Journal of Crohn's & colitis最新文献

{"title":"Higher dietary glycemic index, but not glycemic load, is associated with increased risk of ulcerative colitis: a prospective cohort study.","authors":"Shuyu Ye, Tian Fu, Yiwen Tu, Judith Wellens, Xuejie Chen, Susanna C Larsson, Jiangwei Sun, Lintao Dan, Xiaoyan Wang, Jie Chen, Fernando Magro","doi":"10.1093/ecco-jcc/jjaf036","DOIUrl":"10.1093/ecco-jcc/jjaf036","url":null,"abstract":"<p><strong>Background and aims: </strong>Total carbohydrate intake has been inconsistently associated with inflammatory bowel disease (IBD) risk in previous epidemiological studies. We aimed to evaluate the effects of glycemic index and glycemic load, 2 main indicators for measuring the quality and quantity of carbohydrates, on the risk of IBD subtypes (ie, Crohn's disease [CD] and ulcerative colitis [UC]).</p><p><strong>Methods: </strong>We included 121 148 UK Biobank participants without IBD at baseline, and collected dietary information from a validated web-based 24-hour dietary recall questionnaire. Overall dietary glycemic index and glycemic load were estimated. Cox proportional hazard models were used to calculate multivariable-adjusted hazard ratios (HRs) and 95% CIs. Substitution analyses were conducted to test associations after replacing medium- or high-glycemic-index foods with low-glycemic-index foods.</p><p><strong>Results: </strong>During a median follow-up of 10.6 years, 133 incident CD and 335 incident UC cases were identified. Dietary glycemic index was associated with UC but not CD. The HR of UC was 1.13 (95% CI, 1.01-1.27) per 1-SD increment and 1.46 (95% CI, 1.07-1.99) for the highest versus lowest quartile of glycemic index. Replacing medium or medium- and high-glycemic-index foods with low-glycemic-index foods was associated with a lower risk of UC. No significant associations were found between dietary glycemic load with risk of CD and UC.</p><p><strong>Conclusions: </strong>A higher dietary glycemic index, but not glycemic load, is associated with an increased risk of UC, underscoring the importance of considering glycemic index in dietary recommendations for UC prevention.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574956","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":"Artificial intelligence-assisted approach to assessing bowel wall thickness in pediatric inflammatory bowel disease using intestinal ultrasound images.","authors":"Logiraj Kumaralingam, Kenneth Le May, Van Bao Dang, Javaneh Alavi, Hien Q Huynh, Lawrence H Le","doi":"10.1093/ecco-jcc/jjaf037","DOIUrl":"10.1093/ecco-jcc/jjaf037","url":null,"abstract":"<p><strong>Background and aim: </strong>Intestinal ultrasound (IUS) potentially spares patients from repeated endoscopies under sedation and eliminates the need for alternative imaging modalities like magnetic resonance enterography and computed tomography enterography scans. However, interpreting IUS images is challenging for physicians due to the time-intensive process of identifying markers indicative of inflammatory bowel disease (IBD). This study aims for fully automating the analysis of pediatric IBD to distinguish between abnormal and normal cases.</p><p><strong>Methods: </strong>We used data set of 260 pediatric patients, consisting of 4565 IUS images with 1478 abnormal and 3087 normal cases. Meticulous annotation of the region between the lumen/mucosa and the muscularis/serosa interfaces in a subset of 612 images were performed. An artificial intelligence (AI) algorithm was trained to delineate the region between these interfaces. The boundaries of these regions were extracted, and the average bowel wall thickness (BWT) was calculated and analyzed using cutoff values ranging between 1.5 and 3 mm.</p><p><strong>Results: </strong>This study showed promising segmentation performance in accurately identifying the lumen/mucosa and muscularis/serosa interfaces. In a separate test set of 3953 images, the classification performance at the 2mm BWT cutoff showed the highest sensitivity of 90.29% and a specificity of 93.70%. The AI method showed strong agreement, with an interclass correlation of 0.942 (95% CI: 0.938-0.946), compared to manual clinical measurements.</p><p><strong>Conclusions: </strong>This study demonstrates an AI approach to automate the analysis of pediatric IBD IUS images, providing a reliable tool for early detection, precise characterization, and monitoring of the disease.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574954","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":"Corticosteroid-sparing effects of risankizumab efficacy and safety in patients with moderately to severely active ulcerative colitis.","authors":"Walter Reinisch, Edward V Loftus, Stefan Schreiber, David T Rubin, Edouard Louis, Patrick M Hecht, Elena Marced Barrachina, Jasmina Kalabic, Ramona Vladea, Dolly Sharma, Weijiang Rachel Duan, Yafei Zhang, Remo Panaccione","doi":"10.1093/ecco-jcc/jjaf025","DOIUrl":"10.1093/ecco-jcc/jjaf025","url":null,"abstract":"<p><strong>Background and aims: </strong>This post hoc analysis evaluated the corticosteroid-sparing effects of risankizumab (RZB) therapy in patients with moderate-to-severe ulcerative colitis in the phase 3 induction and maintenance studies, INSPIRE and COMMAND.</p><p><strong>Methods: </strong>Patients were randomized (2:1) to 12 weeks of intravenous RZB or placebo (PBO) induction therapy; responders to intravenous RZB were randomized (1:1:1) to receive subcutaneous RZB 180 mg, 360 mg, or PBO (RZB withdrawal) maintenance therapy. Baseline corticosteroid doses were maintained during induction, with a mandatory taper beginning at maintenance week 0. Efficacy outcomes were evaluated by baseline corticosteroid use at induction week 12, while corticosteroid-free clinical and endoscopic outcomes were assessed at maintenance week 52 among the overall population and among patients on corticosteroids at baseline. Safety was also assessed.</p><p><strong>Results: </strong>At baseline, 35.7% (348/975) of patients were taking corticosteroids. At induction week 12, greater rates were observed for clinical, endoscopic, and patient-reported outcomes in RZB 1200 mg-treated patients compared with PBO, regardless of baseline corticosteroid use. RZB 180 mg and 360 mg treatment resulted in higher corticosteroid discontinuation rates (RZB 180 mg 64.9% [48/74]; RZB 360 mg 54.2% [32/59]; PBO [withdrawal] 36.8% [25/68], P ≤ .01) and corticosteroid-free clinical, endoscopic, and patient-reported outcomes at week 52, compared with PBO (withdrawal). The rates of treatment-emergent adverse events were similar regardless of baseline corticosteroid use during induction and maintenance.</p><p><strong>Conclusions: </strong>The efficacy of RZB induction therapy was independent of corticosteroid use, with high rates of corticosteroid-free outcomes observed in the overall population and among patients with baseline corticosteroid use, reaffirming the potential of RZB to serve as a corticosteroid-sparing therapy for patients with ulcerative colitis.</p><p><strong>Clinicaltrial.gov numbers: </strong>NCT03398148 and NCT03398135.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766212","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":"The mediating role of psychological inflexibility on internalised stigma and patient outcomes in a sample of adults with inflammatory bowel disease.","authors":"Darren P Reynolds, Trudie Chalder, Claire Henderson","doi":"10.1093/ecco-jcc/jjaf055","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjaf055","url":null,"abstract":"<p><strong>Background: </strong>This study examined the relationship between psychological inflexibility, internalised stigma, and patient outcomes in adults with Inflammatory Bowel Disease (IBD). It aimed to explore if psychological inflexibility mediated the relationship between internalised stigma and patient outcomes.</p><p><strong>Methods: </strong>382 participants with IBD took part in a cross-sectional quantitative study conducted via an online survey from May to December 2020. Participants completed questionnaires which assessed psychological inflexibility, committed action, internalised stigma related to IBD, psychological distress, IBD self-efficacy, self-concealment, beliefs about emotions, and fatigue. Participants also completed a sociodemographic and clinical questionnaire in addition to a bespoke Covid-19 questionnaire. Pearson's correlations and exploratory simple mediation analyses were used to examine relationships between variables and the mediating effect of psychological inflexibility.</p><p><strong>Results: </strong>40.5% of participants experienced internalised stigma. Higher psychological inflexibility was associated with higher internalised stigma, lower committed action, poorer health-related quality of life, lower IBD self-efficacy, higher self-concealment, higher fatigue, and more negative beliefs about emotions. Psychological inflexibility partially mediated the relationship between internalised stigma and several patient outcomes (psychological distress, IBD health-related quality of life, IBD self-efficacy, and self-concealment) and completely mediated the relationship between internalised stigma and fatigue.</p><p><strong>Conclusion: </strong>Psychological inflexibility significantly impacts quality of life in individuals with internalised stigma related to IBD and mediates the relationship between internalised stigma and patient outcomes. Increasing psychological flexibility in adults with IBD may reduce distress and enhance quality of life. Longitudinal studies and trials of psychological interventions targeting psychological flexibility warrant exploration.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766218","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":"Patient-donor similarity and donor-derived species contribute to the outcome of faecal microbiota transplantation for ulcerative colitis.","authors":"Dai Ishikawa, Hikaru Watanabe, Kei Nomura, Xiaochen Zhang, Takafumi Maruyama, Rina Odakura, Masao Koma, Tomoyoshi Shibuya, Taro Osada, Shinji Fukuda, Taku Nakahara, Jun Terauchi, Akihito Nagahara, Takuji Yamada","doi":"10.1093/ecco-jcc/jjaf054","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjaf054","url":null,"abstract":"<p><strong>Background and aims: </strong>Clinical applications of faecal microbiota transplantation (FMT) for treating ulcerative colitis (UC) have shown promising results. However, whether the beneficial effects of FMT are due to the transfer and colonisation of donor-derived species in patients remains unclear. Here, we investigated the factors affecting the efficacy of administration of triple antibiotics (A-FMT) and the criteria for appropriate donor and patient-donor matching.</p><p><strong>Methods: </strong>Ninety-seven patients with active UC who were enrolled between March 2014 and October 2019 underwent FMT. The clinical features were assessed based on a reduction in Lichtiger's clinical activity index 4 weeks after A-FMT, with long-term responders (LTR) defined as those with no increase or intensification within 12 months after A-FMT. Microbiome analysis was performed on 147 faecal samples (pre-A-FMT, post-A-FMT, and donor) from 49 patient-donor combinations that were assigned using the one patient-to-one donor strategy.</p><p><strong>Results: </strong>Of the 97 patients, 61 achieved a clinical response, and of those, 35 were classified as having clinical remission. The efficacy of A-FMT was affected by UC severity and previous administration of steroids (p = 0.027), immunosuppressants (p = 0.049), and biologics (p = 0.029). Effective donors were rich in taxa such as Bacteroidota, which are lost in UC, and the abundances of \"patient-origin\" and \"new-amplicon sequence variant\" taxa were significantly lower in Responders compared to Nonresponders (Remission; p = 0.03, LTR; p = 0.05). \"Donor-derived\" amplicon sequence variant sequences, Oscillospiraceae UCG-002 and Alistipes, were significantly enriched in Responders (p < 0.05). Our results showed that the taxonomic composition of patients and the similarity of Bacteroides and butyric acid-producing bacteria in the patient-donor microbiota significantly influenced A-FMT efficacy (p < 0.05).</p><p><strong>Conclusions: </strong>This study provides important insights for developing patient-tailored FMT-based therapies for UC.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766215","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":"Fidaxomicin for Clostridioides difficile infection in patients with inflammatory bowel disease: a multicentre retrospective cohort study.","authors":"Daniele Noviello, María Chaparro, Chiara Viganò, Andreas Blesl, Brigida Barberio, Henit Yanai, Ambrogio Orlando, Rocío Ferreiro-Iglesias, Cristina Bezzio, Alessandra Zilli, Tamás Molnár, Cristian Gheorghe, Francesco Conforti, Tommaso Innocenti, Simone Saibeni, Peter Bossuyt, Raquel Oliveira, Anna Maria Carvalhas Gabrielli, Alessandra Losco, Sophie Vieujean, Enrico Tettoni, Lorena Pirola, Silvia Calderone, Maya Kornowski Cohen, Gabriele Dragoni, Timo Rath, Manuel Barreiro-de Acosta, Edoardo Vincenzo Savarino, Javier Pérez Gisbert, Maurizio Vecchi, Raja Atreya, Flavio Caprioli","doi":"10.1093/ecco-jcc/jjaf056","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjaf056","url":null,"abstract":"<p><strong>Background and aims: </strong>Inflammatory bowel disease (IBD) patients with Clostridioides difficile infection (CDI) are at increased risk of adverse outcomes. Data on fidaxomicin use in IBD remains scarce. We assessed the effectiveness and safety of fidaxomicin for CDI and its impact on IBD outcomes in a large international cohort.</p><p><strong>Methods: </strong>Adult patients with ulcerative colitis (UC) or Crohn's disease (CD) treated with fidaxomicin for documented CDI were retrospectively included. The primary outcome was CDI recurrence rate within 8 weeks (C. difficile toxin detection and CDI-targeted therapy). Secondary outcomes included sustained response (no CDI-targeted therapy within 12 weeks), IBD therapy escalation, colectomy rate, and all-cause mortality within 30, 90, and 180 days.</p><p><strong>Results: </strong>Ninety-six patients (57 UC and 39 CD) from 20 IBD centres were included. Most were on advanced IBD therapy. Half had a previous CDI episode, 15% a severe episode. CDI recurrence rate was 10% at week 8, sustained response 82% at week 12. Compared to patients with previous CDI episode, patients at first episode tended to have a lower recurrence (4.3 vs 16%; p=0.06) and higher sustained response (91 vs 75%; p=0.04) rate. IBD therapy escalation was required in 48% with a numerically lower need for patients achieving vs not-achieving sustained response within 30 days (12 vs 20%; p=0.42). Five UC patients underwent colectomy. One death unrelated to CDI or IBD occurred. One moderate and five mild adverse events were reported.</p><p><strong>Conclusions: </strong>Fidaxomicin was effective and safe in IBD patients with CDI, with greater effectiveness in CDI-naïve patients, potentially influencing short-term IBD outcomes.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756830","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":"Real-world Effectiveness of Ustekinumab Versus Anti-TNF or Vedolizumab in Ulcerative Colitis: Induction and 12-Month Maintenance Results from the Prospective, Observational RUN-UC Study.","authors":"Bernd Bokemeyer, Sandra Plachta-Danielzik, Elena Gilman, Stefanie Howaldt, Wolfgang Mohl, Philipp Efken, Robert Ehehalt, Matthias Kahl, Thomas Krause, Leo Trentmann, Andreas Lügering, Elisabeth Schnoy, Christoph Jochum, Petra Hartmann, Stefan Schreiber","doi":"10.1093/ecco-jcc/jjaf052","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjaf052","url":null,"abstract":"<p><strong>Background: </strong>Real-world evidence (RWE) studies of ustekinumab (UST) in ulcerative colitis (UC) are needed because randomized controlled trials do not represent unselected patient populations in everyday clinical practice. Patients with UC were recruited when starting biologic therapy for the first time or switching to a new biologic therapy. This study assessed the effectiveness of maintenance therapy with UST in comparison to anti-TNF or vedolizumab (VDZ) at 12 months.</p><p><strong>Methods: </strong>Between 2020-2022, 507 UC patients starting biologic therapy for the first time or switching to a new biologic therapy were enrolled at 34 IBD-specialized centres in Germany. After excluding patients receiving other biologics or small molecules, as well as those with stomas or missing outcomes, the final sample consisted of 476 patients. The outcomes were clinical response, clinical remission (CR), and steroid-free remission. Propensity score (PS) adjustment with inverse probability of treatment weighting (IPTW) was used to reduce the effect of confounding due to physician selection of therapy.</p><p><strong>Results: </strong>A total of 476 patients with UC were included in the analysis (UST: 147, anti-TNF: 168, VDZ: 161). Treatment persistence over 12 months differed significantly (p < 0.001) between UST (93.9%), VDZ (87.0%), and anti-TNF (75.0%). The PS-weighted effectiveness of UST in the mITT analysis at month 12 was not significantly different to anti-TNF or VDZ (CR: UST 26.9%, anti-TNF 34.7%, VDZ 40.9%; p=0.063).</p><p><strong>Conclusion: </strong>In the prospective RUN-UC study with PS-weighted groups, UST showed higher treatment persistence but no significant difference in maintenance effectiveness compared to anti-TNF or VDZ in UC.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733764","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 real-world effectiveness of ustekinumab versus anti-TNF in Crohn's disease: 12-month maintenance phase results from the prospective, observational RUN-CD study using propensity score adjustment.","authors":"Bernd Bokemeyer, Sandra Plachta-Danielzik, Elena Gilman, Romina di Giuseppe, Herbert Deppe, Wolfgang Mohl, Niels Teich, Martin Hoffstadt, Axel Schweitzer, Manfred von der Ohe, Annika Gauss, Raja Atreya, Thomas Krause, Irina Blumenstein, Petra Hartmann, Stefan Schreiber","doi":"10.1093/ecco-jcc/jjaf051","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjaf051","url":null,"abstract":"<p><strong>Background: </strong>The prospective RUN-CD registry investigates the effectiveness of ustekinumab (UST) and other biologics in Crohn's disease (CD) across Germany. Based on data from the registry, this study presents the maintenance phase results of a 12-month real-world-evidence (RWE) comparison of CD patients initiating new biologic therapies with UST or anti-TNF.</p><p><strong>Methods: </strong>After excluding patients using biologics other than UST and anti-TNF and those with missing outcomes, the final sample consisted of 618 CD patients. Clinical remission (CR), defined as a Harvey-Bradshaw Index (HBI) ≤4, was the prespecified endpoint at 12 months. Switching to another biologic therapy was considered an outcome failure. Propensity score (PS) adjustment was used to reduce the effect of confounders.</p><p><strong>Results: </strong>The study included 343 CD patients treated with UST and 264 treated with anti-TNF. Over 12 months, the frequency of therapy switches was significantly higher for infliximab (28%) compared to UST (17%) and adalimumab (17%) (p=0.045). There was no significant difference in CR rates at 12 months between the UST and anti-TNF groups (65.8% vs. 60.0%, p=0.262). However, in week-16 responders, CR rates at 12 months were significantly higher with UST (77.6%) versus anti-TNF (65.4%) (p=0.041). The change in EQ-VAS (QoL) scores between UST and anti-TNF showed a 5.1-point difference favouring UST (p=0.002).</p><p><strong>Conclusions: </strong>In this 12-month RWE comparison, overall CR rates were similar between UST and anti-TNF. However, among week-16 responders, CR rates were significantly higher with UST. Additionally, UST was associated with a significantly greater improvement in QoL compared to anti-TNF.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712339","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":"Effect of tofacitinib exposure in utero and during breastfeeding on the immune status of exposed child.","authors":"Katarina Mitrova, Marta Kostrejova, Kristyna Zdychyncova, Milan Lukas, Duricova Dana","doi":"10.1093/ecco-jcc/jjaf049","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjaf049","url":null,"abstract":"<p><strong>Background and aims: </strong>Janus kinase (JAK) inhibitors, such as tofacitinib, are potent anti-inflammatory agents used in the treatment of ulcerative colitis (UC). Current guidelines recommend avoiding their use during pregnancy due to safety concerns, as well as during breastfeeding due to the potential excretion into breast milk.</p><p><strong>Methods: </strong>This case report describes the impact of in utero exposure to tofacitinib during pregnancy and subsequent exposure via breastfeeding on the immune development of the exposed infant.</p><p><strong>Results: </strong>A 37-year-old woman with UC, who was being treated with tofacitinib and vedolizumab, became pregnant and continued both medications, with the tofacitinib dosage reduced from 10 mg to 5mg BID at gestational week 28. The infant was born healthy, with normal growth and development, and received all scheduled non-live vaccinations. At 15 months, immune parameters - including response to vaccination - were evaluated. The results showed normal immunoglobulin levels and an adequate serologic response to vaccination, with no signs of immune dysfunction.</p><p><strong>Conclusions: </strong>This case suggests that prolonged prenatal and postnatal exposure to tofacitinib may not adversely affect infant immune development. However, caution is advised due to the limited number of documented cases. Further research is needed to fully understand the long-term implications of JAK inhibitor exposure during pregnancy and breastfeeding.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702490","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":"The use of International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) in patients with ulcerative colitis: applicability and comparison with other ultrasound scores.","authors":"Tommaso Innocenti, Carmen Rocco, Eleonora Balena, Giulia Petrucci, Erica Nicola Lynch, Siro Bagnoli, Giuseppe Macrì, Francesca Rogai, Beatrice Orlandini, Andrea Giovanni Bonanomi, Stefano Milani, Andrea Galli, Maria Rosa Biagini, Monica Milla, Gabriele Dragoni","doi":"10.1093/ecco-jcc/jjaf050","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjaf050","url":null,"abstract":"<p><strong>Background and aims: </strong>The International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) is an intestinal ultrasound (IUS) score validated for Crohn's disease, potentially applicable to ulcerative colitis (UC). We aimed to confirm the applicability of IBUS-SAS to UC, while comparing its performance with other IUS scores.</p><p><strong>Methods: </strong>Adult patients with UC undergoing colonoscopy were prospectively included and scored with both the Mayo Endoscopic Subscore (MES) and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). IUS was performed within 4 weeks of endoscopy, measuring IBUS-SAS and other 5 UC-developed IUS scores. The Spearman's rank coefficient (ρ) was used to perform correlations, while receiver operating characteristic (ROC) curves were compared with the Hanley & McNeil method.</p><p><strong>Results: </strong>In total, 185 patients were included. The IBUS-SAS showed a strong correlation with both the MES (ρ = 0.72, p < 0.01) and the UCEIS (ρ = 0.73, p < 0.01). Its AUC to detect an endoscopic activity of at least moderate severity (MES ≥ 2 and UCEIS ≥ 5) was 0.87 and 0.89, respectively. The optimal cut-offs of IBUS-SAS to detect a MES ≥ 2 and an UCEIS ≥ 5 were > 19 (sensitivity 79%, specificity 84%) and > 23 (sensitivity 88%, specificity 75%), respectively. Consistently, all the investigated IUS scores correlated with both the MES and the UCEIS (p < 0.01).</p><p><strong>Conclusions: </strong>The IBUS-SAS has an optimal performance in the assessment of UC endoscopic activity, despite having been initially developed for CD. Therefore, it might be adopted as reference score both for CD and UC activity.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702533","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}