There has been much interest in the potential role of diet as a therapeutic option in Crohn's disease (CD). Several recent dietary clinical trials have been reported in "mild" Crohn's disease. Herein, we highlight several methodological pitfalls from these short-term dietary trials in mild CD that should be considered to enable appropriate interpretation by patients and clinicians.

BACKGROUND AND AIMS:We aimed to assess the safety of advanced therapies, excluding tumor necrosis factor inhibitors (anti-TNFs), for the treatment of immune-mediated inflammatory diseases (IMIDs), on pregnancy and neonatal outcomes. METHODS AND ANALYSIS:We performed a systematic review and meta-analysis. Study selection and data extraction were conducted independently by two reviewers. Primary outcomes included live births, major congenital malformations (MCMs), miscarriages, and stillbirths. Risk of bias was assessed using ROBINS-I, and the certainty of evidence was evaluated using GRADE. Meta-analyses of prevalence and odds ratios (ORs) comparing advanced therapies with anti-TNFs were conducted using fixed and random effect models. RESULTS:Of 14 661 manuscripts screened, 49 studies met the inclusion criteria: eight cohorts, nine case series, and 32 case reports. Most cohort studies were at a critical risk of bias. The majority of the available data related to ustekinumab (1324 exposed offspring) and vedolizumab (585 exposed offspring) whereas data on other biologics and JAK inhibitors were very limited. Pregnancies exposed to biologics had a pooled prevalence of 82.43% for live births, 0.55% for MCMs, 8.16% for miscarriage, and 0.00% for stillbirths. No significant differences in adverse pregnancy or neonatal outcomes were observed compared with women exposed to anti-TNFs. Overall, the level of evidence was very low, due largely to reliance on small observational studies and case reports. CONCLUSION:Current evidence does not suggest an increased risk of adverse pregnancy or neonatal outcomes with advanced therapies for IMIDs. However, larger, high-quality studies are needed, and these findings should be interpreted as hypothesis-generating.

Objective Obesity and type 2 diabetes mellitus are increasingly common in patients with inflammatory bowel disease (IBD) and are associated with adverse clinical outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are effective metabolic therapies with potential anti-inflammatory effects but their safety and effectiveness in IBD remain unclear. We conducted a systematic review and meta-analysis to evaluate metabolic, clinical and safety outcomes associated with GLP-1 RA use in IBD.Methods MEDLINE, EMBASE, Web of Science and major international conference proceedings were searched from inception to 1 October 2025. Randomised controlled trials and observational studies evaluating GLP-1 RAs in adults with Crohn's disease or ulcerative colitis were included. Pre-post and comparative studies were analysed separately, with random-effects meta-analyses performed when at least three studies reported an outcome.Results 23 studies including 150 254 patients were analysed. In pre-post studies, GLP-1 RA therapy significantly reduced body mass index (mean difference -3.34 kg/m & sup2;; 95% CI -4.05 to -2.20) and modestly lowered HbA1c (-0.17%; 95% CI -0.33 to -0.01). In comparative analyses, GLP-1 RA use was associated with lower risks of IBD-related hospitalisation (RR 0.76; 95% CI 0.58 to 1.00), IBD-related surgery (RR 0.68; 95% CI 0.54 to 0.85) and ileus or intestinal obstruction (RR 0.53; 95% CI 0.35 to 0.79). Gastrointestinal adverse events were common leading to treatment discontinuation in 11-24% of patients.Conclusion GLP-1 RAs appear safe in patients with IBD and are associated with clinically meaningful weight loss and favourable IBD-related outcomes. Although causality cannot be inferred, these findings support the need for randomised controlled trials.PROSPERO registration number CRD420261350546.

Gastrointestinal (GI) endoscopy is a daily procedure in clinical practice but contributes substantially to healthcare’s environmental footprint. Data on sustainability policies in Switzerland, however, remain scarce. This study aimed to assess the implementation of sustainability practices among members of the Swiss Society of Gastroenterology (SGG-SSG). We conducted a web-based cross-sectional survey between September 2023 and January 2024, targeting all 463 practicing Swiss gastroenterologists listed in the latest SGG-SSG roster. The survey comprised eleven questions covering four domains: respondent demographics; waste and single-use device management and procurement; digitalization; and work–life balance. A total of 161 respondents participated (response rate: 34.8%). Less than half (45.1%) reported waste sorting, while policies for single-use device reduction (23.5%) and waste minimization initiatives (27.8%) were even less common. Nearly half (48.8%) reported including sustainability considerations in procurement policies. In contrast, 52.8% reported having policies to promote work–life balance, and 88.2% reported policies requiring the use of electronic health records, reflecting significant progress in digitalization. While procurement and digitalization efforts are more widely implemented, further coordinated action is needed. Future research should investigate professional attitudes, institutional barriers, and strategies to enhance the adoption of environmentally responsible practices in GI endoscopy. Furthermore, professional societies (particularly SGG-SSG), hospital administrators, and cantonal health authorities must coordinate to establish national standards, integrate sustainability into accreditation, and implement incentives and accountability to reduce the environmental impact of GI endoscopy without compromising quality of care.

Inflammatory bowel diseases frequently affect individuals of reproductive age. Optimal management before and during pregnancy is critical for minimizing maternal and fetal complications. Disease remission at the time of conception reduces the risk of flares and adverse pregnancy outcomes. Most treatments can be safely continued throughout pregnancy and breastfeeding. A multidisciplinary approach is recommended, including tailored disease monitoring and appropriate therapeutic choices, as well as an individualized assessment of delivery mode and breastfeeding.

BACKGROUND AND AIMS:Quality of care in inflammatory bowel disease (IBD) management is crucial for early detection and prevention of disease progression and complications. The European Crohn's and Colitis Organisation (ECCO) developed evidence-based recommendations and quality of care (QoC) standards for IBD management, but gaps between these standards and real-world practices still exist. The E-QUALITY task force aimed to evaluate processes related to quality standards of IBD diagnosis and management across European institutions and identify barriers to meet ECCO QoC standards. METHODS:A web-based survey was conducted from September 2022 to October 2024 among 245 institutions in 35 European countries. The survey assessed processes used to diagnose and monitor disease activity, to prevent infections, and to detect colorectal cancer in IBD. Subgroup analyses were performed based on institution type, patient volume, and geographical distribution. RESULTS:Across participating European centers, most ECCO recommendations were followed in 85% of institutions. Monitoring disease activity and severity within the recommended time occurred in 75% of institutions, although audit mechanisms are lacking in the majority of centers. The main challenges are difficulties in scheduling endoscopy/imaging within the recommended time frame, lack of uniform behavior among physicians in the same unit, and patients' reluctance to undergo regular monitoring. CONCLUSION:Significant gaps in QoC standards remain across European IBD units. Most units lack specific auditing mechanisms to track true standard compliance. Enhanced support from ECCO, through education on guidelines and implementation strategies, and adaptation of recommendations to accommodate real-world challenges may help to bridge these gaps.

BACKGROUND AND AIMS:Inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis, require an interdisciplinary approach for diagnosis, monitoring, and management. The European Crohn's and Colitis Organisation (ECCO) has developed evidence-based recommendations and quality care standards for IBD management, but gaps between these standards and real-world practice persist. The E-QUALITY task force aimed to evaluate the structure, processes, and outcomes of IBD units across Europe and identify barriers to achieving ECCO quality standards. METHODS:A web-based survey was conducted from September 2022 to October 2024 among 245 institutions in 35 European countries. The survey assessed unit structure, interdisciplinary care, services, facilities, and barriers to achieving quality care standards. Subgroup analyses were performed based on institution type, patient volume, and geographical distribution. RESULTS:Formal IBD units were present in 68% of institutions, with interdisciplinary teams available in 94%. Institutions with >500 active patients were more likely to meet ECCO standards for interdisciplinary care, quality indicators, and patient support but faced challenges such as lack of time and referral pathways. Geographical disparities significantly influenced the availability of resources and services. Key barriers to quality care included lack of time (71%), personnel (69%), and funding (45%). CONCLUSIONS:Significant gaps in quality care standards remain across European IBD units. Enhanced support from ECCO, by education and position papers/guidelines may help bridge these gaps.

LINKED CONTENT This article is linked to Riggott et al paper. To view this article, visit https://doi.org/10.1111/apt.17735

Patients with inflammatory bowel disease (IBD) are prone to reduced bone mineral density and elevated overall fracture risk. Osteopenia affects up to 40% of patients with IBD (high regional variability). Besides disease activity, IBD specialists must consider possible side effects of medication and the presence of associated diseases and extraintestinal manifestations. Osteopenia and osteoporosis remain frequent problems in patients with IBD and are often underestimated because of widely differing screening and treatment practices. Malnutrition, chronic intestinal inflammation and corticosteroid intake are the major pathophysiological factors contributing to osteoporosis. Patients with IBD are screened for osteoporosis using dual-energy X-ray absorptiometry (DXA), which is recommended for all patients with a prolonged disease course of more than three months, with repeated corticosteroid administration, aged >40 years with a high FRAX risk score or aged <40 years with multiple risk factors. From a therapeutic perspective, besides good disease control, vitamin D supplementation and glucocorticoid sparing, several specific osteological options are available: bisphosphonates, receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitors (denosumab), parathyroid hormone (PTH) analogues and selective estrogen receptor modulators. This review provides an overview of the pathophysiology, diagnosis, prevention and treatment of IBD-associated bone loss.

Abstract Background and Aim Drug‐induced liver injury (DILI) may present with autoimmune features and require immunosuppressive therapy (IST) to reach biochemical response. Discontinuation of IST without hepatitis relapse may be more frequent in these patients as compared to patients with classical autoimmune hepatitis (AIH). We aimed to determine baseline characteristics and outcome of patients with immune‐mediated drug induced liver injury (IMDILI) with particular emphasis on IST during follow‐up. Methods We performed a single‐center retrospective study of consecutive patients presenting at a tertiary care center between January 2005 and December 2019 either with IMDILI or with classical AIH, for whom full baseline characteristics and a close follow‐up were available over a 12‐month period. Results Overall, 31 patients (IMDILI n = 16, mean age 59 [34–74] years; AIH n = 15, mean age 47 [15–61] years) were included, showing similar biochemical, serological, and histological characteristics. Incriminating drugs in IMDILI patients were mostly represented by nonsteroidal antiinflammatory drugs and sartans. Initial corticosteroids combined with IST led to biochemical response in all patients. Compared to idiopathic AIH, more patients with IMDILI were weaned off corticosteroids at the end of follow‐up (11/16 [68.7%] vs 4/15 [26.6%], P < 0.02). At 1 year of follow‐up, more patients in the IMDILI group compared to the classical AIH group were off any type of IST (13/16 [81%] vs 15/15 [100%], P = 0.08). Conclusions Although presenting with similar baseline biochemical and histological characteristics as idiopathic AIH, patients with IMDILI may not require long‐term IST.

AbstractBackgroundNonalcoholic fatty liver disease (NAFLD) is strongly associated with cardiovascular disease in the general population. Both conditions seem more frequent in patients with inflammatory bowel disease (IBD). We aimed to assess the effect of NAFLD and liver fibrosis on intermediate–high cardiovascular risk in IBD.MethodsWe prospectively included IBD patients undergoing a routine screening program for NAFLD by transient elastography (TE) with associated controlled attenuation parameter (CAP). NAFLD and significant liver fibrosis were defined as CAP ≥275 dB m−1 and liver stiffness measurement by TE ≥8 kPa, respectively. Cardiovascular risk was assessed with the atherosclerotic cardiovascular disease (ASCVD) risk estimator and categorized as low if <5%, borderline if 5%–7.4%, intermediate if 7.5%–19.9%, and high if ≥20% or if previous cardiovascular event. Predictors of intermediate–high cardiovascular risk were investigated by multivariable logistic regression analysis.ResultsOf 405 patients with IBD included, 278 (68.6%), 23 (5.7%), 47 (11.6%), and 57 (14.1%) were categorized as at low, borderline, intermediate, and high ASCVD risk, respectively. NAFLD and significant liver fibrosis were found in 129 (31.9%) and 35 (8.6%) patients, respectively. After adjusting for disease activity, significant liver fibrosis and body mass index, predictors of intermediate–high ASCVD risk were NAFLD (adjusted odds ratio [aOR] 2.97, 95% CI, 1.56–5.68), IBD duration (aOR 1.55 per 10 years, 95% CI, 1.22–1.97), and ulcerative colitis (aOR 2.32, 95% CI, 1.35–3.98).ConclusionsAssessment of cardiovascular risk should be targeted in IBD patients with NAFLD, particularly if they have longer IBD duration and ulcerative colitis.

Objective: The ABC risk score identifies patients at high risk of mortality in acute lower and upper gastrointestinal bleeding (UGIB). We aimed to externally validate the ABC score while comparing it to other prognostication scales when assessing UGIB patients at high risk of negative outcomes before endoscopy. Methods: UGIB patients from a national Canadian registry (REASON) were studied, with mortality prediction as a primary outcome. Secondary endpoints included prognostication of rebleeding, intensive care unit (ICU) admission, ICU and hospitalization lengths of stay (LOS), and a previously proposed composite outcome measure. Univariable and areas under the receiver operating characteristic curve analyses compared discriminatory abilities of the ABC score to the AIMS65, Glasgow Blatchford Scale (GBS), and clinical Rockall score. Results: The REASON registry included 2020 patients [89.4% nonvariceal; mean age (±SD): 66.3±16.4 y; 38.4% female]. Overall mortality, rebleeding, ICU admission, transfusion and composite score rates were 9.9%, 11.4%, 21.1%, 69.0%, and 67.3%, respectively. ICU and hospitalization LOS were 5.4±9.3 and 9.1±11.5 days, respectively. The ABC score displayed superior 30-day mortality prediction [0.78 (0.73; 0.83)] compared with GBS [0.69 (0.63; 0.75)] or clinical Rockall [0.64 (0.58; 0.70)] but not AIMS65 [0.73 (0.67; 0.79)]. Although most scales significantly prognosticated secondary outcomes in the univariable analysis except for ICU LOS, discriminatory abilities on areas under the receiver operating characteristic curve analyses were poor. Conclusions: ABC and AIMS65 display similar good prediction of mortality. Clinical usefulness in prognosticating secondary outcomes was modest for all scales, limiting their adoptions when informing early management of high-risk UGIB patients.

BACKGROUND:The medical treatment of fistulizing Crohn's disease (CD) remains a challenge to clinicians. Over the last 20 years, biologic therapies have been the mainstay of medical treatment of fistulizing CD. The purpose of this study is to compare the efficacy of biologic therapies in inducing response and remission in fistulizing CD. METHODS:We performed a systematic review of the EMBASE, MEDLINE, and Cochrane Central databases from inception to December 2021. Inclusion criteria were any randomized controlled trials (RCTs) that evaluated the efficacy of biologic therapies against an active comparator or placebo for induction of response or remission in adults with fistulizing CD. The proportion of patients with fistula response or remission, as defined by each clinical trial, was our primary study outcome. A Bayesian random-effects network meta-analysis was used to measure treatment effects and results were reported as odds ratio (OR) and 95% confidence interval (CI). RESULTS:In our analysis, 10 studies were included, and all were RCTs. Infliximab was superior to adalimumab in inducing response (OR, 0.24; 95% CI, 0.06-0.99) but not in inducing remission (OR, 0.31; 95% CI, 0.04-2.27). Tumor necrosis factor antagonists were superior to placebo in the induction of response (OR, 0.51; 95% CI, 0.35-0.750) and remission (OR, 0.36; 95% CI, 0.22-0.58). Infliximab was superior to placebo in inducing response (OR, 0.36; 95% CI, 0.17-0.75) and remission (OR, 0.17; 95% CI, 0.03-0.87). Ustekinumab was superior to placebo in inducing response (OR, 0.48; 95% CI, 0.26-0.860) but not in inducing remission (OR, 0.50; 95% CI, 0.13-1.93). When comparing biologic therapies against each other, there was no statistical difference in inducing remission. Vedolizumab was not superior to placebo in inducing remission (OR, 0.32; 95% CI, 0.04-2.29). Certolizumab was not superior to placebo in inducing response (OR, 0.78; 95% CI, 0.40-1.55) or remission (OR, 0.78; 95% CI, 0.40-1.55). CONCLUSIONS:Tumor necrosis factor antagonists are effective in inducing response and remission in fistulizing CD. Infliximab was superior to adalimumab for inducing response but not for inducing remission. Ustekinumab is effective in the induction of response but not in the induction of remission. When compared against each other, biologic therapies showed no significant difference in the induction of remission. Based on the available data, infliximab is the preferred first-line treatment. As for other biologics, the limited published data do not allow us to make firm recommendations. This study supports current practice and emphasizes the need for dedicated RCTs to evaluate the efficacy of biologic therapies in fistulizing CD.

Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory bowel diseases (IBD) characterized by an inflammation of the digestive tract wall. Current guidelines recommend a «treat to target» management and a "tight control" of the inflammation for an optimal follow-up. Intestinal ultrasound, due to its low cost, its feasibility at bed side, its absence of preparation and its non-invasive character, has proved its place in the diagnosis and the follow-up of IBD. It allows the evaluation of various parameters of the lumen, the intestinal wall, the mesentery, the vascularization as well as complications.La maladie de Crohn (MC) et la rectocolite hémorragique (RCH) sont des maladies inflammatoires chroniques de l’intestin (MICI) caractérisées par une inflammation de la paroi du tube digestif. Les recommandations de prise en charge suggèrent de viser une cible thérapeutique et de procéder à une évaluation régulière de l’inflammation appelée « contrôle serré » (tight control en anglais). Le but est de proposer une adaptation thérapeutique si la cible n’est pas atteinte (concept du treat-to-target). L’échographie, par son faible coût, sa faisabilité au lit du malade, son absence de préparation colique et son caractère non invasif, a démontré sa place dans le diagnostic et le suivi des MICI. Elle permet d’évaluer divers paramètres de la lumière, de la paroi intestinale, du mésentère, la vascularisation et de rechercher des complications.

Zusammenfassung Die chronische Obstipation ist eine häufige Erkrankung mit einer Prävalenz von 14 % in der Allgemeinbevölkerung. Unser Ziel war, eine aktuelle Stellungnahme von Schweizer Expert/innen zum klinischen Management der chronischen Obstipation vorzustellen. Nach einer gründlichen Literaturrecherche durch Expert/innen aus den relevanten Bereichen wurden ausgewählte wichtige Empfehlungen der aktuellen ESNM(European Society for Neurogastroenterology and Motility)-Guideline als Grundlage für die Stellungnahme der Schweizer Expert/innen zur Behandlung der Obstipation zusammengestellt und durch einen praxisbezogenen Algorithmus ergänzt. Jeder Empfehlung wurden entsprechende GRADE(Grading of Recommendations, Assessment, Development and Evaluation)-Evidenzniveaus zugewiesen.

Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory bowel diseases (IBD) characterized by an inflammation of the digestive tract wall. Current guidelines recommend a «treat to target» management and a "tight control" of the inflammation for an optimal follow-up. Intestinal ultrasound, due to its low cost, its feasibility at bed side, its absence of preparation and its non-invasive character, has proved its place in the diagnosis and the follow-up of IBD. It allows the evaluation of various parameters of the lumen, the intestinal wall, the mesentery, the vascularization as well as complications.

Primary varicella zoster virus [VZV] infection results in varicella [chickenpox] and its reactivation results in herpes zoster [HZ; shingles]. Patients with inflammatory bowel disease [IBD] are susceptible to complications of primary VZV infection and have an increased risk of HZ. Concerns of VZV and HZ infection in the IBD population have been highlighted by the emergence of JAK inhibitors and their safety profile in this patient population, as with tofacitinib for the treatment of ulcerative colitis [UC]. The current pipeline of emerging therapies includes novel molecules targeting multiple pathways, including JAK/signal transducer and cytokine signalling pathways, such as JAK/STAT. Hence VZV and HZ will be increasingly relevant for gastroenterologists treating IBD patients in light of these emerging therapies. This review will focus on the epidemiology, disease course, prevention, and management of these two distinct infections in patients with IBD.

Inflammatory bowel diseases (IBD) are immune-mediated diseases with complex pathogenesis. IBD’s course is heterogeneous, as is the response of patients to drugs, but physicians often take a “one size-fits-all” approach. Many patients do not respond to their first treatment, lose response, or suffer adverse events caused by medications. The need to manage patients individually, through precision medicine, is clear. Personalizing IBD treatment depends on determining which patients are at high risk of adverse complications, choosing the best therapy for each patient and optimizing treatment efficacy through tight and tailored monitoring. To change the natural course of disease, an individual’s prognosis rather than their symptoms should guide therapy. This thesis outlines current knowledge of IBD pathogenesis and discusses the use of precision medicine to manage IBD patients, with the goal of improving the quality of clinical practice through targeted care.

Background and study aim Checklists prevent errors and have a positive impact on patient morbidity and mortality in surgical settings. Despite increasing use of checklists in gastrointestinal endoscopy units across many countries, a summary of cumulated experience is lacking. The aim of this study was to identify and evaluate the feasibility of successful checklist implementation in gastrointestinal endoscopy units and summarise the evidence of its impact on the commitment in safety culture. Methods A comprehensive literature search was performed identifying the use of a checklist or time-out in endoscopy units from 1978 to January 2020 using OVID MEDLINE, EMBASE, and ISI Web of Knowledge databases, with search terms related to checklist and endoscopy. We summarised overall adherence to checklists from included studies through a narrative synthesis, characterizing barriers and facilitators according to nurse and physician perspectives, while also summarizing safety endpoints. Results The seven studies selected from 673 screened citations were highly heterogeneous in terms of methodology, context, and outcomes. Across five of these, checklist adherence rates post-intervention varied for both nurses (84 % to 96 %) and physicians (66 % to 95 %). Various facilitators (education, continued reassessment) and barriers (lack of safety culture, checklist completion time) were identified. Most studies did not report associations between checklist implementation and clinical outcomes, except for better team communication. Conclusion Implementation of a gastrointestinal endoscopy checklist is feasible, with an understanding of relevant barriers and facilitators. Apart from a significant increase in the perception of team communication, evidence for a measurable impact attributable to gastrointestinal checklist implementation on endoscopic processes and safety outcomes is limited and warrants further study.

SummaryBackgroundThe optimal timing of colonoscopy in acute lower gastrointestinal bleeding (LGIB) remains controversial.AimTo characterise the utility of early colonoscopy (within 24 hours) in managing acute LGIB.MethodsA systematic literature search to October 2019 identified fully published articles and abstracts of randomised controlled trials (RCTs) and observational studies with control groups assessing early colonoscopy in acute LGIB. The primary outcome was rebleeding. Secondary outcomes included mortality, surgery, length of stay (LOS), definite cause of bleeding and adverse events. Odds ratios (ORs) and mean differences (MD) were calculated.ResultsOf 1116 citations, 4 RCTs (466 patients) and 13 observational studies with elective colonoscopy (>24 hours) as control group (1 061 281 patients) were included. No differences in rebleeding were noted between early and elective colonoscopy groups among RCTs alone (OR = 1.70; 0.79; 3.64), or observational studies alone (OR = 1.20; 0.69; 2.09). No other significant between‐group differences in outcomes were found when restricting the analysis to RCTs. Among observational studies only, early colonoscopy was associated with lower rates of all‐cause mortality (OR = 0.86; 0.75; 0.98), surgery (OR = 0.52; 0.42; 0.64), blood transfusion (OR = 0.81; 0.75; 0.87), units of blood transfusion (MD = −4.30; −6.24; −2.36) and shorter LOS (MD = −1.70; −1.70; −1.70 days).ConclusionIn contradistinction to observational studies, data from RCTs do not support a role for early colonoscopy in the routine management of acute LGIB with regards to the most important clinical outcomes. Further research is needed to better identify patients with high‐risk LGIB who may benefit from early colonoscopy.