MAR-2026
The March 2026 journal selection highlights five recent studies focusing on new treatments, long-term management strategies, technology, and lifestyle approaches in inflammatory bowel disease (IBD). Research shows that JAK inhibitors can be effective and relatively safe in managing acute severe ulcerative colitis, while the SHINE-1 trial demonstrates promising results for mirikizumab in paediatric ulcerative colitis. Long-term data from the LIR!C trial indicate that ileocaecal resection may provide durable, therapy-free remission comparable to infliximab, especially in younger patients with ileal Crohn’s disease. A new IOIBD consensus highlights how artificial intelligence can improve accuracy and efficiency in assessing endoscopic and histologic outcomes in clinical trials. Additionally, evidence on the Mediterranean diet suggests it may support clinical remission in IBD, although stronger studies are needed. Together, these studies highlight advances in therapies, clinical trial methodology, and supportive lifestyle strategies in IBD care.
Efficacy of JAK inhibiotrs in ASUC - Meta analysis
A systematic review and meta-analysis of 35 studies involving 664 patients evaluated the effectiveness and safety of Janus kinase (JAK) inhibitors in acute severe ulcerative colitis (ASUC). Short-term clinical response was high with tofacitinib (77.9%) and upadacitinib (86.5%), with colectomy rates around 11%. At intermediate follow-up (<3 months), response and remission rates ranged from 56–57% and 37–47%, respectively, with colectomy rates of 16–21%. Long-term outcomes (3–12 months) showed lower response and remission rates, around 35–41% and 33–38%, with colectomy rates of 22–23%. Reported adverse events included venous thromboembolism (2.2%), herpes zoster (3.4%), and major cardiovascular events (0.7%). High-dose tofacitinib did not demonstrate superior effectiveness compared with standard dosing. Overall, JAK inhibitors appear effective and relatively safe in ASUC management.
A new option for Paediatric UC
The SHINE-1 phase 2 multicentre open-label trial evaluated mirikizumab in 26 paediatric patients (2–<18 years) with moderately-to-severely active ulcerative colitis. At week 12, 69.2% achieved clinical response and 38.5% achieved clinical remission based on modified Mayo score, while 53.8% reached endoscopic remission. PUCAI assessment showed 76.9% clinical response and 38.5% remission. At week 52, 53.8% maintained clinical response and 38.5% remained in clinical remission, with 38.5% achieving endoscopic remission. Additionally, 38.5% achieved steroid-free remission without surgery by week 52. Serious adverse events occurred in 12% of patients, with only one leading to discontinuation. Common adverse events included COVID-19, injection-site pain, headache, fever, and viral upper respiratory infections. Overall, mirikizumab demonstrated encouraging efficacy and acceptable safety in paediatric ulcerative colitis.
Longterm outcomes of LIR!C trail - The data is more clear
A 10-year retrospective follow-up of the LIR!C randomized trial compared laparoscopic ileocaecal resection with infliximab therapy in patients with uncomplicated ileocaecal Crohn’s disease. Data from 129 patients were analyzed with a median follow-up of 11 years. The 10 year therapy-free remission rate was higher after ileocaecal resection (35.8%) compared with infliximab (13.2%). However, overall clinical remission rates were similar between groups (36.5% vs 28.4%). Exploratory analysis suggested an age-dependent benefit of surgery, with younger patients showing greater long-term remission after resection. For example, 20-year-old patients had a 54% remission rate after surgery vs 24% with infliximab. These findings suggest ileocaecal resection can provide durable, therapy-free remission and may be particularly beneficial for younger patients with ileal Crohn’s disease.
IOIBD Consensus on the use of AI for endpoints in IBD trials
The International Organization for the Study of IBD (IOIBD) developed evidence-based consensus statements on the use of artificial intelligence (AI) for assessing endoscopic and histologic endpoints in IBD clinical trials. Through literature review and expert voting, 45 members evaluated 36 statements, reaching consensus on 28 recommendations. Experts agreed that AI-assisted central reading can improve diagnostic accuracy, increase efficiency, reduce costs, and enhance reproducibility compared with traditional assessments. However, the consensus emphasized that AI should complement rather than replace human experts. Key challenges include limited validation, concerns about generalizability, and reliance on human-annotated datasets for training algorithms. Overall, the position paper supports the integration of AI with human assessment to improve endpoint evaluation in future IBD clinical trials.
Mediterranean Diet in management of IBD
A systematic review and meta-analysis evaluated the role of the Mediterranean diet in the treatment of inflammatory bowel disease (IBD). Eight studies were included, with seven studies involving 223 participants reporting remission outcomes. The pooled clinical remission rate with the Mediterranean diet was 62%, with similar remission rates observed in Crohn’s disease (67%) and ulcerative colitis (56%). However, when compared with control diets, the Mediterranean diet did not show a significant advantage in inducing remission. Additionally, none of the included studies reported endoscopic or histological outcomes, limiting the strength of conclusions. Overall, the Mediterranean diet may support clinical remission in IBD, but stronger evidence from well-designed studies is needed to confirm its therapeutic role.