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.
Abstract Background Mirikizumab, an anti-interleukin-23p19 monoclonal antibody approved for ulcerative colitis (UC) and Crohn’s disease, was evaluated in LUCENT-URGE (NCT05767021), a phase 3b, open-label study assessing its effect on bowel urgency (BU) through week (W)28 in adults with moderately-to-severely active UC, using novel BU measures and validated quality of life (QoL) instruments. Methods Patients with UC experiencing BU (baseline severity ≥3 on the urgency numeric rating scale [UNRS]) received 300 mg mirikizumab intravenously at W0, W4, and W8, then 200 mg subcutaneously at W12 and every 4 weeks up to W24. Improvements in QoL and patient-reported outcomes were assessed from baseline to W12 and W28. Results Among 172 patients, 58.1% achieved clinically meaningful improvement (≥3-point reduction in UNRS), and 37.8% reached BU remission (rounded UNRS ≤ 1) by W28. Inflammatory Bowel Disease Questionnaire (IBDQ) scores improved by 56.4 points, with 52.3% of patients achieving IBDQ-remission (IBDQ ≥ 170) and 65.7% achieving IBDQ-response (≥16-point increase) at W28. Absorbent product use for BU dropped from 55.1% at baseline to 29.6% at W28. Patients reporting no sexual activity avoidance (SAA) due to UC symptoms rose from 21.1% to 51.4%. Activity impairment, Wexner Incontinence Score, and anxiety symptoms also showed improvements. Conclusion The majority of mirikizumab-treated patients achieved clinically meaningful BU improvement over 28 weeks. In addition to QoL improvement, patients experienced reduced disruption of daily activities, with meaningful reductions in SAA and use of protective aids due to BU. Achieving BU remission or clinically meaningful improvement with mirikizumab was associated with improvements in patients’ relevant UC symptoms and overall QoL.
Abstract Introduction Thiopurine-induced myelosuppression (TIM) is an important side effect influenced by 2 main genetic polymorphisms, thiopurine-S-methyltransferase (TPMT) and NUDT15. The data on Southeast Asian inflammatory bowel disease (IBD) patients remain limited. Our study aimed to determine the relationship between TPMT and NUDT15 polymorphisms and TIM following thiopurine treatment in Thai patients with IBD. Methods We performed a retrospective cohort study of IBD patients receiving azathioprine with active follow-up at the IBD clinic. TPMT and NUDT15 polymorphisms were checked. Medical records were reviewed for TIM occurrence and its genetic associations. Results A total of 124 IBD patients (73 Crohn’s disease, 51 ulcerative colitis; mean age 46.9 years) were included. Initial azathioprine dosing was 0.87 mg/kg/day, titrated to 1.54 mg/kg/day. TPMT variants were found in 6 patients (4.8%; 5 heterozygous and 1 homozygous) and NUDT15 variants in 21 patients (16.9%; 20 heterozygous and 1 homozygous). Over a 7.6-year follow-up, TIM occurred in 12 patients (9.7%). TIM rate was not significantly different among TPMT polymorphisms (wild-type 9.3%, heterozygous 20%, homozygous 0%), but was significantly different among NUDT15 polymorphisms (7.8% wild-type and heterozygous/homozygous 19%). The cumulative rates of TIM at 6, 12, and 60 months were 2.1%, 3.2%, and 7.2% in wild type and 0%, 5%, and 10% in NUDT15 heterozygous mutation. The only participant with a homozygous mutation developed TIM within the first month. Conclusion NUDT15 polymorphisms are more common than TPMT variants in this study and are significantly associated with TIM. Pre-treatment genotyping may be considered, taking into account local mutation prevalence, test availability, and cost-effectiveness.
Abstract Background Inflammatory bowel diseases (IBDs), including Crohn’s disease (CD) and ulcerative colitis (UC), are increasingly prevalent. Ustekinumab (UST), a biologic therapy, has shown efficacy in treating CD and UC, but its real-world impact is less clear. This study assessed all-cause and IBD-specific healthcare resource utilization (HCRU) and costs, excluding medication costs, among patients with CD and UC initiated on UST. Methods This retrospective cohort study in Ontario, Canada included patients initiating UST between January 2017 and September 2022. Patients were identified through the Johnson & Johnson (J&J) BIOADVANCE® patient support program and deterministically linked to ICES databases. Outcomes were compared between 1 year pre-initiation of therapy and each post-initiation year (up to 4 years). Results were reported for patients who were persistent on UST at each year of the analysis period, patients who were persistent vs. discontinued UST for the duration of Year 1, and patients who were biologic-naïve versus bio-experienced prior to index. Results The study cohort included 2279 patients with CD and 626 patients with UC. UST initiation was associated with significant reductions (P < .001) in the number of all-cause HCRU events in each year of follow-up, including for CD patients who were biologic-naïve and persistent on UST. Non-medication costs were lower for both CD and UC patients in all years, and significant in Years 1-3 for CD and Year 2 for UC patients. Conclusions In CD and UC patients, all-cause and IBD-specific HCRU and non-medication healthcare costs were lower in years following UST initiation.
