Introduction

Colorectal adenomas are commonly found in individuals over the age of 50, but their occurrence in younger individuals is increasing. However, it is still unknown if colorectal cancer in young patients follow different pathways. Therefore, this study aims to compare the types of colorectal adenomas/lesions in individuals under the age of 50 versus those over 50.

Aims & Methods

To assess the differences in adenoma subtypes amongst individuals aged 50 and older versus those under the age of 50.

Results

488.767 screening colonoscopies between 2008 and 2023 were analyzed within the Austrian quality assurance program. 17.216 (3,5%) individuals were under and 471.551 (96,5%) were above. 14,3% (n=2.454) patients under 50 and 25,5% (n=120.018) above had adenomas. 11.8% (n=289) of precursor lesions within those under and 7,9% (9503) above, were Sessile serrated lesions (p<0,001). 3,3% (n=81) were traditional serrated adenomas (TSA) among those <50 and 1,1% (n=1.362) above (p<0,001). 12.7% (n=311) vs. 12.6%(n=15.120; p=0,92)) of adenomas were tubulovillous and 0,57% (n=14) vs. 0,76% (n=915) (p=0,28)were villous comparing <50a and >50a. 71,7% (n=1.759) of adenomas within individuals under 50 and 77,6% (n=93.118) above were tubular (p=0,12)

Conclusion

Individuals under 50 have a significant higher proportion of SSA and TSA but a significant lower proportion of tubular adenomas than those aged 50 and older.

Introduction

The prevalence of functional dyspepsia (FD) and gastroparesis in diabetic patients remains unknown. A high prevalence of gastroparesis has been reported in diabetic patients reaching up to 5%.¹ However, recent consensus specified the symptom pattern for gastroparesis, with nausea and/or vomiting as predominant symptoms, now defined as “gastroparesis-like symptoms” (GPLS).² The global prevalence of GPLS has been estimated to reach only 1.2% in diabetic patients, but type 1 and type 2 diabetes were not assessed separately.²

Aims & Methods

We aimed to assess the prevalence and burden of FD and GPLS in primary care patients with diabetes, comparing patients with type 1 and type 2 diabetes. An online survey was addressed to diabetic patients through general practitioners and diabetic patient associations. The survey included the Rome IV questionnaire and the Patient Assessment of Gastro-Intestinal Disorders-Symptom Severity Index (PAGI-SYM) for upper gastro-intestinal symptoms. Anxiety, depression, somatization, and quality of life were also assessed by specific questionnaires (Generalized Anxiety Disorder GAD-7, Patient Health Questionnaire PHQ-9, PHQ-15, and PAGI-QoL questionnaires respectively).

Results

A total of 216 patients completed the questionnaires, among which 146 had type 1 diabetes, and 68 had type 2 diabetes, (2 patients did not know their type of diabetes). The median age of the population was 56 (50-61) years old, with 134 female patients (61.8%). The prevalence of FD was 13.0% with no difference between the 2 groups. The prevalence of GPLS reached 4.2% and was significantly higher in patients with type 2 diabetes (8.9% vs 2.1%; p=0.03). The burden of upper gastro-intestinal symptoms and their impact on quality of life was higher in type 2 diabetes patients with higher PAGI-SYM and PAGI-QoL scores while anxiety and somatization were not different between type 1 and type 2 diabetes patients (see Table). Overall, patients with GPLS had higher anxiety (9 vs 3; p=0.003), depression (12 vs 3; p=0.001) and somatization scores (16 vs 6; p<0.001) than patients without. Compared to patients with FD without GPLS, GPLS patients had numerically higher but not statistically different scores for symptom severity (51 vs 28; p=0.46), anxiety (9 vs 7; p=0.29), depression (12 vs 7; p=0.07), somatization (16 vs 11.5; p=0.16) and quality of life scores (52 vs 24; p=0.16).

Conclusion

This study confirms that the prevalence of GPLS seems to be higher in diabetic patients compared to available population data, especially in patients with type 2 diabetes. The impact of the symptoms was similar to the impact of FD in this population. Further studies are required to assess the prevalence of delayed gastric emptying in diabetic type 1 and 2 patients with GPLS.

References

1. Choung RS, Locke GR, Schleck CD, et al. Risk of Gastroparesis in Subjects with Type 1 and 2 Diabetes in the General Population. Am J Gastroenterol 2012;107:82-88.
2. Huang I-H, Schol J, Khatun R, et al. Worldwide prevalence and burden of gastroparesis-like symptoms as defined by the United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis. United European Gastroenterol J 2022;10:888-897.

Introduction

Contrast-enhanced harmonic endoscopic ultrasound (CEH-EUS) can demonstrate microvascularization of the tumors. However, most images acquired from CEH-EUS are interpreted subjectively without quantification by time-intensity curves (TICs) analysis.

Aims & Methods

In this study, we used handcrafted software to quantify CEH-EUS images for objective interpretation of tumor microvascularization to make differential diagnosis of pancreatic tumors feasible.
We analyzed the videos of CEH-EUS for pancreatic tumors from the patients in National Taiwan University Hospital and Far Eastern Memorial Hospital. The convex-type echoendoscope (GF-UCT260; Olympus, Tokyo, Japan) equipped with ultrasound (US) systems (EU-ME2) was used for the procedures. The second generation of US contrast agent with Sonazoid (GE Healthcare, Milwaukee,Wisc), which contains perfluorobutane microbubbles with a median diameter of 2–3 μm, was administered bolus and intravenously with a dosage of 0.015 ml encapsulated gas per kilogram body weight. The videos were recorded in AVI formats with 30 frames/second.
The algorithm for getting TICs includes the following steps:
(1) Circling the region of interest(ROI) in the B-mode
(2) Performing speckle tracking of the ROI in the B-mode
(3) Simultaneously obtaining the intensity of ROI (the mean pixel values in the ROI) in the corresponding contrast-enhanced harmonic image
(4) Outputting TICs after subtracting the baseline intensity (defined as mean TIC in the first 10 s for eliminating the different baseline intensities caused by other settings).
(5) Outputting histogram of pixel values and excel file containing all pixel values from the frame with the highest mean pixel value automatically.
(6) Calculating the standard variance of (5) to represent the heterogeneity inside the ROI.
The speckling tracking composes of searching and matching processes. We used full search for the searching process and normalization cross-correlation for the matching process. By using the hardware of CPU with Intel i7-8750H and GPU with Nvidia GTX 1050 Ti, the computation time was 0.7 ms/frame.

Results

The detailed results were shown in Table 1. We collected 10 and 7 videos of CEH-EUS for pancreatic tumors from NTUH and FEMH respectively in this study. Among them, 9 were diagnosed of pancreatic ductal adenocarcinoma (PDAC), 6 were pancreatic neuroendocrine tumors (PNET), and 2 were autoimmune pancreatitis (AIP). The TICs were obtained through our proposed model. Briefly, there were no significant differences in times to peak, the mean peak intensity, the in-slope tangent and standard deviation of pixel value in ROI (from the frame with the highest mean pixel value) among PDAC, PNET, and AIP. However, there was significant difference in the mean peak intensities of PDAC and non-PDAC (37.88 vs 63.12, p=.031).

Table 1.The results from three kinds of pancreatic tumors based on the proposed model

Conclusion

In this study, there were no significant differences in times to peak, the mean peak intensity, and SD of pixel value in ROI (from the frame with the highest mean pixel value) among PDAC, PNET, and AIP, however there was significant difference in the mean peak intensity between PDAC and non-PDAC group. A study with larger test number is needed in the future for further application.

Disclosure

We have no conflicts of interest to disclose.

Introduction

Volatile organic compounds (VOCs) form a specific chemical profile that can be used to detect the colorectal cancer-related changes in human metabolism and thereby, to diagnose this type of cancer even at an early stage.

Aims & Methods

The aim of this study was to characterize the volatile chemical patterns associated with cancer and normal tissues obtained from colorectal cancer patients and identify potential volatile biomarkers of colorectal cancer. In total 50 paired tissue samples were analyzed. Volatiles released by the tissue samples were captured using solid phase microextraction (HS-SPME) and next identified and quantified using gas chromatography with mass spectrometric detection (GC-MS). A Wilcoxon signed-rank test was used to compare the emissions of VOCs from cancer and non-cancerous tissues and p<0.05 was taken as significant threshold.

Results

A total of 163 compounds were found in the headspace of the tissue samples. Amongst these, 149 VOCs were identified in cancer tissues and 147 in non-cancerous ones. 138 volatiles were found in both types of tissues. The predominant chemical classes in both tissues are hydrocarbons (25%) and alcohols (15%). These are followed by aldehydes, ketones and aromatics. Only 40 VOCs (27%) exhibited incidence higher than 50% in cancerous tissues. In case of healthy tissue this number amounted to 44 (30%). 11 volatiles occurred in at least 90% of both types of samples and thereby can be considered as omnipresent. 15 VOCs showed consistent differences in their headspace concentrations above samples under study. Of these, 4 compounds were found to have increased emissions from the cancer tissue, and the other 11 showed the reduced release from this type of samples. The species emitted in higher amounts by cancerous tissue comprised 1-propanol, pyridine, isoprene and methyl thiolacetate (p<0.05).

Conclusion

The results of this study confirm that the chemical fingerprint formed by volatiles in colorectal tissue is altered by colorectal cancer. These VOCs - 1-propanol, pyridine, isoprene, methyl thiolacetate were found to be the most promising biomarker candidates for detecting colorectal cancer.

Introduction

Mortality of acute mesenteric ischemia (AMI) is closely correlated with the development and extent of irreversible transmural intestinal necrosis (ITIN). In this context, the surgical assessment of small bowel viability is difficult, subjective (visual) and invasive. In order to better identify high-risk patients justifying an immediate surgical evaluation, the non-invasive Clichy score was developped in 2017 (Nuzzo et al. Am J Gastroenterol 2017). The aim of this study was to evaluate the diagnostic performance of this score.

Aims & Methods

The development cohort included 67 patients with AMI admitted to our center between 2009 and 2015, with a Clichy score including 3 independent factors (organ failure, elevation of plasma lactate > 2 mmol/L, and intestinal dilation on CT scan > 25mm; area under the ROC curve [AUROC] = 0.94 [95% confidence interval: 0.87–1.00]). The present validation study prospectively included patients admitted to our center for AMI between 2016 and 2018. The presence of ITIN was defined histologically as previously published. The diagnostic performance of the score was assessed by AUROC in the total cohort, and in the AMI subgroups of arterial and venous origin.

Results

52 patients (mean age 65, 37% women) were included. Arterial and venous occlusion induced AMI occurred in 65% and 35% of cases, respectively. ITIN was confirmed in 14 patients (27%). Organ failure, elevation of plasma lactate > 2 mmol/L, and intestinal dilatation > 25 mm was observed in 17 (33%), 15 (29%) and 12 ( 23%) of patients, respectively. The AUROC for the diagnosis of ITIN by the Clichy socre was 0.90 (95% CI = 0.81 – 0.98). In the presence of 0, 1, 2 and 3 factors, the risk of ITIN was 0%, 14%, 55% and 75%, respectively (Figure). In subgroup analyses, the AUROC for the diagnosis of ITIN was 0.96 (0.89 – 1.00) in arterial AMI, and 0.77 (0.53 – 0.85) in venous AMI. In arterial AMI, the risk of ITIN was respectively 0%, 13%, 67% and 100% in the presence of 0, 1, 2 and 3 factors. In venous AMI, the risk of ITIN was respectively 0%, 17%, 50% and 50% in the presence of 0, 1, 2 and 3 factors. The negative predictive value (NPV) of a score of 0 was 100% in both types of AMI. The positive predictive value (PPV) of a score of 3 was 100% in arterial AMI, and 50% in venous AMI.

Conclusion

This prospective study is the first which validates a non invasive diagnostic score of ITIN in the setting of AMI. The diagnostic performance of the score was satisfactory, especially in AMI of arterial origin. These results suggest that these factors should prompt laparotomy consideration if present. In the subgroup of venous AMI, further studies seem necessary to identify other risk factors.

Disclosure

MSD Avenir grant

Introduction

Common variable immunodeficiency (CVID) is the most prevalent primary immune deficiency. Two-thirds of CVID patients present concomitant autoimmune disorders, including gastrointestinal autoimmune disease, other than being at risk for gastric cancer.

Aims & Methods

We aimed to assess the prevalence of autoimmune gastrointestinal manifestation in patients with CVID and to evaluate the diagnostic yield of EGDS for the screening of gastric pre-neoplastic lesions in a prospective cohort of patients with CVID. From June 2020 to June 2022, we prospectively enrolled patients with CVID diagnoses from a tertiary referral center. At enrollment, patients underwent a gastroenterological screening consisting of clinical evaluation and laboratory tests for the screening of autoimmune gastrointestinal disease. Moreover, all patients were proposed to undergo an esophagogastroduodenoscopy (EGD) regardless of the presence of GI symptoms to rule out pre-neoplastic gastric lesions and upper gastrointestinal disease in the presence of clinical suspicion. Patients with lower GI symptoms were proposed for colonoscopy.

Results

We included 94 patients with CVID, of whom 58 (61.7%) were females, with a mean age of 44.3 years old [standard deviation (SD) 16.3]. Overall, 12 patients (12.8%) were diagnosed with one or more gastrointestinal autoimmune diseases. Eight patients (8.5%) had ongoing therapy with intravenous immunoglobulin, while 24 (25.5%) with subcutaneous immunoglobulin. Four patients (4.3%) had a previous celiac disease diagnosis, with a negative serology at screening, and only 1 (1.1%) patient had evidence of villous atrophy and duodenal inflammation at the time of EGD. Three (3.2%) patients were diagnosed with autoimmune atrophic gastritis with negative serology and evidence at biopsies taken during EGD of atrophic gastritis. One patient (1.1%) was diagnosed with ulcerative colitis, one patient (1.1%) with Crohn’s disease, and 5 patients (5.3%) with autoimmune hepatitis. Sixteen (16, 17%) patients reported inhalant allergy, 5 (5.3%) reported food allergy, and 26 (27.7%) reported drug-related allergy. Eleven (11.7) patients reported previous Helicobacter pylori (HP) infection, while only 1 (1.1%) patient was diagnosed with an ongoing HP infection. Fifty-eight patients underwent EGD, with endoscopic evidence of esophagitis in 8 patients (13.8%), gastritis in 45 (77.6%), and duodenal atrophy/inflammation in 23 (39.7%), of whom 41.4% had histological evidence of duodenal lymphocytosis. No patient was diagnosed with gastric cancer. Twenty-three patients underwent colonoscopy according to clinical indication, which showed at biopsy sampling ileal nodular follicular hyperplasia in 2 patients (8.7%), microscopic (lymphocytic) colitis in 2 patients (8.7%), ulcerative colitis in 1 (4.3%) and Crohn's disease in 1 (4.3%).

Conclusion

Celiac disease, atrophic gastritis, and autoimmune hepatitis were the most common gastrointestinal autoimmune overlaps of patients with CVID. Autoimmune gastrointestinal diseases in patients with CVID may pose a particular diagnostic challenge since autoantibodies are often absent. Five percent of CVID patients screened with EGD was found with a gastric pre-neoplastic lesion. Further data are needed to define the optimal timing of endoscopic follow-up of these patients for the screening of pre-neoplastic and neoplastic lesions.

Disclosure

Served as an advisory board member for EG Pharma
Received lecture grants from AlfaSigma, Bromatech, Echosens, Ferring, Mayoly Spindler and Schwabe Pharma.

Introduction

Corpus Atrophic Gastritis (CAG) is a precancerous inflammatory condition of the oxyntic mucosa. Up today, two types of CAG are distinguished: 1) autoimmune (corpus-restricted), defined for CAG sparing the antrum 2) Helicobacter pylori (Hp)-related (multifocal), which involves antrum too.
Antrum involvement/sparing is crucial for both CAG definition as autoimmune and gastric cancer risk level, which is increased in case of pan-atrophy/pan-metaplasia, according to OLGA and OLGIM scores. CAG natural history is still poorly known, especially regarding antrum evolution. In cases with previous antral involvement, possible antrum healing after cure of Hp infection was formerly described. So, given the importance of the criterium antrum-sparing, we aimed to assess antral mucosa changes at long-term follow-up(FU) beside baseline in a cohort of CAG patients.

Aims & Methods

Given the importance of the criterium antrum-spared, we aimed to assess antral mucosa changes at long-term follow-up(FU) beside baseline in a cohort of CAG patients.
We performed a retrospective study on 130 patients with CAG and antrum involvement according to updated Sydney System. Mean time of FU gastroscopy was 40.6(range 4-192) months. In 13 patients corpus atrophy was not confirmed at FU, so were excluded. At baseline, among the remaining 117 patients [mean age 63 (range 20-87) years; F 67.5%], 47 (40.2%) had antral non-atrophic and 70 (59.8%) had antral atrophic gastritis, metaplastic in 84.3%. Histologically diagnosed Hp infection was present in 27.3% of patients, all receiving eradication therapy, anti-parietal cells antibodies (APCA) were positive in 53.8%.

Results

At FU 29/117(24.8%) of patients with tout-court involved antrum showed a complete restitutio ad integrum of antral mucosa. In particular, on 70 cases with antral atrophy at baseline, atrophy regressed in 15 (21.4%). Hp infection at baseline was present in 38% of patients who reported complete antral healing at FU, cured in all but one. Both antral healing and atrophy regression were found to be similar in Hp-cured and not-cured/negatives (p>0.05). In 8 patients (6.8%) a worsening of antral histology at FU was reported: 5 developed antral atrophy, not present at baseline, and 3 antral atrophic patients developed intestinal metaplasia.

Conclusion

Nearly 25% of CAG patients with antral involvement showed complete antrum healing, with regression of baseline antral atrophy in 21.4%. Antral healing occurred also in patients without history of Hp infection and/or eradication. These data suggest that in CAG natural history, concomitant antral involvement may regress irrespective of Hp cure, implying cancer risk reduction and raising queries about histology as sole criteria diagnostic for autoimmune gastritis.

References

1. Lahner et al. Dig LIver Dis 2019
2. Sipponen P et al. Gastroenterology clinics of North America 2000
3. Annibale B Helicobacter 1997