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Mistakes in rumination syndrome and how to avoid them

Alberto Ezquerra-Durán, Elizabeth Barba Orozco

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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.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7
1.
Brockbank EM. Merycism or rumination in man. Br Med J. 1907;1:421–427. [Link]
2.
Malagelada C, Keller J, Sifrim D, et al. European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management. United European Gastroenterol J. Published online 2025:1-45. [Link]
3.
Stanghellini V, Chan FKL, Hasler WL, et al. Gastroduodenal Disorders. Gastroenterology. 2016;150(6):1380-1392. [Link]
4.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edn. 2013th ed. (American Psychiatric Association, ed.). [Link]
5.
Burri E, Cisternas D, Villoria A, et al. Accommodation of the abdomen to its content: integrated abdomino‐thoracic response. Neurogastroenterology & Motility. 2012;24(4):312. [Link]
6.
Barba E, Burri E, Accarino A, et al. Biofeedback-Guided Control of Abdominothoracic Muscular Activity Reduces Regurgitation Episodes in Patients With Rumination. Clinical Gastroenterology and Hepatology. 2015;13(1):100-106.e1. [Link]
7.
Haworth JJ, Treadway S, Hobson AR. The prevalence of rumination syndrome and rumination disorder: A systematic review and meta‐analysis. Neurogastroenterology & Motility. 2024;36(7):1-9. [Link]
8.
O’Brien MD, Bruce BK, Camilleri M. The rumination syndrome: Clinical features rather than manometric diagnosis. Gastroenterology. 1995;108(4):1024-1029. [Link]
9.
Chial HJ, Camilleri M, Williams DE, Litzinger K, Perrault J. Rumination Syndrome in Children and Adolescents: Diagnosis, Treatment, and Prognosis. Pediatrics. 2003;111(1):158-162. [Link]
10.
Halland M, Pandolfino J, Barba E. Diagnosis and Treatment of Rumination Syndrome. Clinical Gastroenterology and Hepatology. 2018;16(10):1549-1555. [Link]
11.
Benninga MA, Nurko S, Faure C, Hyman PE, St. James Roberts I, Schechter NL. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology. 2016;150(6):1443-1455.e2. [Link]
12.
Josefsson A, Hreinsson JP, Simrén M, et al. Global Prevalence and Impact of Rumination Syndrome. Gastroenterology. 2022;162(3):731-742.e9. [Link]
13.
Treasure J, Duarte TA, Schmidt U. Eating disorders. The Lancet. 2020;395(10227):899-911. [Link]
14.
Vijayvargiya P, Iturrino J, Camilleri M, et al. Novel association of rectal evacuation disorder and rumination syndrome: Diagnosis, comorbidities, and treatment. United European Gastroenterology Journal. 2014;2(1):38-46. [Link]
15.
Cai JX, Wong D, Lee DJH, Chan WW. Eating and Psychiatric Disorders Are Independent Risk Factors for Rumination Syndrome. Journal of Clinical Gastroenterology. 2022;56(3):228-233. [Link]
16.
Hartmann AS, Zenger M, Glaesmer H, et al. Prevalence of pica and rumination behaviours in adults and associations with eating disorder and general psychopathology: findings form a population-based study. Epidemiology and Psychiatric Sciences. 2022;31:e40. [Link]
17.
Remes-Troche JM, Cid-Juárez S, Campos-Ramos I, et al. Role of physical, psychological and sexual abuse in functional digestive disorders. A case-controls trial. Revista de gastroenterologia de Mexico. 2008;73(4):209-216. [Link]
18.
Zerbib F, Bredenoord AJ, Fass R, et al. ESNM/ANMS consensus paper: Diagnosis and management of refractory gastro‐esophageal reflux disease. Neurogastroenterology & Motility. 2021;33(4):1-25. [Link]
19.
Yadlapati R, Tye M, Roman S, Kahrilas PJ, Ritter K, Pandolfino JE. Postprandial High-Resolution Impedance Manometry Identifies Mechanisms of Nonresponse to Proton Pump Inhibitors. Clinical Gastroenterology and Hepatology. 2018;16(2):211-218.e1. [Link]
20.
Nakagawa K, Sawada A, Hoshikawa Y, et al. Persistent Postprandial Regurgitation vs Rumination in Patients With Refractory Gastroesophageal Reflux Disease Symptoms: Identification of a Distinct Rumination Pattern Using Ambulatory Impedance-pH Monitoring. American Journal of Gastroenterology. 2019;114(8):1248-1255. [Link]
21.
Sawada A, Guzman M, Nikaki K, et al. Identification of Different Phenotypes of Esophageal Reflux Hypersensitivity and Implications for Treatment. Clinical Gastroenterology and Hepatology. 2021;19(4):690-698.e2. [Link]
22.
Lacy BE, Parkman HP, Camilleri M. Chronic nausea and vomiting: evaluation and treatment. American Journal of Gastroenterology. 2018;113(5):647-659. [Link]
23.
Malik R, Srivastava A, Yachha SK, Poddar U. Chronic vomiting in children: A prospective study reveals rumination syndrome is an important etiology that is underdiagnosed and untreated. Indian Journal of Gastroenterology. 2020;39(2):196-203. [Link]
24.
Murray HB, Pasricha TS, Jehangir A, Thomas JJ, Kuo B, Parkman HP. Detection and characteristics of rumination syndrome in patients presenting for gastric symptom evaluation. Neurogastroenterology & Motility. 2021;33(8):1-8. [Link]
25.
Bredenoord AJ, Chial HJ, Camilleri M, Mullan BP, Murray JA. Gastric accommodation and emptying in evaluation of patients with upper gastrointestinal symptoms. Clinical Gastroenterology and Hepatology. 2003;1(4):264-272. [Link]
26.
Zand Irani M, Jones MP, Halland M, et al. Prevalence, symptoms and risk factor profile of rumination syndrome and functional dyspepsia: a population‐based study. Aliment Pharmacol Ther. 2021;54(11-12):1416-1431. [Link]
27.
Kindt S, Tack J. Impaired gastric accommodation and its role in dyspepsia. Gut. 2006;55(12):1685-1691. [Link]
28.
Thumshirn M, Camilleri M, Hanson RB, Williams DE, Schei AJ, Kammer PP. Gastric mechanosensory and lower esophageal sphincter function in rumination syndrome. American Journal of Physiology-Gastrointestinal and Liver Physiology. 1998;275(2):G314-G321. [Link]
29.
Hoshikawa Y, Fitzke H, Sweis R, et al. Rumination syndrome: Assessment of vagal tone during and after meals and during diaphragmatic breathing. Neurogastroenterology & Motility. 2020;32(11):1-9. [Link]
30.
Halland M, Talley NJ, Jones M, Murray JA, Cameron R, Walker MM. Duodenal Pathology in Patients with Rumination Syndrome: Duodenal Eosinophilia and Increased Intraepithelial Lymphocytes. Digestive Diseases and Sciences. 2019;64(3):832-837. [Link]
31.
Zand Irani M, Eslick GD, Brown G, Talley NJ. Letter: eosinophilic duodenitis and increased intraepithelial lymphocytes in rumination syndrome – more evidence. Alimentary Pharmacology & Therapeutics. 2023;57(11):1353-1354. [Link]
32.
Friesen HJ, Rosen J, Low Kapalu C, et al. Mucosal eosinophils, mast cells, and intraepithelial lymphocytes in youth with rumination syndrome. Neurogastroenterology & Motility. 2021;33(10):1-6. [Link]
33.
Rajindrajith S, Devanarayana NM, Crispus Perera BJ. Rumination syndrome in children and adolescents: a school survey assessing prevalence and symptomatology. BMC Gastroenterology. 2012;12(1):163. [Link]
34.
Barba E, Accarino A, Soldevilla A, Malagelada JR, Azpiroz F. Randomized, Placebo-Controlled Trial of Biofeedback for the Treatment of Rumination. American Journal of Gastroenterology. 2016;111(7):1007-1013. [Link]
35.
Monagas J, Ritwik P, Kolomensky A, et al. Rumination Syndrome and Dental Erosions in Children. Journal of Pediatric Gastroenterology and Nutrition. 2017;64(6):930-932. [Link]
36.
Levine DF, Wingate DL, Pfeffer JM, Butcher P. Habitual rumination: a benign disorder. BMJ. 1983;287(6387):255-256. [Link]
37.
Murray HB, Juarascio AS, Di Lorenzo C, Drossman DA, Thomas JJ. Diagnosis and Treatment of Rumination Syndrome: A Critical Review. American Journal of Gastroenterology. 2019;114(4):562-578. [Link]
38.
Tucker E, Knowles K, Wright J, Fox MR. Rumination variations: aetiology and classification of abnormal behavioural responses to digestive symptoms based on high‐resolution manometry studies. Alimentary Pharmacology & Therapeutics. 2013;37(2):263-274. [Link]
39.
Kessing BF, Bredenoord AJ, Smout AJPM. Objective Manometric Criteria for the Rumination Syndrome. American Journal of Gastroenterology. 2014;109(1):52-59. [Link]
40.
Geysen H, Michielsen S, Rommel N, Vanuytsel T, Tack J, Pauwels A. The gastro‐sphincteric pressure gradient: A new parameter to diagnose a rumination episode. Neurogastroenterology & Motility. 2021;33(6):1-7. [Link]
41.
Nakagawa K, Sawada A, Hoshikawa Y, et al. Persistent Postprandial Regurgitation vs Rumination in Patients With Refractory Gastroesophageal Reflux Disease Symptoms: Identification of a Distinct Rumination Pattern Using Ambulatory Impedance-pH Monitoring. American Journal of Gastroenterology. 2019;114(8):1248-1255. [Link]
42.
Barba E, Burri E, Accarino A, et al. Biofeedback-guided control of abdominothoracic muscular activity reduces regurgitation episodes in patients with rumination. Clinical Gastroenterology and Hepatology. 2015;13(1):100-106.e1. [Link]
43.
Halland M, Parthasarathy G, Bharucha AE, Katzka DA. Diaphragmatic breathing for rumination syndrome: efficacy and mechanisms of action. Neurogastroenterology & Motility. 2016;28(3):384-391. [Link]
44.
Murray HB, Zhang F, Call CC, et al. Comprehensive Cognitive-Behavioral Interventions Augment Diaphragmatic Breathing for Rumination Syndrome: A Proof-of-Concept Trial. Digestive Diseases and Sciences. 2021;66(10):3461-3469. [Link]
45.
Pauwels A, Broers C, Van Houtte B, Rommel N, Vanuytsel T, Tack J. A Randomized Double-Blind, Placebo-Controlled, Cross-Over Study Using Baclofen in the Treatment of Rumination Syndrome. American Journal of Gastroenterology. 2018;113(1):97-104. [Link]
46.
Drossman DA, Tack J, Ford AC, Szigethy E, Törnblom H, Van Oudenhove L. Neuromodulators for Functional Gastrointestinal Disorders (Disorders of Gut−Brain Interaction): A Rome Foundation Working Team Report. Gastroenterology. 2018;154(4):1140-1171.e1. [Link]
47.
Robles A, Romero YA, Tatro E, Quezada H, McCallum RW. Outcomes of Treating Rumination Syndrome with a Tricyclic Antidepressant and Diaphragmatic Breathing. The American Journal of the Medical Sciences. 2020;360(1):42-49. [Link]

Abstract

Topics

Neurogastroenterology & Motility

Citation

Ezquerra-Durán A and Barba-Orozco E. Mistakes in rumination syndrome and how to avoid them. UEG Education 2025; 25: 10-13.

Published

2025

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UEG Mistakes In Articles
New
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 hepatocellular carcinoma and how to avoid them

Spyridon Pantzios, Ioannis Elefsiniotis, Christos Triantos

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
1.
Brockbank EM. Merycism or rumination in man. Br Med J. 1907;1:421–427. [Link]
2.
Malagelada C, Keller J, Sifrim D, et al. European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management. United European Gastroenterol J. Published online 2025:1-45. [Link]
3.
Stanghellini V, Chan FKL, Hasler WL, et al. Gastroduodenal Disorders. Gastroenterology. 2016;150(6):1380-1392. [Link]
4.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edn. 2013th ed. (American Psychiatric Association, ed.). [Link]
5.
Burri E, Cisternas D, Villoria A, et al. Accommodation of the abdomen to its content: integrated abdomino‐thoracic response. Neurogastroenterology & Motility. 2012;24(4):312. [Link]
6.
Barba E, Burri E, Accarino A, et al. Biofeedback-Guided Control of Abdominothoracic Muscular Activity Reduces Regurgitation Episodes in Patients With Rumination. Clinical Gastroenterology and Hepatology. 2015;13(1):100-106.e1. [Link]
7.
Haworth JJ, Treadway S, Hobson AR. The prevalence of rumination syndrome and rumination disorder: A systematic review and meta‐analysis. Neurogastroenterology & Motility. 2024;36(7):1-9. [Link]
8.
O’Brien MD, Bruce BK, Camilleri M. The rumination syndrome: Clinical features rather than manometric diagnosis. Gastroenterology. 1995;108(4):1024-1029. [Link]
9.
Chial HJ, Camilleri M, Williams DE, Litzinger K, Perrault J. Rumination Syndrome in Children and Adolescents: Diagnosis, Treatment, and Prognosis. Pediatrics. 2003;111(1):158-162. [Link]
10.
Halland M, Pandolfino J, Barba E. Diagnosis and Treatment of Rumination Syndrome. Clinical Gastroenterology and Hepatology. 2018;16(10):1549-1555. [Link]
11.
Benninga MA, Nurko S, Faure C, Hyman PE, St. James Roberts I, Schechter NL. Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology. 2016;150(6):1443-1455.e2. [Link]
12.
Josefsson A, Hreinsson JP, Simrén M, et al. Global Prevalence and Impact of Rumination Syndrome. Gastroenterology. 2022;162(3):731-742.e9. [Link]
13.
Treasure J, Duarte TA, Schmidt U. Eating disorders. The Lancet. 2020;395(10227):899-911. [Link]
14.
Vijayvargiya P, Iturrino J, Camilleri M, et al. Novel association of rectal evacuation disorder and rumination syndrome: Diagnosis, comorbidities, and treatment. United European Gastroenterology Journal. 2014;2(1):38-46. [Link]
15.
Cai JX, Wong D, Lee DJH, Chan WW. Eating and Psychiatric Disorders Are Independent Risk Factors for Rumination Syndrome. Journal of Clinical Gastroenterology. 2022;56(3):228-233. [Link]
16.
Hartmann AS, Zenger M, Glaesmer H, et al. Prevalence of pica and rumination behaviours in adults and associations with eating disorder and general psychopathology: findings form a population-based study. Epidemiology and Psychiatric Sciences. 2022;31:e40. [Link]
17.
Remes-Troche JM, Cid-Juárez S, Campos-Ramos I, et al. Role of physical, psychological and sexual abuse in functional digestive disorders. A case-controls trial. Revista de gastroenterologia de Mexico. 2008;73(4):209-216. [Link]
18.
Zerbib F, Bredenoord AJ, Fass R, et al. ESNM/ANMS consensus paper: Diagnosis and management of refractory gastro‐esophageal reflux disease. Neurogastroenterology & Motility. 2021;33(4):1-25. [Link]
19.
Yadlapati R, Tye M, Roman S, Kahrilas PJ, Ritter K, Pandolfino JE. Postprandial High-Resolution Impedance Manometry Identifies Mechanisms of Nonresponse to Proton Pump Inhibitors. Clinical Gastroenterology and Hepatology. 2018;16(2):211-218.e1. [Link]
20.
Nakagawa K, Sawada A, Hoshikawa Y, et al. Persistent Postprandial Regurgitation vs Rumination in Patients With Refractory Gastroesophageal Reflux Disease Symptoms: Identification of a Distinct Rumination Pattern Using Ambulatory Impedance-pH Monitoring. American Journal of Gastroenterology. 2019;114(8):1248-1255. [Link]
21.
Sawada A, Guzman M, Nikaki K, et al. Identification of Different Phenotypes of Esophageal Reflux Hypersensitivity and Implications for Treatment. Clinical Gastroenterology and Hepatology. 2021;19(4):690-698.e2. [Link]
22.
Lacy BE, Parkman HP, Camilleri M. Chronic nausea and vomiting: evaluation and treatment. American Journal of Gastroenterology. 2018;113(5):647-659. [Link]
23.
Malik R, Srivastava A, Yachha SK, Poddar U. Chronic vomiting in children: A prospective study reveals rumination syndrome is an important etiology that is underdiagnosed and untreated. Indian Journal of Gastroenterology. 2020;39(2):196-203. [Link]
24.
Murray HB, Pasricha TS, Jehangir A, Thomas JJ, Kuo B, Parkman HP. Detection and characteristics of rumination syndrome in patients presenting for gastric symptom evaluation. Neurogastroenterology & Motility. 2021;33(8):1-8. [Link]
25.
Bredenoord AJ, Chial HJ, Camilleri M, Mullan BP, Murray JA. Gastric accommodation and emptying in evaluation of patients with upper gastrointestinal symptoms. Clinical Gastroenterology and Hepatology. 2003;1(4):264-272. [Link]
26.
Zand Irani M, Jones MP, Halland M, et al. Prevalence, symptoms and risk factor profile of rumination syndrome and functional dyspepsia: a population‐based study. Aliment Pharmacol Ther. 2021;54(11-12):1416-1431. [Link]
27.
Kindt S, Tack J. Impaired gastric accommodation and its role in dyspepsia. Gut. 2006;55(12):1685-1691. [Link]
28.
Thumshirn M, Camilleri M, Hanson RB, Williams DE, Schei AJ, Kammer PP. Gastric mechanosensory and lower esophageal sphincter function in rumination syndrome. American Journal of Physiology-Gastrointestinal and Liver Physiology. 1998;275(2):G314-G321. [Link]
29.
Hoshikawa Y, Fitzke H, Sweis R, et al. Rumination syndrome: Assessment of vagal tone during and after meals and during diaphragmatic breathing. Neurogastroenterology & Motility. 2020;32(11):1-9. [Link]
30.
Halland M, Talley NJ, Jones M, Murray JA, Cameron R, Walker MM. Duodenal Pathology in Patients with Rumination Syndrome: Duodenal Eosinophilia and Increased Intraepithelial Lymphocytes. Digestive Diseases and Sciences. 2019;64(3):832-837. [Link]
31.
Zand Irani M, Eslick GD, Brown G, Talley NJ. Letter: eosinophilic duodenitis and increased intraepithelial lymphocytes in rumination syndrome – more evidence. Alimentary Pharmacology & Therapeutics. 2023;57(11):1353-1354. [Link]
32.
Friesen HJ, Rosen J, Low Kapalu C, et al. Mucosal eosinophils, mast cells, and intraepithelial lymphocytes in youth with rumination syndrome. Neurogastroenterology & Motility. 2021;33(10):1-6. [Link]
33.
Rajindrajith S, Devanarayana NM, Crispus Perera BJ. Rumination syndrome in children and adolescents: a school survey assessing prevalence and symptomatology. BMC Gastroenterology. 2012;12(1):163. [Link]
34.
Barba E, Accarino A, Soldevilla A, Malagelada JR, Azpiroz F. Randomized, Placebo-Controlled Trial of Biofeedback for the Treatment of Rumination. American Journal of Gastroenterology. 2016;111(7):1007-1013. [Link]
35.
Monagas J, Ritwik P, Kolomensky A, et al. Rumination Syndrome and Dental Erosions in Children. Journal of Pediatric Gastroenterology and Nutrition. 2017;64(6):930-932. [Link]
36.
Levine DF, Wingate DL, Pfeffer JM, Butcher P. Habitual rumination: a benign disorder. BMJ. 1983;287(6387):255-256. [Link]
37.
Murray HB, Juarascio AS, Di Lorenzo C, Drossman DA, Thomas JJ. Diagnosis and Treatment of Rumination Syndrome: A Critical Review. American Journal of Gastroenterology. 2019;114(4):562-578. [Link]
38.
Tucker E, Knowles K, Wright J, Fox MR. Rumination variations: aetiology and classification of abnormal behavioural responses to digestive symptoms based on high‐resolution manometry studies. Alimentary Pharmacology & Therapeutics. 2013;37(2):263-274. [Link]
39.
Kessing BF, Bredenoord AJ, Smout AJPM. Objective Manometric Criteria for the Rumination Syndrome. American Journal of Gastroenterology. 2014;109(1):52-59. [Link]
40.
Geysen H, Michielsen S, Rommel N, Vanuytsel T, Tack J, Pauwels A. The gastro‐sphincteric pressure gradient: A new parameter to diagnose a rumination episode. Neurogastroenterology & Motility. 2021;33(6):1-7. [Link]
41.
Nakagawa K, Sawada A, Hoshikawa Y, et al. Persistent Postprandial Regurgitation vs Rumination in Patients With Refractory Gastroesophageal Reflux Disease Symptoms: Identification of a Distinct Rumination Pattern Using Ambulatory Impedance-pH Monitoring. American Journal of Gastroenterology. 2019;114(8):1248-1255. [Link]
42.
Barba E, Burri E, Accarino A, et al. Biofeedback-guided control of abdominothoracic muscular activity reduces regurgitation episodes in patients with rumination. Clinical Gastroenterology and Hepatology. 2015;13(1):100-106.e1. [Link]
43.
Halland M, Parthasarathy G, Bharucha AE, Katzka DA. Diaphragmatic breathing for rumination syndrome: efficacy and mechanisms of action. Neurogastroenterology & Motility. 2016;28(3):384-391. [Link]
44.
Murray HB, Zhang F, Call CC, et al. Comprehensive Cognitive-Behavioral Interventions Augment Diaphragmatic Breathing for Rumination Syndrome: A Proof-of-Concept Trial. Digestive Diseases and Sciences. 2021;66(10):3461-3469. [Link]
45.
Pauwels A, Broers C, Van Houtte B, Rommel N, Vanuytsel T, Tack J. A Randomized Double-Blind, Placebo-Controlled, Cross-Over Study Using Baclofen in the Treatment of Rumination Syndrome. American Journal of Gastroenterology. 2018;113(1):97-104. [Link]
46.
Drossman DA, Tack J, Ford AC, Szigethy E, Törnblom H, Van Oudenhove L. Neuromodulators for Functional Gastrointestinal Disorders (Disorders of Gut−Brain Interaction): A Rome Foundation Working Team Report. Gastroenterology. 2018;154(4):1140-1171.e1. [Link]
47.
Robles A, Romero YA, Tatro E, Quezada H, McCallum RW. Outcomes of Treating Rumination Syndrome with a Tricyclic Antidepressant and Diaphragmatic Breathing. The American Journal of the Medical Sciences. 2020;360(1):42-49. [Link]

Abstract

Liver cancer is the sixth most common cancer and the third leading cause of cancer-related death. Hepatocellular carcinoma (HCC) accounts for about 90% of cases and mostly arises in chronic liver disease, especially cirrhosis. Viral hepatitis remains a leading cause, but alcohol-related disease and MASLD are rising. With immune checkpoint inhibitors transforming HCC management, it is timely to highlight common mistakes across screening, staging, diagnosis and treatment.

Topics

Digestive Oncology Hepatobiliary

Published

2026

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UEG Podcast Episode
UEG Podcast
Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

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

MASLD with Sven Francque - Part 2

Sven Francque, Pradeep Mundre

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.

Abstract

Topics

Hepatobiliary

Published

2026

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Management of gastric preneoplastic lesions (MAPS 3) - what’s new? With Mario Dinis-Ribeiro (Part 2)

Management of gastric preneoplastic lesions (MAPS 3) - what’s new? With Mario Dinis-Ribeiro (Part 2)

Pradeep Mundre Pradeep Mundre, Mario Dinis-Ribeiro

UEG Standards and Guidelines
New
Clinical Practice Guideline
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Management of paediatric Crohn’s disease: an ECCO-ESPGHAN guideline update

Dror Shouval

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Guideline

Abstract

Objective

To provide an updated, evidence-based European Crohn’s and Colitis Organisation [ECCO]–European Society for Paediatric Gastroenterology, Hepatology and Nutrition [ESPGHAN] guideline for the management, monitoring, and long-term care of pediatric Crohn’s disease [CD].

Methods

A multidisciplinary panel of 27 experts followed ECCO Standard Operating Procedures for guideline development. A systematic review of studies published between January 2018 and October 2024, with targeted updates through June 2025, was conducted across MEDLINE, EMBASE, and Cochrane Central. Evidence was graded using the Oxford Centre for Evidence-Based Medicine levels. Draft statements underwent two Delphi voting rounds involving the guideline panel, ECCO National Representatives, and an international sounding board; statements achieving ≥80% agreement were accepted.

Results

This guideline provides updated recommendations across major domains of pediatric CD care, including risk stratification, treatment targets, induction and maintenance strategies, nutritional therapies, therapeutic drug monitoring, and the roles of imaging and endoscopy. High-risk patients should start anti-TNF therapy as first-line treatment, with proactive and reactive therapeutic drug monitoring to enhance efficacy. For low-risk luminal disease, exclusive enteral nutrition or the Crohn’s Disease Exclusion Diet with partial enteral nutrition are preferred induction options. Long-term management emphasizes achieving endoscopic remission, normal growth, improved quality of life, and reduction of bowel damage. This guideline also reviews emerging advanced therapies, including biologics and small molecules, which are increasingly used in practice but generally not yet approved for pediatric CD, to inform clinicians about their potential role.

Conclusions

This updated ECCO–ESPGHAN guideline integrates new pediatric evidence with contemporary adult data and treat-to-target principles, providing practical recommendations to support personalized, multidisciplinary, and proactive management aimed at improving long-term outcomes in pediatric CD.

Publisher

European Crohn’s and Colitis Organisation logo
European Crohn’s and Colitis Organisation

Guideline

Clinical Practice Guideline

Topics

IBD Paediatrics

Citation

Journal of Crohn's and Colitis, Volume 20, Issue 8, August 2026

Published

2026

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UEG Standards and Guidelines
Clinical Practice Guideline
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ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment

Javier P. Gisbert

Summary

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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 logo
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 Familial Mediterranean Fever and how to avoid them

Manik Gemilyan, Gagik Hakobyan

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References

Mistakes
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Thumshirn M, Camilleri M, Hanson RB, Williams DE, Schei AJ, Kammer PP. Gastric mechanosensory and lower esophageal sphincter function in rumination syndrome. American Journal of Physiology-Gastrointestinal and Liver Physiology. 1998;275(2):G314-G321. [Link]
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Hoshikawa Y, Fitzke H, Sweis R, et al. Rumination syndrome: Assessment of vagal tone during and after meals and during diaphragmatic breathing. Neurogastroenterology & Motility. 2020;32(11):1-9. [Link]
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Zand Irani M, Eslick GD, Brown G, Talley NJ. Letter: eosinophilic duodenitis and increased intraepithelial lymphocytes in rumination syndrome – more evidence. Alimentary Pharmacology & Therapeutics. 2023;57(11):1353-1354. [Link]
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Nakagawa K, Sawada A, Hoshikawa Y, et al. Persistent Postprandial Regurgitation vs Rumination in Patients With Refractory Gastroesophageal Reflux Disease Symptoms: Identification of a Distinct Rumination Pattern Using Ambulatory Impedance-pH Monitoring. American Journal of Gastroenterology. 2019;114(8):1248-1255. [Link]
42.
Barba E, Burri E, Accarino A, et al. Biofeedback-guided control of abdominothoracic muscular activity reduces regurgitation episodes in patients with rumination. Clinical Gastroenterology and Hepatology. 2015;13(1):100-106.e1. [Link]
43.
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Abstract

Familial Mediterranean fever (FMF), also called periodic disease, Armenian disease, etc., is a prototypical autoinflammatory disorder where the underlying mechanism is the dysfunction of innate immunity, resulting in unprovoked episodes of inflammation.1 Although considered rare worldwide, it is prevalent in people of Mediterranean origin; however, one can expect to encounter patients in all parts of the modern world. FMF is a monogenic disease with autosomal recessive inheritance.2 Unlike other monogenic disorders, the diagnosis remains largely clinical, and it is important to understand the limitations of genetic testing. Another distinguishing feature is the well-established effectiveness of lifelong monotherapy with colchicine in preventing attacks and complications.3

Topics

Primary Care

Published

2025

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UEG Podcast Episode
UEG Podcast
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Management of gastric preneoplastic lesions (MAPS 3) - what’s new? With Mario Dinis-Ribeiro (Part 2)

Mario Dinis-Ribeiro, Pradeep Mundre

Summary

AI Generated

Summary is not available for this content yet.

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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.

Abstract

Topics

Stomach & H. Pylori

Published

2025

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