Inflammatory Bowel Diseases最新文献

{"title":"Biologics, small molecules, and extraintestinal malignancies in inflammatory bowel disease: practical questions and evidence-based answers.","authors":"Javier P Gisbert, María Chaparro","doi":"10.1093/ibd/izag192","DOIUrl":"https://doi.org/10.1093/ibd/izag192","url":null,"abstract":"<p><p>Malignancy in inflammatory bowel disease (IBD) is a clinical challenge, encompassing cancer risk with biologics and small molecules and the management of patients with previous malignancy. This review addresses questions on malignancy risk and treatment decisions in IBD, with emphasis on advanced therapies. A bibliographic search identified studies evaluating cancer risk in patients with IBD treated with these agents. The evidence is reassuring. Anti-TNF monotherapy does not appear to increase malignancy risk, although uncertainty persists for lymphoma and melanoma, particularly with concomitant thiopurines, which account for the clearest excess lymphoma risk. Vedolizumab and ustekinumab show favorable safety profiles, and early data for selective anti-IL-23 agents are encouraging. In patients with a history of cancer, available data do not indicate a clear increase in new or recurrent malignancy with anti-TNF agents, vedolizumab, or ustekinumab, although the evidence is largely observational. Evidence for JAK inhibitors and S1P receptor modulators remains limited, supporting a cautious approach, particularly in older or high-risk patients and in those with prior malignancy. In active or recent cancer, decisions should be individualized and multidisciplinary, integrating IBD severity, cancer characteristics, prognosis, prior anticancer therapy, and time since diagnosis. Temporary treatment withdrawal during cancer therapy is often appropriate, although earlier biologic reintroduction may be feasible in selected cases. Cancer treatment should not be compromised because of IBD, as chemotherapy and radiotherapy are feasible, whereas immune checkpoint inhibitors may trigger IBD flares. However, evidence remains constrained by confounding, heterogeneous populations, and limited long-term follow-up, underscoring the need for prospective safety studies.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149060691","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 outcomes of patients with negative small bowel video capsule endoscopy for Crohn's disease: A cohort study.","authors":"Hadar Edelman-Klapper, Irit Avni-Biron, Jacob E Ollech, Shani Hegger, Zohar Levi, Iris Dotan, Henit Yanai","doi":"10.1093/ibd/izag188","DOIUrl":"https://doi.org/10.1093/ibd/izag188","url":null,"abstract":"<p><strong>Background: </strong>In the diagnostic algorithm of Crohn's disease (CD), video capsule endoscopy (VCE) is used as a subsequent investigation when initial assessments are inconclusive (ileocolonoscopy and computed tomography/magnetic resonance enterography). The long-term clinical significance of a negative VCE remains uncertain. Therefore, we evaluated long-term clinical outcomes in patients with suspected CD and inconclusive standard investigation.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adults with inconclusive standard investigation for suspected CD who were referred for VCE at a tertiary inflammatory bowel diseases center between 2008 and 2017. VCE studies were scored using the Lewis score. Patients with a Lewis score <135 were defined as \"negative VCE.\" Patients with negative VCE were followed for subsequent CD or alternative diagnoses. Final CD diagnosis was verified by review of electronic clinical charts.</p><p><strong>Results: </strong>Among 615 consecutive patients (median age 36 years; 57.5% female), 192 (31.2%) were identified with a positive VCE suggestive of small bowel CD. Overall, 18 (4.3%) of 423 patients with a negative VCE had a subsequent diagnosis of CD over a median follow-up of 11 years (interquartile range: 10-13 years; 4665 patient-years); median time to diagnosis was 1.5 years (interquartile range: 1-3 years). An alternative diagnosis was established in ∼70% of patients with negative VCE (mostly functional disorders and noninflammatory conditions). The negative predictive value for a negative VCE to exclude CD was 95.7%.</p><p><strong>Conclusions: </strong>A negative VCE confers a very low likelihood of subsequent CD diagnosis in patients with suspected CD after nondiagnostic standard evaluation. Diagnostic efforts should instead focus on functional evaluation and dietary intervention.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038234","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":"Comparative effectiveness of infliximab vs vedolizumab as first-line biologic therapy in moderate-to-severe ulcerative colitis: A prospective, multicenter, real-world study.","authors":"Dongdong He, Sumei Sha, Xiaolei Liu, Pengfei Yin, Xiaodong Qu, Xinyu Wang, Na Wang, Xin Feng, Zixuan Zhang, Wenting Zhang, Yongquan Shi, Min Chen","doi":"10.1093/ibd/izag185","DOIUrl":"https://doi.org/10.1093/ibd/izag185","url":null,"abstract":"<p><strong>Background: </strong>In real-world clinical settings, direct comparative evidence on the effectiveness of infliximab vs vedolizumab for biologic-naïve patients with moderate-to-severe ulcerative colitis remains limited.</p><p><strong>Methods: </strong>This prospective, multicenter, real-world study enrolled patients with moderate-to-severe ulcerative colitis who were biologic-naïve and began using infliximab or vedolizumab from January 2023 to November 2024. To reduce confounding, inverse probability of treatment weighting was applied. The primary outcome was a composite of 14-week clinical remission and 52-week endoscopic remission. The secondary endpoints encompassed clinical response/remission, endoscopic response/remission, and clinical steroid-free remission at weeks 14 and 30; clinical remission, endoscopic remission, and clinical steroid-free remission at week 52; and the therapeutic continuation rate and adverse events rate across the complete observation period.</p><p><strong>Results: </strong>In total, 251 eligible patients were enrolled. After inverse probability of treatment weighting, vedolizumab was significantly superior to infliximab for the composite endpoint (60.18% vs 39.52%; P = .003). Significantly greater proportions of patients in the vedolizumab group attained clinical remission (84.80% vs 66.49%; P = .003), steroid‑free clinical remission (75.87% vs 59.57%; P = .015), endoscopic response (70.43% vs 52.44%; P = .008), and endoscopic remission (70.43% vs 52.44%; P = .008) at week 14 relative to the infliximab group. Effectiveness endpoints were comparable between groups at week 30. At week 52, vedolizumab remained significantly superior in clinical remission (78.39% vs 57.38%; P = .003), clinical steroid-free remission (75.96% vs 53.39%; P = .002), and endoscopic remission (66.03% vs 51.12%; P = .042). The rate of adverse events did not differ significantly between the vedolizumab and infliximab groups (5.47% vs 7.57%; P = .56).</p><p><strong>Conclusions: </strong>Among patients with moderate-to-severe ulcerative colitis who have not been treated with biologics before, vedolizumab-first therapy showed superior short- and long-term effectiveness vs infliximab-first therapy, with comparable safety profiles. Vedolizumab could serve as the initial biologic agent for moderate‑to‑severe ulcerative colitis.NCT06962020; Selection and Efficacy-Inducing Factors of First-Line Biologic Agents in Moderate-to-Severe Ulcerative Colitis; https://clinicaltrials.gov/study/NCT06962020.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030386","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":"Interpreting therapy escalation after discordant Clostridioides difficile testing in IBD.","authors":"Longwei Qiu, Junyi Tang, Chaochi Yue","doi":"10.1093/ibd/izag186","DOIUrl":"https://doi.org/10.1093/ibd/izag186","url":null,"abstract":"","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030180","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":"Revisiting the role of lymphatics in Crohn's disease.","authors":"Catherine Le Berre, Ashkan Rezazadeh Ardabili, Rafael Czepielewski, Ahuva Cices, Saurabh Mehandru, Jean-Frédéric Colombel","doi":"10.1093/ibd/izag187","DOIUrl":"https://doi.org/10.1093/ibd/izag187","url":null,"abstract":"<p><strong>Background: </strong>Early pathological observations consistently highlighted the involvement of the intestinal lymphatic system in Crohn's disease (CD), although this remains underappreciated in current conceptual models of disease pathogenesis. This narrative review synthesizes evidence supporting lymphatic dysfunction as a key contributor of CD pathogenesis, and discusses its therapeutic potential.</p><p><strong>Methods: </strong>We searched PubMed to identify relevant studies on lymphatic biology in CD, including pathological, clinical, and experimental data.</p><p><strong>Results: </strong>Lymphatic obstruction, lymphangitis, and lymphangiectasia are early, widespread features of CD; structural remodeling coexists with compensatory lymphangiogenesis, suggesting a bidirectional relationship in which lymphatic dysfunction both drives and is sustained by intestinal inflammation. Peyer's patches, closely integrated with the lymphatic network, may represent a portal of entry for luminal pathogens. CD susceptibility genes impair microbial handling at this interface, potentially enabling translocation into the lymphatics, endothelial injury, and the granulomatous lymphangitis hallmark of CD. Experimental models reinforce this framework: pathogens such as Yersinia or norovirus can induce lymphangitis preceding overt intestinal inflammation. Metastatic cutaneous CD, a rare extraintestinal manifestation involving lymphatic vessels characterized by granulomatous dermal inflammation at sites anatomically discontinuous from the gut, may provide a unique window into lymphatic pathology independent of the intestinal microbiome.</p><p><strong>Conclusions: </strong>These observations support an alternative view of CD in which intestinal lymphatic dysfunction plays an under-recognized role in both promoting and sustaining inflammation. This framework may explain disease features (patchy distribution, transmural inflammation, mesenteric hypertrophy) and positions the lymphatic system as a therapeutic target to restore drainage and modulate immune-lymphatic crosstalk.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024765","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":"Integrin β7 induced by CB2R may not be confined to α4β7.","authors":"Christos Zavos","doi":"10.1093/ibd/izag190","DOIUrl":"10.1093/ibd/izag190","url":null,"abstract":"","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148989921","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":"Defining adipose tissue profiles in children with Crohn's disease.","authors":"Dhamyanthi Thangarajah, Karyn Chappell, Anyavathi Helena Burtt, Gary Frost, John M E Fell","doi":"10.1093/ibd/izag174","DOIUrl":"https://doi.org/10.1093/ibd/izag174","url":null,"abstract":"<p><strong>Background: </strong>Adipose tissue measures are poorly defined in pediatric Crohn's disease (CD). Visceral adipose tissue (VAT) plays a role in regulating innate immunity and obesity-related diseases, contributing to poorer long-term health outcomes.</p><p><strong>Methods: </strong>Abdominal tissue volumes and liver fat were quantified using magnetic resonance imaging and magnetic resonance spectrometry in children with CD. Dietary, adipokine, and metabolic profiles were analyzed in subjects with CD. Multivariable linear regression analysis was performed to evaluate the factors associated with tissue volumes.</p><p><strong>Results: </strong>We recruited 25 children with CD and 8 healthy controls. Children with CD exhibited significantly higher VAT and subcutaneous adipose tissue (SCAT) volumes than their healthy counterparts, with increases of 0.33 L (95% CI, 0.12-0.52, P < .01) and 1.83 L (95% CI, 1.34-2.45, P < .01), respectively. Muscle measures were lower in children with CD, while liver fat measurements and BMI-z scores remained within healthy reference ranges. Disease duration, male sex, and C-reactive protein (CRP) levels were significant predictors of VAT in children with CD. SCAT was associated with plasma leptin levels, and VAT correlated with plasma triglyceride levels. Children with CD had diets low in calories and high in non-milk extrinsic sugars.</p><p><strong>Conclusion: </strong>This study describes a specific adiposity pattern in children with Crohn's disease; 'Thin on Outside Fat on the Inside Crohn's associated Obesity' (TOFICO). This is characterized by increased visceral and subcutaneous adipose tissue in the context of normal liver fat and BMI. We have shown that visceral obesity is a robust marker of bowel inflammation in Crohn's disease and is not affected by anthropometric factors, unlike BMI.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944821","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: \"Appendectomy before or after ulcerative colitis and the long-term outcomes\".","authors":"Kartik Dapke, Aakash Desai","doi":"10.1093/ibd/izag180","DOIUrl":"https://doi.org/10.1093/ibd/izag180","url":null,"abstract":"","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897365","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":"Appendectomy before or after ulcerative colitis and the long-term outcomes.","authors":"Cong Dai, Yu-Hong Huang","doi":"10.1093/ibd/izag178","DOIUrl":"10.1093/ibd/izag178","url":null,"abstract":"","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874006","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":"Transitioning to adult care for patients with IBD: the impact of a structured IBD transition program on service engagement.","authors":"Jayne Doherty, Ciaran Hurley, Parker Girod, John Peacock, Laura Neilan, Helen Muldowney, Annemarie Burke, Lorraine Stallard, Shoana Quinn, Annemarie Broderick, Emily Stenke, Seamus Hussey, Karen Hartery, David Kevans, Sarah O Donnell, Eoin Slattery, Garret Cullen, Roisin Stack, Glen Doherty, Clodagh Murphy, Billy Bourke, Cara Dunne","doi":"10.1093/ibd/izag056","DOIUrl":"10.1093/ibd/izag056","url":null,"abstract":"<p><strong>Background and aims: </strong>The British Society of Gastroenterology recommend use of structured transition programs to improve control of chronic gastrointestinal disease in adolescents. We sought to determine the impact of attending a structured transition program on engagement of patients with inflammatory bowel disease (IBD) services and disease outcomes.</p><p><strong>Methods: </strong>We performed a retrospective multicenter study of patients with IBD prior to and post-transfer to adult services. Patients were grouped into those who attended a structured transition program and those who received standard care, transferred with a referral letter.</p><p><strong>Results: </strong>A total of 282 patients were included: 155 patients in our structured transition program cohort and 127 patients in the standard care cohort. Patients who took part in a structured transition program had significantly better engagement with adult IBD services with significantly lower rates of nonattendance at outpatient clinics 1-year post-transfer (12.3% vs 27.2%, P = .002) and significantly lower rates of disengagement with services (4.2% vs 13.1%, P = .015). There were no significant differences seen in rates of biologic failure, need for steroid/surgery or median fecal calprotectin levels between either group. Attending a structured transition program was the only factor that positively impacted engagement with IBD services in a multivariate analysis (OR 4.08, confidence interval 1.41-11.91, P = .01).</p><p><strong>Conclusion: </strong>Structured transition programs in IBD can improve engagement of patients with IBD services with significantly lower rates of disengagement with IBD services seen in our study. Large prospective studies are needed in this field to further investigate this and the impact of these programs on disease outcomes.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":"1731-1740"},"PeriodicalIF":5.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672790","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}