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IBD
Does fecal calprotectin equally and accurately measure disease activity in small bowel and large bowel Crohn’s disease?: a systematic review
Ebby George Simon, Richard Wardle, Aye Aye Thi, Jeanette Eldridge, Sunil Samuel, Gordon William Moran
Intest Res 2019;17(2):160-170.   Published online February 7, 2019
DOI: https://doi.org/10.5217/ir.2018.00114
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Fecal calprotectin (FC) is a highly sensitive disease activity biomarker in inflammatory bowel disease. However, there are conflicting reports on whether the diagnostic accuracy in Crohn’s disease is influenced by disease location. The aim of this study was to undertake a systematic review of the published literature. Relevant databases were searched from inception to November 8, 2016 for cohort and case control studies which had data on FC in patients with isolated small bowel (SB) and large bowel (LB) Crohn’s disease. Reference standards for disease activity were endoscopy, magnetic resonance imaging, computed tomography or a combination of these. The QUADAS-2 research tool was used to assess the risk of bias. There were 5,619 records identified at initial search. The 2,098 duplicates were removed and 3,521 records screened. Sixty-one full text articles were assessed for eligibility and 16 studies were included in the final review with sensitivities and specificities per disease location available from 8 studies. Sensitivities of FC at SB and LB locations ranged from 42.9% to 100% and 66.7% to 100% respectively while corresponding specificities were 50% to 100% and 28.6% to 100% respectively. The sensitivities and specificities of FC to accurately measure disease activity in Crohn’s disease at different disease locations are diverse and no firm conclusion can be made. Better studies need to be undertaken to categorically answer the effect of disease location on the diagnostic accuracy of FC.

Citations

Citations to this article as recorded by  
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  • 13,286 View
  • 311 Download
  • 41 Web of Science
  • 38 Crossref
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IBD
Improving the quality of care for inflammatory bowel disease
Byong Duk Ye, Simon Travis
Intest Res 2019;17(1):45-53.   Published online November 20, 2018
DOI: https://doi.org/10.5217/ir.2018.00113
AbstractAbstract PDFPubReaderePub
Great strides have been achieved in the development of quality-of-care measures and standards for inflammatory bowel disease (IBD) over the last decade. The central structural component of care in IBD revolves around the multidisciplinary team, which should be equipped with the necessary resources to operate and implement decisions. Process measures have been defined by interest groups and can be adapted into process tools for the delivery of care for various patient subgroups and clinical scenarios. The emerging treat-to-target approach to IBD management may be used to achieve optimal long-term and holistic patient-centred outcomes, such as survival, control of inflammation and disease progression, symptomatic remission, quality of life and complications. Other important quality-of-care outcome measures for IBD include disutility of care, healthcare utilization and other patient-reported outcomes such as nutritional status and impact of fistulae. The current challenge for healthcare providers and health systems is the integration of quality-of-care structures and processes into clinical practice, and the consistent delivery of updated evidence-based quality IBD care to various patient populations by individual health care providers. Finally, the awareness and appreciation for quality of care in IBD is increasing in Asia, and Asian healthcare institutions should be encouraged to take the lead in improving the quality of care in IBD.

Citations

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    Journal of Health Services Research & Policy.2025; 30(1): 12.     CrossRef
  • Identification and prioritization of patient-centred strategies to enhance IBD-related care for older adults: a modified Delphi approach
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IBD
Current new challenges in the management of ulcerative colitis
Tomohiro Fukuda, Makoto Naganuma, Takanori Kanai
Intest Res 2019;17(1):36-44.   Published online January 25, 2019
DOI: https://doi.org/10.5217/ir.2018.00126
AbstractAbstract PDFPubReaderePub
Ulcerative colitis (UC) is a chronic inflammatory condition of the gastrointestinal tract. Although the cause of UC is postulated to be multifactorial in nature, including genetic predisposition, epithelial barrier defects, dysregulation of immune responses, and environmental factors, the specific pathogenesis of UC is still incompletely understood. In the treatment of UC so far, a method of suppressing immunity and treating it has been mainstream. Immunosuppressant drugs, including thiopurines (azathioprine or 6-mercaptopurine), anti-tumor necrosis factor-α (anti-TNF-α) antibody (infliximab and adalimumab), and calcineurin inhibitor, can be used in treat patients with corticosteroid-dependent and/or corticosteroid-refractory moderateto- severe UC. Recently, in addition to such a conventional therapeutic agent, golimumab, which is the first transgenic human monoclonal anti-TNF-α antibody to be fabricated, anti α-4/β-7 integrin antibody, and Janus kinase inhibitor have been reported to novel immunosuppressant therapy. Furthermore, other treatments with unique mechanisms different from immunosuppression, have also been suggested, including fecal microbiota transplantation and Indigo naturalis, which is a Chinese herbal medicine. We compared the features and efficacy of these new treatments. In this issue, the features and treatment options for these new treatments is reviewed.

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    Soo-Kyung Park, Sang-Bum Kang, SangSoo Kim, Tae Oh Kim, Jae Myung Cha, Jong Pil Im, Chang Hwan Choi, Eun Soo Kim, Geom Seog Seo, Chang Soo Eun, Dong Soo Han, Dong Il Park
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  • Effects of Dextran Sulfate Sodium-Induced Ulcerative Colitis on the Disposition of Tofacitinib in Rats
    Sung Hun Bae, Hyo Sung Kim, Hyeon Gyeom Choi, Sun-Young Chang, So Hee Kim
    Biomolecules & Therapeutics.2022; 30(6): 510.     CrossRef
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    Sung Hun Bae, Hyeon Gyeom Choi, So Yeon Park, Sun-Young Chang, Hyoungsu Kim, So Hee Kim
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    Katsuyoshi Matsuoka, Ataru Igarashi, Noriko Sato, Yuri Isono, Maki Gouda, Katsuhiko Iwasaki, Ayako Shoji, Tadakazu Hisamatsu
    Journal of Crohn's and Colitis.2021; 15(3): 358.     CrossRef
  • Comparison of Long-Term Outcomes of Infliximab versus Adalimumab Treatment in Biologic-Naïve Patients with Ulcerative Colitis
    Yong Il Lee, Yehyun Park, Soo Jung Park, Tae Il Kim, Won Ho Kim, Jae Hee Cheon
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    Hoon Gil Jo, Geom Seog Seo
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  • The Clinical Features of Inflammatory Bowel Disease in Patients with Obesity
    Seong Kyun Kim, Ho-Su Lee, Beom-Jun Kim, Jin Hwa Park, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Sang Hyoung Park, Masanao Nakamura
    Canadian Journal of Gastroenterology and Hepatology.2021; 2021: 1.     CrossRef
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    You Sun Kim
    Journal of the Korean Medical Association.2021; 64(9): 596.     CrossRef
  • Long-term Outcomes after the Discontinuation of Anti-Tumor Necrosis Factor-α Therapy in Patients with Inflammatory Bowel Disease under Clinical Remission: A Korean Association for the Study of Intestinal Disease Multicenter Study
    Joo Hye Song, Eun Ae Kang, Soo-Kyung Park, Sung Noh Hong, You Sun Kim, Ki Bae Bang, Kyeong Ok Kim, Hong Sub Lee, Sang-Bum Kang, Seung Yong Shin, Eun Mi Song, Jong Pil Im, Chang Hwan Choi
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    Hyo Yeop Song, Geom Seog Seo
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    Suk-Kyun Yang
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    Chang Soo Eun
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    You Sun Kim
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    Jin Wook Lee, Eun Mi Song, Sung-Ae Jung, Sung Hoon Jung, Kwang Woo Kim, Seong-Joon Koh, Hyun Jung Lee, Seung Wook Hong, Jin Hwa Park, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang, Sang Hyoung Park
    Journal of Korean Medical Science.2021;[Epub]     CrossRef
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    Soo-Kyung Park, Sangsoo Kim, Gi-Young Lee, Sung-Yoon Kim, Wan Kim, Chil-Woo Lee, Jong-Lyul Park, Chang-Hwan Choi, Sang-Bum Kang, Tae-Oh Kim, Ki-Bae Bang, Jaeyoung Chun, Jae-Myung Cha, Jong-Pil Im, Kwang-Sung Ahn, Seon-Young Kim, Dong-Il Park
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    Ji Young Chang, Jae Hee Cheon
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    Seung Bin Park, Byung-il Choi, Beom Jae Lee, Nam Joo Kim, Yoon A. Jeong, Moon Kyung Joo, Hyo Jung Kim, Jong-Jae Park, Jae Seon Kim, Yoon-Seok Noh, Hyun Joo Lee
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    Eun Hye Gwak, Hee Young Yoo, So Hee Kim
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    Sung Hun Bae, Sun-Young Chang, So Hee Kim
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    Ji Sang Lee, So Hee Kim
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Optimizing the multidimensional aspects of the patient-physician relationship in the management of inflammatory bowel disease
Deborah Chew, Wong Zhiqin, Norhayati Ibrahim, Raja Affendi Raja Ali
Intest Res 2018;16(4):509-521.   Published online October 25, 2018
DOI: https://doi.org/10.5217/ir.2018.00074
AbstractAbstract PDFPubReaderePub
The patient-physician relationship has a pivotal impact on the inflammatory bowel disease (IBD) outcomes. However, there are many challenges in the patient-physician relationship; lag time in diagnosis which results in frustration and an anchoring bias against the treating gastroenterologist, the widespread availability of medical information on the internet has resulted in patients having their own ideas of treatment, which may be incongruent from the treating physicians’ goals resulting in patient physician discordance. Because IBD is an incurable disease, the goal of treatment is to sustain remission. To achieve this, patients may have to go through several lines of treatment. The period of receiving stepping up, top down or even accelerated stepping up medications may result in a lot of frustration and anxiety for the patient and may compromise the patient-physician relationship. IBD patients are also prone to psychological distress that further compromises the patient-physician relationship. Despite numerous published data regarding the medical and surgical treatment options available for IBD, there is a lack of data regarding methods to improve the therapeutic patient-physician relationship. In this review article, we aim to encapsulate the challenges faced in the patient-physician relationship and ways to overcome in for an improved outcome in IBD.

Citations

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  • Personalize, participate, predict, and prevent: 4Ps in inflammatory bowel disease
    Marco Vincenzo Lenti, Maria Lia Scribano, Livia Biancone, Rachele Ciccocioppo, Daniela Pugliese, Luca Pastorelli, Gionata Fiorino, Edoardo Savarino, Flavio Andrea Caprioli, Sandro Ardizzone, Massimo Claudio Fantini, Gian Eugenio Tontini, Ambrogio Orlando,
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    Kenji Watanabe, Sean Gardiner, Shoko Arai
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  • Ulcerative Colitis Narrative Global Survey Findings: The Impact of Living With Ulcerative Colitis—Patients’ and Physicians’ View
    Marla C Dubinsky, Kenji Watanabe, Pauliina Molander, Laurent Peyrin-Biroulet, Michele Rubin, Gil Y Melmed, J Jasper Deuring, John Woolcott, Joseph C Cappelleri, Kathy Steinberg, Susan Connor
    Inflammatory Bowel Diseases.2021; 27(11): 1747.     CrossRef
  • Physician–patient communication affects patient satisfaction in treatment decision-making: a structural equation modelling analysis of a web-based survey in patients with ulcerative colitis
    Katsuyoshi Matsuoka, Hirono Ishikawa, Takeo Nakayama, Yusuke Honzawa, Atsuo Maemoto, Fumihito Hirai, Fumiaki Ueno, Noriko Sato, Yutaka Susuta, Toshifumi Hibi
    Journal of Gastroenterology.2021; 56(9): 843.     CrossRef
  • 17,224 View
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IBD
Delineating inflammatory bowel disease through transcriptomic studies: current review of progress and evidence
Seow-Neng Chan, Eden Ngah Den Low, Raja Affendi Raja Ali, Norfilza Mohd Mokhtar
Intest Res 2018;16(3):374-383.   Published online July 27, 2018
DOI: https://doi.org/10.5217/ir.2018.16.3.374
AbstractAbstract PDFPubReaderePub

Inflammatory bowel disease (IBD), which comprises of Crohn's disease and ulcerative colitis, is an idiopathic relapsing and remitting disease in which the interplay of different environment, microbial, immunological and genetic factors that attribute to the progression of the disease. Numerous studies have been conducted in multiple aspects including clinical, endoscopy and histopathology for the diagnostics and treatment of IBD. However, the molecular mechanism underlying the aetiology and pathogenesis of IBD is still poorly understood. This review tries to critically assess the scientific evidence at the transcriptomic level as it would help in the discovery of RNA molecules in tissues or serum between the healthy and diseased or different IBD subtypes. These molecular signatures could potentially serve as a reliable diagnostic or prognostic biomarker. Researchers have also embarked on the study of transcriptome to be utilized in targeted therapy. We focus on the evaluation and discussion related to the publications reporting the different approaches and techniques used in investigating the transcriptomic changes in IBD with the intention to offer new perspectives to the landscape of the disease.

Citations

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  • Composition of the colon microbiota in the individuals with inflammatory bowel disease and colon cancer
    Ceren Acar, Sibel Kucukyildirim Celik, H. Ozgur Ozdemirel, Beril Erdem Tuncdemir, Saadet Alan, Hatice Mergen
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    Christopher J Tyler, Mauricio Guzman, Luke R Lundborg, Shaila Yeasmin, Tamara Perez-Jeldres, Andres Yarur, Brian Behm, Parambir S Dulai, Derek Patel, Giorgos Bamias, Jesús Rivera-Nieves
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  • Colonic Mucosal Transcriptomic Changes in Patients with Long-Duration Ulcerative Colitis Revealed Colitis-Associated Cancer Pathways
    Eden Ngah Den Low, Norfilza Mohd Mokhtar, Zhiqin Wong, Raja Affendi Raja Ali
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    Norfilza Mohd Mokhtar, Khairul Najmi Muhammad Nawawi, Jaarvis Verasingam, Wong Zhiqin, Ismail Sagap, Zairul Azwan Mohd Azman, Luqman Mazlan, Hamzaini Abdul Hamid, Nur Yazmin Yaacob, Isa Mohamed Rose, Eden Low Ngah Den, Mah Suit Wan, Raja Affendi Raja Ali
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What's app? Electronic health technology in inflammatory bowel disease
Alissa Walsh, Simon Travis
Intest Res 2018;16(3):366-373.   Published online July 27, 2018
DOI: https://doi.org/10.5217/ir.2018.16.3.366
AbstractAbstract PDFPubReaderePub

Electronic health (eHealth) data collection is increasingly used in many chronic illnesses, to track pattern of disease. eHealth systems have the potential to revolutionize care. Inflammatory bowel disease (IBD) is a paradigm for such an approach: this is a chronic disease that usually affects young and technologically literate patient population, who are motivated to be involved in their own care. A range of eHealth technologies are available for IBD. This review considers the strengths and weaknesses of 7 platforms that focus on patient-provider interaction. These have been developed in Denmark, United States, the Netherlands, and the United Kingdom, demonstrating an international interest in this form of technology and interaction. Not only do these technologies aim to improve care but they also have the potential to collect large amounts of information. Information includes demographics and patient reported outcomes (symptoms, quality of life), quality of care (steroid use, among other metrics) and outcomes such as hospitalization. These data could inform quality improvement programmes to improve their focus. eHealth technology is also open to machine learning to analyze large data sets, through which personalized algorithms may be developed.

Citations

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    Konstantinos Papamichael, Waqqas Afif, David Drobne, Marla C Dubinsky, Marc Ferrante, Peter M Irving, Nikolaos Kamperidis, Taku Kobayashi, Paulo G Kotze, Jo Lambert, Nurulamin M Noor, Xavier Roblin, Giulia Roda, Niels Vande Casteele, Andres J Yarur, Naila
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    Nicholas A Kennedy, Richard Hansen, Lisa Younge, Joel Mawdsley, R Mark Beattie, Shahida Din, Christopher A Lamb, Philip J Smith, Christian Selinger, Jimmy Limdi, Tariq H Iqbal, Alan Lobo, Rachel Cooney, Oliver Brain, Daniel R Gaya, Charles Murray, Richard
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    Krupa Krishnaprasad, Alissa Walsh, Jakob Begun, Sally Bell, David Carter, Rachel Grafton, Alexandra Sechi, Karen Sewell, Anna McMahon, Susan Connor, Graham Radford-Smith, Jane M. Andrews
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Why is it so difficult to evaluate faecal microbiota transplantation as a treatment for ulcerative colitis?
Natalie Grace Fairhurst, Simon P. L. Travis
Intest Res 2018;16(2):209-215.   Published online April 30, 2018
DOI: https://doi.org/10.5217/ir.2018.16.2.209
AbstractAbstract PDFPubReaderePub

Faecal microbiota transplantation (FMT) has recently re-emerged as a viable therapeutic option for colonic disorders. Its efficacy has been proved in the treatment of Clostridium difficile infection which has encouraged research into the use of FMT for other disorders involving gut dysbiosis, such as ulcerative colitis (UC), a chronic inflammatory disease characterized by relapsing and remitting colonic inflammation. Although the FMT protocol for C. difficile treatment is well established, there are numerous additional factors to consider when applying FMT to treat inflammatory diseases. Various studies have attempted to address these factors but technical inconsistency between reports has resulted in a failure to achieve clinically significant findings. Case reports of FMT in UC have shown favorable outcomes yet demonstrating these effects on a larger scale has proved difficult. The following review aims to explore these issues and to analyze why they may be hindering the progression of FMT therapy in UC.

Citations

Citations to this article as recorded by  
  • The Role of Fecal Microbiota Transplantation in the Induction of Remission in Ulcerative Colitis
    Adam Saleh, Shyon Parsa, Manuel Garza, Eamonn M.M. Quigley, Bincy P. Abraham
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IBD
Management of inflammatory bowel disease in older persons: evolving paradigms
Saurabh Kedia, Jimmy K. Limdi, Vineet Ahuja
Intest Res 2018;16(2):194-208.   Published online April 30, 2018
DOI: https://doi.org/10.5217/ir.2018.16.2.194
AbstractAbstract PDFPubReaderePub

The incidence and prevalence of inflammatory bowel disease (IBD) is increasing, and considering the aging population, this number is set to increase further in the future. The clinical features and natural history of elderly-onset IBD have many similarities with those of IBD in younger patients, but with significant differences including a broader differential diagnosis. The relative lack of data specific to elderly patients with IBD, often stemming from their typical exclusion from clinical trials, has made clinical decision-making somewhat challenging. Treatment decisions in elderly patients with IBD must take into account age-specific concerns such as comorbidities, locomotor and cognitive function, and polypharmacy, to set realistic treatment targets in order to enable personalized treatment and minimize harm. Notwithstanding paucity of clinical data, recent studies have provided valuable insights, which, taken together with information gleaned from previous studies, can broaden our understanding of IBD. These insights may contribute to the development of paradigms for the holistic and, when possible, evidence-based management of this potentially vulnerable population and are the focus of this review.

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Endoscopy
Quality is the key for emerging issues of population-based colonoscopy screening
Jin Young Yoon, Jae Myung Cha, Yoon Tae Jeen
Intest Res 2018;16(1):48-54.   Published online January 18, 2018
DOI: https://doi.org/10.5217/ir.2018.16.1.48
AbstractAbstract PDFPubReaderePub

Colonoscopy is currently regarded as the gold standard and preferred method of screening for colorectal cancer (CRC). However, the benefit of colonoscopy screening may be blunted by low participation rates in population-based screening programs. Harmful effects of population-based colonoscopy screening may include complications induced by colonoscopy itself and by sedation, psychosocial distress, potential over-diagnosis, and socioeconomic burden. In addition, harmful effects of colonoscopy may increase with age and comorbidities. As the risk of adverse events in population-based colonoscopy screening may offset the benefit, the adverse events should be managed and monitored. To adopt population-based colonoscopy screening, consensus on the risks and benefits should be developed, focusing on potential harm, patient preference, socioeconomic considerations, and quality improvement of colonoscopy, as well as efficacy for CRC prevention. As suboptimal colonoscopy quality is a major pitfall of population-based screening, adequate training and regulation of screening colonoscopists should be the first step in minimizing variations in quality. Gastroenterologists should promote quality improvement, auditing, and training for colonoscopy in a population-based screening program.

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IBD
Quality indicators in inflammatory bowel disease
Sameer K. Berry, Gil Y. Melmed
Intest Res 2018;16(1):43-47.   Published online January 18, 2018
DOI: https://doi.org/10.5217/ir.2018.16.1.43
AbstractAbstract PDFPubReaderePub

Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is a chronic, debilitating, and expensive condition affecting millions of people globally. There is significant variation in the quality of care for patients with IBD across North America, Europe, and Asia; this variation suggests poor quality of care due to overuse, underuse, or misuse of health services and disparity of outcomes. Several initiatives have been developed to reduce variation in care delivery and improve processes of care, patient outcomes, and reduced healthcare costs. These initiatives include the development of quality indicator sets to standardize care across organizations, and learning health systems to enable data sharing between doctors and patients, and sharing of best practices among providers. These programs have been variably successful in improving patient outcomes and reducing healthcare utilization. Further studies are needed to demonstrate the long-term impact and applicability of these efforts in different geographic areas around the world, as regional variations in patient populations, societal preferences, and costs should inform local quality improvement efforts.

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IBD
Immunological pathogenesis of inflammatory bowel disease
Seung Hoon Lee, Jeong eun Kwon, Mi-La Cho
Intest Res 2018;16(1):26-42.   Published online January 18, 2018
DOI: https://doi.org/10.5217/ir.2018.16.1.26
AbstractAbstract PDFPubReaderePub

Inflammatory bowel disease (IBD) is a chronic inflammatory state of the gastrointestinal tract and can be classified into 2 main clinical phenomena: Crohn's disease (CD) and ulcerative colitis (UC). The pathogenesis of IBD, including CD and UC, involves the presence of pathogenic factors such as abnormal gut microbiota, immune response dysregulation, environmental changes, and gene variants. Although many investigations have tried to identify novel pathogenic factors associated with IBD that are related to environmental, genetic, microbial, and immune response factors, a full understanding of IBD pathogenesis is unclear. Thus, IBD treatment is far from optimal, and patient outcomes can be unsatisfactory. As result of massive studying on IBD, T helper 17 (Th17) cells and innate lymphoid cells (ILCs) are investigated on their effects on IBD. A recent study of the plasticity of Th17 cells focused primarily on colitis. ILCs also emerging as novel cell family, which play a role in the pathogenesis of IBD. IBD immunopathogenesis is key to understanding the causes of IBD and can lead to the development of IBD therapies. The aim of this review is to explain the pathogenesis of IBD, with a focus on immunological factors and therapies.

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Sedation for routine gastrointestinal endoscopic procedures: a review on efficacy, safety, efficiency, cost and satisfaction
Otto S. Lin
Intest Res 2017;15(4):456-466.   Published online October 23, 2017
DOI: https://doi.org/10.5217/ir.2017.15.4.456
AbstractAbstract PDFPubReaderePub

Most gastrointestinal endoscopic procedures are now performed with sedation. Moderate sedation using benzodiazepines and opioids continue to be widely used, but propofol sedation is becoming more popular because its unique pharmacokinetic properties make endoscopy almost painless, with a very predictable and rapid recovery process. There is controversy as to whether propofol should be administered only by anesthesia professionals (monitored anesthesia care) or whether properly trained non-anesthesia personnel can use propofol safely via the modalities of nurse-administered propofol sedation, computer-assisted propofol sedation or nurse-administered continuous propofol sedation. The deployment of non-anesthesia administered propofol sedation for low-risk procedures allows for optimal allocation of scarce anesthesia resources, which can be more appropriately used for more complex cases. This can address some of the current shortages in anesthesia provider supply, and can potentially reduce overall health care costs without sacrificing sedation quality. This review will discuss efficacy, safety, efficiency, cost and satisfaction issues with various modes of sedation for non-advanced, non-emergent endoscopic procedures, mainly esophagogastroduodenoscopy and colonoscopy.

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Non-steroidal anti-inflammatory drug-induced enteropathy
Sung Jae Shin, Choong-Kyun Noh, Sun Gyo Lim, Kee Myung Lee, Kwang Jae Lee
Intest Res 2017;15(4):446-455.   Published online October 23, 2017
DOI: https://doi.org/10.5217/ir.2017.15.4.446
AbstractAbstract PDFPubReaderePub

Non-steroidal anti-inflammatory drugs (NSAIDs) are well known to be associated with serious upper gastrointestinal complications, such as peptic ulcer, bleeding, perforation, and obstruction. Recently, attention has been mainly focused on the small bowel injuries caused by NSAIDs, and new endoscopic techniques such as capsule endoscopy and double balloon endoscopy can help in detecting such injuries. This article reviewed the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of small bowel injuries caused by NSAIDs. Small bowel injures by NSAIDs might occur with a similar frequency and extent as those observed in the upper gastrointestinal tract. The pathogenesis of NSAID-induced enteropathy is complex and not clearly understood. The various lesions observed in the small bowel, including petechiae, reddened folds, loss of villi, erosions, and ulcers can be detected by capsule endoscopy. A drug that could prevent or treat NSAID-induced enteropathy has not yet been developed. Therefore, further investigations should be performed to elucidate the pathogenesis of such enteropathy and develop suitable preventive and treatment strategies.

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Medication adherence in inflammatory bowel disease
Webber Chan, Andy Chen, Darren Tiao, Christian Selinger, Rupert Leong
Intest Res 2017;15(4):434-445.   Published online October 23, 2017
DOI: https://doi.org/10.5217/ir.2017.15.4.434
AbstractAbstract PDFPubReaderePub

Inflammatory bowel disease (IBD) is a chronic idiopathic inflammatory condition with intestinal and extraintestinal manifestations. Medications are the cornerstone of treatment of IBD. However, patients often adhere to medication poorly. Adherence to medications is defined as the process by which patients take their medications as prescribed. Treatment non-adherence is a common problem among chronic diseases, averaging 50% in developed countries and is even poorer in developing countries. In this review, we will examine the adherence data in IBD which vary greatly depending on the study population, route of administration, and methods of adherence measurement used. We will also discuss the adverse clinical outcomes related to non-adherence to medical treatment including increased disease activity, flares, loss of response to anti-tumor necrosis factor therapy, and so forth. There are many methods to measure medication adherence namely direct and indirect methods, each with their advantages and drawbacks. Finally, we will explore different intervention strategies to improve adherence to medications.

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Management of Crohn's disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease
Shu-Chen Wei, Ting-An Chang, Te-Hsin Chao, Jinn-Shiun Chen, Jen-Wei Chou, Yenn-Hwei Chou, Chiao-Hsiung Chuang, Wen-Hung Hsu, Tien-Yu Huang, Tzu-Chi Hsu, Chun-Chi Lin, Hung-Hsin Lin, Jen-Kou Lin, Wei-Chen Lin, Yen-Hsuan Ni, Ming-Jium Shieh, I-Lun Shih, Chia-Tung Shun, Yuk-Ming Tsang, Cheng-Yi Wang, Horng-Yuan Wang, Meng-Tzu Weng, Deng-Chyang Wu, Wen-Chieh Wu, Hsu-Heng Yen, Jau-Min Wong
Intest Res 2017;15(3):285-310.   Published online June 12, 2017
DOI: https://doi.org/10.5217/ir.2017.15.3.285
AbstractAbstract PDFPubReaderePub

Crohn's disease (CD) is a chronic relapsing and remitting inflammatory disease of the gastrointestinal tract. CD is rare in Taiwan and other Asian countries, but its prevalence and incidence have been steadily increasing. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of CD taking into account currently available evidence and the expert opinion of the committee. Thorough clinical, endoscopic, and histological assessments are required for accurate diagnosis of CD. Computed tomography and magnetic resonance imaging are complementary to endoscopic evaluation for disease staging and detecting complications. The goals of CD management are to induce and maintain remission, reduce the risk of complications, and improve quality of life. Corticosteroids are the mainstay for inducing re-mission. Immunomodulating and biologic therapies should be used to maintain remission. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to treatment and receive regular surveillance for cancer. These consensus statements are based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of patients with CD in Taiwan.

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Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease
Shu-Chen Wei, Ting-An Chang, Te-Hsin Chao, Jinn-Shiun Chen, Jen-Wei Chou, Yenn-Hwei Chou, Chiao-Hsiung Chuang, Wen-Hung Hsu, Tien-Yu Huang, Tzu-Chi Hsu, Chun-Chi Lin, Hung-Hsin Lin, Jen-Kou Lin, Wei-Chen Lin, Yen-Hsuan Ni, Ming-Jium Shieh, I-Lun Shih, Chia-Tung Shun, Yuk-Ming Tsang, Cheng-Yi Wang, Horng-Yuan Wang, Meng-Tzu Weng, Deng-Chyang Wu, Wen-Chieh Wu, Hsu-Heng Yen, Jau-Min Wong
Intest Res 2017;15(3):266-284.   Published online June 12, 2017
DOI: https://doi.org/10.5217/ir.2017.15.3.266
AbstractAbstract PDFPubReaderePub

Ulcerative colitis (UC) is an inflammatory bowel disease characterized by chronic mucosal inflammation of the colon, and the prevalence and incidence of UC have been steadily increasing in Taiwan. A steering committee was established by the Taiwan Society of Inflammatory Bowel Disease to formulate statements on the diagnosis and management of UC taking into account currently available evidence and the expert opinion of the committee. Accurate diagnosis of UC requires thorough clinical, endoscopic, and histological assessment and careful exclusion of differential diagnoses, particularly infectious colitis. The goals of UC therapy are to induce and maintain remission, reduce the risk of complications, and improve quality of life. As outlined in the recommended treatment algorithm, choice of treatment is dictated by severity, extent, and course of disease. Patients should be evaluated for hepatitis B virus and tuberculosis infection prior to immunosuppressive treatment, especially with steroids and biologic agents, and should be regularly monitored for reactivation of latent infection. These consensus statements are also based on current local evidence with consideration of factors, and could be serve as concise and practical guidelines for supporting clinicians in the management of UC in Taiwan.

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Current status of endoscopic balloon dilation for Crohn's disease
Fumihito Hirai
Intest Res 2017;15(2):166-173.   Published online April 27, 2017
DOI: https://doi.org/10.5217/ir.2017.15.2.166
AbstractAbstract PDFPubReaderePub

The therapeutic target in Crohn's disease (CD) has been raised to the achievement of mucosal healing. Although effective treatments that target cytokines and other molecules has been widely used for CD, intestinal strictures are still a major cause of surgery. Endoscopic balloon dilation (EBD) is known to be an effective and safe intervention for intestinal strictures in CD. Since frequent intestinal resection often results in short bowel syndrome and can decrease the quality of life, EBD can help avoid surgery. EBD with a conventional colonoscope for Crohn's strictures of the colon and ileo-colonic anastomosis has established efficacy and safety. In addition, EBD using balloon-assisted enteroscopy has recently been applied for small bowel Crohn's strictures. Although the evidence is not strong, EBD may become an alternative to surgery in small bowel strictures in CD. EBD and other new methods such as self-expanding stent implantation for Crohn's strictures may be useful and safe; however, it is important to address several issues regarding these interventions and to establish a protocol for combined therapies.

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Preoperative use of anti-tumor necrosis factor therapy in Crohn's disease: promises and pitfalls
Paulo Gustavo Kotze, Subrata Ghosh, Willem A. Bemelman, Remo Panaccione
Intest Res 2017;15(2):160-165.   Published online April 27, 2017
DOI: https://doi.org/10.5217/ir.2017.15.2.160
AbstractAbstract PDFPubReaderePub

Recent advances in medical and surgical therapy were achieved during the last two decades in the management of Crohn's disease (CD). Anti-tumor necrosis factor (anti-TNF) agents are widely used worldwide. However, a significant proportion of patients still need surgical resections. The impact of previous exposure to these agents on the perioperative and postoperative outcomes is still controversial. In this critical review, we aimed to position the strategy of intentional preoperative use of anti-TNF agents in the management of CD. The indications and contraindications for this strategy are detailed, and despite scarce evidence, the possible advantages and disadvantages of the intentional use of anti-TNF agents before abdominal surgery in CD are discussed.

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Second Korean guidelines for the management of Crohn's disease
Jae Jun Park, Suk-Kyun Yang, Byong Duk Ye, Jong Wook Kim, Dong Il Park, Hyuk Yoon, Jong Pil Im, Kang Moon Lee, Sang Nam Yoon, Heeyoung Lee
Intest Res 2017;15(1):38-67.   Published online January 31, 2017
DOI: https://doi.org/10.5217/ir.2017.15.1.38
AbstractAbstract PDFSupplementary MaterialPubReaderePub

Crohn's disease (CD) is a chronic, progressive, and disabling inflammatory bowel disease (IBD) with an uncertain etiopathogenesis. CD can involve any site of the gastrointestinal tract from the mouth to the anus, and is associated with serious complications, such as bowel strictures, perforations, and fistula formation. The incidence and prevalence rates of CD in Korea are still lower compared with those in Western countries, but they have been rapidly increasing during the recent decades. Although there are no definitive curative modalities for CD, various medical and surgical therapies have been applied for the treatment of this disease. Concerning CD management, there have been substantial discrepancies among clinicians according to their personal experience and preference. To suggest recommendable approaches to the diverse problems of CD and to minimize the variations in treatment among physicians, guidelines for the management of CD were first published in 2012 by the IBD Study Group of the Korean Association for the Study of Intestinal Diseases. These are the revised guidelines based on updated evidence, accumulated since 2012. These guidelines were developed by using mainly adaptation methods, and encompass induction and maintenance treatment of CD, treatment based on disease location, treatment of CD complications, including stricture and fistula, surgical treatment, and prevention of postoperative recurrence. These are the second Korean guidelines for the management of CD and will be continuously revised as new evidence is collected.

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Second Korean guidelines for the management of ulcerative colitis
Chang Hwan Choi, Won Moon, You Sun Kim, Eun Soo Kim, Bo-In Lee, Yunho Jung, Yong Sik Yoon, Heeyoung Lee, Dong Il Park, Dong Soo Han
Intest Res 2017;15(1):7-37.   Published online January 31, 2017
DOI: https://doi.org/10.5217/ir.2017.15.1.7
AbstractAbstract PDFPubReaderePub

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by a relapsing and remitting course. The direct and indirect costs of the treatment of UC are high, and the quality of life of patients is reduced, especially during exacerbation of the disease. The incidence and prevalence of UC in Korea are still lower than those of Western countries, but have been rapidly increasing during the past decades. Various medical and surgical therapies, including biologics, are currently used for the management of UC. However, many challenging issues exist, which sometimes lead to differences in practice between clinicians. Therefore, the IBD study group of the Korean Association for the Study of Intestinal Diseases established the first Korean guidelines for the management of UC in 2012. This is an update of the first guidelines. It was generally made by the adaptation of several foreign guidelines as was the first edition, and encompasses treatment of active colitis, maintenance of remission, and indication of surgery for UC. The specific recommendations are presented with the quality of evidence and classification of recommendations.

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  • Fatal infections in older patients with inflammatory bowel disease on anti-tumor necrosis factor therapy
    Way-Seah Lee, Najib Azmi, Ruey-Terng Ng, Sik-Yong Ong, Sasheela Sri La Ponnampalavanar, Sanjiv Mahadeva, Ida Hilmi
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Irritable bowel syndrome and inflammatory bowel disease overlap syndrome: pieces of the puzzle are falling into place
Rafiz Abdul Rani, Raja Affendi Raja Ali, Yeong Yeh Lee
Intest Res 2016;14(4):297-304.   Published online October 17, 2016
DOI: https://doi.org/10.5217/ir.2016.14.4.297
AbstractAbstract PDFPubReader

Irritable bowel syndrome (IBS), a common gastrointestinal disorder involving the gut-brain axis, and inflammatory bowel disease (IBD), a chronic relapsing inflammatory disorder, are both increasing in incidence and prevalence in Asia. Both have significant overlap in terms of symptoms, pathophysiology, and treatment, suggesting the possibility of IBS and IBD being a single disease entity albeit at opposite ends of the spectrum. We examined the similarities and differences in IBS and IBD, and offer new thoughts and approaches to the disease paradigm.

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The role of small bowel endoscopy in small bowel Crohn's disease: when and how?
Mikang Kim, Hyun Joo Jang
Intest Res 2016;14(3):211-217.   Published online June 27, 2016
DOI: https://doi.org/10.5217/ir.2016.14.3.211
AbstractAbstract PDFPubReaderePub

Endoscopy has a crucial role in the diagnosis, management, and surveillance of inflammatory bowel disease (IBD). It contributes in supporting the diagnosis of IBD with the clinical history, physical examination, laboratory findings, and targeted biopsies. Furthermore, endoscopy has a significant role in assessing disease activity and distribution in treatment efficacy evaluation, post-surgical recurrence risk, and cancer surveillance in patients with long-lasting illness. Endoscopy also provides therapeutic potential for the treatment of IBD, especially with stricture dilatation and treatment of bleeding. Small bowel (SB) endoscopy (capsule endoscopy and device-assisted enteroscopy) and cross-sectional radiologic imaging (computed tomography enterography and magnetic resonance enterography) have become important diagnostic options to diagnose and treat patients with SB Crohn's disease. We reviewed the present role of SB endoscopy in patients with SB Crohn's disease.

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Pathogenic role of the gut microbiota in gastrointestinal diseases
Hiroko Nagao-Kitamoto, Sho Kitamoto, Peter Kuffa, Nobuhiko Kamada
Intest Res 2016;14(2):127-138.   Published online April 27, 2016
DOI: https://doi.org/10.5217/ir.2016.14.2.127
AbstractAbstract PDFPubReaderePub

The gastrointestinal (GI) tract is colonized by a dense community of commensal microorganisms referred to as the gut microbiota. The gut microbiota and the host have co-evolved, and they engage in a myriad of immunogenic and metabolic interactions. The gut microbiota contributes to the maintenance of host health. However, when healthy microbial structure is perturbed, a condition termed dysbiosis, the altered gut microbiota can trigger the development of various GI diseases including inflammatory bowel disease, colon cancer, celiac disease, and irritable bowel syndrome. There is a growing body of evidence suggesting that multiple intrinsic and extrinsic factors, such as genetic variations, diet, stress, and medication, can dramatically affect the balance of the gut microbiota. Therefore, these factors regulate the development and progression of GI diseases by inducing dysbiosis. Herein, we will review the recent advances in the field, focusing on the mechanisms through which intrinsic and extrinsic factors induce dysbiosis and the role a dysbiotic microbiota plays in the pathogenesis of GI diseases.

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Magnetic resonance enterography for the evaluation of the deep small intestine in Crohn's disease
Kazuo Ohtsuka, Kento Takenaka, Yoshio Kitazume, Toshimitsu Fujii, Katsuyoshi Matsuoka, Maiko Kimura, Takashi Nagaishi, Mamoru Watanabe
Intest Res 2016;14(2):120-126.   Published online April 27, 2016
DOI: https://doi.org/10.5217/ir.2016.14.2.120
AbstractAbstract PDFPubReaderePub

For the control of Crohn's disease (CD) a thorough assessment of the small intestine is essential; several modalities may be utilized, with cross-sectional imaging being important. Magnetic resonance (MR) enterography, i.e., MRE is recommended as a modality with the highest accuracy for CD lesions. MRE and MR enteroclysis are the two methods performed following distension of the small intestine. MRE has sensitivity and specificity comparable to computed tomography enterography (CTE); although images obtained using MRE are less clear compared with CTE, MRE does not expose the patient to radiation and is superior for soft-tissue contrast. Furthermore, it can assess not only static but also dynamic and functional imaging and reveals signs of CD, such as abscess, comb sign, fat edema, fistula, lymph node enhancement, less motility, mucosal lesions, stricture, and wall enhancement. Several indices of inflammatory changes and intestinal damage have been proposed for objective evaluation. Recently, diffusion-weighted imaging has been proposed, which does not need bowel preparation and contrast enhancement. Comprehension of the characteristics of MRE and other modalities is important for better management of CD.

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Changing epidemiological trends of inflammatory bowel disease in Asia
Wee Khoon Ng, Sunny H. Wong, Siew C. Ng
Intest Res 2016;14(2):111-119.   Published online April 27, 2016
DOI: https://doi.org/10.5217/ir.2016.14.2.111
AbstractAbstract PDFPubReaderePub

Inflammatory bowel disease (IBD) has become more common in Asia over the past few decades. The rate of increase in prevalence of the disease varies greatly in Asia, with several countries in East Asia experiencing a more than doubled increase in IBD prevalence over the past decade. Historically, ulcerative colitis (UC) is more common than Crohn's disease (CD) in Asia. However, a reverse trend is beginning to appear in more developed countries in Asia such as Japan, Korea, and Hong Kong. While Asian IBD patients share many similarities with their Western counterparts, there are important differences with significant clinical implications. In Asia, there are more men with CD, more ileo-colonic involvement in CD, less familial aggregation, fewer extra-intestinal manifestations and worse clinical outcomes for older-onset patients with UC. These differences are likely related to the different genetic makeup and environmental exposures in different regions. Evaluation of the differences and rates in epidemiologic trends may help researchers and clinicians estimate disease burden and understand the reasons behind these differences, which may hold the key to unravel the etiology of IBD.

Citations

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Close layer
Current status and future perspectives of capsule endoscopy
Hyun Joo Song, Ki-Nam Shim
Intest Res 2016;14(1):21-29.   Published online January 26, 2016
DOI: https://doi.org/10.5217/ir.2016.14.1.21
AbstractAbstract PDFPubReaderePub

Small bowel capsule endoscopy (CE) was first introduced 15 years ago, and a large amount of literature has since been produced, focused on its indication, diagnostic yields, and safety. Guidelines that have made CE the primary diagnostic tool for small bowel disease have been created. Since its initial use in the small bowel, CE has been used for the esophagus, stomach, and colon. The primary indications for small bowel CE are obscure gastrointestinal bleeding, unexplained iron deficiency anemia, suspected Crohn's disease, small bowel tumors, nonsteroidal anti-inflammatory drug enteropathy, portal hypertensive enteropathy, celiac disease, etc. Colon CE provides an alternative to conventional colonoscopy, with possible use in colorectal cancer screening. Guidelines for optimal bowel preparation of CE have been suggested. The main challenges in CE are the development of new devices with the ability to provide therapy, air inflation for better visualization of the small bowel, biopsy sampling systems attached to the capsule, and the possibility of guiding and moving the capsule by an external motion controller. We review the current status and future directions of CE, and address all aspects of clinical practice, including the role of CE and long-term clinical outcomes.

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Current status of biosimilars in the treatment of inflammatory bowel diseases
Dong Il Park
Intest Res 2016;14(1):15-20.   Published online January 26, 2016
DOI: https://doi.org/10.5217/ir.2016.14.1.15
AbstractAbstract PDFPubReaderePub

Introduction of biological therapies have led to dramatic changes in the management of debilitating immune-mediated inflammatory bowel diseases (IBD) including ulcerative colitis and Crohn's disease. However, the long term use of these agents may be very expensive, placing a significant burden on National Healthcare Systems. The development of first biosimilar to infliximab, CT-P13 (Remsima; Celltrion Inc., Incheon, Korea and Inflextra; Hospiral, Lake Forest, Illinois, USA) has become another way to decrease the medical care cost and increase patient treatment option, but, actual equivalence of efficacy and safety of CT-P13 was investigated in rheumatic diseases only. The extrapolation of outcome from rheumatic trials to IBD and the interchangeability of CT-P13 with infliximab have come to be a matter of concern. Two recent retrospective studies reported the similarity of CT-P13 in terms of efficacy and safety. Infliximab biosimilars may be promising new treatment options for IBD patients, however, well-designed, prospective randomized non-inferiority trials should be needed to confidently integrate infliximab biosimilars into IBD treatment.

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Fecal immunochemical test as a biomarker for inflammatory bowel diseases: can it rival fecal calprotectin?
Jun Kato, Sakiko Hiraoka, Asuka Nakarai, Shiho Takashima, Toshihiro Inokuchi, Masao Ichinose
Intest Res 2016;14(1):5-14.   Published online January 25, 2016
DOI: https://doi.org/10.5217/ir.2016.14.1.5
AbstractAbstract PDFPubReaderePub

Accurate evaluation of disease activity is essential for choosing an appropriate treatment and follow-up plan for patients with inflammatory bowel disease (IBD). Endoscopy is required for accurately evaluating disease activity, but the procedures are sometimes invasive and burdensome to patients. Therefore, alternative non-invasive methods for evaluating or predicting disease activity including mucosal status are desirable. Fecal calprotectin (Fcal) is the most widely used fecal marker for IBD, and many articles have described the performance of the marker in predicting disease activity, mucosal healing (MH), treatment efficacy, and risk of relapse. Fecal immunochemical test (FIT) can quantify the concentration of hemoglobin in stool and was originally used for the screening of colorectal cancer. We recently reported that FIT is also a useful biomarker for IBD. A direct comparison between the use of Fcal and FIT showed that both methods predicted MH in ulcerative colitis equally well. However, in the case of Crohn's disease, FIT was less sensitive to lesions in the small intestine, compared to Fcal. FIT holds several advantages over Fcal in regards to user-friendliness, including a lower cost, easy and clean handling, and the ability to make rapid measurements by using an automated measurement system. However, there is insufficient data to support the application of FIT in IBD. Further studies into the use of FIT for evaluating the inflammatory status of IBD are warranted.

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Pharmacologic Agents for Chronic Diarrhea
Kwang Jae Lee
Intest Res 2015;13(4):306-312.   Published online October 15, 2015
DOI: https://doi.org/10.5217/ir.2015.13.4.306
AbstractAbstract PDFPubReaderePub

Chronic diarrhea is usually associated with a number of non-infectious causes. When definitive treatment is unavailable, symptomatic drug therapy is indicated. Pharmacologic agents for chronic diarrhea include loperamide, 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists, diosmectite, cholestyramine, probiotics, antispasmodics, rifaximin, and anti-inflammatory agents. Loperamide, a synthetic opiate agonist, decreases peristaltic activity and inhibits secretion, resulting in the reduction of fluid and electrolyte loss and an increase in stool consistency. Cholestyramine is a bile acid sequestrant that is generally considered as the first-line treatment for bile acid diarrhea. 5-HT3 receptor antagonists have significant benefits in patients with irritable bowel syndrome (IBS) with diarrhea. Ramosetron improves stool consistency as well as global IBS symptoms. Probiotics may have a role in the prevention of antibiotic-associated diarrhea. However, data on the role of probiotics in the treatment of chronic diarrhea are lacking. Diosmectite, an absorbent, can be used for the treatment of chronic functional diarrhea, radiation-induced diarrhea, and chemotherapy-induced diarrhea. Antispasmodics including alverine citrate, mebeverine, otilonium bromide, and pinaverium bromide are used for relieving diarrheal symptoms and abdominal pain. Rifaximin can be effective for chronic diarrhea associated with IBS and small intestinal bacterial overgrowth. Budesonide is effective in both lymphocytic colitis and collagenous colitis. The efficacy of mesalazine in microscopic colitis is weak or remains uncertain. Considering their mechanisms of action, these agents should be prescribed properly.

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Recent Updates on the Treatment of Constipation
Han Seung Ryu, Suck Chei Choi
Intest Res 2015;13(4):297-305.   Published online October 15, 2015
DOI: https://doi.org/10.5217/ir.2015.13.4.297
AbstractAbstract PDFPubReaderePub

The treatment of constipation aims to regulate the frequency and quantity of stool in order to promote successful defecation. Numerous studies on pharmacologic treatments and non-pharmacologic therapies for constipation have attempted to overcome limitations such as temporary and insufficient efficacy. Conventional laxatives have less adverse effects and are inexpensive, but often have limited efficacy. Recently developed enterokinetic agents and intestinal secretagogues have received attention owing to their high efficacies and low incidences of adverse events. Studies on biofeedback and surgical treatment have focused on improving symptoms as well as quality of life for patients with refractory constipation.

Citations

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    Arquivos de Gastroenterologia.2018; 55(suppl 1): 2.     CrossRef
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    European Journal of Integrative Medicine.2018; 24: 23.     CrossRef
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