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Mistakes in nutrition in chronic liver disease and how to avoid them

Manuela Merli

Summary

AI Generated

Malnutrition and sarcopenia are common in chronic liver disease, adversely affecting complications, quality of life, transplant outcomes, and survival, requiring prompt recognition and appropriate management by physicians.

  • Malnutrition frequently occurs in patients with chronic liver disease and worsens their prognosis.
  • Multiple causes of malnutrition in cirrhosis include low dietary intake, malabsorption, metabolic alterations, and modification of substrate utilisation.
  • Sarcopenia, defined by loss of muscle mass and function, is a major component of malnutrition in cirrhosis patients.
  • Sarcopenia adversely affects the number and severity of complications, quality of life, liver transplantation outcomes, and overall survival in advanced liver disease.
  • The material discusses common mistakes regarding nutrition in chronic liver disease and provides evidence and experience-based approaches to avoid them.
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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.

References

Mistakes
References
Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10
1.
Tandon P, Raman M, Mourtzakis M, et al. A practical approach to nutritional screening and assessment in cirrhosis. Hepatology 2017; 65: 1044–1057. [Link]
2.
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39: 412–423. [Link]
3.
Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193. [Link]
4.
Álvares-Da-Silva MR and Reverbel Da Silveira T. Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients. Nutrition 2005; 21: 113–117. [Link]
5.
Carey EJ, Lai JC, Wang CW, et al. A multicenter study to define sarcopenia in patients with end-stage liver disease. Liver Transpl 2017; 23: 625–633. [Link]
6.
Montano-Loza AJ. Clinical relevance of sarcopenia in patients with cirrhosis. World J Gastroenterol 2014; 20: 8061–8071. [Link]
7.
Dasarathy, S. Cause and management of muscle wasting in chronic liver disease. Curr Opin Gastroenterol 2016; 32: 159–165. [Link]
8.
Merli M. Nutrition in cirrhosis: Dos and Don’ts. J Hepatol 2020; 73: 1563–1565. [Link]
9.
Tandon P, Low G, Mourtzakis M, et al. A model to identify sarcopenia in patients with cirrhosis. Clin Gastroenterol Hepatol 2016; 14: 1473–1480. [Link]
10.
Montano-Loza AJ, Angulo P, Meza-Junco J, et al. Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis. J Cachexia Sarcopenia Muscle 2016; 7: 126–135. [Link]
11.
Eslamparast T, Montano-Loza AJ, Raman M, et al. Sarcopenic obesity in cirrhosis — the confluence of 2 prognostic titans. Liver Int 2018; 38: 1706–1717. [Link]
12.
Wu Y, Zhu Y, Feng Y, et al. Royal Free Hospital-Nutritional Prioritizing Tool improves the prediction of malnutrition risk outcomes in liver cirrhosis patients compared with Nutritional Risk Screening 2002. Br J Nutr 2020; 124: 1293–1302. [Link]
13.
Borhofen SM, Gerner C, Lehmann J, et al. The Royal Free Hospital-Nutritional Prioritizing Tool is an independent predictor of deterioration of liver function and survival in cirrhosis. Dig Dis Sci 2016; 61: 1735–1743. [Link]
14.
Nardelli S, Gioia S, Ridola L, et al. Risk of falls in patients with cirrhosis evaluated by timed up and go test: Does muscle or brain matter more? Dig Liv Dis Epub ahead of print 5 July 2021. DOI: 10.1016/j.dld.2021.06.019. [Link]
15.
VanWagner LB, Uttal S, Lapin B, et al. Use of six-minute walk test to measure functional capacity after liver transplantation. Physical Therapy 2016; 96: 1456–1467. [Link]
16.
Anand AC. Nutrition and muscle in cirrhosis. J Clin Exp Hepatol 2017; 7: 340-357. [Link]
17.
Bischoff SC, Bernal W, Dasarathy S, et al. ESPEN practical guideline: clinical nutrition in liver disease. Clin Nutr 2020; 39: 3533–3562. [Link]
18.
Nielsen K, Kondrup J, Martinsen L, et al. Long-term oral refeeding of patients with cirrhosis of the liver. Br J Nutr 1995; 74: 557–567. [Link]
19.
Vaisman N, Katzman H, Carmiel-Haggai M, et al. Breakfast improves cognitive function in cirrhotic patients with cognitive impairment. Am J Clin Nutr 2010; 92: 137–140. [Link]
20.
Plank LD, Gane EJ, Peng S, et al. Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis: a randomized 12-month trial. Hepatology 2008; 48: 557–566. [Link]
21.
Nardelli S, Lattanzi B, Torrisi S, et al. Sarcopenia is risk factor for development of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt placement. Clin Gastroenterol Hepatol 2017; 15: 934–936. [Link]
22.
Córdoba J, López-Hellín J, Planas M, et al. Normal protein diet for episodic hepatic encephalopathy: results of a randomized study. J Hepatol 2004; 41: 38–43. [Link]
23.
Iwasa M, Iwata K, Hara N, et al. Nutrition therapy using a multidisciplinary team improves survival rates in patients with liver cirrhosis. Nutrition 2013; 29: 1418–1421. [Link]
24.
Nguyen DL, Chao D, Ma G, et al. Quality of life and factors predictive of burden among primary caregivers of chronic liver disease patients. Ann Gastroenterol 2015; 28: 124–129. [Link]
25.
Bajaj JS, Wade JB, Gibson DP, et al. The multi-dimensional burden of cirrhosis and hepatic encephalopathy on patients and caregivers. Am J Gastroenterol 2011; 106: 1646–1653. [Link]
26.
Kang SH, Jeong WK, Baik SK, et al. Impact of sarcopenia on prognostic value of cirrhosis: going beyond the hepatic venous pressure gradient and MELD score. J Cachexia Sarcopenia Muscle 2018; 9: 860–870. [Link]
27.
van Vugt JLA, Alferink LJM, Buettner S, et al. A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: a competing risk analysis in a national cohort. J Hepatol 2018; 68: 707–714. [Link]
28.
Lai JC, Covinsky KE, Dodge JL, et al. Development of a novel frailty index to predict mortality in patients with end-stage liver disease. Hepatology 2017; 66: 564–574. [Link]
29.
Rajesh S, George T, Philips CA, et al. Transjugular intrahepatic portosystemic shunt in cirrhosis: an exhaustive critical update. World J Gastroenterol 2020; 26: 5561–5596. [Link]
30.
Praktiknjo M, Clees C, Pigliacelli A, et al. Sarcopenia is associated with development of acute-on-chronic liver failure in decompensated liver cirrhosis receiving transjugular intrahepatic portosystemic shunt. Clin Transl Gastroenterol 2019; 10: e00025. [Link]
31.
EASL. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193. [Link]

Abstract

Malnutrition frequently occurs in patients who have chronic liver disease and worsens their prognosis. There are multiple causes of malnutrition in the context of cirrhosis: low dietary intake, malabsorption, metabolic alterations and modification of substrate utilisation. Sarcopenia, which is defined by loss of muscle mass and function, is a major component of malnutrition in patients with cirrhosis. Sarcopenia adversely affects the number and severity of complications, quality of life, the outcome of liver transplantation and the overall survival rate of patients with advanced liver disease. Physicians should be aware of the clinical and prognostic relevance of nutritional status, how to promptly recognise malnutrition and sarcopenia in patients with liver cirrhosis and how to appropriately manage these conditions. Here we discuss some mistakes that are frequently made regarding nutrition in chronic liver disease, and we provide evidence and experience-based approaches to avoid them. 


Topics

Hepatobiliary Small Intestine & Nutrition

Citation

Merli M and Lapenna L. Mistakes in nutrition in chronic liver disease and how to avoid them. UEG Education 2021; 21: 23–25 

Published

2021

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Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

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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 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 Mistake 10
1.
Tandon P, Raman M, Mourtzakis M, et al. A practical approach to nutritional screening and assessment in cirrhosis. Hepatology 2017; 65: 1044–1057. [Link]
2.
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39: 412–423. [Link]
3.
Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193. [Link]
4.
Álvares-Da-Silva MR and Reverbel Da Silveira T. Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients. Nutrition 2005; 21: 113–117. [Link]
5.
Carey EJ, Lai JC, Wang CW, et al. A multicenter study to define sarcopenia in patients with end-stage liver disease. Liver Transpl 2017; 23: 625–633. [Link]
6.
Montano-Loza AJ. Clinical relevance of sarcopenia in patients with cirrhosis. World J Gastroenterol 2014; 20: 8061–8071. [Link]
7.
Dasarathy, S. Cause and management of muscle wasting in chronic liver disease. Curr Opin Gastroenterol 2016; 32: 159–165. [Link]
8.
Merli M. Nutrition in cirrhosis: Dos and Don’ts. J Hepatol 2020; 73: 1563–1565. [Link]
9.
Tandon P, Low G, Mourtzakis M, et al. A model to identify sarcopenia in patients with cirrhosis. Clin Gastroenterol Hepatol 2016; 14: 1473–1480. [Link]
10.
Montano-Loza AJ, Angulo P, Meza-Junco J, et al. Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis. J Cachexia Sarcopenia Muscle 2016; 7: 126–135. [Link]
11.
Eslamparast T, Montano-Loza AJ, Raman M, et al. Sarcopenic obesity in cirrhosis — the confluence of 2 prognostic titans. Liver Int 2018; 38: 1706–1717. [Link]
12.
Wu Y, Zhu Y, Feng Y, et al. Royal Free Hospital-Nutritional Prioritizing Tool improves the prediction of malnutrition risk outcomes in liver cirrhosis patients compared with Nutritional Risk Screening 2002. Br J Nutr 2020; 124: 1293–1302. [Link]
13.
Borhofen SM, Gerner C, Lehmann J, et al. The Royal Free Hospital-Nutritional Prioritizing Tool is an independent predictor of deterioration of liver function and survival in cirrhosis. Dig Dis Sci 2016; 61: 1735–1743. [Link]
14.
Nardelli S, Gioia S, Ridola L, et al. Risk of falls in patients with cirrhosis evaluated by timed up and go test: Does muscle or brain matter more? Dig Liv Dis Epub ahead of print 5 July 2021. DOI: 10.1016/j.dld.2021.06.019. [Link]
15.
VanWagner LB, Uttal S, Lapin B, et al. Use of six-minute walk test to measure functional capacity after liver transplantation. Physical Therapy 2016; 96: 1456–1467. [Link]
16.
Anand AC. Nutrition and muscle in cirrhosis. J Clin Exp Hepatol 2017; 7: 340-357. [Link]
17.
Bischoff SC, Bernal W, Dasarathy S, et al. ESPEN practical guideline: clinical nutrition in liver disease. Clin Nutr 2020; 39: 3533–3562. [Link]
18.
Nielsen K, Kondrup J, Martinsen L, et al. Long-term oral refeeding of patients with cirrhosis of the liver. Br J Nutr 1995; 74: 557–567. [Link]
19.
Vaisman N, Katzman H, Carmiel-Haggai M, et al. Breakfast improves cognitive function in cirrhotic patients with cognitive impairment. Am J Clin Nutr 2010; 92: 137–140. [Link]
20.
Plank LD, Gane EJ, Peng S, et al. Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis: a randomized 12-month trial. Hepatology 2008; 48: 557–566. [Link]
21.
Nardelli S, Lattanzi B, Torrisi S, et al. Sarcopenia is risk factor for development of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt placement. Clin Gastroenterol Hepatol 2017; 15: 934–936. [Link]
22.
Córdoba J, López-Hellín J, Planas M, et al. Normal protein diet for episodic hepatic encephalopathy: results of a randomized study. J Hepatol 2004; 41: 38–43. [Link]
23.
Iwasa M, Iwata K, Hara N, et al. Nutrition therapy using a multidisciplinary team improves survival rates in patients with liver cirrhosis. Nutrition 2013; 29: 1418–1421. [Link]
24.
Nguyen DL, Chao D, Ma G, et al. Quality of life and factors predictive of burden among primary caregivers of chronic liver disease patients. Ann Gastroenterol 2015; 28: 124–129. [Link]
25.
Bajaj JS, Wade JB, Gibson DP, et al. The multi-dimensional burden of cirrhosis and hepatic encephalopathy on patients and caregivers. Am J Gastroenterol 2011; 106: 1646–1653. [Link]
26.
Kang SH, Jeong WK, Baik SK, et al. Impact of sarcopenia on prognostic value of cirrhosis: going beyond the hepatic venous pressure gradient and MELD score. J Cachexia Sarcopenia Muscle 2018; 9: 860–870. [Link]
27.
van Vugt JLA, Alferink LJM, Buettner S, et al. A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: a competing risk analysis in a national cohort. J Hepatol 2018; 68: 707–714. [Link]
28.
Lai JC, Covinsky KE, Dodge JL, et al. Development of a novel frailty index to predict mortality in patients with end-stage liver disease. Hepatology 2017; 66: 564–574. [Link]
29.
Rajesh S, George T, Philips CA, et al. Transjugular intrahepatic portosystemic shunt in cirrhosis: an exhaustive critical update. World J Gastroenterol 2020; 26: 5561–5596. [Link]
30.
Praktiknjo M, Clees C, Pigliacelli A, et al. Sarcopenia is associated with development of acute-on-chronic liver failure in decompensated liver cirrhosis receiving transjugular intrahepatic portosystemic shunt. Clin Transl Gastroenterol 2019; 10: e00025. [Link]
31.
EASL. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193. [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

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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 abdominal distension and how to avoid them

Elizabeth Barba Orozco, Alberto Ezquerra-Durán

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 Mistake 10
1.
Tandon P, Raman M, Mourtzakis M, et al. A practical approach to nutritional screening and assessment in cirrhosis. Hepatology 2017; 65: 1044–1057. [Link]
2.
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39: 412–423. [Link]
3.
Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193. [Link]
4.
Álvares-Da-Silva MR and Reverbel Da Silveira T. Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients. Nutrition 2005; 21: 113–117. [Link]
5.
Carey EJ, Lai JC, Wang CW, et al. A multicenter study to define sarcopenia in patients with end-stage liver disease. Liver Transpl 2017; 23: 625–633. [Link]
6.
Montano-Loza AJ. Clinical relevance of sarcopenia in patients with cirrhosis. World J Gastroenterol 2014; 20: 8061–8071. [Link]
7.
Dasarathy, S. Cause and management of muscle wasting in chronic liver disease. Curr Opin Gastroenterol 2016; 32: 159–165. [Link]
8.
Merli M. Nutrition in cirrhosis: Dos and Don’ts. J Hepatol 2020; 73: 1563–1565. [Link]
9.
Tandon P, Low G, Mourtzakis M, et al. A model to identify sarcopenia in patients with cirrhosis. Clin Gastroenterol Hepatol 2016; 14: 1473–1480. [Link]
10.
Montano-Loza AJ, Angulo P, Meza-Junco J, et al. Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis. J Cachexia Sarcopenia Muscle 2016; 7: 126–135. [Link]
11.
Eslamparast T, Montano-Loza AJ, Raman M, et al. Sarcopenic obesity in cirrhosis — the confluence of 2 prognostic titans. Liver Int 2018; 38: 1706–1717. [Link]
12.
Wu Y, Zhu Y, Feng Y, et al. Royal Free Hospital-Nutritional Prioritizing Tool improves the prediction of malnutrition risk outcomes in liver cirrhosis patients compared with Nutritional Risk Screening 2002. Br J Nutr 2020; 124: 1293–1302. [Link]
13.
Borhofen SM, Gerner C, Lehmann J, et al. The Royal Free Hospital-Nutritional Prioritizing Tool is an independent predictor of deterioration of liver function and survival in cirrhosis. Dig Dis Sci 2016; 61: 1735–1743. [Link]
14.
Nardelli S, Gioia S, Ridola L, et al. Risk of falls in patients with cirrhosis evaluated by timed up and go test: Does muscle or brain matter more? Dig Liv Dis Epub ahead of print 5 July 2021. DOI: 10.1016/j.dld.2021.06.019. [Link]
15.
VanWagner LB, Uttal S, Lapin B, et al. Use of six-minute walk test to measure functional capacity after liver transplantation. Physical Therapy 2016; 96: 1456–1467. [Link]
16.
Anand AC. Nutrition and muscle in cirrhosis. J Clin Exp Hepatol 2017; 7: 340-357. [Link]
17.
Bischoff SC, Bernal W, Dasarathy S, et al. ESPEN practical guideline: clinical nutrition in liver disease. Clin Nutr 2020; 39: 3533–3562. [Link]
18.
Nielsen K, Kondrup J, Martinsen L, et al. Long-term oral refeeding of patients with cirrhosis of the liver. Br J Nutr 1995; 74: 557–567. [Link]
19.
Vaisman N, Katzman H, Carmiel-Haggai M, et al. Breakfast improves cognitive function in cirrhotic patients with cognitive impairment. Am J Clin Nutr 2010; 92: 137–140. [Link]
20.
Plank LD, Gane EJ, Peng S, et al. Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis: a randomized 12-month trial. Hepatology 2008; 48: 557–566. [Link]
21.
Nardelli S, Lattanzi B, Torrisi S, et al. Sarcopenia is risk factor for development of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt placement. Clin Gastroenterol Hepatol 2017; 15: 934–936. [Link]
22.
Córdoba J, López-Hellín J, Planas M, et al. Normal protein diet for episodic hepatic encephalopathy: results of a randomized study. J Hepatol 2004; 41: 38–43. [Link]
23.
Iwasa M, Iwata K, Hara N, et al. Nutrition therapy using a multidisciplinary team improves survival rates in patients with liver cirrhosis. Nutrition 2013; 29: 1418–1421. [Link]
24.
Nguyen DL, Chao D, Ma G, et al. Quality of life and factors predictive of burden among primary caregivers of chronic liver disease patients. Ann Gastroenterol 2015; 28: 124–129. [Link]
25.
Bajaj JS, Wade JB, Gibson DP, et al. The multi-dimensional burden of cirrhosis and hepatic encephalopathy on patients and caregivers. Am J Gastroenterol 2011; 106: 1646–1653. [Link]
26.
Kang SH, Jeong WK, Baik SK, et al. Impact of sarcopenia on prognostic value of cirrhosis: going beyond the hepatic venous pressure gradient and MELD score. J Cachexia Sarcopenia Muscle 2018; 9: 860–870. [Link]
27.
van Vugt JLA, Alferink LJM, Buettner S, et al. A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: a competing risk analysis in a national cohort. J Hepatol 2018; 68: 707–714. [Link]
28.
Lai JC, Covinsky KE, Dodge JL, et al. Development of a novel frailty index to predict mortality in patients with end-stage liver disease. Hepatology 2017; 66: 564–574. [Link]
29.
Rajesh S, George T, Philips CA, et al. Transjugular intrahepatic portosystemic shunt in cirrhosis: an exhaustive critical update. World J Gastroenterol 2020; 26: 5561–5596. [Link]
30.
Praktiknjo M, Clees C, Pigliacelli A, et al. Sarcopenia is associated with development of acute-on-chronic liver failure in decompensated liver cirrhosis receiving transjugular intrahepatic portosystemic shunt. Clin Transl Gastroenterol 2019; 10: e00025. [Link]
31.
EASL. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193. [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 Mistakes In Articles
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 Mistake 10
1.
Tandon P, Raman M, Mourtzakis M, et al. A practical approach to nutritional screening and assessment in cirrhosis. Hepatology 2017; 65: 1044–1057. [Link]
2.
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39: 412–423. [Link]
3.
Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193. [Link]
4.
Álvares-Da-Silva MR and Reverbel Da Silveira T. Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients. Nutrition 2005; 21: 113–117. [Link]
5.
Carey EJ, Lai JC, Wang CW, et al. A multicenter study to define sarcopenia in patients with end-stage liver disease. Liver Transpl 2017; 23: 625–633. [Link]
6.
Montano-Loza AJ. Clinical relevance of sarcopenia in patients with cirrhosis. World J Gastroenterol 2014; 20: 8061–8071. [Link]
7.
Dasarathy, S. Cause and management of muscle wasting in chronic liver disease. Curr Opin Gastroenterol 2016; 32: 159–165. [Link]
8.
Merli M. Nutrition in cirrhosis: Dos and Don’ts. J Hepatol 2020; 73: 1563–1565. [Link]
9.
Tandon P, Low G, Mourtzakis M, et al. A model to identify sarcopenia in patients with cirrhosis. Clin Gastroenterol Hepatol 2016; 14: 1473–1480. [Link]
10.
Montano-Loza AJ, Angulo P, Meza-Junco J, et al. Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis. J Cachexia Sarcopenia Muscle 2016; 7: 126–135. [Link]
11.
Eslamparast T, Montano-Loza AJ, Raman M, et al. Sarcopenic obesity in cirrhosis — the confluence of 2 prognostic titans. Liver Int 2018; 38: 1706–1717. [Link]
12.
Wu Y, Zhu Y, Feng Y, et al. Royal Free Hospital-Nutritional Prioritizing Tool improves the prediction of malnutrition risk outcomes in liver cirrhosis patients compared with Nutritional Risk Screening 2002. Br J Nutr 2020; 124: 1293–1302. [Link]
13.
Borhofen SM, Gerner C, Lehmann J, et al. The Royal Free Hospital-Nutritional Prioritizing Tool is an independent predictor of deterioration of liver function and survival in cirrhosis. Dig Dis Sci 2016; 61: 1735–1743. [Link]
14.
Nardelli S, Gioia S, Ridola L, et al. Risk of falls in patients with cirrhosis evaluated by timed up and go test: Does muscle or brain matter more? Dig Liv Dis Epub ahead of print 5 July 2021. DOI: 10.1016/j.dld.2021.06.019. [Link]
15.
VanWagner LB, Uttal S, Lapin B, et al. Use of six-minute walk test to measure functional capacity after liver transplantation. Physical Therapy 2016; 96: 1456–1467. [Link]
16.
Anand AC. Nutrition and muscle in cirrhosis. J Clin Exp Hepatol 2017; 7: 340-357. [Link]
17.
Bischoff SC, Bernal W, Dasarathy S, et al. ESPEN practical guideline: clinical nutrition in liver disease. Clin Nutr 2020; 39: 3533–3562. [Link]
18.
Nielsen K, Kondrup J, Martinsen L, et al. Long-term oral refeeding of patients with cirrhosis of the liver. Br J Nutr 1995; 74: 557–567. [Link]
19.
Vaisman N, Katzman H, Carmiel-Haggai M, et al. Breakfast improves cognitive function in cirrhotic patients with cognitive impairment. Am J Clin Nutr 2010; 92: 137–140. [Link]
20.
Plank LD, Gane EJ, Peng S, et al. Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis: a randomized 12-month trial. Hepatology 2008; 48: 557–566. [Link]
21.
Nardelli S, Lattanzi B, Torrisi S, et al. Sarcopenia is risk factor for development of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt placement. Clin Gastroenterol Hepatol 2017; 15: 934–936. [Link]
22.
Córdoba J, López-Hellín J, Planas M, et al. Normal protein diet for episodic hepatic encephalopathy: results of a randomized study. J Hepatol 2004; 41: 38–43. [Link]
23.
Iwasa M, Iwata K, Hara N, et al. Nutrition therapy using a multidisciplinary team improves survival rates in patients with liver cirrhosis. Nutrition 2013; 29: 1418–1421. [Link]
24.
Nguyen DL, Chao D, Ma G, et al. Quality of life and factors predictive of burden among primary caregivers of chronic liver disease patients. Ann Gastroenterol 2015; 28: 124–129. [Link]
25.
Bajaj JS, Wade JB, Gibson DP, et al. The multi-dimensional burden of cirrhosis and hepatic encephalopathy on patients and caregivers. Am J Gastroenterol 2011; 106: 1646–1653. [Link]
26.
Kang SH, Jeong WK, Baik SK, et al. Impact of sarcopenia on prognostic value of cirrhosis: going beyond the hepatic venous pressure gradient and MELD score. J Cachexia Sarcopenia Muscle 2018; 9: 860–870. [Link]
27.
van Vugt JLA, Alferink LJM, Buettner S, et al. A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: a competing risk analysis in a national cohort. J Hepatol 2018; 68: 707–714. [Link]
28.
Lai JC, Covinsky KE, Dodge JL, et al. Development of a novel frailty index to predict mortality in patients with end-stage liver disease. Hepatology 2017; 66: 564–574. [Link]
29.
Rajesh S, George T, Philips CA, et al. Transjugular intrahepatic portosystemic shunt in cirrhosis: an exhaustive critical update. World J Gastroenterol 2020; 26: 5561–5596. [Link]
30.
Praktiknjo M, Clees C, Pigliacelli A, et al. Sarcopenia is associated with development of acute-on-chronic liver failure in decompensated liver cirrhosis receiving transjugular intrahepatic portosystemic shunt. Clin Transl Gastroenterol 2019; 10: e00025. [Link]
31.
EASL. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193. [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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UEG Mistakes In Articles
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Mistakes in hepatitis C and how to avoid them

Ana Catarina Garcia, Gonçalo Alexandrino

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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 Mistake 10
1.
Tandon P, Raman M, Mourtzakis M, et al. A practical approach to nutritional screening and assessment in cirrhosis. Hepatology 2017; 65: 1044–1057. [Link]
2.
Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39: 412–423. [Link]
3.
Merli M, Berzigotti A, Zelber-Sagi S, et al. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193. [Link]
4.
Álvares-Da-Silva MR and Reverbel Da Silveira T. Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients. Nutrition 2005; 21: 113–117. [Link]
5.
Carey EJ, Lai JC, Wang CW, et al. A multicenter study to define sarcopenia in patients with end-stage liver disease. Liver Transpl 2017; 23: 625–633. [Link]
6.
Montano-Loza AJ. Clinical relevance of sarcopenia in patients with cirrhosis. World J Gastroenterol 2014; 20: 8061–8071. [Link]
7.
Dasarathy, S. Cause and management of muscle wasting in chronic liver disease. Curr Opin Gastroenterol 2016; 32: 159–165. [Link]
8.
Merli M. Nutrition in cirrhosis: Dos and Don’ts. J Hepatol 2020; 73: 1563–1565. [Link]
9.
Tandon P, Low G, Mourtzakis M, et al. A model to identify sarcopenia in patients with cirrhosis. Clin Gastroenterol Hepatol 2016; 14: 1473–1480. [Link]
10.
Montano-Loza AJ, Angulo P, Meza-Junco J, et al. Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis. J Cachexia Sarcopenia Muscle 2016; 7: 126–135. [Link]
11.
Eslamparast T, Montano-Loza AJ, Raman M, et al. Sarcopenic obesity in cirrhosis — the confluence of 2 prognostic titans. Liver Int 2018; 38: 1706–1717. [Link]
12.
Wu Y, Zhu Y, Feng Y, et al. Royal Free Hospital-Nutritional Prioritizing Tool improves the prediction of malnutrition risk outcomes in liver cirrhosis patients compared with Nutritional Risk Screening 2002. Br J Nutr 2020; 124: 1293–1302. [Link]
13.
Borhofen SM, Gerner C, Lehmann J, et al. The Royal Free Hospital-Nutritional Prioritizing Tool is an independent predictor of deterioration of liver function and survival in cirrhosis. Dig Dis Sci 2016; 61: 1735–1743. [Link]
14.
Nardelli S, Gioia S, Ridola L, et al. Risk of falls in patients with cirrhosis evaluated by timed up and go test: Does muscle or brain matter more? Dig Liv Dis Epub ahead of print 5 July 2021. DOI: 10.1016/j.dld.2021.06.019. [Link]
15.
VanWagner LB, Uttal S, Lapin B, et al. Use of six-minute walk test to measure functional capacity after liver transplantation. Physical Therapy 2016; 96: 1456–1467. [Link]
16.
Anand AC. Nutrition and muscle in cirrhosis. J Clin Exp Hepatol 2017; 7: 340-357. [Link]
17.
Bischoff SC, Bernal W, Dasarathy S, et al. ESPEN practical guideline: clinical nutrition in liver disease. Clin Nutr 2020; 39: 3533–3562. [Link]
18.
Nielsen K, Kondrup J, Martinsen L, et al. Long-term oral refeeding of patients with cirrhosis of the liver. Br J Nutr 1995; 74: 557–567. [Link]
19.
Vaisman N, Katzman H, Carmiel-Haggai M, et al. Breakfast improves cognitive function in cirrhotic patients with cognitive impairment. Am J Clin Nutr 2010; 92: 137–140. [Link]
20.
Plank LD, Gane EJ, Peng S, et al. Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis: a randomized 12-month trial. Hepatology 2008; 48: 557–566. [Link]
21.
Nardelli S, Lattanzi B, Torrisi S, et al. Sarcopenia is risk factor for development of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt placement. Clin Gastroenterol Hepatol 2017; 15: 934–936. [Link]
22.
Córdoba J, López-Hellín J, Planas M, et al. Normal protein diet for episodic hepatic encephalopathy: results of a randomized study. J Hepatol 2004; 41: 38–43. [Link]
23.
Iwasa M, Iwata K, Hara N, et al. Nutrition therapy using a multidisciplinary team improves survival rates in patients with liver cirrhosis. Nutrition 2013; 29: 1418–1421. [Link]
24.
Nguyen DL, Chao D, Ma G, et al. Quality of life and factors predictive of burden among primary caregivers of chronic liver disease patients. Ann Gastroenterol 2015; 28: 124–129. [Link]
25.
Bajaj JS, Wade JB, Gibson DP, et al. The multi-dimensional burden of cirrhosis and hepatic encephalopathy on patients and caregivers. Am J Gastroenterol 2011; 106: 1646–1653. [Link]
26.
Kang SH, Jeong WK, Baik SK, et al. Impact of sarcopenia on prognostic value of cirrhosis: going beyond the hepatic venous pressure gradient and MELD score. J Cachexia Sarcopenia Muscle 2018; 9: 860–870. [Link]
27.
van Vugt JLA, Alferink LJM, Buettner S, et al. A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: a competing risk analysis in a national cohort. J Hepatol 2018; 68: 707–714. [Link]
28.
Lai JC, Covinsky KE, Dodge JL, et al. Development of a novel frailty index to predict mortality in patients with end-stage liver disease. Hepatology 2017; 66: 564–574. [Link]
29.
Rajesh S, George T, Philips CA, et al. Transjugular intrahepatic portosystemic shunt in cirrhosis: an exhaustive critical update. World J Gastroenterol 2020; 26: 5561–5596. [Link]
30.
Praktiknjo M, Clees C, Pigliacelli A, et al. Sarcopenia is associated with development of acute-on-chronic liver failure in decompensated liver cirrhosis receiving transjugular intrahepatic portosystemic shunt. Clin Transl Gastroenterol 2019; 10: e00025. [Link]
31.
EASL. EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol 2019; 70: 172–193. [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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UEG Standards and Guidelines
New
Clinical Practice Guideline
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ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment

Javier P. Gisbert

Summary

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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.

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 Podcast Episode
UEG Podcast
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MASLD with Sven Francque - Part 2

Sven Francque, 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

Hepatobiliary

Published

2026

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