Updated Guidelines for Sclerosing Mesenteritis: What You Need to Know

Charlottesville, virginia – June 28, 2025 – The american Gastroenterological Association (AGA) has released crucial updates regarding the management of sclerosing mesenteritis (SM), a rare gastrointestinal condition.These guidelines, published in Clinical Gastroenterology and Hepatology, aim to equip gastroenterologists with the latest insights for diagnosis, treatment, and future research directions for this enigmatic disease.

Sclerosing Mesenteritis, previously known as misty mesentery or mesenteric panniculitis, is now better understood thanks to this pragmatic review.The AGA panel, led by Dr. Mark T. Worthington from the University of Virginia, characterizes SM as an uncommon, benign, idiopathic autoimmune disorder affecting the mesenteric fat.

Key Updates on Sclerosing Mesenteritis Management

The updated guidelines emphasize the increasing recognition of sclerosing mesenteritis (SM) by radiologists on CT scans. Furthermore, thay address emerging cases linked to immune checkpoint inhibitors used in cancer therapy. Identifying and managing SM early is crucial, especially when it interferes with cancer treatment.

“CT radiologists increasingly are reporting SM and related lesions, such as misty mesentery,” Dr. Worthington noted. metabolic syndrome and aging are also identified as risk factors for developing sclerosing mesenteritis.

Predicting Disease Activity

A core focus of the updated guidelines is helping clinicians predict disease activity and determine the necessity for additional testing or treatment. Most cases of sclerosing mesenteritis follow an indolent course and require minimal intervention.Conversely, more aggressive cases necessitate prompt identification and tailored treatment strategies, potentially involving referral to specialized centers.

Approximately 60% of sclerosing mesenteritis cases are asymptomatic and require no specific treatment.Abdominal pain remains the most commonly reported symptom; its location shoudl correlate with imaging findings on CT scans.

The Role of CT scans and Biopsies

The guidelines offer clarity on when biopsies are necessary. A biopsy may not be required if the CT scan meets specific criteria outlined by B. Coulier, indicating a lower risk of aggressive disease or malignancy. It’s notable to differentiate sclerosing mesenteritis from other conditions such as non-Hodgkin’s lymphoma.

Pro Tip: Encourage radiologists to use the Coulier criteria for more accurate sclerosing mesenteritis diagnoses via CT scans.

the panelists highlight that patients with sclerosing mesenteritis