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Can IL-23 be a good target for ulcerative colitis?
Publication date: Available online 23 May 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Mariangela Allocca, Federica Furfaro, Gionata Fiorino, Daniela Gilardi, Silvia D'Alessio, Silvio DaneseAbstractA considerable percentage of patients with ulcerative colitis (UC) do not respond to therapies, including anti-tumor necrosis factor (TNF) drugs and vedolizumab, or lose response over time. Hence the continuing need to find new therapeutic strategies and novel drugs to control this chronic debilitating disease. Increased levels of interleukin (IL)-23 and T helper (Th) 17 cell cytokines have been fou...
Source: Best Practice and Research Clinical Gastroenterology - July 5, 2018 Category: Gastroenterology Source Type: research

Pathophysiology of primary biliary cholangitis
Publication date: Available online 24 May 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Aliya F. Gulamhusein, Gideon M. HirschfieldAbstractPrimary biliary cholangitis is a prototypical autoimmune disease characterized by an overwhelming female predominance, a distinct clinical phenotype, and disease specific anti-mitochondrial antibodies targeted against a well-defined auto-antigen. In a genetically susceptible host, multi-lineage loss of tolerance to the E2 component of the 2-oxo-dehydrogenase pathway and dysregulated immune pathways directed at biliary epithelial cells leads to cholestasis, pro...
Source: Best Practice and Research Clinical Gastroenterology - July 5, 2018 Category: Gastroenterology Source Type: research

Biosimilars in ulcerative colitis: When and for who?
Publication date: Available online 26 May 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Akos Ilias, Lorant Gonczi, Zuszsanna Kurti, Peter L. LakatosAbstractThe introduction of biological agents has revolutionized the management of ulcerative colitis (UC). Biosimilars are considered to be equivalent to the reference biologic products in terms of pharmacokinetic properties, clinical effectiveness and safety and have now been approved in inflammatory bowel diseases (IBD). CT-P13 was the first biosimilar to infliximab that obtained regulatory approval by the EMA and US FDA. Accumulating data on biosi...
Source: Best Practice and Research Clinical Gastroenterology - July 5, 2018 Category: Gastroenterology Source Type: research

The impact of biologics in surgical outcomes in ulcerative colitis
Publication date: Available online 8 June 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Marjorie C. Argollo, Paulo Gustavo Kotze, Antonino Spinelli, Tarcia N.F. Gomes, Silvio DaneseAbstractUlcerative Colitis (UC) is an immune mediated condition characterized by inflammation of colonic mucosa, associated with progressive damage of the colon and possible complications, such as hemorrhage, perforation and cancer. It is strongly advocated a treat to target approach in patients with UC consisting in an early and aggressive inflammatory control. Some patients can require colectomy for medically refract...
Source: Best Practice and Research Clinical Gastroenterology - July 5, 2018 Category: Gastroenterology Source Type: research

Safety of biological therapies in ulcerative colitis: An umbrella review of meta-analyses
Publication date: Available online 11 June 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Stefanos Bonovas, Katerina Pantavou, Despo Evripidou, Anan Judina Bastiampillai, Georgios K. Nikolopoulos, Laurent Peyrin-Biroulet, Silvio DaneseAbstractBiological agents have proven clinical efficacy in the treatment of ulcerative colitis (UC). Their adverse effects have also been studied in a substantial number of primary studies and meta-analyses. Given the large volume of information that has been published, the aim of this umbrella review was to effectively summarize the accumulated evidence from randomi...
Source: Best Practice and Research Clinical Gastroenterology - July 5, 2018 Category: Gastroenterology Source Type: research

Variant syndromes of primary biliary cholangitis
Publication date: Available online 14 June 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Lisa Schulz, Marcial Sebode, Sören A. Weidemann, Ansgar W. LohseAbstractPatients with primary biliary cholangitis (PBC) can show biochemical, serological and/or histological features of autoimmune hepatitis (AIH). The term ‘AIH-PBC overlap syndrome’ has been used frequently for these cases and implies the coexistence of two separate diseases. However, the boundaries between ‘classical’ PBC, PBC with features of AIH and ‘classical’ AIH are difficult to define, and therefore the term ‘variant syn...
Source: Best Practice and Research Clinical Gastroenterology - July 5, 2018 Category: Gastroenterology Source Type: research

Primary biliary cholangitis and bone disease
Publication date: Available online 14 June 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Albert Parés, Núria GuañabensAbstractOsteoporosis, characterized by compromised bone strength leading to fragility fractures, is a common event in patients with primary biliary cholangitis (PBC). Osteomalacia, defined by poor bone mineralization is very uncommon. The pathogenesis of osteoporosis is not well clarified, but it mainly results from low bone formation. Few reports have revealed increased bone resorption, particularly in end-stage disease. The prevalence of osteoporosis is about 35% in the most ...
Source: Best Practice and Research Clinical Gastroenterology - July 5, 2018 Category: Gastroenterology Source Type: research

Surgery in ulcerative colitis: When? How?
Publication date: Available online 14 June 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Gaetano Gallo, Paulo Gustavo Kotze, Antonino SpinelliAbstractUlcerative Colitis (UC) is an idiopathic chronically-remitting inflammatory bowel disorder characterized by a contiguous inflammation of the colonic mucosa affecting the rectum that generally extends proximally in a continuous manner through the entire colon. Patients typically experience intermittent exacerbations, with symptoms characterized by bloody diarrhea associated with urgency and tenesmus. The anatomical extent of mucosal involvement is th...
Source: Best Practice and Research Clinical Gastroenterology - July 5, 2018 Category: Gastroenterology Source Type: research

Symptoms of PBC – Pathophysiology and management
Publication date: Available online 14 June 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Amardeep Khanna, Jess Leighton, Lin Lee Wong, David E. JonesAbstractPrimary biliary cholangitis is a chronic cholestatic liver disease characterised by progressive bile duct damage and, ultimately, biliary cirrhosis. Though up to fifty percent of the patients can be asymptomatic at presentation, symptoms when present are frequently debilitating with significant impact on quality of life and functional status. Characteristic symptoms include pruritus, fatigue and an increasingly recognised mild cognitive impai...
Source: Best Practice and Research Clinical Gastroenterology - July 5, 2018 Category: Gastroenterology Source Type: research

Improving prognosis in primary biliary cholangitis – Therapeutic options and strategy
Publication date: Available online 14 June 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Maren H. Harms, Henk R. van Buuren, Adriaan J. van der MeerAbstractOverall survival in primary biliary cholangitis is diminished. As patients are often asymptomatic, the disease may silently progress towards cirrhosis and liver failure. Timely diagnosis and effective treatment options are of vital importance to improve the prognosis of affected patients. Ursodeoxycholic acid is the standard of care first-line therapy and is associated with a reduced risk of liver transplantation and death. Treatment with UDCA...
Source: Best Practice and Research Clinical Gastroenterology - July 5, 2018 Category: Gastroenterology Source Type: research

Is PBC a viral infectious disease?
Publication date: Available online 14 June 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Andrew L. MasonAbstractThe human betaretrovirus and the closely related mouse mammary tumor virus have been linked with the development of cholangitis and mitochondrial antibody production in patients with primary biliary cholangitis (PBC) and mouse models of autoimmune biliary disease, respectively. In vitro, betaretroviruses have been found to stimulate the expression of mitochondrial autoantigens on the cell surface of biliary epithelial cells. In vivo, both mitochondrial autoantigens and viral proteins ha...
Source: Best Practice and Research Clinical Gastroenterology - July 5, 2018 Category: Gastroenterology Source Type: research

Patterns of disease progression and incidence of complications in primary biliary cholangitis (PBC)
Publication date: Available online 14 June 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Ashnila Janmohamed, Palak J. TrivediAbstractClinical outcome for patients with primary biliary cholangitis (PBC) is dictated by development of cirrhosis, portal hypertension and its associated complications; including for some, a predisposition toward hepatocellular carcinoma. However rates of clinical progression vary, and accurately identifying disease course is of critical importance to patients, clinicians, as well as industry, who are committed to developing new effective and life-prolonging therapy as w...
Source: Best Practice and Research Clinical Gastroenterology - July 5, 2018 Category: Gastroenterology Source Type: research

Evolution of our understanding of PBC
Publication date: Available online 15 June 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Atsushi Tanaka, Patrick S.C. Leung, M. Eric GershwinAbstractThe discovery of mitochondrial autoantigens recognized by antimitochondrial antibodies (AMAs) in 1987 marked the dawn of a new era in primary biliary cholangitis (PBC) research. Since then, there has been substantial progress in our understanding of PBC partly bestowed by the development of innovative technologies in molecular biology, immunology, and genetics. Here, we review this evolutionary progress in understanding PBC. We now recognize that the...
Source: Best Practice and Research Clinical Gastroenterology - July 5, 2018 Category: Gastroenterology Source Type: research

Risk stratification and prognostic modelling in primary biliary cholangitis
Publication date: Available online 18 June 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Jorn C. Goet, Maren H. Harms, Marco Carbone, Bettina E. HansenAbstractPrimary biliary cholangitis (PBC) is a slowly progressive chronic cholestatic liver disease that, in a subgroup of patients, may result in liver failure or death. The definition of specific risk profiles, i.e. risk stratification, is of critical importance for the identification of these subgroups and thereby the targeting of care. Over the last few years large multicentre cohort studies have improved our knowledge regarding factors associa...
Source: Best Practice and Research Clinical Gastroenterology - July 5, 2018 Category: Gastroenterology Source Type: research

Can we move directly from 5-ASA to a biologic agent in ulcerative colitis?
Publication date: Available online 20 June 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Pieter Hindryckx, Gregor NovakAbstractEuropean consensus guidelines and reimbursement policies position biologic drugs for ulcerative colitis (UC) as a third-line treatment, after failure of 5-aminosalicylic acid (5-ASA) and corticosteroids/thiopurines. While 5-ASA have a very favorable safety profile, (prolonged) use of corticosteroids and thiopurines is associated with potentially serious adverse events. The therapeutic landscape of UC is rapidly evolving and selective biologic drugs with improved safety ar...
Source: Best Practice and Research Clinical Gastroenterology - July 5, 2018 Category: Gastroenterology Source Type: research