Introduction

The need for a multidisciplinary and expert 24/7 emergency care has led to the implementation of the first Intestinal Stroke Center (ISC) in France. The objective of this study was to assess the impact of treatment in this expert center on the survival of patients with AMI.

Aims & Methods

We used the French National Health Data System (SNDS), covering 99% of the French population. All patients with a diagnosis of AMI and treated in the ISC or in 11 selected university hospitals with vascular and digestive surgical teams (unexposed control hospitals: Strasbourg, Lille, Lyon, Clermont, Nantes, Nice, Toulouse, Bordeaux, Marseille) were included over a period of 9 years between January 1, 2009 and December 31, 2018. The follow-up duration was 12 months, or until death. Survival in the ISC was compared with that of other hospitals using a Cox model with adjustment for age and sex. Survival probabilities in the ISC are presented at 1, 3, and 12 months (M1, 3 and 12) and expressed as Hazard Ratios and their 95% confidence intervals.

Results

A total of 10,126 patients with AMI were identified, including 1,206 patients managed in the ISC, and 8,920 patients managed in control hospitals. Patients managed in the ISC had a lower risk of mortality at M1 (HR = 0.70 [0.70-0.89], p<0.001), at M3 (HR = 0.77 [0.69-0.86], p<0.001) and at M12 (HR = 0.81 [0.73-0.90], p<0.001) compared to non-ISC patients. The probability of survival in the ISC was 76% at M1 [73-78] (vs. 65% [64-66], p<0.001), 71% at M3 [69-74] (vs. 59% [58-60], p<0.001), and 66% at M12 [63-68] (vs. 54% [53-56], p<0.001).

Conclusion

This study is the first to provide comparative results evaluating the benefits of a specialized care for AMI. The results show a significant benefit in terms of survival compared to patients treated in control hospitals (+10% after 12 months). With a median admission of 120 patients / year / center, these epidemiological and prognostic results suggests that regional university hospitals should implement a specialized ISC to improve the prognosis of AMI and reduce disparities in patient care. Based on these findings, treatment of AMI in a specialized ISC was associated with an absolute increase in survival of 10% at 12 months. These results provide essential data to support the implementation of regional ISCs dedicated to the care of AMI in France and in other countries.

Disclosure

MSD Avenir Grant

Introduction

Gastrointestinal involvement is universal among patients with systemic sclerosis (SSc). Small intestinal dysfunction manifests with non-specific gastrointestinal symptoms (abdominal pain, distension, nausea, or vomiting), along with objective signs such as malnutrition, small intestinal bacterial overgrowth, and, in severe cases, chronic intestinal pseudo-obstruction. The pathogenesis of small intestinal dysmotility in SSc has been proposed to follow a sequential progression, beginning with neuropathy, progressing to myopathic damage, and ultimately culminating in fibrosis. Currently, there are no diagnostic techniques available to differentiate between stages of small intestinal involvement.

Aims & Methods

Aim: To assess the discriminative potential of high-resolution jejunal manometry in categorizing small intestinal dysmotility among patients with SSc.

Prospective study evaluating small intestinal motility in consecutive patients with SSc and digestive symptoms between January 2018 and July 2023 and healthy volunteers as controls. A 35-channel high-resolution manometry catheter was trans-nasally inserted into the jejunum under fluoroscopic radiological guidance. Small intestinal motility was continuously recorded for 5 h; 3 h fasting and 2 hours during continuous nutrient perfusion at 2 kcal/min. Tracings were analyzed by conventional qualitative analysis (identifying neuropathic and myopathic motility patterns) and by quantitative analysis of high-resolution parameters (measuring a motility index (MI) that integrates contractile frequency and amplitude over time, and manually counting the number of propagated contractile fronts)

Results

Twenty patients (52 ± 10 years, 95% women) with SSc and 18 healthy subjects (HS) (27 ± 6 years, 78% women) were included. By conventional visual analysis, 6 (30%) patients exhibited abnormal small intestinal motility patterns indicative of neuropathic involvement (uncoordinated bursts n=3 and postprandial minute-rhythm n=3), and 7 (35%) patients showed diminished contractile activity during fasting and after nutrient infusion (mean amplitude <20mmHg), indicative of myopathic involvement. The remaining 7 (35%) patients had apparently normal small intestinal motility.
Quantitative analysis of high-resolution parameters detected additional abnormalities in patients with SSc compared to healthy controls (table 1). A significant decrease in fasting (phase II) propagated fronts was observed in all subgroups, including those with apparently normal motility by conventional analysis. The postprandial response to nutrient infusion was reduced in 15 of 20 patients with SSc. All patients with myopathic involvement had a null response to nutrient infusion. Patients with neuropathic patterns and those with apparently normal motility by conventional analysis also exhibited a poor postprandial response, which was similarly reduced in both groups.

Table 1: Results from quantitative analysis of high-resolution jejunal manometry

Conclusion

High-resolution jejunal manometry detects abnormalities in fasting and postprandial small intestinal motility in patients with systemic sclerosis, even at early stages of intestinal involvement, when neuropathic and myopathic patterns are not evident.

References

Alcala-Gonzalez LG, Malagelada C, Galan C, Nieto A, Accarino A, Azpiroz F. Propagation patterns of jejunal motor activity measured by high-resolution water-perfused manometry. Neurogastroenterol Motil. 2021 Dec;33(12):e14240. doi: 10.1111/nmo.14240. Epub 2021 Aug 11. PMID: 34378830.

Disclosure

Nothing to declare

Introduction

Eosinophilic oesophagitis (EoE) is a chronic, T-helper type 2 immune-mediated oesophageal disease, characterized by symptoms of oesophageal dysfunction and eosinophil-predominant inflammation. In adults, the main clinical presentation associated with EoE is dysphagia and/or food impaction (FI); gastroesophageal reflux-like (GER-like) symptoms are less common but may also be the presenting symptoms.

Aims & Methods

We aimed to assess and compare the clinical, endoscopic, and histological characteristics of adult EoE patients presenting with FI or with no FI (NFI).
A single-center cross-sectional study was conducted on consecutive adult EoE patients (April 2023-April 2024). Based on presenting symptoms, patients were grouped into: I) FI patients, diagnosed following an emergency endoscopy, and II) NFI patients, diagnosed due to the presence of dysphagia or GER-like symptoms (i.e. heartburn, regurgitation, retrosternal-pain) in an outpatient setting. Symptoms were evaluated according to a structured questionnaire. All patients underwent gastroscopy with at least 6 biopsies from distal and medium/proximal oesophageal third. EoE was diagnosed if eosinophils were ≥ 15/high power field, in any biopsy specimen.
The main features were compared between FI and NFI patients by Chi-square and/or Student’s t test for dicotomic or continuous variables.

Results

Thirty-one EoE patients were included [males 74.2%, median-age 34 (19-57) years, BMI ≥ 25 Kg/ m² 61.3%]. FI patients (13; 41.9%) [males 76.9%, median-age 39 (20-57) years] and NFI patients (18; 58.1%) [males 72.2%, median-age 33 (19-57) years] did not differ in terms of age, gender, and BMI (p=0.33, p=1.00, p=0.71, respectively). Moreover, no differences were observed in the occurrence of atopy and the use of proton pump inhibitors (before EoE diagnosis) between FI and NFI groups [30.1% vs 50% (p=0.46) and 46.1% vs 66.6% (p=0.29), respectively].
Before EoE diagnosis, dysphagia and heartburn were less frequently reported in FI patients compared to NFI patients [38.5% vs 83.3% (p=0.02) and 23.1% vs 72.2% (p=0.01)]. Furthermore, 84.6% of FI, compared to 5.5% of NFI patients, showed a diagnostic delay of more than 5 years (p<0.005). The mean EREFS score was significantly higher in FI patients than in NFI patients [5.3 ± 1.8 vs 3.3 ± 2.1 (p=0.005)]. According to the EREFS score, inflammatory (based on Edema, Exudates, and Furrows scores) and fibrostenotic (based on the Rings and Strictures scores) phenotypes were both higher in FI patients than in NFI patients [3.2 ± 1.3 vs 2.1 ± 1.7 (p=0.03) and 2.2 ± 0.8 vs 1.3 ± 0.8 (p=0.005), respectively].

Conclusion

EoE patients presenting with food impaction seem to be paucisymptomatic before the EoE diagnosis compared to those without food impaction. This may explain the delay of EoE diagnosis often requiring emergency gastroscopy.