Intestinal Research

IBD

Management of Crohn’s disease in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease updated in 2023: Jia-Feng Wu, Hsu-Heng Yen, Horng-Yuan Wang, Ting-An Chang, Chung-Hsin Chang, Chen-Wang Chang, Te-Hsin Chao, Jen-Wei Chou, Yenn-Hwei Chou, Chiao-Hsiung Chuang, Wen-Hung Hsu, Tzu-Chi Hsu, Tien-Yu Huang, Tsung-I Hung, Puo-Hsien Le, Chun-Che Lin, Chun-Chi Lin, Ching-Pin Lin, Jen-Kou Lin, Wei-Chen Lin, Yen-Hsuan Ni, Ming-Jium Shieh, I-Lun Shih, Chia-Tung Shun, Tzung-Jiun Tsai, Cheng-Yi Wang, Meng-Tzu Weng, Jau-Min Wong, Deng-Chyang Wu, Shu-Chen Wei; Intest Res 2024;22(3):250-285. Published online July 29, 2024; DOI: https://doi.org/10.5217/ir.2024.00060

Abstract PDF PubReader ePub: Crohn’s disease (CD) is a chronic, fluctuating inflammatory condition that primarily affects the gastrointestinal tract. Although the incidence of CD in Taiwan is lower than that in Western countries, the severity of CD presentation appears to be similar between Asia and the West. This observation indicates the urgency for devising revised guidelines tailored to the unique reimbursement system, and patient requirements in Taiwan. The core objectives of these updated guidelines include the updated treatment choices and the integration of the treat-to-target strategy into CD management, promoting the achievement of deep remission to mitigate complications and enhance the overall quality of life. Given the diversity in disease prevalence, severity, insurance policies, and access to medical treatments in Taiwan, a customized approach is imperative for formulating these guidelines. Such tailored strategies ensure that international standards are not only adapted but also optimized to local contexts. Since the inception of its initial guidelines in 2017, the Taiwan Society of Inflammatory Bowel Disease (TSIBD) has acknowledged the importance of continuous revisions for incorporating new therapeutic options and evolving disease management practices. The latest update leverages international standards and recent research findings focused on practical implementation within the Taiwanese healthcare system.

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IBD

Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease updated in 2023: Hsu-Heng Yen, Jia-Feng Wu, Horng-Yuan Wang, Ting-An Chang, Chung-Hsin Chang, Chen-Wang Chang, Te-Hsin Chao, Jen-Wei Chou, Yenn-Hwei Chou, Chiao-Hsiung Chuang, Wen-Hung Hsu, Tzu-Chi Hsu, Tien-Yu Huang, Tsung-I Hung, Puo-Hsien Le, Chun-Che Lin, Chun-Chi Lin, Ching-Pin Lin, Jen-Kou Lin, Wei-Chen Lin, Yen-Hsuan Ni, Ming-Jium Shieh, I-Lun Shih, Chia-Tung Shun, Tzung-Jiun Tsai, Cheng-Yi Wang, Meng-Tzu Weng, Jau-Min Wong, Deng-Chyang Wu, Shu-Chen Wei; Intest Res 2024;22(3):213-249. Published online July 29, 2024; DOI: https://doi.org/10.5217/ir.2023.00050

Abstract PDF PubReader ePub

Ulcerative colitis (UC) is a chronic inflammation of the gastrointestinal tract and is characterized by alternating periods of inflammation and remission. Although UC incidence is lower in Taiwan than in Western countries, its impact remains considerable, demanding updated guidelines for addressing local healthcare challenges and patient needs. The revised guidelines employ international standards and recent research, emphasizing practical implementation within the Taiwanese healthcare system. Since the inception of the guidelines in 2017, the Taiwan Society of Inflammatory Bowel Disease has acknowledged the need for ongoing revisions to incorporate emerging therapeutic options and evolving disease management practices. This updated guideline aims to align UC management with local contexts, ensuring comprehensive and context-specific recommendations, thereby raising the standard of care for UC patients in Taiwan. By adapting and optimizing international protocols for local relevance, these efforts seek to enhance health outcomes for patients with UC.

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Rescue Therapies for Steroid-refractory Acute Severe Ulcerative Colitis: A Systematic Review and Network Meta-analysis
Chih-Wen Huang, Hsu-Heng Yen, Yang-Yuan Chen
Journal of Crohn's and Colitis.2024;[Epub] CrossRef

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IBD

Long-term efficacy and safety of tofacitinib in patients with ulcerative colitis: 3-year results from a real-world study: Hiromichi Shimizu, Yuko Aonuma, Shuji Hibiya, Ami Kawamoto, Kento Takenaka, Toshimitsu Fujii, Eiko Saito, Masakazu Nagahori, Kazuo Ohtsuka, Ryuichi Okamoto; Intest Res 2024;22(3):369-377. Published online July 16, 2024; DOI: https://doi.org/10.5217/ir.2023.00194

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
The efficacy and safety of tofacitinib for the treatment of refractory ulcerative colitis (UC) has been demonstrated in clinical trials. Although, a series of reports with real-world evidence of its short-term efficacy and safety profiles have already been published, reports of long-term real-world data have been limited. We aimed to show our 3-year evidence on the clinical use of tofacitinib for the treatment of UC, focusing on its efficacy and safety profiles.
Methods
A retrospective observational study was conducted on patients who started tofacitinib for active refractory UC at our hospital. The primary outcome was the retention rate until 156 weeks after initiating tofacitinib. The secondary outcomes were short-term efficacy at 4, 8, and 12 weeks; long-term efficacy at 52, 104, and 156 weeks; prognostic factors related to the cumulative retention rate; loss of response; and safety profile, including adverse events.
Results
Forty-six patients who were able to be monitored for up to 156 weeks after tofacitinib initiation, were enrolled in this study. Continuation of tofacitinib was possible until 156 weeks in 54.3%, with > 50% response rates and > 40% remission rates. Among patients in whom response or remission was achieved and tofacitinib was deescalated after 8 weeks of induction treatment, 54.3% experienced relapse but were successfully rescued by and retained on reinduction treatment, except for 1 patient. No serious AEs were observed in the study.
Conclusions
Tofacitinib is effective and safe as long-term treatment in a refractory cohort of UC patients in real-world clinical practice.

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IBD

Intestinal ultrasound for intestinal Behçet disease reflects endoscopic activity and histopathological findings: Katsuki Yaguchi, Reiko Kunisaki, Sho Sato, Kaori Hirai, Misato Izumi, Yoshimi Fukuno, Mami Tanaka, Mai Okazaki, Rongrong Wu, Yurika Nishikawa, Yusuke Matsune, Shunsuke Shibui, Yoshinori Nakamori, Masafumi Nishio, Mao Matsubayashi, Tsuyoshi Ogashiwa, Ayako Fujii, Kenichiro Toritani, Hideaki Kimura, Eita Kumagai, Yukiko Sasahara, Yoshiaki Inayama, Satoshi Fujii, Toshiaki Ebina, Kazushi Numata, Shin Maeda; Intest Res 2024;22(3):297-309. Published online July 16, 2024; DOI: https://doi.org/10.5217/ir.2023.00129

Abstract PDF PubReader ePub: Background/Aims
Intestinal Behçet disease is typically associated with ileocecal punched-out ulcers and significant morbidity and mortality. Intestinal ultrasound is a noninvasive imaging technique for disease monitoring. However, no previous reports have compared intestinal ultrasound with endoscopic ulcer activity or histopathological findings for intestinal Behçet disease. We evaluated the usefulness of intestinal ultrasound for assessing the activity of ileocecal ulcers in intestinal Behçet disease.
Methods
We retrospectively compared intestinal ultrasound findings with 73 corresponding endoscopic images and 6 resected specimens. The intestinal ultrasound findings were assessed for 7 parameters (bowel wall thickness, vascularity [evaluated using the modified Limberg score with color Doppler], bowel wall stratification, white-plaque sign [strong hyperechogenic lines or spots], mesenteric lymphadenopathy, extramural phlegmons, and fistulas), and endoscopic ulcer activity was classified into active, healing, and scar stages. Histopathological findings were evaluated by consensus among experienced pathologists.
Results
Bowel wall thickness (P< 0.001), vascularity (P< 0.001), loss of bowel wall stratification (P= 0.015), and white-plague sign (P= 0.013) were significantly exacerbated in the endoscopic active ulcer stage. Receiver operating characteristic curve analysis revealed that a bowel wall thickness of > 5.5 mm (sensitivity 89.7%, specificity 85.3%) was potentially useful for detecting active lesions. When compared with histopathological findings, an increase in bowel wall thickness reflected the ulcer marginal ridge, and the white-plaque sign reflected the ulcer bottom.
Conclusions
Intestinal ultrasound is useful for monitoring intestinal ulcer activity in intestinal Behçet disease.

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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

Abstract PDF Supplementary Material PubReader ePub: 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.

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IBD

Halitosis: an underestimated but important extraintestinal manifestation in inflammatory bowel disease: Xiao Xian Qian; Intest Res 2024;22(3):387-388. Published online May 7, 2024; DOI: https://doi.org/10.5217/ir.2024.00016

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IBD

Changes in the clinical course and prognosis of ulcerative colitis in Chinese populations: a retrospective cohort study: Xinyu Liu, Qingfan Yang, Na Diao, Jian Tang, Zicheng Huang, Xiang Gao, Kang Chao; Intest Res 2024;22(3):357-368. Published online May 7, 2024; DOI: https://doi.org/10.5217/ir.2023.00106

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Data on the natural course of Chinese patients with ulcerative colitis (UC) was lacking. This study aimed to evaluate the natural history and prognosis of patients with UC in the past 15 years in China.
Methods
This cohort study included patients with UC in a tertiary hospital in southern China from 2007 to 2021 (cohort I: 2007–2011, cohort II: 2012–2016, cohort III: 2017–2021). Patients’ clinical characteristics and natural history were analyzed retrospectively.
Results
Of 1,139 included patients, 683 patients presented with proctitis or left-sided colitis at diagnosis and 38.5% of them (263/683) developed proximal disease extension. Fifty-eight percent of patients experienced relapse, chronic continuous and intermittent active course. Five patients (0.4%) developed colorectal tumors/dysplasia. The overall surgery rate was 8.6%, and the rates were 14.2%, 7.8%, and 8.0% in the 3 cohorts, respectively (P= 0.059). Average time from diagnosis to surgery decreased from cohorts I to III (144 months vs. 36 months, P< 0.001), so did the use of glucocorticoids (58.2% vs. 43.5%, P< 0.001) and immunosuppressants (14.1% vs. 13.4%, P= 0.016), and days of hospitalization (13 days vs. 9 days, P< 0.001). Biologics were used more frequently during the first year (0.8%, 2.1%, and 13.7% for cohorts I to III, respectively; P< 0.001). The rate of mucosal healing increased over time.
Conclusions
In Chinese UC patients, one-third of patients experienced proximal disease extension. The rates of malignancy and mortality were low. More biologics were used, while use of immunosuppressants and glucocorticoids were reduced over time. Early biologics use seemed to promote mucosal healing, but the rate of colectomy has not dramatically decreased.

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IBD

Achieving high-quality magnetic resonance enterography is critical for assessing Crohn’s disease activity: Kyoung Doo Song; Intest Res 2024;22(2):117-118. Published online April 25, 2024; DOI: https://doi.org/10.5217/ir.2024.0043

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IBD

Efficacy and safety of mirikizumab as induction and maintenance therapy for Japanese patients with moderately to severely active ulcerative colitis: a subgroup analysis of the global phase 3 LUCENT-1 and LUCENT-2 studies: Taku Kobayashi, Katsuyoshi Matsuoka, Mamoru Watanabe, Tadakazu Hisamatsu, Fumihito Hirai, Joe Milata, Xingyuan Li, Nathan Morris, Vipin Arora, Tomoko Ishizuka, Koji Matsuo, Yoichi Satoi, Catherine Milch, Toshifumi Hibi; Intest Res 2024;22(2):172-185. Published online April 25, 2024; DOI: https://doi.org/10.5217/ir.2023.00043

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Mirikizumab is a p19-directed anti-interleukin-23 antibody with potential efficacy against ulcerative colitis (UC). We evaluated the efficacy and safety of mirikizumab in a Japanese subpopulation with moderately to severely active UC from the LUCENT-1 and LUCENT-2 studies.
Methods
LUCENT-1 and LUCENT-2 were phase 3, randomized, double-blind, placebo-controlled trials of mirikizumab therapy in adults with moderately to severely active UC. LUCENT-1 was a 12-week induction trial where patients were randomized 3:1 to receive intravenous mirikizumab 300 mg or placebo every 4 weeks (Q4W). Patients achieving a clinical response with mirikizumab following the induction study were re-randomized 2:1 to double-blind treatment with either mirikizumab 200 mg or placebo subcutaneously Q4W during the 40-week maintenance study. The primary outcomes were clinical remission at week 12 of LUCENT-1 and week 40 of LUCENT-2.
Results
A total of 137 patients enrolled in Japan were randomized to mirikizumab (n = 102) or placebo (n = 35). Compared with placebo, patients who received mirikizumab showed numerically higher clinical remission at week 12 of induction (32.4% [n = 33] vs. 2.9% [n = 1]) and at week 40 of maintenance (48.9% [n = 23] vs. 28.0% [n = 7]). A greater number of patients achieved key secondary endpoints in the mirikizumab group compared with placebo. The frequency of treatment-emergent adverse events was similar across mirikizumab and placebo groups. Efficacy and safety results observed in the Japanese subpopulation were generally consistent with those in the overall population.
Conclusions
Mirikizumab induction and maintenance treatments were effective in Japanese patients with moderately to severely active UC. No new safety concerns were identified.

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IBD

Live-attenuated vaccination in patients with inflammatory bowel disease while continuing or after elective switch to vedolizumab: Hisashi Shiga, Hiroshi Nagai, Yusuke Shimoyama, Takeo Naito, Rintaro Moroi, Yoichi Kakuta, Yoshitaka Kinouchi, Atsushi Masamune; Intest Res 2024;22(3):378-386. Published online March 26, 2024; DOI: https://doi.org/10.5217/ir.2023.00203

Abstract PDF PubReader ePub

Background/Aims
Vedolizumab (VDZ) is a gut-selective agent with a favorable safety profile. We aimed to assess the feasibility of elective switch from other advanced therapies to VDZ and subsequent live-attenuated vaccination while continuing VDZ in patients with inflammatory bowel diseases (IBD).
Methods
We measured antibody titers specific for measles, rubella, mumps, and varicella viruses in IBD patients under immunosuppressive therapy. Those with negative titers and without vaccination history were judged unimmunized. Patients were administered vaccines while continuing VDZ or switched to VDZ if receiving other advanced therapies and then administered vaccines. Co-primary outcomes were the rate of maintaining disease severity after vaccination and the rate without vaccine-induced infection.
Results
Among 107 unimmunized patients, 37 agreed to receive live-attenuated vaccines while continuing VDZ (17 patients) or after switching to VDZ (20 patients). In the 20 patients who electively switched to VDZ, disease severity was maintained except for 1 patient who developed intestinal infection. After 54 weeks, 18 patients (90%) continued to receive VDZ, excluding 2 patients who reverted to their originally administered biologics. In all 37 patients administered live-attenuated vaccines under VDZ treatment, disease severity was maintained after vaccination. Antibody titers became positive or equivocal in 34 patients (91.9%). There were no cases of vaccine-induced infection during a median observation period of 121 weeks.
Conclusions
While live-attenuated vaccines are contraindicated under immunosuppressive therapy, they may be safely administered while receiving VDZ immunotherapy. Switching from other advanced therapies to VDZ and subsequently receiving live-attenuated vaccines may be a safe alternative in unimmunized patients.

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Live Typhoid and Yellow Fever Vaccines Administered to a Patient With Ulcerative Colitis on Vedolizumab
Yash Hegde, Mary S. Hayney, Freddy Caldera
ACG Case Reports Journal.2024; 11(10): e01507. CrossRef

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IBD

Effects of COVID-19 vaccines on patient-reported outcomes in patients with inflammatory bowel disease: a multicenter survey study in Korea: Jung Hyun Ji, Seung Hwan Shin, Yong Eun Park, Jihye Park, Jae Jun Park, Jae Hee Cheon, Tae Il Kim, Sang-Bum Kang, Sang Hyoung Park, Soo Jung Park, IBD Research Group of the Korean Association for the Study of Intestinal Diseases (KASID); Intest Res 2024;22(3):336-350. Published online March 26, 2024; DOI: https://doi.org/10.5217/ir.2023.00077

Abstract PDF PubReader ePub: Background/Aims
The impact of vaccination on inflammatory bowel disease (IBD) patients is still unknown, and no studies have assessed the changes in patient-reported outcomes (PROs) after vaccination in patients with IBD. Therefore, in this study, we investigated the impact of vaccines on the PROs of patients with IBD.
Methods
We conducted a questionnaire survey of patients with IBD who visited outpatient clinics at 4 specialized IBD clinics of referral university hospitals from April 2022 to June 2022. A total of 309 IBD patients were included in the study. Patient information was collected from a questionnaire and their medical records, including laboratory findings, were reviewed retrospectively. Risk factors associated with an increase in PROs after COVID-19 vaccination were analyzed using logistic regression analyses. In addition, we assessed whether there were differences in variables by vaccine order using the linear mixed model.
Results
In multivariate analysis, young age ( < 40 years) and ulcerative colitis (UC) were found to be independent risk factors for aggravation of PROs in patients with IBD. In all patients, platelet count significantly increased with continued vaccination in multiple pairwise comparisons. In UC patients, PROs such as the short health scale, UC-abdominal signs and symptoms, and UC-bowel signs and symptoms were aggravated significantly with continued vaccination. There was no significant increase in the variables of patients with Crohn’s disease.
Conclusions
Therefore, there may be a need to counsel patients with IBD younger than 40 years of age, and patients with UC before they receive COVID-19 vaccinations.

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IBD

Ustekinumab for anti-tumor necrosis factor refractory pediatric ulcerative colitis: a promising approach towards endoscopic healing: Rahiya Rehman, Muhammad Safwan Riaz, Dyadin Esharif, Phinnara Has, Michael Herzlinger, Jason Shapiro, Shova Subedi; Intest Res 2024;22(3):351-356. Published online February 6, 2024; DOI: https://doi.org/10.5217/ir.2023.00091

Abstract PDF PubReader ePub

Background/Aims
To describe the role of ustekinumab in inducing remission and endoscopic healing in anti-tumor necrosis factor α nonresponsive pediatric ulcerative colitis patients at a tertiary care inflammatory bowel disease center.
Methods
A retrospective chart review was performed on patients with ulcerative colitis receiving ustekinumab. Primary outcome was steroidfree clinical remission at follow-up. Secondary outcomes were biochemical remission and endoscopic healing.
Results
Ten children were analyzed; 7 (70%) had ulcerative colitis, and 3 (30%) had inflammatory bowel disease unspecified with colitis. Median follow-up period was 56 weeks. Nine patients (90%) achieved steroid-free clinical remission and biochemical remission. Seven patients had follow-up colonoscopies, out of which 6 (86%) achieved endoscopic remission, while 1 (14%) underwent colectomy. Out of the 3 patients without a follow-up colonoscopy, fecal calprotectin levels downtrended to < 150 mg/kg in 2 patients and < 400 mg/kg in 1 patient from baseline level of > 2,000 mg/kg.
Conclusions
Ustekinumab appears efficacious in achieving not only clinical and biochemical remission but also has promising role in inducing endoscopic healing end point in patients who fail other biologics.

Citations

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Monoclonal antibodies against pediatric ulcerative colitis: a review of clinical progress
Debora Curci, Marianna Lucafò, Giuliana Decorti, Gabriele Stocco
Expert Opinion on Biological Therapy.2024; : 1. CrossRef

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IBD

Association between oral corticosteroid starting dose and the incidence of pneumonia in Japanese patients with ulcerative colitis: a nation-wide claims database study: Katsuyoshi Matsuoka, Tomoyuki Inoue, Hiroaki Tsuchiya, Katsumasa Nagano, Toshiyuki Iwahori; Intest Res 2024;22(3):319-335. Published online February 6, 2024; DOI: https://doi.org/10.5217/ir.2023.00071

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
A previous study demonstrated that half of patients started oral corticosteroids (OCS) for ulcerative colitis (UC) exacerbations at lower doses than recommended by Japanese treatment guidelines (initial OCS prednisolone equivalent dose, 30–40 mg). This may relate to physician’s concern about infection, especially pneumonia including Pneumocystis jirovecii pneumonia (PJP), from high OCS doses. We assessed whether pneumonia incidence is increased with guideline-recommended OCS initial doses.
Methods
This retrospective cohort study used the Japan Medical Data Center claims database (2012–2021). The whole cohort consisted of all UC patients who started OCS during the study period meeting the inclusion and exclusion criteria. The matched cohort was created by propensity score matching; the lower (initial OCS dose < 30 mg), guideline-recommended (30–40 mg), and higher groups ( > 40 mg) in a 2:2:1 ratio. Pneumonia incidence in the primary analysis was evaluated in the matched cohort. A Poisson regression model determined pneumonia-related risk factors in the whole cohort.
Results
After screening, 3,349 patients comprised the whole cohort; 1,775 patients comprised the matched cohort (lower dose, n = 710; guideline-recommended dose, n = 710; higher dose, n = 355). The incidence of any pneumonia was low; no differences were observed in incidence rates across these dose subgroups. In total, 3 PJP cases were found in the whole cohort, but not detected in the matched cohort. Several risk factors for any pneumonia were identified, including age, higher comorbidities index, treatment in large facility and hospitalization.
Conclusions
The incidence of pneumonia, including PJP, in UC patients was low across initial OCS dose treatment subgroups.

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IBD

A novel serum biomarker of endoscopic mucosal healing in inflammatory bowel disease: Hyoun Woo Kang; Intest Res 2024;22(1):3-4. Published online January 29, 2024; DOI: https://doi.org/10.5217/ir.2023.00198

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IBD

The impact of sleep quality on the prognosis of inflammatory bowel disease commonly overlooked by gastroenterologists: Ji Young Chang; Intest Res 2024;22(1):5-7. Published online January 29, 2024; DOI: https://doi.org/10.5217/ir.2023.00193

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Chronic Poor Sleep is Associated with Increased Disease Activity in Patients with Ulcerative Colitis: Prospective Observational Study in Japan
Hideaki Oyama, Rintaro Moroi, Atsushi Sakuma, Yusuke Shimoyama, Hiroshi Nagai, Takeo Naito, Hisashi Shiga, Yoichi Kakuta, Yoshitaka Kinouchi, Atsushi Masamune
Journal of Crohn's and Colitis.2024;[Epub] CrossRef

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1 Crossref

IBD

Which biomarkers best reflect the degree of inflammation in Crohn’s disease?: Jihye Park; Intest Res 2024;22(1):1-2. Published online January 29, 2024; DOI: https://doi.org/10.5217/ir.2023.00161

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IBD

Association of colonic metaplasia of goblet cells and endoscopic phenotypes of the J pouch in patients with ulcerative colitis: a retrospective pilot study: Shintaro Akiyama, Tsubasa Onoda, Shoko Moue, Noriaki Sakamoto, Taku Sakamoto, Hideo Suzuki, Tsuyoshi Enomoto, Daisuke Matsubara, Tatsuya Oda, Kiichiro Tsuchiya; Intest Res 2024;22(1):92-103. Published online January 29, 2024; DOI: https://doi.org/10.5217/ir.2023.00105

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Mucosal adaptation of the ileum toward colonic epithelium has been reported in pouchitis in ulcerative colitis (UC); however, the clinical characteristics, endoscopic findings, and outcomes in patients with pouchitis with ileal mucosal adaptation are poorly understood.
Methods
This was a single-center retrospective study comprising UC patients treated by proctocolectomy with ileal pouch-anal anastomosis who had undergone pouchoscopy at the University of Tsukuba Hospital between 2005 and 2022. Endoscopic phenotypes were evaluated according to the Chicago classification. High-iron diamine staining (HID) was performed to identify sulfomucin (colon-type mucin)-producing goblet cells (GCs) in pouch biopsies. We compared clinical data between patients with (high HID group) and without > 10% sulfomucin-producing GCs in at least one biopsy (low HID group).
Results
We reviewed 390 endoscopic examination reports from 50 patients. Focal inflammation was the most common phenotype (78%). Five patients (10%) required diverting ileostomy. Diffuse inflammation and fistula were significant risk factors for diverting ileostomy. The median proportion of sulfomucin-producing GCs on histological analysis of 82 pouch biopsies from 23 patients was 9.9% (range, 0%–93%). The duration of disease was significantly greater in the high HID group compared to the low HID group. The median percentage of sulfomucin-producing GCs was significantly higher in patients with diffuse inflammation or fistula compared to other endoscopic phenotypes (14% vs. 6.0%, P= 0.011).
Conclusions
Greater proportions of sulfomucin-producing GCs were observed in endoscopic phenotypes associated with poor outcomes in UC, indicating patients with pouchitis showing colonic metaplasia of GCs may benefit from early interventions.

Citations

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Endoscopic assessment of the J pouch in ulcerative colitis: A narrative review
Shintaro Akiyama, Edward L Barnes, Tsubasa Onoda, Naoki Ishikawa, Mamiko Shiroyama, Yuka Ito, David T Rubin, Kiichiro Tsuchiya
DEN Open.2025;[Epub] CrossRef
A Comparative Analysis of Clinical Symptoms and Modified Pouchitis Disease Activity Index Among Endoscopic Phenotypes of the J Pouch in Patients With Inflammatory Bowel Disease
Shintaro Akiyama, Nathaniel A Cohen, Jacob E Ollech, Cindy Traboulsi, Tina Rodriguez, Victoria Rai, Laura R Glick, Yangtian Yi, Joseph Runde, Russell D Cohen, Kinga B Skowron, Roger D Hurst, Konstantin Umanskiy, Benjamin D Shogan, Neil H Hyman, Michele A
Crohn's & Colitis 360.2024;[Epub] CrossRef

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IBD

Effectiveness of transabdominal ultrasonography in predicting clinical relapse of Crohn’s disease: Shinya Fukushima, Takehiko Katsurada, Mutsumi Nishida, Satomi Omotehara, Kensuke Sakurai, Kana Yamanashi, Reizo Onishi, Naoya Sakamoto; Intest Res 2024;22(1):82-91. Published online January 29, 2024; DOI: https://doi.org/10.5217/ir.2023.00093

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Transabdominal ultrasonography (US) helps evaluate Crohn’s disease (CD) activity. We investigated whether the US could predict subsequent adverse outcomes for patients with CD in clinical remission.
Methods
This single-center retrospective study included patients with CD in clinical remission who underwent US between April 2011 and April 2021, focusing on the predictability of subsequent adverse outcomes within 5 years. We used the US-CD, which was calculated using multiple US findings. Predictive variables were assessed using Cox proportional hazards regression analysis, and the predictive value was evaluated using receiver operating characteristic curves.
Results
Seventy-three patients were included. During a median follow-up of 1,441 days (range, 41–1,825 days), 16.4% (12/73) experienced clinical relapse, 9.6% (7/73) required endoscopic balloon dilation (EBD), 58.9% (43/73) required enhanced treatment, and 20.5% (15/73) underwent surgery. In the multivariate analysis, US-CD was significantly associated with clinical relapse (P= 0.038) and the need for enhanced treatment (P= 0.005). The area under the receiver operating characteristic curve for predicting clinical relapse and the need for EBD was 0.77 and 0.81, respectively, with US-CD (cutoff value = 11), and that for requiring enhanced treatment was 0.74 with US-CD (cutoff value = 6). Patients with US-CD ≥ 11 demonstrated a significantly higher occurrence of clinical relapse (P= 0.001) and EBD (P= 0.002) within 5 years. Patients with US-CD ≥ 6 experienced a significantly higher likelihood of requiring enhanced treatment (P< 0.001) within 5 years.
Conclusions
High US-CD is associated with subsequent adverse outcomes in patients with CD.

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IBD

Sarcopenia is common in ulcerative colitis and correlates with disease activity: Pardhu B Neelam, Rimesh Pal, Pankaj Gupta, Anupam K Singh, Jimil Shah, Harshal S Mandavdhare, Harjeet Singh, Aravind Sekar, Sanjay K Bhadada, Usha Dutta, Vishal Sharma; Intest Res 2024;22(2):162-171. Published online January 22, 2024; DOI: https://doi.org/10.5217/ir.2023.00090

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Association of sarcopenia with disease severity in ulcerative colitis (UC) is not clearly defined. We planned to estimate the prevalence of sarcopenia in patients with UC as per the revised definition and its relation with the disease severity.
Methods
A cross-sectional assessment of sarcopenia in patients with UC was performed. Disease activity was graded according to complete Mayo score. Hand grip strength was assessed with Jamar hand dynamometer, muscle mass using a dual energy X-ray absorptiometry scan, and physical performance with 4-m walk test. Sarcopenia was defined as a reduction of both muscle mass and strength. Severe sarcopenia was defined as reduced gait speed in presence of sarcopenia.
Results
Of 114 patients (62 males, mean age: 36.49±12.41 years), 32 (28%) were in remission, 46 (40.4%) had mild-moderate activity, and 36 (31.6%) had severe UC. Forty-three patients (37.7%) had probable sarcopenia, 25 (21.9%) had sarcopenia, and 14 (12.2%) had severe sarcopenia. Prevalence of sarcopenia was higher in active disease (2 in remission, 6 in active, and 17 in severe, P<0.001). Of 14 with severe sarcopenia, 13 had severe UC while 1 had moderate UC. On multivariate analysis, lower body mass index and higher Mayo score were associated with sarcopenia. Of 37 patients with acute severe colitis, 16 had sarcopenia. Requirement of second-line therapy was similar between patients with and without sarcopenia. On follow-up (median: 18 months), there was a non-significant higher rate of major adverse events in those with sarcopenia (47.4% vs. 33.8%, P=0.273).
Conclusions
Sarcopenia and severe sarcopenia in UC correlate with the disease activity.

Citations

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Sarcopenia and frailty in inflammatory bowel disease: Emerging concepts and evidence
Pardhu B Neelam, Alka Sharma, Vishal Sharma
JGH Open.2024;[Epub] CrossRef
Utility of SARC‐F for screening for sarcopenia in ulcerative colitis
Pardhu B. Neelam, Vishal Sharma
Nutrition in Clinical Practice.2024; 39(5): 1270. CrossRef
Response to “Utility of SARC‐F for screening for sarcopenia in ulcerative colitis”
Ilkay Ergenc, Chasan Ismail Basa, Alper Uzum, Sevval Sahin, Haluk Tarık Kani, Rahmi Aslan, Aslı Tufan, Özgür Kasımay, Özlen Atuğ, Yeşim Özen Alahdab
Nutrition in Clinical Practice.2024; 39(5): 1272. CrossRef

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IBD/ Infection

Durability and outcomes of fecal microbiota transplantation for recurrent Clostridioides difficile infection in patients with moderate to severe inflammatory bowel disease: Raseen Tariq, Edward V Loftus Jr, Darrell Pardi, Sahil Khanna; Intest Res 2024;22(2):208-212. Published online January 9, 2024; DOI: https://doi.org/10.5217/ir.2023.00100

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Perception of fecal microbiota transplantation in patients with ulcerative colitis in Korea: a KASID multicenter study
Jebyung Park, Sung Noh Hong, Hong Sub Lee, Jongbeom Shin, Eun Hye Oh, Kwangwoo Nam, Gyeol Seong, Hyun Gun Kim, Jin-Oh Kim, Seong Ran Jeon
The Korean Journal of Internal Medicine.2024; 39(5): 783. CrossRef

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IBD

Assessing quality of magnetic resonance enterography and its impact on disease assessment of ileal Crohn’s disease: Anuj Bohra, Declan J Connoley, Danny Con, Jonathan P Segal, Olga Niewiadomski, Abhinav Vasudevan, Daniel R Van Langenberg, Numan Kutaiba; Intest Res 2024;22(2):152-161. Published online January 5, 2024; DOI: https://doi.org/10.5217/ir.2023.00095

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Background/Aims
Assessment of quality of magnetic resonance enterography (MRE) in small bowel Crohn’s disease (CD) activity evaluation has received little attention. We assessed the impact of bowel distention and motion artifact on MRE activity indices in ileal CD.
Methods
A cohort of patients who underwent contemporaneous MRE and colonoscopy for ileal CD assessment between 2014 and 2021 at 2 centers were audited. An abdominal radiologist blinded to clinical data reviewed each MRE, graded bowel distention and motion artifact upon a pre-specified 3-point scale and calculated the original magnetic resonance index of activity (MaRIA) and simplified MaRIA (sMaRIA), London index and CD MRE index (CDMI). Ileal endoscopic activity was graded via the Simplified Endoscopy Score for CD (SES-CD). The performance of MRE indices in discriminating active disease (SES-CD ≥3) stratified by MRE quality was measured by receiver operator characteristic analyses.
Results
One hundred and thirty-seven patients had MRE and colonoscopy within a median of 16 days (range, 0–30 days) with 63 (46%) exhibiting active disease (SES-CD ≥3). Forty-four MREs (32%) were deemed low quality due to motion artifact and/or moderate to poor distention. Low-quality MREs demonstrated reduced discriminative performance between ileal SES-CD ≥3 and MRE indices (MaRIA 0.838 vs. 0.634, sMaRIA 0.834 vs. 0.527, CDMI 0.850 vs. 0.595, London 0.748 vs. 0.511, P<0.05 for all). Individually the presence of any motion artifact markedly impacted the discriminative performance (e.g., sMaRIA area under the curve 0.544 vs. 0.814, P<0.05).
Conclusions
Image quality parameters can significantly impact MRE disease activity interpretation. Quality metrics should be reported, enabling cautious interpretation in lower-quality studies.

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Magnetic resonance enterography in diagnosing and monitoring of adult-onset IgA vasculitis (Henoch-Schönlein purpura) with gastro-intestinal involvement: Report of two cases
Edoardo Conticini, Susanna Guerrini, Paolo Falsetti, Maria Antonietta Mazzei, Luca Cantarini, Bruno Frediani
The Egyptian Rheumatologist.2024; 46(2): 90. CrossRef
Advocating for Consensus: The Crucial Role of Standardised Magnetic Resonance Imaging Protocols and Image Quality Metrics in Assessment of Crohn’s Disease
Mustafa Mohamedrashed, Mayur Garg, Anuj Bohra
Journal of Crohn's and Colitis.2024; 18(9): 1524. CrossRef
Achieving high-quality magnetic resonance enterography is critical for assessing Crohn’s disease activity
Kyoung Doo Song
Intestinal Research.2024; 22(2): 117. CrossRef
Bowel preparation after mid-gut tubing enhanced the efficacy and compliance of magnetic resonance enterography in Crohn’s disease: a randomized controlled trial
Yun Wang, Min Dai, Minghui Zheng, Yan Jin, Quan Wen, Bota Cui, Zulun Zhang, Jianguo Zhu, Faming Zhang
Therapeutic Advances in Gastroenterology.2024;[Epub] CrossRef

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IBD

The practice of fecal microbiota transplantation in inflammatory bowel disease: Umang Arora, Saurabh Kedia, Vineet Ahuja; Intest Res 2024;22(1):44-64. Published online November 21, 2023; DOI: https://doi.org/10.5217/ir.2023.00085

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Current evidence posits a central role for gut microbiota and the metabolome in the pathogenesis and progression of inflammatory bowel disease (IBD). Fecal microbiota transplantation (FMT) has been established as a means to manipulate this microbiome safely and sustainably. Several aspects of the technical improvement including pretreatment with antibiotics, use of frozen stool samples as well as short donor-to-recipient time are proposed to improve its response rates. Its efficacy in ulcerative colitis has been proven in clinical trials while data is emerging for Crohn’s disease. This review describes briefly the biology behind FMT, the available evidence for its use in IBD, and the host, recipient and procedural factors which determine the clinical outcomes.

Citations

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Perception of fecal microbiota transplantation in patients with ulcerative colitis in Korea: a KASID multicenter study
Jebyung Park, Sung Noh Hong, Hong Sub Lee, Jongbeom Shin, Eun Hye Oh, Kwangwoo Nam, Gyeol Seong, Hyun Gun Kim, Jin-Oh Kim, Seong Ran Jeon
The Korean Journal of Internal Medicine.2024; 39(5): 783. CrossRef

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IBD

Combination of leucine-rich alpha-2 glycoprotein and fecal markers detect Crohn’s disease activity confirmed by balloon-assisted enteroscopy: Ami Kawamoto, Kento Takenaka, Shuji Hibiya, Yoshio Kitazume, Hiromichi Shimizu, Toshimitsu Fujii, Eiko Saito, Kazuo Ohtsuka, Ryuichi Okamoto; Intest Res 2024;22(1):65-74. Published online November 9, 2023; DOI: https://doi.org/10.5217/ir.2023.00092

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Background/Aims
Endoscopic activity confirmed by enteroscopy is associated with poor clinical outcome in Crohn’s disease (CD). We investigated which of the existing biomarkers best reflects endoscopic activity in CD patients including the small bowel, and whether their combined use can improve accuracy.
Methods
One hundred and four consecutive patients with ileal and ileocolonic type CD who underwent balloon-assisted enteroscopy (BAE) from October 2021 to August 2022 were enrolled, with clinical and laboratory data prospectively collected and analyzed.
Results
Hemoglobin, platelet count, C-reactive protein, leucine-rich alpha-2 glycoprotein (LRG), fecal calprotectin, and fecal hemoglobin all showed significant difference in those with ulcers found on BAE. LRG and fecal calprotectin showed the highest areas under the curve (0.841 and 0.853) for detecting ulcers. LRG showed a sensitivity of 78% and specificity of 80% at a cutoff value of 13 μg/mL, whereas fecal calprotectin showed a sensitivity of 91% and specificity of 67% at a cutoff value of 151 μg/g. Dual positivity for LRG and fecal calprotectin, as well as LRG and fecal hemoglobin, both predicted ulcers with an improved specificity of 92% and 100%. A positive LRG or fecal calprotectin/hemoglobin showed an improved sensitivity of 96% and 91%. Positivity for LRG and either of the fecal biomarkers was associated with increased risk of hospitalization, surgery, and relapse.
Conclusions
The biomarkers LRG, fecal calprotectin, and fecal hemoglobin can serve as noninvasive and accurate tools for assessing activity in CD patients confirmed by BAE, especially when used in combination.

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Which biomarkers best reflect the degree of inflammation in Crohn’s disease?
Jihye Park
Intestinal Research.2024; 22(1): 1. CrossRef

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IBD

Precision medicine in inflammatory bowel diseases: Ashwin N. Ananthakrishnan; Intest Res 2024;22(1):8-14. Published online November 9, 2023; DOI: https://doi.org/10.5217/ir.2023.00087

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Inflammatory bowel diseases comprising Crohn’s disease and ulcerative colitis have emerged as global diseases. Multiple distinct therapeutic mechanisms have allowed us to increase our rates of achieving remission and reducing permanent disease-related morbidity. However, there is limited data to inform relative positioning of different therapies. This review will summarize existing literature on use of clinical decision models to inform relative efficacy of one therapeutic mechanism compared to the other given individual patient characteristics. It will also demonstrate the value of serologic, transcriptomic (from biopsies), and microbiome-based biomarkers in identifying which therapy is most likely to work for a given patient. We will review the existing gaps in the literature in this field and suggest a path forward for future studies to better inform patient care, incorporating the principles of precision medicine in the management of inflammatory bowel disease.

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Editorial: Another brick in the CDST wall: Authors' reply
Kyuwon Kim, Byong Duk Ye
Alimentary Pharmacology & Therapeutics.2024; 60(1): 87. CrossRef
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Hiroki Kurumi, Yoshihiro Yokoyama, Takehiro Hirano, Kotaro Akita, Yuki Hayashi, Tomoe Kazama, Hajime Isomoto, Hiroshi Nakase
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Revolutionizing Gastrointestinal Disorder Management: Cutting-Edge Advances and Future Prospects
Chahat Suri, Babita Pande, Tarun Sahu, Lakkakula Suhasini Sahithi, Henu Kumar Verma
Journal of Clinical Medicine.2024; 13(13): 3977. CrossRef

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IBD

Gut microbiota in pathophysiology, diagnosis, and therapeutics of inflammatory bowel disease: Himani Pandey, Dheeraj Jain, Daryl W. T. Tang, Sunny H. Wong, Devi Lal; Intest Res 2024;22(1):15-43. Published online November 8, 2023; DOI: https://doi.org/10.5217/ir.2023.00080

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Inflammatory bowel disease (IBD) is a multifactorial disease, which is thought to be an interplay between genetic, environment, microbiota, and immune-mediated factors. Dysbiosis in the gut microbial composition, caused by antibiotics and diet, is closely related to the initiation and progression of IBD. Differences in gut microbiota composition between IBD patients and healthy individuals have been found, with reduced biodiversity of commensal microbes and colonization of opportunistic microbes in IBD patients. Gut microbiota can, therefore, potentially be used for diagnosing and prognosticating IBD, and predicting its treatment response. Currently, there are no curative therapies for IBD. Microbiota-based interventions, including probiotics, prebiotics, synbiotics, and fecal microbiota transplantation, have been recognized as promising therapeutic strategies. Clinical studies and studies done in animal models have provided sufficient evidence that microbiota-based interventions may improve inflammation, the remission rate, and microscopic aspects of IBD. Further studies are required to better understand the mechanisms of action of such interventions. This will help in enhancing their effectiveness and developing personalized therapies. The present review summarizes the relationship between gut microbiota and IBD immunopathogenesis. It also discusses the use of gut microbiota as a noninvasive biomarker and potential therapeutic option.

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Editorial: Environments-pathogens-the gut microbiota and host diseases
Jinbo Xiong, Zunji Shi
Frontiers in Microbiology.2024;[Epub] CrossRef
Endoplasmic reticulum stress: A possible connection between intestinal inflammation and neurodegenerative disorders
Giorgio Vivacqua, Romina Mancinelli, Stefano Leone, Rosa Vaccaro, Ludovica Garro, Simone Carotti, Ludovica Ceci, Paolo Onori, Luigi Pannarale, Antonio Franchitto, Eugenio Gaudio, Arianna Casini
Neurogastroenterology & Motility.2024;[Epub] CrossRef
Advances in Precision Medicine Approaches for Colorectal Cancer: From Molecular Profiling to Targeted Therapies
Neelakanta Sarvashiva Kiran, Chandrashekar Yashaswini, Rahul Maheshwari, Sankha Bhattacharya, Bhupendra G. Prajapati
ACS Pharmacology & Translational Science.2024; 7(4): 967. CrossRef
Healing from Within: How Gut Microbiota Predicts IBD Treatment Success—A Systematic Review
Luana Alexandrescu, Alina Doina Nicoara, Doina Ecaterina Tofolean, Alexandra Herlo, Andreea Nelson Twakor, Cristina Tocia, Anamaria Trandafir, Andrei Dumitru, Eugen Dumitru, Cristian Florentin Aftenie, Ionela Preotesoiu, Elena Dina, Ioan Tiberiu Tofolean
International Journal of Molecular Sciences.2024; 25(15): 8451. CrossRef
Effect of Mutant and Engineered High-Acetate-Producing Saccharomyces cerevisiae var. boulardii Strains in Dextran Sodium Sulphate-Induced Colitis
Sara Deleu, Inge Jacobs, Jorge F. Vazquez Castellanos, Sare Verstockt, Bruna Trindade de Carvalho, Ana Subotić, Bram Verstockt, Kaline Arnauts, Lowie Deprez, Eva Vissers, Matthias Lenfant, Greet Vandermeulen, Gert De Hertogh, Kristin Verbeke, Gianluca Mat
Nutrients.2024; 16(16): 2668. CrossRef
The emerging role of the gut microbiota and its application in inflammatory bowel disease
Xiu Wang, Jianhua Peng, Peipei Cai, Yuxuan Xia, Chengxue Yi, Anquan Shang, Francis Atim Akanyibah, Fei Mao
Biomedicine & Pharmacotherapy.2024; 179: 117302. CrossRef
Bifidogenic Effect of Human Milk Oligosaccharides on Pediatric IBD Fecal Microbiota
Nize Otaru, Danica Bajic, Pieter Van den Abbeele, Saskia Vande Velde, Stephanie Van Biervliet, Robert E. Steinert, Ateequr Rehman
Microorganisms.2024; 12(10): 1977. CrossRef

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IBD

Ischemia-modified albumin: a novel blood marker of endoscopic mucosal healing in inflammatory bowel disease: Seung Bum Lee, Hyun-Ki Kim, Sang Hyuk Park, Ji-Hun Lim, Sang Hyoung Park; Intest Res 2024;22(1):75-81. Published online November 1, 2023; DOI: https://doi.org/10.5217/ir.2023.00065

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Background/Aims
The achievement of endoscopic remission is an important therapeutic goal in the treatment of inflammatory bowel diseases (IBD). We aimed to evaluate the role of fecal calprotectin (FCP) and ischemia-modified albumin (IMA) as biomarkers for evaluating IBD disease activity.
Methods
A total of 48 patients with IBD (20 with ulcerative colitis and 28 with Crohn’s disease) were included in this study. FCP and serum C-reactive protein levels, erythrocyte sedimentation rate, and IMA were measured in patients with IBD and compared with endoscopic findings.
Results
Elevated FCP and serum IMA levels were significantly associated with endoscopic non-mucosal healing. The correlation between FCP and IMA was not significant. Analysis of the receiver operating characteristic curve showed that both FCP and IMA had diagnostic value in predicting non-mucosal healing. When the Ln(FCP)+IMA/10 value was calculated using both factors, the predictive value for non-mucosal healing increased; however, no significant difference was observed.
Conclusions
IMA could be a candidate serum biomarker for predicting endoscopic mucosal healing in IBD.

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A novel serum biomarker of endoscopic mucosal healing in inflammatory bowel disease
Hyoun Woo Kang
Intestinal Research.2024; 22(1): 3. CrossRef

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IBD

Insomnia is common in inflammatory bowel disease (IBD) and is associated with mental health conditions as well as IBD activity: Alex Barnes, Jane M Andrews, Sutapa Mukherjee, Robert V Bryant, Peter Bampton, Robert J. Fraser, Réme Mountifield; Intest Res 2024;22(1):104-114. Published online November 1, 2023; DOI: https://doi.org/10.5217/ir.2023.00028

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Background/Aims
Insomnia is common in people with chronic medical conditions, such as inflammatory bowel disease (IBD), and is readily treatable through cognitive behavioral therapy for insomnia. This study aimed to describe the associations with insomnia in people with IBD and its relationship to IBD-related disability.
Methods
An online questionnaire was administered through 3 tertiary IBD centers, social media, and Crohn’s Colitis Australia. The questionnaire included the Insomnia Severity Index (ISI), a validated assessment of insomnia. Measures of anxiety, depression, physical activity, and disability were also included. IBD activity was assessed using validated patient reported scores. A multivariate model was constructed for clinically significant insomnia and ISI scores. Subpopulations of Crohn’s disease and ulcerative colitis were considered.
Results
In a cohort of 670 respondents the median age was 41 years (range, 32–70 years), with the majority female (78.4%), the majority had Crohn’s disease (57.3%). Increasingly severe disability was associated with worse insomnia score. Clinically significant insomnia was associated with clinically active IBD, abdominal pain, anxiety, and depression, in a multivariate model. In an ulcerative colitis population, Simple Clinical Colitis Activity Index components of general well-being and urgency were associated with worse ISI score in a model including depression and anxiety. In those with Crohn’s disease, the multivariate model included Harvey Bradshaw Index score in addition to depression and anxiety.
Conclusions
Insomnia is common in people with IBD and is associated with increased disability. Abdominal pain and mental health conditions should prompt consideration for screening for insomnia and referral for cognitive behavioral therapy for insomnia.

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The impact of sleep quality on the prognosis of inflammatory bowel disease commonly overlooked by gastroenterologists
Ji Young Chang
Intestinal Research.2024; 22(1): 5. CrossRef
Sleep quality is associated with reduced quality of life in inflammatory bowel disease through its interaction with pain
Alex Barnes, Robert V Bryant, Sutapa Mukherjee, Paul Spizzo, Réme Mountifield
JGH Open.2024;[Epub] CrossRef
The IBD Clinic of Tomorrow: Holistic, Patient-Centric, and Value-based Care
Benjamin Click, Raymond K. Cross, Miguel Regueiro, Laurie Keefer
Clinical Gastroenterology and Hepatology.2024;[Epub] CrossRef
Chronic Poor Sleep is Associated with Increased Disease Activity in Patients with Ulcerative Colitis: Prospective Observational Study in Japan
Hideaki Oyama, Rintaro Moroi, Atsushi Sakuma, Yusuke Shimoyama, Hiroshi Nagai, Takeo Naito, Hisashi Shiga, Yoichi Kakuta, Yoshitaka Kinouchi, Atsushi Masamune
Journal of Crohn's and Colitis.2024;[Epub] CrossRef

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IBD

Regional variations in the prevalence of primary sclerosing cholangitis associated with inflammatory bowel disease: Kwang Woo Kim, Hyoun Woo Kang; Intest Res 2023;21(4):413-414. Published online October 26, 2023; DOI: https://doi.org/10.5217/ir.2023.00133

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Halitosis: an underestimated but important extraintestinal manifestation in inflammatory bowel disease
Xiao Xian Qian
Intestinal Research.2024; 22(3): 387. CrossRef

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IBD

Treatment of primary sclerosing cholangitis combined with inflammatory bowel disease: You Sun Kim, Edward H. Hurley, Yoojeong Park, Sungjin Ko; Intest Res 2023;21(4):420-432. Published online September 1, 2023; DOI: https://doi.org/10.5217/ir.2023.00039

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Primary sclerosing cholangitis (PSC) is a progressive cholestatic, inflammatory, and fibrotic disease that is strongly associated with inflammatory bowel disease (IBD). PSC-IBD represents a unique disease entity and patients with this disease have an increased risk of malignancy development, such as colorectal cancer and cholangiocarcinoma. The pathogenesis of PSC-IBD involves genetic and environmental factors such as gut dysbiosis and bile acids alteration. However, despite the advancement of disease characteristics, no effective medical therapy has proven to have a significant impact on the prognosis of PSC. The treatment options for patients with PSC-IBD do not differ from those for patients with PSC alone. Potential candidate drugs have been developed based on the pathogenesis of PSC-IBD, such as those that target modulation of bile acids, inflammation, fibrosis, and gut dysbiosis. In this review, we summarize the current medical treatments for PSC-IBD and the status of new emerging therapeutic agents.

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Novel preclinical developments of the primary sclerosing cholangitis treatment landscape
Aalam Sohal, Kris V. Kowdley
Expert Opinion on Investigational Drugs.2024; 33(4): 335. CrossRef
Gut Microbiota in Primary Sclerosing Cholangitis: From Prognostic Role to Therapeutic Implications
Valeria Maccauro, Francesca Fianchi, Antonio Gasbarrini, Francesca Romana Ponziani
Digestive Diseases.2024; 42(4): 369. CrossRef
Global research trends on the relationship between IBD and CRC: a bibliometric analysis from 2000 to 2023
Hao Zhang, Huiru Xin, Mengqi Zhao, Chenyang Bi, Yafei Xiao, Yifan Li, Changjiang Qin
Journal of Health, Population and Nutrition.2024;[Epub] CrossRef
Halitosis: an underestimated but important extraintestinal manifestation in inflammatory bowel disease
Xiao Xian Qian
Intestinal Research.2024; 22(3): 387. CrossRef
Hepatic Nuclear Receptors in Cholestasis-to-Cholangiocarcinoma Pathology
Inyoung Cheon, Minwook Kim, Kang Ho Kim, Sungjin Ko
The American Journal of Pathology.2024;[Epub] CrossRef

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IBD

Malnutrition and inflammation status in nonobese patients with inflammatory bowel disease are associated with nonalcoholic fatty liver disease: a retrospective study: Takahiro Nagata, Sadahiro Funakoshi, Daisuke Morihara, Satoshi Shakado, Keiji Yokoyama, Kazuhide Takata, Takashi Tanaka, Atsushi Fukunaga, Ryo Yamauchi, Hiromi Fukuda, Hiroki Matsuoka, So Imakiire, Hideto Sakisaka, Satoshi Matsuoka, Nobuaki Kuno, Koichi Abe, Hideki Ishibashi, Shinya Ashizuka, Fumihito Hirai; Intest Res 2023;21(4):471-480. Published online August 11, 2023; DOI: https://doi.org/10.5217/ir.2023.00035

Abstract PDF PubReader ePub: Background/Aims
The frequency and details of nonalcoholic fatty liver disease (NAFLD) complications in patients with inflammatory bowel disease (IBD) remain unclear. This study aimed to clarify characteristics of NAFLD in patients with IBD.
Methods
We retrospectively identified and enrolled patients with IBD diagnosed with or without NAFLD by undergoing abdominal computed tomography (CT) at our institution between 2005 and 2020. The primary endpoint was the complication rate of NAFLD in patients with IBD. Secondary endpoints were the clinical characteristics of nonobese patients with IBD and comorbid NAFLD and their association with nutritional and inflammatory parameters.
Results
Twenty-one (21.9%) of 96 eligible patients with IBD also had NAFLD. In nonobese patients (defined as patients with a body mass index <25 kg/m²), C-reactive protein (CRP; P<0.001) and alanine aminotransferase (P=0.018) levels were higher and the albumin level (P=0.005) and prognostic nutritional index (PNI; P=0.002) values were lower in patients with NAFLD than in those without NAFLD. The PNI value was positively correlated (P<0.001) and the CRP level was negatively correlated (P=0.001) with the hepatosplenic ratio. However, in the NAFLD combined group, PNI (P<0.05) and CRP values (P<0.001) were improved over time after CT imaging by continuing IBD treatment.
Conclusions
Worsening nutritional and inflammatory status in IBD patients is associated with complications of NAFLD. Diagnosis of NAFLD in IBD patients using CT imaging might be useful not only for early detection of NAFLD but also in assessing the need for therapeutic intervention for IBD.

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