Colitis Induced by Immune-checkpoint Inhibitors

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  • Yanai Shunichi
    Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University
  • Sugai Tamotsu
    Department of Diagnostic Pathology, Iwate Medical University
  • Matsumoto Takayuki
    Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University

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  • V．免疫チェックポイント阻害薬による大腸炎

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<p>As immune-checkpoint inhibitors （ICI） are becoming standard therapies for various malignant tumors, increasing attention has been paid to their associated immune-related adverse events （irAEs）. The gastrointestinal tract is the major site of irAEs, and it has recently become evident that the large bowel is the most frequently affected region. Endoscopic findings of ICI-induced colitis include a reddish, edematous mucosa with increased mucous exudate, loss of normal vascularity and a granular mucosa. Histopathologic findings of ICI-induced colitis are expansion of the lamina propria, intraepithelial infiltration of neutrophils, crypt architectural distortion, neutrophilic crypt abscess and prominent apoptosis. The clinical, endoscopic and histopathological severity of ICI-induced colitis varies, but colonoscopy together with biopsy is essential for diagnosis. Colonoscopy with biopsy is the gold standard for the diagnosis of ICI-induced colitis. Endoscopists should be aware of the clinical features and pathophysiology of ICI-colitis for the prompt diagnosis and decision-making for treatment. Further prospective studies are needed to assess the efficacy of various medications including immunosuppressive regimens.</p>

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