Qazi Corner, Edition 5: Tofacitinib, Fenofibrates, Pouchitis Guidelines and BLUE-C

Taha Qazi, MD

It is my pleasure to present the first issue Qazi’s Corner of 2024. Over the course of the year, we will continue to highlight important research in gastroenterology, presented at major meeting and conferences, as well as any clinically relevant research publications that can be directly applied to the management of patients in gastroenterology.

In the current version of the publication, we present recent data on the new guidelines for the management of inflammatory conditions of the pouch and pouchitis. In recognition of Colorectal Cancer Awareness month, we also present the result of a new generation multi-DNA target stool test for colon cancer and advanced neoplasia (BLUE-C), initially presented at the American College of Gastroenterology (ACG) 2023 Annual Meeting, but recently published in The New England Journal of Medicine. Ravi Shah, MD, returns to present the results of tofacitinib in the management of acute severe ulcerative colitis (ASUC), and Jeffrey Schwartz, MD, presents on the use of fenfibrates for the management of primary biliary cholangitis (PBC).

Shah, a third-year clinical fellow, describes new evidence for the use of tofacitnib for the management of ASUC. There are limited data on the medical management of acute severe colitis, with the commonly used agents being cyclosporine, infliximab and intravenous corticosteroids. Tofacitinib, an oral non-selective Janus-kinase (JAK) inhibitor, presents a novel means to manage hospitalized patients with severe colitis.

Schwartz, a second-year clinical fellow, reports on a recent trial on the use of fenofibrates in PBC, a chronic autoimmune condition that presents as non-suppurative bile duct injury resulting in eventual fibrosis. In comparing fenofibrates combination therapy with ursodiol to ursodiol alone, the authors of the study reported a higher proportion of biochemical response in patients treated in the combination arm. Fenofibrates appear to show promise as a potential therapeutic agent alongside ursodiol for the management of PBC.

The management of inflammatory conditions of the pouch or ileal-pouch anal anastomosis (IPAA) are complicated by increased variability in practice. In synthesizing the guidelines for management of IPAA inflammatory conditions, the authors of the guidelines hoped to standardize definitions of these conditions and provide a better understanding on the management of inflammatory pouch diseases.

Lastly, despite being the second leading of cause of cancer deaths, colorectal cancer screening adherence continues to not reach targets instructed but our national societies. In the last study presented, I review the BLUE-C study reviewing the role of a next generation multi-target DNA stool test for the sensitivity and specificity of detecting colorectal cancer, advance neoplasia, and dysplasia. Without sacrificing sensitivity, the newer generation stool tests was highly specific in the evaluation of CRC and advanced neoplasia, especially in a younger cohort of patients, representing another non-invasive strategy for CRC screening.