Introduction

Accurate symptom assessment and monitoring over time is critical for effective patient management and research. Standard history taking is unavoidably influenced by both patient-related and physician-related factors. Patient reported outcome measures (PROMs) facilitate evaluation of patients and allow to better assess treatment effects. Validated tools are lacking for paediatric gastroenterological patients.

Aims & Methods

We aimed to adapt and validate for paediatric populations a self-administered Structured Assessment of Gastrointestinal Symptoms (SAGIS) tool that previously has been validated in adult cohorts. Each item of the original SAGIS instrument was thoroughly reviewed for its relevance in the paediatric population. The resulting paediatric (p)SAGIS was utilized over a 35 months’ period in consecutive patients in a paediatric outpatient GI-clinic. Principal components analysis (PCA) followed by Varimax rotation and confirmatory factor analysis (CFA) was performed in derivation and validation samples. Responsiveness to change was assessed in 32 children with inflammatory bowel disease (IBD) after 12 months of therapy.

Results

The final paediatric SAGIS consisted of 21 GI-related Likert-type questions, 8 dichotomous questions assessing extra-intestinal symptoms and two most bothersome symptoms. 1153 children/adolescents completed a total of 2647 questionnaires. Cronbach’s alpha was 0.89, indicating good internal consistency. PCA supported a five-factor model (symptom groups: abdominal pain, dyspepsia, diarrhoea, constipation, dysphagia/nausea), CFA showed good model fit (CFI:0.96, RMSEA:0.075). The initial mean total GI-symptom score in IBD-patients (8.7±10.3) decreased to 3.6±7.7 after 1 year of therapy (p<0.01), and four of five symptom group scores decreased significantly upon treatment (p<0.05). The table shows responsiveness of p-SAGIS in children with IBD, total GI-symptom scores and symptom scores of pSAGIS-domains at the initial visit and after 1 year of therapy (data are given as mean±standard deviation).

Conclusion

The pSAGIS is a novel, easy to use, self-administered instrument for GI-symptom assessment in children/adolescents with excellent psychometric properties. It may standardize GI-symptom assessment and may enable uniform clinical analysis of treatment outcomes.

References

Koloski NA, Jones M, Hammer J, et al. The Validity of a New Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS) for Evaluating Symptoms in the Clinical Setting. Dig Dis Sci. 2017;62:1913-1922

Introduction

Gastric cancer ranks as the fifth most common cancer and the second leading cause of cancer-related deaths. Multifocal atrophic gastritis and gastric intestinal metaplasia (GIM) often coexist and are both associated with the risk of developing gastric cancer, with GIM being the first irreversible mucosal transformation to cancer. Endoscopic surveillance was associated with earlier cancer detection and improved survival. This study aims to evaluate the prevalence, epidemiological characteristics, and clinical features of patients with GIM.

Aims & Methods

This is a single-center, retrospective study from January 1, 2022 to December 31, 2023. Including patients aged ≥18 years who underwent esophagogastroduodenoscopy (EGD) with gastric biopsies confirming GIM, All identified cases of GIM were reviewed by gastrointestinal pathologists to confirm the diagnosis. Th primary outcome was to assess the prevalence, epidemiological characteristic, and clinical features of GIM. The secondary outcome was to evaluate adherence to recommended surveillance protocols for GIM.

Results

Among 3,663 patients who underwent EGD, GIM was identified in (4.17%, n=153). The mean age of patients with GIM was 60 years, Males represented more than half of patients (54.2%), the majority were classified as overweight (Body mass index (BMI) 25–29.9; 64%, n=97) or obese (BMI ≥30; 24.3%, n=37).Smoking was reported in (17.6%, n=27), while (5.2%, n=8) reported alcohol consumption. Moreover, (7.2%, n=11) had a history of prior gastric surgeries. Dyspepsia (33.3%) was the most common indication for EGD. Gastritis was the predominant endoscopic finding and the primary reason for performing gastric biopsies (73%, n=112 ).The most common GIM subtype was complete (52%), followed by incomplete (37%) and mixed (11%). In terms of GIM location, extensive GIM was observed in (28.7%), localized GIM in (17.6%), while the location remained unknown in (53.6%) due to the lack of a follow-up EGD for mapping. Coexisting autoimmune atrophic gastritis was observed in (12.4%, n=19), Helicobacter pylori infection was detected in (16.3%, n=25). Furthermore, Dysplasia was identified in (2.6%, n=4), with low-grade dysplasia and high-grade dysplasia each accounting for (1.3%, n=2) (Table 1). Three patients developed.gastric cancer (2%) , while (4.6%, n=7) were found to have neuroendocrine tumors (NET). First degree family history of gastric cancer was reported in (12.4%, n=19).

Conclusion

This study highlights a 4.17% prevalence of GIM among patients who underwent EGD. High BMI and male sex were observed in more than half of the patients. Dysplasia was detected in 2.6%, gastric cancer in 2%, and NET in 4.6% of cases. Many patients lacked follow-up EGD surveillance, limiting effective monitoring. Larger studies with extended follow-up are required to further investigate these associations and their clinical implications.

Clinical Case Summary

Seronegative enteropathies pose a complex diagnostic challenge, as their histology mimics celiac disease (CeD) (1). We report a 51-year-old patient with hypertension and osteoporosis, referred for abdominal pain, weight loss, and constipation. Blood tests showed no anemia; anti-transglutaminase and anti-endomysium antibodies were negative, but HLA typing was compatible with CeD. Ileocolonoscopy excluded IBD and microscopic colitis, while OEGD revealed villous atrophy (MARSH 3c). Negative anti-enterocyte antibodies, and exclusion of drugs and infections, led to a diagnosis of seronegative CeD. A gluten-free diet was started, but after 1 year, symptoms improved only partially despite good adherence. OEGD showed persistent duodenal damage with increased intraepithelial lymphocytes (IELs), CD3+ and CD8+ T-cells with monoclonal TCR expression (fig. 1), consistent with RCeD type 1, despite no overt malabsorption. The patient began prednisone 50 mg/day, then switched to open-capsule budesonide, with some clinical benefit but persistent atrophy.
A year later, his daughter was diagnosed with CVID and a heterozygous STAT3 variant (c.1252T>C, p.Cys418Arg), somatically acquired in NK-cell leukemia. A luciferase assay confirmed its gain-of-function (GOF) effect (fig. 2). Family studies revealed the same germline variant in the patient. His diagnosis was revised to STAT3 GOF-associated enteropathy. Further investigations revealed hypogammaglobulinemia, splenomegaly, bronchiectasis, and emphysema. Treatment with Ruxolitinib (a JAK1/2 inhibitor) was started, resulting in clinical and histological remission (fig. 3).
STAT3 GOF enteropathy is a very rare condition (2,3) that should be considered in the differential diagnosis of seronegative villous atrophy. Anti-JAK therapy may be effective (4).

References

References of the images:
Figure 1: Histologic aspects at diagnosis
Figure 2: Luciferase assay of STAT3
Figure 3: Histologic aspects after 1 year of therapy

1. Schiepatti A, Sanders DS, Baiardi P, Caio G, Ciacci C, Kaukinen K, et al. Nomenclature and diagnosis of seronegative coeliac disease and chronic non-coeliac enteropathies in adults: the Paris consensus. Gut. 2022 Jun 8;71(11):2218–25.
2. Vogel TP, Leiding JW, Cooper MA, Forbes Satter LR. STAT3 gain-of-function syndrome. Vol. 10, Frontiers in Pediatrics. Frontiers Media SA; 2023.
3. Flanagan SE, Haapaniemi E, Russell MA, Caswell R, Allen HL, De Franco E, et al. Activating germline mutations in STAT3 cause early-onset multi-organ autoimmune disease. Nat Genet. 2014;46(8):812–4.
4. Kaneko S, Sakura F, Tanita K, Shimbo A, Nambu R, Yoshida M, et al. Janus kinase inhibitors ameliorate clinical symptoms in patients with STAT3 gain-of-function. Immunotherapy Advances. 2023;3(1).

Introduction

Device-assisted enteroscopy (DAE) offers comprehensive examination of the gastrointestinal tract, but its efficacy is dependent on adequate bowel preparation. While prior research explored AI models for colonoscopy cleansing, there is a lack of studies evaluating both small bowel and colon cleansing during DAE.

Aims & Methods

The aim of this study was to develop and validate a convolutional neural network (CNN) capable of automatically classifying bowel cleansing levels during DAE, encompassing both small bowel and colon regions. We retrospectively analyzed 28 procedures (single balloon, double-balloon and motorized spiral enteroscopy) from a high-volume center. Bowel preparation was graded as excellent (≥90% visible mucosa), satisfactory (50-90%), or unsatisfactory (<50%). A dataset of 88,623 images (training: 90%, testing: 10%) was used, covering both small bowel and colon areas. The CNN's performance was evaluated against expert consensus using sensitivity, specificity, accuracy, and AUC-ROC.

Results

We included 51948 frames that were considered excellent, 28820 frames that were considered satisfactory and 7855 frames that were considered unsatisfactory. The CNN demonstrated the following performance metrics: excellent cleansing (sensitivity: 97.8%, specificity: 80.3%, accuracy: 90.6%, AUC-ROC: 0.95), satisfactory cleansing (sensitivity: 81.8%, specificity: 97.9%, accuracy: 92.7%, AUC-ROC: 0.95), and unsatisfactory cleansing (sensitivity: 68.7%, specificity: 99.5%, accuracy: 96.8%, AUC-ROC: 0.96).

Conclusion

This study presents the first globally developed CNN for accurate classification of bowel cleansing throughout DAE, encompassing both small bowel and colon. This advancement represents a necessary step for optimizing diagnostic accuracy and therapeutic efficacy in gastrointestinal procedures, namely DAE, underscoring the pivotal role of innovative technologies in advancing medical practice

Introduction

There is a growing interest in the role of artificial intelligence in colonoscopy. In this systematic review and meta-analysis, we aimed to evaluate the efficacy of computer-aided detection (CADe) of colorectal adenomas and polyps.

Aims & Methods

We searched MEDLINE, EMBASE and CENTRAL (from inception to December 2022) for randomized controlled trials (RCTs) comparing colonoscopy with CADe versus standard colonoscopy (SC). We performed a random-effects meta-analysis and reported the results as relative risks (RR) or mean difference (MD) with 95% confidence intervals (CI).

Results

Twelve RCTs comprising 11,340 patients were included in the final analysis. The pooled adenoma detection rate (ADR) was significantly higher in the CADe group compared with the SC group (41.4% vs 33%; RR 1.26, 95% CI 1.18 – 1.35). CADe increased the detection of adenomas regardless of their size (≤5mm [RR 1.56, 95% CI 1.38 – 1.77], 6 – 9mm [RR 1.24 95% CI 1.05 – 1.47] and ≥10mm [RR 1.30, 95% CI 1.11 – 1.53]), location (proximal colon [RR 1.41, 95% CI 1.26 – 1.58] and distal colon [RR 1.44, 95% 1.29 – 1.61]) or morphology (polypoid [RR 1.35, 95% CI 1.17 – 1.56] and non-polypoid [RR 1.55, 95% 1.25 – 1.93]). There was no difference between the CADe and SC groups in detecting advanced adenomas or sessile serrated lesions. Colonoscopy withdrawal time was longer in the CADe group compared with the SC group (MD 0.34 minutes, 95% CI 0.17 – 0.51).

Conclusion

Using CADe during colonoscopy is associated with a significant increase in ADR and adenoma per colonoscopy, which was mainly due to the increased detection of diminutive adenomas. Long-term longitudinal studies are required to evaluate the effect of CADe on the risk of interval colorectal cancer and cancer-related deaths.

Introduction

Gastric intestinal metaplasia (IM), a precancerous lesion, requires precise assessment for surveillance. The Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) staging system, based on histopathology, is the international standard for IM risk stratification. ESGE guidelines recommend endoscopic surveillance for advanced IM (OLGIM stages 3/4). Developed as a substitute, the Endoscopic Grading of Gastric Intestinal Metaplasia (EGGIM) score assesses IM across five gastric regions using a 30% threshold. Two large-scale studies demonstrated excellent performance in predicting advanced IM (OLGIM stage 3/4).

Aims & Methods

To optimize the EGGIM scoring system by refining threshold criteria, incorporating IM morphology, and evaluating simplified scoring approaches.
In this retrospective cohort study, patients undergoing structured gastroscopy at the National Taiwan University Cancer Center were analyzed from February 2022 to September 2024. EGGIM scoring was performed using high-resolution white-light and narrow-band imaging, with histopathological confirmation per the updated Sydney protocol. Three modifications were proposed: (1) EGGIM-15, an extended scoring system with 0–3 per site (0: no IM; 1: IM <30%; 2: 30–60%; 3: >60%); (2) EGGIM-M, integrating morphology (small patches, large patches, carpet-like); and (3) EGGIM-S, a simplified version using only the angle and LC body,. Their diagnostic performance in predicting advanced IM (OLGIM stage 3/4) was evaluated and compared to the original EGGIM score.

Results

Among 944 patients (56% female; median age: 64 years), 64 (6.8%) had advanced IM. The original EGGIM score yielded an AUC of 0.83. EGGIM-15 achieved a similar AUC of 0.82. EGGIM-M reached an AUC of 0.83 in a random forest model, though feature importance remained highest for the original EGGIM (0.786). EGGIM-S demonstrated an AUC of 0.83, which is non-inferior to the original score, while using fewer assessed regions and achieving fewer false positives at a cutoff ≥4.

Conclusion

Neither expansion of scoring thresholds (EGGIM-15) nor inclusion of morphology (EGGIM-M) significantly improved diagnostic accuracy over the original EGGIM. However, the simplified model (EGGIM-S) offers similar performance with practical advantages in efficiency and applicability. This suggests potential for streamlined risk stratification in clinical settings without compromising diagnostic yield.