Introduction

It is sometimes difficult to distinguish between autoimmune pancreatitis (AIP) and pancreatic neoplasm. In imaging diagnostic examination, long or multiple strictures, or segmental/focal narrowing of pancreatic duct without marked upstream dilatation in endoscopic retrograde pancreatography is important finding to diagnose as AIP. It has been speculated that the narrowing of pancreatic duct is attributed to periductal lymphoplasmacytic infiltration characteristic of histology in AIP. We reported a resected case of AIP in which branch pancreatic duct wall thickening demonstrated by endoscopic ultrasound (EUS) reflected periductal lymphoplasmacytic infiltration¹⁾. EUS that provides high resolution image of pancreas can delineate periductal lymphoplasmacytic infiltration as pancreatic duct wall thickening.

Aims & Methods

The aim of this study is to determine whether pancreatic duct wall thickening on EUS contributes to the diagnosis of AIP. From March 2017, when we began focusing on pancreatic duct wall thickening in AIP, to March 2023, there were 24 consecutive patients diagnosed with AIP in our department. EUS was performed in all of them, and the presence of pancreatic duct wall thickening was noted on the EUS report. Pancreatic duct wall thickening was focused on a thickened wall with symmetry, irregular luminal caliber, and a smooth hyperechoic layer covering the surface¹⁾. The international consensus diagnostic criteria for AIP were applied. The detection rate of pancreatic duct wall thickening on EUS, characteristics according to pancreatic duct wall thickening, and the change of pancreatic duct wall thickening after steroid therapy were investigated.

Results

All patients were diagnosed with type 1 AIP (definitive type 19, probable type 2). Median age was 70 years (range: 55-82), and male was 18 patients. The median serum IgG4 level at diagnosis was 446 mg/dL (range: 147-2600). The detection rate of pancreatic duct wall thickening on EUS was 83.3% (20/24). Localization was diffuse in 12 patients and segmental/focal type in 12 patients. Other organ involvement was observed in 13 patients. There was no difference in the above factors depending on the presence or absence of pancreatic duct wall thickening. Twenty patients underwent steroid trial. Among them, 7 patients who underwent EUS after steroid trial showed improvement in pancreatic duct wall thickening.

Conclusion

Pancreatic duct wall thickening on EUS was often seen in patients with AIP and improved with steroid therapy. Focusing on this imaging finding may be useful in the diagnosis of AIP.

References

1. Ishii K, Hisa T, Shiozawa S, et al. A resected case of focal autoimmune pancreatitis with pancreatic duct wall thickening representing periductal lymphoplasmacytic infiltrate. Clin J Gastroenterol 2021; 14: 1278-1285.

Introduction

Growing evidence points to appendectomy as an alternative treatment for ulcerative colitis (UC). Histopathological appendiceal inflammation might be correlated with response to appendectomy. Intestinal ultrasound (IUS) is a non-invasive diagnostic modality used to visualize appendiceal inflammation.

Aims & Methods

We aimed to investigate appendiceal IUS’s relationship with histopathology findings in appendix resection specimens. Therapy-refractory UC patients undergoing appendectomy in single center clinical trials were included. IUS parameters included appendix diameter, wall thickness, submucosal layer thickness and submucosal hyperechogenicity. Submucosal layer hyperechogenicity was quantified using the mean aerial grayscale intensity which is a numerical scale 0-255, with zero corresponding to black. To adjust for variations in depth and gain, we measured the ∆ grayscale intensity using the difference between the submucosa and muscularis propria in a perpendicular fashion. The Robarts Histopathology Index (RHI) was used to measure mucosal histological disease activity in the appendix ranging from 0-33. Appendiceal inflammation was defined as RHI >3, with at least subscores of lamina propria neutrophils or epithelium neutrophils ≥1, or presence of ulcers or erosions.

Results

37 of 55 (67.3%) included patients had a visualized appendix on IUS. The median RHI was 6 (IQR 0-12) and histopathological appendiceal inflammation was present in 21/37 (57%). Submucosal layer thickness was significantly higher, and the submucosal layer hyperechogenicity was significantly enhanced in microscopically inflamed appendices (Table 1). Submucosal hyperechogenicity predicted histopathological appendiceal inflammation (OR 1.03, 95% CI 1.0-1.05; p=0.035). Submucosal thickness ≥0.75 mm diagnosed histopathological appendiceal inflammation with 66.7% sensitivity, 81.3% specificity and an AUC of 0.69 (p=0.046). Submucosal hyperechogenicity >110.20 diagnosed histopathological appendiceal inflammation with 57.1% sensitivity, 81.3% specificity and an AUC of 0.69 (p=0.046).

Conclusion

IUS is able to identify patients with histopathological appendiceal inflammation who may benefit from appendectomy as treatment for UC.

Disclosure

MP received speakers fees from Janssen and Tillotts
EV has nothing to disclose
FV received speaker or honoraria fees from AbbVie, Janssen and Tillotts
MR has nothing to disclose
WB ​has nothing to disclose
GD has served as a consultant and/or received speaker’s fees from AbbVie, Alimentiv, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Celltrion Healthcare, Cytoki Pharma, Eli Lilly, Ferring, Galapagos, Glaxo SmithKline, Gossamer Bio, Immunic, InDex Pharmaceuticals, Janssen, Johnson & Johnson, Kaleido, Pfizer, Progenity, Prometheus Biosciences, Prometheus Laboratories, Protagonist Therapeutics, Takeda, Tillotts, Ventyx Biosciences.
AM has nothing to disclose
CB has nothing to disclose
KG has received grants from Pfizer Inc, Celltrion and Galapagos; consultancy fees from AbbVie, Arena Pharmaceuticals, Galapagos, Gilead, Immunic Therapeutics, Janssen Pharmaceuticals, Novartis, Pfizer Inc., Samsung Bioepis and Takeda and speaker’s honoraria from Abbvie, Celltrion, Ferring, Janssen Pharmaceuticals, Novartis, Pfizer Inc, Samsung Bioepis, Takeda and Tillotts.

Introduction

Disorders of gut brain interaction (DGBIs) is a group of diseases with relatively high prevalence. One of the most common is functional dyspepsia. It has been repeatedly reported that university students tend to have higher prevalence of this disease than general population. Study at medical school is associated with high degree of stress and this could be accumulated during the passing years. As many other factors could affect the symptomatology, the best way to test this hypothesis is to perform a prospective cohort study following one particular group of students over the years.

Aims & Methods

The aim of this study is to evaluate the prevalence of symptoms of functional dyspepsia in selected cohort overtime. This is a prospective, observational study. The observed group were students of medicine from their 1^stto 3^rd year of study. Acquisition of the data was performed by questionnaires. The diagnosis was made by using ROME IV criteria for DGBI. Additional information was obtained from STAX1 and STAX2 validated questionnaires (STAI-X1 shows how the patient feel while answering the questionnaire (anxiety as a state) and STAI-X2 is based on how the patient feel overall (anxiety as a personality trait)) and Beck depression inventory. The measurement was performed in the middle of the school year, every October (2021 to 2023).

Results

Initially 121 students from first year agreed to participate in the study and filled out the questionary. Subsequently the response rate for 2^nd year was 67.8 % and for 3^rd 73%. The symptoms of Functional Dyspepsia were present in 14.9% of participants from 1^st year, 13.4% from 2^nd year and 14.6% from 3^rd year. The cumulative cohort average of STAX 1 was 45.5 points for 1^st year, 46.5 points for 2^nd year and 46.2 points for 3^rd year. The cumulative cohort average of STAX 2 was 47.7 points for 1^st year, 46.2 points for 2^nd year and 46.8 points for 3^rd year. The cumulative cohort average of Beck depression inventory was 8.7 points for 1^st year, 8.8 points for 2^nd year and 8.4 points for 3^rd year. The rate of smoking was 7.4 % of participants from 1^st year, 13.4% participants from 2^nd year and 14.6% from 3^rd year.

Conclusion

The results of this prospective cohort observational study shows that the symptoms of Functional Dyspepsia are highly prevalent among medical students and this varies only insignificantly over time. The probands in average showed no signs of depression however the average levels of anxiety and stress were high during all 3 years. This could be associated with significant rise of smokers within the cohort during the observation period.

Introduction

Inflammatory bowel disease (IBD) often affects patients during their reproductive years. The management of patients wishing to conceive or during pregnancy requires specialized counseling.

Aims & Methods

Our aim was to have a global perspective on the management of IBD by gastroenterologists (GIs) during preconception, pregnancy, breastfeeding and neonatal period.
An anonymous survey (75 questions) was developed to investigate different facets of clinical practice concerning the management of pregnant and breastfeeding in patients with IBD. A national representative from each European country, USA, Latin America, Australia and New Zealand was selected to distribute the survey to their GIs colleagues who treat IBD patients (irrespectively of their experience).

Results

A total of 856 GIs from 36 countries participated in the survey. Among the participants, 63% had over a decade of experience as GIs, and 61% identified themselves as IBD specialists. The most relevant survey results and sub-analyses based on expertise are presented in tables 1 and 2. In the management of pregnant patients in remission, treatment discontinuation occurred either consistently or occasionally as follows: 20% thiopurines, 37% vedolizumab, 31% ustekinumab, and 96% small molecules. Notably, 13% did not always discontinue small molecules in patients contemplating pregnancy. Safety was the main reason for discontinuing IBD therapy during pregnancy. Contrary to the recommendations in clinical practice guidelines, many GIs avoid starting oral or rectal budesonide, anti-TNF, vedolizumab or ustekinumab during a disease flare. Further, a third of GIs would start thiopurines for a flare during pregnancy. Moreover, 13% will never perform a colonoscopy in a pregnant patient to guide decision making. Half of GIs implemented a dedicated outpatient follow-up program for pregnant patients in remission, with 87% enrolling all pregnant patients in this program. Concerning breastfeeding, 14% believed that all drugs can be used while breastfeeding. Regarding offspring’s vaccination, about 20% recommend against the administration of non-live vaccines and only 50% recommended avoiding live vaccines during the first 12 months for children exposed to anti-TNF in-utero. Among those GIs who recommended delaying vaccines in such cases, only 41% recommended testing the infant for detectable anti-TNF levels if live vaccines were required. Among the surveyed GIs, only a minority had a referral obstetrician, and only 35% referred patients with active or complicated IBD, while 45% had a referral paediatrician with expertise in IBD. The main results regarding the medical management and monitoring of IBD during pregnancy, as well as advice on birth outcomes, breastfeeding, and vaccination, are detailed in Table 1.

Conclusion

The management of IBD during pregnancy, lactation, and neonatal period is notably suboptimal, even among GIs specifically dedicated to IBD. It is crucial to address this current need and implement urgent educational measures in this area.

Table 1. Medical management and disease monitoring during pregnancy, advice birth outcomes, breastfeeding, and vaccination.

Disclosure

María José Casanova, has received education funding from Pfizer, Takeda, Janssen, MSD, Dr. Falk, Shire, Ferring, Galápagos and Abbvie.
Javier P. Gisbert has served as speaker, consultant, and advisory member for or has received research funding from MSD, Abbvie, Pfizer, Kern Pharma, Biogen, Mylan, Takeda, Janssen, Roche, Sandoz, Celgene/Bristol Myers, Gilead/Galapagos, Lilly, Ferring, Faes Farma, Shire Pharmaceuticals, Dr. Falk Pharma, Tillotts Pharma, Chiesi, Casen Fleet, Gebro Pharma, Otsuka Pharmaceutical, Norgine and Vifor Pharma.
Aurelien Amiot has received consulting fees from Pfizer, Janssen, Tillotts Pharma, Takeda, and Adacyte as well as lecture fees and travel accommodations from Abbvie, Janssen, Biogen, Fresenius kabi, Takeda Pfizer, Tillotts pharma, Sandoz and Celltrion.
Hannah Gordon has received speaker fees from Janssen, Ferring, AbbVie, IBDscope and consultancy fees from Galapagos
Paulo Kotze has receive consultancy and speaking honorarium for Abbvie, Janssen, Pfizer and Takeda.
Andreas Blesl has served as speaker, consultant, and advisory member for or has received research funding from Abbvie, Aengus, Boston Scientific, Bristol-Myers Squibb, Dr. Falk Pharma, Genericon, Gilead, Janssen, Lilly, MSD, Olympus, Pfizer, Takeda, Vifo
Ignacio Catalán-Serra has received research grants and/or speaker and advisory fees from: Tillots, Takeda, Ferring, Elli Lilly, Bristol-Myers-Squidd, Janssen and Abbvie
Peter Bossuyt has received financial support for research: AbbVie, Amgen, Janssen, Viatris, Pfizer. Lecture fees: AbbVie, Bristol Myers Squibb, CAG, Celltrion, EPGS, Galapagos, Globalport, Janssen, Lilly, Materia Prima, Pentax, Scope, Takeda. Advisory board fees: AbbVie, Arena, Bristol Myers Squibb, Celltrion, CIRC, Dr Falk Benelux, Galapagos, Janssen, Eli Lilly, Pentax, PSI-CRO, Roche, Takeda, Tetrameros
Ariella Bar Gil Shitrit reports consulting/advisory fees from Takeda, Janssen, Neopharm Pfizer and AbbVie; Speaking and teaching fees from Takeda, Janssen, AbbVie, Neopharm, Rafa, BMS, Lilly and Pfizer, and research support from Takeda and Janssen.
Paulina Molander has received speaker and consultancy fees from Abbvie, Orion Pharma, Pfizer, Sandoz, Takeda, Tillotts Pharma, and advisory board member fees from BMS, Gilead and Janssen-Cilag
G Mantzaris: has served as advisory board member for AbbVie, Celgene, Celtrion, Ferring, Genesis, Hospira, Janssen, Millennium Pharmaceuticals, Merck Sharp & Dohme, Mylan, Pharmacosmos, Pfizer, Takeda, and Vianex; has served as a speaker for AbbVie, Angelini, Falk Pharma, Ferring, Galenica, Cenesis, Hospira, Janssen, Merck Sharp & Dohme, Omega Pharma, Takeda, and Vianex; has served as a consultant for Merck Sharp & Dohme and Takeda; and has received research support from AbbVie, Galenica, Genesis, Menarini Group, and Merck Sharp & Dohme.
Pascal Juillerat has receive research grant from Vifor Pharma, consulting/Board/speaker from AbbVie, Arena, Amgen, BMS, Ferring, Gilead, Janssen, Lilly, MSD, Pfizer, Pierre Fabre, Roche, Sandoz, Takeda, Tillots, UCB Pharma .
Krisztina B. Gecse has received research grants from Abbvie, Pfizer Inc, Celltrion and Galapagos, consultancy fees and speaker’s honoraria from AbbVie, Celltrion, Ferring, Galapagos, Immunic Therapeutics, Janssen Pharmaceuticals, Pfizer Inc., Samsung Bioepis, Takeda and Tillotts.
Pär Mirelyd has received paid lectures from Abbvie, Tillotts, Galapagos, Janssen and Pfizer
Uma Mahadevan has received consultant fees from Abbvie, Arena, BMS, Boeringher Ingerlheim, Celltrion, Enveda, Gilead, Janssen, Lilly, Merck/Prometheus Laboratories, Pfizer, Rani Therapeutics, Roivant, Takeda.
Beatriz Iade has served as speaker from Abbvie and Janssen.
Dana Duricova has received lecture fee/ consultancy from Janssen, Takeda, Abbvie, Pfizer, Ferring, Eli-Lilly
Mette Julsgaard has received research grants for other investigator-driven studies from Takeda and Novo Nordisk Foundation (grant no. NNF23OC0081717), has received consultation fees from Ferring and Takeda, and has received speaker’s fees from MSD, Ferring, Tillotts Pharma, and Takeda.
María Chaparro has served as speaker, consultant or research or education funding from MSD, Abbvie, Hospira, Pfizer, Takeda, Janssen, Ferring, Shire Pharmaceuticals, Dr. Falk Pharma, Tillotts Pharma, Biogen, Gilead and Lilly.

Introduction

Pfizer's Institute for Translational Equitable Medicine and our Chief Medical Officer, Aida Habtezion, MD, hosted an IBD Health Equity Summit at DDW 2023 in Chicago, Illinois on May 5, 2023 with a group of 22 key opinion leaders in the gastroenterology field. The purpose of the Summit was to uncover health equity research gaps and quality of care gaps that will enable Pfizer and our partners to determine future directions in IBD research and contribute to achieving healthcare equity by providing opportunities to improve patient outcomes, as well as address practice-based disparities.

Aims & Methods

A full day Summit was designed and developed, bringing together thought leaders and experts (representing research, HCPs and patients) to discuss health disparity gaps and possible solutions. The day was split into two parts: a morning session focused on research, with IBD researchers presenting different facets of the research construct with follow-on discussion with the audience. The afternoon was dedicated to clinical care and also included IBD experts addressing Health Equity concerns and opportunities. A follow-on summary report was developed, distributed and serves as the basis for current and future strategies aimed at closing disparity gaps among IBD patients.

Results

Several overarching themes emerged, highlighting IBD as a global affliction, and challenges that transcend geographical borders. Addressing these challenges will require solutions tailored to local and regional contexts that consider factors such as race, ethnicity, socio-economic status, culture, diets, and sexual orientations. It was also recognized that many of the challenges posed by IBD are not unique to this disease, and that valuable insights can be gained by examining other complex disease states to improve the quality of care and address health disparities in patients with IBD.

Conclusion

IBD Research
Key gaps include low clinical trial participation of patients from diverse communities due to lack of healthcare literacy, low historical representation, bias in recruitment, lack of diversity in providers.
Strategies to address these gaps include improving health literacy, workforce development and educating providers, adequate compensation for time, flexibility for participating in trials, and incorporation of digital health tools for follow-ups.
Clinical Care
There are groups of patients in several regions that lack any care, and addressing healthcare disparities in IBD care for these patients cannot be done online but will need to be done on a local and regional level on the ground.
When addressing health inequities, the heterogeneities within underserved populations like Black and Hispanic patients need to be considered.
Gaps in data on the effectiveness of therapies in specific patient populations (ie, response to anti-TNFs in black patients and patients with comorbidities).
Sponsorship is lacking to establish efforts in underserved communities on a global level; There is an opportunity to provide connection for minority physicians to resources.
By identifying gaps and potential strategies to close them, the participants have provided Pfizer and our partners a roadmap to address health disparities among IBD patients worldwide. These data and information have served as the basis for a go-forward plan to support and invest in change initiatives to close gaps. Our desire is to enlist additional partners and collaborators through a Call to Action to identify solutions at the local level that can accelerate improved IBD care and outcomes for some of the most vulnerable populations in the world.

Disclosure

Employee of Pfizer Inc

Introduction

Surgery is the traditional treatment of traumatic pseudocysts, but with considerable morbidity and mortality. A minimally invasive management of these collections has been increasingly used. Objective: To analyze the outcome following endoscopic treatment of pancreatic pseudocysts caused by abdominal trauma and to study the integrity of the main pancreatic duct (MPD).

Aims & Methods

Patients with pancreatic fluid collections due to abdominal trauma and who underwent endoscopic therapy were studied. All were symptomatic with a persistent collection for more than 6 weeks. Opacification of the MPD allowed characterization according to Takishima Classification (I, II and III) which guided therapy. Endoscopic drainage was divided into: transpapillary (Takishima II and III without bulging), transmural (type I) or combined (type II or III with bulging).

Results

From January 2020 January 2025 51 patients (36 men, mean age of 35.2 years, range - 13.9 years) were identified who developed pancreatic collections after blunt or penetrating abdominal trauma., The average size of the collection was 14.3  5.2 cm. ERP was obtained in 47/51 (90%). Drainage was transmural in 13 (all type I), combined in 24 (type IIa (4), IIb (7) and III (13) and transpapillary in 10 (all type III without bulging). The remaining 4 were drained transmurally. The success of endoscopic treatment was 94% with a recurrence rate of 8%. Stent occlusion occurred in 6%. There were 9 complications, but no procedural-related deaths. Patients with penetrating trauma had more recurrences than those with blunt trauma (p = 0.01). Penetrating trauma conferred a relative risk for development of infection 0.25; (95% 0.07 - 0.88; p = 0.045).

Conclusion

Endoscopic treatment of pancreatic fluid collections that develop after pancreatic trauma is safe and effective and can be considered a first-choice alternative to surgical and/or percutaneous treatment. Pancreatography is useful in determining the best endoscopic approach.

Disclosure

​NO CONFLICT OF INTEREST