United European Gastroenterology Journal最新文献

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: Data on patient-reported outcome measures (PROMs) of patients undergoing endoscopic resections have been sparse. The aim of our study was the prospective assessment of the Gastrointestinal Quality of Life Index (GIQLI) as a baseline and post-endoscopic resection (ER) measurement in patients with epithelial mucosal neoplasms, adenomas and superficial tumours in the upper and lower gastrointestinal tract.

Methods: The study was designed as a prospective single-centre clinical trial. The applied GIQLI consists of 36 items, which are questions assessing symptoms, emotional facts, and the physical and social status of the patient. A baseline assessment and subsequent follow-up after ER were conducted. The ER consisted of EMR, ESD and EFTR techniques following the guidelines.

Results: Of 347 enroled patients, 238 with an indication for ER were analysed. Prior to the procedure, the GIQLI was at 112.74 ± 20.6, which increased after 4-6 weeks to 115.70 ± 20.6 (p < 0.0001, paired t-test). The improvement of PROMs was due to a highly significant rise in the emotional dimension and to some extent by the improvement of the GI-symptom dimension.

Discussion: This prospective study on PROMs shows a significant improvement in quality of life following endoscopic resection. This appears to be related to a decrease in troublesome symptoms and emotional burden after ER. Further studies are necessary to determine whether the choice of specific endoscopic procedures can have a significant impact on the decision-making process in individual patients.

Background: Hypomorphic variants of sucrase-isomaltase (SI) have been associated with irritable bowel syndrome (IBS) in adults, but how their presence influences therapeutic outcomes is uncertain.

Aims: To investigate the frequency of sucrase-isomaltase hypomorphic variants in patients with IBS and their association with short- and long-term outcomes after initiation of a FODMAP diet.

Methods: Clinical outcomes in patients with IBS were retrospectively examined at mean 7.1 (range 2.5-13.4) years after being educated on a FODMAP diet by a gastrointestinal dietitian and their current food intake (Comprehensive Nutrition Assessment Questionnaire) and gastrointestinal symptoms were documented at interview. DNA extracted from whole blood samples was analysed with the Illumina Global Screening Array for sucrase-isomaltase hypomorphic variants.

Results: Of 72 participants (62% female, median age 59 years), 54% had at least one hypomorphic variant of which 85% were single-carriers. On adjusted binary logistic regression analysis, no differences were noted across SI hypomorphic genotypic groups for retrospective analysis of initial response to a FODMAP diet or long-term symptom control. Current dietary intakes of sucrose or starch were not different between non-carriers and carriers, were directly related to FODMAP intake and did not differ in carriers according to adequacy of symptom control. Findings in those with diarrhoea-predominant IBS (n = 29) were similar to the those in the whole group. Too few double-carriers (n = 6) precluded the definition of associations.

Conclusions: The presence of single sucrase-isomaltase hypomorphic variants is common but was not associated with short- or long-term outcomes or dietary intake for patients with IBS who were taught a FODMAP diet.

This international, multidisciplinary consensus report represents the first effort to systematically define and characterize fatty pancreas. A key outcome of this endeavor was the recommendation to adopt "fatty pancreas" as the standardized and inclusive term to describe all forms of fat accumulation in the pancreas. This terminological consensus provides a critical foundation for unified reporting and clinical communication. Another major contribution of the report is the consensus on diagnostic imaging findings, which was based on radiological and endoscopic modalities. The proposed criteria aim to enhance consistency in clinical assessment and support the development of standardized research protocols. In addition to establishing terminology and diagnostic frameworks, the report also synthesizes current knowledge across a wide range of relevant domains. These include the etiology and epidemiology of fatty pancreas, as well as its associations with alcohol consumption, smoking, acute and chronic pancreatitis, pancreatic exocrine insufficiency, type 2 diabetes mellitus, and surgical outcomes. The potential links between fatty pancreas and neoplastic conditions such as intraductal papillary mucinous neoplasms and pancreatic cancer are also addressed, alongside the current understanding of its metabolic implications (beta-cell function and glucose homeostasis) and treatment strategies. Throughout the consensus process, a consistent theme emerged: the limited availability of high-quality, prospective clinical data. Therefore, many of the recommendations in this report are based on expert consensus rather than strong empirical evidence. As such, the statements require rigorous prospective validation before they can be adopted into routine clinical practice. This underscores a critical need for further research, particularly studies aimed at clarifying causal relationships, validating diagnostic tools, and determining the clinical relevance of fatty pancreas across diverse patient populations. This report serves as both a summary of our current understanding and a roadmap for future investigations, aiming to close existing knowledge gaps and guide evidence-based clinical practice in this emerging field.

Background and aims: No medications are currently approved for the prevention of recurrent acute pancreatitis. This trial evaluated whether naldemedine, a peripherally acting μ-opioid receptor antagonist, reduces the risk of acute pancreatitis in patients with recurrent acute pancreatitis.

Methods: This was a multicentre, double-blinded, placebo-controlled randomised trial conducted at four Danish pancreatitis referral centres. Participants aged 18-75 years with recurrent acute pancreatitis, both with and without a diagnosis of chronic pancreatitis, were randomised to receive naldemedine 0.2 mg or a matching placebo daily for up to 12 months. The primary outcome was acute pancreatitis recurrence, defined by the revised Atlanta Criteria. Secondary outcomes included pain flares, gastrointestinal symptoms, and quality of life. At the end of follow-up, the participant's global impression of change, safety and tolerability outcomes, new-onset diabetes and pancreatic exocrine insufficiency were assessed.

Results: 74 participants (mean age: 46 years; 41% female) were randomised to naldemedine (n = 36) or placebo (n = 38). During a median follow-up time of 365 days (IQR, 352-370), participants in the naldemedine group had a numerically lower risk of acute pancreatitis compared to placebo (HR 0.54; 95% CI, 0.29-1.01; p = 0.05). No differences were observed between the groups for secondary efficacy, safety, and tolerability outcomes. Participants treated with naldemedine for at least 1 year had a lower risk of acute pancreatitis (HR 0.49; 95% CI, 0.24-0.97; p = 0.04).

Conclusions: Treatment with naldemedine was safe and well-tolerated and may reduce the risk of recurrent acute pancreatitis. A larger confirmatory trial is needed to verify these findings.

Trial registration: ClinicalTrials.gov Identifier: PAMORA-RAP: NCT04966559.

Background: Little is known about the genetic background of individuals with familial pancreatic cancer (PC). Integrating germline testing into surveillance may uncover previously unrecognized hereditary susceptibility and expand prevention strategies beyond BRCA testing alone. This study evaluated the genetic landscape of high-risk individuals due to familiality (HRI-FHs) enrolled in a national surveillance program.

Methods: Five hundred HRI-FHs from seven centers underwent surveillance and germline testing with a 41-gene NGS panel. Pathogenic/likely pathogenic variants (PGVs) and variants of unknown significance (VUS) were identified and correlated with clinical and imaging findings.

Results: Overall, forty-four (8.8%) out of 500 HRI-FHs carried at least one PGV, including 3.4% in high-penetrance genes (ATM, BRCA1/2, PALB2, BRIP1). Notably, 8 out of 17 (47%) of ATM, BRCA1/2, PALB2 carriers would not have met the national testing criteria based solely on their family history. An additional 5.4% (27/500) carried PGVs in genes linked to other hereditary conditions (CFTR, MUTYH, CTRC, SPINK1, APC), and 39.6% harbored at least one VUS. PGV status, age, and female gender were independent predictors of radiological abnormalities. Two PCs were diagnosed, both in mutation-negative individuals.

Discussion: Integrating germline testing into surveillance redefines the management of familial PC. It uncovers hereditary susceptibility beyond classical criteria and supports cascade testing. PC also arises in mutation-negative HRI. #NCT05724992.

Background: Crohn's disease (CD) and ulcerative colitis (UC) are progressive inflammatory bowel diseases that often result in bowel damage, imposing a significant burden on patients with insufficient disease control due to the limited efficacy of current treatments or complex disease management. There are limited data on how disease monitoring informs treatment decisions in daily clinical practice. The IBD-PODCAST study aimed to estimate the proportion of Crohn's disease and ulcerative colitis patients experiencing suboptimal disease control in a real-world setting.

Objectives: To evaluate disease monitoring practices and their impact on physicians' actions and treatment decisions for patients with suboptimal disease control.

Methods: A non-interventional cross-sectional study was conducted across 103 sites in 10 countries. Criteria for suboptimal disease control were based on STRIDE-II criteria, adapted by an expert panel.

Results: 2185 patients (Crohn's disease: n = 1,108, ulcerative colitis: n = 1077) with a mean (SD) age of 44.0 (14.8) years and disease duration of 12.4 (9.2) years were included. Suboptimal disease control was present in 52.2% of CD (n = 578) and 44.3% of UC patients (n = 477). Disease monitoring via imaging and/or endoscopy over a 12-month period was conducted in approximately 40% of the patients. In patients that were lacking annual monitoring via imaging/endoscopy and/or biochemical monitoring at index, an optimal disease status indicating no objective inflammation was observed in only 31.1% of CD and 36.4% of UC patients. In patients with suboptimal disease control, 391 CD (67.6%) and 324 UC (67.9%) had clinically relevant parameters. In around 50% of these patients, physicians took action.

Conclusions: Annual disease monitoring via imaging/endoscopy was performed in only 40% of inflammatory bowel disease patients. Physicians modified treatment in approximately half of patients with suboptimal disease control and clinically relevant parameters. The study emphasized the importance of consistent monitoring and taking action when targets are not met to improve the quality of life of patients with inflammatory bowel disease.

Background: Reproduction is a fundamental aspect of life. This study aimed to provide an international overview of gastroenterologists' approaches to managing inflammatory bowel disease (IBD) during preconception, pregnancy, lactation, and postpartum.

Methods: An anonymous 75-question survey was distributed to gastroenterologists in 36 countries, including European countries, the United States of America, Latin American countries, Australia, and New Zealand, focusing on clinical practices for managing pregnancy and breastfeeding in IBD patients.

Results: A total of 856 gastroenterologists participated, 61% were IBD specialists. In pregnant patients in remission, participants stated they would discontinue IBD therapy as follows: 19% for thiopurines, 41% for anti-TNF, 37% for vedolizumab, 31% for ustekinumab, and 96% for small molecules. Many gastroenterologists avoided initiating oral or rectal budesonide, anti-TNF, vedolizumab, or ustekinumab during disease flares. Despite existing safety concerns, one-third of gastroenterologists reported initiating thiopurines to manage disease flares during pregnancy. Only 50% of gastroenterologists had specialized follow-up programs for pregnant patients with IBD in remission. Thirteen percent of gastroenterologists believed that all drugs were safe during breastfeeding. For vaccinations, about 20% advised against non-live vaccines, and 50% avoided live-vaccines during the first 12 months for infants exposed to anti-TNF in utero. Few gastroenterologists had referral pathways to IBD-specialized obstetricians or paediatricians.

Conclusion: Our international survey suggests that management of IBD during pregnancy, lactation, and postpartum remains suboptimal, even among gastroenterologists specifically dedicated to IBD. Urgent educational efforts are needed to address these issues and improve care.