Journal of Clinical Gastroenterology

Díaz-Rodríguez, Dahiana M.; Bustamante-Rengifo, Javier A.; García-Perdomo, Herney A.

2024 Journal of Clinical Gastroenterology

doi: 10.1097/mcg.0000000000002064pmid: 39213005

Goals: To evaluate the efficacy and safety of standard triple therapy (STT) in Latin America. Background: Helicobacter pylori infection affects more than 50% of the Latin Americans and leads to gastric mucosa damage. Scarce data on effective therapeutic approaches in the region underscores the need for comprehensive information. Study: The analysis included Randomized Controlled Trials published up to the year 2020, comparing STT with other treatments. Cumulative relative risks (RR) were estimated, with 95% CI, according to intention-to-treat (ITT) and per protocol (PP) analysis. Results: Eleven studies (clinical trials conducted between 1995 and 2013), revealed cumulative eradication rates of 78.31–90.63% (ITT) and 76.71–93.55% (PP). The eradication with the STT was superior to sequential therapy (ITT—RR: 10.6, 95% CI: 1.01 to 1.12) (PP—RR: 10.6, 95% CI: 1.02-1.11) and dual therapy (ITT—RR: 1.61, 95% CI: 1.13-2.30) (PP—RR: 1.72, 95% CI: 1.25-2.37), but is less effective than other triple therapies (PP—RR: 0.85, 95% CI: 0.78-092). Regarding adverse effects, diarrhea, metallic taste, nausea, vomiting, and headache were the most common symptoms across treatments. Abdominal pain was associated with STT (ITT—RR: 1.75, 95% CI: 1.07-2.86). Conclusion: STT was a safe regimen but with acceptable efficacy (most eradication rates <90%). Due to rising clarithromycin resistance, the study suggests avoiding STT as a first-line treatment. These results must be considered with caution due to the low representativeness of several Latin American countries and the lack of recent high-quality randomized studies.

Dayto, Denisse Camille; Blonski, Wojciech; Reljic, Tea; Klocksieben, Farina; Gill, Jeffrey; Gomez-Esquivel, Rene D.; Patel, Brijesh; Taunk, Pushpak; Sephien, Andrew; Thelin, Camille; Kumar, Ambuj

2024 Journal of Clinical Gastroenterology

doi: 10.1097/mcg.0000000000002069pmid: 39213007

Background: Clinical practice guidelines (CPGs) exist for the management of antithrombotic agents in the periendoscopic period; however, their methodological qualities vary. The Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool has been validated for the assessment of the methodological quality of CPGs; however, its reproducibility has not been assessed. The goal of this study was to assess the reproducibility of the AGREE II tool for CPGs published within the last 6 years for the management of antithrombotic agents in the periendoscopic period. Study: A systematic search of PubMed and Embase databases was performed to identify eligible CPGs published between January 1, 2016 and April 14, 2022. The quality of the CPG was independently assessed by 6 reviewers using the AGREE II instrument. The reproducibility was summarized as weighted κ statistic and intraclass correlation coefficient using the SPSS statistical analysis package. Results: The search yielded 343 citations with 7 CPGs from Europe, Asia, and the United States included in the critical appraisal. The overall mean weighted κ score across all guidelines was 0.300 (range, 0.093 to 0.384) indicating a fair agreement. The overall intraclass correlation coefficient was 0.462 (range, 0.175 to 0.570) for single measures and 0.837 (range, 0.560 to 0.888) for average measures indicating moderate reliability. Conclusions: Our study shows only a fair overall interobserver agreement in the methodological quality of the included CPGs. The results suggest the need for education and training of CPG raters to enhance the application of the AGREE II tool to improve its reproducibility.

Göldi, Andreas; Kaymak, Tanay; Esposito, Luca; Lehmann, Anouk; Negoias, Simona; Tamm, Michael; Niess, Jan Hendrik; Hruz, Petr

2024 Journal of Clinical Gastroenterology

doi: 10.1097/mcg.0000000000002068pmid: 39212998

Background: Eosinophilic Esophagitis (EoE) is a chronic inflammatory condition of the esophagus triggered by food and aeroallergens. There is a need for noninvasive biomarkers that reliably detect EoE in patients with cardinal symptoms and predict treatment response to reduce endoscopic evaluations. Study: Nonasthmatic patients 18 years or above with suspected or diagnosed EoE, gastroesophageal reflux disease (GERD), and control individuals with indication for endoscopy were enrolled prospectively between November 2020 and May 2022. Participants underwent body plethysmography with fractionated exhaled nitric oxide (FeNO) level measurement. Besides, serum and fecal biomarkers were measured by ELISA. A follow-up examination was scheduled after treatment initiation in patients with active EoE. Results: The median FeNO level in active EoE (20 ppb) was higher compared with GERD (15 ppb, P=0.038) and control individuals (14 ppb, P=0.046). Median FeNO did not significantly differ in EoE patients who underwent follow-up assessment after treatment response (20 ppb vs. 18 ppb, P=0.771). Serum EDN, ECP, and the absolute eosinophil blood count (AEC) were elevated in active EoE compared with control individuals but not compared with GERD except for AEC. Serum EDN, ECP and AEC decreased in EoE in remission at follow-up assessment. None of the fecal biomarkers was elevated in active EoE or during treatment. Conclusions: Assessment of FeNO may have diagnostic value in differentiating patients with active EoE from non-EoE patients but is not a suitable marker for monitoring disease activity. Serum EDN, ECP, TARC, and AEC levels are emerging as potential candidates for monitoring disease activity in EoE.

El Deen Alkhadraa, Izz; Uebel, Linnea; Kromodikoro, Indy; van Nieuwenhoven, Michiel

2024 Journal of Clinical Gastroenterology

doi: 10.1097/mcg.0000000000002073pmid: 39212999

Background: In 2021, a nation-wide screening program for colorectal cancer (CRC) was step-wise implemented in Region Örebro County (RÖC) for patients aged 60 to 74 years, utilizing the fecal immunochemical test (FIT) to refer patients for colonoscopy. Concurrently, the standardized care course for colorectal cancer (SCC-CRC), initiated in 2016, employs a fast-track pathway for patients with alarm symptoms to undergo colonoscopy. This study compares CRC screening colonoscopies with SCC-CRC colonoscopies in RÖC among patients aged 60 to 67 years. Methods: An initial analysis of the Swedish colorectal screening cohort was combined with a retrospective cohort study, analyzing data from 307 CRC screening patients and 441 age-matched SCC-CRC patients in RÖC. Data included demographics, colonoscopy participation rates, and pathology findings. Statistical analyses compared outcomes between the 2 groups. Results: Among the screening group, 2% tested positive for FIT, with an 86% colonoscopy participation rate (N=9296). In RÖC, 266 screening patients underwent colonoscopy, with 10% diagnosed with CRC, compared with 20% in the SCC-CRC group. In addition, 39% of the screening group in RÖC were diagnosed with advanced adenomas, versus 15% in the SCC-CRC group Conclusions: Screening participation was high, with effectiveness aligning with international counterparts. The SCC-CRC pathway excels in diagnosing CRC among symptomatic patients, while the nationwide screening program is effective in early detection of CRC and advanced adenomas. underscoring the importance of integrating and optimizing both approaches within the Swedish health care system to optimize CRC prevention and management.

Thomas, Raj Jessica; Ali, Adel Hajj; Bolwell, Jacquelyn; Butler, Robert; Burke, Carol A.; Liska, David; Macaron, Carole

2024 Journal of Clinical Gastroenterology

doi: 10.1097/mcg.0000000000002072pmid: 39213008

Background: The risk of metachronous advanced colorectal neoplasia (mACRN) in young adults with advanced lesions at baseline colonoscopy is not well defined. Aims: To examine the risk for (mACRN) in adults <50 years old who had advanced neoplasia (AN) at baseline colonoscopy and determine factors associated with mACRN in these patients. Method: Patients 18 to 49 years of age with ≥1 AN [tubular adenoma (TA) ≥10 mm or with villous features or high-grade dysplasia (HGD), sessile serrated lesion (SSL) ≥10 mm or with dysplasia, traditional serrated adenoma (TSA)] on baseline colonoscopy between 2011 and 2021 who had surveillance colonoscopy >6 months after their baseline examination were included. Outcomes were assessed based on age at baseline colonoscopy, <45 years versus 45 to 49 years, and by follow-up colonoscopy findings: (1) normal, (2) nonadvanced neoplasia (NAN), and (3) AN. Results: Three hundred sixty-six patients with AN underwent ≥1 surveillance colonoscopy: 310 (84.7%) <45 years versus 56 (15.3%) 45 to 49 years. The mean follow-up time was longer for the <45-year-olds versus the 45 to 49-year-olds (43±26.4 vs. 28.4±12.8 mo respectively, P<0.001). The absolute risk of mACRN was 13.5% in the <45 age group versus 16.1% in the 45 to 49 age group, P=0.28. The 3-year cumulative incidence rates of mACRN were comparable for patients <45 and 45 to 49 years old: 10% (95% CI: 10% to 42%) versus 20% (95% CI: 7% to 15%), P=0.065. BMI was the only risk factor associated with mACRN OR 1.045 [95% CI (1.001 to 1.09)]. Conclusions: In our cohort of patients <50 years old with AN at baseline, mACRN occurred at a similar rate to that reported by guidelines in 50 years and older, suggesting that current recommended post polypectomy surveillance is appropriate for this age group. BMI was independently associated with mACRN. Future studies should examine how weight management in patients with high BMI mitigates the recurrence of advanced neoplasia.