Vedran Tomašić

Background/Objectives: Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of various malignancies, but their use is frequently accompanied by immune-related adverse events, among which immune-mediated colitis (IMC) represents one of the most common and clinically significant gastrointestinal toxicities. IMC may lead to treatment interruption, increased morbidity, and compromised quality of life. This review aims to provide a comprehensive overview of the pathophysiology, risk factors, diagnosis, management, and emerging therapeutic strategies with particular emphasis on the role of the gut microbiota and fecal microbiota transplantation (FMT). Methods: This review integrates current international guidelines, meta-analyses, clinical trials, and recent translational studies addressing IMC. The available evidence on immunological mechanisms, predictive biomarkers, clinical presentation, diagnostic algorithms, and treatment options was critically synthesized to outline a structured and multidisciplinary management approach. Results: IMC is driven by dysregulated immune activation, cytokine release, and alterations in gut microbiota. Incidence and severity vary according to ICI class, combination regimens, tumor type, and patient-related factors. Diagnosis requires exclusion of infectious causes, laboratory assessment, and endoscopic and histologic evaluation with CTCAE-based severity grading. Corticosteroids remain the cornerstone of first-line therapy, while infliximab and vedolizumab are effective in steroid-refractory cases. Emerging therapies, including JAK inhibitors and FMT, have shown promising results in refractory disease. Conclusions: IMC is a complex and potentially severe complication of ICI therapy that necessitates early recognition, accurate grading, and individualized, multidisciplinary management. Severity-guided treatment, timely escalation to biologics, and careful balancing of immunosuppression with antitumor efficacy are essential for optimal outcomes. Future research should focus on biomarker validation, microbiome-targeted therapies, and prospective trials to refine therapeutic algorithms and define the optimal role and timing of FMT in clinical practice.

BACKGROUND Increasing age is a major risk factor for colorectal neoplasia, with older adults showing a higher incidence of adenomas compared to individuals under 60 years. Early detection of colonic adenomas and polyps significantly reduces the risk of colorectal cancer. Key quality indicators for colonoscopy include the adenoma detection rate (ADR), polyp detection rate (PDR), and cecal intubation rate (CIR). However, studies comparing these metrics in elderly patients deeply sedated with propofol vs those undergoing colonoscopy without sedation show mixed results. AIM To evaluate deep propofol sedation vs no sedation impact on ADR, PDR, and CIR in elderly patients undergoing screening colonoscopy. METHODS This retrospective cohort study included adults over 60 years who underwent their first screening colonoscopy between January 2017 and September 2023. Exclusion criteria were emergency procedures, inflammatory bowel disease, procedures performed for therapeutic intent, and inadequate bowel preparation [Boston Bowel Preparation Scale (BBPS) score below 6]. Normality was tested by the Kolmogorov-Smirnov test; continuous variables were compared by the Mann-Whitney U test, categorical variables using the χ 2 or Fisher’s exact test. Binary logistic regression identified significant outcome predictors. RESULTS A total of 2034 patients (46.4% female; mean age: 70 years) were included, of whom 622 (30.6%) underwent colonoscopy under deep sedation. The overall PDR was 51.65%, ADR was 33.3%, and CIR was 94.25%. After adjusting for confounders [age, sex, body mass index (BMI), BBPS, operation, and diverticulosis], no significant differences were observed in PDR (51.8% vs 51.5%), ADR (33.5% vs 32.5%), or CIR (93.2% vs 95.3%) between the no-sedation and deep-sedation groups. Higher BMI (B = 0.96, P < 0.01) and male sex (B = 0.64, P < 0.01) were independent predictors of higher ADR. CONCLUSION In this elderly cohort, propofol-induced deep sedation did not significantly improve ADR, PDR, or CIR. Further research is warranted to clarify its effect on colonoscopy quality metrics in older populations.

Mucosal healing is an important therapeutic target in ulcerative colitis (UC) because it is associated with improved clinical outcomes and sustained remission. Conventional white-light endoscopy has limitations, including subjective interpretation, interobserver variability, and difficulty detecting residual microscopic inflammation despite an apparently healed mucosa. Image-enhanced endoscopy (IEE) techniques improve visualization of mucosal and vascular patterns, potentially enhancing the assessment of inflammation and healing in UC. Modalities such as narrow-band imaging, linked-color imaging, blue laser imaging, dual-red imaging, texture and color enhancement imaging, and iSCAN accentuate vascular structures and subtle color differences, allowing more precise differentiation between complete and partial healing. These methods correlate strongly with histological inflammation and better predict clinical relapse compared with conventional scoring systems such as the Mayo Endoscopic Subscore. Quantitative IEE-based indices, including the linked-color imaging index, Paddington International virtual ChromoendoScopy ScOre, and Mucosal Analysis of Inflammatory Gravity by iScan TE-c Image score, provide reproducible and objective measurements that reduce subjective variability. Next-generation endoscopic platforms combining advanced IEE technologies enable real-time, high-resolution evaluation of mucosal microarchitecture and vascular regeneration. This facilitates personalized management by detecting residual inflammation earlier, improving monitoring, optimizing treatment decisions, and ultimately enhancing long-term outcomes while lowering relapse rates in UC patients.

Background/Objectives: Immune checkpoint inhibitors (ICI) represent a significant breakthrough in cancer management, but they can cause adverse effects such as immune-mediated colitis (IMC). The standard first-line treatment is corticosteroids, and second-line treatment is infliximab or vedolizumab. However, a proportion of immune-mediated colitis (IMC) cases are refractory to immunosuppressive treatment, which has led to the exploration of novel approaches such as fecal microbiota transplantation. Methods: We present two patients who both developed grade III IMC following application of durvalumab and pembrolizumab, respectively. Both patients were refractory to corticosteroid therapy, while the first one also showed no improvement to infliximab. We performed two separate applications of FMT on both patients, from different donors, as a rescue treatment. Results: After unsuccessful immunosuppressive treatment and following rescue FMT, both patients demonstrated a rapid and sustained improvement in inflammatory markers, clinical symptoms, quality-of-life scores, and colonoscopy findings, without additional immunosuppressive treatment. Conclusions: FMT appears to be safe and a potentially effective treatment option for patients with refractory IMC both as second- and third-line therapy options. Continued efforts toward rigorous donor screening, use of standardized biobanks, and standardizing FMT protocols will further enhance safety and reproducibility.

Background/Objectives: Inflammatory bowel disease (IBD) is a chronic gastrointestinal disorder marked by relapsing episodes of gastrointestinal inflammation, potentially causing severe symptoms. These unpredictable acute episodes, paired with chronic disabilities, such as fatigue and malabsorption, and extensive pharmacological and surgical treatments, can severely impact patients’ quality of life. This study aimed to assess which aspects of the patients’ lives IBD impacts, and how IBD patients perceive their disease. Methods: All IBD patients who had an appointment in our tertiary centre from 10 October 2022 to 21 February 2023, were invited to complete anonymous questionnaires. The questionnaires used were IBDQ-32, WPAI, and IBD Disk, all designed specifically to assess the IBD patients’ quality of life. Results: The questionnaires were completed by a total of 159 participants, 51% of whom were males, 47.9% who had UC, and 49.4% who had been or were currently treated with biologics. There was no statistically significant difference in the answers from patients with CD compared to UC, as well as those treated with conventional therapies compared to those with advanced options. Most of them considered their health to be good, but only a few (12.8%) claimed, with absolute certainty, that their health was at the level of healthy individuals, and only 13 (8.3%) claimed their health was excellent. A total of 95 (60.1%) participants expressed at least minor limitations when performing strenuous activities, but lighter forms of activities were not affected as much by the disease. A significant portion (48.7%) of the participants believed they were exposed to more stress than others, and their current pharmacological therapy was the cause of fear in 26.5%. A total of 119 (75.3%) participants believed that the disease affected their lives at least mildly during remission. Conclusions: Our study showed that IBD patients have diminished quality of life, not only in the periods of active disease but also during clinical remission. The decline in quality of life was not solely attributed to physical symptoms, as previously thought. Other factors, such as mental health issues, were found to impact quality of life as well. We firmly believe that restoring quality of life should be emphasised in guidelines as one of the most important therapeutic goals.

The global incidence and age-standardized prevalence rate of ulcerative colitis (UC) is increasing worldwide. It is a debilitating and lifelong inflammatory disease affecting both pediatric and adult patients. Thus, it is important to focus on modern treat-to-target approach, based on a tight control of the disease with close monitoring through interval assessments and modification of the treatment. Endoscopy remains the key method for UC assessment, but recent guidelines focus on implementation of non-invasive methods for UC diagnosis and management such as biomarkers (C-reactive protein, fecal calprotectin, and fecal lactofferin) and imaging methods (intestinal ultrasound). We summarize the diagnostic performance of non-invasive tests and present current evidence-based non-invasive strategy recommendations for UC monitoring.

Background: Severe acute respiratory syndrome coronavirus 2 pandemic is affecting public health systems and mental health significantly. Patients with inflammatory bowel disease are witnessing vigorous organizational changes in inflammatory bowel disease centers and experiencing all psychosocial effects of the crisis. We conducted a single-center cross-sectional study in order to assess inflammatory bowel disease patients’ concerns, behavior, and satisfaction with provided healthcare during severe acute respiratory syndrome coronavirus 2 pandemic. Methods: All inflammatory bowel disease patients treated in our center from April 1 to June 1, 2020, were invited to fulfill an anonymous online questionnaire. Results: A total of 132 participants have completed the questionnaire, 63.2% were female, 57.9% had Crohn’s disease (CD) During the first wave of the pandemic, 74.2% of participants perceived themselves as a high-risk group for acquiring coronavirus disease 2019 only because they suffered from inflammatory bowel disease, and 66.2% thought inflammatory bowel disease medications make them more susceptible to coronavirus disease 2019. This especially concerned patients treated with biologics (B = 2.068, P < .01). Females were more stressed (B = −1.451, P < .01) and concerned (B = −1.488, P < .01) about the pandemic, and they also reported more potential benefits from professional psychological help (B = −2.664, P = .02). Six patients (5.3%) discontinued inflammatory bowel disease therapy on their own initiative. Seventy-eight (68.4%) patients were completely satisfied and 14 (12.3%) were partially satisfied with the quality of healthcare provided in our inflammatory bowel disease center. Conclusion: Female inflammatory bowel disease patients tend to be more emotionally vulnerable during severe acute respiratory syndrome coronavirus 2 pandemic. Although psychological support should be continuously available to all inflammatory bowel disease patients, female gender may warrant special attention. Providing patients with adequate and early information during pandemic probably leads to better compliance and higher satisfaction. Cite this article as: Hrabar D, Cacic P, Biscanin A, et al. IBD patients’ perception of severe acute respiratory syndrome coronavirus 2 pandemic and satisfaction with provided healthcare: A cross-sectional study. Turk J Gastroenterol. 2022;33(3):190-195.

The hypothesis of the study was that polymorphisms in promoter regions -238 and -308 of TNF-α could be associated with different clinical outcomes in inflammatory bowel diseases (IBD) and immune-mediated rheumatic diseases (IMRD). The aim was to examine the possible association of both polymorphisms with concentration of C-reactive protein (CRP) and fecal calprotectin (fCAL), onset of the remission and development of the ADA in patients on therapy with anti-TNF inhibitors. The prospective study was done in patients with IBD and IMRD on infliximab (IFX) or adalimumab (ADM). Patients were genotyped for TNF-α -238 and -308 polymorphisms. The concentration of CRP, fCAL, IFX or ADM and antibodies to drugs were measured according to manufacturer’s instructions and followed-up for 6 or 12 months. Out of all patients (N = 112), number of patients in remission did not differ according to genotypes (for IBD patients P = 0.509 vs 0.223; for IMRD patients P = 0.541 vs 0.132 for TNF-α -238 and -308, respectively). Initial CRP concentration was higher in IBD patients with TNF-α -308 GG than GA/AA genotypes in patients who failed to achieve remission [11.8 (4.4–39.6) vs 3.1 (1.5–6.5), P = 0.033]. In IBD patients with remission, fCAL concentration after at least 6 months of therapy was higher in TNF-α-308 GG than in GA genotype [52 (25–552) vs 20 (20–20) µg/g, P = 0.041]. Our results showed the association of TNF-α -308 GG genotype with a higher concentration of CRP and fecal calprotectin in patients with inflammatory bowel diseases on IFX or ADM therapy. Clinical remission and development of antibodies to anti-TNF drugs were not associated with TNF-α -238 and -308 polymorphisms.

The spectrum of non-alcoholic fatty liver disease (NAFLD) ranges from simple steatosis through steatohepatitis to advanced fibrosis and cirrhosis. Although the reason why only a minority of patients develop progressive forms of disease still remains largely unclear, recent research has identified genetic factors as a possible basis for this variation in disease presentation. Most of the studies have been focused on finding associations between advanced disease forms and selected single nucleotide polymorphisms in genes encoding various proteins involved in disease pathogenesis. Although there are many limitations regarding the study design and interpretation of published data, further carefully planned studies together with implementation of new genetic technologies will likely bring new insights into disease pathogenesis and potential benefits to the management of patients with NAFLD.