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Mistakes in Malignancy surveillance in IBD and how to avoid them

Axel Dignass, Edyta Maria Tulewicz-Marti

Summary

AI Generated

This material addresses nine common mistakes in screening for dysplasia and malignancy in inflammatory bowel disease patients and provides guidance on avoiding them.

  • Inflammatory bowel disease comprises chronic, progressive, lifelong, and currently incurable gastrointestinal disorders that may be associated with colorectal dysplasia and cancer development.
  • Technological improvements in disease management and malignancy screening have enabled earlier detection of precancerous lesions and timely resection of premalignant or localised malignant lesions, resulting in improved patient outcomes.
  • The material presents nine common mistakes encountered in screening for dysplastic and malignant lesions in IBD management, based on clinical experience and an evidence-based approach.
  • This content would be most relevant to clinicians managing patients with inflammatory bowel disease who perform or oversee dysplasia surveillance.
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.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9
1.
Gordon H, Biancone L, Fiorino G, et al. ECCO Guidelines on Inflammatory Bowel Disease and Malignancies. Journal of Crohn’s and Colitis 2023; 17: 827–854. [Link]
2.
McMillan C, Li DK, Mohamed G, et al. Longer Colonoscopy Withdrawal Time Is Associated With the Detection of Visible Dysplasia in Patients With Inflammatory Bowel Disease. Crohn’s & Colitis 360 2024; 6: otae020. [Link]
3.
Eder P, Łodyga M, Gawron-Kiszka M, et al. Guidelines for the management of ulcerative colitis. Recommendations of the Polish Society of Gastroenterology and the Polish National Consultant in Gastroenterology. pg 2023; 18: 1–42. [Link]
4.
Laukoetter MG, Mennigen R, Hannig CM, et al. Intestinal Cancer Risk in Crohn’s Disease: A Meta-Analysis. Journal of Gastrointestinal Surgery 2011; 15: 576–583. [Link]
5.
Hassan C, East J, Radaelli F, et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. Endoscopy 2019; 51: 775–794. [Link]
6.
Rao BB, Lashner B, Kowdley KV. Reviewing the Risk of Colorectal Cancer in Inflammatory Bowel Disease After Liver Transplantation for Primary Sclerosing Cholangitis. Inflammatory Bowel Diseases 2018; 24: 269–276. [Link]
7.
Shah SC, Itzkowitz SH. Reappraising Risk Factors for Inflammatory Bowel Disease-associated Neoplasia: Implications for Colonoscopic Surveillance in IBD. Journal of Crohn’s and Colitis 2020; 14: 1172–1177. [Link]
8.
Elford AT, Hirsch R, McKay OM, et al. Identifying the real‐world challenges of dysplasia surveillance in inflammatory bowel disease: a retrospective cohort study in a tertiary health network. Internal Medicine Journal 2024; 54: 96–103. [Link]
9.
Adamina M, Feakins R, Iacucci M, et al. ECCO Topical Review Optimising Reporting in Surgery, Endoscopy, and Histopathology. Journal of Crohn’s and Colitis 2021; 15: 1089–1105. [Link]
10.
Baars JE, Kuipers EJ, Dijkstra G, et al. Malignant transformation of perianal and enterocutaneous fistulas is rare: results of 17 years of follow-up from The Netherlands. Scandinavian Journal of Gastroenterology 2011; 46: 319–325. [Link]
11.
Trivedi PJ, Crothers H, Mytton J, et al. Effects of Primary Sclerosing Cholangitis on Risks of Cancer and Death in People With Inflammatory Bowel Disease, Based on Sex, Race, and Age. Gastroenterology 2020; 159: 915–928. [Link]
12.
Catanzaro E, Gringeri E, Burra P, et al. Primary Sclerosing Cholangitis-Associated Cholangiocarcinoma: From Pathogenesis to Diagnostic and Surveillance Strategies. Cancers 2023; 15: 4947. [Link]
13.
Sokol H, Cosnes J, Chazouilleres O, et al. Disease activity and cancer risk in inflammatory bowel disease associated with primary sclerosing cholangitis. WJG 2008; 14: 3497. [Link]
14.
Murthy SK, Feuerstein JD, Nguyen GC, et al. AGA Clinical Practice Update on Endoscopic Surveillance and Management of Colorectal Dysplasia in Inflammatory Bowel Diseases: Expert Review. Gastroenterology 2021; 161: 1043-1051.e4. [Link]
15.
Aparicio T, Zaanan A, Mary F, et al. Small Bowel Adenocarcinoma. Gastroenterology Clinics of North America 2016; 45: 447–457. [Link]
16.
Lo B, Zhao M, Vind I, et al. The Risk of Extraintestinal Cancer in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis of Population-based Cohort Studies. Clinical Gastroenterology and Hepatology 2021; 19: 1117-1138.e19. [Link]
17.
Beaugerie L, Brousse N, Bouvier AM, et al. Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. The Lancet 2009; 374: 1617–1625. [Link]
18.
Afif W, Sandborn WJ, Faubion WA, et al. Risk Factors for Lymphoma in Patients with Inflammatory Bowel Disease: A Case-control Study. Inflammatory Bowel Diseases 2013; 19: 1384–1389. [Link]
19.
Pedersen N, Duricova D, Elkjaer M, et al. Risk of Extra-Intestinal Cancer in Inflammatory Bowel Disease: Meta-Analysis of Population-Based Cohort Studies. American Journal of Gastroenterology 2010; 105: 1480–1487. [Link]
20.
Yu J, Refsum E, Wieszczy P, et al. Risk of malignant lymphomas in patients with inflammatory bowel disease: a population-based cohort study. BMJ Open Gastroenterol 2023; 10: e001037. [Link]
21.
Tulewicz-Marti E, Stępień-Wrochna B, Maciejewska K, et al. Awareness and Compliance with the Recommendations of Primary and Secondary Prevention of Cancer in Patients with Inflammatory Bowel Disease. JPM 2023; 13: 913. [Link]
22.
Huang S, Liu Z, Liao W, et al. Risk of skin cancers in thiopurines‐treated and thiopurines‐untreated patients with inflammatory bowel disease: A systematic review and meta‐analysis. J of Gastro and Hepatol 2019; 34: 507–516. [Link]
23.
Ariyaratnam J, Subramanian V. Association Between Thiopurine Use and Nonmelanoma Skin Cancers in Patients With Inflammatory Bowel Disease: A Meta-Analysis. American Journal of Gastroenterology 2014; 109: 163–169. [Link]
24.
Kreher MA, Noland MMB, Konda S, et al. Risk of melanoma and nonmelanoma skin cancer with immunosuppressants, part I: Calcineurin inhibitors, thiopurines, IMDH inhibitors, mTOR inhibitors, and corticosteroids. Journal of the American Academy of Dermatology 2023; 88: 521–530. [Link]
25.
Hazenberg HMJL, De Boer NKH, Mulder CJJ, et al. Neoplasia and Precursor Lesions of the Female Genital Tract in IBD: Epidemiology, Role of Immunosuppressants, and Clinical Implications. Inflammatory Bowel Diseases 2018; 24: 510–531. [Link]
26.
Kim SC, Glynn RJ, Giovannucci E, et al. Risk of high-grade cervical dysplasia and cervical cancer in women with systemic inflammatory diseases: a population-based cohort study. Ann Rheum Dis 2015; 74: 1360–1367. [Link]
27.
Allegretti JR, Barnes EL, Cameron A. Are Patients with Inflammatory Bowel Disease on Chronic Immunosuppressive Therapy at Increased Risk of Cervical High-grade Dysplasia/Cancer? A Meta-analysis: Inflammatory Bowel Diseases 2015; 21: 1089–1097. [Link]
28.
Goetgebuer RL, Kreijne JE, Aitken CA, et al. Increased Risk of High-grade Cervical Neoplasia in Women with Inflammatory Bowel Disease: A Case-controlled Cohort Study. Journal of Crohn’s and Colitis 2021; 15: 1464–1473. [Link]
29.
De Francisco R, Castaño‐García A, Martínez‐González S, et al. Impact of Epstein‐Barr virus serological status on clinical outcomes in adult patients with inflammatory bowel disease. Aliment Pharmacol Ther 2018; 48: 723–730. [Link]
30.
Al-Bawardy B, Alfadley AF, Almousallam M, et al. Epstein-Barr virus seroprevalence among inflammatory bowel disease patients in Saudi Arabia. Saudi Journal of Gastroenterology 2024; 30: 168–172. [Link]
31.
Calafat M, Mañosa M, Cañete F, et al. Increased risk of thiopurine‐related adverse events in elderly patients with IBD. Aliment Pharmacol Ther 2019; 50: 780–788. [Link]
32.
Sturm A, Maaser C, Mendall M, et al. European Crohn’s and Colitis Organisation Topical Review on IBD in the Elderly: Table 1. ECCOJC 2016; jjw188. [Link]
33.
Beaugerie L, Rahier J-F, Kirchgesner J. Predicting, Preventing, and Managing Treatment-Related Complications in Patients With Inflammatory Bowel Diseases. Clinical Gastroenterology and Hepatology 2020; 18: 1324-1335.e2. [Link]
34.
Dahmus J, Rosario M, Clarke K. Risk of Lymphoma Associated with Anti-TNF Therapy in Patients with Inflammatory Bowel Disease: Implications for Therapy. CEG 2020; Volume 13: 339–350. [Link]
35.
Russell MD, Stovin C, Alveyn E, et al. JAK inhibitors and the risk of malignancy: a meta-analysis across disease indications. Ann Rheum Dis 2023; 82: 1059–1067. [Link]
36.
Shelton E, Laharie D, Scott FI, et al. Cancer Recurrence Following Immune-Suppressive Therapies in Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis. Gastroenterology 2016; 151: 97-109.e4. [Link]
37.
Gupta A, Peyrin-Biroulet L, Ananthakrishnan AN. Risk of Cancer Recurrence in Patients With Immune-Mediated Diseases With Use of Immunosuppressive Therapies: An Updated Systematic Review and Meta-Analysis. Clinical Gastroenterology and Hepatology 2024; 22: 499-512.e6. [Link]

Abstract

Inflammatory bowel disease (IBD) comprises chronic, progressive, lifelong, and currently incurable disorders of the gastrointestinal tract, which may also be associated with the development of colorectal dysplasia and cancer. However, technological improvements in disease management and malignancy screening over recent decades have enabled earlier detection of precancerous lesions and timely resection of premalignant lesions or even localised malignant lesions, resulting in improved patient outcomes. Here, we discuss mistakes encountered in the screening of dysplastic and malignant lesions when managing patients with IBD. Based on our clinical experience and an evidence-based approach, we present nine common mistakes and how to avoid them.

Topics

IBD

Citation

Tulewicz-Marti E and Dignass A. Mistakes in malignancy surveillance in IBD and how to avoid them. UEG Education 2024; 24: 25-28.

Published

2024

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Mistakes in the management of peritoneal malignancies and how to avoid them

Francesco Saverio Papadia, Matteo Santoliquido, Andrea Barberis, Tarkan Jäger, Charlotte Rabl

Summary

AI Generated

Summary is not available for this content yet.

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.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9
1.
Gordon H, Biancone L, Fiorino G, et al. ECCO Guidelines on Inflammatory Bowel Disease and Malignancies. Journal of Crohn’s and Colitis 2023; 17: 827–854. [Link]
2.
McMillan C, Li DK, Mohamed G, et al. Longer Colonoscopy Withdrawal Time Is Associated With the Detection of Visible Dysplasia in Patients With Inflammatory Bowel Disease. Crohn’s & Colitis 360 2024; 6: otae020. [Link]
3.
Eder P, Łodyga M, Gawron-Kiszka M, et al. Guidelines for the management of ulcerative colitis. Recommendations of the Polish Society of Gastroenterology and the Polish National Consultant in Gastroenterology. pg 2023; 18: 1–42. [Link]
4.
Laukoetter MG, Mennigen R, Hannig CM, et al. Intestinal Cancer Risk in Crohn’s Disease: A Meta-Analysis. Journal of Gastrointestinal Surgery 2011; 15: 576–583. [Link]
5.
Hassan C, East J, Radaelli F, et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. Endoscopy 2019; 51: 775–794. [Link]
6.
Rao BB, Lashner B, Kowdley KV. Reviewing the Risk of Colorectal Cancer in Inflammatory Bowel Disease After Liver Transplantation for Primary Sclerosing Cholangitis. Inflammatory Bowel Diseases 2018; 24: 269–276. [Link]
7.
Shah SC, Itzkowitz SH. Reappraising Risk Factors for Inflammatory Bowel Disease-associated Neoplasia: Implications for Colonoscopic Surveillance in IBD. Journal of Crohn’s and Colitis 2020; 14: 1172–1177. [Link]
8.
Elford AT, Hirsch R, McKay OM, et al. Identifying the real‐world challenges of dysplasia surveillance in inflammatory bowel disease: a retrospective cohort study in a tertiary health network. Internal Medicine Journal 2024; 54: 96–103. [Link]
9.
Adamina M, Feakins R, Iacucci M, et al. ECCO Topical Review Optimising Reporting in Surgery, Endoscopy, and Histopathology. Journal of Crohn’s and Colitis 2021; 15: 1089–1105. [Link]
10.
Baars JE, Kuipers EJ, Dijkstra G, et al. Malignant transformation of perianal and enterocutaneous fistulas is rare: results of 17 years of follow-up from The Netherlands. Scandinavian Journal of Gastroenterology 2011; 46: 319–325. [Link]
11.
Trivedi PJ, Crothers H, Mytton J, et al. Effects of Primary Sclerosing Cholangitis on Risks of Cancer and Death in People With Inflammatory Bowel Disease, Based on Sex, Race, and Age. Gastroenterology 2020; 159: 915–928. [Link]
12.
Catanzaro E, Gringeri E, Burra P, et al. Primary Sclerosing Cholangitis-Associated Cholangiocarcinoma: From Pathogenesis to Diagnostic and Surveillance Strategies. Cancers 2023; 15: 4947. [Link]
13.
Sokol H, Cosnes J, Chazouilleres O, et al. Disease activity and cancer risk in inflammatory bowel disease associated with primary sclerosing cholangitis. WJG 2008; 14: 3497. [Link]
14.
Murthy SK, Feuerstein JD, Nguyen GC, et al. AGA Clinical Practice Update on Endoscopic Surveillance and Management of Colorectal Dysplasia in Inflammatory Bowel Diseases: Expert Review. Gastroenterology 2021; 161: 1043-1051.e4. [Link]
15.
Aparicio T, Zaanan A, Mary F, et al. Small Bowel Adenocarcinoma. Gastroenterology Clinics of North America 2016; 45: 447–457. [Link]
16.
Lo B, Zhao M, Vind I, et al. The Risk of Extraintestinal Cancer in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis of Population-based Cohort Studies. Clinical Gastroenterology and Hepatology 2021; 19: 1117-1138.e19. [Link]
17.
Beaugerie L, Brousse N, Bouvier AM, et al. Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. The Lancet 2009; 374: 1617–1625. [Link]
18.
Afif W, Sandborn WJ, Faubion WA, et al. Risk Factors for Lymphoma in Patients with Inflammatory Bowel Disease: A Case-control Study. Inflammatory Bowel Diseases 2013; 19: 1384–1389. [Link]
19.
Pedersen N, Duricova D, Elkjaer M, et al. Risk of Extra-Intestinal Cancer in Inflammatory Bowel Disease: Meta-Analysis of Population-Based Cohort Studies. American Journal of Gastroenterology 2010; 105: 1480–1487. [Link]
20.
Yu J, Refsum E, Wieszczy P, et al. Risk of malignant lymphomas in patients with inflammatory bowel disease: a population-based cohort study. BMJ Open Gastroenterol 2023; 10: e001037. [Link]
21.
Tulewicz-Marti E, Stępień-Wrochna B, Maciejewska K, et al. Awareness and Compliance with the Recommendations of Primary and Secondary Prevention of Cancer in Patients with Inflammatory Bowel Disease. JPM 2023; 13: 913. [Link]
22.
Huang S, Liu Z, Liao W, et al. Risk of skin cancers in thiopurines‐treated and thiopurines‐untreated patients with inflammatory bowel disease: A systematic review and meta‐analysis. J of Gastro and Hepatol 2019; 34: 507–516. [Link]
23.
Ariyaratnam J, Subramanian V. Association Between Thiopurine Use and Nonmelanoma Skin Cancers in Patients With Inflammatory Bowel Disease: A Meta-Analysis. American Journal of Gastroenterology 2014; 109: 163–169. [Link]
24.
Kreher MA, Noland MMB, Konda S, et al. Risk of melanoma and nonmelanoma skin cancer with immunosuppressants, part I: Calcineurin inhibitors, thiopurines, IMDH inhibitors, mTOR inhibitors, and corticosteroids. Journal of the American Academy of Dermatology 2023; 88: 521–530. [Link]
25.
Hazenberg HMJL, De Boer NKH, Mulder CJJ, et al. Neoplasia and Precursor Lesions of the Female Genital Tract in IBD: Epidemiology, Role of Immunosuppressants, and Clinical Implications. Inflammatory Bowel Diseases 2018; 24: 510–531. [Link]
26.
Kim SC, Glynn RJ, Giovannucci E, et al. Risk of high-grade cervical dysplasia and cervical cancer in women with systemic inflammatory diseases: a population-based cohort study. Ann Rheum Dis 2015; 74: 1360–1367. [Link]
27.
Allegretti JR, Barnes EL, Cameron A. Are Patients with Inflammatory Bowel Disease on Chronic Immunosuppressive Therapy at Increased Risk of Cervical High-grade Dysplasia/Cancer? A Meta-analysis: Inflammatory Bowel Diseases 2015; 21: 1089–1097. [Link]
28.
Goetgebuer RL, Kreijne JE, Aitken CA, et al. Increased Risk of High-grade Cervical Neoplasia in Women with Inflammatory Bowel Disease: A Case-controlled Cohort Study. Journal of Crohn’s and Colitis 2021; 15: 1464–1473. [Link]
29.
De Francisco R, Castaño‐García A, Martínez‐González S, et al. Impact of Epstein‐Barr virus serological status on clinical outcomes in adult patients with inflammatory bowel disease. Aliment Pharmacol Ther 2018; 48: 723–730. [Link]
30.
Al-Bawardy B, Alfadley AF, Almousallam M, et al. Epstein-Barr virus seroprevalence among inflammatory bowel disease patients in Saudi Arabia. Saudi Journal of Gastroenterology 2024; 30: 168–172. [Link]
31.
Calafat M, Mañosa M, Cañete F, et al. Increased risk of thiopurine‐related adverse events in elderly patients with IBD. Aliment Pharmacol Ther 2019; 50: 780–788. [Link]
32.
Sturm A, Maaser C, Mendall M, et al. European Crohn’s and Colitis Organisation Topical Review on IBD in the Elderly: Table 1. ECCOJC 2016; jjw188. [Link]
33.
Beaugerie L, Rahier J-F, Kirchgesner J. Predicting, Preventing, and Managing Treatment-Related Complications in Patients With Inflammatory Bowel Diseases. Clinical Gastroenterology and Hepatology 2020; 18: 1324-1335.e2. [Link]
34.
Dahmus J, Rosario M, Clarke K. Risk of Lymphoma Associated with Anti-TNF Therapy in Patients with Inflammatory Bowel Disease: Implications for Therapy. CEG 2020; Volume 13: 339–350. [Link]
35.
Russell MD, Stovin C, Alveyn E, et al. JAK inhibitors and the risk of malignancy: a meta-analysis across disease indications. Ann Rheum Dis 2023; 82: 1059–1067. [Link]
36.
Shelton E, Laharie D, Scott FI, et al. Cancer Recurrence Following Immune-Suppressive Therapies in Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis. Gastroenterology 2016; 151: 97-109.e4. [Link]
37.
Gupta A, Peyrin-Biroulet L, Ananthakrishnan AN. Risk of Cancer Recurrence in Patients With Immune-Mediated Diseases With Use of Immunosuppressive Therapies: An Updated Systematic Review and Meta-Analysis. Clinical Gastroenterology and Hepatology 2024; 22: 499-512.e6. [Link]

Abstract

Peritoneal malignancies represent a complex and often misjudged clinical challenge. Historically synonymous with a terminal diagnosis, the advent of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) radically altered the prognosis for selected patients. However, progress has been jeopardised by a series of recurring and preventable errors in diagnosis, staging, and treatment selection. This article delineates the ten most critical pitfalls in managing peritoneal surface malignancies. For each pitfall, we provide evidence-based explanations, concrete clinical examples, and strategic recommendations for avoidance. We emphasise the pivotal role of early multidisciplinary discussion, precise imaging, and timely referral to high-volume expert centres to optimise patient outcomes and offer curative intent where previously there was none.

Topics

Digestive Oncology Surgery

Published

2026

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Mistakes in ostomy management and how to avoid them

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Ian White Ian White, Iris Dotan, Revital Barkan

UEG Mistakes In Articles
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

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

Log In Create a free account

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

Mistakes in Pancreatic exocrine insufficiency and how to avoid them

Miroslav Vujasinovic, J. Enrique Domínguez Muñoz, Matthias Löhr

Summary

AI Generated

Summary is not available for this content yet.

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.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9
1.
Gordon H, Biancone L, Fiorino G, et al. ECCO Guidelines on Inflammatory Bowel Disease and Malignancies. Journal of Crohn’s and Colitis 2023; 17: 827–854. [Link]
2.
McMillan C, Li DK, Mohamed G, et al. Longer Colonoscopy Withdrawal Time Is Associated With the Detection of Visible Dysplasia in Patients With Inflammatory Bowel Disease. Crohn’s & Colitis 360 2024; 6: otae020. [Link]
3.
Eder P, Łodyga M, Gawron-Kiszka M, et al. Guidelines for the management of ulcerative colitis. Recommendations of the Polish Society of Gastroenterology and the Polish National Consultant in Gastroenterology. pg 2023; 18: 1–42. [Link]
4.
Laukoetter MG, Mennigen R, Hannig CM, et al. Intestinal Cancer Risk in Crohn’s Disease: A Meta-Analysis. Journal of Gastrointestinal Surgery 2011; 15: 576–583. [Link]
5.
Hassan C, East J, Radaelli F, et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. Endoscopy 2019; 51: 775–794. [Link]
6.
Rao BB, Lashner B, Kowdley KV. Reviewing the Risk of Colorectal Cancer in Inflammatory Bowel Disease After Liver Transplantation for Primary Sclerosing Cholangitis. Inflammatory Bowel Diseases 2018; 24: 269–276. [Link]
7.
Shah SC, Itzkowitz SH. Reappraising Risk Factors for Inflammatory Bowel Disease-associated Neoplasia: Implications for Colonoscopic Surveillance in IBD. Journal of Crohn’s and Colitis 2020; 14: 1172–1177. [Link]
8.
Elford AT, Hirsch R, McKay OM, et al. Identifying the real‐world challenges of dysplasia surveillance in inflammatory bowel disease: a retrospective cohort study in a tertiary health network. Internal Medicine Journal 2024; 54: 96–103. [Link]
9.
Adamina M, Feakins R, Iacucci M, et al. ECCO Topical Review Optimising Reporting in Surgery, Endoscopy, and Histopathology. Journal of Crohn’s and Colitis 2021; 15: 1089–1105. [Link]
10.
Baars JE, Kuipers EJ, Dijkstra G, et al. Malignant transformation of perianal and enterocutaneous fistulas is rare: results of 17 years of follow-up from The Netherlands. Scandinavian Journal of Gastroenterology 2011; 46: 319–325. [Link]
11.
Trivedi PJ, Crothers H, Mytton J, et al. Effects of Primary Sclerosing Cholangitis on Risks of Cancer and Death in People With Inflammatory Bowel Disease, Based on Sex, Race, and Age. Gastroenterology 2020; 159: 915–928. [Link]
12.
Catanzaro E, Gringeri E, Burra P, et al. Primary Sclerosing Cholangitis-Associated Cholangiocarcinoma: From Pathogenesis to Diagnostic and Surveillance Strategies. Cancers 2023; 15: 4947. [Link]
13.
Sokol H, Cosnes J, Chazouilleres O, et al. Disease activity and cancer risk in inflammatory bowel disease associated with primary sclerosing cholangitis. WJG 2008; 14: 3497. [Link]
14.
Murthy SK, Feuerstein JD, Nguyen GC, et al. AGA Clinical Practice Update on Endoscopic Surveillance and Management of Colorectal Dysplasia in Inflammatory Bowel Diseases: Expert Review. Gastroenterology 2021; 161: 1043-1051.e4. [Link]
15.
Aparicio T, Zaanan A, Mary F, et al. Small Bowel Adenocarcinoma. Gastroenterology Clinics of North America 2016; 45: 447–457. [Link]
16.
Lo B, Zhao M, Vind I, et al. The Risk of Extraintestinal Cancer in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis of Population-based Cohort Studies. Clinical Gastroenterology and Hepatology 2021; 19: 1117-1138.e19. [Link]
17.
Beaugerie L, Brousse N, Bouvier AM, et al. Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. The Lancet 2009; 374: 1617–1625. [Link]
18.
Afif W, Sandborn WJ, Faubion WA, et al. Risk Factors for Lymphoma in Patients with Inflammatory Bowel Disease: A Case-control Study. Inflammatory Bowel Diseases 2013; 19: 1384–1389. [Link]
19.
Pedersen N, Duricova D, Elkjaer M, et al. Risk of Extra-Intestinal Cancer in Inflammatory Bowel Disease: Meta-Analysis of Population-Based Cohort Studies. American Journal of Gastroenterology 2010; 105: 1480–1487. [Link]
20.
Yu J, Refsum E, Wieszczy P, et al. Risk of malignant lymphomas in patients with inflammatory bowel disease: a population-based cohort study. BMJ Open Gastroenterol 2023; 10: e001037. [Link]
21.
Tulewicz-Marti E, Stępień-Wrochna B, Maciejewska K, et al. Awareness and Compliance with the Recommendations of Primary and Secondary Prevention of Cancer in Patients with Inflammatory Bowel Disease. JPM 2023; 13: 913. [Link]
22.
Huang S, Liu Z, Liao W, et al. Risk of skin cancers in thiopurines‐treated and thiopurines‐untreated patients with inflammatory bowel disease: A systematic review and meta‐analysis. J of Gastro and Hepatol 2019; 34: 507–516. [Link]
23.
Ariyaratnam J, Subramanian V. Association Between Thiopurine Use and Nonmelanoma Skin Cancers in Patients With Inflammatory Bowel Disease: A Meta-Analysis. American Journal of Gastroenterology 2014; 109: 163–169. [Link]
24.
Kreher MA, Noland MMB, Konda S, et al. Risk of melanoma and nonmelanoma skin cancer with immunosuppressants, part I: Calcineurin inhibitors, thiopurines, IMDH inhibitors, mTOR inhibitors, and corticosteroids. Journal of the American Academy of Dermatology 2023; 88: 521–530. [Link]
25.
Hazenberg HMJL, De Boer NKH, Mulder CJJ, et al. Neoplasia and Precursor Lesions of the Female Genital Tract in IBD: Epidemiology, Role of Immunosuppressants, and Clinical Implications. Inflammatory Bowel Diseases 2018; 24: 510–531. [Link]
26.
Kim SC, Glynn RJ, Giovannucci E, et al. Risk of high-grade cervical dysplasia and cervical cancer in women with systemic inflammatory diseases: a population-based cohort study. Ann Rheum Dis 2015; 74: 1360–1367. [Link]
27.
Allegretti JR, Barnes EL, Cameron A. Are Patients with Inflammatory Bowel Disease on Chronic Immunosuppressive Therapy at Increased Risk of Cervical High-grade Dysplasia/Cancer? A Meta-analysis: Inflammatory Bowel Diseases 2015; 21: 1089–1097. [Link]
28.
Goetgebuer RL, Kreijne JE, Aitken CA, et al. Increased Risk of High-grade Cervical Neoplasia in Women with Inflammatory Bowel Disease: A Case-controlled Cohort Study. Journal of Crohn’s and Colitis 2021; 15: 1464–1473. [Link]
29.
De Francisco R, Castaño‐García A, Martínez‐González S, et al. Impact of Epstein‐Barr virus serological status on clinical outcomes in adult patients with inflammatory bowel disease. Aliment Pharmacol Ther 2018; 48: 723–730. [Link]
30.
Al-Bawardy B, Alfadley AF, Almousallam M, et al. Epstein-Barr virus seroprevalence among inflammatory bowel disease patients in Saudi Arabia. Saudi Journal of Gastroenterology 2024; 30: 168–172. [Link]
31.
Calafat M, Mañosa M, Cañete F, et al. Increased risk of thiopurine‐related adverse events in elderly patients with IBD. Aliment Pharmacol Ther 2019; 50: 780–788. [Link]
32.
Sturm A, Maaser C, Mendall M, et al. European Crohn’s and Colitis Organisation Topical Review on IBD in the Elderly: Table 1. ECCOJC 2016; jjw188. [Link]
33.
Beaugerie L, Rahier J-F, Kirchgesner J. Predicting, Preventing, and Managing Treatment-Related Complications in Patients With Inflammatory Bowel Diseases. Clinical Gastroenterology and Hepatology 2020; 18: 1324-1335.e2. [Link]
34.
Dahmus J, Rosario M, Clarke K. Risk of Lymphoma Associated with Anti-TNF Therapy in Patients with Inflammatory Bowel Disease: Implications for Therapy. CEG 2020; Volume 13: 339–350. [Link]
35.
Russell MD, Stovin C, Alveyn E, et al. JAK inhibitors and the risk of malignancy: a meta-analysis across disease indications. Ann Rheum Dis 2023; 82: 1059–1067. [Link]
36.
Shelton E, Laharie D, Scott FI, et al. Cancer Recurrence Following Immune-Suppressive Therapies in Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis. Gastroenterology 2016; 151: 97-109.e4. [Link]
37.
Gupta A, Peyrin-Biroulet L, Ananthakrishnan AN. Risk of Cancer Recurrence in Patients With Immune-Mediated Diseases With Use of Immunosuppressive Therapies: An Updated Systematic Review and Meta-Analysis. Clinical Gastroenterology and Hepatology 2024; 22: 499-512.e6. [Link]

Abstract

Pancreatic exocrine insufficiency (PEI) is a common yet frequently under-recognised cause of maldigestion, malabsorption, and malnutrition. Although traditionally associated with primary pancreatic disorders such as chronic pancreatitis, cystic fibrosis, pancreatic cancer, or pancreatic surgery, it is now evident that PEI also occurs in a wide range of extra-pancreatic conditions and clinical settings. Advances in diagnostic testing and expanding clinical awareness have improved detection; however, significant misconceptions persist regarding when to suspect PEI; how to interpret diagnostic tests; and how to initiate, optimise, and monitor pancreatic enzyme replacement therapy (PERT). In everyday practice, these errors may lead to delayed diagnosis, inappropriate treatment, persistent symptoms, and preventable nutritional deficiencies. This “Mistakes in…” article highlights common pitfalls in the diagnosis and management of PEI, focusing on inappropriate reliance on faecal elastase testing, failure to recognise secondary causes, undertreatment with PERT, and inadequate nutritional assessment. By addressing these frequent mistakes, we aim to promote a more structured, patient-centred, and evidence-informed approach to PEI that improves clinical outcomes and quality of life.

Topics

Pancreas

Published

2026

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Mistakes in ostomy management and how to avoid them

Mistakes in ostomy management and how to avoid them

Ian White Ian White, Iris Dotan, Revital Barkan

UEG Mistakes In Articles
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Mistakes in transjugular intrahepatic portosystemic shunt (TIPS) in cirrhosis and how to avoid them

Kymentie Ferdinande, Alberto Zanetto, Virginia Hernández-Gea, Marco Senzolo

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References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9
1.
Gordon H, Biancone L, Fiorino G, et al. ECCO Guidelines on Inflammatory Bowel Disease and Malignancies. Journal of Crohn’s and Colitis 2023; 17: 827–854. [Link]
2.
McMillan C, Li DK, Mohamed G, et al. Longer Colonoscopy Withdrawal Time Is Associated With the Detection of Visible Dysplasia in Patients With Inflammatory Bowel Disease. Crohn’s & Colitis 360 2024; 6: otae020. [Link]
3.
Eder P, Łodyga M, Gawron-Kiszka M, et al. Guidelines for the management of ulcerative colitis. Recommendations of the Polish Society of Gastroenterology and the Polish National Consultant in Gastroenterology. pg 2023; 18: 1–42. [Link]
4.
Laukoetter MG, Mennigen R, Hannig CM, et al. Intestinal Cancer Risk in Crohn’s Disease: A Meta-Analysis. Journal of Gastrointestinal Surgery 2011; 15: 576–583. [Link]
5.
Hassan C, East J, Radaelli F, et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. Endoscopy 2019; 51: 775–794. [Link]
6.
Rao BB, Lashner B, Kowdley KV. Reviewing the Risk of Colorectal Cancer in Inflammatory Bowel Disease After Liver Transplantation for Primary Sclerosing Cholangitis. Inflammatory Bowel Diseases 2018; 24: 269–276. [Link]
7.
Shah SC, Itzkowitz SH. Reappraising Risk Factors for Inflammatory Bowel Disease-associated Neoplasia: Implications for Colonoscopic Surveillance in IBD. Journal of Crohn’s and Colitis 2020; 14: 1172–1177. [Link]
8.
Elford AT, Hirsch R, McKay OM, et al. Identifying the real‐world challenges of dysplasia surveillance in inflammatory bowel disease: a retrospective cohort study in a tertiary health network. Internal Medicine Journal 2024; 54: 96–103. [Link]
9.
Adamina M, Feakins R, Iacucci M, et al. ECCO Topical Review Optimising Reporting in Surgery, Endoscopy, and Histopathology. Journal of Crohn’s and Colitis 2021; 15: 1089–1105. [Link]
10.
Baars JE, Kuipers EJ, Dijkstra G, et al. Malignant transformation of perianal and enterocutaneous fistulas is rare: results of 17 years of follow-up from The Netherlands. Scandinavian Journal of Gastroenterology 2011; 46: 319–325. [Link]
11.
Trivedi PJ, Crothers H, Mytton J, et al. Effects of Primary Sclerosing Cholangitis on Risks of Cancer and Death in People With Inflammatory Bowel Disease, Based on Sex, Race, and Age. Gastroenterology 2020; 159: 915–928. [Link]
12.
Catanzaro E, Gringeri E, Burra P, et al. Primary Sclerosing Cholangitis-Associated Cholangiocarcinoma: From Pathogenesis to Diagnostic and Surveillance Strategies. Cancers 2023; 15: 4947. [Link]
13.
Sokol H, Cosnes J, Chazouilleres O, et al. Disease activity and cancer risk in inflammatory bowel disease associated with primary sclerosing cholangitis. WJG 2008; 14: 3497. [Link]
14.
Murthy SK, Feuerstein JD, Nguyen GC, et al. AGA Clinical Practice Update on Endoscopic Surveillance and Management of Colorectal Dysplasia in Inflammatory Bowel Diseases: Expert Review. Gastroenterology 2021; 161: 1043-1051.e4. [Link]
15.
Aparicio T, Zaanan A, Mary F, et al. Small Bowel Adenocarcinoma. Gastroenterology Clinics of North America 2016; 45: 447–457. [Link]
16.
Lo B, Zhao M, Vind I, et al. The Risk of Extraintestinal Cancer in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis of Population-based Cohort Studies. Clinical Gastroenterology and Hepatology 2021; 19: 1117-1138.e19. [Link]
17.
Beaugerie L, Brousse N, Bouvier AM, et al. Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. The Lancet 2009; 374: 1617–1625. [Link]
18.
Afif W, Sandborn WJ, Faubion WA, et al. Risk Factors for Lymphoma in Patients with Inflammatory Bowel Disease: A Case-control Study. Inflammatory Bowel Diseases 2013; 19: 1384–1389. [Link]
19.
Pedersen N, Duricova D, Elkjaer M, et al. Risk of Extra-Intestinal Cancer in Inflammatory Bowel Disease: Meta-Analysis of Population-Based Cohort Studies. American Journal of Gastroenterology 2010; 105: 1480–1487. [Link]
20.
Yu J, Refsum E, Wieszczy P, et al. Risk of malignant lymphomas in patients with inflammatory bowel disease: a population-based cohort study. BMJ Open Gastroenterol 2023; 10: e001037. [Link]
21.
Tulewicz-Marti E, Stępień-Wrochna B, Maciejewska K, et al. Awareness and Compliance with the Recommendations of Primary and Secondary Prevention of Cancer in Patients with Inflammatory Bowel Disease. JPM 2023; 13: 913. [Link]
22.
Huang S, Liu Z, Liao W, et al. Risk of skin cancers in thiopurines‐treated and thiopurines‐untreated patients with inflammatory bowel disease: A systematic review and meta‐analysis. J of Gastro and Hepatol 2019; 34: 507–516. [Link]
23.
Ariyaratnam J, Subramanian V. Association Between Thiopurine Use and Nonmelanoma Skin Cancers in Patients With Inflammatory Bowel Disease: A Meta-Analysis. American Journal of Gastroenterology 2014; 109: 163–169. [Link]
24.
Kreher MA, Noland MMB, Konda S, et al. Risk of melanoma and nonmelanoma skin cancer with immunosuppressants, part I: Calcineurin inhibitors, thiopurines, IMDH inhibitors, mTOR inhibitors, and corticosteroids. Journal of the American Academy of Dermatology 2023; 88: 521–530. [Link]
25.
Hazenberg HMJL, De Boer NKH, Mulder CJJ, et al. Neoplasia and Precursor Lesions of the Female Genital Tract in IBD: Epidemiology, Role of Immunosuppressants, and Clinical Implications. Inflammatory Bowel Diseases 2018; 24: 510–531. [Link]
26.
Kim SC, Glynn RJ, Giovannucci E, et al. Risk of high-grade cervical dysplasia and cervical cancer in women with systemic inflammatory diseases: a population-based cohort study. Ann Rheum Dis 2015; 74: 1360–1367. [Link]
27.
Allegretti JR, Barnes EL, Cameron A. Are Patients with Inflammatory Bowel Disease on Chronic Immunosuppressive Therapy at Increased Risk of Cervical High-grade Dysplasia/Cancer? A Meta-analysis: Inflammatory Bowel Diseases 2015; 21: 1089–1097. [Link]
28.
Goetgebuer RL, Kreijne JE, Aitken CA, et al. Increased Risk of High-grade Cervical Neoplasia in Women with Inflammatory Bowel Disease: A Case-controlled Cohort Study. Journal of Crohn’s and Colitis 2021; 15: 1464–1473. [Link]
29.
De Francisco R, Castaño‐García A, Martínez‐González S, et al. Impact of Epstein‐Barr virus serological status on clinical outcomes in adult patients with inflammatory bowel disease. Aliment Pharmacol Ther 2018; 48: 723–730. [Link]
30.
Al-Bawardy B, Alfadley AF, Almousallam M, et al. Epstein-Barr virus seroprevalence among inflammatory bowel disease patients in Saudi Arabia. Saudi Journal of Gastroenterology 2024; 30: 168–172. [Link]
31.
Calafat M, Mañosa M, Cañete F, et al. Increased risk of thiopurine‐related adverse events in elderly patients with IBD. Aliment Pharmacol Ther 2019; 50: 780–788. [Link]
32.
Sturm A, Maaser C, Mendall M, et al. European Crohn’s and Colitis Organisation Topical Review on IBD in the Elderly: Table 1. ECCOJC 2016; jjw188. [Link]
33.
Beaugerie L, Rahier J-F, Kirchgesner J. Predicting, Preventing, and Managing Treatment-Related Complications in Patients With Inflammatory Bowel Diseases. Clinical Gastroenterology and Hepatology 2020; 18: 1324-1335.e2. [Link]
34.
Dahmus J, Rosario M, Clarke K. Risk of Lymphoma Associated with Anti-TNF Therapy in Patients with Inflammatory Bowel Disease: Implications for Therapy. CEG 2020; Volume 13: 339–350. [Link]
35.
Russell MD, Stovin C, Alveyn E, et al. JAK inhibitors and the risk of malignancy: a meta-analysis across disease indications. Ann Rheum Dis 2023; 82: 1059–1067. [Link]
36.
Shelton E, Laharie D, Scott FI, et al. Cancer Recurrence Following Immune-Suppressive Therapies in Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis. Gastroenterology 2016; 151: 97-109.e4. [Link]
37.
Gupta A, Peyrin-Biroulet L, Ananthakrishnan AN. Risk of Cancer Recurrence in Patients With Immune-Mediated Diseases With Use of Immunosuppressive Therapies: An Updated Systematic Review and Meta-Analysis. Clinical Gastroenterology and Hepatology 2024; 22: 499-512.e6. [Link]

Abstract

TIPS success is rarely about the procedure alone. It depends on decisions made across the entire clinical pathway.

New in the UEG "Mistakes in…" series: Ferdinande et al., present 10 common mistakes in TIPS for cirrhosis, from referral to long-term follow-up.

Key themes:
• Screen the heart first: cardiac decompensation follows TIPS in up to 20% of patients.
• Refer early: delay costs survival in refractory ascites and high-risk variceal bleeding.
• Prevent encephalopathy by design: careful selection, nutrition, rifaximin, and controlled underdilation.
• Individualise haemodynamic targets and follow up structurally.

Topics

Hepatobiliary Surgery

Published

2026

More Like This:

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Mistakes in Pancreatic exocrine insufficiency and how to avoid them

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Matthias Löhr Matthias Löhr, J. Enrique Domínguez Muñoz, Miroslav Vujasinovic

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Mistakes in ostomy management and how to avoid them

Mistakes in ostomy management and how to avoid them

Ian White Ian White, Iris Dotan, Revital Barkan

UEG Mistakes In Articles
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Log in to continue.

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

Log In Create a free account

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

Mistakes in abdominal distension and how to avoid them

Elizabeth Barba Orozco, Alberto Ezquerra-Durán

Summary

AI Generated

Summary is not available for this content yet.

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.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9
1.
Gordon H, Biancone L, Fiorino G, et al. ECCO Guidelines on Inflammatory Bowel Disease and Malignancies. Journal of Crohn’s and Colitis 2023; 17: 827–854. [Link]
2.
McMillan C, Li DK, Mohamed G, et al. Longer Colonoscopy Withdrawal Time Is Associated With the Detection of Visible Dysplasia in Patients With Inflammatory Bowel Disease. Crohn’s & Colitis 360 2024; 6: otae020. [Link]
3.
Eder P, Łodyga M, Gawron-Kiszka M, et al. Guidelines for the management of ulcerative colitis. Recommendations of the Polish Society of Gastroenterology and the Polish National Consultant in Gastroenterology. pg 2023; 18: 1–42. [Link]
4.
Laukoetter MG, Mennigen R, Hannig CM, et al. Intestinal Cancer Risk in Crohn’s Disease: A Meta-Analysis. Journal of Gastrointestinal Surgery 2011; 15: 576–583. [Link]
5.
Hassan C, East J, Radaelli F, et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019. Endoscopy 2019; 51: 775–794. [Link]
6.
Rao BB, Lashner B, Kowdley KV. Reviewing the Risk of Colorectal Cancer in Inflammatory Bowel Disease After Liver Transplantation for Primary Sclerosing Cholangitis. Inflammatory Bowel Diseases 2018; 24: 269–276. [Link]
7.
Shah SC, Itzkowitz SH. Reappraising Risk Factors for Inflammatory Bowel Disease-associated Neoplasia: Implications for Colonoscopic Surveillance in IBD. Journal of Crohn’s and Colitis 2020; 14: 1172–1177. [Link]
8.
Elford AT, Hirsch R, McKay OM, et al. Identifying the real‐world challenges of dysplasia surveillance in inflammatory bowel disease: a retrospective cohort study in a tertiary health network. Internal Medicine Journal 2024; 54: 96–103. [Link]
9.
Adamina M, Feakins R, Iacucci M, et al. ECCO Topical Review Optimising Reporting in Surgery, Endoscopy, and Histopathology. Journal of Crohn’s and Colitis 2021; 15: 1089–1105. [Link]
10.
Baars JE, Kuipers EJ, Dijkstra G, et al. Malignant transformation of perianal and enterocutaneous fistulas is rare: results of 17 years of follow-up from The Netherlands. Scandinavian Journal of Gastroenterology 2011; 46: 319–325. [Link]
11.
Trivedi PJ, Crothers H, Mytton J, et al. Effects of Primary Sclerosing Cholangitis on Risks of Cancer and Death in People With Inflammatory Bowel Disease, Based on Sex, Race, and Age. Gastroenterology 2020; 159: 915–928. [Link]
12.
Catanzaro E, Gringeri E, Burra P, et al. Primary Sclerosing Cholangitis-Associated Cholangiocarcinoma: From Pathogenesis to Diagnostic and Surveillance Strategies. Cancers 2023; 15: 4947. [Link]
13.
Sokol H, Cosnes J, Chazouilleres O, et al. Disease activity and cancer risk in inflammatory bowel disease associated with primary sclerosing cholangitis. WJG 2008; 14: 3497. [Link]
14.
Murthy SK, Feuerstein JD, Nguyen GC, et al. AGA Clinical Practice Update on Endoscopic Surveillance and Management of Colorectal Dysplasia in Inflammatory Bowel Diseases: Expert Review. Gastroenterology 2021; 161: 1043-1051.e4. [Link]
15.
Aparicio T, Zaanan A, Mary F, et al. Small Bowel Adenocarcinoma. Gastroenterology Clinics of North America 2016; 45: 447–457. [Link]
16.
Lo B, Zhao M, Vind I, et al. The Risk of Extraintestinal Cancer in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis of Population-based Cohort Studies. Clinical Gastroenterology and Hepatology 2021; 19: 1117-1138.e19. [Link]
17.
Beaugerie L, Brousse N, Bouvier AM, et al. Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. The Lancet 2009; 374: 1617–1625. [Link]
18.
Afif W, Sandborn WJ, Faubion WA, et al. Risk Factors for Lymphoma in Patients with Inflammatory Bowel Disease: A Case-control Study. Inflammatory Bowel Diseases 2013; 19: 1384–1389. [Link]
19.
Pedersen N, Duricova D, Elkjaer M, et al. Risk of Extra-Intestinal Cancer in Inflammatory Bowel Disease: Meta-Analysis of Population-Based Cohort Studies. American Journal of Gastroenterology 2010; 105: 1480–1487. [Link]
20.
Yu J, Refsum E, Wieszczy P, et al. Risk of malignant lymphomas in patients with inflammatory bowel disease: a population-based cohort study. BMJ Open Gastroenterol 2023; 10: e001037. [Link]
21.
Tulewicz-Marti E, Stępień-Wrochna B, Maciejewska K, et al. Awareness and Compliance with the Recommendations of Primary and Secondary Prevention of Cancer in Patients with Inflammatory Bowel Disease. JPM 2023; 13: 913. [Link]
22.
Huang S, Liu Z, Liao W, et al. Risk of skin cancers in thiopurines‐treated and thiopurines‐untreated patients with inflammatory bowel disease: A systematic review and meta‐analysis. J of Gastro and Hepatol 2019; 34: 507–516. [Link]
23.
Ariyaratnam J, Subramanian V. Association Between Thiopurine Use and Nonmelanoma Skin Cancers in Patients With Inflammatory Bowel Disease: A Meta-Analysis. American Journal of Gastroenterology 2014; 109: 163–169. [Link]
24.
Kreher MA, Noland MMB, Konda S, et al. Risk of melanoma and nonmelanoma skin cancer with immunosuppressants, part I: Calcineurin inhibitors, thiopurines, IMDH inhibitors, mTOR inhibitors, and corticosteroids. Journal of the American Academy of Dermatology 2023; 88: 521–530. [Link]
25.
Hazenberg HMJL, De Boer NKH, Mulder CJJ, et al. Neoplasia and Precursor Lesions of the Female Genital Tract in IBD: Epidemiology, Role of Immunosuppressants, and Clinical Implications. Inflammatory Bowel Diseases 2018; 24: 510–531. [Link]
26.
Kim SC, Glynn RJ, Giovannucci E, et al. Risk of high-grade cervical dysplasia and cervical cancer in women with systemic inflammatory diseases: a population-based cohort study. Ann Rheum Dis 2015; 74: 1360–1367. [Link]
27.
Allegretti JR, Barnes EL, Cameron A. Are Patients with Inflammatory Bowel Disease on Chronic Immunosuppressive Therapy at Increased Risk of Cervical High-grade Dysplasia/Cancer? A Meta-analysis: Inflammatory Bowel Diseases 2015; 21: 1089–1097. [Link]
28.
Goetgebuer RL, Kreijne JE, Aitken CA, et al. Increased Risk of High-grade Cervical Neoplasia in Women with Inflammatory Bowel Disease: A Case-controlled Cohort Study. Journal of Crohn’s and Colitis 2021; 15: 1464–1473. [Link]
29.
De Francisco R, Castaño‐García A, Martínez‐González S, et al. Impact of Epstein‐Barr virus serological status on clinical outcomes in adult patients with inflammatory bowel disease. Aliment Pharmacol Ther 2018; 48: 723–730. [Link]
30.
Al-Bawardy B, Alfadley AF, Almousallam M, et al. Epstein-Barr virus seroprevalence among inflammatory bowel disease patients in Saudi Arabia. Saudi Journal of Gastroenterology 2024; 30: 168–172. [Link]
31.
Calafat M, Mañosa M, Cañete F, et al. Increased risk of thiopurine‐related adverse events in elderly patients with IBD. Aliment Pharmacol Ther 2019; 50: 780–788. [Link]
32.
Sturm A, Maaser C, Mendall M, et al. European Crohn’s and Colitis Organisation Topical Review on IBD in the Elderly: Table 1. ECCOJC 2016; jjw188. [Link]
33.
Beaugerie L, Rahier J-F, Kirchgesner J. Predicting, Preventing, and Managing Treatment-Related Complications in Patients With Inflammatory Bowel Diseases. Clinical Gastroenterology and Hepatology 2020; 18: 1324-1335.e2. [Link]
34.
Dahmus J, Rosario M, Clarke K. Risk of Lymphoma Associated with Anti-TNF Therapy in Patients with Inflammatory Bowel Disease: Implications for Therapy. CEG 2020; Volume 13: 339–350. [Link]
35.
Russell MD, Stovin C, Alveyn E, et al. JAK inhibitors and the risk of malignancy: a meta-analysis across disease indications. Ann Rheum Dis 2023; 82: 1059–1067. [Link]
36.
Shelton E, Laharie D, Scott FI, et al. Cancer Recurrence Following Immune-Suppressive Therapies in Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis. Gastroenterology 2016; 151: 97-109.e4. [Link]
37.
Gupta A, Peyrin-Biroulet L, Ananthakrishnan AN. Risk of Cancer Recurrence in Patients With Immune-Mediated Diseases With Use of Immunosuppressive Therapies: An Updated Systematic Review and Meta-Analysis. Clinical Gastroenterology and Hepatology 2024; 22: 499-512.e6. [Link]

Abstract

Abdominal distension and bloating are among the most frequently misunderstood complaints in gastroenterology. They are often used as interchangeable terms, a conceptual mistake that continues to drive diagnostic errors and ineffective treatment. According to Rome IV, bloating and distension may represent either a primary disorder of gut–brain interaction (DGBI) or occur as symptoms with other DGBIs, such as irritable bowel syndrome (IBS), functional dyspepsia (FD) or functional constipation (FC).

Topics

Neurogastroenterology & Motility

Citation

Barba E and Ezquerra-Durán A. Mistakes in abdominal distension and bloating and how to avoid them. UEG Education 2026; 26: 5-9.

Published

2026

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How to become an advanced endoscopist with Katarzyna Pawlak and Paolo Giorgio Arcidiacono

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Abstract

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Mistakes in ostomy management and how to avoid them

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Ian White Ian White, Iris Dotan, Revital Barkan

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Mistakes in ostomy management and how to avoid them

Revital Barkan, Ian White, Iris Dotan

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References

Mistakes
References
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28.
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31.
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32.
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37.
Gupta A, Peyrin-Biroulet L, Ananthakrishnan AN. Risk of Cancer Recurrence in Patients With Immune-Mediated Diseases With Use of Immunosuppressive Therapies: An Updated Systematic Review and Meta-Analysis. Clinical Gastroenterology and Hepatology 2024; 22: 499-512.e6. [Link]

Abstract

Ostomy management refers to the care and maintenance of an ostomy and involves various aspects to ensure the individual’s health, comfort, and quality of life. This should involve the patient, a close support system (family and/or friends), and a healthcare team, including ostomy nurses and healthcare professionals specialising in ostomy care.

Topics

Primary Care

Published

2025

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