Introduction

Inflammatory Bowel Disease (IBD) is characterized by intestinal plasma cell infiltration and immune dysregulation. Although B cell-specific PTIP deletion alleviates acute DSS-induced colitis, its role in chronic colitis via B cell-macrophage crosstalk was unknown. Here, we show that PTIP deficiency in B cells ameliorates chronic colitis by enhancing macrophage IL-10 production.

Aims & Methods

To investigate the protective mechanisms mediated by B cell-specific PTIP deficiency in IBD.
PTIP expression analysis (PCR, IBD patient B cells). Model of chronic colitis: PTIP^-/- mice (CD19^cre/+PTIP^flox/flox, Jackson Lab) and wild-type (WT) mice received 2% DSS solution for 7 days + pure water for 7 days, 4 cycles. Antibody quantification (ELISA: serum/feces). B cell transplantation: Splenic B cells (A-CD43 beads) → 1×10⁶ cells i.v. to NCG mice (severely immunodeficient, lacking B/T/NK cells) post-DSS. Flow Cytometry.

Results

PTIP expression was upregulated in B cells of IBD patients and early DSS-colitis mice. PTIP-deficient (PTIP^-/-) mice showed milder colitis (reduced weight loss, DAI, histopathology, and splenomegaly), accompanied by altered immune profiles: increased splenic T cells (↓CD4⁺/CD8⁺ ratio, p=0.02), fewer germinal centers/plasma cells, reduced antibodies, and elevated colonic CD8⁺ T cells (p=0.01). These data establish PTIP as a colitis amplifier via B cell-driven immunomodulation.
Splenic B cells (activated B cells and plasma cells) from WT+DSS or PTIP^-/-+DSS mice were transferred into NCG colitis models. PTIP^-/- recipients showed reduced serum IgM/IgA (p = 0.004/0.001) without differences in weight, DAI, or histopathology. Passive serum transfer altered IgG1/IgM levels but did not affect disease severity, confirming that PTIP-deficient B cells attenuate inflammation via a non-antibody-mediated mechanism.
Naïve B cells (CD19⁺CD43⁻) from WT/PTIP^⁻/⁻ mice were transferred into NCG mice pre-DSS. PTIP ^-/- recipients exhibited reduced DAI (p < 0.001), mucosal damage (p = 0.002), and splenomegaly amelioration (p = 0.02), with elevated local IL-10 (intestinal: p = 0.04; fecal: p = 0.008/0.05). Late-phase transfers showed no benefits, indicating PTIP alleviates early inflammation via IL-10-mediated regulation.
PTIP deficiency elevated intestinal IL-10 (p = 0.02) and TGF-β (p = 0.008) in early DSS-colitis, increasing IL-10⁺ M2 macrophages (colon: p = 0.008; lymph nodes: p = 0.01) and B cells. Fecal IL-10 was higher in PTIP+DSS mice (p < 0.05), while IBD patients showed reduced IL-10 (p = 0.01)/TGF-β (p = 0.006). These findings demonstrate that B cell PTIP deficiency enhances macrophage IL-10.
Macrophage depletion eliminated PTIP ^-/- protection in chronic colitis, as PTIP ^-/- mice showed similar disease severity as WT controls (weight loss, DAI, colon shortening, and fecal bleeding). PTIP^-/-B cells secreted more IFN-γ in monoculture but suppressed macrophage IFN-γ secretion in co-culture (p = 0.008 vs. WT), suggesting that PTIP^-/-B cells exert regulatory effects on macrophages. IL-10 neutralization reversed colitis protection in PTIP ^-/- mice, triggering exacerbated inflammation and reduced CD206⁺ M2 macrophages. This study demonstrates that B cell-specific PTIP deletion ameliorates colitis through enhanced IL-10 secretion from macrophages.

Conclusion

PTIP is upregulated in IBD/DSS-colitis. Independent of antibody-mediated pathways, PTIP^⁻/⁻B cells reduce colitis by modulating macrophages to increase IL-10 production and maintain immunological homeostasis. These results identify PTIP as an IBD target by showing that B-cell PTIP deficiency controls macrophage anti-inflammation.

Introduction

The NLRP3 inflammasome is crucial in regulating innate immune responses, balancing inflammation and homeostasis. It acts as a sensor for danger signals, facilitates the release of pro-inflammatory cytokines and plays a role in TGFβ, NF-κB, and IL-6/JAK/STAT3 signaling. Although the NLRP3 inflammasome is well known for its role in inflammation, recent studies suggest that it may also influence liver regeneration by modulating hepatocyte proliferation and tissue remodeling. This study investigates the role of the NLRP3 inflammasome and its related pathways in liver regeneration over time.

Aims & Methods

Using a partial hepatectomy mouse model, this research examines mRNA expression dynamics of NLRP3 and associated components post-surgery through RNA sequencing (RNA-seq). Liver tissue was analyzed at different time points after partial hepatectomy. Pathway analysis investigated the regulation of related signaling pathways, such as TGFβ, NF-κB, IL-6/JAK/STAT3, and endoplasmic reticulum stress responses.

Results

NLRP3 and Caspase-1 mRNA levels remained unchanged during liver regeneration. In contrast, mRNA expression of NLRP3 inhibitors, including Hsp90 and Sugt1 were significantly upregulated. Pathway analysis revealed substantial upregulation of TGFβ pathway during early proliferation phase, increased NF-κB signaling throughout the process, and consistent activation of the IL-6/JAK/STAT3 signaling pathway and endoplasmic reticulum stress responses.

Conclusion

These findings indicate the complex regulatory mechanisms of the NLRP3 inflammasome in liver regeneration and the varying pathway activation at different stages. Understanding the role of the NLRP3 inflammasome in liver regeneration could offer new insights into potential therapeutic approaches for patients with chronic liver disease or impaired hepatic recovery after surgery.

Introduction

Gastric hyperplastic polyps (GHPs) carry a neoplastic transformation risk of up to 5%, with previous studies indicating an increased risk with larger polyp size. We aimed to evaluate the frequency and risk factors of its malignant transformation in a Portuguese cohort.

Aims & Methods

A multicenter retrospective cohort study was conducted including all patients undergoing endoscopic resection of GHPs ≥10mm from January 2013 to January 2024 in Portuguese tertiary reference centers. Patients with hereditary polyposis syndromes were excluded. Demographic, clinical, endoscopic, and histopathological data were collected.

Results

A total of 782 GHPs from eight centers were evaluated. The median age was 68 years (IQR 60-75), and 58.8% were female. Evidence of advanced gastritis stage (OLGIM≥3) and synchronous gastric neoplasia were present in 57 (10.2%) and 37 (4.7%) cases, respectively. The median lesion size was 15 mm (IQR 12-20), and most presented a polypoid morphology (96.8%). Most GHPs were removed by endoscopic mucosal resection (86.6%), followed by cold snare polypectomy (8.1%) endoscopic submucosal dissection (3.6%), and cold snare EMR (1.7%), achieving en-bloc resection in 677 cases (86.6%). Neoplastic transformation was observed in 33 polyps (4.2%) – 25 (3.2%) low/high-grade dysplasia and 8 (1.0%) adenocarcinoma; the resection was non-curative in 30.3% of cases.
In the multivariate analysis, OLGIM≥3 (OR 4.994, 95%CI 1.036-24.065), lesion size ≥25 mm (OR 7.973, 95%CI 7.973 (1.242-51.180), flat/depressed morphology (OR 9.57, 95%CI 1.096-83.712) and synchronous gastric neoplasia (OR 16.956, 95%CI 2.737-105.045) were independently associated with a higher risk of malignant transformation.

Conclusion

The risk of malignant transformation of GHPs in non-neglectable, with lesion size and morphology and concomitant precancerous gastric conditions/lesions being associated with a higher risk. Nevertheless, the rate of non-curative endoscopic resection is high. The identification of these features may help for optimizing and tailoring the selection of adequate endoscopic resection techniques and surveillance strategies in high-risk patients.

Introduction

Artificial intelligence (AI) is playing an increasingly prominent role in gastrointestinal endoscopy, particularly in enhancing real-time lesion detection during colonoscopy. This study evaluates the impact of an advanced AI-assisted detection system on the Adenoma Detection Rate (ADR), Adenomas per Colonoscopy (APC), and predictive performance, comparing outcomes across endoscopists with different levels of experience.

Aims & Methods

Three endoscopists participated in the study: two with limited experience (Physicians A and B) and one expert (Physician C). A total of 720 colonoscopies were analyzed, with 400 procedures performed using AI assistance and 320 without, evenly distributed among the three operators.
Patients included were between 40 and 75 years of age and underwent colonoscopy either as a screening examination or following a positive fecal occult blood test. Exclusion criteria comprised a history of inflammatory bowel disease (IBD), hereditary polyposis syndromes, major colorectal surgery, or inadequate bowel preparation. For each procedure, data were collected on ADR, APC, the predictive accuracy of the AI system, and retraction time (from cecum to anus).

Results

The use of AI resulted in a marked and consistent improvement in all primary performance indicators across all three endoscopists.
In terms of ADR, Physician A improved from 23.8% without AI to 29.7% with AI; Physician B from 26.9% to 31.6%; and Physician C from 34.7% to 36.6%. Similarly, the APC index increased from 0.52 to 0.63 for Physician A, from 0.55 to 0.65 for Physician B, and from 0.64 to 0.73 for Physician C.
The AI system demonstrated high predictive accuracy across all operators, with no false positives recorded for polyps ≥4 mm in size. Prediction rates were 87.9% for Physician A, 89% for Physician B, and 92% for Physician C, confirming the device’s reliability in supporting polyp identification during real-time examination. Retraction times were slightly prolonged with AI usage: 8.3 minutes vs 7.5 for Physician A, 8.7 vs 7.4 for Physician B, and 8.8 vs 8.0 for Physician C. However, these differences did not reach statistical significance, indicating that AI support did not meaningfully affect procedural efficiency.

Conclusion

The integration of AI into colonoscopy workflows significantly improved both ADR and APC, with the most substantial impact observed in less experienced endoscopists. Physicians A and B, who initially showed suboptimal detection metrics, achieved levels of quality comparable to those of the expert operator in the absence of AI, highlighting AI’s value as a tool for bridging the gap in operator performance. The high predictive reliability of the system—particularly for clinically relevant lesions—and the absence of false positives ≥4 mm further support its clinical utility. Although retraction times increased slightly with AI, this change was not statistically significant, suggesting that the diagnostic advantages were not offset by decreased procedural efficiency. Overall, AI proves to be a valuable and scalable solution to enhance adenoma detection, support clinical training, and promote uniform quality standards in colorectal cancer screening.

References

1.Antonelli, G., Gkolfakis, P., Tziatzios, G., Papanikolaou, I. S., Triantafyllou, K., & Hassan, C. (2020). Artificial intelligence-aided colonoscopy: Recent developments and future perspectives. World journal of gastroenterology, 26(47), 7436–7443.
2.Hassan, C., Balsamo, G., Lorenzetti, R., Zullo, A., & Antonelli, G. (2022). Artificial Intelligence Allows Leaving-In-Situ Colorectal Polyps. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 20(11), 2505–2513.e4
3.Houwen, B. B. S. L., Hassan, C., Coupé, V. M. H., Greuter, M. J. E., Hazewinkel, Y., Vleugels, J. L. A., Antonelli, G., Bustamante-Balén, M., Coron, E., Cortas, G. A., Dinis-Ribeiro, M., Dobru, D. E., East, J. E., Iacucci, M., Jover, R., Kuvaev, R., Neumann, H., Pellisé, M., Puig, I., Rutter, M. D., … Dekker, E. (2022). Definition of competence standards for optical diagnosis of diminutive colorectal polyps: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy, 54(1), 88–99.

Clinical Case Summary

Acute Esophageal necrosis (AEN) is a rare clinical entity, with fewer than 150 reported cases in literature and endoscopic prevalence ranging from 0.01 to 0.28%(1). First described by Goldenberg and later characterized by Gurvits in 2007, this condition predominantly affects the distal esophagus due to its relatively poor blood supply, resulting in its characteristic black appearance. AEN typically occurs in male patients with predisposing risk factors such as chronic liver disease, chronic kidney disease, alcoholism, malnutrition and cardiovascular comorbidities(2). It is also associated with sepsis and carries a high mortality rate. Upper gastrointestinal endoscopy remains the gold standard (3). Given the rarity of AEN, the standardized management guidelines are not well defined and the primary therapeutic focus remains on optimizing medical condition.
We present the case of an 81-year old female, marking the first documented instance of AEN in Ireland, who presented with septic shock, profound hypoglycemia with hypothermia and workup revealed Acute Esophageal Necrosis. The development of AEN in our patient was multifactorial, with esophageal ischemia secondary to septic shock induced hypotension playing a key role. The condition may have been exacerbated by reduced cardiac output and vasoconstriction of splanchnic blood vessels secondary to hypothermia. Furthermore, gastric reflux likely contributed to additional mucosal injury. The patient was managed successfully with conservative yet aggressive approach with inotropic support, antibiotics and total parenteral nutrition.
We conclude that AEN should be considered in any patient with predisposing risk factors, particularly in presence of critical illness. This case highlights the urgent need for development of standardized guidelines to ensure timely diagnosis and optimal management for this rare but serious condition.
The poster will include pictures of Upper GI endoscopy of the patient

References

1. Goldenberg SP, Wain SL, Marignani P. Acute necrotizing esophagitis. Gastroenterology. 1990 Feb;98(2):493-6. doi: 10.1016/0016-5085(90)90844-q. PMID: 2295407.

2. https://pubmed.ncbi.nlm.nih.gov/17322991/

3. Sina (2023). Acute Esophageal Necrosis: A Rare and Serious Cause of Digestive Bleeding - Clinical Case Reports Journal (ISSN 2767-0007). [online] Clinical Case Reports Journal. Available at: https://clinicalcasereportsjournal.com/article/1000264/acute-esophageal-necrosis-a-rare-and-serious-cause-of-digestive-bleeding [Accessed 28 Feb. 2025].

Introduction

Inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, are chronic conditions with alternating phases of flare-ups and remission. Due to the persistent and often severe course of these diseases, effective treatment significantly improves patients' daily activities and overall functioning. [1] Given the uncertain prognosis and the frequent disease progression despite pharmacotherapy, it is important to explore additional interventions that could support traditional treatments. While physical activity may provide both anti-inflammatory and functional benefits in IBD, data on its efficacy and safety during disease exacerbation remain scarce. [2] This pilot study is the first real-world investigation into the effects of a supervised physical exercise training in patients hospitalized due to IBD flare.

Aims & Methods

This study aimed to evaluate the effects of an individualized, moderate-intensity, supervised physical exercise training on exercise tolerance, inflammation, and fatigue resistance in patients hospitalized due to IBD flare, and to explore baseline factors associated with greater benefit from the intervention. Patients were randomly assigned to an intervention group, receiving individual cycloergometer training during hospitalization, or to a control group without exercise. Both groups were well balanced at baseline, with no significant differences in demographic, clinical, or laboratory parameters. At both admission and discharge, all patients underwent standardized graded exercise tests to establish their exercise tolerance based on the lactate threshold and heart rate/power output response. Furthermore laboratory assessments, and the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) questionnaire were conducted.

Results

A total of 22 patients were included in the study, with 13 patients in the intervention group and 9 patients in the control group. Although FACIT-F scores improved in both groups, the intervention group demonstrated a significantly greater improvement (median change –39 points; IQR –49 to –11; p = 0.014) compared to the control group (median change –25 points; IQR –52 to –6; p = 0.30). Baseline FACIT-F scores were significantly correlated with changes in heart rate response response during exercise: patients with greater baseline fatigue and poorer functional status experienced greater improvement in exercise tolerance (r = –0.62, p = 0.028). Platelet counts remained more stable in the intervention group (median change +10 ×10³/µl; IQR –65 to +45) compared to a significant increase in the control group (median +74 ×10³/µl; IQR +44.5 to +101.75; p = 0.046). In the intervention group, greater reductions in calprotectin were strongly correlated with more favorable heart rate responses during a graded exercise test (r = –0.92, p = 0.009).

Conclusion

Supervised training program during hospitalization for IBD flare was associated with improved fatigue resistance and more favorable inflammatory responses. Patients with worse baseline functioning obtained greater benefit in exercise tolerance. These findings support the feasibility and potential therapeutic role of individualized physical activity in acute IBD care and highlight the need for further investigation in real-world settings.

References

1. Farrell D, Artom M, Czuber-Dochan W, Jelsness-Jørgensen LP, Norton C, Savage E. Interventions for fatigue in inflammatory bowel disease. Cochrane Database Syst Rev. 2020 Apr 16;4(4):CD012005. doi: 10.1002/14651858.CD012005.pub2.
2. Achtenberg M, Cibor D, Zwolińska-Wcisło M. Structured exercise in patients with inflammatory bowel disease: a literature review. Gastroenterology Review/Przegląd Gastroenterologiczny. 2025;20(1):36-40. doi:10.5114/pg.2025.148473.

Disclosure

Magdalena Achtenberg has received lecture fees and/or travel grants from Ferring and Eli Lilly, unrelated to the present work. Tomasz Dziubyna has received travel grants from Fresenius, unrelated to the present work. Małgorzata Zwolińska-Wcisło, Dorota Cibor, Karolina Gazda, Magdalena Wyrzykowska, Piotr Kosieniak, Maria Wiśniewska, Jerzy A. Żołądź, Marcin Grandys and Joanna Majerczak declare no conflict of interest.

Introduction

Colonoscopy is a standard procedure but it is unclear whether a short or long colonoscope is more favorable regarding procedure efficiency and patient comfort. The performance of different colonoscope lengths cannot be objectively compared in live patients due to various limitations. Hence, the choice of colonoscope length is a matter of personal preference or institutional tradition. Preclinical tools to assess scope performance are needed. We evaluated endoscopists’ performance using short vs. long colonoscopes in the Mikoto simulator, enabling objective measurements using pressure and distension sensors within a 3D-printed, calibrated colon model.

Aims & Methods

Aims: i) Performance comparison of short vs. long comparison in the Mikoto simulator, enabling objective measurements using pressure and distension sensors within a 3D-printed, calibrated colon model. ii) First evaluation of this novel simulator.
Delegates at ESGE Days and DGE-BV 2024 were invited to perform two simulation rounds—one with each scope length in a random order —and completed a survey. Main outcome was the performance of different scope lengths as measured by the caecal intubation time and the proprietary “Mikoto score” (a combination of pressure and distension measurements exerted on the model).

Results

Of 281 participants, 252 complete datasets were analyzed (187 ESGE, 65 DGE-BV). The Mikoto-Score was lower with long scopes (74 vs. 77; p=0.01), and caecal intubation time was longer (2:59 vs. 2:38 min; p=0.01). A second round did not improve performance. Mikoto-Scores were unaffected by scope preference or sedation strategy but were lower in users of the two-person technique. Scores correlated with self-assessed skill and colonoscopy experience (r=0.43, r=0.47). The median system-usability score was 77.5 indicating a good evaluation by the examiners and a good usability.

Conclusion

Using the Mikoto simulator, long colonoscopes caused more colonic distension and longer insertion times, potentially impacting patient comfort. Objective simulator data can inform scope selection in clinical practice. The Mikoto simulator reflects endoscopist self-assessed skill and previous experience.

Disclosure

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