Introduction

No data exist on the relationship between serum and tissue infliximab (IFX) concentrations and outcomes in acute severe ulcerative colitis (ASUC).

Aims & Methods

In hospitalized patients (pts) with ASUC treated with IFX rescue therapy, we assessed relationships between longitudinal serum and tissue IFX concentrations and pt outcomes. In an open-label, prospective study, hospitalized ASUC pts treated with IFX rescue therapy were followed for 22 weeks (wks) at 2 centers. Inclusion criteria: (A) hospitalized ASUC (partial Mayo score [PMS] > 7, baseline Mayo endoscopic score [MES] ≥ 2 and met Truelove/Witts criteria) (B) receiving either standard or accelerated rescue IFX. From IFX initiation until wk 22, clinical scores (PMS) and serum sampling were performed at multiple induction and maintenance timepoints (hospital/outpatient). Colonoscopy scores (MES) and biopsies were collected on day 2-5 post first infusion (early inpatient) and wk 16-22 (maintenance). Outcomes: Median area under the curve (AUC) of serum IFX concentration during early induction (wk 0-2), induction (wk 0-14) and maintenance (wk 15-22) were compared between wk 22 endoscopic remitters (ERs) (MES 0 or 1 without UC-related hospitalization or colectomy) and non-remitters (NRs). Tissue IFX concentrations were compared between groups.

Results

110 serum samples over 22 wks (mean 7.9 samples/pt) with 54 samples between wk 0- 2 (mean= 3.9/pt) were collected. Biopsies at early inpatient (n=17) and maintenance colonoscopies (n=15) were collected from 14 pts. Mean age was 38 years, 50% were female, mean disease duration was 7.8 years and 69% had pancolitis. One NR needed colectomy and another was re-hospitalized. 50% achieved endoscopic remission at wk 22. ERs had numerically higher baseline CRP (49 [±28] vs. 31 [±24] mg/dL), immunomodulator use (71% vs. 43%) and clinical response (86% vs. 43%) to NRs, while albumin (3.3 [±0.9] vs. 2.9 [±0.6] g/dL) and total IFX dose between wk 0-2 (16 [±1] vs. 12 [±6] mg/kg) were more similar. Mean BMI was 23.8 kg/m². Between wk 0-2, the mean number of IFX infusions per pt was 1.5 (±0.7), and median dose per infusion was 11.4 mg/kg (IQR 25-75: 11-19). Median serum IFX concentration AUC was higher in ERs than NRs in early induction (wk 0-2: 568 ug*day/mL [528-1627] vs. 293 [145- 423], p=0.004), all induction (wk 0-14: 3036 [2742-3199] vs. 1768 [1375-2468] p=0.004) and in maintenance (wk 15-22: 841 [309-3295] vs. 405 [295-718] p=0.002). Findings were similar for dose normalized AUC. Peak concentration 2 hrs post first infusion was numerically higher in ERs vs. NRs (median 365 ug/mL [200-484] vs. 187 [140-355] p=0.15) overall and dose-adjusted. Anti- IFX antibodies were detected in one NR maintenance sample. Baseline clearance inversely correlated with AUC (r=-0.7, p=0.03) or dose-normalized induction AUC (r=-0.8, p=0.01). Tissue IFX concentrations were similar in inflamed/non-inflamed tissue and were similar between ERs/NRs in early induction (median 104 ng/mg [89-114] vs. 107 [76-133], p=1.0), and maintenance (10 [4-69] vs. 26 [3-87], p=0.99). Percent of drug in tissue vs. serum was similar between ERs/NRs (induction: median 7% vs 8%; maintenance: 8% vs 6%).

Conclusion

Intense serum and tissue sampling of ASUC pts receiving IFX showed higher serum drug exposure at all timepoints in endoscopic remitters whereas tissue concentrations were similar regardless of outcome. Tissue IFX may be required but not sufficient for achievement of outcomes in ASUC.

Disclosure

PC, SS, and LE report no conflicts of interest.
PL, MR, MS, MF and WT are employees of Alimentiv Inc
RB Speaker/consulting/moderator: Bristol Myers Squibb, Janssen, AbbVie, Takeda, Ferring, Celltrion, Pfizer, Merck, Eli Lilly. Advisory boards: Celltrion, AbbVie, Pfizer, Janssen, Bristol Myers Squibb, Takeda, Merck, Eli Lilly. Educational grants and educational sponsorships: Abbvie, Johnson and Johnson Innovative Medicine, Pfizer, Eli Lilly, Amgen, Pendopharm, Merck, Celltrion, Organon. Travel support: Pfizer, Celltrion, Johnson and Johnson Innovative Medicine, Abbvie.
WA reports consulting fees and participation on advisory board from Johnson & Johnson and Takeda Pharmaceuticals, Inc.
BB reports consulting fees and participation on advisory board from Bristol Myers Squibb, Abbvie, Merck and has grant funding from Merck, Mirador, Prometheus, and Gilead.
PD reports consulting fees from Alimentiv.
MD M. Duijvestein reports speaking fee from Bristol Meyers Squibb, Takeda, Galapagos, Janssen, Dr. Falk, advisory board feest form Abbvie, Bristol Meyers Squibb, Celltrion, Galapagos/Alfasigma, Janssen, Takeda and grant/Research support: Pfizer, Bristol Meyers Squibb, Galapagos Alfasigma, Janssen
MSS Speaker for Abbvie, Janssen, Takeda, Pfizer, Ferring, Novartis, and Lilly. Advisor for Abbvie, Janssen, Takeda, Pfizer, Ferring, Gilead, Amgen, Merck, and Lilly. Research for Abbvie, Janssen, Takeda, Pfizer, and Gilead. Consults for Abbvie, Janssen, Takeda, Pfizer, and Lilly.
RL Consultant for Xencor, Sanofi. SAB member for CJ Biosciences, Ancilia, and Montage Bio.
DL consulting: Abbvie, AltruBio, BMS, Boehringer Ingelheim, Eli Lilly, Johnson & Johnson, PSI, Palatin, Pfizer, Prime, Takeda, Vedanta. Speaking fees: Abbvie, Johnson & Johnson; Grants: Boehringer Ingelheim, Johnson & Johnson.
ES has obtained grant/research support from Abbott (AbbVie), AstraZeneca, CCFA, Janssen Research &Development, Johns Hopkins University, National Institute of Diabetes and Digestive and Kidney (NIDDK), National Institute of Health (NIH), New York Crohn’s Foundation, Pfizer, UCB, UCSF–CCFA Clinical Research Alliance, Genentech. Seres Therapeutics, Celgene Corporation. Consulting fees are reported for AbbVie, Crohn’s and Colitis Foundation of America (CCFA), Entera Health, Evidera, GI Health Foundation, Janssen, Protagonist Therapeutics, Seres Health, Takeda Pharmaceuticals, Bristol Myers Squibb. Stock shareholder of Gilead, and honoraria of GIHealth Foundation for non-branded speaker’s bureau, Janssen for non-branded speaker’s bureau.
BGF reports consulting fees from AbbVie,Abivax,Adiso,AgomAB Therapeutics,Allianthera,Amgen,AnaptysBio,Arena Pharma,Avoro Capital Advisors,Atomwise,,BioJamp,Biora Therapeutics,Blackbird Laboratories,Boehringer-Ingelheim,Boxer Capital,Celsius Therapeutics,Celgene/BMS,Connect BioPharma,Cytoki,Disc Medicine,Duality,EcoR1,Eli Lilly,Equillium,Ermium,First Wave,Forbion,Galapagos,Galen Atlantica,Genentech/Roche,Gilead,Gossamer Pharma,GSK,Hinge Bio,Index Pharma,Imhotex,Immunic Therapeutics,Intercept,JAKAcademy,Janssen,Japan Tobacco Inc.,Kaleido Biosciences,Klick Health,Landos Biopharma,Lenczner Slaght,LifeSci Capital,Lument AB,Mage Biologics,Mestag,Millennium,MiroBio,Monte Rose Tx,Morgan Lewis,Morphic Therapeutics,Mylan,Nexys Therapeutics,Nimbus Therapeutics,OM Pharma,OrbiMed Origo BioPharma,Orphagen,Pandion Therapeutics,Pendopharm,Pfizer,Prometheus Therapeutics and Diagnostics (Merck),Progenity,Protagonist,PTM Therapeutics,Q32 Bio,Rebiotix,REDX,Roche,Roivant/Televant,Sandoz,Sanofi,Seres Therapeutics,Silverback Therapeutics,Sobi,Spyre Therapeutics,Surrozen Inc.,Synedgen,Takeda,Teva,Thelium,Tigenix,Tillotts,Triastek,Ventyx; lecture fees from Takeda,Janssen,and AbbVie; participation on advisory board for AbbVie,AnaptysBio,Boehringer-Ingelheim,Celgene/BMS,Eli Lilly,Genentech/Roche,Janssen,Merck,MiroBio,Origo BioPharma,Pfizer,REDX Pharma,Sanofi,Takeda,Teva,Ecor1Capital,Morphic,GSK; stock or stock options from Evida,EnGene,and Connect Biopharma.
WS reports consulting fees from Alimentiv, Eli Lilly, Forbion, Prometheus Biosciences, Prometheus Laboratories, Shoreline Biosciences, Ventyx Biosciences; stock or stock options from Eli Lilly, Prometheus Biosciences, Prometheus Laboratories, Shoreline Biosciences, Mirador Therapeutics, Ventyx Biosciences; and employee at Mirador Therapeutics and Ventyx Biosciences. Spouse: Eli Lilly – stock, Merck - employee; Prometheus Laboratories – stock, stock options; Ventyx Biosciences – stock, stock options
VJ reports consulting fees and participation on advisory board for AbbVie, Alimentiv, Altrubio, Amgen, AnaptysBio, Arena pharmaceuticals, Asahi Kasei Pharma, Asieris, Astra Zeneca, BiomeBank, Boehringer Ingelheim, Bristol Myers Squibb, Calluna Pharma, Celltrion, Eli Lilly, Endpoint Health, Ensho Therapeutics, Enthera, Exeliom Biosciences, Ferring, Flagship Pioneering, Fresenius Kabi, GlaxoSmithKline, Genentech, Gilead, Janssen, Merck, MRM Health, Nxera Therapeutics, Pandion, Pendopharm, Pfizer, Protagonist, Reistone Biopharma, Roche, Roivant, Sandoz, Sanofi, Second Genome, Sorriso, Spyre Therapeutics, Takeda, Teva, Tillotts, Ventyx, Vividion; speaker fees from AbbVie, Ferring, Bristol Myers Squibb, Galapagos, Janssen, Pfizer, Takeda, Tillotts, and Fresenius Kabi.
NVC reports research grants from R-Biopharm and consulting fees from AcelaBio, Alimentiv, Pfizer, ProciseDX, Prometheus Biosciences, and Spyre Therapeutics. NVC is a current employee of Mirador Therapeutics.

Introduction

Inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, are chronic conditions with alternating phases of flare-ups and remission. Due to the persistent and often severe course of these diseases, effective treatment significantly improves patients' daily activities and overall functioning. [1] Given the uncertain prognosis and the frequent disease progression despite pharmacotherapy, it is important to explore additional interventions that could support traditional treatments. While physical activity may provide both anti-inflammatory and functional benefits in IBD, data on its efficacy and safety during disease exacerbation remain scarce. [2] This pilot study is the first real-world investigation into the effects of a supervised physical exercise training in patients hospitalized due to IBD flare.

Aims & Methods

This study aimed to evaluate the effects of an individualized, moderate-intensity, supervised physical exercise training on exercise tolerance, inflammation, and fatigue resistance in patients hospitalized due to IBD flare, and to explore baseline factors associated with greater benefit from the intervention. Patients were randomly assigned to an intervention group, receiving individual cycloergometer training during hospitalization, or to a control group without exercise. Both groups were well balanced at baseline, with no significant differences in demographic, clinical, or laboratory parameters. At both admission and discharge, all patients underwent standardized graded exercise tests to establish their exercise tolerance based on the lactate threshold and heart rate/power output response. Furthermore laboratory assessments, and the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) questionnaire were conducted.

Results

A total of 22 patients were included in the study, with 13 patients in the intervention group and 9 patients in the control group. Although FACIT-F scores improved in both groups, the intervention group demonstrated a significantly greater improvement (median change –39 points; IQR –49 to –11; p = 0.014) compared to the control group (median change –25 points; IQR –52 to –6; p = 0.30). Baseline FACIT-F scores were significantly correlated with changes in heart rate response response during exercise: patients with greater baseline fatigue and poorer functional status experienced greater improvement in exercise tolerance (r = –0.62, p = 0.028). Platelet counts remained more stable in the intervention group (median change +10 ×10³/µl; IQR –65 to +45) compared to a significant increase in the control group (median +74 ×10³/µl; IQR +44.5 to +101.75; p = 0.046). In the intervention group, greater reductions in calprotectin were strongly correlated with more favorable heart rate responses during a graded exercise test (r = –0.92, p = 0.009).

Conclusion

Supervised training program during hospitalization for IBD flare was associated with improved fatigue resistance and more favorable inflammatory responses. Patients with worse baseline functioning obtained greater benefit in exercise tolerance. These findings support the feasibility and potential therapeutic role of individualized physical activity in acute IBD care and highlight the need for further investigation in real-world settings.

References

1. Farrell D, Artom M, Czuber-Dochan W, Jelsness-Jørgensen LP, Norton C, Savage E. Interventions for fatigue in inflammatory bowel disease. Cochrane Database Syst Rev. 2020 Apr 16;4(4):CD012005. doi: 10.1002/14651858.CD012005.pub2.
2. Achtenberg M, Cibor D, Zwolińska-Wcisło M. Structured exercise in patients with inflammatory bowel disease: a literature review. Gastroenterology Review/Przegląd Gastroenterologiczny. 2025;20(1):36-40. doi:10.5114/pg.2025.148473.

Disclosure

Magdalena Achtenberg has received lecture fees and/or travel grants from Ferring and Eli Lilly, unrelated to the present work. Tomasz Dziubyna has received travel grants from Fresenius, unrelated to the present work. Małgorzata Zwolińska-Wcisło, Dorota Cibor, Karolina Gazda, Magdalena Wyrzykowska, Piotr Kosieniak, Maria Wiśniewska, Jerzy A. Żołądź, Marcin Grandys and Joanna Majerczak declare no conflict of interest.

Introduction

Colonoscopy is a standard procedure but it is unclear whether a short or long colonoscope is more favorable regarding procedure efficiency and patient comfort. The performance of different colonoscope lengths cannot be objectively compared in live patients due to various limitations. Hence, the choice of colonoscope length is a matter of personal preference or institutional tradition. Preclinical tools to assess scope performance are needed. We evaluated endoscopists’ performance using short vs. long colonoscopes in the Mikoto simulator, enabling objective measurements using pressure and distension sensors within a 3D-printed, calibrated colon model.

Aims & Methods

Aims: i) Performance comparison of short vs. long comparison in the Mikoto simulator, enabling objective measurements using pressure and distension sensors within a 3D-printed, calibrated colon model. ii) First evaluation of this novel simulator.
Delegates at ESGE Days and DGE-BV 2024 were invited to perform two simulation rounds—one with each scope length in a random order —and completed a survey. Main outcome was the performance of different scope lengths as measured by the caecal intubation time and the proprietary “Mikoto score” (a combination of pressure and distension measurements exerted on the model).

Results

Of 281 participants, 252 complete datasets were analyzed (187 ESGE, 65 DGE-BV). The Mikoto-Score was lower with long scopes (74 vs. 77; p=0.01), and caecal intubation time was longer (2:59 vs. 2:38 min; p=0.01). A second round did not improve performance. Mikoto-Scores were unaffected by scope preference or sedation strategy but were lower in users of the two-person technique. Scores correlated with self-assessed skill and colonoscopy experience (r=0.43, r=0.47). The median system-usability score was 77.5 indicating a good evaluation by the examiners and a good usability.

Conclusion

Using the Mikoto simulator, long colonoscopes caused more colonic distension and longer insertion times, potentially impacting patient comfort. Objective simulator data can inform scope selection in clinical practice. The Mikoto simulator reflects endoscopist self-assessed skill and previous experience.

Disclosure

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2. Lee SH, Lee DJ. Comparison on colonoscopic parameters according to length of adult-colonoscope. Chin Med J (Engl) 2014; 127: 85-91.
3. Obstein KL, Patil VD, Jayender J et al. Evaluation of colonoscopy technical skill levels by use of an objective kinematic-based system. Gastrointest Endosc 2011; 73: 315-321, 321.e311. doi:10.1016/j.gie.2010.09.005
4. Repici A, Badalamenti M, Maselli R et al. Efficacy of Real-Time Computer-Aided Detection of Colorectal Neoplasia in a Randomized Trial. Gastroenterology 2020; 159: 512-520 e517. doi:10.1053/j.gastro.2020.04.062
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12. Lee HL, Eun CS, Lee OY et al. Significance of colonoscope length in cecal insertion time. Gastrointestinal Endoscopy 2009; 69: 503-508. doi:https://doi.org/10.1016/j.gie.2008.06.006
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14. Dubow RA, Katon RM, Benner KG et al. Short (35-cm) versus long (60-cm) flexible sigmoidoscopy: a comparison of findings and tolerance in asymptomatic patients screened for colorectal neoplasia. Gastrointest Endosc 1985; 31: 305-308. doi:10.1016/s0016-5107(85)72211-0
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25. Tribonias G, Bacasis AD, Komeda Y ​

Clinical Case Summary

A 76-year-old man with chronic liver disease presented with jaundice, fatigue, and weight loss. Laboratory tests showed total bilirubin 20.1 mg/dL and Child-Pugh B liver function. Contrast- enhanced CT (CE-CT) revealed a 9 x 7 x 10 cm right-lobe tumor with right biliary duct invasion. Three biliary drains were placed, reducing bilirubin to 9 mg/dL, but liver function declined to Child-Pugh C. Biopsy confirmed HCC. Given his deteriorating condition and ineligibility for surgery, ECT was performed to achieve tumor control. Intravenous bleomycin (28 mg) was administered before electroporation. No immediate complications occurred. 12 days post-ECT, CE-CT showed tumor devascularization and resolution of biliary invasion. liver function was stabilized, allowing the removal of the drain. At 3 months, CE-CT showed 30% tumor shrinkage and left lobe hypertrophy. To prevent progression, transarterial embolization of residual tumor was performed. Six-month imaging demonstrated further shrinkage and continued left lobe hypertrophy without portal vein embolization. These improvements allowed for right hepatectomy at 10 months. 6 months post- surgery, CE-CT confirmed no recurrence. HCC with biliary invasion is a rare and challenging clinical condition. It often leads to biliary obstruction and progressive hepatic dysfunction. In non-surgical candidates, treatment options are limited. ECT is an emerging locoregional treatment that enhances the intracellular uptake of chemotherapeutic agents through electroporation . Its selective targeting of tumor cells while preserving surrounding structures makes it particularly appealing for tumors involving bile ducts. The disappearance of tumor tissue within the bile ducts suggests that ECT can effectively target intraductal tumor spread. A striking outcome was spontaneous left-lobe hypertrophy without prior portal vein embolization. This case highlights ECT as a potential bridge to surgery in HCC with biliary invasion.

References

Figure 1. Pre-treatment imaging and management.
(a) Contrast-enhanced CT showing a large hepatocellular carcinoma (HCC) in the right liver lobe.
(b, c) Tumor invasion of the right hepatic bile duct (arrow), causing complete biliary obstruction at the
biliary confluence (dashed arrow).
(d) Placement of multiple biliary drains (two in the right lobe and one into the left lobe) to relieve jaundice.
Figure 2. Electrochemotherapy (ECT) procedure and early response.
(a) ConeBeam-CT combined with transarterial angiography for electrode placement guidance.
(b) Percutaneous electrodes targeting the primary tumor and invading bile ducts.
(c) Contrast-enhanced CT at 12 days post-ECT showing successful devascularization of the tumor.
(d) Removal of biliary drains following bilirubin reduction, restored biliary patency, and improved liver function.
Figure 3. Tumor response, liver regeneration and post-surgical follow-up.
(a) Two-month follow-up CT demonstrating 30% tumor shrinkage and left lobe hypertrophy in comparison
to baseline imaging.
(b) Transarterial embolization of the residual hypervascular tumor at three months post-ECT to prevent
tumor progression.
(c) Six-month follow-up showing further tumor regression and complete resolution of tumor within the
biliary duct.
(d) Post-hepatectomy CT at six months confirming no recurrence.

Introduction

Intestinal ultrasound is a noninvasive and inexpensive tool to assess disease activity in patients with inflammatory bowel disease, such as Crohn's and ulcerative colitis by monitoring the disease activity in real time.

Aims & Methods

Intestinal ultrasound is a non-invasive, cost-effective imaging tool for routine clinical evaluations. This study examines its role in monitoring Crohn’s disease, comparing it with CT Enterography.
This is a prospective, descriptive, comparative study including patients with crohn's disease aged over 16, between March 2023 and March 2024. Every patient had a colonoscopy, enteroscan, and digestive ultrasonography; the delay between each test was limited to one month by the same operator. Patients with ileal or recto-colic resections or pregnant women were not included. We develope a form to collect clinical, therapeutic, and epidemiological informations as well as the outcomes of CT, colonoscopy, and ultrasounds. Between ultrasound, CT scan and colonoscopy, we asked our patients to choose the most widely accepted para-clinical test. Ultrasonography's sensitivity (Se) and specificity (Sp) were determined, and data from enteroscanner and ultrasound were analyzed, with a focus on the wall's thickness, vascularization, damage extent, and peridigestive environment. The statistical study was carried out using SPSS 21.0 software. Quantitative variables were expressed as medians and qualitative variables as numbers and percentages. The McNemar test and the Wilcoxon test for associated samples were applied. The significance level was set at 0.05.

Results

Forty-nine patients were included, with a male-to-female ratio of 0.53 and a median age of 32 years. US detected digestive thickening in 81.6% of cases, mainly in the terminal ileum. CT Enterography detected thickening in the proximal small bowel and rectum in 2.2% of cases, which US missed. US sensitivity was 84.4%, with specificity of 50%. No significant difference was found between US and CT for thickening detection. Mesenteric infiltration detected by US was similar to CT (Se = 86.5%, Sp = 100%). For adenopathy, Se was 75% (Sp = 97%). US showed a 60% sensitivity for detecting complications, with a significant difference compared to CT (p = 0.002). There was no correlation between thickening on US and ulcers on endoscopy.

Conclusion

Despite limitations in examining the proximal intestine and rectum, intestinal ultrasonography is a sensitive, accessible method for monitoring Crohn’s disease and detecting complications.

Introduction

Gastrointestinal (GI) transit abnormalities due to dysmotility often affect multiple regions of the GI tract rather than occur in isolation. Identifying regional GI transit delays may influence clinical management. Use of wireless motility capsules (WMC) enable regional and whole GI transit times to be objectively measured; the relationship between symptom profiles and regional transit times are explored here with a new capsule device, the Atmo Capsule.

Aims & Methods

The Atmo Capsule was administered to subjects with suspected upper and/or lower gastrointestinal dysmotility. This analysis utilized data from subjects where valid transit measurements via the Atmo Capsule were available for all regions of the GI tract, and no protocol deviations pertaining to the use of contraindicated medication or inclusion criteria violations were incurred. Regional transit times were considered delayed as follows: gastric emptying ≥ 5 h; small bowel transit, ≥ 6 h; colonic transit, ≥ 59 h. Delays affecting a single region (i.e., gastric, small bowel, or colon) were considered ‘isolated’, delays affecting multiple (> 1) regions were considered ‘generalized’. Symptom profiles were assessed using the Patient Assessment of Gastrointestinal Disorders - Symptoms (PAGI-SYM) and Patient Assessment of Constipation – Symptoms (PAC-SYM) questionnaires: all patients completed the PAGI-SYM while those with symptoms suggestive of lower GI dysmotility completed the PAC-SYM. Data were analyzed via Kruskal-Wallis test.

Results

The WMC was administered to 209 subjects (median age 41; 188 female), of whom 170 had data suitable for this analysis. Delayed GI transit was identified in 100 (59%) subjects: 65 were isolated and 35 were generalized. There were no differences in overall symptom scores in subjects with no delays (PAGI-SYM, median 1.5 [IQR: 1.1, 2.1]; PAC-SYM, 2.0 [1.5, 2.6]), isolated delays (1.5 [1.0, 2.1]; 1.9 [1.2, 2.6]) and generalized transit delays (1.8 [1.4, 2.3]; 2.1 [1.4, 2.8]) (p>0.05 for both) or symptom sub-scores (Table 1). Gastric transit was delayed in 46 subjects: 19 (41%) were isolated and 27 (59%) were generalized. Colonic transit was delayed in 60 subjects: 31 (52%) were isolated and 29 (48%) were generalized. GI symptom profiles were not different in subjects with isolated and generalized transit delays for either the stomach or colon (p>0.05 for all relevant subscales).

Table 1. Symptom profiles amongst patients with no transit delay, isolated transit delay (affecting a single region) and generalized transit delay (affecting multiple regions). Data presented as median (interquartile range) and analyzed via Kruskal-Wallis test.

Conclusion

WMC measurements of regional and whole GI transit using the Atmo Capsule revealed that delayed transit impacting multiple regions were common. However, symptom profiles were unable to distinguish between isolated vs. generalized transit delays, suggesting that symptoms are an unreliable predictor of abnormalities in GI transit as previously found via other transit modalities.

Disclosure

These authors disclose the following: Braden Kuo, Anthony J. Lembo, Eammon M.M. Quigley, Satish S.C. Rao, and William D. Chey serve on the Medical Advisory Board of Atmo Biosciences. Michael Cline and Baharak Moshiree served on the Medical Advisory Board of Atmo Biosciences. Braden Kuo has received funding from NIH, Vanda, Atmo Biosciences, and Takeda and has consulted for Evoke, Takeda, Ironwood, Novo Nordisk, Cindome, and Neurogastrx. Thomas Abell has received funding from Gastric Dysrhythmias, Neurogastrx, NIH GpCRC, and Vanda and has consulted for Enterra Medical, Novo Nordisk, Nuvaira, and Vanda. Anthony J. Lembo has received funding from Ardelyx, Biomerica, GSK, Ironwood, Takeda, and Vibrant and holds stock with Allurion, Bristol Myer Squibb, and J&J. Abigail Stocker has received funding from Cindome, Enterra Medical, and Vanda. William D. Chey has received funding from Atmo Biosciences, Commonwealth Diagnostics Intl, QOL Medical, and Salix; has consulted for AbbVie, Ardelyx, Biomerica, Comvita, Gemelli, Ironwood, Nestle, QOL Medical, Phathom, Redhill, Salix, Vibrant, and Takeda; has filed patents with My Nutrition Health, Digital Manometry, and Rectal Expulsion Device; and holds stock options with Coprata, Evinature, Food Marble, Kiwi Bioscience, and Modify Health. The remaining authors disclose no conflicts.

Introduction

Gastrointestinal dysfunction, especially gastroparesis is a common non-motor disorder among Parkinson’s disease resulting to serious complications and poor quality of life. There are still some limitations on an evaluation and diagnostic test to detect the patients with gastroparesis for early intervention improving outcome.

Aims & Methods

All Parkinson’s disease patients were inquired to complete GCSI, GERD-Q, and PAC-SYM questionnaires. The correlation between the scores and disease severity was evaluated. Factors associated with significant gastroparesis symptoms (GCSI ≥9) were analyzed. Patients who have had gastrointestinal symptoms compatible with gastroparesis were further test for gastric emptying scintigraphy.

Results

76 patients completed GI questionnaires. The majority of patients (60.6%) were classified in PD stage 2 and 3. A large number of patients (82.9%) reported gastroparesis symptoms using GCSI score. The median (IQR) of total GCSI score was 4 (2, 10) with postprandial fullness predominant in subscale. PD duration ≥6 years was associated with high gastroparesis symptoms (GCSI ≥9), adjust OR = 2.96 (1.01, 8.71), p=0.043. Eight consecutive participants could undergo physiologic testing. Only one of eight was definitely confirmed for delayed gastric emptying. No correlation between GCSI score and physiologic testing was observed.

Table 1.Logistic regression analysis on potential factors associated with significant GCSI score.

Conclusion

Gastroparesis symptoms with postprandial fullness predominant were common among Parkinson’s disease. The strong correlation between gastrointestinal scores may illustrate an extensive gastrointestinal involvement, especially in the patients with long term disease duration. However, clinical scores might have a limitation for real-life implementation in Parkinson’s disease because poor correlation between GCSI score and physiologic testing was observed. Score validation and long-term outcome, especially nutritional status and pulmonary complication as sequelae of gastrointestinal dysfunction would be considered in future research.

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