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Introduction

Eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) may coexist. The role of GERD in histologically PPI (proton pump inhibitors)-refractory (PPI-R) EoE has been poorly investigated.

Aims & Methods

We characterized ambulatory reflux monitoring findings and heartburn outcomes in PPI-R EoE patients undergoing 96-h wireless pH monitoring (WPM) or 24-h pH-impedance (MII-pH). In this international study conducted in two EoE referral centres, we enrolled consecutive patients with EoE who did not achieve histological remission with PPIs (≥15 eosinophils/high-power field) and subsequently underwent off-PPIs reflux monitoring. Demographics, symptoms, medical history, endoscopy findings at index endoscopy, and heartburn resolution following a 12-week course of PPI were retrospectively reviewed. Acid exposure time (AET), number of refluxes, and symptoms index and association probability (SI/SAP) were calculated for MII-pH and WPM. Mean nocturnal baseline impedance and post-reflux swallowed induced peristaltic wave index were also calculated for MII-pH. Validated diagnostic thresholds for reflux monitoring and Rome IV criteria were used to formulate each diagnosis. Data are described as median and interquartile range (Q1-Q3) or as counts and percent. Kruskal-Wallis Rank Sum Test was used for continuous data, and Pearson’s Chi-Square test and Fisher’s exact test for counts. Significance threshold was p<0.05.

Results

Among 73 included patients, 54.8% (n=40) had MII-pH, and 45.2% (n=33) had WPM. The prevalence of conclusive GERD was 34.2% (25/73). Among those with normal AET (65.7%, 48/73), 20.8% had positive SI/SAP, while 79.2% had negative SI/SAP. Conclusive GERD was more frequent on WPM (48.5% vs 22.5%, p=0.02), while absence of GERD was more frequent on MII-pH (77.5% vs 51.5%, p=0.02). There was no difference in the prevalence of SI/SAP positivity between MII-pH and WPM. Heartburn was reported in 76.0% of GERD patients and in 66.6% of those without GERD (p=0.41). Patients with GERD and those without GERD received similar doses of PPIs. Among the 28 patients who were assessed for heartburn resolution, those with normal AET combined with SI/SAP positivity had similar response to PPIs compared to those with GERD (60.0% vs 61.1%; p>0.99).

Conclusion

1. Among PPI-R EoE, only one third has GERD, suggesting that an abnormal AET has a limited role in PPI refractoriness. 2. Heartburn response to PPIs does not predict conclusive GERD in patients with EoE. 3. Although per Rome IV criteria EoE should be ruled out to diagnose reflux hypersensitivity, a proportion of EoE patients with a normal AET has positive symptom-reflux correlation suggesting a possible overlap. In this setting, PPIs provided heartburn resolution in most patients regardless of histologically active EoE.

	Conclusive GERD (25)	No GERD evidence (48)	p value
Age at diagnosis	45 (31-51)	33 (28-41)	0.03
Male sex (n)	64.0%	68.7%	0.68
Heartburn	76.0%	66.6%	0.41
Dysphagia	96.0%	88.0%	0.41
Chest Pain	12.0%	12.0%	>0.99
Nausea/dyspepsia/abdominal pain	8.0%	8.3%	>0.99
Food Impaction	28%	38%	0.42
PPI dose (mg)	40 (32-80)	40 (40-80)	0.66
Number of patients with heartburn response to PPIs	61.1%	60.0%	>0.99

GASTROESOPHAGEAL REFLUX DISEASE IS UNCOMMON IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS REFRACTORY TO PROTON PUMP INHIBITORS

Pierfrancesco Visaggi 1, Federica Baiano Svizzero 1, Giulio Del Corso 2, Terence Wong 3, Jason M. Dunn 3, Edoardo Vincenzo Savarino 3, Nicola de Bortoli 1, Sebastian S. Zeki 3

1 Gastroenterology Unit, University of Pisa, Pisa, Italy

2 Institute of Information Science and Technologies “A. Faedo”, National Research Council of Italy (CNR), Pisa, Italy

3 St Thomas' Hospital, London, United Kingdom

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

All about EoE (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Standards and Guidelines

Position Paper

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Abstract

Objectives

Videofluoroscopic swallowing studies (VFSS) remain the gold standard for the instrumental assessment of oropharyngeal swallowing disorders alongside flexible endoscopic evaluation of swallowing (FEES), requiring a high standard of quality and correct implementation. The current best practice position statements aim to guide the clinical practice of VFSS in individuals experiencing swallowing disorders.

Materials and methods

An international expert consensus panel with expertise in oropharyngeal dysphagia, comprised of radiologists, speech-language therapists, otolaryngologists, and other professionals in the field, convened by the European Society of Swallowing Disorders (ESSD) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), developed best practice position statements. They were established using an online Delphi methodology involving an online panel discussion and item preparation and three consecutive rounds. Consensus was reached when ≥ 80% of the participants agreed on a specific recommendation.

Results

Eighteen best practice position statements were formulated, thereby establishing standard recommendations on the technical performance of VFSS. They cover VFSS planning, correct implementation, documentation, radiation protection, equipment and maintenance, and education and training.

Conclusion

These position statements summarise the panel’s deliberations and recommendations in performing VFSS, representing the agreed consensus of experts from ESSD and ESGAR. They provide a structured framework for optimising and standardising the performance of VFSS in patients with swallowing disorders.

Key Points

Question Significant regional and national differences in clinical practice when performing VFSS highlight the need for interdisciplinary recommendations to optimise patient care.

Findings Eighteen statements were developed by representatives of the ESSD and the ESGAR.

Clinical relevance These best practice position statements on the technical performance of VFSS may serve as a basis for standardising the procedure and ensuring high-quality service.

ESSD–ESGAR best practice position statements on the technical performance of videofluoroscopic swallowing studies in adult patients with swallowing disorders

Martina Scharitzer

Publisher

European Society of Gastrointestinal and Abdominal Radiology

Guideline

Position Paper

Topics

Radiology & Imaging

Citation

Eur Radiol 35, 3169–3180 (2025)

Published

2024

UEG Standards and Guidelines

Clinical Practice Guideline

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Summary

Extrahepatic abdominal surgery in patients with cirrhosis of the liver represents a growing clinical challenge due to the increasing prevalence of chronic liver disease and improved long-term survival of these patients. The presence of cirrhosis significantly increases the risk of perioperative morbidity and mortality following abdominal surgery. Advances in preoperative risk stratification, surgical techniques, and perioperative care have led to better outcomes, yet integration of these improvements into routine clinical practice is needed. These clinical practice guidelines provide comprehensive recommendations for the assessment and perioperative management of patients with cirrhosis undergoing extrahepatic abdominal surgery. An individualised patient-centred risk assessment by a multidisciplinary team including hepatologists, surgeons, anaesthesiologists, and other support teams is essential.

EASL Clinical Practice Guidelines on extrahepatic abdominal surgery in patients with cirrhosis and advanced chronic liver disease

Publisher

European Association for the Study of the Liver

Guideline

Clinical Practice Guideline

Topics

Hepatobiliary Surgery

Citation

Journal of Hepatology; 2025

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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ABSTRACT

Importance

The lack of multidisciplinary workflow guidelines and clear definitions and classifications for neoplasms in and around the ampulla of Vater results in inconsistencies affecting patient care and research.

Objective

The PERIPAN international multidisciplinary consensus group aimed to standardize the multidisciplinary diagnostic workflow and achieve consensus on definitions and classifications in order to ensure proper classification and optimal diagnostic assessment and consequently to improve patient care and future research.

Design

An international team of 43 experts (pathologists, surgeons, radiologists, gastroenterologists, oncologists) from 12 countries identified knowledge gaps, reviewed 37061 articles, and proposed recommendations using the Scottish Intercollegiate Guidelines Network methodology (SIGN), including the Delphi methodology and the AGREEII tool for quality assessment and external validation.

Results

The 38 consensus questions and 51 recommendations provide guidance on the following key aspects: I. More specific anatomic criteria for the definition of what qualifies as “ampullary” neoplasms, their distinction from duodenal and common bile duct tumors, and clinicopathologic characteristics of anatomic subsets; II. Avoidance of the confusing term “periampullary” for final classification; III. Refined definitions of intestinal, pancreatobiliary and mixed subtypes, and introduction of rare histologic subtypes; IV. The use and limitations of immunohistochemical and molecular profiling; V. Biopsy acquisition; VI. Clinical information required for accurate pathology assessment of biopsies and ampullectomy specimens; VII. Key items to be included in pathology reports of endoscopic specimens.

Conclusions and Relevance

Recognition of the Brescia PERIPAN guidelines will allow a more accurate classification of true ampullary cancers and their differentiation from other “periampullary” tumors. This will have significant implications for endoscopic interpretation and management, staging, pathologic diagnosis and therapeutic evaluation as well as oncologic treatment of various anatomic and histologic subsets of ampullary tumors. This will enhance the quality of both clinical care and future research in this complex medical field.

The Brescia International Multidisciplinary Consensus Guidelines on the Optimal Pathology Assessment and Multidisciplinary Pathways of Non-Pancreatic Neoplasms in and Around the Ampulla of Vater (PERIPAN)

Mohammad Abu Hilal

Guideline

Clinical Practice Guideline

Topics

Digestive Oncology

Citation

United European Gastroenterology Journal: 1–21.

Published

2025

UEG Podcast Episode

UEG Podcast

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BOSS update: Oesophageal cancer with Massimiliano Di Pietro (bonus episode)

Massimiliano di Pietro, Pradeep Mundre

Topics

Digestive Oncology Endoscopy Oesophagus

Published

2025

UEG Podcast Episode

UEG Podcast

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The Future of Faecal Microbiota Transplantation (FMT) with Maria Vehreschild

Maria J. G. T. Vehreschild, Pradeep Mundre

Topics

Small Intestine & Nutrition

Published

2025

UEG Presentation

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MANAGEMENT OF SEVERE EROSIVE GASTROESOPHAGEAL REFLUX DISEASE (EGERD) WITH HIGH-DOSE PROTON PUMP INHIBITORS: INTERIM RESULTS FROM A REAL-WORLD OBSERVATIONAL STUDY (POWER 3.0)

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Introduction

Treatment response in patients with severe erosive gastroesophageal reflux disease (eGERD) is often inadequate using regular doses of proton pump inhibitors (PPIs), thus necessitating escalation of dosing. High-dose PPIs improve compliance in such patients, leading to better outcomes. However, comparative data on effectiveness of high-dose PPIs is limited.

Aims & Methods

This interim analysis assessed symptomatic improvement of regurgitation in an ongoing, prospective, real-world, observational study to compare the effectiveness of rabeprazole 40mg to pantoprazole 80mg and omeprazole 40mg/esomeprazole 80mg. Adult patients with endoscopically confirmed severe eGERD were enrolled. Patients shifted from low-dose PPIs or started on high-dose PPIs were included; those with complications of GERD were excluded.

Results

A total of 260 patients (rabeprazole, 130; omeprazole/esomeprazole, 65; pantoprazole, 65) from 37 sites in India were analyzed. Although symptomatic improvement of diurnal and nocturnal regurgitation based on patient-reported severity scores was observed among the three arms after 4±1 weeks of treatment, the complete-resolution rate of diurnal regurgitation was significantly higher with rabeprazole (17.97%) compared to omeprazole/esomeprazole (5.08%; p=0.018) and higher than pantoprazole (8.20%; p=0.077). Similarly, complete resolution of nocturnal regurgitation was significantly higher with rabeprazole (14.06%) compared to omeprazole/esomeprazole (1.59%; p=0.007) and higher than pantoprazole (7.94%; p=0.221). Among patients with associated work-related stress (n=132), one-fifth in the rabeprazole arm experienced complete resolution of diurnal regurgitation compared to none in the omeprazole/esomeprazole (p=0.013) or pantoprazole (p=0.030) arms. Patients with lack of regular physical exercise (83.08%) exhibited higher rate of complete resolution of nocturnal regurgitation with rabeprazole (13.73%) compared to the other PPIs. Overall, elderly patients >60 years of age (mean±SD, 68.82±6.54 years) treated with rabeprazole showed significantly higher complete-resolution rates of diurnal regurgitation compared to pantoprazole (36.67% vs. 0%; p=0.003). For complete resolution of nocturnal regurgitation, rabeprazole proved to be significantly better when compared to omeprazole/esomeprazole (31.25% vs. 0%; p=0.015) in elderly patients (Table 1).

Conclusion

The interim results showed that rabeprazole led to significantly higher complete-resolution rates of diurnal and nocturnal regurgitation at 4±1 weeks of treatment than omeprazole/esomeprazole in adults with severe eGERD. In elderly patients, rabeprazole showed significant resolution over pantoprazole.

Disclosure

Study funded by: Dr. Reddy's Laboratories Ltd., Hyderabad, Telangana, India

MANAGEMENT OF SEVERE EROSIVE GASTROESOPHAGEAL REFLUX DISEASE (EGERD) WITH HIGH-DOSE PROTON PUMP INHIBITORS: INTERIM RESULTS FROM A REAL-WORLD OBSERVATIONAL STUDY (POWER 3.0)

Mahesh Goenka 1, Kranthi Pebbili 2, Balakrishna Namala 2

1 Apollo Gleneagles Hospitals, Kolkata, India

2 Dr Reddys Laboratories Ltd, Hyderabad, India

Event

UEG Week Berlin 2025

Topics

Digestive Oncology Endoscopy Neurogastroenterology & Motility Oesophagus Stomach & H. Pylori

Submission format

Late-Breaking Abstract

Session

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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