Journal of Crohn's & colitis最新文献

Background: Intestinal ultrasound (IUS) in pediatric IBD is increasing, but evidence remains limited compared with adults. This study aimed to evaluate the relationship between IUS and clinical, biochemical, and endoscopic measures in pediatric Crohn's disease patients over 1 year, and to assess its ability to predict treatment response and remission.

Methods: Pediatric patients with suspected inflammatory bowel disease were prospectively enrolled and assessed over 1 year. Bowel wall thickness (BWT) and three validated IUS scores were calculated. Remission was combined clinical/biochemical/endoscopic remission. Treatment response was not needing therapy escalation and achieving remission by 1 year.

Results: Sixty-one patients, median age 12.3 years (IQR 10.3-14.7; range 6-17), were included. IUS correlated moderately to strongly with endoscopy (rho 0.43-0.70). Thicker terminal ileum BWT was associated with increased likelihood of ileocecal resection (n = 7, 12%) (OR = 5.85, 95% CI 1.29-26.47, P < .05). Patients' thickest bowel segment became significantly thinner at 1 month (P < .05). Thicker BWT at 6 months was associated with a decreased likelihood of 1-year remission (OR = 0.34; 95% CI 0.16-0.74, P = .006). BWT ≤ 2.8 mm at 6 months predicted treatment response with high sensitivity (73%) and specificity (84%). BWT ≤ 2.5 mm at 1 year predicted remission with high sensitivity (72%) and specificity (90%).

Conclusions: IUS correlated strongly with endoscopy in pediatric Crohn's disease over 1 year, with increased BWT being associated with a higher risk of ileocecal resection and not achieving remission. Thickened (inflamed) bowel became significantly thinner as soon as 1 month. BWT in pediatric patients in remission was significantly lower (≤2.5 mm) than in adults (≤3-4 mm).

Background & aims: Infliximab is an established rescue therapy for patients with steroid-refractory acute severe ulcerative colitis (ASUC), yet optimal dosing strategies minimizing colectomy risk remain unclear. We aimed to develop a model-informed risk stratification algorithm to identify patients at high risk of colectomy within 90 days of initiating infliximab to support personalized dosing.

Methods: We conducted a multicenter, retrospective population pharmacokinetics (popPK) and exposure-response study using data from patients with ASUC. A parametric time-to-event model was developed to characterize the 90-day colectomy risk. Patient characteristics and pharmacokinetic projections were evaluated as predictors. These modelling results informed the development of an algorithm for risk stratification and personalized infliximab rescue dosing.

Results: Seven medical centers contributed data from 72 patients with ASUC, yielding a total of 152 infliximab serum concentrations. Eleven patients underwent colectomy within 90 days. The strongest predictor of colectomy was the clearance-normalized exposure between weeks 2 and 4 (area under the concentration-time curve, AUCw2-4 to Bayesian-forecasted infliximab clearance, CL), with an area under the receiver operating characteristic curve of 0.79 (95% confidence interval [CI], 0.52-1.00). The AUCw2-4/CL ratio was calculated by individualizing the popPK model using the patient's body weight, baseline C-reactive protein, and infliximab concentrations. Patients with a log-transformed AUCw2-4/CL ratio < 5.79 were classified as high risk for colectomy (sensitivity 83%, specificity 85%). Overall classification accuracy was 85% (95% CI, 74-92).

Conclusions: We developed a model-based dose-exposure-response framework to predict colectomy risk in ASUC. We integrated the algorithm into an interactive tool to enable individualized infliximab rescue therapy.

Introduction: The IBD UK Benchmarking surveys, conducted in 2019 and 2023, collected repeated data regarding the quality of inflammatory bowel disease (IBD) care across the UK using both service self-assessments and patient-reported experience measures (PREMs). We aimed to assess variation between patient and provider perspectives.

Methods: All UK hospitals offering specialist IBD services were invited to complete online surveys. Patients were invited through social media, charities, and clinical services. This study compared changes over the 4 years and examined alignment between healthcare-reported and patient-reported assessments.

Results: From 26 760 patient responses and 154 service assessments, patient-perceived care quality (PPCQ) declined between 2019 and 2023 (P < .001). Male sex and older age were associated with higher PPCQ. Greater disease severity was associated with lower PPCQ (P < .001). More patients reported IBD symptoms to impact activities of daily living in 2023 (P < .001). Factors associated with higher PPCQ included rapid diagnosis, being supported by an IBD team, and having knowledgeable IBD nurses. Access, information, communication, and empowerment were identified by patients as needing improvement (P < .001). Services with lowest quartile quality scores in 2019 demonstrated significant improvement over time, whilst those with highest 2019 scores demonstrated significant deterioration in PPCQ (P < .001). Services reported better performance than patients (P < .001).

Conclusions: These data underscore the importance of assessing lived experience and the care quality perception gap between patients and service providers. Regular benchmarking including PREMs should be used to drive and assess service-level, national and international quality improvement initiatives.

Background and aims: Perianal complications such as fistulas and abscesses are common in Crohn's disease (CD) and contribute to significant morbidity. Transperineal ultrasonography (TPUS) has emerged as a non-invasive and accurate method for perianal fistulizing CD (pfCD). This review evaluates the diagnostic accuracy of TPUS compared with magnetic resonance imaging (MRI), transrectal ultrasonography (TRUS), and examination under anesthesia (EUA) for detecting and classifying perianal fistulas and abscesses.

Methods: A comprehensive literature search was conducted across multiple databases through January 2025 to identify studies evaluating TPUS accuracy in detecting perianal fistulas and abscesses compared with MRI, TRUS, or EUA as the reference standard. Meta-analysis was performed to assess TPUS accuracy for fistula detection (FD), fistula classification (FC), internal opening (IO) detection, and abscess detection (AD). The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to evaluate risk of bias.

Results: Of 1059 studies identified, 29 were included in this review. Pooled sensitivities for FD (18 studies, 1474 patients), FC (11 studies, 585 patients), IO detection (six studies, 481 patients), and AD (16 studies, 1276 patients) were 97.5%, 80.3%, 89.6%, and 93.5% respectively while pooled specificities for FD, IO detection, and AD were 69.0%, 66.3%, and 94.5% respectively. The overall TPUS accuracy for FD, FC, IO detection, and AD was 88.0%, 88.6%, 77.8%, and 91.8% respectively. Subgroup analysis on CD patients showed an accuracy of 86.4%, 87.6%, and 83.3% for FD, FC, and AD respectively.

Conclusions: TPUS demonstrates high accuracy in detecting perianal fistulas and abscesses, supporting its use as a non-invasive, first-line diagnostic tool.

Background and aims: Medical treatment of inflammatory bowel disease (IBD) is complex and highly dynamic. This study conducts an extensive population-wide analysis of real-world treatment patterns in ulcerative colitis (UC) and Crohn's disease (CD) to provide population-based estimates to patients, clinicians, and healthcare systems.

Methods: Using Danish nationwide registers, we followed individuals diagnosed with IBD during 2003-2023 in Denmark for up to 10 years. Focusing on 5-aminosalicylic acid (5-ASA), corticosteroids, methotrexate, thiopurines, and advanced therapies (biological and small molecule drugs), we examined cumulative use, use per year after diagnosis, and treatment combinations. Analyses were stratified on sex, age, and calendar year at diagnosis.

Results: In 36 179 individuals with IBD (25 870 UC; 10 309 CD), the 10-year cumulative use of immunomodulators and/or advanced therapies was 37.0% in UC and 74.9% in CD. Long-term treatment was dominated by advanced therapies in CD and 5-ASA in UC. The cumulative use of corticosteroids in UC and 5-ASA in CD declined in recent years, whereas the use of advanced therapies rose in both UC and CD. The use of advanced therapies decreased with increasing age at diagnosis. In the tenth year after diagnosis, approximately half of patients (UC: 43.8% and CD: 50.8%) did not receive any medication.

Conclusions: In this population-based real-world medication study, we observed that 5-ASA remains the mainstay of treatment for UC, whereas advanced therapies dominate long-term treatment for CD. Of note, half of patients did not receive any medical treatment in the tenth year after diagnosis.

Background & aims: Central reading of endoscopy and histopathology is the current standard for disease activity assessment in inflammatory bowel disease (IBD) clinical trials but is limited by interreader and intrareader variability, operational delays, and cost. Artificial intelligence (AI) and machine learning (ML) offer the potential to improve accuracy, efficiency, and reproducibility. The International Organization for the Study of IBD (IOIBD) developed consensus statements on AI/ML use for endoscopic and histologic endpoint assessment in IBD trials.

Methods: As part of the IOIBD endpoints cluster initiative, a narrative, evidence-informed review with literature searches of Medline and Embase (January 2018-February 2025) identified studies applying AI/ML to endoscopy or histology in IBD. Relevant evidence informed 36 survey statements formulated by a steering committee. Seventy-two IOIBD members were invited to vote online; consensus required ≥80% agreement (score: 7-10 on a 10-point scale).

Results: Forty-five members completed the survey. Consensus was reached for 28 statements related to endoscopy, pathology, and trial design. Experts agreed that AI-based central reading could improve diagnostic accuracy, expedite processes, reduce costs, and enhance reproducibility. Combining human and AI assessments was favored over AI replacement. The key limitations identified included insufficient validation, generalizability concerns, and dependence on human-annotated training datasets.

Conclusions: This IOIBD consensus supports the integration of AI/ML into central reading for IBD clinical trials to improve objectivity, efficiency, and consistency, while maintaining human oversight. Further research should address validation, regulatory frameworks, and multimodal integration to enable broader adoption in both trials and clinical practice.

Background and aims: Symptoms of anxiety and depression are common in inflammatory bowel disease (IBD); the aim of this study was to assess the proportion of anxiety and depression in patients newly diagnosed with IBD, compare the rates with the Norwegian general population (NGP), and examine associations with selected sociodemographic, psychological, and disease-related factors.

Methods: This prospective cohort study included newly diagnosed patients with IBD, and data from the HUNT4 survey of the NGP. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Crude statistical comparisons were performed using t-tests, Mann-Whitney U test, chi-square tests, or Fisher's exact tests. Adjusted associations were modeled using multiple robust linear regression and multiple logistic regression.

Results: In total, 938/1562 (62.1%) patients with IBD completed the Hospital Anxiety and Depression Scale (Crohn's disease [CD]: n = 297, ulcerative colitis [UC]: n = 641). The proportion of anxiety was 37.4% in CD and 32.1% in UC, while depression was reported by 21.9% and 16.8%, respectively. Both rates were significantly higher than those observed in the NGP (17.5% for anxiety and 9.4% for depression). Compared with the NGP, males with CD had significantly higher levels of anxiety and depression, males with UC had elevated anxiety only, while females with CD and UC showed increased anxiety and depression. Both substantial fatigue and general self-efficacy were significantly associated with anxiety and depression in IBD.

Conclusions: Newly diagnosed patients with IBD experienced significant psychological challenges compared with the NGP. Early identification of anxiety and depression may enable targeted interventions.