The latest ECCO Topical Review provides important, practice-oriented guidance on the increasingly recognised entity of drug-induced colitis (DIC), with a particular focus on immune checkpoint inhibitor (ICI)-related disease. DIC is described as a heterogeneous condition that can mimic Inflammatory Bowel Disease both clinically and histologically, making diagnosis challenging. Multiple patterns may coexist, ranging from acute and chronic inflammation to microscopic or ischaemic features, none of which are fully specific. As a result, we strongly emphasise the need for close collaboration between clinicians and pathologists, integrating clinical context, endoscopic findings and histology to reach an accurate diagnosis.
A key contribution of this work is the structured framework for diagnosing and managing ICI-induced colitis, a growing complication in oncology. We recommend a multimodal assessment combining symptom grading (CTCAE), stool testing, endoscopy with biopsy and imaging when needed. Corticosteroids remain the cornerstone of treatment, with escalation to advanced therapy in refractory cases, while surgery is reserved for severe complications. This Topical Review also highlights the importance of early objective assessment, careful nutritional support and avoidance of antimotility agents in severe disease. Importantly, decisions on restarting immunotherapy require multidisciplinary evaluation, balancing cancer control with toxicity risk.
Overall, this ECCO Topical Review delivers a much-needed, consensus-based roadmap for clinicians navigating complex cases of drug-induced and ICI-related colitis. By standardising diagnostic approaches and therapeutic strategies, the guidance aims to improve patient outcomes while supporting safer use of modern immunotherapies in both general and IBD populations. Stay tuned very soon in JCC!
