Mucosal Healing in Crohn’s Disease and Ulcerative Colitis

G&H How has the definition of mucosal healing evolved? LP-B For many decades, mucosal healing equaled endoscopic healing. The main change is that, for several years […]

Overlap Between Irritable Bowel Syndrome and Inflammatory Bowel Disease

G&H What features do irritable bowel syndrome and inflammatory bowel disease have in common? AF It is important to note that bowel symptoms are not […]

Clinical Implications of the Recent Dose-Ranging Studies of Adalimumab

G&H How was adalimumab dosing determined for the treatment of Crohn’s disease and ulcerative colitis? BF Currently, standard induction dosing is 160 mg initially, followed […]

Gastro-Hep News

US Preventive Services Task Force Reaffirms Hepatitis B Virus Screening in Pregnant Women All pregnant women should still b8e screened for hepatitis B virus (HBV) infection […]

The Expanding Role of Anti–IL-12 and/or Anti–IL-23 Antibodies in the Treatment of Inflammatory Bowel Disease

Abstract: The interleukin (IL)-12/IL-23 pathway is one of many proposed mechanistic pathways of intestinal inflammation. Earlier studies introduced IL-12 as a major cytokine in the […]

Implementing Dietary Modifications and Assessing Nutritional Adequacy of Diets for Inflammatory Bowel Disease

Abstract: Guidelines for dietary recommendations and nutritional therapy for patients with inflammatory bowel disease (IBD) are lacking, and patients are moving toward popular defined diets […]

The Development of Patient-Reported Outcome Measures in Inflammatory Bowel Disease

G&H What patient-reported outcome measures have traditionally been used in inflammatory bowel disease? PH To some extent, every patient visit involves a physician asking the patient […]

Complications Related to J-Pouch Surgery

Abstract: Restorative proctocolectomy with ileal pouch–anal anastomosis is the gold-standard surgical procedure for familial adenomatous polyposis, refractory ulcerative colitis, and colitis–associated dysplasia requiring colectomy. Numerous […]

Use of Medical Cannabis in Patients With Inflammatory Bowel Disease

G&H What is the current legal status of cannabis? JK As of March 2018, 9 US states have legalized cannabis (also known as marijuana) for […]

The Use of Complementary and Alternative Medicine in Patients With Inflammatory Bowel Disease

Abstract: Complementary and alternative medicine (CAM) includes products or medical practices that encompass herbal and dietary supplements, probiotics, traditional Chinese medicines, and a variety of […]

A Noninvasive Method to Assess Mucosal Healing in Patients With Crohn’s Disease

Abstract: Ongoing inflammation in the gastrointestinal tract and loss of the mucosal barrier are key components of Crohn’s disease. Current treatment paradigms, including treat-to-target, are based […]

Risk Stratification for Prevention of Recurrence of Postoperative Crohn’s Disease

Abstract: Although there have been significant advances in medical therapies to treat Crohn’s disease, an estimated 50% of patients will require surgery within the first […]

Gastro-Hep News

US Food and Drug Administration Approves 8-Week Treatment for Pangenotypic Hepatitis C Virus Infection On August 3, 2017, the US Food and Drug Administration (FDA) approved […]

When Not to Pouch: Important Considerations for Patient Selection for Ileal Pouch–Anal Anastomosis

Abstract: Ileal pouch–anal anastomosis (IPAA) is the preferred surgical treatment for patients who undergo colectomy and wish to avoid a permanent ileostomy. The overall outcomes […]

Advances in the Diagnosis and Management of Colonic Dysplasia in Patients With Inflammatory Bowel Disease

Abstract: The prevalence of colorectal cancer (CRC) in inflammatory bowel disease (IBD) is estimated at 3.7%. Risk factors for CRC include more severe disease (as […]

Gastro-Hep News

Gastroenterology & Hepatology Volume 13, Issue 1, January 2017 Vonoprazan Vs Lansoprazole for the Treatment of Duodenal or Gastric Ulcers Vonoprazan, a potassium-competitive acid blocker used […]

Stem Cell Therapy for Perianal Fistulas in Crohn’s Disease

G&H How common are perianal fistulas in Crohn’s disease, and how effective is standard medical therapy? JP Perianal fistulas affect up to 40% of patients diagnosed […]

Predictors of Aggressive Inflammatory Bowel Disease

Abstract: Inflammatory bowel disease comprises a group of conditions characterized by idiopathic inflammation of the gastrointestinal tract. The natural course of disease can range from an indolent course with prolonged periods of remission to aggressive, incapacitating disease. Predicting which patients are more susceptible to developing severe disease is important, especially when choosing therapeutic agents and treatment strategies. This paper reviews current evidence on the main demographic, clinical, endoscopic, histologic, serologic, and genetic markers that predict aggressive inflammatory bowel disease. In ulcerative colitis, we considered disease to be aggressive when patients had a high relapse rate, need for admission and/or surgery, development of colon cancer, or extraintestinal manifestations. We defined aggressive Crohn’s disease as having a high relapse rate, development of penetrating disease, need for repeat surgery, or multiple admissions for flares. In Crohn’s disease, involvement of the upper gastrointestinal tract and ileum, penetrating disease, early age at diagnosis, smoking, extensive ulceration of the mucosa, high titers of serum antibodies, and mutations of the NOD2 gene are markers of aggressive disease. In ulcerative colitis, patients with more extensive involvement of the colon (pancolitis) have more symptomatology and are at higher risk for needing a colectomy and developing colon cancer. Also, plasmocytic infiltration of the colonic mucosa and crypt atrophy predict treatment failure. As with diagnosis, no single method can predict disease aggressiveness. Multiple serologic and genetic tests are being developed to refine the accuracy of prediction. Endoscopic findings can also predict the future course of disease. At present, clinical manifestations are the most useful way to make therapeutic decisions.

Targeting Mucosal Healing in Crohn’s Disease

Abstract: The goal of medical treatment for Crohn’s disease includes improving patients’ quality of life while reducing the need for hospitalization and surgery. The current medical armamentarium includes 5-aminosalicylates, corticosteroids, immunomodulators, and biologic agents. In the past, response to treatment was measured by clinical improvement in symptoms; however, with the advent of disease-modifying medications, mucosal healing has emerged as an increasingly important goal of therapy. Mucosal healing, or endoscopic remission, is associated with increased rates of clinical remission, fewer hospitalizations, and fewer abdominal surgeries. Both the immunomodulator and biologic classes of medications are effective at inducing mucosal healing. Despite several limitations, mucosal healing has become a desirable and valid measure of disease activity.

Searching for the Delta: 5-Aminosalicylic Acid Therapy for Crohn’s Disease

Abstract: Crohn’s disease (CD) is a chronic inflammatory condition that often requires lifelong medical therapy for the induction and maintenance of remission. Oral mesalamine (5-aminosalicylic acid [5-ASA]) therapy has several forms, which can be categorized into oral formulations and prodrugs. The ability to demonstrate the efficacy of 5-ASA is limited in most clinical trials by the nonspecific endpoints of the Crohn’s Disease Activity Index. Overall, clinical trials have not shown 5-ASA therapy to be superior to placebo for the induction of remission, with the exception of sulfasalazine in colonic CD. 5-ASA therapy has also not been shown to be superior to placebo for maintenance of medically induced remission; however, mesalamine may have a modest effect in surgically induced remission. Further research is needed regarding the optimal monitoring and therapy for patients with mild CD who often achieve remission with placebo in clinical trials.