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MAGNETIC RESONANCE IMAGING-BASED MEASURE OF FIBROSIS IN ENTERIC CROHN’S DISEASE

Iyad Naim 1, Nabeelah Jinnah 1, Caroline L. Hoad 1,2, Christopher Clarke 2, Abhik Mukherjee 1,2, Penny Gowland 1,2, Alex Menys 3, Andrew Bard 3, Olivier Mougin 1, Gordon Moran 1,2

Affiliations

1 University of Nottingham, Nottingham, United Kingdom

2 Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom

3 Motilent, London Uk, London, United Kingdom

Summary

AI Generated

A validation study in 8 Crohn's disease patients with 19 strictures found strong correlations between MRI-derived measures (mean T2 signal intensity and magnetisation transfer Z-spectrum amplitude) and histological fibrosis and inflammation scores in surgically resected bowel strictures.

Mean T2 signal intensity measured using the GI-Seg tool showed strong correlation with global fibrosis scores (r=0.617, p=0.005) and inflammation scores (r=0.692, p=0.001) in 19 strictures from 8 patients undergoing surgical resection.
Magnetisation transfer Z-spectrum amplitude fit demonstrated high correlation with global fibrosis (r=0.775, p=0.008) and inflammation scores (r=0.824, p=0.003) in a subset of 6 patients.
The GI-Seg automated segmentation tool generated 3D models of strictures and measured bowel wall volume and mean signal intensity on T2-weighted scans.
Stricture volume showed moderate but non-significant correlations with fibrosis, inflammation, and muscular hyperplasia scores.
The study supports the potential of these MRI measures as independent imaging biomarkers for fibrosis and inflammation in Crohn's disease strictures, relevant for clinicians managing fibrostenotic disease where 40% of patients require surgery at 5 years.

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Abstract

Introduction

In Crohn’s disease (CD), 10% of patients present with fibrostenosis with a further 10% progressing from inflammatory to a fibrostenotic disease behaviour over 7 years^[1]. The prevalence of CD fibrostenosis is >20%^[2]. 40% of fibrostenotic CD patients need surgery at 5 years compared to ~10% with inflammatory disease^[2]. Fibrotic tissues exhibit excessive accumulation of collagen type 1 and 3, with amide protons in the collagen backbone showing potential for quantification using MT imaging [3].
GI-Seg by Motilent is a tool that uses advanced image analysis algorithms to segment the gastrointestinal tract in MRI scans. The software creates a three-dimensional model of the GI tract, allowing clinicians to visualize and analyse the structure and volume of the organs in detail. GI-Seg is designed to save clinicians time and increase the accuracy of their diagnoses by automating the segmentation process, which can be a time-consuming and error-prone task when done manually.

Aims & Methods

The primary objective of this study is to undertake biological validation of the candidate MRI measures as independent imaging biomarkers of histological fibrosis with the primary outcome being the correlation between MRI measures and histological fibrosis measures. Patients with CD histological diagnosis and in need of surgical resection for stenosis attended a one-hour 3T MRI scanning session within 12 weeks prior to their intestinal resection surgery.
After the surgical resection, consecutive sections were cut in the sample and scored by a specialized gastrointestinal pathologist for inflammation, fibrosis, and muscular hypertrophy. A global score was derived for these variables for each individual bowel wall layer and for the whole bowel wall.
An expert radiologist with the help of the histopathologist located the strictures on the magnetisation transfer (MT) and T2 weighted scans. Z-spectrum quantification involved fitting z-spectra to a three-pool model using the Levenberg-Marquardt algorithm, with voxel-wise mapping of the fitted parameters. The GI-seg tool was also used to generate a 3D model of the stricture on T2 weighted scans measuring bowel wall volume and mean signal intensity of each stricture.
Pearson correlation coefficient was used to quantify the correlation between the variables.

Results

A total of 8 CD (19 strictures) patients were recruited. Strictures were identified in histopathology and located on the in-vivo T2 weighted and MT scans by the radiologist. Out of the 8 patients, 6 were used for Z-spectrum quantification. Bowel wall volumes in mm³ and Mean signal intensity were calculated using the GI-seg tool.
MT Z- spectrum amplitude fit showed a high correlation with global fibrosis (r(10) = .775, p = .008), and inflammation scores (r(10) = .824, p = .003).
Mean T2 signal intensity measured using GI-Seg highly correlated with global fibrosis scores (r(19) = .617, p = .005) , global inflammation scores (r(19) = .692, p = .001) and MT Z- spectrum amplitude fit (r(10) = .941, p < .001).
The volume of each stricture showed a moderate correlation to global fibrosis scores (r(19) = .383, p = .106), global inflammation scores (r(19) = .425, p = .069) and muscular hyperplasia (r(19) = .404, p = .086).

Conclusion

This study reveals a strong correlation between mean T2 signal intensity and global fibrosis, muscular hyperplasia, and inflammation scores in CD strictures. The GI-seg tool accurately measured bowel wall volume and signal intensity, indicating potential as independent imaging biomarkers for fibrosis, inflammation, in CD strictures.

References

[1] Lo B, Vester-Andersen MK, Vind I, et al. Changes in Disease Behaviour and Location in Patients With Crohn's Disease After Seven Years of Follow-Up: A Danish Population-based Inception Cohort. J Crohns Colitis 2018;12:265-272.
[2] Moran GW, Dubeau MF, Kaplan GG, et al. Phenotypic features of Crohn's disease associated with failure of medical treatment. Clin Gastroenterol Hepatol 2014;12:434-42.e1.
[3] Fang ZN, Li XH, Lin JJ, Huang SY, Cao QH, Chen ZH, Sun CH, Zhang ZW, Rieder F, Rimola J, Chen MH, Li ZP, Mao R, Feng ST. Magnetisation transfer imaging adds information to conventional MRIs to differentiate inflammatory from fibrotic components of small intestinal strictures in Crohn's disease. Eur Radiol. 2020 Apr;30(4):1938-1947.

Disclosure

Prof Gordon W Moran is in receipt of research funding from Astra Zeneca, Johnson and Johnson and Bristol Myers Squibb. He is also a consultant for Alimentiv Inc.
Dr Alex Menys and Dr Andrew Bard are employed by Motlient.

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

PP 05 IBD (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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DISORDERS OF GUT-BRAIN INTERACTION (DGBI) AND PARKINSON’S DISEASE: ARE DGBI A RISK FACTOR FOR NEURODEGENERATIVE DISEASE?

Nicholas J. Talley

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Abstract

Event

UEG Week Barcelona 2026

Topics

Nurses

Session

Green endoscopy and hygiene

Citation

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

Published

2026

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DISORDERS OF GUT-BRAIN INTERACTION (DGBI) AND PARKINSON’S DISEASE: ARE DGBI A RISK FACTOR FOR NEURODEGENERATIVE DISEASE?

Nicholas J. Talley

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ESGE live endoscopy III (Complete Session)

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ESGE live endoscopy III (Complete Session)

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Abstract

Event

UEG Week Barcelona 2026

Topics

Endoscopy

Session

ESGE live endoscopy III

Citation

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

Published

2026

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Round table discussion

ESGE live endoscopy III (Complete Session)

The role of nursing in green endoscopy: Training, auditing and waste segregation

Anastasia Tsalouka

When brushing teeth becomes a challenge: Foreign body removal

Arianna Parrella

BASIC ENDOSCOPY TRAINING IN EUROPE: A SURVEY ACROSS 40 COUNTRIES IDENTIFYING GAPS BETWEEN ESGE/ESGENA RECOMMENDATIONS AND REAL-WORLD PRACTICE

Abdellah Hedjoudje

DISORDERS OF GUT-BRAIN INTERACTION (DGBI) AND PARKINSON’S DISEASE: ARE DGBI A RISK FACTOR FOR NEURODEGENERATIVE DISEASE?

Nicholas J. Talley

UEG Presentation

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The role of nursing in green endoscopy: Training, auditing and waste segregation

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The role of nursing in green endoscopy: Training, auditing and waste segregation

Anastasia Tsalouka 1

Affiliations

1 University General Hospital Attikon, Athens, Greece

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Abstract

Event

UEG Week Barcelona 2026

Topics

Nurses

Session

Green endoscopy and hygiene

Citation

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

Published

2026

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DISORDERS OF GUT-BRAIN INTERACTION (DGBI) AND PARKINSON’S DISEASE: ARE DGBI A RISK FACTOR FOR NEURODEGENERATIVE DISEASE?

Nicholas J. Talley

UEG Presentation

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When brushing teeth becomes a challenge: Foreign body removal

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When brushing teeth becomes a challenge: Foreign body removal

Arianna Parrella 1

Affiliations

1 Ramazzini Hospital, Carpi, Italy

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Abstract

Event

UEG Week Barcelona 2026

Topics

Nurses

Session

ESGENA: Our most memorable cases

Citation

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

Published

2026

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Round table discussion

ESGE live endoscopy III (Complete Session)

The role of nursing in green endoscopy: Training, auditing and waste segregation

Anastasia Tsalouka

When brushing teeth becomes a challenge: Foreign body removal

Arianna Parrella

BASIC ENDOSCOPY TRAINING IN EUROPE: A SURVEY ACROSS 40 COUNTRIES IDENTIFYING GAPS BETWEEN ESGE/ESGENA RECOMMENDATIONS AND REAL-WORLD PRACTICE

Abdellah Hedjoudje

DISORDERS OF GUT-BRAIN INTERACTION (DGBI) AND PARKINSON’S DISEASE: ARE DGBI A RISK FACTOR FOR NEURODEGENERATIVE DISEASE?

Nicholas J. Talley

UEG Presentation

New

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

BASIC ENDOSCOPY TRAINING IN EUROPE: A SURVEY ACROSS 40 COUNTRIES IDENTIFYING GAPS BETWEEN ESGE/ESGENA RECOMMENDATIONS AND REAL-WORLD PRACTICE

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BASIC ENDOSCOPY TRAINING IN EUROPE: A SURVEY ACROSS 40 COUNTRIES IDENTIFYING GAPS BETWEEN ESGE/ESGENA RECOMMENDATIONS AND REAL-WORLD PRACTICE

Markus Knutsen Tungodden 1, Anna Mäkinen 2, Michal Prokopič 3, Abdellah Hedjoudje 4

Affiliations

1 Haukeland University Hospital, Bergen, Norway

2 HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland

3 Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia

4 Assistance Publique des Hopitaux de Paris, Université Versailles St-Quentin en Yvelines, Paris, France

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Abstract

Introduction

High-quality endoscopy training is essential for safe and effective endoscopic practice. The ESGE and ESGENA position statement published in 2023 provides structured recommendations for basic endoscopy training (1). However, the extent to which these recommendations have been implemented across Europe has not been systematically assessed.

Aims & Methods

This study aimed to assess current basic endoscopy training practices across Europe, identify gaps between current practice and the ESGE/ESGENA position statement, and explore reasons for these differences to improve future training.
A survey was distributed through the Friends of the UEG Young Talent Group network from September 2025 to January 2026. Eligible participants were gastroenterology trainees and specialists with <10 years of endoscopy experience who had completed their training in Europe. Based on the ESGE/ESGENA position statement, the survey assessed training structure, content, competency assessment, procedure volume, and training satisfaction.

Results

A total of 795 responses were received from 40 countries, of which 710 met inclusion criteria; 47% female, 53% male, and 0.3% non-binary. Half of the trainees (53%) started endoscopy training in their first two years, and only 12% in their last two years. Structured assessments were reported by 65% of respondents, mostly occasional/informal (regular and formal 2.5%), while 35% reported no assessment during training.

Observation (94%) and self-learning (81%) were the most common training elements, while for roughly a third of respondents; lectures, endoscopic workshops, and simulation training were also included. Notably, nearly a third (27%) reported no structured training (e.g., self-taught). Of those who used simulation training, 75% considered it helpful.

Only 26% reported having a formally assigned supervisor; 36% stated their supervisors lacked formal training in teaching endoscopy, while 24% did not know. 26% reported having a logbook for both official purposes and training progression, while 39% used one for official purposes only.

Key barriers to high-quality endoscopy training were lack of structured teaching (68%), limited access to procedures due to clinical workload (58%) and pressure to complete procedures due to service demands (54%). Mean satisfaction score was 3.4/5 (5=highest satisfaction).

Further analyses of procedure volumes, training elements, and subgroup comparisons will be published separately.

Conclusion

These findings suggest substantial gaps between ESGE/ESGENA position statement and real-world basic endoscopy training across Europe. Recognising and addressing these gaps is key to improving current practice. By including respondents with varying years of endoscopy experience, this study may provide a baseline for future comparisons before and after publication of the 2023 position statement, pending further subgroup analyses.

References

1. Antonelli G, Voiosu AM, Pawlak KM, Gonçalves TC, Le N, Bronswijk M, ym. Training in basic gastrointestinal endoscopic procedures: a European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) Position Statement. Endoscopy. helmikuuta 2024;56(02):131–50. doi:10.1055/a-2205-2613

Disclosure

Event

UEG Week Barcelona 2026

Topics

Stomach & H. Pylori Nurses Immunology Endoscopy Digestive Oncology

Submission format

Abstract

Session

Lower GI masterclass: Let's get educated!

Citation

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

Published

2026

More Like This:

Round table discussion

ESGE live endoscopy III (Complete Session)

The role of nursing in green endoscopy: Training, auditing and waste segregation

Anastasia Tsalouka

When brushing teeth becomes a challenge: Foreign body removal

Arianna Parrella

BASIC ENDOSCOPY TRAINING IN EUROPE: A SURVEY ACROSS 40 COUNTRIES IDENTIFYING GAPS BETWEEN ESGE/ESGENA RECOMMENDATIONS AND REAL-WORLD PRACTICE

Abdellah Hedjoudje

DISORDERS OF GUT-BRAIN INTERACTION (DGBI) AND PARKINSON’S DISEASE: ARE DGBI A RISK FACTOR FOR NEURODEGENERATIVE DISEASE?

Nicholas J. Talley

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DISORDERS OF GUT-BRAIN INTERACTION (DGBI) AND PARKINSON’S DISEASE: ARE DGBI A RISK FACTOR FOR NEURODEGENERATIVE DISEASE?

Natasha A Koloski 1, Michael P. Jones 2, Nicholas J. Talley 1

Affiliations

1 University of Newcastle, New Lambton Heights, Australia

2 Macquarie University, North Ryde, Australia

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Abstract

Introduction

Recent research has highlighted the potential role of the brain–gut axis in the development of Parkinson’s disease (PD). Some studies suggest that disorders of gut brain interaction (DGBI) including irritable bowel syndrome (IBS) without diarrhoea, functional dyspepsia (FD) and chronic idiopathic constipation (CIC), may increase the risk of a subsequent PD diagnosis (1). However, findings remain inconsistent; for example, a recent prospective cohort study using Mendelian randomization found no significant association between IBS and the risk of developing PD (2).

Aims & Methods

Given these conflicting results, we aimed to investigate whether DGBI are associated with PD in a large sample of primary care patients. Data was collected from a retrospective cohort study of 1,129,104 patients attending general practices in the United Kingdom. Medical records were searched for a diagnosis of a DGBI (IBS, FD or CIC) and PD were included over an average of 15 years. Multiple logistic regression was used to assess the association of DGBI and a diagnosis of PD, adjusting for age and sex.

Results

The prevalence of IBS, FD and CIC and PD was 12.6%, 17.6%, 1.2% and 0.5% respectively. CIC and FD reported at any time were significantly more common in people with PD whereas IBS (all subtypes) was significantly less common (Table 1).

	Parkinson's Disease Diagnosis No (n=1,123,843) n (%)	Parkinson's Disease Diagnosis Yes (n=5,261) n (%)	P value
DGBI at any time relative to Parkinson's diagnosis
IBS (yes)	141,630 (12.6)	352 (6.7)	<0.001
FD (yes)	197,348 (17.6)	1,071 (20.4)	<0.001
CIC (yes)	13,411 (1.2)	172 (3.3)	<0.001
DGBI prior to Parkinson's diagnosis
IBS (yes)	141,630 (12.6)	300 (5.7)	<0.001
FD (yes)	197,348 (17.6)	723 (13.7)	<0.001
CIC (yes)	13,411 (1.2)	74 (1.4)	0.16

When examining pure DGBI reported at any time, we found that having CIC alone was associated with an increased risk of PD (OR = 2.62, 95% CI 2.20–3.12, p <0.001). FD (OR = 1.15, 95% CI 1.07–1.24, p < 0.001) and having two or more DGBI (OR = 1.45, 95% CI 1.20–1.75, p < 0.001) were also associated with a modestly significant increased risk of PD, even after controlling for age and sex. In contrast, IBS was not significantly associated with PD in the adjusted model.
When assessing DGBI prior to PD onset, chronic constipation was more common in those with PD but this was not significant (Table 1). On the other hand, IBS and FD were less common among individuals with new onset PD (Table 1). In a model examining pure DGBI categories prior to PD, IBS only (OR = 0.51, 95% CI 0.43–0.59, p < 0.001), FD only (OR = 0.26, 95% CI 0.23–0.30, p < 0.001), CIC only (OR = 0.36, 95% CI 0.24–0.54, p < 0.001), and having two or more DGBI (OR = 0.70, 95% CI 0.55–0.89, p = 0.003) were all inversely associated with PD after adjusting for age and sex.

Conclusion

We observed constipation is a risk factor for Parkinson’s disease, but this may be mostly explained by the neurologic disease process inducing bowel dysfunction. While IBS was not associated with Parkinson’s disease in any of the current analyses, we could not subdivide IBS into constipation versus non-constipation subgroups in this dataset (as this diagnostic information was not coded) so an association may have been missed.

References

Konings B, et al. Gastrointestinal syndromes preceding a diagnosis of Parkinson's disease: testing Braak's hypothesis using a nationwide database for comparison with Alzheimer's disease and cerebrovascular diseases. Gut. 2023;72(11):2103-2111.
Wang ZY, et al. Association between irritable bowel syndrome and Parkinson's disease by Cohort study and Mendelian randomization analysis. NPJ Parkinsons Dis. 2024 Mar 28;10(1):70.

Conference

UEG Week Barcelona 2026

Topics

Colorectal

Submission format

Abstract

Session

From immune-mediated colitis to chronic diarrhoea: Advances in clinical care (Posters)

Citation

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

Published

2026

More Like This:

Round table discussion

ESGE live endoscopy III (Complete Session)

The role of nursing in green endoscopy: Training, auditing and waste segregation

Anastasia Tsalouka

When brushing teeth becomes a challenge: Foreign body removal

Arianna Parrella

BASIC ENDOSCOPY TRAINING IN EUROPE: A SURVEY ACROSS 40 COUNTRIES IDENTIFYING GAPS BETWEEN ESGE/ESGENA RECOMMENDATIONS AND REAL-WORLD PRACTICE

Abdellah Hedjoudje

DISORDERS OF GUT-BRAIN INTERACTION (DGBI) AND PARKINSON’S DISEASE: ARE DGBI A RISK FACTOR FOR NEURODEGENERATIVE DISEASE?

Nicholas J. Talley