Intestinal Research

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

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

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

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

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

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

Abstract PDF: 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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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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IBD

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

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

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

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

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

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

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

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

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IBD

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

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

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IBD

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

Abstract PDF PubReader ePub

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

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

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

Abstract PDF PubReader ePub

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

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Integrin Inhibitors for Ulcerative Colitis Treatment
Takanao Tanaka, Keiichi Tominaga, Shunsuke Kojimahara, Mimari Kanazawa, Akira Yamamiya, Takeshi Sugaya, Atsushi Irisawa
Digestion.2025; : 1. CrossRef

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

Abstract PDF Supplementary Material PubReader

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

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Integrin Inhibitors for Ulcerative Colitis Treatment
Takanao Tanaka, Keiichi Tominaga, Shunsuke Kojimahara, Mimari Kanazawa, Akira Yamamiya, Takeshi Sugaya, Atsushi Irisawa
Digestion.2025; : 1. CrossRef

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

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

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IBD

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

Abstract PDF PubReader ePub

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

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

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

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

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Anti-integrin αvβ6 autoantibody in patients with ulcerative colitis after proctocolectomy: a cross-sectional study in Japan: Tsuyoshi Yanagida, Yu Nishida, Yumie Kobayashi, Rieko Nakata, Shuhei Hosomi, Hirotsugu Maruyama, Masaki Ominami, Yuji Nadatani, Shusei Fukunaga, Koji Otani, Fumio Tanaka, Yasuhiro Fujiwara; Received October 22, 2024 Accepted February 18, 2025 Published online April 29, 2025; DOI: https://doi.org/10.5217/ir.2024.00170 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Pouchitis is a common complication in patients with ulcerative colitis (UC) following colectomy with ileal pouch-anal anastomosis (IPAA). Recent studies have identified a novel autoantibody against integrin αvβ6 in patients with UC, correlated with disease activity. This study aimed to assess the association between serum anti-integrin αvβ6 antibody levels and pouch inflammation in patients with postoperative UC.
Methods
Serum anti-integrin αvβ6 antibodies were measured using enzyme-linked immunosorbent assay in patients after IPAA, patients with UC, and controls.
Results
We examined sera from 71 subjects, including 28 patients who underwent IPAA, 23 controls, and 20 patients with mild and moderate-to-severe UC. Post-IPAA, patients with UC had higher median anti-integrin αvβ6 levels than that of controls (P<0.001) but lower than that of patients with active UC (P=0.001). Patients with pouchitis had higher antibody levels than those without (P=0.047). The receiver operating characteristics curve for anti-integrin αvβ6 showed an area under the curve of 0.724. The pouchitis activity index endoscopic sub-score was correlated with antibody levels (r= 0.48, P=0.011).
Conclusions
Serum anti-integrin αvβ6 antibody levels remain elevated in patients with UC even after total colectomy, and were significantly higher in patients with pouchitis than in those without. This antibody could be a novel and useful biomarker for the diagnosis of pouchitis and assessment of disease activity.

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Clinical Value of Anti-Integrin αvβ6 Antibody Serum-Level Measurement in Inflammatory Bowel Diseases
Dorottya Angyal, Fruzsina Balogh, Lorant Gonczi, Livia Lontai, Janos P. Kosa, Nora Garam, Peter L. Lakatos, Akos Ilias
Journal of Clinical Medicine.2026; 15(3): 948. CrossRef

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Efficacy and safety of etrasimod in Japanese patients with ulcerative colitis: results from a phase 2 dose-ranging study: Ken Takeuchi, Hiroshi Nakase, Tadakazu Hisamatsu, Katsuyoshi Matsuoka, Shoko Arai, Hirotoshi Yuasa, Motoki Oe, Ryosuke Ono, Michael Keating, Guibao Gu, Krisztina Lazin, Aoibhinn McDonnell, Koki Fukuta, Toshifumi Hibi; Received December 17, 2024 Accepted March 4, 2025 Published online April 25, 2025; DOI: https://doi.org/10.5217/ir.2024.00213 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Etrasimod is an oral, once-daily, selective sphingosine 1-phosphate1,4,5 receptor modulator for the treatment of moderately to severely active ulcerative colitis (UC). However, its efficacy, safety, and the appropriate dosage have not been extensively investigated in the Japanese population.
Methods
This phase 2, multicenter, randomized, double-blind, placebo-controlled dose-ranging, 12-week trial was carried out among Japanese patients with moderately to severely active UC. Patients were randomized 1:1:1 to receive etrasimod 1 mg once daily (QD), etrasimod 2 mg QD, or placebo. The primary efficacy endpoint was the proportion of patients achieving clinical remission at week 12. Secondary efficacy endpoints and treatmentemergent adverse events (TEAEs) were also investigated. Efficacy endpoints were presented as proportions of patients achieving each outcome.
Results
Overall, 17, 19, and 18 patients received etrasimod 1 mg QD, etrasimod 2 mg QD, and placebo, respectively. One patient receiving etrasimod 1 mg (6.7%), 5 patients receiving etrasimod 2 mg (26.3%), and no patients receiving placebo (0%) achieved clinical remission. More patients receiving etrasimod versus placebo achieved secondary endpoints, except endoscopic normalization, at week 12. TEAEs were experienced by 9 patients receiving etrasimod 1 mg (52.9%), 13 patients receiving etrasimod 2 mg (68.4%), and 10 patients receiving placebo (55.6%). None of the TEAEs were serious and none experienced by patients receiving etrasimod led to treatment discontinuation.
Conclusions
Overall, etrasimod 2 mg QD for up to 12 weeks appeared efficacious and safe in these Japanese patients with moderately to severely active UC. All TEAEs were mild to moderate in severity. (ClinicalTrials.gov: NCT05061446)

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IBD

Clinical characteristics of patients with difficult-to-treat ulcerative colitis: a nested case-control study using a Japanese claims database: Katsuyoshi Matsuoka, Ataru Igarashi, Noriko Sato, Naomi Mizuno, Manabu Ishii, Masato Iizuka, Katsuhiko Iwasaki, Ayako Shoji, Tadakazu Hisamatsu; Intest Res 2026;24(1):103-116. Published online April 25, 2025; DOI: https://doi.org/10.5217/ir.2024.00119

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Despite the advent of advanced therapies, cases of so-called “difficult-to-treat” (D2T) ulcerative colitis (UC) persist. This study aims to clarify the epidemiological and clinical characteristics of patients with D2T UC.
Methods
We conducted a nested case-control study using the Medical Data Vision Claims Database in patients with UC who began an advanced therapy (biologics, advanced small molecules, calcineurin inhibitors) from January 2018 through April 2023. D2T UC patients were defined as having 2 or more switches of advanced therapies, or as undergoing surgery for UC, within 2 years after the first advanced therapy.
Results
Four hundred and one (16.7%) and 1,996 patients (83.3%) met the definitions of patients with D2T UC and non-D2T UC, respectively. After 1:1 matching by index year, 355 patients per group were included in the analysis. Multivariate logistic regression analyses, including sensitivity analyses based on follow-up period after the first advanced therapy, showed that a prescribed corticosteroid dose of ≥ 30 mg/day during the 6-month baseline period was associated with D2T UC. In D2T UC patients, median duration of the first advanced therapy was 99 days, and median number of advanced therapies per year was 1.7. The first advanced therapy was continued for 2 years in 78% of patients with non-D2T UC.
Conclusions
The proportion of D2T UC patients among UC patients starting advanced therapy was 16.7%. The factor most associated with D2T UC was the need for a corticosteroid dose ≥ 30 mg/day during the 6 months before initiation of advanced therapy.

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Extraintestinal Manifestations and Cytomegalovirus Reactivation Are Predictors of Difficult-To-Treat in Ulcerative Colitis
Kotaro Akita, Mayuko Erata, Yoshihiro Yokoyama, Yuta Shimomori, Tomoe Kazama, Hiroki Kurumi, Masanori Nojima, Hiroshi Nakase
Inflammatory Intestinal Diseases.2025; 11(1): 18. CrossRef

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IBD

Comparative short-term efficacy of upadacitinib versus tofacitinib for ulcerative colitis: a 24-week real-world study in Japan: Akiko Tamura, Hiromichi Shimizu, Toshimitsu Fujii, Ami Kawamoto, Ryo Morikawa, Shuji Hibiya, Kento Takenaka, Masakazu Nagahori, Kazuo Ohtsuka, Ryuichi Okamoto; Intest Res 2026;24(1):95-102. Published online March 20, 2025; DOI: https://doi.org/10.5217/ir.2024.00187

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Tofacitinib and upadacitinib are small-molecule compounds that inhibit the Janus kinase pathway for the treatment of refractory ulcerative colitis. Only a few reports have compared the efficacy and safety of these 2 drugs in real-world practice. We aimed to show our real-world evidence of these drugs and compare the efficacy and safety profiles in the treatment of ulcerative colitis.
Methods
This study is a single-center retrospective analysis. Patients treated with tofacitinib or upadacitinib at our hospital between June 2018 and January 2024 who were monitored for 24 weeks were included. The primary outcome was steroid-free clinical remission at 24 weeks. Secondary outcomes were response and remission rates at each time point, time series changes in partial Mayo scores and laboratory results, treatment survival at 24 weeks, and the incidence of adverse events.
Results
A total of 68 patients treated with tofacitinib and 34 patients treated with upadacitinib were included. Steroid-free clinical remission rate at 24 weeks was significantly higher in upadacitinib-treated patients than in tofacitinibtreated patients (64.7% vs. 38.2%). The response rates in upadacitinib-treated patients exceeded 60% after 8 weeks of treatment through to 24 weeks, and the rates were higher than those in tofacitinib-treated patients. The incidences of adverse events were 79.4% in upadacitinib-treated patients and 38.2% in tofacitinib-treated patients. The most common adverse event was acne for upadacitinib.
Conclusions
Upadacitinib was more effective than tofacitinib in inducing remission in ulcerative colitis patients. The incidence of adverse events was significantly higher with upadacitinib than tofacitinib.

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Optimal use and cycling strategies of Janus kinase inhibitors in ulcerative colitis: current evidence and clinical implications from the KASID Guidelines Task Force Team
Seung Min Hong, Dong Hyun Kim, June Hwa Bae, Seung Yong Shin, Eun Mi Song, Ji Eun Kim, Young Joo Yang, Jiyoung Yoon, Sang-Bum Kang, Eun Soo Kim, Seong-Eun Kim, Seong-Jung Kim, Jun Lee, Soo-Young Na, Soo Jung Park, Sang Hyoung Park, Miyoung Choi, Myung Ha
Intestinal Research.2026; 24(1): 27. CrossRef
Upadacitinib after tofacitinib in ulcerative colitis
Hyeon Jin Cho, Eun Soo Kim
Intestinal Research.2025; 23(3): 229. CrossRef
Comparative effectiveness and safety of tofacitinib and filgotinib in patients with ulcerative colitis: A propensity score-weighted cohort study
Fabio Salvatore Macaluso, Walter Fries, Anna Viola, Clara De Francesco, Nunzio Belluardo, Emiliano Giangreco, Maria Cappello, Roberto Ajovalasit, Filippo Mocciaro, Barbara Scrivo, Antonino Carlo Privitera, Maria Emanuela Distefano, Alessandro Vitello, Con
Digestive and Liver Disease.2025; 57(11): 2109. CrossRef
Tofacitinib in acute severe ulcerative colitis: review addressing seven key unmet needs
Chuong Dinh Nguyen, Luan Minh Dang, Thong Duy Vo, Hoang Huu Bui, Eun Soo Kim, Joyce Wing Yan Mak, Choon Jin Ooi
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
Successful treatment of tofacitinib-refractory scleritis associated with multiple systemic inflammatory diseases using upadacitinib
Kodai Yuge, Nobuyo Yawata, Kenichiro Asahara, Satoshi Yamana, Nobuyuki Ono, Koh-Hei Sonoda
Immunological Medicine.2025; : 1. CrossRef
Optimizing Janus kinase inhibitor therapy for ulcerative colitis: a real-world perspective
Shintaro Akiyama
Intestinal Research.2025;[Epub] CrossRef
Janus Kinase Inhibitors for Inflammatory Bowel Disease: Concise Questions and Answers on Their Use in Clinical Practice
Javier P Gisbert, María Chaparro
Inflammatory Bowel Diseases.2025;[Epub] CrossRef
Upadacitinib versus Tofacitinib in the Management of Ulcerative Colitis: A Systematic Review and Meta-Analysis
Tareq Alsaleh, Abdul Mohammed, Aimen Farooq, Magda Elamin, Amr Akl, Karim Mohamed Yassin, Ahmed Elnaggar, Jennifer Seminerio
Inflammatory Intestinal Diseases.2025; 11(1): 29. CrossRef

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IBD

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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Impact of GLP-1 analogues on immune-mediated inflammatory diseases: A systematic review
Chhagan L. Birda, Fadwa Ibrahim, Abhirup Chatterjee, Anuraag Jena, Vishal Sharma, Shaji Sebastian
Autoimmunity Reviews.2026; 25(1): 103936. CrossRef
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
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
Digital Chinese Medicine.2025; 8(1): 100. CrossRef
Research Status of Anemia Associated with Inflammatory Bowel Disease
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Aakash Desai, Himsikhar Khataniar, Fjona Tabaku, Jana G. Hashash, Francis A. Farraye, Gursimran S. Kochhar
Indian Journal of Gastroenterology.2025;[Epub] CrossRef
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Relation of ultra-processed food consumption with ulcerative colitis disease activity
Nancy Sahni, Ayushi, Urvashi Rana, Radhika Khosla, Usha Dutta, Rakesh Kochhar, Vishal Sharma
Indian Journal of Gastroenterology.2025;[Epub] CrossRef
Modulation of inflammatory and cuproptotic crosstalk by Ethyl and propyl gallate: a multi-targeted strategy against experimental colitis
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Sai Anjali Kambala, Seema Pavaman Sindgikar, Daniya Hameed, Chandrashekar J Sorake
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Editorial: The Hidden Burden—Stigmatisation in Inflammatory Bowel Disease: Authors' Reply
Suprabhat Giri, Anuraag Jena, Vishal Sharma, Shaji Sebastian
Alimentary Pharmacology & Therapeutics.2025;[Epub] CrossRef

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IBD

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

Abstract PDF Supplementary Material PubReader ePub

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

Citations

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

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Short-term and long-term outcomes of acute severe ulcerative colitis in Taiwan: a multicenter study with pre- and post-biologics comparison: Wei-Chen Lin, Chun-Chi Lin, Wen-Hung Hsu, Feng-Fan Chiang, Chen-Wang Chang, Tzu-Chi Hsu, Deng-Chyang Wu, Horng-Yuan Wang, Jau-Min Wong, Shu-Chen Wei; Intest Res 2026;24(1):117-128. Published online January 24, 2025; DOI: https://doi.org/10.5217/ir.2024.00112

Abstract PDF PubReader ePub

Background/Aims
Data from Asia regarding the short-term and long-term outcomes for acute severe ulcerative colitis (ASUC) are limited. We assessed the outcomes of ASUC, identified the risk factors for colectomy, and compared colectomy rates between the pre-biologics and post-biologics eras in Taiwan.
Methods
The patients with an ASUC diagnosis between January 2013 and March 2022 at 5 tertiary medical centers were retrospectively analyzed.
Results
In total, 98 patients were enrolled, with 68.4% diagnosed in the post-biologics era. In 78.6% of the ASUC patients initially received intravenous steroid therapy, for which the success rate was 74.1%. As for rescue therapy, 15 patients (93.8%) received biologics and 1 (6.3%) received cyclosporin. Biologics rescue therapy had a 93.3% success rate. One (1%) mortality due to septic shock occurred. The colectomy rate for index ASUC admission was 11.2%. Patients receiving colectomy were predominantly male (P= 0.012) and at older age (P= 0.016). Higher C-reactive protein (P= 0.035), lower albumin (P= 0.017), and hemoglobin (P= 0.023) levels were associated with colectomy risk. During a median follow-up of 24 months, 13 patients (15.1%) had recurrent ASUC and 23.1% of patients received colectomy. The accumulated colectomy rate at 3 years did not differ between the pre- and post-biologics eras (16.1% vs. 13.4%, P= 0.270).
Conclusions
This is the first Asian study on ASUC to compare colectomy rates between the prebiologics and post-biologics eras, revealing no significant difference. The recurrent ASUC had a higher colectomy rate than the index ASUC.

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Serological Assessment of Hepatitis in Patients with Inflammatory Bowel Disease in Taiwan: A Retrospective Cohort Analysis
Yueh-An Lee, Hsu-Heng Yen, Yang-Yuan Chen
Life.2025; 15(6): 893. CrossRef

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IBD

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; Intest Res 2026;24(1):141-150. Published online January 23, 2025; DOI: https://doi.org/10.5217/ir.2024.00096

Abstract PDF PubReader ePub: Background/Aims
Sarcopenia is implicated in inflammatory bowel disease (IBD) complications and surgical outcomes. This study aimed to investigate the prevalence and follow-up of sarcopenia in patients with IBD.
Methods
Consecutive consenting patients with IBD aged > 18 years were included. Patients with associated sarcopenic diseases were excluded. All had measurements of anthropometry, body mass index (BMI), mid-arm muscle circumference, muscle strength, physical performance, and muscle mass (on computed tomography scan). They were followed up for up to 12 months, and incidence of flares, fractures, and surgery was noted.
Results
Of 157 patients screened, 35 refused participation; 5 with associated sarcopenic diseases were excluded. Of 117 patients (median age, 41 years; interquartile range, 18–81 years; 65 men), 73 had ulcerative colitis, 42 Crohn’s disease, and 2 IBD-unclassified. Forty (34.2%) had probable sarcopenia; 47 (40.2%) had sarcopenia (29 ulcerative colitis and 18 Crohn’s disease) including 10 (8.5%) with severe sarcopenia. Ten (21.3%) were in disease remission. Of factors associated with sarcopenia in univariate analysis, only BMI was significant in multivariate analysis. Ninety-nine patients followed up for a median of 7 months (interquartile range, 2–12 months). Freedom from flares was 5.3% in patients with sarcopenia and 46.1% in those without (P= 0.004). Three patients (1 with sarcopenia, 2 without) required surgery.
Conclusions
Sarcopenia was present in 40% of patients with IBD; one-fifth of these had severe sarcopenia. One-fifth were in remission. Low BMI correlated with sarcopenia. More patients with sarcopenia had disease flare. Screening for sarcopenia should be considered in patients with IBD.

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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

Abstract PDF Supplementary Material PubReader ePub

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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1 Crossref

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

Abstract PDF Supplementary Material PubReader ePub: 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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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;[Epub] CrossRef
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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IBD

Health-related quality of life, work productivity, and persisting challenges in treated ulcerative colitis patients: a Japanese National Health and Wellness Survey: Sakiko Hiraoka, Zhezhou Huang, Fei Qin, Fatima Megala Nathan Arokianathan, Kiran Davé, Shweta Shah, Hyunchung Kim; Intest Res 2025;23(4):524-540. Published online January 2, 2025; DOI: https://doi.org/10.5217/ir.2024.00104

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Despite available treatments for ulcerative colitis (UC), unmet needs persist among patients in Japan. This study explored the health-related quality of life (HRQoL), work productivity and activity impairment (WPAI), indirect cost, and unmet needs among treated UC patients in Japan.
Methods
This cross-sectional, observational study utilized data from the online 2017, 2019, and 2021 Japan National Health and Wellness Survey. Respondents were aged ≥ 18 years and had undergone or were on UC treatment (5-aminosalicylic acid, steroids, immunomodulators/immunosuppressants, biologics/Janus kinase inhibitors [JAKi]). Demographic, general health, and clinical characteristics, medication adherence, HRQoL, WPAI, and indirect cost were collected and analyzed.
Results
Among 293 treated UC patients, 83.6% were non-biologic/JAKi users, 29.0% had UC ≥ 15 years, 34.8% had moderate-to-severe disease severity, 55.3% experienced ≥ 1 persisting UC symptom, and 91.5% reported UC as bothersome to an extent. Patients reported EuroQoL visual analog scale score of 68.1 and ≥ 35% reported anxiety and depression. Mean work productivity loss was 29.3%, resulting in an annual mean indirect loss of 1.1 million JPY (45.3 thousand USD) per person. Higher WPAI (impairment) was associated with being male, moderate-to-severe disease severity, and low treatment adherence (P< 0.05). Biologics/JAKi users had higher work impairment, and IM/IS users had higher activity impairment than 5-aminosalicylic acid users (P< 0.05).
Conclusions
Despite treatment, Japanese UC patients experienced high disease burden and persistent disease-related challenges. Overall HRQoL were lower than the mean healthy population and work productivity impairment led to high indirect costs. The findings suggest the importance of new interventions for optimizing UC outcomes.

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Towards an Asian paradigm of inflammatory bowel disease management: A comparative review of China and Japan
Qi Sun, Zhixian Jiang, Lichao Yang, Hao Liu, Peipei Song, Lianwen Yuan
Intractable & Rare Diseases Research.2025; 14(3): 192. CrossRef
Impact of Inflammatory Bowel Disease on Quality of Life and Work Productivity in Patients Under Treatment
Nikolaos Kafalis, Dionysios Kogias, Vasileios P Papadopoulos, Ioannis Moschos, Panagiotis Skendros, Konstantinos Ritis, Georgios Kouklakis
Cureus.2025;[Epub] CrossRef

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IBD

Upadacitinib induction is effective and safe in ulcerative colitis patients including those with prior exposure to tofacitinib: a multicenter real-world cohort study: Robert Gilmore, Richard Fernandes, Imogen Hartley, Arteen Arzivian, Rupert Leong, Bridgette Andrew, Abhinav Vasudevan, Tessa Greeve, Gregory Thomas Moore, Steven Kim, Daniel Lightowler, Abhey Singh, Gillian Mahy, Aditya Mithanthaya, Kannan Venugopaul, Sangwoo Han, Robert Bryant, Jack West, Jonathan Segal, Britt Christensen, Crispin Corte, Nik Ding, Yoon-Kyo An, Jakob Begun; Intest Res 2025;23(3):347-357. Published online December 20, 2024; DOI: https://doi.org/10.5217/ir.2024.00127

Abstract PDF PubReader ePub

Background/Aims
Upadacitinib is a novel selective Janus kinase inhibitor approved for use in ulcerative colitis. Clinical trials had rigorous criteria and excluded many patient subgroups. Given limited real-world effectiveness data, we examined outcomes of patients treated with upadacitinib for ulcerative colitis in a real-world population.
Methods
Patients that commenced upadacitinib for moderate-to-severe ulcerative colitis from September 2022 until March 2023 were identified at 13 inflammatory bowel disease centers across Australia. Clinical, biochemical, endoscopic, and intestinal ultrasound outcomes were recorded retrospectively at baseline, week 8, and week 16.
Results
One hundred and fifty-two patients (61 female [40%], median age 38 years [interquartile range, 28–50]) were included. The primary endpoint of clinical remission was met in 79% at week 8, and 84% at week 16. A total of 42 patients (28%) with prior tofacitinib exposure were included. No significant difference in clinical remission was observed by week 16 between tofacitinib experienced compared to tofacitinib naïve patients (86% vs. 84%, P= 0.67). Complete intestinal ultrasound data was available for 36 patients, showing transmural remission in 64% at week 8 and 81% at week 16, with a decrease in median bowel wall thickness of 2.3 mm and 2.4 mm, respectively.
Conclusions
Upadacitinib resulted in high rates of clinical remission at 8 and 16 weeks in this large real-world cohort of ulcerative colitis patients. Upadacitinib is effective in patients with prior tofacitinib exposure. Intestinal ultrasound shows significant rates of transmural remission at week 8, sustained through week 16.

Citations

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Letter: Toward Intra‐Class Switching With JAK Inhibitors?
Mathieu Uzzan, David Laharie
Alimentary Pharmacology & Therapeutics.2025; 61(5): 919. CrossRef
Effectiveness and Safety of a Second JAK Inhibitor in Ulcerative Colitis: The J2J Multicentre Study
Mathilde Osty, Romain Altwegg, Mélanie Serrero, Alban Benezech, Albane Lecomte, Guillaume Cadiot, Lucine Vuitton, Anne Wampach, Stéphane Nancey, Anthony Buisson, Catherine le Berre, Clea Rouillon, Cyrielle Gilletta, Felix Goutorbe, Mathurin Fumery, Nassim
Alimentary Pharmacology & Therapeutics.2025; 62(4): 430. CrossRef
Upadacitinib and vedolizumab combination therapy for the management of refractory ulcerative colitis and Crohn’s disease
Robert Gilmore, Amrutha Murali, Amirah Etchegaray, Ei Swe, Yoon-Kyo An, Jakob Begun
Intestinal Research.2025; 23(4): 475. CrossRef
Upadacitinib after tofacitinib in ulcerative colitis
Hyeon Jin Cho, Eun Soo Kim
Intestinal Research.2025; 23(3): 229. CrossRef
A Comparison of the Efficacy and Safety of Ustekinumab and Upadacitinib in Biologically Experienced Ulcerative Colitis Patients
Osman Özdoğan, Serkan Yaraş, Mehmet Kasım Aydın, Fehmi Ateş, Engin Altıntaş, Orhan Sezgin
Biomedicines.2025; 13(10): 2455. CrossRef
Is 2nd JAKi treatment for UC worth the effort? A retrospective, multi-centre UK study
Chandni Radia, Yaa Danso, Susan Ritchie, Melissa Hale, Alexander T Elford, Chirag Patel, Lucy Hicks, Sonia Kalyanji, Chaonan Dong, Katie Yeung, Jie Han Yeo, Mohammed Allah-Ditta, Maria Bishara, Karishma Sethi-Arora, Lushen Pillay, Emma L Johnston, Ruth Ru
Journal of Crohn's and Colitis.2025;[Epub] CrossRef
IBD 2024: Charting a New Course in IBD Proceedings of the Takeda Symposium 22–23 November 2024 W Hotel, Brisbane, Queensland, Australia
Uma Mahadevan, Vipul Jairath, Jakob Begun, Aviv Pudipeddi, Mayur Garg, Peter De Cruz, Christopher F. D. Li Wai Suen, Matthew C. Choy, Danny Con, Rose Vaughan, John D. Chetwood, David A. Clark, Craig Haifer, Miles P. Sparrow, Rupert Leong, Réme Mountifield
Journal of Gastroenterology and Hepatology.2025; 40(S3): 3. CrossRef
Three Janus kinase inhibitors in ulcerative colitis: is upadacitinib taking the lead?
Yoon Suk Jung
Intestinal Research.2025; 23(4): 394. CrossRef
Upadacitinib’s Effectiveness and Safety as a Second- or Third-Line Therapy in Patients with Ulcerative Colitis: Data from a Real-World Study
Giammarco Mocci, Antonio Tursi, Franco Scaldaferri, Daniele Napolitano, Daniela Pugliese, Giovanni Maconi, Giovanni Cataletti, Roberta Pica, Claudio Cassieri, Edoardo Vincenzo Savarino, Caterina De Barba, Francesco Costa, Linda Ceccarelli, Manuela Marzo,
Journal of Clinical Medicine.2025; 14(21): 7801. CrossRef
Optimizing Janus kinase inhibitor therapy for ulcerative colitis: a real-world perspective
Shintaro Akiyama
Intestinal Research.2025;[Epub] CrossRef
Janus Kinase Inhibitors for Inflammatory Bowel Disease: Concise Questions and Answers on Their Use in Clinical Practice
Javier P Gisbert, María Chaparro
Inflammatory Bowel Diseases.2025;[Epub] CrossRef

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IBD

Prevalence and risk factors of gallstone disease in Korean patients with ulcerative colitis: Kwangwoo Nam, Jae Yong Lee, Sang Hyoung Park, Ha Won Hwang, Ho-Su Lee, Kyunghwan Oh, Hee Seung Hong, Kyuwon Kim, Jin Hwa Park, Seung Wook Hong, Sung Wook Hwang, Dong-Hoon Yang, Byong Duk Ye, Jeong-Sik Byeon, Seung-Jae Myung, Suk-Kyun Yang; Intest Res 2025;23(4):455-463. Published online November 29, 2024; DOI: https://doi.org/10.5217/ir.2024.00070

Abstract PDF PubReader ePub

Background/Aims
The prevalence of gallstone disease in patients with ulcerative colitis (UC) is higher than in the general population. However, risk factors of gallstone disease in these patients remain unclear. Thus, we investigated the prevalence and risk factors of gallstone disease in Korean patients with UC.
Methods
Patients diagnosed with UC who underwent abdominal imaging studies between 1997 and 2020 were investigated using a well-established referral center-based large volume inflammatory bowel disease cohort. The prevalence and clinical characteristics of patients with gallstone disease were evaluated and compared with those without gallstone disease.
Results
Overall, 2,811 patients with UC were enrolled. During the follow-up period (mean, 5.7 years), 198 patients (7.0%) were diagnosed with gallstone disease and compared with those without gallstone disease (n = 2,613). The proportion of extensive colitis at maximum extent, primary sclerosing cholangitis (PSC), history of cytomegalovirus, corticosteroid use, immunomodulatory use, colectomy, and appendectomy were significantly higher in the gallstone group (all P< 0.05). In multivariate analyses, age ≥ 60 years at gallstone evaluation (odds ratio [OR], 1.027; 95% confidence interval [CI], 1.002–1.052; P= 0.033), PSC (OR, 6.304; 95% CI, 3.162–12.565; P< 0.001), and history of colectomy (OR, 2.494; 95% CI, 1.222–5.087; P= 0.012) were significant risk factors for gallstone disease in patients with UC.
Conclusions
The prevalence of gallstone disease in Korean patients with UC was 7.0%, and age ≥ 60 years at gallstone evaluation, PSC, and history of colectomy were significant risk factors for UC patients with gallstone disease.

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Gallstone burden and risk in Korean patients with ulcerative colitis
Seong Ran Jeon
Intestinal Research.2025; 23(4): 391. CrossRef

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217 Download
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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

Abstract PDF PubReader ePub

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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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

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379 Download
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1 Crossref

IBD

Patient preferences for advanced therapies in ulcerative colitis using conjoint analysis: Taku Kobayashi, Naomi Mizuno, Noriko Sato, Yutaka Kawaguchi, Yoshiko Ikawa, Naruyasu Komorita, Hirono Ishikawa; Intest Res 2025;23(3):318-337. Published online October 14, 2024; DOI: https://doi.org/10.5217/ir.2024.00101

Abstract PDF PubReader ePub: Background/Aims
Selecting an optimal advanced therapy for ulcerative colitis (UC) is difficult because of the increasing number of available therapies. This study assessed UC patients’ preferences for drug profiles in decision-making regarding advanced therapies using conjoint analysis.
Methods
A web-based survey was conducted from October to November 2023 in patients with UC aged ≥ 18 years with prior oral 5-aminosalicylic acid treatment (UMIN000052327). We quantified the importance of drug attributes (location of administration, route/frequency of administration, speed of onset-of-action, maintenancesustainability, risk of serious adverse events within 1 year, and novelty of the drug) and the part-worth utility of attribute levels in mild and severe symptom scenarios, including among employed versus unemployed patients.
Results
Of 372 patients who completed the survey, 365 were evaluated. Patient preferences were generally highly individualized. The route/frequency of administration was the most important attribute in both the mild and severe symptom scenarios. Oral administration was preferred in the mild symptom scenario, whereas no specific preference was observed in the severe symptom scenario. The route/ frequency of administration was more valued in the mild symptom scenario than in the severe one, whereas speed of onset of action was more valued in the severe symptom scenario. No significant difference was found in the preference for drug profiles between employed and unemployed patients.
Conclusions
Patient preferences for the route/frequency of administration, as well as other drug profiles, change with disease severity but demonstrate substantial interindividual variability. Therefore, shared decision-making is important to incorporate patients’ perspectives into the selection of advanced therapies.

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IBD

Histologic healing and clinical outcomes in ulcerative colitis: Raymond Fueng-Hin Liang, Huiyu Lin, Cora Yuk-Ping Chau, Wee Chian Lim; Intest Res 2025;23(2):182-192. Published online September 19, 2024; DOI: https://doi.org/10.5217/ir.2024.00058

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Background/Aims
Growing evidence suggests histologic healing (HH) improves clinical outcomes in ulcerative colitis (UC) patients beyond endoscopic healing (EH). We hypothesize that HH is associated with better clinical outcomes in Asian UC patients, for whom data is lacking.
Methods
We performed a retrospective study of UC patients in clinical remission (CR) with a follow-up colonoscopy and minimum 1-year follow-up post-colonoscopy. Primary outcome was clinical relapse (CRL), defined as either a Simple Clinical Colitis Activity Index score of > 2, medication escalation, hospitalization or colectomy. Predictors of CRL and HH were assessed.
Results
One hundred patients were included with a median follow-up of 22 months. At index colonoscopy, 80 patients were in EH. On follow-up, 41 patients experienced CRL. Of 80 patients in EH, 34 (42.5%) had persistent histologic activity (Nancy Index ≥ 2) and 29 (36.3%) relapsed during the follow-up period. Amongst patients in CR and EH, those with HH had lower CRL rate (26.1% vs. 50.0%, P= 0.028) and longer CRL-free survival (mean 46.1 months vs. 31.5 months, P= 0.015) than those with persistent histologic activity. On bivariable analysis of 100 patients in CR, HH, and Mayo endoscopic score (MES) of 0 were significantly associated with lower risk of CRL. On multivariable analysis, only MES 0 remained predictive of lower CRL risk.
Conclusions
Above and beyond CR and EH, achieving HH improves clinical outcomes in Asian UC patients. However, HH may not confer incremental benefit if MES 0 has been achieved. Further prospective studies evaluating the benefit of histologically guided therapeutic decisions are needed.

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Correlation between clinical and histopathological scoring systems in Egyptian patients with ulcerative colitis (single center study)
Randa Ahmed El Garhy, Faten Wagdi Ragheb, Nermine Mohamed Abd Raboh, Hagar Elessawy, Fatma S. Hafez
The Egyptian Journal of Internal Medicine.2025;[Epub] CrossRef

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Combined eosinophilic gastroenteritis and ulcerative colitis successfully treated by vedolizumab: a case report: Hironobu Takedomi, Kayoko Fukuda, Suma Inoue, Nanae Tsuruoka, Yasuhisa Sakata, Shigehisa Aoki, Motohiro Esaki; Intest Res 2025;23(1):107-111. Published online August 29, 2024; DOI: https://doi.org/10.5217/ir.2024.00013

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A 47-year-old man with over 10 years’ duration of ulcerative colitis treated by 5-aminosalicylic acid and intermittent topical steroids complained of acute epigastric pain. Esophagogastroduodenoscopy revealed diffuse mucosal edema with patchy redness, multiple erosions and nodularity of the stomach. Bioptic examination revealed marked eosinophilic infiltration, confirming the diagnosis of eosinophilic gastroenteritis. Systemic steroid therapy was initiated, whereas his ulcerative colitis and eosinophilia recurred when tapering the steroid. Addition of azathioprine was ineffective, and we subsequently started vedolizumab for eosinophilic gastroenteritis and ulcerative colitis. The medication effectively improved his abdominal symptoms and esophagogastroduodenoscopy and ileocolonoscopy 1 year later revealed endoscopic improvement of both diseases with histologically decreased level of eosinophilic infiltration. Considering that eosinophils also express α4β7 integrins, vedolizumab can be a possible therapeutic candidate for eosinophilic gastroenteritis as well as ulcerative colitis.

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Vedolizumab Induces Remission in Two Cases of Ulcerative Colitis With Upper Gastrointestinal Involvement
Shinya Nakatani, Yuta Yamazaki, Kensuke Higuchi, Yumi Otoyama, Norihiro Suzuki, Kazuo Kikuchi, Takahisa Fujiwara, Atsushi Katagiri, Jyun Ohara, Hitoshi Yoshida
DEN Open.2026;[Epub] CrossRef

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IBD

The prevalence of pouch fistulas in ulcerative colitis following restorative proctocolectomy: a systematic review and meta-analysis: Sheng Wei Lo, Ishaan Dharia, Danujan Sriranganathan, Maia Kayal, Edward L. Barnes, Jonathan P. Segal; Intest Res 2025;23(1):56-64. Published online August 9, 2024; DOI: https://doi.org/10.5217/ir.2024.00009

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Background/Aims
One complication of restorative proctocolectomy with ileo-anal pouch anastomosis is fistula formation in the pouch. Fistulas can be associated with significant morbidity and pouch failure. We conducted a systematic review with meta- analysis to try and understand the prevalence of pouch fistulas in patients with ulcerative colitis following restorative proctocolectomy.
Methods
The Embase, Embase Classic, and PubMed databases were searched between January 1979 and April 2022. Studies were included if there were cross-sectional, case-controlled, population-based or cohort studies reporting on prevalence of pouch fistulas in ulcerative colitis. Studies had to report the number of patients with pouch fistulas using either clinical, endoscopic, or radiological diagnosis in an adult population.
Results
Thirty-three studies screened met the inclusion criteria. The pooled prevalence of developing at least 1 fistula was 0.05 (95% confidence interval [CI], 0.04–0.07). The pooled prevalence of pouch failure in patients with pouch fistula was found to be 0.24 (95% CI, 0.19–0.30). The pooled prevalence of developing a pouch fistula at 3 years, 5 years and more than 5 years was 0.04 (95% CI, 0.02–0.07), 0.05 (95% CI, 0.02–0.07), and 0.05 (95% CI, 0.02–0.10), respectively.
Conclusions
This is the first systematic review and meta-analysis to report the prevalence of pouch fistula. It also provides a pooled prevalence of pouch failure in these patients. These results can help to shape future guidelines, power future studies, and help counsel patients.

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Minimally Invasive Rectal Surgery: Current Status and Future Perspectives in the Era of Digital Surgery
Marta Goglia, Matteo Pavone, Vito D’Andrea, Veronica De Simone, Gaetano Gallo
Journal of Clinical Medicine.2025; 14(4): 1234. CrossRef
PAVFCOS: The development of a core outcome set for pouch anal and vaginal fistula
Lillian Reza, Lara Bapir, Nusrat Iqbal, Charlene Sackitey, Sally Hughes, Mina Babbar, Rali Marinova, Petya Marinova, Pearl Avery, Phillip Lung, Jonathan P. Segal, Pär Myrelid, Paolo Gionchetti, Bram Verstockt, Ailsa Hart, Sue K. Clark, Phil Tozer
Colorectal Disease.2025;[Epub] CrossRef
ECCO Topical Review on Pouch Disorders
Maia Kayal, Gabriele Bislenghi, Michel Adamina, Zaid S Ardalan, Nicolas Avellaneda, Anthony de Buck van Overstraeten, Marjolijn Duijvestein, Maria Manuela Estevinho, Federica Furfaro, Ailsa L Hart, Stefan Holubar, Triana Lobaton, Jacob Ollech, Stephan R V
Journal of Crohn's and Colitis.2025;[Epub] CrossRef

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IBD

Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease updated in 2023: Hsu-Heng Yen, Jia-Feng Wu, Horng-Yuan Wang, Ting-An Chang, Chung-Hsin Chang, Chen-Wang Chang, Te-Hsin Chao, Jen-Wei Chou, Yenn-Hwei Chou, Chiao-Hsiung Chuang, Wen-Hung Hsu, Tzu-Chi Hsu, Tien-Yu Huang, Tsung-I Hung, Puo-Hsien Le, Chun-Che Lin, Chun-Chi Lin, Ching-Pin Lin, Jen-Kou Lin, Wei-Chen Lin, Yen-Hsuan Ni, Ming-Jium Shieh, I-Lun Shih, Chia-Tung Shun, Tzung-Jiun Tsai, Cheng-Yi Wang, Meng-Tzu Weng, Jau-Min Wong, Deng-Chyang Wu, Shu-Chen Wei; Intest Res 2024;22(3):213-249. Published online July 29, 2024; DOI: https://doi.org/10.5217/ir.2023.00050

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Ulcerative colitis (UC) is a chronic inflammation of the gastrointestinal tract and is characterized by alternating periods of inflammation and remission. Although UC incidence is lower in Taiwan than in Western countries, its impact remains considerable, demanding updated guidelines for addressing local healthcare challenges and patient needs. The revised guidelines employ international standards and recent research, emphasizing practical implementation within the Taiwanese healthcare system. Since the inception of the guidelines in 2017, the Taiwan Society of Inflammatory Bowel Disease has acknowledged the need for ongoing revisions to incorporate emerging therapeutic options and evolving disease management practices. This updated guideline aims to align UC management with local contexts, ensuring comprehensive and context-specific recommendations, thereby raising the standard of care for UC patients in Taiwan. By adapting and optimizing international protocols for local relevance, these efforts seek to enhance health outcomes for patients with UC.

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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
Prevalence of viral hepatitis A and C in patients with inflammatory bowel disease: a nationwide population-based study in South Korea
Jin Hwa Park, Sang Hyoung Park, Sang Pyo Lee, Kang Nyeong Lee, Hang Lak Lee, Oh Young Lee, Soorack Ryu, Junwon Go
The Korean Journal of Internal Medicine.2026; 41(1): 95. CrossRef
Short-term and long-term outcomes of acute severe ulcerative colitis in Taiwan: a multicenter study with pre- and post-biologics comparison
Wei-Chen Lin, Chun-Chi Lin, Wen-Hung Hsu, Feng-Fan Chiang, Chen-Wang Chang, Tzu-Chi Hsu, Deng-Chyang Wu, Horng-Yuan Wang, Jau-Min Wong, Shu-Chen Wei
Intestinal Research.2025;[Epub] CrossRef
Endoscopic Techniques for Colorectal Neoplasia Surveillance in Inflammatory Bowel Disease: A Systematic Review and Network Meta‐Analysis
Chih‐Wen Huang, Hsu‐Heng Yen, Yang‐Yuan Chen
United European Gastroenterology Journal.2025; 13(8): 1418. CrossRef
Herpes zoster infection in patients with inflammatory bowel disease
Dong Hyun Kim, Sang-Bum Kang
The Korean Journal of Internal Medicine.2025; 40(3): 347. CrossRef
Annual Therapeutic Drug Monitoring in Patients with Inflammatory Bowel Disease During Infliximab Maintenance Therapy: Balancing Efficacy with Risk of Pharmacokinetic Failure
Yujin Lim, Boram Park, Kyeongman Jeon, Ok Soon Jeong, Eun Ran Kim, Young-Ho Kim, Dong Kyung Chang, Sung Noh Hong
Digestive Diseases and Sciences.2025; 70(8): 2804. CrossRef
Impact of Obesity on the Long-Term Outcomes of Advanced Therapies in IBD: A Real-World Study in Taiwan
Wei-Chun Hsu, Shih-Hua Lin, Chia-Jung Kuo, Horng-Yih Chiu, Chien-Ming Chen, Ming-Yao Su, Cheng-Tang Chiu, Chen-Wang Chang, Tien-Yu Huang, Yu-Bin Pan, Puo-Hsien Le
Journal of Inflammation Research.2025; Volume 18: 7139. CrossRef
Serological Assessment of Hepatitis in Patients with Inflammatory Bowel Disease in Taiwan: A Retrospective Cohort Analysis
Yueh-An Lee, Hsu-Heng Yen, Yang-Yuan Chen
Life.2025; 15(6): 893. CrossRef
Guselkumab in East Asians With Moderate‐to‐Severe Ulcerative Colitis: Subgroup Analysis of the QUASAR Induction and Maintenance Studies
Baili Chen, Byong Duk Ye, Qian Cao, Fumihito Hirai, Masayuki Saruta, Minhu Chen, Susan Pelak, Nicole Shipitofsky, Ye Miao, Keira Herr, Bryan Wahking, Jianmin Zhuo, Tadakazu Hisamatsu
Journal of Gastroenterology and Hepatology.2025; 40(9): 2197. CrossRef
The role of vitamin D deficiency and modifiable risk factors in patients with Crohn’s disease
Xiaoyue Feng, Qin Yin, Ying Kang, Kang Jiang, Mengqing Xu, Fangyu Wang
Frontiers in Immunology.2025;[Epub] CrossRef
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
Intestinal Research.2025; 23(4): 541. CrossRef
Case Report: Cryptococcal Meningitis During Tofacitinib Therapy in Ulcerative Colitis: A Rare Opportunistic Infection
Chien‐Ming Chen, Hsu‐Heng Yen, Yang‐Yuan Chen
International Journal of Rheumatic Diseases.2025;[Epub] CrossRef
Three Janus kinase inhibitors in ulcerative colitis: is upadacitinib taking the lead?
Yoon Suk Jung
Intestinal Research.2025; 23(4): 394. CrossRef
Combining Network Pharmacology, Molecular Docking, and Integrative Studies to Explore the Mechanism of Helminthostachys zeylanica in Alleviating Ulcerative Colitis
Chih‐Ting Lin, Li‐Wei Lin, Li‐Ching Chang, Lung‐Yuan Wu, Fan‐Shiu Tsai
Food Science & Nutrition.2025;[Epub] CrossRef
Acute Severe Ulcerative Colitis Patients From Asia Have Lower Colectomy Risk Than Patients From Australasia
Richard Gareth Fernandes, Dong Hyun Kim, Leonie Ruddick-Collins, Abhinav Vasudevan, Anthony Robert Brownson, Benjamin Ngoi, Chun-Chi Lin, Craig Haifer, Dae Sung Kim, Ei Swe, Emily Kate Wright, Eun Mi Song, Gillian Mahy, Gregory Thomas Moore, Hyun Seok Lee
Clinical Gastroenterology and Hepatology.2025;[Epub] CrossRef
Prevalence and association testing of antinuclear antibodies and inflammatory bowel disease in Taiwan
Tsai-Min Yang, Fang-Ting Lu, Hsu-Heng Yen, Yang-Yuan Chen
PeerJ.2025; 13: e20474. CrossRef
Rescue Therapies for Steroid-refractory Acute Severe Ulcerative Colitis: A Systematic Review and Network Meta-analysis
Chih-Wen Huang, Hsu-Heng Yen, Yang-Yuan Chen
Journal of Crohn's and Colitis.2024; 18(12): 2063. CrossRef
High prevalence of vitamin D deficiency in Taiwanese patients with inflammatory bowel disease
Chen-Ta Yang, Hsu-Heng Yen, Pei-Yuan Su, Yang-Yuan Chen, Siou-Ping Huang
Scientific Reports.2024;[Epub] CrossRef

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Long-term efficacy and safety of tofacitinib in patients with ulcerative colitis: 3-year results from a real-world study: Hiromichi Shimizu, Yuko Aonuma, Shuji Hibiya, Ami Kawamoto, Kento Takenaka, Toshimitsu Fujii, Eiko Saito, Masakazu Nagahori, Kazuo Ohtsuka, Ryuichi Okamoto; Intest Res 2024;22(3):369-377. Published online July 16, 2024; DOI: https://doi.org/10.5217/ir.2023.00194

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Background/Aims
The efficacy and safety of tofacitinib for the treatment of refractory ulcerative colitis (UC) has been demonstrated in clinical trials. Although, a series of reports with real-world evidence of its short-term efficacy and safety profiles have already been published, reports of long-term real-world data have been limited. We aimed to show our 3-year evidence on the clinical use of tofacitinib for the treatment of UC, focusing on its efficacy and safety profiles.
Methods
A retrospective observational study was conducted on patients who started tofacitinib for active refractory UC at our hospital. The primary outcome was the retention rate until 156 weeks after initiating tofacitinib. The secondary outcomes were short-term efficacy at 4, 8, and 12 weeks; long-term efficacy at 52, 104, and 156 weeks; prognostic factors related to the cumulative retention rate; loss of response; and safety profile, including adverse events.
Results
Forty-six patients who were able to be monitored for up to 156 weeks after tofacitinib initiation, were enrolled in this study. Continuation of tofacitinib was possible until 156 weeks in 54.3%, with > 50% response rates and > 40% remission rates. Among patients in whom response or remission was achieved and tofacitinib was deescalated after 8 weeks of induction treatment, 54.3% experienced relapse but were successfully rescued by and retained on reinduction treatment, except for 1 patient. No serious AEs were observed in the study.
Conclusions
Tofacitinib is effective and safe as long-term treatment in a refractory cohort of UC patients in real-world clinical practice.

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Comparative short-term efficacy of upadacitinib versus tofacitinib for ulcerative colitis: a 24-week real-world study in Japan
Akiko Tamura, Hiromichi Shimizu, Toshimitsu Fujii, Ami Kawamoto, Ryo Morikawa, Shuji Hibiya, Kento Takenaka, Masakazu Nagahori, Kazuo Ohtsuka, Ryuichi Okamoto
Intestinal Research.2026; 24(1): 95. CrossRef
Optimal use and cycling strategies of Janus kinase inhibitors in ulcerative colitis: current evidence and clinical implications from the KASID Guidelines Task Force Team
Seung Min Hong, Dong Hyun Kim, June Hwa Bae, Seung Yong Shin, Eun Mi Song, Ji Eun Kim, Young Joo Yang, Jiyoung Yoon, Sang-Bum Kang, Eun Soo Kim, Seong-Eun Kim, Seong-Jung Kim, Jun Lee, Soo-Young Na, Soo Jung Park, Sang Hyoung Park, Miyoung Choi, Myung Ha
Intestinal Research.2026; 24(1): 27. CrossRef
In which patients with ulcerative colitis would filgotinib be effective?
Jihye Park
Intestinal Research.2025; 23(1): 1. CrossRef
Tofacitinib for ulcerative colitis in Brazil: a multicenter observational study on effectiveness and safety
Rogério Serafim Parra, Renata de Sá Brito Fróes, Daniela Oliveira Magro, Sandro da Costa Ferreira, Munique Kurtz de Mello, Matheus Freitas Cardoso de Azevedo, Aderson Omar Mourão Cintra Damião, Alexandre de Sousa Carlos, Luísa Leite Barros, Maria Luiza Qu
BMC Gastroenterology.2025;[Epub] CrossRef
State-of-the-Art Evidence for Clinical Outcomes and Therapeutic Implications of Janus Kinase Inhibitors in Moderate-to-Severe Ulcerative Colitis: A Narrative Review
Yunseok Choi, Suhyun Lee, Hyeon Ji Kim, Taemin Park, Won Gun Kwack, Seungwon Yang, Eun Kyoung Chung
Pharmaceuticals.2025; 18(5): 740. CrossRef
Endo-histologic outcomes in patients with ulcerative colitis responding to tofacitinib
Arshdeep Singh, Arshia Bhardwaj, Devanshi Jain, Riya Sharma, Dharmatma Singh, Ramit Mahajan, Kirandeep Kaur, Aminder Singh, Vikram Narang, Harpreet Kaur, Manavjot Singh, Pritish Gupta, Tanisha Sehgal, Vandana Midha, Ajit Sood
Indian Journal of Gastroenterology.2025;[Epub] CrossRef
Exploring the Factors Associated With the Discontinuation of Tofacitinib in Patients With Rheumatoid Arthritis: A Retrospective Cohort Study
Li‐Huei Chiang, Chia‐Ling Yu, Tzu‐Cheng Tsai, Yao‐Fan Fang
International Journal of Rheumatic Diseases.2025;[Epub] CrossRef
Toward Precision Medicine: Molecular Biomarkers of Response to Tofacitinib in Inflammatory Bowel Disease
Anja Bizjak, Boris Gole, Gregor Jezernik, Uroš Potočnik, Mario Gorenjak
Genes.2025; 16(8): 908. CrossRef
Tofacitinib in acute severe ulcerative colitis: review addressing seven key unmet needs
Chuong Dinh Nguyen, Luan Minh Dang, Thong Duy Vo, Hoang Huu Bui, Eun Soo Kim, Joyce Wing Yan Mak, Choon Jin Ooi
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
Three Janus kinase inhibitors in ulcerative colitis: is upadacitinib taking the lead?
Yoon Suk Jung
Intestinal Research.2025; 23(4): 394. CrossRef
Optimizing Janus kinase inhibitor therapy for ulcerative colitis: a real-world perspective
Shintaro Akiyama
Intestinal Research.2025;[Epub] CrossRef
Reevaluating aminosalicylates role in maintaining remission in ulcerative colitis: Systematic review and meta-analysis in the era of biologics
Themba Mudege, Jonathan Soldera
World Journal of Meta-Analysis.2025;[Epub] CrossRef
Drug-induced liver injury in inflammatory bowel disease: Challenges in diagnosis and monitoring
Arshdeep Singh, Arshia Bhardwaj, Harmeet Kaur, Ashutosh Bawa, Vandana Midha, Ajit Sood
World Journal of Hepatology.2025;[Epub] CrossRef

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Filgotinib induction-study baseline characteristics of patients with ulcerative colitis who achieve sustained corticosteroid-free remission: post hoc analysis of the phase 2b/3 SELECTION study: Taku Kobayashi, Axel Dignass, Xavier Roblin, Yoshie Takatori, Toshihiko Kaise, Alessandra Oortwijn, Corinne Jamoul, Toshifumi Hibi; Intest Res 2025;23(1):65-75. Published online June 14, 2024; DOI: https://doi.org/10.5217/ir.2024.00007

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Background/Aims
Obtaining and maintaining corticosteroid-free remission are important goals of treatment for ulcerative colitis (UC). Characteristics associated with achieving corticosteroid-free remission were assessed in filgotinib-treated patients in SELECTION, a 58-week, phase 2b/3 trial in moderately to severely active UC.
Methods
This post hoc analysis used data from filgotinib-treated patients receiving corticosteroids at maintenance baseline in SELECTION. Univariate logistic regression was performed to assess induction baseline characteristics associated with 6 months of corticosteroid-free remission at week 58, defined as clinical remission without using corticosteroids for at least 6 months.
Results
At maintenance baseline, 92 and 81 patients were receiving corticosteroids in the filgotinib 200 mg and filgotinib 100 mg groups, respectively. Age, body mass index, history of pancolitis, disease duration, fecal calprotectin levels, C-reactive protein levels, Mayo Clinic Score, concomitant corticosteroids, immunomodulators, and aminosalicylates had no statistically significant effect on the likelihood of achieving corticosteroid-free remission. Baseline characteristics associated with increased odds of corticosteroid-free remission were Mayo Clinic Endoscopic Subscore of 2 (vs. 3) in the filgotinib 200 mg and filgotinib 100 mg groups, and female (vs. male) sex, current (vs. former or never) smoking, and being biologic‑naive (vs. experienced) in the filgotinib 200 mg group.
Conclusions
Steroid tapering can be achieved in patients with UC receiving filgotinib 200 mg independently of baseline characteristics such as clinical activity and duration of illness. However, the likelihood of achieving corticosteroid-free remission was higher among patients who were biologic-naive, current smokers, had low endoscopic inflammatory burden and who were female.

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In which patients with ulcerative colitis would filgotinib be effective?
Jihye Park
Intestinal Research.2025; 23(1): 1. CrossRef
Three Janus kinase inhibitors in ulcerative colitis: is upadacitinib taking the lead?
Yoon Suk Jung
Intestinal Research.2025; 23(4): 394. CrossRef

8,847 View
256 Download
3 Web of Science
2 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

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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.

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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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1 Crossref

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

Abstract PDF PubReader ePub

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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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
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
Journal of Clinical Medicine.2025; 14(8): 2803. CrossRef
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
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.2025;[Epub] CrossRef

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Predictors of histologic remission in patients with biologic-naïve, moderate-to-severe ulcerative colitis treated with first-line biologic agents and small-molecule drugs: a single-center, retrospective cohort study: Kijae Jo, Kwang Woo Kim, Hyun Jung Lee, Jong Pil Im, Joo Sung Kim, Seong-Joon Koh; Intest Res 2024;22(4):453-463. Published online May 22, 2024; DOI: https://doi.org/10.5217/ir.2024.00044

Abstract PDF PubReader ePub: Background/Aims
The prevalence and incidence of ulcerative colitis (UC) in Korea is increasing. Each patient has a different disease course and treatment response. Recently, with the development of biologic agents, histological remission has become a treatment goal. In this study, we aimed to identify the predictors of histological remission after first-line biologic agent treatment in patients with biologic agent-naïve UC.
Methods
We retrospectively analyzed the medical records of 92 patients who had been diagnosed with UC and treated with first-line biologic agent treatment at our center, between 2015 and 2022. The clinical characteristics, laboratory test results, and endoscopic and biopsy findings were analyzed. Histological remission was defined as the absence of cryptitis, crypt abscesses, and inflammatory cells on histology. Univariate and multivariate logistic regression analyses were performed to identify the predictors of histological remission after first-line treatment.
Results
Of the total 92 patients, 25 (27.2%) achieved histological remission. Each cohort had a varied body mass index (BMI) distribution, with a statistically significant overweight ratio, as defined by the Asian-Pacific BMI category of 23–25 kg/m², of 48.0% in the histological remission cohort (P= 0.026). A causal correlation between the overweight category and histological remission was confirmed (odds ratio, 3.883; 95% confidence interval, 1.141–13.212; P= 0.030).
Conclusions
We confirmed that the overweight category was a predictor of histological remission after first-line treatment with a biological agent. However, as BMI does not account for skeletal muscle mass, future studies are required to confirm the correlation between skeletal muscle mass and histological remission.

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What to do when traditional rescue therapies fail in acute severe ulcerative colitis: Christopher F. D. Li Wai Suen, Matthew C. Choy, Peter De Cruz; Intest Res 2024;22(4):397-413. Published online May 16, 2024; DOI: https://doi.org/10.5217/ir.2024.00003

Abstract PDF PubReader ePub

Acute severe ulcerative colitis (ASUC) is a medical emergency that affects approximately 25% of patients with ulcerative colitis at some point in time in their lives. Outcomes of ASUC are highly variable. Approximately 30% of patients do not respond to corticosteroids and up to 50% of patients do not respond to rescue therapy (infliximab or cyclosporin) and require emergency colectomy. Data are emerging on infliximab dosing strategies, use of cyclosporin as a bridge to slower acting biologic agents and Janus kinase inhibition as primary and sequential therapy. In this review, we outline contemporary approaches to clinical management of ASUC in the setting of failure to respond to traditional rescue therapies.

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Christopher F.D. Li Wai Suen, Matthew C. Choy, Danny Con, Kaylene Cheng, Julie Nigro, Kerry Breheney, Kristy Boyd, Raquel Pena, Kathryn Burrell, Ourania Rosella, David Proud, Richard Brouwer, Alexandra Gorelik, Danny Liew, William R. Connell, Emily K. Wri
Gastroenterology.2026; 170(1): 118. CrossRef
Optimal use and cycling strategies of Janus kinase inhibitors in ulcerative colitis: current evidence and clinical implications from the KASID Guidelines Task Force Team
Seung Min Hong, Dong Hyun Kim, June Hwa Bae, Seung Yong Shin, Eun Mi Song, Ji Eun Kim, Young Joo Yang, Jiyoung Yoon, Sang-Bum Kang, Eun Soo Kim, Seong-Eun Kim, Seong-Jung Kim, Jun Lee, Soo-Young Na, Soo Jung Park, Sang Hyoung Park, Miyoung Choi, Myung Ha
Intestinal Research.2026; 24(1): 27. CrossRef
Intensified infliximab induction therapy for steroid-refractory acute severe ulcerative colitis – Authors’ reply
Christopher F D Li Wai Suen, Matthew C Choy, Danny Con, Peter De Cruz
The Lancet Gastroenterology & Hepatology.2025; 10(1): 19. CrossRef
Janus kinase inhibitors in the management of acute severe ulcerative colitis: a comprehensive review
Javier P Gisbert, María Chaparro
Journal of Crohn's and Colitis.2025;[Epub] CrossRef
Sequential rescue therapy with JAK inhibitors in corticosteroid and infliximab-refractory acute severe ulcerative colitis: a case series
Amirah Etchegaray, George Tambakis, Rina Kumar, Anthony Croft, Graham Radford-Smith, Gareth J. Walker
Therapeutic Advances in Gastroenterology.2025;[Epub] CrossRef
Population Pharmacokinetic Model for the Use of Intravenous or Subcutaneous Infliximab in Patients with Inflammatory Bowel Disease: Real-World Data from a Prospective Cohort Study
Joo Hye Song, Sung Noh Hong, Myeong Gyu Kim, Minjung Kim, Seong Kyung Kim, Eun Ran Kim, Dong Kyung Chang, Young-Ho Kim
Gut and Liver.2025; 19(3): 376. CrossRef
Three Janus kinase inhibitors in ulcerative colitis: is upadacitinib taking the lead?
Yoon Suk Jung
Intestinal Research.2025; 23(4): 394. CrossRef
Janus Kinase Inhibitors for Inflammatory Bowel Disease: Concise Questions and Answers on Their Use in Clinical Practice
Javier P Gisbert, María Chaparro
Inflammatory Bowel Diseases.2025;[Epub] CrossRef
Recent Advances in the Management of Acute Severe Ulcerative Colitis
Elaine Ong Ming San, Kassem Sharif, Konstantina Rosiou, Michael Rennie, Christian Philipp Selinger
Journal of Clinical Medicine.2024; 13(23): 7446. CrossRef

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Changes in the clinical course and prognosis of ulcerative colitis in Chinese populations: a retrospective cohort study: Xinyu Liu, Qingfan Yang, Na Diao, Jian Tang, Zicheng Huang, Xiang Gao, Kang Chao; Intest Res 2024;22(3):357-368. Published online May 7, 2024; DOI: https://doi.org/10.5217/ir.2023.00106

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Data on the natural course of Chinese patients with ulcerative colitis (UC) was lacking. This study aimed to evaluate the natural history and prognosis of patients with UC in the past 15 years in China.
Methods
This cohort study included patients with UC in a tertiary hospital in southern China from 2007 to 2021 (cohort I: 2007–2011, cohort II: 2012–2016, cohort III: 2017–2021). Patients’ clinical characteristics and natural history were analyzed retrospectively.
Results
Of 1,139 included patients, 683 patients presented with proctitis or left-sided colitis at diagnosis and 38.5% of them (263/683) developed proximal disease extension. Fifty-eight percent of patients experienced relapse, chronic continuous and intermittent active course. Five patients (0.4%) developed colorectal tumors/dysplasia. The overall surgery rate was 8.6%, and the rates were 14.2%, 7.8%, and 8.0% in the 3 cohorts, respectively (P= 0.059). Average time from diagnosis to surgery decreased from cohorts I to III (144 months vs. 36 months, P< 0.001), so did the use of glucocorticoids (58.2% vs. 43.5%, P< 0.001) and immunosuppressants (14.1% vs. 13.4%, P= 0.016), and days of hospitalization (13 days vs. 9 days, P< 0.001). Biologics were used more frequently during the first year (0.8%, 2.1%, and 13.7% for cohorts I to III, respectively; P< 0.001). The rate of mucosal healing increased over time.
Conclusions
In Chinese UC patients, one-third of patients experienced proximal disease extension. The rates of malignancy and mortality were low. More biologics were used, while use of immunosuppressants and glucocorticoids were reduced over time. Early biologics use seemed to promote mucosal healing, but the rate of colectomy has not dramatically decreased.

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The effects of biologics on ulcerative colitis–related colectomy rate: results of a 22-year study
Nur Beyza Tukek, Oguz Kagan Bakkaloglu, Gozde Sen, İbrahim Hatemi, Aykut Ferhat Celik, Yusuf Ziya Erzin
Scandinavian Journal of Gastroenterology.2025; 60(6): 548. CrossRef
Towards an Asian paradigm of inflammatory bowel disease management: A comparative review of China and Japan
Qi Sun, Zhixian Jiang, Lichao Yang, Hao Liu, Peipei Song, Lianwen Yuan
Intractable & Rare Diseases Research.2025; 14(3): 192. CrossRef
Therapeutic management and risk of colectomy in patients with acute severe ulcerative colitis and previous exposure to anti-tumor necrosis factor drugs: a comparative study of GETECCU
Francisco Mesonero, López-García Alicia, Miranda-Bautista José, Rubín de Célix Cristina, Marín-Jiménez Ignacio, Suárez Ferrer Cristina, Martin-Cardona Albert, Fuentes-Valenzuela Esteban, Mínguez Alejando, Castaño Andrés, Roig Cristina, Fernández-Clotet Ag
Journal of Crohn’s and Colitis.2025;[Epub] CrossRef
Manejo de la proctitis ulcerosa refractaria
Manuel Barreiro-de Acosta, Francisco Mesonero, Rocío Ferreiro-Iglesias, Santiago García-López, Mariam Aguas Peris, Mónica Sierra Ausín, Noelia Cano Sanz, Antonio Valdivia Martínez, Ana Cábez, Susan Ramírez, Daniel Ginard
Gastroenterología y Hepatología.2025; : 502646. CrossRef

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Efficacy and safety of mirikizumab as induction and maintenance therapy for Japanese patients with moderately to severely active ulcerative colitis: a subgroup analysis of the global phase 3 LUCENT-1 and LUCENT-2 studies: Taku Kobayashi, Katsuyoshi Matsuoka, Mamoru Watanabe, Tadakazu Hisamatsu, Fumihito Hirai, Joe Milata, Xingyuan Li, Nathan Morris, Vipin Arora, Tomoko Ishizuka, Koji Matsuo, Yoichi Satoi, Catherine Milch, Toshifumi Hibi; Intest Res 2024;22(2):172-185. Published online April 25, 2024; DOI: https://doi.org/10.5217/ir.2023.00043

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Mirikizumab is a p19-directed anti-interleukin-23 antibody with potential efficacy against ulcerative colitis (UC). We evaluated the efficacy and safety of mirikizumab in a Japanese subpopulation with moderately to severely active UC from the LUCENT-1 and LUCENT-2 studies.
Methods
LUCENT-1 and LUCENT-2 were phase 3, randomized, double-blind, placebo-controlled trials of mirikizumab therapy in adults with moderately to severely active UC. LUCENT-1 was a 12-week induction trial where patients were randomized 3:1 to receive intravenous mirikizumab 300 mg or placebo every 4 weeks (Q4W). Patients achieving a clinical response with mirikizumab following the induction study were re-randomized 2:1 to double-blind treatment with either mirikizumab 200 mg or placebo subcutaneously Q4W during the 40-week maintenance study. The primary outcomes were clinical remission at week 12 of LUCENT-1 and week 40 of LUCENT-2.
Results
A total of 137 patients enrolled in Japan were randomized to mirikizumab (n = 102) or placebo (n = 35). Compared with placebo, patients who received mirikizumab showed numerically higher clinical remission at week 12 of induction (32.4% [n = 33] vs. 2.9% [n = 1]) and at week 40 of maintenance (48.9% [n = 23] vs. 28.0% [n = 7]). A greater number of patients achieved key secondary endpoints in the mirikizumab group compared with placebo. The frequency of treatment-emergent adverse events was similar across mirikizumab and placebo groups. Efficacy and safety results observed in the Japanese subpopulation were generally consistent with those in the overall population.
Conclusions
Mirikizumab induction and maintenance treatments were effective in Japanese patients with moderately to severely active UC. No new safety concerns were identified.

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Shuhan Wang, Hui Sun, Qian Wang, Han Xiao
Frontiers in Pharmacology.2025;[Epub] CrossRef
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Alimentary Pharmacology & Therapeutics.2025; 61(12): 1923. CrossRef
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Xi-Yuan Peng, Wei Du, Juan Miao, Li Shi, Wei Li, Meng-Wei Ge, Lu-Ting Shen, Rui Feng, Kang Zhong, Si-Qi Gao, Hong-Lin Chen
International Journal of Clinical Pharmacy.2025; 47(6): 1674. CrossRef
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Yu Zhou, Fang Shen
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Jakub Olszewski, Katarzyna Kozon, Magdalena Sitnik, Katarzyna Herjan, Karolina Mikołap, Bartłomiej Gastoł, Maciej Bara, Piotr Armański, Marcin Sawczuk
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International Journal of Molecular Sciences.2024; 26(1): 121. CrossRef

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The evolving understanding of histology as an endpoint in ulcerative colitis: Shintaro Akiyama, Yusuke Miyatani, David T. Rubin; Intest Res 2024;22(4):389-396. Published online March 13, 2024; DOI: https://doi.org/10.5217/ir.2023.00120

Abstract PDF PubReader ePub

A therapeutic goal for patients with ulcerative colitis (UC) is deep remission including clinical remission and mucosal healing. Mucosal healing was previously defined by endoscopic appearance, but recent studies demonstrate that histological improvements can minimize the risks of experiencing clinical relapse after achieving endoscopic remission, and there is growing interest in the value and feasibility of histological targets of treatment in inflammatory bowel disease, and specifically UC. In this review article, we identify remaining challenges and discuss an evolving role of histology in the management of UC.

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Claudin-2 simplifies histological assessment of activity/remission of ulcerative colitis in real-life daily practice
Gabrio Bassotti, Rachele Del Sordo, Francesco Lanzarotto, Sara Mino, Chiara Ricci, Vincenzo Villanacci
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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
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Beyond mucosal healing: fecal calprotectin and the path toward histologic remission in ulcerative colitis
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Optimizing Janus kinase inhibitor therapy for ulcerative colitis: a real-world perspective
Shintaro Akiyama
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Patients with ulcerative colitis who have normalized histology are clinically stable after de-escalation of therapy
Shintaro Akiyama, Joëlle St-Pierre, Cindy Traboulsi, Alexa Silfen, Victoria Rai, Tina G. Rodriguez, Amarachi I. Erondu, Joshua M. Steinberg, Seth R. Shaffer, Britt Christensen, David T. Rubin
npj Gut and Liver.2024;[Epub] CrossRef

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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.

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Hye Kyung Hyun, Jae Hee Cheon
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Balachandar Selvakumar, Rani Samsudin
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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

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