Nutritional status in perianal Crohn's disease: are we underestimating the impact?

Symptomatic perianal disease is common in patients with Crohn's disease (CD), and perianal fistulas represent the primary form of anal involvement. This type of involvement is associated with a poor prognosis and a disabling course. The treatment is challenging and involves both surgical and medical approaches. Despite combined therapy, a significant portion of patients may still require proctectomy to control the symptoms. Consequently, investigating factors that may influence the outcome of perianal disease remains a priority area of research in CD. Nutritional deficiencies are well documented among CD patients with luminal forms of involvement and are closely related to poor clinical outcomes, therapy response, and postoperative complications. As a result, leading guidelines recommend regular nutritional assessment and correction of nutritional deficiencies in patients requiring a surgical approach. Despite these recommendations and the high rate of surgeries among CD patients with perianal disease, there is a shortage of studies addressing the real impact of nutritional status on the course and outcomes of perianal disease. This knowledge gap underscores the importance of further research to understand better and improve the management of perianal CD. This narrative review aims to provide an overview of nutritional status assessment and the influence of nutritional status on the outcomes of patients with perianal CD.

Immunoglobulin G4-Associated Cholangitis: Two Case Reports and Clinical Use of Classic and Emerging International Diagnostic Criteria.

Immunoglobulin G4-related disease is a multisystem disorder with unique gastrointestinal tract manifestations, often simulating neoplasms and other inflammatory conditions. Appropriate clinical suspicion and application of internationally validated criteria can assist in making the proper diagnosis. This article describes two cases of patients presenting with biliary tract manifestations simulating lymphoproliferative disease and adenocarcinoma, respectively. Clinical, radiological, and histopathological findings ultimately led to the correct diagnosis, and revealed useful nuances for detection of future cases. Application of specific criteria, such as the classic Japan Biliary Association clinical diagnostic criteria published in 2012 and revised in 2020 as well as the 2019 American College of Rheumatology and European League Against Rheumatism (ACR/EULAR) classification criteria, has limitations but provides important warnings to be considered in the diagnostic journey of these challenging cases.