United European Gastroenterology Journal最新文献

Introduction: The prevalence of disorders of the gut-brain interaction (DGBI) among people with obesity in the general population is unknown. Our aim was to assess the prevalence of DGBI among obese subjects in the general population in comparison with normal or overweight subjects, as well as exploring factors associated with DGBI in obesity in Europe.

Methods: We included subjects who completed the internet-based survey of the Rome Foundation Global Epidemiology study in 11 European countries. Obesity was defined as a BMI>30 kg/m² and participants were divided into three classes: 1: BMI 30 to <35 kg/m², 2: BMI 35 to <40 kg/m², and 3: BMI 40 kg/m² or higher. The prevalence of symptoms compatible with DGBI was reported and compared between obese and normal or overweight (BMI between 18.5 and <30 kg/m²) participants. Factors potentially associated with DGBI and obesity including demographics, psychological distress (PHQ-4), non-GI somatic symptoms (PHQ-12), quality of life (PROMIS-10), healthcare access, medication and food consumption were assessed.

Results: We included 20,117 participants in our analysis. The prevalence of obesity was 17.8% (95% CI 17.3, 18.4), with 12.6%, 3.7% and 1.6% in obesity classes 1, 2 and 3, respectively. The prevalence of any DGBI was 44.2% in the obese group versus 39.6% in the normal or overweight group (OR = 1.20 (1.12, 1.30)), with all DGBI being more prevalent in the obese versus normal or overweight group, with the exception for functional constipation where the opposite pattern was seen. Female sex, higher level of psychological distress and more severe non-GI somatic symptoms were seen in the group with DGBI associated with obesity.

Conclusions: Symptoms compatible with DGBI are common among European people with obesity in the general population and are linked with certain demographic and disease-related factors. This should be acknowledged in the management of patients with obesity.

Background and aims: Dye-based chromoendoscopy (DCE) has been the preferred method for colonoscopy surveillance in patients with inflammatory bowel disease (IBD). However, with advances in endoscopy, virtual chromoendoscopy (VCE) techniques have emerged. This network meta-analysis evaluates the effectiveness of different endoscopy techniques for IBD patient surveillance.

Methods: Sixteen randomized controlled trials involving 2514 patients were included in the analysis, comparing endoscopy techniques in IBD patient surveillance: DCE, high-definition white light endoscopy (WLE), standard-definition WLE, i-scan, narrow band imaging (NBI), flexible spectral imaging color enhancement (FICE), and autofluorescence imaging (AFI). We assessed the per patient neoplasia detection rate, positive predictive value (PPV), and withdrawal time between different endoscopy techniques. Moreover, subgroup analysis was conducted to investigate the neoplasia detection rate according to endoscopy techniques using various biopsy protocols.

Results: Comparing neoplasia detection rates revealed that only DCE (OR: 2.56 [1.17-5.59]) significantly increased the neoplasia detection rate compared with standard-definition WLE. The subsequent rankings were high-definition WLE, NBI, FICE, i-scan, and AFI. Moreover, the PPVs of DCE, VCE, and high-definition WLE showed no significant difference compared with that of standard-definition WLE. However, DCE required a significantly longer withdrawal time. Subgroup analysis showed that DCE with random biopsy or target biopsy and high-definition WLE with target biopsy had superior neoplasia detection rates than standard-definition WLE with random biopsy.

Conclusion: DCE significantly outperforms standard-definition WLE in neoplasia detection rates, with random biopsy providing additional benefits. Although DCE does not lower PPV, it requires more withdrawal time. If DCE-based surveillance is not feasible, high-definition WLE with targeted biopsy should be considered as other VCE techniques offer no significant advantages.

Background/aims: Non-coeliac gluten sensitivity (NCGS) is a controversial entity, characterised by symptom improvement with gluten exclusion in the absence of coeliac disease. We primarily investigated the effects of acute and sub-acute gluten on psychological and mood profiles, with secondary outcomes examining gastrointestinal symptoms and biological markers in healthy controls (HC) and individuals with NCGS.

Methods: A randomised, single-blind, crossover study used acute (16 g gluten or whey in yoghurt) and sub-acute (gluten-containing (16 g) or gluten-free muffins per day for 5 days) challenges. (Extra)intestinal symptoms, intestinal permeability, high-sensitive C-reactive protein and cortisol awakening response were assessed. Responses over time were analysed using generalised linear mixed models.

Results: Twenty HCs (15% men, mean age 30 years) and 16 individuals with NCGS (31% men, mean age 33 years) participated. No significant group-by-nutrient interactions were observed. Negative affect scores were higher and positive affect scores were lower in NCGS compared to HC (p = 0.01 and p = 0.04, respectively). Participants experienced higher tension scores after gluten compared with placebo (p = 0.01 acute; p = 0.05 sub-acute) regardless of the group. After acute administration, fatigue scores increased in NCGS (p = 0.03) compared with HC regardless of nutrient intake. After sub-acute administration, abdominal pain scores (p < 0.001) and bloating (p = 0.001) increased in NCGS compared with HC regardless of nutrient intake. No differences were found for biological markers.

Conclusions: These findings reveal that NCGS is characterised by baseline differences in affect, and higher acute fatigue and subacute gastrointestinal symptoms that are not gluten-specific. This may be explained by nocebo effects, warranting research into novel mechanisms and re-evaluating the NCGS definition.

Trial registration: ClinicalTrials.gov no: NCT03798262; NCT03798249.

Background and aims: The long-term outcomes of enteroscopic balloon dilation for small bowel strictures in patients with Crohn's disease are not well understood. Although Crohn's strictures can be classified into web-like, ulcerated, and spindle-shaped strictures based on endoscopic findings, the outcomes of enteroscopic balloon dilation according to the shape of Crohn's strictures have not been analyzed. The primary outcome was to evaluate the cumulative surgery-free rate, and the secondary outcome was to evaluate the risk factor for subsequent surgery after enteroscopic balloon dilation.

Methods: This prospective, longitudinal, observational study enrolled patients with Crohn's disease who underwent enteroscopic balloon dilation for small bowel strictures using single-balloon enteroscopy between 2015 and 2023 at Samsung Medical Center, Seoul, Korea.

Results: A total of 150 consecutive patients who underwent 235 enteroscopic balloon dilations were included in this study with a mean follow-up of 42.4 ± 19.1 months. Thirty-one patients (20.7%) underwent surgery after enteroscopic balloon dilation, and the cumulative 1-, 3-, and 5-year surgery-free rates were 86.7%, 80.4%, and 76.6%, respectively. The cumulative surgery-free rates of enteroscopic balloon dilation for web-like, ulcerated, and spindle-shaped strictures were 96.3%, 91.0%, and 73.3% at 1 year, 96.3%, 84.9%, and 63.0% at 3 years, and 96.3%, 78.3%, and 63.0% at 5 years, respectively (p = 0.001). Multivariate Cox regression analysis identified spindle-shaped stricture (vs. web-like stricture: hazard ratio [HR], 13.33; 95% confidence interval [CI], 1.48-120.24, p = 0.021), ulcerated stricture (vs. web-like stricture: HR, 8.50; 95% CI, 1.05-69.03, p = 0.045), and conventional therapy only (vs. biologic therapy: HR, 2.51; 95% CI, 1.11-5.71; p = 0.028) as risk factors for surgery after enteroscopic balloon dilation. The major complication rate of enteroscopic balloon dilations was 2.7% (4/150) on per-patient analysis and 1.7% (4/235) on per-procedure analysis.

Conclusions: Enteroscopic balloon dilation for small bowel strictures in patients with Crohn's disease may be an effective and safe alternative to surgery. Enteroscopic balloon dilation for web-like strictures showed favorable outcomes and biologic therapy following enteroscopic balloon dilation may be helpful to avoid surgery.

Malabsorption is a complex and multifaceted condition characterised by the defective passage of nutrients into the blood and lymphatic streams. Several congenital or acquired disorders may cause either selective or global malabsorption in both children and adults, such as cystic fibrosis, exocrine pancreatic insufficiency (EPI), coeliac disease (CD) and other enteropathies, lactase deficiency, small intestinal bacterial overgrowth (SIBO), autoimmune atrophic gastritis, Crohn's disease, and gastric or small bowel resections. Early recognition of malabsorption is key for tailoring a proper diagnostic work-up for identifying the cause of malabsorption. A patient's medical and pharmacological history is essential for identifying risk factors. Several examinations such as endoscopy with small intestinal biopsies, non-invasive functional tests and radiological imaging are useful in diagnosing malabsorption. Because of its high prevalence, CD should always be looked for in cases of malabsorption with no other obvious explanations and in high-risk individuals. Nutritional support is key in the management of patients with malabsorption; different options are available, including oral supplements, enteral or parenteral nutrition. In patients with short bowel syndrome, teduglutide proved effective in reducing the need for parenteral nutrition, thus improving the quality of life of these patients. Primary care physicians play a central role in the early detection of malabsorption and should be involved in multidisciplinary teams for improving the overall management of these patients. In this European consensus, involving ten scientific societies and several experts, we have dissected all the issues around malabsorption, including the definitions and diagnostic testing (Part 1), high-risk categories and special populations, nutritional assessment and management, and primary care perspective (Part 2).

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has highlighted the potential exacerbation of gastrointestinal symptoms in patients with disorders of gut-brain interaction (DGBIs). However, the distinct symptom trajectories and psychological burden in patients with post-COVID-19 DGBIs compared with patients with pre-existing irritable bowel syndrome (IBS)/functional dyspepsia (FD) and non-DGBI controls remain poorly understood.

Objectives: To examine the long-term gastrointestinal symptom progression and psychological comorbidities in patients with post-COVID-19 DGBI, patients with pre-existing IBS/FD and non-DGBI controls.

Methods: This post hoc analysis of a prospective multicenter cohort study reviewed patient charts for demographic data and medical history. Participants completed the Gastrointestinal Symptom Rating Scale at four time points: baseline, 1, 6, and 12 months, and the Hospital Anxiety and Depression Scale at 6 and 12 months. The cohort was divided into three groups: (1) post-COVID-19 DGBIs (2) non-DGBI, and (3) pre-existing IBS/FD, with the post-COVID-19 DGBIs group compared to the latter two control groups.

Results: Among 599 eligible patients, 27 (4.5%) were identified as post-COVID-19 DGBI. This group experienced worsening abdominal pain, hunger pain, heartburn, and acid regurgitation, unlike symptom improvement or stability in non-DGBI controls (p < 0.001 for all symptoms, except hunger pain, p = 0.001). While patients with pre-existing IBS/FD improved in most gastrointestinal symptoms but worsened in constipation and incomplete evacuation, patients with post-COVID-19 DGBI exhibited consistent symptom deterioration across multiple gastrointestinal domains. Anxiety and depression remained unchanged in patients with post-COVID-19 DGBI, contrasting with significant reductions in controls (non-DGBI: p = 0.003 and p = 0.057; pre-existing IBS/FD: p = 0.019 and p = 0.007, respectively).

Conclusions: COVID-19 infection is associated with the development of newly diagnosed DGBIs and distinct symptom trajectories when compared with patients with pre-existing IBS/FD. Patients with post-COVID-19 DGBI experience progressive gastrointestinal symptom deterioration and persistent psychological distress, underscoring the need for tailored management strategies for this unique subgroup.

Background: Endoscopic deep learning systems are often developed using high-quality imagery obtained from expert centers. Therefore, they may underperform in community hospitals where image quality is more heterogeneous.

Objective: This study aimed to quantify the performance degradation of a computer aided detection system for Barrett's neoplasia, trained on expert images, when exposed to more heterogeneous imaging conditions representative of daily clinical practice. Further, we evaluated strategies to mitigate this performance loss.

Methods: We developed a computer aided detection system using 1011 high-quality, expert-acquired images from 373 Barrett's patients. We assessed its performance on high, moderate and low image quality test sets, each containing images from an independent group of 117 Barrett's patients. These test sets reflected the varied image quality of routine patient care and contained artefacts such as insufficient mucosal cleaning and inadequate esophageal expansion. We then applied three methods to improve the algorithm's robustness to data heterogeneity: inclusion of more diverse training data, domain-specific pretraining and architectural optimization.

Results: The computer aided detection system, when trained exclusively on high-quality data, achieved area under the curve (AUC), sensitivity and specificity scores of 83%, 85% and 67% on the high quality test set. AUC and sensitivity were significantly lower with 80% (p < 0.001) and 62% (p = 0.002) on the moderate-quality and 71% (p > 0.001) and 47% (p = 0.002) on the low-quality test set. Incorporating robustness-enhancing strategies significantly improved the AUC, sensitivity and specificity to 92% (p = 0.004), 88% (p = 0.84) and 81% (p = 0.003) on the high-quality test set, 93% (p = 0.006), 86% (p = 0.01) and 83% (p = 0.09) on the moderate-quality test set and 84% (p = 0.001), 78% (p = 0.002) and 77% (p = 0.23) on the low-quality test set.

Conclusion: Endoscopic deep learning systems trained solely on high-quality images may not perform well when exposed to heterogeneous imagery, as found in routine practice. Robustness-enhancing training strategies can increase the likelihood of successful clinical implementation.

Background: The association between delayed post-polypectomy bleeding and chronic kidney disease remains unclear.

Objective: This study investigated whether patients with chronic kidney disease are at an increased risk of delayed post-polypectomy bleeding.

Methods: This cohort study included patients who underwent colonoscopy and polypectomy in Korea between 2005 and 2022. We assessed various covariates, including patient-, polyp-, and procedure-related factors, using propensity score matching and inverse probability of treatment weighting to determine the impact of chronic kidney disease on delayed post-polypectomy bleeding risk.

Results: Out of 21,562 patients, 16,591 with 41,014 polyps were included in the analysis. Of these, 2057 (12.4%) had chronic kidney disease, with 894 in early-stage (stages 1 and 2) and 1163 in advanced-stage (stages 3-5). There were 14,534 individuals without chronic kidney disease. After propensity score matching, the risk of delayed post-polypectomy bleeding in patients with chronic kidney disease was significantly higher than that in the non-chronic kidney disease group (OR 1.80, CI 1.12-2.89, p = 0.01). The risk increased with chronic kidney disease stage (OR 2.38, 95% CI 1.01-5.64 for early stage; OR 2.80, 95% CI 1.20-6.51 for advanced stage, all p < 0.05). The results remained robust after inverse probability analysis.

Conclusions: Chronic kidney disease is an independent risk factor for delayed post-polypectomy bleeding, even in the early stages. The risk correlates with the chronic kidney disease stage. Meticulous attention is imperative during polypectomy for all patients with chronic kidney disease, including those in the early stages.