Gastroenterology & Hepatology

December 2023 - Volume 19, Issue 12

Letter From the Editor: Examining Janus Kinase Inhibitors for the Treatment of Inflammatory Bowel Disease

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

How different are drugs in the same class? A review article in this month’s issue of Gastroenterology & Hepatology explores this question in a comprehensive overview of the Janus kinase (JAK) inhibitor (or jakinib) class for the management of patients with inflammatory bowel disease (IBD). Dr Sailish Honap, Professor Silvio Danese, and Professor Laurent Peyrin-­Biroulet delve into the JAK signal transducer and activator of transcription, or JAK-STAT, activation pathway and the different types of JAKs, as well as the pharmacology of this class of drugs. The authors also summarize clinical trial and real-world data on the JAK inhibitors tofacitinib and upadacitinib (which are approved in the United States) as well as filgotinib (which is approved in the United Kingdom, Europe, and Japan) and examine how these agents compare in terms of key characteristics, efficacy, and safety. Other topics of discussion include the future of this class of drugs and important questions that still need to be answered. 

Also included in this month’s issue is a feature article on hepatic encephalopathy (HE). Dr Nancy S. Reau presents a patient case and examines why it is important to make an early and accurate diagnosis of this disease. She also reviews HE symptoms, progression, incidence, pathogenesis, scoring tools, and burden (including the impact of the disease on caregivers in addition to patients). Also examined are treatment strategies (including the 4-pronged management approach), key clinical trial data on the use of rifaximin for HE, and new coding for
this disease. 

The endoscopic management of Crohn’s disease strictures is highlighted in our Advances in IBD column. Dr Gursimran Singh Kochhar examines issues such as which imaging tools to use for the evaluation of these strictures and whether biologic agents and corticosteroid therapy should be stopped in patients prior to undergoing endotherapy for Crohn’s disease strictures. He also reviews different endoscopic approaches in this patient population, including endoscopic balloon dilation, electroincision, and stents. 

This month’s Advances in Hepatology column is authored by Dr Jennifer C. Price. Her discussion includes the importance of preventative hepatology, whether statins and nonselective beta blockers can reduce all-cause mortality in liver disease or prevent liver disease progression, the assessment of sarcopenia and frailty, as well as the prevention and reversal of these two conditions.

Our Advances in Endoscopy column features an interview with Dr Jonathan Cohen on how to support effective teaching in endoscopy. He discusses important issues such as macro trends and learning environment barriers in endoscopic training, the incorporation of simulators, the achievement of competence, challenges of competency-based evaluation, and how endoscopists can develop their teaching abilities. 

In our Case Study Series section this month, Dr Darren M. Brenner presents a patient with irritable bowel syndrome with constipation (IBS-C) who wants to achieve improvements in quality of life and both abdominal and bowel symptoms and is interested in newer treatments. He reviews the range of medical therapies currently available for IBS-C, including over-the-counter laxatives, and focuses on their differences in mechanism of action.

Finally, our quarterly content partnership with the Crohn’s & Colitis Foundation continues with a spotlight on the interactive GI Tract Guide, which can help facilitate discussions about anatomy and IBD with patients. Readers can scan the QR code on page 739 to access this helpful patient resource, which has IBD-specific facts about different organs in the digestive tract. 

As 2023 comes to a close, I hope that you enjoy all of these articles and find them interesting and useful in your clinical practice.


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

Millennium Medical Publishing, Inc