Inflammatory Bowel Diseases最新文献

{"title":"Comparison of Different Sites of Microbiota Shows Increased Pseudomonas Species in the Gut Mucosa in Inflammatory Bowel Disease.","authors":"David Schult-Hannemann, Christina Gassner, Niklas Thur, Chiara Hennig, Lisa Fricke, Lucia Liotta, Simon Weidlich, Monica Steffi Matchado, Bärbel Stecher, Leona Arps, Katja Steiger, Julius Shakhtour, Moritz Jesinghaus, Markus List, Klaus-Peter Janssen, Mohsen Pourjam, Klaus Neuhaus, Dirk Haller, Roland M Schmid, Michael Quante, Moritz Middelhoff, H Carlo Maurer","doi":"10.1093/ibd/izaf185","DOIUrl":"https://doi.org/10.1093/ibd/izaf185","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), is associated with changes in the gut microbiome. Studies comparing fecal, gut mucosal, and salivary microbiomes are rare, and questions remain regarding the interaction of these compartments.</p><p><strong>Methods: </strong>In this case-control study, 16S rRNA gene amplicon sequencing was performed on samples from stool, intestinal mucosa, and saliva of 120 patients with IBD. Patients with signs of non-IBD colonic inflammation (N = 28) and healthy subjects (N = 67) served as controls. A total of 480 16S profiles were analyzed. The results were evaluated with multiple clinical and pathological parameters and potential confounders were considered. The study aimed to find microbial biomarkers specific to IBD and signatures of intestinal barrier dysfunction.</p><p><strong>Results: </strong>Fecal α-diversity of IBD patients was reduced and Pseudomonas species was significantly increased in the mucosa of IBD patients (Pseudomonas-positive mucosa [PSM positive], P value < .001, Mann-Whitney U test). Comparison of matched stool and mucosa samples showed high abundance of Pseudomonas species in gut mucosa but not in fecal samples, especially in CD patients. Interestingly, in PSM positive, Paracoccus species, Bacteroides species, and Streptococcus species were more abundant. Importantly, the results were independent of disease severity, histopathology, medication, and other metadata.</p><p><strong>Conclusions: </strong>The opportunistic pathogenic bacterium Pseudomonas species is more prevalent in the gut mucosa of patients with IBD. This indicates a disruption of the gut barrier with increasing mucosal colonization or invasion of the bacteria. The finding is independent of clinical metadata and confounders and occurs in new-onset IBD but not in non-IBD intestinal inflammation, which suggests disease specificity.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health-Related Physical Fitness in Patients With Inflammatory Bowel Disease vs Healthy Control Subjects.","authors":"Karlijn Demers, Noortje van den Bergh, Bart C Bongers, Sander M J van Kuijk, Zlatan Mujagic, Daisy M A E Jonkers, Marieke J Pierik, Laurents P S Stassen","doi":"10.1093/ibd/izaf169","DOIUrl":"https://doi.org/10.1093/ibd/izaf169","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel disease (IBD) may negatively affect health-related physical fitness. However, the development of interventions to improve health-related physical fitness and thereby disease outcomes is hindered by insufficient evidence. This study compared health-related physical fitness between patients with IBD and healthy control subjects, examined associations with disease and treatment characteristics, and explored patients' perspectives.</p><p><strong>Methods: </strong>In this cross-sectional study, 105 patients with IBD and 102 age- and sex-matched healthy control subjects performed validated tests for body fat (4-site skinfold thickness), cardiorespiratory fitness (steep ramp test), muscular strength (steep ramp test, 60-second sit-to-stand test, hand-held dynamometry), muscular endurance (isokinetic dynamometry), and flexibility (sit-and-reach test). Data on disease and treatment characteristics, fatigue, physical activity, and patients' perspectives were collected.</p><p><strong>Results: </strong>Patients with IBD had higher body fat (29.5% vs 26.9%; P = .012), lower steep ramp test performance (peak work rate 4.2 W/kg vs 4.8 W/kg; P < .001), fewer sit-to-stand repetitions (42 vs 47; P = .002), and reduced hamstring strength (3.0 N/kg vs 3.2 N/kg; P = .011) compared with healthy control subjects. This was associated with higher age, female sex, higher body mass index, fatigue, arthritis, and multiple biologicals used. Most patients considered physical fitness important and beneficial for their symptoms, and the majority expressed interest in professional support.</p><p><strong>Conclusions: </strong>Patients with IBD have higher body fat and reduced cardiorespiratory fitness and muscular strength compared with healthy control subjects. Especially, patients with a higher age, female sex, higher body mass index, fatigue, arthritis, or multiple biologicals used are at risk for such impairments and may benefit from physical exercise interventions.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Letter to the Editor Entitled \"Unaddressed Dimensions in Long-Term Regenerative Therapy for Perianal Crohn's Fistulas\".","authors":"Silvio Laureti, Claudio Isopi, Alberta Cappelli, Alessandra Menon","doi":"10.1093/ibd/izaf202","DOIUrl":"https://doi.org/10.1093/ibd/izaf202","url":null,"abstract":"","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Menopause and Inflammatory Bowel Disease: A Systematic Review.","authors":"Tanvi Kale, Linda Yoo, Ellie Kroeger, Arwa Iqbal, Sunanda Kane, Sara Shihab, Samantha Conley, Kendra Kamp","doi":"10.1093/ibd/izaf204","DOIUrl":"https://doi.org/10.1093/ibd/izaf204","url":null,"abstract":"<p><strong>Background: </strong>Research is limited on the impacts of menopause, defined as the permanent cessation of ovarian function and decline of reproductive hormones, on gastrointestinal symptom severity and disease progression in women with inflammatory bowel disease (IBD). This review synthesizes current evidence on the impact of menopause, menopause transition, and hormonal therapy (HT) on disease activity, IBD and menopause symptom severity, and disease progression among individuals with IBD.</p><p><strong>Methods: </strong>A systematic literature review was reported following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and preregistered at PROSPERO (CRD42024564901). Five databases were searched without date restrictions. Data extraction and risk-of-bias assessment were performed independently by multiple reviewers. Results were qualitatively synthesized.</p><p><strong>Results: </strong>Of 1667 records, 15 studies met inclusion criteria (5 cohort, 3 case-control, 7 cross-sectional) with IBD sample sizes from 37 to 1367. Evidence on HT and IBD risk was mixed: some studies linked HT to increased ulcerative colitis risk while others found no significant association after adjusting for confounders. Women with IBD experience earlier menopause than healthy control subjects. While most women reported no change in IBD symptoms postmenopause, a minority reported symptom worsening. HT may reduce flare severity. Women with IBD reported more severe vulvovaginal symptoms and had distinct vaginal microbiome profiles compared with healthy control subjects.</p><p><strong>Conclusions: </strong>Few studies have explored the relationship between menopause and IBD. There is a need for continued research on the relationship between IBD disease activity and menopause symptoms to create tailored interventions to improve women's health with IBD across the lifespan.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perianal Disease Modifiers Are Associated With Less Severe Luminal Disease Activity in Children With Crohn's Disease at Diagnosis.","authors":"Ben Kang, Jin Soo Moon, Sujin Choi, Seak Hee Oh, Eell Ryoo, Yu Bin Kim, Yon Ho Choe, Yeoun Joo Lee, Minsoo Shin, Hye Ran Yang, Soon Chul Kim, Yoo Min Lee, Hong Koh, Ji-Sook Park, So Yoon Choi, Su Jin Jeong, Yoon Lee, Ju Young Chang, Tae Hyeong Kim, Jung Ok Shim","doi":"10.1093/ibd/izaf209","DOIUrl":"https://doi.org/10.1093/ibd/izaf209","url":null,"abstract":"<p><strong>Background: </strong>There is lack of data regarding the associations between perianal fistulizing disease and other disease characteristics at diagnosis in children with Crohn's disease (CD). We sought to investigate the associations between perianal fistulizing disease and other disease characteristics at diagnosis in children with CD.</p><p><strong>Methods: </strong>This was a multicenter, registry-based, inception cohort study conducted in Korea. Children newly diagnosed with CD were included. Baseline clinicodemographics; results from laboratory, endoscopic, histologic exams; and Paris classification factors were collected, and associations between factors were investigated.</p><p><strong>Results: </strong>A total 699 patients were included. The median age at diagnosis was 14.3 years (IQR, 12.3-15.9 years), and the male-to-female ratio was 2.66:1. Perianal disease modifiers comprised 50.6% (n = 354 of 699) of the patients. The proportion of perianal disease modifiers was higher in males (81.1% vs 64.1%; P < .001), in those with upper gastrointestinal tract involvement (85.3% vs 75.7%; P = .002), and in those with B1 behavior (89.5% vs 79.7%; P < .001). Albumin was higher (P = .006) and CRP was lower (P < .001) in patients with perianal disease modifiers. Females had a higher proportion of B2/B3 behavior (21.4% vs 14.4%; P = .029), higher Pediatric Crohn's Disease Activity Index scores (median 40 vs 32.5; P < .001), higher CRP (P = .017), higher Simple Endoscopic Score for Crohn's Disease scores (P = .01), and more frequent detection of noncaseating granulomas in the lower gastrointestinal tract (P = .008).</p><p><strong>Conclusions: </strong>Perianal fistulizing disease was more common in boys who exhibited milder disease activity, indicating the importance of recognizing perianal fistulizing disease as a clinical clue to the early diagnosis of underlying luminal CD.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Sectional Imaging Features Associated With Disease Progression in Crohn's Disease.","authors":"Salam P Bachour, Shravya Srinivas-Rao, Nikitha Uma Baskaran, Manasi Agrawal, Henrik Albaek Jacobsen, Lone Larsen, Tine Jess, Jean-Frederic Colombel, Ryan C Ungaro, Avinash Kambadakone, Ashwin N Ananthakrishnan","doi":"10.1093/ibd/izaf219","DOIUrl":"https://doi.org/10.1093/ibd/izaf219","url":null,"abstract":"<p><strong>Background and aims: </strong>Progressive Crohn's disease (CD) often requires early initiation of biologic or immunomodulator therapy for disease management. However, some patients may have a milder disease course that may be managed with a less aggressive strategy. Our study aims to determine cross-sectional radiographic features that predict progression of CD.</p><p><strong>Methods: </strong>This was a multi-institution, retrospective cohort of adult CD patients without prior immunomodulator or biologic use, prior surgery, or CD-related hospitalization, who underwent abdominal cross-sectional imaging prior to 2018. Index cross-sectional imaging was reviewed by 2 radiologists who extracted 37 features pertaining to the intestine, mesentery, or extra-luminal complications. The primary outcome was composite progression of disease defined as initiation of an immunomodulator or biologic agent, surgical intestinal resection, or CD-related hospitalization.</p><p><strong>Results: </strong>Our study included 177 CD patients who underwent cross-sectional imaging (81% CT). 81 patients (45.8%) experienced composite progression of disease. On multivariable regression, small bowel wall thickening >5 mm (aOR 8.59; P < .001), distal colonic inflammation (aOR 3.95; P = .03), and segmental mural hyperenhancement (aOR 2.44; P = .04) were independently associated with progression of disease. Absence of radiologic features identified a subgroup with a low rate (13.7%) of disease progression.</p><p><strong>Conclusions: </strong>Cross-sectional imaging can be used to identify patients with mild CD who are at higher risk for progression. Absence of these features may identify mild CD requiring less aggressive treatment strategies and define a population eligible for trials of management strategies for mild CD.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145199199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Generation and Phenotypic Analysis of the IL-10RAR104W/R104W Mouse Model.","authors":"Xiaoya Cao, Zhiyang Zeng, Xiya Cao, Youyuan He, Liren Wang, Dali Li, Xueli Zhang","doi":"10.1093/ibd/izaf099","DOIUrl":"https://doi.org/10.1093/ibd/izaf099","url":null,"abstract":"<p><strong>Background: </strong>Very-early-onset inflammatory bowel disease (VEO-IBD) is a form of IBD that manifests in infants and young children, with a significant proportion of them carrying interleukin 10 receptor alpha (IL-10RA) mutations. Despite the increasing incidence rate, the pathogenesis of VEO-IBD remains elusive, and treatment options are limited. The utilization of a humanized mouse model holds promise for further investigation into VEO-IBD. Previous study has revealed that VEO-IBD patients had a homozygous C > T mutation at IL-10RA position 301, which can be pathogenic.</p><p><strong>Methods: </strong>We generated the corresponding point mutation mouse model via CRISPR/Cas9 technology. Subsequently, we performed various experiments to assess the colitis phenotype in mice and conducted a preliminary exploration of the model's utility.</p><p><strong>Results: </strong>The mouse model progressively developed spontaneous colitis between 6 and 12 weeks. Hematoxylin and eosin (H&E) staining revealed abnormal colonic structure and massive local immune cell infiltration. The mouse model has abnormal levels of inflammatory cytokines in the colonic tissue, with an expansion of F4/80+ macrophages, CD4+ T cells, and B220+ B cells. Among the macrophages, the level of tissue-resident macrophages associated with anti-inflammation was reduced in IL-10RAR104W/R104W mice, while the level of immature macrophages associated with pro-inflammation was increased. Furthermore, we found that bone marrow transplantation can alter the composition of intestinal macrophage populations and treat intestinal inflammation in mutant mice. Finally, the result of subcutaneous tumor-bearing experiments indicated a faster tumor growth rate in the mutant mice.</p><p><strong>Conclusions: </strong>In summary, we have successfully constructed a humanized mouse model with a stable spontaneous colitis phenotype, which is a valuable model for the therapeutic exploration of VEO-IBD.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145185093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Ozanimod Therapy in Patients With Moderately Active Ulcerative Colitis After Failure of 5-Aminosalicylic Acid.","authors":"Andres Yarur, Peter Irving, Britta Siegmund, Marla C Dubinsky, Ashwin N Ananthakrishnan, Miguel Regueiro, Ryan C Ungaro, Timothy Ritter, Hiroshi Nakase, Zhaohui Liu, Dimpy Mehra, Mark T Osterman, Anjali Jain, David T Rubin, Toshifumi Hibi","doi":"10.1093/ibd/izaf195","DOIUrl":"https://doi.org/10.1093/ibd/izaf195","url":null,"abstract":"<p><strong>Background: </strong>We evaluated the efficacy and safety of ozanimod after 5-aminosalicylic acid (5-ASA) failure in advanced therapy (AT)-naive patients with moderate ulcerative colitis (UC) in True North and its open-label extension (OLE).</p><p><strong>Methods: </strong>True North was a randomized, 52-week, phase 3 trial with an optional OLE. Efficacy was assessed in True North and the OLE; safety was assessed through OLE week 190.</p><p><strong>Results: </strong>Overall, 203 AT-naive True North patients had moderate UC (Mayo endoscopic subscore of 2 + modified Mayo score of 4-6 + rectal bleeding subscore ≥1). Of these, 139 were also immunomodulator-naive and not receiving corticosteroids (5-ASA-exposed only) at baseline. Patients with moderate UC receiving ozanimod vs placebo achieved greater efficacy rates for all week 10 and week 52 outcomes, regardless of prior immunomodulator/corticosteroid use (eg, week 10 clinical remission: AT-naive = 36.8% vs 10.6%; 5-ASA-exposed only = 37.9% vs 17.2%). Higher symptomatic response rates were achieved by week 2 with ozanimod in AT-naive patients with moderate UC vs the overall AT-naive population (50.5% vs 38.7%); similar trends were observed in patients exposed only to 5-ASA. Efficacy was maintained through OLE week 190 in patients who entered OLE as True North week 52 ozanimod clinical responders. Of those entering OLE as True North week 10 ozanimod clinical nonresponders, 69.0% of AT-naive patients and 68.4% of patients exposed only to 5-ASA achieved symptomatic response by week 5. No new safety signals emerged.</p><p><strong>Conclusions: </strong>Ozanimod was safe, effective, and durable up to ∼5 years in AT-naive patients with moderate UC who failed conventional therapy. ClinicalTrials.gov: NCT02435992, NCT02531126.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive Behavioral Therapy for Insomnia May Improve Sleep and Pain in Crohn's Disease: A Waitlist Control Pilot Trial.","authors":"Jessica K Salwen-Deremer, Sarah J Westvold, Kelly Aschbrenner, Michael T Smith, Corey A Siegel","doi":"10.1093/ibd/izaf210","DOIUrl":"https://doi.org/10.1093/ibd/izaf210","url":null,"abstract":"<p><strong>Background: </strong>Poor sleep is common in Crohn's disease (CD), prospectively predicts worse disease course, and is often attributable to insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is the recommended treatment for chronic insomnia disorder. CBT-I improves sleep and may improve pain intensity, pain interference, and inflammation. We sought to investigate whether CBT-I impacts these factors in patients with active CD.</p><p><strong>Method: </strong>We recruited patients with insomnia and mild-to-moderate CD symptoms from an inflammatory bowel disease center. Exclusion criteria were other sleep disorders, significant psychiatric concerns, and presence of other common influences on sleep. Participants completed baseline assessments of sleep, pain, and inflammation then were randomized to receive CBT-I immediately, or wait 12 weeks and then repeat the baseline assessment and complete CBT-I. Similar assessments occurred immediately post-CBT-I and 1 month later. CBT-I included sleep restriction, stimulus control, sleep hygiene, arousal reduction, and cognitive therapy.</p><p><strong>Results: </strong>A total of 26 participants completed the study. In group × time analyses, CBT-I led to greater reductions in insomnia severity (P < .001) and wake after sleep onset (P = .02) than waitlist. In pre- to post-treatment analyses, participants reported significant improvements in subjective measures of sleep continuity, CD symptom severity, pain intensity, and pain interference. C-reactive protein trended toward improvement.</p><p><strong>Discussion: </strong>This study provides preliminary evidence of efficacy of CBT-I in people with CD. CBT-I improved self-reported sleep and may improve pain and CD symptoms. The results highlight the importance of addressing sleep concerns in inflammatory bowel disease, particularly in people with persistent pain or fatigue. Future trials powered to detect changes in pain and inflammation are warranted.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145149030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-TNF Therapies Promote a Proximal-to-Distal Healing Pattern in Moderate-to-Severe Ulcerative Colitis.","authors":"Emily C L Wong, Parambir S Dulai, John K Marshall, Vipul Jairath, Walter Reinisch, Neeraj Narula","doi":"10.1093/ibd/izaf199","DOIUrl":"https://doi.org/10.1093/ibd/izaf199","url":null,"abstract":"<p><strong>Background: </strong>Ulcerative colitis (UC) is a chronic inflammatory disease of the colonic mucosa, extending proximally from the rectum. However, the segmental pattern of healing in UC remains unclear. Endoscopic improvement (EI), a key therapeutic endpoint, is typically assessed using the Mayo endoscopic score (MES), which scores the worst affected area and may miss partial/segmental healing. This study evaluates healing patterns in UC and compares conventional MES with a 3-segment MES approach for detecting treatment effects in clinical trials.</p><p><strong>Methods: </strong>A post hoc analysis of HIBISCUS I/II and GARDENIA trials was conducted in UC patients with moderate-to-severe disease (MES >2 up to the descending colon). The primary outcome was the proportion of anti-tumor necrosis factor-treated participants achieving MES ≤1 in the descending colon, sigmoid colon, and rectum at week 10. Secondary outcomes included conventionally measured EI, segmental MES improvements, clinical response, and Patient-Reported Outcome 2 (PRO2) normalization. Outcomes were compared between adalimumab, infliximab, and placebo groups.</p><p><strong>Results: </strong>Among 300 participants, 217 received infliximab or adalimumab, while 83 received placebo. Healing followed a proximal-to-distal pattern, with the highest EI in the descending colon and the lowest in the rectum. Infliximab-treated patients continued this trend at week 54. Anti-tumor necrosis factor therapy significantly improved EI vs placebo (42.9% vs 19.3%; P < .001). No segmental MES approach outperformed conventional MES for detecting treatment effects. Combined endpoints (MES ≤1 + PRO2 normalization) better captured therapeutic benefits than PRO2 alone (28.6% vs 13.3%; P = .006).</p><p><strong>Conclusions: </strong>UC healing follows a proximal-to-distal pattern. Conventional MES remains superior for detecting treatment effects over segmental MES. Further studies should explore alternative endoscopic scoring methodologies.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145148970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}