Introduction

Althouth the advances in treatment of inflammatory bowel disease, the best maintenance therapy after steroid-responsive acute severe ulcerative colitis (ASUC) is still controversial.

Aims & Methods

Our goal was to compare the outcomes of starting different treatment regimens in patients with steroid-responsive ASUC. We did a retrospective single-centre cohort study including all patients hospitalized with ASUC, between 2014-2022, who responded to steroids according to Oxford Criteria. Patients were divided in two groups according to the maintenance treatment after ASUC episode - 5-ASA/immunomodulator (IMM) or biological therapy. Short (<1 year) and long-term (>1 year) outcomes after ASUC hospitalization were assessed. The primary outcome was a composite outcome defined by proximal disease extension, therapy escalation (including steroids), new hospitalization or colectomy.

Results

32 steroid-responsive patients were included, 31% were male. Baseline characteristics are shown in Table 1. Overall, 28% of patients were discharged with 5-ASA/IMM and 72% with biologics (infliximab, vedolizumab, golimumab). During a median follow up of 3 years (IQR 1.7-4.9), 50% of patients needed a new course of steroids, 3% presented proximal disease extension, 53% needed therapy escalation, 31% required a new hospitalization and 16% underwent colectomy. Regarding the composite outcomes, no differences were found between the two groups in short-term outcomes. In long-term-outcomes, patients treated with biologics had a lower rate of events, comparing with patients treated with 5ASA/IMM (67% vs 17%, p=0,013), and a trend towards to a longer time without events (log-rank p=0,093).

Conclusion

In our cohort, no differences were found in short-term outcomes. However, in long-term outcomes, patients treated with biologic had a lower rate of events and a trend towards to a longer time without events, suggesting this may be a better strategy. Our sample size and the low number of patients on 5-ASA/IMM limit our conclusions, further studies with larger sample size and longer follow-up are needed.

Introduction

Hiatal hernia (HH) is a common finding in endoscopic examinations that can cause significant symptoms, depending on its severity. The Hill classification assesses the degree of HH (type II to IV) by considering the width of the cardia and the hiatus on visual inspection during gastroscopy.

Aims & Methods

Our goal was to train a deep learning (DL) model that determines the Hill classification using a novel active learning (AL) pipeline. A total of 21,970 gastroscopic images representing 14,885 examinations from two endoscopy centers were retrospectively identified as the training dataset. A novel AL pipeline was developed to train the DL model. For comparison reasons, a second model was trained with randomly selected images from the same training dataset. An external, publicly available collection of HH images was annotated using the Hill classification and used as test data. Outcomes are the ability of the models to diagnose and classify HH and the time spent by the expert for annotation. The proposed AL pipeline is provided as Open-Source.

Results

The AL-based model was generated in eight consecutive steps, covering about 10% of the unlabeled training data. The model achieved mean accuracy, sensitivity, specificity, and F1-score of 0.878, 0.692, 0.896, and 0.67 respectively, when classifying the four different types of Hill. In diagnosing the existence of a HH (type I vs II-IV), the model achieved 0.828, 0.749, 0.902, 0.808 for the same metrics. The median annotation time per image was 3.62s (Q1-Q3; 3.14-4.69). Obtaining a model via the random image selection that performs similarly, required at least 30% more annotations and thus expert time commitment.

Conclusion

In this work we present a novel AL pipeline, enabling examiners to develop new models for gastrointestinal endoscopy without requiring programming skills. Using the proposed pipeline resulted in a well performing model in less time spent by the expert annotator, compared to traditional model training.

Disclosure

The authors have no conflicts of interest to disclose.

Introduction

Pain, discomfort, and bloating can occur during and after colonoscopy, secondary to bowel distention. Insufflation is the major reason for bowel distention after a colonoscopy. Room air (RA) has slower re-absorption through the intestinal mucosa than carbon dioxide (CO2). Theoretically, with a faster resorption speed, abdominal pain, discomfort, and bloating are expected to be less with CO2 use. Nevertheless, in some clinical studies, CO2 was not found to be superior to RA in terms of post-procedure pain sensation.

Aims & Methods

The aim of this study was to compare abdominal pain sensation and bloating after colonoscopy using RA versus CO2 insufflation. A prospective randomized controlled study conducted on patients performing diagnostic colonoscopy. Enrolled patients were randomized to RA (group 1) versus CO2 insufflation (group 2). All patients were sedated with midazolam (2.5-5 mg) and all colonoscopies were performed by a single endoscopist. Abdominal pain sensation and bloating after the procedure as the primary outcome measure was assessed by a 10-point visual analogue scale (VAS), numerical rating scales from 0 (no pain) to 10 points (maximal pain). The participants were asked about abdominal pain and bloating at 15, 60, and 180 minutes and 24 hours post-procedural.

Results

From July 2021 to August 2022, a total of 64 patients were enrolled. There was 31 males and 33 females. Their mean age was 48.27±16 years. There was a statistically significant increase in abdominal bloating in group 1 (59.4%) compared to group 2 (18.7%), (P=0.018). Also, there was a statistically significant increase in abdominal pain sensation in group 1 compared to group 2 at 60 min (43.8% vs 21.9%) (P=0.011), 180 min (28.1% vs 9.4%) (P=0.017), respectively. None of the studied patients developed pain after 24 hours and there was no statistically significant difference between the studied groups regarding cecal intubation time and total examination time. No adverse events were noted in both groups.

Conclusion

CO2 insufflation is associated with significantly less bloating and less abdominal pain after diagnostic colonoscopy compared to RA insufflation.

Introduction

Eosinophilic esophagitis (EoE) is a Th2-related disease characterized by dysphagia and food impaction. EoE has been associated with several other atopic disorders, supporting the knowledge that it may represent a late manifestation of the so-called “atopic march”. However; in everyday clinical practice, allergic comorbidities are rarely objectivized by means of specialist consultations and often rely on patients’ self-reporting. This bears the risk of not fully recognizing the burden of Th2-related pathology, since EoE patients may outgrow some of the allergic diseases presenting during childhood; or, conversely, they could underestimate the presence and severity of Th2-diseases. To this aim, a multidisciplinary task-force involving multiple specialists was established at our university hospital, in order to systematically investigate newly referred EoE patients.

Aims & Methods

This is a cross-sectional observational study, involving consecutive EoE patients that were referred to our tertiary center from January 2022. We prospectively collected data about patients’ clinical history, specifically recording the presence of Th2-related comorbidities. Each patient underwent an esophagogastroduodenoscopy with differential esophageal biopsies. After reaching a conclusive diagnosis of EoE, patients were referred to dermatology, ear, nose and throat specialist (ENT) for rhinofibroscopy, immunologist (performing prick test, as necessary) and respiratory consultant for spirometry.

Results

40 EoE patients were included (34M, age 31±12 years), with a mean age of onset of 23±16 years. A clinical history of Th2-comorbidities was reported by 90% of the overall population with rhinitis being the most prevalent comorbidity (77.5%), while no patient reported Chronic Rhinosinusitis with Nasal Polyps (CRwNP). Asthma, food allergy and atopic dermatitis (AD) were reported in 15 (37.5%), 14 (35%) and 9 (22.5%) patients, respectively. Following the consultations, the presence of asthma, food allergy and AD did not significantly differ (37.5 vs 30%, 35 vs 45% and 22.5 vs 20%), since only 3 patients reporting a history of asthma did not confirm the diagnosis at spirometry and one patient with a history of AD had dermographic urticaria. On the contrary, following ENT consultation, 6 patients with rhinitis received the diagnosis of CRwNP (0 vs 15%, p=0.01). Overall, nearly 60% of patients had two comorbid Th2 disorders besides EoE and 25% of the whole population of EoE patients had 3 or more.

Conclusion

Our results clearly support the need for a multidisciplinary team approach to investigate the burden of Th2-related pathology in EoE patients. In our hands, the prevalence of Th2-related comorbidities was as high as 97.5% of EoE patients and up to 63% of our population had 2 or more allergic disorders. Furthermore, CRwNP is frequently under-reported and properly diagnosed only following rhinofibroscopy. This is further from being irrelevant when managing EoE patients. Indeed, it may guide the most appropriate choice of therapy by targeting multiple atopic manifestations at the same time, since many Th2-related diseases share common pathophysiological mechanisms and treatment.