Introduction

Symptom relief is the key treatment goal of gastroesophageal reflux disease (GERD). Vonoprazan, a potassium-competitive acid blocker approved in China, was superior in potency and duration of action versus conventional proton pump inhibitors in preclinical studies.¹ However, there are limited real-world data on the effectiveness and safety of vonoprazan in adult Chinese patients.

Aims & Methods

VIEW (NCT04501627) was a multicentre, single-arm, prospective, observational, real-world study conducted in China. Patients received 20 mg vonoprazan, orally, once daily for 4 weeks (8 weeks for insufficient healing), followed by a safety assessment of 2 weeks. In this post hoc subgroup analysis of patients with GERD, effectiveness was assessed, including changes in GERD-typical symptoms, GERD questionnaire (GerdQ) scores and complete relief in patients’ symptom diary.

Results

Among the 2214 patients included in the effectiveness analysis population of the GERD group, 86.7% were aged <65 years and 60.8% were male. Among evaluable patients with all-day heartburn (n=672) and all-day regurgitation (n=728) at baseline, 49.7% (95% confidence interval [CI], 45.9-53.6) and 40.8% (95% CI, 37.2-44.5), respectively, achieved complete symptom relief during the first 2 weeks of treatment. The reduction from baseline in all-day heartburn and regurgitation was significant (P<0.001) on days 1 through 14 of treatment. Among evaluable patients with night-time heartburn (n=746) and night-time regurgitation (n=816) at baseline, complete symptom relief was achieved in 59.9% (95% CI, 56.3-63.5) and 52.8% (95% CI, 49.3-56.3) of patients, respectively, during the first 2 weeks of treatment. The reduction from baseline in night-time heartburn and regurgitation was significant (P<0.001) on days 1 through 14 of treatment. The mean (standard deviation) overall GerdQ score improvement from baseline to week 4 was -1.6 (2.8). The percentage of patients without GERD-typical symptoms increased by 33.5% (95% CI, 30.7-36.3) from baseline to week 4. Symptoms of heartburn, regurgitation and sleep difficulties due to heartburn/regurgitation, and the need for additional medication generally reduced at week 4 compared with that at baseline (Table). Adverse events (AEs; any grade) were reported in 17.4% of patients in the safety population (N=2307), with the most common (>5%) being gastrointestinal disorders (8.3%). Overall, 0.9% of patients had ≥1 AE leading to study discontinuation. No AEs led to death.

Table: Improvement in symptom frequency score and additional medication usage from baseline to week 4 following vonoprazan treatment

Conclusion

This real-world subgroup analysis of Chinese patients with GERD demonstrated that vonoprazan effectively relieved symptoms, improved GerdQ scores and reduced the need for additional medications while maintaining an acceptable safety profile.

References

1. Matsukawa J, Inatomi N, Nishida H, et al. Nihon Yakurigaku Zasshi 2018; 152: 104-110.

Disclosure

Disclosures: This study was funded by Takeda (China) International Trading Co. Ltd. Yinglian Xiao, Xiuling Li and Yiyang Dai have no conflicts of interest. Kailun Liang and Li Xie are Takeda employees and hold Takeda stock options. Minhu Chen received speaker honoraria from Takeda China, AstraZeneca China, Xian Janssen and Eisai China.
Acknowledgements: Medical writing support for the development of this abstract, under the direction of the authors, was provided by Adityadeb Ghosh, M. Pharm, of Cactus Life Sciences (part of Cactus Communications), funded by Takeda (China) International Trading Co., Ltd., an affiliation of Takeda Pharmaceutical Company, and complied with the Good Publication Practice Guidelines 2022.

Introduction

Inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, are chronic conditions with alternating phases of flare-ups and remission. Due to the persistent and often severe course of these diseases, effective treatment significantly improves patients' daily activities and overall functioning. [1] Given the uncertain prognosis and the frequent disease progression despite pharmacotherapy, it is important to explore additional interventions that could support traditional treatments. While physical activity may provide both anti-inflammatory and functional benefits in IBD, data on its efficacy and safety during disease exacerbation remain scarce. [2] This pilot study is the first real-world investigation into the effects of a supervised physical exercise training in patients hospitalized due to IBD flare.

Aims & Methods

This study aimed to evaluate the effects of an individualized, moderate-intensity, supervised physical exercise training on exercise tolerance, inflammation, and fatigue resistance in patients hospitalized due to IBD flare, and to explore baseline factors associated with greater benefit from the intervention. Patients were randomly assigned to an intervention group, receiving individual cycloergometer training during hospitalization, or to a control group without exercise. Both groups were well balanced at baseline, with no significant differences in demographic, clinical, or laboratory parameters. At both admission and discharge, all patients underwent standardized graded exercise tests to establish their exercise tolerance based on the lactate threshold and heart rate/power output response. Furthermore laboratory assessments, and the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F) questionnaire were conducted.

Results

A total of 22 patients were included in the study, with 13 patients in the intervention group and 9 patients in the control group. Although FACIT-F scores improved in both groups, the intervention group demonstrated a significantly greater improvement (median change –39 points; IQR –49 to –11; p = 0.014) compared to the control group (median change –25 points; IQR –52 to –6; p = 0.30). Baseline FACIT-F scores were significantly correlated with changes in heart rate response response during exercise: patients with greater baseline fatigue and poorer functional status experienced greater improvement in exercise tolerance (r = –0.62, p = 0.028). Platelet counts remained more stable in the intervention group (median change +10 ×10³/µl; IQR –65 to +45) compared to a significant increase in the control group (median +74 ×10³/µl; IQR +44.5 to +101.75; p = 0.046). In the intervention group, greater reductions in calprotectin were strongly correlated with more favorable heart rate responses during a graded exercise test (r = –0.92, p = 0.009).

Conclusion

Supervised training program during hospitalization for IBD flare was associated with improved fatigue resistance and more favorable inflammatory responses. Patients with worse baseline functioning obtained greater benefit in exercise tolerance. These findings support the feasibility and potential therapeutic role of individualized physical activity in acute IBD care and highlight the need for further investigation in real-world settings.

References

1. Farrell D, Artom M, Czuber-Dochan W, Jelsness-Jørgensen LP, Norton C, Savage E. Interventions for fatigue in inflammatory bowel disease. Cochrane Database Syst Rev. 2020 Apr 16;4(4):CD012005. doi: 10.1002/14651858.CD012005.pub2.
2. Achtenberg M, Cibor D, Zwolińska-Wcisło M. Structured exercise in patients with inflammatory bowel disease: a literature review. Gastroenterology Review/Przegląd Gastroenterologiczny. 2025;20(1):36-40. doi:10.5114/pg.2025.148473.

Disclosure

Magdalena Achtenberg has received lecture fees and/or travel grants from Ferring and Eli Lilly, unrelated to the present work. Tomasz Dziubyna has received travel grants from Fresenius, unrelated to the present work. Małgorzata Zwolińska-Wcisło, Dorota Cibor, Karolina Gazda, Magdalena Wyrzykowska, Piotr Kosieniak, Maria Wiśniewska, Jerzy A. Żołądź, Marcin Grandys and Joanna Majerczak declare no conflict of interest.

Introduction

Colonoscopy is a standard procedure but it is unclear whether a short or long colonoscope is more favorable regarding procedure efficiency and patient comfort. The performance of different colonoscope lengths cannot be objectively compared in live patients due to various limitations. Hence, the choice of colonoscope length is a matter of personal preference or institutional tradition. Preclinical tools to assess scope performance are needed. We evaluated endoscopists’ performance using short vs. long colonoscopes in the Mikoto simulator, enabling objective measurements using pressure and distension sensors within a 3D-printed, calibrated colon model.

Aims & Methods

Aims: i) Performance comparison of short vs. long comparison in the Mikoto simulator, enabling objective measurements using pressure and distension sensors within a 3D-printed, calibrated colon model. ii) First evaluation of this novel simulator.
Delegates at ESGE Days and DGE-BV 2024 were invited to perform two simulation rounds—one with each scope length in a random order —and completed a survey. Main outcome was the performance of different scope lengths as measured by the caecal intubation time and the proprietary “Mikoto score” (a combination of pressure and distension measurements exerted on the model).

Results

Of 281 participants, 252 complete datasets were analyzed (187 ESGE, 65 DGE-BV). The Mikoto-Score was lower with long scopes (74 vs. 77; p=0.01), and caecal intubation time was longer (2:59 vs. 2:38 min; p=0.01). A second round did not improve performance. Mikoto-Scores were unaffected by scope preference or sedation strategy but were lower in users of the two-person technique. Scores correlated with self-assessed skill and colonoscopy experience (r=0.43, r=0.47). The median system-usability score was 77.5 indicating a good evaluation by the examiners and a good usability.

Conclusion

Using the Mikoto simulator, long colonoscopes caused more colonic distension and longer insertion times, potentially impacting patient comfort. Objective simulator data can inform scope selection in clinical practice. The Mikoto simulator reflects endoscopist self-assessed skill and previous experience.

Disclosure

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2. Lee SH, Lee DJ. Comparison on colonoscopic parameters according to length of adult-colonoscope. Chin Med J (Engl) 2014; 127: 85-91.
3. Obstein KL, Patil VD, Jayender J et al. Evaluation of colonoscopy technical skill levels by use of an objective kinematic-based system. Gastrointest Endosc 2011; 73: 315-321, 321.e311. doi:10.1016/j.gie.2010.09.005
4. Repici A, Badalamenti M, Maselli R et al. Efficacy of Real-Time Computer-Aided Detection of Colorectal Neoplasia in a Randomized Trial. Gastroenterology 2020; 159: 512-520 e517. doi:10.1053/j.gastro.2020.04.062
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12. Lee HL, Eun CS, Lee OY et al. Significance of colonoscope length in cecal insertion time. Gastrointestinal Endoscopy 2009; 69: 503-508. doi:https://doi.org/10.1016/j.gie.2008.06.006
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16. Fujii M, Onoyama T, Ikebuchi Y et al. A novel humanoid-robot simulator for colonoscopy. Endoscopy 2020; 53: E291-E292. doi:10.1055/a-1264-6804
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Clinical Case Summary

A 76-year-old man with chronic liver disease presented with jaundice, fatigue, and weight loss. Laboratory tests showed total bilirubin 20.1 mg/dL and Child-Pugh B liver function. Contrast- enhanced CT (CE-CT) revealed a 9 x 7 x 10 cm right-lobe tumor with right biliary duct invasion. Three biliary drains were placed, reducing bilirubin to 9 mg/dL, but liver function declined to Child-Pugh C. Biopsy confirmed HCC. Given his deteriorating condition and ineligibility for surgery, ECT was performed to achieve tumor control. Intravenous bleomycin (28 mg) was administered before electroporation. No immediate complications occurred. 12 days post-ECT, CE-CT showed tumor devascularization and resolution of biliary invasion. liver function was stabilized, allowing the removal of the drain. At 3 months, CE-CT showed 30% tumor shrinkage and left lobe hypertrophy. To prevent progression, transarterial embolization of residual tumor was performed. Six-month imaging demonstrated further shrinkage and continued left lobe hypertrophy without portal vein embolization. These improvements allowed for right hepatectomy at 10 months. 6 months post- surgery, CE-CT confirmed no recurrence. HCC with biliary invasion is a rare and challenging clinical condition. It often leads to biliary obstruction and progressive hepatic dysfunction. In non-surgical candidates, treatment options are limited. ECT is an emerging locoregional treatment that enhances the intracellular uptake of chemotherapeutic agents through electroporation . Its selective targeting of tumor cells while preserving surrounding structures makes it particularly appealing for tumors involving bile ducts. The disappearance of tumor tissue within the bile ducts suggests that ECT can effectively target intraductal tumor spread. A striking outcome was spontaneous left-lobe hypertrophy without prior portal vein embolization. This case highlights ECT as a potential bridge to surgery in HCC with biliary invasion.

References

Figure 1. Pre-treatment imaging and management.
(a) Contrast-enhanced CT showing a large hepatocellular carcinoma (HCC) in the right liver lobe.
(b, c) Tumor invasion of the right hepatic bile duct (arrow), causing complete biliary obstruction at the
biliary confluence (dashed arrow).
(d) Placement of multiple biliary drains (two in the right lobe and one into the left lobe) to relieve jaundice.
Figure 2. Electrochemotherapy (ECT) procedure and early response.
(a) ConeBeam-CT combined with transarterial angiography for electrode placement guidance.
(b) Percutaneous electrodes targeting the primary tumor and invading bile ducts.
(c) Contrast-enhanced CT at 12 days post-ECT showing successful devascularization of the tumor.
(d) Removal of biliary drains following bilirubin reduction, restored biliary patency, and improved liver function.
Figure 3. Tumor response, liver regeneration and post-surgical follow-up.
(a) Two-month follow-up CT demonstrating 30% tumor shrinkage and left lobe hypertrophy in comparison
to baseline imaging.
(b) Transarterial embolization of the residual hypervascular tumor at three months post-ECT to prevent
tumor progression.
(c) Six-month follow-up showing further tumor regression and complete resolution of tumor within the
biliary duct.
(d) Post-hepatectomy CT at six months confirming no recurrence.

Introduction

Gastrointestinal (GI) transit abnormalities due to dysmotility often affect multiple regions of the GI tract rather than occur in isolation. Identifying regional GI transit delays may influence clinical management. Use of wireless motility capsules (WMC) enable regional and whole GI transit times to be objectively measured; the relationship between symptom profiles and regional transit times are explored here with a new capsule device, the Atmo Capsule.

Aims & Methods

The Atmo Capsule was administered to subjects with suspected upper and/or lower gastrointestinal dysmotility. This analysis utilized data from subjects where valid transit measurements via the Atmo Capsule were available for all regions of the GI tract, and no protocol deviations pertaining to the use of contraindicated medication or inclusion criteria violations were incurred. Regional transit times were considered delayed as follows: gastric emptying ≥ 5 h; small bowel transit, ≥ 6 h; colonic transit, ≥ 59 h. Delays affecting a single region (i.e., gastric, small bowel, or colon) were considered ‘isolated’, delays affecting multiple (> 1) regions were considered ‘generalized’. Symptom profiles were assessed using the Patient Assessment of Gastrointestinal Disorders - Symptoms (PAGI-SYM) and Patient Assessment of Constipation – Symptoms (PAC-SYM) questionnaires: all patients completed the PAGI-SYM while those with symptoms suggestive of lower GI dysmotility completed the PAC-SYM. Data were analyzed via Kruskal-Wallis test.

Results

The WMC was administered to 209 subjects (median age 41; 188 female), of whom 170 had data suitable for this analysis. Delayed GI transit was identified in 100 (59%) subjects: 65 were isolated and 35 were generalized. There were no differences in overall symptom scores in subjects with no delays (PAGI-SYM, median 1.5 [IQR: 1.1, 2.1]; PAC-SYM, 2.0 [1.5, 2.6]), isolated delays (1.5 [1.0, 2.1]; 1.9 [1.2, 2.6]) and generalized transit delays (1.8 [1.4, 2.3]; 2.1 [1.4, 2.8]) (p>0.05 for both) or symptom sub-scores (Table 1). Gastric transit was delayed in 46 subjects: 19 (41%) were isolated and 27 (59%) were generalized. Colonic transit was delayed in 60 subjects: 31 (52%) were isolated and 29 (48%) were generalized. GI symptom profiles were not different in subjects with isolated and generalized transit delays for either the stomach or colon (p>0.05 for all relevant subscales).

Table 1. Symptom profiles amongst patients with no transit delay, isolated transit delay (affecting a single region) and generalized transit delay (affecting multiple regions). Data presented as median (interquartile range) and analyzed via Kruskal-Wallis test.

Conclusion

WMC measurements of regional and whole GI transit using the Atmo Capsule revealed that delayed transit impacting multiple regions were common. However, symptom profiles were unable to distinguish between isolated vs. generalized transit delays, suggesting that symptoms are an unreliable predictor of abnormalities in GI transit as previously found via other transit modalities.

Disclosure

These authors disclose the following: Braden Kuo, Anthony J. Lembo, Eammon M.M. Quigley, Satish S.C. Rao, and William D. Chey serve on the Medical Advisory Board of Atmo Biosciences. Michael Cline and Baharak Moshiree served on the Medical Advisory Board of Atmo Biosciences. Braden Kuo has received funding from NIH, Vanda, Atmo Biosciences, and Takeda and has consulted for Evoke, Takeda, Ironwood, Novo Nordisk, Cindome, and Neurogastrx. Thomas Abell has received funding from Gastric Dysrhythmias, Neurogastrx, NIH GpCRC, and Vanda and has consulted for Enterra Medical, Novo Nordisk, Nuvaira, and Vanda. Anthony J. Lembo has received funding from Ardelyx, Biomerica, GSK, Ironwood, Takeda, and Vibrant and holds stock with Allurion, Bristol Myer Squibb, and J&J. Abigail Stocker has received funding from Cindome, Enterra Medical, and Vanda. William D. Chey has received funding from Atmo Biosciences, Commonwealth Diagnostics Intl, QOL Medical, and Salix; has consulted for AbbVie, Ardelyx, Biomerica, Comvita, Gemelli, Ironwood, Nestle, QOL Medical, Phathom, Redhill, Salix, Vibrant, and Takeda; has filed patents with My Nutrition Health, Digital Manometry, and Rectal Expulsion Device; and holds stock options with Coprata, Evinature, Food Marble, Kiwi Bioscience, and Modify Health. The remaining authors disclose no conflicts.

Introduction

Patients on maintenance hemodialysis are considered to have a higher risk of bleeding after endoscopic submucosal dissection (ESD) for gastric lesions. In high-risk cases, second-look endoscopy (SLE) may reduce the risk of post-ESD bleeding¹. At our institution, SLE is routinely performed following gastric ESD. We evaluated the incidence and risk factors of post-ESD bleeding after gastric ESD among patients on maintenance hemodialysis.

Aims & Methods

We conducted a retrospective, single-center study including 32 hemodialysis patients with 37 gastric lesions who underwent ESD at our hospital between July 22, 2003 and August 31, 2024. Patients were divided into two groups based on the occurrence of post-ESD bleeding. Clinical data including age, sex, body mass index (BMI), age-adjusted Charlson comorbidity index (ACCI), Geriatric Nutritional Risk Index (GNRI), extent of atrophic gastritis, laboratory findings, the use of antithrombotic drugs, Best-J score², details of the procedure, pathological findings and the types of anti-acid medicine prescribed after ESD were collected and analyzed.

Results

The median age was 72 years, with 73% of the patients being male. There were no differences in most of patient characteristics, details of lesions and procedures. Submucosal invasion (0% in the no-bleeding group vs. 28.6% in the bleeding group, p = 0.035) were significantly associated with post-ESD bleeding. In contrast, the use of local hemostatic agents appeared to have a protective effect against post-ESD bleeding (51.7% vs. 0%, p = 0.012). The use of perioperative antithrombotic drugs tended to be higher in the bleeding group (51.7% vs. 0%, p = 0.058). The endoscopic hemostasis at 2nd look endoscopy was not associated with post-ESD bleeding.

Conclusion

Despite routine SLE in hemodialysis patients, the rate of post-ESD bleeding at our institution remains high and similar to previously reported rates. Submucosal invasion, perioperative antithrombotic therapy may be associated with increased, and the use of local hemostatic agents may be associated with decreased bleeding risk. Further strategies should be considered to reduce the risk of post-ESD bleeding in hemodialysis patients.

References

1: Usefulness of the Forrest Classification to Predict Artificial Ulcer Rebleeding during Second-Look Endoscopy after Endoscopic Submucosal Dissection. Clin Endosc. 2016 May;49(3):273-81.
2: Prediction model of bleeding after endoscopic submucosal dissection for early gastric cancer: BEST-J score. Gut. 2021 Mar;70(3):476-484.

Introduction

Gastrointestinal dysfunction, especially gastroparesis is a common non-motor disorder among Parkinson’s disease resulting to serious complications and poor quality of life. There are still some limitations on an evaluation and diagnostic test to detect the patients with gastroparesis for early intervention improving outcome.

Aims & Methods

All Parkinson’s disease patients were inquired to complete GCSI, GERD-Q, and PAC-SYM questionnaires. The correlation between the scores and disease severity was evaluated. Factors associated with significant gastroparesis symptoms (GCSI ≥9) were analyzed. Patients who have had gastrointestinal symptoms compatible with gastroparesis were further test for gastric emptying scintigraphy.

Results

76 patients completed GI questionnaires. The majority of patients (60.6%) were classified in PD stage 2 and 3. A large number of patients (82.9%) reported gastroparesis symptoms using GCSI score. The median (IQR) of total GCSI score was 4 (2, 10) with postprandial fullness predominant in subscale. PD duration ≥6 years was associated with high gastroparesis symptoms (GCSI ≥9), adjust OR = 2.96 (1.01, 8.71), p=0.043. Eight consecutive participants could undergo physiologic testing. Only one of eight was definitely confirmed for delayed gastric emptying. No correlation between GCSI score and physiologic testing was observed.

Table 1.Logistic regression analysis on potential factors associated with significant GCSI score.

Conclusion

Gastroparesis symptoms with postprandial fullness predominant were common among Parkinson’s disease. The strong correlation between gastrointestinal scores may illustrate an extensive gastrointestinal involvement, especially in the patients with long term disease duration. However, clinical scores might have a limitation for real-life implementation in Parkinson’s disease because poor correlation between GCSI score and physiologic testing was observed. Score validation and long-term outcome, especially nutritional status and pulmonary complication as sequelae of gastrointestinal dysfunction would be considered in future research.

References

1. Soliman H, Coffin B, Gourcerol G. Gastroparesis in Parkinson disease: pathophysiology, and clinical management. Brain Sci 2021; 11:1-10.
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5. Pfeiffer RF, Isaacson SH, Pahwa R. Clinical implications of gastric complications on levodopa treatment in Parkinson’s disease. Parkinsonism Relat Dis 2020; 76:63-71.
6. Mukherjee A, Biswas A, Das SK. Gut dysfunction in Parkinson’s disease. World J Gastroenterol2016; 22:5742-52.