Post-colonoscopy colorectal cancer (PCCRC) refers to cancer diagnosed subsequent to a colonoscopy where no malignancy was initially detected. Established risk factors include inflammatory bowel disease, prior colorectal cancer (CRC) diagnosis, or a history of polypectomy. Additionally, younger age and female sex are associated with increased risk, with PCCRC cases more commonly located on the right side. Causes of PCCRC can be divided into missed lesions, incompletely resected lesions, or lesions that were detected but not resected. The proportion of colonoscopies performed under deep sedation varies considerably worldwide. In Sweden, only a small percentage (<2%) of colonoscopies are performed under deep sedation, which is a substantially lower frequency compared with the United States. Being able to change the body position of the patient during the colonoscopy may facilitate the detection of bowel lesions, although this maneuver is more challenging to execute under deep sedation. Nonetheless, only a limited number of studies, notably from China, have explored the impact of deep sedation on polyp miss rates: Lee et al reported a significantly higher adenoma miss rate during deep-sedated compared with unsedated colonoscopy, whereas Dong et al reached the opposite conclusion. We hypothesize that the risk of PCCRC increases when colonoscopy is conducted under deep sedation and that this risk varies depending on the lesion’s location, with a greater likelihood of missing lesions on the left side.

The aim of this study was to evaluate the psychometric properties and construct validity of the PrePain questionnaire in both the general population and a long-term pain population. The PrePain questionnaire is an 11-item self-administered tool that assesses current pain intensity, long-term pain history, and attitudes, emotions, and behaviors related to pain using a visual analog scale (VAS). This non-randomized observational study included 200 participants: 100 individuals with long-term pain and 100 without. Participants were recruited from a specialist pain rehabilitation clinic and via social media. The study involved baseline and follow-up assessments using the PrePain questionnaire, the Short Health Anxiety Inventory (SHAI-14), and the Coping Strategies Questionnaire (CSQ). Statistical analyses included Spearman correlation for test-retest reliability, sign rank-test for sensitivity to change, Cronbach’s α for internal consistency, principal component analysis for subscale analysis, and mixed-effects linear regression for test of criterion validity. A total of 187 participants completed the study. The PrePain questionnaire demonstrated acceptable face validity and moderate test-retest reliability (coefficients ranging from 0.58 to 0.73). Internal consistency was α = 0.63. Principal component analysis suggested a two or three-factor solution. Criterion validity was supported by significant correlations between PrePain items and SHAI-14 and CSQ catastrophizing, except for the pain sensitivity item. No significant changes were observed in the clinical group between baseline and follow-up assessments. The resuts provide preliminary evidence for the reliability of The PrePain questionnaire and its validity for assessing attitudes, emotions, and behaviors related to pain in both clinical and non-clinical populations. Further research is needed to explore its sensitivity to change and utility in clinical practice.

This study applies network theory to registry data to identify prospective differences between individuals who develop long-term pain later in life and those who do not. The research is based on assessments of biological, psychological, and social variables in late adolescence during military conscription in Sweden. The analysis reveals significant differences in the network profiles of adolescent men who later developed long-term pain. These differences are reflected in several network-based outputs, including global, nodal, and edge levels, revealing a consistent picture of the pain-associated network profile. This profile demonstrates how those vulnerable to long-term pain have a specific configuration of variables that skew away from the rest of the population, mainly relating to psychosocial aspects.

Background and aims: Oral microbiota may contribute to the development of upper gastrointestinal (UGI) disorders. We aimed to study the association between the microbiome of saliva, subgingival and buccal mucosa, and UGI disorders, particularly precancerous lesions. We also aimed to determine which oral site might serve as the most effective biomarker for UGI disorders. Methods: In this population-based study, 388 adults underwent upper endoscopy with biopsies for histopathological analysis. UGI symptoms were assessed using a validated questionnaire and 16S rRNA gene sequencing characterized the microbiota in 380 saliva, 200 subgingival and 267 buccal mucosa samples collected during endoscopy. Results: Dysbiosis of the salivary microbiota was observed in subjects with gastroesophageal reflux symptoms (GERS) alone, as well as in those with combined conditions such as GERS and esophagitis, or esophagitis and Barrett's esophagus. Significant microbial alterations were also found in individuals with stomach disorders including H. pylori infection, chemical reactive gastritis, atrophic gastritis, and intestinal metaplasia. However, microbiota dissimilarity in subgingival and buccal mucosa samples, was associated primarily with Barrett's esophagus or gastric atrophy. Among several identified genera, Prevotella, and Fusabacterium in saliva were associated with atrophic gastritis and intestinal metaplasia. In subgingival samples, the link between Fretibacterium in Barrett's esophagus, and Fusabacterium in gastric atrophy and intestinal metaplasia are also notable. Conclusion: Dysbiosis of the saliva microbiota is linked to various UGI disorders. However, microbiota dysbiosis in subgingival and buccal mucosa sites are specifically associated with the pre-malignant conditions Barrett's esophagus and gastric atrophy. The oral microbiome, particularly in the subgingival location, might act as biomarkers for UGI cancers.

Background: Whether uncomplicated diverticulosis gives rise to symptoms is controversial. Diary-based studies of abdominal pain and stool habits in general populations are scarce, and we therefore investigated symptom patterns in diverticulosis from prospectively collected symptom diaries in a random sample of the general population who completed a research colonoscopy.

Methods: In the Swedish population-based colonoscopy (PopCol) study, 745 individuals from the general population underwent a colonoscopy of which 130 had diverticulosis, and none had diverticulitis. Seven-day symptom diaries were completed by 258 participants (age 54, women 64%) of which 50 had diverticulosis. The frequency and location of abdominal pain, bowel habit and other gastrointestinal symptoms were compared between individuals with and without diverticulosis using logistic regression.

Key Results: Diverticulosis was not associated with abdominal pain (OR 1.24, CI 0.61–2.55) or left lower quadrant (LLQ) abdominal pain (OR 1.59, CI 0.73–3.49). Pain duration and severity were not associated with diverticulosis. When individuals with diverticulosis had pain, it was more often in the LLQ (OR 2.45, CI 1.02–5.86) compared with those without diverticulosis. Diverticulosis was not linked to altered bowel habits. Irritable bowel syndrome prevalence was 16% in the diverticulosis group and 19% in the non-diverticulosis group.

Conclusions and Inferences: Participants with diverticulosis did not report more abdominal pain or more LLQ abdominal pain than participants without diverticulosis. Bowel habit was not abnormal in diverticulosis. Our results do not support that uncomplicated diverticulosis cause symptoms in individuals without a history of acute diverticulitis.

Helicobacter pylori disturbs the stomach lining during long-term colonization of its human host, with sequelae including ulcers and gastric cancer. Numerous H. pylori virulence factors have been identified, showing extensive geographic variation. Here we identify a ‘Hardy’ ecospecies of H. pylori that shares the ancestry of ‘Ubiquitous’ H. pylori from the same region in most of the genome but has nearly fixed single-nucleotide polymorphism differences in 100 genes, many of which encode outer membrane proteins and host interaction factors. Most Hardy strains have a second urease, which uses iron as a cofactor rather than nickel, and two additional copies of the vacuolating cytotoxin VacA. Hardy strains currently have a limited distribution, including in Indigenous populations in Siberia and the Americas and in lineages that have jumped from humans to other mammals. Analysis of polymorphism data implies that Hardy and Ubiquitous coexisted in the stomachs of modern humans since before we left Africa and that both were dispersed around the world by our migrations. Our results also show that highly distinct adaptive strategies can arise and be maintained stably within bacterial populations, even in the presence of continuous genetic exchange between strains.

Objectives: This study aimed to assess the impact of on-demand versus continuous prescribing of proton pump inhibitors (PPIs) on symptom burden and health-related quality of life in patients with gastroesophageal reflux disease (GERD) presenting to primary care.

Methods: Thirty-six primary care centres across Europe enrolled adult GERD patients from electronic health records. Participants were randomised to on-demand or continuous PPI prescriptions and were followed for 8 weeks. PPI intake, symptom burden, and quality of life were compared between the two groups using mixed-effect regression analyses. Spearman’s correlation was used to assess the association between changes in PPI dose and patient-reported outcomes.

Results: A total of 488 patients (median age 51 years, 58% women) completed the initial visit, with 360 attending the follow-up visit. There was no significant difference in PPI use between the continuous and on-demand prescription groups (b=.57, 95%CI:0.40-1.53), although PPI use increased in both groups (b = 1.33, 95%CI:0.65 − 2.01). Advice on prescribing strategy did not significantly affect patient-reported outcomes. Both symptom burden (Reflux Disease Questionnaire, b=-0.61, 95%CI:-0.73 − -0.49) and quality of life (12-item Short Form Survey physical score b = 3.31, 95%CI:2.17 − 4.45) improved from baseline to follow-up in both groups. Increased PPI intake correlated with reduced reflux symptoms (n = 347, ρ=-0.12, p = 0.02) and improved quality of life (n = 217, ρ = 0.16, p = 0.02).

Conclusion: In real-world settings, both continuous and on-demand PPI prescriptions resulted in similar increases in PPI consumption with no difference in treatment effects. Achieving an adequate PPI dose to alleviate reflux symptom burden improves quality of life in GERD patients. EudraCT number 2014-001314-25.

Background and Aims Gastritis is a common histological diagnosis, although the prevalence is decreasing in developed populations, alongside decreasing prevalence of H. pylori infection. We sought to determine the prevalence of the etiology of gastritis in a Swedish population sample and to analyze any associations with symptoms, an area of clinical uncertainty. Methods Longitudinal population-based study based in osthammar, Sweden. A randomly sampled adult population completed a validated gastrointestinal symptom questionnaire (Abdominal Symptom Questionnaire, ASQ) in 2011 (N = 1175). Participants < 80 years of age and who were eligible were invited to undergo esophagogastroduodenoscopy (EGD) (N = 947); 402 accepted and 368 underwent EGD with antral and body biopsies (average 54.1 years, range 20-79 years; 47.8% male) with H. pylori serology. Results Gastritis was found in 40.2% (148/368; 95% CI 35.2-45.2%). By rank, the most common histological subtype was reactive (68/148; 45.9%), then H. pylori (44/148; 29.7%), chronic non-H. pylori (29/148; 19.6%), and autoimmune (4/148; 2.7%). Gastritis was significantly associated with older age and H. pylori status (p < 0.01). Gastritis subjects were divided into three histological categories: chronic inactive inflammation, autoimmune gastritis, and active inflammation; there was no difference in the presence of upper gastrointestinal symptoms when categories were compared to cases with no pathological changes. Functional dyspepsia or gastroesophageal reflux were reported in 25.7% (38/148) of those with gastritis (any type or location) versus 34.1% (75/220) with no pathological changes (p = 0.32). Epigastric pain was more common in chronic H. pylori negative gastritis in the gastric body (OR = 3.22, 95% CI 1.08-9.62). Conclusion Gastritis is common in the population with a prevalence of 40% and is usually asymptomatic. Chronic body gastritis may be associated with epigastric pain, but independent validation is required to confirm these findings. Clinicians should not generally ascribe symptoms to histological gastritis.

Self-rated health is a common assessment used in epidemiological research and an independent predictor of morbidity and mortality. We investigate if a single measure of self-rated health in late adolescence predict mortality between 46 and 70 years of age. This study was based on 47 286 Swedish men that conscribed 1969–1970 at age 18–20 and that were still alive in 1997. Self-rated health and data on potential explanatory factors (psychological factors, health status markers and health behaviors) were collected at conscription. Adult socioeconomic position in 1990 was derived from registries. Death and cause of death (cancer, cardiovascular disease, violent and alcohol abuse related disorders) were derived from the Causes of Death Register between 1997 and 2019. Conscripts that rated their health as fair or poor/very poor had significantly higher hazard of all-cause mortality than conscript that rated their health as very good (HRfair = 1.27, 95%CI:1.18–1.37 and HRpoor = 1.25, 95%CI:1.11–1.41) and disease-specific mortality. Adjusting for all explanatory factors attenuated the risk estimates by 9–100%. In conclusion, poor self-rated health reported in late adolescence predicts all-cause and disease-specific mortality between the ages of 46 and 70 years. Psychological factors and health behaviors measured at conscription may serve as potential explanatory factors underlying the predictive ability of self-rated health in late adolescence.

The aim is to investigate the evidence for shared genetic architecture between each of asthma, allergic rhinitis and eczema with gastro-esophageal reflux disease (GERD). Structural equation models (SEM) and polygenic risk score (PRS) analyses are applied to three Swedish twin cohorts (n = 46,582) and reveal a modest genetic correlation between GERD and asthma of 0.18 and bidirectional PRS and phenotypic associations ranging between OR 1.09-1.14 and no correlations for eczema and allergic rhinitis. Linkage disequilibrium score regression is applied to summary statistics of recently published GERD and asthma/allergic disease genome wide association studies and reveals a genetic correlation of 0.48 for asthma and GERD, and Genomic SEM supports a single latent factor. A gene-/gene-set analysis using MAGMA reveals six pleiotropic genes (two at 12q13.2) associated with asthma and GERD. This study provides evidence that there is a common genetic architecture unique to asthma and GERD that may explain comorbidity and requires further investigation.