← Issue №6/ week of Aug 9, 2026/ the whole section, in full

IBD, in full.

All 9 IBD papers in this issue, as full cards, ranked by clinical utility. The issue page carries the strongest few; this is the section, whole.

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IBD9Hepatology14Pancreas/Biliary5Endoscopy16Motility3Colorectal5
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All 9, in full

most clinically useful first
Everything here, in one line each9
IBD retrospective · n=183 · Aug 12, 2026 · Aliment Pharm Ther · IF 6.7

Impact of Prior Biologic Mechanism of Action on Anti-TNF Effectiveness in Inflammatory Bowel Disease: An ENEIDA Registry Study.

New evidenceCrohn's diseaseulcerative colitisbiologicsanti-TNF
Clinical takeawayIn UC patients with active luminal disease requiring biologic escalation, anti-TNF therapy after vedolizumab shows lower remission rates and durability than anti-TNF as first-line or anti-TNF-to-anti-TNF switching. Consider moving anti-TNF earlier in the biologic sequence for UC, or anti-TNF-to-anti-TNF sequencing rather than vedolizumab-then-anti-TNF. In CD patients with active luminal disease, clinical effectiveness remains similar despite higher discontinuation rates, making the sequencing implications less clear.
What it foundIn UC, anti-TNF therapy after vedolizumab (90% of cases) had significantly lower remission rates at short- and long-term follow-up (p < 0.001) and higher treatment discontinuation (HR 1.69 vs first-line, HR 1.91 vs anti-TNF-to-anti-TNF); in CD, anti-TNF after ustekinumab (62% of cases) showed higher discontinuation (HR 1.55 vs first-line) without significant differences in clinical effectiveness.
ContextCurrent IBD guidelines recommend individualizing biologic sequencing based on prior response, but evidence comparing efficacy after different prior mechanisms of action is limited. This registry study provides observational evidence that in UC, the prior biologic choice affects subsequent anti-TNF effectiveness, with vedolizumab being particularly associated with reduced anti-TNF durability and remission. The CD findings are less decisive.
Refinessuggested applicable standard· American College of Gastroenterology, 'ACG Clinical Guideline: Management of Crohn’s Disease in Adults' (Lichtenstein GR, Loftus EV, Afzali A, et al., Am J Gastroenterol 2025;120(6):1225-1264). DOI 10.14309/ajg.0000000000003465, PMID 40701562.

Decision at stakewhether to use anti-TNF therapy after prior failure of a non-anti-TNF biologic (vedolizumab, ustekinumab, etc.)

… Ustekinumab (strong, moderate); risankizumab (strong, moderate), and risankizumab over ustekinumab in prior anti-TNF exposure (conditional, low); mirikizumab (strong, moderate); guselkumab IV-then-SC or all-SC (strong, moderate). …

From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text. The rest of this standard includes DIAGNOSIS, PERIANAL FISTULIZING, POST-OPERATIVE and 3 more.

Our full summary of this standard

DIAGNOSIS: Use fecal calprotectin (cutoff >50-100 μg/g) to differentiate inflammatory from noninflammatory disease OF THE COLON (strong, moderate). Ileocolonoscopy with biopsies for suspected CD; biopsy uninvolved mucosa to define histologic extent; small bowel imaging is part of the initial workup (key concepts, ungraded). CT enterography is comparable to MR enterography for small bowel detection; MRE should be used PREFERENTIALLY in patients younger than 35 years and where serial examinations are likely, because of radiation avoidance, MRE is not a blanket first choice. Intestinal ultrasound is a radiation-free ADJUNCT to diagnosis and to monitoring treatment response (key concept, ungraded, not a graded recommendation). Perform routine endoscopic CRC surveillance in Crohn's colitis (strong, moderate). MILD-TO-MODERATE / LOWER PROGRESSION RISK: Recommend AGAINST oral mesalamine for induction or maintenance (strong, moderate); sulfasalazine should be considered ONLY for symptomatic mild COLONIC CD (key concept). Controlled ileal-release budesonide 9 mg daily for induction of symptomatic remission in mildly-to-moderately active ileocecal CD (strong, moderate), but recommend AGAINST ileal-release budesonide for MAINTENANCE (strong, low). MODERATE-TO-SEVERE / HIGHER RISK: SUGGEST AGAINST requiring failure of conventional therapy before initiating advanced therapy (conditional, LOW, a permission to skip step-up, not a mandate to start advanced therapy upfront). Oral corticosteroids for short-term induction only (strong, low). Recommend AGAINST azathioprine 1.5-2.5 mg/kg/d and 6-mercaptopurine 0.75-1.5 mg/kg/d for INDUCTION (strong, moderate), but SUGGEST the same agents and doses for MAINTENANCE after corticosteroid-induced remission (conditional, low). Check TPMT before starting azathioprine/6-MP (strong, low); measure NUDT15 variants in patients of East Asian ancestry and TPMT variants in all patients prior to thiopurine initiation (strong, moderate). Methotrexate up to 25 mg weekly IM/SC for maintenance after corticosteroid induction (conditional, low). Anti-TNF agents (IV infliximab, SC adalimumab, SC certolizumab pegol) for induction and maintenance (strong, moderate). Recommend COMBINATION IV infliximab + thiopurine over either agent alone in patients naive to both (strong, moderate). Vedolizumab IV for induction and maintenance of symptomatic remission (strong, moderate). Ustekinumab (strong, moderate); risankizumab (strong, moderate), and risankizumab over ustekinumab in prior anti-TNF exposure (conditional, low); mirikizumab (strong, moderate); guselkumab IV-then-SC or all-SC (strong, moderate). Upadacitinib for induction and maintenance in patients PREVIOUSLY EXPOSED TO ANTI-TNF (strong, moderate), the ACG does not endorse it as a first-line biologic-naive option. SC infliximab and SC vedolizumab are maintenance options in responders to IV induction (strong, moderate). PERIANAL FISTULIZING: infliximab for induction (strong, moderate); adalimumab (conditional, low); antibiotics added to infliximab or adalimumab (conditional, very low); vedolizumab, ustekinumab, upadacitinib each (conditional, VERY LOW). Drain perianal abscesses and place setons before escalating advanced therapy (key concept). POST-OPERATIVE: endoscopic assessment at 6-12 months after surgically induced remission over no monitoring (conditional, moderate); in LOW post-op recurrence risk, continued observation rather than immediate medical therapy (conditional, very low); imidazole antibiotics (metronidazole) 1-2 g/d after small intestinal resection (conditional, low); in HIGH-risk CD, anti-TNF to prevent endoscopic recurrence (STRONG, moderate) and vedolizumab (CONDITIONAL, low), these two are not co-equal. SURGERY/ABSCESS: intra-abdominal abscess >2 cm should be treated with antibiotics plus a drainage procedure, and immunosuppression HELD until drainage is achieved (conditional, low). DISEASE MODIFIERS: counsel active smokers to quit; use NSAIDs with caution; assess stress, depression and anxiety as part of comprehensive care (key concepts).

American College of Gastroenterology, 'ACG Clinical Guideline: Management of Crohn’s Disease in Adults' (Lichtenstein GR, Loftus EV, Afzali A, et al., Am J Gastroenterol 2025;120(6):1225-1264). DOI 10.14309/ajg.0000000000003465, PMID 40701562. · reviewed 2026-07-21 ↗
Yagüe Caballero C … Casas Deza D · Alimentary Pharmacology & Therapeutics · IF 6.7 · PubMed ↗Permalink
IBD review · Aug 9, 2026 · Dig Dis Sci · IF 2.5

Effects of Age on Inflammatory Bowel Disease Presentation and Management in Older Adults.

Practice-changingvedolizumabustekinumabbiologicshealth services
Clinical takeawayRisk-stratify older IBD patients using assessment of frailty, comorbidity burden, and drug interactions rather than age alone. Consider vedolizumab and ustekinumab in older patients with acceptable risk profiles; avoid deferring advanced therapy based on age. Reduce corticosteroid burden.
What it foundOlder IBD patients are undertreated with advanced therapies (vedolizumab, ustekinumab) and overtreated with corticosteroids; frailty, comorbidity, and polypharmacy predict treatment tolerability better than age alone.
ContextChallenges current practice patterns where age is often used as a default barrier to advanced therapies in IBD. Argues for individualized, risk-based assessment rather than categorical age-based restrictions.
Refinessuggested applicable standard· American College of Gastroenterology, 'ACG Clinical Guideline: Management of Crohn’s Disease in Adults' (Lichtenstein GR, Loftus EV, Afzali A, et al., Am J Gastroenterol 2025;120(6):1225-1264). DOI 10.14309/ajg.0000000000003465, PMID 40701562.

Decision at stakeUse of vedolizumab and ustekinumab in older adults with moderate-to-severe Crohn's disease

DIAGNOSIS: Use fecal calprotectin (cutoff >50-100 μg/g) to differentiate inflammatory from noninflammatory disease OF THE COLON (strong, moderate). Ileocolonoscopy with biopsies for suspected CD; biopsy uninvolved mucosa to define histologic extent; small bowel imaging is part of the initial workup (key concepts, ungraded). CT enterography is comparable to MR enterography for small bowel detection; MRE should be used PREFERENTIALLY in patients younger than 35 years and where serial examinations are likely, because of radiation avoidance, MRE is not a blanket first choice. Intestinal ultrasound is a radiation-free ADJUNCT to diagnosis and to monitoring treatment response (key concept, ungraded, not a graded recommendation). Perform routine endoscopic CRC surveillance in Crohn's colitis (strong, moderate). …

From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text. The rest of this standard includes PERIANAL FISTULIZING, POST-OPERATIVE, SURGERY/ABSCESS and 3 more.

Our full summary of this standard

DIAGNOSIS: Use fecal calprotectin (cutoff >50-100 μg/g) to differentiate inflammatory from noninflammatory disease OF THE COLON (strong, moderate). Ileocolonoscopy with biopsies for suspected CD; biopsy uninvolved mucosa to define histologic extent; small bowel imaging is part of the initial workup (key concepts, ungraded). CT enterography is comparable to MR enterography for small bowel detection; MRE should be used PREFERENTIALLY in patients younger than 35 years and where serial examinations are likely, because of radiation avoidance, MRE is not a blanket first choice. Intestinal ultrasound is a radiation-free ADJUNCT to diagnosis and to monitoring treatment response (key concept, ungraded, not a graded recommendation). Perform routine endoscopic CRC surveillance in Crohn's colitis (strong, moderate). MILD-TO-MODERATE / LOWER PROGRESSION RISK: Recommend AGAINST oral mesalamine for induction or maintenance (strong, moderate); sulfasalazine should be considered ONLY for symptomatic mild COLONIC CD (key concept). Controlled ileal-release budesonide 9 mg daily for induction of symptomatic remission in mildly-to-moderately active ileocecal CD (strong, moderate), but recommend AGAINST ileal-release budesonide for MAINTENANCE (strong, low). MODERATE-TO-SEVERE / HIGHER RISK: SUGGEST AGAINST requiring failure of conventional therapy before initiating advanced therapy (conditional, LOW, a permission to skip step-up, not a mandate to start advanced therapy upfront). Oral corticosteroids for short-term induction only (strong, low). Recommend AGAINST azathioprine 1.5-2.5 mg/kg/d and 6-mercaptopurine 0.75-1.5 mg/kg/d for INDUCTION (strong, moderate), but SUGGEST the same agents and doses for MAINTENANCE after corticosteroid-induced remission (conditional, low). Check TPMT before starting azathioprine/6-MP (strong, low); measure NUDT15 variants in patients of East Asian ancestry and TPMT variants in all patients prior to thiopurine initiation (strong, moderate). Methotrexate up to 25 mg weekly IM/SC for maintenance after corticosteroid induction (conditional, low). Anti-TNF agents (IV infliximab, SC adalimumab, SC certolizumab pegol) for induction and maintenance (strong, moderate). Recommend COMBINATION IV infliximab + thiopurine over either agent alone in patients naive to both (strong, moderate). Vedolizumab IV for induction and maintenance of symptomatic remission (strong, moderate). Ustekinumab (strong, moderate); risankizumab (strong, moderate), and risankizumab over ustekinumab in prior anti-TNF exposure (conditional, low); mirikizumab (strong, moderate); guselkumab IV-then-SC or all-SC (strong, moderate). Upadacitinib for induction and maintenance in patients PREVIOUSLY EXPOSED TO ANTI-TNF (strong, moderate), the ACG does not endorse it as a first-line biologic-naive option. SC infliximab and SC vedolizumab are maintenance options in responders to IV induction (strong, moderate). PERIANAL FISTULIZING: infliximab for induction (strong, moderate); adalimumab (conditional, low); antibiotics added to infliximab or adalimumab (conditional, very low); vedolizumab, ustekinumab, upadacitinib each (conditional, VERY LOW). Drain perianal abscesses and place setons before escalating advanced therapy (key concept). POST-OPERATIVE: endoscopic assessment at 6-12 months after surgically induced remission over no monitoring (conditional, moderate); in LOW post-op recurrence risk, continued observation rather than immediate medical therapy (conditional, very low); imidazole antibiotics (metronidazole) 1-2 g/d after small intestinal resection (conditional, low); in HIGH-risk CD, anti-TNF to prevent endoscopic recurrence (STRONG, moderate) and vedolizumab (CONDITIONAL, low), these two are not co-equal. SURGERY/ABSCESS: intra-abdominal abscess >2 cm should be treated with antibiotics plus a drainage procedure, and immunosuppression HELD until drainage is achieved (conditional, low). DISEASE MODIFIERS: counsel active smokers to quit; use NSAIDs with caution; assess stress, depression and anxiety as part of comprehensive care (key concepts).

American College of Gastroenterology, 'ACG Clinical Guideline: Management of Crohn’s Disease in Adults' (Lichtenstein GR, Loftus EV, Afzali A, et al., Am J Gastroenterol 2025;120(6):1225-1264). DOI 10.14309/ajg.0000000000003465, PMID 40701562. · reviewed 2026-07-21 ↗
Sisliyan C … Keyashian K · Digestive Diseases and Sciences · IF 2.5 · PubMed ↗Permalink
IBD retrospective · n=1,045 · Aug 11, 2026 · Gut · IF 24.6

Neutralising autoantibodies against IL-10 and HLA-DRB1*01:03 in paediatric patients with inflammatory bowel disease.

Diagnosticpediatricbiomarkerulcerative colitisCrohn's disease
Clinical takeawayIdentifies anti-IL-10 as a prognostic marker for difficult-to-treat pediatric IBD, but clinical testing is not recommended at this time. This research finding may eventually enable risk stratification and inform therapy selection in high-risk patients, pending prospective validation.
What it found2.5% of pediatric IBD patients have anti-IL-10 autoantibodies. Compared with matched controls, anti-IL-10-positive patients exhibited increased difficult-to-treat disease (23% vs 6%), acute severe UC (26% vs 6%), and colectomy (27% vs 6%). HLA-DRB1*01:03 was carried by 80% of anti-IL-10-positive patients vs 1.5% of anti-IL-10-negative patients.
ContextAdvances understanding of pediatric IBD heterogeneity by identifying an immune mechanistic subgroup (IL-10 neutralization pathway) associated with HLA-DRB1*01:03. Opens a question about whether anti-IL-10 status could guide intensified or targeted therapy selection, distinguishing this autoimmune subset from other IBD etiologies.
Emergingsuggested applicable standard· American College of Gastroenterology, 'ACG Clinical Guideline: Management of Crohn’s Disease in Adults' (Lichtenstein GR, Loftus EV, Afzali A, et al., Am J Gastroenterol 2025;120(6):1225-1264). DOI 10.14309/ajg.0000000000003465, PMID 40701562.

Decision at stakeIdentify patients at risk of difficult-to-treat or severe disease to inform timing of advanced therapy escalation

DIAGNOSIS: Use fecal calprotectin (cutoff >50-100 μg/g) to differentiate inflammatory from noninflammatory disease OF THE COLON (strong, moderate). Ileocolonoscopy with biopsies for suspected CD; biopsy uninvolved mucosa to define histologic extent; small bowel imaging is part of the initial workup (key concepts, ungraded). CT enterography is comparable to MR enterography for small bowel detection; MRE should be used PREFERENTIALLY in patients younger than 35 years and where serial examinations are likely, because of radiation avoidance, MRE is not a blanket first choice. Intestinal ultrasound is a radiation-free ADJUNCT to diagnosis and to monitoring treatment response (key concept, ungraded, not a graded recommendation). Perform routine endoscopic CRC surveillance in Crohn's colitis (strong, moderate). …

From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text. The rest of this standard includes PERIANAL FISTULIZING, POST-OPERATIVE, SURGERY/ABSCESS and 3 more.

Our full summary of this standard

DIAGNOSIS: Use fecal calprotectin (cutoff >50-100 μg/g) to differentiate inflammatory from noninflammatory disease OF THE COLON (strong, moderate). Ileocolonoscopy with biopsies for suspected CD; biopsy uninvolved mucosa to define histologic extent; small bowel imaging is part of the initial workup (key concepts, ungraded). CT enterography is comparable to MR enterography for small bowel detection; MRE should be used PREFERENTIALLY in patients younger than 35 years and where serial examinations are likely, because of radiation avoidance, MRE is not a blanket first choice. Intestinal ultrasound is a radiation-free ADJUNCT to diagnosis and to monitoring treatment response (key concept, ungraded, not a graded recommendation). Perform routine endoscopic CRC surveillance in Crohn's colitis (strong, moderate). MILD-TO-MODERATE / LOWER PROGRESSION RISK: Recommend AGAINST oral mesalamine for induction or maintenance (strong, moderate); sulfasalazine should be considered ONLY for symptomatic mild COLONIC CD (key concept). Controlled ileal-release budesonide 9 mg daily for induction of symptomatic remission in mildly-to-moderately active ileocecal CD (strong, moderate), but recommend AGAINST ileal-release budesonide for MAINTENANCE (strong, low). MODERATE-TO-SEVERE / HIGHER RISK: SUGGEST AGAINST requiring failure of conventional therapy before initiating advanced therapy (conditional, LOW, a permission to skip step-up, not a mandate to start advanced therapy upfront). Oral corticosteroids for short-term induction only (strong, low). Recommend AGAINST azathioprine 1.5-2.5 mg/kg/d and 6-mercaptopurine 0.75-1.5 mg/kg/d for INDUCTION (strong, moderate), but SUGGEST the same agents and doses for MAINTENANCE after corticosteroid-induced remission (conditional, low). Check TPMT before starting azathioprine/6-MP (strong, low); measure NUDT15 variants in patients of East Asian ancestry and TPMT variants in all patients prior to thiopurine initiation (strong, moderate). Methotrexate up to 25 mg weekly IM/SC for maintenance after corticosteroid induction (conditional, low). Anti-TNF agents (IV infliximab, SC adalimumab, SC certolizumab pegol) for induction and maintenance (strong, moderate). Recommend COMBINATION IV infliximab + thiopurine over either agent alone in patients naive to both (strong, moderate). Vedolizumab IV for induction and maintenance of symptomatic remission (strong, moderate). Ustekinumab (strong, moderate); risankizumab (strong, moderate), and risankizumab over ustekinumab in prior anti-TNF exposure (conditional, low); mirikizumab (strong, moderate); guselkumab IV-then-SC or all-SC (strong, moderate). Upadacitinib for induction and maintenance in patients PREVIOUSLY EXPOSED TO ANTI-TNF (strong, moderate), the ACG does not endorse it as a first-line biologic-naive option. SC infliximab and SC vedolizumab are maintenance options in responders to IV induction (strong, moderate). PERIANAL FISTULIZING: infliximab for induction (strong, moderate); adalimumab (conditional, low); antibiotics added to infliximab or adalimumab (conditional, very low); vedolizumab, ustekinumab, upadacitinib each (conditional, VERY LOW). Drain perianal abscesses and place setons before escalating advanced therapy (key concept). POST-OPERATIVE: endoscopic assessment at 6-12 months after surgically induced remission over no monitoring (conditional, moderate); in LOW post-op recurrence risk, continued observation rather than immediate medical therapy (conditional, very low); imidazole antibiotics (metronidazole) 1-2 g/d after small intestinal resection (conditional, low); in HIGH-risk CD, anti-TNF to prevent endoscopic recurrence (STRONG, moderate) and vedolizumab (CONDITIONAL, low), these two are not co-equal. SURGERY/ABSCESS: intra-abdominal abscess >2 cm should be treated with antibiotics plus a drainage procedure, and immunosuppression HELD until drainage is achieved (conditional, low). DISEASE MODIFIERS: counsel active smokers to quit; use NSAIDs with caution; assess stress, depression and anxiety as part of comprehensive care (key concepts).

American College of Gastroenterology, 'ACG Clinical Guideline: Management of Crohn’s Disease in Adults' (Lichtenstein GR, Loftus EV, Afzali A, et al., Am J Gastroenterol 2025;120(6):1225-1264). DOI 10.14309/ajg.0000000000003465, PMID 40701562. · reviewed 2026-07-21 ↗
Gharahdaghi N … Uhlig HH · Gut · IF 24.6 · PubMed ↗Permalink
IBD review · Aug 13, 2026 · Inflamm Bowel Dis · IF 4.5

The role of glucagon-like peptide 1 receptor agonists in the management of patients with inflammatory bowel diseases.

Guideline / reviewCrohn's diseaseulcerative colitismicrobiome
Clinical takeawayGLP-1 RAs are not yet established for IBD disease modification. Consider offering them to obese IBD patients (particularly those with metabolic comorbidities including MASLD or cardiovascular disease) primarily for obesity and comorbidity management, with close monitoring for gastrointestinal tolerability, coordination with endoscopy plans, and assessment of lean muscle mass preservation. Pending results of ongoing randomized trials evaluating disease-modifying effects.
What it foundPreclinical studies show that GLP-1 receptor agonists reduce visceral adiposity and attenuate proinflammatory signaling; emerging human data suggest they are safe in patients with IBD and associated with lower hospitalization and surgical rates in those with obesity, although effects on disease activity remain unclear.
ContextObesity affects over half of IBD patients and is associated with increased disease activity, reduced treatment response, and higher surgical risk. GLP-1 RAs have transformed obesity management in the general population and confer cardiovascular benefits. This review synthesizes preclinical mechanisms and emerging clinical safety data to support further investigation of GLP-1 RAs in IBD management.
Emergingsuggested applicable standard· ACG Clinical Guideline Update: Ulcerative Colitis in Adults, Am J Gastroenterol 2025;120(6):1187-1224; AGA Living Guideline on Pharmacological Management of Moderate-to-Severe UC, Gastroenterology 2024 (panel review March 2026, no changes)

Decision at stakewhether to offer glucagon-like peptide-1 receptor agonists to overweight or obese patients with UC, particularly those with cardiometabolic comorbidities

No single passage of this standard matched the paper closely enough to quote, so none is shown. The standard is cited above.

Our full summary of this standard

Confirm ulcerative colitis with endoscopy showing continuous colonic inflammation from the rectum plus histology, after excluding infection with two-step CDI testing. Treat mild-moderate disease with 5-ASA by route and extent (suppository for proctitis, enema for left-sided, oral plus rectal for extensive); if 5-ASA fails, treat as moderate-to-severe rather than stepping up gradually. Position advanced therapy by EFFICACY TIER, not by an anti-TNF-first rule. Advanced-therapy-naive, higher efficacy: infliximab, vedolizumab, ozanimod, etrasimod, upadacitinib, risankizumab, guselkumab; intermediate: golimumab, ustekinumab, tofacitinib, filgotinib, mirikizumab; lower: adalimumab. PREVIOUSLY TNF-EXPOSED, higher efficacy: tofacitinib, upadacitinib, ustekinumab; lower: adalimumab, vedolizumab, ozanimod, etrasimod - S1P modulators are weakest in exactly this group. Do not cycle within the anti-TNF class after primary non-response; switch mechanism. Apply treat-to-target (STRIDE-II) to endoscopic improvement (MES 0-1). Screen for acute severe UC by Truelove-Witts and admit for IV steroids. Begin CRC surveillance 8-10 years after DIAGNOSIS for extensive or left-sided disease; isolated proctitis follows average-risk screening.

ACG Clinical Guideline Update: Ulcerative Colitis in Adults, Am J Gastroenterol 2025;120(6):1187-1224; AGA Living Guideline on Pharmacological Management of Moderate-to-Severe UC, Gastroenterology 2024 (panel review March 2026, no changes) ↗
Beniwal-Patel P … Yarur AJ · Inflammatory Bowel Diseases · IF 4.5 · PubMed ↗Permalink
IBD prospective cohort · n=138 · Aug 7, 2026 · Inflamm Bowel Dis · IF 4.5

Metabolomics predict treatment response to vedolizumab in pediatric IBD: results from the prospective VedoKids cohort study.

DiagnosticvedolizumabbiomarkerpediatricCrohn's disease
Clinical takeawayNo clinical action yet: metabolomic prediction model identified but requires external validation and prospective application in new patient cohorts before clinical implementation.
What it foundRandom Forest models incorporating serum metabolites predicted vedolizumab remission with AUROC 0.80-0.92 in pediatric CD and 0.72-0.90 in UC. Top predictors were PC ae C36:4, citric acid, and malic acid in CD; LysoPC a C26:1, picolinic acid, and serotonin in UC.
ContextBuilds on prior work linking host-microbe metabolites to IBD pathophysiology. Advances biomarker-based prediction of biologic therapy response, currently assessed through clinical response and standard laboratory parameters alone.
Emergingsuggested applicable standard· American College of Gastroenterology, 'ACG Clinical Guideline: Management of Crohn’s Disease in Adults' (Lichtenstein GR, Loftus EV, Afzali A, et al., Am J Gastroenterol 2025;120(6):1225-1264). DOI 10.14309/ajg.0000000000003465, PMID 40701562.

Decision at stakeUse vedolizumab for induction and maintenance of symptomatic remission in moderate-to-severe CD

… MILD-TO-MODERATE / LOWER PROGRESSION RISK: Recommend AGAINST oral mesalamine for induction or maintenance (strong, moderate); sulfasalazine should be considered ONLY for symptomatic mild COLONIC CD (key concept). Controlled ileal-release budesonide 9 mg daily for induction of symptomatic remission in mildly-to-moderately active ileocecal CD (strong, moderate), but recommend AGAINST ileal-release budesonide for MAINTENANCE (strong, low). …

From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text. The rest of this standard includes DIAGNOSIS, PERIANAL FISTULIZING, POST-OPERATIVE and 3 more.

Our full summary of this standard

DIAGNOSIS: Use fecal calprotectin (cutoff >50-100 μg/g) to differentiate inflammatory from noninflammatory disease OF THE COLON (strong, moderate). Ileocolonoscopy with biopsies for suspected CD; biopsy uninvolved mucosa to define histologic extent; small bowel imaging is part of the initial workup (key concepts, ungraded). CT enterography is comparable to MR enterography for small bowel detection; MRE should be used PREFERENTIALLY in patients younger than 35 years and where serial examinations are likely, because of radiation avoidance, MRE is not a blanket first choice. Intestinal ultrasound is a radiation-free ADJUNCT to diagnosis and to monitoring treatment response (key concept, ungraded, not a graded recommendation). Perform routine endoscopic CRC surveillance in Crohn's colitis (strong, moderate). MILD-TO-MODERATE / LOWER PROGRESSION RISK: Recommend AGAINST oral mesalamine for induction or maintenance (strong, moderate); sulfasalazine should be considered ONLY for symptomatic mild COLONIC CD (key concept). Controlled ileal-release budesonide 9 mg daily for induction of symptomatic remission in mildly-to-moderately active ileocecal CD (strong, moderate), but recommend AGAINST ileal-release budesonide for MAINTENANCE (strong, low). MODERATE-TO-SEVERE / HIGHER RISK: SUGGEST AGAINST requiring failure of conventional therapy before initiating advanced therapy (conditional, LOW, a permission to skip step-up, not a mandate to start advanced therapy upfront). Oral corticosteroids for short-term induction only (strong, low). Recommend AGAINST azathioprine 1.5-2.5 mg/kg/d and 6-mercaptopurine 0.75-1.5 mg/kg/d for INDUCTION (strong, moderate), but SUGGEST the same agents and doses for MAINTENANCE after corticosteroid-induced remission (conditional, low). Check TPMT before starting azathioprine/6-MP (strong, low); measure NUDT15 variants in patients of East Asian ancestry and TPMT variants in all patients prior to thiopurine initiation (strong, moderate). Methotrexate up to 25 mg weekly IM/SC for maintenance after corticosteroid induction (conditional, low). Anti-TNF agents (IV infliximab, SC adalimumab, SC certolizumab pegol) for induction and maintenance (strong, moderate). Recommend COMBINATION IV infliximab + thiopurine over either agent alone in patients naive to both (strong, moderate). Vedolizumab IV for induction and maintenance of symptomatic remission (strong, moderate). Ustekinumab (strong, moderate); risankizumab (strong, moderate), and risankizumab over ustekinumab in prior anti-TNF exposure (conditional, low); mirikizumab (strong, moderate); guselkumab IV-then-SC or all-SC (strong, moderate). Upadacitinib for induction and maintenance in patients PREVIOUSLY EXPOSED TO ANTI-TNF (strong, moderate), the ACG does not endorse it as a first-line biologic-naive option. SC infliximab and SC vedolizumab are maintenance options in responders to IV induction (strong, moderate). PERIANAL FISTULIZING: infliximab for induction (strong, moderate); adalimumab (conditional, low); antibiotics added to infliximab or adalimumab (conditional, very low); vedolizumab, ustekinumab, upadacitinib each (conditional, VERY LOW). Drain perianal abscesses and place setons before escalating advanced therapy (key concept). POST-OPERATIVE: endoscopic assessment at 6-12 months after surgically induced remission over no monitoring (conditional, moderate); in LOW post-op recurrence risk, continued observation rather than immediate medical therapy (conditional, very low); imidazole antibiotics (metronidazole) 1-2 g/d after small intestinal resection (conditional, low); in HIGH-risk CD, anti-TNF to prevent endoscopic recurrence (STRONG, moderate) and vedolizumab (CONDITIONAL, low), these two are not co-equal. SURGERY/ABSCESS: intra-abdominal abscess >2 cm should be treated with antibiotics plus a drainage procedure, and immunosuppression HELD until drainage is achieved (conditional, low). DISEASE MODIFIERS: counsel active smokers to quit; use NSAIDs with caution; assess stress, depression and anxiety as part of comprehensive care (key concepts).

American College of Gastroenterology, 'ACG Clinical Guideline: Management of Crohn’s Disease in Adults' (Lichtenstein GR, Loftus EV, Afzali A, et al., Am J Gastroenterol 2025;120(6):1225-1264). DOI 10.14309/ajg.0000000000003465, PMID 40701562. · reviewed 2026-07-21 ↗
Suarez RG … Wine E · Inflammatory Bowel Diseases · IF 4.5 · PubMed ↗Permalink
IBD retrospective · n=92 · Aug 7, 2026 · Inflamm Bowel Dis · IF 4.5

Multi-modal ensemble learning prediction of anti-TNF treatment response in pediatric patients with Crohn's disease using clinical, radiomic, and deep learning MR enterography features.

New evidenceCrohn's diseaseanti-TNFartificial intelligencepediatric
Clinical takeawayRetrospective model without prospective validation or clinical implementation pathway. While retrospectively accurate (AUROC 0.817), clinical use requires prospective validation, definition of actionable thresholds, and workflow integration. No bedside action supported currently.
What it foundA multi-modal ensemble model combining MRE radiologist assessment, radiomic features, deep learning features, and clinical variables predicted anti-TNF treatment response (mucosal healing at 36 months) with AUROC 0.817 (95% CI 0.793-0.842) in 92 pediatric CD patients (37 responders, 55 non-responders), outperforming individual feature types (radiologist 0.706, radiomic 0.710, deep learning 0.724).
ContextAnti-TNF therapy is a major advancement for CD, but many patients fail to respond. Currently, no validated pre-treatment predictor of anti-TNF response exists in routine practice. This study attempts to use multi-modal imaging and machine learning to stratify risk in pediatric CD, extending established principles (imaging predicts outcomes) to a novel technical approach.
Emergingsuggested applicable standard· American College of Gastroenterology, 'ACG Clinical Guideline: Management of Crohn’s Disease in Adults' (Lichtenstein GR, Loftus EV, Afzali A, et al., Am J Gastroenterol 2025;120(6):1225-1264). DOI 10.14309/ajg.0000000000003465, PMID 40701562.

Decision at stakeWhether to initiate anti-TNF therapy in pediatric patients with Crohn's disease

DIAGNOSIS: Use fecal calprotectin (cutoff >50-100 μg/g) to differentiate inflammatory from noninflammatory disease OF THE COLON (strong, moderate). Ileocolonoscopy with biopsies for suspected CD; biopsy uninvolved mucosa to define histologic extent; small bowel imaging is part of the initial workup (key concepts, ungraded). CT enterography is comparable to MR enterography for small bowel detection; MRE should be used PREFERENTIALLY in patients younger than 35 years and where serial examinations are likely, because of radiation avoidance, MRE is not a blanket first choice. Intestinal ultrasound is a radiation-free ADJUNCT to diagnosis and to monitoring treatment response (key concept, ungraded, not a graded recommendation). Perform routine endoscopic CRC surveillance in Crohn's colitis (strong, moderate). …

From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text. The rest of this standard includes PERIANAL FISTULIZING, POST-OPERATIVE, SURGERY/ABSCESS and 3 more.

Our full summary of this standard

DIAGNOSIS: Use fecal calprotectin (cutoff >50-100 μg/g) to differentiate inflammatory from noninflammatory disease OF THE COLON (strong, moderate). Ileocolonoscopy with biopsies for suspected CD; biopsy uninvolved mucosa to define histologic extent; small bowel imaging is part of the initial workup (key concepts, ungraded). CT enterography is comparable to MR enterography for small bowel detection; MRE should be used PREFERENTIALLY in patients younger than 35 years and where serial examinations are likely, because of radiation avoidance, MRE is not a blanket first choice. Intestinal ultrasound is a radiation-free ADJUNCT to diagnosis and to monitoring treatment response (key concept, ungraded, not a graded recommendation). Perform routine endoscopic CRC surveillance in Crohn's colitis (strong, moderate). MILD-TO-MODERATE / LOWER PROGRESSION RISK: Recommend AGAINST oral mesalamine for induction or maintenance (strong, moderate); sulfasalazine should be considered ONLY for symptomatic mild COLONIC CD (key concept). Controlled ileal-release budesonide 9 mg daily for induction of symptomatic remission in mildly-to-moderately active ileocecal CD (strong, moderate), but recommend AGAINST ileal-release budesonide for MAINTENANCE (strong, low). MODERATE-TO-SEVERE / HIGHER RISK: SUGGEST AGAINST requiring failure of conventional therapy before initiating advanced therapy (conditional, LOW, a permission to skip step-up, not a mandate to start advanced therapy upfront). Oral corticosteroids for short-term induction only (strong, low). Recommend AGAINST azathioprine 1.5-2.5 mg/kg/d and 6-mercaptopurine 0.75-1.5 mg/kg/d for INDUCTION (strong, moderate), but SUGGEST the same agents and doses for MAINTENANCE after corticosteroid-induced remission (conditional, low). Check TPMT before starting azathioprine/6-MP (strong, low); measure NUDT15 variants in patients of East Asian ancestry and TPMT variants in all patients prior to thiopurine initiation (strong, moderate). Methotrexate up to 25 mg weekly IM/SC for maintenance after corticosteroid induction (conditional, low). Anti-TNF agents (IV infliximab, SC adalimumab, SC certolizumab pegol) for induction and maintenance (strong, moderate). Recommend COMBINATION IV infliximab + thiopurine over either agent alone in patients naive to both (strong, moderate). Vedolizumab IV for induction and maintenance of symptomatic remission (strong, moderate). Ustekinumab (strong, moderate); risankizumab (strong, moderate), and risankizumab over ustekinumab in prior anti-TNF exposure (conditional, low); mirikizumab (strong, moderate); guselkumab IV-then-SC or all-SC (strong, moderate). Upadacitinib for induction and maintenance in patients PREVIOUSLY EXPOSED TO ANTI-TNF (strong, moderate), the ACG does not endorse it as a first-line biologic-naive option. SC infliximab and SC vedolizumab are maintenance options in responders to IV induction (strong, moderate). PERIANAL FISTULIZING: infliximab for induction (strong, moderate); adalimumab (conditional, low); antibiotics added to infliximab or adalimumab (conditional, very low); vedolizumab, ustekinumab, upadacitinib each (conditional, VERY LOW). Drain perianal abscesses and place setons before escalating advanced therapy (key concept). POST-OPERATIVE: endoscopic assessment at 6-12 months after surgically induced remission over no monitoring (conditional, moderate); in LOW post-op recurrence risk, continued observation rather than immediate medical therapy (conditional, very low); imidazole antibiotics (metronidazole) 1-2 g/d after small intestinal resection (conditional, low); in HIGH-risk CD, anti-TNF to prevent endoscopic recurrence (STRONG, moderate) and vedolizumab (CONDITIONAL, low), these two are not co-equal. SURGERY/ABSCESS: intra-abdominal abscess >2 cm should be treated with antibiotics plus a drainage procedure, and immunosuppression HELD until drainage is achieved (conditional, low). DISEASE MODIFIERS: counsel active smokers to quit; use NSAIDs with caution; assess stress, depression and anxiety as part of comprehensive care (key concepts).

American College of Gastroenterology, 'ACG Clinical Guideline: Management of Crohn’s Disease in Adults' (Lichtenstein GR, Loftus EV, Afzali A, et al., Am J Gastroenterol 2025;120(6):1225-1264). DOI 10.14309/ajg.0000000000003465, PMID 40701562. · reviewed 2026-07-21 ↗
Li H … Dillman JR · Inflammatory Bowel Diseases · IF 4.5 · PubMed ↗Permalink
IBD retrospective · n=469 · Aug 12, 2026 · Inflamm Bowel Dis · IF 4.5

Prior adalimumab exposure alters infliximab pharmacokinetics and trough targets in pediatric Crohn's disease.

New evidenceCrohn's diseaseanti-TNFtherapeutic drug monitoringpediatric
Clinical takeawayIn children with CD and prior adalimumab exposure starting infliximab, lower trough levels should be anticipated and more frequent dose escalation is likely needed. Monitor trough levels closely, expect to intensify dosing sooner than in biologic-naive patients, and recognize that remission remains achievable despite lower observed levels.
What it foundIn 469 children with CD, those with prior adalimumab exposure had lower mean infliximab trough levels (4.73 vs 6.19 µg/mL, P=.003), more frequently required dose intensification (41.2% vs 35.2%, P=.001), yet achieved comparable 1-year endoscopic remission rates (58.8% vs 61.3%, not significant).
ContextStandard practice applies uniform infliximab trough targets. This finding suggests prior biologic exposure alters pharmacokinetics and the exposure-response relationship, refining dosing strategy based on treatment history rather than using fixed targets across all patients.
No standard claimed for this paper

Every paper is compared to the standard governing its question. This one is not: either no standard in the corpus matches it, or the comparison did not hold up on review and was withdrawn rather than published unverified. Both are logged.

Kwon Y … Kim MJ · Inflammatory Bowel Diseases · IF 4.5 · PubMed ↗Permalink
IBD review · Aug 7, 2026 · Inflamm Bowel Dis · IF 4.5

Clinical appraisal of handheld intestinal ultrasound in inflammatory bowel disease: Where are we now?

New evidenceulcerative colitisCrohn's diseaseartificial intelligence
Clinical takeawayIf your practice uses handheld intestinal ultrasound, implement it with structured training (supervised practice, image quality review, feedback) for bedside IBD triage and bowel wall thickness assessment, with predefined escalation to conventional ultrasound, MR enterography, or endoscopy for complex disease, deep pelvic lesions, or suspected complications. Do not rely on handheld color Doppler in Crohn's disease.
What it foundHandheld intestinal ultrasound demonstrates diagnostic performance comparable to conventional ultrasound for IBD bowel wall assessment, with color Doppler feasible in ulcerative colitis but insufficiently validated in Crohn's disease; limitations persist for deep pelvic lesions and complications.
ContextHandheld ultrasound emerges as a portable adjunct to conventional ultrasound in IBD. Current practice relies on conventional ultrasound and cross-sectional imaging for comprehensive IBD assessment; HHIUS may reduce workflow barriers to bedside-point triage in resource-limited settings but does not yet replace standard imaging for complex disease. The paper clarifies what this technology can and cannot do safely, based on early published studies.
Emergingsuggested applicable standard· ACG Clinical Guideline Update: Ulcerative Colitis in Adults, Am J Gastroenterol 2025;120(6):1187-1224; AGA Living Guideline on Pharmacological Management of Moderate-to-Severe UC, Gastroenterology 2024 (panel review March 2026, no changes)

Decision at stakeMonitor disease activity in treated ulcerative colitis using endoscopy to achieve mucosal healing target (MES 0-1)

Confirm ulcerative colitis with endoscopy showing continuous colonic inflammation from the rectum plus histology, after excluding infection with two-step CDI testing. … Apply treat-to-target (STRIDE-II) to endoscopic improvement (MES 0-1). …

From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.

Our full summary of this standard

Confirm ulcerative colitis with endoscopy showing continuous colonic inflammation from the rectum plus histology, after excluding infection with two-step CDI testing. Treat mild-moderate disease with 5-ASA by route and extent (suppository for proctitis, enema for left-sided, oral plus rectal for extensive); if 5-ASA fails, treat as moderate-to-severe rather than stepping up gradually. Position advanced therapy by EFFICACY TIER, not by an anti-TNF-first rule. Advanced-therapy-naive, higher efficacy: infliximab, vedolizumab, ozanimod, etrasimod, upadacitinib, risankizumab, guselkumab; intermediate: golimumab, ustekinumab, tofacitinib, filgotinib, mirikizumab; lower: adalimumab. PREVIOUSLY TNF-EXPOSED, higher efficacy: tofacitinib, upadacitinib, ustekinumab; lower: adalimumab, vedolizumab, ozanimod, etrasimod - S1P modulators are weakest in exactly this group. Do not cycle within the anti-TNF class after primary non-response; switch mechanism. Apply treat-to-target (STRIDE-II) to endoscopic improvement (MES 0-1). Screen for acute severe UC by Truelove-Witts and admit for IV steroids. Begin CRC surveillance 8-10 years after DIAGNOSIS for extensive or left-sided disease; isolated proctitis follows average-risk screening.

ACG Clinical Guideline Update: Ulcerative Colitis in Adults, Am J Gastroenterol 2025;120(6):1187-1224; AGA Living Guideline on Pharmacological Management of Moderate-to-Severe UC, Gastroenterology 2024 (panel review March 2026, no changes) ↗
Miyatani Y … On Behalf Of The Intestinal Ultrasound Group Of The United States And Canada iUSCAN Research Committee · Inflammatory Bowel Diseases · IF 4.5 · PubMed ↗Permalink
IBD review · Aug 12, 2026 · Lancet GH · IF 39.1

The trajectory of inflammatory bowel disease in east and southeast Asia: transitioning from acceleration in incidence to compounding prevalence.

Epidemiologyepidemiology
Clinical takeawayNo change to individual patient management. For clinicians in East and Southeast Asia, this reinforces that IBD burden will continue rising with progression through stage 3 (compounding prevalence), informing healthcare system planning and resource allocation. For clinicians elsewhere, this contextualizes the global rise in IBD associated with economic development.
What it foundIBD incidence in East and Southeast Asia (Japan, South Korea, China, Hong Kong, Malaysia) is accelerating through stage 2 of a four-stage epidemiological progression: stage 1 (emergence), stage 2 (acceleration in incidence), stage 3 (compounding prevalence), and stage 4 (prevalence equilibrium). Each region currently sits in the early, middle, or late phase of stage 2, following the same trajectory that early-industrialised Western regions (Europe, North America, Oceania) have followed; most Western regions have now reached stage 3.
ContextConfirms the established four-stage model of IBD's epidemiological progression following industrialisation. Extends this known Western trajectory to Asia, showing the region follows the same pattern rather than diverging. Opens questions about interventions during the acceleration phase (stage 2) that might alter the disease's trajectory in other emerging economies.
No standard claimed for this paper

Every paper is compared to the standard governing its question. This one is not: either no standard in the corpus matches it, or the comparison did not hold up on review and was withdrawn rather than published unverified. Both are logged.

Okabayashi S … Kaplan GG · Lancet Gastroenterology & Hepatology · IF 39.1 · PubMed ↗Permalink
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