Introduction

Sexual health is a major determining factor in the quality of life and psycho-emotional development of every individual, and may be affected by chronic diseases as inflammatory bowel disease (IBD). The aim of this study is to measure the impact of the disease on patient’s sexual desire.

Aims & Methods

Cross-sectional descriptive study in which 107 patients over 18 years old anonymously undertook the Sexual Desire Inventory (SDI) survey validated in Spanish between the months of March and April 2022. The SDI consists in a questionnaire composed by 13 items that evaluate both dyadic (items 1-9) and solitary (items 10-13) sexual desire, measured from 1 to 8 with a total score of 101. Specifically, items 9 and 13 asked about patient’s sexual desire compared to their peers. Furthermore, they were also asked if they believed their disease affected their sexual desire and to what extent. Sociodemographic data and general information about their disease were collected as well.

Results

107 questionnaires were analyzed. Mean age was 47.21 years (± 13.54), 57.01% male. 39.01% of patients suffered from ulcerative colitis (UC), 59.81% from Crohn´s disease (CD). The average total score in the SDI of 52.99 out of 101 points. There is not a validated threshold to catalogue a reply as normal, considering that the higher the score, the greater the desire. When compared patients with UC and CD, their responses did not show statistically significant differences. Other variables that could have an impact on sexual desire as perianal disease or previous surgery were analyzed, again not showing differences with the overall average. When divided between dyadic and solitary sexual desire, results were constantly higher on dyadic answers (mean 4.6 vs 3.9), with statistically significant difference (p=0.03). However, when compared questions 1 to 8 (regarding dyadic sexual desire) with question 9 (compared to their peers), and questions 10 to 12 (regarding solitary sexual desire) with question 13 (compared to their peers), it did not showed differences. When asked whether they believed their disease affected their sexual desire, 41.12% (44) replied affirmatively, being women 24 of them. From those 44 patients, the average score on the degree to which their desire is affected of 5.43 out of 8, without differences between UC and CU. 38% of the 31 patients with perianal disease agreed with the affirmation as well, with a score of 6.16 out of 8. Patients who answered yes to this question tended to have lower score on the SDI, being statistically significant when compared to the answers on question 13 (p=0.05).

Conclusion

Sexual health is a complex issue which involves a great number of variables. Most statistically significative differences were seen regarding individual sexual desire, being impaired with respect to dyadic desire. There is a remarkable number of patients who felt their disease impaired their sexual desire, seeing a higher proportion between women. Moreover, for the ones affected, it was to a large extent. It is an issue that needs further studies, especially because its impact on quality of life and the lack of quality evidence in this area.

References

1. Ortega V, Zubeidat I, Sierra JC. Further examination of measurement properties of Spanish version of the Sexual Desire Inventory with undergraduates and adolescent students. Psychol Rep. 2006 Aug;99(1):147-65. doi: 10.2466/pr0.99.1.147-165. PMID: 17037461.
2. Spector IP, Carey MP, Steinberg L. The sexual desire inventory: development, factor structure, and evidence of reliability. J Sex Marital Ther. 1996 Fall;22(3):175-90. doi: 10.1080/00926239608414655. PMID: 8880651

Introduction

Helicobacter pylori (HP) is regarded as a class I carcinogenic factor and eradication therapy can reduce the risk of gastric cancer. Patients with HP infections are administered with bismuth quadruple therapy (BQT), triple and dual therapies based on their eradication effectiveness. BQT (bismuth + acid suppressants + 2 antibiotics) and dual therapy are both recommended in China now. Comprehensive understanding on the distribution of current eradication therapies is required to identify gaps observed in real-world practice.

Aims & Methods

This multicenter, retrospective, real-world study (NCT05073367) extracted preexisting electronic data including adult patients (aged ≥18 years) with HP infection between January 1, 2019 and March 31, 2021 from 3 hospitals to assess the diagnosis and treatment pattern of HP infection and effectiveness of eradication therapy in China. In this abstract, we reported the distribution of eradication therapies, difference in initiation year for treatment, and treatment duration.

Results

Of the 22,971 eligible patients with HP infection, 13,233 (57.61%) were prescribed eradication regimens. Mean ± SD age of patients with eradication treatment was 43.7 ± 14.0 years; 65.94% of patients had medical insurance; and 54.50% of patients were women.
In patients who received eradication therapy, the BQT therapy was predominantly prescribed (85.39%; n=11301), followed by triple therapy (7.55%; n=999) and dual therapy (7.06%; n=934). Among those receiving BQT, use of amoxicillin + clarithromycin based regimens (38.72%; n=4376) were the most prevalent, followed by amoxicillin +furazolidone (18.35%; n=2074) and amoxicillin + levofloxacin (17.76%; n=2007) based combination regimens. Proportion of patients receiving BQT decreased over years: 97.24% patients in 2019, 79.98% in 2020, and 78.71% in 2021. The proportion of patients receiving dual and triple therapy increased over the years in 2019, 2020, and 2021 were shown in Table 1. A total of 10,903 patients were analyzed according to various treatment durations with the usage of various eradication therapies. Treatment duration is defined as the number of days that prescribed drugs can cover. Out of the three types of treatments, BQT had the highest proportion of 14-day treatment duration at 90.16%, followed by triple therapy at 76.78%, while dual therapy had the least proportion at 14.42%. For treatment duration >14 days, BQT, dual and triple therapy had a proportion of 4.38%, 82.35%, and 17.27% respectively.
Table 1. Distribution of eradication therapy based upon the type and year of treatment initiation

Treatment	Type of Eradication therapy (N=13, 234) n (%)a	Year of treatment initially prescribed , 2019 (N=4492) n (%)a	Year of treatment initially prescribed, 2020 (N=4125) n (%)a	Year of treatment initially prescribed, 2021 (N=4616) n (%)a
Total Bismuth quadruple therapy Amoxicillin and Clarithromycin Amoxicillin and Furazolidone Amoxicillin and Levofloxacin Amoxicillin and Metronidazole Amoxicillin and Tetracycline Furazolidone and Tetracycline Other Bismuth quadruple Triple therapyc Dual therapyc	13,234b (-) 11,301 (85.39) 4376 (38.72) 2074 (18.35) 2007 (17.76) 76 (0.67) 9 (0.08) 12 (0.11) 2747 (24.31) 999 (7.55) 934 (7.06)	4492 (-) 4368 (97.24) 1800 (41.21) 689 (15.77) 1021 (23.37) 27 (0.62) 5 (0.11) 1 (0.02) 825 (18.89) 105 (2.34) 19 (0.42)	4125 (-) 3299 (79.98) 1324 (40.13) 480 (14.55) 516 (15.64) 10 (0.30) 1 (0.03) 0 (0.00) 968 (29.34) 551 (13.36) 275 (6.67)	4617 (-) 3634 (78.71) 1252 (34.45) 905 (24.90) 470 (12.93) 39 (1.07)) 3 (0.08) 11 (0.30) 954 (26.25) 343 (7.43) 640 (13.86)

Abbreviations: N, total number; n, number in respective category.
^a% = The total usage count of BQT or Triple or Dual eradication therapy/the total usage count of all standard eradication therapies received by eligible participants. Of BQT, the total usage count of different BQT/the total usage count of all BQT.
^bThere is a recurrent patient who changed the treatment pattern from triple therapy (ilaprazole, clarithromycin, levofloxacin) to dual therapy (ilaprazole, ornidazole) after the recurrence.
^cConsidering the table size, outcomes of different treatment regimens under dual and triple therapy were not included in the table.

Conclusion

BQT-based regimen for 14 days was the predominant eradication regimens in all therapies, amoxicillin + clarithromycin based BQT was the most prevalent. Use of dual therapy gradually increased with years for HP eradication in the Chinese real-world clinical practice.

Disclosure

The study was funded by Takeda China. Wensheng Pan, Yan Zhao, and Hongwei Xu have no conflicts of interest. Pengfei Li, Fang Zhou, Li Xie are the employees of Takeda, and they hold Takeda stock options. Medical writing for the development of this abstract was provided by Kusuma Kumari G, PhD, of Indegene Private Limited, and funded by Takeda China. Authors retained full control of the abstract content.

Introduction

Crohn's disease (CD) is a chronic inflammatory bowel disease that is characterized by periods of active inflammation followed by periods of remission. Current Methods for defining Crohn's disease activity are limited by various factors including low specificity, bias, invasiveness, high costs, radiation exposure and patient preference. Therefore, an easy, noninvasive, inexpensive, user-friendly, and repeatable method for the assessment of disease activity is warranted. Abnormal body temperature is a natural indicator of illness. Infrared thermography (IRT) can map body surface temperature remotely. With the advent of modern infrared cameras, data acquisition, and processing techniques, it is now possible to have real-time high-resolution thermographic images. Inflamed bowel loops are hyper-vascular and hyperemic, as detected by high doppler signs of intestinal ultrasound and bowel wall contrast enhancement in MRE, and therefore can be detected using IRT.

Aims & Methods

Our aim was to examine thermal imaging using IRT as a noninvasive tool for detecting bowel wall inflammation and disease activity in Crohn's disease patients.
The design of the study was prospective non -interventional. Consecutive adult CD patients referred for an intestinal ultrasound (IUS) exam were included, and adult healthy volunteers were recruited from the general population. Thermal images were captured using a FLIR ONE thermal camera device (FLIR Systems, Inc. Wilsonville, OR, USA) that connects directly to smartphones and utilizes a frame rate frequency of 8.7 Hz, an object temperature range of -20°C to 120°C and thermal sensitivity of 100 mK . Disease activity was defined using IUS. Thermal images of the study population were processed and compared to the results of IUS in all participants. Our novel thermal image processing algorithms extracted texture and shape features of temperature distribution across the skin covering the region of interest (ROI).

Results

The study cohort included 147 CD patients and 14 healthy volunteers. Using IUS, disease activity was found in 100 CD patients (68%). All 14 healthy volunteers had a normal IUS. The average abdominal temperature measured in the Crohn's patients (both active and inactive) was significantly higher than that of the healthy volunteers (30.4⁰±2.9⁰ C vs. 28⁰±2.9⁰ C, p=0.0032). The average abdominal temperature measured in the Crohn's group with the active disease was also found to be significantly higher than that of the healthy volunteers (30.4±2.99 C vs. 28⁰±2.9⁰ C, p=0.0035). To differentiate between active CD and CD in remission, a new parameter was defined and extracted: the fractal dimension of gradient magnitude (FDGM). The mean FDGM was significantly higher in patients with active disease than in patients with normal IUS (1.66 vs 1.63, p=0.045).

Conclusion

We describe a novel easy-to-use tool for monitoring disease activity in CD. This new method can potentially be used by patients at home as well as an office-based exam that allows precise disease follow-up and disease activity monitoring.

Disclosure

Dan Carter: Consulting fees from Takeda, Abbvie, Taro, and Lapidot; speaker fees and/or research support from Takeda, Abbvie, Janssen, and Lapidot.

Introduction

With a growing interest in sex-specific differences in bowel preparation outcomes, current literature shows inconsistent results. Females have been associated with poor bowel preparation [1], while males may have inadequate bowel preparation due to poor compliance with instructions [2]. Analyses of randomized clinical trials of 1L polyethylene glycol (PEG) plus ascorbic acid (ASC) indicated greater high-quality (HQ) cleansing success in females than in males despite greater adenoma detection in males [3].

Aims & Methods

The effectiveness and tolerability of 1L PEG+ASC was compared in males versus females in a large real-world population. This post-hoc analysis of an observational, multi-centre, retrospective study in Spain and Portugal included patients who received 1L PEG+ASC before undergoing a colonoscopy [4]. Cleansing quality was assessed using the Boston Bowel Preparation Scale (BBPS). Adequate success was BBPS ≥6 with all segmental scores ≥2 and HQ success was BBPS ≥8 with BBPS 3 in the right colon. Polyp detection rate (PDR), adenoma detection rate (ADR) and adverse events (AEs) were also assessed. Results are reported either as mean ± SD. Chic-square test was used to compare outcomes.

Results

A total of 13,169 patients, (M/F: 6,406/6,763 aged 57.6 ± 12.7 / 56.4 ± 13.4 years) were included. The main indication for colonoscopy was (in males vs females) colorectal cancer screening: 42.5% vs 41.2%; diagnostic: 25.9% vs 32.7%; follow up: 28.6% vs 23.9%; or other: 2.9% vs 2.2%. Bowel preparations were taken either as an overnight split dose (males vs females: 32.3% vs 33.2%) or a same-day split dose (67.7% vs 66.8%). Males and females had similar (97.5% vs 97.1%) colonoscopy completion rates. Incomplete colonoscopies due to poor bowel preparation quality were rare and occurred at similar rates in males vs females (0.7% vs 0.9%).
In the overall colon, adequate success was similar in males vs females (89.5% vs 89.1%) (p = 0.40) while HQ success was more frequent in females vs males (54.1% vs 51.8%; p = 0.007). In the right colon segment, adequate success was similar in males vs females (91.4% vs 91.6%; p = 0.61), while HQ success was more frequent in females vs males (50.7% vs 47.8%; p < 0.001). The mean BBPS was similar overall and by segment (Table). As expected from the literature, the PDR and ADR were greater in males vs females in the overall colon and in the right colon (Table).

Table. Sex differences in bowel preparation parameters with 1L PEG + ASC

Variable	Males (n=6,406)	Females (n = 6,763)	P-value
Overall colon adequate success, n (%)	5,734 (89.5)	6,023 (89.1)	ns
Overall colon high-quality success, n (%)	3,317 (51.8)	3,660 (54.1)	0.007
Right colon adequate success, n (%)	5,853 (91.4)	6,196 (91.6)	ns
Right colon high-quality success, n (%)	3,063 (47.8)	3,429 (50.7)	0.0009
Overall colon total BBPS, mean ± SD Right colon BBPS, mean ± SD Transverse colon BBPS, mean ± SD Left colon BBPS, mean ± SD	7.3 ± 1.8 2.4 ± 0.7 2.5 ± 0.7 2.5 ± 0.7	7.3 ± 1.9 2.4 ± 0.7 2.5 ± 0.7 2.4 ± 0.7	ns
PDR overall colon, n (%)	3,552 (55.5)	2,926 (43.3)	<.0001
PDR right colon, n (%)	1,643 (25.7)	1,381 (20.4)	<.0001
ADR overall colon, n (%) na	2,200 (47.3) 4,654	1,753 (37.7) 4,656	<.0001
ADR right colon, n (%) na	1,139 (27.2) 4,193	915 (21.5) 4,264	<.0001

^aNumber of patients for whom histological information was available.

Males had fewer adverse events than females (1.8% vs 2.7%; p = 0.0008). While 98.2% males did not report any adverse events, those who did reported nausea (0.9%) or vomiting (0.6%). Similarly, 97.3% females did not report any adverse events, but those who did reported nausea (1.5%) or vomiting (1.0%).

Conclusion

In real-world clinical practice, 1L PEG + ASC was effective and well tolerated in both males and females. Females attained greater HQ cleansing success both overall and in the right colon.

References

References:

1. Cirocco WC et al. Dis Colon Rectum 1995; 38:964–968
2. Ness RM, et al. Am J Gastroenterol 2001; 96:1797–1802
3. Epstein M et al. Endosc Int Open 2021; 09: E1324–E1334
4. Esteban López-Jamar JM et al. UEG Journal 2022, Vol 10 (S8); OP022

Disclosure

Fatma Akriche and Carmen Turbi Disla are employees of Norgine Ltd

Introduction

The success rate of endoscopic retrograde cholangiopancreatography (ERCP) is suboptimal in patients with complex surgically altered anatomy (e.g. Roux-en-Y anastomosis, pancreaticoduodenectomy) due to difficulty in advancement of scope to the target site and selective biliopancreatic duct cannulation. Although balloon-assisted enteroscopy can achieve a higher rate of intubation, its clinical application is limited by its small working channel and few compatible accessories.

Aims & Methods

We aimed to explore the feasibility and effectiveness of a novel endoscopic approach in patients with complex surgically altered anatomy.
This is a retrospective study of patients who underwent ERCP with complex surgically altered anatomy at our center with an annual ERCP volume of approximately 3000, between January 2018 and November 2022. The endoscopic procedures were performed by three senior endoscopists who had ERCP experience for at least 5 years. Long colonoscopy (measuring 168cm)-assisted ERCP was adopted as a first-line intervention, and selective biliopancreatic duct cannulation was performed after the target site (native papilla or the surgical anastomosis) was reached. For patients with failed cannulation, a plastic guide tube measuring 250 cm was inserted via the working channel of the colonoscope and its distal end was placed near the target site. The colonoscope was then withdrawn while the guide tube was left in-situ. By following the guide tube, a conventional side-viewing duodenoscope was cautiously advanced to the target site and biliopancreatic duct cannulation re-attempted.

Results

A total of 58 patients were recruited (mean age:56.7 years [standard deviation [SD]:14.4; male:36 [62.1%]]. The reconstruction methods were as follows – Roux-en-Y hepaticojejunostomy:32 (55.2%), Billroth-II gastrectomy with Braun anastomosis:11 (19.0%), pancreaticoduodenectomy:10 (17.2%) and Roux-en Y gastrectomy:5 (8.6%). Common bile duct stone was the most common indication for ERCP (n=30; 51.7%), followed by bilioenteric anastomotic stenosis (n=15; 25.9%), pancreaticojejunal anastomotic stenosis (n=7; 12.1%) and chronic pancreatitis (n=6; 10.3%). 55 (94.8%) of 58 had successful intubation by long colonoscope with a mean procedure time of 57.7minutes (SD:23.4). The mean time to reach target site was 19.1minutes (SD:9.0). The target site could not be identified in two patients and intestinal perforation occurred during endoscopic intubation in one patient. Among those with successful endoscopic intubation, biliopancreatic duct cannulation was achieved in 35 (63.6%) patients. For the remaining 20 patients with initial failure of biliopancreatic duct cannulation, intubation rate by duodenoscope was 100% by tracing the guide tube to target site. The success rate of biliopancreatic duct cannulation by duodenoscope was 85% (17/20) with a mean procedure time of 83.5 minutes (SD:21.1). The mean time to reach target site was 17.0minutes (SD:6.1). Notably, 90% (18/20) had either native papilla or pancreaticojejunostomy, in which selective biliopancreatic duct cannulation is known to be technically difficult with any type of forward-viewing scope due to unfavorable cannulation trajectory. For those with failed cannulation, two had anatomical stricture and one had impacted pancreatic stone.

Conclusion

ERCP by conventional duodenoscope with colonoscopy-assisted pre-placement of guide tube is a feasible, effective and safe alternative for patients with complex surgically altered anatomy in experienced endoscopists.