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Surgical treatment of inflammatory bowel disease:From the gastroenterologist’s stand-point

World Journal of Gastrointestinal Surgery 2024年第5期16卷 1235-1254页

作者： John K Triantafillidis inflammatory bowel disease unit “Metropolitan General”HospitalHolargos 15562AtticaGreece Hellenic Society of Gastrointestinal Oncology Haidari 12461AthensGreece

Treatment of ulcerative colitis(UC)and Crohn’s disease(CD)represents,in the majority of cases,a real challenge to the gastroenterologist’s abilities and skills as well as a clinical test concerning his/her levels of medical knowledge and experience.During the last two decades,our pharmaceutical arsenal was significantly strengthened,especially after the introduction of the so-called biological agents,drugs which to a large extent not only improved the results of conservative treatment but also changed the natural history of the disease.However,colectomy is still necessary for some patients with severe UC although smaller compared to the past,precisely because of the improvements achieved in the available conservative treatment.Nevertheless,surgeries to treat colon dysplasia and cancer are increasing to some extent.At the same time,satisfactory improvements in surgical techniques,the pre-and post-operative care of patients,as well as the selection of the appropriate time for performing the surgery have been noticed.Regarding patients with CD,the improvement of conservative treatment did not significantly change the need for surgical treatment since two-thirds of patients need to undergo surgery at some point in the course of their disease.On the other hand,the outcome of the operation has improved through good preoperative care as well as the wide application of more conservative surgical techniques aimed at keeping as much of the bowel in situ as possible.This article discusses the indications for surgical management of UC patients from the gastroenterologist’s point of view,the results of the emerging new techniques such as transanal surgery and robotics,as well as alternative operations to the classic ileo-anal-pouch anastomosis.The author also discusses the basic principles of surgical management of patients with CD based on the results of the relevant literature.The self-evident is emphasized,that is,to achieve an excellent therapeutic result in patients with severe inflammatory bowel disease in today’s era;t

关键词： inflammatory bowel disease Ulcerative colitis Crohn’s disease Surgery Treatment Ileo-anal-pouch anastomosis Indications Techniques

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Precision medicine in inflammatory bowel disease

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Precision Clinical Medicine 2024年第1期7卷 54-80页

作者： Zhen Zeng Mingshan Jiang Xi Li Jing Yuan Hu Zhang Department of Gastroenterology West China HospitalSichuan UniversityChengdu 610041China Centrefor inflammatory bowel disease West China HospitalSichuan UniversityChengdu 610041China Lab of inflammatory bowel disease Frontiers Science Center for Disease-Related Molecular NetworkWest China HospitalSichuan UniversityChengdu 610041China General Practice Ward/International Medical Center Ward General Practice Medical CenterWest China HospitalSichuan UniversityChengdu 610041China

inflammatory bowel disease(IBD)is an incurable disease characterized by remission-relapse cycles throughout its course.Both Crohn's disease(CD)and ulcerative colitis(UC),the two main forms of IBD,exhibit tendency to develop complications and substantial heterogeneity in terms of frequency and severity of relapse,thus posing great challenges to the clinical management for IBD.Current treatment strategies are effective in different ways in induction and maintenance therapies for IBD.Recent advances in studies of genetics,pharmacogenetics,proteomics and microbiome provide a strong driving force for identifying molecular markers of prognosis and treatment response,which should help clinicians manage IBD patients more effectively,and then,improve clinical outcomes and reduce treatment costs of patients.In this review,we summarize and discuss precision medicine in IBD,focusing on predictive markers of disease course and treatment response,and monitoring indices during therapeutic drug monitoring.

关键词： disease course inflammatory bowel disease precision treatment precision monitoring treatment response

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Combination treatment of inflammatory bowel disease:Present status and future perspectives

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World Journal of Gastroenterology 2024年第15期30卷 2068-2080页

作者： John K Triantafillidis Constantinos G Zografos Manousos M Konstadoulakis Apostolos E Papalois inflammatory bowel disease unit "Metropolitan General"HospitalHolargos 15562AtticaGreece Hellenic Society for Gastrointestinal Oncology 354 Iera OdosChaidari 12461AtticaGreece The 2^(nd)Department of Surgery University of AthensSchool of MedicineAretaieion HospitalAthens 11528Greece unit of Surgical Research and Training The 2^(nd)Department of SurgeryUniversity of AthensSchool of MedicineAretaieion HospitalAthens 11528Greece

The treatment of patients with inflammatory bowel disease(IBD),especially those with severe or refractory disease,represents an important challenge for the clinical gastroenterologist.It seems to be no exaggeration to say that in these patients,not only the scientific background of the gastroenterologist is tested,but also the abundance of“gifts”that he should possess(insight,intuition,determ-ination,ability to take initiative,etc.)for the successful outcome of the treatment.In daily clinical practice,depending on the severity of the attack,IBD is treated with one or a combination of two or more pharmaceutical agents.These combin-ations include not only the first-line drugs(e.g.,mesalazine,corticosteroids,antibiotics,etc)but also second-and third-line drugs(immunosuppressants and biologic agents).It is a fact that despite the significant therapeutic advances there is still a significant percentage of patients who do not satisfactorily respond to the treatment applied.Therefore,a part of these patients are going to surgery.In recent years,several small-size clinical studies,reviews,and case reports have been published combining not only biological agents with other drugs(e.g.,immunosuppressants or corticosteroids)but also the combination of two biologi-cal agents simultaneously,especially in severe cases.In our opinion,it is at least a strange(and largely unexplained)fact that we often use combinations of drugs in a given patient although studies comparing the simultaneous administration of two or more drugs with monotherapy are very few.As mentioned above,there is a timid tendency in the literature to combine two biological agents in severe cases unresponsive to the applied treatment or patients with severe extraintestinal manifestations.The appropriate dosage,the duration of the administration,the suitable timing for checking the clinical and laboratory outcome,as well as the treatment side-effects,should be the subject of intense clinical research shortly.In this editorial,we attempt to summarize the existing d

关键词： Biologics for immune-mediated conditions Dual-targeted treatment Combination treatment inflammatory bowel disease Crohn’s

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Are we ready to use new endoscopic scores for ulcerative colitis?

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World Journal of Gastroenterology 2024年第10期30卷 1466-1469页

作者： Rodrigo Quera Paulina Núñez F Universidad de los Andes Inflammatory Bowel Disease ProgramClinica Universidad de los AndesDigestive Disease CenterSantiago 7600976RMChile Digestive disease Center Inflammatory Bowel Disease ProgramClínica Universidad de los AndesSantiago 7620157Chile Department of Gastroenterology Universidad de Chile-Hospital San Juan de DiosSantiago 770123Chile

For ulcerative colitis(UC),the variability in inflammatory activity along the colon poses a challenge in management.The focus on achieving endoscopic healing in UC is evident,where the UC Endoscopic Index of Severity and Mayo Endoscopic Subscore are commonly used for evaluation.However,these indices primarily consider the most severely affected region.Liu et al recent study validates the Toronto inflammatory bowel disease Global Endoscopic Reporting(TIGER)score offering a comprehensive assessment of inflammatory activity across diverse segments of the colon and rectum and a reliable index correlating strongly with UC Endoscopic Index of Severity and moderately with Mayo Endoscopic Subscore(MES).Despite recommendation,certain aspects warrant further invest-igation.Fecal calprotectin,an intermediate target,correlates with TIGER and should be explored.Determining TIGER scores defining endoscopic remission and response,evaluating agreement with histological activity,and assessing inter-endoscopist agreement for TIGER require scrutiny.Exploring the correlation between TIGER and intestinal ultrasound,akin to MES,adds value.

关键词： Ulcerative colitis Sigmoidoscopy Colonoscopy Score index

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Inpatient management of iron deficiency anemia in pediatric patients with inflammatory bowel disease: A single center experience

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World Journal of Clinical Pediatrics 2024年第1期13卷 107-117页

作者： Krishanth Manokaran Jonathan Spaan Giulio Cataldo Christopher Lyons Paul D Mitchell Tatyana Sare LoriA Zimmerman Paul A Rufo Center for inflammatory bowel disease Boston Children's HospitalBostonMA 02115United States Institutional Centers for Clinical and Translational Research Boston Children's HospitalBostonMA 02115United States

BACKGROUND Screening for iron deficiency anemia(IDA)is important in managing pediatric patients with inflammatory bowel disease(IBD).Concerns related to adverse reactions may contribute to a reluctance to prescribe intravenous(IV)iron to treat IDA in this population.AIM To track the efficacy and safety of IV iron therapy in treating IDA in pediatric IBD patients admitted to our center.METHODS A longitudinal observational cohort study was performed on 236 consecutive pediatric patients admitted to our tertiary IBD care center between September 2017 and December 2019.92 patients met study criteria for IDA,of which 57 received IV iron,17 received oral iron,and 18 were discharged prior to receiving iron therapy.RESULTS Patients treated with IV iron during their hospitalization experienced a significant increase of 1.9(±0.2)g/dL in mean(±SE)hemoglobin(Hb)concentration by the first ambulatory follow-up,compared to patients who received oral iron 0.8(±0.3)g/dL or no iron 0.8(±0.3)g/dL(P=0.03).One out of 57(1.8%)patients that received IV iron therapy experienced an adverse reaction.CONCLUSION Our findings demonstrate that treatment with IV iron therapy is safe and efficacious in improving Hb and iron levels in pediatric patients with IDA and active IBD.

关键词： Iron deficiency anemia Pediatric inflammatory bowel disease Intravenous iron therapy inflammatory bowel disease

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Immunotherapy of gastric cancer:Present status and future perspectives

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World Journal of Gastroenterology 2024年第8期30卷 779-793页

作者： John K Triantafillidis Manousos M Konstadoulakis Apostolos E Papalois inflammatory bowel disease unit “Metropolitan General”HospitalHolargos 15562AtticaGreece.Hellenic Society for Gastrointestinal Oncology354 Iera OdosChaidari 12461AtticaGreece Second Department of Surgery University of Athens School of MedicineAretaieion HospitalAthens 11528AtticaGreece unit of Surgical Research and Training Second Department of SurgeryUniversity of AthensSchool of MedicineAretaieion HospitalAthens 11528AtticaGreece

In this editorial,we comment on the article entitled“Advances and key focus areas in gastric cancer immunotherapy:A comprehensive scientometric and clinical trial review(1999-2023),”which was published in the recent issue of the World Journal of Gastroenterology.We focused on the results of the authors’bibliometric analysis concerning gastric cancer immunotherapy,which they analyzed in depth by compiling the relevant publications of the last 20 years.Before that,we briefly describe the most recent data concerning the epidemiological parameters of gastric cancer(GC)in different countries,attempting to give an interpretation based on the etiological factors involved in the etiopathogenesis of the neoplasm.We then briefly discuss the conservative treatment(chemotherapy)of the various forms of this malignant neoplasm.We describe the treatment of resectable tumors,locally advanced neoplasms,and unresectable(advanced)cases.Special attention is given to modern therapeutic approaches with emphasis on immunotherapy,which seems to be the future of GC treatment,especially in combination with chemotherapy.There is also a thorough analysis of the results of the study under review in terms of the number of scientific publications,the countries in which the studies were conducted,the authors,and the scientific centers of origin,as well as the clinical studies in progress.Finally,an attempt is made to draw some conclusions and to point out possible future directions.

关键词： Gastric cancer Chemotherapy Immunotherapy Immune checkpoint inhibitors Bibliometrics Scientometrics

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Real-world efficacy and safety of tofacitinib treatment in Asian patients with ulcerative colitis

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World Journal of Gastroenterology 2024年第13期30卷 1871-1886页

作者： Kentaro Kojima Kenji Watanabe Mikio Kawai Soichi Yagi Koji Kaku Maiko Ikenouchi Toshiyuki Sato Koji Kamikozuru Yoko Yokoyama Tetsuya Takagawa Masahito Shimizu Shinichiro Shinzaki Department of Gastroenterology Hyogo Medical UniversityNishinomiya 663-8501Japan Department of Gastroenterology Gifu University Graduate School of MedicineGifu 501-1194Japan Department of Internal Medicine for inflammatory bowel disease The University of ToyamaToyama 930-0194Japan Center for Clinical Research and Education Hyogo Medical UniversityNishinomiya 663-8501Japan

BACKGROUND Real-world data on tofacitinib(TOF)covering a period of more than 1 year for a sufficient number of Asian patients with ulcerative colitis(UC)are scarce.AIM To investigate the long-term efficacy and safety of TOF treatment for UC,including clinical issues.METHODS We performed a retrospective single-center observational analysis of 111 UC patients administered TOF at Hyogo Medical University as a tertiary inflammatory bowel disease center.All consecutive UC patients who received TOF between May 2018 and February 2020 were enrolled.Patients were followed up until August 2020.The primary outcome was the clinical response rate at week 8.Secondary outcomes included clinical remission at week 8,cumulative persistence rate of TOF administration,colectomy-free survival,relapse after tapering of TOF and predictors of clinical response at week 8 and week 48.RESULTS The clinical response and remission rates were 66.3%and 50.5%at week 8,and 47.1%and 43.5%at week 48,respectively.The overall cumulative clinical remission rate was 61.7%at week 48 and history of anti-tumor necrosis factor-alpha(TNF-α)agents use had no influence(P=0.25).The cumulative TOF persistence rate at week 48 was significantly lower in patients without clinical remission than in those with remission at week 8(30.9%vs 88.1%;P<0.001).Baseline partial Mayo Score was significantly lower in responders vs non-responders at week 8(odds ratio:0.61,95%confidence interval:0.45-0.82,P=0.001).Relapse occurred in 45.7%of patients after TOF tapering,and 85.7%of patients responded within 4 wk after re-increase.All 6 patients with herpes zoster(HZ)developed the infection after achieving remission by TOF.CONCLUSION TOF was more effective in UC patients with mild activity at baseline and its efficacy was not affected by previous treatment with anti-TNF-αagents.Most relapsed patients responded again after re-increase of TOF and nearly half relapsed after tapering off TOF.Special attention is needed for tapering and HZ.

关键词： Ulcerative colitis Tofacitinib Janus kinase inhibitor Real-world Biologics

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Interventional inflammatory bowel disease:endoscopic therapy of complications of Crohn’s disease

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Gastroenterology Report 2022年第1期10卷 145-154页

作者： Bo Shen Center for inflammatory bowel disease Columbia University Irving Medical Center/New York-Presbyterian HospitalNew YorkNYUSA

Endoscopic therapy for inflammatory bowel diseases(IBD)or IBD surgery-associated complications or namely interventional IBD has become the main treatment modality for Crohn’s disease,bridging medical and surgical treatments.Currently,the main applications of interventional IBD are(i)strictures;(ii)fistulas and abscesses;(iii)bleeding lesions,bezoars,foreign bodies,and polyps;(iv)post-operative complications such as acute and chronic anastomotic leaks;and(v)colitis-associated neoplasia.The endoscopic treatment modalities include balloon dilation,stricturotomy,strictureplasty,fistulotomy,incision and drainage(of fistula and abscess),sinusotomy,septectomy,banding ligation,clipping,polypectomy,endoscopic mucosal resection,and endoscopic submucosal dissection.The field of interventional IBD is evolving with a better understanding of the underlying disease process,advances in endoscopic technology,and interest and proper training of next-generation IBD interventionalists.

关键词： Crohn’s disease complication balloon dilation endoscopy fistula fistulotomy sinusotomy stricture strictureplasty stricturotomy therapy

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Exit strategies in inflammatory bowel disease:Looking beyond antitumor necrosis factors

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World Journal of Clinical Cases 2023年第12期11卷 2657-2669页

作者： Federica Crispino Andrea Michielan Mauro Grova Chiara Tieppo Marta Mazza Teresa Marzia Rogger Franco Armelao Azienda Provinciale per i Servizi Sanitari Gastroenterology and Digestive Endoscopy UnitSanta Chiara HospitalTrento 38122Italy inflammatory bowel disease unit Department of MedicineAzienda Ospedaliera Ospedali RiunitiVilla Sofia-CervelloPalermo 90146Italy

The long-term management of patients with inflammatory bowel disease(IBD)is still a matter of debate,and no clear guidelines have been issued.In clinical practice,gastroenterologists often have to deal with patients in prolonged remission after immunomodulatory or immunosuppressive therapies.When planning an exit strategy for drug withdrawal,the risk of disease relapse must be balanced against the risk of drug-related adverse events and healthcare costs.Furthermore,there is still a dearth of data on the withdrawal of novel biologics,such as the anti-α4β7 integrin antibody(vedolizumab)and anti-IL12/23 antibody(ustekinumab),as well as the small molecule tofacitinib.Models for estimating the risk of disease relapse and the efficacy of retreatment should be evaluated according to the patient's age and IBD phenotype.These models should guide clinicians in programming a temporary drug withdrawal after discussing realistic outcomes with the patient.This would shift the paradigm from an exit strategy to a holiday strategy.

关键词： Exit strategy Biologic withdrawal Drug holiday Vedolizumab Ustekinumab Tofacitinib

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Pregnancy and medications for inflammatory bowel disease:An updated narrative review

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World Journal of Clinical Cases 2023年第8期11卷 1730-1740页

作者： Shintaro Akiyama Joshua M Steinberg Mariko Kobayashi Hideo Suzuki Kiichiro Tsuchiya Department of Gastroenterology Faculty of MedicineUniversity of TsukubaTsukuba 305-8575IbarakiJapan Department of inflammatory bowel disease Gastroenterology of the RockiesDenverCO 80027United States

inflammatory bowel disease(IBD)is often diagnosed during the peak reprodu-ctive years of young women.Women with active IBD around conception are at a significantly increased risk of disease relapse during pregnancy,which is associated with poor pregnancy and neonatal outcomes.Given these substantial risks,it is prudent that disease remission should ideally be achieved before conception.Unfortunately,some patients may experience a disease flare-up even if they are in a state of remission before pregnancy.Patients must continue their IBD medications to reduce the risk of disease flare and subsequent poor outcomes during the gestational and postpartum periods.When treating IBD flare-ups during pregnancy,the management is quite similar to the therapeutic approach for non-pregnant patients with IBD,including 5-aminosalicylate,steroids,calcineurin inhibitors(CNIs),and biologic therapies.While the data regarding the safety of CNIs in pregnant women with IBD is limited,the findings in our recent meta-analysis suggest that CNIs may be safer to use in those with IBD than in solid organ transplant recipients.There are several types of biologics and small-molecule therapies currently approved for IBD,and physicians should thoroughly understand their clinical benefits and safety profiles when utilizing these treatments in the context of pregnancy.This review highlights recent studies,including our systematic review and meta-analysis,and discusses the clinical advantages and safety considerations of biologics and small molecules for pregnant women with IBD.

关键词： inflammatory bowel disease Pregnancy Safety Biologics Small molecules

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