← Issue №5/ week of Aug 2, 2026/IBD

Trends in Substance Use Disorder Among Hospitalized Patients With Inflammatory Bowel Disease: An 11-Year Nationwide Study.

From GI Signals issue №5: what this paper found, what it changes, and where it sits against the current standard of care, reviewed by Simon Mathews, MD.

IBD retrospective · n=2,532,450 · Aug 1, 2026 · J Clin Gastro · IF 2.9

Trends in Substance Use Disorder Among Hospitalized Patients With Inflammatory Bowel Disease: An 11-Year Nationwide Study.

New evidenceepidemiologyCrohn's diseaseulcerative colitis
Clinical takeawayScreen hospitalized IBD patients, particularly those with Crohn's disease, male sex, Medicaid insurance, or lower income, for substance use disorder (SUD), with a focus on alcohol, opioid, and cannabis use, and consider integrated care models for SUD management.
What it foundSUD prevalence in hospitalized IBD patients increased from 23.8% to 27.9% in Crohn's disease and 14.2% to 19.4% in ulcerative colitis from 2010 to 2020, with higher rates in Crohn's disease. Patients with SUD were more likely to be male, have Medicaid insurance, and be in a lower income quartile.
ContextConfirms and quantifies the rising trend of SUD in IBD patients, highlighting a need for targeted interventions in this population, especially in higher-risk subgroups.
Refinessuggested 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 stakethe recommendation holds, but with a new subgroup of patients with SUD requiring additional monitoring

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) ↗
Zheng M … Limketkai BN · Journal of Clinical Gastroenterology · IF 2.9 · PubMed ↗Permalink
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