Gastroenterology

The UK vedolizumab real-life experience study in inflammatory bowel disease (VEST): patient characteristics, drug persistence and patient-centred outcomes (2026)

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Type of publication:

Journal article

Author(s):

Bodger, Keith; Booker, Cheryl; Taylor, Frederick; Ahmad, Tariq; Bloom, Stuart; *Butterworth, Jeffrey; Kok, Klaartje; Lobo, Alan; Irving, Peter; Cummings, J R Fraser.

Citation:

Therapeutic Advances in Gastroenterology. 19:17562848261446551, 2026.

Abstract:

Background: VEST was a multi-centre study of real-world use of vedolizumab in inflammatory bowel disease (IBD) in routine practice in the United Kingdom.

Objectives: To describe real-world indications, effectiveness, patient-reported outcomes and safety.

Design: Prospective observational cohort study at 22 centres.

Methods: Patients receiving vedolizumab as part of standard care were included. Data were collected at infusion visits for activity indices (Harvey-Bradshaw Index (HBI) or partial Mayo Score (PMS)), physician global assessment (PGA), patient-reported quality-of-life and treatment perception (IBD-Control Questionnaire) and adverse events. Clinical response (Wk14) was defined as a reduction in HBI 3 or PMS 2, clinical remission as HBI 4 or PMS 1 and analysed using non-responder imputation. One-year persistence was defined as continuing on vedolizumab after an infusion at 48 weeks. Biomarker and endoscopic data were not available.

Results: 364 patients, mean age: 48 years; 132 (36%) with Crohn's disease (CD), 224 (62%) with UC and 8 (2%) with IBD-U; 174 (48%) male; 142 (39%) receiving steroids at baseline (Wk0); 141 (39%) bio-naive. At baseline, 279 (77%) had "active" disease. One-year persistence: 58% overall (54% for active disease). Among persistent cases (n = 212), median (IQR) IBD-Control-8 scores improved from 6 (3-10) at baseline to 14 (10-16) at post-induction (Wk14) and 1 year (p < 0.001 vs baseline). Corresponding scores for IBD-Control-VAS were: 50 (30-70), 80 (65-90) and 85 (70-95), respectively (p < 0.001 vs baseline). Each domain of IBD-Control-8 showed improvement. Baseline and post-induction health status (activity index, PGA or IBD-Control) were associated with 1-year persistence, but no significant associations were observed for disease type, duration, bio-naive status or baseline steroids. Of those with active disease at Wk0, clinical remission rates were 29%, 30% and 38% for CD, UC and IBD-U, respectively, and steroid-free remission rates were 26%, 27% and 38%. Similar remission rates were observed at 1 year. Possible adverse events leading to treatment cessation were rare (3%).

Conclusion: In routine clinical practice in the UK, vedolizumab demonstrated high levels of persistence. Similar rates of clinical response, remission and 1-year persistence were seen in UC and CD patients, and in bio-experienced versus naive cases. Persistent cases experienced significant and sustained improvements in quality of life and treatment perception. Persistence does not imply anti-inflammatory efficacy, as biomarker data were not available.

DOI: 10.1177/17562848261446551

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Exome sequencing directly implicates 68 genes in inflammatory bowel disease (2026)

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Type of publication:

Journal article

Author(s):

Zhu, Ruifei; Zhang, Qian; Yuan, Kai; Zhang, Rui; Turvey, Alexandra K; Stevens, Christine R; Fachal, Laura; Ahmad, Tariq; Bel Kok, Klaartje; Bernstein, Charles N; Bokemeyer, Bernd; Brant, Steven R; Brooks, Johanne; *Butterworth, Jeffrey; Cho, Judy H; Clark, Katie; Cummings, Fraser; Duerr, Richard H; Ennis, Sarah; Farkkila, Martti; Faubion, William A; Foley, Stephen; Franchimont, Denis; Franke, Andre; Hancock, Laura; Hart, Ailsa; Hooper, Patricia; Irving, Peter; Jarvis, Mark; Johnston, Emma; Karlson, Elizabeth W; Kemp, Cheryl; Kennedy, Nick; Kupcinskas, Juozas; Lamb, Christopher A; Lees, Charlie; Lewis, James D; Li, Andy; Limdi, Jimmy; Loescher, Britt-Sabina; Louis, Edouard; McCauley, Jacob L; McGovern, Dermot P B; McLaughlin, John; Moayyedi, Paul; Moran, Gordon; Newberry, Rodney D; Oglesby, Arabis; Palotie, Aarno; Pekow, Joel; Perez, Kate J; Pollok, Richard; Prescott, Natalie; Raine, Tim; Ramadas, Arvind; Ramakrishnan, Subramaniam; Sabic, Ksenija; Sands, Bruce; Satsangi, Jack; Sazonovs, Aleksejs; Schreiber, Stefan; Selinger, Christian; Shedwell, Sophy; Silverberg, Mark S; Singh, Salil; Sokol, Harry; Steed, Helen; Steel, Alan; Uhlig, Holm H; Verma, Ajay; Vermeire, Severine; Weersma, Rinse K; Xavier, Ramnik J; Yu, Mingrui; Parkes, Miles; Rioux, John D; Daly, Mark J; Huang, Hailiang; Anderson, Carl A.

Citation:

MedRxiv : the Preprint Server for Health Sciences. 2026 May 20.

Abstract:

Inflammatory bowel disease (IBD) is a chronic immune-mediated disorder of the gastrointestinal tract whose genetic basis is only partly resolved because most risk variants identified by genome-wide association studies (GWAS) lie in non-coding regions, limiting direct gene assignment and biological interpretation1,2. Here we analysed whole-exome and whole-genome sequencing data from 86,213 IBD cases and 478,363 controls of European ancestry. We identified 68 IBD genes directly implicated by conditionally independent protein-coding associations across the allele frequency spectrum. Many newly implicated IBD genes are supported by orthogonal genomic or pleiotropic evidence, pointing to disease-related pathways and nominating targets with therapeutic relevance. We further identified allelic series and non-additive effects at key loci such as NOD2 and TYK2. These results show that large-scale sequencing can resolve disease genes and pathways that remain ambiguous from non-coding association alone, providing a more direct route from human genetics to biological insight and therapeutic hypotheses.

DOI: 10.64898/2026.05.08.26352648

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A multicentered retrospective cohort study comparing JAK inhibitor therapies in moderate-to-severe ulcerative colitis (2026)

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Type of publication:

Journal article

Author(s):

Kumar, Aditi; Baxter, Joshua; Rimmer, Peter; Noble, Ben; Bower, Joshua; Makki, Mujeeb Ullah; Hatta, Ayiesha; Chikhlia, Anmol; Cheesbrough, Jonathan; Disney, Ben; *Muir, Josh; *Karova, Mariya; *Butterworth, Jeffrey; Sagar, Nidhi; Al-Talib, Ismaeel; Nahal, Jasbir; Ali, Nasima; Sagar, Vandana; Varyani, Fumi; Smith, Sam; Bourne, Stephanie; Hsu, Yu-Kai; Eltahir, Almoiez; de Silva, Shanika; Harvey, Philip.

Citation:

Crohn's & Colitis 360. 8(2):otag045, 2026 Apr.

Abstract:

Background: Tofacitinib, filgotinib, and upadacitinib are Janus kinase inhibitors (JAKi) that have demonstrated efficacy in ulcerative colitis (UC) against placebo. This study aims to compare the clinical efficacy between these drugs.

Methods: This is a multicentered, retrospective cohort study. Patients with UC starting a JAKi were recruited between 2018 and 2024 when starting their first JAKi. Clinical remission and response, based on clinical scores, calprotectin, and endoscopic measurement, were assessed at 3 and 6 months. Both independent and combined variable outcomes were analyzed.

Results: Two hundred and seventy patients were included in the analysis, of which 70 (26%) were on upadacitinib, 51 (19%) on filgotinib, and 149 (55%) on tofacitinib. Clinical, biochemical, and endoscopic remission at 6 months was 91%, 71%, and 80% for upadacitinib; 78%, 67%, and 50% for filgotinib; 73%, 51%, and 44% for tofacitinib. Upadacitinib demonstrated significantly greater clinical response (P = .027) and remission (P = .037) rates at 6 months than tofacitinib. Drug persistence at 12 months was 86% for upadacitinib, 72% for filgotinib, and 69% for tofacitinib. Upadacitinib demonstrated significantly greater 6-month remission rates compared to tofacitinib in the bio-exposed cohort (71% vs 52%, P = .022) and in the bio-naive cohort (93% vs 50%, P = .009). The incidence rates for hospital admissions were 10.2, 21.9, and 14.1 and for colectomies were 6.7, 10.0, and 5.0 per 1000 patient-months at risk for upadacitinib, filgotinib and tofacitinib, respectively.

Conclusion: This study demonstrates that upadacitinib is more likely to achieve 6-month response and remission compared to tofacitinib. In both bio-naive and bio-exposed patients, upadacitinib was more likely to achieve remission at 6 months. The efficacy of JAKi does not appear diminished by prior biologic use.

DOI: 10.1093/crocol/otag045

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Fecal Microbiota Transplantation (FMT) in the Management of Ulcerative Colitis: A Comprehensive Systematic Review and Meta-Analysis of Randomized Controlled Trials (RCTs) (2026)

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Type of publication:

Systematic review

Author(s):

Ahad, Amal; Kumar, Sandeep; Kolomar, Hugh; Williams, Jada; Abdallah, Abrar I; Sadeghzadegan, Amirali; *Yateem, Dana; Kharel, Punam; Chowdhury, Dristy; Alnajar, Fahad; Ali, Muqaddas.

Citation:

Cureus. 18(6):e111804, 2026 Jun.

Abstract:

Ulcerative colitis (UC) is a chronic inflammatory disorder of the colon with increasing global prevalence, particularly in newly industrialized countries. Fecal microbiota transplantation (FMT) has worked as an effective therapeutic strategy aimed at restoring immune homeostasis and gut microbial balance. However, a lack of standardized protocols and comprehensive safety data necessitates further evaluation. This meta-analysis aims to comprehensively analyze the efficacy of FMT in inducing clinical remission in UC, incorporating the latest randomized controlled trials (RCTs). A systematic review and meta-analysis of RCTs investigating FMT in UC were conducted. The primary outcomes were clinical and endoscopic remission, while adverse events (AEs) were assessed as secondary outcomes. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated, and heterogeneity was analyzed using the I2 statistic and Cochran's Q test. Overall, FMT demonstrated a significant benefit in inducing clinical remission compared with placebo (RR 1.55; 95% CI 1.22-1.96; p = 0.0003). For endoscopic remission, FMT showed a significant overall effect (RR 1.68; 95% CI 1.15-2.46; p = 0.007). The incidence of AEs was comparable between the FMT and control groups (RR 0.88; 95% CI 0.77-1.00; p = 0.06). This meta-analysis gives strong confirmation for the efficacy of FMT in inducing both clinical and endoscopic remission in UC patients, with a favorable safety profile. Multi-donor FMT and oral capsule administration appear to be particularly promising. Future research should focus on standardizing protocols, elucidating mechanisms of action, and conducting larger, long-term trials to optimize FMT for UC.

DOI: 10.7759/cureus.111804

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Variation, temporal trends and factors associated with ileostomy reversal after anterior resection surgery for rectal cancer in England: An observational study using administrative data (2026)

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Type of publication:

Journal article

Author(s):

*Olagunju N; *Cheetham M; Savage K; Briggs TWR; Gray WK

Citation:

Colorectal Disease. 28(3):e70427, 2026 Mar.

Abstract:

AIMS: The presence of a temporary ileostomy following anterior resection for rectal cancer substantially impacts the quality of life of patients and long-term functional outcomes. Timely reversal of the ileostomy can help to minimise negative impacts. Using an administrative dataset for England, this study aimed to explore temporal trends in ileostomy reversal rates, variation in reversal rates across trusts and factors associated with delayed reversal.

METHODS: This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics (HES) dataset for England. All patients aged >=17 years undergoing a planned anterior resection for rectal cancer with ileostomy creation between April 1, 2016, and March 31, 2023, were identified. The primary outcome of interest was ileostomy reversal within 18 months.

RESULTS: Data were available for 5,275 ileostomy creations during the study period. Ileostomy was reversed within 18 months in 3,338 (63.5%) patients. Frailty, socio-economic deprivation, open surgery and anastomotic leak were associated with failure to reverse ileostomy within 18 months. There was a steady decrease in rates of ileostomy reversal within 18 months over the course of the study period.

CONCLUSIONS: This study highlights a need to review current ileostomy closure pathways across England, provide equitable access to timely reversal and improve the shared decision-making process between clinicians and patients undergoing surgery for rectal cancer.

DOI: 10.1111/codi.70427

Part 1: Small Bowel Capsule Endoscopy (2026)

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Type of publication:

Service improvement case study

Author(s):

*Giorgia Paparella

Citation:

SaTH Improvement Hub, February 2026

SMART Aim:

To increase the percentage of patients meeting the European Society of Gastrointestinal Endoscopy (ESGE) recommendations for adequate mucosal visualisation (≥ 95%) by 10% by June 2026.

Link to PDF poster

IUGA Opinion Paper on Obstructed Defecation: Management of Clinical and Proctographic Rectoceles (2026)

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Type of publication:

Journal article

Author(s):

*Rachaneni, Suneetha; Dietz, Hans Peter; Latthe, Pallavi; Sirany, Annie; Spivak, Anna; Dua, Anupreet.

Citation:

International Urogynecology Journal. 37(1):75-85, 2026 Jan.

Abstract:

INTRODUCTION AND HYPOTHESIS: Obstructed defecation syndrome (ODS) is a defecatory abnormality with a sensation of incomplete evacuation, the need to strain at stool, the need for digitation in the vagina, the anus, or the perineum. Anterior rectocele and rectal intussusception are the frequent pathologies behind ODS. The review focuses on the assessment and treatment of obstructed defecation in women with rectocele, recto-enterocele and rectal intussusception in the remit of a urogynecologist.

METHODS: A working subcommittee from the International Urogynecology Association (IUGA) Research and Development (R&D) Committee was formed with colorectal surgeons from the American Society of Colon & Rectal Surgeons (ASCRS). An initial document was drafted based on a literature review. The review focused on the treatment options of women with presenting with obstructed defecation and posterior compartment prolapse either on clinical examination or on imaging. After evaluation by the entire IUGA R&D Committee revisions were made. The quality of the evidence was graded and used to form consensus recommendations.

RESULTS: Ultrasound and dynamic MRI are helpful imaging modalities in triaging patients. A defecating proctogram to evaluate the size of rectal intussusception and enterocele is the standard investigation. Conservative therapies are effective first-line management options. The transvaginal native tissue rectocele repair is a safe and effective first-line surgical treatment in women with obstructed defecation.

CONCLUSIONS: When evaluating patients with obstructive defecation, it is important to address anatomy as well as function. In the absence of a clinically significant rectocele or enterocele during vaginal examination, in women with obstructed defecation, referral to a gastroenterologist or colorectal surgeon for further evaluation and management is recommended.

DOI: 10.1007/s00192-025-06288-7

Outcomes of TEMS (Trans-anal Endoscopic Micro-Surgery) for early rectal cancer in a DGH - 10 years' experience (2024)

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Type of publication:

Conference abstract

Author(s):

Kumar S.; *Rehman S.; *McCloud J.; *Clarke R.G.

Citation:

Colorectal Disease. Conference: Association of Coloproctology of Great Britain and Ireland Annual Meeting. Wales United Kingdom. 26(Supplement 1) (pp 71-72), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Introduction: Trans-anal Endoscopic excision for Early Rectal Cancer (ERC) is low risk with excellent outcomes. Strict patient selection with discussion in an ERC MDT identifies appropriate patients for local excision. Trans-anal Endoscopic microsurgery (TEMS) with full-thickness excision is suitable for T1 rectal cancers as well as more advanced cancers in patients with significant comorbidity not fit for major surgery. We present results over a 10-year period. Method(s): We reviewed outcomes of patients undergoing TEMS for ERC, staged on MRI scans between March 2012 and Jan 2022 with follow up to Dec 2023. We included all patients withpotentially curable tumours and excluded patients deemed palliative at presentation. Result(s): 241 TEMS cases were performed with 73 for ERC with T1, T2 and T3 cancers being 70% (51/73), 24% (17/73) and 6% (5/73) respectively. Recurrence rates for T1 Cancer (Sm1, Haggit 1) was 0%. T1/2 with adverse histology was 18.7% to 41.7% and T3 was 80%. Resection margin R0 for T1 lesions was 86%-100% and for T2-T3 lesions was 20-60%. Correlation of T stage, resection margin and adverse histology to recurrence rates was significant. There were no major complications or deaths with 90 days. Conclusion(s): TEMS is a curative option for patients with ERC offering organ preservation and significantly less comorbidity than major resection. This is particularly important in the comorbid patient. Combination treatments with oncology can optimise outcomes in cancers with poor prognostic features and close surveillance will identify any local recurrence requiring salvage surgery.

DOI: 10.1111/codi.17066

Improvement to Stoma Care (2025)

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Type of publication:

Service improvement case study

Author(s):

*Paula Hilditch, *Rebekah Tudor

Citation:

SaTH Improvement Hub, December 2025

SMART Aim:

To improve the quality of stoma care given to patients on surgical wards as measured by pre and post teaching questionnaire and audit of stoma care practice by December 2025.

Link to PDF poster

Artificial Intelligence in Colonoscopy: A Systematic Review of Adenoma Versus Polyp Detection Rates (2025)

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Type of publication:

Systematic Review

Author(s):

Rabba, Waseem; *Asif, Fatima; Younis, Muhammad Y; Nasrullah, Haris; Fatima, Laraib; Arif, Muhammad A.

Citation:

Cureus. 17(12):e98528, 2025 Dec.

Abstract:

Colonoscopy is the gold standard in the prevention of colorectal cancer, but the miss rates of adenoma are high, which restricts its efficacy. To improve lesion recognition, artificial intelligence (AI), especially computer-aided detection (CADe) systems, has been introduced. The aim of this systematic review was to compare AI-assisted colonoscopy in terms of its ability to improve adenoma detection rate (ADR) and polyp detection rate (PDR). An extensive search was performed on PubMed, Embase, and Cochrane Library from 2015 to 2025. There were 17 randomized controlled trials (RCTs) comparing the use of AI-assisted colonoscopy with normal colonoscopy. The methodological quality measure of the included RCTs was Cochrane Risk of Bias 2.0 (RoB 2.0), which subdivided the studies based on low risk, some concerns, or high risk of bias based on whether they were biased in this or that domain. The robVis tool was used to produce the visual summaries. AI-aided colonoscopy effectively enhanced both adenoma detection rate (ADR) and polyp detection rate (PDR) in all of the included studies over conventional colonoscopy. In adenoma detection, accuracy was more than 85%, and in polyp detection, more than 90%. The advantage was also found especially in the detection of small and flat adenomas, which are very often missed in routine practice. The use of AI in colonoscopy is strongly associated with an increase in the detection rate of adenoma and polyps, minimizing the risk of underdiagnosis. The results highlight the clinical promise of AI in the form of a decision-support tool across gastroenterologists and suggest that AI can be applied to enhance the outcomes of preventive and screening colorectal cancer. Future research should be cost-efficient and practical, and combined with some clinical activities.

DOI: 10.7759/cureus.98528

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