Citations 2
An Enhanced Treatment Algorithm Targeting Mucosal Healing Is Effective and Safe in Older Patients With Crohn's Disease: A Post Hoc Analysis of the REACT2 Trial
Goodwin, Shane W. , Vuyyuru, Sudheer K. , Sedaño, Rocío , Zou, Guangyong, Dulai, Parambir S., Singh, Siddharth , Narula, Neeraj, Ma, Christopher, Jairath, Vipul, Zou, Guangyong , Ma, Christopher , Vuyyuru, Sudheer Kumar , Zou, Guangyong , Dulai, Parambir S , Singh, S , Narula, Neeraj , Ma, C , Sedano, Rocio , Dulai, Parambir S. , Narula, Neeraj , Jairath, Vipul
American Journal of Gastroenterology | April 3, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available
INTRODUCTION: Safety and effectiveness of treating to target mucosal healing in older patients with Crohn's disease (CD) is unknown. METHODS: We analyzed CD-related complications by 24 months in the randomized evaluation of an algorithm for Crohn's treatment—study 2-2 trial that randomized practices to an enhanced-care or step-care algorithm to determine whether patient age modifies the effect of treatment. Data were analyzed using marginal Cox regression and modified Poisson regression. RESULTS: There was no difference in treatment between younger and older patients in at 24 months. DISCUSSION: Enhanced-care was effective and not associated with increased risk compared with step-care in older patients with CD.
Pharmacological management of upper gastrointestinal Crohn’s disease: a systematic review
Chatto, Mark, Alaskar, Dimah A. , Ma, Christopher , Yuan, Yuhong , Narula, Neeraj , Singh, Siddharth, Sedaño, Rocío , Bessissow, Talat , Narula, Neeraj , Jairath, V , Sedano, Rocio , Ma, C , Vuyyuru, Sudheer K. , Bessissow, Talat , Danese, Silvio , Peyrin‐Biroulet, Laurent
Journal of Crohn's and Colitis | October 26, 2025 | Volume: 19 | Issue: 10 | Pages: No page available
Abstract Background Upper gastrointestinal Crohn’s disease (UGICD) is an uncommon phenotype with limited management guidelines. We reviewed evidence on the safety and efficacy of pharmacological interventions for UGICD. Methods We searched MEDLINE, Embase, and Cochrane CENTRAL (1990-2025) for randomized controlled trials (RCTs) and comparative observational studies evaluating pharmacological or dietary interventions for UGICD, including esophagus to jejunum. Two reviewers screened studies, extracted data, and assessed bias (Newcastle–Ottawa Scale). Primary outcomes were clinical remission and response. Due to limited, heterogeneous evidence, data are summarized descriptively. Results Of 1207 citations, 11 observational studies (nine retrospective, two prospective) and post-hoc analyses from two RCTs met the criteria, involving 387 patients. Most had ileocolonic involvement (280/387; 72.3%); only 8.5% (33/387) had isolated UGICD. Five studies (137 patients) reported esophageal CD. Follow-up ranged from 6 weeks to 28 years. Interventions and outcomes varied. Anti-tumor necrosis factor (anti-TNF) drugs and corticosteroids, alone or combined with other treatments, were associated with improvements in clinical outcomes, endoscopic healing, and histology, but controlled data are lacking. Other therapies, including proton pump inhibitors, H2-receptor antagonists, enteric nutrition, immunomodulators, anti-integrins, and anti-interleukin12/23, showed moderate to minimal improvement. Conclusions Our systematic review highlights a paucity of evidence to inform therapeutic strategies in UGICD. Positive outcomes were reported for corticosteroids and anti-TNF, but from small observational and uncontrolled studies. Data for most advanced therapies remain limited, highlighting a large unmet need to inform clinical practice.