United European Gastroenterology Journal最新文献

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: Acute pancreatic injury can result from blunt or sharp force trauma, often leading to serious complications. While direct pancreatic trauma is associated with high rates of infection, organ failure, and mortality, little is known about the pancreas as a potential secondary target and remote trauma organ and thereby as a booster of systemic injury.

Methods: We employed a murine model of multiple trauma and hemorrhagic shock in which the pancreas was deliberately spared from the direct trauma impact. Four hours post-trauma, we determined systemic and local inflammatory responses, pancreatic tissue damage, pancreatic lipase (Pnlip in mice), and protease activity, and conducted proteomic profiling of the pancreas. For clinical translation, we performed a post hoc analysis of severely injured polytrauma patients, focusing on acute pancreatic involvement and its association with clinical parameters.

Results: Severe trauma in mice induced rapid systemic inflammation and significantly elevated plasma levels of Pnlip. Notably, pancreatic edema formation was observed in a subset of polytraumatized mice, accompanied by increased activity of matrix metalloproteinases Mmp2 and Mmp9. Proteomic analysis revealed an enrichment of inflammatory and cellular stress pathways in pancreatic tissue. Similarly, in polytraumatized patients, plasma pancreatic lipase (PNLIP in humans) and trypsin concentrations were elevated during the early posttraumatic period and correlated with injury patterns, systemic inflammation, coagulopathy, endotheliopathy, organ failure, and time in hospitals and intensive care units.

Conclusion: Our findings highlight the pancreas as a novel remote responder to severe tissue trauma, even in the absence of direct injury. This widely overlooked dimension of trauma pathophysiology has potential clinical implications. However, further research is essential (i) to unravel the mechanisms driving remote pancreatic enzyme release and (ii) to prove the causality between the pancreatic response and observed clinical parameters.

Background: Bloating refers to the sensation of tension in the abdomen, reported in the presence or absence of visible abdominal distension. These and other gas-related symptoms are often reported by patients with irritable bowel syndrome (IBS) and functional dyspepsia (FD). However, the prevalence of bloating and visible abdominal distension as separate symptoms in these disorders is not well known. The aim of this study was to investigate the link between bloating, distension, and intestinal gas-related symptoms with IBS and FD, and their overall impact.

Methods: Data from a population-based internet survey of adults from the US, UK, and Mexico were used. This survey included Rome IV diagnostic questions for IBS and FD, questions to distinguish between ≥ weekly bloating and/or distension, and the Intestinal Gas Questionnaire (IGQ) to assess the impact of six gas-related symptoms.

Results: The analyses included 131 individuals with only IBS, 360 with only FD, 217 with IBS + FD and 4740 without IBS and FD (reference group). Individuals with IBS (64.9%), FD (50.6%), and especially IBS + FD (88.5%) reported bloating and/or distension more frequently than the reference group (13.7%). Bloating and distension as distinct and combined symptoms were strongly linked to IBS and FD even after correcting for confounding factors. Also, other gas-related symptoms had a higher impact on individuals with IBS and/or FD compared with the reference group.

Discussion: Bloating and visible abdominal distension can occur as concomitant or distinct impactful symptoms and are, together with other gas-related symptoms, strongly linked to IBS and FD. These findings may provide arguments to include bloating and distension as supportive criteria for IBS and FD diagnoses.

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: 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: 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: 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.

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.