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Mistakes in acute severe ulcerative colitis and how to avoid them

David Laharie

Summary

AI Generated

This article addresses common management mistakes in acute severe ulcerative colitis (ASUC), a life-threatening condition that affects approximately one-quarter of UC patients during their lifetime and carries a 1% mortality rate in Western countries.

  • ASUC should be promptly identified using the modified Truelove and Witts criteria recommended by international guidelines, with rapid admission to a digestive unit.
  • More than 25% of ASUC episodes represent the initial presentation of ulcerative colitis.
  • The article discusses frequent and relevant mistakes in ASUC management and strategies to avoid them, based on available evidence and expert opinion where evidence is lacking.
  • Clinicians managing patients with inflammatory bowel disease, particularly those encountering acute severe presentations, would benefit from this guidance.
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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.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9
1.
Dinesen LC, Walsh AJ, Protic MN, et al. The pattern and outcome of acute severe colitis. J Crohns Colitis 2010;4:431-7. [Link]
2.
Adams A, Gupta V, Mohsen W, et al. Early management of acute severe UC in the biologics era: development and international validation of a prognostic clinical index to predict steroid response. Gut 2023;72:433-442. [Link]
3.
Spinelli A, Bonovas S, Burisch J, et al. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment. J Crohns Colitis 2022;16:179–89. [Link]
4.
Dong C, Metzger M, Holsbø E, et al. Systematic review with meta-analysis: mortality in acute severe ulcerative colitis. Aliment Pharmacol Ther. 2020;51:8-33. [Link]
5.
Lynch RW, Lowe D, Protheroe A, et al. Outcomes of rescue therapy in acute severe ulcerative colitis: data from the United Kingdom inflammatory bowel disease audit. Aliment Pharmacol Ther. 2013;38:935-45. [Link]
6.
Ordás I, Domènech E, Mañosa M, et al. Post-operative morbidity and mortality of a cohort of steroid refractory acute severe ulcerative colitis: Nationwide multicenter study of the GETECCU ENEIDA Registry. Am J Gastroenterol 2018;113:1009–16. [Link]
7.
Kaplan GG, McCarthy EP, Ayanian JZ, et al. Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis. Gastroenterology 2008;134:680-7. [Link]
8.
Justiniano CF, Aquina CT, Becerra AZ, et al. Postoperative Mortality After Nonelective Surgery for Inflammatory Bowel Disease Patients in the Era of Biologics. Ann Surg 2019; 269: 686–91. [Link]
9.
Lee H-S, Park SH, Kim S-H, et al. Risk Factors and Clinical Outcomes Associated with Cytomegalovirus Colitis in Patients with Acute Severe Ulcerative Colitis: Inflamm Bowel Dis 2016; 22: 912–8. [Link]
10.
Nguyen GC, Kaplan GG, Harris ML, Brant SR. A National Survey of the Prevalence and Impact of Clostridium difficile Infection Among Hospitalized Inflammatory Bowel Disease Patients. Am J Gastroenterol 2008;103:1443–50. [Link]
11.
Negrón ME, Rezaie A, Barkema HW, et al. Ulcerative Colitis Patients With Clostridium difficile are at Increased Risk of Death, Colectomy and Postoperative Complications: A Population-Based Inception Cohort Study. Am J Gastroenterol 2016; 111: 691–704. [Link]
12.
Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet. 2010 20;375:657-63. [Link]
13.
Nguyen GC, Sam J. Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients. Am J Gastroenterol 2008;103:2272–80. [Link]
14.
Travis SP, Farrant JM, Ricketts C, et al. Predicting outcome in severe ulcerative colitis. Gut 1996;38:905–10. [Link]
15.
Travis SP, Schnell D, Krzeski P, et al. Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). Gut. 2012;61:535-42. [Link]
16.
Carbonnel F, Lavergne A, Lémann M, et al. Colonoscopy of acute colitis. A safe and reliable tool for assessment of severity. Dig Dis Sci 1994;39:1550–7. [Link]
17.
Cacheux W, Seksik P, Lemann M, et al. Predictive factors of response to cyclosporine in steroid-refractory ulcerative colitis. Am J Gastroenterol 2008;103:637–42. [Link]
18.
Corte C, Fernandopulle N, Catuneanu AM, et al. Association between the ulcerative colitis endoscopic index of severity (UCEIS) and outcomes in acute severe ulcerative colitis. J Crohns Colitis. 2015;9:376-81. [Link]
19.
Jarnerot G, Hertervig E, Friis-Liby I, et al. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology 2005;128:1805-11. [Link]
20.
Laharie D, Bourreille A, Branche J, et al. Ciclosporine versus infliximab in acute severe colitis refractory to intravenous steroids: a randomized study. Lancet 2012;380:1909-15. [Link]
21.
Turner D, Walsh CM, Steinhart AH, Griffiths AM. Response to Corticosteroids in Severe Ulcerative Colitis: A Systematic Review of the Literature and a Meta-Regression. Clin Gastroenterol Hepatol 2007;5:103–10. [Link]
22.
Lichtiger S, Present DH, Kornbluth A, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 1994;330:1841-5. [Link]
23.
Hanauer S, Panaccione R, Danese S, et al. Tofacitinib Induction Therapy Reduces Symptoms Within 3 Days for Patients With Ulcerative Colitis. Clin Gastroenterol Hepatol. 2019;17:139-47. [Link]
24.
Gisbert JP, García MJ, Chaparro M. Rescue therapies for steroid-refractory acute severe ulcerative colitis: A review. J Crohns Colitis. 2023 Jan 18. doi: 10.1093/ecco-jcc/jjad004. Online ahead of print. [Link]
25.
Berinstein JA, Sheehan JL, Dias M, et al. Tofacitinib for Biologic-Experienced Hospitalized Patients With Acute Severe Ulcerative Colitis: A Retrospective Case-Control Study. Clin Gastroenterol Hepatol 2021;19:2112-20. [Link]
26.
Kucharzik T, Ellul P, Greuter T, et al. ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease. J Crohns Colitis. 2021 22;15:879-913. [Link]
27.
Rahier JF, Ben-Horin S, Chowers Y, et al. European evidence-based Consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis. 2009;3:47-91. [Link]
28.
Moskovitz DN, Van Assche G, Maenhout B, et al. Incidence of colectomy during long-term follow-up after cyclosporine-induced remission of severe ulcerative colitis. Clin Gastroenterol Hepatol 2006;4:760-5. [Link]
29.
Parc Y, Reboul-Marty J, Lefevre JH, et al. Restorative Proctocolectomy and Ileal Pouch-anal Anastomosis. Ann Surg. 2015;262:849-53. [Link]

Abstract

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.

Topics

IBD

Citation

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

Published

2023

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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.

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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.
Dinesen LC, Walsh AJ, Protic MN, et al. The pattern and outcome of acute severe colitis. J Crohns Colitis 2010;4:431-7. [Link]
2.
Adams A, Gupta V, Mohsen W, et al. Early management of acute severe UC in the biologics era: development and international validation of a prognostic clinical index to predict steroid response. Gut 2023;72:433-442. [Link]
3.
Spinelli A, Bonovas S, Burisch J, et al. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment. J Crohns Colitis 2022;16:179–89. [Link]
4.
Dong C, Metzger M, Holsbø E, et al. Systematic review with meta-analysis: mortality in acute severe ulcerative colitis. Aliment Pharmacol Ther. 2020;51:8-33. [Link]
5.
Lynch RW, Lowe D, Protheroe A, et al. Outcomes of rescue therapy in acute severe ulcerative colitis: data from the United Kingdom inflammatory bowel disease audit. Aliment Pharmacol Ther. 2013;38:935-45. [Link]
6.
Ordás I, Domènech E, Mañosa M, et al. Post-operative morbidity and mortality of a cohort of steroid refractory acute severe ulcerative colitis: Nationwide multicenter study of the GETECCU ENEIDA Registry. Am J Gastroenterol 2018;113:1009–16. [Link]
7.
Kaplan GG, McCarthy EP, Ayanian JZ, et al. Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis. Gastroenterology 2008;134:680-7. [Link]
8.
Justiniano CF, Aquina CT, Becerra AZ, et al. Postoperative Mortality After Nonelective Surgery for Inflammatory Bowel Disease Patients in the Era of Biologics. Ann Surg 2019; 269: 686–91. [Link]
9.
Lee H-S, Park SH, Kim S-H, et al. Risk Factors and Clinical Outcomes Associated with Cytomegalovirus Colitis in Patients with Acute Severe Ulcerative Colitis: Inflamm Bowel Dis 2016; 22: 912–8. [Link]
10.
Nguyen GC, Kaplan GG, Harris ML, Brant SR. A National Survey of the Prevalence and Impact of Clostridium difficile Infection Among Hospitalized Inflammatory Bowel Disease Patients. Am J Gastroenterol 2008;103:1443–50. [Link]
11.
Negrón ME, Rezaie A, Barkema HW, et al. Ulcerative Colitis Patients With Clostridium difficile are at Increased Risk of Death, Colectomy and Postoperative Complications: A Population-Based Inception Cohort Study. Am J Gastroenterol 2016; 111: 691–704. [Link]
12.
Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet. 2010 20;375:657-63. [Link]
13.
Nguyen GC, Sam J. Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients. Am J Gastroenterol 2008;103:2272–80. [Link]
14.
Travis SP, Farrant JM, Ricketts C, et al. Predicting outcome in severe ulcerative colitis. Gut 1996;38:905–10. [Link]
15.
Travis SP, Schnell D, Krzeski P, et al. Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). Gut. 2012;61:535-42. [Link]
16.
Carbonnel F, Lavergne A, Lémann M, et al. Colonoscopy of acute colitis. A safe and reliable tool for assessment of severity. Dig Dis Sci 1994;39:1550–7. [Link]
17.
Cacheux W, Seksik P, Lemann M, et al. Predictive factors of response to cyclosporine in steroid-refractory ulcerative colitis. Am J Gastroenterol 2008;103:637–42. [Link]
18.
Corte C, Fernandopulle N, Catuneanu AM, et al. Association between the ulcerative colitis endoscopic index of severity (UCEIS) and outcomes in acute severe ulcerative colitis. J Crohns Colitis. 2015;9:376-81. [Link]
19.
Jarnerot G, Hertervig E, Friis-Liby I, et al. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology 2005;128:1805-11. [Link]
20.
Laharie D, Bourreille A, Branche J, et al. Ciclosporine versus infliximab in acute severe colitis refractory to intravenous steroids: a randomized study. Lancet 2012;380:1909-15. [Link]
21.
Turner D, Walsh CM, Steinhart AH, Griffiths AM. Response to Corticosteroids in Severe Ulcerative Colitis: A Systematic Review of the Literature and a Meta-Regression. Clin Gastroenterol Hepatol 2007;5:103–10. [Link]
22.
Lichtiger S, Present DH, Kornbluth A, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 1994;330:1841-5. [Link]
23.
Hanauer S, Panaccione R, Danese S, et al. Tofacitinib Induction Therapy Reduces Symptoms Within 3 Days for Patients With Ulcerative Colitis. Clin Gastroenterol Hepatol. 2019;17:139-47. [Link]
24.
Gisbert JP, García MJ, Chaparro M. Rescue therapies for steroid-refractory acute severe ulcerative colitis: A review. J Crohns Colitis. 2023 Jan 18. doi: 10.1093/ecco-jcc/jjad004. Online ahead of print. [Link]
25.
Berinstein JA, Sheehan JL, Dias M, et al. Tofacitinib for Biologic-Experienced Hospitalized Patients With Acute Severe Ulcerative Colitis: A Retrospective Case-Control Study. Clin Gastroenterol Hepatol 2021;19:2112-20. [Link]
26.
Kucharzik T, Ellul P, Greuter T, et al. ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease. J Crohns Colitis. 2021 22;15:879-913. [Link]
27.
Rahier JF, Ben-Horin S, Chowers Y, et al. European evidence-based Consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis. 2009;3:47-91. [Link]
28.
Moskovitz DN, Van Assche G, Maenhout B, et al. Incidence of colectomy during long-term follow-up after cyclosporine-induced remission of severe ulcerative colitis. Clin Gastroenterol Hepatol 2006;4:760-5. [Link]
29.
Parc Y, Reboul-Marty J, Lefevre JH, et al. Restorative Proctocolectomy and Ileal Pouch-anal Anastomosis. Ann Surg. 2015;262:849-53. [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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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.
Dinesen LC, Walsh AJ, Protic MN, et al. The pattern and outcome of acute severe colitis. J Crohns Colitis 2010;4:431-7. [Link]
2.
Adams A, Gupta V, Mohsen W, et al. Early management of acute severe UC in the biologics era: development and international validation of a prognostic clinical index to predict steroid response. Gut 2023;72:433-442. [Link]
3.
Spinelli A, Bonovas S, Burisch J, et al. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment. J Crohns Colitis 2022;16:179–89. [Link]
4.
Dong C, Metzger M, Holsbø E, et al. Systematic review with meta-analysis: mortality in acute severe ulcerative colitis. Aliment Pharmacol Ther. 2020;51:8-33. [Link]
5.
Lynch RW, Lowe D, Protheroe A, et al. Outcomes of rescue therapy in acute severe ulcerative colitis: data from the United Kingdom inflammatory bowel disease audit. Aliment Pharmacol Ther. 2013;38:935-45. [Link]
6.
Ordás I, Domènech E, Mañosa M, et al. Post-operative morbidity and mortality of a cohort of steroid refractory acute severe ulcerative colitis: Nationwide multicenter study of the GETECCU ENEIDA Registry. Am J Gastroenterol 2018;113:1009–16. [Link]
7.
Kaplan GG, McCarthy EP, Ayanian JZ, et al. Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis. Gastroenterology 2008;134:680-7. [Link]
8.
Justiniano CF, Aquina CT, Becerra AZ, et al. Postoperative Mortality After Nonelective Surgery for Inflammatory Bowel Disease Patients in the Era of Biologics. Ann Surg 2019; 269: 686–91. [Link]
9.
Lee H-S, Park SH, Kim S-H, et al. Risk Factors and Clinical Outcomes Associated with Cytomegalovirus Colitis in Patients with Acute Severe Ulcerative Colitis: Inflamm Bowel Dis 2016; 22: 912–8. [Link]
10.
Nguyen GC, Kaplan GG, Harris ML, Brant SR. A National Survey of the Prevalence and Impact of Clostridium difficile Infection Among Hospitalized Inflammatory Bowel Disease Patients. Am J Gastroenterol 2008;103:1443–50. [Link]
11.
Negrón ME, Rezaie A, Barkema HW, et al. Ulcerative Colitis Patients With Clostridium difficile are at Increased Risk of Death, Colectomy and Postoperative Complications: A Population-Based Inception Cohort Study. Am J Gastroenterol 2016; 111: 691–704. [Link]
12.
Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet. 2010 20;375:657-63. [Link]
13.
Nguyen GC, Sam J. Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients. Am J Gastroenterol 2008;103:2272–80. [Link]
14.
Travis SP, Farrant JM, Ricketts C, et al. Predicting outcome in severe ulcerative colitis. Gut 1996;38:905–10. [Link]
15.
Travis SP, Schnell D, Krzeski P, et al. Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). Gut. 2012;61:535-42. [Link]
16.
Carbonnel F, Lavergne A, Lémann M, et al. Colonoscopy of acute colitis. A safe and reliable tool for assessment of severity. Dig Dis Sci 1994;39:1550–7. [Link]
17.
Cacheux W, Seksik P, Lemann M, et al. Predictive factors of response to cyclosporine in steroid-refractory ulcerative colitis. Am J Gastroenterol 2008;103:637–42. [Link]
18.
Corte C, Fernandopulle N, Catuneanu AM, et al. Association between the ulcerative colitis endoscopic index of severity (UCEIS) and outcomes in acute severe ulcerative colitis. J Crohns Colitis. 2015;9:376-81. [Link]
19.
Jarnerot G, Hertervig E, Friis-Liby I, et al. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology 2005;128:1805-11. [Link]
20.
Laharie D, Bourreille A, Branche J, et al. Ciclosporine versus infliximab in acute severe colitis refractory to intravenous steroids: a randomized study. Lancet 2012;380:1909-15. [Link]
21.
Turner D, Walsh CM, Steinhart AH, Griffiths AM. Response to Corticosteroids in Severe Ulcerative Colitis: A Systematic Review of the Literature and a Meta-Regression. Clin Gastroenterol Hepatol 2007;5:103–10. [Link]
22.
Lichtiger S, Present DH, Kornbluth A, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 1994;330:1841-5. [Link]
23.
Hanauer S, Panaccione R, Danese S, et al. Tofacitinib Induction Therapy Reduces Symptoms Within 3 Days for Patients With Ulcerative Colitis. Clin Gastroenterol Hepatol. 2019;17:139-47. [Link]
24.
Gisbert JP, García MJ, Chaparro M. Rescue therapies for steroid-refractory acute severe ulcerative colitis: A review. J Crohns Colitis. 2023 Jan 18. doi: 10.1093/ecco-jcc/jjad004. Online ahead of print. [Link]
25.
Berinstein JA, Sheehan JL, Dias M, et al. Tofacitinib for Biologic-Experienced Hospitalized Patients With Acute Severe Ulcerative Colitis: A Retrospective Case-Control Study. Clin Gastroenterol Hepatol 2021;19:2112-20. [Link]
26.
Kucharzik T, Ellul P, Greuter T, et al. ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease. J Crohns Colitis. 2021 22;15:879-913. [Link]
27.
Rahier JF, Ben-Horin S, Chowers Y, et al. European evidence-based Consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis. 2009;3:47-91. [Link]
28.
Moskovitz DN, Van Assche G, Maenhout B, et al. Incidence of colectomy during long-term follow-up after cyclosporine-induced remission of severe ulcerative colitis. Clin Gastroenterol Hepatol 2006;4:760-5. [Link]
29.
Parc Y, Reboul-Marty J, Lefevre JH, et al. Restorative Proctocolectomy and Ileal Pouch-anal Anastomosis. Ann Surg. 2015;262:849-53. [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 the management of peritoneal malignancies and how to avoid them

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

Mistakes in Pancreatic exocrine insufficiency and how to avoid them

Mistakes in Pancreatic exocrine insufficiency and how to avoid them

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

Mistakes in acute jaundice and how to avoid them

Mistakes in acute jaundice and how to avoid them

Georgios Papatheodoridis Georgios Papatheodoridis, Spyridon Siakavellas

Transitional care with Patrizia Burra & Jorge Amil Dias

Transitional care with Patrizia Burra & Jorge Amil Dias

Pradeep Mundre Pradeep Mundre, Jorge Amil Dias, Patrizia Burra

Mistakes in abdominal distension and how to avoid them

Mistakes in abdominal distension and how to avoid them

Alberto Ezquerra-Durán Alberto Ezquerra-Durán, Elizabeth Barba Orozco

Mistakes in hepatitis C and how to avoid them

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino Gonçalo Alexandrino, Ana Catarina Garcia

UEG Mistakes In Articles
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Mistakes in acute jaundice and how to avoid them

Spyridon Siakavellas, Georgios Papatheodoridis

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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.
Dinesen LC, Walsh AJ, Protic MN, et al. The pattern and outcome of acute severe colitis. J Crohns Colitis 2010;4:431-7. [Link]
2.
Adams A, Gupta V, Mohsen W, et al. Early management of acute severe UC in the biologics era: development and international validation of a prognostic clinical index to predict steroid response. Gut 2023;72:433-442. [Link]
3.
Spinelli A, Bonovas S, Burisch J, et al. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment. J Crohns Colitis 2022;16:179–89. [Link]
4.
Dong C, Metzger M, Holsbø E, et al. Systematic review with meta-analysis: mortality in acute severe ulcerative colitis. Aliment Pharmacol Ther. 2020;51:8-33. [Link]
5.
Lynch RW, Lowe D, Protheroe A, et al. Outcomes of rescue therapy in acute severe ulcerative colitis: data from the United Kingdom inflammatory bowel disease audit. Aliment Pharmacol Ther. 2013;38:935-45. [Link]
6.
Ordás I, Domènech E, Mañosa M, et al. Post-operative morbidity and mortality of a cohort of steroid refractory acute severe ulcerative colitis: Nationwide multicenter study of the GETECCU ENEIDA Registry. Am J Gastroenterol 2018;113:1009–16. [Link]
7.
Kaplan GG, McCarthy EP, Ayanian JZ, et al. Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis. Gastroenterology 2008;134:680-7. [Link]
8.
Justiniano CF, Aquina CT, Becerra AZ, et al. Postoperative Mortality After Nonelective Surgery for Inflammatory Bowel Disease Patients in the Era of Biologics. Ann Surg 2019; 269: 686–91. [Link]
9.
Lee H-S, Park SH, Kim S-H, et al. Risk Factors and Clinical Outcomes Associated with Cytomegalovirus Colitis in Patients with Acute Severe Ulcerative Colitis: Inflamm Bowel Dis 2016; 22: 912–8. [Link]
10.
Nguyen GC, Kaplan GG, Harris ML, Brant SR. A National Survey of the Prevalence and Impact of Clostridium difficile Infection Among Hospitalized Inflammatory Bowel Disease Patients. Am J Gastroenterol 2008;103:1443–50. [Link]
11.
Negrón ME, Rezaie A, Barkema HW, et al. Ulcerative Colitis Patients With Clostridium difficile are at Increased Risk of Death, Colectomy and Postoperative Complications: A Population-Based Inception Cohort Study. Am J Gastroenterol 2016; 111: 691–704. [Link]
12.
Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet. 2010 20;375:657-63. [Link]
13.
Nguyen GC, Sam J. Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients. Am J Gastroenterol 2008;103:2272–80. [Link]
14.
Travis SP, Farrant JM, Ricketts C, et al. Predicting outcome in severe ulcerative colitis. Gut 1996;38:905–10. [Link]
15.
Travis SP, Schnell D, Krzeski P, et al. Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). Gut. 2012;61:535-42. [Link]
16.
Carbonnel F, Lavergne A, Lémann M, et al. Colonoscopy of acute colitis. A safe and reliable tool for assessment of severity. Dig Dis Sci 1994;39:1550–7. [Link]
17.
Cacheux W, Seksik P, Lemann M, et al. Predictive factors of response to cyclosporine in steroid-refractory ulcerative colitis. Am J Gastroenterol 2008;103:637–42. [Link]
18.
Corte C, Fernandopulle N, Catuneanu AM, et al. Association between the ulcerative colitis endoscopic index of severity (UCEIS) and outcomes in acute severe ulcerative colitis. J Crohns Colitis. 2015;9:376-81. [Link]
19.
Jarnerot G, Hertervig E, Friis-Liby I, et al. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology 2005;128:1805-11. [Link]
20.
Laharie D, Bourreille A, Branche J, et al. Ciclosporine versus infliximab in acute severe colitis refractory to intravenous steroids: a randomized study. Lancet 2012;380:1909-15. [Link]
21.
Turner D, Walsh CM, Steinhart AH, Griffiths AM. Response to Corticosteroids in Severe Ulcerative Colitis: A Systematic Review of the Literature and a Meta-Regression. Clin Gastroenterol Hepatol 2007;5:103–10. [Link]
22.
Lichtiger S, Present DH, Kornbluth A, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 1994;330:1841-5. [Link]
23.
Hanauer S, Panaccione R, Danese S, et al. Tofacitinib Induction Therapy Reduces Symptoms Within 3 Days for Patients With Ulcerative Colitis. Clin Gastroenterol Hepatol. 2019;17:139-47. [Link]
24.
Gisbert JP, García MJ, Chaparro M. Rescue therapies for steroid-refractory acute severe ulcerative colitis: A review. J Crohns Colitis. 2023 Jan 18. doi: 10.1093/ecco-jcc/jjad004. Online ahead of print. [Link]
25.
Berinstein JA, Sheehan JL, Dias M, et al. Tofacitinib for Biologic-Experienced Hospitalized Patients With Acute Severe Ulcerative Colitis: A Retrospective Case-Control Study. Clin Gastroenterol Hepatol 2021;19:2112-20. [Link]
26.
Kucharzik T, Ellul P, Greuter T, et al. ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease. J Crohns Colitis. 2021 22;15:879-913. [Link]
27.
Rahier JF, Ben-Horin S, Chowers Y, et al. European evidence-based Consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis. 2009;3:47-91. [Link]
28.
Moskovitz DN, Van Assche G, Maenhout B, et al. Incidence of colectomy during long-term follow-up after cyclosporine-induced remission of severe ulcerative colitis. Clin Gastroenterol Hepatol 2006;4:760-5. [Link]
29.
Parc Y, Reboul-Marty J, Lefevre JH, et al. Restorative Proctocolectomy and Ileal Pouch-anal Anastomosis. Ann Surg. 2015;262:849-53. [Link]

Abstract

Jaundice can be caused by abnormalities in any of the steps comprising the formation, metabolism and excretion of bilirubin. In addition, these processes may be functioning properly, but jaundice can be seen because of an obstruction of the biliary tree at any point, from its intrahepatic origins to its end at the ampulla of Vater. For this reason, it is clear that numerous conditions can result in jaundice. When faced with a patient presenting with jaundice a reasonable and careful diagnostic approach is, therefore, warranted to elucidate the underlying cause of this sign. Conventional wisdom may be that “jaundice by itself never killed anyone,” but it is imperative to find the cause as soon as possible, as prompt intervention saves lives in many cases.

Topics

Hepatobiliary

Citation

Siakavellas S and Papatheodoridis G. Mistakes in acute jaundice and how to avoid them. UEG Education 2018; 18: 24–26.

Published

2025

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Abstract

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Mistakes in abdominal distension and how to avoid them

Elizabeth Barba Orozco, Alberto Ezquerra-Durán

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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.
Dinesen LC, Walsh AJ, Protic MN, et al. The pattern and outcome of acute severe colitis. J Crohns Colitis 2010;4:431-7. [Link]
2.
Adams A, Gupta V, Mohsen W, et al. Early management of acute severe UC in the biologics era: development and international validation of a prognostic clinical index to predict steroid response. Gut 2023;72:433-442. [Link]
3.
Spinelli A, Bonovas S, Burisch J, et al. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment. J Crohns Colitis 2022;16:179–89. [Link]
4.
Dong C, Metzger M, Holsbø E, et al. Systematic review with meta-analysis: mortality in acute severe ulcerative colitis. Aliment Pharmacol Ther. 2020;51:8-33. [Link]
5.
Lynch RW, Lowe D, Protheroe A, et al. Outcomes of rescue therapy in acute severe ulcerative colitis: data from the United Kingdom inflammatory bowel disease audit. Aliment Pharmacol Ther. 2013;38:935-45. [Link]
6.
Ordás I, Domènech E, Mañosa M, et al. Post-operative morbidity and mortality of a cohort of steroid refractory acute severe ulcerative colitis: Nationwide multicenter study of the GETECCU ENEIDA Registry. Am J Gastroenterol 2018;113:1009–16. [Link]
7.
Kaplan GG, McCarthy EP, Ayanian JZ, et al. Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis. Gastroenterology 2008;134:680-7. [Link]
8.
Justiniano CF, Aquina CT, Becerra AZ, et al. Postoperative Mortality After Nonelective Surgery for Inflammatory Bowel Disease Patients in the Era of Biologics. Ann Surg 2019; 269: 686–91. [Link]
9.
Lee H-S, Park SH, Kim S-H, et al. Risk Factors and Clinical Outcomes Associated with Cytomegalovirus Colitis in Patients with Acute Severe Ulcerative Colitis: Inflamm Bowel Dis 2016; 22: 912–8. [Link]
10.
Nguyen GC, Kaplan GG, Harris ML, Brant SR. A National Survey of the Prevalence and Impact of Clostridium difficile Infection Among Hospitalized Inflammatory Bowel Disease Patients. Am J Gastroenterol 2008;103:1443–50. [Link]
11.
Negrón ME, Rezaie A, Barkema HW, et al. Ulcerative Colitis Patients With Clostridium difficile are at Increased Risk of Death, Colectomy and Postoperative Complications: A Population-Based Inception Cohort Study. Am J Gastroenterol 2016; 111: 691–704. [Link]
12.
Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet. 2010 20;375:657-63. [Link]
13.
Nguyen GC, Sam J. Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients. Am J Gastroenterol 2008;103:2272–80. [Link]
14.
Travis SP, Farrant JM, Ricketts C, et al. Predicting outcome in severe ulcerative colitis. Gut 1996;38:905–10. [Link]
15.
Travis SP, Schnell D, Krzeski P, et al. Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). Gut. 2012;61:535-42. [Link]
16.
Carbonnel F, Lavergne A, Lémann M, et al. Colonoscopy of acute colitis. A safe and reliable tool for assessment of severity. Dig Dis Sci 1994;39:1550–7. [Link]
17.
Cacheux W, Seksik P, Lemann M, et al. Predictive factors of response to cyclosporine in steroid-refractory ulcerative colitis. Am J Gastroenterol 2008;103:637–42. [Link]
18.
Corte C, Fernandopulle N, Catuneanu AM, et al. Association between the ulcerative colitis endoscopic index of severity (UCEIS) and outcomes in acute severe ulcerative colitis. J Crohns Colitis. 2015;9:376-81. [Link]
19.
Jarnerot G, Hertervig E, Friis-Liby I, et al. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology 2005;128:1805-11. [Link]
20.
Laharie D, Bourreille A, Branche J, et al. Ciclosporine versus infliximab in acute severe colitis refractory to intravenous steroids: a randomized study. Lancet 2012;380:1909-15. [Link]
21.
Turner D, Walsh CM, Steinhart AH, Griffiths AM. Response to Corticosteroids in Severe Ulcerative Colitis: A Systematic Review of the Literature and a Meta-Regression. Clin Gastroenterol Hepatol 2007;5:103–10. [Link]
22.
Lichtiger S, Present DH, Kornbluth A, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 1994;330:1841-5. [Link]
23.
Hanauer S, Panaccione R, Danese S, et al. Tofacitinib Induction Therapy Reduces Symptoms Within 3 Days for Patients With Ulcerative Colitis. Clin Gastroenterol Hepatol. 2019;17:139-47. [Link]
24.
Gisbert JP, García MJ, Chaparro M. Rescue therapies for steroid-refractory acute severe ulcerative colitis: A review. J Crohns Colitis. 2023 Jan 18. doi: 10.1093/ecco-jcc/jjad004. Online ahead of print. [Link]
25.
Berinstein JA, Sheehan JL, Dias M, et al. Tofacitinib for Biologic-Experienced Hospitalized Patients With Acute Severe Ulcerative Colitis: A Retrospective Case-Control Study. Clin Gastroenterol Hepatol 2021;19:2112-20. [Link]
26.
Kucharzik T, Ellul P, Greuter T, et al. ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease. J Crohns Colitis. 2021 22;15:879-913. [Link]
27.
Rahier JF, Ben-Horin S, Chowers Y, et al. European evidence-based Consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis. 2009;3:47-91. [Link]
28.
Moskovitz DN, Van Assche G, Maenhout B, et al. Incidence of colectomy during long-term follow-up after cyclosporine-induced remission of severe ulcerative colitis. Clin Gastroenterol Hepatol 2006;4:760-5. [Link]
29.
Parc Y, Reboul-Marty J, Lefevre JH, et al. Restorative Proctocolectomy and Ileal Pouch-anal Anastomosis. Ann Surg. 2015;262:849-53. [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

More Like This:

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

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

Mistakes in Pancreatic exocrine insufficiency and how to avoid them

Mistakes in Pancreatic exocrine insufficiency and how to avoid them

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

Mistakes in acute jaundice and how to avoid them

Mistakes in acute jaundice and how to avoid them

Georgios Papatheodoridis Georgios Papatheodoridis, Spyridon Siakavellas

Transitional care with Patrizia Burra & Jorge Amil Dias

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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.

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

Mistakes in hepatitis C and how to avoid them

Ana Catarina Garcia, Gonçalo Alexandrino

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.
Dinesen LC, Walsh AJ, Protic MN, et al. The pattern and outcome of acute severe colitis. J Crohns Colitis 2010;4:431-7. [Link]
2.
Adams A, Gupta V, Mohsen W, et al. Early management of acute severe UC in the biologics era: development and international validation of a prognostic clinical index to predict steroid response. Gut 2023;72:433-442. [Link]
3.
Spinelli A, Bonovas S, Burisch J, et al. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment. J Crohns Colitis 2022;16:179–89. [Link]
4.
Dong C, Metzger M, Holsbø E, et al. Systematic review with meta-analysis: mortality in acute severe ulcerative colitis. Aliment Pharmacol Ther. 2020;51:8-33. [Link]
5.
Lynch RW, Lowe D, Protheroe A, et al. Outcomes of rescue therapy in acute severe ulcerative colitis: data from the United Kingdom inflammatory bowel disease audit. Aliment Pharmacol Ther. 2013;38:935-45. [Link]
6.
Ordás I, Domènech E, Mañosa M, et al. Post-operative morbidity and mortality of a cohort of steroid refractory acute severe ulcerative colitis: Nationwide multicenter study of the GETECCU ENEIDA Registry. Am J Gastroenterol 2018;113:1009–16. [Link]
7.
Kaplan GG, McCarthy EP, Ayanian JZ, et al. Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis. Gastroenterology 2008;134:680-7. [Link]
8.
Justiniano CF, Aquina CT, Becerra AZ, et al. Postoperative Mortality After Nonelective Surgery for Inflammatory Bowel Disease Patients in the Era of Biologics. Ann Surg 2019; 269: 686–91. [Link]
9.
Lee H-S, Park SH, Kim S-H, et al. Risk Factors and Clinical Outcomes Associated with Cytomegalovirus Colitis in Patients with Acute Severe Ulcerative Colitis: Inflamm Bowel Dis 2016; 22: 912–8. [Link]
10.
Nguyen GC, Kaplan GG, Harris ML, Brant SR. A National Survey of the Prevalence and Impact of Clostridium difficile Infection Among Hospitalized Inflammatory Bowel Disease Patients. Am J Gastroenterol 2008;103:1443–50. [Link]
11.
Negrón ME, Rezaie A, Barkema HW, et al. Ulcerative Colitis Patients With Clostridium difficile are at Increased Risk of Death, Colectomy and Postoperative Complications: A Population-Based Inception Cohort Study. Am J Gastroenterol 2016; 111: 691–704. [Link]
12.
Grainge MJ, West J, Card TR. Venous thromboembolism during active disease and remission in inflammatory bowel disease: a cohort study. Lancet. 2010 20;375:657-63. [Link]
13.
Nguyen GC, Sam J. Rising prevalence of venous thromboembolism and its impact on mortality among hospitalized inflammatory bowel disease patients. Am J Gastroenterol 2008;103:2272–80. [Link]
14.
Travis SP, Farrant JM, Ricketts C, et al. Predicting outcome in severe ulcerative colitis. Gut 1996;38:905–10. [Link]
15.
Travis SP, Schnell D, Krzeski P, et al. Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). Gut. 2012;61:535-42. [Link]
16.
Carbonnel F, Lavergne A, Lémann M, et al. Colonoscopy of acute colitis. A safe and reliable tool for assessment of severity. Dig Dis Sci 1994;39:1550–7. [Link]
17.
Cacheux W, Seksik P, Lemann M, et al. Predictive factors of response to cyclosporine in steroid-refractory ulcerative colitis. Am J Gastroenterol 2008;103:637–42. [Link]
18.
Corte C, Fernandopulle N, Catuneanu AM, et al. Association between the ulcerative colitis endoscopic index of severity (UCEIS) and outcomes in acute severe ulcerative colitis. J Crohns Colitis. 2015;9:376-81. [Link]
19.
Jarnerot G, Hertervig E, Friis-Liby I, et al. Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized, placebo-controlled study. Gastroenterology 2005;128:1805-11. [Link]
20.
Laharie D, Bourreille A, Branche J, et al. Ciclosporine versus infliximab in acute severe colitis refractory to intravenous steroids: a randomized study. Lancet 2012;380:1909-15. [Link]
21.
Turner D, Walsh CM, Steinhart AH, Griffiths AM. Response to Corticosteroids in Severe Ulcerative Colitis: A Systematic Review of the Literature and a Meta-Regression. Clin Gastroenterol Hepatol 2007;5:103–10. [Link]
22.
Lichtiger S, Present DH, Kornbluth A, et al. Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N Engl J Med 1994;330:1841-5. [Link]
23.
Hanauer S, Panaccione R, Danese S, et al. Tofacitinib Induction Therapy Reduces Symptoms Within 3 Days for Patients With Ulcerative Colitis. Clin Gastroenterol Hepatol. 2019;17:139-47. [Link]
24.
Gisbert JP, García MJ, Chaparro M. Rescue therapies for steroid-refractory acute severe ulcerative colitis: A review. J Crohns Colitis. 2023 Jan 18. doi: 10.1093/ecco-jcc/jjad004. Online ahead of print. [Link]
25.
Berinstein JA, Sheehan JL, Dias M, et al. Tofacitinib for Biologic-Experienced Hospitalized Patients With Acute Severe Ulcerative Colitis: A Retrospective Case-Control Study. Clin Gastroenterol Hepatol 2021;19:2112-20. [Link]
26.
Kucharzik T, Ellul P, Greuter T, et al. ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease. J Crohns Colitis. 2021 22;15:879-913. [Link]
27.
Rahier JF, Ben-Horin S, Chowers Y, et al. European evidence-based Consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis. 2009;3:47-91. [Link]
28.
Moskovitz DN, Van Assche G, Maenhout B, et al. Incidence of colectomy during long-term follow-up after cyclosporine-induced remission of severe ulcerative colitis. Clin Gastroenterol Hepatol 2006;4:760-5. [Link]
29.
Parc Y, Reboul-Marty J, Lefevre JH, et al. Restorative Proctocolectomy and Ileal Pouch-anal Anastomosis. Ann Surg. 2015;262:849-53. [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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