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Introduction

The therapeutic armamentarium for inflammatory bowel disease (IBD) is rapidly increasing recent years with newer therapies such as vedolizumab (VDZ). Their effectiveness has already been demonstrated against placebo, but head-to-head trials compared to tumour necrosis factor alpha inhibitors (anti-TNF) are scarce.

Aims & Methods

Aim: To compare the effectiveness of VDZ versus anti-TNF in bio-naïve IBD patients in a real world setting.
Methods: A retrospective monocentric study was performed in IBD patients treated with VDZ and anti-TNF at a Belgian University Hospital, from January 2018 to June 2021 with follow-up until December 2021. Primary endpoints considering efficacy after induction and after 1 year of therapy were: clinical response (CRp) and remission (CRm), biochemical response (BRp) and remission (BRm) and endoscopic response (ERp) and remission (ERm). Secondary endpoint was treatment survival during follow-up. For assessment of risk factors influencing efficacy and treatment survival, a multivariate logistic regression and Cox regression model were applied. Propensity scores for VDZ vs. anti-TNF were weighted for age at start biological, IBD type, perianal disease activity, disease duration and previous IBD-related intestinal resection.

Results

In total, 42 patients received VDZ and 57 anti-TNF. At baseline, the VDZ group had an older median age (38 vs. 31 years, P=0.024), longer disease duration (P=0.017) and more moderate to severe comorbidities (21.4% (9/42) vs. 0% (0/57), P<0.001). In the anti-TNF group, percentage of CD patients was higher (77.2% (44/57) vs. 57.1% (24/42),P=0.034), patients had more upper GI, penetrating or stricturing disease (P=0.013 for location and P=0.004 for behavior), perianal disease (P=0.034) and used more immunomodulators (IMM) during treatment (52.6% (30/57) vs. 16.7% (7/42), P<0.001). After treatment induction, CRp (P=0.311) and CRm (P=0.216) rate was not significantly different. The anti-TNF group had a significantly higher BRp rate compared to the VDZ group (87.8% (43/49) vs. (23/34), P=0.026). After adjusting for propensity score, age, IBD type, systemic corticosteroid (CS) or IMM use, the higher rate of BRp remained (aOR 3.83 [1.01-14.60], P=0.049). Similar results were found for BRm (87.8% (43/49) vs. 67.6% (23/34), P=0.026). After adjustment for the same confounders, the higher rate of BRm in the anti-TNF group remained (aOR 3.83 [1.01-14.60], P=0.049). No significant difference was seen for ERp (P=1.000) and ERm (P=0.338). After 1 year, univariate analysis showed no significant difference for CRp (P=0.736) and CRm (P=0.404), nor for BRp (P=0.907) and BRm (0.890) or for ERp (P=0.163) and ERm (P=0.533). Treatment survival using Cox regression model with adjustment for propensity and IMM or CS use, showed no significant longer treatment duration for anti-TNF compared to VDZ (aHR 0.947 [0.36-2.49], P=0.913).

Conclusion

In this tertiary real-world cohort of bio-naïve patients with IBD, anti-TNF and VDZ showed a similar efficacy, with an advantage of anti-TNF regarding onset of action.

THE COMPARATIVE EFFECTIVENESS OF VEDOLIZUMAB AND TNF INHIBITORS IN BIO-NAÏVE PATIENTS WITH IBD: RESULTS FROM A REAL-WORLD EXPERIENCE AT A BELGIAN TERTIARY CENTRE

Liesbeth Deroo 1, Laura Suarez 2, Marie Truyens 3, Jeroen Geldof 1, Soumaya Akhayad 1, Goedele Dewitte 1, Elien Glorieus 3, Triana Lobaton 3

1 Ghent University Hospital, Ghent, Belgium

2 University Hospital of Santiago of Compostela, Santiago de Compostela, Spain

3 Ghent University Hospital, Ghent, Belgium|||Ghent University Hospital, Ghent, Belgium

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

UEG Standards and Guidelines

Consensus

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Abstract

Background

The incidence and prevalence of inflammatory bowel disease [IBD] have increased significantly in low- and middle-income countries [LMICs] in recent decades. Managing IBD in these settings presents substantial challenges. This consensus aims to describe the epidemiology of IBD in LMICs and to highlight the key challenges in its diagnosis and treatment.

Method

The consensus-defining strategy followed the previous European Crohn’s and Colitis Organisation [ECCO] consensus guidelines [available at www.ecco-ibd.eu]. The authors reviewed the available evidence and formulated statements accordingly. Provisional ECCO statements and supporting text were drafted based on a comprehensive literature review and further refined through two voting rounds, which included external reviewers and national representatives from ECCO’s 36 member countries. The final ECCO statements, representing a consensus of at least 80% agreement among participants, were approved during an online meeting. Consensus statements should be interpreted in context with their accompanying commentary rather than in isolation and should not be used solely to guide patient management. The supporting text was finalized under the guidance of each working group leader [VP, HY, TK, AH] and subsequently integrated by the consensus leader [AE].

Results

Data on IBD epidemiology in LMICs remain limited. Public and healthcare professional awareness and timely access to early diagnostic modalities, advanced medical and surgical therapies, and specialist multidisciplinary care are key gaps in IBD care in LMICs. The complexity and chronic nature of IBD, along with the necessity for a multidisciplinary approach, pose significant challenges to adopting a holistic management strategy in LMICs.

Conclusion

There is a critical need for further studies to assess the specific needs of LMICs. Such research will help guide resource allocation and improve IBD management in these settings.

ECCO Consensus on management of Inflammatory Bowel Disease in low-and middle-income countries

Alaa El-Hussuna

Publisher

European Crohn’s and Colitis Organisation

Guideline

Consensus

Topics

IBD

Citation

Journal of Crohn's and Colitis; 2025

Published

2025

UEG Podcast Episode

UEG Podcast

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Pancreatic cystic neoplasms with Marco del Chiaro

Marco Del Chiaro, Egle Dieninyte - Misiune

Topics

Pancreas

Published

2025

UEG Podcast Episode

UEG Podcast

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Best of UEG Week - IBD with Bel Kok

Bel Klaartje Kok, Pradeep Mundre

Topics

IBD

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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Introduction

Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), requires meticulous diagnostic and monitoring protocols to optimize patient outcomes. This document synthesizes key advancements and recommendations for clinical indices, endoscopic scoring, imaging, histological assessment, and tools for evaluating IBD disability. Emphasizing validated, reproducible methods aligns with the ongoing evolution of precision medicine in IBD care, including training. The methodology of the guidelines update process is described in part 1.

ECCO-ESGAR-ESP-IBUS Guideline on Diagnostics and Monitoring of Patients with Inflammatory Bowel Disease: Part 2: IBD scores and general principles and technical aspects

Henit Yanai

Publisher

European Crohn’s and Colitis Organisation

Guideline

Clinical Practice Guideline

Topics

IBD

Citation

Journal of Crohn's and Colitis, Volume 19, Issue 7

Published

2025

UEG Standards and Guidelines

Clinical Practice Guideline

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MAIN RECOMMENDATIONS

ESGE recommends the combination of endoscopic ultrasound-guided tissue acquisition (EUS-TA) and endoscopic retrograde cholangiopancreatography (ERCP)-based tissue acquisition as the preferred diagnostic approach for tissue acquisition in patients with jaundice and distal extrahepatic biliary stricture in the absence of a pancreatic mass.
ESGE suggests that brushing cytology should be completed along with fluoroscopy-guided biopsies, wherever technically feasible, in patients with perihilar biliary strictures.
ESGE suggests EUS-TA for perihilar strictures when ERCP-based modalities yield insufficient results, provided that curative resection is not feasible and/or when cross-sectional imaging has shown accessible extraluminal disease.
SGE suggests using standard ERCP diagnostic modalities at index ERCP. In the case of indeterminate biliary strictures, ESGE suggests cholangioscopy-guided biopsies, in addition to standard ERCP

Diagnostic work-up of bile duct strictures: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Antonio Facciorusso

Publisher

European Society of Gastrointestinal Endoscopy

Guideline

Clinical Practice Guideline

Topics

Endoscopy

Citation

Endoscopy 2025; 57: 166-185

Published

2024

UEG Standards and Guidelines

Clinical Practice Guideline

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Abstract

Pancreatic exocrine insufficiency (PEI) is defined as a reduction in pancreatic exocrine secretion below the level that allows the normal digestion of nutrients. Pancreatic disease and surgery are the main causes of PEI. However, other conditions and upper gastrointestinal surgery can also affect the digestive function of the pancreas. PEI can cause symptoms of nutritional malabsorption and deficiencies, which affect the quality of life and increase morbidity and mortality. These guidelines were developed following the United European Gastroenterology framework for the development of high-quality clinical guidelines. After a systematic literature review, the evidence was evaluated according to the Oxford Center for Evidence-Based Medicine and the Grading of Recommendations Assessment, Development, and Evaluation methodology, as appropriate. Statements and comments were developed by the working groups and voted on using the Delphi method. The diagnosis of PEI should be based on a global assessment of symptoms, nutritional status, and a pancreatic secretion test. Pancreatic enzyme replacement therapy (PERT), together with dietary advice and support, are the cornerstones of PEI therapy. PERT is indicated in patients with PEI that is secondary to pancreatic disease, pancreatic surgery, or other metabolic or gastroenterological conditions. Specific recommendations concerning the management of PEI under various clinical conditions are provided based on evidence and expert opinions. This evidence-based guideline summarizes the prevalence, clinical impact, and general diagnostic and therapeutic approaches for PEI, as well as the specifics of PEI in different clinical conditions. Finally, the unmet needs for future research are discussed.

European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: UEG, EPC, EDS, ESPEN, ESPGHAN, ESDO, and ESPCG evidence-based recommendations

Juan Enrique Dominguez-Munoz

Publishers

European Society for Primary Care Gastroenterology, European Society of Digestive Oncology, European Society for Paediatric Gastroenterology, Hepatology and Nutrition, The European Society for Clinical Nutrition and Metabolism, European Digestive Surgery, European Pancreatic Club

Guideline

Clinical Practice Guideline

Topics

Pancreas

Citation

United European Gastroenterol J. 2024; 1–48. https://doi.org/10.1002/ueg2.12674

Published

2024

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