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Microscopic colitis is a common inflammatory disease of the large intestine responsible for a chronic secretory diarrhea. Microscopic colitis is caused by an inappropriate immune response triggered by pharmacological and/or environmental factors. The diagnosis of microscopic colitis relies on histological assessment of colonic biopsy samples. Microscopic colitis is either categorized into collagenous or lymphocytic colitis. The mainstay of treatment relies on budesonide and withdrawal of deleterious drugs. The benefits of immunomodulators and biological agents in refractory microscopy colitis is currently emerging in patients with resistance or intolerance to budesonide. A better understanding of the immune response in disease pathogenesis may afford new therapeutic strategy in the upcoming years. [ABSTRACT FROM AUTHOR]

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Adverse event of inflammatory bowel disease (IBD) treatments should be kept low through good clinical practice, respect of contraindications and adequate follow-up. Aging and frailty are associated with higher risk of developing serious and/or opportunistic infections as well as neoplasia secondary to immunity impairment. A better knowledge of infectious and neoplastic risks and stratification of treatment choice taking into account individual frailty should be included in therapeutic algorithms. However, the ability of drugs to prevent IBD-associated complications remained unchallenged by age and frailty and support their use even in frailed patients with IBD. [ABSTRACT FROM AUTHOR]

Référence: Syversen SW, Jørgensen KK, Goll GL, et al. Effect of Therapeutic Drug Monitoring vs Standard Therapy During Infliximab Induction on Disease Remission in Patients With Chronic Immune-Mediated Inflammatory Diseases: A Randomized Clinical Trial. JAMA 2021 ; 325 (17) : 1744-54 [ABSTRACT FROM AUTHOR]

Summary: Background: Up to 25% of patients with ulcerative colitis (UC) will require hospitalization for severe flare. In patients hospitalised for severe flare, who previously experienced multiple drug failures, including steroids and anti‐TNF agents, new quick‐acting medical options are needed. Tofacitinib is effective in refractory UC and has a rapid onset of action. Aim: To evaluate effectiveness and safety of tofacitinib as rescue therapy in patients hospitalised for UC flare. Methods: We conducted an observational and multicentre study with both retrospective and prospective collections in 14 GETAID centres. The primary objective was to assess the survival without colectomy following tofacitinib initiation in patients hospitalised for a UC flare. We determined rates of clinical response, clinical remission, and steroid‐free clinical remission at week 6 and week 14 and safety. Results: Fifty‐five patients were included (49 with prior infliximab failure and 19 previously exposed to ciclosporin). With a median follow‐up of 6.5 months (interquartile range [IQR] [3‐12.3]), rate of colectomy‐free survival was estimated at 78.9% (95 CI [68.5‐90.9]) and 73.6% (95 CI [61.9‐87.3]) at 3 and 6 months, respectively. Rates of clinical response, clinical remission and steroid‐free clinical remission were 60%, 45.5% and 37.5% at week 6 and 41.8%, 34.5% and 32.7% at week 14. Regarding safety, no death was observed, three patients withdrew tofacitinib due to adverse events. Two herpes zoster infections occurred in patients aged over 60 years old. No venous thrombotic or major adverse cardiovascular events occurred. Conclusion: Tofacitinib appears as a promising option in patients hospitalised with a UC flare but needs further validation in controlled trials. [ABSTRACT FROM AUTHOR]

Background and Aim: Zenker's diverticulum (ZD) is the most common type of diverticulum in the esophagus. The endoscopic septotomy of the diverticular wall has become a widely accepted treatment modality, but the recurrence rate is unclear. Our aim was to assess short‐term and long‐term success rates after flexible endoscopic septotomy for the treatment of ZD. Methods: All consecutive patients treated at our department for a ZD between November 2014 and September 2018 were included. Endoscopic septotomy was conducted using a diverticuloscope or a distal attachment cap. Data were retrospectively analyzed from a prospectively collected database. We collected data concerning patients, endoscopic procedures, and short‐term clinical outcomes. All patients were reached by phone between October and December 2018 to assess long‐term results. Results: Seventy‐seven patients were referred to our department for a ZD. Sixty patients were treated using a diverticuloscope and 17 patients with a distal attachment cap. For all 77 patients, the myotomy was technically successful. Three patients treated with a diverticuloscope reported complications. Initial treatment success was 93%. After a mean (±SEM) follow up of 23 ± 2 months, 66% of patients had persistent clinical remission. The rate of long‐term treatment success was 72% in treatment‐naïve and 50% in previously treated patients (P = 0.13). Treatment success was 68% in patients treated with the diverticuloscope versus 60% in the group treated with a cap (P = 0.75). Conclusion: The flexible endoscopic septotomy for the treatment of ZD is a safe and effective treatment of ZD, with or without a diverticuloscope. [ABSTRACT FROM AUTHOR]