Optimizing outcomes with maintenance IV UST in highly bio-exposed patients with IBD. Efficacy and adjusted regimen in real world

BACKGROUND AND AIMS

Ustekinumab is an effective treatment for inflammatory bowel diseases. However, some patients do not respond to conventional doses. The aim of the study was to evaluate the effectiveness of intravenous maintenance ustekinumab in patients with secondary failure.

METHODS

Single-center, retrospective study in adult patients with intravenous maintenance ustekinumab. The reduction of biochemical activity markers, ustekinumab trough levels and clinical indices of activity were evaluated. Biological remission was defined as the percentage decrease fecal calprotectin ≥80% and/or final fecal calprotectin ≤250 and C reactive protein <5mg/L.

RESULTS

Thirty-one patients were included: Crohn's disease 77.4%. All included patients were bio-exposed and 61.3% had carried ≥2 biologics. Pre-intravenous maintenance mean Harvey-Bradshaw Index was 6.5±4.38 vs 5±3.1 at week 8 (p=0.024) vs 4.1±3.1 at week 24 (p=0.019). The median ustekinumab trough level pre-intravenous maintenance was 1.40μg/ml [IQR 2.3] vs 5.35μg/ml [IQR 4.1] at week 8 (p<0.001) vs 4.8μg/ml [IQR 3.9] at week 24 (p<0.001). The pre-intravenous maintenance median fecal calprotectin was 809μg/g [IQR: 2256] vs 423μg/g [IQR: 999] at week 8 (p=0.025) vs 333μg/g [508] (p=0.001) at week 24. At the end of follow-up 48% went into biological remission. The presence of perianal disease was associated with lower biological remission (70.6% vs 27.3%, p=0.025). Median intravenous ustekinumab maintenance time was 8.55 [IQR 23.9] months. In 83.9% of patients no serious infections or malignancy were documented.

CONCLUSIONS

The use of maintenance intravenous ustekinumab appears to be an effective and safe strategy that can be evaluated as a salvage treatment especially in highly bio-exposed patients.

Effect of Qingchang Yuyang decoction on treatment efficacy and intestinal flora in patients with ulcerative colitis

This study investigates the therapeutic effects of Qingchang Yuyang Decoction on ulcerative colitis (UC) and its impact on intestinal flora. Using existing case records, a retrospective analysis was conducted utilizing clinical data from 96 UC patients (damp-heat syndrome of the large intestine) treated at our hospital between June 2022 and June 2024. Based on the different treatment methods recorded, 50 patients were included in the observation group and 46 in the control group. The control group received conventional treatment (oral sustained-release mesalazine tablets), while the observation group received oral Qingchang Yuyang Decoction in addition to conventional treatment. The efficacy and effects on intestinal flora were compared between the two groups. The change in the modified Mayo score before and after treatment in the observation group was significantly greater than that in the control group (p < 0.001). After treatment, scores for abdominal pain and diarrhea, mucus-pus-bloody stools, tenesmus, anal burning, and short and red urine were significantly lower in the observation group compared to the control group (p < 0.05). Post-treatment, the observation group showed significantly higher levels of IL-10 than the control group, while IL-8 and TNF-α levels were lower in the observation group (p < 0.05). After treatment, Enterococcus and Enterobacter counts in the observation group were lower, while the observation group had higher levels of Bifidobacterium, Butyric Clostridium, and Lactobacillus compared to the control group (p < 0.05). The complication rate was lower in the observation group (p < 0.05). The combination of Qingchang Yuyang Decoction with sustained-release mesalazine tablets can improve the clinical efficacy in UC, significantly alleviate clinical symptoms, reduce the inflammatory response, adjust intestinal flora distribution, and promote recovery, making it worthy of clinical application.

Association between long-term benzene exposure and inflammatory bowel disease in a national cohort: The modifying effect of genetic susceptibility

BACKGROUND

This study aimed to investigate the effects of environmental benzene exposure and its interaction with genetic susceptibility on inflammatory bowel disease (IBD), with a specific focus on ulcerative colitis (UC) and Crohn's disease (CD).

METHODS

A total of 432,727 participants from the UK Biobank who were free of IBD at baseline were included in the analysis. The annual average benzene concentrations during the follow-up period were evaluated by air dispersion models. The study assessed the incidence of IBD in relation to ambient benzene exposure using Cox proportional hazard models and estimated the exposureresponse relationships using restricted cubic spline models. Additive interactions included relative excess risk due to interaction (RERI) and the attributable proportion (AP) to evaluate the interaction between ambient benzene exposure and genetic predisposition.

RESULTS

A significant association was identified between ambient benzene exposure and the incidence of IBD, with hazard ratios (95 % confidence intervals) of 1.06 (1.03, 1.09) for IBD, 1.08 (1.04, 1.12) for UC, and 1.03 (0.98, 1.09) for CD per 0.1 μg/m3 increase. Furthermore, genetic predispositions were found to significantly modify the relationship between ambient benzene exposure and IBD risk. Individuals with the highest genetic risk and benzene exposure had the highest risk of UC.

CONCLUSION

This study provides compelling evidence of the interaction between environmental factors and genetic susceptibility in the pathogenesis of UC. These findings underscore the importance of considering both genetic and environmental influences in future prevention and intervention strategies for IBD.

Crohn's Colitis Care, a Disease-Specific Electronic Medical Record, Enhances Data Capture in Pediatric Inflammatory Bowel Disease Care

Background and Aim

Crohn's Colitis Care, a structured, disease-specific electronic medical record, is proven to promote more complete data capture in adult Inflammatory Bowel Disease care. This study aimed to determine whether similar effectiveness was seen in pediatrics.

Methods

Matched patient records from a hospital's standard electronic medical record (pre-Crohn's Colitis Care) and those in Crohn's Colitis Care were retrospectively reviewed (12 months each). The presence of disease-specific data items per platform were compared (21 core, 5 age-specific). Data are presented as percentage recorded (recorded items/total eligible for age). Descriptive and statistical analytics were used.

Results

Paired records were reviewed for 114 children, of whom 78 (68%) had Crohn's disease and 69 (61%) were male. Median age at diagnosis was 13.5 years (IQR12.0-15.5), with mean disease duration 3.6 years (±2.4). Crohn's Colitis Care was more likely to capture 9 items: general wellbeing, stool urgency and frequency, disease duration, comorbidities, pubertal stage, sexual activity, alcohol and drug usage (each p < 0.05). The standard platform was more likely to capture 4 items: liquid stools, phenotype, disease indices, and vaccinations (each p < 0.05). Crohn's Colitis Care achieved more eligible data items recorded per patient (75.3% ±11.5 vs. 67.7% ± 8.9; p < 0.001). Item completion rate in both platforms inversely correlated with patient age (p < 0.05).

Conclusions

Consistent with findings in adult care, Crohn's Colitis Care achieved more complete disease-data capture in pediatrics compared to a standard platform. Given that not all items were better recorded in the structured platform, work to understand and address barriers is needed to optimize complete data capture for care and research.

Characteristics, risk factors, and disease course of musculoskeletal manifestations in patients with inflammatory bowel disease: a prospective longitudinal cohort study

BACKGROUND

Musculoskeletal manifestations occur in half of the patients with inflammatory bowel disease (IBD) and contribute to a reduced quality of life (QoL) and increased work disability. We aimed to evaluate the natural disease course, characteristics, and risk factors of musculoskeletal manifestations in patients with IBD.

METHODS

We performed a prospective longitudinal cohort study in patients with IBD with and without musculoskeletal manifestations with a 1-year follow-up. Primary outcome was the proportion of patients with resolution of musculoskeletal manifestations. Secondary outcomes included the proportion of patients with IBD that developed new musculoskeletal manifestations during follow-up; the correlation among IBD activity, baseline characteristics, and musculoskeletal disease course; and the difference in QoL between patients with and without musculoskeletal manifestations.

RESULTS

In total, 243 patients with IBD were included (124 with and 119 without musculoskeletal manifestations). In the majority of patients (62.2%), musculoskeletal manifestations were of noninflammatory nature. Overall, peripheral and axial manifestations were persistent in 85.7 and 44.6% at 1 year, respectively. The QoL at baseline and at 1 year was lower in the group with musculoskeletal manifestations compared with patients without these manifestations. Female sex and age above 40 were associated with the presence of musculoskeletal manifestations.

CONCLUSION

Musculoskeletal manifestations in patients with IBD are mostly noninflammatory disorders, persist at 1 year of follow-up, and occur more frequently in patients of age above 40 and female sex. Overall, patients with musculoskeletal manifestations have lower QoL compared with patients without musculoskeletal manifestations.

Overcoming the challenges of overtreating and undertreating inflammatory bowel disease

Several therapeutic advances have been achieved over the past two decades for inflammatory bowel disease (IBD). The expanding therapeutic armamentarium and the increasingly ambitious treatment targets have led to an increased use of advanced therapies and better outcomes. Nevertheless, many patients remain suboptimally treated and are at risk of disease progression, hospital admission, and surgery, even when advanced therapies are cycled, escalated, or combined. Conversely, IBD can also be characterised by an indolent disease course. Top-down and treat-to-target strategies, although beneficial in a substantial proportion of patients, might not be advantageous in patients with mild disease and might risk overtreatment. Identifying patients with mild activity and a benign disease trajectory in the long-term is important; unnecessary exposure to advanced therapies increases the risk of adverse events and increases financial costs and health-care resource utilisation. This Review details the importance of adopting clinical strategies to avoid the pitfalls of undertreating and overtreating IBD.

Spanish Working Group in Crohn's Disease and Ulcerative Colitis (GETECCU) position paper on cardiovascular disease in patients with inflammatory bowel disease

Cardiovascular diseases (CVD) are the leading cause of death worldwide. Therefore, it is essential to understand their relationship and prevalence in different diseases that may present specific risk factors for them. The objective of this document is to analyze the specific prevalence of CVD in patients with inflammatory bowel disease (IBD), describing the presence of classical and non-classical cardiovascular risk factors in these patients. Additionally, we will detail the pathophysiology of atherosclerosis in this patient group and the different methods used to assess cardiovascular risk, including the use of risk calculators in clinical practice and different ways to assess subclinical atherosclerosis and endothelial dysfunction. Furthermore, we will describe the potential influence of medication used for managing patients with IBD on cardiovascular risk, as well as the potential influence of commonly used drugs for managing CVD on the course of IBD. The document provides comments and evidence-based recommendations based on available evidence and expert opinion. An interdisciplinary group of gastroenterologists specialized in IBD management, along with a consulting cardiologist for this type of patients, participated in the development of these recommendations by the Spanish Group of Work on Crohn's Disease and Ulcerative Colitis (GETECCU).

Aseptic abscess syndrome as first manifestation of Crohn's disease - a case report

BACKGROUND

There exist multiple extraintestinal manifestations of inflammatory bowel disease. The most common are arthritis, aphthous stomatitis, or uveitis. Aseptic abscess syndrome is not usually included among these extraintestinal manifestations. In our case report, we present a rare case of aseptic abscess syndrome as the first manifestation of inflammatory bowel disease.

CASE PRESENTATION

We present the case of a 10-year-old girl whose only initial medical issue was recurrent submandibular lymphadenitis unresponsive to standard antibiotic therapy. A broad differential diagnosis was initiated to exclude an infectious etiology. Eventually, it was necessary to proceed with extirpation of the suspected lymph node. Histological examination showed suppurative granulomatous inflammation, so it was further examined for noninfectious cause. Blood tests revealed positivity of ASCA antibodies (Anti-Saccharomyces cerevisiae) in both IgA and IgG classes. Despite absence of typical gastrointestinal symptoms, bowel ultrasound was performed, followed by magnetic resonance enterography. Both showed inflammatory changes in the terminal ileum. Subsequent endoscopy of the gastrointestinal tract and histological examination of biopsy specimens confirmed a diagnosis of Crohn's disease with terminal ileum and rectum involvement. A standard treatment based on current guidelines led to remission without recurrence of lymphadenitis.

CONCLUSIONS

In cases of lymphadenitis that does not respond to standard antibiotic treatment, diagnosis of aseptic abscess syndrome should be considered as a potential etiology and, subsequently, inflammatory bowel disease should be investigated, given that this syndrome is associated with inflammatory bowel disease in as many as 70% of cases. To our knowledge, this is the first published case report describing aseptic abscess syndrome affecting cervical lymph nodes as an extraintestinal manifestation of pediatric Crohn's disease.

Clinical Significance of histologic healing in IBD: Evidence from randomized controlled trials (RCT) and real world (RW) data

Histologic mucosal healing (HMH) has emerged as a crucial target in managing inflammatory bowel disease, complementing the established goal of endoscopic mucosal healing. This review evaluates the significance of HMH in both Crohn's disease (CD) and ulcerative colitis (UC). In UC, strong evidence shows that HMH correlates with improved long-term outcomes, including reduced hospitalization rates, and decreased need for corticosteroids and colectomy. Histologic healing is increasingly being incorporated as an endpoint in RCTs. Small-molecule therapies, such as S1P modulators and Jak inhibitors, have demonstrated particular efficacy in achieving HMH in UC. Real-world evidence (RWE) further supports HMH's utility as a predictive marker for favorable clinical outcomes in UC. In CD, however, HMH's role is less clear, given challenges in assessing and standardizing histologic healing. RCTs, such as SERENITY and VIVID, show that advanced therapies can achieve HMH in CD, though inconsistent histologic scoring and remission criteria complicate conclusions. Some studies suggest that histologic remission at induction may predict sustained remission, but real-world data offer mixed results regarding its prognostic value. This review provides an overview of current literature, emphasizing the need for standardized histologic assessment and extended studies, particularly for CD, while affirming HMH's growing importance in achieving deeper remission in UC.

Biosimilars and immunogenicity: a matter of concern?

INTRODUCTION

Biosimilars have transformed treatment modalities across various medical fields such as oncology, rheumatology, and immunology. Despite their potential for reducing healthcare costs, concerns persist regarding their ability to induce an immune response, which could affect efficacy and safety. This review critically evaluates the current evidence on the immunogenicity of biosimilars and discusses the regulatory frameworks guiding their approval and monitoring.

AREAS COVERED

This review includes studies from databases like Scopus, PubMed, Web of Science, and ScienceDirect, published up to April 2024. It explores the 'totality of the evidence' approach used by regulatory bodies like the FDA and EMA, detailing analytical, preclinical, and clinical assessments that ensure biosimilars' similarity to their reference products in terms of structure, function, and clinical outcomes. The review also addresses the challenges and limitations in current research methodologies and the implications of immunogenicity on therapeutic efficacy and patient safety.

EXPERT OPINION

While substantial evidence confirms the safety and efficacy of biosimilars, the review emphasizes the need for continuous regulatory vigilance and advanced methodologies in post-marketing surveillance to capture long-term immunogenicity data effectively. It advocates for integrating cutting-edge analytical techniques and personalized medicine to better manage immunogenic risks associated with biological therapies.

Health State Utility Values: The Implications of Patient versus Community Ratings in Assessing the Value of Care

BackgroundHealth-state utility values (HSUVs) are key inputs into cost-utility analyses. There is debate over whether they are best derived from the community or patients, with concerns raised that community-derived preferences may devalue benefits to ill, elderly, or disabled individuals. This tutorial compares the effects of using patient-derived HSUVs versus community-derived HSUVs on incremental cost-effectiveness ratios (ICERs) and shows their implications for policy.DesignWe review published studies that compared HSUVs derived from patients and the community. We then present equations for the gains in quality-adjusted life-years (QALYs) that would be estimated for an intervention using patient versus community HSUVs and discuss the implications of those QALY gains. We present a numerical example as another way of showing how ICERs change when using patient versus community HSUVs.ResultsPatient HSUVs are generally higher than community HSUVs for severe health states. When an intervention reduces mortality, patient ratings yield more favorable ICERs than do community ratings. However, when the intervention reduces morbidity, patient ratings yield less favorable ICERs. For interventions that reduce both morbidity and mortality, the effect on ICERs of patient versus community HSUVs depends on the relative contribution of each to the resulting QALYs.ConclusionsThe use of patient HSUVs does not consistently favor treatments directed at those patients. Rather, the effect depends on whether the intervention reduces mortality, morbidity, or both. Since most interventions do both, using patient HSUVs has mixed implications for promoting investments for people with illness and disabilities. A nuanced discussion of these issues is necessary to ensure that policy matches the intent of the decision makers.HighlightsThe debate about whether health state utility values (HSUVs) are best derived from patients or the community rests in part on the presumption that using community values devalues interventions for disabled persons or those with chronic diseases.However, we show why the effect of using patient HSUVs depends on whether the intervention in question primarily reduces mortality or morbidity or has substantial effects on both.If the intervention reduces mortality, using patient HSUVs will make the intervention appear more cost-effective than using community HSUVs, but if it reduces morbidity, using patient HSUVs will make the intervention appear less cost-effective.If the intervention reduces both morbidity and mortality, a common situation, the effect of patient versus community HSUVs depends on the relative magnitudes of the gains in quality and length of life.

The efficacy and safety of biologic or targeted synthetic DMARDs in rheumatoid arthritis treatment: one year of review 2024

BACKGROUND

Both articular and extra-articular structures are affected by rheumatoid arthritis (RA), a chronic inflammatory rheumatic illness that results in severe joint destruction, disability, and death. To increase the response rate and provide RA patients more options, there is an unmet need for the development of innovative treatment drugs. Evaluation of cellular, cytokine, genomic, and transcriptome profiles that would predict therapeutic response to biologic or targeted disease-modifying anti-rheumatic drugs (DMARDs) with various action modes is necessary for a customized therapy plan in RA. Owing to the development of new biologic medicines that target distinct mechanisms of action, the treatment algorithm for RA has undergone significant modification during the last one to two decades. More patients are now able to undergo biologic therapy early in the progression of their illness, thanks to the availability of less expensive biosimilars.

OBJECTIVE

To summarize the efficacy and safety of biologic or targeted syntheticb/ts DMARDs in RA treatment based on the publications in the past year.

MATERIAL AND METHODS

We compiled the most recent findings from original research publications of 2024 about the effects of b/tsDMARDs on the treatment of RA. In addition, this review article also concluded the recent findings from original research publications of the year 2024 about the effects of b/tsDMARDs biosimilars for treating RA.

CONCLUSION

This article summarizes the evidence and safety of biologic DMARDs (bDMARDs) or targeted synthetic DMARDs (tsDMARDs) in the management of RA, including those that target tumor necrosis factor alpha, interleukin (IL)-6, B cells, T-cell co-stimulation, and Janus kinase (JAK) from original research articles published in 2024.

Frequency of Biological Drug Use in Older Patients with Immune-Mediated Inflammatory Diseases: Results from the Large-Scale Italian VALORE Distributed Database Network

BACKGROUND

Limited real-world data on biological drug use in older patients with immune-mediated inflammatory diseases (IMIDs) exist despite these drugs carrying serious risks in this population.

OBJECTIVE

We aimed to describe the frequency and persistence of biological drug use in older patients (≥ 65 years) with IMID, including inflammatory bowel diseases (IBDs), psoriatic arthritis/psoriasis, rheumatoid arthritis (RA), and ankylosing spondylitis, in a large Italian population.

METHODS

A retrospective cohort study using the VALORE distributed claims database network from 13 Italian regions in the years 2010-2022 was performed. Older patients with IMID receiving biological drugs were included. Yearly prevalence of biological drug use and treatment persistence among incident users, from first dispensing to discontinuation/switching to another drug, was measured. Multivariable logistic regression was employed to identify treatment discontinuation predictors.

RESULTS

The prevalence of biological drug use in older patients with IMID increased dramatically from 2010 (0.44 per 1000 residents) to 2022 (2.48 per 1000 residents). Overall, 25,284 incident users of biological drugs were identified, with a female/male ratio of 1.6 and a mean age of 71.0 (standard deviation ± 5.2) years. The median duration of follow-up was 4.2 (2.5-6.6) years, and the most common indication for use was RA (n = 8371; 33.1%). Overall, biological drug persistence was 54.4% at 1 year from treatment start. The highest persistence rates were found for vedolizumab and ustekinumab in patients with IBD (ulcerative colitis, 68.1% and 76.2%, respectively; Crohn's disease, 69.6% and 88.1%, respectively). Polypharmacy, advanced age, and female sex were identified as predictors of treatment discontinuation.

CONCLUSIONS

This study documented a significant rise in biological drug use among older patients with IMID in Italy over the last decade. Around 50% of users discontinued treatment after the first year, with even higher rates observed in very old patients with polypharmacy. These findings highlight potential concerns about the use of biological therapies in older patients and underscore the urgent need for large-scale cohort studies to address the current knowledge gaps regarding their safety and effectiveness in this vulnerable population.

Colorectal Cancer and Inflammatory Bowel Disease

Colorectal cancer (CRC) in patients with ulcerative colitis (UC) and Crohn's disease accounts for ∼5% of all cases of CRC. Although it only accounts for a fraction of CRC cases, inflammatory bowel disease (IBD)-related CRC is a serious consequence of chronic inflammation that needs attention. There is a better understanding today about the pathogenesis contributing to IBD-CRC and the role of genetics and gut microbiota. Guidelines recommend timely screening and surveillance of UC and Crohn's patients, and it is usually timed from the initial diagnosis. This helps with early detection of dysplasia and CRC in this subset of patients, thus allowing for earlier intervention. However, dysplasia is not always easy to discern and management of CRC in each patient may differ. A multidisciplinary approach should be adopted in managing CRC in IBD. Although the oncologic principles of managing sporadic CRC and IBD-CRC are the same, surgical resection should be tailored to each patient.

Clinical and Microbiological Characteristics of Hospitalized Adults Aged ≤ 45 Years With Clostridioides (Formerly Clostridium) difficile Infection: A Prospective Observational Cohort Study From Hungary

Studies focusing on young adults with Clostridiodes (formerly Clostridium) difficile infection (CDI) are scarce. Our objective was to assess characteristics and outcomes of CDI among hospitalized young adults between the ages of 18-45 years at diagnosis, compared to a subcohort of randomly selected older patients aged > 45 years. We performed a prospective, observational cohort study by enrolling and stratifying 234 consecutive cases of first/recurrent CDI at our tertiary referral center between 2015 and 2019. At 30 days post-treatment initiation, young adults had a higher clinical cure (99.1% vs. 81.2%; p < 0.01) and lower all-cause mortality (0.9% vs. 16.4%; p < 0.01). Metronidazole was a common first-line choice (77.8% vs. 46.2%; p < 0.01) with similar relapse rates (6.0% vs. 5.1%, p = 0.56). We conclude that CDI in patients aged between 18 and 45 years was associated with fewer complications and higher clinical cure with metronidazole, compared to older patients.

Temporary loop end ileostomy reduces the risk of stoma outlet obstruction: a comparative clinical study in patients undergoing restorative proctocolectomy and ileal pouch-anal anastomosis

PURPOSE

Stoma outlet obstruction (SOO) is a serious complication of restorative proctocolectomy (RPC) and ileal pouch-anal anastomosis (IPAA). When the ileal mesentery to the pouch is under excessive tension, the ileum near the ileostomy twists easily, causing SOO. Loop-end ileostomy (EI) for fecal diversion was introduced in 2021 to prevent SOO, and we aimed to verify whether temporary EI reduces the incidence of SOO in RPC and IPAA patients relative to loop ileostomy (LI).

METHODS

This study included 106 consecutive RPC and IPAA patients with a diverting ileostomy and categorized them into LI (n = 75) or EI (n = 31) groups. The clinical characteristics of the patients were analyzed and compared.

RESULTS

Patient characteristics were similar between the groups, except for higher preoperative steroid use in the LI group (38.7%; p = 0.0116). There were no significant differences between the groups in anatomical factors, such as abdominal wall thickness and the height-adjusted distance between the root of the superior mesenteric artery and the bottom of the external anal sphincter. There were no significant differences in surgery-related factors, with ≥ 90% of the patients in each group undergoing laparoscopic procedures. A multivariate logistic regression analysis revealed that EI significantly reduced the risk of SOO relative to LI (OR, 0.18; 95% CI 0.03-0.92; p = 0.0399).

CONCLUSION

EI reduced SOO levels after RPC and IPAA and may be beneficial for cases in which anastomosis is challenging.

Dietary Relationships between Obesity and Inflammatory Bowel Diseases: A Narrative Review of Diets Which May Promote Both Diseases

PURPOSE OF REVIEW

The pandemic of obesity preceded global spread of Inflammatory Bowel diseases by almost 2 decades. A pathogenic relationship has been described between obesity and inflammatory bowel diseases, but Crohn`s disease may be selectively impacted. The role of diet in pathogenesis has also gained significant support in the last few decades. This review explores dietary relationships to account for epidemiological observations. Quantifiable indices for diets have been described including a glycemic index, inflammatory indices and levels of food processing. Meta-analyses have been published which examine each for effects on obesity and co-morbidities as well as Crohn's disease and ulcerative colitis. This review suggests that ultra-processed foods provide the best link between obesity and Crohn's disease explaining epidemiological observations. However, the other 2 types of dietary indices likely contribute to ulcerative colitis as well as to co-morbidities related to both obesity and inflammatory bowel diseases. The term ultra-processed foods cover a large number of additives and extensive work is needed to define individual or combined harmful effects. Furthermore, the interactions among the 3 main indices need clarification in order to precisely apply therapeutic diets to both diseases (obesity and inflammatory bowel disease).

Global evolution of inflammatory bowel disease across epidemiologic stages

During the twentieth century, inflammatory bowel disease (IBD) was considered a disease of early industrialized regions in North America, Europe and Oceania1. At the turn of the twenty-first century, IBD incidence increased in newly industrialized and emerging regions in Africa, Asia and Latin America, while the prevalence in early industrialized regions continued to grow steadily2-4. Changes in the incidence and prevalence denote the evolution of IBD across four epidemiologic stages: stage 1 (emergence), characterized by low incidence and prevalence; stage 2 (acceleration in incidence), marked by rapidly rising incidence and low prevalence; and stage 3 (compounding prevalence), where the incidence decelerates, plateaus or declines while the prevalence steadily increases. A fourth stage (prevalence equilibrium) has been proposed in which the prevalence slope plateaus due to demographic shifts in an ageing IBD population, but it has not yet been evidenced. To date, these stages have remained theoretical, lacking specific numerical indicators to define transition points. Here, using real-world data from 522 population-based studies encompassing 82 global regions and spanning more than a century (1920-2024), we show spatiotemporal transitions across stages 1-3 and model stage 4 progression. Understanding the evolution of IBD across epidemiologic stages enables healthcare systems to better anticipate the future worldwide burden of IBD.

British Society of Gastroenterology guidelines on colorectal surveillance in inflammatory bowel disease

Patients with inflammatory bowel disease (IBD) remain at increased risk for colorectal cancer and death from colorectal cancer compared with the general population despite improvements in inflammation control with advanced therapies, colonoscopic surveillance and reductions in environmental risk factors. This guideline update from 2010 for colorectal surveillance of patients over 16 years with colonic inflammatory bowel disease was developed by stakeholders representing UK physicians, endoscopists, surgeons, specialist nurses and patients with GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodological support.An a priori protocol was published describing the approach to three levels of statement: GRADE recommendations, good practice statements or expert opinion statements. A systematic review of 7599 publications, with appraisal and GRADE analysis of trials and network meta-analysis, where appropriate, was performed. Risk thresholding guided GRADE judgements.We made 73 statements for the delivery of an IBD colorectal surveillance service, including outcome standards for service and endoscopist audit, and the importance of shared decision-making with patients.Core areas include: risk of colorectal cancer, IBD-related post-colonoscopy colorectal cancer; service organisation and supporting patient concordance; starting and stopping surveillance, who should or should not receive surveillance; risk stratification, including web-based multivariate risk calculation of surveillance intervals; colonoscopic modalities, bowel preparation, biomarkers and artificial intelligence aided detection; chemoprevention; the role of non-conventional dysplasia, serrated lesions and non-targeted biopsies; management of dysplasia, both endoscopic and surgical, and the structure and role of the multidisciplinary team in IBD dysplasia management; training in IBD colonoscopic surveillance, sustainability (green endoscopy), cost-effectiveness and patient experience. Sixteen research priorities are suggested.

IBD-related disability among patients with ulcerative colitis in China: a cross-sectional study

Background

Ulcerative colitis (UC) is a chronic inflammatory disorder that can lead to physical, psychological, and social disabilities among patients.

Objectives

To evaluate the disability level in a cross-sectional study of Chinese patients with UC and identify factors associated with disability.

Design

This was a cross-sectional study.

Methods

Between April 2022 and March 2023, UC patients from the Affiliated Hospital of Nanjing University of Chinese Medicine responded to questionnaires including the Inflammatory Bowel Disease Disability Index (IBD-DI), Fatigue Severity Scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7. In addition, demographic characteristics and clinical data of the patients were collected. Associated factors were identified by univariate and multivariate logistic regression analyses.

Results

A total of 345 patients completed the questionnaires. The median (interquartile range) IBD-DI score was 16.2 (9.6-26.5), and the overall prevalence of disability was 39.7%. IBD-DI correlated with Mayo score, fatigue, anxiety, depression, hemoglobin (HGB), albumin (ALB), and erythrocyte sedimentation rate (ESR). Furthermore, the self-reported disability (IBD-DI > 20) was associated with lower BMI, active UC, disease severity of moderate and severe, disease location of left-sided UC (E2), using corticosteroids or biologics for treatment, Mayo score, fatigue, depression, anxiety, HGB, ALB, complement 3 (C3), and ESR. Notably, lower BMI, higher Mayo score, fatigue, and depression were identified as independent risk factors of disability in UC patients.

Conclusion

This study revealed a significant level of disability among the Chinese UC population. Several clinical factors were identified to affect the level of disability, notably the risk factors including BMI, disease severity, fatigue, and depression.

Characterization of the salivary microbiome of adults with inflammatory bowel disease

Background

Perturbations of the gut microbiota in patients with inflammatory bowel disease (IBD) have been extensively characterised, but changes to the oral microbiome remain understudied. This study aimed to evaluate the oral microbiome of adults with IBD and of matched controls.

Methods

Saliva samples and data were obtained from a Canadian population cohort (n = 320). The salivary microbiome was characterised using 16S rRNA gene sequencing and examined for differences between control participants and those with IBD, as well as disease subcategories (Crohn's Disease and Ulcerative Colitis).

Results

Alpha diversity was significantly lower in participants with IBD than controls in unadjusted models and many remained significant after adjusting for covariates. Significant differences in some beta diversity metrics between participants with IBD and controls were found, although these did not remain significant when adjusted for covariates. Ten genera were significantly differentially abundant between cases and controls. Veillonella and Streptococcus were both increased in abundance in IBD cases vs controls (25% vs 22% and 14% vs 12%, respectively).

Conclusion

These results showcase changes in oral microbial diversity and composition in those living with IBD and highlight the potential of using the salivary microbiome as a biomarker for screening or monitoring IBD.

AI-Assisted Glucocorticoid Treatment Response Prediction of Active Ulcerative Active Patients

BACKGROUND

Glucocorticoids are recommended for the induction and remission phase of ulcerative colitis (UC). Early identification of glucocorticoid therapy response contributes to more precise treatment management. We aim to use deep learning model to predict glucocorticoid response prognosis in active UC.

METHODS

From January 2006 to December 2023, 485 intestinal histological whole slide images (WSIs) of 212 UC patients from two medical centers in China was collected. We developed and validated a deep learning model (UCG-SwinT) based on WSI and clinical data to predict the treatment response of glucocorticoid induction therapy. Response was defined as steroid effectiveness and steroid dependence. We used area under the curves (AUCs) to evaluate the performance of the model and compared it to clinical factors. Grad-CAM was used to visualize the histological features the model focused when predicting treatment response.

RESULTS

The AUCs of predicting response in training, validation, and external testing set were 0.750, 0.727, and 0.723, respectively. The UCG-SwinT model performs better while combining histopathological images with clinical data than simply inputting histopathological images, with AUCs of 0.826, 0.731, and 0.725 in predicting treatment response in the training, validation, and external testing cohorts and outperformed all clinical factors. Grad-CAM showed that increased inflammatory cells and intestinal mucosal microvascular dilation are related to glucocorticoid response in UC patients.

CONCLUSIONS

UCG-SwinT has the potential to predict glucocorticoid response in active UC patients and has guiding significance for individualized clinical treatment.

Insights into Modeling Inflammatory Bowel Disease from Stem Cell Derived Intestinal Organoids

Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), is a multifactorial, immune-mediated condition marked by chronic gastrointestinal inflammation. This condition significantly impairs patients' quality of life and represents a major public health challenge globally. Pathogenesis of IBD arises from complex interplay among genetic predisposition, environmental factors, immune dysregulation, and microbial dysbiosis. Although significant strides have been made in unraveling these mechanisms, existing therapeutic options remain inadequate in addressing the full spectrum of clinical needs, underscoring the urgent demand for innovative strategies. Regenerative medicine has emerged as a promising frontier, offering novel tools for therapeutic development. We briefly consolidated current knowledge on IBD pathogenesis and treatments, emphasized the pivotal potential of human intestinal organoids (including adult stem cell-derived organoids and pluripotent stem cell- derived organoids) as a robust platform for mechanistic studies and treatment exploration. Leveraging this technology, we aim to advance personalized and next-generation therapies for IBD.

Laboratory test utilization and effect on clinical outcomes in a pediatric setting

Given recent economic concerns, there has been pressure on the health-care system to improve efficiency, quality and reduce cost. The clinical laboratory is now under close scrutiny to adopt "practicing to value" which involves shifting its focus from performing many tests to performing only necessary tests. To achieve this, clinical laboratories have been implementing strategies for effective laboratory test utilization and participating in health outcome studies to provide evidenced-based insights on test utilization, clinical decision-making and policy improvements. It is essential to highlight the full spectrum of this additional role of the clinical laboratory to administrators, policy makers and other health-care stakeholders, as clinical laboratories are an easy target for economic restrictions. This review highlights how strategic stewardship implementation by a clinical laboratory improves clinical outcomes in a pediatric setting.

Isolated perianal Crohn's disease: a systematic review and expert consensus proposing novel diagnostic criteria and management advice

Perianal fistulae can present a diagnostic challenge when distinguishing perianal Crohn's disease from idiopathic perianal fistulae. This distinction is key, as perianal Crohn's disease requires inflammatory bowel disease (IBD) therapy, whereas idiopathic perianal fistulae are primarily managed surgically. When luminal inflammation is absent, but Crohn's disease is suspected, the term isolated perianal Crohn's disease is sometimes applied. However, no formal guidance exists for diagnosing or managing isolated perianal Crohn's disease. Furthermore, whereas fistula granuloma might provide specific evidence of Crohn's disease, they are rarely detected in perianal fistulae, so are unlikely to sensitively delineate aetiology. This project aimed to develop an opinion-based framework for isolated perianal Crohn's disease. A systematic review evaluated clinical features suggestive of isolated perianal Crohn's disease and evidence for IBD therapies in patients with perianal fistulae without luminal IBD. The findings of this systematic review informed a multidisciplinary consensus process with IBD specialists, resulting in the formulation of diagnostic criteria and management recommendations for isolated perianal Crohn's disease. We then tested this diagnostic approach in a prospective cohort of 50 patients treated as having idiopathic perianal fistulae at a proctology referral centre, identifying six (12%) individuals as meeting the diagnostic criteria. Our findings underscore the scarcity of evidence guiding isolated perianal Crohn's disease diagnosis and the need for a composite risk-based assessment. The proposed framework provides a tool for clinical practice and research but requires validation and refinement. Clear communication with patients is essential, given the diagnostic and therapeutic uncertainties. Future studies should refine these criteria, explore biological markers for isolated perianal Crohn's disease, and establish evidence-based methods to differentiate isolated perianal Crohn's disease within the perianal fistulae spectrum.

The effects of biologics on ulcerative colitis-related colectomy rate: results of a 22-year study

BACKGROUND

To assess the impact of the biological era on colectomy rates in ulcerative colitis (UC) patients and identify factors associated with the necessity for colectomy in a large cohort from Eastern Europe.

METHODS

A retrospective cohort study was conducted on UC patients followed at a tertiary care center covering 1999 to 2021. Patients who underwent colectomy due to disease activity were compared to those who did not. Factors related to colectomy and the influence of the biological era were analyzed.

RESULTS

Among 1197 patients with a median follow-up of 3.3 years, 18% received biological agents and 5.3% underwent colectomy due to disease activity. The colectomy rate was lower in the biological era compared to the pre-biological era (2% vs. 12%; p < 0.001). Independent predictors of colectomy included steroid dependency, steroid resistance, lack of mucosal remission, and elevated CRP levels. Patients who achieved and maintained mucosal remission and had CRP levels below 3 mg/L had a significantly lower risk of colectomy.

CONCLUSIONS

The biological era has significantly reduced colectomy rates in UC patients. Achieving mucosal remission and maintaining low CRP levels are essential for preventing colectomy and improving long-term outcomes.

Enrichment of human IgA-coated bacterial vesicles in ulcerative colitis as a driver of inflammation

The gut microbiome contributes to chronic inflammatory responses in ulcerative colitis (UC), but molecular mechanisms and disease-relevant effectors remain unclear. Here we analyze the pro-inflammatory properties of colonic fluid obtained during colonoscopy from UC and control patients. In patients with UC, we find that the pelletable effector fraction is composed mostly of bacterial extracellular vesicles (BEVs) that exhibit high IgA-levels and incite strong pro-inflammatory responses in IgA receptor-positive (CD89+) immune cells. Biopsy analyses reveal higher infiltration of CD89+ immune cells in the colonic mucosa from patients with UC than control individuals. Further studies show that IgA-coated BEVs, but not host-derived vesicles nor soluble IgA, are potent activators of pro-inflammatory responses in CD89+ cells. IgA-coated BEVs also exacerbate intestinal inflammation in a dextran sodium sulfate colitis model using transgenic mice expressing human CD89. Our data thus implicate a link between IgA-coated BEVs and intestinal inflammation via CD89+ immune cells, and also hint a potential new therapeutic target for UC.

Efficacy and safety of the ustekinumab biosimilar ABP 654 in patients with moderate-to-severe plaque psoriasis: a randomized double-blinded active-controlled comparative clinical study over 52 weeks

BACKGROUND

ABP 654 is a biosimilar to ustekinumab reference product (RP). ABP 654 has been shown to have an amino acid sequence identical to ustekinumab RP and they are similar in structure, purity and potency, as well as clinical pharmacokinetics and safety in healthy volunteers.

OBJECTIVES

To compare the efficacy, safety and immunogenicity of ABP 654 and ustekinumab RP in patients with moderate-to-severe plaque psoriasis in a randomized double-blinded active-controlled single-transition comparative clinical study (NCT04607980).

METHODS

Patients were randomized 1 : 1 to receive ABP 654 or ustekinumab RP at a weight-based dose of 45 mg or 90 mg administered subcutaneously on day 1 (week 0), week 4 and week 16. At week 28, patients with a ≥ 75% improvement in Psoriasis Area and Severity Index (PASI) were re-randomized such that those initially randomized to ABP 654 continued to receive ABP 654 and those initially randomized to ustekinumab RP were re-randomized to either continue on ustekinumab RP or transition to ABP 654. The primary efficacy endpoint was percentage improvement in PASI from baseline to week 12. Secondary endpoints included additional efficacy measurements, as well as an assessment of adverse events and antidrug antibodies.

RESULTS

At week 12, the observed mean (SD) percentage improvement in PASI from baseline was 81.9 (19.9) and 81.9 (19.6) for the ABP 654 and ustekinumab RP treatment groups, respectively. The point estimate of the mean difference in percentage PASI improvement from baseline to week 12 between the treatment groups was 0.14 with a two-sided 90% confidence interval (CI) of (-2.6 to 2.9), well within the prespecified similarity margin of (-10 to 10). In addition, throughout the study, secondary efficacy analyses and safety and immunogenicity profiles were similar across the treatment groups.

CONCLUSIONS

These results indicate that ABP 654 and ustekinumab RP are clinically similar in efficacy, safety and immunogenicity in patients with moderate-to-severe plaque psoriasis. Further, a single transition from ustekinumab RP to ABP 654 at week 28 had no impact on the efficacy, safety or immunogenicity results for the remainder of the 52-week study, supporting a conclusion of no clinically meaningful differences between ABP 654 and ustekinumab RP.

Distribution of epithelial endoplasmic reticulum stress-related proteins in adult and pediatric Crohn's disease: Association with inflammation and fibrosis

BACKGROUND/AIMS

Intestinal strictures in Crohn's disease (CD), driven by fibrosis remain challenging to treat. Current treatments focus on inflammation, but are less effective against fibrosis. Endoplasmic Reticulum Stress-Related Proteins, including Protein disulfide isomerases (PDIs), may contribute to fibrosis; their roles in CD remain unclear. This study investigated the distribution of AGR2, BiP, PDIA6, ERP44 in intestinal epithelium and their association with fibrosis and inflammation in pediatric and adult CD.

METHODS

We retrospectively analyzed 224 patients (2009-2023). CD patients with and without strictures, non IBD controls, and ulcerative colitis patients were compared. Immunohistochemistry assessed Endoplasmic Reticulum Stress-Related protein distribution in epithelium. H&E and Masson's trichrome staining evaluated inflammation and fibrosis. Correlations between protein distribution, inflammation and fibrosis were examined.

RESULTS

AGR2 and BiP were increased in fibro-inflammatory and fibrotic intestinal epithelial tissues, especially in pediatric-onset CD. ERP44 was associated with fibrosis exclusively in pediatric CD. PDIA6 was upregulated in CD compared to non IBD, without fibrosis association. Distinct protein distribution patterns were observed between pediatric and adult CD, and between ileum and colon.

CONCLUSIONS

Distinct patterns of AGR2, BiP, PDIA6, and ERP44 in fibrotic and inflammatory intestinal tissues suggest potential roles in CD-associated fibrosis, warranting exploration as biomarkers or therapeutic targets.

Potential therapeutic strategies targeting efferocytosis for inflammation resolution and tissue repair in inflammatory bowel disease

Efferocytosis, the process by which apoptotic cells (ACs) are recognized and cleared by phagocytes, is a critical mechanism in maintaining intestinal immune homeostasis and promoting the resolution of inflammation. Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), is characterized by chronic intestinal inflammation, wherein defective efferocytosis contributes to the accumulation of ACs, secondary necrosis, and sustained mucosal damage. This review delineates the molecular mechanisms underlying efferocytosis and systematically examines its functional roles across five key intestinal phagocytic cell types: macrophages, dendritic cells (DCs), neutrophils, intestinal epithelial cells (IECs), and Paneth cells (PCs). Particular emphasis is placed on the dysregulation of efferocytosis capacity in IBD pathogenesis and the consequences of impaired apoptotic cell clearance in both professional and non-professional phagocytes. Furthermore, we evaluate emerging therapeutic strategies designed to restore or enhance efferocytosis, including modulation of macrophage polarization, LC3-associated phagocytosis pathways, nanotechnology-enabled delivery systems, and stem cell-based interventions. A comprehensive understanding of cell-type-specific efferocytosis in the intestinal microenvironment offers promising directions for the development of targeted, inflammation-resolving therapies for IBD.

Progress in understanding of relationship between blood concentrations of ustekinumab and clinical outcomes of inflammatory bowel disease

Ustekinumab is widely used in the treatment of immune diseases due to its well-established efficacy and safety profile. In recent years, studies have found that adjusting dosing strategies and optimizing drug concentrations during long-term therapy can significantly improve the prognosis of some patients. Therapeutic drug concentration monitoring (TDM) can measure the concentration of ustekinumab in vivo, thereby guiding personalized treatment strategy decisions. This review elaborates on the relationship between different drug concentrations of ustekinumab and clinical efficacy and outcomes, and explores the value of individualized treatment strategies based on TDM for clinical treatment based on the existing literature.

ATF3 restoration as a potential strategy in managing ulcerative colitis: Implications from Sishen pill research

BACKGROUND

Ulcerative colitis (UC) is a chronic inflammatory bowel disease with limited therapeutic options, particularly for moderate-to-severe cases. The present study evaluated the therapeutic potential of Sishen Pill (SSP) through Activating Transcription Factor 3 (ATF3).

METHODS

Colonic biopsy samples were collected from 11 UC patients and 6 healthy controls (HCs). A murine colitis model was established using dextran sodium sulfate (DSS) and treated with SSP. The therapeutic efficacy of SSP was evaluated by measuring body weight, colonic length, and inflammatory markers in wild-type (WT) mice. Transcriptomic analysis revealed differentially expressed genes in colonic tissues following Atf3 knockout. Western blotting, immunofluorescence, immunohistochemical, and Luminex assays were conducted to assess the effect of SSP on Neutrophil Extracellular Traps (NETs) formation and ATF3 signaling.

RESULTS

ATF3 expression was significantly reduced in the inflamed mucosa of UC patients, correlating with disease severity. UC tissues also exhibited increased spontaneous NETs formation. In DSS-induced colitis mice, ATF3 expression was similarly reduced, whereas SSP treatment upregulated ATF3, mitigated weight loss, reduced colonic shortening, alleviated histopathological damage, and lowered inflammatory cytokine levels. Atf3 knockout mice (Atf3-/-) displayed more severe DSS-induced colitis with enhanced immune response as compared to control littermates (Atf3+/+). Transcriptomic analyses revealed that SSP downregulated key genes involved in NETs formation pathways, tumor necrosis factor (TNF) and cytokine-cytokine receptor signaling. Experimental validation confirmed that SSP reduced the levels of NETs-related proteins [Myeloperoxidase (MPO), Peptidylarginine Deiminase 4 (PAD4), Lymphocyte Antigen 6 Complex, G (Ly6G), Neutrophil Elastase (NE), Citrullinated Histone H3 (CitH3)] in the colorectal tissue of colitis mice. It also down-regulated TNF pathway-related proteins [Phosphorylated Extracellular Signal-Regulated Kinase (p-ERK), Matrix Metalloproteinase 9 (MMP9)]. Furthermore, SSP intervention reduced pro-inflammatory factors [interleukin (IL)-6, IL1β, Granulocyte Colony-Stimulating Factor (G-CSF) and TNF-α] and decreased CXCL1/CXCR2 axis factors, including CXCL1 protein levels and diminished CXCR2+MPO+ positive expressed cells. Importantly, these beneficial effects of SSP were ATF3-dependent, as SSP did not exert its effects in Atf3-/- mice.

CONCLUSION

SSP ameliorates colitic mice through multiple mechanisms, including the inhibition of NETs formation, attenuation of inflammatory responses, and suppression of CXCL1/CXCR2-mediated inflammation, all via modulation of ATF3 expression. These findings support the potential of SSP as a promising adjunctive therapy for UC and underscore the therapeutic potential of targeting ATF3 in future treatment strategies.

Discovery and optimization of ibuprofen derivatives as the NF-κB/iNOS pathway inhibitors for the treatment of ulcerative colitis

In this study, a series of novel ibuprofen (Ibu) hybrid molecules with aminothiazole heterocycles were designed, synthesized and evaluated for their anti-inflammatory potency in vitro and in vivo. Among all these derivatives, compounds 6 and 8 effectively inhibited the production of NO (with 87 %, 79 % NO-inhibitory rates, respectively) with minimal cytotoxic effect in RAW 264.7 macrophages. Anti-inflammatory mechanism studies revealed that representative compound 6 dose-dependently inhibited pro-inflammatory cytokines by blocking the activation of NF-κB signaling pathway in LPS stimulated RAW 264.7 macrophages. In vivo experiments showed that 10 mg/kg compound 6 had a good improvement effect in DSS-induced mouse acute colitis compared to Ibu. Our findings will provide new insights into the development of new drugs with anti-inflammatory functions.

Utility of rotational thrombo-elastometry as an objective measure of hypercoagulability in ulcerative colitis

BACKGROUND AND AIMS

Inflammatory bowel disease (IBD) has an increased risk of venous thromboembolism (VTE), with factors such as hospitalization and surgery enhancing this risk. This study was aimed at evaluating rotational thrombo-elastometry (ROTEM) for assessing blood coagulation status in ulcerative colitis (UC) and determining its relationship with disease severity and response to treatment.

METHODS

This was a prospective age and sex-matched study with 60 patients each in UC and irritable bowel syndrome groups, the latter being controls. Clinical details and blood investigations, including ROTEM (clotting time [CT], clot formation time [CFT], alpha angle [AA], maximum clot firmness [MCF], maximum lysis [ML]) and D-dimer, were collected, analyzed and compared between the two groups. A hypercoagulable state was defined by Kaufmann et al. as having two or more of the following: short CT and/or CFT time, increased AA and increased MA.

RESULTS

There were 60 patients with UC (age, 38.6 ± 11.64 years; 44 males). The UC group significantly had more patients with hypercoagulable ROTEM than the control group (66.7% vs. 36.7%, p = 0.001). In UC patients with hypercoagulable ROTEM, nine patients were in remission and 31 patients had active disease. Compared to controls, CT, CFT, AA, MCF and D-dimer levels were significantly abnormal in the UC group. Among UC patients with increasing severity, only CFT, AA and D-dimer differed significantly across the groups. There were no significant differences in ROTEM values and D-dimer in patients with severe UC at admission compared to one-week post-discharge. Only hemoglobin (OR, 0.61; 95% CI, 0.38-0.98; p = 0.04) was found to be a significant independent predictor of a hypercoagulable state of active UC, on multivariate analysis.

CONCLUSIONS

More patients with UC had hypercoagulable ROTEM compared to controls, which increased with disease severity. Low hemoglobin was predictive of a hypercoagulable state in active UC.

Advanced Therapies in Elderly Patients With Inflammatory Bowel Disease: A Comparative Retrospective Cohort Study in Taiwan

Purpose

Inflammatory Bowel Disease (IBD) predominantly affects younger individuals, but emerging data indicates a shift toward older populations. Elderly-onset IBD (diagnosed at 60 years or older) differs from younger-onset IBD, presenting with atypical symptoms and higher risks of infections and malignancies. However, drug persistence is underexplored in the elderly IBD group, warranting further investigation to optimize treatment strategies for this demographic.

Patients and Methods

This retrospective cohort study included IBD patients receiving advanced therapies at the Chang Gung IBD Center from October 2017 to September 2023. Patients were stratified into two groups: elderly-onset (≥60 years) and control (<60 years). We compared one-year persistence of advanced therapies, opportunistic infections, IBD-related admissions, complications, surgeries, and acute flare-ups between the groups. Specifically, we analyzed the one-year persistence of various advanced therapies within the elderly-onset cohort.

Results

The study included 511 IBD patients, 107 of whom were elderly-onset. Elderly-onset patients had a higher body mass index, a higher proportion of ulcerative colitis, fewer smokers, and lower levels of white blood cells, hemoglobin, and albumin. Differences were noted in Montreal classifications and a higher use of Vedolizumab. Clinical outcomes, including steroid-free remission rates, one-year therapy persistence, infections, complications, surgeries, and flare-ups, were comparable between groups. In Crohn's disease (CD), Infliximab and Ustekinumab exhibited higher one-year persistence. Predictors of one-year therapy persistence included Montreal L1 (OR: 6.722; 95% CI: 1.296-34.852; P=0.023), Ustekinumab use (OR: 5.672; 95% CI: 1.138-28.267; P=0.034), and hemoglobin level (OR: 1.612; 95% CI: 1.210-2.147; P=0.001) with an optimal cutoff of 11.65 g/dL.

Conclusion

Elderly-onset IBD patients display unique clinical characteristics and therapy persistence, particularly in CD, highlighting the necessity for customized therapeutic strategies.

Factors driving persistence to first-line advanced therapies in inflammatory bowel disease: a real-world study from a tertiary referral centre

Factors driving the persistence of advanced therapies-defined as the duration from therapy initiation to discontinuation-in inflammatory bowel disease (IBD) remain unclear. This study aimed to evaluate the persistence of biologics and oral small molecules in a real-word IBD cohort and to identify influencing factors. Data from IBD patients starting advanced therapy at a tertiary referral centre after 2010 were retrospectively collected, including persistence and discontinuation reasons. Differences in persistence probability among therapies were analysed, and factors influencing persistence versus discontinuation due to failure were assessed by univariate and multivariate analyses. Among 274 included patients [median age 42.5 years; F/M 119/155; 146 with Crohn's disease (CD) and 128 with ulcerative colitis; median follow-up 38 months (IQR 14-75)], 141 (51.5%) remained persistent with first-line therapy, while 70 (26%) discontinued due to failure. No significant difference in persistence was observed among drugs (p = 0.11). Univariate analysis identified CD phenotype (p < 0.01), disease duration prior to therapy (p = 0.01), concomitant mesalamine or steroids (p < 0.01), and therapy optimisation (p < 0.01) as factors influencing persistence. Multivariate analysis confirmed CD phenotype as associated with higher persistence, while therapy optimisation was linked to increased discontinuation risk. CD was associated with better drug persistence, while therapy optimisation correlated with a higher discontinuation rate. Targeting deep healing and enhancing timely, precise optimisation strategies is essential for improving treatment outcomes.

Transmural Healing Assessed by Combination of Fecal Calprotectin and Intestinal Ultrasonography Is Associated With Reduced Risk of Bowel Damage Progression in Patients With Crohn's Disease

BACKGROUND

Fecal calprotectin (Fcal) and intestinal ultrasonography (IUS) could be used as noninvasive tools to monitor mucosal and transmural healing, respectively, in Crohn's disease (CD). We assessed the agreement between Fcal and IUS to detect active CD and investigated their complementary to predict long-term CD outcomes.

METHODS

In this prospective study, we consecutively included CD patients with concomitant IUS and Fcal testing within 7 days. Patients were divided into 4 groups: Transmural healing (TH; both normal), IUS healing (Fcal > 100 µg/g but normal IUS), biochemical remission reflecting mucosal healing (MH; Fcal < 100 µg/g but abnormal IUS), and no healing (abnormal Fcal and IUS). The primary endpoint was active CD. The secondary endpoints were time to bowel damage progression, time to relapse-related drug discontinuation, and patients' acceptability (10-points acceptability numerical scale).

RESULTS

Among the included 112 patients, 44.6% (50/112), 12.5% (14/112),16.1% (18/112), and 26.8% (30/122) achieved TH, IUS healing, biochemical remission, and no healing, respectively. The agreement between IUS and Fcal to detect an active CD was poor (71.4%, κ-coefficient = 0.41 ± 0.09). Transmural healing was associated with a reduced risk of bowel damage progression compared to no healing (P < .0001) contrary to IUS healing (P = .15) or biochemical remission (P = .84). Transmural healing was associated with a lower risk of relapse-related drug discontinuation than MH (hazard ratio [HR] = 0.09 [0.02-0.45], P = .003), IUS healing (HR = 0.10 [0.02-0.60], P = .001), or no healing (HR = 0.09 [0.018-0.04], P = .002). IUS was better accepted than Fcal testing (9.6 ± 0.8 vs 7.9 ± 2.3; P < .0001, 10-points range-acceptability numerical scale).

CONCLUSIONS

Transmural healing, evaluated by the combination of noninvasive and well-accepted tools such as Fcal and IUS, is associated with improved long-term outcomes and could be used to monitor patients with CD in daily practice.

Risk Factors for Chronic Kidney Disease in Patients With Crohn's Disease

BACKGROUND

Patients with inflammatory bowel diseases (IBD), including Crohn's disease (CD), are at risk of complications, including kidney disease. It is important to identify IBD patients at higher risk of chronic kidney disease (CKD) to improve prevention and treatment. Here, we investigated the clinical and metabolomic characteristics of CD patients who develop CKD.

METHODS

We identified adult CD patients with (CD + CKD, n = 87) and selected CD patients without CKD (CD controls) matched by age, race, and gender. We collected data on demographic characteristics (age, smoking status, ethnicity, gender), IBD characteristics (diagnosis, Montreal classification, medication use, IBD-related surgeries, perianal disease), and kidney-related factors (primary sclerosing cholangitis, end-stage renal disease, hypertension, diabetes, organ transplantation, and nephrolithiasis). Univariate and multivariate analyses were conducted and odds ratios were calculated to identify risk factors for CKD. Serum samples were collected for untargeted metabolomic analysis.

RESULTS

Chronic kidney disease was far more common in CD patients than UC patients. Crohn's disease patients with kidney stones had a 10-fold higher risk of developing CKD than those without kidney stones. Crohn's disease patients with more than 2 IBD-related surgeries had a 7.3-fold higher risk of developing CKD than those who had not undergone surgery. There was no relationship between the number of biologics used or mesalamine use and the risk of CKD. The serum of CD + CKD patients had elevated levels of pro-inflammatory metabolites and those linked to kidney injury.

CONCLUSIONS

We recommend regular kidney function monitoring and ensuring proper hydration to prevent or manage potential kidney-related complications in CD patients. Patients with resections and kidney stones are particularly vulnerable.

Efficacy and safety of mirikizumab in the treatment of inflammatory bowel disease: A meta-analysis

BACKGROUND

This meta-analysis explores the efficacy and safety of mirikizumab in treating IBD.

METHODS

A comprehensive search was conducted encompassing randomized controlled trials examining the efficacy of mirikizumab in treating IBD across PubMed, Embase, Cochrane Library, and Web of Science, with a search deadline of November 1, 2023. Quality assessment leaned on the Cochrane manual risk-of-bias evaluation, while Stata 15 undertook the data analysis.

RESULTS

Three randomized controlled studies involving 1602 individuals were finally included. Our meta-analysis suggested that mirikizumab can improve clinical remission (RR = 2.11, 95% CI [1.74, 2.55]), clinical response (RR = 1.68, 95% CI [1.50, 1.89]), endoscopic remission (RR = 1.95, 95% CI [1.65, 2.31]), histologic-endoscopic mucosal improvement (RR = 1.92, 95% CI [1.60, 2.32]) in inflammatory bowel disease (IBD).

CONCLUSION

According to our meta-analysis, mirikizumab is a promising drug in the treatment of IBD.

Human milk oligosaccharides modulating inflammation in infants, adults and older individuals - from concepts to applications

The increasing global prevalence of inflammatory diseases such as ulcerative colitis and irritable bowel syndrome, represents a challenging task for healthcare systems. Several approaches to disease management target the intestinal microbiome, which plays a key role in health and disease. One promising approach is modulating the microbiome using human milk oligosaccharides (HMOs). Originating from human milk, HMOs are indigestible carbohydrates which act in a host-optimized prebiotic fashion by providing an energy source for health-promoting intestinal bacteria and exhibiting systemic effects. Commercial products supporting infant health and development have been the primary fields of HMO application. Advancements in the large-scale production of HMOs through bioengineering and precision fermentation have led to evaluating their potential for managing inflammatory diseases. Several in vitro studies and observations on model systems have been clinically validated in infants, resulting in a large body of evidence supporting the safety and efficacy of HMOs in inflammatory disorders. While novel approaches seek to explore interventions in adults, the primary goal for the future is to provide cost-efficient, safe, and reliable healthcare compounds across all age groups.

Comparative efficacy of subcutaneous infliximab switching in remission and non-remission patients with inflammatory bowel disease after intravenous maintenance: 1-year outcome from a multicentre cohort study

Background

Elective switching from intravenous (IV) to subcutaneous (SC) infliximab (IFX) has shown efficacy in patients with inflammatory bowel disease (IBD). However, long-term outcomes for patients not in remission remain unclear.

Objectives

We evaluated the effectiveness of SC IFX switching in both remission and non-remission patients.

Design

This study was a retrospective multicentre study conducted across five tertiary hospitals in Korea.

Methods

Patients with IBD who switched to SC IFX between January 2021 and January 2023 were included. Clinical remission was defined as a Crohn's Disease Activity Index of <150 or a partial Mayo score of <2. Biochemical remission was defined as faecal calprotectin of <250 µg/g and C-reactive protein of <0.5 mg/dL. We investigated the treatment persistence rate of SC IFX and trends in pharmacokinetics, clinical indices and biomarkers over 1 year of follow-up, analysing the data based on the baseline remission state.

Results

Among 127 patients included, 90 (70.9%) were in clinical remission, and 37 (29.1%) were not at the time of switching. The one-year treatment persistence rate was 92.1%, with no significant difference between the clinical remission and non-remission groups (p = 0.139). Persistence was also unaffected by baseline biochemical remission status. IFX pharmacokinetics and biomarkers improved significantly in both clinical groups over 12 months (p < 0.005). Disease activity indices remained stable in the remission group and decreased in the non-remission group after switching. Previous biologics exposure was the only significant predictor of treatment persistence (hazard ratio, 5.634; 95% confidence interval, 1.357-23.384; p = 0.017). Adverse events related to SC IFX occurred in 15.7% of patients. The optimal SC IFX cutoff levels associated with clinical and biochemical remission were 11 and 17 μg/mL, respectively.

Conclusion

Switching from IV to SC IFX during maintenance therapy demonstrated high treatment persistence and safety, irrespective of clinical and biochemical remission status.

Switch acceptance and persistence of adalimumab biosimilars in IBD patients: a prospective observational study

Background

Prospective data about the acceptance and outcomes of switching from the adalimumab (ADA) reference product (RP) to multiple ADA biosimilars in inflammatory bowel disease (IBD) patients are lacking.

Objectives

To evaluate the acceptance rate of switching from the ADA RP to ADA biosimilars, identify factors associated with non-acceptance, assess persistence at 6 and 12 months, determine reasons for discontinuation, analyze changes in disease activity, and explore patient perceptions at 12 months.

Design

A prospective study was conducted at a French tertiary center between July 2020 and September 2021, including consecutive IBD outpatients treated with ADA RP for over 6 weeks.

Methods

Patients were offered a switch to five different ADA biosimilars, with the presence of a trained nurse. Data were collected on acceptance rates, persistence at 6 and 12 months, discontinuation reasons, disease activity, and patient perceptions using a 5-item questionnaire at 12 months.

Results

Of the 97 patients included, 91.8% accepted the switch. The only factor linked to non-acceptance was a poor opinion of generic drugs. Persistence with the initial ADA biosimilar was 68.6% at 6 months and 60.4% at 12 months. The overall survival rate without biosimilar discontinuation was 76.7% at 6 months and 71% at 12 months. Injection site pain (24.7%) was the leading cause of discontinuation, and 22 patients switched back to the ADA originator. Clinical remission was maintained in 90.4% of patients at 12 months. Among respondents, 65.8% reported a positive experience with the switch.

Conclusion

The study demonstrates high acceptance and favorable outcomes for switching to ADA biosimilars in IBD patients, including sustained efficacy and good treatment persistence. These findings suggest that switching to ADA biosimilars is a viable option for IBD patients, with positive results in terms of both clinical effectiveness and patient adherence.

Recent developments in managing luminal microbial ecology in patients with inflammatory bowel disease: from evidence to microbiome-based diagnostic and personalized therapy

INTRODUCTION

Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is a chronic condition characterized by abnormal immune responses and intestinal inflammation. Emerging evidence highlights the vital role of gut microbiota in IBD's onset and progression. Recent advances have shaped diagnostic and therapeutic strategies, increasingly focusing on microbiome-based personalized care. Methodology: this review covers studies from 2004 to 2024, reflecting the surge in research on luminal microbial ecology in IBD. Human studies were prioritized, with select animal studies included for mechanistic insights. Only English-language, peer-reviewed articles - clinical trials, systematic reviews, and meta-analyses - were considered. Studies without clinical validation were excluded unless offering essential insights. Searches were conducted using PubMed, Scopus, and Web of Science.

AREAS COVERED

we explore mechanisms for managing IBD-related microbiota, including microbial markers for diagnosis and novel therapies such as fecal microbiota transplantation, metabolite-based treatments, and precision microbiome modulation. Additionally, we review technologies and diagnostic tools used to analyze gut microbiota composition and function in clinical settings. Emerging data supporting personalized therapeutic strategies based on individual microbial profiles are discussed.

EXPERT OPINION

Standardized microbiome research integration into clinical practice will enhance precision in IBD care, signaling a shift toward microbiota-based personalized medicine.

Shaping the future of inflammatory bowel disease: a global research agenda for better management and public health response

Inflammatory bowel disease (IBD) is a growing global health challenge affecting more than 7 million people worldwide. With increasing prevalence across all age groups, including children and adolescents, IBD places substantial strain on health-care systems and society, resulting in high direct medical costs, lost productivity and reduced quality of life. Despite therapeutic advances, suboptimal disease control and delays in timely diagnosis and adequate treatment persist. Regional disparities in health-care access contribute to these challenges, especially in low-income countries. Addressing these inequities is crucial for improving global IBD outcomes. Using a Delphi methodology, experts from clinical care, research, public health and advocacy (including patient representation) identified priorities across six domains (37 statements in total): epidemiology, care models, treatment strategies, education and awareness, patient and community engagement, and leadership to promote health equity. These priorities emphasize quantifying the burden of IBD, addressing health-care disparities, validating care models, exploring novel treatments, advancing education, engaging patients and advocating for health equity policies. The comprehensive approach seeks to optimize care models, promote patient engagement and ensure equitable access to health care. The identified priorities serve as a guide for both clinical and non-clinical researchers, and funders dedicated to IBD-related initiatives, fostering international collaboration to improve IBD management and reduce its impact globally.

Switching from Adalimumab Reference Product to and Among Adalimumab Biosimilars Outside the USA: Insights for US Clinicians

Ten adalimumab biosimilars have been introduced in the United States (USA) since 2023, while adalimumab biosimilars have been available for several years in other countries. These experiences of biosimilar uptake outside the USA can inform US-based healthcare professionals on switching in real-life practice settings. Considerations include how healthcare professionals might meaningfully address patient concerns about outcomes to improve patient satisfaction. A search of the MEDLINE database was used to identify publications on switching to and among adalimumab biosimilars in an ex-US setting, with no restriction on publication language and using a time frame of 1 January 2017 through 12 December 2023, coinciding with the European Union approval of the first adalimumab biosimilar, adalimumab-atto, in March 2017. This narrative review aims to provide insights into the efficacy and safety of transitioning to and among adalimumab biosimilars in adult patients from clinical studies but also, more importantly, using real-world evidence (RWE) from outside the USA. Overall, RWE suggested that efficacy and outcomes were consistent in patients who underwent switching from the reference product (RP) across various immune-mediated inflammatory diseases when compared to patients who did not switch from the RP. The ex-US RWE of RP and biosimilar adalimumab switches generally reflected the experiences observed in clinical trials; however, RWE findings elucidated several challenges to biosimilar uptake, including patient education, provider training, and supportive policies.

Antioxidant and anti-inflammatory effects of Equisetum arvense L. on acid-induced ulcerative colitis in rats

Equisetum arvense L. (EAL) has a long history in traditional medicine for its ability to address various digestive and inflammatory conditions. Here, we aimed to evaluate the therapeutic potential of the EAL hydroalcoholic extract (HAEA) compared with the standard medications in a rat model of ulcerative colitis (UC) caused by acetic acid. Eighty-one male Sprague Dawley rats were acquired and randomly allocated into nine equal groups: healthy control group, negative control groups (receiving normal saline and carboxymethyl cellulose gel base), positive control groups (receiving asacol rectally and mesalazine orally), and test groups treated with different amounts of HAEA. At the end of the experiment (7 days), colonic injury was evaluated by macroscopic, biochemical, and stereological assessments. The effectiveness of HAEA on colonic tissue was proved by significantly decreasing the malondialdehyde (MDA) and interleukin-1β (IL-1β) concentrations as well as myeloperoxidase (MPO) activity and increasing the superoxide dismutase (SOD) activities and glutathione peroxidase (GPx) in comparison to negative control groups. Particularly, the HAEA gel 10% rectal enema was significantly effective in decreasing MDA and IL-1β, as well as increasing GPx and SOD activities in comparison to positive control groups (P < 0.05). According to the stereological evaluations, HAEA 600 mg/kg orally and gel 10% rectal enema-treated groups, as well as the positive control groups, had significantly higher epithelium, submucosa, and muscularis mucosa volume density in comparison to the negative control groups (P < 0.001). This study showed promising therapeutic effects in all HAEA-treated groups, particularly HAEA gel 10% rectal enema in the induced UC rat model compared to conventional treatments. Both in vivo and in vitro findings indicate that EAL has the potential to be used as an additive therapeutic strategy in UC patients.

Spanish Working Group in Crohn's Disease and Ulcerative Colitis (GETECCU) position paper for the management of non-perianal fistulizing Crohn's disease

Crohn's disease consists on a complex condition where, despite most patients initially present with an inflammatory behavior, a significant proportion develop complicated lesions such as strictures, fistulas, abscesses, or even perforations. These lesions progressively increase over time and are associated with a higher risk of surgery and hospitalization. Despite significant advances in their management after the introduction of biological therapies, particularly anti-TNF agents, these complications continue to pose challenges for the multiple professionals involved in their care. Fistulas that do not involve the perianal region (entero-enteric, entero-urinary, or entero-cutaneous) require a multidisciplinary strategy that combines medical, interventional, and surgical approaches. Their treatment ranges from general supportive measures to the use of antibiotics or, frequently, advanced therapies. Nevertheless, in cases of certain septic complications or those refractory to medical treatment, percutaneous drainage or surgical intervention remains essential. Although these lesions have a significant impact, evidence regarding the best strategies in this context, as well as the efficacy and safety of different therapies in these patients, remains limited. This is highlighted by the absence of specific recommendations in current guidelines. The objective of this document is to provide a comprehensive overview of non-perianal fistulizing Crohn's disease, addressing its epidemiological, clinical, and therapeutic aspects from a multidisciplinary perspective.

A systematic review on the role of gut microbiome in inflammatory bowel disease: Spotlight on virome and plant metabolites

Inflammatory bowel diseases (IBD), including ulcerative colitis and Crohn's disease, arise from various factors such as dietary, genetic, immunological, and microbiological influences. The gut microbiota plays a crucial role in the development and treatment of IBD, though the exact mechanisms remain uncertain. Current research has yet to definitively establish the beneficial effects of the microbiome on IBD. Bacteria and viruses (both prokaryotic and eukaryotic) are key components of the microbiome uniquely related to IBD. Numerous studies suggest that dysbiosis of the microbiota, including bacteria, viruses, and bacteriophages, contributes to IBD pathogenesis. Conversely, some research indicates that bacteria and bacteriophages may positively impact IBD outcomes. Additionally, plant metabolites play a crucial role in alleviating IBD due to their anti-inflammatory and microbiome-modulating properties. This systematic review discusses the role of the microbiome in IBD pathogenesis and evaluates the potential connection between plant metabolites and the microbiome in the context of IBD pathophysiology.