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      The role of small-bowel endoscopy in inflammatory bowel disease: an updated review on the state-of-the-art in 2021

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          Abstract

          The impact of small-bowel (SB) capsule endoscopy and device-assisted enteroscopy on clinical practice, since their introduction 2 decades ago, has been remarkable. These disruptive technologies have transformed the investigation and management of SB pathology and now have a firmly established place in guidelines and clinical algorithms. Furthermore, recent years have witnessed innovations, driven by the demand of new goals in the management of inflammatory bowel disease (IBD), such as mucosal healing and evolving strategies based on tight monitoring and accelerated escalation of care. These developments in SB endoscopy have also been paralleled by refinement in dedicated radiological SB imaging technologies. This updated review highlights the current state of the art and more recent innovations with a focus on their role in IBD.

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          Most cited references148

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          Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies.

          Inflammatory bowel disease is a global disease in the 21st century. We aimed to assess the changing incidence and prevalence of inflammatory bowel disease around the world.
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            Ulcerative colitis

            Ulcerative colitis is a chronic inflammatory disease affecting the colon, and its incidence is rising worldwide. The pathogenesis is multifactorial, involving genetic predisposition, epithelial barrier defects, dysregulated immune responses, and environmental factors. Patients with ulcerative colitis have mucosal inflammation starting in the rectum that can extend continuously to proximal segments of the colon. Ulcerative colitis usually presents with bloody diarrhoea and is diagnosed by colonoscopy and histological findings. The aim of management is to induce and then maintain remission, defined as resolution of symptoms and endoscopic healing. Treatments for ulcerative colitis include 5-aminosalicylic acid drugs, steroids, and immunosuppressants. Some patients can require colectomy for medically refractory disease or to treat colonic neoplasia. The therapeutic armamentarium for ulcerative colitis is expanding, and the number of drugs with new targets will rapidly increase in coming years.
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              Crohn's disease.

              Crohn's disease is a chronic inflammatory disease of the gastrointestinal tract, with increasing incidence worldwide. Crohn's disease might result from a complex interplay between genetic susceptibility, environmental factors, and altered gut microbiota, leading to dysregulated innate and adaptive immune responses. The typical clinical scenario is a young patient presenting with abdominal pain, chronic diarrhoea, weight loss, and fatigue. Assessment of disease extent and of prognostic factors for complications is paramount to guide therapeutic decisions. Current strategies aim for deep and long-lasting remission, with the goal of preventing complications, such as surgery, and blocking disease progression. Central to these strategies is the introduction of early immunosuppression or combination therapy with biologicals in high-risk patients, combined with a tight and frequent control of inflammation, and adjustment of therapy on the basis of that assessment (treat to target strategy). The therapeutic armamentarium for Crohn's disease is expanding, and therefore the need to develop biomarkers that can predict response to therapies will become increasingly important for personalised medicine decisions in the near future. In this Seminar, we provide a physician-oriented overview of Crohn's disease in adults, ranging from epidemiology and cause to clinical diagnosis, natural history, patient stratification and clinical management, and ending with an overview of emerging therapies and future directions for research.
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                Author and article information

                Journal
                Ann Gastroenterol
                Ann Gastroenterol
                Annals of Gastroenterology
                Hellenic Society of Gastroenterology (Greece )
                1108-7471
                1792-7463
                Sep-Oct 2021
                02 July 2021
                : 34
                : 5
                : 599-611
                Affiliations
                [a ]Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, Hampstead, London, United Kingdom (Alexandros Skamnelos, Nikolaos Lazaridis, Erasmia Vlachou, Nikolaos Koukias, Alberto Murino, Edward J. Despott)
                [b ]Division of Gastroenterology, University Hospital and Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece (Alexandros Skamnelos, Dimitrios Christodoulou)
                [c ]Genesis Hospital of Thessaloniki, Thessaloniki, Greece (Nikolaos Lazaridis)
                [d ]Army Share Funds Hospital (NIMTS), Athens, Greece (Erasmia Vlachou, Periklis Apostolopoulos)
                [e ]Department of Gastroenterology, University Hospital of Patras, Patras, Greece (Nikolaos Koukias)
                Author notes
                Correspondence to: Dr Edward John Despott, MD, FRCP, FEBGH, FASGE, MD(Res), Royal Free Unit for Endoscopy, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, Pond Street, Hampstead, London NW3 2QG United Kingdom, e-mail: edespott@ 123456doctors.org.uk
                Article
                AnnGastroenterol-34-599
                10.20524/aog.2021.0652
                8375652
                34475730
                80a8f515-581d-4ff3-85c7-60e49ed34e26
                Copyright: © Hellenic Society of Gastroenterology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 05 February 2021
                : 14 April 2021
                Categories
                Invited Review

                small-bowel endoscopy,enteroscopy,capsule endoscopy,inflammatory bowel disease,crohn’s disease

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