Jejunojejunal Intussusception as Initial Presentation of Coeliac Disease: A Case Report and Review of Literature

Intussusception as the initial presentation of coeliac disease has been rarely reported, with an incidence of 1% in all coeliac disease presentations. Furthermore, intussusception requiring surgical reduction as the primary presentation for coeliac disease in adults is even rarer. Presented here is a case of a 37-year-old female Asian patient who presented with abdominal pain and distension; she was diagnosed with small bowel obstruction due to jejunojejunal intussusception and required surgical reduction as the initial presentation of coeliac disease.

An Overview of Novel and Emerging Therapies for Inflammatory Bowel Disease

Inflammatory bowel disease, consisting of Crohn’s disease and ulcerative colitis, causes chronic gastrointestinal symptoms and can lead to morbidity and mortality if uncontrolled or untreated. However, for patients with moderate-to-severe disease, currently available therapies do not induce or maintain remission in >50% of patients. This underscores the need for additional therapies. In this review, the authors detail the novel therapies vedolizumab, tofacitinib, and ustekinumab and delve into therapies which may come onto the market within the next 10 years, including JAK-1 inhibitors (filgotinib and upadacitinib), IL-23 inhibitors (guselkumab, mirikizumab, and risankizumab), the anti-β4β7 and anti-βEβ7 integrin monoclonal antibody etrolizumab, the sphingosine-1-phosphate subtypes 1 and 5 modulator ozanimod, and mesenchymal stem cells. Further studies are required before these emerging therapies gain approval.

The Gene Expression Signature Modulated by Dupilumab is Correlated with Histological Severity and Endoscopic Features of Mucosal Inflammation and Remodelling in Eosinophilic Oesophagitis

Dupilumab is a monoclonal antibody that inhibits IL-4 and IL-13 signalling in multiple Type 2 inflammatory disorders, including eosinophilic oesophagitis (EoE). This article reviews the oral presentation given by Dr Collins at the United European Gastroenterology (UEG) Week Virtual 2020 and describes the results of a post hoc analysis of a Phase II proof-of-concept study of dupilumab in adults with active EoE. The aim of the analysis was to ascertain whether there were any correlations between gene expression and disease severity in patients enrolled in the study.

That Gut Feeling: The Role of Inflammatory Cytokines in Depression Among Patients with Inflammatory Bowel Disease

There is mounting evidence of an associative link between inflammatory bowel disease (IBD) and clinical depression. In the first major treatise on the eponymous disease, Burrill Crohn himself noted that: “The number of cases of ileitis that have been rescued from institutions for the treatment of mental diseases emphasises not the personality but the end results of the drain of the disease upon the psychic constitution of the sufferer.” In the 70 years since that prescient statement, a high incidence of neuropsychiatric symptoms (depression, anxiety, cognitive fatigue, and sleep disorders) in patients with IBD has been frequently observed. Since patients with depression have significantly increased rates of relapse, surgery, hospitalisation, and suicide, recognising and treating depression is of paramount importance. In this narrative review, the authors will trace some of the biochemical connections between intestinal inflammation and neuropsychiatric symptoms and focus on strategies to manage both. Additionally, the authors offer a cautionary reflection on the extant need for widespread screening for depression among patients with IBD.

Achalasia Cardia: A Comprehensive Review

Achalasia cardia is the best characterised oesophageal motility disorder. It is characterised by progressive ganglion cell degeneration in the oesophageal myenteric plexus, which results in impaired lower oesophageal sphincter (LES) relaxation upon swallowing and aperistalsis in the distal smooth muscle segment of the oesophagus. The usual presenting features are dysphagia to both liquids and solids from onset, regurgitation of undigested food, retrosternal pain, heartburn, and weight loss. Initial investigations include upper gastrointestinal (GI) endoscopy and timed barium oesophagogram, whereas high resolution manometry is diagnostic. Therapy in achalasia cardia is directed towards biochemical or mechanical reduction in LES pressures. If candidates are fit for surgery, pneumatic dilatation, peroral endoscopic myotomy, and laparoscopic Heller’s myotomy are the mainstays of therapy that act by mechanical disruption of LES. On the other hand, botulinum toxin and pharmacotherapy (nitrates and calcium channel blockers) act by biochemical reduction of LES and are reserved for surgically unfit patients with limited life expectancy because of their short-lived efficacy. Oesophagectomy is reserved for treating refractory longstanding cases, who have previously failed multiple therapies.

Cachexia in Patients with Gastrointestinal Cancers: Contributing Factors, Prevention, and Current Management Approaches

Cancer cachexia is highly prevalent among patients with the advanced stage of cancers and leads to a higher risk of mortality. Delayed management of cachexia results in suboptimal treatment outcomes and irreversible progression to refractory cachexia. The purpose of this review is to provide the pathophysiology of cancer cachexia, emerging diagnostic criteria with potential biomarkers, prevention strategies, and novel treatment approaches. Cachexia is characterised by the presence of an inflammatory process in conjunction with muscle mass and unintentional body weight loss. Various biomarkers such as leptin, ghrelin, TNFα, essential amino acids, total amino acids, and C-reactive protein are indicative of cachexia. Increased circulating levels of β-dystroglycan, myosin heavy-chain, and dystrophin are indicators of shortened survival time as skeletal muscle tissues break down. Despite muscle wasting being a hallmark of cachexia, recommended cachexia management is limited to nutritional counselling and administration of an appetite stimulant and corticosteroids for a short period, which often fail to reverse cancer cachexia. It is critical to monitor weight loss using the cachexia grading system for early detection, to halt progression to refractory cachexia and improve the survival of patients with cancer cachexia.

Stem Cell Therapies: A Review of Current Therapeutic Approach for Inflammation-Associated Sigmoid Colon Diseases

Chronic inflammation is the single major contributor to the pathogenesis of sigmoid colon inflammatory diseases such as segmental colitis associated disease and inflammatory bowel disease (IBD). Existing conventional anti-inflammatory treatments have not proven to be a sufficient long-term solution for management of symptoms due to the immunosuppressive nature of these agents. Stem cell (SC) transplantation is a novel approach to treatment that could improve the prognosis of IBD patients in the long term by preventing inflammation, restoring defective immune balance, and promoting mucosal healing. Multiple studies have shown that bone marrow SC, mesenchymal SC (MSC), and most recently intestinal SC (ISC) have had marked success in improving immune functionality in cases of IBD. Effects of bone marrow SC did not show the kind of longevity that researchers initially anticipated, leading them to instead pursue thorough study of MSC. The tolerogenic effects of MSC have proven them to be a key player in the development of SC therapy; however, their exact mechanism of action has yet to be fully characterised. Due to existing discrepancies in the data detailing the association between MSC and colorectal cancer risk, ISC have since become of interest with the intention of finding a more reliable alternative source of SC. Preliminary studies have shown that ISC may be capable of achieving the same immunomodulatory effects as MSC but with reduced colorectal cancer risk, suggesting them to be the most promising new method of treating inflammatory-based sigmoid colon diseases under study thus far.