Intestinal Research最新文献

{"title":"Comments on \"Upadacitinib and vedolizumab combination therapy for the management of refractory ulcerative colitis and Crohn's disease\".","authors":"Longwei Qiu, Junyi Tang, Chaochi Yue","doi":"10.5217/ir.2026.00236","DOIUrl":"https://doi.org/10.5217/ir.2026.00236","url":null,"abstract":"","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disease characteristics, outcomes, and poor prognostic factors of perianal fistula in Korean patients with Crohn's disease: a multicenter, retrospective observational study.","authors":"Hyuk Yoon, Sang Bum Kang, Seong-Joon Koh, Chang Kyun Lee, Dongwoo Kim, Eun Soo Kim, Sung Noh Hong, Dong Hyun Kim, Jin Wook Lee, Soo Jung Park, Chang Hwan Choi, Byung Ik Jang, Eun Mi Song, Soo-Kyung Park, Youngdoe Kim, Jong Min Choi, Su Young Jung, YoungJa Lee, Sang Hyoung Park","doi":"10.5217/ir.2026.00036","DOIUrl":"https://doi.org/10.5217/ir.2026.00036","url":null,"abstract":"<p><strong>Background/aims: </strong>A high proportion (39%-50%) of Korean patients with Crohn's disease (CD) suffer from perianal fistula, and real-world data on clinical practice remain limited. This study aimed to identify characteristics of perianal fistulizing CD (pfCD), treatment patterns, disease outcomes, and factors associated with poor prognosis in clinical practice in Korea.</p><p><strong>Methods: </strong>This was a multicenter, retrospective, observational study using chart reviews and clinical assessment of adult patients with pfCD from 15 medical centers. Patients were aged ≥ 19 years and had been treated for a newly diagnosed perianal fistula after January 1, 2011, with ≥ 1 year of follow-up. At enrollment, patient demographics, characteristics, treatments, and clinical outcomes were assessed.</p><p><strong>Results: </strong>Between September 2022 and August 2023, 487 patients met the inclusion criteria. Median age at initial diagnosis of perianal fistula was 21.7 years; 65.1% of patients had complex pfCD and 26.5% had multiple fistulas. Most patients (62.4%) had fistula-related surgical intervention (minor: 90.8%, 276/304; major: 22.4%, 68/304). Fistula recurrence was common (36.8%); median time to recurrence was 0.9 years (range, 0.01-10.8 years). Complications of perianal fistula including abscess (hazard ratio [HR], 1.67) and stricture (HR, 3.23), and fistula-related surgical intervention during the recurrence period (HR, 1.50) were positively associated and use of biologics (HR, 0.38) was negatively associated with recurrence events.</p><p><strong>Conclusions: </strong>This study highlights the high burden of disease, with most patients receiving multiple treatments and over one-third experiencing fistula recurrence. Biologics may be associated with lower risk of fistula recurrences.</p>","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed tomography enterography-defined transmural healing is associated with lower hospitalization risk in patients with Crohn's disease.","authors":"Yuki Yoshimatsu, Shinichi Hashimoto, Masahiro Tanabe, Satoko Matsumoto, Shunsuke Ito, Atsushi Goto, Koichi Hamabe, Jun Nishikawa, Katsuyoshi Ito, Taro Takami","doi":"10.5217/ir.2026.00113","DOIUrl":"https://doi.org/10.5217/ir.2026.00113","url":null,"abstract":"<p><strong>Background/aims: </strong>Transmural healing (TH) has emerged as a potential therapeutic target in Crohn's disease because transmural inflammation may persist despite clinical or endoscopic remission. However, evidence linking TH assessed by computed tomography enterography (CTE) to long-term outcomes remains limited. This study evaluated the association between TH assessed by low-dose CTE and long-term clinical outcomes.</p><p><strong>Methods: </strong>We performed a post hoc analysis of a previously reported retrospective cohort of patients with Crohn's disease who underwent low-dose CTE. Patients in clinical remission (Crohn's Disease Activity Index < 150) at the time of CTE and with ≥ 2 years of follow-up were included. TH was defined according to predefined imaging criteria. The primary outcome was maintenance of clinical remission. Secondary outcomes included hospitalization, bowel obstruction, corticosteroid initiation or escalation, and bowel surgery. Time-to-event outcomes were analyzed using Kaplan-Meier methods and Cox proportional hazards models.</p><p><strong>Results: </strong>Fifty-two patients were included, and 10 (19.2%) achieved TH. Prior bowel surgery was more common in the TH group (80.0% vs. 40.5%; P=0.040). During a mean follow-up of 83.1 months, Kaplan-Meier analyses showed significantly higher remission maintenance and lower hospitalization rates in the TH group (P=0.007 and P=0.013, respectively). In multivariable Cox analyses, TH remained independently associated with lower hospitalization risk (hazard ratio, 0.084; 95% confidence interval, 0.010-0.728; P=0.025), but not with clinical relapse.</p><p><strong>Conclusions: </strong>CTE-defined TH was independently associated with lower hospitalization risk, but not with maintenance of clinical remission, in patients with Crohn's disease; however, this association may have been influenced by prior bowel surgery.</p>","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and safety of small bowel endoscopy in Crohn's disease in Japan: a large-scale claims database analysis.","authors":"Shuhei Hosomi, Yu Nishida, Tsuyoshi Yanagida, Koji Fujimoto, Rieko Nakata, Akinari Sawada, Hirotsugu Maruyama, Masaki Ominami, Yuji Nadatani, Shusei Fukunaga, Koji Otani, Yasuhiro Fujiwara","doi":"10.5217/ir.2026.00149","DOIUrl":"https://doi.org/10.5217/ir.2026.00149","url":null,"abstract":"<p><strong>Background/aims: </strong>Evidence on the population-level utilization and safety of balloon-assisted endoscopy (BAE) and small bowel capsule endoscopy (SBCE) for Crohn's disease in Japan is limited. We aimed to characterize trends in BAE, SBCE, and patency capsule examination, as well as adverse events (AEs).</p><p><strong>Methods: </strong>We analyzed the Medical Data Vision claims database. Annual utilization was assessed per patient-year for the complete calendar years 2009-2021. AEs were defined by claimsbased therapeutic interventions after procedures. The association between patency capsule examination and SBCE-related AEs was assessed using generalized estimating equations (GEE) adjusted for age, sex, and calendar year.</p><p><strong>Results: </strong>Among 19,881 eligible patients with Crohn's disease, 4,657 BAE and 2,679 SBCE procedures were identified. Modality switching was uncommon, with 83.9% of patients with ≥2 examinations (n =1,683) undergoing the same modality at the second examination. Utilization of both modalities increased over time, and patency capsule examination before SBCE increased from 2013 to 2021. SBCE-related AEs were rare in patients with patency capsule examination compared to those without patency capsule examination (0.88% vs. 1.47%). In the main GEE analysis, patency capsule examination was not independently associated with lower odds of SBCE-related AEs (adjusted odds ratio, 0.62; 95% confidence interval, 0.28-1.37; P= 0.235), with a similar result in sensitivity analyses.</p><p><strong>Conclusions: </strong>The use of BAE and SBCE has increased in Japan alongside the spread of patency capsule examination. SBCE-related AEs were uncommon overall and numerically less frequent when preceded by patency assessment.</p>","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intestinal ultrasound in the assessment of complicated Crohn's disease: a comprehensive review.","authors":"Min Kyu Kim, Sung Wook Hwang","doi":"10.5217/ir.2026.00111","DOIUrl":"https://doi.org/10.5217/ir.2026.00111","url":null,"abstract":"<p><p>Crohn's disease (CD) frequently progresses to stricturing or penetrating behavior, which often necessitates surgical or interventional management. Accurate, real-time assessment of these complications is essential for optimizing therapeutic strategies. This review summarizes the current evidence on the utility of intestinal ultrasound (IUS) and its advanced modalities in diagnosing, characterizing, and monitoring complicated CD. As a noninvasive, radiation-free, and cost-effective point-of-care tool, IUS demonstrates high diagnostic accuracy for detecting intestinal strictures, comparable to computed tomography and magnetic resonance enterography, and its diagnostic performance can be further enhanced by the use of small intestine contrast ultrasonography (SICUS). While differentiating between inflammatory and fibrotic strictures remains a critical clinical challenge, advanced techniques such as contrast-enhanced ultrasound (CEUS) and elastography are actively being investigated for elucidating the nature of stricture, albeit with heterogeneous results to date. Recent standardization of sonographic criteria for strictures has been proposed, with further clinical validation highly anticipated. Furthermore, IUS exhibits strong diagnostic performance in detecting penetrating complications, including abscess and fistulas. The diagnostic yield for these lesions is significantly enhanced by SICUS, which utilizes luminal distension to better visualize extra-luminal tracts. Notably, CEUS plays an important role in distinguishing true avascular abscesses from phlegmons. In conclusion, IUS has established itself as a highly reliable imaging modality for the evaluation of complicated CD. The utility of IUS is expected to grow, driving further research and optimizing point-of-care management for complicated CD.</p>","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Upadacitinib and upadacitinib-vedolizumab combination therapy for refractory pediatric-onset inflammatory bowel disease.","authors":"Hirotaka Shimizu, Ichiro Takeuchi, Hiroshi Oue, Hiroaki To, Atsushi Tanioka, Rina Komorizono, Katsuhiro Arai","doi":"10.5217/ir.2026.00119","DOIUrl":"https://doi.org/10.5217/ir.2026.00119","url":null,"abstract":"<p><strong>Background/aims: </strong>To evaluate the efficacy and safety of upadacitinib in patients with highly refractory pediatric-onset inflammatory bowel disease (IBD) and to describe the outcomes of upadacitinib-vedolizumab combination therapy (UVCT) in treatment-refractory cases.</p><p><strong>Methods: </strong>This retrospective, single-center study included 18 patients (7 with ulcerative colitis, 6 with Crohn's disease, and 5 with very early-onset IBD) who received upadacitinib between November 2022 and November 2025. Five patients underwent UVCT. All patients had previously failed multiple therapies (median, 3 prior advanced therapies). The primary outcome was the upadacitinib continuation rate. The secondary outcomes included corticosteroid- and tacrolimusfree remission rates, safety profiles, and UVCT outcomes.</p><p><strong>Results: </strong>The median age at upadacitinib initiation was 13.0 years (range, 2.3-21.6 years). The 52-week continuation rate was 55.6%. Among patients who received corticosteroids at baseline, 50% achieved corticosteroid-free status by 6 months; all patients who received tacrolimus at baseline discontinued tacrolimus within 6 months. No serious adverse events attributable to upadacitinib were observed and no cases of herpes zoster reactivation occurred. Five patients with persistent corticosteroid/tacrolimus dependence underwent UVCT, 4 of whom achieved clinical remission with withdrawal of corticosteroids/tacrolimus, with endoscopic improvement confirmed in 3. One patient with very early-onset IBD required colectomy.</p><p><strong>Conclusions: </strong>Upadacitinib demonstrated acceptable efficacy and safety in patients with highly refractory pediatric-onset IBD. In this small subgroup, UVCT was associated with clinical remission in most patients (4/5), suggesting that it may warrant further investigation as a salvage strategy to avert surgery. Prospective, multicenter studies are needed to define the optimal positioning within pediatric-onset IBD treatment algorithms.</p>","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on \"Ustekinumab-induced Henoch-Schönlein purpura in Crohn's disease: a case report and literature review\".","authors":"Se Jin Park, Jae Il Shin","doi":"10.5217/ir.2026.00155","DOIUrl":"https://doi.org/10.5217/ir.2026.00155","url":null,"abstract":"","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149109585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative outcomes for tirzepatide versus glucagon-like peptide-1 receptor agonists in patients with inflammatory bowel disease: a national propensity matched study.","authors":"Krishan S Patel, Butros Fakhoury, Kavin Parmar, Vinay Jahagirdar, Arun J Sanyal, Juan Pablo Arab, Raseen Tariq","doi":"10.5217/ir.2026.00152","DOIUrl":"https://doi.org/10.5217/ir.2026.00152","url":null,"abstract":"<p><strong>Background/aims: </strong>Evidence suggests glucagon-like peptide-1 receptor agonists (GLP-1RAs) may improve disease-specific outcomes for inflammatory bowel disease (IBD). Tirzepatide, a dual GLP-1 and glucose-dependent insulinotropic polypeptide receptor agonist, may offer additional benefits. We compared clinical and safety outcomes among patients with IBD treated with tirzepatide versus GLP-1RAs.</p><p><strong>Methods: </strong>Patients aged ≥ 18 years with IBD were identified within a retrospective multiinstitutional U.S. database who were prescribed tirzepatide or GLP-1RA between May 2022 and January 2025. Propensity score matching (1:1) was performed for demographics, comorbidities, and IBD medications. Outcomes were assessed over 18 months and included intravenous (IV) steroid use, intestinal surgery, emergency department visits, hospitalization, and a composite of IV steroids and surgery. Adverse outcomes were assessed.</p><p><strong>Results: </strong>After matching, 3,042 patients (mean age, 54.6 years; 71.3% female) were analyzed in each cohort. Median follow-up was 540 days (interquartile range, 478-540 days) for tirzepatide versus 540 days (interquartile range, 540-540 days) for GLP-1RA. Patients taking tirzepatide had a significantly reduced risk of IV steroid use (adjusted hazard ratio [aHR], 0.81; 95% confidence interval [CI], 0.68-0.94) and composite IBD outcomes (aHR, 0.86; 95% CI, 0.73-0.97) with similar risk of hospitalization, emergency department visit and receipt of intestinal surgery. In patients with ulcerative colitis specifically, tirzepatide was similarly associated with a reduced risk of IV steroid use (aHR, 0.82; 95% CI, 0.69-0.97). Adverse outcome risks were similar.</p><p><strong>Conclusions: </strong>Patients with IBD prescribed tirzepatide may have lower risk of IV steroid use compared to those taking GLP-1RAs. Prospective studies are warranted to validate these results and explore underlying mechanisms.</p>","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microplastics and inflammatory bowel disease: dissecting the evidence from observational links to potential causal mechanisms.","authors":"Wei Si Soong, Lai Ti Gew, Jactty Chew, Norfilza Mohd Mokhtar, Hong Heng See, Raja Affendi Raja Ali","doi":"10.5217/ir.2025.00343","DOIUrl":"https://doi.org/10.5217/ir.2025.00343","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD) has surged globally, and environmental factors such as microplastics (MPs) have emerged as potential contributors alongside a complex interplay between altered gut microbiota and dysregulated immune response in genetically susceptible individuals. While current evidence linking MPs to intestinal inflammation remains largely associative, a causal relationship between MP exposure and IBD in humans has yet to be confirmed. Therefore, this review aims to summarize current evidence regarding the occurrence, detection, and potential pathogenic roles of MPs in IBD. Emerging evidence suggests that MPs disrupt gastrointestinal integrity and immune homeostasis through multiple pathological mechanisms. MPs physically compromise the intestinal barrier by downregulating key tight junction proteins such as ZO-1 and claudin-1, altering endocytosis, and inducing oxidative stress. Concurrently, MPs induce gut microbial dysbiosis, often reflected by a reduced Firmicutes/Bacteroidetes ratio, depletion of commensal taxa, and overgrowth of proinflammatory bacteria, including Escherichia coli, Bilophila wadsworthia, and Ruminococcus gnavus. These changes trigger proinflammatory cascades and exacerbate mucosal damage, processes that are closely linked to the pathophysiology of IBD. Current detection of MPs in stool and colon tissue samples from individuals with IBD commonly relies on a combination of microscopic (e.g., optical microscopy) and spectroscopic (e.g., Fourier-transform infrared spectroscopy or Raman spectroscopy) approaches. These approaches enable the identification and characterization of MPs within biological matrices. In summary, this review explores the potential pathogenic mechanisms linking MPs to IBD, providing insights that support a possible causal relationship and highlighting a novel, underexplored environmental factor in disease onset and progression.</p>","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of liver cirrhosis during azathioprine therapy for inflammatory bowel disease.","authors":"Jihye Park, Jae Seung Lee, Mi Na Kim, Soo Jung Park, Jae Jun Park, Tae Il Kim, Jae Hee Cheon","doi":"10.5217/ir.2026.00051","DOIUrl":"https://doi.org/10.5217/ir.2026.00051","url":null,"abstract":"","PeriodicalId":14481,"journal":{"name":"Intestinal Research","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}