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Introduction

Patients with recently diagnosed celiac disease (CD), usually present with upper gastrointestinal manifestations, including bloating, abdominal pain and chronic diarrhea or constipation, thus adopting several restrictive tendencies, apart from the standard-of -care gluten-free diet (GFD). Avoidant/restrictive food intake disorder (ARFID) is a newly established eating disorder affecting primarily children, but with emerging evidence among adults. We aimed to examine the prevalence of ARFID and the eating attitude among adults with recently diagnosed celiac disease.

Aims & Methods

In a prospectively maintained cohort of adult patients with a recent diagnosis of celiac disease, we evaluated eating habits of patients with a recent diagnosis of CD who were under GFD through the Eating Attitudes Test (EAT-26) and the prevalence of ARFID through nine item avoidant/restrictive food intake disorder screen (NIAS), containing three subscales (picky eating, appetite, fear).

Results

A total of 28 patients were enrolled [mean age 37.07 years old (IQR 23.47), 22 females (78.6%)], with a mean body mass index (BMI) of 23.7kg/m²(mean weight 65.2 kg and mean height 1,70m). A self-reported suspected food intake disorder had been reported by 35.7% of patients, while 21.4% were referred to a specialized mental care professional and 7.1% had been diagnosed by a non-specific food disorder in the past 6 months. Physical activity was limited or absent in 78.6% of enrolled patients.
Both EAT-26 and NIAS questionnaires displayed acceptable values on reliability analysis (Cronbach's alpha score 0.618 and 0.658 respectively). A total of 14% (4 out of 28 patients,100% females) met criteria for ARFID, with a mean score of 42 points on the total scale of NIAS. Patients with ARFID reported that other people think that they are too thin (p=0.004) and felt external pressure from others to eat (p<0.001).
Females reported to push significantly themselves to eat regularly or large amounts of food on a daily basis (p=0.04), significantly consumed more time and thought to food (p<0.001), enjoyed trying new rich foods (p=0.02) and suffered from eating binges (p=0.003) compared to males. However, there were no differences between BMI, the self-reported suspected food disorder and the diagnosed mental health conditions. Additionally, CD patients with suspected and diagnosed food disorder scored similarly to all given questionnaires.

Conclusion

In a small sample of patients with recently diagnosed CD, ARFID may present up to 15% and contribute to persistent symptomatology and food restrictive attitude, despite being on GFD. Although females were found to be more susceptible to ARFID, by reporting more binge eating symptomatology and external factors exerting pressure, no significant differences were found on age, gender, BMI in our cohort.

PREVALENCE OF AVOIDANT/ RESTRICTIVE FOOD INTAKE DISORDER AMONG PATIENTS WITH NEWLY DIAGNOSED CELIAC DISEASE

Artemis Trikola 1, Eleni Beka 2, IOANNIS LAPPAS 1, Georgia Emmanouilidou 1, Maria Ellina 1, Lampros Chrisaugis 1, GEORGIOS KRANIDIOTIS 1, Gerasimos Stefanidis 1, Nikos Viazis 2

1 Athens Naval Hospital, Athens, Greece

2 Evangelismos Hospital, Athens, Greece

Conference

UEG Week Vienna 2024

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

Coeliac disease: Part 2 (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Standards and Guidelines

Clinical Practice Guideline

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Introduction

Inflammatory bowel disease [IBD] has a high incidence and prevalence in young individuals, affecting people in their reproductive years. The diagnosis of IBD raises many questions; these include concerns about sexuality, disease heritability, and the impact of medications and disease activity on fertility, pregnancy outcomes, and lactation. Uncertainty about the health of the offspring may influence patients’ choices in family planning. Therefore, the management of patients who wish to conceive or who are pregnant requires specialised counselling and appropriate management. This involves a multidisciplinary approach and close involvement of the prospective parents under a shared decision-making model. These updated consensus guidelines address these issues and aim to optimise and harmonise pre-conceptional, pregnancy, and post-pregnancy IBD management and counselling.

ECCO Guidelines on Sexuality, Fertility, Pregnacy, and Lactation

Joana Torres

Publisher

European Crohn’s and Colitis Organisation

Guideline

Clinical Practice Guideline

Topics

IBD

Citation

Journal of Crohn's and Colitis, Volume 17, Issue 1, January 2023, Pages 1–27

Published

2022

UEG Standards and Guidelines

Clinical Practice Guideline

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Introduction

This is the second European Crohn’s and Colitis Organisation [ECCO] evidence-based consensus on extraintestinal manifestations [EIMs] of inflammatory bowel disease [IBD] and anaemia. Up to 50% of patients with IBD will develop at least one EIM, which may impact each body system; hence they are a source of considerable morbidity, or even mortality in the case of primary sclerosing cholangitis [PSC] or venous thromboembolic events [VTE]. Broadly, EIMs can be categorized as classical, arising from inflammatory pathology at distant sites, the consequences of systemic inflammation and treatment, or wider associations. The underlying pathophysiology of extraintestinal inflammation is not fully understood. Potential driving forces include extension of the immune-mediated response from the inflamed gut to other organs, with shifts in leukocyte trafficking, changes to the intestinal microbiota, and underlying predisposing genetic factors. The systemic consequences of IBD lead to broader associations, including VTEs and anaemia. Whether these are strictly EIMs is of debate, but they are included within this guideline as they incur a considerable health burden to patients with IBD.

ECCO Guidelines on Extraintestinal Manifestations in Inflammatory Bowel Disease

Hannah Gordon

Publisher

European Crohn’s and Colitis Organisation

Guideline

Clinical Practice Guideline

Topics

IBD

Citation

Journal of Crohn's and Colitis, Volume 18, Issue 1, January 2024, Pages 1–37

Published

2023

UEG Standards and Guidelines

Clinical Practice Guideline

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Main recommendations

1 ESGE/ESGAR recommend computed tomographic colonography (CTC) as the radiological examination of choice for the diagnosis of colorectal neoplasia.
Strong recommendation, high quality evidence.

ESGE/ESGAR do not recommend barium enema in this setting.
Strong recommendation, high quality evidence.

2 ESGE/ESGAR recommend CTC, preferably the same or next day, if colonoscopy is incomplete. The timing depends on an interdisciplinary decision including endoscopic and radiological factors.
Strong recommendation, low quality evidence.

ESGE/ESGAR suggests that, in centers with expertise in and availability of colon capsule endoscopy (CCE), CCE preferably the same or the next day may be considered if colonoscopy is incomplete.
Weak recommendation, low quality evidence.

3 When colonoscopy is contraindicated or not possible, ESGE/ESGAR recommend CTC as an acceptable and equally sensitive alternative for patients with alarm symptoms.
Strong recommendation, high quality evidence.
Because of lack of direct evidence, ESGE/ESGAR do not recommend CCE in this situation.
Very low quality evidence.

ESGE/ESGAR recommend CTC as an acceptable alternative to colonoscopy for patients with non-alarm symptoms.
Strong recommendation, high quality evidence.
In centers with availability, ESGE/ESGAR suggests that CCE may be considered in patients with non-alarm symptoms.
Weak recommendation, low quality evidence.

4 Where there is no organized fecal immunochemical test (FIT)-based population colorectal screening program, ESGE/ESGAR recommend CTC as an option for colorectal cancer screening, providing the screenee is adequately informed about test characteristics, benefits, and risks, and depending on local service- and patient-related factors.
Strong recommendation, high quality evidence.

ESGE/ESGAR do not suggest CCE as a first-line screening test for colorectal cancer.
Weak recommendation, low quality evidence.

5 ESGE/ESGAR recommend CTC in the case of a positive fecal occult blood test (FOBT) or FIT with incomplete or unfeasible colonoscopy, within organized population screening programs.
Strong recommendation, moderate quality evidence.

ESGE/ESGAR also suggest the use of CCE in this setting based on availability.
Weak recommendation, moderate quality evidence.

6 ESGE/ESGAR suggest CTC with intravenous contrast medium injection for surveillance after curative-intent resection of colorectal cancer only in patients in whom colonoscopy is contraindicated or unfeasible
Weak recommendation, low quality evidence.

There is insufficient evidence to recommend CCE in this setting.
Very low quality evidence.

7 ESGE/ESGAR suggest CTC in patients with high risk polyps undergoing surveillance after polypectomy only when colonoscopy is unfeasible.
Weak recommendation, low quality evidence.

There is insufficient evidence to recommend CCE in post-polypectomy surveillance.
Very low quality evidence.

8 ESGE/ESGAR recommend against CTC in patients with acute colonic inflammation and in those who have recently undergone colorectal surgery, pending a multidisciplinary evaluation.

Strong recommendation, low quality evidence.

9 ESGE/ESGAR recommend referral for endoscopic polypectomy in patients with at least one polyp >= 6 mm detected at CTC or CCE.
Follow-up CTC may be clinically considered for 6 – 9-mm CTC-detected lesions if patients do not undergo polypectomy because of patient choice, comorbidity, and/or low risk profile for advanced neoplasia.

Strong recommendation, moderate quality evidence.

Imaging alternatives to colonoscopy: CT colonography and colon capsule. European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline – Update 2020

Cristiano Spada

Publishers

European Society of Gastrointestinal Endoscopy, European Society of Gastrointestinal and Abdominal Radiology

Guideline

Clinical Practice Guideline

Topics

Endoscopy Radiology & Imaging

Citation

Endoscopy 2020; 52(12): 1127-1141

Published

2020

UEG Standards and Guidelines

Clinical Practice Guideline

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Abstract

Background: Evidence and practice recommendations on the use of transanal total mesorectal excision (TaTME) for rectal cancer are conflicting.

Objective: We aimed to summarize best evidence and develop a rapid guideline using transparent, trustworthy, and standardized methodology.

Methods: We developed a rapid guideline in accordance with GRADE, G-I-N, and AGREE II standards. The steering group consisted of general surgeons, members of the EAES Research Committee/Guidelines Subcommittee with expertise and experience in guideline development, advanced medical statistics and evidence synthesis, biostatisticians, and a guideline methodologist. The guideline panel consisted of four general surgeons practicing colorectal surgery, a radiologist with expertise in rectal cancer, a radiation oncologist, a pathologist, and a patient representative. We conducted a systematic review and the results of evidence synthesis by means of meta-analyses were summarized in evidence tables. Recommendations were authored and published through an online authoring and publication platform (MAGICapp), with the guideline panel making use of an evidence-to-decision framework and a Delphi process to arrive at consensus.

Results: This rapid guideline provides a weak recommendation for the use of TaTME over laparoscopic or robotic TME for low rectal cancer when expertise is available. Furthermore, it details evidence gaps to be addressed by future research and discusses policy considerations. The guideline, with recommendations, evidence summaries, and decision aids in user-friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/4494.

Conclusions: This rapid guideline provides evidence-informed trustworthy recommendations on the use of TaTME for rectal cancer.

Keywords: Rectal cancer · TaTME · Transanal TME · Clinical practice guideline · GRADE · EAES

Additional resource: https://app.magicapp.org/#/guideline/LGm87E

UEG and EAES rapid guideline: Systematic review, meta-analysis, GRADE assessment and evidence-informed European recommendations on TaTME for rectal cancer

Marco Milone

Publisher

European Association for Endoscopic Surgery and other interventional techniques

Guideline

Clinical Practice Guideline

Topics

Digestive Oncology Surgery

Citation

Surgical Endoscopy volume 36, pages2221–2232 (2022)

Published

2021

UEG Presentation

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Nutrition in chronic liver disease

Manuela Merli 1

1 Sapienza University of Rome, Rome, Italy

Event

UEG Week Berlin 2025

Topics

Hepatobiliary Nurses Small Intestine & Nutrition Pancreas

Session

Mistakes in …: Hepatobiliary and pancreas

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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Summary

Extrahepatic abdominal surgery in patients with cirrhosis of the liver represents a growing clinical challenge due to the increasing prevalence of chronic liver disease and improved long-term survival of these patients. The presence of cirrhosis significantly increases the risk of perioperative morbidity and mortality following abdominal surgery. Advances in preoperative risk stratification, surgical techniques, and perioperative care have led to better outcomes, yet integration of these improvements into routine clinical practice is needed. These clinical practice guidelines provide comprehensive recommendations for the assessment and perioperative management of patients with cirrhosis undergoing extrahepatic abdominal surgery. An individualised patient-centred risk assessment by a multidisciplinary team including hepatologists, surgeons, anaesthesiologists, and other support teams is essential.

EASL Clinical Practice Guidelines on extrahepatic abdominal surgery in patients with cirrhosis and advanced chronic liver disease

Publisher

European Association for the Study of the Liver

Guideline

Clinical Practice Guideline

Topics

Hepatobiliary Surgery

Citation

Journal of Hepatology; 2025

Published

2025

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