Intestinal Research

Intestinal Behcet's Disease: Suk-Kyun Yang; Intest Res 2005;3(1):1-10. Published online June 30, 2005

Abstract PDF: Behcet's disease is a multisystem disease characterized by recurrent oral and genital ulcerations in association with skin and ocular lesions. Gastrointestinal involvement of Behcet's disease is one of the major causes of morbidity and mortality in this disease, as it often results in serious complications such as perforation and bleeding. However, much remains unknown about the epidemiology, clinical characteristics, treatment, and prognosis of intestinal Behcet's disease. In this brief review, the author summarized the differences in epidemiology and clinical characteristics of intestinal Behcet's disease among different regions, the problems in its diagnosis and treatment, and its clinical course and long-term prognosis. (Intest Res 2005;3:1-10)

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Role of Peroxisome Proliferator-Activated Receptor g in Inflammatory Bowel Disease and Colon Cancer: Sang Kil Lee, Hyo Jong Kim; Intest Res 2004;2(2):53-57. Published online December 22, 2004

Abstract PDF: The peroxisome proliferator-activated receptor γ (PPARγ) and its partner the retinoid X receptor (RXR) are two nuclear receptors that are expressed mainly in adipose tissue and which have a role in lipid metabolism and insulin sensitization. New sites of PPARγ expression have been described, especially in the intestinal tract. Concomitantly, new functions have been attributed to PPARγ in regulation of inflammation and carcinogenesis. These new functions of PPARγ have led to novel ideas about pathophysiology of inflammatory bowel disease and colon cancer to development of innovative treatment strategies with PPARγ agonist. (Intestinal Research 2004;2:53-57)

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Post-infectious Irritable Bowel Syndrome: Young Soo Park, Dong Ho Lee; Intest Res 2004;2(1):11-14. Published online April 16, 2004

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Clinical Usage of Probiotics and Its Mechanism of Action: Dong Soo Han, Joon Yong Park; Intest Res 2004;2(1):5-10. Published online April 16, 2004

Abstract PDF: Probiotics has been prescribed for various medical purposes. The benefit of using probiotics has been clarified in antibiotics associated diarrhea, travelers' diarrhea, acute diarrhea, diarrhea in the pediatric field, functional diarrhea and some part of inflammatory bowel disease. However, the mechanism of action of probiotics is still in the investigation. Its functions of excreting bacterial products, adhesion to bowel wall, competition with other bacteria, and promoting mucin secretion from bowel mucosa have been discussed as the mechanism of action of probiotics. Recently the immune modulation of probiotics started to be regarded as the main part of its mechanism of action. Probiotics may produce its immune modulation by modifying the activation of Toll-like receptor: the main receptor of inducing innate immunity. (Intestinal Research 2004;2:5-10)

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Experimental Model for the Study of Intestinal Diseases: Ki Baik Hahm; Intest Res 2003;1(2):159-167. Published online November 27, 2003

Abstract PDF: No abstract available

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Inflammatory Bowel Disease and Pregnancy: Won Ho Kim; Intest Res 2003;1(2):141-158. Published online November 27, 2003

Abstract PDF: Because peak age of onset for inflammatory bowel disease (IBD) coincides with the peak age for conception and pregnancy, female patients with IBD concern pregnancy-related problems including sexual health, inheritance of disease in the offspring, fertility, the effect of pregnancy on disease, and conversely, the effect of disease on the course of pregnancy, as well as the safety of drugs. The clinicians must be prepared to address these issues and to discuss with patients and their spouses. Generally fertility is normal, although may be decreased in women with active Crohn's disease and in patients who received operation for IBD in both Crohn's disease and ulcerative colitis. Women with inactive IBD do not have increased risk of complicated pregnancy. However, active disease is associated with 2-3 times higher risk of complications such as preterm delivery or low birth weight. Inadequate therapy for IBD may results in exacerbation of disease and consequently, cause many pregnancy-related problems, including infertility, miscarriage or pre-term delivery. Furthermore, evidences have suggested that both Crohn's disease and ulcerative colitis tend to worsen if the disease is active at conception. Therefore, the focus should be on inducing remission before conception and maintaining remission during pregnancy. Treatment strategies in pregnant patients with IBD need to be evaluated carefully, and possibility of medication side effects on both the patients and the fetus must be weighed against the risks of active disease. Although the data on the safety of medications in pregnancy are limited, a key principle of management is that active disease, not the medications used to treat it, poses the greatest danger to pregnancy. (Intestinal Research 2003;2:141-158)

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Current Status and Perspectives for Colonic Polyp Researches in Korea: Jin Bae Kim, Dong Soo Han; Intest Res 2003;1(1):19-21. Published online May 27, 2003

Abstract PDF: Colorectal cancer is one of the most common malignancies in the United States and Europe. In the United States, approximately 131,000 new cases of colon cancer occur annually, of which 57,000 will lead to death. Recently, the incidence of colorectal cancer has been increasing markedly in Korea. Most of colorectal cancers follow typical adenoma-carcinoma sequences, therefore it is meanwhile epidemiologic and clinical study for colon polyps, because removal of colon polyps can significantly reduce the mortality from colorectal cancers. There were few epidemiologic data about colonic polyps in Korea. Therefore, it would be needed prospective multicenter study to find clinical characteristics of colon polyp in Korea. Here, we present preliminary data about clinical, endoscopic, and histological aspects of colon polyps in Korea and review perspectives. (Intestinal Research 2003;1:19-21)

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Azathioprine and 6-Mercaptopurine in Ulcerative Colitis: Won Ho Kim, In Hye Park, Jae Hee Cho, Tae Il Kim; Intest Res 2003;1(1):5-18. Published online May 27, 2003

Abstract PDF: Most of patients with ulcerative colitis have intermittent chronic disease demonstrating recurrent flare-ups of bloody diarrhea and symptom-free periods. Sulfasalazine and mesalazine are the first-line medical therapy in patients with mild to moderate activity, as both of them are effective in inducing and maintenance of remission. However, significant proportion of patients needs stronger drugs such as corticosteroids. As corticosteroids are ineffective for the prevention of relapse and associated with frequents side-effects, immunosuppressors, 6-mercaptopurine (6-MP) and its prodrug azathioprine, have been used in selected patients. After absorption azatioprine is rapidly converted to 6-MP non-enzymatically and 6-MP is either inactivated by thiopurine methyltransferase (TPMT) to 6-methylmercaptopurine or by xanthine oxidase to 6-thiouric acid, or it is activated via a multistep enzymatic pathway to the putative active metabolites, 6-thioguanine nucleotides (6-TGN). Clinical responsiveness and side effects are associated with TPMT genotype and phenotype, because the enzymatic activity of TPMT is genetically determined. Until now, significant proportion of patients with proper indication are not receiving immunosuppressors because of safety concern and delayed onset of action. Recently, however, gastroenterologists' acceptance for immunomodulators is increasing based on favorable results regarding efficacy and safety. The recent application of the study of variability in drug response due to genetic factors, termed pharmacogenetics, has provided a chance for tailored dosing in the individual patients. (Intestinal Research 2003;1:5-18)

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Helminths in alternative therapeutics of inflammatory bowel disease: Himani Pandey, Daryl W. T. Tang, Sunny H. Wong, Devi Lal; Received May 25, 2023 Accepted November 1, 2023 Published online January 12, 2024; DOI: https://doi.org/10.5217/ir.2023.00059 [Epub ahead of print]

Abstract PDF PubReader ePub: Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, is a nonspecific chronic inflammation of the gastrointestinal tract. Despite recent advances in therapeutics and newer management strategies, IBD largely remains untreatable. Helminth therapy is a promising alternative therapeutic for IBD that has gained some attention in the last two decades. Helminths have immunomodulatory effects and can alter the gut microbiota. The immunomodulatory effects include a strong Th2 immune response, T-regulatory cell response, and the production of regulatory cytokines. Although concrete evidence regarding the efficacy of helminth therapy in IBD is lacking, clinical studies and studies done in animal models have shown some promise. Most clinical studies have shown that helminth therapy is safe and easily tolerable. Extensive work has been done on the whipworm Trichuris, but other helminths, including Schistosoma, Trichinella, Heligmosomoides, and Ancylostoma, have also been explored for pre-clinical and animal studies. This review article summarizes the potential of helminth therapy as an alternative therapeutic or an adjuvant to the existing therapeutic procedures for IBD treatment.

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The evolving understanding of histology as an endpoint in ulcerative colitis: Shintaro Akiyama, Yusuke Miyatani, David T. Rubin; Received September 13, 2023 Accepted January 24, 2023 Published online March 13, 2024; DOI: https://doi.org/10.5217/ir.2023.00120 [Epub ahead of print]

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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.

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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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Cardiovascular disease: extraintestinal manifestation of inflammatory bowel disease: Samridhi Lakhanpal, Kanishk Aggarwal, Harmanjit Kaur, Kunal Kanwar, Vasu Gupta, Jill Bhavsar, Rohit Jain; Received August 20, 2023 Accepted November 6, 2023 Published online May 7, 2024; DOI: https://doi.org/10.5217/ir.2023.00104 [Epub ahead of print]

Abstract PDF PubReader ePub: Inflammatory bowel disease (IBD) is a spectrum of diseases characterized by the interplay of the aberrant immune system, genetic factors, environmental factors, and intestinal microbiota, resulting in relapsing inflammation of the gastrointestinal tract. Underlying pro-inflammatory state and immune dysregulation act as a catalyst for increasing the likelihood of developing extraintestinal manifestations, including cardiovascular diseases (CVD) like atherosclerosis, pericarditis, myocarditis, venous and arterial thromboembolism, arrhythmias, despite a lower prevalence of classic CVD risk factors, like high body mass index or dyslipidemia compared to the general population. Chronic inflammation damages endothelium resulting in the recruitment of inflammatory cells, which induce cytotoxicity, lipoprotein oxidation, and matrix degradation, which increases the risk of atherosclerosis. Additionally, intestinal dysbiosis disrupts the intestinal mucosal barrier, releasing endotoxins and lipopolysaccharides into circulation, further exaggerating the atherosclerotic process. Abnormal collagen metabolism and alteration of nitric oxide-mediated vasodilation lead to blood pressure dysregulation in patients with IBD. Therefore, it is essential to make lifestyle modifications like smoking cessation, dietary changes, and increasing physical activity with adherence to medication to mitigate the risk of developing CVD in patients with IBD. This article reviews the potential links between IBD and the increased risk of CVD in such individuals.

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What to do when traditional rescue therapies fail in acute severe ulcerative colitis: Christopher F. D. Li Wai Suen, Matthew C. Choy, Peter De Cruz; Received January 7, 2024 Accepted March 22, 2024 Published online May 16, 2024; DOI: https://doi.org/10.5217/ir.2024.00003 [Epub ahead of print]

Abstract PDF PubReader ePub: Acute severe ulcerative colitis (ASUC) is a medical emergency that affects approximately 25% of patients with ulcerative colitis at some point in time in their lives. Outcomes of ASUC are highly variable. Approximately 30% of patients do not respond to corticosteroids and up to 50% of patients do not respond to rescue therapy (infliximab or cyclosporin) and require emergency colectomy. Data are emerging on infliximab dosing strategies, use of cyclosporin as a bridge to slower acting biologic agents and Janus kinase inhibition as primary and sequential therapy. In this review, we outline contemporary approaches to clinical management of ASUC in the setting of failure to respond to traditional rescue therapies.

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Complex dichotomous links of nonalcoholic fatty liver disease and inflammatory bowel disease: exploring risks, mechanisms, and management modalities: Kanishk Aggarwal, Bhupinder Singh, Abhishek Goel, Durgesh Kumar Agrawal, Sourav Bansal, Sai Gautham Kanagala, Fnu Anamika, Aachal Gupta, Rohit Jain; Received December 31, 2023 Accepted April 15, 2024 Published online June 5, 2024; DOI: https://doi.org/10.5217/ir.2024.00001 [Epub ahead of print]

Abstract PDF PubReader ePub: Nonalcoholic fatty liver disease (NAFLD) has been shown to be linked to inflammatory bowel disease (IBD) due to established risk factors such as obesity, age, and type 2 diabetes in numerous studies. However, alternative research suggests that factors related to IBD, such as disease activity, duration, and drug-induced toxicity, can contribute to NAFLD. Recent research findings suggest IBD relapses are correlated with dysbiosis, mucosal damage, and an increase in cytokines. In contrast, remission periods are characterized by reduced metabolic risk factors. There is a dichotomy evident in the associations between NAFLD and IBD during relapses and remissions. This warrants a nuanced understanding of the diverse influences on disease manifestation and progression. It is possible to provide a holistic approach to care for patients with IBD by emphasizing the interdependence between metabolic and inflammatory disorders.

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