Intestinal Research

Original Article

Miscellaneous

Bowel movement alterations predict the severity of diverticular disease and the risk of acute diverticulitis: a prospective, international study: Antonio Tursi, Daniele Piovani, Giovanni Brandimarte, Francesco Di Mario, Walter Elisei, Marcello Picchio, Gisella Figlioli, Gabrio Bassotti, Leonardo Allegretta, Maria Laura Annunziata, Mauro Bafutto, Maria Antonia Bianco, Raffaele Colucci, Rita Conigliaro, Dan L. Dumitrascu, Ricardo Escalante, Luciano Ferrini, Giacomo Forti, Marilisa Franceschi, Maria Giovanna Graziani, Frank Lammert, Giovanni Latella, Daniele Lisi, Giovanni Maconi, Debora Compare, Gerardo Nardone, Lucia Camara de Castro Oliveira, Chaves Oliveira Enio, Savvas Papagrigoriadis, Anna Pietrzak, Stefano Pontone, Ieva Stundiene, Tomas Poškus, Giuseppe Pranzo, Matthias Christian Reichert, Stefano Rodino, Jaroslaw Regula, Giuseppe Scaccianoce, Franco Scaldaferri, Roberto Vassallo, Costantino Zampaletta, Angelo Zullo, Erasmo Spaziani, Stefanos Bonovas, Alfredo Papa, Silvio Danese, DICA International Group; Intest Res 2025;23(1):96-106. Published online August 12, 2024; DOI: https://doi.org/10.5217/ir.2024.00046

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Patients with diverticular disease (DD) frequently have abnormal bowel movements. However, it is unknown whether the entity of these alterations is associated with the severity of DD. We aimed to assess bowel habits and their relationship with the severity of DD according to Diverticular Inflammation and Complication Assessment (DICA) classification, Combined Overview on Diverticular Assessment (CODA) score, and fecal calprotectin (FC).
Methods
An international, multicenter, prospective cohort study was conducted in 43 centers. A 10-point visual analog scale (VAS) was used to assess the severity of constipation and diarrhea. The association of constipation and diarrhea with DICA classification, CODA score, and basal FC was tested using non-parametric tests. Survival methods for censored observations were applied to test the association of constipation and diarrhea with the incidence of acute diverticulitis over a 3-year follow-up.
Results
Of 871 patients with DD were included in the study. Of these, 208 (23.9%) and 199 (22.9%) reported a VAS score for constipation and diarrhea at least 3 at baseline, respectively. Higher constipation and diarrhea scores were associated with increasing DICA classification, CODA score and basal FC (P< 0.001). Constipation and diarrhea scores were independently associated with an increased hazard of developing acute diverticulitis (hazard ratio [HR]_constipation = 1.15 per 1-VAS point increase, 95% confidence interval [CI], 1.04–1.27; P=0.004; and HR_diarrhea =1.14; 95% CI, 1.03–1.26; P=0.014, respectively).
Conclusions
In newly diagnosed patients with DD, higher endoscopic and combined scores of DD severity were associated with higher scores of constipation and diarrhea at baseline. Both constipation and diarrhea were independent prognostic factors of acute diverticulitis.

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Review

IBD

The evolving understanding of histology as an endpoint in ulcerative colitis: Shintaro Akiyama, Yusuke Miyatani, David T. Rubin; Intest Res 2024;22(4):389-396. Published online March 13, 2024; DOI: https://doi.org/10.5217/ir.2023.00120

Abstract PDF PubReader ePub

A therapeutic goal for patients with ulcerative colitis (UC) is deep remission including clinical remission and mucosal healing. Mucosal healing was previously defined by endoscopic appearance, but recent studies demonstrate that histological improvements can minimize the risks of experiencing clinical relapse after achieving endoscopic remission, and there is growing interest in the value and feasibility of histological targets of treatment in inflammatory bowel disease, and specifically UC. In this review article, we identify remaining challenges and discuss an evolving role of histology in the management of UC.

Citations

Citations to this article as recorded by

Claudin-2 simplifies histological assessment of activity/remission of ulcerative colitis in real-life daily practice
Gabrio Bassotti, Rachele Del Sordo, Francesco Lanzarotto, Sara Mino, Chiara Ricci, Vincenzo Villanacci
European Journal of Gastroenterology & Hepatology.2025; 37(4): 409. CrossRef
Role of 5-aminosalicylic acid in ulcerative colitis management in 8 Asian territories: a physician survey
Julajak Limsrivilai, Allen Yu-hung Lai, Silvia T. H. Li, Murdani Abdullah, Raja Affendi Raja Ali, Satimai Aniwan, Hoang Huu Bui, Jen-Wei Chou, Ida Normiha Hilmi, Wee Chian Lim, Jose Sollano, Michelle Mui Hian Teo, Shu-Chen Wei, Wai Keung Leung
Intestinal Research.2025; 23(2): 117. CrossRef
Beyond mucosal healing: fecal calprotectin and the path toward histologic remission in ulcerative colitis
Yehyun Park
Intestinal Research.2025; 23(2): 115. CrossRef
Patients with ulcerative colitis who have normalized histology are clinically stable after de-escalation of therapy
Shintaro Akiyama, Joëlle St-Pierre, Cindy Traboulsi, Alexa Silfen, Victoria Rai, Tina G. Rodriguez, Amarachi I. Erondu, Joshua M. Steinberg, Seth R. Shaffer, Britt Christensen, David T. Rubin
npj Gut and Liver.2024;[Epub] CrossRef

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Original Article

Miscellaneous

A simple phenotypic classification for celiac disease: Ajit Sood, Vandana Midha, Govind Makharia, B. K. Thelma, Shivalingappa S Halli, Varun Mehta, Ramit Mahajan, Vikram Narang, Kriti Sood, Kirandeep Kaur; Intest Res 2018;16(2):288-292. Published online April 30, 2018; DOI: https://doi.org/10.5217/ir.2018.16.2.288

Abstract PDF PubReader ePub

<b>Background/Aims</b><br/>

Celiac disease is a global health problem. The presentation of celiac disease has unfolded over years and it is now known that it can manifest at different ages, has varied presentations, and is prone to develop complications, if not managed properly. Although the Oslo definitions provide consensus on the various terminologies used in literature, there is no phenotypic classification providing a composite diagnosis for the disease.

Methods

Various variables identified for phenotypic classification included age at diagnosis, age at onset of symptoms, clinical presentation, family history and complications. These were applied to the existing registry of 1,664 patients at Dayanand Medical College and Hospital, Ludhiana, India. In addition, age was evaluated as below 15 and below 18 years. Cross tabulations were used for the verification of the classification using the existing data. Expert opinion was sought from both international and national experts of varying fields.

Results

After empirical verification, age at diagnosis was considered appropriate in between A1 (<18) and A2 (≥18). The disease presentation has been classified into 3 types–P1 (classical), P2 (non-classical) and P3 (asymptomatic). Complications were considered as absent (C0) or present (C1). A single phenotypic classification based on these 3 characteristics, namely age at the diagnosis, clinical presentation, and intestinal complications (APC classification) was derived.

Conclusions

APC classification (age at diagnosis, presentation, complications) is a simple disease explanatory classification for patients with celiac disease aimed at providing a composite diagnosis.

Citations

Citations to this article as recorded by

Analyzing the landscape of coeliac crisis in adult and paediatric populations: A systematic review and meta-analysis
Arkadeep Dhali, Rick Maity, Hareesha Rishab Bharadwaj, Syed Hasham Ali, Muhammad Hamza Shah, David Surendran Sanders
Digestive and Liver Disease.2025; 57(6): 1149. CrossRef
Clinicopathologic Analysis of Malabsorption Syndrome in a Tertiary Care Center in South India
Nidhya Ganesan, S. Shrinnivi, R. Shivani, R. K. Kartikayan
Medical Journal of Dr. D.Y. Patil Vidyapeeth.2024; 17(3): 616. CrossRef
Prevalence of haplotype DQ2/DQ8 and celiac disease in children with type 1 diabetes
Agnieszka Zubkiewicz-Kucharska, Tatiana Jamer, Joanna Chrzanowska, Katarzyna Akutko, Tomasz Pytrus, Andrzej Stawarski, Anna Noczyńska
Diabetology & Metabolic Syndrome.2022;[Epub] CrossRef
Celiac crisis, a rare occurrence in adult celiac disease: A systematic review
Daniel Vasile Balaban, Alina Dima, Ciprian Jurcut, Alina Popp, Mariana Jinga
World Journal of Clinical Cases.2019; 7(3): 311. CrossRef
The spectrum of clinical and subclinical endocrinopathies in treatment-naïve patients with celiac disease
Vipin Gupta, Alka Singh, Rajesh Khadgawat, Ashish Agarwal, Asif Iqbal, Wajiha Mehtab, P.K. Chaturvedi, Vineet Ahuja, Govind K. Makharia
Indian Journal of Gastroenterology.2019; 38(6): 518. CrossRef

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