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OUTCOME PREDICTORS FOR SIGMOID VOLVULUS: A SINGLE-CENTER RETROSPECTIVE COHORT STUDY

Seoyoon Choi 1, Jung Hyun Ji 1, Jihye Park 1, Soo Jung Park 1, Jae Hee Cheon 1, Tae Il Kim 1, Jae Jun Park 1

Affiliations

1 Yonsei University College of Medicine / Institute of Gastroenterology, Seoul, Korea, Republic of

Summary

AI Generated

A single-center retrospective study of 59 sigmoid volvulus patients identified CT imaging features and patient age associated with endoscopic decompression failure and recurrence risk.

Initial endoscopic decompression was successful in 83.1% of patients (49 of 59), but 40% of those without prior episodes experienced recurrence during mean 411-day follow-up
Larger cross-sectional diameter of distended colon (>85 mm) was associated with both endoscopic treatment failure (odds ratio 25.4) and recurrence (hazard ratio 9.9)
Suspected bowel ischemia on initial CT (odds ratio 8.8) and age under 65 (odds ratio 5.1) were associated with endoscopic decompression failure
Larger maximal long axis length (>230 mm) and short axis length (>150 mm) of twisted sigmoid colon on CT were associated with increased recurrence risk
The authors suggest these CT features may help identify patients requiring early surgical consultation or elective surgery after initial endoscopic improvement

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Abstract

Introduction

Although sigmoid volvulus is potentially life-threatening condition in elderly patients, prognostic factors for sigmoid volvulus are not well known.

Aims & Methods

The aim of this study is to evaluate clinical outcomes and investigate prognostic factors for patients with sigmoid volvulus. We retrospectively reviewed 85 patients who were treated with sigmoid volvulus from January 2005 to January 2023 at a single tertiary referral center. After exclusion of patients who received emergency bowel resection surgery or improved by conversative treatment alone, a total of 59 patients were included. Patient and abdominal computed tomography (CT)-related factors potentially associated with clinical outcomes were analyzed by logistic and Cox regression analyses.

Results

The mean age of the patients was 72.4 years, and 74.3% were male. 49 patients (83.1%) were improved on initial endoscopic decompression therapy. Regarding factors related with failure of initial endoscopic decompression therapy, suspected bowel ischemia on initial CT (odds ratio 8.847, 95% CI 0.666–117.462), age<65 (odds ratio 5.138, 95% CI 0.574–46.025), larger (>85 mm) cross-sectional diameter of distended colon (odds ratio 25.400, 95% CI 1.015–635.804) were related with endoscopic treatment failure. On the other hand, of the 35 patients without previous volvulus episode who improved after initial endoscopic decompression therapy, 14 patients (40.0%) had recurrence of sigmoid volvulus during a mean follow-up of 411 days. Patients showing larger cross-sectional diameter of distended colon (>85mm, hazard ratio 9.925, 95% CI 1.618–60.863), larger maximal long (>230mm, hazard ratio 4.456, 95% CI 0.931–21.327) and short (>150mm, hazard ratio 2.828, 95% CI 0.639–12.505) axis length of overall twisted sigmoid colon were related with volvulus recurrence.

Conclusion

Prognostic factors unravelled in our study may be useful in management of patients with sigmoid volvulus. Early surgical backup consultation may be needed in patients having factors related with failure of endoscopic decompression therapy. Meanwhile, elective surgical treatment after improvement on initial endoscopic therapy may be considered in patients showing high risk features for recurrence on CT scan.

References

1. R. Kusunoki et al, Initial Computed Tomography Findings of Long and Distended Colon Are Risk Factors for the Recurrence of Sigmoid Volvulus, Digestive Diseases and Sciences (2021) 66:1162–1167
2. C. Humbert et al, Stratification of sigmoid volvulus early recurrence risk using a combination of CT features, Diagnostic and Interventional Imaging 103 (2022) 79-85
3. Z. Slack et al, Prognostic factors in the decision-making process for sigmoid volvulus: results of a single-centre retrospective cohort study, BMC Surgery (2022) 22:95
4. EM Kim et al, Clinical outcomes of sigmoid volvulus and risk factors for its recurrence: a multicenter study in Korea, International Journal of Colorectal Disease (2020) 35:1841–1847
5. A Abdelrahim et al, Dilemma of sigmoid volvulus management, Ann R Coll Surg Engl 2021; 104: 95–99

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Abstract

Session

PP 06 Other lower GI disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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EFFECTS OF EXCLUSIVE PALATABLE ELEMENTAL DIET ON BODY COMPOSITION IN OBESE AND LEAN MICE

Ali Rezaie

The role of lifestyle changes and diet

Eirini Dimidi

FRUCTANS BOOST COLONIC FERMENTATION BUT DO NOT AGGRAVATE SYMPTOMS IN NON-CONSTIPATED IBS PATIENTS ON A LOW FODMAP DIET – A RANDOMIZED CONTROLLED TRIAL

Magnus Simrén

Ostomy management

Revital Barkan

HIGH ADHERENCE TO THE MEDITERRANEAN DIET DELAYS SURGERY AND REPROGRAMS INTESTINAL CELLULAR STATES IN CROHN’S DISEASE

Stefania Vetrano

Evidence of disordered eating in disorders of gut–brain interaction

Chloé Melchior

UEG Presentation

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EFFECTS OF EXCLUSIVE PALATABLE ELEMENTAL DIET ON BODY COMPOSITION IN OBESE AND LEAN MICE

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EFFECTS OF EXCLUSIVE PALATABLE ELEMENTAL DIET ON BODY COMPOSITION IN OBESE AND LEAN MICE

Aida Pirvaram 1, Gabriela Laughton 1, Ignacio Rivera 1, Maritza Sanchez 1, Stacy Weitsman 1, Maria Jesus Millan 1, Juliana Germano 1, Angel Trujillo 1, Victoria Murray 1, Krystyna Houser 2, Sepideh Mehravar 1, Ruchi Mathur 1,3, Mark Pimentel 1,4, Ali Rezaie 1,5

Affiliations

1 Medically Associated Science and Technology (MAST) Program, Cedar-Sinai, Los Angeles, CA, Los Angeles, United States

2 mBiota Elemental, Sana Monica, Los Angeles, United States

3 Division of Endocrinology, Diabetes and Metabolism. Department of Medicine, Cedar -Sinai, Los Angeles, CA., Los Angeles, United States

4 Karsh Division of Gastroenterology and Hepatology, Department of Medicine, Cedar -Sinai, Los Angeles, CA, Los Angeles, United States

5 Karsh Division of Gastroenterology and Hepatology, Department of Medicine, Cedar-Sinai, Los Angeles, CA, Los Angeles, United States

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Abstract

Introduction

Elemental diets (EDs) are nutritionally complete formulations used in gastrointestinal disorders, consisting of low fat content, free amino acids, easily absorbable carbohydrates, and micronutrients. We have previously shown in a human trial that eucaloric palatable ED (PED) induces weight loss with preferential fat reduction and relative preservation of lean mass (Rezaie et al., 2025). We therefore evaluated the impact of PED on body composition in controlled lean and obese murine models.

Aims & Methods

Five groups of 8–10-week-old male mice (n=5 per group) were studied. After 4 days of acclimation, mice were randomized to 14 days of dietary intervention: lean mice (C57BL/6J) to chow or PED (mBIOTA Elemental, US), and obese mice (C57BL/6J DIO, pre-conditioned on high-fat diet [HFD; Research Diets, US]) to PED, chow (LabDiet, US), or continued HFD.
Body weight was recorded at baseline and day 14 along with microCT imaging (Revvity, USA) of the abdomen and pelvis to quantify visceral fat, subcutaneous fat, total fat, and muscle volume. CT images were analyzed using Analyze 15.0 with standardized segmentation. Paired two-tailed t-tests and one-way ANOVA with Bonferroni correction were used.

Results

In lean mice groups, PED led to a trend toward weight loss (27.1±1.0, 23.9±3.4 g, p=0.052). This was accompanied by reductions in total fat (2461±603 to 1778±930 mm³, p = 0.01) and subcutaneous fat (1294±367 to 892±392 mm³, p=0.005). (Table) Visceral fat decreased numerically (1074± 244 to 791± 542 mm³, p=0.18), while muscle mass was preserved (5149±460 to 5471±503 mm³, p=0.21).

In contrast, chow-fed lean mice did not lose weight (27.2±1.4 to 27.2±1.3 g, p 0.98) and demonstrated an increase in visceral fat (689±101 to 1068±256 mm³, p=0.03), with no significant change in total fat (1808±351.2 to 2245±330.5 mm³,p=0.12) or muscle mass (5467±705.7 to 5385 ± 479.4 mm³, p=0.34). As compared to regular chow, PED in lean mice resulted in greater changes in visceral fat (−282 to +379 mm³, p =0.009) and total fat (−683 to +437 mm³, p< 0.01), with a trend toward reduced subcutaneous fat (p=0.06) and no difference in muscle mass (p=0.39).

Obese mice transitioning from HFD to PED exhibited transient reductions in food intake initially. Continued HFD resulted in weight gain (33.6±2.5 to 35.0±3.2 g, p=0.04). Switching to chow induced weight loss (34.6±2.4 to 30.5±1.5 g, p=0.0065) with reductions in visceral (p=0.001), subcutaneous (p=0.01), and total fat (p=0.004), and increased muscle mass (p=0.02). PED induced marked weight loss (35.4±1.0 to 23.2±2.4 g, p<0.01) with profound reductions in visceral, subcutaneous, and total fat (all p<0.001) and reduced muscle mass (p=0.004). Weight loss was predominantly driven by reductions in adipose tissue.

Table. Abdominal fat and mid-body muscle mass in lean and obese mice before and after 14 days of dietary intervention.

Group	Total fat (Baseline) (mm³, mean ± SD)	Total fat (Day 14) (mm³, mean ± SD)	Visceral fat (Baseline) (mm³, mean ± SD)	Visceral fat (Day 14) (mm³, mean ± SD)	Subcutaneous fat (Baseline) (mm³, mean ± SD)	Subcutaneous fat (Day 14) (mm³, mean ± SD)	Muscle mass (Baseline) (mm³, mean ± SD)	Muscle mass (Day 14) (mm³, mean ± SD)
Lean-PED	2461±603.7	1778 ± 930.1*	1074 ± 244.3	791.2 ± 542.4	1294 ± 367.1	892.8 ± 392.8*	5149 ± 460.2	5471 ± 503.8
Lean-Chow	1808 ± 351.2	2245 ± 330.5	689.1 ± 101.8	1068 ± 256.8*	1015 ± 339.6	1099 ± 110.9	5467 ± 705.7	5385 ± 479.4
Obese-PED	7392 ± 1239	2245 ± 954.4*	3334 ± 746.6	938.6 ± 536.2*	3956 ± 596.3	1226 ± 464.0*	5733 ± 476.3	4743 ± 384.7*
Obese-Chow	6724 ± 1752	3481 ± 709.9*	3087 ± 759.3	1539 ± 415.4*	3542 ± 997.1	1876 ± 401.0*	5414 ± 356.3	5823 ± 275.5*
Obese-HFD	6080 ± 1166	6647 ± 1334	2788 ± 397.8	2852 ± 757.6	3202 ± 792.9	3721 ± 769.0	5420 ± 425.3	5784 ± 629.6

* p < 0.05 vs baseline (paired t-test)

Conclusion

PED induces rapid and pronounced reductions in visceral and subcutaneous adipose tissue. Weight reductions are fat-predominant, with preservation of muscle in lean mice and modest muscle loss during early adaptation in obese mice. Together with prior human data, these findings support a preferential effect of elemental nutrition on adipose tissue. Further mechanistic studies are warranted.

References

Rezaie et al. Clinical Gastroenterology and Hepatology.2025
https://doi.org/10.1016/j.cgh.2025.03.002

Disclosure

Ali Rezaie is a consultant/speaker for Bausch Health; and has equity in Alimetry, Gemelli Biotech, and Good LFE.
Ruchi Mathur has equity in Gemelli Biotech and Good LFE.
Krystyna Houser has equity in Good LFE. Mark Pimentel is a consultant for Ferring Pharmaceuticals, Inc, Salvo Health, and Vivante Health, Inc; has received grant support from Bausch Health; and has equity in Gemelli Biotech, Salvo Health, Vivante Health, and Good LFE.
The remaining authors disclose no conflicts.

Event

UEG Week Barcelona 2026

Topics

Surgery Small Intestine & Nutrition Endoscopy

Submission format

Abstract

Session

Nutrition, metabolism and the therapeutics of obesity

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

EFFECTS OF EXCLUSIVE PALATABLE ELEMENTAL DIET ON BODY COMPOSITION IN OBESE AND LEAN MICE

Ali Rezaie

The role of lifestyle changes and diet

Eirini Dimidi

FRUCTANS BOOST COLONIC FERMENTATION BUT DO NOT AGGRAVATE SYMPTOMS IN NON-CONSTIPATED IBS PATIENTS ON A LOW FODMAP DIET – A RANDOMIZED CONTROLLED TRIAL

Magnus Simrén

Ostomy management

Revital Barkan

HIGH ADHERENCE TO THE MEDITERRANEAN DIET DELAYS SURGERY AND REPROGRAMS INTESTINAL CELLULAR STATES IN CROHN’S DISEASE

Stefania Vetrano

Evidence of disordered eating in disorders of gut–brain interaction

Chloé Melchior

UEG Presentation

New

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The role of lifestyle changes and diet

Eirini Dimidi 1

Affiliations

1 King's College London, London, United Kingdom

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Neurogastroenterology & Motility Surgery Primary Care Small Intestine & Nutrition

Session

Chronic constipation: How to diagnose and treat this frequent condition in clinical practice

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

EFFECTS OF EXCLUSIVE PALATABLE ELEMENTAL DIET ON BODY COMPOSITION IN OBESE AND LEAN MICE

Ali Rezaie

The role of lifestyle changes and diet

Eirini Dimidi

FRUCTANS BOOST COLONIC FERMENTATION BUT DO NOT AGGRAVATE SYMPTOMS IN NON-CONSTIPATED IBS PATIENTS ON A LOW FODMAP DIET – A RANDOMIZED CONTROLLED TRIAL

Magnus Simrén

Ostomy management

Revital Barkan

HIGH ADHERENCE TO THE MEDITERRANEAN DIET DELAYS SURGERY AND REPROGRAMS INTESTINAL CELLULAR STATES IN CROHN’S DISEASE

Stefania Vetrano

Evidence of disordered eating in disorders of gut–brain interaction

Chloé Melchior

UEG Presentation

New

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

FRUCTANS BOOST COLONIC FERMENTATION BUT DO NOT AGGRAVATE SYMPTOMS IN NON-CONSTIPATED IBS PATIENTS ON A LOW FODMAP DIET – A RANDOMIZED CONTROLLED TRIAL

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FRUCTANS BOOST COLONIC FERMENTATION BUT DO NOT AGGRAVATE SYMPTOMS IN NON-CONSTIPATED IBS PATIENTS ON A LOW FODMAP DIET – A RANDOMIZED CONTROLLED TRIAL

Joost Algera 1,2, Chloé Melchior 3,1, Jenny Lövdahl 2,1, Kristina Cullman 1, Amanda Blomsten 1, Sanna Nybacka 1, Stine Störsrud 2,1, Hans Törnblom 1,2, Magnus Simrén 1,2,4

Affiliations

1 Sahlgrenska Academy, University Of Gothenburg, Gothenburg, Sweden

2 Sahlgrenska University Hospital, Gothenburg, Sweden

3 Rouen University Hospital, INSERM U1073, CIC-CRB-1404, Rouen, France

4 University of North Carolina, Chapel Hill, United States

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Abstract

Introduction

Fermentable oligo-, di-, monosaccharides and polyols (FODMAP) may provoke gastrointestinal (GI) symptoms through physiological mechanisms in patients with irritable bowel syndrome (IBS)¹, and fructans have been suggested to be of particular importance². Negative expectations can exacerbate symptoms (nocebo effects)³ but the extent to which food components aggravate symptoms through physiological processes versus the contribution of patients' expectations of symptoms remains unclear.

Aims & Methods

We aimed to assess the link between GI symptoms, fructan intake, and colonic fermentation using an ingestible gas-sensing capsule and breath tests in patients with non-constipated (diarrhea-predominant and mixed) IBS on a low FODMAP diet.
Non-constipated IBS patients (Rome IV, n=89, age 18–50 years, 83% females) were included in this randomized, placebo-controlled trial (NCT04830410). Baseline assessment was made while patients retained their habitual diet. Next, the patients adhered to a low FODMAP diet for three weeks with all foods provided. During week 3, patients were challenged with fructans or maltodextrin (sham), with either high (18g; 6g tds, n=24) or low dosages (6g; 2g tds, n=65).
Patients reported severity of GI (IBS-SSS) at baseline and at the end of week 2 and 3, as well as stool form (BSFS) for all bowel movements. Colonic fermentation was assessed at baseline and at the end of week 3: luminal colonic hydrogen and carbon dioxide concentrations (overall and regional [per quartile of colonic transit time]) were measured using a gas-sensing capsule⁴, with breath concentrations of hydrogen and methane concentrations also examined. The gas-sensing capsule also provided whole gut and segmental transit times.

Results

The low FODMAP diet reduced overall IBS symptom severity at the end of week 2 compared to the habitual diet (IBS-SSS; mean change = -89 ± 94, P<0.0001), as well as individual symptoms P<0.0001 for all). Moreover, the low FODMAP diet reduced the frequency of loose stools at the end of week 2 (% loose stools; mean change 10% ± 19%, P<0.0001).
At the end of week 3, no significant differences in symptoms or transit times were observed between the fructans and sham challenges. This was observed for both 18g and 6g interventions (Table). Breath hydrogen and methane were higher in the 18g fructans group compared with sham (P<0.01 for both). Luminal hydrogen concentration (overall and in quartile 4) was higher in the 18g fructans group compared with sham (P=0.03 and P=0.04) while there were no differences in carbon dioxide concentrations. No differences in colonic fermentation were observed between the 6g fructans and sham groups.
In the 6g population, the intervention period increased overall IBS symptom severity, independent of fructans or sham intervention [ß-coefficient: 37 (95% CI: 5-70), p=0.03].

Table 1. Fructans vs. sham	18 g Fructans (n=12)	18 g Sham (n=12)	6 g Fructans (n=32)	6 g Sham (n=33)
IBS-SSS Total Pain intensity Pain frequency Abdominal distension Bowel habit dissatisfaction Daily life interference	210 ± 93 35 ± 25 28 ± 33 43 ± 35 49 ± 15 55 ± 19	173 ± 104 24 ± 21 32 ± 34 25 ± 20 44 ± 24 50 ± 27	200 ± 123 31 ± 28 36 ± 36 35 ± 35 44 ± 21 54 ± 26	223 ± 101 40 ± 27 39 ± 32 38 ± 30 49 ± 22 57 ± 24
BSF Loose stools, % BSF Normal stools, % BSF Hard stools, %	14 ± 14 59 ± 30 10 ± 13	22 ± 27 67 ± 27 10 ± 17	14 ± 22 69 ± 28 17 ± 22	18 ± 23 69 ± 27 10 ± 12
Colonic transit time (h) Whole gut transit time (h)	18.7 (15.6-39.4) 26.8 (24.2-35.3)	17.9 (16.0-18.9) 26.1 (24.3-28.3)	21.8 (14.6-40.1) 28.6 (23.5-50.8)	23.4 (14.6-36.6) 32.5 (25.0-50.0)
Overall luminal H2, % Overall luminal CO2, %	6.93 ± 3.88 * 19.34 ± 4.40	3.10 ± 2.33 16.65 ± 3.38	6.10 ± 3.43 24.44 ± 9.34	5.28 ± 4.37 25.71 ± 7.47
Breath H2, AUC (ppm) Breath CH4, AUC (ppm)	3399 ± 2432 * 1033 ± 698 *	1503 ± 434 529 ± 511	1740 ± 1944 658 ± 813	1693 ± 1504 890 ± 1142

Conclusion

In non-constipated IBS patients following a low FODMAP diet, supplementation with 18 g (but not 6 g) fructans per day led to increased colonic fermentation, without severe aggravation of GI symptoms. Independent of intervention, IBS symptom severity increased, highlighting the role of the nocebo effect. Central and peripheral processes may both be important in FODMAP-related symptoms with individual variations.

References

1. Ong DK, Mitchell SB, Barrett JS, Shepherd SJ, Irving PM, Biesiekierski JR, et al. Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J Gastroenterol Hepatol. 2010;25(8):1366–73.
2. Van den Houte K, Colomier E, Routhiaux K, Mariën Z, Schol J, Van den Bergh J, et al. Efficacy and findings of a blinded randomized reintroduction phase for the low FODMAP diet in Irritable Bowel Syndrome. Gastroenterology. 2024 Jul;167(2):333-342.
3. Elsenbruch S. Unravelling the power of nocebo in symptom response to food challenge in irritable bowel syndrome. The Lancet Gastroenterology & Hepatology, 2025; 10, 780-781
4. Berean KJ, Ha N, Ou JZ, Chrimes AF, Grando D, Yao CK, et al. The safety and sensitivity of a telemetric capsule to monitor gastrointestinal hydrogen production in vivo in healthy subjects: a pilot trial comparison to concurrent breath analysis. Aliment Pharmacol Ther. 2018;48(6):646–54.

Event

UEG Week Barcelona 2026

Topics

Small Intestine & Nutrition Primary Care Colorectal

Submission format

Abstract

Session

Insights into IBS

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

EFFECTS OF EXCLUSIVE PALATABLE ELEMENTAL DIET ON BODY COMPOSITION IN OBESE AND LEAN MICE

Ali Rezaie

The role of lifestyle changes and diet

Eirini Dimidi

FRUCTANS BOOST COLONIC FERMENTATION BUT DO NOT AGGRAVATE SYMPTOMS IN NON-CONSTIPATED IBS PATIENTS ON A LOW FODMAP DIET – A RANDOMIZED CONTROLLED TRIAL

Magnus Simrén

Ostomy management

Revital Barkan

HIGH ADHERENCE TO THE MEDITERRANEAN DIET DELAYS SURGERY AND REPROGRAMS INTESTINAL CELLULAR STATES IN CROHN’S DISEASE

Stefania Vetrano

Evidence of disordered eating in disorders of gut–brain interaction

Chloé Melchior

UEG Presentation

New

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

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

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Ostomy management

Revital Barkan 1

Affiliations

1 Department of Gastroenterology Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel

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Abstract

Event

UEG Week Barcelona 2026

Topics

Colorectal Surgery IBD

Session

Mistakes in… Lower GI

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

More Like This:

EFFECTS OF EXCLUSIVE PALATABLE ELEMENTAL DIET ON BODY COMPOSITION IN OBESE AND LEAN MICE

Ali Rezaie

The role of lifestyle changes and diet

Eirini Dimidi

FRUCTANS BOOST COLONIC FERMENTATION BUT DO NOT AGGRAVATE SYMPTOMS IN NON-CONSTIPATED IBS PATIENTS ON A LOW FODMAP DIET – A RANDOMIZED CONTROLLED TRIAL

Magnus Simrén

Ostomy management

Revital Barkan

HIGH ADHERENCE TO THE MEDITERRANEAN DIET DELAYS SURGERY AND REPROGRAMS INTESTINAL CELLULAR STATES IN CROHN’S DISEASE

Stefania Vetrano

Evidence of disordered eating in disorders of gut–brain interaction

Chloé Melchior

UEG Presentation

New

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

HIGH ADHERENCE TO THE MEDITERRANEAN DIET DELAYS SURGERY AND REPROGRAMS INTESTINAL CELLULAR STATES IN CROHN’S DISEASE

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HIGH ADHERENCE TO THE MEDITERRANEAN DIET DELAYS SURGERY AND REPROGRAMS INTESTINAL CELLULAR STATES IN CROHN’S DISEASE

Alejandra Angela Carriles Linares 1,2, Michele Salerno 1,2, Stefano De Zanet 1,2, Faris Hrvat 1, Laura Loy 2, Roberto Gabbiadini 2, Patrizia Gnagnarella 3, Giuseppe Privitera 1,2, Arianna Dal Buono 2, Cristina Bezzio 1,2, Daniele Piovani 1,2, Stefanos Bonovas 1,2, Gisella Figlioli 1,2, Giulia Rizzo 2, Giada Mori 2, Gianluca Tognon 4, Samuel Elias Pineda Chavez 2,1, Massimo Claudio Fantini 5,6, Sara Onali 5,6, Michele Carvello 1,2, Antonino Spinelli 1,2, Alessandro Armuzzi 1,2, Stefania Vetrano 2,1

Affiliations

1 Humanitas University, Pieve Emanuele, Milan, Italy

2 IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

3 IEO European Institute of Oncology IRCCS, Milan, Italy

4 University of Skövde, Skövde, Sweden

5 Azienda Ospedaliero-Universitaria di Cagliari, Monserrato, Cagliari, Italy

6 University of Cagliari, Monserrato, Cagliari, Italy

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Abstract

Introduction

Fibrostenotic Crohn’s disease (CD) leads to intestinal obstruction and surgery, yet determinants of fibrogenesis remain poorly defined. While dietary patterns influence inflammation, their role in fibrotic progression remains unclear. We investigated whether Mediterranean diet adherence influences disease progression.

Aims & Methods

We conducted a retrospective cohort study including 1,092 patients with Crohn’s disease from two tertiary referral centers (mean age at diagnosis 33.6 years, SD 15.3; 54% male), with B1 disease in 67%, B2 in 27%, and B3 in 6%. Mediterranean diet adherence was quantified using a validated food frequency questionnaire and a 0–9-point score.
The primary outcome was intestinal surgery for fibrostenotic CD, and the secondary outcome was de novo intestinal stenosis. Time-to-event analyses were performed using Kaplan–Meier estimates and multivariable Cox regression, with time zero defined as first clinical assessment. Patients were censored at last clinical follow-up for surgery and at last colonoscopy for stenosis, reflecting routine clinical practice with variable follow-up intervals.
Mechanistic studies were performed in SAMP1/YitFc mice fed a Mediterranean or control diet for 12 weeks. Disease severity, fibrosis, and ileal remodeling were assessed. Spatial transcriptomics was performed in murine tissue, while bulk RNA sequencing was conducted on fibroblasts from 10 CD patients stratified by diet adherence.

Results

Over a median follow-up of 2.54 years (3,772 person-years), 313 patients (28.7%) underwent surgery, corresponding to an incidence rate of 8.3 per 100 person-years. The 5-year cumulative incidence of surgery decreased progressively across Mediterranean diet adherence levels (39.2% low, 31.8% moderate, 25.0% high; p < 0.001).
For de novo stenosis, the 5-year cumulative incidence was 49.6% (95% CI 45.6–53.2%), with a graded reduction across adherence levels (56.4%, 51.2%, 35.8%). Multivariable models confirmed an independent protective association between higher Mediterranean diet adherence and both outcomes.
In mice, the Mediterranean diet attenuated intestinal inflammation and collagen deposition compared with the control diet (p < 0.001).
Spatial transcriptomics revealed diet-dependent remodeling of the intestinal microenvironment, characterized by expansion of goblet cells and RGS5+ structural myofibroblasts, with reduced SPP1+ pro-fibrotic and CD74+ inflammatory fibroblasts. In contrast, the control diet promoted inflammatory and metabolically dysregulated stromal states. Similarly, in human samples, high Mediterranean diet adherence was associated with enrichment of RGS5+ structural myofibroblasts in the intestinal mucosa.

Conclusion

Higher adherence to the Mediterranean diet is associated with reduced risk of intestinal surgery and de novo stenosis in CD. Integrated human and experimental data suggest that the Mediterranean diet may modulate fibrostenotic progression by directly reshaping epithelial and stromal cellular states, beyond anti-inflammatory effects, providing a potential strategy to influence intestinal tissue remodeling.

Event

UEG Week Barcelona 2026

Topics

Paediatrics Small Intestine & Nutrition IBD Gut Microbiota

Submission format

Abstract

Session

Beyond prescriptions: Improving IBD outcomes with non-pharmaceutical approaches

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Evidence of disordered eating in disorders of gut–brain interaction

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Evidence of disordered eating in disorders of gut–brain interaction

Chloé Melchior 1

Affiliations

1 Rouen University Hospital, INSERM U1073, CIC-CRB-1404, Rouen, France

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Neurogastroenterology & Motility Small Intestine & Nutrition

Session

Eating disorders and unexplained weight loss

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Magnus Simrén

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