P0338 Decreased colonic peristalsis assessed with motility MRI is associated with chronic structural damage as well as disease activity against the Mayo Endoscopic subscore

Abstract Background Disturbed colonic motility is an important driver of ulcerative colitis (UC) symptoms1 yet to be assessed with modern techniques. Motility Magnetic Resonance Enterography (mMRE) can quantify bowel wall movement while objectively assessing mural, extramural and structural changes in UC. In this study we examined: 1. Whether changes in colonic motility are associated with disease chronicity and 2. If motility changes are associated with endoscopically assessed disease activity measured with Mayo endoscopic subscore (MES) against healthy controls. Methods This prospective study included adults with known UC who underwent MRE and colonoscopy with clinical data and disease duration collected. A total of 49 patients were included (mean age 38.6 ± 13.2 years, 54% female). 30 matched healthy controls were scanned and analysed by two board-certified radiologists, blinded to clinical and endoscopic information. Motility was quantified using FDA-approved GIQuant software (higher values reflect greater motility). Segmental chronicity features (loss of haustration, submucosal fat, increased pericolic fat, and colon shortening) were evaluated. MES (0–3) served as the reference standard determined by two experienced gastroenterologists in consensus. Data was analysed as follows: 1. Disease chronicity: In segments with MES ≤ 1, point-biserial Pearson correlations were used to assess associations between motility and chronicity features. 2. Disease activity: Differences between UC and controls were assessed across colonic regions, and the relationship between motility and MES was evaluated using ordinal regression. Diagnostic performance for detecting MES ≥1, MES ≥2, and MES = 3 was measured using ROC AUC. Results 1. Disease chronicity: Motility showed significant inverse correlations with loss of haustration (r = −0.54, p < 0.001) and increased pericolic fat (r = −0.53, p < 0.001), with weaker associations for submucosal fat deposition (r = −0.28, p = 0.002) and colon shortening (r = −0.23, p = 0.01). 2. Disease activity: UC segments demonstrated substantially lower motility than controls (mean difference −136 GIQuant units; 95% CI − 192 to − 80, p < 0.001). Higher motility was strongly associated with lower MES (OR per 1 SD increase, 0.38; 95% CI 0.27–0.53). Motility showed excellent discrimination for any endoscopic activity (MES ≥1: AUC 0.83) and acceptable performance for higher grades (MES 2: AUC 0.70, MES =3: AUC 0.73). Conclusion Colonic motility showed an association with disease chronicity and disease activity. This association presents a key mechanistic area for further exploration with therapeutic implications. Reference: 1. Reddy et al. Colonic Motility and transit in Health and Ulcerative Colitis. 1991:101:1289-1297 Gastroenterology Conflict of interest: Dr. Menys, Alex: Motilent Sarikhani, Mahshad: No conflict of interest Torabi, Ala: CEO Motilent Associate Prof UCL Amouei, Mehrnam: No conflict of interest Vahedi Tafreshi, Homayoon: No conflict of interest Sima, Ali Reza: No conflict of interest Naim, Iyad: Motilent employee Kolahdoozan, Shadi: No conflict of interest Bhatnagar, Gauraang: Share options: Motilent Ltd. Fetch Health Radiology Lead: Motilent Central reader: Alimentiv Received payment for IBUS bootcamp Copenhagen, October 2025 funded by Helmsley. Colombel, Jean-Frédéric: Grant: AbbVie, Janssen Pharmaceuticals, Takeda, Prometheus and Bristol Myers Squibb Lectures from: AbbVie, Roche and Takeda Other: AbbVie, Amgen, AnaptysBio, Allergan, Apini, Arena Pharmaceuticals, Astellas, Boehringer Ingelheim, Bristol Myers Squibb, candidrx Celgene, Celltrion, Clearview Curogen, Eli Lilly, Envision Pharma Ferring Pharmaceuticals, Galmed Research, Glaxo Smith Kline, Roche, Janssen Pharmaceuticals, Kaleido Biosciences, Immunic, Iterative Scopes, Landos, Microba Life Science, Merck, Mirador, Novartis, Otsuka Pharmaceutical, Owkin, Pfizer, Protagonist Therapeutics, Sanofi, Sun Pharma, Takeda, Teva, TiGenix, and is holding stock options in Intestinal Biotech Development Radmard, Amir Reza: No conflict of interest