BackgroundThe eradication rate of Helicobacter pylori (H. pylori) decreased gradually. This study aimed to analyze the e cacy and safety of a 14-day combination of vonoprazan and amoxicillin as the rst-line eradication therapy for H. pylori infection, and compared them with those of the bismuth quadruple therapy. MethodsA prospective randomized clinical trial (RCT) was designed, involving patients with H. pylori infection in 6 institutions who did not receive any treatment yet. They were randomly assigned into VA-dual group (vonprazan 20mg b.i.d + amoxicillin 750mg q.i.d) or EACP-quadruple group (esomeprazole 20mg + amoxicillin 1000mg + clarithromycin 500mg + colloidal bismuth subcitrate 220mg b.i.d) for 14 days in ratio of 1:1. At least 28 days later, the eradication rate were detected by the 13 C-urea breath test (UBT). ResultsA total of 562 patients from February 2022 to September 2022 were enrolled and 316 were randomly. In the ITT analysis, the eradication rates of H. pylori in VA-dual group and EACP-quadruple group were 89.9% and 81.0% respectively, p = 0.037. In the PP analysis were 97.9% and 90.8%, p = 0.009. The different eradication rate was 8.9% (95%CI, 1.2-16.5%) and 7.2% (95%CI, 1.8-12.4%) in ITT and PP analysis, both lower limit of the 95%CI was still higher than the prespeci ed margin. In addition, the incidence of adverse events in VA-dual group was signi cantly lower than that in EACP-quadruple group (19.0% vs. 43.0%, P < 0.001). ConclusionThe e cacy and safety of a 14-day combination therapy of vonoprazan and amoxicillin in eradicating H. pylori are superior to bismuth quadruple therapy, and this combination signi cantly reduces the use of antibiotics.

Poor preoperative nutritional status for individuals with Crohn's disease (CD) is associated with intra-abdominal septic complications (IASCs). The present study aimed to investigate the association of the common nutrition indices serum albumin and body mass index (BMI) with IASCs. Sixty-four CD patients who had received elective intestinal operations were retrospectively investigated. Among these patients, 32 had received individualized fortified nutrition support. IASCs occurred in 7 patients (10.9%). Compared with non-IASC patients, IASC patients had a lower BMI (17.6 ± 2.7 vs 15.6 ± 1.3 kg/m2, P = 0.048). The area under the receiver operating characteristic curve according to the BMI-based IASC prediction was 0.772 (95% confidence interval [CI], 0.601–0.944; P = 0.020) with an optimum diagnostic cutoff value of 16.2 kg/m2. A BMI < 16.2 kg/m2 significantly increased the risk of developing an IASC (odds ratio [OR], 10.286; 95% CI, 1.158–91.386). Even after correction with the simplified CD activity index (CDAI), a low BMI level remained associated with IASCs (OR, 7.650; 95% CI, 0.808–72.427; P = 0.076). Serum albumin was not associated with IASCs. Although the fortified nutrition support group had an albumin level comparable to the control group, this group had a higher simplified CDAI score, a lower BMI level, and a comparable incidence rate of IASCs. Thus, BMI more accurately reflects the basic preoperative nutritional status of CD patients than serum albumin. BMI can aid in guiding preoperative nutrition support and judging the appropriate operation time for CD.

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Sclerosing mesenteritis (SM) is an extremely rare disease characterized by chronic non-specific inflammation, fat necrosis and fibrosis of the mesentery. We presented a 77-year-old man with progressive dyschezia, abdominal pain and mass in left lower quadrant. Computed tomography (CT) exhibited a thickened mesentery, enlarged lymph nodes and strand-like densities around the mesenteric vessels. However, laboratory investigation, colonoscopy and positron emission tomography did not provide any specific results for diagnosis. Because of the exacerbating abdominal pain, partial colectomy was performed and SM was diagnosed based on the pathological changes of mesentery including fat necrosis, multifocal lipid-filled macrophages, lymphocytes and multifocal fibrosis. Although SM is difficult to diagnose and often found by incident, progressive deterioration of abdominal symptoms and general status alteration are indicators of SM. Some typical imaging and pathologic manifestations are also helpful to SM diagnosis. There is no standard treatment for SM. Operation is preferred in those at the stage of fibrosis and particularly combined with intestinal obstruction. Therefore, a multidisciplinary collaboration is essential to diagnose and manage this rare disease, with combined approaches in gastroenterology, colorectal surgery, pathology and radiology.

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