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Diverticulitis: When not to be worried?

Johannes Kurt Schultz 1

Affiliations

1 Univertsity of Oslo, Oslo, Norway

Summary

AI Generated

A surgeon argues that most patients with acute diverticulitis can be managed conservatively without routine imaging, antibiotics, or surgery, with intervention reserved for sepsis or severe peritonitis.

The speaker stated that in immunocompetent patients with mild diverticulitis, CT imaging is not necessary if leukocyte count is low and there is no abdominal guarding, based on a Dutch cohort study reporting 96% negative predictive value for complications.
Two randomized trials totaling over 1000 patients showed no benefit of antibiotics for uncomplicated diverticulitis, with no significant differences in recurrence rates, complications, or need for sigmoid resection compared to observation alone.
Conservative management of extraluminal air is successful in most cases, with a Finnish study of 172 patients reporting over 99% success for air bubbles around the colon and high success rates for distant intraperitoneal air in non-septic patients without severe peritonitis.
Most perforations occur at the first episode of diverticulitis rather than with recurrent attacks, so prophylactic surgery to prevent future complications is not justified according to the speaker.
The speaker recommended that uncomplicated diverticulitis should be managed by gastroenterologists rather than surgeons, and that surgeons should avoid overuse of imaging, antibiotics, and operative intervention.

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Abstract

Event

UEG Week Berlin 2025

Topics

Colorectal Hepatobiliary Pancreas

Session

Predicting disease severity

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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European Guideline on Pre-Operative Prevention of Surgical Site Infections Following Digestive Surgery: A Joint Update of the WHO SSI Guideline for Gastrointestinal Surgery by UEG, ESCP, EAES, and SIS-E

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DOES ELF PREDICT PROGRESSION BILE DUCT CHANGES BASED ON SEQUENTIAL ERC EXAMINATIONS AND DISEASE OUTCOME IN PSC?

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UEG Standards and Guidelines

Clinical Practice Guideline

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European Guideline on Pre-Operative Prevention of Surgical Site Infections Following Digestive Surgery: A Joint Update of the WHO SSI Guideline for Gastrointestinal Surgery by UEG, ESCP, EAES, and SIS-E

Adele Sayers

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Guideline

Abstract

This is an update of the WHO SSI guideline published in 2018, focussing on areas pertinent for gastrointestinal (GI) surgery and hepatobiliary and pancreatic (HBP) surgical procedures. Based on new information and appraisal of current evidence, the following recommendations can be suggested: During skin preparation, we suggest using alcohol-based chlorhexidine for clean, clean-contaminated, and contaminated GI and HBP surgical field preparation in the absence of a mucous membrane (e.g., stoma, genitalia, anus). Preoperatively, we suggest that corticosteroids and anti-TNF medication be discontinued. No recommendations could be made on the following comparisons, given the paucity of high-quality evidence and panel discussion not favouring one intervention over the other based on clinical experience: 2%-3% chlorhexidine gluconate versus aqueous povidone-iodine for surgical field preparation. 4%-5% chlorhexidine gluconate versus aqueous povidone-iodine for surgical field preparation. Aqueous chlorhexidine gluconate versus aqueous povidone-iodine for surgical field preparation Pre-operative dexamethasone in single-dose versus no pre-operative dexamethasone for patients undergoing GI surgery. Discontinuing Vedolizumab preoperatively versus continuing Vedolizumab preoperatively for patients undergoing GI surgery. Discontinuing Ustekinumab preoperatively versus continuing Ustekinumab preoperatively for patients undergoing GI surgery.

Publishers

European Association for Endoscopic Surgery and other interventional techniques, European Society for Coloproctology

Guideline

Clinical Practice Guideline

Topics

Surgery

Citation

United European Gastroenterology Journal, 2025; 13:1887–1904

Published

2025

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European Guideline on Pre-Operative Prevention of Surgical Site Infections Following Digestive Surgery: A Joint Update of the WHO SSI Guideline for Gastrointestinal Surgery by UEG, ESCP, EAES, and SIS-E

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UEG Presentation

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Variceal bleeding from Ligation to Sengstaken

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Variceal bleeding from Ligation to Sengstaken

Thomas Rösch 1

Affiliations

1 Clinic for Interdisciplinary Endoscopy, Hamburg, Germany

Summary

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Abstract

Event

UEG Week Berlin 2025

Topics

Nurses

Session

Endoscopic techniques: Emergency and difficult situations

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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European Guideline on Pre-Operative Prevention of Surgical Site Infections Following Digestive Surgery: A Joint Update of the WHO SSI Guideline for Gastrointestinal Surgery by UEG, ESCP, EAES, and SIS-E

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Cynthia Levy

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UEG Podcast Episode

UEG Podcast

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MASLD with Sven Francque - Part 1

Sven Francque, Pradeep Mundre

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Abstract

Topics

Hepatobiliary

Published

2026

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Johanna Arola

UEG Presentation

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Can we harmonise methods of microbiological surveillance

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Can we harmonise methods of microbiological surveillance

Heike Martiny, Prof. Dr. 1

Affiliations

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

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Abstract

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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Adele Sayers

Variceal bleeding from Ligation to Sengstaken

Thomas Rösch

MASLD with Sven Francque - Part 1

Pradeep Mundre

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LINERIXIBAT SIGNIFICANTLY IMPROVES CHOLESTATIC PRURITUS IN PRIMARY BILIARY CHOLANGITIS: RESULTS OF THE PIVOTAL PHASE 3 GLISTEN TRIAL

Cynthia Levy

DOES ELF PREDICT PROGRESSION BILE DUCT CHANGES BASED ON SEQUENTIAL ERC EXAMINATIONS AND DISEASE OUTCOME IN PSC?

Johanna Arola

UEG Presentation

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

LINERIXIBAT SIGNIFICANTLY IMPROVES CHOLESTATIC PRURITUS IN PRIMARY BILIARY CHOLANGITIS: RESULTS OF THE PIVOTAL PHASE 3 GLISTEN TRIAL

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

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LINERIXIBAT SIGNIFICANTLY IMPROVES CHOLESTATIC PRURITUS IN PRIMARY BILIARY CHOLANGITIS: RESULTS OF THE PIVOTAL PHASE 3 GLISTEN TRIAL

Gideon M. Hirschfield 1, Christopher L. Bowlus 2, David Jones 3, Andreas E. Kremer 4, Marlyn J. Mayo 5, Atsushi Tanaka 6, Pietro Andreone 7, Jidong Jia 8, Qinglong Jin 9, Ricardo Macias-Rodriguez 10, Alexander R. Cobitz 11, Brooke M. Currie 11, Ciara Gorey 12, Ivana Lazic 12, Danielle J. Podmore 12, Andrea Ribiero 13, Jennifer B. Shannon 14, Brandon Swift 14, Megan M. McLaughlin 11, Cynthia Levy 15

Affiliations

1 Toronto General Hospital, Toronto, Canada

2 University of California Davis School of Medicine, Sacramento, United States

3 Newcastle University, Newcastle Upon Tyne, United Kingdom

4 University Hospital Zurich, Zurich, Switzerland

5 University of Texas Southwestern Medical School, Dallas, United States

6 Teikyo University School of Medicine, Tokyo, Japan

7 Azienda Ospedaliero-Universitaria di Modena and Università di Modena e Reggio Emilia, Modena, Italy

8 Capital Medical University, Beijing, China

9 The First Hospital of Jilin University, Changchun, China

10 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

11 GSK, Collegeville, United States

12 GSK, London, United Kingdom

13 GSK, Madrid, Spain

14 GSK, Durham, United States

15 University of Miami, Miami, United States

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Abstract

Introduction

Cholestatic pruritus is common, debilitating and undertreated in patients with primary biliary cholangitis (PBC). Here, we describe the results of GLISTEN (NCT04950127), a Phase 3 study investigating the efficacy and safety of the ileal bile acid transporter inhibitor linerixibat for pruritus in PBC.

Aims & Methods

In this double-blind, randomised, placebo-controlled study, patients with PBC and moderate-to-severe pruritus received oral linerixibat 40 mg or placebo twice daily. Pruritus severity and pruritus-related sleep interference were assessed using a 0–10 numerical rating scale. The primary endpoint was change from baseline in worst itch over 24 weeks. Secondary endpoints included: at Week 2, change in worst itch; over 24 weeks, change in sleep interference; at Week 24, proportion of responders (≥ 2-, ≥ 3-, ≥ 4-point reduction in worst itch) and analysis of responses to 2 patient global impression items (itch severity and change). Safety endpoints included adverse event (AE) reporting.

Results

238 patients were randomised; 95% were female, itch severity was mean (standard deviation [SD]) 7.34 (1.54), 52% had alkaline phosphatase < 1.67 times upper limit of normal, and 47% were receiving stable therapy for pruritus. Pruritus improvement over 24 weeks was significantly greater with linerixibat than placebo: least-squares (LS) mean change -2.86 versus -2.15, adjusted mean difference -0.72; p = 0.001. At Week 24, the observed mean (SD) difference from baseline in pruritus was -3.66 (2.50) with linerixibat and -2.82 (2.32) with placebo. The effect of linerixibat was rapid and superior to placebo at Week 2: LS mean change -1.78 versus -1.07, adjusted mean difference -0.71; p < 0.001. Linerixibat also significantly improved pruritus-related sleep interference over 24 weeks versus placebo: LS mean change ‑2.77 versus -2.24, adjusted mean difference -0.53; p = 0.024. At Week 24, more patients on linerixibat than placebo achieved a ≥ 2-point (68% vs 64%), ≥ 3-point (56% vs 43%) or ≥ 4-point (41% vs 29%) reduction in pruritus and a higher proportion of linerixibat than placebo-treated patients reported their pruritus was very much improved (55% vs 37%) or absent (21% vs 9%). AEs reported more frequently with linerixibat than placebo were predominantly gastrointestinal (GI), including diarrhoea (61% vs 18% of patients) and abdominal pain (18% vs 3% of patients); 4% of patients in the linerixibat group discontinued treatment due to diarrhoea.

Conclusion

In patients with PBC and moderate-to-severe pruritus, linerixibat rapidly and significantly improved pruritus and pruritus-related sleep interference versus placebo. While GI AEs were more common with linerixibat than placebo, they rarely led to treatment discontinuation.

Disclosure

Funded by GSK. Various authors declare conflicts of interest as consultants, employee, recipients of grants and stockholders. These will be reported in full during the presentation.

Event

UEG Week Berlin 2025

Topics

Hepatobiliary Immunology Mechanisms & Personalised Medicine

Submission format

Abstract

Session

Advances in management of immune-mediated biliary disease

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Adele Sayers

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Thomas Rösch

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Pradeep Mundre

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Heike Martiny, Prof. Dr.

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Cynthia Levy

DOES ELF PREDICT PROGRESSION BILE DUCT CHANGES BASED ON SEQUENTIAL ERC EXAMINATIONS AND DISEASE OUTCOME IN PSC?

Johanna Arola

UEG Presentation

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DOES ELF PREDICT PROGRESSION BILE DUCT CHANGES BASED ON SEQUENTIAL ERC EXAMINATIONS AND DISEASE OUTCOME IN PSC?

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DOES ELF PREDICT PROGRESSION BILE DUCT CHANGES BASED ON SEQUENTIAL ERC EXAMINATIONS AND DISEASE OUTCOME IN PSC?

Martti A. Färkkilä 1, Hannu Kautiainen 2, Mette Vesterhus 3, Andrea Tenca 4, Johanna Arola 5

Affiliations

1 Helsinki University Hospital, Helsinki, Finland

2 University of Eastern Finland, Kuopio, Finland

3 Haraldsplass Deaconess Hospital, Bergen, Norway

4 Clinic of Gastroenterology - Helsinki University Hospital, Helsinki, Finland

5 University of Helsinki, Helsinki, Finland

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Abstract

Introduction

Primary sclerosing cholangitis (PSC) is a chronic inflammatory disease affecting the biliary epithelium, leading to bile duct strictures and eventually cirrhosis. Liver fibrosis is a well-established predictor of disease outcome in PSC. The Enhanced Liver Fibrosis (ELF) test, which combines three direct serum markers—hyaluronic acid (HA), tissue inhibitor of metalloproteinases-1 (TIMP-1), and amino-terminal pro-peptide of type III pro-collagen (PIIINP)—has been shown to correlate with the Ishak staging of liver histology in PSC. Both the ELF score and its individual components demonstrate moderate diagnostic accuracy in distinguishing advanced fibrosis (AUROC 0.73–0.78) and cirrhosis (AUROC 0.73–0.81) [1].
However, liver fibrosis and cirrhosis in PSC develop as secondary consequences of bile duct strictures and therefore represent late-stage indicators of disease progression. We have previously shown that biliary levels of calprotectin and interleukin-8 (IL-8) can help identify patients at higher risk of developing bile duct strictures. Moreover, our findings indicated that commonly used liver function tests, particularly plasma alkaline phosphatase (P-ALP), lack both sensitivity and specificity for effectively monitoring PSC progression [2].

Aims & Methods

To study: 1) the association of ELF with ERC-score, 2) the predictive value of ELF for bile duct disease progressio assessed by ≥2 increase in ERC score or need for dilatation, 3) the role of ELF-test to predict the overall disease outcome.
We included patients from Helsinki PSC-registry with ELF determined at least once, and ≥2 ERC examinations. End of f/u was 31.12.23. ERC -score was determined as described earlier [3]. ELF ≥9.8 was used as a marker for advanced liver fibrosis.

Results

In total, we included 397 patients. Demographics, laboratory results, and outcomes stratified by ELF levels, are presented in the table. Increase of ERC-score did not differ between groups, but the score at baseline associated with ELF-test (p<0.001). Progression of PSC assessed by increase of ERC score≥2 or dilatation did not correlated with ELF-levels (p=0.11), but ln[P-hyaluronic acid] showed close association with progression of bile duct changes (p<0.001). The probability for LTx increased in a linear way with the increase of ELF-level. (<0.001).

Variables	ELF ≤9.8 N=310	ELF 9.8-11.2 N=62	ELF ≥11.3 N=25	p for linearity
Person years. [Median (IQR) of person years]	2181 [5.6(3.5,11.8)]	414 [5.6(3.5,11.8)]	82 [2.5(1.3,3.8)]	-
PSC duration, mean (SD), years	6.9(5.8)	8.8(6.0)	11.2(8.1)	<0.001
AOM, mean (SD)	1.39(0.46)	1.83(0.56)	2.49(0.67)	<0.001
P-ALP, U/l, median (IQR)	94(74,135)	168(107,250)	317(203,438)	<0.001
P-Bil, µmol/l, median (IQR)	11(8,17)	13(9,18)	29(17,48)	<0.001
Biliary calprotectin, mg/l, median (IQR)	1.3(0.2,15.8)	13.4(0.9,71.0)	22.4(9.1,133.0)	<0.001
Increase of ERC score ≥2, n(%)*	35(11)	9(15)	4(16)	0.35
Increase of ERC score≥2 or dilatation, n(%)*	142(46)	40(65)	20(80)	<0.001
CCA, HCC, GBCA, Death, LTx (Incidence (95% CI), [no])**	15(10 to 21), [32]	60(39 to 89), [25]	220(30 to 347), [18]	<0.001

* Adjusted linearity for age, sex, PSC duration, intra-and extrahepatic disease,and ERC-score at baseline
** per 1000 pyrs. Adjusted for age, sex, PSC duration, intra-and extrahepatic disease.
Abbreviations: AOM, Amsterdam-Oxford model; CCA, cholangiocarcinoma, GB-CA, gallbladder carcinoma; LTx, liver transplantation.

Conclusion

The ELF test correlates with the severity of bile duct disease and the risk of liver transplantation, but it is not suitable for assessing the progression of bile duct changes based on sequential ERC examinations. The role of hyaluronic acid as a surrogate marker of bile duct changes deserves further studies.

References

[1] Thorburn DT et al. Hepatology Communications 2024;8(7):e0467, [2] Färkkilä M et al. JHEP Rep. 2024 Jul 2;6(10):101161, [3] Boyd S, et al. Endoscopy. 2016;48:432-9.

Event

UEG Week Berlin 2025

Topics

Hepatobiliary Immunology Mechanisms & Personalised Medicine

Submission format

Abstract

Session

Advances in management of immune-mediated biliary disease

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

European Guideline on Pre-Operative Prevention of Surgical Site Infections Following Digestive Surgery: A Joint Update of the WHO SSI Guideline for Gastrointestinal Surgery by UEG, ESCP, EAES, and SIS-E

Adele Sayers

Variceal bleeding from Ligation to Sengstaken

Thomas Rösch

MASLD with Sven Francque - Part 1

Pradeep Mundre

Can we harmonise methods of microbiological surveillance

Heike Martiny, Prof. Dr.

LINERIXIBAT SIGNIFICANTLY IMPROVES CHOLESTATIC PRURITUS IN PRIMARY BILIARY CHOLANGITIS: RESULTS OF THE PIVOTAL PHASE 3 GLISTEN TRIAL

Cynthia Levy

DOES ELF PREDICT PROGRESSION BILE DUCT CHANGES BASED ON SEQUENTIAL ERC EXAMINATIONS AND DISEASE OUTCOME IN PSC?

Johanna Arola

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