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Mistakes in hepatitis C and how to avoid them

Ana Catarina Garcia, Gonçalo Alexandrino

Summary

AI Generated

Hepatitis C virus infection affects approximately 50 million people globally, and while direct-acting antivirals achieve over 97% cure rates, significant barriers in diagnosis, treatment access, and disease awareness persist.

  • HCV causes around 1 million new infections and 242,000 deaths annually, with 55–85% of acute infections progressing to chronic disease that often remains silent until advanced liver damage occurs.
  • Untreated chronic HCV can lead to liver cirrhosis and hepatocellular carcinoma, with transmission occurring primarily through percutaneous blood exposure, and less commonly through vertical or sexual routes.
  • Oral direct-acting antivirals demonstrate remarkable safety and effectiveness, achieving sustained virological response in over 97% of patients regardless of genotype or disease stage.
  • Despite highly effective treatments, significant barriers remain in diagnosis, treatment access, and disease awareness that limit HCV management.
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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.
World Health Organization (WHO). Hepatitis C-Key facts, https://www.who.int/news-room/fact-sheets/detail/hepatitis-c (accessed 23 April 2025). [Link]
2.
Sallam M, Khalil R. Contemporary Insights into Hepatitis C Virus: A Comprehensive Review. Microorganisms 2024; 12: 1035. [Link]
3.
Reiberger T, Lens S, Cabibbo G, et al. EASL position paper on clinical follow-up after HCV cure. J Hepatol 2024; 81: 326–344. [Link]
4.
Krassenburg LAP, Zanjir WR, Georgie F, et al. Evaluation of Sustained Virologic Response as a Relevant Surrogate Endpoint for Long-term Outcomes of Hepatitis C Virus Infection. Clin Infect Dis 2021; 72: 780–786. [Link]
5.
Pawlotsky J-M, Negro F, Aghemo A, et al. EASL recommendations on treatment of hepatitis C: Final update of the series☆. J Hepatol 2020; 73: 1170–1218. [Link]
6.
Schillie S, Wester C, Osborne M, et al. CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020. MMWR Recomm Rep 2020; 69: 1–17. [Link]
7.
Terrault NA. Hepatitis C elimination: challenges with under-diagnosis and under-treatment. F1000Research 2019; 8: 54. [Link]
8.
World Health Organization (WHO). Updated recommendations on simplified service delivery and diagnostics for hepatitis C infection, https://www.who.int/publications/i/item/9789240052697 (accessed 23 April 2025). [Link]
9.
World Health Organization (WHO). Global health sector strategies on HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030, https://www.who.int/publications/i/item/9789240053779 (accessed 23 April 2025). [Link]
10.
Centers for Disease Control and Prevention. Clinical Screening and Diagnosis for Hepatitis C, https://www.cdc.gov/hepatitis-c/hcp/diagnosis-testing/index.html (2025, accessed 23 April 2025). [Link]
11.
World Health Organization (WHO). Recommendations and guidance on hepatitis C virus self-testing, https://www.who.int/publications/i/item/9789240031128 (accessed 23 April 2025). [Link]
12.
American Association for the Study of Liver Diseases, Infectious Diseases Society of America. Clinical Practice Guidance for Testing, Managing, and Treating Hepatitis C Virus Infection: 2023 Update, https://www.hcvguidelines.org/ (accessed 23 April 2025). [Link]
13.
Trickey A, Fraser H, Lim AG, et al. The contribution of injection drug use to hepatitis C virus transmission globally, regionally, and at country level: a modelling study. Lancet Gastroenterol Hepatol 2019; 4: 435–444. [Link]
14.
Tacke F, Horn P, Wai-Sun Wong V, et al. EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol 2024; 81: 492–542. [Link]
15.
Gonzalez-Aldaco K, Torres-Reyes LA, Ojeda-Granados C, et al. Metabolic Dysfunction-Associated Steatotic Liver Disease in Chronic Hepatitis C Virus Infection: From Basics to Clinical and Nutritional Management. Clin Pract 2024; 14: 2542–2558. [Link]
16.
Fuster D, García-Calvo X, Zuluaga P, et al. Assessment of liver disease in patients with chronic hepatitis C and unhealthy alcohol use. World J Gastroenterol 2021; 27: 3223–3237. [Link]
17.
Taylor AL, Denniston MM, Klevens RM, et al. Association of Hepatitis C Virus With Alcohol Use Among U.S. Adults: NHANES 2003–2010. Am J Prev Med 2016; 51: 206–215. [Link]
18.
Idilman R. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. Turk J Gastroenterol 2017; 28: 412–416. [Link]
19.
Hernandez MD, Sherman KE. HIV/hepatitis C coinfection natural history and disease progression: Curr Opin HIV AIDS 2011; 6: 478–482. [Link]
20.
Vento S. Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. J Viral Hepat 2000; 7: 7–8. [Link]
21.
Dhanasekaran R, Kwo PY. Hepatitis C and Hepatocellular Cancer: To Treat or Not to Treat. Clin Liver Dis 2021; 17: 169–173. [Link]
22.
Néant N, Solas C. Drug-Drug Interactions Potential of Direct-Acting Antivirals for the treatment of Chronic Hepatitis C Virus infection. Int J Antimicrob Agents 2020; 56: 105571. [Link]
23.
Lee YA, Friedman SL. Reversal, maintenance or progression: What happens to the liver after a virologic cure of hepatitis C? Antiviral Res 2014; 107: 23–30. [Link]
24.
Terrault NA. Care of Patients Following Cure of Hepatitis C Virus Infection. Gastroenterol Hepatol 2018; 14: 629–634. [Link]

Abstract

Hepatitis C virus (HCV) infection remains an important global health concern. It is estimated that there are approximately 50 million people infected with HCV globally, with around 1 million new infections each year and about 242,000 deaths annually attributed to HCV-related complications. Most acute HCV infections (55–85%) become chronic due to the virus’s effective evasion strategies, with spontaneous clearance being rare once chronicity is established. This condition often progresses silently, with many individuals unaware of their infection until advanced liver damage has occurred. If left untreated, HCV can lead to severe complications, including liver cirrhosis and hepatocellular carcinoma (HCC). HCV transmission occurs mainly through percutaneous exposure to infected blood. HCV can also spread from mother to infant (vertical transmission) and, less frequently, via sexual contact.1,2 In recent years, the introduction of oral direct-acting antivirals (DAAs), with remarkable safety and effectiveness profiles, has led to a sustained virological response (SVR) in virtually all (>97%) HCV-infected patients, regardless of HCV genotype or disease stage. However, significant barriers remain, such as issues with diagnosis, access to treatment and awareness of the disease.

Here, we discuss some of the misconceptions in HCV management and provide a practical management approach grounded in evidence and clinical experience.

Topics

Hepatobiliary

Citation

Garcia A.C and Alexandrino G. Mistakes in hepatits C and how to avoid them. UEG Education 2025; 25: 14-17.

Published

2025

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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.
World Health Organization (WHO). Hepatitis C-Key facts, https://www.who.int/news-room/fact-sheets/detail/hepatitis-c (accessed 23 April 2025). [Link]
2.
Sallam M, Khalil R. Contemporary Insights into Hepatitis C Virus: A Comprehensive Review. Microorganisms 2024; 12: 1035. [Link]
3.
Reiberger T, Lens S, Cabibbo G, et al. EASL position paper on clinical follow-up after HCV cure. J Hepatol 2024; 81: 326–344. [Link]
4.
Krassenburg LAP, Zanjir WR, Georgie F, et al. Evaluation of Sustained Virologic Response as a Relevant Surrogate Endpoint for Long-term Outcomes of Hepatitis C Virus Infection. Clin Infect Dis 2021; 72: 780–786. [Link]
5.
Pawlotsky J-M, Negro F, Aghemo A, et al. EASL recommendations on treatment of hepatitis C: Final update of the series☆. J Hepatol 2020; 73: 1170–1218. [Link]
6.
Schillie S, Wester C, Osborne M, et al. CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020. MMWR Recomm Rep 2020; 69: 1–17. [Link]
7.
Terrault NA. Hepatitis C elimination: challenges with under-diagnosis and under-treatment. F1000Research 2019; 8: 54. [Link]
8.
World Health Organization (WHO). Updated recommendations on simplified service delivery and diagnostics for hepatitis C infection, https://www.who.int/publications/i/item/9789240052697 (accessed 23 April 2025). [Link]
9.
World Health Organization (WHO). Global health sector strategies on HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030, https://www.who.int/publications/i/item/9789240053779 (accessed 23 April 2025). [Link]
10.
Centers for Disease Control and Prevention. Clinical Screening and Diagnosis for Hepatitis C, https://www.cdc.gov/hepatitis-c/hcp/diagnosis-testing/index.html (2025, accessed 23 April 2025). [Link]
11.
World Health Organization (WHO). Recommendations and guidance on hepatitis C virus self-testing, https://www.who.int/publications/i/item/9789240031128 (accessed 23 April 2025). [Link]
12.
American Association for the Study of Liver Diseases, Infectious Diseases Society of America. Clinical Practice Guidance for Testing, Managing, and Treating Hepatitis C Virus Infection: 2023 Update, https://www.hcvguidelines.org/ (accessed 23 April 2025). [Link]
13.
Trickey A, Fraser H, Lim AG, et al. The contribution of injection drug use to hepatitis C virus transmission globally, regionally, and at country level: a modelling study. Lancet Gastroenterol Hepatol 2019; 4: 435–444. [Link]
14.
Tacke F, Horn P, Wai-Sun Wong V, et al. EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol 2024; 81: 492–542. [Link]
15.
Gonzalez-Aldaco K, Torres-Reyes LA, Ojeda-Granados C, et al. Metabolic Dysfunction-Associated Steatotic Liver Disease in Chronic Hepatitis C Virus Infection: From Basics to Clinical and Nutritional Management. Clin Pract 2024; 14: 2542–2558. [Link]
16.
Fuster D, García-Calvo X, Zuluaga P, et al. Assessment of liver disease in patients with chronic hepatitis C and unhealthy alcohol use. World J Gastroenterol 2021; 27: 3223–3237. [Link]
17.
Taylor AL, Denniston MM, Klevens RM, et al. Association of Hepatitis C Virus With Alcohol Use Among U.S. Adults: NHANES 2003–2010. Am J Prev Med 2016; 51: 206–215. [Link]
18.
Idilman R. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. Turk J Gastroenterol 2017; 28: 412–416. [Link]
19.
Hernandez MD, Sherman KE. HIV/hepatitis C coinfection natural history and disease progression: Curr Opin HIV AIDS 2011; 6: 478–482. [Link]
20.
Vento S. Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. J Viral Hepat 2000; 7: 7–8. [Link]
21.
Dhanasekaran R, Kwo PY. Hepatitis C and Hepatocellular Cancer: To Treat or Not to Treat. Clin Liver Dis 2021; 17: 169–173. [Link]
22.
Néant N, Solas C. Drug-Drug Interactions Potential of Direct-Acting Antivirals for the treatment of Chronic Hepatitis C Virus infection. Int J Antimicrob Agents 2020; 56: 105571. [Link]
23.
Lee YA, Friedman SL. Reversal, maintenance or progression: What happens to the liver after a virologic cure of hepatitis C? Antiviral Res 2014; 107: 23–30. [Link]
24.
Terrault NA. Care of Patients Following Cure of Hepatitis C Virus Infection. Gastroenterol Hepatol 2018; 14: 629–634. [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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The European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer: Methodological Protocol

Laura Leeuwenburgh

Summary

AI Generated

Summary is not available for this content yet.

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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.

Guideline

ABSTRACT

Background

Pancreatic cancer remains one of the most lethal cancers despite extensive efforts and research conducted over the past decades. To effectuate groundbreaking improvements in pancreatic cancer treatment, interdisciplinary and international collaboration is essential. Evidence-based guidelines, including state-of-the-art evidence and expert opinion, are crucial to guide medical specialists, researchers, and patients, especially on issues where consensus is still lacking. This article describes the methodological protocol for the development of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer. The guideline aims to identify current knowledge gaps on pancreatic cancer management, develop questions based on these knowledge gaps, and answer these questions with evidence-based recommendations supplemented, when evidence is lacking, with expert advice for treatment and future research.

Methods

This guideline development protocol is developed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The process is structured into six stages: First, 13 theme-based multidisciplinary working groups are established, comprising representatives from 30 European medical and patient societies. Second, these working groups identify the most relevant current knowledge gaps on pancreatic cancer within their theme and formulate key questions. Third, the available evidence to answer these key questions is obtained through systematic reviews and the certainty of evidence is assessed using the GRADE approach. Fourth, recommendations are developed based on the available evidence. Fifth, all participants reach consensus on the recommendations through a modified Delphi process. Sixth, the recommendations are discussed during an open conference, including an external validation committee.

Discussion

This methodological protocol of the European Multidisciplinary Evidence-Based Guideline on Pancreatic Cancer is designed to identify key knowledge gaps across 13 themes and formulate evidence-based recommendations. This guideline initiative unites 30 European medical and patient societies for pancreatic cancer.

Summary

  • Methodological protocol of an international multi-disciplinary guideline involving 30 European medical and patient societies.

  • This protocol highlights the six stages of the guideline development process, adhering to the key principles of the GRADE methodology, and thereby aims to maximise transparency and methodological quality.

  • With addressing knowledge gaps, this guideline will uncover areas with limited evidence. A priority rating for research needs, based on a survey, will be established, highlighting areas where future research is most warranted.

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

Clinical and Public Health Guidelines 3 (2026)

Published

2026

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Summary

AI Generated

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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.

Abstract

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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.

Abstract

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Summary

AI Generated

Summary is not available for this content yet.

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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.
World Health Organization (WHO). Hepatitis C-Key facts, https://www.who.int/news-room/fact-sheets/detail/hepatitis-c (accessed 23 April 2025). [Link]
2.
Sallam M, Khalil R. Contemporary Insights into Hepatitis C Virus: A Comprehensive Review. Microorganisms 2024; 12: 1035. [Link]
3.
Reiberger T, Lens S, Cabibbo G, et al. EASL position paper on clinical follow-up after HCV cure. J Hepatol 2024; 81: 326–344. [Link]
4.
Krassenburg LAP, Zanjir WR, Georgie F, et al. Evaluation of Sustained Virologic Response as a Relevant Surrogate Endpoint for Long-term Outcomes of Hepatitis C Virus Infection. Clin Infect Dis 2021; 72: 780–786. [Link]
5.
Pawlotsky J-M, Negro F, Aghemo A, et al. EASL recommendations on treatment of hepatitis C: Final update of the series☆. J Hepatol 2020; 73: 1170–1218. [Link]
6.
Schillie S, Wester C, Osborne M, et al. CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020. MMWR Recomm Rep 2020; 69: 1–17. [Link]
7.
Terrault NA. Hepatitis C elimination: challenges with under-diagnosis and under-treatment. F1000Research 2019; 8: 54. [Link]
8.
World Health Organization (WHO). Updated recommendations on simplified service delivery and diagnostics for hepatitis C infection, https://www.who.int/publications/i/item/9789240052697 (accessed 23 April 2025). [Link]
9.
World Health Organization (WHO). Global health sector strategies on HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030, https://www.who.int/publications/i/item/9789240053779 (accessed 23 April 2025). [Link]
10.
Centers for Disease Control and Prevention. Clinical Screening and Diagnosis for Hepatitis C, https://www.cdc.gov/hepatitis-c/hcp/diagnosis-testing/index.html (2025, accessed 23 April 2025). [Link]
11.
World Health Organization (WHO). Recommendations and guidance on hepatitis C virus self-testing, https://www.who.int/publications/i/item/9789240031128 (accessed 23 April 2025). [Link]
12.
American Association for the Study of Liver Diseases, Infectious Diseases Society of America. Clinical Practice Guidance for Testing, Managing, and Treating Hepatitis C Virus Infection: 2023 Update, https://www.hcvguidelines.org/ (accessed 23 April 2025). [Link]
13.
Trickey A, Fraser H, Lim AG, et al. The contribution of injection drug use to hepatitis C virus transmission globally, regionally, and at country level: a modelling study. Lancet Gastroenterol Hepatol 2019; 4: 435–444. [Link]
14.
Tacke F, Horn P, Wai-Sun Wong V, et al. EASL–EASD–EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol 2024; 81: 492–542. [Link]
15.
Gonzalez-Aldaco K, Torres-Reyes LA, Ojeda-Granados C, et al. Metabolic Dysfunction-Associated Steatotic Liver Disease in Chronic Hepatitis C Virus Infection: From Basics to Clinical and Nutritional Management. Clin Pract 2024; 14: 2542–2558. [Link]
16.
Fuster D, García-Calvo X, Zuluaga P, et al. Assessment of liver disease in patients with chronic hepatitis C and unhealthy alcohol use. World J Gastroenterol 2021; 27: 3223–3237. [Link]
17.
Taylor AL, Denniston MM, Klevens RM, et al. Association of Hepatitis C Virus With Alcohol Use Among U.S. Adults: NHANES 2003–2010. Am J Prev Med 2016; 51: 206–215. [Link]
18.
Idilman R. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. Turk J Gastroenterol 2017; 28: 412–416. [Link]
19.
Hernandez MD, Sherman KE. HIV/hepatitis C coinfection natural history and disease progression: Curr Opin HIV AIDS 2011; 6: 478–482. [Link]
20.
Vento S. Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. J Viral Hepat 2000; 7: 7–8. [Link]
21.
Dhanasekaran R, Kwo PY. Hepatitis C and Hepatocellular Cancer: To Treat or Not to Treat. Clin Liver Dis 2021; 17: 169–173. [Link]
22.
Néant N, Solas C. Drug-Drug Interactions Potential of Direct-Acting Antivirals for the treatment of Chronic Hepatitis C Virus infection. Int J Antimicrob Agents 2020; 56: 105571. [Link]
23.
Lee YA, Friedman SL. Reversal, maintenance or progression: What happens to the liver after a virologic cure of hepatitis C? Antiviral Res 2014; 107: 23–30. [Link]
24.
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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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Malignancy in IBD with Hannah Gordon

Hannah Gordon, Pradeep Mundre

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Abstract

Topics

Digestive Oncology IBD

Published

2026

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