Intestinal Research

Brief Communication

IBD

Novel inflammatory bowel disease (IBD) specific electronic medical record allows scalable auditing of IBD severity, therapy and complications to show the current unmet need in IBD care: Alex Barnes, David Carter, Patricia Kaazan, Alissa Walsh, Susan Connor, Jane M Andrews; Intest Res 2022;20(4):506-508. Published online April 26, 2022; DOI: https://doi.org/10.5217/ir.2022.00003

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Original Articles

IBD

Abdominal aortic calcification in patients with inflammatory bowel disease: does anti-tumor necrosis factor α use protect from chronic inflammation-induced atherosclerosis?: Aikaterini Mantaka, Nikolaos Galanakis, Dimitrios Tsetis, Ioannis E. Koutroubakis; Intest Res 2022;20(4):495-505. Published online August 8, 2022; DOI: https://doi.org/10.5217/ir.2022.00017

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Background/Aims
Abdominal aortic calcium (AAC) deposition has been suggested as a marker of early atherosclerosis. There is no published data on the evaluation of AAC in inflammatory bowel disease (IBD).
Methods
AAC was quantified by computed tomography or enterography scans performed in 98 IBD patients and 1:1 age and sex matched controls. AAC deposition was correlated with IBD characteristics, disease activity or severity parameters, laboratory tests and cardiovascular disease (CVD) risk factors.
Results
Moderate-severe grade of AAC was found in 35.7% of IBD patients compared to 30.6% of controls (P= 0.544). IBD with CVD and ulcerative colitis patients had significantly higher rates of more severe atherosclerotic lesions (P= 0.001 and P= 0.01, respectively). AAC deposition was similarly distributed in age groups ( < 45, 45–64, and ≥ 65 years) among patients and controls. Multivariate analysis after excluding CVD risk confounders for non-CVD patients found extensive disease (P= 0.019) and lifetime steroids (P= 0.04) as independent risk factors for AAC. Anti-tumor necrosis factor α (TNF-α) use was negatively associated with AAC deposition in non-CVD IBD patients (odds ratio, 0.023; 95% confidence interval, 0.001–0.594; P= 0.023).
Conclusions
More than one-third of IBD patients have moderate to severe AAC. Better control of inflammation with anti-TNF-α agents seems to protect IBD patients from ACC deposition and subsequent atherosclerosis.

Citations

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Abdominal aortic calcification among gastroenterological and transplant surgery
Yuki Imaoka, Masahiro Ohira, Miho Akabane, Kazunari Sasaki, Hideki Ohdan
Annals of Gastroenterological Surgery.2024;[Epub] CrossRef
A Potential New Link Between Inflammation and Vascular Calcification
Xinjiang Cai, Yin Tintut, Linda L. Demer
Journal of the American Heart Association.2023;[Epub] CrossRef
Associations between systemic immune-inflammation index and abdominal aortic calcification: Results of a nationwide survey
Ruijie Xie, Xiaozhu Liu, Haiyang Wu, Mingjiang Liu, Ya Zhang
Nutrition, Metabolism and Cardiovascular Diseases.2023; 33(7): 1437. CrossRef
Cardiovascular manifestations of inflammatory bowel diseases and the underlying pathogenic mechanisms
Ying Xiao, Don W. Powell, Xiaowei Liu, Qingjie Li
American Journal of Physiology-Regulatory, Integrative and Comparative Physiology.2023; 325(2): R193. CrossRef

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Gastrointestinal bleeding risk of non-vitamin K antagonist oral anticoagulants versus warfarin in general and after polypectomy: a population-based study with propensity score matching analysis: Jong Yop Pae, Eun Soo Kim, Sung Kook Kim, Min Kyu Jung, Jun Heo, Jang Hoon Lee, Min Ae Park; Intest Res 2022;20(4):482-494. Published online April 15, 2022; DOI: https://doi.org/10.5217/ir.2021.00161

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Background/Aims
Gastrointestinal bleeding (GIB) risk for non-vitamin K antagonist oral anticoagulants (NOACs) compared with warfarin is largely unknown. We aimed to determine the risk of overall and post-polypectomy GIB for NOACs and warfarin.
Methods
Using the Korean National Health Insurance database, we created a cohort of patients who were newly prescribed NOACs or warfarin between July 2015 and December 2017 using propensity score matching (PSM). Kaplan-Meier analysis with log-rank test was performed to compare the risk of overall and post-polypectomy GIB between NOACs (apixaban, dabigatran, and rivaroxaban) and warfarin. Post-polypectomy GIB was defined as bleeding within 1 month after gastrointestinal endoscopic polypectomy.
Results
Out of 234,206 patients taking anticoagulants (187,687 NOACs and 46,519 warfarin), we selected 39,764 pairs of NOACs and warfarin users after PSM. NOACs patients showed significantly lower risk of overall GIB than warfarin patients (log-rank P<0.001, hazard ratio, 0.86; 95% confidence interval, 0.78–0.94; P=0.001). Among NOACs, apixaban showed the lowest risk of GIB. In the subgroup of 7,525 patients who underwent gastrointestinal polypectomy (lower gastrointestinal polypectomy 93.1%), 1,546 pairs were chosen for each group after PSM. The NOACs group showed a high risk of post-polypectomy GIB compared with the warfarin group (log-rank P=0.001, hazard ratio, 1.97; 95% confidence interval, 1.16–3.33; P=0.012).
Conclusions
This nationwide, population-based study demonstrates that risk of overall GIB is lower for NOACs than for warfarin, while risk of post-polypectomy GIB is higher for NOACs than for warfarin.

Citations

Citations to this article as recorded by

Updates on the Prevention and Management of Post-Polypectomy Bleeding in the Colon
Hisham Wehbe, Aditya Gutta, Mark A. Gromski
Gastrointestinal Endoscopy Clinics of North America.2024; 34(2): 363. CrossRef
Re-bleeding and all-cause mortality risk in non-variceal upper gastrointestinal bleeding: focusing on patients receiving oral anticoagulant therapy
Won Shik Kim, Seung Han Kim, Moon Kyung Joo, Jong-Jae Park, Beom Jae Lee, Hoon Jai Chun
Annals of Medicine.2023;[Epub] CrossRef
Nonvitamin K oral anticoagulants with proton pump inhibitor cotherapy ameliorated the risk of upper gastrointestinal bleeding
Parata Chaiyana, Karjpong Techathuvanan, Supatsri Sethasine
Scientific Reports.2023;[Epub] CrossRef

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IBD

Clinical features of very early-onset inflammatory bowel disease in Japan: a retrospective single-center study: Masaaki Usami, Ichiro Takeuchi, Reiko Kyodo, Yuri Hirano, Kosuke Kashiwagi, Hiroki Fujikawa, Hirotaka Shimizu, Toshinao Kawai, Katsuhiro Arai; Intest Res 2022;20(4):475-481. Published online June 13, 2022; DOI: https://doi.org/10.5217/ir.2021.00142

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Background/Aims
Very early-onset inflammatory bowel disease (VEO-IBD), defined as IBD diagnosed in patients younger than 6 years, is a challenge for pediatric gastroenterologists. Although there have been reports regarding VEO-IBD in Western countries, those in Asia are still lacking. This study aimed to investigate the clinical features of Japanese VEO-IBD patients.
Methods
Patients with VEO-IBD diagnosed between 2006 and 2019 were evaluated retrospectively. The disease phenotypes were classified into ulcerative colitis type (UC-type) and Crohn’s disease type (CD-type), and the clinical features and courses were compared between the phenotypes.
Results
Overall, 54 VEO-IBD patients (19 patients with UC-type and 35 patients with CD-type) were evaluated. The median age at onset was 18 months. One patient had severe combined immunodeficiency (SCID), and 9 patients had monogenic IBD. Monogenic IBD was more prevalent in the CD-type patients with perianal disease (CD-type (PD)). The age at onset was significantly lower in the CD-type group (P<0.05). The most common initial symptom was bloody stools (70%), followed by diarrhea (63%), weight loss (24%), fever (20%), and perianal disease (20%). Excluding patients with SCID and monogenic IBD, 23 out of 44 patients (52%) required biologics. The biologics were switched in 11 out of 44 patients (25%), and the majority of these patients (82%) were in the CD-type group. Overall, 9 patients (20%) required intestinal resection or ostomy placement.
Conclusions
CD-type tends to occur at an earlier age, and monogenic IBD occurs significantly more frequently in CD-type (PD). Disease severity and treatment should be individualized, owing to the disease heterogeneity.

Citations

Citations to this article as recorded by

Impact of age at diagnosis on long‐term prognosis in patients with intestinal Behçet's disease
Ji Young Chang, Soo Jung Park, Jae Jun Park, Tae Il Kim, Jae Hee Cheon, Jihye Park
Journal of Gastroenterology and Hepatology.2024; 39(3): 519. CrossRef
Neither hepatic steatosis nor fibrosis is associated with clinical outcomes in patients with intestinal Behçet’s disease
Hye Kyung Hyun, Jihye Park, Soo Jung Park, Jae Jun Park, Tae Il Kim, Jae Seung Lee, Hye Won Lee, Beom Kyung Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Seung Up Kim, Jae Hee Cheon
European Journal of Gastroenterology & Hepatology.2024; 36(4): 445. CrossRef
Surgical outcomes of very-early-onset ulcerative colitis: retrospective comparative study with older pediatric patients
Takashi Fumita, Keita Terui, Ryohei Shibata, Ayako Takenouchi, Shugo Komatsu, Satoru Oita, Hiroko Yoshizawa, Yuichi Hirano, Yusaku Yoshino, Takeshi Saito, Tomoro Hishiki
Pediatric Surgery International.2024;[Epub] CrossRef
Fecal Calprotectin at Postinduction Is Capable of Predicting Persistent Remission and Endoscopic Healing after 1 Year of Treatment with Infliximab in Pediatric Patients with Crohn’s Disease
Yoo Min Lee, Eun Sil Kim, Sujin Choi, Hyo-Jeong Jang, Yu Bin Kim, So Yoon Choi, Byung-Ho Choe, Ben Kang
Gut and Liver.2024; 18(3): 498. CrossRef
Genomic testing identifies monogenic causes in patients with very early-onset inflammatory bowel disease: a multicenter survey in an Iranian cohort
Golnaz Eslamian, Mahnaz Jamee, Tooba Momen, Pejman Rohani, Sarehossadat Ebrahimi, Mehrnaz Mesdaghi, Soodeh Ghadimi, Mahboubeh Mansouri, Seyed Alireza Mahdaviani, Mahnaz Sadeghi-shabestari, Morteza Fallahpour, Bibi Shahin Shamsian, Narges Eslami, Samin Sha
Clinical and Experimental Immunology.2024; 217(1): 1. CrossRef

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IBD

Long-term clinical and real-world experience with Crohn’s disease treated with anti-tumor necrosis factor-α antibodies: Haruka Otake, Satohiro Matsumoto, Hirosato Mashima; Intest Res 2022;20(4):464-474. Published online March 31, 2022; DOI: https://doi.org/10.5217/ir.2021.00139

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Background/Aims
Although anti-tumor necrosis factor (TNF)-α agents are important therapeutic drugs for Crohn’s disease (CD), data regarding their long-term sustained effects are limited. Herein, we evaluated the long-term loss of response (LOR) to anti-TNF-α agents in patients with CD.
Methods
This retrospective study included patients with CD who started treatment with infliximab or adalimumab as a first-line therapeutic approach. The cumulative event-free, retention, and surgery-free rates after the start of biological therapy were analyzed. Secondary LOR was analyzed in patients who achieved corticosteroid-free clinical remission after the start of biological therapy. Cox proportional hazards models were used to analyze the predictive factors of secondary LOR.
Results
The cumulative event-free rates at 1, 2, 5, and 10 years were 83.3%, 75.1%, 37.4%, and 23.3%, respectively. The incidence of LOR was 10.6% per patient-year of follow-up. At 12–14 weeks after the start of biological therapy, the proportion of patients with a C-reactive protein to albumin (CRP/ALB) ratio ≥0.18 was significantly higher in patients with LOR (P<0.001). Multivariate analysis indicates that a CRP/ALB ratio ≥0.18 (hazard ratio [HR], 5.86; 95% confidence interval [CI], 1.56–22.0; P=0.009) and upper gastrointestinal tract inflammation (HR, 3.00; 95% CI, 1.26–7.13; P=0.013) were predictive factors of secondary LOR.
Conclusions
Although anti-TNF-α agents contributed to long-term clinical remission of CD, the annual incidence of secondary LOR was 10.6%. The CRP/ALB ratio at 3 months after the start of biological therapy and upper gastrointestinal tract inflammation were identified as predictive factors of secondary LOR.

Citations

Citations to this article as recorded by

Impact of age at diagnosis on long‐term prognosis in patients with intestinal Behçet's disease
Ji Young Chang, Soo Jung Park, Jae Jun Park, Tae Il Kim, Jae Hee Cheon, Jihye Park
Journal of Gastroenterology and Hepatology.2024; 39(3): 519. CrossRef
Effectiveness and Tolerability of Methotrexate Combined with Biologics in Patients with Crohn’s Disease: A Multicenter Observational Study
Jihye Park, Jaeyoung Chun, Soo Jung Park, Jae Jun Park, Tae Il Kim, Hyuk Yoon, Jae Hee Cheon
Digestive Diseases and Sciences.2024; 69(3): 901. CrossRef
Developing a Machine-Learning Prediction Model for Infliximab Response in Crohn’s Disease: Integrating Clinical Characteristics and Longitudinal Laboratory Trends
Yun Qiu, Shixian Hu, Kang Chao, Lingjie Huang, Zicheng Huang, Ren Mao, Fengyuan Su, Chuhan Zhang, Xiaoqing Lin, Qian Cao, Xiang Gao, Minhu Chen
Inflammatory Bowel Diseases.2024;[Epub] CrossRef
Effectiveness of Switching to Subcutaneous Infliximab in Ulcerative Colitis Patients Experiencing Intravenous Infliximab Failure
June Hwa Bae, Jung-Bin Park, Ji Eun Baek, Seung Wook Hong, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Sung Wook Hwang
Gut and Liver.2024; 18(4): 667. CrossRef
Comparative real-world outcomes between ustekinumab, infliximab, and adalimumab in bio-naïve and bio-experienced Crohn’s disease patients: a retrospective multicenter study
Ji Eun Na, Yong Eun Park, Jongha Park, Tae-Oh Kim, Jong Hoon Lee, Su Bum Park, Soyoung Kim, Seung Bum Lee
BMC Gastroenterology.2024;[Epub] CrossRef
Usefulness of Serum Leucine-rich Alpha 2 Glycoprotein in Crohn’s Disease: Is There Any Difference between Small Intestine and Colonic Lesions?
Satohiro Matsumoto, Hirosato Mashima
Crohn's & Colitis 360.2023;[Epub] CrossRef
Enrichment of Activated Fibroblasts as a Potential Biomarker for a Non-Durable Response to Anti-Tumor Necrosis Factor Therapy in Patients with Crohn’s Disease
Soo-Kyung Park, Gi-Young Lee, Sangsoo Kim, Chil-Woo Lee, Chang-Hwan Choi, Sang-Bum Kang, Tae-Oh Kim, Jaeyoung Chun, Jae-Myung Cha, Jong-Pil Im, Kwang-Sung Ahn, Seon-Young Kim, Min-Suk Kim, Chang-Kyun Lee, Dong-Il Park
International Journal of Molecular Sciences.2023; 24(19): 14799. CrossRef

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IBD

Physician education can minimize inappropriate steroid use in patients with inflammatory bowel disease: the ACTION study: Yehyun Park, Chang Hwan Choi, Hyun Soo Kim, Hee Seok Moon, Do Hyun Kim, Jin Ju Kim, Dennis Teng, Dong Il Park; Intest Res 2022;20(4):452-463. Published online March 11, 2022; DOI: https://doi.org/10.5217/ir.2021.00125

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Background/Aims
Epidemiological data on steroid use in South Korean patients with inflammatory bowel disease (IBD) are limited. We documented the steroid use patterns in these patients, and whether physician education on appropriate steroid use affected these patterns.
Methods
ACTION was an observational cohort study conducted in adults (≥19 years) with IBD. A retrospective chart review was performed at baseline (cohort 1) and 1 year after physician training (cohort 2). Eligible cases with excessive or inappropriate steroid use were identified, along with any associated risk factors.
Results
Data were collected during May 2018-July 2019 from patients with Crohn’s disease (CD) and ulcerative colitis (UC) in cohort 1 (n=1,685) and cohort 2 (n=1,649). At baseline, 155 patients (9.2%) had received steroids within the previous 12 months, 46 (29.7%) of whom had used steroids excessively, 16 (34.8%) of these having inappropriately used excessive steroids. Although steroid exposure was similar in cohort 1 (9.2%) and cohort 2 (9.7%), the latter comprised fewer excessive steroid users (20.0% vs. 29.7%). Severe disease was associated with excessive steroid use in cases with UC, but not with CD.
Conclusions
Although, overall steroid use was relatively low in South Korean patients with IBD, one-third of steroid users used them excessively, and one-third among these used excessive steroids inappropriately. High disease activity was the main risk factor for excessive steroid use which may potentially be reduced by physician education, especially in cases with UC. Active screening to minimize excessive and inappropriate steroid use through physician education should be considered.

Citations

Citations to this article as recorded by

The Reliability and Quality of Short Videos as a Source of Dietary Guidance for Inflammatory Bowel Disease: Cross-sectional Study
Zixuan He, Zhijie Wang, Yihang Song, Yilong Liu, Le Kang, Xue Fang, Tongchang Wang, Xuanming Fan, Zhaoshen Li, Shuling Wang, Yu Bai
Journal of Medical Internet Research.2023; 25: e41518. CrossRef
Corticosteroid, a double-edged sword in inflammatory bowel disease management: possibility of reducing corticosteroid use through physician education
Seulji Kim, Seong-Joon Koh
Intestinal Research.2022; 20(4): 389. CrossRef

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IBD

Efficacy of hepatitis B vaccination in patients with ulcerative colitis: a prospective cohort study: Anurag Mishra, Amarender Singh Puri, Sanjeev Sachdeva, Ashok Dalal; Intest Res 2022;20(4):445-451. Published online February 8, 2022; DOI: https://doi.org/10.5217/ir.2021.00106

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Background/Aims
Response to vaccine in patients with inflammatory bowel disease is lower than in the general population. We aimed to evaluate the efficacy of hepatitis B virus (HBV) vaccination in patients with ulcerative colitis (UC) versus controls.
Methods
We prospectively compared antibody response to HBV vaccination in 100 patients with UC versus controls. HBV vaccination was given to all the cases and controls at 0, 1 and 6 months. Anti-hepatitis B surface (anti-HBs) titers were then measured 4 weeks after the first and the third dose. Adequate immune response (AIR) was considered if the anti-HBs titer was >10 IU/L and effective immune response (EIR) if the anti-HBs titer was >100 IU/L.
Results
Median anti-HBs titer was lower in patients with UC than controls (67 IU/L vs. 105 IU/L, P<0.01). AIR and EIR were significantly lower in patients than in controls (82% vs. 96%, P=0.001; 41% vs. 66%, P<0.001, respectively). Univariate analysis showed that age <30 years, mild to moderate severity of disease, disease duration <5 years, male sex, post first dose anti-HBs titer >2 IU/L and non-exposure to corticosteroids, azathioprine and biologicals were predictors of AIR in patients with UC (P<0.05). Multivariate analysis revealed that only non-exposure to corticosteroids, azathioprine and biologicals, male sex, and disease duration <5 years were independent predictors of AIR.
Conclusions
Response rate to the HBV vaccination in patients with UC was significantly lower as compared to the controls. Male sex, shorter disease duration, and non-exposure to immunomodulators were independent predictors of AIR.

Citations

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Immunogenicity of Hepatitis B Vaccination in Patients with Ulcerative Colitis on Infliximab Is Attenuated Compared to Those on 5-Aminosalicylic Acid Therapies: A Prospective Observational Study
Mohammad Shehab, Fatema Alrashed, Munerah Alyaseen, Zainab Safar, Tunrayo Adekunle, Ahmad Alfadhli, Talat Bessissow
Vaccines.2024; 12(4): 364. CrossRef
Beyond the survey, to the ideal therapy for Asian
Ki Jae Jo, Jong Pil Im
Intestinal Research.2023; 21(3): 280. CrossRef

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Statement

IBD

Korean Association for the Study of Intestinal Diseases guidance for clinical practice of adult inflammatory bowel disease during the coronavirus disease 2019 pandemic: expert consensus statements: Yong Eun Park, Yoo Jin Lee, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Jae Gon Lee, Hee Chan Yang, Miyoung Choi, Seong-Eun Kim, Seung-Jae Myung; Intest Res 2022;20(4):431-444. Published online January 5, 2022; DOI: https://doi.org/10.5217/ir.2021.00111

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Many unexpected problems have resulted from the unprecedented coronavirus disease 2019 (COVID-19) pandemic. The optimal management of patients with inflammatory bowel disease (IBD) during the COVID-19 pandemic has also been a challenge. Therefore, the Korean Association for the Study of Intestinal Diseases (KASID) developed a consensus statement of experts regarding the management of IBD during the COVID-19 pandemic. This consensus statement made recommendations regarding the risk and treatment of COVID-19 in IBD patients. This statement emphasizes that IBD is not a risk factor for COVID-19, and care should be taken not to exacerbate IBD in patients in remission state by maintaining their medications, except for corticosteroids.

Citations

Citations to this article as recorded by

Mobile monitoring system detects the disease activity pattern and shows the association with clinical outcomes in patients with newly diagnosed Crohn’s disease
Yoo Jin Lee, Sang Gyu Kwak, Eun Soo Kim, Sung Kook Kim, Hyun Seok Lee, Yun Jin Chung, Byung Ik Jang, Kyeong Ok Kim, Jeongseok Kim, Hyeong Ho Jo, Eun Young Kim
Scientific Reports.2024;[Epub] CrossRef
Update on SARS-CoV-2 vaccination of patients with inflammatory bowel disease: what clinicians need to know
Yoo Jin Lee, Seong-Eun Kim, Yong Eun Park, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Jae Gon Lee, Hee Chan Yang, Seung-Jae Myung
Intestinal Research.2022; 20(3): 386. CrossRef

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Reviews

IBD

Natural history of inflammatory bowel disease: a comparison between the East and the West: Eun Mi Song, Suk-Kyun Yang; Intest Res 2022;20(4):418-430. Published online December 2, 2021; DOI: https://doi.org/10.5217/ir.2021.00104

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Over the past decades, there has been a rapid increase in the incidence and prevalence of inflammatory bowel disease (IBD) in Asia. The natural history of IBD in Asian patients could be different from that in Western patients due to variations in disease phenotypes and genotypes as well as the healthcare environment between the 2 populations. To adequately cope with this disease, it is important to fully understand the potential differences in its natural history among different populations. In this review, we evaluated the differences in the clinical course of IBD between Asian and Western patients with regards to phenotypic progression, hospitalization, major surgery, risk of colorectal cancer, and mortality, mainly based on the results of population-based studies. The findings of our narrative review suggest that the clinical course of Asian patients with IBD, especially ulcerative colitis, is better than that of Western patients, as indicated by the lower rates of major surgery and hospitalization. In addition, similar to Western patients, the clinical course of Asian patients with IBD has been improving as evidenced by the decreasing rates of disease behavior progression (in Crohn’s disease), hospitalization, and major surgery.

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Could histologic healing be a new treatment target in patients with ulcerative colitis?
Soyoung Kim, Sang Hyoung Park
The Korean Journal of Internal Medicine.2024; 39(1): 2. CrossRef
Inflammatory bowel disease evolution in the past two decades: a chronological multinational study
Pezhman Alavinejad, Seyed Jalal Hashemi, Nitin Behl, Ahmad Hormati, Abubakr Elbasuny, Naser Ebrahimi Daryani, Mehdi Pezeshgi Modarres, Masoud Arshadzadeh, Samira Panahande, Dao Viet Hang, Aya Mohammed Mahros, Abazar Parsi, Hazhir Javaherizadeh, Ata Rehman
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Kyuwon Kim, Byong Duk Ye
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Predictors of histologic remission in patients with biologic-naïve, moderate-to-severe ulcerative colitis treated with first-line biologic agents and small-molecule drugs: a single-center, retrospective cohort study
Kijae Jo, Kwang Woo Kim, Hyun Jung Lee, Jong Pil Im, Joo Sung Kim, Seong-Joon Koh
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Risk of avascular necrosis in patients with inflammatory bowel disease: Insights from a nationwide cohort study and the impact of corticosteroid use
Jung Min Moon, Kyoung-Eun Kwon, Ju Won Lee, Kyung Rok Minn, Kyuwon Kim, Jeongkuk Seo, Seung Yong Shin, Sun-Young Jung, Chang Hwan Choi
Digestive and Liver Disease.2024;[Epub] CrossRef
Natural course of ulcerative colitis in China: Differences from the West?
Jian Wan, Jun Shen, Jie Zhong, Wensong Ge, Yinglei Miao, Xiaolan Zhang, Zhonghui Wen, Yufang Wang, Jie Liang, Kaichun Wu
United European Gastroenterology Journal.2024;[Epub] CrossRef
Prevalence and risk factors for gallstone and renal stone formation in patients with intestinal Behçet’s disease
Jaewon Song, Soo Jung Park, Jae Jun Park, Tae Il Kim, Jihye Park, Jae Hee Cheon
The Korean Journal of Internal Medicine.2024; 39(5): 770. CrossRef
Old and New Biologics and Small Molecules in Inflammatory Bowel Disease: Anti-Tumor Necrosis Factors
Sang Un Kim, Hyun Seok Lee
The Korean Journal of Gastroenterology.2024; 84(2): 35. CrossRef
Characteristics, clinical outcomes, and prognostic factors of colorectal cancer in patients with Crohn’s disease: American versus Korean tertiary referral center perspectives
Tanita Suttichaimongkol, Sung Wook Hwang, Nayantara Coelho-Prabhu, John B. Kisiel, Byong Duk Ye, Suk-Kyun Yang, Edward V. Loftus, Sang Hyoung Park
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Primary surgery versus pharmacotherapy for newly diagnosed ileocecal Crohn’s disease: a hospital-based cohort study
Yehyun Park, Soo Jung Park, Tae Il Kim, Won Ho Kim, Jae Hee Cheon
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Korean clinical practice guidelines on biologics for moderate to severe Crohn’s disease
Seong-Joon Koh, Sung Noh Hong, Soo-Kyung Park, Byong Duk Ye, Kyeong Ok Kim, Jeong Eun Shin, Yong Sik Yoon, Hong Sub Lee, Sung Hoon Jung, Miyoung Choi, Soo-Young Na, Chang Hwan Choi, Joo Sung Kim
Intestinal Research.2023; 21(1): 43. CrossRef
Long‐term clinical outcomes of intestinal Behçet's disease: A 30‐year cohort study at a tertiary hospital in South Korea
Jihye Park, Soo Jung Park, Jae Jun Park, Tae Il Kim, Jae Hee Cheon
Journal of Gastroenterology and Hepatology.2023; 38(3): 386. CrossRef
Past, present, and future of Intestinal Research
Jae Hee Cheon
Intestinal Research.2023; 21(1): 1. CrossRef
Association of Waist Circumference with the Risk of Inflammatory Bowel Disease: a Nationwide Cohort Study of 10 Million Individuals in Korea
Yeonjin Je, Kyungdo Han, Jaeyoung Chun, Yuna Kim, Jie-Hyun Kim, Young Hoon Youn, Hyojin Park, Jong Pil Im, Joo Sung Kim
Journal of Crohn's and Colitis.2023; 17(5): 681. CrossRef
Primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD): a condition exemplifying the crosstalk of the gut–liver axis
You Sun Kim, Edward H. Hurley, Yoojeong Park, Sungjin Ko
Experimental & Molecular Medicine.2023; 55(7): 1380. CrossRef
Treatment of inflammatory bowel disease–Asian perspectives: the results of a multinational web-based survey in the 8th Asian Organization for Crohn’s and Colitis meeting
Eun Mi Song, Soo-Young Na, Sung Noh Hong, Siew Chien Ng, Tadakazu Hisamatsu, Byong Duk Ye
Intestinal Research.2023; 21(3): 339. CrossRef
How have treatment patterns for patients with inflammatory bowel disease changed in Asian countries?
Jihye Park
Intestinal Research.2023; 21(3): 275. CrossRef
Treatment of primary sclerosing cholangitis combined with inflammatory bowel disease
You Sun Kim, Edward H. Hurley, Yoojeong Park, Sungjin Ko
Intestinal Research.2023; 21(4): 420. CrossRef
Golimumab for Ulcerative Colitis: One More Option to SAVE the Colon
Sang Hyoung Park
Crohn's & Colitis 360.2023;[Epub] CrossRef
Advancements in the Management of Moderate-to-Severe Ulcerative Colitis: A Revised 2023 Korean Treatment Guidelines
Soo-Young Na
The Korean Journal of Medicine.2023; 98(5): 223. CrossRef
Virofree Associates with the Modulation of Gut Microbiomes and Alleviation of DSS-Induced IBD Symptoms in Mice
Wei-Sheng Lin, Wan-Chen Cheng, Min-Hsiung Pan
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Eun Mi Song, Arum Choi, Sukil Kim, Sung Hoon Jung
Journal of Korean Medical Science.2023;[Epub] CrossRef
Which biologic agents increase perioperative complications in patients with inflammatory bowel disease?
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Miscellaneous

Involvement of the cannabinoid system in chronic inflammatory intestinal diseases: opportunities for new therapies: Priscila A. Lima, Bárbara B. Berg, Marina Gomes Miranda e Castor; Intest Res 2022;20(4):392-417. Published online May 31, 2022; DOI: https://doi.org/10.5217/ir.2021.00160

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The components of the endogenous cannabinoid system are widely expressed in the gastrointestinal tract contributing to local homeostasis. In general, cannabinoids exert inhibitory actions in the gastrointestinal tract, inducing anti-inflammatory, antiemetic, antisecretory, and antiproliferative effects. Therefore, cannabinoids are interesting pharmacological compounds for the treatment of several acute intestinal disorders, such as dysmotility, emesis, and abdominal pain. Likewise, the role of cannabinoids in the treatment of chronic intestinal diseases, such as irritable bowel syndrome and inflammatory bowel disease, is also under investigation. Patients with chronic intestinal inflammatory diseases present impaired quality of life, and mental health issues are commonly associated with long-term chronic diseases. The complex pathophysiology of these diseases contributes to difficulties in diagnosis and, therefore, in the choice of a satisfactory treatment. Thus, this article reviews the involvement of the cannabinoid system in chronic inflammatory diseases that affect the gastrointestinal tract and highlights possible therapeutic approaches related to the use of cannabinoids.

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Cannabigerol as an anti-inflammatory agent altering the level of arachidonic acid derivatives in the colon tissue of rats subjected to a high-fat high-sucrose diet
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Editorial

IBD

Corticosteroid, a double-edged sword in inflammatory bowel disease management: possibility of reducing corticosteroid use through physician education: Seulji Kim, Seong-Joon Koh; Intest Res 2022;20(4):389-391. Published online October 28, 2022; DOI: https://doi.org/10.5217/ir.2022.00117

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Estimation of patients affected by inflammatory bowel disease potentially eligible for biological treatment in a real-world setting
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Letters to the Editor

IBD

Update on SARS-CoV-2 vaccination of patients with inflammatory bowel disease: what clinicians need to know: Yoo Jin Lee, Seong-Eun Kim, Yong Eun Park, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Jae Gon Lee, Hee Chan Yang, Seung-Jae Myung, Clinical Practice Guideline Committee of the Korean Association for the Study of Intestinal Diseases; Intest Res 2022;20(3):386-388. Published online March 11, 2022; DOI: https://doi.org/10.5217/ir.2020.00172

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Brief Communication

IBD

Colonic oncostatin M expression evaluated by immunohistochemistry and infliximab therapy outcome in corticosteroid-refractory acute severe ulcerative colitis: Jim O’Connell, Jayne Doherty, Amy Buckley, David Cormican, Cara Dunne, Karen Hartery, John Larkin, Finbar MacCarthy, Paul McCormick, Susan McKiernan, Brian Mehigan, Cian Muldoon, Ciara Ryan, Jacintha O’Sullivan, David Kevans; Intest Res 2022;20(3):381-385. Published online March 11, 2022; DOI: https://doi.org/10.5217/ir.2021.00073

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Original Articles

Microbiota

Relationship between the gut microbiota and bile acid composition in the ileal mucosa of Crohn’s disease: Shigeki Bamba, Osamu Inatomi, Atsushi Nishida, Masashi Ohno, Takayuki Imai, Kenichiro Takahashi, Yuji Naito, Junichi Iwamoto, Akira Honda, Naohiro Inohara, Akira Andoh; Intest Res 2022;20(3):370-380. Published online May 14, 2021; DOI: https://doi.org/10.5217/ir.2021.00054

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Background/Aims
Crosstalk between the gut microbiota and bile acid plays an important role in the pathogenesis of gastrointestinal disorders. We investigated the relationship between microbial structure and bile acid metabolism in the ileal mucosa of Crohn’s disease (CD).
Methods
Twelve non-CD controls and 38 CD patients in clinical remission were enrolled. Samples were collected from the distal ileum under balloon-assisted enteroscopy. Bile acid composition was analyzed by liquid chromatography-mass spectrometry. The gut microbiota was analyzed by 16S rRNA gene sequencing.
Results
The Shannon evenness index was significantly lower in endoscopically active lesions than in non-CD controls. β-Diversity, evaluated by the UniFrac metric, revealed a significant difference between the active lesions and non-CD controls (P=0.039). The relative abundance of Escherichia was significantly higher and that of Faecalibacterium and Roseburia was significantly lower in CD samples than in non-CD controls. The increased abundance of Escherichia was more prominent in active lesions than in inactive lesions. The proportion of conjugated bile acids was significantly higher in CD patients than in non-CD controls, but there was no difference in the proportion of primary or secondary bile acids. The genera Escherichia and Lactobacillus were positively correlated with the proportion of conjugated bile acids. On the other hand, Roseburia, Intestinibacter, and Faecalibacterium were negatively correlated with the proportion of conjugated bile acids.
Conclusions
Mucosa-associated dysbiosis and the alteration of bile acid composition were identified in the ileum of CD patients. These may play a role in the pathophysiology of ileal lesions in CD patients.

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A critical review on inflammatory bowel diseases risk factors, dietary nutrients regulation and protective pathways based on gut microbiota during recent 5 years
Pengkui Xia, Tao Hou, Hong Jin, Yaqi Meng, Jing Li, Fuchao Zhan, Fang Geng, Bin Li
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Rupa Tharu, Geetika Malik Ahlawat, Savitesh Kushwaha, Poonam Khanna
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Crohn’s disease: Why the ileum?
Nicolas Richard, Guillaume Savoye, Mathilde Leboutte, Asma Amamou, Subrata Ghosh, Rachel Marion-Letellier
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Kwang Woo Kim
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Tadakuni Monma, Junichi Iwamoto, Hajime Ueda, Makoto Tamamushi, Fumio Kakizaki, Naoki Konishi, Shoichiro Yara, Teruo Miyazaki, Takeshi Hirayama, Tadashi Ikegami, Akira Honda
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IBD

Intestinal ultrasonography and fecal calprotectin for monitoring inflammation of ileal Crohn’s disease: two complementary tests: José María Paredes, Tomás Ripollés, Ángela Algarra, Rafael Diaz, Nadia Moreno, Patricia Latorre, María Jesús Martínez, Pilar Llopis, Antonio López, Eduardo Moreno-Osset; Intest Res 2022;20(3):361-369. Published online March 15, 2022; DOI: https://doi.org/10.5217/ir.2021.00126

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Background/Aims
Tight control of inflammation and adjustment of treatment if activity persists is the current strategy for the management of Crohn’s disease (CD). The usefulness of fecal calprotectin (FC) in isolated involvement of the small intestine in CD is controversial. To assess the usefulness of FC to determine the inflammatory activity detected by intestinal ultrasonography (IUS) in ileal CD.
Methods
Patients with exclusively ileal involvement CD who underwent IUS and an FC were prospectively included. Simple ultrasound index was used to determine inflammatory activity. The usual statistical tests for comparison of diagnostic techniques were used.
Results
One hundred and five patients were included, IUS showed inflammatory activity in 59% of patients and complications in 18.1%. FC showed a significant correlation with IUS in the weak range (Spearman coefficient r=0.502; P<0.001); the area under the receiver operating characteristic curve was 0.79 (95% confidence interval, 0.70–0.88; P<0.001). The FC value that best reflected the activity in IUS was 100 μg/g with sensitivity, specificity, and positive and negative predictive values of 73.0%, 71.4%, 79.3% and 63.8%, respectively. There were no differences in FC concentration between patients with or without transmural complications. The addition of serum C-reactive protein to FC did not improve the ability to assess IUS activity.
Conclusions
FC has a significant correlation with IUS to monitor ileal CD activity. This correlation is weak and it does not allow assessing the presence of CD complications. Both tests should be used in conjunction for tight control of ileal CD. More studies on noninvasive tests in this location are needed.

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Novelties and Perspectives of Intestinal Ultrasound in the Personalised Management of Patients with Inflammatory Bowel Diseases—A Systematic Review
Vasile-Claudiu Mihai, Liliana Gheorghe, Ioana-Irina Rezuș, Alina Ecaterina Jucan, Mihaela-Cristiana Andronic, Otilia Gavrilescu, Mihaela Dranga, Andrei-Mihai Andronic, Cristina Cijevschi Prelipcean, Ciprian Rezuș, Cătălina Mihai
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Myung‐won You, Sung Kyoung Moon, Yong Dae Lee, Shin Ju Oh, Seong Jin Park, Chang Kyun Lee
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Sara Massironi, Alice Laffusa, Tommaso Lorenzo Parigi, Silvio Danese
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Application of transabdominal ultrasound in Crohn’s disease
Wei-Jie Chen, Lei-Lei Luo, Zhi-Xing Dong, Jing Wu, Xing-Xing Gu, Zhao-Lian Bian
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IBD

Clinical outcomes and predictors of response for adalimumab in patients with moderately to severely active ulcerative colitis: a KASID prospective multicenter cohort study: Seung Yong Shin, Soo Jung Park, Young Kim, Jong Pil Im, Hyo Jong Kim, Kang-Moon Lee, Ji Won Kim, Sung-Ae Jung, Jun Lee, Sang-Bum Kang, Sung Jae Shin, Eun Sun Kim, You Sun Kim, Tae Oh Kim, Hyun-Soo Kim, Dong Il Park, Hyung Kil Kim, Eun Soo Kim, Young-Ho Kim, Do Hyun Kim, Dennis Teng, Jong-Hwa Kim, Wonyong Kim, Chang Hwan Choi, on behalf of the IBD Research Group of the Korean Association for the Study of Intestinal Diseases; Intest Res 2022;20(3):350-360. Published online July 23, 2021; DOI: https://doi.org/10.5217/ir.2021.00049

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Background/Aims
This study assessed the efficacy and safety of adalimumab (ADA) and explored predictors of response in Korean patients with ulcerative colitis (UC).
Methods
A prospective, observational, multicenter study was conducted over 56 weeks in adult patients with moderately to severely active UC who received ADA. Clinical response, remission, and mucosal healing were assessed using the Mayo score.
Results
A total of 146 patients were enrolled from 17 academic hospitals. Clinical response rates were 52.1% and 37.7% and clinical remission rates were 24.0% and 22.0% at weeks 8 and 56, respectively. Mucosal healing rates were 39.0% and 30.1% at weeks 8 and 56, respectively. Prior use of anti-tumor necrosis factor-α (anti-TNF-α) did not affect clinical and endoscopic responses. The ADA drug level was significantly higher in patients with better outcomes at week 8 (P<0.05). In patients with lower endoscopic activity, higher body mass index, and higher serum albumin levels at baseline, the clinical response rate was higher at week 8. In patients with lower Mayo scores and C-reactive protein levels, clinical responses, and mucosal healing at week 8, the clinical response rate was higher at week 56. Serious adverse drug reactions were identified in 2.8% of patients.
Conclusions
ADA is effective and safe for induction and maintenance in Korean patients with UC, regardless of prior anti-TNF-α therapy. The ADA drug level is associated with the efficacy of induction therapy. Patients with better short-term outcomes were predictive of those with an improved long-term response.

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Han Na Oh, Seung Yong Shin, Jong-Hwa Kim, Jihye Baek, Hyo Jong Kim, Kang-Moon Lee, Soo Jung Park, Seok-Young Kim, Hyung-Kyoon Choi, Wonyong Kim, Woo Jun Sul, Chang Hwan Choi
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Seok-Young Kim, Seung Yong Shin, Soo Jung Park, Jong Pil Im, Hyo Jong Kim, Kang-Moon Lee, Ji Won Kim, Sung-Ae Jung, Jun Lee, Sang-Bum Kang, Sung Jae Shin, Eun Sun Kim, You Sun Kim, Tae Oh Kim, Hyun-Soo Kim, Dong Il Park, Hyung Kil Kim, Eun Soo Kim, Young-
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Sophie Vieujean, Edouard Louis
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Seung Bum Lee, Hee Seung Hong, Chang Kyun Lee, Bo-In Lee, Sol Kim, Seong-Joon Koh, Hosun Yu, Jung-Bin Park, Sung Wook Hwang, Byong Duk Ye, Suk-Kyun Yang, Sang Hyoung Park
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IBD

A nationwide analysis on the influence of obesity in inflammatory bowel disease hospitalizations: Dushyant Singh Dahiya, Asim Kichloo, Farah Wani, Jagmeet Singh, Dhanshree Solanki, Hafeez Shaka; Intest Res 2022;20(3):342-349. Published online May 21, 2021; DOI: https://doi.org/10.5217/ir.2021.00046

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Background/Aims
Proinflammatory cytokines released from adipocytes can influence the development, progression, and treatment of inflammatory bowel disease (IBD), and may be associated with worse clinical outcomes.
Methods
For 2016–2018, we analyzed data from the Nationwide Inpatient Sample to identify adult (≥18 years) hospitalizations with a primary discharge diagnosis of IBD. The study sample was divided based on the presence or absence of obesity. The primary outcomes included inpatient mortality, while the secondary outcomes consisted of system-based complications and disease implications on the United States healthcare system.
Results
We identified 282,005 hospitalizations of IBD from 2016 to 2018. Of these hospitalizations, 26,465 (9.4%) had a secondary diagnosis of obesity while 255,540 (90.6%) served as controls. IBD hospitalizations with obesity had a higher mean age (47.9 years vs. 45.2 years, P<0.001), middle age (range, 40–65 years) predominance (37.7% vs. 28.9%, P<0.001), female predominance (64.1% vs. 52.5%, P<0.001) and higher proportion of patients with comorbidities compared to the non-obese cohort. White predominance was observed in both subgroups. No difference in the odds of inpatient mortality was noted between the 2 subgroups; however, IBD hospitalizations with obesity had higher mean total hospital charge ($50,126 vs. $45,001, P<0.001), longer length of stay (5.5 days vs. 4.9 days, P<0.001) and higher proportion of complications compared to the non-obese cohort.
Conclusions
Obese IBD hospitalizations had higher length of stay, total hospital charge, and complications compared to the non-obese cohort.

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Real-world data for golimumab treatment in patients with ulcerative colitis in Japan: interim analysis in post-marketing surveillance: Shiro Nakamura, Teita Asano, Hiroaki Tsuchiya, Kanami Sugimoto, Yuya Imai, Seiji Yokoyama, Yasuo Suzuki; Intest Res 2022;20(3):329-341. Published online August 4, 2021; DOI: https://doi.org/10.5217/ir.2021.00032

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Background/Aims
Golimumab (GLM) is an anti-tumor necrosis factor-α drug approved for treating moderate-to-severe active ulcerative colitis (UC). A 52-week post-marketing surveillance (PMS) was initiated to evaluate its safety and effectiveness in patients with UC in Japan. We present an interim report of the ongoing PMS.
Methods
Patients received 200 mg of subcutaneous GLM at week 0, 100 mg at week 2, and 100 mg 4 weekly thereafter. The safety analysis set included 392 patients with UC, and the effectiveness analysis set 387 patients. Safety and effectiveness were assessed at week 6.
Results
Adverse drug reactions (ADRs) were reported in 8.2% (32/392) and serious ADRs in 4.6% (18/392). The most frequent ADRs were infection and infestation (3.3%), with herpes zoster being the most common. ADRs were significantly higher in patients with concomitant corticosteroid use (odds ratio [OR], 3.45; 95% confidence interval [CI], 1.40–9.68). No significant difference in ADR incidence was observed between patients aged ≥65 and <65 years (OR, 1.23; 95% CI, 0.35–3.47). Six-week effectiveness of GLM was confirmed by a decrease in the partial Mayo score (–2.3; 95% CI, –2.6 to –2.1) and C-reactive protein levels (–0.64; 95% CI, –0.92 to –0.36), including in the biologics-experienced population.
Conclusions
The safety and effectiveness of GLM at week 6 in a real-world setting were demonstrated in patients with UC in Japan. ADR patterns were consistent with previous reports with no new safety signals. Concomitant corticosteroid use may be associated with increased ADR incidence. The final results of the ongoing PMS are necessary for further evaluation.

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Real-world effectiveness and safety of advanced therapies for the treatment of moderate-to-severe ulcerative colitis: Evidence from a systematic literature review
Peter M. Irving, Peter Hur, Raju Gautam, Xiang Guo, Severine Vermeire
Journal of Managed Care & Specialty Pharmacy.2024; 30(9): 1026. CrossRef
Reviewing not Homer’s Iliad, but “Kai Bao Ben Cao”: indigo dye—the past, present, and future
Yusuke Yoshimatsu, Tomohisa Sujino, Takanori Kanai
Intestinal Research.2023; 21(2): 174. CrossRef
Golimumab for Ulcerative Colitis: One More Option to SAVE the Colon
Sang Hyoung Park
Crohn's & Colitis 360.2023;[Epub] CrossRef
Advancements in the Management of Moderate-to-Severe Ulcerative Colitis: A Revised 2023 Korean Treatment Guidelines
Soo-Young Na
The Korean Journal of Medicine.2023; 98(5): 223. CrossRef
Pharmacogenetics-based personalized treatment in patients with inflammatory bowel disease: A review
Ji Young Chang, Jae Hee Cheon
Precision and Future Medicine.2021; 5(4): 151. CrossRef

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IBD

Evaluation of nutritional status using bioelectrical impedance analysis in patients with inflammatory bowel disease: Seung Hyuk Kim, You Sun Kim, Si Hyeong Lee, Hyun Mi Lee, Won Eui Yoon, Seo Hyun Kim, Hee Jun Myung, Jeong Seop Moon; Intest Res 2022;20(3):321-328. Published online July 20, 2021; DOI: https://doi.org/10.5217/ir.2021.00022

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Background/Aims
Nutritional status influences quality of life among patients with inflammatory bowel disease (IBD), although there is no clear method to evaluate nutritional status in this setting. Therefore, this study examined whether bioelectrical impedance analysis (BIA) could be used to evaluate the nutritional status of patients with IBD.
Methods
We retrospectively analyzed data from 139 Korean patients with IBD who were treated between November 2018 and November 2019. Patients were categorized as having active or inactive IBD based on the Harvey-Bradshaw index (a score of ≥5 indicates active Crohn’s disease) and the partial Mayo scoring index (a score of ≥2 indicates active ulcerative colitis). BIA results and serum nutritional markers were analyzed according to disease activity.
Results
The mean patient age was 45.11±17.71 years. The study included 47 patients with ulcerative colitis and 92 patients with Crohn’s disease. Relative to the group with active disease (n=72), the group with inactive disease (n=67) had significantly higher values for hemoglobin (P<0.001), total protein (P<0.001), and albumin (P<0.001). Furthermore, the group with inactive disease had higher BIA values for body moisture (P=0.047), muscle mass (P=0.046), skeletal muscle mass (P=0.042), body mass index (P=0.027), and mineral content (P=0.034). Moreover, the serum nutritional markers were positively correlated with the BIA results.
Conclusions
Nutritional markers evaluated using BIA were correlated with serum nutritional markers and inversely correlated with disease activity. Therefore, we suggest that BIA may be a useful tool that can help existing nutritional tests monitor the nutritional status of IBD patients.

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BODY FAT COMPOSITION IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES: A COMPARATIVE STUDY BETWEEN SKINFOLDS AND ULTRASONOGRAPHY
Isadora Sayuri Macedo TUMA, Maria Paula Carlin CAMBI, Thyago Proença de MORAES, Daniéla Oliveira MAGRO, Paulo Gustavo KOTZE
Arquivos de Gastroenterologia.2024;[Epub] CrossRef
Navigating the Intersection: Sarcopenia and Sarcopenic Obesity in Inflammatory Bowel Disease
Valentin Calvez, Guia Becherucci, Carlo Covello, Giulia Piccirilli, Irene Mignini, Giorgio Esposto, Lucrezia Laterza, Maria Elena Ainora, Franco Scaldaferri, Antonio Gasbarrini, Maria Assunta Zocco
Biomedicines.2024; 12(6): 1218. CrossRef
Association between inflammatory bowel disease and osteoporosis in European and East Asian populations: exploring causality, mediation by nutritional status, and shared genetic architecture
Jian Kang, Xize Wu, Yue Li, Shuangli Zhao, Shixuan Wang, Dongdong Yu
Frontiers in Immunology.2024;[Epub] CrossRef
Evaluation of Nutritional Characteristics Reveals Similar Prevalence of Malnutrition in Patients with Ulcerative Colitis and Crohn’s Disease
Arshdeep Singh, Vandana Midha, Ramit Mahajan, Shruti Verma, Chandan Kakkar, Jasmine Grover, Dharmatma Singh, Ramandeep Kaur, Abhishek Masih, Namita Bansal, Catherine Wall, Ajit Sood
Digestive Diseases and Sciences.2023; 68(2): 580. CrossRef
Response to Ustekinumab Therapy Is Associated with an Improvement of Nutritional Status in Patients with Crohn’s Disease
Lorenzo Bertani, Claudia D’Alessandro, Marco Fornili, Francesca Coppini, Federico Zanzi, Luca Carmisciano, Francesca Geri, Giovanni Baiano Svizzero, Emma Maria Rosi, Alice De Bernardi, Linda Ceccarelli, Maria Gloria Mumolo, Laura Baglietto, Massimo Bellin
Journal of Clinical Medicine.2023; 12(19): 6118. CrossRef
Clinical Implications of Dietary Probiotic Supplement (Associated with L-Glutamine and Biotin) in Ulcerative Colitis Patients’ Body Composition and Quality of Life
Flavia Maria Pavel, Simona Gabriela Bungau, Delia Mirela Tit, Timea Claudia Ghitea, Ruxandra Cristina Marin, Andrei-Flavius Radu, Radu Dumitru Moleriu, Tiberia Ilias, Cristian Bustea, Cosmin Mihai Vesa
Nutrients.2023; 15(24): 5049. CrossRef

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IBD

Risk factors for non-reaching of ileal pouch to the anus in laparoscopic restorative proctocolectomy with handsewn anastomosis for ulcerative colitis: Shigenobu Emoto, Keisuke Hata, Hiroaki Nozawa, Kazushige Kawai, Toshiaki Tanaka, Takeshi Nishikawa, Yasutaka Shuno, Kazuhito Sasaki, Manabu Kaneko, Koji Murono, Yuuki Iida, Hiroaki Ishii, Yuichiro Yokoyama, Hiroyuki Anzai, Hirofumi Sonoda, Soichiro Ishihara; Intest Res 2022;20(3):313-320. Published online March 12, 2021; DOI: https://doi.org/10.5217/ir.2020.00158

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Background/Aims
Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis and handsewn anastomosis for ulcerative colitis requires pulling down of the ileal pouch into the pelvis, which can be technically challenging. We examined risk factors for the pouch not reaching the anus.
Methods
Clinical records of 62 consecutive patients who were scheduled to undergo RPC with handsewn anastomosis at the University of Tokyo Hospital during 1989–2019 were reviewed. Risk factors for non-reaching were analyzed in patients in whom hand sewing was abandoned for stapled anastomosis because of nonreaching. Risk factors for non-reaching in laparoscopic RPC were separately analyzed. Anatomical indicators obtained from presurgical computed tomography (CT) were also evaluated.
Results
Thirty-seven of 62 cases underwent laparoscopic procedures. In 6 cases (9.7%), handsewn anastomosis was changed to stapled anastomosis because of non-reaching. Male sex and a laparoscopic approach were independent risk factors of non-reaching. Distance between the terminal of the superior mesenteric artery (SMA) ileal branch and the anus > 11 cm was a risk factor for non-reaching.
Conclusions
Laparoscopic RPC with handsewn anastomosis may limit extension and induction of the ileal pouch into the anus. Preoperative CT measurement from the terminal SMA to the anus may be useful for predicting non-reaching.

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Preoperative Simulation of Ileal Pouch–Anal Anastomosis in Patients With Ulcerative Colitis Using a 3-Dimensional Printed Model
Shota Yokose, Koji Murono, Hiroaki Nozawa, Kazuhito Sasaki, Shigenobu Emoto, Hiroyuki Matsuzaki, Yuichiro Yokoyama, Shinya Abe, Yuzo Nagai, Yuichiro Yoshioka, Takahide Shinagawa, Hirofumi Sonoda, Shin Murai, Koichi Komatsu, Soichiro Ishihara
Inflammatory Bowel Diseases.2023; 29(12): 1865. CrossRef
Preoperative Computed Tomography Indices Predict Non-reach Prior to Ileal Pouch-Anal Anastomosis
Evan D. Adams, Charlotte A Lansky, Cindy E. Kallman, Karen N. Zaghiyan, Phillip R. Fleshner
Diseases of the Colon & Rectum.2023;[Epub] CrossRef
Laparoscopic vs open restorative proctectomy after total abdominal colectomy for ulcerative colitis or familial adenomatous polyposis
Hiroaki Nozawa, Keisuke Hata, Kazuhito Sasaki, Koji Murono, Kazushige Kawai, Shigenobu Emoto, Soichiro Ishihara
Langenbeck's Archives of Surgery.2022; 407(4): 1605. CrossRef
Recent Advance in the Management of Dysplasia in the Ulcerative Colitis
Dong-Hoon Yang
Journal of Digestive Cancer Reports.2021; 9(2): 50. CrossRef

5,439 View
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IBD

Factors associated with anti-tumor necrosis factor effectiveness to prevent postoperative recurrence in Crohn’s disease: Anthony Buisson, Lisa Cannon, Konstantin Umanskiy, Roger D. Hurst, Neil H. Hyman, Atsushi Sakuraba, Joel Pekow, Sushila Dalal, Russell D. Cohen, Bruno Pereira, David T. Rubin; Intest Res 2022;20(3):303-312. Published online August 4, 2021; DOI: https://doi.org/10.5217/ir.2021.00018

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
We assessed the effectiveness of anti-TNF agents and its associated factors to prevent endoscopic and clinical postoperative recurrence (POR) in Crohn’s disease (CD).
Methods
From a prospectively-maintained database, we retrieved 316 CD patients who underwent intestinal resection (2011–2017). Endoscopic (Rutgeerts index ≥ i2 at 6 months) and clinical (recurrence of symptoms leading to hospitalization or therapeutic escalation) POR were assessed.
Results
In 117 anti-TNF-naïve patients, anti-TNF therapy was more effective than immunosuppressive agents (odds ratio [OR], 8.8; 95% confidence interval [CI], 1.8–43.9; P= 0.008) and no medication/5-aminosalicylates (OR, 5.2; 95% CI, 1.0–27.9; P= 0.05) to prevent endoscopic POR. In 199 patients exposed to anti-TNF prior to the surgery, combination with anti-TNF and immunosuppressive agents was more effective than anti-TNF monotherapy (OR, 2.32; 95% CI, 1.02–5.31; P= 0.046) to prevent endoscopic POR. Primary failure to anti-TNF agent prior to surgery was predictive of anti-TNF failure to prevent endoscopic POR (OR, 2.41; 95% CI, 1.10–5.32; P= 0.03). When endoscopic POR despite anti-TNF prophylactic medication (n = 55), optimizing anti-TNF and adding an immunosuppressive drug was the most effective option to prevent clinical POR (hazard ratio, 7.38; 95% CI, 1.54–35.30; P= 0.012). Anti-TNF therapy was the best option to prevent clinical POR (hazard ratio, 3.10; 95% CI, 1.09–8.83; P= 0.034) in patients with endoscopic POR who did not receive any biologic to prevent endoscopic POR (n = 55).
Conclusions
Anti-TNF was the most effective medication to prevent endoscopic and clinical POR. Combination with anti-TNF and immunosuppressive agents should be considered in patients previously exposed to anti-TNF.

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Ji Young Chang, Soo Jung Park, Jae Jun Park, Tae Il Kim, Jae Hee Cheon, Jihye Park
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Chak Lam Ip, Ray Boyapati, Rahul Kalla
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Volkan Doğru, Jean H. Ashburn, Umut Akova, Alton G. Sutter, Eren Esen, Emily M. Gardner, Andre da Luz Moreira, Arman Erkan, John Kirat, Michael J. Grieco, Feza H. Remzi
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Clinical Significance of Prognostic Nutrition Index in Patients with Crohn’s Disease after Primary Bowel Resection
Hyeon Woo Bae, Yong Joon Lee, Min Young Park, Seung Yoon Yang, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Kang Young Lee, Jae Hee Cheon, Joseph C. Carmichael, Byung Soh Min
Yonsei Medical Journal.2024; 65(7): 380. CrossRef
How Reliable Is Endoscopic Scoring of Postoperative Recurrence in Crohn Disease?: A Systematic Review and Meta-Analysis
Eline M. L. van der Does de Willebois, Vittoria Bellato, Marjolijn Duijvestein, Susan van Dieren, Silvio Danese, Pierpaolo Sileri, Christianne J. Buskens, Andrea Vignali, Willem A. Bemelman
Annals of Surgery Open.2024; 5(1): e397. CrossRef
Systematic review: Patient‐related, microbial, surgical, and histopathological risk factors for endoscopic post‐operative recurrence in patients with Crohn's disease
Michiel T. J. Bak, Karlijn Demers, Nassim Hammoudi, Matthieu Allez, Mark S. Silverberg, Gwenny M. Fuhler, Kaushal Parikh, Marieke J. Pierik, Laurents P. S. Stassen, C. Janneke van der Woude, Michail Doukas, Oddeke van Ruler, Annemarie C. de Vries
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Javier P. Gisbert, María Chaparro
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Preventing Recurrence of Crohn’s Disease Post-Ileocaecal Surgery in Paediatric Patients: A Therapy Guide Based on Systematic Review of the Evidence
Jiri Bronsky, Kristyna Zarubova, Michal Kubat, Vojtech Dotlacil
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Anti-TNF Agents and New Biological Agents (Vedolizumab and Ustekinumab) in the Prevention and Treatment of Postoperative Recurrence After Surgery in Crohn’s Disease
Javier P. Gisbert, María Chaparro
Drugs.2023; 83(13): 1179. CrossRef
Prevention of postoperative recurrence in Crohn’s disease: the never-ending story
Jung-Bin Park, Sang Hyoung Park
Intestinal Research.2022; 20(3): 279. CrossRef
Timing of individualized surgical intervention in Crohn’s disease
Kai Xia, Ren-Yuan Gao, Xiao-Cai Wu, Lu Yin, Chun-Qiu Chen
World Journal of Gastrointestinal Surgery.2022; 14(12): 1320. CrossRef

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Perspective

IBD

Endoscopy for assessment of mucosal healing in ulcerative colitis: time bound or response guided?: Ajit Sood, Ramit Mahajan, Arshdeep Singh, Vandana Midha, Varun Mehta; Intest Res 2022;20(3):297-302. Published online February 8, 2022; DOI: https://doi.org/10.5217/ir.2021.00099

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The timing of colonoscopy in patients with active ulcerative colitis (UC) lacks coherence. The published guidelines and recommendations advocate time-bound colonoscopy in patients with active UC to assess for mucosal healing. However, the practice of performing colonoscopies at fixed time frames lacks reasoning. The time to achieve mucosal healing in UC is not uniform across the patient populations and is influenced by the disease severity and efficacy and time to therapeutic response of the drugs being used. Additionally, with the availability of sensitive noninvasive inflammatory biomarkers such as fecal calprotectin, that parallel the disease activity and correlate with mucosal healing, the notion of performing colonoscopy at fixed intervals sounds unjustifiable. The authors express their view that a response-guided colonoscopy (driven by normalization of clinical symptoms and inflammatory biomarkers), rather than a time-bound colonoscopy, would be more logical, apart from being cost-effective and patient-friendly.

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Seung Bum Lee, Hyun-Ki Kim, Sang Hyuk Park, Ji-Hun Lim, Sang Hyoung Park
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Hyoun Woo Kang
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Hsu-Heng Yen, Jia-Feng Wu, Horng-Yuan Wang, Ting-An Chang, Chung-Hsin Chang, Chen-Wang Chang, Te-Hsin Chao, Jen-Wei Chou, Yenn-Hwei Chou, Chiao-Hsiung Chuang, Wen-Hung Hsu, Tzu-Chi Hsu, Tien-Yu Huang, Tsung-I Hung, Puo-Hsien Le, Chun-Che Lin, Chun-Chi Lin
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Ji Eun Kim, Minjee Kim, Min-Ji Kim, Eun Ran Kim, Sung Noh Hong, Dong Kyung Chang, Sang Yun Ha, Young-Ho Kim
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The Korean Journal of Gastroenterology.2022; 80(2): 85. CrossRef

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Reviews

IBD

Landscape of inflammatory bowel disease in Singapore: Daren Low, Nidhi Swarup, Toshiyuki Okada, Emiko Mizoguchi; Intest Res 2022;20(3):291-296. Published online January 7, 2022; DOI: https://doi.org/10.5217/ir.2021.00089

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Inflammatory bowel disease (IBD), primarily Crohn’s disease and ulcerative colitis, had been widely recognized to affect the Western population. However, the notable rise in prevalence of IBD in Asia, including Singapore, had garnered much attention to the causal role of the shift in trend, and more importantly, effective and safe management of the conditions of these groups of patients in terms of therapy, healthcare economics as well as patient well-being. This review presents a summary of the current landscape of IBD in Singapore, and discuss on areas that can be explored to improve and better understand the local condition, as prevalence continues to grow.

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Mariana Rodriguez Duran, Ghazala A. Datoo O’Keefe
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Oh Chan Kwon, Yuna Kim, Jaeyoung Chun, Kyungdo Han, Min-Chan Park, Ryul Kim, Jie-Hyun Kim, Young Hoon Youn, Hyojin Park
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You Sun Kim, Edward H. Hurley, Yoojeong Park, Sungjin Ko
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Yong Eun Park
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Yoo Jin Lee, Eun Soo Kim
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Cancer

Endoscopic diagnosis and treatment of early colorectal cancer: Seung Wook Hong, Jeong-Sik Byeon; Intest Res 2022;20(3):281-290. Published online July 26, 2022; DOI: https://doi.org/10.5217/ir.2021.00169

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Early colorectal cancer refers to cancer in the colorectum that is confined to the mucosa or submucosa and does not invade the muscularis propria, irrespective of lymph node or distant metastasis. As the number of persons undergoing screening colonoscopy increases, the proportion of patients diagnosed with precancerous colorectal lesions and early colorectal cancer also increases. In the last decade, innovative optical technologies for endoscopic diagnosis have been introduced and endoscopic treatment techniques such as endoscopic submucosal dissection have provided major breakthroughs in the management of early colorectal cancer. With these remarkable developments, endoscopic treatment has established itself as an alternative to surgical resection in the treatment of early colorectal cancer. This review will discuss the endoscopic diagnosis and treatment of early colorectal cancer. Furthermore, the unmet needs in this field and the latest research addressing those issues will be summarized.

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Andrea Cassinotti, Marco Parravicini, Thomas P. Chapman, Marco Balzarini, Lorenzo Canova, Simone Segato, Valentina Zadro, Simon Travis, Sergio Segato
Therapeutic Advances in Gastroenterology.2023;[Epub] CrossRef
Prediction of disease recurrence or residual disease after primary endoscopic resection of pT1 colorectal cancer—results from a large nationwide Danish study
Ilze Ose, Katarina Levic, Lau Caspar Thygesen, Orhan Bulut, Thue Bisgaard, Ismail Gögenur, Tine Plato Kuhlmann
International Journal of Colorectal Disease.2023;[Epub] CrossRef

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Editorial

IBD

Prevention of postoperative recurrence in Crohn’s disease: the never-ending story: Jung-Bin Park, Sang Hyoung Park; Intest Res 2022;20(3):279-280. Published online July 26, 2022; DOI: https://doi.org/10.5217/ir.2022.00081

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Case Report

Miscellaneous

Endoscopic balloon dilations for strictures of rectum, ileocecal valve and duodenum in a patient with X-linked inhibitor of apoptosis deficiency: a case report: Shinsuke Otagiri, Takehiko Katsurada, Kensuke Sakurai, Junichi Sugita, Naoya Sakamoto; Intest Res 2022;20(2):274-277. Published online February 8, 2022; DOI: https://doi.org/10.5217/ir.2021.00029

Abstract PDF PubReader ePub: X-linked inhibitor of apoptosis (XIAP) deficiency is a rare primary immunodeficiency and gastrointestinal (GI) lesions in XIAP deficiency are similar to Crohn’s disease. For patients with Crohn’s disease, endoscopic balloon dilation (EBD) is known to be a standard procedure for intestinal strictures including upper GI tract. However, there are no articles which mention the efficacy of EBDs for the strictures in upper GI tract in patients with XIAP deficiency. Herein, we describe an 18-year-old male with XIAP deficiency in whom EBDs for the rectum, ileocecal valve (ICV), and duodenum were performed. Before hematopoietic stem cell transplantation (HSCT), GI endoscopy revealed strictures of the rectum, ICV and duodenum with active ulcers. Although these ulcers healed after HSCT, the strictures progressed. Therefore, we performed EBDs for the strictures of the rectum, ICV, and duodenum. In contrast studies, we did not find any other strictures in the small intestine. Throughout the patient’s clinical course, no complications of EBD occurred. He started eating after EBDs, but abdominal symptoms did not relapse without any dietary restrictions. Our case suggests that EBD could be an effective and safe procedure for intestinal strictures including upper GI tract after HSCT in patients with XIAP deficiency.

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Brief Communication

IBD

Correlation of fecal calprotectin and patient-reported outcome measures in patients with ulcerative colitis: Nagesh Kamat, Sudheer K Vuyyuru, Saurabh Kedia, Pabitra Sahu, Bhaskar Kante, Peeyush Kumar, Mukesh Kumar Ranjan, Mukesh Kumar Singh, Sambuddha Kumar, Vikas Sachdev, Govind Makharia, Vineet Ahuja; Intest Res 2022;20(2):269-273. Published online February 8, 2022; DOI: https://doi.org/10.5217/ir.2021.00064

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Depression and active disease are the major risk factors for fatigue and sleep disturbance in inflammatory bowel disease with consequent poor quality of life: Analysis of the interplay between psychosocial factors from the developing world
Partha Pal, Rupa Banerjee, Polina Vijayalaxmi, D. Nageshwar Reddy, Manu Tandan
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Current and emerging biomarkers for ulcerative colitis
Jan K. Nowak, Rahul Kalla, Jack Satsangi
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Original Articles

IBD

One-year clinical efficacy and safety of indigo naturalis for active ulcerative colitis: a real-world prospective study: Yuichi Matsuno, Takehiro Torisu, Junji Umeno, Hiroki Shibata, Atsushi Hirano, Yuta Fuyuno, Yasuharu Okamoto, Shin Fujioka, Keisuke Kawasaki, Tomohiko Moriyama, Tomohiro Nagasue, Keizo Zeze, Yoichiro Hirakawa, Shinichiro Kawatoko, Yutaka Koga, Yoshinao Oda, Motohiro Esaki, Takanari Kitazono; Intest Res 2022;20(2):260-268. Published online April 29, 2022; DOI: https://doi.org/10.5217/ir.2021.00124

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Background/Aims
Recent studies suggested a favorable effect of indigo naturalis (IN) in inducing remission for refractory ulcerative colitis (UC), however, the maintenance effect of IN for patients with UC remains unknown. Therefore, we conducted a prospective uncontrolled open-label study to analyze the efficacy and safety of IN for patients with UC.
Methods
Patients with moderate to severe active UC (clinical activity index [CAI] ≥ 8) took 2 g/day of IN for 52 weeks. CAI at weeks 0, 4, 8, and 52 and Mayo endoscopic subscore (MES) and Geboes score (GS) at weeks 0, 4, and 52 were assessed. Clinical remission (CAI ≤ 4), mucosal healing (MES ≤ 1), and histological healing (GS ≤ 1) rates at each assessment were evaluated. Overall adverse events (AEs) during study period were also evaluated. The impact of IN on mucosal microbial composition was assessed using 16S ribosomal RNA gene sequences.
Results
Thirty-three patients were enrolled. The rates of clinical remission at weeks 4, 8, and 52 were 67%, 76%, and 73%, respectively. The rates of mucosal healing at weeks 4 and 52 were 48% and 70%, respectively. AEs occurred in 17 patients (51.5%) during follow-up. Four patients (12.1%) showed severe AEs, among whom 3 manifested acute colitis. No significant alteration in the mucosal microbial composition was observed with IN treatment.
Conclusions
One-year treatment of moderate to severe UC with IN was effective. IN might be a promising therapeutic option for maintaining remission in UC, although the relatively high rate of AEs should be considered.

Citations

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Indigo naturalis (Qing dai) for inflammatory bowel disease: A systematic review and meta-analysis
Rinkalben Kakdiya, Daya Krishna Jha, Arup Choudhury, Anuraag Jena, Vishal Sharma
Clinics and Research in Hepatology and Gastroenterology.2024; 48(1): 102250. CrossRef
Reply to “Ferroptosis in the colon epithelial cells as a therapeutic target for ulcerative colitis”
Akihito Yokote, Noriyuki Imazu, Junji Umeno, Keisuke Kawasaki, Shin Fujioka, Yuta Fuyuno, Yuichi Matsuno, Tomohiko Moriyama, Kohta Miyawaki, Koichi Akashi, Takanari Kitazono, Takehiro Torisu
Journal of Gastroenterology.2024; 59(1): 77. CrossRef
Risk of Infection in Patients With Inflammatory Bowel Disease Treated With Interleukin-Targeting Agents: A Systematic Review and Meta-Analysis
Konstantinos Ouranos, Hira Saleem, Stephanos Vassilopoulos, Athanasios Vassilopoulos, Evangelia K Mylona, Fadi Shehadeh, Markos Kalligeros, Bincy P Abraham, Eleftherios Mylonakis
Inflammatory Bowel Diseases.2024;[Epub] CrossRef
Herbal Medicines for the Treatment of Active Ulcerative Colitis: A Systematic Review and Meta-Analysis
Preetha Iyengar, Gala Godoy-Brewer, Isha Maniyar, Jacob White, Laura Maas, Alyssa M. Parian, Berkeley Limketkai
Nutrients.2024; 16(7): 934. CrossRef
Clinical Efficacy and Future Application of Indigo Naturalis in the Treatment of Ulcerative colitis
Dianzhen Wu, Qi Huang, Yingbi Xu, Ruiyi Cao, Ming Yang, Jin Xie, Dingkun Zhang
Journal of Ethnopharmacology.2024; : 118782. CrossRef
Ferroptosis in the colon epithelial cells as a therapeutic target for ulcerative colitis
Akihito Yokote, Noriyuki Imazu, Junji Umeno, Keisuke Kawasaki, Shin Fujioka, Yuta Fuyuno, Yuichi Matsuno, Tomohiko Moriyama, Kohta Miyawaki, Koichi Akashi, Takanari Kitazono, Takehiro Torisu
Journal of Gastroenterology.2023; 58(9): 868. CrossRef
Hyaluronic acid/inulin-based nanocrystals with an optimized ratio of indigo and indirubin for combined ulcerative colitis therapy via immune and intestinal flora regulation
Jin Xie, Qi Huang, Huijuan Xie, Jun Liu, Shimin Tian, Ruiyi Cao, Ming Yang, Junzhi Lin, Li Han, Dingkun Zhang
International Journal of Biological Macromolecules.2023; 252: 126502. CrossRef
High-Quality Indigo Naturalis Obtained with Automatic Foam Separation
Xin Yang, Jun Tang, Juan Su, Xin Yang, Ming Yang, Xiangbo Yang, Qisen Ji, Yanan He, Li Han, Dingkun Zhang
ACS Applied Materials & Interfaces.2023; 15(37): 43272. CrossRef

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IBD

Fecal microbiota transplantation for induction of remission, maintenance and rescue in patients with corticosteroid-dependent ulcerative colitis: a long-term follow-up real-world cohort study: Avnish Kumar Seth, Priti Jain; Intest Res 2022;20(2):251-259. Published online February 8, 2022; DOI: https://doi.org/10.5217/ir.2021.00069

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Background/Aims
To study role of fecal microbiota transplantation (FMT) in induction, maintenance, and rescue in patients with corticosteroid-dependent ulcerative colitis (CDUC).
Methods
Patients with active CDUC received 3 fortnightly sessions of colonoscopic induction FMT (iFMT) in addition to standard of care. In patients who achieved clinical remission (CR) or response, prednisolone was tapered from week 4 and azathioprine from week 12. Responders were advised maintenance FMT (mFMT) every 6 months. Those with relapse were offered rescue FMT (rFMT), and low dose prednisolone was added if there was no improvement in 2 weeks.
Results
All 27 patients enrolled completed iFMT and were followed up for 39 months (range, 9–71 months). The mean Mayo score decreased from 6.4±2.5 at baseline to 2.6±3.7 at week 4, 2.6±3.4 at week 12, and 2.8±3.8 at week 24 (P<0.05). Corticosteroid-free CR and clinical response at week 12 were seen in 13 patients (48%) and 1 patient (3.7%), respectively. Corticosteroid and azathioprine-free CR at week 24 was seen in 13 patients (48%) and in them histological response was seen in 2 patients (15.2%) at week 4, 5 patients (38.4%) at week 12, and 10 patients (76.9%) at week 24. First relapse was seen in 10 of 13 responders (76.9%) at a median of 14.8 months (range, 6–34 months) after iFMT and was less frequent in patients on mFMT. Relapse was treated successfully with rFMT alone in 4 patients (40%) and rFMT with low dose steroids in 5 patients (50%).
Conclusions
iFMT, mFMT, and rFMT may have a role in treatment of selected patients with CDUC.

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Umang Arora, Saurabh Kedia, Vineet Ahuja
Intestinal Research.2024; 22(1): 44. CrossRef
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Malik Kasapoglu, Rajesh Yadavalli, Sarosh Nawaz, Abdulaziz Althwanay, Esraa M AlEdani, Harleen Kaur, Samia Butt
Cureus.2024;[Epub] CrossRef
Fecal microbiota transplantation: Applications and challenges in India
Suranjana Banik, Balamurugan Ramadass
Gastroenterology, Hepatology and Endoscopy Practice.2023; 3(2): 44. CrossRef
Single-Donor and Pooling Strategies for Fecal Microbiota Transfer Product Preparation in Ulcerative Colitis: Systematic Review and Meta-Analysis
Benoît Levast, Mathieu Fontaine, Stéphane Nancey, Pierre Dechelotte, Joël Doré, Philippe Lehert
Clinical and Translational Gastroenterology.2023;[Epub] CrossRef
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Yu Kyung Jun, Da-Ae Yu, Yoo Min Han, Soo Ran Lee, Seong-Joon Koh, Hyunsun Park
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Faecal microbiota transplantation with anti-inflammatory diet (FMT-AID) followed by anti-inflammatory diet alone is effective in inducing and maintaining remission over 1 year in mild to moderate ulcerative colitis: a randomised controlled trial
Saurabh Kedia, Shubi Virmani, Sudheer K Vuyyuru, Peeyush Kumar, Bhaskar Kante, Pabitra Sahu, Kanav Kaushal, Mariyam Farooqui, Mukesh Singh, Mahak Verma, Aditya Bajaj, Manasvini Markandey, Karan Sachdeva, Prasenjit Das, Govind K Makharia, Vineet Ahuja
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IBD

Vedolizumab for perianal fistulizing Crohn’s disease: systematic review and meta-analysis: Fares Ayoub, Matthew Odenwald, Dejan Micic, Sushila R. Dalal, Joel Pekow, Russell D. Cohen, David T. Rubin, Atsushi Sakuraba; Intest Res 2022;20(2):240-250. Published online February 8, 2022; DOI: https://doi.org/10.5217/ir.2021.00091

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Background/Aims
Perianal fistulas are a debilitating manifestation of Crohn’s disease (CD). Despite the advent of anti-tumor necrosis factor (anti-TNF) therapy, the medical management of fistulizing CD continues to be challenged by unmet needs. We conducted a systematic review and meta-analysis of the effectiveness of vedolizumab for the management of perianal fistulizing CD.
Methods
A search of PubMed, EMBASE and the Cochrane Library was performed from inception to June 2020 for studies reporting rates of perianal fistula healing in CD patients treated with vedolizumab. The primary outcome of interest was complete healing of perianal fistulas and the secondary outcome was partial healing. The pooled fistula healing rates with 95% confidence intervals (CI) were calculated utilizing a random effects model.
Results
A total of 74 studies were initially identified, 4 of which met the inclusion criteria. A total of 198 patients with active perianal fistulas were included, 87% of whom had failed previous anti-TNF therapy. The pooled complete healing rate was 27.6% (95% CI, 18.9%–37.3%) with moderate heterogeneity (I2=49.4%) and the pooled partial healing rate was 34.9% (95% CI, 23.2%–47.7%) with high heterogeneity (I2=67.1%).
Conclusions
In a meta-analysis of 4 studies that included 198 patients with perianal fistulizing CD, the majority of whom had failed previous anti-TNF therapy, vedolizumab treatment led to healing of perianal fistulas in nearly one-third of the patients. The lack of high-quality data and significant study heterogeneity underscores the need for future prospective studies of fistula healing in patients receiving anti-integrin therapy.

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Arshdeep Singh, Vandana Midha, Gursimran Singh Kochhar, Bo Shen, Ajit Sood
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Indian Journal of Gastroenterology.2024; 43(1): 48. CrossRef
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Emily Rinebold, Alex L. Huang, Sue J. Hahn
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Vineet Ahuja, Ida Hilmi, Byong Duk Ye, Khoon Lin Ling, Siew C. Ng, Rupert W. Leong, Peeyush Kumar, Xin Hui Khoo, Govind K. Makharia, Jose Sollano, Pises Pisespongsa, Nazri Mustaffa, Rupa Banerjee, Alex Hwong‐Ruey Leow, Raja Affendi Raja Ali, Sai Wei Chuah
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Mohammad Shehab, Davide De Marco, Peter L. Lakatos, Talat Bessissow
Expert Opinion on Biological Therapy.2024; 24(8): 733. CrossRef
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Klaudia Farkas, Hajnal Székely, Péter Bacsur, Balázs Bánky, Zsuzsa Bianka Élthes, László Harsányi, Katalin Edit Müllner, Ágnes Milassin, Károly Palatka, Patrícia Sarlós, Tamás Szamosi, Tamás Molnár, Pál Miheller
Orvosi Hetilap.2024; 165(Supplement): 1. CrossRef
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Bernadett Farkas, Péter Bacsur, Emese Ivány, Anita Bálint, Mariann Rutka, Klaudia Farkas, Tamás Molnár
Orvosi Hetilap.2024; 165(32): 1252. CrossRef
Choosing Therapy for Moderate to Severe Crohn’s Disease
Malcolm Irani, Bincy Abraham
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Is There a Best First Line Biological/Small Molecule in IBD: Are We Ready for Sequencing?
Gustavo Drügg Hahn, Petra Anna Golovics, Panu Wetwittayakhlang, Alex Al Khoury, Talat Bessissow, Peter Laszlo Lakatos
Biomedicines.2022; 10(4): 749. CrossRef
The Optimal Management of Fistulizing Crohn’s Disease: Evidence beyond Randomized Clinical Trials
Panu Wetwittayakhlang, Alex Al Khoury, Gustavo Drügg Hahn, Peter Laszlo Lakatos
Journal of Clinical Medicine.2022; 11(11): 3045. CrossRef
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Jan Marsal, Manuel Barreiro-de Acosta, Irina Blumenstein, Maria Cappello, Thomas Bazin, Shaji Sebastian
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