Intestinal Research

IBD

Ulcerative colitis-associated neoplasms often harbor poor prognostic histologic components with low detection by biopsy: Ryoya Sakakibara, Shinya Sugimoto, Kaoru Takabayashi, Hiroki Kiyohara, Yusuke Wakisaka, Yuta Kaieda, Miho Kawaida, Yusuke Yoshimatsu, Tomohisa Sujino, Naoki Hosoe, Motohiko Kato, Masayuki Shimoda, Yohei Mikami, Yasushi Iwao, Takanori Kanai; Intest Res 2024;22(4):428-438. Published online May 7, 2024; DOI: https://doi.org/10.5217/ir.2024.00006; Funded: Takeda Science Foundation

Abstract PDF PubReader ePub: Background/Aims
Poorly differentiated adenocarcinoma, signet-ring cell carcinoma, and mucinous adenocarcinoma (por/sig/muc), which are considered to be histologic subtypes with a poor prognosis, occur more frequently with colitis-associated cancer than with sporadic tumors. However, their invasiveness and manifestations are unclear. This study aimed to determine the prevalence of the por/sig/muc component in ulcerative colitis-associated neoplasms (UCANs) and its association with invasiveness and to clarify its clinicohistologic and endoscopic features.
Methods
This retrospective observational study included patients diagnosed with ulcerative colitis-associated high-grade dysplasia or adenocarcinoma from 1997 to 2022 who were divided according to the presence or absence of a por/sig/muc component.
Results
Thirty-five patients had UCAN with a por/sig/muc component and 66 had UCAN without this component. The 5-year survival rate was significantly lower in the por/sig/muc group than in the tub group (67% vs. 96%, P= 0.001), which was attributed to disease above stage III and depth to below the subserosa. Biopsy-based diagnosis before resection detected a por/sig/muc component in only 40% of lesions (14/35). Lesions with a por/sig/muc component were prevalent even in the early stages: stage 0 (4/36, 11%), I (8/20, 40%), II (7/12, 58%), III (10/14, 71%), and IV (6/8, 75%).
Conclusions
This is the first investigation that shows UCANs with a por/sig/muc component tended to be deeply invasive and were often not recognized preoperatively. Endoscopists should be aware that UCAN often has a por/sig/muc component that is not always recognized on biopsy, and the optimal treatment strategy needs to be carefully considered.

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IBD

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; Intest Res 2024;22(4):453-463. Published online May 22, 2024; DOI: https://doi.org/10.5217/ir.2024.00044; Funded: National Research Foundation of Korea, Ministry of Science and ICT, Seoul Metropolitan Government Seoul National University

Abstract PDF PubReader ePub: Background/Aims
The prevalence and incidence of ulcerative colitis (UC) in Korea is increasing. Each patient has a different disease course and treatment response. Recently, with the development of biologic agents, histological remission has become a treatment goal. In this study, we aimed to identify the predictors of histological remission after first-line biologic agent treatment in patients with biologic agent-naïve UC.
Methods
We retrospectively analyzed the medical records of 92 patients who had been diagnosed with UC and treated with first-line biologic agent treatment at our center, between 2015 and 2022. The clinical characteristics, laboratory test results, and endoscopic and biopsy findings were analyzed. Histological remission was defined as the absence of cryptitis, crypt abscesses, and inflammatory cells on histology. Univariate and multivariate logistic regression analyses were performed to identify the predictors of histological remission after first-line treatment.
Results
Of the total 92 patients, 25 (27.2%) achieved histological remission. Each cohort had a varied body mass index (BMI) distribution, with a statistically significant overweight ratio, as defined by the Asian-Pacific BMI category of 23–25 kg/m², of 48.0% in the histological remission cohort (P= 0.026). A causal correlation between the overweight category and histological remission was confirmed (odds ratio, 3.883; 95% confidence interval, 1.141–13.212; P= 0.030).
Conclusions
We confirmed that the overweight category was a predictor of histological remission after first-line treatment with a biological agent. However, as BMI does not account for skeletal muscle mass, future studies are required to confirm the correlation between skeletal muscle mass and histological remission.

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IBD

Early change in serum leucine-rich α-2-glycoprotein predicts clinical and endoscopic response in ulcerative colitis: Ryo Karashima, Shintaro Sagami, Yoko Yamana, Masa Maeda, Aya Hojo, Yusuke Miyatani, Masaru Nakano, Takahisa Matsuda, Toshifumi Hibi, Taku Kobayashi; Intest Res 2024;22(4):473-483. Published online June 5, 2024; DOI: https://doi.org/10.5217/ir.2023.00135; Funded: Kitasato University Kitasato Institute Hospital

Abstract PDF PubReader ePub: Background/Aims
Leucine-rich α-2-glycoprotein (LRG) is a new serum biomarker reflecting the disease activity of ulcerative colitis (UC), but its change during the acute phase has not been enough investigated.
Methods
Patients with UC who initiated the induction therapy with steroid or advanced therapy (biologics or Janus kinase inhibitors) were prospectively enrolled. Associations of LRG, C-reactive protein (CRP) and fecal calprotectin (FC) at baseline, week 1, and week 8 with clinical remission at week 8 and subsequent endoscopic improvement within 1 year (Mayo endoscopic subscore of 0 or 1) were assessed.
Results
A total of 143 patients with UC were included. LRG and CRP at week 1 were significantly lower in the clinical remission group than in the non-remission group (LRG, 20.6 μg/mL vs. 28.4 μg/mL, P< 0.001; CRP, 0.9 mg/dL vs. 2.3 mg/dL, P< 0.001) while FC demonstrated the difference between groups only at week 8. The area under the curves of week 1 LRG, CRP, and FC for week 8 clinical remission using the receiver operating characteristic curves analysis were 0.68, 0.71, and 0.57, respectively. Furthermore, LRG and CRP predicted subsequent endoscopic improvement as early as week 1, while FC was predictive only at week 8.
Conclusions
LRG can be an early-phase biomarker predicting subsequent clinical and endoscopic response to induction therapy.

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IBD

Perianal fistulizing lesions of Crohn’s disease are associated with long-term behavior and its transition: a Chinese cohort study: Wei Zhan, Xiaoyin Bai, Hong Yang, Jiaming Qian; Intest Res 2024;22(4):484-495. Published online July 15, 2024; DOI: https://doi.org/10.5217/ir.2024.00021; Funded: National Key R&D Program of China, National High-Level Hospital Clinical Research Funding, Capital Health Research and Development of Special Foundation, CAMS Innovation Fund for Medical Sciences, National Natural Science Foundation of China, National Key Clinical Specialty Construction Project, Peking Union Medical College Teaching Reform in Undergraduate Education

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Crohn’s disease (CD) has a progressive nature and commonly perianal involvement. The aim of this study is to assess the prevalence, surgical treatment, and outcome of perianal fistulizing CD with associated risk factors in a large Chinese cohort.
Methods
Hospitalized patients diagnosed with CD in our center were consecutively enrolled between January 2000 and December 2018. Transition of disease behavior was classified according to the presence or absence of penetrating behavior (B3 in the Montreal classification) at diagnosis and at a median follow-up of 102 months.
Results
A total of 504 patients were included, of whom 207 (41.1%) were classified as B3 and 348 (69.0%) as L2/3 at follow-up. Transition of behavior to B3 was observed in 86 patients (17.1%). The incidence of perianal fistulizing lesions was 10.9% at 10 years with a final prevalence of 27.0% (n = 136) at the end of follow-up. Multivariate Cox regression identified independent risks of perianal fistulizing lesions for persistent B3 (hazard ratio, 4.72; 95% confidence interval, 1.91–11.66) and behavior transition of progressed to B3 (hazard ratio, 9.90; 95% confidence interval, 4.60–21.33). Perianal surgical treatments were performed in 104 patients (20.6%). Thirty-six cases (7.1%) were refractory, and it is independently associated with behavior of persistent B3 (P= 0.011).
Conclusions
Perianal fistulizing lesions occurred frequently in Chinese CD patients. Its incidence and refractory outcome were closely associated with the penetrating CD behavior. An additional risk of perianal fistulizing lesions was indicated for CD patients with behavior of progressing to B3, suggesting further attention.

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IBD

Association between oral corticosteroid starting dose and the incidence of pneumonia in Japanese patients with ulcerative colitis: a nation-wide claims database study: Katsuyoshi Matsuoka, Tomoyuki Inoue, Hiroaki Tsuchiya, Katsumasa Nagano, Toshiyuki Iwahori; Intest Res 2024;22(3):319-335. Published online February 6, 2024; DOI: https://doi.org/10.5217/ir.2023.00071; Funded: Janssen Pharmaceutical K.K.

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
A previous study demonstrated that half of patients started oral corticosteroids (OCS) for ulcerative colitis (UC) exacerbations at lower doses than recommended by Japanese treatment guidelines (initial OCS prednisolone equivalent dose, 30–40 mg). This may relate to physician’s concern about infection, especially pneumonia including Pneumocystis jirovecii pneumonia (PJP), from high OCS doses. We assessed whether pneumonia incidence is increased with guideline-recommended OCS initial doses.
Methods
This retrospective cohort study used the Japan Medical Data Center claims database (2012–2021). The whole cohort consisted of all UC patients who started OCS during the study period meeting the inclusion and exclusion criteria. The matched cohort was created by propensity score matching; the lower (initial OCS dose < 30 mg), guideline-recommended (30–40 mg), and higher groups ( > 40 mg) in a 2:2:1 ratio. Pneumonia incidence in the primary analysis was evaluated in the matched cohort. A Poisson regression model determined pneumonia-related risk factors in the whole cohort.
Results
After screening, 3,349 patients comprised the whole cohort; 1,775 patients comprised the matched cohort (lower dose, n = 710; guideline-recommended dose, n = 710; higher dose, n = 355). The incidence of any pneumonia was low; no differences were observed in incidence rates across these dose subgroups. In total, 3 PJP cases were found in the whole cohort, but not detected in the matched cohort. Several risk factors for any pneumonia were identified, including age, higher comorbidities index, treatment in large facility and hospitalization.
Conclusions
The incidence of pneumonia, including PJP, in UC patients was low across initial OCS dose treatment subgroups.

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Functional disorder

Diagnostic strategy of irritable bowel syndrome: a low- and middle-income country perspective: Amal Arifi Hidayat, Langgeng Agung Waskito, Titong Sugihartono, Hafeza Aftab, Yudith Annisa Ayu Rezkitha, Ratha-korn Vilaichone, Muhammad Miftahussurur; Intest Res 2024;22(3):286-296. Published online March 26, 2024; DOI: https://doi.org/10.5217/ir.2023.00199; Funded: Universitas Airlangga

Abstract PDF PubReader ePub: Irritable bowel syndrome (IBS) is a highly prevalent gastrointestinal disorder associated with substantial impairment which considerably burdens healthcare systems worldwide. Research on IBS has largely been conducted in high-income countries posing barriers to the application of diagnostic strategies in low- and middle-income countries (LMICs) due to differences in disease characteristics, healthcare resources, and socioeconomic factors. This review discusses the diagnostic issues associated with LMICs. We present a concise overview of the relevant approaches and propose a diagnostic strategy based on the latest evidence. A positive diagnostic strategy that relies on appropriate symptom-based criteria is crucial within the diagnostic framework. A combination of complete blood count, fecal occult blood test, and complete stool test may reliably identify individuals with suspected IBS who are more likely to have organic diseases, thus justifying the necessity for a colonoscopy. Eventually, we developed a diagnostic algorithm based on a limited setting perspective that summarizes the available evidence and may be applied in LMICs.

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IBD

Changes in the clinical course and prognosis of ulcerative colitis in Chinese populations: a retrospective cohort study: Xinyu Liu, Qingfan Yang, Na Diao, Jian Tang, Zicheng Huang, Xiang Gao, Kang Chao; Intest Res 2024;22(3):357-368. Published online May 7, 2024; DOI: https://doi.org/10.5217/ir.2023.00106; Funded: National Nature Science Foundation of China, Guangdong Provincial Clinical Research Center for Digestive Diseases

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Data on the natural course of Chinese patients with ulcerative colitis (UC) was lacking. This study aimed to evaluate the natural history and prognosis of patients with UC in the past 15 years in China.
Methods
This cohort study included patients with UC in a tertiary hospital in southern China from 2007 to 2021 (cohort I: 2007–2011, cohort II: 2012–2016, cohort III: 2017–2021). Patients’ clinical characteristics and natural history were analyzed retrospectively.
Results
Of 1,139 included patients, 683 patients presented with proctitis or left-sided colitis at diagnosis and 38.5% of them (263/683) developed proximal disease extension. Fifty-eight percent of patients experienced relapse, chronic continuous and intermittent active course. Five patients (0.4%) developed colorectal tumors/dysplasia. The overall surgery rate was 8.6%, and the rates were 14.2%, 7.8%, and 8.0% in the 3 cohorts, respectively (P= 0.059). Average time from diagnosis to surgery decreased from cohorts I to III (144 months vs. 36 months, P< 0.001), so did the use of glucocorticoids (58.2% vs. 43.5%, P< 0.001) and immunosuppressants (14.1% vs. 13.4%, P= 0.016), and days of hospitalization (13 days vs. 9 days, P< 0.001). Biologics were used more frequently during the first year (0.8%, 2.1%, and 13.7% for cohorts I to III, respectively; P< 0.001). The rate of mucosal healing increased over time.
Conclusions
In Chinese UC patients, one-third of patients experienced proximal disease extension. The rates of malignancy and mortality were low. More biologics were used, while use of immunosuppressants and glucocorticoids were reduced over time. Early biologics use seemed to promote mucosal healing, but the rate of colectomy has not dramatically decreased.

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IBD

Halitosis: an underestimated but important extraintestinal manifestation in inflammatory bowel disease: Xiao Xian Qian; Intest Res 2024;22(3):387-388. Published online May 7, 2024; DOI: https://doi.org/10.5217/ir.2024.00016; Funded: National Natural Science Foundation of China

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IBD

Assessing quality of magnetic resonance enterography and its impact on disease assessment of ileal Crohn’s disease: Anuj Bohra, Declan J Connoley, Danny Con, Jonathan P Segal, Olga Niewiadomski, Abhinav Vasudevan, Daniel R Van Langenberg, Numan Kutaiba; Intest Res 2024;22(2):152-161. Published online January 5, 2024; DOI: https://doi.org/10.5217/ir.2023.00095; Funded: Australian Government Research Training Program

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Assessment of quality of magnetic resonance enterography (MRE) in small bowel Crohn’s disease (CD) activity evaluation has received little attention. We assessed the impact of bowel distention and motion artifact on MRE activity indices in ileal CD.
Methods
A cohort of patients who underwent contemporaneous MRE and colonoscopy for ileal CD assessment between 2014 and 2021 at 2 centers were audited. An abdominal radiologist blinded to clinical data reviewed each MRE, graded bowel distention and motion artifact upon a pre-specified 3-point scale and calculated the original magnetic resonance index of activity (MaRIA) and simplified MaRIA (sMaRIA), London index and CD MRE index (CDMI). Ileal endoscopic activity was graded via the Simplified Endoscopy Score for CD (SES-CD). The performance of MRE indices in discriminating active disease (SES-CD ≥3) stratified by MRE quality was measured by receiver operator characteristic analyses.
Results
One hundred and thirty-seven patients had MRE and colonoscopy within a median of 16 days (range, 0–30 days) with 63 (46%) exhibiting active disease (SES-CD ≥3). Forty-four MREs (32%) were deemed low quality due to motion artifact and/or moderate to poor distention. Low-quality MREs demonstrated reduced discriminative performance between ileal SES-CD ≥3 and MRE indices (MaRIA 0.838 vs. 0.634, sMaRIA 0.834 vs. 0.527, CDMI 0.850 vs. 0.595, London 0.748 vs. 0.511, P<0.05 for all). Individually the presence of any motion artifact markedly impacted the discriminative performance (e.g., sMaRIA area under the curve 0.544 vs. 0.814, P<0.05).
Conclusions
Image quality parameters can significantly impact MRE disease activity interpretation. Quality metrics should be reported, enabling cautious interpretation in lower-quality studies.

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Magnetic resonance enterography in diagnosing and monitoring of adult-onset IgA vasculitis (Henoch-Schönlein purpura) with gastro-intestinal involvement: Report of two cases
Edoardo Conticini, Susanna Guerrini, Paolo Falsetti, Maria Antonietta Mazzei, Luca Cantarini, Bruno Frediani
The Egyptian Rheumatologist.2024; 46(2): 90. CrossRef
Advocating for Consensus: The Crucial Role of Standardised Magnetic Resonance Imaging Protocols and Image Quality Metrics in Assessment of Crohn’s Disease
Mustafa Mohamedrashed, Mayur Garg, Anuj Bohra
Journal of Crohn's and Colitis.2024; 18(9): 1524. CrossRef
Achieving high-quality magnetic resonance enterography is critical for assessing Crohn’s disease activity
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Yun Wang, Min Dai, Minghui Zheng, Yan Jin, Quan Wen, Bota Cui, Zulun Zhang, Jianguo Zhu, Faming Zhang
Therapeutic Advances in Gastroenterology.2024;[Epub] CrossRef

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IBD/ Infection

Durability and outcomes of fecal microbiota transplantation for recurrent Clostridioides difficile infection in patients with moderate to severe inflammatory bowel disease: Raseen Tariq, Edward V Loftus Jr, Darrell Pardi, Sahil Khanna; Intest Res 2024;22(2):208-212. Published online January 9, 2024; DOI: https://doi.org/10.5217/ir.2023.00100; Funded: National Institute of Diabetes and Digestive and Kidney Diseases

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Citations

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Perception of fecal microbiota transplantation in patients with ulcerative colitis in Korea: a KASID multicenter study
Jebyung Park, Sung Noh Hong, Hong Sub Lee, Jongbeom Shin, Eun Hye Oh, Kwangwoo Nam, Gyeol Seong, Hyun Gun Kim, Jin-Oh Kim, Seong Ran Jeon
The Korean Journal of Internal Medicine.2024; 39(5): 783. CrossRef

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1 Crossref

IBD

Efficacy and safety of mirikizumab as induction and maintenance therapy for Japanese patients with moderately to severely active ulcerative colitis: a subgroup analysis of the global phase 3 LUCENT-1 and LUCENT-2 studies: Taku Kobayashi, Katsuyoshi Matsuoka, Mamoru Watanabe, Tadakazu Hisamatsu, Fumihito Hirai, Joe Milata, Xingyuan Li, Nathan Morris, Vipin Arora, Tomoko Ishizuka, Koji Matsuo, Yoichi Satoi, Catherine Milch, Toshifumi Hibi; Intest Res 2024;22(2):172-185. Published online April 25, 2024; DOI: https://doi.org/10.5217/ir.2023.00043; Funded: Eli Lilly and Company

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Mirikizumab is a p19-directed anti-interleukin-23 antibody with potential efficacy against ulcerative colitis (UC). We evaluated the efficacy and safety of mirikizumab in a Japanese subpopulation with moderately to severely active UC from the LUCENT-1 and LUCENT-2 studies.
Methods
LUCENT-1 and LUCENT-2 were phase 3, randomized, double-blind, placebo-controlled trials of mirikizumab therapy in adults with moderately to severely active UC. LUCENT-1 was a 12-week induction trial where patients were randomized 3:1 to receive intravenous mirikizumab 300 mg or placebo every 4 weeks (Q4W). Patients achieving a clinical response with mirikizumab following the induction study were re-randomized 2:1 to double-blind treatment with either mirikizumab 200 mg or placebo subcutaneously Q4W during the 40-week maintenance study. The primary outcomes were clinical remission at week 12 of LUCENT-1 and week 40 of LUCENT-2.
Results
A total of 137 patients enrolled in Japan were randomized to mirikizumab (n = 102) or placebo (n = 35). Compared with placebo, patients who received mirikizumab showed numerically higher clinical remission at week 12 of induction (32.4% [n = 33] vs. 2.9% [n = 1]) and at week 40 of maintenance (48.9% [n = 23] vs. 28.0% [n = 7]). A greater number of patients achieved key secondary endpoints in the mirikizumab group compared with placebo. The frequency of treatment-emergent adverse events was similar across mirikizumab and placebo groups. Efficacy and safety results observed in the Japanese subpopulation were generally consistent with those in the overall population.
Conclusions
Mirikizumab induction and maintenance treatments were effective in Japanese patients with moderately to severely active UC. No new safety concerns were identified.

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Mirikizumab – a new option in treatment of inflammatory bowel diseases
Jakub Olszewski, Katarzyna Kozon, Magdalena Sitnik, Katarzyna Herjan, Karolina Mikołap, Bartłomiej Gastoł, Maciej Bara, Piotr Armański, Marcin Sawczuk
Prospects in Pharmaceutical Sciences.2024; 22(3): 178. CrossRef

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IBD

Ischemia-modified albumin: a novel blood marker of endoscopic mucosal healing in inflammatory bowel disease: Seung Bum Lee, Hyun-Ki Kim, Sang Hyuk Park, Ji-Hun Lim, Sang Hyoung Park; Intest Res 2024;22(1):75-81. Published online November 1, 2023; DOI: https://doi.org/10.5217/ir.2023.00065; Funded: National Research Foundation of Korea, Ministry of Science and ICT

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
The achievement of endoscopic remission is an important therapeutic goal in the treatment of inflammatory bowel diseases (IBD). We aimed to evaluate the role of fecal calprotectin (FCP) and ischemia-modified albumin (IMA) as biomarkers for evaluating IBD disease activity.
Methods
A total of 48 patients with IBD (20 with ulcerative colitis and 28 with Crohn’s disease) were included in this study. FCP and serum C-reactive protein levels, erythrocyte sedimentation rate, and IMA were measured in patients with IBD and compared with endoscopic findings.
Results
Elevated FCP and serum IMA levels were significantly associated with endoscopic non-mucosal healing. The correlation between FCP and IMA was not significant. Analysis of the receiver operating characteristic curve showed that both FCP and IMA had diagnostic value in predicting non-mucosal healing. When the Ln(FCP)+IMA/10 value was calculated using both factors, the predictive value for non-mucosal healing increased; however, no significant difference was observed.
Conclusions
IMA could be a candidate serum biomarker for predicting endoscopic mucosal healing in IBD.

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A novel serum biomarker of endoscopic mucosal healing in inflammatory bowel disease
Hyoun Woo Kang
Intestinal Research.2024; 22(1): 3. CrossRef

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IBD

Gut microbiota in pathophysiology, diagnosis, and therapeutics of inflammatory bowel disease: Himani Pandey, Dheeraj Jain, Daryl W. T. Tang, Sunny H. Wong, Devi Lal; Intest Res 2024;22(1):15-43. Published online November 8, 2023; DOI: https://doi.org/10.5217/ir.2023.00080; Funded: Nanyang Technological University, Wang Lee Wah Memorial Fund, Ministry of Education - Singapore

Abstract PDF PubReader ePub

Inflammatory bowel disease (IBD) is a multifactorial disease, which is thought to be an interplay between genetic, environment, microbiota, and immune-mediated factors. Dysbiosis in the gut microbial composition, caused by antibiotics and diet, is closely related to the initiation and progression of IBD. Differences in gut microbiota composition between IBD patients and healthy individuals have been found, with reduced biodiversity of commensal microbes and colonization of opportunistic microbes in IBD patients. Gut microbiota can, therefore, potentially be used for diagnosing and prognosticating IBD, and predicting its treatment response. Currently, there are no curative therapies for IBD. Microbiota-based interventions, including probiotics, prebiotics, synbiotics, and fecal microbiota transplantation, have been recognized as promising therapeutic strategies. Clinical studies and studies done in animal models have provided sufficient evidence that microbiota-based interventions may improve inflammation, the remission rate, and microscopic aspects of IBD. Further studies are required to better understand the mechanisms of action of such interventions. This will help in enhancing their effectiveness and developing personalized therapies. The present review summarizes the relationship between gut microbiota and IBD immunopathogenesis. It also discusses the use of gut microbiota as a noninvasive biomarker and potential therapeutic option.

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IBD

Precision medicine in inflammatory bowel diseases: Ashwin N. Ananthakrishnan; Intest Res 2024;22(1):8-14. Published online November 9, 2023; DOI: https://doi.org/10.5217/ir.2023.00087; Funded: National Institutes of Health

Abstract PDF PubReader ePub

Inflammatory bowel diseases comprising Crohn’s disease and ulcerative colitis have emerged as global diseases. Multiple distinct therapeutic mechanisms have allowed us to increase our rates of achieving remission and reducing permanent disease-related morbidity. However, there is limited data to inform relative positioning of different therapies. This review will summarize existing literature on use of clinical decision models to inform relative efficacy of one therapeutic mechanism compared to the other given individual patient characteristics. It will also demonstrate the value of serologic, transcriptomic (from biopsies), and microbiome-based biomarkers in identifying which therapy is most likely to work for a given patient. We will review the existing gaps in the literature in this field and suggest a path forward for future studies to better inform patient care, incorporating the principles of precision medicine in the management of inflammatory bowel disease.

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Kyuwon Kim, Byong Duk Ye
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IBD

Association of colonic metaplasia of goblet cells and endoscopic phenotypes of the J pouch in patients with ulcerative colitis: a retrospective pilot study: Shintaro Akiyama, Tsubasa Onoda, Shoko Moue, Noriaki Sakamoto, Taku Sakamoto, Hideo Suzuki, Tsuyoshi Enomoto, Daisuke Matsubara, Tatsuya Oda, Kiichiro Tsuchiya; Intest Res 2024;22(1):92-103. Published online January 29, 2024; DOI: https://doi.org/10.5217/ir.2023.00105; Funded: Japan Foundation for Applied Enzymology, Japan Society for the Promotion of Science

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Mucosal adaptation of the ileum toward colonic epithelium has been reported in pouchitis in ulcerative colitis (UC); however, the clinical characteristics, endoscopic findings, and outcomes in patients with pouchitis with ileal mucosal adaptation are poorly understood.
Methods
This was a single-center retrospective study comprising UC patients treated by proctocolectomy with ileal pouch-anal anastomosis who had undergone pouchoscopy at the University of Tsukuba Hospital between 2005 and 2022. Endoscopic phenotypes were evaluated according to the Chicago classification. High-iron diamine staining (HID) was performed to identify sulfomucin (colon-type mucin)-producing goblet cells (GCs) in pouch biopsies. We compared clinical data between patients with (high HID group) and without > 10% sulfomucin-producing GCs in at least one biopsy (low HID group).
Results
We reviewed 390 endoscopic examination reports from 50 patients. Focal inflammation was the most common phenotype (78%). Five patients (10%) required diverting ileostomy. Diffuse inflammation and fistula were significant risk factors for diverting ileostomy. The median proportion of sulfomucin-producing GCs on histological analysis of 82 pouch biopsies from 23 patients was 9.9% (range, 0%–93%). The duration of disease was significantly greater in the high HID group compared to the low HID group. The median percentage of sulfomucin-producing GCs was significantly higher in patients with diffuse inflammation or fistula compared to other endoscopic phenotypes (14% vs. 6.0%, P= 0.011).
Conclusions
Greater proportions of sulfomucin-producing GCs were observed in endoscopic phenotypes associated with poor outcomes in UC, indicating patients with pouchitis showing colonic metaplasia of GCs may benefit from early interventions.

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Endoscopic assessment of the J pouch in ulcerative colitis: A narrative review
Shintaro Akiyama, Edward L Barnes, Tsubasa Onoda, Naoki Ishikawa, Mamiko Shiroyama, Yuka Ito, David T Rubin, Kiichiro Tsuchiya
DEN Open.2025;[Epub] CrossRef
A Comparative Analysis of Clinical Symptoms and Modified Pouchitis Disease Activity Index Among Endoscopic Phenotypes of the J Pouch in Patients With Inflammatory Bowel Disease
Shintaro Akiyama, Nathaniel A Cohen, Jacob E Ollech, Cindy Traboulsi, Tina Rodriguez, Victoria Rai, Laura R Glick, Yangtian Yi, Joseph Runde, Russell D Cohen, Kinga B Skowron, Roger D Hurst, Konstantin Umanskiy, Benjamin D Shogan, Neil H Hyman, Michele A
Crohn's & Colitis 360.2024;[Epub] CrossRef

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IBD

Serum albumin is the strongest predictor of anti-tumor necrosis factor nonresponse in inflammatory bowel disease in resource-constrained regions lacking therapeutic drug monitoring: Peeyush Kumar, Sudheer K. Vuyyuru, Prasenjit Das, Bhaskar Kante, Mukesh Kumar Ranjan, David Mathew Thomas, Sandeep Mundhra, Pabitra Sahu, Pratap Mouli Venigalla, Saransh Jain, Sandeep Goyal, Rithvik Golla, Shubi Virmani, Mukesh K. Singh, Karan Sachdeva, Raju Sharma, Nihar Ranjan Dash, Govind Makharia, Saurabh Kedia, Vineet Ahuja; Intest Res 2023;21(4):460-470. Published online March 17, 2023; DOI: https://doi.org/10.5217/ir.2022.00128; Funded: Indian Council for Medical Research

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Background/Aims
Evidence on predictors of primary nonresponse (PNR), and secondary loss of response (SLR) to anti-tumor necrosis factor (anti-TNF) agents in inflammatory bowel disease is scarce from Asia. We evaluated clinical/biochemical/molecular markers of PNR/SLR in ulcerative colitis (UC) and Crohn’s disease (CD).
Methods
Inflammatory bowel disease patients treated with anti-TNF agents (January 2005–October 2020) were ambispectively included. Data concerning clinical and biochemical predictors was retrieved from a prospectively maintained database. Immunohistochemistry for expression of oncostatin M (OSM), OSM receptor (OSM-R), and interleukin-7 receptor (IL-7R) were done on pre anti-TNF initiation mucosal biopsies.
Results
One-hundred eighty-six patients (118 CD, 68 UC: mean age, 34.1±13.7 years; median disease duration at anti-TNF initiation, 60 months; interquartile range, 28–100.5 months) were included. PNR was seen in 17% and 26.5% and SLR in 47% and 28% CD and UC patients, respectively. In CD, predictors of PNR were low albumin (P<0.001), postoperative recurrence (P=0.001) and high IL-7R expression (P<0.027) on univariate; and low albumin alone (hazard ratio [HR], 0.09; 95% confidence interval [CI], 0.03–0.28; P<0.001) on multivariate analysis respectively. Low albumin (HR, 0.31; 95% CI, 0.15–0.62; P=0.001) also predicted SLR. In UC, predictors of PNR were low albumin (P<0.001), and high C-reactive protein (P<0.001), OSM (P<0.04) and OSM-R (P=0.07) stromal expression on univariate; and low albumin alone (HR, 0.11; 95% CI, 0.03–0.39; P=0.001) on multivariate analysis respectively.
Conclusions
Low serum albumin at baseline significantly predicted PNR in UC and PNR/SLR in CD patients. Mucosal markers of PNR were high stromal OSM/OSM-R in UC and high IL-7R in CD patients.

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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
Tofacitinib in Steroid-Refractory Acute Severe Ulcerative Colitis: A Retrospective Analysis
Sayan Malakar, Srikanth Kothalkar, Umair Shamsul Hoda, Uday C Ghoshal
Cureus.2023;[Epub] CrossRef

4,298 View
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IBD

Treatment of primary sclerosing cholangitis combined with inflammatory bowel disease: You Sun Kim, Edward H. Hurley, Yoojeong Park, Sungjin Ko; Intest Res 2023;21(4):420-432. Published online September 1, 2023; DOI: https://doi.org/10.5217/ir.2023.00039; Funded: National Institutes of Health, PLRC Pilot and Feasibility, Pittsburgh Liver Research Center

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Primary sclerosing cholangitis (PSC) is a progressive cholestatic, inflammatory, and fibrotic disease that is strongly associated with inflammatory bowel disease (IBD). PSC-IBD represents a unique disease entity and patients with this disease have an increased risk of malignancy development, such as colorectal cancer and cholangiocarcinoma. The pathogenesis of PSC-IBD involves genetic and environmental factors such as gut dysbiosis and bile acids alteration. However, despite the advancement of disease characteristics, no effective medical therapy has proven to have a significant impact on the prognosis of PSC. The treatment options for patients with PSC-IBD do not differ from those for patients with PSC alone. Potential candidate drugs have been developed based on the pathogenesis of PSC-IBD, such as those that target modulation of bile acids, inflammation, fibrosis, and gut dysbiosis. In this review, we summarize the current medical treatments for PSC-IBD and the status of new emerging therapeutic agents.

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Novel preclinical developments of the primary sclerosing cholangitis treatment landscape
Aalam Sohal, Kris V. Kowdley
Expert Opinion on Investigational Drugs.2024; 33(4): 335. CrossRef
Gut Microbiota in Primary Sclerosing Cholangitis: From Prognostic Role to Therapeutic Implications
Valeria Maccauro, Francesca Fianchi, Antonio Gasbarrini, Francesca Romana Ponziani
Digestive Diseases.2024; 42(4): 369. CrossRef
Global research trends on the relationship between IBD and CRC: a bibliometric analysis from 2000 to 2023
Hao Zhang, Huiru Xin, Mengqi Zhao, Chenyang Bi, Yafei Xiao, Yifan Li, Changjiang Qin
Journal of Health, Population and Nutrition.2024;[Epub] CrossRef
Halitosis: an underestimated but important extraintestinal manifestation in inflammatory bowel disease
Xiao Xian Qian
Intestinal Research.2024; 22(3): 387. CrossRef
Hepatic Nuclear Receptors in Cholestasis-to-Cholangiocarcinoma Pathology
Inyoung Cheon, Minwook Kim, Kang Ho Kim, Sungjin Ko
The American Journal of Pathology.2024;[Epub] CrossRef

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Colorectal neoplasia

The elderly population are more vulnerable for the management of colorectal cancer during the COVID-19 pandemic: a nationwide, population-based study: Hong Sun Kang, Seung Hoon Jeon, Su Bee Park, Jin Young Youn, Min Seob Kwak, Jae Myung Cha; Intest Res 2023;21(4):500-509. Published online August 29, 2023; DOI: https://doi.org/10.5217/ir.2023.00004; Funded: Ministry of Food and Drug Safety

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Background/Aims
The impact of coronavirus disease 2019 (COVID-19) on the management of colorectal cancer (CRC) may worse in elderly population, as almost all COVID-19 deaths occurred in the elderly patients. This study aimed to evaluate the impact of COVID-19 on CRC management in the elderly population.
Methods
The numbers of patients who underwent colonoscopy, who visited hospitals or operated for CRC in 2020 and 2021 (COVID-19 era) were compared with those in 2019, according to 3 age groups (≥70 years, 50–69 years, and ≤49 years), based on the nationwide, population-based database (2019–2021) in South Korea.
Results
The annual volumes of colonoscopy and hospital visits for CRC in 2020 were more significantly declined in the old age group than in the young age group (both P<0.001). In addition, the annual volume of patients operated for CRC numerically more declined in old age group than in young age group. During the first surge of COVID-19 (March and April 2020), old age patients showed statistically significant declines for the monthly number of colonoscopies (–46.5% vs. –39.3%, P<0.001), hospital visits (–15.4% vs. –7.9%, P<0.001), CRC operations (–33.8% vs. –0.7%, P<0.05), and colonoscopic polypectomies (–41.8% vs. –38.0%, P<0.001) than young age patients, compared with those of same months in 2019.
Conclusions
Elderly population are more vulnerable for the management of CRC during the COVID-19 pandemic. Therefore, the elderly population are more carefully cared for in the management of CRC during the next pandemic.

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To overcome medical gap in screening and surveillance of colorectal cancer during the COVID-19 pandemic
Yoo Min Han
Intestinal Research.2023; 21(4): 418. CrossRef

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197 Download
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1 Crossref

Microbiota

Gut microbiome on immune checkpoint inhibitor therapy and consequent immune-related colitis: a review: Sung Wook Hwang, Min Kyu Kim, Mi-Na Kweon; Intest Res 2023;21(4):433-442. Published online August 29, 2023; DOI: https://doi.org/10.5217/ir.2023.00019; Funded: Asan Institute for Life Sciences, Asan Medical Center

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Immune checkpoint inhibitors have dramatically revolutionized the therapeutic landscape for patients with advanced malignancies. Recently, convincing evidence has shown meaningful influence of gut microbiome on human immune system. With the complex link between gut microbiome, host immunity and cancer, the variations in the gut microbiota may influence the efficacy of immune checkpoint inhibitors. Indeed, some bacterial species have been reported to be predictive for cancer outcome in patients treated with immune checkpoint inhibitors. Although immune checkpoint inhibitors are currently proven to be an effective anti-tumor treatment, they can induce a distinct form of toxicity, termed immune-related adverse events. Immune-related colitis is one of the common toxicities from immune checkpoint inhibitors, and it might preclude the cancer therapy in severe or refractory cases. The manipulation of gut microbiome by fecal microbiota transplantation or probiotics administration has been suggested as one of the methods to enhance anti-tumor effects and decrease the risk of immune-related colitis. Here we review the role of gut microbiome on immune checkpoint inhibitor therapy and consequent immune-related colitis to provide a new insight for better anti-cancer therapy.

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Date yogurt supplemented with Lactobacillus rhamnosus (ATCC 53103) encapsulated in wild sage (Salvia macrosiphon) mucilage and sodium alginate by extrusion: The survival and viability against the gastrointestinal condition, cold storage, heat, and salt wi
Mahsa Abbasi Saadi, Seyed Saeed Sekhavatizadeh, Hassan Barzegar, Behrooz Alizadeh Behbahani, Mohammad Amin Mehrnia
Food Science & Nutrition.2024; 12(10): 7630. CrossRef
Toxicity in the era of immune checkpoint inhibitor therapy
Synat Keam, Naimah Turner, Fernanda G. Kugeratski, Rene Rico, Jocelynn Colunga-Minutti, Rayansh Poojary, Sayan Alekseev, Anisha B. Patel, Yuanteng Jeff Li, Ajay Sheshadri, Monica E. Loghin, Karin Woodman, Ashley E. Aaroe, Sarah Hamidi, Priyanka Chandrasek
Frontiers in Immunology.2024;[Epub] CrossRef
Endoscopic findings of immune checkpoint inhibitor-related gastrointestinal adverse events
Min Kyu Kim, Sung Wook Hwang
Clinical Endoscopy.2024; 57(6): 725. CrossRef

3,420 View
303 Download
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3 Crossref

IBD

Clinical features of enteric and colo-duodenal fistula in patients with Crohn’s disease: Jun Su Lee, Sang-Bum Kang, Kwangbeom Park, Yong Sik Yoon, Chang Sik Yu, Sung Wook Hwang, Byong Duk Ye, Suk-Kyun Yang, Jong Lyul Lee, Sang Hyoung Park; Intest Res 2023;21(3):406-410. Published online February 22, 2023; DOI: https://doi.org/10.5217/ir.2022.00125; Funded: Korea Health Industry Development Institute, Ministry of Health and Welfare, National Research Foundation of Korea, Ministry of Science and ICT

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The potential for medical therapies to address fistulizing Crohn’s disease: a state-of-the-art review
Mohammad Shehab, Davide De Marco, Peter L. Lakatos, Talat Bessissow
Expert Opinion on Biological Therapy.2024; 24(8): 733. CrossRef

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253 Download
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IBD

Does caffeine have a double-edged sword role in inflammation and carcinogenesis in the colon?: Emiko Mizoguchi, Takayuki Sadanaga, Toshiyuki Okada, Takanori Minagawa, Jun Akiba; Intest Res 2023;21(3):306-317. Published online April 20, 2023; DOI: https://doi.org/10.5217/ir.2022.00118; Funded: Ishibashi Foundation for the Promotion of Science, Japan Society for the Women’s Health Science, Fukuoka Clinical Medical Research Award, Japanese Society for the Promotion of Science

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Caffeine (1,3,7-trimethylxanthine, also abbreviated to CAF) is a natural chemical with stimulant effects and is commonly included in many drinks and foods, including coffee, tea, cola, energy drinks, cocoa, chocolates, and so on. Our group previously reported that oral administration of CAF efficiently suppressed the development of intestinal inflammation in a dextran sulfate sodium (DSS)-induced murine acute colitis model by suppressing the expression of chitinase 3-like 1, one of the mammalian chitinases without enzymatic activity. Chitinases are hydrolytic enzymes that break down chitin, a polymer of N-acetylglucosamine, and chitinase-like proteins have no enzymatic activity with preserving chitin-binding ability. CAF binds a cleft of the chitinase active site and plays a role as a pan-chitinase inhibitor. Although CAF showed an anti-inflammatory effect in the above model, oral administration of low-dose CAF with 10% sucrose showed potentially neoplastic effects in colonic epithelial cells in a DSS-induced murine chronic colitis model. In this review, we would like to discuss the pros and cons of coffee/CAF in colonic inflammation and neoplasia with an example of pathological finding.

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Evaluation of the effect of roasting and digestion on biological activity of compounds of coffee extracts - in vitro assessment of the bioavailability, cytoprotective properties and modulation of inflammatory response
Joanna Grzelczyk, Grażyna Budryn, Dominik Szwajgier, Ewa Baranowska-Wójcik, Małgorzata Zakłos-Szyda
Food Chemistry.2024; 460: 140648. CrossRef
Recently Updated Role of Chitinase 3-like 1 on Various Cell Types as a Major Influencer of Chronic Inflammation
Emiko Mizoguchi, Takayuki Sadanaga, Linda Nanni, Siyuan Wang, Atsushi Mizoguchi
Cells.2024; 13(8): 678. CrossRef
Comprehensive evaluation of Capsosiphon fulvescens water extract: Assessing its effects on intestinal barrier integrity and inflammation in vitro and in vivo
Yu Rim Kim, Soo-yeon Park, Ji Yeon Kim
Journal of Functional Foods.2024; 123: 106563. CrossRef

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IBD

Animal models of inflammatory bowel disease: novel experiments for revealing pathogenesis of colitis, fibrosis, and colitis-associated colon cancer: Chan Hyung Lee, Seong-Joon Koh, Zaher A Radi, Aida Habtezion; Intest Res 2023;21(3):295-305. Published online May 31, 2023; DOI: https://doi.org/10.5217/ir.2023.00029; Funded: National Research Foundation of Korea, Ministry of Science and ICT, National Research Foundation of Korea, Ministry of Education

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Inflammatory bowel disease (IBD), comprising Crohn’s disease and ulcerative colitis, is a lifelong disease that manifests with chronic intestinal inflammation, sequential fibrosis, and an increased risk of colitis-associated colon cancer (CAC). The combined effects of genetic, immunological, environmental, and microbial factors render it difficult to determine the specific mechanism underlying the induction and perpetuation of IBD. Various animal models of IBD have contributed enormously to the understanding of IBD pathogenesis in terms of genomics, transcriptomics, proteomics, microbiome, and drug development of novel therapeutics. Although comprehensive research on IBD has been enabled by advanced technologies, such as genetically engineered models, there is a great need to develop relevant in vivo models of colitis and fibrosis. Here, we review 4 categories of animal models of acute and chronic intestinal inflammation, fibrosis, and CAC: chemically induced, genetically engineered, T cell transfer, and spontaneous gene mutation models.

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Kyung-Soo Chun, Eun-Hee Kim, Do-Hee Kim, Na-Young Song, Wonki Kim, Hye-Kyung Na, Young-Joon Surh
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Lactobacillus paracasei Jlus66 relieves DSS-induced ulcerative colitis in a murine model by maintaining intestinal barrier integrity, inhibiting inflammation, and improving intestinal microbiota structure
Fazheng Yu, Xiaoxu Wang, Honglin Ren, Jiang Chang, Jian Guo, Zhaoqi He, Ruoran Shi, Xueyu Hu, Yuanyuan Jin, Shiying Lu, Yansong Li, Zengshan Liu, Pan Hu
European Journal of Nutrition.2024; 63(6): 2185. CrossRef
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
Intestinal Research.2024; 22(4): 453. CrossRef
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Haitao Zheng, Xiaoli Ping, Ruizi Wu, Cen Lei, Huijia Mao, Yanni Pan, Yongpeng He, Xin Zhao
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Fai-Chu Wong, Yit-Lai Chow, Sheri-Ann Tan, Lingmin Tian, Weibin Bai, Tsun-Thai Chai
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Niusha Esmaealzadeh, Amirhossein Abdolghaffari, Maryam Baeeri, Maede Hasanpour, Mehrdad Iranshahi, Cristina Santarcangelo, Mahdi Gholami, Roodabeh Bahramsoltani
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Marisa O Pacheco, Isabelle K Gerzenshtein, Whitney L Stoppel, Carlos M Rinaldi‐Ramos
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Estrogen Receptor β Activation Mitigates Colitis-associated Intestinal Fibrosis via Inhibition of TGF-β/Smad and TLR4/MyD88/NF-κB Signaling Pathways
Fangmei Ling, Yidong Chen, Junrong Li, Mingyang Xu, Gengqing Song, Lei Tu, Huan Wang, Shuang Li, Liangru Zhu
Inflammatory Bowel Diseases.2024;[Epub] CrossRef
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Hye-Myung Ryu, S. M. Shamsul Islam, Bushra Riaz, Hasan M. Sayeed, Bunsoon Choi, Seonghyang Sohn
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Immuno-therapeutic and prophylactic potential of Trichinella spiralis antigens for inflammatory bowel diseases
Majed H. Wakid, Walaa A. El Kholy, Muslimah N. Alsulami, Eman S. El-Wakil
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Leveraging Organ‐on‐Chip Models to Investigate Host–Microbiota Dynamics and Targeted Therapies for Inflammatory Bowel Disease
Tim Kaden, Raquel Alonso‐Román, Johannes Stallhofer, Mark S. Gresnigt, Bernhard Hube, Alexander S. Mosig
Advanced Healthcare Materials.2024;[Epub] CrossRef
Development of a novel complex inflammatory bowel disease mouse model: Reproducing human inflammatory bowel disease etiologies in mice
Sun-Min Seo, Na-Won Kim, Eun-Seon Yoo, Ji-Hun Lee, Ah-Reum Kang, Han-Bi Jeong, Won-Yong Shim, Dong-Hyun Kim, Young-Jun Park, Kieun Bae, Kyong-Ah Yoon, Yang-Kyu Choi, Pradeep Dudeja
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Gut Microbiome and Colorectal Cancer
Tae-Geun Gweon
The Korean Journal of Gastroenterology.2023; 82(2): 56. CrossRef
Mitochondrial dysfunctions in T cells: focus on inflammatory bowel disease
Hoyul Lee, Jae-Han Jeon, Eun Soo Kim
Frontiers in Immunology.2023;[Epub] CrossRef

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Functional bowel disorder

An Asian perspective on irritable bowel syndrome: Kee Wook Jung, Seung-Jae Myung; Intest Res 2023;21(2):189-195. Published online May 31, 2022; DOI: https://doi.org/10.5217/ir.2021.00136; Funded: National Research Foundation of Korea, Ministry of Education, Korea Health Industry Development Institute, Ministry of Health and Welfare

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Irritable bowel syndrome (IBS) is a prevalent chronic disorder, and its epidemiology depends on the diagnostic criteria used. Recently, the Rome IV criteria for IBS were published by changing the frequency of abdominal pain and excluding abdominal discomfort from the previously used Rome III criteria. However, the recent Asian consensus on IBS recommends the inclusion of abdominal discomfort and abdominal pain as diagnostic criteria. The low fermentable oligo-, di-, mono-saccharides, and polyols (FODMAP) diet has been proven to be effective in Western patients. Moreover, recent well-designed studies reported its effectiveness and the microbial changes after implementing it in Asian patients with IBS. However, traditional Korean foods including kimchi, one of representative FODMAP-rich food, exhibited a poor correlation with the food-related symptoms of IBS. Therefore, the low FODMAP diet protocol should be cautiously applied to IBS patients, especially to Korean patients with IBS. In Asian countries, there are lots of traditional herbal medicines and treatments for IBS; however, these studies have limitations including the heterogeneity of herbal mixtures and relatively small sample size. Therefore, well-designed studies based on large samples are required to validate complementary and alternative medicine in the treatment of Asian patients with IBS.

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The Role of Diet in the Management of Irritable Bowel Syndrome: A Comprehensive Review
Maleesha Jayasinghe , Vinuri Karunanayake, Ali Mohtashim, Dilushini Caldera , Piyalka Mendis , Omesh Prathiraja, Fatemeh Rashidi, John A Damianos
Cureus.2024;[Epub] CrossRef
Downregulated APOD and FCGR2A correlates with immune infiltration and lipid-induced symptoms of irritable bowel syndrome
Yamei Ran, Kangqi Wu, Chenglin Hu, Renzheng Liang, Li Zhang, Juan Xiao, Yongmei Peng, Wenjing Sun
Scientific Reports.2023;[Epub] CrossRef
Technical Feasibility of Quantitative Measurement of Various Degrees of Small Bowel Motility Using Cine Magnetic Resonance Imaging
Ji Young Choi, Jihye Yun, Subin Heo, Dong Wook Kim, Sang Hyun Choi, Jiyoung Yoon, Kyuwon Kim, Kee Wook Jung, Seung-Jae Myung
Korean Journal of Radiology.2023; 24(11): 1093. CrossRef
Letter to the Editor: Survey-Based Analysis of Clinical Treatment Status of Irritable Bowel Syndrome in Korea: Suggestions for Future Research
Ji Young Chang
Journal of Korean Medical Science.2023;[Epub] CrossRef
Effectiveness of Medilac-S as an Adjuvant to Conventional Irritable Bowel Syndrome Treatments: A Systematic Review with Meta-Analysis
Annie Tremblay, Xiaoyu Xu, James Colee, Thomas A. Tompkins, Sylvie Binda
Gastroenterology Insights.2023; 14(4): 491. CrossRef
Comments on Efficacy of a Synbiotic Containing Lactobacillus paracasei DKGF1 and Opuntia humifusa in Elderly Patients with Irritable Bowel Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial
Kwang Woo Kim
Gut and Liver.2023; 17(6): 954. CrossRef

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Infection

Interferon-gamma release assay has poor diagnostic accuracy in differentiating intestinal tuberculosis from Crohn’s disease in tuberculosis endemic areas: Karan Sachdeva, Peeyush Kumar, Bhaskar Kante, Sudheer K. Vuyyuru, Srikant Mohta, Mukesh K. Ranjan, Mukesh K. Singh, Mahak Verma, Govind Makharia, Saurabh Kedia, Vineet Ahuja; Intest Res 2023;21(2):226-234. Published online June 13, 2022; DOI: https://doi.org/10.5217/ir.2022.00010; Funded: Indian Council of Medical Research, Center for Advanced Research in Intestinal Diseases

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Background/Aims
Intestinal tuberculosis (ITB) and Crohn’s disease (CD) frequently present with a diagnostic dilemma because of similar presentation. Interferon-gamma release assay (IGRA) has been used in differentiating ITB from CD, but with sparse reports on its diagnostic accuracy in tuberculosis endemic regions and this study evaluated the same.
Methods
Patients with definitive diagnosis of ITB (n=59) or CD (n=49) who underwent IGRA testing (n=307) were retrospectively included at All India Institute of Medical Sciences, New Delhi (July 2014 to September 2021). CD or ITB was diagnosed as per standard criteria. IGRA was considered positive at >0.35 IU/mL. Relevant data was collected and IGRA results were compared between ITB and CD to determine its accuracy.
Results
Among 59 ITB patients (mean age, 32.6±13.1 years; median disease duration, 1 year; male, 59.3%), 24 were positive and 35 tested negative for IGRA. Among 49 CD patients (mean age, 37.8±14.0; median disease duration, 4 years; male, 61.2%), 12 were positive and 37 tested negative for IGRA. Hence, for diagnosing ITB, IGRA showed a sensitivity, specificity, positive and negative predictive values of 40.68%, 75.51%, 66.67%, and 51.39%, respectively. The area under the curve of IGRA for ITB diagnosis was 0.66 (95% confidence interval, 0.55–0.75). In a subset (n=64), tuberculin skin test (TST) showed sensitivity, specificity, positive and negative predictive values of 64.7%, 73.3%, 73.3%, and 64.71%, respectively. IGRA and TST were concordant in 38 (59.4%) patients with κ=0.17.
Conclusions
In a tuberculosis endemic region, IGRA had poor diagnostic accuracy for differentiating ITB from CD, suggesting a limited value of IGRA in this setting.

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New diagnostic strategies to distinguish Crohn's disease and gastrointestinal tuberculosis
Himanshu Narang, Saurabh Kedia, Vineet Ahuja
Current Opinion in Infectious Diseases.2024; 37(5): 392. CrossRef
Interferon-gamma release assays as a tool for differential diagnosis of gastrointestinal tuberculosis
Tsvetelina Velikova, Anita Aleksandrova
World Journal of Clinical Cases.2024; 12(27): 6015. CrossRef
Diagnostic yield and technical performance of the novel motorized spiral enteroscopy compared with single-balloon enteroscopy in suspected Crohn's disease: a prospective study (with video)
Partha Pal, Piyush Vishwakarma, Aniruddha Pratap Singh, Palle Manohar Reddy, Mohan Ramchandani, Rupa Banerjee, Anuradha Sekaran, Polina Vijayalaxmi, Hardik Rughwani, Pradev Inavolu, Santosh Darishetty, Pradeep Rebala, Guduru Venkat Rao, Manu Tandan, D. Na
Gastrointestinal Endoscopy.2023; 97(3): 493. CrossRef
Evidence-based approach to diagnosis and management of abdominal tuberculosis
Daya Krishna Jha, Mythili Menon Pathiyil, Vishal Sharma
Indian Journal of Gastroenterology.2023; 42(1): 17. CrossRef
Technical performance and diagnostic yield of motorised spiral enteroscopy compared with single-balloon enteroscopy in suspected Crohn’s disease: a randomised controlled, open-label study (the MOTOR-CD trial)
Partha Pal, Mohan Ramchandani, Rupa Banerjee, Piyush Viswakarma, Aniruddha Pratap Singh, Manohar Reddy, Hardik Rughwani, Rajendra Patel, Anuradha Sekaran, Swathi Kanaganti, Santosh Darisetty, Zaheer Nabi, Jagadish Singh, Rajesh Gupta, Sundeep Lakhtakia, R
Gut.2023; 72(10): 1866. CrossRef

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Anti-inflammatory properties of butyrate-producing atypical Escherichia coli in a murine colitis model: Ji Hyung Kim, Jee In Yoo, Hyun Woo Ma, I Seul Park, Mijeong Son, Yoojin Shin, Ki Beom Kim, Seung Won Kim, Si Jae Park, Jihye Park; Intest Res 2023;21(2):266-269. Published online November 14, 2022; DOI: https://doi.org/10.5217/ir.2022.00112; Funded: Daewoong Foundation, National Research Foundation of Korea, Ministry of Science and ICT

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Laparoscopic surgery contributes to a decrease in short-term complications in surgical ulcerative colitis patients during 2008–2017: a multicenter retrospective study in China: Zerong Cai, Xiaosheng He, Jianfeng Gong, Peng Du, Wenjian Meng, Wei Zhou, Jinbo Jiang, Bin Wu, Weitang Yuan, Qi Xue, Lianwen Yuan, Jinhai Wang, Jiandong Tai, Jie Liang, Weiming Zhu, Ping Lan, Xiaojian Wu; Intest Res 2023;21(2):235-243. Published online December 2, 2022; DOI: https://doi.org/10.5217/ir.2022.00012; Funded: National Natural Science Foundation of China, Science and Technology Planning Project of Guangdong Province, National Key Clinical Discipline in general surgery

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Background/Aims
The aim of this study was to analyze the chronological changes in postoperative complications in surgical ulcerative colitis patients over the past decade in China and to investigate the potential parameters that contributed to the changes.
Methods
Ulcerative colitis patients who underwent surgery during 2008–2017 were retrospectively enrolled from 13 hospitals in China. Postoperative complications were compared among different operation years. Risk factors for complications were identified by logistic regression analysis.
Results
A total of 446 surgical ulcerative colitis patients were analyzed. Fewer short-term complications (24.8% vs. 41.0%, P=0.001) and more laparoscopic surgeries (66.4% vs. 25.0%, P<0.001) were found among patients who received surgery during 2014–2017 than 2008–2013. Logistic regression suggested that independent protective factors against short-term complications were a higher preoperative body mass index (odds ratio [OR], 0.870; 95% confidence interval [CI], 0.785–0.964; P=0.008), laparoscopic surgery (OR, 0.391; 95% CI, 0.217–0.705; P=0.002) and elective surgery (OR, 0.213; 95% CI, 0.067–0.675; P=0.009). The chronological decrease in short-term complications was associated with an increase in laparoscopic surgery.
Conclusions
Our data revealed a downward trend of short-term postoperative complications among surgical ulcerative colitis patients in China during the past decade, which may be due to the promotion of minimally invasive techniques among Chinese surgeons.

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Surgical Options for Appropriate Length of J-Pouch Construction for Better Outcomes and Long-term Quality of Life in Patients with Ulcerative Colitis after Ileal Pouch-Anal Anastomosis
Weimin Xu, Wenbo Tang, Wenjun Ding, Zhebin Hua, Yaosheng Wang, Xiaolong Ge, Long Cui, Xiaojian Wu, Wei Zhou, Zhao Ding, Peng Du
Gut and Liver.2024; 18(1): 85. CrossRef
Time trend in surgical indications and outcomes in ulcerative colitis—A two decades in-depth retrospective analysis
Guillaume Le Cosquer, Lena Capirchio, Pauline Rivière, Marie Armelle Denis, Florian Poullenot, Christophe Remue, Frank Zerbib, Daniel Leonard, Bertrand Célérier, Alex Kartheuser, David Laharie, Olivier Dewit
Digestive and Liver Disease.2023; 55(10): 1338. CrossRef
Surgical Treatment in Ulcerative Colitis, Still Topical: A Narrative Review
Eduard Slonovschi, Pratyusha Kodela, Monalisa Okeke, Sandeep Guntuku, Shanmukh Sai Pavan Lingamsetty
Cureus.2023;[Epub] CrossRef
Surgical outcomes and stoma-related complications in inflammatory bowel disease in Saudi Arabia: a retrospective study
Thamer A. Bin Traiki, Sulaiman A. Alshammari, Mansoor A. Abdulla, Fayez G. Aldarsouni, Noura S. Alhassan, Maha-Hamdien Abdullah, Awadh Alqahtani, Khayal A. Alkhayal
Annals of Saudi Medicine.2023; 43(6): 386. CrossRef

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IBD

Risks of colorectal cancer and biliary cancer according to accompanied primary sclerosing cholangitis in Korean patients with ulcerative colitis: a nationwide population-based study: Eun Hye Oh, Ye-Jee Kim, Minju Kim, Seung Ha Park, Tae Oh Kim, Sang Hyoung Park; Intest Res 2023;21(2):252-265. Published online December 2, 2022; DOI: https://doi.org/10.5217/ir.2022.00092; Funded: Korean Society of Gastroenterology

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
We conducted a nationwide population-based study to investigate incidence rates of colorectal and biliary cancers according to accompanying primary sclerosing cholangitis in Korean ulcerative colitis patients.
Methods
We used the Health Insurance Review and Assessment claim database from January 2007 to April 2020. Standardized incidence ratios of colorectal and biliary cancers in ulcerative colitis patients were calculated.
Results
Among 35,189 newly diagnosed ulcerative colitis patients, 1,224 patients were diagnosed with primary sclerosing cholangitis. During the study period, 122 and 52 patients were diagnosed with colorectal and biliary cancers, respectively. Incidences of colorectal cancer were not higher in ulcerative colitis patients than those in the general population (standardized incidence ratios, 0.83; 95% confidence interval, 0.69–0.99), regardless of accompanied primary sclerosing cholangitis (standardized incidence ratio, 0.73; 95% confidence interval, 0.24–1.71). While incidences of biliary cancer were not higher in ulcerative colitis patients than those in the general population (standardized incidence ratio, 1.14; 95% confidence interval, 0.80–1.58), these were much higher with accompanied primary sclerosing cholangitis (standardized incidence ratio, 10.07; 95% confidence interval, 5.75–16.36). Cumulative incidences of colorectal and biliary cancers increased in patients who were diagnosed with ulcerative colitis at an older age.
Conclusions
In Korean ulcerative colitis patients, colorectal cancer incidences were not higher than those in the general population regardless of accompanied primary sclerosing cholangitis. However, biliary cancer incidences were much higher in ulcerative colitis patients with primary sclerosing cholangitis than in those without, or in the general population.

Citations

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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
Are the risks of colorectal cancer and biliary cancer really increased if patients with ulcerative colitis have primary sclerosing cholangitis?
Jung Wook Lee, Won Moon
Intestinal Research.2023; 21(2): 171. CrossRef

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IBD

Performing colonoscopy before steroid induction is associated with shorter steroid use in patients with ulcerative colitis: Taku Kobayashi, Eri Udagawa, Lisa Hirose, Toshifumi Hibi; Intest Res 2023;21(2):205-215. Published online December 15, 2022; DOI: https://doi.org/10.5217/ir.2021.00164; Funded: Takeda Pharmaceutical Company

Abstract PDF PubReader ePub: Background/Aims
Risks of long-term steroid use in patients with ulcerative colitis (UC) outweigh the benefits, thus dosing should be tapered once a response is achieved. Colonoscopy is a key technique for assessing disease severity and optimizing treatment involving steroids. This retrospective longitudinal cohort study of patients with UC explored factors associated with the duration of systemic steroid use.
Methods
The Japan Medical Data Center database, an employer-based insurance claims database, was used to select individuals initiating prednisolone, with a prescription issued between January 1, 2010, and January 31, 2018. The study included adults with a confirmed diagnosis of UC, who had received ≥1 year of continuous treatment with 5-aminosalicylic acid, biologics, or thiopurine. Factors associated with prednisolone duration were assessed using a multivariate regression model.
Results
Median duration of prednisolone treatment was 98 days, and colonoscopy was performed ≤1 month before or at the first prescription of prednisolone (index date) in 32.8% of patients (607/1,853). Shorter durations of prednisolone treatment were associated with colonoscopy ≤1 month before or at the index date and higher prednisolone dose at index date, with incidence rate ratios (IRRs) of 0.776 (95% confidence interval [CI], 0.682–0.884; P<0.001) and 0.998 (95% CI, 0.996–1.000; P=0.018), respectively. Charlson Comorbidity Index scores of 1 and ≥2 predicted longer prednisolone treatment (IRR, 1.332; 95% CI, 1.174–1.511; P<0.001 and IRR, 1.599; 95% CI, 1.357–1.885; P<0.001, respectively).
Conclusions
Performing colonoscopy before or at the time of initiating steroid was associated with a shorter duration of steroid use in patients with UC.

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An oval-shaped calcification in Crohn’s disease patient with mechanical ileus: Young Min Kwak, Dong Hoon Baek, Byoung Chul Lee; Intest Res 2023;21(2):270-272. Published online March 3, 2023; DOI: https://doi.org/10.5217/ir.2022.00134; Funded: Pusan National University Hospital

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Efficacy and safety of filgotinib as induction and maintenance therapy for Japanese patients with moderately to severely active ulcerative colitis: a post-hoc analysis of the phase 2b/3 SELECTION trial: Toshifumi Hibi, Satoshi Motoya, Tadakazu Hisamatsu, Fumihito Hirai, Kenji Watanabe, Katsuyoshi Matsuoka, Masayuki Saruta, Taku Kobayashi, Brian G Feagan, Chantal Tasset, Robin Besuyen, Chohee Yun, Gerald Crans, Jie Zhang, Akira Kondo, Mamoru Watanabe; Intest Res 2023;21(1):110-125. Published online March 11, 2022; DOI: https://doi.org/10.5217/ir.2021.00143; Funded: Gilead Sciences, Inc. (Foster City, CA, USA), Galapagos (Mechelen, Belgium)

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
The safety and efficacy of filgotinib, a once-daily oral Janus kinase 1 preferential inhibitor, were evaluated in Japanese patients with ulcerative colitis (UC) in the phase 2b/3 SELECTION trial.
Methods
SELECTION (NCT02914522) was a randomized, placebo-controlled trial comprising 2 induction studies and a maintenance study. Adults with moderately to severely active UC were randomized in induction study A (biologic-naïve) or B (biologic-experienced) to receive filgotinib 200 mg, 100 mg, or placebo once daily for 11 weeks. Patients in clinical remission or Mayo Clinic score response at week 10 entered the 47-week maintenance study. Efficacy and safety outcomes were assessed in Japanese patients enrolled in Japan.
Results
Overall, 37 and 72 Japanese patients were enrolled in Japan in induction studies A and B, respectively, and 54 entered the maintenance study. Numerically higher proportions of filgotinib 200 mg-treated than placebo-treated patients achieved clinical remission in induction study A (4/15 [26.7%] vs. 0/6 [0%]) and the maintenance study (5/20 [25.0%] vs. 0/9 [0%]), but not induction study B (1/29 [3.4%] vs. 1/14 [7.1%]). Both doses were well tolerated, and no new safety signals were noted. Herpes zoster was reported in 1 filgotinib 200 mg-treated patient in each of induction study A (2.3%, 1/44) and the maintenance study (5.0%, 1/20).
Conclusions
These data, alongside those of the overall SELECTION population, suggest the potential of filgotinib 200 mg as a viable treatment option for Japanese patients with UC. Owing to small patient numbers, data should be interpreted cautiously.

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Olga Maria Nardone, Irene Zammarchi, Giovanni Santacroce, Subrata Ghosh, Marietta Iacucci
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Cancers.2023; 15(15): 3824. CrossRef
Integrated safety analysis of filgotinib for ulcerative colitis: Results from SELECTION and SELECTIONLTE
Stefan Schreiber, Gerhard Rogler, Mamoru Watanabe, Séverine Vermeire, Christian Maaser, Silvio Danese, Margaux Faes, Paul Van Hoek, Jeremy Hsieh, Ulrik Moerch, Yan Zhou, Angela de Haas, Christine Rudolph, Alessandra Oortwijn, Edward V. Loftus
Alimentary Pharmacology & Therapeutics.2023; 58(9): 874. CrossRef
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Zhimin Wu, Tao Zhang, Xiaofei Ma, Shuai Guo, Qingqing Zhou, Arshad Zahoor, Ganzhen Deng
Inflammopharmacology.2023; 31(6): 2901. CrossRef
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Alessandro Mannucci, Ferdinando D’Amico, Ahmad El Saadi, Laurent Peyrin-Biroulet, Silvio Danese
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