Intestinal Research

Original Articles

Miscellaneous

Characteristics and usefulness of transabdominal ultrasonography in immune-mediated colitis: Kensuke Sakurai, Takehiko Katsurada, Mutsumi Nishida, Satomi Omotehara, Shinya Fukushima, Shinsuke Otagiri, Kazunori Nagashima, Reizo Onishi, Ryo Takagi, Yoshito Komatsu, Naoya Sakamoto; Intest Res 2023;21(1):126-136. Published online July 22, 2022; DOI: https://doi.org/10.5217/ir.2021.00166

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Background/Aims
The usefulness of ultrasonography (US) in diseases of the gastrointestinal tract has been reported recently. This prospective study aimed to determine the features of US findings in immune-mediated colitis (IMC), an adverse event induced by immune checkpoint inhibitor, and examine the correlation between US findings, colonoscopy (CS) findings, and severity of colitis.
Methods
We studied patients examined using CS and US upon suspicion of IMC in Hokkaido University Hospital between April 2018 and February 2021. Endoscopic findings of IMC were assessed using the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). The severity of US findings in IMC was evaluated using US grade, which is the ultrasonographic grading scale in ulcerative colitis. Bowel wall thickness and the intensity of the color Doppler signal were also analyzed. Severity of colitis was evaluated using Common Terminology Criteria for Adverse Events (CTCAE) grade version 5.
Results
Fourteen patients with IMC were enrolled. The US findings were bowel wall thickening, loss of stratification, ulceration and increased blood flow signal. The US grade was moderately correlated with the UCEIS (r=0.687, p=0.009) and CTCAE grade (r=0.628, p=0.035). Bowel wall thickness and UCEIS (r=0.628, p=0.020), as well as color Doppler signal grade and CTCAE grade (r=0.724, p=0.008), were significantly correlated.
Conclusions
US findings in IMC were mainly similar to those of ulcerative colitis, but there were some findings that were characteristic only of IMC. Significant correlation was found between US findings, CS findings, and severity of colitis. Hence, US could be useful for the evaluation of IMC.

Citations

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Symptomatic and Sonographic Improvement of Immune Checkpoint Inhibitor Enterocolitis With Risankizumab
Rena Mei, Emily Pepe, David Y Oh, Katy K Tsai, Rishika Chugh, Michael G Kattah
Inflammatory Bowel Diseases.2025; 31(4): 1182. CrossRef
Response
Malek Shatila, Yinghong Wang
Gastrointestinal Endoscopy.2024; 100(2): 349. CrossRef
Ultrasound's echo in the endoscopic realm: navigating checkpoint colitis
Steven Nicolaides, Zaid Ardalan, Alex Boussioutas
Gastrointestinal Endoscopy.2024; 100(2): 349. CrossRef
Systematic review of immune checkpoint inhibitor-related gastrointestinal, hepatobiliary, and pancreatic adverse events
Malek Shatila, Hao Chi Zhang, Anusha Shirwaikar Thomas, Antonio Pizuorno Machado, Sidra Naz, Nitish Mittal, Christine Catinis, Krishnavathana Varatharajalu, Carolina Colli Cruz, Eric Lu, Deanna Wu, Julie R Brahmer, Franck Carbonnel, Stephen B Hanauer, Bre
Journal for ImmunoTherapy of Cancer.2024; 12(11): e009742. CrossRef
Endoscopic findings of immune checkpoint inhibitor-related gastrointestinal adverse events
Min Kyu Kim, Sung Wook Hwang
Clinical Endoscopy.2024; 57(6): 725. CrossRef
Gut microbiome on immune checkpoint inhibitor therapy and consequent immune-related colitis: a review
Sung Wook Hwang, Min Kyu Kim, Mi-Na Kweon
Intestinal Research.2023; 21(4): 433. CrossRef

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IBD

Incidence comparison of adverse events in patients with inflammatory bowel disease receiving different biologic agents: retrospective long-term evaluation: Brigida Barberio, Edoardo Vincenzo Savarino, Timothy Card, Cristina Canova, Francesco Baldisser, Alessandro Gubbiotti, Davide Massimi, Matteo Ghisa, Fabiana Zingone; Intest Res 2022;20(1):114-123. Published online August 4, 2021; DOI: https://doi.org/10.5217/ir.2021.00037

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Background/Aims
Current literature is lacking in studies comparing the incidence of adverse events (AEs) in patients with inflammatory bowel diseases (IBD) treated with adalimumab (ADA) or vedolizumab (VDZ) in a real-life scenario. Therefore, our primary aim was to compare the AEs occurring in patients taking ADA to those of patients taking VDZ.
Methods
In this single center study, data on AEs from IBD patients who underwent treatment with ADA and VDZ were retrospectively collected. AE rates per 100 person-years were calculated. A Cox regression model was used to estimate the hazard ratios of the AEs between the 2 drugs.
Results
A total of 16 ADA patients (17.2%) and 11 VDZ patients (7.6%) had AEs causing drug interruption during the study period (P=0.02). Most of the AEs were noninfectious extraintestinal events (50% in ADA and 54.5% in VDZ) while infections accounted for 31.2% of the AEs in patients treated with ADA and 27.3% in those treated with VDZ. The incidence rate of AEs causing withdrawal of therapy was 13.2 per 100 person-years for ADA and 5.3 per 100 person-years for VDZ, corresponding to a 76% lower risk in patients in VDZ. Considering the first year of treatment, we observed 34 subjects treated with ADA (36.5%) having at least 1 AEs and 57 (39.3%) among those taking VDZ (P=0.67).
Conclusions
VDZ has a lower incidence rate of AEs causing withdrawal of treatment compared to ADA but a similar risk of AEs not causing drug interruption. Real-life head-to-head studies are still necessary to further explore the safety profile of these drugs.

Citations

Citations to this article as recorded by

Impact of age at diagnosis on long‐term prognosis in patients with intestinal Behçet's disease
Ji Young Chang, Soo Jung Park, Jae Jun Park, Tae Il Kim, Jae Hee Cheon, Jihye Park
Journal of Gastroenterology and Hepatology.2024; 39(3): 519. CrossRef
Comparative Risk of Serious Infection With Vedolizumab vs Anti-Tumor Necrosis Factor in Inflammatory Bowel Disease: Results From Nationwide Swedish Registers
Sara Karlqvist, Michael C. Sachs, Carl Eriksson, Yang Cao, Scott Montgomery, Jonas F. Ludvigsson, Ola Olén, Jonas Halfvarson
American Journal of Gastroenterology.2024; 119(12): 2480. CrossRef
The effect of medical cannabis in inflammatory bowel disease: analysis from the UK Medical Cannabis Registry
Nishaanth Dalavaye, Simon Erridge, Martha Nicholas, Manaswini Pillai, Lara Bapir, Carl Holvey, Ross Coomber, James J Rucker, Jonathan Hoare, Mikael H Sodergren
Expert Review of Gastroenterology & Hepatology.2023; 17(1): 85. CrossRef
Infectious complications in patients with inflammatory bowel disease in Asia: the results of a multinational web-based survey in the 8th Asian Organization for Crohn’s and Colitis meeting
Yu Kyung Jun, Seong-Joon Koh, Dae Seong Myung, Sang Hyoung Park, Choon Jin Ooi, Ajit Sood, Jong Pil Im
Intestinal Research.2023; 21(3): 353. CrossRef
Beyond the survey, to the ideal therapy for Asian
Ki Jae Jo, Jong Pil Im
Intestinal Research.2023; 21(3): 280. CrossRef
Which biologic agents increase perioperative complications in patients with inflammatory bowel disease?
Jihye Park
Intestinal Research.2022; 20(1): 1. CrossRef
Feasibility of a Clinical Decision Support Tool for Ustekinumab to Predict Clinical Remission and Relapse in Patients With Crohn’s Disease: A Multicenter Observational Study
Jihye Park, Jaeyoung Chun, Hyuk Yoon, Jae Hee Cheon
Inflammatory Bowel Diseases.2022;[Epub] CrossRef
Personalized medicine in inflammatory bowel disease: Perspectives on Asia
Su Hyun Park, Sang Hyoung Park
Journal of Gastroenterology and Hepatology.2022; 37(8): 1434. CrossRef
Real-World Evidence of the Effectiveness and Safety of Ustekinumab for the Treatment of Crohn’s Disease: Systematic Review and Meta-Analysis of Observational Studies
Cristina Rubín de Célix, María Chaparro, Javier P. Gisbert
Journal of Clinical Medicine.2022; 11(14): 4202. CrossRef
Effectiveness and Safety of Golimumab in Patients with Ulcerative Colitis: A Multicenter, Prospective, Postmarketing Surveillance Study
Jongwook Yu, Soo Jung Park, Hyung Wook Kim, Yun Jeong Lim, Jihye Park, Jae Myung Cha, Byong Duk Ye, Tae Oh Kim, Hyun-Soo Kim, Hyun Seok Lee, Su Young Jung, Youngdoe Kim, Chang Hwan Choi
Gut and Liver.2022; 16(5): 764. CrossRef
Vedolizumab Is Safe and Efficacious for the Treatment of Pediatric-Onset Inflammatory Bowel Disease Patients Who Fail a Primary Biologic Agent
Sujin Choi, Eun Sil Kim, Yiyoung Kwon, Mi Jin Kim, Yon Ho Choe, Byung-Ho Choe, Ben Kang
Journal of Korean Medical Science.2022;[Epub] CrossRef

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Case Report

Rectal tuberculosis after infliximab therapy despite negative screening for latent tuberculosis in a patient with ulcerative colitis: Jatinderpal Singh, Amarender S Puri, Sanjeev Sachdeva, Puja Sakhuja, Kulandaivelu Arivarasan; Intest Res 2016;14(2):183-186. Published online April 27, 2016; DOI: https://doi.org/10.5217/ir.2016.14.2.183

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Tumor necrosis factor-α inhibitors are now considered as standard therapy for patients with severe inflammatory bowel disease who do not respond to corticosteroids, but they carry a definite risk of reactivation of tuberculosis. We present a case in which a patient with inflammatory bowel disease developed a de novo tuberculosis infection after the start of anti-tumor necrosis factor-α treatment despite showing negative results in tuberculosis screening. Although there are many case reports of pleural, lymph nodal and disseminated tuberculosis following infliximab therapy, we present the first case report of rectal tuberculosis following infliximab therapy.

Citations

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Rectal tuberculosis: A systematic review
Poras Chaudhary, Ashutosh Nagpal, Sam B. Padala, Mangarai Mukund, Lalit K. Bansal, Romesh Lal
Indian Journal of Tuberculosis.2022; 69(3): 268. CrossRef
A case of paradoxical response during anti-tuberculosis treatment in a patient with ulcerative colitis
Shuhei Hosomi, Naoko Sugita, Atsushi Kanamori, Masaki Ominami, Koji Otani, Noriko Kamata, Fumio Tanaka, Yasuaki Nagami, Koichi Taira, Yasuhiro Fujiwara
Clinical Journal of Gastroenterology.2022; 15(3): 592. CrossRef
Safety and effectiveness of adalimumab in the treatment of ulcerative colitis: results from a large-scale, prospective, multicenter, observational study
Haruhiko Ogata, Takashi Hagiwara, Takeshi Kawaberi, Mariko Kobayashi, Toshifumi Hibi
Intestinal Research.2021; 19(4): 419. CrossRef
Risk of tuberculosis with anti-tumor necrosis factor-alpha therapy in patients with psoriasis and psoriatic arthritis in Indian population
Soumajyoti Sarkar, Saumya Panda, Byungsoo Kim, SmritiK Raychaudhuri, Asutosh Ghosh, SibaP Raychaudhuri
Indian Journal of Dermatology, Venereology and Leprology.2020; 86(1): 1. CrossRef
Tuberculosis rectal: presentación clínica infrecuente y diagnóstico diferencial con enfermedad de Crohn
M. Gompertz, L. Carreño, L.C. Gil La Rotta
Revista de Gastroenterología de México.2019; 84(4): 524. CrossRef
Bacteriologically Determined De Novo Tuberculosis during Tumor Necrosis Factor-α Inhibitor Therapy
Gen Takahashi, Hiroyuki Kobayashi, Yasuyuki Saito, Sho Ohsawa, Kuniaki Suzuki, Shinichi Ishihara, Takeshi Hisada
Internal Medicine.2019; 58(24): 3593. CrossRef
Rectal tuberculosis: An uncommon clinical presentation and differential diagnosis with Crohn's disease
M. Gompertz, L. Carreño, L.C. Gil La Rotta
Revista de Gastroenterología de México (English Edition).2019; 84(4): 524. CrossRef
Asian Organization for Crohn's and Colitis and Asia Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti-tumor necrosis factor treatment. Part 1: risk assessment
Dong Il Park, Tadakazu Hisamatsu, Minhu Chen, Siew Chien Ng, Choon Jin Ooi, Shu Chen Wei, Rupa Banerjee, Ida Normiha Hilmi, Yoon Tae Jeen, Dong Soo Han, Hyo Jong Kim, Zhihua Ran, Kaichun Wu, Jiaming Qian, Pin-Jin Hu, Katsuyoshi Matsuoka, Akira Andoh, Yasu
Intestinal Research.2018; 16(1): 4. CrossRef
Asian Organization for Crohn's and Colitis and Asian Pacific Association of Gastroenterology consensus on tuberculosis infection in patients with inflammatory bowel disease receiving anti‐tumor necrosis factor treatment. Part 1: Risk assessment
Dong II Park, Tadakazu Hisamatsu, Minhu Chen, Siew Chien Ng, Choon Jin Ooi, Shu Chen Wei, Rupa Banerjee, Ida Normiha Hilmi, Yoon Tae Jeen, Dong Soo Han, Hyo Jong Kim, Zhihua Ran, Kaichun Wu, Jiaming Qian, Pin‐Jin Hu, Katsuyoshi Matsuoka, Akira Andoh, Yasu
Journal of Gastroenterology and Hepatology.2018; 33(1): 20. CrossRef

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Review

'Lemonade Legs': Why do Some Patients Get Profound Hypomagnesaemia on Proton-Pump Inhibitors?: Nathan S. S. Atkinson, D. John M. Reynolds, Simon P. L. Travis; Intest Res 2015;13(3):227-232. Published online June 9, 2015; DOI: https://doi.org/10.5217/ir.2015.13.3.227

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Proton pump inhibitors (PPIs) are widely used though an association with hypomagnesaemia and hypocalcaemia has only been described since 2006. Patients typically present after years of stable dosing with musculoskeletal, neurological or cardiac arrhythmic symptoms, but it is likely that many cases are under-recognised. Magnesium levels resolve rapidly on discontinuation of PPI therapy and hypomagnesaemia recurs rapidly on rechallenge with any agent in the class. The cellular mechanisms of magnesium homeostasis are increasingly being understood, including both passive paracellular absorption through claudins and active transcellular transporters, including the transient receptor potential channels (TRPM6) identified in the intestine and nephron. PPIs may alter luminal pH by modulating pancreatic secretions, affecting non-gastric H+K+ATPase secretion, altering transporter transcription or channel function. A small reduction in intestinal absorption appears pivotal in causing cumulative deficiency. Risk factors have been associated to help identify patients at risk of this effect but clinical vigilance remains necessary for diagnosis.

Citations

Citations to this article as recorded by

Use of Acid-Suppression Therapy and Odds of Migraine and Severe Headache in the National Health and Nutrition Examination Survey
Margaret Slavin, Cara L. Frankenfeld, Alexander B. Guirguis, Elizabeth K. Seng
Neurology Clinical Practice.2024;[Epub] CrossRef
Magnesium Homeostasis
Aubrey R. Morrison
Clinical Journal of the American Society of Nephrology.2023; 18(7): 969. CrossRef
Risk of urinary stone formation associated to proton pump inhibitors: A systematic review and metanalysis
Rawa Bapir, Kamran Hassan Bhatti, Ahmed Eliwa, Herney Andrés García-Perdomo, Nazim Gherabi, Derek Hennessey, Vittorio Magri, Panagiotis Mourmouris, Adama Ouattara, Gianpaolo Perletti, Joseph Philipraj, Konstantinos Stamatiou, Musliu Adetola Tolani, Lazaro
Archivio Italiano di Urologia e Andrologia.2022; 94(4): 507. CrossRef
An overview of diagnosis and management of drug‐induced hypomagnesemia
George Liamis, Ewout J. Hoorn, Matilda Florentin, Haralampos Milionis
Pharmacology Research & Perspectives.2021;[Epub] CrossRef
Effects of Proton Pump Inhibitors on the Gastrointestinal Microbiota in Gastroesophageal Reflux Disease
Yi-Chao Shi, Shun-Tian Cai, Ya-Ping Tian, Hui-Jun Zhao, Yan-Bing Zhang, Jing Chen, Rong-Rong Ren, Xi Luo, Li-Hua Peng, Gang Sun, Yun-Sheng Yang
Genomics, Proteomics & Bioinformatics.2019; 17(1): 52. CrossRef
Atrial fibrillation and gastrooesophageal reflux disease: association mechanisms, treatment approaches
O. N. Antropova, N. V. Pyrikova, I. V. Osipova
Russian Journal of Cardiology.2019; (7): 103. CrossRef
Do stop me now: gastric acid-reducing drugs following renal transplantation
Ines Held, Rhodri Pyart
Journal of Kidney Care.2018; 3(1): 6. CrossRef
Magnesium homeostasis in cattle: absorption and excretion
Holger Martens, Sabine Leonhard-Marek, Monika Röntgen, Friederike Stumpff
Nutrition Research Reviews.2018; 31(1): 114. CrossRef
A Review of the Novel Application and Potential Adverse Effects of Proton Pump Inhibitors
Li-Yuan Yu, Lu-Ning Sun, Xue-Hui Zhang, Yue-Qi Li, Lei Yu, Zi-Qing-Yun Yuan, Ling Meng, Hong-Wen Zhang, Yong-Qing Wang
Advances in Therapy.2017; 34(5): 1070. CrossRef
Prokinetics for the treatment of functional dyspepsia: Bayesian network meta-analysis
Young Joo Yang, Chang Seok Bang, Gwang Ho Baik, Tae Young Park, Suk Pyo Shin, Ki Tae Suk, Dong Joon Kim
BMC Gastroenterology.2017;[Epub] CrossRef
Proton Pump Inhibitors Should be Used with Caution in Critically Ill Patients to Prevent the Risk of Clostridium difficile Infection
Jung Hwa Min, You Sun Kim
Gut and Liver.2016; 10(4): 493. CrossRef
Impact of Long-Term Proton Pump Inhibitor Therapy on Gut Microbiota in F344 Rats: Pilot Study
Cheol Min Shin, Nayoung Kim, Yong Sung Kim, Ryoung Hee Nam, Ji Hyun Park, Dong Ho Lee, Yeong-Jae Seok, Yeon-Ran Kim, Joo-Hyon Kim, Jung Min Kim, Joo Sung Kim, Hyun Chae Jung
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