Mistakes in hepatitis C and how to avoid them

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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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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9

World Health Organization (WHO). Hepatitis C-Key facts, https://www.who.int/news-room/fact-sheets/detail/hepatitis-c (accessed 23 April 2025). [Link]

Sallam M, Khalil R. Contemporary Insights into Hepatitis C Virus: A Comprehensive Review. Microorganisms 2024; 12: 1035. [Link]

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]

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]

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]

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]

Terrault NA. Hepatitis C elimination: challenges with under-diagnosis and under-treatment. F1000Research 2019; 8: 54. [Link]

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]

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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ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment

Javier P. Gisbert

Mistakes in abdominal distension and how to avoid them

Alberto Ezquerra-Durán

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

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ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment

Javier P. Gisbert

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Guideline

Introduction

Ulcerative colitis [UC] is a chronic inflammatory bowel disease [IBD] characterised by colonic inflammation extending to a variable extent from the rectum. Care of the patient with UC requires appropriate input from across the multiprofessional team. These guidelines summarise the recommended medical treatment for adults with UC.

In 2022, the European Crohn’s and Colitis Organisation [ECCO] published new guidelines on the management of UC in two papers focused on the medical and surgical management of the disease.¹^,² For the 2022 UC guidelines, ECCO adopted the Grading of Recommendations Assessment, Development, and Evaluation [GRADE] approach, a systematic process for developing guidelines that addresses how to frame healthcare questions, summarise the evidence, formulate recommendations, and grade their strength and the quality of associated evidence.³ The present paper represents an update to the 2022 guidelines and focuses specifically on the medical management of UC, while a companion paper developed as part of the same process addresses optimal surgical management [ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment].

For this iteration of the guidelines, we have introduced several new, clinically relevant questions selected by members of the guidelines group, alongside a systematic approach to reviewing and updating previous topics to incorporate new evidence and to reappraise all findings within the context of contemporary practice. We have also introduced several “practice points” to summarise evidence and provide expert recommendations in key areas where the evidence remains limited but clinical decisions are still required. In such instances, where application of the GRADE methodology may be impractical, we adopted an approach based on systematic literature review, expert discussion, and voting to reach consensus recommendations outside the formal GRADE process.

Patients living with UC can have a variable disease course.⁴ In this document, we discuss therapeutic approaches stratified by disease severity [mildly-to-moderately active and moderately-to-severely active disease]. Definitions of disease severity are commonly used to establish clinical trial inclusion criteria and may be based on several distinct assessment frameworks.⁵ It is also important to remember that these definitions capture severity at a given point in time and may not reflect the cumulative long-term burden of disease experienced by a patient.⁶

It is also important to consider disease extent when planning treatment in UC, as this may affect the optimal route of drug administration. This is typically defined according to disease involving the rectum only [proctitis], disease distal to the splenic flexure [left-sided or distal UC], or disease extending proximal to the splenic flexure [extensive UC].⁷ It should be noted that disease distribution can change⁴ and that proximal disease extension can be a negative prognostic marker.⁸

Publisher

European Crohn’s and Colitis Organisation

Guideline

Clinical Practice Guideline

Topics

IBD

Citation

Journal of Crohn's and Colitis, Volume 20, Issue 7, July 2026

Published

2026

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UEG Mistakes In Articles

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Mistakes in abdominal distension and how to avoid them

Elizabeth Barba Orozco, Alberto Ezquerra-Durán

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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

World Health Organization (WHO). Hepatitis C-Key facts, https://www.who.int/news-room/fact-sheets/detail/hepatitis-c (accessed 23 April 2025). [Link]

Sallam M, Khalil R. Contemporary Insights into Hepatitis C Virus: A Comprehensive Review. Microorganisms 2024; 12: 1035. [Link]

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]

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]

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]

Terrault NA. Hepatitis C elimination: challenges with under-diagnosis and under-treatment. F1000Research 2019; 8: 54. [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.

13.

14.

15.

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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UEG Standards and Guidelines

Consensus

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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

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Guideline

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.

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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ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease

Henit Yanai

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Guideline

Introduction

The therapeutic landscape of inflammatory bowel disease [IBD] has undergone a profound transformation with the advent of novel immunosuppressive and biologic agents. These advancements have revolutionised the management of Crohn’s disease [CD] and ulcerative colitis [UC], enabling tighter control of inflammation and significantly improved patient outcomes. However, while older treatment strategies, including prolonged corticosteroids, purine analogues, and anti-tumour necrosis factor [TNF]/thiopurine combination therapy, carried a substantial immunosuppressive burden, the expanding therapeutic armamentarium introduces new agents with distinct infection risk profiles that require updated, evidence-based guidance. By definition, opportunistic infections are infections caused by organisms that infrequently induce disease in immunocompetent hosts but can result in significant morbidity or mortality in immunocompromised individuals. As treatment strategies increasingly rely on potent modulation of the immune system, ranging from traditional thiopurines to advanced small molecules, a structured, evidence-based approach to infection prevention, diagnosis, and management has become indispensable for the clinician. The European Crohn’s and Colitis Organisation [ECCO] has long recognised this clinical imperative, previously publishing consensus statements in 2009 and 2014, followed by a comprehensive guideline in 2021. This 2026 update is warranted by the rapid expansion of the therapeutic armamentarium, specifically the introduction of newer small molecules, advanced biologics, and evolving vaccination strategies. This update integrates the most recent data on risk stratification, viral, bacterial, mycobacterial, and vaccine-preventable infections, emphasising a preventative strategy tailored to the contemporary IBD treatment paradigm.

Publisher

European Crohn’s and Colitis Organisation

Guideline

Clinical Practice Guideline

Topics

IBD

Citation

Journal of Crohn's and Colitis, Volume 20, Issue 7, July 2026

Published

2026

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UEG Podcast Episode

UEG Podcast

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Coeliac disease with David Sanders

David S. Sanders, Pradeep Mundre

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Abstract

Topics

Small Intestine & Nutrition

Published

2026

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ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment

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Mistakes in abdominal distension and how to avoid them

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Mistakes in Pancreatic exocrine insufficiency and how to avoid them

Miroslav Vujasinovic, J. Enrique Domínguez Muñoz, Matthias Löhr

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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

World Health Organization (WHO). Hepatitis C-Key facts, https://www.who.int/news-room/fact-sheets/detail/hepatitis-c (accessed 23 April 2025). [Link]

Sallam M, Khalil R. Contemporary Insights into Hepatitis C Virus: A Comprehensive Review. Microorganisms 2024; 12: 1035. [Link]

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]

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]

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]

Terrault NA. Hepatitis C elimination: challenges with under-diagnosis and under-treatment. F1000Research 2019; 8: 54. [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.

13.

14.

15.

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

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

More Like This:

ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment

Javier P. Gisbert

Mistakes in abdominal distension and how to avoid them

Alberto Ezquerra-Durán

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

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