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Inflammatory Bowel Disease: Clinical Advances and Therapeutic Prospects
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Inflammatory Bowel Disease: Clinical Advances and Therapeutic Prospects

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: 20 October 2025 | Viewed by 10722

Special Issue Editor

Dr. Antonio M. Caballero-Mateos

E-Mail Website
Guest Editor
1. Gastroenterology and Hepatology Department, San Cecilio University Hospital, 18016 Granada, Spain
2. Internal Medicine Department, Hospital Comarcal "Santa Ana", 18600 Motril, Spain
Interests: endoscopy; biliary tract diseases; pancreatic diseases; liver cirrhosis; inflammatory bowel disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Inflammatory bowel disease (IBD), encompassing Crohn's disease and ulcerative colitis, casts a long shadow over the lives of millions worldwide. The relentless cycle of inflammation, pain, and uncertainty can be immensely debilitating, demanding not only exceptional medical care but also unwavering resilience from patients. Yet, amidst the challenges, a beacon of hope shines brightly: unprecedented scientific advancements are illuminating the path towards better diagnosis, more effective treatments, and improved quality of life for individuals living with IBD.

Having cared for IBD patients firsthand, I understand the profound impact this disease has on their lives. The relentless symptoms and uncertainty can be truly devastating. This Special Issue offers a unique opportunity to showcase research addressing not only the biological aspects of IBD but also the holistic needs of patients, ultimately improving their quality of life and well-being. We invite you to contribute your groundbreaking work, illuminating diverse aspects of the disease journey, from the intricate dance of genetic and environmental factors to the development of personalized therapeutic strategies.

Dr. Antonio M. Caballero-Mateos
Guest Editor

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • inflammatory bowel disease
  • Crohn's disease
  • ulcerative colitis
  • risk factors
  • therapeutic strategies

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Published Papers (6 papers)

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Research

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13 pages, 2563 KiB  
Article
Temporal Trends in the Use of Biological Agents in Patients with Inflammatory Bowel Disease: Real-World Data from a Tertiary Inflammatory Bowel Disease Greek Center During a 5-Year Period
by Panagiotis Markopoulos, Aikaterini Gaki, Georgios Kokkotis, Konstantina Chalakatevaki, Nikolaos Kioulos, Vasso Kitsou, Constantinos Tsitsigiannis, Michael Gizis, Paraskevi Prapa, Stamatina-Lydia Chatzinikolaou, Efrosini Laoudi, Ioannis Koutsounas and Giorgos Bamias
J. Clin. Med. 2025, 14(4), 1357; https://doi.org/10.3390/jcm14041357 - 18 Feb 2025
Viewed by 857
Abstract
Background/Objectives: Therapeutic management of inflammatory bowel diseases (IBD) is rapidly evolving in the era of novel biological therapies. However, real-world data relating to the usage trends and treatment persistence remain inconsistent. This study aimed to investigate trends in biological use, dose intensification, and [...] Read more.
Background/Objectives: Therapeutic management of inflammatory bowel diseases (IBD) is rapidly evolving in the era of novel biological therapies. However, real-world data relating to the usage trends and treatment persistence remain inconsistent. This study aimed to investigate trends in biological use, dose intensification, and treatment persistence in IBD patients, who received treatment in a large tertiary center in Greece. Methods: Patients with IBD who underwent at least one biological treatment between 2018 and 2022 were included in this retrospective study. Data on patients’ demographics, type of disease, use of biologicals, dose intensification, and treatment persistence were analyzed for time trends. Results: Data from 409 patients with IBD (mean age 39 (range 17–87), female 51%, 56.9% CD, mean duration of disease: 9.3 years) were included in the study. The number of patients on biologics was raised from 133 in 2018 to 368 in 2022 (a 28.1% yearly increase), while the percentage of patients who were treated with anti-TNF biosimilars increased to >60% of the total anti-TNF population in 2022. We observed a gradual increase in non-anti-TNF therapies in bio-naïve patients, in particular vedolizumab (46% of all biologicals in UC; 16% in CD) and ustekinumab (16.3% of all biologicals in UC, 31% in CD). The 3-year persistence rate of IFX was 64% in CD and 56% in UC, whereas it was 61% for ADA in CD. Dose intensification of anti-TNF was efficient in >50% of CD patients and >30% of UC patients; however, the majority of patients who required dose escalation within the first year eventually became unresponsive. The 3-year persistence of vedolizumab as a first-line treatment was 82% for CD and 69% for UC, respectively. The 3-year persistence of ustekinumab as first-line treatment for CD was 65%. No significant differences regarding the efficacy of anti-TNF, ustekinumab, or vedolizumab were detected when they were used as first-line treatments for Crohn’s disease; similarly, no significant differences were detected between infliximab and vedolizumab as first-line treatments for UC. Conclusions: There was a gradual increase in the use of biologicals, including biosimilars, between the years 2018–2022, reflecting adherence to current guidance with adoption of an early escalation strategy. Newer, post-anti-TNF biologics such as vedolizumab and ustekinumab have been rapidly incorporated into therapeutic approaches for both CD and UC. Full article
(This article belongs to the Special Issue Inflammatory Bowel Disease: Clinical Advances and Therapeutic Prospects)
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14 pages, 1861 KiB  
Article
Genetic Risk of Ankylosing Spondylitis and Second-Line Therapy Need in Crohn’s Disease: A Mendelian Randomization Study
by Mahmud Omar, Mohammad Omar, Yonatan Shneor Patt, Offir Ukashi, Yousra Sharif, Adi Lahat, Christian Phillip Selinger and Kassem Sharif
J. Clin. Med. 2024, 13(24), 7496; https://doi.org/10.3390/jcm13247496 - 10 Dec 2024
Viewed by 928
Abstract
Background: Crohn’s disease (CD) and Ankylosing Spondylitis (AS) are chronic conditions with overlapping inflammatory pathways. This research investigates the genetic association between AS and the requirement for more aggressive therapeutic interventions in CD, suggesting a likelihood of increased severity in CD progression among [...] Read more.
Background: Crohn’s disease (CD) and Ankylosing Spondylitis (AS) are chronic conditions with overlapping inflammatory pathways. This research investigates the genetic association between AS and the requirement for more aggressive therapeutic interventions in CD, suggesting a likelihood of increased severity in CD progression among individuals diagnosed with AS. Methods: This study utilized two-sample Mendelian randomization (TSMR) to analyze GWAS datasets for AS and CD requiring second-line treatment. Instrumental variables were selected based on single-nucleotide polymorphisms of genome-wide significance. Analytical methods included inverse-variance weighted (IVW), MR Egger, and other MR approaches, alongside sensitivity analysis, to validate the findings. Results: Our results indicated a significant association between AS genetic predisposition and the increased need for second-line treatments in CD. The IVW method showed an Odds Ratio (OR) of 2.16, and MR Egger provided an OR of 2.71, both were statistically significant. This association persisted even after the exclusion of influential outlier SNP rs2517655, confirming the robustness of our findings. Conclusions: This study suggests that genetic factors contributing to AS may influence the progression of CD, potentially necessitating more intensive treatment strategies. These findings underscore the importance of early screening in patients with co-existing AS and CD for tailoring treatment approaches, thus advancing personalized medicine in the management of these complex conditions. Full article
(This article belongs to the Special Issue Inflammatory Bowel Disease: Clinical Advances and Therapeutic Prospects)
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18 pages, 279 KiB  
Article
Prevalence of Metabolic Syndrome and Its Association with Cardiovascular Outcomes in Hospitalized Patients with Inflammatory Bowel Disease
by Ryan Njeim, Sai Shanmukha Sreeram Pannala, Nadim Zaidan, Toni Habib, Medha Rajamanuri, Elie Moussa, Liliane Deeb and Suzanne El-Sayegh
J. Clin. Med. 2024, 13(22), 6908; https://doi.org/10.3390/jcm13226908 - 16 Nov 2024
Cited by 1 | Viewed by 1162
Abstract
Background: Patients with autoimmune diseases experience a higher burden of metabolic syndrome (MetS) and cardiovascular disease (CVD). There is a paucity of data regarding MetS in patients with inflammatory bowel disease (IBD) and its impact on CVD. In this retrospective study, we [...] Read more.
Background: Patients with autoimmune diseases experience a higher burden of metabolic syndrome (MetS) and cardiovascular disease (CVD). There is a paucity of data regarding MetS in patients with inflammatory bowel disease (IBD) and its impact on CVD. In this retrospective study, we aimed to evaluate the prevalence of MetS components in IBD patients, as well as their association with acute coronary syndrome (ACS), heart failure and arrhythmias. Methods: After pooling 5 years of data from the National Inpatient Sample (NIS) Database (2016–2020), we compared traditional cardiovascular risk factors between IBD and non-IBD patients. We then investigated the association between MetS (represented by a calculated metabolic score (CMS) ranging from 0 to 4, based on the presence or absence of hypertension, obesity, dyslipidemia and type II diabetes) and CVD, separately for Crohn’s disease (CD) and ulcerative colitis (UC) patients. Results: The prevalence of the different MetS components was found to be lower in IBD patients compared to non-IBD patients. Comparing CD (n = 806,875) and UC (n = 575,925) identified a higher prevalence of MetS components in UC. Higher CMS was positively associated with ACS and arrhythmias in both CD and UC. This association was evident in heart failure, with the odds ratio increasing from 2.601 for CMS = 1 to 6.290 for CMS = 4 in UC patients and from 2.622 to 5.709 in CD patients. Conclusions: Our study highlights the positive association between traditional components of MetS and CVD in IBD patients. Our findings suggest that chronic inflammation explains only partially the CVD burden in hospitalized IBD patients. Full article
(This article belongs to the Special Issue Inflammatory Bowel Disease: Clinical Advances and Therapeutic Prospects)
13 pages, 1462 KiB  
Article
Liver Fibrosis Index-4 Does Not Correlate to Liver Elastography in Patients with Inflammatory Bowel Disease
by Iván Ferraz-Amaro, Alejandro Hernández-Camba, Marta Carrillo-Palau, Noemi Hernández Álvarez-Buylla, Antonia de Vera-González, Alejandra González-Delgado, Elena Heras-Recuero and Miguel Á. González-Gay
J. Clin. Med. 2024, 13(21), 6430; https://doi.org/10.3390/jcm13216430 - 27 Oct 2024
Viewed by 1105
Abstract
Background: Inflammatory bowel disease (IBD) is associated with an increased prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD). The Fibrosis-4 (FIB-4) index is a non-invasive tool for assessing liver fibrosis that has been validated in various liver diseases. The main objective of [...] Read more.
Background: Inflammatory bowel disease (IBD) is associated with an increased prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD). The Fibrosis-4 (FIB-4) index is a non-invasive tool for assessing liver fibrosis that has been validated in various liver diseases. The main objective of this study was to study whether the FIB-4 index is a reliable predictor of liver fibrosis, as assessed through elastography, in patients with IBD. We additionally aimed to analyze if FIB-4 associates with IBD characteristics such as lipid profile, subclinical carotid atherosclerosis, and insulin resistance indices. Methods: A cross-sectional study was conducted, enrolling 197 patients with IBD. Subjects underwent comprehensive clinical and laboratory evaluations. Hepatic fibrosis was assessed non-invasively using the FIB-4 index and transient elastography, while abdominal ultrasonography was performed to grade hepatic steatosis based on the degree of fat infiltration. To investigate the associations between disease characteristics and FIB-4 score and the correlation of this index to elastography, a multivariable linear regression analysis was conducted. Results: The presence of diabetes, hypertension, and metabolic syndrome was associated with significantly higher FIB-4 levels. However, FIB-4 did not show a relationship with disease characteristics such as phenotype or activity indices. Furthermore, FIB-4 did not demonstrate a correlation with liver stiffness values measured by elastography. Conclusions: Our findings suggest that the FIB-4 index may not be a reliable tool for assessing hepatic fibrosis in patients with IBD. This observation is particularly significant given the high prevalence of MASLD in the IBD population. Full article
(This article belongs to the Special Issue Inflammatory Bowel Disease: Clinical Advances and Therapeutic Prospects)
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Review

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16 pages, 1698 KiB  
Review
Paradigm Shift in Inflammatory Bowel Disease Management: Precision Medicine, Artificial Intelligence, and Emerging Therapies
by Antonio M. Caballero Mateos, Guillermo A. Cañadas de la Fuente and Beatriz Gros
J. Clin. Med. 2025, 14(5), 1536; https://doi.org/10.3390/jcm14051536 - 25 Feb 2025
Viewed by 3578
Abstract
Inflammatory bowel disease (IBD) management stands at the cusp of a transformative era, with recent breakthroughs heralding a paradigm shift in treatment strategies. Traditionally, IBD therapeutics revolved around immunosuppressants, but the landscape has evolved significantly. Recent approvals of etrasimod, upadacitinib, mirikizumab, and risankizumab [...] Read more.
Inflammatory bowel disease (IBD) management stands at the cusp of a transformative era, with recent breakthroughs heralding a paradigm shift in treatment strategies. Traditionally, IBD therapeutics revolved around immunosuppressants, but the landscape has evolved significantly. Recent approvals of etrasimod, upadacitinib, mirikizumab, and risankizumab have introduced novel mechanisms of action, offering renewed hope for IBD patients. These medications represent a departure from the status quo, breaking years of therapeutic stagnation. Precision medicine, involving Artificial Intelligence, is a pivotal aspect of this evolution, tailoring treatments based on genetic profiles, disease characteristics, and individual responses. This approach optimizes treatment efficacy, and paves the way for personalized care. Yet, the rising cost of IBD therapies, notably biologics, poses challenges, impacting healthcare budgets and patient access. Ongoing research strives to assess cost-effectiveness, guiding policy decisions to ensure equitable access to advanced treatments. Looking ahead, the future of IBD management holds great promise. Emerging therapies, precision medicine, and ongoing research into novel targets promise to reshape the IBD treatment landscape. As these advances continue to unfold, IBD patients can anticipate a brighter future, one marked by more effective, personalized, and accessible treatments. Full article
(This article belongs to the Special Issue Inflammatory Bowel Disease: Clinical Advances and Therapeutic Prospects)
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16 pages, 503 KiB  
Review
Future of Acute Severe Ulcerative Colitis—A Narrative Review
by Leshni Pillay, Janakan Selvarajah, Bridgette Andrew, Britt Christensen, Finlay Macrae and Jonathan P. Segal
J. Clin. Med. 2024, 13(24), 7723; https://doi.org/10.3390/jcm13247723 - 18 Dec 2024
Cited by 1 | Viewed by 2245
Abstract
While corticosteroids have led to significant reduction in ASUC mortality over the last few decades, they are associated with significant side effects and up to 30% of patients have steroid refractory ASUC, which means we require safer and better therapies for patients with [...] Read more.
While corticosteroids have led to significant reduction in ASUC mortality over the last few decades, they are associated with significant side effects and up to 30% of patients have steroid refractory ASUC, which means we require safer and better therapies for patients with ASUC. Several salvage therapies have been proposed in guidelines; however, we lack high quality head-to-head randomised controlled trials to assess effectiveness and safety of these agents. Furthermore, the role of newer novel agents in ASUC management is unclear. We aim to present an up to date review and envisage future treatment of ASUC without steroids based on current trials and data. In summary, we conclude that ASUC treatment still heavily relies on corticosteroids despite the side effect profile. While infliximab and cyclosporine have extensive data, there are no prospective studies comparing them with corticosteroids as initial therapy. Novel therapies open up the possibility of oral options but require prospective data before any conclusion can be made. Full article
(This article belongs to the Special Issue Inflammatory Bowel Disease: Clinical Advances and Therapeutic Prospects)
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