European guidelines on microscopic colitis: United European Gastroenterology and European Microscopic Colitis Group statements and recommendations

Introduction: Microscopic colitis is a chronic inflammatory bowel disease characterised by normal or almost normal endoscopic appearance of the colon, chronic watery, nonbloody diarrhoea and distinct histological abnormalities, which identify three histological subtypes, the collagenous colitis, the lymphocytic colitis and the incomplete microscopic colitis. With ongoing uncertainties and new developments in the clinical management of microscopic colitis, there is a need for evidence-based guidelines to improve the medical care of patients suffering from this disorder. Methods: Guidelines were developed by members from the European Microscopic Colitis Group and United European Gastroenterology in accordance with the Appraisal of Guidelines for Research and Evaluation II instrument. Following a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation methodology was used to assess the certainty of the evidence. Statements and recommendations were developed by working groups consisting of gastroenterologists, pathologists and basic scientists, and voted upon using the Delphi method. Results: These guidelines provide information on epidemiology and risk factors of microscopic colitis, as well as evidence-based statements and recommendations on diagnostic criteria and treatment options, including oral budesonide, bile acid binders, immunomodulators and biologics. Recommendations on the clinical management of microscopic colitis are provided based on evidence, expert opinion and best clinical practice. Conclusion: These guidelines may support clinicians worldwide to improve the clinical management of patients with microscopic colitis

The impact of real-time feedback by deep learning during echocardiographic scanning on test-retest variability of left ventricular systolic function measurements

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Norwegian University of Science and Technology, St. Olavs University Hospital, Central-Norway Health Authority OnBehalf Department of Circulation and Medical imaging, Norwegian University of Science and Technology, Trondheim, Norway Background/introduction Left ventricular (LV) ejection fraction (EF) is the most widely used measure of systolic cardiac function. LV foreshortening is a common problem within echocardiography and cause inaccuracies in estimation of EF and end-diastolic volume (EDV). Guidance of LV length during scanning could improve quality but has not yet been available. Purpose To evaluate the impact of real-time feedback using a robust deep learning (DL) tool during echocardiographic scanning to reduce test-retest variability in assessment of EF and LV EDV. Methods Patients scheduled for echocardiography were included if they were in sinus rhythm and had no need for use of contrast. Three consecutive echocardiograms were performed, where the first and second by two of three experienced sonographers and the third (reference) by one of four cardiologists in random order. Data collection was divided into two periods. In the first period, sonographers were told to provide high quality echocardiograms for analyses of LV function and no additional tool was provided. Thereafter, the sonographers were trained in use of the DL algorithm on 10 patients each. In the second period of inclusion, the real-time DL was used during scanning by the sonographers performing the second exam (Sonographer 2), while the first (Sonographer 1) had participated in training but had no access to the DL tool. All exams included the standard apical views, and the reference exams included tri-plane recordings of the LV as well. All measurements were done retrospectively blinded to the others. LV EF and EDV were measured in four- and two-chamber views and averaged by the method of discs’ formula. The coefficients of variation (CoV) were compared for both LV EF and EDV (two groups of sonographers vs cardiologist) before and after the introduction of DL. Results A total of 88 patients were included (45% women), 41 in period 1 and 47 in period 2. Mean (SD) age was 63 (16) years, LV EF was 53 (12) % and LV EDV was 126 (55) ml. Main findings are shown in the table. There was no significant difference in CoV for neither LV EF nor EDV using the DL tool. Compared to the first period the sonographers not using the DL tool had poorer reproducibility of LV EDV in period 2 (p ≤0.02), while there was a trend for reduced CoV for LV EDV for those using the algorithm (p = 0.11). By using the DL algorithm, LV foreshortening was reduced by 2.4 mm (p &amp;lt;0.001), and similarly, alignment of the mitral annulus was numerically improved (p = 0.10).  Whether other markers of image quality were changed is not known. Conclusion The novel real-time DL algorithm to reduce foreshortening provided more standardized recordings when used by experienced sonographers during scanning, but these changes did not result in significant improvement in test-retest variation. Further development and investigations are needed to significantly reduce test-retest variability. Abstract Table_1  Abstract Figure. DL_tool </jats:sec

Pathogenesis of Microscopic Colitis: A Systematic Review

BACKGROUND: Whereas the exact aetiology of microscopic colitis [MC] remains unknown, a dysregulated immune response to luminal factors or medications is the most accepted pathogenesis hypothesis. METHODS: We conducted a systematic review of the pathogenesis of MC. We applied the Joanna Briggs Institute methodologies and the PRISMA statement for the reporting of systematic reviews [PROSPERO Trial Identifier: CRD42020145008]. Populations, Exposure of interest, and Outcome [PEO] questions were used to explore the following topics in MC: 1] intestinal luminal factors; 2] autoimmunity; 3] innate immunity; 4] adaptive immunity; 5] extracellular matrix; 6] genetic risk factors; and 7] mechanism of diarrhoea. A search was done in PubMed, Embase, and Web of Science up to February 2020. A narrative description was performed explaining the findings for each aspect of MC aetiopathogenesis. RESULTS: Thirty-eight documents provided evidence for PEO1, 100 for PEO2, 72 for PEO3 and 4, 38 for PEO5, 20 for PEO6, and 23 for PEO7. The majority of documents were cohorts, case reports, and case series, with a few case-control and some experimental studies. Consistency among data provided by different studies was considered to support pathogenetic hypotheses. MC is a multifactorial disease believed to involve innate and adaptive immune responses to luminal factors, genetic risk, autoimmunity, and extracellular matrix alterations, all contributing by varied mechanisms to watery diarrhoea. CONCLUSIONS: This is the first systematic review on the aetiology of MC supporting the notion that MC is a multifactorial disease. However, high-profile studies are lacking, and most evidence derives from small heterogeneous studies

A cross-ethnic survey of CFB and SLC44A4, Indian ulcerative colitis GWAS hits, underscores their potential role in disease susceptibility

The first ever genome-wide association study (GWAS) of ulcerative colitis in genetically distinct north Indian population identified two novel genes namely CFB and SLC44A4. Considering their biological relevance, we investigated allelic/genetic heterogeneity in these genes among ulcerative colitis cohorts of north Indian, Japanese and Dutch origin using high-density ImmunoChip case-control genotype data. Comparative linkage disequilibrium profiling and test of association were performed. Of the 28 CFB SNPs, similar strength of association was observed for rs4151657 (novel ulcerative colitis GWAS SNP) in north Indians (P=1.73 x 10(-10)) and Japanese (P= 2.02 x 10(-12)) but not in the Dutch. Further, a three-marker haplotype was shared between north Indians and Japanese (