Volume 88 - 2025 - Fasc.4 - Original articles
Disease course and symptoms in smoking versus non-smoking patients with Celiac disease
Background and study aims: Knowledge about the impact of
smoking in Celiac disease is limited. We aimed to assess clinical
differences between smoking and non-smoking patients with celiac
disease.
Patients and methods: We conducted a cross-sectional
questionnaire-based study among patients with Celiac disease
distributed through a common interest group. Patients answered
questions regarding the clinical manifestation of disease, adherence
to a gluten-free diet and symptom development over time.
Patients were asked whether they smoked at the time of diagnosis.
Comparisons to the Swiss General Population were performed
using data from the Swiss federal statistic office with data from the
health survey 2012.
Results: Data on smoking status was available from 1537
individuals. We found a significantly lower proportion of smokers
among questionnaire respondents compared to the Swiss general
population in the same time frame (8.5% vs 28.2%, p < 0.01).
Compared to non-smokers, smokers had a higher age at diagnosis
(39 years vs 32 years, p < 0.01) and more frequently reported
diarrhea as an initial symptom (67% vs 56%, p =0.013). Smokers
tended to adhere less strictly to a gluten-free diet than non-smokers
(69% strict adherence vs. 77% p =0.052). Six and twelve months
after diagnosis, the proportion of patients with symptomatic
improvement was not different between smokers and non-smokers.
Conclusions: We found a lower rate of smokers in this large
group of celiac disease patients compared to the general population.
Differences in presenting symptoms and higher age at diagnosis
suggest that smoking might influence disease onset and/or
presentation in an early phase.
A virtual-live hybrid training session is feasible with positive impact on colonoscopy key performance indicators amongst trainees
Background: Colonoscopy is a complex, operator dependent,
practical skill. Attainment of key performance indicators (KPIs)
by endoscopists depends primarily upon training. Local factors
can lead to unstructured training, contingent upon the observed
practice of trainers who may not be consciously competent
(understand colonoscopy, can identify and deconstruct problems).
We sought to demonstrate the feasibility and impact of a virtuallive
colonoscopy-training course.
Methods: Trainees underwent a one-day training course
(intervention) by physically remote, consciously-competent
endoscopists, consisting of interactive theoretical and live
sessions, where trainees performed colonoscopy in their local
endoscopy unit receiving real-time instructions via a teleconference
monitor. KPIs (Caecal intubation rate[CIR], adenoma
detection rate[ADR], withdrawal time[WT], Gloucester Comfort
Score[GCS] and Visual Analog Scale[VAS]) were assessed on
trainee-performed colonoscopies for 3 weeks prior and 4 weeks
after the intervention. Qualitative trainee and trainer feedback
was obtained.
Results: 6 trainees (mean 654 prior colonoscopies) participated
performing 60 colonoscopies (33 pre-, 27 post-intervention).
Favourable trends in CIR (91% vs 96%, p=0.386), ADR (39%
vs 63%, p=0.069) were observed as well as endoscopist-reported
GCS>3 (18% vs 11%, p=0.495) and nurse-reported GCS>3 (22%
vs 8%, p=0.131). There was good agreement between trainee- and
nurse reported GCS and patient reported VAS. Trainees and
trainers reported favourable qualitative experiences.
Conclusions: This is the first demonstration of colonoscopy
training remotely via teleconference with a positive impact on
KPIs. This approach has the potential to create standardized
colonoscopy training experiences removing the barriers of
travel and allowing exposure to consciously-competent trainers.
ClinicalTrials.gov NCT06101836.
Correlating Quality of Life with Point-of-Care Intestinal Ultrasound in Inflammatory Bowel Disease (CUALITY Study)
Background: Inflammatory bowel disease (IBD) impacts
patients’ quality of life (QoL), and hence, there is a need to
assess this through patient-reported outcomes (PRO). Intestinal
ultrasound (IUS) is a non-invasive tool for monitoring IBD
activity, but little is known about its correlation with PRO. This
study explored the cross-sectional relationship between PRO,
assessed by the IBD Questionnaire-32 (IBDQ-32), and IUS
parameters in patients with ulcerative colitis (UC).
Methods: This prospective study included 37 Colombian
patients with UC. IUS parameters such as bowel wall thickness
(BWT), colour Doppler signal (CDS), and mesenteric fat
hypertrophy were assessed, followed by IBDQ-32 completion.
Two IUS-experienced gastroenterologists, blinded to the IBDQ-
32, performed the assessments.
Results: In UC, lower IBDQ-32 scores were significantly
correlated with increased BWT (p=0.050), presence of CDS
(p=0.022), higher Limberg score (p=0.032), and mesenteric
fat hypertrophy (p=0.040). The gastrointestinal and systemic
symptom dimensions of the IBDQ-32 showed significant
correlations with both BWT (p=0.013 and p=0.013) and CDS
(p=0.002 and p=0.003), respectively.
Conclusions: In UC, IUS parameters are significantly
correlated with quality of life, reinforcing the value of IUS as a
point-of-care tool.