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Introduction

The worldwide prevalence of diabetes is increasing and while there are numerous studies on the impact of prediabetes and diabetes on cancer incidence, research focusing on the Korean population is scarce.

Aims & Methods

This study aimed to evaluate whether prediabetes, diabetes, and poorly controlled diabetes in the Korean population affect the risk of the incidence of various types of gastrointestinal cancers using integrated data of two public datasets. Combining data from the National Health Insurance Service (NHIS) and Korean National Health and Nutrition Examination Survey (KNHANES) from 2013 to 2021, we generated integrated datasets using 3 key identifiers: name, gender, and date of birth. Subsequently, a retrospective cohort study was performed using the combined cohort to enroll subjects aged 20 years or older from 2014 to 2019 (N = 30,684) and followed up until 2021. The 4 groups were defined as follows: group 1 (non-diabetic individuals): hemoglobin A1c (HbA1c) < 5.7% and fasting glucose level (FBS) < 100 mg/dL, group 2 (prediabetes): no diabetes and 5.7% ≤ HbA1c < 6.5% or 100 ≤ FBS < 125 mg/dL, group 3 (controlled diabetes): diagnosed as diabetes and HbA1c < 8.0%, and group 4 (uncontrolled diabetes):diagnosed as diabetes and HbA1c ≥ 8.0%. Covariates including age, sex, alcohol consumption, smoking status, body mass index, total cholesterol, hypertension, income level were adjusted for, and cancer diagnoses were determined using both claim ICD-10 C codes and cancer-specified diagnosis code (V193). We evaluated the risk of overall cancer and gastrointestinal cancers including stomach, colorectal, pancreatic, bile duct, and liver cancers in the 4 groups.

Results

In the final dataset, 24,058 individuals were included, and 675 subjects (2.8 %) developed any cancers during the follow-up. Compared to group 1 (reference), overall cancer risk was significantly increased in the groups 2-4 (adjusted hazard ratio [95% confidence interval]; 1.249 [1.05-1.487], 1.990 [1.511-2.613], and 2.435 [1.305-4.544] in the groups 2, 3, and 4, respectively; p_trend < 0.001.) Among gastrointestinal cancers, the risk of pancreatic cancer was significantly increased in group 2 as well as group 3 (1.249 [1.050-1.487] and 6.412 [1.870 – 21.983], respectively.); the risk of liver cancer was increased in the groups 3 and 4 (2.407 [1.095 – 5.291] and 5.483 [1.413-21.28], respectivley). For stomach and bile duct cancers, the risk was significantly increased only in group 4 (6.349 [2.296-17.557] and 8.676 [1.339-56.228], respectively.) Colorectal cancer risk also showed a positive correlation with diabetes, which did not reach a statistical significance (p > 0.05).

Conclusion

We conducted a novel retrospective cohort study using the integrated dataset of NHIS and KNHANES. Diabetes and prediabetes are risk factors for various types of cancer. The impact of diabetes on gastrointestinal cancers varies possibly depending on the mechanism specific to each cancer type, including the presence or absence of glycemic control, the presence of diabetes, and the prediabetes status.

PREDIABETES, DIABETES AND GASTROINTESTINAL CANCER RISK IN KOREAN ADULTS: RESULTS FROM THE INTEGRATED DATA OF NATIONAL HEALTH INSURANCE SERVICE AND KOREAN NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY

Hyemin Jo 1, Eunjeong Ji 1, Cheol-Min Shin 1, Soyeon Ahn 1, Jung Hun Ohn 1, Yonghoon Choi 1, Yu Kyung Jun 1, Hyuk Yoon 1, Young-Su Park 1, Nayoung Kim 1, Dong-Ho Lee 1

1 Seoul National University Bundang Hospital, Seongnam, Korea, Republic of

Conference

UEG Week Vienna 2024

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

The varied spectrum of malnutrition (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

UEG Podcast Episode

UEG Podcast

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AI Essentials: Basics and upper GI

Alanna Ebigbo, Pradeep Mundre, Louis Liu

Topics

Endoscopy

Published

2024

UEG Standards and Guidelines

Clinical Practice Guideline

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ABSTRACT

Introduction

Since the publication of the first European Society for the Study of Coeliac Disease (ESsCD) guidelines in 2019, significant advancements have emerged in the diagnosis of coeliac disease (CeD) in adults. These 2025 guidelines incorporate new evidence to refine diagnostic strategies, aiming for improved accuracy of testing, and enhance overall quality of clinical care.

Methods

A multidisciplinary panel of experts revised the ESsCD guidelines using the AGREE II instrument (Appraisal of Guidelines for Research and Evaluation II) and the GRADE methodology (The Grading of Recommendations Assessment, Development, and Evaluation). Clinical questions were structured using the PICO format, and statements and recommendations were finalised through a Delphi consensus process. Literature quality was assessed using AMSTAR-2 and QUADAS-2 tools.

Results

The updated guidelines are presented in two parts. Part 1 focuses on adult CeD diagnosis, introducing major changes such as a conditional no-biopsy approach for selected adults with high-titre IgA anti-TG2 serology (≥ 10 × ULN). Regarding serology, the use of validated high-performance ELISAs displaying a high diagnostic accuracy is emphasised, while routine use of IgA anti-Endomysium serology is no longer recommended for confirmation. Revised duodenal biopsy protocols now mandate at least four samples from the second part of the duodenum, with bulb biopsies conditionally included. The guidelines provide structured approaches for diagnosing potential CeD, seronegative villous atrophy, and CeD in individuals already on a gluten-free diet. HLA-DQ2/DQ8 typing is recommended for diagnostic clarification in select cases.

Conclusions

The updated 2025 ESsCD guidelines provide a comprehensive framework for the diagnosis of CeD in adults. By integrating evolving diagnostic strategies, minimising over-testing, and patient-centred care approaches, they aim to optimise patient outcomes, quality of life and use of diagnostic resources at the same time.

European Society for the Study of Coeliac Disease 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 1: Diagnostic Approach

Abdulbaqi Al-Toma

Guideline

Clinical Practice Guideline

Topics

Small Intestine & Nutrition

Citation

United European Gastroenterology Journal; 2025; 00:1–32

Published

2025

UEG Podcast Episode

Journal Podcast

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Episode 6: UEG Journal October Spotlight

Mohsan Subhani, Maria Manuela Estevinho

Topics

Endoscopy Hepatobiliary IBD Pancreas

Published

2025

UEG Mistakes In Articles

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Crohn’s disease (CD) is a chronic inflammatory bowel condition that can present with a wide range of intestinal and extra-intestinal manifestations. This condition can develop at any age and have a significant impact and impairment on quality of life for individuals including on relationships, educational attainment and work productivity. In particular, the time around and after diagnosis often involves the most upheaval for patients, and equally the biggest opportunity for effective intervention. Several recent advances have had a major impact on optimal management of patients with newly diagnosed CD. Here, we discuss the mistakes that are commonly made when managing patients presenting with a new diagnosis of CD. We summarise the evidence base and offer helpful and pragmatic tips for practising clinicians.

Mistakes in newly diagnosed Crohn's disease and how to avoid them

Joana Roseira, Nurulamin Noor

Topics

IBD

Citation

Roseira J and Noor N. Mistakes in newly diagnosed crohn's disease and how to avoid them. UEG Education 2025; 25: 18-23.

Published

2025

UEG Mistakes In Articles

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The complexity of managing inflammatory bowel disease (IBD) stems from the heterogeneity of Crohn’s disease and ulcerative colitis. This leads to differences in disease course, complications, and treatment responses among patients. Current treatment strategies rely on a trial-and-error approach, but there's a need for personalized therapy. Efforts have been made to develop reliable prognostic and predictive biomarkers to overcome disease heterogeneity. This article discusses common mistakes in biomarker development, interpretation, and application in IBD, emphasizing evidence-based insights and lessons learned from other fields.

Mistakes in biomarkers for IBD and how to avoid them

James C. Lee, Chris Palmer-Jones

Topics

IBD

Citation

: Palmer-Jones C. and Lee J. C. Mistakes in biomarkers for IBD and how to avoid them. UEG Education 2023; 23: 8-11.

Published

2023

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Introduction

Celiac disease (CD) is an immune-mediated systemic disease, triggered by the ingestion of gluten, which only develops in genetically predisposed individuals. The main characteristics of the disease are the gluten-dependent small intestinal mucosal lesion, villous atrophy and crypt hyperplasia, and the production of the specific serum autoantibodies. The gold standard for diagnosis has been based on the biopsy findings. In 2012, new ESPGHAN diagnostic guidelines removed the necessity of duodenal biopsy in symptomatic children showing a high serum transglutaminase 2 titers (TG2-IgA) together with the presence of endomysial antibodies (EmA) and HLA DQ2 and/or DQ8.

Aims & Methods

Our aim was to assess the clinical outcome of the diagnostic change in children by comparing new serology-based diagnosed patients to the biopsy-based ones.
We conducted a retrospective analysis of data collected from the medical charts of the patients diagnosed during a four-year period, from 2010 to 2014, being a time overlapping the guideline change. From a total of 63 patients, 30 were biopsy-diagnosed and 33 diagnoses were based on serology only. Clinical data and laboratory parameters were compared between the groups at diagnosis and at follow-ups at 1 year, 2 years and at their latest follow-up visit during the gluten-free diet (GFD) treatment, median time 8.7 years for the serology-based group and 10 years for the biopsy-based group.

Results

Our results show clear improvement upon GFD in gastrointestinal symptoms in both groups. However, there was a general trend for better treatment outcomes in the biopsy-based group compared to the serology-based group at 1 and 2 years of follow-up. Body mass index Z score was in the biopsy group at baseline -1.5, at 1 year on GFD -0.2 and at 2 years -0.2. The corresponding results in the serology group was -1.51, -0.8 (p=0-056), and -1.35 (p=0.023). Anemia was observed in the serology group at one year as frequently (25%) as at baseline (26.7%) but in the biopsy group improvement from baseline was seen, 27.4% to 7.1 % of patients. At two years, anemia was present in 16.6% of patients. Ferritin values were significantly lower in the serology group at one year (27.5 µg/L vs 59, p=0.040) but not anymore at 2 years. After two years on GFD both TG2-IgA and EmA were often still above the cut-off for positivity in both diagnostic groups (serology group 58.3 % and 50% respectively and in the biopsy group somewhat less, 50% and 28.6% respectively). At long term, no anemia was present anymore. However, 4 children from serology group and 8 from the biopsy group showed antibodies above cut-off even after 8.7 and 10 years of treatment, respectively. Upon long-term follow-up the patients from the biopsy-proven group seemed to be more compliant with the follow-up visits and more adherent to the gluten-free diet.

Conclusion

Both clinical and laboratory results show slow recovery upon gluten-free diet. High percentage of autoantibody positivity still at 2 years on GFD indicates substantial amounts of gluten in the diet. Biopsy-proven patients seemed to have a faster recovery than the serology-diagnosed. Serological diagnosis also appears to negatively influence the adherence and compliance to treatment and follow-up. Novel (drug/vaccine) treatments adjunctive to GFD are an unmet need also in children. Duodenal mucosal recovery results on long-term GFD are warranted.

IMPACT OF SEROLOGY-BASED CELIAC DISEASE DIAGNOSIS ON PEDIATRIC PATIENTS’ OUTCOME

Iulia Enache 1, Alexandra Palaga 2, Daniel Vasile Balaban 1, Diana Czika 2, Mariana Jinga 1, Alina Popp 3

1 University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania|||Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania

2 National Institute for Mother and Child Health, Bucharest, Romania

3 University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania|||National Institute for Mother and Child Health, Bucharest, Romania

Conference

UEG Week Vienna 2024

Topics

Small Intestine & Nutrition

Submission format

Abstract

Session

SMALL INTESTINAL (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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