Introduction

Disability is a multidimensional concept encompassing physical, psychological, and social limitations that can significantly burden individuals living with inflammatory bowel disease (IBD). However, as disability is shaped by various factors—including cultural, social, and healthcare-related influences that can differ between countries—its prevalence and characteristics may vary globally.

Aims & Methods

We aimed to meta-analyse global data on prevalence of moderate-to-severe disability (MSD) to explore differences in disability prevalence and characteristics by country, IBD subtype, disease activity. MEDLINE EMBASE, EMBASE Classic (from inception to 1^st December 2024) to identify cross-sectional and case-control studies reporting the prevalence of MSD based on validated tools (IBD–Disk and IBD-Disability Index) in adult patients (≥18 years) with confirmed IBD. Data were extracted, and pooled prevalence (PP), odds ratios (OR), and 95% confidence intervals (CIs) were calculated.

Results

The search strategy generated 3089 citations. From these, 160 individual articles appeared to be relevant to the study question and 17 fulfilled the eligibility criteria, containing 8225 patients with IBD recruited from 11 different countries. The pooled prevalence of MSD in patients with IBD was 29.6% (95% CI 22.6-37.1%; I²=98.0%, p<0.01), with no evidence of funnel plot asymmetry (Egger test, p=0.10). The lowest pooled prevalence of MSD was 7.0% in one Dutch study from the Netherlands, and the highest 51% and 52% in two studies from China and Italy, respectively. The pooled prevalence of MSD was higher in patients with IBD with active disease (56.9%, 95% CI 20.3-89.7%, I² = 93.0%, p<0.01) compared with those with inactive disease (27.0%, 95% CI 3.3-62.0%, I² = 93.0%, p<0.01). Based on three studies that reported MSD prevalence in both active and inactive disease, active IBD increased the odds of MSD more than threefold (odds ratio 3.13, 95% CI 1.74-5.64).

Conclusion

The global prevalence of MSD in the IBD population is 29.6%, and even higher among patients with active disease. These findings underscore the value of incorporating disability assessment into both clinical decision-making and routine therapeutic response —especially in the context of disease modification trials.

Introduction

Older adults with ulcerative colitis (UC) have greater morbidity than younger adults, yet there is paucity of data on the management and outcomes of those who present with acute severe ulcerative colitis (ASUC) in this patient population. This study aims to investigate differences in the management and outcomes between older and younger patients hospitalised with ASUC.

Aims & Methods

We conducted a retrospective study on all ASUC presentations to a Quaternary Sydney hospital over a 10-year period. A modified True-love Witts’ Criteria was used to identify ASUC as ≥6 bloody bowel motions daily and presence of at least one systemic feature, including heart rate >90 bpm, temperature >37.8°C, haemoglobin <105 g/L, and C-reactive protein (CRP) ≥30 mg/L. Older patients who presented with ASUC was defined as those ≥65 years old at time of presentation. Data collected on management included rates of rescue therapy, colectomy and TPN requirement. Data collected on outcomes included hospital length of stay and rates of ICU admission, 30- and 90-day readmission, and 30- and 90-day mortality.

Results

A total of 172 presentations met criteria for ASUC. Of these presentations, 148 patients (86.1%) were <65 years old and 24 patients (13.9%) were ≥65 years old. Median age at presentation in older adults was 73.6 years old and in younger adults was 32.0 years old. Older adults had similar rates of need for rescue therapy (37.5% vs 35.1%, p=0.08), colectomy (12.5% vs 9.5%, p=0,64) and TPN (12.5% vs 10.1%, p=0.73), as their younger counterparts. Older adults (n=6, 25.0%) had significantly higher rates of ICU admission (p<0.01) compared to those <65 years old (n=3, 2.0%). Older adults also had significantly higher 30- and 90-day mortality rates (n=3, p<0.01). There was no mortality observed in adults <65 years old. There was no significant difference in 30- and 90-day readmission rates between older adults and those <65 years old at time of ASUC presentation. Table 1 compares management and outcomes in adults <65 years old and ≥65 years old who presented with ASUC.

Table 1. Comparison of management and outcomes in adults <65 years old and ≥65 years old who presented with ASUC

	Age <65 (n=148)	Age ≥ 65 (n=24)	p-value
Received rescue therapy (n, %)	52 (35.1)	9 (37.5)	0.08
Underwent colectomy (n, %)	14 (9.5)	3 (12.5)	0.64
Required TPN (n, %)	15 (10.1)	3 (12.5)	0.73
Required ICU admission (n, %)	3 (2.0)	6 (25.0)	<0.01
30-day readmission (n, %)	22 (14.9)	6 (25.0)	0.21
90-day readmission (n, %)	30 (20.3)	8 (33.3)	0.15
30-day mortality (n, %)	0 (0.0)	3 (12.5)	<0.01
90-day mortality (n, %)	0 (0.0)	3 (12.5)	<0.01
Mean length of stay (days)	10.3	14.0	0.12

Conclusion

Despite similar rates of need for rescue therapy and colectomy, older patients who present with ASUC are more likely to have poorer outcomes, with increased requirement of ICU admission and higher mortality rates compared to patients <65 years old. The higher morbidity and mortality observed in our study in older adults who present with ASUC highlights the need for further research to optimise care pathways and improve outcomes in this patient population.

Introduction

Patients with ulcerative colitis (UC) are at increased risk of developing colorectal cancer (CRC), and this is assumed to be due to chronic inflammation of the colorectal mucosa.

Aims & Methods

To identify risk factors for the development of dysplasia or CRC in patients with UC. Retrospective observational cohort study. Clinical data and colonoscopy findings were collected from medical records. A 1:2 Propensity Score Matching (PSM) was performed to balance covariates adjusting for disease extension, age, gender, smoking habit and disease duration. An Andersen-Gill model was used to account for multiple colonoscopies per patient and time-varying risk of dysplasia or CRC, allowing for recurrent events and intra-individual correlation.

Results

A total of 571 UC patients were identified, median age at diagnosis was 39.5 (27.3-54.2), and 304 (53.2%) were men. At diagnosis, 147 (25.7%) had proctitis, 203 (35.6%) left side colitis and 191 (33.5%) extensive colitis. During a median follow-up of 7.1 years (IQR 3.7– 13.3), 51 patients (9.8%) developed dysplasia/CRC. This was more frequent in males (72.9% vs. 27.1%, p=0.004) and in older patients [48.1 years (36.7–60.2) vs. 38.5 years (26.5–53.8), p=0.004].
After PSM adjustment, 123 patients were included, 41 of whom had dysplasia/CRC, with a total of 381 colonoscopies over a follow-up period of 14.6 years (IQR 8.0–22.4). Macroscopic inflammatory activity was present in 283 (74.3%) colonoscopies and microscopic involvement in 5 (1.3%). Older age at diagnosis (aHR 1.03, 95% CI 1.04–1.10, p<0.001) and higher degree of macroscopic inflammation (aHR 1.44, 95% CI 1.02–2.03, p=0.041) were associated with an increased risk of dysplasia/CRC development; advance therapy, family history of CRC, disease extension and microscopic inflammation were not associated with an increased risk.

Table 1. Baseline characteristics of the complete cohort and after Propensity Matching Score.

	Complete cohort				PMS
	N = 571	No dysplasia/CRC	Dysplasia/CRC	p	N = 123	No dysplasia/CRC	Dysplasia/CRC	p
		515 (90.2%)	56 (9.8%)			82 (66.6%)	41 (33.3%)
Male, n (%)	304 (53.2)	262 (59.4)	42 (75)	0.123	88 (71.5)	59 (67)	29 (33)	0.88
Age at diagnosis median (IQR), years	39.5 (27.3-54.2)	36.2 (25.9-49.5)	41.6 (28.5-56.2)	<0.0001	48.3 (35.6-59.0)	41.6 (28.5-56.2)	36.2 (25.9-49.5)	0.372
Disease extension, n (%) -Proctitis (E1) -Left side (E2) -Pancolitis (E3)	147 (25.7) 203 (35.6) 191 (33.5)	127 (24.1) 182 (35.3) 178 (34.6)	20 (35.7) 21 (37.5) 13 (23.2)	0.808	38 (30.9) 46 (37.4) 39 (31.7)	26 (31.7) 31 (37.8) 25 (30.5)	12 (29.3) 15 (36.6) 14 (34.1)	0.914
Mayo endoscopic score at diagnosis, n (%) -Mild (Mayo 1) -Moderate (Mayo 2) -Severe (Mayo 3)	83 (14.3) 279 (47.9) 108 (18.6)	68 (13.2) 256 (49.7) 96 (18.6)	15 (26.8) 23 (41.1) 11 (19.6)	0.106	24 (23.3) 53 (51.45) 26 (25.2)	16 (19,5) 35 (42,6) 16 (19,5)	8 (19.5) 18 (43.9) 10 (24.4)	0.797
Smokers, n (%) -Yes -Ex-smokers	66 (11.6) 86 (15.1)	57 (11.1) 77 (15)	9 (16.1) 9 (16.1)	0,004	20 (16.3) 103 (83.7)	13 (15.9) 69 (84.1)	7 (9.8) 34 (82.9)	0.863
EIMs at diagnosis, n (%)	40 (7)	38 (7.4)	2 (3.6)	0.887	11 (8.9)	10 (12.2)	1 (2.4)	0.074
Advanced therapy, n (%)	152 (26.8)	142 (27.7)	10 (17.9)	0.113	36 (29.3)	25 (30.5)	11 (26.9)	0.674

Conclusion

Older age at diagnosis and the presence of macroscopic involvement on successive colonoscopies are associated with an increased risk of developing dysplasia or CRC in patients with UC.

Disclosure

Beatriz Gros has worked as an advisor for Abbvie, Pfizer, Alphasigma and Roche and has served as an speaker for Abbvie, Pfizer, Alphasigma, Roche, Janssen, Takeda and Gilead.

Introduction

Aim: To report on the efficacy and safety of elective switching from intravenously (IV) to subcutaneously (SC) administered Vedolizumab in Inflammatory Bowel Disease (IBD) patients in clinical remission.

Aims & Methods

Retrospective analysis of IBD patients in clinical remission who were receiving Vedolizumab IV for treatment of their disease in a single tertiary center and were switched to SC, based on their physician’s choice. The primary endpoint was disease deterioration during the follow-up period, according to the disease specific composite measures. In CD, clinical remission was defined as Crohn's Disease Activity Index (CDAI) <150 and in UC as Simple Clinical Colitis Activity Index (SCCAI) <2.

Results

Between December 2023 and February 2025, 86 patients (Crohn’s disease = 17, Ulcerative colitis = 69) were consulted in order to switch from IV to SC vedolizumab administration. Five patients (5,8%) did not want to change and therefore, 81 patients (94,2%) were finally switched. All patients were in clinical remission. After a mean (SD) follow up period of 8 (4) months, 9 patients (11,1%) experienced worsening of their disease, and were either switched back to IV VDZ (n=4, 4,9%) or to another agent (n=5, 6,2%). The remaining 72 patients (88,8%) showed favorable response, none of them requested an unscheduled visit, or developed an adverse event (clinical or laboratory) or needed escalation of treatment.

Conclusion

Elective switching from IV to SC Vedolizumab seems to be an effective and safe approach in real-world every day clinical practice in IBD patients in clinical remission.

Introduction

Intestinal ultrasound (IUS) is increasingly used as a point-of-care tool for patients with ulcerative colitis (UC). Non-invasive monitoring is essential for managing disease progression and therapeutic intervention in pediatric UC patients. The Milan Ultrasound criteria (MUC), ulcerative colitis intestinal ultrasound score (UC-IUS), and Civitelli score show promise as real-time disease activity assessment tools, potentially reducing the need for invasive procedures like endoscopy.

Aims & Methods

A prospective cohort of 34 pediatric UC patients underwent IUS and colonoscopy to assess disease activity using MUC, UCIUS, and Civitelli scores. Assessments were conducted within a 7-day interval, with no therapeutic changes between procedures. Diagnostic accuracy was determined using receiver operating characteristic (ROC) curves, with endoscopy as the reference
standard, and histological parameters assessed in a subset of patients using the Nancy Index.

Results

The study included 34 pediatric UC patients (median age: 14.7 years; 65% male) with varied disease severities and durations (median duration: 12.6 months; median PUCAI: 30; median fecal calprotectin: 1041 μg/g). Bowel wall thickness (BWT) correlated significantly with all IUS scores; however, no correlation was observed between BWT and baseline Mayo endoscopic disease activity. The area under the curve (AUC) was 0.528 (CI:0.348–0.704) for MUC, 0.602 (CI: 0.418–0.768) for UC-IUS, and 0.572 (CI: 0.388–0.742) for the Civitelli score, indicating moderate diagnostic accuracy. While differences among scores were not statistically significant, UC-IUS demonstrated the highest accuracy. In 16 patients with available Nancy Index data, the AUC values were 0.500 for MUC, 0.579 for Civitelli, and 0.563 for UC-IUS, further supporting moderate accuracy (Table 1).

Score	AUC (vs Endoscopic Findings)	AUC (vs Histological Parameters)
MUC	0. 528	0.500
UC-IUS	0.602	0.563
Civitelli	0.572	0.579

Table 1. Ultrasound characteristics and disease activity scores for the pediatric patients with UC.

Conclusion

Both MUC, Civitelli, and UC-IUS scores provide moderate diagnostic accuracy in assessing pediatric UC, though potentially less effective than in adult populations. UC-IUS, with its emphasis on vascularization, haustration and wall thickness, may offer enhanced sensitivity in pediatric patients. Lowering the cut-off for bowel wall thickness may improve accuracy in children, given their thinner, yet highly vascularized bowel walls, particularly in early disease stages.

References

1. van Wassenaer EA, van Rijn RR, Zwetsloot SLM, et al. Intestinal Ultrasound to Assess Ulcerative Colitis Disease Activity in Children: External Validation and Comparison of 2 Intestinal Ultrasound Activity Indices. Inflamm Bowel Dis. 2023;29:1217-1222.
2. Allocca M, Dell'Avalle C, Craviotto V, et al. Predictive value of Milan ultrasound criteria in ulcerative colitis: A prospective observational cohort study. United European Gastroenterol J. 2022;10:190-197

Introduction

Vedolizumab, a α4β7 integrin monoclonal antibody represents an effective and well-tolerated therapeutic option for patients with moderate to severe Crohn's disease (CD)¹. Its use as a first-line biologic therapy is authorized in some European countries, particularly Belgium, providing an opportunity to assess its performance when introduced early in the treatment algorithm. Real-world data on long-term treatment persistence, particularly beyond three years, remain limited. This retrospective monocentric study aims to assess Vedolizumab persistence over five years in patients with CD, as well as evaluating the ability to predict treatment persistence based on the CDST (Crohn’s Disease Subtype Tool) score.

Aims & Methods

This is a retrospective monocentric study including 60 patients with CD, followed at a central university hospital in Brussels. All patients were treated with Vedolizumab administered intravenously, between 2015 and 2024. We evaluated treatment persistence defined as the continuation of Vedolizumab without interruption assessed at 6,12,24,36,and 60 months. Patients who had not yet reached the pre-set follow-up time points at the time of inclusion were excluded from the analysis at that specific time point, without being considered as treatment discontinuation. Persistence was described cross-sectionally at each time point. A CDST score was retrospectively calculated for all patients based on the available data before treatment initiation.

Results

A total of 60 patients with CD treated with Vedolizumab were included. Follow-up duration ranged between 1 and 107 months. The cohort consisted of 52% males with a mean age of 45.4 ± 14.5 years. 58 patients had completed at least 6 months of follow-up. Treatment persistence with Vedolizumab was 93% at 6 months (54/58), 87% at 12 months (47/54), 76.5% at 24 months (39/51), 67.4% at 36 months (31/46), and 56.1% at 60 months (23/41). 62% of patients were bio-naïve. The mean CDST score for all patients was 20.6 ± 2.6. The distribution of patients according to their predicted response to Vedolizumab was as follows: low probability of response (CDST ≤ 13): 1 patient (2%); intermediate probability (13 < CDST ≤ 19): 12 patients (20%); high probability of response (CDST > 19): 47 patients (78%). A comparative analysis of the CDST scores between patients who discontinued treatment and those with treatment persistence was performed at each follow-up time point. At 6 months, the mean CDST score was 20.47 in the treatment discontinuation group versus 21.2 in the persistence group (p = 0.713). At 12 months, the means were 21.6 and 21.0, respectively (p = 0.713). Similar trends were observed at 24 months (19.2 vs 20.9; p = 0.304), at 36 months (18.23 vs 20.9; p = 0.136), and at 60 months (19.7 vs 20.6; p = 0.523). These results suggest a trend toward higher CDST scores in patients with treatment persistence, although these differences did not reach statistical significance. Of the patients who completed five years of vedolizumab treatment, 9 out of 23 (39%) were biologic-naïve, while 14 out of 23 (61%) had prior exposure to biologic therapies.

Conclusion

This real-world retrospective study provides valuable insights into the long-term use of Vedolizumab in patients with CD, with a follow-up period extending up to five years. Treatment persistence over time was favorable in both biologic-naïve and exposed patients, particularly among those with a high CDST score. The extended follow-up period reinforces the durability and safety of Vedolizumab as a long-term therapeutic option in clinical practice. Prospective studies are needed to confirm these findings and identify predictors of sustained response.

References

Sandborn, W. J., Feagan, B. G., Fedorak, R. N., & et al. (2013). Vedolizumab as induction and maintenance therapy for ulcerative colitis. New England Journal of Medicine, 369(8), 699-710.

Introduction

The European Society of Gastrointestinal Endoscopy (ESGE) recommends colorectal cancer (CRC) screening for individuals at average risk, aged 50-75 years. However, recent trends indicate an increasing incidence of colorectal neoplasms among younger individuals.

Aims & Methods

The primary aim of this cross-sectional study is to record the prevalence of polyps, adenomas, and advanced neoplasia (high-grade dysplasia and CRC) in individuals up to 49 years old, and secondarily to identify predictors of neoplasia and high-grade dysplasia. The data were collected retrospectively through the hospital’s electronic database. All serial colonoscopies, with cecum intubation, from 1/1/2018 until 31/12/2024 were included. Endoscopies in patients with diagnosed familial polyposis syndromes, inflammatory bowel disease and those with poor bowel preparation were excluded. Patients’ demographics, CRC family history and the recorded polyps' size, location, Paris classification, and pathology reports were collected. SPSS 23 (IBM, Armonk, NY, USA) was used for the statistical analysis.

Results

Table. Polyps, adenomas and advanced adenomas by age groups
	<25 (n=36)	25-29 (n=31)	30-34 (n=61)	35-39 (n=76)	40-44 (n=146)	45-49 (n=218)	Total (n=568)	P
Polyps, n (%)	0 (0)	2 (6.5)	6 (9.8)	20 (26.3)	52 (35.6)	86 (39.4)	166 (29.2)	<0.001
Adenoma, n (%)	0 (0)	1 (3.2)	2 (3.3)	9 (11.8)	21 (14.4)	36 (16.5)	68 (12.1)	0.006
Advanced adenoma, n (%)	0 (0)	1 (3.2)	0 (0)	3 (3.9)	4 (2.8)	12 (5.6)	20 (3.5)	0.266

A total of 568 colonoscopies were included, involving 306 male patients (53.8%), with a median age of 42 years (IQR: 36-46). Of these, 71 patients (12.5%) had a family history of CRC. At least one polyp was identified in 166 patients (29.2%), with adenomas observed in 68 patients (12.1%) and advanced neoplasia in 20 patients (3.5%), including 3 patients (0.5%) diagnosed with CRC (Table). Advanced adenomas were more frequently detected in colonoscopies performed due to visible blood in stools (8.5%) and as follow-up after diverticulitis (7.1%). In multivariate analysis, in which age, family history of CRC, and bowel preparation quality were included as variables, the presence of adenomas and advanced adenomas was significantly associated with age (adenoma OR = 1.08; 95% CI: 1.04-1.13 and advanced adenoma OR = 1.08; 95% CI: 1.00-1.18).
In total 271 polyps were identified. Ninety-four were adenomas of which 74 had low-grade dysplasia and 20 high-grade dysplasia or cancer. Sixteen of 177 not-adenomatous polyps were found to be serrated and 2 of those had low-grade dysplasia. “Large” polyps [≥10mm] had a higher probability of being adenomas (71.4%) compared to “small” [5-9mm] (26.2%) and “diminutive” [<5mm] (24.4%), Chi square P<0.001. Regarding the Paris classification Ip and Isp presented a higher probability to be adenomas (87.5% and 86.4% respectively) in contrast to Is and 0-IIa (35.6% and 12.2% respectively), Chi square P<0.001.
The resected adenomas were also categorized according to the type of reported dysplasia to identify predictors of high-grade dysplasia. High-grade dysplasia was present in 42.5% of large polyps compared to 4.5% of small and 6.2% of diminutive (Chi square P<0.001). High-grade dysplasia was also present in a higher frequency in polyps resected from the “left” colon (26.2%) compared to the “right” (10.3%) and in 0-IIa (66.7%) and Ip (38.1%) compared to Isp (21.1%) and Is (12.5%) polyps according to the Paris classification, but not in a statistically significant degree (Chi square P<0.010).

Conclusion

Despite the relatively small sample size of our study, initiation of screening at a younger age should be considered to be lowered, since adenoma and advanced adenoma were identified in 15% and 4.3% of individuals aged 35-49.

Disclosure

GB: Advisor/lecturer for Janssen, Pfizer, Takeda, Abbvie, MSD, Mylan, Genesis Pharma, Adacyte Therapeutics, Amgen, Ferring, Cooper; Funding (Grants/Honoraria): Pfizer, Takeda, Abbvie, Aenorasis; Research/Clinical Trials: Abbvie, Takeda.