Journal of Crohn's & colitis最新文献

{"title":"Knowledge, Values, and Preferences Regarding Contraceptive Choices Among Women Living With Inflammatory Bowel Disease.","authors":"Jimmy K Limdi, Sarah Rhodes, Eleanor Liu, Anish J Kuriakose Kuzhiyanjal, Matthew Brookes, Jennifer Farraye, Rachel Cannon, Elisabeth Woodhams, Francis A Farraye","doi":"10.1093/ecco-jcc/jjae181","DOIUrl":"10.1093/ecco-jcc/jjae181","url":null,"abstract":"<p><strong>Background and aims: </strong>Active inflammatory bowel disease (IBD) at conception is associated with adverse pregnancy outcomes. International guidelines address antenatal care, but contraception counseling and risk assessment are not addressed. Data on healthcare professionals' guidance for women with IBD regarding contraception are scarce. We aimed to describe contraceptive use, preferences, knowledge, and barriers among women with IBD.</p><p><strong>Methods: </strong>A 34-item questionnaire was administered to female IBD patients aged 18-45. Disease control was measured using PRO-2 and IBD-control questionnaire, and contraceptive preferences were assessed by the contraceptive features survey. Logistic regression explored associations between contraceptive use, attitudes, disease remission status, and other factors.</p><p><strong>Results: </strong>Of 338 women surveyed, 243 (74%) used some form of contraception. Oral birth control pills (28%) and barrier methods (18%) were most used but 20% used long-acting methods. Women with active disease were more likely to use long-acting contraception (23%) compared to those in remission (17%). Contraceptive priorities were effectiveness (78%), ease of use (75%), and minimal side effects (68%). Only 25% women had discussed reproductive issues with their IBD clinician, though 85% were comfortable to do so. Preferred sources for reproductive counseling were IBD nurses (79%), general practitioners (75%), IBD doctors (68%), and gynecologists (49%).</p><p><strong>Conclusions: </strong>A quarter of women with IBD were not using any contraception, and long-acting contraceptive use was low. Women prefer effective, easy-to-use contraceptives with minimal side effects but lack knowledge on effective contraception-related issues. Better education and proactive discussions between healthcare providers and patients could improve reproductive health in women with IBD.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741873","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 multicenter 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":"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 remain 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 centers 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, and sustained response 82% at week 12. Compared with patients with previous CDI episode, patients at first episode tended to have a lower recurrence (4.3% vs 16%; P = .06) and higher sustained response (91% vs 75%; P = .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 = .42). Five UC patients underwent colectomy. One death unrelated to CDI or IBD occurred. One moderate and 5 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":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-integrin αvβ6 IgG antibody as a diagnostic and prognostic marker in ulcerative colitis: A cross-sectional and longitudinal study defining a specific disease phenotype.","authors":"Eleftheria Pertsinidou, Benita Salomon, Daniel Bergemalm, Samira Salihovic, Charlotte R H Hedin, Maria Ling Lundström, Åsa V Keita, Maria K Magnusson, Carl Eriksson, May-Bente Bengtson, Olle Grännö, Tone B Aabrekk, Robert Movérare, Niclas Rydell, Helena Ekoff, Johan Rönnelid, Mauro D'Amato, Trond E Detlie, Gert Huppertz-Hauss, Randi Opheim, Petr Ricanek, Vendel A Kristensen, Lena Öhman, Johan D Söderholm, Robert Kruse, Carl M Lindqvist, Marie Carlson, Dirk Repsilber, Marte L Høivik, Jonas Halfvarson","doi":"10.1093/ecco-jcc/jjaf062","DOIUrl":"10.1093/ecco-jcc/jjaf062","url":null,"abstract":"<p><strong>Background and aims: </strong>The diagnostic and prognostic properties of anti-integrin αvβ6 immunoglobulin G (IgG) autoantibodies in ulcerative colitis (UC) are poorly understood. We aimed to assess the diagnostic performance of anti-integrin αvβ6 autoantibodies and examine their association with disease outcomes.</p><p><strong>Methods: </strong>Serum samples from a Swedish inception cohort of patients with suspected inflammatory bowel disease (IBD, n = 473) were analyzed using an in-house fluorescence enzyme immunoassay based on EliA technology. Findings were validated in a Norwegian population-based inception cohort (n = 570). Diagnostic performance was assessed by calculating the area under the curve (AUC) with 95% confidence intervals and determining sensitivity and specificity. Reclassification was evaluated using the net reclassification index.</p><p><strong>Results: </strong>In the discovery cohort, patients with UC, IBD-unclassified, or colonic Crohn's disease exhibited higher median autoantibody levels compared to symptomatic and healthy controls. In the validation cohort, the autoantibody demonstrated 79% sensitivity and 94% specificity for UC vs symptomatic controls at a cut-off of 400 UA/l. Its diagnostic performance (AUC = 0.92, 95% CI, 0.89-0.95) was superior to hs-CRP (AUC = 0.65, 95% CI, 0.60-0.70, P < .001) and faecal calprotectin (fcalpro) (AUC = 0.88, 95% CI, 0.84-0.92, P = .09). Combining the autoantibody with fcalpro further improved diagnostic accuracy (AUC = 0.97, 95% CI, 0.95-0.98) and patient reclassification (P < .001). Autoantibody positivity was associated with a severe phenotype of UC, characterised by increased inflammatory activity and higher IL-17A and granzyme B levels. Higher autoantibody levels were linked to an aggressive disease course, remaining stable in aggressive UC but decreasing in indolent disease (P = .003).</p><p><strong>Conclusions: </strong>Anti-integrin αvβ6 is a reliable diagnostic and prognostic marker for UC, with potential clinical implementation.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12086997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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":"Risankizumab Is Associated With Normalization of Biomarkers in Patients With Crohn's Disease: Results From the Phase 3 ADVANCE, MOTIVATE, and FORTIFY Studies.","authors":"Raja Atreya, Marc Ferrante, Remo Panaccione, Brian Feagan, Oksana Shchukina, Vipul Jairath, Florian Rieder, Tadakazu Hisamatsu, Britta Siegmund, Kristina Kligys, Alexandra Song, Javier Zambrano, Madhuja Mallick, Yafei Zhang, Alessandro Armuzzi, Geert D'Haens","doi":"10.1093/ecco-jcc/jjae164","DOIUrl":"10.1093/ecco-jcc/jjae164","url":null,"abstract":"<p><strong>Background and aims: </strong>Normalization of high-sensitivity C-reactive protein (hs-CRP) and fecal calprotectin (FCP) are suggested as intermediate treatment targets for Crohn's disease (CD). This analysis evaluates achievement of biomarker normalization and the relationship between improvements in biomarker concentrations and clinical and endoscopic outcomes among patients treated with risankizumab.</p><p><strong>Methods: </strong>This post hoc analysis included patients with moderately to severely active CD and elevated baseline hs-CRP (>5 mg/L) or FCP (>250 µg/g) concentrations from the 12-week ADVANCE and MOTIVATE induction studies, and the 52-week FORTIFY maintenance study. We assessed the proportion of patients achieving biomarker normalization, defined as hs-CRP ≤5 mg/L and FCP ≤250 µg/g, and the association between achieving biomarker normalization and improved clinical and endoscopic outcomes.</p><p><strong>Results: </strong>Among 748 patients with elevated baseline hs-CRP or FCP concentrations, higher proportions of patients treated with risankizumab vs placebo achieved normalization of hs-CRP (Week 12: placebo, 17.5%; risankizumab 600 mg, 48.5%; Week 52: placebo, 29.5%; risankizumab 180 mg, 45.2%; risankizumab 360 mg, 40.8%) and FCP (Week 12: placebo, 9.1%; risankizumab 600 mg, 26.0%; Week 52: placebo, 28.0%; risankizumab 180 mg, 43.0%; risankizumab 360 mg, 44.0%; nominal p < 0.05 vs placebo for all comparisons). Achievement of both clinical or endoscopic outcomes and improvement of biomarker concentrations occurred at higher rates among patients treated with risankizumab vs placebo, regardless of prior exposure to biologic therapies.</p><p><strong>Conclusions: </strong>Risankizumab treatment led to sustained normalization of inflammatory biomarkers with improved clinical and endoscopic results.</p><p><strong>Clinical trial registration number: </strong>ADVANCE, NCT03105128; MOTIVATE, NCT03104413; FORTIFY, NCT03105102.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental risk factors of inflammatory bowel disease: toward a strategy of preventative health.","authors":"Tarun Chhibba, Beatriz Gros, James A King, Joseph W Windsor, Julia Gorospe, Haim Leibovitzh, Mingyue Xue, Williams Turpin, Kenneth Croitoru, Ashwin N Ananthakrishnan, Richard B Gearry, Gilaad G Kaplan","doi":"10.1093/ecco-jcc/jjaf042","DOIUrl":"10.1093/ecco-jcc/jjaf042","url":null,"abstract":"<p><p>The pathogenesis of inflammatory bowel disease (IBD) involves a complex interplay between genetic, environmental, and microbial factors. Many of these environmental determinants are modifiable, offering opportunities to prevent disease or delay its onset. Advances in the study of preclinical IBD cohorts offer the potential to identify biomarkers that predict individuals at high risk of developing IBD, enabling targeted environmental interventions aimed at reducing IBD incidence. This review summarizes findings from 79 meta-analyses on modifiable environmental factors associated with the development of IBD. Identified risk factors include smoking, Western diets, ultra-processed foods, and early life antibiotic use, while protective factors include breastfeeding, Mediterranean diets rich in fiber, plant-based foods, and fish, along with an active physical lifestyle. Despite the promise shown by observational data, interventional or randomized controlled studies evaluating the efficacy of modifying environmental risk factors remain limited and mostly focus on dietary intervention. This review aims to inform the design of higher quality interventional and randomized controlled studies for disease prevention while providing actionable guidance to healthcare providers on reducing the risk of developing IBD through environmental modifications.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1 Analog Use is Associated With Improved Disease Course in Inflammatory Bowel Disease: A Report from the Epi-IIRN.","authors":"Yuri Gorelik, Itai Ghersin, Rona Lujan, Dima Shlon, Yiska Loewenberg Weisband, Amir Ben-Tov, Eran Matz, Galia Zacay, Iris Dotan, Dan Turner, Haggai Bar-Yoseph","doi":"10.1093/ecco-jcc/jjae160","DOIUrl":"10.1093/ecco-jcc/jjae160","url":null,"abstract":"<p><strong>Background and aims: </strong>The growing use of glucagon-like peptide 1 (GLP-1) analogs for type 2 diabetes mellitus (DM2) and obesity necessitates studies about their use in patients with inflammatory bowel diseases (IBD).</p><p><strong>Methods: </strong>Data on patients with DM2 were retrieved from an Israeli nationwide cohort of patients with IBD (epi-IIRN), recording GLP-1 analog exposure for at least 6 months. The primary outcome was poor disease outcomes (ie, composite of steroid dependence, initiation of advanced IBD therapy, hospitalization, surgery, or death). Cox proportional hazard models with time-varying covariables were used to assess the impact of GLP-1 use on outcomes during follow-up.</p><p><strong>Results: </strong>We included 3737 patients (24 338 patient-years) with IBD and DM2 [50.4% ulcerative colitis (UC)], of whom 633 were treated with GLP-1 analogs. Accounting for demographics IBD/DM2 related variables, medication use, and laboratory measurements, GLP-1 analog use was associated with reduced composite outcome in the full cohort (adjusted hazard ratio [aHR] 0.74, 95% confidence interval [CI] 0.62-0.89) and in each subtype [UC (aHR 0.71, 95% CI 0.52-0.96) and Crohn's disease (aHR 0.78, 95% CI 0.62-0.99)]. Similar trends were seen in multivariate analyses of each individual outcome, although only hospitalization was significant (aHR 0.74, 95% CI 0.61-0.91). The protective effect of GLP-1 analogs was seen in patients with obesity (aHR 0.61, 95% CI 0.50-0.77), but not in non-obese (aHR 0.94, 95% CI 0.67-1.31).</p><p><strong>Conclusions: </strong>GLP-1 analogs are associated with improved outcomes in IBD, specifically in patients with obesity. The mechanisms of these effects require further investigation as well as their role in patients without DM2.</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":"142515366","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":"Multimodal metagenomic analysis reveals microbial InDels as superior biomarkers for pediatric Crohn's disease.","authors":"Mengping Shen, Sheng Gao, Ruixin Zhu, Wei Wang, Wenxing Gao, Liwen Tao, Wanning Chen, Xinyue Zhu, Yuwei Yang, Tingjun Xu, Tingting Zhao, Na Jiao, Min Zhi, Lixin Zhu","doi":"10.1093/ecco-jcc/jjaf039","DOIUrl":"10.1093/ecco-jcc/jjaf039","url":null,"abstract":"<p><strong>Background and aims: </strong>The gut microbiome is closely associated with pediatric Crohn's disease (CD), while the multidimensional microbial signature and their capabilities for distinguishing pediatric CD are underexplored. This study aims to characterize the microbial alterations in pediatric CD and develop a robust classification model.</p><p><strong>Methods: </strong>A total of 1175 fecal metagenomic sequencing samples, predominantly from 3 cohorts of pediatric CD patients, were re-analyzed from raw sequencing data using uniform process pipelines to obtain multidimensional microbial alterations in pediatric CD, including taxonomic profiles, functional profiles, and multi-type genetic variants. Random forest algorithms were used to construct classification models after comparing multiple machine learning algorithms.</p><p><strong>Results: </strong>We found pediatric CD samples exhibited reduced microbial diversity and unique microbial characteristics. Pronounced abundance differences in 45 species and 1357 KEGG orthology genes. Particularly, Enterocloster bolteae emerged as a pivotal pediatric CD-associated species. Additionally, we identified a vast amount of microbial genetic variants linked to pediatric CD, including 192 structural variants, 1256 insertions/deletions (InDels), and 3567 single nucleotide variants, with a considerable portion of these variants located in non-genic regions. The InDel-based model outperformed other predictive models against multidimensional microbial signatures, achieving an area under the ROC curve (AUC) of 0.982. The robustness and disease specificity were further confirmed in an independent CD cohort (AUC = 0.996) and 5 other microbiome-associated pediatric cohorts.</p><p><strong>Conclusions: </strong>Our study provided a comprehensive landscape of microbial alterations in pediatric CD and introduced a highly effective diagnostic model rooted in microbial InDels, which contributes to the development of noninvasive diagnostic tools and targeted therapies.</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":"143574957","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 and validation of a risk prediction tool for the diagnosis of inflammatory bowel disease in patients presenting in primary care with abdominal symptoms.","authors":"Nosheen Umar, Steven Wambua, Phil Harvey, Samuel Cusworth, Krish Nirantharakumar, Shamil Haroon, Nigel Trudgill, Nicola J Adderley","doi":"10.1093/ecco-jcc/jjaf044","DOIUrl":"10.1093/ecco-jcc/jjaf044","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with inflammatory bowel disease (IBD) may experience delays in their diagnosis. This study aimed to develop and validate a risk prediction tool for IBD.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using primary care data from 2010 to 2019, including symptomatic patients aged ≥18. UK-based primary care databases linked to hospital records were utilized for model development and validation. Cox proportional hazards models were used to derive risk equations for IBD, ulcerative colitis (UC), and Crohn's disease (CD) in men and women. Candidate predictors included demographics, comorbidities, symptoms, extraintestinal manifestations, and laboratory results. Model performance was evaluated using measures of fit, discrimination, and calibration at 1, 2, 3, and 5 years after symptom onset.</p><p><strong>Results: </strong>In total, 2 054 530 patients were included in the derivation cohort and 673 320 in the validation cohort. In the derivation cohort, 0.7% were diagnosed with IBD (66.3% UC and 33.7% CD). Predictors in the final IBD model included age, smoking, body mass index, gastrointestinal symptoms, extraintestinal manifestations, comorbidities, family history of IBD, and laboratory investigations. The model demonstrated good discrimination and calibration; C-statistic 0.78 (95% confidence interval [CI], 0.77-0.79) in men and 0.78 (95% CI, 0.77-0.79) in women. In the validation cohort, the model tended to slightly overestimate IBD risk at higher risk thresholds.</p><p><strong>Conclusions: </strong>A risk model using patient demographics, symptoms, and laboratory results accurately predicted IBD, UC, and CD at 1, 2, 3, and 5 years after symptom onset, potentially aiding in prioritizing patients for a referral or fecal calprotectin testing in primary care.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12010163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Modified Multiplier of the Simple Endoscopic Score for Crohn's Disease Endoscopic Improvement Thresholds Enhances Effect Size Differentiation Between Adalimumab Versus Placebo: A Post Hoc Analysis of the EXTEND Trial.","authors":"Emily C L Wong, Parambir S Dulai, John K Marshall, Stephen Laroux, Vipul Jairath, Walter Reinisch, Neeraj Narula","doi":"10.1093/ecco-jcc/jjae171","DOIUrl":"10.1093/ecco-jcc/jjae171","url":null,"abstract":"<p><strong>Introduction: </strong>The Modified Multiplier of the Simple Endoscopic Score for Crohn's Disease (MM-SES-CD) refines the assessment of endoscopic CD severity by differentially weighting parameters in the original SES-CD. A threshold of <22.5 for MM-SES-CD suggests endoscopic remission (ER) and correlates with a low risk of long-term disease progression. This study examines whether MM-SES-CD-defined ER and response criteria are more sensitive to treatment effects compared to conventional SES-CD definitions.</p><p><strong>Methods: </strong>This post hoc analysis of the EXTEND (extend the safety and efficacy of adalimumab through endoscopic healing) trial compared various SES-CD and MM-SES-CD definitions of ER and endoscopic response in CD patients treated with adalimumab or placebo. The study included participants with moderate-severe CD and a baseline MM-SES-CD score ≥ 22.5. The primary outcome of ER, defined as MM-SES-CD < 22.5, was evaluated at Weeks 12 and 52. Area under the curve (AUC) analyses compared thresholds for predicting Week 52 ER.</p><p><strong>Results: </strong>Of the 100 participants (77.5% of the EXTEND population), 51 received adalimumab and 49 received placebo. At Week 12, 62% achieved MM-SES-CD ≥ 20% reduction from baseline, compared to 39% with SES-CD ≥ 50% reduction. At Week 52, 56.9% of adalimumab-treated participants achieved MM-SES-CD < 22.5, compared to 10.2% in the placebo group. Modified Multiplier of the Simple Endoscopic Score for Crohn's Disease ≥ 20% reduction at Week 12 better predicted Week 52 ER than SES-CD ≥ 50% reduction (AUC: 0.73 vs 0.62, p = 0.002).</p><p><strong>Conclusion: </strong>MM-SES-CD definitions improved discrimination between treatment and placebo and offered superior predictive accuracy for Week 52 ER. Its use may enhance trial efficiency and better predict long-term disease outcomes.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}