Intestinal Research

Original Article

Practices and perceptions of imaging assessment in inflammatory bowel disease: a nationwide survey of physicians in Korea by 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); Received February 4, 2026 Accepted March 12, 2026 Published online April 17, 2026; DOI: https://doi.org/10.5217/ir.2026.00043 [Epub ahead of print]

Abstract PDF: 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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Review

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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Original Articles

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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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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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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Review

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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Original Articles

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.

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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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Reviews

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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Original Article

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

Abstract PDF Supplementary Material PubReader ePub

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

Citations

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Optimizing disease assessment and care pathways for pregnant women with inflammatory bowel disease
Arshdeep Singh, Harmeet Kaur, Arshia Bhardwaj, Vandana Midha, Ajit Sood
Indian Journal of Gastroenterology.2026;[Epub] CrossRef

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Case Report

IBD

Ustekinumab-induced Henoch-Schönlein purpura in Crohn’s disease: a case report and literature review: Merih Deniz Toruner, Tugce Guvenir, Volkan Yilmaz, Ramazan Erdem Er, Murat Toruner; Intest Res 2026;24(1):177-181. Published online November 14, 2025; DOI: https://doi.org/10.5217/ir.2025.00009

Abstract PDF PubReader ePub

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

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Ustekinumab

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

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Reviews

IBD

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

Abstract PDF PubReader ePub

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

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Maternal gut microbial legacy shapes intestinal health and susceptibility of offspring to colitis
Ji-Min Lee, Min-Ji Kim, Hoyul Lee, Yujin Hyun, Sung-Wook Nam, Dong-Gyu Jeon, Jae-Ho Shin, Eun Soo Kim
npj Biofilms and Microbiomes.2026;[Epub] CrossRef

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IBD

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

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

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Original Articles

IBD

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

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

1,617 View
27 Download

IBD

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

Abstract PDF Supplementary Material PubReader ePub

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

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Risk Factors of Latent Tuberculosis Infection among Incarcerated Populations: A Case–Control Study in Shenzhen, China
Zhenyang Liu, Yawei Cui, Jiarong Xu, Zhikai Ding, Ao Huang
Journal of Epidemiology and Global Health.2026;[Epub] CrossRef

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

Abstract PDF Supplementary Material PubReader ePub

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

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Interpreting vedolizumab persistence: lessons from real-world trajectories in ulcerative colitis
Jung Min Moon
Intestinal Research.2026; 24(1): 3. CrossRef

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

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

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

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

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Review

IBD

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

Abstract PDF Supplementary Material PubReader ePub

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

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Rational design of nanotherapy for ulcerative colitis: New strategies, mechanistic approaches, and translational challenges
Wenyuan Xu, Qiulin Deng, Liuhong Chen, Xishun Zhou, Yao Dong, Chenran Ren, Xi Zeng, Deliang Cao
Nanomedicine: Nanotechnology, Biology and Medicine.2026; 71: 102894. CrossRef
Endoscopic and pathologic findings of esophagogastroduodenal involvement in Crohn disease in Korea: a prospective single-center cohort study
Ga Hee Kim, Jihun Kim, Ji Yong Ahn, Sang Hyoung Park, Sung Wook Hwang, Byong Duk Ye, Hwoon-Yong Jung, Suk-Kyun Yang
Inflammatory Bowel Diseases.2026;[Epub] CrossRef
KASID and Intestinal Research journal: a central academic hub for research of intestinal diseases in the Asia-Pacific region
Jae Hee Cheon, Hye Kyung Hyun, You Sun Kim, Dong Il Park, Tae Il Kim, Dong Soo Han
Intestinal Research.2026; 24(1): 6. CrossRef
Comparative analysis of strain-specific gut microbiota dynamics and disease progression in DSS-induced murine colitis
Yeonsu Oh, Ho-Seong Cho
Korean Journal of Veterinary Service.2026; 49(1): 1. CrossRef

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Original Article

IBD

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

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

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221 Download

Review

IBD

Gut, bone, and muscle: the triad of osteosarcopenia in inflammatory bowel disease: Shilpa Sharma; Intest Res 2025;23(3):254-289. Published online April 29, 2025; DOI: https://doi.org/10.5217/ir.2024.00185; Correction in: Intest Res 2026;24(1):192

Abstract PDF PubReader ePub

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

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Osteosarcopenic obesity and the progression of physical frailty, cognition function, and mental health: First longitudinal evidence from ELSA
Qihang Yang, Yibo Qiao, Pengfei Shi, Zongqiang Huang
The Journal of nutrition, health and aging.2026; 30(1): 100744. CrossRef
Correction: Gut, bone, and muscle: the triad of osteosarcopenia in inflammatory bowel disease
Shilpa Sharma
Intestinal Research.2026; 24(1): 192. CrossRef
Cross-talk of gut-bone-muscle: osteosarcopenia in experimental colitis models
Shilpa Sharma
Laboratory Animal Research.2026;[Epub] CrossRef

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Case Report

IBD

Inflammatory bowel disease in a young female patient with a novel de novo TRAF3 frameshift variant responsive to ustekinumab: a case report: Ichiro Takeuchi, Kosuke Taniguchi, Katsuhiro Arai, Toru Uchiyama, Miho Terao, Asuka Hori, Toshinao Kawai, Takako Yoshioka, Reiko Kyodo, Hirotaka Shimizu, Satoshi Fujita, Kenichiro Motomura, Yuka Okazaki, Takashi Ishikawa, Masao Ogura, Kentaro Hayashi, Kenji Matsumoto, Shuji Takada, Masafumi Onodera, Hideaki Morita, Kenichiro Hata; Intest Res 2026;24(1):182-188. Published online April 4, 2025; DOI: https://doi.org/10.5217/ir.2024.00190

Abstract PDF Supplementary Material PubReader ePub: Tumor necrosis factor receptor-associated factor 3 (TRAF3) is an anti-inflammatory molecule that negatively regulates the non-canonical nuclear factor-κB pathway. Although TRAF3 haploinsufficiency (TRAF3 HI) can influence innate and adaptive immune cells, its effect on inflammatory bowel disease (IBD) development remains unclear. Here, we report the first case of severe early-onset IBD with a novel TRAF3 variant leading to HI, successfully treated with ustekinumab. A 6-year-old girl with a recurrent parotitis, otitis media, tonsilitis, and atopic dermatitis developed IBD involving the stomach, small intestine, and colon. At diagnosis, the immunoglobulin (Ig)G and IgA levels were relatively high, and lymphocyte subsets showed increased counts of plasmablasts, class-switch recombination B cells, and circulating T-follicular helper cells. Treatment with azathioprine and infliximab failed to maintain remission marked by several relapses accompanied by erythema nodosum and arthritis; however, ustekinumab, an anti-interleukin (IL)-12/23p40 antibody, led to long-term clinical remission, normalizing the Ig level and reducing abnormal lymphocyte counts. Whole-exome sequencing revealed a novel heterozygous mutation in TRAF3 [p.(Pro487Leufs*8)], resulting in TRAF3 under-expression. Our case may highlight the contribution of TRAF3 HI to the development of IBD and provide insights into IBD pathophysiology, suggesting the involvement of the IL-12/23-T-follicular helper cell pathway affected by genetic mutations.

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Original Articles

IBD

Characteristics and long-term outcomes of children with perianal Crohn’s disease: Ching-Chun Lin, Ichiro Takeuchi, Hirotaka Shimizu, Reiko Kyodo, Mitsuru Kubota, Akira Ishiguro, Katsuhiro Arai; Intest Res 2026;24(1):164-173. Published online March 5, 2025; DOI: https://doi.org/10.5217/ir.2024.00154

Abstract PDF PubReader ePub

Background/Aims
The incidence of perianal lesions (PL) in children with Crohn’s disease (CD) is higher in East Asia than in Western countries. Early intervention for PL is essential to prevent sphincter dysfunction and ostomy placement. In this study, we aimed to investigate the clinical features, treatment, and consequences of pediatric CD with PL.
Methods
We retrospectively reviewed a cohort of children diagnosed with CD from 2010 to 2020 at a Japanese children’s hospital. Demographics, treatments, and outcomes were evaluated and compared among subgroups.
Results
Among 112 pediatric patients with CD, 36 (32.1%) had experienced PL during the observational period. The median ages at diagnosis and follow-up periods were 131 and 70 months, respectively. Six (85.7%) patients in the very early-onset (VEO) group (CD diagnosed before 6 years old) and 24 (82.8%) in the older age group had PL upon diagnosis of CD (P= 0.851). Biologics were given to 94.4% of patients: infliximab (67.7%), adalimumab (58.8%), ustekinumab (44.1%), risankizumab (11.8%), and vedolizumab (5.9%). Biologics were introduced within 1 year in 89.5% and 40.0% of patients diagnosed in 2016–2020 and 2010–2016, respectively (P= 0.002). Seton was frequently used in the older age group (87.5 vs. 42.9%, P= 0.190). Ostomy was frequently required in the VEO group (42.9% vs. 0.0%, P= 0.006).
Conclusions
Patients with VEO-CD and PL had a notably high risk of ostomy placement. The earlier introduction of biologics and surgical interventions reduced corticosteroids use and ostomy placement in pediatric CD patients with PL.

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Asian–Pacific perspectives on the management of very early-onset inflammatory bowel disease
Ichiro Takeuchi, Katsuhiro Arai, Pornthep Tanpowpong, Ming-Wei Lai, Andrew S Day, Way Seah Lee, James Guoxian Huang, Karen Sophia Calixto-Mercado, Rosanna Ming Sum Wong, Muhammad Arshad Alvi, Zubin Grover, Jung Ok Shim, Ujjal Poddar
Intestinal Research.2025; 23(4): 405. CrossRef

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1 Crossref

IBD

Process of empowerment in mothers of children with very-early-onset inflammatory bowel disease: a qualitative study: Mikako Yokoo, Satomi Nomura, Satoe Fukui, Ichiro Takeuchi, Hirotaka Shimizu, Katsuhiro Arai; Intest Res 2026;24(1):151-163. Published online February 24, 2025; DOI: https://doi.org/10.5217/ir.2024.00048

Abstract PDF PubReader ePub: Background/Aims
Mothers of children with very-early-onset inflammatory bowel disease (VEO-IBD) face unique challenges; however, these challenges and their consequences have not been well described. This study clarified the experiences and processes of empowerment of mothers of children with VEO-IBD.
Methods
This study performed a qualitative inductive analysis using semi-structured interviews. The interview content was transcribed, generating core categories, categories, and subcategories with a focus on mothers raising children with VEO-IBD. A modified grounded theory approach was employed to inductively construct a theory from the qualitative data.
Results
Fifteen mothers of children with VEO-IBD were interviewed (mean age, 43.9 ± 6.2 years). The modified grounded theory approach revealed the processes experienced by the mothers. The mothers faced various difficulties when their children developed VEO-IBD; however, their efforts to cope with these difficulties changed their situation. Furthermore, they were supported by various individuals, including family members, medical personnel, and, occasionally, families of other children with VEO-IBD. These processes strengthened and empowered the mothers.
Conclusions
Mothers of children with VEO-IBD who faced various difficulties were empowered through their efforts and support from family and others who understood their challenges. This process of empowerment continues throughout the development of children with VEO-IBD.

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357 Download

IBD

Burden of inflammatory bowel disease in India: analysis of the Global Burden of Disease study from 1990 to 2019: Suprabhat Giri, Anuraag Jena, Praveen Kumar-M, Jaikumar Rajavoor Muniswamy, Preetam Nath, Vishal Sharma; Intest Res 2026;24(1):84-94. Published online February 6, 2025; DOI: https://doi.org/10.5217/ir.2024.00134

Abstract PDF PubReader ePub

Background/Aims
Inflammatory bowel disease (IBD) is increasing across the globe, more so in populous countries like India. We aimed to study the disease burden and epidemiological trends of IBD in India and look closer into the disease pattern across the country from 1990 to 2019.
Methods
The burden of IBD was estimated in India using the data from the Global Burden of Disease estimate for 2019, which is a comprehensive worldwide project. The analysis included various parameters like incidence, prevalence, mortality, disability-adjusted life years, years lived with disability, and years of life lost as age-adjusted rates (per 100,000 population). Using modeling, the prediction was also made for 2050 in India.
Results
The age-standardized incidence, prevalence, mortality, and disability rates of IBD in India for 2019 were 2.34, 20.34, 0.40, and 13.04, respectively. These are lower than the global incidence, prevalence, mortality, and disability rates of 4.97, 59.25, 0.54, and 20.15, respectively. The annual rates of change in incidence, prevalence, mortality, and disability rates in India from 1990 to 2019 were 0.05, –0.02, –0.36, and –0.35, respectively. The annual rates of change in incidence and prevalence are higher than the global rate of –0.18 and –0.19, while the annual rates of change in mortality and disability are lower than the global rate of –0.19 and –0.26.
Conclusions
The incidence and prevalence of IBD in India are lower compared to the global population but are increasing at a faster rate than the global population.

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Chhagan L. Birda, Fadwa Ibrahim, Abhirup Chatterjee, Anuraag Jena, Vishal Sharma, Shaji Sebastian
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Burden of anemia in inflammatory bowel disease: A systematic review and meta-analysis
Rupa Tharu, Savitesh Kushwaha, Rachana Srivastava, Vaneet Jearth, Nitin Kaushal, Anupam Kumar Singh, Shweta Khandelwal, Poonam Khanna
Clinical Epidemiology and Global Health.2026; 37: 102262. CrossRef
Editorial: The Hidden Burden—Stigmatisation in Inflammatory Bowel Disease: Authors' Reply
Suprabhat Giri, Anuraag Jena, Vishal Sharma, Shaji Sebastian
Alimentary Pharmacology & Therapeutics.2026; 63(6): 901. CrossRef
Histological interpretation and reporting of intestinal mucosal biopsies in suspected cases of inflammatory bowel disease: Joint IAPM-ISG-CCFI Working Group Recommendations
Prasenjit Das, Puja Sakhuja, Aminder Singh, Arshdeep Singh, Sagir Akhtar, Saurabh Kedia, Vishal Sharma, Kim Vaiphei, Anna Pulimood, Roopa Rachel Paulose, Anuradha Sekaran, Sanjeev Vasudev Katti, Mala Banerjee, Ritambhra Nada, Nuzhat Hussain, Niraj Kumari,
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Modulation of colonic DNA methyltransferase by mild moxibustion and electroacupuncture in ulcerative colitis TET2 knockout mice
Gege Feng, Yue Zhang, Huangan Wu, Lu Zhu, Hongxiao Xu, Zhe Ma, Yan Huang
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Research Status of Anemia Associated with Inflammatory Bowel Disease
莉娟孙
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Efficacy of tirzepatide for weight loss and it’s comparative effectiveness to weight loss surgery in inflammatory bowel disease
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Priyanka Raju Chougule, Sukesh Narayan Sinha
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Nancy Sahni, Ayushi, Urvashi Rana, Radhika Khosla, Usha Dutta, Rakesh Kochhar, Vishal Sharma
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Modulation of inflammatory and cuproptotic crosstalk by Ethyl and propyl gallate: a multi-targeted strategy against experimental colitis
Priyanka Raju Chougule, Sukesh Narayan Sinha, Sudip Ghosh, Sangaraju Rajendra, Saikanth Varma, Suresh Challa, Manjula Bhanoori
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IBD

Understanding fatigue among Japanese patients with inflammatory bowel disease: insights from international comparisons and meta-analysis: Makoto Tanaka, Momoko Takai, Sayaka Wakai, Kayoko Sakagami, Hiroaki Ito; Intest Res 2025;23(3):372-381. Published online January 22, 2025; DOI: https://doi.org/10.5217/ir.2024.00145

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Background/Aims
Fatigue is a common symptom in patients with inflammatory bowel disease (IBD). The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale has demonstrated reliability and validity in assessing fatigue in patients with IBD and is used worldwide. This study aimed to examine the current state of fatigue among Japanese patients with IBD using the FACIT-F scale and to compare these findings with data from global studies through a systematic review.
Methods
Data from 488 patients with IBD treated at a specialized IBD clinic were analyzed. Patient characteristics, such as sex, age, disease duration, disease activity, FACIT-F scores, and sleep duration, were collected. A literature search identified 8 studies that met our inclusion criteria for an international comparison. A meta-analysis was performed on the Fatigue Subscale (FS) scores of FACIT-F to estimate the pooled mean.
Results
The mean FACIT-F (FS) score in this study was 39.9 ± 8.6. Four variables were significantly associated with fatigue: low Emotional Well-Being subscale scores, sleep duration < 6 hours, albumin level below the reference value, and being unmarried. The meta-analysis revealed that the pooled mean score was 40.2 (95% confidence interval, 39.5–40.9), and between-study heterogeneity was moderate (I² = 41%).
Conclusions
The FACIT-F (FS) scores and related factors in Japanese patients with IBD demonstrated a similar trend to those in other countries. These findings can be used to identify patients in need of support and to consider interventions for modifiable factors. This study will help promote international collaborative research.

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Sexual satisfaction and associated factors among patients with inflammatory bowel disease in Japan
Sayaka Wakai, Makoto Tanaka, Momoko Takai, Kayoko Sakagami, Hiroaki Ito
Japan Journal of Nursing Science.2025;[Epub] CrossRef

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IBD

Factors affecting 1-year persistence with vedolizumab for ulcerative colitis: a multicenter, retrospective real-world study: Taku Kobayashi, Tadakazu Hisamatsu, Satoshi Motoya, Toshimitsu Fujii, Reiko Kunisaki, Tomoyoshi Shibuya, Minoru Matsuura, Ken Takeuchi, Sakiko Hiraoka, Hiroshi Yasuda, Kaoru Yokoyama, Noritaka Takatsu, Atsuo Maemoto, Toshiyuki Tahara, Keiichi Tominaga, Masaaki Shimada, Nobuaki Kuno, Jovelle L. Fernandez, Kaori Ishiguro, Mary Cavaliere, Hisato Deguchi, Toshifumi Hibi; Intest Res 2026;24(1):64-75. Published online January 16, 2025; DOI: https://doi.org/10.5217/ir.2024.00063

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Background/Aims
The objectives of this real-world study were to determine 1-year persistence with vedolizumab in patients with ulcerative colitis and to evaluate factors contributing to loss of response.
Methods
In this multicenter, retrospective, observational chart review, patients with moderately to severely active ulcerative colitis who received ≥ 1 dose of vedolizumab in clinical practice at 16 tertiary hospitals in Japan (from December 2018 through February 2020) were enrolled.
Results
Persistence with vedolizumab was 64.5% (n = 370); the median follow-up time was 53.2 weeks. Discontinuation due to loss of response among initial clinical remitters was reported in 12.5% (35/281) of patients. Multivariate analysis showed that concomitant use of tacrolimus (odds ratio [OR], 2.76; 95% confidence interval [CI], 1.00–7.62; P= 0.050) and shorter disease duration (OR for median duration ≥ 7.8 years vs. < 7.8 years, 0.33; 95% CI, 0.13–0.82; P= 0.017) were associated with discontinuation due to loss of response. Loss of response was not associated with prior use of anti-tumor necrosis factor alpha therapy, age at the time of treatment, disease severity, or concomitant corticosteroids or immunomodulators. Of the 25 patients with disease duration < 1 year, 32.0% discontinued due to loss of response.
Conclusions
Persistence with vedolizumab was consistent with previous reports. Use of tacrolimus and shorter disease duration were the main predictors of decreased persistence.

Citations

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Interpreting vedolizumab persistence: lessons from real-world trajectories in ulcerative colitis
Jung Min Moon
Intestinal Research.2026; 24(1): 3. CrossRef
Real-World Experience of Switching from Intravenous to Subcutaneous Vedolizumab in Korean Patients with Inflammatory Bowel Disease
Yu Kyung Jun, Yonghoon Choi, Cheol Min Shin, Young Soo Park, Nayoung Kim, Dong Ho Lee, Sung Wook Hwang, Hyuk Yoon
Gut and Liver.2026; 20(2): 266. CrossRef
Real-world utility of platelet count, hemoglobin, and iron levels as predictors of clinical response to vedolizumab in patients with ulcerative colitis: a retrospective, single-center study in Poland
Aleksandra Sobolewska-Włodarczyk, Jakub Orliński, Żaneta Witas, Łukasz Woźniak, Zuzanna Łysoń, Anita Gąsiorowska
BMC Gastroenterology.2026;[Epub] CrossRef
Real‐World Effectiveness and Safety of Vedolizumab in Patients ≥ 70 Versus < 70 Years With Ulcerative Colitis: Multicenter Retrospective Study
Tadakazu Hisamatsu, Taku Kobayashi, Satoshi Motoya, Toshimitsu Fujii, Reiko Kunisaki, Tomoyoshi Shibuya, Minoru Matsuura, Sakiko Hiraoka, Ken Takeuchi, Hiroshi Yasuda, Kaoru Yokoyama, Noritaka Takatsu, Atsuo Maemoto, Toshiyuki Tahara, Keiichi Tominaga, Ma
Journal of Gastroenterology and Hepatology.2025; 40(6): 1435. CrossRef
Increasing age at diagnosis raises malignancy risk and aminosalicylate intolerance influences therapeutic strategies in ulcerative colitis: a multicenter I‑BRITE cohort study
Shintaro Akiyama, Yuka Ito, Mamiko Shiroyama, Satoshi Suzuki, Masanori Ochi, Toshiro Kamoshida, Hiroshi Kashimura, Junichi Iwamoto, Rie Saito, Tsuyoshi Kaneko, Kazuto Ikezawa, Yoshinori Hiroshima, Junji Hattori, Takashi Mamiya, Satoshi Fukuda, Kazuho Iked
Journal of Gastroenterology.2025; 60(10): 1259. CrossRef
Mayo Endoscopic Subscore at Week 24 Is a Predictor of Future Loss of Response to Vedolizumab in Patients with Ulcerative Colitis in Clinical Remission
Daisuke Saito, Minoru Matsuura, Hiromu Morikubo, Noritaka Hibi, Haruka Komatsu, Noriaki Oguri, Takeshi Fujima, Haruka Wada, Ryota Ogihara, Tatsuya Mitsui, Mari Hayashida, Jun Miyoshi, Teppei Omori, Tadakazu Hisamatsu
Inflammatory Intestinal Diseases.2025; 10(1): 387. CrossRef

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IBD

Role of 5-aminosalicylic acid in ulcerative colitis management in 8 Asian territories: a physician survey: Julajak Limsrivilai, Allen Yu-hung Lai, Silvia T. H. Li, Murdani Abdullah, Raja Affendi Raja Ali, Satimai Aniwan, Hoang Huu Bui, Jen-Wei Chou, Ida Normiha Hilmi, Wee Chian Lim, Jose Sollano, Michelle Mui Hian Teo, Shu-Chen Wei, Wai Keung Leung; Intest Res 2025;23(2):117-128. Published online January 6, 2025; DOI: https://doi.org/10.5217/ir.2024.00085

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Clinical guidelines typically endorse conventional therapies such as 5-aminosalicylic acid (5-ASA) as the mainstay of ulcerative colitis management. However, the degree of adoption and application of guideline recommendations by physicians within Asia remains unclear. This study aims to understand the prescribing patterns of 5-ASA and implementation of current guideline recommendations across Asian clinical practice. A physician survey was conducted among inflammatory bowel disease specialists in 8 Asian territories to understand practices and preferences in ulcerative colitis management, focusing on the use of 5-ASA and concordance with guideline recommendations. Survey findings were validated by country experts in diverse healthcare settings. Subgroup analyses stratified data by income levels and treatment reimbursement status. Ninety-eight valid responses were received from inflammatory bowel disease specialists or gastroenterologists among 8 economic entities. Significant differences were found in clinical practices and treatment preferences for ulcerative colitis management among different income-level and government-subsidy groups. Survey results are summarized in 8 findings that illustrate trends in 5-ASA use and guideline implementation across Asian territories. This study emphasizes socioeconomic factors that impact the adoption of guideline recommendations in real-world practice. Our findings indicate an eclectic approach to guideline implementation across Asia, based on resource availability and feasibility of treatment goals.

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Selective Drug‐Free Active Surveillance in Ulcerative Colitis: Biomarker‐Guided, Patient‐Centered Approach
Tsutomu Nishida, Naoto Osugi, Takahiro Amano, Takeo Yoshihara
JGH Open.2026;[Epub] CrossRef

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Original Articles

IBD

Persistence of advanced therapies in patients with inflammatory bowel disease: retrospective cohort study using a large healthcare claims database in Japan: Katsuyoshi Matsuoka, Ko Nakajo, Shiho Kawamura, Yongjing Zhang, Hsingwen Chung, Bryan Wahking, Jin Yu Tan, Hong Qiu; Intest Res 2025;23(3):358-371. Published online January 2, 2025; DOI: https://doi.org/10.5217/ir.2024.00118

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
There are few studies that comprehensively report real-world persistence for first-line advanced therapies used to treat inflammatory bowel disease. We aimed to describe persistence of first-line advanced therapies among incident biologic or Janus kinase inhibitor users with inflammatory bowel disease.
Methods
Retrospective cohort study using the Japan Medical Data Center database from January 1, 2010, until September 30, 2022. Patients aged ≥15 years with relevant diagnostic and treatment codes were included. All eligible patients were observed until study end (September 30, 2022), death, or disenrollment, whichever occurred first.
Results
Among 1,115 patients with Crohn’s disease included in the analysis, 41.4% initiated adalimumab, 37.4% infliximab, 18.1% ustekinumab, and 3.0% vedolizumab. Median age was 31.2–34.8 years, 72.8% to 85.9% were male. Persistence at 12 months was 84.7% for adalimumab, 87.7% for infliximab, 91.3% for ustekinumab, and 53.1% for vedolizumab. Persistence at 24 months was 76.3%, 76.8%, 80.4%, and 28.6%, respectively. Among 1,942 patients with ulcerative colitis, 24.8% initiated adalimumab, 33.6% infliximab, 11.2% golimumab, 17.5% vedolizumab, 5.6% ustekinumab, and 7.3% tofacitinib. Mean age was 38.2–40.4 years, 57.4% to 65.8% were male. Persistence at 12 months was 57.6% for adalimumab, 87.7% for infliximab, 54.9% for golimumab, 69.7% for vedolizumab, and 84.0% for ustekinumab. At month 24, persistence for ustekinumab was 75.0%, versus 42.9%–59.4% for other treatments.
Conclusions
Index treatment with ustekinumab resulted in high persistence through 24 months after initiation in patients with Crohn’s disease or ulcerative colitis. Our study provides insights into the real-world usage of advanced treatments for patients with IBD in Japan.

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Real-world outcomes of ustekinumab, vedolizumab, and tumor necrosis factor inhibitors in very-early-onset inflammatory bowel disease: a multi-center cohort study
Ryusuke Nambu, Itaru Iwama, Ichiro Takeuchi, Shin-ichiro Hagiwara, Yuri Etani, Emiri Kaji, Atsushi Yoden, Fumihiko Kakuta, Yusuke Hoshi, Naoya Tsumura, Tatsuki Mizuochi, Hideki Kumagai, Koji Yokoyama, Takuya Nishizawa, Masaaki Usami, Yugo Takaki, Ryo Eban
Journal of Gastroenterology.2026; 61(4): 398. CrossRef
Interpreting vedolizumab persistence: lessons from real-world trajectories in ulcerative colitis
Jung Min Moon
Intestinal Research.2026; 24(1): 3. CrossRef
Effect of Concomitant Immunomodulator Use by UST–CDST Classification on Clinical Relapse in Crohn’s Disease Patients Treated with Ustekinumab: A Multicenter Study
Joo Hye Song, Gyeol Seong, Jongbeom Shin, Sung Min Kong, Boram Cha, Kye Sook Kwon
Digestive Diseases and Sciences.2026;[Epub] CrossRef
Real-World Experience of Switching from Intravenous to Subcutaneous Vedolizumab in Korean Patients with Inflammatory Bowel Disease
Yu Kyung Jun, Yonghoon Choi, Cheol Min Shin, Young Soo Park, Nayoung Kim, Dong Ho Lee, Sung Wook Hwang, Hyuk Yoon
Gut and Liver.2026; 20(2): 266. CrossRef

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IBD

Knowledge and perspectives towards the use of histology in inflammatory bowel disease by gastroenterologists across the Asia-Pacific region: Thanaboon Chaemsupaphan, Aviv Pudipeddi, Huiyu Lin, Hsin-Yun Wu, Julajak Limsrivilai, Wee Chian Lim, Shu-Chen Wei, Rupert W. Leong; Intest Res 2025;23(3):338-346. Published online December 2, 2024; DOI: https://doi.org/10.5217/ir.2024.00086

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Recently, histological mucosal assessment has gained momentum as a potential new treatment target for patients with inflammatory bowel disease (IBD) in the Asia-Pacific region. This study aimed to evaluate and compare the knowledge and acceptability of histological assessment among gastroenterologists across the region.
Methods
A cross-sectional survey among gastroenterologists in the Asia-Pacific region was conducted and compared against a previous Australian survey. The questionnaire assessed knowledge and attitude towards the role and application of histology in IBD practice. Statistical analyses were employed to compare scores and identify predictors.
Results
A total of 221 gastroenterologists from 12 countries, including 77 (34.8%) from Australia, responded to questionnaire, with 185 (83.7%) completing the survey. The mean knowledge score was 9.8 ± 3.3 (51.6%). There was no significant difference in the average score among countries (P= 0.53). IBD specialist (P< 0.01), doctoral degree (P= 0.02), and regular participation in IBD multidisciplinary meetings (P= 0.01) were associated with higher scores. Most respondents (90.7%) agreed on the importance of histology in IBD. While 54.6% of Australians perceived the role of histology as established, only 37.0% of Asians respondents considered this similarly (P= 0.02). Histological activity alone minimally influences treatment escalation in patients with endoscopic remission, but achieving combined histo-endoscopic remission often leads to therapy de-escalation.
Conclusions
Although gastroenterologists in the Asia-Pacific region are aware of the role of histology in IBD, their knowledge remains limited, and its clinical utility is not widely adopted. There is a need to promote the routine use of standardized histological assessment in IBD practice.

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Comparison of the performance between an AI-based vision transformer and human endoscopists in predicting the endoscopic and histologic activities of ulcerative colitis
Yuan-Yen Chang, Han-Po Yang, Yang-Yuan Chen, Hsu-Heng Yen
DIGITAL HEALTH.2026;[Epub] CrossRef
Asia Pacific association of gastroenterology consensus statements on histopathological evaluation of inflammatory bowel diseases
Rupert W. Leong, Thanaboon Chaemsupaphan, Huiyu Lin, Wee Chian Lim, Choon Jin Ooi, John D. Chetwood, Ren Mao, Hsin Yun Wu, Shu Chen Wei, Govind Makharia, Vineet Ahuja, Rupa Banerjee, Raja Atreya, Julajak Limsrivilai, Satimai Aniwan, Pises Pisespongsa, Ida
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef

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Reviews

IBD

Optimizing 5-aminosalicylate for moderate ulcerative colitis: expert recommendations from the Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition: Filiz Akyüz, Yoon Kyo An, Jakob Begun, Satimai Aniwan, Huu Hoang Bui, Webber Chan, Chang Hwan Choi, Nazeer Chopdat, Susan J Connor, Devendra Desai, Emma Flanagan, Taku Kobayashi, Allen Yu-Hung Lai, Rupert W Leong, Alex Hwong-Ruey Leow, Wai Keung Leung, Julajak Limsrivilai, Virly Nanda Muzellina, Kiran Peddi, Zhihua Ran, Shu Chen Wei, Jose Sollano, Michelle Mui Hian Teo, Kaichun Wu, Byong Duk Ye, Choon Jin Ooi; Intest Res 2025;23(1):37-55. Published online November 4, 2024; DOI: https://doi.org/10.5217/ir.2024.00089

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The lack of clear definition and classification for “moderate ulcerative colitis (UC)” creates ambiguity regarding the suitability of step-up versus top-down treatment approaches. In this paper, experts address crucial gaps in assessing and managing moderate UC. The Asia-Pacific, Middle East, and Africa Inflammatory Bowel Disease Coalition comprised 24 experts who convened to share, discuss and vote electronically on management recommendations for moderate UC. Experts emphasized that the goal of treating UC is to attain clinical, biomarker, and endoscopic remission using cost-effective strategies such as 5-aminosalicylates (5-ASAs), well-tolerated therapy that can be optimized to improve outcomes. Experts agreed that 5-ASA therapy could be optimized by maximizing dosage (4 g/day for induction of remission), combining oral and topical administration, extending treatment duration beyond 8 weeks, and enhancing patient adherence through personalized counselling and reduced pill burden. Treatment escalation should ideally be reserved for patients with predictors of aggressive disease or those who do not respond to 5-ASA optimization. Premature treatment escalation to advanced therapies (including biologics and oral small molecules) may have long-term health and financial consequences. This paper provides consensus-based expert recommendations and a treatment algorithm, based on current evidence and practices, to assist decision-making in real-world settings.

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CU104, a novel barrier function enhancer, improves colitis via modulation of barrier function and immune cell recruitment
I Seul Park, Ji Hyung Kim, Dongyeop Kim, Ye Won Kim, Yoojin Shin, Ki Beom Kim, Haiying Zhang, Tae Il Kim, Seung Won Kim, Young-Guen Kwon, Jae Hee Cheon
Frontiers in Immunology.2026;[Epub] CrossRef
Dosing 5-ASA for Ulcerative Colitis: Is the Maximum Optimum?
Nai-Yu Chen, Chiao-Hsiung Chuang
Digestive Diseases and Sciences.2026;[Epub] CrossRef
Inflammatory bowel disease in Africa: the current landscape of pharmacological treatments and the promise of emerging innovations
Murtada A. Oshi
Exploration of Drug Science.2025;[Epub] CrossRef

21,482 View
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3 Crossref

IBD

Complex dichotomous links of nonalcoholic fatty liver disease and inflammatory bowel disease: exploring risks, mechanisms, and management modalities: Kanishk Aggarwal, Bhupinder Singh, Abhishek Goel, Durgesh Kumar Agrawal, Sourav Bansal, Sai Gautham Kanagala, Fnu Anamika, Aachal Gupta, Rohit Jain; Intest Res 2024;22(4):414-427. Published online June 5, 2024; DOI: https://doi.org/10.5217/ir.2024.00001

Abstract PDF PubReader ePub

Nonalcoholic fatty liver disease (NAFLD) has been shown to be linked to inflammatory bowel disease (IBD) due to established risk factors such as obesity, age, and type 2 diabetes in numerous studies. However, alternative research suggests that factors related to IBD, such as disease activity, duration, and drug-induced toxicity, can contribute to NAFLD. Recent research findings suggest IBD relapses are correlated with dysbiosis, mucosal damage, and an increase in cytokines. In contrast, remission periods are characterized by reduced metabolic risk factors. There is a dichotomy evident in the associations between NAFLD and IBD during relapses and remissions. This warrants a nuanced understanding of the diverse influences on disease manifestation and progression. It is possible to provide a holistic approach to care for patients with IBD by emphasizing the interdependence between metabolic and inflammatory disorders.

Citations

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The epidemiology of inflammatory bowel disease: exploring the impacts of environmental factors
Jihye Park, Jae Hee Cheon
The Korean Journal of Internal Medicine.2026; 41(2): 186. CrossRef
Elucidating the association between nonalcoholic fatty liver disease and incidence of inflammatory bowel disease: a focus on systemic inflammation
Sihyun Kim, Jong Pil Im
Intestinal Research.2025; 23(1): 3. CrossRef

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Original Articles

IBD

Early change in serum leucine-rich α-2-glycoprotein predicts clinical and endoscopic response in ulcerative colitis: Ryo Karashima, Shintaro Sagami, Yoko Yamana, Masa Maeda, Aya Hojo, Yusuke Miyatani, Masaru Nakano, Takahisa Matsuda, Toshifumi Hibi, Taku Kobayashi; Intest Res 2024;22(4):473-483. Published online June 5, 2024; DOI: https://doi.org/10.5217/ir.2023.00135

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Background/Aims
Leucine-rich α-2-glycoprotein (LRG) is a new serum biomarker reflecting the disease activity of ulcerative colitis (UC), but its change during the acute phase has not been enough investigated.
Methods
Patients with UC who initiated the induction therapy with steroid or advanced therapy (biologics or Janus kinase inhibitors) were prospectively enrolled. Associations of LRG, C-reactive protein (CRP) and fecal calprotectin (FC) at baseline, week 1, and week 8 with clinical remission at week 8 and subsequent endoscopic improvement within 1 year (Mayo endoscopic subscore of 0 or 1) were assessed.
Results
A total of 143 patients with UC were included. LRG and CRP at week 1 were significantly lower in the clinical remission group than in the non-remission group (LRG, 20.6 μg/mL vs. 28.4 μg/mL, P< 0.001; CRP, 0.9 mg/dL vs. 2.3 mg/dL, P< 0.001) while FC demonstrated the difference between groups only at week 8. The area under the curves of week 1 LRG, CRP, and FC for week 8 clinical remission using the receiver operating characteristic curves analysis were 0.68, 0.71, and 0.57, respectively. Furthermore, LRG and CRP predicted subsequent endoscopic improvement as early as week 1, while FC was predictive only at week 8.
Conclusions
LRG can be an early-phase biomarker predicting subsequent clinical and endoscopic response to induction therapy.

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Real-World Effectiveness of and Optimization Strategies for Mirikizumab in Pediatric Ulcerative Colitis: A Prospective, Observational Study
Keisuke Jimbo, Nobuyasu Arai, Mitsuyoshi Suzuki, Emiko Suzuki, Musashi Hibio, Masumi Nagata, Masamichi Sato, Eri Miyata, Eri Hoshino, Takahiro Kudo, Hiromichi Shoji
Inflammatory Bowel Diseases.2026; 32(4): 711. CrossRef
Role of leucine-rich α-2-glycoprotein in Taiwanese patients with inflammatory bowel disease as a predictive biomarker for endoscopic activity
Yun-Chu Chen, Meng-Tzu Weng, Feng-Pai Tsai, Zhi-Che Chen, Hsin-Yun Wu, Chien-Chih Tung, Chun-Ying Wang, Shu-Chen Wei
World Journal of Gastroenterology.2026;[Epub] CrossRef
Alpha-2 Glycoprotein in Serum as Noninvasive Biomarker of Inflammatory Bowel Diseases Severity in Children
Andrey N. Surkov, Olga B. Gordeeva, Olga E. Krasnova, Sadig T. Fatullaev, Natalya A. Izotova, Evgeniy E. Bessonov, Irine Dzharkava, Albina V. Dobrotok, Albina D. Guseynova, Mariya S. Rudneva, Elizaveta N. Il’yashenko, Leyla S. Namazova-Baranova
Pediatric pharmacology.2026; 22(6): 672. CrossRef
Leucine-rich alpha-2 glycoprotein as a blood biomarker in inflammatory bowel disease: clinical implications and future perspectives
Takayuki Yamamoto
Expert Review of Gastroenterology & Hepatology.2026; 20(2): 147. CrossRef
The diagnostic accuracy of plasma and serum calprotectin is inferior to C-reactive protein in patients with suspected Crohn’s disease
M. H. Rasmussen, J. B. Brodersen, C. L. Brasen, J. S. Madsen, T. Knudsen, J. Kjeldsen, M. D. Jensen
Scandinavian Journal of Gastroenterology.2025; 60(3): 235. CrossRef
Changes of leucine-rich alpha 2 glycoprotein could be a marker of changes of endoscopic and histologic activity of ulcerative colitis
Yuki Aoyama, Sakiko Hiraoka, Eriko Yasutomi, Toshihiro Inokuchi, Takehiro Tanaka, Kensuke Takei, Shoko Igawa, Keiko Takeuchi, Masahiro Takahara, Junki Toyosawa, Yasushi Yamasaki, Hideaki Kinugasa, Jun Kato, Hiroyuki Okada, Motoyuki Otsuka
Scientific Reports.2025;[Epub] CrossRef
Real‐World Effectiveness and Safety of Mirikizumab Induction Therapy in Patients With Ulcerative Colitis: A Multicentre Retrospective Observational Study
Yasuhiro Takagi, Toshiyuki Sato, Takanori Nishiguchi, Akira Nogami, Masataka Igeta, Soichi Yagi, Maiko Ikenouchi, Mikio Kawai, Koji Kamikozuru, Yoko Yokoyama, Toshihiko Tomita, Hirokazu Fukui, Masayuki Fukata, Taku Kobayashi, Shinichiro Shinzaki
Alimentary Pharmacology & Therapeutics.2025; 61(12): 1923. CrossRef
Leucine-Rich Alpha-2 Glycoprotein 1 as a Biomarker for Evaluation of Inflammatory Bowel Disease Activity in Children
Betül Aksoy, Yeliz Çağan Appak, Murat Akşit, Serenay Çetinoğlu, Sinem Kahveci, Şenay Onbaşı Karabağ, Selen Güler, İlksen Demir, İnanç Karakoyun, Maşallah Baran
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Editorial: Real‐World Effectiveness of Mirikizumab in Ulcerative Colitis—A Valuable but Preliminary Glimpse. Authors' Reply
Shinichiro Shinzaki, Yasuhiro Takagi, Toshiyuki Sato
Alimentary Pharmacology & Therapeutics.2025; 61(12): 1967. CrossRef

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IBD/ Endoscopy

Adequacy of sigmoidoscopy as compared to colonoscopy for assessment of disease activity in patients of ulcerative colitis: a prospective study: Sameet Tariq Patel, Anuraag Jena, Sanjay Chandnani, Shubham Jain, Pankaj Nawghare, Saurabh Bansal, Harsh Gandhi, Rishikesh Malokar, Jay Chudasama, Prasanta Debnath, Seemily Kahmei, Rima Kamat, Sangeeta Kini, Qais Q Contractor, Pravin M Rathi; Intest Res 2024;22(3):310-318. Published online May 16, 2024; DOI: https://doi.org/10.5217/ir.2023.00174

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Patients of ulcerative colitis (UC) on follow-up are routinely evaluated by sigmoidoscopy. There is no prospective literature to support this practice. We assessed agreement between sigmoidoscopy and colonoscopy prospectively in patients with disease extent beyond the sigmoid colon.
Methods
We conducted a prospective observational study at a tertiary care institute for agreement between sigmoidoscopy and colonoscopy. We assessed endoscopic activity using the Mayo Endoscopic Score (MES) and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and histological activity using the Nancy Index (NI), Robarts Histopathology Index (RHI), and Simplified Geboes Score (SGS).
Results
Sigmoidoscopy showed a strong agreement with colonoscopy for MES and UCEIS with a kappa (κ) of 0.96 and 0.94 respectively. The misclassification rate for MES and UCEIS was 3% and 5% respectively. Sigmoidoscopy showed perfect agreement (κ = 1.00) with colonoscopy for assessment of the presence of endoscopic activity in the colon using MES ≥ 1 as activity criteria and strong agreement (κ = 0.93) using MES > 1 as activity criteria. Sigmoidoscopy showed strong agreement with colonoscopy for assessment of the presence of endoscopic activity using UCEIS (κ = 0.92). Strong agreement was observed between sigmoidoscopy and colonoscopy using NI (κ = 0.86), RHI (κ = 1.00), and SGS (κ = 0.92) for the detection of histological activity. The misclassification rate for the detection of histological activity was 2%, 0%, and 1% for NI, RHI, and SGS respectively.
Conclusions
Sigmoidoscopy showed strong agreement with colonoscopy for endoscopic and histologic disease activity. Sigmoidoscopy is adequate for assessment of disease activity in patients with UC during follow-up evaluation.

Citations

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Sigmoidoscopy is sufficient to assess endoscopic response to therapy in pediatric ulcerative colitis: A cohort study
Shira Yuval Bar‐Asher, Esther Orlanski‐Meyer, Ibrahim Shamasnah, Dotan Yogev, Dan Turner
Journal of Pediatric Gastroenterology and Nutrition.2026; 82(1): 98. CrossRef
Reshaping study design for faster extrapolation‐based drug approval in pediatric inflammatory bowel diseases: An ESPGHAN–NASPGHAN position paper
Dan Turner, Amit Assa, Mikkel Malham, Shira Yuval Bar‐Asher, Carla Rayan, Jeffrey S. Hyams, Holm H. Uhlig, Brad Pasternak, David C. Wilson, Hilary K. Michel, Lissy de Ridder, Eric Zuckerman, Marina Aloi, Peter Szitanyi, Marla C. Dubinsky, Anne M. Griffith
Journal of Pediatric Gastroenterology and Nutrition.2026; 82(3): 867. CrossRef
ECCO consensus on management of inflammatory bowel disease in low- and middle-income countries
Alaa El-Hussuna, Almuthe Christina Hauer, Tarkan Karakan, Valerie Pittet, Henit Yanai, Jalpa Devi, Jesus K Yamamoto-Furusho, Ali Reza Sima, Hailemichael Desalegn, Mutaz Idrees Sultan, Vishal Sharma, Hany Shehab, Lamya Mrabti, Natalia Queiroz, Anuraag Jena
Journal of Crohn’s and Colitis.2026;[Epub] CrossRef
Comments on “Adequacy of sigmoidoscopy as compared to colonoscopy for assessment of disease activity in patients of ulcerative colitis: a prospective study”
Sidharth Harindranath
Intestinal Research.2025; 23(2): 225. CrossRef

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IBD

Defining management strategies for acute severe ulcerative colitis using predictive models: a simulation-modeling study: Danny Con, Peter De Cruz; Intest Res 2024;22(4):439-452. Published online May 7, 2024; DOI: https://doi.org/10.5217/ir.2023.00175

Abstract PDF PubReader ePub

Background/Aims
Robust management algorithms are required to reduce the residual risk of colectomy in acute severe ulcerative colitis (ASUC) refractory to standard infliximab salvage therapy. The aim of this study was to evaluate the performance and benefits of alternative ASUC management strategies using simulated prediction models of varying accuracy.
Methods
This was a simulation-based modeling study using a hypothetical cohort of 5,000 steroid-refractory ASUC patients receiving standard infliximab induction. Simulated predictive models were used to risk-stratify patients and escalate treatment in patients at high risk of failing standard infliximab induction. The main outcome of interest was colectomy by 3 months.
Results
The 3-month colectomy rate in the base scenario where all 5,000 patients received standard infliximab induction was 23%. The best-performing management strategy assigned high-risk patients to sequential Janus kinase inhibitor inhibition and mediumrisk patients to accelerated infliximab induction. Using a 90% area under the curve (AUC) prediction model and optimistic treatment efficacy assumptions, this strategy reduced the 3-month colectomy rate to 8% (65% residual risk reduction). Using an 80% AUC prediction model with only modest treatment efficacy assumptions, the 3-month colectomy rate was reduced to 15% (35% residual risk reduction). Overall management strategy efficacy was highly dependent on predictive model accuracy and underlying treatment efficacy assumptions.
Conclusions
This is the first study to simulate predictive model-based management strategies in steroid-refractory ASUC and evaluate their effect on short-term colectomy rates. Future studies on predictive model development should incorporate simulation studies to better understand their expected benefit.

Citations

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Medical management of acute severe ulcerative colitis in the hospitalized patient
Loren G Rabinowitz, Ajay Gade, Joseph D. Feuerstein
Expert Review of Gastroenterology & Hepatology.2025; 19(5): 467. CrossRef
Three Janus kinase inhibitors in ulcerative colitis: is upadacitinib taking the lead?
Yoon Suk Jung
Intestinal Research.2025; 23(4): 394. CrossRef

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2 Crossref

Review

IBD

Cardiovascular disease: extraintestinal manifestation of inflammatory bowel disease: Samridhi Lakhanpal, Kanishk Aggarwal, Harmanjit Kaur, Kunal Kanwar, Vasu Gupta, Jill Bhavsar, Rohit Jain; Intest Res 2025;23(1):23-36. Published online May 7, 2024; DOI: https://doi.org/10.5217/ir.2023.00104

Abstract PDF PubReader ePub

Inflammatory bowel disease (IBD) is a spectrum of diseases characterized by the interplay of the aberrant immune system, genetic factors, environmental factors, and intestinal microbiota, resulting in relapsing inflammation of the gastrointestinal tract. Underlying pro-inflammatory state and immune dysregulation act as a catalyst for increasing the likelihood of developing extraintestinal manifestations, including cardiovascular diseases (CVD) like atherosclerosis, pericarditis, myocarditis, venous and arterial thromboembolism, arrhythmias, despite a lower prevalence of classic CVD risk factors, like high body mass index or dyslipidemia compared to the general population. Chronic inflammation damages endothelium resulting in the recruitment of inflammatory cells, which induce cytotoxicity, lipoprotein oxidation, and matrix degradation, which increases the risk of atherosclerosis. Additionally, intestinal dysbiosis disrupts the intestinal mucosal barrier, releasing endotoxins and lipopolysaccharides into circulation, further exaggerating the atherosclerotic process. Abnormal collagen metabolism and alteration of nitric oxide-mediated vasodilation lead to blood pressure dysregulation in patients with IBD. Therefore, it is essential to make lifestyle modifications like smoking cessation, dietary changes, and increasing physical activity with adherence to medication to mitigate the risk of developing CVD in patients with IBD. This article reviews the potential links between IBD and the increased risk of CVD in such individuals.

Citations

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Association Between Inflammatory Bowel Disease and Venous Leg Ulcers: Insight From Mendelian Randomization Analyses
Yanfeng Lin, Xiaohui Qin, Haiyan Zhang, Jinke Huang, Xingshun Qi
Canadian Journal of Gastroenterology and Hepatology.2026;[Epub] CrossRef
Therapeutic Potential of Fecal Microbiota Transplantation for Male Sexual Dysfunction: Evidence and Clinical Perspectives
Junyi Chen, Chenfeng Bu, Xia Li, Lei Wu, Xingxiang He
Microbiota Medicine Research.2026; 1(1): 12. CrossRef
Metabolic Disorders and Inflammatory Bowel Diseases
Hye Kyung Hyun, Jae Hee Cheon
Gut and Liver.2025; 19(3): 307. CrossRef
Carnitine: Its Crucial Role in Metabolic Health and Cardiovascular Function
Fremita Fredrick, Kanishk Aggarwal, Anish Kumar Reddy Meda, Fnu Anamika, Amishi Singla, Pranjal Jain, Rohit Jain
Journal of Dietary Supplements.2025; 22(5): 664. CrossRef
The gut-heart axis: a correlation between Paneth cells’ dysfunction, microbiome dysbiosis, and cardiovascular diseases
Aysa Rezabakhsh, Solomon Habtemariam, Rezayat Parvizi, Anne Meddahi-Pellé, Violeta Rodriguez Ruiz, Graciela Pavon-Djavid, Abolfazl Barzgari
Cell Communication and Signaling.2025;[Epub] CrossRef
Study design of ‘PASIBO’ - co-creation and development of a physical activity intervention to patients with inflammatory bowel disease
Tanja Thomsen, Marie Villumsen, Anja Poulsen, Anders B. G. Hansen, Bente A. Esbensen, Tine Jess, Mette Aadahl
BMC Health Services Research.2025;[Epub] CrossRef
From Gut Inflammation to Cardiovascular Conflagration: Mapping IBD’s Cardiometabolic Risks
Oscar Noble, Dayoung Jeon, Megan Lewis, Christopher Fan, Khurram Nasir, Bincy P. Abraham
Current Atherosclerosis Reports.2025;[Epub] CrossRef
Cardiovascular Complications Are Increased in Inflammatory Bowel Disease: A Path Toward Achievement of a Personalized Risk Estimation
Vito Annese, Maria Laura Annunziata, Guglielmo Albertini Petroni, Emanuele Orlando, Sofia Cinque, Marzio Parisi, Paolo Biamonte, Giuseppe Dell’Anna, Anna Latiano, Serenella Castelvecchio
Journal of Personalized Medicine.2025; 15(9): 418. CrossRef
Coagulopathy and platelet abnormalities in patients with inflammatory bowel disease
Dae Sung Kim, Won Moon
The Korean Journal of Internal Medicine.2025; 40(6): 866. CrossRef
Clinical Outcomes of Venous Thromboembolism in Patients with Ankylosing Spondylitis vs. Other Immune-mediated Inflammatory Diseases: Insights from the RIETE Registry
Romain Chopard, Gregory Piazza, Laurent Bertoletti, Nicolas Meneveau, Leticia Guirado, José Antonio Porras, Francisco Rivera-Cívico, José Felipe Varona Arche, Manuel Monreal, Clément Prati
Thrombosis and Haemostasis.2025;[Epub] CrossRef

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Original Articles

IBD

Effects of COVID-19 vaccines on patient-reported outcomes in patients with inflammatory bowel disease: a multicenter survey study in Korea: Jung Hyun Ji, Seung Hwan Shin, Yong Eun Park, Jihye Park, Jae Jun Park, Jae Hee Cheon, Tae Il Kim, Sang-Bum Kang, Sang Hyoung Park, Soo Jung Park, IBD Research Group of the Korean Association for the Study of Intestinal Diseases (KASID); Intest Res 2024;22(3):336-350. Published online March 26, 2024; DOI: https://doi.org/10.5217/ir.2023.00077

Abstract PDF PubReader ePub

Background/Aims
The impact of vaccination on inflammatory bowel disease (IBD) patients is still unknown, and no studies have assessed the changes in patient-reported outcomes (PROs) after vaccination in patients with IBD. Therefore, in this study, we investigated the impact of vaccines on the PROs of patients with IBD.
Methods
We conducted a questionnaire survey of patients with IBD who visited outpatient clinics at 4 specialized IBD clinics of referral university hospitals from April 2022 to June 2022. A total of 309 IBD patients were included in the study. Patient information was collected from a questionnaire and their medical records, including laboratory findings, were reviewed retrospectively. Risk factors associated with an increase in PROs after COVID-19 vaccination were analyzed using logistic regression analyses. In addition, we assessed whether there were differences in variables by vaccine order using the linear mixed model.
Results
In multivariate analysis, young age ( < 40 years) and ulcerative colitis (UC) were found to be independent risk factors for aggravation of PROs in patients with IBD. In all patients, platelet count significantly increased with continued vaccination in multiple pairwise comparisons. In UC patients, PROs such as the short health scale, UC-abdominal signs and symptoms, and UC-bowel signs and symptoms were aggravated significantly with continued vaccination. There was no significant increase in the variables of patients with Crohn’s disease.
Conclusions
Therefore, there may be a need to counsel patients with IBD younger than 40 years of age, and patients with UC before they receive COVID-19 vaccinations.

Citations

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Bowel Urgency in Crohn's Disease: Bridging the Gap Between Patients and Healthcare Providers
Marla Dubinsky, Alison Potts Bleakman, Stephan Vavricka, Simon Travis, Vipul Jairath, Remo Panaccione, María Chaparro, Bénédicte Caron, Deborah A. Fisher, Richard Moses, Aisha Vadhariya, Alissa Walsh
American Journal of Gastroenterology.2025;[Epub] CrossRef

10,905 View
222 Download
1 Crossref

IBD

Association between nonalcoholic fatty liver disease and incidence of inflammatory bowel disease: a nationwide population‑based cohort study: Ying-Hsiang Wang, Chi-Hsiang Chung, Tien-Yu Huang, Chao-Feng Chang, Chi-Wei Yang, Wu-Chien Chien, Yi-Chiao Cheng; Intest Res 2025;23(1):76-84. Published online February 21, 2024; DOI: https://doi.org/10.5217/ir.2023.00078

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Nonalcoholic fatty liver disease (NAFLD) is a common disease with severe inflammatory processes associated with numerous gastrointestinal diseases, such as inflammatory bowel disease (IBD). Therefore, we investigated the relationship between NAFLD and IBD and the possible risk factors associated with the diagnosis of IBD.
Methods
This longitudinal nationwide cohort study investigated the risk of IBD in patients with NAFLD alone. General characteristics, comorbidities, and incidence of IBD were also compared.
Results
Patients diagnosed with NAFLD had a significant risk of developing IBD compared to control individuals, who were associated with a 2.245-fold risk of the diagnosis of IBD and a 2.260- and 2.231-fold of increased diagnosis of ulcerative colitis and Crohn’s disease, respectively (P< 0.001). The cumulative risk of IBD increased annually during the follow-up of patients with NAFLD (P< 0.001).
Conclusions
Our results emphasize that NAFLD significantly impacts its incidence in patients with NAFLD. If patients with NAFLD present with risk factors, such as diabetes mellitus and dyslipidemia, these conditions should be properly treated with regular follow-ups. Furthermore, we believe that these causes may be associated with the second peak of IBD.

Citations

Citations to this article as recorded by

Bidirectional interplay between gut and liver in inflammatory bowel disease and hepatobiliary conditions
Ali Abdulla, Ayan M. Sheikhnoor, Kevin Ferrao, Lucy I. Stiles, Kosha J. Mehta
Clinical and Experimental Medicine.2026;[Epub] CrossRef
Elucidating the association between nonalcoholic fatty liver disease and incidence of inflammatory bowel disease: a focus on systemic inflammation
Sihyun Kim, Jong Pil Im
Intestinal Research.2025; 23(1): 3. CrossRef
Metabolic Disorders and Inflammatory Bowel Diseases
Hye Kyung Hyun, Jae Hee Cheon
Gut and Liver.2025; 19(3): 307. CrossRef
Intestinal Barrier Dysfunction in Inflammatory Bowel Disease: Pathophysiology to Precision Therapeutics
Balachandar Selvakumar, Rani Samsudin
Inflammatory Bowel Diseases.2025; 31(12): 3450. CrossRef
Multiomics analysis reveals the potential mechanism of high‐fat diet in dextran sulfate sodium‐induced colitis mice model
Yuyang Zhao, Zhimin Chen, Ruiyi Dong, Yufan Liu, Yixin Zhang, Yan Guo, Meiyi Yu, Xiang Li, Jiangbin Wang
Food Science & Nutrition.2024; 12(10): 8309. CrossRef

7,349 View
345 Download
4 Web of Science
5 Crossref

IBD

Ustekinumab for anti-tumor necrosis factor refractory pediatric ulcerative colitis: a promising approach towards endoscopic healing: Rahiya Rehman, Muhammad Safwan Riaz, Dyadin Esharif, Phinnara Has, Michael Herzlinger, Jason Shapiro, Shova Subedi; Intest Res 2024;22(3):351-356. Published online February 6, 2024; DOI: https://doi.org/10.5217/ir.2023.00091

Abstract PDF PubReader ePub

Background/Aims
To describe the role of ustekinumab in inducing remission and endoscopic healing in anti-tumor necrosis factor α nonresponsive pediatric ulcerative colitis patients at a tertiary care inflammatory bowel disease center.
Methods
A retrospective chart review was performed on patients with ulcerative colitis receiving ustekinumab. Primary outcome was steroidfree clinical remission at follow-up. Secondary outcomes were biochemical remission and endoscopic healing.
Results
Ten children were analyzed; 7 (70%) had ulcerative colitis, and 3 (30%) had inflammatory bowel disease unspecified with colitis. Median follow-up period was 56 weeks. Nine patients (90%) achieved steroid-free clinical remission and biochemical remission. Seven patients had follow-up colonoscopies, out of which 6 (86%) achieved endoscopic remission, while 1 (14%) underwent colectomy. Out of the 3 patients without a follow-up colonoscopy, fecal calprotectin levels downtrended to < 150 mg/kg in 2 patients and < 400 mg/kg in 1 patient from baseline level of > 2,000 mg/kg.
Conclusions
Ustekinumab appears efficacious in achieving not only clinical and biochemical remission but also has promising role in inducing endoscopic healing end point in patients who fail other biologics.

Citations

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Positionspapier der Gesellschaft für Pädiatrische Gastroenterologie und Ernährung (GPGE) zum zulassungsüberschreitenden Gebrauch von für Erwachsene mit CED zugelassenen Biologika und Signalinhibitoren bei Kindern und Jugendlichen
Jan Däbritz, Martin Classen, Kathrin Krohn, Andreas Krahl, Stephan Buderus, Elke Lainka, Jan de Laffolie, Carsten Posovszky
Zeitschrift für Gastroenterologie.2025; 63(03): 255. CrossRef
New Therapeutic Challenges in Pediatric Gastroenterology: A Narrative Review
Valeria Dipasquale, Claudio Romano
Healthcare.2025; 13(8): 923. CrossRef
The ‘totality of evidence’ and ‘extrapolation’ of SB17, a ustekinumab biosimilar
Jae Hee Cheon, Byong Duk Ye, Alessandro Armuzzi, Florian Rieder, Giampiero Girolomoni, Luis Puig, Hojung Jung, Steven R. Feldman
Expert Opinion on Biological Therapy.2025; 25(6): 615. CrossRef
Evolving Trends in Pediatric Inflammatory Bowel Disease Management in Japan: A Decade of Nationwide Data
Miki Urushiyama, Kunio Tarasawa, Rintaro Moroi, Hideya Iwaki, Yusuke Hoshi, Hiroshi Nagai, Yusuke Shimoyama, Takeo Naito, Fumihiko Kakuta, Hisashi Shiga, Shin Hamada, Yoichi Kakuta, Kiyohide Fushimi, Yoshitaka Kinouchi, Daiki Abukawa, Kenji Fujimori, Atsu
JGH Open.2025;[Epub] CrossRef
Long‐term effects of ustekinumab in children with inflammatory bowel disease: A systematic review
Breno Oliveira Marques, Ana Beatriz Ferreira Gusmão, Ana Luiza Ferreira Gusmão, Bianca Ferraz de Almeida Silva, Gabrielle Silva Sousa, Jessica Sabrina Gonçalves Fernandes, Nikolas Brayan da Silva Bragas, Natalia Oliveira e Silva
Journal of Pediatric Gastroenterology and Nutrition.2025; 81(4): 1045. CrossRef
Monoclonal antibodies against pediatric ulcerative colitis: a review of clinical progress
Debora Curci, Marianna Lucafò, Giuliana Decorti, Gabriele Stocco
Expert Opinion on Biological Therapy.2024; 24(10): 1133. CrossRef

6,852 View
309 Download
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6 Crossref

IBD

Sarcopenia is common in ulcerative colitis and correlates with disease activity: Pardhu B Neelam, Rimesh Pal, Pankaj Gupta, Anupam K Singh, Jimil Shah, Harshal S Mandavdhare, Harjeet Singh, Aravind Sekar, Sanjay K Bhadada, Usha Dutta, Vishal Sharma; Intest Res 2024;22(2):162-171. Published online January 22, 2024; DOI: https://doi.org/10.5217/ir.2023.00090

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Association of sarcopenia with disease severity in ulcerative colitis (UC) is not clearly defined. We planned to estimate the prevalence of sarcopenia in patients with UC as per the revised definition and its relation with the disease severity.
Methods
A cross-sectional assessment of sarcopenia in patients with UC was performed. Disease activity was graded according to complete Mayo score. Hand grip strength was assessed with Jamar hand dynamometer, muscle mass using a dual energy X-ray absorptiometry scan, and physical performance with 4-m walk test. Sarcopenia was defined as a reduction of both muscle mass and strength. Severe sarcopenia was defined as reduced gait speed in presence of sarcopenia.
Results
Of 114 patients (62 males, mean age: 36.49±12.41 years), 32 (28%) were in remission, 46 (40.4%) had mild-moderate activity, and 36 (31.6%) had severe UC. Forty-three patients (37.7%) had probable sarcopenia, 25 (21.9%) had sarcopenia, and 14 (12.2%) had severe sarcopenia. Prevalence of sarcopenia was higher in active disease (2 in remission, 6 in active, and 17 in severe, P<0.001). Of 14 with severe sarcopenia, 13 had severe UC while 1 had moderate UC. On multivariate analysis, lower body mass index and higher Mayo score were associated with sarcopenia. Of 37 patients with acute severe colitis, 16 had sarcopenia. Requirement of second-line therapy was similar between patients with and without sarcopenia. On follow-up (median: 18 months), there was a non-significant higher rate of major adverse events in those with sarcopenia (47.4% vs. 33.8%, P=0.273).
Conclusions
Sarcopenia and severe sarcopenia in UC correlate with the disease activity.

Citations

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Prevalence and outcome of sarcopenia in patients with inflammatory bowel disease: a follow-up study
Vikram Dharap, Devendra Desai, Philip Abraham, Tarun Gupta, Pavan Dhoble, Nirad Mehta, Jagdish Modhe
Intestinal Research.2026; 24(1): 141. CrossRef
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Beiying Deng, Yinghui Liu, Pengzhan He, Nian Wang, Lin Xu, Jingjing Ma
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Shilpa Sharma
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Solène Dermine, Thomas Bazin, Fatimé Adam Hassan, Johanna Bettolo, Lore Billiauws, Justine Bourdillel, Clément Bresteau, Olivier Corcos, Myriam El khatib, Ashiq Mohamed Gouse, Coralie Hutinet, Alexandre Nuzzo, Francisca Joly
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Young Joo Yang, Seong Ran Jeon
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Daye Park, Jihye Park, Soo Jung Park, Jae Jun Park, Tae Il Kim, Jae Hee Cheon
The Korean Journal of Internal Medicine.2025; 40(4): 606. CrossRef
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Shilpa Sharma
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Urvashi Rana, Harshal S. Mandavdhare
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Pardhu B Neelam, Alka Sharma, Vishal Sharma
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Mirella Sherif, Rabab Fouad, Tamer Elbaz, Maryse Awadalla, Omnia Tantawi, Mohamed Negm, Dalia Abd El-kareem, Ibrahim Naguib, Hany Shehab, Hedy A. Badary
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Reviews

IBD

Helminths in alternative therapeutics of inflammatory bowel disease: Himani Pandey, Daryl W. T. Tang, Sunny H. Wong, Devi Lal; Intest Res 2025;23(1):8-22. Published online January 12, 2024; DOI: https://doi.org/10.5217/ir.2023.00059

Abstract PDF PubReader ePub

Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, is a nonspecific chronic inflammation of the gastrointestinal tract. Despite recent advances in therapeutics and newer management strategies, IBD largely remains untreatable. Helminth therapy is a promising alternative therapeutic for IBD that has gained some attention in the last two decades. Helminths have immunomodulatory effects and can alter the gut microbiota. The immunomodulatory effects include a strong Th2 immune response, T-regulatory cell response, and the production of regulatory cytokines. Although concrete evidence regarding the efficacy of helminth therapy in IBD is lacking, clinical studies and studies done in animal models have shown some promise. Most clinical studies have shown that helminth therapy is safe and easily tolerable. Extensive work has been done on the whipworm Trichuris, but other helminths, including Schistosoma, Trichinella, Heligmosomoides, and Ancylostoma, have also been explored for pre-clinical and animal studies. This review article summarizes the potential of helminth therapy as an alternative therapeutic or an adjuvant to the existing therapeutic procedures for IBD treatment.

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Advancements in therapeutic strategies and drug development for inflammatory bowel diseases
Yu Zhou, Fang Shen
Exploration of Immunology.2025;[Epub] CrossRef

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IBD

The practice of fecal microbiota transplantation in inflammatory bowel disease: Umang Arora, Saurabh Kedia, Vineet Ahuja; Intest Res 2024;22(1):44-64. Published online November 21, 2023; DOI: https://doi.org/10.5217/ir.2023.00085

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Current evidence posits a central role for gut microbiota and the metabolome in the pathogenesis and progression of inflammatory bowel disease (IBD). Fecal microbiota transplantation (FMT) has been established as a means to manipulate this microbiome safely and sustainably. Several aspects of the technical improvement including pretreatment with antibiotics, use of frozen stool samples as well as short donor-to-recipient time are proposed to improve its response rates. Its efficacy in ulcerative colitis has been proven in clinical trials while data is emerging for Crohn’s disease. This review describes briefly the biology behind FMT, the available evidence for its use in IBD, and the host, recipient and procedural factors which determine the clinical outcomes.

Citations

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The AMP–antibiotic–microbiota triad in IBD: a mechanistic framework for dysregulated antimicrobial defense
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Original Article

IBD

Combination of leucine-rich alpha-2 glycoprotein and fecal markers detect Crohn’s disease activity confirmed by balloon-assisted enteroscopy: Ami Kawamoto, Kento Takenaka, Shuji Hibiya, Yoshio Kitazume, Hiromichi Shimizu, Toshimitsu Fujii, Eiko Saito, Kazuo Ohtsuka, Ryuichi Okamoto; Intest Res 2024;22(1):65-74. Published online November 9, 2023; DOI: https://doi.org/10.5217/ir.2023.00092

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Endoscopic activity confirmed by enteroscopy is associated with poor clinical outcome in Crohn’s disease (CD). We investigated which of the existing biomarkers best reflects endoscopic activity in CD patients including the small bowel, and whether their combined use can improve accuracy.
Methods
One hundred and four consecutive patients with ileal and ileocolonic type CD who underwent balloon-assisted enteroscopy (BAE) from October 2021 to August 2022 were enrolled, with clinical and laboratory data prospectively collected and analyzed.
Results
Hemoglobin, platelet count, C-reactive protein, leucine-rich alpha-2 glycoprotein (LRG), fecal calprotectin, and fecal hemoglobin all showed significant difference in those with ulcers found on BAE. LRG and fecal calprotectin showed the highest areas under the curve (0.841 and 0.853) for detecting ulcers. LRG showed a sensitivity of 78% and specificity of 80% at a cutoff value of 13 μg/mL, whereas fecal calprotectin showed a sensitivity of 91% and specificity of 67% at a cutoff value of 151 μg/g. Dual positivity for LRG and fecal calprotectin, as well as LRG and fecal hemoglobin, both predicted ulcers with an improved specificity of 92% and 100%. A positive LRG or fecal calprotectin/hemoglobin showed an improved sensitivity of 96% and 91%. Positivity for LRG and either of the fecal biomarkers was associated with increased risk of hospitalization, surgery, and relapse.
Conclusions
The biomarkers LRG, fecal calprotectin, and fecal hemoglobin can serve as noninvasive and accurate tools for assessing activity in CD patients confirmed by BAE, especially when used in combination.

Citations

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Leucine-rich alpha-2 glycoprotein as a blood biomarker in inflammatory bowel disease: clinical implications and future perspectives
Takayuki Yamamoto
Expert Review of Gastroenterology & Hepatology.2026; 20(2): 147. CrossRef
Leucine-rich alpha-2 glycoprotein in combination with C-reactive protein for predicting endoscopic activity in Crohn’s disease: a single-centre, cross-sectional study
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Fatemeh Ojaghi Shirmard, Seyed Morteza Pourfaraji, Behrad Saeedian, Tannaz Bagheri, Abdulrahman Ismaiel, Satohiro Matsumoto, Nastaran Babajani
European Journal of Gastroenterology & Hepatology.2025; 37(8): 891. CrossRef
Diagnostic accuracy and cut-off values of serum leucine-rich alpha-2 glycoprotein for Crohn’s disease activity in the small bowel
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Leucine-rich alpha-2 glycoprotein is useful in predicting clinical relapse in patients with Crohn’s disease during biological remission
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Kensuke Takei, Toshihiro Inokuchi, Sakiko Hiraoka, Mikako Ishiguro, Junki Toyosawa, Yuki Aoyama, Shoko Igawa, Keiko Takeuchi, Yasushi Yamasaki, Hideaki Kinugasa, Masahiro Takahara, Seiji Kawano, Toshiharu Mitsuhashi, Motoyuki Otsuka
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Selection of anti-cytokine biologics by pretreatment levels of serum leucine-rich alpha-2 glycoprotein in patients with inflammatory bowel disease
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Scientific Reports.2024;[Epub] CrossRef

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Review

IBD

Gut microbiota in pathophysiology, diagnosis, and therapeutics of inflammatory bowel disease: Himani Pandey, Dheeraj Jain, Daryl W. T. Tang, Sunny H. Wong, Devi Lal; Intest Res 2024;22(1):15-43. Published online November 8, 2023; DOI: https://doi.org/10.5217/ir.2023.00080

Abstract PDF PubReader ePub

Inflammatory bowel disease (IBD) is a multifactorial disease, which is thought to be an interplay between genetic, environment, microbiota, and immune-mediated factors. Dysbiosis in the gut microbial composition, caused by antibiotics and diet, is closely related to the initiation and progression of IBD. Differences in gut microbiota composition between IBD patients and healthy individuals have been found, with reduced biodiversity of commensal microbes and colonization of opportunistic microbes in IBD patients. Gut microbiota can, therefore, potentially be used for diagnosing and prognosticating IBD, and predicting its treatment response. Currently, there are no curative therapies for IBD. Microbiota-based interventions, including probiotics, prebiotics, synbiotics, and fecal microbiota transplantation, have been recognized as promising therapeutic strategies. Clinical studies and studies done in animal models have provided sufficient evidence that microbiota-based interventions may improve inflammation, the remission rate, and microscopic aspects of IBD. Further studies are required to better understand the mechanisms of action of such interventions. This will help in enhancing their effectiveness and developing personalized therapies. The present review summarizes the relationship between gut microbiota and IBD immunopathogenesis. It also discusses the use of gut microbiota as a noninvasive biomarker and potential therapeutic option.

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