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Summary: Background: Inflammatory bowel disease (IBD) follows a heterogenous disease course and predicting a patient's prognosis is challenging. There is a wide burden of illness in IBD and existing tools measure disease activity at a snapshot in time. Comprehensive assessment of IBD severity should incorporate disease activity, prognosis, and the impacts of disease on a patient. This review investigates the concept of disease severity in adults with IBD to highlight key components contributing to this. Methods: To perform this narrative review, a Medline search was conducted for full‐text articles available at 1st March 2024 using search terms which encompassed disease activity assessment, disease severity, prognosis, natural history of Crohn's disease (CD) and ulcerative colitis (UC), and the burden of IBD. Results: Current methods of disease assessment in IBD have evolved from a focus on the burden of symptoms to one that includes inflammatory targets, genetic, serological, and proteomic profiles, and assessments of quality‐of‐life (QoL), disability, and psychosocial health. Longitudinal studies of IBD suggest that the burden of illness is driven by disease phenotype, clinical markers of complicated disease course (previous intestinal resection, corticosteroid use, perianal disease in CD, recent hospitalisations in UC), gut inflammation, and the impact of IBD on the patient. Conclusions: Disease severity in IBD can be difficult to conceptualise due to the multitude of factors that contribute to IBD outcomes. Measurement of IBD severity may better encapsulate the full burden of illness rather than gut inflammation alone at a single timepoint and may be associated with longitudinal outcomes. [ABSTRACT FROM AUTHOR]

Background and Aim: Inflammatory bowel disease (IBD) is a progressive condition where ongoing inflammation in the gastrointestinal tract can lead to complications such as strictures, and fistulae. The long‐term outcomes of newly diagnosed patients under current medical therapy can be used to plan health service provision and guide patients. Methods: Prospective population‐based data on all incident patients diagnosed with IBD in Canterbury was gathered in 2014 (n = 205). The medical records of these patients were followed for medication use, disease progression, hospitalization, surgery and mortality, in the 10 years since their diagnosis. Survival analysis and cox regression determined characteristics associated with earlier time to these outcomes. Results: Medical records of 184 IBD patients were able to be retrieved. Immunomodulators were used by 62% and biologics by 35%; hospitalization occurred for 42% and surgery for 15%. Montreal phenotype progression occurred for 21 and 7% of the cohort died. Younger age at diagnosis hazard ratio (HR) 2.1 (95% confidence interval [CI] 1.1–4.0) and Crohn's disease HR 1.7 (95% CI 1.1–2.6) was associated with immunomodulator use. Younger age was also associated with biologic use HR 2.9 (95% CI 1.2–6.9). Male gender was associated with surgery HR 2.8 (95% CI 1.2–6.4). Perianal disease at diagnosis (14.7%) was associated with immunomodulator use HR 2.58 (95% CI 1.44–4.59) and Montreal phenotype progression HR 2.93 (95% CI 1.10–7.77). Conclusion: In the 10 years since diagnosis disease progression and treatment escalation occurred for most of this population‐based cohort. Earlier intervention for patients with higher‐risk characteristics may improve long‐term outcomes reducing the burden on health systems. [ABSTRACT FROM AUTHOR]

Background and Aims Modifiable risk factors in inflammatory bowel disease [IBD], such as physical activity, may be used as prevention strategies. However, the findings of previous studies on the association between physical activity and IBD risk have been inconsistent. We aimed to perform a systematic review and meta-analysis to estimate the effect of physical activity on IBD risk. Methods A search was conducted for relevant studies published before April 2023 that assessed the effect of pre-IBD diagnosis levels of physical activity on IBD incidence. Individual summary statistics [relative risks; RR], and confidence intervals [CI] were extracted with forest plots generated. We used the Grading of Recommendations Assessment, Development and Evaluation [GRADE] approach to assess the quality of evidence. Results Ten observational studies were included. For cohort studies, there were 1182 Crohn's disease [CD] and 2361 ulcerative colitis [UC] patients, with 860 992 participants without IBD. For case-control studies, there were 781 CD to 2636 controls, and 1127 UC to 3752 controls. Compared with individuals with low physical activity levels, the RRs of CD in individuals with high physical activity levels for cohort and case-control studies were 0.78 [95% CI 0.68-0.88, p  = 0.0001] and 0.87 [95% CI 0.79-0.95, p  = 0.003], respectively. For UC, the RRs were 0.62 [95% CI 0.43-0.88, p  = 0.008] and 0.74 [95% CI 0.51-1.07, p  = 0.11]. Conclusion This meta-analysis suggests that physical activity is inversely associated with the risk of developing IBD, more so in CD than in UC. [ABSTRACT FROM AUTHOR]

Preoperative exclusive enteral nutrition (EEN) improves nutritional status, reduces intestinal inflammation, and likely improves surgical outcomes. Crohn’s disease exclusion diet with partial enteral nutrition (CDED) also reduces intestinal inflammation but its safety preoperatively is unknown. This single-blinded, multicentre, randomised controlled trial of three preoperative nutritional therapies aimed to assess the feasibility of recruiting and retaining patients and collecting primary and secondary effectiveness outcomes. Adults undergoing elective Crohn’s disease surgery with a body mass index (BMI) > 18.5 kg/m2 and without significant weight loss were eligible to participate. Patients were randomly assigned to six weeks of preoperative EEN, CDED, or standard care. Feasibility, nutritional, radiological, and surgical outcomes were recorded. Over 18 months, 48 patients were screened, 17 (35%) were randomised, and 13/17 (76%) patients were retained in the intervention phase. It was feasible to collect primary and secondary effectiveness data; at day 30, three patients had Clavien Dindo Grade 2 complications, and 10 had no complications. Nutritional therapy adherence of patients retained in the study was high. Recruitment and retention of patients who need elective Crohn’s disease surgery for preoperative nutritional therapy is possible, although a shorter duration may improve EEN completion. The impact on surgical outcomes should be assessed in a larger study. [ABSTRACT FROM AUTHOR]

Summary: Background: Telehealth is a growing model of care, greatly accelerated with the demands of the COVID‐19 pandemic. Telecare is a synchronous audio‐visual or audio‐only format of health delivery. Aims: To evaluate the existing literature on telecare within adult gastroenterology subspecialties to determine if outcomes are comparable to traditional in‐person consultations and to highlight the Pokapū Network, a local initiative in the Lakes Region of New Zealand, amongst these international findings. Methods: We completed an OVID MEDLINE search using the terms gastroenterology, endoscopy, digestive system, inflammatory bowel disease, functional, hepatology, liver, telemedicine, telehealth, videoconferencing, remote consultation, video clinic and telephone clinic. Results: Patients showed positive attitudes towards telecare and, in several reports, would elect to have telecare consults in the future. Telecare reduces travel time and out‐of‐pocket costs for patients and the need for patients to take time off work. Generally, patients engaging with telecare show equivalent health outcomes to patients engaging with traditional models of care. Patients from ethnic minority groups or lower socio‐economic backgrounds, or who are older, are less likely to complete a 'successful' telecare consult. Conclusion: Telecare is a useful model of care to allow gastroenterology centres to function within the context of COVID‐19 isolation and beyond. It has significant benefits for patients who face geographical and financial barriers to accessing healthcare. Telecare models such as the Pokapū Network hold promise in reducing inequities for gastroenterology patients. Such models must be introduced with consideration of digital disparities that exist amongst patients to avoid worsening the digital divide. [ABSTRACT FROM AUTHOR]

Australasia, encompassing Australia, New Zealand, and Papua New Guinea, has some of the highest prevalence's of inflammatory bowel disease (IBD) in the world. The way IBD medicine is practiced varies between and within these countries. There are numerous shared issues of IBD care between Australia and New Zealand, whereas Papua New Guinea has its' own unique set of circumstances. This review looks to explore some of the barriers to IBD care across the continent from the perspective of local IBD healthcare professionals. Barriers to IBD care that are explored include access to IBD multidisciplinary teams, provision of nutritional-based therapies, the prevalence and engagement of IBD-associated mental health disorders, access to medicine, access to endoscopy, rural barriers to care, Indigenous IBD care and paediatric issues. We look to highlight areas where improvements to IBD care across Australasia could be made as well as address research needs. [ABSTRACT FROM AUTHOR]

This article is a special edition of the journal Alimentary Pharmacology & Therapeutics focused on inflammatory bowel disease (IBD). It includes a range of articles written by experts in the field, covering topics such as disease prevention, disease severity, the gut-brain axis, dietary management, and the optimization of biologic drugs for treatment. The authors provide a roadmap for IBD prevention, discuss the various factors that contribute to disease severity, highlight the importance of managing psychological health in IBD patients, present dietary strategies for managing symptoms, and explore the optimization of biologic drugs through therapeutic drug monitoring. The article concludes with a guide for clinicians on recently approved and emerging therapies for IBD. The authors express their gratitude to the contributing authors and hope that readers will find these papers informative. [Extracted from the article]