Introduction

Helicobacter pylori (Hp) infection is one of the major causes of gastric cancer and represents a significant global public health challenge. In Japan, where the incidence of gastric cancer is high, reducing the risk through the eradication of Hp is deemed crucial. While enhancing awareness about Hp is thought to encourage testing and contribute to treatment, there is a lack of evaluation regarding the Japanese population's awareness of Hp.

Aims & Methods

In this cross-sectional study, we aim to assess baseline knowledge and attitude tuwards Hp among Japanese population. Participants were recruited through an online survey platform (Macromill, Inc), with ages ranging from 20 to 69, reflecting the age demographic composition of Japan equally across genders. Referencing the existing surveys on Hp^1-3, we assessed knowledge on five key aspects related to Hp: risk of infection (scored out of 7), diseases caused by Hp (scored out of 7), methods of testing (scored out of 5), benefits and side effects of Hp eradication (scored out of 8), and knowledge of gastric cancer prevention (scored out of 10). Attributes of participants, socioeconomic factors, and health literacy (HLS-14)⁴ were also evaluated to study their correlation with knowledge about Hp.

Results

A total of 3,095 individuals participated. Of these, 56.3% reported having some knowledge about Hp. 865 participants (28.0%) had undergone Hp testing, 354 (11.4%) confirmed Hp infection, and 283 (9.1%) had received treatment for Hp. About 55.6% (1,722 participants) consider that the treatment for Hp posed a significant financial burden. The average correct response rate across all knowledge items was 45.6% (SD: 19.0%). The individual correct response rates were 57.3% for risk of Hp infection, 50.9% for diseases caused by Hp, 24.5% for methods of testing, 45.6% for benefits and side effects of Hp eradication, and 44.4% for knowledge of gastric cancer prevention. Higher scores were significantly associated with having an income over 4 million yen, a family history of Hp, personal Hp testing history, Hp treatment history, and higher health literacy. Over 80% of respondents acknowledged that understanding the relationship between Hp and stomach symptoms, recognizing Hp as a gastric cancer risk, and knowing that Hp eradication reduces future gastric cancer risk influenced their decision on the need for eradication. Similarly, the same proportion reported that believing that the harshness of the treatment exceeds the current symptoms and the high costs of testing and treatment influenced their decisions for eradication.

Conclusion

The level of understanding of Hp among the Japanese population is moderate and influenced by income level, health literacy, and personal experience with the Hp infection. Many consider testing and treatment burdensome. Enhancing correct understanding of Hp could potentially increase testing and treatment rates, contributing to the future reduction of gastric cancer in Japan.

References

1. Kimberly S Bailey, et al., Helicobacter pylori treatment knowledge, access and barriers: a cross-sectional study. Helicobacter 2023;28(2):e12954.
2. You Wu, et al., Awareness and attitudes regarding Helicobacter pylori infection in Chinese physicians and public population: A national cross-sectional survey.Helicobacter 2020;25(4):e12705
3. Thomas Zheng Jie Teng, et al., Helicobacter pylori knowledge and perception among multi-ethnic Asians.Helicobacter 2021;26(3):e12794.
4. Machi Suka, et al.,The 14-item health literacy scale for Japanese adults (HLS-14). Environ Health Prev Med. 2013;18(5):407-15.

Introduction

Axial spondyloarthritis (axSpA), characterised by chronic inflammation of the sacroiliac joints (SIJs) and spine, is a common extraintestinal manifestation in Inflammatory Bowel Disease (IBD). It is associated with poor outcomes and a substantial impact on quality of life. Thus, early detection is important to optimally tailor treatment and suppress the inflammation in all disease domains. However, the prevalence and pattern of axial involvement have not been described in early IBD.

Aims & Methods

We aimed to describe the prevalence and distribution of axial symptoms, clinical findings and MRI-determined inflammatory and structural lesions in the spine and SIJs of patients with newly diagnosed IBD. Patients with newly diagnosed IBD from a prospective population-based inception cohort were consecutively included. Structured rheumatological interview collecting data on peripheral and axial symptoms and clinical evaluation were performed. MRI assessment for spine and SIJ inflammation and structural lesions was based on validated and widely applied scoring systems [1,2]. Further, an expert assessment of the MRIs as +/- indicative of axSpA applying standardized definitions was performed [3,4].

Results

Of 110 included patients (mean age 42 years, 40% male, 40 with Crohn’s disease (CD), 70 with ulcerative colitis (UC)), 74 had active IBD. At the time of evaluation, 4 patients received treatment with systemic glucocorticoid and one received TNF-inhibitor. Nine patients were HLA-B27 positive. None were previously diagnosed with SpA.
Back and/or buttock pain was reported by 48(44.9%) patients and inflammatory back pain by 10(9.1%). In 23(21.5%) patients the pain could not be better explained by competing conditions (for example degenerative disc disease, nerve root compression, osteoporosis or fibromyalgia) according to the assessing rheumatologist. The axial symptoms were accompanied by peripheral joint and/or entheseal symptoms in 30(62.5 %) patients and 33(68.8%) had tender and/or swollen joints and/or entheses.
According to the MRI expert, MRIs of 17(16.7%) patients were indicative of axSpA (spine and SIJs evaluated together), while 11(10.8%) of the spine-MRIs and 13(12.7%) of the SIJ-MRIs were indicative of axSpA. Only 10 of the 17 patients with typical axSpA MRI findings had axial symptoms. There was no difference in symptoms or MRI findings between patients with UC and CD, or between patients with active and inactive IBD.
Spine bone marrow oedema (BME) in ≥1 slice was present in 30(30.3%) patients. SIJ BME in ≥1 slice was found in 27(26.5%) patients, erosion was present in 24(23.5%) patients, fat lesions in 12(11.8%) and ankylosis in 3(2.9%). The definition of positive MRI for sacroiliitis was fulfilled in 12 (11.8%) patients of whom six had axial symptoms. The Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axSpA were met in 11 cases.

Conclusion

One out of six patients with newly diagnosed IBD had findings indicative of axSpA on spine and SIJs MRI. Since only ̴60% of these patients were symptomatic, we conclude that axSpA may be an underdiagnosed early-occurring condition among IBD patients. Our results indicate a low threshold for performing MRI of the spine and SIJs and a need for multidisciplinary collaboration to ensure early detection of axial involvement to enable an optimal therapeutic strategy and prevent future structural damage and disability.

References

1. Maksymowych et al., Art Rheum, 2005, 53(5) and 53(4)
2. Maksymowych et al., Journal of rheum, 2014
3. Lambert et al., Ann Rheum Dis 2016
4. Maksymowych et al., Rheumatology 2021

Introduction

Patients with inflammatory bowel disease (IBD) are at increased risk of reduced bone mineral density (BMD), often linked to chronic inflammation, corticosteroid use, biologics, and vitamin D deficiency. 25-hydroxyvitamin D (25(OH)D) is a fat-soluble vitamin essential for calcium and phosphorus homeostasis, and its deficiency is common in IBD due to malabsorption, dietary, altered metabolism, or impaired VDR signaling.

Aims & Methods

This cross-sectional study aimed to evaluate the relationship between serum 25(OH)D levels, BMD, and body composition in IBD patients. A total of 73 outpatients with IBD (38 ulcerative colitis, 35 Crohn’s disease) were assessed. Body composition was evaluated using BMI and bioelectrical impedance analysis (BIA). BMD was measured using whole-body dual-energy X-ray absorptiometry (DEXA), and vitamin D status was assessed by serum 25(OH)D concentration. Statistical analysis included descriptive and comparative tests (Chi-square and t-test).

Results

Participants had a mean age of 45.27±11.37 years, with 67.1% being female and a mean disease duration of 10.22±7.54 years. Most patients (93.15%) were in clinical and endoscopic remission. The average BMI was 26.85±4.51 kg/m², with 39.7% classified as overweight. DEXA revealed a high prevalence of osteopenia (39.7%) and osteoporosis (19.0%). Mean BMD Z-scores were whole body -1.32±1.13, spine -0.92±1.19, and femoral neck -0.34±1.02. Mean serum 25(OH)D level was 31.20±8.78 ng/mL; 52.1% had insufficient levels and 47.9% were sufficient. Vitamin D insufficiency was significantly associated with osteopenia/osteoporosis (p=0.0144) and with overweight/obesity (p=0.0265). No significant associations were observed between vitamin D levels and age (p=0.6476), sex (p=0.4565), lean mass (p=0.2941), fat mass (p=0.1218), phase angle (p=0.3154), or regional BMD (total body p=0.5001; spine p=0.3067; femoral neck p=0.2364).

Conclusion

IBD patients are vulnerable to low serum vitamin D levels and present a high prevalence of low BMD. Vitamin D insufficiency was associated with altered BMI and increased risk of osteopenia/osteoporosis, though not with other body composition metrics. Further studies are needed with larger and more clinically heterogeneous samples to confirm these associations and guide screening and supplementation strategies.

References

Khan, ZAW, Shetty, S., Pai, GC, Acharya, KKV, & Nagaraja, R. (2020). Prevalence of low bone mineral density in inflammatory bowel disease and factors associated with it. Indian journal of gastroenterology: official journal of the Indian Society of Gastroenterology, 39(4), 346–353. https://doi.org/10.1007/s12664-020-01048-5
Kuo, YW, Kuo, CJ, Le, PH, Chang, ML, Lin, CY, Hsu, CM, Lin, WP, Chen, CW, Lin, WR, Ho, YP, Su, MY, and Chiu, CT (2025). Risk factors and awareness of bone fragility in inflammatory bowel disease in Taiwan: a cross-sectional study. Biomedicines, 13(3), 638. https://doi.org/10.3390/biomedicines13030638
Chauhan, G., & Rieder, F. (2025). The Pathogenesis of Inflammatory Bowel Diseases. Surgical Clinics of North America, 105(2), 201–215. https://doi.org/10.1016/j.suc.2024.10.008
Kärnsund, S., Lo, B., Bendtsen, F., Holm, J., & Burisch, J. (2020). Systematic review of the prevalence and development of osteoporosis or low bone mineral density and its risk factors in patients with inflammatory bowel disease. World Journal of Gastroenterology, 26(35), 5362–5374. https://doi.org/10.3748/wjg.v26.i35.5362
Aaseth, JO, Finnes, TE, Askim, M., & Alexander, J. (2024). The importance of vitamin K and the combination of vitamins K and D for calcium metabolism and bone health: a review. Nutrients, 16(15), 2420. https://doi.org/10.3390/nu16152420