Introduction Although the benefits of physical activity are well-recognized, the relationship between it and the psychological state and quality of life of patients with inflammatory bowel disease (IBD) in China remains unclear. Here, this study explores the association analysis between the level of physical activity in IBD and fatigue, anxiety, depression, and quality of life. Methods In this multicentre investigative study, clinical data including age, work status, disease duration, disease stage, and bowel manifestations were collected from 321 patients with IBD. Physical activity level, fatigue, psychological status, and quality of life of IBD patients were assessed by the International Physical Activity Questionnaire (IPAQ), Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F), Generalized Anxiety Disorder-7 items (GAD-7), Patient Health Questionnaire Depression Inventory (PHQ-9), and Inflammatory Bowel Disease Quality of Life Questionnaire (IBD-Q), respectively. Results Of the 321 IBD patients, 57.3% (n=184) were diagnosed with Crohn's disease (CD) and 42.7% (n=137) with ulcerative colitis (UC). Among the CD patients, 42.93% had a low level of physical activity, 54.89% experienced severe fatigue, 46.20% had varying degrees of anxiety, and 50.0% had depression problems. Additionally, 21.74% reported a poor quality of life. The mean IBD-Q score was 188.09±28.21. The correlation between physical activity level, psychological status, and quality of life was not statistically significant in CD patients. However, in UC patients, physical activity level was correlated with the GAD-7, IBD-Q total scores, affective functioning, and social functioning scores (P=0.02, P=0.023, P=0.012, and P=0.004, respectively), with higher levels of physical activity associated with lower GAD-7 scores and higher IBD-Q scores. Furthermore, self-fatigue and lack of time were the main reasons preventing patients from participating in physical activities. Aerobic exercise was more accepted and chosen by patients than muscle training and flexibility training. Conclusion IBD has a low overall physical activity level and suffers from varying degrees of fatigue, anxiety, and depression, which affect its quality of life. Higher levels of physical activity are associated with better psychological status and quality of life. Therefore, it is essential to enhance physical activity levels among individuals with IBD.

Background Depression and anxiety were not only common but also with serious consequence in inflammatory bowel diseases (IBD) patients. The current study endeavors to define distinct depression and anxiety profiles of IBD patients and identify central symptoms within different profiles to facilitate targeted interventions. Methods The research employed K-means Clustering to delineate the depression and anxiety profiles, followed by a repetition of the analysis using Latent Profile Analysis (LPA). Furthermore, network analysis was utilized to identify central symptoms within the various profiles. Results K‑means Clustering identified Cluster 1 (38.89%), Cluster 2 (45.33%) and Cluster 3 (15.78%), while LPA yielded the low-risk group (39.56%), the mild-risk group (44.22%) and the high-risk group (16.22%). A majority of patients in the three clusters were predominantly in a single LPA-derived patient class (96.1—99.0%). Network analysis revealed that connections within each symptom in PHQ-9 and GAD-7 were stronger than those between symptoms. Furthermore, PHQ 6 (“guilt”), PHQ2 (“sad mood”)and GAD 7 (“feeling afraid”) were identified as the central symptoms in Cluster 1. PHQ2 (“sad mood”), GAD 3(“excessive worry”) and GAD 1 (“nervousness”) emerged as the central symptoms in Cluster 2. Additionally, GAD3 (“excessive worry”), GAD 4 (“trouble relaxing”) and GAD 6(“irritability”) were identified as the central symptoms in Cluster 3. Conclusion We defined three distinct depression and anxiety profiles among IBD patients and pinpointed central symptoms within each profile. These findings underscore the importance of directing research towards those central symptoms within each profile in order to develop targeted intervention strategies.

Long-term remission in Crohn's disease (CD) remains challenging. While ustekinumab effectively induces remission, strategies to enhance its maintenance efficacy are urgently needed. This study evaluated therapeutic drug monitoring (TDM)-guided ustekinumab optimization for sustained CD management. A retrospective observational study was conducted involving 158 patients [TDM: n = 87, age(16 39), male = 64; Non-TDM: n = 71, age(16-40), male = 57] with moderate-to-severe CD who achieved clinical remission following ustekinumab therapy, between October 2020 and November 2024, sourced from three inflammatory bowel disease centers. All patients received 8 weekly ustekinumab maintenance treatment with or without therapeutic drug monitoring (TDM)-guided optimization. The clinical outcomes and disease relapse were evaluated at year 1 and 2. The non-TDM group had a slightly higher endoscopic response and mucosal healing rate at baseline, there were no statistically significant differences between two cohorts at baseline with respect to demographic and clinical characteristics. In this multicenter retrospective study of 158 CD patients in clinical remission, TDM-guided dosing (n = 87) significantly improved 1 year (83.9% vs. 70.4%, p = 0.042) and 2 year remission rates (71.3% vs. 46.5%, p = 0.002) compared to standard therapy (n = 71). Subgroup analyses confirmed benefits in endoscopic responders and mucosal healing cohorts. TDM patients exhibited higher ustekinumab trough levels (3.00 vs. 1.46 μg/mL at year 1, p < 0.001) and lower relapse rates (p = 0.003). Neither the TDM nor the non-TDM cohorts reported any severe adversative events. TDM-guided optimization of ustekinumab maintenance treatment is an efficacious and safe strategy for CD patients with ustekinumab induced clinical remission.

BACKGROUND & AIMS:Previous results showed that combined treatment of biologics and exclusive enteral nutrition (EEN) brought moderate-to-severe Crohn's disease patients significant improvements in clinical and endoscopic outcomes. Despite its essential role and favorable safety profile, EEN in the treatment of adult Crohn's disease is frequently underestimated because of lower compliance and several side effects, including EEN-related diarrhea (EEND). METHODS:In this prospective, single-center randomized clinical trial, 147 eligible patients with actively moderate-to-severe Crohn's disease treated with biologics and concomitant 16-week EEN were included. Sixty-one patients without EEND were enrolled in the ND group (without EEN-related diarrhea), and other patients with EEND who received pancreatic enzyme replacement therapy (PERT) (43 patients) or not (43 patients) were recruited in PERT and NPERT groups, respectively. The clinical outcomes, biologic outcomes, and endoscopic outcomes were evaluated. Quality of life (QoL) and psychological status were also assessed at baseline and endpoints (week 16). RESULTS:Bowel movements (daily frequency decreased by 5.3 times) and stool consistency (reduced watery and loose stool) were greatly improved in PERT group at week 16. At week 16, patients in the ND and PERT groups achieved similar clinical responses (93% in ND group and 94.7% in PERT group, p = 0.731) and clinical remission (86.0% in ND group and 86.8% in PERT group, p = 0.90) while patients in the NPERT group had significantly lower proportions of these clinical outcomes (67.9% clinical response and 57.1% clinical remission). No significant difference was observed in endoscopic outcomes between each group (p = 0.904). QoL and mental status including anxiety and depression in PERT group had great improvement compared with the NPERT group. CONCLUSIONS:Our prospective results provided invaluable evidence that PERT supplementation efficiently improved EEND in Crohn's disease patients with combined treatment of biologics and 16-week EEN, which had a promising effect in active Crohn's disease induction. TRIAL REGISTRATION:ChiCTR2200058343.

Transmural healing (TH), a comprehensive therapeutic target in Crohn’s disease (CD), is associated with reduced long-term complications. However, evidence on the role of exclusive enteral nutrition (EEN) in TH remains limited. This study aimed to evaluate the efficacy of biologics combined with 16-week EEN in achieving early TH and improving clinical outcomes. This real-world, multicenter retrospective study analyzed medical records of patients with moderate-to-severe CD from 2016 to 2024. Patients received either biologics with concomitant 16-week EEN (BioEEN) or biologics alone (Bio). Clinical and endoscopic outcomes, including transmural healing, were assessed at week 16, year 1, and year 2. At baseline, demographic and clinical characteristics were comparable between the two groups. The BioEEN group demonstrated superior clinical response rates compared to the Bio group (95.1% vs. 70.6% at week 16; P  < 0.001), with sustained benefits at week 52 (87.8% vs. 59.5%; P  < 0.001). Subgroup analysis revealed higher endoscopic response, mucosal healing, and TH rates in both colorectal and ileal segments at weeks 16 and 52 in the BioEEN group. Additionally, the BioEEN group had significantly lower rates of surgery, escalated treatment, bowel damage progression, and disease relapse at 1 and 2 years. Regression analysis identified the 16-week EEN as the sole protective factor for early transmural healing and improved long-term outcomes. Combined treatment of biologics and 16-week EEN promotes early transmural healing, thereby enhancing long-term clinical outcomes in CD patients.

BACKGROUND AND AIM:To study the corresponding strategies to control stomach cancer, a comprehensive assessment of the disease burden is required. Herein, we present long-term trends in the burden of stomach cancer in China over the past three decades, as well as its epidemiological features. METHODS:We characterized the burden of stomach cancer in China using the GBD 2021 methods and results, based on prevalence, incidence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) estimated using the DisMod-MR 2-1. We also used joinpoint and age-period-cohort (APC) analysis methods to interpret the epidemiological characteristics of stomach cancer, project the disease burden of stomach cancer in China over the next decade, and compare these trends with global prevalence patterns. RESULTS:The age-standardized incidence (ASIR) and mortality rates (ASMR) in both sexes changed from 48.03 (40.21, 56.69) to 29.05 (22.42, 36.2) and from 46.05 (38.88, 54.43) to 21.51 (16.66, 26.61) per 100 000 people in China from 1990 to 2021. The age-standardized DALY rate in China decreased from 1181.61 (978.38, 1390.89) per 100 000 people in 1990 to 501.26 (387.29, 627.98) per 100 000 people in 2021. The average annual percentage change (AAPC) in age-standardized incidence, prevalence, and mortality rates for stomach cancer in China were -1.61 (95% CI: -1.73, -1.48), -0.50 (95% CI: -0.67, -0.32), and -2.44 (95% CI: -2.62, -2.26). The effects of age, period, and cohort on mortality rates differed. CONCLUSIONS:In the next decade, China's ASIR and ASMR for stomach cancer will continue to decline. However, despite the decrease in incidence, the overall burden of stomach cancer in China will remain significantly higher than the global average. The burden of stomach cancer in China will be a major public health challenge, given the country's large population base and aging population.

INTRODUCTION:Despite increasing studies confirming the efficacy of vedolizumab (VDZ) in Crohn's disease (CD), improving the responses to this biologic agent remains challenging in clinical practice. In this article, we investigated the efficacy of combined treatment of VDZ and 16-week exclusive enteral nutrition (EEN) in moderately to severely active CD. METHODS:From October 2020 to October 2023, 81 patients with moderately to severely active CD treated with VDZ from 2 inflammatory bowel disease centers were retrospectively selected. Forty-one patients received treatment of VDZ with concomitant 16-week EEN (VDZ + EEN cohort), and 40 patients received VDZ treatment alone (VDZ cohort). Clinical and biological outcomes were evaluated. Endoscopic response and mucosal healing were assessed by colonoscopy at weeks 16 and 52. RESULTS:There was no statistically significant difference between 2 groups at baseline for demographic and clinical characteristics. Compared with patients treated with VDZ alone, patients in the VDZ + EEN cohort achieved higher rates of clinical response (84.2% vs 40.0%), clinical remission (81.6% vs 30.0%), endoscopic response (91.4% vs 34.6%), including mucosal healing (85.7% vs 26.9%) at week 16. The superiority of VDZ + EEN treatment sustained in maintenance, with 76.7% (vs 33.3%) clinical response, 70.0% (vs 26.7%) clinical remission, 76.9% (vs 33.3%) endoscopic response, and 61.5% (vs 26.7%) mucosal healing at week 52. None of the patients experienced severe adverse events. DISCUSSION:VDZ with concomitant 16-week EEN might be an effective and optimized approach with solid efficacy in the induction and maintenance treatment of active CD.

BACKGROUND & AIMS:Although biologics were prescribed to achieve and maintain clinical remission of active Crohn's disease (CD), almost half of patients experienced a loss of response or intolerance. Here, we investigated the efficacy of combined treatment of biologics and 16-weeks exclusive enteral nutrition (EEN) in moderate-to-severe CD patients with small intestine lesions. METHODS:This was a real-world, multicenter retrospective study, from October 2016 to March 2023, medical records of patients registered at three IBD centers were reviewed for patients with ileal or ileocolonic CD in moderate-to-severe activity. All patients received treatment of biologics with concomitant 16-week EEN (BioEEN) or biologics alone (Bio). The clinical outcomes and endoscopic outcomes were assessed at week 16 and 52. RESULTS:There was no statistically significant difference between Bio (97 patients) and BioEEN group (100 patients) at baseline for demographic and clinical characteristics. Compared to treatment with biologics alone, patients with BioEEN treatment achieved higher rates of clinical response (95.0% vs. 66.0%), clinical remission (87.0% vs. 52.6%), endoscopic response (91.4% vs. 47.4%) including mucosal healing (85.7% vs. 23.7%) at week 16. The superiority of BioEEN sustained in maintenance, with 84.7% (vs. 49.1%) clinical response, 77.8% (vs. 38.6%) clinical remission, 69.2% (vs. 32.6%) endoscopic response and 51.9% (vs. 18.6%) mucosal healing at week 52. CONCLUSIONS:Combined treatment of biologics and 16-week EEN was an efficient therapeutic strategy with affirmative effectiveness for small intestine diseases of active CD.

Background: Although increasing studies have reported that dose escalation can improve treatment response to ustekinumab in patients with Crohn's disease (CD), their strategies mainly focus on maintenance regimen. Evidence of ustekinumab dose escalation in induction regimen, particularly in severe CD, remains limited. This study evaluated the efficacy and safety of intravenous ustekinumab with 2 initial doses in patients with severely active CD. Methods: A retrospective observational study of 99 adult patients with severe CD treated with ustekinumab from 3 IBD centers included 48 patients with standard and 51 with optimized induction treatment. Clinical outcomes, inflammatory biomarkers including fecal calprotectin (FC) normalization, and endoscopic outcomes were evaluated at weeks 16 and 48. Adverse events and treatment decisions after initial induction were also collected. Results: Compared with the standard group, 2 initial intravenous injections of ustekinumab achieved higher clinical response (92.2%, 47 of 51, P =.656), clinical remission (88.2%, 45 of 51, P =.221), endoscopic response (75.8%, 25 of 33, P =.125), and FC normalization (70.6%, 36 of 51, P =.138) at week 16. The mucosal healing rate at week 16 (63.6%, P =.022) was statistically higher in the optimization group. At week 48, patients with optimized treatment achieved higher clinical response (80.4%, 41 of 51, P =.003), clinical remission (70.6%, 36 of 51, P =.007), FC normalization (66.7%, 34 of 51, P =.031), endoscopic response (72.7%, 24 of 33, P =.006), and mucosal healing (57.6%, 19 of 33, P =.004). At the last follow-up, 82.4% of optimally treated patients adhered to continued treatment with ustekinumab (P <.001). Conclusions: Optimization of ustekinumab by 2 initial intravenous inductions is more effective than standard therapy for adult patients with severe CD.

AbstractBackgroundAlthough poor medication adherence has a negative impact on disease prognosis in patients with inflammatory bowel disease (IBD), finding proven solutions remains a challenge. In this study, we developed a telehealth management model based on education and patient‐centered medical care (PCEB) using the social media platform WeChat.ObjectiveTo investigate the effect of PCEB on adherence and clinical outcomes.MethodsIn this retrospective cohort, 543 IBD patients (274 in the PCEB group and 269 in the routine group) at the IBD center of Renmin Hospital (Wuhan University, Wuhan, China) were enrolled between January 2020 and September 2022. The routine group received routine follow‐up and management, while for PCEB patients, a comprehensive IBD education program and PCEB were conducted. Medication adherence and clinical outcomes were also evaluated.ResultsThere were no differences between the PCEB and routine groups in terms of patient demographics and clinical characteristics, including disease classification, duration, biological treatment, and educational background at baseline. Compared with routine treatment, PCEB greatly improved patient medication adherence, as assessed by compliance with oral medication, enteral nutrition, biological infusion, and scheduled endoscopic assessment. Clinical and endoscopic remission in patients with PCEB increased during short‐term (month 4) and long‐term (month 12) follow‐ups, along with a decrease in relapse rates for CD (13.3% vs. 31.8%) and UC (19.8% vs. 37.2%).ConclusionThe telehealth model applied to the PCEB group improved medication adherence and clinical outcomes in patients with IBD. This is a new and powerful solution for the long‐term management of this chronic and progressive disease.

In all international medical student (IMS) programs in China, language barriers between IMSs and Chinese patients greatly reduced the learning in clinical practice and brought great challenges to IMSs in their transition from preclinical to clinical practice. This study aimed to investigate the role of bilingual simulated patients (B-SPs) in IMSs learning of medical history collection in China. 48 IMSs of grade 4 between October 2020 to Jan 2021 were enrolled in this study. During the training of medical history collection, students were randomly arranged into two groups trained with either B-SPs (B-SP group) or English-speaking SP (E-SP group). All SPs in Objective Structured Clinical Exam station (OSCE) were trained in the Affiliated Hospital of Wuhan University. Clinical skills in medical history collection were assessed by instructors during pre-clinical, post-clinical OSCE and clinical rotations. The scores of IMSs in each group were analyzed in terms of medical history collection including the ability to effectively consult for information and key communication skills related to patient care. Our results indicated that IMS in B-SP group obtained similar scores in preclinical training for history collection (67.3 ± 8.46 vs 67.69 ± 8.86, P < 0.05) compared to E-SP group, while obtaining significantly higher score improvements between pre- and post-OSCE (17.22 (95

Although histopathological evaluation after endoscopic submucosal dissection (ESD) is critical to assess the accuracy of endoscopic diagnosis, it is still challenging to perform precise endoscopic to pathological evaluation. We evaluated the importance of tissue marking dye (TMD)-targeted marking for post-ESD specimen guided by magnificent endoscope on histopathological accuracy and endoscopic-to-histopathological reconstruction. A total of 81 specimens resected by ESD [43 without TMD marking (N-TMD group), and 38 specimens with TMD-targeted cancerous areas marking guided by post-procedural magnifying endoscopy on resected specimens (TMD group)] between January 31, 2019, and January 31, 2022 at the Renmin Hospital of Wuhan University were included in the study. The baseline characteristics of patients, discrepancies between endoscopic and histopathological diagnosis, and the impact of TMD on histopathological diagnosis and reconstruction were analyzed. Discrepancies between endoscopic (pre-ESD) and histopathological (post-ESD) diagnosis increased significantly in TMD group (68.4

AIM:This study is performed to analyze the role of long non-coding RNA plasmacytoma variant translocation 1 in prostate cancer.METHODS AND MATERIALS:Plasmacytoma variant translocation 1, miR-515-5p, and high mobility group B3 mRNA expressions were examined using quantitative real-time polymerase chain reaction and immunohistochemistry. After gain-of-function and loss-of-function models were established, the changes in cell proliferation, migration, and invasion were evaluated using cell counting kit-8 assay, 5-ethynyl-2'-deoxyuridine assay, and Transwell experiments. Validation of the targeting relationships between plasmacytoma variant translocation 1 and miR-515-5p, and between miR-515-5p and high mobility group B3 was conducted using bioinformatics prediction, a dual-luciferase reporter assay, and an RNA immunoprecipitation experiment. Moreover, the effects of plasmacytoma variant translocation 1 and miR-515-5p on high mobility group B3 protein expression were examined using Western blot.RESULTS:Plasmacytoma variant translocation 1 expression and high mobility group B3 expression were up-regulated in prostate cancer tissues and cell lines while miR-515-5p expression was down-regulated. Plasmacytoma variant translocation 1 knockdown restrained the proliferation, migration, and invasion of LNCaP and DU145 cells in vitro, and the transfection with miR-515-5p inhibitors reversed these effects. Mechanistically, plasmacytoma variant translocation 1 could repress the function of miR-515; high mobility group B3 was proved to be a target gene of miR-515-5p, and its expression could be indirectly positively modulated by plasmacytoma variant translocation 1.CONCLUSION:Plasmacytoma variant translocation 1 accelerates prostate cancer progression by repressing miR-515-5p's function to upregulate high mobility group B3 expression.

Cancer-associated fibroblasts (CAFs), as the activated fibroblasts in tumor stroma, are important modifiers of tumor progression. TGFβ1 has been the mostly accepted factor to fuel normal fibroblasts transformation into CAFs. Ca2+/calmodulin-dependent protein kinase II (CaMKII) is thought to play an important role in fibroblasts activation induced by TGFβ1. The aim of this study is to investigate the potential role of CaMKII in TGFβ1-induced fibroblasts activation and CAF-like differentiation. Cross talk between CaMKII-dependent fibroblasts and colon cancer in colon cancer progression also was addressed Immunostaining demonstrated that in colon cancer stroma, CaMKII overexpressed in stromal CAFs. In vitro, TGFβ1 increased CAF markers expression in human colon fibroblasts CCD-18Co, but not in CaMKII depletion fibroblasts. CaMKII knockdown by CaMKII shRNA significantly inhibited TGFβ1-induced fibroblasts activation and CAF-like differentiation. Smad3, AKT, and MAPK were targeted in TGFβ1–CaMKII-mediated pathway. Human colon cancer cell line HCT-116 activated fibroblasts directly, whereas CaMKII depletion dragged CCD-18Co fibroblasts undergoing CAF-associated trans-differentiation. Furthermore, increased proliferation, migration, and invasion of colon cancer cells were stimulated when co-cultured with normal fibroblasts, but not with CaMKII depletion fibroblasts. These findings provide evidence that CaMKII is a critical mediator in TGFβ1-induced fibroblasts activation and is involved in the cross talk with colon cancer cells. CaMKII is a potentially effective target for future treatment of colon cancer.

Background Early detection is critical in limiting the spread of 2019 novel coronavirus (COVID-19). Although previous data revealed characteristics of GI symptoms in COVID-19, for patients with only GI symptoms onset, their diagnostic process and potential transmission risk are still unclear. Methods We retrospectively reviewed 205 COVID-19 cases from January 16 to March 30, 2020, in Renmin Hospital of Wuhan University. All patients were confirmed by virus nuclei acid tests. The clinical features and laboratory and chest tomographic (CT) data were recorded and analyzed. Results A total of 171 patients with classic symptoms (group A) and 34 patients with only GI symptoms (group B) were included. In patients with classical COVID-19 symptoms, GI symptoms occurred more frequently in severe cases compared to non-severe cases (20/43 vs. 91/128, respectively, p < 0.05). In group B, 91.2% (31/34) patients were non-severe, while 73.5% (25/34) patients had obvious infiltrates in their first CT scans. Compared to group A, group B patients had a prolonged time to clinic services (5.0 days vs. 2.6 days, p < 0.01) and a longer time to a positive viral swab normalized to the time of admission (6.9 days vs. 3.3 days, respectively, p < 0.01). Two patients in group B had family clusters of SARS-CoV-2 infection. Conclusion Patients with only GI symptoms of COVID-19 may take a longer time to present to healthcare services and receive a confirmed diagnosis. In areas where infection is rampant, physicians must remain vigilant of patients presenting with acute gastrointestinal symptoms and should do appropriate personal protective equipment.

Background: Early detection of infected patients is one of the most important steps to mitigate spreading of 2019 novel coronavirus (2019-nCoV). Here, we report a set of atypical 2019-nCoV pneumonia cases with gastrointestinal symptoms onset but without fever or other respiratory symptoms.Methods: We retrospectively reviewed data of admitted patients of 2019-nCoV pneumonia with only digestive symptoms and no fever on the onset from January 17-24, 2019 in Renmin Hospital of Wuhan University. The patients' history, clinical features, physical findings, complete blood count, biochemical results, chest X-ray imaging, microbiological investigation and viral pathogens results were recorded and analyzed.Findings: From January 17 to 24, 2020, nine admitted patients with only digestive symptoms and no fever on the onset had been identified as 2019-nCoV infection. None of the patients had history of contact with animals or visited to the Huanan seafood wholesale market in Wuhan, while they all had exposure history of confirmed or suspected 2019-nCoV-infected patients. Six patients had anorexia (66.7%). Other symptoms include nausea, vomit and diarrhea. All presented digestive symptoms occurred 1-3 days (median time: 2.1 days) before the patients' visit. None of the cases had fever on onset while 5 patients occurred fever and/or respiratory symptoms 2-5 days after initial non-specific presentations. Other 4 patients never presented respiratory symptoms or fever in the following admissions. Pulmonary infiltrates including multifocal patchy ground-glass opacities were detected on CT scans in all cases at the day of their first clinic visit. All nine patients were admitted to hospital under isolation, supportive care, remained stable and none of them was transferred to ICU as of Feb 2, 2020.Interpretation: Patients with recent gastrointestinal symptoms as well as confirmed or suspected 2019-nCoV pneumonia exposure history are potential 2019-nCoV pneumonia candidates. It is significant to take atypical symptoms into account to avoid missed diagnosis, and important for gastroenterologists to strengthen protection to avoid possible infection.Funding: Project of Hubei Provincial Clinical Research Center for Digestive Disease Minimally Invasive Incision (Grant No. 2018BCC337); Hubei Province Major Science and Technology Innovation Project (Grant No. 2018-916-000-008 to Honggang Yu); The National Natural Science Foundation of China [Grant Nos. 81672387 to Honggang Yu]; The National Natural Science Foundation of China [Grant Nos. 81302131 to Ping An]. Declaration of Interest: All authors declared no conflict of interest.Ethical Approval: The study protocol was approved by the ethics committee of Renmin Hospital of Wuhan University.

As recently outlined by Ren Mao and colleagues1 in The Lancet Gastroenterology & Hepatology, patients with inflammatory bowel disease (IBD) are at increased risk of opportunistic infections. Particular attention is therefore required for these patients during the ongoing coronavirus disease 2019 (COVID-19) pandemic.

Background: An outbreak and worldwide spread of COVID-19 was derived from Wuhan, China where over half of the confirmed COVID-19 cases were reported. Protection for special populations at high infection risk such as patients with inflammatory bowel diseases (IBD) is extremely urgent and challenging. Methods: We kept alerts since the first reported COVID-19 case and started to send educational and instructional alerts and took measures to 318 registered IBD patients (204 UC and 114 CD) 20 days earlier to the shutdown of Wuhan. The patients’ infection risks, responses to our alerts and actions were assessed and reported diagnosis of COVID-19 infection was recorded. Findings: With the early and later upgrading alerts and actions for COVID-19 prevention and control, all registry IBD patients received and responsed to our timely guidance. Till now none of them reported COVID-19 infection. Interpretation: Our early warning and protective actions for prevention are undoubtedly the most critical step during this unpredictable storm. Well consciousness to prevent and control infection, timely and decisive adoption and adjustment of protective measures are the key to protection for our IBD patients. Our experience provides inspirative encouragements and suggestions in current COVID-19 worldwide spread and future pandemic diseases. Funding Statement: The National Natural Science Foundation of China [Grant Nos. 81870392 to Weiguo Dong]; The National Natural Science Foundation of China [Grant Nos. 81302131 to Ping An]; The National Natural Science Foundation of China [Grant Nos. 81901817 to Mengyao Ji]. Declaration of Interests: All authors declared no conflict of interest. Ethics Approval Statement: The study protocol was approved by the ethics committee of Renmin Hospital of Wuhan University and waiver of informed consent was obtained.