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( Rupa Banerjee ),( Partha Pal ),( Zaheer Nabi ),( Upender Shava ),( Girish Ganesh ),( D. Nageshwar Reddy ) 대한장연구학회 2021 Intestinal Research Vol.19 No.4
Background/Aims: Information on pediatric inflammatory bowel disease (PIBD) and very early onset IBD (VEOIBD) are sparse in India, where IBD is emerging. We aimed to evaluate characteristics of VEOIBD and later onset PIBD (LO-PIBD) in India. Methods: We performed retrospective analysis of a large, prospectively maintained IBD registry. PIBD was divided in to VEOIBD (<6 years) and LO-PIBD (6-17 years). Demographic data, disease characteristics and treatment were compared between the PIBD groups and with other Asian/Western studies as well as the adult patients of the registry. Results: Of 3,752 IBD patients, 292 (7.8%) had PIBD (0-17 years) (175 Crohn’s disease [CD], 113 ulcerative colitis [UC], 4 IBD-undifferentiated; 22 VEOIBD [7.5%], and 270 LO-PIBD [92.5%]). VEOIBD patients had more severe disease compared to LO-PIBD in both UC (P= 0.003) and CD (P< 0.001). Familial IBD was more common in VEOIBD (13.6%) compared to LO-PIBD (9.2%). Ileal disease (L1) was an independent risk factor for diagnostic delay in pediatric CD. Diagnostic delay ( >6 months) was significantly lower in VEOIBD (40.9%) than in LO-PIBD (78.8%) (P< 0.001). Compared to other Asian and Western studies, extensive UC (72.5%) and complicated CD (stricturing/penetrating: 42.7%) were relatively more common. Perianal CD was relatively less frequent (7.4%). PIBD had a significantly higher number of complicated and ileal CD and extensive UC comparison to adult cohort of the registry. Conclusions: VEOIBD has more aggressive phenotype than LO-PIBD. Disease appears distinct from other Asian and Western studies and adult onset disease, with more complicated CD and extensive UC. (Intest Res 2021;19:398-407)
Rupa Banerjee,Partha Pal,Susan Hutfless,B Girish Ganesh,D Nageshwar Reddy 대한장연구학회 2019 Intestinal Research Vol.17 No.4
Background/Aims: Information about familial aggregation of inflammatory bowel disease (IBD) in Asia is limited. We aimed to analyze the prevalence and risk of familial IBD in an Indian cohort and compare familial and sporadic cases. Methods: Familial IBD cases were identified from a large prospectively maintained IBD registry. The prevalence of IBD in first- and seconddegree relatives of index cases was evaluated. The disease behavior was compared to that of sporadic cases. Results: Total 3,553 patients (ulcerative colitis [UC], 2,053; Crohn’s disease [CD], 1,500) were included. Familial IBD was noted in 4.13% of CD and 4.34% of UC patients. Family history was commoner in pediatric group (<18 years) (P=0.0002; odds ratio [OR], 2.8; 95% confidence interval [CI], 1.6–4.8). Majority had paternal transmission (UC, 67.42%; CD, 70.97%). Concordance of disease type was higher in UC (79.7%) compared to CD (37.1%). Familial IBD was associated with higher cumulative relapse rate (CD, P<0.001; UC, P<0.001), higher cumulative rate of surgery (CD, P<0.001; UC, P<0.001) and higher rate of biologic use (CD, P=0.010; UC, P=0.015). Pan-colitis was higher in familial UC (P=0.003; OR, 1.935; 95% CI, 1.248–3.000). Fistulizing disease was commoner in familial CD (P=0.041; OR, 2.044; 95% CI, 1.030–4.056). Conclusions: The prevalence of familial IBD in India appears comparable to rest of Asia but lower than the West. It is associated with a younger age of onset, higher incidence of pan-colitis in UC and fistulizing complications in CD. Familial IBD has higher cumulative relapse, surgery and biologic use rates. Hence, family history of IBD could have important prognostic implications.
( Rupa Banerjee ),( Sai Wei Chuah ),( Ida Normiha Hilmi ),( Deng-chyang Wu ),( Suk-kyun Yang ),( Dirk Demuth ),( Dirk Lindner ),( Shashi Adsul ) 대한장연구학회 2021 Intestinal Research Vol.19 No.1
Background/Aims: The efficacy and safety of vedolizumab in moderate-to-severely active Crohn’s disease (CD) were demonstrated in the GEMINI 2 study (NCT00783692). This post-hoc exploratory analysis aimed to assess the efficacy and safety of vedolizumab in the subgroup of patients from Asian countries. Methods: During the induction phase (doses at day 1, 15), clinical remission, enhanced clinical response, and change in C-reactive protein at 6 weeks; during the maintenance phase, clinical remission, enhanced clinical response, glucocorticoid-free remission and durable clinical remission at 52 weeks, were the efficacy outcomes of interest. Efficacy and safety of vedolizumab compared to placebo were assessed in Asian countries (Hong Kong, India, Malaysia, Singapore, South Korea, and Taiwan) using descriptive analyses. Results: During the induction phase, in Asian countries (n=51), 14.7% of the vedolizumab-treated patients achieved clinical remission at week 6 compared to none with placebo (difference, 14.7%; 95% confidence interval, 15.8%-43.5%). In non-Asian countries (n=317), the remission rate at week 6 with vedolizumab was 14.5%. During maintenance, in Asian countries, clinical remission rates at 52 weeks with vedolizumab administered every 4 weeks, vedolizumab administered every 8 weeks and placebo were 41.7%, 36.4%, and 0%, respectively; while enhanced clinical response rates were 41.7%, 63.6%, and 42.9%, respectively. During induction, 39.7% of patients with vedolizumab experienced an adverse event compared to 58.8% of patients with placebo, and vedolizumab was generally well-tolerated. Conclusions: This post-hoc analysis demonstrates the treatment effect and safety of vedolizumab in moderate-to-severely active CD in patients from Asian countries. (Intest Res 2021;19:83-94)
Rupa Banerjee,Raja Affendi Raja Ali,Shu Chen Wei,Shashi Adsul 거트앤리버 소화기연관학회협의회 2020 Gut and Liver Vol.14 No.6
The advent of biologics and biologic therapy has transformed the management of inflammatory bowel disease (IBD) with enhanced early and adequate responses to treatment, fewer hospitalizations, a reduced need for surgery, and unprecedented outcomes including complete mucosal and histologic healing. However, an important issue with the use of anti-tumor necrosis factor (anti-TNF) agents in IBD is the increased risk of tuberculosis (TB). This is compounded by the diagnostic dilemma when differentiating between Crohn’s disease and gastrointestinal TB, and the potentially serious consequences of initiating an incorrect treatment in the case of misdiagnosis. The interplay between IBD and TB is most relevant in Asia, where more than 60% of the 10.4 million new TB cases in 2016 were reported. A number of studies have reported an increased risk of TB with anti-TNF agents, including in patients who had tested negative for TB prior to treatment initiation. The limited evidence currently available regarding adhesion molecule antagonists such as vedolizumab suggests a comparatively lower risk of TB, thus making them a promising option for IBD management in TBendemic regions. This comprehensive review examines the available literature on the risk of TB with the use of biologics in the TB-endemic regions of Asia, focusing on the diagnostic dilemma, the risk of reactivation, and the optimized management algorithms for latent and active disease.
( Silvio Danese ),( Rupa Banerjee ),( Jr Fraser Cummings ),( Iris Dotan ),( Paulo G Kotze ),( Rupert Wing Loong Leong ),( Kristine Paridaens ),( Laurent Peyrin-biroulet ),( Glyn Scott ),( Gert Van Ass 대한장연구학회 2018 Intestinal Research Vol.16 No.4
Symptomatic ulcerative colitis (UC) can be a chronic, disabling condition. Flares in disease activity are associated with many of the negative impacts of mild-to-moderate UC. Rapid resolution of flares can provide benefits to patients and healthcare systems. i Support Therapy-Access to Rapid Treatment (iSTART) introduces patient-centered care for mild-to-moderate UC. iSTART provides patients with the ability to self-assess symptomology and self-start a short course of second-line treatment when necessary. An international panel of experts produced consensus statements and recommendations. These were informed by evidence from systematic reviews on the epidemiology, mesalazine (5-ASA) treatment, and patient use criteria for second-line therapy in UC. Optimized 5-ASA is the first-line treatment in all clinical guidelines, but may not be sufficient to induce remission in all patients. Corticosteroids should be prescribed as second-line therapy when needed, with budesonide MMX<sup>®</sup> being a preferred steroid option. Active involvement of suitable patients in management of UC flares has the potential to improve therapy, with patients able to show good accuracy for flare self-assessment using validated tools. There is a place in the UC treatment pathway for an approach such as iSTART, which has the potential to provide patient, clinical and economic benefits. (Intest Res 2018;16:522-528)
Choon Jin Ooi,Ida Hilmi,Rupa Banerjee,Sai Wei Chuah,Siew Chien Ng,Govind K Makharia,Pises Pisespongsa,Min Hu Chen,Zhi Hua Ran,Byong Duk Ye,Dong Il Park,Khoon Lin Ling,David Ong,Vineet Ahuja,Khean Lee 대한장연구학회 2019 Intestinal Research Vol.17 No.3
The Asia-Pacific Working Group on inflammatory bowel disease (IBD) was established in Cebu, Philippines, under the auspices of the Asian Pacific Association of Gastroenterology with the goal of improving IBD care in Asia. This consensus is carried out in collaboration with Asian Organization for Crohn’s and Colitis. With biologic agents and biosimilars becoming more established, it is necessary to conduct a review on existing literature and establish a consensus on when and how to introduce biologic agents and biosimilars in the conjunction with conventional treatments for ulcerative colitis (UC) and Crohn’s disease (CD) in Asia. These statements also address how pharmacogenetics influence the treatments of UC and CD and provide guidance on response monitoring and strategies to restore loss of response. Finally, the review includes statements on how to manage treatment alongside possible hepatitis B and tuberculosis infections, both common in Asia. These statements have been prepared and voted upon by members of IBD workgroup employing the modified Delphi process. These statements do not intend to be all-encompassing and future revisions are likely as new data continue to emerge.
( Nitesh Pratap ),( Rakesh Kalapala ),( Santosh Darisetty ),( Nitin Joshi ),( Mohan Ramchandani ),( Rupa Banerjee ),( Sandeep Lakhtakia ),( Rajesh Gupta ),( Manu Tandan ),( Nageshwar Reddy ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2011 Journal of Neurogastroenterology and Motility (JNM Vol.17 No.1
Background/Aims High-resolution manometry (HRM) with pressure topography is used to subtype achalasia cardia, which has therapeutic implications. The aim of this study was to compare the clinical characteristics, manometric variables and treatment outcomes among the achalasia subtypes based on the HRM findings. Methods The patients who underwent HRM at the Asian Institute of Gastroenterology, Hyderabad between January 2008 and January 2009 were enrolled. The patients with achalasia were categorized into 3 subtypes: type I - achalasia with minimum esophageal pressurization, type Ⅱ - achalasia with esophageal compression and type Ⅲ - achalasia with spasm. The clinical and manometric variables and treatment outcomes were compared. Results Eighty-nine out of the 900 patients who underwent HRM were diagnosed as achalasia cardia. Fifty-one patients with a minimum follow-up period of 6 months were included. Types I and Ⅱ achalasia were diagnosed in 24 patients each and 3 patients were diagnosed as type Ⅲ achalasia. Dysphagia and regurgitation were the main presenting symptoms in patients with types I and Ⅱ achalasia. Patients with type Ⅲ achalasia had high basal lower esophageal sphincter pressure and maximal esophageal pressurization when compared to types I and II. Most patients underwent pneumatic dilatation (type I, 22/24; type Ⅱ, 20/24; type Ⅲ, 3/3). Patients with type Ⅱ had the best response to pneumatic dilatation (18/20, 90.0%) compared to types I (14/22, 63.3%) and Ⅲ (1/3, 33.3%). Conclusions The type Ⅱ achalasia cardia showed the best response to pneumatic dilatation. (J Neurogastroenterol Motil 2011;17:48-53)
( Dong Il Park ),( Tadakazu Hisamatsu ),( Minhu Chen ),( Siew Chien Ng ),( Choon Jin Ooi ),( Shu Chen Wei ),( Rupa Banerjee ),( Ida Normiha Hilmi ),( Yoon Tae Jeen ),( Dong Soo Han ),( Hyo Jong Kim ) 대한장연구학회 2018 Intestinal Research Vol.16 No.1
Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn’s and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web- based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 1 of the statements comprised 2 parts: risk of TB infection Recommenda-during anti-TNF therapy, and screening for TB infection prior to commencing anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment. (Intest Res 2018;16:4-16)
Dong Il Park,Tadakazu Hisamatsu,Min-Hu Chen,Siew Chien Ng,Choon Jin Ooi,Shu Chen Wei,Rupa Banerjee,Ida Normiha Hilmi,Yoon Tae Jeen,한동수,Hyo Jong Kim,Zhi Hua Ran,Kaichun Wu,Jiaming Qian,Pin-Jin Hu,Katsu 대한장연구학회 2018 Intestinal Research Vol.16 No.1
Because anti-tumor necrosis factor (anti-TNF) therapy has become increasingly popular in many Asian countries, the risk of developing active tuberculosis (TB) among anti-TNF users may raise serious health problems in this region. Thus, the Asian Organization for Crohn’s and Colitis and the Asia Pacific Association of Gastroenterology have developed a set of consensus statements about risk assessment, detection and prevention of latent TB infection, and management of active TB infection in patients with inflammatory bowel disease (IBD) receiving anti-TNF treatment. Twenty-three consensus statements were initially drafted and then discussed by the committee members. The quality of evidence and the strength of recommendations were assessed by using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Web- based consensus voting was performed by 211 IBD specialists from 9 Asian countries concerning each statement. A consensus statement was accepted if at least 75% of the participants agreed. Part 2 of the statements comprised 3 parts: management of latent TB in preparation for anti-TNF therapy, monitoring during anti-TNF therapy, and management of an active TB infection after anti-TNF therapy. These consensus statements will help clinicians optimize patient outcomes by reducing the morbidity and mortality related to TB infections in patients with IBD receiving anti-TNF treatment.
( Ajit Sood ),( Vineet Ahuja ),( Vandana Midha ),( Saroj Kant Sinha ),( C. Ganesh Pai ),( Saurabh Kedia ),( Varun Mehta ),( Sawan Bopanna ),( Philip Abraham ),( Rupa Banerjee ),( Shobna Bhatia ),( Kar 대한장연구학회 2020 Intestinal Research Vol.18 No.4
Despite several recent advances in therapy in inflammatory bowel disease (IBD), 5-aminosalicylic acid (5-ASA) therapy has retained its place especially in ulcerative colitis. This consensus on 5-ASA is obtained through a modified Delphi process, and includes guiding statements and recommendations based on literature evidence (randomized trials, and observational studies), clinical practice, and expert opinion on use of 5-ASA in IBD by Indian gastroenterologists. The aim is to aid practitioners in selecting appropriate treatment strategies and facilitate optimal use of 5-ASA in patients with IBD. (Intest Res 2020;18:355-378)