Post-polypectomy monitoring is essential to prevent lesion recurrence and reduce the risk of colorectal cancer. The quality of the initial colonoscopy is crucial. A complete colonoscopy (with visualized cecum), after adequate preparation, performed by an experienced endoscopist (with an adenoma detection rate of at least 25%) who has performed a complete resection of the identified polyps and provided clear recommendations for subsequent follow-up enables optimal and high-quality management after colorectal polypectomy. Current follow-up ­recommendations vary based on the type, number, and size of resected polyps, as well as the individual characteristics of the patient. Usually, for patients with non-advanced polyps (<10mm, 1-2 tubular adenomas), monitoring via colonoscopy is recommended at intervals of 7 to 10 years. In contrast, patients with advanced adenomas (size ≥10mm, presence of villous components or high-grade dysplasia), or multiple adenomas (≥3), require closer monitoring, often within 3 to 5 years. This text details the current surveillance recommendations, risk factors, and the importance of personalizing follow-up strategies.

Proton pump inhibitors (PPIs) are the first line of treatment for peptic ulcer and gastroesophageal reflux disease (GERD). Current national guidelines state that chronic PPI therapy is indicated for esophagitis grade C and D, for Barrett’s esophagus, Zollinger-Ellison syndrome, or to prevent bleeding ulcers with chronic NSAID intake in at-risk patients. In primary care, guidelines propose empiric short-term PPI therapy during a maximum of 8 weeks to control symptoms, confirming a putative GERD diagnosis, followed by PPI therapy interruption. Yet, the available data suggest insufficient occurrence of down-titration and/or cessation. Moreover, PPIs are also used for treatment of dyspeptic symptoms and a number of other non-gastrointestinal indications, such as ear-nose-throat and pulmonary symptoms, or to protect the stomach in case of polypharmacy intake. As such, concerns have emerged about the considerable impact of PPIs on the healthcare budget, and an increasing number of risks and side effects associated with chronic use. An ongoing national study, the PEPPER trial, aims to provide quality evidence to determine the most effective strategy for stopping chronic PPI intake in patients for whom there is no firm medical indication for their continued use

Helicobacter pylori is a Gram-negative bacterium responsible for chronic gastritis, peptic ulcers, and gastric adenocarcinoma, recognized as a class I carcinogen by the WHO. Worldwide prevalence is approximately 50%, with significant geographical variations. In Belgium, migrant populations present higher infection rates. Rising antibiotic resistance, particularly to clarithromycin (21%) and levofloxacin (24%), causes challenges for eradication protocols.

First-line therapies feature quadruple regimens with or without bismuth, personalized according to local resistance rates and antimicrobial susceptibility testing (AST) results, if possible. Specific management is recommended for refractory cases, children, and HIV patients. Esomeprazole 2 x 40mg and rabeprazole 2 x 20mg are more powerful than other proton pomp inhibitors (PPIs).

Diagnosis involves non-invasive methods (urea breath test, fecal antigen test) and invasive techniques (biopsies for histology and AST). Endoscopic diagnosis is based on the regular disposition of gastric collecting venules (RAC), determining the need for targeted biopsies for AST. Post-treatment eradication confirmation is critical, typically through a breath test conducted at least four weeks after antibiotic cessation and two weeks after PPI discontinuation

We herein present several relevant developments in the hepato-gastroenterology field during the year 2020. An expert consensus has resulted in a clearer nomenclature for “non-alcoholic” fatty liver disease, which is now referred to as "metabolic" liver disease and clearly defined using positive criteria. In fibrosing steatohepatitis, lanifibranor, which is a triple agonist of the three isoforms of the peroxisome proliferator-activated receptor (PPAR α, δ, γ), has demonstrated clear superiority over placebo in terms of disease resolution, fibrosis regression, and metabolic profile improvement. For patients with advanced hepatocellular carcinoma, the combined approach of atezolizumab (anti-programmed death-ligand 1 [anti-PD-L1]) and bevacizumab (anti–vascular endothelial growth factor [anti-VEGF) is a huge improvement and sets a new standard treatment in first-line. In cholestatic pruritus cases, fibrates are deemed to exert beneficial effects on the symptoms. Rifaximin, a broad-spectrum and, poorly absorbed antibiotic, has been demonstrated to be effective for preventing hepatic encephalopathy. This agent is now reimbursed when given in combination with lactulose. For inflammatory bowel diseases, ustekinumab (anti-interleukin [IL]12-IL23) is also now reimbursed in ulcerative colitis cases, and infliximab (anti-tumor necrosis factor [TNF]) as well as vedolizumab (anti-integrin) can be administered subcutaneously. Lastly, inflammatory bowel disease patients were proven not to exhibit any increased risk of coronavirus infection or developing severe COVID-19. In spite of their immunosuppressive therapy, these patients can (and should) benefit from the currently available vaccines.