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Anticoagulation management and portal vein thrombosis

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Anticoagulation management and portal vein thrombosis

Emmanuel Tsochatzis 1

1 UCL Institute of Liver and Digestive Health, London, United Kingdom

Event

UEG Week Vienna 2024

Topics

Hepatobiliary Small Intestine & Nutrition

Session

Update on the management of patients with cirrhosis

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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Diagnosis and management of autoimmune hepatitis

Emma Culver 1

1 Oxford University Hospitals NHS Foundation Trust, University of Oxford, Oxford, United Kingdom

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Hepatobiliary Immunology

Session

Autoimmune disease of liver and bile ducts

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Early management of acute pancreatitis: What can we offer

Hanna Sternby 1

1 Institution of Clinical Sciences, Lund, Sweden

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Endoscopy Pancreas Radiology & Imaging

Session

A 360-degree appraisal of acute pancreatitis

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Can we harmonise methods of microbiological surveillance

Heike Martiny, Prof. Dr. 1

1 Charité - Universitätsmedizin Campus Benjamin Franklin, CC 5, Berlin, Germany

Event

UEG Week Berlin 2025

Topics

Nurses

Session

Hygiene: Update 2025

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Diverticulitis

Johannes Kurt Schultz 1

1 Univertsity of Oslo, Oslo, Norway

Event

UEG Week Berlin 2025

Topics

Colorectal Hepatobiliary Primary Care

Session

Cross-cutting: Management changes in high prevalence problems

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Poster

Audio / Video Poster

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Introduction

There is a well-established association between inflammation and malignant tumors. Furthermore, in hepatocellular carcinoma (HCC), liver functional is a critical determinant of prognosis. Accordingly, the C-reactive protein-to-albumin ratio (CAR), which integrates C-reactive protein—a biomarker of systemic inflammation—and albumin—an indicator of liver functional—has been proposed as a potentially valuable prognostic marker in HCC.

Aims & Methods

This study aims to assess the prognostic value of CAR in predicting outcomes in patients with unresectable HCC treated with Atezolizumab/Bevacizumab (Atezo/Bev) combination therapy.A total of 289 patients who received Atezo /Bev across multiple centers between September 2020 and December 2024 were included in this analysis.The baseline characteristics of the cohort were as follows: median age 74.0 years ( IQR, 67.0–79.0), male/female gender distribution 224/65, performance status (PS 0/1/≥2）185/95/9, etiology (hepatitis B/hepatitis C/alcoholic/non-B, non-C) 58/92/37/102, CRP 0.27 mg/dL (0.10–0.91), albumin 3.8 g/dL (3.4–4.2), CAR 0.068 (0.026–0.239), Child-Pugh score (5/6/≥7 points) 165/82/42, Barcelona Clinic Liver Cancer (BCLC) stage (≤A/B/≥C) 24/84/181, alpha-fetoprotein (AFP) level 27.5 ng/mL (5.2–606.6), and median observation period 14.8 months (6.9–26.4). The distribution of patients according to the line of Atezo/Bev was 233/56 for primary/secondary or later systemic therapy lines, respectively.

Results

The median cumulative progression-free survival (PFS) was 6.8 months (95% confidence interval [CI], 5.4–9.8), and the median cumulative overall survival (OS) was 26.5 months (95% CI, 21.4–29.9). Time-dependent receiver operating characteristic (ROC) analysis identified an optimal cutoff for predicting median OS at 0.0056. The radiological responses, according to RECIST version 1.1, were as follows: partial response 5.7%, stable disease 24.7%, progressive disease 45.9%, respectively. The objective response rate (ORR) and disease control rate were 30.5% and 76.3%. Notably, significant differences in radiological responses (p=0.002) and ORR (p = 0.011) were observed based on CAR values. Multivariate analysis, incorporating age, gender, PS, etiology, BCLC stage, Child-Pugh classification, systemic therapy line, AFP, neutrophil-to-lymphocyte ratio (NLR), and CAR, revealed that age (≥75 years) (hazard ratio [HR], 1.361; 95% confidence interval [CI], 1.028–1.802; p=0.031), BCLC stage (≥C) (HR, 1.439; 95% CI, 1.017–2.037; p=0.040), and CAR (≥0.056) (HR, 1.471; 95% CI, 1.105–1.957; p=0.008) were independently associated with PFS. Additionally, in multivariate analysis adjusted for the same covariates, age (≥75 years) (HR, 1.458; 95% CI, 1.004–2.117; p=0.048), Child-Pugh classification (≥7) (HR, 2.329; 95% CI, 1.445–3.754; p<0.001), AFP (≥100ng/ml) (HR, 1.587; 95% CI, 1.087–2.319; p=0.017), and CAR (≥0.056) (HR, 2.042; 95% CI, 1.386–3.008; p<0.001) were independently associated with OS. In the time-dependent ROC analysis, the area under the ROC curve (AUROC) at 6, 12, 18, 24, 30, and 36 months for NLR was 0.690, 0.683, 0.651, 0.573, 0.493, and 0.474, respectively, and 0.757, 0.687, 0.699, 0.695, 0.663, and 0.597 for CAR, with CAR showing a significantly better AUROC after 24 months.

Conclusion

CAR serves as a valuable predictive biomarker for survival in patients undergoing Atezo/Bev for unresectable HCC.

References

Toshifumi Tada, Takashi Kumada , Atsushi Hiraoka et al. C‑reactive protein to albumin ratio predicts survival in patients with unresectable hepatocellular carcinoma treated with Lenvatinib. Scientific Reports. 2022 May 19;12(1):8421.

PREDICTIVE ABILITY OF THE CRP-ALBUMIN RATIO FOR SURVIVAL IN PATIENTS WITH HEPATOCELLULAR CARCINOMA WHO WERE TREATED WITH ATEZOLIZUMAB/BEVACIZUMAB

Mayumi Ehara 1, Toshifumi Tada 1, Takanori Matsuura 1, Shohei Komatsu 2, Takumi Fukumoto 2, Takashi Nishimura 3, Yuzo Kodama 1

1 Department of Internal Medicine, Division of Gastroenterology, Kobe University Graduate School of Medicine, Kobe, Japan

2 Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

3 Department of Internal medicine, Division of Gastroenterology and Hepatology, Hyogo Medical University, Nishinomiya, Japan

Conference

UEG Week Berlin 2025

Topics

Hepatobiliary

Submission format

Abstract

Session

LIVER (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Poster

Audio / Video Poster

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Introduction

Breath volatile organic compounds (VOCs) are promising non-invasive biomarkers for clinical purposes. In digestive health, gut microbiome VOCs enter the bloodstream and diffuse into exhaled breath, offering a real-time snapshot of gut activity and metabolism. Translating these biomarkers into clinical practice depends on precise identification and robust validation—challenges that require standardized protocols and data integration. Our previously developed breath collection and GC-MS analysis method identified 148 on-breath VOCs against ambient background that were catalogued into an Atlas using purified chemical standards. Building on this success, further method development was undertaken, with a focus on enhancing the detection of previously underrepresented compound classes.

Aims & Methods

Our aim was to create a high-resolution TD-GC-MS method using a PEG-phase column to detect and confidently identify gut microbial VOCs—fatty acyls, esters, phenols, indoles, and sulfones. By combining enhanced sample preparation and compound enrichment with rigorous spectral and retention-time matching, plus improved quality-control and identity-confirmation protocols, we could reliably assign chemical identities to candidate VOCs in breath samples.

Results

Using three metrics; standard deviation analysis, paired t-test, and ROC-AUC evaluation, we identified 621 VOCs as potential breath biomarkers, 223 of which met all three on-breath criteria. These tools effectively distinguished exhaled VOCs from ambient background, allowing us to select a focused subset for confident chemical identification. Notably, over 25% of these are metabolites derived from the gut microbiome, and their detection offers mechanistic insights into microbial activity. Butyric acid, for example, serves as a crucial energy source for colonocytes and plays a key role in regulating intestinal inflammation. Branched-chain fatty acids—including isobutyric acid, isovaleric acid, 2-methylbutyric acid, and 4-methylvaleric acid—are products of protein fermentation and have been associated with inflammatory responses. The phenolic compound p-cresol, linked to dysbiosis, may affect gut barrier integrity, while 2-methylindole, derived from altered tryptophan metabolism, has implications for immune modulation and gut homeostasis. Dimethyl sulfone, involved in sulphur metabolism, may contribute to inflammatory signalling. Alongside previously identified short-chain fatty acids such as acetic and propionic acid, these compounds represent a broad and functionally diverse profile of gut microbial metabolism. Their detection across all on-breath metrics supports their endogenous origin in exhaled breath.

Conclusion

The high-confidence identification of these gut-derived VOCs reinforces their potential as non-invasive biomarkers for monitoring gastrointestinal health. With the updated methodology, our Atlas now includes a total of 186 confirmed on-breath VOCs, paving the way for improved diagnostic breath tests tailored to gut health and disease.

Disclosure

No conflict of interest

TARGETED ANALYSIS OF VOLATILE METABOLITES FROM THE GUT MICROBIOME IN EXHALED BREATH

Wisenave Arulvasan 1, Julia Greenwood 1, Matteo Tardelli 1, Owen Birch 1, Simon Coplowe 1, Steven Levett 1, Huw Davies 1, Frederik Jan van Schooten 2, Billy Boyle 1, Max Allsworth 1

1 Owlstone Medical, Cambridge, United Kingdom

2 Maastricht University, Faculty of Health, Medicine and Life Sciences, Pharmacology and Toxicology, Maastricht, Netherlands

Conference

UEG Week Berlin 2025

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

NUTRITION (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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