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The most viewed articles in the last three months among those published since 2022.

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IBD
Use of thiopurines in inflammatory bowel disease: an update
Arshdeep Singh, Ramit Mahajan, Saurabh Kedia, Amit Kumar Dutta, Abhinav Anand, Charles N. Bernstein, Devendra Desai, C. Ganesh Pai, Govind Makharia, Harsh Vardhan Tevethia, Joyce WY Mak, Kirandeep Kaur, Kiran Peddi, Mukesh Kumar Ranjan, Perttu Arkkila, Rakesh Kochhar, Rupa Banerjee, Saroj Kant Sinha, Siew Chien Ng, Stephen Hanauer, Suhang Verma, Usha Dutta, Vandana Midha, Varun Mehta, Vineet Ahuja, Ajit Sood
Intest Res 2022;20(1):11-30.   Published online April 15, 2021
DOI: https://doi.org/10.5217/ir.2020.00155
AbstractAbstract PDFPubReaderePub
Inflammatory bowel disease (IBD), once considered a disease of the Western hemisphere, has emerged as a global disease. As the disease prevalence is on a steady rise, management of IBD has come under the spotlight. 5-Aminosalicylates, corticosteroids, immunosuppressive agents and biologics are the backbone of treatment of IBD. With the advent of biologics and small molecules, the need for surgery and hospitalization has decreased. However, economic viability and acceptability is an important determinant of local prescription patterns. Nearly one-third of the patients in West receive biologics as the first/initial therapy. The scenario is different in developing countries where biologics are used only in a small proportion of patients with IBD. Increased risk of reactivation of tuberculosis and high cost of the therapy are limitations to their use. Thiopurines hence become critical for optimal management of patients with IBD in these regions. However, approximately one-third of patients are intolerant or develop adverse effects with their use. This has led to suboptimal use of thiopurines in clinical practice. This review article discusses the clinical aspects of thiopurine use in patients with IBD with the aim of optimizing their use to full therapeutic potential.

Citations

Citations to this article as recorded by  
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IBD
Korean clinical practice guidelines on biologics and small molecules for moderate-to-severe ulcerative colitis
Soo-Young Na, Chang Hwan Choi, Eun Mi Song, Ki Bae Bang, Sang Hyoung Park, Eun Soo Kim, Jae Jun Park, Bora Keum, Chang Kyun Lee, Bo-In Lee, Seung-Bum Ryoo, Seong-Joon Koh, Miyoung Choi, Joo Sung Kim, on behalf of the IBD Research Group of the Korean Association for the Study of Intestinal Diseases
Intest Res 2023;21(1):61-87.   Published online May 31, 2022
DOI: https://doi.org/10.5217/ir.2022.00007
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Ulcerative colitis (UC), a relapsing-remitting chronic inflammatory bowel disease (IBD), has a variable natural course but potentially severe disease course. Since the development of anti-tumor necrosis factor (TNF) agents has changed the natural disease course of moderate-to-severe UC, therapeutic options for patients who failed conventional treatments are expanding rapidly. IBD clinical trials have demonstrated the potential efficacy and safety of novel biologics such as anti-integrin α4β7 and anti-interleukin-12/23 monoclonal antibodies and small molecules such as a Janus kinase inhibitor. Anti-TNF biosimilars also have been approved and are widely used in IBD patients. Wise drug choices should be made considering evidence-based efficacy and safety. However, the best position of these drugs remains several questions, with limited data from direct comparative trials. In addition, there are still concerns to be elucidated on the effect of therapeutic drug monitoring and combination therapy with immunomodulators. The appropriate treatment regimens in acute severe UC and the risk of perioperative use of biologics are unclear. As novel biologics and small molecules have been approved in Korea, we present the Korean guidelines for medical management of adult outpatients with moderate-to-severe UC and adult hospitalized patients with acute severe UC, focusing on biologics and small molecules.

Citations

Citations to this article as recorded by  
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Microbiota
The role of microbiome in colorectal carcinogenesis and its clinical potential as a target for cancer treatment
Sang Hoon Kim, Yun Jeong Lim
Intest Res 2022;20(1):31-42.   Published online May 21, 2021
DOI: https://doi.org/10.5217/ir.2021.00034
AbstractAbstract PDFPubReaderePub
The role of gut microbiome-intestinal immune complex in the development of colorectal cancer and its progression is well recognized. Accordingly, certain microbial strains tend to colonize or vanish in patients with colorectal cancer. Probiotics, prebiotics, and synbiotics are expected to exhibit both anti-tumor effects and chemopreventive effects during cancer treatment through mechanisms such as xenometabolism, immune interactions, and altered eco-community. Microbial modulation can also be safely used to prevent complications during peri-operational periods of colorectal surgery. A deeper understanding of the role of intestinal microbiota as a target for colorectal cancer treatment will lead the way to a better prognosis for colorectal cancer patients.

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Original Article
IBD
Biomarker dynamics during infliximab salvage for acute severe ulcerative colitis: C-reactive protein (CRP)-lymphocyte ratio and CRP-albumin ratio are useful in predicting colectomy
Danny Con, Bridgette Andrew, Steven Nicolaides, Daniel R van Langenberg, Abhinav Vasudevan
Intest Res 2022;20(1):101-113.   Published online March 12, 2021
DOI: https://doi.org/10.5217/ir.2020.00146
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background/Aims
The residual risk of colectomy after infliximab salvage in steroid-refractory acute severe ulcerative colitis (ASUC) is required to inform the need for subsequent maintenance biologic therapy. The aim of this study was to determine the dynamic response of common serum biomarkers to infliximab salvage and assess their utility in predicting subsequent colectomy.
Methods
A retrospective single-center cohort study was conducted on all patients who received infliximab salvage for steroid-refractory ASUC between January 1, 2010, and July 31, 2019. Biomarkers were assessed on admission and days 1 and 3 post infliximab, and included C-reactive protein (CRP)-albumin-ratio (CAR), CRP-lymphocyte-ratio (CLR), platelet-lymphocyte-ratio (PLR) and neutrophil-lymphocyte-ratio (NLR).
Results
Of 94 patients (median age, 35 years; 67% of male), 20% required colectomy at 12 months. Biomarkers on day 3 post-infliximab best differentiated nonresponders, who had higher CRP, lower albumin and lower lymphocyte count (each P< 0.05). Day 3 predictive performance (area under the curve) for 12-month colectomy was best for CAR (0.871) and CLR (0.874), which were similar to Lindgren (0.829; P> 0.05) but superior to Mayo (0.726), partial Mayo (0.719), PLR (0.719), Ho index (0.714), NLR (0.675), Travis score (0.657) and endoscopic Mayo (0.609) (each P< 0.05). A day 3 CAR cutoff of 0.47 mg/g had 79% sensitivity, 80% specificity, 94% negative predictive value (NPV) to predict colectomy; while a day 3 CLR cutoff of 6.0 mg/109 had 84% sensitivity, 84% specificity, 96% NPV.
Conclusions
CAR and CLR measured on day 3 post infliximab salvage for steroid-refractory ASUC represent simple and routinely performed biomarkers that appear to be strong predictors of colectomy. Prospective studies are required to confirm the utility of these predictive scores.

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Review
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
AbstractAbstract PDFPubReaderePub
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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Original Article
Functional bowel disorder
An evaluation of dietary adequacy among patients with constipation-predominant irritable bowel syndrome in Malaysia
Nor Hamizah Shafiee, Nurul Huda Razalli, Norfilza M. Mokhtar, Eunice Tan, Raja Affendi Raja Ali
Intest Res 2022;20(1):124-133.   Published online January 22, 2021
DOI: https://doi.org/10.5217/ir.2020.00050
AbstractAbstract PDFPubReaderePub
Background/Aims
Substantial proportions of patients with constipation-predominant irritable bowel syndrome (IBS-C) linked their symptoms with particular intake of foods. However, there is lack of current data regarding the intake among IBS-C patients before any dietary interventions. Thus, this study aimed to evaluate the dietary adequacy among IBS-C against the standard recommended nutrient intake (RNI) and healthy controls.
Methods
A retrospective case-control study was conducted involving IBS-C patients and healthy control subjects. A validated 126-food items frequency questionnaire was administered to all the subjects to assess their dietary intake, guided by dietitians. The calculated nutrients intake for IBS-C patients was then compared against the standard RNI and healthy controls.
Results
A total of 306 subjects were recruited, among which 218 were diagnosed with IBS-C and 88 were included as healthy controls. IBS-C patients had significantly lower intake of wholegrain products, fried foods, dairy products, fruits, and vegetables compared to healthy controls. The daily intake of energy, certain macronutrients, and micronutrients among IBS-C patients was significantly lower than the healthy subjects. Less than 5% of IBS-C patients and healthy subjects achieved the standard recommendation for dietary fiber. Also, various vitamin intake (B1, B2, B6, folate, B12, E, K, and potassium) among IBS-C patients did not meet the standard RNI.
Conclusions
Dietary intakes of IBS-C patients did not meet the recommended intake for Malaysian and showed the nutritional inadequacies compared to the control subjects. Our study highlighted the importance of dietary evaluation prior to planning strategies for dietary intervention targeting IBS-C patients.

Citations

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    Marlynna Sarkawi, Raja Affendi Raja Ali, Norhazlina Abdul Wahab, Norshafila Diana Abdul Rathi, Norfilza Mohd Mokhtar
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Review
Cancer
Korean Guidelines for Postpolypectomy Colonoscopic Surveillance: 2022 revised edition
Su Young Kim, Min Seob Kwak, Soon Man Yoon, Yunho Jung, Jong Wook Kim, Sun-Jin Boo, Eun Hye Oh, Seong Ran Jeon, Seung-Joo Nam, Seon-Young Park, Soo-Kyung Park, Jaeyoung Chun, Dong Hoon Baek, Mi-Young Choi, Suyeon Park, Jeong-Sik Byeon, Hyung Kil Kim, Joo Young Cho, Moon Sung Lee, Oh Young Lee, Korean Society of Gastrointestinal Endoscopy, Korean Society of Gastroenterology, Korean Association for the Study of Intestinal Diseases
Intest Res 2023;21(1):20-42.   Published online January 31, 2023
DOI: https://doi.org/10.5217/ir.2022.00096
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Colonoscopic polypectomy is effective in decreasing the incidence and mortality of colorectal cancer (CRC). Premalignant polyps discovered during colonoscopy are associated with the risk of metachronous advanced neoplasia. Postpolypectomy surveillance is the most important method for managing advanced metachronous neoplasia. A more efficient and evidence-based guideline for postpolypectomy surveillance is required because of the limited medical resources and concerns regarding colonoscopy complications. In these consensus guidelines, an analytic approach was used to address all reliable evidence to interpret the predictors of CRC or advanced neoplasia during surveillance colonoscopy. The key recommendations state that the high-risk findings for metachronous CRC following polypectomy are as follows: adenoma ≥10 mm in size; 3 to 5 (or more) adenomas; tubulovillous or villous adenoma; adenoma containing high-grade dysplasia; traditional serrated adenoma; sessile serrated lesion containing any grade of dysplasia; serrated polyp of at least 10 mm in size; and 3 to 5 (or more) sessile serrated lesions. More studies are needed to fully comprehend the patients who are most likely to benefit from surveillance colonoscopy and the ideal surveillance interval to prevent metachronous CRC.

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    Jin-Dong Wang, Guo-Shuai Xu, Xin-Long Hu, Wen-Qiang Li, Nan Yao, Fu-Zhou Han, Yin Zhang, Jun Qu
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    Hee Man Kim, Tae Il Kim
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    Yunho Jung, Hyun Gun Kim, Dong-Hoon Yang, Hyoun Woo Kang, Jae Jun Park, Dong Hoon Baek, Jaeyoung Chun, Tae-Geun Gweon, Hyeon Jeong Goong, Min Seob Kwak, Hyun Jung Lee, Soo-Kyung Park, Jong Hoon Lee
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    Su Young Kim
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Original Article
IBD
Clinical outcomes and predictors of response for adalimumab in patients with moderately to severely active ulcerative colitis: a KASID prospective multicenter cohort study
Seung Yong Shin, Soo Jung Park, Young Kim, Jong Pil Im, Hyo Jong Kim, Kang-Moon Lee, Ji Won Kim, Sung-Ae Jung, Jun Lee, Sang-Bum Kang, Sung Jae Shin, Eun Sun Kim, You Sun Kim, Tae Oh Kim, Hyun-Soo Kim, Dong Il Park, Hyung Kil Kim, Eun Soo Kim, Young-Ho Kim, Do Hyun Kim, Dennis Teng, Jong-Hwa Kim, Wonyong Kim, Chang Hwan Choi, on behalf of the IBD Research Group of the Korean Association for the Study of Intestinal Diseases
Intest Res 2022;20(3):350-360.   Published online July 23, 2021
DOI: https://doi.org/10.5217/ir.2021.00049
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background/Aims
This study assessed the efficacy and safety of adalimumab (ADA) and explored predictors of response in Korean patients with ulcerative colitis (UC).
Methods
A prospective, observational, multicenter study was conducted over 56 weeks in adult patients with moderately to severely active UC who received ADA. Clinical response, remission, and mucosal healing were assessed using the Mayo score.
Results
A total of 146 patients were enrolled from 17 academic hospitals. Clinical response rates were 52.1% and 37.7% and clinical remission rates were 24.0% and 22.0% at weeks 8 and 56, respectively. Mucosal healing rates were 39.0% and 30.1% at weeks 8 and 56, respectively. Prior use of anti-tumor necrosis factor-α (anti-TNF-α) did not affect clinical and endoscopic responses. The ADA drug level was significantly higher in patients with better outcomes at week 8 (P<0.05). In patients with lower endoscopic activity, higher body mass index, and higher serum albumin levels at baseline, the clinical response rate was higher at week 8. In patients with lower Mayo scores and C-reactive protein levels, clinical responses, and mucosal healing at week 8, the clinical response rate was higher at week 56. Serious adverse drug reactions were identified in 2.8% of patients.
Conclusions
ADA is effective and safe for induction and maintenance in Korean patients with UC, regardless of prior anti-TNF-α therapy. The ADA drug level is associated with the efficacy of induction therapy. Patients with better short-term outcomes were predictive of those with an improved long-term response.

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    Soo-Young Na
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Reviews
IBD
Update on the epidemiology of inflammatory bowel disease in Asia: where are we now?
Sang Hyoung Park
Intest Res 2022;20(2):159-164.   Published online April 29, 2022
DOI: https://doi.org/10.5217/ir.2021.00115
AbstractAbstract PDFPubReaderePub
Inflammatory bowel disease (IBD) has become a global disease. As IBD is a chronic disease that can result in remarkable morbidity and disability, estimation and understanding the disease burden of IBD is imperative to prepare adequate health care systems. However, variations in IBD incidence or prevalence may reflect differences in the distribution, and there are regional disparities in Asia with a large population of approximately 4.6 billion in 2020, which is equivalent to 60% of the total world population. Although comprehensive understanding of the epidemiology of IBD in Asian countries is difficult, this review includes updated data regarding the incidence and prevalence of IBD and the estimated disease burden in Asia.

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    Kwang Woo Kim, Hyoun Woo Kang
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    Eun Ae Kang, Jae Hee Cheon
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    De-feng Li, Mei-feng Yang, Hao-ming Xu, Min-zheng Zhu, Yuan Zhang, Cheng-mei Tian, Yu-qiang Nie, Jian-yao Wang, Yu-jie Liang, Jun Yao, Li-sheng Wang
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    Saheli Biswas, Ena Ray Banerjee
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    Tae Il Kim
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    You Sun Kim, Min Jeong Na, Byong Duk Ye, Jae Hee Cheon, Jong Pil Im, Joo Sung Kim
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    Jasminka Talapko, Aleksandar Včev, Tomislav Meštrović, Emina Pustijanac, Melita Jukić, Ivana Škrlec
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IBD
An integrative review of physical activity in adults with inflammatory bowel disease
Suja P Davis, Patricia B. Crane, Linda P. Bolin, Lee Ann Johnson
Intest Res 2022;20(1):43-52.   Published online January 22, 2021
DOI: https://doi.org/10.5217/ir.2020.00049
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Adults with inflammatory bowel disease (IBD) search for self-management strategies to manage their symptoms and improve their quality of life (QOL). Physical activity (PA) is one of the self-management strategies widely adopted by adults with IBD. This integrative review aimed to synthesize the evidence on health outcomes of PA in adults with IBD as well as to identify the barriers to engaging in PA. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), published literature was searched to identify the articles that addressed PA in adults with IBD. Twenty-eight articles met the inclusion criteria. Many of the reviewed studies used the terms of PA and exercise interchangeably. Walking was the most common PA reported in the studies. The findings from the majority of the reviewed studies supported the benefits of moderate-intensity exercise/PA among adults with IBD. The reviewed studies noted the following positive health outcomes of PA: improvement in QOL, mental health, sleep quality, gastrointestinal symptoms, fatigue and cardiorespiratory fitness. More importantly, participation in PA reduced the risk for development of IBD and the risk for future active disease. The findings from the reviewed studies highlighted the following barriers to engage in PA: fatigue, joint pain, abdominal pain, bowel urgency, active disease and depression.

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Original Article
IBD
Effectiveness of administering zinc acetate hydrate to patients with inflammatory bowel disease and zinc deficiency: a retrospective observational two-center study
Kensuke Sakurai, Shigeru Furukawa, Takehiko Katsurada, Shinsuke Otagiri, Kana Yamanashi, Kazunori Nagashima, Reizo Onishi, Keiji Yagisawa, Haruto Nishimura, Takahiro Ito, Atsuo Maemoto, Naoya Sakamoto
Intest Res 2022;20(1):78-89.   Published online January 22, 2021
DOI: https://doi.org/10.5217/ir.2020.00124
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background/Aims
Inflammatory bowel disease (IBD) patients frequently have zinc deficiency. IBD patients with zinc deficiency have higher risks of IBD-related hospitalization, complications, and requiring surgery. This study aimed to examine the effectiveness of zinc acetate hydrate (ZAH; Nobelzin) in IBD patients with zinc deficiency.
Methods
IBD patients with zinc deficiency who received ZAH from March 2017 to April 2020 were registered in this 2-center, retrospective, observational study. Changes in serum zinc levels and disease activity (Crohn’s Disease Activity Index [CDAI]) before and after ZAH administration were analyzed.
Results
Fifty-one patients with Crohn’s disease (CD, n = 40) or ulcerative colitis (UC, n = 11) were registered. Median serum zinc level and median CDAI scores significantly improved (55.5–91.0 μg/dL, P< 0.001; 171.5–129, P< 0.001, respectively) in CD patients 4 weeks after starting ZAH administration. Similarly, median serum zinc levels and CDAI scores significantly improved (57.0–81.0 μg/dL, P< 0.001; 177–148, P= 0.012, respectively) 20 weeks after starting ZAH administration. Similar investigations were conducted in groups where no treatment change, other than ZAH administration, was implemented; significant improvements were observed in both serum zinc level and CDAI scores. Median serum zinc levels in UC patients 4 weeks after starting ZAH administration significantly improved from 63.0 to 94.0 μg/dL (P= 0.002), but no significant changes in disease activity were observed. One patient experienced side effects of abdominal discomfort and nausea.
Conclusions
ZAH administration is effective in improving zinc deficiency and may contribute to improving disease activity in IBD.

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  • 493 Download
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Review
IBD
Management of inflammatory bowel disease in the COVID-19 era
Kyeong Ok Kim, Byung Ik Jang
Intest Res 2022;20(1):3-10.   Published online February 3, 2021
DOI: https://doi.org/10.5217/ir.2020.00156
AbstractAbstract PDFPubReaderePub
During the coronavirus disease 2019 (COVID-19) pandemic, many unpredictable changes have occurred in the medical field. Risk of COVID-19 does not seem to increase in patients with inflammatory bowel disease (IBD) considering based on current reports. Current medications for IBD do not increase this risk; on the contrary, some of these might be used as therapeutics against COVID-19 and are under clinical trial. Unless the patients have confirmed COVID-19 and severe pneumonia or a high oxygen demand, medical treatment should be continued during the pandemic, except for the use of high-dose corticosteroids. Adherence to general recommendations such as social distancing, wearing facial masks, and vaccination, especially for pneumococcal infections and influenza, is also required. Patients with COVID-19 need to be withhold immunomodulators or biologics for at least 2 weeks and treated based on both IBD and COVID-19 severity. Prevention of IBD relapse caused by sudden medication interruption is important because negative outcomes associated with disease flare up, such as corticosteroid use or hospitalization, are much riskier than medications. The outpatient clinic and infusion center for biologics need to be reserved safe spaces, and endoscopy or surgery should be considered in urgent cases only.

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Original Article
IBD
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
AbstractAbstract PDFSupplementary MaterialPubReaderePub
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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Case Report
Miscellaneous
A case of autoimmune enteropathy with CTLA4 haploinsufficiency
Haruka Miyazaki, Namiko Hoshi, Michitaka Kohashi, Eri Tokunaga, Yuna Ku, Haruka Takenaka, Makoto Ooi, Nobuyuki Yamamoto, Suguru Uemura, Noriyuki Nishimura, Kazumoto Iijima, Keisuke Jimbo, Tsubasa Okano, Akihiro Hoshino, Kohsuke Imai, Hirokazu Kanegane, Ichiro Kobayashi, Yuzo Kodama
Intest Res 2022;20(1):144-149.   Published online January 22, 2021
DOI: https://doi.org/10.5217/ir.2020.00041
AbstractAbstract PDFPubReaderePub
Autoimmune enteropathy (AIE) is a rare disease, characterized by intractable diarrhea, villous atrophy of the small intestine, and the presence of circulating anti-enterocyte autoantibodies. Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome, and mutations in FOXP3, which is a master gene of regulatory T cells (Tregs), are major causes of AIE. Recent studies have demonstrated that mutations in other Treg-associated genes, such as CD25 and CTLA4, show an IPEX-like phenotype. We present the case of a 13-year-old girl with CTLA4 haploinsufficiency, suffering from recurrent immune thrombocytopenic purpura and intractable diarrhea. We detected an autoantibody to the AIE-related 75 kDa antigen (AIE-75), a hallmark of the IPEX syndrome, in her serum. She responded well to a medium dose of prednisolone and a controlled dose of 6-mercaptopurine (6-MP), even after the cessation of prednisolone administration. Serum levels of the soluble interleukin-2 receptor and immunoglobulin G (IgG) were useful in monitoring disease activity during 6-MP therapy. In conclusion, autoimmune-mediated mechanisms, similar to the IPEX syndrome, may be involved in the development of enteropathy in CTLA4 haploinsufficiency. Treatment with 6-MP and monitoring of disease activity using serum levels of soluble interleukin-2 receptor and IgG is suggested for such cases.

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Statement
Endoscopy
Use of device-assisted enteroscopy in small bowel disease: an expert consensus statement by the Korean Association for the Study of Intestinal Diseases
Han Hee Lee, Jin Su Kim, Hyeon Jeong Goong, Shin Hee Lee, Eun Hye Oh, Jihye Park, Min Cheol Kim, Kwangwoo Nam, Young Joo Yang, Tae Jun Kim, Seung-Joo Nam, Hee Seok Moon, Jae Hyun Kim, Duk Hwan Kim, Seong-Eun Kim, Seong Ran Jeon, Seung-Jae Myung, The Small Intestine Research Group of the Korean Association for the Study of Intestinal Diseases (KASID)
Intest Res 2023;21(1):3-19.   Published online January 31, 2023
DOI: https://doi.org/10.5217/ir.2022.00108
AbstractAbstract PDFPubReaderePub
The introduction of device-assisted enteroscopy (DAE) in the beginning of 21st century has revolutionized the diagnosis and treatment of diseases of the small intestine. In contrast to capsule endoscopy, the other main diagnostic modality of the small bowel diseases, DAE has the unique advantages of observing the region of interest in detail and enabling tissue acquisition and therapeutic intervention. As DAE becomes an essential procedure in daily clinical practice, there is an increasing need for correct guidelines on when and how to perform it and what technical factors should be considered. In response to these needs, the Korean Association for the Study of Intestinal Diseases developed an expert consensus statement on the performance of DAE by reviewing the current evidence. This expert consensus statement particularly focuses on the indications, choice of insertion route, therapeutic intervention, complications, and relevant technical points.

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    Joana Mota, Maria João Almeida, Francisco Mendes, Miguel Martins, Tiago Ribeiro, João Afonso, Pedro Cardoso, Helder Cardoso, Patrícia Andrade, João Ferreira, Miguel Mascarenhas, Guilherme Macedo
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    Giulia Catassi, Clelia Marmo, Antonio Gasbarrini, Maria Elena Riccioni
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    Jihye Park, Jin Su Kim, Joo Hye Song, Kwangwoo Nam, Seong-Eun Kim, Eui Sun Jeong, Jae Hyun Kim, Seong Ran Jeon
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    Jihye Park, Jin Su Kim, Joo Hye Song, Kwangwoo Nam, Seong‐Eun Kim, Eui Sun Jeong, Jae Hyun Kim, Seong Ran Jeon
    Journal of Gastroenterology and Hepatology.2024;[Epub]     CrossRef
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Original Articles
IBD
Clinical presentation of COVID-19 in patients with inflammatory bowel disease: a systematic review and meta-analysis
Anupam K. Singh, Anuraag Jena, Praveen Kumar-M, Daya Krishna Jha, Vishal Sharma
Intest Res 2022;20(1):134-143.   Published online January 18, 2021
DOI: https://doi.org/10.5217/ir.2020.00108
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background/Aims
Coronavirus disease 2019 (COVID-19) is recognized to have variable clinical manifestations. The clinical presentation of patients with inflammatory bowel disease (IBD) having COVID-19 is unclear.
Methods
We identified articles reporting about the clinical presentation of COVID-19 in those with underlying IBD from PubMed and Embase. The studies, irrespective of design or language, were included. The overall pooled frequency of various symptoms was estimated. Joanna Briggs Institute Critical appraisal checklist was used to assess the quality of studies.
Results
Eleven studies, including 1,325 patients, were included in the pooled analysis. The pooled estimates for clinical presentation were; fever: 67.53% (95% confidence interval [CI], 45.38–83.88), cough: 59.58% (95% CI, 45.01–72.63), diarrhea: 27.26% (95% CI, 19.51–36.69), running nose: 27% (95% CI, 15.26–43.19) and dyspnea: 25.29% (95% CI, 18.52–33.52). The pooled prevalence rates for abdominal pain, nausea and vomiting were 13.08% (95% CI, 9.24–18.19), 10.08% (95% CI, 5.84–16.85) and 8.80% (95% CI, 4.43–16.70) per 100 population, respectively.
Conclusions
The clinical presentation of COVID-19 in IBD patients is similar to the general population.

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  • Small Bowel Diverticulosis and COVID-19: Awareness Is the Key: A Case Series and Review of the Literature
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    Mariana Rolim Fernandes MACEDO, Carlos Arthur Fernandes SOBREIRA, Carola Braz de LAVOR, Camila Ribeiro RÔLA, Ticiana Maria de Lavor ROLIM, Francisco Sérgio Rangel de Paula PESSOA, Milena Santana GIRÃO, Caio César Furtado FREIRE, Ranna Caroline Bezerra SIE
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    Yoo Jin Lee, Kyeong Ok Kim, Min Cheol Kim, Kwang Bum Cho, Kyung Sik Park, Byeong Ik Jang
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    Yoo Jin Lee, Eun Soo Kim
    The Korean Journal of Internal Medicine.2022; 37(5): 920.     CrossRef
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    Yong Eun Park, Yoo Jin Lee, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Jae Gon Lee, Hee Chan Yang, Miyoung Choi, Seong-Eun Kim, Seung-Jae Myung
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    Ho Min Yong, Sung-Jo Park, Seong Ran Jeon, Heesu Park, Hyun Gun Kim, Tae Hee Lee, Junseok Park, Jin-Oh Kim, Joon Seong Lee, Bong Min Ko, Hyeon Jeong Goong, Suyeon Park
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    Yong Eun Park, Yoo Jin Lee, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Jae Gon Lee, Hee Chan Yang, Miyoung Choi, Seong-Eun Kim, Seung-Jae Myung
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    Giorgos Bamias, Georgios Kokkotis, Angeliki Christidou, Dimitrios K. Christodoulou, Vasileios Delis, Georgia Diamantopoulou, Smaragdi Fessatou, Anthia Gatopoulou, Olga Giouleme, Panagiota Kafritsa, Chrisostomos Kalantzis, Andreas Kapsoritakis, Pantelis Ka
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IBD
Maintaining infliximab induced clinical remission with azathioprine and 5-aminosalicylates in acute severe steroid-refractory ulcerative colitis has lower cost and high efficacy (MIRACLE): a multicenter study
Ramit Mahajan, Arshdeep Singh, Saurabh Kedia, Kirandeep Kaur, Vandana Midha, Pabitra Sahu, Varun Mehta, Dharmatma Singh, Namita Bansal, Khushdeep Dharni, Sandeep Kaushal, Vineet Ahuja, Ajit Sood
Intest Res 2022;20(1):64-71.   Published online February 3, 2021
DOI: https://doi.org/10.5217/ir.2020.00100
AbstractAbstract PDFPubReaderePub
Background/Aims
Infliximab (IFX) has been used to induce and maintain remission in patients with severe steroid-refractory ulcerative colitis (UC). Long-term use of biologics in developing countries is limited by high cost and frequent side effects. An optimal maintenance strategy in these patients needs to be established.
Methods
A retrospective analysis of maintenance of clinical remission with combination of azathioprine (AZA) and 5-aminosalicylates (5-ASA) in patients with severe steroidrefractory UC where IFX (5 mg/kg intravenously at weeks 0, 2, 6) had been used only as an induction therapy was done at 2 centers in India. Primary outcome was the proportion of patients maintaining corticosteroid-free sustained clinical remission (SCR) at the end of study period. Rates of relapse and cost of therapy were also analyzed.
Results
Of the 137 patients who received rescue IFX induction therapy, 77 (56.2%) achieved clinical remission (mean age 34.81 ± 13.32 years, 68.83% males, median follow-up 4 years, range 3 months to 6 years) and were included. Cumulative corticosteroid-free SCR was maintained in 68%, 59%, 42%, and 35% patients at 1, 2, 4, and 6 years respectively. Sixty-seven relapses were observed in 33 patients. Majority of the relapses (45/67, 67.16%) occurred within first 2 years of follow-up. Two relapses were managed with re-induction with IFX, one required colectomy, whereas all other responded to repeat course(s) of corticosteroids. Annual per capita maintenance therapy with 5-ASA and AZA was cheaper by US$ 4,526 compared to maintaining remission with IFX.
Conclusions
Clinical remission achieved with IFX induction therapy in severe steroid-refractory UC can be sustained over long time with a combination of AZA and 5-ASA.

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  • Effect of Ornithine α-Ketoglutarate on Intestinal Microbiota and Serum Inflammatory Cytokines in Dextran Sulfate Sodium Induced Colitis
    Tao Wang, Junquan Tian, Wenxuan Su, Fan Yang, Jie Yin, Qian Jiang, Yuying Li, Kang Yao, Tiejun Li, Yulong Yin
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    Soo-Young Na
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    Alexander Keith Turbayne, Miles Patrick Sparrow
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  • Identifying Care Challenges as Opportunities for Research and Education in Inflammatory Bowel Disease in South Asia
    Madhura Balasubramaniam, Neilanjan Nandi, Tina Aswani-Omprakash, Shaji Sebastian, Vishal Sharma, Parakkal Deepak, Shrinivas Bishu, Neha D. Shah, Sumit Bhatia, Tauseef Ali, Sharan Khela, Kiran Peddi
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    Madhura Balasubramaniam, Neilanjan Nandi, Tina Aswani-Omprakash, Shaji Sebastian, Vishal Sharma, Parakkal Deepak, Shrinivas Bishu, Neha D. Shah, Sumit Bhatia, Tauseef Ali, Sharan Khela, Kiran Peddi
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    Ji Young Chang, Jae Hee Cheon
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IBD
The dietary practices and beliefs of British South Asian people living with inflammatory bowel disease: a multicenter study from the United Kingdom
Benjamin Crooks, Ravi Misra, Naila Arebi, Klaartje Kok, Matthew J. Brookes, John McLaughlin, Jimmy K. Limdi
Intest Res 2022;20(1):53-63.   Published online January 6, 2021
DOI: https://doi.org/10.5217/ir.2020.00079
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background/Aims
Epidemiological associations have implicated factors associated with Westernization, including the Western diet, in the development of inflammatory bowel disease (IBD). The role of diet in IBD etiopathogenesis, disease control and symptom management remains incompletely understood. Few studies have collected data on the dietary habits of immigrant populations living with IBD. Our aim was to describe the dietary practices and beliefs of British South Asians with IBD.
Methods
A 30-item questionnaire was developed and consecutively administered to 255 British South Asians with IBD attending gastroenterology clinics in the United Kingdom.
Results
Fifty-one percent of participants believed diet was the initiating factor for their IBD and 63% felt diet had previously triggered disease relapse. Eighty-nine percent avoided certain dietary items in the belief that this would prevent relapse. The most commonly avoided foods and drinks were spicy and fatty foods, carbonated drinks, milk products, alcohol, coffee, and red meat. A third of patients had tried a whole food exclusion diet, most commonly lactose- or gluten-free, and this was most frequently reported amongst those with clinically active IBD (P= 0.02). Almost 60% of participants avoided eating the same menu as their family, or eating out, at least sometimes, to prevent IBD relapse.
Conclusions
British South Asians with IBD demonstrate significant dietary beliefs and food avoidance behaviors with increased frequency compared to those reported in Caucasian IBD populations. Studies in immigrant populations may offer valuable insights into the interaction between diet, Westernization and cultural drift in IBD pathogenesis and symptomatology.

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    Lidia Neamți, Simona R. Gheorghe, Amalia Ventuneac, Tudor Drugan, Cristina Drugan, Ciprian N. Silaghi, Lidia Ciobanu, Alexandra M. Crăciun
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    Ilaria Saracino, Enzo Spisni, Veronica Imbesi, Chiara Ricci, Nikolas Dussias, Patrizia Alvisi, Paolo Gionchetti, Fernando Rizzello, Maria Valerii
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Review
IBD
Natural history of inflammatory bowel disease: a comparison between the East and the West
Eun Mi Song, Suk-Kyun Yang
Intest Res 2022;20(4):418-430.   Published online December 2, 2021
DOI: https://doi.org/10.5217/ir.2021.00104
AbstractAbstract PDFPubReaderePub
Over the past decades, there has been a rapid increase in the incidence and prevalence of inflammatory bowel disease (IBD) in Asia. The natural history of IBD in Asian patients could be different from that in Western patients due to variations in disease phenotypes and genotypes as well as the healthcare environment between the 2 populations. To adequately cope with this disease, it is important to fully understand the potential differences in its natural history among different populations. In this review, we evaluated the differences in the clinical course of IBD between Asian and Western patients with regards to phenotypic progression, hospitalization, major surgery, risk of colorectal cancer, and mortality, mainly based on the results of population-based studies. The findings of our narrative review suggest that the clinical course of Asian patients with IBD, especially ulcerative colitis, is better than that of Western patients, as indicated by the lower rates of major surgery and hospitalization. In addition, similar to Western patients, the clinical course of Asian patients with IBD has been improving as evidenced by the decreasing rates of disease behavior progression (in Crohn’s disease), hospitalization, and major surgery.

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    Sang Un Kim, Hyun Seok Lee
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    Jihye Park, Soo Jung Park, Jae Jun Park, Tae Il Kim, Jae Hee Cheon
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    Jae Hee Cheon
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    Yeonjin Je, Kyungdo Han, Jaeyoung Chun, Yuna Kim, Jie-Hyun Kim, Young Hoon Youn, Hyojin Park, Jong Pil Im, Joo Sung Kim
    Journal of Crohn's and Colitis.2023; 17(5): 681.     CrossRef
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    You Sun Kim, Edward H. Hurley, Yoojeong Park, Sungjin Ko
    Experimental & Molecular Medicine.2023; 55(7): 1380.     CrossRef
  • Treatment of inflammatory bowel disease–Asian perspectives: the results of a multinational web-based survey in the 8th Asian Organization for Crohn’s and Colitis meeting
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    You Sun Kim, Edward H. Hurley, Yoojeong Park, Sungjin Ko
    Intestinal Research.2023; 21(4): 420.     CrossRef
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    Sang Hyoung Park
    Crohn's & Colitis 360.2023;[Epub]     CrossRef
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    Soo-Young Na
    The Korean Journal of Medicine.2023; 98(5): 223.     CrossRef
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    Wei-Sheng Lin, Wan-Chen Cheng, Min-Hsiung Pan
    ACS Omega.2023; 8(44): 41427.     CrossRef
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    Eun Mi Song, Arum Choi, Sukil Kim, Sung Hoon Jung
    Journal of Korean Medical Science.2023;[Epub]     CrossRef
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    Jihye Park
    Intestinal Research.2022; 20(1): 1.     CrossRef
  • Is primary sclerosing cholangitis with inflammatory bowel disease different between patients in the East and West?
    Yong Eun Park
    Intestinal Research.2022; 20(2): 157.     CrossRef
  • Bioactive Components and Potential Mechanism Prediction of Kui Jie Kang against Ulcerative Colitis via Systematic Pharmacology and UPLC-QE-MS Analysis
    Jinbiao He, Chunping Wan, Xiaosi Li, Zishu Zhang, Yu Yang, Huaning Wang, Yan Qi, Ivan Luzardo-Ocampo
    Evidence-Based Complementary and Alternative Medicine.2022; 2022: 1.     CrossRef
  • Antiviral Prophylaxis Against Hepatitis B Virus in Patients Treated with Anti-Tumor Necrosis Factor α Agents for Inflammatory Bowel Disease
    Eun Ae Kang, Jae Hee Cheon
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  • Personalized medicine in inflammatory bowel disease: Perspectives on Asia
    Su Hyun Park, Sang Hyoung Park
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  • Updates on conventional therapies for inflammatory bowel diseases: 5-aminosalicylates, corticosteroids, immunomodulators, and anti-TNF-α
    Jihye Park, Jae Hee Cheon
    The Korean Journal of Internal Medicine.2022; 37(5): 895.     CrossRef
  • Inflammatory bowel disease in Korea: epidemiology and pathophysiology
    Jung Won Lee, Chang Soo Eun
    The Korean Journal of Internal Medicine.2022; 37(5): 885.     CrossRef
  • Management of inflammatory bowel disease beyond tumor necrosis factor inhibitors: novel biologics and small-molecule drugs
    Soo-Young Na, You Sun Kim
    The Korean Journal of Internal Medicine.2022; 37(5): 906.     CrossRef
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    You Sun Kim, Min Jeong Na, Byong Duk Ye, Jae Hee Cheon, Jong Pil Im, Joo Sung Kim
    Gut and Liver.2022; 16(6): 995.     CrossRef
  • Comparison between Pediatric Crohn’s Disease and Ulcerative Colitis at Diagnosis in Korea: Results from a Multicenter, Registry-Based, Inception Cohort Study
    Sowon Park, Ben Kang, Seung Kim, Sujin Choi, Hyo Rim Suh, Eun Sil Kim, Ji Hyung Park, Mi Jin Kim, Yon Ho Choe, Yeoun Joo Lee, Jae Hong Park, Eell Ryoo, Hong Koh, Byung-Ho Choe
    Gut and Liver.2022; 16(6): 921.     CrossRef
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Original Articles
Microbiota
Relationship between the gut microbiota and bile acid composition in the ileal mucosa of Crohn’s disease
Shigeki Bamba, Osamu Inatomi, Atsushi Nishida, Masashi Ohno, Takayuki Imai, Kenichiro Takahashi, Yuji Naito, Junichi Iwamoto, Akira Honda, Naohiro Inohara, Akira Andoh
Intest Res 2022;20(3):370-380.   Published online May 14, 2021
DOI: https://doi.org/10.5217/ir.2021.00054
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background/Aims
Crosstalk between the gut microbiota and bile acid plays an important role in the pathogenesis of gastrointestinal disorders. We investigated the relationship between microbial structure and bile acid metabolism in the ileal mucosa of Crohn’s disease (CD).
Methods
Twelve non-CD controls and 38 CD patients in clinical remission were enrolled. Samples were collected from the distal ileum under balloon-assisted enteroscopy. Bile acid composition was analyzed by liquid chromatography-mass spectrometry. The gut microbiota was analyzed by 16S rRNA gene sequencing.
Results
The Shannon evenness index was significantly lower in endoscopically active lesions than in non-CD controls. β-Diversity, evaluated by the UniFrac metric, revealed a significant difference between the active lesions and non-CD controls (P=0.039). The relative abundance of Escherichia was significantly higher and that of Faecalibacterium and Roseburia was significantly lower in CD samples than in non-CD controls. The increased abundance of Escherichia was more prominent in active lesions than in inactive lesions. The proportion of conjugated bile acids was significantly higher in CD patients than in non-CD controls, but there was no difference in the proportion of primary or secondary bile acids. The genera Escherichia and Lactobacillus were positively correlated with the proportion of conjugated bile acids. On the other hand, Roseburia, Intestinibacter, and Faecalibacterium were negatively correlated with the proportion of conjugated bile acids.
Conclusions
Mucosa-associated dysbiosis and the alteration of bile acid composition were identified in the ileum of CD patients. These may play a role in the pathophysiology of ileal lesions in CD patients.

Citations

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  • A critical review on inflammatory bowel diseases risk factors, dietary nutrients regulation and protective pathways based on gut microbiota during recent 5 years
    Pengkui Xia, Tao Hou, Hong Jin, Yaqi Meng, Jing Li, Fuchao Zhan, Fang Geng, Bin Li
    Critical Reviews in Food Science and Nutrition.2024; 64(24): 8805.     CrossRef
  • Gut microbiota disparities between active Crohn's disease and healthy controls: A global systematic review
    Rupa Tharu, Geetika Malik Ahlawat, Savitesh Kushwaha, Poonam Khanna
    Clinical Epidemiology and Global Health.2024; 25: 101497.     CrossRef
  • Gut microbes improve prognosis of Klebsiella pneumoniae pulmonary infection through the lung-gut axis
    Yuxiu Tang, Liquan Chen, Jin Yang, Suqing Zhang, Jun Jin, Yao Wei
    Frontiers in Cellular and Infection Microbiology.2024;[Epub]     CrossRef
  • Integrated Analysis of Microbiome and Metabolome Reveals Disease-Specific Profiles in Inflammatory Bowel Diseases and Intestinal Behçet’s Disease
    Yehyun Park, Jae Bum Ahn, Da Hye Kim, I Seul Park, Mijeong Son, Ji Hyung Kim, Hyun Woo Ma, Seung Won Kim, Jae Hee Cheon
    International Journal of Molecular Sciences.2024; 25(12): 6697.     CrossRef
  • Gut Bacterial Composition and Nutritional Implications in Mexican and Spanish Individuals with Inflammatory Bowel Disease Compared to Healthy Controls
    Ricardo García-Gamboa, Osiris Díaz-Torres, Misael Sebastián Gradilla-Hernández, Vicente Pérez-Brocal, Andrés Moya, Marisela González-Avila
    International Journal of Molecular Sciences.2024; 25(22): 11887.     CrossRef
  • hUCMSCs Regulate Bile Acid Metabolism to Prevent Heart Failure–Induced Intestinal Injury by Inhibiting the Activation of the STAT3/NF‐κB/MAPK Signaling Pathway via TGR5
    Zetian Wang, Wei Luo, Qing Wang, Chunzheng Liu, Yanshan Gong, Baitian Li, Xuejiao Zeng, Jiaqi Lin, Zehua Su, Xin Li, Yongze Yu, Zhongmin Liu, Ling Gao, Lijun Liao
    Food Frontiers.2024;[Epub]     CrossRef
  • Compositional changes in fecal microbiota associated with clinical phenotypes and prognosis in Korean patients with inflammatory bowel disease
    Seung Yong Shin, Young Kim, Won-Seok Kim, Jung Min Moon, Kang-Moon Lee, Sung-Ae Jung, Hyesook Park, Eun Young Huh, Byung Chang Kim, Soo Chan Lee, Chang Hwan Choi
    Intestinal Research.2023; 21(1): 148.     CrossRef
  • Meta-Analysis Reveals Compositional and Functional Microbial Changes Associated with Osteoporosis
    Oluwamayowa S. Akinsuyi, Luiz F. W. Roesch, Olubukola Oluranti Babalola
    Microbiology Spectrum.2023;[Epub]     CrossRef
  • Crohn’s disease: Why the ileum?
    Nicolas Richard, Guillaume Savoye, Mathilde Leboutte, Asma Amamou, Subrata Ghosh, Rachel Marion-Letellier
    World Journal of Gastroenterology.2023; 29(21): 3222.     CrossRef
  • The Emerging Role of Raman Spectroscopy as an Omics Approach for Metabolic Profiling and Biomarker Detection toward Precision Medicine
    Gabriel Cutshaw, Saji Uthaman, Nora Hassan, Siddhant Kothadiya, Xiaona Wen, Rizia Bardhan
    Chemical Reviews.2023; 123(13): 8297.     CrossRef
  • Current insights on the roles of gut microbiota in inflammatory bowel disease-associated extra-intestinal manifestations: pathophysiology and therapeutic targets
    Yizhe Tie, Yongle Huang, Rirong Chen, Li Li, Minhu Chen, Shenghong Zhang
    Gut Microbes.2023;[Epub]     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
  • Evaluation of gut dysbiosis using serum and fecal bile acid profiles
    Tadakuni Monma, Junichi Iwamoto, Hajime Ueda, Makoto Tamamushi, Fumio Kakizaki, Naoki Konishi, Shoichiro Yara, Teruo Miyazaki, Takeshi Hirayama, Tadashi Ikegami, Akira Honda
    World Journal of Clinical Cases.2022; 10(34): 12484.     CrossRef
  • Microbial Modulation in Inflammatory Bowel Diseases
    Jongwook Yu, Jae Hee Cheon
    Immune Network.2022;[Epub]     CrossRef
  • 6,807 View
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  • 16 Web of Science
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IBD
Long-term efficacy and tolerability of dose-adjusted thiopurine treatment in maintaining remission in inflammatory bowel disease patients with NUDT15 heterozygosity
Takato Maeda, Hirotake Sakuraba, Hiroto Hiraga, Shukuko Yoshida, Yoichi Kakuta, Hidezumi Kikuchi, Shogo Kawaguchi, Keisuke Hasui, Tetsuya Tatsuta, Daisuke Chinda, Tatsuya Mikami, Shinsaku Fukuda
Intest Res 2022;20(1):90-100.   Published online January 22, 2021
DOI: https://doi.org/10.5217/ir.2020.00133
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background/Aims
Thiopurines are key drugs for inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD). Recently, NUDT15 polymorphism (R139C, c.415C > T) has been shown to be associated with thiopurineinduced adverse events in Asian populations. In patients with the C/T genotype, low-dose thiopurine treatment is recommended, but its long-term efficacy and tolerability remain unclear. This study aimed to uncover the long-term efficacy and appropriate dosage of thiopurine for IBD patients with the C/T genotype.
Methods
A total of 210 patients with IBD (103 UC and 107 CD) determined to have NUDT15 R139C variants were enrolled. Clinical data were retrospectively reviewed from medical records.
Results
Of 46 patients (21.9%) with the C/T genotype, 30 patients (65.2%) were treated with thiopurines. Three of whom (10.0%) discontinued thiopurine treatment due to adverse events and 27 of whom continued. The median maintenance dosage of 6-mercaptopurine was 0.25 mg/kg/day (range, 0.19–0.36 mg/kg/day), and 6-thioguanine nucleotides level was 230 (104–298) pmol/8 × 108 red blood cells. Cumulative thiopurine continuation rates for 120 months for patients with the C/C and C/T genotypes were not significantly different (P= 0.895). Cumulative non-relapse rates in the patients with UC treated with thiopurine monotherapy and surgery-free rates in CD patients treated with combination therapy (thiopurines and anti-tumor necrosis factor-α agents) for maintenance remission were not significantly different at 60 months (C/C vs. C/T, P= 0.339 and P= 0.422, respectively).
Conclusions
Low-dose thiopurine treatment is an effective and acceptable treatment for patients with C/T genotype.

Citations

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  • Effectiveness and Tolerability of Methotrexate Combined with Biologics in Patients with Crohn’s Disease: A Multicenter Observational Study
    Jihye Park, Jaeyoung Chun, Soo Jung Park, Jae Jun Park, Tae Il Kim, Hyuk Yoon, Jae Hee Cheon
    Digestive Diseases and Sciences.2024; 69(3): 901.     CrossRef
  • New genetic biomarkers predicting 5-aminosalicylate-induced adverse events in patients with inflammatory bowel diseases
    Jihye Park, I. Seul Park, Ji Hyung Kim, Jung Hyun Ji, Soo Jung Park, Jae Jun Park, Tae Il Kim, Seung Won Kim, Jae Hee Cheon
    Therapeutic Advances in Gastroenterology.2024;[Epub]     CrossRef
  • Efficacy of optimised thiopurine therapy in patients with moderate-to-severe ulcerative colitis: retrospective long-term follow-up from two randomised trials
    Anette Mertz Nielsen, Klaus Theede, Lise Lotte Gluud, Marianne Kiszka-Kanowitz
    Scandinavian Journal of Gastroenterology.2024; 59(6): 669.     CrossRef
  • Real-world NUDT15 genotyping and thiopurine treatment optimization in inflammatory bowel disease: a multicenter study
    Motoki Makuuchi, Yoichi Kakuta, Junji Umeno, Toshimitsu Fujii, Tetsuya Takagawa, Takashi Ibuka, Miki Miura, Yu Sasaki, Sakuma Takahashi, Hiroshi Nakase, Hiroki Kiyohara, Keiichi Tominaga, Yosuke Shimodaira, Sakiko Hiraoka, Nobuhiro Ueno, Shunichi Yanai, T
    Journal of Gastroenterology.2024; 59(6): 468.     CrossRef
  • A systematic review of aspects of NUDT15 pharmacogenomic variants and thiopurine-induced myelosuppression
    Rachel Palmer, Jaime Peters
    RPS Pharmacy and Pharmacology Reports.2024;[Epub]     CrossRef
  • Updates on conventional therapies for inflammatory bowel diseases: 5-aminosalicylates, corticosteroids, immunomodulators, and anti-TNF-α
    Jihye Park, Jae Hee Cheon
    The Korean Journal of Internal Medicine.2022; 37(5): 895.     CrossRef
  • Risk factors and prognostic value of acute severe lower gastrointestinal bleeding in Crohn’s disease
    Jiyoung Yoon, Dae Sung Kim, Ye-Jee Kim, Jin Wook Lee, Seung Wook Hong, Ha Won Hwang, Sung Wook Hwang, Sang Hyoung Park, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang
    World Journal of Gastroenterology.2021; 27(19): 2353.     CrossRef
  • Importance of NUDT15 Polymorphisms in Thiopurine Treatments
    Yoichi Tanaka, Yoshiro Saito
    Journal of Personalized Medicine.2021; 11(8): 778.     CrossRef
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  • 8 Web of Science
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Miscellaneous
Addition of computed tomography chest increases the diagnosis rate in patients with suspected intestinal tuberculosis
Saurabh Kedia, Raju Sharma, Sudheer Kumar Vuyyuru, Deepak Madhu, Pabitra Sahu, Bhaskar Kante, Prasenjit Das, Ankur Goyal, Karan Madan, Govind Makharia, Vineet Ahuja
Intest Res 2022;20(2):184-191.   Published online May 4, 2021
DOI: https://doi.org/10.5217/ir.2020.00104
AbstractAbstract PDFPubReaderePub
Background/Aims
Intestinal tuberculosis (ITB) is difficult to diagnose due to poor sensitivity of definitive diagnostic tests. ITB may be associated with concomitant pulmonary tuberculosis (PTB) which may remain undetected on chest X-ray. We assessed the role of contrast enhanced computed tomography (CECT) chest in detecting the prevalence of active PTB, and increasing the diagnostic yield in patients with suspected ITB.
Methods
Consecutive treatment naïve patients with suspected ITB (n=200) who underwent CECT chest (n=88) and had follow-up duration>1 year were recruited in this retrospective study (February 2016 to October 2018). ITB was diagnosed in the presence of caseating granuloma, positive acid fast stain or culture for Mycobacterium tuberculosis on biopsy, presence of necrotic lymph nodes (LNs) on CT enterography or positive response to anti-tubercular therapy. Evidence of active tuberculosis on CECT-chest was defined as presence of centrilobular nodules with or without consolidation/miliary nodules/thick-walled cavity/enlarged necrotic mediastinal LNs.
Results
Sixty-five of eighty-eight patients (mean age, 33.8±12.8 years; 47.7% of females) were finally diagnosed as ITB (4-caseating granuloma on biopsy, 12-necrotic LNs on CT enterography, 1-both, and 48-response to anti-tubercular therapy) and 23 were diagnosed as Crohn’s disease. Findings of active TB on CECT chest with or without necrotic abdominal LNs were demonstrated in 5 and 20 patients, respectively. No patient with Crohn’s disease had necrotic abdominal LNs or active PTB. Addition of CECT chest in the diagnostic algorithm improved the sensitivity of ITB diagnosis from 26.2% to 56.9%.
Conclusions
Addition of CECT chest significantly improves the sensitivity for definite diagnosis in a patient with suspected ITB.

Citations

Citations to this article as recorded by  
  • Imaging in Abdominal Tuberculosis
    Anuradha Sharma, Ankur Goyal, Devasenathipathy Kandasamy, Saurabh Kedia, Vineet Ahuja, Raju Sharma
    Indographics.2024; 03(02): 045.     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
  • Risk factors identification of COVID‐19 patients with chronic obstructive pulmonary disease: A retrospective study in Punjab‐Pakistan
    Muhammad Muneeb Hassan, M. H. Tahir, Muhammad Ameeq, Farrukh Jamal, John T. Mendy, Christophe Chesneau
    Immunity, Inflammation and Disease.2023;[Epub]     CrossRef
  • Strengthening Tuberculosis Services for Children and Adolescents in Low Endemic Settings
    Jeffrey R. Starke, Connie Erkens, Nicole Ritz, Ian Kitai
    Pathogens.2022; 11(2): 158.     CrossRef
  • Stringent screening strategy significantly reduces reactivation rates of tuberculosis in patients with inflammatory bowel disease on anti‐TNF therapy in tuberculosis endemic region
    Peeyush Kumar, Sudheer K. Vuyyuru, Bhaskar Kante, Pabitra Sahu, Sandeep Goyal, Deepak Madhu, Saransh Jain, Mukesh Kumar Ranjan, Sandeep Mundhra, Rithvik Golla, Mukesh Singh, Shubi Virmani, Anvita Gupta, Nidhi Yadav, Mani Kalaivani, Raju Sharma, Prasenjit
    Alimentary Pharmacology & Therapeutics.2022; 55(11): 1431.     CrossRef
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Case Report
IBD
Granulocyte and monocyte apheresis therapy for patients with active ulcerative colitis associated with COVID-19: a case report
Miki Koroku, Teppei Omori, Harutaka Kambayashi, Shun Murasugi, Tomoko Kuriyama, Yuichi Ikarashi, Maria Yonezawa, Ken Arimura, Kazunori Karasawa, Norio Hanafusa, Masatoshi Kawana, Katsutoshi Tokushige
Intest Res 2022;20(1):150-155.   Published online March 12, 2021
DOI: https://doi.org/10.5217/ir.2020.00148
AbstractAbstract PDFPubReaderePub
Coronavirus disease 2019 (COVID-19), caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is now a pandemic. Although several treatment guidelines have been proposed for patients who have both inflammatory bowel disease and COVID-19, immunosuppressive therapy is essentially not recommended, and the treatment options are limited. Even in the COVID-19 pandemic, adjuvant adsorptive granulocyte and monocyte apheresis may safely bring ulcerative colitis (UC) into remission by removing activated myeloid cells without the use of immunosuppressive therapy. Our patient was a 25-year-old Japanese male with UC and COVID-19. This is the first case report of the induction of UC remission with granulocyte and monocyte apheresis treatment for active UC associated with COVID-19.

Citations

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  • Phenotypic changes in immune cells induced by granulocyte and monocyte adsorptive apheresis in patients with severe COVID‐19: An ex vivo study
    Ryo Hisamune, Kazuma Yamakawa, Katsuhide Kayano, Noritaka Ushio, Takeshi Wada, Kohei Taniguchi, Akira Takasu
    Acute Medicine & Surgery.2024;[Epub]     CrossRef
  • SARS-CoV-2 vaccination for adult patients with inflammatory bowel disease: expert consensus statement by KASID
    Yoo Jin Lee, Seong-Eun Kim, Yong Eun Park, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Jae Gon Lee, Hee Chan Yang, Miyoung Choi, Seung-Jae Myung
    Intestinal Research.2022; 20(2): 171.     CrossRef
  • SARS-CoV-2 Vaccination for Adult Patients with Inflammatory Bowel Disease: Expert Consensus Statements by KASID
    Yoo Jin Lee, Seong-Eun Kim, Yong Eun Park, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Jae Gon Lee, Hee Chan Yang, Miyoung Choi, Seung-Jae Myung
    The Korean Journal of Gastroenterology.2021; 78(2): 117.     CrossRef
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  • 323 Download
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Reviews
Miscellaneous
Involvement of the cannabinoid system in chronic inflammatory intestinal diseases: opportunities for new therapies
Priscila A. Lima, Bárbara B. Berg, Marina Gomes Miranda e Castor
Intest Res 2022;20(4):392-417.   Published online May 31, 2022
DOI: https://doi.org/10.5217/ir.2021.00160
AbstractAbstract PDFPubReaderePub
The components of the endogenous cannabinoid system are widely expressed in the gastrointestinal tract contributing to local homeostasis. In general, cannabinoids exert inhibitory actions in the gastrointestinal tract, inducing anti-inflammatory, antiemetic, antisecretory, and antiproliferative effects. Therefore, cannabinoids are interesting pharmacological compounds for the treatment of several acute intestinal disorders, such as dysmotility, emesis, and abdominal pain. Likewise, the role of cannabinoids in the treatment of chronic intestinal diseases, such as irritable bowel syndrome and inflammatory bowel disease, is also under investigation. Patients with chronic intestinal inflammatory diseases present impaired quality of life, and mental health issues are commonly associated with long-term chronic diseases. The complex pathophysiology of these diseases contributes to difficulties in diagnosis and, therefore, in the choice of a satisfactory treatment. Thus, this article reviews the involvement of the cannabinoid system in chronic inflammatory diseases that affect the gastrointestinal tract and highlights possible therapeutic approaches related to the use of cannabinoids.

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    Biomedicine & Pharmacotherapy.2024; 178: 117286.     CrossRef
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    Sitong Zhang, Xipeng Sun, Yameng Zhang, Rong Huang, Wenyou Situ, Huaxi Yi, Lingjun Tong
    Food Science of Animal Products.2024; 2(3): 9240078.     CrossRef
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    Dinesh Thapa, Leon N. Warne, Marco Falasca
    International Journal of Molecular Sciences.2023; 24(19): 14677.     CrossRef
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IBD
Landscape of inflammatory bowel disease in Singapore
Daren Low, Nidhi Swarup, Toshiyuki Okada, Emiko Mizoguchi
Intest Res 2022;20(3):291-296.   Published online January 7, 2022
DOI: https://doi.org/10.5217/ir.2021.00089
AbstractAbstract PDFPubReaderePub
Inflammatory bowel disease (IBD), primarily Crohn’s disease and ulcerative colitis, had been widely recognized to affect the Western population. However, the notable rise in prevalence of IBD in Asia, including Singapore, had garnered much attention to the causal role of the shift in trend, and more importantly, effective and safe management of the conditions of these groups of patients in terms of therapy, healthcare economics as well as patient well-being. This review presents a summary of the current landscape of IBD in Singapore, and discuss on areas that can be explored to improve and better understand the local condition, as prevalence continues to grow.

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    Mariana Rodriguez Duran, Ghazala A. Datoo O’Keefe
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    Oh Chan Kwon, Yuna Kim, Jaeyoung Chun, Kyungdo Han, Min-Chan Park, Ryul Kim, Jie-Hyun Kim, Young Hoon Youn, Hyojin Park
    Frontiers in Medicine.2023;[Epub]     CrossRef
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    You Sun Kim, Edward H. Hurley, Yoojeong Park, Sungjin Ko
    Intestinal Research.2023; 21(4): 420.     CrossRef
  • Evolving Trends and Burden of Inflammatory Bowel Disease in Asia, 1990–2019: A Comprehensive Analysis Based on the Global Burden of Disease Study
    Xuejie Chen, Xin Xiang, Weitong Xia, Xindi Li, Sidan Wang, Shuyu Ye, Li Tian, Lian Zhao, Feiyan Ai, Zhaohua Shen, Kai Nie, Minzi Deng, Xiaoyan Wang
    Journal of Epidemiology and Global Health.2023; 13(4): 725.     CrossRef
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    Yong Eun Park
    Intestinal Research.2022; 20(2): 157.     CrossRef
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    Yoo Jin Lee, Eun Soo Kim
    The Korean Journal of Internal Medicine.2022; 37(5): 920.     CrossRef
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    You Sun Kim, Min Jeong Na, Byong Duk Ye, Jae Hee Cheon, Jong Pil Im, Joo Sung Kim
    Gut and Liver.2022; 16(6): 995.     CrossRef
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  • 6 Web of Science
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Original Article
IBD
One-year clinical efficacy and safety of indigo naturalis for active ulcerative colitis: a real-world prospective study
Yuichi Matsuno, Takehiro Torisu, Junji Umeno, Hiroki Shibata, Atsushi Hirano, Yuta Fuyuno, Yasuharu Okamoto, Shin Fujioka, Keisuke Kawasaki, Tomohiko Moriyama, Tomohiro Nagasue, Keizo Zeze, Yoichiro Hirakawa, Shinichiro Kawatoko, Yutaka Koga, Yoshinao Oda, Motohiro Esaki, Takanari Kitazono
Intest Res 2022;20(2):260-268.   Published online April 29, 2022
DOI: https://doi.org/10.5217/ir.2021.00124
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background/Aims
Recent studies suggested a favorable effect of indigo naturalis (IN) in inducing remission for refractory ulcerative colitis (UC), however, the maintenance effect of IN for patients with UC remains unknown. Therefore, we conducted a prospective uncontrolled open-label study to analyze the efficacy and safety of IN for patients with UC.
Methods
Patients with moderate to severe active UC (clinical activity index [CAI] ≥ 8) took 2 g/day of IN for 52 weeks. CAI at weeks 0, 4, 8, and 52 and Mayo endoscopic subscore (MES) and Geboes score (GS) at weeks 0, 4, and 52 were assessed. Clinical remission (CAI ≤ 4), mucosal healing (MES ≤ 1), and histological healing (GS ≤ 1) rates at each assessment were evaluated. Overall adverse events (AEs) during study period were also evaluated. The impact of IN on mucosal microbial composition was assessed using 16S ribosomal RNA gene sequences.
Results
Thirty-three patients were enrolled. The rates of clinical remission at weeks 4, 8, and 52 were 67%, 76%, and 73%, respectively. The rates of mucosal healing at weeks 4 and 52 were 48% and 70%, respectively. AEs occurred in 17 patients (51.5%) during follow-up. Four patients (12.1%) showed severe AEs, among whom 3 manifested acute colitis. No significant alteration in the mucosal microbial composition was observed with IN treatment.
Conclusions
One-year treatment of moderate to severe UC with IN was effective. IN might be a promising therapeutic option for maintaining remission in UC, although the relatively high rate of AEs should be considered.

Citations

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  • Indigo naturalis (Qing dai) for inflammatory bowel disease: A systematic review and meta-analysis
    Rinkalben Kakdiya, Daya Krishna Jha, Arup Choudhury, Anuraag Jena, Vishal Sharma
    Clinics and Research in Hepatology and Gastroenterology.2024; 48(1): 102250.     CrossRef
  • Reply to “Ferroptosis in the colon epithelial cells as a therapeutic target for ulcerative colitis”
    Akihito Yokote, Noriyuki Imazu, Junji Umeno, Keisuke Kawasaki, Shin Fujioka, Yuta Fuyuno, Yuichi Matsuno, Tomohiko Moriyama, Kohta Miyawaki, Koichi Akashi, Takanari Kitazono, Takehiro Torisu
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  • Risk of Infection in Patients With Inflammatory Bowel Disease Treated With Interleukin-Targeting Agents: A Systematic Review and Meta-Analysis
    Konstantinos Ouranos, Hira Saleem, Stephanos Vassilopoulos, Athanasios Vassilopoulos, Evangelia K Mylona, Fadi Shehadeh, Markos Kalligeros, Bincy P Abraham, Eleftherios Mylonakis
    Inflammatory Bowel Diseases.2024;[Epub]     CrossRef
  • Herbal Medicines for the Treatment of Active Ulcerative Colitis: A Systematic Review and Meta-Analysis
    Preetha Iyengar, Gala Godoy-Brewer, Isha Maniyar, Jacob White, Laura Maas, Alyssa M. Parian, Berkeley Limketkai
    Nutrients.2024; 16(7): 934.     CrossRef
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    Dianzhen Wu, Qi Huang, Yingbi Xu, Ruiyi Cao, Ming Yang, Jin Xie, Dingkun Zhang
    Journal of Ethnopharmacology.2024; : 118782.     CrossRef
  • Ferroptosis in the colon epithelial cells as a therapeutic target for ulcerative colitis
    Akihito Yokote, Noriyuki Imazu, Junji Umeno, Keisuke Kawasaki, Shin Fujioka, Yuta Fuyuno, Yuichi Matsuno, Tomohiko Moriyama, Kohta Miyawaki, Koichi Akashi, Takanari Kitazono, Takehiro Torisu
    Journal of Gastroenterology.2023; 58(9): 868.     CrossRef
  • Hyaluronic acid/inulin-based nanocrystals with an optimized ratio of indigo and indirubin for combined ulcerative colitis therapy via immune and intestinal flora regulation
    Jin Xie, Qi Huang, Huijuan Xie, Jun Liu, Shimin Tian, Ruiyi Cao, Ming Yang, Junzhi Lin, Li Han, Dingkun Zhang
    International Journal of Biological Macromolecules.2023; 252: 126502.     CrossRef
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    Xin Yang, Jun Tang, Juan Su, Xin Yang, Ming Yang, Xiangbo Yang, Qisen Ji, Yanan He, Li Han, Dingkun Zhang
    ACS Applied Materials & Interfaces.2023; 15(37): 43272.     CrossRef
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Review
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
AbstractAbstract PDFPubReaderePub
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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Original Articles
IBD
Vedolizumab does not increase perioperative surgical complications in patients with inflammatory bowel disease, cohort study
Vitaliy Y. Poylin, Jose Cataneo Serrato, Jonathan Pastrana Del Valle, Joseph D. Feuerstein
Intest Res 2022;20(1):72-77.   Published online February 3, 2021
DOI: https://doi.org/10.5217/ir.2020.00117
AbstractAbstract PDFPubReaderePub
Background/Aims
Biologics are increasingly used to manage ulcerative colitis (UC) and Crohn’s disease (CD). However, even with earlier usage of biologic therapy, a significant proportion of patients will require surgery. Vedolizumab is an anti-integrin antibody that is increasingly used given that it is more gut selective and associated with fewer side effects. The aim of this study is to assess the effect of vedolizumab compared to anti-tumor necrosis factor (anti-TNF) therapy on the perioperative complications in patients undergoing surgery for inflammatory bowel disease (IBD).
Methods
Retrospective review of patients treated for IBD at a tertiary care center between 2013 and 2017. Rates of 30- and 90-day complications for patients on vedolizumab were compared to patients on anti-TNF regimens.
Results
One hundred and ninety-nine patients met inclusion criteria with 87 (43%) patients undergoing surgery for CD, 111 (55.8%) for UC and 1 (0.5%) for indeterminate colitis. Thirty-eight patients received preoperative vedolizumab and 94 received anti-TNF. There were more males and lower body mass index in the anti-TNF group. There was no significant difference in overall rate of complications at 30 or 90 days. There was a trend for lower leak rate vedolizumab group (0% for vedolizumab vs. 2.1% for anti-TNF at 30 days, P= 1.00; 0% for vedolizumab vs. 1.1% for anti-TNF at 90 days, P= 1.00). Multivariate analysis showed low albumin ( < 3.6 g/dL) at the time of surgery to be a significant risk factor for overall and infectious complications at 90 days (odds ratio, 3.24; 95% confidence interval, 1.12–8.79; P= 0.021).
Conclusions
Perioperative vedolizumab does not increase rates of perioperative complications in IBD surgery when compared to anti-TNF medications.

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    Shubha Bhat, Benjamin Click, Miguel Regueiro
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    Ye Rin Koh, Kenneth C. Cummings
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    Current Gastroenterology Reports.2024; 26(5): 125.     CrossRef
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    Hyeon Woo Bae, Yong Joon Lee, Min Young Park, Seung Yoon Yang, Yoon Dae Han, Min Soo Cho, Hyuk Hur, Kang Young Lee, Jae Hee Cheon, Joseph C. Carmichael, Byung Soh Min
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    Gabriele Dragoni, Tommaso Innocenti, Aurelién Amiot, Fabiana Castiglione, Laura Melotti, Stefano Festa, Edoardo Vincenzo Savarino, Marie Truyens, Konstantinos Argyriou, Daniele Noviello, Tamas Molnar, Vincent Bouillon, Cristina Bezzio, Piotr Eder, Samuel
    American Journal of Gastroenterology.2024; 119(8): 1525.     CrossRef
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    Ye Rin Koh, Kenneth C. Cummings
    Rheumatic Disease Clinics of North America.2024; 50(3): 545.     CrossRef
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    Ibrahim Gomaa, Sara Aboelmaaty, Himani Bhatt, Robert A. Vierkant, Sherief F. Shawki, David W. Larson, Kevin T. Behm, Kristen K. Rumer
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    Sailish Honap, Patrick Netter, Silvio Danese, Laurent Peyrin-Biroulet
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    Brad Pasternak, Ashish Patel, Paul Tran, Lisa McMahon
    Journal of Pediatric Gastroenterology & Nutrition.2023; 76(2): 137.     CrossRef
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    William J. Kane, Puja Shah Berry
    Clinics in Colon and Rectal Surgery.2023; 36(03): 210.     CrossRef
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    Jihye Park
    Intestinal Research.2022; 20(1): 1.     CrossRef
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    Soo-Young Na, You Sun Kim
    The Korean Journal of Internal Medicine.2022; 37(5): 906.     CrossRef
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    Expert Opinion on Biological Therapy.2021; : 1.     CrossRef
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IBD
Risk factors for non-reaching of ileal pouch to the anus in laparoscopic restorative proctocolectomy with handsewn anastomosis for ulcerative colitis
Shigenobu Emoto, Keisuke Hata, Hiroaki Nozawa, Kazushige Kawai, Toshiaki Tanaka, Takeshi Nishikawa, Yasutaka Shuno, Kazuhito Sasaki, Manabu Kaneko, Koji Murono, Yuuki Iida, Hiroaki Ishii, Yuichiro Yokoyama, Hiroyuki Anzai, Hirofumi Sonoda, Soichiro Ishihara
Intest Res 2022;20(3):313-320.   Published online March 12, 2021
DOI: https://doi.org/10.5217/ir.2020.00158
AbstractAbstract PDFPubReaderePub
Background/Aims
Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis and handsewn anastomosis for ulcerative colitis requires pulling down of the ileal pouch into the pelvis, which can be technically challenging. We examined risk factors for the pouch not reaching the anus.
Methods
Clinical records of 62 consecutive patients who were scheduled to undergo RPC with handsewn anastomosis at the University of Tokyo Hospital during 1989–2019 were reviewed. Risk factors for non-reaching were analyzed in patients in whom hand sewing was abandoned for stapled anastomosis because of nonreaching. Risk factors for non-reaching in laparoscopic RPC were separately analyzed. Anatomical indicators obtained from presurgical computed tomography (CT) were also evaluated.
Results
Thirty-seven of 62 cases underwent laparoscopic procedures. In 6 cases (9.7%), handsewn anastomosis was changed to stapled anastomosis because of non-reaching. Male sex and a laparoscopic approach were independent risk factors of non-reaching. Distance between the terminal of the superior mesenteric artery (SMA) ileal branch and the anus > 11 cm was a risk factor for non-reaching.
Conclusions
Laparoscopic RPC with handsewn anastomosis may limit extension and induction of the ileal pouch into the anus. Preoperative CT measurement from the terminal SMA to the anus may be useful for predicting non-reaching.

Citations

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  • Preoperative Simulation of Ileal Pouch–Anal Anastomosis in Patients With Ulcerative Colitis Using a 3-Dimensional Printed Model
    Shota Yokose, Koji Murono, Hiroaki Nozawa, Kazuhito Sasaki, Shigenobu Emoto, Hiroyuki Matsuzaki, Yuichiro Yokoyama, Shinya Abe, Yuzo Nagai, Yuichiro Yoshioka, Takahide Shinagawa, Hirofumi Sonoda, Shin Murai, Koichi Komatsu, Soichiro Ishihara
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    Evan D. Adams, Charlotte A Lansky, Cindy E. Kallman, Karen N. Zaghiyan, Phillip R. Fleshner
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    Hiroaki Nozawa, Keisuke Hata, Kazuhito Sasaki, Koji Murono, Kazushige Kawai, Shigenobu Emoto, Soichiro Ishihara
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    Dong-Hoon Yang
    Journal of Digestive Cancer Reports.2021; 9(2): 50.     CrossRef
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Review
IBD
Artificial intelligence in inflammatory bowel disease: implications for clinical practice and future directions
Harris A. Ahmad, James E. East, Remo Panaccione, Simon Travis, James B. Canavan, Keith Usiskin, Michael F. Byrne
Intest Res 2023;21(3):283-294.   Published online April 20, 2023
DOI: https://doi.org/10.5217/ir.2023.00020
AbstractAbstract PDFPubReaderePub
Inflammatory bowel disease encompasses Crohn’s disease and ulcerative colitis and is characterized by uncontrolled, relapsing, and remitting course of inflammation in the gastrointestinal tract. Artificial intelligence represents a new era within the field of gastroenterology, and the amount of research surrounding artificial intelligence in patients with inflammatory bowel disease is on the rise. As clinical trial outcomes and treatment targets evolve in inflammatory bowel disease, artificial intelligence may prove as a valuable tool for providing accurate, consistent, and reproducible evaluations of endoscopic appearance and histologic activity, thereby optimizing the diagnosis process and identifying disease severity. Furthermore, as the applications of artificial intelligence for inflammatory bowel disease continue to expand, they may present an ideal opportunity for improving disease management by predicting treatment response to biologic therapies and for refining the standard of care by setting the basis for future treatment personalization and cost reduction. The purpose of this review is to provide an overview of the unmet needs in the management of inflammatory bowel disease in clinical practice and how artificial intelligence tools can address these gaps to transform patient care.

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  • The Histological Detection of Ulcerative Colitis Using a No-Code Artificial Intelligence Model
    Yuichiro Hamamoto, Michihiro Kawamura, Hiroki Uchida, Kazuhiro Hiramatsu, Chiaki Katori, Hinako Asai, Shigeki Shimizu, Satoshi Egawa, Kyotaro Yoshida
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