Serrated polyposis is the commonest polyposis syndrome and often goes unrecognised

The edition in brief

The US Multi-Society Task Force on Colorectal Cancer describes serrated polyposis syndrome as the commonest polyposis syndrome and one that often goes unrecognised. Diagnosis rests on WHO criteria for size, cumulative number and location of serrated polyps; management is meticulous inspection, clearing of the colon and frequent surveillance, with surgery for cancer or unmanageable polyp burden; first-degree relatives should have colonoscopic screening, and germline testing is only for those meeting criteria for a known syndrome. Across 1,983 high-causality cases in the US DILIN registry from 2004 to 2024, antibiotics remained the leading cause of drug-induced liver injury (41%), but their share fell while herbal and dietary supplements and anticancer drugs rose; older adults and oncology patients had higher mortality. A meta-analysis of 16 studies found refractory ascites was associated with substantially worse social, mental and physical functioning than stable cirrhosis. In 345 children after a first variceal bleed at 44 centres, six-week mortality was 4.1%, with worse outcomes in cirrhosis, biliary atresia, decompensation and after sclerotherapy.