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  • 1. Aims and Scope

    Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE

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    Yong Chan Lee Professor of Medicine
    Director, Gastrointestinal Research Laboratory
    Veterans Affairs Medical Center, Univ. California San Francisco
    San Francisco, USA

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    Deputy Editor
    Jong Pil Im Seoul National University College of Medicine, Seoul, Korea
    Robert S. Bresalier University of Texas M. D. Anderson Cancer Center, Houston, USA
    Steven H. Itzkowitz Mount Sinai Medical Center, NY, USA
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    All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
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Do We Have an Opportunity to Avoid Opportunistic Infections in Asian Patients with Inflammatory Bowel Disease?

Suhyun Park , Sang Hyoung Park

Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to: Sang Hyoung Park
ORCID https://orcid.org/0000-0002-5366-5749
E-mail shpark78@amc.seoul.kr

See “Current Status of Opportunistic Infection in Inflammatory Bowel Disease Patients in Asia: A Questionnaire-Based Multicenter Study” by Hong Yang, et al. on page 726, Vol. 16, No. 5, 2022.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gut Liver 2022;16(5):663-664

Published online September 15, 2022, Published Date September 15, 2022 https://doi.org/10.5009/gnl220364

Copyright © Gut and Liver.

The risk of opportunistic infections among patients with inflammatory bowel disease (IBD) is an emerging issue of safety that continues to evolve along with the emergence of new mechanisms of therapy and new approaches to treatment. It is an important safety issue, as immunomodulators and biologic agents are being used more often and earlier during the disease course.1 In particular, biologic therapies have been associated with an increased risk of opportunistic infections.2,3 Even though immunosuppressive therapy is a major risk of opportunistic infections in patients with IBD, some risk factors are inherent to individual patients’ characteristics such as malnutrition, older age, congenital immunodeficiency, human immunodeficiency virus infection, chronic diseases, and diabetes mellitus.4 Therefore, the European Consensus guidelines on the prevention, diagnosis, and management of opportunistic infections detail a vaccination and systemic workup to consider before the commencement of immunosuppressive therapy, including steroids, azathioprine, 6‐mercaptopurine, and biologic agents.4

In this issue of Gut and Liver, Yang et al.5 investigated the current status of opportunistic infections in patients with IBD in Asia through a questionnaire-based multinational, multicenter study. The strengths of the current study include a multinational, multicenter survey in Asia, along with the multiple hospital systems for diagnosis, treatment, and prevention of IBD represented. In this study, surveys of 82 members of the Asian Organization for Crohn’s and Colitis from seven countries were analyzed, with all four regions represented.

Considering the different epidemiological perspectives of infection as well as the differences in resources between Asia and the West, there are gaps in approaches to diagnosis, treatment, and prevention of opportunistic infections in IBD. For example, due to the intermediate endemicity of hepatitis A and hepatitis B viruses in Korea compared with that in the United States and Western Europe, Park et al.6 suggested producing a guideline on the prevention and management of viral hepatitis in IBD. In the case of Clostridioides difficile infection (CDI), which can worsen underlying IBD, increase the risk of IBD treatment failure, and increase the risk of hospitalization and surgery,7 the symptoms of CDI overlap with those of an IBD flare making it difficult to diagnose. It makes it difficult to diagnose CDI in patients with IBD due to the lack of a uniform diagnostic tool for CDI.

Yang et al.5 have retrospectively assessed the state of opportunistic infections in Asian patients with IBD in the present scenario by using a questionnaire-based multicenter study. The authors’ analysis has reinforced our understanding of the increased risk for opportunistic infections among patients with IBD, as well as the presence of differences in diagnostic equipment for cytomegalovirus infection across countries. In addition, more than half of the members in Asian countries recommended hepatitis B virus vaccination when the hepatitis B surface antigen was tested negative, a rate slightly higher than that in the United States (around 50%).8 Also, it should be noted with caution that updated CDI guidelines published by the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America in 2018 until now have recommended vancomycin as the first-line treatment for patients with an initial CDI episode.9 Even though, this survey was conducted in 2017, it did not reflect updated guidelines.

Each of these findings should further motivate clinicians to strive to optimize the guidelines to be more suitable for Asian patients through the development of health facilities, adjustment of medical insurance policies, and increased vaccination efforts.

No potential conflict of interest relevant to this article was reported.

  1. Viget N, Vernier-Massouille G, Salmon-Ceron D, Yazdanpanah Y, Colombel JF. Opportunistic infections in patients with inflammatory bowel disease: prevention and diagnosis. Gut 2008;57:549-558.
    Pubmed CrossRef
  2. Bonovas S, Fiorino G, Allocca M, et al. Biologic therapies and risk of infection and malignancy in patients with inflammatory bowel disease: a systematic review and network meta-analysis. Clin Gastroenterol Hepatol 2016;14:1385-1397.
    Pubmed CrossRef
  3. Ogata H, Hagiwara T, Kawaberi T, Kobayashi M, Hibi T. Safety and effectiveness of adalimumab in the treatment of ulcerative colitis: results from a large-scale, prospective, multicenter, observational study. Intest Res 2021;19:419-429.
    Pubmed KoreaMed CrossRef
  4. Kucharzik T, Ellul P, Greuter T, et al. ECCO guidelines on the prevention, diagnosis, and management of infections in inflammatory bowel disease. J Crohns Colitis 2021;15:879-913.
    Pubmed CrossRef
  5. Yang H, Ran Z, Jin M, Qian JM. Current status of opportunistic infection in inflammatory bowel disease patients in Asia: a questionnaire-based multicenter study. Gut Liver 2022;16:726-735.
    Pubmed CrossRef
  6. Park SK, Choi CH, Chun J, et al. Prevention and management of viral hepatitis in inflammatory bowel disease: a clinical practice guideline by the Korean Association for the Study of Intestinal Diseases. Intest Res 2020;18:18-33.
    Pubmed KoreaMed CrossRef
  7. Khanna S. Management of Clostridioides difficile infection in patients with inflammatory bowel disease. Intest Res 2021;19:265-274.
    Pubmed KoreaMed CrossRef
  8. Ben Musa R, Gampa A, Basu S, et al. Hepatitis B vaccination in patients with inflammatory bowel disease. World J Gastroenterol 2014;20:15358-15366.
    Pubmed KoreaMed CrossRef
  9. Johnson S, Lavergne V, Skinner AM, et al. Clinical practice guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on management of Clostridioides difficile infection in adults. Clin Infect Dis 2021;73:755-757.
    Pubmed CrossRef

Article

Editorial

Gut and Liver 2022; 16(5): 663-664

Published online September 15, 2022 https://doi.org/10.5009/gnl220364

Copyright © Gut and Liver.

Do We Have an Opportunity to Avoid Opportunistic Infections in Asian Patients with Inflammatory Bowel Disease?

Suhyun Park , Sang Hyoung Park

Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to:Sang Hyoung Park
ORCID https://orcid.org/0000-0002-5366-5749
E-mail shpark78@amc.seoul.kr

See “Current Status of Opportunistic Infection in Inflammatory Bowel Disease Patients in Asia: A Questionnaire-Based Multicenter Study” by Hong Yang, et al. on page 726, Vol. 16, No. 5, 2022.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Body

The risk of opportunistic infections among patients with inflammatory bowel disease (IBD) is an emerging issue of safety that continues to evolve along with the emergence of new mechanisms of therapy and new approaches to treatment. It is an important safety issue, as immunomodulators and biologic agents are being used more often and earlier during the disease course.1 In particular, biologic therapies have been associated with an increased risk of opportunistic infections.2,3 Even though immunosuppressive therapy is a major risk of opportunistic infections in patients with IBD, some risk factors are inherent to individual patients’ characteristics such as malnutrition, older age, congenital immunodeficiency, human immunodeficiency virus infection, chronic diseases, and diabetes mellitus.4 Therefore, the European Consensus guidelines on the prevention, diagnosis, and management of opportunistic infections detail a vaccination and systemic workup to consider before the commencement of immunosuppressive therapy, including steroids, azathioprine, 6‐mercaptopurine, and biologic agents.4

In this issue of Gut and Liver, Yang et al.5 investigated the current status of opportunistic infections in patients with IBD in Asia through a questionnaire-based multinational, multicenter study. The strengths of the current study include a multinational, multicenter survey in Asia, along with the multiple hospital systems for diagnosis, treatment, and prevention of IBD represented. In this study, surveys of 82 members of the Asian Organization for Crohn’s and Colitis from seven countries were analyzed, with all four regions represented.

Considering the different epidemiological perspectives of infection as well as the differences in resources between Asia and the West, there are gaps in approaches to diagnosis, treatment, and prevention of opportunistic infections in IBD. For example, due to the intermediate endemicity of hepatitis A and hepatitis B viruses in Korea compared with that in the United States and Western Europe, Park et al.6 suggested producing a guideline on the prevention and management of viral hepatitis in IBD. In the case of Clostridioides difficile infection (CDI), which can worsen underlying IBD, increase the risk of IBD treatment failure, and increase the risk of hospitalization and surgery,7 the symptoms of CDI overlap with those of an IBD flare making it difficult to diagnose. It makes it difficult to diagnose CDI in patients with IBD due to the lack of a uniform diagnostic tool for CDI.

Yang et al.5 have retrospectively assessed the state of opportunistic infections in Asian patients with IBD in the present scenario by using a questionnaire-based multicenter study. The authors’ analysis has reinforced our understanding of the increased risk for opportunistic infections among patients with IBD, as well as the presence of differences in diagnostic equipment for cytomegalovirus infection across countries. In addition, more than half of the members in Asian countries recommended hepatitis B virus vaccination when the hepatitis B surface antigen was tested negative, a rate slightly higher than that in the United States (around 50%).8 Also, it should be noted with caution that updated CDI guidelines published by the Society for Healthcare Epidemiology of America and the Infectious Diseases Society of America in 2018 until now have recommended vancomycin as the first-line treatment for patients with an initial CDI episode.9 Even though, this survey was conducted in 2017, it did not reflect updated guidelines.

Each of these findings should further motivate clinicians to strive to optimize the guidelines to be more suitable for Asian patients through the development of health facilities, adjustment of medical insurance policies, and increased vaccination efforts.

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

References

  1. Viget N, Vernier-Massouille G, Salmon-Ceron D, Yazdanpanah Y, Colombel JF. Opportunistic infections in patients with inflammatory bowel disease: prevention and diagnosis. Gut 2008;57:549-558.
    Pubmed CrossRef
  2. Bonovas S, Fiorino G, Allocca M, et al. Biologic therapies and risk of infection and malignancy in patients with inflammatory bowel disease: a systematic review and network meta-analysis. Clin Gastroenterol Hepatol 2016;14:1385-1397.
    Pubmed CrossRef
  3. Ogata H, Hagiwara T, Kawaberi T, Kobayashi M, Hibi T. Safety and effectiveness of adalimumab in the treatment of ulcerative colitis: results from a large-scale, prospective, multicenter, observational study. Intest Res 2021;19:419-429.
    Pubmed KoreaMed CrossRef
  4. Kucharzik T, Ellul P, Greuter T, et al. ECCO guidelines on the prevention, diagnosis, and management of infections in inflammatory bowel disease. J Crohns Colitis 2021;15:879-913.
    Pubmed CrossRef
  5. Yang H, Ran Z, Jin M, Qian JM. Current status of opportunistic infection in inflammatory bowel disease patients in Asia: a questionnaire-based multicenter study. Gut Liver 2022;16:726-735.
    Pubmed CrossRef
  6. Park SK, Choi CH, Chun J, et al. Prevention and management of viral hepatitis in inflammatory bowel disease: a clinical practice guideline by the Korean Association for the Study of Intestinal Diseases. Intest Res 2020;18:18-33.
    Pubmed KoreaMed CrossRef
  7. Khanna S. Management of Clostridioides difficile infection in patients with inflammatory bowel disease. Intest Res 2021;19:265-274.
    Pubmed KoreaMed CrossRef
  8. Ben Musa R, Gampa A, Basu S, et al. Hepatitis B vaccination in patients with inflammatory bowel disease. World J Gastroenterol 2014;20:15358-15366.
    Pubmed KoreaMed CrossRef
  9. Johnson S, Lavergne V, Skinner AM, et al. Clinical practice guideline by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA): 2021 focused update guidelines on management of Clostridioides difficile infection in adults. Clin Infect Dis 2021;73:755-757.
    Pubmed CrossRef
Gut and Liver

Vol.16 No.5
September, 2022

pISSN 1976-2283
eISSN 2005-1212

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