General Gastroenterology Research Articles

60 Exploring clinician perspectives on the utility and impact of psychosocial assessment on the management of hospitalized paediatric patients

Abstract Background A substantial number of paediatric inpatient, medical admissions may involve underlying psychosocial challenges. However, patients’ in-hospital care will focus on patients’ acute medical needs, despite growing evidence that holistic care incorporating patients’ broader psychosocial needs could improve physical health outcomes and health-related quality of life. Psychosocial assessment tools may facilitate clinicians’ ability to identify and address underlying mental health needs. Nonetheless, it remains unclear whether clinicians perceive these tools, and the clinical information they generate, as adding value to patient care planning. Objectives This study determines to explore the clinician-perceived views on the MyHEARTSMAP tool report and whether this report has impacted their patient care, and if so, how. Design/Methods We conducted a cross-sectional survey sub-study, within a larger randomized control trial at BC Children’s Hospital, sampling from nine inpatient specialties: general paediatrics, cardiology, nephrology, neurology, endocrinology, gastroenterology, orthopaedic surgery, urology, and general surgery. The survey was designed, validated, and administered using the Modified Dillman’s approach. Automated reminders were sent to participants if they did not respond to the survey after completing the consent form. . Eligible clinicians were asked to provide their perceptions towards the MyHEARTSMAP report through an online survey. Eligibility screening and consent retrieval were obtained prior to clinicians completing the survey. Qualitative and quantitative analyses of survey responses were conducted, summarizing proportions and counts of closed-ended responses and a content analysis of open-ended items. Results A total of 65 clinicians enrolled into our study (88% women, 85% nurses). Most clinicians (92%) found that patient-reported psychosocial assessment was beneficial for establishing patient-clinician relationships and providing information about the patient’s mental health that may not have been previously queried about. Of the clinicians who had read and used the MyHEARTSMAP screening report in their practice, a majority (84%) found it helpful for their patient care. Most clinicians felt that the MyHEARTSMAP screening report facilitated clinician-patient communication (87%) and patient involvement in the care process (90%). About half of the clinicians (52%) felt the screening report’s interface and design could be improved to allow for ease of use. Currently, the paper screening report is placed in the patients’ physical chart for clinicians to assess, but they would prefer it to be implemented onto the digital charting system used at BC Children’s Hospital. Conclusion Clinicians' perceptions towards the MyHEARTSMAP report showed acceptability amongst those who had previously encountered it. While clinicians believe psychosocial screening is beneficial, exploring options for better accessibility to the screening results is necessary to increase utilization.

Complications of deep infiltrative endometriosis of gastrointestinal tract

Objective. To summarize the literature data on the main complications of deep infiltrative endometriosis, including ileocecal. Endometriosis is a complex disease that can begin to develop from birth. Despite all the already existing theories of the origin and development of this disease, further large-scale studies are required to investigate the etiology, pathogenesis, and phenotypes of this nosology and its relationship with pain and infertility. External genital endometriosis often affects various parts of the gastrointestinal tract. The rectosigmoid junction of the colon is most commonly affected (81.3%), followed by the appendix (6.4%), small intestine (4.7%), dome of the cecum (4.1%), and other parts of the gastrointestinal tract (1.7%). In recent years, interest in ileocecal endometriosis and its timely diagnosis and treatment has begun to grow among practicing specialists. Presently, deep infiltrative endometriosis is widely studied by obstetricians–gynecologists and by related specialists, such as general surgeons, coloproctologists, and gastroenterologists, in connection with extragenital lesions leading to severe complications. Cases of intestinal perforation caused by deep infiltrative endometriosis, bleeding, and small intestinal obstruction have been described.

Analysis of Deep Vein Thrombosis: A Prospective Observational Study.

Objective This prospective observational study aimed to investigate the prevalence, acquired risk factors, and treatment outcomes of deep vein thrombosis (DVT) at a tertiary care center in India. Materials and methods Conducted from 2022 to 2024, the study included 100 patients diagnosed with lower extremity DVT. The study subjects included patients visiting the general surgery, vascular surgery, surgical gastroenterology, general medicine, emergency medicine, and obstetrics and gynecology departments with symptoms suggestive of DVT. The primary objectives were to evaluate the effectiveness of conventional anticoagulation and thrombolytic therapy as well as to assess the various acquired risk factors for DVT. Patients underwent comprehensive clinical and biochemical evaluations, including venous Doppler ultrasound, and were treated based on their clinical presentations. The study's primary end outcome was early recanalization rates on day 14 post-initiation of treatment and occurrence of post-thrombotic syndrome (PTS). Secondary outcome measures included duration of hospital stay, time taken to return to workand early complications. Results The highest incidence of DVT was in individuals in their forties, with a mean age of 44.84+/-11.71 years and a female preponderance of 58% (n=58). Key acquired risk factors identified included hypertension (25%; n=25), diabetes mellitus (20%; n=20), obesity (16%; n=16), and smoking (34%; n=34). Obesity (16%; n=16), a history of DVT (25%; n=25), trauma/immobilization (9%; n=9), pregnancy (10%; n=10), smoking (34%; n=34), and cancer (20%; n=20) were also identified as important acquired risk factors contributing to the occurrence of DVT. Amongst the study participants, 28% (n=28) had femoro-popliteal segment involvement, 36% (n=36) had calf vein thrombosis, and the remaining 36% (n=36) showed femoro-iliac segment thrombosis. Conventional anticoagulation was administered to 69% (n=69) of patients, while 31% (n=31) received thrombolytic therapy. Both treatments showed similar recanalization rates, but thrombolytic therapy was associated with a longer hospital stay (8.61+/-1.65 days; p=0.024; p<0.05) and return to work period (14.65+/-2.31 days; p=0.012; p<0.05). Post-thrombotic syndrome was less common in the thrombolytic therapy group (3%; n=3). Three patients died in the study, with the cause being pulmonary embolism. The descriptive statistics were computed to delineate the study sample. After completion of data collection, data analysis was achieved using SPSS for Windows, Version 16 (Released 2007; SPSS Inc., Chicago, United States), and the correlations sought after were achieved using the chi-square test of significance. Conclusion The study underscores the importance of recognizing and managing acquired risk factors for DVT, thereby facilitating early diagnosis and ultimately reducing morbidity and mortality. Understanding these factors and employing effective treatment strategies are crucial for better management and prevention of DVT, enhancing patient outcomes.

Choosing Your Endoscopist: A Retrospective Single-Centre Cohort Study.

Background Colorectal cancer is one of the most commoninternal malignancies affecting Australians, and colonoscopy is widely accepted as a part of comprehensivelarge bowel assessment. Different specialties perform colonoscopies, most commonly general surgeons and gastroenterologists. Analysing performance outcomes against benchmarks allows insight into inter-specialty differences and enables the improvement of overall service provision and quality. Methods We performed a retrospective single-centre cohort study on 2086 patients undergoing colonoscopies by seven surgeons (S) and nine gastroenterologists (G) between July 2021 and June 2023. Primary outcomes were comparative caecal intubation rates (CIR), photo documentation rates (PDR), documented withdrawal rates (DWR), withdrawal times (WT), and adenoma detection rates (ADR). Secondary outcomes characterised adenoma frequency, optimal WT, and indications for colonoscopies. Results We found significant differences in CIR (S: 94.9%, 990/1043;G: 99%, 1033/1043, P<0.01), PDR (S: 95.9%, 949/990; G: 99.1%, 1024/1033, P<0.01), DWR (S: 17.4%, 181/1043; G: 87.3%, 911/1043, P<0.01), WT >6 minutes (S: 82.3%, 149/181; G: 97.8%, 891/911, P<0.01), and ADR (S: 37.9%, 193/509; G: 59.7%, 421/705, P<0.01). Subgroup analysis revealed adenoma frequency peaked at 50-70 years oldand optimal WT was ≥9 minutes. We demonstrated surgeons mainly perform colonoscopies for diverticulitis surveillance, abnormal imaging, post-cancer resections, and rectal bleeding, but gastroenterologists predominantly investigate bowel symptoms, polyp surveillance, positive faecal occult blood test, and anaemia. Conclusion Despite both specialties surpassing national standards in CIR and ADR, there were significant differences in performance indicators. We believe ADR differences could be explained by different indications specialties perform colonoscopies for. Increasing WT ≥9 minutes could improve ADR, and education on the usage of withdrawal timer on endoscopes will improve DWR.

Dietary Habits and Their Impact on Gastroesophageal Reflux Disease (GERD).

Introduction Gastroesophageal reflux disease (GERD) is marked by the frequent occurrence of stomach acid flowing back into the esophagus, causing symptoms such as heartburn and acid regurgitation at least once a week. When reflux leads to troublesome symptoms and esophageal damage and adversely affects quality of life, it is diagnosed as GERD. Age, gender, ethnicity, genetic predispositions, and aspects of diet and lifestyle, including factors like obesity and smoking, are associated with GERD. Methodology This cross-sectional study was conducted within the Departments of General Medicine, Surgery, and Gastroenterology at Khyber Teaching Hospital (KTH) in Peshawar, spanning from January 2024 to June 2024. Patients who visited these departments or the Outpatient Department within the specified period with GERD were included in the study. A non-probability purposive sampling technique was used. For the analysis, we utilized IBM SPSS Statistics version 21. Results This study consists of 280 participants. The mean age of the participants in this study was 44.60 years. GERD has a significant association with obesity (69.99) and lack of exercise (80%), and a negative association was found between other gastrointestinal conditions (55.71%) and smoking (64.28). Common symptoms among GERD patients were swallowing difficulty, regurgitation, heartburn, and chest pain. Conclusion Our study is the first to examine the relationship between lifestyle factors and GERD among Pakistani patients. Our findings highlight significant associations between GERD and several factors, including gender, BMI, dietary habits, and lack of exercise. Notably, cultural and regional differences appear to influence GERD prevalence and its risk factors, as demonstrated by the minimal impact of alcohol consumption in our study population.

Optimizing Cost-Effective Care for Chronic Constipation in General Gastroenterology Using an Office-Based, Point-Of-Care Test (RED): Cost-Effectiveness and Cost-Minimization Analysis.

We aimed to evaluate the cost-effectiveness/cost-savings of point-of-care anorectal function testing with an investigational device (RED) to triage therapy for chronic constipation in general gastroenterology. A Markov model was constructed to evaluate cost-effectiveness/cost-savings over a 1-year time horizon comparing empiric drug/pelvic floor physical therapy to testing guided care. RED appears to inform the cost-effective strategy for chronic constipation. Compared with usual care without RED, it reduces insurer costs by $810 and patient costs by $6,903. Point-of-care testing using RED appears cost-effective/cost-saving to triage chronic constipation care in general gastroenterology.

The Saudi Gastroenterology Association consensus on the clinical care pathway for the diagnosis and treatment of GERD.

Gastroesophageal reflux disease (GERD) is one of the most common problems encountered in outpatient general medicine and gastroenterology clinics. GERD may present with classic esophageal symptoms, extraesophageal symptoms, or mixed symptoms. The diagnosis and treatment of GERD are challenging due to the variety of symptoms and multifactorial pathophysiology. Since there is no consensus on the diagnosis and treatment of GERD in Saudi Arabia, the Saudi Gastroenterology Association established an expert group to formulate a consensus on the clinical care pathway for the diagnosis and treatment of GERD to update health-care providers in Saudi Arabia. The expert group reviewed the literature including recently published international guidelines, clinical trials, and expert opinion and conducted virtual and in-person meetings. A total of 22 statements on the definition, diagnosis, and treatment of GERD were formulated, and three algorithms for the clinical care of GERD were developed with a detailed description for each step. The expert group endorsed the new definition of GERD, the practical principles of interpretation of the diagnostic GERD evaluation, and the practical guidance for GERD treatment including medical, surgical, and endoscopic therapy. The expert group recommends further studies to investigate local data on the diagnosis and treatment of GERD.

Managing cow's milk protein allergy during the 2022 formula shortage: decision-making among pediatric healthcare providers.

Cow's milk protein allergy (CMPA) affects 2%-7% of infants and is managed with hypoallergenic formulas. The 2022 recalls of infant formulas due to factors including contamination led to specialty formula shortages, highlighting CMPA management challenges. Understanding healthcare providers' (HCPs) decision-making in transitioning to alternative formulas during shortages is crucial. Limited attention has been given to how pediatric physicians make these choices. This study utilized US HCPs' de-identified survey data to assess driving factors when switching extensively hydrolyzed formulas during shortages. 104 eligible HCPs participated, including general pediatrics, pediatric allergy/immunology, and pediatric gastroenterology specialists. Safety, tolerability, and efficacy were identified as top factors for switching formulas. Formula 1 was considered well-tolerated, patient-accepted, and safe by all HCPs. Most expressed strong belief in Formula 1's safety and effectiveness. Findings inform CMPA management during shortages, offering guidance to HCPs for suitable formula selection and enhanced infant care.

Патология билиарного тракта: от МКБ-10 к МКБ-11

Pathology of the biliary tract is widespread among the adult population of many countries around the world. This is due to the high incidence of risk factors in these populations. In addition to the commonality of risk factors and progression, another characteristic feature of the entire group of biliary diseases of both organic and functional nature is the presence of similar clinical manifestations. The main manifestation of biliary tract pathology is biliary pain. This article reflects modern data on the most common variants of biliary tract pathology in the practice of general practitioners and gastroenterologists in the light of the transition from ICD X to ICD XI, and presents a step-by-step diagnostic algorithm and approaches to the management of patients with biliary pain, including an example own clinical case.

Acute toxic hepatitis caused by ashwagandha consumption

Drug-induced liver damage is becoming one of the important liver diseases and a diagnostic problem for general practitioners and gastroenterologists. A case report of suspected liver damage caused by ashwagandha is described. The disease appeared 2 months after starting to take ashwagandha 1 g per day and occurred with cholestatic and cytolytic forms of liver damage, jaundice and skin itching. The therapy led to an improvement in the patient's general condition, but the jaundice tended to be protracted. It is recommended to avoid repeated use of dietary supplement (Ashwagandha).

Extensively Hydrolyzed Formula and Infant Colic Symptoms: Secondary Analysis of a Prospective Cohort Study.

Cow's milk protein allergy (CMPA) affects 2% to 3% of infants and is managed with hypoallergenic formulas. The 2022 recalls of infant formulas due to factors including contamination led to specialty formula shortages, highlighting CMPA management challenges. Understanding health care providers' (HCPs) decision-making in transitioning to alternative formulas during shortages is crucial. Limited attention has been given to how pediatric physicians make these choices. This study utilized US HCPs' de-identified survey data to assess driving factors when switching extensively hydrolyzed formulas during shortages. A total of 104 eligible HCPs participated, including general pediatrics, pediatric allergy/immunology, and pediatric gastroenterology specialists. Safety, tolerability, and efficacy were identified as top factors for switching formulas. Formula 1 was considered well-tolerated, patient-accepted, and safe by all HCPs. Most expressed strong belief in Formula 1's safety and effectiveness. Findings inform CMPA management during shortages, offering guidance to HCPs for suitable formula selection and enhanced infant care.

An endoscopic scoring system for achalasia: the CARS score

Background and AimsThe diagnosis of achalasia is associated with an average delay of two years. Endoscopic features may prompt an earlier diagnosis. We aimed to develop and test a novel endoscopic CARS score for the prediction of achalasia. MethodsPart 1: Twenty endoscopic videos were taken from patients undergoing endoscopy for dysphagia or reflux. A survey with videos and endoscopic criteria options was distributed to 6 esophagologists and 6 general gastroenterologists. Inter-rater reliability (IRR) was measured and logistic regression was used to evaluate predictive performance. Three rounds of review were conducted to select the final score of four components. Part 2A retrospective review was conducted for consecutive patients who had comprehensive esophageal testing. Each patient had a CARS endoscopic score calculated based on findings reported at endoscopy. ResultsFrom a video review and analysis of score components, IRR ranged from 0.23 to 0.57 for score components. The final CARS score was selected based on the following four components: Contents, Anatomy, Resistance, and Stasis. In a mixed effects model, the mean score across raters was higher for achalasia compared to non-achalasia subjects (4.44 vs. 0.87, p = < 0.01). In part 2 of the study, achalasia patients had a higher mean CARS score compared to those with no / ineffective motility disorder (mean 4.1 vs 1.3, p = < 0.01). ConclusionsWe developed a CARS score based on reliability performance in a video-based survey and tested the score in clinical setting. The CARS score performed well in predicting achalasia.

Hemothorax Due to Transdiaphragmat-ic Liver Penetrating Injury Caused by Broken Knife

Thoracic trauma is one of the most fatal cases of patients admitted to emergency departments. Thoracic trauma occurs in 20–25% of all trauma patients worldwide and is the third cause of trauma-related deaths. Approximately 5% of trauma admissions are liver injuries. In some blunt or penetrating injuries, both intrathoracic and intra-abdominal organs may be injured. It is aimed to present the case of a broken knife entering from the right paravertebral location, causing hemothorax as a result of diaphragm and liver injury without injuring the lungs, due to the importance of the multidisciplinary approach among surgical departments in the study.&#x0D; A 44-year-old male patient was admitted to the emergency department due to penetrating injury. An oblique injury of approximately 5 cm was seen in the posterior part of the right hemithorax. Radiologically, It was detected that the knife, which entered through the 10th intercostal space, was stuck inside and the knife handle was broken. It was observed that the broken blade entered from the paravertebral region, passed into the intrathoracic area, causing hemothorax, and passed from the edge of the inferior vena cava and embedded itself in the liver. Multidisciplinary operation planning was made among the departments. All department surgeons were present in the operating room at the same time. The paravertebral space was assessed and the embedded blade was slowly withdrawn by the neurosurgeon. Explorative laparotomy was done by the general surgeon and gastroenterology surgeon. Transdiaphragmatic injury was evaluated by the thoracic surgeon and major vascular structures were evaluated by the cardiovascular surgeon. In the postoperative period, the patient was discharged on the 5th postoperative day with full recovery without any complications.&#x0D; Penetrating trauma is one of the most fatal cases of patients admitted to emergency departments. In some cases, intrathoracic and intra-abdominal penetrating injury may occur together, rarely from a single entrance location. The timing of critical intervention varies depending on whether the patient's vitals are stable or unstable. If the hemodynamics are stable in penetrating injuries, all affected anatomical structures should be evaluated with radiological examinations. For successful, uncomplicated surgical treatments, controlled techniques, interdepartmental consensus and, when necessary, simultaneous presence of surgeons in the surgery are essential

Home-based fecal calprotectin utilization in a general pediatric gastroenterology clinic.

Remote investigation and monitoring have gained importance in ambulatory practice. A home-based fecal calprotectin (FC) test has been developed where the sample is processed and analyzed at home through a smartphone application. We aimed to assess the use of standard ELISA (sFC) versus home-based (hFC) FCtesting in a general pediatric gastroenterology clinic. Ambulatory pediatric patients with hFCor sFC performed between August 2019 and November 2020 were included. Data regarding demographics, clinical characteristics, medication use, investigations, and final diagnosis, categorized as inflammatory bowel disease (IBD), functional gastrointestinal (GI) disorders, organic non-IBD (ONI) GI disorders, non-GI disorders, and undetermined after 6 months of investigation, were recorded. A total of 453 FC tests from 453 unique patients were included. Of those, 249 (55%) were hFC. FC levels (median) were higher in children with IBD compared to non-IBD diagnosis (sFC 795 vs. 57 μg/g, hFC 595 vs. 47 μg/g, p < 0.001), and in ONI compared to functional GI disorders (sFC 85 vs. 54 μg/g, p = 0.003, hFC 57 vs. 40 μg/g, p < 0.001). No significant difference was observed between different ONI GI disorders or subtypes of functional disorders. Age did not significantly influence levels. Overall, hFC and sFC provide similar results in the general pediatric GI ambulatory setting. FC is a sensitive but not disease-specific marker to identify patients with IBD. Values appear to be higher in ONI GI disorders over functional disorders, although cut-off values have yet to be determined.

P814 Empowering IBD communities worldwide: The global impact of www.ibd-eii.com in disseminating evidence-based information and educational support

Abstract Background In recent decades, the volume of inflammatory bowel disease (IBD) research has surged, presenting a challenge for health care professionals to be updated. This is even more complicated for professionals in countries with low IBD prevalence and for registrars, fellows and other healthcare professionals. Methods IBD-EII website was launched the 8th February 2023 and serves as a comprehensive, unfunded and free platform offering up-to-date IBD evidence-based data. To highlight the impact, analyzing its first 8 months (data extracted via Google Analytics as of October 26, 2023) and using a google form questionnaire that was sent to subscribers in August 2023. Results The website encompasses over 300 trials and study summaries, along with 22 evidence-corner summaries, 102 guidelines from 12 scientific societies, 19 infographics featuring classifications and scores, 65 Cochrane meta-analyses and 13 network meta-analysis. Over the study period, there were 151,736 visits from 139 countries, with an average of 8.29 visits per user. The top-engaged countries were the United States, United Kingdom, Spain, Russia, and India (Figure 1). The site garnered 1058 subscriptions, with 10 (0.9%) individuals unsubscribing during the study period. Of the 850 invited users, 81 (9.5%) filled the questionnaire. Of them 53 (65.4%) were female. There were 49 (60.5%) healthcare professionals, 35 (43.2%) patients/family members of a patient, 4 (6%) were IBD researchers/ pharma industry workers, working for patients organization or both doctor and patient. Among healthcare professionals, 22 (44%) were IBD specialists, 14 (28%) general gastroenterologists, 4 (8%) trainees/ med school, 12 (24%) were IBD nurses/dieticians or pharmacists, 3 (6%) others. Most people have heard of the website in social media 66 (81.5%), by colleagues recommendation 8 (9.9%), congresses 7 (8.6%), or other 5 (6%). Website impact: 80 (98.8%) thought it was useful, 80 (98.8%) recommended to be subscribed. The most valuable sections were "evidence corner" 56 (69.1%) followed by guidelines 48 (59.3%) and timeline 35 (43.2%). Conclusion The data highlights the significant global impact of www.ibd-eii.com in disseminating evidence-based information to a diverse international community of healthcare professionals and patients. The website stands as a novel resource, fostering collaboration and empowerment within the global IBD community.

P253 Knowledge and acceptability of the Lémann Index to measure progressive intestinal damage in Crohn’s disease: results from an international cross-sectional survey

Abstract Background Chronic inflammation in Crohn’s disease (CD) predisposes to progressive structural bowel damage (SBD). The Lémann index (LI) is a prospectively validated tool that captures extent and severity of strictures, penetrating disease and surgery to generate a SBD score.1 It is earmarked as a potential outcome measurement tool for CD modification trials. Understanding perceived barriers and knowledge gaps is critical to its wider adoption. Methods We conducted a multinational, cross-sectional study (March to October 2023) to determine SBD and LI knowledge, and LI acceptability. An online survey link (REDCap) was distributed to clinicians by email through GI professional societies and snowball sampling. The questionnaire included 23 items, 5 sections (demographic, SBD knowledge, LI perception and knowledge, future LI adoption, and optional case) and responses (binary, 5-point Likert scale, 10-point visual analogue scale (VAS) and free-text) were captured on Excel. Results From 170 respondants: 82 (48%) were female; 142 (82.4%) from Europe, 13 North America (7.6%) and 13 Asia (7.6%). Most were IBD specialists (121; 71.2%), General Gastroenterologists (36; 21.2%), managing &amp;gt;40 CD patients per month (60; 35.3%). 88 (51.8%) questionnaires were incomplete (≥1 questions were unanswered). From completed responses, 99 (92.5%) knew about SBD, 97 (90.7%) rated it ‘’very’’ and ‘’fairly’’ important to measure SBD in clinical trials and 82 (76.6%) in clinical practice; 5 (4.7%) felt it was ‘’not important’’. Most agreed LI would improve long-term outcomes in CD (55; 55%) and show achievement of treatment targets (74; 74.7%). More (43; 42.6%) replied it was ‘’very difficult’’ or ‘’difficult’’ to complete the LI for each patient; 36 (36%) felt that it took ‘’significant’’ or ‘’a lot’’ of effort (Figure 1). Most (86; 80.4%) were untrained in calculating the LI; 73 (68.2%) felt it was ‘’very’’ and ‘’fairly’’ important to receive training. Most reported intestinal ultrasound instead of MR enterography to be important (VAS scores 8-10) for encouraging LI calculation in future clinical trials (53; 54.6%) and clinical practice (49; 52.7%) (Figure 2). Lack of time (80.2%), automated calculation methods (64.2%) and dedicated radiologist (50.6%) were the top 3 perceived barriers to wider adoption. Conclusion Most respondents had baseline knowledge of SBD and perceived the LI to be important in future long term CD research and clinical practice. Interventions to improve training and automation are needed to facilitate wider adoption of the LI. Reference 1. Pariente B, et al.Validation and Update of the Lémann Index to Measure Cumulative Structural Bowel Damage in Crohn's Disease.Gastroenterology.2021 Sep;161(3):853-864.e13.

P1127 Diagnostic delay and economic burden in IBD: a multicenter italian experience in patients treated with biologics

Abstract Background Inflammatory bowel diseases (IBDs), Crohn's disease (CD) and ulcerative colitis (UC), are chronic and immune-mediated diseases with a relapsing-remitting trend. The overall incidence of these diseases is increasing. However, it is estimated that more than one third of patients experienced symptoms for more than one year before diagnosis. Delay in IBD diagnosis has several clinical, therapeutic and economic implications. Early diagnosis and proper treatment are the cornerstones for improving the standard of care for these patients. This study aims to evaluate the diagnostic delay (DD) in patients with IBD and to analyze the clinical burden of the delay in IBD diagnosis in patients treated with biological drugs. Methods An observational and retrospective study was performed in IBD patients, regularly followed in four IBD Units. Data regarding delay in IBD diagnosis were assessed through a questionnaire evaluating the disease course. Moreover, data about biologics dispensation were obtained from the medical records in the period 2020-2022 Results 344 IBD patients were enrolled (UC 228, CD 116, M 198, F 146). Median age at diagnosis was 42 years (IQR 9-82); Median DD was 12 months (IQR: 6-24). No significant difference was found in median DD between UC [12 months (IQR: 4.5-12.0)] and CD patients [12 months (IQR: 12-48)]. However, the proportion of patients with a DD &amp;gt;24 months was significantly (p=0.007) higher in CD (41/110 = 37,3%) than in UC patients (20/220=9%). After a median disease duration of 10 years (IQR: 4-17), overall, 164 patients (49.7%) were exposed to one biologic agent, 105 patients (31.8%) were exposed to two biologic agents, 61 (18.5%) to three or more biologic agents. 18,5% of patients (61/330) underwent surgery. The statistical analysis showed that DD &amp;gt;24 months was not statistically significant associated with history of ≥ 2 biological drugs (p=0.51). Conversely, there was association with surgical treatment (p=0.004). Conclusion The diagnostic delay in IBD represents a challenge with clinical and, therapeutic impact. It’s crucial to cooperate with general practitioner and gastroenterologists not dedicated to IBD in order to reduce the diagnostic delay and guarantee an effective, appropriate and early treatment that will improve the patients’ quality of life and meanwhile reduce the health care system costs.

AYURVEDIC &amp; CONTEMPORARY PERSPECTIVE OF IRRITABLE BOWEL SYNDROME – CONCEPTUAL STUDY

Irritable bowel syndrome (IBS), often known as irritable colon, is a prevalent reason for visits to general practitioners or gastroenterologists. People with IBS experience a lot of distress. This functional, idiopathic gastrointestinal condition is characterized by abdominal pain and unusual bowel habits, such as constipation, diarrhea, and alternating diarrhea and constipation. IBS continues to be a significant health issue for people around the world who are working age. IBS is the functional GIT condition that accounts for most outpatient visits to gastroenterology clinics. IBS therapies or precise diagnostic signs still need to be improved. The fundamental cause of IBS is still unknown, and it is still very challenging to cure. The sickness is frustrating for the patient and the clinician because of the patient's poor quality of life. There is a solid theoretical basis for Ayurveda regarding the causes of IBS. IBS is known as grahani in Ayurveda, which refers to the ability of the small intestine or duodenum to remain intact. The condition is referred to as graham if the function of these organs is affected or if the gut loses control and becomes less effective at absorbing nutrients. It can be effectively managed through diet, manner of life, and stress management.

Disorders of Copper Metabolism in Children-A Problem too Rarely Recognized.

Copper plays an important role in metabolic processes. Both deficiency and excess of this element have a negative effect and lead to pathological conditions. Copper is a cofactor of many enzymatic reactions. Its concentration depends on the delivery in the diet, the absorption in enterocytes, transport with the participation of ATP7A/ATP7B protein, and proper excretion. Copper homeostasis disorders lead to serious medical conditions such as Menkes disease (MD) and Wilson's disease (WD). A mutation in the ATP7A gene is the cause of Menkes disease, it prevents the supply of copper ions to enzymes dependent on them, such as dopamine β-hydroxylase and lysyl oxidase. This leads to progressive changes in the central nervous system and disorders of the connective tissue. In turn, Wilson's disease is an inherited autosomal recessive disease. It is caused by a mutation of the ATP7B gene encoding the ATP7B protein which means excess copper cannot be removed from the body, leading to the pathological accumulation of this element in the liver and brain. The clinical picture is dominated by the liver, neurological, and/or psychiatric symptoms. Early inclusion of zinc preparations and chelating drugs significantly improves the prognosis in this group of patients. The aim of the study is to analyse, based on the latest literature, the following factors: the etiopathogenesis, clinical picture, diagnostic tests, treatment, prognosis, and complications of disease entities associated with copper disturbances: Menkes disease and Wilson's disease. In addition, it is necessary for general practitioners, neurologists, and gastroenterologists to pay attention to these disease entities because they are recognized too late and too rarely, especially in the paediatric population.

Traitement guidé des infections à Helicobacter pylori : évolutions des pratiques pour un diagnostic moderne et remboursé ?

AbstractDespite unanimous recommendations from international and national scientific societies and the HAS in 2017 to favor treatment of Helicobacter pylori infections guided by a sensitivity test carried out from gastric biopsies, almost all of the treated patients still receive empirical treatment poorly tolerated and source of the continuous development over forty years of the resistance of this bacteria to antibiotics. It is time for General Practitioners, Gastroenterologists and Biologists to coordinate and mobilize to promote the guided treatment of the most common chronic bacterial infection and thus enter into a process of proper use of antibiotics. The recent reimbursement of PCR detecting H. pylori and the mutations responsible for resistance to clarithromycin should remove one of the obstacles to this guided treatment strategy. We propose a new management algorithm for these infections taking into account the reimbursements recently obtained. Recent technological advances already make it possible to imagine a future integrating sensitivity tests from a non-invasive sample: stools, saving numerous unnecessary fiberoscopies at a time when recourse to a gastroenterologist is difficult. For this near future we propose a new algorithm of what will be the coordinated work of general practitioners, gastroenterologists and biologists.