000170419 001__ 170419
000170419 005__ 20260420103355.0
000170419 0247_ $$2doi$$a10.3390/gastroent17010020
000170419 0248_ $$2sideral$$a148879
000170419 037__ $$aART-2026-148879
000170419 041__ $$aeng
000170419 100__ $$aPolo Cuadro, Cristina
000170419 245__ $$aImmune-mediated colitis in the era of immune checkpoint inhibition: from mechanisms to clinical management
000170419 260__ $$c2026
000170419 5060_ $$aAccess copy available to the general public$$fUnrestricted
000170419 5203_ $$aImmunotherapy with immune checkpoint inhibitors (ICIs) has represented a major breakthrough in the treatment of multiple solid and hematological malignancies, significantly improving survival and tumor control. However, the blockade of immune regulatory pathways such as cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death protein 1/programmed death-ligand 1 (PD-1/PD-L1) is associated with the development of immune-related adverse events, among which immune-mediated colitis (IMC) constitutes one of the most relevant gastrointestinal complications due to its frequency, potential severity, and impact on the continuation of oncologic treatment. IMC typically presents with diarrhea, abdominal pain, and gastrointestinal bleeding, and may progress to severe, life-threatening forms. Its incidence varies according to the type of ICI, and is higher with CTLA-4 inhibitors and particularly elevated with combination therapies. The pathophysiology is complex and multifactorial, involving dysregulated activation of proinflammatory T lymphocytes, impairment of immune regulatory mechanisms, disruption of the intestinal epithelial barrier, and a key modulatory role of the gut microbiota. Diagnosis requires a high index of clinical suspicion and relies on endoscopy with biopsies, given the poor correlation between clinical severity and endoscopic or histological findings. Fecal biomarkers, such as calprotectin and lactoferrin, are useful for risk stratification and disease monitoring. Treatment is based on a stepwise immunosuppressive approach, with corticosteroids as first-line therapy and biologic agents such as infliximab or vedolizumab in refractory cases. Emerging strategies, including fecal microbiota transplantation, offer new therapeutic perspectives. This article provides a comprehensive review of the current evidence on the epidemiology, pathophysiology, diagnosis, and management of IMC, as well as future challenges and opportunities in its clinical management.
000170419 536__ $$9info:eu-repo/grantAgreement/ES/ISCIII JR24-00033
000170419 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttps://creativecommons.org/licenses/by/4.0/deed.es
000170419 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000170419 700__ $$aCorsino Roche, Pilar
000170419 700__ $$0(orcid)0000-0002-6811-6654$$aGascón Ruiz, Marta$$uUniversidad de Zaragoza
000170419 700__ $$0(orcid)0000-0003-3970-5457$$aGarcía López, Santiago$$uUniversidad de Zaragoza
000170419 700__ $$aYagüe Caballero, Carmen
000170419 700__ $$aRoyo Esteban, Ana
000170419 700__ $$aAlmenara Michelena, Laura
000170419 700__ $$0(orcid)0000-0001-6883-8940$$aCasas Deza, Diego
000170419 7102_ $$11007$$2610$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Medicina
000170419 773__ $$g17, 20 (2026), 23$$tGastroenterology Insights$$x2036-7422
000170419 8564_ $$s1268588$$uhttps://zaguan.unizar.es/record/170419/files/texto_completo.pdf$$yVersión publicada
000170419 8564_ $$s2543933$$uhttps://zaguan.unizar.es/record/170419/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000170419 909CO $$ooai:zaguan.unizar.es:170419$$particulos$$pdriver
000170419 951__ $$a2026-04-18-10:49:13
000170419 980__ $$aARTICLE