Patients with inflammatory bowel disease (IBD) are at higher risk of pneumonia due to the disease itself and the use of immune-modifying medications. We conducted a retrospective analysis of TriNetX US Collaborative Network data on patients with IBD who received the 20-valent pneumococcal conjugate vaccine (PCV20). Propensity score matching was performed to adjust for differences in demographics and pneumonia-related risk factors. After propensity score matching, 12,796 patients were included in the analysis. The mean ages of the vaccinated and control groups were 55.2 ± 16.3 and 55.8 ± 17.1years, respectively, with females comprising 53% of each group. The most commonly prescribed IBD therapies across both cohorts included prednisone, methylprednisolone, budesonide, and adalimumab. Compared to the control group, patients who received PCV20 experienced significantly lower risks of pneumonia, acute respiratory failure, hospital admissions, ICU admissions, and all-cause mortality. These findings align with current recommendations supporting pneumococcal vaccination in adult patients with IBD and highlight the importance of further studies to clarify the extent of vaccine-related benefit in this population.

Various methods have been developed for mucosal defect closure after colorectal endoscopic submucosal dissection (ESD), but prolonged procedure time and technical complexity remain challenges. The SureClip Traction Band (SCTB; Micro-Tech, Nanjing, China), originally designed as a traction device, has recently been used for defect closure. This study evaluated its efficacy for defect closure following colorectal ESD. We retrospectively analyzed colorectal ESD cases (≤ 50mm) between January 2023 and August 2025 in which SCTB was used for defect closure. The primary outcome was the complete closure rate. Secondary outcomes included closure time, numbers of SCTBs and additional clips used, and the incidence of delayed bleeding (DB), delayed perforation (DP), and post-ESD coagulation syndrome (PECS). Historical control cases (non-SCTB group) were ESDs for lesions ≤ 50mm performed between January 2022 and March 2023. In total,55 lesions were closed using SCTB. The mean resected specimen size was 35.5 ± 9.0mm, and the complete closure rate was 98.2%. The median closure time(IQR) was 8.6 (4.5)min, with an average of 1.1 ± 0.3 SCTBs and 6.6 ± 2.1 additional clips used per case. Complication rates in the SCTB versus non-SCTB groups were similar for DB (1.8% vs. 1.5%, p = 1.00) and DP (0% vs. 2.2%, p = 0.56). However, the incidence of PECS was significantly lower in the SCTB group (3.6% vs. 14.0%, p = 0.04). Endoscopicclosure using SCTB achieved a high complete closure rate with a short procedure time and reduced incidence of PECS after colorectal ESD.

The gastrointestinal (GI) tract is a highly immunologically active organ where coordinated crosstalk between Toll-like receptor 4 (TLR4) and NLRP3 inflammasome maintains epithelial integrity, supports mucosal repair, and promotes immune tolerance. This review aims to summarize current understanding of TLR4-NLRP3 interactions in the gut, examine their in disease, examine their roles in disease, and evaluate emerging therapeutic strategies targeting this axis. A comprehensive review of recent literature was conducted, focusing on regulatory mechanisms governing TLR4-NLRP3 signaling under homeostasis and dysregulation. Studies addressing epithelial barrier function, cytokine signaling, pyroptosis, metabolic endotoxemia, dysbiosis, and gut-brain axis communication were examined. Research using organoids, gut-on-chip system, microbiota modulation, and multi-omics approaches was also evaluated to understand therapeutic and translational advancements. Findings indicate that balanced TLR4-NLRP3 signaling preserves epithelial barrier integrity, regulates inflammatory responses, and supports immunological tolerance. Dysregulation disrupts these protective mechanisms and initiates feed-forward cycle of epithelial damage, metabolic endotoxemia, dysbiosis, and heightened cytokine-driven inflammation. Such aberrant activity contributes to major intestinal diseases-including inflammatory bowel disease, necrotizing enterocolitis, and colorectal cancer-as well as extraintestinal conditions such as obesity, type 2 diabetes, and neuroinflammation through gut-brain axis pathways. Novel therapeutic strategies, including selective small-molecule inhibitors and microbiota-based interventions, show potential for targeted modulation. The TLR4-NLRP4 axis is a context-dependent regulator of gut and systemic immunity. Targeted modulation of this pathway represents a promising strategy to restore immune homeostasis while preserving host defense, supporting its relevance as a translational therapeutic target across multiple immune-mediated disorders.

Early discrimination of non-pancreatic periampullary lesions (NPLs) is challenging owing to their complex anatomy and the absence of representative clinical symptoms. To establish an interpretable machine learning (ML) model that integrates clinical variables and endoscopic ultrasonography (EUS) features to diagnose NPLs. A total of 158 patients, suspected of having NPLs and who underwent EUS, were enrolled and randomly allocated into a training cohort (TC, n = 110) and a validation cohort (VC, n = 48). Risk clinical and EUS features were identified by multivariate logistic regression analysis and subsequently input into five ML classifiers to develop predictive models. The performance of ML models was assessed using the area under the curve (AUC), calibration curve, and decision curve analysis (DCA). The Shapley Additive Explanations (SHAP) approach was employed to interpret the result of the optimal ML model. Among the five ML models developed, the ExtraTrees model achieved the highest AUC values of 0.94 (95% confidence interval (CI): 0.89-0.99) and 0.94 (95% CI: 0.82-1.00) in TC and VC, respectively. This performance was followed by the extreme gradient boosting model (AUC = 0.94/0.93), the light gradient boosting machine (AUC = 0.92/0.91), the support vector machine (AUC = 0.91/0.94), and the logistic regression model (AUC = 0.86/0.87). The calibration curve and DCA graphically suggested good agreement and superior clinical benefits for the ExtraTrees model. SHAP analysis identified abdominal discomfort, lesion diameter, irregular shape, surface ulceration, and nonsmooth margin as the most influential features in the model's decision-making process. Our developed ML model exhibited superior capability and higher clinical benefit in distinguishing malignant from benign NPLs, particularly the ExtraTrees model. Furthermore, the SHAP analysis provided insightful interpretation of the ExtraTrees model for individualized and transparent prediction of NPLs.

Outcome monitoring supports quality improvement (QI) by helping organisations track performance, identify gaps, and guide improvements. This is particularly important for the management of costly chronic diseases with high practice variation such as inflammatory bowel disease (IBD). Although the value of outcome data for QI is increasingly recognised, little is known about its use in practice. We explored how Dutch IBD centres implement outcome-based QI. A survey was sent to 67 Dutch IBD centres covering outcome monitoring practices, data infrastructure, involvement of healthcare providers in QI discussions, and the perceived value of using outcomes for QI. Fourteen follow-up interviews explored experiences, barriers, and facilitators. Twenty-eight centres were included (54% non-academic teaching, 25% academic, and 21% general hospitals), of which 79% regularly discussed outcomes within their IBD teams to support QI efforts. Of those, 95% implemented ≥ 1 QI initiatives annually informed by these discussions and 47% assessed their effectiveness regularly. However, consistent use of outcome-based QI was uncommon-only 18% discussed outcomes > 2 times per year. Commonly monitored outcomes were medication use (68%) clinician-reported outcomes (55%), and patient-reported outcomes (55%). Interviews revealed QI efforts were often limited by informal discussions that lacked aggregate data use and clear goals. Data systems were fragmented, and staff responsibilities were unclear. Staff engagement and management support were key enablers. While outcome monitoring is common, it is not consistently used to support QI. Clarifying roles, improving data integration, and support in selecting meaningful outcomes may strengthen sustainable outcome-based QI.

Patients with inflammatory bowel disease (IBD) experience increased rates of sexual dysfunction (SD). This study investigated SD longitudinally in patients initiating a biologic or small molecule therapy. Patients with Crohn's disease (CD) or ulcerative colitis (UC) starting biologic or small molecule therapy were surveyed at induction, 2months, and 6months. Measures included the IBD-Female and Male Sexual Dysfunction Scales (FSDS, MSDS), PROMIS Sexual Function and Satisfaction Brief Profile, Harvey Bradshaw Index (HBI), Simple Clinical Colitis Activity Index (SCCAI), partial Mayo score, Short IBD Questionnaire (SIBDQ), PHQ-9, and IBD Disability Index (IBDDI). Endoscopic and biomarker data were collected. Correlations, longitudinal changes, and predictors of SD were analyzed. A total of 170 patients (89 males, 81 females) completed baseline surveys, 132 at 2months, and 115 at 6months. Median age was 31.5years; 59% had CD. At baseline, median HBI was 5.5, SCCAI 6, and pMayo 4. SD scores correlated with clinical disease activity (p < 0.05) but not consistently with endoscopic or biomarker measures. SD was associated with impaired quality of life, depression, and disability (p < 0.05). Among responders to therapy, SD, SIBDQ, and IBDDI significantly improved (p < 0.05). Multivariate analysis showed that more severe clinical disease activity predicted worse SD, while time after therapy initiation and improved quality of life were independently associated with better SD. Advanced therapy can improve SD in IBD. Improvements appear to be mediated by reductions in clinical disease activity and psychosocial factors.