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Introduction

Achalasia is a primary motility disorder, which presented by dysphagia. The most effective treatment of the disease is surgical (peroral myotomy or laparoscopic myotomy). However, there are few studies which assess the changes in esophageal motility after surgery.

Aims & Methods

The aim of our study was evaluating the changes in esophageal manometry in patients with achalasia after peroral endoscopic myotomy (POEM).
Subjects and methods: 43 patients with achalasia were consequently observed before and 1 year after POEM. Females predominated (28 subjects). All patients examined endoscopically, then high resolution manometry (HRM) was performed by Solar™ GI (MMS/Laborie, Netherland). Achalasia was defined as described in Chicago Classification 4.0. Eight patients had I type of achalasia, 24 – II type and 11 – III type.

Results

The median Eckardt score was 7 on the start and 2 – after POEM in 35 patients (group A). However, 8 patients were dissatisfied with the surgery (4 pts with II type achalasia and 4 – III type). They continued to suffer from dysphagia and/or noncardiac chest pain (group B).
According to HRM the mean resting pressure of LES in group A reduced 2 folds from 39,1±2,7 mmHg to 18,9±1,4 mmHg. Also we revealed the dramatic decrease in integrated residual pressure (IRP) from 22,8±0,7 mmHg to 9,8±0,6 mmHg and DCI: from 1865,5±286,9 to 128,2±53,8. In a group B the mean resting pressure of LES reduced from 48,8±2,4 mmHg to 33,6±2,4 mmHg. The integrated residual pressure (IRP) decreased from 22,8±0,7 mmHg to 15,01±0,6 mmHg and DCI: from 2999,6±417,6 to 1038,1±107,7.
Even though, we didn’t observed the peristaltic waves in two groups before and after POEM as a normal manometric criteria: the consistent contraction of upper part of esophagus and then lower part of esophagus. Besides, HRM evaluated persisting spastic contraction in the middle and lower part of esophagus in patients with type III achalasia from group B. Two patients from group B with type II had good results in esophageal manometry.

Conclusion

The reduction of resting pressure, integrated resting pressure and distal contractile interval in several times can be accepted as criteria of POEM effectiveness. Besides, in patients with III type of achalasia we must assess the absence of spastic contraction as additional criteria of POEM satisfaction.

HIGH RESOLUTION ESOPHAGEAL MANOMETRY IN EVALUATION OF EFFICACY OF PERORAL ENDOSCOPIC MYOTOMY

Elen Valitova 1, Olga Berezina 2, Dmitry S. Bordin 3, Ivan Kanischev 2, Kirill Shishin 2

1 A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation|||Organizational and Methodological Department on Gastroenterology of Moscow Department of Health, 111111, Russian Federation

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

3 A.S. Loginov Moscow Clinical Scientific Center, Moscow, Russian Federation|||Russian University of Medicine, Moscow, Russian Federation|||Tver State Medical University, Tver, Russian Federation

Conference

UEG Week Vienna 2024

Topics

Oesophagus

Submission format

Abstract

Session

OESOPHAGEAL, GASTRIC AND DUODENAL (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Paradigm-shifting trials in GI: Origins of the Waterfall trial

Egle Dieninyte - Misiune 1, Enrique de-Madaria 2

1 Center of hepatology, gastroenterology and dietetics, Vilnius university Santaros Klinikos, Lithuania

2 Hospital General Universitario de Alicante, Alicante, Spain

Topics

Pancreas

Published

2023

UEG Standards and Guidelines

Consensus

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ABSTRACT

Introduction

Abdominal distension is an objective visible sign of increased abdominal girth. Bloating is a feeling of abdominal fullness and discomfort. Bloating may be associated or not with abdominal distension. Bloating and abdominal distension are among the most commonly reported gastrointestinal symptoms and may be associated with both organic and functional disorders. Nevertheless, specific consensus and recommendations on diagnosis, underlying mechanisms, assessment and management of functional bloating and abdominal distension are still lacking. The aim of this European consensus, then, is to provide expert opinions and recommendations on the epidemiology, diagnosis, pathophysiology and treatment of functional bloating and abdominal distension.

Methods

A multidisciplinary team of experts in the field, including European specialists and national societies, participated in the development of this consensus. Relevant questions were formulated and addressed through a literature review and statements were developed and voted using a Delphi process.

Results

Functional bloating and abdominal distension are common and frequently overlap with other disorders of gut-brain interaction. Diagnosis is made according to the Rome IV criteria after the exclusion of organic disease, based on the physical examination and assessment of the patient's medical history and alarming signs. In the absence of alarming signs or any relevant finding, clinical laboratory, imaging or endoscopic tests are unnecessary. The pathophysiology of functional bloating and abdominal distension is multifactorial and involves visceral hypersensitivity, abdomino-phrenic dyssynergia, intestinal dysmotility and dysbiosis. Treatment may include dietary modifications (e.g. lactose-limiting diet and low FODMAP diet), probiotics, antispasmodics (e.g., otilonium bromide, peppermint oil), rifaximin, secretagogues (e.g., linaclotide), neuromodulators (e.g., serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, buspirone), and plethysmography-based biofeedback. Moreover, cognitive behaviour therapy and hypnotherapy can be used in case of functional bloating associated with irritable bowel syndrome.

Conclusion

This consensus provides an evidence-based framework for the evaluation and treatment of patients with functional bloating and abdominal distension.

European Consensus on Functional Bloating and Abdominal Distension—An ESNM/UEG Recommendations for Clinical Management

Chloé Melchior

Publisher

European Society of Neurogastroenterology and Motility

Guideline

Consensus

Topics

Neurogastroenterology & Motility

Citation

United European Gastroenterology Journal, 2025; 13:1613–1651

Published

2025

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Introduction

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) induce weight loss, and have been associated with an overall decreased risk of esophageal cancer. Obesity is strongly associated with esophageal adenocarcinoma and substantial weight loss may decrease the risk of this malignancy, whereas weight loss does not decrease the risk of esophageal squamous cell carcinoma. We examined the hypotheses that GLP-1RA treatment decreases the risk of esophageal adenocarcinoma.

Aims & Methods

This population-based case-control study included all cases of esophageal adenocarcinoma and esophageal squamous cell carcinoma in adults who had dispensed medication for type 2 diabetes in Denmark (2007-2020), Finland (2011-2018), Iceland (2009-2019), Norway (2007-2019), or Sweden (2007-2020). For each case participant, >10 control participants who had dispensed medication for type 2 diabetes were randomly sampled from the general populations. Data came from well-validated nationwide health-data registries with prospectively collected data. Multivariable logistic regression provided odds ratios (OR) for esophageal adenocarcinoma and esophageal squamous cell carcinoma with 95% confidence intervals (CI), adjusted for sex, age, calendar year, country, comorbidity, obesity, alcohol overconsumption, and tobacco smoking.

Results

This study included 2,909 case participants with esophageal adenocarcinoma, 670 case participants with esophageal squamous cell carcinoma, and 55,408 control participants. The risk of esophageal adenocarcinoma was not decreased in GLP-1RA users compared with non-users (adjusted OR 1.3, 95% CI 1.1-1.5). However, the risk of esophageal squamous cell carcinoma was decreased (adjusted OR 0.5, 95% CI 0.3-0.8).

Conclusion

Standard GLP-1RA treatment in patients with type 2 diabetes might not decrease the risk of esophageal adenocarcinoma. Confounding by indication may have been the most important, or even the sole, contributor to the decreased risk of esophageal squamous cell carcinoma observed, although anticarcinogenic mechanisms of GLP-1RAs other than weight loss cannot be ruled out.

GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST TREATMENT AND RISK OF ESOPHAGEAL CANCER

Johan Hardvik Åkerström 1, Giola Santoni 1, My von Euler-Chelpin 2, Helgi Birgisson 3, Eivind Ness-Jensen 4, Joonas H. Kauppila 5, Dag Holmberg 1, Jesper Lagergren 1

1 Karolinska Institutet, Stockholm, Sweden

2 University of Copenhagen, Copenhagen, Denmark

3 The Icelandic Cancer Registry, Reykjavik, Iceland

4 Norwegian University of Science and Technology, Levanger, Norway

5 University of Oulu, Oulu, Finland

Conference

UEG Week Berlin 2025

Topics

Oesophagus

Submission format

Abstract

Session

Barrett's oesophagus and oesophageal cancer (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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DCC SALIVARY METHYLATION ANALYSIS IS NONINVASIVE AND USEFUL METHOD FOR SCREENING PATIENTS WITH SUPERFICIAL HYPOPHARYNGEAL CANCER

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Introduction

With the progress of endoscopic technology, the usefulness of endoscopic early diagnosis and treatment of hypopharyngeal cancer has been reported¹. However, it is unfeasible to perform detailed pharyngeal observation requiring sedation for all subjects undergoing upper gastrointestinal endoscopy. There is an urgent need to establish a minimally invasive and simple evaluation method for high-risk patients with hypopharyngeal cancer.

Aims & Methods

The aim of this study is to verify the diagnostic accuracy of superficial hypopharyngeal cancer by salivary DNA promotor methylation analysis. Sixty-one patients with superficial hypopharyngeal cancer who underwent endoscopic resection at Okayama University Hospital (derivation cohort), 23 patients at Hiroshima City Hospital (validation cohort), and 51 healthy controls were recruited. We assessed DNA methylation values of four genes: Deleted in Colorectal Cancer (DCC); Prostaglandin D2 Receptor 1 (PTGDR1); Endothelin Receptor β (EDNRB); and E Cadherin (ECAD) in tissue and saliva samples by quantitative methylation-specific PCR for bisulfite converted DNA.

Results

In the resected tissue samples, DCC (methylation value in normal mucosa: 3.94, in cancer: 12.1; p=0.003), EDNRB (11.84, 29.9; p=0.001), and ECAD (1.09, 4.73; p=0.043), showed significant differences in the amount of methylation between cancer and non-cancer site, except PTGDR1 (3.3, 4.33; p=0.47). When performing receiver operating characteristic analysis of salivary methylation for superficial pharyngeal cancer diagnosis in the derivation cohort, the area under the curve (AUC) of DCC was 0.917 (95% confidence interval (CI): 0.864 - 0.97), while the AUC of EDNRB and ECAD were 0.68 (95%CI: 0.576 - 0.784) and 0.639 (95%CI：0.441 - 0.838), respectively. With the cutoff for the DCC methylation value in saliva samples setting at ≥ 0.163%, the sensitivity to detect hypopharyngeal cancer was 83.6% with a specificity of 90.2%. Applying this cutoff value to 23 cases of the validation cohort, 18 cases (78.3%) of superficial hypopharyngeal cancer patients were detectable.

Conclusion

In hypopharyngeal cancer patients, salivary DNA methylation analysis of DCC showed high diagnostic accuracy even at the stage of superficial cancer. Saliva can be collected easily and noninvasively, and could be a useful tool for picking up patients who are at high-risk for hypopharyngeal cancer.

References

1. Muto M, Minashi K, Yano T, et al. Early detection of superficial squamous cell carcinoma in the head and neck region and esophagus by narrow band imaging: a multicenter randomized controlled trial. J Clin Oncol 2010; 28: 1566-1572.

DCC SALIVARY METHYLATION ANALYSIS IS NONINVASIVE AND USEFUL METHOD FOR SCREENING PATIENTS WITH SUPERFICIAL HYPOPHARYNGEAL CANCER

Ryosuke Hirai 1, Hideaki Kinugasa 1, Soichiro Ako 1, Koichiro Tsutsumi 1, Makoto Abe 2, Koji Miyahara 2, Masahiro Nakagawa 2, Motoyuki Otsuka 1

1 Okayama University Hospital, Okayama, Japan

2 Hiroshima City Hospital, Hiroshima, Japan

Event

UEG Week Copenhagen 2023

Topics

Digestive Oncology Mechanisms & Personalised Medicine Oesophagus Stomach & H. Pylori

Submission format

Abstract

Session

Molecular roadway to upper GI cancer

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Introduction

Low fermentable oligo-, di-, and monosaccharides and polyol (FODMAP) diet is currently recommended for the treatment of irritable bowel syndrome (IBS). However, long-term adherence is not high due to its complex nature.
Recently, ChatGPT (OpenAI, San Francisco, California, USA), a large scale unsupervised language model, was introduced as an easily accessible internet based chat, and demonstrated unprecedented capabilities of processing natural conversations and the ability to provide insightful and comprehensive replies.

Aims & Methods

In this brief proof of concept study, we aimed to evaluate the feasibility of using ChatGPT as a readily available guide for adherence to a low FODMAP diet.
We presented ChatGPT with 3 sets of questions concerned with low FODMAP:
(1) 10 questions in the form of “is Bⁱ low FODMAP” were prompted to ChatGPT in which Bⁱ is the i element of a list of 10 base products, 5 of which are considered low FODMAP, and 5 high FODMAP; We chose base products upon which there was unanimous agreement among different available lists of FODMAP-containing foods.
(2) 10 questions in the form of “is Dⁱ low FODMAP” were prompted to ChatGPT in which Dⁱ is the i element of a list of 10 popular dishes, 5 of which are considered low FODMAP, and 5 high FODMAP
(3) 7 questions in the form of “suggest a low FODMAP Cⁱ recipe” were prompted to ChatGPT in which Cⁱ is the I course of a traditional 7 course meal.
Questions and answers were then presented to two dietitians from our gastroenterology institute (M.D and C.P), both experienced in the care of IBS patients and low FODMAP guidance.
Dietitians were independently asked to grade each answer as correct or incorrect, and check whether they would use this answer as future recommendation for patients.

Results

A complete agreement between the two dietitians was observed (100% same review of chatGPT answers).
Out of the 27 submitted questions, 22 answers were reviewed as correct (81%).
From the 5 answers that were deemed as wrong, 4 (80%) were from the base products list, and 3 of these 4 were of high FODMAP base products. The additional wrong answer was from the popular dishes list, in which, a dish that contained high FODMAP ingredients was suggested as low FODMAP by the ChatGPT answer.
In the dishes and recipes section ChatGPT provided suggestions for alternative ingredients and food preparation techniques that would make the dishes low FODMAP. All the suggestions were deemed as correct by both dietitians.

Conclusion

ChatGPT perfomed well in answering questions regarding low FODMAP diet. It could possibly be used as an auxiliary tool for daily decisions on low FODMAP diet.

USE OF CHATGPT AS A GUIDE FOR LOW FODMAP DIET ADHERENCE: A PROOF-OF-CONCEPT STUDY

Itai Ghersin 1, Rita Brun 1, Moriya Damari 1, Chiley Pinhas 1, Yuri Gorelik 1

1 Rambam Health Care Campus, Haifa, Israel

Conference

UEG Week Copenhagen 2023

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

PP 04 Nutrition (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Introduction

Dietary regimens for symptom management in irritable bowel syndrome (IBS) include a low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) diet and a gluten-free diet. However, scientific evidence supporting these dietary recommendations for managing IBS symptoms is weak: trials have been non-blinded and underpowered, while mechanistic understanding and objective markers of response remain scarce.

Aims & Methods

We therefore conducted a large double-blind study to investigate the effect of FODMAPs and gluten on symptomatic and molecular data including gut microbiota and the metabolome, both at a group and subgroup (differential response) level. Moreover, the accuracy of the Bristol Stool Form Scale (BSFS) used in IBS subtype diagnosis was assessed, and thus overcome the lack of objective evaluation of IBS symptoms. The results were recently collected in a doctoral thesis.

Results

Trial data revealed that gluten caused no symptoms and that FODMAPs triggered only modest symptoms of IBS. Subjective reporting according to the BSFS conformed only modestly with stool water content. FODMAPs increased saccharolytic microbial genera, phenolic-derived metabolites and 3-indolepropionate, but decreased bile acids. Saccharolytic genera correlated with increased plasma concentrations of phenolic-derived metabolites and 3-indolepropionate, metabolites related to decreased risk of incident type 2 diabetes and inflammation. Indeed, among FODMAP-related metabolites, only weak correlations to IBS symptoms were detected, as with 3-indolepropionate to abdominal pain and interference with quality of life, warranting further investigation. Gluten displayed a modest effect on metabolites involved in lipid metabolism, but with no interpretable link to health. No molecular biomarkers of a differential response to the challenges were found, despite comprehensive exploration with multiple analytical approaches. This could be explained by the absence of baseline variables, such as other omics layers or psychological factors, that could have determined the difference.

Conclusion

Diet only had a modest effect on IBS symptoms. Caution should be taken when subtyping IBS with BSFS.

EFFECTS OF FODMAPS AND GLUTEN ON IRRITABLE BOWEL SYNDROME - FROM SELF-REPORTED SYMPTOMS TO MOLECULAR PROFILING

Elise Nordin 1, Elise Nordin 1, Rikard Landberg 1, Per Martin Hellström 2

1 Chalmers Univerisity of Technology, Gothenburg, Sweden

2 Uppsala University, Uppsala, Sweden

Conference

UEG Week Copenhagen 2023

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

PP 04 Nutrition (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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