Introduction

Rising antimicrobial resistance has critically impaired the efficacy of standard triple therapy for Helicobacter pylori (H. pylori), especially in Latin America, where resistance to clarithromycin and metronidazole exceeds 20–30%. Bismuth-based quadruple therapy and newer potassium-competitive acid blockers (P-CABs), such as tegoprazan, offer enhanced acid suppression and pharmacological stability. Limecycline, a soluble tetracycline derivative with 5000-fold greater solubility than tetracycline, may serve as a suitable alternative where tetracycline is scarce. We aimed to evaluate the real-world efficacy and tolerability of a quadruple regimen combining limecycline, furazolidone, bismuth, and tegoprazan.

Aims & Methods

We conducted a prospective, multicentre pilot study in Lima (Peru) and Bogotá (Colombia) between January and May 2024. Adults ≥18 years with confirmed H. pylori infection by histology, rapid urease test or 13C-urea breath test (UBT-C13) were included. Participants received limecycline 300 mg, furazolidone 100 mg, bismuth subcitrate 262 mg, and tegoprazan 50 mg, all administered twice daily for 14 days. Antibiotics and acid suppressors were withheld four weeks prior to eradication testing. Eradication was assessed 6–8 weeks after therapy. Safety, adherence, and adverse events (AEs) were recorded. Results are reported with 95% confidence intervals (CI) and p-values where relevant.

Results

Seventy-two patients were enrolled (mean age: 55 [95% CI: 51–59]; range 25–83; 79% female). Of these, 56% were treatment-naïve, while 44% had failed at least one prior regimen. Per-protocol analysis showed an eradication rate of 98.6% (71/72; 95% CI: 92.6–99.9%). Only one patient discontinued due to a rash. Mild AEs were reported in 11.1% (95% CI: 5.2–20.1%), including nausea (6.9%), constipation (2.8%) and diarrhoea (1.4%). No severe events or hospitalisations occurred. The eradication rate did not significantly differ by prior treatment history (p = 0.88). This therapy achieved >95% eradication even in previously treated patients, surpassing thresholds recommended by international guidelines.

Table. Clinical Outcomes with Quadruple Therapy (n = 72)

Parameter	Value	95% CI / Additional Info
Mean age (years)	55	51–59
Female sex, n (%)	57 (79%)	68.6–87.1%
Treatment-naïve, n (%)	40 (56%)	44.4–67.1%
Prior treatment failure (≥1), n (%)	32 (44%)	32.9–55.6%
Completed full regimen, n (%)	71 (98.6%)	92.6–99.9%
Confirmed eradication, n (%)	71/72 (98.6%)	92.6–99.9%; p = NS by treatment history
Mild adverse events, n (%)	8 (11.1%)	5.2–20.1%
Discontinuation due to AE, n (%)	1 (1.4%)	0.04–7.5%
Diagnostic method for cure	UBT-C13 or histology	Post-treatment, 6–8 weeks

Conclusion

This multicentre pilot study demonstrates that the limecycline–furazolidone–bismuth–tegoprazan quadruple regimen is a highly effective and well-tolerated option for H. pylori eradication in Latin American real-world settings. A near-100% eradication rate (98.6%; 95% CI: 92.6–99.9%), including in patients with treatment failure, supports its use as both empirical first-line and salvage therapy. Limecycline emerges as a promising substitute for tetracycline, and tegoprazan offers robust acid control. These findings justify further validation in large-scale, randomised controlled trials. With this empirical quadruple therapy, we achieved eradication consistently superior to 95%.

References

• Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;71(9):1724–1762. doi:10.1136/gutjnl-2022-327745

• Jung HK, Kim SE, Kwon KA, et al. A randomized, double-blind, controlled trial of tegoprazan-based triple therapy versus lansoprazole-based triple therapy for Helicobacter pylori eradication. Gut Liver. 2021;15(2):212–221. doi:10.5009/gnl19545

• Choi SC, Lee SY, Kim YH, et al. Efficacy of tetracycline-containing regimens as second-line treatment for Helicobacter pylori: a nationwide multicenter study in Korea. Helicobacter. 2019;24(6):e12652. doi:10.1111/hel.12652

Introduction

Although national guidance on the management of Helicobacter pylori (H. pylori) infection in the UK is reviewed regularly, the recommendations on treatment and follow-up are not aligned with guidance in the rest of Europe. This is mainly due to the issue that there are no up to date data available on H. pylori prevalence or primary resistance to drugs usually used in eradication regimens.

Aims & Methods

Aim of this study was to analyse the current UK practice on H. pylori management to highlight areas that warrant improvement. UK data collected at AEG-REDCap e-CRF until January 2025 from the European Registry on H. pylori management (Hp-EuReg) were analysed. Modified intention-to-treat (mITT) and per protocol (PP) analyses were performed and the Fisher’s exact test was used for comparison of categorical data (significance for p<0.05).

Results

Data on 462 patients from 3 different centres across the UK was analysed. The mean age of the patients was 55 years (SD 16 years). The indication to test for H. pylori was non-investigated dyspepsia in 47%, dyspepsia with normal endoscopy in 21%, iron deficiency anaemia in 10%, duodenal ulcer in 9.7%, gastric ulcer in 6.9%, and gastric preneoplastic conditions in 1.3%. Of the 257 patients for whom data on regular concurrent medication was available, 222 (87%) took proton pump inhibitors (PPI) daily. Standard triple therapy regimens were given in 97.6% with 90.9% of these having undergone a 7-day regimen, 1.7% a 10-day regimen and 7.4% a 14-day regimen. Most commonly prescribed regimens were amoxicillin-clarithromycin-PPI (75.5%), amoxicillin-metronidazole-PPI (11.1%) and clarithromycin-metronidazole-PPI (9.1%). In the majority of cases, PPI was prescribed at low dose (76%); standard dose was given in 21%, and high dose in 3% of patients. The incidence of at least one adverse event due to treatment was reported in 31% of cases. Tests to confirm eradication success were done in 85% of patients, with practice varying between the different sites (p<0.001). This was also confirmed for the length of prescribed treatment (p<0.001) and the PPI dose used (p<0.001). Eradication was successful in 71% in the mITT analysis, and in 71% of the PP analysis. Patients treated for 7 days showed treatment success in 70% in the mITT analysis, and 69.4% in the PP analysis, compared to 93% (both mITT and PP) in those treated for 14 days (p<0.01). Adverse events were associated with reduced eradication treatment success (mITT: 62 vs 76%; PP: 63 vs 76%; p<0.01). The effect was more pronounced for compliance, with only 5 patients having reported not to have completed >90% of their course of treatment (PP: 29% vs 80%, p<0.05). Second-line treatment was documented for 109 patients, with 20 different regimens having been prescribed. The overall mITT success of second-line treatment was 48.5%.

Conclusion

Clarithromycin-based triple therapy remains the standard in the UK, despite a treatment failure of ≈30%. While adherence to national British or European guidelines on treatment duration and PPI dosage varies by centre, this does not uniformly affect treatment success. Despite British guidance advocating to assess treatment success based on symptom response, eradication was confirmed in the majority of patients. A review of national guidance on H. pylori management in the UK is required, along with efforts to generate national data on prevalence and resistance patterns.

Disclosure

JB: Advisory fee by Flynn Pharma LTD UK and Juvise Pharmaceuticals France
OPN: Speaker fee or research funding from Allergan, Mayoly Spindler, Richen, Biocodex and Juvisé.
JPG: Speaker or consultancy fees, advisory board member or research funding form Mayoly, Allergan/Abbvie, Diasorin, Richen, Juvisé, Biocodex.
IB, MCS, ACC, PP, LM, FM, COM, and PP have no conflict of interest to declare.

Introduction

Helicobacter pylori (H. pylori) is a well-recognized gastric carcinogen. However, whether this infection is related to colorectal polyps and colorectal cancer remains debatable. Data from some recent studies have indicated a significant association between H. pylori infection and the development of colorectal polyps or cancer. Potential effects of H. pylori on the colorectal mucosa include the induction of inflammatory responses, alteration of gut flora, and the release of toxins.
The aim was to investigate the association between H.pylori infection and colorectal polyps.

Aims & Methods

We retrospectively included patients diagnosed with colorectal polyps who underwent H. pylori testing between September 2024 and March 2025. Patients with incomplete colonoscopies were excluded. Demographic, clinical, and endoscopic data were subsequently collected. Polyp subtypes and dysplasia grades were extracted from histopathology reports. Screening for H. pylori infection was performed on gastric biopsies. Patients were divided into two groups: Group 1 (H. pylori-negative) and Group 2 (H. pylori-positive). The number, size, location, and pathological type of colorectal polyps were compared between the two groups.

Results

One hundred thirty patients were included, with a male-to-female sex ratio of 3.2. The mean age was 56.3 ± 11.23 years. The main comorbidities were diabetes (33.1%), dyslipidemia (26.9%), and hypertension (25.4%). The locations of colorectal polyps varied: 18.5% in the rectum, 17.7% in the sigmoid colon, 8.5% in the left colon, 7.7% in the transverse colon, 16.9% in the right colon, and 30.8% of patients had polyps in multiple locations. A total of 219 polyps were identified, with a mean of 2.16 polyps per patient and a mean size of 5.9 mm (range: 2–30 mm).
Histopathological examination revealed predominantly hyperplastic polyps (36.9%), low-grade dysplastic adenomas (48.5%), high-grade dysplastic adenomas (7.7%), and adenocarcinomas (6.9%). The prevalence of H. pylori infection was 31.5%.
Statistical analyses showed that the H. pylori-positive group had a significantly higher proportion of colorectal polyps with sizes ≥10 mm (55.6% vs. 44.4%, p = 0.027) and multiple polyps (≥5) (56.3% vs. 43.8%, p = 0.04) compared to the H. pylori-negative group. However, neither dysplasia grading nor polyp localization was significantly associated with H. pylori infection.

Conclusion

In our study, H. pylori infection was associated with an increased risk of large and multiple colorectal polyps. Further studies are needed to confirm these findings and to better understand the impact of H. pylori eradication on the occurrence of colorectal polyps, as well as its tumorigenic effects on the colorectal mucosa.

Introduction

Endoscopic drainage is standard of care in malignant biliary obstruction (MBO).

Aims & Methods

The aim of this study was to investigate efficacy of biliary stenting in providing access to systemic chemotherapy. Patients with biliary obstruction (bilirubin >2.5 mg/dl) caused by unresectable biliary or pancreatic cancer were retrospectively analyzed with respect to use of chemotherapy and survival. Laboratory data were analyzed at baseline, 7-10 and 28-35 days following biliary stenting.

Results

Patients with MBO (n=78) were allocated into one of three groups according to bilirubin level [mg/dl] 2.5 – 5.99 (group 1), 6.0 - 15.0 (group 2) and >15 (group 3). On first blood testing mean bilirubin declines from baseline in respective groups were: 1.19 (29.5%), 3.77 (38.5%) and 7.1 (27.3%), and on second measurement 1.61 (40%), 5.69 (58.2%) and 13.0 (50%). Chemotherapy was applied in 28 (35.8%) patients, less frequently in group 3 than in group 1 (31.2% vs 44.0%; p =0.07) and group 2 (vs 38.1%; p =0.06). Mean survival time was 4.8 ±2.8 months and was significantly shorter in group 3 as compared to group 2 (3.8 ±2.0 vs 6.2 ±3.9 months; p =0.02) and to group 1 (vs 5.4 ±2.7 months; p =0.03).

Conclusion

In two-thirds of patients with MBO endoscopic biliary drainage does not grant access to chemotherapy. Use of chemotherapy and survival time are significantly higher in patients with bilirubin level below 15 mg/dl as compared to those with greater bilirubinemia, but in patients with bilirubin level below 6 mg/dl the biliary drainage is minimally effective.

Disclosure

No.

Introduction

Autism Spectrum Disorder (ASD) is closely associated with gut-brain axis dysfunction[1]. Fecal microbiota transplantation (FMT) may alleviate gastrointestinal and behavioral symptoms in ASD children by remodeling gut microbiota[2], yet the key functional bacterial strains underlying FMT-mediated neurobehavioral regulation remain unidentified.

Aims & Methods

This study aims to systematically evaluate FMT efficacy through a cohort study, combined with metagenomic analysis to investigate the dynamic patterns of microbiota colonization in ASD children. We will thoroughly identify core bacterial strains and analyze the relationship between their colonization patterns and therapeutic outcomes. The children aged 0-18 years meeting the diagnostic criteria for ASD were included in this study. The clinical data of recipients was collected before FMT, alongside questionnaire surveys and fecal sample collection. Pre-FMT assessments were conducted by pediatric psychologists using standardized scales. Donor feces were extracted via standardized protocols, and 100 mL of donor microbiota suspension was administered into the jejunum or ileum via colonoscopy or nasojejunal tube once every other day, total three sessions. Post-FMT fecal samples were collected from recipients at 1, 2, 4, 12, and 24 weeks for metagenomic analysis at species and strain levels. At 12 and 24 weeks post-FMT, the same psychologists reevaluated recipients using assessment scales, while parents completed follow-up questionnaires to document clinical outcomes. Finally, correlation analysis was conducted between laboratory data and clinical outcomes.

Results

A total of age-matched healthy pediatric donors (86 fecal samples) and 52 ASD children (351 fecal samples) were included. Results revealed that 69.2% of ASD children exhibited gastrointestinal (GI) symptoms (e.g., constipation or diarrhea), 58.3% had one or more food protein allergies, and 78.5% experienced sleep disturbances (<8 hours/day). Post-FMT, GI symptoms improved most significantly: 80% of recipients showed at least one grade reduction in Gastrointestinal Symptom Rating Scale (GSRS) scores, while 60% demonstrated improvements in autism-related behavioral traits, including reduced emotional dysregulation/negativity and enhanced sensory responsiveness. Clinical improvements became more pronounced over time. Metagenomic analysis demonstrated a significant increase in gut microbiota diversity and structural remodeling in recipients, with microbial profiles converging toward donor compositions. Correlation analysis identified donor-derived Bacteroidetes and Bacillota phyla as closely associated with clinical improvements.

Conclusion

FMT can significantly and 'long-term' reconstruct the gut microbiota of children with autism, effectively alleviating concurrent symptoms such as gastrointestinal disorders. Successful colonization of Bacteroidetes and Bacillota from donor sources is closely related to clinical improvement.

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.
2.Dossaji Z, Khattak A, Tun KM, Hsu M, Batra K, Hong AS. Efficacy of Fecal Microbiota Transplant on Behavioral and Gastrointestinal Symptoms in Pediatric Autism: A Systematic Review. Microorganisms. 2023 Mar 22;11(3):806.

Introduction

Common bile duct (CBD) stones are one of the most frequent indications for endoscopic retrograde cholangiopancreatography (ERCP). Endoscopic complete sphincterotomy (EST) followed by balloon or basket extraction is widely considered the gold standard technique for the treatment of CBD stones; being successful in more than 90% of cases with approximately 5% overall rate of adverse events [1]. Endoscopic papillary large balloon dilatation (EPLBD) is an effective technique in treating large common bile duct (CBD) stones. However, the efficacy and safety of EPLBD in the setting of periampullary diverticula (PAD) are prospectively lacking.

Aims & Methods

This study aimed to compare the effectiveness and short-term safety of EPLBD after limited sphincterotomy with those of EST for extracting large CBD stones in the setting of PAD prospectively. Forty-eight patients with large CBD stone(s) > 1 cm were recruited. All patients had a PAD. Before the procedure patients were evaluated by history taking, clinical examination full investigations including proper imaging studies. During the procedure, patients were randomized to either group I; patients treated with EPLBD after limited sphincterotomy, and group II; patients treated with EST. CBD clearance was defined as a single procedure (EPLBD vs EST), single session (no repeat ERCP), and non-assisted (no lithotripsy used) stone extraction. After the procedure patients were hospitalized with clinical, laboratory, and imaging assessment.

Results

Table 1: Univariate regression of the parameters affecting stone extraction

PAD: periampullary diverticulum			* significant as P value≤ 0.05
	Odds ratio	95% CI	P value​
The used technique	5.92	1.32 to 25.3	0.009∗
Stone (s) number	0.62	0.17 to 2.25	0.468
Stone (s) diameter (mm)	2.59	0.63 to 10.56	0.187
Type of PAD​	1.32	0.65 to 2.67	0.437

The overall stone extraction rate in the current study was only 77.3% (n=34). The efficacy of stone extraction was significantly higher in the EPLBD (n= 21,87.5%) group compared to EST (n= 13, 54.17%) group (p = 0.011). The procedure-related adverse events were lower in the EPLBD group compared to the EST group. Pancreatitis was significantly higher in the EST (n=14, 58.33%) group than in the EPLBD (n=3, 12.5%) group (p= 0.001). There were no perforations or case fatalities in either group. The predictors of stone extraction were analyzed using univariate regression (Table 1), and it is noticeable that the used technique was the independent predictor of success in stone extraction (Odds Ratio: 5.92, 95% Confidence Interval: 1.38 to 25.30, p-value = 0.009).

Conclusion

The current practice guidelines of the ESGE and ASGE suggest that for large CBD stones, an EST followed by a large balloon dilatation is preferable to EST alone because combining dilatation with EST improves duct clearance and reduces the need for lithotripsy without adding risk. Our results among PAD patients seem to echo this: the EPLBD approach in comparison to EST yielded higher stone clearance on first attempt even without using lithotripsy by the study design. Hence, based on the current study these existing recommendations can be extrapolated to the PAD population based on our study which is one of the first randomized trials in the specific PAD subgroup.

References

1. Zippi M, Traversa G, Pica R, De Felici I, Cassieri C, Marzano C, et al. Efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) performed in patients with Periampullary duodenal diverticula (PAD). Clin Ter. 2014;165(4):e291-4.

Introduction

Tissue acoustic properties, such as sound speed, attenuation, and impedance, are closely associated with its mechanical characteristics. Acoustic microscopy, which employs high-frequency ultrasound ranging from several tens of MHz to several GHz, enables the quantitative evaluation of these acoustic properties. Understanding the acoustic properties of biological tissues may offer new insights into disease pathology. Furthermore, because clinical ultrasound images depend on tissue acoustic properties, understanding them could improve the interpretation of echogenic patterns and contribute to developing new diagnostic approaches. Although acoustic microscopy has been applied to cardiovascular and cutaneous tissues in medical research, studies focusing on the liver, particularly hepatic tumours, remain limited.

Aims & Methods

This study aimed to quantify sound speed in hepatocellular carcinoma (HCC)—the most common primary liver tumour—and to examine its relationship with histopathological features. Histopathological classification followed World Health Organization criteria, including histological grade (well, moderately, and poorly differentiated) and histological growth pattern (trabecular, pseudoglandular, and solid). Tissue sound speed was measured using a scanning acoustic microscope (AMS-50SI; Honda Electronics Co., Ltd.) with an 80 MHz transducer. Regions of interest were identified on haematoxylin and eosin-stained slides. Serial 10 μm-thick sections were prepared from formalin-fixed, paraffin-embedded tissue blocks and rehydrated for measurement. Differences in sound speed among histological categories were compared, and statistical analysis was conducted to assess significance. A p-value of < 0.05 was considered significant. This study was approved by the institutional review board, and written informed consent was obtained.

Results

Tissue sound speed was measured at 66 sites from 51 patients. Histological grading identified 22 well, 41 moderately, and 3 poorly differentiated cases. Median sound speeds were 1584.0 m/s, 1595.9 m/s, and 1550.1 m/s, respectively. Poorly differentiated HCC showed significantly lower sound speed than the other grades (p = 0.021). Growth patterns included 50 trabecular, 10 pseudoglandular, and 6 solid cases, with median sound speeds of 1595.9 m/s, 1586.0 m/s, and 1563.6 m/s, respectively. The trabecular pattern tended to exhibit higher sound speed than the solid pattern (p = 0.063). Tissues with abundant fat or glycogen (n = 16) had significantly lower sound speeds than those without (p = 0.002). After excluding these cases, which could act as potential confounding factors, sound speed in poorly differentiated HCC remained significantly lower (p = 0.016), and higher values in the trabecular pattern persisted. Additionally, the pseudoglandular pattern showed greater variability in sound speed than the trabecular pattern.

Conclusion

Variations in acoustic properties among histological subtypes of HCC may contribute to developing novel quantitative assessments in ultrasound imaging and pathological diagnosis.

Disclosure

Kazuto Kobayashi, a co-author, has reported a relationship with Honda Electronics Co., Ltd. that includes: employment.