TOPLINE

Patients with symptomatic sclerosing mesenteritis (SM) presented with abdominal pain and had conditions such as immunoglobulin G4 (IgG4)-related disease, abdominal and/or pelvic malignancies, or metabolic syndrome.

METHODOLOGY

• Researchers conducted a prospective cohort study to evaluate the clinical features, outcomes, and therapeutic management of patients with symptomatic SM over 11-year follow-up.
• They included 55 patients with symptomatic SM (mean age at diagnosis, 62 years; 56.4% women) who presented at two tertiary medical centres in Greece from January 2014 to 2025. 
• Symptomatic SM was classified as mild, moderate, or severe on the basis of symptoms and imaging findings, ranging from a localised mesenteric fat mass to a complicated course requiring hospitalisation and/or surgery.
• All patients underwent annual clinical examinations, CT or MRI, and laboratory tests throughout the follow-up period.
• Treatment selection depended on the severity of the disease, clinical features, and radiologic signs, and treatment response was assessed after at least 12 months of continuous treatment. Patients were divided into three groups: responsive, non-progressive, and progressive on the basis of symptom improvement and imaging results.

TAKEAWAY

• All patients with symptomatic SM presented with abdominal pain at their initial evaluation, with bloating being the second most common symptom (83.6%), followed by nausea (40%).
• IgG4-related SM was diagnosed in 23.6% of patients (20% with a definite diagnosis and 3.6% with a possible diagnosis). Among them, 76.9% received corticosteroids in combination with colchicine and 23.1% received corticosteroids alone, and 91.7% of patients were responsive to corticosteroids after at least 12 months of continuous treatment.
• Concomitant abdominal and/or pelvic malignancies were diagnosed within 6 months of SM diagnosis in 9.1% of patients, and 9.1% had coexisting systemic autoimmune rheumatic diseases. In terms of endoscopic procedures, duodenal atrophy was identified on upper endoscopy in 10.9% of patients with symptomatic SM, which was unrelated to coeliac disease.
• Among patients with metabolic syndrome-associated SM, 53.1% met the full criteria for metabolic syndrome and 31.3% had insulin resistance; these patients had a higher frequency of class 1 obesity than other SM cases (34.4% vs 8.7%; P = .027). Overall, 32.7% of patients with symptomatic SM required hospitalisation, most commonly due to severe abdominal pain from bowel ischaemia (14.5%).

IN PRACTICE

"[The study] results should be taken into account when consulting patients with symptomatic SM, as the clinical management, prognosis, and therapeutic approach may differ according to the underlying systemic disorder," the authors wrote.

SOURCE

This study was led by Christina Liava, MD, MS, Hippokration General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece. It was published online on August 04, 2026, in Therapeutic Advances in Gastroenterology.

LIMITATIONS

The modest sample size may have limited the statistical power to detect differences between SM subgroups. Patients were recruited from tertiary referral centres and presented with more severe disease courses, thereby limiting the generalisability of the findings. The study lacked an age-matched control group.

DISCLOSURES

This study did not receive any funding. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.