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Hepatitis B virus (HBV) infection is the most common chronic viral infection in the world. Despite the availability of a preventative vaccine, more than 250 million people worldwide are chronically infected with HBV. The complications of chronic HBV infection—cirrhosis and hepatocellular cancer (HCC)—account for more than 850,000 deaths per year. HBV is transmitted haematogenously and sexually, with the majority of HBV infections being transmitted vertically (or perinatally) in high prevalence regions. HBV infection acquired at birth or in early childhood results in chronicity in >95% of cases, whereas only 5–10% of those who are infected in adulthood will progress to chronic infection. 

Mistakes in chronic hepatitis B management and how to avoid them

Mistakes in chronic hepatitis B management and how to avoid them

Patrick Kennedy, Upkar S. Gill

Topics

Hepatobiliary

Citation

Gill US and Kennedy PTF. Mistakes in chronic hepatitis B management and how to avoid them. UEG Education 2019; 19: 22–24 

Published

2019
UEG Standards and Guidelines
Clinical Practice Guideline
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ABSTRACT

Importance

The lack of multidisciplinary workflow guidelines and clear definitions and classifications for neoplasms in and around the ampulla of Vater results in inconsistencies affecting patient care and research.

Objective

The PERIPAN international multidisciplinary consensus group aimed to standardize the multidisciplinary diagnostic workflow and achieve consensus on definitions and classifications in order to ensure proper classification and optimal diagnostic assessment and consequently to improve patient care and future research.

Design

An international team of 43 experts (pathologists, surgeons, radiologists, gastroenterologists, oncologists) from 12 countries identified knowledge gaps, reviewed 37061 articles, and proposed recommendations using the Scottish Intercollegiate Guidelines Network methodology (SIGN), including the Delphi methodology and the AGREEII tool for quality assessment and external validation.

Results

The 38 consensus questions and 51 recommendations provide guidance on the following key aspects: I. More specific anatomic criteria for the definition of what qualifies as “ampullary” neoplasms, their distinction from duodenal and common bile duct tumors, and clinicopathologic characteristics of anatomic subsets; II. Avoidance of the confusing term “periampullary” for final classification; III. Refined definitions of intestinal, pancreatobiliary and mixed subtypes, and introduction of rare histologic subtypes; IV. The use and limitations of immunohistochemical and molecular profiling; V. Biopsy acquisition; VI. Clinical information required for accurate pathology assessment of biopsies and ampullectomy specimens; VII. Key items to be included in pathology reports of endoscopic specimens.

Conclusions and Relevance

Recognition of the Brescia PERIPAN guidelines will allow a more accurate classification of true ampullary cancers and their differentiation from other “periampullary” tumors. This will have significant implications for endoscopic interpretation and management, staging, pathologic diagnosis and therapeutic evaluation as well as oncologic treatment of various anatomic and histologic subsets of ampullary tumors. This will enhance the quality of both clinical care and future research in this complex medical field.

The Brescia International Multidisciplinary Consensus Guidelines on the Optimal Pathology Assessment and Multidisciplinary Pathways of Non-Pancreatic Neoplasms in and Around the Ampulla of Vater (PERIPAN)

The Brescia International Multidisciplinary Consensus Guidelines on the Optimal Pathology Assessment and Multidisciplinary Pathways of Non-Pancreatic Neoplasms in and Around the Ampulla of Vater (PERIPAN)

Mohammad Abu Hilal

Guideline

Clinical Practice Guideline

Topics

Digestive Oncology

Citation

United European Gastroenterology Journal: 1–21.

Published

2025
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The relationship between nutrition and inflammatory bowel disease (IBD) has been an area of substantial interest and research for many decades now. Evidence-based nutritional strategies are being utilised as a key part of the therapeutic armamentarium in Crohn’s disease for both induction and maintenance, as primary and adjuvant treatment methods. Exclusive enteral nutrition, for instance, is well established in the treatment of paediatric IBD and adult centres are increasingly incorporating it into treatment models as an effective, drug-free alternative.  The role for partial enteral nutrition and Crohn’s disease specific diets are also being more clearly elucidated. Used appropriately, and through engagement with dietetic support services, nutritional therapies can not only achieve the IBD treatment ‘targets’ but serve to optimise other vital aspects of care, such as growth, bone health, body composition and overall patient well-being. Here we discuss some of the mistakes that are frequently made in the area of nutritional management of IBD. The discussion is evidence based, with key references incorporated for further analysis beyond the scope of this article, and combines several decades of leading clinical and research experience in the area of nutrition and IBD from the authors. 


Mistakes in nutrition in IBD and how to avoid them

Mistakes in nutrition in IBD and how to avoid them

Richard K Russell, Konstantinos Gerasimidis

Topics

Small Intestine & Nutrition

Citation

Meredith J, Russell RK and Gerasimidis K. Mistakes in nutrition in IBD and how to avoid them. UEG Education 2020; 20: 25–30.

Published

2020
UEG Mistakes In Articles
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Children and adolescents with chronic diseases requiring lifelong care face unique challenges that affect their daily lives and those of their families. Initially, these patients receive specialized care in pediatric facilities, where parents play a key role in treatment decisions. However, transitioning to adult healthcare facilities is inevitable, and this process, recognized as crucial years ago, involves moving adolescents with chronic conditions from child-centered to adult-oriented care. This transition can be complicated by varying age limits for pediatric care and the scarcity of adult care centers with specific expertise. The transition often requires cooperation between different centers or even countries due to patient mobility. The transition phase is critical, as it can lead to loss of follow-up, treatment suspension, and increased risks of complications or disease relapse. Beyond medical management, various factors influence the long-term prognosis of chronic conditions, making a well-organized transition program essential. While many hospitals have implemented transition models with mixed results in satisfaction, disease control, and follow-up adherence, there are frequent shortcomings in the process. This Mistakes In article will outline eight common mistakes made during the transition from pediatric to adult care, supported by literature and professional experience.

Mistakes in transitional care for children and young adults and how  to avoid them

Mistakes in transitional care for children and young adults and how to avoid them

Patrizia Burra, Hans Törnblom, Jorge Amil Dias, Moriam Mustapha

Topics

Primary Care

Citation

Jorge Amil-Dias, Hans Törnblom, Moriam Mustapha and Patrizia Burra. Mistakes in transitional care for children and young adults and how to avoid them. UEG Education 2023; 23: 22-25.

Published

2023
UEG Mistakes In Articles
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Ulcerative colitis (UC) is a lifelong inflammatory bowel disease (IBD) of unknown origin characterized by alternating flare and remission periods. An acute severe episode, so-called acute severe UC (ASUC), may happen in approximately one-quarter of patients during their life.1 Notably, more than 25% of ASUC episodes correspond to the index presentation of the disease. Patients with ASUC should be promptly identified by the modified Truelove and Witts criteria recommended by the most recent international guidelines and admitted rapidly to a digestive unit. Indeed, ASUC is a life-threatening condition still leading to a 1% death rate in Western countries. In the current article, we will discuss the most frequent and/or relevant mistakes in managing patients admitted for an ASUC episode and how to avoid them. The manuscript is based on the available evidence and expert opinion when evidence is lacking.

Mistakes in acute severe ulcerative colitis and how to avoid them

Mistakes in acute severe ulcerative colitis and how to avoid them

David Laharie

Topics

IBD

Citation

David Laharie. Mistakes in acute severe ulcerative colitis and how to avoid them. UEG Education 2023; 23: 19-21.

Published

2023
UEG Standards and Guidelines
Position Paper
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Summary of Recommendations

1 ESGE recommends that each center implements a written policy regarding the management of iatrogenic perforations, including the definition of procedures that carry a higher risk of this complication. This policy should be shared with the radiologists and surgeons at each center.

2 ESGE recommends that in the case of an endoscopically identified perforation, the endoscopist reports its size and location, with an image, and statement of the endoscopic treatment that has been applied.

3 ESGE recommends that symptoms or signs suggestive of iatrogenic perforation after an endoscopic procedure should be rapidly and carefully evaluated and documented with a computed tomography (CT) scan.

4 ESGE recommends that endoscopic closure should be considered depending on the type of the iatrogenic perforation, its size, and the endoscopist expertise available at the center. Switch to carbon dioxide (CO2) endoscopic insufflation, diversion of digestive luminal content, and decompression of tension pneumoperitoneum or pneumothorax should also be performed.

5 ESGE recommends that after endoscopic closure of an iatrogenic perforation, further management should be based on the estimated success of the endoscopic closure and on the general clinical condition of the patient. In the case of no or failed endoscopic closure of an iatrogenic perforation, and in patients whose clinical condition is deteriorating, hospitalization and surgical consultation are recommended.

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement – Update 2020

Gregorios A. Paspatis

Publisher

European Society of Gastrointestinal Endoscopy logo
European Society of Gastrointestinal Endoscopy

Guideline

Position Paper

Topics

Endoscopy

Citation

Endoscopy 2020; 52(09): 792-810

Published

2020
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Clinical Practice Guideline
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Summary

Vascular diseases of the liver include portal vein thrombosis (with or without cirrhosis), portosinusoidal vascular disorder, Budd-Chiari syndrome, sinusoidal obstruction syndrome, non-obstructive sinusoidal dilatation and peliosis, splanchnic artery aneurysms, and hepatic arteriovenous fistulas. Except for portal vein thrombosis in cirrhosis, these are all rare conditions. Since the last Clinical Practice Guidelines were issued by the European Association for the Study of the Liver in 2016, much data has been published on the diagnosis and management – medical and interventional – of patients with vascular liver diseases. Based on a thorough review of the relevant literature, recommendations are provided to address key clinical dilemmas. The document emphasises personalised care, considering individual risk factors and clinical presentation. Multidisciplinary management involving hepatologists, haematologists, pathologists, interventional radiologists and surgeons is essential in this area. Our aim is to provide guidance on the management of patients with vascular liver diseases based on the best available evidence.

EASL Clinical Practice Guidelines on vascular diseases of the liver

EASL Clinical Practice Guidelines on vascular diseases of the liver

Publisher

European Association for the Study of the Liver logo
European Association for the Study of the Liver

Guideline

Clinical Practice Guideline

Topics

Hepatobiliary

Citation

Journal of Hepatology; Volume 84, Issue 2, 399-456

Published

2025
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