Volume 89 - 2026 - Fasc.2 - Original articles
Significance of leptin, Galectin-1 and Galectin-3 in tumor lymphangiogenesis
Background and study aims: Leptin, Galectin-1 and
Galectin-3 are essential players in tumorigenesis, angiogenesis,
and metastasis, but their lymphangiogenic role is unclear. Here,
the associations of leptin, Galectin-1 and Galectin-3 with markers
of lymphangiogenesis were evaluated in colorectal cancer (CRC).
Patients and methods: A total of 120 patients with CRC were
included in the study. The expressions of leptin, Galectin-1,
Galectin-3, and vascular endothelial growth factor- C (VEGF-C)
were analyzed in CRC tissue and compared with lymphatic
vessel density (LVD). Also, the concentrations of Galectin-1 and
Galectin-3 were determined in the sera of CRC patients (n=38).
Results: LVD positively correlated with the intensity of leptin
or Galectin-1 expression (as defined by intensity score, IS) in
tissues. Although there was no significant association between
tissue expression of Galectin-3 and LVD, serum Galectin-3
concentrations were markedly decreased in patients with high
LVD. The positive correlation was observed between intensity
of VEGF-C and leptin expressions. No significant relationship
was found between VEGF-C and Galectin-1 expression, while
the intensity of VEGF-C expression positively correlated with
Galectin-3 expression in tumor tissue. Further, high leptin
expression, determined by a total score (sum of percentage score
(PS) and IS) > 4, was related to regional lymph node metastasis
and TNM stages, indicating a more aggressive CRC phenotype.
Conclusions: The results suggest that leptin and Galectin-1 are
involved in the formation of new lymphatic vessels in tumor, either
dependently or independently of VEGF-C. It seems that high
leptin expression reflects regional metastases and progression of
CRC.
High relapse rates after budesonide in microscopic colitis: a large retrospective analysis revealing the need for advanced therapies
Background: Microscopic colitis (MC) is a chronic inflammatory bowel disorder causing watery diarrhea despite normal endoscopic findings. Budesonide is the only approved therapy, yet long-term durability and the need for alternatives in steroid-dependent or -refractory cases remain unclear.
Methods: We performed a retrospective single-center cohort study of all patients with histologically confirmed MC between 2013 and 2022, with ≥3 months of follow-up. Demographics, clinical features, treatments, and outcomes were collected. Clinical remission followed Hjortswang criteria: fewer than three stools per day or fewer than one watery stool per day on average.
Results: A total of 239 idiopathic MC patients met inclusion criteria. Spontaneous remission occurred in 19.2%, more often in males (OR 2.39, p=0.02). Corticosteroids, predominantly budesonide, were prescribed in 78.7% and induced remission in 75.5% within three months. Relapse affected 54.8% of responders, typically during tapering (44.6%) or shortly after cessation (55.3%). Younger age predicted relapse (OR 0.97, p=0.003). Conventional alternatives, including 5-ASA, cholestyramine, methotrexate, and azathioprine, were largely ineffective after corticosteroid failure or dependency. Advanced therapies (anti-TNF agents, vedolizumab, JAK inhibitors) were initiated in 12.6%, more often in younger patients (OR 0.95, p=0.001) and those with a family history of IBD (OR 4.11, p=0.03). These therapies achieved post-induction remission in 70% of refractory cases. Two patients required colectomy.
Conclusion: In this large cohort with long-term follow-up, budesonide remained the primary treatment, yet over half of responders relapsed during tapering or after discontinuation. Conventional alternatives showed limited benefit. Advanced therapies demonstrated meaningful effectiveness in steroid-refractory or steroid-dependent MC, underscoring the need for broader therapeutic options.
Helicobacter pylori prevalence and antibiotic resistance in patients undergoing bariatric surgery in Luxembourg: Impact and implications
Background: Helicobacter pylori (H. pylori) infection is a global health concern and may be relevant in candidates for bariatric surgery, yet data on prevalence and antimicrobial resistance in Luxembourg are limited.
Materials and Methods: We conducted a retrospective, single-center cohort study including 1,110 patients with obesity evaluated for bariatric surgery at the Centre Hospitalier de Luxembourg between 2010 and 2020. H. pylori status was determined on gastric biopsy and antimicrobial resistance by susceptibility testing. Collected variables included demographics, BMI, eradication outcomes, and postoperative results (BMI loss and complications). A comparative group of 125 patients without obesity with biopsy-proven H. pylori infection was included for descriptive comparison.
Results: H. pylori prevalence among bariatric candidates was 29.3%. Among infected patients, 23.3% had strains resistant to at least one antibiotic, and first-line eradication was successful in 86.3%. Infection prevalence differed by nationality, being higher among Portuguese nationals than Luxembourgish patients or those from neighboring countries and was slightly higher in women than in men. Postoperatively, mean BMI reduction was 13.7 kg/m² after sleeve gastrectomy and 14.9 kg/m² after bypass surgery. H. pylori status was not associated with weight-loss outcomes or postoperative complications after adjustment.
Conclusion: Approximately one-third of bariatric surgery candidates in Luxembourg have H. pylori infection, with notable antibiotic resistance and variation by nationality and sex. After eradication and adjustment for confounders, H. pylori status was not linked to postoperative weight loss or complication rates.
From theory to practice: a Belgian consensus on minimal monitoring strategies for patients with IBD treated with advanced therapies
Background and study aims: Inflammatory bowel diseases (IBD) are chronic conditions requiring lifelong management, often involving advanced therapies. To harmonize the current heterogeneity in monitoring practices we developed a Belgian Standard of Care (SOC) guidance for patients with IBD treated with these advanced therapies.
Methods: A multistep approach was adopted. First, a core team of IBD clinicians conducted a national survey to evaluate current practices and identify gaps. Next, a SOC guidance document was drafted and reviewed by multiple stakeholders, including physicians and IBD nurses from the Belgian IBD Research and Development (BIRD) group and patient organizations. Feedback was then incorporated to develop a consensus-based framework tailored to current Belgian clinical practices.
Results: This SOC guidance outlines minimal follow-up requirements across treatment phases, emphasizing clinical, biochemical, endoscopic and cross-sectional assessments, while also discussing additional relevant outcomes such as quality of life.
Conclusions: The SOC guidance document offers a comprehensive, consensus-based framework to homogenize the monitoring of patients with IBD receiving advanced therapies. By standardizing monitoring practices, it aims to enhance quality of care, safety and long-term outcomes, ensuring alignment with international standards while addressing specific national requirements and availabilities.
Outcomes of autologous hematopoietic stem cell transplantation in patients with refractory Crohn’s disease: a single-center retrospective case series
Background and aims: Despite advances in biological therapies, a subset of patients with Crohn’s disease (CD) remains or becomes refractory to all available treatments. Emerging evidence indicates that autologous hematopoietic stem cell transplantation (aHSCT) may offer a viable therapeutic option for carefully selected treatment-refractory CD patients.
Patients and methods: We retrospectively analyzed the outcomes of all CD patients who underwent aHSCT for treatment-refractory disease at our IBD referral center between 2011 and 2023. All included patients had severe disease, unsuitable for surgery.
Results: We included 24 CD patients (15 females, median age at transplantation 31.0 [27.0-34.5] years, median disease duration 13.0 [9.8-17.3] years) who underwent mobilization, of whom 23 patients proceeded to transplantation. All patients had CD with small bowel involvement, while 10 patients (41.7%) had concomitant perianal disease.
After a median follow-up of 114.6 [66.0-138.4] months, 8 patients (34.8%) were still in remission without need for advanced therapy. Persistent disease activity after aHSCT, defined as total SES-CD >3, occurred in 15 patients (65.2%) with median time to restarting advanced therapy of 7.0 [5.0-25.0] months.
At last follow-up, all patients are still alive. There were a few ICU admissions because of hemodynamic instability due to neutropenic fever following mobilization and transplantation. In the follow-up period, infectious complications occurred in 12 patients (52.2%).
Conclusions: Autologous hematopoietic stem cell transplantation is a safe and effective therapy for inducing and maintaining remission in carefully selected therapy-refractory CD patients after extensive multidisciplinary discussion. Although many patients didn’t achieve remission, most regained response to previously ineffective therapies
Risk-stratified evaluation of prophylactic strategies for delayed bleeding after gastric ESD: a multicenter retrospective study on clipping efficacy in the low-risk category
Background and study aims: Delayed bleeding (DB) remains a major complication after gastric endoscopic submucosal dissection (ESD), and risk-stratified preventive strategies are not well established. This study evaluated the efficacy of the modified search, coagulation, and clipping (MSCC) method and MSCC combined with polyglycolic acid sheets and fibrin glue (PMSCC) using the Bleeding after ESD Trend from Japan (BEST-J) score.
Patients and methods: We retrospectively analyzed 303 patients who underwent gastric ESD with MSCC or PMSCC between April 2018 and March 2024. DB was defined as bleeding requiring emergency endoscopic hemostasis or transfusion, or a hemoglobin decrease ≥ 2 g/dL. Observed DB rates were compared with threshold rates derived from the BEST-J score.
Results: In the low-risk category (MSCC/PMSCC: 237/0), no DB occurred in the MSCC group (0%; 95% confidence interval [CI]: 0.00–1.54%), with the upper CI limit below the threshold rate (2.8%). In the intermediate-risk category, DB occurred in one patient in the MSCC group (1/29; 3.4%; 95% CI: 0.08–17.8%), and no DB was observed in the PMSCC group (0/3; 0.0%; 95% CI: 0.00–70.8%); the confidence intervals overlapped the threshold rate (6.1%). In the high-risk category, DB occurred in 1/4 (25.0%; 95% CI: 0.63–80.6%) and 5/30 (16.7%; 95% CI: 5.6–34.7%) patients in the MSCC and PMSCC groups, respectively; neither the observed rate nor its confidence interval fell below the threshold rate (11.4%).
Conclusions: The MSCC method is an effective prophylactic strategy for preventing DB in the low-risk category as defined by the BEST-J score.