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

UEG Week Berlin 2025 Recordings Gut Guide online What's new on Gutflix

Trending on Gutflix

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

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

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

THE EFFECT OF CORTICOTROPIN-RELEASING HORMONE ON DUODENAL PERMEABILITY AND IMMUNE ACTIVATION IN HEALTHY VOLUNTEERS

Jolien Schol 1, Lukas Balsiger 1, Joran Toth 1, Karlien Raymenants 1, I-Hsuan Huang 1, Justine Luca 1, Karen Van den Houte 1, Tim Vanuytsel 1, Jan Tack 1

Affiliations

1 KU Leuven, TARGID, Leuven, Belgium

Summary

AI Generated

A randomized crossover study in 20 healthy volunteers found that acute intravenous CRH administration decreased duodenal permeability and tryptase release in biopsy supernatant, contrary to the hypothesis that CRH would increase permeability and immune activation.

Participants received 100 µg intravenous CRH or placebo in a double-blind crossover design, with duodenal biopsies taken two hours post-injection for permeability and immune marker assessment.
CRH administration significantly decreased FITC-D4 flux (41.4 pmol placebo vs 33.0 pmol CRH, p<0.0001) and showed a trend toward increased TEER (p=0.056), indicating decreased duodenal permeability.
Tryptase release in biopsy supernatant was significantly lower after CRH exposure (6.06 ng/mL placebo vs 4.03 ng/mL CRH, p=0.031), with a trend toward decreased eosinophil-derived neurotoxin (p=0.061).
No significant correlation was found between changes in permeability measures and changes in tryptase, chymase, or eosinophil-derived neurotoxin secretion.
This study may interest researchers investigating gut-brain axis mechanisms, particularly the unexpected protective effects of acute CRH on intestinal barrier function in healthy individuals.

Download PDF

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

Introduction

The pathophysiology of disorders of gut-brain interaction is complex and incompletely understood. In functional dyspepsia, increased gut permeability and low-grade mucosal inflammation with eosinophils and mast cells have been reported. Stress as well as exogenously administered corticotropin-releasing hormone (CRH) have been shown to increase small bowel permeability in vivo in a mast-cell dependent fashion. Moreover, eosinophil-derived CRH has been implicated in mast cell activation.

Aims & Methods

The aim of the current study was to evaluate whether acute CRH administration can induce increased duodenal mucosal permeability and immune activation in healthy volunteers (HVs).
HVs without gastrointestinal symptoms were recruited. The use of drugs such as NSAIDs, mast cell stabilizers or corticoids was prohibited. An i.v. bolus of 100 µg CRH or placebo (NaCl 0.9%) was administered in a crossover, double blind, randomized fashion with a 1-week washout period. Two hours after injection a gastroscopy with duodenal biopsies was performed. Duodenal permeability was evaluated in Ussing chambers measuring trans-epithelial electrical resistance (TEER) and the flux of a fluorescence-labeled dextran of 4kDa (FITC-D4). Duodenal biopsies were incubated at 37°C in culture medium for 24h. Sandwich ELISA was performed on supernatant for eosinophil derived neurotoxin (EDN), tryptase and chymase, corrected for biopsy weight. Analysis was performed using marginal mixed models in SAS. Correlation analysis was performed using Pearson correlation coefficient. Results are described as mean ± SEM. P-values < 0.05 were considered significant after correction for multiple testing.

Results

Twenty HVs (65% women, 27±1 years, BMI 23.2 ± 0.6 kg/m²) completed the study. Tryptase release in supernatant was significantly lower after CRH exposure, 6.06±0.88 ng/mL vs 4.03±0.46 ng/mL after CRH exposure (n=16, p= 0.031). Chymase release however, was not significantly different between both conditions (2805.82 ± 447.85 pg/mL/mg for placebo vs 2001.19±365.91 for CRH pg/mL/mg; p=0.27, n=15). There was a trend towards a decrease in EDN, after CRH exposure (13.3±2.05 µg/L/mg for placebo vs 8.96±1.11 µg/L/mg for CRH; p=0.061; n=16). Correlation analysis of delta values showed a significant correlation between ∆ tryptase and ∆ chymase (r 0.79, p=0.0062, n=10) and ∆ tryptase and ∆ EDN (r 0.60, p=0.019, n=15). No significant correlation was found between ∆ chymase and ∆ EDN (r 0.36, p=0.30, n=10).
A trend towards an decreased mucosal permeability was observed after CRH administration for TEER (25.75 ± 0.91 Ω.cm² for placebo vs 27.20 ± 1.44 Ω.cm² for CRH; p=0.056). Likewise, FITC-D4 flux was significantly lower in the CRH condition (41.4 ± 5.6 pmol for placebo vs 33.0 ± 2.7 pmol for CRH, p<0.0001). There was no significant correlation of delta values of FITC-D4 flux or TEER with delta values of supernatant for tryptase, chymase or EDN secretion.

Conclusion

Acutely administered CRH in vivo decreased tryptase release in supernatant of duodenal biopsies, suggesting an increased tryptase release in vivo, and decreased duodenal permeability in healthy subjects. However, no correlation between permeability and tryptase release was found.

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

PP 01 Oesophageal, gastric and duodenal disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

More Like This:

ROME V FUNCTIONAL DYSPEPSIA AND ITS SUBGROUPS: RESULTS FROM THE ROME V GLOBAL EPIDEMIOLOGY STUDY

Jan Tack

Dysbiosis vs microbiome testing

William Fusco

THE DUODENAL MICROENVIRONMENT IN FUNCTIONAL DYSPEPSIA SHOWS MINIMAL MOLECULAR AND FUNCTIONAL IMPACT ON THE INTESTINAL BARRIER AND MAST CELL BIOLOGY

Tim Vanuytsel

Upper GI disorders

Hans Törnblom

OVERDIAGNOSIS OF SUPERIOR MESENTERIC ARTERY SYNDROME: LIMITED DIAGNOSTIC CONCORDANCE BETWEEN IMAGING MODALITIES AND LIMITED BENEFIT OF SURGERY

Tim Vanuytsel

Dyspepsia: To treat or to scope

Juan Mendive

UEG Presentation

New

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

ROME V FUNCTIONAL DYSPEPSIA AND ITS SUBGROUPS: RESULTS FROM THE ROME V GLOBAL EPIDEMIOLOGY STUDY

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

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

ROME V FUNCTIONAL DYSPEPSIA AND ITS SUBGROUPS: RESULTS FROM THE ROME V GLOBAL EPIDEMIOLOGY STUDY

Florencia Carbone 1, Jóhann Hreinsson 2, Cedric Van de Bruaene 1, Karen Van den Houte 1, Tiffany Taft 3,4, Olafur S. Palsson 3,5, Ami D. Sperber 3,6, Jan Tack 3,1

Affiliations

1 KULeuven, UZLeuven, Leuven, Belgium

2 University of Gothenburg, Gothenburg, Sweden

3 Rome Foundation Research Institute, North Carolina, United States

4 Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States

5 University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States

6 Ben-Gurion University of the Negev, Farod, Israel

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

Abstract

Introduction

Functional dyspepsia (FD) is a common upper gastroduodenal disorder of gut-brain interaction (DGBI) subdivided into postprandial distress syndrome (PDS) characterized by postprandial fullness and/or early satiation and, epigastric pain syndrome (EPS) characterized by epigastric pain (EP) and/or burning (EB).

Aims & Methods

This study aimed to assess the prevalence and impact of FD and its subgroups as recently defined by Rome V criteria. 30,000 respondents from 15 countries completed the Rome V diagnostic questionnaire (online survey). Additional items assessed demographics, medical history and healthcare-seeking, psychologic distress (Patient Health Questionnaire-4 (PHQ-4), and quality of life (PROMIS Global-10). Subjects reporting a history of relevant organic disease, or meeting criteria for self‐induced or cyclic vomiting, or cannabinoid hyperemesis were excluded. Overlap with irritable bowel syndrome (IBS), chronic nausea and vomiting (CNVS) and functional heartburn (FH) was also evaluated.

Results

The Rome V FD prevalence was 8.5% (range 2.7-13%), PDS 5.3% (range 1.8-9%) and EPS 3.1% (range 0.9-4.8%). Within the EPS group, 23% (21-26%) reported EP and 21% (19-24%) EB. Also in this subgroup postprandial EPS in the absence of PDS symptoms was present in 40% of the individuals. The prevalence of FD decreased with age (mean: 44±16 years old) and it was more common in females (60% of FD cases), as it was for the PDS subgroup (65%), but less pronounced in the EPS subgroup (52%), OR 1.70 (1.45-2.01). FD-IBS overlap was 37%, and higher for EPS (41%) compared to PDS (35%), OR 1.28 (1.09-1.51). The prevalence of FH was low (2.8%) and, in line with Rome V, there was no overlap with CNVS. The proportion of subjects reporting prior GERD diagnosis was 23%, 27% and 21% for FD, EPS and PDS, respectively. Compared to the general population without DGBI symptoms, individuals with FD symptoms had more prevalent anxiety and depression, lower quality of life, and increased healthcare-seeking and medication intake.

	FD N= 2,542¹	EPS N= 941¹	PDS N= 1,601¹	No DGBI N= 15,284¹
Age	44±16 (44, 45)	45±16(44, 46)	43±16(43, 44)	47±16(47, 48)
Age groups 18–34 35–49 50–64 65+	33%(31%, 35%) 31%(30%, 33%) 20%(19%, 22%) 16%(14%, 17%)	29%(26%, 32%) 32%(29%, 35%) 23%(20%, 26%) 16%(14%, 19%)	35%(32%, 37%) 31%(29%, 34%) 19%(17%, 21%) 15%(13%, 17%)	26%(25%, 27%) 30%(29%, 30%) 23%(23%, 24%) 21%(20%, 22%)
Females	60%(58%, 62%)	52%(48%, 55%)	65%(62%, 67%)	44%(44%, 45%)
Rome V IBS Previous dx of GERD	37%(35%, 39%) 23%(22%, 25%)	41%(38%, 44%) 27%(24%, 30%)	35%(33%, 37%) 21%(19%, 23%)	- 7.3%(6.9%, 7.7%)
Anxiety Depression Mental QoL Physical QoL Doctor visits ≥1x month Medication intake ≥1 week	38%(36%, 40%) 38%(36%, 40%) 11.7±3.5(12, 12) 12.66±2.76(13, 13) 18%(16%, 19%) 50%(48%, 52%)	35%(32%, 38%) 34%(31%, 37%) 12.0±3.6(12, 12) 12.86±2.72(13, 13) 19%(17%, 22%) 52%(49%, 56%)	39%(37%, 42%) 40%(38%, 43%) 11.5±3.4(11, 12) 12.54±2.78(12, 13) 17%(15%, 19%) 48%(46%, 51%)	10%(9.7%, 11%) 11%(10%, 11%) 14.2±3.2(14, 14) 15.37±2.53(15, 15) 9.7%(9.3%, 10%) 22%(21%, 23%)
¹Mean ±SD (95% CI), % (95% CI) Abbreviations: CI = Confidence Interval, SD = standard deviation; CI = confidence interval; IBS = irritable bowel syndrome; GERD = gastroesophageal reflux disease; QoL = quality of life

Conclusion

FD, as defined by the Rome V criteria, is a prevalent and impactful condition. The largest subgroup is PDS. Refinements in Rome V definitions have eliminated the overlap between PDS, EPS and CNVS. A substantial proportion of EPS is characterized by postprandial epigastric pain in the absence of PDS symptoms.

Event

UEG Week Barcelona 2026

Topics

Oesophagus Small Intestine & Nutrition Neurogastroenterology & Motility

Submission format

Abstract

Session

Functional upper GI disorders: From epidemiology to therapies

Citation

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

Published

2026

More Like This:

ROME V FUNCTIONAL DYSPEPSIA AND ITS SUBGROUPS: RESULTS FROM THE ROME V GLOBAL EPIDEMIOLOGY STUDY

Jan Tack

Dysbiosis vs microbiome testing

William Fusco

THE DUODENAL MICROENVIRONMENT IN FUNCTIONAL DYSPEPSIA SHOWS MINIMAL MOLECULAR AND FUNCTIONAL IMPACT ON THE INTESTINAL BARRIER AND MAST CELL BIOLOGY

Tim Vanuytsel

Upper GI disorders

Hans Törnblom

OVERDIAGNOSIS OF SUPERIOR MESENTERIC ARTERY SYNDROME: LIMITED DIAGNOSTIC CONCORDANCE BETWEEN IMAGING MODALITIES AND LIMITED BENEFIT OF SURGERY

Tim Vanuytsel

Dyspepsia: To treat or to scope

Juan Mendive

UEG Presentation

New

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

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

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

Dysbiosis vs microbiome testing

William Fusco 1

Affiliations

1 Università Cattolica del Sacro Cuore, Rome, Italy

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

Abstract

Event

UEG Week Barcelona 2026

Topics

Gut Microbiota Small Intestine & Nutrition

Session

Navigating between fake and truth in GI testing

Citation

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

Published

2026

More Like This:

ROME V FUNCTIONAL DYSPEPSIA AND ITS SUBGROUPS: RESULTS FROM THE ROME V GLOBAL EPIDEMIOLOGY STUDY

Jan Tack

Dysbiosis vs microbiome testing

William Fusco

THE DUODENAL MICROENVIRONMENT IN FUNCTIONAL DYSPEPSIA SHOWS MINIMAL MOLECULAR AND FUNCTIONAL IMPACT ON THE INTESTINAL BARRIER AND MAST CELL BIOLOGY

Tim Vanuytsel

Upper GI disorders

Hans Törnblom

OVERDIAGNOSIS OF SUPERIOR MESENTERIC ARTERY SYNDROME: LIMITED DIAGNOSTIC CONCORDANCE BETWEEN IMAGING MODALITIES AND LIMITED BENEFIT OF SURGERY

Tim Vanuytsel

Dyspepsia: To treat or to scope

Juan Mendive

UEG Presentation

New

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

THE DUODENAL MICROENVIRONMENT IN FUNCTIONAL DYSPEPSIA SHOWS MINIMAL MOLECULAR AND FUNCTIONAL IMPACT ON THE INTESTINAL BARRIER AND MAST CELL BIOLOGY

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

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

THE DUODENAL MICROENVIRONMENT IN FUNCTIONAL DYSPEPSIA SHOWS MINIMAL MOLECULAR AND FUNCTIONAL IMPACT ON THE INTESTINAL BARRIER AND MAST CELL BIOLOGY

Pauline Huyghe 1, Matthias Ceulemans 2, Theo Thijs 1, Joran Toth 1, Mona Farhadipour 3, Lorenzo Giorio 1, Kaline Arnauts 1, Åsa V. Keita 4, Bram Verstockt 5, Lucas Wauters 5, Inge Depoortere 1, Jan Tack 5, Tim Vanuytsel 5

Affiliations

1 KU Leuven, Translational Research Center for Gastrointestinal Disorders (TARGID), Leuven, Belgium

2 Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, United States

3 Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, United States

4 Linköping University Clinical and Exper. Medicine Faculty of Health Sciences, Linköping, Sweden

5 University Hospitals Leuven and KU Leuven, Translational Research in Gastrointestinal Disorders, Leuven, Belgium

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

Abstract

Introduction

Functional dyspepsia (FD) is characterised by upper abdominal symptoms without an organic cause and has been associated with duodenal immune activation and barrier dysfunction, although findings are inconsistent.

Aims & Methods

We aimed to examine RNA‑ and protein‑level changes in duodenal biopsies, and the effects of the duodenal microenvironment on immune activation and epithelial permeability in mast cells and duodenal organoids, respectively.
Bulk RNA sequencing of duodenal biopsies of 28 healthy controls (HC) and 22 FD patients was performed on an Illumina HiSeq 4000 platform. Differential gene expression (DESeq2 in R (v4.3.0)) and gene ontology (GO biological process) enrichment analysis (ShinyGO (v0.85.1)) were conducted. Genes with FDR<0.05 were included in functional enrichment analyses. Inflammatory cytokines were quantified in total protein extracts from duodenal biopsies of 29 HC and 29 FD patients using the Olink Multiplex Inflammation I kit (Target 96).
To evaluate the effect of the microenvironment on mast cell activation and epithelial barrier function, biopsy supernatant (SN) of FD patients and HC was used (two duodenal biopsies cultured in RPMI for 24h (37°C, 5% CO₂₎)). HMC1.1 mast cells were cultured under standard conditions and stimulated for 24h with 30% biopsy SN. Degranulation was assessed by measuring β‑hexosaminidase release. Duodenal organoids, generated from HC and FD biopsies, were expanded in Matrigel under expansion conditions (5µM CHIR in addition to (1)) and passaged mechanically before dissociation and seeding onto collagen I-coated Transwells. Transepithelial electrical resistance (TEER) was measured daily until stabilisation, after which Transwells were stimulated basolaterally with 30% biopsy SN. TEER was measured every 24h, and after 48h of stimulation epithelial permeability was also assessed using FITC-dextran (4kDa) and horseradish peroxidase passage.

Results

Only limited transcriptomic differences were observed between FD and HC samples. In total, 42 genes were differentially expressed, with 31 genes up- and 11 downregulated in FD, with no functional enrichment among the upregulated genes. However, the downregulated genes showed enrichment for pathways associated with ‘TGF‑β1 production’ (FDR: 0.008) and ‘inflammatory response’ (FDR: 0.016), indicating potential immune dysregulation involving TGF‑β1 signaling. This is further supported by reduced expression of FURIN (log₂ fold change: -0.4, FDR: 0.02), a protease required for activation of TGF‑β1. In addition, principal component analysis showed no clear separation between FD and HC groups, highlighting the modest nature of the transcriptional differences. Consistently, proteomic profiling of 96 inflammation‑related protein biomarkers revealed no differences between the two cohorts.
Stimulation of HMC1.1 did not result in any significant differences between FD and HC SN. Next, duodenal organoid-derived monolayers were stimulated with HC and FD biopsy SN for 48h. Both for monolayers derived from HC and FD patients, stimulation with neither FD nor HC SN resulted in a significant change in permeability compared to the negative control.

Conclusion

In contrast to the popular hypothesis of duodenal immune activation in FD, only minor transcriptomic and no significant proteomic alterations in inflammatory markers were present in patients with FD compared to HC. Furthermore, the duodenal microenvironment did not differentially influence mast cell activation or epithelial permeability, arguing against direct effector roles of locally secreted mediators in FD.

References

1: Vissers E et al. Inflamm Bowel Dis. 2025.

Event

UEG Week Barcelona 2026

Topics

Mechanisms & Personalised Medicine Small Intestine & Nutrition Immunology Endoscopy

Submission format

Abstract

Session

Decoding the upper GI tract using biomarkers

Citation

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

Published

2026

More Like This:

ROME V FUNCTIONAL DYSPEPSIA AND ITS SUBGROUPS: RESULTS FROM THE ROME V GLOBAL EPIDEMIOLOGY STUDY

Jan Tack

Dysbiosis vs microbiome testing

William Fusco

THE DUODENAL MICROENVIRONMENT IN FUNCTIONAL DYSPEPSIA SHOWS MINIMAL MOLECULAR AND FUNCTIONAL IMPACT ON THE INTESTINAL BARRIER AND MAST CELL BIOLOGY

Tim Vanuytsel

Upper GI disorders

Hans Törnblom

OVERDIAGNOSIS OF SUPERIOR MESENTERIC ARTERY SYNDROME: LIMITED DIAGNOSTIC CONCORDANCE BETWEEN IMAGING MODALITIES AND LIMITED BENEFIT OF SURGERY

Tim Vanuytsel

Dyspepsia: To treat or to scope

Juan Mendive

UEG Presentation

New

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

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

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

Upper GI disorders

Hans Törnblom 1

Affiliations

1 Inst of medicine, Gothenburg, Sweden

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

Abstract

Event

UEG Week Barcelona 2026

Topics

Neurogastroenterology & Motility Paediatrics

Session

What’s new in… Rome V?

Citation

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

Published

2026

More Like This:

ROME V FUNCTIONAL DYSPEPSIA AND ITS SUBGROUPS: RESULTS FROM THE ROME V GLOBAL EPIDEMIOLOGY STUDY

Jan Tack

Dysbiosis vs microbiome testing

William Fusco

THE DUODENAL MICROENVIRONMENT IN FUNCTIONAL DYSPEPSIA SHOWS MINIMAL MOLECULAR AND FUNCTIONAL IMPACT ON THE INTESTINAL BARRIER AND MAST CELL BIOLOGY

Tim Vanuytsel

Upper GI disorders

Hans Törnblom

OVERDIAGNOSIS OF SUPERIOR MESENTERIC ARTERY SYNDROME: LIMITED DIAGNOSTIC CONCORDANCE BETWEEN IMAGING MODALITIES AND LIMITED BENEFIT OF SURGERY

Tim Vanuytsel

Dyspepsia: To treat or to scope

Juan Mendive

UEG Presentation

New

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

OVERDIAGNOSIS OF SUPERIOR MESENTERIC ARTERY SYNDROME: LIMITED DIAGNOSTIC CONCORDANCE BETWEEN IMAGING MODALITIES AND LIMITED BENEFIT OF SURGERY

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

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

OVERDIAGNOSIS OF SUPERIOR MESENTERIC ARTERY SYNDROME: LIMITED DIAGNOSTIC CONCORDANCE BETWEEN IMAGING MODALITIES AND LIMITED BENEFIT OF SURGERY

Christian von Muhlenbrock 1,2,3, Sandrien Abbeel 4, Thomas Debrouwere 1, Dirk Vanbeckevoort 1, Jan Tack 1, Tim Vanuytsel 1

Affiliations

1 KU Leuven, Leuven, Belgium

2 Universidad de Chile, Santiago, Chile

3 Universidad de los Andes, Santiago, Chile

4 KU Leuven, Eppegem, Belgium

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

Abstract

Introduction

Superior mesenteric artery (SMA) syndrome is traditionally described as a rare vascular cause of duodenal obstruction. However, overlapping symptoms with functional gastrointestinal disorders and variable radiological criteria raise concerns regarding overdiagnosis.

Aims & Methods

We aimed to evaluate diagnostic concordance across modalities and clinical outcomes following medical and surgical treatment in patients referred for suspected SMA syndrome.We retrospectively analyzed 49 consecutive patients undergoing hypotonic barium duodenography (HBD) for suspected SMA syndrome based on symptoms and standard imaging (ultrasound or CT) in a tertiary neurogastroenterology center (2003–2023). SMA syndrome was defined by the combination of fixed abrupt narrowing of the third duodenum and proximal duodenal dilatation on HBD, the gold standard for the diagnosis in our center, in the absence of a more plausible diagnosis. CT-based aortomesenteric angle (AMA) and distance (AMD), intestinal manometry findings, gastric emptying, and treatment outcomes were also assessed.

Results

Only 11/49 patients (22%) met strict HBD criteria for SMA syndrome. Clinical presentation, BMI, and weight loss were indistinguishable between HBD-confirmed cases and controls (Table 1). CT criteria lacked specificity: 4 patients with positive CT findings had negative HBD and were ultimately diagnosed with alternative disorders of gut–brain interaction. AMA was lower in confirmed cases (18.8° vs 26.5°, p=0.05), whereas AMD did not significantly differ. Conservative medical management (n=6) led to symptom improvement in 50%. In contrast, despite >5% weight gain in 80% of patients undergoing a duodenojejunostomy (n=4) or gastroenterostomy (n=1) , meaningful symptom improvement occurred in only one patient, with procedure-related complications observed (dumping syndrome in 2 and worsening of gastroparesis-like symptoms in 1 patient).

Parameters	Patients with SMA syndrome on HBD (N=11)	Control group (N=38)	p-value
Age (years)	30.5 ± 3.2	34.0 ± 1.9	0.37
Body mass index (kg/m2)	17.5 (16.2, 19.3)	17.5 (16.4, 19.1)	1.00
Gender Male Female	1 (9%) 10 (91%)	7 (18%) 31 (82%)	0.66
Patients reporting weight loss	10 (91%)	32 (84%)	1.00
Weight loss (kg)	8.7 ± 1.6	9.8 ± 1.5	0.96
Weight loss of >10%	8 (73%)	22 (58%)	0.49
Aortamesenteric angle (°)	18.8 ± 2.52	26.5 ± 2.11	0.05
Aortamesenteric distance (mm)	5 (4.5, 7.5)	7.0 (6, 9)	0.13
Gastric emptying study: t1/2 (minutes)	70 (64.5, 85.5)	119 (74, 159)	0.02

Conclusion

In a tertiary referral setting, most patients suspected of SMA syndrome do not meet strict diagnostic criteria on HBD. Standard radiological findings alone may overestimate the condition, and surgical intervention frequently fails to improve symptoms. These findings question whether SMA syndrome represents a distinct clinical entity in most cases and support a highly restrictive, conservative management strategy.

Event

UEG Week Barcelona 2026

Topics

Small Intestine & Nutrition Endoscopy

Submission format

Abstract

Session

Small intestine diseases: Inside the black box

Citation

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

Published

2026

More Like This:

ROME V FUNCTIONAL DYSPEPSIA AND ITS SUBGROUPS: RESULTS FROM THE ROME V GLOBAL EPIDEMIOLOGY STUDY

Jan Tack

Dysbiosis vs microbiome testing

William Fusco

THE DUODENAL MICROENVIRONMENT IN FUNCTIONAL DYSPEPSIA SHOWS MINIMAL MOLECULAR AND FUNCTIONAL IMPACT ON THE INTESTINAL BARRIER AND MAST CELL BIOLOGY

Tim Vanuytsel

Upper GI disorders

Hans Törnblom

OVERDIAGNOSIS OF SUPERIOR MESENTERIC ARTERY SYNDROME: LIMITED DIAGNOSTIC CONCORDANCE BETWEEN IMAGING MODALITIES AND LIMITED BENEFIT OF SURGERY

Tim Vanuytsel

Dyspepsia: To treat or to scope

Juan Mendive

UEG Presentation

New

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

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

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

Dyspepsia: To treat or to scope

Juan Mendive 1

Affiliations

1 European Society for Primary Care Gastroenterology (ESPCG), Sant Adrià de Besòs ( Barcelona), Spain

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

Abstract

Event

UEG Week Barcelona 2026

Topics

Hepatobiliary Primary Care Neurogastroenterology & Motility Endoscopy

Session

Cross-cutting: Diagnostic - invasive or not invasive

Citation

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

Published

2026

More Like This:

ROME V FUNCTIONAL DYSPEPSIA AND ITS SUBGROUPS: RESULTS FROM THE ROME V GLOBAL EPIDEMIOLOGY STUDY

Jan Tack

Dysbiosis vs microbiome testing

William Fusco

THE DUODENAL MICROENVIRONMENT IN FUNCTIONAL DYSPEPSIA SHOWS MINIMAL MOLECULAR AND FUNCTIONAL IMPACT ON THE INTESTINAL BARRIER AND MAST CELL BIOLOGY

Tim Vanuytsel

Upper GI disorders

Hans Törnblom

OVERDIAGNOSIS OF SUPERIOR MESENTERIC ARTERY SYNDROME: LIMITED DIAGNOSTIC CONCORDANCE BETWEEN IMAGING MODALITIES AND LIMITED BENEFIT OF SURGERY

Tim Vanuytsel

Dyspepsia: To treat or to scope

Juan Mendive