Letter From the Editor: Exploring Immune Checkpoint Inhibitor Colitis

Gary R. Lichtenstein, MD, AGAF, FACP, FACG

The use of immune checkpoint inhibitors has been increasing. Although these agents can be effective treatment options for a number of malignancies, including melanoma and renal cell carcinoma, gastrointestinal immune-related adverse events such as immune-mediated colitis are common. A review article in this month’s issue of Gastroenterology & Hepatology highlights the diagnosis and management of immune checkpoint inhibitor colitis. As Dr Jana G. Hashash, Dr Fadi F. Francis, and Dr Francis A. Farraye point out, even though most immune-mediated complications are mainly managed by oncologists, gastroenterologists also play a role in diagnosing, risk stratifying, and managing these complications. The authors provide a thorough overview of immune checkpoint inhibitor colitis, including its clinical presentation, diagnostic workup, treatment, prevention, and recurrence.

Our other review article this month focuses on the treatment of chronic hepatitis B virus infection, which remains a global health problem. Dr Eugenia Tsai starts by reviewing the phases and life cycle of hepatitis B virus infection. She then discusses current treatments, including preferred and nonpreferred nucleos(t)ide analogues, and reviews the advantages and limitations of the therapies. She also examines different therapeutic approaches currently in clinical development, including entry inhibitors, hepatitis B surface antigen release inhibitors, capsid assembly modulators, and covalently closed circular DNA inhibitors, and highlights recent data.

Our hepatology coverage continues with our Advances in Hepatology column, which centers on the gut microbiota and alcohol-associated liver disease. Dr Bernd Schnabl discusses recent discoveries linking the microbiome to alcohol-associated liver disease, whether probiotics and prebiotics can be used to help manage alcohol-associated liver disease, the use of fecal microbiota transplantation (FMT) and phage therapy, and the importance of precision medicine, among other issues.

FMT is also discussed in our Advances in IBD column, which highlights microbiologic approaches for the treatment of patients with inflammatory bowel disease. Dr Monika Fischer reviews the available research on FMT in inflammatory bowel disease, including a Cochrane review of the 4 randomized controlled trials of FMT in ulcerative colitis. She also discusses recent research on capsule formulations of FMT, live biotherapeutic products, and autologous fecal transplant, along with related issues.

Our Advances in Endoscopy column features an interview with Dr Joseph C. Anderson on the detection and resection of sessile serrated polyps. His discussion covers how these polyps differ from hyperplastic polyps, different detection and visualization methods that can be used, how to help ensure complete resection, and concerns about different snare techniques, among other issues. He also provides a number of useful accompanying endoscopic images.

Finally, achalasia is the focus of our Advances in GERD column. Dr Peter J. Kahrilas discusses the current definition of achalasia and how common this disorder is, the use of high-resolution manometry in its diagnosis, the importance of differentiating subtypes of the disorder, common treatment options, and the use of the functional luminal imaging probe, along with related issues.

May this issue provide you with helpful information that you can put to good use in your clinical practice.


Gary R. Lichtenstein, MD, AGAF, FACP, FACG

Millennium Medical Publishing, Inc