Introduction

​Hypercontractile esophagus (HE) is rare. Esophageal high-resolution manometry (HRM) with solid test meal (STM) in Chicago Classification (CCv4.0) may improve diagnostic yield but outcome data are lacking.

Aims & Methods

Aim: Evaluate the clinical features and long-term outcome of HE, and determine the clinical significance of hypercontractility detected only using STM.
Methods: Single-center analysis of all patients with >/=2 hypercontractile swallows (HS) (distal contractile integral [DCI]>8000mmHg.s.cm) on HRM studies with single water swallows(SWS) and/or STM between June 2014-December 2021. A telephone survey was conducted between January-June 2023 using Impaction Dysphagia Questionnaire [IDQ], Eckardt scores and the Gastro-Esophageal Reflux Disease Questionnaire (GERD-Q) to determine long-term outcomes.

Results

48 patients (29[60.4%]Female, 63.0[13.4] years) with HE who presented with dysphagia (60%), reflux (37.5%) and chest pain (29.2%) and 58 controls (28[48.3%]Female,49[13.4] years) with dysphagia(n=43.1%), reflux (n=41.4%) and chest pain(15.5%) with normal HRM findings with both SWS and STM were identified from 454 studies performed. More patients had HS with STM vs SWS (n=41[85.4%] vs. n=7[14.6%], p<0.001). Dysphagia was significantly associated with mean DCI(B=0.000,p=0.035) and maximal DCI (B=0.000, p=0.036) during STM. 43% (n=3/7) and 22% (n=9/41) of patients with >/=2 HS using SWS and STM respectively were on medical therapy at mean(SD) clinic follow-up of 28.7(29.2) months. At mean(SD) follow-up telephone survey of 61.3(27.1) months from HRM, symptom scores (mean,SD) amongst 36/48 (75%) patients and 58 controls showed significantly higher dysphagia scores: IDQ (3.8[7.2] vs 1.0[1.9],p=0.03). Whilst overall Eckardt scores were not significantly different between patients and controls (1.2 [1.9] vs 1.2[1.4, p=0.4), patients recorded significantly higher Eckardt dysphagia score compared to controls (0.46[0.7] vs 0.14[0.3], p=0.007) respectively. Conversely, patients had lower Eckardt chest pain scores compared to controls (0.14[0.36] vs 0.45[0.68], p=0.02) and similar GERDq scores (6.4[1.9] vs 7.0[1.9], pNS) respectively.

Conclusion

STM enhanced diagnostic yield of hypercontractile esophagus and identified more patients who benefitted from medical therapy. Dysphagia was significantly associated with HRM parameters during the STM, with higher symptoms scores for dysphagia compared to controls at long term follow up. However, most patients did not require aggressive intervention.

Disclosure

Nil

Introduction

Eight hospitals in the southwest of the Netherlands collaborate to provide high quality, uniform care for inflammatory bowel disease (IBD). To achieve this, a care pathway (CP) was implemented for treating IBD with biologics and small molecules (1). The CP is a decision-support tool that provides guidelines for medication prescribing, procedures, treatment adjustments, and recommendations for follow-up.

Aims & Methods

This study aimed to evaluate the effect of a CP on patient outcomes and healthcare utilization.
A longitudinal multicentre non-randomised cohort study with a baseline observation period (December 2020 – December 2021) and a follow-up period (March 2022 – March 2023) was conducted, in which adult patients with IBD treated with biologics or small molecules were included. Outcomes were collected according to the International Consortium for Health Outcomes Measurement (ICHOM) standard set from electronic health records or through validated questionnaires. Missing data were handled using single imputation nested within a bootstrap procedure. Effect of the CP on these outcomes were analysed with case-mix adjusted (generalized) linear mixed models.

Results

A total of 1,173 patients participated in the study, with the majority being female (55%) and a median age of 45 years (IQR 33-58). Most patients had Crohn's disease (64%). The CP was associated with a 0.22 increase on the ibd-control-8 score (β=0.22, p=0.28), and an increase on the probability of achieving endoscopic/radiologic (β=0.14, p=0.29), biochemical (β=0.18, p=0.22) and patient-reported remission (β=0.19, p=0.21). Probability of clinician-reported remission decreased slightly (β=-0.09, p=0.59). Emergency room visits (β=-0.36, p=0.13), hospital admissions (β=-0.41, p=0.10), and length of stay (β=-0.09, p=0.56) reduced, although these associations were not significant. The CP had no effect on quality of life (β=0.00, p=0.83), anaemia probability (β=-0.01, p=0.95) or on nutritional status (β=-0.01, p=0.34).

Conclusion

A CP for the management of IBD with biologicals and small molecules has clinically significant potential to reduce healthcare utilization, while improving patient-reported disease control, and disease remission. These results emphasize that clinical care pathways can improve care and reduce healthcare utilisation for complex diseases. However, the adherence to the CP and whether these results lead to a reduction in healthcare costs should be further investigated.

References

(1) van Linschoten R, van Leeuwen N, Nieboer D, Birnie E, Scherpenzeel M, Verweij KE, et al. Value-based care pathway for inflammatory bowel disease: a protocol for the multicentre longitudinal non-randomised parallel cluster IBD Value study with baseline period. (2044-6055 (Electronic))

Disclosure

Drs. Visser received a speaker fee from Lilly, Prof. Dr. van der Woude reports grants from Pfizer and Janssen and personal fees from AbbVie and Celltrion, Dr. van Noord reports personal fees from Janssen, Takeda, and Falk, Dr. West reports personal fees from AbbVie, Janssen, and Pfizer outside the submitted work.

Introduction

Sudden decrease of colonoscopy (CS) can be related with the status of colorectal cancer (CRC).

Aims & Methods

The aim of this study is to evaluate the status of CS, esophagogastroduodenoscopy (EGD), and CRC according to big national disasters such as the Great East Japan Earthquake in 2011 and the spread of COVID-19 infection in 2020. As a study population, we retrospectively used commercially anonymized health insurance claims data covering 4,601,921 patients ≥50 years old (Male 2,403,826/ Female 2,198,095) from January 2010 to December 2022. Main outcome was a yearly analysis for 2010-2022 about 1. rate of CS and EGD, 2. rate of CRC and positive rate of CS for CRC, 3. number of surgeries for CRC. Additionally, a monthly analysis for those rates were performed to examinate the effect of the earthquake and COVID-19 infection.

Results

The rates of CS and EGD in 2010/2011/2012 were 3.10%/3.41%/3.42% and 6.94%/6.96%/7.00%. Those in 2019/2020/2021 were 5.20%/4.74%/5.37% and 7.47%/6.42%/6.84%. Deficiencies for CS and EGD were found not in 2011 (The earthquake) but were present in 2020 (COVID-19). The rates of CRC in 2019/2020/2021 were 0.20%/0.17%/0.19% with a decrease rate of 12.0% in 2020. The positive rate for CRC decreased from 6.74% in 2010 to 3.44% in 2022. However, there were no definite changes in 2011 and 2020. The rate of surgery for CRC in 2019/2020/2021 were 0.087%/0.079%/0.087% and the deficiency was found in 2020.

Conclusion

The rates of CS and CRC decreased in 2020 due to COVID-19. On the other hand, they were not affected by the earthquake.

Introduction

MAPS III redefined the risk of gastric cancer and provides a well-defined screening and surveillance protocol for patients with precancerous lesions [1]. It represents an updated guideline, emphasizing the importance of evaluation of gastric mucosa and targeted biopsy. To date, the role of magnification endoscopy has become increasingly significant for the accurate assessment of gastric mucosal patterns.

Aims & Methods

The aim of this study is to compare magnified-endoscopy and standard (non-magnified) endoscopy in terms of their effectiveness in detecting dysplastic lesions and the concordance between endoscopic grading of gastric intestinal metaplasia (EGGIM) [2] and histological findings (operative link on gastritis assessment or gastric intestinal metaplasia OLGA/OLGIM).
A retrospective, single-center study was conducted, enrolling patients who had undergone upper GI-endoscopy for surveillance according with MAPS III. The procedures were performed using high-definition endoscopes, with or without magnification, following adequate mucosal preparation [3]. Only endoscopic reports containing at least five images of the antrum, body, and incisura (minimum of 15 images) both using WLI and BLI chromoendoscopy, were included. The endoscopic records were retrospectively reviewed to assess EGGIM classification on each region of interest (0-2) and the total score (0-10). During all exams targeted biopsies were performed, and histological analyses were also collected. Image review was carried out by three expert endoscopists, blinded to the histological reports.

Results

A total of 96 patients were enrolled (40 males, 41.6%; median age 66.1 years, IQR 56.6–73.4). Fifty-four patients (56.2%) underwent standard upper-GI endoscopy (Group A), while 42 patients (43.8%) received magnifying endoscopy (Group B). Upon re-evaluation of endoscopic images, 42 out of 54 patients in Group A (77.7%) showed an EGGIM score of 0–4, while 12 patients (22.3%) had an EGGIM score ≥5. A higher proportion of patients in Group B showed EGGIM ≥5 (19 patients, 45.2%; p=0.01). Histological analysis revealed that 18 of 96 patients (18.7%) had advanced stages (OLGA/OLGIM III–IV), with a significantly higher prevalence in Group B (15 patients) compared to Group A (3 patients; p<0.001). Linear regression analysis between EGGIM and OLGA/OLGIM scores demonstrated a statistically significant correlation in both groups, which was higher in Group B (p=0.02 and p<0.001, respectively). Dysplastic lesions were identified in two cases, both of them were detected using magnifying endoscopy.

Conclusion

EGGIM shows good correlation with the OLGA/OLGIM staging systems, particularly in examinations performed with magnification. Despite a potential selection bias due to the retrospective nature of the study, our findings demonstrate that the use of magnification during surveillance of upper-GI precancerous conditions is highly effective.

References

1. Dinis-Ribeiro, M. et al. MAPS III: ESGE/EHMSG/ESP guideline update 2025. Endoscopy, 2025
2. Esposito G, et al. Endoscopic grading of gastric intestinal metaplasia (EGGIM): a multicenter validation study, Endoscopy, 2019
3. Manfredi G, et al. Premedication with simethicone and N-acetylcysteine for improving mucosal visibility during upper gastrointestinal endoscopy in a Western population. Endosc Int Open, 2021

Introduction

Liver transplantation has become one of the key curative treatment options for hepatocellular carcinoma (HCC). However, a subset of patients experiences HCC recurrence after transplantation. Furthermore, due to the shortage of donor organs, there is a great need to identify patients with the best possible outcome who may be eligible for transplantation. While several clinical models aimed to predict recurrence and are integrated into clinical practice such as Milan-Criteria, there is a great need for molecular biomarkers that would allow objective assessment taken to account tumor-biology to better predict diseases recurrence. MicroRNAs (miRNAs) play a crucial role in the regulation of gene expression, contributing to the development and progression of HCC and are considered as potential HCC biomarkers.

Aims & Methods

This study aimed to explore miRNAs form the HCC prior transplantation as predictive biomarker for post-transplant HCC recurrence and to assess their value in combination with other tools as a personalized predictive score. The proof-of-concept study included 20 HCC patients who underwent liver transplantation between 2007 and 2021 (n = 10 with recurrence, n = 10 without). MiRNA profiling was performed on formalin-fixed, paraffin-embedded (FFPE) HCC tissue obtained at the time of transplantation. MiRNAs were extracted using the Qiagen miRNeasy Kit and analyzed via Agilent miRNA microarray. The recurrence-free survival (RFS) of the subject population was assessed using a Kaplan–Meier analysis. The predictive value of different miRNAs was evaluated using a receiver operating characteristic (ROC) analysis.

Results

Out of approximately 4,000 analyzed miRNAs, three candidates (miR-3692-5p, miR-424, miR-718) demonstrated the strongest discriminatory power between recurrence and non-recurrence. miR-3692-5p alone exhibited excellent predictive accuracy (AUC = 0.995, p < 0.0001), clearly outperforming traditional models such as the Milan criteria (AUC = 0.550, p = 0.706). The other two miRNAs also showed significant but comparatively lower predictive value. However, combined as a 3-miRNA signature, they achieved excellent overall predictive performance (AUC = 0.9, p < 0.05). Furthermore, the study revealed that the expression levels of miR-3692-5p can effectively classify patients into high- and low-risk categories for HCC recurrence. The high-risk group, characterized by low expression levels, exhibited a significantly shorter median recurrence-free survival (RFS) of 17 months compared to 38.5 months (p <0.005).

Conclusion

This study identified three miRNAs capable of distinguishing between recurrent and non-recurrent HCC post-transplantation, both individually and as a combined miRNA-signature. Integrating molecular biomarkers into existing clinical risk models improved predictive and prognostic accuracy, highlighting the potential of personalized molecular biomarkers in transplant oncology.

Introduction

Colorectal cancer (CRC) remains a major cause of mortality and morbidity worldwide. Projected increases in CRC cases pose a significant challenge to the capacity of colonoscopy programs. Referrals for symptomatic colonoscopy exceed capacity in Ireland and most European nations. Fecal Immunochemical Test (FIT) with a lower cut-off (50ng/ml) has been proposed as a tool to aid triage of referrals which do not meet criteria for urgent colonoscopy, potentially allowing colonoscopy to be avoided.

Aims & Methods

The aim of this study was to evaluate FIT testing outcomes when combined with an endoscopy nurse delivered clinical triage and evaluate suitability as a ‘rule out’ test for serious gastrointestinal pathology.
This multi-centre study included symptomatic patients from sixteen hospitals across Ireland who were referred for colonoscopy from 2023-2024. All patients received ‘FIT testing at the front door’. Using an advanced endoscopy nurse triage approach, assessing patient clinical characteristics and FIT result (positive result determined as FIT≥50ng/mL), patients were triaged into urgent colonoscopy or remained on the routine (P2) colonoscopy list.
Among 7,808 patients sent for FIT testing, 408 were excluded on the basis of missing FIT results (n = 407) or incomplete data (n = 1). The remaining 7,400 patients were included in an analysis assessing FIT positivity rates (FIT≥50 ng/mL) as well as factors associated with positive results. A subset of 1,815 patients from five hospitals, who had lower endoscopy outcomes available, were further analysed to determine frequencies of endoscopy findings (ex: normal, CRC, and IBD) and to evaluate the sensitivity, specificity and negative predictive value of FIT-centered endoscopy nurse clinical triage. IBM SPSS Statistics 29.0.1.0 was used for statistical analysis.

Results

Of 7,400 patients who underwent FIT testing across sixteen sites, 16.4% (n=1,215) had a positive result (FIT≥50ng/mL). Multivariate analysis showed that increased age (OR = 1.029; 95% CI = 1.025-1.033; p-value<0.001) and male sex (OR = 1.44; 95% CI = 1.273-1.63; p-value<0.001) were significantly associated with positive FIT results.
At five sites, 1,815 patients who underwent FIT testing were referred for colonoscopy. At these sites, 79.0% (n=1,433) had a FIT<50ng/mL of whom 0.14% (n=2) had CRC and 1.5% (n=21) had significant findings at colonoscopy (ex: CRC or IBD). In contrast, 21.0% (n=382) had a FIT≥50ng/mL of whom 6.8% (n=26) had CRC and 19.1% (n=73) had significant findings at colonoscopy (ex: CRC or IBD).
The proportion of patients with CRC was significantly greater when FIT≥50ng/mL compared to FIT<50ng/mL (Fisher’s Exact Test, p-value <0.001). The sensitivity, specificity, and negative predictive value of FIT≥50ng/mL for CRC at subsequent colonoscopy is 92.9% (95%CI=75.0-98.8%), 80.1% (95%CI=78.1-81.9%), and 99.9% (95%CI=99.4-99.9%), respectively.

Conclusion

FIT testing is useful in low risk symptomatic patients referred for colonoscopy and when combined with enhanced nurse led clinical triage has a very good negative predictive value for serious gastrointestinal pathology.

Introduction

Sepsis is a life-threatening condition characterized by organ dysfunction resulting from a dysregulated host response to infection. A defining feature of sepsis is the presence of bacteria in the bloodstream or the translocation of intestinal microbes to distant organs such as the lungs. Many of these pathogens originate from the intestinal microbiota. The intestinal mucosa serves as a critical barrier, and its damage or dysfunction is considered a central factor enabling bacterial invasion and systemic spread during sepsis.

Aims & Methods

This study aims to characterize sepsis-induced dysfunction of the intestinal barrier. Specifically, we investigate whether, and how, the functions of the gastrointestinal epithelial barrier are modulated by different sepsis-causing bacterial strains. To this end, an in vitro model was developed using intestinal epithelial cell lines (HCT-116 and Caco-2) co-cultured with bacterial isolates. These isolates, representing diverse sepsis etiologies, were obtained from the blood of septic patients. The impact of bacterial interaction on epithelial integrity was assessed by quantifying the protein levels of E-cadherin and Occludin using Western blot analysis.

Results

Co-culture with sepsis-associated bacterial strains led to the disruption of epithelial cell-cell junctions. Specifically, Escherichia coli strains BK10478, BK01267, and BK06223, at a multiplicity of infection (MOI) of 5, induced a marked downregulation of both Occludin (a tight junction protein) and E-cadherin (an adherens junction protein) in HCT-116 cells. Notably, only a subset of these strains elicited similar effects in Caco-2 cells. Some bacterial isolates had no detectable impact on junctional protein expression in either cell line, highlighting strain-specific and cell-type-dependent responses.

Conclusion

Sepsis is a heterogeneous syndrome characterized by complex host-pathogen interactions. Our findings reveal that the ability of sepsis-associated E. coli strains to compromise epithelial cell-cell junctions is both strain-specific and dependent on the epithelial cell type. Given the essential role of barrier integrity in preventing bacterial translocation, these results provide novel insights into sepsis pathogenesis and underscore the therapeutic potential of strategies aimed at preserving or restoring epithelial barrier function.