Inflammatory Bowel Diseases最新文献

Background: In real-world clinical settings, direct comparative evidence on the effectiveness of infliximab vs vedolizumab for biologic-naïve patients with moderate-to-severe ulcerative colitis remains limited.

Methods: This prospective, multicenter, real-world study enrolled patients with moderate-to-severe ulcerative colitis who were biologic-naïve and began using infliximab or vedolizumab from January 2023 to November 2024. To reduce confounding, inverse probability of treatment weighting was applied. The primary outcome was a composite of 14-week clinical remission and 52-week endoscopic remission. The secondary endpoints encompassed clinical response/remission, endoscopic response/remission, and clinical steroid-free remission at weeks 14 and 30; clinical remission, endoscopic remission, and clinical steroid-free remission at week 52; and the therapeutic continuation rate and adverse events rate across the complete observation period.

Results: In total, 251 eligible patients were enrolled. After inverse probability of treatment weighting, vedolizumab was significantly superior to infliximab for the composite endpoint (60.18% vs 39.52%; P = .003). Significantly greater proportions of patients in the vedolizumab group attained clinical remission (84.80% vs 66.49%; P = .003), steroid‑free clinical remission (75.87% vs 59.57%; P = .015), endoscopic response (70.43% vs 52.44%; P = .008), and endoscopic remission (70.43% vs 52.44%; P = .008) at week 14 relative to the infliximab group. Effectiveness endpoints were comparable between groups at week 30. At week 52, vedolizumab remained significantly superior in clinical remission (78.39% vs 57.38%; P = .003), clinical steroid-free remission (75.96% vs 53.39%; P = .002), and endoscopic remission (66.03% vs 51.12%; P = .042). The rate of adverse events did not differ significantly between the vedolizumab and infliximab groups (5.47% vs 7.57%; P = .56).

Conclusions: Among patients with moderate-to-severe ulcerative colitis who have not been treated with biologics before, vedolizumab-first therapy showed superior short- and long-term effectiveness vs infliximab-first therapy, with comparable safety profiles. Vedolizumab could serve as the initial biologic agent for moderate‑to‑severe ulcerative colitis.NCT06962020; Selection and Efficacy-Inducing Factors of First-Line Biologic Agents in Moderate-to-Severe Ulcerative Colitis; https://clinicaltrials.gov/study/NCT06962020.

Background: Early pathological observations consistently highlighted the involvement of the intestinal lymphatic system in Crohn's disease (CD), although this remains underappreciated in current conceptual models of disease pathogenesis. This narrative review synthesizes evidence supporting lymphatic dysfunction as a key contributor of CD pathogenesis, and discusses its therapeutic potential.

Methods: We searched PubMed to identify relevant studies on lymphatic biology in CD, including pathological, clinical, and experimental data.

Results: Lymphatic obstruction, lymphangitis, and lymphangiectasia are early, widespread features of CD; structural remodeling coexists with compensatory lymphangiogenesis, suggesting a bidirectional relationship in which lymphatic dysfunction both drives and is sustained by intestinal inflammation. Peyer's patches, closely integrated with the lymphatic network, may represent a portal of entry for luminal pathogens. CD susceptibility genes impair microbial handling at this interface, potentially enabling translocation into the lymphatics, endothelial injury, and the granulomatous lymphangitis hallmark of CD. Experimental models reinforce this framework: pathogens such as Yersinia or norovirus can induce lymphangitis preceding overt intestinal inflammation. Metastatic cutaneous CD, a rare extraintestinal manifestation involving lymphatic vessels characterized by granulomatous dermal inflammation at sites anatomically discontinuous from the gut, may provide a unique window into lymphatic pathology independent of the intestinal microbiome.

Conclusions: These observations support an alternative view of CD in which intestinal lymphatic dysfunction plays an under-recognized role in both promoting and sustaining inflammation. This framework may explain disease features (patchy distribution, transmural inflammation, mesenteric hypertrophy) and positions the lymphatic system as a therapeutic target to restore drainage and modulate immune-lymphatic crosstalk.

Background: Adipose tissue measures are poorly defined in pediatric Crohn's disease (CD). Visceral adipose tissue (VAT) plays a role in regulating innate immunity and obesity-related diseases, contributing to poorer long-term health outcomes.

Methods: Abdominal tissue volumes and liver fat were quantified using magnetic resonance imaging and magnetic resonance spectrometry in children with CD. Dietary, adipokine, and metabolic profiles were analyzed in subjects with CD. Multivariable linear regression analysis was performed to evaluate the factors associated with tissue volumes.

Results: We recruited 25 children with CD and 8 healthy controls. Children with CD exhibited significantly higher VAT and subcutaneous adipose tissue (SCAT) volumes than their healthy counterparts, with increases of 0.33 L (95% CI, 0.12-0.52, P < .01) and 1.83 L (95% CI, 1.34-2.45, P < .01), respectively. Muscle measures were lower in children with CD, while liver fat measurements and BMI-z scores remained within healthy reference ranges. Disease duration, male sex, and C-reactive protein (CRP) levels were significant predictors of VAT in children with CD. SCAT was associated with plasma leptin levels, and VAT correlated with plasma triglyceride levels. Children with CD had diets low in calories and high in non-milk extrinsic sugars.

Conclusion: This study describes a specific adiposity pattern in children with Crohn's disease; 'Thin on Outside Fat on the Inside Crohn's associated Obesity' (TOFICO). This is characterized by increased visceral and subcutaneous adipose tissue in the context of normal liver fat and BMI. We have shown that visceral obesity is a robust marker of bowel inflammation in Crohn's disease and is not affected by anthropometric factors, unlike BMI.

Background and aims: The British Society of Gastroenterology recommend use of structured transition programs to improve control of chronic gastrointestinal disease in adolescents. We sought to determine the impact of attending a structured transition program on engagement of patients with inflammatory bowel disease (IBD) services and disease outcomes.

Methods: We performed a retrospective multicenter study of patients with IBD prior to and post-transfer to adult services. Patients were grouped into those who attended a structured transition program and those who received standard care, transferred with a referral letter.

Results: A total of 282 patients were included: 155 patients in our structured transition program cohort and 127 patients in the standard care cohort. Patients who took part in a structured transition program had significantly better engagement with adult IBD services with significantly lower rates of nonattendance at outpatient clinics 1-year post-transfer (12.3% vs 27.2%, P = .002) and significantly lower rates of disengagement with services (4.2% vs 13.1%, P = .015). There were no significant differences seen in rates of biologic failure, need for steroid/surgery or median fecal calprotectin levels between either group. Attending a structured transition program was the only factor that positively impacted engagement with IBD services in a multivariate analysis (OR 4.08, confidence interval 1.41-11.91, P = .01).

Conclusion: Structured transition programs in IBD can improve engagement of patients with IBD services with significantly lower rates of disengagement with IBD services seen in our study. Large prospective studies are needed in this field to further investigate this and the impact of these programs on disease outcomes.

Background: Transmural healing (TMH) indicates resolution of inflammation in all bowel wall layers and is an emerging therapeutic target in Crohn's disease (CD). Standardized sonographic criteria for TMH and early improvement, termed Transmural Response (TMR), have not been established. This systematic review synthesizes published definitions to provide an up-to-date overview of the current evidence base for intestinal ultrasound (IUS)-based assessment in CD.

Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Comprehensive searches of databases identified full-text articles that pre-specified TMH, TMR or normal/abnormal bowel on trans-abdominal IUS in pediatric or adult participants with CD. Definitions were summarized descriptively.

Results: Eighty-three full-text studies (8033 patients) met eligibility criteria; 39 (47%) defined TMH and 22 (27%) defined TMR. TMH definitions most often included bowel-wall thickness (BWT) ≤ 3mm (31/39, 79%), absent or minimal Doppler flow (25/39, 64%), and preserved bowel wall stratification (10/39, 26%). All TMR definitions required BWT reduction, but thresholds varied (absolute ≥ 1 mm or relative ≥ 25% in 16/22, 73%). Nine studies (9/22, 41%) also required Doppler flow improvement and 4/22 (18%) included additional criteria. Pediatric-specific criteria were reported in 2 TMH and one TMR studies, extrapolating from adult BWT values. Heterogeneity precluded quantitative pooling.

Conclusions: Standardized IUS definitions of TMH and TMR in CD are lacking. Consistent, validated criteria are essential to enable reproducible ultrasound endpoints, support treat-to-target strategies, and facilitate incorporation of IUS into CD clinical trials and routine care.