Introduction

Data are needed to clarify the positioning of biological therapies and small molecules for early resolution of moderately to severely active luminal Crohn’s disease (CD). We aimed to compare early response for advanced CD therapies in a systematic review with network meta-analysis.

Aims & Methods

We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials between inception and Sep 10, 2022. The co-primary outcomes were the induction of clinical response, defined as ≥70-point reduction in Crohn’s Disease Activity Index (CDAI-70 response) from baseline, and clinical remission, defined as CDAI ≤150 at week 2. Network meta-analysis was conducted under the Bayesian framework (PROSPERO ID: CRD42022368509).

Results

Of 16,242 and 19,281 studies from databases and congress proceedings, respectively, a total of 61 studies, comprising 17,436 patients, were included in this study. Infliximab 5 mg/kg combined with azathioprine or monotherapy ranked highest for induction of clinical response at week 2 and was significantly superior to adalimumab 160/80 mg, adalimumab 80/40 mg, certolizumab 400 mg, risankizumab 1200 mg, and risankizumab 600 mg. Accordingly, infliximab 5 mg/kg ranked highest for induction of clinical remission at week 2. Findings were consistent throughout week 6 in the overall population and bio-naïve patients. Upadacitinib 45 mg QD ranked highest at week 2 but was not significantly superior to biologics for the induction of CDAI-100 response; of note, no data on CDAI-100 response for infliximab 5 mg/kg were found. Comparison of agents for bio-exposed patients was first possible at week 4; herein, adalimumab 160/80 mg and ustekinumab 6 mg/kg ranked highest for induction of both clinical response and clinical remission in the absence of data on infliximab 5 mg/kg. Finally, Vedolizumab 300 mg, guselkumab 200/600/1200 mg, mirikizumab 200/600/1000 mg, and filgotinib 200 mg reached significant differences from placebo at weeks 4, 8, 8, and 10, respectively, in either CDAI scores or 2-item patient-reported outcome (PRO-2) scores.


Table 1: League plot for the comparison of biologics and small molecule drugs for the induction of a CDAI-70 response at week 2 in patients with moderately to severely active luminal Crohn’s disease. The values in each cell represent the relative treatment effect (relative risk and 95% credible intervals) of the column-defining treatment compared to the row-defining treatment. A double asterisk indicates statistical significance.

Conclusion

We found infliximab 5 mg/kg, combined with azathioprine or alone, to be consistently superior to all other agents and associated with the most rapid onset of effect, particularly among bio-naïve patients. This network meta-analysis has implications for rational individualized therapeutic decision-making in patients with CD.

Disclosure

M.A., J.G., and O.H.N.: None
C.S.: reports research grants from Takeda, paid speaker by MSD, Tillotts.
A.P.: reports research grants and personal fees from Janssen, Takeda, and MSD, personal fees from Bristol Myers Squibb. National coordinator of studies from AbbVie, Boehringer Ingelheim, and Bristol Myers Squibb. None of these pertain to the research submitted here.
J.B.: reports grants and personal fees from AbbVie, grants and personal fees from Janssen-Cilag, personal fees from Celgene, grants and personal fees from MSD, personal fees from Pfizer, grants and personal fees from Takeda, grants and personal fees from Tillots Pharma, personal fees from Samsung Bioepis, grants, and personal fees from Bristol Myers Squibb, grants from Novo Nordisk, personal fees from Pharmacosmos, personal fees from Ferring, personal fees from Galapagos, outside the submitted work.
J.B.S.: has received research grants from Takeda, Janssen and is national coordinator of studies from AbbVie, Arena Pharmaceuticals, Ely Lilly, and Boehringer Ingelheim. None of these pertain to the research submitted here.

Introduction

Diarrhea after cholecystectomy is a well-known complication that worsens the quality of life of the patient and may become a real challenge for the doctor.
Both changes in the bile acids spectrum (BAsS) and possible changes in microbiota and Small Intestinal Bacterial Overgrowth (SIBO) may have a major impact. What is primary in this circle is not fully understood.

Aims & Methods

The aim was to assess BAsS and SIBO in patients prior to cholecystectomy, three and twelve months after cholecystectomy.
Methods: Initially, the bile of the patients was obtained directly from the gallbladder after it was removed during the surgery. For the second and third time, the bile of the same patients after cholecystectomy was obtained in 3 and 12 months postoperatively, after the intubation of the duodenum under ultrasound control. The spectrum of BA was assessed using photocalorimetry. To assess the possible influence of SIBO, all the patients underwent a hydrogen breath test before cholecystectomy, and if SIBO was confirmed, they were not included in the study. Successive hydrogen breath tests were performed 3 and 12 months after cholecystectomy to all the patients who were included. The data were analyzed using parametric and non-parametric methods of evaluating the results through the Statistica program (StatSoft Inc, USA).

Results

14 patients, predominantly women (71.4%) were enrolled in the study. The spectrum of BA three months after cholecystectomy showed a tendency for secondary BA (deoxycholic acid) to predominate over primary BA (cholic acid) (P>0.05). After 12 months, the BAs pool returned to the baseline in most of the patients (P>0.05). SIBO was not registered in patients 3 months after cholecystectomy, but it was detected in 50% of cases (P>0.05) after 12 months.

Conclusion

The predominance of secondary BA in the early postoperative period probably indicates an increase in the number of bacteria, for the transformation of primary BA in the ileum, but the breath test is not sensitive enough to determine this.
Over time, if the equilibrium in a complex mechanism of BA homeostasis is not achieved (the amount of bile in the ileum, bacteria, FXR, etc.), this may lead to the SIBO development.

Introduction

The coexistence of HBV and hepatic steatosis is frequent, but its impact on the progression of liver disease remains poorly characterized and much debated.

Aims & Methods

We aim by this study to determine the prevalence, associated factors, consequences of this association and response to treatment.
A retrospective analysis was conducted over 20 years from 2005 to 2025 on a single-center cohort of 124 patients with chronic HBV, of whom 16.1% (n=20) had steatosis (confirmed by imaging). Demographic, virological, metabolic and histological (fibrosis stage) characteristics were compared between the groups with and without steatosis. And statistical tests (Chi², Mann-Whitney, logistic regression) were used.
For the comparison, we defined:
- Group A: combining steatosis and HBV
- Group B: HBV without steatosis.

Results

The prevalence of steatosis in patients with HBV in our series was 16.1%, with a mean age of 52.1 years higher than that of patients with HBV without steatosis, (45.8 years), with a p-value of 0.02. Furthermore, in our work there was a clear female predominance, with a sex ratio of 3 F/H in group A vs 0.9F/H in group B with a p-value of 0.04.
In the history of our patients, we found that 30% of patients had high blood pressure in group A compared with 18% in group B, 10% had diabetes in group A compared with 8% in the other group, and there was no significant difference in smoking habits (15% compared with 12%). Statistical regression did not find any significant correlation in those signs. On the other hand, in the case of dyslipidemia, there was a slight predominance of group A (15% vs. 10%) with a p-value of 0.045.
The analysis of hepatic test didn’t show any big difference between results of GGT, PAL and ASAT but for ALAT there was a higher in patients with steatosis with a median of 62 vs 52,1 and a p-value of 0,02.
Our study also found no difference in serological results: 95% of patients with steatosis were Hbs Ag positive, with the presence of Hbc Ab in all patients at the time of diagnosis. These results were not very different from those of patients without steatosis (Hbs Ag positive in 96.8% and Hbc Ab positive in all patients). Only 10% of patients had a positive Hbe Ag in group A vs 7.2% in group B. The median viral load before treatment was 1870 UI/ml vs 2450 UI/ml with no real difference noted between the 2 groups, confirmed by statistical regression which found a p=0.82 value.
Our study found no real impact on liver disease, showing no worsening of fibrosis (30% F≥2 with steatosis vs 25% without, p=0.62*).
After analysis using the association Chi² test, our study found similar virological responses under treatment (83% in group A vs 78% in group B, p=0.75*).

Conclusion

In this cohort, steatosis in HBV patients (16.1%) was associated with age and female sex. Hepatic test showed a higher ALAT fold among patient with steatosis. However, higher viral load or more severe fibrosis was not demonstrated. Steatosis in HBV does not appear to have a negative influence on the course of the disease. These results suggest that the management of HBV with steatosis should primarily target virological control, without requiring any specific therapeutic adaptation.

Disclosure

no conflict of interest

Introduction

Impedance planimetry (EndoFLIP®) is an emerging tool in the assessment of esophageal motility, with its role in daily clinical practice gradually being defined. In contrast to high-resolution manometry (HRM), EndoFLIP® is generally well tolerated and can be performed during the same endoscopic session, allowing for a dynamic and functional evaluation of the esophagogastric junction and the esophagus. However, its applicability within the diagnostic algorithm for dysphagia remains insufficiently established.

Aims & Methods

A retrospective single-center observational study was conducted on EndoFLIP® procedures performed between September 2019 and December 2024 in patients whose primary symptom was dysphagia. Variables assessed included prior performance of HRM, diagnoses established by both HRM and EndoFLIP®, and therapeutic decisions made based on EndoFLIP® findings. All procedures were performed under general anesthesia.

Results

A total of 106 EndoFLIP® procedures were performed, with a median age of 59 years and 50.9% male. The median initial Eckardt score was 3 (maximum 12). 78.3% of patients presented pathological findings on EndoFLIP®, and in two-thirds (n=77), these findings led to a change in the therapeutic approach, implemented in the same endoscopic procedure in 22 cases. Half of the patients (n=49) had not previously undergone MAR due to: intolerance (n=23); assessment of distensibility plateau in eosinophilic esophagitis (n=11); optimization of initial endoscopy with simultaneous EndoFLIP® (n=6); assessment of treated achalasia and/or post-surgical status (n=3). In these patients, the majority had diagnostic findings on EndoFLIP® (78.8%), with the most frequent being achalasia (n=12). Of the patients who underwent MAR, nearly one-third (n=16) had inconclusive results. In only one case did the EndoFLIP® not show any abnormalities, while the remaining cases were diagnosed with achalasia (n=4), OJEG (n=4), and absence of contractility (n=3). When evaluating suspected OJEG (n=14) in MAR, only three were confirmed on EndoFLIP®, while the others were reclassified as normal study (n=8), achalasia (n=2), and absence of contractility (n=1).

Conclusion

This study highlights the need for a paradigm shift, advocating for the routine use of EndoFLIP® in the assessment of dysphagia in various contexts, including initial screening of motor disorders during index endoscopy, post-surgical evaluations, and a more accurate assessment of the esophagogastric junction (EGJ) and esophageal caliber in specific pathologies. EndoFLIP® allows for faster diagnoses, reduces the need for additional testing, and potentially enables earlier therapeutic planning, sometimes within a single session.