UEG Week 2025: Relive the Highlights

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LITERATURE-BASED HELICOBACTER PYLORI RESISTANCE DATA INTEGRATED INTO THE EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG): LIMITED USEFULNESS FOR PREDICTING FIRST-LINE EMPIRICAL TREATMENT EFFECTIVENESS

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Introduction

Helicobacter pylori infection is the primary cause of gastritis, peptic ulcer disease, and gastric cancer. Without an effective vaccine, eradication therapy is essential for disease control. However, rising antibiotic resistance worldwide has compromised treatment effectiveness, highlighting the need to evaluate how literature-based resistance rate data can inform the success of eradication regimens in clinical practice.

Aims & Methods

Current study aimed to assess whether such literature-based data could reliably predict the outcomes of first-line empirical eradication therapy.
Antibiotic resistance data for clarithromycin, metronidazole, and levofloxacin were obtained through a systematic review of published studies. Resistance prevalence was calculated for three timeframes: the year of treatment, the preceding year, and a weighted average over the current and previous four years. These rates were matched with data from the European Registry on H. pylori Management (Hp-EuReg), a prospective, real-word study involving first-line empirical H. pylori treatments and their outcomes. Data collected spanned from 2008 to 2024 and encompassed 23 countries. Modified intention-to-treat analyses were conducted using multivariate logistic regression with 10,000 stratified bootstraps, adjusting for covariates such as patient age, sex, country, year of prescription, first-line treatment regimen, proton pump inhibitor dosage, treatment duration, compliance, and assigned resistance values. Additional analyses assessed whether resistance to a specific antibiotic impacted each treatment effectiveness containing that antibiotic.

Results

A total of 18,219 patients from 13 European countries were included in the final analysis. Accounting all first-line empirical treatments, resistance to clarithromycin and levofloxacin in the current year influenced treatment effectiveness in opposite directions. Clarithromycin resistance was associated with a slight increase in treatment success (OR=1.02, 95%CI 1.00-1.03); whereas levofloxacin resistance was associated with a slight decrease (OR=0.98, 95%CI 0.97-1.00, respectively). Both associations had minimal effect sizes with questionable clinical relevance. Resistance to clarithromycin from the previous year was also paradoxically associated with improved treatment effectiveness (OR=1.01, 95%CI 1.00-1.02).
For standard clarithromycin-amoxicillin triple therapy, a higher rate of clarithromycin resistance (both current and over the preceding four years) was slightly associated with reduced treatment success (OR=0.99, 95%CI 0.99-1.00).
For clarithromycin-metronidazole triple therapy, resistance rate to clarithromycin was not associated with effectiveness (OR=0.97, 95%CI 0.93-1.01); while metronidazole resistance showed a slightly association with reduced effectiveness (OR=0.96, 95%CI 0.93-1.00).
For all other regimens evaluated, no significant associations were observed between specific antibiotic resistance rates—whether current or past—and the likelihood of successful H. pylori eradication.

Conclusion

Despite several statistically significant associations between resistance patterns and treatment outcomes, the effect sizes were minimal and of questionable clinical relevance. Thus, the reliability of antibiotic resistance data from external (literature-based) cohorts appears negligible and of limited utility in influencing the clinical choice of first-line therapies for H. pylori infection in real-world settings.

Disclosure

Javier P. Gisbert has served as speaker, consultant, and advisory member for or has received research funding from: Mayoly, Allergan/Abbvie, Diasorin, Richen, Juvisé and Biocodex.
Olga P. Nyssen received research funding from: Mayoly, Allergan/Abbvie, Richen, Juvisé and Biocodex.

LITERATURE-BASED HELICOBACTER PYLORI RESISTANCE DATA INTEGRATED INTO THE EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG): LIMITED USEFULNESS FOR PREDICTING FIRST-LINE EMPIRICAL TREATMENT EFFECTIVENESS

Ismail Kirrout 1, Beatriz Nafria 2, Ángeles Pérez-Aísa 3, Bojan Tepes 4, Irina Voynovan 5, Samuel Jesús Martínez-Domínguez 6, Alfredo J. Lucendo 7, Liudmila Vologzhanina 8, Sayar Abdulkhakov 9, Javier Tejedor-Tejada 10, Tatiana Ilchishina 11, Boris Starostin 12, Aiman Sarsenbaeva 13, Matteo Pavoni 14, Oleg Zaytsev 15, Jose Maria Huguet 16, Antonietta Gerarda Gravina 17, Ana Garre Vázquez 18, Monica Perona 19, Sergei Alekseenko 20, M. Soledad Marcos 21, Manuel Pabon-Carrasco 22, Oscar Núñez Martínez 23, Dmitrii Andreev 24, Miguel Areia 25, Jesús Barrio 26, Antonio Moreno 27, Blas José Gómez Rodríguez 28, Pavel Bogomolov 29, Maja Denkovski 30, Igor Bakulin 31, Inmaculada Ortiz Polo 32, Natalia Bakulina 31, Manuel Domínguez Cajal 33, Dmitry S. Bordin 34, Antonio Gasbarrini 35, Ricardo Pinto 36, Mónica Sánchez Alonso 37, Ramón Pajares Villarroya 38, Irene Arteagoitia 39, Manuel Jiménez-Moreno 40, Pablo Parra 18, Olga P. Nyssen 18, Luis Bujanda 2, Anna Cano-Catala 41, Leticia Moreira Ruiz 42, Francis Mégraud 43, Colm O'Morain 44, Nuria Montes 1, Javier P. Gisbert 18

1 Unidad de Metodología, Instituto de Investigación Sanitaria Princesa (IIS-Princesa); Servicio de Reumatología, Hospital Universitario de La Princesa; Plant Physiology, Pharmaceutical and Health Sciences Department, Boadilla del Monte, Spain

2 Department of Gastroenterology, Biodonostia Health Research Institute, Department of Medicine, Universidad del País Vasco (UPV/EHU), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), San Sebastián, Spain

3 Department of Gastroenterology, Hospital Universitario Costa del Sol, Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Marbella, Spain

4 Department of Gastroenterology, DC Rogaska, Rogaska Slatina, Slovenia

5 A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation

6 Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Zaragoza, Spain

7 Department of Gastroenterology, Hospital General de Tomelloso, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Tomelloso, Spain

8 Gastrocentr, Perm, Russian Federation

9 Kazan (Volga region) Federal university, Kazan State Medical University, Kazan, Russian Federation

10 Department of Gastroenterology, Hospital Universitario de Cabueñes, Asturias, Spain

11 Department of Gastroenterology, SM-clinic, Saint-Petersburg, Russian Federation

12 Saint-Petersburg State Budgetary Institution Healthcare City Policlinic 38, Saint-Petersburg, Russian Federation

13 Department of Gastroenterology, Chelyabinsk Regional Clinical Hospital, Chelyabinsk, Russian Federation

14 Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi University Hospital, Bologna, Italy

15 First Clinical Medical Centre, Kovrov, Russian Federation

16 Department of Gastroenterology, Hospital General Universitario de Valencia, Valencia, Spain

17 Department of Hepatogastroenterology, University of study of Campania "L. Vanvitelli", Naples, Italy

18 Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Madrid, Spain

19 Department of Gastroenterology, Hospital Quirón Marbella, Marbella, Spain

20 Far Eastern State Medical University, Khabarovsk, Russian Federation

21 Department of Gastroenterology, Hospital 12 de Octubre, Madrid, Spain

22 Department of Gastroenterology, Hospital Universitario Virgen de Valme, Sevilla, Spain

23 Department of Gastroenterology, Hospital Universitario La Moraleja, Faculty of Medicine, Universidad Francisco de Vitoria, Faculty of Medicine, Universidad CEU San Pablo, Madrid, Spain

24 Russian University of Medicine, Moscow, Russian Federation

25 Department of Gastroenterology, Portuguese Oncology Institute of Coimbra, Faculty of Medicine of the University of Porto (FMUP), RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto), Coimbra, Portugal

26 Department of Gastroenterology, Hospital Universitario Río Hortega, Gerencia Regional de Salud de Castilla y León (SACYL), Valladolid, Spain

27 Department of Gastroenterology, Hospital Universitario Virgen del Rocío, Sevilla, Spain

28 Department of Gastroenterology, Hospital Universitario Virgen Macarena, Sevilla, Spain

29 Universal Clinic Private Medical Center, Moscow, Russian Federation

30 Interni oddelek, Diagnostic Centre, Bled, Slovenia

31 Department of Gastroenterology, Mechnikov North-Western State Medical University, Saint-Petersburg, Russian Federation

32 Department of Gastroenterology, Hospital Universitario y Politécnico la Fe, Valencia, Spain

33 Department of Gastroenterology and Hepatology, Hospital Universitario San Jorge, Huesca, Spain

34 Department of Pancreatic, Biliary and upper digestive tract disorders, A. S. Loginov Moscow clinical scientific center, Department of outpatient therapy and family medicine, Moscow, Russian Federation

35 Department of Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

36 Department of Gastroenterology, Centro Hospitalar do Porto, Instituto De Ciências Biomédicas de Abel Salazar, Universidade do Porto, Center for Research in Health Technologies and Information Systems (CINTESIS), Porto, Portugal

37 Department of Gastroenterology, Hospital Universitario Santa Bárbara, Ciudad Real, Spain

38 Department of Gastroenterology, Hospital Universitario Infanta Sofía, Faculty of Medicine, Universidad Europea de Madrid, Madrid, Spain

39 Department of Gastroenterology, Hospital Universitario de Cruces, Vizcaya, Spain

40 Department of Gastroenterology, Hospital Universitario de Burgos, Burgos, Spain

41 Gastrointestinal Oncology, Endoscopy and Surgery (GOES) research group, Althaia Xarxa Assistencial Universitària de Manresa, Institut de Recerca i Innovació en Ciències de la Vida i de la Salut de la Catalunya Central (IRIS-CC), Manresa, Spain

42 Department of Gastroenterology, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelon

43 INSERM U1312 BRIC, Université de Bordeaux, Bordeaux, France

44 Faculty of Health Sciences, Trinity College Dublin, Dublin, Ireland

Event

UEG Week Berlin 2025

Topics

Mechanisms & Personalised Medicine Stomach & H. Pylori

Submission format

Abstract

Session

H. pylori: Between bench and bedside

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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LONG-TERM PROTON PUMP INHIBITOR USE AND RISK OF GASTRIC NEUROENDOCRINE NEOPLASMS IN A POPULATION-BASED STUDY FROM THE FIVE NORDIC COUNTRIES

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Introduction

Hypergastrinemia, caused by chronic atrophic gastritis or Helicobacter pylori (H. pylori) associated pangastritis, is associated with an increased risk of non-cardia gastric cancer. Recent studies have also found an increased risk of gastric cancer in long-term proton pump inhibitor (PPI) users. Patients with chronic atrophic gastritis also have an increased risk of neuroendocrine neoplasms (NEN) due to hypergastrinemia. However, whether long-term PPI use increases the risk of gastric NEN has not been assessed in the general population.

Aims & Methods

The aim of the present study was to assess the risk of gastric NEN among long-term PPI users in a multinational population-based study from the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden). The study was based on the Nordic Gastric and Esophageal Tumor Study (NordGETS), which is a population-based multinational sex, age, calendar year, and country matched case-control study including all adults (≥18 years of age) with a diagnosis of gastric or esophageal tumor in the Nordic countries. In the present study, the cases were incident gastric NEN identified in the cancer registries and the exposure was long-term use of PPI categorised into three equal-sized groups (tertiles) of defined daily doses (DDDs) from the medication registries of the Nordic countries between 1996 and 2020. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for chronic atrophic gastritis, NEN in the duodenum or pancreas, and H. pylori infection identified in the patient registries and medication registries.

Results

In total, 1,790 gastric NEN case patients were compared to 17,897 control participants. After a one-year run-in period, the median follow-up was 11.8 years. The risk of incident gastric NEN increased in PPI users compared to non-users in a dose-dependent manner. The adjusted OR for incident gastric NEN was 1.83 (95% CI 1.56 to 2.15) in the highest tertile of PPI use (>385 DDDs, entire drug history) compared to no PPI use (Table). The risk was higher in the younger age group (<65 years) than the older age group (≥65 years) and the estimates were consistent when excluding individuals with chronic atrophic gastritis, other NENs, and H. pylori.

Table Risk of gastric neuroendocrine neoplasms (NEN) by proton pump inhibitor (PPI) exposure defined by tertiles of defined daily doses (DDD) for the entire drug history between 1996 and 2020.
PPI (DDD)*	Crude odds ratio (95% confidence interval)**	Adjusted odds ratio (95% confidence interval)***
None	1.00 (reference)	1.00 (reference)
Tertile 1	1.46 (1.25-1.70)	1.34 (1.14-1.58)
Tertile 2	1.54 (1.30-1.81)	1.37 (1.15-1.64)
Tertile 3	1.92 (1.65-2.24)	1.83 (1.56-2.15)
* Tertiles: 1 ≤56 DDDs; 2 >56-385 DDDs; 3 >385 DDDs. Matched for sex, age, calendar year, and country. * Matched for sex, age, calendar year, and country, and adjusted for chronic atrophic gastritis, NEN in duodenum or pancreas, and H. pylori.

Conclusion

In this population-based study from the five Nordic countries the risk of gastric NEN was increased in PPI users compared to non-users of PPI in a seemingly dose-dependent manner. The risk was higher in younger age groups of PPI users compared to older age groups.

Disclosure

No conflicts of interest

LONG-TERM PROTON PUMP INHIBITOR USE AND RISK OF GASTRIC NEUROENDOCRINE NEOPLASMS IN A POPULATION-BASED STUDY FROM THE FIVE NORDIC COUNTRIES

Eivind Ness-Jensen 1, Giola Santoni 2, Cecilia Radkiewicz 2, My von Euler-Chelpin 3, Joonas H. Kauppila 4, Helgi Birgisson 5, Reidar Fossmark 6, Jesper Lagergren 7

1 NTNU, Norwegian University of Science and Technology, Levanger, Norway|||Nord-Trøndelag Hospital Trust, Levanger Hospital, Levanger, Norway

2 Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden

3 University of Copenhagen, Copenhagen, Denmark

4 University of Oulu and Oulu University Hospital, Oulu, Finland|||Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden

5 Icelandic Cancer Registry, Reykjavík, Iceland

6 NTNU, Norwegian University of Science and Technology, Trondheim, Norway|||Oslo University Hospital, Oslo, Norway

7 King's College London and Guy’s and St Thomas Foundation Trust, London, United Kingdom|||Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden

Event

UEG Week Berlin 2025

Topics

Digestive Oncology Endoscopy Oesophagus

Submission format

Abstract

Session

From prediction to detection in upper GI

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Who is at risk: Is it all about anticoagulants?

Franco Radaelli 1

1 Valduce Hospital, Como, Italy

Event

UEG Week Berlin 2025

Topics

Endoscopy Radiology & Imaging

Session

Crash course: Lower GI bleeding

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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Constipation: Paediatric and adult gastroenterologist

Marc Benninga 1, Maura Corsetti 2

1 Academisch Medisch Centrum Onderzoekschool Oncologie Pediatrics and Pediat. Surgery - Dep. Of Pediat, AZ Amsterdam, Netherlands

2 University of Nottingham, Nottingham, United Kingdom

Event

UEG Week Berlin 2025

Session

When adult gastroenterologist meets paediatrician: Focus on reflux, constipation and chronic pain

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Poster

Standard Poster

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Clinical Case Summary

We present the case of a 50-year-old man with six months of persistent, non-bloody watery diarrhea (8–10 episodes/day), unresponsive to antibiotics and probiotics. His past medical history was unremarkable, he took no home medications, and denied raw meat or fish consumption. Notably, he had recently started working in an animal feed production facility one month before symptom onset. Initial labs showed mild leukocytosis (10.04 x 10³/µL; ULN: 8.77) and mildly elevated CRP (7.5 mg/L; ULN: 3.4). Extensive infectious workup, including CMV serology, Quantiferon, stool cultures for Salmonella, and tests for fungi and parasites (e.g., Giardia), fecal elastase, rectal swabs for Klebsiella pneumoniae carbapenemase and Clostridium difficile returned negative. Colonoscopy and upper GI endoscopy were normal, and biopsies from all intestinal segments showed no pathological findings. He was discharged with partial improvement (3–4 bowel movements/day) and normalized CRP, but was readmitted a week later for worsening symptoms. Repeat blood work, thyroid function, serum calcitonin and inflammatory markers were within normal limits. Intestinal ultrasound showed a tubular descending colon suggestive of nonspecific left-sided colitis; other bowel segments were normal. Stool tests remained negative.Urine toxicology was positive for cannabinoids. Upon further questioning, the patient admitted to regular use over the past eight months, including during both hospitalisations (CUDIT-R score = 12). After cessation of cannabinoid use, diarrhea resolved completely. At 3-month follow-up, he was asymptomatic, with normal bowel habits and labs. He reported only sporadic cannabinoid use at present (CUDIT-R score 7). This case illustrates the potential for chronic cannabinoid use to induce persistent diarrhea mimicking infectious or inflammatory disease. Screening for substance use should be considered in chronic unexplained diarrhea.

CHRONIC DIARRHEA LINKED TO CANNABINOID USE: A CASE REPORT

Francesco Savino 1, Emanuela Stano 1, Antonella Contaldo 1, Mariabeatrice Rita Daniela Principi 1

1 Università degli Studi di Bari "Aldo Moro", Bari, Italy

Conference

UEG Week Berlin 2025

Topics

Colorectal

Submission format

Clinical Case

Session

CLINICAL CASES (Posters)

Published

2025

UEG Presentation

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Motility mayhem: The paediatric battle with gut disorders

Marc Benninga 1

1 Academisch Medisch Centrum Onderzoekschool Oncologie Pediatrics and Pediat. Surgery - Dep. Of Pediat, AZ Amsterdam, Netherlands

Event

UEG Week Berlin 2025

Topics

Neurogastroenterology & Motility Paediatrics Standards & Guidelines Stomach & H. Pylori

Session

From guidelines to clinical practice: The gut-brain connection - PPIs and guideline application in clinical practice

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Poster

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Clinical Case Summary

Introduction: Gastric siderosis (GS) refers to the abnormal deposition of iron within the gastric mucosa, a condition that can be associated with various underlying pathologies. Our case depicts a case of gastric siderosis with iron deposition in the stomach in association with excessive oral iron intake, presenting unusually with chronic diarrhea. Such association has been mentioned previously in the literature but not established.
Case: A 70-year-old lady with a history of iron deficiency anemia and chronic kidney disease presented with 3 weeks of progressively worsening diarrhea. Home medicines included iron pills. She denied any blood in stool, abdominal pain, recent travel, or antibiotic use. Her vitals and her abdominal exam were unremarkable. Stool studies, including stool parasite, C. difficile toxin, calprotectin, and bacterial PCR, were negative.
Colonoscopy showed a normal macroscopic appearance with random biopsies negative for microscopic colitis. An upper endoscopy was performed demonstrating normal esophagus but pitted brown spots mucosa in the gastric body, and antrum. Biopsies were taken, with antral ones demonstrating antral mucosa with iron deposition in the glands and lamina propria concerning gastric siderosis. Oral iron was discontinued and the patient endorsed improvement in symptoms upon outpatient follow-up with endoscopic resolution at 6 months.
Discussion: Iron deposition in gastric mucosa induces a highly oxidative state, producing injury. However, siderosis due to oral iron use is less commonly associated with mucosal injury, with cases seen with changes ranging from erythema to mucosal erosions. Our patient had pattern B on biopsy involving stroma, whereas A involves macrophages in gastric inflammation, and C involves glands in hemochromatosis. No association with the duration or amount of exposure is associated with differences in symptoms. Non-bloody diarrhea occurs without active ulceration being reported, making our patient unique.

References

1. Marginean EC, Bennick M, et al. Gastric siderosis: patterns and significance. Am J Surg Pathol. 2006 Apr;30(4):514-20. doi: 10.1097/00000478-200604000-00013. PMID: 16625099.
2. Abraham SC, Yardley JH, Wu TT. Erosive injury to the upper gastrointestinal tract in patients receiving iron medication: an underrecognized entity. Am J Surg Pathol. 1999 Oct;23(10):1241-7. doi: 10.1097/00000478-199910000-00009. PMID: 10524525.
3. Siah CW, Ombiga et al. Normal iron metabolism and the pathophysiology of iron overload disorders. Clin Biochem Rev. 2006 Feb;27(1):5-16. PMID: 16886043; PMCID: PMC1390789.
4. Idoate Gastearena MA, et al. A comparative study on the gastroduodenal tolerance of different antianaemic preparations. Hum Exp Toxicol. 2003 Mar;22(3):137-41. doi: 10.1191/0960327103ht330oa. PMID: 12723894.
5. Wang J, Pantopoulos K. Regulation of cellular iron metabolism. Biochem J. 2011 Mar 15;434(3):365-81. doi: 10.1042/BJ20101825. PMID: 21348856; PMCID: PMC3048577.
6. Hattori H. High prevalence of haemosiderin accumulation in the cytoplasm of gastric glands in patients with liver cirrhosis. J Clin Pathol. 2004 Jun;57(6):621-4. doi: 10.1136/jcp.2003.010405. PMID: 15166268; PMCID: PMC1770335.
7. De Petris G, Gatius Caldero S, et al. Histopathological changes in the gastrointestinal tract due to drugs: an update for the surgical pathologist (part I of II). Int J Surg Pathol. 2014 Apr;22(2):120-8. doi: 10.1177/1066896913502229. Epub 2013 Sep 10. PMID: 24021899.

GASTRIC SIDEROSIS IN THE SETTING OF ORAL IRON INTAKE

Bipneet Singh 1, Mohammad Zarrar Khan 2, Palak Patel Rodrigues 3, Palak Grover 1, Gurleen Kaur 4

1 Henry Ford Allegiance, Jackson, United States

2 Henry Ford Detroit, Detroit, United States

3 Henry Ford, Detroit, United States

4 Government Medical College, Amritsar, India

Conference

UEG Week Berlin 2025

Topics

Oesophagus

Submission format

Clinical Case

Session

CLINICAL CASES (Posters)

Published

2025

UEG Week 2025: Relive the Highlights

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