Introduction

Gastric cancer is the third leading cause of cancer-related death worldwide, and most cases of gastric cancer are diagnosed at an advanced stage with a poor prognosis. Early diagnosis of gastric cancer is important for increasing survival rates and improving treatment outcomes. However, there has been no accurate biomarker specific for gastric cancer. This study aims to elucidate the pathways involved in gastric cancer development by evaluating metabolic differences between intestinal metaplasia and gastric cancer and highlighting metabolic changes between the groups.

Aims & Methods

The tissues of intestinal metaplasia and gastric cancer were obtained from 37 gastric cancer patients. Multivariate metabolic analysis was performed using Principal Component Analysis (PCA) and Partial Least Squares Discriminant Analysis (PLS-DA) to distinguish metabolic profiles and identify metabolomes that were significantly different between intestinal metaplasia and gastric cancer.

Results

PCA and PLS-DA significantly separated the gastric cancer tissue and intestinal metaplasia. Most of the metabolites related to steroid hormone biosynthesis were decreased, while metabolites that promote to cancer cell growth, such as s-Adenosyl-L-Methionine, S-adenosylmethioninamine, nopaline and N-acetylputrescine, were increased. In addition, the lysine degradation pathways demonstrated increases in L-lysine, L-lysopine and 5-Acetaminopentanoate, and N6-Acetyl-N6-hydroxy-L-lysine, which is consistent with the literature, but it requires further elucidation.

Conclusion

This is the first study to show metabolomic differences between the intestinal metaplasia and gastric cancer tissue using liquid chromatography with tandem mass spectrometry (LC-MS/MS). The metabolites found in this study could be used as novel biomarkers for the early detection of gastric cancer with further validation research.

Introduction

Functional diseases of the gastrointestinal tract are a common diagnosis, with the most common manifestations being functional dyspepsia and IBS. The pathophysiological mechanisms and etiology of this group of diseases are not fully understood, but stress is believed to play a key role.

Aims & Methods

This study aims to evaluate the effectiveness of a low-histamine diet in patients with irritable bowel syndrome. Patients who meet the ROME IV criteria were included in the study. The study included 120 patients, divided into three groups: low- histamine diet, FODMAP diet and mediterranian diet.Questionnaires were used to assess stress levels PSS-4, anxiety GAD-7, severity of IBS - IBS Severity Score, and quality of life. The questionnaires were completed three times: both at the beginning of the study, immediately after the end of the 4-week diet, and one month after the end of the diet therapy.

Results

The low-histamine diet led to a statistically significant improvement in IBS symptoms compared to baseline. These findings suggest that the dietary intervention had a positive therapeutic effect ( low- histamine diet : t = 9.6181, p-value < 0.001, low FODMAP diet Z = 22, p-value < 0.001, mediterannian diet Z =119, p-value < 0.001).

Conclusion

Dietary therapy plays a key role in the management of IBS. The low-histamine diet shows promising results and may serve as a viable alternative to the FODMAP diet.

Disclosure

The study was launched after receiving approval from the Research Ethics Committee (REC) at the Medical University "Prof. Dr. Paraskev Stoyanov" – Varna, protocol 111/ 20.01.2022y.Data were processed and analyzed using appropriate statistical methods chosen according to the nature of the variables and research questions. The analysis includes:

• Evaluation of the statistical significance of the main and interactions between the factors (Repeated Measures with Wicolxon and Paired t-test).
• Regression analysis to assess relationships between dependent and independent variables. As well as using heteroskedasticity-robust standard error estimates (HC3) to ensure accuracy of regression analysis results.

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

The LiverRisk score has been developed as blood-based tool to estimate liver stiffness measurement (LSM) in the general population (i.e., in subjects without known chronic liver disease (CLD), and thus, detect compensated advanced chronic liver disease (cACLD; LSM ≥10kPa) and stratify their risk of liver-related events. Notably, its utility in other settings is unclear as a one-size-fits-all blood-based test. We aimed to evaluate its diagnostic/prognostic performance in patients referred to specialized hepatology outpatient clinics (i.e., tertiary care).

Aims & Methods

Subjects with known/suspected CLD at first LSM (cohort-I, n=5897) or first referral & LSM (cohort-II, n=1558) were retrospectively included. Calibration/agreement of the LiverRisk score with LSM was assessed as well as its diagnostic accuracy for LSM-defined cACLD compared to FIB-4/APRI. Finally, its predictive performance for hepatic decompensation was evaluated.

Results

In cohort-I/II, mean age was 48.3/51.8years, 44.2%/44.7% were female, predominant etiologies were viral hepatitis (51.8%)/MASLD (63.7%), median LSM was 6.9 [5.1-10.9]/ 5.8 [4.5-8.8]kPa, and 1690 (28.7%)/ 322 (20.7%) had cACLD.
Despite a moderate correlation (Pearson’s r: 0.325/0.422), the LiverRisk score systematically underestimated LSM (mean difference according to the Bland-Altman-method: -2.9/-1.8 points≙kPa). Variation of observed differences was considerable (95%CI of agreement: 39.4 and 35.2 points≙kPa), and showed a clear pattern towards larger disagreement at higher values with lower LiverRisk score than LSM.
The diagnostic accuracy of the LiverRisk for cACLD (AUROC: 0.757 [95%CI: 0.744-0.770]/ 0.790 [95%CI: 0.762-0.819]) was comparable to FIB-4 (0.769/0.813) and APRI (0.747/0.765). The cut-off of 10points≙kPa yielded an overall accuracy of 74.2%/81.2%, high specificity (91.9/93.4%), but low negative predictive value (76.6/84.5%) with false-negative results in 20.0%/13.5% in cohort-I/II, respectively.
In cohort-I, 208 (3.5%) patients developed hepatic decompensation (median follow-up: 4.7years). The LiverRisk score showed a reasonable accuracy for predicting hepatic decompensation within 2 years (AUROC: 0.817); however, it was inferior to LSM (0.891, p<0.001) and FIB-4 (0.912, p<0.001). The strata of LiverRisk score (and of LSM/FIB-4) discriminated patient groups of distinct risks for hepatic decompensation.

Conclusion

While being a major step forward for screening subjects without known liver disease in primary care, the LiverRisk score was not superior (vs. FIB-4) for diagnosis of cACLD or (vs. FIB-4/LSM) for prediction of hepatic decompensation in a tertiary care setting, i.e., in cohorts with a higher pre-test probability of cACLD. Notably, FIB-4 even outperformed the LiverRisk score in terms of prognostic utility.

Introduction

Nonalcoholic fatty liver disease (NAFLD) is a widespread metabolic disorder associated with intestinal dysbiosis, low-grade systemic inflammation, and small intestinal bacterial overgrowth (SIBO). Targeting the gut-liver axis through microbiome-modulating therapies may represent a promising approach to disease management.

Aims & Methods

The aim was to investigate gut microbiota alterations in NAFLD patients and assess the efficacy of microbiota-based therapy on metabolic, inflammatory, and structural liver parameters. The study included 152 NAFLD patients and 47 controls. Gut microbiota composition was evaluated using qRT-PCR, and SIBO was diagnosed via hydrogen breath testing. The therapeutic protocol included rifaximin (200 mg TID for 14 days), Saccharomyces boulardii CNCM I-745 (1 capsule BID for 30 days), and essential phospholipids (600 mg TID for 30 days). Liver function tests, inflammatory markers, and steatometry were assessed before and after treatment.

Results

Alterations in gut microbiota composition indicative of dysbiosis—including increased Firmicutes/Bacteroides ratio and Actinobacteria abundance—were identified in NAFLD. Strong correlations emerged between the F/B index and triglycerides (r = 0.78), TNF-α (r = 0.77), and between Actinobacteria and hsCRP (r = 0.66). SIBO rates declined significantly post-treatment (51% → 17%). Liver enzymes, inflammatory markers, and steatometric parameters improved substantially (p<0.05).

Conclusion

Microbiota-targeted therapy combining rifaximin, S. boulardii, and phospholipids effectively corrected dysbiosis, reduced inflammation, improved metabolic parameters, and promoted liver structural recovery in NAFLD patients. These findings support incorporating microbiome-focused interventions into routine clinical practice for NAFLD. ​

Introduction

Dynamic transperineal ultrasound (DTP-US) enables the calculation of the pubo-rectal muscle (PR) length and the ano-rectal angle (ARA) width, offering a static and dynamic evaluation of the pelvic floor. DTP-US is usually followed by a Gel Expulsion Test (GET), in the same way that high-resolution anorectal manometry (HR-AM) is usually followed by balloon expulsion test (BET).
DTP-US+GET may be an innovative way of testing constipated patients for functional defecation disorders (FDD) diagnosis.

Aims & Methods

Our aims were: to determine normal values for DTP-US; to explore accuracy of DTP-US+GET in diagnosing a Rome IV FDD. To obtain normal values, 17 healthy females (HVs) underwent DTP-US+GET.
Fifty-six females meeting Rome IV criteria for functional constipation (FC) underwent DTP-US+GET.
Measurements were acquired in supine (SUP) and left lateral (LL) positions. At rest, during squeezing and during straining were evaluated: PR length; ARA width; variation in length of PR and in width of ARA between rest and squeezing or straining (expressed as a percentage of the resting measurement).
All 56 FC patients previously underwent HR-AM+BET. DTP-US examiners were blinded to HR-AM+BET result.
GET was performed in a sitting position filling the rectum with ultrasound gel (120 ml). GET was considered positive if patient was unable to evacuate gel after 30 seconds.

Results

No differences were observed in mean age between HVs and FC groups (p=0.57).
Thirty-eight patients (67.86%) showed a FDD on HR-ARM+BET. Thirty-eight patients showed a positive GET. No HVs failed GET.
DTP-US straining results are summarized in Table-1. FDD patients showed different mean values for straining measurements compared with HVs (p<0.001): HVs showed an increase in PR length and an increase in ARA; FDD showed a length reduction in PR and a closure of ARA.
To diagnose FDD, at least 3 out of 4 abnormal values on percentage variations during straining and a positive GET were needed: abnormal DTP-US+GET showed a strong association with FDD (OR 198.33), with a sensibility of 92.11%, a specificity of 94.44% and an accuracy of 94.42% in diagnosing FDD.

Table-1 –DTP-US values and differences between HV and FDD group

Conclusion

DTP-US+GET is an innovative and promising new technique to diagnose FDD in constipated patients. It can be performed by a skilled gastroenterologist, is not expensive and requires only a convex probe, with no radiation exposure. In this pilot study, we provided normal values for DTP-US and tested these values to diagnose FDD in a set of constipated patients, obtaining a diagnostic accuracy of 94.42%.