Journal of Crohn's & colitis最新文献

{"title":"Epidemiology of inflammatory bowel disease in the Middle East and North Africa: a multinational, tertiary care registry (MIRAGE) study.","authors":"Mohammad Shehab, Nahla Azzam, Ahmed Al-Hindawi, Fatema Alrashed, Badr Al-Bawardy, Sara Abid, Abdulelah A Bashandi, Reem M AlShihri, Mariam Mukhtar, Omar Saadah, Othman Alharbi, Ahmed Al-Darmaki, Shamsa Al Harthi, Khalid Al-Ejji, Ahmed Ayash, Abdullah Al Sahli, Nadia Khamees, Osama E Salem, Eman A Mohamed, Maha Maher, Gehad Daba, Ahmed Alwassief Helal, Mohamad Abdulhakim Alnassar, Ahmed Alfadhli, Mohammed Nabil Quraishi, Shane W Goodwin, Yuhong Yuan, Mahmoud Mosli, Vipul Jairath","doi":"10.1093/ecco-jcc/jjag145","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjag145","url":null,"abstract":"<p><strong>Background and aims: </strong>Inflammatory bowel disease (IBD) is increasing in the Middle East and North Africa (MENA), yet region-specific evidence on phenotype and treatment patterns remains limited. We aimed to characterize IBD epidemiology, clinical phenotypes, and therapy use across MENA centers.</p><p><strong>Methods: </strong>This was a multicenter cross-sectional study across 13 centers in seven MENA countries. Adults with ulcerative colitis (UC), Crohn's disease (CD), or IBD-unclassified (IBD-U) were included. Demographics, Montreal phenotype/behavior, smoking status, disease duration, perianal disease, and therapies were collected. Descriptive statistics and between-group comparisons were performed.</p><p><strong>Results: </strong>We analyzed 10 340 patients (52% UC, 45% CD, 3% IBD-U). Mean age was 39.79 ± 14.4 years in UC and 34.57 ± 12.9 years in CD (P < .0001). UC patients were slightly more often female (51.6%), while CD patients were male-predominant (59.0%). Current smoking was more common in CD than in UC (12.0% vs 5.6%). Mean disease duration was 9.73 ± 7.5 years, longest in Jordan (14.1 years) and shortest in Qatar (2.45 years; P < .001). Biologic exposure differed by subtype (P < .001), with the highest rate in CD (57.9%). In UC, extensive colitis (E3) was the most common phenotype. In CD, ileocolonic involvement (L3) predominated with mainly non-stricturing, non-penetrating behavior (B1). Perianal disease affected approximately 13% overall, with rates varying by country, highest in UAE and lowest in Egypt and Qatar.</p><p><strong>Conclusion: </strong>This multi-country hospital-based registry study helps define contemporary IBD patterns in MENA: slight UC predominance, high rates of extensive UC and ileocolonic B1 CD, and heterogeneous biologic use. Our data provide insights into regional IBD epidemiological trends and treatment adoption.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 9","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120761","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":"Single-cell insights into drug response and resistance in inflammatory bowel disease: cellular hallmarks and precision therapy.","authors":"Chunshan Yin, Ruohang He, Hanke Ma, Yu Fu","doi":"10.1093/ecco-jcc/jjag136","DOIUrl":"10.1093/ecco-jcc/jjag136","url":null,"abstract":"<p><strong>Background & aims: </strong>The treatment of inflammatory bowel disease faces a persistent efficacy ceiling, with approximately 30%-50% of patients failing to achieve or sustain remission with current biologics and small-molecule inhibitors. This challenge is partly attributable to profound mucosal heterogeneity. Single-cell and spatial multi-omics technologies have enabled this heterogeneity to be characterized at cellular and spatial resolution. We aimed to synthesize single-cell and spatial multi-omics evidence to clarify the cellular mechanisms underlying therapeutic response and resistance and their implications for precision therapy.</p><p><strong>Methods: </strong>We examined single-cell evidence across therapies targeting tumor necrosis factor, integrins, interleukin-12/23, and Janus kinases and organized the findings around three interacting cellular hallmarks: immune dysregulation, stromal remodeling, and epithelial reprogramming.</p><p><strong>Results: </strong>Single-cell and spatial multi-omics studies indicate that therapeutic efficacy may depend on the capacity to remodel multicellular communication networks rather than simply neutralizing individual molecular targets. Treatment resistance is associated with bypass pathway activation, drug-induced paradoxical reprogramming and pathogenic subset enrichment, and alternative homing routes. Predictive models link multicellular modules, dynamic gene expression signatures, and multi-omics integration frameworks to treatment outcomes and may facilitate the development of clinically accessible patient-stratification tools.</p><p><strong>Conclusions: </strong>These findings support a cellular ecosystem framework for understanding therapeutic response and resistance in inflammatory bowel disease. Translating this framework into precision care will require functional validation of candidate mechanisms and prospective clinical evaluation of predictive tools for treatment selection.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 9","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148993336","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":"Distinct intestinal eosinophil subsets in ulcerative colitis and their modulation by advanced inflammatory bowel disease therapies.","authors":"Inge Jacobs, Matthias Ceulemans, Matthias Lenfant, Jonathan Cremer, Gert De Hertogh, Marc Ferrante, João Sabino, Séverine Vermeire, Christine Breynaert, Tim Vanuytsel, Bram Verstockt","doi":"10.1093/ecco-jcc/jjag141","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjag141","url":null,"abstract":"<p><strong>Background and aims: </strong>Despite the importance of eosinophils in histologic scoring systems of ulcerative colitis (UC), the impact of advanced therapies on eosinophils is poorly understood. Additionally, data regarding distinct eosinophil subsets in UC are scarce.</p><p><strong>Methods: </strong>Colonic immune cells from 20 patients were analyzed by flow cytometry, alongside matched stool samples measuring fecal calprotectin and eosinophil-derived neurotoxin. In a separate cohort of 29 UC patients starting advanced therapy, immune cells from blood and colon were profiled at baseline and post-induction. Treatment response was defined as a Mayo endoscopic subscore of 0-1. A retrospective cohort (n = 21) was used to validate our findings.</p><p><strong>Results: </strong>Inflamed colonic tissue was characterized by an increased abundance of total eosinophils (P = .007), with an enrichment of B-Eos (CD80- PD-L1-) and depletion of A-Eos (CD80+ PD-L1+ active eosinophils) (both P < .0001) compared with unaffected tissue (correlated with histological activity RHI, P = .003). Endoscopic response to advanced therapy was associated with a reduction in total eosinophils (P = .0008) and various other immune cells, whereas nonresponse showed significant immune remodeling. Exploratory analyses in patients treated with vedolizumab (n = 11) demonstrated reductions in colonic total eosinophils (P = .07) and B-Eos (P = .008), together with an increase in A-Eos (P = .0003), resulting in an increased A-Eos/B-Eos ratio irrespective of endoscopic outcome.</p><p><strong>Conclusion: </strong>We confirmed enrichment of total eosinophils in inflamed colonic tissue, characterized by an increase in B-Eos and a reduction in A-Eos, resulting in a decreased A-Eos/B-Eos ratio. Exploratory analyses suggest that vedolizumab is associated with reduced B-Eos, increased A-Eos, and restoration of the A-Eos/B-Eos ratio, raising the hypothesis that this therapy may differentially modulate mucosal eosinophil biology. These findings identify distinct eosinophil subsets as potential biomarkers and therapeutic targets in UC and provide a biological framework for future mechanistic studies.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 9","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149043043","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 JAK inhibitors on extraintestinal manifestations and concurrent immune-mediated inflammatory diseases in patients with inflammatory bowel disease.","authors":"Marie Truyens, Xenia Tolstoy, Giulio Calabrese, Anneline Cremer, Konrad Lewandowski, Konstantinos Argyriou, Ioannis Drygiannakis, Eathar Shakweh, Ploutarchos Pastras, Haluk Tarik Kani, María José García, Hannah Gordon, Davide Giuseppe Ribaldone, Konstantinos Karmiris, Carla Felice, Irene Moraleja Yudego, Andreas Blesl, Alessia Todeschini, Paola Balestrieri, Rafal Filip, Thibault Taelman, Nora Vladimirova, Georgios Michalopoulos, Mohamed Attauabi, Lieven Pouillon, Nurulamin Noor, Tommaso Innocenti, Sophie Vieujean, Tarkan Karakan, Manuel Barreiro-de Acosta, Giammarco Mocci, Maria Manuela Estevinho, Edoardo Vincenzo Savarino, Aranzazu Jauregui-Amezaga, Tom Holvoet, Christina Kapizioni, Gizem Dagci, Spyridon Vrakas, Charlotte R H Hedin, Olga Maria Nardone, Grażyna Rydzewska, Ioannis Koutroubakis, Ioannis Psaroudakis, Gabriele Dragoni, Jeroen Geldof, Gaëlle Varkas, Jo Lambert, Triana Lobatón","doi":"10.1093/ecco-jcc/jjag129","DOIUrl":"10.1093/ecco-jcc/jjag129","url":null,"abstract":"<p><strong>Background and aims: </strong>Extraintestinal manifestations (EIMs) and immune-mediated inflammatory diseases (IMIDs) are common in inflammatory bowel diseases (IBD) and contribute substantially to morbidity. The aim was to evaluate the real-world effectiveness of JAK inhibitors on EIMs/IMIDs.</p><p><strong>Methods: </strong>This multicenter retrospective study included adults with ulcerative colitis (UC) or Crohn's disease (CD) and one or more EIM/IMID initiating a JAK inhibitor (tofacitinib, upadacitinib, or filgotinib). Baseline was defined as treatment initiation; EIM/IMID and IBD activity were assessed at fixed timepoints using physician global assessment. Response rates are reported as observed, with patients discontinuing for worsening of the manifestation counted as non-responders. Logistic and Cox regression analyses identified factors associated with response and treatment discontinuation.</p><p><strong>Results: </strong>A total of 246 patients were included; 67% had two or more prior advanced therapies. Peripheral spondyloarthritis (SpA) (48%) and axial SpA (43%) were the most prevalent EIMs/IMIDs. Peripheral SpA response rates were 82% post-induction and 74% at month 12; axial SpA response rates were 71% and 59%, respectively. Psoriasis response was observed in 65% post-induction and in 50% at month 12, and hidradenitis suppurativa response in 91% and 78%, respectively. Steroid-free clinical IBD remission was 58% at month 12, and was independently associated with peripheral SpA response (adjusted odds ratio [aOR] 4.2, 95% CI 1.2-14.7). Treatment was discontinued in 31%; factors associated with discontinuation were filgotinib use (adjusted hazard ratio [aHR] 3.0, 95% CI 1.4-6.2) and co-existing axial and peripheral SpA (aHR 2.8, 95% CI 1.5-5.1).</p><p><strong>Conclusions: </strong>JAK inhibitors were associated with favorable physician-assessed outcomes for EIMs/IMIDs in treatment-experienced IBD patients. Co-existing axial and peripheral SpA was associated with treatment discontinuation, suggesting a more complex phenotype.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 9","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898391","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":"Effectiveness and safety of tacrolimus versus infliximab as rescue therapy for intravenous corticosteroid-refractory acute severe ulcerative colitis: a multicenter cohort study.","authors":"Takahito Katano, Shinji Okabayashi, Hajime Yamazaki, Mao Matsubayashi, Kanade Serizawa, Masatoshi Nakashima, Motoki Kaneko, Katsuyoshi Matsuoka, Ryota Ogihara, Hiroki Kiyohara, Keiichi Tominaga, Koji Kaku, Mayo Tanabe, Katsuyoshi Ando, Kousaku Kawashima, Manabu Shiraki, Ruriko Nishigaki, Masato Aizawa, Tomoyuki Hayashi, Nobuaki Nishimata, Misaki Nakamura, Masaki Takao, Yuichi Shimodate, Kenji Kinoshita, Tsunaki Sawada, Yuma Hotta, Toshihiro Inokuchi, Takashi Ibuka, Akira Matsui, Yoshiharu Yamaguchi, Keisuke Itoh, Ken Kurokawa, Atsuhiro Hirayama, Kazuki Kakimoto, Yu Sasaki, Tsutomu Mizoshita, Hiroshi Nakase, Yusuke Honzawa","doi":"10.1093/ecco-jcc/jjag143","DOIUrl":"10.1093/ecco-jcc/jjag143","url":null,"abstract":"<p><strong>Background & aims: </strong>Acute severe ulcerative colitis (ASUC) refractory to intravenous corticosteroids (IVCS) is a major clinical challenge with limited rescue therapy options. Although tacrolimus has been proposed as a potential rescue therapy, its effectiveness and safety compared with infliximab, widely used in this setting, remain unclear.</p><p><strong>Methods: </strong>A multicenter retrospective cohort study was conducted across 34 Japanese institutions, including hospitalized patients with IVCS-refractory ASUC who received infliximab or tacrolimus as rescue therapy between January 2014 and March 2023. The primary outcome was clinical remission at day 14, using two-item patient-reported outcome scoring. Secondary outcomes included clinical response at day 3 and 7, colectomy, and adverse events within 56 days. A modified Poisson regression model was used for analysis.</p><p><strong>Results: </strong>Among 300 patients (infliximab, n = 113; tacrolimus, n = 187), clinical remission at day 14 occurred in 41.6% and 33.7%, respectively, with no difference (adjusted risk ratio [RR] 0.87 [95% CI: 0.65, 1.17]). Clinical response at day 3 was lower with tacrolimus (infliximab 42.5% vs tacrolimus 24.1%; adjusted RR 0.58 [95% CI: 0.42, 0.80]) but did not differ at day 7 (infliximab 63.7% vs tacrolimus 51.9%; adjusted RR 0.83 [95% CI: 0.69, 1.01]). No difference in colectomy within 56 days was observed, although rates were higher in the tacrolimus (13.3% vs 20.3%; adjusted RR 1.58 [95% CI: 0.93, 2.67]). Adverse events were similar between groups (infliximab 8.8% vs tacrolimus 7.5%; adjusted RR 0.77 [95% CI: 0.37, 1.57]).</p><p><strong>Conclusions: </strong>Tacrolimus demonstrated comparable effectiveness and safety to infliximab as rescue therapy for IVCS-refractory ASUC, although early response was slower.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 9","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019284","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":"Clinical outcomes following switch from risankizumab to guselkumab in Crohn's disease.","authors":"Cong Dai, Yu-Hong Huang","doi":"10.1093/ecco-jcc/jjag119","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjag119","url":null,"abstract":"","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 8","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762378","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 monitoring of pan-enteric mucosal healing and biologic persistence in Crohn's disease-the MILESTONE-CD prospective cohort.","authors":"Offir Ukashi, Ahmad Albshesh, Bella Ungar, Danielle Varon, Hadar Levy, Adi Talan Asher, Moran Goren, Ola Haj, Asaf Zlotnik, Eyal Zimlichman, Rami Eliakim, Shomron Ben-Horin, Uri Kopylov","doi":"10.1093/ecco-jcc/jjag118","DOIUrl":"10.1093/ecco-jcc/jjag118","url":null,"abstract":"<p><strong>Background: </strong>Mucosal healing (MH) is associated with improved long-term outcomes in Crohn's disease (CD), but longitudinal pan-enteric data are limited.</p><p><strong>Methods: </strong>This prospective observational study enrolled adults with CD initiating first-line biologic who were assessed at weeks 0, 14, 26, 52, 78, and 104 using fecal calprotectin (FCP), intestinal ultrasound (IUS), and pan-enteric video capsule endoscopy (VCE). The primary outcome was biologic discontinuation for any reason within 104 weeks. Secondary outcomes included MH (Lewis score < 135 and Eliakim score = 0) and flare-driven biologic discontinuation. Analyses used generalized estimating equations (GEE), Kaplan-Meier, and Cox models.</p><p><strong>Results: </strong>Among 59 patients (median age-30 [23-43] years, male-52.5%, inflammatory phenotype-79.7%), 35 received anti-TNF, 21 vedolizumab, and 3 ustekinumab. Overall, 29 (49.2%) patients discontinued biologics after 39 (28-52) weeks, including 21 (35.6%) flare-driven discontinuations. With non-responder imputation, pan-enteric MH increased from 3.4% to 16.9%, 18.6%, and 32.2% at weeks 14, 52, and 104 (P < .001), consistent on observed-data GEE. Week-14 log-transformed FCP was most strongly associated with week-52 MH (area under the curve 0.804, 95% CI, 0.685-0.923, P = .002, optimal cutoff 172 mcg/g; lagged GEE odds ratio [OR] 0.59, 0.39-0.89, P = .012), whereas same-visit transmural remission (bowel wall thickness ≤ 3mm) showed the strongest association with MH (OR 4.97, 1.91-12.91, P = .001). Week-14 Lewis score ≥ 350 (Hazard ratio [HR] 3.18, 95% CI, 1.16-8.73, P = .025) and perianal disease (HR 3.93, 95% CI, 1.45-10.62, P = .007) were independently associated with flare-driven discontinuation.</p><p><strong>Conclusion: </strong>Pan-enteric MH accrues incrementally beyond year 1. Integrated FCP, IUS, and VCE assessments may optimize individualized biologic decisions in CD.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 8","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681578","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":"Automated AI-based Mayo Endoscopic Scoring for ulcerative colitis across adult and pediatric cohorts from diverse populations.","authors":"Kamal Hammouda, Rishi Dakarapu, Chathruckan Rajendra, Hyojeong Lee, Sahar Almahfouz Nasser, Sharmistha Rudra, Vasantha Kolachala, Caitlin Diefendorf, Irina Geiculescu, Sushma Maddipatla, Anant Madabhushi, Subra Kugathasan","doi":"10.1093/ecco-jcc/jjag122","DOIUrl":"10.1093/ecco-jcc/jjag122","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic assessment in ulcerative colitis (UC) is critical for clinical decision-making but limited by interobserver variability. AI-powered systems may improve consistency, but dataset heterogeneity has hindered clinical translation. We developed and evaluated a deep learning framework for standardized Mayo Endoscopic Score (MES) prediction across adult and pediatric populations from diverse regions.</p><p><strong>Patients and methods: </strong>Using three multi-institutional datasets, we trained and validated convolutional neural network models to predict MES. The primary dataset (LIMUC; 564 adults, 11 276 images, Turkey) supported model development, with external validation on TMC (308 adults, 7978 images, China) and the Emory Pediatric dataset (EPC; 80 children, 113 images, USA). Two models were developed: UC-Re for binary remission classification (MES 0-1 vs 2-3) and UC-MES for four-class grading (MES 0-3). Imaging artifacts were corrected using inpainting, and Fourier-Spatial Image Harmonization (FSIH) mitigated inter-institutional domain shifts. Performance was evaluated using area under the operating characteristic curve (AUC), F1-score, and quadratic weighted kappa (QWK).</p><p><strong>Results: </strong>UC-Re achieved AUCs of 0.98, 0.95, and 0.98 across LIMUC, TMC, and EPC, with F1-scores of 0.92, 0.87, and 0.93, respectively. UC-MES demonstrated strong ordinal consistency (QWK = 0.81-0.85), comparable to inter-expert agreement (QWK = 0.88). Most misclassifications occurred between adjacent MES categories, reflecting human-like patterns.</p><p><strong>Conclusions: </strong>This novel AI-based framework predicts MES across geographically diverse adult and pediatric UC datasets. Its strong performance, including comparability to expert gastroenterologists in EPC, supports its potential as a decision-support tool for standardized endoscopic monitoring. However, prospective multicenter validation is warranted prior to routine clinical implementation.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 8","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13484516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803734","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":"Efficacy, safety, and outcomes of endoscopic submucosal dissection for inflammatory bowel disease-associated colorectal neoplasia: a systematic review and meta-analysis comparing Asian and Western outcomes.","authors":"Miguel Martins, Maria Vitória Nunes, Guilherme Macedo, Mathieu Pioche, Jérémie Jacques, Sophie Geyl, Yuto Shimamura, Margarida Marques, Susana Lopes, Amadeu Cr Nunes, Isabel Faria-Ramos, Giulio Calabrese, Sandro Sferrazza, Alessandro Rimondi, Alberto Murino, Edward Despott, Roberto De Sire, Roberta Maselli, João Santos-Antunes, Bernardo Sousa-Pinto, Rui Morais","doi":"10.1093/ecco-jcc/jjag082","DOIUrl":"10.1093/ecco-jcc/jjag082","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic submucosal dissection (ESD) is increasingly being adopted worldwide for the treatment of colorectal neoplasia. However, its role in patients with inflammatory bowel disease (IBD) remains debatable, due to chronic inflammation-related fibrosis, potentially affecting outcomes. This study aimed to assess the efficacy and safety of ESD for colorectal neoplastic lesions in IBD patients, comparing Asian and Western settings.</p><p><strong>Methods: </strong>A systematic review was conducted by searching MEDLINE and Web of Science until January 2025, in accordance to MOOSE guidelines. We included primary studies reporting ESD performance in IBD patients. We performed random-effects meta-analysis for several outcomes, including en-bloc, R0, and curative resection rates, frequency of adverse events (post-procedural bleeding and perforation), local recurrence, and need for additional surgery after ESD. Certainty of evidence was assessed using GRADE.</p><p><strong>Results: </strong>We included 20 studies (565 patients and 732 lesions). The meta-analytical frequencies of en-bloc, R0, and curative resection rates were 95.7% (95% CI = 93.5-97.9%; I2 = 60.1%), 84.6% (95% CI = 79.4-90.1%; I2 = 68.9%), and 83.9% (95% CI = 76.3-92.4%; I2 = 75.9%), respectively. Postprocedural bleeding and perforation occurred in 7.0% (95% CI = 4.4-11.2%; I2 = 16.9%) and 7.9% (95% CI = 5.3-11.9%; I2 = 2.4%) of cases, respectively. Local recurrence frequency was 5.3% (95% CI = 3.5-7.9%; I2 = 0%). The meta-analytical need for additional surgery was 13.3% (95% CI = 9.5-18.1%; I2 = 42.5%). No differences were found between Asian and Western studies for any outcome. The certainty of evidence was considered \"low\" in four outcomes and \"very low\" in the remaining outcomes.</p><p><strong>Conclusion: </strong>ESD may be feasible and safe for treating IBD-associated colorectal neoplasias, but the available evidence is limited. Similar results were observed between Asian and Western studies.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 8","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148803802","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":"Characterization of remission levels in patients with ulcerative colitis treated with 5-aminosalicylates: results of the cross-sectional CARUC-ASA study by the Belgian IBD Research and Development Group.","authors":"Catherine Reenaers, Guy Lambrecht, Lieven Pouillon, Filip Baert, Anneline Cremer, Arnaud Colard, Christophe Claessens, Thomas Billiet, Jeroen Geldof, Astrid De Zutter, Jean-François Rahier, Michael Somers, Dries Reynders, Laura Vansteenkiste, Ingrid Arijs, Edouard Louis, Bram Verstockt","doi":"10.1093/ecco-jcc/jjag100","DOIUrl":"10.1093/ecco-jcc/jjag100","url":null,"abstract":"<p><strong>Background: </strong>5-Aminosalicylic acid (5-ASA) remains the first-line therapy for mild-to-moderate ulcerative colitis (UC). Modern treatment goals extend beyond symptom control to include steroid-free remission, endoscopic healing, and biomarker normalization. Real-world evidence on 5-ASA's ability to achieve these targets is limited. This study assessed remission levels and associated factors in Belgian UC patients in clinical remission on 5-ASA.</p><p><strong>Methods: </strong>This cross-sectional, multicenter, phase 4 study included UC patients in clinical remission (PRO-2 ≤ 1, no rectal bleeding) treated with 5-ASA for ≥6 months. Patients receiving corticosteroids, immunomodulators, or advanced therapies were excluded. Outcomes were complete clinical remission (PRO-2 = 0, no urgency), endoscopic remission (MES ≤ 1, UCEIS ≤ 1), complete endoscopic remission (MES = 0), histological remission (Geboes 0-1), biological remission (fecal calprotectin <150 µg/g), and deep remission (clinical, endoscopic, and histological). Adherence was assessed using MARS-5.</p><p><strong>Results: </strong>In total, 198 patients were enrolled (median age 50 years; 41% female). Treatment was oral 5-ASA only (n = 134, 68%), rectal only (n = 19, 9%), or combination (n = 45, 23%). Biological remission was observed in 78%, endoscopic remission in 87%, complete endoscopic remission in 70%, and histological remission in 80%. Deep remission occurred in 24%, limited by persistent urgency (63%). Adherence was high (median MARS-5: 24). Oral 5-ASA only was significantly associated with endoscopic remission (P < .001).</p><p><strong>Conclusion: </strong>In this real-world Belgian cohort, patients in clinical remission on 5-ASA achieved high rates of objective remission, while deep remission was low because of persistent urgency. These findings confirm 5-ASA's continued relevance in mild-to-moderate UC and highlight the importance of addressing residual symptoms despite mucosal healing.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":"20 8","pages":""},"PeriodicalIF":8.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703188","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}