aDepartment of Pharmacology and Therapeutics, University of Porto; MedInUP, Centre for Drug Discovery and Innovative Medicines; Centro Hospitalar São João, Porto, Portugal bIBD Unit, DIMEC, University of Bologna, Bologna, Italy cDepartment of Gastroenterology and Hepatology, Chaim Sheba Medical Center, Tel Hashomer, Israel dGastrointestinal Unit ASST Fatebenefratelli Sacco—University of Milan—Milan, Italy eIBD Unit Complesso Integrato Columbus, Gastroenterological and Endocrino-Metabolical Sciences Department, Fondazione Policlinico Universitario Gemelli Universita’ Cattolica del Sacro Cuore, Rome, Italy fDepartment of Gastroenterology, IBD Unit, University Hospital Santiago De Compostela (CHUS), A Coruña, Spain gDepartment of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark hFirst Department of Medicine, Semmelweis University, Budapest, Hungary iIBD Unit, St Mark’s Hospital, Middlesex, UK jDepartment of Gastroenterology, University Hospital of Ghent, Ghent, Belgium kInstitute of Pathology, Medical University of Graz, Graz, Austria lDepartment of Gastroenterology, Pennine Acute Hospitals NHS Trust; Institute of Inflammation and Repair, University of Manchester, Manchester, UK mUnit of General Surgery, Second University of Naples, Napoli, Italy nMaria Skłodowska-Curie Memorial Cancer Centre and Institute of Oncology, Department of Oncological Gastroenterology Warsaw; Medical Centre for Postgraduate Education, Department of Gastroenterology, Hepatology and Clinical Oncology, Warsaw, Poland oDepartment of Medicine, University of Cambridge, Cambridge, UK pImperial College London; Chelsea and Westminster Hospital, London, UK qDepartment of Pathobiology /NC22, Lerner Research Institute; Department of Gastroenterology, Hepatology and Nutrition/A3, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

/pdf/third-european-evidence-based-consensus-on-diagnosis-and-2g4pj48jlg.pdf

Third European Evidence-based Consensus on Diagnosis and Management of Ulcerative Colitis. Part 1: Definitions, Diagnosis, Extra-intestinal Manifestations, Pregnancy, Cancer Surveillance, Surgery, and Ileo-anal Pouch Disorders.

ACG Clinical Guideline: Ulcerative Colitis in Adults

This article reviews the wide range of cancers associated with inflammatory bowel disease and the drugs used to manage them. Surveillance recommendations are presented.

https://www.nejm.org/doi/suppl/10.1056/NEJMra1403718/suppl_file/nejmra1403718_appendix.pdf

Cancers Complicating Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is a chronic disorder involving mainly the intestinal tract, but possibly other gastrointestinal and extraintestinal organs. Although etiology is still uncertain, recent knowledge in pathogenesis has accumulated, and novel diagnostic and therapeutic modalities have become available for clinical use. Therefore, the previous guidelines were urged to be updated. In 2016, the Japanese Society of Gastroenterology revised the previous versions of evidence-based clinical practice guidelines for ulcerative colitis (UC) and Crohn’s disease (CD) in Japanese. A total of 59 clinical questions for 9 categories (1. clinical features of IBD; 2. diagnosis; 3. general consideration in treatment; 4. therapeutic interventions for IBD; 5. treatment of UC; 6. treatment of CD; 7. extraintestinal complications; 8. cancer surveillance; 9. IBD in special situation) were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases. The guidelines were developed with the basic concept of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Recommendations were made using Delphi rounds. This English version was produced and edited based on the existing updated guidelines in Japanese.

/pdf/evidence-based-clinical-practice-guidelines-for-inflammatory-26ydqn7c5o.pdf

Evidence-based clinical practice guidelines for inflammatory bowel disease

AGA Clinical Practice Guidelines on the Management of Moderate to Severe Ulcerative Colitis.

Inflammation is an Independent Risk Factor for Colonic Neoplasia in Patients with Ulcerative Colitis: a Case–Control Study

Background: Positron emission tomography (PET) using 18-fluorodeoxyglucose (18-FDG) is a noninvasive, functional imaging modality most often used to assess cancer. The aim of this study was to perform PET/computed tomography (CT) on patients with quiescent ulcerative colitis (UC) to understand the limits of this technology for assessing inflammatory activity.



Methods: We identified patients diagnosed with UC in a strictly defined remission state. PET/CT was performed in standard fashion, using approximately 10 mCi of 18-FDG with a 60-minute uptake delay. Uptake in each of 4 colonic segments (recto-sigmoid [r-s], descending, transverse, and ascending), and distal small bowel were scored on a 3-point scale (0 = no uptake or uptake ≤liver; 1 = uptake somewhat >liver; 2 = uptake much greater than liver).



Results: Ten patients participated in this study, 6 male. Eight had pancolitis, 1 had extensive colitis, and 1 had procto-sigmoiditis, with a median disease duration was 32 years. A PET scan was performed mean 37 days after endoscopy. Six patients had no increased 18-FDG uptake, 3 had increased uptake in the r-s region, 1 patient with r-s uptake also had ascending colon uptake, and 1 had ileal uptake with no colonic signal.



Conclusions: In this study, PET demonstrated inflammatory activity in the colon despite negative endoscopic, histologic, and symptom assessment. This has important implications in the understanding of UC disease quiescence. Further exploration of this highly sensitive modality should be performed.



(Inflamm Bowel Dis 2008)

/pdf/positron-emission-tomography-pet-used-to-image-subclinical-1t8zv7or92.pdf

Positron emission tomography (PET) used to image subclinical inflammation associated with ulcerative colitis (UC) in remission.

Background A 75-year-old female presented with a 1 month history of nonbloody diarrhea, associated with abdominal cramping and urgency. Her medical history was notable for chronic myelomonocytic leukemia, diagnosed 6 years previously and managed expectantly by monitoring the patient's complete blood count. Over several months, the patient's symptoms progressed, which resulted in significant weight loss. The patient's course of disease was ultimately complicated by acute disseminated encephalomyelitis and death. Investigations Physical examination, laboratory investigations, stool studies, colonoscopy with biopsies, immunohistochemistry and pathologic review of biopsy specimens. Diagnosis Leukemic colitis Management Management of underlying leukemia with systemic hydroxyurea and topical colonic 5-aminosalicylic acid therapy.

Alana P. Bunnag

Papers

Inflammation is an Independent Risk Factor for Colonic Neoplasia in Patients with Ulcerative Colitis: a Case–Control Study

Positron emission tomography (PET) used to image subclinical inflammation associated with ulcerative colitis (UC) in remission.

Colonic infiltration with chronic myelomonocytic leukemia.

M1097 Measurement of Lumenal pH in Patients with Mildly to Moderately Active UC: A Pilot Study Using SmartPill pH.Ptm

Correlation Between Clinical, Endoscopic, and Histologic Disease Activity in Ulcerative Colitis: 1712