Εsophageal Crohn's disease in adults: A systematic review of the literature.

Intestinal ultrasound to detect postoperative recurrence in patients with Crohn's disease: an international, multidisciplinary, RAND/UCLA appropriateness method study.

To investigate changes in the fatty acid composition of the lumbar vertebral bone marrow in patients with Crohn's disease (CD) and its relationships with disease activity and complex disease behavior. This study, designed as a single-center, cross-sectional, and prospective trial, was conducted between September 2023 and February 2025, with 83 CD patients and 70 healthy individuals. Disease activity was evaluated using the CD activity index (CDAI). Disease behavior was recorded based on the Montreal classification. Quantitative analysis of saturated, unsaturated, monounsaturated, and polyunsaturated fatty acids (SFA, UFA, MUFA, and PUFA) for lumbar vertebrae by using a two-dimensional bipolar multi-echo 3-T MRI. Spearman correlation and logistic regression analyses were employed. PUFA was significantly lower, whereas MUFA was significantly higher in the CD than in the control group (p = 0.03 and 0.04, respectively). CDAI was positively correlated with UFA and PUFA (r = 0.30 and 0.47; p = 0.01 and p < 0.001, respectively), and negatively correlated with SFA (r = -0.29, p = 0.01). The complicated disease behavior negatively correlated with PUFA only (r = -0.31; p = 0.01). Regression analysis showed that PUFA was an independent risk factor for CDAI (p = 0.01). PUFA and disease duration were independent impact factors for complicated disease behavior (p = 0.02 and 0.01, respectively). CD patients exhibited alterations in bone marrow fatty acid composition compared to healthy controls. Bone marrow PUFA was a potential predictor of disease activity state and complicated disease behavior. Questions What was the relationship of bone marrow fatty acids with disease activity and complex disease behavior in patients with Crohn's disease (CD)? Findings Alterations in bone marrow fatty acid composition were found in CD. Polyunsaturated fatty acids were related to disease activity and complex disease behavior. Clinical relevance Non-invasive MRI imaging assessment of bone marrow fatty acids in vivo has the potential to monitor disease activity and treatment response, which may provide a new imaging marker for insight into the inflammation in CD.

Dysfunctional intestinal fibrosis is an irreversible complication of Crohn's disease (CD). The complex heterogeneity of intestinal mesenchymal cells makes it difficult to understand the pathogenesis of intestinal fibrosis. Previously, we identified Meflin as a marker of fibroblast subsets. This study aimed to explore the role of Meflin-positive fibroblasts in intestinal fibrogenesis and investigate the potential of pharmacological control of Meflin expression as a treatment for patients with CD. Our results indicated that Meflin expression was upregulated in fibroblasts at the early stage of fibrosis but was downregulated in established fibrosis in both patients with CD and 2 different mouse models, which are the chronic dextran sodium sulfate (DSS) model and an IL-10-deficient model that spontaneously develops intestinal inflammation. Meflin-deficient mice exacerbated intestinal fibrosis with dysregulated expression of noncanonical Wnt ligand WNT5A and its receptor ROR2. Pharmacologically induced Meflin expression through the administration of a synthetic retinoid reversed intestinal fibrosis in the DSS model and suppressed profibrotic protein secretion in fibroblasts isolated from patients with CD. Our findings indicate that Meflin-positive fibroblasts represent a functional subpopulation that suppresses intestinal fibrosis. Augmentation of Meflin expression shows antifibrotic effects and holds promise as a therapeutic approach for intestinal fibrosis in patients with CD.

To describe the flexible coping strategies and measures made by Crohn's disease patients during the COVID-19 epidemic to determine their experiences with COVID-19 and epidemic management. A descriptive phenomenology study based on interviews. Twelve patients with Crohn's disease were interviewed from two Grade III and Grade A hospitals in Nanjing from February 2022 to June 2022. Twelve interviews were audio-taped or recorded live and content was analysed following Colaizzi's seven-step method. Transcripts were verbatim transcribed and analysed using Colaizzi's seven-step descriptive phenomenological method. Data management was supported by NVivo 11 software. The analysis of interviews identified five themes and 14 subthemes. Crohn's disease patients demonstrated a capacity for adapting to the evolving landscape of medical care during the COVID-19 epidemic, underscoring the importance of self-management. Patients took voluntary measures to cope with the continuous adjustment of epidemic management, such as flexible adjustment of medical treatment plans. Improving existing management measures may help both healthcare professionals and patients in effectively responding to infectious disease epidemics, which suggests that we should pay attention to humanized management and hospital construction in the future. Additionally, we should pay more attention to the psychological impact of COVID-19, both positive and negative. No patient or public contribution.

Th1/Th17 cytokine signatures correlate with Crohn's disease activity in a 54‑week cohort of patients treated with adalimumab.

Development and validation of a machine learning model and a web tool for predicting the risk of Crohn's disease diagnosis in Chinese patients.

An algorithm-enhanced stool DNA system improves the differential diagnosis of colorectal cancer versus Crohn's disease in high-risk symptomatic patients.

Repeated intravenous weight-based ustekinumab maintenance as an optimization strategy for Crohn's disease patients with loss of response to standard therapy.

Children with Crohn's Disease (CD) who develop internally penetrating complications (IPCs; abscesses and inflammatory masses) are at high risk for surgery and other adverse events. Early anti-tumor-necrosis-factor therapy (anti-TNF) improves outcomes among children with CD and anti-TNF initiation soon after IPC resolution decreases surgical risk. We aimed to evaluate the safety and effectiveness of early anti-TNF therapy among children hospitalized with active IPCs. We conducted a multicenter retrospective study of children (age ≥6 years) diagnosed with IPCs from 2007-2021. The exposure was anti-TNF within 30 days of IPC diagnosis. Outcomes included 1) infectious serious adverse events (iSAE) within 90 days, 2) non-infectious CD-related SAE (cdSAE), 3) CD-related surgery, and 4) combined clinical-biochemical-corticosteroid-free remission within 1 year. Outcomes were compared via inverse-probability-of-treatment-weighted Kaplan-Meier curves (log-rank test) and Cox proportional hazards models stratified by percutaneous drainage (PD) status. Among 203 patients (median age 16 years, 50% female), 87 (43%) received early anti-TNF within 30 days of IPC diagnosis. In Cox analyses, early anti-TNF was not linked to iSAE, cdSAE, or surgeries, but was associated with increased combined clinical-biochemical-corticosteroid-free remission (HR 1.65, 95%CI 1.20, 2.27). However, surgical risk differed by PD status: patients receiving early anti-TNF and PD had lower risk versus PD alone (event-free survival 58% versus 15%, log-rank P=0.04). Early anti-TNF therapy in children with IPCs was not associated with iSAE or cdSAE. Notably, in those undergoing PD, early anti-TNF was associated with decreased surgeries. These findings support early anti-TNF initiation within a multidisciplinary treatment framework. Prospective studies with standardized treatment protocols are needed.

Residential greenness has been associated with reduced risk of inflammatory bowel disease (IBD), but its association in the context of COVID-19, a condition associated with increased IBD risk, remains unclear. We evaluated whether the protective association between greenness and IBD persisted among individuals with SARS-CoV-2 infection. We conducted a nationwide cohort study of 6,900,341 individuals with confirmed COVID-19 in South Korea, using linked data from the National Health Insurance Service, Korea Disease Control and Prevention Agency, and satellite-derived normalized difference vegetation index (NDVI) from NASA's Terra MODIS (MOD13A3, version 6.1). Individuals were categorized into low (0.2 to <0.4), moderate (0.4 to <0.6), or high (≥0.6) NDVI groups. The primary outcome was incident IBD (Crohn's disease and ulcerative colitis) ≥30 days after infection, defined using ICD-10 codes. Inverse probability of treatment weighting balanced covariates, and weighted Cox models estimated adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs). Higher residential greenness was associated with lower risk of developing IBD following COVID-19 infection, with aHRs of 0.93 (95% CI, 0.90-0.97) for moderate and 0.71 (0.68-0.74) for high NDVI compared with low. Subtype analyses showed more consistent associations for ulcerative colitis (aHR 0.91 [95% CI, 0.87-0.96] for moderate; aHR 0.60 [0.57-0.63] for high NDVI). For Crohn's disease, associations were weaker and limited to individuals exposed to high NDVI (aHR, 0.90 [95% CI, 0.85-0.96]). Associations were more apparent among individuals with mild COVID-19 and were stronger among females, adults aged 40 to 59 years, and those with pre-existing comorbidities. Higher residential greenness was associated with a lower incidence of IBD after COVID-19. Maintaining access to greenness during periods of restricted mobility may help counteract infection-related inflammation.

To develop and evaluate Crohn-BOOST, an open-source tool enabling semi-automatic segmentation of intestinal lesions and creeping fat on magnetic resonance enterography (MR Enterography), and to assess whether quantitative metrics derived from these segmentations relate to radiological disease activity scored with simplified MaRIA (sMaRIA) and Nancy indices. A fully annotated MR Enterography dataset was also curated to support future artificial intelligence research. This retrospective single-center study included 102 patients with Crohn's disease (134 analyzable small-bowel lesions). Crohn-BOOST was used to delineate bowel lesions and creeping fat. Extracted metrics included lesion volume, wall thickness, lesion length, ADC, arterial enhancement, and creeping fat volume. Radiologic activity was assessed with sMaRIA and Nancy scores. Spearman correlations (95% CI by bootstrap), multivariable linear regression, and fivefold cross-validation were performed (p < 0.05). Segmentation time was < 3 min per patient. Inter-reader reproducibility in a two-reader subset (n = 30) was high (Dice 0.85 for lesions; 0.87 for creeping fat). Lesion volume (sMaRIA r = 0.65; Nancy r = 0.61; p < 0.001) and ADC (sMaRIA r = -0.70) showed the strongest correlations with radiological activity. In multivariable models, these two metrics remained independent predictors, whereas creeping fat volume and enhancement metrics were not. Crohn-BOOST enables fast, reproducible 3D quantification on routine MR Enterography and supports objective estimation of radiological disease activity. Lesion volume and ADC show strong associations with sMaRIA and Nancy scores, while creeping fat volume appears more related to chronic remodeling than acute inflammation.

Crohn's disease (CD) is a chronic autoimmune inflammatory bowel disease (IBD) with significant diagnostic and therapeutic challenges. We reported a case of a 20-year-old Bangladeshi male with an 8-month history of severe upper abdominal pain, bowel discomfort, and intermittent low-grade fever. Initial investigations showed mild anemia and elevated inflammatory markers. Magnetic resonance enterography revealed distal small bowel thickening, suggestive of IBD. Colonoscopy and biopsy confirmed chronic ileitis without granulomas and an ulcer at the terminal ileum. Despite the absence of granulomas, clinical symptoms, elevated fecal calprotectin, and high C-reactive protein (CRP)led to a diagnosis of CD. The disease later progressed to a perianal abscess, a fistulizing complication. The patient received three doses of infliximab but subsequently discontinued therapy. He remained untreated for 3-years and subsequently developed an intestinal perforation requiring right hemicolectomy with ileostomy. Following ileostomy reversal, adalimumab was advised. This case highlighted the diagnostic and therapeutic challenges of CD in Bangladesh.

Crohn disease (CD), a subtype of inflammatory bowel disease, may be complicated by extraintestinal manifestations. Although cutaneous findings are among the most frequent, metastatic Crohn disease (MCD), defined as mucocutaneous CD at sites noncontiguous with the gastrointestinal tract, is rare. Children with MCD are more likely than adults to develop genital inflammation. Case reports describe the vulva, scrotum, and penis as common locations of involvement in children with genital MCD. We report a case of a pediatric patient with systemic lupus erythematosus who developed vaginal discharge as a presenting symptom of MCD in the absence of an anorectal-vaginal fistula. We describe an unusual combination of clinical features and intend to improve awareness of uncommon extraintestinal manifestations of CD.

AGA Clinical Practice Update on Diagnosis and Treatment of Hemorrhoids: Expert Review.

Wumei Wan alleviates intestinal fibrosis via the microbiota-metabolite-YAP-mechanotransduction axis.

Spectrum of Colopathy and Severe Polyposis Associated With Pentosan Polysulfate Sodium Maculopathy: A Retrospective Case Series.

Outcomes after repair of enterocutaneous fistulas at a specialized center.

To explore concerns and coping experiences regarding sexual well-being in inflammatory bowel disease and examine the relationship between these concerns and affected individuals' background factors. Explanatory sequential mixed methods study. Recruitment flyers (n = 1347) were distributed to individuals attending inflammatory bowel disease outpatient clinics in seven facilities. Participants completed a questionnaire assessing demographics, concerns and coping experiences related to their sexual well-being. Those who provided consent participated in semi-structured online interviews. Quantitative data were analysed descriptively, and qualitative data were analysed using content analysis. A total of 551 participants completed the questionnaire, and 21 participated in the interviews. Among them, 251 (45.6%) reported experiences of concerns related to romantic relationships and marriage, sexual life, pregnancy, childbirth and childcare. The nature of these concerns varied by background factors: unmarried individuals more often reported relationship concerns; those with surgical or perianal history more often reported sexual concerns; and women, married individuals and individuals with Crohn's disease more often reported pregnancy-related concerns. Coping experiences were categorized as (1) active barrier management, (2) partner and professional support, (3) passive or resignation coping and (4) cognitive reframing. Sexual well-being is significantly affected among individuals with inflammatory bowel disease. Many participants reported understanding and support from significant others or relied on personal coping strategies; however, others reported an absence of coping experiences. Sharing these findings with individuals with inflammatory bowel disease and healthcare professionals may enhance awareness and promote support strategies to improve these individuals' sexual well-being. Concerns about sexual well-being are influenced by both clinical and psychosocial factors, including treatment history, life stage and partner relationships. Healthcare professionals should provide individualised and comprehensive care that incorporates the partners and families of individuals with inflammatory bowel disease to better address sexual well-being. This study presents the first large-scale mixed methods evidence on how individuals with inflammatory bowel disease experience sexual well-being, providing direct implications for improving quality of life. By illustrating both adaptive and absent coping strategies, the findings contribute essential insight to inform patient-centred clinical practice and psychosocial care. The Good Reporting of a Mixed-Methods Study (GRAMMS) guidelines were followed. No patient or public contribution.

Efficacy and Safety of Titrated High-Dose Cholecalciferol Supplementation in Children and Young Adult Patients with Inflammatory Bowel Disease.