Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have progressed from the initial discovery of endogenous GLP-1 biology in 1986 to widely used therapies for type 2 diabetes and obesity, with expanding indications driven by pleiotropic metabolic and cardiovascular benefits. Although no randomized controlled trials have evaluated GLP-1RA as inflammatory bowel disease (IBD)-directed therapy, retrospective observational studies in IBD populations prescribed GLP-1RA for metabolic indications provide emerging real-world evidence regarding weight loss efficacy, IBD-related outcomes, and adverse events. This narrative review summarizes GLP-1RA pharmacology, mechanistic rationale, and the current clinical evidence base in IBD, with emphasis on safety considerations and priorities for prospective trials.

In this study we evaluated the effectiveness of vedolizumab (anti-integrin) vs ustekinumab/risankizumab (anti-interleukin) therapy for isolated small-bowel Crohn's disease using a real-world, multicenter national database. We found that anti-interleukin therapy was more effective for inducing steroid-free remission and reducing hospitalizations.

Background:Patients with inflammatory bowel disease (IBD) receiving immunosuppressive therapies are at increased risk of vaccine-preventable diseases, including influenza. Despite recommendations for annual influenza vaccination, uptake remains suboptimal. The COVID-19 pandemic prompted a surge in telemedicine (Tele-M) use, raising concerns about its impact on vaccination rates due to reduced in-person interactions. This study aimed to assess the impact of IBD-specific Tele-M on influenza vaccine uptake and identify predictors of vaccination in patients with IBD. Methods:This single-center retrospective study evaluated influenza vaccine uptake among adult patients with IBD seen between September 2021 and April 2022. Patients were categorized into two groups: Tele-M only and ≥1 in-person visit. Vaccination status was confirmed using the Wisconsin Immunization Registry. Primary outcome was influenza vaccination frequency by visit type, while secondary outcomes evaluated the impact of Tele-M on other vaccinations and predictors of influenza vaccine uptake. Results:Among 547 patients, 53.2% received Tele-M only, and 46.8% had ≥1 in-person visit. Influenza vaccine uptake was similar between the Tele-M only and ≥1 in-person visit groups (69.0% vs. 75.1%, respectively, P = .11). The uptake of pneumococcal, hepatitis B, and zoster vaccines was also comparable. Predictors of higher influenza vaccine uptake included age ≥65, female sex, receipt of ≥3 COVID-19 vaccines, and previous influenza vaccination. Conclusions:IBD-specific Tele-M did not adversely affect influenza vaccine uptake among patients with IBD. These findings highlight the importance of ensuring vaccination compliance irrespective of healthcare delivery modes. Collaboration among healthcare providers is crucial to improve vaccination rates in patients with IBD.

Healthcare maintenance plays a vital role in the long-term management of patients with inflammatory bowel disease (IBD), particularly those receiving immunosuppressive therapies. This review emphasizes the importance of maintaining up-to-date vaccinations, regular bone and mental health assessments, and appropriate cancer screening in this population. It also highlights the added complexity of preventive care in immunosuppressed patients, outlining specific modifications to vaccination and screening strategies required to ensure safe and effective disease management. Gastroenterologists and other clinicians involved in IBD care should remain familiar with current guidelines and consistently integrate preventive health measures into routine clinical practice.

BACKGROUND:Inflammatory bowel disease (IBD) and myeloproliferative neoplasms (MPNs) share chronic inflammation and immune dysregulation. AIM:We evaluated the incidence of MPNs among patients with IBD and clinical outcomes of IBD-MPN coexistence. METHODS:Two retrospective cohort analyses were conducted using the TriNetX database. First, adults with ulcerative colitis (UC) or Crohn's disease (CD) were compared with matched non-IBD controls to estimate incident MPN risk. A coexistence second analysis included patients with UC or CD who developed MPNs and then were matched to IBD without MPN controls to assess 5-year outcomes, including IBD-related complications, surgical interventions, colorectal cancer (CRC) and primary sclerosing cholangitis (PSC). Medication subgroup analyses were performed to evaluate associations with MPN risk. RESULTS:After matching, 3873 patients with UC-MPN and 3474 patients with CD-MPN were included. Compared with matched non-IBD controls, incident MPN risk was higher in UC (HR 1.60, p = 0.01) and CD (HR 1.56, p < 0.001). In CD, MPN coexistence was associated with higher risks of CRC (HR 1.52, p = 0.012), intestinal fistula (HR 2.84, p < 0.001), obstruction (HR 2.05, p < 0.001), perforation (HR 2.37, p < 0.001), small bowel resection (HR 3.69, p < 0.001) and colectomy (HR 2.10, p < 0.001). In UC, MPN coexistence was associated with higher risks of CRC (HR 1.50, p = 0.001), PSC (HR 1.75, p = 0.03) and pouchitis (HR 1.68, p = 0.003). Exposure to thiopurines (HR 1.28, p < 0.001) was associated with increased MPN risk, whereas TNF, IL-23 and JAK inhibitors were not. CONCLUSIONS:IBD is associated with increased MPN risk, and IBD-MPNs coexistence is associated with worse IBD-related complications and malignancy risk.

Contemporary IBD care lacks precise osteoporosis risk estimates and data on comparative therapy. In U.S., IBD patients had a 56

Inflammatory Bowel Disease (IBD) is an immune-mediated disorder characterized by chronic intestinal inflammation. IBD, along with its associated treatments, may have systemic effects including potential implications for female fertility. Anti-Müllerian hormone (AMH) levels are commonly used as a biomarker of ovarian reserve and fertility potential. However, the impact of IBD and its therapies on AMH levels remains unclear. This study aims to evaluate the association between IBD, AMH levels, and fertility. This retrospective study analyzed electronic medical records from a multicenter academic institution from January 2017 to September 2024. Female patients with recorded AMH levels and a diagnosis of IBD were identified and compared to a control group without an IBD diagnosis. Baseline characteristics were compared between the two groups. Fisher’s exact test was used for statistical analysis. A total of 146 patients were included in the study, with 67 patients diagnosed with IBD and 79 control patients. Among patients with IBD, 7.5

Risankizumab (RZB) and ustekinumab (UST) are interleukin inhibitors that are used for the treatment of moderate-to-severe Crohn’s disease (CD). Data on outcomes of RZB in patients previously treated with UST are limited. We aim to evaluate the efficacy of RZB in patients previously exposed to UST. This retrospective study included adult patients with CD who were prescribed RZB and had prior UST exposure at a multicenter academic institution between 1/2022 and 8/2024. We extracted demographic, CD-related, and medication-related data, as well as subjective and objective endpoints while on UST and RZB. Fisher’s exact test and the Wilcoxon rank-sum test were used in the analysis. Among 68 patients treated with RZB and prior UST therapy, 43 (63.2

Background:Cholecystectomy (CCY) may alter bile acid flow and gut microbiota, increasing the risk of gastrointestinal disease. Prior studies have suggested that CCY may be associated with bile acid diarrhea and microscopic colitis; however, the association with the new diagnosis of inflammatory bowel disease (IBD) remains unstudied. In this study, we evaluated whether CCY was associated with a greater risk of de novo IBD. Methods:We conducted a retrospective cohort study, analyzing data from the TriNetX network (2010-2024), using 1:1 propensity score matching between adult patients undergoing CCY and controls, based on variables that included demographics, comorbidities and medication use. The primary outcome was risk of de novo IBD. Secondary outcomes included the risk of developing ulcerative colitis (UC) or Crohn's disease (CD). Kaplan-Meier analysis with hazard ratios (HRs) and 95% confidence intervals (CIs) was used to compare time-to-event rates. Results:Among 570,317 matched pairs, CCY was associated with a greater risk of IBD (adjusted HR [aHR] 1.29, 95%CI 1.22-1.35; P<0.001), and specifically CD (aHR 1.83, 95%CI 1.69-1.99; P<0.001), but not the risk of UC. This elevated risk persisted across both sexes and all age groups. Among patient characteristics, tobacco use was associated with the greatest additional risk of IBD post-CCY (aHR 1.43, 95%CI 1.19-1.76; P<0.001). Conclusions:Prior CCY is associated with a greater risk of CD but not UC. These findings support the need for a low threshold to think about CD in patients with gastrointestinal symptoms after CCY.

INTRODUCTION:There are limited data on the impact of glucagon-like peptide-1 receptor agonist (GLP-1RA) on the risk of recurrent pouchitis after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). METHODS:A retrospective cohort study was conducted in the TriNetX Research Network in adult patients with obesity and IPAA for UC with a history of pouchitis in whom a GLP-1RA was initiated compared to those patients in whom a GLP-1RA was not initiated. The primary outcome was the risk of recurrent pouchitis within 12 months. The secondary outcomes were mean number of antibiotic prescriptions, anti-diarrheal medication use, Crohns-like disease of pouch (CLDP), and pouch excision. One-to-one propensity score matching was performed. RESULTS:We identified 43 UC-IPAA patients with obesity and history of pouchitis (mean age 51.7 ± 14.7 years, mean body mass index [BMI] 34.4 ± 6 kg/m2, 60.4% female). After propensity score matching, the GLP-1RA cohort had a significantly decreased risk of recurrent pouchitis (26.3% vs 52.6%; adjusted odds ratio [aOR], 0.32; 95% CI, 0.12-0.84) compared to the control cohort. Mean antibiotic prescriptions were numerically lower in the GLP-1RA cohort (2 vs 4.4, P = .16). Anti-diarrheal medication use was lower in the GLP-1RA cohort (18.4% vs 47.3%; aOR, 0.23; 95% CI, 0.07-0.67). There was no difference in the risk of CLDP. Zero patients required pouch excision in both cohorts. CONCLUSION:Our study in a small cohort of patients with UC-IPAA and obesity with a history of pouchitis showed that GLP-1RA use was associated with decreased risk of recurrent pouchitis and anti-diarrheal medication use.

BACKGROUND:Perianal Crohn's disease (PCD) is a severe and disabling phenotype of Crohn's disease that often requires multidisciplinary medical and surgical management. Although ustekinumab (UST) and vedolizumab (VDZ) are widely used after antitumor necrosis factor (anti-TNF) failure, direct comparative data specifically in PCD remain limited. METHODS:We conducted a multicenter, retrospective cohort study using the TriNetX US Collaborative Network to compare the effectiveness of UST versus VDZ in adults (18 y or older) with PCD between January 2017 and May 2023. Outcomes were perianal-specific clinical events, including definitive fistula surgery, incision and drainage, diversion procedures, and antibiotic use (metronidazole or ciprofloxacin), assessed at 1 and 2 years after biological initiation. Propensity score matching (PSM) (1:1) was performed to balance baseline variables. Time-to-event analyses were conducted in the matched population using Kaplan-Meier methods, and hazard ratios (HRs) were estimated using Cox proportional hazards models within the matched cohorts. RESULTS:A total of 2936 patients were identified before PSM: 1997 patients in the UST group and 939 patients in the VDZ group. After PSM, 936 patients were included in each cohort. In the matched cohorts, UST was associated with significantly lower risk of definitive perianal fistula surgery (HR: 0.66, 95% CI: 0.50-0.89; P<0.01), and composite surgical events (HR: 0.70, 95% CI: 0.54-0.87; P<0.01) compared with VDZ at 1 year. Rates of antibiotic use, incision and drainage of perianal abscess, and diversion procedures were numerically lower but not statistically significant. At 2 years, these findings persisted, with significantly lower cumulative incidence of definitive perianal fistula surgery (HR: 0.78, 95% CI: 0.61-0.90; P=0.03), composite surgical events (HR: 0.81, 95% CI: 0.69-0.90; P<0.01), and antibiotic use (HR: 0.86, 95% CI: 0.75-0.93; P=0.04) in the UST cohort compared with VDZ. Rates of incision and drainage and diversion procedures remained similar between groups. CONCLUSION:In this large real-world cohort, UST was associated with lower risks of perianal surgical interventions at one and two years and reduced antibiotic utilization at two years compared with VDZ in patients with PCD. These findings highlight meaningful differences in real-world effectiveness between therapies and support the need for prospective studies to further evaluate comparative effectiveness in this population.