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Inflammatory Bowel Disease: Clinical Pathogenesis and Management Strategies
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Inflammatory Bowel Disease: Clinical Pathogenesis and Management Strategies

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: 25 August 2026 | Viewed by 1873

Special Issue Editor

Dr. Francesco Colombo

E-Mail Website
Guest Editor
Department of General Surgery, Department of Biomedical and Clinical Sciences “L. Sacco”, University of Milan, ASST Fatebenefratelli Sacco, 20157 Milan, Italy
Interests: inflammatory bowel diseases (IBDs); colorectal tumors; diverticular disease; intestinal obstruction conditions; functional gastrointestinal disorders; intestinal motility disorders; intestinal hemorrhage; minimally invasive colorectal surgery techniques

Special Issue Information

Dear Colleagues,

Inflammatory bowel diseases (IBDs), comprising Crohn’s disease and ulcerative colitis, are chronic, relapsing conditions of the gastrointestinal tract with rising global incidence. The primary aim of current research and clinical care is to elucidate the complex pathogenesis of IBDs and to optimize individualized, long-term management strategies. IBD pathogenesis involves a multifactorial interplay of genetic susceptibility, environmental factors, epithelial barrier dysfunction, and dysregulated mucosal immune responses.

Despite therapeutic advances, key challenges remain: identifying predictive biomarkers, preventing disease progression, and calibrating surgical interventions.

This Special Issue of the Journal of Clinical Medicine, entitled “Inflammatory Bowel Disease: Clinical Pathogenesis and Management Strategies”, is devoted to articles that focus on the optimization of IBD care, particularly considering treat-to-target strategies, individualized surgical risk stratification, and tailored surgical as well as medical techniques. Importantly, articles that address unmet challenges and opportunities to improve outcomes are welcome.

Dr. Francesco Colombo
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

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

  • epithelial barrier dysfunction
  • intestinal microbiota dysbiosis
  • minimally invasive surgery in IBDs
  • disease monitoring
  • perianal disease treatment
  • surgical complications in IBD
  • prehabilitation
  • stoma formation and management
  • timing of surgery in IBDs
  • risk stratification for IBD surgery
  • patient-reported outcomes post-surgery

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (2 papers)

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Research

12 pages, 340 KB  
Article
Five-Year Persistence of Vedolizumab in Crohn’s Disease: Results from a Real-World Cohort
by Marc Harb, Vinciane Muls, Alice Hoyois and Jennifer Aoun
J. Clin. Med. 2026, 15(4), 1387; https://doi.org/10.3390/jcm15041387 - 10 Feb 2026
Viewed by 606
Abstract
Background: Vedolizumab (VDZ) is an α4β7 anti-integrin monoclonal antibody effective in Crohn’s disease (CD). While its short- and mid-term efficacy is well established, real-world data on long-term outcomes beyond 3 years are scarce. Recent studies suggest a progressive decline in persistence rates [...] Read more.
Background: Vedolizumab (VDZ) is an α4β7 anti-integrin monoclonal antibody effective in Crohn’s disease (CD). While its short- and mid-term efficacy is well established, real-world data on long-term outcomes beyond 3 years are scarce. Recent studies suggest a progressive decline in persistence rates after 2 to 3 years, with very limited data beyond this period. The primary objective of this study was to evaluate the 5-year persistence of VDZ. Secondary objectives were to describe clinical, biological, and endoscopic responses at 2 years among patients remaining on treatment, and to identify predictors of long-term persistence, including the baseline Clinical Decision Support Tool (CDST) score. Methods: We conducted a retrospective observational study which included 60 adult patients with CD treated with VDZ before April 2025. Collected baseline variables included age, sex, BMI, smoking status, disease duration and location, prior biologic exposure, and CDST score. Treatment persistence was evaluated at 5 years. Clinical, biological, and endoscopic responses were assessed at 2 years. A global response was then defined as the achievement of a clinically significant improvement, normalization or marked reduction in inflammatory biomarkers, and endoscopic improvement. Predictors of persistence were also analyzed. Results: The mean age of this cohort was 45.4 ± 15.2 years, mean disease duration was 12.7 ± 10.1 years, and mean CDST score was calculated at 20.6 ± 2.7. At 5 years, 23/41 patients (56.1%) remained on VDZ therapy. Persistence was significantly associated with male sex (65.2% vs. 27.8%), longer disease duration (215 vs. 106 months), absence of rheumatologic manifestations (13.0% vs. 44.4%), and clinico-biological response at 12 months (65.2% vs. 30.8%). At 24 months, a global response was observed in all patients persisting at 5 years compared to 22.2% of those who discontinued (p < 0.001). At 2 years, 39/51 patients (76.5%) remained on VDZ. Persistence was associated with longer disease duration (189 vs. 75 months), male sex (61.5% vs. 25.0%), and absence of isolated colonic disease (0% vs. 16.7%). A global response at 2 years was achieved by 89.7% of persistent patients compared with none of the non-persistent group (p < 0.001). The CDST, uniformly elevated in this cohort, did not discriminate between persistent and non-persistent patients, but reflected appropriate initial patient selection. Conclusions: This real-world study documents 5-year outcome data on VDZ persistence in Crohn’s disease, a duration infrequently studied, with 56% of patients maintaining treatment. Early response at 12 and 24 months emerged as a key determinant of long-term persistence, highlighting the value of assessing 2-year outcomes to identify durable responders. Although not discriminatory in this homogeneous cohort, the CDST score emphasizes the potential role of predictive tools in guiding personalized therapeutic strategies. These results contribute to defining the long-term role of VDZ in the management of CD. Full article
(This article belongs to the Special Issue Inflammatory Bowel Disease: Clinical Pathogenesis and Management Strategies)
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13 pages, 479 KB  
Article
Comparison of Azathioprine-Induced Pancreatitis and Gastrointestinal Intolerance in IBD: Role of Demographics, Clinical Variables, and HLA DQA1/DRB1 Alleles
by Tugce Eskazan, Oguz Kagan Bakkaloglu, Murat Toruner, Haluk Tarik Kani, Bilger Cavus, Volkan Yilmaz, Nalan Gulsen Unal, Ozlen Atug, Burhan Cagcag, Mehtap Dogruel, Erkan Yilmaz, Filiz Akyuz, Yusuf Ziya Erzin, Ali Ibrahim Hatemi and Aykut Ferhat Celik
J. Clin. Med. 2025, 14(23), 8539; https://doi.org/10.3390/jcm14238539 - 2 Dec 2025
Cited by 1 | Viewed by 987
Abstract
Background: Azathioprine (AZA)-associated acute pancreatitis (AP) and gastrointestinal intolerance (GI-INT) are major causes of drug discontinuation in inflammatory bowel disease (IBD). This study compared HLA alleles, demographics, and clinical variables between AZA-AP and AZA-GI-INT. Methods: Data from five IBD centers included control ( [...] Read more.
Background: Azathioprine (AZA)-associated acute pancreatitis (AP) and gastrointestinal intolerance (GI-INT) are major causes of drug discontinuation in inflammatory bowel disease (IBD). This study compared HLA alleles, demographics, and clinical variables between AZA-AP and AZA-GI-INT. Methods: Data from five IBD centers included control (n = 88), AZA-AP (n = 44), and GI-INT (n = 44) groups. AP was defined by the Atlanta criteria, and GI-INT as acute dyspeptic symptoms related to AZA that resolved after withdrawal. Demographics, disease features, and HLA-DQA1/DRB1 alleles were assessed for associations. Results: Among 176 patients, female sex was more frequent in AZA-AP and GI-INT than controls (p = 0.018, p < 0.001). AZA-AP patients were older at diagnosis vs. controls (p = 0.016) but not vs. GI-INT (p = 0.15). Smoking and alcohol were more common in AZA-AP. The median onset of AP was four weeks, with 91% occurring within three months. GI-INT occurred rapidly, with a median of one day and a maximum of three days after the first dose. HLA-DQA1/DRB1 positivity was comparable in GI-INT and controls (9.2% vs. 14.8%, p = 0.42) but higher in AZA-AP (27.3% vs. 14.8%, p = 0.08). Regression identified female sex, smoking, alcohol, budesonide, and HLA-DQA1/DRB1 positivity (OR 3.01, 95% CI 1.004–9.058; p = 0.049) as independent risk factors for AZA-AP. Conclusions: AZA-AP, but not GI-INT, appears genetically influenced, with HLA-DQA1/DRB1 association extending across populations. In IBD, AZA-AP usually emerges within three months and is linked to female sex, smoking, alcohol, and budesonide. GI-INT typically develops within hours to three days of initiation. These findings support AZA-AP and GI-INT as distinct idiosyncratic entities shaped by genetic, metabolic, and sensitivity factors. Full article
(This article belongs to the Special Issue Inflammatory Bowel Disease: Clinical Pathogenesis and Management Strategies)
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