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.

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).

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.

A recent UEG survey indicated that dysphagia, heartburn, bloating, abdominal pain and changes to bowel habit are each reported by 5–15% of the general population.1 For patients with mild symptoms, negative tests provide reassurance and simple, symptomatic management might be all that is required (e.g. acid suppression, stool regulation). However, for those with severe symptoms that persist on therapy, ruling out life-threatening disease is not sufficient, and referral to the neurogastroenterology and motility (NGM) laboratory for physiological measurements is often indicated. Clinical investigations aim to explain the cause of symptoms and establish a diagnosis that can guide rational treatment. Until recently, it could be argued that manometry, scintigraphy, breath tests and related tests rarely provided this information. As a result, only patients with suspected major motility disorders (e.g. achalasia, severe reflux disease or faecal incontinence) were routinely referred to the NGM laboratory for tests. Technological advances, such as high-resolution manometry (HRM), now provide objective measurements not only of motility, but also of function in terms of the movement (and digestion) of ingested material within the gastrointestinal tract. Furthermore, the ability to associate events (such as bolus retention, reflux or gas production) with symptoms provides an indication of visceral sensitivity and can identify what is causing patient complaints. Here, I discuss frequent mistakes in clinical investigation of gastrointestinal motility and function based on a series of consensus documents published by members of the International Working Group for Disorders of Gastrointestinal Motility and Function.