Pub Date : 2025-09-01DOI: 10.1016/j.bpg.2025.102061
Emese Ivány , Bernadett Farkas , Péter Bacsur , Mariann Rutka , Noémi Gálfalvi , Klaudia Farkas (Associate Professor) , Zoltán Szepes (Professor) , Tamás Molnár (Professor)
Bowel urgency (BU) is a distressing symptom among patients with ulcerative colitis (UC), significantly impacting quality of life (QoL). Its pathophysiology is not completely understood. Despite its high prevalence, BU is not consistently assessed in clinical practice and has historically received limited attention as a research and treatment target. The aim of this narrative review was to highlight the clinical relevance of BU and to summarize current treatment approaches. Evidence suggests that mesalazine and budesonide foam may help reduce BU. Among advanced therapies, vedolizumab and Janus kinase inhibitors have demonstrated early improvements in urgency, anti-interleukin-23 antibodies have also shown promising effects. Additionally, the novel S1P receptor modulator etrasimod has been associated with symptomatic relief. Additional alternative therapies are also helpful. Despite these therapeutic options, the management of BU remains challenging. Further research and the development of targeted treatments are warranted to address this unmet clinical need.
{"title":"A narrative review on the frequency, pathophysiology and management of bowel urgency associated with ulcerative colitis","authors":"Emese Ivány , Bernadett Farkas , Péter Bacsur , Mariann Rutka , Noémi Gálfalvi , Klaudia Farkas (Associate Professor) , Zoltán Szepes (Professor) , Tamás Molnár (Professor)","doi":"10.1016/j.bpg.2025.102061","DOIUrl":"10.1016/j.bpg.2025.102061","url":null,"abstract":"<div><div>Bowel urgency (BU) is a distressing symptom among patients with ulcerative colitis (UC), significantly impacting quality of life (QoL). Its pathophysiology is not completely understood. Despite its high prevalence, BU is not consistently assessed in clinical practice and has historically received limited attention as a research and treatment target. The aim of this narrative review was to highlight the clinical relevance of BU and to summarize current treatment approaches. Evidence suggests that mesalazine and budesonide foam may help reduce BU. Among advanced therapies, vedolizumab and Janus kinase inhibitors have demonstrated early improvements in urgency, anti-interleukin-23 antibodies have also shown promising effects. Additionally, the novel S1P receptor modulator etrasimod has been associated with symptomatic relief. Additional alternative therapies are also helpful. Despite these therapeutic options, the management of BU remains challenging. Further research and the development of targeted treatments are warranted to address this unmet clinical need.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"78 ","pages":"Article 102061"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.bpg.2025.102050
Pierluigi Puca , Loris Riccardo Lopetuso , Lucrezia Laterza , Alfredo Papa , Silvio Danese , Alfredo Cesario , Andrea Damiani , Antonio Gasbarrini , Giovanni Arcuri , Franco Scaldaferri
Federated learning is an emerging paradigm in artificial intelligence that enables the training of robust models across decentralized datasets without requiring the physical transfer of sensitive data. This privacy-preserving approach has gained increasing traction in medical research, where data fragmentation and legal barriers often hinder the development of multicentric trials and AI applications.
In this review, we first provide an explanation of federated learning's process and functioning. We then provide a structured overview of its implementation in clinical research, highlighting key multicentric studies in several fields of medicine. These studies consistently demonstrate that FL achieves comparable, and in some cases superior, diagnostic and prognostic performance in comparison to centralized learning approaches, with area under the curve values often exceeding 0.80. We then consider the potential of federated learning in the context of inflammatory bowel diseases, where data heterogeneity, geographic dispersion, and patient privacy concerns currently limit the development of large-scale predictive models. In doing so, we will provide specific focus on its application in multicentric trials and basic research. Finally, aspects like semantic interoperability in federated learning and privacy issues will also be discussed.
We believe that federated learning could transform the way inflammatory bowel diseases datasets are utilized across institutions, facilitating collaborative algorithm development in areas such as treatment response prediction, endoscopic image analysis, and disease phenotyping—without compromising patient confidentiality.
{"title":"Federated learning in inflammatory bowel disease: The future of privacy-preserving Artificial Intelligence","authors":"Pierluigi Puca , Loris Riccardo Lopetuso , Lucrezia Laterza , Alfredo Papa , Silvio Danese , Alfredo Cesario , Andrea Damiani , Antonio Gasbarrini , Giovanni Arcuri , Franco Scaldaferri","doi":"10.1016/j.bpg.2025.102050","DOIUrl":"10.1016/j.bpg.2025.102050","url":null,"abstract":"<div><div>Federated learning is an emerging paradigm in artificial intelligence that enables the training of robust models across decentralized datasets without requiring the physical transfer of sensitive data. This privacy-preserving approach has gained increasing traction in medical research, where data fragmentation and legal barriers often hinder the development of multicentric trials and AI applications.</div><div>In this review, we first provide an explanation of federated learning's process and functioning. We then provide a structured overview of its implementation in clinical research, highlighting key multicentric studies in several fields of medicine. These studies consistently demonstrate that FL achieves comparable, and in some cases superior, diagnostic and prognostic performance in comparison to centralized learning approaches, with area under the curve values often exceeding 0.80. We then consider the potential of federated learning in the context of inflammatory bowel diseases, where data heterogeneity, geographic dispersion, and patient privacy concerns currently limit the development of large-scale predictive models. In doing so, we will provide specific focus on its application in multicentric trials and basic research. Finally, aspects like semantic interoperability in federated learning and privacy issues will also be discussed.</div><div>We believe that federated learning could transform the way inflammatory bowel diseases datasets are utilized across institutions, facilitating collaborative algorithm development in areas such as treatment response prediction, endoscopic image analysis, and disease phenotyping—without compromising patient confidentiality.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"78 ","pages":"Article 102050"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/S1521-6918(25)00096-4
{"title":"Copyright Information","authors":"","doi":"10.1016/S1521-6918(25)00096-4","DOIUrl":"10.1016/S1521-6918(25)00096-4","url":null,"abstract":"","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"78 ","pages":"Article 102069"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145659000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.bpg.2025.102056
Pierluigi Puca , Gaetano Coppola , Simone Parello , Ivan Capobianco , Stefania Colantuono , Franco Scaldaferri , Alfredo Papa
Inflammatory bowel diseases (IBD) are systemic inflammatory conditions increasingly recognized to confer excess risk of atherosclerotic cardiovascular disease (ASCVD), particularly in younger patients and during periods of active disease. We here synthesize evidence across epidemiology, mechanisms, risk stratification, and management at the IBD–ASCVD interface.
Across population cohorts and meta-analyses, IBD associates with modest but consistent increases in ischemic heart disease, cerebrovascular events, and peripheral arterial disease, with higher relative risks for mesenteric ischaemia and for premature events; risk escalates with inflammatory burden and flares, while traditional factors alone partially explain the association. Prolonged corticosteroid exposure correlates with adverse vascular outcomes, whereas effective control of intestinal inflammation, particularly with anti-TNF biologics, appears protective; the absolute cardiovascular risk with Janus kinase inhibitors seems largely determined by baseline risk profile and is low in appropriately selected patients.
Proposed drivers include dysbiosis and microbially derived metabolites (e.g., trimethylamine-N-oxide, imidazole propionate), intestinal barrier failure with low-grade endotoxemia and Toll-like receptor-4 activation, neutrophil- and platelet-mediated thromboinflammation, and inflammasome pathways that accelerate atherothrombosis.
For risk stratification, non-invasive vascular measures (arterial stiffness, carotid intima–media thickness, coronary artery calcium) and general calculators (SCORE2/ASCVD) are informative, though underestimation in younger patients is possible; expert guidance emphasizes mitigation of inflammatory activity, smoking cessation, prudent steroid use, and lipid monitoring with small-molecule therapy.
In conclusion, IBD confers clinically relevant ASCVD risk through immune–microbiome–barrier interactions superimposed on traditional factors. Routine cardiovascular assessment, aggressive control of intestinal inflammation, lifestyle optimization, and judicious therapy selection should be embedded in IBD care, while prospective studies refine prediction tools and test targeted preventive strategies across phenotypes and ages.
炎症性肠病（IBD）是一种系统性炎症性疾病，越来越多的人认为它会导致动脉粥样硬化性心血管疾病（ASCVD）的过度风险，尤其是在年轻患者和疾病活动期。我们在此综合了IBD-ASCVD界面的流行病学、机制、风险分层和管理方面的证据。在人群队列和荟萃分析中，IBD与缺血性心脏病、脑血管事件和外周动脉疾病的适度但持续增加相关，与肠系膜缺血和过早事件的相对风险较高相关；风险随着炎症负担和炎症发作而增加，而传统因素仅部分解释了这种关联。长期皮质类固醇暴露与不良血管结局相关，而有效控制肠道炎症，特别是使用抗tnf生物制剂，似乎具有保护作用；使用Janus激酶抑制剂的绝对心血管风险似乎主要取决于基线风险概况，并且在适当选择的患者中较低。提出的驱动因素包括生态失调和微生物衍生代谢物（例如，三甲胺- n -氧化物，丙酸咪唑），低级别内毒素血症和toll样受体-4激活的肠屏障衰竭，中性粒细胞和血小板介导的血栓炎症，以及加速动脉粥样硬化血栓形成的炎性小体途径。对于风险分层，非侵入性血管测量（动脉硬度，颈动脉内膜-中膜厚度，冠状动脉钙化）和一般计算器（SCORE2/ASCVD）提供了信息，尽管年轻患者可能被低估；专家指导强调减轻炎症活动，戒烟，谨慎使用类固醇，并用小分子治疗监测血脂。总之，IBD通过叠加传统因素的免疫-微生物-屏障相互作用赋予临床相关的ASCVD风险。常规心血管评估、积极控制肠道炎症、优化生活方式和明智的治疗选择应纳入IBD护理，而前瞻性研究应完善预测工具，并测试跨表型和年龄的针对性预防策略。
{"title":"Atherosclerotic cardiovascular disease and inflammatory bowel disease: epidemiology, pathogenesis and risk assessment","authors":"Pierluigi Puca , Gaetano Coppola , Simone Parello , Ivan Capobianco , Stefania Colantuono , Franco Scaldaferri , Alfredo Papa","doi":"10.1016/j.bpg.2025.102056","DOIUrl":"10.1016/j.bpg.2025.102056","url":null,"abstract":"<div><div>Inflammatory bowel diseases (IBD) are systemic inflammatory conditions increasingly recognized to confer excess risk of atherosclerotic cardiovascular disease (ASCVD), particularly in younger patients and during periods of active disease. We here synthesize evidence across epidemiology, mechanisms, risk stratification, and management at the IBD–ASCVD interface.</div><div>Across population cohorts and meta-analyses, IBD associates with modest but consistent increases in ischemic heart disease, cerebrovascular events, and peripheral arterial disease, with higher relative risks for mesenteric ischaemia and for premature events; risk escalates with inflammatory burden and flares, while traditional factors alone partially explain the association. Prolonged corticosteroid exposure correlates with adverse vascular outcomes, whereas effective control of intestinal inflammation, particularly with anti-TNF biologics, appears protective; the absolute cardiovascular risk with Janus kinase inhibitors seems largely determined by baseline risk profile and is low in appropriately selected patients.</div><div>Proposed drivers include dysbiosis and microbially derived metabolites (e.g., trimethylamine-N-oxide, imidazole propionate), intestinal barrier failure with low-grade endotoxemia and Toll-like receptor-4 activation, neutrophil- and platelet-mediated thromboinflammation, and inflammasome pathways that accelerate atherothrombosis.</div><div>For risk stratification, non-invasive vascular measures (arterial stiffness, carotid intima–media thickness, coronary artery calcium) and general calculators (SCORE2/ASCVD) are informative, though underestimation in younger patients is possible; expert guidance emphasizes mitigation of inflammatory activity, smoking cessation, prudent steroid use, and lipid monitoring with small-molecule therapy.</div><div>In conclusion, IBD confers clinically relevant ASCVD risk through immune–microbiome–barrier interactions superimposed on traditional factors. Routine cardiovascular assessment, aggressive control of intestinal inflammation, lifestyle optimization, and judicious therapy selection should be embedded in IBD care, while prospective studies refine prediction tools and test targeted preventive strategies across phenotypes and ages.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"78 ","pages":"Article 102056"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.bpg.2025.102064
Vytautas Kiudelis , Juozas Kupcinskas , Alexander Link
Despite substantial progress in understanding the complex pathophysiology of inflammatory bowel diseases (IBD), specific and accurate non-invasive biomarkers for diagnosis and disease monitoring remain an unmet clinical need. Endoscopy and histology are still considered the diagnostic gold standard, while fecal calprotectin has been increasingly adopted in practice but with recognized limitations. Blood-derived biomarkers, in contrast, remain largely nonspecific and of limited utility. Since the discovery of small non-coding RNAs known as microRNAs, these molecules have emerged as promising candidates for non-invasive diagnosis across a range of diseases, including IBD. Over the past decade, a growing body of research has investigated their potential in blood and fecal samples; however, systematic evaluation and integration of this evidence are still lacking. In this review, we provide a comprehensive synthesis of current studies on circulating and fecal miRNAs as non-invasive biomarkers for IBD, highlighting methodological heterogeneity and outlining key directions for future research toward clinically applicable next-generation biomarkers.
{"title":"Circulating and faecal microRNAs as non-invasive biomarkers for IBD: current evidence and next steps","authors":"Vytautas Kiudelis , Juozas Kupcinskas , Alexander Link","doi":"10.1016/j.bpg.2025.102064","DOIUrl":"10.1016/j.bpg.2025.102064","url":null,"abstract":"<div><div>Despite substantial progress in understanding the complex pathophysiology of inflammatory bowel diseases (IBD), specific and accurate non-invasive biomarkers for diagnosis and disease monitoring remain an unmet clinical need. Endoscopy and histology are still considered the diagnostic gold standard, while fecal calprotectin has been increasingly adopted in practice but with recognized limitations. Blood-derived biomarkers, in contrast, remain largely nonspecific and of limited utility. Since the discovery of small non-coding RNAs known as microRNAs, these molecules have emerged as promising candidates for non-invasive diagnosis across a range of diseases, including IBD. Over the past decade, a growing body of research has investigated their potential in blood and fecal samples; however, systematic evaluation and integration of this evidence are still lacking. In this review, we provide a comprehensive synthesis of current studies on circulating and fecal miRNAs as non-invasive biomarkers for IBD, highlighting methodological heterogeneity and outlining key directions for future research toward clinically applicable next-generation biomarkers.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"78 ","pages":"Article 102064"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145659003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.bpg.2025.102055
Joana Roseira , Maria Manuela Estevinho , Beatriz Gros , Irene Marafini , Virginia Solitano , Paula Sousa , Cristina Carretero , Winnie Zou , Nasim Parsa , Aline Charabaty , Lumir Kunovsky
Endoscopy remains an essential modality for the diagnosis, risk stratification, monitoring, and therapy of inflammatory bowel disease (IBD). Recent advances, including high-definition imaging, dye-based and virtual chromoendoscopy, and AI-assisted interpretation, improve dysplasia detection and grading of inflammatory activity, enabling treat-to-target care. In Crohn's disease, small-bowel and pan-enteric capsule endoscopy expand noninvasive assessment, while device-assisted enteroscopy allows targeted biopsy and therapy when tissue or intervention is required. Standardized scoring systems (MES/UCEIS, SES-CD, Rutgeerts) support objective follow-up, including early postoperative evaluation. Therapeutically, endoscopic balloon dilation for short strictures and advanced resection techniques (EMR/ESD) for visible dysplasia in experienced centers provide organ-sparing options; endoscopic fistula closure remains investigational. This review synthesizes contemporary trials and ECCO, ESGE, and ASGE guidance into practical algorithms that promote precise surveillance and timely intervention, positioning endoscopy as a functional, predictive, and increasingly personalized tool in IBD care.
{"title":"Advances in endoscopy in IBD diagnostics and management","authors":"Joana Roseira , Maria Manuela Estevinho , Beatriz Gros , Irene Marafini , Virginia Solitano , Paula Sousa , Cristina Carretero , Winnie Zou , Nasim Parsa , Aline Charabaty , Lumir Kunovsky","doi":"10.1016/j.bpg.2025.102055","DOIUrl":"10.1016/j.bpg.2025.102055","url":null,"abstract":"<div><div>Endoscopy remains an essential modality for the diagnosis, risk stratification, monitoring, and therapy of inflammatory bowel disease (IBD). Recent advances, including high-definition imaging, dye-based and virtual chromoendoscopy, and AI-assisted interpretation, improve dysplasia detection and grading of inflammatory activity, enabling treat-to-target care. In Crohn's disease, small-bowel and pan-enteric capsule endoscopy expand noninvasive assessment, while device-assisted enteroscopy allows targeted biopsy and therapy when tissue or intervention is required. Standardized scoring systems (MES/UCEIS, SES-CD, Rutgeerts) support objective follow-up, including early postoperative evaluation. Therapeutically, endoscopic balloon dilation for short strictures and advanced resection techniques (EMR/ESD) for visible dysplasia in experienced centers provide organ-sparing options; endoscopic fistula closure remains investigational. This review synthesizes contemporary trials and ECCO, ESGE, and ASGE guidance into practical algorithms that promote precise surveillance and timely intervention, positioning endoscopy as a functional, predictive, and increasingly personalized tool in IBD care.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"78 ","pages":"Article 102055"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145659004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.bpg.2025.102063
Juozas Kupcinskas (Prof), Loris Lopetuso (Prof)
{"title":"Shaping the future of IBD care: Insights from emerging science and innovation","authors":"Juozas Kupcinskas (Prof), Loris Lopetuso (Prof)","doi":"10.1016/j.bpg.2025.102063","DOIUrl":"10.1016/j.bpg.2025.102063","url":null,"abstract":"","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"78 ","pages":"Article 102063"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145659002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.bpg.2025.102030
Clelia Cicerone , Paulo Gustavo Kotze
Perianal fistulas are a common complication of Crohn's disease (CD), affecting approximately 40 % of patients. Fistulas develop because of sustained transmural inflammation of the bowel wall. Despite advances in treatment, one-third of patients with CD continue to experience recurrent fistulas, and perianal CD remains a challenging condition. This review aims to explore emerging therapeutic strategies for perianal fistulizing CD, focusing on novel biologics, advances in surgical strategies, and combination therapies.
{"title":"New weapons for the management of perianal Crohn's disease","authors":"Clelia Cicerone , Paulo Gustavo Kotze","doi":"10.1016/j.bpg.2025.102030","DOIUrl":"10.1016/j.bpg.2025.102030","url":null,"abstract":"<div><div>Perianal fistulas are a common complication of Crohn's disease (CD), affecting approximately 40 % of patients<strong>.</strong> Fistulas develop because of sustained transmural inflammation of the bowel wall. Despite advances in treatment, one-third of patients with CD continue to experience recurrent fistulas, and perianal CD remains a challenging condition. This review aims to explore emerging therapeutic strategies for perianal fistulizing CD, focusing on novel biologics, advances in surgical strategies, and combination therapies.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"77 ","pages":"Article 102030"},"PeriodicalIF":4.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.bpg.2025.101981
Virginia Solitano , Jurij Hanžel , Maria Manuela Estevinho , Rocio Sedano , Luca Massimino , Federica Ungaro , Vipul Jairath
The term Advanced Combination Treatment (ACT) involves the combination of at least two biologics or the use of a biologic with a small molecule drug, each with different mechanisms of action. This narrative review evaluates the current evidence supporting ACT in inflammatory bowel disease (IBD), focusing on preclinical studies, real-world evidence, and randomized controlled trials. A systematic review of randomized controlled trials has concluded that ACT significantly improves clinical outcomes, without significant safety concerns in patient with IBD. However, variability in trial designs and the lack of standardized outcome measures have led to initiatives aimed at mitigating these issues through a clear expert consensus. While the evidence for ACT in IBD is compelling, substantial challenges remain in standardizing treatment protocols and ensuring long-term safety. In the meantime, the use of ACT in clinical practice remains off-label and requires careful consideration of patient-specific factors. Future clinical trials should consider robust biomarkers for patient selection and leverage mechanistic insights to select combination components.
{"title":"Reaching the therapeutic ceiling in IBD: Can Advanced Combination Treatment (ACT) offer a solution?","authors":"Virginia Solitano , Jurij Hanžel , Maria Manuela Estevinho , Rocio Sedano , Luca Massimino , Federica Ungaro , Vipul Jairath","doi":"10.1016/j.bpg.2025.101981","DOIUrl":"10.1016/j.bpg.2025.101981","url":null,"abstract":"<div><div>The term Advanced Combination Treatment (ACT) involves the combination of at least two biologics or the use of a biologic with a small molecule drug, each with different mechanisms of action. This narrative review evaluates the current evidence supporting ACT in inflammatory bowel disease (IBD), focusing on preclinical studies, real-world evidence, and randomized controlled trials. A systematic review of randomized controlled trials has concluded that ACT significantly improves clinical outcomes, without significant safety concerns in patient with IBD. However, variability in trial designs and the lack of standardized outcome measures have led to initiatives aimed at mitigating these issues through a clear expert consensus. While the evidence for ACT in IBD is compelling, substantial challenges remain in standardizing treatment protocols and ensuring long-term safety. In the meantime, the use of ACT in clinical practice remains off-label and requires careful consideration of patient-specific factors. Future clinical trials should consider robust biomarkers for patient selection and leverage mechanistic insights to select combination components.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"77 ","pages":"Article 101981"},"PeriodicalIF":4.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/S1521-6918(25)00065-4
{"title":"Copyright Information","authors":"","doi":"10.1016/S1521-6918(25)00065-4","DOIUrl":"10.1016/S1521-6918(25)00065-4","url":null,"abstract":"","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"77 ","pages":"Article 102038"},"PeriodicalIF":4.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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