Introduction

Viral infections targeting the intestinal epithelium are a significant cause of gastroenteritis, leading to decreased nutrient and electrolyte absorption. Despite supportive care, the lack of effective treatment options necessitates exploration of various alternatives, with probiotics being among them. Probiotics, live microorganisms with demonstrated health benefits, have emerged as a potential solution due to their ability to interfere with viral replication and modulate immune responses. The use of intestinal organoids in research has highlighted the advantages, particularly in mimicking the innate immune response and allowing for the study of host-specific interactions.

Aims & Methods

Building upon in vivo evidence of probiotics' antiviral activity, this study aims to investigate their immunomodulatory effects on primary human intestinal epithelial cells derived from organoids. Intestinal organoids were established from the non-inflamed ileal and colonic mucosa of Crohn's disease and Ulcerative colitis patients. Organoid-derived monolayers were generated and used to evaluate the anti-viral effect of L. rhamnosus GG® and B. animalis ssp. lactis BB-12. Differentiated intestinal epithelial monolayers were exposed to the probiotic strains with multiplicity of infection (MOI) 1:10 for 3 hours, and following extensive washing incubated for additional 24 hours in complete medium containing antibiotics. The expression of viral recognition genes (IFIH1, TLR3, TLR7, TLR9), antiviral response signaling pathway genes (IRF3, IRF7, MAVS), antiviral cytokines (Type I IFN) genes (IFNA1, IFNB1), Type I IFN signaling pathway genes (STAT1, STAT2) and Interferon Stimulated Genes (EIF2AK2, IFITM1, IFITM2, IFITM3, OAS1, MX1) was assessed by Real Time RT-PCR.

Results

Exposure to both L. rhamnosus GG® and B. animalis ssp. lactis BB-12 significantly increased the expression of the antiviral cytokine IFNB in ileum-derived monolayers but not in colon-derived monolayers compared to untreated controls. Moreover, B. animalis ssp. lactis BB-12, but not L. rhamnosus GG®, significantly induced the expression of OAS1, a gene involved in the inhibition of viral replication, in both ileum and colon-derived monolayers compared to untreated controls.

Conclusion

Preliminary findings suggest that certain probiotic strains may elicit robust antiviral responses, presenting a promising avenue for the prevention and management of viral gastroenteritis.

Introduction

The prevalence of musculoskeletal disorders (MSD) among gastroenterologists is estimated between 39 to 89%. Factors associated with MSDs among endoscopists include a high number of procedures (over 20/week), prolonged procedure times (over 16 hours/week), the age of the endoscopist (> 40 years vs ≤ 40 years), and female sex.
This study aimed to evaluate the prevalence of MSD among French gastroenterologists and identify risk factors of MSD

Aims & Methods

A computerized, anonymized questionnaire was e-mailed to all members of French society of endoscopy (SFED) over a one-month period. Demographic data were collected, as well as the level of endoscopic activity performed, the quantity and volume of endoscopies performed per week, the presence of pain associated with the practice of endoscopy, and an assessment of stress.

Results

485 gastroenterologists responded to the questionnaires, the majority were male (55%), with a median age of 48 years (IQR 37–60), and 45.6% practiced endoscopy for more than 20 years. 74.3% of respondents worked full-time, mostly in private practice (47% in private practice, 13% in mixed public-private practice). Endoscopy was performed for a median of 15 hours per week (IQR 10–18.8), with 24 procedures per week (IQR 15–30).
76.3% of participants had already experienced joint and/or musculoskeletal pain related to work. Pain complaints mainly concerned the lower back (55%), shoulders (36% left, 37% right%), neck (50%), and wrists (30% both side). More than half of the participants (55.9%) reported that the pain persisted after procedures, with 17.8% experiencing nocturnal pain and about a quarter reporting pain lasting more than 3 months.
The impact of MSD on workload was evaluated. 5.1% of the gastroenterologists reported loss of efficiency, 3,8% adapted their job, 2.4% decreased their activity, and 2.1% had work stoppage. 35% declared to have management of their MSD (28.1% painkiller, 23.2% reeducation, 3.5% surgery). To reduce discomfort, 74.7% of respondents reported using an adjustable-height examination table, and half adjusted the height and distance of the screen.
In multivariate analysis, factors associated with MSD were, femal sexe (OR 1.85 (1.15-3.01) p = 0.012, number of endoscopy (OR 1.05 (1.01-1.11) p=0.03, activity > 20 years (OR 2.42 (0.89, 6.47) p=0.079.) The risk of MSD was higher after 16.5 hours of endoscopy/ week (Se 35%, Sp 83%).

Conclusion

Musculoskeletal pain among French gastroenterologists is common and concerning. Therefore, it is essential to develop preventive programs to support their health and ensure the quality and safety of care.

Introduction

Early detection of gastric neoplasms in esophagogastroduodenoscopy (EGD) remains challenging due to the subtle and indistinct appearance of the lesions. In addition to white light imaging (WLI), image-enhanced endoscopy techniques, such as linked color imaging (LCI), are commonly used to detect such lesions. Recently, a computer-aided detection (CADe) system compatible with WLI and LCI (CAD EYE; Fujifilm Co., Tokyo, Japan) has been developed. However, evidence of its effectiveness in real-world clinical settings remains limited.

Aims & Methods

We conducted a multicenter, non-randomized confirmatory trial to evaluate the performance of CAD EYE in detecting gastric neoplasms. Between July 2023 and January 2024, patients undergoing EGD for known early gastric neoplasms were recruited at four institutions in Japan. While systematically observing the entire stomach with WLI and LCI, we investigated whether these lesions were detected by CAD EYE. The primary outcome was the sensitivity of CAD EYE (WLI-CADe and LCI-CADe) in detecting tumors. Secondary outcomes included identifying tumor characteristics and factors associated with missed detections by CAD EYE. To determine the sample size, we presumed the sensitivity of CAD EYE to be 95% based on pre-approval data, with a threshold set at 90%. The number of lesions required was calculated to be 150, ensuring that the lower limit of the 95% confidence interval (CI) exceeded the threshold of 90%. Assuming one lesion per patient and accounting for a 5% dropout rate, we recruited a total of 160 patients.

Results

A total of 174 lesions from 162 patients (mean age: 73.7±9.5 years, male: 69.7%) were analyzed. Current or past history of Helicobacter pylori (H. pylori) infection was observed in 158 patients (97.5%). The mean tumor diameter was 15.1 ± 11.3 mm, and the morphology consisted of 6 protruded, 51 flat elevated, and 117 flat types. Histology included 151 differentiated adenocarcinoma, 20 undifferentiated adenocarcinoma, 2 adenocarcinoma of fundic-gland type, and 1 tubular adenoma. The sensitivities of WLI-CADe and LCI-CADe in detecting tumors were 92.0% (95% CI: 86.9%–95.5%) and 96.5% (95% CI: 92.6%–98.7%), respectively. The sensitivity of LCI-CADe met expectations, as the lower limit of the 95% CI exceeded the threshold of 90%; however, WLI-CADe failed to meet the same standard. In WLI-CADe, lesions located on the anterior/posterior wall were missed significantly more often than those on the greater/lesser curvature (13.9% [11 of 79] vs. 3.2% [3 of 95]; P = 0.020); whereas no difference was observed in LCI-CADe. Other factors, such as H. pylori infection status, tumor morphology, location, and histology, showed no differences between lesions detected and missed by WLI-CADe and LCI-CADe.

Conclusion

The use of CADe with LCI demonstrated satisfactory sensitivity in detecting gastric neoplasms in real-world clinical settings, suggesting its potential to assist endoscopists in tumor detection. However, CADe with WLI did not meet the expected standards, possibly due to limitations, such as detecting lesions located on the anterior/posterior wall.

Disclosure

CAD EYE was temporarily provided by Fujifilm Co. Osamu Dohi has received a research grant, not related to this study, from Fujifilm Co. The remaining authors declare no conflicts of interest.