Dysplasia is a precancerous lesion of colorectal cancer in patients with long-standing inflammatory bowel diseases (IBDs), such as ulcerative colitis and Crohn’s disease. Recent guidelines suggest endoscopic resection as a key modality for the treatment of endoscopically resectable dysplasia in patients with colitis. Endoscopic submucosal dissection (ESD) has been suggested as one of the therapeutic options for dysplasia that is potentially resectable but not suitable for the conventional endoscopic mucosal resection technique. Several recent studies supported the feasibility of ESD for the treatment of colitis-associated dysplasia in terms of the en bloc and complete resection rates and the risk of procedure-related complications. However, these studies were performed exclusively in expert centers. Moreover, the local and metachronous recurrence rates were relatively high, and long-term outcome data are still lacking. Endoscopists should be highly skilled in colorectal ESD and have an intensive understanding of not only the lesions but also the conditions of patients with IBDs. Therefore, the decision to perform ESD for colitis-associated dysplasia should be made scrupulously after careful discussion with patients, in collaboration with a multidisciplinary IBD team including physicians, surgeons, and pathologists specialized in IBDs.

Background: Liver cirrhosis contributes to high liver-related mortality globally. Systemic inflammation mediated by immune cells contributes to the progression of liver cirrhosis. Growing evidence shows that several pro- and anti-inflammatory cytokines might have an important role in liver cirrhosis. Objective: To evaluate the association between serum IL-6, IL-10, IL-12, and IL-23 levels and severity of liver cirrhosis. Methods: This observational study was carried out at the Department of Internal Medicine, Universitas Sumatera Utara, Indonesia from March 2018 to August 2019. The severity of liver cirrhosis was assessed by using the Child-Pugh score. IL-6, IL-10, IL-12, and IL-23 levels, hepatitis and renal function were measured in all study subjects. Independent t-test and Mann-Whitney tests were conducted to observe differences between groups. Results: A total of 78 liver cirrhosis patients were enrolled, mean age was 50.6±11.4. Median serum IL-6, IL-10, IL-12, and IL-23 levels were 24.5(2.6-46.4)pg/ml, 2.1(0.4-9.3)pg/ml, 3.5(1.4-20.8)pg/ml and 20.3(9.2-218)pg/ml, respectively. A higher IL-6 level was associated with more severe liver cirrhosis (p=0.001) and the presence of hepatic encephalopathy (p=0.018). Higher IL-23 level was found in patients with no hepatic encephalopathy (p=0.049). There was no association between serum cytokines levels and hepatitis viral infection status. Conclusion: IL-6 is associated with the severity of liver cirrhosis.

Prisoners in correctional facilities are predisposed to chronic viral infections because of their high-risk behaviors or unsafe lifestyle. The economic and public health burden of chronic hepatitis B and C and its sequelae need to be addressed, such as by finding the risk factors and therefore reducing the spread of HCV and HBV infection in prisons. This study aimed to see the profile of Hepatitis B and C Virus Infection in prisoners in Lubuk Pakam Correctional Facilities. This cross-sectional study was in Lubuk Pakam Correctional Facilities in 2016. From 1114 prisoners in Lubuk Pakam correctional facility, we randomly examined 120 prisoners for HBV and HCV serology markers. From 120 prisoners, six prisoners were HBV positive, 21 prisoners were HCV positive and one prisoner positive for both HCV and HBV infection. The most common risk factors for prisoners getting HBV infection are tattoos and free sex (36.4% and 36.4%, respectively). The most common risk factors for HCV infection in prisoners are tattoos and free sex (40% and 35%, respectively).

Background Crohn′s disease (CD) is a progressive inflammatory bowel disease that can lead to complications such as strictures or penetrating disease, and ultimately surgery, representing a complex clinical challenge in the care of patients. We aimed to evaluate the influence of CD phenotype in the retention rate of ustekinumab in the Sustain study. Methods Retrospective, multicentre study (>60 sites) including patients with active CD [(Harvey-Bradshaw (HBI)>4)] who received ≥1 dose of ustekinumab intravenously before July 2018. Clinical remission was defined as HBI≤4 and response as ≥3 points decrease from baseline. Loss of response (LoR) was defined as reappearance of symptoms that led to intensifying the treatment dose, adding another medication to control CD, switching or surgery in patients with short-term remission. Disease characteristics were collected (date of diagnosis; location; behaviour: inflammatory, stenosing or penetrating; presence of perianal disease or extraintestinal manifestations; previous surgeries, etc.). The retention rates in patients on ustekinumab depending of their disease phenotype were evaluated by descriptive analysis and Kaplan-Meier survival curves. Survival curves were compared using the log-rank test. Predictive factors were assessed by Cox-regression. Data quality was assured by remote monitoring. Results 463 CD patients were included (Table 1). 87 patients (18.6%) had penetrating CD in our cohort. The probability of maintaining UST treatment was 91% at 6, 83% at 12, 76% at 18 and 73% at 24 months. Similar retention rates were observed in patients with inflammatory (77.6%), stricturing (76.4%) and penetrating (79%) disease behaviour (p>0.05). Figure 1. Conclusion Ustekinumab has shown to be equally effective in the treatment of inflammatory, stricturing and penetrating CD phenotype in Sustain, the largest study evaluating its use in CD in clinical practice, having the longest follow-up period reported to date.

Background Biological treatments used for the treatment of inflammatory bowel disease (IBD) have demonstrated their efficacy and safety, although these results were obtained from studies that mostly include young people generally included in clinical trials. The objective of our study is to assess the efficacy of these treatments in the elderly population in real life Methods Patients have been retrospectively included with established diagnosis of IBD aged 65 years or older at the time of initiating biological treatment(Infliximab, Adalimumab, Golimumab, Ustekinumab or Vedolizumab).Among the patients included, the clinical response (at the discretion of the researcher)after induction(around 12 weeks of treatment)and at 52 weeks was assessed.When that were available, the data related to endoscopic response at week 52 were collected(endoscopic activity was classified as moderate, mild or severe, according to the researcher) Results A total of 1090 patients were included(707 CD and 383 UC).The indication for biologic in our experience was lack of response to immunosuppressants(292, 27.1%), corticodependence(318, 29.5%), perianal disease(31, 2.9%), treatment for postoperative recurrence(76, 7.0%), severe corticorefractory ulcerative colitis(59, 5.5%), others(303, 28.1%).After induction, at approximately 12–14 weeks of treatment, 419(39.6%) were in clinical remission, 502(47.4%) had a response without remission, and 137 patients(12.9%) had no response.The percentages of remission with the different biologics were: infliximab 159 patients(42.6%), adalimumab 118 patients (38.4%), golimumab 9 patients(32.1%), ustekinumab 50(32.7%), vedolizumab 84(40.6%)(p = 0.3).At 52 weeks of treatment 442 patients(50.63%) clinical remission, 249 patients had a response (28.5%) and 53 patients had no response (6.1%). Before one year of treatment, 129 patients(14.8%) had suspended treatment due to ineffectiveness, being significantly higher(p <0.0001) for golimumab 9 patients(37.5%) compared to the rest of the biological treatments analyzed.We analyzed the percentages of clinical response to the different biological treatments, without identifying statistically significant differences between the remission rates: infliximab 160 (51.3%), adalimumab 131(50.9%), golimumab 10(41.7%), ustekinumab 49(44.9%) and vedolizumab 92(53.8%).In colonoscopy at 52 weeks(performed 218 patients), 35.8% endoscopic remission(78 patients), 32.1% mild activity(70 patients), 26.1% moderate activity(57 patients) and 6.0% severe activity(13 patients). Conclusion Biological drugs have response rates in elderly patients similar to those described in the general population. In our experience, golimumab was the drug that had to be discontinued most frequently due to ineffectiveness.