Healthy Lifestyle Is a Protective Factor from Moderate and Severe Relapses and Steroid Use in Inflammatory Bowel Disease: A Prospective Cohort Study.

BACKGROUND: A healthy lifestyle, including good adherence to a Mediterranean diet (MD) and regular physical exercise, may be an important factor during the course of inflammatory bowel disease (IBD). Our aim is to determine whether adherence to MD, physical activity, and the combination of both can impact on IBD course. METHODS: This prospective cohort study includes 693 IBD outpatients who were in remission with a median follow-up time of 27 months (interquartile range 22-29 months). Each patient completed a survey to assess their adherence to the MD and physical activity. Healthy lifestyle was considered to be a proper adherence to both MD and an active lifestyle. Relapse during follow-up, severity of relapses, need for systemic steroids, and therapy changes were recorded. RESULTS: During the follow-up period, 188 patients (27.1%) experienced relapse, of which 56.1% were moderate or severe. Among patients with relapse, 85 (45%) required treatment with corticosteroids, and 15 (7.9%) were hospitalized. Patients with ulcerative colitis (CU) were more adherent to healthy lifestyle than patients with Crohn's disease (P = .011). Healthy lifestyle was associated with lower risk of moderate and severe relapses (adjusted Hazard ratio [aHR], 0.250; 95% confidence interval [CI], 0.093-0.670) and steroids use (aHR 0.292; 95% CI, 0.103-0.828) in IBD patients and with lower risk of moderate and severe relapses (aHR 0.270; 95% CI, 0.093-0.789) in UC patients. CONCLUSIONS: Healthy lifestyle has a favorable influence on promoting a milder disease course, and thus should be a crucial part of clinical management of patients with IBD.

Healthy lifestyle including adherence to a Mediterranean diet and physical exercise has a favorable influence on promoting a milder disease course and thus should be a crucial part of clinical management of patients with IBD.

Helicobacter pylori Diagnostic Tests Used in Europe: Results of over 34,000 Patients from the European Registry on Helicobacter pylori Management.

BACKGROUND AND AIMS: Several methods are available to diagnose Helicobacter pylori infection. Our objective was to evaluate the tests used for both the initial diagnosis and the confirmation of eradication after treatment in Europe. METHODS: The European Registry on the management of Helicobacter pylori infection is an international, multicentre, prospective, non-interventional registry aiming to evaluate the management of Helicobacter pylori-infected patients in Europe. Countries with at least 100 cases registered from June 2013 to April 2021, and with a validated diagnostic method were analysed. Data were quality reviewed. RESULTS: A total of 34,920 adult patients from 20 countries were included (mean age 51 years; 61% women). To establish the initial diagnosis, invasive tests were performed in 19,801 (71%) patients, non-invasive in 11,369 (41%), and both in 3437 (12%). The most frequent were histology (n = 11,885; 43%), a rapid urease test (n = 10,636; 38%) and an urea breath test (n = 7577; 27%). According to the age, invasive tests were indicated in 11,179 (77%) ≥50 years, and in 8603 (65%) <50 years. Depending on the country, the use of invasive tests ranged from 29-99% in <50 years to 60-99% in ≥50. Most of the tests used to confirm eradication were non-invasive (n = 32,540; 93%), with the urea breath test being the most frequent (n = 32,540; 78%). In 2983 (9%) post-treatment tests, histology (n = 1887; 5%) or a rapid urease test (n = 1223; 4%) were performed. CONCLUSION: A great heterogeneity was observed for the initial diagnosis and confirmation of the eradication. The reasons for the apparent lack of adherence to the clinical guidelines should be further explored.

Esófago de Barrett, hacia la mejora de la práctica clínica / Barrett's esophagus, towards improved clinical practice

La principal relevancia clínica del esófago de Barrett (EB), resultado de la exposición crónica al reflujo gastroesofágico, es su potencial progresión a adenocarcinoma esofágico (ACE). Aunque no se recomienda el cribado de EB en la población general, tras su diagnóstico es beneficiosa una estrategia de seguimiento para la detección precoz de displasia o neoplasia. El patrón oro para el diagnóstico y seguimiento es la endoscopia oral de alta definición con toma de biopsias aleatorias. Además, toda lesión visible debe resecarse de forma completa preferentemente mediante resección endoscópica mucosa, que se considerará curativa en presencia de displasia de bajo grado (DBG), displasia de alto grado (DAG) o ACE confinado a la mucosa (T1a), tras lo cual se debe erradicar el EB residual mediante ablación endoscópica. En ausencia de lesión visible, la ablación por radiofrecuencia es el tratamiento de elección para erradicar el EB con DBG, DAG o ACE intramucoso. (AU)

The main clinical relevance of Barrett's esophagus (BE), a result of chronic exposure to gastroesophageal reflux, is its potential progression to esophageal adenocarcinoma (EAC). Although screening for BE is not recommended in the general population, after diagnosis of BE, a surveillance strategy for early detection of dysplasia or neoplasia is needed. The gold standard for diagnosis and surveillance is high-definition oral endoscopy with random biopsies. In addition, any visible lesion should be completely resected, which will be considered curative in the presence of low grade dysplasia (LGD), high-grade dysplasia (HGD) or EAC confined to the mucosa (T1a), followed by eradication of residual BE by endoscopic ablation. In the absence of a visible lesion, radiofrequency ablation should be performed to eradicate BE with LGD, HGD or intramucosal EAC. (AU)

Barrett's esophagus, towards improved clinical practice. / Esófago de Barrett, hacia la mejora de la práctica clínica.

The main clinical relevance of Barrett's esophagus (BE), a result of chronic exposure to gastroesophageal reflux, is its potential progression to esophageal adenocarcinoma (EAC). Although screening for BE is not recommended in the general population, after diagnosis of BE, a surveillance strategy for early detection of dysplasia or neoplasia is needed. The gold standard for diagnosis and surveillance is high-definition oral endoscopy with random biopsies. In addition, any visible lesion should be completely resected, which will be considered curative in the presence of low grade dysplasia (LGD), high-grade dysplasia (HGD) or EAC confined to the mucosa (T1a), followed by eradication of residual BE by endoscopic ablation. In the absence of a visible lesion, radiofrequency ablation should be performed to eradicate BE with LGD, HGD or intramucosal EAC.

Impact of the lockdown period due to the COVID-19 pandemic in patients with inflammatory bowel disease / Impacto del confinamiento debido a la pandemia por COVID-19 en pacientes con enfermedad inflamatoria intestinal

Introduction: The lockdown period due to the coronavirus disease 2019 (COVID-19) in Spain probably had a significant emotional impact on chronic patients and hence on those who are suffering from inflammatory bowel disease (IBD) due to their high risk of emotional disorders. The aim of this study was to learn how COVID-19 influenced patients suffering from IBD during the quarantine period, focusing in particular on psychological distress through the Perceived Stress Scale-10 (PSS-10) and also the impact of the pandemic on therapeutic adherence using the Visual Analogue Scale (VAS).Patients and methods: A prospective, single-centre and analytical observational study was carried out in the IBD unit in August 2020. Patients were contacted and interviewed by phone. A descriptive analysis was carried out and subsequently the factors associated with the loss of therapeutic adherence and higher-moderate levels of stress were analyzed through logistic regression multivariate analyses.Results: A total of 426 patients were included with a median PSS-10 score of 12 (10–16). A higher level of stress was reported by those who were not married, women and those who experienced an increase in IBD-related symptoms. Adherence to treatment was not associated with stress based on the PSS-10 questionnaire.Conclusions: Although the lockdown period due to the COVID-19 pandemic has probably had a significant emotional impact on Spaniards with IBD, IBD patients in general had lower PSS-10 scores.

Introducción: El confinamiento debido a la pandemia por COVID-19 en España tuvo probablemente un importante impacto emocional en los pacientes crónicos, y por tanto en aquellos que sufren enfermedad inflamatoria intestinal (EII) debido a su riesgo incrementado de padecer desórdenes emocionales. El objetivo de este estudio es el de conocer como la COVID-19 ha influido a los pacientes con EII durante el período de cuarentena, haciendo hincapié en el nivel de estrés a través de la Escala de Estrés Percibido (PSS-10) así como en la adherencia a los tratamientos por medio de la escala visual analógica (VAS).Pacientes y métodos: Estudio prospectivo, unicéntrico y observacional realizado en la Unidad de EII durante el mes de agosto de 2020. Los pacientes fueron entrevistados por teléfono. Se llevó a cabo un análisis descriptivo inicial, posteriormente se identificaron los factores relacionados con la pérdida de adherencia, así como con los niveles altos-moderados de estrés a través de análisis de regresión logística multivariante.Resultados: Fueron incluidos un total de 426 pacientes con una puntuación media en la escala PSS-10 de 12 (10-16). Los niveles más altos de estrés se reportaron en aquellos pacientes que no estaban casados, las mujeres o aquellos que habían incrementado sintomatología relacionada con su EII. La adherencia al tratamiento no se asoció con el nivel de estrés basado en el cuestionario PSS-10.Conclusiones: A pesar de que el período de cuarentena por COVID-19 haya podido tener un importante papel en el impacto emocional de la población española con EII, los pacientes con EII tuvieron en general niveles bajos según el cuestionario PSS-10.

Empirical rescue treatment of Helicobacter pylori infection in third and subsequent lines: 8-year experience in 2144 patients from the European Registry on H. pylori management (Hp-EuReg).

OBJECTIVE: To evaluate the use, effectiveness and safety of Helicobacter pylori empirical rescue therapy in third and subsequent treatment lines in Europe. DESIGN: International, prospective, non-interventional registry of the clinical practice of European gastroenterologists. Data were collected and quality reviewed until October 2021 at Asociación Española de Gastroenterología-Research Electronic Data Capture. All cases with three or more empirical eradication attempts were assessed for effectiveness by modified intention-to-treat and per-protocol analysis. RESULTS: Overall, 2144 treatments were included: 1519, 439, 145 and 41 cases from third, fourth, fifth and sixth treatment lines, respectively. Sixty different therapies were used; the 15 most frequently prescribed encompassed >90% of cases. Overall effectiveness remained <90% in all therapies. Optimised treatments achieved a higher eradication rate than non-optimised (78% vs 67%, p<0.0001). From 2017 to 2021, only 44% of treatments other than 10-day single-capsule therapy used high proton-pump inhibitor doses and lasted ≥14 days. Quadruple therapy containing metronidazole, tetracycline and bismuth achieved optimal eradication rates only when prescribed as third-line treatment, either as 10-day single-capsule therapy (87%) or as 14-day traditional therapy with tetracycline hydrochloride (95%). Triple amoxicillin-levofloxacin therapy achieved 90% effectiveness in Eastern Europe only or when optimised. The overall incidence of adverse events was 31%. CONCLUSION: Empirical rescue treatment in third and subsequent lines achieved suboptimal effectiveness in most European regions. Only quadruple bismuth-metronidazole-tetracycline (10-day single-capsule or 14-day traditional scheme) and triple amoxicillin-levofloxacin therapies reached acceptable outcomes in some settings. Compliance with empirical therapy optimisation principles is still poor 5 years after clinical practice guidelines update. TRIAL REGISTRATION NUMBER: NCT02328131.

Impact of the lockdown period due to the COVID-19 pandemic in patients with inflammatory bowel disease.

INTRODUCTION: The lockdown period due to the coronavirus disease 2019 (COVID-19) in Spain probably had a significant emotional impact on chronic patients and hence on those who are suffering from inflammatory bowel disease (IBD) due to their high risk of emotional disorders. The aim of this study was to learn how COVID-19 influenced patients suffering from IBD during the quarantine period, focusing in particular on psychological distress through the Perceived Stress Scale-10 (PSS-10) and also the impact of the pandemic on therapeutic adherence using the Visual Analogue Scale (VAS). PATIENTS AND METHODS: A prospective, single-centre and analytical observational study was carried out in the IBD unit in August 2020. Patients were contacted and interviewed by phone. A descriptive analysis was carried out and subsequently the factors associated with the loss of therapeutic adherence and higher-moderate levels of stress were analyzed through logistic regression multivariate analyses. RESULTS: A total of 426 patients were included with a median PSS-10 score of 12 (10-16). A higher level of stress was reported by those who were not married, women and those who experienced an increase in IBD-related symptoms. Adherence to treatment was not associated with stress based on the PSS-10 questionnaire. CONCLUSIONS: Although the lockdown period due to the COVID-19 pandemic has probably had a significant emotional impact on Spaniards with IBD, IBD patients in general had lower PSS-10 scores.