Patients with Helicobacter pylori infection who are taking acetylsalicylic acid (aspirin) are at risk of ulcer bleeding, which has led many to ask whether prophy- lactic eradication therapy might be an effective tool in routine practice. The randomized HEAT study, which enrolled over 5000 primary care patients with H. pylori infection taking daily aspirin, has now shown that eradication therapy is indeed able to reduce the short- term risk of ulcer bleeding (Hawkey et al.). For patients with achalasia, peroral endoscopic myotomy (POEM) is an effective alternative to pneumatic dilation using a balloon. Analysis of long-term data from a study comparing pneumatic dilation versus POEM in achalasia patients confirmed the superiority of POEM even after 5 years, as well as a low long-term risk of complications from POEM (Kuipers et al.). Major research efforts are currently being directed toward the treatment of celiac disease using novel drugs, including transglutaminase inhibitors and anti-cytokine antibodies. In a phase 2 trial in celiac patients with gluten exposure, IMGX003, an enzyme that breaks down gluten, resulted in reduced mucosal damage together with symptom relief (Murray et al.). These new treatment options may help greatly improve celiac patients’ quality of life. [...]
The NordICC trial has been the topic of many discussions in recent weeks. The interim results of this large, randomized study on colonoscopy screening for colorectal cancer confirm that invitation to a screening colonoscopy can significantly reduce the 10-year risk of colorectal cancer. Nonetheless, analysis of longer follow-up is needed to conclusively assess the impact of screening colonoscopies on mortality (Bretthauer et al.). Fecal microbiota transfer (FMT) is currently being investigated for the treatment of a number of conditions, including irritable bowel syndrome and ulcerative colitis. However, it remains unclear whether the beneficial effects of this procedure on patients’ symptoms and microbiota are actually durable. An analysis of a randomized trial in irritable bowel syndrome patients after 2 and 3 years of follow-up now reports that the clinical response to FMT and its beneficial impact on dysbiosis are both sustained over the long term (El-Salhy et al.). A study in ulcerative colitis patients has investigated the efficacy of FMT supplemented by an antiinflammatory diet. Addition of this diet induced deep remission and long- term maintenance of remission more effectively than optimized standard medical therapy (Kedia et al.).
Although early fluid resuscitation is considered to be a crucial treatment for acute pancreatitis with a major impact on prognosis, the optimal amount of fluid to deliver is not clearly defined. A randomized study now reports no differences in clinical outcomes between aggressive or moderate early fluid resuscitation yet significantly higher rates of fluid overload with aggressive fluid therapy (de-Madaria et al.). Moderation in the volume of fluid replacement thus appears key.
To date, the duration of protection from hepatitis B vaccination has not been known. A recent study has now demonstrated adequate protection in 86% of vaccinated individuals 35 years after vaccination, meaning booster doses are not currently required in the general population (Bruce et al.). A new study from Austria has uncovered harmful alcohol consumption in 25% of patients with suspected nonalcoholic fatty liver disease (NAFLD). Screening for harmful alcohol consumption using structured questionnaires (e.g. AUDIT-C, 3 questions on alcohol consumption) or ethyl glucuronide in urine or hair may thus be advisable for patients with presumed NAFLD (Staufer et al.). Severe acute autoimmune hepatitis remains a critical situation, since some patients do not respond to corticosteroids and may require urgent liver transplantation. A recent study describes two scores that are early predictors of which patients will not respond to corticosteroids and will thus require urgent liver transplantation (João et al.).
We hope you find the literature selection in this issue of the Falk Gastro Review Journal engaging. Stay healthy, optimistic, and enjoy the spring!
Christoph Neumann-Haefelin and Peter Hasselblatt
Department of Internal Medicine II, Medical University Clinic of Freiburg (Germany)