Episode 6: UEG Journal October Spotlight

00:00:06: Hello and welcome back

00:00:07: to UEG

00:00:07: Journal Photocast.

00:00:09: Your quick dive into the latest and most impactful research in gastroenterology.

00:00:15: I am Dr.

00:00:16: Mohsin Subhani, trainee-associated editor of UEG Journal and hepatologist based at University Hospital, Northingham.

00:00:26: And I'm Maria Manoelas-Devino, trainee-associated editor of the UEG Journal and the gastroenterologist and assistant professor in Portugal.

00:00:35: We are back for the latest episode and we have picked out five outstanding articles from the latest issue of UG Journal.

00:00:44: And as always, we'll keep it short and sharp.

00:00:47: In under twenty minutes, we'll walk you through the key takeaways and what they might mean for your day-to-day clinical practice.

00:00:55: So grab a coffee and join us for a fast and well-focused roundup of what is new in GI research.

00:01:04: We will start with a latest guideline related to gallbladder polyps, titled as devised guideline for the treatment and follow-up of gallbladder polyps, do not reduce unwarranted cholecystectomy.

00:01:18: The guideline was proposed by Mike Van Doreen and colleagues based in Netherlands.

00:01:25: We see a lot of weather polyps all the time.

00:01:27: Usually they are found incidentally on ultrasound.

00:01:30: Mostly they are benign, but it's hard to know which ones really matter.

00:01:34: Modern imaging still can't reliably tell us those that are benign and distinguished from those that are malignant.

00:01:42: So diagnosis is only certain after removal and histology.

00:01:50: over one centimeter, but that is probably too cautious.

00:01:53: The risk of cancer in this polyps is less than point four percent.

00:01:58: Risk goes

00:01:59: higher

00:02:00: in polyps of size greater than two centimeter.

00:02:03: A recent cohort study of over six hundred thousand patients published in German gastroheb found no increases of cancer in people with gallbladder polyps, those without gallbladder polyps.

00:02:16: This Dutch multicenter study analyzed three hundred and two patients with gallbladder polyps from twenty-six hospitals comparing the two thousand and seventeen, two thousand and twenty-two European guidelines.

00:02:29: The two thousand and twenty-two update mainly changed the age risk factor from fifty to sixty years old.

00:02:36: In the current study, patients were followed up for a median of twenty-three months with about three imaging studies each.

00:02:44: overall, twenty-nine percent underwent cholecystectomy after roughly two years.

00:02:48: Using twenty-seventeen guidelines, eighty-one percent of these surgeries met the criteria whereas based on twenty-twenty-two guidelines, seventy-seven percent met the guideline for cholecystectomy.

00:03:01: Interestingly, there was only difference of three cases.

00:03:04: Yes, and the pathology results were telling.

00:03:07: Of those operated, sixty-nine percent had non-neoplastic polyps and thirty-two had no abnormality at all.

00:03:16: Indeed, only six patients corresponding to nine percent had adenomas, three of which had low-grade dysplasia and one with high-rate dysplasia.

00:03:26: No invasive cancers were found.

00:03:29: So even after revising the guidelines, unnecessary surgery remains common.

00:03:33: Author suggests moving beyond simple size and age cut-off to include imaging morphology or contrast enhanced features to better predict the risk of cancer in gallbladder polyps.

00:03:46: Yes, so.

00:03:47: in short, gallbladder polyps are frequent but cancer is rare.

00:03:51: Our recurrent follow-up and surgical thresholds still lead to over-treatment.

00:03:57: Gallbladder polyps are often harmless.

00:03:59: In this large ditch cohort, almost a third of the patient underwent surgery, yet only one in ten had an adenoma and none had cancer.

00:04:10: Updating European guidelines from twenty seventeen to twenty twenty-two only changed a little.

00:04:16: It's a time for comprehensive imaging-based risk stratification to avoid unnecessary cholecystectomies in this cohort.

00:04:25: And with that, let's move from the gold leather to the pancreas.

00:04:28: Our next paper explores the long-term efficacy and safety of digital single operator video pancreatoscopy guided lithotripsy for pancreatic duct stones, a very different but equally fascinating area.

00:04:43: Over the last decade, digital single-operator video pancreatoscopy has emerged as an alternative.

00:04:50: It does allow direct visualization and electro-idolic nitotripsi of pancreatic stones and their endoscopic control.

00:04:58: However, long-term data have been limited.

00:05:01: This multi-center retrospective study by Conard and colleagues included fifty-eight patients with chronic calcified pancreatitis who underwent single use.

00:05:09: Videopentratoscopy guided lithotripsy between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease

00:05:27: between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease between the year of the disease.

00:05:41: Long-term clinical success, meaning sustained pain reduction at twenty-four months, was maintained in seventy-one percent of the patients.

00:05:49: Complete ductal clearance was achieved in seventy-nine percent.

00:05:53: Usually, after a single session, this appeared to be key determine of lasting pain control.

00:05:59: Importantly, adverse events occurred in twenty-six percent, mainly mild to moderate post-ERCP pentatitis in about one-fifth of the patients.

00:06:10: Interestingly, quality of life scores didn't change significantly.

00:06:14: The physical component scores stayed at around forty-five and the mental score near fifty, suggesting that while pain improves, other factors like disease-related disability still continue to limit the quality of life of these patients.

00:06:29: The authors conclude that a digital single-operative video concrutoscopy guided lithotype C is a safe and effective endoscopic option.

00:06:38: for chronic calcified pancreatitis when complete ductal clearance is achieved, but future studies are required to compare with other available techniques for pancreatic lithotrypsy.

00:06:52: So the message is... For patients with obstructing pancreatic leg stones, direct vision lithotripsy achieves durable pain relief in most cases, with acceptable safety.

00:07:03: However, the quality of life of these patients may depend on further management of chronic pancreatitis.

00:07:11: And with that, let's move on from the pancreas to liver.

00:07:14: Our next paper identifies key predictor of relevant weight loss in patients with metabolic dysfunctional associated steatotic liver disease, a topic with major implication for everyday hepatology, and general practice.

00:07:28: This multi-center attack study by cookies and colleagues included over nine hundred patients with MaslT and these were followed up for twenty one month over four tertiary centers.

00:07:41: Lifestyle was standardized focusing on diet and physical activity and outcomes were reassessed after roughly two years.

00:07:50: Yes, and despite consistent counseling, only about eighteen percent of patients managed to lose at least seven percent of their baseline weight.

00:07:59: And the seven percent is the percentage that is usually defined as clinically relevant weight loss.

00:08:07: Still, this is a very important group study because even modest reductions in body weight have been shown to improve steatosis, inflammation and the fibrosis.

00:08:18: Exactly.

00:08:19: The authors then multivariable analysis to identify independent predictor of this success.

00:08:25: They found baseline BMI of greater than thirty was a strong predictor with odds ratio of greater than two for achieving more than seven percent body weight loss.

00:08:36: Interestingly, sport from a nutritionist doubled the likelihood of success and GLP-one receptor agonist use also increased odds by nearly two-fold.

00:08:47: Two biological markers stood out and they were blurbine of greater than one point two milligram potassium liter or a liver stiffness of greater than ten kilopascals.

00:08:58: Both were independently associated with greater weight loss, possibly reflecting better metabolic engagement or greater disease awareness.

00:09:07: And these findings are quite revealing.

00:09:09: Only one in five patients actually worked with a nutritionist, yet a subgroup achieved much higher success rates.

00:09:18: This reinforces our structure, lifestyle support, combined with pharmacological tools like GL, P-one, agonists can make a real difference in muscle de-management.

00:09:29: And that link with elevated bilirubin, the likely mild elevations consistent with Gilbert syndrome, is intriguing.

00:09:37: It feeds with data suggesting bilirbrins, antioxidants and metabolic regulatory roles might confer protection against metabolic dysfunction.

00:09:46: The key take-home message for me from this study is a meaningful weight loss in Mazzaldi remains difficult to achieve, but patients with high BMI at the start with structural nutrients both and a GLP-One therapy on both could do better.

00:10:01: in addition.

00:10:02: Elevated belowrobin are a labor stiffness layer could be used as a personalized feedback to induce behavior change and supplement the weight loss.

00:10:11: In addition, dietary spout with specific low carb diet can be helpful.

00:10:17: Absolutely.

00:10:18: Tailoring lifestyle and pharmacologic strategies to the individual patient profile seems key for the long-term outcomes in Manzoldi.

00:10:26: And now let's move to our next paper, which discuss IBIS.

00:10:31: SAS in highly accurate intestinal ultrasound score for predicting endoscopic disease activity in ulcerative colitis.

00:10:39: This was written by a well-known group from Germany.

00:10:42: So, let's start by explaining what the IBUS-SOS actually is.

00:10:47: IBUS-SOS stands for International Bowel Ultrasonic Segmental Activity Score.

00:10:53: It's a standardized scoring system developed by the IBUS group to quantify inflammation seen on intestinal ultrasound.

00:11:00: Quite right, Manuela.

00:11:02: Intestinal ultrasound is gaining attention because it's non-invasive, widely available and can be done repeatedly without much discomfort, unlike the endoscopy, which remains the gold standard but requires palpropatiation, sedation and patient coming to hospital for short stay and having the procedure done.

00:11:21: Yes, and that's where the Albusas comes in.

00:11:24: It combines four key ultrasound features, bone wall thickness, blood flow or vascularization, loss of bowel loss stratification, and inflammatory fat changes around the bowl.

00:11:37: These all together into a single numerical score.

00:11:41: This score was originally validated for Crohn's disease, but the study we are discussing today asks whether it could also predict inflammation and ulcerative colitis, where inflammation is limited and only involving superficial lining of colon, which is micoza and some micoza.

00:11:58: Exactly, the researchers from the University Hospital Erlen, Germany, enrolled fifty-eight patients with all sorts of colitis.

00:12:05: Each patient underwent an intestinal ultrasound, and their IBUS SAS scores were compared with established clinical, endoscopic, histological, and biochemical markers, with things like the myoscore, the CIS, Nancy index, CRP, and fecal coprotectin.

00:12:23: And the results were very encouraging, a cutoff of fifteen point nine on iBus SAS score predict active disease on endoscopy with hundred percent sensitivity and eighty percent specificity.

00:12:36: That means ultrasound detected all patients who actually had information while correctly identifying most of those in remission.

00:12:44: Yes, and it's worth noting that Lindbergh score, an older ultrasound score that considers bowel wall thickening and Doppler signal, also performed well.

00:12:54: However, the eye was sawed slightly outperformed it, particularly to predict esologic inflammation.

00:13:01: Authors even proposed additional threshold of thirty-eight for moderate and sixty-nine for severe endoscopic disease activity.

00:13:10: Those gradations could help condition monitor disease progression and response to treatment without always repeating endoscopy.

00:13:18: Yes, and the correlations were strong across the board.

00:13:21: not just with endoscopy, but also with histology and biomarkers like CRP and fical colbrum.

00:13:27: This reinforces that what we see on ultrasound really reflects what is happening in the tissue.

00:13:33: And of course, as Manuela said, there are certain limitations.

00:13:38: This was a single-center study in a highly experienced unit.

00:13:41: Sample size was very modest, so the next step would be to validate study in multiple other centers with the diversity of the patients.

00:13:50: Still, this is a promising step toward using ultrasound as a routine objective measures in ulcerative colitis and not just in Crohn's disease.

00:14:00: And honestly, if we can assess inflammation without scopes or sedation, that's a win-win for both doctors and patients.

00:14:08: Yes, exactly.

00:14:09: That would mean fewer scopes, less prep, and it's important to move towards more patient-friendly monitoring, which is precise, standardized and accessible.

00:14:19: So, to sum up, the ibussos is a reliable, validated ultrasound score that correlates strongly with disease activity in assertive colitis.

00:14:29: It could become a universal imaging tool for IBD if future studies confirm these results.

00:14:36: And finally, we will look to a fresh new study that looked at how gluten exposure, both a single dose and five days of intake, affected gastrointestinal and psychological symptoms in two groups.

00:14:48: People with self-reported non-silicic gluten sensitivity and the other group held the controls.

00:14:55: It was a randomized single-blinded crossover trial done at Lubin in Belgium.

00:15:00: Participant consumed sixteen grams of gluten about what most people eat daily or placebo made from the protein.

00:15:09: First as a one-time challenge mixed in yogurt and later as a daily muffin for five days.

00:15:16: During those periods, the researchers tracked not just only digestive symptoms like bloating and pain, but also fatigue, tension and mood, using validated psychological scales.

00:15:28: They also measured biological markers, including CRP, intestinal permeability and cortisol levels, to see if any physical changes accompanied the symptoms.

00:15:39: So what happened?

00:15:40: Well, people with non-silic-gluten sensitivity did show higher fatigue after acute challenge and more blotting and abdominal pain after the five-day phase.

00:15:50: But here is the kicker.

00:15:52: Those effects were not specific to gluten.

00:15:55: They happened regardless of whether participants were taking gluten or placebo.

00:16:00: Right, there were no significant gluten-by-group interactions, meaning gluten itself did not stand as a cause.

00:16:07: They also found that people with non-cellular gluten sensitivity had higher negative effects, that is more negative mood and lower positive effect at baseline even before any gluten exposure.

00:16:20: And when they looked at biological marker, nothing changed.

00:16:23: No difference in inflammation, cortisol, or intestinal permeability, so no evidence of leaky gut or immune-related reaction from gluten.

00:16:33: So in short, the body didn't seem to react to gluten, however, the mind might have.

00:16:40: Arthur suggests that much of what happened in non-celec gluten sensitivity could be explained by Nocebo's effect.

00:16:47: which when negative expectations cause real symptoms, in fact, more than half of the participants are reported symptoms during placebo that they attribute to gluten.

00:16:57: Yes, that's remarkable.

00:16:59: And I think that these findings fit with other older studies.

00:17:02: For example, the one published by The Graphs in the year.

00:17:07: that was a multi-centered trial that showed that expectation alone can trigger gastrointestinal and psychological symptoms.

00:17:15: Exactly, so rather than seeing non-silic gluten sensitivity as a pure gluten-driven condition, it might be more accurate to view it as a part of gut brain access where psychological dietary and sensory factors overlap.

00:17:30: The authors even suggest rethinking how we diagnose and manage non-cellular gluten sensitivity, integrating psychological evaluation and possibly cognitive vihuvior therapy, especially exposure-based BCT, instead of just telling patients to avoid gluten forever.

00:17:49: Yes, this research helps refine how we think about gluten sensitivity, not Dismissing it, but understanding it through a broader lens of God-brand communication, and that's the key.

00:18:01: Moving from blaming gluten to understanding the person.

00:18:05: Exactly.

00:18:06: Gluten may not be the violent after all.

00:18:09: Maybe it's just a scapegoat in a bigger psychological story.

00:18:14: Thank you very much for joining us.

00:18:16: So stay tuned for our next cutting edge episode for latest research in GI, been published in Jiu Jitsu Journal.

00:18:25: And please don't forget to like, subscribe and share.

00:18:29: Thank you very much.