Introduction

Chronic constipation (CC) is managed differently across global regions due to cultural, dietary, and healthcare system differences. Emerging pharmacological options offer promise, yet real-world adoption remains limited by systemic barriers including cost and availability. This study reports findings from the Bali Chronic Constipation Roundtable, which was conducted in November 2024 to examine the regional practices in Asian and compare them to Western approaches.

Aims & Methods

A multinational expert panel representing gastroenterologists from 12 countries in East, Southeast, and South Asia convened to review survey data, real-world clinical practices, and guideline applicability. All attendees completed a questionnaire exploring the regional epidemiology and challenges related to CC. Key domains assessed included symptom profiles, diagnostic tools, treatment access and practices, and cultural perceptions.

Results

CC prevalence in Asia varied significantly, ranging from 3.5% in Indonesia to up to 40% in Taiwan. Demographic groups disproportionately affected included the elderly (81.0% of respondents), women (45.2%), and children (23.8%). The Rome IV criteria emerged as the most frequently cited CC diagnostic approach (71.4%), followed by physician diagnosis (61.9%), local criteria (19.0%), and Bristol Stool Chart (4.8%). Experts opined that CC prevalence differed based on these varying definitions. Due to regional variations in symptom interpretation, patients frequently associate constipation with predominant symptoms like sensation of incomplete evacuation in Asia (72.1-96.5%) rather than hard stools in Western countries (81.7-100%). Strict adherence to ROME criteria might exclude patients without significant pain, potentially underdiagnosing cases. Colonic transit time is also significantly different in Asia (15.8-24.5 hours) compared to Western countries (30.0-40.0 hours), and similarly for fibre intake (9.7g/day in Asia, 16.0g/day in the USA) owing to regional dietary differences.
In terms of accessibility, experts highlighted a lack of representativeness in internet-based surveys in Asia in rural populations, causing underreporting in population-level data. 100% of respondents expressed a gap in the availability of diagnostic tools and pharmacotherapy in Asia. Access to anorectal manometry and colonic transit studies was limited in lower-resource settings, hindering diagnosis and management. The main challenges were lack of specialized centres (76.2%), patient adherence (66.7%), cost (61.9%), and access to diagnostic tools (57.1%). In terms of pharmacological therapy, osmotic laxatives were the most commonly used initial therapy in CC management (86.7% of respondents), while newer agents such as IBAT inhibitors showed efficacy in refractory cases. However, the use of newer agents was limited due to cost (76.2%) and availability (38.1%).

Key Differences in Chronic Constipation: East and West

Conclusion

Significant differences exist between Asian and Western CC management. Regionally adapted diagnostic criteria and treatment pathways are urgently needed to reflect real-world practice and improve care across Asia.

References

1. Pinto Sanchez MI, Bercik P. Epidemiology and burden of chronic constipation. Canadian Journal of Gastroenterology and Hepatology. 2011;25:11B-5B.
2. Patimah AW, Lee YY, Dariah MY. Frequency patterns of core constipation symptoms among the Asian adults: a systematic review. BMC gastroenterology. 2017 Dec;17:1-2.
3. Jaruvongvanich V, Patcharatrakul T, Gonlachanvit S. Prediction of delayed colonic transit using Bristol stool form and stool frequency in Eastern constipated patients: a difference from the West. Journal of Neurogastroenterology and Motility. 2017 Oct 30;23(4):561.
4. Yu D, Zhao L, Zhao W. Status and trends in consumption of grains and dietary fiber among Chinese adults (1982–2015). Nutrition Reviews. 2020 Aug 1;78(Supplement_1):43-53.
5. Hoy KM, Goldman JD. Dietary fiber intake of the US population. Food Surv Res Gr Diet Data Br No. 2014;12:1-6.
6. Werth BL, Christopher SA. Laxative use in the community: a literature review. Journal of clinical medicine. 2021 Jan 4;10(1):143.

Introduction

Anti-mitochondrial antibodies (AMA) are commonly associated with Primary Biliary Cholangitis (PBC), a progressive liver disease. However, the clinical significance of AMA positivity in patients with normal liver enzymes remains poorly understood. Despite the presence of AMA, many patients maintain normal liver function, raising the question of whether these individuals are at risk for developing liver-related complications.

Aims & Methods

This study aims to evaluate the natural history, prognostic implications, and potential risk factors for disease progression in AMA-positive patients with normal liver enzymes.
A retrospective cohort study was conducted using a national healthcare database to identify patients (aged>18) with a positive AMA and normal liver enzymes between 2002 and 2023. Demographics, biochemical parameters, and liver-related complications were analyzed. Multivariate regression models assessed predictors of disease progression.

Results

Among 1,018 patients, 76 (7.5 %) developed Primary biliary cholangitis (PBC), and 30 (2.9%) progressed to cirrhosis over a median follow-up of 6.3 years. Liver-related complications were rare, with esophageal varices in 1.1%, ascites in 1.8%, hepatocellular carcinoma in 0.2%, and liver transplantation in 0.1%. Notably, higher AMA titers were strongly associated with increased risk of developing PBC, cirrhosis and liver-related complications, demonstrating a clear titer-dependent pattern.

Conclusion

Most AMA-positive patients with normal liver enzymes do not develop clinically significant liver disease. However, higher AMA titers identify a high-risk subgroup that warrants closer monitoring. These findings underscore the need for risk-stratified follow-up strategies and may influence future clinical guidelines.

Introduction

Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1 RAs) have gained attention for their role in managing type 2 diabetes and obesity. These drugs help regulate blood sugar levels and promote satiety. This effect benefits weight management, as it supports better control over eating habits and can lead to significant weight loss in some patients. In addition, recent studies showed promising influences on reducing alcohol consumption.

Aims & Methods

This systematic review assesses the impact of GLP-1 RA treatment on alcohol consumption behaviors. Following PRISMA guidelines, this study is conducted through a comprehensive search in PubMed, EMBASE, Scopus, Cochrane, and ClinicalTrials.gov up to February 1, 2025. It included participants with occasional or excessive alcohol use, focusing on self-reported intake, alcohol-related diagnoses, relapse rates, and neuroimaging. Data extraction and risk-of-bias assessments were independently performed by reviewers using the CASP tool, with both qualitative and quantitative synthesis of outcomes.

Results

Thirteen studies are included in this study with a sample size of 5,246,188 participants. The GLP-1 RAs consisted of Semaglutide, Exenatide, Liraglutide, Dulaglutide, and Tirzepatide. The overall mean alcohol intake decreased significantly from 11.8 ± 1.0 to 4.3 ± 0.5 units per week (p < 0.001) ¹. At week 12, participants in the dulaglutide group consumed approximately 29% less alcohol than those in the placebo group (adjusted relative effect = 0.71, 95% CI 0.52–0.97, P = 0.04) ². In contrast, a randomized controlled trial (RCT) involving Exenatide showed no difference in alcohol consumption (in grams) between the treatment and placebo ³. Additionally, two observational studies reported significant reductions in Alcohol Use Disorders Identification Test (AUDIT) scores with Semaglutide (B = -5.1, SE = 1.3, p < 0.001) and Tirzepatide (B = -6.7, SE = 1.3, p < 0.001) ^4,5. An additional observational study demonstrated a notable decrease in AUDIT-Consumption compared to unexposed individuals (DiD: 0.09 points, 95% CI: 0.03–0.14, p = 0.0025) ⁶. The CASP assessments rated most studies as moderate to high quality.

Conclusion

GLP-1 receptor agonists appear to offer a promising, effective, and well-tolerated pharmacological approach for reducing alcohol consumption and preventing relapse in alcohol use disorder (AUD). Further large-scale randomized trials are required to confirm their efficacy and guide clinical practice.

References

1. O’Farrell M, Almohaileb FI, le Roux CW. Glucagon-like peptide-1 analogues reduce alcohol intake. Diabetes Obes Metab. 2025;27(3):1601-1604. doi:10.1111/DOM.16152
2. Probst L, Monnerat S, Vogt DR, et al. Effects of dulaglutide on alcohol consumption during smoking cessation. JCI Insight. 2023;8(22). doi:10.1172/JCI.INSIGHT.170419
3. Klausen MK, Jensen ME, Møller M, et al. Exenatide once weekly for alcohol use disorder investigated in a randomized, placebo-controlled clinical trial. JCI Insight. 2022;7(19). doi:10.1172/JCI.INSIGHT.159863
4. Quddos F, Hubshman Z, Tegge A, et al. Semaglutide and Tirzepatide reduce alcohol consumption in individuals with obesity. Scientific Reports 2023 13:1. 2023;13(1):1-12. doi:10.1038/s41598-023-48267-2
5. Richards J, Dorand MF, Royal K, Mnajjed L, Paszkowiak M, Simmons WK. Significant Decrease in Alcohol Use Disorder Symptoms Secondary to Semaglutide Therapy for Weight Loss: A Case Series. J Clin Psychiatry. 2023;85(1). doi:10.4088/JCP.23M15068
6. Farokhnia M, Tazare J, Pince CL, et al. Glucagon-like peptide-1 receptor agonists but not dipeptidyl peptidase-4 inhibitors reduce alcohol intake.

Disclosure

The authors declare no conflicts of interest regarding the publication of this abstract. All findings and conclusions are the authors' own and do not represent the views of any funding organizations or institutions.

Introduction

International guidelines recommend endoscopic submucosal dissection (ESD) for en-bloc resection of rectal lesions suspected of submucosal invasive cancer (SMI). ESD achieves favorable outcomes for benign lesions and early rectal cancers (ERC) with superficial (<1000μm) SMI. However, for ERCs with deep (≥1000μm) SMI, the rate of histologically radical (R0) resection remains suboptimal, at maximum 64% for SM2-3 lesions, even in expert centres. The muscle-retracting sign (MRS) has emerged as a potential endoscopic marker of deep SMI detected during endoscopic resection. Predicting deep SMI is particularly relevant in rectal lesions, as incorrect selection of resection modality may lead to non-radical endoscopic resections and the need for surgical salvage, which carries significant morbidity. To address some of these limitations, we applied the novel pocket-detection method (PDM) for MRS detection. This approach enhances visualization of the submucosal space and facilitates early identification of the MRS.

Aims & Methods

The aim of this study was to evaluate the diagnostic accuracy of the MRS detected using the PDM as an innovative approach for identifying deeply invasive ERC during endoscopic resection of rectal lesions.
In this prospective, observational, single-centre study consecutive rectal lesions that underwent endoscopic resection using the PDM between August 2023 and March 2025 were included. Directionality of initial submucosal dissection targeted any morphological or surface vascular pattern at risk of deep SMI to attempt MRS identification. Histopathology was the reference standard for MRS diagnostic accuracy in detecting deep SMI. Deep SMI was defined as ≥1000μm invasion from the muscularis mucosa at histopathology.

Results

38 rectal lesions, median size 30 mm (IQR 20-40), were included. PDM for MRS detection was successful in all cases, with MRS-positive in 15/38 (39.5%). Deep SMI was confirmed in 15/38 (39.5%). Accuracy of MRS-positive for deep SMI detection was 84.2%, (95% CI 69.6-92.6%), sensitivity 80% (95% CI 54.8-92.9%), specificity 87% (95% CI 67.9-95.5%), positive predictive value 80% (95% CI 54.8-92.9%), negative predictive value 87% (95% CI 67.9-95.5%), positive likelihood ratio 6.13, negative likelihood ratio 0.23, area under the curve 0.83 (95% CI: 0.71–0.96). The rate of R0 resection was 92.1% (35/38).

Conclusion

MRS detected using the PDM demonstrated moderate-to-high accuracy in predicting deep SMI in early rectal cancer. This finding may allow selection of endoscopic resection strategy based on invasion depth.