Endoscopic Assessment Research Articles

Клинико-лабораторные и ультразвуковые показатели в оценке активности воспаления при болезни Крона

The evolution of ultrasound equipment and the growing experience of investigators have increased the role of intestinal ultrasound in the evaluation of the gastrointestinal tract in patients with Crohn's disease. Purpose of the study: to assess the degree of activity of Crohn's disease using transabdominal ultrasound examination of the intestine Methods. We prospectively evaluated 30 patients aged 18–70 years with an established diagnosis of Crohn's disease. Patients underwent clinical assessment of Crohn's disease activity, laboratory assessment included C-reactive protein and fecal calprotectin, and endoscopic activity was assessed using the simplified endoscopic Crohn's disease assessment method. Segments of the colon and terminal ileum were assessed using intestinal ultrasound. The study was performed by a sonographer using a LOGIQ E9 machine using convex (2.5–5 MHz) and linear [(5–10 MHz) transducers. The study was carried out without special preparation, on an empty stomach, without additional contrast enhancement. Certain ultrasound parameters (intestinal wall thickness, vascularization pattern, intestinal wall architectural disorder, fibrofatty proliferation, mesenteric lymphadenopathy, ascites) were used to determine the sonographic assessment of activity. Statistical analysis was performed using Statistical Package for the Social Sciences (IBM SPSS Statistics 23) Results. Changes in intestinal wall thickness were found in all parts of the intestine, as well as increased vascularity according to the Limberg scale. Intestinal wall thickness was significantly correlated with changes in the level of C-reactive protein, fecal calprotectin and moderately correlated with the clinical activity index. Conclusions. Our study shows that transabdominal intestinal ultrasound is an effective and easy-to-use tool for assessing Crohn's disease activity and monitoring disease progression in routine practice.

Biomarkers in inflammatory bowel disease: a practical guide.

Inflammatory bowel disease (IBD), comprising ulcerative colitis (UC) and Crohn's disease (CD), is a costly condition in terms of morbidity and healthcare utilization, with an increasing prevalence now approaching 1% in the Western world. Endoscopic assessment of IBD remains the gold standard for diagnosis, evaluation of treatment response and determination of post-operative recurrence, but is expensive and invasive. Biomarkers can facilitate non-invasive disease assessment, with C-reactive protein and faecal calprotectin as the most widely available biomarkers in current clinical practice. This narrative review summarizes the evidence for their use in both UC and CD and offers practical guidance for healthcare providers taking into account the limitations of biomarker interpretation. We present evidence for the future use of novel biomarkers in IBD and discuss how biomarker discovery could deliver the goal of precision medicine in IBD.

Kiosk 8R-TB-04 - Cardiac Magnetic Resonance T1 Mapping and Strain in Patients with Crohn’s Disease and Endoscopic Assessment of Inflammation

Kiosk 8R-TB-04 - Cardiac Magnetic Resonance T1 Mapping and Strain in Patients with Crohn’s Disease and Endoscopic Assessment of Inflammation

Accuracy of the Pancolonic Modified Mayo Score in predicting the long-term outcomes of ulcerative colitis: a promising scoring system

Background: Different endoscopic scoring systems for assessing ulcerative colitis (UC) severity are available. However, most of them are not correlated with disease extent. Objectives: Our study aimed to compare the predictive value of the PanMay score versus the endoscopic Mayo (MES), Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and Dublin score in predicting long-term outcomes of UC. Design: This retrospective study enrolled consecutive UC patients who underwent colonoscopy before at least a 3-year follow-up. Methods: The PanMayo, MES, UCEIS, and Dublin scores and the baseline clinical and demographic characteristics of the participants were assessed. Endpoints were disease flare that required novel biological therapy, colectomy, and hospitalization. Patients were stratified using baseline clinical activity. Results: Approximately 62.8% of the 250 enrolled patients were in clinical remission. In these patients, the PanMayo, MES, and Dublin scores were positively associated with the risk of clinical flare. The MES score increased with clinical flare. The PanMayo score (>12 points), but not the MES score, was associated with the need for novel biological initiation and biological escalation. Furthermore, the Dublin and UCEIS scores of patients in remission who need novel biological treatment had a similar trend. Colectomy risk was associated with PanMayo and Dublin scores. Conclusion: The combined endoscopic assessment of disease extent and severity can be more accurate in predicting outcomes among patients with UC. PanMayo score can be utilized in addition to the existing scoring systems, thereby leading to a more accurate examination. Summary: UC endoscopic scores do not assess extension. Our study aimed to analyze the predictive value of the PanMayo score. Based on 250 patients, results showed that the long-term disease outcomes of UC could be predicted with the PanMayo score more accurately.

CURRENT PHARMACOLOGICAL MANAGEMENT IN UPPER GASTROINTESTINAL BLEEDING

Upper gastrointestinal bleeding is a common reason for presentation to the hospital. Appropriate resuscitation followed by endoscopic assessment and endotherapy for high-risk lesions (active bleeding or non-bleeding with visible vessels) forms the cornerstone of management. Pharmacological therapies are utilised at each stage of management in both variceal and non-variceal bleeding. Proton pump inhibitors and prokinetic agents can be administered pre-endoscopically with vasoactive medication and antibiotics utilised in suspected variceal bleeding. Epinephrine may be used as a temporising measure to improve visualisation during endoscopy but should not applied as a single agent. Topical endoscopic therapies have also shown promise in achieving haemostasis. Following endoscopy, a high dose of proton pump inhibitor should be given to patients who require endotherapy and vasoactive medications, and antibiotics continued in confirmed variceal bleeds. The timing of resumption of antithrombotic medication is dependent on the agent utilised and underlying thrombotic risk.

Effect of Premedication with Glycopyrrolate on Patient Tolerance and Procedure Outcomes in Patients Undergoing Unsedated Upper Gastrointestinal Endoscopy: A Randomized Placebo-controlled Trial.

An optimal topical pharyngeal anesthesia (TPA) is required for better patient tolerance and procedural outcomes of an unsedated upper gastrointestinal endoscopy (UGIE). Several additional strategies have been tried to improve patient tolerance with limited success. We hypothesized that premedication with glycopyrrolate would enhance TPA and improve patient tolerance and procedural outcomes of an unsedated UGIE. We conducted a randomized, double-blind, placebo-controlled trial between July 2020 and May 2022. Consecutive patients undergoing unsedated UGIE were randomly assigned to receive either intravenous glycopyrrolate or a placebo 30 minutes before TPA. Patient tolerance, comfort level for the endoscopist, cardiorespiratory fluctuations, percentage of failed esophageal intubation, and incomplete examination were studied. 380 patients were randomized to 190 in each arm. The median (IQR) VAS scores for the overall patient satisfaction in the glycopyrrolate and placebo groups were 8 (1) and 7 (2), respectively (p = 0.04). The median (IQR) VAS scores for endoscopist assessment of patient cooperation in the glycopyrrolate and placebo groups were 8 (1.3) and 8 (1), respectively (p = 0.04). There was no difference in the percentage of failed esophageal intubation and incomplete examination, fluctuations in heart rate, and oxygen saturation of the participants. However, the mean arterial pressure (MAP) on-table before the start of the procedure at 1 minute and 3 minutes was significantly higher in the glycopyrrolate group (p = 0.01, 0.01, and 0.04, respectively). In unsedated UGIE, glycopyrrolate premedication significantly improves the patient tolerance and endoscopist's comfort, with minimal cardiorespiratory effects. Hence, it could be incorporated into day-care unsedated endoscopy practice.Trial registration - CTRI/2020/07/026786. Ramalingam R, Senthamizhselvan K, Harichandrakumar KT, et al. Effect of Premedication with Glycopyrrolate on Patient Tolerance and Procedure Outcomes in Patients Undergoing Unsedated Upper Gastrointestinal Endoscopy: A Randomized Placebo-controlled Trial. Euroasian J Hepato-Gastroenterol 2023;13(2):55-60.

Efficacy and Safety of Ustekinumab for Ulcerative Colitis Through 4 Years: Final Results of the UNIFI Long-Term Maintenance Study.

Ulcerative colitis (UC) is a chronic condition that may require long-term treatment. We report the final efficacy and safety results of the UNIFI long-term extension study of ustekinumab in patients with UC through 4 years. Ustekinumab induction responders who completed 44 weeks of maintenance treatment and agreed to enter the long-term extension continued their subcutaneous maintenance therapy (90 mg ustekinumab every 8 or 12 weeks [q8w or q12w] or placebo). Starting at week 56, randomized patients could receive dose adjustment to 90 mg q8w. Symptoms and adverse events were assessed through the study; endoscopic assessment was conducted at week 200. Of the 348 patients randomized to subcutaneous ustekinumab at maintenance baseline (q8w and q12w combined), 55.2% were in symptomatic remission at week 200. A greater proportion of biologic-naive patients (67.2% [117/174]) were in symptomatic remission than those with a history of biologic failure (41.6% [67/161]). Among patients in symptomatic remission at week 200, 96.4% were corticosteroid-free. Of the 171 patients with endoscopic evaluation at week 200, 81.6% (71/87) in the q12w group and 79.8% (67/84) in the q8w group had endoscopic improvement. From weeks 156 to the final safety visit (up to week 220), no deaths, major adverse cardiovascular events, or tuberculosis occurred in patients receiving ustekinumab. Nasopharyngitis, UC worsening, and upper respiratory tract infections were the most frequently reported adverse events. The long-term efficacy of ustekinumab maintenance in patients with UC was confirmed through 4 years. No new safety signals were observed. ClinicalTrials.gov number NCT02407236.

A Phase 2 evaluation of a new flavored peg and sulfate solution compared to an over-the-counter laxative, peg and sports drink bowel preparation combination

BackgroundAcceptability and tolerance of bowel preparation is critical to overcome patient hesitancy in undergoing colon cancer screening and surveillance colonoscopy. To improve patient experience, a new sports drink-flavored bowel preparation containing polyethylene glycol (PEG) and sulfate salts (FPSS) was developed to provide a similar experience to a commonly used but not United States Food and Drug Administration (FDA) approved PEG and sports drink bowel preparation (PEG-SD), while also achieving improved cleansing efficacy.MethodsThis FPSS preparation, approved by the FDA in June 2023, was evaluated in a non-randomized Phase 2 study in which 40 patients requiring colonoscopy were prepared with FPSS and 20 with PEG-SD.ResultsOverall cleansing success was high with FPSS based on unblinded local endoscopist assessment (93%) and blinded central reading (97%), exceeding PEG-SD which achieved success rates of 84% (local read), 74% and 68% (blinded central reads). Similar differences favoring FPSS were seen for excellent preparations and cleansing success by colon segment as rated by local endoscopists. Both preparations were well-tolerated, with 93% of FPSS patients rating their preparation as Tolerable to Very Easy to consume, compared to 100% of PEG-SD. Patients who had previously taken a preparation for colonoscopy found FPSS and PEG-SD better than their prior preparation (73% and 70%, respectively) and nearly all would request their assigned study preparation again in the future. About two thirds of FPSS patients agreed that the preparation tasted similar to a sports drink.ConclusionThe new sports drink-like flavored preparation compares favorably to PEG-SD for bowel cleansing efficacy while achieving similar patient satisfaction. The study was registered at www.clinicaltrials.gov (NCT03328507) on 01/11/2017.

Role of artificial intelligence in imaging and endoscopy for the diagnosis, monitoring and prognostication of inflammatory bowel disease: a scoping review protocol

IntroductionInflammatory bowel diseases (IBD) are immune-mediated conditions that are increasing in incidence and prevalence worldwide. Their assessment and monitoring are becoming increasingly important, though complex. The best disease control is...

S74 Which Endoscopic Severity Assessment Tool Correlates Best With Non-Invasive Crohn’s Disease Activity Parameters?

S74 Which Endoscopic Severity Assessment Tool Correlates Best With Non-Invasive Crohn’s Disease Activity Parameters?

OGBN P33 The Missing LINX® - Reconstituting the Hill Valve

Abstract Background Magnetic sphincter augmentation (MSA) with LINX® is an increasingly utilised procedure as an effective and safe alternative for fundoplication in the management of gastro oesophageal reflux disease (GORD). Our aim was to evaluate the post-operative LINX® endoscopic appearances in maintaining the competence of the Hills valve. Here we present a retrospective review of endoscopic assessment post insertion of LINX® Reflux Management System. Methods Patients who underwent magnetic sphincter augmentation with LINX® between December 2012 and December 2022 at a single district general hospital were recruited for a retrospective case analysis. Photographs taken at the time of endoscopy were assessed to evaluate the gastroesophageal flap valve using the Hill classification. Results Of 186 patients who underwent MSA, 40 underwent endoscopy post-operatively and of these 35 had photographs suitable for evaluation. There were various indications for endoscopy including dysphagia (13), dyspepsia (9), abdominal pain (7), laryngopharyngeal reflux (2), odynophagia (2), Barrett’s surveillance (1) and food bolus (1). Median time from LINX® to endoscopy was 2.5 years. 33 out of 35 patients (94.2%) were found to have Hills Grade I. One patient (2.8%) had Hills Grade II and one patient (2.8%) had a recurrence of their hiatus hernia, Hills Grade IV. Conclusions Endoscopy is a useful modality to assess symptomatic patients after MSA with LINX®. This study has confirmed reconstitution of the Hills valve on endoscopic assessment in 94.2% of patients. This supports LINX® as an effective and robust solution in the management of GORD.

Evaluation of Disease Activity in Inflammatory Bowel Disease: Diagnostic Tools in the Assessment of Histological Healing.

Inflammatory bowel disease (IBD) comprises two types of chronic intestinal disorders: Crohn's disease and ulcerative colitis. In long-standing ulcerative colitis disease activity, histological persistent inflammation has been linked to an increased risk of relapse, and long-term corticosteroid use, even when endoscopic remission is reached. In Crohn's disease, the discontinuous nature of lesions and transmural inflammation have limited the standardized histological assessment. The current evidence from research proposes that besides clinical and endoscopic healing, the achievement of histological healing constitutes an endpoint to assess disease activity and remission in IBD patients concerning better long-term disease outcomes. Histological alterations may persist even in the absence of endoscopic lesions. For these reasons, new advanced techniques promise to revolutionize the field of IBD by improving the endoscopic and histologic assessment, disease characterization, and ultimately patient care, with an established role in daily practice for objective assessment of lesions. This review outlines the importance of including microscopic evaluation in IBD, highlighting the clinical benefits of a deep state of disease remission using validated diagnostic methods and scoring systems for daily clinical practice.

OGBN P23 Diagnosing and mapping Barrett's oesophagus: a need to be better

Abstract Background The diagnosis of Barrett's oesophagus is made by endoscopic assessment of the oesophageal epithelium and histopathological confirmation of intestinal metaplasia on oesophageal biopsies. There are clear standards for the diagnosis of Barrett's oesophagus described by the British Society of Gastroenterologists (BSG). It is vital to maintain these standards to ensure accuracy of diagnosis (to prevent both over-diagnosis and under-diagnosis) and to ensure that conversion to dysplasia or neoplasia is not missed. This study aimed to assess the quality of Barrett's surveillance at our institution and implement changes in our service to improve diagnosis. Methods All patients who were due to have Barrett's surveillance endoscopy in 2022 were identified from our electronic hospital waiting lists. Initial endoscopy reports, where the Barrett's was diagnosed, were obtained and assessed for quality of adherence to BSG standards, such as image capture, number of biopsies, recording of Prague classification, use of high-definition screens and use of adjuncts (such as infacol or acetic acid). Histopathological reports were obtained and assessed for correlation with endoscopic findings. Results 192 patients were identified for this study. All had Barrett's oesophagus diagnosed between 2016 and 2020, either on endoscopic grounds, histopathological suggestion of intestinal metaplasia, or both. A total of 29 different endoscopists (including consultant gastroenterologists, surgeons, trainees, nurse endoscopists and endoscopists from outsourcing companies) had performed the primary diagnostic scope in this cohort. 55 patients (29%) did not have any images captured and recorded on their endoscopy report. 36 patients (19%) did not have a Prague classification recorded. Only 127 patients (66%) had intestinal metaplasia on biopsies. p53 status was not recorded in any case. Conclusions This study highlights several deficiencies in the current practice of diagnosis of Barrett's oesophagus and these findings may be replicated in other units. These data have been used to develop a wide-ranging quality improvement programme for Barrett's surveillance, including dedicated Barrett's lists shared amongst a small number of experienced endoscopists, use of a high resolution scope and camera system, image capture and appropriate 'pointing' of procedures to allow enough time for accurate mapping and use of endoscopic adjuncts.

The effect of pre-endoscopy maltodextrin beverage on gastric residual volume and patient’s well-being: a randomised controlled trial

Prolonged fasting prior to oesophagogastroduodenoscopy (OGDS) could be noxious to patients’ well-being. Strict fasting protocol has been used prior to OGDS with the concern of reduced visibility or suboptimal endoscopic assessment. Maltodextrin beverages were also commonly used as the pre-operative carbohydrate loading in enhanced recovery after surgery (ERAS) protocol. Our study aimed to look for the effects of maltodextrin beverage 2 h before OGDS on gastric residual volume and patient’s well-being scores. This was a single-blinded, stratified randomised controlled trial, comparing control group (A, received 400 ml of plain water) and carbohydrate loading group (B, received 400 ml of Carborie). The primary objectives were to measure the gastric residual volume (GRV) and patient’s well-being scores using visual analogue scale (VAS) scores for hunger, thirst, anxiety, tiredness and general discomfort. Of 80 randomised patients, 78 completed the study (38 received plain water and 40 Carborie). The median (IQR) GRV was not significantly different between group A and B (5.0 ml (20) vs 4.0 ml (19), p = 0.777). Both groups showed significant reduction in VAS scores in all five parameters (p ≤ 0.001). There were no complications attributed to endoscopy in either group. Pre-endoscopy maltodextrin beverage is as safe as clear water with improved patient’s well-being in both groups.Clinical Trial Registration: NCT05106933.

ImprovedOutcomes of UpperGastrointestinalEndoscopy with Intensive Counselling and Videotapes; ARandomized Controlled Trial

Objective: The purpose of the study that we are currently conducting is to advise patients, implement various measures (such as videotapes), and permit patients' family members to accompany them inside the endoscopy room for the duration of the process in order to improve patients' levels of compliance. Material and Methods: A randomized control trial study was conducted in tertiary care private hospital from March to August 2022. Each group has 125 participants. Consecutive sampling was done in study period and participants were randomly allocated to intervention or control groups. Group A, the intervention group, received counselling about EGD'ssafety and comfort and saw videotapes. Patients'family member was allowed to stay in the endo-scopic room during the procedure. Group B received simply standard protocol counselling. The self-developed questionnaire included socio-demographic characteristics, and an endoscopist assessed procedure difficulty and compliance. Data were entered into SPSS version 20. Compliance, endoscopist evaluation, and esophago-gastroduodenoscopy duration were compared between groups. Results: A total of 250 study participants were included in the study. 125 were randomized in Group A and 125 were randomized in Group B. The most common comorbidities in study participants were diabetes, hypertension and ischemic heart disease. The chi-square test was used to access the time of the procedure, tolerated procedure, and endoscopist assessment between group A and group B. There was a statistically significant improvement in terms of these outcomes with the intervention. Conclusion: Extensive counselling, videotapes, and allowing family members to stay in the endoscopy room improves the outcomes of patients in terms of the time of the procedure, tolerated procedure, and endoscopist assessment.

An education-based telehealth group improves the management and clinical outcomes of patients with inflammatory bowel disease in China (THEIM study).

Although poor medication adherence has a negative impact on disease prognosis in patients with inflammatory bowel disease (IBD), finding proven solutions remains a challenge. In this study, we developed a telehealth management model based on education and patient-centered medical care (PCEB) using the social media platform WeChat. To investigate the effect of PCEB on adherence and clinical outcomes. In this retrospective cohort, 543 IBD patients (274 in the PCEB group and 269 in the routine group) at the IBD center of Renmin Hospital (Wuhan University, Wuhan, China) were enrolled between January 2020 and September 2022. The routine group received routine follow-up and management, while for PCEB patients, a comprehensive IBD education program and PCEB were conducted. Medication adherence and clinical outcomes were also evaluated. There were no differences between the PCEB and routine groups in terms of patient demographics and clinical characteristics, including disease classification, duration, biological treatment, and educational background at baseline. Compared with routine treatment, PCEB greatly improved patient medication adherence, as assessed by compliance with oral medication, enteral nutrition, biological infusion, and scheduled endoscopic assessment. Clinical and endoscopic remission in patients with PCEB increased during short-term (month 4) and long-term (month 12) follow-ups, along with a decrease in relapse rates for CD (13.3% vs. 31.8%) and UC (19.8% vs. 37.2%). The telehealth model applied to the PCEB group improved medication adherence and clinical outcomes in patients with IBD. This is a new and powerful solution for the long-term management of this chronic and progressive disease.

A unicentric cross-sectional observational study on chronic intestinal inflammation in total colonic aganglionosis: beware of an underestimated condition

BackgroundInflammatory Bowel Diseases (IBD) are known to occur in association with Hirschsprung disease (HSCR). Most of cases are represented by Crohn Disease (CD) occurring in patients with Total Colonic Aganglionosis (TCSA) with an estimated prevalence of around 2%. Based on these considerations and on a number of provisional data belonging to our Center for Digestive Diseases, we developed a unicentric cross-sectional observational study aimed at describing phenotype, genotype, pathology and metagenomics of all patients with TCSA and Crohn-like lesions.ResultsOut of a series of 62 eligible TCSA patients, 48 fulfilled inclusion criteria and were enrolled in the study. Ten patients did not complete the study due to non-compliance or withdrawal of consent and were subsequently dropped out. A total of 38 patients completed the study. All patients were tested for chronic intestinal inflammation by a combination of fecal calprotectine (FC) or occult fecal blood (OFB) and underwent fecal metagenomics. Nineteen (50%) tested positive for FC, OFB, or both and subsequently underwent retrograde ileoscopy. Fourteen patients (36.8%) presented Crohn-like lesions, occurring after a median of 11.5 years after surgery (range 8 months − 21.5 years). No statistically significant differences regarding demographic, phenotype and genotype were observed comparing patients with and without lesions, except for need for blood transfusion that was more frequent in those with lesions. Faecal microbiome of patients with lesions (not that of caregivers) was less biodiverse and characterized by a reduction of Bacteroidetes, and an overabundance of Proteobacteria. FC tested negative in 3/14 patients with lesions (21%).ConclusionsOur study demonstrated an impressive 10-folds higher incidence of chronic inflammation in TCSA. Up to 50% of patients may develop IBD-like lesions postoperatively. Nonetheless, we failed in identifying specific risk factors to be used to implement prevention strategies. Based on the results of our study, we suggest screening all TCSA patients with retrograde ileoscopy regardless of FC/OFB values. The frequency of endoscopic assessments and the role of FC/OFB screening in prompting endoscopy is yet to be determined.

Endoscopic Assessment of Cholesteatoma Following Microscope Assisted Tympano: Mastoidectomy: Study design: a cross section descriptive study.

The online version contains supplementary material available at 10.1007/s12070-023-04263-6.

PREVALENCE AND ASSOCIATED FACTORS OF PEPTIC ULCER DISEASE AMONG DYSPEPTIC PATIENTS AT ENDOSCOPY UNIT IN KABUL, AFGHANISTAN

Introduction: Dyspepsia is a medical term utilized to describe a cluster of symptoms related to the digestive system, particularly in the upper gastrointestinal tract. The most prevalent causes of dyspepsia encompass gastro esophageal reflux disease (GERD), peptic ulcer disease (PUD), and non-ulcer dyspepsia (NUD). A peptic ulcer is a sore or erosion that forms in the lining of the stomach, upper part of the small intestine, or lower part esophagus.
 Materials and Methods: The study incorporated 500 dyspeptic patients who underwent upper gastrointestinal endoscopic assessments. This hospital-based analytical cross-sectional study was conducted at the endoscopy unit of different hospitals, spanning from January 1, 2023, to September 30, 2023.
 Results: The findings revealed that out of 500 dyspeptic patients, 45 (9%) exhibited positive results for peptic ulcer, while 455 (91%) displayed non-peptic ulcer conditions. The correlation between dyspepsia and peptic ulcer was statistically significant (χ2= 73, P= 0.01). Gender-specific prevalence indicated that 17 (37.7%) males and 28 (62.2%) females exhibited peptic ulcers. When stratified by age, the prevalence was 20 (44.4%) for individuals aged 18-40, 10 (22.2%) for those aged 41-52, and 15 (33.3%) for those above 52 years. Notably, significant differences were observed among age groups (χ2= 85, P= 0.04). Peptic ulcer prevalence was 16 (35.55%) for urban residents and 29 (64.44%) for rural residents. In the context of smoking habits, 30 (66.6%) of smokers exhibited peptic ulcers, compared to 15 (33.3%) of non-smokers. The association between smoking and peptic ulcers was statistically significant (χ2= 101, P= 0.02). Additionally, 28 (62.2%) of individuals with H. pylori infections displayed peptic ulcers, in contrast to 17(37.7%) without the infection. The association between H. pylori infection and peptic ulcers was statistically significant (χ2= 85, P= 0.05). Regarding NSAID use, 29 (64.4%) of participants who used NSAIDs and 16 (35.5%) who did not use NSAIDs showed peptic ulcer prevalence. The highest prevalence was among individuals using NSAIDs for pain relief. The association between NSAID use and peptic ulcers was statistically significant (χ2= 100, P= 0.05).
 Discussion: These results highlight the significance of addressing these risk factors in the management and prevention of peptic ulcer disease.

Using Computer Vision to Improve Endoscopic Disease Quantification in Therapeutic Clinical Trials of Ulcerative Colitis

Endoscopic assessment of ulcerative colitis (UC) typically reports only the maximum severity observed. Computer vision methods may better quantify mucosal injury detail, which varies among patients. Endoscopic video from the UNIFI clinical trial (A Study to Evaluate the Safety and Efficacy of Ustekinumab Induction and Maintenance Therapy in Participants With Moderately to Severely Active Ulcerative Colitis) comparing ustekinumab and placebo for UC were processed in a computer vision analysis that spatially mapped Mayo Endoscopic Score (MES) to generate the Cumulative Disease Score (CDS). CDS was compared with the MES for differentiating ustekinumab vs placebo treatment response and agreement with symptomatic remission at week 44. Statistical power, effect, and estimated sample sizes for detecting endoscopic differences between treatments were calculated using both CDS and MES measures. Endoscopic video from a separate phase 2 clinical trial replication cohort was performed for validation of CDS performance. Among 748 induction and 348 maintenance patients, CDS was lower in ustekinumab vs placebo users at week 8 (141.9 vs 184.3; P < .0001) and week 44 (78.2 vs 151.5; P < .0001). CDS was correlated with the MES (P < .0001) and all clinical components of the partial Mayo score (P < .0001). Stratification by pretreatment CDS revealed ustekinumab was more effective than placebo (P < .0001) with increasing effect in severe vs mild disease (-85.0 vs -55.4; P < .0001). Compared with the MES, CDS was more sensitive to change, requiring 50% fewer participants to demonstrate endoscopic differences between ustekinumab and placebo (Hedges' g= 0.743 vs 0.460). CDS performance in the JAK-UC replication cohort was similar to UNIFI. As an automated and quantitative measure of global endoscopic disease severity, the CDS offers artificial intelligence enhancement of traditional MES capability to better evaluate UC in clinical trials and potentially practice.