Abstract Background Inflammatory bowel disease (IBD) and hidradenitis suppurativa (HS) frequently coexist and share overlapping immune pathways, yet comparative real-world outcomes between IL-12/23 or IL-23 inhibitors and Janus kinase (JAK) inhibitors in this population remain poorly defined. Methods We conducted a retrospective cohort study using a large, multicenter, real-world dataset. Adults (≥16 years) with IBD and HS who initiated an IL-12/23 or IL-23 inhibitor after anti-TNF therapy or a JAK inhibitor were included; patients with prior exposure to the opposing drug class were excluded. Propensity score matching (1:1) yielded 150 patients per cohort. Outcomes from 30-365 days included acute care utilization, corticosteroid use, IBD complications, and overall and hidradenitis-specific antibiotic use. Results After propensity score matching, 300 patients were included (150 per cohort; mean age 38 years; 75.3% female). Rates of emergency department visits or hospitalization were similar between groups (RR 1.20, 95% CI, 0.82-1.77). Corticosteroid use risk was numerically higher in the IL-12/23 or IL-23 cohort (RR 1.20, 95% CI, 0.98-1.46). IBD-related complications did not differ significantly (RR 1.06, 95% CI, 0.58-1.93). Overall antibiotic use was comparable, while hidradenitis-specific antibiotic use was higher in the IL-12/23 or IL-23 cohort (RR 1.47, 95% CI, 1.11-1.95). Conclusions In this real-world analysis, IL-12/23 or IL-23 inhibitor therapy was associated with higher hidradenitis-specific antibiotic use and numerically greater but statistically nonsignificant corticosteroid exposure, while hospitalization and IBD-related complications were comparable. These findings should be interpreted cautiously given the absence of validated disease-activity measures; prospective studies are needed to inform optimal therapeutic selection.
Abstract Background Emerging evidence supports the use of Janus kinase inhibitors (JAKi) in acute severe ulcerative colitis (ASUC). However, risk factors associated with non-response and the need for short-term colectomy in ASUC patients treated with JAKi remain poorly understood. Methods We conducted a systematic review and individual-level data meta-analysis of real-world studies evaluating tofacitinib or upadacitinib for the treatment of ASUC. The primary and secondary outcomes were colectomy within 30 days and 12 weeks, respectively. Generalized linear mixed-effects models were used for univariable and multivariable analyses to estimate odds ratios (ORs). A stratified Cox proportional hazards model was used to assess colectomy-free survival. Results Twenty-three studies with 145 patients were included (69.0% treated with tofacitinib, 31.0% with upadacitinib). The overall colectomy rate was 13.1% within 30 days and 20.5% within 12 weeks. In univariable analyses, prior exposure to anti-tumor necrosis factor (TNF) therapy before ASUC hospitalization was statistically significantly associated with lower odds of colectomy within 30 days (OR 0.44, P = .006) and 12 weeks (OR 0.51, P = .008). Prior anti-TNF exposure remained significantly associated with lower odds of colectomy in multiple multivariable analyses. No other clinical or laboratory variables were significantly associated with primary/secondary outcomes. Conclusions Prior anti-TNF exposure before hospitalization is associated with lower short-term colectomy rates in ASUC patients treated with JAKi. Our findings highlight the need for future studies to optimize the position of JAKi in the ASUC management algorithm and to identify novel predictive biomarkers to advance precision medicine strategies.
Abstract Background We aimed to assess the rates of physician-documented fatigue according to diagnostic codes among patients with inflammatory bowel diseases (IBDs) in a nationwide cohort and to identify clinical factors associated with its documentation. Methods We used the nationwide epi- Israeli IBD Research Nucleus cohort derived from 4 HMOs covering approximately 98% of the Israeli population, matched to non-IBD controls. Physician-documented fatigue was defined using routinely collected ICD9 and textual codes and explored in association with demographic, laboratory-derived disease severity clusters, comorbidities, medications, healthcare utilization, and sickness absence. Predictors for fatigue documentation were explored using multivariable Cox models incorporating time-varying covariates. Results Fatigue was documented in 16.4% of the 31 945 patients with IBD and 11.0% of the 73 106 matched controls (odds ratio [OR] = 1.60, 95% confidence interval [CI] 1.54-1.66). Fatigue was more prevalent in IBD than matched controls across age groups and comorbidity strata. Among patients with IBD, there was no difference in fatigue rate between those with Crohn’s disease and ulcerative colitis. Time-to-fatigue was shorter among females (P < .001). Across adult males and females and pediatric boys and girls, anemia, anxiety, and ≥3 healthcare contacts were independently associated with higher rates of fatigue documentation, with the strongest associations observed for frequent healthcare contact (HRs ranging from 4.21 [95% CI 1.49-11.70] to 10.22 [95% CI 7.47-13.90]). Longer disease duration was consistently associated with a lower hazard, while additional subgroup-specific associations were observed for sleep disorders, steroid dependency, and IBD-related medications. Conclusions Fatigue is more frequently documented among patients with IBD than matched non-IBD controls, especially in females. Several risk factors were associated with fatigue which should be considered in clinical practice. The lower frequency of documented fatigue compared with patient-reported estimates suggests that routine clinical coding captures only part of the overall fatigue burden.
Abstract Background Inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC), Crohn’s disease (CD), and IBD unclassified (IBDU), affects over 7 million people worldwide. While incidence has plateaued in higher-income countries, it continues to rise in lower- and middle-income regions, including Latin America. Data from northern Central America remain scarce. Aim To characterize the clinical and phenotypic profile of IBD in Honduras, El Salvador, and Guatemala. Methods The Inflammatory Bowel Disease in Northern Central America Research and Epidemiological Study (IBD-NCARES) was a multinational, multicenter descriptive study spanning 15 years. Cases were identified using ICD-10 codes and confirmed by chart review. Sociodemographic, behavioral, and clinical variables were collected. Results Among 277 patients, UC was the predominant subtype (57.8%), highest in Honduras (71.4%). CD accounted for 11.9% of cases, with greater frequency in Honduras (25.7%). IBDU was frequent in El Salvador (40.3%) and Guatemala (38.2%) compared with Honduras (2.9%). Delayed diagnosis (>1 year) occurred in 35% of UC and 60.6% of CD patients. Complicated CD was observed in 54.5% (B2 30.3%; B3 24.2%). Extraintestinal manifestations included vascular (18.2%) and hepatic/pancreatic (9.1%) complications. Most patients received 5-aminosalicylates or systemic steroids. Only 5.1% of the overall cohort received advanced therapies. Conclusion This first multinational study of IBD in northern Central America highlights UC predominance, high rates of IBDU (likely inflated by incomplete diagnostics), frequent diagnostic delay, and limited use of advanced therapies. These findings underscore the need for regional registries, improved diagnostic capacity, and expanded therapeutic resources.
Abstract Background Pouchitis is the most frequent long-term complication after ileal pouch–anal anastomosis (IPAA) for ulcerative colitis. This study aimed to describe current international practices, definitions, and treatment strategies among experienced clinicians. Methods An international web-based survey was conducted in 2025, following CROSS guidelines, exploring diagnostic, monitoring, and therapeutic practices. Responses were anonymized and analyzed descriptively. Results A total of 412 physicians from 49 countries completed the survey, mostly gastroenterologists involved in IBD care (362/412, 87.8%). Most clinicians (156/412, 37.9%) estimated a pouchitis prevalence of 26%-50% among patients with IPAA, typically occurring within the first postoperative year. Follow-up was scheduled every 3-6 months by 164/412 (39.8%) physicians, with nearly half (47.6%) reporting the use of the pouch disease activity index (PDAI). Fecal calprotectin was the preferred non-invasive monitoring tool (326/412, 79.1%), whereas intestinal ultrasound was selected by 130/412 respondents (31.69%). Endoscopy was the primary diagnostic and follow-up modality (398/412, 96.6%), with biopsies routinely taken (364/412, 88%), although 46.7% of respondents reported not using a standardized histological scoring system. Prophylactic therapy was prescribed by 222/412 (53.9%), mainly probiotics (27.7%) and rectal mesalazine (18.2%). In acute pouchitis, ciprofloxacin plus metronidazole was the preferred first-line regimen (218/412, 52.9%). For chronic antibiotic-dependent or refractory pouchitis, advanced therapies were the predominant first-line option (254/412, 61.7%), with vedolizumab (198/412, 48.1%), and infliximab (170/412, 41.3%) most frequently selected. Ustekinumab, selective IL-23 inhibitors, JAK inhibitors and S1P receptor modulators were increasingly used in refractory cases. Treatment targets were primarily clinical (156/412, 37.9%) and endoscopic (124/412, 30.1%) remission, and most respondents (246/396, 62.1%) reported performing endoscopic assessment within 3-6 months after advanced treatment initiation. Conclusions This international survey demonstrates substantial heterogeneity in pouchitis diagnosis, monitoring, and treatment, highlighting important gaps in standardized disease assessment and treatment strategies. The findings support the need for consensus-based approaches and prospective, pouch-specific studies to improve the standardization of pouchitis care.
