Introduction

Chronic constipation is a prevalent gastrointestinal complaint with increasing incidence among the aging population. Examining colonoscopy performance in chronic constipation across age groups, this study aims to comprehensively assess diagnostic yield and compare results with average-risk controls.

Aims & Methods

A retrospective analysis was conducted on 50,578 colonoscopy procedures performed over 12 years, including 5,478 constipated patients. An average-risk control group (n=4,100) was included. Data extracted from electronic medical records covered demographics, operational aspects, and colonoscopy findings. The primary outcome measures included the diagnosis rate of colorectal cancer (CRC), polyp detection rate (PDR) and inflammatory bowel disease (IBD) diagnoses in constipated patients versus controls, with age-based and multivariate analyses.

Results

Constipated patients exhibited lower rates of adequate bowel preparation (92.7% vs. 85.3%; p < 0.001) and a lower cecal intubation rate. No significant variances between CRC and PDR were observed between constipated and controls, except for a potential of a slightly elevated CRC risk in constipated patients older than 80 (2.50% vs. 0% in controls; p = 0.07). However, multivariate analysis demonstrated that constipation did not confer an increased risk for CRC or polyp detection across all age groups. Notably, younger constipated patients exhibited a higher rate of IBD diagnoses (1.7% vs. 0.1% in controls; p < 0.001).

Conclusion

Conclusion: Constipation did not confer an increased risk for CRC or polyps among all age groups, except for a potential signal of elevated CRC risk in patients older than 80, and was associated with higher rates of IBD in younger patients.

References

1. Aziz I, Whitehead WE, Palsson OS, Törnblom H, Simrén M. An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation. Expert Rev Gastroenterol Hepatol. 2020 Jan;14(1):39-46.
2. Camilleri M, Brandler J. Refractory Constipation: How to Evaluate and Treat. Gastroenterol Clin North Am. 2020 Sep;49(3):623-642.
3. Shahini E, Sinagra E, Vitello A, Ranaldo R, Contaldo A, Facciorusso A, Maida M. Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature. World J Gastroenterol. 2023 Mar 21;29(11):1685-1707.
4. Mahmood S, Farooqui SM, Madhoun MF. Predictors of inadequate bowel preparation for colonoscopy: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2018;30:819–826.
5. Hassan C, East J, Radaelli F, Spada C, Benamouzig R, Bisschops R, et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019. Endoscopy. 2019 Aug;51(8):775-794.
6. Włodarczyk J, Waśniewska A, Fichna J, Dziki A, Dziki Ł, Włodarczyk M. Current Overview on Clinical Management of Chronic Constipation. J Clin Med. 2021 Apr 16;10(8):1738.
7. James SL, van Langenberg DR, Taylor KM, Gibson PR. Characterization of ulcerative colitis-associated constipation syndrome (proximal constipation). JGH Open. 2018 Aug 5;2(5):217-222.

Introduction

Irritable Bowel Syndrome (IBS) is a chronic disorder of the gut-brain interaction characterized by visceral hypersensitivity. There is growing evidence underscoring the beneficial impact of probiotics and postbiotics with psychobiotics properties in relieving stress-related gastrointestinal disorders in humans especially in patients suffering from IBS. We have previously shown that high GABA-producer L. lactis CNCM I-5388 exerts antinociceptive properties after 5- and 10-days oral treatment in an IBS-like rat model. We demonstrated, using both mutant L. lactis ΔgadB strains and GABA_B receptor antagonist that these antinociceptive properties were dependent on the GAD-enzymatic activity of L. lactis and mediated by host’s GABA_B receptors. In addition, we have shown that CNCM I-5388 displayed a high cell-bound GAD activity and survival in vitro under HCl-mediated acidic stress.

Aims & Methods

In this work, we were interested in studying the GABA-producer L. lactis CNCM I-5388 as an active-enzyme postbiotic to relieve visceral hypersensitivity mediated by a psychological stress.
L.lactis CNCM I-5388 was inactivated by ethanol (EtOH) while maintaining its GAD activity. Female Wistar rats were treated orally for 1, 5 or 10 days by the EtOH-treated nonviable L.lactis CNCM I-5388 form or the viable L. lactis CNCM I-5388 or vehicle. Visceral sensitivity in response to colorectal distension was measured by electromyography before and after partial restraint stress (PRS). GABA levels were quantified by HPLC both in the stomach collected from rats and in the gastric compartment of the TIM-1 human gut model in fed state.

Results

A daily treatment for 5 and 10 days by L. lactis CNCM I-5388 both in its viable and nonviable forms counteracted visceral hypersensitivity-induced by PRS in response to colorectal distension. However, after a single administration only viable L. lactis CNCM I-5388 tended to reduce visceral hypersensitivity. After 5-days treatment, the production of GABA within the stomach was enhanced in stressed rats treated with the viable or nonviable L. lactis CNCM I-5388 form. This increase was confirmed by using the TIM-1 human gut model.

Conclusion

Our results highlight that a postbiotic with an active-GAD of L. lactis CNCM I-5388, similarly to its viable psychobiotic form, exerts visceral antinociceptive properties in an IBS-like rat model. These effects are associated with GABA production in the stomach where the low pH promotes GAD activity. From a clinical point of view, this “active GAD-bag” concept offers a new therapeutic perspective in the management of visceral pain in IBS patients with a superior safety profile compared with GABA-producing pyschobiotics that could acquire antibiotic resistance and virulence factors in chronic use.

Disclosure

Jonna Koper, Elyse Parent, Nabil Bosco, Nathalie Ballet and Sophie Legrain-Raspaud are full-time employees of Lesaffre. None of the authors have a conflict of interest.

Introduction

H. pylori represents one of the most widespread bacterial infections worldwide and increases the risk of gastric adenocarcinoma and lymphoma. It has been designated a Class I carcinogen by the WHO which leads to the recommendation that all infected patients should be treated [1,2].
Clarithromycin is a key antibiotic in the treatment of H.pylori infection and according to the recent Maastricht VI Consensus Report, empirical treatments for H. pylori eradication should be based on clarithromycin resistance rates. When individual susceptibility testing is not available, the recommended first-line empirical treatment differs according to the local rate of resistance to this antibiotic [3,4,5].
As gastric biopsy culture is invasive and expensive, this technique is mainly performed following treatment failure. However, clarithromycin resistance rates should be studied in different regions of the world according to the fore mentioned recommendations.

Aims & Methods

The aim of this study was to describe the antibiotic resistance profile of H.pylori isolates from gastric biopsies in our geographical area.
A prospective study was performed from October 2021 to December 2022 in our Hospital, a referral tertiary hospital covering an area of 340,000 inhabitants. Gastric biopsies from patients that underwent gastric endoscopy routinely were collected and immediately transported to the laboratory of Microbiology for H. pylori culture and antibiotic susceptibility testing (AST). Pathological Anatomy (PA) results and empirical treatment data were collected from medical records.

Results

641 gastric biopsies were cultured and H. pylori was isolated in 148 by microbiological culture (positivity rate of culture: 22.2%). The median age of patients was 58 years; 52% of them were women and 84.7% were outpatients.
141 out of 148 isolates were available for AST. Most H. pylori isolates (60.3%) were susceptible to all tested antibiotics. Metronidazole and levofloxacin resistance rates were 17% . Rates of resistance to clarithromycin, rifampicin and amoxicillin were 12%, 4.3% and 3.5% respectively. None of the isolates was resistant to tetracycline.
Co-resistance to two antibiotics was detected in 8.5 % of the isolates. The resistance phenotype levofloxacin and clarithromycin was the most frequent co-resistance detected (n=5). Four isolates (2.8%) were resistant to three antibiotics concomitantly. Two of them presented the triple amoxicillin, levofloxacin and metronidazole resistance.
Dual clarithromycin and metronidazole resistance was found in one isolate and another isolate presented the triple clarithromycin, metronidazole and levofloxacin resistance.
The multiplex real-time PCR assay that detects the most frequent mutations associated with clarithromycin resistance in H. pylori was performed on 84 biopsies. The most frequent detected mutation was A2143G (78.9%), followed by A2142G (21.1%).
PA results were available in 623 of 641 cultured biopsies. Results were coincident in 93.4 % of the specimens processed by PA and Microbiology.

Conclusion

The lack of resistance to tetracycline in our isolates suggests that the use of this antibiotic in bismuth containing quadruple therapies could be a good option. Clarithromycin resistance rate below 15% and the high rates of metronidazole resistance may support the use of triple therapy with clarithromycin, amoxicillin and PPI in our area. As antibiotic susceptibility patterns depend on each geographical area and may vary over time, empirical antibiotic treatments for H. pylori infection should be based on local information.PA results were available in 623 of 641 cultured biopsies. Results were coincident in 93.4 % of the specimens processed by PA and Microbiology.

References

1. FitzGerald R., Smith S.M. An Overview of Helicobacter pylori Infection. Methods Mol Biol. 2021, 2283, 1-14. doi: 10.1007/978-1-0716-1302-3_1.

2. Smith SM, O'Morain C, McNamara D. Antimicrobial susceptibility testing for Helicobacter pylori in times of increasing antibiotic resistance. World J Gastroenterol. 2014, 20, 9912-9921. doi: 10.3748/wjg.v20.i29.9912.

3. Malfertheiner P, Megraud F, Rokkas T, Gisbert JP, Liou JM, Schulz C, Gasbarrini A, Hunt RH, Leja M, O'Morain C, Rugge M, Suerbaum S, Tilg H, Sugano K, El-Omar EM; European Helicobacter and Microbiota Study group. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022, gutjnl-2022-327745. doi: 10.1136/gutjnl-2022-327745.

4. de Brito BB, da Silva FAF, Soares AS, Pereira VA, Santos MLC, Sampaio MM, Neves PHM, de Melo FF. Pathogenesis and clinical management of Helicobacter pylori gastric infection. World J Gastroenterol. 2019, 25, 5578-5589. doi: 10.3748/wjg.v25.i37.5578.
   

5. Nyssen OP, Bordin D, Tepes B On behalf of the Hp-EuReg Investigators, et al European Registry on Helicobacter pylori management (Hp-EuReg): patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients Gut 2021, 70, 40-54.