Background: Distinct faecal microbiota profiles are reported to be associated with various subtypes of IBS. Circulating antibodies to cytolethal distending toxin B (CdtB) and vinculin are proposed as biomarkers to identify post‐infectious IBS. The aim of our study was to analyse serum levels of anti‐CdtB and anti‐vinculin antibodies in patients with different functional gastrointestinal disorders (FGID) and their correlation with the composition of faecal microbiome.Methods: The study cohort comprised 65 prospectively recruited individuals: 15 with diarrhoea‐type‐IBS (IBS‐D), 13 with constipation‐type‐IBS (IBS‐C), 15 with functional dyspepsia (FD) and 22 healthy controls. FGID subgroups were defined according to Rome III criteria. Serum levels of anti‐CdtB and anti‐vinculin antibodies were measured by ELISA. Faecal microbiome composition analysis and assessment of dysbiosis were performed by GA‐map® Dysbiosis Test.Results: Positivity rate either for anti‐CdtB or anti‐vinculin antibodies was higher in the IBS‐C group (76.9%) compared to IBS‐D (40.0%), FD (60%) and healthy (63.6%) groups.Dysbiosis was more frequent in subjects positive for anti‐CdtB antibodies and in IBS‐C patients, who showed an increased amount of opportunistic/pro‐inflammatory bacteria and reduced gut protective bacteria. IBS‐C patients showed a high inter‐individual variation of bacterial communities compared to other FGID subgroups and healthy individuals, whereas microbial profiles of patients with IBS‐D and FD were overlapping with those of healthy controls. No bacteria markers showed significant differences between FGID subgroups and healthy controls.Conclusion: Neither anti‐CdtB/anti‐vinculin antibodies nor faecal microbial profiles allowed to discriminate between specific FGID subgroups. Dysbiosis was more frequent in patients presenting with anti‐CdtB antibodies and in IBS‐C patients.

Background: Helicobacter pylori antibiotic resistance is the most relevant cause of treatment failure. Antibiotic susceptibility testing (AST) allows for selecting the appropriate eradication regimen.Aims: To assess the diagnostic accuracy of gastric aspirate‐based genotypic AST (G‐AST) for detecting clarithromycin and levofloxacin resistance compared with conventional phenotypic AST (P‐AST).Methods: We recruited 461 consecutive patients scheduled for endoscopy. H. pylori was detected intraprocedurally using Endofaster, a novel method combining endoscopy with gastric juice analysis. For H. pylori‐positive patients, we collected gastric aspirates and biopsies. G‐AST was performed using DNA extracted from aspirates, with Sanger sequencing to detect polymorphisms in the 23S rRNA and gyrA genes associated, respectively, with resistance to macrolides and fluoroquinolones. P‐AST was performed on H. pylori isolated from biopsies using ETEST.Results: One hundred and seventy‐eight (40.4%) patients tested positive for H. pylori during endoscopy. Paired gastric biopsies and aspirates were available from 152 H. pylori‐positive patients. By P‐AST, resistance rates were 15.1% (23/152) for clarithromycin and 18.4% (28/152) for levofloxacin. G‐AST showed a high level of agreement with P‐AST for clarithromycin (kappa 0.86) and levofloxacin (kappa 0.81) resistance and diagnostic accuracy of 97% and 95%, respectively.Conclusions: The novel method combining endoscopy with immediate intraprocedural gastric juice analysis for the detection of H. pylori, followed by AST in case of a positive finding, is valid and practical for tailoring eradication regimens for H. pylori infection. Genotypic AST from gastric aspirates is highly accurate for detecting clarithromycin and levofloxacin resistances.

Chronic atrophic gastritis with/without intestinal metaplasia is defined as a gastric precancerous condition (GPC) that increases the risk of gastric cancer according to the severity of atrophy [1]. Advanced endoscopic imaging permits accurate visualization of the mucosa and optical diagnosis of GPC [2]. Endocytoscopy introduces a further step, providing ultrahigh magnification images and in vivo histologic assessment of nuclear and cellular structures; however, data on endocytoscopic characterization of GPC are lacking [3]. Here, we report a series of four exemplary cases demonstrating characteristic changes in endocytoscopy along different histological stages of gastric carcinogenesis, from chronic nonatrophic gastritis through atrophic gastritis, intestinal metaplasia, and gastric dysplasia/adenocarcinoma ([Video 1]). Video 1 Endocytoscopic characterization of gastric mucosa in patients with 1) chronic nonatrophic gastritis, 2) chronic atrophic gastritis, 3) intestinal metaplasia, and 4) gastric dysplasia/adenocarcinoma. Examinations were conducted using an Olympus endoscopy system (GIF-H290EC – Evis X1 CV-1500; Olympus, Tokyo, Japan) after double staining of the gastric mucosa with 0.05 % crystal violet and 1 % methylene blue. Patient 1 was a 58-year-old woman who underwent esophagogastroduodenoscopy because of dyspeptic symptoms (no alarm symptoms). White-light endoscopy (WLE) showed diffuse erythema of the gastric mucosa without focal lesions. Histology confirmed the diagnosis of a mild Helicobacter pylori-negative chronic nonatrophic gastritis ([Fig. 1]). A 4-week course of proton pump inhibitor therapy led to improvement of the symptoms. Patient 2 was a 46-year-old woman with autoimmune gastritis who was referred for surveillance endoscopy. WLE revealed multifocal atrophy, which was severe (stage III) according to the histopathological operative link on gastritis assessment (OLGA) staging system [4] ([Fig. 2]). Patient 3 was a 48-year-old man with alcoholic liver cirrhosis who underwent index esophagogastroduodenoscopy that revealed small esophageal varices. There were no signs of portal hypertension in the stomach but multiple areas of intestinal metaplasia were present. The operative link on gastric intestinal metaplasia (OLGIM) stage [4] was III ([Fig. 3]). Patients 2 and 3 were included in a 3-year surveillance program in accordance with current guidelines [5]. Patient 4 was a 70-year-old man with hepatic metastases. WLE revealed a 3-cm flat ulcerated lesion on the anterior wall of the gastric corpus. Histopathological analysis of targeted biopsies confirmed atrophic gastritis with advanced GPC (OLGA/IM stage IV) and a moderately differentiated intestinal-type adenocarcinoma in the perilesional and tumor areas, respectively ([Fig. 4]). The patient received palliative chemotherapy. Endocytoscopy has the potential to support GPC identification reliably and should be further evaluated in upper gastrointestinal diseases. Endoscopy_UCTN_Code_TTT_1AO_2AB Article published online: 21 August 2023 © 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Background and Aims: The mineral compound Luvos Healing Earth (LHE) is a commercially available remedy empirically used for a variety of gastrointestinal disorders. The aim of this study was to investigate the possible effect of prolonged LHE therapy on gut microbiota in healthy individuals and in patients with diarrhea-predominant irritable bowel syndrome (IBS-D). Methods: In this prospective exploratory study, a total of 20 participants, including 12 healthy controls and 8 patients with IBS-D, received treatment with LHE (Magenfein Granulat, 1 sachet bid) for 6 weeks. Fecal samples were collected for microbiota analysis in the morning fasting state at regular intervals at 6 different timepoints: 2 weeks before starting therapy (Screen), and every 2 weeks during LHE therapy (V0-V3). Additionally, a follow-up visit was scheduled 4 weeks after the end of treatment (V4). Microbiota analysis was performed using the GA-map® Dysbiosis Test Lx v2. Dysbiosis Index, bacterial diversity, as well as the balance or imbalance of functionally important bacteria were assessed. Results: The microbiota analysis revealed an overlap in gut microbiota profiles between healthy controls and patients with IBS-D. Bacterial communities were consistently stable during the entire treatment period, and no significant variations in composition were observed 4 weeks after the end of the therapeutic intervention. There was a remarkable stability of microbiota profiles over time within each individual and a high inter-individual variation. The majority of fecal samples exhibited profiles, reflecting an eubiotic state, with no significant changes in dysbiosis index, functional bacteria profiles, or bacterial diversity. Conclusion: Our findings indicate intraindividual resilience of microbiota consortia during the entire study period. Prolonged intake of LHE does not cause significant alterations in fecal microbiota profiles in healthy controls and patients with IBS-D. Luvos Healing Earth does not affect the stability of gut microbial diversity and bacterial functions.

Chronic atrophic gastritis and intestinal metaplasia (IM) are gastric precancerous conditions (GPCs) associated with an increased risk of gastric cancer. Early detection and accurate characterization of GPC are therefore crucial for risk stratification and the implementation of preventive strategies. In the absence of clear mucosal changes observed through white-light imaging (WLI) or virtual chromoendoscopy, endocytoscopy can help unveil the presence of GPC by enabling in vivo assessment of nuclear and cellular structures at ultra-high magnification. Endocytoscopy is typically performed using WLI following dye-based staining of the mucosa. In this case, we demonstrate that combining endocytoscopy with the texture and color enhancement imaging (TXI) mode substantially improves the assessment of the gastric mucosa. In a 61-year-old man undergoing esophagogastroduodenoscopy, WLI showed multifocal erythema in the stomach, without clearly visible lesions on either WLI or narrow-band imaging. Conventional endocytoscopy revealed multiple small spots of IM with characteristic changes in glandular structures, which were even more evident when using the TXI mode. Histological analysis of targeted biopsies confirmed small foci of IM in both the antrum and corpus. The patient was enrolled in a surveillance program because of his clinical background. The combination of endocytoscopy with the TXI mode significantly enhances the delineation of mucosal and cellular architecture, supporting a more accurate optical diagnosis.