Introduction

Helicobacter pylori is class I carcinogen responsible for 89% of non cardia gastric cancer.

Aims & Methods

For the first time in Europe screen and treat application study was implemented in Maribor, Slovenia. The study was conducted by the National Institute for Public Health and Comunity Health Center Maribor. 5500 asymptomatic individuals 30-34 years of age were invited to participate (randomised sample). Additional 769 participants were included (nonrandomised group). The test-and-treat program was free of charge for all eligible participants. Locally validated H. pylori IgG serology and UBT as a confirmatory test were used. Quadruple bismuth based 14 day eradication therapy was the first line therapy. REDCap IT platform (pretreatment questionnaires, treatment protocols, side effects, compliance, complications…) was used to collect data for quality assurance, monitoring, and evaluation.

Results

Response rate to the written postal invitation was 24%; in men 21.7% and 29.7% in women (p<0,001). Gender and age distribution were similar in both study arms. There were in total of 2,105 persons who at minimum conducted a partial interview with the registered nurse. The seropositivity rate was 13,6% in randomised sample, 15,1% in nonrandomised sample and 14,2% in combined sample. Higher seropositivity rates was found in immigrants (36%,) and those participants whose highest finished level of education is a 2-year vocational school (33.3%, P >0,001). The dropout rate of -22.8% was recorded for participants with a positive serology who should continue with a confirmatory UBT. Second highest dropout rate of -19,9% was recorded for participants with a positive UBT result who were referred to treatment (12 pregnant women not included). Among the patients with a positive UBT 80.1% of total and 85.6% of randomised sample, respectively, initiated eradication therapy. Patients’ adherence towards treatment was 90.6%. The rate of reported adverse events was 35.9%, The most frequently reported symptoms were nausea, diarrhoea and abdominal pain. More men reported the absence of adverse events during therapy compared to women (76.5% versus 54.5%, respectively, p= 0.014). The eradication rate for 92 patients who concluded the therapy and were retested by UBT was 95,7%.

Conclusion

The combined use of primary serology testing and confirmatory UBT showed no evident shortcomings. The use of quadruple bismuth-based treatment scheme showed encouraging eradication and adherence rates, whereas the incidence of adverse events due to this therapy was within the acceptable range. Specific software/application should be created and integrated into existing information technology (IT) structures of the primary health care system to digitally support the process of preventive testing and treatment. Education and public awareness campaign to increase the participation rate are of crucial importance.

Introduction

Upper gastrointestinal bleeding (UGIB) is a common medical emergency, with peptic ulcer bleeding (PUB) accounting for up to 59% of cases. Effective risk assessment is essential for patient stratification, guiding clinical decisions on endoscopy timing, level of care, and discharge planning. Although several scoring systems exist for UGIB, most are designed for general use rather than specifically for PUB.

Aims & Methods

This study aims to evaluate the accuracy of six pre-endoscopic scoring systems—Glasgow-Blatchford Score (GBS), Modified GBS (MGBS), Rockall Score (RS), AIMS65, H3B2 and MAP score—in predicting intervention needs, clinical outcomes, and level of care in patients admitted with PUB. A retrospective cohort study was conducted between 2020 and 2023, including patients admitted with PUB at a tertiary center. Pre-endoscopic scores were assessed, and data on the hemostatic treatment, level of care, mortality, and rebleeding rates were collected and analyzed.

Results

A total of 364 patients (66.8% male; mean age 71.7±17 years; median Charlson Comorbidity Index (CCI): 5.2) were admitted. Most were hospitalized at level 1 (68.1%) and level 2 (30.2%) care units, with 75.3% requiring emergency endoscopic hemostasis. The best scores for predicting endoscopic treatment were GBS, MGBS, and H3B2 (AUROC 0.93, 0.91, and 0.87, respectively; p<0.001). For rebleeding risk, GBS and MGBS performed best (AUROC 0.70 and 0.68). However, overall predictive value for 1-year mortality was low, with RS performing best (AUROC 0.67), closely followed by the CCI (AUROC 0.66). GBS, H3B2, and MAP were the most effective for differentiating levels of care (p<0.001)

Conclusion

GBS and H3B2 demonstrated the highest accuracy in predicting the need for endoscopic treatment and rebleeding risk in PUB. However, while these scores are valuable for acute management, long-term outcomes may require additional prognostic factors in these patients.

References

1. Sasaki Y, Abe T, Kawamura N, et al. Prediction of the need for emergency endoscopic treatment for upper gastrointestinal bleeding and new score model: a retrospective study. BMC Gastroenterol. 2022;22(1):337. 2022 doi:10.1186/s12876-022-02413-8
2. Akhila Arya PV, Thulaseedharan NK, Raj R, et al. AIMS65, Glasgow-Blatchford bleeding score and modified Glasgow-Blatchford bleeding score in predicting outcomes of upper gastrointestinal bleeding: An accuracy and calibration study. Indian J Gastroenterol. 2023;42(4):496-504. doi:10.1007/s12664-023-01387-z
3. Tham J, Stanley A. Clinical utility of pre-endoscopy risk scores in upper gastrointestinal bleeding. Expert Rev Gastroenterol Hepatol. 2019;13(12):1161-1167. doi:10.1080/17474124.2019.1698292

Introduction

International guidelines recommend endoscopic submucosal dissection (ESD) for en-bloc resection of rectal lesions suspected of submucosal invasive cancer (SMI). ESD achieves favorable outcomes for benign lesions and early rectal cancers (ERC) with superficial (<1000μm) SMI. However, for ERCs with deep (≥1000μm) SMI, the rate of histologically radical (R0) resection remains suboptimal, at maximum 64% for SM2-3 lesions, even in expert centres. The muscle-retracting sign (MRS) has emerged as a potential endoscopic marker of deep SMI detected during endoscopic resection. Predicting deep SMI is particularly relevant in rectal lesions, as incorrect selection of resection modality may lead to non-radical endoscopic resections and the need for surgical salvage, which carries significant morbidity. To address some of these limitations, we applied the novel pocket-detection method (PDM) for MRS detection. This approach enhances visualization of the submucosal space and facilitates early identification of the MRS.

Aims & Methods

The aim of this study was to evaluate the diagnostic accuracy of the MRS detected using the PDM as an innovative approach for identifying deeply invasive ERC during endoscopic resection of rectal lesions.
In this prospective, observational, single-centre study consecutive rectal lesions that underwent endoscopic resection using the PDM between August 2023 and March 2025 were included. Directionality of initial submucosal dissection targeted any morphological or surface vascular pattern at risk of deep SMI to attempt MRS identification. Histopathology was the reference standard for MRS diagnostic accuracy in detecting deep SMI. Deep SMI was defined as ≥1000μm invasion from the muscularis mucosa at histopathology.

Results

38 rectal lesions, median size 30 mm (IQR 20-40), were included. PDM for MRS detection was successful in all cases, with MRS-positive in 15/38 (39.5%). Deep SMI was confirmed in 15/38 (39.5%). Accuracy of MRS-positive for deep SMI detection was 84.2%, (95% CI 69.6-92.6%), sensitivity 80% (95% CI 54.8-92.9%), specificity 87% (95% CI 67.9-95.5%), positive predictive value 80% (95% CI 54.8-92.9%), negative predictive value 87% (95% CI 67.9-95.5%), positive likelihood ratio 6.13, negative likelihood ratio 0.23, area under the curve 0.83 (95% CI: 0.71–0.96). The rate of R0 resection was 92.1% (35/38).

Conclusion

MRS detected using the PDM demonstrated moderate-to-high accuracy in predicting deep SMI in early rectal cancer. This finding may allow selection of endoscopic resection strategy based on invasion depth.

Introduction

Delayed bleeding after gastric endoscopic submucosal dissection (ESD) is a serious complication in older adults. The BEST-J score, developed by Hatta et al. (Gut, 2021), is widely used for bleeding risk stratification but does not reflect systemic factors. The Prognostic Nutritional Index (PNI), calculated as [10 × serum albumin (g/dL)] + [0.005 × total lymphocyte count (/μL)], may complement this score. This study evaluated whether combining PNI with the BEST-J score improves risk stratification.

Aims & Methods

We retrospectively analyzed 252 patients who underwent gastric ESD between April 2016 and February 2025, including 127 older (≥75 years) and 125 younger (<75 years) individuals. Patients were classified into low (<40) and high (≥40) PNI groups. The association between delayed bleeding, PNI, and BEST-J score was analyzed using receiver operating characteristic (ROC) analysis. To evaluate internal validity, we conducted 5-fold cross-validation of a logistic regression model that added 1 point for PNI < 40 to the BEST-J score. A cutoff value of PNI < 40 was used, based on previously reported clinical thresholds reflecting impaired nutritional and immune status, including its predictive value for bleeding in various clinical settings (Zhao et al., 2024; Lin et al., 2021).

Results

The delayed bleeding rate was 4.7% in the older group and 0.8% in the younger group. Mean PNI was lower in bleeding cases (44.7) than in non-bleeding cases (48.5). Among older adults, the AUCs for PNI and BEST-J alone were 0.65 and 0.72, respectively. Adding 1 point for PNI < 40 improved the AUC to 0.82. Cross-validation confirmed good model reproducibility, with a mean AUC of 0.861 and standard deviation of 0.147, indicating stable predictive performance without overfitting. The inclusion of PNI < 40 enhanced model sensitivity for identifying bleeding cases without substantially compromising specificity, improving clinical applicability. These associations were most prominent in older patients, supporting age-specific application of the combined model.

Conclusion

The combination of BEST-J and PNI provides an improved and practical approach to risk stratification for delayed bleeding after gastric ESD in older adults. Cross-validation supports the model's internal validity and suggests applicability to broader clinical populations. Given the disproportionately higher bleeding risk in the older cohort, our findings underscore the importance of incorporating host-related factors such as nutrition into stratification strategies specifically in this age group.

References

1. Hatta W, Tsuji Y, Yoshio T, et al. Prediction model of bleeding after endoscopic submucosal dissection for early gastric cancer: BEST-J score. Gut. 2021;70(3):476–484. doi:10.1136/gutjnl-2019-319926.
2. Zhao Y, Chen X, Zhang M, et al. Association of Prognostic Nutritional Index with Post-Discharge Bleeding in Acute Coronary Syndrome Patients on Dual Antiplatelet Therapy. Front Cardiovasc Med. 2024;11:11995920.
3. Lin Y, Wang J, Chen Z, et al. Preoperative Prognostic Nutritional Index Predicts Intraoperative Transfusion and Surgical Outcomes in Hepatocellular Carcinoma Patients Undergoing Hepatectomy. Cancers (Basel). 2021;13(11):2508.

Introduction

Helicobacter pylori (HP) has been designated as a Grade I Carcinogen by the WHO and remains an important factor in the pathogenesis of intestinal-type gastric cancer. Gastric cancer was the fifth most common malignant disease in the world in 2022 (Globocan) with 968,784 new cases(1), after lung, breast, colorectal and prostate cancers. The incidence of gastric cancer has changed significantly since the first estimates in 1975, when stomach cancer was the leading cancer, and one of the most important factors has been the eradication of HP.(2)

Aims & Methods

The purpose of this study was to determinate the trends in the incidence of HP in our region, and also of the precancerous lesions.
There have been included in the study a group of 12541 patients from the years 2014-2018 and a group of 7138 patients from more recently years 2020-2024.
All the patients had dyspeptic syndrome and in all the patients upper digestive endoscopy has been performed in the Gastroenterology Clinic from Târgu Mureș, Emergency Clinical Hospital. Patients with haemorrhage were excluded from the study. In all the patients gastric biopsies and histopathological exam were made, OLGA classification was used.

Results

From the first group, in 2131 patients (52,9% males and 47,1% females) were found gastric changes. Histopathological, 32,7% of the patients had atrophic gastritis, 43,1% intestinal metaplasia (23,7% complete metaplasia and 19,4% incomplete metaplasia) and 0,7% dysplasia. Active gastritis/pangastritis with HP was identified in 59,3% of the patients. In 4,8% of cases there were revealed polyps (hyperplastic, adenomatous) and were removed.
In the second group from 2560 patients (54,4% males and 45,6 females) that underwent upper gastrointestinal with biopsy sampling, HP was present in 442 patients (17,26%.) Histopathological, 14,50% of the patients had atrophic gastritis, 23,8% intestinal metaplasia and 2,58% dysplasia.

Conclusion

HP incidence is decreasing, as it has been treated by the gastroenterologist and also by the general practitioner. The decreasing in incidence of HP is corelating with the decreasing of the precancerous lesions and gastric cancer, so ​it is worth to treat it.

References

1. Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1.0, Cancer incidence and mortality worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: Inter- national Agency for Research on Cancer Available from: http://globocan.iarc.fr. Accessed 27.03.2025
2. Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report, Gut 2022;71:1724–1762.

Disclosure

no conflict of interest

Introduction

It remains uncertain if the addition of Saccharomyces boulardii (S. boulardii) to Vonoprazan-amoxicillin dual therapy as a first-line treatment can enhance the Helicobacter pylori (H. pylori) eradication rate and decrease the incidence of adverse events. Therefore, we conducted the randomized controlled trials (RCTs) to address this issue.

Aims & Methods

This is a single-center, prospective randomized controlled study. A total of 150 eligible patients, recruited from December 2023 to November 2024, were randomly assigned to the VA (vonoprazan 20 mg twice daily, amoxicillin 750 mg 3 times daily for 10 days) and VAS groups (vonoprazan 20 mg twice daily, amoxicillin 750 mg 3 times daily, and S. boulardii 250 mg twice daily for 10 days). The eradication rates, adverse events, safety, and compliance were compared between the two groups. Factors associated with eradication rate were explored.

Results

The eradication rates of VA and VAS were 89.3% and 93.3%, respectively, by intention-to-treat analysis (P = 0.384); 93.1%, and 94.6%, respectively, by per-protocol analysis (P=0.966). The incidence of adverse events significantly lower in the VAS group (5.4%) than in the VA group (22.2%; P=0.003). There was no significant difference in compliance between the VA (96%) and VAS groups (98.7%, P = 0.612). Body surface area (BSA) was found to be a influencing factor for eradication rate in both VA and VAS groups. Serum chemistry tests revealed no significant differences in liver and kidney function before and after treatment in both groups.

Conclusion

Although the addition of S. boulardii to VA dual therapy could not increase the eradication rate, it could decrease the incidence of adverse events. Low-BSA patients are more suitable candidates for this regimen.