Pablo Vega

Aims: This study aimed to describe the characteristics of newly diagnosed inflammatory bowel disease (IBD) patients and to analyse their clinical course within the first 5 years after diagnosis, including the need for surgery, hospitalisations and treatments. Methods: This prospective and large multicentre incident cohort registry in Spain enrolled adults diagnosed with Crohn's disease (CD), ulcerative colitis (UC) or unclassified IBD (IBD‐U) in 2017 and followed them for 5 years. Results: A total of 3301 patients were enrolled: 1526 with CD, 1633 with UC and 142 with IBD‐U. Their median age at diagnosis was 43 years (interquartile range 31–56) and approximately 50% were male. Within 5 years post‐diagnosis, 30% received biologics or JAK inhibitors (JAKi), 34% were hospitalised at least once and 9% underwent surgery. The cumulative incidence of biologic/JAKi treatment, hospitalisations and surgeries was higher among CD patients. Use of biologics/JAKi correlated with a more aggressive CD phenotype, greater UC extent and younger age at diagnosis. Biologics/JAKi treatment was associated with lower hospitalisation risk in both CD (Hazard ratio [HR] = 0.4, 95% confidence interval [CI] = 0.2–0.6) and UC patients (HR = 0.5, 95% CI = 0.2–0.9). However, it was not associated with the risk of abdominal surgery in CD but was linked to an increased risk of surgery in UC (HR = 11.9, 95% CI = 4.6–30.4). Conclusions: This large multicentre cohort demonstrated a higher use of biologics/JAKi during the first 5 years after IBD diagnosis than previously reported. Treatment with biologics/JAKi was associated with reduced risk of hospitalisation. However, under current clinical practice patterns, this therapeutic approach did not translate into lower risk of abdominal surgery.

Background and Aim: Around 10% of patients with inflammatory bowel disease do not fulfill the diagnostic criteria for Crohn's disease (CD) or ulcerative colitis (UC). These cases are labelled as inflammatory bowel disease unclassified (IBDU). The aim of the study was to compare therapeutic requirements in patients with IBDU and UC and to identify predictive factors of reclassification. Methods: This was a multicenter retrospective cohort study based on the ENEIDA registry. Patients diagnosed with IBDU or indeterminate colitis between January 2010 and December 2016 were included. All cases were matched by sex, age at diagnosis, and disease extent with at least two UC patients from the same hospital. The Kaplan–Meier method was performed to assess diagnostic changes during follow‐up. Fine–Gray competing‐risks regression analysis identified predictive factors of reclassification. Results: Two hundred and nine IBDU patients and 465 UC patients were included. After a median follow‐up of 90 months, no significant differences were observed in the use of immunomodulator (37.3% vs. 37%, p = 0.934) and advanced therapies (29.2% vs. 23.9%, p = 0.143) between IBDU and UC. No statistical differences were found in the surgical rates (5.7% vs. 4.7%, p = 0.579). Overall, 59 IBDU patients (28.2%) were reclassified (30 UC and 29 CD). Baseline extensive colitis was associated with a lower probability of subsequent reclassification to UC (SHR: 0.33; 95% CI: 0.12–0.91). No independent predictive factors for reclassification to CD were identified. Conclusions: Therapeutic management of IBDU and UC patients tended to be similar. Two‐thirds of patients remained classified as IBDU.

Background: The expanding use of targeted therapies in inflammatory bowel disease has made treatment sequencing increasingly relevant, yet evidence on anti‐TNF effectiveness after prior biologics with different mechanisms of action (MOA) remains limited. Our objective is to evaluate the durability of anti‐TNF treatment in this scenario. Methods: Multicentre study based on data from the ENEIDA registry. Patients who received second‐line anti‐TNF therapy after a first biologic with a different MOA for active luminal disease were identified. Using propensity score matching, each case was matched with three controls from two cohorts: patients treated with second‐line anti‐TNF after another anti‐TNF and patients receiving first‐line anti‐TNF therapy. Treatment durability and short‐ and long‐term clinical effectiveness were assessed. Results: Sixty‐six Crohn's disease patients and 117 UC patients receiving anti‐TNF after other MOA were included. In CD, second‐line anti‐TNF therapy after a different MOA (62% ustekinumab) was associated with a higher risk of treatment discontinuation compared with first‐line anti‐TNF therapy (HR 1.55; 95% CI, 1.05–2.30), without significant differences in short‐ or long‐term clinical effectiveness. In UC, anti‐TNF therapy after a different MOA (90% vedolizumab) was associated with lower treatment durability compared with first‐line anti‐TNF therapy (HR 1.69; 95% CI, 1.31–2.19) and with anti‐TNF after another anti‐TNF agent (HR 1.91; 95% CI, 1.48–2.48), its remission rates significantly lower at both short‐ and long‐term follow‐up ( p < 0.001). Conclusions: Anti‐TNF therapy used after a different MOA is associated with reduced effectiveness and durability compared with its use as first‐line therapy or after another anti‐TNF agent, especially in UC.

Background/Objectives: Computer-aided detection (CADe) systems are increasingly used in endoscopy to enhance lesion recognition. PolyDeep is a CADe/x tool previously assessed in an observational study. The aim of our study is to determine if PolyDeep-assisted colonoscopy reduces the adenoma miss rate (AMR) compared with conventional colonoscopy. Methods: We carried out a multicenter randomized controlled trial with a tandem colonoscopy design in participants from a colorectal cancer screening program (positive fecal immunochemical test-FIT or surveillance). Expert endoscopists performed all colonoscopies, and patients were allocated to groups by a computer-generated sequence. The primary endpoint was AMR; secondary endpoints included polyp miss rate (PMR), serrated lesion miss rate (SLMR) and advanced polyp miss rate (APMR). Results: From May to November 2023, we recruited 260 patients and excluded 20, leaving 240 for analysis. Baseline characteristics were balanced between groups (62.1% male; mean age 62.3 ± 6.5 years; 65.8% FIT-positive; mean first withdrawal time 13:38 ± 08:07 min; mean second withdrawal time 07:50 ± 03:38 min; lesion detection rate 76.6%; mean polyps per patient 3.4 ± 3.1). We did not find statistically significant differences between PolyDeep-assisted and conventional colonoscopy groups in AMR (21.3% vs. 18.1%, p = 0.5), PMR (21.8% vs. 20.3%, p = 0.7), SLMR (23.4% vs. 25.6%, p = 0.9) or APMR (7.3% vs. 11.3%, p = 0.5). In the subgroup analysis according to indication, we did not find any statistically significant differences. Conclusions: In the context of a CRC screening program, PolyDeep-assisted colonoscopy did not reduce AMR.

Background/Objectives: Computer-aided detection (CADe) systems are increasingly used in endoscopy to enhance lesion recognition. PolyDeep is a CADe/x tool previously assessed in an observational study. The aim of our study is to determine if PolyDeep-assisted colonoscopy reduces the adenoma miss rate (AMR) compared with conventional colonoscopy. Methods: We carried out a multicenter randomized controlled trial with a tandem colonoscopy design in participants from a colorectal cancer screening program (positive fecal immunochemical test-FIT or surveillance). Expert endoscopists performed all colonoscopies, and patients were allocated to groups by a computer-generated sequence. The primary endpoint was AMR; secondary endpoints included polyp miss rate (PMR), serrated lesion miss rate (SLMR) and advanced polyp miss rate (APMR). Results: From May to November 2023, we recruited 260 patients and excluded 20, leaving 240 for analysis. Baseline characteristics were balanced between groups (62.1% male; mean age 62.3 ± 6.5 years; 65.8% FIT-positive; mean first withdrawal time 13:38 ± 08:07 minutes; mean second withdrawal time 07:50 ± 03:38 minutes; lesion detection rate 76.6%; mean polyps per patient 3.4 ± 3.1). We did not find statistically significant differences between PolyDeep-assisted and conventional colonoscopy groups in AMR (21.3% vs 18.1%, p = 0.5), PMR (21.8% vs 20.3%, p = 0.7), SLMR (23.4% vs 25.6%, p = 0.9) or APMR (7.3% vs 11.3%, p = 0.5). In the subgroup analysis according to indication, we did not find any statistically significant differences. Conclusions: In the context of a CRC screening program, PolyDeep-assisted colonoscopy did not reduce AMR.

Background: PolyDeep is a computer-aided detection and characterization system that has demonstrated a high diagnostic yield for in vitro detection of colorectal polyps. Our objective is to compare the diagnostic performance of expert endoscopists and PolyDeep for colorectal polyp detection. Methods: PolyDeep Advance 1 (NCT05514301) is an unicentric diagnostic test study with a second observer design. Endoscopists performed colonoscopy blinded to PolyDeep’s detection results. The main endpoint was the sensitivity for colorectal polyp (adenoma, serrated or hyperplastic lesion) detection. The secondary endpoints were the diagnostic performance for diminutive lesions (≤5 mm), neoplasia (adenoma, serrated lesion) and adenoma detection. Results: We included 205 patients (55.1% male, 63.0 ± 6.2 years of age) referred to colonoscopy (positive faecal immunochemical occult blood test = 60.5%, surveillance colonoscopy = 39.5%). We excluded eight patients due to incomplete colonoscopy. Endoscopists detected 384 lesions, of which 39 were not detected by PolyDeep. In contrast, PolyDeep predicted 410 possible additional lesions, 26 of these predictions confirmed by endoscopists as lesions, resulting in a potential 6.8% detection increase with respect to the 384 lesions detected by the endoscopists. In total, 410 lesions were detected, 20 were not retrieved, five were colorectal adenocarcinoma, 343 were colorectal polyps (231 adenomas, 39 serrated and 73 hyperplastic polyps), 42 were normal mucosa and 289 were ≤5 mm. We did not find statistically significant differences between endoscopists and PolyDeep for colorectal polyp detection (Sensitivity = 94.2%, 91.5%, p = 0.2; Specificity = 9.5%, 14.3%, p = 0.7), diminutive lesions (Sensitivity = 92.3%, 89.5%, p = 0.4; Specificity = 9.8%, 14.6%, p = 0.7), neoplasia (Sensitivity = 95.2%, 92.9%, p = 0.3; Specificity = 9.6%, 13.9%, p = 0.4) and adenoma detection (Sensitivity = 94.4%, 92.6%, p = 0.5; Specificity = 7.2%, 11.8%, p = 0.2). Conclusions: Expert endoscopists and PolyDeep have similar diagnostic performance for colorectal polyp detection.

Background: PolyDeep is a computer-aided detection and characterization system that has demonstrated a high diagnostic yield for in vitro detection of colorectal polyps. Our objective is to compare the diagnostic performance of expert endoscopists and PolyDeep for colorectal polyp detection. Methods: PolyDeep Advance 1 (NCT05514301) is an unicentric diagnostic test study with a second observer design. Endoscopists performed the colonoscopy blinded to PolyDeep. The main endpoint was the sensitivity for colorectal polyp (adenoma, serrated or hyperplastic lesion) detection. The secondary endpoints were the diagnostic performance for diminutive lesions (≤5 mm), neoplasia (adenoma, serrated lesion) and adenoma detection. Results: We included 205 patients (55.1% male, 63.0 ± 6.2 years of age) referred to colonoscopy (positive faecal immunochemical occult blood test = 60.5%, surveillance colonoscopy = 39.5%). We excluded 8 patients due to incomplete colonoscopy. Endoscopists detected 384 lesions, of which 39 were not detected by PolyDeep. In contrast, PolyDeep predicted 410 possible additional lesions, 26 of these predictions confirmed by endoscopists as lesions, resulting in a potential 6.8% detection increase with respect to the 384 lesions detected by the endoscopists. In total, 410 lesions were detected, 20 were not retrieved, 5 were colorectal adenocarcinoma, 343 were colorectal polyps (231 adenomas, 39 serrated and 73 hyperplastic polyps), 42 were normal mucosa and 289 were ≤5mm. We did not find statistically significant differences between endoscopists and PolyDeep for colorectal polyp detection (Sensitivity = 94.2%, 91.5%, p = 0.2; Specificity = 9.5%, 14.3%, p = 0.7), diminutive lesions (Sensitivity = 92.3%,89.5%, p = 0.4; Specificity = 9.8%, 14.6%, p = 0.7), neoplasia (Sensitivity = 95.2%, 92.9%, p = 0.3; Specificity = 9.6%, 13.9%, p = 0.4) and adenoma detection (Sensitivity = 94.4%, 92.6%, p = 0.5; Specificity = 7.2%, 11.8%, p = 0.2). Conclusion: Expert endoscopists and PolyDeep have similar diagnostic performance for colorectal polyp detection.

INTRODUCTION: The coexistence of HIV infection and inflammatory bowel disease (IBD) is uncommon. Data on the impact of HIV on IBD course and its management are scarce. The aim of this study was to describe the IBD phenotype, therapeutic requirements, and prevalence of opportunistic infections (OIs) in IBD patients with a coexistent HIV infection. METHODS: Case-control, retrospective study includes all HIV-positive patients diagnosed with IBD in the Nationwide study on genetic and environmental determinants of inflammatory bowel disease registry. Patients with positive HIV serology (HIV-IBD) were compared with controls (HIV seronegative), matched 1:3 by year of IBD diagnosis, age, sex, and type of IBD. RESULTS: A total of 364 patients (91 HIV-IBD and 273 IBD controls) were included. In the whole cohort, 58% had ulcerative colitis, 35% had Crohn's disease (CD), and 7% were IBD unclassified. The HIV-IBD group presented a significantly higher proportion of proctitis in ulcerative colitis and colonic location in CD but fewer extraintestinal manifestations than controls. Regarding treatments, nonbiological therapies (37.4% vs 57.9%; P = 0.001) and biologicals (26.4% vs 42.1%; P = 0.007), were used less frequently among patients in the HIV-IBD group. Conversely, patients with HIV-IBD developed more OI than controls, regardless of nonbiological therapy use. In the multivariate analysis, HIV infection (odds ratio 4.765, 95% confidence interval (CI) 2.48–9.14; P < 0.001) and having ≥1 comorbidity (OR 2.445, 95% CI 1.23–4.85; P = 0.010) were risk factors for developing OI, while CD was protective (OR 0.372, 95% CI 0.18–0.78; P = 0.009). DISCUSSION: HIV infection seems to be associated with a less aggressive phenotype of IBD and a lesser use of nonbiological therapies and biologicals but entails a greater risk of developing OI.

(1) Scant information is available concerning the characteristics that may favour the acquisition of COVID-19 in patients with inflammatory bowel disease (IBD). Therefore, the aim of this study was to assess these differences between infected and noninfected patients with IBD. (2) This nationwide case–control study evaluated patients with inflammatory bowel disease with COVID-19 (cases) and without COVID-19 (controls) during the period March–July 2020 included in the ENEIDA of GETECCU. (3) A total of 496 cases and 964 controls from 73 Spanish centres were included. No differences were found in the basal characteristics between cases and controls. Cases had higher comorbidity Charlson scores (24% vs. 19%; p = 0.02) and occupational risk (28% vs. 10.5%; p < 0.0001) more frequently than did controls. Lockdown was the only protective measure against COVID-19 (50% vs. 70%; p < 0.0001). No differences were found in the use of systemic steroids, immunosuppressants or biologics between cases and controls. Cases were more often treated with 5-aminosalicylates (42% vs. 34%; p = 0.003). Having a moderate Charlson score (OR: 2.7; 95%CI: 1.3–5.9), occupational risk (OR: 2.9; 95%CI: 1.8–4.4) and the use of 5-aminosalicylates (OR: 1.7; 95%CI: 1.2–2.5) were factors for COVID-19. The strict lockdown was the only protective factor (OR: 0.1; 95%CI: 0.09–0.2). (4) Comorbidities and occupational exposure are the most relevant factors for COVID-19 in patients with IBD. The risk of COVID-19 seems not to be increased by immunosuppressants or biologics, with a potential effect of 5-aminosalicylates, which should be investigated further and interpreted with caution.

The authors wish to make the following corrections to this paper