Clinical characteristics and treatment of inflammatory bowel disease: A comparison of Eastern and Western perspectives

Inflammatory bowel disease(IBD) is a chronic, relapsing intestinal inflammatory disorder with unidentified causes. Both environmental factors and genetic aspects are believed to be crucial to the pathogenesis of IBD. The incidence and prevalence of IBD have recently been increasing throughout Asia, presumably secondary to environmental changes. This increasing trend in IBD epidemiology necessitates specific health care planning and education in Asia. To this end, we must gain a precise understanding of the distinctive clinical and therapeutic characteristics of Asian patients with IBD. The phenotypes of IBD reportedly differ considerably between Asians and Caucasians. Thus, use of the same management strategies for these different populations may not be appropriate. Moreover, investigation of the Asian-specific clinical aspects of IBD offers the possibility of identifying causative factors in the pathogenesis of IBD in this geographical area. Accordingly, this review summarizes current knowledge of the phenotypic manifestations and management practices of patients with IBD, with a special focus on a comparisonof Eastern and Western perspectives.

Psychosocial issues in evidence-based guidelines on inflammatory bowel diseases: A review

AIM:To study statements and recommendations on psychosocial issues as presented in international evidence-based guidelines on the management of inflammatory bowel diseases(IBD).METHODS:MEDLINE,guidelines International Network,National Guideline Clearing House and National Institute for Health and Care Excellence were searched from January 2006 to June 30,2013 for evidencebased guidelines on the management of IBD.RESULTS:The search yielded 364 hits.Thirteen guidelines were included in the review,of which three wereprepared in Asia,eight in Europe and two in the United States.Eleven guidelines made statements and recommendations on psychosocial issues.The guidelines were concordant in that mental health disorders and stress do not contribute to the aetiology of IBD,but that they can influence its course.It was recommended that IBD-patients should be screened for psychological distress.If indicated,psychotherapy and/or psychopharmacological therapy should be recommended.IBDcentres should collaborate with mental health care specialists.Tobacco smoking patients with Crohn’s disease should be advised to quit.CONCLUSION:Patients and mental health specialists should be able to participate in future guideline groups to contribute to establishing recommendations on psychosocial issues in IBD.Future guidelines should acknowledge the presence of psychosocial problems in IBD-patients and encourage screening for psychological distress.

COVID-19 in gastroenterology and hepatology:Lessons learned and questions to be answered

BACKGROUND Although coronavirus disease 2019(COVID-19)presents primarily as a lower respiratory tract infection,increasing data suggests multiorgan,including the gastrointestinal(GI)tract and liver,involvement in patients who are infected by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).AIM To provide a comprehensive overview of COVID-19 in gastroenterology and hepatology.METHODS Relevant studies on COVID-19 related to the study aim were undertaken through a literature search to synthesize the extracted data.RESULTS We found that digestive symptoms and liver injury are not uncommon in patients with COVID-19 and varies in different individuals.The most common GI symptoms reported are diarrhea,nausea,vomiting,and abdominal discomfort.Other atypical GI symptoms,such as loss of smell and taste and GI bleeding,have also been reported along with the evolvement of COVID-19.Liver chemistry abnormalities mainly include elevation of aspartate transferase,alanine transferase,and total bilirubin.It is postulated to be related to the binding of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)virus to the angiotensin converting enzyme-2 receptor located on several different human cells.CONCLUSION Standardized criteria should be established for diagnosis and grading of the severity of GI symptoms in COVID-19 patients.Gastroenterology and hepatology in special populations,such as children and elderly,should be the focus of further research.Future long-term data regarding GI symptoms should not be overlooked.