Objective:To evaluate the efficacy and safety of upadacitinib in the real-world treatment of difficult-to-treat Crohn's disease (DTT-CD) .Methods:This multicenter, retrospective cohort study included patients diagnosed with DTT-CD according to the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) criteria, and treated at eight Chinese inflammatory bowel disease centers between January 2023 and March 2025. Clinical outcomes were assessed after 12 weeks of induction therapy with upadacitinib (45 mg qd), including clinical remission rate, clinical response rate, and incidence of adverse events.Results:Among 151 enrolled DTT-CD patients, the clinical remission rate was 47.0%, and the clinical response rate was 90.7% after 12 weeks of treatment. Adverse events occurred in 42 cases (27.8%) .Conclusion:Upadacitinib demonstrated favorable efficacy in inducing clinical remission in DTT-CD patients, with a good safety profile at the induction dose (45 mg qd) .
Objective:To explore the natural course of ulcerative proctitis (UP) and the risk factors associated with disease extent progression.Methods:A retrospective cohort study was conducted, including UP patients who had undergoing prospective regisration in the Department of Gastroenterology, Xijing Hospital of Digestive Diseases, Air Force Medical University between January 2000 and May 2023. All patients were ≥ 18 years old at the time of diagnosis and followed up for more than one year. The disease extent in patients at diagnosis and during follow-up was assessed according to the Montreal classification. The clinical data were compared between the progression group and the non-progression group. The cumulative proportions of disease extent progression were analyzed with the Kaplan-Meier method, and the risk factors associated with disease extent progression were analyzed with the Cox proportional hazards regression model.Results:A total of 184 UP patients were included, with a median follow-up time of 4.8 (2.8, 8.5) years. Among them, 96 were male (52.2%) and 88 were female (47.8%), with a median age at diagnosis of 39.1 (28.8, 49.7) years. At the time of diagnosis, 95 (51.6%) patients had moderate endoscopic manifestations and 64 (34.8%) had severe endoscopic manifestations, while only 25 (13.6%) patients had mild lesions. 116 patients (63.0%) experienced disease extent progression in a median time of 4.2 (1.8, 9.0) years. The cumulative proportions of disease extent progression in 1, 3, 5, and 10 years were 13.0%, 39.0%、56.7% and 78.3%, respectively. Cox regression analysis identified the use of 5-aminosalicylic acid as a protective factor against disease extent progression ( HR = 0.55, 95% CI: 0.31 ~ 0.96, P = 0.035). During follow-up, only one patient (0.5%) underwent surgery. Five patients (2.7%) were diagnosed with dysplasia, and all of these patients had experienced disease extent progression before the development of dysplasia. Conclusions:Patients with UP had a high proportion of moderate-to-severe active endoscopic findings at diagnosis, and nearly two-thirds of patients experienced disease progression during follow-up, but the rates of colectomy and neoplasia were relatively low. 5-ASA was a protective factor against disease extent progression.
Objective:To investigate the differences in cell-free DNA (cfDNA) concentrations between the inflammatory bowel disease (IBD) patients with different disease severities and the significance.Methods:Cross-sectional study was conducted. Ninety-one patients with IBD were included in the Second Affiliated Hospital of Zhengzhou Univesity from April 2021 to May 2022, including 48 patients with ulcerative colitis (UC) and 43 patients with Crohn′s disease (CD). Fifteen healthy people were assigned as healthy control group. The differences in cfDNA concentration between IBD group and healthy control group and between IBD patients with different disease severities were compared. The correlations between cfDNA concentration and laboratory indicators of IBD patients were analyzed.Results:The cfDNA concentration of IBD patients was higher than that of healthy control group [ (86.7±22.6) ng/ml vs. (52.6±15.8) ng/ml, P<0.001], and the cfDNA concentrations of UC and CD patients were higher than that of healthy control group (both P<0.001), the differences were statistically significant. The cfDNA concentration of mild, moderate and severe UC patients increased successively, and the differences were statistically significant [ (62.9±11.1) ng/ml vs. (83.6±17.1) ng/ml vs. (103.9±19.1) ng/ml, all P<0.01]. cfDNA concentration of UC patients was positively correlated with disease activity ( r = 0.74, P<0.001). cfDNA concentration of active CD patients was significantly higher than that in remission stage [ (104.2±17.2) ng/ml vs. (78.6±18.6) ng/ml, P<0.001]. cfDNA concentration in CD patients was positively correlated with disease activity ( r = 0.58, P<0.001). cfDNA concentration in UC patients was positively correlated with C-reactive protein (CRP) ( r = 0.4, P<0.01) and erythrocyte sedimentation rate (ESR) ( r = 0.37, P<0.01), and negatively correlated with hemoglobin ( r = -0.46, P<0.01) and albumin ( r = -0.51, P<0.01). cfDNA concentration in CD patients was positively correlated with CRP ( r = 0.48, P<0.01) and ESR ( r = 0.38, P<0.05), and negatively correlated with hemoglobin ( r = -0.45, P<0.01) and albumin ( r = -0.32, P<0.05) . Conclusion:cfDNA concentration closely correlates with disease severity of IBD patients and is a new indicator to evaluate disease severity of IBD patients.
Melatonin is an amine hormone with high content in gastrointestinal tract, which plays a positive role in anti-inflammatory, antioxidant and other aspects. Intestinal microbiota imbalance and intestinal immune damage caused by enteritis are often accompanied by a decrease in endogenous melatonin. Supplementation of melatonin may improve intestinal microbiota disregulation and immune damage of intestinal mucosa. This article reviews the progress of melatonin-mediated microbiota metabolism and intestinal immune in the treatment of enteritis.
Pouchitis is a common complication of ileal pouch anal anastomosis (IPAA) in patients with ulcerative colitis or familial adenomatous polyposis and the mechanism is unknown. The dietary factors including dietary ingredients and mode are related to the occurrence and progression of pouchitis. Dietary factors may play a potential role in changing gut microbiome and regulating immune response. Therefore, adjusting the diet can prevent and treat pouchitis. This article reviews the research progress of the influence of dietary factors on pouchitis.
