Introduction

The association between chronic Helicobacter pylori infection and hormone levels affecting food intake and obesity remains controversial. Thus, our aim was to investigate the long-term effect of H. pylori eradication on changes in ghrelin and leptin levels.

Aims & Methods

A total of 72 patients meeting the inclusion and exclusion criteria were enrolled (July 2020 to November 2022). Participants were randomly assigned to two treatment groups (group 1: 14-day regimen with esomeprazole, amoxicillin, and clarithromycin; group 2: 14-day regimen with esomeprazole, amoxicillin, metronidazole and colloidal bismuth subcitrate). We evaluated changes in insulin resistance (HOMA-IR score), body mass index (BMI) and serum levels of ghrelin and leptin (ELISA test) at baseline, two months, and one year following successful H. pylori eradication.

Results

Of the 72 patients included, 13.9% (10/72) did not complete the study protocol. Both treatment groups were similar at enrolment and showed no statistically significant differences (p = 0.332 for OLGIM stages; p = 0.583 and p= 0.696 for antrum and corpus atrophy respectively, p = 0.177 and p = 0.296 for antrum and corpus intestinal metaplasia respectively). No statistically significant changes were present in BMI (p = 0.910) and insulin resistance (p = 0.342) after H. pylori eradication. A statistically significant decrease in ghrelin serum levels was observed in both treatment groups (p < 0.001), but not in leptin serum levels (p = 0.309), as shown in Table 1.

Table 1. Changes in various parameters over time in the entire cohort.

Conclusion

Successful eradication of chronic H. pylori gastritis decreased serum ghrelin levels regardless of the presence of gastric mucosal atrophy. Furthermore, no changes in BMI or waist circumference were detected after one year of follow-up, proving that H. pylori eradication is not related to weight gain through hormonal changes as previously hypothesized. These results reduce the fear that massive H. pylori eradication from the population could be associated with obesity.

References

1. Martin-Nunez GM, Cornejo-Pareja I. Clemente-Postigo M, Tinahones FJ, Moreno-Indias I. Helicobacter pylori Eradication Therapy Affect the Gut Microbiota and Ghrelin Levels. Front Med 2021;8:712908.
2. Yanagi H, Tsuda A, Matsushima M, Takahashi S, Ozawa G, Koga Y, et al. Changes in the gut microbiota composition and the plasma ghrelin level in patients with Helicobacter pylori-infected patients with eradication therapy. BMJ Open Gastro 2017;4:e000182.
3. Roper J, Francois F, Shue PL, Mourad MS, Pei Z, Olivares de Perez AZ, et al. Leptin and ghrelin in relation to Helicobacter pylori status in adult males. J Clin Endocrinol Metab 2008;93: 2350-2357.
4. Nwokolo CU, Freshwater DA, O'Hare P, Randeva HS. Plasma ghrelin following cure of Helicobacter pylori. Gut 2003;52:637–40.

Disclosure

None of the authors have any conflict of interest regarding this study.
KT was a speaker for Abbvie, Pfizer, Krka, Altamedics, Viatris, Eli Lilly.
BT served as a speaker or received research grant from KRKA, Ewopharma, Swixx pharma, Infai GmbH.
RO was speaker for Abbvie, Lek Sandoz, Medis, Ewopharma, Polymetria, Nutricia.
ML, UPF, GA and DŠ have no conflict of interest to declare.

Introduction

Severe acute colitis (SAC) <represents a critical complication of inflammatory bowel disease (IBD), requiring prompt and appropriate management. Opportunistic infections, particularly those caused by cytomegalovirus (CMV) and Clostridioides difficile (C. difficile), can significantly influence clinical outcomes and therapeutic responses, especially in immunocompromized individuals. This study aims to evaluate the incidence of these opportunistic infections in patients with SAC complicating IBD and to analyze their impact on clinical progression and treatment efficacy.

Aims & Methods

A retrospective study was conducted involving patients admitted for SAC, diagnosed based on Truelove and Witts criteria and a Lichtiger score exceeding 10. Initial assessments included CMV polymerase chain reaction (PCR) testing on colonic biopsies and/or blood samples, detection of C. difficile toxins A/B in stool specimens, and standard microbiological evaluations. Clinical, biological, and therapeutic response data were systematically collected.

Results

Fifty-five patients over the age of 18 were included, with a mean age of 42.36 years (range: 18–74) and a slight female predominance (55%). In 34% of cases, SAC was the initial manifestation of IBD. All patients met the Truelove and Witts criteria and had a Lichtiger score >10 upon admission. Endoscopic signs of severity were observed in 40% of patients.
Intravenous corticosteroid therapy using hydrocortisone hemisuccinate was administered as the first-line treatment for all patients, yielding a 60% response rate.
CMV co-infection was identified in 4 patients, all of whom were refractory to intravenous corticosteroids and subsequently received ganciclovir. Two patients responded favorably to second-line therapy with cyclosporine, while the remaining two did not respond to infliximab and required subtotal colectomy.
C. difficile co-infection was detected in 6 patients, treated with intravenous metronidazole and oral vancomycin. Among these, 3 patients did not respond to first-line medical therapy; one acheved clinical improvement with cyclosporine, whereas two required emergency subtotal colectomy due to the development of toxic megacolon.
Bivariate analysis revealed a statistically significant association between CMV co-infection and corticosteroid treatment failure (p=0.009). No significant association was found between C. difficile co-infection and first-line treatment failure in SAC.

Conclusion

Opportunistic infections, particularly CMV, are linked to unfavorable therapeutic responses in patients with SAC. Early detection of these co-pathogens is crucial for promptly adjusting treatment strategies, including the consideration of second-line therapies or surgical interventions. These findings underscore the importance of systematic screening for opportunistic infections in SAC patients to optimize management and improve clinical outcomes.

Disclosure

The authors report no conflicts of interest

Introduction

Chronic constipation (CC) is a frequent gastrointestinal disorder which significantly affects patients' quality of life. International guidelines recommend the use of polyethylene glycol (PEG) as part of the first-line management of CC after the failure of diet and lifestyle modifications. However, limited data are available on how PEG is used in daily clinical practice. Therefore, a national survey among gastroenterologists (GEs) and general practitioners (GPs) was conducted to evaluate its use in the management of CC.

Aims & Methods

Members of Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) and Italian Federation of General Practitioners (FIMMG) were invited to complete a 44-item online survey. The questionnaire was structured to explore several dimensions regarding the use of PEG (e.g. type of PEG used, formulations and dosages recommended, etc.).

Results

The survey was completed by 1188 physicians (317 GEs, 871 GPs). GEs were significantly younger (mean age 44.9 vs. 51.0 years, p<0.01) and more likely to have less than 10 years of experience compared to GPs.
PEG was prescribed as part of first-line treatment in addition to dietary and behavioral advice more frequently by GEs than GPs (92.4% vs. 82.9%, p<0.001). GPs preferred to prescribe PEG in the early morning or evening before bedtime compared to GEs (p<0.001), which preferred mid-morning or midafternoon (p<0.01). GPs more often recommended taking it away from other drugs and/or supplements compared to GEs (76.7% vs 61.5%, p<0.001).
GEs considered PEG products to be taken continuously more often than GPs (36.9% vs 18.6%, p<0.001) and were more inclined to avoid setting a fixed treatment duration (62.8% vs 38.2%, p<0.001), while GPs often recommend a short-term or an on-demand use. GEs also more often preferred to discontinue PEG gradually compared to GPs (74.8% vs. 63.0%, p<0.001)
PEG’s formulation choices varied: GEs favored the powder formulation less than GPs (58.7% vs 78.9%, p<0.001), and more often started therapy at higher dosages (Table 1). Moreover, GEs gave more importance on palatability compared to GPs (71.9% vs 60.4%, p<0.001).
Safety perceptions were similarly high across the groups, GEs were more likely to prescribe PEG than GPs to patients with comorbidities such as chronic kidney disease (75.7% vs 64.0%, p<0.001) and during pregnancy/lactation (71.3% vs 48.8%, p<0.001).

Table 1. Prescription of PEG as part of first line management of CC and PEG's initial dosage answers.

Conclusion

To the best of our knowledge, this is the first national survey to assess how PEG is prescribed by GEs and GPs in daily clinical practice. The survey highlighted a certain heterogeneity in prescription behaviors. GEs tended to adopt longer-term therapeutic strategy, starting with higher doses. Moreover, they paid greater attention to PEG palatability and were more confident on PEG safety in patients with chronic comorbidities. These findings underscored the need for shared knowledge and approaches to optimize constipation management across different care settings.

Introduction

Enteroscopy-assisted ERCP (E-ERCP) is used to treat biliary-enteric anastomotic stricture and common bile duct stones after alimentary tract reconstruction. However, anastomotic stricture usually responds poorly to balloon dilation caused by severe fibrosis. Here, we report a novel technique, endoscopic radial incision (ERI) combined with E-ERCP, to treat biliary-enteric anastomotic stricture and common bile duct stones.

Aims & Methods

From October 2023 to November 2024, six patients with biliary-enteric anastomotic stricture and common bile duct stones who responded poorly to balloon dilation received ERI combined with E-ERCP in Zhongshan Hospital, Fudan University. The primary outcomes were relief of biliary-enteric anastomotic stricture and the removal of common bile duct stones. The secondary outcome was the complication rate of the procedure.

Results

The mean age was 48 and 3 patients were male. All 6 patients successfully received ERI combined with E-ERCP. Four patients with anastomotic stricture were incised by Hook knife, while two patients with the Hook knife not reaching the anastomotic area was incised by the top of the snare. After the ERI, the diameters of the biliary-enteric anastomotic stoma enlarged from 3 mm to 10 mm. The mean diameter of common bile duct stones was 8 mm. All the common bile duct stones were removed by basket catheter successfully, confirmed by intraoperative common bile duct radiography and postoperative MRCP. The mean procedure time was 32 minutes and the mean postoperative hospitalization time was 2 days. No intraoperative and postoperative complications occurred.

Conclusion

ERI combined with E-ERCP, as a novel technique, could be an effective and safe method to treat biliary-enteric anastomotic stricture and common bile duct stones after alimentary tract reconstruction.

Introduction

With the global rise in obesity, endoscopic bariatric therapy (EBT) is increasingly adopted as a less invasive alternative to surgery. Among the most commonly used approaches are space-occupying techniques via intragastric balloons (IGB) and restrictive methods like endoscopic gastroplasty (EG).

Aims & Methods

This study aimed to evaluate changes in anthropometric parameters and body composition following EBT, and to identify early predictors of weight loss associated with these procedures. This analysis combined data from two single-center, randomized trials involving obese patients undergoing EBT using either IGB (ClinicalTrials.gov NCT06673550) or EG (ClinicalTrials.gov NCT04854317). The primary outcome was the effect of EBT on body circumferences (arm, waist, hip, calf) and body composition metrics including fat mass (FM), fat-free mass (FFM), and body cell mass (BCM). The secondary outcome focused on identifying predictive factors for weight loss. The 6-month follow-up was chosen for assessment, corresponding to the standard IGB removal timeline.

Results

Between July 2020 and January 2024, 318 obese patients were included: 156 received IGB (mean age 46±14 years; 69.2% female; mean BMI 41.9±9.1 kg/m²; 53.0% with class III obesity), while 162 underwent EG (mean age 46±10 years; 87.5% female; mean BMI 36.6±3.1 kg/m²; 58.3% with class II obesity). Follow-up at 6 months was completed by 93.5% in the IGB group (146/156) and 70.4% in the EG group (114/162). Average total body weight loss (TBWL) was 14.2±7.1% for IGB and 16±6% for EG, with corresponding excess weight loss (EWL) of 30.8±23.3% and 39.7±14.9%, respectively. Both groups showed significant reductions in all body circumferences (p<0.001). FM and FM% decreased markedly (p<0.001), while FFM% (p<0.001) and BCM% (p<0.05) increased. In the EG group, linear regression revealed a significant correlation between phase angle and both TBWL (r=0.327, p<0.05) and EWL (r=0.274, p<0.05), a relationship not observed in the IGB group. This difference may be due to distinct baseline characteristics, particularly BMI, and the differing mechanisms of action between the two EBT modalities.

Conclusion

Both IGB and EG demonstrated effectiveness in promoting weight loss, reducing body measurements, and improving body composition in obese patients. Phase angle may serve as a valuable predictor of weight loss in certain EBT approaches, suggesting its potential role in guiding personalized obesity treatment strategies.

Disclosure

Dr Vadalà di Prampero and Dr Milutin Bulajic are consultants for Apollo Endosurgery, EndoTools Therapeutics and USGI Medical.

Introduction

EndoZip^TM is a fully automated endoscopic suturing device designed to reduce gastric volume for obesity treatment, minimizing the operator-dependence for endoscopic gastroplasty. A recent multicenter clinical trial showed that the device is easy-to-use, safe, and effective for treating class I and II obesity. In this study, we aim to assess the efficacy and safety of EndoZip^TM to facilitate improvement in patients with obesity-related comorbidities.

Aims & Methods

This is the analysis, including the Italian site only, of a prospective, single-arm, open-label, clinical trial including patients with a BMI of 30-42 kg/m² and hypertension and/or type 2 diabetes mellitus (T2DM) who failed non-invasive weight-loss therapies and were deemed suitable for bariatric endoscopy according to the multidisciplinary team.
We report the percentage of total body weight loss (%TBWL), changes in Hb1AC and/or Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), changes in ambulatory blood pressure monitor (ABPM), and/or treatment for hypertension following automatic endoscopic procedure. Incidence of adverse events was also recorded.
Patients’ clinical health conditions were evaluated at 6 and 12 months as compared to baseline and classified as “Improved”, “No change”, or “Worsened”.

Results

Twenty patients (80% female, mean age 51.9±9.8, mean BMI 34.9±3.2 kg/m2) were enrolled at a single tertiary center. Five patients (25%) had both hypertension and T2DM, eleven (55%) had only hypertension, and four (20%) had only T2DM. One patient with hypertension was lost to follow-up.
At 12 months, the mean %TBWL was 11.4% (with SE 1.1%). Among patients with T2DM, improvement was observed in all subjects at 6 months. At 12 months, 5 out of 8 (62.5%) showed an improvement in their diabetes health condition, 2 out of 8 (25%) showed no change, and one patient experienced worsening in HbA1c and HOMA-IR. In the group of patients with hypertension, 7 out of 13 (54%) showed an improvement in ABPM values and/or in their hypertension medication. Meanwhile, 4 out of 13 (31%) experienced no change, and in 2 out of 13 (15%), there was a worsening of their condition. In these two cases, the patients had discontinued an antihypertensive medication. One anticipated severe adverse event, immediate post-procedure bleeding, was reported. The event was effectively managed endoscopically with a single clip and a 2 mL injection of fibrin glue, without the need for blood transfusion. No pathologies were identified in the esophagus, and the sutures in the stomach were found to be intact.

Conclusion

Based on these preliminary results, automatic endoscopic gastroplasty seems to be safe and promising for the treatment of obesity and associated comorbidities such as hypertension and T2DM.

References

Boskoski I, Lopez-Nava G, Ravishankar A, Bove V, Matteo MV, De Siena M, Pontecorvi V, Giannetti G, Iaconelli A, Spada C, Shamah SE. Automatic endoscopic gastroplasty for the treatment of obesity: results from a prospective multicenter study (with video). Gastrointest Endosc. 2025 Apr;101(4):818-827. doi: 10.1016/j.gie.2024.09.026. Epub 2024 Sep 21. PMID: 39307402.