Are we ready to use new endoscopic scores for ulcerative colitis?

For ulcerative colitis(UC),the variability in inflammatory activity along the colon poses a challenge in management.The focus on achieving endoscopic healing in UC is evident,where the UC Endoscopic Index of Severity and Mayo Endoscopic Subscore are commonly used for evaluation.However,these indices primarily consider the most severely affected region.Liu et al recent study validates the Toronto Inflammatory Bowel Disease Global Endoscopic Reporting(TIGER)score offering a comprehensive assessment of inflammatory activity across diverse segments of the colon and rectum and a reliable index correlating strongly with UC Endoscopic Index of Severity and moderately with Mayo Endoscopic Subscore(MES).Despite recommendation,certain aspects warrant further invest-igation.Fecal calprotectin,an intermediate target,correlates with TIGER and should be explored.Determining TIGER scores defining endoscopic remission and response,evaluating agreement with histological activity,and assessing inter-endoscopist agreement for TIGER require scrutiny.Exploring the correlation between TIGER and intestinal ultrasound,akin to MES,adds value.

Evolving role of endoscopy in inflammatory bowel disease:Going beyond diagnosis

Inflammatory bowel disease,encompassing Crohn’s disease(CD)and ulcerative colitis,are chronic immune-mediated inflammatory bowel diseases(IBD)that primarily affect the gastrointestinal tract with periods of activity and remission.Large body of evidence exist to strengthen the prognostic role of endoscopic evaluation for both disease activity and severity and it remains the gold standard for the assessment of mucosal healing.Mucosal healing has been associated with improved clinical outcomes with prolonged remission,decreased hospitalization,IBD-related surgeries and colorectal cancer risk.Therefore,endoscopic objectives in IBD have been incorporated as part of standard care.With the known increased risk of colorectal cancer in IBD,although prevention strategies continue to develop,regular surveillance for early detection of neoplasia continue to be paramount in IBD patients’care.It is thanks to evolving technology and visualization techniques that surveillance strategies are continuously advancing.Therapeutic endoscopic options in IBD have also been expanding,from surgery sparing therapies such as balloon dilation of fibrostenotic strictures in CD to endoscopic mucosal resection of neoplastic lesions.In this review article,we discuss the current evidence on the use of endoscopy as part of standard of care of IBD,its role in surveillance of neoplasia,and the role of interventional endoscopic therapies.

Hepatobiliar manifestations in inflammatory bowel disease: A practical approach

Inflammatory bowel diseases(IBD)are associated with various hepatobiliary disorders.They can occur at any moment in the course of the disease or associated with the treatment.The prevalence of liver dysfunction can reach up to 50%in different studies.Nonalcoholic fatty liver disease is considered the most common hepatobiliary complication in IBD,while primary sclerosing cholangitis is the most specific.Management of hepatic manifestations in IBD involves a multidisciplinary approach that includes a high index of suspicion and joint management with hepatologists.The medical confrontation with abnormal liver tests must include an exhaustive study to determine if these patterns can be related to IBD,associated diseases or to the therapies used.

Endoscopic colorectal cancer surveillance in inflammatory bowel disease: Considerations that we must not forget

Inflammatory bowel disease(IBD),encompassing Crohn's disease and ulcerative colitis,is a chronic immune-mediated inflammatory disease that primarily affects the gastrointestinal tract and is characterized by periods of activity and remission.The inflammatory activity of the disease involving the colon and rectum increases the risk of colorectal cancer(CRC)over the years.Although prevention strategies are evolving,regular surveillance for early detection of neoplasia as a secondary prevention strategy is paramount in the care of IBD patients.In this review article,we discuss the current evidence of the risks of developing CRC and evaluate the best available strategies for screening and surveillance,as well as future opportunities for cancer prevention.

Role of capsule endoscopy in inflammatory bowel disease:Anything new?

Capsule endoscopy(CE)is a recently developed diagnostic method for diseases of the small bowel that is non-invasive,safe,and highly tolerable.Its role in patients with inflammatory bowel disease has been widely validated in suspected and established Crohn’s disease(CD)due to its ability to assess superficial lesions not detected by cross-sectional imaging and proximal lesions of the small bowel not evaluable by ileocolonoscopy.Because CE is a highly sensitive but less specific technique,differential diagnoses that can simulate CD must be considered,and its interpretation should be supported by other clinical and laboratory indicators.The use of validated scoring systems to characterize and estimate lesion severity(Lewis score,Capsule Endoscopy Crohn’s Disease Activity Index),as well as the standardization of the language used to define the lesions(Delphi Consensus),have reduced the interobserver variability in CE reading observed in clinical practice,allowing for the optimization of diagnoses and clinical management strategies.The appearance of the panenteric CE,the incorporation of artificial intelligence,magnetically-guided capsules,and tissue biopsies are elements that contribute to CE being a promising,unique diagnostic tool in digestive tract diseases.