Intestinal Research

Original Articles

IBD

Propensity score-matched real-world comparative treatment outcomes of Janus kinase inhibitors for ulcerative colitis in patients with and without prior exposure to anti-tumor necrosis factor α antibody: Maiko Ikenouchi, Hirokazu Fukui, Soichi Yagi, Akira Nogami, Koji Kaku, Toshiyuki Sato, Mikio Kawai, Koji Kamikozuru, Yoko Yokoyama, Tetsuya Takagawa, Toshihiko Tomita, Taku Kobayashi, Shinichiro Shinzaki; Intest Res 2025;23(4):464-474. Published online February 3, 2025; DOI: https://doi.org/10.5217/ir.2024.00148

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Background/Aims
Tofacitinib (TFB), filgotinib (FIL), and upadacitinib (UPA) are Janus kinase (JAK) inhibitors approved for moderate-to-severe ulcerative colitis (UC). The appropriate positioning of each JAK inhibitor in the treatment algorithm, however, is unclear. Furthermore, real-world efficacy of JAK inhibitors for patients with UC and prior anti-tumor necrosis factor α antibody (aTNF) treatment are not fully investigated. We compared the efficacy and safety of 3 JAK inhibitors in patients with UC, considering their prior aTNF exposure.
Methods
A retrospective study was conducted in patients with UC who started TFB, FIL, or UPA at 2 academic centers. This propensity score-matched cohort study assessed the effectiveness of the 3 JAK inhibitors for UC in patients with and without prior aTNF exposure, comparing steroid-free clinical remission and response rates after 8 weeks.
Results
Among 274 patients who met the inclusion criteria, 145 experienced aTNF exposure (TFB: 59.2%, 100/169; FIL: 34.5%, 20/58; UPA: 53.2%, 25/47). Based on propensity score-matching, UPA led to a higher steroid-free clinical remission rates than TFB (adjusted odds ratio [aOR], 5.57; 95% confidence interval [CI], 1.42–21.90) or FIL (aOR, 9.00; 95% CI, 1.42–57.10) in patients exposed to aTNF. Steroid-free clinical remission and clinical response rates did not differ significantly between each group in patients non-exposed to aTNF. The incidence of adverse events was slightly higher with UPA than TFB or FIL.
Conclusions
UPA may be more effective for UC than TFB or FIL, especially in patients with previous aTNF exposure, although consideration should be given to adverse events.

Citations

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Long-term clinical outcomes with filgotinib in ulcerative colitis: 12-month results from the FILGUITO study
Antonio M Caballero-Mateos, Claudio Trigo-Salado, Álvaro Suárez-Toribio, María del Mar Martín-Rodríguez, Francisco J Rodríguez-González, Teresa Valdés-Delgado, Héctor Pallarés-Manrique, Ana María Trapero-Martínez, Raúl Olmedo-Martín, Cristina Bailón-Gaona
World Journal of Gastroenterology.2026;[Epub] CrossRef
Optimal use and cycling strategies of Janus kinase inhibitors in ulcerative colitis: current evidence and clinical implications from the KASID Guidelines Task Force Team
Seung Min Hong, Dong Hyun Kim, June Hwa Bae, Seung Yong Shin, Eun Mi Song, Ji Eun Kim, Young Joo Yang, Jiyoung Yoon, Sang-Bum Kang, Eun Soo Kim, Seong-Eun Kim, Seong-Jung Kim, Jun Lee, Soo-Young Na, Soo Jung Park, Sang Hyoung Park, Miyoung Choi, Myung Ha
Intestinal Research.2026; 24(1): 27. CrossRef
The Evolving Landscape of Advanced Therapies in Inflammatory Bowel Disease: Current Evidence and Emerging Targets
Daniele Balducci, Marta Mosca, Sabrina Monaco, Susanna Faenza, Stefano Fabiani, Fabio Cortellini, Nicola Cesaro, Gianpiero Stefanelli, Salvatore Paba, Maddalena Pecchini, Michele Montori, Marco Valvano
Gastrointestinal Disorders.2026; 8(1): 13. CrossRef
Comparative effectiveness and safety of tofacitinib and filgotinib in patients with ulcerative colitis: A propensity score-weighted cohort study
Fabio Salvatore Macaluso, Walter Fries, Anna Viola, Clara De Francesco, Nunzio Belluardo, Emiliano Giangreco, Maria Cappello, Roberto Ajovalasit, Filippo Mocciaro, Barbara Scrivo, Antonino Carlo Privitera, Maria Emanuela Distefano, Alessandro Vitello, Con
Digestive and Liver Disease.2025; 57(11): 2109. CrossRef
Three Janus kinase inhibitors in ulcerative colitis: is upadacitinib taking the lead?
Yoon Suk Jung
Intestinal Research.2025; 23(4): 394. CrossRef
Optimizing Janus kinase inhibitor therapy for ulcerative colitis: a real-world perspective
Shintaro Akiyama
Intestinal Research.2025;[Epub] CrossRef
Janus Kinase Inhibitors for Inflammatory Bowel Disease: Concise Questions and Answers on Their Use in Clinical Practice
Javier P Gisbert, María Chaparro
Inflammatory Bowel Diseases.2025;[Epub] CrossRef
Upadacitinib versus Tofacitinib in the Management of Ulcerative Colitis: A Systematic Review and Meta-Analysis
Tareq Alsaleh, Abdul Mohammed, Aimen Farooq, Magda Elamin, Amr Akl, Karim Mohamed Yassin, Ahmed Elnaggar, Jennifer Seminerio
Inflammatory Intestinal Diseases.2025; 11(1): 29. CrossRef

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IBD

Early resolution of bowel urgency by budesonide foam enema results in improved quality of life in patients with ulcerative colitis: a multicenter prospective observational study: Taku Kobayashi, Kei Moriya, Toshimitsu Fujii, Shigeki Bamba, Shinichiro Shinzaki, Akihiro Yamada, Takashi Hisabe, Shintaro Sagami, Shuji Hibiya, Takahiro Amano, Noritaka Takatsu, Katsutoshi Inagaki, Ken-ichi Iwayama, Toshifumi Hibi; Intest Res 2025;23(2):157-169. Published online July 15, 2024; DOI: https://doi.org/10.5217/ir.2024.00005

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Background/Aims
Bowel urgency is an important symptom for quality of life determination in patients with ulcerative colitis (UC). Few clinical studies have focused on bowel urgency as an efficacy endpoint. Budesonide foam enema has shown efficacy for clinical and endoscopic improvement in mild-to-moderate UC. We evaluated the improvement of clinical symptoms (bowel urgency), safety, and treatment impact of twice-daily budesonide foam enema on the quality of life in patients with UC.
Methods
This open-label, multicenter, prospective observational study comprised a 4-week observation period assessing the effectiveness and safety of twice-daily budesonide foam enema. Mild-to-moderate UC patients who had bowel urgency were included. Patients collected data daily in an electronic patient-reported outcome system or logbooks. The primary endpoint was the rate of resolution of bowel urgency at the end of the 4-week observation period. The rate of bowel incontinence was also assessed.
Results
Sixty-one patients were enrolled. Of patients with a final evaluation, the rate of resolution of bowel urgency was 58.5% (31/53; 95% confidence interval, 44.1%–71.9%). Bowel urgency decreased over time, with a significant difference observed on day 7 versus day 0. Bowel incontinence showed a decreasing trend from day 5, with a significant difference confirmed on day 12 versus day 0. The clinical remission rate was 64.4% (38/59; 95% confidence interval, 50.9%–76.4%). One adverse event not related to budesonide rectal foam occurred.
Conclusions
The findings suggest that bowel urgency can be improved early with twice-daily budesonide foam enema. No new safety signals were observed.

Citations

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The choice of treatment approach for mild and moderate ulcerative colitis: A review
Oleg V. Golovenko, Irina D. Loranskaia, Alexey M. Osadchuk
Consilium Medicum.2025; 27(12): 744. CrossRef

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333 Download
2 Web of Science
1 Crossref

IBD

Seven days triple therapy for eradication of Helicobacter pylori does not alter the disease activity of patients with inflammatory bowel disease: Shinichiro Shinzaki, Toshimitsu Fujii, Shigeki Bamba, Maiko Ogawa, Taku Kobayashi, Masahide Oshita, Hiroki Tanaka, Keiji Ozeki, Sakuma Takahashi, Hiroki Kitamoto, Kazuhito Kani, Sohachi Nanjo, Takeshi Sugaya, Yuko Sakakibara, Toshihiro Inokuchi, Kazuki Kakimoto, Akihiro Yamada, Hisae Yasuhara, Yoko Yokoyama, Takuya Yoshino, Akira Matsui, Misaki Nakamura, Taku Tomizawa, Ryosuke Sakemi, Noriko Kamata, Toshifumi Hibi; Intest Res 2018;16(4):609-618. Published online October 10, 2018; DOI: https://doi.org/10.5217/ir.2018.00044

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Background/Aims
The influences of Helicobacter pylori eradication therapy on the disease course of inflammatory bowel disease (IBD) are still unclear. We therefore conducted a multicenter, retrospective cohort study to evaluate the safety of H. pylori eradication therapy for IBD patients.
Methods
IBD patients with H. pylori eradication from 2005 to 2015 (eradication group) and control patients (non-eradication group; 2 paired IBD patients without H. pylori eradication matched with each eradicated patient) were included. IBD exacerbation (increased/additional IBD drug or IBD-associated hospitalization/surgery) and disease improvement based on the physicians’ global assessment were investigated at baseline, and at 2 and 6 months after eradication or observation.
Results
A total of 429 IBD (378 ulcerative colitis, 51 Crohn’s disease) patients, comprising 144 patients in the eradication group and 285 patients in the non-eradication group, were enrolled at 25 institutions. IBD exacerbation was comparable between groups (eradication group: 8.3% at 2 months [odds ratio, 1.76; 95% confidence interval, 0.78–3.92; P=0.170], 11.8% at 6 months [odds ratio, 1.60; 95% confidence interval, 0.81–3.11; P=0.172]). Based on the physicians’ global assessment at 2 months, none of the patients in the eradication group improved, whereas 3.2% of the patients in the non-eradication group improved (P=0.019). Multivariate analysis revealed that active disease at baseline, but not H. pylori eradication, was an independent factor for IBD exacerbation during 2 months’ observation period. The overall eradication rate was 84.0%–comparable to previous reports in non-IBD patients.
Conclusions
H. pylori eradication therapy does not alter the short-term disease activity of IBD.

Citations

Citations to this article as recorded by

The Controversies in the Relationship Between Helicobacter pylori Infection and Inflammatory Bowel Disease: Narrative Review
Jonatan Vukovic, Ivana Jukic
Journal of Clinical Medicine.2025; 14(17): 6083. CrossRef
Helicobacter pylori and Inflammatory Bowel Disease: Unraveling the Complex Interactions and Clinical Implications
Elaheh Karimzadeh‐Soureshjani, Farab Pourhasan, Pouria Ahmadi Simab, Nabi Jomehzadeh, Ali Saeedi‐Boroujeni
JGH Open.2025;[Epub] CrossRef
Factors Associated With Decision to Treat or Not to Treat Helicobacter pylori Infection in Children: Data From the EuroPedHp Registry
Thu Giang Le Thi, Katharina Werkstetter, Kallirroi Kotilea, Patrick Bontems, José Cabral, Maria Luz Cilleruelo, Michal Kori, Josefa Barrio, Matjaž Homan, Nicolas Kalach, Rosa Lima, Marta Tavares, Pedro Urruzuno, Zrinjka Misak, Vaidotas Urbonas, Sibylle Ko
Helicobacter.2024;[Epub] CrossRef
Impact of Helicobacter pylori Eradication on Inflammatory Bowel Disease Onset and Disease Activity: To Eradicate or Not to Eradicate?
Antonietta Gerarda Gravina, Raffaele Pellegrino, Veronica Iascone, Giovanna Palladino, Alessandro Federico, Rocco Maurizio Zagari
Diseases.2024; 12(8): 179. CrossRef
Bibliometric analysis of the correlation between H. pylori and inflammatory bowel disease
Yantong Li, Limin Li, Wenmeng Yin, Juyi Wan, Xiaolin Zhong
JGH Open.2024;[Epub] CrossRef
Discussion on the common controversies of Helicobacter pylori infection
Hang Yang, Yi Mou, Bing Hu
Helicobacter.2023;[Epub] CrossRef
Helicobacter pylori and Inflammatory Bowel Disease: An Unresolved Enigma
Juris Pokrotnieks, Stanislav Sitkin
Inflammatory Bowel Diseases.2023; 29(3): e5. CrossRef
Helicobacter Pylori and Autoimmune Diseases: Involving Multiple Systems
Li Wang, Zheng-Min Cao, Li-Li Zhang, Xin-can Dai, Zhen-ju Liu, Yi-xian Zeng, Xin-Ye Li, Qing-Juan Wu, Wen-liang Lv
Frontiers in Immunology.2022;[Epub] CrossRef
Helicobacter pylori infection in patients with inflammatory bowel diseases: a single-centre, prospective, observational study in Egypt
Ekram W. Abd El-Wahab, Ebtessam I. Youssef, Ehab Hassouna
BMJ Open.2022; 12(5): e057214. CrossRef
Is the Presence of Helicobacter Pylori in the Colonic Mucosa, Provocative of Activity in Ulcerative Colitis?
Javad Ranjbar, Bita Geramizadeh, Kamran Bagheri Lankarani, Zahra Jowkar, Mitra Mirzai, Elham Moazamian
Clinical Pathology.2022;[Epub] CrossRef
Helicobacter pylori infection and inflammatory bowel diseases
Yu. P. Uspenskiy, N. V. Baryshnikova, A. N. Suvorov, A. V. Svarval
Russian Journal of Infection and Immunity.2021; 11(1): 68. CrossRef
Ulcerative colitis relapse after Helicobacter pylori eradication in a 12-year-old boy with duodenal ulcer
Yuji Fujita, Keiichi Tominaga, Takanao Tanaka, Takeshi Sugaya, Shigemi Yoshihara
BMC Gastroenterology.2021;[Epub] CrossRef
Effect of sequential eradication therapy on serum osteoprotegerin levels in patients with Helicobacter pylori infection and co-existing inflammatory bowel disease
Hussam Murad, Misbahuddin Rafeeq, Mahmoud Mosli, Mamdouh Gari, Mohammed Basheikh
Journal of International Medical Research.2021;[Epub] CrossRef
Extra-Gastric Manifestations of Helicobacter pylori Infection
Antonietta G. Gravina, Kateryna Priadko, Paola Ciamarra, Lucia Granata, Angela Facchiano, Agnese Miranda, Marcello Dallio, Alessandro Federico, Marco Romano
Journal of Clinical Medicine.2020; 9(12): 3887. CrossRef
Comparison of new and classical point mutations associated with clarithromycin resistance in Helicobacter pylori strains isolated from dyspeptic patients and their effects on phenotypic clarithromycin resistance
Bekir Kocazeybek, Merve Kutlu Sakli, Pelin Yuksel, Mehmet Demirci, Reyhan Caliskan, Tevhide Ziver Sarp, Suat Saribas, Suleyman Demiryas, Fatma Kalayci, Huseyin Cakan, Hayriye Kirkoyun Uysal, Nesrin Gareayaghi, Sevgi Ergin, Yusuf Ziya Erzin, Kadir Bal, İhs
Journal of Medical Microbiology .2019; 68(4): 566. CrossRef
Review:Helicobacter pyloriand extragastric diseases
Francesco Franceschi, Marcello Covino, Claire Roubaud Baudron
Helicobacter.2019;[Epub] CrossRef

10,721 View
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Narrow-band imaging with magnifying endoscopy for Peyer's patches is useful in predicting the recurrence of remissive patients with ulcerative colitis: Satoshi Hiyama, Hideki Iijima, Syoichiro Kawai, Akira Mukai, Eri Shiraishi, Shuko Iwatani, Toshio Yamaguchi, Manabu Araki, Yoshito Hayashi, Shinichiro Shinzaki, Tsunekazu Mizushima, Masahiko Tsujii, Tetsuo Takehara; Intest Res 2016;14(4):314-321. Published online October 17, 2016; DOI: https://doi.org/10.5217/ir.2016.14.4.314

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<b>Background/Aims</b><br/>

Peyer's patches (PPs) are aggregates of lymphoid follicles that are mainly located in the distal ileum; they play a major role in mucosal immunity. We recently reported that patients with ulcerative colitis (UC) have alterations in PPs that can be detected using narrow-band imaging with magnifying endoscopy (NBI-ME). However, the usefulness of NBI-ME in UC treatment as a whole is still unknown.

Methods

We collected NBI-ME images of PPs from 67 UC patients who had undergone ileocolonoscopy. We evaluated changes in the villi using the "villi index," which is based on three categories: irregular formation, hyperemia, and altered vascular network pattern. The patients were divided into two groups on the basis of villi index: low (L)- and high (H)-types. We then determined the correlation between morphological alteration of the PPs and various clinical characteristics. In 52 patients who were in clinical remission, we also analyzed the correlation between NBI-ME findings of PPs and clinical recurrence.

Results

The time to clinical recurrence was significantly shorter in remissive UC patients with H-type PPs than in those with L-type PPs (P<0.01). Moreover, PP alterations were not correlated with age, sex, disease duration, clinical activity, endoscopic score, or extent of disease involvement. Multivariate analysis revealed that the existence of H-type PPs was an independent risk factor for clinical recurrence (hazard ratio, 3.3; P<0.01).

Conclusions

UC patients with morphological alterations in PPs were at high risk of clinical relapse. Therefore, to predict the clinical course of UC, it may be useful to evaluate NBI-ME images of PPs.

Citations

Citations to this article as recorded by

Mucosal Healing of Ulcerative Colitis Based on Endoscopic Diagnosis, Histopathology, and Mucosal Inflammatory Mediators
Kazuhiko Uchiyama, Tomohisa Takagi, Eiki Murakami, Yuji Naito
Inflammatory Intestinal Diseases.2025; 10(1): 233. CrossRef
Possible Role of Image-Enhanced Endoscopy in the Evaluation of Mucosal Healing of Ulcerative Colitis
Minoru Matsuura, Daisuke Saito, Jun Miyoshi, Tadakazu Hisamatsu
Digestion.2023; 104(1): 42. CrossRef
Endoscopic alterations in Peyer's patches in patients with ulcerative colitis: A prospective, multicenter study
Satoshi Hiyama, Hideki Iijima, Yuko Sakakibara, Takuya Yamada, Akira Mukai, Yuriko Otake, Toshio Yamaguchi, Manabu Araki, Shoichiro Kawai, Yoshiki Tsujii, Takahiro Inoue, Yoshito Hayashi, Shinichiro Shinzaki, Tetsuo Takehara
Journal of Gastroenterology and Hepatology.2020; 35(7): 1143. CrossRef
Can narrow-band imaging of Peyer's patches predict the recurrence of ulcerative colitis?
Yoon Jae Kim
Intestinal Research.2016; 14(4): 295. CrossRef

8,798 View
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