Intestinal Research

Comments on “Week 2 remission with vedolizumab as a predictor of long-term remission in patients with ulcerative colitis: a multicenter, retrospective, observational study”: Philippe Pinton; Received September 22, 2025 Accepted October 26, 2025 Published online January 15, 2026; DOI: https://doi.org/10.5217/ir.2025.00234 [Epub ahead of print]

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Diagnosis of intestinal tuberculosis: a systematic review and meta-analysis: Pubet Weeranawin, Tanawat Geeratragool, Wanruchada Katchamart, Julajak Limsrivilai; Received June 6, 2025 Accepted September 24, 2025 Published online January 7, 2026; DOI: https://doi.org/10.5217/ir.2025.00098 [Epub ahead of print]

Abstract PDF: Background/Aims
Diagnosis of intestinal tuberculosis (ITB) is challenging. Histopathology and microbiological examination remain the gold standard, but previous studies show varied diagnostic performance. We aimed to systematically evaluate the accuracy of tests to diagnose ITB in both conventional and novel methods.
Methods
We searched MEDLINE and EMBASE from inception to October 2023. All studies enrolling at least 10 patients with reported information regarding the diagnosis of ITB based on endoscopic biopsy specimens, stool tests, and blood tests were included. We performed a meta-analysis using a random-effects model to estimate the performance of each test.
Results
Of 3,308 abstracts reviewed, 55 studies with 6,072 participants met the inclusion criteria. Endoscopic tissue biopsy for acid-fast bacilli, the presence of caseous granuloma on histopathology, polymerase chain reaction (PCR) for tuberculosis, mycobacterial culture, and Xpert MTB/RIF showed pooled sensitivity of 12% (95% confidence interval [CI], 8%–17%), 18% (95% CI, 12%–27%), 58% (95% CI, 44%–72%), 23% (95% CI, 12%–40%) and 29% (95% CI, 17%–46%), respectively. The liquid medium culture showed higher sensitivity than conventional Lowenstein-Jensen medium (25% [95% CI, 13%–43%] and 6% [95% CI, 3%–13%]). Pooled sensitivity and specificity of stool PCR for TB were 73% (95% CI, 43%–90%) and 95% (95% CI, 79%–99%), respectively. Additionally, the pooled sensitivity and specificity of interferon-gamma release assay (IGRA) were 86% (95% CI, 79%–91%) and 86% (95% CI, 81%–89%).
Conclusions
Endoscopic tissue biopsy samples had limited sensitivity in diagnosing ITB. IGRA showed good accuracy and may be combined with other methods to improve the diagnostic yield. Stool PCR demonstrated a good performance but based on a few studies.

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Population-based screening colonoscopy in Korea: balancing benefits and limitations: Hyoung Il Choi, Jae Myung Cha; Received August 22, 2025 Accepted September 28, 2025 Published online January 2, 2026; DOI: https://doi.org/10.5217/ir.2025.00188 [Epub ahead of print]

Abstract PDF: Population-based colonoscopy screening is considered one of the most effective strategies for reducing the incidence and mortality of colorectal cancer. Its major strength lies in its dual benefits: early detection of colorectal cancer and prevention via the removal of precancerous lesions. Colonoscopy has a high sensitivity and provides a full colonic evaluation in a single session, thereby reducing the need for frequent testing. However, this approach has notable limitations. Colonoscopy is an invasive procedure associated with rare but serious complications such as perforation and bleeding. Participation rates tend to be lower than those of noninvasive methods like fecal immunochemical tests. Additionally, implementing colonoscopy as a populationbased tool requires significant resources, including trained endoscopists, endoscopy facilities, and financial investments. The quality of colonoscopy may also vary depending on the operator’s skill and adherence to guidelines. Given these trade-offs, population-based colonoscopy screening must be carefully evaluated in terms of cost-effectiveness, feasibility, and public acceptance within each country’s healthcare system. Therefore, population-based colonoscopy screening should be approached with a balanced understanding of its benefits and limitations to ensure cost-effectiveness, feasibility, alignment with each country’s healthcare infrastructure, and integration with existing screening programs.

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The JAK attack: transforming the management of ulcerative colitis in India: Arshdeep Singh, Arshia Bhardwaj, Vandana Midha, Ajit Sood; Received July 26, 2025 Accepted September 8, 2025 Published online January 2, 2026; DOI: https://doi.org/10.5217/ir.2025.00153 [Epub ahead of print]

Abstract PDF: Inflammatory bowel disease is increasingly recognized as a significant clinical entity in India, reflecting the country’s ongoing epidemiological transition. With a rising incidence and an expanding disease spectrum, the limitations of conventional therapeutic agents, such as corticosteroids and thiopurines, have become increasingly evident. This review examines the transformative role of Janus kinase inhibitors, particularly tofacitinib, in redefining therapeutic goals and bridging the gap between medical innovation and real-world implementation in resource-limited settings. Tofacitinib represents a pivotal advancement in the therapeutic landscape of ulcerative colitis (UC) in India, offering the advantages of oral administration, rapid onset of action, predictable pharmacokinetics, and cost-effective generic formulations–thereby overcoming several longstanding barriers to the adoption of advanced therapies. Accumulating real-world evidence from India supports its clinical utility across various phenotypes of UC, including corticosteroid-dependent or refractory disease, acute severe UC, ulcerative proctitis, elderly-onset UC, and in achieving deeper remission endpoints such as histologic healing. Furthermore, its incorporation into routine clinical practice has contributed to a measurable reduction in corticosteroid reliance, thereby aligning treatment strategies with international standards of care. By combining efficacy, safety, accessibility, and ease of use, tofacitinib has catalyzed a paradigm shift in the management of UC in the Indian context.

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Orofacial granulomatosis in pediatric Crohn’s disease: clinical outcomes and genetic background in the era of biologics: a retrospective study in Japan: Ryusuke Nambu, Takeo Naito, Mei Haruyama, Junichi Hosokawa, Hirotaka Shimizu, Ichiro Takeuchi, Shin-ichiro Hagiwara, Tatsuki Mizuochi, Yugo Takaki, Takashi Ishige, Takuya Nishizawa, Takahiro Kudo, Natsuki Ito, Yosuke Kawai, Yoichi Kakuta, Masao Nagasaki, Toshiaki Shimizu, Itaru Iwama, Katsuhiro Arai; Received June 18, 2025 Accepted September 1, 2025 Published online January 2, 2026; DOI: https://doi.org/10.5217/ir.2025.00109 [Epub ahead of print]

Abstract PDF: Background/Aims
Occasionally, pediatric Crohn’s disease (CD) may develop after diagnosis of orofacial granulomatosis (OFG), which is characterized by chronic granulomatous lesions of the oral mucosa, lips, and perioral area. This study aimed to clarify clinical characteristics, treatment responses, and potential genetic contributors in pediatric patients with CD complicating OFG.
Methods
We studied pediatric patients with CD complicating OFG who were treated from 2013 to 2022 at 7 Japanese institutions specializing in pediatric inflammatory bowel disease. Their clinical courses were analyzed retrospectively, and analyses of 71 genes associated with monogenic inflammatory bowel disease were performed.
Results
Among 13 patients, 8 were girls. Median ages at diagnosis of OFG and CD were 9.2 (3.8–15.3) and 10.3 (6.4–15.3) years old, respectively. Upper gastrointestinal lesions were frequent in 8 cases (62%), while perianal lesions were present in 7 (54%). OFG failed to improve or relapsed despite remission of intestinal lesions in about half of the patients (n = 7, 54%). During follow-up, OFG went into remission in 7 patients, including 6 of the 9 who were treated with biologics (66%) and 1 of the 4 who were not (25%). In 8 patients, the NCF1 p.Arg90His allele was detected by genetic analysis; 7 were heterozygous and 1 homozygous, a higher prevalence than in the general Japanese population.
Conclusions
Clinical features of OFG associated with pediatric CD are diverse, and biologic agents were beneficial for OFG patients. NCF1 p.Arg90His mutation may contribute to the pathogenesis of pediatric CD complicating OFG.

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Integrating perspectives on transabdominal intestinal ultrasound in inflammatory bowel disease management: a nationwide cross-sectional survey of physicians and patients in China: Longxi Yun, Zhaojue Wang, Yujun Chen, Ning Chen, Yan Chen, Xiaoqi Zhang, Xiaoyan Xie, Ren Mao, Yue Li, Qingli Zhu, Minhu Chen, China IUS Group; Received May 8, 2025 Accepted August 21, 2025 Published online January 2, 2026; DOI: https://doi.org/10.5217/ir.2025.00074 [Epub ahead of print]

Abstract PDF: Background/Aims
The awareness, accessibility, and utilization of transabdominal intestinal ultrasound (IUS) in inflammatory bowel disease (IBD) management from both physicians’ and patients’ perspectives remains unclear in China. This nationwide cross-sectional survey aimed to gauge the current utilization of IUS, physician and patient perceptions and knowledge gap in IBD management across China.
Methods
A structured questionnaire, developed by the China IUS Group, was distributed to 612 physicians (69.8% of gastroenterologists, 28.0% of radiologists) from 38 tertiary hospitals and 1,154 IBD patients. Results: A total of 91.7% of physicians expressed an intention to incorporate IUS into future clinical practice. However, while 69.3% of physicians reported IUS availability at their institutions, its utilization varied widely. Only 16.5% of physicians applied IUS to more than 75% of their IBD patients. Additionally, 27.1% of physicians reported receiving IUS training. Radiologists were more likely than gastroenterologists to consider IUS as a sensitive tool for evaluating treatment efficacy (48.3% vs. 19.4%, P< 0.001), intestinal wall fibrosis (33.7% vs. 27.4%, P< 0.001), intestinal fistula (27.9% vs. 11.2%, P< 0.001), abdominal abscesses (49.4% vs. 28.6%, P< 0.001), and disease severity (30.2% vs. 11.0%, P< 0.001). Patients expressed high satisfaction with IUS (76.1%), yet 39.2% had safety concerns.
Conclusions
Despite growing recognition of IUS in China, its wide utilization in IBD management requires further promotion. The notable disparity between gastroenterologists and radiologists regarding IUS underscores the need for targeted, specialty-specific training. Strengthening patient education efforts is essential to further enhance patient acceptance of IUS.

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Fecal surrogate markers strongly correlate with endoscopic findings in pediatric onset inflammatory bowel disease: a retrospective study in Japan: Ryoko Yoshimura, Takahiro Kudo, Masanori Toda, Kosuke Kashiwagi, Masumi Nagata, Kaori Aoki, Natsuki Ito, Kazuhide Tokita, Nobuyasu Arai, Reiko Kyodo, Masamichi Sato, Eri Miyata, Keisuke Jimbo, Yoshikazu Ohtsuka, Toshiaki Shimizu, Hiromichi Shoji; Received January 5, 2025 Accepted April 2, 2025 Published online December 12, 2025; DOI: https://doi.org/10.5217/ir.2025.00103 [Epub ahead of print]

Abstract PDF PubReader ePub: Background/Aims
Endoscopy serves as the gold standard for assessing disease activity in inflammatory bowel disease (IBD). Noninvasive biomarkers have been under exploration as potential alternatives. This study aims to examine the diagnostic effectiveness of fecal immunochemical tests, along with levels of fecal calprotectin (FC) and fecal lactoferrin (FL), in stool samples from patients with early-onset IBD.
Methods
Children with childhood-onset IBD who visited the Department of Pediatrics and Adolescent Medicine at Juntendo University Hospital between August 2019 and July 2023 were included. FC levels, FL levels, and fecal immunochemical test results were measured using a colloidal gold agglutination assay. Fecal biomarker results and endoscopic findings were reviewed retrospectively.
Results
Sixty-five patients had ulcerative colitis (UC), 20 had Crohn’s disease (CD), and 3 had unclassified IBD. The participants, aged 3–27 years (median, 18.0 years), included 56 males and 32 females. Stool samples (n = 1,105) were analyzed, from 803 with UC, 251 with CD, and 51 with IBD. Endoscopic evaluations were conducted in 45 UC patients and 18 CD patients. A significant correlation was found between the FC and FL. These biomarkers were significantly correlated with the endoscopic activity index in both UC and CD patients.
Conclusions
FC is valuable for diagnosing endoscopic inflammation and predicting recurrence. A significant correlation was observed between FC and FL. In patients with UC and CD, both markers strongly correlated with endoscopic activity. Thus, FC and FL can serve as a reliable alternative to endoscopic evaluation in pediatric patients with childhood-onset IBD.

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Preventive and therapeutic effects of co-administration of Bacteroides thetaiotaomicron and infliximab on dextran sodium sulfate-induced colitis in mice: Sara Ahmadi Badi, Hamid Reza Moradi, Ahmad Berimipour, Shima Shojaie, Arian Kariman, Hananeh Tavakoli Aval, Seyed Amirhesam Seyedi, Mehdi Davari, Mohammad Hassan Sohouli, Shohreh Khatami, Seyed Davar Siadat, Pejman Rohani; Received April 22, 2025 Accepted August 21, 2025 Published online December 12, 2025; DOI: https://doi.org/10.5217/ir.2025.00061 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
The gut microbiota plays a crucial role in the pathogenesis and treatment of inflammatory bowel diseases (IBD). This study aimed to investigate the effects of active, heat-inactivated, and cell-free supernatant (CFS) forms of Bacteroides thetaiotaomicron, alone or in combination with infliximab, in dextran sodium sulfate (DSS)-induced colitis in mice. Colitis was induced by oral administration of DSS for seven days. B. thetaiotaomicron in its various forms was orally administered at a dose of 1 × 10⁸ CFU prior to and during colitis induction. Infliximab was intraperitoneally injected from days 3 to 5 of DSS exposure. Colitis severity, gene expression, tumor necrosis factor alpha levels, and gut microbiota were assessed by disease activity index, reverse transcription-quantitative polymerase chain reaction (RT-qPCR), enzyme-linked immunosorbent assay (ELISA), and qPCR, respectively.
Results
Active B. thetaiotaomicron and its CFS form significantly alleviated colitis symptoms compared to the heat-inactivated form. Furthermore, co-administration of active B. thetaiotaomicron and infliximab significantly modulated the colonic mRNA expression of Ocln, Tff3, Muc2 (upregulated), and Ace2 (downregulated). This combination also exhibited synergistic improvement in colitis severity in treated mice.
Conclusions
These findings underscore the therapeutic potential of B. thetaiotaomicron in IBD, either alone or in combination with infliximab, and support further development of microbiota-based strategies for IBD prevention and treatment.

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Comparison between endoscopic resection and transanal surgery for treatment of rectal tumors: a systematic review and meta‑analysis: Chan Hyuk Park, Byung Wook Jung, Yoon Suk Jung; Received August 18, 2025 Accepted September 28, 2025 Published online December 5, 2025; DOI: https://doi.org/10.5217/ir.2025.00180 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Both endoscopic resection (ER) and transanal surgery (TAS) are minimally invasive treatment options that allow organ preservation in early rectal tumors. We conducted a meta-analysis to compare treatment outcomes between the 2 treatments.
Methods
We searched all relevant studies published until January 2024 that examined the comparative outcomes between ER and TAS for rectal tumors, including adenoma, adenocarcinoma, and neuroendocrine tumor (NET). TAS included transanal excision, transanal endoscopic microsurgery, and transanal minimally invasive surgery.
Results
Seventeen studies with a total of 1,569 patients were included in this meta-analysis. For adenoma/adenocarcinoma, the R0 resection rate did not differ between ER and TAS (risk ratio [RR], 0.99; 95% confidence interval [CI], 0.94–1.03). For NET, the R0 resection rate was lower in the ER group than in the TAS group (RR, 0.76; 95% CI, 0.68–0.84) and the procedure time for ER was shorter than that for TAS. For both adenoma/adenocarcinoma and NET, ER and TAS did not differ in terms of complication rates, additional surgery, and recurrence.
Conclusions
ER and TAS showed similar treatment outcomes for adenoma/adenocarcinoma. Considering that TAS typically incurs higher costs than ER, ER may be favored in the treatment of rectal adenoma/adenocarcinoma. For rectal NET, TAS showed a superior R0 resection rate than ER. However, given that TAS requires a long procedure time, expensive equipment, and complex manipulations, TAS may be considered selectively for large NETs with suspected deep tumorous infiltration.

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Recent updates on the endoscopic treatment of rectal neuroendocrine tumor: Sunghyeok Ryou, Kwangwoo Nam; Received July 18, 2025 Accepted September 8, 2025 Published online November 27, 2025; DOI: https://doi.org/10.5217/ir.2025.00141 [Epub ahead of print]

Abstract PDF PubReader ePub: The incidence of rectal neuroendocrine tumors has been gradually increasing, primarily due to the widespread use of screening colonoscopy and growing awareness of the disease. Most rectal neuroendocrine tumors are small ( < 10 mm), well-differentiated, and low-grade lesions at the time of diagnosis, and they are usually asymptomatic. Given these characteristics, endoscopic resection is considered a feasible treatment option for early-stage lesions. However, due to their inherent malignant potential, a comprehensive initial diagnostic evaluation is essential. Lymph node or distal metastasis can be present at diagnosis or may develop long after apparently successful primary treatment. Therefore, achieving complete resection using the most optimal resection method is crucial. Modified endoscopic mucosal resection and endoscopic submucosal dissection are recommended over conventional forceps or snare polypectomy, which are associated with high incomplete resection rates. In case of incomplete resection, additional endoscopic resection can be a feasible option in selected cases. Furthermore, regular post-resection surveillance is needed, especially in patients with high-risk of recurrence such as poor pathologic result or incomplete resection.

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Effectiveness, safety, and pharmacokinetics of the infliximab biosimilar CT-P13 after non-medical switch from the infliximab originator in patients with inflammatory bowel disease: Ryohei Nomaru, Teruyuki Takeda, Atsushi Takahashi, Hiroyuki Mikumo, Shigeyoshi Yasukawa, Akihiro Koga, Takao Kanemitsu, Yoichiro Ono, Noritaka Takatsu, Masaki Miyaoka, Takashi Hisabe, Hisatomi Arima, So Imakiire, Eri Yamauchi, Shinya Ashizuka, Fumihito Hirai; Received June 30, 2025 Accepted September 4, 2025 Published online November 27, 2025; DOI: https://doi.org/10.5217/ir.2025.00118 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
The introduction of anti-tumor necrosis factor-α antibodies transformed the landscape of inflammatory bowel disease (IBD) treatment. Because biologics are associated with increased medical costs, the use of biosimilars (BS) is recommended. However, high-quality evidence on the efficacy of BS in Japan remains limited. Therefore, this study aimed to evaluate the efficacy and safety of BS in patients with IBD.
Methods
Patients with IBD who underwent a non-medical switch (NMS) from infliximab originator (IFX-O) to IFX-BS at Fukuoka University Chikushi Hospital were prospectively evaluated. The observation period was up to 56 weeks after the NMS, and the rate of continuation, clinical remission at 56 weeks, safety, and changes in trough concentration were analyzed. Moreover, a questionnaire survey regarding BS and NMS was conducted.
Results
A total of 167 patients were included in this study. The continuation rate for IFX-BS therapy after NMS was high (95.6%). The remission maintenance rate at 56 weeks was 85.7% for patients with Crohn’s disease and 77.8% for patients with ulcerative colitis. Adverse events were observed in 22.8% of patients. However, only 2 severe adverse events were recorded. The ratios of trough concentrations at 8, 24, and 56 weeks to that at week 0 were 115.6%, 101.2%, and 123.5%, respectively, indicating statistical non-inferiority. In a questionnaire survey, only 6.2% of the patients were aware of BS, however, more than half of them agreed with the NMS recommendation.
Conclusions
The efficacy and safety of IFX-BS after NMS are high. In addition, its trough concentration is serologically non-inferior to baseline values.

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Escalation to biologics after corticosteroids in patients with newly diagnosed Crohn’s disease in Japan: a claims analysis from 2010 to 2021: Minoru Matsuura, Annabelle Yoon, Jun Miyoshi, Tadakazu Hisamatsu; Received April 17, 2025 Accepted August 18, 2025 Published online November 25, 2025; DOI: https://doi.org/10.5217/ir.2025.00059 [Epub ahead of print]

Abstract PDF PubReader ePub: Background/Aims
A previous health insurance claims study of Japanese patients with newly diagnosed Crohn’s disease (CD) reported an increase in “step-up” approach from 2010 to 2020, with biologic use in the first year remaining stable. This study examined systemic corticosteroid (SCS) use for newly diagnosed CD in Japan and compared patients who were escalated (“step-up”) and were not escalated to biologics.
Methods
This retrospective longitudinal cohort study used health insurance claims data (JMDC database). Patients diagnosed with CD from 2010 to 2020 who had no CD-related claims for ≥ 1 year before index, were traceable for ≥ 1 year after index, and treated with ≥ 1 pre-defined treatment were included. Patients classified by SCS and/or biologic use within 1 year after diagnosis were compared.
Results
Of 823 patients, 379 (46.1%) received SCS in the first year; of these, 43.5% escalated to biologics (step-up group) and 56.5% did not (SCS group). The proportion of patients receiving SCS increased from 25.8% in 2010–2011 to 55.5% in 2020; proportion escalated to biologics increased from 33.8% in 2016–2017 to 51.0% in 2020. The step-up group was significantly younger, more likely to have perianal lesions, and received more intensive treatments than the SCS group. In terms of SCS use, the step-up group was more likely to have shorter time-to-SCS initiation, and a higher initial SCS dose, than the SCS group.
Conclusions
Escalation from SCS to biologics in Japanese patients with newly diagnosed CD increased between 2016 and 2020, particularly in patients with younger onset CD or perianal complications.

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Evolution of surgical trends in Crohn’s disease during the biologic era: population-based cohort insights from Taiwan, a low-endemicity region: Er-Hsiang Yang, Nai-Yu Chen, Ching-Lan Cheng, Yu-Ching Chang, Po-Chuan Chen, Lu-Hsuan Wu, Jui-Wen Kang, Hsueh-Chien Chiang, Po-Jun Chen, Bo-Wen Lin, Hsin-Yu Kuo, Chiao-Hsiung Chuang; Received January 10, 2025 Accepted August 21, 2025 Published online November 25, 2025; DOI: https://doi.org/10.5217/ir.2025.00003 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Surgery remains a crucial treatment option for Crohn’s disease (CD), even with the introduction of biological agents. This nationwide cohort study in Taiwan investigates surgery trends and the impacts of biologics in a region with a low prevalence of CD.
Methods
This retrospective population-based cohort study used Taiwan’s National Health Insurance Database from 2003 to 2018. The cohort included 725 CD patients. Patient characteristics, surgery outcomes, and impact of the biologic era on surgical risk were analyzed.
Results
During the study period, 292 CD patients (40.3%) underwent surgery, with 125 in the pre-biologic era and 167 in the post-biologic era. The incidences of intestinal surgery (IS) and perianal surgery (PS) have significantly decreased. The cumulative probabilities of IS were 20%, 35%, and 44% after 1, 5, and 10 years, respectively; the PS incidences were 3%, 5%, and 7%, respectively. The cumulative incidence of IS was significantly lower in the post-biologic era compared to the pre-biologic era (P= 0.049). CD patients had high second IS incidences of 31% at 5 years after the first IS.
Conclusions
Our study demonstrates the surgical incidences have decreased in the biologic era but remained relatively high in a region with low disease prevalence. This suggests the need for further improvements in CD management.

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Efficacy and safety of filgotinib in the treatment of ulcerative colitis with a focus on rapid and sustained efficacy: a narrative review: Tadakazu Hisamatsu, Toshihiko Kaise, Chisa Nagakura, Makoto Kamiya, Shu-Chen Wei; Received July 25, 2025 Accepted September 28, 2025 Published online November 19, 2025; DOI: https://doi.org/10.5217/ir.2025.00155 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: The rising incidence of ulcerative colitis (UC) globally highlights the necessity for treatment strategies that extend beyond symptom control to include inducing and maintaining remission, achieving biochemical and endoscopic remission, and restoring quality of life. Janus kinase inhibitors, such as filgotinib (FIL), show promise in treating UC. This review consolidates evidence on FIL in treating UC from the SELECTION and SELECTIONLTE trials, and real-world studies. Overall, FIL demonstrated rapid symptom relief (e.g., improved rectal bleeding and stool frequency) within 7 days and durable efficacy (e.g., clinical remission, Mayo Clinic Score response) up to 4 years. Improvements in health-related quality of life (HRQoL) and reduced corticosteroid dependency were also observed. The 200 mg dose generally elicited greater efficacy responses than the 100 mg dose, and hence may potentially be a more suitable choice for optimizing treatment outcomes. Although FIL may be an effective long-term treatment option regardless of prior biologic experience, biologic-naive patients may experience greater sustained clinical improvements. Safety outcomes indicated that FIL was well tolerated with no unexpected safety signals in SELECTION and SELECTIONLTE. These findings support FIL’s potential as a robust therapeutic option for UC, due to its acceptable safety profile and benefits across clinical and HRQoL outcomes.

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The role of the Mediterranean diet in the management of inflammatory bowel disease: a narrative review: Peter Vivian Acire, Stephanie C. Brown, Andrew S. Day; Received May 6, 2025 Accepted August 12, 2025 Published online November 19, 2025; DOI: https://doi.org/10.5217/ir.2025.00043 [Epub ahead of print]

Abstract PDF PubReader ePub: Inflammatory bowel disease (IBD) is characterized by the presence of gastrointestinal inflammation, that in some individuals leads on to complications, including strictures. IBD can be associated with significant morbidity with disruption of daily activities. Although the precise cause of IBD is unknown, epidemiologic studies indicate that diet is one contributory factor. Furthermore, various specific nutritional interventions have roles in the management of IBD. While the contribution of the Mediterranean diet (MedDiet) to the development or management of IBD has not yet been clearly delineated, available data are generally supportive. The MedDiet includes the consumption of a pattern of particular foods, such as plentiful vegetables, fruit, seafood, and olive oil, along with lifestyle features. Adherence to a MedDiet is associated with enrichment of beneficial components of the intestinal microbiome and enhanced barrier function: outcomes that are likely beneficial to individuals with IBD. The focus of this review was to highlight the evidence for the MedDiet in the setting of IBD, whilst giving an overview of the underlying health impacts of the MedDiet and the putative mechanisms of this dietary approach.

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Alteration of miR-21 and miR-24 expression: biomarker for early detection of synchronous metastases in colorectal cancer: a cross-sectional study in Indonesia: Yudith Annisa Ayu Rezkitha, Amal Arifi Hidayat, Irine Normalina, Ricky Indra Alfaray, Maria Inge Lusida, Takashi Matsumoto, Yoshio Yamaoka, Muhammad Miftahussurur; Received December 2, 2024 Accepted August 26, 2025 Published online November 19, 2025; DOI: https://doi.org/10.5217/ir.2024.00206 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Timely detection with highly accurate biomarkers would be helpful in effectively managing colorectal cancer (CRC). We aim to investigate the accuracy of 3 emerging biomarkers—miR-21, miR-24, and miR-145—in detecting synchronous metastases in CRC.
Methods
We recruited newly diagnosed CRC patients with extensive investigations to determine cancer staging and metastatic status. The expression levels of miR-21, miR-24, and miR-145 in tumor biopsy were measured using reverse transcription quantitative polymerase chain reaction. Multivariate and receiver operating characteristic analyses were conducted to evaluate the association and performance of these miRNAs in identifying various metastases.
Results
Out of the 63 Indonesian patients involved, 37 (58.7%) were diagnosed with localized CRC, whereas the remaining 26 (41.3%) were identified as having metastases: 31.7% liver, 14.3% lung, 3.2% bone, and 4.8% other metastases. There was a significant downregulation of miR-24 expression in metastatic CRC patients compared to those without metastases (0.024 [4.680] vs. 12.900 [42.376], P< 0.01). Overexpression of miR-21 was identified as an independent risk factor of synchronous metastasis (odds ratio [OR], 1.016; 95% confidence interval [CI], 1.003–1.030; P< 0.05), particularly lung (OR, 1.011; 95% CI, 1.002–1.020; P< 0.05) and bone (OR, 1.022; 95% CI, 1.001–1.043; P< 0.05) metastases. No association was found between miR-145 expression and metastatic status. The miR-21/24 ratio accurately identified synchronous metastases irrespective of organ site, with an area under the curve (95% CI) of 0.833 (0.722–0.944) and positive predictive value of 94.4%.
Conclusions
Alteration of miR-21 and miR-24 expression levels was associated with a high incidence of synchronous metastases in Indonesian CRC. The mir-21/24 ratio demonstrated significant potential as a biomarker for detecting synchronous metastases in CRC.

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Optimizing Janus kinase inhibitor therapy for ulcerative colitis: a real-world perspective: Shintaro Akiyama; Received June 1, 2025 Accepted June 19, 2025 Published online November 14, 2025; DOI: https://doi.org/10.5217/ir.2025.00096 [Epub ahead of print]

Abstract PDF PubReader ePub: In real-world clinical practice, 3 Janus kinase (JAK) inhibitors—tofacitinib, filgotinib, and upadacitinib—are now available for the treatment of ulcerative colitis. Emerging real-world evidence highlights distinct efficacy and safety profiles among these agents, largely attributed to differences in JAK selectivity and dosing strategies. Notably, data are accumulating on differential efficacy, predictors of therapeutic response, and outcomes in patients who switch between JAK inhibitors, contributing to a clearer understanding of the optimal positioning of each agent. Regarding safety, particular attention has been given to risks such as herpes zoster infection and drug-induced acne, underscoring the importance of appropriate patient education and individualized risk assessment. This review summarizes clinical trials and current real-world data on tofacitinib, filgotinib, and upadacitinib in ulcerative colitis, and discusses strategies for optimizing their clinical application.

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The impact of inflammatory bowel disease on women’s health: a cross sectional study in India: Arshia Bhardwaj, Arshdeep Singh, Riya Sharma, Gopal Bhardwaj, Liza Joshi, Ramit Mahajan, Dharmatma Singh, Pankaj Kumar, Marla C. Dubinsky, Shaji Sebastian, Vandana Midha, Ajit Sood; Received May 26, 2025 Accepted August 12, 2025 Published online November 14, 2025; DOI: https://doi.org/10.5217/ir.2025.00088 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
The gender-specific impact of inflammatory bowel disease (IBD) on women in low- and middle-income countries remains underexplored. We aimed to assess the effects of IBD on different domains of women’s health.
Methods
A cross-sectional study was conducted in women with IBD at a tertiary care center in North India. Women with IBD were interviewed using a structured questionnaire assessing menstrual, reproductive, sexual, mental, social, and financial health, and healthcare access.
Results
Two hundred and two women (median age, 41 years; ulcerative colitis [n = 155, 76.7%]) were enrolled. Anemia was present in 161 women (79.7%), with a median hemoglobin of 10.5 g/dL. Among menstruating women (n = 138), 69 (50%) had irregular cycles, and 39 (28.3%) experienced IBD exacerbations during menstruation. Sexual dysfunction was reported in 82.5% (n = 137/166). Pregnancy-related concerns were common (n= 120, 59.4%), mainly due to risk of heritability and safety of IBD medication. Ten women (4.9%) attributed pregnancy loss to disease activity. Cervical cancer screening (3.0%) and human papillomavirus vaccination (4.0%) rates were low. The median SICC-IBD (social impact of chronic conditions in IBD) score was 0.6. Forty-three women (21.3%) reported difficulties in finding a partner due to IBD. Limited access to IBD specialists (n = 150, 74.3%) and medications (n = 164, 81.2%) were reported in hometown. Fifty-five women (27.2%) relied on loans to manage treatment expenses.
Conclusions
IBD affects women across physical, reproductive, social, and financial domains. Culturally sensitive, multidisciplinary care models are essential to address these unmet needs.

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A survey on the practices and patterns in the management of acute severe ulcerative colitis in India: Arshia Bhardwaj, Arshdeep Singh, Riya Sharma, Vandana Midha, Ajit Sood; Received April 21, 2025 Accepted August 18, 2025 Published online November 14, 2025; DOI: https://doi.org/10.5217/ir.2025.00060 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
The real-world management of acute severe ulcerative colitis (ASUC) varies considerably across regions and healthcare settings. This study aimed to evaluate current management practices for ASUC among gastroenterologists in India.
Methods
A structured, web-based survey covering 5 thematic domains (provider and institutional characteristics, clinical workload and initial management, diagnostic practices, infectious work-up, and strategies for rescue therapy) was disseminated via email. Responses were analyzed using descriptive statistics.
Results
A total of 228 responses were received from across India’s 5 geographic zones. The majority of respondents were affiliated with either corporate hospitals (n = 76, 33.3%) or teaching hospitals (n = 68, 29.8%). The majority (n = 135, 59.2%) reported managing up to 10 ASUC cases annually. The Truelove and Witts criteria were the most commonly used for diagnosis (n = 169, 74.1%). Nutritional assessment was performed by 89 respondents (39.0%). Biopsies for cytomegalovirus during index sigmoidoscopy were obtained by 75 (32.9%). Intravenous hydrocortisone was the preferred steroid (n = 188, 82.5%). Low molecular weight heparin for thromboprophylaxis was never prescribed by 62 respondents (27.2%). Oxford criteria were most frequently used to assess steroid response (n = 150, 65.8%). More than half of the respondents (n = 125, 54.8%) reported that fewer than 50% of patients accepted rescue therapy. Rescue therapy was initiated on or after day 5 by 153 respondents (67.1%). Early involvement of colorectal surgeons was reported by 66 (28.9%). A majority (n = 200, 87.7%) were associated with low-volume centers for ileal pouch-anal anastomosis, performing < 5 procedures per year.
Conclusions
This nationwide survey reveals considerable heterogeneity in ASUC management in India. Standardizing care through patient and healthcare provider education and context-specific guidelines is imperative.

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Antinuclear antibodies seroconversion and endoscopic response to infliximab in biologic-naive Crohn’s disease: a Chinese single-center, retrospective study: Jinlu Tong, Xitao Xu, Yuan Cao, Mingming Zhu, Juntao Lu, Yuqi Qiao, Zhanghan Dai, Tianrong Wang, Ying Sun, Zhijun Cao, Shen Jun; Received February 4, 2025 Accepted July 21, 2025 Published online November 14, 2025; DOI: https://doi.org/10.5217/ir.2025.00018 [Epub ahead of print]

Abstract PDF PubReader ePub: Background/Aims
The development of antinuclear antibodies (ANAs) during infliximab treatment has been observed in previous clinical trials. To evaluate the clinical significance of ANA seroconversion and its potential association with the formation of antibodies against infliximab.
Methods
This retrospective study included 130 Crohn’s disease patients undergoing infliximab therapy. ANA titers were measured at baseline and after 6 months of treatment. Inverse probability of treatment weighting was applied to control for confounding variables.
Results
Among the 111 patients with negative baseline ANA, 36 (32.4%) developed ANA positivity after 6 months of infliximab treatment. After adjustment with inverse probability of treatment weighting, a significantly higher proportion of patients in the ANA non-seroconversion group achieved endoscopic remission at 6 months compared to those with ANA seroconversion (64.5% vs. 35.5%: adjusted odds ratio [aOR], 3.61; 95% confidence interval [CI], 1.30–10.02; P= 0.014). At 18 months, patients in the non-seroconversion group also exhibited higher rates of both endoscopic response (57.5% vs. 42.3%: aOR, 3.38; 95% CI, 1.15–9.96; P= 0.027) and endoscopic remission (60.0% vs. 40.1%: aOR, 2.91; 95% CI, 1.06–8.01; P= 0.039) compared to the seroconversion group. Additionally, patients who developed ANA seroconversion had a higher rate of detectable antibodies against infliximab at both 6 and 18 months. A multivariable analysis identified female sex, older age at diagnosis, and lower serum albumin levels as independent predictors of ANA seroconversion at 6 months.
Conclusions
ANA non-seroconversion at 6 months was associated with higher rates of endoscopic remission and a lower likelihood of developing antibodies against infliximab.

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Ustekinumab-induced Henoch-Schönlein purpura in Crohn’s disease: a case report and literature review: Merih Deniz Toruner, Tugce Guvenir, Volkan Yilmaz, Ramazan Erdem Er, Murat Toruner; Received January 22, 2025 Accepted July 13, 2025 Published online November 14, 2025; DOI: https://doi.org/10.5217/ir.2025.00009 [Epub ahead of print]

Abstract PDF PubReader ePub

Crohn’s disease is a chronic inflammatory disease of the digestive tract with extraintestinal manifestations, which include skin conditions, arthritis, ocular inflammation, and several autoimmune conditions. Dermatologic manifestations in Crohn’s disease complicate the treatment course and prognosis and should be addressed promptly. Here, we report a 20-year-old male with a history of Crohn’s disease, presenting with palpable purpura, consistent with Henoch-Schönlein purpura, upon administration of ustekinumab. The immunoglobulin A vasculitis was treated with prednisone and the discontinuation of ustekinumab. Due to the increased usage of biological agents in inflammatory bowel diseases, associations between biologics and vasculitides should be further studied in Crohn’s disease patients for alternative treatment strategies and to understand potential adverse effects caused by biologics in Crohn’s disease.

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Ustekinumab

Reactions Weekly.2026; 2093(1): 97. CrossRef

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Treatment patterns and outcomes in patients with steroid-dependent ulcerative colitis in Japan: a claims database study: Masayuki Saruta, Takumi Sugiyama, Takumi Tajima, Chisa Nagakura, Yan Zhong, Toshihiko Kaise; Received February 18, 2025 Accepted August 12, 2025 Published online November 13, 2025; DOI: https://doi.org/10.5217/ir.2025.00032 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Guidelines recommend that steroid treatment for ulcerative colitis (UC) is tapered or withdrawn within 3 months of initiation, and thiopurine treatment or advanced therapy is administered for steroid-dependent UC. This study aimed to clarify real-world treatment patterns and outcomes in patients with steroid-dependent UC in Japan.
Methods
A retrospective analysis of JMDC (Japan Medical Data Center) claims data was conducted to identify patients with a new UC diagnosis between June 2010 and September 2019. Index dates were the UC treatment start date (initiation of any UC treatment), steroid dependence/resistance confirmation date (identification of steroid-dependent UC), and treatment intensification date (initiation of thiopurine treatment/advanced therapy).
Results
Of 5,602 patients with newly diagnosed UC, 986 (17.6%) initiated steroids within 12 months (85.4% [842/986] received 5-aminosalicylic acid at the UC treatment start date). Of these 986 patients, 429 (43.5%) were classified as steroid-dependent (steroid dependence/resistance confirmation date). Of these 429 patients, 128 (29.8%) initiated thiopurine treatment and 75 (17.5%) initiated advanced therapy (treatment intensification date); 226 (52.7%) continued with steroids only. Across these groups, 3-6% discontinued steroids within 3 months of initiation. Hospitalization due to UC in the 12 months after the treatment intensification date occurred in 24.2% (31/128) and 18.7% (14/75) of patients who initiated thiopurine and advanced therapy, respectively.
Conclusions
Over half of patients with steroid-dependent UC continued steroid treatment only. Steroid discontinuation within 3 months of initiation was low, irrespective of whether thiopurines or advanced therapy were initiated. Management of patients with steroid-dependent UC in Japan requires further treatment optimization toward guideline adherence.

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Post-marketing surveillance of tofacitinib in patients with ulcerative colitis in Japan: a post hoc analysis of safety and effectiveness in older (≥65 years) and younger (<65 years) patients: Katsuyoshi Matsuoka, Takayuki Yamamoto, Minoru Matsuura, Toshimitsu Fujii, Shoko Arai, Yutaka Endo, Keiko Sato, Hirotoshi Yuasa, Yasushi Mizuno, Yuki Kobayashi, Tadakazu Hisamatsu; Received April 16, 2025 Accepted July 14, 2025 Published online November 10, 2025; DOI: https://doi.org/10.5217/ir.2025.00058 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
To assess, post hoc, tofacitinib safety/effectiveness in patients with ulcerative colitis (UC), stratified by age, using data from a 60-week post-marketing surveillance (PMS) study in Japan.
Methods
All patients with UC receiving tofacitinib in Japan were enrolled in a large PMS study. Incidence proportions of adverse events (AEs), incidence rates (IRs; unique patients with events/100 patient-years of exposure) of clinically important AEs, reasons for discontinuation, and partial Mayo score clinical remission, stratified by age ( ≥ 65 and < 65 years), were evaluated.
Results
The analysis included 212 older ( ≥ 65 years) and 1,770 younger ( < 65 years) patients. Demographics and baseline disease characteristics were generally similar between groups; however, more older versus younger patients had cardiovascular disease (23.1% vs. 4.6%). Incidence proportions of AEs were comparable between groups, but IRs (95% confidence intervals) in older versus younger patients were numerically higher for herpes zoster (9.81 [5.72–15.71] vs. 5.44 [4.28–6.82]), and higher for serious infections (4.45 [1.92–8.76] vs. 1.14 [0.65–1.85]). More older versus younger patients discontinued due to AEs (28.6% vs. 17.6%); more younger versus older patients discontinued due to insufficient clinical responses (50.3% vs. 35.2%). Clinical remission rates through 60 weeks were generally similar between groups.
Conclusions
Older patients had higher IRs of herpes zoster and serious infection than younger patients, although tofacitinib effectiveness was similar between age groups. Discontinuation due to AEs was more common in older patients. Despite the smaller sample size of older versus younger patients, a focused evaluation of older patients is of benefit.

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IBD

Elderly-onset inflammatory bowel disease in Asia: clinical characteristics and therapeutic strategies: Jiyoung Yoon, Daein Kim, You Sun Kim; Intest Res 2025;23(4):430-442. Published online October 28, 2025; DOI: https://doi.org/10.5217/ir.2025.00221

Abstract PDF PubReader ePub: The incidence and prevalence of elderly-onset inflammatory bowel disease (EO-IBD) are increasing worldwide. The rising incidence of EO-IBD in Asia is driven by rapid industrialization and an aging population. Older patients often have multiple comorbidities and polypharmacy, which make diagnosis and management of the disease more challenging. Additionally, Asian patients with EO-IBD exhibit unique clinical characteristics, including frequent ileal involvement. Differences in phenotype between patients with EO-IBD in Western and Asian countries may explain subsequent disparities in the natural history of these patients. Although EO-IBD often manifests with a mild clinical course at diagnosis, it poses distinct diagnostic and therapeutic challenges. Understanding these characteristics is essential for optimizing patient care and for optimizing patient outcomes. In this review, we explore the epidemiology, disease burden, and clinical characteristics of EO-IBD in Asia, as well as the therapeutic approaches for treating the disease.

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IBD

Practices and perceptions of 5-aminosalicylic acid use in Crohn’s disease: a nationwide survey of physicians in Korea by KASID Guidelines Taskforce Team: June Hwa Bae, Seung Yong Shin, Dong Hyun Kim, Seung Min Hong, Eun Mi Song, Ji Eun Kim, Young Joo Yang, Jiyoung Yoon, Sang-Bum Kang, Eun Soo Kim, Sung Eun Kim, Seong-Jung Kim, Jun Lee, Soo-Young Na, Soo Jung Park, Sang Hyoung Park, Won Moon, Sung-Ae Jung, KASID Guidelines Taskforce Team of the Korean Association for the Study of the Intestinal Diseases (KASID); Intest Res 2025;23(4):491-501. Published online October 28, 2025; DOI: https://doi.org/10.5217/ir.2025.00211

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Despite international guidelines recommending against the use of 5-aminosalicylic acid (5-ASA) for Crohn’s disease (CD), it remains widely prescribed. This study aimed to investigate current patterns of 5-ASA use and physicians’ perceptions of its efficacy among Korean specialists.
Methods
A nationwide online survey was conducted in August 2025 targeting Korean gastroenterologists and colorectal surgeons managing inflammatory bowel disease. The questionnaire included 19 items addressing prescribing behaviors, perceived efficacy, and clinical decision-making regarding 5-ASA in CD.
Results
A total of 118 out of 124 physicians (95.2%) responded to the survey. The majority (67.8%) reported prescribing 5-ASA to more than half of their patients with CD. Standard to high doses ( > 2 g/day) were commonly used (94.9%), and timedependent formulations were preferred (92.4%). Although 55.1% used 5-ASA irrespective of disease location, it was frequently prescribed for colonic/ileocolonic disease (57.7%). Physicians primarily used 5-ASA in cases of non-active or mildly active CD. Notably, over 70% of respondents perceived 5-ASA to have a marginal yet beneficial effect on clinical remission, biomarker improvement, and mucosal healing. Approximately one-third of physicians reported continuing 5-ASA even after initiating biologics or small molecules.
Conclusions
This survey reveals a substantial gap between clinical guidelines and current practice in Korea regarding 5-ASA use for CD. Many physicians continue to view 5-ASA as a relevant option, particularly for patients with low inflammatory burden. These discrepancies likely reflect practical factors such as clinical experience and drug characteristics, which should be carefully considered before excluding 5-ASA from CD management.

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Infection

The impact of the quality improvement program on Clostridioides difficile infection management: a quasi-experimental study: Jung Yun Lee, Jae-Ki Choi, Tae-Geun Gweon, Young Eun An, Hyo Suk Kim, Jae Hyuck Chang, Tae Ho Kim, Chang Whan Kim, Young-Seok Cho; Intest Res 2025;23(4):551-558. Published online October 28, 2025; DOI: https://doi.org/10.5217/ir.2025.00137

Abstract PDF PubReader ePub: Background/Aims
Clostridioides difficile infection (CDI) is a major cause of nosocomial diarrhea. This study aimed to implement a quality improvement program to expedite proper CDI treatment, including discontinuing laxatives and associated antibiotics.
Methods
Stool test results positive for CDI were automatically sent via text message to the quality improvement team, specialists in CDI management. The quality improvement team played an advisory role in this treatment. The outcome of this study was the competency of CDI treatment within 24 hours of stool test reporting. Competency was investigated using 3 different models: Model 1, initiation of CDI treatment within 24 hours of positive stool test report; Model 2, Model 1 criteria met with no concurrent laxative use; and Model 3, Model 2 criteria met with no concurrent associated antibiotics. Competency rates were compared between pre- and post-intervention periods (1 year each). Analyses were performed for inpatients with CDI.
Results
In total, 310 inpatients with CDI (129 pre-intervention, 181 post-intervention) were included in this study. The rates of competency for Model 1 (85.3% vs. 95.6%, p= 0.006), Model 2 (81.4% vs. 92.3%, p= 0.004), and Model 3 (35.7% vs. 56.4%, p< 0.001) in the post-intervention group were higher to those in the pre-intervention group.
Conclusions
Quality improvement program enhanced the quality of CDI treatment in terms of prompt treatment and discontinuation of concomitant laxatives and associated antibiotics. (cris.nih.go.kr; KCT0005892)

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IBD

Targeting the gut microbiome in inflammatory bowel disease: from concept to clinical reality: Nathalie Rolhion, Harry Sokol; Intest Res 2025;23(4):396-404. Published online October 28, 2025; DOI: https://doi.org/10.5217/ir.2025.00104

Abstract PDF PubReader ePub: The gut microbiota, a complex community of trillions of microorganisms inhabiting the human gastrointestinal tract, has emerged as a critical regulator of immune homeostasis and gastrointestinal health. In the context of inflammatory bowel disease (IBD), comprising primarily Crohn’s disease and ulcerative colitis, disruptions to this microbial ecosystem—collectively termed dysbiosis—have been increasingly recognized as central to disease pathogenesis. Recent research has established that alterations in gut microbiota not only reflect disease states but may actively drive immune dysregulation, barrier dysfunction, and mucosal inflammation. This review synthesizes current knowledge on the role of the gut microbiota in IBD and evaluates the therapeutic landscape of microbiota-modulating strategies using selected examples. Fecal microbiota transplantation, while offering proof-of-concept validation, is hindered by standardization challenges and variable clinical outcomes. As a response, microbiome-based therapeutics have evolved toward defined live biotherapeutic products including bacterial consortia and single-strain products, postbiotics, and metabolite-centered approaches targeting specific pathways. Groundbreaking research into rationally designed synthetic microbiomes and next-generation probiotics is driving a paradigm shift in microbiota-based treatment for IBD from empirical to precision-guided interventions.

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IBD

Asian–Pacific perspectives on the management of very early-onset inflammatory bowel disease: Ichiro Takeuchi, Katsuhiro Arai, Pornthep Tanpowpong, Ming-Wei Lai, Andrew S Day, Way Seah Lee, James Guoxian Huang, Karen Sophia Calixto-Mercado, Rosanna Ming Sum Wong, Muhammad Arshad Alvi, Zubin Grover, Jung Ok Shim, Ujjal Poddar; Intest Res 2025;23(4):405-429. Published online October 28, 2025; DOI: https://doi.org/10.5217/ir.2025.00082

Abstract PDF PubReader ePub: Children diagnosed with inflammatory bowel disease (IBD) before the age of 6 years are considered to have “very early-onset IBD (VEO-IBD),” which is challenging to diagnose and treat. Notably, many children with VEO-IBD have monogenic forms of the disease, meaning that early genetic testing is useful. However, because the prevalence of genetic variants causing VEO-IBD differs globally, the diagnosis and treatment of this disease should be tailored to each region. In the present review paper, the IBD Subcommittee of the Scientific Committee of the Asia-Pacific Society of Pediatric Gastroenterology, Hepatology and Nutrition (APSPGHAN) has summarized the epidemiology, presenting features, diagnosis, and treatment of VEO-IBD in the Asia– Pacific region, with an aim to guide clinicians and researchers who work with VEO-IBD in this area. Our 3 main messages are as follows: endoscopy is essential for VEO-IBD diagnosis; all children diagnosed with VEO-IBD should be suspected of having a monogenic form; and children with suspected monogenic IBD should undergo early genetic testing. Our messages aim to improve the early diagnosis and treatment of VEO-IBD in the Asia–Pacific region, including the early detection of monogenic IBD in this area.

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IBD

Knowledge and acceptability of the Lémann Index as a tool to measure disease progression and bowel damage in Crohn’s disease: results from an international survey: Charlotte Wong, Johan Burisch, Ryan C Ungaro, Anthony Buisson, Jérôme Lambert, Jean-Frédéric Colombel, Joana Torres, Naila Arebi; Intest Res 2025;23(4):512-523. Published online October 28, 2025; DOI: https://doi.org/10.5217/ir.2024.00183

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Crohn’s disease (CD) progresses to structural bowel damage (SBD). The Lémann Index (LI) captures stricture extent/severity, penetrating disease and surgery as a SBD score, and is earmarked for future CD modification trials. Understanding knowledge gaps and perceived barriers is critical to wider adoption.
Methods
A multinational, cross-sectional study was distributed through a survey link (REDCap, Research Electronic Data Capture) to gastrointestinal professional societies with snowball sampling using 23 questionnaire items in 5 sections to determine SBD and LI knowledge, and LI acceptability. Factors associated with acceptability and perception were evaluated.
Results
Of the 107 respondents, 49 (45.8%) were female; 87 (81.3%) were from Europe. Most were inflammatory bowel disease specialists (n = 80, 74.8%) or general gastroenterologists (n = 22, 20.6%), managing > 40 CD patients per month (n = 35, 32.7%). A total of 98 (91.6%) knew about SBD; “very important” rating for clinical trials and clinical practice was 56.1% and 41.4%, respectively. A 39.3% describe LI scoring as “very difficult” or “difficult”; 33.6% reported “significant” or “a lot” of effort. Acceptability (composite scores of > 36) were significantly associated with respondents who had received LI training (P<0.001). Automated methods, intestinal ultrasound and evidence of benefit would encourage LI use in clinical trials, while additional time and automated methods would promote use in clinical practice. The top 3 perceived adoption barriers were: lack of time (60.7%), limited automated methods (47.7%) and need for dedicated radiologists (38.3%).
Conclusions
Most respondents had baseline knowledge of SBD. The LI was perceived as important for advancing future CD research and care. More training and automation will facilitate LI adoption.

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Is the incidence and risk of gallstones increased in ulcerative colitis?: Published online October 21, 2025

Abstract

Prevalence and Risk Factors of Gallstone Disease in Korean Patients with Ulcerative Colitis
Intest Res. 2025;23(4):455-463

Up to 50% of patients with inflammatory bowel disease (IBD) may develop hepatobiliary complications (EIMs), and gallstone disease is known to be one of the most common conditions.
Among these complications, the association between gallstone disease and Crohn’s disease (CD) has been more extensively studied than in ulcerative colitis (UC). The prevalence of gallstone disease has been reported to be higher in CD patients (1.8%–34.2%) compared with healthy individuals (0.7%–14.9%). However, UC is also associated with hepatobiliary complications, including gallstone disease, although its specific risk factors remain unclear.
In this retrospective study, authors analyzed 2,811 Korean patients with UC who were diagnosed with gallstone disease through imaging tests. The incidence and associated risk factors of gallstone disease were evaluated according to age, disease extent, medication history, and surgical history.

Gallstone disease occurred in 7% of Korean patients with ulcerative colitis, a prevalence higher than that of the general population.
Older age (≥60 years), primary sclerosing cholangitis (PSC), and a history of colectomy were identified as independent risk factors for gallstone development.
Patients with PSC or a history of colectomy showed a significantly higher cumulative risk of gallstone disease.
Regular abdominal imaging is recommended for high-risk UC patients to facilitate early detection and management.

Best regards,

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IBD

Latent tuberculosis infection screening in patients with inflammatory bowel disease: a nationwide retrospective cohort study in South Korea comparing IGRA alone versus a combination of TST and IGRA: Ye-Jee Kim, Jiyeon Kim, Jiwon Lee, Tae Sun Shim, Sang Hyoung Park, Kyung-Wook Jo; Intest Res 2025;23(4):541-550. Published online October 14, 2025; DOI: https://doi.org/10.5217/ir.2025.00136

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
We aimed to evaluate if using the interferon-gamma release assay (IGRA) alone is effective for latent tuberculosis infection (LTBI) screening in preventing active tuberculosis in patients with inflammatory bowel disease (IBD) before initiating anti-tumor necrosis factor alpha (anti-TNF-α) therapy, compared to using both the tuberculin skin test and IGRA.
Methods
Using South Korea’s Health Insurance Review and Assessment Service, we selected IBD patients treated with anti-TNF-α agents for ≥ 1 year who underwent LTBI screening between 2018 and 2021. We compared the 1-year incidence rate and standardized incidence ratio of active tuberculosis incidence after starting anti-TNF-α treatment to the general population based on the LTBI screening strategy.
Results
Of the 4,215 enrolled patients, 3,505 underwent IGRA alone for LTBI screening, while 710 received both tuberculin skin test and IGRA. Within 1 year of starting anti-TNF-α treatment, 15 patients (0.36%) developed active tuberculosis, with a mean follow-up period of 4,200.6 person-years. The 1-year tuberculosis incidence rates were 372.3 (95% confidence interval [CI], 198.2–636.6) per 100,000 person-years for the IGRA alone group and 282.3 (95% CI, 34.2–1,019.9) per 100,000 person-years for the combination group. The standardized incidence ratios were similar: 14.34 (95% CI, 7.63–24.52) for the IGRA alone group and 11.25 (95% CI, 1.26–40.61) for the combination group.
Conclusions
Using IGRA alone may be an effective strategy for LTBI screening in IBD patients before starting anti-TNF-α therapy. (Intest Res, Published online)

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Endoscopy

Balancing safety and effectiveness in colonoscopy for older adults: a narrative review: Min-Jae Kim, Yuna Kim, Jie-Hyun Kim, Young Hoon Youn, Jaeyoung Chun; Intest Res 2025;23(4):443-454. Published online October 2, 2025; DOI: https://doi.org/10.5217/ir.2025.00092

Abstract PDF PubReader ePub: Colonoscopy is becoming more widely used in older adults for screening and diagnostic evaluation of colorectal cancer. While advanced age itself is not a contraindication, elderly patients often present unique challenges, including frailty, comorbidities and polypharmacy, which increase the risk of complications during the procedure. Rather than chronological age alone, frailty is important in risk assessment and clinical decision-making before performing a colonoscopy. This review summarizes recent evidence, particularly from large cohort studies and clinical guidelines, to provide a balanced evaluation of the advantages and disadvantages of performing colonoscopies on older adults. Ultimately, we emphasize the importance of judicious patient selection, customized bowel preparation and tailored sedation management to optimize the safety and effectiveness of colonoscopy in this vulnerable group.

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Filgotinib effectiveness and safety as second or third-line therapy in patients with ulcerative colitis: data from a real-world study: Antonio Tursi, Giammarco Mocci, Francesco Costa, Linda Ceccarelli, Edoardo Savarino, Caterina De Barba, Caterina Mucherino, Elvira D’Antonio, Laura Montesano, Manuela Marzo, Franco Scaldaferri, Daniele Napolitano, Daniela Pugliese, Antonietta Gerarda Gravina, Raffaele Pellegrino, Rocco Spagnuolo, Francesco Luzza, Antonio Cuomo, Laura Donnarumma, Giovanni Maconi, Giovanni Cataletti, Lorenzo Bertani, Giorgia Bodini, Andrea Pasta, Simona Piergallini, Mariaelena Serio, Antonella Scarcelli, Pietro Capone, Fabio Cortellini, Stefano Rodino, Ladislava Sebkova, Giuliana Vespere, Silvia Sedda, Vittorio D’Onofrio, Leonardo De Luca, Federica Gaiani, Stefano Kayali, Cristiano Pagnini, Maria Giovanna Graziani, Maria Carla Di Paolo, Leonardo Allegretta, Alessia Immacolata Cazzato, Stefano Scorza, Antonio Ferronato, Davide Giuseppe Ribaldone, Giovanni Aragona, Patrizia Perazzo, Giacomo Forti, Michela Di Fonzo, Federico Iacopini, Roberta Pica, Claudio Cassieri, Francesca Maria Onidi, Paolo Usai Satta, Walter Elisei, Marcello Picchio, Alfredo Papa; Received April 29, 2025 Accepted July 14, 2025 Published online September 29, 2025; DOI: https://doi.org/10.5217/ir.2025.00067 [Epub ahead of print]

Abstract PDF PubReader ePub

Background/Aims
Real-world data on the use of filgotinib (FILGO) in patients with ulcerative colitis (UC) are limited. This study aims to provide consistent results on the effectiveness and safety of FILGO in treating UC.
Methods
A retrospective assessment of clinical and endoscopic activity was conducted in a cohort of patients with UC according to the full Mayo score. The primary co-endpoints of the study were the evaluation of the effectiveness and safety of FILGO.
Results
We enrolled 102 patients with a median follow-up of 24 weeks (interquartile range, 8–24 weeks). At 8 weeks and the end of follow-up, clinical remission was achieved by 38 (37.2%) and 47 (46.1%) patients, respectively. Clinical remission was achieved in 13 of 18 patients (72.2%) receiving first-line therapy, 7 of 19 patients (36.8%) receiving second-line therapy, and 27 of 65 patients (41.5%) receiving third-line therapy (P= 0.002). Clinical remission at 8 weeks predicted clinical remission at the end of follow-up (P= 0.021). Age > 40 years (P= 0.046) and being on second- or third-line of treatment (P= 0.005) were negative predictors for clinical remission. Seventy-one patients (69.6%) achieved a clinical response. At endoscopic evaluation, mucosal healing was observed in 18 out of 30 patients (60.0%). Steroid-free remission was present in 38 out of 46 patients (82.6%). Five patients (4.9%) needed colectomy. Adverse events were recorded in 6 patients (5.8%): 2 cases (2%) were severe, requiring discontinuation of FILGO.
Conclusions
Our real-world data confirms that FILGO is safe and effective for patients with UC. Its efficacy is significantly improved when used as a first-line treatment.

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Upadacitinib’s Effectiveness and Safety as a Second- or Third-Line Therapy in Patients with Ulcerative Colitis: Data from a Real-World Study
Giammarco Mocci, Antonio Tursi, Franco Scaldaferri, Daniele Napolitano, Daniela Pugliese, Giovanni Maconi, Giovanni Cataletti, Roberta Pica, Claudio Cassieri, Edoardo Vincenzo Savarino, Caterina De Barba, Francesco Costa, Linda Ceccarelli, Manuela Marzo,
Journal of Clinical Medicine.2025; 14(21): 7801. CrossRef

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1 Crossref

Real-world effectiveness and safety of carotegrast methyl in patients with ulcerative colitis: a multicenter retrospective cohort study: Ryoji Koshiba, Kazuki Kakimoto, Takuya Inoue, Makoto Sanomura, Mitsuyuki Murano, Hiroaki Ito, Yoshihiko Nakanishi, Ken Kawakami, Noboru Mizuta, Keijiro Numa, Naohiko Kinoshita, Kei Nakazawa, Azusa Hara, Yuki Hirata, Naokuni Sakiyama, Shoko Arimitsu, Takako Miyazaki, Shiro Nakamura, Hiroki Nishikawa; Received April 25, 2025 Accepted June 30, 2025 Published online August 12, 2025; DOI: https://doi.org/10.5217/ir.2025.00066 [Epub ahead of print]

Abstract PDF PubReader ePub: Background/Aims
Carotegrast methyl is a novel small-molecule drug that inhibits α4 integrin. It is prescribed for up to 6 months in patients with moderate ulcerative colitis who have demonstrated an inadequate response to or intolerance of 5-aminosalicylic acid. However, only a few clinical trials have been conducted to assess its effectiveness. This study aimed to evaluate the efficacy and safety of carotegrast methyl in patients with ulcerative colitis.
Methods
This multicenter retrospective study included patients with active ulcerative colitis treated with carotegrast methyl between March 2022 and October 2024. The primary outcome was the clinical remission rate following treatment with carotegrast methyl. Secondary outcomes included the clinical response rate, predictors of clinical remission, ulcerative colitis relapse rate after discontinuing carotegrast methyl, and incidence of adverse events.
Results
This study included 62 patients who received carotegrast methyl treatment. The median duration of administration was 84 days, with 48.4% of patients achieving clinical remission at the time of carotegrast methyl discontinuation. In 42 patients with corticosteroid/advanced therapies-naive disease, the clinical remission rate was 54.8%. Multivariate analysis identified the baseline partial Mayo score as an independent predictor of clinical remission. Among those who achieved clinical remission, 34.8% experienced a relapse with a median time to relapse of 152 days. Adverse events occurred in 8 patients, but none were serious.
Conclusions
Carotegrast methyl demonstrated good efficacy and safety, potentially benefiting patients with low baseline disease activity. This drug may be a useful treatment option to consider before systemic corticosteroid therapy for ulcerative colitis.

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Peroxisome proliferator-activated receptors in inflammatory bowel disease: linking immunometabolism, lipid signaling, and therapeutic potential: Kiandokht Bashiri, Mark C. Mattar, Alireza Meighani, Andrew L. Mason; Received May 29, 2025 Accepted July 7, 2025 Published online August 11, 2025; DOI: https://doi.org/10.5217/ir.2025.00090 [Epub ahead of print]

Abstract PDF PubReader ePub: Inflammatory bowel disease (IBD), encompassing Crohn’s disease (CD) and ulcerative colitis, is a chronic condition marked by immune dysregulation, genetic predisposition, and metabolic disturbances. Emerging evidence highlights the role of lipid metabolism and peroxisome proliferator-activated receptor (PPAR) signaling in modulating immune responses in IBD. PPAR-γ and PPAR-α regulate macrophage polarization, T-cell differentiation, and epithelial barrier integrity, influencing disease severity and progression. Alterations in PPAR activity contribute to metabolic stress and inflammation, linking IBD pathophysiology to immunometabolism. Studies suggest that targeting PPARs may mitigate inflammation through modulation of cytokine production, immune cell function, and gut microbiota interactions. In this review, we focus specifically on CD and explore how PPAR signaling intersects with mesenteric adipose tissue dysfunction and microbial dysbiosis, 2 hallmark features of CD. PPAR agonists, already used in metabolic-inflammatory diseases such as metabolic-associated liver disease, have demonstrated antiinflammatory effects in experimental colitis models. Translating these findings into clinical applications could offer novel treatment strategies for CD. Future research should focus on clinical trials, genetic studies, and microbiota-targeted approaches to elucidate PPAR-driven mechanisms in CD pathogenesis. Understanding the interplay between PPARs, lipid metabolism, and immune responses may lead to innovative therapeutic strategies, improving disease management and patient outcomes.

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Crohn’s Disease Diagnosed Only by Capsule Endoscopy Shows Milder Disease Course: Published online July 24, 2025

Abstract

Clinical characteristics and long-term disease course in patients with Crohn’s disease as diagnosed by video capsule endoscopy: a multicenter retrospective matched case-control study
Intest Res. 2025;23(3):290-301

Video capsule endoscopy (VCE) is rarely used as a primary diagnostic tool for Crohn’s disease (CD), particularly in patients who show no abnormalities on ileocolonoscopy or cross-sectional imaging such as CT or MR enterography. This multicenter study, conducted at three tertiary hospitals between 2007 and 2022, evaluated the clinical features and long-term outcomes of patients diagnosed with CD based solely on VCE findings. Among 3,752 CD patients, only 24 (0.6%) were identified through VCE alone, highlighting the rarity of this diagnostic pathway.
These patients demonstrated distinct clinical characteristics compared to matched controls who were diagnosed using conventional methods. Specifically, they had significantly different disease locations and behavior at diagnosis, along with milder disease activity and lower levels of inflammatory markers such as C-reactive protein (CRP) and fecal calprotectin. Over a 10-year follow-up period, the VCE-diagnosed group experienced more favorable outcomes, including lower cumulative rates of disease complications, biologics use, hospitalizations, and surgical interventions. These findings suggest that although rare, Crohn’s disease cases detected only by VCE represent a clinically unique subgroup with a less aggressive disease course.

Very low prevalence: Only 0.6% of Crohn’s disease cases were diagnosed solely using video capsule endoscopy findings.
Milder initial disease: These patients had significantly lower disease activity and inflammatory markers (CRP, fecal calprotectin) at diagnosis.
Better long-term outcomes: Over a 10-year follow-up, they experienced fewer complications, less need for biologic therapy, and lower rates of hospitalization and surgery.

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Week 2 remission with vedolizumab as a predictor of long-term remission in patients with ulcerative colitis: a multicenter, retrospective, observational study: Taku Kobayashi, Tadakazu Hisamatsu, Satoshi Motoya, Toshimitsu Fujii, Reiko Kunisaki, Tomoyoshi Shibuya, Minoru Matsuura, Ken Takeuchi, Sakiko Hiraoka, Hiroshi Yasuda, Kaoru Yokoyama, Noritaka Takatsu, Atsuo Maemoto, Toshiyuki Tahara, Keiichi Tominaga, Masaaki Shimada, Nobuaki Kuno, Mary Cavaliere, Kaori Ishiguro, Jovelle L Fernandez, Toshifumi Hibi; Received April 9, 2024 Accepted April 6, 2025 Published online July 14, 2025; DOI: https://doi.org/10.5217/ir.2025.00047 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Vedolizumab (VDZ), a gut-selective monoclonal antibody for ulcerative colitis (UC) treatment, has no established biomarkers or clinical features that predict long-term remission. Week 2 remission, a potential predictor of long-term remission, could inform maintenance treatment strategy.
Methods
This retrospective, observational chart review included patients with UC in Japan who initiated VDZ between December 2018 and February 2020. Outcome measures included 14- and 54-week remission rates in patients with week 2 and non-week 2 remission (remission by week 14), 54-week remission rates in patients with week 14 remission and primary nonresponse, and predictive factors of week 2 and week 54 remission (logistic regression).
Results
Overall, 332 patients with UC (176 biologic-naïve and 156 biologic-non-naïve) were included. Significantly more biologic-naïve than biologic-non-naïve patients achieved week 2 remission (36.9% vs. 28.2%; odds ratio [OR], 1.43; 95% confidence interval [CI], 1.05–1.94; P= 0.0224). Week 54 remission rates were significantly different between week 14 remission and primary nonresponse (both groups: P< 0.0001), and between week 2 and non-week 2 remission (all patients: OR, 2.41; 95% CI, 1.30–4.48; P= 0.0052; biologic-naïve patients: OR, 2.40; 95% CI, 1.10–5.24; P= 0.0280). Week 2 remission predictors were male sex, no anti-tumor necrosis factor alpha exposure, and normal/mild endoscopic findings. Week 54 remission was significantly associated with week 2 remission and no tacrolimus use.
Conclusions
Week 2 remission with VDZ is a predictor of week 54 remission in patients with UC. Week 2 may be used as an evaluation point for UC treatment decisions. (Japanese Registry of Clinical Trials: jRCT-1080225363)

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Efficacy and safety of carotegrast methyl in active ulcerative colitis: a real-world prospective cohort study: Takahiro Shimoyama, Takayuki Yamamoto, Haruka Miyao, Saki Aota, Shoichi Morita, Ryohei Sakaguchi; Received March 21, 2025 Accepted May 8, 2025 Published online July 14, 2025; DOI: https://doi.org/10.5217/ir.2025.00046 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader: Background/Aims
Carotegrast methyl, an oral α4-integrin inhibitor, was recently approved for the treatment of active ulcerative colitis (UC). However, real-world data regarding its efficacy and safety remain scarce. This study aimed to assess the clinical effectiveness and safety profile of carotegrast methyl in patients with active UC.
Methods
Patients with active UC received carotegrast methyl at a dosage of 960 mg three times daily. Treatment was discontinued at 8 weeks for patients who achieved endoscopic remission. For those not achieving endoscopic remission, treatment was continued for up to 24 weeks. Clinical and endoscopic assessments were performed at 8 and 24 weeks to evaluate treatment progress.
Results
Among 50 UC patients, 45% achieved clinical remission, and 22% achieved endoscopic remission by week 8. Of those who discontinued treatment after reaching endoscopic remission, 55% experienced relapse during a median follow-up period of 30 weeks. For patients who continued treatment through 24 weeks, 52% achieved clinical remission, with a cumulative remission maintenance rate of 74.2%. Mild adverse events were reported in 6% of patients, including hyperamylasemia, hepatic dysfunction, and elevated biliary enzymes, all of which resolved after discontinuation of treatment. In 8 patients who relapsed and were re-administered carotegrast methyl, 62.5% achieved clinical remission, demonstrating the drug’s effectiveness and safety in re-treatment.
Conclusions
Carotegrast methyl effectively induces both clinical and endoscopic remission in patients with active UC and has a favorable safety profile. Re-administration is safe and effective for patients experiencing relapse.

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Cross-ethnic evaluation of gut microbial signatures reveal increased colonization with oral pathobionts in the north Indian inflammatory bowel disease cohort: Arshdeep Singh, Garima Juyal, Ranko Gacesa, Mohan C. Joshi, Vandana Midha, B. K. Thelma, Rinse K Weersma, Ajit Sood; Received December 23, 2024 Accepted April 23, 2025 Published online July 14, 2025; DOI: https://doi.org/10.5217/ir.2024.00216 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Inflammatory bowel disease (IBD) has become a global health concern. With the growing evidence of the gut microbiota’s role in IBD, studying microbial compositions across ethnic cohorts is essential to identify unique, populationspecific microbial signatures.
Methods
We analyzed stool samples and clinical data from 254 IBD patients (226 ulcerative colitis, 28 Crohn’s disease) and 66 controls in northern India using metagenomic shotgun sequencing to assess microbiota diversity, composition, and function. Results were replicated in 436 IBD patients and 903 controls from the Netherlands using identical workflows. Using machine learning, we evaluated the generalizability of Indian IBD signals to the Dutch cohort, and vice versa.
Results
Indian IBD patients exhibited reduced bacterial diversity and an abundance of opportunistic pathogens, including Clostridium, Streptococcus, and oral bacteria like Streptococcus oralis and Bifidobacterium dentium. There was a significant loss of energy metabolic pathways and distinct co-occurrence patterns among microbial species. Notably, 39% of these signals replicated in the Dutch cohort. Unique to the Indian cohort were oral pathobionts such as Scardovia, Oribacterium, Actinomyces dentalis, and Klebsiella pneumoniae. Both Indian and Dutch IBD patients shared reduced butyrate producers. Machine-learning diagnostic models trained on the Indian cohort achieved high predictive accuracy (sensitivity 0.84, specificity 0.95) and moderately generalized to the Dutch cohort (sensitivity 0.77, specificity 0.69).
Conclusions
IBD patients across populations exhibit shared and unique microbial signatures, suggesting a role for the oral-gut microbiome axis in IBD. Crossethnic diagnostic models show promise for broader applications in identifying IBD.

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Ulcerative colitis disease severity affects the speed of symptom relief under filgotinib treatment: a post hoc analysis of the phase 2b/3 SELECTION study: Masayuki Saruta, Silvio Danese, Yoshie Takatori, Toshihiko Kaise, Christine Rudolph, Marc Ferrante, Toshifumi Hibi; Received October 23, 2024 Accepted April 28, 2025 Published online June 30, 2025; DOI: https://doi.org/10.5217/ir.2024.00169 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Filgotinib is an oral, once-daily, Janus kinase 1 preferential inhibitor approved for the treatment of ulcerative colitis (UC). This study aimed to assess symptomatic response with filgotinib 200 mg (FIL200) according to disease severity using baseline partial Mayo Clinic Score (pMCS).
Methods
In the phase 2b/3 SELECTION study (NCT02914522), adults with moderate-to-severe UC were randomized to receive FIL200, filgotinib 100 mg, or placebo for 11 weeks in induction studies A (biologic-naive) and B (biologic-experienced). In this post hoc analysis, symptomatic remission (Mayo rectal bleeding subscore of 0 and stool frequency subscore ≤ 1) rates were assessed daily from baseline to day 15 and fortnightly from week 2 to week 10 by baseline pMCS (pMCS ≥ 7, pMCS < 7) in patients who received induction FIL200.
Results
Of those who received FIL200 in induction studies A and B, 90 and 148 patients had a pMCS ≥ 7, and 155 and 114 had a pMCS < 7, respectively. Symptomatic remission rates were generally significantly higher in the pMCS < 7 than ≥ 7 group from day 2–15 (day 2: 8.4% vs. 1.1%, P= 0.009 [induction study A]; 8.8% vs. 0.7%, P= 0.004 [induction study B]). However, by week 10, there was no longer a significant difference in the rates between the pMCS ≥ 7 and < 7 groups (43.3% vs. 54.8%, P= 0.124 [induction study A]; 26.4% vs. 39.5%, P= 0.099 [induction study B]).
Conclusions
Symptomatic response to FIL200 occurred more rapidly in the less severe disease groups than in the more severe disease groups; however, regardless of disease severity, both groups benefited from continued FIL200 treatment.

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IBD

Evolution of inflammatory bowel disease in Korea: a 60-year perspective on clinical and research development: Suk-Kyun Yang; Intest Res 2025;23(3):233-253. Published online June 23, 2025; DOI: https://doi.org/10.5217/ir.2025.00073

Abstract PDF Supplementary Material PubReader ePub: Inflammatory bowel disease (IBD) was once considered rare in Korea, with the first reported case documented in 1961. Since then, its incidence and prevalence have increased markedly, accompanied by significant progress in clinical care and research. This narrative review traces the historical evolution of IBD in Korea, dividing the timeline into 4 periods: 1960–1979, 1980–1999, 2000–2019, and 2020–2039. For each period, major developments in the research environment and trends, diagnostic process, patient population and characteristics, and treatment are outlined. Over the past 6 decades, diagnostic and therapeutic approaches in Korea have advanced markedly, transitioning from limited diagnostic capacity and symptom-based management to practices that align with global standards. Notably, Korean patients with IBD exhibit distinctive clinical features compared with Western counterparts, including a markedly higher proportion of proctitis and a lower long-term risk of colectomy in ulcerative colitis, and a substantially higher prevalence of perianal fistulas in Crohn’s disease, highlighting the need for population- specific strategies to advance personalized medicine. In parallel, the research landscape has evolved through multicenter collaborations, expanded research capacity, and growing international engagement, positioning Korea as an increasingly active contributor to the global IBD research community. Looking ahead, the future of IBD research in Korea is expected to be shaped by innovation-driven research, including advances in artificial intelligence, large-scale data integration, and deeper international collaboration. By tracing the clinical and research trajectory of IBD in Korea, this review offers insight into how the country has adapted to global trends and is preparing to meet future challenges.

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IBD

A real-world comparison of subcutaneous to intravenous administration of infliximab in patients with inflammatory bowel disease: Kwang Woo Kim, Hyoun Woo Kang, Seong-Joon Koh, Hyuk Yoon, Sihyun Kim, Yukyung Jun, Hyun Jung Lee, Jong Pil Im, Young Soo Park, Ji Won Kim, Joo Sung Kim, Seoul National University Inflammatory Bowel Disease Research Network (SIRN); Intest Res 2025;23(4):483-490. Published online June 23, 2025; DOI: https://doi.org/10.5217/ir.2025.00001

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
We compared intravenous and subcutaneous infliximab (IFX) as treatment for inflammatory bowel disease (IBD).
Methods
This retrospective, multicenter, observational study enrolled patients treated with either intravenous or subcutaneous IFX. Sequential parameters were compared at baseline, 6 months, and 12 months following the initiation of treatment with either type of IFX. The primary outcome was the comparison of the IFX trough levels after 12 months of treatment.
Results
In total, 183 participants were included in this study. After 6 months, the subcutaneous group exhibited significant differences compared to the intravenous group; in terms of clinical disease activity (0% vs. 15%, P= 0.007) and IFX trough level (21.72 ± 8.71 μg/mL vs. 7.70 ± 16.65 μg/mL, P= 0.002). After 12 months, subcutaneous, as compared to intravenous, achieved improved clinical disease activity (0% vs. 15%, P= 0.044) and IFX trough level (20.41 ± 12.91 μg/mL vs. 7.06 ± 6.81 μg/mL, P< 0.001). Analyzing the sequential changes compared with baseline data within each group, we observed significant alterations in subcutaneous; 6 months fecal calprotectin (676.3 ± 976.6 μg/g vs. 253.9 ± 483.9 μg/g, P= 0.014), 6 months IFX trough level (7.00 ± 5.67 μg/mL vs. 18.44 ± 6.34 μg/mL, P= 0.026), and 12 months IFX trough level (7.00 ± 5.67 μg/mL vs. 21.33 ± 4.50 μg/mL, P= 0.034).
Conclusions
This study indicates the potential suitability of subcutaneous IFX as an alternative treatment option for IBD.

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Comparative effectiveness of ustekinumab versus infliximab in the management of perianal fistulizing Crohn's disease: a retrospective study in China: Mengqi Chen, Zihan Chen, Jianming Lin, Linxin Liu, Tong Tu, Xiaoling Li, Baili Chen, Yao He, Minhu Chen, Zhirong Zeng, Xiaojun Zhuang; Received October 16, 2024 Accepted April 23, 2025 Published online June 11, 2025; DOI: https://doi.org/10.5217/ir.2024.00168 [Epub ahead of print]

Abstract PDF PubReader ePub: Background/Aims
Ustekinumab (UST) and infliximab (IFX) are both effective in the treatment of perianal fistulizing Crohn’s disease (CD), but limited research has focused on comparing the efficacy of UST versus IFX in this field. This study aimed to compare the effectiveness of UST or IFX in treating perianal fistula of CD patients naive to biological agents in a real-world setting.
Methods
A retrospective cohort study included patients with perianal fistulizing CD treated with UST or IFX was conducted to evaluate the rates of luminal and perianal fistula response and remission at 6 months after treatment.
Results
Ninety-seven patients (49 UST and 48 IFX) were enrolled. Compared to IFX, UST exhibited significantly higher rates of treatment success (89.8% vs. 50.0%, P< 0.001) and intestinal clinical response (85.7% vs. 68.8%, P= 0.048), but no significant differences in fistula remission, fistula response, fistula closure, intestinal clinical remission, endoscopic remission and endoscopic response was observed. Furthermore, multivariate analyses demonstrated complexity of fistula was conversely associated with fistula remission between the UST and IFX groups. Finally, the rates of disease relapse and operation in the IFX group were higher as compared to the UST group during follow-up.
Conclusions
UST may serve as a promising alternative to IFX for the treatment of perianal fistulizing CD.

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Clinical spectrum of acute severe ulcerative colitis in the biologic era: a prospective cohort study from India: Arshdeep Singh, Mayur Luthra, Arshia Bhardwaj, Ramit Mahajan, Riya Sharma, Dharmatma Singh, Devanshi Jain, Omesh Goyal, Varun Mehta, Kirandeep Kaur, Yogesh Kumar Gupta, Vandana Midha, Ajit Sood; Received November 18, 2024 Accepted March 4, 2025 Published online June 9, 2025; DOI: https://doi.org/10.5217/ir.2024.00189 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Acute severe ulcerative colitis (ASUC) is a time-critical situation requiring urgent intervention. Limited data exist on the evolving clinical spectrum of ASUC in the era of advanced therapies.
Methods
This prospective real-world observational cohort study included 145 adult patients hospitalized with ASUC between January 2020 and June 2024. ASUC was defined by the modified Truelove and Witts criteria. Demographics and disease characteristics, including disease severity, probable precipitating factors, and corticosteroid failure rates, were recorded.
Results
The median age of patients was 36 years (interquartile range, 26–48.5 years) with 63 females (43.4%). Most patients had left-sided colitis (53.1%). The median disease duration was 1 year (IQR, 0.5–3 years), with 91 patients (62.7%) presenting with ASUC within the first year of diagnosis of ulcerative colitis. One-third of the patients had previous exposure to biologics and small molecules. The most commonly reported probable precipitants of ASUC were poor compliance with treatment (n = 43, 29.6%), antibiotic use (n = 35, 24.1%), high perceived stress (n = 32, 22.1%), and Clostridioides difficile infection (n = 19, 13.1%). Forty patients (27.5%) were non-responders to intravenous corticosteroids (IVCS). Twenty-nine patients (20%) received medical rescue therapy (infliximab, n = 14 [48.27%], cyclosporine A, n = 6 [20.68%], and tofacitinib, n = 9 [31.03%]). Seven patients (4.82%; 4 after non-response to IVCS and 3 after non-response to medical rescue therapy) underwent colectomy.
Conclusions
In this cohort of ASUC patients, poor treatment compliance, antibiotic use, stress, and C. difficile infection were common precipitants of flare-ups. Nearly one-third of patients required medical rescue therapy, and a small proportion ultimately underwent colectomy.

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IBD

Upadacitinib and vedolizumab combination therapy for the management of refractory ulcerative colitis and Crohn’s disease: Robert Gilmore, Amrutha Murali, Amirah Etchegaray, Ei Swe, Yoon-Kyo An, Jakob Begun; Intest Res 2025;23(4):475-482. Published online June 9, 2025; DOI: https://doi.org/10.5217/ir.2024.00174

Abstract PDF PubReader ePub

Background/Aims
Inflammatory bowel disease (IBD) is characterised by chronic inflammation of the gastrointestinal tract, and encompasses both ulcerative colitis (UC) and Crohn’s disease (CD). Refractory disease is common, a combination of advanced drug therapies may be required to obtain maximal efficacy. We describe the use of upadacitinib therapy in combination with vedolizumab therapy for the management of refractory UC and CD.
Methods
In this retrospective observational study, patients who received upadacitinib in combination with vedolizumab were identified at a tertiary IBD center between November 2022 and March 2024. Patients were followed for 6 months with clinical, biochemical, endoscopic and intestinal ultrasound outcomes.
Results
Sixteen patients (7 with UC, 9 with CD) were identified. Median age was 44 years (range, 25–58 years), 11 (69%) were male, and median number of prior biologic exposures was 3 (range, 2–5). Twelve patients (75%) achieved clinical response, clinical remission, biochemical remission, corticosteroid-free clinical remission, and transmural remission by intestinal ultrasound. Eleven patients (69%) achieved endoscopic remission, with 4 (25%) achieving histological remission. Adverse events were seen in 8 patients (50%), but the majority were mild and did not require interruption of therapy.
Conclusions
Upadacitinib in combination with vedolizumab may have a role in refractory UC and CD patients who have previously failed to respond to standard therapy, with a favorable safety profile. Prospective studies are required to determine the safety and efficacy of this combination in larger cohorts before routine use can be recommended.

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Efficacy and Safety of Vedolizumab and Tofacitinib (VETO) Combination Therapy in Refractory Ulcerative Colitis Unresponsive to Anti‐TNF and a Second‐Line Advanced Therapy: A Prospective Cohort Nested Within a Randomised Trial
Pardhu Bharath Neelam, Dhanush Mekala, Rajender Patel, Rupa Banerjee
Alimentary Pharmacology & Therapeutics.2026; 63(1): 81. CrossRef
Inflammatory Bowel Disease: Understanding Therapeutic Effects of Distinct Molecular Inhibitors as the Key to Current and Future Advanced Therapeutic Strategies
Alice Laffusa, Cesare Burti, Chiara Viganò, Francesca Poggi, Laura Grieco, Vincenzo Occhipinti, Salvatore Greco, Stefania Orlando
Biomedicines.2025; 13(11): 2667. CrossRef
Synergistic effects of vedolizumab and JAK 1,2,3 inhibitors in Crohn’s disease: insights from a systems biology and artificial intelligence-based approach
Ignacio Marín-Jiménez, Mónica Sierra-Ausín, Teresa Letosa-Abián, Jesús Aparicio, Carmen Montoto-Otero, Silvia Sánchez-Ramón
Frontiers in Immunology.2025;[Epub] CrossRef

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The duration of prior anti-tumor necrosis factor agents is associated with the effectiveness of vedolizumab in patients with ulcerative colitis: a real-world multicenter retrospective study: Taku Kobayashi, Tadakazu Hisamatsu, Satoshi Motoya, Minoru Matsuura, Toshimitsu Fujii, Reiko Kunisaki, Tomoyoshi Shibuya, Ken Takeuchi, Sakiko Hiraoka, Hiroshi Yasuda, Kaoru Yokoyama, Noritaka Takatsu, Atsuo Maemoto, Toshiyuki Tahara, Keiichi Tominaga, Masaaki Shimada, Nobuaki Kuno, Mary Cavaliere, Kaori Ishiguro, Jovelle L Fernandez, Toshifumi Hibi; Received August 9, 2024 Accepted March 20, 2025 Published online June 4, 2025; DOI: https://doi.org/10.5217/ir.2024.00126 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Previous literature suggests that the response of patients with ulcerative colitis to vedolizumab may be affected by previous biologic therapy exposure. This real-world study evaluated vedolizumab treatment effectiveness in biologicnon-naïve patients.
Methods
This was a multicenter, retrospective, observational chart review of records from 16 hospitals in Japan (December 1, 2018, to February 29, 2020). Included patients who had ulcerative colitis, were aged ≥ 20 years, and received at least 1 dose of vedolizumab. Outcomes included clinical remission rates from weeks 2 to 54 according to prior biologic exposure status and factors associated with clinical remission up to week 54.
Results
A total of 370 eligible patients were included. Clinical remission rates were significantly higher in biologic-naïve (n=197) than in biologic-non-naïve (n=173) patients for weeks 2 to 54 of vedolizumab treatment. Higher clinical remission rates up to week 54 were significantly associated with lower disease severity (partial Mayo score ≤ 4, P= 0.001; albumin ≥ 3.0, P= 0.019) and the duration of prior anti-tumor necrosis factor α (anti-TNFα) therapy (P= 0.026). Patients with anti-TNFα therapy durations of < 3 months, 3 to < 12 months, and ≥ 12 months had clinical remission rates of 28.1%, 32.7%, and 60.0%, respectively (P= 0.001 across groups).
Conclusions
The effectiveness of vedolizumab in biologic-non-naïve patients was significantly influenced by duration of prior anti-TNFα therapy. (Japanese Registry of Clinical Trials: jRCT-1080225363)

Citations

Citations to this article as recorded by

Long-Term Outcomes and Prognostic Factors for Vedolizumab-Treated Japanese Patients with Ulcerative Colitis
Shinya Fukushima, Takehiko Katsurada, Takahiro Ito, Atsuo Maemoto, Fumika Orii, Toshifumi Ashida, Masanao Nasuno, Hiroki Tanaka, Katsuyoshi Ando, Mikihiro Fujiya, Yoshihiro Yokoyama, Satoshi Motoya, Hiroshi Nakase
Inflammatory Intestinal Diseases.2025; 11(1): 1. CrossRef

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Impact of stool transplantation and metformin on polyp reduction and inflammation in an APC Min mouse model: Yeon Ji Kim, Jiwon Lee, Eunmi Lee, Seun Ja Park, Jae Hyun Kim; Intest Res 2025;23(3):382-389. Published online May 19, 2025; DOI: https://doi.org/10.5217/ir.2025.00011

Abstract PDF PubReader ePub: Background/Aims
Familial adenomatous polyposis is a hereditary condition characterized by numerous adenomatous polyps in the colon and rectum, significantly increasing colorectal cancer risk. Current management strategies, such as prophylactic colectomy, are invasive and have long-term consequences, highlighting the need for alternative therapies. This study aimed to evaluate whether stool transplantation and metformin therapy synergistically reduce polyp formation and inflammation.
Methods
APC Min mice were divided into 4 groups: control, anti-control (antibiotic pretreatment), stool (stool transplantation), and stool+metformin. Polyp burden, bacterial abundance, inflammatory cytokines (interleukin [IL]-6, tumor necrosis factor [TNF]-α, IL-10), and tumorigenic markers (NF-κB, Cox2, c-myc, β-catenin) were assessed using messenger RNA (mRNA) and protein analyses of intestinal tissues, along with serum and fecal microbiota evaluations.
Results
Stool transplantation combined with metformin significantly reduced bacterial abundance and polyp burden. The anti-control group showed similar reductions, suggesting suppression of gut microbiota re-establishment. TNF-α and IL-10 levels remained unchanged, but a significant increase in IL-6 was observed in the stool+metformin group’s intestinal tissues, indicating localized immune activation. Intestinal Cox2 mRNA expression was reduced in the combination group, correlating with polyp suppression. Protein levels of NF-κB, Cox2, and β-catenin showed no significant changes in vivo, while in vitro experiments revealed a decrease in NF-κB and an increase in Cox2, suggesting complex regulation of inflammation-related pathways.
Conclusions
Stool transplantation combined with metformin reduces polyp burden in APC Min mice through gut microbiota modulation and localized immune activation. These findings support the therapeutic potential of this combination treatment for familial adenomatous polyposis.

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Lifestyle restrictions are associated with impaired quality of life but not reduction in relapse in ulcerative colitis: Hajime Yamazaki, Masakazu Nagahori, Tadakazu Hisamatsu, Taku Kobayashi, Teppei Omori, Jimmy K. Limdi, John T. McLaughlin, Shu-Chen Wei, Jovelle Fernandez, Shunichi Fukuhara, Katsuyoshi Matsuoka; Received November 29, 2024 Accepted March 18, 2025 Published online May 14, 2025; DOI: https://doi.org/10.5217/ir.2024.00199 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Patients with ulcerative colitis (UC) in remission commonly restrict thir lifestyle to prevent relapse; however, the effectiveness and impact on quality of life (QOL) is unclear. This study investigated whether lifestyle restrictions are associated with relapse reduction and assessed their impact on QOL.
Methods
This multicenter, prospective cohort study was conducted in Japan (2018–2021) via the YOURS registry, enrolling patients with UC in clinical remission. Patients were followed for 2 years. A baseline questionnaire evaluated lifestyle restrictions in diet, work/study/housework, and physical exercise. QOL was assessed by Disease Impact Scale every 3 months during the first year of follow-up. Associations of lifestyle restrictions with relapse and QOL were assessed by Cox regression analysis and linear mixed-effects models, respectively.
Results
Among 911 patients in clinical remission for > 90 days, 63% had adopted dietary avoidance; 47%, work/study/housework avoidance; and 8%, physical exercise avoidance. Overall, 216 patients relapsed. Lifestyle restrictions were not associated with reduced risk of relapse (multivariableadjusted hazard ratios [95% confidence interval]: dietary avoidance, 1.08 [0.81–1.44]; and work/study/housework avoidance, 1.14 [0.87–1.50]); physical exercise avoidance was associated with increased relapse (multivariable-adjusted hazard ratio, 1.58; 95% confidence interval, 1.02–2.44). All lifestyle restrictions were associated with impaired QOL (P <0.01).
Conclusions
Lifestyle restrictions were not associated with relapse reduction in patients with UC; however, they were associated with impaired QOL. Clinicians should engage in evidence-based discussions with patients with UC in remission regarding lifestyle restrictions (UMIN Clinical Trials Registry; UMIN000031995).

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Association among different histologic scoring systems and accuracy of fecal calprotectin for clinical and histologic remission: Published online April 30, 2025

Abstract

Predictive accuracy of fecal calprotectin for histologic remission in ulcerative colitis
Intest Res. 2025;23(2):144-156

Histologic remission is increasingly recognized as an important objective in the management of ulcerative colitis (UC). However, histologic evaluation requires invasive procedures, prompting interest in fecal calprotectin (FC) as a non-invasive surrogate marker.
In this prospective observational cohort study (n = 347), patients with UC underwent concurrent clinical, endoscopic, biochemical, and histologic evaluations. Four histologic indices (Geboes Score (GS), Continuous GS, Nancy Index (NI), and Robarts Histopathology Index (RHI)) were evaluated for internal concordance and their correlation with FC concentrations. The concordance between different histologic indices was high. FC levels demonstrated fair correlations with clinical, endoscopic, and histologic parameters. Notably, an FC threshold below 100 μg/g predicted histologic remission with greater than 80% accuracy, irrespective of the histologic scoring system applied. These results underscore the potential of FC as a reliable, non-invasive biomarker indicative of histologic remission.

There was a moderate to strong correlation among histologic indices (Geboes Score, Continuous Geboes Score, Nancy Index, Robarts Histopathology Index) and poor to fair correlation between clinical or endoscopic indices (partial Mayo score, Mayo endoscopic score, total Mayo score) and histologic indices.
The concordance between different histologic indices was high.
The FC values had fair correlations with clinical, endoscopic, and histologic scores.
A cutoff for FC (less than 100 μg/g) had >80% accuracy in identifying patients who were in histologic remission, regardless of the histologic indices used.

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IBD

Gut, bone, and muscle: the triad of osteosarcopenia in inflammatory bowel disease: Shilpa Sharma; Intest Res 2025;23(3):254-289. Published online April 29, 2025; DOI: https://doi.org/10.5217/ir.2024.00185

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Inflammatory bowel disease (IBD) is a group of chronic inflammatory conditions affecting the gastrointestinal tract that can lead to multiple systemic complications. Among these, osteosarcopenia has emerged as a significant concern, characterized by the concurrent deterioration of bone density and muscle mass, strength, and function. This dual deterioration significantly elevates the risk of falls and fractures, thereby exacerbating morbidity and diminishing quality of life. The pathogenesis of IBD-associated osteosarcopenia is multifactorial, with chronic intestinal inflammation serving as a central driver. Pro-inflammatory cytokines simultaneously disrupt bone homeostasis and muscle metabolism, creating a catabolic environment that impacts both tissues. Nutritional deficiencies, common in IBD due to malabsorption and decreased dietary intake, further compromise both bone mineralization and muscle protein synthesis. Management requires a comprehensive approach combining nutritional optimization, structured physical therapy, and lifestyle modifications. Pharmacological interventions integrate diseasespecific treatments with targeted therapies including vitamin D supplementation, hormonal treatments, and bisphosphonates when indicated. This review synthesizes current evidence regarding the prevalence, pathogenesis, and clinical impact of osteosarcopenia in IBD, highlighting areas requiring further investigation.

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Osteosarcopenic obesity and the progression of physical frailty, cognition function, and mental health: First longitudinal evidence from ELSA
Qihang Yang, Yibo Qiao, Pengfei Shi, Zongqiang Huang
The Journal of nutrition, health and aging.2026; 30(1): 100744. CrossRef

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