Gastroenterology

PANCREATIC EXOCRINE INSUFFICIENCY AT A GLANCE Clinical point Key message Definition Inadequate pancreatic enzyme delivery and/or intraluminal enzyme activity causes impaired digestion, especially of fat, with possible malabsorption and nutritional deficiency. Think of EPI in Chronic pancreatitis, recurrent/severe acute pancreatitis, pancreatic cancer, pancreatic resection, cystic fibrosis, and selected post-upper-GI-surgery or intestinal disorders. Typical clues Steatorrhea, […]

WHIPPLE DISEASE AT A GLANCE Clinical point Key information Cause Rare chronic systemic infection caused by Tropheryma whipplei, a Gram-positive bacterium. Classic clues Chronic diarrhoea, weight loss, malabsorption and migratory or intermittent arthralgia/arthritis; systemic features may precede gastrointestinal symptoms by years. Important extraintestinal sites Central nervous system (CNS), heart/endocardium, joints, eyes, lymph nodes and lungs.

TROPICAL SPRUE AT A GLANCE Clinical point Key information Core concept Acquired small-intestinal enteropathy associated with residence in or prolonged travel to certain tropical regions; presents with chronic diarrhoea and malabsorption. Typical clues Chronic diarrhoea or steatorrhoea, weight loss, folate and/or vitamin B12 deficiency, megaloblastic anaemia, and relevant geographic exposure. Diagnosis Clinical–epidemiological context plus exclusion

COELIAC DISEASE AT A GLANCE Domain Key point Definition Immune-mediated systemic disorder triggered by gluten in genetically susceptible individuals. Trigger Wheat, barley, and rye; gluten exposure is required for accurate diagnostic testing unless a validated alternative pathway is being used First-line test tTG-IgA plus total serum IgA plus total serum IgA while the patient is

ESOPHAGEAL CANCER AT A GLANCE Major histologies Squamous cell carcinoma (SCC) and adenocarcinoma (AC). Classic presentation Progressive dysphagia, usually solids → liquids, with weight loss. Diagnosis Upper GI endoscopy with multiple biopsies. Staging Contrast CT chest/abdomen ± pelvis; FDG PET-CT when potentially curable; EUS for locoregional T/N assessment when feasible. Early disease Selected superficial T1a

PEPTIC ESOPHAGEAL STRICTURE AT A GLANCE Domain Key point Definition Benign fibrotic narrowing caused by chronic reflux-related mucosal injury, usually in the distal esophagus. Typical symptom Progressive dysphagia to solids. Typical location Distal esophagus, often near the gastroesophageal junction. Diagnosis EGD with careful inspection and biopsy; barium esophagram for selected tight or complex strictures. Definitive

BARRETT’S ESOPHAGUS  AT A GLANCE Definition Metaplastic replacement of the normal stratified squamous epithelium of the distal esophagus by specialized intestinal-type columnar epithelium, usually as a consequence of chronic gastroesophageal reflux. Major association Chronic gastroesophageal reflux disease (GERD). Major cancer risk Esophageal adenocarcinoma (EAC). Site lower 1/3 of esophagus Major risk factors Male sex, age

IRRITABLE BOWEL SYNDROME 2026 UPDATE Rome V is now available and updates IBS diagnostic criteria: recurrent abdominal pain or discomfort, on average ≥3 days/month during the previous 3 months, with symptom onset ≥6 months before diagnosis, plus ≥2 of: relationship to defecation, change in stool frequency, or change in stool form. The 2021 ACG/BSG guidance

CHRONIC PANCREATITIS At a glance Domain Practical point Definition Progressive fibro-inflammatory pancreatic condition with irreversible structural injury and leading to both exocrine/endocrine dysfunction. Etiology Use TIGAR-O: toxic-metabolic, idiopathic, genetic, autoimmune, recurrent/severe acute pancreatitis, obstructive. Clinical pattern Pain (major presentation) and/or maldigestion; later steatorrhea, weight loss, diabetes, nutritional and bone complications. Diagnosis CT or MRI/MRCP is

ACUTE PANCREATITIS At a glance Domain Practical point Diagnosis (Revised Atlanta Classification 2012) 2 of 3: characteristic upper abdominal pain, Sr. Amylase/lipase ≥3× ULN, or compatible imaging. Etiology Gallstones and alcohol account for about two-thirds of cases; actively assess biliary, alcohol, metabolic, drug, structural and uncommon causes. Severity Persistent organ failure >48 h is the