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IBD
Artificial intelligence for endoscopy in inflammatory bowel disease
Kento Takenaka, Ami Kawamoto, Ryuichi Okamoto, Mamoru Watanabe, Kazuo Ohtsuka
Intest Res 2022;20(2):165-170.   Published online January 7, 2022
DOI: https://doi.org/10.5217/ir.2021.00079
AbstractAbstract PDFPubReaderePub
Inflammatory bowel disease (IBD), with its 2 subtypes, Crohn’s disease and ulcerative colitis, is a complex chronic condition. A precise definition of disease activity and appropriate drug management greatly improve the clinical course while minimizing the risk or cost. Artificial intelligence (AI) has been used in several medical diseases or situations. Herein, we provide an overview of AI for endoscopy in IBD. We discuss how AI can improve clinical practice and how some components have already begun to shape our knowledge. There may be a time when we can use AI in clinical practice. As AI systems contribute to the exact diagnosis and treatment of human disease, we should continue to learn best practices in health care in the field of IBD.

Citations

Citations to this article as recorded by  
  • Deep Learning Model Using Stool Pictures for Predicting Endoscopic Mucosal Inflammation in Patients With Ulcerative Colitis
    Jung Won Lee, Dongwon Woo, Kyeong Ok Kim, Eun Soo Kim, Sung Kook Kim, Hyun Seok Lee, Ben Kang, Yoo Jin Lee, Jeongseok Kim, Byung Ik Jang, Eun Young Kim, Hyeong Ho Jo, Yun Jin Chung, Hanjun Ryu, Soo-Kyung Park, Dong-Il Park, Hosang Yu, Sungmoon Jeong
    American Journal of Gastroenterology.2025; 120(1): 213.     CrossRef
  • Could histologic healing be a new treatment target in patients with ulcerative colitis?
    Soyoung Kim, Sang Hyoung Park
    The Korean Journal of Internal Medicine.2024; 39(1): 2.     CrossRef
  • From Data to Insights: How Is AI Revolutionizing Small-Bowel Endoscopy?
    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
    Diagnostics.2024; 14(3): 291.     CrossRef
  • The Role of Artificial Intelligence in the Diagnosis and Treatment of Ulcerative Colitis
    Petar Uchikov, Usman Khalid, Nikola Vankov, Maria Kraeva, Krasimir Kraev, Bozhidar Hristov, Milena Sandeva, Snezhanka Dragusheva, Dzhevdet Chakarov, Petko Petrov, Bistra Dobreva-Yatseva, Ivan Novakov
    Diagnostics.2024; 14(10): 1004.     CrossRef
  • Deep learning and minimally invasive inflammatory activity assessment: a proof-of-concept study for development and score correlation of a panendoscopy convolutional network
    Pedro Cardoso, Miguel Mascarenhas, João Afonso, Tiago Ribeiro, Francisco Mendes, Miguel Martins, Patrícia Andrade, Hélder Cardoso, Miguel Mascarenhas Saraiva, João P.S. Ferreira, Guilherme Macedo
    Therapeutic Advances in Gastroenterology.2024;[Epub]     CrossRef
  • Knowledge, attitudes, and practices of endoscopy among gastroenterologists in diagnosis and management of inflammatory bowel disease in China: a multicenter cross-sectional study
    Yinghao Sun, Gechong Ruan, Xiaoyin Bai, Wei Han, Minglan Yang, Lixin Jin, Yanni Huang, Xiaoxia Hou, Ke Shu, Yingying Liu, Yafeng Lu, Yan Zhao, Jie Zhong, Hong Yang
    BMC Gastroenterology.2024;[Epub]     CrossRef
  • Endoscopic findings of immune checkpoint inhibitor-related gastrointestinal adverse events
    Min Kyu Kim, Sung Wook Hwang
    Clinical Endoscopy.2024; 57(6): 725.     CrossRef
  • The pathobiology of follicular lymphoma
    Joaquim Carreras
    Journal of Clinical and Experimental Hematopathology.2023; 63(3): 152.     CrossRef
  • Artificial Intelligence in Digestive Endoscopy—Where Are We and Where Are We Going?
    Radu-Alexandru Vulpoi, Mihaela Luca, Adrian Ciobanu, Andrei Olteanu, Oana-Bogdana Barboi, Vasile Liviu Drug
    Diagnostics.2022; 12(4): 927.     CrossRef
  • Artificial intelligence within the small bowel: are we lagging behind?
    Stefania Chetcuti Zammit, Reena Sidhu
    Current Opinion in Gastroenterology.2022; 38(3): 307.     CrossRef
  • 5,734 View
  • 421 Download
  • 13 Web of Science
  • 10 Crossref
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Original Articles
Inflammatory Bowel Diseases
Ustekinumab for the treatment of refractory pediatric Crohn’s disease: a single-center experience
Alexandra Cohen, Najma Ahmed, Ana Sant’Anna
Intest Res 2021;19(2):217-224.   Published online April 22, 2020
DOI: https://doi.org/10.5217/ir.2019.09164
AbstractAbstract PDFPubReaderePub
Background/Aims
Despite the well-established efficacy of tumor necrosis factor (TNF) antagonists as treatment options for Crohn’s disease, many pediatric patients need a change in therapy due to adverse events and loss of response, highlighting the necessity for medications with a different mechanism of action. Ustekinumab has been shown to be effective in inducing clinical remission in some adults with disease refractory to anti-TNF agents, however, minimal data exists in the pediatric population.
Methods
We conducted a retrospective chart review of 11 pediatric patients receiving ustekinumab, specifically extracting baseline data, information on prior treatment and response, indications for starting ustekinumab, clinical information, and laboratory parameters pre- and post-therapy. Clinical response was defined as a decrease in abbreviated Pediatric Crohn’s Disease Activity Index score.
Results
Patients ranged from 12 to 17 years of age upon initiation of treatment with ustekinumab. Five of 11 patients demonstrated a clinical response. Among these patients, 2 remained in clinical remission, while the remaining 3 experienced a secondary loss of response. The other 6 patients were primary nonresponders who either remained unwell or demonstrated slight clinical worsening. All patients who clinically responded to ustekinumab and had an initially elevated CRP experienced complete normalization of their values. Mucosal healing was seen on endoscopy in 1 responder, with 2 other patients showing endoscopic improvement.
Conclusions
These results demonstrate for the first time that ustekinumab has the potential to induce not only clinical and biochemical remission, but also endoscopic improvement, in the pediatric population. Future research is needed to determine factors that influence response to therapy.

Citations

Citations to this article as recorded by  
  • Clinical effectiveness and safety of ustekinumab in youth with refractory inflammatory bowel disease: A retrospective cohort study
    Abdulhamid Alhadab, Amal Almarhoon, Amena AlAlwan, AbdelHai Hammo
    Saudi Journal of Gastroenterology.2025; 31(2): 59.     CrossRef
  • Oral manifestations of Crohn disease managed with ustekinumab
    Patrick Ruck, Elizabeth S. Gosnell, James R. Rick
    The Journal of the American Dental Association.2025; 156(2): 160.     CrossRef
  • STEP-CD study: ustekinumab use in paediatric Crohn’s disease—a multicentre retrospective study from paediatric IBD Porto group of ESPGHAN
    Gemma Pujol-Muncunill, Víctor Manuel Navas-López, Oren Ledder, Shlomi Cohen, Marina Lekar, Dan Turner, Kaija-Leena Kolho, Arie Levine, Nicholas M. Croft, Jiri Bronsky, Dror S. Shouval, Amit Assa, Rachel Harris, Fevronia Kiparissi, Marina Aloi, Nadeem Ahma
    European Journal of Pediatrics.2024; 183(8): 3253.     CrossRef
  • Medical management of pediatric inflammatory bowel disease in the Asia‐Pacific region: A position paper by the Asian Pan‐Pacific Society for Pediatric Gastroenterology, Hepatology, and Nutrition (APPSPGHAN) PIBD Working Group
    Way Seah Lee, Katsuhiro Arai, George Alex, Suporn Treepongkaruna, Kyung Mo Kim, Chee Liang Choong, Karen S. C. Mercado, Andy Darma, Anshu Srivastava, Marion M. Aw
    Journal of Gastroenterology and Hepatology.2023; 38(4): 523.     CrossRef
  • Real-world effectiveness and safety of ustekinumab induction therapy for Korean patients with Crohn’s disease: a KASID prospective multicenter study
    Kyunghwan Oh, Hee Seung Hong, Nam Seok Ham, Jungbok Lee, Sang Hyoung Park, Suk-Kyun Yang, Hyuk Yoon, You Sun Kim, Chang Hwan Choi, Byong Duk Ye
    Intestinal Research.2023; 21(1): 137.     CrossRef
  • Effectiveness and Safety of Ustekinumab for Pediatric Inflammatory Bowel Disease: A Systematic Review
    Shengbo Fang, Sixi Zhang, Chunyan Zhang, Libo Wang
    Pediatric Drugs.2023; 25(5): 499.     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
  • 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
  • Augmented ustekinumab dosing is needed to achieve clinical response in patients with anti-TNF refractory pediatric Crohn’s disease: a retrospective chart review
    Phinga Do, John Andersen, Ashish Patel, Gaith Semrin, Luis Sifuentes-Dominguez, Phuong Luu, Bhaskar Gurram
    F1000Research.2021; 9: 316.     CrossRef
  • Ustekinumab Dose Intensification in Paediatric Crohn's Disease
    Rosa Rodríguez‐Mauriz, Carlos Seguí Solanes, Isabel Masiques Mas, Nuria Rudi Sola
    Journal of Paediatrics and Child Health.2021; 57(7): 1148.     CrossRef
  • 7,778 View
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  • 9 Web of Science
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Inflammatory bowel diseases
Predictive factors for achievement of mucosal healing by budesonide 2-mg foam in ulcerative colitis: a pooled analysis of data from two clinical trials
Toshifumi Hibi, Makoto Naganuma, Eisei Oda, Yoji Yamada, Yoshitomo Chujoh, Ryoichi Yoshihara, Mamoru Watanabe
Intest Res 2020;18(1):56-68.   Published online December 11, 2019
DOI: https://doi.org/10.5217/ir.2019.00064
AbstractAbstract PDFPubReaderePub
Background/Aims
Mucosal healing (MH) of distal lesions in ulcerative colitis (UC) has recently been confirmed with budesonide 2-mg foam (BF) treatment in 2 clinical trials; however, few studies have investigated the predictive factors for complete MH.
Methods
We conducted a post hoc analysis using pooled data from phase II and III clinical trials evaluating the efficacy and safety of BF for UC. Additionally, we analyzed the relationships between complete MH and baseline factors and clinical symptoms from baseline to week 6.
Results
Among the 291 Japanese patients from the 2 pooled clinical studies, 119 patients in the BF twice a day group and 117 in the placebo group were included in the full analysis set. The proportion of patients with a rectal bleeding (RB) subscore of 0 was significantly higher in the BF group than in the placebo group after a 5-day treatment (P<0.05). After a 2-day treatment, significantly more patients in the BF group had a stool frequency (SF) subscore of 0 than patients in the placebo group (P<0.05). Multivariate analysis showed that complete MH at week 6 was influenced by baseline SF subscore and 5-aminosalicylic acid (5-ASA) enema or suppository use (P=0.0086 and P=0.0015, respectively). The relationship between complete MH at week 6 and RB subscore after week 2 was also confirmed.
Conclusions
Normal SF at baseline, history of 5-ASA topical product use, and elimination of RB after week 2 are suggested predictors of complete MH at week 6 with twice-daily BF treatment.

Citations

Citations to this article as recorded by  
  • Impact of twice‐daily budesonide foam administration on early clinical response and endoscopic remission in patients with ulcerative colitis: a post hoc analysis
    Kenji Watanabe, Fumihito Hirai, Kiyonori Kobayashi, Ken Takeuchi, Shinsuke Kurosu, Katsutoshi Inagaki, Ken‐ichi Iwayama, Makoto Naganuma
    Journal of Gastroenterology and Hepatology.2024; 39(11): 2367.     CrossRef
  • Precision medicine and drug optimization in adult inflammatory bowel disease patients
    Sophie Vieujean, Edouard Louis
    Therapeutic Advances in Gastroenterology.2023;[Epub]     CrossRef
  • The Prognostic Value of Residual Nonrectal Inflammation in Ulcerative Colitis
    Eun Ae Kang
    Gut and Liver.2022; 16(3): 487.     CrossRef
  • Bowel frequency (night) and urgent defecation are improved by budesonide foam in patients with ulcerative colitis: a retrospective observational study
    Ryosuke Miyazaki, Toshiyuki Sakurai, Mariko Shimada, Yuko Iwashita, Naoki Shibuya, Yoshihiro Akita, Haruna Miyashita, Yuki Maruyama, Masayuki Saruta
    BMC Gastroenterology.2022;[Epub]     CrossRef
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    Su Hyun Park, Sang Hyoung Park
    Journal of Gastroenterology and Hepatology.2022; 37(8): 1434.     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
  • Budesonide MMX in the Treatment of Ulcerative Colitis: Current Perspectives on Efficacy and Safety
    Giovanni Maconi, Deborah Camatta, Rosanna Cannatelli, Francesca Ferretti, Anna Carvalhas Gabrielli, Sandro Ardizzone
    Therapeutics and Clinical Risk Management.2021; Volume 17: 285.     CrossRef
  • 6,468 View
  • 183 Download
  • 9 Web of Science
  • 7 Crossref
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Review
IBD
Stem cell-based therapy for inflammatory bowel disease
Hiromichi Shimizu, Kohei Suzuki, Mamoru Watanabe, Ryuichi Okamoto
Intest Res 2019;17(3):311-316.   Published online July 25, 2019
DOI: https://doi.org/10.5217/ir.2019.00043
AbstractAbstract PDFPubReaderePub
Inflammatory bowel disease (IBD) is an idiopathic, multi-etiological disease characterized by inflammation and mucosal destruction of the gastrointestinal tract. Despite the remarkable advance in immunomodulating therapies, there still remains a certain population of patients who are refractory to conventional as well as biologic therapies and fail to achieve mucosal healing. To improve the prognosis of those patients, at least 2 types of stem cells have been tested for their potential therapeutic use. Transplantation of hematopoietic stem cells or mesenchymal stem cells have been tested in several clinical studies, but their beneficial effect still remains controversial. In this review, we would like to overview the recent clinical challenges of stem cell-based therapies in IBD and also introduce our new therapeutic plan of intestinal stem cell transplantation for IBD, based on our ex vivo intestinal organoid culture technique.

Citations

Citations to this article as recorded by  
  • Mesenchymal stem cell-derived exosomes as a plausible immunomodulatory therapeutic tool for inflammatory diseases
    Muhammad Zubair, Fatma A. Abouelnazar, Muhammad Asad Iqbal, Jingyun Pan, Xuwen Zheng, Tao Chen, Wenming Shen, Jinnan Yin, Yongmin Yan, Pengjun Liu, Fei Mao, Ying Chu
    Frontiers in Cell and Developmental Biology.2025;[Epub]     CrossRef
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    Kean Chang Phang, Mohammad Firdaus Bin Abdul Aziz
    Asian Bioethics Review.2025;[Epub]     CrossRef
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    Emma Ruysseveldt, Brecht Steelant, Tine Wils, Jonathan Cremer, Dominique M.A. Bullens, Peter W. Hellings, Katleen Martens
    Journal of Allergy and Clinical Immunology.2024; 154(3): 631.     CrossRef
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    Gut and Liver.2024; 18(6): 949.     CrossRef
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    Bashdar M. Hussen, Mohammad Taheri, Raya Kh. Yashooa, Gaylany H. Abdullah, Snur R. Abdullah, Ramiar Kamal Kheder, Suhad A. Mustafa
    International Journal of Surgery.2024; 110(12): 8002.     CrossRef
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    Cellular and Molecular Gastroenterology and Hepatology.2022; 13(3): 789.     CrossRef
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    Stem Cell Research & Therapy.2022;[Epub]     CrossRef
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    Frontiers in Cell and Developmental Biology.2022;[Epub]     CrossRef
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    Organoid.2022; 2: e22.     CrossRef
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    Jinsha Liu, Joey Paolo Ting, Shams Al-Azzam, Yun Ding, Sepideh Afshar
    International Journal of Molecular Sciences.2021; 22(6): 2805.     CrossRef
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    Min Young Park, Yong Sik Yoon, Jong Lyul Lee, Sang Hyoung Park, Byong Duk Ye, Suk-Kyun Yang, Chang Sik Yu
    Stem Cell Research & Therapy.2021;[Epub]     CrossRef
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    Meng-Meng Zhang, Ke-Lu Yang, Yan-Cheng Cui, Yu-Shi Zhou, Hao-Ran Zhang, Quan Wang, Ying-Jiang Ye, Shan Wang, Ke-Wei Jiang
    Frontiers in Cell and Developmental Biology.2021;[Epub]     CrossRef
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    Satrio Wibowo, Krisni Subandiyah, Kusworini Handono, Sri Poeranto
    Open Access Macedonian Journal of Medical Sciences.2021; 9(B): 931.     CrossRef
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    Ji Young Chang, Jae Hee Cheon
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    Jiuheng Yin, Chao Zhou, Kunqiu Yang, Yanbei Ren, Yuan Qiu, Pengyuan Xu, Weidong Xiao, Hua Yang
    Cell Biology International.2020; 44(6): 1405.     CrossRef
  • Letter: off‐label use of hyperbaric oxygen therapy in inflammatory bowel disease—Authors’ reply
    Melek Simsek, Nanne K. H. de Boer
    Alimentary Pharmacology & Therapeutics.2020; 52(1): 216.     CrossRef
  • The Role of Immune and Epithelial Stem Cells in Inflammatory Bowel Disease Therapy
    Agata Binienda, Sylwia Ziolkowska, Ingvild H. Hauge, Maciej Salaga
    Current Drug Targets.2020; 21(14): 1405.     CrossRef
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  • 267 Download
  • 20 Web of Science
  • 20 Crossref
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Original Articles
IBD
The novel latex agglutination turbidimetric immunoassay system for simultaneous measurements of calprotectin and hemoglobin in feces
Sakiko Hiraoka, Shiho Takashima, Toshihiro Inokuchi, Asuka Nakarai, Masahiro Takahara, Keita Harada, Yasuhiro Seki, Katsunori Watanabe, Jun Kato, Hiroyuki Okada
Intest Res 2019;17(2):202-209.   Published online December 14, 2018
DOI: https://doi.org/10.5217/ir.2018.00086
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Background/Aims
Fecal calprotectin (Fcal) as well as the fecal immunochemical test (FIT) are useful biomarkers for detecting activity and mucosal healing in inflammatory bowel diseases. Here, we report the performance of simultaneous measurements of Fcal and FIT for ulcerative colitis (UC) patients using the newly-developed latex agglutination turbidimetric immunoassay (LATIA) system.
Methods
Fcal and hemoglobin were measured by the LATIA system in 152 UC patients who underwent colonoscopy. Fcal was also quantified with a conventional enzyme-linked immunosorbent assay (ELISA). Fecal markers were evaluated in conjunction with the mucosal status of UC, which was assessed via the Mayo endoscopic subscore (MES) classification.
Results
The LATIA system could quantify calprotectin and hemoglobin simultaneously with the same fecal samples within 10 minutes. The values of the Fcal-LATIA closely correlated with those of the Fcal-ELISA (Spearman rank correlation coefficient, r=0.84; P<0.0001). The values of Fcal for each assay and the FIT all significantly correlated with the MESs (Spearman rank correlation coefficient, Fcal-LATIA: r=0.58, Fcal-ELISA: r=0.55, and FIT: r=0.72). The mucosal healing predictability (determined by an MES of 0 alone) of the Fcal-LATIA, Fcal-ELISA, and FIT-LATIA with the cutoffs determined by receiver operating characteristic curve analysis was 0.79, 0.78, and 0.92 for sensitivity, respectively, and 0.78, 0.69, and 0.73 for specificity, respectively.
Conclusions
The performance of the novel Fcal-LATIA was equivalent to that of the conventional Fcal assay. Simultaneous measurements with FITs would promote the clinical relevance of fecal biomarkers in UC.

Citations

Citations to this article as recorded by  
  • Systematic scoping review: Use of the faecal immunochemical test residual buffer to enhance colorectal cancer screening
    Timothy McAuliffe, Joseph C. Anderson, Robin J. Larson, Douglas J. Robertson
    Alimentary Pharmacology & Therapeutics.2024; 59(9): 1033.     CrossRef
  • Evaluation of a faecal calprotectin method using the OC-SENSOR PLEDIA
    Shane O’Driscoll, Carolyn Piggott, Sally C. Benton
    Clinical Chemistry and Laboratory Medicine (CCLM).2022; 60(6): 901.     CrossRef
  • International consensus on methodological issues in standardization of fecal calprotectin measurement in inflammatory bowel diseases
    Ferdinando D'Amico, David T. Rubin, Paulo Gustavo Kotze, Fernando Magro, Britta Siegmund, Taku Kobayashi, Pablo A. Olivera, Peter Bossuyt, Lieven Pouillon, Edouard Louis, Eugeni Domènech, Subrata Ghosh, Silvio Danese, Laurent Peyrin‐Biroulet
    United European Gastroenterology Journal.2021; 9(4): 451.     CrossRef
  • Faecal Calprotectin in Assessment of Mucosal Healing in Adults with Inflammatory Bowel Disease: A Meta-Analysis
    Mariusz A. Bromke, Katarzyna Neubauer, Radosław Kempiński, Małgorzata Krzystek-Korpacka
    Journal of Clinical Medicine.2021; 10(10): 2203.     CrossRef
  • Leucine-rich alpha-2 glycoprotein as a marker of mucosal healing in inflammatory bowel disease
    Eriko Yasutomi, Toshihiro Inokuchi, Sakiko Hiraoka, Kensuke Takei, Shoko Igawa, Shumpei Yamamoto, Masayasu Ohmori, Shohei Oka, Yasushi Yamasaki, Hideaki Kinugasa, Masahiro Takahara, Keita Harada, Masaki Furukawa, Kouichi Itoshima, Ken Okada, Fumio Otsuka,
    Scientific Reports.2021;[Epub]     CrossRef
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    Eun Soo Kim
    Gut and Liver.2021; 15(5): 637.     CrossRef
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    Zhongsheng Cao, Chenglong Ye, Lunan Li, Xiaoge Geng, Wensheng Pan, Jiyong Jing
    World Academy of Sciences Journal.2021;[Epub]     CrossRef
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    Małgorzata Krzystek-Korpacka, Radosław Kempiński, Mariusz Bromke, Katarzyna Neubauer
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    Natsuki Ishida, Kiichi Sugiura, Takahiro Miyazu, Satoshi Tamura, Satoshi Suzuki, Shinya Tani, Mihoko Yamade, Moriya Iwaizumi, Yasushi Hamaya, Satoshi Osawa, Takahisa Furuta, Ken Sugimoto
    Clinical and Translational Gastroenterology.2020; 11(12): e00289.     CrossRef
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    Jun Kato, Takeichi Yoshida, Sakiko Hiraoka
    Expert Review of Clinical Immunology.2019; 15(6): 667.     CrossRef
  • 8,716 View
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  • 9 Web of Science
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IBD
Patient self-reported symptoms using visual analog scales are useful to estimate endoscopic activity in ulcerative colitis
Saya Tsuda, Reiko Kunisaki, Jun Kato, Mayu Murakami, Masafumi Nishio, Tsuyoshi Ogashiwa, Takeichi Yoshida, Hideaki Kimura, Masayuki Kitano
Intest Res 2018;16(4):579-587.   Published online October 10, 2018
DOI: https://doi.org/10.5217/ir.2018.00021
AbstractAbstract PDFPubReaderePub
Background/Aims
In clinical practice, colonoscopy has been regarded as the gold standard for the evaluation of disease severity as well as mucosal healing in ulcerative colitis (UC). Some activity indices incorporating patient symptoms as parameters have been shown to reflect the endoscopic activity of UC. The aim of this study was to examine whether self-reported symptoms with visual analog scales (VAS) can predict endoscopic activity.
Methods
A cross-sectional study of 150 UC patients who underwent colonoscopy with submission of VAS scores of 4 symptoms: general condition, bloody stools, stool form, and abdominal pain (0: no symptoms, 10: the most severe symptoms). Each VAS score was compared with colonoscopic activity assessed with the Mayo endoscopic subscore (MES).
Results
All VAS scores were significantly correlated with the endoscopic severity (Spearman correlation coefficients of general condition, bloody stools, stool form, and abdominal pain: 0.63, 0.64, 0.58, and 0.43, respectively). Mucosal healing defined as MES 0 alone was predicted by VAS score <1.5 on general condition or 0 on bloody stools with sensitivity of 0.84 and 0.76 and specificity of 0.66 and 0.76, respectively. Additionally, VAS score <2.5 on stool form predicted active lesions in distal colorectum alone with sensitivity of 0.67 and specificity of 0.66, suggesting that this item could predict the indication of topical therapy.
Conclusions
Self-reported VAS scores on symptoms were correlated with endoscopic activity of UC. To clarify the relationship between VAS and mucosal healing, further validation studies are needed.

Citations

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  • Defining Comprehensive Disease Control for Use as a Treatment Target for Ulcerative Colitis in Clinical Practice: International Delphi Consensus Recommendations
    Stefan Schreiber, Silvio Danese, Axel Dignass, Eugeni Domènech, Massimo C Fantini, Marc Ferrante, Jonas Halfvarson, Ailsa Hart, Fernando Magro, Charlie W Lees, Salvo Leone, Marieke J Pierik, Michele Peters, Polly Field, Helen Fishpool, Laurent Peyrin-Biro
    Journal of Crohn's and Colitis.2024; 18(1): 91.     CrossRef
  • Anxiety and care experiences in adolescents with chronic health conditions: an international, longitudinal study across the transfer of care
    Anna Alanen, Mira Kallio, Evelyn Culnane, Mari Koivisto, Miko Pasanen, Sanna Salanterä, Susan Sawyer, Silja Kosola
    BMJ Paediatrics Open.2024; 8(1): e002836.     CrossRef
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Trough level of infliximab is useful for assessing mucosal healing in Crohn's disease: a prospective cohort study
Akihiro Koga, Toshiyuki Matsui, Noritaka Takatsu, Yasumichi Takada, Masahiro Kishi, Yutaka Yano, Takahiro Beppu, Yoichiro Ono, Kazeo Ninomiya, Fumihito Hirai, Takashi Nagahama, Takashi Hisabe, Yasuhiro Takaki, Kenshi Yao, Hirotsugu Imaeda, Akira Andoh
Intest Res 2018;16(2):223-232.   Published online April 30, 2018
DOI: https://doi.org/10.5217/ir.2018.16.2.223
AbstractAbstract PDFSupplementary MaterialPubReaderePub
<b>Background/Aims</b><br/>

Decreased trough levels of infliximab (TLI) and antibodies to infliximab (ATI) are associated with loss of response (LOR) in Crohn's disease. Two prospective studies were conducted to determine whether TLI or ATI better correlates with LOR (Study 1), and whether TLI could become a predictor of mucosal healing (MH) (Study 2).

Methods

Study 1 was conducted in 108 patients, including those with LOR and remission to compare ATI and TLI in discriminating the 2 conditions based on receiver operating characteristic (ROC) curve analyses. Study 2 involved 35 patients who were evaluated endoscopically.

Results

In Study 1, there were no differences between the 2 assays in ROC curve analyses; the TLI cutoff value for LOR was 2.6 µg/mL (sensitivity, 70.9%; specificity, 79.2%), and the ATI cutoff value was 4.9 µg/mL (sensitivity, 65.5%; specificity, 67.9%). The AUROC (area under the ROC curve) of TLI was greater than that of ATI. AUROC was useful for discriminating between the 2 conditions. In Study 2, the TLI was significantly higher in the colonic MH group than in the non-MH group (2.7 µg/mL vs. 0.5 µg/mL, P=0.032).

Conclusions

TLI is better than ATI for clinically diagnosing LOR, and a correlation was observed between TLI and colonic MH.

Citations

Citations to this article as recorded by  
  • Mucosal and Transmural Healing and Long-term Outcomes in Crohn’s Disease
    Bruce E Sands, Silvio Danese, J Casey Chapman, Khushboo Gurjar, Stacy Grieve, Deepika Thakur, Jenny Griffith, Namita Joshi, Kristina Kligys, Axel Dignass
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Association of endoscopic and histological remission with clinical course in patients of ulcerative colitis
Vikram Narang, Ravneet Kaur, Bhavna Garg, Ramit Mahajan, Vandana Midha, Neena Sood, Ajit Sood
Intest Res 2018;16(1):55-61.   Published online January 18, 2018
DOI: https://doi.org/10.5217/ir.2018.16.1.55
AbstractAbstract PDFPubReaderePub
<b>Background/Aims</b><br/>

The therapeutic goal for treating ulcerative colitis (UC) patients has shifted to achieving mucosal healing over the past few years. However, at present, limited data is available on the correlation between endoscopic findings and histological remission in patients with endoscopic mucosal healing.

Methods

This was a prospective observational study conducted over a period of 18 months (January 2014 to June 2015) at Dayanand Medical College and Hospital, Ludhiana, Punjab, India. Patients diagnosed with UC who had been in clinical remission (n=76) for at least 6 months were evaluated for endoscopic remission. Those in endoscopic remission (Mayo score ≤1; 46/76, 60.5%) were subjected to multiple biopsies from the rectosigmoid region and histological remission, which was then defined as grade 0/1 as per the Geboes criteria.

Results

Of the 46 patients in endoscopic remission (age, 18–73 years; male:female=1.5:1.0), majority had E1 (proctitis) disease (21/46, 45.6%) followed by E2 (left sided colitis) (18/46, 39.1%) and E3 disease (pancolitis) (7/46, 15.2%) at baseline. Histological remission was noted in 67.3% (31/46) of the patients, while 32.7% (15/46) still retained the histologically active disease in the form of infiltration of the lamina propria by eosinophils and neutrophils (13/15, 86.6%), cryptitis (14/15, 93.3%), and crypt abscesses (8/15, 53.3%). On follow-up, after 1 year, 87.1% (27/31) of the patients who had been in histological remission remained clinically asymptomatic, while 12.9% (4/31) had relapsed. Among the 15 histologically active patients, 46.6% (7/15) remained in clinical remission, while 53.3% (8/15) had relapsed.

Conclusions

Histological remission, rather than endoscopic remission, predicts a sustained clinical remission and allows monitoring of therapy for the subsequent disease course in patients with UC.

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Focused Review: Intestinal Behçet's Disease
Treatment and outcomes: medical and surgical treatment for intestinal Behçet's disease
Tadakazu Hisamatsu, Mari Hayashida
Intest Res 2017;15(3):318-327.   Published online June 12, 2017
DOI: https://doi.org/10.5217/ir.2017.15.3.318
AbstractAbstract PDFPubReaderePub

Behçet's disease (BD) is a chronic relapsing disease involving multiple organ systems. BD is characterized clinically by oral and genital aphthae, cutaneous lesions, and ophthalmological, neurological, and/or gastrointestinal manifestations. It is widely recognized that the presence of intestinal lesions may be a poor prognostic factor in intestinal BD, increasing the risk of surgery and decreasing the quality of life. Despite this, the management of intestinal BD has not been standardized. Empirical therapies including 5-aminosalicylic acid and corticosteroids have been used anecdotally to treat intestinal BD, but recent studies have provided evidence for the efficacy of anti-tumor necrosis factor α monoclonal antibodies. The development of agents targeting tumor necrosis factor α continues, it seems likely that they will change the therapeutic strategy and clinical outcomes of intestinal BD and inflammatory bowel disease. Monitoring disease activity such as endoscopic evaluation will become more important to obtain better outcomes. Here, we review current and future perspectives in the treatment and outcomes of intestinal BD.

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Original Article
The predictive variable regarding relapse in patients with ulcerative colitis after achieving endoscopic mucosal healing
Takuya Yoshino, Kohei Yamakawa, Satoshi Nishimura, Koutaro Watanabe, Shujiro Yazumi
Intest Res 2016;14(1):37-42.   Published online January 26, 2016
DOI: https://doi.org/10.5217/ir.2016.14.1.37
AbstractAbstract PDFPubReaderePub
<b>Background/Aims</b><br/>

Mucosal healing (MH) is a proposed therapeutic goal for patients with ulcerative colitis (UC). Whether MH is the final goal for UC, however, remains under debate. Therefore, to elucidate clinical variables predicting relapse after MH in UC could be useful for establishing further therapeutic strategy. The aim of this study is to evaluate the predictive variables for relapse in UC-patients after achieving MH.

Methods

From April 2010 to February 2015, 298 UC-patients treated at Kitano Hospital were retrospectively analyzed. MH was defined as Mayo endoscopic subscore of 0 or 1. The cumulative relapse free rate after achieving MH was evaluated. Predictive variables for relapse in UC-patients were assessed by Cox regression analysis.

Results

Of 298 UC-patients, 88 (29.5%) achieved MH. Of the 88 UC patients who achieved MH, 21 (23.9%) experienced UC-relapse. Based on Kaplan-Meier analysis, the cumulative relapse free rate at 1, 3, and 5 years after achieving MH was 87.9%, 70.2%, and 63.8%, respectively. The cumulative relapse free rate tended to be higher in the Mayo-0 group (76.9%) than in the Mayo-1 group (54.1%) at 5 years, although the difference was not statistically significant (P=0.313). Cox regression analysis indicated that the use of an immunomodulator was a predictive variable for relapse in UC-patients after achieving MH (P=0.035).

Conclusions

Our data demonstrated that the prognosis of UC patients after achieving endoscopic MH could be based on UC refractoriness requiring an immunomodulator.

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