Academic trend at home and abroad

Advances in study on the diagnosis and treatment of small intestinal diseases in 2023

Expand
  • Department of Gastroenterology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received date: 2023-12-10

  Online published: 2024-07-04

Abstract

In 2023, multiple important discoveries and breakthroughs have been made in the field of small intestine diseases, and database-based global epidemiological study on small intestinal cancer was first released. It showed that the global incidence rate of small intestinal cancer in 2020 was 0.6/100 000, which was on an upward trend compared with the average incidence rate from 2010 to 2020 (average annual change percentage in different continents, 2.20% to 21.67%). The burden of small intestinal cancer was geographic disparity, and age-standardized incidence rate (1.4/100 000) was highest in North America. The incidence rate of small intestinal cancer in China was 0.32/100 000 for men and 1.95/100 000 for women. Risk factors for small bowel cancer (β = 0.008 to 0.198; OR = 1.07 to 10.01) included higher human development index and gross domestic product; smoking and drinking habits; lack of exercise, obesity, diabetes, and lipid metabolism disorders; history of inflammatory bowel diseases. Therapeutically, the combined use of sulindac and erlotinib has been effective in reducing the polyp burden in patients with familial adenomatous polyposis. For Crohn’s disease in the small intestine, in terms of software, AI-assisted endoscopic recognition has been proven to reduce misdiagnosis ,improving medical quality. In terms of hardware, the electric spiral enteroscopy is a double-edged sword. Although it has a higher rate of completing entire small intestine examination, it cannot be widely used in clinical practice until its safety is fully guaranteed. In terms of drugs, with the in-depth understanding of the pathogenesis of the disease, targeted therapy for the inflammatory process has gradually become a research hotspot. Clinical data on small-molecule agents such as upadacitinib and filgotinib are continuously accumulating. In terms of surgery, the latest evidence supports that surgery may become a first-line treatment for specific Crohn’s disease. The diagnosis and treatment of small intestine bleeding are also continuously improving. Thalidomide, as a drug used to treat small intestine bleeding caused by capillary malformations, has brought good news to a large number of patients. In addition, the surgical treatment for small intestine obstruction is gradually being updated, and there are now more accurate prediction models for treatment decisions in patients with small intestine obstruction. Looking ahead, with the continuous development and innovation of medical technology, and artificial intelligence, the diagnosis and treatment of small intestinal diseases will become more precise and efficient.

Cite this article

ZHANG Shuowen, GU Yubei . Advances in study on the diagnosis and treatment of small intestinal diseases in 2023[J]. Journal of Diagnostics Concepts & Practice, 2024 , 23(02) : 119 -125 . DOI: 10.16150/j.1671-2870.2024.02.004

References

[1] HUANG J, CHAN S C, FUNG Y C, et al. Incidence, risk factors, and temporal trends of small intestinal cancer: a global analysis of cancer registries[J]. Gastroenterology, 2023, 165(3):600-612.
[2] SUNADA K, YAMAMOTO H, YANO T, et al. Advances in the diagnosis and treatment of small bowel lesions with Crohn's disease using double-balloon endoscopy[J]. Therap Adv Gastroenterol, 2009, 2(6):357-366.
[3] 张德宇, 彭立嗣, 李诗钰, 等. 《治疗性超声内镜:欧洲消化内镜学会指南》解读[J]. 中华消化内镜杂志, 2022, 39(7):520-527.
  ZHANG D Y, PENG L S, LI S Y, et al. Interpretation of Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) guideline[J]. Chin J Dig Endosc, 2022, 39(7):520-527.
[4] SAMADDER N J, NEKLASON D W, BOUCHER K M, et al. Effect of sulindac and erlotinib vs placebo on duodenal neoplasia in familial adenomatous polyposis: a randomized clinical trial[J]. JAMA, 2016, 315(12):1266-1275.
[5] SAMADDER N J, FOSTER N, MCMURRAY R P, et al. Phase Ⅱ trial of weekly erlotinib dosing to reduce duodenal polyp burden associated with familial adenomatous polyposis[J]. Gut, 2023, 72(2):256-263.
[6] ATREYA R, SIEGMUND B. Location is important: diffe-rentiation between ileal and colonic Crohn's disease[J]. Nat Rev Gastroenterol Hepatol, 2021, 18(8):544-558.
[7] XIE W, HU J, LIANG P, et al. Deep learning-based lesion detection and severity grading of small-bowel Crohn's disease ulcers on double-balloon endoscopy ima-ges[J]. Gastrointest Endosc, 2024, 99(5):767-777.e5.
[8] PAL P, VISHWAKARMA P, SINGH A P, et al. Diagnostic yield and technical performance of the novel motori-zed spiral enteroscopy compared with single-balloon enteroscopy in suspected Crohn's disease: a prospective study (with video)[J]. Gastrointest Endosc, 2023, 97(3):493-506.
[9] PAL P, RAMCHANDANI M, BANERJEE R, et al. Technical performance and diagnostic yield of motorised spiral enteroscopy compared with single-balloon enteroscopy in suspected Crohn's disease: a randomised controlled, open-label study (the MOTOR-CD trial)[J]. Gut, 2023, 72(10):1866-1874.
[10] COLOMBEL J F, UNGARO R C, SANDS B E, et al. Vedolizumab, adalimumab, and methotrexate combination therapy in Crohn's disease (EXPLORER)[J]. Clin Gastroenterol Hepatol, 2023,S1542-3565(23)00746-2.
[11] LOFTUS E V JR, PANéS J, LACERDA A P, et al. Upadacitinib induction and maintenance therapy for Crohn's disease. N Engl J Med, 2023, 388(21):1966-1980.
[12] VERMEIRE S, SCHREIBER S, PETRYKA R, et al. Clinical remission in patients with moderate-to-severe Crohn's disease treated with filgotinib (the FITZROY study): results from a phase 2, double-blind, randomised, placebo-controlled trial[J]. Lancet, 2017, 389(10066):266-275.
[13] D'HAENS G R, LEE S, TAYLOR S A, et al. Filgotinib for the treatment of small bowel Crohn's disease: the DIVERGENCE 1 trial[J]. Gastroenterology, 2023, 165(1):289-292.e3.
[14] RIMOLA J, RODRIGUEZ S, GARCíA-BOSCH O, et al. Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn's disease[J]. Gut, 2009, 58(8):1113-1120.
[15] AGRAWAL M, EBERT A C, POULSEN G, et al. Early ileocecal resection for Crohn's disease is associated with improved long-term outcomes compared with anti-tumor necrosis factor therapy: a population-based cohort study[J]. Gastroenterology, 2023, 165(4):976-985.e3.
[16] TORRES J, MEHANDRU S, COLOMBEL J F, et al. Crohn's disease[J]. Lancet, 2017, 389(10080):1741-1755.
[17] PEYRIN-BIROULET L, LOFTUS E V JR, COLOMBEL J F, et al. The natural history of adult Crohn's disease in population-based cohorts[J]. Am J Gastroenterol, 2010, 105(2):289-297.
[18] NING S B, YANG H, LI B, et al. Balloon-assisted entero-scopy-based endoscopic stricturotomy for deep small bowel strictures from Crohn's disease: First cohort study of a novel approach[J]. Dig Liver Dis, 2023, 55(10):1397-1402.
[19] 中华医学会消化内镜学分会小肠镜和胶囊内镜学组, 国家消化系统疾病临床医学研究中心(上海). 中国小肠出血内镜诊治专家共识意见(2023版)[J]. 中华消化内镜杂志, 2023, 40(12):949-960.
  Enteroscopy and Capsule Endoscopy Group, Digestive Endoscopy Branch of Chinese Medical Association; National Clinical Research Center for Digestive Diseases (Shanghai). Chinese consensus on endoscopic diagnosis and managment of small bowel bleeding (version 2023)[J]. Chin J Dig Endosc, 2023, 40(12):949-960.
[20] GE Z Z, CHEN H M, GAO Y J, et al. Efficacy of thalidomide for refractory gastrointestinal bleeding from vascular malformation[J]. Gastroenterology, 2011, 141(5):1629-37.e374.
[21] CHEN H, WU S, TANG M, et al. Thalidomide for recurrent bleeding due to small-intestinal angiodysplasia[J]. N Engl J Med, 2023, 389(18):1649-1659.
[22] WANG Y C, PAN J, LIU Y W, et al. Adverse events of video capsule endoscopy over the past two decades: a systematic review and proportion meta-analysis[J]. BMC Gastroenterol, 2020, 20(1):364.
[23] JIANG X, QIU X O, LI Z, et al. Small-sized versus standard magnetic capsule endoscopy in adults: a two-center, double-blinded randomized controlled trial[J]. Endoscopy, 2023, 55(1):52-57.
[24] WASSMER C H, REVOL R, UHE I, et al. A new clinical severity score for the management of acute small bowel obstruction in predicting bowel ischemia: a cohort study[J]. Int J Surg, 2023, 109(6):1620-1628.
[25] KROUSE R S, ANDERSON G L, ARNOLD K B, et al. Surgical versus non-surgical management for patients with malignant bowel obstruction (S1316): a pragmatic comparative effectiveness trial[J]. Lancet Gastroenterol Hepatol, 2023, 8(10):908-918.
Outlines

/