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Abstract Background Semaglutide, a glucagon-like peptide-1 receptor agonist, has shown sustained and clinically significant weight loss in the general population. There are limited data on outcomes of its use in patients with inflammatory bowel disease (IBD). Methods A retrospective cohort study was conducted between June 4, 2021, and December 11, 2023, using TriNetX, a U.S. multi-institutional database in patients with obesity who had IBD compared with patients without IBD. The primary aim was to assess the mean total body weight (TBW) change between 6 and 15 months from initiation of semaglutide compared with baseline between the 2 cohorts. One-to-one (1:1) propensity score matching was performed for demographics, comorbid conditions, smoking status, and mean body mass index. A 2-sample t test was performed to assess mean TBW change from baseline, with a P value <.05 considered to be statistically significant. We also compared the risk of IBD-specific outcomes with and without semaglutide use in patients with IBD. Results Out of 47 424 patients with IBD and obesity, 150 (0.3%) patients were prescribed semaglutide (mean age 47.4 ± 12.2 years; mean TBW 237 ± 54.8 pounds; mean body mass index 36.9 ± 6.5 kg/m2; 66% Crohn’s disease). There was no difference in mean TBW change after initiation of semaglutide in the IBD and non-IBD cohorts (−16 ± 13.4 pounds vs −18 ± 12.7 pounds; P = .24). There was no difference in mean TBW change between 6 and 12 months (−16 ± 13 pounds vs −15 ± 11.2 pounds; P = .24) and 12 and 15 months (−20 ± 13.2 pounds vs −21 ± 15.3 pounds; P = .49) between the 2 cohorts. There was no difference in the risk of oral or intravenous steroid use and any-cause hospitalization in the semaglutide group compared with the group without semaglutide use in patients with IBD. Conclusion Semaglutide use is effective in patients with IBD and obesity similar to patients without IBD, with >5% mean weight loss. There was no increased risk of IBD-specific adverse events with semaglutide use. Lay Summary Semaglutide use in patients with inflammatory bowel disease (IBD) and obesity is associated with similar weight loss compared with patients without IBD, with a >5% mean weight loss. There was no increased risk of IBD-specific adverse events with semaglutide use.

AbstractInflammatory bowel diseases (IBD), comprising Crohn’s disease and ulcerative colitis, are chronic, inflammatory, immune mediated, relapsing-remitting conditions of the gastrointestinal tract with multidimensional and often negative effects on patients’ quality of life. The global burden of IBD is increasing and is forecast to affect 1% of the population in early industrialized nations over the next 10 years. Advances in our understanding of the causes and pathogenesis of IBD in the past three decades have translated into new treatments that modulate the immune inflammatory cascade. Modern goals of treatment are clinical remission through assessment of patient reported outcomes and deep remission defined as mucosal healing on colonoscopy or imaging. Achieving both clinical and deep remission affords patients a better long term prognosis and quality of life. This review summarizes the latest evidence on IBD diagnosis, staging, and prognosis, with a detailed focus on current treatments.

Abstract Background Fecal microbiota transplantation (FMT) has been investigated as a treatment option for patients with inflammatory bowel disease with controversial results. We sought to perform a systematic review and meta-analysis to evaluate the benefit of FMT in patients with ulcerative colitis. Methods Double-blind randomized controlled trials (RCTs) including adult patients with active ulcerative colitis who received either FMT or placebo were eligible for inclusion. Outcomes of interest included the rate of combined clinical and endoscopic remission, endoscopic remission or response, clinical remission or response, and specific adverse events. The results were pooled together using Reviewer Manager 5.4 software. Publication bias was assessed using the Egger’s test. Results Six RCTs involving 324 patients were included. Our findings demonstrate that compared with placebo, FMT has significant benefit in inducing combined clinical and endoscopic remission (odds ratio, 4.11; 95% confidence interval, 2.19-7.72; P < .0001). Subgroup analyses of influencing factors showed no differences between pooled or single stool donors (P = .71), fresh or frozen FMT (P = .35), and different routes or frequencies of delivery (P = .80 and .48, respectively). Pre-FMT antibiotics, bowel lavage, concomitant biologic therapy, and topical rectal therapy did not affect combined remission rates (P values of .47, .38, .28, and .40, respectively). Clinical remission or response and endoscopic remission or response were significantly higher in patients who received FMT compared with placebo (P < .05) without any differences in serious or specific adverse events. Conclusions FMT demonstrated a clinical and endoscopic benefit in the short-term treatment of active ulcerative colitis, with a comparable safety profile to placebo. Future RCTs are required to standardize study protocols and examine data on maintenance therapy. Lay Summary Our systematic review of double-blind randomized controlled trials demonstrates that fecal microbiota transplantation is effective in inducing short-term clinical and endoscopic remission in adult patients with active ulcerative colitis and with a similar safety profile as compared with placebo.

INTRODUCTION:There are limited data regarding the natural history after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). The principal objectives of this study were to identify 4 key outcomes in the natural history after IPAA within 1, 3, 5, and 10 years: the incidence of pouchitis, Crohn's-like disease of the pouch, use of advanced therapies after IPAA, and pouch failure requiring excision in a network of electronic health records.METHODS:We performed a retrospective cohort study in TriNetX, a research network of electronic health records. In addition to evaluating incidence rates, we also sought to identify factors associated with pouchitis and advanced therapy use within 5 years of IPAA after 1:1 propensity score matching, expressed as adjusted hazard ratios (aHRs).RESULTS:Among 1,331 patients who underwent colectomy with IPAA for UC, the incidence of pouchitis increased from 58% in the first year after IPAA to 72% at 10 years after IPAA. After propensity score matching, nicotine dependence (aHR 1.61, 95% confidence interval [CI] 1.19-2.18), antitumor necrosis factor therapy (aHR 1.33, 95% CI 1.13-1.56), and vedolizumab prior to colectomy (aHR 1.44, 95% CI 1.06-1.96) were associated with an increased risk of pouchitis in the first 5 years after IPAA. The incidence of Crohn's-like disease of the pouch increased to 10.3% within 10 years of IPAA while pouch failure increased to 4.1%. The incidence of advanced therapy use peaked at 14.4% at 10 years after IPAA.DISCUSSION:The incidence of inflammatory conditions of the pouch remains high in the current era, with 14% of patients requiring advanced therapies after IPAA.

INTRODUCTION:The risk of small bowel cancer (SBC) in inflammatory bowel disease (IBD) is unclear. We compared the recent trends of SBC in patients with IBD and stratified them based on disease type.METHODS:We used TriNetX database to access the electronic health records for patients with IBD, ulcerative colitis (UC), and Crohn's disease (CD) from 2005 to 2024. We used propensity score matching to compare the rate of SBC in patients with IBD, UC, and CD compared with the general population. We adjusted for all known confounders.RESULTS:From 2010 to 2024, there was an increasing trend of diagnosed SBC in patients with IBD, with an average annual percentage change of 3.2% (P < 0.001). Patients with CD (adjusted hazard ratio = 4.83; 95% confidence interval: 3.58-6.53; P < 0.0001) had an increased risk of SBC compared with the general population without IBD, as well as patients with UC (adjusted hazard ratio = 2.28; 95% confidence interval: 1.65-3.14; P < 0.0001). The ileum was the most common location across all subgroups.DISCUSSION:Both patients with CD and, interestingly, UC had an elevated risk of developing SBC compared with the general population.