Inflammatory bowel disease (IBD) is more common in young and middle-aged individuals, often presenting challenges related to fertility. This article discusses key issues in consultation, guidance, and management during the pre-pregnancy, pregnancy, and lactation periods based on the latest guidelines and research progress on the management of IBD patients during pregnancy and lactation, providing guiding opinions for clinical practice.

Objective:To explore the risk factors for short-term surgery in patients with acute severe ulcerative colitis (ASUC) .Methods:A retrospective case-control study was conducted. Consecutive patients with ASUC admitted to the Department of Gastroenterology at Zhongnan Hospital of Wuhan University from January 2019 to June 2023 were enrolled. Clinical data such as general information, clinical manifestations, laboratory tests, and colonoscopy examinations were analyzed. Based on whether the patients underwent surgery within 90 days after admission, the patients were divided into short-term surgery group and short-term non-surgery group, and the differences in clinical characteristics between the two groups were compared. Univariate and multivariate Logistic regression analyses were performed to identify the risk factors for short-term surgery.Results:A total of 90 patients were included, with 58 males and 32 females, age 42.0 (30.8, 54.3) years, disease duration 1.00 (0.15, 4.25) years, body mass index (21.4 ± 3.8) kg/m 2; according to the ulcerative colitis endoscopic index of severity (UCEIS) results of 83 patients, 31 were moderate activity, and 52 were severe activity. After a follow-up period of 8.4 (3.9, 14.7) months, a total of 15 patients (16.7%) underwent surgery. Ten patients undergoing surgery within 90 days after admission were set as the short-term surgery group ( n = 10), and 5 patients undergoing surgery more than 90 days after admission and 75 receiving drug treatment were set as the short-term non-surgery group ( n = 80). Compared with the short-term non-surgery group, patients in the short-term surgery group were older, and had a higher proportion of UCEIS 7-8 points and lower remission rates induced by glucocorticoids and biological agents, with all differences being statistically significant (all P < 0.05). Univariate and multivariate Logistic regression analyses found that age ≥55 years ( P = 0.009, OR = 13.266, 95% CI: 1.922-91.548) and high baseline CRP ( P = 0.014, OR = 1.010, 95% CI: 1.002-1.019) were independent risk factors for short-term surgery in ASUC patients. Postoperative complications occurred in 4 patients, including 1 of anastomotic ulceration, 1 of ileostomy infection, and 2 of pouchitis. Conclusion:The surgery rate in ASUC patients is high, and patients who are older or have elevated CRP are more likely to undergo short-term surgery.

Objective:To evaluate the long-term clinical efficacy and the influence on anal function of surgery combined with ustekinumab (UST) in active Crohn's disease (CD) patients with perianal fistula.Methods:A retrospective cohort study was conducted. Clinical data of active CD patients with perianal fistula undergoing surgery combined with UST at Longhua Hospital of Shanghai University of Traditional Chinese Medicine from August 2020 to December 2022 were collected. The primary endpoints were clinical healing rate, Wexner score, and anorectal manometry values at week 52 of treatment. Secondary endpoints included the Crohn's disease activity index (CDAI), perianal Crohn's disease activity index (PDAI), laboratory indicators [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fecal calprotectin (FC) ], endoscopic remission rate, Van Assche score, and radiographic healing rate at week 52 of treatment.Results:A total of 28 patients were included, with 22 males (78.6%) and 6 females (21.4%) ; age (25.2 ± 7.7) (16.0-52.0) years. There was 1 patient (3.6%) of simple anal fistula. There were 27 patients (96.4%) of complex anal fistulas, including 12 of high intersphincteric type, 15 of high transsphincteric type, in which 15 with branched tracts (or ≥2 fistula tracts). The pre-treatment CDAI was 187.0 (156.0, 245.0), and the PDAI was 10.0 (9.0, 12.0). Among the 28 patients, 23 (82.1%) underwent fistulotomy, 1 (3.6%) underwent transanal opening of intersphincteric space (TROPIS), and 4 (14.3%) underwent video-assisted anal fistula treatment (VAAFT) combined with fistula-tract laser closure (FiLaC). All the patients received UST treatment postoperatively, without concurrent use of immunosuppressants or corticosteroid therapy. At week 52 of treatment, 28 (100%) patients achieved clinical healing. Compared to pre-treatment, Wexner score of patients at week 52 of treatment was significantly lower [0 (0, 0) vs. 1.0 (0, 3.0), P < 0.001], maximum anal sphincter pressure increased [ (137.6±40.9) mmHg vs. (105.1±29.2) mmHg, P < 0.001], maximum anal sphincter contraction time extended [9.0 (5.0, 15.0) s vs. 4.0 (2.0, 6.0) s, P < 0.001], and there was no significant decrease in anal resting pressure ( P > 0.05). Compared to pre-treatment, CDAI, PDAI, Van Assche scores, and simple endoscopic score for Crohn's disease (SES-CD) of patients at week 52 of treatment all significantly decreased (all P < 0.001), and CRP, ESR, and FC all decreased (all P < 0.05), with statistically significant differences. The radiographic healing rate at week 52 of treatment was 75.0% (21/28), and the radiographic remission rate was 92.9% (26/28). The endoscopic remission rate was 57.1% (16/28), and the endoscopic response rate was 82.1% (23/28) . Conclusion:The long-term clinical healing rate of active CD patients with perianal fistula receiving surgery combined with UST is high, and the anal function can be improved significantly.

Granulomatous vasculitis is a kind of necrotizing granulomatous vasculitis with the prominent feature of detectable anti-neutrophil cytoplasmic antibodies in serum, which often involves the respiratory tract and kidneys, and the onset of symptoms in the digestive tract is rare, and we now report a rare case of granulomatous vasculitis in which the gastrointestinal tract was involved as the first symptom in order to improve the clinician's understanding of this disease.

The pathogenesis of inflammatory bowel disease (IBD) is complex, including multiple factors such as genetic predisposition, environmental factors, intestinal microbiota disorders, epithelial barrier dysfunction, and immune system dysregulation. Among these factors, the gut microbiome plays an important role. Notably, Akkermansia. muciniphila is an intestinal bacterium potentially associated with IBD. This review summarizes the mechanism of action of Akkermansia. muciniphila in IBD, including strengthening the intestinal barrier, modulating inflammatory responses, interacting with the gut microbiome, and its potential in IBD treatment. Additionally, the strain specificity and safety of Akkermansia.muciniphila are also discussed.

Inflammatory bowel disease (IBD) is a refractory chronic inflammatory disease of the intestine, and its etiological mechanism is still unclear. Recent studies have shown that the intestinal macrophages participates the intestinal immunity by regulating exosomes, intestinal flora, ubiquitination and deubiquitination, immune metabolism and autophagy, plays an important role in maintaining intestinal homeostasis, and is closely related to the occurrence and development of IBD. Investigating the underlying mechanisms of macrophages in IBD advancement may provide new therapeutic approaches. This article reviews the latest research progress on the multifaceted mechanisms of intestinal macrophages in IBD.

Objective:Based on data from the Global Burden of Disease Study 2021 (GBD 2021), this study aims to analyze the epidemiological trends of inflammatory bowel diseases (IBD) in China from 1990 to 2021 and to assess the projected disease burden.Methods:Data on incidence, prevalence, mortality, and disability-adjusted life years (DALY) for IBD in China from 1990 to 2021 were extracted from the GBD 2021 database. Annual percent change (EAPC) and Bayesian age-period-cohort (BAPC) analyses were employed to evaluate these trends. Additionally, predictions for the disease burden over the next 25 years were made.Results:The age-standardized incidence rate of IBD in China rose from 0.74 per 100 000 in 1990 to 1.40 per 100 000 in 2021, an 89.19% increase. The age-standardized prevalence rate increased from 5.59 per 100 000 in 1990 to 9.16 per 100 000 in 2021, marking a 63.86% rise. Conversely, the age-standardized case fatality rate decreased from 0.75 per 100 000 in 1990 to 0.33 per 100 000 in 2021, a reduction of 56.00%. The total DALYs decreased from 162 186 in 1990 to 136 932 in 2021, a decline of 15.57%, while the age-standardized DALY rate fell from 18.38 per 100 000 in 1990 to 7.68 per 100 000 in 2021, a decrease of 58.22%. Analysis by age group revealed that the age-standardized incidence rate for the 35-39 years cohort increased most significantly, with an EAPC of 3.23%. The age-standardized prevalence rate for the 50-54 years cohort increased most significantly, with an EAPC of 2.85%. Gender analysis indicated that from 1990 to 2021, the age-standardized prevalence rate was higher among females than males, but the age-standardized case fatality rate rate was higher among males. From 2004 to 2021, the age-standardized DALY rate declined for both sexes, though it remained higher in males. By 2046, the number of new cases is projected to be slightly higher in males, while case fatality rate and DALYs are expected to remain low for both genders.Conclusions:Over the past three decades, the disease burden of IBD in China has increased significantly, particularly in terms of incidence and prevalence. Despite a general decrease in case fatality rates, the burden of IBD may increase in the elderly population due to aging demographics. Therefore, effective preventive measures, early screening, and aggressive treatment are crucial, especially for the elderly.

Objective:To identify the incidence and prevalence of inflammatory bowel disease (IBD) in the northern Chinese population of Jinan, Shangdong Province, along with its temporal trends from 2005 to 2022.Methods:By utilizing the data from the Jinan basic medical insurance system, a population-based IBD cohort was constructed. This facilitated the computation of both the incidence and prevalence rates of IBD, alongside their temporal trends throughout the 2005 to 2022 timeframe. The 95% confidence intervals were estimated using poisson regression.Results:The overall incidence rate of IBD showed a yearly increasing trend, with age-standardized incidence rates rising from 0.03/100 000 in 2005 to 5.39/100 000 in 2022. The age-standardized incidence rate of ulcerative colitis (UC) increased from 0.03/100 000 in 2005 to 4.97/100 000 in 2022. The age-standardized incidence rate of Crohn's disease (CD) rose from 0.05/100 000 in 2011 to 0.44/100 000 in 2022. The crude prevalence of IBD increased from 0.60/100 000 in 2005 to 32.39/100 000 in 2022. Specifically, the crude prevalence of UC increased from 0.60/100 000 in 2005 to 31.44/100 000 in 2022, while the crude prevalence of CD increased from 0.05/100 000 in 2011 to 1.19/100 000 in 2022.Conclusions:Analysis of recent medical insurance data reveals a continuous uptrend in both the incidence and prevalence of IBD in Jinan, a northern city in China. This underscores the urgent need for enhanced medical resources and healthcare guaruntee to ensure the well-being of individuals afflicted with IBD.

Objective:To compare the clinical characteristics of monogenic and non-monogenic early-onset inflammatory bowel disease (EO-IBD) in children and to explore the necessity of genetic analysis in EO-IBD research.Methods:A retrospective analysis of clinical data was conducted on 73 children diagnosed with EO-IBD at the Children's Hospital affiliated with Capital Institute of Pediatrics between January 2017 and December 2023. Genetic analysis was performed utilizing next-generation sequencing technology, with patients stratified into monogenic and non-monogenic groups based on the presence or absence of pathogenic mutations. Subsequently, a comparative analysis of clinical characteristics was conducted between these two cohorts of EO-IBD patients.Results:Among the 73 EO-IBD cases, 27 (37%) were diagnosed as monogenic IBD, and 46 (63%) as non-monogenic IBD. Compared to the non-monogenic group, the monogenic group had an earlier age of onset [1 (0.2, 3.0) months vs. 15 (4.1, 51.3) months, P < 0.001], with a higher incidence within the first month of life (70.4% vs. 13.0%, P < 0.001). Monogenic IBD cases were more likely to present with Crohn's disease (CD) phenotypes (88.9% vs. 52.2%, P = 0.003) and colonic involvement (L2) (91.7% vs. 62.5%, P < 0.001), but were less likely to present with non-penetrating, non-stricturing (B1) disease (87.5% vs. 95.8%, P = 0.019). Children in the monogenic group were more prone to severe malnutrition (74.1% vs. 21.3%, P < 0.001), perianal abscesses (40.7% vs. 8.7%, P < 0.001), perianal tags (22.2% vs. 0%, P = 0.004), fever (74.1% vs. 23.9%, P < 0.001), oral ulcers (44.4% vs. 6.5%, P < 0.001), and skin lesions (33.3% vs. 2.2%, P < 0.001). Regarding treatment, the monogenic group had higher usage of thalidomide (88.9% vs. 54.3%, P = 0.002) and hematopoietic stem cell transplantation (HSCT) (37.0% vs. 0, P < 0.001) and a higher mortality rate (22.2% vs. 2.2%, P = 0.017) . Conclusions:For children with IBD presenting at an early age, especially within the first month of life, and showing symptoms like fever, oral ulcers, skin lesions, severe malnutrition, and perianal disease, monogenic IBD should be considered. Genetic testing results can aid in guiding treatment decisions.

Crohn's disease (CD) is an autoimmune disease with an unclear pathogenesis, primarily affecting the digestive tract. Perianal involvement represents a complex form of CD. Refractory proctoanal CD is a major cause of rectal resection and permanent anal sphincter dysfunction in patients. The colon pull-through with delayed anastomosis of the anal canal involves the resection of the diseased rectum and the management of the dentate line and anal canal. After the pulled-through colon has adhered to the anal canal, a revision and anastomosis are performed, aiming to preserve anal function and enhance the patients' quality of life. The specific criteria and timing for selecting this surgical approach for refractory proctoanal CD merit further discussion and investigation.