Appearance Of Mucosa Research Articles

Endoscopic assessment of minor papilla morphology: Predictors of successful cannulation and procedural pancreatitis risk in minor papilla endotherapy.

We evaluated for predictors of successful cannulation and post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in minor papilla endotherapy (MPE), emphasizing endoscopic minor papilla morphology. We retrospectively analyzed 232 MPEs in 65 patients, assessing minor papilla morphology based on three features: bulge as "prominent" or "subtle," mucosal appearance as "papilla-like" resembling the main papilla or "SMT-like" akin to a gastrointestinal submucosal tumor, and orifice visibility as "clear" or "unclear." Cannulation success was evaluated in 65 enrolled patients, with PEP risk assessed in all 232 MPEs. Minor papilla morphology was categorized as prominent/subtle bulge in 42/23 patients, papilla-like/SMT-like mucosal appearance in 42/23, and clear/unclear orifice visibility in 24/41. Cannulation succeeded in 54/65 patients (83%). A papilla-like appearance and clear orifice visibility was significantly associated with cannulation success. PEP incidence was 5.2% and predominantly mild. A papilla-like appearance significantly decreased PEP incidence, while precutting technique and orifice dilation significantly increased PEP risk. Evaluating minor papilla morphology may help predict cannulation success and PEP risk in MPE. A papilla-like mucosal appearance prognosticates cannulation success and reduced PEP risk, with clear orifice visibility serving as a success predictor. These findings provide practical guidance for preprocedural planning by emphasizing the importance of minor papilla morphology evaluation.

Polyp Endotherapy for Multiple Jejunal Lipomas Presenting as Small Bowel Intussusception: “Loop and Let Go Technique”

AbstractA 46-year-old woman presented with abdominal pain, vomiting, and intermittent constipation for the last 2 days. She had similar history of recurrent symptoms for the last 6 months. Abdominal examination showed mild central abdominal tenderness and generalized abdominal fullness and no palpable mass. A diagnosis of intestinal obstruction was considered. Nasogastric aspiration was performed with intravenous (IV) antibiotics and IV fluids. Computed tomography (CT) scan of the abdomen showed “bowel in bowel” or “target” sign appearance of jejunum with a submucosal hypodense lesion (suggestive of lipoma) acting as the lead point. There were two more submucosal lipomas of sizes approximately 3 cm each in the distal jejunal loops. A diagnosis of jejunal lipomas causing small bowel intussusception was made. The patient improved with conservative management. Exploratory laparotomy was planned with an intent to resect the small bowel. The patient did not provide consent for the same and so the option of enteroscopy-guided polyp endotherapy was offered to the patient. An antegrade single balloon enteroscopy was done (SIF-Q180, Olympus Medical Systems, United States). Three submucosal lesions with smooth overlying mucosa were noted in the mid and distal jejunum consistent with lipomas. The base of the lesions was ligated tightly using endoloop to make them ischemic and detach. Notable changes in color and mucosal appearance were noted after the application of endoloop. Since all the lipomas detected on cross-sectional radiologic imaging have been tackled via antegrade route, a retrograde enteroscopy was not attempted further. After 2 days, the patient was discharged in stable condition. Follow-up cross-sectional imaging at 3 months showed no residual lipomas, and she remained symptom-free at the end of 6 months.

Association between maxillary sinus floor perforation by dental implants and mucosal thickening: A cone-beam computed tomography study

ObjectiveTo investigate the association of perforation of the maxillary sinus floor by dental implants with mucosal thickening and to describe its characteristics in perforated cases. Study designOne-hundred and twenty-nine maxillary sinuses of 93 patients presenting 202 dental implants in the maxillary posterior region were retrospectively assessed in cone-beam computed tomography scans and classified according to maxillary sinus perforation, bone graft, mucosal thickening, and mucosal appearance. Logistic regression determined the chance of mucosal thickening in perforated maxillary sinuses. The chi-square test compared categorical variables between maxillary sinus perforated or not by implants and maxillary sinus with or without mucosal thickening. The significance level assumed was 5 % (α = 0.05). ResultsThere was perforation of 60 maxillary sinuses floor (46.5 %) by 74 dental implants. The chance of mucosal thickening was higher when the implant tip was trespassing on the maxillary sinus floor (p < 0.001). There was a significant association between maxillary sinus mucosal thickening and perforation by a dental implant with the tip trespassing the maxillary sinus floor (p < 0.05). ConclusionMaxillary sinus mucosal thickening is associated with sinus floor perforation by dental implants and does not depend on the number of implants perforating it. Clinical relevanceThere is an association between dental implants’ perforation of the maxillary sinus floor and the thickening of the maxillary sinus. In those cases, the appearance of the mucosa thickening may be irregular, local, or total opacification of the sinus cavity.

REAL-WORLD EXPERIENCE AND PERSPECTIVES ON THE TREATMENT OF ULCERATIVE COLITIS: RESULTS FROM A HEALTHCARE PROVIDER SURVEY

Abstract BACKGROUND Treatment decisions for patients with ulcerative colitis (UC) depend on the disease severity. This observational, cross-sectional, web-based survey sought to provide insight into the real-world symptoms and clinical characteristics that factor into healthcare providers’ (HCPs) treatment choices for their patients with UC in the United States. METHODS Self-reported data were collected from HCPs using a standard web-based questionnaire between 21 November 2022 and 6 December 2022. Eligible HCPs were required to have treated at least 10 adult patients with UC per month, worked more than 20 hours per week in direct patient care; and be able to complete the survey in English. HCPs included gastroenterologists (GIs), primary care physicians (PCPs), internal medicine (IM) or family medicine (FM) physicians, nurse practitioners (NPs), or physician assistants (PAs). Questionnaire responses were summarized through descriptive statistics, and post hoc comparisons between HCP types (GIs, FM/IM/PCPs, PAs, NPs) were performed using binomial regression models without adjustment for multiple comparisons. RESULTS Among 459 HCPs (male: 47.9%; 30-49 years age-group: 55.1%), 55.3% were physicians, 22.7% were NPs, and 22.0% were PAs. Approximately, 50% of the HCPs described their primary medical specialty as primary care/family care, followed by 37.7% in gastroenterology, and 12.9% in IM. From a list of 13 symptoms, when asked to select three symptoms they considered most important in deciding a course of treatment for UC, HCPs chose rectal bleeding (60%), followed by cramping or other abdominal pain (45%), diarrhea (41%), anemia (34%), and bowel urgency (28%, Fig. 1). The proportions were similar across HCP types except a greater proportion of GIs (60%) selected diarrhea than the other specialties (NPs: 42%, P=0.0127; FM/IM/PCPs: 33%, P&amp;lt;0.0001; PAs: 32%, P&amp;lt;0.0001). Rectal bleeding (87.4%), clinical remission (86.7%), abdominal pain (81.4%), stool frequency (77.6%), bowel urgency (77.3%), mucosal appearance (72.9%), and histologic appearance (71.5%) were rated as “very important” or “extremely important” by HCPs for deciding treatment choices (Fig. 2). A higher percentage of GIs, PAs, and NPs rated several symptoms more frequently vs FM/IM/PCPs, including bowel urgency (GIs: P&amp;lt;0.0001; PAs: P=0.0182; NPs: P=0.0342), mucosal appearance (P&amp;lt;0.0001, P=0.0091; P=0.0009), and stool frequency (P=0.0013; P=0.0283; P=0.0114) as “very important” or “extremely important.” CONCLUSION Results suggest a need for education among some specialties, particularly FMs, IMs, and PCPs, about the clinical presentation of UC and most important symptoms to consider when deciding treatment options for patients with UC. Fig. 1 Most important ulcerative colitis symptoms healthcare providers selected when deciding on a patient’s course of treatment Fig. 2 The level of importance assigned by the healthcare providers to the symptoms when deciding on the course of treatment for the patients with ulcerative colitis

Progress of ulcerative colitis patients during the COVID-19 pandemic.

We have previously demonstrated that the first wave of the coronavirus disease 2019 (COVID-19) pandemic caused exacerbations in ulcerative colitis (UC) patients, probably through psychological and physical stress. However, successive waves of the COVID-19 pandemic continuously followed the first. The effects of this chronic stress on the disease condition in UC patients are of interest. To clarify the effect of chronic stress from COVID-19 on disease condition in patients aggravated after the first wave. Our previous study investigated 289 consecutive UC outpatients treated in one center during March and April 2020, the period of the first wave of the COVID-19 pandemic. In this study, an identical group of 289 UC patients was evaluated using UC-disease activity index (UC-DAI), endoscopic mucosal appearance score, and Matts pathological grade scoring. Of the 289 UC patients included in the study in 2020, 10 patients dropped out as of 2021 and another 11 patients dropped out as of 2022, making three groups for 2020, 2021 and 2022. No significant differences in characteristics were found among the three groups. UC-DAI scores had aggravated during the period of the first wave of the COVID-19 pandemic, but significantly recovered in 2021 and remained stable in 2022. Matts grade scores significantly recovered in 2021 from those in 2020 and remained stable in 2022. Disease activity of UC patients recovered in 2021 and remained stable in 2022, aggravated by the stress of the first wave of COVID-19 in 2020 despite persistence of the pandemic.

Evaluation of Tofacitinib in Primary Sclerosing Cholangitis and Associated Colitis: A Multicenter, Retrospective Study

Evaluation of Tofacitinib in Primary Sclerosing Cholangitis and Associated Colitis: A Multicenter, Retrospective Study

S3625 Invasive Lobular Carcinoma of the Breast With Gastric Metastases

Introduction: Gastric metastasis from breast cancer is a rare phenomenon with an incidence rate of approximately 0.3% per a previous review. It is important to be able to distinguish primary gastric carcinoma from metastasis of other primary malignancies which are infrequently known to metastasize to the stomach. Initial presentations vary and are non-specific – dyspepsia, dysphagia and hematemesis should raise suspicion in the correct clinical context. We present a case of a patient with a prior history of invasive lobular carcinoma status post lumpectomy and radiation therapy 3 years prior undergoing esophagogastroduodenoscopy revealing gastric metastasis from invasive lobular carcinoma. Case Description/Methods: 82-year-old female with a history of decompensated liver cirrhosis secondary to non-alcoholic steatohepatitis, invasive lobular carcinoma of the left breast status post lumpectomy and radiation therapy 3 years prior presented to the emergency department with worsening dysphagia to liquids and abdominal pain with distension. Pertinent labs revealed alkaline phosphatase of 308, AST 132, ALT 63, total bilirubin of 1.1, albumin 2.7 and creatinine of 2.6 (baseline of 1.2). Ultrasound of abdomen demonstrated cirrhosis with large amount of perihepatic ascites. EGD was performed revealing diffuse gastritis with a few gastric erosions. The antral area of the stomach was notable for the mucosa taking on a thickening of the folds particularly in the prepyloric antrum. This area was biopsied. A 4mm sessile gastric polyp along the lateral wall/greater curvature of the body of the stomach was identified and biopsied. The duodenum had normal appearing mucosa. Biopsy results of the gastric polyp and thickened antral folds were consistent with metastatic lobular carcinoma of the breast which were CK7 and GATA3 positive by immunohistochemistry. The tumor was found to be ER+, PR-, HER2-0. Discussion: Breast cancer is the most common malignancy in women in the United States with the exception of skin cancer. Invasive lobular carcinoma commonly metastasizes to bone, lung and liver. Although gastric metastasis of invasive breast cancer is relatively rare, non-specific gastrointestinal symptoms in any patient with a prior history of breast cancer should raise suspicion. Gastroenterologists should be mindful of subtle changes in mucosal appearance during endoscopic evaluation and consider a biopsy of the area of concern to rule out metastatic breast cancer (Figure).Figure 1.: Gastric polyp Figure 1B: Thickened antral folds Figure 1C: Antral fold biopsy demonstrating CK7 positivity Figure 1D: Antral fold biopsy demonstrating GATA3 positivity.

S485 Prevalence of Eosinophilic Esophagitis in Hispanic Children and Young Adults in South Florida

Introduction: Eosinophilic Esophagitis (EoE) is a chronic allergic/immune Th-2 mediated disease of eosinophil dysfunction/infiltration of the esophageal mucosa which is increasing in developed countries. With advances in treatments for EoE, it is paramount to study characteristics of EoE in varying populations. Studies on the incidence/prevalence of EoE in Spain, Latin America, and US populations have shown conflicting results in minorities with EoE, and there are no studies of the Hispanic population specific to South Florida. Our study aims to evaluate the epidemiology of EoE presenting to specialty clinics in metropolitan Miami area. Methods: We conducted a 5-year chart review from Pediatric GI and Allergy/Immunology clinics in Miami, FL for biopsy-proven EoE patients. All patients had esophageal biopsies with > 15 eos/hpf. Patients were referred for GI endoscopy and/or Allergy evaluation for EoE. Patients were identified by ICD-10 diagnosis code (K20.0) and categorized by sex, age at diagnosis, race, ethnicity, residential zip codes, presenting symptoms, months to diagnosis, esophageal mucosal appearance, peak eosinophil biopsy count biopsy, PPI responsiveness, atopic history/comorbidities, and food/environment allergy testing. Results: Our cross-sectional study revealed 227 EoE patients, 168 males (74%), mean 12 + 5yrs (range 3-27), 203 White (89%), 9 Black (4%), 7 Asian (3%), 9 Other (4%), and overwhelming Hispanic 195 (86%) population, consisting of 181 White Hispanic (93%) compared to 14 non-White Hispanics (7%). The prevalence of EoE in Hispanics was 54.4/100,000 in Miami-Dade County, from a pediatric population of 458,224. Even with 55% Commercial vs 45% Medicaid, 3 out of 4 highest EoE/zip code accounted for the top 3 median incomes/zip code. Mean peak eos biopsy count was 58/hpf, serum eos was 433 cells/uL, and IgE 243 kU/L. The most common presenting symptoms were abdominal pain, vomiting, and dysphagia. A majority were PPI nonresponders with atopic comorbidities. Conclusion: In South Florida, with its White-Hispanic majority, the elevated EoE prevalence from our study is unique to the US literature. Additionally, the highest EoE prevalence was found in zip codes with the highest median incomes. Our clinics found EoE to be increasing in esophageal biopsies of atopic males presenting with abdominal pain and dysphagia. With new EoE therapies treating the underlying systemic disease, epidemiologic data of diverse U.S. populations can help guide treatment decisions and lead to improved care.

S3421 HIV/AIDS, and MAC vs COVID Diarrhea

Introduction: During the COVID pandemic, it was difficult to differentiate COVID diarrhea vs other causes, especially in the HIV/AIDS population. HIV infected patients are at high risk for GI infections. Biopsy of the small intestine identifies etiologies which help to differentiate infection, inflammatory, and neoplastic GI disease. Case Description/Methods: A 39-year-old male presented with two months of epigastric abdominal pain, severe diarrhea, and dehydration during the COVID pandemic in 2020. Past medical history of AIDS wasting syndrome. The patient was severely hypotensive. Exam was notable for mild epigastric tenderness,and hepatomegaly. Complete blood count (CBC) revealed a Hemoglobin (Hg) of 4.3 g. COVID 19 was positive. Gastrointestinal panel PCR was negative. CD4 count 1, HIV RNA viral load 48,700. MRI of the abdomen and pelvis showed diffuse bowel wall thickening in the small intestines. On hospital day 2, Esophagogastroduodenoscopy (EGD) and Colonoscopy were performed for anemia and diarrhea, which revealed abnormal variegated mucosa in the duodenum. Colonoscopy showed a normal mucosal appearance. The pathology report of the duodenum revealed macrophages in the lamina propria, which stained positive for Acid Fast Bacilli. Duodenal biopsy showed markedly expanded lamina propria with numerous histiocytes having finely granular chromatin pattern (Panel 1 and 2). The patient was diagnosed with Mycobacterium avium-intracellulare enteritis. Discussion: This 39-year-old male presented with chronic diarrhea without fever or respiratory symptoms. The most pertinent question for the health care team was whether COVID 19 caused the diarrhea.. Endoscopy with biopsy of the small intestine was essential for an accurate diagnosis. MAC infection in HIV has been dramatically declining since the widespread use of antiretroviral therapy and prophylaxis against MAC infection compared to the 1990s (from 65.3/1000 in 1992 to 2/1000 in 2015) (1). It is important to differentiate MAC from other diseases with a macrophage infiltration or inclusions: including Whipple’s, histoplasmosis, and macroglobulinemia. Patients with MAC enteritis present with fever, and watery diarrhea with diffuse small bowel malabsorption which mimics Whipple’s disease. However, the key to differentiate these two entities is doing a duodenal biopsy showing foamy macrophages with PAS-positive acid-fast bacilli (2).Figure 1.: Histology finding.

Peri-Ulcerative Mucosal Inflammation Appearance is an Independent Risk Factor for 30-Day Rebleeding in Patients with Gastric Ulcer Bleeding: A Multicenter Retrospective Study.

AimThe aim of this study was to identify clinical endoscopic indicators related to peri-ulcerative mucosal inflammation and to analyze whether the degree of peri-ulcerative mucosal inflammation appearance is an independent risk factor for gastric ulcer rebleeding.MethodsWe conducted a retrospective study that included patients with gastric ulcer bleeding who were hospitalized at three medical centers in China from January 1, 2016 to December 31, 2019. Ulcer rebleeding that occurred within 30 days of successful initial hemostasis was analyzed to determine whether this event was related to the degree of peri-ulcerative mucosal inflammation appearance or other mucosal inflammation-related factors.ResultsWe enrolled 1111 patients and determined that GBS-Rebleeding-ROC (P<0.001), age (P=0.01), use of NSAIDs (P=0.001), bile reflux (P<0.001), and Helicobacter pylori (P<0.001) are all risk factors for peri-ulcerative mucosal inflammation appearance. Through multivariate analysis, we determined that severe peri-ulcerative mucosal inflammation appearance (P=0.002) was an independent risk factor for ulcer rebleeding within 30 days. Finally, we developed a risk assessment model using factors associated with mucosal inflammation that may be useful for early prediction of rebleeding.ConclusionThe risk factors for peri-ulcerative mucosal inflammation appearance were identified. Severe peri-ulcerative mucosal inflammation appearance is an independent risk factor for ulcer rebleeding.

Morphological and ultrastructural features of the laryngeal mound of Egyptian Cattle Egret (Bubulcus ibis, Linnaeus, 1758)

BackgroundAccording to our acknowledgment this is the first full anatomical description of the studied laryngeal mound of the Egyptian Cattle Egret (Bubulcus ibis, Linnaeus, 1758). This study was obtained with the aid of scanning electron microscopy (SEM) and histological techniques. Heads of ten healthy adult male Egyptian cattle egrets were used in this study.ResultsThe laryngeal mound (Mons laryngealis) was a pear-shaped musculoskeletal elevation. It represented 20.55 and 67.87% of the total length of the oropharyngeal floor and the pharyngeal floor, respectively. By SEM view, the lateral aspect of the caudal third of the laryngeal mound had a serrated mucosal appearance, forming of 6–7 finger-like projections. Furthermore, the terminal part of the laryngeal mound (except the middle part) was bordered a transverse row of pyramidal-shaped papillae, which demarcated from the esophagus. Histologically, laryngeal salivary glands termed (cricoarytenoid salivary glands) of the laryngeal mound were simple tubular type and were arranged in one row within the lamina propria connective tissue close to the lamina epithelialis. Those glands were surrounded by abundant aggregation of lymphocytes, extended overlying the surface lining epithelium. The glottis within the laryngeal mound was supported by hyaline cartilages; dorsally by paired arytenoid cartilages, ventrolaterally by cricoid cartilage, and caudodorsally by procricoid cartilage. Two groups of intrinsic laryngeal skeletal muscles have connected the cartilages. The glandular epithelium of the laryngeal salivary glands and chondrocytes of the laryngeal cartilages showed strongly positive alcian blue reaction.ConclusionsThe laryngeal mound shows certain features that are unique as an adaptation to lifestyles and bird’s habitat.

Endoscopic activity in inflammatory bowel disease: clinical significance and application in practice

Endoscopy is vital for diagnosis, assessing treatment response, monitoring and surveillance in patients with inflammatory bowel disease (IBD). With the growing importance of mucosal healing as a treatment target, the assessment of disease activity by endoscopy has been accepted as the standard of care for IBD. There are many endoscopic activity indices for facilitating standardized reporting of the gastrointestinal mucosal appearance in IBD, and each index has its strengths and weaknesses. Although most endoscopic indices do not have a clear-cut validated definition, endoscopic remission or mucosal healing is associated with favorable outcomes, such as a decreased risk of relapse. Therefore, experts suggest utilizing endoscopic indices for monitoring disease activity and optimizing treatment to achieve remission. However, the regular monitoring of endoscopic activity is limited in practice owing to several factors, such as the complexity of the procedure, time consumption, inter-observer variability, and lack of a clear-cut, validated definition of endoscopic response or remission. Although experts have recently suggested consensus-based definitions, further studies are needed to define the values that can predict long-term outcomes.

Tubularized and Effaced Gastric Cardia Mimicking Barrett Esophagus Following Sleeve Gastrectomy: Protocolized Endoscopic and Histological Assessment With High-resolution Manometry Analysis.

To describe expected endoscopic and histological changes at gastro-esophageal junction (GEJ) and define diagnostic paradigms for Barrett esophagus (BE) postsleeve gastrectomy (SG). De novo incidence of BE post SG was reported as high as 18.8%. A confounding factor is the lack of standardized definition of BE post SG, which may differ from the general population due to procedure-induced alterations of GEJ. Part 1 involved evaluating endoscopic changes of GEJ post SG (N = 567) compared to pre SG (N = 320), utilizing protocolized preoperative screening, postoperative surveillance and synoptic reporting. Part 2 involved dedicated studies examining causes of altered anatomical and mucosal GEJ appearance using histopathology (N = 55) and high-resolution manometry (HRM) (N = 15). Part 1 - A characteristic tubularized cardia segment projecting supra-diaphragmatically was identified and almost exclusive to post SG (0.6% vs.26.6%, P < 0.001). True BE prevalence was low (4.1%pre SG vs. 3.8%post SG, P = 0.756), esophagitis was comparable (32.1% vs. 25.9%, P = 0.056). Part 2 - Histologically-confirmed BE was found in 12/55 patients, but 70.8% had glandular-type gastric mucosa implying tubularized cardia herniation. HRM of tubularized cardia demonstrated concordance of supra-diaphragmatic cardia herniation between endoscopy and HRM (3 cm vs. 3.2 cm, P = 0.168), with frequent elevated isobaric intraluminal pressurizations in supra-and infra-diaphragmatic cardia compartments. A novel appearance of tubularized cardia telescoping supra-diaphragmatically with flattening of gastric folds is common post SG, likely associated with isobaric hyper-pressurization of proximal stomach. incidence of true BE post SG is low in short-intermediate term. These provided a clear framework for approaching endoscopic screening and surveillance, with correct anatomical and mucosal identifications, and clarified key issues of SG and BE.

Evaluation of the effect of periapical lesions and other odontogenic conditions on maxillary sinus mucosal thickness characteristics and mucosal appearance: A CBCT study.

Background. This retrospective study aimed to investigate the effect of various dental and maxillary sinus variables on maxillary sinus mucosal thickness (MT). The variables included periodontal bone loss (PBL), periapical status, dental restorations of posterior maxillary teeth, and the distance from the root apices to the sinus mucosa. Methods. Cone-beam computed tomography (CBCT) images of the maxillary sinuses (n = 600) in 300 patients were examined. The sinus MT and the distance of the roots from maxillary sinuses were measured. Apical lesions of the roots, PBL, and situations of adjacent teeth were recorded. The relationships between these conditions and MT and characterization of MT were evaluated. The Kruskal–Wallis H test was used to compare groups due to the non-normal distribution of the data. The relationship between categorical variables was analyzed using chi-squared test. Results. There was a significant correlation between maxillary sinus MT and periapical lesions, PBL, and restorations (P < 0.05). MT increased as the apical lesions of premolar teeth enlarged (P < 0.05, P = 0.022). MT increased in cases of mild PBL of molar teeth (P = 0.041). Conclusion. In this retrospective study, the MT significantly increased in patients with periapical lesions, inadequate endodontic treatment, increased PBL, and inadequate dental restorations.

Comparative Evaluation of Clinical, Endoscopic and Histopathological Findings of Helicobacter Pylori-Associated Gastroduodenitis in Children

Background: Chronic colonization with Helicobacter pylori (Hp) has been shown to significantly increase the risk of gastric ulcer and duodenum as well as chronic gastritis in children and adults. Due to the importance of early detection and treatment of HP infection especially in children, this study aimed to compare the clinical, endoscopic and histopathological findings in children with HP gastroduodenitis and control group. Materials and Methods: In this cross-sectional study, all children referred to the gastroenterology clinic of children´s hospital, Qazvin, Iran, between 2016 and 2018, with a history of gastrointestinal complaints underwent upper gastrointestinal endoscopy if necessary, then tissue samples were taken, and rapid urease test was performed. Subsequently the patients were divided into two equal groups of 200: HP positive (patient group), and Hp negative (control group). Results: The mean age in the Hp positive group and in the control group was 8.11±3.68 and7.22±2.96 years, respectively (P<0.05). The most common clinical manifestation in the Hp positive group was chronic abdominal pain (n=66, P<0.001). Endoscopic examinations revealed that the evidence of mucosal erythema, erosions and nodular mass of the corpus, antrum and bulb were significantly higher in Hp positive group. Histopathologic studies also showed more evidence of corpus, antrum and bulb inflammation in the Hp positive group compared to the control group. Conclusion: Overall, based on the results of this study, it seems that endoscopic evidence of mucosal appearance of erythema, obvious nodularity and mucosal erosion in the corpus and antrum as well as bulb of duodenum in children with HP gastro- duodenitis has a diagnostic value.

An expert consensus to standardise the assessment of histological disease activity in Crohn's disease clinical trials.

Targeting histological remission or response in Crohn's disease (CD) is not recommended in clinical practice guidelines or as an outcome in clinical trials due to uncertainties regarding index validity and prognostic relevance. To conduct a modified RAND/University of California Los Angeles appropriateness process with the goal of producing a framework to standardise histological assessment of CD activity in clinical trials. A total of 115 statements generated from literature review and expert opinion were rated on a scale of 1-9 by a panel of 11 histopathologists and 6 gastroenterologists. Statements were classified as inappropriate, uncertain or appropriate based upon the median panel rating and degree of disagreement. The panellists considered it important to measure histological activity in clinical trials to determine efficacy and that absence of neutrophilic inflammation is an appropriate histological target. They were uncertain whether the Global Histological Activity Score was an appropriate instrument for measuring histological activity. The Geboes Score and Robarts Histopathology Index were considered appropriate. Two biopsies from five segments should be biopsied, and the colon and the ileum should be analysed separately for all indices. Endoscopic mucosal appearance should guide biopsy procurement site with biopsies taken from the ulcer edge, or the most macroscopically inflamed area in the absence of ulcers. We evaluated the appropriateness of items for assessing histological disease activity in CD clinical trials. These items will be used to develop a novel histological index.

ORAL SOFT TISSUE MYXOMA: CASE REPORT

The soft tissue myxoma in the maxillofacial region is a rare benign neoplasm, with low recurrence, slow and painless growth. A 54-year-old male sought treatment with increased volume in anterior region of maxilla, evolving for 10 years asymptomatically, after extraction of tooth 11. Clinically, it had normal mucosal appearance, with a soft consistency, located in the canine sulcus region. A low-density image compatible with ovoid-shaped cyst was observed on the tomography in primary buccal fascial space. According to clinical and imaging examination the diagnostic hypothesis was lipoma. The lesion was treated by surgical excision. Macroscopically presented a gelatinous consistency, measuring 52 x 42 x 32 mm, spherical appearance with brown coloration. Histology showed arranged cells of stellate, fusiform, or rounded shape. In the fundamental myxoid substance small islands of odontogenic epithelial remains could be found, findings compatible with myxoma. The follow-up of 3 years showed no signal of recurrence.

Impact of various central endoscopy reading models on treatment outcome in Crohn’s disease using data from the randomized, controlled, exploratory cohort arm of the BERGAMOT trial

Endoscopic assessment of mucosal appearance by independent central reading has become the standard method to assess Crohn's disease activity in clinical trials. The performance characteristics of various endoscopy reading models have yet to be systematically evaluated. This substudy included patients with Crohn's disease in the exploratory induction cohort of the BERGAMOT trial (NCT02394028) randomly assigned to etrolizumab or placebo. Endoscopies conducted at baseline and week 14 were independently scored using the Simple Endoscopic Score for Crohn's Disease (SES-CD) by a local reader (LR) and 2 central readers (CRs). Five endoscopy reading models were compared: single LR, single CR, average of 2 CRs, and 2 models incorporating the LR and 1 or 2 CRs depending on alignment between the LR and the CR, defined according to a sliding scale applied to a range of scores. Five hundred thirty-five videos were scored. Models involving 2 readers demonstrated lower placebo rates (3.4%) than the single LR (11.9%) and the single CR (6.8%) models. Treatment effect size based on endoscopic improvement (≥50% reduction in SES-CD from baseline) was highest with the 2 models incorporating the LR and 1 or 2 CRs (Δ= 16.2%). Further, in the etrolizumab arm, models with 2 readers demonstrated the lowest variability for the SES-CD. Central endoscopy reading models in Crohn's disease have an impact on placebo response rates and effect size. Incorporating the LR appears to be important because models using both CRs and LRs resulted in the greatest treatment effect size for endoscopic improvement with etrolizumab, lower placebo rates, and reduced variability.

Mortality Risk in Irritable Bowel Syndrome: Results From a Nationwide Prospective Cohort Study.

Mortality concern is a frequent driver of care seeking in patients with irritable bowel syndrome (IBS). Data on mortality in IBS are scarce, and population-based studies have been limited in size. We examined mortality in IBS. A nationwide, matched, population-based cohort study was conducted in Sweden. We identified 45,524 patients undergoing a colorectal biopsy at any of Sweden's 28 pathology departments and with a diagnosis of IBS from 2002 to 2016 according to the National Patient Register, a nationwide registry of inpatient and outpatient specialty care. We compared the mortality risk between these individuals with IBS and age- and sex-matched reference individuals (n = 217,316) from the general population and siblings (n = 53,228). In separate analyses, we examined the role of mucosal appearance for mortality in IBS. Finally, we examined mortality in 41,427 patients with IBS not undergoing a colorectal biopsy. Cox regression estimated hazard ratios (HRs) for death. During follow-up, there were 3,290 deaths in individuals with IBS (9.4/1,000 person-years) compared with 13,255 deaths in reference individuals (7.9/1,000 person-years), resulting in an HR of 1.10 (95% confidence interval [CI] = 1.05-1.14). After adjustment for confounders, IBS was not linked to mortality (HR = 0.96; 95% CI = 0.92-1.00). The risk estimates were neutral when patients with IBS were compared with their siblings. The underlying mucosal appearance on biopsy had only a marginal impact on mortality, and patients with IBS not undergoing a colorectal biopsy were at no increased risk of death (HR = 1.02; 95% CI = 0.99-1.06). IBS does not seem to confer an increased risk of death.

P111 CORRELATION OF FECAL CALPROTECTIN AND MUCOSAL BIOPSY IN IDENTIFYING SUBCLINICAL INFLAMMATION IN ULCERATIVE COLITIS PATIENTS: A PRELIMINARY STUDY

Abstract Background For years, the gold standard for Ulcerative Colitis (UC) remission was mucosal appearance during endoscopy. However, recent literature suggests histological or “deep” remission is important for preventing flares and maintaining clinical remission. There are now validated histological scoring systems to identify subclinical inflammation, the simplest being the Nancy Histology Index (NHI). Colonoscopy with histological evaluation is the gold standard for UC monitoring, but frequent endoscopy is not always possible. Literature reporting the utility of fecal calprotectin (FC) in detecting subclinical inflammation is limited. We seek to evaluate the correlation of FC and C-reactive protein (CRP) with NHI scores to better assess their role in detecting subclinical UC. Methods We retrospectively evaluated clinical data and pathology slides of 69 UC patients that were collected over 6-months period at university of Kentucky. Pathology slides were scored according to NHI by a trained researcher and verified by an IBD pathologist. Presence of acute activity was defined as NHI&amp;gt;2. Mayo endoscopic scores (MES) were based on endoscopic reports from one expert endoscopist. Endoscopic remission was defined as MES &amp;lt;2. FC and CRP were recorded if collected within a month of endoscopy. FC was defined as elevated (≥120 mcg/g) or borderline (50.1–120 mcg/g). Elevated CRP was defined as (&amp;gt; 0.9 mg/dl). Results 33 of the 69 (47.8%) patients analyzed were in endoscopic remission. 17 of those 33 (51.5%) patients in endoscopic remission had acute histological activity (NHI &amp;gt;2). 7 (21.2%) patients with acute histological activity completed FC testing. Of the 7 who submitted FC, 4 were elevated, and 1 was borderline. 15 of the 17 NHI positive patients submitted CRP, 4 (26%) were elevated. Finally, among the 17 patients with NHI &amp;gt;2, four patients flared within a year (Table 1). In these 4 flared patients, FC was abnormal in 3 patients. CRP was negative in these three patients. One patient did not complete a FC or CRP. Conversely, of the 16 patients with quiescent UC and NHI &amp;lt;2 only 1 patient flared within a year. FC and CRP were not completed at the time of endoscopy. Conclusion We successfully identified an important subset of UC patients in clinical and endoscopic remission with active histological activity. Most patients in this subset had elevated fecal calprotectin levels. This suggests fecal calprotectin can be used for disease monitoring to proactively identify subclinical activity before disease flare. Our findings suggest that biopsies should be performed in all UC patients even in the absence of endoscopic abnormality, and fecal calprotectin should be ordered at regular intervals to pre-emptively detect and prevent UC flares.