Introduction

Inadequate nutritional status is a major complication of chronic gastrointestinal diseases such as Inflammatory Bowel Diseases (IBD), including two main types: Crohn's Disease (CD) and Ulcerative Colitis (UC) [1]. Previously, sarcopenia and myopenia were associated only with ageing, but they also affect patients with chronic diseases, including IBD, regardless of age [2]. Both malnutrition and sarcopenia lead to poorer health outcomes in IBD patients, increasing the risk of hospitalization, disease exacerbation, need for surgery and post-operative complications [3, 4].

Aims & Methods

The aim of this study was to assess the prevalence of sarcopenia, myopenia and malnutrition in Polish patients with IBD using clinical tools available in daily practice. A total of 91 IBD patients (48 CD, 43 UC), aged 18-65 years, with both inactive and active disease (30 and 61, respectively), were included in the study. Sarcopenia was assessed using the Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire and the 5-times sit-to-stand test, while myopenia was evaluated through the Fat-Free Mass Index (FFMI). Nutritional status was determined using BMI, the Nutritional Risk Screening (NRS-2002), biochemical parameters (albumin and ferritin levels), and body composition analysis.

Results

Malnutrition was identified in 22% of patients based on BMI (3 inactive, 17 active IBD) and in 31.9% based on NRS-2002 (1 inactive, 28 active IBD). Based on BMI, 25 patients (27.5%) were classified as excessive body weight, and 44% of these were in the active phase of the disease. Hypoalbuminemia and low ferritin levels were observed in 64% and 38.3% of participants, respectively. Sarcopenia was present in 24.3% of patients (SARC-F) and 17.6% (sit-to-stand test), while myopenia was detected in 36.7%. Sarcopenia and myopenia were more common during active disease phases. A significant association was found between regular physical activity of patients and a reduced incidence of myopenia (OR = 0.24; 95% CI: 0.09 - 0.64) – compared to patients who did not declare such activity. It was observed that patients receiving biological therapy had a significantly lower prevalence of malnutrition according to the NRS - 2002 scale (OR = 0.33; 95% CI: 0.11 - 0.98). Additionally, in this patient group, a trend toward a lower prevalence of sarcopenia, as assessed by the SARC - F questionnaire, was observed. No significant associations were found between the increased prevalence of either sarcopenia or myopenia and disease type, patient gender, or disease duration.

Conclusion

Our study shows that malnutrition and sarcopenia are prevalent in Polish IBD patients, necessitating comprehensive assessment tools. We demonstrated that reliance on BMI alone is insufficient. While BMI identified malnutrition in a lower percentage of patients, the use of additional parameters, such as the NRS - 2002 scale and biochemical markers, provided a more comprehensive assessment. Higher BMI values can obscure malnutrition by masking muscle loss and nutritional deficiencies, making standard BMI assessments insufficient. In addition, we observed that biological therapy can have a beneficial effect on the nutritional status of IBD patients. We have shown that all of the methods we have presented for detecting malnutrition and sarcopenia can be successfully used in patients with IBD. However, further research is needed to identify the preferred method.

References

[1] Massironi S, Viganò C, Palermo A, Pirola L, Mulinacci G, Allocca M, Peyrin-Biroulet L, Danese S. Inflammation and malnutrition in inflammatory bowel disease. Lancet Gastroenterol Hepatol. 2023 Jun;8(6):579-590. doi: 10.1016/S2468-1253(23)00011-0.
[2] Neelam PB, Sharma A, Sharma V. Sarcopenia and frailty in inflammatory bowel disease: Emerging concepts and evidence. JGH Open. 2024 Jan 27;8(1):e13033. doi: 10.1002/jgh3.13033.
[3] Liu S, Ding X, Maggiore G, Pietrobattista A, Satapathy SK, Tian Z, Jing X. Sarcopenia is associated with poor clinical outcomes in patients with inflammatory bowel disease: a prospective cohort study. Ann Transl Med. 2022 Mar;10(6):367. doi: 10.21037/atm-22-1126.
[4] Dhaliwal A, Quinlan JI, Overthrow K, Greig C, Lord JM, Armstrong MJ, Cooper SC. Sarcopenia in Inflammatory Bowel Disease: A Narrative Overview. Nutrients. 2021 Feb 17;13(2):656. doi: 10.3390/nu13020656.

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.

Introduction

Irritable bowel syndrome (IBS) poses a significant healthcare challenge, characterized by chronic gastrointestinal and extraintestinal symptoms impacting individuals' well-being. Treatment preferences may vary among patients from different ethnic groups, such as Arab and Jewish Israelis, necessitating tailored approaches.

Aims & Methods

A bilingual (Hebrew/Arabic) questionnaire grading patients' preferences of treatment goals was developed. It was administered online in Israeli IBS Facebook groups, as well as in two hospital gastroenterology clinics.

Results

The study included 267 IBS patients (91 Arabs and 176 Jews). Demographic analysis revealed a higher proportion of females in both groups, with a significantly greater percentage among Jews compared to Arabs (84% vs. 64.8%, respectively, p<0.001). The median age for Arabs and Jews was for both 32 (interquartile ranges of 26-42 and 24-62, respectively). Arabs exhibited higher rates of mixed-type IBS and constipation, while Jews had a higher prevalence of predominant diarrhea IBS. Arabs reported more bloating, higher rates of IBS-related comorbidities, and medication usage.
When asked to rate the importance of treatment goals, both populations preferred improvement in abdominal pain, bloating, and regular defecation, while assigning lower importance to improving difficulty in mental and/or physical aspects of intercourse, as well as arthralgia and myalgia. Arab patients assigned lower importance scores to various symptoms compared to their Jewish counterparts.

Conclusion

This study highlights the impact of ethnicity on patients' treatment goals. Understanding patient’s preferences will enable tailoring an individual approach to each IBS patient.

Disclosure

None

Introduction

A small-scale study modeled the cost-effectiveness of colorectal cancer (CRC) screening, incorporating productivity factors.

Aims & Methods

Using real-world data, this research aimed to evaluate the cost-utility of Taiwan's CRC screening program, factoring in potential lifetime productivity savings. After interlinkages among databases of the Taiwan Cancer Registry, National Mortality Registry, Taiwan CRC Screening Database, and National Health Insurance claim records, we estimated lifetime survival functions for stage-specific subcohorts using a rolling extrapolation algorithm after stratified by sex and age from 2004 to 2017. We multiplied the survival rates with average utility values of EQ-5D collected from CRC cases at National Cheng Kung University Hospital, to sum up quality-adjusted life expectancy (QALE). We multiplied monthly medical costs and insured salaries by survival probabilities. We summed them over a lifetime for both the index and age-, sex-, and calendar-year matched reference subcohorts for comparison. Lifetime productivity (LP) was assessed only up to age 65. After weighing different stage distributions, we calculated the differences in total QALE loss, lifetime medical expenditures (LME), and LP between screened versus non-screened groups. Finally, we estimated the costs associated with implementing fecal immunochemical testing (FIT) in Taiwan's CRC screening program. We applied a 3% annual discount and an exchange rate of 30.58 New Taiwan Dollars per U.S. Dollar (USD) at the end of 2018.

Results

We enrolled 77,169 CRC patients aged 50–74 in the study. After weighted by different stage distribution, a screen-detected CRC case would save 2.6 (95% CI, 2.3–2.9) and 2.5 (95% CI, 2.1–2.6) QALYs for women and men, respectively, accompanied by 7,000 USD (95% CI, 4,000–10,000) and 8,000 USD (95% CI, 6,000–10,000) in LME, and 17,000 USD (95% CI, 16,000–19,000) and 23,000 USD (95% CI, 22,000–25,000) in LP. For every 100,000 persons screened, the program spent 682,000 USD for FIT, 1,051,000 USD and 1,987,000 USD for men and women, respectively, for colonoscopy, 61,000 USD and 133,000 USD for surveillance colonoscopy and 9,000 USD and 15,000 USD for treating complications. The incremental cost-utility ratio (ICUR) of 6,650 and 6,230 USD per QALY for women and men, respectively, would become 120 and -2970 USD per QALY after accounting for lifetime productivity.

Conclusion

After considering lifetime productivity, Taiwan's CRC screening program would be close to being cost-saving. Future corroboration studies are warranted.

Introduction

The performance of large language model (LLM) across specific medical domains is uncertain. We evaluated the performance of ChatGPT-4 and two Chinese LLMs in answering open-ended questions regarding gastroenterology.

Aims & Methods

We selected ChatGPT (4-Turbo, OpenAI) and two Chinese LLMs (model A and B), and embedded our own digestive disease-related knowledge database in the LLMs via retrieval-augmented generation (RAG). We presented 200 questions, with 3 different expressions for each question and 5 repeated queries for each expression. Questions were selected from those commonly encounter in a clinical setting from patients. The accuracy and readability were assessed using a three-classification criterion (good, borderline, poor). Responses with “good” rating in accuracy were further assessed using a 3-point scale. For responses with “poor” rating in accuracy, the LLMs were further prompted to self-correct. The stability was assessed through the consistency in changing-expression and repeating-query groups.

Results

For accuracy evaluation, model B demonstrated superior accuracy, with 94.9% of “good” rating, compared to 92.3% in model A and 90.3% in ChatGPT-4 (all P <0.001). Three LLMs showed comparable average scores in “good” rating responses (2.590 vs 2.573 vs 2.536, P=0.754). For readability evaluation, ChatGPT-4 and model A demonstrated superior readability, with 94.4% and 93.1% of “good” rating, compared to 76.3% in model B (all P< 0.001). The average response length of ChatGPT-4 was comparable to model A and significantly shorter than model B (207.45 vs 271.33 vs 336.87, P<0.001). For stability evaluation, model A demonstrated superior stability in repeating queries than ChatGPT-4 and model B. The stability in changing different expressions was not satisfactory for all the three LLMs and needs to be further improved.

Conclusion

Our study preliminarily demonstrated three LLMs' potential in accurately answering questions regarding gastroenterology, and their application to clinical practice still needs further exploration.

Disclosure

Authors declare no competing interest for this article.