Journal of Crohn's & colitis最新文献

{"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}

{"title":"Comparative risk of postoperative complications in ulcerative colitis patients following preoperative advanced therapies: a network meta-analysis with meta-regression.","authors":"Mohammad Al Hayek, Maria Manuela Estevinho, Maia Kayal, Osamah Al Hayek, Alessandro Armuzzi, Johan Burisch, Qasi Najah, Vipul Jairath, Steven D Wexner, Edward V Loftus, Laurent Peyrin-Biroulet, Silvio Danese, Muhammed Elhadi, Fernando Magro","doi":"10.1093/ecco-jcc/jjag111","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjag111","url":null,"abstract":"<p><strong>Background: </strong>The expanding use of biologic and small-molecule therapies for ulcerative colitis (UC) has raised concerns regarding perioperative safety. We conducted a network meta-analysis to compare short-term postoperative complications associated with preoperative exposure to these agents in patients undergoing colorectal surgery.</p><p><strong>Methods: </strong>We systematically searched PubMed, Web of Science, and the Cochrane Library through September 15, 2025, for cohort studies of adults with UC who were exposed to biologic or small-molecule therapy within 12 weeks prior to surgery. Interventions included biologic therapy, small-molecule therapy, and no biologic or small-molecule therapy (control). The primary outcome was overall postoperative complications at 30 and 90 days. Venous thromboembolism (VTE) was assessed as a key secondary outcome. Random-effects network meta-analysis was performed using risk ratios (RRs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Sixteen retrospective cohort studies involving 3235 patients were included. At 30 days, ustekinumab and tofacitinib were associated with lower overall postoperative complication rates than control (RR: 0.29; 95% CI: 0.09-0.96; and RR: 0.66; 95% CI: 0.46-0.96, respectively). Anti-tumor necrosis factor (TNF) therapy was associated with higher complication rates compared with vedolizumab, ustekinumab, and tofacitinib at 30 days (RR: 1.27; 95% CI: 1.00-1.63; RR: 3.67; 95% CI: 1.12-12.03; and RR: 1.61; 95% CI: 1.14-2.27, respectively). At 90 days, anti-TNF therapy was associated with higher complication rates than control (RR 1.20, 95% CI 1.03-1.40), although the 90-day analysis was based on limited data. VTE rates were similar across treatments at both time points.</p><p><strong>Conclusion: </strong>Preoperative ustekinumab and tofacitinib were associated with fewer 30-day postoperative complications than control or anti-TNF therapy, while vedolizumab was associated with fewer complications than anti-TNF therapy. At 90 days, anti-TNF therapy was associated with higher complication rates compared with control. These findings, particularly at 90 days based on limited data, should be interpreted with caution and require confirmation in well-designed prospective studies with rigorous adjustment for confounding factors.</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":"148698616","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":"Correction to: Rapid resolution of colon inflammation and microbiome remodeling with vancomycin therapy in a patient with primary sclerosing cholangitis.","authors":"","doi":"10.1093/ecco-jcc/jjag123","DOIUrl":"https://doi.org/10.1093/ecco-jcc/jjag123","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":"148709171","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":"Anti-TNF withdrawal or long-term treatment in ulcerative colitis (BIOSTOP): a multicentre open label, randomized controlled trial.","authors":"Ingrid Prytz Berset, Frode Lerang, Bjørn Moum, Jørgen Jahnsen, Tore Grimstad, Vendel Kristensen, Håvard Wiig, Tone Aabrekk, Eivind Ness-Jenssen, Sigrun Eskeland, Ellen Melsom, Hilde Von Volkmann, Gert Huppertz-Hauss, Roald Torp, Øystein Hovlid, Magne Buset, Gro Riise, Gunnar Horvei, Torgeir Finjord, Lars-Petter Jelsness-Jørgensen, Inge C Olsen, Frode L Jahnsen, Tor Å Myklebust, Katarina Mølsæter, Dag Arne Lihaug Hoff, Knut E A Lundin","doi":"10.1093/ecco-jcc/jjag110","DOIUrl":"10.1093/ecco-jcc/jjag110","url":null,"abstract":"<p><strong>Background and aims: </strong>Anti-tumour necrosis factor (anti-TNF) treatment is effective in ulcerative colitis (UC). Optimal treatment duration is uncertain. This trial studies outcome after anti-TNF withdrawal compared to maintenance treatment in UC.</p><p><strong>Methods: </strong>In this prospective, multicentre, randomized, controlled, open-label non-inferiority study, patients in deep clinical, biochemical and endoscopic remission were randomized 1:1 to anti-TNF withdrawal or maintenance treatment. Primary endpoint was endoscopically confirmed remission (Mayo Endoscopic Score 0 or 1) after two years, including UC flares treated with anti-TNF, or non-biologic agents. Secondary endpoints were clinical remission, UC flare rate and treatment response. We needed 170 participants to show non-inferiority with a 15% margin.</p><p><strong>Results: </strong>Between June 2017 and December 2021, 172 UC patients from 19 Norwegian hospitals were randomized; 86 in each group. The per-protocol population was 163 patients. Nine patients were excluded due to consent withdrawal or protocol violation. Eighty percent (66/82) of anti-TNF withdrawal and 96% (78/81) of maintenance patients were in endoscopic remission after 2 years. UC flares occurred in 52% (45/86) of withdrawal and 12% (10/86) of maintenance patients. Anti-TNF retreatment was successful in 74% (20/27).</p><p><strong>Conclusion: </strong>Two years after anti-TNF withdrawal in UC patients in deep remission, endoscopically confirmed remission rate was significantly lower compared to maintenance treatment. Non-inferiority could not be proven. UC flare rate after anti-TNF withdrawal was high, but most were successfully treated. The majority did not receive AZA. Importantly, 48% of anti-TNF withdrawal patients remained in steroid-free remission. No significant predictors for UC activity after anti-TNF withdrawal were identified.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (registration number NCT03011268), and EudraCT (registration number 2016-001409-18).</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":"148681596","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":"Modifiable lifestyle factors in early life and inflammatory bowel disease risk in two birth cohorts.","authors":"Annie Guo, Ida Sigvardsson, Henrik Imberg, Tereza Lerchova, Johnny Ludvigsson, Ketil Størdal, Karl Mårild","doi":"10.1093/ecco-jcc/jjag114","DOIUrl":"10.1093/ecco-jcc/jjag114","url":null,"abstract":"<p><strong>Background and aims: </strong>Early life may be a critical period for the development of inflammatory bowel disease (IBD) susceptibility. The aim was to examine the association between early-life adherence to a healthy lifestyle and later IBD risk.</p><p><strong>Methods: </strong>In two Scandinavian birth cohorts (1997-2009), we developed the a priori Modifiable Health-related Lifestyle Score (MHLS) and an empirically weighted Optimal Risk Score (ORS) by ages 1 and 3 years, incorporating data on smoking exposure, delivery mode, breastfeeding, diet quality, antibiotic use, physical activity, and body mass index. Linked national registers identified diagnoses of any IBD, Crohn's disease (CD), and ulcerative colitis (UC) through 2023-2024. Cox regression and random-effects models, adjusted for parental IBD and sociodemographic characteristics, were used to estimate pooled hazard ratios (aHRs) across MHLS and ORS tertiles.</p><p><strong>Results: </strong>By a mean age of 20 years at the end of follow-up, 732 of 117 487 participants were diagnosed with IBD. Children with high vs low MHLS by age 1 year had a reduced risk of later IBD (aHR = 0.77 [95% CI = 0.61-0.98]), particularly CD (aHR = 0.57 [0.38-0.86]). ORS analyses yielded estimates nearly identical to MHLS by age 1 year and showed that high vs low adherence to a healthy lifestyle by age 3 was associated with a reduced risk of IBD (aHR = 0.77 [95% CI = 0.63-0.95]) and CD (aHR = 0.68 [95% CI = 0.49-0.94]), but not of UC. Associations were similar for childhood-onset IBD.</p><p><strong>Conclusion: </strong>A healthy lifestyle in early childhood was associated with a reduced risk of IBD, particularly CD, suggesting that early lifestyle modifications may help prevent the disease.</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/PMC13503009/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148815312","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":"Management of pediatric Crohn's disease: an ECCO-ESPGHAN guideline update.","authors":"Dror S Shouval, Iva Hojsak, Erasmo Miele, Christiane Sokollik, Dan Turner, Kaija-Leena Kolho, Rotem Sigall-Boneh, Patrick F van Rheenen, Eytan Wine, Richard K Russell, Seamus Hussey, Neil Chanchlani, Amit Assa, Javier Martin de Carpi, Luca Scarallo, Anne M Griffiths, Anat Yerushalmy-Feler, Caterina Strisciuglio, Lissy de Ridder, Jiri Bronsky, Hannah Gordon, Michel Adamina, Johanna C Escher, Marco Gasparetto, Laura Gianolio, David C Wilson, Marina Aloi","doi":"10.1093/ecco-jcc/jjag084","DOIUrl":"10.1093/ecco-jcc/jjag084","url":null,"abstract":"<p><strong>Objective: </strong>To provide an updated, evidence-based European Crohn's and Colitis Organisation [ECCO]-European Society for Paediatric Gastroenterology, Hepatology and Nutrition [ESPGHAN] guideline for the management, monitoring, and long-term care of pediatric Crohn's disease [CD].</p><p><strong>Methods: </strong>A multidisciplinary panel of 27 experts followed ECCO Standard Operating Procedures for guideline development. A systematic review of studies published between January 2018 and October 2024, with targeted updates through June 2025, was conducted across MEDLINE, EMBASE, and Cochrane Central. Evidence was graded using the Oxford Centre for Evidence-Based Medicine levels. Draft statements underwent two Delphi voting rounds involving the guideline panel, ECCO National Representatives, and an international sounding board; statements achieving ≥80% agreement were accepted.</p><p><strong>Results: </strong>This guideline provides updated recommendations across major domains of pediatric CD care, including risk stratification, treatment targets, induction and maintenance strategies, nutritional therapies, therapeutic drug monitoring, and the roles of imaging and endoscopy. High-risk patients should start anti-TNF therapy as first-line treatment, with proactive and reactive therapeutic drug monitoring to enhance efficacy. For low-risk luminal disease, exclusive enteral nutrition or the Crohn's Disease Exclusion Diet with partial enteral nutrition are preferred induction options. Long-term management emphasizes achieving endoscopic remission, normal growth, improved quality of life, and reduction of bowel damage. This guideline also reviews emerging advanced therapies, including biologics and small molecules, which are increasingly used in practice but generally not yet approved for pediatric CD, to inform clinicians about their potential role.</p><p><strong>Conclusions: </strong>This updated ECCO-ESPGHAN guideline integrates new pediatric evidence with contemporary adult data and treat-to-target principles, providing practical recommendations to support personalized, multidisciplinary, and proactive management aimed at improving long-term outcomes in pediatric 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":"148803792","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}