Early chronic pancreatitis (ECP) represents a potentially reversible stage in the natural history of chronic pancreatic disease. Timely diagnosis of ECP offers a possibility for intervention, yet its diagnosis remains challenging due to nonspecific symptoms, lack of standardized criteria, and the limited diagnostic sensitivity of conventional tools. This review aims to synthesize recent advancements in the understanding, detection, and management of ECP, with a focus on innovation in imaging techniques and biomarker profiling. The goal is to facilitate earlier diagnosis and more effective patient stratification. We reviewed the literature from the past five years, including original studies, meta-analyses, and expert consensus statements, to address the current evidence across genetic, inflammatory, imaging, and biochemical domains relevant to ECP. Endoscopic ultrasound and advanced magnetic resonance techniques offer high sensitivity in detecting early parenchymal changes, although inter-observer variability and lack of standardization persist. Biomarker discovery has focused on inflammatory (IL-6, sCD163), fibrotic (TGF-β1, TIMP-1), and oxidative markers, as well as novel candidates like microRNAs. Genetic predisposition (PRSS1, SPINK1, CTRC, CPA1, CLDN2) significantly influences disease onset and progression and could enable selection of high-risk individuals. Therefore, diagnosing ECP should involve a multidisciplinary precision-based approach integrating clinical, radiologic, molecular, serologic, and genetic data for individualized risk stratification.

Inflammatory bowel disease (IBD) includes Crohn’s disease (CD) and ulcerative colitis (UC), chronic immune-mediated conditions of the gastrointestinal tract characterized by alternating periods of disease activity and remission with a complex multifactorial pathogenesis. Persistent intestinal inflammation in IBD is a key driver of disease progression and is strongly associated with the development of complications such as dysplasia, colorectal cancer (CRC), intestinal strictures, and fistulas. It may also result in changes in anorectal function, identifiable and classifiable using high-resolution anorectal manometry. Histologic and endoscopic assessments are essential for the evaluation of intestinal inflammation. Cumulative inflammatory burden (CIB) is an important concept that quantifies inflammatory exposure in IBD over time by integrating the severity and duration of histologic inflammation across the disease course, highlighting the importance of long-term inflammatory activity in the development of CRC. Histologic healing may be an important therapeutic target in IBD to reduce the risk of long-term complications. In parallel, emerging precision medicine approaches aim to improve risk stratification and enable early, individualized interventions to reduce disease-related outcomes. Endoscopy also plays a fundamental role in monitoring high-risk patients and guiding treatment decisions. This review aims to characterize the main intestinal complications extending beyond the mucosa that are associated with cumulative chronic inflammation in patients with IBD, including dysplasia, CRC, strictures, fistulas, and anorectal dysfunction in an era increasingly focused on achieving complete mucosal healing. Particular attention is drawn to the significant role of persistent histologic and endoscopic inflammation in disease progression and development of complications, highlighting the specific features and associated risk factors of these disease-related outcomes. Throughout, this review emphasizes the fundamental role of endoscopy in the timely detection, monitoring, and therapeutic management of IBD-related complications, thereby reinforcing its role in comprehensive patient care.

Neurogastroenterology disorders, also known as “Disorders of Gut-Brain Interaction” are gastrointestinal disorders that comprise a wide range of symptoms such as dysphagia, chest pain, heartburn, abdominal pain, nausea and vomiting, bloating, constipation, diarrhea or stool discharge. Scarcity of recognition, knowledge and training leading to the underdiagnosis of these conditions is associated with increased referrals to gastroenterologists or emergency room visits, along with a dramatic rise in healthcare costs and impaired quality of life. Despite advances in endoscopy and radiology, motility and pH impedance procedures remain the cornerstone of an accurate “Disorders of Gut-Brain Interaction” diagnosis, but these procedures need to be performed by well-trained personnel in a dedicated motility unit, with high-performance equipment. The primary motility procedures include high-resolution esophageal manometry and pH monitoring for esophageal function, high-resolution anorectal manometry and balloon expulsion tests for anorectal function, as well as hydrogen/methane breath tests for identifying dysbiosis and food intolerances. The purpose of this article is to highlight the importance of establishing a Neurogastroenterology and Motility Unit, and to provide an up-to-date overview on the main issues encountered when setting up a motility laboratory in the community or academic practice, including considerations for personnel training, equipment, and commonly performed motility procedures and their clinical usefulness.