Inflammatory Bowel Diseases最新文献

{"title":"Sensitivity and specificity of diagnostic modalities to diagnose CMV in coexisting IBD in patients hospitalized with acute colitis: a systematic review and meta-analysis.","authors":"Simon Mark Seddon, David Godfrey, Sheng Wei Lo, George Azzi, Faris Gondal, William Beattie, Jonathan Segal","doi":"10.1093/ibd/izag140","DOIUrl":"https://doi.org/10.1093/ibd/izag140","url":null,"abstract":"<p><strong>Background: </strong>Cytomegalovirus (CMV), a common infection, can reactivate and cause CMV-associated colitis in immunosuppressed people, like those with known inflammatory bowel disease (IBD). Diagnosis of CMV colitis is limited by the broad spectrum of CMV infection and the invasiveness of biopsy-based investigations. We aimed to generate diagnostic accuracy estimates for serum, stool, and tissue polymerase chain reaction (PCR), pp65 antigenemia, and hematoxylin and eosin (H&E) staining in diagnosing CMV colitis in IBD patients hospitalized with acute colitis.</p><p><strong>Methods: </strong>We systematically searched the MEDLINE and EMBASE databases via OVID from inception until March 3, 2025, for eligible studies for a meta-analysis. Included studies needed to compare 2 tests and report true positives, false negatives, false positives, and true negatives to enable sensitivity and specificity calculations.</p><p><strong>Results: </strong>In total, 23 studies were included. Tissue PCR had the highest log diagnostic odds ratio at 2.93, with a pooled sensitivity of 95% and pooled specificity of 66%. The remaining pooled sensitivity and specificity, respectively, were stool PCR 70% and 92%, serum PCR 61% and 91%, pp65 antigenemia 33% and 98%, and H&E 44% and 99%.</p><p><strong>Conclusions: </strong>Tissue PCR had the best performance and was the most sensitive marker of CMV colitis in IBD, albeit with poor specificity. Stool PCR is a promising test, but further diagnostic studies are needed. Serum PCR, pp65 antigenemia, and H&E, when positive, seem to be useful in confirming CMV colitis. There is a need for further studies to develop an optimal PCR cutoff to differentiate low-level CMV reactivation from true CMV colitis on PCR testing, which may enhance the diagnostic yield from an endoscopic biopsy that tests both tissue PCR and IHC given the higher sensitivity of tissue PCR.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446178","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":"Healthcare professionals' knowledge, attitudes, and practice with addressing sexual health among people living with inflammatory bowel disease: A UK cross-sectional survey.","authors":"Anish J Kuriakose Kuzhiyanjal, Sarah Rhodes, Karishma Sethi-Arora, Laura Hancock, Christian Selinger, Christopher A Lamb, David T Rubin, Jimmy K Limdi","doi":"10.1093/ibd/izag121","DOIUrl":"https://doi.org/10.1093/ibd/izag121","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel diseases (IBDs) affect multiple aspects of well-being, including sexual health (SH). Although sexual dysfunction (SD) is widely prevalent among people living with IBD, patients report a lack of proactive discussion of SH by healthcare providers (HCPs). The study aimed to assess HCPs' knowledge, attitudes, and barriers to assessing SH in patients living with IBD in the United Kingdom.</p><p><strong>Methods: </strong>An adapted 32-item questionnaire survey was conducted between January and September 2024. The survey was distributed to various IBD HCPs through diverse professional and organizational networks in the United Kingdom. The survey collected information on HCP demographics and practice patterns regarding SH. Logistic regression analysis identified factors that were associated with HCP comfort in discussing SH.</p><p><strong>Results: </strong>The survey was completed by 249 eligible participants (53% female). Forty-one percent of HCPs estimated SD prevalence at 10% to 25% in general for IBD patients, while 33% did not know the SD prevalence among their IBD patients. Despite 65% of HCPs feeling \"very\" or \"somewhat\" comfortable discussing sexual function, only 9% routinely discussed this with patients. While HCPs stated lack of time (70%), unclear referral pathways (55%) and insufficient knowledge (51%) as main barriers, HCPs (95%) were interested in further education on SH.</p><p><strong>Conclusions: </strong>Although HCPs recognize SD as an important aspect of IBD care, it is often neglected. Time pressures, limited knowledge, and unclear referral pathways are key barriers that hinder HCPs from engaging with patients on SH. HCPs express a strong interest in further education on SH.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148420859","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":"Timing of biologic prophylaxis and postoperative recurrence in Crohn's disease: A real-life cohort study using propensity score weighting.","authors":"Angelo Del Gaudio, Federica Di Vincenzo, Giuseppe Cuccia, Gaetano Coppola, Lucrezia Laterza, Franco Sacchetti, Paola Caprino, Luigi Sofo, Gabriele Dragoni, Elisa Foscarini, Francesca Profeta, Elisa Schiavoni, Daniele Napolitano, Antonio Gasbarrini, Daniela Pugliese, Alfredo Papa, Loris Riccardo Lopetuso, Franco Scaldaferri","doi":"10.1093/ibd/izag130","DOIUrl":"https://doi.org/10.1093/ibd/izag130","url":null,"abstract":"<p><strong>Background: </strong>Postoperative recurrence is a major challenge in the management of Crohn's disease after ileocolonic resection. Although international guidelines recommend early initiation of biologic prophylaxis, the optimal timing remains uncertain in real-world practice.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of Crohn's disease patients undergoing ileocolonic resection. All patients received biologic prophylaxis within 16 weeks after surgery. Patients were stratified into 3 timing groups: <8 weeks, 8 to 12 weeks, and >12 and ≤16 weeks. To account for baseline differences, a propensity score-based inverse probability of treatment weighting approach was applied. The primary outcome was endoscopic recurrence (ER) at 6 to 12 months.</p><p><strong>Results: </strong>Among 173 patients, 79 (46%) initiated biologic prophylaxis within 8 weeks after surgery, 32 (18%) between 8 and 12 weeks, and 62 (36%) between >12 and ≤16 weeks. ER at 6 to 12 months occurred in 103 (59.5%) patients. In the inverse probability of treatment weighting-weighted analysis, initiation of biologic therapy more than 12 weeks after surgery was associated with a significantly higher risk of ER compared with initiation within 8 weeks (risk ratio, 1.96; 95% confidence interval, 1.45-2.65; P < .001), whereas no significant difference was observed between initiation within 8 weeks and 8-12 weeks (risk ratio, 1.44; 95% confidence interval, 0.93-2.23; P = .10). In multivariable logistic regression analysis, smoking, prior intestinal resections, and delayed initiation of biologic prophylaxis were independently associated with ER.</p><p><strong>Conclusions: </strong>In half of patients, prophylactic biologic therapy was initiated more than 8 weeks after ileocolonic resection. Initiation of biologic prophylaxis beyond 12 weeks after surgery was associated with a significantly increased risk of ER.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411621","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":"Inflammatory bowel disease in the aging population.","authors":"Adam S Faye, Bharati Kochar, David Choi, Thais Gift, Kendra J Kamp, Nicholas L Rider, Gilaad G Kaplan","doi":"10.1093/ibd/izag122","DOIUrl":"https://doi.org/10.1093/ibd/izag122","url":null,"abstract":"<p><p>As the prevalence of inflammatory bowel disease (IBD) rises rapidly among older adults, gastroenterologists and other health care providers increasingly face challenges in managing age-related comorbidities, polypharmacy, and functional impairments such as frailty and sarcopenia. This narrative review proposes a dual approach to management by optimizing care for patients aged >60 years while promoting the healthy aging of those aged 40-60 years. For patients aged >60 years, we emphasize prescribing effective corticosteroid-sparing medications to control inflammation, conducting medication reconciliations to assess appropriateness and drug interactions, and evaluating baseline hepatic and renal function for necessary dose adjustments. For patients aged 40-60 years, we advise regular screening and nutritional counseling to delay the onset of age-related comorbidities and recommend targeting endoscopic remission to modify the disease course and reduce complications and disability later in life. Given that patients with IBD receiving long-term immunosuppression are at increased risk of infections, adherence to age-appropriate vaccination schedules is also recommended. A proactive and personalized approach to disease management has the potential to optimize quality of life for older adults with IBD.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148411606","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":"Cancer risk with methotrexate-TNF antagonist combination therapy compared to TNF-antagonist monotherapy in IBD.","authors":"Sama Anvari, Wasuwit Wanchaitanawong, Xin Xiong, Tianxi Cai, Ashwin N Ananthakrishnan","doi":"10.1093/ibd/izag143","DOIUrl":"https://doi.org/10.1093/ibd/izag143","url":null,"abstract":"<p><strong>Background and aims: </strong>In patients with inflammatory bowel diseases (IBD), tumor necrosis factor antagonists (anti-TNFs) are frequently used alongside immunomodulators to improve treatment efficacy. While an increased risk of cancers with thiopurines is well established, there is sparse data on cancer risk with methotrexate.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of patients with Crohn's disease (CD) or ulcerative colitis (UC) at a large, integrated healthcare system. Eligible patients received either anti-TNF monotherapy or combination (anti-TNF + methotrexate) between 1999 and 2025. The primary outcome was incident cancer confirmed by chart review. Cox-proportional hazards models were used to identify the independent effect of combination therapy on cancer risk, adjusting for relevant covariates.</p><p><strong>Results: </strong>Our study included 2332 patients with IBD (80.9%) on anti-TNF monotherapy and 549 (19.1%) on combination therapy. Mean age at inclusion was 35 years, and 75.8% had CD. Mean follow-up duration was 3.3 years. Over 1353 and 8031 person-years of follow-up, incidence rates of all cancers were 7.4 and 6.4 per 1000 person-years in the combination and monotherapy groups, respectively (P = .64). We observed no increased risk of cancer between groups for all cancers (adjusted HR 0.94, 95% CI, 0.47-1.89), skin cancer (adjusted HR 0.57, 95% CI, 0.07-4.51) or non-skin cancers (adjusted HR 1.00, 95% CI, 0.48-2.11). Age ≥ 60 years and prior thiopurine exposure were associated with an increased risk of cancer.</p><p><strong>Conclusions: </strong>Combination anti-TNF and methotrexate therapy was not associated with an increased cancer risk compared to anti-TNF monotherapy in patients with IBD in our cohort.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404569","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 achieving transmural healing experience superior long-term outcomes compared with those with endoscopic or radiologic healing alone.","authors":"Sudheer Kumar Vuyyuru, Shane W Goodwin, Virginia Solitano, Darryl Ramsewak, Zahra Kassam, Cassandra Townsend, Jamie Gregor, Melanie Beaton, Eileen Crowley, Maan Alkhattabi, Michael Sey, Vipul Jairath","doi":"10.1093/ibd/izag114","DOIUrl":"https://doi.org/10.1093/ibd/izag114","url":null,"abstract":"<p><strong>Background: </strong>Crohn's disease (CD) is characterized by transmural inflammation, and achieving transmural healing (TH), may lead to improved long-term outcomes. However, evidence supporting this hypothesis is limited.</p><p><strong>Methods: </strong>Adult patients diagnosed with CD who underwent ileocolonoscopy and cross-sectional imaging within 6 months were included. Long-term outcomes of CD-related surgery and hospitalization in patients with TH, endoscopic healing (EH) alone, radiologic healing (RH) alone, and no healing (NH) were assessed. We used Cox proportional hazards models and modified Poisson regression.</p><p><strong>Results: </strong>Among 180 included patients, 26.7% achieved TH, 21.1% achieved EH, 12.8% achieved RH, and 39.4% were classified as NH. At baseline, 54.4% were on biologics which increased to 81.7% at last follow-up (76-78 months across groups). Cumulative probabilities of surgery were lowest in patients with TH (0%, 2.3%, 7.0% at 1, 3, and 5 years) and highest in patients with NH (13%, 20.5%, and 26.9%, respectively) (P = .03). On Cox proportional hazard regression analysis, TH was associated with a significantly reduced risk of CD-related surgery (hazard ratio, 0.01; 95% confidence interval, 0.00-0.35; P = .009) compared with NH. The probabilities of surgery were lower for patients with RH compared with EH (10% vs 13.2%, 10% vs 18.4%, and 21.2% vs 26.9% at 1, 3, and 5 years) but were not statistically significant (P = .41). Probabilities of CD-related hospitalization were lowest with TH (4.3%, 8.8%, and 13.6% at 1, 3 and 5 years) but were not statistically different than other healing categories (P = .67).</p><p><strong>Conclusions: </strong>TH was associated with superior long-term outcomes compared with EH or RH alone. Future studies should focus on standardizing its definition and evaluate treat-to-target strategies.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382011","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":"Higher body mass index is associated with lower drug concentrations in patients with inflammatory bowel disease treated with ustekinumab but not vedolizumab.","authors":"Joyce Lee, Rachel Porth, Alessandra Saraga, Ajay Gade, Tina Deyhim, Mostafa Soliman, Sadra Habibi Moini, Samantha Zullow, Loren Rabinowitz, Laurie Grossberg, Adam S Cheifetz, Konstantinos Papamichael","doi":"10.1093/ibd/izag139","DOIUrl":"https://doi.org/10.1093/ibd/izag139","url":null,"abstract":"<p><strong>Background: </strong>There are limited data regarding the impact of body mass index (BMI) on pharmacokinetics in patients with inflammatory bowel disease (IBD) treated with vedolizumab (VDZ) or ustekinumab (UST). The aim of the study was to investigate the association of BMI with VDZ and UST concentrations in IBD.</p><p><strong>Methods: </strong>This single-center, retrospective study included consecutive patients with IBD who received intravenous (iv) VDZ or UST and underwent therapeutic drug monitoring (TDM) from November 2016 to March 2023. We assessed the correlation of BMI with drug concentrations using Spearman's rank test.</p><p><strong>Results: </strong>The study population consisted of 170 patients; 89 (52%) patients received iv VDZ [44% Crohn's disease (CD)] and 81 received UST (81% CD). There was an inverse correlation of baseline BMI [ρ: -0.321; 95% confidence interval (CI) -0.534 to -0.070; P = .011] and BMI at first TDM (ρ: -0.253; 95% CI, -0.462 to -0.018; P = .031) with UST concentration at first TDM. Regarding the latter, subgroup analyses revealed that this correlation referred only to patients with Crohn's disease (CD) (ρ: -0.293; 95% CI, -0.515 to -0.035; P = .023) or patients with IBD on standard UST dosing (ρ: -0.369; 95% CI, -0.616 to -0.055; P = .019). In contrast, there was no correlation of BMI with VDZ concentrations. Multivariable linear regression analysis identified higher BMI at first TDM as an independent variable associated with lower UST concentrations (B: -0.408; 95% CI, -0.930 to -0.217; P = .002).</p><p><strong>Conclusion: </strong>This study demonstrated an inverse correlation between BMI and UST concentrations in patients with CD or patients with IBD on standard UST dosing, suggesting the need for closer TDM and dose adjustments to ensure optimal drug exposure in these patients with higher BMI.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":""},"PeriodicalIF":5.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148375544","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":"Rethinking the dose: A Bayesian meta-analysis of infliximab intensification in acute severe ulcerative colitis.","authors":"Manjeet K Goyal, Priyata Dutta, Matthew C Choy, Jeffrey A Berinstein, Syed A Hassan, Vishal Sharma, Vineet Ahuja, Elliot Berinstein, Christopher F D Li Wai Suen, Peter D R Higgins, Danny Con, Peter De Cruz, Shrinivas Bishu","doi":"10.1093/ibd/izag042","DOIUrl":"10.1093/ibd/izag042","url":null,"abstract":"<p><strong>Introduction: </strong>The optimal infliximab (IFX) dosing strategy for acute severe ulcerative colitis (ASUC) remains unclear. Though intensified IFX dosing is frequently employed, evidence supporting its efficacy has been mixed and it is uncertain if intensified IFX more effectively captures remission than standard-dose IFX. We conducted an updated meta-analysis comparing standard- vs intensified-dose IFX in ASUC, incorporating PREDICT-UC trial data and applying a Bayesian framework to better integrate prior evidence and quantify uncertainty.</p><p><strong>Methods: </strong>Electronic databases were systematically searched from inception to December 2024 (PROSPERO ID: CRD42024616359). We conducted a 2-step meta-analysis. First, retrospective cohort studies were assessed with a frequentist random-effects meta-analytic approach. Second, because there is only 1 trial (PREDICT-UC) comparing intensified vs standard IFX in ASUC, we applied a Bayesian meta-analytic approach by using historical trials of standard-dose IFX in ASUC to define the prior probability distribution and then compared that to PREDICT-UC.</p><p><strong>Results: </strong>Ten retrospective cohort studies (530 standard-dose and 406 intensified-dose patients) were included in the frequentist analysis. We applied a Bayesian binomial regression model with the historical randomized controlled trials of standard-dose IFX as the reference group. The estimated 3-month colectomy rate for standard-dose IFX was 27% (95% credible interval, 22%-33%). In the PREDICT-UC trial, observed colectomy rates were 15% in patients receiving rescue-dose IFX at 5 mg/kg and 6% in those receiving upfront intensified dosing at 10 mg/kg. Posterior estimates for both intensified dosing strategies in PREDICT-UC were credibly lower than the standard-dose IFX reference.</p><p><strong>Conclusion: </strong>Integrating observational and trial data via Bayesian methods suggests that intensified IFX dosing reduces early colectomy in ASUC. These findings support prospective, adequately powered trials to confirm benefit, identify subgroups most likely to respond, and refine individualized accelerated-dosing algorithms.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":"1344-1353"},"PeriodicalIF":5.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770553","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":"Sustained Clinical Remission Following a Second Autologous Hematopoietic Stem Cell Transplantation for Refractory Crohn Disease.","authors":"Milton Artur Ruiz, Roberto Luiz Kaiser Junior, Gabriel Piron-Ruiz","doi":"10.1093/ibd/izaf292","DOIUrl":"10.1093/ibd/izaf292","url":null,"abstract":"<p><p>Crohn disease is a debilitating inflammatory bowel disease lacking curative options for patients refractory to standard medical therapy. While autologous hematopoietic stem cell transplantation has demonstrated therapeutic potential in selected cases of refractory disease, there are no prior reports documenting its use in a repeat setting for this indication. A 48-year-old male patient with severe, refractory Crohn disease who failed comprehensive medical management, including multiple biologic agents is presented. Following a rapid clinical relapse six months after an initial non-myeloablative autologous hematopoietic stem cell transplantation, a second procedure was performed three years later using the same mobilization and conditioning regimen (cyclophosphamide and rabbit anti-thymocyte globulin), with the addition of one year of post-transplant cyclosporine to maintain sustained immunosuppression. At 30 months following the second autologous hematopoietic stem cell transplantation, the patient remains in sustained clinical and endoscopic remission off all immunosuppressive and biologic medications. This case documents the feasibility and favorable long-term outcome of a second non-myeloablative autologous hematopoietic stem cell transplantation, suggesting this approach may be a valid and effective salvage option for highly selected patients with severe, refractory Crohn disease.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":"1415-1417"},"PeriodicalIF":5.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762625","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":"Early immunomodulator therapy reduces the risk of intestinal resection in Crohns disease: a systematic review and meta-analysis.","authors":"Jiyoung Yoon, Yu Kyung Jun, Hye Sun Lee, Jun Hwan Yoo, Jae Jun Park","doi":"10.1093/ibd/izag040","DOIUrl":"10.1093/ibd/izag040","url":null,"abstract":"<p><strong>Background: </strong>The optimal timing for initiating immunomodulators (IMs) in Crohns disease (CD) remains unclear. We assessed whether early IM therapy reduces the risk of intestinal resection.</p><p><strong>Methods: </strong>MEDLINE, EMBASE, and the Cochrane Library were systematically searched for studies comparing outcomes by timing of IM (thiopurines or methotrexate) initiation in CD. The primary outcome was intestinal resection. Pooled hazard ratios (HRs) with 95% CIs were calculated using a random-effects model.</p><p><strong>Results: </strong>Seven cohort studies including 4297 patients were analyzed. Early IM initiation was associated with a 47% lower risk of intestinal resection compared with late or no IM therapy (pooled HR, 0.53; 95% CI, 0.44-0.65; I2 = 23%). This protective effect was consistent across subgroups, including studies in which all patients received IMs and early initiation was associated with a lower risk than late initiation (HR 0.59; 95% CI, 0.42-0.83). When early treatment was defined as initiation within 1-2 years of diagnosis, early IM use was associated with a lower risk of intestinal resection than late or no IM therapy, with no heterogeneity (HR 0.55; 95% CI, 0.43-0.70; I2 = 0%). A broader definition of early treatment as within 3 years of diagnosis also showed benefit compared with late or no IM therapy (HR, 0.52; 95% CI, 0.37-0.74) but with moderate heterogeneity (I2 = 57%).</p><p><strong>Conclusions: </strong>Early IM therapy is associated with a substantially lower risk of intestinal resection in CD compared with later or no IM therapy. The most consistent benefit occurs when treatment is initiated within the first 1-2 years after diagnosis, supporting the concept of a therapeutic \"window of opportunity\" during which timely IM initiation may favorably alter the disease course.</p>","PeriodicalId":13623,"journal":{"name":"Inflammatory Bowel Diseases","volume":" ","pages":"1333-1343"},"PeriodicalIF":5.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672847","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}