This case discusses a 76-year-old female patient with a large mass at the major papilla of Vater, initially suspected to be an ampullary adenoma. The lesion, identified during an upper endoscopy for anemia and fatigue, showed chronic inflammation but no malignancy. The patient's medical history included breast cancer and a partial distal pancreatectomy for an intraductal papillary mucinous neoplasm. Further imaging and biopsies did not confirm malignancy or adenoma but suggested actinomycosis. Actinomycosis, caused by Actinomyces species, presents challenges due to its rarity, slow progression, and difficulty in diagnosis. It can mimic malignancies, especially occurs following surgery, and requires long-term antibiotic therapy. We present the first documented case of actinomycosis involving the ampulla of Vater and emphasize the importance of considering actinomycosis in the differential diagnosis of ampullary masses, particularly in postsurgical patients with granulomatous tissue.
Introduction:Inflammatory bowel diseases (IBD), in particular Crohn's disease (CD) and ulcerative colitis (UC), are chronic conditions that have a considerable impact on patients' quality of life and healthcare resources, as they require frequent visits and hospitalisations. Telemedicine offers a potential advantage by enabling remote healthcare. Studies have shown that telemedicine can improve quality of life and reduce healthcare use, although results vary depending on study design and location. Our study investigates the views of French-speaking Belgian IBD patients on telemedicine. It aims to assess acceptability and preferences to guide future implementation. Methods:We designed a questionnaire available online (between October 2023 and June 2024) for which any patient with IBD followed up in an adult gastroenterology consultation was eligible. The 69-item questionnaire was validated by test patients and distributed via Epic®, social media and printed forms. Data were collected using REDCap® and analyzed using SPSS®, applying univariate and multivariate analyses to identify factors influencing acceptance of telemedicine. Results:257 respondents validated their questionnaire. The majority were women (54%) with an average age of 45 years [17-85]. Most patients had Crohn's disease (63%) and were using immunosuppressive therapy (44%) and/or biologics (30%), with a high compliance rate (98%). Although 68% had discovered telemedicine because of our survey, 82% were interested in remote consultations, citing time savings and reduced absence from work as advantages, while expressing concerns about reduced personal contact and technical problems. Acceptance was significantly associated with time saved and frequency of visits (p<0.05). Conclusion:Our study reveals strong acceptance of telemedicine, regardless of previous experience, with a preference for video over telephone consultations. It also demonstrates openness to follow-up without direct human contact (e.g., application-based tools), although concerns remain about the potential loss of personal interaction. The results underline the importance of addressing patient concerns and ensuring a solid human and technical infrastructure for the expansion of telemedicine.
Acute ischemic colitis associated with the use of neuroleptic agents is a rare but potentially life-threatening condition, and its true incidence is likely underestimated. The exact pathophysiological mechanisms underlying this complication remain poorly understood. Sigmoidoscopy or colonoscopy is considered the gold standard for diagnosis, although various imaging modalities can also aid in the diagnostic process. Preventive measures primarily involve the management of constipation and the reduction of risk factors. In cases of suspected neuroleptic-induced ischemic colitis, prompt adjustments in medication-either through dose reduction or substitution with alternative antipsychotics-should be considered. This article presents two cases of ischemic colitis caused by neuroleptic treatment, emphasizing the critical importance of early diagnosis and timely intervention.
Irritable bowel syndrome with constipation (IBS-C) is a common subtype of functional bowel disorder associated with substantial symptom burden and reduced quality of life. Management typically begins with dietary and lifestyle modification, laxatives, and antispasmodics; however, many patients experience inadequate relief, underscoring the need for more effective therapies. Linaclotide, a synthetic guanylin analog, is an established treatment for IBS-C. By activating guanylate cyclase-C (GCC) receptors on intestinal epithelial cells, it promotes intestinal fluid secretion, accelerates transit, and alleviates visceral hypersensitivity. Randomized controlled trials have demonstrated its efficacy and favorable safety profile, with mild-to-moderate diarrhea and abdominal pain being the most common adverse events. Because clinical trial populations may not fully reflect real-world patient diversity, real-world evidence (RWE) provides valuable complementary data. This review summarizes current RWE on linaclotide in IBS-C, integrating findings from multiple studies to present a comprehensive view of its effectiveness and safety in routine clinical practice.
Background and study aims:Since 2019, pancreatic surgery in Belgium has been centralised to high-volume centres to improve care quality and reduce postoperative morbidity and mortality. All patients who are potential surgical candidates are discussed preoperatively at a centralised multidisciplinary board (MCCC = Multidisciplinair Consult Complexe Chirurgie). Typically, patients with a (possible) malignancy have already been evaluated by a multidisciplinary tumour board (MDT) in the referring hospital. This study aimed to assess the impact of the MCCC on the diagnosis of solid and cystic pancreatic lesions and to analyse referral patterns. Patients and methods:This single-centre, non-interventional retrospective study included 217 patients with a newly diagnosed pancreatic lesion, discussed at the MCCC of Ghent University Hospital between July 1, 2019, and December 31, 2021. The influence of the MCCC on the diagnosis of pancreatic lesions was analysed. Results:Among 217 patients (median age 65 years; 50% male), the most frequent diagnoses were pancreatic adenocarcinoma (n=99; 45,6%), IPMN (12%) and pancreatitis (7%). The MCCC altered the initial diagnostic assessment in 18,4% of cases. Among benign referrals, 20% (5/25) were ultimately found malignant, likely altering treatment. None of the 166 patients referred with a malignant diagnosis were reclassified as benign. During the first three years after centralisation, referral quality remained unchanged, with 12% unspecified lesions annually. Summary:Centralisation may over time affect referral quality as expertise concentrates. Initial diagnosis and staging still occur in referring hospitals and are first discussed locally. This early analysis shows stable referral appropriateness after centralisation. Ongoing monitoring is needed to evaluate longterm effects of centralisation on diagnostic quality and early detection.
We report a case of a patient who received three cycles of Peptide Receptor Radionuclide Therapy (PRRT) with [177Lu] Lu-DOTATATE for a small intestine neuroendocrine tumor (siNET) and developed recurrent GI (gastrointestinal) bleeding. These complications required four admissions on intensive care unit (ICU), transfusion of fourteen units of packed cells and finally surgery. Radiation safety precautions were respected at all hospital wards. Histopathology of the culprit lesion did not reveal tumor, but showed a large-caliber angiodysplastic lesion. The somatostatin receptor (SSTR) positive tumor consisted of a confluent mass of adenopathies invading the mesenteric vein. We hypothesize the amino-acid infusion, which is supportive therapy given prior to PRRT, caused vasodilatation in the pre-existing angiodysplastic lesion. The vasodilatation together with the high venous pressure due to tumoral invasion of the mesenteric vein may have aggravated bleeding symptoms.
Background and aim of the study:Cardiopulmonary complications, malnutrition, frailty and minimal hepatic encephalopathy are underrecognized complications of cirrhosis with a major impact on mortality and morbidity. The aim of this study is to investigate a new locally introduced care pathway with standardized screening for these complications and its impact on patients care and hospital financing. Patients and methods:We performed a single center retrospective study of 40 patients hospitalized with cirrhosis who participated in the care pathway between April 2023 and June 2024. Electronic medical records were evaluated for screened complications and financial outcomes were calculated within our population, consecutively with and without this care pathway. Long term data regarding survival and referral were collected in June 2025. Results:Hepatopulmonary syndrome was diagnosed in 14.7% of the patients. Frailty was present in 57.7% of the patients and malnutrition in 45%. Minimal hepatic encephalopathy was established in 17.5% of the patients. The median justified hospital days were significantly higher with the care pathway compared to without [8.4 (6.0-10.8) vs 6.2( 4.9-8.6) p<0.01 ( Z=-3.43)]. In 15 (37.5%) patients, the care pathway added a higher financial reimbursement for the hospital compared to when the care pathway would not have been performed. Conclusions:This study emphasizes the importance of systematic screening and education of these complications. Due to systematical screening these underrecognized complications get identified earlier. Performing this care pathway did significantly and positively impact the number of justified hospital days and financial reimbursement for the hospital.
Background and study aims:Pediatric data on post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) prophylaxis remains limited. This study evaluated the effectiveness and safety of combined rectal indomethacin and lactated Ringer's (LR) as prophylaxis for PEP in children undergoing ERCP. Patients and methods:We retrospectively reviewed all pediatric ERCPs performed at a single tertiary center (2012- 2025). The study group consisted of procedures performed after 2021, when a standardized prophylaxis protocol (100 mg rectal indomethacin before ERCP plus LR at 2.5 L·m-2, started 2 hours before and continued 6 hours after) was implemented. Procedures performed before 2021 served as the control group. Primary and secondary endpoints were the development of PEP and cholangitis, respectively. Analyses considered American Society for Gastrointestinal Endoscopy (ASGE) procedural complexity, stent placement/type, and naive papilla status. Results:Seventy-five children underwent 95 ERCPs (prophylaxis group: 23 patients/38 procedures; control group: 55 patients/65 procedures). Baseline demographic and procedural characteristics were similar between the prophylaxis and control groups. Post-ERCP pancreatitis developed in 13.2% of procedures in the prophylaxis group and 13.8% in the control group (RD -0.7%; 95% CI -18.5 to 19.9; p = 1.000). Cholangitis developed in 5.3% of procedures in the prophylaxis group and 7.7% in the control group (RD -2.4%; 95% CI -15.3 to 14.0; p = 1.000). Adjustment for stent type did not meaningfully alter the associations between prophylaxis and outcomes. All PEP cases were mild to moderate. No treatment-related adverse events-including indomethacin-associated gastrointestinal or renal complications, or fluid-overload events-were observed in either group. Conclusions:Combined rectal indomethacin plus LR was feasible and well tolerated in pediatric ERCP but did not significantly reduce PEP or cholangitis. These findings highlight the need for larger, multicenter pediatric trials to define optimal prophylaxis.
We report a rare drugs adverse effect of a GLP1-RA, presenting as severe gastric stasis, eosinophilic duodenitis, and high bowel obstruction. The patient, treated with oral semaglutide for type 2 diabetes and obesity, developed progressive upper gastrointestinal symptoms culminating in faecal vomiting. Endoscopic and histological findings revealed marked eosinophilic infiltration of the duodenum. To our knowledge, this is the first reported case linking semaglutide to eosinophil-driven duodenitis causing mechanical obstruction. As the use of GLP1-RAs expands, clinicians should be aware of rare but potentially serious gastrointestinal adverse effects, particularly in patients with risk factors for impaired motility. Early recognition of symptoms and consideration of underlying eosinophilic gastrointestinal disease are essential for timely diagnosis and management.
Background:STRIDE II guidelines highlight the importance of closely monitoring patients with inflammatory bowel disease (IBD) to assess therapy effectiveness and predict or manage flares. However, with a growing patient population, the outpatient clinic capacity is strained, and many patients, especially those in longterm remission, may not require frequent in-person visits. This study aims to assess the interest for optimizing resources through remote monitoring for patients with IBD in a high-volume referral centre. Methods:An anonymous survey was conducted in 281 adult IBD patients, either untreated or on stable subcutaneous or oral maintenance therapy for more than one year. We assessed interest in a remote monitoring program and insights into their preferences for its implementation as well as eventual cost and time savings. Results:Of the 281 patients (52% female, 67% Crohn's disease, 32% ulcerative colitis, 1% IBD type unclassified), 76% expressed interest in reducing their outpatient visits in favour of remote monitoring. Of note, 79% of these 214 patients were willing to attend outpatient clinic visits every two years. However, patients emphasized the importance of personal contact in establishing a trustworthy and safe remote monitoring system. Additionally, the study identified cost and time savings for patients, as a visit to the outpatient visit took a median (interquartile range) of 3 (2-4) hours. Conclusion:Remote monitoring is a promising program for IBD patients in stable remission, offering potential financial and time savings for employers, patients, and society. However, further research is required to evaluate the safety and feasibility of this approach.
Intraperitoneal focal fat infarction (IFFI) encompasses a group of rare conditions that are clinically and radiologically similar, arising from focal fatty tissue necrosis. These entities often mimic other acute abdominal conditions such as acute appendicitis or cholecystitis. We present the case of a 65-year-old female with progressive abdominal pain, ultimately diagnosed with IFFI using contrast-enhanced computed tomography (CT). Omental infarction (OI) was the leading diagnosis, though a definitive distinction from epiploic appendagitis (EA) could not be made on imaging. Conservative management with anti-inflammatory medication, analgesia, and low-molecular-weight heparins (LMWH) proved effective, resulting in complete resolution within five days. This case highlights the diagnostic value of CT-imaging in differentiating IFFI from other causes of acute abdomen, thereby avoiding unnecessary surgical interventions. The aetiology of OI will be discussed, along with a detailed focus on management strategies that may also apply to other causes of IFFI.
Background and study aims:Peptide receptor radionuclide therapy (PRRT) has been reimbursed in Belgium since 2022. Post marketing monitoring of efficacy in Belgian context has not yet been performed. This study aimed to evaluate the efficacy and safety of PRRT in patients with progressive metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs). Patients and methods:Our retrospective analysis included GEP-NET patients who received at least one cycle of [177Lu] Lu-DOTA-TATE at Institute Jules Bordet (Brussels, Belgium) between 2013 and 2023. Treatment response was assessed according to RECIST 1.1 (Response Evaluation Criteria in Solid Tumors). Progression free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier analysis. Treatment safety profiles were reported descriptively. Results:Following initial PRRT (PRRT-1), in 110 patients with progressive metastatic GEP-NETs (grades 1-3), median PFS was 22.5 months (95% CI: 19.7-29), and median OS was 42.3 months (95% CI: 34.3-55). RECIST 1.1 responses were complete response in 1%, partial response in 21.6%, stable disease in 60.8%, and progression in 16.7% of patients. Median time of follow-up post PRRT-1 was 26.4 months (range: 0.8 - 106.4). Grade 3-4 anemia, leukopenia, lymphopenia and thrombocytopenia occurred in 1.9%, 2.8%, 50.5% and 2.8% of patients, respectively. Two patients (1.8%) developed myelodysplastic syndrome. Grade 3 or 4 renal toxicity was observed in two patients who had impaired renal function prior to PRRT. Conclusion:Post-marketing analysis in an ENETS Center of Excellence confirmed that the efficacy and safety of PRRT in GEPNETs are consistent with phase 3 trial data.
The January-March edition of the Acta Gastroenterologica Belgica journal always carries a distinctive quality, due to its dissemination during the Belgian Week of Gastroenterology, held this year in Liège. This edition also marks my final editorial as Editor-in- Chief of the journal, a position I have been privileged and honoured to hold, first as Associate Editor and then as Editor-in-Chief. It is with great pleasure that I now pass on the role of Editor-in-Chief to my colleague, Heiko De Schepper.
Dear reader, As 2025 draws to an end, the editorial board of Acta Gastro-Enterologica Belgica looks back on a productive year and ahead to more high-quality scientific research in 2026. We would also like to take this opportunity to extend our warmest thanks to the dedicated team of associate editors with whom we are fortunate to work. They ensure that all submissions to our journal are reviewed fairly and promptly. We would also like to thank all the reviewers who take their time to read and score these papers despite their busy schedules. We hope we can count on your enthusiasm in 2026 as well. Last but not least, a very sincere word of gratitude for Mrs. Mia Persoons, the manager of our editorial office, without whom our Acta simply would not exist in its current form. In addition to all these warm feelings, we are pleased to present you, dear reader, with another interesting and educational issue of Acta.
Background:Inflammatory bowel disease (IBD) impacts patients' quality of life (QoL), and hence, there is a need to assess this through patient-reported outcomes (PRO). Intestinal ultrasound (IUS) is a non-invasive tool for monitoring IBD activity, but little is known about its correlation with PRO. This study explored the cross-sectional relationship between PRO, assessed by the IBD Questionnaire-32 (IBDQ-32), and IUS parameters in patients with ulcerative colitis (UC). Methods:This prospective study included 37 Colombian patients with UC. IUS parameters such as bowel wall thickness (BWT), colour Doppler signal (CDS), and mesenteric fat hypertrophy were assessed, followed by IBDQ-32 completion. Two IUS-experienced gastroenterologists, blinded to the IBDQ- 32, performed the assessments. Results:In UC, lower IBDQ-32 scores were significantly correlated with increased BWT (p=0.050), presence of CDS (p=0.022), higher Limberg score (p=0.032), and mesenteric fat hypertrophy (p=0.040). The gastrointestinal and systemic symptom dimensions of the IBDQ-32 showed significant correlations with both BWT (p=0.013 and p=0.013) and CDS (p=0.002 and p=0.003), respectively. Conclusions:In UC, IUS parameters are significantly correlated with quality of life, reinforcing the value of IUS as a point-of-care tool.
Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy but may induce rare immune-related adverse events including pancreatitis (ICI-PI-), which occurs in 2-4% of cases. Such ICI-PI may necessitate treatment discontinuation. We report the rare case of a 51-year-old female with Lynch syndrome treated with pembrolizumab for metastatic urothelial carcinoma. A pancreatic mass was identified during follow-up by PET/CT. Pathology from endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) could not exclude adenocarcinoma. Surgical resection revealed pathology consistent with type II autoimmune pancreatitis (AIP) in a case which represent by definition , a type III ICI-PI. We explore diagnostic criteria focusing on clinical, serological, histological as well as medical imaging features and management.
Background and study aims:Anal fissure is a prevalent condition characterized by severe pain resulting from a tear in the epithelial layer surrounding the anus. This systematic review aims to assess the effectiveness of both surgical and conservative approaches in the management of anal fissures. Methods:A systematic review was conducted, encompassing randomized controlled trials (RCTs), quasi-experimental, and clinical studies published between 2019 and 2024. A comprehensive literature search was performed in Medline, PubMed, and other databases using keywords such as 'anal fissure,' 'sphincterotomy,' and 'topical treatment.' The study adhered to the PICOS framework and followed the PRISMA guidelines. Quality assessment was conducted using the Joanna Briggs Institute (JBI) criteria, and a total of 38 studies were included in the analysis. Results:Of 38 included studies, 27 investigated conservative treatments and 11 evaluated surgical approaches. Conservative methods - particularly topical diltiazem and nifedipine, botulinum toxin injections, and pelvic floor therapy - were effective in pain reduction and healing for many patients and had mostly mild adverse effects. Surgical LIS demonstrated superior long-term healing in refractory cases. Conclusions:Both surgical and conservative approaches serve as complementary strategies in the management of anal fissures. Surgical methods, particularly LIS, provide an effective treatment option with high success rates, while conservative approaches are beneficial in the early stages and for specific patient populations.
Extra-pulmonary tuberculosis can affect any part of the digestive system, including the esophagus. Esophageal involvement in tuberculosis is considered rare and its atypical manifestation can lead to delayed or misdiagnosis. Primary esophageal tuberculosis (ET) occurs when the esophagus is directly affected by tuberculosis while secondary ET arises from infiltration by surrounding structures. We report the case of a 44-year-old immunocompetent Tibetan patient who presented with dysphagia, in whom gastroscopy revealed a subepithelial lesion (SEL). The patient was diagnosed with secondary esophageal tuberculosis by tissue acquisition with endoscopic ultrasound (EUS) and successfully treated with tuberculostatic drugs. Esophageal tuberculosis must be considered when a subepithelial lesion of the esophagus is found, especially in patients originating from endemic areas.
Background:Acute pancreatitis (AP) in children is an uncommon but increasingly recognized medical condition, with dyslipidemias, especially severe hypertriglyceridemia, being a rare etiology. The correlation between primary lipid disorders and AP is rarely documented in pediatrics. Objective:To outline three pediatric cases of acute pancreatitiscomplicated severe hypertriglyceridemia, emphasizing the challenges in diagnosis, treatment approaches, and outcome. Cases:Case 1: A 40-day-old infant with consanguineous parents who was exclusively breastfed showed signs of vomiting and distension in the abdomen. Laboratory analyses indicated triglycerides at 15.6 g/L and lipase at six times the upper limit of normal. Imaging confirmed Balthazar stage C pancreatitis. Management through fasting and intravenous fluids showed clinical improvement. Case 2: A 2-month-old baby had a fever and was vomiting. The lipid panel showed triglycerides at 25.24 g/L, which is a sign of familial hypertriglyceridemia (type IV). The lipase level was high at 498 IU/L, and an ultrasound showed infiltration around the pancreas. Supportive management improved symptoms, but high triglyceride levels required changes in diet and the introduction of fibrates at 2 years of age. Case 3: A 12-year-old with a history of dyslipidemia and recurrent pancreatitis was hospitalized for an episode. Triglycerides rose to 35 g/L, and the lipase level was high. A CT scan showed Balthazar stage C pancreatitis. Treatment included fasting, a special diet, fibrates, and omega-3. The patient had five recurrent episodes over 24 months, despite a brief improvement, primarily as a result of inadequate dietary adherence. Conclusion:These cases reflect that, even though severe hypertriglyceridemia is uncommon in children, it should be considered when making a differential diagnosis of acute pancreatitis, especially if lactescent serum is observed. Age-related dietary limitations and long-term adherence make management challenging.
A 62-year-old Caucasian patient was admitted to the hospital for the management of alcohol dependence (approximately 280g of ethanol per day for the past 10 years). He had no other relevant medical history. He reported asthenia, physical deconditioning and severe inappetence with a marked decrease of food intake in the past months, eating a maximum of one meal per day. On clinical examination, there were significant oedema of the lower limbs, marked conjunctival jaundice and low brachial perimeter compatible with myopenia (26 cm). The results of the blood test were as follows: total bilirubin 7.2 mg/dL (direct 6.4 mg/dL), INR 1.31, CRP 25.2 mg/dL, albumin 31 g/L, prealbumin 0.13 g/L, ASAT 251 U/L, ALAT 77 U/L, gamma-GT 3718 U/L, alkaline phosphatases 374 U/L, ferritin 3777 μg/L (transferrin saturation 85%), triglycerides 344 mg/dL. IgG, IgA, IgM were normal. Platelets and neutrophils were normal. Viral serologies B and C were negative. Ultrasonography showed a hyperechoic liver without bile duct dilatation. Liver elasticity was high (32.2 kPa), as well as controlled attenuation parameter or CAP (342 dB/m). Due to significant cholestasis, hepatocellular insufficiency and high liver elasticity, we measured the hepatic venous pressure gradient (9 mmHg) and performed a transvenous liver biopsy (Fig 1A-D).
