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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. 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. 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. 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.

Helicobacter pylori (H. pylori) infection is a global health concern and may be relevant in candidates for bariatric surgery, yet data on prevalence and antimicrobial resistance in Luxembourg are limited. We conducted a retrospective, single-center cohort study including 1,110 patients with obesity evaluated for bariatric surgery at the Centre Hospitalier de Luxembourg between 2010 and 2020. H. pylori status was determined on gastric biopsy and antimicrobial resistance by susceptibility testing. Collected variables included demographics, BMI, eradication outcomes, and postoperative results (BMI loss and complications). A comparative group of 125 patients without obesity with biopsy-proven H. pylori infection was included for descriptive comparison. H. pylori prevalence among bariatric candidates was 29.3%. Among infected patients, 23.3% had strains resistant to at least one antibiotic, and first-line eradication was successful in 86.3%. Infection prevalence differed by nationality, being higher among Portuguese nationals than Luxembourgish patients or those from neighboring countries and was slightly higher in women than in men. Postoperatively, mean BMI reduction was 13.7 kg/m² after sleeve gastrectomy and 14.9 kg/m² after bypass surgery. H. pylori status was not associated with weight-loss outcomes or postoperative complications after adjustment. Approximately one-third of bariatric surgery candidates in Luxembourg have H. pylori infection, with notable antibiotic resistance and variation by nationality and sex. After eradication and adjustment for confounders, H. pylori status was not linked to postoperative weight loss or complication rates.

Helicobacter pylori (H. pylori) is a gram-negative bacterium that infects approximately half of the worldwide population. Although asymptomatic in most people, it can cause non-ulcer dyspepsia, gastro-duodenal ulcer disease and gastric cancer. H. pylori infection has also been correlated with extra-intestinal diseases like unexplained iron-deficiency anemia, immune thrombocytopenia and vitamin B12 deficiency. Its impact on pregnancy issues has also been studied, but the relationship is less clear. Recently, multiple meta-analyses found that H. pylori infection is correlated with gestational diabetes mellitus, preeclampsia, nausea and hyperemesis gravidarum, and adverse birth outcomes such as birth defects and fetal growth restriction. There is no recommendation for treating H. pylori infection during pregnancy according to the Maastricht VI consensus. This article aims to state the current knowledge about H. pylori infection and pregnancy-related diseases.

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.

Inflammatory bowel diseases (IBD) are chronic conditions requiring lifelong management, often involving advanced therapies. To harmonize the current heterogeneity in monitoring practices we developed a Belgian Standard of Care (SOC) guidance for patients with IBD treated with these advanced therapies. A multistep approach was adopted. First, a core team of IBD clinicians conducted a national survey to evaluate current practices and identify gaps. Next, a SOC guidance document was drafted and reviewed by multiple stakeholders, including physicians and IBD nurses from the Belgian IBD Research and Development (BIRD) group and patient organizations. Feedback was then incorporated to develop a consensus-based framework tailored to current Belgian clinical practices. This SOC guidance outlines minimal follow-up requirements across treatment phases, emphasizing clinical, biochemical, endoscopic and cross-sectional assessments, while also discussing additional relevant outcomes such as quality of life. The SOC guidance document offers a comprehensive, consensus-based framework to homogenize the monitoring of patients with IBD receiving advanced therapies. By standardizing monitoring practices, it aims to enhance quality of care, safety and long-term outcomes, ensuring alignment with international standards while addressing specific national requirements and availabilities.

Omental infarction (OI) is an uncommon and often misdiagnosed cause of acute abdominal pain. Through increasing use of computed tomography (CT) early identification has improved, avoiding unnecessary surgical intervention. A 49-year-old woman presented with right-sided abdominal pain radiating to the epigastrium. Laboratory tests revealed elevated inflammatory markers while abdominal ultrasound was inconclusive. CT revealed a localized area of fat stranding in the right hypochondrium, consistent with OI. The patient was managed conservatively with analgesia and intravenous fluids. She was discharged pain-free after 4 days of hospitalization. On reassessment three weeks later, she remained asymptomatic with normalized inflammatory markers. OI should be considered in the differential diagnosis of right-sided abdominal pain. CT is essential for establishing diagnosis, guiding management and avoiding unnecessary surgery. Conservative treatment is safe and effective in most cases, provided patients are closely monitored for clinical deterioration.

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.

Histoplasmosis is typically a self-limiting infection in immunocompetent individuals, but may present as a life-threatening disseminated disease in immunocompromised hosts. Gastrointestinal (GI) symptoms, radiological abnormalities and endoscopic findings are non-specific. We report a case of disseminated histoplasmosis in a kidney transplant recipient presenting with hemorrhagic shock due to severe colonic ulcerations. This case highlights the importance of maintaining a high index of suspicion for GI histoplasmosis in patients originating from endemic regions and underscores the need for careful endoscopic evaluation with adequate tissue sampling.

Since the onset of the COVID-19 pandemic, both SARS-CoV-2 infection and vaccination have been implicated as potential triggers for de novo autoimmune hepatitis (AIH). This review summarizes published cases, outlining clinical and biological features, treatment approaches, and outcomes. A PubMed search identified reports of new-onset AIH following SARS-CoV-2 infection or COVID-19 vaccination up to February 1, 2025. Inclusion criteria encompassed case reports, series, and reviews. Data were extracted on demographics, vaccine type, onset timing, laboratory findings, histology, treatments, and outcomes. A total of 74 post-vaccination AIH cases and 22 post-infection cases were included. Post-vaccination AIH predominantly affected older women (median age 62) and occurred mainly after mRNA vaccines, with a median onset of 14 days. Most patients showed marked transaminase elevation, high IgG, and positive ANA (74.3%). Liver biopsies (performed in 92% of cases) showed features compatible with AIH. A total of 80% of the 50 cases of our study with available serology and liver histology were classified as probable / definite AIH, according to the simplified AIH score. Corticosteroid therapy was effective in most cases (survival 95.9%). Post-infection AIH cases showed similar features but affected younger individuals (median age 47), with uniformly favorable responses to immunosuppression. New-onset AIH can occur following both SARS-CoV-2 infection or vaccination. Although these events remain rare, recognition of this association is essential for timely diagnosis and management.

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.

Care for patients with IBD has changed over the last decades with increased prevalence and subsequent financial and organizational burden on the health care system. The aim of this work was to develop a nationwide consensus on how to organize care for patients with IBD. We developed a consensus document through a modified Delphi process including different Belgian stakeholders involved in the care for patients with IBD. Through two voting rounds and a consensus meeting statements were developed. Thirty-three statements reached consensus through the Delphi process. The statements can be classified in six major domains: IBD registry and data utilization, Patient reported data, Multidisciplinary care, IBD nurse role and financial support, Access to diagnostic and monitoring tools and Treatment and medication reimbursement. We developed a broadly supported consensus on how to organize care for patients with IBD in the Belgian healthcare environment. Selection of focus area should seek for balance between optimization of clinical outcomes, securing quality of care and maintaining financial sustainability.

A large amount of FODMAP-rich food is part of a balanced and recommended diet for the general population. This study aims to assess quantitatively FODMAP consumption in a sample of the Belgian adult population of healthy volunteers (HV) and irritable bowel syndrome (IBS) patients. Participants completed five-day food diaries. Food portions were translated into quantities (g or ml) with the help of the "Poids et Mesure" manual (CSS, 2005). Nutritional valorisations were conducted using validated nutritional tables (Souci Fachmann Kraut, Ciqual, Nubel) and data from published studies. Student t-test and Mann-Whitney U test were performed for comparisons. Statistical significance was fixed at 5%. Forty food diaries were analysed (20 HV, 60% F, mean age 40 (16); 20 IBS patients, 85% F, mean age 46.7 (20.0)). The mean total FODMAP consumption was moderate for HV and was significantly lower in IBS patients (15.3 (5.4) g/d vs. 8.4 (5.1) g/d; p=0.0002), specifically for lactose (p=0.0009) and fructans (p=0.0004). In both groups, lactose represented the highest proportion of FODMAP consumed, while galactans were the least consumed. Most of the HV were considered as moderate or high consumers of FODMAP (45% [9g/d; 15.9g/d]; 45% &#x2265;16g/d), while IBS patients were mainly low consumers (65% <9g/d). FODMAP consumption in the Belgian adult general population is moderate, with the highest proportion of lactose, while IBS patients consume significantly fewer FODMAP.

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.

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.

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Chronic idiopathic diarrhea represents a diagnostic and therapeutic challenge to gastroenterologists. We aimed to explore the diagnostic and therapeutic yield of 72h stool collection combined with bile acid quantification, in chronic diarrhea patients, to differentiate bile acid malabsorption from other causes of diarrhea and thus enabling tailored treatment. We performed a retrospective study on 252 stool collections combined with bile acid quantification. Descriptive statistics, Pearson correlation analysis and ANOVA with post hoc between-group t-tests were used. Idiopathic bile acid diarrhea was present in up to one third of patients with diarrhea-predominant IBS and functional diarrhea. Steatorrhea was highly prevalent both in patients with a clinical suspicion of fat malabsorption (57%) as well as patients with non-specific diarrhea (23%). We show a significant difference in fecal bile acid and fat content in patients with vs. without predisposing risk factors for bile acid or fat malabsorption (e.g. cholecystectomy). The prevalence of steatorrhea was also significantly higher in patients with previous enteric resection or bariatric surgery. Bile acid diarrhea was significantly more frequent in patients with previous colonic resection, probably due to combined resection of a distal ileal segment during right hemicolectomy. We could not show higher rates of bile acid diarrhea post-cholecystectomy compared to the other groups. Bile acid diarrhea and steatorrhea are prevalent findings in patients with chronic diarrhea. Using this 72h stool analysis with bile acid quantification can help clinicians in the complex management of chronic diarrhea.