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All GORD symptoms are not the same: How may a better understanding of pathophysiology change the diagnostic approach?

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All GORD symptoms are not the same: How may a better understanding of pathophysiology change the diagnostic approach?

Daniel Sifrim 1

Affiliations

1 Queen Mary University London, Blizard Institute, London, United Kingdom

Summary

AI Generated

Understanding the pathophysiology of different reflux-related symptoms enables tailored diagnostic approaches, with specific testing methods matched to symptom mechanisms.

Basal impedance can identify mucosal integrity damage in the 65% of heartburn patients without esophagitis who have dilation of intercellular spaces and immunological infiltration.
Persistent postprandial regurgitation on PPIs, particularly in young women, may indicate rumination rather than refractory reflux and can be diagnosed using HRM with impedance showing high-frequency early postprandial retrograde flow with 100% symptom correlation.
Oesophageal chest pain may result from acid reflux, hypersensitivity to distension, hypercontractility, or oesophageal shortening during longitudinal muscle contraction, which can be evaluated with high-resolution manometry during meals.
The speaker stated that proximal extent of reflux determines symptom perception because the proximal oesophagus has more superficial afferent nerves and greater sensitivity than the distal oesophagus.
Distinguishing whether reflux precedes cough or cough provokes reflux is clinically critical because the treatments differ—anti-reflux therapy versus cough suppressants.
Hypervigilance, a psychological phenomenon common in hypersensitive oesophagus, can be quantified using a questionnaire and represents an important component of oesophageal hypersensitivity.

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Abstract

Event

UEG Postgraduate Teaching Programme Vienna 2024

Topics

Education & Training Neurogastroenterology & Motility Oesophagus Primary Care Stomach & H. Pylori Surgery

Session

Management of GORD in 2024

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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UEG Presentation

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Panel discussion: Therapy update - EoE

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Abstract

Event

UEG Week Berlin 2025

Topics

Mechanisms & Personalised Medicine Small Intestine & Nutrition Oesophagus Paediatrics

Session

Therapy update: EoE

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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UEG Presentation

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Diet: 1,6, or more?

Alfredo J. Lucendo 1

Affiliations

1 Hospital General de Tomelloso, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Tomelloso, Spain

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Abstract

Event

UEG Week Berlin 2025

Topics

Mechanisms & Personalised Medicine Small Intestine & Nutrition Oesophagus Paediatrics

Session

Therapy update: EoE

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Diet: 1,6, or more?

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Oesophagus diseases

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UEG Presentation

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Oesophagus diseases

Karthik Ravi 1

Affiliations

1 Mayo, None, United States of America

Summary

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Abstract

Event

UEG Week Vienna 2024

Topics

Endoscopy Gut Microbiota IBD Oesophagus Stomach & H. Pylori

Session

Best of DDW

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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UEG Presentation

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

Panel discussion: ABC of the EAS and the IAS - Why physiology matters when managing faecal incontinence

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Panel discussion: ABC of the EAS and the IAS - Why physiology matters when managing faecal incontinence

Summary

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Abstract

Event

UEG Postgraduate Teaching Programme Vienna 2024

Topics

Colorectal Education & Training Neurogastroenterology & Motility

Session

ABC of the EAS and the IAS: Why physiology matters when managing faecal incontinence

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Mercè Navarro

UEG Presentation

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

Management of peptic ulcer disease: Conventional and new therapeutic options

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Management of peptic ulcer disease: Conventional and new therapeutic options

Tomica Milosavljevic 1

Affiliations

1 University of Belgrade Clinical Center of Serbia Gastroenterology and Hepatolog, Belgrade, Serbia

Summary

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Abstract

Event

UEG Postgraduate Teaching Programme 2023

Topics

Endoscopy Oesophagus Radiology & Imaging Small Intestine & Nutrition Stomach & H. Pylori Surgery

Session

Peptic ulcer disease continues to call for vigilance

Published

2023

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Mercè Navarro

UEG Presentation

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

HIV INFECTION IS ASSOCIATED WITH A LESS AGGRESSIVE PHENOTYPE OF INFLAMMATORY BOWEL DISEASE. A MULTICENTER STUDY BASED ON THE ENEIDA REGISTRY

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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HIV INFECTION IS ASSOCIATED WITH A LESS AGGRESSIVE PHENOTYPE OF INFLAMMATORY BOWEL DISEASE. A MULTICENTER STUDY BASED ON THE ENEIDA REGISTRY

Margalida Calafat Sard 1, Carles Suria Bolufer 2, Francisco Mesonero Gismero 3, Ruth María de Francisco García 4, Carmen Yagüe Caballero 5, Luisa De la Peña 6, Alejandro Hernández-Camba 7, Ainhoa Marcé 8, Beatriz Gallego 9, NOELIA MARTÍN VICENTE 10, Montserrat Rivero 11, Isabel Iborra colomino 12, Iván Guerra 13, Marta Carrillo Palau 14, Lucía Madero 15, Beatriz Burgueño 16, David Monfort Miquel 17, Gisela Torres-Vicente 18, Marta Teller 19, JUAN ANGEL FERRER ROSIQUE 20, Pablo Vega 21, Cristina Roig Ramos 22, Ángel Ponferrada-Díaz 23, Elena Betoré 24, Yamile Zabana 25, Javier Gisbert 26, David Busquets Casals 27, Noelia Alcaide 28, Blau Camps Aler 29, Jesús Legido Gil 30, Maria González-Vivó 31, Unknown Unknown 32, Isabel Pérez-Martínez 33, Diego Casas Deza 34, Jordi Guardiola 35, Laura Arranz Hernández 36, Mercè Navarro 37, Fernando Gomollón 38, Fiorella Cañete 39, Miriam Mañosa Ciria 39, Eugeni Domenech Morral 40

Affiliations

1 Hospital Universitari Germans Trias i Pujol, Barcelona, Spain|||CIBEREHD, Madrid, Spain

2 Hospital Clínic Universitari de València, Universitat de València, Valencia, Spain

3 Hospital Universitario Ramon y Cajal, Madrid, Spain

4 Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain

5 Hospital Universitario Miguel Servet, Zaragoza, Spain

6 Hospital Universitari de Bellvitge, L'hospitalet del Llobregat, Spain

7 Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain

8 Hospital de Sant Joan Despí Hospital Moisès Broggi, Sant Joan Despí, Spain

9 Hospital Clínico Universitario «Lozano Blesa», Instituto de Investigación Sanitaria, Zaragoza, Spain

10 Hospital Hospital Universitario de Galdakao, Galdakao, Spain

11 Marqués de Valdecilla Universitary Hospital, Santander, Spain

12 La Fe Universitary and Politecnic Hospital, Valencia, Spain

13 Hospital Universitario de Fuenlabrada, Madrid, Spain

14 Hospital Universitario de Canarias, Islas Canarias, Spain

15 Hospital General Universitario Dr Balmis de Alicante. ISABIAL, Alicante, Spain

16 Hospital Rio Hortega, Valladolid, Spain

17 Consorci Sanitari de Terrassa, Terrassa, Spain

18 Hospital Arnau De Vilanova, Lerida, Spain

19 Althaia, Xarxa Assistencial Universitària de Manresa, Manresa, Spain

20 Hospital Universitario Fundación Alcorcón, Alcorcón, Spain

21 Complexo Hospitalario Universitario de Ourense, Ourense, Spain

22 Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain

23 Hospital Infanta Leonor, Madrid, Spain

24 Hospital Universitario San Jorge, Huesca, Spain

25 Hospital Universitari Mútua Terrassa, Terrassa, Spain|||CIBEREHD, Madrid, Spain

26 CIBEREHD, Madrid, Spain|||Hospital Universitario de la Princesa, IIS-Princesa, Madrid, Spain|||UAM, Madrid, Spain

27 H. DE GIRONA DR. J. TRUETA/ICO GERONA, Girona, Spain

28 Hospital Clínico Universitario de Valladolid, Valladolid, Spain

29 Hospital de Granollers, Granollers, Spain

30 Complejo Asistencial de Segovia, Segovia, Spain

31 Hospital Parc de Salut Mar, Barcelona, Spain

32 Universitat de Valencia, Valencia, Spain|||Hospital Clínic Universitari de València, Valencia, Spain

33 Hospital Universitario Central de Asturias, Oviedo, Spain

34 Hospital Universitario Miguel Servet, Zaragoza, Spain|||Instituto de Investigación Sanitaria de Aragón (IISA), Aragón, Spain

35 Hospital Universitario de Bellvitge, L'Hospitalert de LLobregat (Barcelona), Spain

36 Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain

37 Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain

38 Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain|||CIBEREHD, Madrid, Spain

39 CIBEREHD, Madrid, Spain|||Hospital Universitari Germans Trias i Pujol, Badalona, Spain

40 CIBEREHD, Madrid, Spain|||Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain

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Abstract

Introduction

The coexistence of immune-mediated diseases and non-pharmacological immunosuppression states are rare and might determine the natural history of the disease and therapeutic decisions of the physician. IBD guidelines recommend screening for human immunodeficiency virus (HIV) before starting immunosuppressive treatment, but data on the impact of HIV infection on IBD and its management in the era of biological drugs are scarce.

Aims & Methods

Aims: Therefore, our aim was to describe the IBD phenotype, immunosuppressive requirements, and prevalence of opportunistic infections (OI) in patients with IBD and coexisting HIV infection.
Methods: Case-control, retrospective, multicenter study including all IBD patients with available HIV serology on the ENEIDA registry (a large, prospectively maintained database of the Spanish Working Group in IBD –GETECCU). IBD patients with positive HIV serology were selected (HIV+) and compared to HIV seronegative IBD patients (controls), matched 1:3 by year of IBD diagnosis, age, gender and type of IBD. Demographic, clinical IBD characteristics, therapeutic requirements, OI and IBD complications were registered.

Results

Ninety-one HIV+ IBD patients and 273 controls were included. In the whole cohort, 81.3% were men, 58.2% had ulcerative colitis (UC), 35.2% Crohns’ disease (CD) and 6.6% IBD unclassified. Median age at IBD diagnosis was 38 years (IQR 30-48), median age at HIV infection diagnosis was 36 years (IQR 30-42), 49.5% being firstly diagnosed of IBD. Among UC patients, HIV+ had a lower proportion of extensive disease (24.5% vs. 46.5%; P=0.002), and a higher proportion of proctitis (39.6% vs. 15.1%; P<0.001) than controls, without differences on disease proximal progression (11.3% vs. 10%). Among CD patients, HIV+ presented a higher proportion of colonic involvement than controls (40.1% vs. 12.5%, P=0.002) and lower penetrating behavior (9.4% vs. 24%; ns). HIV+ had a lower proportion of extraintestinal manifestations (9.9% vs. 24.9%; P=0.004). Although it was not statistically significant, a trend towards a lower proportion of hospitalizations (25.6% vs. 35.3%) and IBD complications (6.3% vs. 9.2%) in HIV+ was observed. Regarding IBD therapeutic requirements, immunosuppressant (37.4% vs. 57.9%; P=0.001) and biological drugs (26.4% vs. 42.1%; P=0.007) were used less frequently among HIV+ than among controls. Conversely, HIV+ had a higher rate of OI (28.6% vs. 9.5%; P<0.001) and malignancies (13.2% vs. 8.8%, ns) than controls.

Conclusion

The coexistence of IBD and HIV infection seems to be associated with a less aggressive IBD phenotype and a lower use of immunosuppressants and biologicals but with a remarkable rate of OI.

Disclosure

I have served as a speaker, consultant and advisory member for or has received research funding from Takeda, Gilead, Janssen, Faes Farma, FalK and MSD

Event

UEG Week Copenhagen 2023

Topics

IBD Paediatrics

Submission format

Abstract

Session

IBD aetiology

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Mercè Navarro

UEG's educational platform for gastroenterology education bringing recordings, courses, guidelines, and more together in one place.

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