Gastroenterology Insights

Since its establishment, Gastroenterology Insights has been committed to advancing the understanding of digestive diseases through the publication of high-quality clinical, translational, and basic research [...]

Background: Biologic and small-molecule therapies have transformed inflammatory bowel disease (IBD) management, yet real-world evidence from the Gulf region remains limited. This study evaluated 12-month clinical, biochemical, and endoscopic outcomes among adults with moderate-to-severe Crohn’s disease (CD) or ulcerative colitis (UC) receiving advanced therapy in Bahrain. Material and Methods: This retrospective observational cohort included 122 patients who remained on the same biologic or small-molecule therapy for 12 months and underwent baseline and follow-up endoscopy. The primary outcome was clinical remission; secondary outcomes included corticosteroid-free status, endoscopic outcomes, IBD-related hospitalization and surgery, and biochemical changes. Results: Of the 122 patients, 95 (77.9%) had CD and 27 (22.1%) had UC. At 12 months, 49.2% achieved clinical remission, 60.7% were corticosteroid-free, and endoscopic response and remission were achieved in 62.3% and 49.2%, respectively. Significant improvements were observed in C-reactive protein, serum albumin, and fecal calprotectin (all p < 0.001). In exploratory, unadjusted analyses, clinical remission and corticosteroid-free status were more frequent with anti-TNF than with non-anti-TNF therapy, whereas endoscopic outcomes did not differ significantly. IBD-related hospitalization (40.2%) and surgery (28.7%) remained substantial. Conclusions: Among patients with moderate-to-severe IBD who remained on biologic or small-molecule therapy for 12 months, treatment was associated with meaningful clinical, biochemical, and endoscopic improvement. However, hospitalization and surgery remained substantial, and the treatment-completer design may have overestimated effectiveness relative to the broader population initiating therapy. These findings add real-world evidence from Bahrain and support larger prospective, multicenter studies with standardized outcomes and longer follow-up.

Mucinous adenocarcinoma (MAC) is a distinct colorectal cancer subtype characterized by specific clinicopathological and molecular features and a propensity for peritoneal dissemination. However, whether mucinous histology primarily represents a prognostic phenotype or independently modifies response to anticancer treatment remains uncertain. This critical narrative review evaluated the therapeutic significance of mucinous histology across localized and metastatic colon cancer. A structured PubMed/MEDLINE search was conducted from database inception through 14 September 2026 using MeSH terms and title/abstract keywords related to mucinous histology, colon or colorectal adenocarcinoma, and treatment-related outcomes. The primary search identified 2896 records and was supplemented by targeted searches and reference-list screening. Evidence was interpreted using a four-level framework distinguishing prognostic association, treatment-response association, differential treatment effect, and validated predictive biomarkers. In localized disease, available evidence supports a clinically meaningful benefit from adjuvant chemotherapy in stage III MAC, whereas evidence in stage II disease does not support treatment modification based on histology alone. In metastatic disease, historical cohorts report lower objective response to cytotoxic chemotherapy, but current evidence does not establish intrinsic MAC-specific chemotherapy resistance. Retrospective anti-VEGF and anti-EGFR studies provide treatment-response signals without demonstrating validated histology-specific predictive effects. In dMMR/MSI-H disease, immune-checkpoint blockade remains guided by molecular status rather than mucinous morphology. Peritoneal-predominant dissemination further complicates response assessment and interpretation of locoregional treatment outcomes. Current evidence does not support mucinous histology as a stand-alone predictive biomarker for treatment selection. MAC should instead be interpreted as a contextual clinicopathological modifier alongside disease stage, resectability, metastatic distribution, and validated molecular biomarkers.