Introduction

Gastrointestinal (GI) transit abnormalities due to dysmotility often affect multiple regions of the GI tract rather than occur in isolation. Identifying regional GI transit delays may influence clinical management. Use of wireless motility capsules (WMC) enable regional and whole GI transit times to be objectively measured; the relationship between symptom profiles and regional transit times are explored here with a new capsule device, the Atmo Capsule.

Aims & Methods

The Atmo Capsule was administered to subjects with suspected upper and/or lower gastrointestinal dysmotility. This analysis utilized data from subjects where valid transit measurements via the Atmo Capsule were available for all regions of the GI tract, and no protocol deviations pertaining to the use of contraindicated medication or inclusion criteria violations were incurred. Regional transit times were considered delayed as follows: gastric emptying ≥ 5 h; small bowel transit, ≥ 6 h; colonic transit, ≥ 59 h. Delays affecting a single region (i.e., gastric, small bowel, or colon) were considered ‘isolated’, delays affecting multiple (> 1) regions were considered ‘generalized’. Symptom profiles were assessed using the Patient Assessment of Gastrointestinal Disorders - Symptoms (PAGI-SYM) and Patient Assessment of Constipation – Symptoms (PAC-SYM) questionnaires: all patients completed the PAGI-SYM while those with symptoms suggestive of lower GI dysmotility completed the PAC-SYM. Data were analyzed via Kruskal-Wallis test.

Results

The WMC was administered to 209 subjects (median age 41; 188 female), of whom 170 had data suitable for this analysis. Delayed GI transit was identified in 100 (59%) subjects: 65 were isolated and 35 were generalized. There were no differences in overall symptom scores in subjects with no delays (PAGI-SYM, median 1.5 [IQR: 1.1, 2.1]; PAC-SYM, 2.0 [1.5, 2.6]), isolated delays (1.5 [1.0, 2.1]; 1.9 [1.2, 2.6]) and generalized transit delays (1.8 [1.4, 2.3]; 2.1 [1.4, 2.8]) (p>0.05 for both) or symptom sub-scores (Table 1). Gastric transit was delayed in 46 subjects: 19 (41%) were isolated and 27 (59%) were generalized. Colonic transit was delayed in 60 subjects: 31 (52%) were isolated and 29 (48%) were generalized. GI symptom profiles were not different in subjects with isolated and generalized transit delays for either the stomach or colon (p>0.05 for all relevant subscales).

Table 1. Symptom profiles amongst patients with no transit delay, isolated transit delay (affecting a single region) and generalized transit delay (affecting multiple regions). Data presented as median (interquartile range) and analyzed via Kruskal-Wallis test.

Conclusion

WMC measurements of regional and whole GI transit using the Atmo Capsule revealed that delayed transit impacting multiple regions were common. However, symptom profiles were unable to distinguish between isolated vs. generalized transit delays, suggesting that symptoms are an unreliable predictor of abnormalities in GI transit as previously found via other transit modalities.

Disclosure

These authors disclose the following: Braden Kuo, Anthony J. Lembo, Eammon M.M. Quigley, Satish S.C. Rao, and William D. Chey serve on the Medical Advisory Board of Atmo Biosciences. Michael Cline and Baharak Moshiree served on the Medical Advisory Board of Atmo Biosciences. Braden Kuo has received funding from NIH, Vanda, Atmo Biosciences, and Takeda and has consulted for Evoke, Takeda, Ironwood, Novo Nordisk, Cindome, and Neurogastrx. Thomas Abell has received funding from Gastric Dysrhythmias, Neurogastrx, NIH GpCRC, and Vanda and has consulted for Enterra Medical, Novo Nordisk, Nuvaira, and Vanda. Anthony J. Lembo has received funding from Ardelyx, Biomerica, GSK, Ironwood, Takeda, and Vibrant and holds stock with Allurion, Bristol Myer Squibb, and J&J. Abigail Stocker has received funding from Cindome, Enterra Medical, and Vanda. William D. Chey has received funding from Atmo Biosciences, Commonwealth Diagnostics Intl, QOL Medical, and Salix; has consulted for AbbVie, Ardelyx, Biomerica, Comvita, Gemelli, Ironwood, Nestle, QOL Medical, Phathom, Redhill, Salix, Vibrant, and Takeda; has filed patents with My Nutrition Health, Digital Manometry, and Rectal Expulsion Device; and holds stock options with Coprata, Evinature, Food Marble, Kiwi Bioscience, and Modify Health. The remaining authors disclose no conflicts.

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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25. Tribonias G, Bacasis AD, Komeda Y ​

Introduction

Gastrointestinal dysfunction, especially gastroparesis is a common non-motor disorder among Parkinson’s disease resulting to serious complications and poor quality of life. There are still some limitations on an evaluation and diagnostic test to detect the patients with gastroparesis for early intervention improving outcome.

Aims & Methods

All Parkinson’s disease patients were inquired to complete GCSI, GERD-Q, and PAC-SYM questionnaires. The correlation between the scores and disease severity was evaluated. Factors associated with significant gastroparesis symptoms (GCSI ≥9) were analyzed. Patients who have had gastrointestinal symptoms compatible with gastroparesis were further test for gastric emptying scintigraphy.

Results

76 patients completed GI questionnaires. The majority of patients (60.6%) were classified in PD stage 2 and 3. A large number of patients (82.9%) reported gastroparesis symptoms using GCSI score. The median (IQR) of total GCSI score was 4 (2, 10) with postprandial fullness predominant in subscale. PD duration ≥6 years was associated with high gastroparesis symptoms (GCSI ≥9), adjust OR = 2.96 (1.01, 8.71), p=0.043. Eight consecutive participants could undergo physiologic testing. Only one of eight was definitely confirmed for delayed gastric emptying. No correlation between GCSI score and physiologic testing was observed.

Table 1.Logistic regression analysis on potential factors associated with significant GCSI score.

Conclusion

Gastroparesis symptoms with postprandial fullness predominant were common among Parkinson’s disease. The strong correlation between gastrointestinal scores may illustrate an extensive gastrointestinal involvement, especially in the patients with long term disease duration. However, clinical scores might have a limitation for real-life implementation in Parkinson’s disease because poor correlation between GCSI score and physiologic testing was observed. Score validation and long-term outcome, especially nutritional status and pulmonary complication as sequelae of gastrointestinal dysfunction would be considered in future research.

References

1. Soliman H, Coffin B, Gourcerol G. Gastroparesis in Parkinson disease: pathophysiology, and clinical management. Brain Sci 2021; 11:1-10.
2. Rao SS, Hofmann LA, Shakil A. Parkinson’s disease: diagnosis and treatment. Am Fam Physician 2006; 74:2046-54.
3. Choi JH, Lee JY, Cho JW, Koh SB, Yang YS, Yoo D, et al. Double- blind, randomized, placebocontrolled trial of DA-9701 in Parkinson’s disease: PASS-GI study. Mov Disord 2020; 35:1966-76.
4. Poirier AA, Aube B, Cote M, Morin N, Paolo TD, Soulet D. Gastrointestinal dysfunctions in Parkinson’s disease: symptoms and treatments. Parkinsons Dis 2016; 2016:1-23.
5. Pfeiffer RF, Isaacson SH, Pahwa R. Clinical implications of gastric complications on levodopa treatment in Parkinson’s disease. Parkinsonism Relat Dis 2020; 76:63-71.
6. Mukherjee A, Biswas A, Das SK. Gut dysfunction in Parkinson’s disease. World J Gastroenterol2016; 22:5742-52.

Introduction

Neurosurgical patients often face several difficulties with nutritional support due to severe brain injury, neurological disease, or post-surgical complications. This study aimed to assess the outcomes of long-term enteral nutrition via percutaneous endoscopic gastrostomy (PEG) in this population.

Aims & Methods

Single center, retrospective analysis of patients who were referred for PEG from 2001 to 2023. Patients who presented with severe traumatic brain injury (TBI), hemorrhagic stroke, brain tumor or other conditions that required neurosurgery were selected. Demographic, anthropometric and clinical data were recorded.

Results

196 patients were included, 57% were younger than 65 years. Stroke (41.8%), TBI (35.2%) and brain tumors (19.9%) were the most frequent conditions. The median time from diagnosis to PEG was 94 days. At the time of PEG procedure, only 38.5% were underweight. 21 patients were lost to follow up. Among the remaining, 75.4% died, 12.6% were alive and PEG-fed, and 12% had the tube removed. Of the surviving patients who remained PEG-fed, the majority (77%) were stroke patients. Median overall survival post-PEG was 11.5 months, with 88% of patients surviving more than one month. Albumin, transferrin, and total cholesterol levels at the time of PEG were associated with longer survival. Albumin (p<0.001) and transferrin (p<0.01) were significantly associated with lower short-term mortality risk.

Conclusion

PEG is an effective method for long-term enteral nutrition in neurosurgical patients. Although survival is limited, reflecting the severity of the underlying conditions, the majority of patients survived beyond one month, supporting the adequacy of the procedure. Higher serum albumin levels were associated with longer survival, suggesting its potential role as a prognostic biomarker in this population. Careful patient selection, timely intervention, and consideration of nutritional status may help optimize outcomes for neurosurgical patients requiring PEG.

Introduction

Primary biliary cholangitis (PBC) is a chronic autoimmune liver disease characterized by progressive bile duct damage and cholestasis. While ursodeoxycholic acid (UDCA) is the first-line therapy, about 40% of patients have incomplete responses, necessitating alternative treatments.

Aims & Methods

This meta-analysis evaluates the efficacy and safety of novel oral anti-cholestatic agents for PBC, focusing on key biochemical and symptomatic outcomes. A systematic literature search was conducted across electronic databases. Eligible studies included randomized controlled, retrospective, and open-label trials investigating novel oral anti-cholestatic agents in PBC patients. Data on efficacy (e.g., alkaline phosphatase [ALP] reduction) and safety outcomes were extracted and analyzed using meta-analytic techniques.

Results

Ten studies involving 878 patients were analyzed. Investigated therapies included seladelpar, fenofibrate, saroglitazar, bezafibrate, elafibranor, and budesonide. Novel anti-cholestatic agents significantly lowered ALP levels compared to controls (SMD -2.80; 95% CI [-3.56, -2.03]; p<0.00001), with saroglitazar showing the largest effect size (SMD -4.62; 95% CI [-5.54, -3.70]). Subgroup analysis revealed that fibrates (fenofibrate, bezafibrate, and saroglitazar) demonstrated the most consistent ALP reduction across studies (SMD -3.15; 95% CI [-3.89, -2.41]; p<0.00001).
In addition to ALP reduction, several agents showed improvements in other liver function tests. Bilirubin levels decreased significantly with novel therapies (MD -0.22 mg/dL; 95% CI [-0.35, -0.09]; p=0.001). Gamma-glutamyl transferase (GGT) also showed substantial reduction (SMD -1.98; 95% CI [-2.56, -1.40]; p<0.00001).
Symptomatic improvements were observed, particularly for pruritus. Bezafibrate and seladelpar demonstrated the most promising results, with mean reductions in visual analog scale scores for pruritus of 30% and 35%, respectively. Fatigue scores also improved, though to a lesser extent (SMD -0.42; 95% CI [-0.68, -0.16]; p=0.002).
Safety profiles were comparable to controls, with no significant increase in serious adverse events (OR 1.21; 95% CI [0.81, 1.83]; p=0.35). The most common adverse events were mild gastrointestinal symptoms (10-15% of patients) and transient elevations in creatinine (5-8% of patients). No significant hepatotoxicity was observed across the studies.

Conclusion

Novel oral anti-cholestatic agents show promise in managing PBC patients with suboptimal UDCA responses, demonstrating significant improvements in biochemical markers and some symptomatic relief. However, study heterogeneity, small sample sizes, and limited follow-up durations restrict direct comparisons and generalizability. Further research is needed to confirm long-term efficacy and safety.

References

1 Trivella J, John BV, Levy C. Primary biliary cholangitis: Epidemiology, prognosis, and treatment. Hepatol Commun 2023; 7: e0179. [PMID: 37267215 DOI: 10.1097/HC9.0000000000000179]
2 Purohit T, Cappell MS. Primary biliary cirrhosis: Pathophysiology, clinical presentation and therapy. World J Hepatol 2015; 7: 926-941. [PMID: 25954476 DOI: 10.4254/wjh.v7.i7.926]
3 Tanaka A, Takikawa H, Mochida S, Koike K, Miwa H, Shimosegawa T. Changing nomenclature for PBC from ‘primary biliary cirrhosis’ to ‘primary biliary cholangitis’. J Gastroenterol 2016; 51: 748-749. [PMID: 27230619 DOI: 10.1007/s00535-016-1223-z]

Introduction

Type 1 gastric neuroendocrine tumors (T1-gNETs) are well-differentiated, typically indolent neoplasms associated with chronic atrophic gastritis (CAG) and hypergastrinemia, with nearly 100% long-term survival. However, they have a high recurrence rate of 30-60% within the first year after resection. Tumor size is the most critical prognostic factor, while the role of grading is less definitive compared to other digestive NETs. International guidelines recommend conservative management for tumors <1 cm, advocating for approaches such as endoscopic resection or surveillance, which have shown excellent outcomes. However, the management strategies and outcomes for tumors > 1 cm remain less clearly defined due to the lack of scientific data in this specific patient population.

Aims & Methods

This study aimed to investigate management strategies and clinical outcomes in a homogeneous population of patients with T1-gNETs > 1 cm. The findings are expected to provide valuable insights and guide the development of more effective management strategies.
The present study was designed as an international multicentric retrospective analysis, conducted in 7 Western centers. It included consecutive patients diagnosed with T1-gNETs >1 cm in diameter, collected between 2004 and 2023, with at least 12 months of follow-up. The primary endpoints were disease progression (DP) (tumor recurrence or metastasis development) and the Progression-Free Survival. The Cox regression method was used to identify factors associated with progression.

Results

The study included 104 patients (61 females, 43 males) with a median age of 61 years and a median tumor size of 15 mm (range 11–60 mm). 61.5% of tumors were classified as G1, 37.5% as G2, and 1% as G3. 75 patients (72.1 %) underwent endoscopic resection (27 EMR, 5 m-EMR, 14 ESD, 7 snare polypectomy, and 22 unspecified techniques). Surgical procedures were performed in 33 patients (31.7%), 13 of whom had previously undergone endoscopic resection. One patient (1%) received treatment with somatostatin analogues, while 8 patients (7.7%) received no treatment.
The R0 resection rate was 51.9%. During follow-up, 26 patients (25%) experienced recurrence, 7 (6.7%) developed metastases, and 12 (11.5%) died, with 2 deaths (1.9%) due to tumor-related causes. The median overall survival and progression-free survival were 59.5 months (range 13–215) and 51.5 months (range 4–215), respectively.
Univariate analysis showed that R0 resection (HR 0.32, p=0.02) and advanced endoscopic techniques (m-EMR/ESD) (HR 0.09, p=0.02) were associated with better outcomes. In contrast, other resection methods (standard EMR, snare polypectomy, or unspecified techniques) and tumor size were associated with a higher risk of disease progression (HR 10.13, p=0.02; HR 1.03, p=0.003, respectively).

Conclusion

T1-gNETs >1 cm often recur and can progress, exhibiting potentially aggressive behavior, especially in larger lesions. Endoscopic resection should employ advanced techniques to prevent incomplete removal, which is associated with poor outcomes.