Background: Due to the rapid development of new diagnostic and therapeutic endoscopic techniques, there has been a gap between their development and implementation in daily practice, as well as in their uptake in guideline recommendations1. We investigated the effectiveness of spectral focused imaging (SFI), a new optical chromoendoscopy system (SonoScape, Shenzhen, China)2, in diagnosing subtle mucosal changes in patients with inactive ulcerative colitis.

Materials and Methods: A group of 12 patients with quiescent ulcerative colitis were randomly assigned at a 1:1 ratio to undergo colonoscopy with high-definition white light (group A) or SFI (group B). The mucosal pattern, location of the mucosal changes (measured in centimeters from the anal verge), morphology, size and duration of the endoscopic procedure were recorded, while the disease activity was established following the Mayo endoscopic score for ulcerative colitis. Subsequent to the endoscopic characterization, targeted biopsies (or random biopsies in a case of normal colonic mucosa) were obtained from every segment for histopathological follow-up analysis.

Results: The median endoscopic activity index, based on the Mayo ulcerative colitis endoscopic score, was 1 for both groups of patients. Taking into account the duration of the examination, the median value was 17.3 minutes in group A and 18.5 minutes in group B Upon examining the concordance between the endoscopic prediction of disease activity and the histological findings, we obtained a 55% degree of conformity in group A, compared to 90% in group B. Conclusions: This pilot study showed that image-enhanced endoscopy using SFI might increase the rate of detection and demarcation for subtle inflammatory changes in the mucosa, correlating with potential histologic activity. Furthermore, this diagnostic tool could provide a more accurate and earlier identification of areas of minimal inflammation than conventional techniques.

Diverticulosis is a chronic acquired disease defined by the presence of diverticular protrusions throughout the wall layers of the digestive tract. Colonic diverticular disease is defined as clinically manifest or symptomatic diverticulosis, either by inflammation, diverticular bleeding or segmental colitis. It is a frequent cause of hospitalization in industrialized countries and also makes a major contribution to health care costs. Due to the spread of the Western-style diet, low in fibre and high in processed foods, the prevalence of diverticulosis is now increasing globally. Obesity is a significant risk factor contributing to the increased prevalence of both diverticular disease and diverticulitis and its complications, particularly in the younger population, previously considered to be at much lower risk than the geriatric population. Diverticulitis occurs when one or more diverticula, together with adjacent colonic tissue, undergo an inflammatory process. Approximately 15% of patients who suffer an episode of acute diverticulitis will experience complications, the most common of which is peridiverticular abscess, which can be complicated by peritonitis. Less common complications are colonic lumen stenosis and fistulae. Being a relatively common disease in the general population, with a constantly increasing prevalence, and also a disease with potentially reducible complications, especially in the case of frail patients with multiple comorbidities, it is necessary not only to update the therapeutic strategies, but also to set up multidisciplinary medical teams in which communication between the specialists involved results in a personalized approach to each case.

Background: Growing insights into complex molecular pathways involved in the pathogenesis of inflammatory bowel diseases (IBD) have led to advent of new treatment options. Currently, there are three classes of biological agents approved for the treatment of IBD: anti-tumor necrosis factor agents (anti-TNFs), vedolizumab (VDZ) and ustekinumab. Each of these molecules have different targets in the inflammatory process, inhibiting specific mediators. Since the therapeutic options tend to increase and become more and more variate, it would be important to establish predictive markers of response to choose the best therapeutic option for the most suitable patient. Nowadays, the concept of „personalized medicine” which means selecting the right drug for the right person at the right time based on the characterization of an individual’s phenotype and genotype seems to be more reasonable and tends to replace the strategy “one drug suits all” that we used for many years.

Aim: To present the currently available data regarding the clinical predictors of response not only to anti-TNFs, but also to VDZ and ustekinumab.

Methods: A literature search was performed in PubMed to identify publications reporting on predictive factors of response to biologic therapy in patients with IBD, using pre-defined keywords. We selected RCTs, observational studies, reviews and meta-analyses.

Results: For anti-TNF agents most of the evaluated factors have not proved to be accurate enough as to enter daily clinical practice as a decisive tool to enable an individualized therapeutic approach. Factors identified as potential predictors include disease behavior/ phenotype, disease severity, CRP, prior anti-TNF exposure, but the results were variable and sometimes conflicting. For VDZ, even more discouraging results were obtained, with only few factors (disease severity and prior anti-TNF exposure) showing limited value. Regarding ustekinumab, no predicting factor has been reported yet to be helpful in clinical practice.

Conclusion: Current scientific results cannot establish a single biomarker that fulfills all criteria for being an appropriate prognostic indicator for response to any biological treatment in IBD. Further research is needed to identify new and more reliable predictors or to better evaluate the existing ones.