Introduction

Faecal incontinence (FI) is a prevalent and debilitating anorectal problem which can cause embarrassment, anxiety, social isolation and diminishes quality of life (QoL). Currently, there is no optimal treatment option for FI, consequently, treatments primarily focus on symptom reduction and improving QoL. In order to gain a clearer understanding of the challenge’s patients encounter, it is essential to actively listen to patients’ perspectives and experiences, as well as the specific outcomes they aim to achieve from treatment.
This study aims to explore how FI impacts patients’ lives and identify important treatment outcomes as part of the development of a Core Outcome Set (COS).

Aims & Methods

Patients with FI were recruited from surgery and gastroenterology outpatient clinics in the Netherlands. Semi-structured interviews were performed, audio recorded, transcribed per verbatim and coded. Thematic analysis was performed to identify (sub)themes and categories relevant to the patients.

Results

Twelve interviews were conducted before saturation was reached (75% female, 25% male, mean age 63, range 39-83 year). Four main themes emerged ‘Physical symptoms’, ‘Impact on daily life’, ‘Emotional impact’ and ‘Coping’. Patients expressed how FI severely limits daily activities and emotional wellbeing. Patients' treatment priorities centred on resuming normal activities rather than solely on (physical) symptom reduction.

Conclusion

The impact of FI extends far beyond uncontrolled loss of faeces, affecting psychological, emotional, and social wellbeing. Patients prioritise outcomes focussed on reclaiming normalcy and independence rather than focusing on physical symptoms alone. Integrating these patient-centered outcomes in future studies could enhance treatment satisfaction and patient-perceived treatment success. Furthermore, outcomes identified through this study will be combined with other outcomes identified through literature review, forming a comprehensive list for a Delphi survey with relevant stakeholders to establish a consensus on a final list of outcomes for a COS for FI.

Introduction

Cancer is the second leading cause of death globally. Colon cancer is the fifth most prevalent type of cancer. Screening, particularly colonoscopy, reduces incidence by 40% and mortality by 50%. The process of bowel preparation before a colonoscopy is complex and requires the patient’s compliance. Enhanced education using a smartphone application has been shown to improve bowel preparation quality. However, heterogeneity was observed among the studies.

Aims & Methods

AIMS: To determine if providing instructions through an application enhances bowel preparation quality in Thai patients undergoing elective colonoscopy.

METHODS: From July 2022 to January 2024, a prospective, endoscopist-blinded, randomized, controlled trial was conducted. Consecutive patients aged > 18 years old who had convenient access to the Line application were randomly assigned in a 1:1 ratio to be educated via the smartphone application (APP group) or the standard education (control group). All patients received the same purgative regimen. The primary outcome was the Boston Bowel Preparation Scales (BBPS). Secondary outcomes included adenoma detection and cecal intubation rates, cecal intubation time, withdrawal time, and patient satisfaction.

Results

The trial aims to recruit 488 patients. A total of 272 patients (APP group, n = 131; control group, n =141) were preliminary analyzed. The mean age was 61.5 years old, and 29% were male. The mean BBPS was comparable between the APP and control groups (8.30 ± 0.99 vs 8.51 ± 1.19, P = 0.173). Both groups achieved adequate bowel preparation (BBPS>6) in 99.2% of cases. All secondary outcomes corresponded with the primary outcome. In the subgroup analysis among the elderly, levels of education, income, and waiting times for colonoscopies, BBPS was not impacted by the providing methods. No adverse events related to education were observed.

Conclusion

Both standard and enhanced education using the smartphone application resulted in excellent bowel preparation. Eligible patients included in this study might influence this outcome. However, using the smartphone application was well-received and could potentially replace standard education for bowel preparation.

References

1. Virani S, Bilheem S, Chansaard W, Chitapanarux I, Daoprasert K, Khuanchana S, et al. National and Subnational Population-Based Incidence of Cancer in Thailand: Assessing Cancers with the Highest Burdens. Cancers. 2017;9(8):108.

2. May FP, Shaukat A. State of the Science on Quality Indicators for Colonoscopy and How to Achieve Them. Official journal of the American College of Gastroenterology | ACG. 2020;115(8):1183-90.

3. Desai M, Nutalapati V, Bansal A, Buckles D, Bonino J, Olyaee M, et al. Use of smartphone applications to improve quality of bowel preparation for colonoscopy: a systematic review and meta-analysis. Endosc Int Open. 2019;7(2):E216-E24.

Introduction

Inadequate bowel preparation is linked to reduced adenoma detection rates (ADR), and establishing a threshold for bowel preparation below which colonoscopies should be repeated early is crucial for patient outcomes. However, manual bowel cleansing efficacy evaluation relies on the clinical observer's experience, resulting in subjectivity with clinical and economic implications. The Boston Bowel Preparation Scale (BBPS) is the most validated scoring scale. Our group previously constructed an AI-based bowel preparation assessment model to calculate e-BBPS scores.

Aims & Methods

This prospective, single-center study was conducted at the Eighth Affiliated Hospital, Sun Yat-sen University in China from October 2021 to November 2022. Eligible patients underwent screening colonoscopy by one of three study endoscopists. The AI calculated the e-BBPS score during colonoscope withdrawal. The endoscopist assessed bowel preparation adequacy using BBPS after the colonoscopy. If both BBPS and e-BBPS deemed bowel preparation adequate, the same endoscopist performed a second colonoscopy. If either considered it inadequate, the patient underwent bowel re-cleansing before the second colonoscopy. Video recordings were evaluated for bowel preparation using BBPS by five independent endoscopist raters.

Results

From October 8, 2021, to November 9, 2022, a total of 393 patients were included for analysis. In patients with unqualified-AI, the >5mm AMR was significantly higher than in patients with qualified-AI (p=0.0056, OR 0.2734, 95% CI 0.1139, 0.6565), as were the AMR <0.001 (p=0.2532, 95% CI 0.1583, 0.4052), diminutive AMR (p<0.001, OR 0.2160, 95% CI 0.1206, 0.3867), >5mm PMR (p=0.0152, OR 0.4335, 95% CI 0.2288, 0.8213), and PMR (p <0.001, OR 0.4532, 95% CI 0.3447, 0.5958). No significant differences were observed in the overall >5mm ADR, ADR, >5mm PDR, and PDR. In the first pass, no statistical differences were found in ADR between the qualified-AI and unqualified-AI groups, though there was a trend toward a higher ADR in the qualified-AI group. In the second pass, patients in the qualified-AI group achieved significantly lower >5mm ADR, ADR, diminutive ADR, advanced ADR, >5mm PDR, and PDR compared to those in the unqualified-AI group.
Cohen's kappa analysis revealed high agreement between expert raters, clinical scoring, and e-BBPS (ranging from 0.7791 to 0.8322). However, the agreement between general endoscopists and other raters was only low to moderate (0.2937 to 0.6071). Fleiss' kappa also indicated that the overall agreement among all raters was only 0.575 (p < 0.001, 95% CI 0.574, 0.575), while the Fleiss' kappa for Expert and Clinical scoring, as well as Expert, Clinical scoring, and e-BBPS were 0.809 (p < 0.001, 95% CI 0.807, 0.810) and 0.800 (p < 0.001, 95% CI 0.799, 0.801), respectively.

Conclusion

This study validates the e-BBPS bowel preparation evaluation threshold, confirming that patients with a score of ≤3 have adequate bowel preparation for detecting >5mm adenomatous polyps, while those with a score of >3 require repeat bowel preparation. This conclusion supports the implementation and promotion of fully automated bowel preparation assessment systems, which may improve the objectivity of bowel preparation evaluation and standardize clinical practice for screening colonoscopies in the future.

Introduction

Effective colorectal cancer prevention relies on the quality of screening colonoscopy examinations. Cecal withdrawal time is significantly associated with adenoma detection rate (ADR), which is an established quality indicator for screening colonoscopy. Therefore, we introduced a real-time cecal withdrawal timer (CWT) that alerts the physician of the elapsed time since cecal intubation.

Aims & Methods

An observational, retrospective, single-center study to evaluate CWT in screening colonoscopy tests. The CWT is activated by a vocal command when the physician achieves cecal intubation. Following activation, the elapsed time is audio-announced every minute until the end of the procedure. The ADR of colonoscopies with and without the CWT was evaluated following CWT implementation from January 2023 to February 2024. Moreover, the ADR of the entire department in this period was compared with the year before.

Results

Of 1,557 colonoscopies between January 2023 and February 2024, 908 (58.3%) were performed with the CWT with a median withdrawal time of 8.75 (IQR: 6.9-12.0) minutes. During this period, the CWT usage was greater than 50% in 11 out of 14 months. Considering only months with CWT usage over 50%, the ADR of colonoscopies with CWT was 28.3% compared to 19.2% in those without (p<0.001). Among physicians who performed at least 20 tests with and 20 tests without the CWT, 6 out of 8 demonstrated improved ADR with the cecal timer. Notably, the 2 physicians who did not improve ADR had baseline ADR exceeding 30%. The overall ADR of the department between January 2023 and February 2024 was 25.5%, compared to 26.2% in 2022 (p=0.704).

Conclusion

Initial findings of the CWT program suggest its potential in enhancing screening colonoscopy quality indicators, although long-term prospective follow-up is warranted.

Disclosure

Nothing to declare

Introduction

Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder characterized by abdominal pain and changes in bowel habits. Small intestinal bacterial overgrowth (SIBO) refers to a group of gastrointestinal syndromes caused by an excessive number of bacteria in the small intestine. Up to now, the relationship between IBS and SIBO remains contentious. So we set out to investigate the differences between these two conditions.

Aims & Methods

Participants who met the Rome III diagnostic criteria for IBS and had a negative lactulose hydrogen and methane breath test (LHMBT) were diagnosed with IBS. Those who presented with gastrointestinal symptoms and had a positive LHMBT were diagnosed with SIBO. Overlapping cases were excluded. Participants who had a negative LHMBT and no significant abdominal symptoms were classified as healthy controls (HC). All participants were instructed to provide fecal samples for 16S rRNA sequencing.

Results

Our results showed that a history of enteritis was more common in IBS patients, and the severity of gastrointestinal symptoms was significantly higher in IBS and SIBO groups compared to healthy controls. IBS patients also reported more severe symptoms than SIBO. Additionally, IBS patients were more affected by their symptoms, while the SIBO group reported more dissatisfaction with bowel habits. We observed differences in dietary intake between the groups, with IBS patients having the highest total energy and protein intake, and the lowest dietary fiber intake. SIBO patients had higher fat intake and significantly lower carbohydrate intake compared to the other two groups. Regarding the fecal microbiome, both IBS and SIBO patients had higher structural diversity and lower functional diversity than the HC group. The abundance of Firmicutes/Bacteroidetes in the IBS group was significantly higher than in the other two groups. Our analyses indicated that the fecal microbiome could significantly distinguish the three groups, and specific bacterial species were associated with different symptoms in each group. In SIBO, Thalassospira and Christensenellaceae_group were associated with intestinal motility abnormalities, while Ruminococcaceae_group, Butyricimonas, and Oscillospira were associated with gas production. In the IBS group, Klebsiella and Mitsuokella were associated with abdominal pain, and other bacteria such as Escherichia_Shigella and Enterobacter were generally associated with enteritis infection, abdominal pain, and diarrhea. We also found that the predicted KEGG pathways were enriched in various nutrient metabolism pathways, with potential implications for elevated blood folate levels and vitamin B12 deficiency in SIBO patients.Protein bacterial motility and biofilm formation_ Escherichia coli, were mainly enhanced in IBS, and these functions were related to the mucosal barrier damage.

Conclusion

Our study shows that although IBS and SIBO share similar symptom spectra, they may be two distinct diseases. Despite the potential differences in the fecal flora of small intestinal flora in SIBO group, significant differences were found between IBS and SIBO in terms of clinical phenotype and fecal microbiome. Further exclusion of SIBO using lactulose hydrogen and methane breath testing in patients who meet the diagnostic criteria for IBS is warranted, as the differences suggest that different treatment strategies may be needed for these two populations. Future studies are needed to explore the underlying mechanisms and potential therapies for these conditions, which may ultimately benefit patients with IBS and SIBO.

References

1. Quigley EMM, Murray JA, Pimentel M. AGA Clinical Practice Update on Small Intestinal Bacterial Overgrowth: Expert Review. Gastroenterology. 2020; 159(4):1526-1532. DOI: 10.1053/j.gastro.2020.06.090
2. Bushyhead D, Quigley EMM. Small Intestinal Bacterial Overgrowth-Pathophysiology and Its Implications for Definition and Management. Gastroenterology. 2022; 163(3):593-607. DOI: 10.1053/j.gastro.2022.04.002
3. Ghoshal UC, Nehra A, Mathur A, Rai S. A meta-analysis on small intestinal bacterial overgrowth in patients with different subtypes of irritable bowel syndrome. J Gastroenterol Hepatol. 2020; 35(6):922-931. DOI: 10.1111/jgh.14938
4. Mearin F,Lacy BE,Chang L, et al. BowelDisorders[J].Gastroenterology,2016;150;1393-1407.
5. Zhu L, Huang D, Shi L, et al.Intestinal symptoms and psychological factors jointly affect quality of life of patients with irritable bowel syndrome with diarrhea.Health
Qual Life Outcomes. 2015;13:49.
6. Sperber AD,Dumitrascu D, Fukudo S, et al.Gut 2017;66:1075–1082
7. Jindong Zhang, Jiao Liu, Shiwei Zhu, Ben Wang, Qiong Jia, Qihua He, Lijin Song, Yuan Fang, Baoli Zhu, Liping Duan. Berberine alleviates visceral hypersensitivity in rats by altering gut microbiome and suppressing spinal microglial activation. Acta Pharmacologica Sinica，Accepted 2020

Introduction

​The gut microbiota is often altered in chronic liver diseases and hepatocellular carcinoma (HCC), and increasing evidence suggests that it may influence response to cancer immunotherapy. Strategies to modulate the gut microbiome (i.e., fecal microbiota transplant (FMT)) may help to improve efficacy of immune checkpoint inhibitors (ICIs) or even overcome resistance to ICIs.

Aims & Methods

​In this single-center phase II pilot study (ClinicalTrials.gov ID: NCT05750030), we plan to include 12 patients with advanced HCC who progressed on atezolizumab/bevacizumab. Patients will receive atezolizumab/bevacizumab every 3 weeks in combination with a single FMT via colonoscopy from donors with HCC who responded to PD-(L)1-based immunotherapy. The primary endpoint is safety, measured by incidence and severity of treatment-related adverse events (TRAEs). The main secondary endpoint is best overall response (BOR) according to RECISTv1.1 and mRECIST. Here, we report results of a preplanned interim analysis.

Results

Of 6 patients included so far, 5 were male, 5 had BCLC stage C, and 5 had Child-Pugh class A. All patients underwent successful FMT without any periinterventional complications. TRAEs related to FMT were all low-grade (grade 1-2) and included bloating (n=2), constipation (n=2), and diarrhea (n=1). TRAEs related to atezolizumab included one grade 2 pruritus, and TRAEs related to bevacizumab included arterial hypertension (one grade 3 and two grade 2) and proteinuria (one grade 3 and one grade 1). All patients had at least one follow-up imaging. Two patients had partial response, 3 patients had stable disease, and 1 patient had progressive disease as BOR according to both RECISTv1.1 and mRECIST, which corresponds to an objective response rate of 33% and a disease control rate of 83%.

Conclusion

Based on acceptable safety and promising efficacy results, the decision to continue recruitment in this trial was made. An update with longer follow-up will be presented at the meeting, including analyses of the gut microbiome.

Disclosure

AF received travel support from Takeda and Amgen, he received speaker honoraria from AbbVie
KP has nothing to disclose.
BS received travel support from AbbVie, AstraZeneca, Gilead and Ipsen, speaker honoraria from Eisai as well as grant support from AstraZeneca and Eisai.
BL received speaker honoraria from Chiesi and Gilead.
LP has nothing to disclose.
AK has nothing to disclose.
KR has nothing to disclose.
KZ has nothing to disclose.
MT received speaker honoraria from Albireo, BMS, Falk Foundation, Gilead, Intercept, Madrigal and MSD; he has advised for Abbvie, Albireo, BiomX, Boehringer Ingelheim, Falk Pharma GmbH, Genfit, Gilead, Hightde, Intercept, Ipsen, Jannsen, MSD, Novartis, Phenex, Pliant, Rectify Regulus, Siemens and Shire. He further received travel grants from Abbvie, Falk, Gilead Intercept and Jannsen and research grants from Albireo, Almylam, Cymabay, Falk, Gilead, Intercept, MSD, Takeda and Ultragenyx. He is also co-inventor of patents on the medical use of NorUDCA filed by the Medical Universities of Graz and Vienna.
DT served as a speaker and/or consultant and/or advisory board member for Siemens, Roche, Sanova, Bristol-Myers Squibb and received travel support from Bayer and Siemens.
CG nothing to disclose.
MP received speaker honoraria from Bayer, BMS, Eisai, Ipsen, Lilly, MSD, and Roche; he is a consultant/advisory board member for AstraZeneca, Bayer, BMS, Eisai, Ipsen, Lilly, MSD, and Roche; he received grants from AstraZeneca, Bayer, BMS, and Roche; he received travel support from Bayer, BMS, Ipsen, and Roche.

Introduction

United European Gastroenterology (UEG) Guideline on IgG4-related digestive disease provides evidence-based recommendations for the diagnosis and management of immunoglobulin G4 (IgG4)-related digestive disease in adults and children. IgG4-related digestive disease can be diagnosed only with a comprehensive work-up that includes histology, organ morphology at imaging, serology, search for other organ involvement, and response to glucocorticoid treatment. Indications for treatment are symptomatic patients with obstructive jaundice, abdominal pain, posterior pancreatic pain, and involvement of extra-pancreatic digestive organs. Treatment with glucocorticoids should be weight-based and initiated at a dose of 0.6–0.8 mg/kg body weight/day orally for 1 month to induce remission and then be tapered within two additional months. Response to initial treatment should be assessed at week 2–4 with clinical, biochemical, and morphological markers.

Aims & Methods

The aim of this study is to evaluate the adherence to diagnostic, therapeutic and management recommendations of the IgG4 guideline across Europe. The invitation to participate in the study was published at My Connect UEG platform. Questions in the survey were related to the organ involvement, diagnosis, treatment and follow up of newly diagnosed patients with IgG4-related digestive diseases in the three-year period (January 2021 - December 2023) after the publication of the guideline in 2020. We have received data from 14 European centers (12 countries).

Results

One hundred ninety-nine patients (76% males) were included in this multicentric study.
IgG4-related digestive disease was diagnosed in 54, 75, and 70 patients during 2021, 2022 and 2023 respectively.
Most of the patients had concomitant pancreatic and biliary tree involvement (46%), followed by pancreatic (34%), biliary tree (19%), esophageal (1.5%) or bowel (0.5%) involvement. Among autoimmune pancreatitis (AIP) patients, 76% received a definite diagnosis.
The combination of CT and MRI was employed in 63% of the patients, whereas 13% received only either CT or MRI.
Endoscopic ultrasound was performed in 56% of the patients.
Pancreatic exocrine and endocrine function at baseline were controlled in 78% and 76% of the patients, respectively.
Most of the patients (72%) received induction treatment with glucocorticoids (GC) according to UEG guidelines, whereas 8%, 7%, and 13% received a different GC scheme, a different drug, or no treatment, respectively.
Eleven patients underwent surgery due to suspected cancer.
Follow up assessment was performed according to guidelines (between 2-4 weeks from treatment start) in 48% of the patients and after 4 weeks in 38% of the patients, but 7% did not receive any follow-up imaging.
Among the 37 patients with biliary tract and liver involvement, 51% underwent MRI and CT, while EUS was used in 43% of the patients.
Treatment and imaging follow up mirrored UEG guidelines in 78% and 57% of the patients, respectively.
Five patients underwent surgery due to suspected cancer.
Three cases of IgG4-RD of the esophagus and one case of IgG4-related bowel disease were detected.

Conclusion

IgG4-related digestive disease was diagnosed in pancreas and the bile duct (concomitant or isolated) in most of the patients. IgG4-related disease in other digestive organs is very rare. Adherence to the European guidelines is high in the context of diagnosis and the first line treatment. Surgery was performed in 8% of all cases due to the suspected cancer. There are still differences across Europe regarding the follow up of patients.

Disclosure

Dr Vujasinovic and Dr Löhr have received lecture fees from Abbott and Viatris.
Dr Ponsioen received research grants from Gilead and Perspectum and consultancy fees from Chemomab and NGM.