United European Gastroenterology Journal最新文献

Background: Bowel urgency (BU) is reported by over 80% of patients with ulcerative colitis (UC) and 60% of those with Crohn's disease (CD). However, the impact of advanced therapies on BU has not been consistently evaluated.

Objectives: To assess the effect of advanced therapies on BU improvement in patients with UC and CD.

Methods: This retrospective cohort study included all consecutive patients with confirmed UC or CD who started an advanced therapy with available data regarding BU before and after induction therapy between 2023 and 2024 at two tertiary centers. BU was assessed using the numeric-rating-scale urgency score (NRS-us), with BU defined as NRS-us ≥ 3. The primary endpoint was BU improvement (NRS-us ≤ 3 or reduction of at least two points) after the induction phase. Multivariate logistic regression analysis identified factors associated with BU improvement.

Results: A total of 159 patients were included (56% male; 65% UC; median age: 36 years (Interquartile range [IQR] 27-25)). TNFα inhibitors were the most frequently used agents (49.6%). At baseline, the median NRS-us was 7. After induction, 50.9% of patients achieved BU improvement, with a mean reduction of 2.3 ± 2.9 points. BU improvement was significantly associated with clinical remission (false-discovery-rate [FDR] = 0.009 in CD and FDR = 0.010 in UC), normalization of fecal calprotectin (FDR = 0.001), CRP (FDR = 0.008), and bowel wall thickness on intestinal ultrasound (FDR = 0.001). No significant differences were observed between therapeutic classes.

Conclusion: BU improved in approximately half of IBD patients following induction with advanced therapies. Its improvement correlated with clinical, biochemical, and ultrasound remission, supporting the incorporation of BU assessment into routine clinical monitoring.

Background: Histopathological interpretation is crucial for diagnosing inflammatory bowel disease (IBD), distinguishing between Crohn's Disease (CD), Ulcerative Colitis (UC), IBD-Unclassified (IBD-U), and Non-IBD colitis (NIBDC). However, interobserver variability and limited expertise can reduce diagnostic accuracy. Large Language Models (LLMs) such as GPT-5 may offer clinical support in interpreting histology reports.

Methods: We analyzed 100 real-life histological reports from ileo-colonoscopies, equally representing CD, UC, IBD-U, and NIBDC, collected across five Italian healthcare centers, including both IBD-specialized and non-specialized hospitals. A reference standard was established by an expert pathologist. Independent classifications were generated by GPT-5, five gastrointestinal pathologists, five IBD-expert gastroenterologists (GIs), and five non-expert GIs. Diagnostic performance (accuracy, recall, precision, F1-score), agreement with the reference standard (Cohen's κ), and inter-rater reliability (Fleiss' κ) were assessed.

Results: GPT-5 achieved the highest agreement with the reference standard with the highest accuracy (76.0%), compared to pathologists (68.6%), IBD-experts (69.2%), and non-experts (63.2%). Agreement with the reference standard was substantial for GPT-5 (κ = 0.671) and moderate for human groups (κ = 0.508-0.588). GPT-5 showed perfect recall for CD and UC, high recall for NIBDC (96.0%), but poor performance for IBD-U (recall 8.0%, F1-score 14.3%). Fleiss' κ indicated moderate agreement among pathologists and IBD-experts, and fair agreement among non-experts.

Conclusion: GPT-5 demonstrated reliable performance in interpreting IBD histological reports, exhibiting high accuracy and strong agreement with the reference standard. While unreliable for IBD-U, GPT-5 may serve as a supportive tool in histopathological interpretation of IBD, particularly in centers with limited access to expert pathologists or IBD-specialists.

Background: Ileal pouch-anal anastomosis (IPAA) is a standard surgical procedure for ulcerative colitis (UC) and familial adenomatous polyposis. However, pouch-related fistulae (PRF) are a significant complication. There is no consensus on the optimal treatment for PRF.

Objective: This study evaluated the effectiveness of autologous adipose tissue injection (AATI) as a treatment for PRF.

Methods: Twenty-one patients with IPAA and a total of 29 PRF were treated with AATI. Patients who did not achieve healing after the first treatment were offered repeated injections. Patients were followed for a median of 16 months after AATI. Outcomes including clinical healing, treatment complications, and recurrence of PRF were registered.

Results: After a single treatment with AATI, 48% of the fistulae were clinically healed. Repeated treatments increased the healing rate to 69%. An additional 14% responded to AATI by reduced secretion from PRF. The procedure was well tolerated with minimal complications.

Conclusion: AATI appears to be a safe, minimally invasive, and sphincter-saving treatment for PRF with promising healing rates. Further studies with larger cohorts are necessary to validate these findings.

Background: Colorectal cancer (CRC) is a major health concern. In Sweden, a CRC screening program was implemented nationwide between 2019 and 2022. This study evaluated participation, colonoscopy adherence, and diagnostic outcomes for the program's first five years.

Methods: The target group of screening was all residents 60-74 years old. Data were retrieved from SveReKKS, the Swedish national quality register for CRC screening and colonoscopies. A positive FIT test was defined as ≥ 40 μg Hb/g for females, ≥ 80 μg Hb/g in feces for males. Participation, FIT positivity, colonoscopy adherence, quality indicators, and neoplasia detection rates were assessed.

Results: Among 884,866 invitees, the overall participation rate was 64.3%. Participation was higher in older age groups, among females, but lower in regions with low population density. FIT positivity was 2.7%, with no major variation by age or sex. Colonoscopy adherence among FIT-positive individuals was 82%, with lower adherence among men and regional variation. The detection rate for CRC was 6.6%, 29.9% for advanced adenomas and adenocarcinoma, and an overall adenoma detection rate of 49.7%. Quality metrics were high: 98% had adequate bowel preparation, caecal intubation rate was 96%, and the complication rates (bleeding and perforation) were low (0.5% early, 0.7% late).

Conclusion: The first 5 years of the implementation of CRC screening in Sweden demonstrated high participation and excellent diagnostic performance, although colonoscopy adherence fell slightly below the guideline targets. These findings support the effectiveness of FIT-based screening and highlight areas for further improvement, including enhancing colonoscopy uptake among men and in low-density regions.

Background & aims: Metabolic dysfunction-associated steatohepatitis (MASH) increasingly drives hepatocellular carcinoma (HCC) development. We characterized inflammatory infiltrates in liver biopsies from MASH patients who developed HCC versus controls to identify predictive immune signatures.

Method: Formalin-fixed paraffin-embedded (FFPE) liver biopsies from MASH patients were categorized as pre-HCC MASH (n = 10) or control MASH (n = 13) by the ESCALON consortium. Standardized histological analysis and multiplexed immunohistochemistry were performed targeting CD4, CD8, PD1, PDL1, FoxP3, CXCR6, CD3, CD68, and CD20 using a PhenoImager Fusion scanner. Single-cell RNA-seq datasets characterized hepatic CD4 T cell heterogeneity. Clinical parameters measured included ALT, AST, GGT, alkaline phosphatase, platelets, and INR.

Results: Pre-HCC MASH showed inflammation extending from portal to periportal areas versus portal-only distribution in controls. Analysis of 291,908 cells revealed significantly higher CD4+ density (p = 0.0243) and CD4+PD1+ cells (p = 0.017) in pre-HCC patients, while CD8+ and regulatory T cell densities remained unchanged. Single-cell RNA-seq identified potential phenotypic shifts from Th1 cytotoxicity toward tissue-repair and Th17 CD4+ T cells in MASH livers. Combined immunological and clinical variables (sex, age, CD4+ T cell numbers, ALT, alkaline phosphatase and platelets) achieved excellent predictive performance (ROC-AUC = 0.944) for HCC development.

Conclusions: Increase in liver CD4+ T cell infiltration characterizes MASH-to-HCC progression. These immune signatures combined with clinical parameters demonstrate remarkable predictive value for identifying high-risk MASH patients.

Background: While tumor necrosis factor (TNF) inhibitors can induce paradoxical reactions, sarcoidosis-like disease has hardly been reported so far. This study aimed to describe the epidemiological, diagnostic and therapeutic features of TNF inhibitor-induced sarcoidosis-like lesions in patients with inflammatory bowel disease.

Methods: We conducted a case series across 59 institutions affiliated with the Groupe d'Etude Therapeutique des Affections Inflammatoires du Tube Digestif. Diagnosis of TNF inhibitor-induced sarcoidosis was based on typical clinical and radiological signs, histological evidence of non-necrotizing granuloma, exclusion of alternative diagnoses, and a timeline consistent with drug exposure. A pharmacovigilance expert reviewed each case to confirm drug causality.

Results: We identified 14 cases of sarcoidosis-like lesions, including 9 patients with Crohn's disease, 4 ulcerative colitis, and 1 with unclassified inflammatory bowel disease. The implicated medications were infliximab (8), adalimumab (5), and golimumab (1), predominantly in first-time biotherapy users (71%). The median time from treatment initiation to sarcoidosis diagnosis was 27.5 months (range 3-91). Common clinical manifestations included dyspnea (71%), coughing (50%) and fever (50%). Ten patients discontinued TNF inhibitor therapy and started oral steroids, leading to complete symptom resolution in seven cases and improvement in two. Median time from steroid initiation to clinical remission of sarcoidosis was 84 days (range 11-134). After a median follow-up of 40 months, while no relapses occurred in 13 patients, one showed persistent sarcoidosis activity.

Conclusions: TNF inhibitor-induced sarcoidosis should be considered in inflammatory bowel disease patients with chronic respiratory symptoms or fever after exclusion of mycobacterial infection. Management involves discontinuation of TNF inhibitors and a course of steroids.

Background: Limited data are available on the management and outcomes of postoperative Crohn's disease (CD) in older patients. We aimed to describe the management of CD in the postoperative setting and assess surgical postoperative recurrence (POR) in this population.

Methods: This was a case-control study including all adult patients with CD from the ENEIDA registry who had undergone a first intestinal resection with ileo-colonic anastomosis. Patients were grouped according to their age at the time of the first surgery in older (over 60 years) subjects and controls (between 18 and 60 years of age).

Results: A total of 3982 (535 older subjects and 3454 controls) underwent a first intestinal resection for CD with an ileo-colonic anastomosis. Time from CD diagnosis to surgery was significantly longer in older patients (114 ± 128 vs. 93 ± 97 months; p < 0.001). Older patients also had a lower proportion of penetrating CD (25% vs. 39%; p < 0.0001) and perianal disease (14% vs. 25%; p < 0.0001). A significantly lower proportion of older patients started preventive therapies for POR (32% vs. 51%; p < 0.0001). The cumulative risk of surgical POR was 3.2%, 5.3% and 10.1% in the older group and 3.6%, 6.6% and 14.2% in the control group at three, five and 10 years, respectively (p = 0.093). In the multivariate logistic regression analysis, only prevention with thiopurines was associated with a lower risk of surgical POR.

Conclusions: Although postoperative preventive therapy with immunomodulators or biologicals is prescribed less often in older patients after a first intestinal resection, they develop surgical POR as often as younger adult patients.

Background: Filgotinib is a preferential Janus kinase 1 (JAK-1) inhibitor registered for the treatment of ulcerative colitis (UC). Real-world effectiveness of filgotinib, especially for difficult-to-treat (DTT, failure of ≥ 2 prior advanced therapies) patients, has been scarcely reported.

Objective: This study aimed to assess the effectiveness and safety of filgotinib for UC patients in routine care.

Methods: The Dutch ICC registry enrolled UC patients initiating filgotinib and prospectively evaluated outcomes up to 52 weeks. The primary outcome was corticosteroid-free clinical remission (CSFR, Simple Clinical Colitis Activity Index [SCCAI] ≤ 2 without steroid use) at week 52. Secondary outcomes included clinical remission (SCCAI ≤ 2), biochemical remission (C-reactive protein serum concentration < 5 mg/L and/or faecal calprotectin level < 250 μg/g), treatment persistence and safety.

Results: A total of 96 UC patients were included. At 52 weeks, 39.5% (34/76) of patients with disease activity at baseline were in CSFR. Out of the patients that met the criteria for DTT disease (n = 68; 71%), 36.4% achieved CSFR. Treatment persistence at 52 weeks was 71.4% (CI 56.5-90.3) and 53.4% (CI 42.6-67.0) for non-DTT and DTT patients, respectively. The main reasons for discontinuation of filgotinib were primary non-response (n = 21, 54%) or secondary loss of response (n = 8, 23%). No severe infections were documented. Most reported adverse events included headache (n = 5), nausea (n = 3) and hypercholesterolemia (n = 3).

Conclusion: Filgotinib is an effective and well-tolerated treatment option for UC, including DTT disease. No new safety signals were found.

United European Gastroenterology (UEG) has launched an initiative to promote physician well-being and prevent burnout. This current concept article is based on a survey of the National Societies Forum and National Societies Committee, a meta-analysis by Shiha et al., and a scoping review of evidence-based interventions. It identifies key systemic and individual drivers of burnout, outlines its consequences, and presents strategies for intervention-recognising that physician burnout threatens individual health, patient safety, and the sustainability of health care systems. Burnout in gastroenterology is driven by demanding workloads, complex procedures, and increasing administrative tasks. Addressing physician well-being must be viewed as a systemic challenge requiring coordinated efforts from individuals, hospitals, and scientific societies. National and specialist GI societies are pivotal. They must implement initiatives and advocate for systemic change through education, policy advocacy, and sustainable work design. Acknowledgement of burnout is a start. Progress requires commitment to well-being and continuing research.