Introduction

Celiac disease (CD) is a complex multi-systemic autoimmune disease. The present study aims to determine the rate of mucosal recovery and predictors of persistent mucosal damage after GFD. There is still little evidence on the best method for assessing gluten-free diet (GFD) adherence and mucosal recovery during treatment.

Aims & Methods

The retrospective study included only adult patients (age≥18 years old), with biopsy-proven CD evaluated at a tertiary referral centre between 2016-2021.We performed a logistic regression analysis to identify factors associated with partial mucosal recovery (MR) after GFD. We included in the multivariate analysis parameters available at the time of CD diagnosis.

Results

A total of 102 patients were enrolled, two thirds were females, median age of 39 yrs. The initial biopsy analysis showed different stages of villous atrophy (VA) in 79 (77.4%) cases, while 23(22.5%) cases showed mild enteropathy (Marsh 1,2). After at least 12 months of GFD, 26 (25.5%) patients had persistent VA despite good or excellent adherence to GFD. Younger patients (< 35yrs), who showed severe mucosal damage (Marsh 3c lesions) and who had increased anti-gliadin antibody (AGA) levels were at risk for failure to obtain mucosal recovery (MR). The multivariate Cox regression analysis demonstrated that complete mucosal atrophy (p = 0.007) and high AGA antibody levels (p = 0.001) were independent risk factors for a lack of mucosal improvement after at least 12 months of GFD. Interestingly, genotype, tTG-IgA antibody levels, or duration of GFD levels did not influence the occurrence of MR.

Conclusion

Although AGA seropositivity has lost much of their diagnostic significance in recent years due to the introduction of the more sensitive and specific antibody tests, our study reported that patients aged < 35yrs, who showed severe mucosal damage (Marsh 3c lesions) and who had increased AGA antibody levels at diagnosis were at risk for failure to obtain MR. The elevated AGA levels at diagnosis could be used as a prognostic tool for assessing MR.

Disclosure

nothing to disclose

Introduction

Transition of adolescents with inflammatory bowel disease (IBD) to adult care is a challenge for patients, families, and healthcare providers. Considering that ~ 25% of IBD patients are diagnosed before the age of 16 years, and that these patients are at higher risk for poorer clinical disease outcomes. interest in the transition of care has been increasing considerably in the last decade. To assess the main clinical and epidemiological features of a single centre pedriatic population of IBD patients at diagnosis and at the time of transition to the adult center

Aims & Methods

From June 2014 to June 2023 we performed a multicenter, observational, cross-sectional study that included pediatric patients with IBD enrolled in the only pediatric IBD reference center in Sardinia. Data were obtained from the patients’ medical records and from a questionnaire administered at the inclusion visit.

Results

Sixty-five IBD patients were enrolled (UC 40, CD 25, M 32, F 33). Median age at diagnosis was 13 years (IQR 2-18). After a median disease duration of 8 years (IQR: 1-25), no UC patients experienced proximal estension of proctitis or left-sided colitis, and no CD patients experienced new localizations of disease. Fifteen patients developed extraintestinal manifestations. No significant difference was found in median diagnostic delay (DD) between UC [4 months (IQR: 1-84)] and CD patients [4,5 months (IQR: 1-48)]. At the transition visit, overall, twenty-nine patients (44,6%) were exposed to one biologic agent (vs 3% at baseline; p<0.02); 0 patients (0%) were exposed to two biologic agents. 4,6% of patients (3/ 65) underwent surgery

Conclusion

Our results provide important insights into the clinical and epidemiological features of paediatric IBD population, and while waiting for a nation Italian registry, present eligible data on the IBD population in Sardinia

Introduction

Enteroscopy is an established method for endoscopic diagnosis and interventions in the small intestine. Currently, there are three procedures available: single-balloon enteroscopy, double-balloon enteroscopy, and motorized spiral enteroscopy. Recent studies have shown that motorized spiral enteroscopy is very effective but also associated with more complications. There are no comparative studies between double-balloon and motorized spiral enteroscopy.

Aims & Methods

This randomized, prospective trial was conducted at two tertiary centers. All consecutive patients with an indication for enteroscopy were asked to participate in the study. Patients were randomly assigned to the motorized spiral or double-balloon arm after being informed. The examination was then performed with the respective procedure.
This study aims to compare the effectiveness of the new motorized spiral enteroscopy with double-balloon enteroscopy. The time to diagnosis or complete enteroscopy and possible complications of both procedures were investigated.

Results

39 enteroscopies (19 motorized spiral, 20 double-balloon) were performed in 36 patients. In the spiral group, access was achieved orally in 58% of cases. A complete enteroscopy was possible in 26% of cases with a median time of 36 minutes. In 16%, a complete enteroscopy was possible via the oral route. In the double-balloon group, access was achieved orally in 85% of cases. A complete enteroscopy was possible in 10% of cases with a median time of 45 minutes. In 5%, a complete enteroscopy was possible via the oral route. Diagnostic yield was higher in double balloon enteroscopy compared to spiral enteroscopy with positive findings in 75% and 32% respectively. There was one perforation in the motorized spiral group. There were no severe complications in the balloon group.

Conclusion

Motorized spiral enteroscopy seems to be more effective in terms of speed and depth. However, it is also associated with more complications

Introduction

There is a close relationship between the rise in obesity and the increase in consumption of sugar-sweetened beverages. According to a report by the World Health Organization (WHO), about 18% of children and adolescents worldwide are affected by overweight or obesity. Sweet beverage consumption is particularly high in this age group. The WHO recommends reducing sugar intake to prevent and treat obesity. Reduction of sugar intake can be achieved through partial substitution with alternative sweeteners. Erythritol is a naturally occurring non-caloric bulk sweetener. Unlike sugar, erythritol does not affect plasma glucose and insulin concentrations yet stimulates the release of gastrointestinal satiation hormones.

Aims & Methods

This study aimed to evaluate the impact of daily erythritol versus sucrose intake over 5 weeks on parameters of glycemic control, food intake and gastrointestinal symptoms in healthy adolescents.
In this randomized, double-blind, parallel trial, 30 healthy, lean adolescents (15 per group: mean ± SD; age: 16.9 ± 1.5 years; BMI: 20.9 ± 1.8 kg/m²) were included. For a duration of 5 weeks, they received a daily total of 36 g of erythritol (divided into two portions of 18 g in 150 mL tap water; ERY), or 25 g of sucrose (divided into two portions of 12.5 g in 150 mL tap water; SUC). During the week before and the last week of intervention, food intake was assessed by food records. Before and after the intervention period, an oral glucose tolerance test was carried out and blood samples were collected at fixed time points to measure plasma glucose and insulin. Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and Homeostatic Model Assessment of Insulin Sensitivity (HOMA-%S)) were calculated. The Gastrointestinal Symptom Rating Scale (GSRS) was applied to assess gastrointestinal symptoms at 3 timepoints (before, during week 3, and after the intervention).

Results

In the erythritol-group, parameters of glycemic control were not significantly different in response to the intervention. In the sucrose-group Cmax for blood glucose was not significantly different but Cmax for blood insulin (PRE_SUC: 91.67 ± 33.71 mIU/L vs. POST_SUC: 127.38 ± 68.24 mIU/L; p = 0.030) and HOMA-IR (PRE_SUC: 1.79 ± 0.74 vs. POST_SUC: 2.51 ± 0.74; p < 0.001) were significantly increased, while HOMA-%S (PRE_SUC: 70.5 ± 47.3 vs. POST_SUC: 43.2 ± 12.5; p = 0.016) was significantly reduced after the intervention period. In the erythritol-group, total sugar intake (PRE_ERY: 90.3 ± 34.0 g vs. POST_ERY: 71.0 ± 36.0 g; p = 0.034) and total carbohydrate intake (PRE_ERY: 256.8 ± 54.8 g vs. POST_ERY: 211.1 ± 71.0 g; p = 0.038) were significantly reduced after the intervention period, while total caloric intake (PRE_ERY: 2113.7 ± 495.4 kcal vs. POST_ERY: 1855.1 ± 495.7 kcal; p = 0.068) showed a trend of reduction. In the sucrose-group, total sugar intake (PRE_SUC: 75.4 ± 31.2 g vs. POST_SUC: 92.4 ± 24.7 g; p = 0.073) showed a trend of increase after the intervention period, while total carbohydrate and total caloric intakes were not significantly different. The total score of GSRS was not significantly different between the groups but increased significantly over time in both groups (p = 0.045).

Conclusion

Daily erythritol intake in healthy, lean adolescents over 5 weeks did not affect parameters of glycemic control but led to a significant reduction of total carbohydrate and total sugar intake. In contrast, the sucrose intervention resulted in a significant increase in maximum insulin concentration and HOMA-IR, along with a significant decrease in HOMA-%S.

Introduction

Anorectal disorders, causing fecal incontinence or evacuation dysfunction are common, affecting up to 5% of the general population (1). Most of these disorders result from an intricate combination of disturbances, including neurologic and pelvic floor musculature dysfunction, and have a significant impact in the quality of life of patients (2,3). Anorectal manometry (ARM) is the gold standard for the evaluation of anorectal functional disorders. Nevertheless, the accessibility to this exam is limited, and the complexity of data analysis and report is a significant drawback (4).

Aims & Methods

This pilot study aimed to develop and validate an artificial intelligence (AI) model to automatically differentiate motility patterns of fecal incontinence (FI) from obstructed defecation (OD) using ARM data.
We included ARM exams performed at a large gastrointestinal motility clinic in Brazil (Pelvia – Gastrointestinal Motility and Continence, Paraná, Brazil) between 2015 and 2021. All ARM procedures were performed using water-perfused probes with eight radial transducers with a distal latex balloon. We developed and tested multiple machine learning algorithms for the automatic interpretation of ARM data. Four models were tested: k-nearest neighbors (KNN), support vector machines (SVM), random forests (RF) and gradient boosting (xGB). These models were trained using a stratified 5-fold strategy. Their performance was assessed after fine-tuning of each model’s hyperparameters, using 90% of data for training and 10% of data for testing.

Results

A total of 827 ARM exams were used in this study, 493 of patients diagnosed with obstructed defecation (OD), while the remaining 334 presented FI. The performance marks of the different tuned models, including the precision, sensitivity and the F1-score, is summarized on table 1. After fine-tuning, the xGB model presented an overall accuracy (84.6 ± 2.9%), similar to that of RF (82.7 ± 4.8%) and SVM (81.0 ± 8.0%), and higher that of KNN (74.4 ± 3.8%). The xGB models showed the highest discriminating performance between OD and FI, with an area under the curve of 0.939.

Conclusion

The tested machine learning algorithms, particularly the xGB model, accurately differentiated between FI and OD manometric patterns. Subsequent development of these tools may optimize the access to ARM studies, which may significantly impact on the management of patients with anorectal functional diseases.

References

1. Whitehead WE, Wald A, Diamant NE, et al. Functional disorders of the anus and rectum. Gut 1999;45 Suppl 2:Ii55-9.
2. Maeda Y, Vaizey CJ, Hollington P, et al. Physiological, psychological and behavioural characteristics of men and women with faecal incontinence. Colorectal Dis 2009;11:927-32.
3. Remes-Troche JM, Rao SS. Defecation disorders: neuromuscular aspects and treatment. Curr Gastroenterol Rep 2006;8:291-9.
4. Brown HW, Guan W, Schmuhl NB, et al. If We Don't Ask, They Won't Tell: Screening for Urinary and Fecal Incontinence by Primary Care Providers. J Am Board Fam Med 2018;31:774-782.

Introduction

The new nomenclature of Non alcoholic fatty liver disease (NAFLD) as metabolic dysfunction-associated steatotic liver disease (MASLD), has an excellent concordance and 99% of individuals with NAFLD meet MASLD criteria. MASLD is becoming the most rapidly increasing contributor to the disease burden related to adverse liver outcomes, including cirrhosis, liver failure, and HCC. To curb this rising tide of MASLD (38.2% global prevalence), an early comprehensive and efficient management strategies are very crucial. Saroglitazar, a novel dual PPAR α/γ agonist operates through a multifaceted mechanism of action, targeting key pathways driving the progression of MASLD, and have shown benefits at different stages of disease ranging from early to advance fibrosis and compensated cirrhosis.

Aims & Methods

We tried to evaluate the effect of Saroglitazar in MASLD associated early fibrosis, in a population where majority did not have diabetes and hypertension at baseline.
A prospective, real world study was conducted at a single centre setting in North India with 67 patients showing ultrasonographic evidence of fatty liver changes and dyslipidemia. Transient elastography was performed to reliably exclude advanced liver disease and treatment progression at 3 and 6 months after Saroglitazar 4 mg OD prescription. The Controlled Attenuation Parameter (CAP) and liver stiffness measurement (LSM) were assessed as primary treatment endpoints along with other markers of liver function and metabolic health as secondary efficacy parameters. Changes were evaluated using paired t-tests, from baseline to the 12 and 24 week mark. This rigorous methodology allowed for a comprehensive assessment of Saroglitazar's impact on both liver health and metabolic parameters.

Results

The 67 patients, who followed the study inclusion criteria and treated with Saroglitazar 4 mg OD, were evaluated on primary and secondary efficacy parameters. They had the mean age 50.34 ±11.69 and mean body weight 82.1 ±11.9. Among them, 61.2% are males, 88.1% non diabetic, 89.6% non hypertensive, and 83.6% are not having any family history of NAFLD. 57.8% of them had F0-F1 fibrosis and 34.4% had F2 fibrosis at baseline. The mean reduction in CAP was 34.7 (p<0.001) and 38.7 dB/m (p<0.001) and mean reduction in LSM was 0.53 (p=0.043) and 1.31 Kpa (p<0.001), respectively at 12 and 24 weeks (n=32). A significant and consistent reduction in AST, ALT, TG, LDL and HbA1c was also seen. No new safety signals were observed.

Table: Absolute and percentage mean changes in Primary and secondary study parameters at 12 and 24 weeks

Conclusion

Treatment with Saroglitazar 4 mg significantly reduces liver stiffness and steatosis, improves liver enzymes, and other metabolic parameters like serum glucose and lipid profile. It could be a crucial treatment component for an early comprehensive and efficient management of MASLD and helpful in curbing the rising tide of global MASLD burden. Saroglitazar treatment was safe.

References

1. Targher G, Byrne CD, Tilg HMASLD: a systemic metabolic disorder with cardiovascular and malignant complicationsGut 2024;73:691-702.
2. Lei Miao, Giovanni Targher, Christopher D. Byrne, Ying-Ying Cao, Ming-Hua Zheng, Current status and future trends of the global burden of MASLD, Trends in Endocrinology & Metabolism, 2024,ISSN 1043-2760, https://doi.org/10.1016/j.tem.2024.02.007.
3. Soto A, Spongberg C, Martinino A, Giovinazzo F. Exploring the Multifaceted Landscape of MASLD: A Comprehensive Synthesis of Recent Studies, from Pathophysiology to Organoids and Beyond. Biomedicines. 2024; 12(2):397. https://doi.org/10.3390/biomedicines12020397