical and demographic factors. Continuous and categorical variables were summarized using medians and proportions, respectively. First-line treatments were compared with those of the European Registry on H. pylori Management (Hp-EuReg) to contrast Primary and Specialised (that is, gastroenterologists) Care, respectively.

Results

A total of 211,972 subjects were identified with a H. pylori infection record and, at least, one of the possible treatment patterns. The median age at infection diagnosis was 55 years (IQR, 44-66), with women representing 65%. The most frequent first-line treatments included: proton pump inhibitor (PPI) plus a single-capsule containing bismuth, tetracycline and metronidazole (Pylera®) (PPI+ScBQT) with 36% of cases; PPI, clarithromycin, amoxicillin (PPI+C+A) with 30%; and the combination PPI, clarithromycin, amoxicillin, metronidazole (PPI+C+A+M), with 26%. The most commonly used first-line combination among individuals aged 18-64 years was PPI+ScBQT, as well as in those with a recorded diagnosis of obesity, chronic kidney disease, and in current smokers. However, among individuals aged ≥65 years, as well as in those with a recorded diagnosis of peptic ulcer, the most frequent first-line treatment was PPI+C+A. Comparison between Specialised and Primary Care showed that, since 2013, the use of PPI+C+A by Gastroenterologists has decreased from 40% to less than 1% by 2023, with a similar trend observed in Primary Care, although it remains prescribed in over 10% of cases in 2023. The use of non-bismuth quadruple therapy (PPI+C+A+M) significantly increased since 2015, with a higher proportion in Specialised (40%) compared to Primary Care (30%). ScBQT is currently the most widely prescribed regimen, accounting for approximately 60% of prescriptions in both settings.

Conclusion

H. pylori eradication treatments in Primary Care are heterogeneous, with single-capsule bismuth quadruple therapy being the most prescribed. The use of first-line treatment guidelines has generally aligned with Spanish and European recommendations, although their adoption in Primary Care has been slower than in Specialised Care.

Disclosure

Javier P. Gisbert has served as speaker, consultant, and advisory member for or has received research funding from: Mayoly, Allergan/Abbvie, Diasorin, Richen, Juvisé and Biocodex.
Olga P. Nyssen received research funding from: Mayoly, Allergan/Abbvie, Richen, Juvisé and Biocodex.

Introduction

Although national guidance on the management of Helicobacter pylori (H. pylori) infection in the UK is reviewed regularly, the recommendations on treatment and follow-up are not aligned with guidance in the rest of Europe. This is mainly due to the issue that there are no up to date data available on H. pylori prevalence or primary resistance to drugs usually used in eradication regimens.

Aims & Methods

Aim of this study was to analyse the current UK practice on H. pylori management to highlight areas that warrant improvement. UK data collected at AEG-REDCap e-CRF until January 2025 from the European Registry on H. pylori management (Hp-EuReg) were analysed. Modified intention-to-treat (mITT) and per protocol (PP) analyses were performed and the Fisher’s exact test was used for comparison of categorical data (significance for p<0.05).

Results

Data on 462 patients from 3 different centres across the UK was analysed. The mean age of the patients was 55 years (SD 16 years). The indication to test for H. pylori was non-investigated dyspepsia in 47%, dyspepsia with normal endoscopy in 21%, iron deficiency anaemia in 10%, duodenal ulcer in 9.7%, gastric ulcer in 6.9%, and gastric preneoplastic conditions in 1.3%. Of the 257 patients for whom data on regular concurrent medication was available, 222 (87%) took proton pump inhibitors (PPI) daily. Standard triple therapy regimens were given in 97.6% with 90.9% of these having undergone a 7-day regimen, 1.7% a 10-day regimen and 7.4% a 14-day regimen. Most commonly prescribed regimens were amoxicillin-clarithromycin-PPI (75.5%), amoxicillin-metronidazole-PPI (11.1%) and clarithromycin-metronidazole-PPI (9.1%). In the majority of cases, PPI was prescribed at low dose (76%); standard dose was given in 21%, and high dose in 3% of patients. The incidence of at least one adverse event due to treatment was reported in 31% of cases. Tests to confirm eradication success were done in 85% of patients, with practice varying between the different sites (p<0.001). This was also confirmed for the length of prescribed treatment (p<0.001) and the PPI dose used (p<0.001). Eradication was successful in 71% in the mITT analysis, and in 71% of the PP analysis. Patients treated for 7 days showed treatment success in 70% in the mITT analysis, and 69.4% in the PP analysis, compared to 93% (both mITT and PP) in those treated for 14 days (p<0.01). Adverse events were associated with reduced eradication treatment success (mITT: 62 vs 76%; PP: 63 vs 76%; p<0.01). The effect was more pronounced for compliance, with only 5 patients having reported not to have completed >90% of their course of treatment (PP: 29% vs 80%, p<0.05). Second-line treatment was documented for 109 patients, with 20 different regimens having been prescribed. The overall mITT success of second-line treatment was 48.5%.

Conclusion

Clarithromycin-based triple therapy remains the standard in the UK, despite a treatment failure of ≈30%. While adherence to national British or European guidelines on treatment duration and PPI dosage varies by centre, this does not uniformly affect treatment success. Despite British guidance advocating to assess treatment success based on symptom response, eradication was confirmed in the majority of patients. A review of national guidance on H. pylori management in the UK is required, along with efforts to generate national data on prevalence and resistance patterns.

Disclosure

JB: Advisory fee by Flynn Pharma LTD UK and Juvise Pharmaceuticals France
OPN: Speaker fee or research funding from Allergan, Mayoly Spindler, Richen, Biocodex and Juvisé.
JPG: Speaker or consultancy fees, advisory board member or research funding form Mayoly, Allergan/Abbvie, Diasorin, Richen, Juvisé, Biocodex.
IB, MCS, ACC, PP, LM, FM, COM, and PP have no conflict of interest to declare.

Introduction

Helicobacter pylori (H. pylori) is a well-recognized gastric carcinogen. However, whether this infection is related to colorectal polyps and colorectal cancer remains debatable. Data from some recent studies have indicated a significant association between H. pylori infection and the development of colorectal polyps or cancer. Potential effects of H. pylori on the colorectal mucosa include the induction of inflammatory responses, alteration of gut flora, and the release of toxins.
The aim was to investigate the association between H.pylori infection and colorectal polyps.

Aims & Methods

We retrospectively included patients diagnosed with colorectal polyps who underwent H. pylori testing between September 2024 and March 2025. Patients with incomplete colonoscopies were excluded. Demographic, clinical, and endoscopic data were subsequently collected. Polyp subtypes and dysplasia grades were extracted from histopathology reports. Screening for H. pylori infection was performed on gastric biopsies. Patients were divided into two groups: Group 1 (H. pylori-negative) and Group 2 (H. pylori-positive). The number, size, location, and pathological type of colorectal polyps were compared between the two groups.

Results

One hundred thirty patients were included, with a male-to-female sex ratio of 3.2. The mean age was 56.3 ± 11.23 years. The main comorbidities were diabetes (33.1%), dyslipidemia (26.9%), and hypertension (25.4%). The locations of colorectal polyps varied: 18.5% in the rectum, 17.7% in the sigmoid colon, 8.5% in the left colon, 7.7% in the transverse colon, 16.9% in the right colon, and 30.8% of patients had polyps in multiple locations. A total of 219 polyps were identified, with a mean of 2.16 polyps per patient and a mean size of 5.9 mm (range: 2–30 mm).
Histopathological examination revealed predominantly hyperplastic polyps (36.9%), low-grade dysplastic adenomas (48.5%), high-grade dysplastic adenomas (7.7%), and adenocarcinomas (6.9%). The prevalence of H. pylori infection was 31.5%.
Statistical analyses showed that the H. pylori-positive group had a significantly higher proportion of colorectal polyps with sizes ≥10 mm (55.6% vs. 44.4%, p = 0.027) and multiple polyps (≥5) (56.3% vs. 43.8%, p = 0.04) compared to the H. pylori-negative group. However, neither dysplasia grading nor polyp localization was significantly associated with H. pylori infection.

Conclusion

In our study, H. pylori infection was associated with an increased risk of large and multiple colorectal polyps. Further studies are needed to confirm these findings and to better understand the impact of H. pylori eradication on the occurrence of colorectal polyps, as well as its tumorigenic effects on the colorectal mucosa.

Clinical Case Summary

Materials and methods: 24-year-old man with an episode of nausea, anorexia and loss of 4-5 kg in a week, which resolved spontaneously without drugs. During the episode had hyperchromic urine, yellowing of skin and eyes.After 1 month small increase of serum transaminases x 1.5. Regular bowel function. No clinical signs. US regular. Anti-HbsAg and HCV-Ab negative. After another month he had highly increase of serum transaminases with AST x 27 and ALT x50 GGT x3, Total bilirubin 2.85. Negative ANA, AMA, LKM, IgA anti TTG, anti EBV, anti CMV, alpha1 anti trypsian slight increase. He performed a new serum analysis with increase of anti-TTG IgA. He subsequently performed genetics for celiac disease and confirmed homozygous DQ2.Performs EGDS for suspected celiac disease which documents nodularity in bulb and DII scalloping. Histological examination shows Marsh 3B.After 150 g gluten daily intake had IgA anti TTG x 4. A diagnosis of celiac disease is made and he started GFD with serum transaminases x 2After 2 months with good adherence to GFD has AST x20 and ALT x 50. He denies alcohol abuse.Negative hemochromatosis mutations. Stable weight, Regular bowel function. We perform liver biopsy. The histological examination documents Histological Activity index acc. Knodell modified by Ishak: 7 Grading.
Results: Diagnosis is moderately active chronic autoimmune hepatitis.Therapy is started with prednisone 40 mg daily. With AST x10 and ALT x 20After 15 days of therapy AST x 5 and ALT x9, therefore values halving and normal bilirubin. Currently under follow-up in our Hospital
Conclusions: Although the history is still unknown and the histological exam is compatible but not certain, the good response to steroid therapy is a positive factor that proves the correctness of the diagnosis. This diagnostic difficulty leads us to always evaluate the autoimmune cause in a young patient without risk factors with a small increase in transaminases.

References

University of Salerno

Introduction

Helicobacter pylori treatment´s effectiveness decreases as treatment eradication attempts fail.

Aims & Methods

To evaluate the use and effectiveness of empirical rescue therapies on third and subsequent lines, in Europe.
Sub-study of the the European Registry on H. pylori Management (Hp-EuReg), an international, multicenter, prospective, non-interventionist registry starting in 2013 aiming to evaluate the decisions and outcomes of H. pylori management by European gastroenterologists (38 countries, 400 researchers). All infected adult patients were systematically registered at AEG-REDCap e-CRF until December 2023, all cases with three or more eradication attempts were extracted. Only the empirically prescribed therapies were considered. Effectiveness was analysed by modified intention-to-treat (mITT) and per protocol (PP). Data were subject to quality review.

Results

In total, 3,351 rescue treatments were included: 2,349, 688, 228 and 86 in third-, fourth-, fifth- and sixth-line treatments, respectively. Mean age was 51 years, 68% of patients were women and 5.3% were allergic to penicillin. Sixty-eight different treatment schemes were used, being the three-in-one single-capsule bismuth quadruple therapy the most commonly prescribed (Table). Overall effectiveness was 73% by mITT, and 74% by PP analyses. Bismuth quadruple therapy as single-capsule provided the highest mITT overall cure rate (84%) and achieved 87% when optimised with high-dose PPIs (p>0.05). Quadruple PPI-bismuth-tetracycline-metronidazole achieved optimal eradication rate (91% by mITT), only when high-dose PPIs and 14-day prescriptions were used. The use of doxycycline instead of tetracycline was associated with lower eradication rates in classical bismuth quadruple therapies (p<0.05).

Conclusion

Empirical rescue treatments in third and subsequent lines obtain, in general, suboptimal eradication rates in Europe; however, bismuth quadruple therapy as single-capsule obtained encouraging results. Only the optimised bismuth quadruple therapy achieved ≥90% effectiveness.

Disclosure

Javier P. Gisbert has served as speaker, consultant, and advisory member for or has received research funding from: Mayoly, Allergan/Abbvie, Diasorin, Richen, Juvisé and Biocodex.
Olga P. Nyssen received research funding from: Mayoly, Allergan/Abbvie, Richen, Juvisé and Biocodex.