Introduction

Acute upper gastrointestinal bleeding (AUGIB) is a common medical emergency. We compare the characteristics and management of variceal vs non-variceal causes of AUGIB in the 2022 UK audit.

Aims & Methods

Prospective multi-centre observational study of adults (>16 years) presenting in or to UK hospitals with AUGIB between 3 May and 2 July 2022.

Results

In this interim analysis, endoscopy was performed for 2315 of the first 2881 patients and a cause identified in 1542. Those identified with varices (14%, 212/1542) were younger than those with non-variceal AUGIB (median age 57 vs 70 yr, respectively). For varices, sites included:87%(185/212) oesophageal;18%(38/212) gastric;3%(7/212) duodenal. 43%(92/212) were on non-selective beta-blocker prophylaxis on admission;32%(68/212) had a history of previous AUGIB and 24%(50/212) were on a variceal band ligation programme. 69%(147/212) had stigmata of recent bleeding;75%(160/212) received endotherapy:62%(132/212) had variceal therapy (banding – 124, glue or thrombin injection – 11) and 6%(12/212) required a Sengstaken tube. 4%(8/212) underwent TIPSS and 58%(123/212) were discharged on a non-selective beta-blocker. For those with non-variceal causes, findings included:58%(777/1330) peptic ulcer disease;26%(353/1330) oesophagitis;5%(69/1330) portal hypertensive gastropathy;7%(96/1330) malignancy and 28%(369/1330) others. 38%(506/1330) had stigmata of recent bleeding;34%(447/1330) received endotherapy:13%(176/1330) had a single modality and 20%(271/1330) ≥1 modality. Different modalities included:23%(105/447) thermal device;60%(270/447) adrenaline injection;48%(215/447) haemostatic clips;24%(109/447) haemostatic powders or gel;14%(64/447) argon plasma coagulation and 8%(37/447) others . Outcomes for patients with variceal vs non-variceal cause of bleeding are shown (Table 1).

Conclusion

Patients with variceal bleeding were younger, with higher therapeutic and transfusion requirements, re-bleeding rates and length of stay. Mortality was not significantly different to non-variceal bleeding.

Introduction

A major difficulty in treating Crohn’s disease (CD) lies in the unreliable association between clinical symptoms and underlying inflammation, hindering effective monitoring. Intestinal ultrasound (IUS) has emerged as a valuable, non-invasive, and well tolerated tool for assessing inflammatory activity in CD. The "Selecting Therapeutic Targets in Inflammatory Bowel Disease" (STRIDE-II) guidelines recognize the transformative impact of IUS in inflammation assessment but hesitate to endorse transmural healing as a primary treatment target due to current limitations of available therapies in achieving this outcome. However, limited data exist on the applicability of IUS in patients with newly diagnosed CD who might not have developed irreversible fibrotic alterations.

Aims & Methods

The primary aim of this study was to characterize the sonographic features of CD at diagnosis and throughout the initial year post-diagnosis. Additionally, we sought to assess the predictive capability of IUS herein.
We conducted a prospective, population-based cohort study involving newly diagnosed patients with CD. Patients were systematically monitored using IUS in tandem with symptomatic, biochemical, and endoscopic evaluations throughout the first year following diagnosis. Transmural remission (TR) was defined as BWT ≤ 3 mm without colour Doppler signal, and symptomatic remission as Harvey-Bradshaw Index ≤ 4.

Results

During the study period (May 2021 – May 2023), 201 patients with adult-onset CD were included. No significant associations were observed between sonographic characteristics of inflammation and diagnostic delay.
At three months post-diagnosis, TR was achieved in 38% of patients, with a higher proportion observed in those with colonic disease (L1: 33%, L2: 52%, L3: 27%; p= 0.05). TR at three months was significantly associated with symptomatic remission at subsequent follow-ups during the first year (3 months: 87% vs. 51%, p < 0.001; 6 months: 87% vs. 61%, p = 0.004; 9 months: 76% vs. 49%, p = 0.012; 12 months: 87% vs. 64%, p = 0.013), as well as a reduced risk of treatment escalation (20% vs. 65%, p < 0.0001) during this period.
By 12-month, 41% of patients achieved TR, with no significant association observed with disease location. In a multivariable analysis adjusted for age, sex, smoking, disease location, and baseline sonographic inflammation, a higher body mass index (BMI) significantly decreased the likelihood of achieving transmural remission (overweight: Odds ratio (OR) = 0.13, 95% confidence interval (CI): 0.02–0.93; obesity: OR = 0.06, 95% CI: 0.01–0.64).
Among the 126 patients with ileal or ileocolonic disease, 16 (13%) underwent ileocecal resection (ICR) within the first year. In an analysis of receiver operating characteristic area under the curve (ROC AUC), which included endoscopic, symptomatic, sonographic, and biochemical findings, the International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) in the terminal ileum at diagnosis emerged as the most accurate predictor of ICR during this period: IBUS-SAS 63 (AUC = 0.92, sensitivity = 100%, specificity = 73%).

Conclusion

The findings of this study highlight TR as an attainable goal for newly diagnosed CD patients with a positive impact on the disease course. Moreover, the negative influence of high BMI on the likelihood of achieving TR underscores the necessity for further investigation into the impact of weight on the disease course of IBD. The study also reveals that sonographic inflammation in the terminal ileum at diagnosis is the most accurate predictor of the need of ICR within the first year.

Introduction

The relationship between disruptions in the intestinal microbiome, psychological well-being, and modern lifestyle factors in individuals with prevalent non-communicable diseases, such as atherosclerosis, has been partially elucidated but remains inadequately investigated. This raises the inquiry into the feasibility of diagnosing, preventing, and treating atherosclerosis through the measurement and adjustment of disease markers associated with intestinal microbiome, psychological state, and lifestyle indicators.

Aims & Methods

This study aims to broaden the spectrum of these markers to a degree adequate for establishing models to diagnose atherosclerosis within the alternative categories of "no atherosclerosis," "asymptomatic atherosclerosis," and "symptomatic atherosclerosis," as well as by the level of associated health risks (non-significant, significant, and high). Our cohort study data were employed to fulfill this goal.

Results

We identified microbial markers from 955 gut microbiome species and other markers from 52 indicators of psychological state and lifestyle among participants. Marker properties were assessed based on their ability to distinguish between "no atherosclerosis," "asymptomatic atherosclerosis," and "symptomatic atherosclerosis" groups, as well as "not significant risk," "significant risk," and "high risk" groups. We measured their correlation with each participant's group membership using the p-level parameter to prioritize markers, resulting in a rating for each. Eleven microbial species (including Oxalobacter aliiformigenes, Lactobacillus acidophilus, and Bifidobacterium longum) and six other indicators (including "feeling of slowness" and "duration of physical activity") showed the highest scores. Cluster-type models based on these markers accurately predict group membership, with predictive accuracies ranging from 93.7% to 97.1%. This study provides novel insights into atherosclerosis-associated markers, laying a foundation for future research in this field.

Conclusion

The inclusion of microbial, psychological state, and lifestyle indicators has significantly enhanced the existing markers for atherosclerosis. These new markers have facilitated the development of models that, for the first time, enable the diagnosis of atherosclerosis within the categories of "no atherosclerosis," "asymptomatic atherosclerosis," and "symptomatic atherosclerosis," as well as by the associated health risks (non-significant, significant, and high). In addition to microbial markers, these models also incorporate an individual's psychological state and lifestyle indicators.

References

1. Meleshko T. V., Pallah O. V., Rukavchuk R. O., Yusko L. S., & Boyko N. V. (2020). Edible Fruits Extracts Affect Intestinal Microbiota Isolated from Patients with Noncommunicable Diseases Associated With Chronic Inflammation. Biotechnologia Acta, 13 (5), 87-100.
2. Toth, S., Boyko, N., & Sihotsky, V. (2021). Hypothesis of “stroke-stop” formula: a tool for risk index determination in development of acute cerebrovascular disease in asymptomatic individuals with carotid stenosis.
3. Bubnov, R. V., Spivak, M. Y., Lazarenko, L. M., Bomba, A., & Boyko, N. V. (2015). Probiotics and immunity: provisional role for personalized diets and disease prevention. EPMA Journal, 6, 1-11.
4. Kopolovets, I., Berek, P., Stefanic, P., Lotnyk, D., Mucha, R., Hertelyova, Z., ... & Sihotsky, V. (2020). Relevance of Lp-PLA2 blood concentration for morphological structure of atherosclerotic plaque: a shift from reactive to predictive, preventive and personalized medicine to predict stroke in patients with asymptomatic internal carotid artery stenosis.

Introduction

Chronic fatigue (CF) is prevalent among patients with ulcerative colitis (UC) and Crohn's disease (CD), but the influence of the disease activity is not established.

Aims & Methods

The primary aim of this study was to evaluate the prevalence and probability of chronic fatigue (CF) in patients with CD and UC one year after diagnosis, stratified by different measures for disease remission (symptomatic, biochemical, endoscopic, and histological). Additionally, we aimed to evaluate factors associated with chronic fatigue among patients in endoscopic/radiological remission.

Patients ≥18 years with CD and UC were recruited from the Inflammatory Bowel Disease South-Eastern Norway (IBSEN III) study, a population-based, observational inception cohort. Fatigue was assessed using Fatigue Questionnaire (FQ), and CF was defined as a dichotomized score of ≥4 with a duration of ≥6 months. Only patients with complete FQ data, without history of colectomy, were eligible for inclusion. Binary logistic regression analyses were used to examine the probability of CF for various indicators of remission, including i) symptomatic remission (Harvey–Bradshaw index score <5 for CD and Simple Clinical Colitis Activity Index score <3 for UC), ii) biochemical remission (Fecal calprotectin ≤ 250 µg/g), iii) endoscopic/radiological remission (Mayo endoscopic score 0 in UC, and endoscopically verified absence of inflammation combined with normal intestinal MRI/CT in CD), and iv) histological remission (normal histology in all mucosal biopsies). Additionally, in patients with endoscopic/radiological remission, associations between CF and selected clinical factors were evaluated using binary logistic regression analysis.

Results

In total, 711/1416 patients with CD or UC diagnosis were included (CD: 33.8%, UC: 66.2%). Among them, 619 (87.1%) underwent colonoscopy, intestinal MRI/CT and/or fecal calprotectin testing. Prevalence of CF stratified by different indicators of remission is presented in table 1. In univariate binary logistic regression analysis regarding measures for disease remission, the probability of CF was only significantly reduced in patients with UC in symptomatic remission (OR: 0.48 (0.30, 0.77), p=0.003). Among patients with CD and UC in endoscopic/radiological remission (n=181), CF was independently associated with current biological treatment (OR: 2.92 (1.002, 8.49), p=0.05) and sleep disturbance (OR: 6.23 (2.03, 19.14), p=0.001) in multivariate logistic regression.

Conclusion

The probability of CF one year after diagnosis was not associated with either low fecal calprotectin level, normal endoscopic/radiological examinations, or normal histology. Among patients with UC, but not CD, symptomatic remission was associated with a reduced probability of CF. For patients in endoscopic/radiological remission, CF was independently associated with sleep disturbances and current biological treatment.

Disclosure

All authors report no conflict of interest.

Introduction

Approximately 50% of people have problems with hemorrhoids at some point in their lives. We aimed to investigate the effectiveness of a new rectal micro-encapsulated sodium butyrate suppository in the treatment of hemorrhoid disease.

Aims & Methods

All consecutive patients attending the outpatient clinic of the 5 participating hospitals with symptoms of pain, pruritus or passing of bright blood per rectum due to hemorrhoid disease were eligible for entering the study. Pregnant women and patients with rectal cancer were excluded. The intensity of symptoms was evaluated with a 5-point Likert scale, while hemorrhoids were classified as internal or external. All patients received once a day for 10 days a suppository that weighs 2,0gr and contains sodium butyrate, sodium alginate, carboxymethylcellulose, triglycerides of saturated fatty acids with the addition of monoglycerides and diglycerides. The effectiveness of treatment was evaluated at the end of the 10-day administration and was defined as the complete disappearance of pain, pruritus and hemorrhage. The concomitant use of lidocaine or phlebotropic drugs that were administered according to the treating physician’s judgment was also recorded.

Results

From January 2024 till March 2025, 179 patients [male/female: 106/73, mean±SD age: 51±24, mean±SD BMI: 27.42±5.91) received the rectal micro-encapsulated sodium butyrate suppository for the treatment of pain (n=82), pruritus (n=55) and hemorrhage (n=143). Twenty-one patients (11.7%) had also diabetes mellitus, 18 (10.0%) were receiving anticoagulants and 51 (28.5%) were active smokers. Ninety (50.3%) patients had external and 135 (75.4%) internal hemorrhoids [grade 1=52 (38.5%), grade 2=54 (40.0%), grade 3=21 (15.5%), grade 4=6 (4.4%)]. The mean±SD intensity of pain and pruritus was 2.10±1.24 and 1.90±1.34 respectively. Thirty-two (17.8%) patients had also an anal fissure. Forty (22.3%) patients were receiving lidocaine ointment and 29 (16.2%) were receiving phlebotropic drugs during the time of the rectal suppository administration. After the 10-day administration period success of treatment was seen in 161 (89.9%) patients. No adverse events from the use of the rectal suppository were seen.

Conclusion

The use of micro-encapsulated sodium butyrate in suppository form appears to be safe and effective for the treatment of symptoms due to hemorrhoid disease.

Disclosure

No conflicts of interest