UEG's educational platform for gastroenterology education bringing recordings, courses, guidelines, and more together in one place.

UEG Week Berlin 2025 Recordings Gut Guide online

Rate for better recommendations!

Your feedback helps us show you more of what you like and less of what you dislike!

More of this!

We will show you more similar content.

Not for me!

We won't suggest this again.

Bookmark!

Save this content for later!

New to myUEG? Create an account! Log In with myUEG account

UEG Poster

Standard Poster

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

Free for all myUEG account holders. Your access level is set automatically based on your occupation. Medical professionals get full access to all content. If you are a non-medical user, you can only access UEG Week content from congresses you attended.

Not sure what you can access? Learn more about account types.

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.

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

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

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

UEG Podcast Episode

UEG Podcast

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

Not sure what you can access? Learn more about account types.

The weird, wonderful , unusual and unexpected in gastroenterology

Pradeep Mundre 1, Charles Murray 2

1 Bradford Teaching Hospitals NHS trust, Leeds, United Kingdom

2 Royal Free Hospital, London, United Kingdom

Published

2024

UEG Podcast Episode

UEG Podcast

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

Not sure what you can access? Learn more about account types.

Well-rounded care in functional disorders with Tim Vanuytsel

Tim Vanuytsel, Egle Dieninyte - Misiune

Topics

Primary Care

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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

Not sure what you can access? Learn more about account types.

ABSTRACT

Background

Gallbladder polyps are seen in up to 7% of adults and carry a low malignancy risk. Guidelines on indication for surgery and follow-up remain controversial because of regional differences in the development of malignancy. This study compares European practice guidelines for gallbladder polyps and assesses the percentage of patients in whom cholecystectomy was indicated according to the guidelines with a true adenoma postoperatively.

Methods

Dutch patients with active follow-up or surgery for gallbladder polyps between 2018 and 2020 in 26 participating centres were included. Data on demographics, imaging characteristics, surgery and histopathology were assessed. Indications for cholecystectomy were examined for all patients comparing 2017 and 2022 European guidelines.

Results

A cohort of 302 patients was included. Patients in follow-up underwent imaging three times (median) and were followed up during a median of 23.2 months (IQR 10.9–47.4). In total, 88 patients (29%) underwent cholecystectomy after a median period of 23 months and a median of two instances of imaging. In 71 of 88 patients (81%) who underwent cholecystectomy, the gallbladder polyps was a valid indication for cholecystectomy according to 2017 guidelines, compared to 68 of 88 (77%) according to 2022 guidelines. The difference only occurred due to age as a risk factor which changed from 50 to 60 years of age. Of 71 operated patients, non-neoplastic polyps were found in 49 (69%), no gallbladder wall abnormality was found in 23 (32%). An adenoma was found in six patients (9%), of which three had low grade dysplasia and one had high grade dysplasia.

Discussion

Despite revision of guidelines in 2022, a significant number of patients still undergo follow-up and cholecystectomy for non-neoplastic gallbladder polyps, indicating the need for a more comprehensive risk assessment algorithm in the management of gallbladder polyps.

Revised Guidelines for the Treatment and Follow-Up of Gallbladder Polyps Do Not Reduce Unwarranted Cholecystectomies: Results of the POLYP Study

Mike van Dooren, Elise A.J. de Savornin Lohman

Guideline

Clinical Practice Guideline

Topics

Hepatobiliary Surgery

Citation

United European Gastroenterology Journal, 2025; 13:1133–1140

Published

2025

UEG Standards and Guidelines

New

Clinical Practice Guideline

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

Not sure what you can access? Learn more about account types.

ABSTRACT

Introduction

Since the publication of the first European Society for the Study of Coeliac Disease (ESsCD) guidelines in 2019, substantial advances have been made in understanding the management and complex disease courses of coeliac disease (CeD) in adults. These 2025 updated guidelines aim to integrate new evidence, refine management strategies, and promote a personalised and multidisciplinary approach to care.

Methods

The ESsCD convened a multidisciplinary panel of experts to revise the 2019 guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework. Evidence was appraised and graded according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Statements and recommendations were draughted within working groups and finalised through a structured Delphi consensus process.

Results

The updated guidelines are presented in two parts. Part 1, which has already been published, addresses the diagnostic approach to CeD in adults, whereas Part 2 focuses on disease management, structured follow-up, and the evaluation and treatment of persistent symptoms despite a gluten-free diet or refractory disease. New or expanded sections include guidance on the safe inclusion of oats, use of low-FODMAP diets in patients with persistent symptoms, management of exocrine pancreatic insufficiency, recognition of functional asplenia and related vaccination recommendations, and stratified bone-health screening. The guidelines also discuss nutritional and psychosocial support, digital models of care, and structured transition from paediatric to adult services. Updated therapeutic strategies for refractory CeD are provided, including immunosuppressive and novel pharmacologic options.

Conclusions

These updated guidelines offer a comprehensive, evidence-based framework for the management and follow-up of adults with CeD. By integrating recent scientific advances with pragmatic, patient-centred recommendations, they seek to optimise clinical outcomes, quality of life, and long-term health in individuals with CeD.

European Society for the Study of Coeliac Disease (ESsCD) 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 2: Management, Follow-Up, and Complex Disease Courses

Abdulbaqi Al-Toma

Guideline

Clinical Practice Guideline

Topics

Immunology Small Intestine & Nutrition

Citation

United European Gastroenterology Journal, 2026

Published

2026

UEG Poster

Standard Poster

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

Not sure what you can access? Learn more about account types.

Introduction

Bile acids malabsorption (BAM) is considered as a one of the possible mechanisms of the irritable bowel syndrome with diarrhea (IBS-D) development. Limitations of BAM first-line treatment – bile acid sequestrants – require investigation of new therapeutic approaches. Probiotic bacteria capable to produce bile salt hydrolase (BSH) are promising in the treatment of IBS-D and assumed BAM

Aims & Methods

The aim of the trial was to compare the effectiveness of combined treatment (a probiotic based on strains of Lactobacillus, Streptococcus, Bifidobacterium, Saccharomyces boulardii and cholestyramine) with cholestyramine monotherapy in the treatment of IBS-D.
Materials and methods: a 12-week randomized trial included 108 patients with IBS-D that were divided into 2 groups: a control group (n=51) receiving only cholestyramine (monotherapy) and an experimental group (n=57) receiving a combination of cholestyramine and the study probiotic (based on strains of Lactobacillus, Streptococcus, Bifidobacterium, Saccharomyces boulardii). Before the start of the treatment, the relative activity (RA) of the BSH of the investigated probiotic was determined using the ultraperformance liquid chromatography with mass spectrometry (UPLC-MS). During the stages of the study, patients were evaluated using clinical scales, including symptoms questionnaires with visual analog scale (VAS).

Results

The BSH RA of the studied probiotic was 2.07±0.06 U/ml compared to 1.0±0.04 U/ml of capsules with L. plantarum and 0.03±0.01 U/ml – with L. plantarum without BSH-genes. In the experimental group, the severity of bloating and visceral sensitivity index values were lower after 8 and 12 weeks, and the value of the type of stool according to the Bristol scale and its daily frequency – after 12 weeks compared to the control group, p<0.05 in all. According to the scale of IBS-adequate relief, the percentage of achieving a clinical effect was higher in the experimental group compared to the control group after 12 weeks, OR = 1.31 (95% CI; 1.03-1.68), p=0.038.

Conclusion

Additional prescribing of a probiotic with BSH producing bacterial strains was more effective in relieving the clinical manifestations of IBS-D and achieving a therapeutic effect compared to cholestyramine monotherapy.

BILE SALT HYDROLASE PRODUCING PROBIOTICS IN THE MANAGEMENT OF IRRITABLE BOWEL SYNDROME WITH DIARRHEA: A RANDOMIZED STUDY

Artem Neverovskyi 1, Serhii Polishchuk 1

1 Bogomolets National Medical University, Kyiv, Ukraine

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Abstract

Session

Gut microbiome in clinical practice: From diagnosis to therapy (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Poster

Audio / Video Poster

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

Not sure what you can access? Learn more about account types.

Introduction

New biologics such as vedolizumab (VDZ) and ustekinumab (UST) have expanded the therapeutic armamentarium for inflammatory bowel diseases (IBD) over the past decade. Head-to-head trials comparing safety to tumor necrosis factor alpha inhibitors (anti-TNF) are limited. Data on safety of biologic sequencing remains scarce.

Aims & Methods

Aim: To assess the impact of different biologics and previous treatments on the incidence of severe adverse events (SAE) in a real-world tertiary IBD patient cohort.
Methods: A retrospective monocentric study was performed at the Ghent University Hospital. Patients starting anti-TNF, VDZ or UST from January 2018 to June 2021 with follow-up until December 2021 were included. SAE were defined as intestinal resection (IR), IBD-inflammation related hospitalization (IBD-hosp), IBD-treatment related hospitalization (e.g. infections) (treat-hosp), malignancy and death. Cox regression analysis was used to explore risk factors (RF) of SAE.

Results

In total 267 patients were included: 84 on VDZ, 69 UST, 60 infliximab (IFX) and 54 adalimumab (ADM). At baseline a significant difference was found between biologic groups for age (younger in IFX and ADM - P=0.001), IBD type (Crohn’s disease (CD): VDZ 51.2%, UST 73.9%, IFX 70%, ADM 77.8% - P=0.003), CRP (in mg/L, med, IQR - VDZ: 5[1.6-12.4], UST: 8.5[2.8-19.3], IFX: 13 [1.87-31.8], ADM:3.2[1-8.1] - P<0.001) and calprotectin (in µg/g, med, IQR) (VDZ: 579 [175- 1801], UST: 707 [244-2889], IFX: 652 [65-2449], ADM 200 [43.7-789] - P=0.021)). Perianal CD rate was higher in anti-TNF and UST patients (P=0.003) and prior disease duration differed significantly (VDZ: 9years, UST10y, IFX 2y,ADM 3.5y - P<0.001)). Concomitant immunomodulator (IMM) use was higher in the IFX group (81.7% vs 25% for all other groups P<0.001)) and corticosteroid (CS) use differed among treatment groups (VDZ 78.6%, UST 68.1%, IFX 70%, ADM 55.6% (P=0.041)). Number of prior biologics was higher in the UST group (P<0.001).
No significant difference in SAE rate could be found between different biologics (UST 37.7%, IFX 33.3%, VDZ 23.8%, ADM 22.2% - P=0.148). Cox regression revealed age ≥60years (aHR 2.00, 95%CI 1.11-3.60, P=0.020) and higher number of previous biologics (aHR 1.29, 95%CI 1.03-1.60, P=0.024) as independent RF for SAE. Considering SAEs types, IR rate was not significantly different between biologic groups (VDZ 4.8%, UST 15.9%, IFX 8.3%, ADM 5.6% - P=0.096). Cox regression revealed previous IMM use as an independent RF for IR (aHR 4.26, 95%CI 1.62-11.19, P=0.003). No significant difference was found between biologics considering IBD-hosp (VDZ 15.5%, UST 30.4%, IFX 21.7%, ADM 14.8% – P=0.087). Higher number of previous biologics was an independent RF for IBD-hosp (aHR 1.32, 95%CI 1.02-1.71, P=0.036). Treat-hosp rate was not significantly different between biologic groups (VDZ 7.1%, UST 10.1%, IFX 6.7%, ADM 5.6% – P=0.811). Age ≥60years was found to be an independent RF of treat-hosp (aHR 4.93, 95%CI 1.91-12.76, P=0.001). Six patients developed malignancy (3 VDZ: colorectal carcinoma, melanoma, low grade appendix neoplasia; 2 IFX: cervix CIN3, gastric adenocarcinoma; 1 ADM: basal cell carcinoma). One patient died due to progressive melanoma while on VDZ.

Conclusion

In this tertiary real-world IBD patient cohort, no influence of type of biologic on the SAE rate could be found. Elderly age (≥60 years) and higher number of previous biologics were an independent RF for SAEs.