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UEG Standards and Guidelines

Position Paper

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Abstract

The role of long-term parenteral support in patients with underlying benign conditions who do not have intestinal failure (IF) is contentious, not least since there are clear benefits in utilising the oral or enteral route for nutritional support. Furthermore, the risks of long-term home parenteral nutrition (HPN) are significant, with significant impacts on morbidity and mortality. There has, however, been a recent upsurge of the use of HPN in patients with conditions such as gastro-intestinal neuromuscular disorders, opioid bowel dysfunction, disorders of gut-brain interaction and possibly eating disorders, who do not have IF. As a result, the European Society of Clinical Nutrition and Metabolism (ESPEN), the European Society of Neuro-gastroenterology and Motility (ESNM) and the Rome Foundation for Disorders of Gut Brain Interaction felt that a position statement is required to clarify - and hopefully reduce the potential for harm associated with - the use of long-term parenteral support in patients without IF. Consensus opinion is that HPN should not be prescribed for patients without IF, where the oral and/or enteral route can be utilised. On the rare occasions that PN commencement is required to treat life-threatening malnutrition in conditions such as those listed above, it should only be prescribed for a time-limited period to achieve nutritional safety, while the wider multi-disciplinary team focus on more appropriate biopsychosocial holistic and rehabilitative approaches to manage the patient's primary underlying condition.

Avoiding the use of long-term parenteral support in patients without intestinal failure: A position paper

Simon Lal

Publishers

European Society of Neurogastroenterology and Motility, The European Society for Clinical Nutrition and Metabolism

Guideline

Position Paper

Topics

Neurogastroenterology & Motility

Citation

Neurogastroenterol Motil 2024; Volume 36, Issue 9

Published

2024

UEG Mistakes In Articles

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The coordination of smooth muscle and nerve function in the gastrointestinal tract is crucial for digestion and waste disposal. Disorders in this process can lead to chronic intestinal pseudo-obstruction (CIPO), a severe condition where the intestines fail to propel contents. Managing CIPO involves improving intestinal motility, maintaining nutrition, treating complications, managing exacerbations, and carefully considering invasive procedures. This article focuses on common mistakes in CIPO diagnosis and management, offering evidence-based insights and clinical experience.

Mistakes in chronic intestinal pseudo-obstruction

Carolina Malagelada, Luis Gerardo Alcala Gonzalez

Topics

Neurogastroenterology & Motility

Citation

Malagelada C and Alcalá-González LG. Mistakes in chronic intestinal pseudo obstruction and how to avoid them. UEG Education 2024; 24: 12-17.

Published

2024

UEG Presentation

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EFFICACY AND SAFETY OF APRAGLUTIDE ONCE-WEEKLY IN PATIENTS WITH SHORT BOWEL SYNDROME AND INTESTINAL FAILURE (SBS-IF): RESULTS FROM THE STARS STUDY – A GLOBAL PHASE 3 DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED TRIAL

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Introduction

In SBS-IF, patients (pts) depend on parenteral support (PS) to meet nutritional and/or fluid requirements. Apraglutide (APRA) is a long-acting novel GLP-2 analogue dosed once-weekly that stimulates intestinal adaptation, with the potential to reduce PS requirements. This phase 3 trial assessed the efficacy and safety of APRA vs placebo (PBO) in adult pts with SBS-IF.

Aims & Methods

In this phase 3 double-blind, PBO-controlled trial (NCT04627025) conducted in 73 centres and 18 countries, 164 pts were randomized 2:1 to once-weekly subcutaneous APRA (5 mg if pt ≥50 kg, 2.5 mg if pt <50 kg) or PBO, stratified by intestinal anatomy (stoma or colon-in-continuity [CIC]). The primary endpoint was relative change from baseline (BL) in weekly PS volume at Week (Wk) 24. Key secondary endpoints at Wk 24 were reduction of additional ≥1 day/Wk off PS from BL, and in the stoma subgroup, relative change from BL in weekly PS volume. Two other key secondary endpoints at Wk 48 in the CIC subgroup were reduction of ≥1 day/Wk off PS, and percentage of pts reaching total enteral autonomy. Wk 24 clinical responders were defined as proportion of pts with ≥20% PS reduction at Wks 20 and 24. Adverse events (AEs) were collected.

Results

A total of 163 dosed pts (80 stoma; 83 CIC),155 (95%) completed the study. BL demographics and mean BL weekly PS volume (APRA 13.1 L; PBO 12.9 L) were similar in both arms. At Wk 24, APRA-treated pts had a significantly larger reduction from BL in weekly PS volume vs PBO (APRA -25.5%; PBO -12.5%; p=0.001); both stoma and CIC subgroups demonstrated comparable treatment effects. In pts with stoma, the relative reduction from BL to Wk 24 in weekly PS volume in APRA pts vs PBO was statistically significant (-25.6% vs -7.8%; p<0.001) (Table 1). In pts with CIC, there was a numerical benefit in APRA that did not reach statistical significance (APRA -25.2%; PBO -17.6%; nominal p=0.179). In the overall population, statistically significant PS reductions from BL were seen from Wk 8 onward. A significantly higher proportion of APRA pts achieved a reduction of ≥1 day/Wk off PS at Wk 24 (APRA 43.0%; PBO 27.5%; p=0.040). At Wk 48 in the CIC subgroup, 51.8% of APRA vs 44.4% of PBO-treated pts achieved ≥1 day/wk off PS (p=0.348), and enteral autonomy was reached in 7 of 56 (12.5%) APRA vs 2 of 27 (7.4%). APRA was well tolerated. Of 110 APRA-treated pts, only 4 (3.6%) discontinued APRA due to an AE, vs 1 of 53 (1.9%) PBO-treated pts.

Conclusion

APRA is the first once-weekly GLP-2 analogue to demonstrate efficacy in a phase 3 trial in SBS-IF. At Wk 24, APRA demonstrated significantly greater relative reductions in weekly PS volume from BL and a higher proportion of pts achieved an additional ≥1 day off PS, with comparable treatment effects in pts with stoma or CIC. APRA showed a favourable safety profile consistent with prior APRA studies in SBS-IF.

n for the first key secondary is observed value and the percentage, difference in percentages and its p-value is based on results of multiple imputations. *nominal p-value. APRA, apraglutide; BL, baseline; CI, confidence interval; LSM, least square mean; PBO, placebo; PS, parenteral support; SBS-IF, short bowel syndrome and intestinal failure.
Endpoint	Population	Apraglutide (n=110)	Placebo (n=53)	APRA vs PBO Difference [LSM or % (95% CI)]	p-value
Primary Endpoint		LSM or n (%)
Relative % change from BL in actual PS weekly volume at Wk 24, Least Square Mean (LSM)	Overall	-25.5	-12.5	-13.0 (-20.9, -5.0)	0.001
Key Secondary Endpoints
Percentage of subjects achieving a reduction of ≥1 day/wk off PS from BL at Wk 24, n (%) *	Overall	46 (43.0)	14 (27.5)	15.6 (0.7, 30.5)	0.040
Relative % change from BL in actual PS weekly volume at Wk 24, mean	Stoma (n=80)	-25.6	-7.8	-17.8 (-28.4, -7.3)	<0.001
Percentage of subjects achieving a reduction of ≥1 day/wk off PS from BL at Wk 48, n (%)	CIC (n=83)	29/56 (51.8)	12/27 (44.4)	7.3 (-16.4, 29.8)	0.348
Subjects reaching enteral autonomy at Wk 48, n (%)	CIC (n=83)	7/56 (12.5)	2/27 (7.4)	5.1 (-12.9, 18.5)	0.387
Other Secondary Endpoint Clinical responders at Week 24 (≥20% PS reduction at both Wks 20 and 24), n (%)	Overall	47 (42.7)	11 (20.8)	22.0 (7.7, 36.2)	0.003**

Disclosure

FJ: Research funding from Takeda Pharma, VectivBio, Zealand, Baxter, Mobile3esolutions, Carembouche Consultant or advisor for Takeda, VectivBio, Ironwood; NorthSea Therapeutics, Hamni, Zealand, Mobile3esolutions, Carembouche. Lecturer for Baxter, BBraun, Fresenius Kabi, Janssen, Theradial; TV: Research Grants for Danone, MyHealth, Takeda, VectivBio. Consultancy for Baxter, BMS, Dr. Falk Pharma, Hanmi Pharm, North Sea Therapeutics, Takeda, Truvion, VectivBio, Zealand Pharma. Lecturer for Abbott, Baxter, Biocodex, Dr. Falk Pharma, Fresenius Kabi, Ipsen, Menarini, MyHealth, Remedus, Takeda, Truvion, VectivBio. DK: Consultant or advisor forTakeda Pharma, VectivBio, OWYN; SL: Investigator-initiated/unrestricted research grants from Fresenius Kabi, Baxter and Takeda. Honoraria and/or educational support from Takeda, Zealand, VectivBio, Fresenius Kabi, B Braun, Baxter, Northsea. KT: Board Member/Advisory Panel/Speaker for Abbott Nutrition Health Institute, Nutricia North America,Takeda Pharmaceuticals, VectivBio – now part of Ironwood Pharmaceuticals, Inc; PJ: Honoraria, educational and/or grants from Albumedix A/S, ArTara Therapeutics, Bainan Biotech, Baxter, Coloplast A/S, Ferring Pharmaceuticals, Fresenius Kabi, GlyPharma Therapeutic, Hanmi Pharmaceuticals, Ironwood, Naia Pharmaceuticals, NPS Pharmaceuticals, Protara Therapeutics, Shire, Takeda, The Novo Nordisk Foundation, Therachon, VectivBio AG, Zealand Pharma A/S; NNY, CL, RS, IS, SH: Ironwood employees; FB: Ironwood consultant; KI: Grant support from Takeda Pharma, VectivBio, NorthSea Therapeutics. Consultant or advisor for Takeda Pharma, VectivBio, Northsea Therapeutics, Hanmi Pharmaceuticals. Speaker or member of speakers bureau for Takeda Pharma.

EFFICACY AND SAFETY OF APRAGLUTIDE ONCE-WEEKLY IN PATIENTS WITH SHORT BOWEL SYNDROME AND INTESTINAL FAILURE (SBS-IF): RESULTS FROM THE STARS STUDY – A GLOBAL PHASE 3 DOUBLE-BLIND, RANDOMIZED, PLACEBO-CONTROLLED TRIAL

Francisca Joly 1, Tim Vanuytsel 2, Donald Kirby 3, Simon Lal 4, Kelly Tappenden 5, Palle Bekker Jeppesen 6, Nader N. Youssef 7, Carrie Li 7, Reda Sheik 7, Isabelle Statovci 7, Susanna Huh 8, Federico Bolognani 7, Kishore Iyer 9

1 Beaujon Hospital Service de Gastroenterologie, Clichy, France

2 KU Leuven, Leuven, Belgium

3 Cleveland Clinic, Cleveland, United States

4 University of Manchester, Manchester, United Kingdom

5 The University of Utah, Salt Lake City, United States

6 Rigshospitalet, Copenhagen, Denmark

7 Ironwood Pharmaceuticals, Basel, Switzerland

8 Ironwood Pharmaceuticals, Boston, United States

9 Mount Sinai Medical Center, New York, United States

Event

UEG Week Vienna 2024

Topics

Mechanisms & Personalised Medicine Neurogastroenterology & Motility Radiology & Imaging Small Intestine & Nutrition

Submission format

Abstract

Session

Short bowel syndrome

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Management of chronic intestinal pseudo-obstruction

Carolina Malagelada 1

1 Hospital Vall d`Hebron, Barcelona, Spain

Event

UEG Postgraduate Teaching Programme Vienna 2024

Topics

Education & Training IBD Neurogastroenterology & Motility Small Intestine & Nutrition

Session

When the bowel loses its flow

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Poster

Standard Poster

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Introduction

Long-term antithrombotic therapy is recommended in short bowel syndrome (SBS) caused by acute mesenteric ischemia (AMI). However, evidence-based recommendations on drug choice, duration and monitoring of treatment are lacking. Also, guidelines are based on data on other artery diseases and overlook the altered drug absorption in patients with SBS. To understand current practices, we aimed to assess the long-term antithrombotic management of AMI.

Aims & Methods

An online survey was sent to centers contributing to the chronic intestinal failure database of the HAN-CIF (Home Artificial Nutrition – Chronic Intestinal Failure) special interest group of ESPEN (European Society on Clinical nutrition and Metabolism), treating patients with SBS post-AMI. The survey featured 10 cases varying in postsurgical intestinal anatomy, revascularization and etiology and focused on drug class, administration route, duration and monitoring of antithrombotic therapy.

Results

The survey was completed by 43 centers. In case of idiopathic AMI leading to SBS, anticoagulation (65.1% of all physicians) or antiplatelet (32.6%) therapy were mostly prescribed (Figure 1; jejunocolic anastomosis, idiopathic). Antiplatelet therapy was prescribed more often to patients with type 3 anatomy (37.2%, largest absorptive capacity) than to other anatomy groups (30.2 and 32.6% in type 1 and 2 respectively). Antiplatelet drugs (39.5%) or combination therapy (18.6%) were more commonly prescribed in case of revascularization compared to no revascularization (32.6% or 2.3% respectively). Anticoagulants were very common in patients with atrial fibrillation (90.7%), venous thrombosis (95.3%) and antiphospholipid syndrome (83.7%). More antiplatelet drugs (27.9%) or combination therapy (18.6%) were preferred with concomitant peripheral artery disease. In hypovolemic shock, no therapy (41.9%) or anticoagulants (51.2%) were common.
Parenteral drugs were more prescribed to patients with type 1 anatomy (51.2% of all physicians; lowest absorptive capacity) than to patients with type 2 (44.2%) or 3 (20.9%) anatomy.
Antiplatelet drugs were mainly prescribed lifelong (94.7% of this drug class), while anticoagulants were prescribed for 6 (19.4%) to 12 (16.1%) months or lifelong (51.6%), irrespective of anatomy, revascularization or etiology.
Vitamin K antagonists were consistently monitored, whereas aspirin was not. Monitoring of subcutaneous low molecular weight heparins (no monitoring, 36.8% - always monitoring, 42.1% - in specific circumstances, 21.0%) and non-vitamin K oral anticoagulants varied (no monitoring, 50.0%).

Conclusion

In a case-based survey, anticoagulant versus antiplatelet drug choice depended on the anatomy, revascularization and etiology. However, there was a high variability in case of idiopathic AMI. Administration route depended on anatomy. More detailed practice guidelines are needed.

Disclosure

TV has participated in advisory boards, as a consultant and/or as a speaker on behalf of Boehringer Ingelheim, Bayer, Daiichi Sankyo, BMS/Pfizer, Sanofi Aventis, and Leo Pharma

EXAMINING LONG-TERM ANTITHROMBOTIC TREATMENT PATTERNS IN PATIENTS WITH SHORT BOWEL SYNDROME POST ACUTE MESENTERIC ISCHEMIA: INSIGHTS FROM AN INTERNATIONAL SURVEY

Barbara Deleenheer 1, Cristina Cuerda 2, Palle Bekker Jeppesen 3, Francisca Joly 4, Simon Lal 5, Georg Lamprecht 6, Mundi Manpreet 7, Loris Pironi 8, Kinga Szczepanek 9, Thomas Vanassche 10, Lorenz Van der Linden 11, André Van Gossum 12, Geert J.A. Wanten 13, Tim Vanuytsel 11

1 KU Leuven, Leuven, Belgium|||University Hospitals Leuven, Leuven, Belgium|||University Hospitals Leuven, Leuven, Belgium

2 Hospital General Universitario Gregorio Marañón, Madrid, Spain

3 Rigshospitalet, Copenhagen, Denmark

4 Beaujon Hospital Service de Gastroenterologie, Clichy, France

5 Salford Royal Foundation Trust, Salford, United Kingdom

6 Rostock University Medical Center, Rostock, Germany

7 Mayo Clinic, Rochester, United States

8 University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy

9 Stanley Dudrick’s Memorial Hospital, Skawina, Poland

10 University Hospitals Leuven, Leuven, Belgium

11 KU Leuven, Leuven, Belgium|||University Hospitals Leuven, Leuven, Belgium

12 Hôpital Erasme, University of Brussels, Bruxelles, Belgium

13 Radboud University Nijmegen, Nijmegen, Netherlands

Conference

UEG Week Vienna 2024

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

SMALL INTESTINAL (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Presentation

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MAGNETIC RESONANCE IMAGING (MRI) SHOWS CHANGES IN BOWEL MORPHOLOGY AND MOTILITY IN SHORT BOWEL SYNDROME WITH INTESTINAL FAILURE (SBS-IF) AND COLON-IN-CONTINUITY (CIC) AFTER TREATMENT WITH THE LONG-ACTING GLUCAGON-LIKE PEPTIDE-2 (GLP-2) ANALOG APRAGLUTIDE

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Introduction

SBS-IF is a severe organ failure with long-term parenteral support (PS) dependence. In the first years after extensive surgery, spontaneous structural (elongation of intestinal villi and crypts) and functional (incl. motility) intestinal changes occur, stimulating a more efficient nutrient and fluid absorption in the remnant bowel. GLP-2 analogs are hypothesized to boost intestinal adaptation resulting in increased intestinal absorption and reduced PS needs. Apraglutide (APRA) is a long-acting GLP-2 analog in development for SBS-IF. We investigated the effect of APRA at 52 weeks (W) on bowel morphology and motility based on magnetic resonance imaging (MRI).

Aims & Methods

STARS Nutrition is a 52-W multicenter, open-label, phase 2 study in adult SBS-IF-CiC pts receiving weekly subcutaneous APRA injections (5mg). We hypothesized that APRA treatment would lead to thickening of the intestinal mucosa, intestinal lengthening, reduced bowel dilatation and reduced intestinal motility. Therefore, MRI scans of the abdomen, incl. cine sequences, after oral intake of a mannitol solution (600mL) were performed at baseline and at 4W, 24W and 48W of treatment. Morphology parameters were measured on static MRI sequences; GI Quant software was used to quantify motility on cine MRI sequences. Data are presented as median (IQR). Nominal p-values are calculated using Wilcoxon matched-pairs signed rank tests with significance set at 0.05.

Results

Nine pts were included and comprise the full study population. While the numerically increased colon length failed to reach significance, small bowel length increased significantly from 29.7 to 40.7 cm (p=0.012) at 48W. Duodenal wall thickness increased by 0.8 (0.2;1.2) mm (p=0.020). There were no diameter changes in the small bowel nor colon. Changes in motility were evaluated using data from 7 pts, due to missing data. Over time, small bowel motility gradually reduced, albeit not significant. Motility in the proximal colon was significantly reduced at 48W. In the distal colon, decreased motility was observed at 4W and 24W, but returned to baseline level at 48W.

Conclusion

Using static and cine MRI sequences in pts with SBS-IF-CIC, STARS Nutrition shows that APRA treatment was associated with small bowel lengthening and increased duodenal wall thickness suggesting an intestinotrophic effect. Both effects may contribute to an increased surface area for absorption. The reduced motility, especially in the proximal colon may reduce transit time, allowing more time for absorption of nutrients, fluids and electrolytes; and reduced fecal output. Whether bowel lengthening results from a direct effect of APRA vs. changes in motility with passive elongation is subject of further investigation.

Disclosure

Astrid Verbiest, Mark Krogh Hvistendahl, Ragna Vanslembrouck, Ronald Peeters, Riccardo Sartoris – nothing to declare.
Palle Bekker Jeppesen – received grants/research support/honoraria or consultation fees from Agomab, Albumedix A/S, ArTara Therapeutics, Bainan Biotech, Baxter, Coloplast, Ferring, Fresenius Kabi, GLyPharma, Naia Pharma, NPS Pharmaceuticals, NorthSea Therapeutics, Shire, Takeda, The Novo Nordisk Foundation, Therachon, VectivBio and Zealand Pharma.
Francisca Joly – has received grants/research support/honoraria or consultation fees from Agomab, Baxter, Fresenius Kabi, Nestlé Health Sciences, BBraun, Theradial, Mayoli, Biocodex, mobile3e Consulting, Carembouche, NPS Pharmaceuticals, NorthSea Therapeutics, Shire, Takeda, Therachon, VectivBio and Zealand Pharma.
Tim Vanuytsel – has served on the speaker bureau for Abbott, Agomab, Baxter, Biocodex, Dr. Falk Pharma, Fresenius Kabi, Ipsen, Menarini, Microbiotica, MyHealth, Remedus, Takeda, Truvion, VectivBio and Zealand Pharma. TV has provided clinical advice to Baxter, Danone, Dr. Falk Pharma, MyHealth, NorthSea Therapeutics, Shire, Therachon, Takeda, VectivBio, Zealand Pharma. TV has received research grants from Danone, MyHealth, Takeda and VectivBio.
Federico Bolognani, Carrie Li and Nader N. Youssef – employees of VectivBio/Ironwood.

This research was supported by VectivBio AG/Ironwood.

MAGNETIC RESONANCE IMAGING (MRI) SHOWS CHANGES IN BOWEL MORPHOLOGY AND MOTILITY IN SHORT BOWEL SYNDROME WITH INTESTINAL FAILURE (SBS-IF) AND COLON-IN-CONTINUITY (CIC) AFTER TREATMENT WITH THE LONG-ACTING GLUCAGON-LIKE PEPTIDE-2 (GLP-2) ANALOG APRAGLUTIDE

Astrid Verbiest 1, Alex Menys 2, Ragna Vanslembrouck 3, Ronald Peeters 3, Riccardo Sartoris 4, Mark Krogh Hvistendahl 5, Federico Bolognani 6, Carrie Li 6, Nader N. Youssef 6, Palle Bekker Jeppesen 5, Francisca Joly 4, Tim Vanuytsel 1

1 University of Leuven, Leuven, Belgium|||University Hospitals Leuven, Leuven, Belgium

2 Motilent, London, United Kingdom

3 University Hospitals Leuven, Leuven, Belgium

4 Hôpital Beaujon, Clichy, France

5 Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

6 VectivBio/Ironwood, Basel, Switzerland

Event

UEG Week Vienna 2024

Topics

Mechanisms & Personalised Medicine Neurogastroenterology & Motility Radiology & Imaging Small Intestine & Nutrition

Submission format

Abstract

Session

Short bowel syndrome

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Poster

Standard Poster

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Introduction

Chronic intestinal pseudo-obstruction (CIPO) is a rare, heterogeneous, and challenging gastrointestinal motility disorder lacking clinical guidelines in adults.

Aims & Methods

We aimed to develop an international consensus among international experts in gut motility on the diagnosis and management of CIPO based on existing literature and expert opinion. Two experts from each continental motility society and experts on pathology, surgery, and nutritional aspects of CIPO were selected for participation. A list of >130 statements was drafted, subdivided into 11 topics. After revisions and validation by the experts of the list of statements, a systematic literature review was performed to summarize available data on every statement. Using a Delphi process of 3 voting rounds, consensus statements were identified (defined as >80% agreement).

Results

Consensus was reached for 77/139 statements. The panel defined CIPO as symptoms caused by severe small bowel dysmotility without mechanical obstruction, and with documented dilated intestine or air/fluid levels, mimicking mechanical obstruction. Pseudo-obstructive episodes or continuous pseudo-obstructive symptoms were considered a cardinal feature of CIPO. Abdominal pain, bloating, and distension were also considered cardinal symptoms, while nausea/vomiting, diarrhea, or constipation were considered associated symptoms.
Radiographic imaging was considered mandatory in the diagnostic work-up, to confirm intestinal dilation or air/fluid levels and to rule out mechanical obstruction.. No other diagnostic test was considered indispensable for the diagnosis, including endoscopy, manometry, or laparoscopy. Screening for secondary causes of CIPO, including systemic sclerosis, paraneoplastic disease, or infectious disease, was supported, with a possible role for transmural histology. Differential diagnoses, including drug adverse effects, adhesions, or enteric radiation, should be ruled out. The experts also recommended screening for complications such as nutritional deficiencies and osteoporosis.
Management requires dietary adjustment, with supplementation for deficiencies, and setting up home parenteral nutrition if enteral nutrition fails. Small intestinal bacterial overgrowth was recognized as a main contributor to symptom aggravation and should be treated by intermittent antibiotics without the need for breath testing confirmation in patients with CIPO. There was no consensus regarding choice or efficacy of drug therapy, including prokinetics (e.g. pyridostigmine, prucalopride), laxatives, or somatostatin analogs. Opioids and surgical resections should be avoided; although endoscopic or surgical decompression procedures may be helpful in acute or persisting pseudo-obstructive symptoms.

Conclusion

This expert consensus developed key statements for the definition, diagnosis, and treatment of CIPO in adult patients. It provides the opportunity to harmonize the management of these patients and to highlight the gaps in the current literature.

Disclosure

Jan Tack has given Scientific advice to Aclipse, Adare, AlfaSigma, Clasado, Danone, Falk, FitForMe, Ironwood, Kyowa Kirin, Menarini, Promed, Ricordati, Takeda, Truvion, Tsumura, Zealand Pharmaceuticals, has received research support from Biohit, Kiowa Kirin, ProMed, Sofar and Takeda, and has served on the Speaker bureau for Abbott, Bio-Codex, Mayoly, Menarini, ProMed, Reckitt-Benckiser, Schwabe, Takeda, Thai Meiji and Truvion Pharmaceuticals.

INTERNATIONAL CONSENSUS ON CHRONIC INTESTINAL PSEUDO-OBSTRUCTION IN ADULTS

Bert Broeders 1, Heithem Soliman 2, Rebecca E Burgell 3, Michael Camilleri 4, Roberto De Giorgio 5, Claudia Defilippi 6, Kee Wook Jung 7, Simon Lal 8, Ana Maria Madrid 6, Carolina Malagelada 9, Atsushi Nakajima 10, Loris Pironi 11, Tim Vanuytsel 12, Nicholas Verne 13, Arved Weimann 14, May Wong 15, Vincenzo Stanghellini 16, Jan Tack 17

1 Ku Leuven, Leuven, Belgium

2 Hôpital Louis Mourier - AP-HP, Colombes, France

3 Alfred Health and Monash University, Prahran, Australia

4 Mayo Clinic Dept. of Gastroenterology Charlton Bldg., Rm. 8-110, Rochester, MN, United States

5 University of Ferrara, Ferarra, Italy

6 Hospital Clinico Universidad de Chile, Santiago, Chile

7 Asan Medical Center, Seoul, Korea, Republic of

8 Salford Royal Foundation Trust, Salford, United Kingdom

9 Hospital Vall d`Hebron, Barcelona, Spain

10 Yokohama City University Hosp. Dept. of Gastroenterology, Yokohama, Japan

11 University of Bologna S. Orsola-Malpighi Hospital, Bologna, Italy

12 KU Leuven, Leuven, Belgium

13 University of Tennessee College of Medicine, Memphis, United States

14 St. George Hospital, Leipzig, Germany

15 Royal North Shore Hospital, Sydney, Australia

16 University of Bologna Policlinico S.Orsola-Malpighi Internal Med. & Gastroenterology - Department of, Bologna, Italy

17 University of Leuven, University Hospital Gasthuisberg, Leuven, Belgium

Conference

UEG Week Berlin 2025

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

Lower GI motility (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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