Volume 88 - 2025 - Fasc.3 - Original articles
Esophagogastroduodenoscopy findings in patients with or without recent use of antiplatelets, anticoagulants, or NSAIDs and non-variceal upper gastrointestinal bleeding: A retrospective cohort study.
Background: Use of antiplatelets, anticoagulants,
or aspirin/NSAIDs increases the risk of major
gastrointestinal (GI) bleeding. This study aimed to analyze
esophagogastroduodenoscopy (EGD) findings in patients
treated with these drugs (drug-exposed) versus those who were
not (non-exposed), who presented with signs suggestive of nonvariceal
upper GI bleeding.
Patients and Methods: This retrospective cohort study
included patients aged over 16 years with signs suggestive of
upper GI bleeding, no history of gastrointestinal malignancy,
and no portal hypertension or varices, hospitalized at the
General Hospital of Ioannina, Greece, from January 2019 to
October 2023. Differences between the two patient groups
were tested for significance with the chi-square test. Relative
Risk (RR) and Odds Ratio (OR) were calculated to assess the
association between drug exposure and endoscopic findings. A
p-value less than 0.05 was consider ed statistically significant.
Results: A total of 405 patients (268 males; mean age 73.1 ±
16.8 years) were enrolled: 303 drug-exposed (193 males; mean
age 77.6 ± 12.2) and 102 non-exposed (75 males; mean age
59.7 ± 20.9). Peptic ulcer disease (PUD) was the most common
bleeding cause. Drug exposure was strongly associated with
vascular lesions (angiodysplasias, Dieulafoy’s lesion, GAVE)
(RR: 12.12, 95% CI: 1.68–87.3, p = 0.01; OR: 13.62, 95% CI:
1.84–100.64, p = 0.002). Notably, 75% of angiodysplasia cases
occurred in anticoagulant-treated patients, with 50% receiving
DOACs.
Conclusion: Upper GI bleeding in patients on antiplatelets,
anticoagulants, or NSAIDs/aspirin should prompt suspicion
of pre-existing lesions, particularly PUD and angiodysplasias.
Real-world Effectiveness and Safety of Tofacitinib in Multi-Refractory Ulcerative Colitis: insights from a Belgian Cohort with prior Anti-TNF and Vedolizumab Exposure
(1) Erasme University Hospital, Department of Gastroenterology, Brussels, Belgium; (2) University Hospital Ghent, Department of Gastroenterology, Ghent, Belgium;
(3) Imelda General Hospital, Department of Gastroenterology, Bonheiden, Belgium; (4) CHU UCL Namur, Department of Gastroenterology, Yvoir, Belgium; (5) AZ
Delta, Department of Gastroenterology, Roeselare, Belgium; (6) CHU Saint-Luc, Department of Gastroenterology, Brussels, Belgium; (7) University Hospital Antwerp,
Department of Gastroenterology, Edegem, Belgium; (8) CHR de la Citadelle, Department of Gastroenterology, Liège, Belgium; (9) AZ Sint-Lucas, Department of
Gastroenterology, Brugge, Belgium; (10) Clinique Saint-Jean, Department of Gastroenterology, Brussels, Belgium; (11) AZ Sint-Jan, Department of Gastroenterology,
Brugge, Belgium; (12) Ziekenhuis Oost-Limburg Sint-Jan, Department of Gastroenterology, Genk, Belgium; (13) AZ Groeninge, Department of Gastroenterology, Kortrijk,
Belgium; (14) AZ Voorkempen, Department of Gastroenterology, Malle, Belgium; (15) CH Mouscron, Department of Gastroenterology, Mouscron, Belgium; (16) Jessa
ZH, Department of Gastroenterology, Hasselt, Belgium; (17) Maria ZH Noord-Limburg, Department of Gastroenterology, Overpelt, Belgium; (18) Sint-Andries ZH,
Department of Gastroenterology, Tielt, Belgium; (19)Sint-Trudo ZH, Department of Gastroenterology, Sint-Truiden, Belgium; (20)ZH Maas en Kempen, Department of
Gastroenterology, Maaseik, Belgium; (21) ZNA Jan Palfijn, Department of Gastroenterology, Merksem, Belgium; (22) ZNA Antwerpen, Department of Gastroenterology,
Antwerpen, Belgium; (23) Onze-Lieve-Vrouwziekenhuis, Department of Gastroenterology, Aalst, Belgium; (24) GZA Sint-Vincentius ZH, Department of Gastroenterology,
Antwerpen, Belgium; (25) AZ Turnhout, Department of Gastroenterology, Turnhout, Belgium; (26) University Hospital CHU of Liège, Department of Gastroenterology,
Liège, Belgium.
Classic galactosemia in the differential diagnosis of neonatal low gammaglutamyltransferase cholestasis
Neonatal cholestasis is a diagnostic challenge that warrants
extensive investigation as there can be serious sequalae such
as liver failure, cirrhosis, or other extrahepatic complications.
To differentiate the etiology of cholestasis, a distinction can be
made between high and low gamma-glutamyltransferase (GGT)
cholestasis. Low GGT cholestasis points towards progressive
familial intrahepatic cholestasis type 1-2 and 4-6, bile acid
synthesis disorders, tight-junction protein type 2 deficiency and
some forms of hypopituitarism. Classic galactosemia is generally
not included in the differential diagnosis of low GGT cholestasis.
Here, we demonstrate low GGT cholestasis in 9 consecutive
patients with classic galactosemia at the University Hospitals of
Leuven, Belgium. All neonatal cholestasis should be managed with
prompt cessation of galactose intake, but in classic galactosemia it
can be lifesaving. We now add that low GGT cholestasis increases
the likelihood of galactosemia. Conversely, high GGT cholestasis
could point to other causes, like biliary atresia, where there may
be no need to stop breastfeeding. In galactosemia, we observe
a rise in GGT after initiation of a galactose-free diet, which we
suggest.
Diagnostic and therapeutic yield of 72h stool collection combined with bile acid quantification: a retrospective analysis
Background and study aims: Chronic idiopathic diarrhea
represents a diagnostic and therapeutic challenge to
gastroenterologists. We aimed to explore the diagnostic and
therapeutic yield of 72h stool collection combined with bile acid
quantification, in chronic diarrhea patients, to differentiate
bile acid malabsorption from other causes of diarrhea and thus
enabling tailored treatment.
Patients and methods:We performed a retrospective study
on 252 stool collections combined with bile acid quantification.
Descriptive statistics, Pearson correlation analysis and ANOVA
with post hoc between-group t-tests were used.
Results: Idiopathic bile acid diarrhea was present in up to one
third of patients with diarrhea-predominant IBS and functional
diarrhea. Steatorrhea was highly prevalent both in patients with
a clinical suspicion of fat malabsorption (57%) as well as patients
with non-specific diarrhea (23%). We show a significant difference
in fecal bile acid and fat content in patients with vs. without
predisposing risk factors for bile acid or fat malabsorption
(e.g. cholecystectomy). The prevalence of steatorrhea was also
significantly higher in patients with previous enteric resection
or bariatric surgery. Bile acid diarrhea was significantly more
frequent in patients with previous colonic resection, probably
due to combined resection of a distal ileal segment during right
hemicolectomy. We could not show higher rates of bile acid
diarrhea post-cholecystectomy compared to the other groups.
Conclusion: Bile acid diarrhea and steatorrhea are prevalent
findings in patients with chronic diarrhea. Using this 72h stool
analysis with bile acid quantification can help clinicians in the
complex management of chronic diarrhea.
Fermentable Oligo-Di-Mono-saccharides And Polyols (FODMAP) consumption in Belgian healthy adults and irritable bowel syndrome patients
Background and study aims: A large amount of FODMAP-rich
food is part of a balanced and recommended diet for the general
population. This study aims to assess quantitatively FODMAP
consumption in a sample of the Belgian adult population of
healthy volunteers (HV) and irritable bowel syndrome (IBS)
patients.
Patients and methods: Participants completed five-day food
diaries. Food portions were translated into quantities (g or ml)
with the help of the “Poids et Mesure” manual (CSS, 2005).
Nutritional valorisations were conducted using validated
nutritional tables (Souci Fachmann Kraut, Ciqual, Nubel) and
data from published studies. Student t-test and Mann-Whitney U
test were performed for comparisons. Statistical significance was
fixed at 5%.
Results: Forty food diaries were analysed (20 HV, 60% F, mean
age 40 (16); 20 IBS patients, 85% F, mean age 46.7 (20.0)). The
mean total FODMAP consumption was moderate for HV and
was significantly lower in IBS patients (15.3 (5.4) g/d vs. 8.4 (5.1)
g/d; p=0.0002), specifically for lactose (p=0.0009) and fructans
(p=0.0004). In both groups, lactose represented the highest
proportion of FODMAP consumed, while galactans were the least
consumed. Most of the HV were considered as moderate or high
consumers of FODMAP (45% [9g/d; 15.9g/d]; 45% ≥16g/d), while
IBS patients were mainly low consumers (65% <9g/d).
Conclusions: FODMAP consumption in the Belgian adult
general population is moderate, with the highest proportion of
lactose, while IBS patients consume significantly fewer FODMAP.