Inflammatory Bowel Diseases最新文献

The rapidly evolving field of Inflammatory Bowel Disease (IBD) places growing educational demands on gastroenterology trainees, many of whom report gaps in confidence and preparedness in managing IBD across diverse clinical settings. This article provides a practical, inclusive framework to support gastroenterology fellows in achieving core competency in IBD care while outlining scalable pathways for those interested in developing specialized expertise. Traditional resources such as major conferences, society guidelines, consensus statements, and peer-reviewed journals form the foundation of evidence-based training. Equally vital, however, are opportunities to refine cross-disciplinary skills through close collaboration with radiology, pathology, and endoscopy teams. Visiting observerships at leading IBD centers can be pivotal for immersive, hands-on exposure to complex case management and multidisciplinary care models. The article highlights a growing array of digital and longitudinal learning platforms including webinars, educational websites, podcasts, and programs such as virtual grand rounds, IBD Live, IBD-EII, and IBD REACH that offer flexible, accessible, and globally connected learning experiences. Additionally, it underscores the importance of mentorship, leadership development, and institutional support from program directors in fostering individualized IBD training tracks. By integrating traditional educational foundations with innovative, accessible non-traditional resources and platforms, this guide positions IBD training within a framework of inclusivity, equity, and lifelong learning.

Background: Ileocecal resection (ICR) for stricturing (B2) or internal penetrating (B3) phenotypes of Crohn disease (CD) is associated with higher rate of recurrence. Whether patients are at an increased risk of reprogression to complicated behavior (B2/B3) after index surgery remains unknown.

Methods: This retrospective study included adult patients with CD who underwent ICR during 1990-2020. We extracted disease characteristics, preoperative and postoperative treatments. The primary outcome was reprogression to B2/B3 disease following ICR. Multivariable logistic regression was used to assess the association between preoperative phenotype and postoperative disease behavior, adjusting for confounders.

Results: Our study included 297 patients with CD who underwent ICR between 1990-2020. Over half (52%) were male, the mean age at surgery was 36 years, and the mean disease duration was 15 years. At resection, disease phenotypes were B1 (nonstricturing, nonpenetrating) in 20%, B2 in 54%, and B3 in 25%. Postoperatively, 56% of patients received advanced therapy. After a median follow-up period of 14 years, 73% of patients had B1, 23% developed B2, and 4% developed B3 disease. Disease reprogression to B2/B3 disease was independent of preoperative disease behavior (P = .90) with 68%, 74%, and 75% of patients whose disease was B1, B2, or B3 at surgery, respectively, having their disease reclassified as B1 at last follow-up. Only 3% of those who underwent surgery for B3 redeveloped B3 disease.

Conclusions: Recurrence of stricturing or penetrating complications following an initial ileocecal resection is independent of preoperative phenotype in CD under contemporary CD management.

Background: Rapidity of onset of efficacy following dose escalation of subcutaneous infliximab after loss of response remains unclear in Crohn's disease (CD) and ulcerative colitis (UC). This post hoc analysis of the LIBERTY-CD and LIBERTY-UC trials evaluated time to response recovery following dose escalation of subcutaneous infliximab after loss of response, and characterized patients who experienced early recovery.

Methods: This analysis included week 10 responders to intravenous infliximab induction who were randomized to receive subcutaneous infliximab 120 mg every other week (Q2W) and underwent dose escalation to 240 mg Q2W following loss of response. Time to response recovery was assessed, and outcomes pre-/post-dose escalation were analyzed by recovery timing (early [≤8 weeks], late [>8 weeks], non-recovery). Week 102 outcomes and factors associated with early recovery were evaluated.

Results: Response recovery was achieved in 85.1% (40/47) with CD and 82.3% (51/62) with UC, with early recovery in 66.0% (31/47) and 69.4% (43/62), respectively. Early recovery groups in CD and UC showed greater serum infliximab increases than late or non-recovery groups. At week 102, numerically higher rates of clinical response and clinical remission in CD, and endoscopic remission in UC, were observed in early versus late recovery group. Factors associated with early recovery differed between CD and UC: systemic inflammatory and pharmacokinetic parameters were linked to early recovery in CD, while mucosal and gut-specific factors predominated in UC.

Conclusion: Dose escalation of subcutaneous infliximab led to rapid response recovery in most patients with CD and UC. Early recovery was associated with favorable long-term outcomes.

Clinical trial registration numbers: NCT03945019 and NCT04205643.

Background: Crohn's disease (CD) patients exhibit changed body composition, with elevated visceral adipose tissue (VAT) and reduced skeletal muscle (SM). This study aimed to investigate the impact of VAT and SM on the efficacy of CD biologics and develop a predictive model for loss of response.

Methods: This was a multicenter retrospective cohort study. CD patients initially treated with infliximab and ustekinumab were enrolled between January 2018 and December 2023. The visceral fat index (VFI) and skeletal muscle index (SMI) were measured using computed tomography. Patients were divided into 3 groups based on tertiles of VFI (quartile 1 [Q1]: <0.575; Q2: 0.575-0.885; Q3: ≥0.885) and SMI (Q1: <36.4; Q2: 36.4-44.4; Q3: ≥44.4). The primary outcome was loss of response at 52 weeks and the secondary outcome was primary nonresponse after induction.

Results: A total of 248 patients were included. The lowest SMI group had higher rates of primary nonresponse (Q1 vs Q2 vs Q3: 15.7% vs 7.2% vs 3.7%; P = .021) and loss of response (Q1 vs Q2 vs Q3: 38.0% vs 17.1% vs 16.5%; P < .001). Higher VFI was linked with increased loss of response (Q1 vs Q2 vs Q3: 12.8% vs 17.1% vs 41.7%; P < .001) and lower mucosal healing rates (Q1 vs Q2 vs Q3: 63.9% vs 40.0% vs 26.9%; P < .001). Elevated VFI (male >0.887, female >0.679) and reduced SMI (male <40.2, female <31.0) were independent risk factors for 52-week loss of response. A predictive model combining body composition parameters and clinical data showed strong performance, with an externally validated area under the curve of area under the curve of 0.902 (95% confidence interval, 0.828-0.975).

Conclusions: Elevated VAT and reduced SM were associated with loss of response in CD biologics. The predictive model integrating body composition parameters demonstrated good performance.

Background: Patients undergoing ileal pouch-anal anastomosis (IPAA) for inflammatory bowel disease (IBD) commonly experience postoperative inflammatory complications, including pouchitis and cuffitis. While pelvic floor dysfunction has been associated with these complications, the predictive value of preoperative anorectal manometry (ARM) remains unclear. We evaluated the association between abnormal preoperative ARM and postoperative inflammatory outcomes in IPAA patients.

Methods: In this historical cohort study we assessed IPAA patients who underwent preoperative ARM with ileostomy closure during the period from January 2009 to December 2024. Patients were divided into 2 groups-normal vs abnormal pelvic floor function-based on ARM. Primary outcomes were a composite measure of endoscopic inflammatory pouch disease (EIPD) and endoscopic evidence of rectal cuffitis after the perioperative period. Secondary outcomes included individual components of the composite primary outcome. Multivariable logistic regression was used to assess associations while controlling for covariates.

Results: We included 179 patients in this study, 46 (25.7%) with abnormal ARM and 133 (74.3%) with normal ARM. In multivariable regression, abnormal ARM was associated with modestly increased odds of cuffitis (odds ratio [OR], 2.136; 95% CI, 1.050-4.345; P = .037) but was not associated with EIPD (OR, 1.490; 95% CI, 0.710-3.104; P = .287). Secondary outcomes were similar between groups, except for diffuse pouch inflammation, which was more frequently observed among patients with abnormal ARM (P = .024).

Conclusions: Abnormal preoperative ARM was associated with increased odds of postoperative cuffitis but not composite endoscopic pouch inflammation in IPAA patients. Given the modest effect size and limited precision, these findings warrant confirmation in larger, prospective studies.