Annemarie Charlotte de Vries

Background.: The clinical course of primary sclerosing cholangitis (PSC)-associated inflammatory bowel disease (IBD) after liver transplantation (LTx) varies significantly across studies. This meta-analysis aims to provide a comprehensive estimation of incidence rates (IR) for IBD-related outcomes and PSC recurrence. Methods.: Online databases (January 2000-June 2025) were searched for studies on PSC patients with or without IBD at LTx. Studies reporting posttransplant outcomes of interest were included. The pooled IR were calculated with the “meta” package (R Studio [V.4.3.2]) using a random effects model. Results.: A total of 34 studies (3828 patients; 67% with IBD at transplantation) were included. The IR of preexiting IBD exacerbation was 36.1 per 1000 person-years (95% confidence intervals [CI], 23.0-56.5). Medically refractory IBD requiring colectomy occurred at an IR of 12.4 per 1000 person-years (95% CI, 8.9-17.4). The IRs of colorectal neoplasia and advanced neoplasia were 10.3 (95% CI, 6.4-16.7) and 7.7 (95% CI, 5.6-10.7) per 1000 person-years, respectively. Among posttransplant PSC-only patients, the IR of newly diagnosed IBD was 20.0 (95% CI, 12.0-33.4). PSC recurrence occurred more frequently in PSC-IBD patients (31.9; 95% CI, 25.0-40.5) than in PSC-only patients (21.4; 95% CI, 11.3-40.6), corresponding to an incidence rate ratio of 2.16 (95% CI, 1.72-2.72; P < 0.001). Conclusions.: After LTx for PSC, patients remain at substantial risk of colorectal neoplasia and de novo IBD. PSC-IBD is associated with a higher risk of disease recurrence. These findings support continued endoscopic surveillance and close monitoring of IBD activity.

Background: Reports on postoperative outcomes after ileocolic resection (ICR) in Crohn’s disease (CD) vary widely. To provide insights into these differences, we compared international data on preoperative characteristics and postoperative management and outcome. Methods: CD patients undergoing ICR were included from prospective cohort studies in the Netherlands (NL), France (FR), Canada (CAN), and United States of America (USA). Results: Among 1761 patients, 79% underwent primary resection. In this population, surgery for Montreal classification B1 disease was more common (22% vs 0%-5%) and performed after shorter disease duration (4.3 vs 6.2-7.1 years) in NL than in other cohorts. Active smoking was more prevalent in NL and FR than in CAN and USA (23%-34% vs 7%-13%). In CAN, 54% were biologic-naive versus 27%-36% in other cohorts. Postoperative prophylaxis was prescribed in 28% of patients in NL and CAN, compared with 48% in FR and USA. Ileocolonoscopy within 12 months was performed in 72% in USA versus 88% in other cohorts. In the re-resection population, B1 disease at surgery and disease duration did not differ, whereas other findings were similar. Endoscopic postoperative recurrence (modified Rutgeerts’ score ≥ i2b) varied from 36% in FR to 41% in NL, 15% in USA to 24% in CAN after primary resection and from 43% in NL, 46% in FR, 26% in CAN to 29% in USA cohort after re-resection. Conclusions: Notable differences in preoperative characteristics and postoperative management and outcomes for ileocolic (re-)resections in CD were observed across European and North American countries.

Background: Postoperative endoscopic recurrence after ileocecal resection in Crohn's disease (CD) occurs frequently and typically precedes clinical and surgical relapse. Endoscopic scoring systems are central to postoperative management, yet their optimal use remains debated. The aim was to provide a summary and critical appraisal of established and novel endoscopic scoring systems used for recurrence in adult CD. Methods: A scoping review was conducted based on a systematic search in PubMed, EMBASE, and the Cochrane Library databases. Following qualitative synthesis, narrative reviews and studies involving pediatric or animal populations were excluded. Remaining evidence was integrated and critically appraised. The interpretation of findings was further refined through expert discussion within the IMPACT consortium. Results: The Rutgeerts score (RS) remains the most widely used index in clinical studies, but shows important limitations, including moderate interobserver reproducibility, limited differentiation between anastomotic and ileal lesions, and reduced applicability to modern anastomotic configurations. Modified and updated RS variants, as well as newer indices, emphasize lesion location and postoperative anatomy, and may improve prognostic stratification in selected cohorts. The choice of postoperative endoscopic index and the threshold used to define recurrence has major clinical implications. Heterogeneity in anatomic lesions considered, cutoffs for adapting treatments, and reproducibility limit the universal adoption of any single index. Conclusion: Endoscopic indices remain essential for classification and standardization for postoperative disease recurrence in CD but should be interpreted together with their current level of validation. These findings highlight the need for further validation, harmonization of definitions, and refinement of postoperative endoscopic evaluation.

Was not provided for this article.

Background: Over recent decades, there has been a more pronounced shift towards earlier therapeutic intervention in luminal Crohn's disease (CD). However, it remains unclear if similar strategies apply to active perianal fistulizing CD (pCD). This study explores the patient journey by assessing pCD management across diagnostic time periods in a large national cohort. Methods: Patients with active pCD were included in a multicentre cohort across 41 Dutch academic and non‐academic hospitals. Diagnostic modalities, medical and surgical treatments were evaluated over the pCD disease course, particularly within the first year after pCD diagnosis, and compared across four time periods: < 2010, 2010–2015, 2015–2020 and > 2020. Results: Four hundred and forty patients were included (53.0% female; median pCD disease course 4.1 years). 12% were diagnosed before 2010, 11% in 2010–2015, 31% in 2015–2020, 46% after 2020. Over time, imaging (MRI or EUS) within the first year after pCD diagnosis was used in 37% of cases diagnosed before 2010 to 66%, 83% and 95% in subsequent periods. Endoscopic evaluation for proctitis was performed in 23%, 40%, 57% and 60%. First‐line anti‐TNF use was initiated in 27% followed by 58%, 68% and 69%. A seton was placed in 27% initially and in 42%, 51% and 52% in later years. Fistula surgery aimed at closure was performed in 14%, 4%, 8% and 19% over time. Conclusions: This national cohort illustrates substantial progress in early pCD management over time. These shifts likely reflect growing clinical awareness of the importance of early and multidisciplinary interventions. However, surgical procedures aimed at fistula closure remain infrequently performed in the early disease course, which may be related to the inclusion of a predominantly therapy‐refractory patient group.

Background: Iron deficiency anaemia (IDA) is common in inflammatory bowel disease (IBD) and impairs quality of life. Hepcidin, the regulator of systemic iron homeostasis, may predict response to iron therapy; however, its utility in IBD remains unclear. This study evaluated whether baseline hepcidin predicts response to oral and intravenous (IV) iron in active IBD to guide personalised treatment. Methods: Ninety adults with active IBD and iron deficiency (with or without anaemia) from two randomised trials received IV iron, oral ferrous fumarate (FF) or oral ferric maltol (FM). Response at 12 weeks was defined as haemoglobin increase ≥ 1.2 mmol/L (19.3 g/L) or normalisation in IDA or ferritin > 100 μg/L and transferrin saturation > 20% in iron deficient patients. Baseline iron indices including ferritin, hepcidin, and soluble transferrin receptor (sTfR) were measured. Logistic regression and receiver operating curve analyses evaluated predictive performance. Results: Baseline hepcidin strongly predicted response to iron therapy: AUC _(FF) : 0.86, 95% CI: 0.71–1.00 and AUC _(IV) : 0.63, 95% CI: 0.30–0.96. Hepcidin > 2.68 μg/mL identified non‐responders to FF with 89% sensitivity and 77% specificity. Each twofold increase in baseline hepcidin or ferritin reduced the odds of response [log ₂ (hepcidin) OR: 0.71, 95% CI: 0.56–0.89; log ₂ (ferritin) OR: 0.38, 95% CI: 0.21–0.69]. Higher transferrin/log ₁₀ (ferritin) (OR: 2.95, 95% CI: 1.38–6.30) and sTfR/log ₁₀ (ferritin) ratios (OR: 1.29, 95% CI: 1.05–1.59) increased likelihood of response. Conclusion: Baseline hepcidin supports route selection for iron therapy: higher levels favour IV iron, while lower levels indicate likely oral response. Ferritin‐based indices, notably transferrin/log ₁₀ (ferritin), offer pragmatic alternatives where hepcidin testing is unavailable. Trial Registration: ClinicalTrials.gov identifier: NCT05581420 and NCT05456932

Background: Clinical trials have demonstrated the long‐term efficacy of ustekinumab in the treatment of ulcerative colitis (UC). However, real‐world data on its long‐term effectiveness beyond 1 year of follow‐up remain limited. Methods: This multicenter cohort study evaluated the effectiveness of ustekinumab in adults with UC treated in routine clinical practice for up to 4 years. Data were obtained from two prospective Dutch registries: IBDREAM and the ICC registry. The primary outcome was corticosteroid‐free remission at year 3, with remission defined as a hierarchical, composite endpoint based on endoscopic, biochemical, and clinical parameters. Subgroup analysis was performed in patients with difficult‐to‐treat IBD, defined as prior failure of ≥ 2 advanced therapies with different mechanisms of action. Secondary outcomes included dose escalation and safety. Results: A total of 198 patients were included; median age was 49 years, 48% were women, median disease duration was 8 years, and 42.4% had difficult‐to‐treat IBD. At years 2, 3, and 4, 35.8% (49/137), 34.3% (34/99), and 26.6% (17/64) of patients were in corticosteroid‐free remission. Among patients in corticosteroid‐free remission at week 12 ( n = 83), 50.0% remained in remission at year 3. Corticosteroid‐free remission rates at year 3 in patients with difficult‐to‐treat IBD and other patients were 19.2% and 51.1%, respectively. One‐hundred‐seven adverse events were recorded in 64 patients, including six serious adverse events. Conclusion: These real‐world data confirm the effectiveness of ustekinumab in inducing and maintaining remission for up to 4 years in UC. The medication was particularly effective in patients with limited prior exposure to advanced therapies. Results support the established safety profile of ustekinumab.

Background: Sexual function is one of the determinants of quality of life (QoL) and is prevalent in approximately half of the patients with inflammatory bowel disease. However, the sexual function in patients with perianal fistulizing Crohn's disease (pCD) needs to be further elucidated. This study aimed to evaluate the sexual function, the correlation with health‐related QoL (HR‐QoL), and to identify risk factors for sexual dysfunction (SD) in patients with active pCD. Methods: Patients with active pCD were identified from a prospective multicentre cohort study in 41 Dutch hospitals. Respondents to sexual function (FSFI for females or IIEF‐5 for males) and HR‐QoL questionnaires were included in this study. The primary outcome was the prevalence of SD (FSFI p = 0.046). A weak correlation of SD was observed with the CAF‐QoL scale ( r = 0.25) and the sIBDQ ( r = −0.24). Older age (aOR 1.0; 95% CI 1.0–1.1), a longer pCD duration (aOR 0.9; 95% CI 0.8–0.9) and a decreased pCD‐related QoL (aOR 1.0; 95% CI 1.0–1.1) were independently associated with SD. In subgroup analysis of patients with a known partner status (66.1%), having a partner (aOR 0.3; 95% CI 0.1–0.9) was identified as a protective factor. Conclusion: Sexual dysfunction is common in both male and female patients with active pCD. A weak correlation between HR‐QoL and sexual dysfunction suggests that these questionnaires do not fully assess sexual function, highlighting the need for separate evaluation. Factors such as age, reduced pCD‐related QoL, longer pCD duration and having a partner were associated with sexual dysfunction. Given its prevalence, routine sexual function assessment by the treating team is recommended, with referral to a sexologist or other expert when needed.

Background: Risankizumab, a monoclonal antibody targeting interleukin-23, is approved for the treatment of Crohn’s disease (CD). Real-world evidence on its effectiveness remains limited. We assessed 1-year effectiveness and safety of risankizumab in a prospective cohort of patients with CD, emphasizing difficult-to-treat disease. Methods: Data were retrieved from the Dutch Initiative on Crohn and Colitis Registry. At baseline and at weeks 12, 24, and 52, clinical remission (Harvey-Bradshaw Index ≤4), biochemical remission (fecal calprotectin ≤250 µg/g and C-reactive protein levels ≤5 mg/L), systemic corticosteroids use, and safety outcomes were determined. The primary outcome was corticosteroid-free clinical remission (CSFCR) at week 24. Difficult-to-treat disease was defined as the failure of advanced therapies with at least 2 different mechanisms of action. Results: In total, 151 patients initiated risankizumab before August 1, 2025; 136 (90.1%) of 151 patients had difficult-to-treat disease. At baseline, 90 (59.6%) patients had Harvey-Bradshaw Index >4. Of those, at week 24, 31 (50%) of 62 patients were in CSFCR; this rate was 53.3% when including all patients. Analysis including only patients with difficult-to-treat disease revealed that 51.8% of these patients were in CSFCR at week 24. Twenty-two (14.6%) patients discontinued treatment after a median of 183.5 days (Q1-Q3: 90.0-295.2 days), most following nonresponse. Regarding adverse events, 35.3 possibly and 16.6 probably risankizumab-related events per 100 person-years were reported. Conclusion: In this prospective multicenter study, risankizumab demonstrated favorable effectiveness and safety profile in patients with CD, including those with difficult-to-treat disease, bowel surgery, and stoma. These findings support the use of risankizumab in patients with difficult-to-treat disease.

Background: The treatment of perianal fistulas remains challenging, with low healing and high recurrence rates. Autologous adipose-derived regenerative therapies and platelet-rich plasma (PRP) have emerged as adjuncts to surgical intervention for cryptoglandular and Crohn’s disease (CD)-related perianal fistulas (PAF). This systematic review evaluates the outcomes of these therapies as an add-on to surgical intervention. Methods: A systematic search was conducted in several online databases up to December 2025. Studies with ≥10 patients reporting on the use of intraoperative autologous adipose-derived therapies and/or PRP for the treatment of cryptoglandular or CD-related PAF, and clinical healing rates, were included. Other outcomes comprised radiologic healing (as defined in the study), recurrence rates and complications. The study quality was assessed with the Effective Public Health Practice Tool. Results: In total, 28 studies on individual cases were included (n = 1017 patients, range 10–219) (17 in cryptoglandular PAF, 8 in CD-related PAF and 3 in both entities). A total of 57% of the studies were rated low quality. In cryptoglandular PAF, reported healing rates with adipose-derived therapies ranged from 50% to 90% across studies of low to good methodological quality. For PRP, three of the four randomized trials demonstrated no superiority over standard care. In CD-related PAF, healing rates after treatment with adipose-derived therapies ranged from 40% to 80%. For PRP, three studies, of which two were low quality, reported highly variable healing rates (33–80%). Radiologic healing, reported in 10 studies, ranged from 38 to 76% in cryptoglandular and 33–75% in CD-related PAF. Recurrence rates remained <17% for adipose-derived therapies and <31% following treatment with PRP. Major complications occurred in <15% of the patients. Conclusions: High heterogeneity with regard to fistula complexities, outcome definitions and surgical method was observed in the available studies on autologous add-on therapies. This hinders an overall effectiveness analysis. The promising healing rates, low recurrence rates after healing and low complication rates warrant high-quality trials.