IBD Journal Scan
Key articles from high impact journals in last month
Editorial Recommendations
MAY-2025
An out-of-the-box approach towards persistent remission in UC
A large international trial assessed whether laparoscopic appendicectomy can help maintain remission in ulcerative colitis (UC) patients. Conducted across 22 centers in the Netherlands, Ireland, and the UK, the study included 197 patients in remission but with a recent history of relapse. Participants were randomized to either undergo appendicectomy alongside standard medical treatment or continue medical treatment alone. After one year, the relapse rate was significantly lower in the appendicectomy group (36%) compared to the control group (56%). Adverse events were similar across both groups, with two cases of incidental low-grade tumors found post-surgery. The study concludes that appendicectomy is more effective than medical therapy alone in preventing UC relapse. The trial was registered and funded by Dutch and UK research bodies.
Knowledge is knowing when to start, wisdom is knowing when to stop: A peek at the exit strategy to Anti-TNF
This multicentre, quadruple-blind randomized trial assessed the effects of withdrawing anti-TNF therapy in patients with Crohn’s disease or ulcerative colitis in stable remission. A total of 140 patients who had been in remission for over six months were randomized to either continue anti-TNF therapy (maintenance group) or stop it (withdrawal group), while all continued immunomodulators. After 12 months, sustained remission rates were slightly higher in the maintenance group (84%) than the withdrawal group (76%), though not statistically significant. However, more patients in the withdrawal group showed elevated inflammation markers and endoscopic activity. Adverse and serious adverse events were comparable between groups. The study suggests that while withdrawal may be safe for some, it poses a modestly increased risk of disease relapse.
One glance won’t save your pants": HD white light endoscopy vs Chromendoscopy
A multicentre randomized trial evaluated whether high-definition (HD) white-light endoscopy with segmental re-inspection (double-pass) is as effective as HD dye-based chromoendoscopy in detecting colorectal neoplasia in inflammatory bowel disease (IBD) patients. A total of 563 IBD patients undergoing surveillance were randomized into three groups: segmental HD white-light, HD chromoendoscopy, or single-pass HD white-light endoscopy. Neoplasia detection rates were 10.3% for segmental re-inspection and 13.1% for chromoendoscopy, confirming non-inferiority. Detection per 10-minute withdrawal time was also similar between these two methods. Single-pass HD white-light endoscopy showed a lower detection rate (6.1%), though not significantly. The study concludes that longer inspection time with HD white-light endoscopy can achieve neoplasia detection rates comparable to chromoendoscopy, potentially offering a simpler, effective alternative.
At similar efficacy rates on follow-up, Ustekinumab edges over Anti-TNF and Vedolizumab with higher treatment persistence rates.
A real-world, multicentre study in Germany evaluated the effectiveness of ustekinumab (UST) compared to anti-TNF agents and vedolizumab (VDZ) in ulcerative colitis (UC) patients starting or switching biologic therapy. Among 476 eligible patients enrolled between 2020 and 2022, treatment persistence over 12 months was highest with UST (93.9%), followed by VDZ (87.0%) and anti-TNF (75.0%). Despite differences in persistence, the 12-month clinical remission rates were not significantly different among the three groups after adjusting for treatment selection bias: UST (26.9%), anti-TNF (34.7%), and VDZ (40.9%) (P = 0.063). The study suggests UST is a viable maintenance option for UC, offering similar effectiveness to other biologics in routine clinical practice.
ENC member publication - Role of 5-ASA in management of UC; Survey outcomes among Southeast Asian nations
A survey of 98 inflammatory bowel disease specialists from eight Asian regions explored how current ulcerative colitis (UC) treatment guidelines—especially 5-aminosalicylic acid (5-ASA) use—are applied in real-world practice. Despite clinical guidelines endorsing 5-ASA as standard therapy, the study found considerable variation in prescribing patterns and adherence to recommendations. Differences were linked to economic status and reimbursement policies across regions. Data were validated by local experts and analyzed by income level and treatment access. The results revealed that guideline implementation often reflects local resource constraints and healthcare systems, leading to a diverse, pragmatic approach in UC management. The study highlights how socioeconomic disparities affect the consistency and feasibility of guideline-based treatment in Asia.