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Functional dyspepsia: Diagnosis and treatment

Lucas Wauters, Jan Tack, Tim Vanuytsel

Summary

AI Generated

This is an online educational course on functional dyspepsia covering diagnosis using Rome IV criteria, pathophysiology, and evidence-based management approaches for the condition and its syndromes including postprandial distress and epigastric pain syndrome.

  • The course teaches diagnosis of functional dyspepsia using Rome IV criteria and recognition of cardinal and associated symptoms
  • Content covers the pathophysiology of functional dyspepsia, mechanisms of action of different drugs, and evidence-based therapy choices
  • The course includes postprandial distress syndrome and epigastric pain syndrome as recognized syndromes within functional dyspepsia
  • Combined material duration is approximately 40 minutes with an estimated 60 minutes needed to complete the course including final assessment
  • The course is suitable for gastroenterologists in training as well as physicians, surgeons, nurses, dietitians and medical students with an interest in gastroenterology
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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Overview

Functional dyspepsia is a common and chronic functional gastrointestinal disorder (FGID) defined by upper abdominal symptoms. Correct diagnosis and recognition of the existing syndromes, including postprandial distress and epigastric pain syndrome is important, as this will affect the management decisions.

All aspects of functional dyspepsia —from its definition and impact to pathophysiology and management— are covered in this online course by Lucas Wauters, Jan Tack and Tim Vanuytsel. The course includes comprehensive PPT slides and bespoke video presentations, which were filmed in Leuven in March 2020. The combined material has a total duration of approximately 40 minutes. The estimated time needed to complete the course, including the final assessment, is 60 minutes.

Learning objectives

  • How to reach a diagnosis of functional dyspepsia using Rome IV criteria
  • To recognize the cardinal and associated symptoms of functional dyspepsia
  • To understand the impact and pathophysiology of functional dyspepsia
  • To understand the mechanisms of action of different drugs used to treat functional dyspepsia
  • To make evidence-based choices on existing therapies for functional dyspepsia

Target audience

This course is suitable for gastroenterologists in training, but is also appropriate for physicians and surgeons in other disciplines, as well as nurses, dietitians and medical students who have an interest in gastroenterology.

This course was developed by Lucas Wauters, Jan Tack and Tim Vanuytsel (department of Gastroenterology and Hepatology, KU Leuven University Hospitals Leuven) in receipt of an Activity Grant from UEG.

Reviewed & updated February 2023

Event

Functional dyspepsia: Diagnosis and treatment

Topics

Neurogastroenterology & Motility

Accreditation status

accredited

Duration

1 hour

Published

2020

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GASTRIC ENDOSCOPIC SUBMUCOSAL DISSECTION DEFECT RESOLUTION STRATEGIES: THE PATH TO CLOSURE WITH THROUGH-THE-SCOPE HELIX TACK SUTURE SYSTEM

João António Cunha Neves 1, Jéssica Chaves 2, Joana Roseira 1, Mario Dinis-Ribeiro 2, Diogo Libânio 2

Affiliations

1 Unidade Local de Saúde do Algarve, Portimão, Portugal

2 Porto Comprehensive Cancer Center, Porto, Portugal|||MEDCIDS - Department of Community, Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal

Summary

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Summary is not available for this content yet.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Clinical Case Summary

Closure of mucosal defects after endoscopic submucosal dissection (ESD) may reduce the risk of postprocedural perforation and bleeding. However, defect closure with traditional through-the-scope (TTS) or over-the-scope (OTS) clips and OTS suturing devices may be technically limited by defect size and location. The development of a new through-the-scope helix tack suture system (TTSS) has emerged as a promising tool for overcoming these limitations, particularly when combined with TTS clips.

We present two cases of gastric ESD defect closure with TTSS and adjunctive TTS clip application, highlighting the outcomes and main challenges to achieve complete defect closure.

CASE 1: 73-year-old woman with a 15mm Paris 0-IIb dysplastic lesion of the posterior wall of the antrum. En-bloc ESD was performed and the 25mm mucosal defect was closed with TTSS in a ‘Z’ pattern. However, suboptimal tack placement resulted in incomplete closure of the central portion of the scar, leaving two areas of exposed submucosa at the edges. Complete defect closure was accomplished with the additional placement of four TTS clips at the edges, only possible due to the previously achieved proximity.

CASE 2: 55-year-old man referred for ESD of a 13mm Paris 0-IIa dysplastic lesion in the lesser curvature of the antrum. En-bloc ESD was accomplished, and the resulting 25mm mucosal defect was closed using TTSS in a 'Z' pattern. Complete defect closure was achieved with the additional placement of one TTS clip.

Both patients were discharged the following day and presented with no complications at 1-month follow-up.

These cases highlight the potential of TTSS becoming a practical solution for the closure of complex post-ESD defects, allowing earlier patient discharge. While this novel TTSS with adjunctive TTS clip application appears to be effective in the management of sizable defects, proper suture pattern and tack placement are paramount for achieving complete defect closure.

References

  1. Kobara H, Tada N, Fujihara S, Nishiyama N, Masaki T. Clinical and technical outcomes of endoscopic closure of postendoscopic submucosal dissection defects: Literature review over one decade. Dig Endosc. 2023 Jan;35(2):216-231.
  2. Hernandez-Lara A, Garcia Garcia de Paredes A, Rajan E, Storm AC. Step-by-step instruction: using an endoscopic tack and suture device for gastrointestinal defect closure. VideoGIE. 2021;6(6):243-245.
  3. Hernandez A, Marya NB, Sawas T, Rajan E, Gades NM, Wong Kee Song LM, et al. Gastrointestinal defect closure using a novel through-the-scope helix tack and suture device compared to endoscopic clips in a survival porcine model (with video). Endosc Int Open. 2021 Apr;9(4):E572-E577.
  4. Canakis A, Dawod SM, Dawod E, Simons M, Di Cocco B, Westerveld DR, et al. Efficacy, Feasibility, and Safety of the X-Tack Endoscopic HeliX Tacking System: A Multicenter Experience. J Clin Gastroenterol. 2024 Jan 29.
  5. Canakis A, Deliwala SS, Frohlinger M, Twery B, Canakis JP, Shaik MR, et al. Endoscopic outcomes using a novel through-the-scope tack and suture system for gastrointestinal defect closure: a systematic review and meta-analysis. Endoscopy. Published online March 22, 2024.

Conference

UEG Week Vienna 2024

Topics

Oesophagus

Submission format

Clinical Case

Session

Clinical Cases (Posters)

Published

2024

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GENDER GAP IN THE TREATMENT OF FUNCTIONAL DYSPEPSIA? DATA FROM THE GERIATRIC POPULATION

Jakob Worbs 1, Emma Complido 1, Olaf Kelber 1, Karen Nieber 2, Karin Kraft 3

Affiliations

1 Steigerwald Arzneimittelwerk GmbH, Darmstadt, Germany

2 Leipzig University, Leipzig, Germany

3 University Medicine Rostock, Rostock, Germany

Summary

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Summary is not available for this content yet.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Functional gastrointestinal disorders (FGIDs) are more prevalent in female than in male patients [1,2]. This triggers the question whether this is also reflected in medical care, especially also in self-medication, where often botanicals are used. A potential source of data to address this question is the PhytoVIS study, a pharmacoepidemiological study conducted in Germany in more than 20,000 patients taking herbal medicinal products.

Aims & Methods

To have a large and homogenous data base for a gender-related evaluation, records for a clinically proven herbal medicinal product (HMP) often used in FGIDs, STW 5 [3,4], were evaluated to uncover potential gender-related differences in the pharmacotherapy of FGIDs.

Results

1513 records were evaluated, 71 % of them from females and 29 % from males, i.e. a 4 % higher proportion of females compared to the overall population of the PhytoVIS study. Main criterium for the evaluation was the Clinical Global Impression Scale – Efficacy (CGI-E). No major differences between females and males were found, apart that women perceived a minimally better effect of the therapy. The reported symptoms were differentiated into symptoms associated with functional dyspepsia (FD), irritable bowel syndrome (IBS), or symptoms that can be associated with both. As far as the records allow a differentiation, no gender differences could be observed. This applies also to the perceived efficacy, the tolerability and the onset of action.

Conclusion

So, while there are differences in the prevalence of FGIDs in women and men, there are no therapeutically relevant pharmacoepidemiological differences in patients with functional gastrointestinal diseases treated with a medicinal product indicated in these diseases, so suggesting that there is no gender gap in this highly relevant therapeutic field.

References

1. Kim YS, Kim N. Sex-Gender Differences in Irritable Bowel Syndrome. J Neurogastroenterol Motil. 2018;24:544-558
2. Houghton LA, Heitkemper M, Crowell M, Emmanuel A, Halpert A, McRoberts JA, Toner B. Age, Gender and Women's Health and the Patient. Gastroenterology. 2016; S0016-5085(16)00183-9;
3. Malfertheiner P. STW 5 (Iberogast) Therapy in Gastrointestinal Functional Disorders. Dig Dis. 2017;35 Suppl 1:25-29
4. Madisch A, Vinson BR, Abdel-Aziz H, Kelber O, Nieber K, Kraft K, Storr M. Modulation of gastrointestinal motility beyond metoclopramide and domperidone : Pharmacological and clinical evidence for phytotherapy in functional gastrointestinal disorders. Wien Med Wochenschr. 2017;167:160-168

Disclosure

JW and EC were interns, OK, is employee of Steigerwald Arzneimittelwerk GmbH, Darmstadt, Germany, KN und KK have received fees from the same company.

Conference

UEG Week Vienna 2024

Topics

Oesophagus

Submission format

Abstract

Session

OESOPHAGEAL, GASTRIC AND DUODENAL (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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

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COVID-19 ENCEPHALITIS IN A CIRRHOTIC PATIENT

Sahar Hamza 1, Sabbah Meriam 1, Dorra Trad 1, Houssaina Jlassi 1, Norsaf Bibani 1, Dalila Gargouri 1

Affiliations

1 Habib Thameur Hospital, Tunis, Tunisia

Summary

AI Generated

Summary is not available for this content yet.

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Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Clinical Case Summary

We report the case of a 64-year-old man with preexisting hepatic sarcoidosis complicated by liver cirrhosis, who presented with confusion as an initial manifestation of COVID-19 confirmed by rapid Antigenic test. His Child Pugh score was 8 (Class B) and MELD was 16. Chest radiographs showed bilateral patchy interstitial opacities. Computed tomography (CT) of the brain was normal. Lumbar puncture was not performed because of a marked thrombocytopenia. Urine cytobacteriological examination did not show a urinary tract infection. An abdominal ultrasound showed normal hepatoportal flow and a mild ascites. Ascitic fluid analysis did not show spontaneous bacterial peritonitis. Since the patient was cirrhotic, we have considered the diagnosis of hepatic encephalopathy as a possible explanation for the neurological symptoms, so he started Lactulose and Rifaximin. However, his clinical condition showed no improvement, the neurological disorders remained the same. A brain MRI showed in FLAIR MR sequences a few hyperintensities punctiform in the white matter of the supratentorial region and the subcortical of the left insula region. There were no signs of a cerebral granuloma nor toxoplasmosis. It did not show venous thrombosis. There were no microheamorragies neither ischemic lesions. After careful evaluation by neurologic experts, encephalitis associated with SARS-CoV-2 infection was concluded. The patient was treated by intravenous Dexamethasone and he fully recovered without sequelae. This case illustrates the fact that neurological manifestations associated with COVID-19 infection are not necessarily a reflection of critical illness, and should incite clinicians to actively look for any evidence of COVID-19 infection as a differential diagnosis in patients with preexisting cirrhosis, presenting with neurological symptoms, during the epidemic period of COVID-19.

Conference

UEG Week Copenhagen 2023

Submission format

Clinical Case

Session

PP 12 Clinical Cases (Posters)

Published

2023

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INCREASE IN POINT-PREVALENCE AND COSTS OF LIVER CIRRHOSIS IN THE NETHERLANDS – A NATIONWIDE HEALTH CLAIMS DATA ANALYSIS

Koos de Wit 1, Gwen M.C. Masclee 1, Minneke J. Coenraad 2, Frans Cuperus 3, Matthijs Kramer 4, Raoel Maan 5, Robert Bart Takkenberg 1, Marten Lantinga 1

Affiliations

1 Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, Netherlands

2 Leiden University Medical Centre, Leiden, Netherlands

3 University Medical Center Groningen, Groningen, Netherlands

4 Maastricht University Medical Centre+, Maastricht, Netherlands

5 Erasmus University Medical Center, Rotterdam, Netherlands

Summary

AI Generated

Summary is not available for this content yet.

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Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Chronic liver injury ultimately progresses to the development of cirrhosis. Patients with cirrhosis can be in a compensated or decompensated phase, the latter marked by clinical events such as ascites, hepatic encephalopathy and variceal bleeding. These events are associated with significant morbidity and mortality and the management is challenging and labor-intensive. Due to ongoing unhealthy lifestyle factors resulting in chronic liver injury, the burden of cirrhosis on healthcare systems in Europe is increasing. There is however limited data on the impact of cirrhosis on Dutch healthcare resources.

Aims & Methods

We aimed to determine the point-prevalence and claimed health costs of adults (≥ 18 years) registered as patients with cirrhosis at Dutch hospitals. To this end we extracted health claims data (timeframe 2017-2021) from the records of the Dutch health claims database (Vektis), which covers almost all inhabitants of the Netherlands. We used diagnosis codes ‘compensated cirrhosis’ and ‘decompensated cirrhosis’ to identify patients.

Results

The point prevalence of patients with cirrhosis increased from 48,7 patients per 100.000 adult Dutch inhabitants in 2017 to 75,2 per 100.000 in 2021 (+54%). The point-prevalence for cirrhosis was highest in the province of Limburg with 105,6 patients per 100.000 adult Dutch inhabitants. The annual increase in unique new patients for which hospitals claimed costs was n=3.725 in 2018, n=3.840 in 2019 (+3%), n=3.749 in 2020 (-2%) and n=3.695 in 2021 (-1%). The largest increase was observed in the province of Zuid-Holland (approximately 5 new patients per 100.000 adult Dutch inhabitants per year). Total number of hospital admissions increased with 19% from 2.443 admissions in 2017 to 2.899 admissions in 2021. The median length of stay for admitted patients with cirrhosis in 2017-2021 was four days [IQR 2-7 days]. The annual reported costs for patients with cirrhosis increased from €35 million in 2017 to €78 million in 2021 (+120%).

Conclusion

The point-prevalence of Dutch adults registered as a patient with cirrhosis in Dutch hospitals increased by more than fifty percent, with remarkable regional differences. Consequently, the total healthcare costs claimed for these patients more than doubled in less than five years.

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

PP 07 Liver & biliary (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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A RARE AND UNEXPECTED CAUSE OF DYSPHAGIA IN A 61-YEAR-OLD MALE: DIFFUSE IDIOPATHIC SKELETAL HYPEROSTOSIS (DISH) (“FORESTIER SYNDROME”)

Paolo Vaia 1, Mario Romeo 1, Marina Cipullo 1, Rossella D'Onofrio 1, Annachiara Coppola 1, Fiammetta Di Nardo 1, Antonio Scafuri 1, paola ciamarra 1, Marcello Dallio 1, Alessandro Federico 1

Affiliations

1 University of Campania "Luigi Vanvitelli", Naples, Italy

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Abstract

Clinical Case Summary

Background: Dysphagia represents a relatively common entity determined by a heterogeneous spectrum of frequent conditions ranging predominantly from oesophageal organic lesions (benign or malignant) to motility dysfunctions. However, rare extra-oesophageal causes of dysphagia, including neuromuscular disorders or mediastinum disorders, have been described.
Case presentation: A 61-year-old male patient was admitted to our department complaining of progressive worsening oropharyngeal dysphagia, especially for solid food. Six months before, he received an upper gastrointestinal barium X-ray showing no specific signs.
On admission, the diagnostic work-up included esophagogastroduodenoscopy (EGDS) and manometry: EGDS highlighted a hypopharyngeal sub-stenosis requiring the use of a paediatric endoscope to pass through it, while manometry evidenced an unspecific triple pressure trace at the upper oesophageal sphincter level suggesting an ab extrinsic compression. Moreover, an expert multidisciplinary “dysphagia” team composed of gastroenterologists, endocrinologists, otolaryngologists, and neurologists, excluded thyroid-related determinants, and ruled out other common causes of dysphagia.
Considering these findings, a neck-column CT scan was performed and the following radiological criteria of Diffuse Idiopathic Skeletal Hyperostosis (DISH) or “Forestier Syndrome” were revealed: flowing ossifications mainly along the anterior longitudinal ligament of at least four contiguous vertebrae with preserved inter-articular discs height and absence of apophyseal joints. Finally, the patient was surgically managed gaining the complete resolution of his symptoms.
Conclusion: DISH represents a rare cause of dysphagia. Clinicians should be aware that the diagnostic work-up of “unexplained” dysphagia should routinely include extra-oesophageal conditions, especially the rare ones.

References

  1. Mazières B. Diffuse idiopathic skeletal hyperostosis (Forestier-Rotes-Querol disease): what's new? Joint Bone Spine. 2013 Oct;80(5):466-70. doi: 10.1016/j.jbspin.2013.02.011. Epub 2013 Apr 6. PMID: 23566663.
  2. Karaarslan N, Gürbüz MS, Çalışkan T, Simsek AT. Forestier syndrome presenting with dysphagia: case report of a rare presentation. J Spine Surg. 2017 Dec;3(4):723-726. doi: 10.21037/jss.2017.11.05. PMID: 29354755; PMCID: PMC5760404
  3. Legaye J. Forestier's syndrome : a rare cause of dysphagia. A case report and review of the literature. Acta Orthop Belg. 2020 Jun;86(2):216-219. PMID: 33418609.

Conference

UEG Week Vienna 2024

Topics

Oesophagus

Submission format

Clinical Case

Session

Clinical Cases (Posters)

Published

2024

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Federico Biagi Federico Biagi, Rachele Ciccocioppo, Andrea Rastelli, Giovanni Arpa, Yiftach Shoval, Elena Betti, Patrizia Pignatti, Chiara Scarcella, Annalisa Schiepatti, STILIANO MAIMARIS

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FLOW CYTOMETRY FOR THE ASSESSMENT OF ABERRANT INTRAEPITHELIAL LYMPHOCYTES IN NON-RESPONSIVE COELIAC DISEASE AND NON-COELIAC ENTEROPATHIES

STILIANO MAIMARIS 1, Annalisa Schiepatti 1, Chiara Scarcella 1, Patrizia Pignatti 2, Elena Betti 3, Yiftach Shoval 1, Giovanni Arpa 4, Andrea Rastelli 1, Rachele Ciccocioppo 5, Federico Biagi 1

Affiliations

1 University of Pavia, Pavia, Italy

2 Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Pavia, Italy

3 Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy, Pavia, Italy

4 Pathology Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Pavia, Italy

5 AOUI Policlinico GB Rossi & University of Verona, Verona, Italy

Summary

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Patients with coeliac disease (CD) and unsatisfactory clinical response to a gluten-free diet (GFD) are identified as having non-responsive coeliac disease (NRCD), and may require investigations to exclude possible complications of CD. Refractory coeliac disease (RCD) is the most common complication of CD and can be divided into RCD type 1 and type 2 based on intraepithelial lymphocyte (IEL) immunophenotyping. Methods for the assessment of IEL phenotype in RCD include traditional immunohistochemistry (IHC), PCR-based clonality analysis of TCR-γ gene rearrangement and flow cytometry (FC). However, the role of monitoring IEL immunophenotype with FC in patients with NRCD and known RCD is poorly defined. Moreover, very little is known about the utility of FC for evaluating IEL phenotype in patients with non-coeliac enteropathies (NCEs), for which differential diagnosis with RCD is challenging.

Aims & Methods

We aimed to investigate the reproducibility and significance of monitoring IEL immunophenotype with FC in patients with RCD, NRCD, and NCEs under regular follow-up at a referral centre. Patients who underwent FC for IEL immunophenotyping between January-2012 and February-2023 were divided into two groups: group 1) patients with known RCD or patients with NRCD in whom complications of CD were suspected; group 2) patients with NCEs lacking clinical and histological response. Data was retrospectively collected on clinical features, IEL immunophenotyping with FC, IHC, analysis of γ-TCR clonality, and on mortality and progression to lymphoma. An aberrant IEL phenotype was defined as >20% CD103+,CD3-,CD8-,CD3ε+ at FC. Reproducibility of FC results and concordance of FC with IHC and γ-TCR clonality analysis were evaluated. Overall survival and lymphoma-free survival were compared among coeliac patients based on IEL phenotype at FC.

Results

52 patients (18 RCD, 21 NRCD, 13 NCEs; 38 F, mean age at FC testing 55±13 years) underwent 100 total FC IEL phenotype determinations and an aberrant IEL phenotype was found at FC in 9/52 (7RCD, 2NRCD). 22 patients had at least two FC determinations during follow-up. Interestingly, immunophenotype (both aberrant and normal) remained unchanged in all these 22 patients (Cohen’s κ=1.00). Concordance of FC with IHC was fair (Cohen’s κ=0.40) but only minimal with γ-TCR clonality (Cohen’s κ=0.22). Over a median follow-up of 33 months (IQR 3-59) after FC, 6/52 (11%) progressed to lymphoma and 13/52 (25%) died. Mortality was markedly increased in coeliac patients with aberrant IELs compared to those with a normal immunophenotype (89% vs 7% mortality, HR 5.5, 95% CI 1.8-17.3, p<0.01). None of the 13 patients with NCEs showed an aberrant IEL phenotype at FC, although 3/13 developed lymphoma and 4/13 died (three lymphoma, one pulmonary adenocarcinoma).

Conclusion

FC is an accurate and reproducible tool for evaluating IEL phenotype in patients with RCD and NRCD and provides valuable prognostic information. Further study is needed on the diagnostic and prognostic role of FC in NCEs.

Conference

UEG Week Copenhagen 2023

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

PP 03 Small intestinal (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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