Introduction

Recently, artificial intelligence-based computer-aided detection (CADe) for colonoscopy has garnered attention due to its effectiveness in increasing the adenoma detection rate (ADR). However, theoretically, CADe systems cannot reduce exposure errors for polyps obscured by objects. In this regard, computer-aided quality improvement (CAQ) which expects to induce the meticulous mucosal inspection and leading to a reduction of blind spot area. In this study, we developed and evaluated CAQ for colonoscopy.

Aims & Methods

This was a single-center, retrospective study conducted from April 1, 2022 to October 31, 2023. We randomly extracted videos of the entire colonoscopies and created 18,922 training images. Quadrant images were made from one image and three endoscopists annotated the following scores; i) (overall) quality of image(not evaluable 0 or evaluable 1), ii) appropriate distance between the colon mucosa and the endoscope(Scored on a scale of 0 to 8), iii) the amount of residue in the colon,(Scored on a scale of 0 to 8) and ⅳ) presence of blind area in the field of view (e.g., fold or flexure) (Scored on a scale of 0 to 4). We conducted supervised machine learning using annotated images. The CAQ deployed multi-head deep convolutional neural network model which can output multiclass prediction from one image. Consequently, the CAQ system outputs aforementioned score from colonoscopy video. To validate its performance, we randomly selected videos from the cecum to the hepatic flexure performed by 19 endoscopists and calculated CAQ model scores. We compared CAQ scores between endoscopists with low and high ADR (ADR cutoff is 35%) and with and without the history of detecting early depressed-type colorectal cancer by endoscopists.

Results

62 videos were included as validation samples. Among the 19 endoscopists, 11 had a low ADR and 8 had a high ADR. The results showed a significant difference in the rate of evaluable images between endoscopists with low and high ADR (median 70% vs. 77%, p = 0.003, t-test). There was also a significant difference in the evaluation score of the distance (median 3.8 vs. 4.2, p = 0.003, t-test). A significant difference was also obtained in the score for the amount of residue in the colon(median 5.3 vs. 5.7, p = 0.01, t-test). However, there was no significant difference in the scores evaluating the presence of blind areas(median 1.01 vs. 1.10, p = 0.13, t-test)
Among the 19 endoscopists, 5 endoscopists had a history of detecting early depressed-type colorectal cancer, while 14 did not. The results showed a significant difference was observed in the rate of evaluable images between endoscopists with and without a history of detecting early depressed-type colorectal cancer(median 80% vs. 71%, p < 0.001, t-test) . Additionally, there was a difference in the evaluation scores for the distance (median 4.5 vs. 3.8, p < 0.001, t-test). There was also a difference in the scores assessing the presence or absence of blind spots (median 1.2 vs. 1.0, p = 0.006, t-test). Moreover, a significant difference was found in the evaluation scores for the amount of residue in the colon(median 5.9 vs. 5.3, p < 0.001, t-test) .

Conclusion

The CAQ system developed in this study was able to quantify the skill of endoscopists. Such CAQ is expected to standardize the observation technique of colonoscopy and may lead to elucidation of detection techniques for significant lesions such as early depressed-type colorectal cancer.

Clinical Case Summary

Materials and methods: 24-year-old man with an episode of nausea, anorexia and loss of 4-5 kg in a week, which resolved spontaneously without drugs. During the episode had hyperchromic urine, yellowing of skin and eyes.After 1 month small increase of serum transaminases x 1.5. Regular bowel function. No clinical signs. US regular. Anti-HbsAg and HCV-Ab negative. After another month he had highly increase of serum transaminases with AST x 27 and ALT x50 GGT x3, Total bilirubin 2.85. Negative ANA, AMA, LKM, IgA anti TTG, anti EBV, anti CMV, alpha1 anti trypsian slight increase. He performed a new serum analysis with increase of anti-TTG IgA. He subsequently performed genetics for celiac disease and confirmed homozygous DQ2.Performs EGDS for suspected celiac disease which documents nodularity in bulb and DII scalloping. Histological examination shows Marsh 3B.After 150 g gluten daily intake had IgA anti TTG x 4. A diagnosis of celiac disease is made and he started GFD with serum transaminases x 2After 2 months with good adherence to GFD has AST x20 and ALT x 50. He denies alcohol abuse.Negative hemochromatosis mutations. Stable weight, Regular bowel function. We perform liver biopsy. The histological examination documents Histological Activity index acc. Knodell modified by Ishak: 7 Grading.
Results: Diagnosis is moderately active chronic autoimmune hepatitis.Therapy is started with prednisone 40 mg daily. With AST x10 and ALT x 20After 15 days of therapy AST x 5 and ALT x9, therefore values halving and normal bilirubin. Currently under follow-up in our Hospital
Conclusions: Although the history is still unknown and the histological exam is compatible but not certain, the good response to steroid therapy is a positive factor that proves the correctness of the diagnosis. This diagnostic difficulty leads us to always evaluate the autoimmune cause in a young patient without risk factors with a small increase in transaminases.

References

University of Salerno

Introduction

Functional Constipation (FC) and Constipation-predominant Irritable Bowel Syndrome (IBS-C) are two common disorders of gut-brain interaction (DGBI) which can often present overlapping symptoms, thus making difficult to distinguish them. ​

Aims & Methods

This study aims to determine whether the demographic and clinical profiles of consecutive patients diagnosed with FC and IBS-C differ in real-world clinical practice.
Demography and clinical information from the first clinical consultation where the diagnosis was made by a single consultant using a standardized clinical letter were retrospectively collected from January 2016 to March 2025 at a single tertiary care neurogastroenterology clinic in the UK Data were collected using a standardised template and were reported as median [interquartile range (IQR)] or frequency (%), and compared using the Chi-square test or Mann-Whitney U test.

Results

	FC (n= 88)	IBS - C (n=257)	p-value
Demography and general characteristics
Male, n (%) Age (years), median (IQR) Duration of symptoms (year),median (IQR)	24 (27%) 47 (25) 12,5 (17)	42 (16%) 32 (26) 5 (10)	0.036 0.0001 0.0001
Total number of concomitant medical condition, median (IQR) Chronic pain, n (%) Abdominal surgeries, n (%)	1 (2) 12 (14%) 24 (27%)	4 (4,5) 66 (26%) 112 (44%)	0.001 0.02 0.01
Total number of hospital admissions, median (IQR)	1 (2)	1 (5)	1.0
Total number of previous diagnostic investigation at first consultation, median (IQR)	1 (2)	1 (2)	1.0
Concomitant medications
Total number of concomitant medications, median (IQR) Tricyclic antidepressant, n (%) Selective Serotonin Reuptake Inhibitor, n (%) Serotonin-norepinephrinereuptake inhibitors, n (%) Opioids n, (%) Laxatives n, (%) Antispasmodics n, (%)	3 (4,5) 12 (14%) 12 (14%) 8 (9%) 13 (15%) 61 (70%) 3 (3%)	4 (4,5) 44 (18%) 39 (15%) 13 (5%) 82 (31%) 116 (45%) 42 (16%)	0.001 0.550 0.859 0.268 0.003 0.0001 0.003
Gi symptoms
Nausea, n (%) Early satiety n, (%) Vomiting, n (%) Post pandrial fulness, n (%) Heartburn, n (%) Abdominal pain, n (%)	16 (19%) 6 (7%) 7 (8%) 8 (9%) 13 (15%) 9 (10%)	93 (37%) 56 (21%) 45 (17%) 53 (20%) 52 (19%) 234 (91%)	0.002 0.002 0.04 0.02 0.330 0.0001

A total of 88 FC and 257 IBS-C consecutive patients were diagnosed according to Rome IV criteria. FC patients were older and most frequently males, with a longer duration of symptoms. Abdominal pain was largely absent in FC patients and when present this was not related to defecation but reported as result of long-lasting lack of bowel movement. Upper gastrointestinal symptoms were more frequent in IBS-C compared to FC. Comorbidities, particularly chronic pain syndromes, and abdominal surgeries were more frequently reported by IBS-C patients. in addition, IBS-C patients were more frequently on pain medications, while FC on laxatives. Table 1 summarizes the data collected in both groups.

Conclusion

This real-world study suggests that FC and IBS-C patients differ in demographic, clinical profile and comorbidities. IBS-C patients report a more severe clinical picture despite FC patients and had a longer duration of symptoms.

References

Bharucha AE, Sharma M. Painful and Painless Constipation: All Roads Lead to (A Change in) Rome. Dig Dis Sci. 2018 Jul;63(7):1671-1674. doi: 10.1007/s10620-018-5027-2. PMID: 29564675; PMCID: PMC6293467.
Bouchoucha M, Devroede G, Mary F, Bon C, Bejou B, Benamouzig R. Painful or Mild-Pain Constipation? A Clinically Useful Alternative to Classification as Irritable Bowel Syndrome with Constipation Versus Functional Constipation. Dig Dis Sci. 2018 Jul;63(7):1763-1773. doi: 10.1007/s10620-018-4995-6. Epub 2018 Feb 28. PMID: 29492744.

Introduction

Gastric cancer ranks as the fifth most common cancer and the second leading cause of cancer-related deaths. Multifocal atrophic gastritis and gastric intestinal metaplasia (GIM) often coexist and are both associated with the risk of developing gastric cancer, with GIM being the first irreversible mucosal transformation to cancer. Endoscopic surveillance was associated with earlier cancer detection and improved survival. This study aims to evaluate the prevalence, epidemiological characteristics, and clinical features of patients with GIM.

Aims & Methods

This is a single-center, retrospective study from January 1, 2022 to December 31, 2023. Including patients aged ≥18 years who underwent esophagogastroduodenoscopy (EGD) with gastric biopsies confirming GIM, All identified cases of GIM were reviewed by gastrointestinal pathologists to confirm the diagnosis. Th primary outcome was to assess the prevalence, epidemiological characteristic, and clinical features of GIM. The secondary outcome was to evaluate adherence to recommended surveillance protocols for GIM.

Results

Among 3,663 patients who underwent EGD, GIM was identified in (4.17%, n=153). The mean age of patients with GIM was 60 years, Males represented more than half of patients (54.2%), the majority were classified as overweight (Body mass index (BMI) 25–29.9; 64%, n=97) or obese (BMI ≥30; 24.3%, n=37).Smoking was reported in (17.6%, n=27), while (5.2%, n=8) reported alcohol consumption. Moreover, (7.2%, n=11) had a history of prior gastric surgeries. Dyspepsia (33.3%) was the most common indication for EGD. Gastritis was the predominant endoscopic finding and the primary reason for performing gastric biopsies (73%, n=112 ).The most common GIM subtype was complete (52%), followed by incomplete (37%) and mixed (11%). In terms of GIM location, extensive GIM was observed in (28.7%), localized GIM in (17.6%), while the location remained unknown in (53.6%) due to the lack of a follow-up EGD for mapping. Coexisting autoimmune atrophic gastritis was observed in (12.4%, n=19), Helicobacter pylori infection was detected in (16.3%, n=25). Furthermore, Dysplasia was identified in (2.6%, n=4), with low-grade dysplasia and high-grade dysplasia each accounting for (1.3%, n=2) (Table 1). Three patients developed.gastric cancer (2%) , while (4.6%, n=7) were found to have neuroendocrine tumors (NET). First degree family history of gastric cancer was reported in (12.4%, n=19).

Gastric Intestinal Metaplasia characteristic	Percentage
Location Localized Extensive. Unknown	27 (17.6%) 44 (28.7%) 82 (53.6%)
Type of GIM Incomplete Complete Mixed	51 (37%) 71 (52%) 15 (11%)
Autoimmune Atrophic Gastritis Absent Present	134 (87.6%) 19 (12.4%)
Helicobacter Pylori (H. pylori) Absent Present	128 (83.7%) 25 (16.3%)
Dysplasia Absent Low Grade High Grade	149 (97.4%) 2 (1.3%) 2 (1.3%)

Conclusion

This study highlights a 4.17% prevalence of GIM among patients who underwent EGD. High BMI and male sex were observed in more than half of the patients. Dysplasia was detected in 2.6%, gastric cancer in 2%, and NET in 4.6% of cases. Many patients lacked follow-up EGD surveillance, limiting effective monitoring. Larger studies with extended follow-up are required to further investigate these associations and their clinical implications.

Introduction

Biomarkers associated with the progression from gastric intestinal metaplasia (GIM) to gastric adenocarcinoma (GA) could provide valuable insights into identifying patients with increased risk for GA. Currently, the discovery of effective GA biomarkers poses a challenge due to the complexity of predictive and actionable value. Rarely can tumorigenesis be attributed solely to an individual molecule, as GA arises from the complex interplay of various intrinsic and environmental factors and collective interactions among multiple molecules.

Aims & Methods

The aim of this study was to identify potential biomarkers for the GIM-to-GA progression and potential drug repurposing for GIM. Sixty-four surgical biopsies were collected from 16 patients (4 tissue biopsies per patient) at St. Olav’s Hospital, Norway. Transcriptome datasets of GIM, GA, and normal tissues were compared within the same stomachs. Computational platform ScType was used for cell-type identification based on given scRNA-seq data and a comprehensive cell marker database. Ingenuity pathway analysis, Pagerank centrality, GO and MSigDB enrichments, CopyKat, aneuploid analysis, docking analysis, pathology and immunohistochemistry (IHC) were used for data and pathway mining, protein-protein interaction (PPI), and molecular structure-based drug repurposing.

Results

GIM displayed 110 canonical pathways that exhibited a negative correlation with GA. Wnt/β-catenin, ERK/MAPK, mTOR, neuregulin, and BRCA1 pathways were activated in both GIM and GA. Conversely, pathways such as HIPPO, p53, toll-like receptor, aryl hydrocarbon receptor, LPS/IL-1-mediated inhibition of RXR function, and eIF2 were inactivated in GIM but activated in GA. GIM exhibited elevated gene expression compared to GA in tumor microenvironment-related cells. Particularly, RBP2 expression and goblet cell-related gene expression were found to be restricted in GIM, but not in GA. Chromosome instability occurred mainly in GA cells with high rates of gain or loss of chromosomes 1, 7, 12, 21 (gain), and 5, 7, 8, X (loss). CD44 IHC expression was expanded from the basal part of mucosa in normal and GIM stomachs to the upper part of the mucosa in GA stomachs. PPI analysis of 865 GIM-related proteins showed seven network nodes (i.e., drug targets) including epidermal growth factor receptor (EGFR), SRC (proto-oncogene tyrosine-protein kinase), paxillin (PXN), Jun proto-oncogene (JUN), breast cancer type 1 susceptibility protein (BRCA1), tumor protein P53 (TP53 or p53), mouse double minute 2 homolog (MDM2), and CD44. These network node proteins were also shown in The Human Protein Atlas and IHC, with the exception of SRC in GA. Computational drug repurposing of approved and investigational drugs/compounds (e.g., as found on www.clinicaltrials.gov) identified the following drugs as effective for GIM: dasatinib with or without erlotinib, nilotinib, afatinib on SRC, SM1-71 on SRC, JNJ-26483327 on EGFR, Afatinib on EGFR, ingenol mebutate on protein kinase C (PKC) family, amoxapine, benoxaprofen, avobenzone, amlexanox, alprazolam, praziquantel, ibuprofen piconol, tranilast, and restoril.

Conclusion

The druggable protein network associated with GIM progression toward GA was identified. The distinct phenotypic patterns between GIM and GA might challenge the notion that GIM serves as the primary precancerous lesion in GA tumorigenesis rather than shares a common cause with tissue-resident stem cells. Further validation of the druggable protein network is needed for the development of a cost-effective surveillance program and preventive treatment of the GIM-to-GA progression.

Introduction

Helicobacter pylori (H. pylori) infection remains a major public health problem. Given the high resistance to antibiotics, different treatment strategies must be validated in each specific country. The recurrence rates of H. pylori infection and its predictors remain unclear.

Aims & Methods

To determine the independent factors predicting recurrence after successful eradication with a first-line treatment for H. pylori infection.
All patients were submitted to eradication treatment with five quadruple therapies (A-Concomitant with metronidazole 500mg tid, 14 days; B-Concomitant with metronidazole 500mg bid, 14 days; C-Quadruple with bismuth, 10 days; D-Sequential, 14 days; E-Hybrid, 14 days)) in a blind, randomized trial. Esomeprazole was the proton-pump inhibitor of choice. Efficacy rate at 1-2 months and recurrence rate at 12 months using ¹³C-urea breath test were evaluated. Sociodemographic data, personal/family history, health status and biochemical parameters were assessed using univariate and multivariate analyses.

Results

A total of 126 patients (42.9% males; mean age: 57.4±16.7 years) concluded the treatment protocol (A-25; B-21; C-27; D-24; E-29). Overall efficacy rate of quadruple therapy regimens was 98.4%(n=124): Group A-100%; Group B-100.0%; Group C-100.0%; Group D-100.0%; Group E-93.1% (p=0.147). Overall recurrence rate of quadruple therapy regimens was 4.1%(n=5/123): Group A-12.0%; Group B-9.5%; Group C-0.0%; Group D-0.0%; Group E-0.0% (p=0.009). After univariate/multivariate analysis, high LDL-cholesterol level (OR 1.032, p=0.042), non-bismuth concomitant H. pylori eradication regimen (OR 8.904, p=0.064) and alcoholism (OR 8.333, p=0.035) were independent risk factors for H. pylori reinfection.

Conclusion

In this South-European country, all quadruple therapy regimens with or without bismuth are very effective for H. pylori eradication. The 12-months recurrence rate of H. pylori infection after successful eradication is <5%. High LDL-cholesterol, non-bismuth concomitant H. pylori eradication regimen and alcoholism are independent predictors for H. pylori reinfection. A close surveillance on infectious state in high-risk patients is crucial to prevent long-term H. pylori-associated complications.

References

1. Zamani, M., Ebrahimtabar, F., Zamani, V., et al. (2018) Systematic review with meta-analysis: the worldwide prevalence of Helicobacter pylori infection. Aliment Pharmacol Ther 47(7), 868-876.
2. Malfertheiner, P., Megraud, F., O’Morain, C.A., et al. (2017) Management of Helicobacter pylori infection – the Maastricht V/Florence Consensus Report. Gut 66(1), 6-30.
3. Savoldi, A., Carrara, E., Graham, D.Y., et al. (2018) Prevalence of antibiotic resistance in Helicobacter pylori: a systematic review and meta-analysis in World Health Organization Regions. Gastroenterology 155(5), 1372-1382.
4. Lopo, I., Libânio, D., Pita, I., et al. (2018) Helicobacter pylori antibiotic resistance in Portugal: Systematic review and metaanalysis. Helicobacter 23(4), e12493.
5. Hu, Y., Wan, J.H., Li, X.Y., et al. Systematic review with meta-analysis: the global recurrence rate of Helicobacter pylori. Aliment Pharmacol Ther. 2017;46(9):773-779.
6. Zhao, H., Yan, P., Zhang, N., et al. The recurrence rate of Helicobacter pylori in recent 10 years: A systematic review and meta-analysis. Helicobacter. 2021;26(6):e12852.

Disclosure

None of the authors have anything to declare with regard to personal or financial interests in carrying out this work.