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Introduction

Helicobacter pylori (Hp) infection is highly prevalent in Portugal, affecting over 60% of the population. Antibiotic resistance poses a significant challenge to Hp treatment; however, empirical regimens remain the standard of care over susceptibility-guided approaches. This study aims to evaluate the most recommended therapeutic options for Hp eradication and to identify risk factors associated with treatment failure.

Aims & Methods

Prospective cohort study conducted in a single centre, including all patients treated for Hp infection between 2013 and 2024. We analysed four eradication regimens: triple therapy (Tri), bismuth quadruple therapy (QuadB), concomitant quadruple therapy (QuadC) and sequential quadruple therapy (QuadS). We collected data on patient demographics and clinical characteristics and compared adherence rates, treatment effectiveness and incidence of adverse events.

Results

Included 591 patients, with a median age of 57 years (IQR 47-66) and female sex 57.2%. The main indication for Hp testing was dyspeptic symptoms (61.1%). The prescribed therapeutic regimens were QuadC in 34.0% of patients, QuadB in 32.8%, Tri in 23.2% and QuadS in 10.0%. According to the intention-to-treat analysis, QuadC (92.9%) and QuadB (90.4%) showed significantly higher eradication rates compared with Tri (73.9%, p<0.001), with no difference observed for QuadS (84.2%, p=0.30 vs QuadC; p=0.61 vs QuadB). Adverse events were significantly less frequent with Tri (0.06%) and QuadS (0.02%) compared to QuadC (0.18%, p<0.01) and QuadB (0.17%, p<0.05), but overall adherence to treatment was 97.1%, with no significant difference among regimens (p=0.19). Logistic regression identified predictive factors for treatment failure: prior eradication attempts (OR 2.31; 95% CI 0.3-1.4), poor adherence (OR 14.5; 95% CI 0.7-4.7) and absence of statin use (OR 2.33; 95% CI 0.07-1.6), with an AUC of 0.72.

Conclusion

QuadC and QuadB therapies are more effective for Hp eradication but are associated with increased rates of adverse events, without a negative impact on overall treatment adherence. Therapeutic failure is more likely in non-naive patients, those with poor adherence to treatment and without statin use.

EFFECTIVENESS AND ADVERSE EVENTS OF HELICOBACTER PYLORI TREATMENT REGIMENS: AN ELEVEN-YEAR PROSPECTIVE COHORT STUDY

Rita Regatia 1, Maria Inês Viegas 1, Sandra Saraiva 1, Miguel Areia 1, Mara Costa 1, Luís Elvas 1, Susana Alves 1, Daniel Brito 1, Teresa Cadime 1

1 Portuguese Oncology Institute of Coimbra, Coimbra, Portugal

Conference

UEG Week Berlin 2025

Topics

Stomach & H. Pylori

Submission format

Abstract

Session

H. pylori: From epidemiology to therapy (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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A MULTICENTER RETROSPECTIVE STUDY OF INFLUENTIAL FACTORS ON STENOSIS AFTER MODERATE RESECTION OF CIRCUMFERENCE IN ESOPHAGEAL ENDOSCOPIC SUBMUCOSAL DISSECTION

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Introduction

Endoscopic submucosal dissection (ESD) is an effective treatment for superficial esophageal cancer, but postoperative stenosis remains a significant concern. Particularly, probability of the stenosis is less investigated in cases with a 50%-75% circumferential mucosal defect.

Aims & Methods

This study aimed to identify influential factors for postoperative stenosis after the moderate circumferential resection in esophageal ESD. This multi-center retrospective observational study analyzed data from 513 patients across 19 institutions who underwent esophageal ESD from April 2018 to March 2022 and showed 50% to 75% of the circumferential mucosal defect. We firstly overviewed the current status on the postoperative stenosis, the steroid use, and postoperative adverse events in these patients. Subsequently, we identified influential factors for postoperative stenosis. Patients were categorized into stenosis and no stenosis groups, and univariate and multivariate analyses were performed for each parameter. We further investigated influential factors of stenosis in two cohorts: steroid and no steroid groups. Finally, the parameters were compared between the steroid and no steroid groups to assess the tendency of the steroid use in general practice.

Results

Postoperative stenosis was observed in 28 cases (5%). Univariate analysis comparing the stenosis group (n = 28) and no stenosis group (n = 485) revealed significant differences in the prior endoscopic treatment near the lesion (p = 0.02), cervical esophageal location (p = 0.04), defect circumference (p =0.01), and procedure duration (p = 0.02). There was no significant difference in the steroid use between two groups. Multivariate analyses identified history of prior endoscopic treatment close to the lesion (p = 0.01, odds ratio [OR], 5.10), cervical esophageal lesions (p = 0.03, OR, 3.97), large circumferential defect (p <0.01, OR, 3.78), and longer procedure duration (p <0.01, OR, 3.83) as independent risk factors for stenosis formation. Among the steroid group, significant associations of the postoperative stenosis were revealed with the prior endoscopic treatment near the lesion (p = 0.02), cervical esophageal location (p = 0.04), and >5/8 of defect circumference (p = 0.02). In the no steroid group, only the procedure duration (p = 0.01) showed a significant difference between the stenosis and non-stenosis groups. Comparison between the steroid (n = 223) and no steroid groups (n = 290) revealed significant differences in the prior endoscopic treatment near the lesion (p <0.01), cervical esophageal lesions (p <0.01), and resected specimen dimensions (p <0.01). The stenosis rates were 7% in the steroid group and 4% in the no steroid group, without a significant difference. No significant difference in adverse events was observed between the two groups.

Conclusion

In esophageal ESD with a 50%-75% circumferential mucosal defect, the steroid was used in over 40% of patients, and postoperative stenosis still occurred in 5%. Because wider circumference, location of the cervical esophagus, prior endoscopic treatment close to the lesion, and prolonged operative time were identified as independent risk factors on the stenosis, steroid therapy should be preferred in these cases. Particularly, lesions with a history of endoscopic treatment, on cervical esophagus, and with >5/8 of defect circumference should require more aggressive countermeasures than currently applied.

A MULTICENTER RETROSPECTIVE STUDY OF INFLUENTIAL FACTORS ON STENOSIS AFTER MODERATE RESECTION OF CIRCUMFERENCE IN ESOPHAGEAL ENDOSCOPIC SUBMUCOSAL DISSECTION

Akira Dobashi 1, Tsugumi Habu 2, Osamu Goto 3, Toshiyuki Yoshio 4, Waku Hatta 5, Noboru Kawata 6, Atsushi Goto 7, Unknown Unknown 8, Yugo Iwaya 9, Tetsuya Tatsuta 10, Takuto Hikichi 11, Jun Nakamura 11, Shinjiro Yamaguchi 12, Takashi Ohta 12, Yohei Furumoto 13, Tsutomu Nishida 14, Masashi Yamamoto 14, Mikitaka Iguchi 15, Tatsuo Yachida 16, Hiroko Nebiki 17, Tomoaki Yamasaki 17, Toshiaki Narasaka 18, Eriko Koizumi 2, Yosuke Tsuji 19, Kazuki Sumiyama 1, Mitsuhiro Fujishiro 19

1 The Jikei University School of Medicine, Tokyo, Japan

2 Nippon Medical School Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan

3 Nippon Medical School, Tokyo, Japan

4 Cancer Institute Hospital, Japanese Foundation for Cancer Reserch, Tokyo, Japan

5 Tohoku University, Graduate School of Medicine, Sendai, Japan

6 Shizuoka Cancer Center, Shizuoka, Japan

7 Yamaguchi University Graduate School of Medicine, Ube, Japan

8 Tonan Hospital, Hokkaido, Japan

9 Shinshu University School of Medicine, Matsumoto, Japan

10 Hirosaki University Hospital, Aomori, Japan

11 Fukushima Medical University Hospital, Fukushima, Japan

12 Kansai Rosai Hospital, Hyogo, Japan

13 Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

14 Toyonaka Municipal Hospital, Toyonaka, Japan

15 Wakayama Medical University, Wakayama, Japan

16 Faculty of Medicine, Kagawa University, Kagawa, Japan

17 Osaka City General Hospital, Osaka, Japan

18 University of Tsukuba, Tsukuba, Japan

19 The University of Tokyo, Tokyo, Japan

Event

UEG Week Berlin 2025

Topics

Endoscopy Oesophagus

Submission format

Abstract

Session

Endoscopic resection in the upper GI tract

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Can we cure or palliate?

Arjan Bredenoord 1

1 Amsterdam UMC, Amsterdam, Netherlands

Event

UEG Week Berlin 2025

Topics

Oesophagus Primary Care

Session

Spastic oesophagus: Is it curable?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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EMR or ESD for duodenal adenoma: Too much recurrence and too much risk?

Marc Barthet 1, Naohisa Yahagi 2

1 Hopital Nord, Marseille, France

2 Keio University Cancer Center - Cancer Center, Keio University Cancer Center; Tokyo/JP, Tokyo, Japan

Event

UEG Week Berlin 2025

Session

Never waste a good disaster

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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CHANGING THE COURSE OF CROHN’S DISEASE WITH AN EARLY USE OF ADALIMUMAB: THE CURE STUDY FROM THE GETAID

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Introduction

Crohn's disease (CD) is a disabling and destructive disease. Early intervention associated with tight monitoring appear to the best way to achieve deep remission and to prevent disease progression. Whether anti-TNF (tumor necrosis factor) therapy can be interrupted in patients with early CD who have undergone a period of prolonged deep remission is unknown.

Aims & Methods

The primary objective was to evaluate the sustained deep remission rate one year after discontinuation of a 12-month course of adalimumab in adult patients with early CD who achieved deep remission at 12 months after treatment induction and who were already in clinical remission and biomarker remission at 6 months.
We carried out a multicentre prospective GETAID cohort study. All patients had early luminal CD less than 24 months since diagnosis, and were naïve to biologics. The primary study endpoint was percentage of patients with sustained deep remission one year after stopping a 12-months course of adalimumab (+/- 3 months) in adult patients with early-stage CD who achieved deep remission without therapeutic intervention (i.e. no surgery, no clinical flare-up, no introduction of CD-related treatment, no need for adalimumab optimization) AND who were already in clinical remission (CDAI < 150) and biomarker remission (CRP < 5 mg/L and fecal calprotectin < 250) at 6 months. A clinical flare-up was defined as a CDAI > 220 or an increase in CDAI between two subsequent visits > 70.

Results

A total of 171 patients received treatment with adalimumab between March 2015 and March 2019.
In this cohort, 39.2% (67/171) were active smokers. The median disease duration was 4 [2-9] months. CD location was ileal (42.7%, 73/171), colonic (12.3%, 21/171), and ileo colonic (44.4%, 76/171). Twenty-one patients (12.3%) had perianal disease. The majority of patients had an inflammatory phenotype (71.3%, 122/171). At inclusion, median CRP level was 9.0 [3.0-24.0] mg/L, and median fecal calprotectin was 440.5 [159.0-838.0] µg/g.
Overall, 38/171 (22.2%) of patients achieved deep remission after a 12-month course of adalimumab. From those who achieved deep remission, 7 patients did not discontinue adalimumab. In this study, 7/31 (22.6%) patients maintained their deep remission for one year after their treatment discontinuation (24 months from initiation of adalimumab). Among the whole cohort, only 4% (7/171) of patients were in deep remission off adalimumab at 2 years. Median time between adalimumab discontinuation and the first clinical relapse was 14 months. No predictive factor associated with loss of deep remission in the year following treatment discontinuation was identified. No serious adverse event was reported.

Conclusion

In this first prospective trial exploring withdrawal of advanced therapy in early CD, 22.6% achieved deep remission at one year with adalimumab; among them, about a quarter maintained deep remission at two years. These results demonstrate that anti-TNF therapy should not be discontinued, even in patients with early CD.

CHANGING THE COURSE OF CROHN’S DISEASE WITH AN EARLY USE OF ADALIMUMAB: THE CURE STUDY FROM THE GETAID

Bénédicte Caron 1, Elodie Jeanbert 1, Florian Poullenot 2, Yoram Bouhnik 3, Lucine Vuitton 4, Catherine Reenaers 5, Stephane NANCEY 6, pierre Blanc 7, Xavier Roblin 8, Stéphanie Viennot 9, Jean-Louis Dupas 10, Anne Laure Pelletier 11, Arnaud Bourreille 12, Jacques Moreau 13, Jerome Filippi 14, Maria Nachury 15, Guillaume Bouguen 16, Marion Simon 17, Ludovic Caillo 18, Anthony Buisson 19, Laurianne Plastaras 20, Vered Abitbol 21, Alexandre Aubourg 22, Médina Boualit 23, David Laharie 24, Laurent Peyrin-Biroulet 25

1 Nancy University Hospital, Vandoeuvre les Nancy, France

2 Bordeaux University Hospital, Bordeaux, France

3 CHU Beaujon Dept. of IBD and Nutrition, Clichy, France

4 Besançon university hospital gastroenterology, Courbevoie, France

5 Assistants en formation gastro, réseau Ulg - CHU Sart Tilman, Assistants en formation gastro, réseau, Lantremange, Belgium

6 Lyon University Hospital, Pierre Benite, France

7 Hopital Saint Eloi, Montpellier, France

8 University of St. Etienne Dept. de Gastroenterologie, Saint Etienne, France

9 CHRU de Caen HGE 19è étage, Caen Cedex, France

10 CHU Nord Amiens, Amiens, France

11 Hopital Beaujon, Paris, France

12 Hopital Hotel Dieu Et Hme - Hge Aile Sud, Nantes Cedex 1, France

13 Centre Hospitalier Universitaire de Toulouse, Hopital Rangueil, Toulouse, France

14 Hopital de lAchet Dept. de Gastroenterlogie Dept. de Nutrition Oncologie, Nice Cedex 3, France

15 CHRU Lille, Courbevoie Cedex, France

16 CHU Pontchaillou, Rennes, France

17 Institut Mutualiste Montsouris, Paris, France

18 CHU DE NIMES, Nîmes, France

19 CHU Estaing Clermont-Ferrand, Clermont-ferrand, France

20 Chu Colmar, Colmar, France

21 Hopital Cochin Gastroentérologie AP-HP, Paris Cedex 14, France

22 Cabinet Medical, Chambray Les Tours, France

23 Ch Valenciennes, Valenciennes Cedex, France

24 CHU de Bordeaux Hopital Haut-Leveque Dept. de Gastroenterologie, Pessac cedex, France

25 Inserm U1256, Nancy University Hospital, Vandoeuvre-les-Nancy, France

Event

UEG Week Berlin 2025

Topics

IBD Mechanisms & Personalised Medicine

Submission format

Abstract

Session

Clinical management of IBD

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Introduction

Lynch syndrome (LS) is associated with an increased risk of upper gastrointestinal (GI) cancers. While upper GI surveillance is recommended in several guidelines, there remains international variability and ongoing debate regarding its implementation, timing, and extent. This study evaluated the incidence of gastric (GC), duodenal (DC), and jejunal cancers (JC) in LS patients using data from the German Consortium for Familial Intestinal Cancer (GCFIC). In addition, the diagnostic yield of esophagogastroduodenoscopy (EGD) and push enteroscopy (PE), performed at a tertiary care center, was retrospectively analyzed.

Aims & Methods

A total of 960 endoscopic procedures (494 EGD, 466 PE) were retrospectively analyzed in 349 LS patients documented at a tertiary care center. Push enteroscopy (PE) was performed using a colonoscope to allow deeper insertion into the small intestine, enabling inspection of the proximal jejunum. Clinically relevant findings included intestinal metaplasia, Barrett’s esophagus, adenomas, and carcinomas. These findings were systematically compared between EGD and PE to evaluate diagnostic yield. The GCFIC database was evaluated to determine cancer incidence by genotype.

Results

In the GCFIC cohort (n=2859), the majority of GC (2.2%), DC (2.1%), and JC (1.9%) occurred in high-risk pathogenic variant carriers (PGV) (MLH1, MSH2, EPCAM). However, a small proportion of cancers was also observed in low-risk PGV carriers: GC in two MSH6 carriers, DC in five patients with MSH6 or PMS2, and JC in seven low-risk carriers (MSH6: 3, PMS2: 4). In the NZET cohort, 22% of procedures and 50 % of patients revealed relevant findings. Gastric adenomas were found in 3.7%, gastric cancer in 1.1%, and intestinal metaplasia in 28% of patients. Duodenal adenomas were found in 3.7% and cancer in 0.9%. Jejunal neoplasia was detected exclusively by PE (adenomas 1.7%, cancer 0.6%).

	EGD (n= 499)		PE (n= 468)		all examinations (n= 964)		per patient (n= 349)		p- value	significant (p < 0.05)
Intestinal metaplasia	54	10.9%	78	16.7%	132	13.8%	98	28.1%	0.014	yes
Gastric adenoma	7	1.4%	4	0.9%	11	1.1%	9	2.6%	0.529	no
Dysplastic fundic gland	1	0.2%	3	0.6%	4	0.4%	4	1.1%
Gastric cancer	4	0.8%	0	0%	4	0.4%	4	1.1%
Duodenal adenoma	8	1.6%	7	1.5%	15	1.6%	13	3.7%	0.828	no
Duodenal cancer	2	0.4%	1	0.2%	3	0.3%	3	0.9%
Jejunal adenoma	0	0%	7	1.7%	8	0.8%	7	2%
Jejunal cancer	0	0%	2	0.4%	2	0.2%	2	0.6%
Clincally relevant findings	92	19%	118	25%	209	22%	175	50.1%	0.02	yes

Conclusion

Upper gastrointestinal surveillance is essential in patients with Lynch syndrome. Push enteroscopy (PE) provides diagnostic value beyond conventional esophagogastroduodenoscopy (EGD), particularly in detecting jejunal neoplasia, and should be considered in high-risk surveillance protocols.