AGA Clinical Practice Update on Endoscopic Scoring Systems in Inflammatory Bowel Disease: Commentary.

Description: Endoscopic scoring systems evaluate the severity of inflammation and provide objectivity, uniformity, and standardization of reporting of mucosal appearances in patients with inflammatory bowel disease; thus, they have been advised for assessing the efficacy of medical treatment and prognosis. This American Gastroenterological Association (AGA) Clinical Practice Update Expert Commentary aims to review the utilized endoscopic scoring systems and their role in assessing mucosal healing in inflammatory bowel disease and the practical challenges in their applications, as well as to discuss the future of endoscopic scoring systems.

Methods: This expert commentary was commissioned and approved by the AGA Institute Clinical Practice Updates Committee and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the Clinical Practice Updates Committee and external peer review through standard procedures of Clinical Gastroenterology and Hepatology.

Mechanical versus biological mitral valve replacement: Insights from propensity score matching on survival and reoperation rates.

Objectives: Patients with symptomatic mitral valve disease unsuitable for repair can be sufficiently treated with surgical mitral valve replacement. The decision between biological and mechanical mitral valve replacement can be difficult, especially due to the question of the lesser of 2 evils: anticoagulation versus reoperation.

Methods: This single-center, retrospective study included all patients undergoing mitral valve replacement between 2001 and 2020.

Utility of FDG PET/CT in assessing bowel inflammation.

Purpose: To develop a methodology for the quantification of gastrointestinal (GI) inflammation as indicated by 2-deoxy-2-(F)fluoro-D-glucose (FDG) uptake on positron-emissions tomography/computed tomography (PET/CT) imaging. This is intended to investigate the feasibility of using standard uptake value (SUV) levels to assess levels of GI inflammation in humans.

Methods: 131 participants were injected with a weight-controlled dose of FDG 180 minutes prior to PET/CT scanning.

Development of a narrow-band imaging classification to reduce the need for routine biopsies of gastric polyps.

Background: Most incidental gastric polyps identified during upper endoscopy are considered low-risk. However, current guidelines recommend sampling all gastric polyps for histopathologic analysis. We aimed to devise a simple narrow-band imaging (NBI) classification to reduce the need for routine biopsies of low-risk gastric polyps.

Endoscopic Management of Complex Lesions in Patients With Inflammatory Bowel Disease.

Patients with inflammatory bowel disease (IBD) have a higher risk of developing colitis-associated dysplastic lesions. Surveil-lance colonoscopy with endoscopic imaging techniques such as chromoendoscopy has been suggested. However, complex dysplastic lesions of larger size, challenging location behind folds, and nonpolypoid morphology defy standard polypectomy techniques and require advanced management with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD).

Biosimilars in Inflammatory Bowel Disease.

Over the past 2 decades, biological therapy with monoclonal antibodies targeting tumor necrosis factor-α has become a cornerstone of treatment of patients with inflammatory bowel disease. Although clinically effective, the biological therapies remain expensive, and their availability and utilization have been at times limited due to their high costs. Biosimilars are biological products similar to but not identical to the original biological agent or "reference biologic," also called "originator biologic.

Confocal Laser Endomicroscopy in the Evaluation of Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, can be effectively monitored with the use of endoscopy. The additional application of small field imaging technology such as confocal laser endomicroscopy CLE during ongoing endoscopic evaluation has led to real-time visualization of mucosal abnormalities and thus in vivo histology. The endomicroscopy (CLE) can improve IBD endoscopic evaluation by identifying seemingly normal-appearing mucosa, assessing the function of the intestinal barrier of the epithelium and vascular permeability, and by characterizing any mucosal lesions, including dysplastic lesions.

A User-Friendly Prediction Tool to Identify Colectomy Risk in Patients With Ulcerative Colitis.

Background: Many patients with ulcerative colitis (UC) fear the potential side effects of immunosuppressive therapies. However, those with medically refractory disease often require total proctocolectomy (TPC) with a permanent ostomy or pouch, which may reduce quality of life. Prior studies have identified TPC predictors; however, no clinically useful prognostic tools exist to guide shared therapeutic decision-making.

Clinical differences of Helicobacter pylori infection in children.

Helicobacter pylori infection is widely spread all over the world. The prevalence of H. pylori infection in the world varies and depends on numerous factors such as age, ethnicity, geographical and socioeconomic status.

Editorial: Endoscopic Scoring Systems in Crohn's Disease for Evaluation of Responsiveness to Treatment: Are we Ready for the Prime Time of Endoscopic Assessment?

There are currently two validated endoscopic indices for evaluation of Crohn's disease (CD), the Crohn's disease Endoscopic Index of Severity (CDEIS) and the Simple Endoscopic Score for Crohn's disease (SES-CD). The study by Khanna et al. evaluated the responsiveness of the SES-CD and CDEIS using data from a trial of adalimumab.

The Role of Chromoendoscopy in Evaluating Colorectal Dysplasia.

Chromoendoscopy pertains to image-enhanced endoscopic techniques such as dye-based chromoendoscopy and electronic chromoendoscopy using narrow-band imaging, flexible spectral imaging color enhancement, and i-scan. Dye-based chromoendoscopy has been demonstrated to improve colorectal dysplasia detection in high-risk patients with long-term inflammatory bowel disease, and electronic chromoendoscopy techniques have been shown to improve characterization of diminutive colorectal lesions, allowing for optical diagnosis during a colonoscopy examination. This article reviews endoscopic imaging using chromoendoscopy techniques for colorectal dysplasia evaluation.

Endomicroscopy and Molecular Tools to Evaluate Inflammatory Bowel Disease.

Endoscopy is an essential tool for effective care of patients with inflammatory bowel disease (IBD), including Crohn disease and ulcerative colitis. The newest endoscopic small-field imaging technologies with confocal endomicroscopy have allowed real-time imaging of gastrointestinal mucosal during ongoing endoscopic evaluation and in vivo histology. Thus, endomicroscopy has a potential to further enhance the endoscopic evaluation of IBD.

How to Assess and Document Endoscopies in IBD Patients by Including Standard Scoring Systems.

Endoscopy has become an essential tool for effective management of patients with inflammatory bowel disease, including Crohn's disease and ulcerative colitis. The endoscopic management of inflammatory bowel disease ranges from diagnosing the disease, assessing the disease's extent, and activity to monitor the responses to various medical therapies with assessment of mucosal healing, serving as a predictor of disease course and response to therapy to finally treating the disease's complications. In general, the use of endoscopic scoring systems has been recommended for assessing the activity of the disease, and the prognosis and efficacy of medical treatment.

Evaluation and Detection of Dysplasia in IBD: the Role of Chromoendoscopy and Enhanced Imaging Techniques.

Patients with ulcerative colitis (UC) and Crohn's disease (CD) colitis are at significantly higher risk for the development of colitis-associated colorectal cancer (CAC), a risk associated with increased duration and extent of disease [1]. CAC in patients with ulcerative colitis and Crohn's colitis arises from dysplastic tissue in the background of mucosal inflammatory changes. Regular surveillance by colonoscopy is a recommended cancer prevention strategy endorsed by the US and European GI societies [2-4].

In-vivo microscopy in the diagnosis of intestinal neoplasia and inflammatory conditions.

Confocal laser endomicroscopy (CLE) is a rapidly emerging tool in endoscopic imaging allowing in-vivo microscopy of examined gastrointestinal mucosa. This review will discuss the most recent advances of confocal laser endomicroscopy in the diagnosis of intestinal neoplasia and inflammatory conditions.

Treatment of ulcerative colitis.

Purpose Of Review: Ulcerative colitis is a chronic inflammatory disease of the colon of unknown cause that is characterized by alternating intervals of active and inactive disease in 80-90% of patients. The primary goal of treatment is to induce and maintain remission using therapy tailored to the individual patient. The purpose of this review was to describe the management of ulcerative colitis with emphasis on the use of anti-tumor necrosis factor (TNF) agents.