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Clinical Case Summary

We present a case of a 64-year-old man diagnosed with type-2 hereditary hemorrhagic telangiectasia (HHT) at age 20.
Since the age of 63, he reported epistaxis and melenas, with chronic anemia and identification of duodenal telangiectasias refractory to argon plasma coagulation, requiring frequent blood transfusions, IV iron supplementation, hospitalizations, as well as initiation of tranexamic acid and octreotide 20mg IV LAR, with lower frequency of GI bleeding.
In a new admission for melenas (Hgb=7.8g/dL), abdominal distension was noted, and an abdominal ultrasound showed de novo ascites and no other signs of chronic liver disease. Diagnostic paracentesis showed a SAAG of 1.9, compatible with portal hypertension (PH). Thoraco-abdominal-pelvic CT-angiography showed multiple and diffuse intrahepatic arterio-venous shunts without other arterio-venous malformation (AVM) identified. PH was assumed to be secondary to the AVM. Additionally, an echocardiogram showed signs suggestive of pulmonary hypertension in the context of HHT. After a multidisciplinary meeting, bevacizumab was initiated at 10mg/kg/dose every two weeks, and the patient was discharged after clinical and analytical improvement.
Four months after starting bevacizumab (7 injections), he reported no melena, no clinically detectable ascites; there was no need for inpatient care with Hgb=11.0g/dL.
HHT is a rare inherited syndrome characterized by AVM in multiple organs. Bevacizumab is an off-label drug for HHT, currently used for difficult-to-treat cases, especially when there is refractory severe GI bleeding and complicated hepatic AVM. This case illustrates gastroenterological complications of a rare disease and the potential role of bevacizumab in its management. Team assembly and screening are essential to the multidisciplinary care needed for this disease.

HEREDITARY HEMORRHAGIC TELANGIECTASIA AND ITS CHALLENGES FOR GASTROENTEROLOGISTS – A CASE REPORT

Ana Teresa Ferreira 1, Tiago Guedes 1, Maria Pereira Coutinho 1, Sara Archer 1, Sofia Ponte 1, Maria Inês Novo 1, Daniela Gonçalves Ferreira 1, Luís Maia 1, Isabel Pedroto 1

1 Centro Hospitalar Universitário de Santo António, Porto, Portugal

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Clinical Case

Session

PP 12 Clinical Cases (Posters)

Published

2023

UEG Mistakes In Articles

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Cholangioscopy is a minimally invasive, endoscopic technique that allows direct visualisation of the bile ducts, facilitating both diagnostic and therapeutic interventions. It is a useful tool in managing biliary diseases, allowing characterisation and tissue acquisition for strictures of undetermined aetiology, facilitating extension assessment for biliary cancer and providing intraductal lithotripsy for complex biliary stones.

Mistakes in cholangioscopy and how to avoid them

Marianna Arvanitakis, Malina Wiesand, Paraskevas Gkolfakis

Published

2025

UEG Standards and Guidelines

Consensus

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ABSTRACT

Malabsorption is a complex and multifaceted condition characterised by the defective passage of nutrients into the blood and lymphatic streams. Several congenital or acquired disorders may cause either selective or global malabsorption in both children and adults, such as cystic fibrosis, exocrine pancreatic insufficiency (EPI), coeliac disease (CD) and other enteropathies, lactase deficiency, small intestinal bacterial overgrowth (SIBO), autoimmune atrophic gastritis, Crohn's disease, and gastric or small bowel resections. Early recognition of malabsorption is key for tailoring a proper diagnostic work-up for identifying the cause of malabsorption. Patient's medical and pharmacological history are essential for identifying risk factors. Several examinations like endoscopy with small intestinal biopsies, non-invasive functional tests, and radiologic imaging are useful in diagnosing malabsorption. Due to its high prevalence, CD should always be looked for in case of malabsorption with no other obvious explanations and in high-risk individuals. Nutritional support is key in management of patients with malabsorption; different options are available, including oral supplements, enteral or parenteral nutrition. In patients with short bowel syndrome, teduglutide proved effective in reducing the need for parenteral nutrition, thus improving the quality of life of these patients. Primary care physicians have a central role in early detection of malabsorption and should be involved into multidisciplinary teams for improving the overall management of these patients. In this European consensus, involving 10 scientific societies and several experts, we have dissected all the issues around malabsorption, including the definitions and diagnostic testing (Part 1), high-risk categories and special populations, nutritional assessment and management, and primary care perspective (Part 2).

European Consensus on Malabsorption—UEG & SIGE, LGA, SPG, SRGH, CGS, ESPCG, EAGEN, ESPEN, and ESPGHAN Part 2: Screening, Special Populations, Nutritional Goals, Supportive Care, Primary Care Perspective

Marco Vincenzo Lenti

Publishers

European Society for Paediatric Gastroenterology, Hepatology and Nutrition, The European Society for Clinical Nutrition and Metabolism, European Association for Gastroenterology, Endoscopy and Nutrition, European Society for Primary Care Gastroenterology, Società Italiana di Gastroenterologia ed Endoscopia Digestiva

Guideline

Consensus

Topics

Endoscopy Pancreas Primary Care Small Intestine & Nutrition

Citation

United European Gastroenterol J, 13: 773-797.

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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Summary

The updated EASL Clinical Practice Guidelines on the management of hepatitis B virus (HBV) infection provide comprehensive, evidence-based recommendations for its management. Spanning ten thematic sections, the guidelines address diagnostics, treatment goals, treatment indications, therapeutic options, hepatocellular carcinoma surveillance, management of special populations, HBV reactivation prophylaxis, post-transplant care, HBV prevention strategies, and finally address open questions and future research directions. Chronic HBV remains a global health challenge, with over 250 million individuals affected and significant mortality due to cirrhosis and hepatocellular carcinoma. These guidelines emphasise the importance of early diagnosis, risk stratification based on viral and host factors, and tailored antiviral therapy. Attention is given to simplified algorithms, vaccination, and screening to support global HBV elimination targets. The guidelines also discuss emerging biomarkers and evolving definitions of functional and partial cure. Developed through literature review, expert consensus, and a Delphi process, the guidelines aim to equip healthcare providers across disciplines with practical tools to optimise HBV care and outcomes worldwide.

EASL Clinical Practice Guidelines on the management of hepatitis B virus infection

Publisher

European Association for the Study of the Liver

Guideline

Clinical Practice Guideline

Topics

Hepatobiliary

Citation

Journal of Hepatology, Volume 83, Issue 2, 502 - 583

Published

2025

UEG Podcast Episode

UEG Podcast

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Oesophageal cancer with Massimiliano di Pietro (Part 2)

Massimiliano di Pietro, Pradeep Mundre

Topics

Digestive Oncology Endoscopy Oesophagus

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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Summary

Recent years have witnessed significant advances in the imaging, molecular profiling, and systemic treatment of cholangiocarcinoma (CCA). Despite this progress, the early detection, precise classification, and effective management of CCA remain challenging. Owing to recent developments and the significant differences in CCA subtypes, EASL commissioned a panel of experts to draft evidence-based recommendations on the management of extrahepatic CCA, comprising distal and perihilar CCA. Particular attention is given to the need for accurate classification systems, the integration of emerging molecular insights, and practical strategies for diagnosis and treatment that reflect real-world clinical scenarios.

EASL Clinical Practice Guidelines on the management of extrahepatic cholangiocarcinoma

Publisher

European Association for the Study of the Liver

Guideline

Clinical Practice Guideline

Topics

Digestive Oncology Hepatobiliary

Citation

Journal of Hepatology, Volume 83, Issue 1, 211 - 238

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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Abstract

The current consensus guideline offers a comprehensive and practical guidance on the diagnostic and monitoring of patients with inflammatory bowel disease (IBD). It provides recommendations on requirements for initial diagnosis, detection of complications, the use of monitoring tools in patients with IBD and diagnostics in specific situations, such as pregnancy, postoperatively and for cancer surveillance. The guideline is a joint project of the European Crohn’s and Colitis Organization (ECCO), the European Society of Gastrointestinal and Abdominal Radiology, the European Society of Pathology, and the International Bowel Ultrasonography Group under the leadership of ECCO.

ECCO-ESGAR-ESP-IBUS Guideline on Diagnostics and Monitoring of Patients with Inflammatory Bowel Disease: Part 1: initial diagnosis, monitoring of known inflammatory bowel disease, detection of complications

Torsten Kucharzik

Publisher

European Crohn’s and Colitis Organisation

Guideline

Clinical Practice Guideline

Topics

IBD

Citation

Journal of Crohn's and Colitis, Volume 19, Issue 7

Published

2025

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