Inflammatory Bowel Diseases最新文献

{"title":"Prospective real-world experience with risankizumab in difficult-to-treat Crohn's disease: results from the Dutch Initiative on Crohn and Colitis Registry.","authors":"Loriane M M Verleye, Marieke J Pierik, Annemarie C de Vries, Fiona D M van Schaik, Andrea E van der Meulen-de Jong, Willemijn A van Dop, Mark Löwenberg, Marijn C Visschedijk, Myrthe R Naber, Dianne G Bouwknegt, Tessa E H Römkens, Alexander G L Bodelier, Philip W Voorneveld, Bas Oldenburg, Lauranne A A P Derikx, Marjolijn Duijvestein, Zlatan Mujagić","doi":"10.1093/ibd/izag045","DOIUrl":"10.1093/ibd/izag045","url":null,"abstract":"<p><strong>Background: </strong>Risankizumab, a monoclonal antibody targeting interleukin-23, is approved for the treatment of Crohn's disease (CD). Real-world evidence on its effectiveness remains limited. We assessed 1-year effectiveness and safety of risankizumab in a prospective cohort of patients with CD, emphasizing difficult-to-treat disease.</p><p><strong>Methods: </strong>Data were retrieved from the Dutch Initiative on Crohn and Colitis Registry. At baseline and at weeks 12, 24, and 52, clinical remission (Harvey-Bradshaw Index ≤4), biochemical remission (fecal calprotectin ≤250 µg/g and C-reactive protein levels ≤5 mg/L), systemic corticosteroids use, and safety outcomes were determined. The primary outcome was corticosteroid-free clinical remission (CSFCR) at week 24. Difficult-to-treat disease was defined as the failure of advanced therapies with at least 2 different mechanisms of action.</p><p><strong>Results: </strong>In total, 151 patients initiated risankizumab before August 1, 2025; 136 (90.1%) of 151 patients had difficult-to-treat disease. At baseline, 90 (59.6%) patients had Harvey-Bradshaw Index  >4. Of those, at week 24, 31 (50%) of 62 patients were in CSFCR; this rate was 53.3% when including all patients. Analysis including only patients with difficult-to-treat disease revealed that 51.8% of these patients were in CSFCR at week 24. Twenty-two (14.6%) patients discontinued treatment after a median of 183.5 days (Q1-Q3: 90.0-295.2 days), most following nonresponse. Regarding adverse events, 35.3 possibly and 16.6 probably risankizumab-related events per 100 person-years were reported.</p><p><strong>Conclusion: </strong>In this prospective multicenter study, risankizumab demonstrated favorable effectiveness and safety profile in patients with CD, including those with difficult-to-treat disease, bowel surgery, and stoma. These findings support the use of risankizumab in patients with difficult-to-treat disease.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":"1460-1470"},"PeriodicalIF":5.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13414538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147618672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of serious infection, myocardial infarction, stroke, and thromboembolic events in patients in the United States with ulcerative colitis treated with tofacitinib compared with biologic treatments.","authors":"David T Rubin, Stefan Schreiber, Laurent Peyrin-Biroulet, Silvio Danese, Milena A Gianfrancesco, Arif Soonasra, Sarah Sidhu, Ivana Vranic, Ahmed Shelbaya, David Gruben, Yuqin Wei, Kevin L Winthrop, Jeffrey R Curtis, Miguel D Regueiro, Marla C Dubinsky","doi":"10.1093/ibd/izag142","DOIUrl":"https://doi.org/10.1093/ibd/izag142","url":null,"abstract":"<p><strong>Background: </strong>This analysis of insurer-complete administrative data and claims from a United States database (Komodo Health) assessed the risk of serious infections, myocardial infarction (MI), stroke, and venous thromboembolism (VTE) among patients with ulcerative colitis (UC) initiating tofacitinib or biologic treatments.</p><p><strong>Methods: </strong>Patients with UC initiating treatment with tofacitinib, ustekinumab, vedolizumab, or tumor necrosis factor inhibitors (TNFis) from May 31, 2018, to September 30, 2022, were included. Stabilized inverse probability treatment weights (sIPTWs) were calculated and Cox proportional hazards models with sIPTWs were used to calculate hazard ratios; bootstrapping was used to calculate 95% CIs.</p><p><strong>Results: </strong>In total, 5171, 10 424, 17 129, and 29 872 patients initiated tofacitinib, ustekinumab, vedolizumab, and TNFis, respectively. The mean patient age at index was 43.1 years and the mean follow-up was 359.2 days. At baseline, a greater proportion of patients initiating tofacitinib vs biologics had used ≥ 2 prior biologics (46.3% vs 7.5%-33.7%, respectively). Incidence rates (IRs)/100 patient-years (PY) of serious infections were 2.62, 2.73, 2.45, and 3.25 for tofacitinib, ustekinumab, vedolizumab, and TNFi, respectively. For MI/stroke and VTE the IRs/100 PY were, respectively, 0.13 and 0.17 for tofacitinib, 0.17 and 0.16 for ustekinumab, 0.17 and 0.23 for vedolizumab, and 0.19 and 0.33 for TNFi. There were no significant differences in the risk of developing serious infections, MI/stroke, or VTE between treatments.</p><p><strong>Conclusions: </strong>No significant risk differences were observed among patients with UC initiating tofacitinib compared with biologics in a large US claims database. These findings add to evaluations of treatment risks vs benefits in patients with UC.</p><p><strong>European union post-authorization study (pas) register number: </strong>EUPAS103443.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148602602","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 hostile abdomen dilemma: the safety of primary anastomosis in the presence of an intraoperative abscess in Crohn disease.","authors":"Tommaso Violante, Stefano Cardelli, Giacomo Calini, Marco Novelli, Maurizio Coscia, Anna Paola Pezzuto, Giancarlo Rosati, Nikolas Konstantine Dussias, Fernando Rizzello, Matteo Rottoli","doi":"10.1093/ibd/izag148","DOIUrl":"https://doi.org/10.1093/ibd/izag148","url":null,"abstract":"<p><strong>Background: </strong>Encountering an intra-abdominal abscess during elective surgery for Crohn disease (CD) presents a clinical dilemma. While guidelines often recommend temporary fecal diversion, stomas carry substantial morbidity. Existing literature is heavily confounded by selection bias, obscuring the true safety of bowel reconstruction. This study evaluated the safety of primary anastomosis in the presence of an intraoperative abscess.</p><p><strong>Methods: </strong>A retrospective review of patients undergoing ileocecal resection for CD was conducted. To isolate the impact of the abscess and eliminate selection bias, an a priori multivariable logistic regression model and a 1:2 propensity score matched (PSM) analysis were utilized on the subcohort of patients who underwent primary anastomosis. The primary endpoint was the rate of 30-day postoperative complications.</p><p><strong>Results: </strong>Among the 810 included patients (210 with an intraoperative abscess, 600 without), an abscess significantly increased operative complexity, resulting in higher rates of open conversion (29.3% vs 10.3%, P < .001) and fecal diversion (24.8% vs 6.2%, P < .001). However, multivariable analysis demonstrated that an abscess was not an independent predictor of overall 30-day complications (odds ratio [OR], 1.25; P = .190). Furthermore, in the PSM cohort of 474 patients, rates of anastomotic leak (10.1% vs 11.7%, P = .718), overall complications (41.1% vs 38.0%, P = .571), and severe complications (8.2% vs 10.8%, P = .480) were statistically identical between the abscess and non-abscess groups.</p><p><strong>Conclusion: </strong>While an intraoperative abscess increases operative difficulty, it does not independently compromise anastomotic integrity. Primary anastomosis in an infected field is safe, allowing surgeons to spare appropriately selected patients at experienced centers the profound morbidity of an unnecessary stoma.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591462","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":"Classifications of rheumatological extraintestinal manifestations in inflammatory bowel disease: Unmet needs in clinical practice and trials.","authors":"Olga Maria Nardone, Yuhong Yuan, Francesco Caso, Janet Pope, Dennis McGonagle, Vipul Jairath","doi":"10.1093/ibd/izag144","DOIUrl":"https://doi.org/10.1093/ibd/izag144","url":null,"abstract":"<p><strong>Background: </strong>Rheumatological extraintestinal manifestations (EIMs) represent the most frequent complications of inflammatory bowel disease (IBD). Despite their clinical relevance, they remain heterogeneously defined and inconsistently assessed in both clinical practice and clinical trials. This narrative review aimed to summarize current evidence on the diagnostic assessment of IBD-associated rheumatological EIMs and to identify unmet needs for clinical evaluation and trial design.</p><p><strong>Methods: </strong>A literature search was performed to identify studies evaluating the diagnosis and assessment of IBD-associated rheumatological EIMs. Data were extracted on diagnostic definitions, classification systems, outcome measures, and the use of patient-reported outcomes (PROs) across observational studies and randomized controlled trials.</p><p><strong>Results: </strong>Substantial heterogeneity was observed in the diagnostic assessment of IBD-associated rheumatological EIMs, with inconsistent use of classification criteria and frequent reliance on nonstandardized clinical evaluation. No PRO instruments specifically developed or validated for IBD-associated rheumatological EIMs were identified. In randomized controlled trials, rheumatological EIMs were variably reported, with heterogeneous endpoints and limited structured assessment, particularly in phase 3 IBD trials.</p><p><strong>Conclusions: </strong>Evidence from this review reflects considerable methodological variability in the assessment of rheumatological EIMs in IBD. Standardized definitions, harmonized outcome measures, and the development of EIM-specific PROs are needed to support consistent endpoint selection and improve the evaluation of rheumatological outcomes in future clinical trials.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148578560","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":"Upadacitinib as a rescue therapy for steroid- and infliximab-refractory acute severe ulcerative colitis: short- and long-term effectiveness and safety in a multicenter cohort study.","authors":"Nalan Gülşen Ünal, Oğuz Kağan Bakkaloğlu, Taylan Kav, Tuğçe Eşkazan, Haluk Tarık Kani, Atilla Akpınar, Pırıl Akıncıoğlu, Gizem Dağcı, İbrahim Şendur, İlker Büyüktorun, Sezgin Barutçu, Güner Kılıç, Göksel Bengi, Bilger Çavuş, Nevin Oruç, Yeşim Özen Alahdab, Özlen Atuğ, Dinç Dinçer, Tarkan Karakan, Ali İbrahim Hatemi, Yusuf Ziya Erzin, Ahmet Tezel, Murat Törüner, Filiz Akyüz, Aykut Ferhat Çelik","doi":"10.1093/ibd/izag126","DOIUrl":"https://doi.org/10.1093/ibd/izag126","url":null,"abstract":"<p><strong>Background: </strong>Acute severe active ulcerative colitis (ASUC) often requires rescue therapy when standard medical treatment fails. Data on the use of upadacitinib (UPA) as a rescue option after failure of steroids and infliximab (IFX) and on the long-term outcomes of UPA treatment up to 48 weeks, remain scarce.</p><p><strong>Methods: </strong>We evaluated hospitalized patients with ASUC (Truelove and Witts criteria) who received UPA following the failure of intravenous corticosteroids (IV-CS) and IFX. Outcomes included UPA persistence, clinical remission (CR), partial Mayo score (pMAYO) ≤ 2, clinical response (≥3-point reduction in pMAYO), and colectomy rates over 48 weeks of follow-up.</p><p><strong>Results: </strong>Fifty patients with ASUC from 11 centers (male, 54%) received UPA treatment following IV-CS/IFX failure. Prior IFX exposure was 86%, and > 50% of the patients had received ≥ 2 biologics. Continuation was 52% overall (week 4, 90%; week 48, 52%). Discontinuation was due to primary nonresponse (42%), secondary loss of response (46%), or other causes (13%). Adverse events related to UPA occurred in 24% of patients and almost all were nonsevere. Stool frequency, rectal bleeding, pMayo score, and C-reactive protein (CRP) improved rapidly by week 1 and were thereafter maintained to week 48. Colectomy occurred in 22% of patients (nearly half of them in week 1). Week 1 CRs were 60%/30% while the week 48 CR rate was 51%. Higher baseline CRP predicted colectomy; no factor affected UPA persistence.</p><p><strong>Conclusion: </strong>In this multicenter cohort of patients with ASUC who failed IV-CS and IFX rescue, third-line UPA was associated with a low colectomy rate and sustained response up to 1 year, with an acceptable safety profile. UPA may provide sufficient disease control to prevent or delay colectomy, or to serve as a bridge to alternative therapies.</p><p><strong>Summary: </strong>In this retrospective multicenter cohort (11 centers), 50 patients with severe ulcerative colitis refractory to intravenous corticosteroids and infliximab received upadacitinib. Improved symptoms and C-reactive protein (CRP) levels occurred by week 1 and persisted to week 48; colectomy occurred in 22% and adverse events in 24% of patients.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148561869","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":"Increased risk of respiratory syncytial virus infection in patients with active inflammatory bowel disease: a matched cohort study.","authors":"Mohamed H Eldesouki, Youssef Hafez, Ahmed E Salem, Mohammad Alomari, Jana G Hashash, Francis A Farraye","doi":"10.1093/ibd/izag134","DOIUrl":"https://doi.org/10.1093/ibd/izag134","url":null,"abstract":"<p><strong>Background: </strong>Immune dysregulation, immunosuppressive therapy and active inflammatory bowel disease (IBD) increase susceptibility to respiratory syncytial virus (RSV) infection. We evaluated the risk of RSV infection in patients with active and nonactive IBD.</p><p><strong>Methods: </strong>Using the TriNetX Analytics Network from October 2024 through March 2025, we identified adult patients (aged ≥18 years) with IBD. Patients were classified as having active IBD if they had recent IBD complications, IBD-related surgery, or elevated inflammatory markers (within preceding 6 months); those without recent complications,surgeries, or elevated inflammatory markers were classified as having nonactive IBD within the same period. Outcomes were assessed within 180 days after the index date and included RSV infection, bacterial pneumonia, intensive care unit (ICU) admission, and mechanical ventilation.</p><p><strong>Results: </strong>Among 141 763 patients (47 883 patients with active IBD, 93 880 patients with nonactive IBD), 2879 patients with active IBD and 3583 with nonactive IBD received the RSV vaccination. After matching, each cohort included 46 308 patients. Active IBD was associated with higher odds of RSV infection (adjusted odds ratio [aOR], 1.55; 95% CI, 1.18-2.04), bacterial pneumonia (aOR, 2.58; 95% CI, 2.08-3.19), ICU admissions (aOR, 2.07; 95% CI, 1.88-2.28), and mechanical ventilation (aOR, 2.41; 95% CI, 2.01-2.88). RSV risk remained higher among patients with active IBD both with and without systemic corticosteroid exposure. Among RSV-vaccinated patients, RSV infection rates were not significantly different between active and nonactive IBD (aOR, 1.26; 95% CI, 0.78-1.79).</p><p><strong>Conclusion: </strong>Patients with active IBD had higher risk of RSV infection. Increased RSV risk was observed both among patients with active IBD with and without systemic corticosteroid exposure. Among RSV-vaccinated patients, RSV infection rates were not significantly different between active and nonactive IBD. Further prospective studies are needed to validate these findings.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148561899","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":"Appendicectomy in ulcerative colitis: a narrative review of epidemiology, pathophysiology, and emerging therapeutic implications.","authors":"M Juwanwarnage Nuwanthi Rashika Vanojan, Oluwalanoayo Oluwadara Agbabiaka, Devya Kumaresan, Shuker Yahia","doi":"10.1093/ibd/izag145","DOIUrl":"https://doi.org/10.1093/ibd/izag145","url":null,"abstract":"<p><p>Evidence from multiple studies shows that the appendix may play a significant role in the pathogenesis of ulcerative colitis (UC). These findings have sparked interest in the possibility of appendicectomy as a potential adjunctive strategy in UC. This narrative review was conducted by synthesizing data from meta-analyses, immunological research, surgical case studies, population data reports, and prospective trials published since 2000. The evidence was appraised with a focus on appendicectomy and its clinical outcomes in UC, risks and limitations, as well as possible future directions. Observational studies show a reduced risk of colectomy and UC-related hospital admissions when appendicectomy is performed before UC diagnosis. On the other hand, appendicectomy post UC diagnosis in the presence of appendiceal inflammation has shown increased risk of colectomy. But if an appendicectomy is performed in the absence of inflammation, it might not correlate to the risk or reduce the risk of relapse and complications. Evidence also shows that patients with refractory UC may benefit from appendicectomy and may show longer periods of remission. However, some studies show appendicectomy might increase the colorectal cancer risk due to alterations in immunity and microbiota. While medical management remains the first line, appendicectomy may act as an adjunct surgical option in carefully selected cases before escalating to a colectomy. Large multicenter studies and randomized clinical trials are required to identify strategies for patient selection, potential complications, durability of response, and long-term outcomes.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148548985","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":"Underevaluation of bowel urgency in clinical care: patient experiences and outcomes in ulcerative colitis: a retrospective cohort study.","authors":"Priyanka K Gill, Holly Finch, Levi Stein, Gilaad G Kaplan, Cathy Lu, Kerri L Novak, Cynthia H Seow, Richard J M Ingram, Marie-Louise Martin, Meaghan Martin, Tushar Shukla, Meena Mathivanen, Remo Panaccione, John K Marshall, Christopher Ma","doi":"10.1093/ibd/izag102","DOIUrl":"https://doi.org/10.1093/ibd/izag102","url":null,"abstract":"<p><strong>Background: </strong>Bowel urgency increases the burden of disease in patients with ulcerative colitis (UC). It is unclear how urgency impacts UC-related outcomes independent of other hallmark symptoms such as rectal bleeding and increased stool frequency. We aimed to evaluate the assessment of urgency in real-world patients with UC and to characterize its association with UC-related outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with UC who were attending the IBD Clinic in Calgary, Canada, and had an index visit between December 2022-May 2023. We determined the correlation between urgency and other symptoms, endoscopy, and biomarkers. We assessed the association between urgency and developing a UC-related event in follow-up, defined by the requirement for advanced treatment change, hospitalization, or surgery for UC, evaluated using Cox proportional hazards and modeling urgency as a time-varying covariable.</p><p><strong>Results: </strong>A total of 262 patients were included. Across all encounters, urgency was evaluated in 58.2% of visits, almost exclusively as being present or absent. Urgency was weakly-to-modestly correlated with rectal bleeding (r = 0.46), endoscopic appearance (0.31), and fecal calprotectin (0.33). One in 5 patients had persistent urgency, despite the normalization of rectal bleeding and stool frequency. Urgency was associated with an increased hazard of a UC-related event, after adjusting for rectal bleeding and stool frequency (adjusted hazard ratio, 2.64; 95% CI, 1.29-5.40; P = .008).</p><p><strong>Conclusion: </strong>Urgency is inconsistently assessed in routine clinical care, although when present it provides additive information to other measures of disease activity in UC and is associated with an increased risk of disease-related events.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470248","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":"Artificial intelligence assessment of endoscopic severity and extent: A machine learning approach to continuous evaluation of endoscopic inflammation in ulcerative colitis.","authors":"Alvin T George, Klaus Gottlieb, Daniel R Colucci, William J Eastman, Shrujal Baxi, Chakib Battioui, Julian Lehrer, Evan Yu, Pavel Brodskiy, Yeli Wang, Darren Thomason, Mohammad Haft-Javaherian, David T Rubin","doi":"10.1093/ibd/izag135","DOIUrl":"https://doi.org/10.1093/ibd/izag135","url":null,"abstract":"<p><strong>Background: </strong>The endoscopy subscore is a therapeutic endpoint in ulcerative colitis trials but is limited by reader variability and inability to fully capture the degree of inflammation across the colon. We developed the artificial intelligence assessment of endoscopic severity and extent (AI-ESe), a continuous, more granular assessment of inflammation throughout the colon to better capture the totality of inflammation, rather than a single score based on the worst lesion.</p><p><strong>Methods: </strong>AI-ESe analyzes endoscopic videos through a multistep process including preprocessing for image quality, endoscope stalling (pausing) detection to mitigate mucosal oversampling, and disease severity assessments, generating an inflammatory heatmap. We aimed to validate the stalling and severity algorithms and analyze the overall output of AI-ESe to measure the construct validity and the heterogeneity of inflammation on holdout endoscopic video datasets.</p><p><strong>Results: </strong>Stalling detection reduced the mean absolute temporal disagreement in position estimates from 39 seconds with uniform sampling to 23 seconds using this novel model against a human reference standard, which is comparable to the interreader variability of humans (16 seconds). Model assessment of disease severity achieved a quadratic weighted kappa of 0.80. The overall output of AI-ESe correlated with conventional classifications of the endoscopy subscore, while capturing substantial heterogeneity in inflammation severity. Among videos with an endoscopy subscore of 3, the proportion of moderately to severely inflamed mucosa ranged from 17.9% to 100%.</p><p><strong>Conclusions: </strong>AI-ESe enabled detailed assessment of endoscopic inflammation, capturing heterogeneous burden of disease within conventional endoscopic severity classifications in ulcerative colitis. Granular disease assessments using AI-ESe demonstrate an enhanced approach to disease evaluation.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470325","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 association between artificial light at night and inflammatory bowel disease incidence, surgery, and health services utilization: population-based observational studies.","authors":"M Ellen Kuenzig, Charles N Bernstein, Stephanie Coward, Trevor J B Dummer, Michael Elten, Jennifer L Jones, Gilaad G Kaplan, Eric Lavigne, Sanjay K Murthy, Juan Nicolás Peña-Sánchez, Laura E Targownik, Zhiyin Li, Jun Guan, Furong Tang, Eric I Benchimol","doi":"10.1093/ibd/izag141","DOIUrl":"https://doi.org/10.1093/ibd/izag141","url":null,"abstract":"<p><strong>Introduction: </strong>The urban environment increases the risk of inflammatory bowel disease (IBD). Specific environmental exposures involved in IBD etiology remain unknown. We examined the association between outdoor artificial light at night (ALAN) and IBD incidence, surgery, and health services utilization (HSU).</p><p><strong>Methods: </strong>Using population-based deterministically linked health administrative data from Ontario, Canada we conducted a birth cohort study (incidence), matched case-control study (incidence), and cohort study (surgery, HSU). Individuals with IBD were identified using previously validated algorithms. ALAN, the average digital number of lights consistently present, was a 3-level variable: <35 (reference), 35-60, > 60. We used Cox proportional hazards models (birth cohort, surgery), conditional logistic regression (matched case-control study), and Poisson regression (HSU).</p><p><strong>Results: </strong>Among 3 929 374 individuals in the birth cohort, 5539 (0.1%) developed IBD; no association between ALAN at birth and IBD was observed (35-60: hazard ratio [HR] 1.03, 95% confidence interval [CI] 0.87-1.22; >60: HR 0.93, 95% CI 0.78-1.11). Among 32 176 IBD cases matched to 160 709 controls, high ALAN was associated with a lower IBD risk (>60: odds ratio [OR] 0.84, 95% CI 0.78-0.92); there was no association between IBD and the middle ALAN level. High ALAN was associated with fewer IBD-specific outpatient visits (rate ratio [RaR] 0.93, 95% CI 0.86-0.99) and hospitalizations (RaR 0.83, 95% CI 0.72-0.95) 1 year after diagnosis. ALAN was not associated with surgery or emergency department visits.</p><p><strong>Discussion: </strong>The association between ALAN and IBD is heterogeneous. Additional research is needed to understand how ALAN impacts IBD and identify other environmental exposures contributing to IBD etiology.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148470327","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}