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RANDOMIZED CONTROLLED TRIAL: ENDOSCOPIC ULTRASONOGRAPHY GUIDED DEPLOYMENT OF EMBOLISATION COIL WITH CYANOACRYLATE GLUE INJECTION VERSUS ISOLATED GLUE INJECTION FOR GASTRIC VARIES

Ashok Jhajharia 1, Sumit Yadav 1, Prachis Ashdhir 1, Saksham Seth 1

Affiliations

1 SMS Medical College & Hospital, Jaipur, Jaipur, India

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Abstract

Introduction

Gastric variceal bleeding is life-threating condition with high risk of rebleed with challenging management with standard management including cyanoacrylate glue injection. We aimed to compare efficacy and safety of endoscopic ultrasonography (EUS)-guided coil embolization and cyanoacrylate injection versus EUS-guided cyanoacrylate injection alone in management of gastric varices.

Aims & Methods

Single-centre, parallel-randomized controlled trial involving 24 participants with gastric varices (GOV II and IGV I) who were randomly allocated to EUS-guided coil embolization and cyanoacrylate injection (n = 12) or EUS guided cyanoacrylate Injection alone (n = 12). Primary end points were technical and clinical success rates of both procedures. Secondary end points were reappearance of gastric varices during follow-up with rebleeding, and complication.

Results

Average size of varices were almost similar (21mm and 22mm) in both. Mean number of coils required were 2.1 per patient and volume of cyanoacrylate needed was less in combined modality group (2.5ml vs 4ml). Technical success rate was 100% in both groups. Immediate disappearance of varices was observed in 66.67% of patients treated with coils and cyanoacrylate, versus 8.33% of patients treated with cyanoacrylate alone (P=0.009). Rebleeding at 10 months occurred in none of patients treated with combined and 5 of 12 (41.66%) of those treated alone (P=0.03). 1 patient died in only cyanoacrylate group after intervention because of pulmonary embolism.

Conclusion

EUS guided coil embolization with cyanoacrylate injection achieved excellent clinical success, with lower rates of rebleeding than cyanoacrylate treatment alone. Long term follow-up and mean sample required to further Validate our data.

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

Liver and biliary: Clinical aspects (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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USE AND PERSISTENCE OF INFLIXIMAB (IV AND SC) IN FRANCE BETWEEN 2021 AND 2024: THE RIPOSTE IBD NATIONWIDE POPULATION-BASED COHORT STUDY

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BEYOND THE BOWEL: SHIFTING CAUSES OF MORTALITY IN INFLAMMATORY BOWEL DISEASE ACROSS THE BIOLOGIC ERA - DATABASE STUDY OF AMERICAN POPULATION (1990–2025)

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ESGE live endoscopy II (Complete Session)

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ESGE live endoscopy II (Complete Session)

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Abstract

Event

UEG Week Barcelona 2026

Topics

Endoscopy

Session

ESGE live endoscopy II

Citation

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

Published

2026

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ESGE live endoscopy II (Complete Session)

Radiological assessment of response for organ preservation: Can ctDNA help in early stage?

Sofia Gourtsoyianni

PROSPECTIVE VALIDATION OF AN ALGORITHMIC TOOL TO SAFELY CEASE ANTI-TUMOR NECROSIS FACTOR THERAPY IN CROHN’S DISEASE: A STEPPED WEDGE CLUSTER RANDOMIZED TRIAL

Annemarie de Vries

USE AND PERSISTENCE OF INFLIXIMAB (IV AND SC) IN FRANCE BETWEEN 2021 AND 2024: THE RIPOSTE IBD NATIONWIDE POPULATION-BASED COHORT STUDY

Laura Pina Vegas

BEYOND THE BOWEL: SHIFTING CAUSES OF MORTALITY IN INFLAMMATORY BOWEL DISEASE ACROSS THE BIOLOGIC ERA - DATABASE STUDY OF AMERICAN POPULATION (1990–2025)

Aakash Desai

Recognising and responding to extraintestinal manifestations of IBD in the clinic

Gerhard Rogler

UEG Presentation

New

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Radiological assessment of response for organ preservation: Can ctDNA help in early stage?

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Radiological assessment of response for organ preservation: Can ctDNA help in early stage?

Violaine Randrian 1, Sofia Gourtsoyianni 2

Affiliations

1 Centre Hospitalier Universitaire de Poitiers, Poitiers, France

2 School of Medicine, National & Kapodistrian University of Athens, Athens, Greece

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Abstract

Event

UEG Week Barcelona 2026

Session

Organ preservation in colorectal cancer dos and don’ts

Citation

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

Published

2026

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ESGE live endoscopy II (Complete Session)

Radiological assessment of response for organ preservation: Can ctDNA help in early stage?

Sofia Gourtsoyianni

PROSPECTIVE VALIDATION OF AN ALGORITHMIC TOOL TO SAFELY CEASE ANTI-TUMOR NECROSIS FACTOR THERAPY IN CROHN’S DISEASE: A STEPPED WEDGE CLUSTER RANDOMIZED TRIAL

Annemarie de Vries

USE AND PERSISTENCE OF INFLIXIMAB (IV AND SC) IN FRANCE BETWEEN 2021 AND 2024: THE RIPOSTE IBD NATIONWIDE POPULATION-BASED COHORT STUDY

Laura Pina Vegas

BEYOND THE BOWEL: SHIFTING CAUSES OF MORTALITY IN INFLAMMATORY BOWEL DISEASE ACROSS THE BIOLOGIC ERA - DATABASE STUDY OF AMERICAN POPULATION (1990–2025)

Aakash Desai

Recognising and responding to extraintestinal manifestations of IBD in the clinic

Gerhard Rogler

UEG Presentation

New

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

PROSPECTIVE VALIDATION OF AN ALGORITHMIC TOOL TO SAFELY CEASE ANTI-TUMOR NECROSIS FACTOR THERAPY IN CROHN’S DISEASE: A STEPPED WEDGE CLUSTER RANDOMIZED TRIAL

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PROSPECTIVE VALIDATION OF AN ALGORITHMIC TOOL TO SAFELY CEASE ANTI-TUMOR NECROSIS FACTOR THERAPY IN CROHN’S DISEASE: A STEPPED WEDGE CLUSTER RANDOMIZED TRIAL

Mees van der Hoff 1, Jonne Staal 2, Doranne Thomassen 3, Marjolijn Duijvestein 4, Monique Devillers 2, Djuna C de Jong 1, Marijn C. Visschedijk 5, Petra van Boeckel 6, Frank Wolfhagen 7, Alexander Bodelier 8, Rachel West 9, Sander van der Marel 10, Janneke Wonders 11, Jeroen P.W. Maljaars 3, Simone Wolfkamp 12, Wout Mares 13, Tessa E.H. Römkens 14, Rosalie C. Mallant-Hent 15, Adriaan Tan 16, Esmerij van der Zanden 17, Dirk van Asseldonk 18, Greetje Tack 19, Stella C M Heemskerk 2, Suzanne Polinder 2, Marcel G. W. Dijkgraaf 20, Ewout Steyerberg 3, C. Janneke van der Woude 2, Geert R. D'Haens 1, Annemarie de Vries 2

Affiliations

1 Amsterdam UMC, Amsterdam, Netherlands

2 Erasmus MC, Rotterdam, Netherlands

3 LUMC, Leiden, Netherlands

4 Radboudumc, Nijmegen, Netherlands

5 UMC Groningen, Groningen, Netherlands

6 St. Antonius Hospital, Nieuwegein, Netherlands

7 Albert Schweitzer Hospital, Dordrecht, Netherlands

8 Amphia Hospital, Breda, Netherlands

9 Sint Franciscus Gasthuis, Rotterdam, Netherlands

10 Haaglanden MC, Den Haag, Netherlands

11 Haga Hospital, Den Haag, Netherlands

12 OLVG, Amsterdam, Netherlands

13 Gelderse Vallei Hospital, Ede, Netherlands

14 Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands

15 Flevo Hospital, Almere, Netherlands

16 Canisius Wilhelmina Hospital, Nijmegen, Netherlands

17 Amstelland Hospital, Amstelveen, Netherlands

18 Noordwest Ziekenhuisgroep, Alkmaar, Netherlands

19 Frisius MC, Leeuwarden, Netherlands

20 University of Amsterdam, Amsterdam, Netherlands

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Abstract

Introduction

Anti-tumor necrosis factor (TNF) treatments are the cornerstone of medical therapy for moderate-to-severe Crohn’s Disease (CD). Despite the risk of relapse, cessation of anti-TNF might be considered in a subpopulation to reduce toxicity and cost. In an attempt to identify this subpopulation, the CEASE predictive tool was developed^1,2 based on clinical and biochemical features associated with successful cessation in a number of cohorts including STORI³. In this stepped-wedge cluster randomised clinical trial, we aimed to assess whether cessation of anti-TNF therapy was non-inferior to continuation of anti-TNF therapy regarding relapse risk in patients with a low estimated risk of relapse according to the CEASE-tool.

Aims & Methods

Adult patients on infliximab (IFX) or adalimumab (ADL) maintenance treatment for luminal CD were eligible when they were in steroid-free remission (HBI<5) for ≥6 months and had a 1-year relapse risk predicted by the CEASE-tool of ≤33.3%. The nineteen participating centres were randomised into three clusters of the stepped wedge design, with 6, 12 or 18 months of follow up for both the continuation and cessation group, respectively. Follow up for all patients was amended to a minimum of 12 months to increase statistical power. Sample size calculation was based on an acceptable 30% difference in relapse risk. Risk of relapse within one year was estimated using the Kaplan-Meier estimator with robust standard errors to account for clustering.
Hence, we needed to recruit 228 patients for 80% power to detect an absolute non-inferiority margin difference between the group proportions of 30%, accounting for intracluster correlations up to 0.02. The primary endpoint was documented CD relapse defined as HBI ≥5 AND faecal calprotectin >250 ug/g at 2 consecutive time points OR ulcerations on endoscopy OR a CD complication necessitating medical or surgical intervention.

Results

Baseline characteristics	Age (p>0.9)	Female (p=0.4)	Smoking (p=0.3)	Age at diagnosis (p=0.2)	Disease location (p=0.001)	Disease behavior (p=0.9)	Perianal disease (p=0.033)	Inflximab (p=0.001)	CEASE-score (p=0.095)
Continuation (n=106)	49 [34, 58]	55 (51.9%)	7 (6.6%)	≤16: 10 (9.4%) 17–39: 62 (58.5%) ≥40: 34 (32.1%)	Ileal: 23 (21.7%) Colonic: 32 (30.2%) Ileocolonic: 51 (48.1%)	Non-stricturing, non-penetrating: 60 (56.6%) Stricturing: 29 (27.4%) Penetrating: 17 (16.0%)	32 (30.2%)	85 (80.2%)	26.3 [22.4, 30.0]
Cessation (n=112)	49 [33, 59]	64 (57.1%)	14 (12.5%)	<16: 7 (6.3%) 17–39: 79 (70.5%) ≥40: 26 (23.2%)	Ileal: 49 (43.8%) Colonic: 32 (26.8%) Ileocolonic: 33 (29.5%)	Non-stricturing, non-penetrating: 67 (59.8%) Stricturing: 29 (25.9%) Penetrating: 16 (14.3%)	20 (17.9%)	67 (59.8%)	28.2 [23.3, 30.9]

We included 228 participants at 19 academic and teaching hospitals in The Netherlands, which were followed up for 12-18 months.
At one year, 2/106 participants in the continuation group and 35/112 in the cessation group met the protocol-defined criteria for relapse. At one year, the estimated risk of relapse in the continuation group was 2.07% [95% CI 0-4.74%], whereas the risk of relapse in the cessation group was 36.02% [24.66-45.67%]. The risk difference at one year was 33.95% [24.66%-40.93%].
In addition, a relapse was suspected but not strictly confirmed before the treating physician re-initiated treatment in a relevant proportion of participants. If we include medical or surgical intervention for suspected relapse in our definition, relapses were observed in 2/106 participants in the continuation and 48/112 in the control group within one year. The estimated 1-year risk of relapse in the continuation group was then still 2.07%, 95% CI [0-4.74%], whereas the risk of relapse in the cessation group was 44.48% [35.40-52.27%]. In this case, the risk difference at one year was 42.41% [35.40%-40.93%].

Conclusion

Our preliminary results suggest that in CD patients with a low (≤33.3%) 1-year relapse risk according to the CEASE tool, cessation is not non-inferior compared to continuation of anti-TNF treatment.

References

1. Ten Bokkel Huinink et al. Eur J Gastroenterol Hepatol. 2022
2. Pauwels et al. Clin Gastroenterol Hepatol. 2022
3. Louis et al. Gastroenterology. 2012

Disclosure

This research was funded by ZonMW; the (non-profit) Dutch Organisation for knowledge and innovation in health, healthcare and well-being.
M.D. has received speaking fees from Bristol Meyers Squibb, Takeda, Galapagos, Janssen, and Dr. Falk; advisory board fees from AbbVie, Bristol Meyers Squibb, Celltrion, Galapagos/Alfasigma, Janssen, and Takeda; and grant/research support from Pfizer, Bristol Meyers Squibb, Galapagos/Alfasigma, Janssen, and Lilly.
M.V. has received speaker fees from Janssen-Cilag, AbbVie b.v, Galapagos, Takeda, and Ferring.
A.B. has served as an advisory board member of Takeda, AbbVie, and Janssen.
R.W. has served on the advisory board and as an invited speaker for Janssen, Pfizer and Takeda.
S.v.d.M. reports participation in advisory boards or collaborations with Pfizer, Abbvie, and Janssen; involvement in an IBD documentary with Takeda; and a podcast with Janssen.
J.W. has received research grants from MSD, and the CJ Vaillant Foundation; and for other investigator driven research from the Haaglanden Medical Center Research Fund and the Research Fund Bronovo.
J.M. reports grants, consuting fees, and payment for lectures from Galapagos, Abbvie, and Takeda.
T.R. has participated in advisory boards, or as a speaker or consultant: Janssen, Takeda, Ferring.
R.M.H. has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from ITS and is a member of the national IBD committee of the Dutch Association for Gastroenterology and Hepatology.
D.v.A. has served on advisory boards, or as speaker or consultant for Ferring, DrFalk, Takeda, Janssen, Galapagos. He has received research grants from Noordwest Academie, Janssen and DrFalk.
J.v.d.W. has received grants from ZonMW, Falk and Pfizer, has received consulting fees from Janssen, Galapagos, and Pfizer, has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Ferring and AbbVie, and had leadership roles in the European Crohn's & Colitis organization, United European Gastroenterology council and the Dutch Association for Gastroenterology (NVGE).
G.D. has received research grants from Abbvie, Alimentiv, BMS, J&J, Pfizer, Takeda; consulting fees from Abbvie, Agomab, Alimentiv, AstraZeneca, AMT, Bristol Meiers Squibb, Boehringer Ingelheim, Celltrion, Eli Lilly, Exeliom Biosciences, Galapagos, Index Pharmaceuticals, Kaleido, Glaxo Smith Kline, Gossamerbio, Pfizer, Immunic, Johnson and Johnson, Polpharma, Procise Diagnostics, Prometheus laboratories, Prometheus Biosciences, Progenity, Protagonist, and Ventyx; speaker’s fees from Abbvie, Arena, Boehringer Ingelheim, Celltrion, Galapagos, Gilead, Pfizer, BMS, and Takeda; data monitoring board: Galapagos, AstraZeneca, Seres Health.
A.d.V. has served on advisory boards for Takeda, Janssen, Bristol-Myers Squibb, AbbVie, Pfizer, and Galapagos/Alfa Sigma; and unrestricted research grants from Takeda, Lilly, Janssen, and Pfizer.
Remaining authors report no conflicts of interest.

Event

UEG Week Barcelona 2026

Topics

IBD

Submission format

Abstract

Session

Teaching an old dog new tricks: New implementations of current IBD drugs

Citation

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

Published

2026

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Sofia Gourtsoyianni

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Annemarie de Vries

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Aakash Desai

Recognising and responding to extraintestinal manifestations of IBD in the clinic

Gerhard Rogler

UEG Presentation

New

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USE AND PERSISTENCE OF INFLIXIMAB (IV AND SC) IN FRANCE BETWEEN 2021 AND 2024: THE RIPOSTE IBD NATIONWIDE POPULATION-BASED COHORT STUDY

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USE AND PERSISTENCE OF INFLIXIMAB (IV AND SC) IN FRANCE BETWEEN 2021 AND 2024: THE RIPOSTE IBD NATIONWIDE POPULATION-BASED COHORT STUDY

Julien Kirchgesner 1, Stephane NANCEY 2, Nathalie Quiles 3, Clément Prati 4, Lucile Foulley 5, Caroline Habauzit 5, Salim Benkhalifa 5, Laura Pina Vegas 6

Affiliations

1 Saint-Antoine Hospital - Department of Gastroenterology, Paris, France

2 CHU Lyon, Pierre Benite, France

3 Hopital Saint Joseph, Marseille, France

4 Centre Hospitalier Universitaire Hôpital Jean Minjoz, Besançon, France

5 Celltrion Healthcare France, Issy Les Moulineaux, France

6 Hôpital Henri Mondor, Créteil, France

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Abstract

Introduction

Subcutaneous infliximab (IFX-SC) is available in France since February 2021. Beyond the pivotal studies, real-world data are needed to assess use, effectiveness, and safety of IFX-SC. The RIPOSTE study aimed to evaluate the real-world use of IFX-SC in a nationwide French cohort.

Aims & Methods

This nationwide population-based cohort study is based on data from the French administrative health databases (SNDS), including out- and in-patient data for 99% of the French general population. All patients with at least one IFX SC or intravenous (IV) delivery between February 1, 2021 (date of IFX-SC availability in France) and December 31, 2024, were included, regardless of indication. IBD patients were selected, with diagnoses of Crohn's disease (CD) and ulcerative colitis (UC) based on published algorithms¹. Three groups were defined: (1) IFX-IV incident user (no administration of IFX-IV over the past 10 years); (2) IFX-SC initiation group (patients who received less than 3 infusions of IFX-IV before initiating IFX-SC); (3) IFX-SC switch group (patients who received at least 3 infusions of IFX-IV before initiating IFX-SC). Patients were followed from the first IFX dispensing until discontinuation (no new delivery within 3 months after the end of estimated exposure), initiation of another advanced therapy, death, or December 31, 2024, whichever occurred first. Persistence was assessed using Kaplan-Meier method. Concomitant exposure of immunosuppressant (IS) and occurrence of serious adverse events were also assessed.

Results

A total of 65,438 patients received at least one IFX delivery in this period, 40,969 treated solely with IFX-IV and 24,469 patients treated with IFX-SC. In the incident IFX-IV cohort, CD represented 5,548 patients (mean age: 41 years (SD 16.8)) and UC, 4,004 patients (mean age: 45 years (SD 17.9)). Among all adult patients treated with IFX-SC, 13,527 (55.3%) had CD including 3,385 (25%) in the IFX-SC initiation group. A total of 5,749 patients (23.5%) had UC including 1,556 (27%) in IFX-SC initiation group. The mean age at entry for the IFX-SC population was 43 years (SD, 15.5), with 52% of women. In the IFX-SC initiation group, 9.1% of CD patients and 8.5% of UC patients had no prior IFX-IV exposure. Concomitant IS use at initiation was observed in 42% of CD patients and 37% of UC patients. In CD, the 4-years drug persistence was 42% [IC95%: 40-44] for IFX-IV users, while rates were significantly higher in patients treated with IFX-SC, 52% for initiators [IC95%: 50-55] and 60% [IC95%: 60-64] in the switch group (p<0.001). In UC, the 4-years drug persistence were also significantly higher in both IFX-SC groups (initiator: 46% [IC95%: 41-51]; switch: 62% [IC95%: 40-44]) compared to IFX-IV users (32% [IC95%: 30-35]) (p<0.001 between each of the groups over the given period) (Table1). Regarding safety at 4 years, cumulative incidence of serious infections was numerically higher in the IFX-IV group (14% in CD and 17% in UC) compared to IFX-SC (9% and 8% in CD and UC IFX-SC initiators, respectively; 7% and 6% in CD and UC IFX-SC switchers, respectively), MACE and cancer rates were similar in all IFX groups.

Table 1: Drug persistence between IFX-SC and IFX-IV	SC initiation CD, N = 3,385 / UC, N = 1,556 (p<0.001 between each of the groups over the given period)	SC switch CD, N = 10,142 / UC, N = 4,193 (p<0.001 between each of the groups over the given period)	IV incident CD, N = 5,548 / UC, N= 4,004 (p<0.001 between each of the groups over the given period)
6 months 24 months 48 months	0.85 / 0.78 0.61 / 0.56 0.52 / 0.46	0.88 / 0.87 0.68 / 0.70 0.60 / 0.62	0.79 / 0.70 0.51 / 0.40 0.42 / 0.32

Conclusion

Based on a French nationwide population-based cohort study, IBD patients who switched from IFX-IV to IFX-SC may benefit from a better drug persistence with a good safety profile at 4 years. Further analyses including propensity score matching to control residual confounding are ongoing.

References

Kirchgesner J, Lemaitre M, Rudnichi A, et al. Therapeutic management of inflammatory bowel disease in real-life practice in the current era of anti-TNF agents: analysis of the French administrative health databases 2009-2014. Aliment Pharmacol Ther 2017;45:37–49.

Disclosure

Thanks: Heva
Funding : Celltrion Healthcare France

Event

UEG Week Barcelona 2026

Topics

IBD

Submission format

Abstract

Session

Lessons from large IBD real-world cohorts

Citation

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

Published

2026

More Like This:

ESGE live endoscopy II (Complete Session)

Radiological assessment of response for organ preservation: Can ctDNA help in early stage?

Sofia Gourtsoyianni

PROSPECTIVE VALIDATION OF AN ALGORITHMIC TOOL TO SAFELY CEASE ANTI-TUMOR NECROSIS FACTOR THERAPY IN CROHN’S DISEASE: A STEPPED WEDGE CLUSTER RANDOMIZED TRIAL

Annemarie de Vries

USE AND PERSISTENCE OF INFLIXIMAB (IV AND SC) IN FRANCE BETWEEN 2021 AND 2024: THE RIPOSTE IBD NATIONWIDE POPULATION-BASED COHORT STUDY

Laura Pina Vegas

BEYOND THE BOWEL: SHIFTING CAUSES OF MORTALITY IN INFLAMMATORY BOWEL DISEASE ACROSS THE BIOLOGIC ERA - DATABASE STUDY OF AMERICAN POPULATION (1990–2025)

Aakash Desai

Recognising and responding to extraintestinal manifestations of IBD in the clinic

Gerhard Rogler

UEG Presentation

New

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

BEYOND THE BOWEL: SHIFTING CAUSES OF MORTALITY IN INFLAMMATORY BOWEL DISEASE ACROSS THE BIOLOGIC ERA - DATABASE STUDY OF AMERICAN POPULATION (1990–2025)

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BEYOND THE BOWEL: SHIFTING CAUSES OF MORTALITY IN INFLAMMATORY BOWEL DISEASE ACROSS THE BIOLOGIC ERA - DATABASE STUDY OF AMERICAN POPULATION (1990–2025)

Ashesh Das 1, Mahnoor Gelani 2, Fazia Khattak 3, Mahad Ahmad 4, Rovan Emad Aladham 5, Krish Keswani 6, Elena Alupei 7, Mohamed Nasser Elshabrawi 8, Aakash Desai 9

Affiliations

1 Mayo Clinic, Rochester, United States

2 Liaquat University of Medical and Health Science, Jamshoro, Pakistan

3 Khyber Medical College, Peshawar, Pakistan

4 Riphah International University, Rawalpindi, Pakistan

5 Faculty of Medicine Port Said University, Port Said, Pakistan

6 GMERS Medical College, Gotri, Vadodara, India

7 Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

8 Clinical Research Department, Aswan Heart Center, Magdi Yaqoup Foundation, Aswan, Egypt

9 Allegheny Health Network, Pittsburgh, United States

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Abstract

Introduction

Biologic therapies have fundamentally altered the natural history of inflammatory bowel disease (IBD), yet their downstream impact on the systemic causes of mortality remains incompletely characterized. [1] This study examines how the leading underlying causes of death in patients with IBD like cardiovascular disease, infection, and malignancy have shifted across sequential treatment eras in the United States.[2]

Aims & Methods

We queried the CDC WONDER Multiple Cause of Death database to identify adult decedents with IBD (Crohn's disease or ulcerative colitis; ICD-9: 555–558; ICD-10: K50–K52) listed as a contributing cause of death. Mortality trends were stratified by temporal exposure to evolving treatment eras: the Pre-Biologic Era (1990–1998), the Early Biologic Era (1999–2010), and the Widespread Biologic Era (divided into 2011–2020 and 2021–2025 to capture recent trends). The absolute and proportional distributions of underlying causes of death—cardiovascular (ICD I00–I99), infection (ICD A00–B99), and malignancy (ICD C00–D48) were compared across eras alongside sex-stratified mortality.

Results

A total of 27,655 IBD-associated deaths were identified (Pre-Biologic: n = 7,414; Early Biologic: n = 7,929; Widespread 2011–2020: n = 7,571; Widespread 2021–2026: n = 4,741). Females accounted for the majority of IBD-associated deaths consistently across all eras (55.9%–60.8%). Cardiovascular disease was the dominant underlying cause throughout all biologic eras, accounting for 59.6%, 62.1%, and 57.7% of deaths in the Early Biologic, Widespread 2011–2020, and Widespread 2021–2026 eras, respectively. Absolute cardiovascular deaths declined markedly by 41.8% between the two Widespread biologic periods. Infection-related mortality constituted 35.9%, 33.2%, and 35.7% across the same periods, demonstrating a 7.6% relative increase in the most recent era. Malignancy-related deaths, while the smallest category, rose proportionally from 4.5% to 6.6% between the Early and most recent Widespread eras (a 47% relative increase).

Conclusion

Despite the transformative impact of biologics on luminal disease control, cardiovascular disease remains the predominant contributor to IBD-associated mortality, underscoring a persistent and under-addressed systemic burden. The relative rise in malignancy-related deaths across successive biologic eras warrants heightened vigilance for immunosuppression-associated neoplasia. These findings support the urgent need for integrated cardio-gastroenterology care models and systematic oncologic surveillance in the aging IBD population.

References

1) Banerjee, R., Ali, R. A. R., Wei, S. C., & Adsul, S. (2020). Biologics for the Management of Inflammatory Bowel Disease: A Review in Tuberculosis-Endemic Countries. Gut and liver, 14(6), 685–698. https://doi.org/10.5009/gnl19209
2) Follin-Arbelet, B., Cvancarova Småstuen, M., Hovde, Ø., Jelsness-Jørgensen, L. P., & Moum, B. (2023). Mortality in Patients with Inflammatory Bowel Disease: Results from 30 Years of Follow-up in a Norwegian Inception Cohort (the IBSEN study). Journal of Crohn's & colitis, 17(4), 497–503. https://doi.org/10.1093/ecco-jcc/jjac156

Event

UEG Week Barcelona 2026

Topics

IBD

Submission format

Abstract

Session

Lessons from large IBD real-world cohorts

Citation

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

Published

2026

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Recognising and responding to extraintestinal manifestations of IBD in the clinic

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Recognising and responding to extraintestinal manifestations of IBD in the clinic

Gerhard Rogler 1

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1 UniversitätsSpital Zürich, Zurich, Switzerland

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Abstract

Event

UEG Week Barcelona 2026

Topics

Mechanisms & Personalised Medicine IBD

Session

Extraintestinal manifestations in IBD

Citation

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

Published

2026

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Recognising and responding to extraintestinal manifestations of IBD in the clinic

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