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Pediatric inflammatory bowel disease (PIBD) is rising rapidly in many industrialized and affluent areas in the Asia‐Pacific region. Current available guidelines, mainly from Europe and North America, may not be completely applicable to clinicians caring for children with PIBD in this region due to differences in disease characteristics and regional resources constraints. This position paper is an initiative from the Asian Pan‐Pacific Society for Pediatric Gastroenterology, Hepatology and Nutrition (APPSPGHAN) with the aim of providing an up‐to‐date, evidence‐based approach to PIBD in the Asia‐Pacific region, taking into consideration the unique disease characteristics and financial resources available in this region. A group of pediatric gastroenterologists with special interest in PIBD performed an extensive literature search covering epidemiology, disease characteristics and natural history, management, and monitoring. Gastrointestinal infections, including tuberculosis, need to be excluded before diagnosing IBD. In some populations in Asia, the Nudix Hydrolase 15 (NUD15) gene is a better predictor of leukopenia induced by azathioprine than thiopurine‐S‐methyltransferase (TPMT). The main considerations in the use of biologics in the Asia‐Pacific region are high cost, ease of access, and potential infectious risk, especially tuberculosis. This position paper provides a useful guide to clinicians in the medical management of children with PIBD in the Asia‐Pacific region. [ABSTRACT FROM AUTHOR]

Disease phenotype of pediatric inflammatory bowel disease (PIBD) in children from the Asia‐Pacific region differs from that of children from the West. Many parts of Asia are endemic for tuberculosis, making diagnosis and management of pediatric Crohn's disease a challenge. Current available guidelines, mainly from Europe and North America, may not be completely applicable to clinicians caring for children with PIBD in Asia due to differences in disease characteristics and regional resource constraints. This position paper is an initiative from the Asian Pan‐Pacific Society for Pediatric Gastroenterology, Hepatology and Nutrition (APPSPGHAN) that aims to provide an up‐to‐date, evidence‐based approach to PIBD in the Asia‐Pacific region. A group of pediatric gastroenterologists with a special interest in PIBD performed an extensive literature search covering epidemiology, disease characteristics and natural history, management, and monitoring. Attention was paid to publications from the region with special consideration to a resource‐limited setting. This current position paper deals with surgical management, disease monitoring, immunization, bone health, and nutritional issues of PIBD in Asia. A special section on differentiating pediatric Crohn's disease from tuberculosis in children is included. This position paper provides a useful guide to clinicians in the surgical management, disease monitoring, and various health issues in children with IBD in Asia‐Pacific region. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Since the etiology and the pathogenesis of inflammatory bowel disease (IBD) are still not well known, research on IBD often focuses on these topics. Investigative science papers about IBD in Chinese medical journals from 1989 to 2003 were viewed to understand the progress of basic IBD research in China. MATERIALS AND METHODS: The basic science investigative papers about IBD from 1989 to 2003 in Chinese periodicals (VIP and CMCC) were reviewed and analyzed; the key words used were as follows: inflammatory bowel disease, ulcerative colitis, Crohn's disease, basic science investigation, and literature review. RESULTS: There were 3454 articles about IBD published in Chinese medical journals from 1989 to 2003, and during these 15 years, 508 papers focused on basic scientific investigations. There were 463 papers investigating the pathogenesis of IBD, 287 papers on immunological mechanisms, and 176 papers about other mechanisms. There were 142 papers investigating the mechanisms of Chinese traditional medicine on IBD from 1989 to 2003, which included 117 papers related to animal experiments and 25 papers related to clinical studies. CONCLUSIONS: There have been relatively few investigative scientific papers on IBD published in Chinese medical journals. However, the study of IBD has been emphasized in China. Research on the immunological mechanisms of IBD has been predominant. Furthermore, a large number of the research papers were about the mechanisms and effects of Chinese traditional medicine on IBD. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to gain consensus among young people with a stoma due to inflammatory bowel disease (IBD) on the priorities for the content of an intervention for the self‐management of stoma‐related distress. The current identification and management of distress in young people with a stoma is often suboptimal in clinical settings and there is a need for improved support resources. Methods: Two consensus group meetings were carried out via online video conferencing, using nominal group technique. Participants generated, rated on a Likert scale and discussed, topics for inclusion in a future self‐management intervention. Results: Nineteen young people, aged 19–33, with a stoma due to IBD took part in one of two group meetings. Participants were located across England, Scotland, and Northern Ireland. Twenty‐nine topics were generated by participants, seven of which reached consensus of ≥80%, that is, a mean of ≥5.6 on a 7‐point Likert scale. These were: receiving advice from young people with lived experience of stoma surgery; advice on/addressing concerns about romantic relationships, sex and intimacy; information about fertility and pregnancy related to stoma surgery; stoma 'hacks', for example, useful everyday tips regarding clothing, making bag changes easier and so forth; reflecting on and recognising own emotional response to surgery; tips on managing the stoma during the night; and processing trauma related to the illness and surgery journey. Conclusions: Findings extend previous research on young people's experiences of stoma surgery, by generating consensus on young people's priorities for managing distress related to surgery and living with a stoma. These priorities include topics not previously reported in the literature, including the need for information about fertility and pregnancy. Findings will inform the development of a self‐management resource for young people with an IBD stoma and have relevance for the clinical management of stoma‐related distress in this population. Patient or Public Contribution: Three patient contributors are co‐authors on this paper, having contributed to the study design, interpretation of results and writing of the manuscript. The study's Patient and Public Involvement and Engagement advisory group also had an integral role in the study. They met with the research team for four 2‐h virtual meetings, giving input on the aims and purpose of the study, recruitment methods, and interpretation of findings. The group also advised on the age range for participants. The views of young people with a stoma are the central component of the study reported in this paper, which aims to gain consensus among young people with an IBD stoma on their priorities for the content of a resource to self‐manage distress related to stoma surgery. [ABSTRACT FROM AUTHOR]

Background: For adults with inflammatory bowel disease (IBD), they experience many challenges in dietary decision‐making. Thus, this study examined the perspective and experiences of adults with IBD in dietary decision‐making. Objective: This study aimed to explore the perception and consideration of people with IBD in their daily dietary decisions through monitoring, interpretation and action during the decision‐making process. Design: A qualitative study of individuals affected by IBD was conducted through semistructured interviews. Results: Twenty patients were recruited from four tertiary hospitals in Nanjing, China, and each participant completed a semistructured interview. The majority of participants reported on the process and experience of dietary decision‐making. Key themes were categorised into three stages: (1) assessing needs, preferences and food cues (monitor); (2) moving from experience to expertise (interpret) and (3) balancing expectations amidst limitations (act). The majority of participants reported that their decisions were shaped by assessing current disease status and food cues. Those interviewed with IBD were willing to make tradeoffs for bowel stability, but their decisions were also influenced by past dietary experiences and traditional Chinese beliefs. The lack of awareness of dietary guidelines was a significant barrier to healthy eating decisions. Positive or negative feelings accompanied dietary decisions. Conclusion: Although most people with IBD change their diet after diagnosis, the changes made are often inconsistent with existing dietary recommendations. Several factors can influence the dietary decision‐making process. This study will help assess the experiences of people with IBD in dietary decision‐making to encourage the formation of targeted dietary health and well‐being interventions. Knowledge of nutrition and diet should be provided in education and training programmes for IBD management. Patient or Public Contribution: The first three authors of this paper were the lead researchers in this study's design. These authors were mentored by patient researchers who also contributed to the manuscript, and the research process was co‐lead and directed by other patient participants and consultants. The results of this paper were directly obtained from patient participants. [ABSTRACT FROM AUTHOR]

In the past, hydrogen sulfide (H2S) was recognized as a toxic and dangerous gas; in recent years, with increased research, we have discovered that H2S can act as an endogenous regulatory transmitter. In mammals, H2S‐catalyzing enzymes, such as cystathionine‐β‐synthase, cystathionine‐γ‐lyase, and 3‐mercaptopyruvate sulfurtransferase, are differentially expressed in a variety of tissues and affect a variety of biological functions, such as transcriptional and posttranslational modification of genes, activation of signaling pathways in the cell, and metabolic processes in tissues, by producing H2S. Various preclinical studies have shown that H2S affects physiological and pathological processes in the body. However, a detailed systematic summary of these roles in health and disease is lacking. Therefore, this review provides a thorough overview of the physiological roles of H2S in different systems and the diseases associated with disorders of H2S metabolism, such as ischemia–reperfusion injury, hypertension, neurodegenerative diseases, inflammatory bowel disease, and cancer. Meanwhile, this paper also introduces H2S donors and novel release modes, as well as the latest preclinical experimental results, aiming to provide researchers with new ideas to discover new diagnostic targets and therapeutic options. [ABSTRACT FROM AUTHOR]

It remains unclear how effective COVID‐19 vaccinations will be in patients with weakened immunity due to diseases, transplantation, and dialysis. We conducted a systematic review comparing the efficacy of COVID‐19 vaccination in patients with solid tumor, hematologic malignancy, autoimmune disease, inflammatory bowel disease, and patients who received transplantation or dialysis. A literature search was conducted twice using the Medline/PubMed database. As a result, 21 papers were included in the review, and seropositivity rate was summarized by specific type of disease, transplantation, and dialysis. When different papers studied the same type of patient group, a study with a higher number of participants was selected. Most of the solid tumor patients showed a seropositivity rate of more than 80% after the second inoculation, but a low seropositivity was found in certain tumors such as breast cancer. Research in patients with certain types of hematological malignancy and autoimmune diseases has also reported low seropositivity, and this may have been affected by the immunosuppressive treatment these patients receive. Research in patients receiving dialysis or transplantation has reported lower seropositivity rates than the general population, while all patients with inflammatory bowel disease have converted to be seropositive. Meta‐analysis validating these results will be needed, and studies will also be needed on methods to protect patients with reduced immunity from COVID‐19. [ABSTRACT FROM AUTHOR]

In our own study, hemolytic I E. coli i were isolated more frequently from patients with IBD, 7 of 15, compared with healthy controls, 1 of 9; this difference did, however, not reach statistical significance (p = 0.18), Paper V. The clonal nature of I E. coli i isolated from IBD patients contradicts the possible assumption that IBD through an impaired immune system allows an overgrowth of I E. coli i at random. This indicates that a patient with IBD with a concomitant I Salmonella i , I Campylobacter i or I C. difficile i infection probably has a higher risk of a positive stool sample simply because of more frequent submission of stool samples from IBD patients compared to patients with acute gastroenteritis alone [16]. Increased levels of antibodies towards I E. coli i antigens in IBD patients, Paper VII, supports a more direct interaction of I E. coli i with the immune system in IBD patients, even though IBD medications will also influence the serologic response, Paper VIII. Increased levels of antibodies towards I E. coli i antigens in IBD patients further support a more direct interaction of I E. coli i with the immune system in IBD patients, Paper VII, even though IBD medications will also influence the serologic response, Paper VIII. Recently, through metagenomics in a pediatric population comparing IBD patients with their healthy siblings, a strong correlation to IBD has been found with the abundance of bacterial virulence genes, enriched specifically in the UC microbiome with I E. coli i abundance, suggesting that I E. coli i is a central driver in UC pathogenesis [113]. [Extracted from the article]

Aim The aim of this study was to compare the methodological quality and input paper characteristics of systematic reviews and meta-analyses reported in the medical and surgical literature by performing a systematic 'overview of reviews'. Ulcerative colitis ( UC) and Crohn's disease ( CD) were used as the framework for this comparison as they are relatively common serious conditions, with both medical and surgical options for therapy. Method Medline, Embase, CINHAL and the Cochrane Database were searched to November 2013. Eligible papers were systematic reviews or meta-analyses that considered a question of therapy in CD or UC. Two independent reviewers selected the papers, extracted the data and scored their methodology using the AMSTAR scoring system. The papers were categorized into medical therapy (M), surgical therapy (S) or medical and surgical therapy ( MS) groups. Following retrieval of the sample of meta-evidence papers, the original input studies used in their creation were identified and a search of Medline, Embase, CINHAL and the Cochrane Database was performed. A team of researchers then examined the collection of papers for bibliographic and financial information. Results Five hundred papers were identified in the meta-evidence search, of which 118 were deemed eligible. There was a difference in the AMSTAR-rated average quality of the papers between the S and M group (S 7.36 vs M 8.75, P = 0.01). On average S papers were published in journals with a lower impact factor (S 3.26, M 5.04, MS 5.30, P < 0.001). S papers also showed more heterogeneity ( I2; S 37%, M 24%, MS 10%, P < 0.001). Some 25% of S meta-analyses used data-sets with significant heterogeneity ( I2 > 75%), compared with 8% of M meta-analyses and 3% of the MS meta-analyses. Some 5% of S papers were done on data sets that had I2 values > 90%. There was no difference in the average number of papers assessed in each group, the average number of patients per meta-paper, the average time covered by the reviews, the average number of papers considered within each meta-analysis, or the average number of patients considered within each meta-analysis. Considering the conclusions of each meta-analysis, S meta-evidence was 50% more likely than M meta-evidence to be unable to make recommendations for practice. A total of 1499 original input papers were identified, of which 283 were used in more than one review. Within the non-repeated papers ( n = 1023) the average impact factor within the S group was lower than that of the M and the MS groups (3.720 vs 11.230 vs 7.563, respectively; ANOVA P < 0.001). M papers had higher rates of pharmaceutical sponsorship than S papers (M 56% vs S 1%) and twice the level of government support (M 16% vs S 8%). Of note, 21% of M papers had corporate sponsorship but did not list any conflict of interest. Conclusion Compared with M meta-analyses, S meta-analyses in the UC and CD domain are more likely to be of poorer methodological quality, are of a greater degree of heterogeneity and less often offer a positive conclusion. The papers used to generate meta-evidence in M papers have a greater degree of corporate and government sponsorship, and are more likely to come from journals with higher impact factors. [ABSTRACT FROM AUTHOR]

Background: The mental health response to the coronavirus (COVID‐19) pandemic–related product shortages in those living with chronic gastrointestinal (GI) disorders has received little attention. We aimed to explore the association between the pandemic‐related product shortages and psychological distress in people with GI disorders. Methods: This online cross‐sectional survey was nested within an ongoing, international, prospective study of well‐being in people with GI disorders. The study was advertised in multiple countries in May‐September 2020 via patient organizations and social media. The primary outcome measure was distress, evaluated by the Depression Anxiety Stress Scale. We utilized linear regressions, adjusting for covariates and testing individual moderation effects. Key Results: Overall, 831 people completed the survey from 27 countries, of whom 82% were female (mean age = 49 years). The most common disorders included inflammatory bowel disease (n = 322), celiac disease (n = 273), and irritable bowel syndrome (n = 260). Significant problems accessing food were reported by 19.8%, non‐medical therapies by 16%, toilet paper by 10.8%, and essential medication by 8.9% of the sample (>5% pain medication). There was a positive association between toilet paper and pain medication shortages and distress, and a negative association between food shortages and distress. Significant moderation effects were identified for COVID‐19 prevalence and toilet paper and food shortages, and between COVID‐19 fear and pain medication shortages. Conclusions and Inferences: The study documented a significant relationship between product shortages and psychological distress, which were associated with COVID‐19 prevalence and fear. Strategies addressing COVID‐19 fear could potentially modify the relationship between shortages and distress. [ABSTRACT FROM AUTHOR]

Background: The high prevalence of chronic inflammatory diseases or autoimmune reactions is a major source of concern and affects the quality of life of patients. Chronic inflammatory or autoimmune diseases are associated with many diseases in humans, including asthma, rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease and cancer. Splenic tyrosine kinase (SYK) is a non–receptor tyrosine kinase that plays an important role in immune receptor signalling in immune and inflammatory responses. Methods: This is a review article in which we searched for keywords "splenic tyrosine kinase", "inflammation" and "autoimmune diseases" in published literature such as Pubmed and Web of Science to collect relevant information and then conducted a study focusing on the latest findings on the involvement of SYK in chronic inflammatory or autoimmune diseases. Results: This paper reviews the regulation of Fcγ, NF–κB, B cell and T cell–related signalling pathways by SYK, which contributes to disease progression in chronic inflammatory and autoimmune diseases such as airway fibrosis, inflammatory skin disease and inflammatory bowel disease. Conclusion: This paper shows that SYK plays an important role in chronic inflammatory and autoimmune diseases. syk targets hematological, autoimmune and other inflammatory diseases and therefore, inhibition of SYK expression or blocking its related pathways may provide new ideas for clinical prevention and treatment of inflammatory or autoimmune diseases. [ABSTRACT FROM AUTHOR]

Background: Inflammatory bowel diseases (IBDs) are chronic gastrointestinal diseases that negatively affect the enjoyment of food and engagement in social and cultural gatherings. Such experiences may promote psychosocial challenges, an aspect of IBD often overlooked and under‐supported in clinical settings and research. Objectives: This study explored the psychosocial experiences that young adults with IBD have with food via a qualitative patient‐led research process. Methods: Trained patient researchers conducted this study by engaging peers via semi‐structured interviews and focus groups in a three‐step co‐design process. Participants (n = 9) identified the research topic (SET), explored the topic and identified emerging themes (COLLECT), refined themes and made recommendations for healthcare system change (REFLECT). Results: Themes that emerged included: 'Experimenting with Food', 'Evolution Over Time', 'Diet Changes are Emotional' and 'Role of Stigma'. Participants identified the significance and frustrations of repeated testing and experimenting with food compatibility, and noted nuances in food relationships as they gain knowledge and experience over time. They emphasized the importance of maintaining a sense of hope throughout and wished to impart this to newly diagnosed patients. Conclusion: Participants experience numerous psychosocial challenges as they strive to manage their diet, noting gaps in support available from IBD practitioners. Participants made practical recommendations for healthcare system change to improve patient outcomes, highlighting the importance of sharing stories and collaboratively including patients in the development of new services and protocols. Authors recommend further research in this area to build a body of knowledge and support that helps IBD patients maintain hope while navigating challenges with food. Patient or Public Contribution: The first four authors on this paper were the lead researchers in this study's design and analysis and identify as patients; they conducted the research with this identity at the forefront following a peer‐to‐peer research model. These authors were mentored by patient researchers who also contributed to the manuscript, and the research process itself was co‐lead and directed by other patient participants and consultants. Results and recommendations coming from this paper came directly from patient participants. [ABSTRACT FROM AUTHOR]

One of the hottest topics in biomedical research is to decipher the functional implications of the Gasdermin (GSDM) protein family in human pathologies. These proteins are the key effectors of a lytic and pro‐inflammatory cell death type termed pyroptosis (also known as "Gasdermin‐mediated programmed cell death"). However, ever‐growing evidence showed that GSDMs can play multiple and complex roles in a context‐dependent manner. In this sense, Gasdermin‐B (GSDMB; the only GSDM gene absent in mice and rats) has been implicated in antibacterial defense, numerous inflammatory pathologies (e.g., asthma, ulcerative colitis), and cancer, but both cell death‐dependent and ‐independent functions have been reported in these diseases, fueling the debate on whether GSDMB has genuine pyroptotic capacity. Recently, a series of seminal papers cast light on the GSDMB multitasking capacity by showing that different GSDMB transcriptional isoforms have distinct biological activities. Nonetheless, there are still obscure areas to be clarified on the precise functional involvement of GSDMB translated variants in physiological and pathological conditions. In this viewpoint, we critically discuss the most recent and exciting data on this topic and propose a series of relevant challenges that need to be overcome before GSDMB‐driven biomedical applications (as a biomarker of disease risk/progression/outcome or as specific therapeutic target) become a reality in clinical settings. [ABSTRACT FROM AUTHOR]

Epidemiological data suggest that the prevalence of autoimmune diseases is increasing. Although evidence implies that people with chronic illnesses experience higher levels of burnout, there are few available insights for developing preventative interventions. This paper builds on the conservation of resources (COR) and the job demands–resources (JD‐R) framework to investigate the association between impaired health, burnout, and work engagement. In two studies, we research the role of health status as a resource, respectively, autoimmune illness symptom severity as a diminished resource, and investigate its variance explanation in burnout and work engagement above and beyond the effects of job demands and resources. Study 1 investigated the hypotheses among 87 employees with inflammatory bowel diseases. Controlling for job demands and resources, symptom severity was positively associated with (exhaustion) burnout and negatively associated with work engagement. In Study 2, we applied mixed model analyses using a sample of 129 employees with multiple sclerosis. We found significant associations of symptom severity on burnout and vigor work engagement above and beyond the effects of job demands and social support. Our studies provide important insights for employees with chronic illnesses and the organizations in which they work and give indications for theory development, future research, and the development of interventions. [ABSTRACT FROM AUTHOR]

Background: This study aims to review and summarize the current up to date literature that explore the current treatment approaches to immune mediated colitis and the role of surgical specialties in the landscape of management. Methods: A narrative review of papers was performed following a literature search through Medline, EMBASE and Cochrane Central databases pertaining to immune mediated colitis as an adverse event of cancer immunotherapy. Results: Current guidelines for the diagnosis and treatment of immune mediated colitis mirror the approach to the workup of inflammatory bowel disease and guided by treating oncology and gastroenterology specialties. Immune mediated colitis however relies on surgical specific skills as a consequence of obtaining a diagnosis as well as in the management of complications that may arise. Conclusion: Immune mediate colitis management has largely been under the purview of medical specialties. This review explores the current landscape of managing immune mediated colitis from a surgical perspective and highlights key areas in which surgeons can engage in the multidisciplinary care of this condition. To facilitate prompt diagnosis and management of immune‐mediated colitis, there is an increasing necessity for surgeons to become familiar with the latest multidisciplinary approaches and recommendations. [ABSTRACT FROM AUTHOR]

Aims and objectives. To review the literature on inflammatory bowel disease in older and younger people and to identify whether they included a nursing or psychosocial perspective, or were informed by theories of ageing. Background. Inflammatory bowel disease, manifested as Crohn's disease and ulcerative colitis, affects younger and older people and is associated with a range of psychosocial factors. Nurses have an important role to play in caring for people with inflammatory bowel disease. Methods. A systematic review of literature related to inflammatory bowel disease and older people was carried out using the MEDLINE, CINAHL EMBASE and Cochrane databases between 1990-2006. Conclusions. Generally speaking, the clinical features of inflammatory bowel disease are similar in younger and older people, as are indications for surgery, survival and the usual wide spectrum of severity of disease. Corticosteroid treatment carries additional risk for older people. The studies used both retrospective and prospective designs, with the former using patient records, and the latter using follow-up of patients with inflammatory bowel disease. Sample sizes were adequate for statistical analyses but there was no reference to reliability or validity of data collection methods. None of the studies considered psychosocial aspects, or the role of nurses in caring for people with inflammatory bowel disease. A specific gerontological perspective was lacking from the papers reviewed. While the clinical features of inflammatory bowel disease are similar in younger and older people, with the bimodal distribution of age of onset of inflammatory bowel disease, the possibility exists that quality of life and adjustment in older people depend on age of onset. This has not been investigated. Future lines of enquiry taking psychosocial aspects of inflammatory bowel disease into account in older people are explored. Relevance to clinical practice. Nurses play an increasingly important role in the assessment and management of inflammatory bowel disease patients. Little is known about factors which could predict poorer psychosocial health and the impact non-intestinal manifestations may have on this in older people with inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

Background: Despite increased awareness of diet and nutrition being integral to the management of patients with inflammatory bowel disease (IBD), there are gaps in the knowledge of IBD healthcare providers regarding nutrition. Furthermore, high quality evidence on nutritional assessment and dietary management of IBD is limited. A Delphi consensus from a panel of experts allows for best‐practice guidelines to be developed, especially where high quality evidence is limited. The aim was to develop guidelines for the nutritional assessment and dietary management of IBD using an eDelphi online consensus agreement platform. Methods: Seventeen research topics related to IBD and nutrition were systematically reviewed. Searches in Cochrane, Embase®, Medline® and Scopus® electronic databases were performed. GRADE was used to develop recommendations. Experts from the IBD community (healthcare professionals and patients with IBD) were invited to vote anonymously on the recommendations in a custom‐built online platform. Three rounds of voting were carried out with updated iterations of the recommendations and evaluative text based on feedback from the previous round. Results: From 23,824 non‐duplicated papers, 167 were critically appraised. Fifty‐five participants completed three rounds of voting and 14 GRADE statements and 42 practice statements achieved 80% consensus. Comprehensive guidance related to nutrition assessment, nutrition screening and dietary management is provided. Conclusions: Guidelines on the nutritional assessment and dietary management of IBD have been developed using evidence‐based consensus to improve equality of care. The statements and practice statements developed demonstrate the level of agreement and the quality and strength of the guidelines. Key points: Comprehensive guidelines related to nutrition assessment, nutrition screening and dietary management of inflammatory bowel disease have been developed.Fourteen GRADE statements and 42 practice statements achieved 80% consensus agreementFifty‐five participants comprising experts from the inflammatory bowel disease (IBD) community (healthcare professionals and patients with IBD) took part in the online consensus voting [ABSTRACT FROM AUTHOR]

Genomics is playing an increasingly important role in gastrointestinal medicine, providing new insights into disease biology, improving diagnosis, personalizing treatments, and enhancing preventive strategies. This shift is evident in the publication of genomics-related papers in mainstream journals read by colorectal surgeons and gastroenterologists. There have also been tangible changes in service delivery, such as universal colorectal tumor testing for mismatch repair deficiency in the UK and the establishment of a network of multidisciplinary team genomics champions. The concept of "mainstreaming" genetic testing, where it is done by the clinical team caring for the patient, is gaining acceptance and speeding up the testing process. Targeted genetic testing is already being used in the management of inflammatory bowel disease and cancer treatment. For patients with Lynch syndrome, surveillance is now done through the national bowel cancer screening program in the UK. The papers in this issue of Colorectal Disease discuss the role of circulating tumor DNA as a predictor of outcome after rectal cancer surgery and the comparison of colorectal cancer in young and older patients. While there are still challenges, genomics will continue to revolutionize the diagnosis, treatment, and prevention of gastrointestinal diseases, leading to better patient outcomes and improved public health. [Extracted from the article]

Crohn's disease (CD) is a complex multisystemic inflammatory disorder and part of the inflammatory bowel diseases (IBDs). About 20% of the subjects affected by IBDs are paediatric patients and 21% of them present extraintestinal manifestations. Among the extraintestinal manifestations of CD, oral manifestations are rather frequent (20–50% of affected people) and can be difficult to identify, being frequently aspecific and not pathognomonic. Their early diagnosis by the dentist is extremely important, because extraintestinal manifestations can precede intestinal symptoms, in all patients but especially in children. The aim of this paper is to report the case of a CD adolescent patient that presented a gingival manifestation. [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Nguyen et al paper. To view this article, visit https://doi.org/10.1111/apt.17607 [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Nørgård et al paper. To view this article, visit https://doi.org/10.1111/apt.17520 [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Gold et al paper. To view this article, visit https://doi.org/10.1111/apt.17498 [ABSTRACT FROM AUTHOR]

The increasing prestige of the journal is reflected in the most recent increase in our impact factor (IF); during 2019, our 2-year IF increased from 7.357 to 7.731 ranking I AP&T i in 11th place among 84 journals in gastroenterology and hepatology. The 10 papers published during 2018 that were the most highly cited during 2019[[1]] included such diverse topics as the epidemiology of I Helicobacter pylori i infection, the intestinal mirobiome and dysbiosis, biologic agents for IBD and evolving treatments for chronic viral hepatitis. Increased risk of developing Crohn's disease or ulcerative colitis in 17 018 patients while under treatment with anti-TNF agents, particularly etanercept, for autoimmune diseases other than inflammatory bowel disease. [Extracted from the article]

Surgeons, who documented what they had seen and felt in the abdomen of the patient, made the earliest descriptions of Crohn's disease (CD). Dalziel wrote the first pathology description in 1913. Crohn and his coworkers reinvented what Dalziel had written about and called it by a different name, 'regional enteritis'. Later others elaborated on the histologic features, at first the lymphoid follicles, later the granulomas. Some thought the latter were comprised of lymphatic endothelial cells and that endothelial plugs obstructed the lymphatics. Tonelli and others recognized that lymphedema was important and caused by obstructions to lymphatic vasculature. Some lymphatics they described contained lymphocyte plugs and others granulomas. Immunohistochemistry (IHC) has now shown that endothelial cells are not the cause of lymphatic obstruction, but rather CD68‐positive macrophages, concluding that the 'lymphocyte thrombi' are passive, caught upstream of granuloma‐obstructed lymphatics. Numerous authors recognized that transmural edema was the most significant change in Crohn's disease and that this was later followed by fibrosis and contracture of the diseased segment. Key descriptive papers spoke of the segmental lymphedema. Most recently, attention has been given to attachments of the intralymphatic CD68+ granulomas to a focal point where endothelial damage occurred, damage suggesting infectious penetration of the mucosa, necrosis of lymphatic endothelium and then granulomatous response, both inside and outside the lymphatics, of submucosa, muscularis, and subserosa. D2‐40 IHC outlines the endothelium, and anti‐CD68 shows the granulomas. IHC adds a valuable perspective when reviewing CD resections. [ABSTRACT FROM AUTHOR]

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that may progress to colorectal cancer in severe cases. Carnitine palmitoyltransferase‐1A (CPT1A) has been reported to be upregulated in colorectal cancer. This paper aims to explore the role of CPT1A in UC and its pathogenesis. An in vivo mice model of UC was constructed by administrating 3% dextran sulfate sodium (DSS). The expression level of CPT1A was examined by quantitative real‐time polymerase chain reaction and Western blot. The intestinal damage, inflammatory response and oxidative stress were assessed by hematoxylin and eosin staining, colon length, and commercial kits. Thereafter, an in vitro cell model of UC was established by stimulating HT‐29 cells with 2% DSS. The peroxisome proliferator‐activated receptor α (PPARα) signaling agonist GW7647 was used for treatment. Cell viability and apoptosis was assayed by cell counting kit‐8 assay and terminal dUTP nick‐end labeling assay, respectively. The inflammatory cytokines and oxidative stress‐related factors was evaluated using corresponding commercial detection kits. In DSS‐induced mice model of UC, CPT1A expression was upregulated. Interference of CPT1A attenuated histological damage, the disease activity index and colon length in colitis. We also found downregulation of CPT1A inhibited inflammatory response and oxidative stress, and inhibited PPARα signaling pathway in UC mice. Additionally, in DSS‐induced HT‐29 cells, downregulation of CPT1A promoted cell viability, reduced cell apoptosis, inflammatory response, and oxidative stress, which was partly abolished by additional treatment with GW7647. In summary, downregulation of CPT1A exerts a protective effect in DSS‐induced UC partially through suppressing PPARα signaling, suggesting that CPT1A might be a potential target for the treatment of UC. [ABSTRACT FROM AUTHOR]

In Reply to (Meta-analysis on obesity and risk of inflammatory bowel disease: re-analysis is needed) The third issue raised refers to the association between BMI, as a continuous variable, and IBD in a dose-response analysis according to two mentioned studies.[[6], [8]] Indeed, we used the data of these studies in our meta-analysis. With regard to the dose-response analysis and continuous variable, we did not perform a linear dose-response analysis in our paper, instead, and respectfully, we conducted non-linear dose-response analyses. [Extracted from the article]

Low-dose methotrexate (LD-MTX) is presently the mainstay of treatment of rheumatoid arthritis (RA).[1], [2], [3], [4] It is one of the safest drugs to treat RA.[5] Therefore, it is called "The Anchor Drug" in RA[6] and recommended by the American College of Rheumatology and European League Against Rheumatism as its first-line treatment.[[7]] Over time, its efficacy in treating several additional systemic immunoinflammatory rheumatic diseases (SIRDs)[9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19] has broadened its use worldwide. In a paper on the long-term safety of LD-MTX in RA published in 2009, MTX HP was seen only in 0.43%.[28] The issue of MTX-related HP has been recently revisited.[[22]] In his 2018 review, Balk[23] quotes the figures of 1%-8% for MTX-related HP with 1 exceptionally high figure of 33%. Thus, it could be concluded that it is not the MTX but the disease RA itself that makes a patient more prone to developing ILD rather than the treatment with MTX. Infection rates in patients from five rheumatoid arthritis (RA) registries: contextualising an RA clinical trial programme. [Extracted from the article]

Aim: The medical management of inflammatory bowel disease (IBD) is rapidly progressing; however, many patients with the disease still require surgery. Often this is done as an emergency. Initiatives such as the National Emergency Laparotomy Audit have shown how evidence‐based emergency surgery improves outcomes for the patient. The aim of this scoping review is to describe the current evidence base on risk stratification in emergency abdominal surgery for IBD. Methods: A literature search, abstract and full paper screening resulted in 17 articles representing 63 472 patients from seven countries. Results: It is likely that age, the American Society of Anesthesiologists grade, comorbidity and organ dysfunction play a similar role in risk stratification in IBD patients as in other emergency abdominal surgery cohorts. However, the reporting of what is considered an IBD emergency is variable. Six studies include clear definitions of emergency in our study. The range of what is considered an emergency is within 12 h of admission to any time within an unplanned admission. Conclusion: To have data driven, evidence‐based emergency surgical practice in IBD we need consistency of reporting, including the definitions of emergency and urgency. Core descriptor sets in IBD would be valuable. [ABSTRACT FROM AUTHOR]

Aim: To estimate psychiatric comorbidity in childhood onset immune‐mediated inflammatory diseases (IMID). Methods: The PRISMA guidelines were followed, and the protocol was registered at Prospero (ID: CRD42021233890). Literature was searched in PubMed, PsycINFO and Embase. Original papers on prevalence rates of diagnosed psychiatric disorders and/or suicide in paediatric onset inflammatory bowel disease (pIBD), rheumatic diseases (RD) and autoimmune liver diseases were selected. Pooled prevalence rates of psychiatric disorders (grouped according to ICD‐10 criteria) within the various IMID were calculated using random‐effects meta‐analysis. Risk of bias was evaluated by the Newcastle‐Ottawa scale. Results: Twenty‐three studies were included; 13 describing psychiatric disorders in pIBD and 10 in RD. Anxiety and mood disorders were mostly investigated with pooled prevalence rates in pIBD of 6% (95% confidence interval (CI): 4%–9%) and 4% (95%CI: 2%–8%), respectively, in register‐based studies, and 33% (95%CI: 25%–41%) and 18% (95%CI: 12%–26%), respectively, in studies using psychiatric assessment. In RD, rates were 13% (95%CI: 12%–15%) for anxiety disorders and 20% (95%CI: 15%–26%) for mood disorders based on psychiatric assessment. Conclusion: Anxiety and depression are commonly reported in childhood onset IMID. Physicians should be attentive to mental health problems in these patients as they seem overlooked. [ABSTRACT FROM AUTHOR]

Background Fatigue is a common and leading concern for patients with inflammatory bowel disease ( IBD). It is managed inadequately in IBD, and there is little evidence to support interventions. Aim To examine patients' experience of and factors contributing to IBD-fatigue, and to appraise its management by patients and healthcare professionals. Methods Seven electronic databases were searched. Subject headings and free-text searching were used, with no time limit set. Reference lists of retrieved papers were searched manually. Results Twenty-eight papers were reviewed. Researchers used terms including 'fatigue', 'low energy', 'tiredness', 'decline in vitality and vigour' and 'reduced energy and vitality'. Different definitions were used to conceptualise fatigue. None of the reviewed studies asked patients to describe the experience of fatigue in their own words. Numerous physical, psychological and situational factors associated with fatigue were identified. Three small randomised control trials reported a favourable effect of infliximab and adalimumab on fatigue. One intervention study reported benefit from a stress management programme and one from solution-focused therapy. Conclusions Inconsistent use of terminology, lack of data from patients' perspective on inflammatory bowel disease-fatigue and lack of evidence to support its management contribute to fatigue being largely ignored or overlooked by healthcare professionals. Future research should explore the experience of IBD-fatigue from the individual patient perspective. Further studies are required to fully explore the factors associated with fatigue and to develop patient-centred interventions to reduce fatigue. [ABSTRACT FROM AUTHOR]

LINKED CONTENT This article is linked to Rønnow Sand et al papers. To view these articles, visit https://doi.org/10.1111/apt.17119 and https://doi.org/10.1111/apt.17234 [ABSTRACT FROM AUTHOR]

LINKED CONTENT This article is linked to Rønnow Sand et al papers. To view these articles, visit https://doi.org/10.1111/apt.17119 and https://doi.org/10.1111/apt.17249 [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Ricciuto et al paper. To view this article, visit https://doi.org/10.1111/apt.17936 [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Yiu et al papers. To view these articles, visit https://doi.org/10.1111/apt.18006 and https://doi.org/10.1111/apt.18136 [ABSTRACT FROM AUTHOR]

LINKED CONTENT This article is linked to Taxonera et al paper. To view this article, visit https://doi.org/10.1111/apt.15804 [ABSTRACT FROM AUTHOR]

Figures from the Editor's selected issue highlights will be displayed each month in the journal image carousel on the BJCP homepage http://bpspubs.onlinelibrary.wiley.com/hub/journal/10.1111/(ISSN)1365-2125/ We live in a most interesting time. Some of us will be at the forefront of patient care, either treating patients, providing drugs or perhaps directing laboratory development and implementation of new diagnostic tests. The next study, from Switzerland, models the pharmacokinetics and pharmacodynamics of Cenerimod in healthy subjects and patients with systemic lupus erythematosus (http://onlinelibrary.wiley.com/doi/10.1111/bcp.14182/full). [Extracted from the article]

LINKED CONTENT This article is linked to Taxonera et al paper. To view this article, visit https://doi.org/10.1111/apt.15804 [ABSTRACT FROM AUTHOR]

The reader of this commentary on Haley's paper by Stein will note that Stein refers to Haley as ‘the author of the critiqued paper’ or ‘ACP,’ rather than by name. This unusual style was occasioned by the Editor's decision that Stein should comment on the paper without any knowledge of its authorship, in order that the focus of Stein's comments be on the substance of that paper and that his comments not be influenced by who had written it. The admittedly somewhat awkward references to ‘ACP’ have been retained in Stein's comments in order to make that point clear-Ed. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD) is a heterogeneic disease with a variety of treatments targeting different mechanisms. A multistate, mechanistic, mathematical model of IBD was developed in part 1 of this two‐part article series. In this paper, application of the model to predict response of key clinical biomarkers following different treatment options for Crohn's disease was explored. Five therapies, representing four different mechanisms of action, were simulated in the model and longitudinal profiles of key clinical markers, C‐reactive protein and fecal calprotectin were compared with clinical observations. Model simulations provided an accurate match with both central tendency and variability observed in biomarker profiles. We also applied the model to predict biomarker and clinical response in an experimental, combination therapy of existing therapeutic options and provide possible mechanistic basis for the increased response. Overall, we present a validated, modular, mechanistic model construct, which can be applied to explore key biomarkers and clinical outcomes in IBD. [ABSTRACT FROM AUTHOR]

Hydroxycinnamic acids (HCAs) are a major class of phenolic acids with the characteristic phenylpropanoid C6‐C3 backbone. Its typically conjugated status with plant cell wall components and liberation by limited enzymes might be the reason for its neglect by researchers compared to flavonoid‐type polyphenols. The polyphenol–gut microbiota interactions and their impact on human health have captured the interest of researchers recently. In addition, there has been a significant progress over the past few years in understanding the gut microbiota‐modulating effect of HCA using animal model studies. This review discusses the metabolism of HCA in the digestive tract, HCA–gut microbiota interactions, and its link to colorectal cancer, inflammatory bowel diseases, mental‐cognitive impairments, nonalcoholic liver disease, and obesity. The effects of food matrix and processing technologies on HCA bioavailability and HCA–gut microbiota interactions, and HCA safety concerns are also featured in this review. This paper has provided an in‐depth insight on HCA–gut microbiota relationship and identified the current literature gaps for future research. [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Deputy et al papers. To view these articles, visit https://doi.org/10.1111/apt.16800 and https://doi.org/10.1111/apt.16841 [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Hadi et al papers. To view these articles, visit https://doi.org/10.1111/apt.16730. [ABSTRACT FROM AUTHOR]

LINKED CONTENT: This article is linked to Kumar et al papers. To view these articles, visit https://doi.org/10.1111/apt.16839 and https://doi.org/10.1111/apt.16878 [ABSTRACT FROM AUTHOR]

Dear Editors, We read with interest the paper by Estruch et al "Utility of the combined use of 3 serologic markers in the diagnosis and monitoring of chronic enteropathies in dogs,"1 the results section of the abstract of which would suggest that an assay based on combined measurements of OmpC (ACA), canine calprotectin (ACNA), and gliadin-derived peptide (AGA) is useful to differentiate chronic enteropathy/inflammatory bowel disease (CE/IBD) and non-IBD gastrointestinal disorders.1 However, in the materials and methods section, the differentiation of dogs with primary gastrointestinal disease from those with some forms of secondary gastrointestinal disease is described, not the differentiation of dogs with CE/IBD from those with non-IBD chronic gastrointestinal disease as stated in the abstract. While the work-up mentioned did include a minimum database and fecal examination for endoparasites, a standardized diagnostic work-up, including the outcome of broad-spectrum anthelminthic therapy or dietary trials, or tissue diagnosis, all essential for a diagnosis of IBD, are missing. [Extracted from the article]

Summary: Background: 5‐aminosalicylates (5‐ASA) are widely used in inflammatory bowel disease (IBD), but emerging evidence suggests that they may be safely withdrawn in significant subsets of patients. This is important to address: 5‐ASA therapy accounts for up to 25% of total healthcare costs in ulcerative colitis (UC), while almost a third of patients with Crohn's disease (CD) receive long‐term 5‐ASA despite no clear evidence of benefit. Further, rationalising medication burden may improve overall adherence and outcome. Aims: To summarise the rationale for 5‐ASA withdrawal, review the current evidence in both UC and CD and consider the data surrounding colorectal cancer (CRC) prevention, guiding an evidence‐based withdrawal strategy. Methods: PubMed was searched to identify relevant studies. Only papers published in English were reviewed, with priority given to randomised clinical trials and meta‐analyses. Results: For patients with UC, consideration of 5‐ASA withdrawal should be made on a case‐by‐case basis, but it appears safest for those in deep remission without any of the following risk factors: younger age (<40 years), remission for less than 2 years, a history of multiple flares, extensive disease. 5‐ASA withdrawal should also be considered in patients with UC escalated to biologic therapy who have achieved remission and in all patients with CD. Although 5‐ASA therapy may have chemopreventive benefits for CRC, the cost‐benefit ratio appears significant, and this indication is not justified by evidence in those who have achieved remission and are continuing therapy with other agents, or in those in sustained remission without a history of extensive disease. Conclusions: Although the majority of patients with IBD receive 5‐ASA during their disease course, safe withdrawal appears possible in many, with important implications for both health economics and patient experience. A number of unanswered questions, however, remain. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic, secondary to SARS‐CoV‐2, has resulted in high mortality and morbidity worldwide. As inflammatory bowel disease (IBD) is a chronic disease, and most patients are on long‐term immunosuppressive agents, there is understandable concern, particularly in terms of therapy. In view of this, experts in IBD across the Asia Pacific region were invited to put together recommendations based on their experience and the currently available data. In general, most IBD therapies (with a few exceptions) can be continued safely, and the general consensus is that maintaining disease control should remain the main principle of management. In addition, social distancing measures and the appropriate use of personal protective equipment should be strictly adhered to. During the current pandemic, face‐to‐face clinic follow ups and non‐urgent procedures should be kept to a minimum. This is a concerted effort by the members of the Asian Pacific Association of Gastroenterology Inflammatory Bowel Disease (IBD) Workgroup members to provide guidance on IBD management (all‐in‐one succinct review paper) during the difficult COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Summary: Background: There is an increasing body of evidence showing that earlier use of biologics improves clinical outcomes in Crohn's disease (CD). Aim: To perform a systematic review and meta‐analysis to assess the impact of early biologic use in the treatment of CD. Methods: PubMed and Embase databases were searched for English language papers and conference abstracts published through April 30, 2019. Studies were selected for inclusion if patients initiated biologics within 2 years of a CD diagnosis or if earlier biologics use (top‐down) was compared with a conventional step‐up strategy. Random‐effects meta‐analyses were conducted to compare clinical remission (CR), relapse and endoscopic healing rates between early biologic treatment (<2 years of disease duration or top‐down treatment strategy) and late/conventional treatment (biologic use after >2 years of disease duration or conventional step‐up treatment strategy). Results: A total of 3069 records were identified, of which 47 references met the selection criteria for systematic review. A total of 18 471 patients were studied, with a median follow‐up of 64 weeks (range 10‐416). Meta‐analysis found that early use of biologics was associated with higher rates of clinical remission (OR 2.10 [95% CI: 1.69‐2.60], n = 2763, P <.00001), lower relapse rates (OR 0.31 [95% CI: 0.14‐0.68], n = 596, P =.003) and higher mucosal healing rates (OR 2.37 [95% CI: 1.78‐3.16], n = 994, P <.00001) compared with late/conventional management. Conclusions: Early biologic treatment is associated with improved clinical outcomes in both adult and paediatric CD patients, not only in prospective clinical trials but also in real‐world settings. [ABSTRACT FROM AUTHOR]