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Clinical Case Summary

We report the case of a 54-year-old male with harmful alcohol consumption who presented to the emergency department for hematemesis with acute anaemisation. After stabilising the patient, an urgent gastroscopy was performed and large esophageal varices with red points were found, over which elastic bands (EVBL) were placed.
Hours after the endoscopic procedure, the patient presented a new episode of hematemesis and hemodynamic instability. After resucitation, he was transferred to the care unit for a new gastroscopy. In it, four small varicose cords with constant drooling of blood and clots were observed. Given the impossibility of EVBL, the patient was fitted with a fully covered self-expanding metal stent (SEMSs), achieving clinical stability for him.
Following this procedure, an etiological study was carried out, concluding that portal cavernomatosis secondary to chronic pancreatitis was the cause of the current clinical case. Given the etiology and what happened, five days after the endoscopic procedure, endovascular treatment was performed by Interventional Radiology with complete embolisation of oesophageal varices and subsequent recanalisation of the splenoportal axis by angioplasty and placement of a vascular stent. After that, the oesophageal stent was removed without complications. Six months later, the patient underwent clinical and endoscopic follow-ups, showing a lack of esophageal varices and other data of portal hypertension.
According to the latest consensus of Baveno VII and ESGE for the management of variceal hemorrhage, SEMSs implantation is considered the safest option as a bridge therapy to a more definitive treatment of refractory variceal bleeding; allowing time for etiological investigation and appropriate patient management^1-2.

References

1. de Franchis R, Bosch J, Garcia-Tsao G et al. Baveno VII – Renewing consensus in portal hypertension. J Hepatol 2022; 76: 959-74 https://doi.org/10.1016/j.jhep.2021.12.022
2. Gralnek IM, Camus-Duboc M, García-Pagán JC et al. Endoscopic diagnosis and managemet of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy 2022; 54 (11): 1094-1120 https://doi.org/10.1055/a-1939-4887

MANAGEMENT OF MASSIVE ESOPHAGEAL VARICEAL HEMORRHAGE OF PREHEPATIC CAUSE

Fernando Berdugo Hurtado 1, Maria Cristina Bailon Gaona 1, López Peña Concepción 1, Raúl Gijon Villanova 1, Adelina García Robles 1

1 San Cecilio University Hospital, Granada, Spain

Conference

UEG Week Vienna 2024

Topics

Oesophagus

Submission format

Clinical Case

Session

Clinical Cases (Posters)

Published

2024

UEG Podcast Episode

UEG Podcast

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Physician Wellbeing

Martina Müller-Schilling, Egle Dieninyte - Misiune

Published

2024

UEG Standards and Guidelines

New

Clinical Practice Guideline

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ABSTRACT

Introduction

Since the publication of the first European Society for the Study of Coeliac Disease (ESsCD) guidelines in 2019, substantial advances have been made in understanding the management and complex disease courses of coeliac disease (CeD) in adults. These 2025 updated guidelines aim to integrate new evidence, refine management strategies, and promote a personalised and multidisciplinary approach to care.

Methods

The ESsCD convened a multidisciplinary panel of experts to revise the 2019 guidelines using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) framework. Evidence was appraised and graded according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Statements and recommendations were draughted within working groups and finalised through a structured Delphi consensus process.

Results

The updated guidelines are presented in two parts. Part 1, which has already been published, addresses the diagnostic approach to CeD in adults, whereas Part 2 focuses on disease management, structured follow-up, and the evaluation and treatment of persistent symptoms despite a gluten-free diet or refractory disease. New or expanded sections include guidance on the safe inclusion of oats, use of low-FODMAP diets in patients with persistent symptoms, management of exocrine pancreatic insufficiency, recognition of functional asplenia and related vaccination recommendations, and stratified bone-health screening. The guidelines also discuss nutritional and psychosocial support, digital models of care, and structured transition from paediatric to adult services. Updated therapeutic strategies for refractory CeD are provided, including immunosuppressive and novel pharmacologic options.

Conclusions

These updated guidelines offer a comprehensive, evidence-based framework for the management and follow-up of adults with CeD. By integrating recent scientific advances with pragmatic, patient-centred recommendations, they seek to optimise clinical outcomes, quality of life, and long-term health in individuals with CeD.

European Society for the Study of Coeliac Disease (ESsCD) 2025 Updated Guidelines on the Diagnosis and Management of Coeliac Disease in Adults. Part 2: Management, Follow-Up, and Complex Disease Courses

Abdulbaqi Al-Toma

Guideline

Clinical Practice Guideline

Topics

Immunology Small Intestine & Nutrition

Citation

United European Gastroenterology Journal, 2026

Published

2026

UEG Standards and Guidelines

Clinical Practice Guideline

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Abstract

Background

There are several options for the surgical management of GERD in adults. Previous guidelines and systematic reviews have compared the effects of total fundoplication versus pooled effects of different techniques of partial fundoplication.

Objective

To develop evidence-informed, trustworthy, pertinent recommendations on the use of total, posterior partial and anterior partial fundoplications for the management of GERD in adults.

Methods

We performed an update systematic review, network meta-analysis, and evidence appraisal using the GRADE and the Confidence in Network Meta-Analysis methodologies. An international, multidisciplinary panel of surgeons, gastroenterologists, and a patient representative reached unanimous consensus through an evidence-to-decision framework to select among multiple interventions, and a Delphi process to formulate the recommendation. The project was developed in an online authoring and publication platform (MAGICapp), and was overseen by an external auditor.

Results

We suggest posterior partial fundoplication over total posterior or anterior 90° fundoplication in adult patients with GERD. We suggest anterior >90° fundoplication as an alternative, although relevant comparative evidence is limited (weak recommendation). The guideline, with recommendations, evidence summaries and decision aids in user friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/j20X4n.

Conclusion

This rapid guideline was developed in line with highest methodological standards and provides evidence-informed recommendations on the surgical management of GERD. It provides user-friendly decision aids to inform healthcare professionals' and patients' decision making.

Key summary

Various surgical options exist for the management of GERD in adults.
We summarized evidence through network meta-analysis of interventions.
We suggest partial posterior fundoplication over total posterior or anterior 90° fundoplication.
We suggest anterior >90 degrees may be an alternative.

Keywords: AGREE‐S, fundoplication, GERD, guideline, Nissen, Toupét

UEG and EAES rapid guideline: Update systematic review, network meta-analysis, CINeMA and GRADE assessment, and evidence-informed European recommendations on surgical management of GERD

Sheraz Markar

Publishers

European Society for Paediatric Gastroenterology, Hepatology and Nutrition, European Association for Endoscopic Surgery and other interventional techniques

Guideline

Clinical Practice Guideline

Topics

Oesophagus Stomach & H. Pylori Surgery

Citation

United European Gastroenterol J. 2022; 10( 9): 983– 98

Published

2022

UEG Standards and Guidelines

Consensus

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Highlights

Across European cancer centres, imaging protocols show considerable heterogeneity.

This European collaboration conducted a consensus finding survey on mCRC imaging.

An imaging protocol scorecard is provided to facilitate implementation in trials.

Abstract

Background

Treatment monitoring in metastatic colorectal cancer (mCRC) relies on imaging to evaluate the tumour burden. Response Evaluation Criteria in Solid Tumors provide a framework on reporting and interpretation of imaging findings yet offer no guidance on a standardised imaging protocol tailored to patients with mCRC. Imaging protocol heterogeneity remains a challenge for the reproducibility of conventional imaging end-points and is an obstacle for research on novel imaging end-points.

Patients and methods

Acknowledging the recently highlighted potential of radiomics and artificial intelligence tools as decision support for patient care in mCRC, a multidisciplinary, international and expert panel of imaging specialists was formed to find consensus on mCRC imaging protocols using the Delphi method.

Results

Under the guidance of the European Organisation for Research and Treatment of Cancer (EORTC) Imaging and Gastrointestinal Tract Cancer Groups, the European Society of Oncologic Imaging (ESOI) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR), the EORTC-ESOI-ESGAR core imaging protocol was identified.

Conclusion

This consensus protocol attempts to promote standardisation and to diminish variations in patient preparation, scan acquisition and scan reconstruction. We anticipate that this standardisation will increase reproducibility of radiomics and artificial intelligence studies and serve as a catalyst for future research on imaging end-points. For ongoing and future mCRC trials, we encourage principal investigators to support the dissemination of these imaging standards across recruiting centres.

Keywords

Colorectal cancer
Imaging
Computed tomography
Positron emission tomography
Standardisation
Radiomics
Artificial intelligence

Imaging standardisation in metastatic colorectal cancer: A joint EORTC-ESOI-ESGAR expert consensus recommendation

Marcus Unterrainer, Christophe Deroose

Publisher

European Society of Gastrointestinal and Abdominal Radiology

Guideline

Consensus

Topics

Digestive Oncology Radiology & Imaging Colorectal

Citation

European Journal of Cancer, Volume 176, 2022, Pages 193-206

Published

2022

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Introduction

COVID-19 pandemic has negatively affected treatment of H. pylori and has long-term consequences, in particular, bacterial susceptibility decreased to broad-spectrum antibiotics used in typical H. pylori eradication regimens. Currently, there is limited scientific data on the effectiveness and safety of standard eradication regimens in the post-COVID period. The aim of the study is to investigate the effectiveness and safety of 10- and 14-day H. pylori eradication regimens used during 2022-2025 and to compare their effectiveness and safety with 10-day regimens used during 2019-2021 in Ukraine, as well as to identify the relationship between unsuccessful treatment cases and anamnestic data.

Aims & Methods

We conducted retrospective multicenter observational study during 2019-2025 years. A comparative analysis of the effectiveness and safety of various eradication regimens for group I (n=82) treated during 2019-2021 years and group II patients (n=74) treated during 2022-2025 years was performed. We determined frequency, intensity, and spectrum of side effects in both groups. A multivariate regression analysis of relationship between unsuccessful treatment cases and anamnestic data was performed.

Results

Comparative analysis revealed no statistical difference in the eradication rates between groups I and II (p≥0.05). The lowest eradication rate among patients in group II was detected on three-component regimens esomeprazole + clarithromycin +amoxicillin (67%) and pantoprazole + clarithromycin/metronidazole/tinidazole (70%). The highest eradication rate was on quadruple regimen esomeprazole + levofloxacin +amoxicillin + furazolidone (100%). In group II, the frequency of side effects, their intensity, and spectrum significantly increased after 14-day treatment (p<0.001) in comparison with group I. Regression analysis revealed that male gender, history of COVID-19 infection, and first treatment attempts were significantly more frequently associated with unsuccessful treatment (p<0.05).

Conclusion

Standard 14-day three-component H. pylori eradication regimens esomeprazole + clarithromycin +amoxicillin, pantoprazole + clarithromycin/metronidazole/tinidazole, pantoprazole + amoxicillin + metronidazole/tinidazole have inappropriate eradication rates (≤70%). The 14-day quadruple esomeprazole + levofloxacin +amoxicillin + furazolidone regimen demonstrates a high eradication rate (>90%), but is accompanied by frequent and diverse side effects, reduced adherence to treatment. Treatment failure is significantly associated with male gender, previous COVID-19 infection, and first treatment attempts.

Disclosure

The authors declare no conflict of interest.

EVALUATION OF THE EFFICACY AND SAFETY OF DIFFERENT REGIMENS FOR HELICOBACTER PYLORI ERADICATION THERAPY DURING THE COVID-19 PANDEMIC AND POST-PANDEMIC PERIOD IN UKRAINE: A RETROSPECTIVE OBSERVATIONAL STUDY

Volodymyr Cherniavskyi 1, Alina Baylo 1

1 Bogomolets National Medical University, Kyiv, Ukraine

Conference

UEG Week Berlin 2025

Topics

Stomach & H. Pylori

Submission format

Abstract

Session

H.PYLORI (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

UEG Standards and Guidelines

Consensus

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ABSTRACT

This international, multidisciplinary consensus report represents the first effort to systematically define and characterize fatty pancreas. A key outcome of this endeavor was the recommendation to adopt “fatty pancreas” as the standardized and inclusive term to describe all forms of fat accumulation in the pancreas. This terminological consensus provides a critical foundation for unified reporting and clinical communication. Another major contribution of the report is the consensus on diagnostic imaging findings, which was based on radiological and endoscopic modalities. The proposed criteria aim to enhance consistency in clinical assessment and support the development of standardized research protocols. In addition to establishing terminology and diagnostic frameworks, the report also synthesizes current knowledge across a wide range of relevant domains. These include the etiology and epidemiology of fatty pancreas, as well as its associations with alcohol consumption, smoking, acute and chronic pancreatitis, pancreatic exocrine insufficiency, type 2 diabetes mellitus, and surgical outcomes. The potential links between fatty pancreas and neoplastic conditions such as intraductal papillary mucinous neoplasms and pancreatic cancer are also addressed, alongside the current understanding of its metabolic implications (beta-cell function and glucose homeostasis) and treatment strategies. Throughout the consensus process, a consistent theme emerged: the limited availability of high-quality, prospective clinical data. Therefore, many of the recommendations in this report are based on expert consensus rather than strong empirical evidence. As such, the statements require rigorous prospective validation before they can be adopted into routine clinical practice. This underscores a critical need for further research, particularly studies aimed at clarifying causal relationships, validating diagnostic tools, and determining the clinical relevance of fatty pancreas across diverse patient populations. This report serves as both a summary of our current understanding and a roadmap for future investigations, aiming to close existing knowledge gaps and guide evidence-based clinical practice in this emerging field.

International Multidisciplinary Consensus Report on Definitions, Diagnostic Criteria, and Management of Fatty Pancreas: A Joint Statement Endorsed by EPC, APA, EASD, EASL, ESGAR, ESGE, ESP, ESPCG, ESPEN, ESPGHAN, IAP, JPS, KPBA, LAPSG, and UEG

Miroslav Vujasinovic

Publishers

European Society for Paediatric Gastroenterology, Hepatology and Nutrition, The European Society for Clinical Nutrition and Metabolism, European Society for Primary Care Gastroenterology, European Society of Pathology, European Society of Gastrointestinal Endoscopy, European Society of Gastrointestinal and Abdominal Radiology, European Association for the Study of the Liver, European Pancreatic Club

Guideline

Consensus

Topics

Pancreas

Citation

United European Gastroenterology Journal, 2026; 14:e70185

Published

2026

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