Inflammatory Bowel Diseases最新文献

{"title":"Early Top-Down Treatment With Biologics Improves the Rates of Transmural Remission in Crohn's Disease-A Risk-Adjusted Propensity Score Matched Analysis.","authors":"Samuel Raimundo Fernandes, Inês Coelho Rodrigues, André Da Silva Neves, Sofia Saraiva, Ana Rita Gonçalves, Paula Moura Santos, Ana Valente, Luís Araújo Correia, Helena Cortez- Pinto, Fernando Magro","doi":"10.1093/ibd/izaf112","DOIUrl":"https://doi.org/10.1093/ibd/izaf112","url":null,"abstract":"<p><strong>Background: </strong>Early top-down treatment with biologics has been associated with higher rates of endoscopic remission compared to step-up treatment in Crohn's disease (CD). The benefits in relation to transmural remission are currently unknown. Better stratification of patients suitable for top-down strategies is needed.</p><p><strong>Methods: </strong>Retrospective study including CD patients naïve to immunomodulators and biologics and with endoscopic and radiologic evidence of active disease at baseline. Transmural remission rates were compared between patients receiving early top-down treatment (start of biologics within 6 months of immunomodulators) and conventional step-up treatment (start of biologics > 6 months after immunomodulators). The influence of risk factors for disabling disease (age at diagnosis, disease duration, smoking, phenotype, perianal disease, extensive small bowel disease, and elevated C-reactive protein) on transmural remission rates was also assessed and adjusted through propensity score-matched analysis.</p><p><strong>Results: </strong>In total, 327 patients were included in the main analysis, 47.7% receiving early top-down treatment with biologics. Transmural remission rates decreased from 33.3% to 0% in patients with 0 and 6 risk factors for disabling disease, respectively. Early top-down treatment resulted in higher rates of transmural remission (33.3% vs 18.1%, P = .002) and was an independent predictor for this outcome in the multivariate analysis (odds ratio [OR] 2.187, 95% confidence interval [95% CI], 1.270-3.665, P = .005). Comparable results were found in the propensity score matched analysis (34% vs 17%, P = .002; OR 2.3, 95% CI, 1.268-4.174, P = .006).</p><p><strong>Conclusions: </strong>Early top-down treatment with biologics improves the rates of transmural remission in CD. Risk factors for disabling disease significantly impact the chances of obtaining transmural remission and may help clinicians identify patients suitable for more aggressive treatment strategies.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484177","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 Outcome of Colonic and Ileal Crohn's Disease: A Two-Decade Population-Based Study in Pediatric-Onset Disease.","authors":"Mathurin Fumery, Guillaume Savoye, Hélène Sarter, Claire Dupont-Lucas, Valérie Bertrand, Pauline Wils, Nicolas Richard, Nathalie Guillon, Corinne Gower-Rousseau, Dominique Turck, Delphine Ley, Ariane Leroyer","doi":"10.1093/ibd/izaf133","DOIUrl":"https://doi.org/10.1093/ibd/izaf133","url":null,"abstract":"<p><strong>Introduction: </strong>Crohn's disease (CD) location would influence the risk of complications and therapeutic strategies. The objective of this study was to compare the clinical presentation at diagnosis and the natural history of colonic CD in comparison to ileal CD and ulcerative colitis (UC) in pediatric-onset inflammatory bowel disease (IBD).</p><p><strong>Patients and methods: </strong>All children (<17 years) with a diagnosis of CD or UC made between 1988 and 2011 in a population-based registry were included. The presentation at diagnosis, the risks of complications, surgery, hospitalization, and exposure to different treatments in ileal CD (CD-L1), colonic CD (CD-L2), and UC were compared.</p><p><strong>Results: </strong>A total of 215 CD-L1 patients, 234 CD-L2 patients, and 337 UC patients were included. Over the study period, the annual incidence rates of CD-L1, CD-L2, and UC were 0.65 (95% CI, 0.57-0.74), 0.71 (0.62-0.81), and 1.02 (0.92-1.14) per 105 persons, respectively. At diagnosis, the proportion of males (L1 53%; L2 53%; UC 43%; P = .012), age at diagnosis (15.0; 13.7; 14.0 years; P = .003), family history of IBD (13%; 11%; 5%; P = .005), diagnostic delay (3.0; 3.0; 2.0 months; P = .001), and smoking prevalence (12%; 8%; 6%; P = .041) were different between the 3 groups. Bloody stools at diagnosis were observed in 15%, 44%, and 91% for, respectively, CD-L1, CD-L2, and UC (P < .001), and diarrhea in 47%, 72%, and 65% (P < .001). At diagnosis, the presence of granuloma was identified in 13% of CD-L1 patients and 31% of CD-L2 patients (P < .001). The risk of extension to L3 was significantly higher in the CD-L2 group than in the CD-L1 group (at 5 years-37% vs. 14%, P < .001). L2 location was associated with a lower risk of luminal fistula (hazard ratio [HR] 0.4 [0.2-0.6], P < .001) but was associated with a higher risk of anoperianal lesion (HR 2.1 [1.3-3.4], P = .003). The prevalence of extraintestinal manifestations, articular (P < .001) and cutaneous (P < .001), was higher in CD-L2. While the 5-year risk of surgery was significantly higher in case of CD-L1 (37%, 13%, and 13%; P < .001), the 5-year exposure to corticosteroids (55%, 69%, and 67%; P < .001), immunosuppressants (47%, 61%, and 42%; p < .001), and anti-TNF (16%, 35%, and 21%; P < .001) were higher in case of L2 location.</p><p><strong>Conclusions: </strong>The clinical presentation and evolution of ileal and colonic CD differ significantly in children. Colonic location is associated with a high risk of perianal CD, extraintestinal manifestations, and exposure to steroids, immunosuppressants, and anti-TNFs. These differences could justify different therapeutic approaches.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484180","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":"Efficacy of Risankizumab Dose Escalation Among Patients With Inflammatory Bowel Disease.","authors":"William Schreiber-Stainthorp, Adam S Faye, Jordan E Axelrad","doi":"10.1093/ibd/izaf130","DOIUrl":"https://doi.org/10.1093/ibd/izaf130","url":null,"abstract":"","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484178","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":"The Dual Role of ACE2 in IBD: Balancing SARS-CoV-2 Susceptibility and Gut Homeostasis.","authors":"Laura Francesca Pisani, Guglielmo Albertini Petroni, Luca Pastorelli, Chiara Porta","doi":"10.1093/ibd/izaf132","DOIUrl":"https://doi.org/10.1093/ibd/izaf132","url":null,"abstract":"","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484184","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":"Natural History, Treatment Persistence and Predictors of Treatment Failure in Patients With Ulcerative Colitis on 5-Aminosalicylic Acid: A US Population-Level Cohort Study.","authors":"Gursimran S Kochhar, Himsikhar Khataniar, Jana G Hashash, Miguel Regueiro, Francis A Farraye, Aakash Desai","doi":"10.1093/ibd/izaf129","DOIUrl":"https://doi.org/10.1093/ibd/izaf129","url":null,"abstract":"<p><strong>Introduction: </strong>Limited data exist on the natural history and treatment persistence in ulcerative colitis (UC) patients on 5-aminosalicylic acid (5-ASA) in the era of biologic agents and small molecules.</p><p><strong>Methods: </strong>This was a retrospective cohort study utilizing the US Collaborative Network in patients with UC who were initiated on 5-ASA between 2015 and 2019. The 1-, 3-, and 5-year incidence rates of advanced therapy use and colectomy were calculated. Predictors of advanced therapy use and colectomy within 5 years were analyzed and expressed as adjusted odds ratios (aORs) with 95% confidence intervals (CIs) after 1:1 propensity score matching (PSM).</p><p><strong>Results: </strong>Among 15 177 patients in the UC 5-ASA cohort (mean age 47.2 ± 19.1 years old, 49.2% female and 70.3% White), the 1-, 3- and 5-year incidence of advanced therapy use was 5.37%, 11.56% and 15.8%, respectively. After PSM, age < 40 years old (aOR 1.93, 95% CI, 1.73-2.15), male sex (aOR 1.13, 1.02-1.25), obesity (aOR 1.18, 95% CI, 1.05-1.31), pancolitis (aOR 1.18, 95% CI, 1.03-1.36), steroid use (aOR 1.79, 95% CI, 1.53-2.09), and CRP ≥ 12 mg/L (aOR 1.39, 95% CI, 1.05-1.83) prior to 5-ASA initiation were associated with advanced therapy use within 5 years. The 1-, 3- and 5-year incidence of colectomy was 0.74%, 1.28%, and 1.64% respectively. After PSM, male sex (aOR 1.36, 95% 1.06-1.74), obesity (aOR 1.32, 95% CI, 1.02-1.69), primary sclerosing cholangitis (aOR 2.37, 95% CI, 1.11-5.06), pancolitis (aOR 1.90, 95% CI, 1.29-2.78), and steroid use (aOR 1.96, 95% CI, 1.35-2.84) were associated with colectomy within 5 years.</p><p><strong>Conclusion: </strong>Our study provides updated estimates of advanced therapy utilization and colectomy as well as predictors of disease progression in patients with UC on 5-ASA in the biologic era.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484181","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":"Inflammation of the Rectal Cuff is Associated With Strictures and Fistulas in Patients With Ulcerative Colitis who Have an Ileal Pouch-Anal Anastomosis.","authors":"Joseph Carter Powers, Katherine Westbrook Cates, Emma Dester, Mark Zemanek, Benjamin L Cohen, Bret Lashner, Andrei I Ivanov, Olga Lavryk, Katherine Falloon, Manuel B Braga-Neto, Tracy Hull, Taha Qazi","doi":"10.1093/ibd/izaf127","DOIUrl":"https://doi.org/10.1093/ibd/izaf127","url":null,"abstract":"<p><strong>Background: </strong>Patients with medically refractory ulcerative colitis (UC) may undergo colectomy with ileal pouch-anal anastomosis (IPAA). Rectal cuff inflammation following surgery is common and may be associated with pouch failure, but the mechanisms underlying this association remain unclear. We assessed whether endoscopic cuff inflammation is associated with fistula and stricture development.</p><p><strong>Methods: </strong>This cohort study included adults with UC who were grouped based on whether they had cuff inflammation with mucosal breaks on any endoscopy following IPAA. Endoscopic, clinical, and imaging data were reviewed for all patients to identify the development of strictures and/or fistulas. Multivariable Cox proportional hazard models were used to compare time to development of each outcome. Sub-analyses were conducted to determine whether persistent inflammation, new onset mucosal breaks, and resolution of mucosal breaks predicted the development of each outcome.</p><p><strong>Results: </strong>A total of 324 patients met eligibility criteria with 96 (29.6%) patients with cuff inflammation and 228 (70.4%) of patients without inflammation. Patients with cuff inflammation had a higher risk of strictures of the pouch/pre-pouch ileum (adjusted hazard ratio [aHR] = 3.27; 95% CI, 1.70-6.33; P < .001) and fistulas of the pouch or rectal cuff (aHR = 4.24; 95% CI, 1.83-9.83; P = .001). Individuals with persistent, but not single-instance, inflammation were at higher risk of pouch strictures, fistulas, and pouch failure, and both durations were associated with a higher risk of anastomotic strictures.</p><p><strong>Conclusions: </strong>Endoscopic cuff inflammation is associated with strictures and fistulas of the IPAA, and individuals with persistent inflammation appear to have the highest risk.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484179","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":"Patients With Crohn's Disease and Terminal Ileum Resection are at Increased Risk of Colorectal Cancer: A Population-Based Study.","authors":"Inas Mikhail, Omar Al Ta'ani, Razan Aburumman, Saqr Alsakarneh, Francis A Farraye, Jana G Hashash","doi":"10.1093/ibd/izaf118","DOIUrl":"https://doi.org/10.1093/ibd/izaf118","url":null,"abstract":"<p><p>Patients with Crohn's disease (CD) who undergo terminal ileum (TI) resection experience altered bile acid absorption, which may influence colorectal cancer (CRC) risk. We conducted a propensity-matched cohort study using TriNetX to compare CRC risk in patients with CD who underwent TI resection versus those who did not. Terminal ileum resection was associated with an increased risk of CRC (aHR = 2.58, 95% CI, 1.72-3.86). Patients with TI resection also had higher odds of colorectal polyps. These findings suggest the need for heightened CRC surveillance in patients with CD undergoing TI resection.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144511873","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":"Correction to: Screen Failures and Causes in Inflammatory Bowel Disease Randomized Controlled Trials: A Study of 16 913 Screened Patients.","authors":"","doi":"10.1093/ibd/izaf134","DOIUrl":"10.1093/ibd/izaf134","url":null,"abstract":"","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301997","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":"Can One Disease Hide Another?","authors":"Clotylde Dumas, Nicolas Macagno, Laura Beyer-Berjot","doi":"10.1093/ibd/izaf123","DOIUrl":"https://doi.org/10.1093/ibd/izaf123","url":null,"abstract":"","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301996","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":"Dualistic Implications of Angiotensin-Converting Enzyme 2 (ACE2) Expression in Inflammatory Bowel Disease.","authors":"Arno R Bourgonje","doi":"10.1093/ibd/izaf131","DOIUrl":"https://doi.org/10.1093/ibd/izaf131","url":null,"abstract":"","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309828","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}