Gastroenterology & Hepatology

May 2022 - Volume 18, Issue 5

Letter From the Editor: Treatment for Patients With Inflammatory Bowel Disease

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

There has been a significant expansion in the options for inflammatory bowel disease (IBD) treatment over the past decade. A number of articles in this month’s issue of Gastroenterology & Hepatology explore different treatment approaches for patients who have IBD. One of our review articles this month focuses on sphingosine-1 phosphate (S1P) receptor modulators. Dr Tenzin Choden, Dr Nathaniel Aviv Cohen, and Dr David T. Rubin discuss the mechanism of action of this novel class of IBD drugs as well as practical concerns and positioning. The authors also review phase 2 and 3 trial data on ozanimod and phase 2 trial data on etrasimod. Approximately 1 year ago, ozanimod became the first S1P receptor modulator to be approved by the US Food and Drug Administration for patients who have moderately to severely active ulcerative colitis. 

Another review article this month focuses on using a treat-to-target management approach for patients with Crohn’s disease. This treatment approach targets objective markers of inflammation instead of clinical symptoms alone. Dr Shawn Gurwara and Dr Jason K. Hou review the STARDUST trial, which was the first treat-to-target randomized trial of adult Crohn’s disease patients using endoscopy and biomarkers to adjust doses of ustekinumab. The authors examine the design and findings of the study as well as its limitations. They also discuss further questions involving this management approach for patients who have Crohn’s disease. 

Our Advances in IBD column reviews another treatment for Crohn’s disease, vedolizumab. Dr Stephen B. Hanauer provides an overview of the use of this drug in this setting, including how its mechanism of action compares with other lymphocyte trafficking agents, key study data, when clinical effects occur, long-term data, and therapeutic drug monitoring. 

Our third review article this month focuses on single-use duodenoscopes for endoscopic retrograde cholangiopancreatography. As Dr Timothy Lee, Ms Sarah Enslin, and Dr Vivek Kaul note, recent outbreaks of multidrug-resistant organism infections associated with duodenoscopes have resulted in heightened awareness and concern regarding high-level disinfection processes as well as duodenoscope design. The authors review 2 single-use, fully disposable duodenoscopes currently on the market, focusing on their performance, safety, efficacy, cost, and impact on the environment. The authors also discuss the advantages and disadvantages of single-use duodenoscopes as well as their limitations and future considerations.

Finally, our 2 other columns this month involve screening. Our Advances in Hepatology column highlights screening for hepatitis B virus (HBV) and tuberculosis (TB). Dr Amit Chitnis discusses the similarities between these diseases and the prevalence of coinfection in the United States. In addition, he examines other important issues such as the current screening guidelines for HBV and whether screening for HBV in patients with TB or vice versa might be cost-effective. Our Advances in GERD column focuses on the detection of esophageal precancerous disease using novel screening and DNA testing. Dr David M. Poppers discusses the low screening rates for esophageal cancer and the main risk factors for this highly morbid and fatal disease. He also relates his experience using the novel tools EsoCheck and EsoGuard, 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