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UTILITY OF CT COLONOGRAPHY AS A DIAGNOSTIC PROCEDURE FOR IRRITABLE BOWEL SYNDROME

TSUNEYA WADA 1, Eiji Kubota 2, Tamaki Yamada 1, Atsushi Ohara 1, Takeshi Kamiya 2, Hiromi Kataoka 2

Affiliations

1 Okazaki City Medical Association, Okazaki, Japan

2 Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

Summary

AI Generated

Patients with irritable bowel syndrome diagnosed by Rome IV criteria experienced significantly higher pain scores during computed tomography colonography with carbon dioxide insufflation compared to controls, particularly immediately after gas injection and at plateau pressure.

In a prospective single-center study of 123 subjects undergoing CTC for colorectal cancer screening, 15 patients met Rome IV criteria for IBS and were compared to controls.
IBS patients reported significantly higher VAS pain scores at two time points: immediately after carbon dioxide gas injection (p<0.01) and until injection pressure reached plateau at 18 mmHg (p<0.01); maximum VAS scores were also significantly higher in IBS patients (p<0.05).
No significant differences were found between groups in background characteristics, volume of carbon dioxide injected, or total colon length.
Although IBS-SS scores were significantly higher in IBS patients, no significant correlation was found between VAS pain scores and either IBS-SS or IBS-QOL scores.
The authors suggest pain perception during CTC might be a potential diagnostic method for IBS, though they note further study is needed to clarify associations with IBS severity.

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Abstract

Introduction

Computed tomography colonography (CTC) has been developed as a less invasive alternative method to colonoscopy for colorectal cancer screening. Some subjects who underwent CTC reported abdominal pain induced by carbon dioxide gas injection during examination. We speculated that pain perception during CTC might reflect visceral hypersensitivity related to irritable bowel syndrome (IBS).

Aims & Methods

In this study, we investigated whether pain perception induced by carbon dioxide gas injection during CTC is different between patients with IBS and healthy controls. Furthermore, we evaluated the correlation between the pain score during CTC and the severity of the IBS symptom or the quality of life of patients with IBS. A prospective study of consecutively registered patients who underwent CTC for colorectal cancer screening in a single medical center was conducted. IBS was diagnosed using the Rome IV criteria, and patients with IBS were classified into IBS subgroups according to the predominant stool pattern experienced by the patient. In addition, all subjects completed the IBS Severity Scale (IBS-SS) and IBS-QOL questionnaire. Pain perception during CTC was quantified using the visual analog scale (VAS) at six time points during the CTC as follows: (1) before CTC, (2) immediately after carbon dioxide gas injection, (3) until the injection pressure reached a plateau (18 mmHg), (4) in the prone position after carbon dioxide gas injection, (5) in the supine position after carbon dioxide gas injection, and (6) after CTC. We also evaluated the association between the VAS and IBS-SS scores.

Results

One hundred twenty-three subjects who underwent CTC were enrolled in this study. Thirteen subjects were excluded because of incomplete questionnaires (n = 10) or a diagnosis of colorectal cancer with CTC (n = 3). Fifteen patients were diagnosed as having IBS on the basis of the Rome IV criteria for IBS. Patients with IBS were classified into the following groups: IBS with diarrhea (IBS-D, n = 1), IBS with constipation (IBS-C, n = 3), mixed IBS (IBS-M, n = 3), and unspecified IBS (IBS-U, n = 8). No significant differences in background characteristics, including age, sex, alcohol consumption, and smoking habit, were found between the IBS and control groups. The volume of carbon dioxide gas injected during CTC did not show a significant difference between the two groups. The total colon length was not significantly different between the two groups. The VAS score of the IBS groups was significantly higher than that of the control group at two time points, (2) immediately after carbon dioxide gas injection (p < 0.01) and (3) until the injection pressure reached a plateau (18 mmHg; p < 0.01). The maximum VAS score during CTC was also significantly higher in the IBS groups than in the control group (p < 0.05). Although the IBS-SS score was significantly higher in the IBS groups than in the control group, we found no significant correlation between the VAS and IBS-SS scores in the IBS groups. The IBS-QOL score also did not show any significant correlation with the VAS score.

Conclusion

Our study indicates that pain perception evaluated using the VAS during CTC might be a potential diagnostic method for IBS. Further study is necessary to clarify the association between pain perception induced by CTC and IBS severity.

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Abstract

Session

PP 06 Other lower GI disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Ostomy management

Revital Barkan 1

Affiliations

1 Department of Gastroenterology Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel

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Abstract

Event

UEG Week Barcelona 2026

Topics

Colorectal Surgery IBD

Session

Mistakes in… Lower GI

Citation

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

Published

2026

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Yehuda Chowers

UEG Presentation

New

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Barrett’s oesophagus and overdiagnosis: Pioneering the ‘less-is-more’ approach

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Barrett’s oesophagus and overdiagnosis: Pioneering the ‘less-is-more’ approach

Sanne van Munster 1

Affiliations

1 Amsterdam UMC, Amsterdam, Netherlands

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Abstract

Event

UEG Week Barcelona 2026

Topics

Digestive Oncology Stomach & H. Pylori Oesophagus Endoscopy

Session

Upper GI endoscopy: Screen wisely

Citation

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

Published

2026

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Yehuda Chowers

UEG Presentation

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UEG Journal Best Paper Award

Mathias Cook 1

Affiliations

1 Aalborg University Hospital, Aalborg, Denmark

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Abstract

Event

UEG Week Barcelona 2026

Topics

Endoscopy IBD

Session

Hot topics in European Gastroenterology

Citation

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

Published

2026

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Yehuda Chowers

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Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

MICROBIOTA‑ORIENTED DIETARY PATTERN, PROTEOMIC MEDIATORS, AND INCIDENT INFLAMMATORY BOWEL DISEASE: A UK BIOBANK PROSPECTIVE COHORT STUDY

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MICROBIOTA‑ORIENTED DIETARY PATTERN, PROTEOMIC MEDIATORS, AND INCIDENT INFLAMMATORY BOWEL DISEASE: A UK BIOBANK PROSPECTIVE COHORT STUDY

Xingyan Zhou 1, Ya Zheng 1, Rui Ji 1

Affiliations

1 The First Hospital of Lanzhou University, Lanzhou, China

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Abstract

Introduction

Gut dysbiosis is widely recognized as a pivotal trigger in the pathogenesis of inflammatory bowel disease (IBD). As a key determinant of the gut microenvironment, dietary patterns profoundly influence the composition of the microbiota, mucosal barrier integrity, and host immunity. Consequently, diet has gained increasing attention as a target for IBD prevention and management. Nevertheless, the optimal strategies for microbiota-oriented dietary interventions remain unclear, and the underlying mechanisms linking diet-microbiota interactions to IBD risk are poorly understood.

Aims & Methods

To evaluate the role of diet-microbiota interactions in IBD etiology, we examined the association between a microbiota-oriented dietary pattern (quantified by the Dietary Index for Gut Microbiota, DI-GM) and incident IBD in a prospective cohort (n = 208,143). Furthermore, we integrated high-throughput plasma proteomic data in a subset (n = 21,919) to identify diet-associated circulating proteins and performed mediation analyses to identify candidate biomarkers underlying the diet-microbiota-IBD axis.

Results

Over a median follow-up of 10.8 years, higher adherence to the microbiota-oriented dietary pattern was associated with a 16% lower risk of incident IBD (hazard ratio, 0.84; 95% CI, 0.72–0.98). Proteomic profiling identified 429 plasma proteins associated with the microbiota-oriented dietary pattern, with functional enrichment primarily in immune-inflammatory responses, cytokine-mediated signaling, and tissue repair pathways. Following selection of 57 candidate proteins by LASSO regression, mediation analysis identified 9 that significantly mediated the association between the microbiota-oriented dietary pattern and IBD risk, individually accounting for 13%–36% of the total effect, including OXT (oxytocin-neurophysin 1), SLC39A5 (solute carrier family 39 member 5), CGREF1 (cell growth regulator with EF hand domain protein 1), IGDCC4 (immunoglobulin superfamily DCC subclass member 4), MMP8 (matrix metalloproteinase 8), IL19 (interleukin-19), ALPP (alkaline phosphatase, placental type), AREG (amphiregulin), and IL15 (interleukin-15). Notably, OXT demonstrated the highest proportion mediated, whereas IGDCC4 exhibited a protective effect, in contrast to the risk-increasing effects of the other 8 mediators.
Table 1. Associations between the microbiota-oriented dietary pattern and incident IBD in the main cohort (n = 208,143)^a.

Exposure	Hazard Ratio (95% CI)	P value
Adherence levels to a microbiota-oriented dietary pattern
Lower (0–4)	1.00 [Reference]	-
Intermediate (5–6)	0.85 (0.74, 0.98)	0.02
Higher (≥7)	0.84 (0.72, 0.98)	0.03
P for trend	-	0.02

ᵃ Fully adjusted for demographic, socioeconomic, lifestyle, and dietary covariates.

Conclusion

These findings underscore the potential preventive role of diet, a highly modifiable factor, in IBD. Proteomic signatures may complement traditional dietary assessments and provide mechanistic insight into diet-IBD associations.

Disclosure

The authors declare that they have no competing interests.

Event

UEG Week Barcelona 2026

Topics

IBD Mechanisms & Personalised Medicine Immunology Gut Microbiota Small Intestine & Nutrition

Submission format

Abstract

Session

On bugs and food: New lessons in microbiomics and dietomics in IBD

Citation

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

Published

2026

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Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

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Surviving upper GI adverse events (Complete Session)

Summary

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Abstract

Event

UEG Week Barcelona 2026

Session

Surviving upper GI adverse events

Citation

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

Published

2026

More Like This:

Ostomy management

Revital Barkan

Barrett’s oesophagus and overdiagnosis: Pioneering the ‘less-is-more’ approach

Sanne van Munster

UEG Journal Best Paper Award

Mathias Cook

MICROBIOTA‑ORIENTED DIETARY PATTERN, PROTEOMIC MEDIATORS, AND INCIDENT INFLAMMATORY BOWEL DISEASE: A UK BIOBANK PROSPECTIVE COHORT STUDY

Rui Ji

Surviving upper GI adverse events (Complete Session)

GOING DEEP: THE EFFECT OF ULTRA-PROCESSED FOODS ON THE SMALL INTESTINE, A PILOT STUDY ON ILEOSTOMY PATIENTS

Yehuda Chowers

UEG Presentation

New

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

GOING DEEP: THE EFFECT OF ULTRA-PROCESSED FOODS ON THE SMALL INTESTINE, A PILOT STUDY ON ILEOSTOMY PATIENTS

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GOING DEEP: THE EFFECT OF ULTRA-PROCESSED FOODS ON THE SMALL INTESTINE, A PILOT STUDY ON ILEOSTOMY PATIENTS

Haggai Bar-Yoseph 1,2, Zohar Leshinsky 1, Yuval Molcho 1, Jonathan Sahar 2, Julia Belansky 2, Neta Milman 2, Tal Gefen 2, Alexandra Blatt 1, Sigal Pressman 1, Tarek Arraf 1, Rabiaa Fared 1, Inbar Kesten 1, Haim Gilshtein 1, Timothy Cooper 2, Maria Postnikov 1, Naama Geva-Zatorsky 2, Shai Shen-Orr 2, Yehuda Chowers 3

Affiliations

1 Rambam Health Care Campus, Haifa, Israel

2 Technion - Israel Institute of Technology, Haifa, Israel

3 CytoReason, Tel Aviv, Israel

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Abstract

Introduction

Epidemiological and clinical studies suggest that the consumption of ultra-processed foods (UPFs) is associated with an increased incidence of metabolic and immune-mediated diseases, including inflammatory bowel disease (IBD). However, little is known about the specific effects of UPF consumption on the human small intestine-the primary site of nutrient-host interactions and the major location of Crohn’s disease involvement.

Aims & Methods

Our aim was to comprehensively characterize the dynamic microbial and host transcriptional changes that occur in the human small intestine during exposure to a high-UPF (h-UPF) diet.
Patients with an ileostomy were recruited into a crossover study involving alternating 10-day periods of a nutritionist-guided high-UPF (h-UPF) or low-UPF (l-UPF) diet. At the end of each period, clinical samples including blood, ileostomy effluent, and mucosal biopsies were collected. Participants subsequently received a challenge meal representing the opposite diet, with repeat sampling performed 6 hours later to capture acute responses. Analysis included deep shotgun metagenomic sequencing of effluent and mucosal specimens, alongside mucosal transcriptomic profiling using both bulk RNA sequencing and spatial transcriptomics (CosMx platform). Paired statistical analyses were performed to identify significant differences between dietary conditions.

Results

Eleven participants (including 9 with stable IBD and 2 non-IBD) completed the study with high dietary compliance. No significant differences in macronutrient composition or fiber intake were observed between dietary periods. Luminal and mucosal small intestine microbiome communities were found to be distinct (Beta diversity, PERMANOVA q=0.001). Both niches were primarily composed of Bacillota (62-69%), Proteobacteria (20-22%), Actinomycetota (3-8%), and Bacteroidata (4-5%) phyla. While community dynamics were highly individual, differential abundance analysis using ANCOM-BC identified a significant enrichment of species from the Enterobacterales order following the h-UPF period (q<0.1). Specifically, enriched taxa included Escherichia albertii, Klebsiella variicola, Enterobacter cloacae, Salmonella enterica, and Citrobacter freundii. Concurrently, mucosal transcriptomic profiling revealed an increase in immune-related and inflammatory pathways after h-UPF consumption. These effects remained significant even after adjustment for cell composition using spatial data from the CosMx platform, suggesting that UPF consumption directly influences both cell migration and host regulatory pathways.

Conclusion

UPF consumption is associated with rapid and reproducible microbial and host transcriptional changes in the human small intestine. Using a unique ileostomy-based model, we demonstrate that these changes involve an enrichment of potentially pro-inflammatory bacteria and the activation of mucosal immune pathways previously linked to IBD activity. These findings provide mechanistic insights into how dietary UPFs may drive intestinal inflammation and underscore the need for further large-scale studies.

Disclosure

None

Event

UEG Week Barcelona 2026

Topics

Mechanisms & Personalised Medicine Small Intestine & Nutrition Immunology Endoscopy

Submission format

Abstract

Session

Decoding the upper GI tract using biomarkers

Citation

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

Published

2026

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Ostomy management

Revital Barkan

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Mathias Cook

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Rui Ji

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Yehuda Chowers