Drug-induced gastrointestinal injury (DIGI). Updates, reflections and key points

The goals of this short narrative review are 1) to provide an update in recent developments in the field of drug-induced gastrointestinal injury (DIGI), and 2) to distill few key points to approach with confidence a difficult and vast area of gastrointestinal pathology. DIGI is a challenging diagnosis as it can produce almost any pattern of the injury of the gastrointestinal tract. The recognition of a pattern and the knowledge of which drugs can produce that pattern, are the first step of the diagnostic process; communication with the clinical team and a high level of suspicion are then paramount. The pathologist can be the leading clinicians of the care team in few situations in which she/he can recognize the drug at the microscope. Knowledge of the most relevant differential diagnoses of DIGI is essential to avoid significant pitfalls. Finally, several DIGIs due to recently developed immunomodulators used in oncology have shown relevance given their sometimes fatal outcome and the accumulating evidence of a common morphological appearance among them.