Scandinavian Journal of Gastroenterology最新文献

{"title":"<i>Clostridioides difficile</i> enteritis: a targeted review of current literature.","authors":"Lefika Bathobakae, Rammy Bashir, Atang Koodirile, Katrina Villegas, Islam Rajab, Edgar W Perez, Yana Cavanagh, Abraham El-Sedfy, Jin S Suh","doi":"10.1080/00365521.2025.2515423","DOIUrl":"10.1080/00365521.2025.2515423","url":null,"abstract":"<p><p><i>Clostridioides difficile</i> enteritis (CDE) is a rare but clinically significant form of <i>Clostridioides difficile</i> infection (CDI) affecting the small intestine. CDE poses a diagnostic challenge owing to its rarity, complexity, and nonspecific presentation. The current data is retrospective in the form of case reports and conference proceedings. The lack of widespread awareness and limited literature on CDE often result in diagnostic delays, contributing to increased morbidity. This targeted narrative review sought to consolidate the current knowledge on the epidemiology, pathophysiology, clinical presentation, and management of CDE, addressing a critical gap in the existing literature. Electronic databases, including PubMed, Embase, and Web of Science, were searched for published cases from inception to April 2024. The initial search yielded 2,120 articles, which were filtered using study design, English language, and human subjects. After screening for duplicates and excluding irrelevant articles, 44 articles comprising 49 patients were included in the final review. Of the 49 individual cases reviewed, 25 (51%) were male and 24 (49%) were female. The patients' <b>ages</b> ranged from 16 to 91 years, with a mean age of 53.4 years. Abdominal pain and diarrhea were the chief complaints reported in 37/49 (76%) and 35/49 (71%) cases, respectively. About 42/49 (86%) cases were effectively treated with antibiotics, while some cases required fecal microbiota transplantation or surgical exploration. Given its <b>grave</b> course, CDE warrants prompt and appropriate treatment to prevent complications such as fulminant enteritis, compartment syndrome, and bowel perforation.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"675-685"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced liver fibrosis test improves diagnostic efficiency and reduces testing costs for advanced liver fibrosis in steatotic liver disease.","authors":"Christel Pussinen, Anni Kelkka, Kari Pulkki, Anna Lempiäinen, Fredrik Åberg","doi":"10.1080/00365521.2025.2517219","DOIUrl":"10.1080/00365521.2025.2517219","url":null,"abstract":"<p><strong>Objective: </strong>We performed cost-analysis to evaluate the most economic testing approach for diagnosing compensated advanced chronic liver disease in low- and high-prevalence populations in the Finnish healthcare system.</p><p><strong>Materials and methods: </strong>In a simulated analysis of 1000 individuals at risk of (low prevalence) or diagnosed (high prevalence) with metabolic dysfunction-associated steatotic liver disease or alcohol-related liver disease, we compared five different testing strategies for compensated advanced chronic liver disease based on costs and incremental diagnostic accuracy, The Fibrosis-4 index, enhanced liver fibrosis test, and liver stiffness measurements were performed in various combinations.</p><p><strong>Results: </strong>In the low-prevalence setting, the least costly testing strategy for compensated advanced chronic liver disease detection was fibrosis-4 index, followed by enhanced liver fibrosis test if fibrosis-4 index > 1.30, and liver stiffness measurement if the enhanced liver fibrosis test score was > 9.8. In the high-prevalence setting, the most economic testing strategy was fibrosis-4 index, followed by enhanced liver fibrosis test if fibrosis-4 index was 1.30-2.67, and/or liver stiffness measurement if fibrosis-4 index > 2.67 or enhanced liver fibrosis test score > 9.8.</p><p><strong>Conclusions: </strong>Integration of the enhanced liver fibrosis test in the diagnostic testing strategy for compensated advanced chronic liver disease in individuals with risk factors for or a diagnosis of metabolic dysfunction-associated steatotic/alcohol-related liver disease can decrease costs by reducing unnecessary referrals to secondary care and limiting the need for liver stiffness measurements, while maintaining good diagnostic accuracy.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"728-736"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The central role of gastrin in <i>Helicobacter pylori</i> gastric carcinogenesis.","authors":"Helge Waldum, Irvin Modlin","doi":"10.1080/00365521.2025.2509094","DOIUrl":"10.1080/00365521.2025.2509094","url":null,"abstract":"<p><p>Gastric cancer is still a prevalent and lethal cancer. Gastric hypoacidity and gastritis have long been recognized in the pathogenesis. The identification of <i>Helicobacter(H.) pylori</i> as the main cause of gastritis leading to peptic ulcer disease and gastric cancer was a breakthrough. <i>H. pylori</i> was the first bacterium accepted as a carcinogen. The mechanism was not found before <i>H. pylori</i> was shown to predispose to cancer only after having induced oxyntic atrophy incriminating reduced killing of microorganisms and/or secondary hypergastrinemia. <i>H. pylori</i> has an uncertain carcinogenic role in cardia cancer, making microbes more unlikely. Gastrin has a trophic effect on the oxyntic mucosa, particularly on the enterochromaffin like cell carrying the gastrin receptor. Every condition with long-term hypergastrinemia in whatever species predisposes to gastric neoplasia. All observations on gastric neoplasia connected to <i>H. pylori</i> gastritis (the protective effect of duodenal ulcer, increased risk with oxyntic atrophy and preserved risk after loss of <i>H. pylori</i> in complete oxyntic atrophy) may be explained by gastrin. The role of gastrin in gastric carcinogenesis is also reflected by autoimmune gastritis and profound long-term gastric acid inhibition.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"652-663"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescription of NSAIDs and proton pump inhibitors are associated with increased faecal calprotectin levels in patients with functional bowel disorder: an observational study.","authors":"Alice Sandberg-Janzon, Pontus Karling","doi":"10.1080/00365521.2025.2512368","DOIUrl":"10.1080/00365521.2025.2512368","url":null,"abstract":"<p><strong>Background: </strong>Proton pump inhibitors (PPIs) and nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with elevated fecal calprotectin (FC) levels, but their significance in functional bowel disorders remains unclear.</p><p><strong>Objective: </strong>This study assessed the prevalence of elevated FC levels in patients referred to gastroenterologists from primary care and examined the impact of PPI and NSAID use on FC levels.</p><p><strong>Methods: </strong>We included 431 patients with irritable bowel syndrome (IBS) or unspecified functional bowel disorders, all having at least one FC test prior to referral. Prescription data for PPIs and NSAIDs within one year of the FC test were recorded.</p><p><strong>Results: </strong>Nineteen percent of patients had PPI prescriptions and 8% had NSAID prescriptions within 90 days of the FC test. These patients showed significantly higher FC levels than those without such prescriptions (PPIs: 66 vs. 23 μg/g, <i>p</i> < 0.001; NSAIDs: 57 vs. 25 μg/g, <i>p</i> < 0.001). A negative correlation was observed between time since PPI prescription and FC levels (rs = -0.270; <i>p</i> = 0.002). FC levels did not differ significantly across functional bowel disorder subtypes. A FC level >50 μg/g was associated with a higher likelihood of referral for colonoscopy (40% vs. 19%, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>PPI and NSAID use may lead to elevated FC levels, potentially causing unnecessary gastrointestinal investigations. The use of these medications should be considered when interpreting FC test results.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"635-642"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence for early gastric cancer boundary recognition in NBI and nF-NBI endoscopic images.","authors":"Kaicheng Hong, Changda Lei, Xiuji Kan, Yifan Ouyang, Yutong Mei, Yunbo Guo, Bilin Wang, Deqing Zhang, Junbo Li, Rui Li, Yuguo Tang","doi":"10.1080/00365521.2025.2509818","DOIUrl":"10.1080/00365521.2025.2509818","url":null,"abstract":"<p><strong>Objectives: </strong>Precise delineation of early gastric cancer (EGC) margins is essential for complete resection during endoscopic submucosal dissection. This study aimed to develop deep learning-based models for EGC boundary detection in narrow-band imaging (NBI) and near-focus NBI (NF-NBI) images.</p><p><strong>Methods: </strong>A total of 1215 NBI and 1646 NF-NBI images from EGC patients were used to train three convolutional neural networks (CNN1-CNN3), generating six deep learning models (Model1-Model6). Segmentation performance was compared among models and endoscopists of varying seniority.</p><p><strong>Results: </strong>On NBI images, Model3 achieved an accuracy of 0.9348, compared to 0.7272, 0.7277, and 0.9435 for junior, intermediate, and senior endoscopists, respectively. The corresponding Dice coefficients were 0.8310 (95% CI, 0.8120-0.8500), 0.6153 (95% CI, 0.5827-0.6480), 0.6528 (95% CI, 0.6237-0.6819), and 0.8360 (95% CI, 0.8169-0.8550), with recall values of 0.9773, 0.6845, 0.7596, and 0.9784, respectively. On NF-NBI images, Model6 showed an accuracy of 0.9483, compared to 0.6885 (junior), 0.7826 (intermediate), and 0.9621 (senior endoscopists). Dice coefficients were 0.8526 (95% CI, 0.8410-0.8642), 0.6757 (95% CI, 0.6569-0.6944), 0.7161 (95% CI, 0.6941-0.7382), and 0.8618 (95% CI, 0.8512-0.8725), with recall values of 0.9831, 0.8095, 0.8317, and 0.9889, respectively.</p><p><strong>Conclusions: </strong>The proposed deep learning models accurately delineated EGC boundaries in NBI and NF-NBI images, achieving diagnostic performance comparable to that of senior endoscopists.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"624-634"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spondyloarthritis features in IBD patients: prevalence, referral trends and clinical implications. A questionnaire-based study.","authors":"Nina Pettersson, Fredrik Kragbjerg, Arvid Hamrin, Helena Forsblad-d'Elia, Pontus Karling","doi":"10.1080/00365521.2025.2504076","DOIUrl":"10.1080/00365521.2025.2504076","url":null,"abstract":"<p><strong>Objectives: </strong>This study examines the prevalence of spondyloarthritis (SpA) features in patients with inflammatory bowel disease (IBD) and their rates of referral to rheumatologists.</p><p><strong>Material and methods: </strong>A questionnaire was administered to 2087 IBD patients (≥18 years) in Sweden, assessing demographics, medications and SpA features based on the ASAS and ESSG classification criteria. Patient that met our self-reported adapted criteria are referred to as suspected SpA.</p><p><strong>Results: </strong>Among the 1032 respondents, 59.1% met our questionnaire-based adapted SpA criteria. However, depending on different criteria (based on adapted ASAS, ESSG, peripheral or axial symptoms) only 24.3-44.0% of these patients had been referred to a rheumatologist. Patients with suspected SpA had higher usage of immunomodulators (42.8-48.8% vs. 37.0%), biologics (27.1-32.4% vs. 14.9%) and steroids (58.1-64.8% vs. 46.2%) compared to those without suspected SpA. Additionally, suspected SpA patients reported a higher incidence of active colitis (30.4-40.4% vs. 11.8%). Logistic regression analysis identified significant associations between suspected axial SpA and factors such as age, smoking, psoriasis, anterior uveitis and a high P-SCCAI score (≥5). Female gender and BMI ≥30 kg/m² were linked to suspected peripheral SpA.</p><p><strong>Conclusion: </strong>The study highlights a significant prevalence of self-reported SpA in IBD patients, with many remaining undiagnosed and un-referred to rheumatologists. These findings emphasize the need for greater awareness and improved collaboration between gastroenterologists and rheumatologists for better SpA management in IBD patients.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"686-697"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a new model for predicting malignant pancreatic cystic lesions based on clinical and EUS characteristics.","authors":"Yifan Xu, Yan Chen, Jianguo Cheng, Ting Yang, Yu Zhang, Jinfang Xu, Jie Chen","doi":"10.1080/00365521.2025.2523433","DOIUrl":"https://doi.org/10.1080/00365521.2025.2523433","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop and validate a predictive model integrating clinical and Endoscopic Ultrasound (EUS) morphological characteristics to improve the diagnosis of malignant pancreatic cystic lesions (PCLs) in radiologically challenging cases.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients with pathologically confirmed PCLs at The First Affiliated Hospital of Naval Medical University between January 2006 and June 2023. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA).</p><p><strong>Results: </strong>Among 126 enrolled patients, multivariate logistic regression identified six independent predictors of malignancy: weight loss (OR:29.118, 95% CI: 1.894-1031.096, <i>p</i> = 0.010), serum CA19-9 level > 29.3 U/ml (OR: 24.601, 95% CI:7.305-110.886, <i>p</i> < 0.001), location of head-neck (OR: 3.539, 95% CI:1.106-12.857, <i>p</i> = 0.033), thickened cystic wall (OR:3.605, 95% CI:1.106-12.857, <i>p</i> = 0.033), solid component (OR:7.124, 95% CI: 2.113-30.399, <i>p</i> = 0.001) and peripancreatic invasion (OR:8.749, 95% CI: 1.367-78.268, <i>p</i> = 0.021). The model demonstrated high discriminative ability, with an AUC of 0.938 in the training set and 0.951 in the validation set. DCA demonstrated a net benefit (NB) of 0.224 at 10-80% threshold probabilities, potentially avoiding 10% unnecessary surgeries.</p><p><strong>Conclusions: </strong>This EUS-based nomogram improves malignancy prediction in radiologically challenging PCLs, offering clinical utility for personalized management. External validation is warranted to confirm its generalizability.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"1-10"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144542102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual functioning in patients with inflammatory bowel diseases (IBD): prevalence, predictors, and potential benefits of cognitive behavioral therapy (CBT).","authors":"Vicky Lehmann, Dunja Bastiaens, Jos Bosch, Floor Bennebroek Evertsz","doi":"10.1080/00365521.2025.2506141","DOIUrl":"10.1080/00365521.2025.2506141","url":null,"abstract":"<p><strong>Objectives: </strong>Patients with inflammatory bowel diseases (IBD) express concerns about their disease's effects on intimacy and sexuality. This study assessed sexual dysfunction in IBD patients and indirect beneficial effects of IBD-specific cognitive behavioral therapy (CBT) on improving sexual functioning over time.</p><p><strong>Materials & methods: </strong><i>N</i> = 118 patients participated in a multi-center randomized controlled trial (RCT) and were assigned to either an 8-week 'IBD-specific CBT' intervention or waitlist-control group. Standardized self-report measures assessed sexual functioning (the sexuality item of the Inflammatory Bowel Disease Questionnaire, IBDQ), symptoms of depression and anxiety (Hospital Anxiety and Depression Scale: HADS), health-related quality of life (HRQoL; MOS Short-Form Health Survey: SF-36), and IBD symptoms/disease activity (Simple Clinical Colitis Activity Index: P-SCCAI, Harvey Bradshaw Index: P-HBI). Data were analyzed cross-sectionally and longitudinally by means of repeated measures and mediation analyses.</p><p><strong>Results: </strong>At baseline, nearly half of patients reported sexual problems, including 21.4% with moderate and 15.5% with (very) severe sexual problems, as well as 10.2% reporting sexual abstinence due to IBD. At baseline, sexual functioning was weakly to moderately associated with symptoms of depression or anxiety (<i>r</i><-0.4) and physical health complaints (<i>r</i>=.3). Longitudinally, 'IBD-specific CBT' had positive effects on sexual functioning which were mediated by improved depressive symptoms (R²=32.9%).</p><p><strong>Conclusions: </strong>Impairments in sexual functioning are common in IBD patients, which appears in part related to depressive symptoms. Addressing sexual problems in clinical care is crucial, and this study provided preliminary evidence that 'IBD-specific CBT' directed at mental health outcomes, such as depressive complaints, can parallelly help to alleviate sexual dysfunction.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"707-715"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased mucosal and T-cell expression of 4-1BB and PD-1 are modulated by anti-TNFα treatment in Crohn's disease.","authors":"Morten Aagaard Nielsen, Mia Bendix, Christian Lodberg Hvas, Bent Deleuran, Line S Reinert, Jørgen Agnholt, Anders Dige","doi":"10.1080/00365521.2025.2505622","DOIUrl":"10.1080/00365521.2025.2505622","url":null,"abstract":"<p><strong>Objective: </strong>Pro-inflammatory T-cell responses dominate in Crohn's disease (CD). This may result from a dysbalanced expression of co-stimulatory and inhibitory T-cell receptors. The present study investigated if a dysbalanced co-stimulatory and inhibitory T-cell receptor expression are present in CD and can be rebalanced by anti-TNFα treatment.</p><p><strong>Methods: </strong>Mucosal biopsies from 27 patients with active CD receiving anti-TNF treatment were examined for the mRNA levels of the co-stimulatory 4-1BB and inhibitory PD-1 T-cell receptor. Levels of mRNA were compared between inflamed and noninflamed tissue, and before and after treatment. Peripheral T cells from 12 healthy controls (HC) and 11 active CD patients were evaluated for their expression of 4-1BB and PD-1 by flow cytometry.</p><p><strong>Results: </strong>The 4-1BB mRNA levels in inflamed mucosa were upregulated (> 2-fold) compared with uninflamed mucosa (<i>p</i> < 0.05). Anti-TNFα treatment reduced the 4-1BB and PD-1 mRNA levels in the inflamed gut tissue (<i>p</i> < 0.05). In <i>in vitro</i> activated T cells, the percentage of both 4-1BB and PD-1 positive CD4+ and CD8+ T cells increased more than 1.5 fold compared with HC (<i>p</i> < 0.05). The 4-1BB/PD-1 ratio on activated peripheral T cells was significantly reduced in CD after anti-TNF therapy (<i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>A dysbalanced mucosal proinflammatory co-stimulatory T cell receptor expression was present in active CD and modified by anti-TNFα treatment. However, anti-TNFα treatment did not normalize the expression of 4-1BB or PD-1 on peripheral T cells although a modest increased immunoregulatory capacity could be demonstrated.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"698-706"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting severe inflammatory bowel disease: a risk matrix model based on the IBSEN III inception cohort.","authors":"Vibeke Strande, Milada Hagen, Charlotte Lund, Øyvind Asak, May-Bente Bengtson, Raziye Boyar, Trond Espen Detlie, Svein Oskar Frigstad, Magne Henriksen, Kristina I Aass Holten, Øistein Hovde, Gert Huppertz-Hauss, Ole Høie, Ingunn Johansen, Asle W Medhus, Bjørn Christian Olsen, Randi Opheim, Gøri Perminow, Petr Ricanek, Roald Torp, Jørgen Valeur, Simen Vatn, Tone Bergene Aabrekk, Bjørn Moum, Marte Lie Høivik, Vendel A Kristensen","doi":"10.1080/00365521.2025.2512591","DOIUrl":"10.1080/00365521.2025.2512591","url":null,"abstract":"<p><strong>Background and aims: </strong>Identifying patients at risk of developing severe inflammatory bowel disease (IBD) can aid treatment decisions. However, predicting disease course remains challenging. We aimed to identify predictive factors associated with severe disease course in the first year after IBD diagnosis.</p><p><strong>Methods: </strong>Newly diagnosed adult (≥18 years) patients with IBD were recruited from a population-based inception cohort (IBSEN III study). Preselected baseline factors were tested for associations with severe disease course, defined as IBD-related hospitalisation, surgery, treatment with ≥2 steroid courses, >2 biologics and/or new event of complication (stricture, fistula, abscess only applicable Crohn's disease (CD)). From a best fitted multivariable logistic regression model stratified by diagnosis and age (18-40/>40 years), probability of severe disease for given combinations of predictive factors was summarised in prediction matrices.</p><p><strong>Results: </strong>At one-year follow-up, 90/559 (16%) patients with ulcerative colitis (UC) and 74/312 (24%) with CD had severe disease. Treatment with systemic steroids, vitamin D deficiency, Simple Clinical Colitis Activity Index >2, and hypoalbuminemia at diagnosis were all significantly associated with severe disease in UC patients. CD patients with stricturing or penetrating disease behaviour, systemic steroids and hypoalbuminemia at diagnosis were associated with severe disease course. The least favourable combination of these factors increased the probability of severe disease from 3% (95%CI[0-5%]) to 72% (95%CI[66-79%]) for UC and from 8% (95%CI[3-13%]) to 88% (95%CI[84-93%]) for CD.</p><p><strong>Conclusions: </strong>Our study identified predictive factors associated with severe disease the first year after diagnosis. The probability of severe disease summarised in matrices enables easy risk stratification.</p>","PeriodicalId":21461,"journal":{"name":"Scandinavian Journal of Gastroenterology","volume":" ","pages":"716-727"},"PeriodicalIF":1.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144249442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}