Intestinal Research

Original Articles

IBD/ Endoscopy

Adequacy of sigmoidoscopy as compared to colonoscopy for assessment of disease activity in patients of ulcerative colitis: a prospective study: Sameet Tariq Patel, Anuraag Jena, Sanjay Chandnani, Shubham Jain, Pankaj Nawghare, Saurabh Bansal, Harsh Gandhi, Rishikesh Malokar, Jay Chudasama, Prasanta Debnath, Seemily Kahmei, Rima Kamat, Sangeeta Kini, Qais Q Contractor, Pravin M Rathi; Intest Res 2024;22(3):310-318. Published online May 16, 2024; DOI: https://doi.org/10.5217/ir.2023.00174

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Background/Aims
Patients of ulcerative colitis (UC) on follow-up are routinely evaluated by sigmoidoscopy. There is no prospective literature to support this practice. We assessed agreement between sigmoidoscopy and colonoscopy prospectively in patients with disease extent beyond the sigmoid colon.
Methods
We conducted a prospective observational study at a tertiary care institute for agreement between sigmoidoscopy and colonoscopy. We assessed endoscopic activity using the Mayo Endoscopic Score (MES) and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and histological activity using the Nancy Index (NI), Robarts Histopathology Index (RHI), and Simplified Geboes Score (SGS).
Results
Sigmoidoscopy showed a strong agreement with colonoscopy for MES and UCEIS with a kappa (κ) of 0.96 and 0.94 respectively. The misclassification rate for MES and UCEIS was 3% and 5% respectively. Sigmoidoscopy showed perfect agreement (κ = 1.00) with colonoscopy for assessment of the presence of endoscopic activity in the colon using MES ≥ 1 as activity criteria and strong agreement (κ = 0.93) using MES > 1 as activity criteria. Sigmoidoscopy showed strong agreement with colonoscopy for assessment of the presence of endoscopic activity using UCEIS (κ = 0.92). Strong agreement was observed between sigmoidoscopy and colonoscopy using NI (κ = 0.86), RHI (κ = 1.00), and SGS (κ = 0.92) for the detection of histological activity. The misclassification rate for the detection of histological activity was 2%, 0%, and 1% for NI, RHI, and SGS respectively.
Conclusions
Sigmoidoscopy showed strong agreement with colonoscopy for endoscopic and histologic disease activity. Sigmoidoscopy is adequate for assessment of disease activity in patients with UC during follow-up evaluation.

Citations

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Sigmoidoscopy is sufficient to assess endoscopic response to therapy in pediatric ulcerative colitis: A cohort study
Shira Yuval Bar‐Asher, Esther Orlanski‐Meyer, Ibrahim Shamasnah, Dotan Yogev, Dan Turner
Journal of Pediatric Gastroenterology and Nutrition.2026; 82(1): 98. CrossRef
Reshaping study design for faster extrapolation‐based drug approval in pediatric inflammatory bowel diseases: An ESPGHAN–NASPGHAN position paper
Dan Turner, Amit Assa, Mikkel Malham, Shira Yuval Bar‐Asher, Carla Rayan, Jeffrey S. Hyams, Holm H. Uhlig, Brad Pasternak, David C. Wilson, Hilary K. Michel, Lissy de Ridder, Eric Zuckerman, Marina Aloi, Peter Szitanyi, Marla C. Dubinsky, Anne M. Griffith
Journal of Pediatric Gastroenterology and Nutrition.2026; 82(3): 867. CrossRef
ECCO consensus on management of inflammatory bowel disease in low- and middle-income countries
Alaa El-Hussuna, Almuthe Christina Hauer, Tarkan Karakan, Valerie Pittet, Henit Yanai, Jalpa Devi, Jesus K Yamamoto-Furusho, Ali Reza Sima, Hailemichael Desalegn, Mutaz Idrees Sultan, Vishal Sharma, Hany Shehab, Lamya Mrabti, Natalia Queiroz, Anuraag Jena
Journal of Crohn’s and Colitis.2026;[Epub] CrossRef
Comments on “Adequacy of sigmoidoscopy as compared to colonoscopy for assessment of disease activity in patients of ulcerative colitis: a prospective study”
Sidharth Harindranath
Intestinal Research.2025; 23(2): 225. CrossRef

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IBD

Clinical features of very early-onset inflammatory bowel disease in Japan: a retrospective single-center study: Masaaki Usami, Ichiro Takeuchi, Reiko Kyodo, Yuri Hirano, Kosuke Kashiwagi, Hiroki Fujikawa, Hirotaka Shimizu, Toshinao Kawai, Katsuhiro Arai; Intest Res 2022;20(4):475-481. Published online June 13, 2022; DOI: https://doi.org/10.5217/ir.2021.00142

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Background/Aims
Very early-onset inflammatory bowel disease (VEO-IBD), defined as IBD diagnosed in patients younger than 6 years, is a challenge for pediatric gastroenterologists. Although there have been reports regarding VEO-IBD in Western countries, those in Asia are still lacking. This study aimed to investigate the clinical features of Japanese VEO-IBD patients.
Methods
Patients with VEO-IBD diagnosed between 2006 and 2019 were evaluated retrospectively. The disease phenotypes were classified into ulcerative colitis type (UC-type) and Crohn’s disease type (CD-type), and the clinical features and courses were compared between the phenotypes.
Results
Overall, 54 VEO-IBD patients (19 patients with UC-type and 35 patients with CD-type) were evaluated. The median age at onset was 18 months. One patient had severe combined immunodeficiency (SCID), and 9 patients had monogenic IBD. Monogenic IBD was more prevalent in the CD-type patients with perianal disease (CD-type (PD)). The age at onset was significantly lower in the CD-type group (P<0.05). The most common initial symptom was bloody stools (70%), followed by diarrhea (63%), weight loss (24%), fever (20%), and perianal disease (20%). Excluding patients with SCID and monogenic IBD, 23 out of 44 patients (52%) required biologics. The biologics were switched in 11 out of 44 patients (25%), and the majority of these patients (82%) were in the CD-type group. Overall, 9 patients (20%) required intestinal resection or ostomy placement.
Conclusions
CD-type tends to occur at an earlier age, and monogenic IBD occurs significantly more frequently in CD-type (PD). Disease severity and treatment should be individualized, owing to the disease heterogeneity.

Citations

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Process of empowerment in mothers of children with very-early-onset inflammatory bowel disease: a qualitative study
Mikako Yokoo, Satomi Nomura, Satoe Fukui, Ichiro Takeuchi, Hirotaka Shimizu, Katsuhiro Arai
Intestinal Research.2026; 24(1): 151. CrossRef
Long‐term clinical and endoscopic outcomes of ustekinumab in pediatric Crohn's disease with anti‐tumor necrosis factor failure
Yoko Yamamoto, Ichiro Takeuchi, Hirotaka Shimizu, Hiroki Fujikawa, Masanori Toda, Eri Miyata, Hiroaki To, Satoru Nagata, Katsuhiro Arai
Journal of Gastroenterology and Hepatology.2025; 40(1): 123. CrossRef
Disease phenotypic and outcome of very-early onset inflammatory bowel disease in Asian children: an understudied population
Way-Seah Lee, Kee-Seang Chew, James-Guoxian Huang, Pornthep Tanpowpong, Karen S. C. Mercado, Almida Reodica, Veena Logarajah, K. L. W. Hathagoda, Shaman Rajindrajith, Yoko Kin-Yoke Wong, Suporn Treepongkaruna, Marion Margaret Aw
Frontiers in Pediatrics.2025;[Epub] CrossRef
Curing inflammatory bowel diseases: breaking the barriers of current therapies– emerging strategies for a definitive treatment
Daniele Noviello, Chiara Amoroso, Maurizio Vecchi, Federica Facciotti, Flavio Caprioli
Current Opinion in Immunology.2025; 95: 102593. CrossRef
Feasibility and Safety of Small Bowel Capsule Endoscopy in Very Early-Onset Inflammatory Bowel Disease: A Multi-Institutional Study
Shin-ichiro Hagiwara, Hirotaka Shimizu, Ryusuke Nambu, Keisuke Jimbo, Emiri Kaji, Takuya Nishizawa, Fumihiko Kakuta, Itaru Iwama, Takashi Ishige, Takahiro Kudo, Katsuhiro Arai
Inflammatory Bowel Diseases.2025; 31(12): 3279. CrossRef
Asian–Pacific perspectives on the management of very early-onset inflammatory bowel disease
Ichiro Takeuchi, Katsuhiro Arai, Pornthep Tanpowpong, Ming-Wei Lai, Andrew S Day, Way Seah Lee, James Guoxian Huang, Karen Sophia Calixto-Mercado, Rosanna Ming Sum Wong, Muhammad Arshad Alvi, Zubin Grover, Jung Ok Shim, Ujjal Poddar
Intestinal Research.2025; 23(4): 405. CrossRef
Impact of age at diagnosis on long‐term prognosis in patients with intestinal Behçet's disease
Ji Young Chang, Soo Jung Park, Jae Jun Park, Tae Il Kim, Jae Hee Cheon, Jihye Park
Journal of Gastroenterology and Hepatology.2024; 39(3): 519. CrossRef
Neither hepatic steatosis nor fibrosis is associated with clinical outcomes in patients with intestinal Behçet’s disease
Hye Kyung Hyun, Jihye Park, Soo Jung Park, Jae Jun Park, Tae Il Kim, Jae Seung Lee, Hye Won Lee, Beom Kyung Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Seung Up Kim, Jae Hee Cheon
European Journal of Gastroenterology & Hepatology.2024; 36(4): 445. CrossRef
Surgical outcomes of very-early-onset ulcerative colitis: retrospective comparative study with older pediatric patients
Takashi Fumita, Keita Terui, Ryohei Shibata, Ayako Takenouchi, Shugo Komatsu, Satoru Oita, Hiroko Yoshizawa, Yuichi Hirano, Yusaku Yoshino, Takeshi Saito, Tomoro Hishiki
Pediatric Surgery International.2024;[Epub] CrossRef
Fecal Calprotectin at Postinduction Is Capable of Predicting Persistent Remission and Endoscopic Healing after 1 Year of Treatment with Infliximab in Pediatric Patients with Crohn’s Disease
Yoo Min Lee, Eun Sil Kim, Sujin Choi, Hyo-Jeong Jang, Yu Bin Kim, So Yoon Choi, Byung-Ho Choe, Ben Kang
Gut and Liver.2024; 18(3): 498. CrossRef
Genomic testing identifies monogenic causes in patients with very early-onset inflammatory bowel disease: a multicenter survey in an Iranian cohort
Golnaz Eslamian, Mahnaz Jamee, Tooba Momen, Pejman Rohani, Sarehossadat Ebrahimi, Mehrnaz Mesdaghi, Soodeh Ghadimi, Mahboubeh Mansouri, Seyed Alireza Mahdaviani, Mahnaz Sadeghi-shabestari, Morteza Fallahpour, Bibi Shahin Shamsian, Narges Eslami, Samin Sha
Clinical and Experimental Immunology.2024; 217(1): 1. CrossRef

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11 Web of Science
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Miscellaneous

Risk factors for severity of colonic diverticular hemorrhage: Ken Kinjo, Toshiyuki Matsui, Takashi Hisabe, Hiroshi Ishihara, Toshiki Kojima, Kenta Chuman, Shigeyoshi Yasukawa, Tsuyoshi Beppu, Akihiro Koga, Satoshi Ishikawa, Masahiro Kishi, Noritaka Takatsu, Fumihito Hirai, Kenshi Yao, Toshiharu Ueki, Masakazu Washio; Intest Res 2018;16(3):458-466. Published online July 27, 2018; DOI: https://doi.org/10.5217/ir.2018.16.3.458

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

Colonic diverticular hemorrhage (DH) was a rare disease until the 1990s, and its incidence has increased rapidly since 2000 in Japan. In recent years, colonic DH has been the most frequent cause of lower gastrointestinal bleeding (LGIB). Nearly all cases of DH are mild, with the bleeding often stopping spontaneously. Some cases, however, require surgery or arterial embolization. In this study, using a cohort at Fukuoka University Chikushi Hospital, we investigated factors associated with severe colonic DH.

Methods

Among patients with LGIB who underwent colonoscopy at our hospital between 1995 and 2013, DH was identified in 273 patients. Among them, 62 patients (22.7%) were defined as having severe colonic DH according to recurrence of bleeding in a short period, and/or the necessity of transfusion, arterial embolization, or surgery. We then evaluated risk factors for severe DH among DH patients in this retrospective cohort.

Results

Among the 273 patients with DH, use of non-steroidal anti-inflammatory drugs (NSAIDs) (odds ratio [OR], 2.801; 95% confidence interval [CI], 1.164–6.742), Charlson Risk Index (CRI) ≥2 (OR, 3.336; 95% CI, 1.154–7.353), right-sided colonic DH (OR, 3.873; 95% CI, 1.554–9.653), and symptoms of cerebral hypoperfusion (such as light-headedness, dizziness, or syncope) (OR, 2.926; 95% CI, 1.310–6.535) showed an increased risk of severe DH even after controlling for other factors.

Conclusions

Severe DH occurred in 23% of DH patients, and NSAID use, CRI ≥2, right-sided colonic DH, and symptoms of cerebral hypoperfusion are suggested to be predictors of severe DH.

Citations

Citations to this article as recorded by

Management of Colonic Diverticular Disease in the Older Adult
Hiep S. Phan, Lisa L. Strate
Current Gastroenterology Reports.2025;[Epub] CrossRef
Clinical Factors Associated with Severity of Colonic Diverticular Bleeding and Impact of Bleeding Site
Hirohito Amano, Takatsugu Yamamoto, Ken Ikusaka, Naoaki Aoki, Miyoko Sakurai, Taku Honda, Kyohei Maruyama, Hitoshi Aoyagi, Akari Isono, Koichiro Abe, Yoshinari Asaoka, Shinya Kodashima, Atsushi Tanaka
Journal of Clinical Medicine.2023; 12(5): 1826. CrossRef
Effectiveness and Safety of Endoscopic Submucosal Dissection for Colorectal Neoplasm in Patients with High Charlson Comorbidity Index Score: A HASID Multicenter Study
Dong-Hyun Kim, Yong-Wook Jung, Byung-Chul Jin, Hyung-Hoon Oh, Hyo-Yeop Song, Seong-Jung Kim, Dae-Seong Myung, Sang-Wook Kim, Jun Lee, Geom-Seog Seo, Young-Eun Joo, Hyun-Soo Kim
Journal of Clinical Medicine.2023; 12(19): 6255. CrossRef
Risk factors for patients hospitalized with recurrent colon diverticular bleeding: a single center experience
Hye-Su You, Dong Hyun Kim, Seo-Yeon Cho, Seon-Young Park, Chang Hwan Park, Hyun-Soo Kim, Sung Kyu Choi
Frontiers in Medicine.2023;[Epub] CrossRef
Construction of a Model for Predicting the Severity of Diverticular Bleeding in an Elderly Population
Tomoyuki Okada, Tsuyoshi Mikamo, Ayana Nakashima, Atsushi Yanagitani, Kiwamu Tanaka, Hajime Isomoto
Internal Medicine.2022; 61(15): 2247. CrossRef
Diagnosis and Treatment of Colonic Diverticular Disease
You Sun Kim
The Korean Journal of Gastroenterology.2022; 79(6): 233. CrossRef
Development and Validation of Predictive Assessment of Complicated Diverticulitis Score
Marcello Covino, Valerio Papa, Antonio Tursi, Benedetta Simeoni, Loris Riccardo Lopetuso, Lorenzo Maria Vetrone, Francesco Franceschi, Gianludovico Rapaccini, Antonio Gasbarrini, Alfredo Papa
Journal of Personalized Medicine.2021; 11(2): 80. CrossRef
Risk of Rebleeding in Patients with Small Bowel Vascular Lesions
Akira Harada, Takehiro Torisu, Shin Fujioka, Yuichiro Yoshida, Yasuharu Okamoto, Yuta Fuyuno, Atsushi Hirano, Junji Umeno, Kumiko Torisu, Tomohiko Moriyama, Motohiro Esaki, Takanari Kitazono
Internal Medicine.2021; 60(23): 3663. CrossRef
Vegetarianism as a protective factor for asymptomatic colonic diverticulosis in Asians: a retrospective cross-sectional and case-control study
Jihun Bong, Hyoun Woo Kang, Hyeki Cho, Ji Hyung Nam, Dong Kee Jang, Jae Hak Kim, Jun Kyu Lee, Yun Jeong Lim, Moon-Soo Koh, Jin Ho Lee
Intestinal Research.2020; 18(1): 121. CrossRef

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