World Gastroenterology Organization Research Articles

Assessment of endoscope reprocessing at World Gastroenterology Organisation training centers using adenosine triphosphate testing.

Background and study aims Adequacy of endoscope disinfection in resource-limited settings is unknown. Adenosine triphosphate (ATP) testing is useful for evaluation of endoscope reprocessing, and ATP <200 relative light units (RLUs) after manual endoscope cleaning has been associated with adequacy of endoscope disinfection. Methods Consecutive endoscopes undergoing reprocessing at five World Gastroenterology Organisation (WGO) training centers underwent ATP testing before and after an on-site educational intervention designed to optimize reprocessing practices. Results A total of 343 reprocessing cycles of 65 endoscopes were studied. Mean endoscope age was 5.3 years (range 1-13 years). Educational interventions, based on direct observation of endoscope reprocessing practices at each site, included refinements in pre-cleaning, manual cleaning, high-level disinfection, and endoscope drying and storage. The percentage of reprocessing cycles with post-manual cleaning ATP ≧200 decreased from 21.4% prior to educational intervention to 14.8% post-intervention ( P =0.11). In multivariable logistic modelling, gastroscopes were significantly less likely (odds ratio [OR] 0.04, 95% confidence interval [CI] 0.01-0.19; P <0.001) than colonoscopes to achieve post-manual cleaning ATP < 200. No other factor (educational intervention, study site, endoscope age) was significantly associated with improved outcomes. Endoscope ID was not significantly associated with ATP values, and sites that performed manual versus automated HLD did not have significantly different likelihood of post-manual cleaning ATP <200 (OR 1.18, 95% CI 0.56-2.50; P =0.67). Conclusions In resource-limited settings, approximately 20% of endoscope reprocessing cycles may result in inadequate disinfection. This was not significantly improved by a comprehensive educational intervention. Alternative approaches to endoscope reprocessing are needed.

Summarizing Consensus Guidelines on Obesity Management: A Joint, Multidisciplinary Venture of the International Federation for the Surgery of Obesity & Metabolic Disorders (IFSO) and World Gastroenterology Organisation (WGO).

Summarizing Consensus Guidelines on Obesity Management: A Joint, Multidisciplinary Venture of the International Federation for the Surgery of Obesity & Metabolic Disorders (IFSO) and World Gastroenterology Organisation (WGO).

Methodology and Results of a Joint IFSO-WGO Delphi Survey of 94 Intercontinental, Interdisciplinary Experts in Obesity Management

BackgroundObesity affects 1.5 billion people worldwide, yet few are treated effectively and considerable variability exists in its management. In 2020, a joint International Federation of Surgery for Obesity and Metabolic Diseases (IFSO) and World Gastroenterology Organization (WGO) advisory committee initiated the drafting of consensus guidelines on obesity management, to be based on detailed literature reviews and the results of an extensive multi-disciplinary survey of intercontinental experts. This paper reports on the latter. The objective of this study is to identify areas of consensus and non-consensus among intercontinental, inter-disciplinary experts in obesity management.MethodsGuided by an international consensus-survey expert, a three-round online Delphi survey was conducted in the summer of 2021 of international obesity-management experts spanning the fields of medicine, bariatric endoscopy and surgery, psychology, and nutrition. Issues like epidemiology and risk factors, patient selection for metabolic and bariatric surgery (ASMBS-Clinical-Issues-Committee, Surg Obes Relat Dis : Off J Am Soc Bariatric Surg. 8:e27-32, 1), psychological issues, patient preparation for MBS, bariatric endoscopy, and outcomes and follow-up were addressed.ResultsNinety-four experts from six continents voted on 180 statements, with consensus reached on 158, including consensus agreement with 96 and disagreement with 24 statements (38 had other response options besides agree/disagree). Among unanimous opinions were the need for all medical societies to work together to address obesity, for regular regional and national obesity surveillance, for multi-disciplinary management, to recognize the increasing impact of childhood and adolescent obesity, to accept some weight regain as normal after MBS, and for life-long follow-up of MBS patients.ConclusionsObesity is a major health issue that requires aggressive surveillance and thoughtful multidisciplinary management.

A patient with constipation

Constipation is slow, difficult, or systematically insufficient bowel movement (bowel voiding). The World Health Organization in the “International Statistical Classification of Diseases and Related Health Problems. ICD-10” classifies constipation as a disease (code K59.0). Meanwhile, gastroenterology organizations such as the World Gastroenterology Organization and the American Gastroenterological Association take a different position, emphasizing that constipation is not a disease, but a symptom. Leading Russian gastroenterologists share the same position.

NSAID-esophagitis: how to break the vicious circles of pathogenesis? Clinical case

The article presents a complex clinical case of drug‑induced erosive esophagitis grade C with the formation of Schatzki ring in patient S., 85 years old. A feature of the case under consideration is the long‑term persistence of both esophageal (dysphagia, odynophagia) and extraesophageal (thoracalgia) complaints, which required an extensive differential diagnosis to rule out the cardiac genesis of the pain syndrome. The diagnostic search was complicated by the patient’s advanced age, the presence of serious accompanying somatic pathology, moderate cognitive decline, contradictory data from X‑ray examination and computer tomography, and the patient’s categorical refusal to perform a biopsy, which made histological confirmation of the presumptive diagnosis impossible. Empirical appointment of pantoprazole (Nolpaza) made it possible to level the phenomenon of odynophagia and improve the condition of the esophageal mucosa, but long‑term use of Nolpaza in high doses was required for restoration of erosive‑destructive changes in the damaged esophagus and stomach.&#x0D; Moreover, the literature review is presented, which reveals modern ideas about the mechanisms of Schatzki ring, the features of management and treatment of patients with dysphagia and Schatzki ring according to the guidelines of authoritative international organizations — the World Gastroenterology Organization, the American College of Gastroenterology. The key provisions of the specified organizations, which regulate the doctor’s actions in the management of patients with Schatzki ring, are given. The advantages of prescribing pantoprazole (Nolpaza) are described, taking into account the peculiarities of its mechanism of action, bioequivalence to the original pantoprazole, CYP450‑unassociated hepatic metabolism, the absence of significant drug interactions, serious adverse events, the possibility of its administration to elderly and senile patients without dose correction, the expediency and safety of the long‑term intake.&#x0D;

Helicobacter pylori World Gastroenterology Organization Global Guideline

Helicobacter pylori remains a major health problem worldwide, causing considerable morbidity and mortality due to peptic ulcer disease and gastric cancer. The burden of disease falls disproportionally on less well-resourced populations. As with most infectious diseases, the largest impact on reducing this burden comes from improvement in socioeconomic status, which interrupts transmission. This has been observed in many regions of the world, but the prevalence of infection remains high in many regions where improvements in living standards are slow to occur. Meanwhile, the optimal clinical management and treatment pathways remain unsettled and are evolving with changing antimicrobial resistance patterns. Despite decades of research and clinical practice, major challenges remain. The quest for the most effective, safe, and simple therapy remains the major issue for clinicians. The search for an effective vaccine appears to be elusive still. Clinical guidelines do not infrequently proffer discordant advice. A major challenge for guidelines is for relevance across a variety of populations with a varying spectrum of disease, antimicrobial resistance rates, and vastly different resources. As local factors are central to determining the impact and management strategies for H. pylori infection, it is important that pathways are based on the best available local knowledge rather than solely extrapolating from guidelines formulated in other regions, which may be less applicable. To this end, this revision of the World Gastroenterology Organisation (WGO) H. pylori guideline uses a "Cascades" approach that seeks to summarize the principles of management and offer advice for pragmatic, relevant and achievable diagnostic and treatment pathways based on established key treatment principles and using local knowledge and available resources to guide regional practice.

Minimizing the Risks of Simethicone in Endoscope Reprocessing.

This statement was written under the auspices of the World Gastroenterology Organization's Guidelines Committee. The authors are members of the Review Team of the WGO Endoscope Disinfection Guideline and have experience in endoscopy, endoscope reprocessing, and microbiology, including biofilms. During the preparation of the WGO Update on Endoscope Disinfection Guidelines, concerns about simethicone on endoscope channel surfaces compromising cleaning and disinfection were raised. Publications on simethicone, including modes of delivery, effectiveness, and risks, have been reviewed. The paper was written as a companion to the new guidelines with a focus on minimizing the risks of simethicone in endoscope reprocessing.

Association of Diet, Body Mass Index, and Lifestyle on the Gastrointestinal Health Risk in a Sample of Adults.

Gastrointestinal functional disorders are characterized by abnormalities in motility with visceral hypersensitivity, representing a global public health problem. We aimed to determine whether eating habits, lifestyle characteristics, and body mass index (BMI) are associated with gastrointestinal health risk. The Gastrointestinal Health (GIH) test of the World Gastroenterology Organization (WGO) and the Roma IV criteria were applied. We obtained information on food consumption habits and aerobic exercise, among other variables. Not exercising regularly, drinking water and eating vegetables less than recommended, having high body weight, and taking symptomatic medication were variables that explained 73% of the probabilities of not having good GIH (R2 = 0.734). According to Rome IV criteria, women had a 50% higher risk than men of having functional bowel disorder (RR 1.6, 95% CI: 1.04, 2.45). Among the men studied, eating few or no vegetables and drinking less than 1 L of water daily was more frequent; however, the women had significantly more intestinal symptoms. In addition, constipation was higher among women than men (p = 0.020). All of the above explains the prognostic value of eating habits and the importance of paying attention to body weight to reduce the risk of gastrointestinal disease.

Sero-Prevalence of Helicobacter pylori Infection among Pregnant Women Attending Antenatal Clinic in Garissa County, Kenya

The public health impact of H. pylori (HP) infection is gradually becoming evident. The bacterium is now being implicated as an etiologic agent in various gastric diseases. In developing countries, HP infection is markedly more prevalent at younger ages than in developed countries. According to the World Gastroenterology Organization, the prevalence of H. pylori in Kenya was 48% in ages between 2-4, 80% at the age of 6, and 95% in the adult population. The main objective of the study was to determine the prevalence of Pylori infection among pregnant patients attending the antenatal clinic in Garissa County, Kenya. This study utilized a cross-sectional study design to determine the prevalence of H. pylori infection. Probability proportion to the size and a simple random technique was used to collect the data. Blood samples drawn from study participants were tested according to the standard H. pylori tests and as per the Kit manufacturers’ instructions and procedure. Information from the laboratory analysis and questionnaires were then recorded in the questionnaire. Informed consent was obtained from the study participants before the study data collection tools were administered. Data Collected was entered into Excel and then exported to SPSS version 20. Frequencies and percentages were used to describe data, while Chi-square and binary logistic regression analysis were used to establish the association between the independent and dependent variables. Results show that the seroprevalence of H. pylori among sample pregnant women was 45%. Inferential analysis shows that respondents levels of education (χ2 = 10.07, df = 1, p = 0.002), parity (χ2 = 15.776, df = 3, p = 0.001) and type of toilet (χ2 (10.415(3), p = 0.015) was associated with the prevalence of H. pylori at bivariate level. Logistic regression analysis establishes that having a higher level of education (A.O.R = 2.483, p = 0.023, living in urban areas (A.O.R = 0.274, p = 0.014), being in casual employment A.O.R = 0.208 p = 0.024), having more than four children (A.O.R = 7.971, p = 0.006) and sharing of beds (A.O.R = 0.034, p = 0.0001) were predictors of H. pylori infection. This study concludes that about half of the study participants had H. pylori infection and socio-demographic and environmental conditions contribute to the prevalence. There is a need to sensitize pregnant women on the cause and prevention of H. pylori. Also, maintaining proper environmental and sanitation hygiene will aid in reducing transmission

2021 Guidelines on Helicobacter pylori. Coincidences and divergences between the Spanish and World Gastroenterology Organisation (WGO) guidelines.

This editorial summarizes and discusses the most relevant aspects of the latest WGO guidelines on Helicobacter pylori infection, while considering the recently reported Spanish consensus on its management.

World Gastroenterology Organisation Global Guidelines: Diet and the Gut.

World Gastroenterology Organisation Global Guidelines: Diet and the Gut.

Laxative use and mortality in patients on haemodialysis: a prospective cohort study

BackgroundPatients on haemodialysis (HD) are often constipated. This study aimed to assess the relationship between constipation and mortality in such patients. In this study, constipation was defined as receiving prescription laxatives, based on the investigation results of “a need to take laxatives is the most common conception of constipation” reported by the World Gastroenterology Organization Global Guidelines.MethodsThis cohort study included 12,217 adult patients on HD enrolled in the Japan-Dialysis Outcomes and Practice Patterns study phases 1 to 5 (1998 to 2015). The participants were grouped into two based on whether they were prescribed laxatives during enrolment at baseline. The primary endpoint was all-cause mortality in 3 years, and the secondary endpoint was cause-specific death. Missing values were imputed using multiple imputation methods. All estimations were calculated using a Cox proportional hazards model with an inverse probability of treatment weighting using the propensity score.ResultsLaxatives were prescribed in 30.5% of the patients, and there were 1240 all-cause deaths. There was a significant association between laxative prescription and all-cause mortality [adjusted hazard ratio (AHR), 1.12; 95% confidence interval (CI): 1.03 to 1.21]. Because the Kaplan-Meier curves of the two groups crossed over, we examined 8345 patients observed for more than 1.5 years. Laxative prescription was significantly associated with all-cause mortality (AHR, 1.35; 95% CI: 1.17 to 1.55). The AHR of infectious death was 1.62 (95% CI: 1.14 to 2.29), and that of cancerous death was 1.60 (95% CI: 1.08 to 2.36). However, cardiovascular death did not show a significant inter-group difference.ConclusionsConstipation requiring use of laxatives was associated with an increased risk of death in patients on HD. It is important to prevent patients receiving HD from developing constipation and to reduce the number of patients requiring laxatives.

Uniting the Global Gastroenterology Community to Meet the Challenge of Climate Change and Non-Recyclable Waste

Uniting the Global Gastroenterology Community to Meet the Challenge of Climate Change and Non-Recyclable Waste

Editorial introductions.

Current Opinion in Gastroenterology was launched in 1985. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of gastroenterology is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Chantal HoussetChantal HoussetChantal Housset was trained as a Hepatologist in Université Paris 5 René Descartes, France. She was NIH Visiting Scientist at University of California San Francisco, in 1992. She obtained a PhD degree from Université Paris 07, France, in 1993 and Research Direction Habilitation from Université Paris 06, France, in 1998. She was appointed fulltime Researcher at INSERM (National Institute of Health and Medical Research) in 1994, and full-time Professor in Cell Biology at Université Paris 06, in 2000. She is Course Director of molecular and cellular biology at Sorbonne Université Medical School & Life Science Department. She is a member of the Reference Center for Inflammatory Biliary Diseases and Auto-immune Hepatitis, in Saint-Antoine Hospital, and of the Rare Liver Disease National Network (FILFOIE). She is Director of an INSERM-Sorbonne Université Laboratory of translational reasearch in Saint-Antoine Research Center (CRSA). The expertise of the Laboratory relates to the mechanisms responsible for metabolic and biliary diseases of the liver and their progression towards fibrosis. Dr Housset is member of the University National Council (CNU) in Cell Biology. She published 170 articles. Her main scientific contributions relate to the mechanisms of bile secretion, the pathobiology of biliary diseases, the origins and functions of liver myofibroblasts. Eamonn M.M. QuigleyEamonn M.M. QuigleyEamonn M.M. Quigley is Chief of Gastroenterology and Hepatology at Houston Methodist Hospital in Houston, Texas, USA, Professor of Medicine at Weill Cornell Medical College and David M Underwood Chair of Medicine in Digestive Disorders. A graduate of University College Cork, Ireland, Dr Quigley trained in internal medicine in Glasgow and Manchester, and in gastroenterology in Glasgow, the Mayo Clinic, Rochester, Minnesota, USA, and Manchester. In 1986, he joined the faculty at the University of Nebraska Medical Center in Omaha, Nebraska, USA, where he ultimately served as Chief of Gastroenterology and Hepatology. Returning to Cork in 1998, he served as Dean of the Medical School at UCC for seven years and was a principal investigator at its Alimentary Pharmabiotic Center from its inception. He served as president of both the American College of Gastroenterology and the World Gastroenterology Organization and is a past editor-in-chief of the American Journal of Gastroenterology. Clinical and research interests include irritable bowel syndrome, gastrointestinal motility and the role of the gut microbiota and probiotics in health and in gastrointestinal and metabolic disorders.

Editorial introductions.

Current Opinion in Gastroenterology was launched in 1985. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of gastroenterology is divided into 12 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Editor and Section Editors for this issue. EDITOR Ciarán P. KellyCiarán P. KellyCiarán P. Kelly, MD, is Professor of Medicine at Harvard Medical School, Director of Gastroenterology Training and Medical Director of the Celiac Center at Beth Israel Deaconess Medical Center, Boston, Massachussets, USA. Dr Kelly earned his medical degree from Trinity College in Dublin, Ireland where he was a Foundation Scholar and recipient of numerous academic awards. Dr Kelly has also received postgraduate clinical and research awards from the Crohn's and Colitis Foundation of America, the American Gastroenterological Association and the National Institutes of Health. He is an American Gastroenterology Association Fellow and a Fellow of the American College of Gastroenterology. Dr Kelly has longstanding clinical and research interests in intestinal infection and inflammation. He has been involved in patient care and research in Clostridium difficile infection for more than 25 years and leads NIH-funded research programs that evaluate potential C. difficile vaccines and other immune-based treatments. His interest in the pathophysiology, diagnosis and management of celiac disease is also longstanding and, as Medical Director of the Celiac Center at BIDMC which he founded in 2004, he heads clinical, research and educational programs in celiac disease. Dr Kelly has served as a committee member of the NIH, Center for Scientific Review as well as FDA, CDC and NIH committees on celiac disease and C. difficile infection. Dr Kelly is the author of more than 250 clinical and basic research book chapters, invited reviews, and peer-reviewed, original articles appearing in such journals as Infection & Immunity, American Journal of Physiology, Gastroenterology, Journal of Biological Chemistry, Journal of Clinical Investigation, New England Journal of Medicine and Lancet. SECTION EDITORS Mark H. WilcoxMark H. WilcoxProf. Mark H. Wilcox is a consultant microbiologist and the Head of Research and Development in Microbiology at the Leeds Teaching Hospitals (LTHT), where he is also the Infection Lead of Leeds NIHR Diagnostic Technologies Medical Technology and In Vitro Diagnostic Co-operative; Professor of Medical Microbiology at the University of Leeds, UK; and Lead on Clostridium difficile for Public Health England (PHE). He serves in multiple advisory roles, including to UK SAGE (COVID-19), as co-chair of the UK Technical Validation Group for COVID-19 test, as a medical advisor to the National Infection Prevention & Control Lead (NHSImprovement/England, the Medical Research Council's Infection and Immunity Panel, as Chair of PHE's Rapid Review Panel (reviews the utility of infection prevention & control products for the NHS) and member of the UK NHS Antimicrobial Resistance Programme Board. He has formerly been the Director of Infection Prevention (4 years), Infection Control Doctor (8 years), Clinical Director of Pathology (6 years) at LTHT and Head of Microbiology (15 years). Prof Wilcox leads a Healthcare Associated Infection Research Group at the University of Leeds, comprising ∼30 doctors, scientists and nurses. Projects include multiple aspects of Clostridium difficile infection, diagnostics, antimicrobial resistance and the gut microbiome, infection prevention and control interventions, and the clinical development of new antimicrobial agents. Eamonn M.M. QuigleyEamonn M.M. QuigleyEamonn M.M. Quigley is Chief of Gastroenterology and Hepatology at Houston Methodist Hospital in Houston, Texas, USA, Professor of Medicine at Weill Cornell Medical College and David M Underwood Chair of Medicine in Digestive Disorders. A graduate of University College Cork, Ireland, Dr Quigley trained in internal medicine in Glasgow and Manchester, and in gastroenterology in Glasgow, the Mayo Clinic, Rochester, Minnesota, USA, and Manchester. In 1986, he joined the faculty at the University of Nebraska Medical Center in Omaha, Nebraska, USA, where he ultimately served as Chief of Gastroenterology and Hepatology. Returning to Cork in 1998, he served as Dean of the Medical School at UCC for 7 years and was a principal investigator at its Alimentary Pharmabiotic Center from its inception. He served as president of both the American College of Gastroenterology and the World Gastroenterology Organization and is a past editor-in-chief of the American Journal of Gastroenterology. Clinical and research interests include irritable bowel syndrome, gastrointestinal motility and the role of the gut microbiota and probiotics in health and in gastrointestinal and metabolic disorders.

Recent Advances in the Management of Infantile Colic

The diagnosis and management of infantile colic has come a long way since the first case series published by Wessel et al in 1954. This paved the way for framing the diagnostic criteria for infantile colic i.e. Wessels criteria and to its current evolution of Rome IV criteria of Functional gastrointestinal disorders. The management of colic has evolved from the use of gripe water to its current use of probiotics. This review discusses the advances in the treatment of colic, the use of probiotics and the role of Lactobacillus reuteri DSM17938 in infantile colic. There is further emphasis on the other available options with their limitations and the side effects. L reuteri DSM 17938 since its discovery in the year 1962 by Professor Gerard Reuter has found its place in clinical research and multiple studies substantiate the efficacy of this naturally occurring probiotic which is not only limited to infantile colic but to multiple other indications and is recommended by the World Gastroenterology Organization (WGO) and the European Society of Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN).

Women in leadership positions in gastroenterology and hepatology.

Being the first woman to serve as the president of the World Gastroenterology Organisation gives me the opportunity to reflect on the place of women in gastroenterology and enables me to assess both how far we have come and the scale of the tasks still facing us.

WGO Guidance for the Care of Patients With COVID-19 and Liver Disease.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the least deadly but most infectious coronavirus strain transmitted from wild animals. It may affect many organ systems. Aim of the current guideline is to delineate the effects of SARS-CoV-2 on the liver. Asymptomatic aminotransferase elevations are common in coronavirus disease 2019 (COVID-19) disease. Its pathogenesis may be multifactorial. It may involve primary liver injury and indirect effects such as “bystander hepatitis,” myositis, toxic liver injury, hypoxia, and preexisting liver disease. Higher aminotransferase elevations, lower albumin, and platelets have been reported in severe compared with mild COVID-19. Despite the dominance of respiratory disease, acute on chronic liver disease/acute hepatic decompensation have been reported in patients with COVID-19 and preexisting liver disease, in particular cirrhosis. Metabolic dysfunction-associated fatty liver disease (MAFLD) has a higher risk of respiratory disease progression than those without MAFLD. Alcohol-associated liver disease may be severely affected by COVID-19—such patients frequently have comorbidities including metabolic syndrome and smoking-induced chronic lung disease. World Gastroenterology Organization (WGO) recommends that interventional procedures such as endoscopy and endoscopic retrograde cholangiopancreatography should be performed in emergency cases or when they are considered strictly necessary such as high risk varices or cholangitis. Hepatocellular cancer surveillance may be postponed by 2 to 3 months. A short delay in treatment initiation and non-surgical approaches should be considered. Liver transplantation should be restricted to patients with high MELD scores, acute liver failure and hepatocellular cancer within Milan criteria. Donors and recipients should be tested for SARS-CoV-2 and if found positive donors should be excluded and liver transplantation postponed until recovery from infection.

Monitoring of gluten in dairy products

According to the World Gastroenterology Organization, the prevalence of celiac disease in the world is estimated at 1 in 300 people. According to unofficial statistics of the Celiac Disease Union, about 400,000 Ukrainian citizens have an individual intolerance to gluten. Given the large number of people with individual gluten intolerance and its only treatment – a lifelong diet, there is a need to monitor gluten in food, namely in dairy products. As not all manufacturers adhere to the HACCP system in good faith in their production, there is a risk of gluten entering the finished product. The aim of the study was to evaluate dairy products for gluten content. The article presents information on the results of monitoring gluten in dairy products (butter, margarine, kefir, sour milk cheeses, yogurt, hard and soft cheeses) producers of different regions of Ukraine by molecular genetic method in 2018–2020 using diagnostic R-Biopharm kits. According to research, it was found that 17 % of dairy products do not contain gluten, 83% contain from 2 to 5 mg/kg; 37.5 % of hard and soft cheeses, sweet cream butter, margarine do not contain gluten; 62.5 % contain gluten in the amount of 2 to 5 mg/kg, which is within acceptable limits for people with celiac disease. Studies have shown that a significant percentage of dairy products contain from 2 to 5 mg kg of gluten, which may indicate accidental entry into the final product or technical contamination. However, although these products are not certified as gluten-free and meet the requirements of current legislation. A significant range of products with a gluten content of up to 5 mg/kg encourages the implementation of the Gluten Control (Monitoring) Program in all products to increase the range for people with individual needs. Prospects for further research are to monitor meat products, semi-finished products, dietary products, baby food of domestic production for further analysis of compliance with current legislation and safety for people with individual intolerance to gluten.

World Gastroenterology Organisation classification and a new type-based prognostic model for hepatitis B virus-related acute-on-chronic liver failure

BackgroundThe acute-on-chronic liver failure (ACLF) classification, proposed by the World Gastroenterology Organisation (WGO), attempts to cover all ACLF patients diagnosed in the East and West. This study aimed to explore and establish a prognostic model based on this classification. MethodsA total of 1159 hepatitis B virus–ACLF patients, enrolled with 90-day follow-up data, were divided into three groups (type A, B, and C) according to WGO ACLF classification and analyzed. A model of ACLF prognosis based on type (MAPT) was developed in a derivation cohort (n = 566); its reproducibility was tested in a validation cohort (n = 593). ResultsA significant difference in 90-day mortality among the three groups was observed (31.1%, type A; 40.9%, type B; 61.4%, type C, P < 0.001). ACLF type was determined to be an independent risk factor of 90-day mortality in HBV-ACLF patients. An MAPT, inclusive of type and five other variables, was built and validated; it was found to be superior to the Chronic Liver Failure (CLIF) Consortium ACLF score, Model for End-Stage Liver Disease, CLIF-Sequential Organ Failure, and Child-Turcotte-Pugh scores in predicting 90-day mortality, with an area under the receiver operating characteristic curve of 0.802 (95% CI [0.763–0.836]), sensitivity of 71.77%, and specificity of 75.82%. ConclusionsThe MAPT model showed excellent predictive value for 90-day mortality in HBV-ACLF and can likely expand the clinical application of WGO ACLF classification.