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Introduction

Several studies suggest that new-onset diabetes mellitus (NOD) may be an early manifestation of pancreatic ductal adenocarcinoma (PDAC). Therefore, the international CAncer of the Pancreas Screening (CAPS) Consortium recommends glucose and HbA1c monitoring in high-risk individuals (HRIs) for PDAC. However, evidence that such monitoring improves the detection of PDAC is lacking.

Aims & Methods

The aim of this study was to investigate NOD, glucose and HbA1c values in relation to the development of PDAC in a screening program for HRIs. Analysis was performed on individuals participating in the Familial Pancreatic Cancer (FPC) surveillance study, in which HRIs with a hereditary predisposition for PDAC are followed yearly by MRI and/or EUS and blood sampling. Individuals who underwent fasting glucose and/or HbA1c monitoring at least once were included.

Results

In October 2021, the FPC cohort consisted of 463 HRIs, of which 404 had undergone at least one glucose or HbA1c measurement. Of these, 9 individuals developed PDAC and 4 non-PDAC individuals were diagnosed with NOD. Glucose levels ranged between 3.4-10.7 mmol/L (mean 5.4 ± 0.7), and HbA1c levels between 25-68 mmol/mol (mean 37.3 ± 3.6). The percentage of cases with at least one elevated value was comparable between the PDAC and non-PDAC group for glucose (33% and 27%, p=0.707) and HbA1c (22% and 14%, p=0.623).

Conclusion

In this large HRI surveillance cohort, measuring glucose and HbA1c values did not contribute to PDAC detection. Larger and longer term studies are needed to determine the final role of glucose and HbA1c monitoring in PDAC surveillance.

ASSESSMENT OF GLUCOSE AND HBA1C MONITORING IN A PANCREATIC CANCER SURVEILLANCE PROGRAM FOR HIGH-RISK INDIVIDUALS

Jihane Meziani 1, G. J. Y. Jedidja de Jong 1, Paul Fockens 2, Frank P. Vleggaar 3, Marco J. Bruno 1, Djuna L. Cahen 1

1 University Medical Center Rotterdam, Rotterdam, Netherlands

2 Amsterdam University Medical Center, Amsterdam, Netherlands

3 University Medical Center Utrecht, Utrecht, Netherlands

Conference

UEG Week Copenhagen 2023

Topics

Pancreas

Submission format

Abstract

Session

PP 08 Pancreas (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

UEG Presentation

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TRYPTOPHAN DEFICIENCY IS FREQUENT IN THE WESTERNIZED POPULATION AND INSTIGATES SEVERE COURSE OF INTERNAL-MEDICINE DISEASES

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Introduction

Micronutrient deficiency is an underestimated problem in the westernized population with unclear effects on the manifestation of acute or chronic disease. Westernized lifestyle instigates disrupted gut-microbial crosstalk and chronic low-grade inflammation¹. Tryptophan (Trp) is an essential amino acid used for de novo synthesis of cellular nicotinamide adenine dinucleotide (NAD). We have previously shown increased Trp degradation in several chronic inflammatory disorders, including IBD^2,3. Whether Trp deficiency is a widespread phenomenon in the western population is unknown. Here, we tested the hypothesis that Trp deficiency is frequent in the western population and associates with increased overall disease severity in internal-medicine and especially gastrointestinal (GI) diseases.

Aims & Methods

To screen the micronutrient status of the healthy population, we assessed quantitative amino acid levels in n=15.188 healthy controls (HC) with a commercially available home-care dry blood spot test for targeted metabolomics (cohort 1). Self-reported symptoms were assessed with a digital questionnaire. To validate Trp deficiency (defined as the lowest Trp quartile) in acute internal-medicine diseases (cohort 2), we measured serum Trp by HPLC in HC (n=291) and patients presenting in the emergency ward of the University Hospital Schleswig-Holstein, Kiel (n=4349, categorized by ICD10; thereof GI diseases n=516 (K00-K93: diseases of the digestive system); 10/2023-09/2024). Next to laboratory and clinical assessment at presentation, disease courses were followed up digitally for at least 6 months. Statistical analyses were performed with linear mixed models (LMM) and logistic regression correcting for age and sex at birth; predictive performance was evaluated via area under the receiver-operating-characteristic (AUROC; R version 4.4.1).

Results

In cohort 1, 39.3% of HC presented with Trp deficiency. Trp deficiency significantly inversely correlated with the amount of self-reported symptoms, such as e.g. GI symptoms. Validating these findings in internal-medicine and a subgroup of GI diseases in cohort 2, we found significantly reduced serum Trp compared to HC (mean Trp 56.58±10.84µM vs. 45.06±16.65 (all disease groups), 45.21±20.69 (GI diseases)), especially when the serum inflammation marker C-reactive protein was not elevated (<5 mg/l). Here, Trp deficiency was observed in 1.4% of HC, while it was strongly increased in all disease groups (26.6%) and GI diseases (30.2%). Using LMM, we found that patients that were hospitalized, admitted to the ICU or died within the follow-up period had a significantly lower Trp compared to patients with favourable outcomes (outpatient/no ICU/alive). Patients with Trp at the lowest compared to the highest quartile underwent longer hospitalisation and ICU treatment (all diseases: 3.17/0.37 days (d) longer; GI diseases: 3.91/0.48d longer) as well as a higher number of in-hospital procedures (all diseases: 1.47 more; GI diseases: 3.3 more). The predictive value of Trp for complicated outcomes (hospitalisation, hospitalisation >7d, ICU treatment, death) as assessed by AUROC was low-moderate (all diseases: AUC 0.69, 0.67, 0.61, 0.72; GI diseases: AUC 0.61, 0.6, 0.54 and 0.62, respectively).

Conclusion

We report that Trp deficiency is frequent in the westernized population and associates with more severe disease courses. Our data suggests Trp degradation along the de novo NAD synthesis pathway as an overarching metabolic hallmark of chronic low-grade inflammation and a risk factor for severe disease courses of internal-medicine and GI diseases.

References

1. Christ, A. & Latz, E. The Western lifestyle has lasting effects on metaflammation. Nature Reviews Immunology vol. 19 267–268 Preprint at https://doi.org/10.1038/s41577-019-0156-1 (2019).
2. Harris, D. M. M. et al. Tryptophan degradation as a systems phenomenon in inflammation – an analysis across 13 chronic inflammatory diseases. EBioMedicine 102, 105056 (2024).
3. Nikolaus, S. et al. Increased Tryptophan Metabolism Is Associated With Activity of Inflammatory Bowel Diseases. Gastroenterology 153, (2017).

TRYPTOPHAN DEFICIENCY IS FREQUENT IN THE WESTERNIZED POPULATION AND INSTIGATES SEVERE COURSE OF INTERNAL-MEDICINE DISEASES

Lina Welz 1, Jeanette Franzenburg 1, Sascha Thielke 2, Katrin Franzpötter 3, Sarah Meier 3, Corina Maetzler 2, Olaf Schneider 4, Jan Heyckendorf 2, Thomas Bahmer 2, Domagoj Schunk 2, Stefan Schreiber 5, Konrad Aden 1

1 University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany|||University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany

2 University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany

3 Christian-Albrechts-Universität zu Kiel, Kiel, Germany

4 Cerascreen, Leipzig, Germany

5 University Hospital Schleswig-Holstein, Kiel, Germany|||University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany

Event

UEG Week Berlin 2025

Topics

Gut Microbiota Small Intestine & Nutrition

Submission format

Abstract

Session

The gut ecosystem: From pathogenesis to treatment

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Summary: Is the surgical "era" coming to an end?

Ivo Boskoski 1, Ralph Peterli 2

1 Catholic University of Rome Digestive Endoscopy Unit, Rome, Italy

2 St. Claraspital AG, Basel, Switzerland

Event

UEG Postgraduate Teaching Programme Berlin 2025

Topics

Endoscopy Surgery

Session

Is the surgical "era" coming to an end?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Clinical Case Summary

The patient (Male, 86-year-old, undergoig home treatment with Olmesartan and Lisinopril) was admitted for persistent rectal bleeding and fatigue lasting two weeks. Laboratory tests revealed normocytic anemia (Hb 8.2 g/dL) without elevated inflammatory markers. His medical history included only mild chronic kidney disease, and he was not on immunosuppressive therapy.

Colonoscopy showed a large, sharply demarcated solitary ulcer in the cecum, with normal surrounding mucosa. Initial differential diagnosis included neoplasia and ischemic colitis. Histopathology of ulcer biopsies revealed chronic inflammation and CMV inclusion bodies. This was confirmed by positive CMV IgM/IgG serology and detectable CMV DNA in blood (2.5×10² copies/mL).

The patient began intravenous ganciclovir with rapid improvement. Bleeding ceased, and energy levels improved. A follow-up colonoscopy at 10 days showed healing of the ulcer with no residual CMV on repeat biopsies. He completed four weeks of antiviral therapy. Final follow-up showed complete clinical, endoscopic, and histologic resolution (All endoscopic images are available)

CMV colitis is rarely diagnosed in immunocompetent patients. However, immunosenescence in the elderly may predispose them to viral reactivation. Solitary ulcers are also an atypical presentation, leading to diagnostic delays. This case illustrates the importance of early biopsy and considering viral etiologies even when typical risk factors are absent. Prompt antiviral therapy led to full resolution, highlighting the need for clinicians to expand the differential diagnosis in atypical presentations.

CMV colitis can occur in immunocompetent elderly patients and may mimic malignancy or ischemic colitis. Histological evaluation is key, and early antiviral therapy can lead to excellent outcomes. Clinicians should remain alert to atypical presentations, especially in the elderly, and be willing to consider less common diagnoses when faced with unusual clinical findings.

References

Case Jr R, et al. (BMJ Case Rep 2019;12:e226355. doi:10.1136/bcr-2018-226355)
Anat Yerushalmy-Feler et al. , Diagnosis and Management of CMV Colitis doi.org/10.1007/s11908-019-0664-y

Disclosure

nothing to declare

A DIAGNOSTIC CHALLENGE: UNUSUAL PRESENTATION OF A SOLITARY CECAL ULCER IN AN ELDERLY PATIENT

Nicolo' Guido Maria Bevilacqua 1, Piercarlo Farris 1, Eugenio Marconato 1, Federico Desideri 1

1 Ospedale Provinciale di Bolzano, Bolzano, Italy

Conference

UEG Week Berlin 2025

Topics

Colorectal

Submission format

Clinical Case

Session

CLINICAL CASES (Posters)

Published

2025

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Introduction

Direct oral anticoagulants (DOACs), particularly rivaroxaban and apixaban, are increasingly utilized to manage thromboembolic conditions due to their favorable efficacy and safety profiles. However, gastrointestinal bleeding (GIB) remains a significant concern associated with these medications, particularly considering pharmacogenetic variations among populations. This study aims to evaluate the frequency and identify risk factors associated with GIB in patients using rivaroxaban and apixaban in a Mexican healthcare setting.

Aims & Methods

This retrospective observational study analyzed data from January 2018 to December 2023 at the Centro Médico Nacional 20 de Noviembre, Mexico City. The cohort consisted of 278 patients: 136 on DOAC therapy (rivaroxaban or apixaban) and 142 controls without anticoagulation. Clinical data, demographic characteristics, comorbidities, and concomitant medications were systematically reviewed. Statistical methods employed included chi-square tests, Student's t-tests, and logistic regression analysis to assess the risk factors and association between anticoagulant type and incidence of GIB.

Results

The study population had a mean age of 67.36 ± 15.05 years, with an equal gender distribution (52.9% male). Rivaroxaban was significantly linked to increased GIB-related hospitalizations compared to controls (OR 1.29, 95% CI: 1.10–1.52, p < 0.001), while apixaban showed no statistically significant increase. NSAID co-administration dramatically raised the risk of GIB in rivaroxaban users (OR 16.1, 95% CI: 1.22–212.6, p = 0.03). Patients treated with DOACs experienced more hospitalizations (average 0.49 ± 0.80) and longer hospital stays (2.19 ± 3.54 days) compared to controls (0.30 ± 0.62 hospitalizations, 0.99 ± 2.68 days, respectively). Mortality rates were not significantly different between groups.

Conclusion

Rivaroxaban and apixaban present similar overall risks of gastrointestinal bleeding, although rivaroxaban is associated with higher hospitalization rates. Concomitant NSAID use substantially elevates the risk in patients on rivaroxaban. This underscores the necessity of individualized anticoagulant management strategies, especially in populations with distinct genetic and clinical characteristics, such as the Mexican demographic.

References

Lopes RD, Guimarães PO, Kolls BJ, et al. Gastrointestinal bleeding with novel oral anticoagulants: A systematic review and meta-analysis. BMJ. 2015;350:h1857.
Ruff CT, Giugliano RP, Braunwald E, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383(9921):955-962.
Granger CB, Alexander JH, McMurray JJV, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981-992.

COMPARATIVE ANALYSIS OF GASTROINTESTINAL BLEEDING RISKS IN PATIENTS TREATED WITH RIVAROXABAN VERSUS APIXABAN: A RETROSPECTIVE STUDY IN A MEXICAN HOSPITAL SETTING

Hugo Sebastian De Marino Herrera 1, Yenni Joseline Cruz Ramirez 1, Sofia Mercedes Narvaez Chavez 1, Miriam Gabriela Reyes Zermeño 2

1 Centro Medico Nacional 20 de Noviembre, ISSSTE, UNAM, México City, Mexico

2 Centro Médico Nacional 20 de Noviembre, Issste, Mexico City, Mexico

Conference

UEG Week Berlin 2025

Topics

Oesophagus

Submission format

Abstract

Session

OESOPHAGEAL, GASTRIC AND DUODENAL (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Discussion: IBD-Nurses - All around the GUT

Federica Furfaro 1, Susanna Jäghult 2, Simona Radice 3

1 Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Milan, Milano, Italy

2 Danderyds sjukhus, Stockholm, Sweden

3 San Rafaele Research Hospital, Milan, Italy

Event

UEG Week Copenhagen 2023

Topics

IBD Nurses Standards & Guidelines

Session

IBD nurses: All around the gut

Published

2023

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Introduction

The progression of Barrett’s Esophagus (BE) to malignancy is accompanied by increasing copy number alterations (CNAs). However, the timing of CNAs events during evolution remains unclear. This study leverages multi-regional, longitudinal sequencing of BE to map CAN temporal dynamics, identify key drivers of BE progression, and improve risk stratification.

Aims & Methods

Two BE cohorts were analyzed. The discovery cohort included shallow whole-genome sequencing (sWGS, 0.4X) from 777 BE samples across 88 patients, while the validation cohort included 256 BE samples from 95 patients. We refined the bioinformatics tool RASCAL¹ to improve absolute CNA analysis by automatically selecting high-quality samples. Phylogenetic trees were generated by MEDICC2² to classify CNAs along an evolutionary timeline (Figure 1). Risk scores were computed based on the probability of CNA occurrence in non-progressing vs. dysplastic BE samples. A random forest model was trained to predict dysplasia based on risk score and validated in an independent cohort.

Results

In the discovery cohort, 52.3% (260/497) of NDBE and 75.2% (124/165) of dysplastic samples were high-quality, with 16.9% (21/124) of dysplastic samples exhibiting whole genome doubling (WGD). In the validation cohort, 79.4% (181/228) of NDBE and 86.2% (25/29) of dysplasia/cancer samples were high-quality, with WGD in 24.0% (6/25) of dysplastic cases. Early-stage CNAs in non-progressing BE showed specific chromosomal gains and losses, whereas later-stage CNAs in dysplasia were more widespread and less commonly shared. Risk scoring of known drivers revealed that SMAD4 losses and CCND3/GATA4 gains were linked to dysplasia. Our model with divergent evolutionary patterns predicted dysplasia with an AUC of 0.89 (Sensitivity: 80.6%, Specificity: 95.7%) in the discovery set and AUC of 0.84 in the validation set (Sensitivity: 73.1%, Specificity: 93.9%).

Conclusion

This study maps CNA evolutionary trajectories in BE, demonstrating selective constraints in early evolution and stochastic processes in dysplastic progression. CNA-based risk scores offer a promising tool for lesion risk stratification.

References

Sauer C M, Eldridge M D, Vias M, et al. Absolute copy number fitting from shallow whole genome sequencing data. Biorxiv, 2021: 2021.07. 19.452658.
Kaufmann T L, Petkovic M, Watkins T B K, et al. MEDICC2: whole-genome doubling aware copy-number phylogenies for cancer evolution. Genome biology, 2022, 23(1): 241.