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This paper focusses on two particular groups of conditions: drug-induced injuries and parasitic infections. With aging populations and increased use of complex pharmacologic regimens\u2014including immunosuppressants and biologics\u2014drug-related GI pathology is nowadays more frequently encountered. However, the histologic changes are often non-specific and overlap with more common conditions such as inflammatory bowel disease (IBD), ischemia, autoimmune diseases, or infections. Key patterns include lymphocytic or neutrophilic inflammation, crypt apoptosis, crypt abscesses, and architectural distortion. Certain agents, such as mycophenolate, olmesartan, immune checkpoint inhibitors, or ion exchange resins (e.g. sodium polystyrene sulfonate\/kayexalate, sevelamer), have distinct but subtle histopathologic signatures. Parasitic infections, although less frequent in high-income countries, remain relevant due to global travel and migration. Organisms such as\n                    <jats:italic>Schistosoma, Strongyloides<\/jats:italic>\n                    , or\n                    <jats:italic>Giardia<\/jats:italic>\n                    can mimic IBD, neoplasia, or cause unexpected eosinophilic or granulomatous inflammation. Parasite ova may require special stains and careful morphologic assessment to be identified. Importantly, some helminths have been associated with chronic complications including cancer or fibrosis, thus underscoring the need for accurate recognition. For the practicing pathologist, these rare but impactful conditions demand a\u00a0high index of suspicion, especially in cases with atypical histology or poor clinical correlation. Using some illustrative cases, this paper highlights diagnostic strategies and key morphologic features to improve recognition and avoid misdiagnosis of these underappreciated entities.\n                  <\/jats:p>","DOI":"10.1007\/s00292-025-01501-2","type":"journal-article","created":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T13:15:24Z","timestamp":1763990124000},"page":"51-58","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rare non-neoplastic gastrointestinal diseases\u2013drugs and bugs","Seltene nichtneoplastische gastrointestinale Erkrankungen \u2013 Medikamente und Parasiten"],"prefix":"10.1007","volume":"47","author":[{"given":"Lena","family":"Angerer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Zauner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rupert","family":"Langer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"1501_CR1","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/j.path.2010.05.009","volume":"3","author":"LW Lamps","year":"2010","unstructured":"Lamps\u00a0LW (2010) Infectious Diseases of the Lower Gastrointestinal Tract. 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All studies mentioned were in accordance with the ethical standards indicated in each case.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The supplement containing this article is not sponsored by industry.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}