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MANAGEMENT OF METASTATIC CUTANEOUS CROHN´S DISEASE USING USTEKINUMAB: A SINGLE CENTRE STUDY

Haidee Aleman Gonzalez 1, Emma Whitehead 1, Jack Turnbull 1, Shaji Sebastian 1

Affiliations

1 Hull University Teaching Hospitals, Kingston upon Hull, United Kingdom

Summary

AI Generated

A single-centre retrospective review of 10 patients with biopsy-proven metastatic Crohn's disease reports improvement in all patients treated with ustekinumab, with complete healing in 4 and partial response in 6.

Ten patients with cutaneous Crohn's disease (median age 53 years, most commonly perianal location) were treated with ustekinumab after 90% had failed anti-TNF therapy
All patients showed improvement with a median time to response of 10 weeks, with 4 achieving complete healing and 6 showing partial response over a median 45-month follow-up
Dose escalation was performed in 8 patients, and most maintained therapeutic or supratherapeutic drug levels ranging from 2 to 6 mg/L
The authors conclude that their series shows satisfactory response to ustekinumab in metastatic Crohn's disease, though larger studies are needed for confirmation

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Abstract

Introduction

Metastatic Crohn’s disease (MCD), also known as cutaneous Crohn’s disease is one of the rarest cutaneous lesions in IBD. It is defined by granulomatous lesions infiltrating the skin that are discontinuous from the affected GI tract. In most occasions, MCD occurs parallel to the course of a well-establish GI disease, but occasionally it can precede the GI manifestations from months to years. Studies addressing the therapeutic approach to MCD are limited. Ustekinumab is licenced for Crohn`s disease and also for skin disorders including psoriasis. We report our experience in managing MCD in a tertiary IBD centre.

Aims & Methods

This is a single centre retrospective review of biopsy proven cutaneous Crohn’s disease. Patient details obtained from patient records included demographic data, previous failure to biologics and/or IMS, response and time to response to Ustekinumab and therapeutic drug monitoring.

Results

A retrospective review of patients with cutaneous Crohn’s disease was performed. All patients had undergone a skin biopsy for histologically confirmation. Ten patients were included (Males: Females 5:5). Median age was 53 years (IQR 24-67). The most common location was the perianal area often preceded by a surgical wound from a proctectomy and 2 patients had peristomal skin affected. Ninety- percent of patients had failed antiTNF therapy and 6 out of 10 had failed to both Infliximab and Adalimumab, one of them had also lost response to Vedolizumab. All patients received ustekinumab with median follow up since initiation of 45 months (IQR 27-60). All patients noticed improvement since initiation of Ustekinumab with a median time to response of 10 weeks (IQR 4-28). Four out of 10 patients achieved a complete healing of the skin lesions while rest of patients reported a partial response. Most patients had therapeutic or supratherapeutic Ustekinumab level ranging from 2 to 6 mg/L. Dose escalation was done in 8 patients.

Conclusion

Metastatic Crohn’s disease is a rather uncommon entity with different clinical manifestations. Our series report satisfactory response to ustekinumab in MCD. Larger studies are required to confirm these findings.

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

PP 05 IBD (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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UEG Podcast Episode

Journal Podcast

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Episode 3: UEG Journal July spotlight

Mohsan Subhani, Maria Manuela Estevinho

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Abstract

Published

2025

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Episode 3: UEG Journal July spotlight

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Ariadna Aguilar

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Marina Titova

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José Berkeley Cotter

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New

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What are the diagnostic options?

Ariadna Aguilar 1

Affiliations

1 Hospital Universitari Vall d'Hebrón, Barcelona, Spain

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Abstract

Event

UEG Week Barcelona 2026

Topics

Endoscopy Primary Care Neurogastroenterology & Motility

Session

Non-achalasia dysphagia: From symptoms to solution

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Episode 3: UEG Journal July spotlight

Maria Manuela Estevinho

What are the diagnostic options?

Ariadna Aguilar

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Fernando Azpiroz

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Jakob Nikolas Kather

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Marina Titova

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José Berkeley Cotter

UEG Presentation

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VISIBLE ABDOMINAL DISTENSION AND BLOATING SENSATION: RESPONSES TO A NON-INSTRUMENTAL BIOFEEDBACK TREATMENT.

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VISIBLE ABDOMINAL DISTENSION AND BLOATING SENSATION: RESPONSES TO A NON-INSTRUMENTAL BIOFEEDBACK TREATMENT.

Claudia Barber 1, Teodora Pribic 2, Jordi Serra 1, Fernando Azpiroz 2

Affiliations

1 University Hospital Vall d'Hebron, Barcelona, Spain

2 Vall D'Hebron Research Institute, Barcelona, Spain

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Abstract

Introduction

In patients with disorders of the gut-brain interaction abdominal bloating is a visceral sensation (sensation of pressure/fullness), whereas visible abdominal distension is a somatic manifestation with abnormal postural tone (abdominophrenic dyssynergia, i.e., diaphragmatic push and abdominal wall relaxation). Abdominophrenic dyssynergia can be corrected by a simple non-instrumental technique, and our aim was to determine the relation of distension and bloating responses over time.

Aims & Methods

In a randomized, placebo-controlled, parallel trial (ClincalTrials.gov number NCT06150638) 40 consecutive patients (34 women, 6 men; age range 18–58 years) with disorders of gut-brain interaction complaining of visible abdominal distension were randomized to receive biofeedback or placebo. Patients in the biofeedback group were explained the mechanism of distension, and were taught to relax the diaphragm and contract the abdominal wall, using an original audiovisual support and hands-on guidance by a trained operator. In the placebo group, sham measurements of abdominal and thoracic motion were performed, and a pill of placebo was administered. Three 30-min sessions were performed over a 4-week intervention period, with instructions to perform daily exercises (biofeedback group) or to take placebo three times a day (control group) at home. After the intervention, patients allocated to the placebo group were offered biofeedback treatment. After receiving biofeedback treatment, patients in both groups were instructed to continue practicing these same exercises over time, and were followed up: visible abdominal distension and sensation of abdominal pressure/fullness (bloating) were measured at 1 and 3 months using 10-cm scales for 7 consecutive days, and the mean values (±SE) were calculated.

Results

After undergoing the three treatment sessions, abdominal distension improved in the biofeedback group (n=19; by 24±7 %), but not in the placebo group (n=20; 8±3 % change; p=0.025 vs feedback group). In the 20 patients randomized to placebo, subsequent biofeedback treatment improved abdominal distension (by 35±7 %). Follow-up in all patients after biofeedback (n=36) showed a sustained improvement in abdominal distension and bloating sensation at 1 month (by 39±5 % and 36±7 %, respectively; p<0.001 vs before treatment for both), and at 3 months (by 37±5 % and 34±8 %, respectively; p<0.003 vs before treatment for both).

Conclusion

In patients with disorders of gut-brain interaction, correction of abdominophrenic dyssynergia by a simple, non-instrumental technique, produces a sustained improvement of visible abdominal distension, associated with a concomitant improvement of bloating sensation.

Disclosure

I have the following Conflict of Interest to declare: Coloplast, Schwabe

Event

UEG Week Berlin 2025

Topics

Neurogastroenterology & Motility Oesophagus

Submission format

Abstract

Session

Lower GI motility I

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Marina Titova

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José Berkeley Cotter

UEG Presentation

New

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

Artificial intelligence and digital health in digestive diseases: From hype to implementation

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Artificial intelligence and digital health in digestive diseases: From hype to implementation

Jakob Nikolas Kather 1

Affiliations

1 Dresden University of Technology, Dresden, Germany

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Abstract

Event

UEG Week Barcelona 2026

Topics

Endoscopy Mechanisms & Personalised Medicine Digestive Oncology

Session

Opening plenary

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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UEG Presentation

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This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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A DIFFERENTIATED APPROACH TO SELECTING THE ENDOSCOPIC SURGICAL TECHNIQUE FOR THE TREATMENT OF ESOPHAGEAL ACHALASIA

Oleksandr Babii 1, Natalia Prolom 1, Serhii Tarabarov 1, Marina Titova 1

Affiliations

1 SI “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine”, Dnipro, Ukraine

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Abstract

Introduction

The main goal in treating esophageal achalasia (EA) is to facilitate the patency of the esophagogastric junction (EGJ). Among the current treatment options for EA, pneumatic balloon dilation (BD) is the most common method because it is simple to perform, minimally invasive, and does not require special training. Because recurrence after BD is common, peroral endoscopic myotomy (POEM) has been increasingly adopted. However, clear indications for the use of EA treatment methods have not been definitively determined.

Aims & Methods

The aim of this study was to determine the indications for a differentiated approach to the treatment of EA.
From January 2023 to December 2025, 31 patients diagnosed with EA were evaluated and treated in the digestive system surgery department. High resolution manometry (HRM) classified patients as type I (n=12), type II (n=16), and type III (n=3). The cohort included 12 men (38.7%) and 19 women (61.3%) aged 28 to 74 (40.2 ± 5.4) years. The Eckardt score was used for clinical assessment of EA symptoms. Fluoroscopy was used to determine the diameter of the esophagus, evacuation rate, and length of EGJ narrowing. Endoscopy assessed retained esophageal contents and resistance to passage through the lower esophageal sphincter (LES). EUS with compression elastography was used to determine the structure of the wall of the distal third of the esophagus and LES: a green–yellow pattern indicated hypertrophy, whereas a blue pattern indicated fibrosis. As the first stage of treatment, all patients underwent pneumatic balloon dilation (BD) with balloon systems with a diameter of 35 mm.

Results

After a course of BD (2-5 sessions lasting 60-180 sec) according to the Eckardt score, the symptomatic effectiveness of treatment was 87.1%; the effectiveness of LES relaxation during HRM was 83.8%; the increase in contrast evacuation rate during fluoroscopy was 77.4% after the first course and 80.6% after the repeat BD course. Regardless of the type of EA, the pressure in the LES did not differ (p>0.05), but it decreased significantly (p<0.05) after the BD course. In 2 (6.5%) cases, there were post-dilatation complications: submucosal haematoma and longitudinal tears of the mucous membrane of the distal third of the esophagus. During the follow-up period of up to 16 months, EA recurrence after the first course of BD was observed in 22.6% of cases: type I – 2 (6.5%), type II – 4 (12.9%), type III – 1 (3.2%). In 19.4% of cases of EA recurrence, repeated courses of BD were ineffective. To determine the causes of recurrence in these patients, EUS was performed and fibrosis with thickening of the wall of the distal third of the esophagus – 3.26 (3.12; 3.38) mm and LES – 5.65 (5.14; 6.14) mm was diagnosed. The presence of fibrosis contributed to post-dilatation complications and EA recurrence. In 19.4% of cases of EA recurrence following BD, POEM was performed. According to the Eckardt score, symptomatic treatment efficacy and increased contrast evacuation rate during fluoroscopy at follow-up periods up to 12 months were observed in 5 out of 6 patients.

Conclusion

EA recurrence is associated with fibrotic transformation of the wall of the distal third of the esophagus and LES. The use of HRM allows assessing the effectiveness of BD. EUS enables differentiation between hypertrophy and fibrotic transformation of the distal esophageal wall and the LES; the latter may warrant myotomy.

Event

UEG Week Barcelona 2026

Topics

Mechanisms & Personalised Medicine Surgery Neurogastroenterology & Motility Endoscopy Oesophagus

Submission format

Abstract

Session

Achalasia: Beyond the bird's beak - Tailoring therapy to the patient

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Episode 3: UEG Journal July spotlight

Maria Manuela Estevinho

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Ariadna Aguilar

VISIBLE ABDOMINAL DISTENSION AND BLOATING SENSATION: RESPONSES TO A NON-INSTRUMENTAL BIOFEEDBACK TREATMENT.

Fernando Azpiroz

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Jakob Nikolas Kather

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Marina Titova

THREE IS NOT A CROWD: IMPROVING THE STUDY OF CHRONIC CONSTIPATION

José Berkeley Cotter

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THREE IS NOT A CROWD: IMPROVING THE STUDY OF CHRONIC CONSTIPATION

Ana Isabel Ferreira 1,2, Cátia Arieira 1,2, Pedro Campelo 1,2, Sofia Xavier 1,2, José Berkeley Cotter 1,2

Affiliations

1 Unidade Local de Saúde do Alto Ave, Guimarães, Portugal

2 School of Medicine, University of Minho, Braga, Portugal

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Abstract

Introduction

High-definition anorectal manometry (HD-ARM), balloon expulsion test (BET) and magnetic resonance defecography (MR-defecography) are important tools in studying constipation.

Aims & Methods

Evaluate the prevalence of functional defecation disorders and structural anorectal alterations in patients with constipation and compare the findings of HD-ARM and BET with MR-defecography.
Retrospective cohort study including patients with functional constipation (FC) or irritable bowel syndrome with constipation (IBS-C) submitted to HD-ARM, BET and MR-defecography. Patients were divided into three groups: 1) normal anorectal evacuation pattern in HD-ARM and BET; 2) abnormal anorectal evacuation pattern and BET; 3) normal anorectal evacuation pattern and abnormal BET, or abnormal anorectal evacuation pattern and normal BET.

Results

A total of 64 patients were included, 49 with FC (76.6%) and 15 with IBS-C (23.4%). There were 20 patients in group 1 (31.3%), 11 in group 2 (17.2%) and 33 in group 3 (51.5%). In MR-defecography, 47 patients had relevant structural anorectal alterations (73.4%) and 15 had an abnormal contraction of the puborectalis during the defecatory maneuver (23.4%).
Nineteen patients were diagnosed with dyssynergic defecation (29.7%). These patients had significantly higher residual anal pressure and lower percentage of anal relaxation during defecation (109.6±43.2 vs 85.8±29.7 mmHg, p=0.038 and 9% vs 24%, p=0.018, respectively), as well as a lower differential of rectoanal pressure (-32.2±31.4 vs 3.0±29.6 mmHg, p<0.001).
Patients with structural anorectal alterations had a significantly higher body mass index (BMI) (27.4±4.5 vs 23.5±3.3, p=0.002), and all obese patients had structural alterations.
Comparing the findings of HD-ARM and BET with MR-defecography: in group 1, 15 patients had structural alterations (75.0%); in group 2, 8 patients had structural alterations (72.7%); in group 3, 22 patients only had structural alterations (66.7%), 6 only had dyssynergic defecation (18.2%), 2 patients had both (6.0%) and 3 did not have any findings (9.1%). In 24.2% of patients with inconclusive findings in HD-ARM and BET, MR-defecography allowed the diagnosis of dyssynergic defecation.

Conclusion

Patients with structural anorectal alterations had a significantly higher BMI. Almost three quarters of patients with FC and IBS-C had relevant structural anorectal alterations and one third had dyssynergic defecation. Therefore, it is important to combine MR-defecography with HD-ARM and BET in the study of constipation.

Conference

UEG Week Berlin 2025

Topics

Colorectal

Submission format

Abstract

Session

LOWER GI (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

Episode 3: UEG Journal July spotlight

Maria Manuela Estevinho

What are the diagnostic options?

Ariadna Aguilar

VISIBLE ABDOMINAL DISTENSION AND BLOATING SENSATION: RESPONSES TO A NON-INSTRUMENTAL BIOFEEDBACK TREATMENT.

Fernando Azpiroz

Artificial intelligence and digital health in digestive diseases: From hype to implementation

Jakob Nikolas Kather

A DIFFERENTIATED APPROACH TO SELECTING THE ENDOSCOPIC SURGICAL TECHNIQUE FOR THE TREATMENT OF ESOPHAGEAL ACHALASIA

Marina Titova

THREE IS NOT A CROWD: IMPROVING THE STUDY OF CHRONIC CONSTIPATION

José Berkeley Cotter