Inflammatory bowel disease (IBD) is an idiopathic long-term relapsing and remitting disorder including ulcerative colitis and Crohn’s disease. The aim of therapy is to induce and maintain remission. Anti-TNF therapies dramatically improved clinical outcomes but primary failure or secondary loss is a common problem as well as potential side effects potentially limiting efficacy and long-term use. The advent of new targeted agents with the potential for greater safety is welcomed in IBD and offers the potential for different agents as the disease becomes refractory or even combination therapies to maximise effectiveness without compromising safety in the future. More data are required to understand the best positioning in pathways and longer-term safety effects.

Interleukins are considered to be potential therapeutic targets that can alter the prognosis and disease progression of IBD. IL-21 has proven to be involved in effector Th1, Th2 and Th17 responses. Similarly, IL-33, a newly identified cytokine, has been shown to control the Th1 effector response and the action of the colonic Tregs in animal models of colitis and patients with IBD. In this retrospective study, we have studied the expression of these interleukins, using immunohistochemistry, in 121 patients with moderate to severe IBD before and after treatment with biologics. The results were statistically processed using SPSS^TM. Increased IL-21 expression was found in the UC and CD groups versus the controls. The IL-33 expression was found to be increased in the post-treatment UC and CD groups, suggesting a protective role of this interleukin against bowel inflammation. The IL-33 expression post-treatment was reversely correlated with the activity index score in CD patients, suggesting a better response to treatment in patients with higher IL-33 mucosa levels. This is the first immunohistochemical study of the expression of those interleukins in bowel mucosa before and after treatment with biologics. These data support a possibly promising future use of these interleukins as biomarkers of severe disease and response to treatment and as potential therapeutic targets for novel monoclonal antibodies.

The usefulness of virtual chromoendoscopy (VC) in capsule endoscopy (CE) isa controversial issue, with conflicting studies regarding its efficacy. FICE and a blue filter were embedded in the PillCam^TM software, with the aim to assist readers in identifying the source of obscure gastrointestinal (GI) bleeding (OGIB), coeliac disease mucosal changes and other small and large bowel lesions, including polyps and tumors. This review aims to summarize the existing evidence on the value of VC in the visualization and identification of different types of pathology. Overall, VC in CE with FICE 1 and 2 can be a useful adjunctive tool and may increase the visibility of pigmented lesions, such as angiectasias and ulcers. However, it does not appear to improve the detection of polyps or tumors. On the other hand, the role of FICE 3 and the blue filter appears to be limited. FICE may also be helpful in differentiating hyperplastic and adenomatous colonic polyps during colon capsule endoscopy, although more evidence is needed.

Patients diagnosed with Crohn’s disease are increasingly subjected to repeat colonoscopic and radiological examinations to assess the extent of the disease severity and the effects of treatment. Pillcam^TM Crohn’s video capsule, a modified colon capsule, was developed to generate a minimally invasive mouth to rectum video of the gastrointestinal tract. The capsule provides a wide-angle panoramic mucosal view to assess inflammation, ulceration, stenosis, disease extent, and effect of treatment. This review summarizes the evidence of its utility in both adult and paediatric Crohn’s disease and reviews the scoring systems used to quantify findings. The literature survey indicates that the Pillcam^TM Crohn’s capsule offers high sensitivity and specificity for the detection of inflammatory lesions and the extent and distribution of disease, and it could be considered a reliable imaging modality in both adults and childhood with Crohn’s disease.

Background and objectives: Bisphosphonates (BPs) are selective inhibitors of osteoclasts, used for the treatment of bone disorders. The objective of this study is to investigate the possible effects of BPs on the tongue’s mucosa. Materials and Methods: Specimens of the tongue of 20 female 12-month old Wistar rats were taken. Ten were used as control group, while in the remaining alendronate (Fosamax, Merck) was administered per os from 13 weeks. Observation of the harvested samples was made by Transmission Electron Microscopy (TEM). Results: In the experimental group, focal alterations were observed to various extent in all specimens. The basement membrane was intact. Furthermore, an increase at the intercellular space was observed, predominantly at the middle layer, and the desmosomes were disorganized. In the lamina propria focal edema was observed. Conclusions: Investigation on the effect of BPs on the tongue’s mucosa through TEM hasn’t been documented in the past. According to our results, BPs seem to cause mild mucosal lesions on the tongue.