Intestinal Research

Association between remnant cholesterol and advanced colorectal adenoma in individuals under 50 years of age: Kwangmin Joo, Jong Yoon Lee, Jong Hoon Lee; Received March 18, 2026 Accepted April 13, 2026 Published online June 11, 2026; DOI: https://doi.org/10.5217/ir.2026.00093 [Epub ahead of print]

Abstract PDF: Background/Aims
The incidence of early-onset colorectal cancer is rising globally. While metabolic dysregulation is a known risk, the specific contribution of lipid profiles to colorectal carcinogenesis in young adults remains unclear. Remnant cholesterol (RC) has emerged as a significant cardiovascular risk factor, but its association with young-onset colorectal neoplasia is not fully elucidated.
Methods
We conducted a retrospective, cross-sectional study of 4,100 asymptomatic individuals under 50 years of age undergoing screening colonoscopy. RC was calculated as total cholesterol minus high-density lipoprotein cholesterol and low-density lipoprotein cholesterol. We used multivariate logistic regression to assess the independent association between RC levels and the presence of young-onset adenoma (YOA) and advanced YOA.
Results
Patients with YOA had significantly higher RC levels than controls (17.65 ± 14.52 mg/dL vs. 14.69 ± 11.14 mg/dL; P< 0.001). In adjusted multivariate analysis, RC was independently associated with YOA risk (odds ratio [OR], 1.011; 95% confidence interval [CI], 1.003–1.019; P= 0.005). Notably, for advanced YOA, RC remained the only lipid parameter that retained statistical significance in the multivariable model (OR, 1.021; 95% CI, 1.004–1.038; P= 0.015), whereas traditional lipid markers were not significant.
Conclusions
Higher RC levels were independently associated with YOA and advanced YOA in this cohort of asymptomatic individuals under 50 years of age. Among the lipid parameters examined, RC remained statistically significant in the multivariable model for advanced YOA.

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Current burden and health care utilization of inflammatory bowel disease in the United States, 2023–2024: Donghee Kim, Pojsakorn Danpanichkul, Karn Wijarnpreecha, Sidhartha R. Sinha, Aijaz Ahmed; Received February 11, 2026 Accepted April 23, 2026 Published online June 11, 2026; DOI: https://doi.org/10.5217/ir.2026.00046 [Epub ahead of print]

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Evidence-based clinical practice guidelines for diagnosis and medical management of acute colonic diverticulitis developed by the Korean Association for the Study of Intestinal Diseases (KASID): Jae Gon Lee, Yong Eun Park, Ji Young Chang, Hyun Joo Song, Duk Hwan Kim, Young Joo Yang, Byung Chang Kim, Myung-Won You, Kyuwon Kim, Kwang Woo Kim, Yuna Kim, Seong-Eun Kim, Seung-Jae Myung, on behalf of the Clinical Practice Guideline Taskforce of the Korean Association for the Study of Intestinal Diseases; Received November 28, 2025 Accepted December 28, 2025 Published online June 8, 2026; DOI: https://doi.org/10.5217/ir.2025.00299 [Epub ahead of print]

Abstract PDF: Acute colonic diverticulitis is a common gastrointestinal inflammatory disorder. The incidence of acute colonic diverticulitis has been steadily increasing in Korea, particularly among younger and middle-aged adults. This rising prevalence, along with the observed differences in clinical characteristics compared to Western populations, underscores the need for region-specific, evidence-based guidance. The Korean Association for the Study of Intestinal Diseases (KASID) established a task force to develop these clinical practice guidelines to optimize the diagnosis and medical management of acute colonic diverticulitis tailored to the Korean healthcare environment. These guidelines were developed through a systematic literature review, critical appraisal of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, and expert consensus via a modified Delphi method. They addressed 12 clinical questions encompassing prognostic factors, diagnostic modalities, initial management for uncomplicated diverticulitis, management of complications, and prevention of recurrence. The resulting recommendations provide clinicians with evidence-based guidance for individualized management based on patients’ condition and values. These guidelines aim to enhance the quality of care and optimize outcomes for patients with acute colonic diverticulitis in Korea.

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Rapid diagnosis and therapeutic mitigation in inflammatory bowel disease: utilizing the window of opportunity–findings from the UAE Epi-IBD study: Thaer Khaleel Swaid, Layth Raafat Hamzeh, Laurette L. Bukasa, Tine Jess, Mohammed Nabil Quraishi; Received January 25, 2026 Accepted April 12, 2026 Published online June 1, 2026; DOI: https://doi.org/10.5217/ir.2026.00032 [Epub ahead of print]

Abstract PDF: Background/Aims
To determine time to diagnosis (TTD) and its impact on surgery and advanced therapy (AT) burden in inflammatory bowel disease (IBD) in a multi-ethnic United Arab Emirates (UAE) cohort, a region in the acceleration phase of IBD incidence.
Methods
Retrospective analysis of the UAE Epi-IBD registry. TTD was calculated from patient-reported symptom onset to diagnosis. Logistic, Poisson regression and Cox proportional hazards models were used. Sensitivity analyses using 6- and 18-month thresholds and TTD quartiles were performed.
Results
Among 243 patients (148 Crohn’s disease [CD], 95 ulcerative colitis [UC]), median TTD was 4.0 months (interquartile range [IQR], 1.5–9.0 months) for CD and 3.0 months (IQR, 1.0–7.0 months) for UC (P= 0.111, Wilcoxon; log-rank P= 0.054), shorter than pooled estimates from high-income countries. UC TTD accelerated significantly post-2021 (2.0 months vs. 5.5 months; P= 0.006), while CD remained stable (P= 0.646). Diagnostic speed was identical between tertiary and non-tertiary settings (P= 0.943). Diagnostic delay did not predict AT exposure (P= 0.986) or surgical risk (P= 0.586); instead, penetrating CD phenotype drove therapy burden (P= 0.019). Time to first AT was rapid (median 4.5 months for CD, 14.0 months for UC). Era-stratified analysis showed a trend toward higher AT use in 2021 to 2025 (incidence rate ratio, 1.36; 95% CI, 0.98–1.89; P= 0.071), consistent with expanding therapeutic availability, though null association between delay and outcomes persisted after adjustment.
Conclusions
TTD in this cohort is shorter than global benchmarks and comparable to recent Asian data. Diagnostic delay did not predict adverse outcomes, though limited surgical events and short follow-up preclude definitive conclusions. Multiple factors beyond healthcare system architecture may contribute, and larger multicenter studies are needed.

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Utilizing intestinal ultrasound to assess treatment response in ulcerative colitis: Shintaro Sagami, Taku Kobayashi; Received January 5, 2026 Accepted April 8, 2026 Published online June 1, 2026; DOI: https://doi.org/10.5217/ir.2026.00006 [Epub ahead of print]

Abstract PDF: Intestinal ultrasound (IUS) enables frequent, noninvasive assessment of inflammatory activity in ulcerative colitis and can support treat-to-target decisions without bowel preparation. Evidence from prospective cohorts indicates that early IUS changes within 1 to 2 weeks—particularly reductions in bowel wall thickness and color Doppler vascularity—are associated with shortterm response and can guide timely treatment optimization during induction. Follow-up assessments at 6 to 12 weeks further improve risk stratification by reassessing bowel wall thickness and Doppler vascularity, including composite indices such as the Milan Ultrasound Criteria, which correlate with endoscopic outcomes and subsequent medium- to long-term clinical events (e.g., relapse and colectomy). This review synthesizes the most reproducible IUS parameters and proposes a practical, time-windowed monitoring approach integrating IUS with symptoms, biomarkers, and endoscopy, whereby assessments within 1–2 weeks and again at 6–12 weeks provide actionable information to accelerate induction optimization and anticipate later outcomes in ulcerative colitis.

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Incidence and treatment-based risk stratification of opportunistic infections in patients with inflammatory bowel disease: an ambispective cohort study in Brazil: José Eugenio Rios Ricci Jr, Tarsila Campanha da Rocha Ribeiro, Fernando Antonio Basile Colugnati, Lívia de Almeida Costa, Pedro de Morais, Jordana AS Lopes, Hugo B Araújo, Matheus A Pacheco, Mariana V de S Paulo, João Baptista de Paula Fraga, Lucélia Paula Cabral Schmidt, Thais de Andrade Almeida, Roberta Oliveira Raimundo Borsato, Liliana Andrade Chebli, Júlio Maria Fonseca Chebli; Received September 4, 2025 Accepted February 11, 2026 Published online May 21, 2026; DOI: https://doi.org/10.5217/ir.2025.00208 [Epub ahead of print]

Abstract PDF PubReader ePub: Background/Aims
The risk of opportunistic infections (OIs) in inflammatory bowel disease (IBD) patients in Latin America is poorly known. We assessed the incidence and stratified the risk of OIs in IBD patients on immunosuppressive therapies.
Methods
In this ambispective cohort study, we retrospectively analyzed the medical charts of IBD patients between March 2014 and March 2021 and prospectively analyzed those from April 2021 to April 2024. The incidence rate of OIs was expressed as the number per 1,000 patient-years (PY) and calculated for each treatment category. The risks of OIs associated with immunosuppressants were compared with exposure to aminosalicylates or no treatment using the Cox proportional hazards model.
Results
In a total of 3,279.6 PY of follow-up, OIs occurred in 60 of 498 patients (12.0%) with an incidence rate of 18.3 per 1,000 PY. The most common OIs were herpes zoster (HZ; n=28, 5.6%) and tuberculosis (n=17, 3.4%). The incidence rates of HZ and tuberculosis were 8.5 and 5.18 per 1,000 PY, respectively. Compared with patients on aminosalicylates or no treatment, the risk of OIs was higher in those on combination therapies with anti-tumor necrosis factor (TNF) and thiopurines (hazard ratio [HR], 7.67; 95% confidence interval [CI], 2.26–26.06), followed by thiopurine monotherapy (HR, 5.35; 95% CI, 1.56–18.3), and antiTNF monotherapy (HR, 5.04; 95% CI, 1.50–16.97).
Conclusions
IBD patients on long-term anti-TNF and/or thiopurine therapy had a higher risk of OIs, especially HZ and tuberculosis, compared with non-immunosuppressed patients. In the choice of therapies for IBD, the balance of individual drug effectiveness and safety is crucial.

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Guselkumab efficacy and safety in East Asian participants with moderately to severely active Crohn’s disease: subgroup analysis of the phase 3 GALAXI 2 and GALAXI 3 trials: Hiroshi Nakase, Baili Chen, Qian Cao, Katsuyoshi Matsuoka, Tadakazu Hisamatsu, Dong Il Park, Keira Herr, Bryan Wahking, Wai Chun Yiu, Jianmin Zhuo, Minhu Chen; Received July 22, 2025 Accepted January 12, 2026 Published online May 21, 2026; DOI: https://doi.org/10.5217/ir.2025.00150 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Guselkumab, a dual-acting interleukin-23p19 subunit inhibitor, demonstrated efficacy and safety in participants with moderately to severely active Crohn’s disease in the global phase 3 GALAXI 2 and 3 trials. We report a subgroup analysis in East Asian participants.
Methods
GALAXI 2 and 3 (NCT03466411) are identical, 48-week treat-through trials. Participants were randomized 2:2:2:1 to guselkumab 200 mg IV every 4 weeks (q4w; ×3), followed by 100 mg SC every 8 weeks (q8w) or 200 mg SC q4w; ustekinumab; or placebo. Placebo participants not in clinical response at week (W)12 received ustekinumab. Co-primary endpoints were the composite of clinical response at W12 and clinical remission at W48, and the composite of clinical response at W12 and endoscopic response at W48. This subgroup analysis included participants from China, Japan, South Korea, and Taiwan.
Results
The East Asian subgroup included 192 participants. Rates of clinical response at W12 and clinical remission at W48 with guselkumab were 55.6% (100 mg SC q8w) and 51.0% (200 mg SC q4w) versus 3.1% with placebo. Rates of clinical response at W12 and endoscopic response at W48 with guselkumab were 44.4% (100 mg SC q8w) and 39.2% (200 mg SC q4w), versus 0% for placebo. Numerically higher proportions of guselkumab participants achieved clinical and endoscopic outcomes at W48 relative to ustekinumab. Adverse event rates were consistent with the global population.
Conclusions
Efficacy of guselkumab in East Asian participants was consistent with that observed in the global GALAXI 2 and 3 population. The safety profile was favorable and consistent with previous reports.

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Real-world use and perceptions of advanced combined therapies in treating inflammatory bowel disease: Hsin-Yun Wu, Zhi-Che Chen, Meng-Tzu Weng, Agnes Hiu Yan Ho, Joyce Wing Yan Mak, Rupert W Leong, Siew-Chien Ng, Uma Mahadevan, Fernando Magro, Deng-Chyang Wu, Shu-Chen Wei; Received December 18, 2025 Accepted March 17, 2026 Published online May 19, 2026; DOI: https://doi.org/10.5217/ir.2025.00325 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Combining therapies targeting distinct pathways shows promise in breaking the therapeutic ceiling for inflammatory bowel disease. The study explored real-world experiences and gaps between current evidence and clinical practice regarding advanced combined therapies.
Methods
A cross-sectional online survey was conducted via QR code during meetings or email invitation. The survey covered participant demographics, experiences with advanced combined therapies for ulcerative colitis, Crohn’s disease, and knowledge of these therapies.
Results
Between March and October of 2024, 234 participants from 20 countries replied and 51.7% had adopted advanced combined therapies (86.0% had treated ulcerative colitis, 66.9% Crohn’s disease, and 52.9% both). Among the 48.3% who had no experience, 76.1% would try if indicated. Refractory diseases were the most common indications. For combined therapies duration, 52.8% were time-oriented, favoring limited use within 6 months. Physicians reported no adverse events in 59.5% of cases. Of the events, infections (69.8%) were most common. Add-on strategy was the most commonly adopted, particularly the Janus kinase inhibitor added on anti-integrin for ulcerative colitis and anti-tumor necrosis factor alpha added on anti-interleukin 12/23 for Crohn’s disease. Concomitant strategy followed, while sequential strategy was the least used. More non-Asian experts were experienced (82.4%) compared to Asian participants (46.5%). Both inexperienced and non-Asian physicians preferred add-on strategy, but prioritized goal-oriented use, targeting clinical and endoscopic remission.
Conclusions
In real-world practice, advanced combined therapies were primarily used for refractory inflammatory bowel disease with limited duration. Add-on use was the most adopted. Differences in treatment approaches reflect varying levels of physician experience and geographical locations.

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Transabdominal intestinal ultrasound parameters as intermediate treatment targets in a treat-to-target strategy for moderate-to-severe ulcerative colitis: Longxi Yun, Zhaojue Wang, Qingli Zhu, Yalong Zhu, Hui Xu, Bei Tan, Wenbo Li, Yue Li; Received November 12, 2025 Accepted January 25, 2026 Published online May 19, 2026; DOI: https://doi.org/10.5217/ir.2025.00286 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
This study aimed to investigate the prognostic value of early post-induction intestinal ultrasound (IUS) f indings in predicting long-term clinical outcomes among patients with moderate-to-severe ulcerative colitis (UC).
Methods
This retrospective, single-center study consecutively enrolled patients with moderate-to-severe, left-sided or extensive UC. Clinical endpoints were assessed at the end of follow-up or 1 year after induction therapy (for patients with at least 1 year of follow-up) and categorized as clinical remission (Short Clinical Colitis Activity Index [SCCAI] ≤2) or non-remission (SCCAI >2). Patients who experienced a negative disease course before the evaluation point were classified as clinical non-remission.
Results
A total of 56 patients were included. The bowel wall thickness (BWT; 5.1±1.7 mm vs. 6.0±1.4 mm; P=0.032) and Milan ultrasound criteria (MUC; 8.3±3.2 vs. 9.9±2.2; P=0.029) evaluated at early follow-up IUS were lower for patients reaching longterm clinical remission. Patients with BWT <5 mm on early follow-up IUS (83% vs. 45%; P=0.006) or MUC <6.2 (100% vs. 45%; P<0.001) had a significantly higher rate of long-term clinical remission. Kaplan-Meier analysis revealed a lower cumulative probability of a negative disease course in patients with BWT <5 mm (P=0.025) or MUC <6.2 (P=0.025). Cox regression analysis identified BWT ≥5 mm as an independent predictor of a negative disease course.
Conclusions
BWT <5 mm and MUC <6.2 may serve as intermediate targets for IUS-guided “treat-to-target” strategy, offering a practical approach to improve longterm clinical remission in patients with moderate-to-severe UC.

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Appropriate J-pouch volume associated with improved clinical outcomes and long-term quality of life in patients with ulcerative colitis after ileal pouch-anal anastomosis: results from China UC Pouch Center Union: Weimin Xu, Zhujiang Dai, Wenjun Ding, Long Cui, Xiaojian Wu, Wei Zhou, Zhao Ding, Peng Du; Received January 4, 2026 Accepted February 23, 2026 Published online May 7, 2026; DOI: https://doi.org/10.5217/ir.2026.00003 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
A well-functioning and well-constructed pouch is crucial for the long-term quality of life (QOL) in ulcerative colitis (UC) patients after ileal pouch-anal anastomosis (IPAA). What pouch volume is appropriate to construct to maintain satisfactory pouch function for better long-term prognosis remains unknown.
Methods
UC patients who underwent IPAA from January 2008 to January 2024 in our pouch surgery centers affiliated with the China UC Pouch Center Union were enrolled. The primary outcomes were the occurrence of postoperative complications and impaired long-term QOL.
Results
A total of 222 eligible UC patients with a median follow-up time of 8.0 years (interquartile range, 4.0–10.3 years) were enrolled. Among the patients, 117 (52.7%) had a pouch with volume <120 mL, whereas 105 (47.3%) had a pouch volume ≥120 mL. We found that patients with pouch volume ≥ 120 mL were more likely to achieve significantly improved long-term QOL (P= 0.013), better bowel function (P= 0.030) as well as have decreased risk of late postoperative complications (P= 0.005), mainly presented as pouchitis (P= 0.039). Furthermore, we demonstrated that a small pouch with volume < 120 mL is an independent risk factor for the development of late postoperative complications (odds ratio, 2.157; P= 0.013) and impaired long-term QOL (odds ratio, 2.049; P= 0.018).
Conclusions
A J-pouch volume ≥ 120 mL could be a considerable option for colorectal surgeons in pouch configurations to achieve better long-term prognosis.

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Safety of Janus kinase inhibitors compared to biologic therapy in patients with inflammatory bowel disease: Gursimran S. Kochhar, Himsikhar Khataniar, Parambir S. Dulai, Aakash Desai; Received September 21, 2025 Accepted January 28, 2026 Published online May 7, 2026; DOI: https://doi.org/10.5217/ir.2025.00232 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
There is a paucity of data regarding the comparative safety of Janus kinase inhibitors (JAKi) compared to biologic therapy in inflammatory bowel disease (IBD).
Methods
A retrospective cohort study was conducted using the U.S. Collaborative Network to assess the risk of adverse events in patients with IBD on JAKi compared to biologic therapies (tumor necrosis factor inhibitor, ustekinumab or vedolizumab). Outcomes assessed included infections, major adverse cardiovascular events (MACE), malignancy, venous thromboembolism (VTE), gastrointestinal perforations and laboratory abnormalities within 2 years. 1:1 propensity score matching (PSM) was performed.
Results
There were 3,186 patients in the JAKi cohort (mean age 44.3 ± 17.1, 46.5% male sex, 85.7% ulcerative colitis, 72% tofacitinib) and 60,462 patients in the biologic cohort. After PSM, there was no difference in the risk of bacterial (adjusted odds ratio [aOR], 1.08; 95% confidence interval [CI], 0.82–1.43), viral (aOR, 1.06; 95% CI, 0.84–1.32), or fungal infections (aOR, 1.10; 95% CI, 0.84–1.44), MACE (aOR, 0.72; 95% CI, 0.47–1.10), malignancy (aOR, 0.98; 95% CI, 0.71–1.35), and VTE (aOR, 0.95; 95% CI, 0.67–1.34). This was consistent in subgroup analyses based on IBD type, JAKi type and age group. There was a higher risk of low-density lipoprotein ≥ 190 mg/dL (aOR, 1.78; 95% CI, 1.03–3.05) and grade 3 or higher lymphopenia (aOR, 2.28; 95% CI, 1.60–3.26) in the JAKi cohort. There was no difference in the 4-year risk of MACE or malignancy in the tofacitinib cohort compared with the biologic cohort.
Conclusions
Our real-world study did not show an increased risk of adverse events except severely elevated LDL and lymphopenia in patients on JAKi compared to biologic therapy.

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Dyslipidemia and hyperglycemia synergistically increase the risk of intestinal barrier dysfunction: evidence from a case-control study in China: Chao Zhang, Dandan Lin, He Yu, Ying Yang, Zongtao Chen; Received July 31, 2025 Accepted October 30, 2025 Published online May 7, 2026; DOI: https://doi.org/10.5217/ir.2025.00163 [Epub ahead of print]

Abstract PDF PubReader ePub: Background/Aims
Previous evidence regarding the combined effects of metabolic disorders on intestinal barrier function (IBF) remains limited. We hypothesized that metabolic disorders interact to increase the risk of intestinal barrier dysfunction.
Methods
This retrospective case-control study included 4,289 individuals who underwent IBF assessment. Controls with normal biomarker levels were propensity score–matched to cases with abnormal D-lactic acid, diamine oxidase (DAO), or endotoxin. Logistic regression and interaction models were applied to assess associations between metabolic indicators and intestinal barrier dysfunction.
Results
Hypertension (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.20–1.55; P< 0.001), dyslipidemia (OR, 1.70; 95% CI, 1.49–1.96; P< 0.001), and hyperglycemia (OR, 1.80; 95% CI, 1.57–2.08; P< 0.001) were significantly associated with intestinal barrier dysfunction. Subgroup analyses confirmed that dyslipidemia and hyperglycemia were independently associated with elevated DAO, D-lactic acid, and endotoxin levels. Both multiplicative and additive interactions were observed between key metabolic factors. Particularly, dyslipidemia and hyperglycemia showed significant additive interactions (relative excess risk due to interaction, 0.79 [95% CI, 0.19–1.35, P= 0.008]; attributable proportion due to interaction, 0.29 [95% CI, 0.06–0.46, P= 0.008]; synergy index, 1.82 [95% CI, 1.13–3.41, P= 0.008]). When stratified by age and sex, broadly similar trends were observed in participants aged ≥ 50 years and in males.
Conclusions
Dyslipidemia and hyperglycemia are associated with intestinal barrier dysfunction and show a synergistic combined effect. Individuals with both should receive prioritized IBF monitoring and early metabolic intervention to protect barrier integrity.

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Acute severe ulcerative colitis in the biologic era: has the clinical spectrum truly changed?: Published online April 21, 2026

Abstract

Clinical spectrum of acute severe ulcerative colitis in the biologic era: a prospective cohort study from India
Intest Res. 2026;24(2):236-247

Acute severe ulcerative colitis (ASUC) remains a life-threatening complication of ulcerative colitis that requires urgent hospitalization and rapid therapeutic escalation. In this issue, Singh et al. report findings from a prospective cohort of 145 patients with ASUC in India (2020–2024) offering a contemporary view of its clinical spectrum.
Although the proportion of patients presenting with ASUC as their initial manifestation has declined from ~25% to 12%, nearly 60% were diagnosed within 1 year of disease onset, pointing to an inherently aggressive early-onset subgroup. Notably, this study confirms that even in the biologic era, ASUC remains a highly severe condition, with intravenous corticosteroid failure occurring in 27.6% of patients, a rate comparable to that reported in historical cohorts. Importantly, modifiable precipitating factors — including poor adherence (29.6%), antibiotic use (24.1%), psychological stress (22.1%), and C. difficile infection (13.1%) — represent actionable targets in clinical practice. The relatively low colectomy rate (4.8%) reflects the successful shift toward medical rescue strategies, yet the fundamental biology of steroid refractoriness remains unresolved.
Although the single-center design and relatively small sample size limit the generalizability, this study provides valuable real-world insight into the contemporary clinical spectrum and management patterns of ASUC in the biologic era. These findings underscore that while biologics have successfully reduced colectomy through effective medical rescue strategies, they have not altered the upstream disease biology that drives steroid refractoriness.

The proportion of patients presenting with ASUC as the initial manifestation of ulcerative colitis has decreased from ~25% to 12%, yet 60% of patients were diagnosed within 1 year of their ASUC presentation — suggesting a subgroup with inherently aggressive early-onset disease.
Despite widespread prior exposure to immunosuppressants and biologics, the rate of intravenous corticosteroid failure (27.6%) remained unchanged from historical cohorts, indicating that current therapies have not altered the fundamental biology of steroid refractoriness.
Common precipitating factors included poor treatment adherence (29.6%), antibiotic use (24.1%), high perceived stress (22.1%), recent travel (20.7%), and Clostridioides difficile infection (13.1%).
Rescue medical therapy was required in 20% of patients (infliximab 48.3%, tofacitinib 31.0%, cyclosporine 20.7%), and colectomy during index hospitalization remained low at 4.8%, reflecting a shift toward intensive medical management.

Best regards,

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Integrated endoscopic and medical approaches for Crohn’s disease-associated strictures: Rintaro Moroi, Yoichi Kakuta, Atsushi Masamune; Received December 12, 2025 Accepted January 6, 2026 Published online April 20, 2026; DOI: https://doi.org/10.5217/ir.2025.00317 [Epub ahead of print]

Abstract PDF PubReader ePub: Crohn’s disease (CD) frequently results in fibrostenotic or anastomotic intestinal strictures, a major cause of morbidity despite advances in medical therapy. Endoscopic management is a central component of stricture treatment, providing organ-preserving alternatives to surgery. This review summarizes the current evidence for 3 principal endoscopic modalities: endoscopic balloon dilation (EBD), endoscopic stricturotomy (ES), and stent-based interventions. EBD, the most widely used technique, is recommended as the first-line therapy for short, non-angulated strictures, with consistently high technical and clinical success; however, repeat dilations are required during long-term follow-up. ES using an electrosurgical knife offers a targeted solution for fibrotic or EBD-refractory strictures, achieving high technical success, even in anatomically complex lesions, although delayed bleeding may occur. Stent-based interventions, including self-expandable metallic stents and biodegradable stents, have recently re-emerged as an option for intermediate-length or difficult strictures, including those beyond the typical length limit for EBD or ES; short-term, removable, anti-migration stents show a more favorable safety profile. These 3 modalities provide complementary strengths, and treatment selection should be individualized based on stricture length, morphology, location, associated inflammation, prior surgery, and endoscopist expertise. An integrated approach that optimizes endoscopic and medical therapies is essential for improving long-term outcomes and minimizing the need for repeated surgery in patients with CD.

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One-year effectiveness and safety of ustekinumab treatment in patients with ulcerative colitis: an Asan-Crohn’s and Colitis Association in Daegu-Gyeongbuk (CCAiD) multicenter real-world cohort study: Ji Eun Baek, Min Kyu Kim, Eun Soo Kim, Kyeong Ok Kim, Hyeong Ho Jo, Sung Wook Hwang, Sang Hyoung Park, Byung Ik Jang, Eun Young Kim, Sung Kook Kim, Suk-Kyun Yang, Byong Duk Ye; Received October 12, 2025 Accepted December 30, 2025 Published online April 20, 2026; DOI: https://doi.org/10.5217/ir.2025.00258 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
This study aimed to evaluate the 1-year effectiveness and safety of ustekinumab (UST) in Korean patients with ulcerative colitis (UC).
Methods
We conducted a multicenter retrospective study of UC patients who received UST between January 2021 and October 2023. The primary endpoint was clinical remission at week (W) 8. Secondary endpoints included clinical remission at W16–20 and W52–56; corticosteroid-free clinical remission at W8, W16–20, and W52–56; clinical response at the same time points; endoscopic remission at W16–20 and W52–56; UST interval shortening and persistence through W52–56; and adverse events (AEs).
Results
Sixty patients were included. After excluding one patient in clinical remission at baseline, 49.2% (29/59) achieved clinical remission at W8. Clinical remission rates were 59.3% (35/59) at W16–20 and 55.9% (33/59) at W52–56. Endoscopic remission was achieved in 15.3% (9/59) at W16–20 and 11.9% (7/59) at W52–56. The 12-month UST persistence rate was 84.9%. Multivariable analysis identified factors associated with clinical remission at W52–56: higher body mass index at baseline (adjusted odds ratio [aOR], 1.26; 95% confidence interval [CI], 1.00–1.57; P< 0.05), concomitant immunomodulator use (aOR, 4.69; 95% CI, 1.04–21.06; P= 0.04), and endoscopic improvement at W16–20 (aOR, 13.47; 95% CI, 2.87–63.30; P< 0.01), while prior exposure to advanced therapies was associated with lower remission (aOR, 0.20; 95% CI, 0.04–0.98; P< 0.05). AEs occurred in 24 patients (40.0%), with 1 serious AE (1.7%).
Conclusions
UST showed favorable 1-year effectiveness and an acceptable safety profile in Korean patients with UC.

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Impact of Portulaca oleracea L. extract in patients with irritable bowel syndrome: Kwangwoo Nam, Jung Ho Choi, Yong Sung Kim, Seong Lee, Jee Hun Park, Hyeongjoo Kim, Sangyun Lee, Yerin Lee, Doohyuck Lee, Sunghyeok Ryou, Jeong Eun Shin; Received August 31, 2025 Accepted December 28, 2025 Published online April 20, 2026; DOI: https://doi.org/10.5217/ir.2025.00200 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Portulaca oleracea is known to have anti-inflammatory and immunoregulatory effects, and also showed positive effect on complete spontaneous bowel movement and bowel symptoms in patients with chronic constipation in a previous study. Thus, we aimed to investigate the impact of P. oleracea in patients with irritable bowel syndrome (IBS).
Methods
Patients with IBS defined by ROME IV criteria were enrolled between July 2022 and April 2023. Patients were randomly assigned to P. oleracea or placebo group and took drugs for 8 weeks. Clinical data including gastrointestinal and IBS symptoms, laboratory tests including inflammatory and immunologic laboratory markers, and stool tests including fecal calprotectin and stool microbial analysis were evaluated at the baseline, week 4, and week 8.
Results
A total of 108 patients were initially enrolled and 101 patients were finally included in the analysis. There was significant improvement during 8 weeks in P. oleracea group compared to placebo group in the aspect of gastrointestinal and IBS-related bowel symptoms (Gastrointestinal Symptom Rating Scale total score: from 44.1 to 31.7 vs. from 41.4 to 39.9; IBS-Symptom Severity Score total score: from 232.0 to 120.6 vs. from 202.7 to 178.2), especially in the aspect of abdominal pain. Interleukin-6 (IL-6) was significantly decreased during 8 weeks in P. oleracea group, although there was no significant difference between 2 groups. In addition, increase in IL-6 during study period was significantly associated with dysbiosis in stool microbial analysis. There was no significant adverse event.
Conclusions
P. oleracea has positive impact in patients with IBS showing improvement of immunologic cytokine and stool microbiome.

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IBD

Practices and perceptions of imaging assessment in inflammatory bowel disease: a nationwide survey of physicians in Korea by the KASID Guidelines Taskforce Team: Ji Eun Kim, Young Joo Yang, June Hwa Bae, Seung Yong Shin, Dong Hyun Kim, Seung Min Hong, Eun Mi Song, 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, Myung Ha Kim, Won Moon, Sung-Ae Jung, KASID Guidelines Taskforce Team of the Korean Association for the Study of Intestinal Diseases (KASID); Intest Res 2026;24(2):270-280. Published online April 17, 2026; DOI: https://doi.org/10.5217/ir.2026.00043

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Imaging-based assessment is essential for evaluating disease activity and structural damage in inflammatory bowel disease (IBD). This study aimed to evaluate real-world use and perceptions of imaging modalities among Korean IBD experts and to identify implications for future domestic guideline development.
Methods
A nationwide, web-based survey was conducted among board-certified gastroenterologists affiliated with the Korean Association for the Study of Intestinal Diseases. The questionnaire assessed respondent characteristics, imaging modality use in Crohn’s disease (CD) and ulcerative colitis (UC), and perceptions of clinical utility using a 5-point Likert scale. Results were summarized as frequencies and percentages.
Results
Of 150 invited clinicians, 133 responded, with 74.4% practicing in tertiary referral centers. In CD, computed tomography enterography (CTE) and magnetic resonance enterography (MRE) were the most used modalities at diagnosis and follow-up. In contrast, IUS utilization was low (6.8% at diagnosis and 10.5% during follow-up), and 82.0% reported no intestinal ultrasound (IUS) use in the preceding year. In UC, CT-based strategies also predominated, and more than half reported no imaging during follow-up. Major barriers to IUS adoption included limited experience, time constraints, and institutional or equipment limitations. CT/CTE and MRE were perceived as useful for diagnosis and complication assessment, whereas IUS was viewed as suitable for repeated monitoring but highly operator dependent.
Conclusions
IBD imaging practices in Korea rely predominantly on CT-based modalities, with limited real-world use of MRE and IUS despite their recognized clinical potential. Future Korean guidelines should acknowledge these real-world limitations while encouraging gradual integration of MRE and IUS.

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Biology and preclinical models of colorectal cancer metastasis: Yoojeong Seo, Jinho Jang, Jae-Il Park; Received December 9, 2025 Accepted January 5, 2026 Published online March 26, 2026; DOI: https://doi.org/10.5217/ir.2025.00315 [Epub ahead of print]

Abstract PDF PubReader ePub: Metastatic colorectal cancer (mCRC) is the principal cause of CRC-related mortality, yet the biology of mCRC remains only partly understood and challenging to interrogate experimentally. Despite recent progress in mapping recurrent genetic and epigenetic alterations and treatment responses of mCRC, these efforts provide limited insight into how heterogeneous primary tumors breach tissue barriers, survive in circulation, and colonize distant organs. In this review, we summarize current experimental systems for studying mCRC, including genetically engineered mouse models, carcinogen-induced and transplant models, and patient-derived organoid and xenograft platforms, and discuss how each captures or fails to capture key steps of the metastatic cascade and organ-specific microenvironments. We highlight practical obstacles to longitudinal sampling and quantitative readouts of metastatic burden, as well as conceptual gaps in modeling immune and stromal influences. Finally, we outline how emerging approaches, including single-cell and spatial transcriptomics, and advances in longitudinal tracking of metastatic burden could be combined into an integrated framework that more faithfully links mechanistic insight to clinical behavior and ultimately to metastasis-specific therapies.

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Clinical usefulness of fecal calprotectin in assessing disease activity and endoscopic remission in intestinal Behçet’s disease: Woojin Ahn, Seoyoon Choi, So Jung Han, Soo Jung Park, Jae Jun Park, Tae Il Kim, Jihye Park, Jae Hee Cheon; Received October 19, 2025 Accepted January 5, 2026 Published online March 26, 2026; DOI: https://doi.org/10.5217/ir.2025.00267 [Epub ahead of print]

Abstract PDF PubReader ePub

Background/Aims
Intestinal Behçet’s disease (BD) is a manifestation of BD involving the gastrointestinal tract. Although fecal calprotectin (FC) is a useful inflammatory marker, its role in intestinal BD is unclear.
Methods
We retrospectively analyzed 78 patients with intestinal BD to evaluate correlations between FC levels and the Disease Activity Index for Intestinal Behçet’s Disease (DAIBD), C-reactive protein (CRP), and erythrocyte sedimentation rate. FC and CRP levels were compared between patients in endoscopic remission and those with active disease. Receiver operating characteristic (ROC) curve analysis was used to evaluate FC’s ability to predict endoscopic activity and ulcer size.
Results
FC levels significantly correlated with DAIBD scores (r= 0.253, P= 0.025) and CRP (r= 0.227, P= 0.046). Patients with endoscopically active disease had higher FC (1,124 ± 1,957 μg/g vs. 367 ± 1,208 μg/g; P< 0.001) and CRP levels (16.0 ± 23.7 mg/L vs. 14.4 ± 46.5 mg/L; P= 0.027) than those in remission. Patients with larger ulcers ( ≥ 30 mm) had higher FC levels than those with smaller ulcers (2,212 ± 2,609 μg/g vs. 962 ± 1,822 μg/g; P= 0.034). An FC cutoff level of 176 μg/g discriminated active endoscopic disease (sensitivity 59.3%, specificity 83.3%), with an area under the ROC curve (AUC) of 0.724 (95% confidence interval, 0.605–0.843; P= 0.002), outperforming CRP (AUC, 0.657).
Conclusions
FC levels correlated with DAIBD scores and endoscopic inflammation in intestinal BD. FC outperformed CRP in detecting endoscopic activity, supporting its use in disease management.

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Behçet's Disease: Scoping Review with ☸️SAIMSARA

SAIMSARA Journal.2026;[Epub] CrossRef

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Prospective evaluation of artificial intelligence-assisted monitoring of the effective withdrawal time on adenoma detection: Thomas Ka Luen Lui, Carla Pui-Mei Lam, Vivien Wai-Man Tsui, Rex Wan-Hin Hui, Elvis Wai-Pan To, Loey Lung-Yi Mak, Michael Kwan-Lung Ko, Kevin Sze-Hang Liu, Cynthia Ka-Yin Hui, Jing Jia Liu, Xiao Xiao, Wai K. Leung; Received October 16, 2025 Accepted December 28, 2025 Published online March 18, 2026; DOI: https://doi.org/10.5217/ir.2025.00262 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Standard withdrawal time (SWT) is a recognized colonoscopy quality metric but may not capture mucosal examination quality. We developed an artificial intelligence (AI)-derived metric, effective withdrawal time (EWT), to quantify clear mucosal visualization. This study prospectively evaluated EWT versus SWT on adenoma detection rate (ADR) and other metrics.
Methods
In this prospective single-center study, patients undergoing colonoscopy were enrolled. EWT was calculated in real-time using an AI system with endoscopists blinded to results. Multivariable analyses assessed the association of EWT and SWT with binary (e.g., ADR) and count outcomes (e.g., adenoma or polyp per colonoscopy [APC or PPC]), adjusting for patient and procedural characteristics.
Results
We analyzed 193 colonoscopies by 16 endoscopists. After adjustment, each 1-minute EWT increase was associated with higher odds of adenoma detection (ADR: odds ratio [OR], 1.38; 95% confidence interval [CI], 1.15–1.67) and a > 2-fold increase in adenomas detected per procedure (APC: incidence rate ratio [IRR], 2.14; 95% CI, 1.97–2.32). Both parameters were significantly better with EWT than SWT (OR, 1.38 vs. 1.06; P< 0.01 for ADR; IRR, 2.14 vs. 1.15; P= 0.02 for APC). EWT demonstrated stronger correlation with APC (R² = 0.97) and PPC (R² = 0.96) than SWT (R² = 0.67 and 0.68, respectively; P< 0.01).
Conclusions
AI-derived EWT is a novel quality indicator reflecting mucosal examination thoroughness, serving as a stronger, more independent predictor of ADR than SWT. (Clinical Trials.gov identifier: NCT06063720)

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Colorectal cancer screening: Technological innovation from single modality testing to a comprehensive intelligent prevention and control system
Dan Ren, Man-Li Cui, Ming-Xin Zhang
World Chinese Journal of Digestology.2026; 34(3): 220. CrossRef

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Deciphering the diet-inflammatory bowel disease relationship: knowledge gaps and future perspectives: Arshdeep Singh, Arshia Bhardwaj, Vandana Midha, Ajit Sood; Received November 5, 2025 Accepted December 28, 2025 Published online March 4, 2026; DOI: https://doi.org/10.5217/ir.2025.00278 [Epub ahead of print]

Abstract PDF PubReader ePub: Diet is increasingly recognized not as a passive exposure but as a dynamic determinant of inflammatory bowel disease (IBD) pathogenesis, progression, and treatment response. This review article redefines diet as a multidimensional modifier acting through complex interactions with genetics, microbiota, intestinal barrier function, and environmental exposures. Beyond nutrient composition, we highlight how age, sex, habitual diet, cooking methods, contaminants, and lifestyle collectively shape disease trajectories. We also identify key research priorities: incorporation of long-term, mechanistically anchored trials; development of digital, biomarker-informed dietary assessment tools; and integration of polygenic, microbial, and metabolic data to inform individualized therapy. Emerging evidence also calls for culturally tailored and patient-centered frameworks that ensure real-world adherence and equity in dietary interventions. Reframing diet as a biological, behavioral, and environmental nexus shifts it from the periphery to the forefront of IBD care, transforming it from a confounder in research to a therapeutic frontier in clinical practice.

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Impact of filgotinib on health-related quality of life over 3 years in Japanese patients with ulcerative colitis: a post hoc analysis of the SELECTION and SELECTION long-term extension trials: Katsuyoshi Matsuoka, Stefan Schreiber, Erina Hata, Toshihiko Kaise, Toshifumi Hibi; Received September 9, 2025 Accepted December 7, 2025 Published online March 4, 2026; DOI: https://doi.org/10.5217/ir.2025.00219 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
This post hoc analysis of the phase 2b/3 SELECTION (NCT02914522) study and its long-term extension (SELECTIONLTE; NCT02914535) evaluated the impact of filgotinib 200 mg (FIL200) on health-related quality of life (HRQoL) and work productivity in Japanese patients with ulcerative colitis over 3 years.
Methods
Patients in SELECTION were randomized to FIL200, filgotinib 100 mg, or placebo (PBO) during the induction phase. Week-10 responders were re-randomized to continue assigned treatment or PBO in the 47-week maintenance phase. Patients who completed the SELECTION induction and maintenance phases (completers) and week-10 non-responders could enter SELECTIONLTE. HRQoL and work productivity were assessed using EQ 5-dimension (EQ-5D), EQ visual analog scale, Inflammatory Bowel Disease Questionnaire (IBDQ), 36-item Short Form Health Survey (SF-36), and Work Productivity and Activity Impairment (WPAI) questionnaires at week 10 (FIL200 vs. PBO), and at week 10 and years 1–3 (completers and non-responders who received only FIL200 in SELECTION+SELECTIONLTE).
Results
Proportions of patients with minimal clinically important differences (MCIDs) at week 10 were higher with FIL200 versus PBO for IBDQ total score (77% vs. 54%), SF-36 mental component summary (58% vs. 21%), and SF-36 physical component summary (54% vs. 36%). All measures (except WPAI absenteeism) showed mean score changes from baseline at week 10 in the direction of improved HRQoL with FIL200 versus PBO. MCID rates were maintained in completers up to 3 years and increased notably in non-responders (except WPAI absenteeism and EQ-5D) from week 10 to years 1–3.
Conclusions
FIL200 treatment was associated with sustained improvements in HRQoL and work productivity over 3 years in Japanese patients with ulcerative colitis, consistent with the overall SELECTION and SELECTIONLTE trial populations.

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Characteristics of monogenic inflammatory bowel disease in very early-onset cases: a Japanese multicenter registry study: Natsuki Ito, Takahiro Kudo, Keisuke Jimbo, Ryusuke Nambu, Fumihiko Kakuta, Tatsuki Mizuochi, Takeshi Saito, Shin-ichiro Hagiwara, Naomi Iwata, Nao Tachibana, Hideki Kumagai, Takashi Ishige, Toshifumi Yodoshi, Mikihiro Inoue, Shigeo Nishimata, Hitoshi Tajiri, Eitaro Hiejima, Mika Sasaki, Sawako Kato, Hirotaka Shimizu, Yuri Hirano, Toshiaki Shimizu, Katsuhiro Arai, Japanese Pediatric Inflammatory Bowel Disease Registry (JPIBD-R); Received September 1, 2025 Accepted December 22, 2025 Published online February 24, 2026; DOI: https://doi.org/10.5217/ir.2025.00203 [Epub ahead of print]

Abstract PDF PubReader ePub: Background/Aims
Very early-onset inflammatory bowel disease (VEO-IBD), defined as IBD diagnosed before 6 years of age, is highly influenced by genetic factors. Monogenic IBD is a type of enterocolitis caused by a single pathogenic variant. However, information on Asian patients with VEO-IBD and monogenic IBD is limited. This study investigated real-world data on VEOIBD and monogenic IBD in Japan.
Methods
We evaluated patients with VEO-IBD registered in the Japanese Pediatric Inflammatory Bowel Disease Registry, a multicenter prospective registry study conducted between 2012 and 2021. We categorized patients into monogenic and non-monogenic IBD groups and compared their clinical characteristics and outcomes.
Results
Among 703 pediatric patients with IBD, 68 (9.7%) had VEO-IBD. Of these, 26 (38.2%) had ulcerative colitis, 16 (23.5%) had Crohn’s disease, 23 (33.8%) had unclassified IBD (IBD-U), and 3 (4.4%) had Behçet’s disease. Genetic testing was performed in 25 patients (36.8%), and monogenic IBD was identified in 5 of the 23 patients with IBD-U (7.4% of the VEO-IBD cohort). All 5 monogenic cases presented with an IBD-U phenotype. Monogenic IBD included A20 haploinsufficiency, interleukin-10 receptor subunit alpha deficiency, chronic granulomatous disease, Wiskott–Aldrich syndrome, and Hermansky–Pudlak syndrome. Monogenic IBD was significantly associated with IBD-U phenotype (P= 0.015) and severe infections before 1 year of age (P= 0.004).
Conclusions
Patients with VEO-IBD who present an IBD-U phenotype and have a history of severe infections during infancy should be prioritized for genetic analysis to investigate the possibility of monogenic IBD.

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Temporal hospitalization trends for inflammatory bowel disease in Taiwan: Hao-Yu Wu, Meng-Tzu Weng, Chien-Chih Tung, Yuan-Ting Chang, Shu-Chen Wei; Received August 31, 2025 Accepted November 19, 2025 Published online February 24, 2026; DOI: https://doi.org/10.5217/ir.2025.00199 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Scant population-based data are available for inflammatory bowel disease (IBD)-related hospitalization rates in Asian countries. We investigated the epidemiological trends of hospitalization rate and lengths of hospital stay of the IBD population in Taiwan.
Methods
Data for the period from 2001 to 2017 were retrieved from the National Health Insurance database. The average annual percentage change (AAPC) was analyzed by summarizing the trend with an underlying Joinpoint regression model. Data for the prebiologics era (2001–2010) and postbiologics era (2011–2017) were compared using regression discontinuity design.
Results
A total of 4,376 patients with IBD were analyzed (1,167 Crohn’s disease [CD] and 3,209 ulcerative colitis [UC]). Between 2001 and 2017, the all-cause hospitalization rates per 100,000 person-years increased significantly in those with IBD (AAPC, 10.5%; 95% confidence interval [CI], 9.6% to 11.4%), CD (AAPC, 14.1%; 95% CI, 10.0% to 18.5%), and UC (AAPC, 10.1%; 95% CI, 8.3% to 11.8%). However, hospitalization rates per 100 patients with IBD decreased for IBD (AAPC, −2.6%; 95% CI, −4.0% to −1.2%) and UC (AAPC, −1.8%; 95% CI, −2.8% to −0.7%) but not for CD (AAPC, −1.6%; 95% CI, −3.5% to 0.4%). Significant downward trends in length of hospital stay were identified for patients with IBD. Hospitalization, surgical, and mortality rates associated with IBD were significantly lower in the postbiologic than in the prebiologic eras.
Conclusions
We observed an upward hospitalization trend relative to the general population but a downward trend within the IBD population in Taiwan. The declining hospitalization, surgical, and mortality rates might be attributed to advances in clinical management.

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Evaluation of the Mayo endoscopic score in ulcerative colitis using a multimodal large language model: a human-blinded accuracy study: Antonietta Gerarda Gravina, Raffaele Pellegrino, Giuseppe Imperio, Michele Izzo, Ilaria De Costanzo, Fabio Landa, Stefano Pellegrino, Alessandro Federico; Received July 16, 2025 Accepted September 21, 2025 Published online February 12, 2026; DOI: https://doi.org/10.5217/ir.2025.00138 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
To date, some large language models (LLMs), such as Chat Generative Pre-trained Transformer 4-omni (ChatGPT-4o), can process images through visual transformer patching. An LLM analysis was conducted to assess the ability of ChatGPT-4o to assign the Mayo endoscopic score (MES).
Methods
A selection set of high-quality endoscopic frames was identified to compare 4 input models to select the most performant, confirmed in an extended set of 304 frames. Concordance with the evaluation by expert endoscopists was assessed.
Results
Only one of the pre-tested models demonstrated significant concordance (κ = 0.232, 95% confidence interval [CI] = 0.167 to 0.296, P= 0.003; ρ = 0.36, P= 0.011), with a mean bias of –0.26 ± 1.192 (95% CI, –2.596 to 2.076). This was confirmed in the extended set (κ = 0.260, 95% CI = 0.195 to 0.324, P< 0.001; ρ = 0.288, P< 0.001). The absolute concordance for the selected model was 44% and 45.3% in the selection and extended sets, respectively. For the identification of moderately-to-severely active disease, a sensitivity of 73% (95% CI, 60% to 82%), specificity of 60% (95% CI, 54% to 66%), positive predictive value of 32% (95% CI, 25% to 40%), and negative predictive value of 90% (95% CI, 84% to 93%) were identified.
Conclusions
ChatGPT-4o shows a mild potential in evaluating MES in endoscopic frames, but further refinements are mandatory.

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Editorial: The emerging role of large language model chatbots in gastroenterology and digestive endoscopy
Antonietta Gerarda Gravina, Raffaele Pellegrino, Rocco Maurizio Zagari
Frontiers in Medicine.2026;[Epub] CrossRef

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Colitis-associated colorectal neoplasia in ulcerative colitis with primary sclerosing cholangitis: a nationwide study: Koichi Komatsu, Takahide Shinagawa, Motoi Uchino, Hiroki Ikeuchi, Koji Okabayashi, Shiro Oka, Kitaro Futami, Michio Itabashi, Kazuhiro Watanabe, Masatsune Shibutani, Yoshiki Okita, Toshifumi Wakai, Yusuke Mizuuchi, Kinya Okamoto, Kazutaka Yamada, Yu Sato, Takayuki Ogino, Hideaki Kimura, Kenichi Takahashi, Koya Hida, Yusuke Kinugasa, Fumio Ishida, Junji Okuda, Koji Daito, Takayuki Yamamoto, Seiichiro Yamamoto, Fumikazu Koyama, Tsunekazu Hanai, Koji Komori, Dai Shida, Junya Arakaki, Yoshito Akagi, Shigeki Yamaguchi, Hideki Ueno, Keiji Matsuda, Atsuo Maemoto, Riichiro Nezu, Shin Sasaki, Eiji Sunami, Tatsuki Noguchi, Kenichi Sugihara, Yoichi Ajioka, Soichiro Ishihara, the Study Group for Inflammatory Bowel Disease Associated Intestinal Cancers by the Japanese Society for Cancer of the Colon and Rectum; Received July 14, 2025 Accepted September 21, 2025 Published online February 12, 2026; DOI: https://doi.org/10.5217/ir.2025.00133 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Ulcerative colitis (UC)-associated colorectal neoplasia (UCAN) in patients with UC and primary sclerosing cholangitis (PSC) has not been studied well in Japan. This retrospective study examined the clinicopathological features and prognosis of UCAN in patients with PSC-UC.
Methods
A total of 808 patients with UCAN were enrolled from 1983 to 2020 and categorized into PSC (PSC-UCAN, n = 26) and no PSC (UCAN-alone, n = 782) groups. Clinicopathological features were compared between the 2 groups, and the 10-year overall survival (OS) and cancer-specific survival (CSS) were analyzed.
Results
The PSC-UCAN group had a shorter UC duration before UCAN diagnosis (12.8 years vs. 16.9 years, P= 0.044), were younger at UCAN diagnosis (47.8 years vs. 53.3 years, P= 0.046), and developed UCAN more frequently in the right-sided colon (34.6% vs. 15.9%, P= 0.028) than the UCAN-alone group. The PSC-UCAN group showed a trend toward a lower proportion of high-grade dysplasia (19.2% vs. 30.7%) and a higher proportion of early-stage cancers (53.9% vs. 31.2%). The 10-year OS (64.6% vs. 79.3%, P=0.080) and CSS (80.8% vs. 83.9%, P=0.60) were comparable.
Conclusions
Patients with PSC-UCAN showed earlier and younger development of UCAN than patients with only UCAN, with a high prevalence in the right-sided colon. Early-stage cancer was more frequently observed in the PSC-UCAN group, despite the shorter duration of UC. Patients with PSC-UC probably benefit from early initiation of surveillance colonoscopy.

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Efficacy and safety of subcutaneous guselkumab in East Asian participants with moderately to severely active Crohn’s disease: subgroup analysis of the phase 3 GRAVITI study: Wenjia Liu, Hong Guo, Tae Oh Kim, Ken Takeuchi, Tadakazu Hisamatsu, Jennifer Fable, Mobolaji Olurinde, Bryan Wahking, Keira Herr, Jianmin Zhuo, Qian Cao; Received June 23, 2025 Accepted October 2, 2025 Published online February 12, 2026; DOI: https://doi.org/10.5217/ir.2025.00107 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
The GRAVITI (NCT05197049) study demonstrated efficacy and safety of guselkumab, a dual-acting interleukin-23p19 subunit inhibitor, as subcutaneous (SC) induction and maintenance therapy in participants with moderate to severely active Crohn’s disease (CD). We report post hoc subgroup analyses in East Asian participants.
Methods
Seventy-one East Asian participants were randomized 1:1:1 to guselkumab 400 mg SC every 4 weeks (q4w) (x3) followed by 100 mg SC every 8 weeks (q8w) starting at Week 16 (n = 23), guselkumab 400 mg SC q4w (x3) followed by 200 mg SC q4w starting at Week 12 (n = 20), or placebo (n = 28) in the phase 3 double-blind, placebo-controlled, treat-through GRAVITI study. From Week 16, placebo participants meeting rescue criteria were eligible for rescue treatment with guselkumab. Clinical remission at Week 12 and endoscopic response at Week 12 were co-primary endpoints, additional endpoints included Patient-Reported Outcome-2 remission (Week 12), clinical response (Week 12), clinical remission (Week 24 and Week 48), and endoscopic response (Week 48), and safety through Week 48.
Results
Greater proportions of East Asian participants receiving guselkumab 400 mg SC achieved clinical remission versus placebo (41.9% vs. 14.3%) and endoscopic response versus placebo (39.5% vs. 21.4%) at Week 12. At Week 48, greater proportions of participants in both guselkumab groups (100 mg SC q8w, 69.6%; 200 mg SC q4w, 60.0%) achieved clinical remission versus placebo (10.7%) and endoscopic response versus placebo (43.5%, 60.0%; vs. placebo 0.0%). The adverse event profile was generally consistent with the global population.
Conclusions
Efficacy and safety results of SC guselkumab in East Asian participants with moderately to severely active CD reflect findings from the global study.

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Efficacy and safety of mirikizumab in maintenance therapy for ulcerative colitis in difficult-to-treat inflammatory bowel disease: a single-center retrospective study in Japan: Ichiro Mizushima, Yusuke Yoshimatsu, Hiroki Kiyohara, Shinya Sugimoto, Tomohisa Sujino, Kaoru Takabayashi, Yohei Mikami, Takanori Kanai; Received August 13, 2025 Accepted November 19, 2025 Published online February 11, 2026; DOI: https://doi.org/10.5217/ir.2025.00176 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Randomized controlled trials have confirmed the efficacy and safety of mirikizumab, an anti-interleukin-23p19 monoclonal antibody, for moderate-to-severe active ulcerative colitis (UC). However, there are no real-world data on the efficacy and safety of mirikizumab for UC as maintenance therapy, especially in difficult-to-treat inflammatory bowel disease (DTT-IBD). This study aimed to evaluate the long-term efficacy and safety of mirikizumab in patients with UC of DTT-IBD.
Methods
This was a single-center retrospective observational study involving adult patients with UC who received mirikizumab between January 2023 and April 2025 and met the criteria for DTT-IBD (e.g., failure of biologics and advanced small molecule drugs with at least 2 different mechanisms of action). The primary outcome was the clinical response at week 52. Secondary outcomes included steroid-free clinical remission within 52 weeks and the persistency of mirikizumab use. Adverse events were also recorded.
Results
Thirty-two patients were included in this study. The median 2-item patient-reported outcome score at baseline was 3 (interquartile range, 2–4). The proportion of patients with a clinical response at week 52 was 33.3% (95% confidence interval, 14.6%–57.0%). Steroid-free clinical remission was achieved in 26.7% (95% confidence interval, 12.3%–45.9%) of the patients. The cumulative continuous rate of mirikizumab use at week 52 was approximately 60%. Only 1 patient developed a serious adverse event requiring hospitalization (pneumonia), and mirikizumab was successfully resumed after recovery.
Conclusions
The present study demonstrated real-world data regarding maintenance therapy with mirikizumab for UC among patients with DTT-IBD.

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Safety and effectiveness of budesonide rectal foam for ulcerative colitis in a large-scale, multicenter, prospective observational study: final report of post-marketing surveillance in Japan: Masayuki Saruta, Teppei Omori, Akira Nagaki, Yuki Arai, Minami Umeyama, Shinsuke Kurosu, Kiyotoshi Kuramoto, Yasuo Suzuki; Received July 31, 2025 Accepted November 13, 2025 Published online February 11, 2026; DOI: https://doi.org/10.5217/ir.2025.00164 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Budesonide rectal foam was approved in Japan in 2017 for mild to moderate active ulcerative colitis (UC). This is the final report of post-marketing surveillance to evaluate real-world safety and effectiveness.
Methods
This Japanese large-scale, prospective, multicenter, open-label observational study included patients with active-phase mild to moderate UC newly started on budesonide 2 mg rectal foam. Safety was evaluated by adverse drug reactions (ADRs). Effectiveness was evaluated using clinical remission rates and partial Mayo scores. Effectiveness by background (disease phenotype, severity, clinical course, age, prior topical therapy, baseline advanced therapy [biologicals/Janus kinase inhibitors]) was also assessed.
Results
There were 633 and 503 patients in the safety and effectiveness analyses, respectively. ADRs occurred in 4.3% (27/633) of patients. Eight glucocorticoid-related ADRs occurred in 7 patients (1.1%). Clinical remission rates were 44.2% (165/373), 72.1% (191/265), and 69.8% (333/477) at week 2, week 6, and the final evaluation, respectively. There were statistically significant changes from baseline in partial Mayo scores at all timepoints (all P< 0.0001 vs. baseline). At 2, 4, 6, and 6–12 weeks, mean± standard deviation changes from baseline in partial Mayo scores were −2.1 ± 1.9, −2.7 ± 2.1, −3.1 ± 2.3, and −3.4 ± 2.3 points, respectively. Statistically significant improvements were maintained at all timepoints in subgroup analyses by background (disease phenotype, severity, clinical course, age, prior topical therapy, baseline advanced therapy).
Conclusions
No new safety concerns were identified. Partial Mayo score improved in a variety of patient background factors. Health condition improvements were confirmed in this Japanese post-marketing surveillance. (Japan Registry of Clinical Trials, identifier jRCT1080223802)

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Real-world effectiveness and safety of upadacitinib in Korean patients with inflammatory bowel disease: a single-center retrospective study: Ji Eun Kim, Yeong Chan Lee, Minjee Kim, Eun Ran Kim, Dong Kyung Chang, Young-Ho Kim, Sung Noh Hong; Received September 22, 2025 Accepted December 7, 2025 Published online February 10, 2026; DOI: https://doi.org/10.5217/ir.2025.00235 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Upadacitinib, a selective Janus kinase 1 inhibitor, has demonstrated efficacy in clinical trials for inflammatory bowel disease (IBD); however, real-world data from Asian populations remain limited.
Methods
We conducted a singlecenter retrospective study to evaluate the real-world effectiveness and safety of upadacitinib in Korean patients with ulcerative colitis (UC) or Crohn’s disease (CD). Adult patients who initiated upadacitinib between July 2021 and November 2024 were included. Symptom-based clinical activity was assessed using patient-reported outcomes at baseline and 6 months. Adverse events and surgical interventions were also documented.
Results
Forty patients (28 CD, 12 UC) were analyzed. At 6 months, symptom-based clinical remission was achieved in 82.4% of CD and 81.8% of UC patients, with clinical response rates of 88.2% and 90.9%, respectively. No clinical or treatment-related factors were significantly associated with remission in univariate analyses. Adverse events occurred in 57.5% of patients, all grade 1, and no treatment discontinuations were required. Six patients with CD required surgery during treatment.
Conclusions
Upadacitinib was effective and well tolerated over 6 months in Korean patients with moderate-to-severe IBD, including those with biologic-experienced patients. These findings support its use in routine clinical practice, while highlighting the need for prospective studies to confirm its long-term safety and efficacy in Asian populations.

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Association between anti-tumor necrosis factor alpha exposure and new-onset autoimmune diseases in inflammatory bowel disease: a nationwide case-control study in Korea: Shin Ju Oh, Ji Eun Kim, Su Jin Jeong, Chang Kyun Lee, the Big Data Research Group (BDRG) of the Korean Society of Gastroenterology; Received September 2, 2025 Accepted December 3, 2025 Published online February 10, 2026; DOI: https://doi.org/10.5217/ir.2025.00195 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Autoimmune-related events following anti-tumor necrosis factor alpha (anti-TNF-α) therapy are increasingly reported, but population-level data on new-onset autoimmune disease in inflammatory bowel disease (IBD) remain limited. We evaluated whether anti-TNF-α exposure is associated with autoimmune disease development in IBD.
Methods
We conducted a nationwide population-based case-control study using data from the Korean National Health Insurance Service database (2004–2018). Patients with IBD who developed new-onset autoimmune diseases, including psoriasis, interstitial lung disease (ILD), systemic lupus erythematosus, systemic vasculitis, and central nervous system disorders, were matched 1:1 to controls by age, sex, diagnosis year, and IBD subtype. Logistic regression with propensity score matching and spline modeling was used to assess associations, including subgroup and sensitivity analyses.
Results
Among 8,586 matched pairs, anti-TNF-α therapy was associated with increased risks of autoimmune disease (adjusted odds ratio [aOR], 1.65), particularly psoriasis (aOR, 1.58) and ILD (aOR, 1.88). A non-linear dose–response relationship was observed: the risk rose sharply at early exposure, plateaued at approximately 30 prescriptions, and gradually declined beyond 64. This association remained regardless of prior immunosuppressant use and was attenuated but significant in immunosuppressant users with psoriasis. No significant associations were found for systemic lupus erythematosus, central nervous system disorders, or vasculitis. Patients receiving prolonged concomitant therapy ( ≥ 90 days) showed increased risk (aOR, 1.43). Monotherapy showed a non-significant trend (aOR, 1.19).
Conclusions
Anti-TNF therapy for IBD is associated with an increased risk of developing new-onset autoimmune diseases, especially psoriasis and ILD. Careful monitoring is warranted, particularly in patients receiving prolonged or combined immunosuppressive therapies.

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First-line biologic therapy selection highly impacts ulcerative colitis outcomes: results from the APPETISER study: Diari M’Baye, Marianne Hupé, Marie Dodel, Maëva Bazoge, Bruno Pereira, Anthony Buisson; Received July 5, 2025 Accepted November 13, 2025 Published online February 10, 2026; DOI: https://doi.org/10.5217/ir.2025.00125 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
We compared the effectiveness of 2 strategies based on the choice of the first biologic owing to either drug efficacy or better acceptability in patients with ulcerative colitis (UC).
Methods
We collected real-world data of all consecutive UC patients ≥ 18 years starting a first line of biologic for active UC with follow-up > 6 months. Patients were considered as receiving either an effectiveness-based strategy (EBS) if they started with infliximab or vedolizumab, or acceptability-based strategy (ABS) if they started with adalimumab or golimumab. Corticosteroid-free clinical remission (PRO2-CFREM) was defined as the absence of bleeding, normalization of stool frequency and no steroid assessed as a binary criterion each month. All comparisons were adjusted using propensity scores.
Results
Overall, 130 patients and 3,355 months were analyzed. The percentage of months spent in PRO2-CFREM within the first 24 months (primary endpoint) was greater in EBS arm than in ABS arm (74.2% vs. 46.6%; P< 0.001), was higher within the first 6 months (60.4% vs. 18.9%), and was not rescued later between months 7 and 12 (73.1% vs. 38.6%), months 13 and 18 (79.9% vs. 57.0%) or M19 and M24 (83.3% vs. 64.6%) (P< 0.001 for all comparisons). EBS group had a lower risk to first-line biologic discontinuation (adjusted hazard ratio [aHR], 6.5; 95% confidence interval [CI], 2.8–15.3: P< 0.001) and a trend for lower risk of colectomy (aHR, 4.5; 95% CI, 0.9–22.3; P= 0.068).
Conclusions
The choice of first-line biologic is highly impacting UC outcome and cannot be fully compensated by later treatments, advocating for the use of the most effective therapeutic option as first-line biologic.

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Analysis of gut microbiota in super donors for fecal microbiota transplantation and isolated gut commensal bacteria of inhibition against Clostridioides difficile: Ki Sung Kang, Gee Hyeun Choi, Yu Jin Kim, Won Suk Lee, Do Eun Lee, Min Yeong Kim, Hyuk Yoon, Dong Ho Lee; Received August 18, 2025 Accepted November 25, 2025 Published online February 4, 2026; DOI: https://doi.org/10.5217/ir.2025.00179 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Fecal microbiota transplantation (FMT) is increasingly recognized as an alternative to antibiotics for treating recurrent Clostridioides difficile infection. The success of FMT heavily depends on the appropriate selection of donors, encompassing factors such as diet patterns, lifestyle, environmental exposures, and intestinal microbiota diversity.
Methods
A potential super donor was identified from 5 healthy adults and provided stool samples periodically over 2 years (2021–2022). The samples underwent 16S rRNA sequencing via the Illumina MiSeq platform, and microbial diversity was analyzed using QIIME 2 in comparison with 152 healthy individuals.
Results
The stool microbiome composition of the potential super donor remained stable without significant changes over a 2-year period. Both alpha and beta diversity analyses revealed significant differences between the super donor and the 152 healthy individuals. The super donor exhibited significantly higher microbial diversity based on alpha diversity metrics (P< 0.0001) and distinct compositional profiles as shown by beta diversity. Linear discriminant analysis effect size (LEfSe) analysis indicated that Faecalibacterium and Prevotella strains comprised a significant proportion, with notable differences in relative abundance patterns (P< 0.05). Furthermore, 7 bacterial species were isolated from the super donor, all of which demonstrated inhibitory effects on the growth of C. difficile in vitro.
Conclusions
These findings suggest that selecting donors with specific microbiota profiles, particularly those exhibiting higher microbial diversity, may potentially contribute to the inhibition of C. difficile, and further clinical studies are warranted to validate these findings.

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Do endoscopists really need to switch between 10‑mm and 15‑mm cold snares for 4–10 mm colorectal polyps?: Published online January 29, 2026

Abstract

Does the Size of the Cold Snare Affect the Outcome of Cold Snare Polypectomy in the Colon? A KASID Prospective Multicenter Study
Intest Res. 2026;24(1):76-83

Cold snare polypectomy (CSP) is now widely recommended for removing colorectal polyps smaller than 10 mm, as it provides effective resection without electrocautery, thereby reducing the risk of thermal injury and shortening procedure time. However, in real-world practice, endoscopists often alternate between different snare sizes—or simply continue using a larger snare after performing EMR—raising practical concerns about precision, bleeding risk, and completeness of resection, particularly for polyps in the common 4–10 mm range.
In this KASID prospective multicenter study, patients with non-pedunculated polyps measuring 4–10 mm underwent CSP using either a 10-mm or 15-mm dedicated cold snare. Notably, both snares shared identical wire thickness and hexagonal loop design, thereby isolating snare size as the key variable. Among 182 analyzed lesions (10-mm group: 92; 15-mm group: 90), histological complete resection rates were high and did not differ significantly between groups (93.5% vs. 92.2%). No delayed bleeding or perforation events occurred in either group, and immediate outcomes—including intraprocedural bleeding requiring hemostasis—were comparable. Interestingly, multivariable analysis revealed that a larger iatrogenic ulcer (>8 mm), serving as a proxy for adequate resection margin, was associated with higher complete resection rates, whereas snare size itself was not.
This study stands out as a prospective, multicenter, randomized comparison focusing on the most common "small polyp" size range, utilizing two dedicated snares with controlled device characteristics (identical shape and wire thickness) and a clinically meaningful primary endpoint (histological complete resection rate).

In CSP for 4–10 mm non-pedunculated colorectal polyps, histological complete resection rates were 93.5% (10-mm snare) vs. 92.2% (15-mm snare), with no significant difference between groups.
Safety outcomes were reassuring: no delayed bleeding or perforation occurred in either group.
Clinically relevant intraprocedural bleeding requiring hemostasis was similar between groups (6.5% vs. 5.6%), and other technical and safety parameters (e.g., presence of submucosal tissue in specimens, hematoma formation) did not differ significantly.
Snare size was not associated with complete resection; however, an iatrogenic ulcer size >8 mm was independently associated with higher complete resection (OR 3.89), underscoring the importance of adequate margin capture during CSP.
Practical implication: Within the commonly used 10–15 mm snare range for small polyps, endoscopists may reasonably select snare size based on workflow and preference, while focusing their technique on ensuring an adequate resection margin rather than expecting size-driven differences in efficacy.

Best regards,

Kwang Woo Kim

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IBD

Optimal use and cycling strategies of Janus kinase inhibitors in ulcerative colitis: current evidence and clinical implications from the KASID Guidelines Task Force Team: Seung Min Hong, Dong Hyun Kim, June Hwa Bae, Seung Yong Shin, Eun Mi Song, Ji Eun Kim, Young Joo Yang, Jiyoung Yoon, Sang-Bum Kang, Eun Soo Kim, Seong-Eun Kim, Seong-Jung Kim, Jun Lee, Soo-Young Na, Soo Jung Park, Sang Hyoung Park, Miyoung Choi, Myung Ha Kim, Won Moon, Sung-Ae Jung, KASID Guidelines Taskforce Team of the Korean Association for the Study of Intestinal Diseases (KASID); Intest Res 2026;24(1):27-37. Published online January 28, 2026; DOI: https://doi.org/10.5217/ir.2025.00309

Abstract PDF PubReader ePub: Janus kinase (JAK) inhibitors are an important treatment option for ulcerative colitis, providing rapid onset of action, oral administration, and efficacy even after biologic failure. The 3 approved agents—tofacitinib, filgotinib, and upadacitinib—differ in JAK isoform selectivity, leading to clinically meaningful differences in efficacy and safety. Evidence from network meta-analyses, clinical trials, and real-world studies consistently shows that upadacitinib provides the highest efficacy for induction and maintenance of remission, whereas filgotinib demonstrates the most favorable safety profile. The strong efficacy of upadacitinib and tofacitinib is particularly relevant in patients with severe disease, including acute severe ulcerative colitis, and upadacitinib maintains high efficacy regardless of prior advanced therapy exposure. JAK inhibitors also benefit extraintestinal manifestations. Although risks such as herpes zoster, serious infection, thromboembolism, and major cardiovascular events differ among agents, long-term data suggest generally acceptable safety when used appropriately. Intraclass JAK-to-JAK cycling is feasible, with about half of patients achieving steroid-free clinical remission in retrospective cohorts. Based on mechanistic, clinical, and real-world evidence, filgotinib may be a first-line option for patients with lower disease activity or when safety is a priority, whereas upadacitinib or tofacitinib may be preferred in higher disease activity. Strategically selecting agents may improve durability and outcomes.

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Tumor

Does the size of the cold snare affect the outcome of cold snare polypectomy in the colon? A KASID prospective multicenter study: Seongwoo Choi, Jaeyoung Chun, Geunhyuk Choi, Yoojin Lee, Taegeun Gweon, Yunho Jung; Intest Res 2026;24(1):76-83. Published online January 28, 2026; DOI: https://doi.org/10.5217/ir.2025.00189

Abstract PDF PubReader ePub: Background/Aims
Cold snare polypectomy (CSP) is recommended for colorectal polyps <10 mm; however, the impact of snare size on clinical outcomes remains unclear. This study evaluated the efficacy and safety of 10-mm and 15-mm snares for CSP of small colorectal polyps.
Methods
In this prospective multicenter study, patients with 4–10 mm non-pedunculated polyps underwent CSP with either a 10-mm or 15-mm snare. Both snares had identical wire thickness and hexagonal loop design. The primary outcome was histological complete resection rate (CRR). Secondary outcomes included adverse events and technical parameters.
Results
In total, 182 patients were enrolled (10-mm group: n = 92; 15-mm group: n = 90). Baseline characteristics, including age, sex, polyp size, morphology, location, and pathology, were comparable between groups. Histological CRRs were 90.2% in the 10-mm group and 91.1% in the 15-mm group (P= 0.483). No significant differences were observed in the presence of submucosal tissue within specimens (P= 0.523), iatrogenic ulcer size (P= 0.532), hematoma occurrence (P= 0.391), or intraprocedural bleeding requiring hemostasis (6.5% vs. 5.6%; P= 0.974). No cases of delayed bleeding or perforation were reported. Logistic regression analysis identified iatrogenic ulcer size > 8 mm as an independent predictor of complete resection (odds ratio, 3.89; 95% confidence interval, 1.15–13.21; P= 0.029); snare size was not significantly associated with CRR (P= 0.519).
Conclusions
CSP using either a 10-mm or a 15-mm snare for 4–10 mm non-pedunculated colorectal polyps showed no significant difference in complete resection or safety outcomes within this size range. (Clinical Research Information Service [CRIS], KCT0005031)

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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 Supplementary Material PubReader ePub: 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 PubReader ePub: 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 PubReader ePub: 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 Supplementary Material PubReader ePub: 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 Supplementary Material PubReader ePub: 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.

Citations

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Early-Life Iron Exposure Influences Long-Term Gut Microbiota Recovery After Intestinal Dysbiosis
Thibault Maumy, Claire McCartney, Ayodeji Samuel Ajayi, Claire Gerkins, Gabriela Fragoso, Annie Calvé, Manuela M. Santos
Microorganisms.2026; 14(5): 1105. CrossRef

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Tumor

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; Intest Res 2026;24(1):38-51. Published online December 5, 2025; DOI: https://doi.org/10.5217/ir.2025.00180

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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Beyond technique: toward strategy-based endoscopic resection for rectal neuroendocrine tumors
Seong-Jung Kim
The Korean Journal of Internal Medicine.2026; 41(3): 441. CrossRef
Endoscopic Resection of Rectal Neuroendocrine Tumors: Pathologic Risk Stratification and Surveillance Strategies
Ji Eun Kim
Journal of Digestive Cancer Research.2025; 13(3): 228. CrossRef

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2 Crossref

Colorectal neoplasia

Recent updates on the endoscopic treatment of rectal neuroendocrine tumor: Sunghyeok Ryou, Kwangwoo Nam; Intest Res 2026;24(2):208-213. Published online November 27, 2025; DOI: https://doi.org/10.5217/ir.2025.00141

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.

Citations

Citations to this article as recorded by

Beyond technique: toward strategy-based endoscopic resection for rectal neuroendocrine tumors
Seong-Jung Kim
The Korean Journal of Internal Medicine.2026; 41(3): 441. CrossRef
Endoscopic Resection of Rectal Neuroendocrine Tumors: Pathologic Risk Stratification and Surveillance Strategies
Ji Eun Kim
Journal of Digestive Cancer Research.2025; 13(3): 228. CrossRef

3,022 View
171 Download
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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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