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Free for all myUEG account holders. Your access level is set automatically based on your occupation. Medical professionals get full access to all content. If you are a non-medical user, you can only access UEG Week content from congresses you attended.

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Introduction

In Japan, more than ten years have passed since direct oral anticoagulants (DOACs) was released in 2011. The differences between DOACs and warfarin (VKA) have gradually become clearer, and many studies have been reported regarding the differences in gastrointestinal bleeding risk^(1)(2)(3). However, there are few reports that examine the prevalence of gastric mucosal injury or ulcers rather than the risk of bleeding.

Aims & Methods

The aim of this study is to reveal the clinical features about patients with gastric ulcer taking anticoagulants (DOACs or VKA). This study is a retrospective cross-sectional study conducted in a single hospital. Data were extracted from the records of subjects who underwent upper gastrointestinal endoscopy at our department between April 2015 and December 2022. We focused on subjects who took anticoagulants (DOACs or VKA), and compared the prevalence of gastric ulcer between subjects taking DOAC and those taking VKA. Subjects taking anticoagulants were limited to those taking that anticoagulant as the only anti-thrombotic agents. This study was conducted separately for subjects taking antacids (P-CAB or PPI) and those not taking antacids (NO P-CAB, NO PPI and NO H2RA). Statistical analyses were performed by Fisher’s exact test.

Results

Of the 8,602 subjects analyzed, 522 subjects were taking anticoagulants, of which 103 were taking VKA (76 men, 27 women, mean age 73.1±12.0 years) and 297 were taking DOACs (205 men, 92 women, mean age 74.9±8.7 years). Among subjects taking DOACs, 33 subjects received Dabigatran, 93 received Edoxaban, 87 received Rivaroxaban, and 84 received Apixaban. The prevalence of gastric ulcer in subjects taking antacids was 6.7% (4/60) on VKA and 2.9% (5/170) on DOACs (p=0.24). The prevalence of gastric ulcer in subjects not taking antacids was 23.1% (9/39) on VKA and 5.4% (6/111) on DOACs (p=0.004).

Conclusion

Without concomitant use of antacids, subjects taking DOACs had a statistically significantly lower prevalence of gastric ulcers than those taking warfarin. These results suggest that DOACs are gentler on the gastric mucosa and user friendly than warfarin.

References

(1) Miller CS, et al. Clin Gastroenterol Hepatol. 15(11): 1674-1683, 2017
(2) Ray WA, et al. JAMA. 320(21): 2221-2230, 2018
(3) Ingason AB, et al. Ann Intern Med. 174(11): 1493-1502, 2021

COMPARISON OF GASTRIC ULCER CASES IN PATIENTS TAKING WARFARIN OR DOACS

Yuji Shimada 1, Hiroki Nago 1, Masahiro Yamaguchi 1, Yuichiro Terai 1, Rihwa Om 1, Yuji Kita 1, Yuji Ikeda 1, Sho Sato 1, Ayato Murata 1, Shunsuke Sato 1, Akihito Nagahara 2, Takuya Genda 1

1 Juntendo University Shizuoka Hospital, Izunokuni-city, Japan

2 Juntendo University School of Medicine, Tokyo, Japan

Conference

UEG Week Vienna 2024

Topics

Oesophagus

Submission format

Abstract

Session

Upper GI bleeding (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Online Course

New

accredited

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Bowel function is significantly affected after rectal surgery. While sphincter-preserving techniques aim to maintain anal continence, many patients experience a spectrum of bowel dysfunction, collectively known as Low Anterior Resection Syndrome (LARS). LARS includes symptoms such as incontinence, constipation, urgency, and stool clustering, which can severely impact a patient’s quality of life. The prevalence of LARS is alarmingly high, affecting a majority of patients, and symptoms can persist for years after surgical treatment.

Target audience

Gastroenterologists
Colorectal surgeons
Oncologists
Nurses/Stoma therapists
Primary care physicians

Consequences of proctology surgery (LARS)

Harald Rosen, Andreas Rink, Peter Christensen, Franco Marinello

Event

Consequences of proctology surgery (LARS)

Topics

Surgery

Accreditation status

accredited

Duration

1 hour

Published

2026

UEG Standards and Guidelines

New

Clinical Practice Guideline

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ABSTRACT

Introduction

Since the publication of the first European Society for the Study of Coeliac Disease (ESsCD) guidelines in 2019, substantial advances have been made in understanding the management and complex disease courses of coeliac disease (CeD) in adults. These 2025 updated guidelines aim to integrate new evidence, refine management strategies, and promote a personalised and multidisciplinary approach to care.

Methods

The ESsCD convened a multidisciplinary panel of experts to revise the 2019 guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework. Evidence was appraised and graded according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Statements and recommendations were draughted within working groups and finalised through a structured Delphi consensus process.

Results

The updated guidelines are presented in two parts. Part 1, which has already been published, addresses the diagnostic approach to CeD in adults, whereas Part 2 focuses on disease management, structured follow-up, and the evaluation and treatment of persistent symptoms despite a gluten-free diet or refractory disease. New or expanded sections include guidance on the safe inclusion of oats, use of low-FODMAP diets in patients with persistent symptoms, management of exocrine pancreatic insufficiency, recognition of functional asplenia and related vaccination recommendations, and stratified bone-health screening. The guidelines also discuss nutritional and psychosocial support, digital models of care, and structured transition from paediatric to adult services. Updated therapeutic strategies for refractory CeD are provided, including immunosuppressive and novel pharmacologic options.

Conclusions

These updated guidelines offer a comprehensive, evidence-based framework for the management and follow-up of adults with CeD. By integrating recent scientific advances with pragmatic, patient-centred recommendations, they seek to optimise clinical outcomes, quality of life, and long-term health in individuals with CeD.

European Society for the Study of Coeliac Disease (ESsCD) 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 2: Management, Follow-Up, and Complex Disease Courses

Abdulbaqi Al-Toma

Guideline

Clinical Practice Guideline

Topics

Immunology Small Intestine & Nutrition

Citation

United European Gastroenterology Journal, 2026

Published

2026

UEG Podcast Episode

Journal Podcast

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Therapeutic sequencing in IBD: Determining the optimal position of vedolizumab in Crohn's Disease

Christian Agboton, Haluk Tarik Kani

Published

2024

UEG Podcast Episode

Journal Podcast

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UEG Journal Best Paper Award 2022 - Combining biologics and small molecules in IBD

Katarzyna Pawlak 1, Laurent Goessens 2

1 Department Gastroenterology, Endoscopy Unit, Hospital of the Ministry of Interior and Administration, Szczecin, Poland

2 Centre Hospitalier de Mouscron, Belgium

Topics

IBD

Published

2022

UEG Mistakes In Articles

New

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Pancreatic exocrine insufficiency (PEI) is a common yet frequently under-recognised cause of maldigestion, malabsorption, and malnutrition. Although traditionally associated with primary pancreatic disorders such as chronic pancreatitis, cystic fibrosis, pancreatic cancer, or pancreatic surgery, it is now evident that PEI also occurs in a wide range of extra-pancreatic conditions and clinical settings. Advances in diagnostic testing and expanding clinical awareness have improved detection; however, significant misconceptions persist regarding when to suspect PEI; how to interpret diagnostic tests; and how to initiate, optimise, and monitor pancreatic enzyme replacement therapy (PERT). In everyday practice, these errors may lead to delayed diagnosis, inappropriate treatment, persistent symptoms, and preventable nutritional deficiencies. This “Mistakes in…” article highlights common pitfalls in the diagnosis and management of PEI, focusing on inappropriate reliance on faecal elastase testing, failure to recognise secondary causes, undertreatment with PERT, and inadequate nutritional assessment. By addressing these frequent mistakes, we aim to promote a more structured, patient-centred, and evidence-informed approach to PEI that improves clinical outcomes and quality of life.