Introduction

Inflammatory bowel diseases (IBD) are chronic systemic conditions that affect patients' lives in various ways. To date, there is a scarce evidence correlating fecal incontinence, sexual dysfunctions, disease activity, and quality of life (QoL) in these patients. This study aimed to evaluate the impact of fecal incontinence on sexual functions such as erectile and prostatic function in a cohort of IBD patients; and to analyse the relationship among fecal incontinence, sexual function and QoL.

Aims & Methods

IBD patients were enrolled from IBD clinic of the Gastroenterology Unit of the University Hospital of Salerno. Demographic characteristics, anthropometric data, and usage of immunosuppressive drugs were collected. Patients underwent a physical examination, and laboratory tests, including C-reactive protein (CRP) and fecal calprotectin (FC). A standardized questionnaire was used to assess gastrointestinal (GI) symptoms such as abdominal pain and fecal incontinence. For the latter, we also used the Wexner score. Crohn's Disease Activity Index (CDAI) and Mayo score as well as FC levels, and endoscopic findings were used to classify IBD patients as in active or in remission phase. Patients with perianal manifestations were excluded. Hormonal values (FSH, LH, Prolactin, 17-betaestradiol, testosterone) were measured. Sexual function was evaluated using the International Index of Erectile Function (IIEF), Male Sexual Health Questionnaire (MSHQ), Ejaculatory Dysfuction (EjD), prostatic dysfunction using the National Institute of Health - Chronic Prostatitis Symptom Index (NIH-CPSI) and International Prostatic Symptoms Score (IPSS). QoL was assessed by FiQol domains (lifestyle, coping behaviour, self‐perception and depression, embarrassment).

Results

Eighty-five male IBD patients (47 Crohn's disease [CD] and 38 ulcerative colitis [UC]), were enrolled. Mean age was 43.7 ± 15.9 years; mean BMI was 36.4±25.5 Kg/m². Twenty-four CD patients had an active disease and 23 were in remission, while 20 UC patients had an active disease and 18 were in remission. UC patients showed significantly higher fecal incontinence and Wexner scores compared to CD patients (1.0±1.9 vs 0.4±1.2, p=0.05 and 2.84±4.2 vs 2.3±1.1, p=0.01, respectively). Only the Mayo score significantly correlated with Wexner score (Rs=0.578; p<0.001), and fecal incontinence (Rs=0.584; p<0.001). Sexual function, evaluated by erectile and prostatic scores, nicely correlated each other’s (p<0.05 in all cases). However, no association was found between fecal incontinence and all sexual function scores. The FiQol domain self‐perception and depression was significantly associated with IIEF (p=0.01).

Conclusion

This study highlighted the prevalence of fecal incontinence is higher in UC than CD patients. However, fecal incontinence did not impact on sexual function, evaluated by erectile and prostatic scores. QoL influenced erectile function.

Introduction

Barrett Esophagus (BE) is a long-term complication of inadequately controlled gastroesophageal reflux (GERD) resulting in the metaplastic transformation of the esophageal epithelium. Current therapy involves proton pump inhibitors (PPIs), aiming at reducing gastric, and consequently esophageal acid exposure time (AET), thereby eliminating the main pathogenic drive to dysplasia/adenocarcinoma progression. However, current guidelines recommend a standard dose PPI therapy for BE chemoprevention, without taking into consideration the need for 24-hour pH-impedance monitoring (24h MII-pH), which is the only investigation able to objectively estimate the esophageal acid exposure time (AET) and evaluate the real effectiveness of PPI therapy.

Aims & Methods

This study included prospectively enrolled BE patients referred to our tertiary care center. We identified consecutive patients with histological diagnosis of non-dysplastic BE treated with a standard dose of PPI administered once or twice daily (either pantoprazole or esomeprazole 40mg OD or 20mg BID), according to guidelines. After at least 8 weeks of PPI therapy, all participants underwent a high-resolution manometry (HRM) and 24h MII-pH monitoring on therapy. A cohort of refractory GERD patients matched for age, sex and PPI regimen (dose and type) were used as controls. GERD symptoms were recorded in the whole population by using the standardized GERD-Q questionnaire. Results are expressed as mean±SD.

Results

A total of 33 BE (23M, 50±17 years) and 33 GERD patients (21M, 48±14 years) were enrolled. Typical GERD symptoms were significantly less severe in BE patients compared to controls (2.1±2.1 vs 3.1±2.3; p<0.05). Half of the population of BE patients did not achieve adequate esophageal acid suppression (AET<4%) under standard dose regimen. Despite matching PPI regimen, the risk of having a pathological 24h MII-pH was doubled in BE compared to refractory GERD patients (50% vs 25%; p<0.05). The mean AET was significantly higher in BE compared to GERD patients (6.6±10.2%vs 1.9±3%; p<0.05), particularly in the supine position (7.3±15.5% vs 2.3±5.6%; p<0.05), despite similar levels of gastric acid suppression (44.1± 25.7% vs 49.2±27%; p=NS). Although the average number of reflux events was comparable between BE and controls (49±29 vs 40±22), BE exhibited a notably prolonged reflux clearance time (mean duration of the longest reflux episode: 27.8±25.7 vs 12.7±27.3 min; p<0.05). Furthermore, Type IIIA esophagogastric junction (EGJ) morphology was more prevalent BE group compared to controls (45% vs 21%; p<0.05) as was the prevalence of ineffective esophageal motility (IEM) according to the Chicago Classification version 4.0 (42% vs 12%; p<0.05).

Conclusion

Despite the reduced severity of typical GERD symptoms, analogous therapeutic regimens and comparable gastric acid suppression, BE patients showed a significantly increased esophageal AET, especially in the supine position, compared to refractory GERD patients. Furthermore, at HRM, BE patients showed a higher prevalence of Type IIIA EGJ morphology and IEM that could justify these results. Our data show that half of the whole BE population failed to achieve an adequate esophageal acid suppression despite therapy, emphasizing the relevance of performing an HRM and a 24h MII-pH in all non-dysplastic BE patients, in order to tailor the therapeutic strategy and improve BE long-term outcomes.

Introduction

The Ki-67 labeling index is a well-established marker of cellular proliferation and has been associated with worse disease-free and overall survival in gastrointestinal stromal tumors (GISTs). Recent evidence highlights its potential role in risk stratification, particularly when Ki-67 exceeds certain thresholds. However, current assessment relies on postoperative histopathology. Radiomics, by extracting quantitative features from computer tomography (CT) images, may offer a non-invasive method to predict Ki-67 expression preoperatively. This meta-analysis aimed to evaluate the diagnostic performance of CT-based radiomics for predicting Ki-67 status in GISTs.

Aims & Methods

A systematic review and meta-analysis were conducted according to PRISMA guidelines). Four electronic databases (PubMed, Scopus, Science Direct, Cochrane Library) were searched for relevant articles up to December 2024. Eligible studies assessed CT radiomics in predicting Ki-67 in histologically confirmed GISTs. Pooled sensitivity, specificity, and area under the curve (AUC) were calculated using a random-effects model. Subgroup analyses were performed based on cohort type, CT protocol, number of features, and Ki-67 cutoff values. Study quality was assessed using the QUADAS-2 tool.

Results

Six studies comprising 1,632 patients met the inclusion criteria. Pooled sensitivity and specificity were 0.71 (95% CI: 0.63–0.79) and 0.76 (95% CI: 0.73–0.78), respectively. The pooled AUC was 0.79 (95% CI: 0.74–0.84). Subgroup analyses showed consistent performance across imaging protocols and feature counts, while Ki-67 cutoffs (8% vs. 10%) significantly impacted diagnostic accuracy. Sensitivity analysis confirmed robustness of specificity estimates. Publication bias was detected for specificity (Egger’s test p = 0.006).

Conclusion

CT radiomics demonstrates moderate accuracy for non-invasively predicting Ki-67 expression in GISTs. Given Ki-67's prognostic significance, radiomics could support preoperative risk assessment and personalized treatment planning. Further prospective validation is warranted.

Disclosure

No Conflict of Interest ​

Introduction

Patients with type 2 diabetes mellitus (T2DM) are at increased risk of developing colorectal adenomas and cancer. Newer medications such as sodium-glucose cotransporter-2 (SGLT2) inhibitor and glucagon-like peptide-1 receptor agonists (GLP-1 RA) are increasingly used in DM patients with promising results on improving glycaemic control and other outcomes. While studies showed that the use of GLP-1 RA could affect intestinal transit time and bowel preparation quality, their effect on adenoma detection remains unclear.

Aims & Methods

This population-based retrospective cohort study included all adult T2DM patients who were prescribed with either GLP-1 RA or SGLT2 inhibitors for more than 180 days, and had undergone colonoscopy between 2018 and 2024 in Hong Kong. Anonymous patient’s data were retrieved from the territory-wide electronic medical system (CDARS). We excluded patients with history of previous colonoscopy or were on both medications. The primary outcome was proportion of patients with adenoma detected (ADR) during colonoscopy in GLP-1 versus SGLT2 group. GLP-1 RA use was treated as a time-varying variable to address immortal-time bias. Multivariable Cox regression model with adjusted hazard ratio (aHR) was used as primary analysis, which adjusted for patient’s age and sex, smoking and drinking status, body mass index, colonoscopy’s quality (bowel preparation, scope withdrawal time and indications), time-weighted mean HbA1c, concurrent illnesses (hypertension, stroke, ischemic heart disease, chronic renal disease and chronic liver disease), medication uses (dipeptidyl peptidase 4, insulin, metformin, pioglitazone, statin, sulfonylurea, proton pump inhibitor). Propensity-score matching (PSM) with 1:2 match was used as secondary analysis.

Results

There was a total of 12,789 DM patients who had colonoscopy during the study period (977 on GLP-1 RA and 11812 on SGLT2). Among them, 6192 (48.4%) patients were found to have adenomas during colonoscopy (GLP-1 38.3% and SGLT2 49.2%). In the time-dependent analysis, GLP-1 group was found to have a significantly lower ADR when compared to SGLT2 group (aHR: 0.40; 95% CI 0.36–0.45; P<0.01). In the PSM cohort (1:2 match), all covariates were well matched with absolute standardized mean difference < 0.1. PSM analysis showed a similar finding with aHR: 0.38 (95% CI 0.33–0.43; P<0.01; Table 1). There was a duration-response relationship with longer GLP-1 use duration linked to greater reduction in ADR (<1 year: aHR 0.71, 95% CI 0.60–0.84; 1–<2 years: aHR 0.51, 95% CI 0.43–0.61; ≥2 years: aHR 0.33, 95% CI 0.28–0.38; P-trend<0.01). Consistent lower ADRs were observed across different levels of bowel preparation quality (from BBPS 3 to 9) in GLP-1 group with HRs of 0.37–0.45 (p ≤ 0.01). Subgroup analysis showed similar results across most demographics, clinical factors, and comorbidities (HRs 0.34–0.44, p < 0.01), except in subgroups with short scope withdrawal time.

Table 1. Association between GLP-1 RA use with ADR

Conclusion

DM patients who use GLP-1 RA are found to have a lower rate of adenoma detected during colonoscopy than those who use SGLT-2 in this population-based study. The results remain similar even after stratified according to different levels of bowel preparation quality. These findings may suggest a potential protective role of GLP-1 receptor agonists against colorectal adenoma development, which warrant further prospective study to confirm.