Urquhart, Siri A.

Lay Summary Oral vancomycin shows promise in treating pouchitis in patients with primary sclerosing cholangitis and ulcerative colitis. In this study, vancomycin helped reduce stool frequency, urgency, and incontinence. More research is needed to confirm its long-term benefits and best treatment practices.

Inflammatory bowel disease (IBD) is a group of chronic inflammatory conditions of the gastrointestinal tract resulting from an inappropriate immune response to an altered gut microbiome in genetically predisposed individuals. Endoscopy plays a central role in IBD management, aiding in diagnosis, disease staging, monitoring, and therapeutic guidance. Patients with IBD face an increased risk of colorectal neoplasia due to chronic inflammation. Artificial intelligence (AI)-based systems show promise in detecting and classifying dysplasia and neoplasia during endoscopic evaluation. While there have been several studies on the application of AI to detect and diagnose various types of neoplasia in the non-IBD population, the literature in patients with IBD is limited. We aim to summarize the current evidence on the application of AI technologies to detect IBD-associated neoplasia, highlighting potential benefits, limitations, and future directions. A comprehensive literature search was performed using the PubMed database to identify relevant studies from January 2010 to February 2025. Additional references were identified from the relevant articles’ bibliographies. AI-assisted endoscopy, particularly using machine learning and deep learning techniques, has shown promise in improving lesion detection rates and supporting real-time decision-making. Computer-aided detection systems may increase the sensitivity of dysplasia identification, while computer-aided diagnosis tools can aid in lesion characterization. Early studies suggest that AI can reduce interobserver variability, improve targeting of biopsies, and potentially lead to more personalized surveillance strategies. Although clinical data specific to IBD-related neoplasia remain limited compared to sporadic colorectal neoplasia, the integration of AI into endoscopic practice holds significant potential to enhance dysplasia detection and improve patient outcomes. Continued research, validation in IBD-specific cohorts, and integration with clinical workflows are essential to realize the full impact of AI in this setting.

ABSTRACT Immunoglobulin A vasculitis (IgAV) is an immune-mediated disorder that commonly involves dermatologic, musculoskeletal, renal, and gastrointestinal systems. Drug-induced cases of IgAV are rare and sparsely documented in the literature. We report a case of a patient with Crohn's disease who developed a tender, palpable purpuric rash on the torso and extremities 3 weeks after receiving a dose of ustekinumab. This case underscores the importance of considering IgAV in patients with inflammatory bowel disease who present with cutaneous symptoms while undergoing treatment with advanced therapies.

Abstract Background Patients with Crohn’s disease (CD) who have ileal or any small bowel (SB) involvement are at increased risk of developing SB cancer. Due to the rarity of this complication of CD, we aimed to describe the clinical features, presentation, and of small bowel neoplasms (SBN) in patients with CD. Methods A case-control study was performed to include patients ≥18 years old with a diagnosis of CD with or without SBN at a single large referral center from January 1992 to May 2023. Patients were identified using bioinformatics and natural language processing tools, as well as anatomic pathology records. Two age- and sex-matched controls were identified for each case. Results In total, 54 patients with CD and SBN and 108 patients with CD without SBN were identified. Of the cases, most had ileal CD (55.6%) with stricturing (59.3%) phenotype. Median duration of CD prior to SBN diagnosis was 19.5 years. Nonpenetrating/nonstricturing behavior (odds ratio [OR], 9.23; 95% CI, 2.91-29.32; P = .0008) was significantly associated with an increased odds of SBN. History of tobacco use (OR, 0.27; 95% CI, 0.13-0.60; P = .0011) and IBD-associated colonic neoplasia (OR, 0.18; 95%, CI 0.4-0.85; P = .0303) were protective in development of SBN. Conclusions Nonpenetrating/nonstricturing CD appeared to raise SBN risk. History of tobacco use and colonic IBD-associated neoplasia are associated with reduced risk of SBN. Further studies with large sample sizes are needed to determine true incidence and risk factors associated with SBN in CD and assess potentially protective effects of early surgery.

Abstract Background and Aims Patients with inflammatory bowel disease (IBD) face increased risk of colorectal cancer (CRC). While the natural history of conventional dysplastic precursor lesions has been well-studied, the neoplastic potential of recently described nonconventional (NC) IBD-associated colonic mucosal lesions is unclear. We aimed to assess the incidence of antecedent NC lesions in patients with IBD who developed CRC. Methods A case-cohort study was performed to include patients with a diagnosis of IBD with or without CRC who underwent at least 2 surveillance endoscopic procedures at our institution between 1/1/2007 and 5/31/2023. NC lesions included serrated change and indefinite for dysplasia. Detection rates pre- and post-introduction of high-definition (HD) surveillance colonoscopy were compared. Results In total, 87 patients with IBD and CRC and 200 patients with IBD without CRC were identified. Of the cases, a majority had ulcerative colitis (n = 52, 60%), most commonly with extensive involvement (n = 46, 89%). Conventional (hazard ratio [HR] 2.18, 95% confidence interval [CI] 1.34-3.52) and NC (HR 2.28, 95% CI 1.59-3.26) lesions were associated with increased risk of CRC. Conventional lesions in the post-HD era appeared to have a stronger association with CRC (HR 2.79, 95% CI 1.62-4.77) than NC lesions (HR 1.62, 95% CI 0.86-3.06). Conclusions Both conventional and NC lesions seem to be associated with increased risk of CRC. Conventional lesions are more strongly associated with CRC than NC lesions in the post-HD era, but misclassifications in the pre-HD era may have resulted in a biased increased risk estimate for NC lesions.

ABSTRACT Orofacial granulomatosis (OFG) is a rare syndrome that can occur in association with Crohn's disease (CD). The electronic medical record was searched for “OFG” and “CD.” A total of 297 patients were identified, and relevant data were abstracted. Five patients met inclusion criteria. Most (80%) had ileocolonic CD with nonstricturing/nonpenetrating phenotype. The most common treatments included intralesional corticosteroids (4 patients), oral corticosteroids (3 patients), and anti-TNF agents, specifically infliximab (3 patients). Intralesional corticosteroid administration was followed by partial response in 3 patients, but recurrences were common following initial injection. One patient had no response to topical or oral corticosteroids, antihistamines, or oral antibiotics, but partial response to intralesional corticosteroids and infliximab. None of the patients had complete response to any therapies directed at this condition. OFG may be characterized by partial response, often requiring long-term therapy. Additional investigations into novel treatments may improve future clinical outcomes.

Lay Summary Upadacitinib, a selective JAK-1 inhibitor, was used as rescue therapy for ulcerative colitis in the setting of pregnancy following use of mesalamine, vedolizumab, infliximab, and corticosteroids. This resulted in an uncomplicated live full birth without need for surgical intervention.

LINKED CONTENTThis article is linked to Fernandez‐Clotet et al paper. To view this article, visithttps://doi.org/10.1111/apt.17968