Introduction

Pharmacologic therapy is a key component of obesity management, either as standalone treatment or in conjunction with procedural interventions. The role of weight loss medications in the peri-ESG period remains unclear, with questions surrounding whether ESG reduces the need for pharmacotherapy or serves as a platform for combination therapy. Limited data exist on how prescribing patterns evolve before and after ESG in real-world settings. This study aims to evaluate the use of anti-obesity medications before and after ESG, focusing on patterns of pharmacologic initiation and its relationship to weight loss outcomes.

Aims & Methods

We conducted a retrospective review of 236 patients who underwent ESG at Singapore General Hospital between November 2020 and December 2025. All procedures were performed by a single experienced endoscopist using a U-shaped suturing pattern. For this analysis, we examined the use of anti-obesity medications before and after the ESG. Medications included GLP-1 receptor agonists, sympathomimetic agents, lipase inhibitors, and combination therapies. The primary outcome was the proportion of patients receiving pharmacotherapy across timepoints and its association with total body weight loss (%TBWL).

Results

Among the 236 ESG patients, 21.6% had previously used anti-obesity medications, most commonly GLP-1 receptor agonists or phentermine. This group consistently achieved the lowest total body weight loss (%TBWL) across all follow-up points. Compared to medication-naïve patients, their mean %TBWL was significantly lower at 6 months (9.9% vs 17.2%, p = 0.015), 12 months (7.8% vs 13.8%, p = 0.026), and 24 months (4.3% vs 10.6%, p = 0.003). These findings underscore the complexity of obesity care, as even patients exposed to multiple treatment modalities may continue to experience suboptimal outcomes.
After ESG, 37.7% of patients were initiated on pharmacotherapy, most commonly semaglutide (n = 66), including 38 on subcutaneous and 28 on oral formulations, with estimated mean doses of 1.63 mg/week and 13.2 mg/day, respectively. Phentermine and liraglutide were used in 13.9% and 3.0% of patients. Patients who received medications only after ESG had lower %TBWL at 6 months compared to those never on medications (14.0% vs 18.8%, p = 0.027), but outcomes were similar by 12 and 24 months. This suggests that pharmacotherapy may help support suboptimal early responders and mitigate longer-term differences.

Conclusion

Anti-obesity medications, particularly semaglutide, are commonly introduced after ESG to support patients with suboptimal early weight loss. While those requiring pharmacotherapy initially experienced less %TBWL, outcomes equalized by 12 months, suggesting a role for adjunctive treatment in slower responders. Patients who had previously used weight loss medications consistently achieved poorer outcomes, highlighting the challenges of obesity management even with multimodal therapy. These findings underscore the importance of individualized treatment strategies and the complementary role of pharmacotherapy alongside ESG in real-world practice.

Disclosure

​NIL

Introduction

Non-alcoholic fatty liver disease (NAFLD) is a significant public health concern. Social media (SoMe) is increasingly popular in lower-middle-income countries and can potentially influence perceptions and understanding of illness. Approximately one-third of Sri Lanka's population uses SoMe for health information. We assessed the quality of NAFLD-related content on SoMe.

Aims & Methods

This observational, cross-sectional study aimed to assess the accuracy, completeness and quality of SoMe content relating to NAFLD across Facebook, YouTube, TikTok, Instagram and X (Twitter) from Sri Lanka, in Sinhala, English, and Tamil languages. Posts containing keywords related to NAFLD published between January 2005 to December 2024 were evaluated. Specialist gastroenterologists independently reviewed the content using standardized scales for accuracy (0-3), completeness (0-5), and global quality score (GQS) (0-5). Posts were categorized by source profile [healthcare institution (HI), healthcare professional (HP), alternative healthcare professionals (AHP), non-healthcare person (NHP), or undisclosed identity (UI)] and content type [health education (HEd), health promotion (HProm), HEd and HProm or product endorsement]. User interactions (likes, shares, views) were also analyzed and correlated with reviewer scores.

Results

The analysis included 289 SoMe posts [158 (54.7%) YouTube, 101 (34.9%) Facebook, 14 (4.8%) TikTok, 11 (3.8%) X, 5 (1.7%) Instagram] relating to NAFLD in three languages [214 (74.0%) Sinhala, 54 (18.7%) Tamil, 21 (7.3%) English]. Posts from UI (36.0%) and NHP (26.0%) comprised the majority of content sources. HP (22.1%), AHP (14.2%), and HI (1.7%) represented the remainder. HProm (61.9%) was the predominant content type followed by HEd and HProm (17.6%), HEd alone (11.8%), and product endorsement (8.7%).
The mean accuracy score was 1.78/3(59.3%), with significant differences between sources (HP: 2.35/3(78.5%), AHP: 1.53/3(51.0%), NHP:1.65/3(55.1%), UI: 1.63/3(54.3); p<0.001). Completeness scores averaged 2.1/5(42%), with content in English scoring higher [2.52/5(50.4%)] than Sinhala [2.05/5(40.97%)] and Tamil [2.17/5(43.33%)]. GQS averaged 2.4/5(48.4%). 82% of posts were classified as "Rotten" (<60% composite reviewer score for accuracy, completeness, and global quality). Content quality by platform was compared using ANOVA (mean) and Kruskal-Wallis (median) tests. Posts on Facebook and YouTube showed significantly higher completeness and GQS compared to other platforms (p<0.05).
User interaction analysis was conducted using both Pearson’s and Spearman’s correlation tests. There were no significant correlations observed between accuracy, completeness, or GQS and views or likes. Inter-reviewer variation was assessed using ANOVA and non-parametric tests. There was no statistically significant inter-reviewer variation in scoring patterns, indicating consistency within reviewer groups.

Conclusion

The majority of the SoMe content was from NHP sources. HP delivered the most accurate content. Facebook and YouTube emerged as platforms with relatively higher-quality content compared to others. Overall accuracy, completeness and GQS remained suboptimal across platforms. Most posts (82%) failed to meet adequate quality standards. Notably, user engagement metrics did not correlate with content quality. These findings highlight the need for improved quality control measures and health literacy initiatives to enhance the reliability of information regarding NAFLD on SoMe platforms.

Disclosure

All authors confirm no conflicts of interests to declare.

Introduction

Confocal laser endomicroscopy (CLE) can detect acute duodenal epithelial disruption in response to food application, potentially identifying personalized elimination diets (1). A pilot study in functional dyspepsia (FD) showed that the 6-food elimination diet (6FED) provided symptom relief. (2). Earlier research in FD, however, showed that the high rate of acute food-induced mucosal alterations on CLE were not associated with altered permeability or changes in mast cell activation ex vivo (3).

Aims & Methods

To evaluate a personalized elimination diet in patients living with FD based on results of CLE, assessing duodenal mucosal changes to locally applied food solutions from the 6FED.
A randomized, double-blind, cross-over, sham-controlled trial was conducted in 17 Rome IV FD patients, in whom immunoglobulin E (IgE) sensitization to nutrients was excluded via food-specific serum IgEs. Baseline symptoms were assessed using the Leuven Postprandial Distress Scale (LPDS) and Patient Assessment of GI Disorders–Symptom Severity Index (PAGI-SYM). Index upper GI endoscopy (EGD) was followed at least 2 weeks later by an EGD with CLE. During CLE, duodenal mucosa was visualized at baseline and after consecutive, random administration of egg white, soy, milk, wheat, lyophilized fish/shellfish and nuts solutions. In case of a reaction to the first 2 food solutions, an additional CLE was scheduled. All patients underwent a crossover dietary intervention excluding foods to which they tested positively (real diet, RD) and negatively (sham diet, SD) in random order. Following 4 weeks of diet, LPDS and PAGI-SYM scores were reevaluated. Missing data were considered non-responder, based on an extreme case approach. Data are reported as mean ± SEM. Comparisons were done using a paired t-test or related-Samples Wilcoxon test, as applicable. Response rate was evaluated using a McNemar test. P<.05 is considered significant.

Results

Dietary outcome was available from 17 patients (age 35±3.7y, 16 female, BMI 22±0.7 kg/m2). In 7% of exams (n=2), acute alterations were already present at baseline. Twelve patients (71%) underwent a second CLE procedure. One patient dropped out after the first diet (which was RD). Three patients did not have a reliable RD/SD comparison due to non-response (n=1) or early response on CLE (n=2), underwent a standardized control diet, and were excluded from the analysis. Among the 14 patients in the cross-over dietary intervention, the proportion with a clinically significant 0.7 decrease in LPDS was similar for both diets (RD 4/14 vs. SD 2/14, p=0.41). No significant differences were found in LPDS subdomains or in the total PAGI-SYM score or PAGI-SYM fullness domain between the two diets (all p>.05).

Conclusion

In patients with FD, without systemic IgE-sensitization, CLE visualized a high rate of acute, food-induced, mucosal alterations, which could not be translated in symptom benefit following a dietary intervention excluding these foods vs. foods that did not trigger a reaction in this double-blind, controlled diet intervention study. None of the analyzed clinical outcome measures differed between the two diets. Given the results of this first double-blind controlled diet intervention in patients living with FD, CLE-based diets cannot be recommended in this population.

References

1. Fritscher-Ravens A, Schuppan D, Ellrichmann M, Schoch S, Rocken C, Brasch J, et al. Confocal endomicroscopy shows food-associated changes in the intestinal mucosa of patients with irritable bowel syndrome. Gastroenterology. 2014;147(5):1012-20 e4.
2. Schol J, Vanuytsel T, Routhiaux K, Huang I, Balsiger L, Van Den Houte K, et al. The six-food elimination diet improves symptoms of functional dyspepsia. Submitted for publication. 2025.
3. Van de Bruaene C, Schol J, Balsiger L, Raymenants K, Toth J, Farre R, et al., editors. Observation of local, food-induced changes of the duodenal mucosa in functional dyspepsia cannot be translated in permeability alterations or changes in mast cell activation ex vivo. F; 2024; Bangkok, Thailand: Neurogastroenterology And Motility.

Introduction

Studies have shown that adults with irritable bowel syndrome (IBS) may be associated with anxiety, mood disorders, chronic headache, and other neuropsychiatric conditions. This growing body of evidence can allude to a possible bidirectional gut-brain connection. While adolescence is the age when both IBS and neuropsychiatric illnesses often first manifest, this population remains under-studied.

Aims & Methods

We aim to assess the association between the presence of irritable bowel syndrome (IBS) and neurologic and psychiatric disorders in a nationwide cohort of adolescents. This cross-sectional study included all adolescents aged 16-21 who underwent mandatory medical evaluations as part of their conscription between 2000-2021. All individuals completed comprehensive medical interviews. Suspected diagnoses prompted referral to board-certified specialists for confirmation and severity grading based on predefined criteria. IBS was diagnosed according to the Rome II-IV criteria by a certified gastroenterologist.
Neurologic disorders included attention-deficit/hyperactivity disorder [ADHD], epilepsy, chronic headache, sleep disorders. Psychiatric disorders included psychotic, personality, general anxiety disorder [GAD], non-combat post-traumatic stress disorder [PTSD], mood, dissociative, and eating disorders. Each diagnosis was classified by severity (mild, moderate, severe). Unadjusted and multivariate-adjusted logistic regression models were fitted to estimate odds ratios (ORs) for associations with IBS. The adjusted models were accounted for age, sex, intelligence score, body mass index (BMI), socioeconomic status (SES), education, country of origin, and any concurrent neuropsychiatric diagnoses.

Results

The study included 1,561,717 adolescents (666,442 [42%] women, mean age 17.4 ± 1.4 years), of whom 7,230 (0.46%) were diagnosed with IBS (4,778 mild; 1,948 moderate; 504 severe). Neurologic disorders were present in 1,661 (23.0%) and 143,348 (9.2%) of those with and without IBS, respectively. The respective numbers of people with psychiatric disorders were 773 (10.7%) and 49,889 (3.2%). In multivariable adjusted models, those with IBS were more likely to have chronic headache (aOR 4.7, 95% CI: 4.4-5.1), GAD (aOR 3.6, 95% CI: 3.2-3.9), eating disorders (aOR 2.6, 95% CI: 1.9-3.5), mood disorders (aOR 2.5, 95% CI: 2.1-3.1), personality disorders (aOR 2.5, 95% CI: 2.1-2.9), and dissociative disorders (aOR 19.1, 95% CI: 12.5-28.9). Patients with severe IBS (n=504) were independently associated with the presence of at least one severe neurologic (aOR 2.9, 95% CI: 1.2-7.1) or psychiatric disorder (aOR 3.8, 95% CI: 2.6-5.4).

Conclusion

In this large nationwide cohort, adolescents with IBS were more likely to have several tested neurologic and psychiatric disorders, compared to those without IBS. Longitudinal studies are needed to explore the directionality and long-term implications of these associations.

Introduction

Irritable bowel syndrome (IBS) has a profound impact on health-related quality of life. Increasing evidence suggests psychological factors have a large impact in the development and course of IBS, and in particular quality of life, with large individual heterogeneity. This observational study aims to investigate the influence of personality traits using the Big Five Inventory (BFI) and examine their associations with abdominal pain, general and gastrointestinal-specific anxiety, and quality of life in patients with IBS.

Aims & Methods

Data from a large observational study in patients with IBS (Rome III criteria) was used, in which patients completed questionnaires with regards to personality traits (BFI-44), symptom severity, general anxiety, GI-specific anxiety, and quality of life. Multivariable regression models and a network correlation analysis were used to determine underlying associations.

Results

194 patients were included for analysis (74.7% female, mean age 51.36 years). There was a positive association of neuroticism to GI-specific anxiety (B 7.234, P = 0.040) and general anxiety (B 0.954, P = 0.040) with a strong negative association to mental quality of life (B – 3.576, P = 0.007). In addition, a strong negative association of agreeableness to mental quality of life was found (B – 4.266, P = 0.001). Although there were no significant associations of personality traits to abdominal pain, positive associations were found regarding general anxiety (B 6.304, p < 0.001) and GI-specific anxiety (B 0.034, P <0.001) of abdominal pain. There were no associations found with regards to the other personality traits openness, conscientiousness or extroversion.

Conclusion

IBS patients with a higher level of neuroticism were more likely to experience higher levels of GI-specific and general anxiety. The trait neuroticism and/or agreeableness was more likely to have a significant lower mental quality of life in IBS. These findings emphasize the contribution of personality traits in the pathophysiology and course of IBS, pleading for a more personalized approach in patient management.