Intestinal Research

Volume 16(4); October 2018

Editorial

IBD

Home-based fecal calprotectin test is expected to play an important role in patients with inflammatory bowel diseases: Young-Ho Kim; Intest Res 2018;16(4):507-508. Published online October 25, 2018; DOI: https://doi.org/10.5217/ir.2018.00136

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Citations

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Fecal calprotectin levels in COVID-19: Lessons from a systematic review on its use in inflammatory bowel disease during the pandemic
Anuraag Jena, Praveen Kumar-M, Anupam Kumar Singh, Vishal Sharma
Digestive and Liver Disease.2021; 53(3): 295. CrossRef

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Review

IBD

Optimizing the multidimensional aspects of the patient-physician relationship in the management of inflammatory bowel disease: Deborah Chew, Wong Zhiqin, Norhayati Ibrahim, Raja Affendi Raja Ali; Intest Res 2018;16(4):509-521. Published online October 25, 2018; DOI: https://doi.org/10.5217/ir.2018.00074

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The patient-physician relationship has a pivotal impact on the inflammatory bowel disease (IBD) outcomes. However, there are many challenges in the patient-physician relationship; lag time in diagnosis which results in frustration and an anchoring bias against the treating gastroenterologist, the widespread availability of medical information on the internet has resulted in patients having their own ideas of treatment, which may be incongruent from the treating physicians’ goals resulting in patient physician discordance. Because IBD is an incurable disease, the goal of treatment is to sustain remission. To achieve this, patients may have to go through several lines of treatment. The period of receiving stepping up, top down or even accelerated stepping up medications may result in a lot of frustration and anxiety for the patient and may compromise the patient-physician relationship. IBD patients are also prone to psychological distress that further compromises the patient-physician relationship. Despite numerous published data regarding the medical and surgical treatment options available for IBD, there is a lack of data regarding methods to improve the therapeutic patient-physician relationship. In this review article, we aim to encapsulate the challenges faced in the patient-physician relationship and ways to overcome in for an improved outcome in IBD.

Citations

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Personalize, participate, predict, and prevent: 4Ps in inflammatory bowel disease
Marco Vincenzo Lenti, Maria Lia Scribano, Livia Biancone, Rachele Ciccocioppo, Daniela Pugliese, Luca Pastorelli, Gionata Fiorino, Edoardo Savarino, Flavio Andrea Caprioli, Sandro Ardizzone, Massimo Claudio Fantini, Gian Eugenio Tontini, Ambrogio Orlando,
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Notable gaps between patients’ and physicians’ perspectives on communication and disease management in Japan: multifaceted ad hoc analyses of the global Ulcerative Colitis Narrative Survey for further optimal care
Kenji Watanabe, Sean Gardiner, Shoko Arai
Therapeutic Advances in Gastroenterology.2022;[Epub] CrossRef
Ulcerative Colitis Narrative Global Survey Findings: The Impact of Living With Ulcerative Colitis—Patients’ and Physicians’ View
Marla C Dubinsky, Kenji Watanabe, Pauliina Molander, Laurent Peyrin-Biroulet, Michele Rubin, Gil Y Melmed, J Jasper Deuring, John Woolcott, Joseph C Cappelleri, Kathy Steinberg, Susan Connor
Inflammatory Bowel Diseases.2021; 27(11): 1747. CrossRef
Physician–patient communication affects patient satisfaction in treatment decision-making: a structural equation modelling analysis of a web-based survey in patients with ulcerative colitis
Katsuyoshi Matsuoka, Hirono Ishikawa, Takeo Nakayama, Yusuke Honzawa, Atsuo Maemoto, Fumihito Hirai, Fumiaki Ueno, Noriko Sato, Yutaka Susuta, Toshifumi Hibi
Journal of Gastroenterology.2021; 56(9): 843. CrossRef

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Statement

IBD

Consensus recommendations for patient-centered therapy in mild-to-moderate ulcerative colitis: the i Support Therapy–Access to Rapid Treatment (iSTART) approach: Silvio Danese, Rupa Banerjee, JR Fraser Cummings, Iris Dotan, Paulo G Kotze, Rupert Wing Loong Leong, Kristine Paridaens, Laurent Peyrin-Biroulet, Glyn Scott, Gert Van Assche, Jan Wehkamp, Jesús K Yamamoto-Furusho; Intest Res 2018;16(4):522-528. Published online October 16, 2018; DOI: https://doi.org/10.5217/ir.2018.00073

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Symptomatic ulcerative colitis (UC) can be a chronic, disabling condition. Flares in disease activity are associated with many of the negative impacts of mild-to-moderate UC. Rapid resolution of flares can provide benefits to patients and healthcare systems. i Support Therapy–Access to Rapid Treatment (iSTART) introduces patient-centered care for mild-to-moderate UC. iSTART provides patients with the ability to self-assess symptomology and self-start a short course of second-line treatment when necessary. An international panel of experts produced consensus statements and recommendations. These were informed by evidence from systematic reviews on the epidemiology, mesalazine (5-ASA) treatment, and patient use criteria for second-line therapy in UC. Optimized 5-ASA is the first-line treatment in all clinical guidelines, but may not be sufficient to induce remission in all patients. Corticosteroids should be prescribed as second-line therapy when needed, with budesonide MMX® being a preferred steroid option. Active involvement of suitable patients in management of UC flares has the potential to improve therapy, with patients able to show good accuracy for flare self-assessment using validated tools. There is a place in the UC treatment pathway for an approach such as iSTART, which has the potential to provide patient, clinical and economic benefits.

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Sodium orthovanadate protects against ulcerative colitis and associated liver damage in mice: insights into modulations of Nrf2/Keap1 and NF-κB pathways
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Original Articles

Microbiota

Development and diversity of lactic acid producing bacteria and bifidobacteria in healthy full term Indian infants from Himachal Pradesh: Sampan Attri, Rishi Mahajan, Gunjan Goel; Intest Res 2018;16(4):529-536. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00050

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Background/Aims
The initial microbial colonization is a crucial step for the healthy development of an infant. Previous studies from India reported the dominance of target microbial species among Indian infants without any analysis on the diversity of target groups. This is the first study from India with an objective to investigate the establishment and diversity of lactic acid producing bacteria (LAB) and bifidobacteria in vaginally delivered, full term, breastfed infants for the first 4 months after birth.
Methods
Present study used polymerase chain reaction-denaturating gradient gel electrophoresis (PCR-DGGE) based sequence analysis of LAB and bifidobacteria in healthy infants. The results were used to compare the development and early colonization by LAB and bifidobacteria using diversity indices during the initial months of development of gut microbiota in infants.
Results
During the first 4 months, the Shannon diversity index (H) of LAB increased from 1.16 to 1.318 and for bifidobacteria the H increased from 0.975 to 1.293 (P<0.05). Higher Sorenson’s pair wise similarity coefficient was observed for LAB and bifidobacteria during 2nd and the 3rd month. The species of the genera Enterococcus, Streptococcus, and Lactobacillus were dominant among the LAB group whereas Bifidobacterium breve was dominant species among Bifidobacterium group.
Conclusions
Our results indicate that in breast fed infants, the microbial diversity of LAB and bifidobacteria increased during the period of study.

Citations

Citations to this article as recorded by

Development and Functions of the Infant Gut Microflora: Westernvs. Indian Infants
Lalit Bharadia, Neha Agrawal, Nandan Joshi
International Journal of Pediatrics.2020; 2020: 1. CrossRef

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IBD

IBD2020 global forum: results of an international patient survey on quality of care: Peter Irving, Johan Burisch, Richard Driscoll, Mats Olsson, John R Fullarton, Barry S Rodgers-Gray, Simon PL Travis; Intest Res 2018;16(4):537-545. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00041

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Background/Aims
IBD2020 is a global forum for standards of care in inflammatory bowel disease (IBD). The aim of the IBD2020 survey was to identify and describe variations in quality care of IBD.
Methods
Patients with IBD from Finland, Italy, France, Canada, Germany, UK, Spain and Sweden were surveyed during 2013 to 2014, covering: disease characteristics; impact on life and work; organization and perceived quality of care.
Results
Seven thousand five hundred and seven patients participated (median age, 39 years [range, 10–103 years]; 2,354 male [31.4%]), including 4,097 (54.6%) with Crohn’s disease (CD) and 3,410 (45.4%) with ulcerative colitis (UC). Median time from symptom onset to diagnosis was 1 year for both CD (range, 0–47 years) and UC (range, 0–46 years), with no clear evidence of improvement in diagnostic delay over the preceding 24 years. Half of the patients (3,429; 50.0%) rated their care as “excellent” or “very good,” with similar results for CD and UC across countries. Five factors were significantly (P<0.01) associated with perceived good quality of care: quality of specialist communication; review consultation being long enough; failure to share information; no access to a dietician; speed of advice.
Conclusions
The IBD2020 survey has highlighted areas related to quality of care of IBD from the patients’ perspective, with scope for improvement.

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IBD

Experience of patients with inflammatory bowel disease in using a home fecal calprotectin test as an objective reported outcome for self-monitoring: Shu-Chen Wei, Chien-Chih Tung, Meng-Tzu Weng, Jau-Min Wong; Intest Res 2018;16(4):546-553. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00052

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Background/Aims
Fecal calprotectin (fC) level is a predictive marker of mucosal healing for patients with inflammatory bowel disease (IBD). Home fC tests are now available. We evaluated the performance of the smartphone-based IBDoc home testing system in patients with IBD and obtained their feedback as an objective patient-reported outcome.
Methods
This prospective study enrolled consecutive patients with IBD in clinical remission. fC in the same stool sample was assessed by using both the laboratory test (Quantum Blue calprotectin test) and home test (IBDoc). The correlation between the 2 tests was analyzed using the Pearson method. In addition, the patients were asked to fill a questionnaire based on their experience.
Results
Fifty-one patients with IBD (68 tests and 49 questionnaires) were included. The correlation between Quantum Blue test and IBDoc was good (r=0.776, P<0.0001). After the test, 56% patients found IBDoc easy to perform, and 96% were satisfied with it. Thirty-nine patients (80%) had a strong (>70%) probability to use it for future monitoring if the price was acceptable. By using 250 μg/g as the cutoff, the agreement between home test and laboratory results was 80%, and by using 600 μg/g as the cutoff, the agreement increased to 92%.
Conclusions
The correlation between the laboratory and home tests was good. Most patients found the home test to be feasible and easy to use and preferred it over laboratory test and endoscopy for monitoring. Therefore, the home test could be used as an objective patient-reported outcome.

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Calprotectin in inflammatory bowel disease
Fatemeh Khaki-Khatibi, Durdi Qujeq, Mehrdad Kashifard, Soheila Moein, Mahmood Maniati, Mostafa Vaghari-Tabari
Clinica Chimica Acta.2020; 510: 556. CrossRef
Remote Monitoring Empowerment of Patients with IBDs during the SARS-CoV-2 Pandemic
Mauro Mastronardi, Margherita Curlo, Maurizio Polignano, Natalino Vena, Daniela Rossi, Gianluigi Giannelli
Healthcare.2020; 8(4): 377. CrossRef
Usability of IBDoc, a Novel Fecal Calprotectin Home-Based Rapid Test in Clinical Practice
Mia Jülke Røer, Milada Cvancarova Småstuen, Arne Gustav Røseth
Point of Care: The Journal of Near-Patient Testing & Technology.2019; 18(3): 85. CrossRef
Home-based fecal calprotectin test is expected to play an important role in patients with inflammatory bowel diseases
Young-Ho Kim
Intestinal Research.2018; 16(4): 507. CrossRef

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IBD

Usefulness of fecal calprotectin by monoclonal antibody testing in adult Japanese with inflammatory bowel diseases: a prospective multicenter study: Shiro Nakamura, Hirotsugu Imaeda, Hiroki Nishikawa, Masaki Iimuro, Minoru Matsuura, Hideo Oka, Junsuke Oku, Takako Miyazaki, Hirohito Honda, Kenji Watanabe, Hiroshi Nakase, Akira Andoh; Intest Res 2018;16(4):554-562. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00027

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Background/Aims
Noninvasive objective monitoring is advantageous for optimizing treatment strategies in patients inflammatory bowel disease (IBD). Fecal calprotectin (FCP) is superior to traditional biomarkers in terms of assessing the activity in patients with IBD. However, there are the differences among several FCP assays in the dynamics of FCP. In this prospective multicenter trial, we investigated the usefulness of fecal FCP measurements in adult Japanese patients with IBD by reliable enzyme immunoassay using a monoclonal antibody.
Methods
We assessed the relationship between FCP levels and disease or endoscopic activity in patients with ulcerative colitis (UC, n=64) or Crohn’s disease (CD, n=46) compared with healthy controls (HCs, n=64).
Results
FCP levels in UC patients strongly correlated with the Disease Activity Index (rs=0.676, P<0.0001) and Mayo endoscopic subscore (MES; rs=0.677, P<0.0001). FCP levels were significantly higher even in patients with inactive UC or CD compared with HCs (P=0.0068, P<0.0001). The optimal cutoff value between MES 1 and 2 exhibited higher sensitivity (94.1%). FCP levels were significantly higher in active UC patients than in inactive patients (P<0.001), except those with proctitis. The Crohn’s Disease Activity Index tended to correlate with the FCP level (rs=0.283, P=0.0565).
Conclusions
Our testing method using a monoclonal antibody for FCP was well-validated and differentiated IBD patients from HCs. FCP may be a useful biomarker for objective assessment of disease activity in adult Japanese IBD patients, especially those with UC.

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Treatment escalation and de-escalation decisions in Crohn’s disease: Delphi consensus recommendations from Japan, 2021
Hiroshi Nakase, Motohiro Esaki, Fumihito Hirai, Taku Kobayashi, Katsuyoshi Matsuoka, Minoru Matsuura, Makoto Naganuma, Masayuki Saruta, Kiichiro Tsuchiya, Motoi Uchino, Kenji Watanabe, Tadakazu Hisamatsu, Akira Andoh, Shigeki Bamba, Motohiro Esaki, Mikihi
Journal of Gastroenterology.2023; 58(4): 313. CrossRef
Mucosal concentrations of N‐acetyl‐5‐aminosalicylic acid related to endoscopic activity in ulcerative colitis patients with mesalamine
Tomohiro Fukuda, Makoto Naganuma, Kaoru Takabayashi, Yuya Hagihara, Shun Tanemoto, Ena Nomura, Yusuke Yoshimatsu, Shinya Sugimoto, Kosaku Nanki, Shinta Mizuno, Yohei Mikami, Kayoko Fukuhara, Tomohisa Sujino, Makoto Mutaguchi, Nagamu Inoue, Haruhiko Ogata,
Journal of Gastroenterology and Hepatology.2020; 35(11): 1878. CrossRef
Clinical management for small bowel of Crohn’s disease in the treat-to-target era: now is the time to optimize treatment based on the dominant lesion
Kenji Watanabe
Intestinal Research.2020; 18(4): 347. CrossRef

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IBD

Usefulness of fecal immunochemical test and fecal calprotectin for detection of active ulcerative colitis: Dong Ju Kim, Yoon Mi Jeoun, Dong-won Lee, Ja Seol Koo, Sang Woo Lee; Intest Res 2018;16(4):563-570. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00020

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Background/Aims
Ulcerative colitis undergoes periods of exacerbation and remission. Fecal calprotectin levels increase with gut inflammation and correlate with endoscopic disease activity in ulcerative colitis. Intestinal blood loss and fecal immunochemical test levels also correlate with endoscopic disease activity. This study statistically evaluated the usefulness of fecal calprotectin, fecal immunochemical test, and C-reactive protein (CRP) as markers of disease activity.
Methods
A total 106 ulcerative colitis patients who underwent endoscopy and fecal calprotectin, fecal immunochemical test, and CRP testing, from March 2015 to August 2016, were retrospectively reviewed. Disease activity was assessed using a partial Mayo score and Mayo endoscopic score. The ability of fecal and serologic tests to reflect endoscopic disease severity was statistically evaluated.
Results
Among 106 patients, 68 underwent endoscopy and stool study within 2 weeks. In patients with mild to severe activity, fecal immunochemical test and fecal calprotectin were superior to CRP at Mayo endoscopic score detection rate. The area under the curves of fecal immunochemical test and fecal calprotectin for the detection of Mayo endoscopic score ≥1 were 0.956 and 0.942, respectively, and were superior to that of CRP (0.756). At Mayo endoscopic score, the effects of combination of fecal immunochemical test and CRP or fecal calprotectin and CRP were found to be higher than those of the independent fecal immunochemical test or fecal calprotectin.
Conclusions
Fecal immunochemical test and fecal calprotectin can effectively detect active ulcerative colitis better than remission. As these markers reflect the status of mucosal inflammation, they may reduce the requirement for invasive endoscopic examination.

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Histologic features and predicting prognosis in ulcerative colitis patients with mild endoscopic activity
Seung Yong Shin, Hee Sung Kim, Kisung Kim, Chang Won Choi, Jung Min Moon, Jeong Wook Kim, Hyun Jin Joo, Jeongkuk Seo, Muhyeon Sung, Chang Hwan Choi
The Korean Journal of Internal Medicine.2024; 39(1): 68. CrossRef
Prostaglandin E‐major urinary metabolite diagnoses mucosal healing in patients with ulcerative colitis in remission phase
Toshiyuki Sakurai, Yoshihiro Akita, Haruna Miyashita, Ryosuke Miyazaki, Yuki Maruyama, Tomoko Saito, Mariko Shimada, Takuji Yamasaki, Seiji Arhihiro, Tomohiro Kato, Tomokazu Matsuura, Masahiro Ikegami, Isao Okayasu, Masayuki Saruta
Journal of Gastroenterology and Hepatology.2022; 37(5): 847. CrossRef
Alternative diagnoses and demographics associated with a raised quantitative faecal immunochemical test in symptomatic patients
Mark S Johnstone, Gillian Miller, Grace Pang, Paul Burton, Georgios Kourounis, Jack Winter, Emilia Crighton, David Mansouri, Paul Witherspoon, Karen Smith, Stephen T McSorley
Annals of Clinical Biochemistry: International Journal of Laboratory Medicine.2022; 59(4): 277. CrossRef
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
Intestinal Research.2022; 20(2): 269. CrossRef
Determining the usefulness of Capsule Scoring of Ulcerative Colitis in predicting relapse of inactive ulcerative colitis
Mao Matsubayashi, Taku Kobayashi, Shinji Okabayashi, Masaru Nakano, Shintaro Sagami, Ryo Ozaki, Hiroki Kiyohara, Hiromu Morikubo, Kunio Asonuma, Yusuke Miyatani, Shin Maeda, Toshifumi Hibi
Journal of Gastroenterology and Hepatology.2021; 36(4): 943. CrossRef
Biomarkers of Inflammation in Inflammatory Bowel Disease: How Long before Abandoning Single-Marker Approaches?
Gabriele Dragoni, Tommaso Innocenti, Andrea Galli
Digestive Diseases.2021; 39(3): 190. CrossRef
Biomarkers Predictive of Response to Thiopurine Therapy in Inflammatory Bowel Disease
Jack S. Cornish, Elisa Wirthgen, Jan Däbritz
Frontiers in Medicine.2020;[Epub] CrossRef
Predictive values of stool-based tests for mucosal healing among Taiwanese patients with ulcerative colitis: a retrospective cohort analysis
Hsu-Heng Yen, Mei-Wen Chen, Yu-Yao Chang, Hsuan-Yuan Huang, Tsui-Chun Hsu, Yang-Yuan Chen
PeerJ.2020; 8: e9537. CrossRef
What is the appropriate cut-off value of CRP to predict endoscopic remission in patients with ulcerative colitis in clinical remission?
Jongbeom Shin, Sung Min Kong, Gyeol Seong, Young-Ho Kim
International Journal of Colorectal Disease.2020; 35(12): 2249. CrossRef
Prostaglandin E-Major Urinary Metabolite Predicts Relapse in Patients With Ulcerative Colitis in Clinical Remission
Natsuki Ishida, Kiichi Sugiura, Takahiro Miyazu, Satoshi Tamura, Satoshi Suzuki, Shinya Tani, Mihoko Yamade, Moriya Iwaizumi, Yasushi Hamaya, Satoshi Osawa, Takahisa Furuta, Ken Sugimoto
Clinical and Translational Gastroenterology.2020; 11(12): e00289. CrossRef
Approaches to Integrating Biomarkers Into Clinical Trials and Care Pathways as Targets for the Treatment of Inflammatory Bowel Diseases
Parambir S. Dulai, Laurent Peyrin-Biroulet, Silvio Danese, Bruce E. Sands, Axel Dignass, Dan Turner, Gerassimos Mantzaris, Juergen Schölmerich, Jean-Yves Mary, Walter Reinisch, William J. Sandborn
Gastroenterology.2019; 157(4): 1032. CrossRef

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Medication non-adherence in inflammatory bowel diseases is associated with disability: Jonathan Perry, Andy Chen, Viraj Kariyawasam, Glen Collins, Chee Choong, Wei Ling Teh, Nikola Mitrev, Friedbert Kohler, Rupert Wing Loong Leong; Intest Res 2018;16(4):571-578. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00033

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Background/Aims
Medication non-adherence is common in inflammatory bowel diseases (IBD). The short-term consequences of non-adherence include increased disease relapse but the long-term impact upon patients in terms of daily functional impairment are less well characterized. Identifying negative outcomes, such as disability, may encourage adherence.
Methods
Consecutive ambulatory IBD subjects completed the Medication Adherence Rating Scale (MARS; non-adherence defined as ≤16), Inflammatory Bowel Diseases Disability Index (IBD-DI; disability: <3.5) and Beliefs about Medicines Questionnaire (high necessity/concerns: ≥16). The primary outcome was the association between medication non-adherence and disability. Secondary outcomes were the predictors of these outcomes.
Results
A total of 173 subjects on IBD maintenance medications were recruited (98 Crohn’s disease, 75 ulcerative colitis: median IBD-DI, –5.0; interquartile range [IQR], –14.0 to 4.0 and median MARS, 19.0; IQR, 18 to 20) of whom 24% were non-adherent. Disability correlated significantly with medication non-adherence (r=0.38, P<0.0001). Median IBD-DI for non-adherers was significantly lower than adherers (–16.0 vs. –2.0, P<0.0001). Predictors of disability included female sex (P=0.002), previous hospitalization (P=0.023), management in a referral hospital clinic (P=0.008) and medication concerns (P<0.0001). Non-adherence was independently associated with difficulty managing bowel movements (odds ratio [OR], 3.71; 95% confidence interval [CI], 1.50–9.16, P=0.005), rectal bleeding (OR, 2.69; 95% CI, 1.14–6.36; P=0.024) and arthralgia/arthritis (OR, 2.56; 95% CI, 1.11–5.92; P=0.028).
Conclusions
Medication non-adherence was associated with significantly increased disability in IBD. Female gender, higher disease severity and medication concerns were additional predictors of disability.

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Adherence to therapy of patients with inflammatory bowel diseases
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Patient self-reported symptoms using visual analog scales are useful to estimate endoscopic activity in ulcerative colitis: Saya Tsuda, Reiko Kunisaki, Jun Kato, Mayu Murakami, Masafumi Nishio, Tsuyoshi Ogashiwa, Takeichi Yoshida, Hideaki Kimura, Masayuki Kitano; Intest Res 2018;16(4):579-587. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00021

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Background/Aims
In clinical practice, colonoscopy has been regarded as the gold standard for the evaluation of disease severity as well as mucosal healing in ulcerative colitis (UC). Some activity indices incorporating patient symptoms as parameters have been shown to reflect the endoscopic activity of UC. The aim of this study was to examine whether self-reported symptoms with visual analog scales (VAS) can predict endoscopic activity.
Methods
A cross-sectional study of 150 UC patients who underwent colonoscopy with submission of VAS scores of 4 symptoms: general condition, bloody stools, stool form, and abdominal pain (0: no symptoms, 10: the most severe symptoms). Each VAS score was compared with colonoscopic activity assessed with the Mayo endoscopic subscore (MES).
Results
All VAS scores were significantly correlated with the endoscopic severity (Spearman correlation coefficients of general condition, bloody stools, stool form, and abdominal pain: 0.63, 0.64, 0.58, and 0.43, respectively). Mucosal healing defined as MES 0 alone was predicted by VAS score <1.5 on general condition or 0 on bloody stools with sensitivity of 0.84 and 0.76 and specificity of 0.66 and 0.76, respectively. Additionally, VAS score <2.5 on stool form predicted active lesions in distal colorectum alone with sensitivity of 0.67 and specificity of 0.66, suggesting that this item could predict the indication of topical therapy.
Conclusions
Self-reported VAS scores on symptoms were correlated with endoscopic activity of UC. To clarify the relationship between VAS and mucosal healing, further validation studies are needed.

Citations

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Defining Comprehensive Disease Control for Use as a Treatment Target for Ulcerative Colitis in Clinical Practice: International Delphi Consensus Recommendations
Stefan Schreiber, Silvio Danese, Axel Dignass, Eugeni Domènech, Massimo C Fantini, Marc Ferrante, Jonas Halfvarson, Ailsa Hart, Fernando Magro, Charlie W Lees, Salvo Leone, Marieke J Pierik, Michele Peters, Polly Field, Helen Fishpool, Laurent Peyrin-Biro
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Gian Paolo Caviglia, Federico De Blasio, Marta Vernero, Angelo Armandi, Chiara Rosso, Giorgio Maria Saracco, Elisabetta Bugianesi, Marco Astegiano, Davide Giuseppe Ribaldone
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Minkyung Han, Yoon Suk Jung, Jae Hee Cheon, Sohee Park
Yonsei Medical Journal.2020; 61(5): 382. CrossRef
Systematic Review of Development and Content Validity of Patient-reported Outcome Measures in Inflammatory Bowel Disease: Do We Measure What We Measure?
Emma M van Andel, Brechtje D M Koopmann, Femke Crouwel, Casper G Noomen, Nanne K H de Boer, Dirk P van Asseldonk, Lidwine B Mokkink
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The Usefulness of Microencapsulated Sodium Butyrate Add-On Therapy in Maintaining Remission in Patients with Ulcerative Colitis: A Prospective Observational Study
Marta Vernero, Federico De Blasio, Davide Giuseppe Ribaldone, Elisabetta Bugianesi, Rinaldo Pellicano, Giorgio Maria Saracco, Marco Astegiano, Gian Paolo Caviglia
Journal of Clinical Medicine.2020; 9(12): 3941. CrossRef
Prediction of treatment outcome and relapse in inflammatory bowel disease
Jun Kato, Takeichi Yoshida, Sakiko Hiraoka
Expert Review of Clinical Immunology.2019; 15(6): 667. CrossRef

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High risk of tuberculosis during infliximab therapy despite tuberculosis screening in inflammatory bowel disease patients in India: Ashish Agarwal, Saurabh Kedia, Saransh Jain, Vipin Gupta, Sawan Bopanna, Dawesh P Yadav, Sandeep Goyal, Venigalla Pratap Mouli, Rajan Dhingra, Govind Makharia, Vineet Ahuja; Intest Res 2018;16(4):588-598. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00023

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Background/Aims
The data on the risk of tuberculosis (TB) reactivation with infliximab (IFX) in patients with inflammatory bowel disease (IBD) from TB endemic countries, like India, is limited. The risk of TB reactivation on IFX and its predictors in patients with IBD was assessed.
Methods
This retrospective review included consecutive patients with IBD who received IFX, and were on follow-up from January 2005 to November 2017. The data was recorded on age/disease duration, indications for IFX, screening for latent tuberculosis (LTB) before IFX, response to IFX, incidence and duration when TB developed after IFX, and type of TB (pulmonary [PTB]/extra-pulmonary [EPTB]/disseminated).
Results
Of 69 patients (22 ulcerative colitis/47 Crohn’s disease; mean age, 35.6±14.5 years; 50.7% males; median follow-up duration after IFX, 19 months [interquartile range, 5.5–48.7 months]), primary non-response at 8 weeks and secondary loss of response at 26 and 52 weeks were seen in 14.5%, 6% and 15% patients respectively. Prior to IFX, all patients were screened for LTB, 8 (11.6%) developed active TB (disseminated, 62.5%; EPTB, 25%; PTB, 12.5%) after a median of 19 weeks (interquartile range, 14.0–84.5 weeks) of IFX. Of these 8 patients’ none had LTB, even when 7 of 8 were additionally screened with contrast-enhanced chest tomography. Though not statistically significant, more patients with Crohn’s disease than ulcerative colitis (14.9% vs. 4.5%, P=0.21), and those with past history of TB (25% vs. 9.8%, P=0.21), developed TB. Age, gender, disease duration, or extraintestinal manifestations could not predict TB reactivation.
Conclusions
There is an extremely high rate of TB with IFX in Indian patients with IBD. Current screening techniques are ineffective and it is difficult to predict TB after IFX.

Citations

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RATE OF INFECTION (TUBERCULOSIS) IN BRAZILIANS IBD PRIVATE PATIENTS: FOLLOW-UP 15 YEARS
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Stringent screening strategy significantly reduces reactivation rates of tuberculosis in patients with inflammatory bowel disease on anti‐TNF therapy in tuberculosis endemic region
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Seong Ji Choi, Min Sun Kim, Eun Sun Kim, Juneyoung Lee, Jae Min Lee, Hyuk Soon Choi, Bora Keum, Yoon Tae Jeen, Hong Sik Lee, Hoon Jai Chun, Chang Duck Kim
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Rupa Banerjee, Partha Pal, Joyce Wing Yan Mak, Siew C Ng
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Indian Journal of Gastroenterology.2019; 38(1): 44. CrossRef
Multidrug-resistant Disseminated Tuberculosis Related to Infliximab in a Patient with Ulcerative Colitis and Negative Evaluation for Latent Tuberculosis
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IBD

Response to hepatitis B vaccination in patients with inflammatory bowel disease: a prospective observational study in Korea: Ji Young Chang, Sung-Ae Jung, Chang Mo Moon, Seong-Eun Kim, Hye-Kyung Jung, Ki-Nam Shim; Intest Res 2018;16(4):599-608. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00012

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Background/Aims
Testing for hepatitis B virus (HBV) serologic markers and appropriate vaccination are required in the management of inflammatory bowel disease (IBD) patients. We evaluated immunogenicity for HBV in IBD patients and the response to the HBV vaccination.
Methods
From May 2014 to August 2016, patients diagnosed with IBD were prospectively included and evaluated for anti-HBs antibody, anti-HBc antibody, and HBs antigen. Among the 73 patients who were confirmed with nonimmunity to HBV, 44 patients who had completed the 3-dose HBV vaccination series received a single booster vaccination, while 29 patients who had not completed the vaccinations series or were unsure of receiving the vaccination received a full vaccination series.
Results
An optimal response was obtained in 70.5% of the patients in the booster group, and 89.7% of the patients in the full vaccination group. Age younger than 26 years (odds ratio [OR], 6.01; 95% confidence interval [CI], 1.15–31.32; P=0.033) and a complete previous vaccination series (OR, 0.15; 95% CI, 0.03–0.80; P=0.026) were associated with optimal vaccine response. Previous complete vaccination series (OR, 0.11; 95% CI, 0.02–0.73; P=0.022) was the only predictive factor for lower compliance.
Conclusions
The response to the HBV vaccination was lower in patients older than 26 years and for those patients with a complete vaccination history. Since patients with a complete vaccination history also had poor compliance, serum HBV-titers should be checked more thoroughly, and a full vaccination series should be administered in cases when there is a negative response to the booster vaccination.

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
Meta‐analysis: hepatitis B vaccination in inflammatory bowel disease
Anupam Kumar Singh, Anuraag Jena, Gaurav Mahajan, Ritin Mohindra, Vikas Suri, Vishal Sharma
Alimentary Pharmacology & Therapeutics.2022; 55(8): 908. CrossRef
Efficacy of hepatitis B vaccination in patients with ulcerative colitis: a prospective cohort study
Anurag Mishra, Amarender Singh Puri, Sanjeev Sachdeva, Ashok Dalal
Intestinal Research.2022; 20(4): 445. CrossRef
A Review of Vaccinations in Adult Patients with Secondary Immunodeficiency
Elda Righi, Tolinda Gallo, Anna Maria Azzini, Fulvia Mazzaferri, Maddalena Cordioli, Mara Merighi, Evelina Tacconelli
Infectious Diseases and Therapy.2021; 10(2): 637. CrossRef
Vaccination in the Elderly and IBD
Anthony J. Choi, Preston Atteberry, Dana J. Lukin
Current Treatment Options in Gastroenterology.2019; 17(4): 492. CrossRef

7,863 View
142 Download
4 Web of Science
5 Crossref

IBD

Seven days triple therapy for eradication of Helicobacter pylori does not alter the disease activity of patients with inflammatory bowel disease: Shinichiro Shinzaki, Toshimitsu Fujii, Shigeki Bamba, Maiko Ogawa, Taku Kobayashi, Masahide Oshita, Hiroki Tanaka, Keiji Ozeki, Sakuma Takahashi, Hiroki Kitamoto, Kazuhito Kani, Sohachi Nanjo, Takeshi Sugaya, Yuko Sakakibara, Toshihiro Inokuchi, Kazuki Kakimoto, Akihiro Yamada, Hisae Yasuhara, Yoko Yokoyama, Takuya Yoshino, Akira Matsui, Misaki Nakamura, Taku Tomizawa, Ryosuke Sakemi, Noriko Kamata, Toshifumi Hibi; Intest Res 2018;16(4):609-618. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00044

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Background/Aims
The influences of Helicobacter pylori eradication therapy on the disease course of inflammatory bowel disease (IBD) are still unclear. We therefore conducted a multicenter, retrospective cohort study to evaluate the safety of H. pylori eradication therapy for IBD patients.
Methods
IBD patients with H. pylori eradication from 2005 to 2015 (eradication group) and control patients (non-eradication group; 2 paired IBD patients without H. pylori eradication matched with each eradicated patient) were included. IBD exacerbation (increased/additional IBD drug or IBD-associated hospitalization/surgery) and disease improvement based on the physicians’ global assessment were investigated at baseline, and at 2 and 6 months after eradication or observation.
Results
A total of 429 IBD (378 ulcerative colitis, 51 Crohn’s disease) patients, comprising 144 patients in the eradication group and 285 patients in the non-eradication group, were enrolled at 25 institutions. IBD exacerbation was comparable between groups (eradication group: 8.3% at 2 months [odds ratio, 1.76; 95% confidence interval, 0.78–3.92; P=0.170], 11.8% at 6 months [odds ratio, 1.60; 95% confidence interval, 0.81–3.11; P=0.172]). Based on the physicians’ global assessment at 2 months, none of the patients in the eradication group improved, whereas 3.2% of the patients in the non-eradication group improved (P=0.019). Multivariate analysis revealed that active disease at baseline, but not H. pylori eradication, was an independent factor for IBD exacerbation during 2 months’ observation period. The overall eradication rate was 84.0%–comparable to previous reports in non-IBD patients.
Conclusions
H. pylori eradication therapy does not alter the short-term disease activity of IBD.

Citations

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Factors Associated With Decision to Treat or Not to Treat Helicobacter pylori Infection in Children: Data From the EuroPedHp Registry
Thu Giang Le Thi, Katharina Werkstetter, Kallirroi Kotilea, Patrick Bontems, José Cabral, Maria Luz Cilleruelo, Michal Kori, Josefa Barrio, Matjaž Homan, Nicolas Kalach, Rosa Lima, Marta Tavares, Pedro Urruzuno, Zrinjka Misak, Vaidotas Urbonas, Sibylle Ko
Helicobacter.2024;[Epub] CrossRef
Impact of Helicobacter pylori Eradication on Inflammatory Bowel Disease Onset and Disease Activity: To Eradicate or Not to Eradicate?
Antonietta Gerarda Gravina, Raffaele Pellegrino, Veronica Iascone, Giovanna Palladino, Alessandro Federico, Rocco Maurizio Zagari
Diseases.2024; 12(8): 179. CrossRef
Bibliometric analysis of the correlation between H. pylori and inflammatory bowel disease
Yantong Li, Limin Li, Wenmeng Yin, Juyi Wan, Xiaolin Zhong
JGH Open.2024;[Epub] CrossRef
Discussion on the common controversies of Helicobacter pylori infection
Hang Yang, Yi Mou, Bing Hu
Helicobacter.2023;[Epub] CrossRef
Helicobacter pylori and Inflammatory Bowel Disease: An Unresolved Enigma
Juris Pokrotnieks, Stanislav Sitkin
Inflammatory Bowel Diseases.2023; 29(3): e5. CrossRef
Helicobacter Pylori and Autoimmune Diseases: Involving Multiple Systems
Li Wang, Zheng-Min Cao, Li-Li Zhang, Xin-can Dai, Zhen-ju Liu, Yi-xian Zeng, Xin-Ye Li, Qing-Juan Wu, Wen-liang Lv
Frontiers in Immunology.2022;[Epub] CrossRef
Helicobacter pylori infection in patients with inflammatory bowel diseases: a single-centre, prospective, observational study in Egypt
Ekram W. Abd El-Wahab, Ebtessam I. Youssef, Ehab Hassouna
BMJ Open.2022; 12(5): e057214. CrossRef
Is the Presence of Helicobacter Pylori in the Colonic Mucosa, Provocative of Activity in Ulcerative Colitis?
Javad Ranjbar, Bita Geramizadeh, Kamran Bagheri Lankarani, Zahra Jowkar, Mitra Mirzai, Elham Moazamian
Clinical Pathology.2022;[Epub] CrossRef
Helicobacter pylori infection and inflammatory bowel diseases
Yu. P. Uspenskiy, N. V. Baryshnikova, A. N. Suvorov, A. V. Svarval
Russian Journal of Infection and Immunity.2021; 11(1): 68. CrossRef
Ulcerative colitis relapse after Helicobacter pylori eradication in a 12-year-old boy with duodenal ulcer
Yuji Fujita, Keiichi Tominaga, Takanao Tanaka, Takeshi Sugaya, Shigemi Yoshihara
BMC Gastroenterology.2021;[Epub] CrossRef
Effect of sequential eradication therapy on serum osteoprotegerin levels in patients with Helicobacter pylori infection and co-existing inflammatory bowel disease
Hussam Murad, Misbahuddin Rafeeq, Mahmoud Mosli, Mamdouh Gari, Mohammed Basheikh
Journal of International Medical Research.2021;[Epub] CrossRef
Extra-Gastric Manifestations of Helicobacter pylori Infection
Antonietta G. Gravina, Kateryna Priadko, Paola Ciamarra, Lucia Granata, Angela Facchiano, Agnese Miranda, Marcello Dallio, Alessandro Federico, Marco Romano
Journal of Clinical Medicine.2020; 9(12): 3887. CrossRef
Comparison of new and classical point mutations associated with clarithromycin resistance in Helicobacter pylori strains isolated from dyspeptic patients and their effects on phenotypic clarithromycin resistance
Bekir Kocazeybek, Merve Kutlu Sakli, Pelin Yuksel, Mehmet Demirci, Reyhan Caliskan, Tevhide Ziver Sarp, Suat Saribas, Suleyman Demiryas, Fatma Kalayci, Huseyin Cakan, Hayriye Kirkoyun Uysal, Nesrin Gareayaghi, Sevgi Ergin, Yusuf Ziya Erzin, Kadir Bal, İhs
Journal of Medical Microbiology .2019; 68(4): 566. CrossRef
Review:Helicobacter pyloriand extragastric diseases
Francesco Franceschi, Marcello Covino, Claire Roubaud Baudron
Helicobacter.2019;[Epub] CrossRef

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Colorectal neoplasia

Rates of metachronous adenoma after curative resection for left-sided or right-sided colon cancer: Yuk Fai Lam, Wai Kay Seto, Teresa Tong, Ka Shing Cheung, Oswens Lo, Ivan FN Hung, Wai Lun Law, Wai K Leung; Intest Res 2018;16(4):619-627. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00013

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Background/Aims
We determined the rates of metachronous colorectal neoplasm in colorectal cancer (CRC) patients after resection for right (R)-sided or left (L)-sided cancer.
Methods
Consecutive CRC patients who had undergone surgical resection for curative intent in our hospital between 2001 and 2004 were identified. R-sided colonic cancers refer to cancer proximal to splenic flexure whereas L-sided cancers include rectal cancers. Patients were included only if they had a clearing colonoscopy performed either before or within 6 months after the operation. Findings of surveillance colonoscopy performed up to 5 years after colonic resection were included in the analysis.
Results
Eight hundred and sixty-three CRC patients underwent curative surgical resection during the study period. Three hundred and twenty-seven patients (107 R-sided and 220 L-sided) fulfilled the inclusion criteria and had at least 1 postoperative surveillance colonoscopy performed. The proportion of patients who had polyp and adenoma on surveillance colonoscopy was significantly higher among patients with L-sided than R-sided cancers (polyps: 30.9% vs. 19.6%, P=0.03; adenomas: 25.5% vs. 13.1%, P=0.01). The mean number of adenoma per patient on surveillance colonoscopy was also higher for patients with L-sided than R-sided tumors (0.52; 95% confidence interval [CI], 0.37–0.68 vs. 0.22; 95% CI, 0.08–0.35; P<0.01). Multivariate analysis showed that L-sided cancers, age, male gender and longer follow-up were independent predictors of adenoma detection on surveillance colonoscopy.
Conclusions
Patients with Lsided cancer had a higher rate of metachronous polyps and adenoma than those with R-sided cancer on surveillance colonoscopy.

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Journal of Biophotonics.2024;[Epub] CrossRef
IMMUNOREACT 9 metachronous rectal cancers have high HLA-ABC expression on healthy epithelium but a lower infiltration of CD3+ T cells than primary lesions
Beatrice Salmaso, Melania Scarpa, Valerio Pellegrini, Astghik Stepanyan, Roberta Salmaso, Andromachi Kotsafti, Federico Scognamiglio, Dario Gregori, Giorgio Rivella, Ottavia De Simoni, Giulia Becherucci, Silvia Negro, Chiara Vignotto, Gaya Spolverato, Ces
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Kwangwoo Nam, Jeong Eun Shin
The Korean Journal of Internal Medicine.2021; 36(2): 305. CrossRef

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Case Reports

Endoscopy

Magnified single-balloon enteroscopy in the diagnosis of intestinal follicular lymphoma: a case series: Kenichiro Takahashi, Shigeki Bamba, Masahiro Kawahara, Atsushi Nishida, Osamu Inatomi, Masaya Sasaki, Tomoyuki Tsujikawa, Ryoji Kushima, Mitsushige Sugimoto, Katsuyuki Kitoh, Akira Andoh; Intest Res 2018;16(4):628-634. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00003

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The objective of this study was to evaluate the magnified endoscopic findings in the diagnosis of follicular lymphoma in the small intestine in comparison with those of intestinal follicular lymphoma and lymphangiectasia. Four patients with follicular lymphoma and 3 with lymphangiectasia in the small intestine were retrospectively analyzed. A prototype magnifying singleballoon enteroscope was used. The findings of the intestinal follicular lymphoma and lymphangiectasia were retrospectively analyzed to determine the magnified endoscopic findings of follicular lymphoma in the small intestine. Opaque white granules were observed in 3 of the 4 patients with follicular lymphoma. Magnified narrow-band imaging (NBI) of the opaque white granules showed stretched microvessels, which had a diminutive tree-like appearance. The remaining patient had no opaque white granules and only displayed whitish villi. Magnified NBI observation of the whitish villi revealed the absence of marginal villus epithelium, which was confirmed by histology. The magnified NBI enteroscopy revealed the diminutive tree-like appearance on the opaque white granules and the absence of marginal villus epithelium of the whitish villi in intestinal follicular lymphoma. These findings may be useful in diagnosing follicular lymphoma.

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A case of intestinal T‐cell lymphoma, not otherwise specified, that showed characteristic findings by magnified endoscopy combined with narrow‐band imaging
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5-Aminosalicylic acid aggravates colitis mimicking exacerbation of ulcerative colitis: Jun Miyoshi, Katsuyoshi Matsuoka, Atsushi Yoshida, Makoto Naganuma, Tadakazu Hisamatsu, Tomoharu Yajima, Nagamu Inoue, Susumu Okamoto, Yasushi Iwao, Haruhiko Ogata, Fumiaki Ueno, Toshifumi Hibi, Takanori Kanai; Intest Res 2018;16(4):635-640. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00015

Abstract PDF PubReader ePub

Ulcerative colitis (UC) is one of the major clinical phenotypes of inflammatory bowel diseases. Although 5-aminosalicylic acid (5-ASA) is widely used for UC and its efficacy and safety have been demonstrated, a few patients paradoxically develop a severe exacerbation of colitis by 5-ASA administration. It is crucial to know clinical features including endoscopic findings in this condition for making a correct diagnosis and a prompt decision to withdraw the medication. Here, we report case series with UC exacerbated by 5-ASA. Medical records of 8 UC patients experiencing an exacerbation of colitis after induction of 5-ASA that was improved by the withdrawal of 5-ASA but also re-aggravated by dose increase or re-administration of 5-ASA were reviewed. The patients were newly diagnosed with UC, started 5-ASA and developed an exacerbation in approximately 2 to 3 weeks. They did not appear to have systemic allergic reactions. Seven of the 8 patients had a high fever. Three of 5 patients who undertook total colonoscopy showed right-side-dominant colitis. These findings suggest clinical characteristics in this condition. Further assessment of clinical and endoscopic features in more cases is necessary for establishing diagnostic criteria and understanding underlying mechanisms in those cases where 5-ASA aggravates the colitis.

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