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    Asian Pacific Association of Gastroenterology (APAGE) Clinical Practice Guidelines on the Use of Small Molecules and IL-23 p19 Inhibitors in Ulcerative Colitis and Crohn's Disease
    (2026-07-01)
    Ooi, Choon Jin
    ;
    Ling, Khoon Lin
    ;
    Limsrivilai, Julajak
    ;
    Wei, Shu Chen
    ;
    Mak, Joyce Wing Yan
    Ulcerative colitis (UC) and Crohn's disease (CD) are increasingly prevalent in the Asia Pacific region, necessitating updated, region-specific guidance on advanced therapies. Targeted small molecule agents, such as filgotinib, tofacitinib, upadacitinib, etrasimod, and ozanimod; and the IL-23 p19 inhibitors (guselkumab, mirikizumab, risankizumab) are the newest advanced therapies in our armamentarium for the treatment of IBD. The aim of the Asia-Pacific consensus statements is to provide context-specific recommendations integrating real-world evidence specific to our region. The Asian-Pacific Association of Gastroenterology (APAGE) Committee on Inflammatory Bowel Disease, with the participation of Asian Education Network in Inflammatory Bowel Disease (AEN-IBD), convened a forum of 34 IBD experts from 12 countries to develop consensus guidelines on the best practices on the use of these new advanced therapies using the modified Delphi method. IL-23 p19 inhibitors have shown good efficacy in biologic-naïve and experienced patients in both UC and CD, with clinical and endoscopic superiority over ustekinumab and an excellent safety profile. JAK inhibitors (tofacitinib and filgotinib) are efficacious in UC, and upadacitinib is efficacious in both UC and CD. They have a rapid time to response, and emerging data on acute severe UC appears promising. However, careful screening and monitoring is needed for known side effects, and prophylactic vaccination for herpes zoster should be considered. S1P modulators (ozanimod, etrasimod) are efficacious in UC with a favorable side effect profile.
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    Optimizing colorectal polyp detection and localization: Impact of RGB color adjustment on CNN performance
    (2025-06-01)
    Jamrasnarodom, Jirakorn
    ;
    Rajborirug, Pharuj
    ;
    Pisespongsa, Pises
    ;
    Pasupa, Kitsuchart
    Colorectal cancer, arising from adenomatous polyps, is a leading cause of cancer-related mortality, making early detection and removal crucial for preventing cancer progression. Machine learning is increasingly used to enhance polyp detection during colonoscopy, the gold standard for colorectal cancer screening, despite its operator-dependent miss rates. This study explores the impact of RGB color adjustment on Convolutional Neural Network (CNN) models for improving polyp detection and localization in colonoscopic images. Using datasets from Harvard Dataverse for training and internal validation, and LDPolypVideo-Benchmark for external validation, RGB color adjustments were applied, and YOLOv8s was used to develop models. Bayesian optimization identified the best RGB adjustments, with performance assessed using mean average precision (mAP) and F<inf>1</inf>-scores. Results showed that RGB adjustment with 1.0 R-1.0 G-0.8 B improved polyp detection, achieving an mAP of 0.777 and an F<inf>1</inf>-score of 0.720 on internal test sets, and localization performance with an F<inf>1</inf>-score of 0.883 on adjusted images. External validation showed improvement but with a lower F<inf>1</inf>-score of 0.556. While RGB adjustments improved performance in our study, their generalizability to diverse datasets and clinical settings has yet to be validated. Thus, although RGB color adjustment enhances CNN model performance for detecting and localizing colorectal polyps, further research is needed to verify these improvements across diverse datasets and clinical settings. • RGB Color Adjustment: Applied RGB color adjustments to colonoscopic images to enhance the performance of Convolutional Neural Network (CNN) models. • Model Development: Used YOLOv8s for polyp detection and localization, with Bayesian optimization to identify the best RGB adjustments. • Performance Evaluation: Assessed model performance using mAP and F<inf>1</inf>-scores on both internal and external validation datasets.
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    Ten missteps in the management of inflammatory bowel disease in Asia: An expert report by the Asian Pacific Association of Gastroenterology Working Group on Inflammatory Bowel Disease
    (2024-08-01)
    Ahuja, Vineet
    ;
    Hilmi, Ida
    ;
    Ye, Byong Duk
    ;
    Ling, Khoon Lin
    ;
    Ng, Siew C.
    Inflammatory bowel disease (IBD) is rapidly emerging in the Asia Pacific region. However, there are many challenges in the diagnosis and management of this condition. The Asian Pacific Association of Gastroenterology (APAGE) Working Group on IBD conducted a round table meeting to identify 10 common mistakes in the management of IBD in Asia. To summarize, many physicians still over rely on a definitive histological diagnosis before starting treatment and do not fully establish disease extent such as perianal and proximal gastrointestinal involvement in Crohn's disease (CD) or extent of involvement in ulcerative colitis (UC). It is also essential to actively look for evidence of extra-intestinal manifestations, which may influence choice of therapy. In terms of conventional therapy, underuse of topical 5 aminosalicylates (5-ASAs) in UC and inappropriate dosing of corticosteroids are also important considerations. Acute severe UC remains a life-threatening condition and delay in starting rescue therapy after inadequate response to intravenous steroids is still common. Anti-tumor necrosis factors should be considered first line in all cases of complex perianal fistulizing CD. Most patients with IBD are on potent immunosuppressive therapy and should be screened for latent infections and offered vaccinations according to guidelines. Under-recognition and management of significant complications such as anemia, osteoporosis, malnutrition, and thromboembolism should also be addressed. Colonoscopy is still not properly performed for dysplasia/cancer surveillance and for evaluating post-op recurrence of CD. Another common misstep is inappropriate withdrawal of medications during pregnancy leading to increased complications for the mother and the newborn.