Introduction

The rising incidence of early-onset colorectal cancer (eoCRC) in many countries underscores the need for risk-adapted screening approaches. Excess weight is a modifiable and increasingly prevalent risk factor for eoCRC. Given the routine collection of body mass index (BMI) in clinical settings, BMI-based screening initiation may offer a straightforward and scalable strategy to improve early detection.

Aims & Methods

We aimed to identify BMI-specific ages at which individuals reach 5-year cumulative colorectal cancer (CRC) risk levels equivalent to typical screening initiation ages (ages 45 and 50). Using GLOBOCAN 2022 data, we estimated country-specific 5-year cumulative CRC risks for adults aged 30–60 across six North American and European countries (United States, Canada, Germany, France, United Kingdom, and Italy). As the average BMI at CRC screening initiation ages in the included countries falls within the overweight range (BMI 25–29.9 kg/m²^​), we considered these age-specific risk estimates representative of individuals with overweight and reflective of average risk at screening initiation. Age-specific risks for individuals with normal weight (BMI 18.5–24.9 kg/m²) and obesity (BMI ≥30 kg/m²) were derived by proportionally adjusting the risks of the overweight population using odds ratios and confidence intervals from a meta-analysis of 20 cohort studies. Risk-adapted starting ages were defined as the age at which individuals with normal weight or obesity reached the same 5-year CRC risk as those with overweight at age 45 or 50.

Results

Using individuals with overweight as the reference group for average-risk at screening initiation, those with obesity reached the same 5-year cumulative CRC risk observed at age 45 by age 41 (95% CI, 37-45) in Canada and the United States, and by age 42 (95% CIs, 38-45) in the included European countries. Individuals with normal weight reached this risk level later, by age 47 (95% CI, 46-48) in Germany, the United Kingdom, and Italy and at age 48 (95% CIs, 47-50) in the United States, Canada, and France. For the age 50 benchmark, individuals with obesity reached comparable CRC risk between ages 46 (95% CIs, 41-51) and 47 (95% CI, 44-50) (see Table 1 for detailed results by country and BMI category).

Table 1. Risk-adapted starting ages for colorectal cancer, by BMI category and country

Conclusion

These findings support incorporating BMI into CRC screening strategies to enable earlier detection in high-risk individuals. Current age-based guidelines may not fully capture elevated risk in individuals with excess weight, potentially delaying detection in this subgroup. BMI-based risk stratification may be a feasible, low-cost approach that could complement existing screening programs by enabling earlier initiation for those at higher risk. Future studies should evaluate its integration with other risk factors and its impact on healthcare systems.

Introduction

Treatment of small bowel angiodysplasia by argon plasma coagulation (APC) during device assisted enteroscopy (DAE) has been shown to be effective at reducing transfusion requirements and rebleeding rates. Patients with angiodysplasia often have comorbidities that warrant prescribing of antiplatelets and oral anticoagulants. There is a paucity of data on continued use of such drugs with respect to the risk of haemorrhage and perforation such that current ESGE guidelines are unable to provide specific guidance in this regard.

Aims & Methods

We retrospectively reviewed patients from our tertiary referral centre who had DAEs with APC for capsule confirmed angiodysplasia from our electronic databases from August 2022 to April 2025. Patient demographics (age and gender) and antiplatelet and anticoagulant use were recorded. The quantity, location, and size of angiodysplasia, the wattage of APC used to ablate angiodysplasia, adjunctive endoscopic therapy (clips), and immediate and late complications were recorded. All DAEs were performed by two experienced endoscopists, the majority under conscious sedation and blood thinners (aspirin, clopidogrel or oral anticoagulant) were not routinely discontinued for the DAE. Outcomes were compared between the blood thinner groups and controls using a chi-squared test. A p value < 0.05 was considered significant.

Results

78 DAE procedures (68 individuals) performed over the 32 month period were included, 48/78 (62%) male, mean age 71 (SD=10). Overall 36/78 were on any blood thinner at the time of DAE. Clopidogrel was held in 2/78 (3%) cases and oral anticoagulant (warfarin/DOAC) in 4/78 (5%) before the DAE, all for clinical reasons, while 36 were not prescribed blood thinners at any time and considered controls. 17/78 (22%) were on oral anticoagulant, 23/78 (29%) on aspirin and 11/78 (14%) on clopidogrel. 6/78(8%) were on both oral anticoagulant and an antiplatelet. Demographics were similar between groups apart from patients who were on oral anticoagulants who were significantly older (77 vs 70, p=0.005). Angiodysplasia were multiple in 67/78 (86%), large in 49/78 (63%), and with signs of recent or active bleeding in 9/78 (12%). The proportion of DAEs with a large angiodysplasia identified was similar between those on any blood thinner and controls, 10/17 in the anticoagulant group vs 39/61 in no anticoagulant group, p=0.6 and 20/14 in antiplatelet group vs 29/44 in no antiplatelet group, p=0.5. Similarly, there was no difference in the rate at which signs of active bleeding from angiodysplasia was seen in the blood thinner group (4/36, 11%) vs the no blood thinner group (5/42, 11%), p=0.9. In 73 cases where the wattage used was known, 71 used 25W and 2 used 30W. In 7/78 (9%), a clip was used in addition to APC to control bleeding, 4/36 and 3/42 in the control and any blood thinner groups respectively. Of interest, clips were more likely to be used when the patient was not taking an anticoagulant (7/61 vs 0/17) but not statistically significant (p=0.1432). No immediate or late complications occurred in any of the groups.

Conclusion

Our data provides evidence that anticoagulants and antiplatelets do not have to be interrupted for treatment of small bowel angiodysplasia with APC during DAE, including for the treatment of multiple and large lesions.

Clinical Case Summary

We report the case of a 40-year-old male patient who was initially diagnosed with Crohn’s disease following chronic diarrhea and the development of perianal fistulas and abscesses requiring surgical drainage.
Pre-operative pelvic MRI revealed a complex anorectal-perineal fistula associated with a posterior abscess. Magnetic Resonance Enterography (MRE) demonstrated circumferential wall thickening and homogeneous mucosal enhancement in the terminal ileum, ileocecal area, and recto-sigmoid region, with no evidence of mesenteric hypervascularity, fat stranding, or enlarged lymph nodes. Colonoscopy revealed small aphthous ulcers in the caecum and terminal ileum. Histological examination of biopsies showed nonspecific chronic inflammation; however, no samples were sent for mycobacterial culture or PCR.
Pre-biologic screening, including a chest X-ray and interferon-gamma release assay (Quantiferon-TB), was negative. The patient was started on azathioprine and anti-TNF-alpha therapy. Four weeks later, his perianal lesions worsened, with increased purulent discharge. Surgical exploration and biopsy of the complex fistula were performed, revealing Mycobacterium tuberculosis on GeneXpert PCR testing.
Anti-TNF therapy was promptly discontinued, and the patient was started on standard quadruple anti-tuberculosis treatment. Clinical outcome was favorable, with progressive healing of the perianal fistulas.
This case underscores the critical importance of excluding gastro-intestinal and perianal tuberculosis, even in the presence of a negative Quantiferon-TB test, before initiating immunosuppressive therapy in patients suspected of having Crohn’s disease.

Introduction

Capsule endoscopy (CE) is a valuable, non-invasive diagnostic tool for the evaluation of small bowel disorders, particularly in patients with suspected inflammatory bowel disease (IBD), known Crohn’s disease, or non-responsive celiac disease (NRCD) (1). Its role in identifying mucosal lesions and guiding clinical decision-making continues to expand, especially in the context of complex or unclear gastrointestinal symptoms.

Aims & Methods

This observational, single-centre retrospective study included all CE procedures performed at the Department of Gastroenterology of the Azienda Ospedaliera–Università di Padova between January 1, 2018, and December 31, 2024. Indications for CE included suspected IBD (e.g., diarrhea, abdominal pain, elevated fecal calprotectin), follow-up of known ileal Crohn’s disease, and evaluation of NRCD. Demographic and clinical data were collected in a dedicated database. CE was considered positive if at least one of the following findings was present: evidence of recent bleeding, ulcers, or villous atrophy. Multivariate analyses were used to assess risk factors associated with ulcers and villous atrophy. Statistical analyses were conducted using STATA 18.

Results

A total of 351 CE procedures were included: 210 for suspected IBD, 108 for IBD follow-up, and 37 for NRCD. The mean age of the cohort was 45.7 ± 16.0 years, with 47% male patients. The diagnostic yield was 39.3% for suspected IBD, 44.4% for IBD follow-up, and 56.7% for NRCD. The prevalence of recent bleeding was similar across groups (31.1% vs. 27.4% vs. 31.6%, p=0.895), as was the presence of ulcers (65.3% vs. 62.1% vs. 40%, p=0.105). However, villous atrophy was significantly more frequent in NRCD patients (0% in suspected IBD, 2.3% in IBD, and 66.7% in NRCD; p<0.001). No association was found between lesions and age, sex, hemoglobin levels, or comorbidities. CE findings led to therapeutic changes in 37% of IBD cases and in 16% of NRCD cases.

Conclusion

This single-centre cohort study confirms the high diagnostic yield of capsule endoscopy in patients with small bowel disorders and highlights its impact on their clinical management.

References

1. Tamilarasan AG, Tran Y, Paramsothy S, Leong R. The diagnostic yield of pan-enteric capsule endoscopy in inflammatory bowel disease: A systematic review and meta-analysis. Journal of Gastroenterology and Hepatology (Australia). 2022 Dec 1;37(12):2207–16.

Introduction

Studies have generally highlighted three groups of patients at particular risk of dysphagia: the elderly, those with neurological pathology and the critically ill. Over the last decade, there has been increasing interest in the role of critical illness related dysphagia, however, less is known about the impact of infection and sepsis on unwell patients in hospital. In this study, we aimed to assess the prevalence and factors predicting dysphagia in patients with no prior history of dysphagia, admitted to hospital with infections or sepsis.

Aims & Methods

Participants ≥ 18 years of age admitted to hospital with infections or sepsis caused by pneumonia, urine tract infections or cholecystitis were recruited from an NHS Trust. Researchers, electronic patient record administrators and clinical coding staff screened patient data over 12 months from 01/02/2022 to 01/02/2023. All patients with potentially confounding conditions or pathology, such as previous or ongoing dysphagia, acute head injuries or stroke, were excluded. Those that remained had data extracted from their notes, including age, gender, length of stay (LOS), intensive care unit (ICU) admission status, co-morbidities, type of infection/sepsis, obesity, frailty and mortality. Patient data was then subjected to statistical analysis, including Chi-squared, T-Tests, Logistic regression and Cox regression.

Results

Over the study period, 4475 patients (M: 2031, F: 2444) were admitted with infections (Pneumonia 2465, UTI 1888 and Cholecystitis 401). Of these, 189 (4.2%) developed dysphagia (Pneumonia 6.0%, UTI 3.5%, Cholecystitis 0.8%). Additionally, 865 patients (M: 434, F: 431) were admitted with sepsis (Pneumonia 535, UTI 413 and Cholecystitis 55). Of these, 54 (6.2%) had dysphagia (Pneumonia 9.3%, UTI 3.4%, Cholecystitis 3.6%).
Logistic regression revealed that increasing age, the presence of sepsis, delirium, dementia and Parkinson’s disease (PD) were significantly associated with an increased risk of dysphagia (OR 1.02, 1.74, 1.60, 2.43, 3.88; P 0.002, 0.013, 0.008, <0.001, <0.001). Obesity and female gender were associated with a reduced risk of dysphagia (OR 0.53, 0.65; P 0.006, 0.001). Other comorbidities such as diabetes, chronic obstructive pulmonary disease (COPD), cirrhosis and heart failure were not significantly associated with dysphagia. Additionally, Cox regression revealed that increasing age, sepsis, dysphagia, delirium and frailty all significantly increased LOS (HR 0.99, 0.63, 0.59, 0.67, 0.79; P <0.001, <0.001, <0.001, <0.001, <0.001).

Conclusion

Our study has identified that infection and sepsis-associated dysphagia is a major syndrome, with age being a significant determinant. Additionally, patients with PD, delirium or dementia without previous or existing dysphagia are at high risk of developing dysphagia should they be admitted with infections or sepsis. Our novel findings should increase clinical awareness of infection and sepsis-associated dysphagia in hospitalised patients and prompt greater study of this phenomenon.

References

Sasegbon A, O'Shea L, Hamdy S. Examining the relationship between sepsis and oropharyngeal dysphagia in hospitalised elderly patients: a retrospective cohort study. Frontline Gastroenterol. 2018 Oct;9(4):256-261. doi: 10.1136/flgastro-2018-100994. Epub 2018 Jun 2. PMID: 30245787; PMCID: PMC6145432.

Disclosure

None to disclose

Introduction

Recommendations for bowel preparation prior to capsule endoscopy exploration in clinical guidelines are controversial and unclear.

Aims & Methods

To assess the contribution of the Boston cleansing scale (BBPS) in the previous colonoscopy, the discontinuation of iron therapy, a low-fibre diet, and the use of simethicone prior to capsule ingestion to obtain adequate visualization during capsule endoscopy exploration of the small bowel.
Prospective study of capsule examinations. In our centre, capsule preparation includes a fibre-free diet the day before, liquids only the evening before, 8-hour fasting, and simethicone. Capsule preparation is categorized as adequate/inadequate according to the Brotz scale.
Statistical analysis was performed with SPSS software.

Results

A total of 117 capsule explorations were analysed: 79 (67.5%) had adequate preparation and 38 (32.5%) had inadequate preparation.
The factors in which the association was studied and the major regression model are shown in Table 1. In the final model were included the Boston score for the right colon (p=0.032; OR=2.639) and transverse colon (p=0.002; OR=0.191), after ruling out confounding and interaction. Homer-Lemeshow test with p value 0.246. Specificity of 91.1%, sensitivity of 18.4%, and accuracy of 67.7%. Area under the ROC curve was 0.305 (0.205–0.404).
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Conclusion

1. In our series, the use of simethicone, a low-fiber diet, and the discontinuation of iron therapy did not contribute to adequate preparation for capsule exploration.
2. Meanwhile, the Boston score for the right and transverse colon in pre-capsule colonoscopy can help predict capsule cleanliness.
3. Further studies are needed to find variables that help predict adequate preparation for capsule endoscopy.

References

Rondonotti E, Spada C, Adler S, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) technical review. Endoscopy 2018; 50(4): 423-446.