Gastric polyps: a retrospective cohort analysis of 23,668 endoscopies indicates changing epidemiological and phenotypic characteristics.

Introduction: Growing adoption of endoscopic procedures in clinical practice has gradually increase the detection rate of gastric polypoid lesions. Aim: To identify the epidemiologic characteristics of gastric polyps as well as changes of these parameters during a 15-year period. Material and methods: We reviewed all the upper endoscopies archived in our database reporting a polypoid lesion from 2003 to 2018. Demographic data, indication for endoscopy, morphological characteristics of polyps, histology, and presence of Helicobacter pylori were collected. We compared the abovementioned data between 2 periods: 2003-2010 and 2010-2018. Results: A total of 989 (4.2%) patients from 23,668 reviewed were identified to harbour a polypoid lesion. Mean patient age was 63.2 years, with 58.8% being female. Most polyps (65.2%) were less than 5 mm in diameter and located in the fundus. Hyperplastic polyps (HPs) were the predominant type (28.6%) while fundic gland polyps (FGPs) were found in 24.1% of patients. Adenomas were the least common type (2.7%). Other pathology was identified in 43.3%. Comparison between the 2 periods revealed a rise of FGPs against HPs with a concomitant shift of location from antrum to fundus and an increase in the number of polyps per patient. Conclusions: FGPs and HPs were the most common polyps found in our cohort, with a change of their pattern during the 15 years. It is imperative to acknowledge the distinct characteristics of gastric polyps so as to properly assess the malignant potential that some of them, or their surrounding gastric mucosa, harbour.

Ulcerative colitis after SARS-CoV-2 infection.

Although severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) affects mainly the respiratory system, the gastrointestinal tract is also considered a site of viral activity. We hereby present the case of a 74-year-old male patient with the diagnosis of new-onset ulcerative colitis. One month earlier, the patient presented fever, running nose, and diarrhea and was tested positive for SARS-CoV-2. Studies with COVID-19 patients revealed significant changes in gut microbiota composition and alterations in immune responses that could lead to chronic inflammation and manifestations of inflammatory bowel disease. We review additional cases of ulcerative colitis presented after SARS-CoV-2 infection and summarize the possible mechanisms that underlie the gastrointestinal abnormalities in COVID-19 patients.

Ulcerative colitis after SARS-CoV-2 infection

ABSTRACT Although severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) affects mainly the respiratory system, the gastrointestinal tract is also considered a site of viral activity. We hereby present the case of a 74-year-old male patient with the diagnosis of new-onset ulcerative colitis. One month earlier, the patient presented fever, running nose, and diarrhea and was tested positive for SARS-CoV-2. Studies with COVID-19 patients revealed significant changes in gut microbiota composition and alterations in immune responses that could lead to chronic inflammation and manifestations of inflammatory bowel disease. We review additional cases of ulcerative colitis presented after SARS-CoV-2 infection and summarize the possible mechanisms that underlie the gastrointestinal abnormalities in COVID-19 patients.

The natural history of COVID-19 in patients with inflammatory bowel disease: a nationwide study by the Hellenic Society for the study of IBD.

OBJECTIVES: COVID-19 has evolved into a global health crisis, variably affecting the management of patients with chronic illnesses. Patients with inflammatory bowel disease (IBD) may represent a vulnerable population due to frequent administration of immune-modifying treatments. We aimed to depict the natural history of COVID-19 infection in Greek patients with IBD at a nationwide level via unbiased reporting of all cases that were registered during the sequential waves of the pandemic. METHODS: Following a national call from the Hellenic Society for the study of IBD, we enrolled all IBD patients with established diagnoses of COVID-19. Clinical and epidemiological data, including COVID-19 modifying factors and IBD-associated therapies, were analyzed against adverse outcomes (hospitalization, ICU admission and death). RESULTS: We identified 154 IBD patients who were diagnosed with COVID-19 (men: 58.4%; mean age=41.7 years [SD = 14.9]; CD: 64.3%). Adverse outcomes were reported in 34 patients (22.1%), including 3 ICU admissions (1.9%) and two deaths (1.3%). Multivariate logistic regression analysis showed that age (OR = 1.04, 95% CI, 1-1.08) and dyspnea at presentation (OR = 7.36, 95% CI, 1.84-29.46) were associated with worse outcomes of COVID-19 infection. In contrast, treatment with biologics, in particular anti-TNF agents, exerted a protective effect against an unfavorable COVID-19 disease course (OR = 0.4, 95% CI, 0.16-0.99). Patients on subcutaneous biologics were more likely to halt treatment due to the infection as compared to those on intravenous biologics. CONCLUSIONS: IBD patients who developed COVID-19 had a benign course with adverse outcomes being infrequent. Treatment with anti-TNF biologics had a protective effect, thus, supporting continuation of therapy during the pandemic.

Optimal duration of concomitant nonbismuth quadruple therapy as first-line therapy for Helicobacter pylori: a prospective, open-label, comparative study.

BACKGROUND: Concomitant nonbismuth quadruple therapy is recommended as first-line treatment for Helicobacter pylori infection in high clarithromycin resistance areas, but the ideal duration of the regimen remains elusive. Aim of this study was to assess the efficacy and tolerability of 10- versus 14-day concomitant therapy for H. pylori eradication in an area of high clarithromycin and low dual clarithromycin/metronidazole resistance. METHODS: This was a prospective, open-label study including adult patients with H. pylori infection without previous treatment, from September 2014 to June 2017. Concomitant therapy consisting of pantoprazole 40 mg, amoxicillin 1g, clarithromycin 500 mg, and a nitroimidazole 500 mg was administered twice daily for 10 days in the first phase and for 14 days in the second phase of the study. Efficacy and side effects were compared between groups using chi-square and Fisher's exact tests. RESULTS: In per protocol analysis, rates of eradication for the 10- and 14-day regimen were 91.9% (114/124) and 90.9% (110/121), respectively (P = 0.77). In intention to treat analysis, rates of eradication were lower than 90%. Specifically, rates were 86.3% (114/132) for the 10-day regimen and 85.2% (110/129) for the 14-day regimen (P = 0.8). Side effects, present in 31.3% of treated patients, were significantly more common in the 14-day group (P = 0.015). Four patients discontinued treatment, all in the 14-day group. CONCLUSIONS: Ten day concomitant nonbismuth quadruple therapy for H. pylori is highly efficacious and better tolerated than the 14-day regimen. Thus, 10-day therapy may be preferred as first-line treatment in clinical practice.