BACKGROUND:Malnutrition is a common problem in inflammatory bowel diseases (IBD) and is associated with poorer outcomes and reduced quality of life. Body mass index (BMI) is commonly used to assess nutritional status but does not reflect body composition. Data on nutritional status and energy requirements in IBD are limited. The aim of our study was to evaluate nutritional status and energy requirements in hospitalized and outpatient patients with active IBD, and in patients with IBD in remission, in relation to caloric and protein intake. METHODS:This single-center prospective cohort study assessed nutritional status using the fat-free mass index (FFMI), derived from bioelectrical impedance vector analysis (BIVA). Energy requirements were measured by indirect calorimetry (Q-NRG). Protein requirements and caloric and protein intake were evaluated. Active IBD patients were evaluated longitudinally at baseline and 12 weeks and compared cross-sectionally with patients in remission. RESULTS:Following remission, FFMI increased by 1.1 kg/m² in hospitalized patients (n = 14), significantly greater than the 0.4 kg/m² increase in outpatients (n = 12) (P = .026). No significant differences were observed between groups in BMI change (P = .45) or resting energy expenditure reduction (P = .53). Once in remission, the caloric balance of hospitalized and outpatient patients were comparable to patients with IBD in remission (n = 11) (P = .66). CONCLUSIONS:Hospitalized patients with active IBD showed greater improvement in BIVA-derived nutritional status during remission than outpatients, despite similar BMI changes and stable energy expenditure. BIVA-derived FFMI may be useful for nutritional assessment of patients with IBD. Given the small sample size and exploratory design, these results should be interpreted as hypothesis-generating.
BACKGROUND:Recent evidence has shown that ulcerative colitis patients with increased neutrophil biomarkers are linked to complicated disease and refractory response. In the pathology of colitis, neutrophils are recruited to the colon and yield acute damage via reactive oxygen species (ROS), degranulation, and neutrophil extracellular traps (NETosis). RAB27A is a regulator of intracellular membrane trafficking and has been shown to play a role in neutrophil activation by enabling the increased release of proteolytic granules and ROS. Studies have shown significant upregulation of RAB27A expression in biopsies of moderate and severe ulcerative colitis patients, while preclinical studies genetically deleting RAB27A in ulcerative colitis models have shown improved outcomes. METHODS:To evaluate the impact of RAB27A inhibition in ulcerative colitis and lower activated neutrophil toxicity in the disease, we developed IMYX-3, a first-in-class small molecule oral inhibitor of RAB27A activity and applied it to the study of diseased neutrophils and models. RESULTS:IMYX-3 lowers neutrophil ROS, degranulation, NETosis, and cytokine secretion. Preclinical efficacy was demonstrated in dextran sulfate sodium and Il10-/- mouse models, in which IMYX-3 treatment led to improved colon length, reduced systemic inflammation, lower levels of activated neutrophil function, and comparable disease outcomes compared with standard-of-care control mice. In vitro toxicity profiling as well as pharmacokinetic and toxicology studies in rodents and canines showed a favorable drug profile, with no significant adverse events observed at doses up to 30 times the predicted therapeutic range. CONCLUSION:IMYX-3 effectively inhibits RAB27A activation in neutrophils, yielding improved outcomes in preclinical disease models with no major safety concerns.
BACKGROUND:Ulcerative colitis (UC) remains associated with significant morbidity despite therapeutic advances. The impact of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on UC disease activity is not well defined. METHODS:We performed a retrospective cohort study using electronic health records from a single tertiary academic health system (2022-2024). Adults with UC initiating liraglutide or semaglutide for metabolic indications and maintained on therapy ≥ 12 weeks were included. A 1:1 matched cohort of UC patients not receiving GLP-1 RAs served as controls. The primary outcome was symptomatic remission at 12 weeks (partial Mayo ≤ 2 with rectal bleeding subscore 0). Multivariable logistic regression assessed adjusted odds of remission. RESULTS:A total of 150 GLP-1 RA patients were matched to 150 controls with comparable baseline characteristics. GLP-1 RA use was associated with higher remission rates at 4 weeks (34.7% vs 15.3%, P = .001), 8 weeks (54.7% vs 18.0%, P < .001), and 12 weeks (66.7% vs 25.3%, P < .001). Mean partial Mayo scores improved from 5.8 at baseline to 2.1 at 12 weeks in the GLP-1 RA group vs 4.6 in controls (P < .01). GLP-1 RA use remained independently associated with remission (adjusted OR 5.90, 95% CI 3.52-9.86; P < .001). Weight loss was not associated with remission. Semaglutide demonstrated higher remission rates than liraglutide (72.5% vs 60%; OR 1.77, P = .04). Endoscopic outcomes in a subset showed higher remission (58% vs 38%) and improvement (69% vs 47%). CONCLUSION:GLP-1 RA therapy was associated with significantly improved UC disease activity and higher remission rates compared to matched controls, with a modest advantage observed for semaglutide. These findings support a potential adjunctive role for GLP-1 RAs in UC, particularly in patients with metabolic comorbidities.
BACKGROUND AND AIMS:Immune checkpoint-inhibitor (ICI) colitis is a common adverse event that is primarily treated with corticosteroids but may require selective immunosuppressive therapy (SIT). Although endoscopic features have been associated with SIT use, it remains unclear whether these associations differ by ICI type. METHODS:We conducted a 2-center retrospective cohort study and included patients with histologically confirmed ICI colitis. Endoscopic images were reviewed by gastroenterologists specialized in inflammatory bowel disease (IBD) and scored using the Mayo score and the Immune-Mediated Colitis Endoscopic Score (IMCES). Early SIT use was defined as SIT use within 3 weeks after the start of colitis treatment. Features associated with SIT use were stratified by ICI type, and discriminative performance was evaluated using receiver operating characteristic (ROC) analysis. RESULTS:Among 255 included patients, 38% required SIT. Biochemical parameters associated with early SIT use were C-reactive protein (CRP) (odds ratio (OR), 1.41; P = .005), and albumin (OR, 0.92; P = .020). Endoscopic features associated with SIT use included erythema (OR, 4.09; P = .006) and exudate (OR, 3.24; P = .012), which were limited to patients treated with anti-cytotoxic T-lymphocyte-associated antigen 4-based (aCTLA-4-based) therapy. In multivariable analysis, ICI type remained the only variable associated with early SIT use (OR, 12.8; P < .001). The IMCES demonstrated areas under the curves (AUCs) of 0.57 (95% CI, 0.50-0.65) for overall and 0.61 (95% CI, 0.53-0.69) for early SIT use. CONCLUSIONS:In patients with ICI colitis, escalation to SIT use was primarily associated with ICI type, with limited additional value of biochemical or endoscopic features. The IMCES showed poor predictive performance in this external validation cohort.
BACKGROUND:Immunosuppression is a recognized risk factor for severe and disseminated coccidioidomycosis; however, data describing outcomes in patients with inflammatory bowel disease (IBD) receiving advanced therapy, including biologics and small molecules, remain limited. We aim to describe the prevalence, clinical presentation, treatment patterns, and outcomes of coccidioidomycosis in IBD patients receiving advanced therapy at an endemic tertiary care center. METHODS:We performed a retrospective observational study of adult patients with IBD at Mayo Clinic Arizona diagnosed with coccidioidomycosis between 2023 and 2026. Patients were included if IBD diagnosis preceded coccidioidomycosis diagnosis and advanced therapy had been active for at least 4 weeks before infection. Cases were classified as proven, probable, or possible based on microbiologic, clinical, radiographic, and serologic criteria. Clinical outcomes included antifungal treatment duration, hospitalization related to coccidioidomycosis or IBD, IBD treatment modification after diagnosis, re-emergence of coccidioidomycosis symptoms, and IBD-related surgery. RESULTS:A total of 48 patients met inclusion criteria. Among 1083 tested IBD patients receiving advanced therapy, coccidioidomycosis positivity prevalence was 4.4% when including all serologically positive patients and 1.9% when restricted to proven or probable cases. The median age at coccidioidomycosis diagnosis was 40 years (range 19-87 years), and 30 (62.5%) of 48 had Crohn's disease. Proven or probable infection was identified in 21 (43.8%) of 48 patients, while 14 (29.2%) of 48 patients were classified as possible. Antifungal therapy was prescribed in 32 (66.7%) of 48 patients, including all proven cases, 15 (88.2%) of 17 probable cases, 9 (64.3%) of 14 possible cases, and 3 (25.0%) of 12 nondiagnostic cases. Among proven/probable/possible cases, the median antifungal treatment duration was 174 days (range 8-831 days). Advanced IBD therapy was continued in 3 (75.0%) of 4 proven cases, 9 (52.9%) of 17 probable cases, 12 (85.7%) of 14 possible cases, and all nondiagnostic cases. Hospitalization occurred in 6 (12.5%) of 48 of the cohort, all of which were proven/probable cases. Most patients remained on advanced therapy after diagnosis, although tumor necrosis factor α inhibitors were the most interrupted or discontinued agents. CONCLUSIONS:In this endemic tertiary care cohort, management decisions varied according to diagnostic certainty. Patients with proven or probable coccidioidomycosis were more likely to receive antifungal therapy and undergo advanced IBD therapy modification, whereas most patients with possible or nondiagnostic serologic findings remained on advanced therapy without major IBD-related complications. Prolonged antifungal treatment was common, highlighting the complexity of managing coccidioidomycosis in immunosuppressed patients with IBD.
BACKGROUND:Real-world data on ustekinumab (UST) in Asian inflammatory bowel disease (IBD) populations remain limited. The T-RUST (Taiwan Multicenter Real-world Ustekinumab Study) study evaluated the effectiveness, durability, and safety of UST in patients with Crohn's disease (CD) and ulcerative colitis (UC). METHODS:This retrospective multicenter study utilized data from the Taiwan Association for the Study of Intestinal Diseases IBD Registry between September 2019 and April 2025. Patients with CD or UC treated with UST were evaluated for clinical response and remission at weeks 4, 8, and 52. Subgroup analyses examined drug persistence according to biologic treatment history (biologic naive vs biologic experienced), prior advanced therapies, and difficult-to-treat IBD status. Fistula closure, endoscopic, radiologic, and histological remission, as well as safety outcomes, were assessed. RESULTS:A total of 379 patients were included, comprising 301 (79.4%) with CD and 78 (20.6%) with UC. Among patients with available week 52 data, clinical response was achieved in 183 (90.1%) of 203 CD patients and 40 (97.6%) of 41 UC patients. Corresponding clinical remission was achieved in 172 (84.7%) of 203 and 37 (90.2%) of 41 patients, respectively. Fistula closure was achieved in 17 (45.9%) of 37 patients with active fistulizing CD, including 10 (45.5%) of 22 patients with perianal fistulas. One-year UST persistence exceeded 80% in both cohorts, with persistence observed in 273 (91.0%) of 300 CD patients and 67 (85.9%) of 78 UC patients. UST was generally well tolerated, with no new safety signals identified. CONCLUSIONS:UST demonstrated sustained effectiveness, meaningful fistula healing, and a favorable safety profile in this real-world IBD cohort. These findings support its role as a durable and well-tolerated therapeutic option in Asian clinical practice.
BACKGROUND AND AIM:Hormonal contraception (HCT) is widely used among women with ulcerative colitis (UC), yet its impact on disease activity and inflammatory burden remains unclear. We aimed to evaluate the association between HCT exposure, the risk of recurrent flares and inflammatory biomarkers in women with UC. METHODS:We conducted a multicenter retrospective longitudinal cohort study including female patients with UC. HCT exposure was treated as a time-dependent variable. The primary outcome was the risk of recurrent flares, assessed using an Andersen-Gill extension of the Cox model. Secondary outcomes included longitudinal biomarker changes and cumulative inflammatory burden using linear mixed-effects models and time-weighted area-under-the-curve analyses. RESULTS:A total of 225 women met inclusion criteria, of whom 58 (25.8%) were exposed to HCT after UC diagnosis. During a median follow-up of 5.3 (IQR 3.3-7.5) years, we identified 374 flares. HCT exposure was not associated with an increased risk of recurrent flares (adjusted HR (aHR) 0.93; 95% CI, 0.62-1.40; P = .742) but extensive UC (aHR 1.85; 95% CI, 1.22-2.79; P = .003), ex-smoker status (aHR 2.07; 95% CI, 1.07-4.01; P = .031) and age (aHR 0.97; 95% CI, 0.96-0.99; P < .001) were. A total of 13 747 biomarker measurements were available during follow-up. In adjusted longitudinal analysis, C-reactive protein was higher during HCT-exposed months (β for log-CRP = 0.254, P = .0038), whereas platelet count, erythrocyte sedimentation rate, albumin, alpha-1-acid glycoprotein and fecal calprotectin were not. The cumulative systemic inflammatory burden (AUC/time) remained comparable between exposure periods. No adverse events related to HCT exposure were identified. CONCLUSIONS:HCT was not associated with an increased risk of recurrent UC flares or a consistent increase in cumulative systemic inflammatory burden. No HCT-related safety signals were identified; however, the modest number of exposed women cannot exclude smaller effects or rare safety outcomes.
BACKGROUND AND AIMS:Patients with inflammatory bowel disease (IBD) who undergo multiple surgeries or stoma creation experience higher rates of anxiety and depression compared with patients with who have not undergone surgery. However, there are limited comparative data on short-term psychiatric outcomes in patients with IBD undergoing stoma-related IBD surgery vs nonstoma IBD surgery, specifically in patients treated with biologics. METHODS:We conducted a population-based cohort study using TriNetX, of adults 18 to 65 years of age with newly diagnosed IBD between January 1, 2016, and December 31, 2019. Eligible patients had received biologic therapy and had no prior IBD-related surgeries or psychiatric diagnoses. Two cohorts were defined: (1) patients who underwent IBD-related surgery resulting in colostomy or ileostomy creation and (2) patients who underwent IBD-related surgery without ostomy creation. Incidence of depression, anxiety, and adjustment disorders was assessed using International Classification of Diseases-Tenth Revision codes from postoperative day 1 up to 6 months postsurgery. Variables were propensity score matched for the two cohorts. RESULTS:A total of 1636 biologic-treated patients with IBD were included (818 per cohort). Comparing ostomy patients with nonostomy patients, depression occurred in 11.37% vs 6.24% (odds ratio [OR], 1.93; 95% confidence interval [CI], 1.35-2.76), anxiety occurred in 15.53% vs 11.98% (OR, 1.35; 95% CI, 1.02-1.79), and adjustment disorders occurred in 4.4% vs 2.57% (OR, 1.75; 95% CI, 1.01-3.02). CONCLUSIONS:Overall, ostomy creation was associated with greater short-term psychiatric morbidity in patients with IBD treated with biologics. Future research should explore specific factors that make this group of patients more vulnerable to anxiety and depression and aim to develop targeted mental health interventions.
BACKGROUND:In patients with Crohn's disease (CD) treated with infliximab (IFX), the annual rate of loss of response is approximately 10%. This study aimed to compare patients who initiated primary IFX in the disease course with those who received IFX as a second-line biologic after a longer disease duration and greater prior treatment exposure. METHODS:This retrospective study reviewed medical records of children with Crohn's disease (CD) who received IFX therapy. Patients were classified according to prior adalimumab (ADL) exposure status, and IFX trough levels (TLs) and endoscopic outcomes were compared between groups. RESULTS:A total of 469 children with CD were included, including 372 in the biologic-naive group and 97 in the ADL-exposed group. There was no statistically significant difference in demographic data and disease severity at diagnosis between the two groups. However, at the time of IFX initiation, patients in group 2-who had a longer disease duration-were significantly older (P < .001) and had a higher body mass index than those in group 1 (P < .001). As the 1-year outcome of IFX therapy, the proportion achieving endoscopic remission (ER) did not differ significantly between group 1 and group 2 (61.3% vs 58.8%; P = .328). However, at the 1-year assessment, IFX TLs were significantly lower in group 2 than in group 1 (4.73 µg/mL vs 6.19 µg/mL, P = .003), and a significantly higher proportion of group 2 required dose intensification (41.2% vs 35.2%; P = .001). In a combined-cohort logistic regression, erythrocyte sedimentation rate, body mass index, IFX TLs, and dose intensification were significantly associated with ER. CONCLUSIONS:Prior ADL exposure was associated with lower IFX TLs despite comparable rates of ER when IFX was used as first- or second-line biologic therapy in pediatric CD. Patients with prior ADL exposure achieved ER at lower observed IFX TLs than biologic-naive patients, suggesting a potential difference in the exposure-response relationship according to prior ADL exposure status.
Obesity is increasingly prevalent among patients with inflammatory bowel diseases (IBD), with more than half of individuals with Crohns disease (CD) or ulcerative colitis (UC) classified as overweight or obese at diagnosis. Beyond body mass index (BMI), visceral adipose tissue (VAT) is emerging as a critical determinant of adverse IBD outcomes, including increased disease activity, reduced therapeutic response, higher surgical risk, and postoperative recurrence. Obesity and excess VAT also amplify cardiometabolic comorbidities commonly observed in IBD, such as metabolic dysfunction-associated steatotic liver disease (MASLD) and atherosclerotic cardiovascular disease (CVD), even in patients without traditional risk factors. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have transformed obesity management and confer established CVD and metabolic benefits. Preclinical studies show that GLP-1 RAs reduce visceral adiposity, modulate gut microbiota, enhance intestinal barrier integrity, and attenuate proinflammatory signaling pathways relevant to IBD pathogenesis. Emerging human data suggest that therapy with GLP-1 RAs is safe in patients with IBD and is associated with lower rates of hospitalization and surgical risk, particularly among patients with obesity, although effects on disease activity remain unclear. Several ongoing randomized controlled trials are evaluating GLP-1 RAs as adjunctive therapy for IBD. Beyond intestinal inflammation, GLP-1 RAs may favorably impact IBD-associated comorbidities, including MASLD, CVD, neurologic disorders, chronic pain, and metabolic bone disease. Important considerations include gastrointestinal tolerability, procedural implications for endoscopy, and the risk of lean muscle mass loss, underscoring the need for multidisciplinary care. As obesity becomes increasingly common in IBD, GLP-1 RAs represent a promising therapeutic strategy warranting further prospective investigation.
Gastroenterologist-performed intestinal ultrasound (IUS) is increasingly used to monitor inflammatory bowel disease (IBD) due to its noninvasive, real-time, and cost-effective attributes, alongside high diagnostic accuracy. However, wider adoption remains limited by the cost, size, and workflow demands of cart-based or high-end ultrasound platforms. Handheld ultrasound has emerged as a miniaturized alternative that can be and applied at the bedside. Early studies of handheld intestinal ultrasound (HHIUS) in IBD have demonstrated reproducibility and diagnostic performance comparable to conventional IUS for selected applications, particularly bowel wall thickness assessment, with limitations in assessing deep pelvic lesion and complications. Whereas interdevice comparisons specific to IBD are lacking, data from general medicine suggest rapid improvements in image quality and usability of handheld devices. However, most comparative studies have not evaluated color Doppler, a core IUS parameter. In ulcerative colitis, Doppler-inclusive assessment using the Milan Ultrasound Criteria appears feasible with HHIUS, whereas color Doppler performance in Crohn's disease remains insufficiently validated. Hardware accessibility alone does not ensure IUS competency. Safe implementation requires structured training, including supervised practice, image quality review, and feedback, which may be supplemented by real-time telementoring and artificial intelligence. Taken together, HHIUS may be best positioned as a complementary bedside adjunct for triage, focused assessment, selected monitoring, resource-limited settings, and education, with predefined escalation to conventional IUS, magnetic resonance enterography/computed tomography, or endoscopic reassessment when appropriate. Future studies are needed to evaluate color Doppler performance, interdevice reproducibility, and safe integration of HHIUS into clinical workflows and training programs.
BACKGROUND:Anti-tumor necrosis factor (TNF) medical therapy is a major advancement for Crohn's disease (CD) management, yet many patients fail to respond. This study aims to develop and evaluate a multi-modal ensemble model to predict anti-TNF treatment response in pediatric patients with CD using pre-treatment magnetic resonance enterography (MRE) and non-imaging clinical data. METHODS:This retrospective study included 92 pediatric CD patients (median [IQR] age, 14.6 [12.7, 16.6] years; 65.2% male; 37 responders and 55 non-responders) who underwent MRE within 3 months before initiating anti-TNF therapy between 2009 and 2021. Responders achieved mucosal healing within 36 months; non-responders did not, underwent surgery, or changed therapy. Four pre-treatment feature sets were used: (1) radiologist MRE assessment, (2) radiomic features from bowel regions, (3) deep learning features from representative bowel images, and (4) non-imaging clinical features. A 2-stage stacking ensemble model was trained and evaluated. The area under the receiver operating characteristic curve (AUROC) was the primary performance metric. RESULTS:The multi-modal ensemble model integrating all MRE-based features achieved an AUROC of 0.771 [95% confidence intervals (CI): 0.745, 0.797], outperforming models using individual feature types (radiologist assessment: 0.706 [0.691, 0.721]; radiomic: 0.710 [0.691, 0.729]; deep learning: 0.724 [0.700, 0.749]). Combining MRE and clinical features (0.739 [0.696, 0.781]) achieved the highest AUROC of 0.817 [0.793, 0.842], though not significantly (P = .10). Radiomic features reflecting intensity distribution and texture heterogeneity were most predictive of treatment response. CONCLUSION:A multi-modal ensemble model combining MRE-based radiologist assessment, radiomic, deep learning, and clinical features accurately predicted anti-TNF treatment response in pediatric CD patients.
BACKGROUND:Biologic prophylaxis is used to prevent postoperative recurrence (POR) of Crohn's disease (CD) in high-risk patients who have undergone ileocolonic resection (ICR). There are limited data to guide clinicians' choice of prophylactic biologic class to prevent POR in patients previously exposed to biologics. We aimed to determine if reutilizing a prophylactic biologic class is associated with lower risk of POR in patients preoperatively exposed to biologics. METHODS:Adult CD patients who underwent ICR between 2009 and 2020 and were ever preoperatively exposed to biologics were included. Composite POR, including endoscopic (Rutgeerts ≥ i2b) and/or radiographic recurrence, was compared between patients who: received no prophylaxis, reutilized prophylaxis, or received a new class of prophylaxis (≤3 months from ICR) using Kaplan-Meier analysis. A multivariate Cox proportional hazards regression model was utilized to compare the 3 groups along with clinically established risk factors. RESULTS:A total of 635 biologic-exposed patients (≥2 biologics: 46%) who postoperatively received no prophylactic biologic (63.8%), who reutilized prophylactic biologic (30.7%), or who received a new class of prophylactic biologic (5.5%) were included. On multivariable analysis, no biologic prophylaxis was associated with a higher risk of recurrence (adjusted hazard ratio, 1.33; 95% confidence interval, 1.01-1.74; P = .04), and new biologic prophylaxis (adjusted hazard ratio, 1.50; 95% confidence interval, 0.89-2.53; P = .13) was associated with a similar risk of recurrence when compared with reutilization. Recurrence-free survival was similar among the 3 groups (P = .08); however, in patients undergoing their first ICR (P = .026) and in patients previously exposed only to anti-tumor necrosis factor agents (P = .051), the reutilization group demonstrated longer recurrence-free survival. CONCLUSIONS:Reutilization of biologic classes can be a valid strategy to prevent postoperative CD recurrence.
BACKGROUND:Appendectomy has been proposed to influence ulcerative colitis (UC) outcomes, but its effect based on timing before or after diagnosis and long-term UC outcomes remains unclear. MATERIALS AND METHODS:Using TriNetX U.S. Collaborative Network, we identified adults with UC (2010-2024) who underwent appendectomy before or after diagnosis. Two 1:1 propensity score-matched comparisons were performed: appendectomy-before-UC and appendectomy-after-UC versus controls. The primary outcome was a 5-year composite of oral/intravenous (IV) corticosteroid use or colectomy. Secondary outcomes included individual composite outcomes and advanced therapy initiation in biologic-naive patients. Subgroup analyses stratified by age and biologic exposure were also performed. RESULTS:After matching, appendectomy after UC diagnosis showed no association with the composite outcome (aHR 0.98, 95% CI, 0.83-1.16), oral steroids (aHR 0.90, 95% CI, 0.75-1.09), IV steroids (aHR 1.11, 95% CI, 0.87-1.43), colectomy (aHR 1.24, 95% CI, 0.77-1.99), or advanced therapy initiation (aHR 0.97, 95% CI, 0.63-1.48). Appendectomy before UC diagnosis also showed no difference in the composite outcome (aHR 0.91, 95% CI, 0.76-1.09), oral steroids (aHR 0.88, 95% CI, 0.72-1.08), colectomy (aHR 0.99, 95% CI, 0.60-1.63), or advanced therapy initiation (aHR 0.77, 95% CI, 0.53-1.13). However, IV steroid use was reduced (aHR 0.68, 95% CI, 0.51-0.90, P = .006). In subgroup analyses, advanced therapy initiation was lower in patients aged 18-40 years following appendectomy after UC diagnosis (aHR 0.56, 95% CI, 0.33-0.96, P = .03). CONCLUSION:Appendectomy was not associated with improved long-term UC outcomes of oral/IV steroid use, colectomy or initiation of advanced therapy regardless of timing.
BACKGROUND:Sarcopenia and related body-composition abnormalities are increasingly discussed as potential prognostic markers in inflammatory bowel disease (IBD). Their relevance to endoscopic outcomes and biologic therapy-related outcomes remains insufficiently clarified because of heterogeneous definitions, study populations, and outcome measures. This systematic review investigated whether sarcopenia is associated with endoscopic outcomes and the course of biologic therapy in IBD, with particular attention to Crohn's disease. METHODS:In this PROSPERO-registered systematic review, PubMed and Embase were searched to April 1, 2025 for observational studies in adults with IBD assessing sarcopenia or muscle-related parameters and relevant clinical outcomes. RESULTS:Sarcopenia prevalence varied widely. Three studies assessed endoscopic outcomes, and five studies assessed biologic therapy-related outcomes, predominantly in Crohn's disease. Several studies reported associations between sarcopenia or low skeletal muscle parameters and poorer endoscopic outcomes, postoperative endoscopic recurrence, loss of response to biologic therapy, or reduced treatment persistence. Findings were not fully consistent, and interpretation was limited by heterogeneous sarcopenia definitions, different imaging modalities, small study numbers, and nonequivalent outcome measures. CONCLUSIONS:Sarcopenia and related body-composition parameters may be associated with an unfavorable endoscopic course and less favorable biologic therapy-related outcomes, particularly in Crohn's disease. However, the current evidence is predominantly observational, heterogeneous, and limited by small study numbers. Importantly, these associations do not establish causality, and sarcopenia may reflect greater inflammatory burden, malnutrition, or more severe disease rather than acting as an independent prognostic factor. These findings should therefore be considered hypothesis-generating and do not yet support routine implementation of sarcopenia assessment for risk stratification or treatment decision-making in IBD.
