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.

Clinical Case Summary

Tumor necrosis factor-alpha (TNF-α) inhibitors are used to treat Crohn’s disease due to their immunosuppressive effect; however, serious adverse events may occur.
A 40-year-old female followed at a tertiary hospital gastroenterology clinic, was diagnosed with Crohn’s disease in 2017. She started immunosuppressive therapy with adalimumab, which was switched to infliximab in 2022 due to loss of response. Before the switch, screening tests (Interferon-Gamma Release Assays and Purified Protein Derivative) yielded negative results. Three months later, she presented with systemic decline, weight loss, and cough. Neurological signs emerged: left-sided weakness, hyperreflexia, hypoesthesia, dysmetria, disdiadochokinesia, and gait ataxia.
Laboratory tests were nonspecific, showing elevated C-reactive protein without leukocytosis. Chest computed tomography revealed multiple centrilobular micronodules with a diffuse tree-in-bud pattern, predominantly in upper lobes. Brain magnetic resonance imaging showed a 13 mm lobulated, peripherally enhancing brainstem lesion with central necrosis in the right pons and midbrain.
Bronchoalveolar lavage was negative for acid-fast bacillus and mycobacterial culture. Despite no microbiological confirmation, disseminated tuberculosis was diagnosed based on clinical, epidemiological context, and anti-TNF-α therapy.
She was treated with rifampin, levofloxacin, and ethambutol for 9 months due to hepatotoxicity and ototoxicity from first- and second-line drugs. Despite clinical cure, scarring lesions persisted in the brainstem and lungs.
Late sequelae included left-sided weakness and sensory loss, gait ataxia, and bilateral hearing impairment.
This case highlights the risk of severe infections with biologic agents and the importance of thorough screening prior to their use.

References

Torres J, Bonovas S, Doherty G, Kucharzik T, Gisbert JP, Raine T, Adamina M, Armuzzi A, Bachmann O, Bager P, Biancone L, Bokemeyer B, Bossuyt P, Burisch J, Collins P, El-Hussuna A, Ellul P, Frei-Lanter C, Furfaro F, Gingert C, Gionchetti P, Gomollon F, González-Lorenzo M, Gordon H, Hlavaty T, Juillerat P, Katsanos K, Kopylov U, Krustins E, Lytras T, Maaser C, Magro F, Marshall JK, Myrelid P, Pellino G, Rosa I, Sabino J, Savarino E, Spinelli A, Stassen L, Uzzan M, Vavricka S, Verstockt B, Warusavitarne J, Zmora O, Fiorino G. ECCO Guidelines on Therapeutics in Crohn's Disease: Medical Treatment. J Crohns Colitis. 2020 Jan 1;14(1):4-22. doi: 10.1093/ecco-jcc/jjz180. PMID: 31711158.
Onal IK, Kekilli M, Tanoglu A, Erdal H, Ibis M, Arhan M. Tuberculosis and Crohn's Disease Revisited. J Coll Physicians Surg Pak. 2015 Jun;25(6):443-8. PMID: 26100999.

DISSEMINATED TUBERCULOSIS AFTER INFLIXIMAB USE IN A PATIENT WITH CROHN'S DISEASE

Kelson Batista 1, DANIELLE Queiroz Bonilha 1, Hugo Brandao Araujo 1, Diego Delgado 1, Julia Manara Martins 1, amanda clevelario 1, Ciro Montes 1, Cristiane Kibune Nagasako 1

1 State University of Campinas, Campinas, Brazil

Conference

UEG Week Berlin 2025

Topics

IBD

Submission format

Clinical Case

Session

CLINICAL CASES (Posters)

Published

2025

UEG Presentation

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.

Interfering substances effect endoscope reprocessing

Annette Rittich 1

1 None, Hamburg, Germany

Event

UEG Week Berlin 2025

Topics

Nurses

Session

Hygiene: Update 2025

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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 journey to become a proactive and involved nurse in the endoscopy room

Arianna Parrella 1

1 Ramazzini Hospital, Carpi, Italy

Event

UEG Week Berlin 2025

Topics

Nurses

Session

New trends and developments in endoscopic techniques

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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

DUAL MODULATION OF GPBAR1/RORΓT ATTENUATES CHOLESTATIC INFLAMMATION VIA IL-23/IL-17 PATHWAY REGULATION IN MURINE MODEL OF PSC

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

Introduction

Primary sclerosing cholangitis (PSC) is a progressive autoimmune cholestatic liver disease often associated with inflammatory bowel disease (IBD), particularly ulcerative colitis [1]. In PSC, reduced expression and function of the bile acid receptor GPBAR1 (TGR5) in cholangiocytes is associated with a dysfunctional gut–liver immune axis and impaired resolution of inflammation [2,3]. Parallelly, the transcription factor RORγt in Th17 cells sustains IL-17 perpetuating IL-23-driven intestinal [4] and liver inflammation [5]. While GPBAR1 mediates anti-inflammatory responses to secondary bile acids, RORγt governs Th17 differentiation and cytokine secretion. Recent clinical studies have demonstrated that IL-23 inhibitors, such as risankizumab [6] and mirikizumab [7], are effective in treating IBD, highlighting the significance of the IL-23/IL-17 axis. GPBAR1/RORγt dual simultaneous modulation represents a novel strategy to counteract the fibrotic and inflammatory environment characteristic of PSC.

Aims & Methods

We evaluated the therapeutic efficacy of PBT002, a dual GPBAR1 agonist and RORγt inverse agonist, in modulating immune and fibrotic pathways in PSC. Transcriptomic distribution of target genes was assessed using publicly available single-cell RNA-sequencing datasets from healthy human livers [8]. Differential gene expression was validated in two independent cohorts of patients with PSC and PBC, and further confirmed in an external validation cohort (GSE159676). Functional studies were performed in vitro using primary human cholangiocytes (NHC), immortalized hepatic stellate cells (LX-2), primary monocyte-derived macrophages and CD4+ T lymphocytes. In vivo efficacy was assessed in Abcb4^⁻/⁻ mice treated with PBT002 (10 mg/kg/day) for 12 weeks.

Results

Single-cell transcriptomic analysis revealed that IL-17 and IL-23 cytokines are predominantly expressed by immune cells, whereas their receptors (IL23R, IL17RA, IL17RC, IL17RE) are enriched in epithelial cells, including hepatocytes and cholangiocytes. Deconvolution analysis of liver bulk transcriptomes from PSC and PBC cohorts showed features of immune exhaustion, with a mild upregulation of pro-inflammatory markers and IL-17 receptor subunits, along with prominent overexpression of PD-L1, a known pro-fibrotic mediator. In vitro, exposure of hepatic stellate cells, macrophages, and CD4+ T cells to supernatants from inflamed cholangiocytes induced strong activation, which was reversed by PBT002 treatment. In vivo, PBT002 significantly reduced hepatocellular damage, as shown by decreased serum ALT, AST, ALP, and bilirubin levels. Histological analyses revealed marked reductions in periductal inflammation and liver fibrosis. Gene expression profiling confirmed significant downregulation of M1 and Th17-associated genes (Rorc, Il17f, Il22, Il23a) in colon and liver. Bile acid profiling showed restoration of key GPBAR1 agonists and RORγt antagonists (DCA, 3-oxo-DCA, allo-LCA), while microbiota analysis demonstrated increased abundance of protective taxa (e.g., Blautia, Sutterellaceae), inversely associated with disease severity.

Conclusion

PBT002 exerts potent immunomodulatory effects in experimental PSC by rebalancing M1/M2 and Th17/Treg homeostasis through dual GPBAR1 activation and RORγt inhibition. These effects correlate with restoration of bile acid and microbiota profiles, confirming the key role of the microbiota–bile acid–immune axis in PSC and supporting PBT002’s clinical development for immune-mediated cholangiopathies, particularly in PSC-IBD overlap.

References

1. Fiorucci, S. et al. Bile Acids-Based Therapies for Primary Sclerosing Cholangitis: Current Landscape and Future Developments. Cells 13, (2024).
2. Di Giorgio, C. et al. Liver GPBAR1 Associates With Immune Dysfunction in Primary Sclerosing Cholangitis and Its Activation Attenuates Cholestasis in Abcb4-/- Mice. Liver Int. Off. J. Int. Assoc. Study Liver 45, e16235 (2025).
3. Reich, M. et al. Downregulation of TGR5 (GPBAR1) in biliary epithelial cells contributes to the pathogenesis of sclerosing cholangitis. J. Hepatol. 75, 634–646 (2021).
4. Biagioli, M. et al. Development of dual GPBAR1 agonist and RORγt inverse agonist for the treatment of inflammatory bowel diseases. Pharmacol. Res. 208, 107403 (2024).
5. Garcia Moreno, A. S. et al. IL-17 signaling in primary sclerosing cholangitis patient-derived organoids. Hepatol. Commun. 8, (2024).
6. Louis, E. et al. Risankizumab for Ulcerative Colitis: Two Randomized Clinical Trials. JAMA 332, 881–897 (2024).
7. D’Haens, G. et al. Mirikizumab as Induction and Maintenance Therapy for Ulcerative Colitis. N. Engl. J. Med. 388, 2444–2455 (2023).
8. Andrews, T. S. et al. Single-Cell, Single-Nucleus, and Spatial RNA Sequencing of the Human Liver Identifies Cholangiocyte and Mesenchymal Heterogeneity. Hepatol. Commun. 6, 821–840 (2022).

DUAL MODULATION OF GPBAR1/RORΓT ATTENUATES CHOLESTATIC INFLAMMATION VIA IL-23/IL-17 PATHWAY REGULATION IN MURINE MODEL OF PSC

Cristina Di Giorgio 1, Carmen Massa 1, Michele Biagioli 1, Ginevra Lachi 1, Eleonora Giannelli 1, Silvia Marchianò 1, Ginevra Urbani 1, Benedetta Sensini 1, Francesca Paniconi 1, Maria Rosaria Sette 1, Elva Morretta 2, Maria Chiara Monti 2, Angela Zampella 2, Stefano Fiorucci 1

1 University of Perugia, Perugia, Italy

2 University of Naples, Federico II, Naples, Italy

Event

UEG Week Berlin 2025

Topics

Hepatobiliary Immunology Mechanisms & Personalised Medicine

Submission format

Abstract

Session

Advances in management of immune-mediated biliary disease

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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.

EUS-guided therapy of gastric varices: The role of endoscopic nurse-team work

Ela Bak 1, Katarzyna Pawlak 2

1 Wojskowy Instytut Medyczny, Warsaw, Poland

2 Hospital of the Ministry of Interior and Administration, Szczecin, Poland

Event

UEG Week Berlin 2025

Topics

Nurses

Session

Endoscopic techniques: Emergency and difficult situations

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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

The presence of bubbles during esophagogastroduodenoscopy (EGD) is common and may impair adequate mucosal visualization (MV).

Aims & Methods

The primary objective was to evaluate the effect of pre-endoscopic simethicone administration on mucosal visibility, using the GRACE (Gastroscopy Rate of Cleanliness Evaluation) scale. Secondary objectives included assessment of endoscopy duration, endoscopist satisfaction, and the detection rate of endoscopic findings.
This was a prospective, single-center, randomized, blinded study including patients undergoing elective EGD between December 2024 and March 2025. Patients were randomized into three groups: A (100 mg simethicone ≤10 minutes before EGD), B (100 mg simethicone >10 minutes before EGD), and C (50 mL water, placebo). All received a total volume of 50 mL. Patients with gastroparesis, achalasia, or prior gastrointestinal surgery were excluded. MV was assessed using the GRACE scale (validated in 2024), which scores each segment (esophagus, stomach, duodenum) from 0 to 3 based on bubble quantity, resulting in a total score from 0 (inadequate) to 9 (excellent). Endoscopist satisfaction was subjectively assessed on a scale from 0 (not satisfied) to 10 (highly satisfied).

Results

A total of 82 patients were included (18 in group A, 34 in group B, and 30 in group C). Fifty-two patients received 100 mg of simethicone and 30 received placebo. Median simethicone administration time was 8 minutes in group A and 19 minutes in group B. Simethicone significantly improved MV compared to placebo (mean GRACE score: 7.62±1.7 vs 5.83±1.7; p<0.001), with significant improvements in all segments (esophagus: 2.65 vs 2.03, p<0.001; stomach: 2.21 vs 1.63, p=0.002; duodenum: 2.69 vs 2.17, p=0.001). A very weak negative correlation was found between GRACE score and simethicone timing (r = -0.058; p = 0.685). Median endoscopist satisfaction was higher in the simethicone group (8 vs 7; p=0.001), and strongly correlated with total GRACE score (r = 0.855; p<0.001). No significant differences were observed in endoscopy duration (7 vs 6 minutes; p=0.800) or diagnostic yield (p=0.416).

Conclusion

Pre-endoscopic administration of simethicone significantly improved mucosal visibility across all upper GI segments, supporting its routine use in clinical practice. The GRACE scale is a useful and objective tool that correlates strongly with subjective endoscopist satisfaction.

References

Esposito G, Dilaghi E, Costa-Santos C, Ligato I, Annibale B, Dinis-Ribeiro M, Areia M; GRACE Investigators. The Gastroscopy RAte of Cleanliness Evaluation (GRACE) Scale: an international reliability and validation study. Endoscopy. 2025 Apr;57(4):312-320. doi: 10.1055/a-2422-0856. Epub 2024 Sep 25. Erratum in: Endoscopy. 2025 Apr;57(4):C2. doi: 10.1055/a-2545-0228. PMID: 39321961
Manfredi G, Bertè R, Iiritano E, Alicante S, Londoni C, Brambilla G, Romeo S, Menozzi F, Griffanti P, Brandi G, Moreschi O, Pezzilli R, Zullo A, Buscarini E. Premedication with simethicone and N-acetylcysteine for improving mucosal visibility during upper gastrointestinal endoscopy in a Western population. Endosc Int Open. 2021 Feb;9(2):E190-E194. doi: 10.1055/a-1315-0114. Epub 2021 Jan 25. PMID: 33532557; PMCID: PMC7834924.

EFFICACY OF SIMETHICONE PRIOR TO UPPER ENDOSCOPY ON MUCOSAL VISUALIZATION: PRELIMINARY RESULTS OF A BLINDED PROSPECTIVE TRIAL

Daniela Abrantes 1, André Bargas Bárbara 1, Ana Catarina Bravo 1, Bárbara Abreu 1, Madalina Gututui 1, Inês Alves 1, Daniel Tavares 1, Marisa Morais 1, Mafalda Mantas 1, João Cortez-Pinto 1, Catarina Frias-Gomes 1, Carolina Palmela 1, Catarina Gouveia 1, Elídio Barjas 1, Manuela Canhoto 1, Lídia Maria Roque Ramos 1, Joana Torres 1, Alexandre Oliveira Ferreira 1, Rui Loureiro 1, Maria Luisa Gloria 1

1 Unidade Local de Saúde de Loures/Odivelas, Hospital Beatriz Angelo, Loures, Portugal

Conference

UEG Week Berlin 2025

Topics

Oesophagus

Submission format

Abstract

Session

Endoscopic management of adverse events (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Presentation

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

TARGETED PHAGE INTERVENTION IMPROVES BACTERIAL-DRIVEN COLITIS AND RESPONSE TO TOPICAL CORTICOSTEROIDS BY ATTENUATING VIRULENCE OF CROHN’S DISEASE-ASSOCIATED BACTERIA

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

Introduction

Current therapies for inflammatory bowel disease (IBD) suppress inflammation rather than inhibiting underlying microbial drivers. Treatment failures of frontline interventions, including corticosteroids, can lead to dose escalation and risk of adverse effects.^1,2 Bacteria with pro-inflammatory potential, like adherent-invasive Escherichia coli (AIEC), have been postulated as a possible microbial driver in Crohn’s disease (CD), however, targeting these bacteria with precision in IBD remains challenging.^3,4 Most antibiotics have broad-spectrum activity and disturb the background microbiome, which may exacerbate inflammation.⁵ Attention has shifted towards bacteriophages, yet their underlying mechanisms of treating IBD, and how they may work as an adjunctive therapy, remains elusive.

Aims & Methods

We aimed to assess whether and how phage therapy, specific for a CD-associated bacterium, reduces colitis severity using gnotobiotic mouse models.
In vitro kill curves and biofilm challenges were used to identify lytic phage candidates. Adult germ-free C57BL/6 mice were colonized with altered Schaedler-flora (ASF) and E. coli NRG857c (NRG), a CD-associated isolate. After 3 weeks, mice were treated with an NRG-specific lytic phage (1x10⁹ PFU/dose; daily or TIW) or vehicle (PBS) for 2 weeks (n=6/group) and then exposed to 1 cycle of dextran sulfate sodium (2%; DSS) in drinking water. PBS-treated mice (n=6) not exposed to DSS served as controls. Phage treatment was also tested in a spontaneous model of colitis using C57BL/6NTac-Il10^em8Tac (IL-10^-/-) mice, treated weekly. Mice were monitored daily for weight, stool consistency, and occult blood. Fecal contents were cultured to determine bacterial load, and the expression of NRG fimS was quantified using qPCR as an assessment of virulence. At endpoint, colon tissues were collected for histological and immunohistochemistry analysis to quantify colitis severity and NRG infiltration, respectively. Additional C57BL/6 mice were colonized and treated as previously described. During colitis induction, mice received a low-dose of budesonide (2μg/day)⁶ (n=5) or vehicle (n=5) until endpoint. Mice were monitored daily for disease activity and colon tissues were collected for histological analysis. HPLC was used to determine active budesonide levels.

Results

HER259 was identified as a lytic phage against CD-associated AIEC NRG. In ASF and NRG colonized mice, HER259 reduced clinical symptoms (p< 0.001, p< 0.001) and histological scores (p< 0.0001, p< 0.001) in chemical induced and spontaneous colitis, respectively. A 1-log reduction in NRG bacterial load was observed in HER259-treated mice (p< 0.001). Reisolated NRG exhibited a reduced FimS ON/OFF ratio (p-value < 0.01). Immunohistochemistry revealed reduced infiltration of NRG into the lamina propria following HER259 treatment, with greater accumulation in the epithelium. HER259 treatment increased the efficacy of a sub-therapeutic dosing regimen of budesonide (p< 0.001), which was independent of microbial-based drug metabolism as determined by HPLC.

Conclusion

Our results demonstrate that lytic phage targeting a CD-associated bacterium attenuates colitis in two gnotobiotic mouse models. The intervention did not lead to complete eradication of the disease-driving agent, but instead modulated bacterial virulence mechanisms and enhanced responses to corticosteroid therapy. The data suggests that alternative mechanisms should be considered when translating phage therapy to treat IBD in clinical trials.

References

1. Yan, Y. et al. Commensal bacteria promote azathioprine therapy failure in inflammatory bowel disease via decreasing 6-mercaptopurine bioavailability. Cell Rep Med 4, 101153 (2023).
2. Nagayama, M., Gogokhia, L. & Longman, R. S. Precision microbiota therapy for IBD: premise and promise. Gut Microbes 17, 2489067 (2025).
3. Darfeuille-Michaud, A. et al. High prevalence of adherent-invasive Escherichia coli associated with ileal mucosa in Crohn’s disease. Gastroenterology 127, 412–421 (2004).
4. A, D.-M. et al. Presence of adherent Escherichia coli strains in ileal mucosa of patients with Crohn’s disease. Gastroenterology 115, 1405–1413 (1998).
5. Nelson, R. L., Suda, K. J. & Evans, C. T. Antibiotic treatment for Clostridium difficile-associated diarrhoea in adults. Cochrane Database Syst Rev 3, (2017).
6. Bercik, P. et al. Chronic gastrointestinal inflammation induces anxiety-like behavior and alters central nervous system biochemistry in mice. Gastroenterology 139, (2010).