Esophagus to Small Intestine

United European Gastroenterol J. 2023;11(3):271−81

Dragoni G, Castiglione F, Bezzio C, Pugliese D, Spagnuolo R, Viola A, Cocomazzi F, Aratari A, Savarino EV, Balestrieri P, Onali S, Viganò C, Ribaldone DG, Innocenti T, Testa A, Saibeni S, Privitera G, Milla M, Armuzzi A, Fantini MC, Fiorino G

Comparison of 2 strategies for the management of postoperative recurrence in Crohn’s disease patients with 1 clin-ical risk factor: A multicenter IG-IBD study

Background: The management of postoperative recurrence in Crohn’s disease (CD) after ileocolonic resection is a highly debated topic. Prophy-lactic immunosuppression after surgery is currently recommended in the presence of at least 1 clinical risk factor.
Objective: Aim of the present study was to determine whether early immunosuppression can be avoided and guided by endoscopy in CD patients with only 1 risk factor.
Methods: CD patients with only 1 risk factor for postoperative recurrence, including previous intestinal resection, extensive small intestine resec-tion (> 50 cm), fistulizing phenotype, history of perianal disease, and active smoking, were retrospectively included. Two groups were formed based on whether immunosuppression was started immediately after surgery (“prophylaxis group”) or guided by endoscopy (“endoscopy-driven group”). Primary end points were rates of any endoscopic recurrence (Rutgeerts ≥ i2a) and severe endoscopic recurrence (i4) within 12 months after surgery. Secondary outcomes were clinical recurrence rates at 6, 12 and 24 months after surgery.
Results: A total of 195 patients were enrolled, of whom 61 (31.3%) received immunoprophylaxis. No differences between immunoprophylaxis and the endoscopy-driven approach were found regarding any endoscopic recurrence (36.1% vs. 45.5%, respectively, p = 0.10) and severe en-doscopic recurrence (9.8% vs. 15.7%, respectively, p = 0.15) at the first endoscopic evaluation. Clinical recurrence rates were also not statistically different (p = 0.43, p = 0.09, and p = 0.63 at 6, 12, and 24 months, respectively).

Conclusions: In operated Crohn’s disease patients with only 1 risk factor for postoperative recurrence, immediate immunoprophylaxis does not decrease the rate of early clinical and endoscopic recurrence. Prospective studies are needed to confirm these results.

Dr. G. Fiorino, Gastroenterology and Endoscopy, Vita-Salute San Raffaele University, Milan, Italy,
E-Mail: gionataf@gmail.com

DOI: 10.1002/ueg2.12367

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Esophagus to Small Intestine

Ten-day vonoprazan-amoxicillin dual therapy as a first-line treatment of Helicobacter pylori infection compared with bismuth-containing quadruple therapy

Am J Gastroenterol. 2023;118(4):627−34

Esophagus to Small Intestine

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)

Gut. 2023;72:1054−72

Burgos-Santamaría D, Nyssen OP, Gasbarrini A, Vaira D, Pérez-Aisa Á, Rodrigo L, Pellicano R, Keco-Huerga A, Pabón-Carrasco M, Cas-tro-Fernandez M, Boltin D, Barrio J, Phull P, Kupcinskas J, Jonaitis L, Ortiz-Polo I, Tepes B, Lucendo AJ, Huguet JM, Areia M, Brglez Jurecic N, Den-kovski M, Bujanda L, Ramos-San Román J, Cuadrado-Lavín A, Gomez-Camarero J, Jiménez Moreno MA, Lanas A, Martinez-Dominguez SJ, Alfaro E, Marcos-Pinto R, Milivojevic V, Rokkas T, Leja M, Smith S, Tonkić A, Buzás GM, Doulberis M, Venerito M, Lerang F, Bordin DS, Lamy V, Capelle LG, Marlicz W, Dobru D, Gridnyev O, Puig I, Mégraud F, O’Morain C, Gisbert JP; Hp-EuReg Investigators

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