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CHARACTERISTICS AND MANAGEMENT OF PYODERMA GANGRENOSUM AND ERYTHEMA NODOSUM IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: PIONOSO MULTICENTER STUDY

Iago Rodríguez-Lago 1, Milagros Vela Gonzalez 2, Ingrid Ordás 3, Ruth de Francisco 4,5, María Dolores Martín-Arranz 6, Margalida Calafat Sard 7, Carlos Taxonera Samso 8, Francisco Mesonero Gismero 9, Esteban Fuentes-Valenzuela 10, Alicia Granja 11, Ángel Ponferrada-Díaz 12, Pilar Varela Trastoy 13, Yamile Zabana 14, Lucía Madero 15, Beatriz López-Cauce 16, Marta Carrillo Palau 17, Viviana Laredo De La Torre 18, Eduard Brunet 19, Montserrat Rivero 20, Javier P. Gisbert 21, Cristina Polo Cuadro 22, José Ignacio González 23, Carles Suria 24, Rufo Lorente Poyatos 25, Ainara Elorza 1, Lara Arias 26, María del Carmen Muñoz 27, Alejandro Mínguez Sabater 28, Rocío Ferreiro-Iglesias 29, Ramón Pajares 30, Jesus Castro Poceiro 31, Gerard Surís 32, Cristina Roig Ramos 33, Raquel Mena 34, Alfredo J. Lucendo 35, Luisa De la Peña 36, Eduardo Iyo 37, Yolanda Ber Nieto 38, Eva Iglesias-Flores 39, Coral Tejido 40, Daniel Sebastian Ceballos Santos 41, Eva Sesé 42, Teresa Martínez Pérez 43, Alejandra Fernández 44, Pau Sendra 45, Alejandro Hernández-Camba 46, Elena Ricart 47, Eugeni Domenech Morral 7, Manuel Barreiro de Acosta 29

Affiliations

1 Hospital Universitario de Galdakao, Bilbao, Spain

2 Hospital Nuestra Senora de la Candelaria, Santa Cruz de Tenerife, Spain

3 Hospital Clinic de Barcelona, Barcelona, Spain

4 Hospital Universitario Central de Asturias, Oviedo, Spain

5 Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain

6 Hospital Universitario la Paz, Madrid, Spain

7 Hospital Universitari Germans Trias i Pujol, Badalona, Spain

8 Hospital Clinico San Carlos, Madrid, Spain

9 Hospital Universitario Ramon y Cajal, Madrid, Spain

10 Hospital Universitario Río Hortega, Valladolid, Spain

11 Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain

12 Hospital Universitario Infanta Leonor, Madrid, Spain

13 Hospital Universitario de Cabueñes, Gijón, Spain

14 Hospital Universitari Mútua Terrassa, Terrassa, Spain

15 Hospital General Universitario de Alicante, Alicante, Spain

16 Hospital General Universitario Gregorio Marañón, Madrid, Spain

17 Hospital Universitario de Canarias, Tenerife, Spain

18 Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain

19 Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí. CIBERehd, Instituto de Salud Carlos III, Sabadell, Spain

20 Hospital Universitario Marqués de Valdecilla, Santander, Spain

21 Hospital Universitario de la Princesa,Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain

22 Hospital Universitario Miguel Servet, Zaragoza, Spain

23 Hospital Universitario de Navarra, Pamplona, Spain

24 Hospital Clínico Universitario de Valencia, Valencia, Spain

25 Hospital General Universitario de Ciudad Real, Ciudad Real, Spain

26 Hospital Universitario de Burgos, Burgos, Spain

27 Hospital Universitario de Basurto, Bilbao, Spain

28 Hospital Universitario y Politécnico La Fe, Valencia, Spain

29 Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain

30 Hospital Universitario Infanta Sofía, Madrid, Spain

31 Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain

32 Hospital del Mar, Barcelona, Spain

33 Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

34 Consorci Sanitari de Terrassa, Terrassa, Spain

35 Hospital General de Tomelloso, Tomelloso, Spain

36 Hospital Universitari de Bellvitge, Barcelona, Spain

37 Hospital Comarcal de Inca, Inca, Spain

38 Hospital Universitario San Jorge, Huesca, Spain

39 Hospital Universitario Reina Sofía, Córdoba, Spain

40 Complexo Hospitalario Universitario de Ourense, Ourense, Spain

41 Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain

42 Hospital Universitario Arnau de Vilanova, Lleida, Spain

43 Hospital Virgen de la Luz, Cuenca, Spain

44 Hospital Universitario de Salamanca, Salamanca, Spain

45 Hospital Universitario Son Espases, Palma, Spain

46 Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain

47 Hospital Clinic, Barcelona, Spain

Summary

AI Generated

A multicenter registry study of 542 inflammatory bowel disease patients with erythema nodosum or pyoderma gangrenosum found that these cutaneous manifestations occurred in approximately 1% of patients, modified IBD management in 21% of cases, and showed higher remission rates with erythema nodosum (77%) compared to pyoderma gangrenosum (43%) at 8 weeks.

Among 52,555 IBD patients in the ENEIDA registry, 401 developed erythema nodosum and 141 developed pyoderma gangrenosum between January 2013 and February 2023
Erythema nodosum was associated predominantly with Crohn's disease (76%), occurred mainly in women (77%), presented with bilateral lower limb lesions in most cases, and achieved remission in 77% of patients at 8 weeks
Pyoderma gangrenosum was more evenly distributed between ulcerative colitis (52%) and Crohn's disease, occurred in women (60%), and achieved complete remission in 43% of patients at 8 weeks with partial response in 49%
Steroids were the mainstay of treatment for both conditions (73% oral for erythema nodosum, 54% for pyoderma gangrenosum), with anti-TNF biologicals used in 18% of erythema nodosum and 38% of pyoderma gangrenosum cases
Both conditions showed a 21% recurrence rate, with these cutaneous manifestations modifying IBD clinical management in 18% of erythema nodosum cases and 29% of pyoderma gangrenosum cases

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Abstract

Introduction

Inflammatory bowel disease (IBD) is a chronic condition of the gastrointestinal tract. Around 20% of patients develop at least one extraintestinal manifestation, the most frequent being articular, followed by cutaneous, ocular and hepatobiliary. Among those involving the skin, erythema nodosum (EN) and pyoderma gangrenosum (PG) are frequently observed.

Aims & Methods

Our aim was to describe the characteristics of PG and EN in both ulcerative colitis (UC) and Crohn’s disease (CD), and provide a detailed description of their treatment, prognosis and their impact on IBD management. This was a retrospective, multicenter study including all patients with a diagnosis of EN or PG between January 2013 and February 2023. Patients were identified from the ENEIDA registry, a prospectively-maintained database supported by GETECCU. Demographic and clinical characteristics (subtype, date of diagnosis, number of cutaneous lesions, distribution, and location), along with therapeutic requirements and prognosis were registered. Descriptive statistics were used, followed by non-parametric comparisons by chi-square tests.

Results

A total of 542 patients (401 with EN and 141 with PG) fulfilled the inclusion criteria among 52,555 IBD patients included in the ENEIDA registry at the time of data extraction.
EN was predominantly observed in women (77%), with a mean age of 47 years (SD 15) and CD (76%). It was mostly located in the lower limbs (97%), followed by upper limbs (9%); lesions were frequently multiple (75%) and bilateral (65%). EN modified the management of IBD in 18% of cases. Steroids were the most frequently used drugs (73% oral, 17% topical, 13% iv); 18% of patients were treated with biologicals, mostly anti-TNF agents. After 8 weeks of diagnosis, partial response was observed in 19% of patients, and remission in 77%. Recurrence rate of EN was 21%, with 60% of patients developing multiple episodes.
PG was mainly seen in women (60%), with a mean age 52 years (SD 14) and UC (52%). It was usually located in the lower limbs (75%), but it was also observed in arms, thorax or periostomal (12-13%). The most common type was classic (77%), followed by pustular (19%). Multiple lesions were observed in 56% of patients and unilateral distribution in 62%. PG modified the management of IBD in 29% of cases. Oral steroids were commonly used (54%), followed by biological agents (38%), oral antibiotics (27%), and cyclosporin (18%). PG modified the management of IBD in 29% of cases. After 8 weeks of diagnosis, 49% of patients showed partial response and 43% achieved complete remission. Recurrence rate of PG was 21%, with 55% of them developing multiple episodes.

Conclusion

Up to 1% of patients in the ENEIDA registry developed EN and/or PG. They are usually located in the lower limbs and with multiple lesions. Steroids are the mainstay of their treatment, being anti-TNF the main biological agents. These cutaneous manifestations modify the clinical management of IBD in 21% of cases. Clinical remission rates are higher in EN than in PG, although recurrence occurs in one fifth of patients.

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

PP 05 IBD (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Egle Dieninyte - Misiune

Introduction: Are you stuck in the biliary cannulation nightmare: Wake up, here comes the sun

Andrea Anderloni

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EFFECT OF SAME-SESSION ENDOSCOPIC ULTRASONOGRAPHY ON ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN PANCREATICOBILIARY DISEASES: A RANDOMIZED CONTROLLED TRIAL

Zefeng Xing

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Chengwei Tang

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Best of UEG Week 2026 - Endoscopy with Giuseppe Vanella

Giuseppe Vanella, Egle Dieninyte - Misiune

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Abstract

Topics

Endoscopy

Published

2026

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Egle Dieninyte - Misiune

Introduction: Are you stuck in the biliary cannulation nightmare: Wake up, here comes the sun

Andrea Anderloni

PEPPERMINT OIL VERSUS URSODEOXYCHOLIC ACID FOR PREVENTING RECURRENT CHOLEDOCHOLITHIASIS AFTER ERCP STONE CLEARANCE: A 2-YEAR PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Hongzhang Shen

Summary: Acute pancreatitis: Are we still innocent bystanders?

Andrada Seicean

EFFECT OF SAME-SESSION ENDOSCOPIC ULTRASONOGRAPHY ON ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN PANCREATICOBILIARY DISEASES: A RANDOMIZED CONTROLLED TRIAL

Zefeng Xing

PREVENTION OF ACUTE PANCREATITIS RELATED ORGAN FAILURE WITH EARLY USE OF CELECOXIB -- AN INVESTIGATOR-INITIATED, PROSPECTIVE, MULTI-CENTER, DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL TRIAL

Chengwei Tang

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Introduction: Are you stuck in the biliary cannulation nightmare: Wake up, here comes the sun

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Introduction: Are you stuck in the biliary cannulation nightmare: Wake up, here comes the sun

Andrea Anderloni 1

Affiliations

1 San Matteo Hospital, Pavia, Italy

Summary

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Hepatobiliary Endoscopy

Session

Are you stuck in the biliary cannulation nightmare: Wake up, here comes the sun

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Egle Dieninyte - Misiune

Introduction: Are you stuck in the biliary cannulation nightmare: Wake up, here comes the sun

Andrea Anderloni

PEPPERMINT OIL VERSUS URSODEOXYCHOLIC ACID FOR PREVENTING RECURRENT CHOLEDOCHOLITHIASIS AFTER ERCP STONE CLEARANCE: A 2-YEAR PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Hongzhang Shen

Summary: Acute pancreatitis: Are we still innocent bystanders?

Andrada Seicean

EFFECT OF SAME-SESSION ENDOSCOPIC ULTRASONOGRAPHY ON ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN PANCREATICOBILIARY DISEASES: A RANDOMIZED CONTROLLED TRIAL

Zefeng Xing

PREVENTION OF ACUTE PANCREATITIS RELATED ORGAN FAILURE WITH EARLY USE OF CELECOXIB -- AN INVESTIGATOR-INITIATED, PROSPECTIVE, MULTI-CENTER, DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL TRIAL

Chengwei Tang

UEG Presentation

New

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PEPPERMINT OIL VERSUS URSODEOXYCHOLIC ACID FOR PREVENTING RECURRENT CHOLEDOCHOLITHIASIS AFTER ERCP STONE CLEARANCE: A 2-YEAR PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

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PEPPERMINT OIL VERSUS URSODEOXYCHOLIC ACID FOR PREVENTING RECURRENT CHOLEDOCHOLITHIASIS AFTER ERCP STONE CLEARANCE: A 2-YEAR PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Haitao Huang 1,2, Yiwen Feng 3, Huanlu Xu 3, Jianlong Chen 3, Liyun Zheng 1, Dongchao Xu 1, Xiaofeng Zhang 1,2, Hangbin Jin 1,2, jing Yang 1,2, Hongzhang Shen 1,2

Affiliations

1 Hangzhou First People's Hospital, Hangzhou, China

2 School of Medicine, Westlake University, Hangzhou, China

3 The Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China

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Abstract

Introduction

Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard for common bile duct stones (CBDS) clearance, but stone recurrence remains a significant clinical challenge, affecting 4%–24% of patients. Ursodeoxycholic acid (UDCA) is commonly used for prevention, but its efficacy is controversial, particularly for pigment stones, and its use is often limited by dose-dependent diarrhea. Peppermint oil, a hydrocholeretic agent with calcium-channel blocking properties, may offer an alternative by promoting biliary flushing and relaxing the sphincter of Oddi.

Aims & Methods

This prospective, randomized, open-label, active-controlled trial (NCT04484870) enrolled patients aged 18–80 years with complete CBDS clearance confirmed by ERCP. Participants were randomized (1:1) to receive Peppermint Oil (0.45 g, t.i.d., before meals) or UDCA (10 mg/kg/day, b.i.d.) for 6 months, with a 24-month follow-up. The primary endpoint was CBDS recurrence (defined as stones identified >6 months post-clearance). Recurrence-free survival was analyzed using Kaplan–Meier and Cox proportional hazards models. Outcome assessors were blinded to group allocation (PROBE design).

Results

A total of 211 patients (107 Peppermint Oil, 104 UDCA) were included in the ITT analysis. At 24 months, stone recurrence occurred in 25.2% (27/107) of the Peppermint Oil group and 37.5% (39/104) of the UDCA group (Log-rank P = 0.076). After adjusting for pre-specified variables (age, history of EST, CBD diameter, and periampullary diverticulum), Peppermint Oil showed a consistent trend towards risk reduction (adjusted HR = 0.69, 95% CI 0.41–1.14, P = 0.148). Periampullary diverticulum was identified as an independent risk factor for recurrence (HR = 1.76, 95% CI 1.02–3.03, P = 0.042). Liver function recovery trajectories were comparable between groups (P > 0.05). While overall adverse event rates were similar (13.1% vs. 8.7%, P = 0.417), the UDCA group had a significantly higher incidence of diarrhea (6.7% vs. 0%, P = 0.006). Menthol eructation (7.5%) and mild heartburn (4.7%) were more common with Peppermint Oil.

Conclusion

Peppermint oil (Danshu Capsule) demonstrated a favorable trend towards reducing CBDS recurrence compared to UDCA, although the primary endpoint did not reach statistical significance. Its distinct safety profile, particularly the absence of diarrhea, suggests it is a well-tolerated and promising alternative for long-term prevention, especially in patients who have undergone EST or are intolerant to UDCA.

Event

UEG Week Barcelona 2026

Topics

Radiology & Imaging Hepatobiliary Endoscopy

Submission format

Abstract

Session

Endoscopy: Taming the biliary tree

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Summary: Acute pancreatitis: Are we still innocent bystanders?

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Chengwei Tang

UEG Presentation

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Summary: Acute pancreatitis: Are we still innocent bystanders?

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Summary: Acute pancreatitis: Are we still innocent bystanders?

Andrada Seicean 1

Affiliations

1 University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca, Romania, Cluj Napoca, Romania

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Surgery Pancreas Endoscopy

Session

Acute pancreatitis: Are we still innocent bystanders?

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

Best of UEG Week 2026 - Endoscopy with Giuseppe Vanella

Egle Dieninyte - Misiune

Introduction: Are you stuck in the biliary cannulation nightmare: Wake up, here comes the sun

Andrea Anderloni

PEPPERMINT OIL VERSUS URSODEOXYCHOLIC ACID FOR PREVENTING RECURRENT CHOLEDOCHOLITHIASIS AFTER ERCP STONE CLEARANCE: A 2-YEAR PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Hongzhang Shen

Summary: Acute pancreatitis: Are we still innocent bystanders?

Andrada Seicean

EFFECT OF SAME-SESSION ENDOSCOPIC ULTRASONOGRAPHY ON ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN PANCREATICOBILIARY DISEASES: A RANDOMIZED CONTROLLED TRIAL

Zefeng Xing

PREVENTION OF ACUTE PANCREATITIS RELATED ORGAN FAILURE WITH EARLY USE OF CELECOXIB -- AN INVESTIGATOR-INITIATED, PROSPECTIVE, MULTI-CENTER, DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL TRIAL

Chengwei Tang

UEG Presentation

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EFFECT OF SAME-SESSION ENDOSCOPIC ULTRASONOGRAPHY ON ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN PANCREATICOBILIARY DISEASES: A RANDOMIZED CONTROLLED TRIAL

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EFFECT OF SAME-SESSION ENDOSCOPIC ULTRASONOGRAPHY ON ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN PANCREATICOBILIARY DISEASES: A RANDOMIZED CONTROLLED TRIAL

Zhen Li 1, Yile Zeng 1, Zefeng Xing 1

Affiliations

1 Qilu Hospital of Shandong University, Jinan, China

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Abstract

Introduction

Endoscopic Ultrasonography (EUS) is increasingly being used in preoperative examinations in pancreatobiliary diseases for Endoscopic retrograde cholangiopancreatography (ERCP). However, it has never been tested in a randomized trial. This study aims to investigate the clinical value of performing EUS prior to ERCP versus performing conventional ERCP alone, focusing on avoiding unnecessary procedures, ensuring treatment concordance, reducing radiation exposure, and preventing complications.

Aims & Methods

In this single-center, parallel-group randomized controlled trial, patients with pancreaticobiliary diseases and a clear indication for ERCP were enrolled. Using a random number table, participants were assigned to either the EUS+ERCP group or the ERCP alone group. The primary outcomes were the rate of avoided unnecessary ERCP and the concordance rate between actual and initially planned interventional strategies. Secondary outcomes included technical success, difficult cannulation, procedure time, radiation dose, and complications.

Results

A total of 208 patients were randomized (105 to EUS+ERCP, 103 to ERCP alone). In the EUS+ERCP group, ERCP was avoided in 18 patients (17.1%) because EUS findings precluded the need for intervention. Among patients who proceeded to ERCP, the strategy concordance rate was significantly higher in the EUS+ERCP group (78/87, 89.7%) than in the ERCP alone group (74/103, 71.8%) (P = 0.002). The EUS+ERCP group also had significantly lower fluoroscopy time, radiation dose, DAP (Dose area product), and ERCP procedure time (P < 0.05). No significant differences were observed between groups in technical success, difficult cannulation, total procedure time, or complication rates (all P>0.05).

Conclusion

Performing EUS prior to ERCP significantly improves concordance between the interventional strategy and the procedure, safely reduces unnecessary ERCP procedures, and lowers radiation exposure. These findings suggest that pre-procedural EUS should be considered, when feasible, for patients with an indication for ERCP to optimize clinical decision-making.

Event

UEG Week Barcelona 2026

Topics

Radiology & Imaging Hepatobiliary Endoscopy

Submission format

Abstract

Session

Endoscopy: Taming the biliary tree

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

Best of UEG Week 2026 - Endoscopy with Giuseppe Vanella

Egle Dieninyte - Misiune

Introduction: Are you stuck in the biliary cannulation nightmare: Wake up, here comes the sun

Andrea Anderloni

PEPPERMINT OIL VERSUS URSODEOXYCHOLIC ACID FOR PREVENTING RECURRENT CHOLEDOCHOLITHIASIS AFTER ERCP STONE CLEARANCE: A 2-YEAR PROSPECTIVE RANDOMIZED CONTROLLED TRIAL

Hongzhang Shen

Summary: Acute pancreatitis: Are we still innocent bystanders?

Andrada Seicean

EFFECT OF SAME-SESSION ENDOSCOPIC ULTRASONOGRAPHY ON ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN PANCREATICOBILIARY DISEASES: A RANDOMIZED CONTROLLED TRIAL

Zefeng Xing

PREVENTION OF ACUTE PANCREATITIS RELATED ORGAN FAILURE WITH EARLY USE OF CELECOXIB -- AN INVESTIGATOR-INITIATED, PROSPECTIVE, MULTI-CENTER, DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL TRIAL

Chengwei Tang

UEG Presentation

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PREVENTION OF ACUTE PANCREATITIS RELATED ORGAN FAILURE WITH EARLY USE OF CELECOXIB -- AN INVESTIGATOR-INITIATED, PROSPECTIVE, MULTI-CENTER, DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL TRIAL

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PREVENTION OF ACUTE PANCREATITIS RELATED ORGAN FAILURE WITH EARLY USE OF CELECOXIB -- AN INVESTIGATOR-INITIATED, PROSPECTIVE, MULTI-CENTER, DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED CLINICAL TRIAL

Luming Huang 1, Libin Huang 1, Zhe Feng 1, Min Zhou 1, jingsun jiang 1, Xu Zeng 1, Zhiyin Huang 1, Chengwei Tang 1

Affiliations

1 West China Hospital, Sichuan University, Chengdu, China

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Abstract

Introduction

Our previous multi-center randomized clinical trial (RCT) has confirmed that cyclooxygenase-2 (COX-2) inhibitors effectively shortened the duration of organ failure (OF) in patients with severe acute pancreatitis (SAP). We intended to clarify whether early use of COX-2 inhibitor celecoxib could prevent the occurrence of acute pancreatitis (AP) related OF, thereby further reducing the incidence of SAP.

Aims & Methods

A prospective, multi-center, double-blind, randomized, placebo-controlled clinical trial was conducted in 20 hospitals in China. Predicted non-mild AP patients with an interval from symptom onset to enrollment ≤48 hours, no OF (modified Marshall score ≤1 for any organ), a score of ‌systemic inflammatory response syndrome (SIRS) ≥2 or modified harmless acute pancreatitis score (HAPS) ≥2 were eligible for this study. They were randomly assigned into celecoxib group (200mg celecoxib oral twice a day for 7days) or the same dosage and course of placebo to placebo group. If the patients developed OF, the double-blind trial medication was discontinued and replaced with celecoxib (200mg oral twice a day) until the OF was fully alleviated. All of the enrolled patients accepted conventional treatments. The primary outcome was the occurrence of OF.

Results

From September 2025 to April 2026, 278 predicted non-mild AP patients were enrolled and randomly divided into the placebo group (n=142) and celecoxib group (n=136). The occurrence of OF in celecoxib group (16.9%) was significantly reduced compared with those in placebo group (35.9%), p<0.001. Accordingly, the incidence of SAP was also significantly lower in the celecoxib group (5.9% vs 18.3%, p=0.002). In addition, the duration of OF in the celecoxib group (preventive) was significantly shorter than that of the placebo group (therapeutic) with median 1.0 days [IQR 1.0-2.4] vs 1.8 days [1.0-3.0], p=0.038. Subgroup analysis based on the interval from symptom onset to enrolment (≤24 hours or >24 hours) showed that the success rate of OF prevention of the celecoxib group was higher in the former.

Conclusion

Early use of COX-2 inhibitor celecoxib effectively decreased the occurrence of AP related OF, thus reducing the incidence of SAP. The earlier COX-2 inhibitor was used after AP onset, the better the effect it would have.

Event

UEG Week Barcelona 2026

Topics

Pancreas Mechanisms & Personalised Medicine

Submission format

Abstract

Session

Acute pancreatitis: From prevention to treatment

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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