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BERLIN — Psychosocial factors, such as anxiety and depression, are associated with an increased risk for both self-reported “clinical” and symptomatic, or “hard,” flare in inflammatory bowel disease (IBD), suggested a study of UK patients.

The research was presented at the European Crohn’s and Colitis Organisation (ECCO) 2025 Congress.

“Despite clinical remission, there is a significant burden of psychosocial comorbidity in IBD patients,” said study presenter Lauranne A.A.P. Derikx, PhD, a gastroenterology researcher at Erasmus University MC, Rotterdam, the Netherlands.

“Anxiety, sleep, and somatization were associated with an increased risk of clinical flare, and depression and lack of exercise were associated with an increased risk of hard flare,” she said. “Altogether, this supports a holistic approach in IBD patients.”

 

Stephen E. Lupe, PsyD, director of behavioral medicine for the department of gastroenterology, hepatology and nutrition at the Cleveland Clinic, Ohio, who was not involved in the study, agreed.

“Whole-person care is so important” in IBD, and this study is part of a growing literature making the connection between symptom flare and factors such as anxiety, depression, stress, and even trauma, he said in an interview.

 

Searching for Predictive Links

The relapsing and remitting disease course in IBD is dynamic and hard to predict, Derikx said. Unfortunately, clinicians don’t know which patients with IBD will develop a flare or when it will occur.

There’s a high prevalence of psychosocial comorbidity among patients with IBD and a “bidirectional relationship between psychosocial vulnerabilities” and the disease course via the gut-brain axis, Derikx noted.

To determine which psychosocial factors may be associated with and predictive of IBD flare, researchers analyzed data from the PREdiCCt study, a large prospective study of patients with IBD from 47 centers across the United Kingdom that aims to determine the factors associated with developing a flare.

The median age of PREdiCCT study participants was 44 years, median duration of IBD was 10 years, and 35% were receiving advanced IBD therapy. The median fecal calprotectin level was 49 mcg/g, although 18% of patients had a level > 250 mcg/g, Derikx noted.

To be included in PREdiCCT, patients must have received the diagnosis of IBD more than 6 months previously, had not change their medication for more than 2 months, and answered “yes” to the question: Do you think your disease has been well controlled in the past 1 month? The question was chosen as a measure of clinical remission.

The team collected stool samples and gathered information via questionnaires about lifestyle, diet, and other factors.

 

Depression and Anxiety Increase Risk

Researchers included 1641 patients — 830 with Crohn’s and 811 with ulcerative colitis or IBD unclassified (IBDU) — with complete datasets in their analysis of associations between psychosocial factors and IBD flare.

Baseline questionnaires identified moderate anxiety in 18.8% of participants, severe anxiety in 16.1%, moderate depression in 9.8%, severe depression in 5.7%, sleep disturbances in 46.4%, moderate somatization in 22.8%, severe somatization in 7.9%, insufficient exercise in 22.2%, and consumption of more than 14 units of alcohol in 24%.

After 24 months of follow-up, 36% of patients had experienced a clinical flare, defined as answering “no” to the question: Do you think your disease has been well controlled in the past 1 month/since you last logged in to the [study] portal?

In addition, 13% of patients experienced a hard flare, defined as a clinical flare plus C-reactive protein levels > 5 mg/L and/or a calprotectin level > 250 mcg/g and a change in IBD therapy.

Survival analyses with Cox frailty models adjusted for baseline fecal calprotectin, sex, index of multiple deprivation, hospital site, and patient age revealed statistically significant associations between several psychosocial factors and increased risk for flare.

Moderate anxiety in Crohn’s disease increased clinical flare risk (adjusted hazard ratio [aHR], 1.64), as did severe anxiety in both Crohn’s disease (aHR, 1.86) and ulcerative colitis/IBDU (aHR, 1.46). Moderate depression and severe depression increased the flare risk in ulcerative colitis/IBDU (aHR, 1.72 and 1.67, respectively). Also increasing clinical flare risk was poor sleep quality in Crohn’s disease (aHR, 1.58), and severe somatization in Crohn’s disease (aHR, 3.86) and ulcerative colitis/IBDU (aHR, 1.96).

Fewer psychosocial factors were associated with increased risk for hard flare: moderate depression in ulcerative colitis/IBDU (aHR, 2.5), severe somatization in Crohn’s disease (aHR, 2.34), and lack of exercise in ulcerative colitis/IBDU (aHR, 1.55).

 

Physician-Patient Disconnect

There is “very little correlation” between self-reported and symptomatic flare in IBD, Lupe said. “This happens all the time, where the gastroenterologist will come out of the endoscopy suite and go: ‘You’re in remission.’ And the patient goes: ‘What are you talking about? I’m still going to the bathroom 20 times a day.’ ”

Now there are data showing that, if the care team undertakes behavioral work with patients who have IBD, “the medications work more effectively,” Lupe said.

“I think medicine is in a point of transition right now,” he added. “We’re (moving from) looking at people as disease states and ‘how do I treat the disease’ to ‘how do I take care of this human being,’ knowing that everything this human being does, including everything we put in our mouth, everything we experience, changes what happens inside our body, and it’s measurable.”

The PREdiCCt study is sponsored by the University of Edinburgh, Scotland. Derikx declared relationships with AbbVie, Janssen Pharmaceuticals, Sandoz, Galapagos, and Pfizer. Other authors also declared relationships with pharmaceutical companies.

A version of this article appeared on Medscape.com.

BERLIN — Psychosocial factors, such as anxiety and depression, are associated with an increased risk for both self-reported “clinical” and symptomatic, or “hard,” flare in inflammatory bowel disease (IBD), suggested a study of UK patients.

The research was presented at the European Crohn’s and Colitis Organisation (ECCO) 2025 Congress.

“Despite clinical remission, there is a significant burden of psychosocial comorbidity in IBD patients,” said study presenter Lauranne A.A.P. Derikx, PhD, a gastroenterology researcher at Erasmus University MC, Rotterdam, the Netherlands.

“Anxiety, sleep, and somatization were associated with an increased risk of clinical flare, and depression and lack of exercise were associated with an increased risk of hard flare,” she said. “Altogether, this supports a holistic approach in IBD patients.”

 

Stephen E. Lupe, PsyD, director of behavioral medicine for the department of gastroenterology, hepatology and nutrition at the Cleveland Clinic, Ohio, who was not involved in the study, agreed.

“Whole-person care is so important” in IBD, and this study is part of a growing literature making the connection between symptom flare and factors such as anxiety, depression, stress, and even trauma, he said in an interview.

 

Searching for Predictive Links

The relapsing and remitting disease course in IBD is dynamic and hard to predict, Derikx said. Unfortunately, clinicians don’t know which patients with IBD will develop a flare or when it will occur.

There’s a high prevalence of psychosocial comorbidity among patients with IBD and a “bidirectional relationship between psychosocial vulnerabilities” and the disease course via the gut-brain axis, Derikx noted.

To determine which psychosocial factors may be associated with and predictive of IBD flare, researchers analyzed data from the PREdiCCt study, a large prospective study of patients with IBD from 47 centers across the United Kingdom that aims to determine the factors associated with developing a flare.

The median age of PREdiCCT study participants was 44 years, median duration of IBD was 10 years, and 35% were receiving advanced IBD therapy. The median fecal calprotectin level was 49 mcg/g, although 18% of patients had a level > 250 mcg/g, Derikx noted.

To be included in PREdiCCT, patients must have received the diagnosis of IBD more than 6 months previously, had not change their medication for more than 2 months, and answered “yes” to the question: Do you think your disease has been well controlled in the past 1 month? The question was chosen as a measure of clinical remission.

The team collected stool samples and gathered information via questionnaires about lifestyle, diet, and other factors.

 

Depression and Anxiety Increase Risk

Researchers included 1641 patients — 830 with Crohn’s and 811 with ulcerative colitis or IBD unclassified (IBDU) — with complete datasets in their analysis of associations between psychosocial factors and IBD flare.

Baseline questionnaires identified moderate anxiety in 18.8% of participants, severe anxiety in 16.1%, moderate depression in 9.8%, severe depression in 5.7%, sleep disturbances in 46.4%, moderate somatization in 22.8%, severe somatization in 7.9%, insufficient exercise in 22.2%, and consumption of more than 14 units of alcohol in 24%.

After 24 months of follow-up, 36% of patients had experienced a clinical flare, defined as answering “no” to the question: Do you think your disease has been well controlled in the past 1 month/since you last logged in to the [study] portal?

In addition, 13% of patients experienced a hard flare, defined as a clinical flare plus C-reactive protein levels > 5 mg/L and/or a calprotectin level > 250 mcg/g and a change in IBD therapy.

Survival analyses with Cox frailty models adjusted for baseline fecal calprotectin, sex, index of multiple deprivation, hospital site, and patient age revealed statistically significant associations between several psychosocial factors and increased risk for flare.

Moderate anxiety in Crohn’s disease increased clinical flare risk (adjusted hazard ratio [aHR], 1.64), as did severe anxiety in both Crohn’s disease (aHR, 1.86) and ulcerative colitis/IBDU (aHR, 1.46). Moderate depression and severe depression increased the flare risk in ulcerative colitis/IBDU (aHR, 1.72 and 1.67, respectively). Also increasing clinical flare risk was poor sleep quality in Crohn’s disease (aHR, 1.58), and severe somatization in Crohn’s disease (aHR, 3.86) and ulcerative colitis/IBDU (aHR, 1.96).

Fewer psychosocial factors were associated with increased risk for hard flare: moderate depression in ulcerative colitis/IBDU (aHR, 2.5), severe somatization in Crohn’s disease (aHR, 2.34), and lack of exercise in ulcerative colitis/IBDU (aHR, 1.55).

 

Physician-Patient Disconnect

There is “very little correlation” between self-reported and symptomatic flare in IBD, Lupe said. “This happens all the time, where the gastroenterologist will come out of the endoscopy suite and go: ‘You’re in remission.’ And the patient goes: ‘What are you talking about? I’m still going to the bathroom 20 times a day.’ ”

Now there are data showing that, if the care team undertakes behavioral work with patients who have IBD, “the medications work more effectively,” Lupe said.

“I think medicine is in a point of transition right now,” he added. “We’re (moving from) looking at people as disease states and ‘how do I treat the disease’ to ‘how do I take care of this human being,’ knowing that everything this human being does, including everything we put in our mouth, everything we experience, changes what happens inside our body, and it’s measurable.”

The PREdiCCt study is sponsored by the University of Edinburgh, Scotland. Derikx declared relationships with AbbVie, Janssen Pharmaceuticals, Sandoz, Galapagos, and Pfizer. Other authors also declared relationships with pharmaceutical companies.

A version of this article appeared on Medscape.com.

BERLIN — Psychosocial factors, such as anxiety and depression, are associated with an increased risk for both self-reported “clinical” and symptomatic, or “hard,” flare in inflammatory bowel disease (IBD), suggested a study of UK patients.

The research was presented at the European Crohn’s and Colitis Organisation (ECCO) 2025 Congress.

“Despite clinical remission, there is a significant burden of psychosocial comorbidity in IBD patients,” said study presenter Lauranne A.A.P. Derikx, PhD, a gastroenterology researcher at Erasmus University MC, Rotterdam, the Netherlands.

“Anxiety, sleep, and somatization were associated with an increased risk of clinical flare, and depression and lack of exercise were associated with an increased risk of hard flare,” she said. “Altogether, this supports a holistic approach in IBD patients.”

 

Stephen E. Lupe, PsyD, director of behavioral medicine for the department of gastroenterology, hepatology and nutrition at the Cleveland Clinic, Ohio, who was not involved in the study, agreed.

“Whole-person care is so important” in IBD, and this study is part of a growing literature making the connection between symptom flare and factors such as anxiety, depression, stress, and even trauma, he said in an interview.

 

Searching for Predictive Links

The relapsing and remitting disease course in IBD is dynamic and hard to predict, Derikx said. Unfortunately, clinicians don’t know which patients with IBD will develop a flare or when it will occur.

There’s a high prevalence of psychosocial comorbidity among patients with IBD and a “bidirectional relationship between psychosocial vulnerabilities” and the disease course via the gut-brain axis, Derikx noted.

To determine which psychosocial factors may be associated with and predictive of IBD flare, researchers analyzed data from the PREdiCCt study, a large prospective study of patients with IBD from 47 centers across the United Kingdom that aims to determine the factors associated with developing a flare.

The median age of PREdiCCT study participants was 44 years, median duration of IBD was 10 years, and 35% were receiving advanced IBD therapy. The median fecal calprotectin level was 49 mcg/g, although 18% of patients had a level > 250 mcg/g, Derikx noted.

To be included in PREdiCCT, patients must have received the diagnosis of IBD more than 6 months previously, had not change their medication for more than 2 months, and answered “yes” to the question: Do you think your disease has been well controlled in the past 1 month? The question was chosen as a measure of clinical remission.

The team collected stool samples and gathered information via questionnaires about lifestyle, diet, and other factors.

 

Depression and Anxiety Increase Risk

Researchers included 1641 patients — 830 with Crohn’s and 811 with ulcerative colitis or IBD unclassified (IBDU) — with complete datasets in their analysis of associations between psychosocial factors and IBD flare.

Baseline questionnaires identified moderate anxiety in 18.8% of participants, severe anxiety in 16.1%, moderate depression in 9.8%, severe depression in 5.7%, sleep disturbances in 46.4%, moderate somatization in 22.8%, severe somatization in 7.9%, insufficient exercise in 22.2%, and consumption of more than 14 units of alcohol in 24%.

After 24 months of follow-up, 36% of patients had experienced a clinical flare, defined as answering “no” to the question: Do you think your disease has been well controlled in the past 1 month/since you last logged in to the [study] portal?

In addition, 13% of patients experienced a hard flare, defined as a clinical flare plus C-reactive protein levels > 5 mg/L and/or a calprotectin level > 250 mcg/g and a change in IBD therapy.

Survival analyses with Cox frailty models adjusted for baseline fecal calprotectin, sex, index of multiple deprivation, hospital site, and patient age revealed statistically significant associations between several psychosocial factors and increased risk for flare.

Moderate anxiety in Crohn’s disease increased clinical flare risk (adjusted hazard ratio [aHR], 1.64), as did severe anxiety in both Crohn’s disease (aHR, 1.86) and ulcerative colitis/IBDU (aHR, 1.46). Moderate depression and severe depression increased the flare risk in ulcerative colitis/IBDU (aHR, 1.72 and 1.67, respectively). Also increasing clinical flare risk was poor sleep quality in Crohn’s disease (aHR, 1.58), and severe somatization in Crohn’s disease (aHR, 3.86) and ulcerative colitis/IBDU (aHR, 1.96).

Fewer psychosocial factors were associated with increased risk for hard flare: moderate depression in ulcerative colitis/IBDU (aHR, 2.5), severe somatization in Crohn’s disease (aHR, 2.34), and lack of exercise in ulcerative colitis/IBDU (aHR, 1.55).

 

Physician-Patient Disconnect

There is “very little correlation” between self-reported and symptomatic flare in IBD, Lupe said. “This happens all the time, where the gastroenterologist will come out of the endoscopy suite and go: ‘You’re in remission.’ And the patient goes: ‘What are you talking about? I’m still going to the bathroom 20 times a day.’ ”

Now there are data showing that, if the care team undertakes behavioral work with patients who have IBD, “the medications work more effectively,” Lupe said.

“I think medicine is in a point of transition right now,” he added. “We’re (moving from) looking at people as disease states and ‘how do I treat the disease’ to ‘how do I take care of this human being,’ knowing that everything this human being does, including everything we put in our mouth, everything we experience, changes what happens inside our body, and it’s measurable.”

The PREdiCCt study is sponsored by the University of Edinburgh, Scotland. Derikx declared relationships with AbbVie, Janssen Pharmaceuticals, Sandoz, Galapagos, and Pfizer. Other authors also declared relationships with pharmaceutical companies.

A version of this article appeared on Medscape.com.

BERLIN — Gut microbial biomarkers identified using machine learning can differentiate patients with inflammatory bowel disease (IBD) from healthy control individuals, according to a study presented at the European Crohn’s and Colitis Organisation (ECCO) 2025 Congress.

Of the four techniques the researchers tested, a “machine-learning approach achieves the highest diagnostic accuracy, effectively distinguishing IBD and particularly differentiating Crohn’s disease from healthy controls in independent cohorts,” said study presenter Jee-Won Choi, department of biology, Kyung Hee University, Seoul, Republic of Korea.

“Integrating microbial markers with conventional diagnostics could enhance [their] clinical utility,” Choi said. However, further research is needed to determine the long-term validity of the biomarkers.

Some experts questioned the reliability of the markers for IBD diagnosis because of the makeup of study populations, which included patients with known IBD who likely have undergone treatment that may have altered their gut microbiomes.

 

Biomarkers Found and Tested

The gut microbiota exists in two states: Eubiosis, which supports health, and inflammatory dysbiosis, an imbalanced state associated with disease, most notably IBD, Choi noted.

Although many studies have explored the differences between these two states, there have been three major challenges in identifying IBD biomarkers: The studies have had small sample sizes, they’ve concentrated on a single analytical approach, and they’ve had low reproducibility.

To overcome those challenges, researchers used a large-scale dataset and used multiple methods to determine which analytical approach yielded the most reliable results, Choi said. They validated their results in three independent cohorts with diverse populations.

The study included 414 patients with Crohn’s disease, 880 with ulcerative colitis, and 2467 healthy control individuals from 21 centers in the Republic of Korea. Their gut microbiota profiles were analyzed from stool samples using 16S ribosomal RNA gene sequencing.

Researchers used four techniques to identify potential IBD biomarkers in the samples: differential abundance analysis, supervised random forest machine learning, unsupervised network analysis, and literature-based curation.

Biomarker candidates generated by these methods were then compared for their diagnostic ability using a machine learning model. The findings were tested in three independent cohorts — one domestic and one international population, both of which included patients with IBD and healthy control individuals, and one dataset of patients without IBD.

The results showed that there were distinct differences in the microbial composition between healthy control individuals and patients with Crohn’s disease and with ulcerative colitis. Patients with IBD, particularly those with Crohn’s disease, consistently had a significantly higher prevalence of dysbiosis, Choi said.

Each of the four analytical techniques revealed distinct microbial biomarkers associated with IBD in general, as well as with Crohn’s disease and ulcerative colitis individually.

When comparing IBD patients overall with healthy control individuals, supervised machine learning resulted in the most effective biomarker sets for distinguishing between groups, with the area under the receiver operating characteristics curve (AUC) reaching 0.971. By comparison, the AUC results were 0.94 for literature-based curation, 0.924 for differential abundance analyses, and 0.914 for unsupervised network analysis.

Supervised machine learning also outperformed the other techniques when distinguishing between healthy control individuals and patients with ulcerative colitis (AUC, 0.958), and between patients with ulcerative colitis and those with Crohn’s disease (AUC, 0.902).

All the techniques performed strongly when distinguishing between healthy control individuals and patients with Crohn’s disease, with AUCs ranging from 0.911 to 0.95.

When the researchers turned to the independent datasets, they found that the biomarkers were able to distinguish between healthy control individuals and patients with IBD in general and particularly between healthy control individuals and those with Crohn’s disease, with AUCs of 0.969 in the domestic cohort and 0.848 in the international cohort.

The non-IBD cohort also demonstrated that the biomarkers were able to differentiate patients with metabolic dysfunction–associated steatotic liver disease, colorectal cancer, rheumatoid arthritis, and irritable bowel syndrome from those with ulcerative colitis and Crohn’s disease with a high degree of accuracy (AUCs ranging from 0.97 to 0.999).

 

Diagnostic Utility Questioned

Speaking from the audience, James Lindsay, PhD, professor of inflammatory bowel disease, Barts and The London School of Medicine and Dentistry, England, questioned the utility of the findings.

“Obviously, all these patients had IBD, and so they will have had treatment with antibiotics, etc,” he said. “Surely the right validation cohort would be a group of people who have not yet been diagnosed with IBD to see whether your biomarker is able to separate those because the reason that people with IBD will have a difference is all the reasons that you have explained, ie, these patients were on treatment at the time that you took the samples.”

As a result, the biomarker panel isn’t for diagnosis but to confirm known disease, he added.

It’s important to look for microbiome signals of IBD, session co-chair, Lissy de Ridder, MD, PhD, associate professor of pediatric gastroenterology, Erasmus MC Sophia Children’s Hospital, Rotterdam, the Netherlands, said in an interview.

De Ridder agreed that the biomarkers need to be validated in patients who aren’t on treatments that could affect their gut microbiomes. Not only do medications for IBD make a big difference but also do other drugs such as proton-pump inhibitors and antibiotics, as well as dietary interventions.

“Having said that, because it’s a large population, that’s always a good start to take lessons from and then go more into the details” in further analyses, de Ridder added.

This research was funded by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea. No relevant financial relationships were declared.

A version of this article appeared on Medscape.com.

BERLIN — Gut microbial biomarkers identified using machine learning can differentiate patients with inflammatory bowel disease (IBD) from healthy control individuals, according to a study presented at the European Crohn’s and Colitis Organisation (ECCO) 2025 Congress.

Of the four techniques the researchers tested, a “machine-learning approach achieves the highest diagnostic accuracy, effectively distinguishing IBD and particularly differentiating Crohn’s disease from healthy controls in independent cohorts,” said study presenter Jee-Won Choi, department of biology, Kyung Hee University, Seoul, Republic of Korea.

“Integrating microbial markers with conventional diagnostics could enhance [their] clinical utility,” Choi said. However, further research is needed to determine the long-term validity of the biomarkers.

Some experts questioned the reliability of the markers for IBD diagnosis because of the makeup of study populations, which included patients with known IBD who likely have undergone treatment that may have altered their gut microbiomes.

 

Biomarkers Found and Tested

The gut microbiota exists in two states: Eubiosis, which supports health, and inflammatory dysbiosis, an imbalanced state associated with disease, most notably IBD, Choi noted.

Although many studies have explored the differences between these two states, there have been three major challenges in identifying IBD biomarkers: The studies have had small sample sizes, they’ve concentrated on a single analytical approach, and they’ve had low reproducibility.

To overcome those challenges, researchers used a large-scale dataset and used multiple methods to determine which analytical approach yielded the most reliable results, Choi said. They validated their results in three independent cohorts with diverse populations.

The study included 414 patients with Crohn’s disease, 880 with ulcerative colitis, and 2467 healthy control individuals from 21 centers in the Republic of Korea. Their gut microbiota profiles were analyzed from stool samples using 16S ribosomal RNA gene sequencing.

Researchers used four techniques to identify potential IBD biomarkers in the samples: differential abundance analysis, supervised random forest machine learning, unsupervised network analysis, and literature-based curation.

Biomarker candidates generated by these methods were then compared for their diagnostic ability using a machine learning model. The findings were tested in three independent cohorts — one domestic and one international population, both of which included patients with IBD and healthy control individuals, and one dataset of patients without IBD.

The results showed that there were distinct differences in the microbial composition between healthy control individuals and patients with Crohn’s disease and with ulcerative colitis. Patients with IBD, particularly those with Crohn’s disease, consistently had a significantly higher prevalence of dysbiosis, Choi said.

Each of the four analytical techniques revealed distinct microbial biomarkers associated with IBD in general, as well as with Crohn’s disease and ulcerative colitis individually.

When comparing IBD patients overall with healthy control individuals, supervised machine learning resulted in the most effective biomarker sets for distinguishing between groups, with the area under the receiver operating characteristics curve (AUC) reaching 0.971. By comparison, the AUC results were 0.94 for literature-based curation, 0.924 for differential abundance analyses, and 0.914 for unsupervised network analysis.

Supervised machine learning also outperformed the other techniques when distinguishing between healthy control individuals and patients with ulcerative colitis (AUC, 0.958), and between patients with ulcerative colitis and those with Crohn’s disease (AUC, 0.902).

All the techniques performed strongly when distinguishing between healthy control individuals and patients with Crohn’s disease, with AUCs ranging from 0.911 to 0.95.

When the researchers turned to the independent datasets, they found that the biomarkers were able to distinguish between healthy control individuals and patients with IBD in general and particularly between healthy control individuals and those with Crohn’s disease, with AUCs of 0.969 in the domestic cohort and 0.848 in the international cohort.

The non-IBD cohort also demonstrated that the biomarkers were able to differentiate patients with metabolic dysfunction–associated steatotic liver disease, colorectal cancer, rheumatoid arthritis, and irritable bowel syndrome from those with ulcerative colitis and Crohn’s disease with a high degree of accuracy (AUCs ranging from 0.97 to 0.999).

 

Diagnostic Utility Questioned

Speaking from the audience, James Lindsay, PhD, professor of inflammatory bowel disease, Barts and The London School of Medicine and Dentistry, England, questioned the utility of the findings.

“Obviously, all these patients had IBD, and so they will have had treatment with antibiotics, etc,” he said. “Surely the right validation cohort would be a group of people who have not yet been diagnosed with IBD to see whether your biomarker is able to separate those because the reason that people with IBD will have a difference is all the reasons that you have explained, ie, these patients were on treatment at the time that you took the samples.”

As a result, the biomarker panel isn’t for diagnosis but to confirm known disease, he added.

It’s important to look for microbiome signals of IBD, session co-chair, Lissy de Ridder, MD, PhD, associate professor of pediatric gastroenterology, Erasmus MC Sophia Children’s Hospital, Rotterdam, the Netherlands, said in an interview.

De Ridder agreed that the biomarkers need to be validated in patients who aren’t on treatments that could affect their gut microbiomes. Not only do medications for IBD make a big difference but also do other drugs such as proton-pump inhibitors and antibiotics, as well as dietary interventions.

“Having said that, because it’s a large population, that’s always a good start to take lessons from and then go more into the details” in further analyses, de Ridder added.

This research was funded by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea. No relevant financial relationships were declared.

A version of this article appeared on Medscape.com.

BERLIN — Gut microbial biomarkers identified using machine learning can differentiate patients with inflammatory bowel disease (IBD) from healthy control individuals, according to a study presented at the European Crohn’s and Colitis Organisation (ECCO) 2025 Congress.

Of the four techniques the researchers tested, a “machine-learning approach achieves the highest diagnostic accuracy, effectively distinguishing IBD and particularly differentiating Crohn’s disease from healthy controls in independent cohorts,” said study presenter Jee-Won Choi, department of biology, Kyung Hee University, Seoul, Republic of Korea.

“Integrating microbial markers with conventional diagnostics could enhance [their] clinical utility,” Choi said. However, further research is needed to determine the long-term validity of the biomarkers.

Some experts questioned the reliability of the markers for IBD diagnosis because of the makeup of study populations, which included patients with known IBD who likely have undergone treatment that may have altered their gut microbiomes.

 

Biomarkers Found and Tested

The gut microbiota exists in two states: Eubiosis, which supports health, and inflammatory dysbiosis, an imbalanced state associated with disease, most notably IBD, Choi noted.

Although many studies have explored the differences between these two states, there have been three major challenges in identifying IBD biomarkers: The studies have had small sample sizes, they’ve concentrated on a single analytical approach, and they’ve had low reproducibility.

To overcome those challenges, researchers used a large-scale dataset and used multiple methods to determine which analytical approach yielded the most reliable results, Choi said. They validated their results in three independent cohorts with diverse populations.

The study included 414 patients with Crohn’s disease, 880 with ulcerative colitis, and 2467 healthy control individuals from 21 centers in the Republic of Korea. Their gut microbiota profiles were analyzed from stool samples using 16S ribosomal RNA gene sequencing.

Researchers used four techniques to identify potential IBD biomarkers in the samples: differential abundance analysis, supervised random forest machine learning, unsupervised network analysis, and literature-based curation.

Biomarker candidates generated by these methods were then compared for their diagnostic ability using a machine learning model. The findings were tested in three independent cohorts — one domestic and one international population, both of which included patients with IBD and healthy control individuals, and one dataset of patients without IBD.

The results showed that there were distinct differences in the microbial composition between healthy control individuals and patients with Crohn’s disease and with ulcerative colitis. Patients with IBD, particularly those with Crohn’s disease, consistently had a significantly higher prevalence of dysbiosis, Choi said.

Each of the four analytical techniques revealed distinct microbial biomarkers associated with IBD in general, as well as with Crohn’s disease and ulcerative colitis individually.

When comparing IBD patients overall with healthy control individuals, supervised machine learning resulted in the most effective biomarker sets for distinguishing between groups, with the area under the receiver operating characteristics curve (AUC) reaching 0.971. By comparison, the AUC results were 0.94 for literature-based curation, 0.924 for differential abundance analyses, and 0.914 for unsupervised network analysis.

Supervised machine learning also outperformed the other techniques when distinguishing between healthy control individuals and patients with ulcerative colitis (AUC, 0.958), and between patients with ulcerative colitis and those with Crohn’s disease (AUC, 0.902).

All the techniques performed strongly when distinguishing between healthy control individuals and patients with Crohn’s disease, with AUCs ranging from 0.911 to 0.95.

When the researchers turned to the independent datasets, they found that the biomarkers were able to distinguish between healthy control individuals and patients with IBD in general and particularly between healthy control individuals and those with Crohn’s disease, with AUCs of 0.969 in the domestic cohort and 0.848 in the international cohort.

The non-IBD cohort also demonstrated that the biomarkers were able to differentiate patients with metabolic dysfunction–associated steatotic liver disease, colorectal cancer, rheumatoid arthritis, and irritable bowel syndrome from those with ulcerative colitis and Crohn’s disease with a high degree of accuracy (AUCs ranging from 0.97 to 0.999).

 

Diagnostic Utility Questioned

Speaking from the audience, James Lindsay, PhD, professor of inflammatory bowel disease, Barts and The London School of Medicine and Dentistry, England, questioned the utility of the findings.

“Obviously, all these patients had IBD, and so they will have had treatment with antibiotics, etc,” he said. “Surely the right validation cohort would be a group of people who have not yet been diagnosed with IBD to see whether your biomarker is able to separate those because the reason that people with IBD will have a difference is all the reasons that you have explained, ie, these patients were on treatment at the time that you took the samples.”

As a result, the biomarker panel isn’t for diagnosis but to confirm known disease, he added.

It’s important to look for microbiome signals of IBD, session co-chair, Lissy de Ridder, MD, PhD, associate professor of pediatric gastroenterology, Erasmus MC Sophia Children’s Hospital, Rotterdam, the Netherlands, said in an interview.

De Ridder agreed that the biomarkers need to be validated in patients who aren’t on treatments that could affect their gut microbiomes. Not only do medications for IBD make a big difference but also do other drugs such as proton-pump inhibitors and antibiotics, as well as dietary interventions.

“Having said that, because it’s a large population, that’s always a good start to take lessons from and then go more into the details” in further analyses, de Ridder added.

This research was funded by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea. No relevant financial relationships were declared.

A version of this article appeared on Medscape.com.

The Association of VA Hematology/Oncology outlined its concerns over “unintended consequences” to recent changes at the US Department of Veterans Affairs (VA) in a March 3, 2025, letter to Secretary Doug A. Collins. “Indiscriminate cuts to contracts and personnel could have unforeseen consequences in many research areas within the VA, so we implore scrutiny,” the letter warns.

“We have already seen specific examples this past week of swift contract cuts impairing the VA’s ability to implement research protocols, process and report pharmacogenomic results, management of Electronic Health Record Modernization (EHRM) council workgroups, and execute new oncology services through the Close to Me initiative,” AVAHO Executive Director Julie Lawson said. 

As Lawson noted, the return-to-office order for the staff of the Clinical Resource Hubs (CRHs) and the National Tele-Oncology programs could significantly impair their ability to function. Both departments have been fully remote since their start and are key elements of VA care for rural veterans. In fiscal year 2024, > 500,000 veterans received > 1.4 million CRH encounters. Nearly 20,000 veterans have utilized the National Tele-Oncology program in > 80,000 cancer-care encounters.

“We have significant concern that a blanket return to office of these fully remote programs, without an adequate plan for office space, teleworking equipment, and clinical and administrative support could have significant disruption and impairment in their delivery of care, negatively impacting veteran outcomes,” Lawson said.

AVAHO also strongly urged Collins to continue VA investment in clinical trials specifically and research in general: "To implement and execute research, there must be an adequte system in place to support these research programs."

The Association of VA Hematology/Oncology outlined its concerns over “unintended consequences” to recent changes at the US Department of Veterans Affairs (VA) in a March 3, 2025, letter to Secretary Doug A. Collins. “Indiscriminate cuts to contracts and personnel could have unforeseen consequences in many research areas within the VA, so we implore scrutiny,” the letter warns.

“We have already seen specific examples this past week of swift contract cuts impairing the VA’s ability to implement research protocols, process and report pharmacogenomic results, management of Electronic Health Record Modernization (EHRM) council workgroups, and execute new oncology services through the Close to Me initiative,” AVAHO Executive Director Julie Lawson said. 

As Lawson noted, the return-to-office order for the staff of the Clinical Resource Hubs (CRHs) and the National Tele-Oncology programs could significantly impair their ability to function. Both departments have been fully remote since their start and are key elements of VA care for rural veterans. In fiscal year 2024, > 500,000 veterans received > 1.4 million CRH encounters. Nearly 20,000 veterans have utilized the National Tele-Oncology program in > 80,000 cancer-care encounters.

“We have significant concern that a blanket return to office of these fully remote programs, without an adequate plan for office space, teleworking equipment, and clinical and administrative support could have significant disruption and impairment in their delivery of care, negatively impacting veteran outcomes,” Lawson said.

AVAHO also strongly urged Collins to continue VA investment in clinical trials specifically and research in general: "To implement and execute research, there must be an adequte system in place to support these research programs."

The Association of VA Hematology/Oncology outlined its concerns over “unintended consequences” to recent changes at the US Department of Veterans Affairs (VA) in a March 3, 2025, letter to Secretary Doug A. Collins. “Indiscriminate cuts to contracts and personnel could have unforeseen consequences in many research areas within the VA, so we implore scrutiny,” the letter warns.

“We have already seen specific examples this past week of swift contract cuts impairing the VA’s ability to implement research protocols, process and report pharmacogenomic results, management of Electronic Health Record Modernization (EHRM) council workgroups, and execute new oncology services through the Close to Me initiative,” AVAHO Executive Director Julie Lawson said. 

As Lawson noted, the return-to-office order for the staff of the Clinical Resource Hubs (CRHs) and the National Tele-Oncology programs could significantly impair their ability to function. Both departments have been fully remote since their start and are key elements of VA care for rural veterans. In fiscal year 2024, > 500,000 veterans received > 1.4 million CRH encounters. Nearly 20,000 veterans have utilized the National Tele-Oncology program in > 80,000 cancer-care encounters.

“We have significant concern that a blanket return to office of these fully remote programs, without an adequate plan for office space, teleworking equipment, and clinical and administrative support could have significant disruption and impairment in their delivery of care, negatively impacting veteran outcomes,” Lawson said.

AVAHO also strongly urged Collins to continue VA investment in clinical trials specifically and research in general: "To implement and execute research, there must be an adequte system in place to support these research programs."

BERLIN — Lusvertikimab, a first-in-class interleukin (IL)–7 receptor antagonist, demonstrated clinical and endoscopic efficacy in patients with moderate to severe ulcerative colitis (UC) in the 10-week induction period of a randomized, placebo-controlled, phase 2 clinical trial.

Lusvertikimab is unique in targeting the IL-7 receptor, a key player in immune-mediated inflammation.

“We have a new mode of action in ulcerative colitis,” with a strong safety profile, lead investigator, Arnaud Bourreille, MD, associate professor of gastroenterology from Nantes University Hospital, France, said in an interview.

“We achieved the primary endpoint” — improvement in the modified Mayo score (MMS) from baseline to week 10 — “for both the low dose and the high dose of lusvertikimab,” said Bourreille, who presented the findings at the European Crohn’s and Colitis Organisation (ECCO) 2025 Congress. “For us practitioners, this is very good news.”

Current treatment options for UC remain limited, especially for patients with an inadequate response to biologics or small molecules.

Overall, biologics are only effective in around half the patients, Bourreille noted. We need other treatments that have different mechanisms of action, as is the case with lusvertikimab.

The multicenter, double-blind CoTikiS study evaluated the IL-7 receptor antagonist in 136 adults with moderately to severely active UC (MMS, 4-9) and inadequate response to conventional therapies and/or failure to advanced therapies. Around 40% of the patients were exposed to one or more biologics.

The 50-week study had a 10-week induction period with two doses of lusvertikimab (450 and 850 mg), followed by a 24-week open-label extension, where patients received infusions of the high dose (850 mg) every 4 weeks, and a 16-week safety follow-up period free of treatment.

For the induction period, patients were randomized 1:1:1 to receive placebo (n = 49), 450 mg lusvertikimab (n = 35), or 850 mg lusvertikimab (n = 50) intravenously at weeks 0, 2, and 6. The diagnosis in two patients was modified to Crohn’s disease; therefore, they were not included.

In meeting the trial’s primary endpoint, lusvertikimab significantly reduced disease severity, compared with placebo, at week 10 in both dose groups separately and when pooled.

The MMS in the 450-mg group showed a difference of –1.16 points vs placebo (P = .019), whereas in the 850-mg group, the MMS showed a difference of –0.9 points vs placebo (P = .036). In the pooled group, the difference was –1.00 points vs placebo (P = .010).

The secondary endpoints of clinical remission and endoscopic remission also favored lusvertikimab for the pooled doses vs placebo, at 16% vs 4% (odds ratio [OR], 4.25; P = .066) and 25% vs 13% (OR, 2.33; P = .120), respectively.

For the other secondary endpoints, 32% achieved endoscopic improvement in the pooled group vs 13% in the placebo group (OR, 3.29; P = .027), and the mean score change in the UC Endoscopic Index of Severity was –1.35 for the pooled group vs –0.32 for the placebo group (P = .007).

Fecal calprotectin was reduced by 830 μg/g in the 450-mg group (P =.009), by 635 μg/g in the 850-mg group (P = .018), and 716 μg/g in the pooled group. It was increased by 189 μg/g in the placebo group (P = .004).

No safety concerns were reported.

Bourreille noted that there was a little more lymphopenia in patients on lusvertikimab vs placebo, which is explained by the drug’s mechanism of action. However, “it was transient lymphopenia, without any infection and without any need to interrupt the treatment.”

Next, Bourreille said, we need to demonstrate the efficacy and the safety of the drug in the long term.

“There may be a place for lusvertikimab in patients with Crohn’s disease because the mechanism of action of IL-7 receptor antagonist would potentially have good efficacy in that disease too,” he added.

Giorgos Bamias, MD, professor of gastroenterology at the School of Medicine, National and Kapodistrian University of Athens, Greece, who comoderated the session, pointed out that the results supported further clinical development of lusvertikimab.

“As elevated mucosal IL-7/IL-7 [receptor] expression predicts refractoriness to currently used biologic therapies, it would be very interesting to see the potential of lusvertikimab as a treatment for patients who were exposed to advanced therapy or as part of combination therapeutics,” he said.

The study was funded by OSE Immunotherapeutics. Bourreille received funding from OSE Immunotherapeutics; grants from Takeda and Mauna Kea Technologies; and personal fees from AbbVie, Celltrion, Ferring, Galapagos, Gilead, MSD, Medtronic, OSE Immunotherapeutics, Janssen, Pfizer, Roche, Takeda, Tillotts, and Vifor Pharma. Bamias reported receiving grants from Takeda, AbbVie, Mylan/Viatris/Biocon, Genesis Pharma, Ferring, Vianex, and Aenorasis and personal fees/honoraria as adviser/lecturer from AbbVie, Adacyte Therapeutics, Amgen, Bristol Myers Squibb, Ferring, Galenica, Genesis Pharma, Johnson & Johnson, Eli Lilly, MSD, Mylan/Viatris/Biocon, Pfizer, Takeda, and Vianex.

A version of this article appeared on Medscape.com.

BERLIN — Lusvertikimab, a first-in-class interleukin (IL)–7 receptor antagonist, demonstrated clinical and endoscopic efficacy in patients with moderate to severe ulcerative colitis (UC) in the 10-week induction period of a randomized, placebo-controlled, phase 2 clinical trial.

Lusvertikimab is unique in targeting the IL-7 receptor, a key player in immune-mediated inflammation.

“We have a new mode of action in ulcerative colitis,” with a strong safety profile, lead investigator, Arnaud Bourreille, MD, associate professor of gastroenterology from Nantes University Hospital, France, said in an interview.

“We achieved the primary endpoint” — improvement in the modified Mayo score (MMS) from baseline to week 10 — “for both the low dose and the high dose of lusvertikimab,” said Bourreille, who presented the findings at the European Crohn’s and Colitis Organisation (ECCO) 2025 Congress. “For us practitioners, this is very good news.”

Current treatment options for UC remain limited, especially for patients with an inadequate response to biologics or small molecules.

Overall, biologics are only effective in around half the patients, Bourreille noted. We need other treatments that have different mechanisms of action, as is the case with lusvertikimab.

The multicenter, double-blind CoTikiS study evaluated the IL-7 receptor antagonist in 136 adults with moderately to severely active UC (MMS, 4-9) and inadequate response to conventional therapies and/or failure to advanced therapies. Around 40% of the patients were exposed to one or more biologics.

The 50-week study had a 10-week induction period with two doses of lusvertikimab (450 and 850 mg), followed by a 24-week open-label extension, where patients received infusions of the high dose (850 mg) every 4 weeks, and a 16-week safety follow-up period free of treatment.

For the induction period, patients were randomized 1:1:1 to receive placebo (n = 49), 450 mg lusvertikimab (n = 35), or 850 mg lusvertikimab (n = 50) intravenously at weeks 0, 2, and 6. The diagnosis in two patients was modified to Crohn’s disease; therefore, they were not included.

In meeting the trial’s primary endpoint, lusvertikimab significantly reduced disease severity, compared with placebo, at week 10 in both dose groups separately and when pooled.

The MMS in the 450-mg group showed a difference of –1.16 points vs placebo (P = .019), whereas in the 850-mg group, the MMS showed a difference of –0.9 points vs placebo (P = .036). In the pooled group, the difference was –1.00 points vs placebo (P = .010).

The secondary endpoints of clinical remission and endoscopic remission also favored lusvertikimab for the pooled doses vs placebo, at 16% vs 4% (odds ratio [OR], 4.25; P = .066) and 25% vs 13% (OR, 2.33; P = .120), respectively.

For the other secondary endpoints, 32% achieved endoscopic improvement in the pooled group vs 13% in the placebo group (OR, 3.29; P = .027), and the mean score change in the UC Endoscopic Index of Severity was –1.35 for the pooled group vs –0.32 for the placebo group (P = .007).

Fecal calprotectin was reduced by 830 μg/g in the 450-mg group (P =.009), by 635 μg/g in the 850-mg group (P = .018), and 716 μg/g in the pooled group. It was increased by 189 μg/g in the placebo group (P = .004).

No safety concerns were reported.

Bourreille noted that there was a little more lymphopenia in patients on lusvertikimab vs placebo, which is explained by the drug’s mechanism of action. However, “it was transient lymphopenia, without any infection and without any need to interrupt the treatment.”

Next, Bourreille said, we need to demonstrate the efficacy and the safety of the drug in the long term.

“There may be a place for lusvertikimab in patients with Crohn’s disease because the mechanism of action of IL-7 receptor antagonist would potentially have good efficacy in that disease too,” he added.

Giorgos Bamias, MD, professor of gastroenterology at the School of Medicine, National and Kapodistrian University of Athens, Greece, who comoderated the session, pointed out that the results supported further clinical development of lusvertikimab.

“As elevated mucosal IL-7/IL-7 [receptor] expression predicts refractoriness to currently used biologic therapies, it would be very interesting to see the potential of lusvertikimab as a treatment for patients who were exposed to advanced therapy or as part of combination therapeutics,” he said.

The study was funded by OSE Immunotherapeutics. Bourreille received funding from OSE Immunotherapeutics; grants from Takeda and Mauna Kea Technologies; and personal fees from AbbVie, Celltrion, Ferring, Galapagos, Gilead, MSD, Medtronic, OSE Immunotherapeutics, Janssen, Pfizer, Roche, Takeda, Tillotts, and Vifor Pharma. Bamias reported receiving grants from Takeda, AbbVie, Mylan/Viatris/Biocon, Genesis Pharma, Ferring, Vianex, and Aenorasis and personal fees/honoraria as adviser/lecturer from AbbVie, Adacyte Therapeutics, Amgen, Bristol Myers Squibb, Ferring, Galenica, Genesis Pharma, Johnson & Johnson, Eli Lilly, MSD, Mylan/Viatris/Biocon, Pfizer, Takeda, and Vianex.

A version of this article appeared on Medscape.com.

BERLIN — Lusvertikimab, a first-in-class interleukin (IL)–7 receptor antagonist, demonstrated clinical and endoscopic efficacy in patients with moderate to severe ulcerative colitis (UC) in the 10-week induction period of a randomized, placebo-controlled, phase 2 clinical trial.

Lusvertikimab is unique in targeting the IL-7 receptor, a key player in immune-mediated inflammation.

“We have a new mode of action in ulcerative colitis,” with a strong safety profile, lead investigator, Arnaud Bourreille, MD, associate professor of gastroenterology from Nantes University Hospital, France, said in an interview.

“We achieved the primary endpoint” — improvement in the modified Mayo score (MMS) from baseline to week 10 — “for both the low dose and the high dose of lusvertikimab,” said Bourreille, who presented the findings at the European Crohn’s and Colitis Organisation (ECCO) 2025 Congress. “For us practitioners, this is very good news.”

Current treatment options for UC remain limited, especially for patients with an inadequate response to biologics or small molecules.

Overall, biologics are only effective in around half the patients, Bourreille noted. We need other treatments that have different mechanisms of action, as is the case with lusvertikimab.

The multicenter, double-blind CoTikiS study evaluated the IL-7 receptor antagonist in 136 adults with moderately to severely active UC (MMS, 4-9) and inadequate response to conventional therapies and/or failure to advanced therapies. Around 40% of the patients were exposed to one or more biologics.

The 50-week study had a 10-week induction period with two doses of lusvertikimab (450 and 850 mg), followed by a 24-week open-label extension, where patients received infusions of the high dose (850 mg) every 4 weeks, and a 16-week safety follow-up period free of treatment.

For the induction period, patients were randomized 1:1:1 to receive placebo (n = 49), 450 mg lusvertikimab (n = 35), or 850 mg lusvertikimab (n = 50) intravenously at weeks 0, 2, and 6. The diagnosis in two patients was modified to Crohn’s disease; therefore, they were not included.

In meeting the trial’s primary endpoint, lusvertikimab significantly reduced disease severity, compared with placebo, at week 10 in both dose groups separately and when pooled.

The MMS in the 450-mg group showed a difference of –1.16 points vs placebo (P = .019), whereas in the 850-mg group, the MMS showed a difference of –0.9 points vs placebo (P = .036). In the pooled group, the difference was –1.00 points vs placebo (P = .010).

The secondary endpoints of clinical remission and endoscopic remission also favored lusvertikimab for the pooled doses vs placebo, at 16% vs 4% (odds ratio [OR], 4.25; P = .066) and 25% vs 13% (OR, 2.33; P = .120), respectively.

For the other secondary endpoints, 32% achieved endoscopic improvement in the pooled group vs 13% in the placebo group (OR, 3.29; P = .027), and the mean score change in the UC Endoscopic Index of Severity was –1.35 for the pooled group vs –0.32 for the placebo group (P = .007).

Fecal calprotectin was reduced by 830 μg/g in the 450-mg group (P =.009), by 635 μg/g in the 850-mg group (P = .018), and 716 μg/g in the pooled group. It was increased by 189 μg/g in the placebo group (P = .004).

No safety concerns were reported.

Bourreille noted that there was a little more lymphopenia in patients on lusvertikimab vs placebo, which is explained by the drug’s mechanism of action. However, “it was transient lymphopenia, without any infection and without any need to interrupt the treatment.”

Next, Bourreille said, we need to demonstrate the efficacy and the safety of the drug in the long term.

“There may be a place for lusvertikimab in patients with Crohn’s disease because the mechanism of action of IL-7 receptor antagonist would potentially have good efficacy in that disease too,” he added.

Giorgos Bamias, MD, professor of gastroenterology at the School of Medicine, National and Kapodistrian University of Athens, Greece, who comoderated the session, pointed out that the results supported further clinical development of lusvertikimab.

“As elevated mucosal IL-7/IL-7 [receptor] expression predicts refractoriness to currently used biologic therapies, it would be very interesting to see the potential of lusvertikimab as a treatment for patients who were exposed to advanced therapy or as part of combination therapeutics,” he said.

The study was funded by OSE Immunotherapeutics. Bourreille received funding from OSE Immunotherapeutics; grants from Takeda and Mauna Kea Technologies; and personal fees from AbbVie, Celltrion, Ferring, Galapagos, Gilead, MSD, Medtronic, OSE Immunotherapeutics, Janssen, Pfizer, Roche, Takeda, Tillotts, and Vifor Pharma. Bamias reported receiving grants from Takeda, AbbVie, Mylan/Viatris/Biocon, Genesis Pharma, Ferring, Vianex, and Aenorasis and personal fees/honoraria as adviser/lecturer from AbbVie, Adacyte Therapeutics, Amgen, Bristol Myers Squibb, Ferring, Galenica, Genesis Pharma, Johnson & Johnson, Eli Lilly, MSD, Mylan/Viatris/Biocon, Pfizer, Takeda, and Vianex.

A version of this article appeared on Medscape.com.

BERLIN — A multicenter study comparing three endoscopic imaging techniques used to monitor patients with inflammatory bowel disease (IBD) for neoplasia found that virtual chromoendoscopy has the highest detection rate.

The research, presented at the European Crohn’s and Colitis Organisation (ECCO) 2025 Congress, also found “significant variability in IBD surveillance practice in the real world,” said study presenter Chandni Radia, MD, Department of Gastroenterology, King’s College Hospital NHS Foundation Trust, London, England.

Although dye chromoendoscopy with targeted biopsies traditionally was considered the gold standard for neoplasia detection in patients with IBD, randomized trials have challenged its superiority over virtual chromoendoscopy and high-definition white-light endoscopy, the researchers noted. They hypothesized that the modality used would not affect the neoplasia detection rate.

To investigate, they conducted a retrospective observational cohort study of adults with ulcerative colitis, Crohn’s disease or primary sclerosing cholangitis (PSC) who underwent routine clinical IBD surveillance at one of five centers in the United Kingdom between 2019 and 2023. They examined data from the endoscopy reporting software, alongside endoscopy reports, endoscopy images, and electronic patient records.

In all, 2673 colonoscopies performed on 2050 patients were included, with 1032 procedures using dye chromoendoscopy, 366 using virtual chromoendoscopy, and 1275 using high-definition white-light endoscopy.

The overall neoplasia detection rate was 11.4%, “which is very similar to what has previously been seen in the literature,” Radia said.

However, the detection rate varied significantly by procedure: 19% in virtual chromoendoscopy, 12% in dye chromoendoscopy, and 9% in white-light endoscopy (P < .001). After accounting for a range of potential confounding factors, virtual chromoendoscopy still had the highest neoplasia detection rate.

Dye chromoendoscopy had a “prolonged withdrawal time and increased need for targeted biopsies without improving their neoplasia yield, which goes against our aspirations of sustainability,” Radia noted.

“It was interesting to see that the procedures with the most dye chromoendoscopy seem to have the longest withdrawal time, and those with the most white-light endoscopy seem to have the shortest,” she said. The difference remained significant even after controlling for procedures with polypectomy, “which has a significantly longer withdrawal time compared to procedures without.” 

 

Results Varied by Center

There was wide variability between the five centers on several findings. The neoplasia detection rate ranged from 7.4% to 17.2%, depending on the center.

The surveillance method also varied. One center, for example, used white-light endoscopy in 82% of cases and dye chromoendoscopy in the other 18%. At another center, 61% of patients had dye chromoendoscopy, 36% white-light endoscopy, and 3% virtual chromoendoscopy. In a third center, 48% had virtual chromoendoscopy, 46% white-light endoscopy, and 6% dye chromoendoscopy.

The centers had varying proportions of patients with each of the three conditions, with ulcerative colitis ranging from 46% to 63%, Crohn’s disease from 9% to 39%, and PSC from 14% to 45%.

The heterogeneity of patients between the modality groups is one of the study’s limitations, Radia said. Others are the shorter withdrawal time with white-light endoscopy and the lack of standardized withdrawal time for the procedures.

The research team’s analyses are ongoing and include examination of the types of neoplasia detected, as well as accounting for endoscopist experience and patients who underwent two procedures with different modalities, Radia said.

 

Reflection of ‘Real-Life Practice’

Because the study was a retrospective analysis, it contains inherent biases and other issues, Raf Bisschops, MD, PhD, director of endoscopy, University of Leuven, Belgium, who co-chaired the session, said in an interview.

However, it was a “thorough analysis” that reflects “real-life practice,” he said. As such, it lends “huge support” to virtual chromoendoscopy, which “actually goes against the new [British Society of Gastroenterology] guideline that is about to come out.” The society plans to recommend in favor of dye chromoendoscopy, but the new study findings could be still incorporated into the upcoming guidelines so as to also endorse virtual chromoendoscopy.

Whatever the modality used, clinicians need to make sure they “pay attention” when looking for small neoplastic lesions, and “anything that can help you do that, that draws your attention to cell lesions ... can be helpful,” Bisschops said.

Performing targeted biopsies, as with dye chromoendoscopy, can be problematic, as “people don’t pay attention anymore to those cell lesions; they just focus on taking the 32 biopsies, which is a huge endeavor and it’s a pain to do it,” he added.

Radia has received a Research Training Fellowship Award from the UK patient organization PSC Support. No other funding was declared. Radia declared relationships with Abbvie, Galapogos, and Dr. Falk Pharma.

A version of this article appeared on Medscape.com.

BERLIN — A multicenter study comparing three endoscopic imaging techniques used to monitor patients with inflammatory bowel disease (IBD) for neoplasia found that virtual chromoendoscopy has the highest detection rate.

The research, presented at the European Crohn’s and Colitis Organisation (ECCO) 2025 Congress, also found “significant variability in IBD surveillance practice in the real world,” said study presenter Chandni Radia, MD, Department of Gastroenterology, King’s College Hospital NHS Foundation Trust, London, England.

Although dye chromoendoscopy with targeted biopsies traditionally was considered the gold standard for neoplasia detection in patients with IBD, randomized trials have challenged its superiority over virtual chromoendoscopy and high-definition white-light endoscopy, the researchers noted. They hypothesized that the modality used would not affect the neoplasia detection rate.

To investigate, they conducted a retrospective observational cohort study of adults with ulcerative colitis, Crohn’s disease or primary sclerosing cholangitis (PSC) who underwent routine clinical IBD surveillance at one of five centers in the United Kingdom between 2019 and 2023. They examined data from the endoscopy reporting software, alongside endoscopy reports, endoscopy images, and electronic patient records.

In all, 2673 colonoscopies performed on 2050 patients were included, with 1032 procedures using dye chromoendoscopy, 366 using virtual chromoendoscopy, and 1275 using high-definition white-light endoscopy.

The overall neoplasia detection rate was 11.4%, “which is very similar to what has previously been seen in the literature,” Radia said.

However, the detection rate varied significantly by procedure: 19% in virtual chromoendoscopy, 12% in dye chromoendoscopy, and 9% in white-light endoscopy (P < .001). After accounting for a range of potential confounding factors, virtual chromoendoscopy still had the highest neoplasia detection rate.

Dye chromoendoscopy had a “prolonged withdrawal time and increased need for targeted biopsies without improving their neoplasia yield, which goes against our aspirations of sustainability,” Radia noted.

“It was interesting to see that the procedures with the most dye chromoendoscopy seem to have the longest withdrawal time, and those with the most white-light endoscopy seem to have the shortest,” she said. The difference remained significant even after controlling for procedures with polypectomy, “which has a significantly longer withdrawal time compared to procedures without.” 

 

Results Varied by Center

There was wide variability between the five centers on several findings. The neoplasia detection rate ranged from 7.4% to 17.2%, depending on the center.

The surveillance method also varied. One center, for example, used white-light endoscopy in 82% of cases and dye chromoendoscopy in the other 18%. At another center, 61% of patients had dye chromoendoscopy, 36% white-light endoscopy, and 3% virtual chromoendoscopy. In a third center, 48% had virtual chromoendoscopy, 46% white-light endoscopy, and 6% dye chromoendoscopy.

The centers had varying proportions of patients with each of the three conditions, with ulcerative colitis ranging from 46% to 63%, Crohn’s disease from 9% to 39%, and PSC from 14% to 45%.

The heterogeneity of patients between the modality groups is one of the study’s limitations, Radia said. Others are the shorter withdrawal time with white-light endoscopy and the lack of standardized withdrawal time for the procedures.

The research team’s analyses are ongoing and include examination of the types of neoplasia detected, as well as accounting for endoscopist experience and patients who underwent two procedures with different modalities, Radia said.

 

Reflection of ‘Real-Life Practice’

Because the study was a retrospective analysis, it contains inherent biases and other issues, Raf Bisschops, MD, PhD, director of endoscopy, University of Leuven, Belgium, who co-chaired the session, said in an interview.

However, it was a “thorough analysis” that reflects “real-life practice,” he said. As such, it lends “huge support” to virtual chromoendoscopy, which “actually goes against the new [British Society of Gastroenterology] guideline that is about to come out.” The society plans to recommend in favor of dye chromoendoscopy, but the new study findings could be still incorporated into the upcoming guidelines so as to also endorse virtual chromoendoscopy.

Whatever the modality used, clinicians need to make sure they “pay attention” when looking for small neoplastic lesions, and “anything that can help you do that, that draws your attention to cell lesions ... can be helpful,” Bisschops said.

Performing targeted biopsies, as with dye chromoendoscopy, can be problematic, as “people don’t pay attention anymore to those cell lesions; they just focus on taking the 32 biopsies, which is a huge endeavor and it’s a pain to do it,” he added.

Radia has received a Research Training Fellowship Award from the UK patient organization PSC Support. No other funding was declared. Radia declared relationships with Abbvie, Galapogos, and Dr. Falk Pharma.

A version of this article appeared on Medscape.com.

BERLIN — A multicenter study comparing three endoscopic imaging techniques used to monitor patients with inflammatory bowel disease (IBD) for neoplasia found that virtual chromoendoscopy has the highest detection rate.

The research, presented at the European Crohn’s and Colitis Organisation (ECCO) 2025 Congress, also found “significant variability in IBD surveillance practice in the real world,” said study presenter Chandni Radia, MD, Department of Gastroenterology, King’s College Hospital NHS Foundation Trust, London, England.

Although dye chromoendoscopy with targeted biopsies traditionally was considered the gold standard for neoplasia detection in patients with IBD, randomized trials have challenged its superiority over virtual chromoendoscopy and high-definition white-light endoscopy, the researchers noted. They hypothesized that the modality used would not affect the neoplasia detection rate.

To investigate, they conducted a retrospective observational cohort study of adults with ulcerative colitis, Crohn’s disease or primary sclerosing cholangitis (PSC) who underwent routine clinical IBD surveillance at one of five centers in the United Kingdom between 2019 and 2023. They examined data from the endoscopy reporting software, alongside endoscopy reports, endoscopy images, and electronic patient records.

In all, 2673 colonoscopies performed on 2050 patients were included, with 1032 procedures using dye chromoendoscopy, 366 using virtual chromoendoscopy, and 1275 using high-definition white-light endoscopy.

The overall neoplasia detection rate was 11.4%, “which is very similar to what has previously been seen in the literature,” Radia said.

However, the detection rate varied significantly by procedure: 19% in virtual chromoendoscopy, 12% in dye chromoendoscopy, and 9% in white-light endoscopy (P < .001). After accounting for a range of potential confounding factors, virtual chromoendoscopy still had the highest neoplasia detection rate.

Dye chromoendoscopy had a “prolonged withdrawal time and increased need for targeted biopsies without improving their neoplasia yield, which goes against our aspirations of sustainability,” Radia noted.

“It was interesting to see that the procedures with the most dye chromoendoscopy seem to have the longest withdrawal time, and those with the most white-light endoscopy seem to have the shortest,” she said. The difference remained significant even after controlling for procedures with polypectomy, “which has a significantly longer withdrawal time compared to procedures without.” 

 

Results Varied by Center

There was wide variability between the five centers on several findings. The neoplasia detection rate ranged from 7.4% to 17.2%, depending on the center.

The surveillance method also varied. One center, for example, used white-light endoscopy in 82% of cases and dye chromoendoscopy in the other 18%. At another center, 61% of patients had dye chromoendoscopy, 36% white-light endoscopy, and 3% virtual chromoendoscopy. In a third center, 48% had virtual chromoendoscopy, 46% white-light endoscopy, and 6% dye chromoendoscopy.

The centers had varying proportions of patients with each of the three conditions, with ulcerative colitis ranging from 46% to 63%, Crohn’s disease from 9% to 39%, and PSC from 14% to 45%.

The heterogeneity of patients between the modality groups is one of the study’s limitations, Radia said. Others are the shorter withdrawal time with white-light endoscopy and the lack of standardized withdrawal time for the procedures.

The research team’s analyses are ongoing and include examination of the types of neoplasia detected, as well as accounting for endoscopist experience and patients who underwent two procedures with different modalities, Radia said.

 

Reflection of ‘Real-Life Practice’

Because the study was a retrospective analysis, it contains inherent biases and other issues, Raf Bisschops, MD, PhD, director of endoscopy, University of Leuven, Belgium, who co-chaired the session, said in an interview.

However, it was a “thorough analysis” that reflects “real-life practice,” he said. As such, it lends “huge support” to virtual chromoendoscopy, which “actually goes against the new [British Society of Gastroenterology] guideline that is about to come out.” The society plans to recommend in favor of dye chromoendoscopy, but the new study findings could be still incorporated into the upcoming guidelines so as to also endorse virtual chromoendoscopy.

Whatever the modality used, clinicians need to make sure they “pay attention” when looking for small neoplastic lesions, and “anything that can help you do that, that draws your attention to cell lesions ... can be helpful,” Bisschops said.

Performing targeted biopsies, as with dye chromoendoscopy, can be problematic, as “people don’t pay attention anymore to those cell lesions; they just focus on taking the 32 biopsies, which is a huge endeavor and it’s a pain to do it,” he added.

Radia has received a Research Training Fellowship Award from the UK patient organization PSC Support. No other funding was declared. Radia declared relationships with Abbvie, Galapogos, and Dr. Falk Pharma.

A version of this article appeared on Medscape.com.

BERLIN — Artificial intelligence (AI)–assisted capsule endoscopy (CE) readings showed higher sensitivity and accuracy in detecting ulcers and erosions in patients with inflammatory bowel disease (IBD) than did conventional readings in a first-of-its-kind, multicenter study. 

In addition to the model’s superior diagnostic performance than standard of care, it also achieved a significant reduction in the mean reading time per exam. 

Furthermore, the study clinically validated an AI model in real time for small-bowel CE. 

The AI model addresses long-standing limitations of CE interpretation, including time-consuming readings and interobserver variability.

“It’s a huge improvement on the technology readiness level of the AI model,” said senior study investigator Miguel Mascarenhas, MD, PhD, head of the precision medicine unit at the Hospital São João, Faculty of Medicine, University of Porto, Portugal. 

Until now, there has been no AI system using a CE platform that has proven so effective in so many real-life clinical settings, he explained. “This technology is set to transform endoscopic practice and clinical management in inflammatory bowel disease.” 

The findings were presented at European Crohn’s and Colitis Organisation 2025 Congress by Francisco Mendes, MD, a resident in gastroenterology, also at the Hospital São João.

 

More Lesions, Less Time

Researchers conducted the prospective study involving centers in Portugal, Spain, and the United States between January 2021 and April 2024. Two CE devices (PillCamSB3 and Olympus EC-10) were analyzed for their performance across 137 CE exams in 137 patients, 49 of whom had Crohn’s disease. AI-assisted readings were compared with standard-of-care readings, with expert board consensus considered to be the gold standard. Key performance metrics included sensitivity, specificity, positive predictive value (PPV), and negative PV (NPV). 

During expert board review, ulcers and erosions were identified in 56 patients (40.9%), with a sensitivity of 60.7%, specificity of 98.8%, a PPV of 97.1%, and an NPV of 78.4%, leading to an overall accuracy for the detection of ulcers and erosions of 83.2%.

In comparison, the AI-assisted readings outperformed conventional readings with a sensitivity of 94.6%, specificity of 80.2%, a PPV of 76.8%, an NPV of 95.6%, leading to an overall accuracy of 86.1%.

The AI-assisted model diagnosis was noninferior (P < .001) and superior (P < .001) to conventional diagnosis for detection of ulcers and erosions. The AI model demonstrated consistent performance across different CE devices and centers. 

In addition, the mean time taken per reading was under 4 minutes (239 seconds) per exam for AI, compared with around 1.0-1.5 hours for standard-of-care readings.

The increased diagnostic accuracy of this AI model done in far less time allows us to engage more with the patient and attend to other care-related tasks, Mascarenhas said. 

CE has great potential not only in IBD but also in other gastrointestinal-related screening, including colorectal cancer screening, he added. Once the bottleneck of reading time with CE is solved, it will become the first-line tool for screening.

Reading time is “one of several barriers” to integration of CE into clinical practice, Shomron Ben-Horin, MD, director, Sheba Medical Center, Tel-Aviv University, Israel, said in an interview. But it “is the most accurate modality for detection of inflammatory activity along the entire small bowel.”

Based on these study results, AI is the way to go, said Ben-Horin, who was not involved in the study. “There was even a signal for better accuracy, which is intriguing,” he added. This study points toward AI being more accurate than the physicians in reading, and that is important.

Also commenting was Miles Parkes, MD, consultant gastroenterologist at Addenbrooke’s Hospital in Cambridge, England. 

“Both the sensitivity and the specificity of the output are reassuring, but there might be some devil in the detail,” he said. “However, as a general principle the performance of this model is impressive.” 

Mascarenhas and Mendes declared no financial disclosures. Ben Horin received fees from Medtronic to attend the conference. Parkes declared no financial disclosures.

A version of this article appeared on Medscape.com.

BERLIN — Artificial intelligence (AI)–assisted capsule endoscopy (CE) readings showed higher sensitivity and accuracy in detecting ulcers and erosions in patients with inflammatory bowel disease (IBD) than did conventional readings in a first-of-its-kind, multicenter study. 

In addition to the model’s superior diagnostic performance than standard of care, it also achieved a significant reduction in the mean reading time per exam. 

Furthermore, the study clinically validated an AI model in real time for small-bowel CE. 

The AI model addresses long-standing limitations of CE interpretation, including time-consuming readings and interobserver variability.

“It’s a huge improvement on the technology readiness level of the AI model,” said senior study investigator Miguel Mascarenhas, MD, PhD, head of the precision medicine unit at the Hospital São João, Faculty of Medicine, University of Porto, Portugal. 

Until now, there has been no AI system using a CE platform that has proven so effective in so many real-life clinical settings, he explained. “This technology is set to transform endoscopic practice and clinical management in inflammatory bowel disease.” 

The findings were presented at European Crohn’s and Colitis Organisation 2025 Congress by Francisco Mendes, MD, a resident in gastroenterology, also at the Hospital São João.

 

More Lesions, Less Time

Researchers conducted the prospective study involving centers in Portugal, Spain, and the United States between January 2021 and April 2024. Two CE devices (PillCamSB3 and Olympus EC-10) were analyzed for their performance across 137 CE exams in 137 patients, 49 of whom had Crohn’s disease. AI-assisted readings were compared with standard-of-care readings, with expert board consensus considered to be the gold standard. Key performance metrics included sensitivity, specificity, positive predictive value (PPV), and negative PV (NPV). 

During expert board review, ulcers and erosions were identified in 56 patients (40.9%), with a sensitivity of 60.7%, specificity of 98.8%, a PPV of 97.1%, and an NPV of 78.4%, leading to an overall accuracy for the detection of ulcers and erosions of 83.2%.

In comparison, the AI-assisted readings outperformed conventional readings with a sensitivity of 94.6%, specificity of 80.2%, a PPV of 76.8%, an NPV of 95.6%, leading to an overall accuracy of 86.1%.

The AI-assisted model diagnosis was noninferior (P < .001) and superior (P < .001) to conventional diagnosis for detection of ulcers and erosions. The AI model demonstrated consistent performance across different CE devices and centers. 

In addition, the mean time taken per reading was under 4 minutes (239 seconds) per exam for AI, compared with around 1.0-1.5 hours for standard-of-care readings.

The increased diagnostic accuracy of this AI model done in far less time allows us to engage more with the patient and attend to other care-related tasks, Mascarenhas said. 

CE has great potential not only in IBD but also in other gastrointestinal-related screening, including colorectal cancer screening, he added. Once the bottleneck of reading time with CE is solved, it will become the first-line tool for screening.

Reading time is “one of several barriers” to integration of CE into clinical practice, Shomron Ben-Horin, MD, director, Sheba Medical Center, Tel-Aviv University, Israel, said in an interview. But it “is the most accurate modality for detection of inflammatory activity along the entire small bowel.”

Based on these study results, AI is the way to go, said Ben-Horin, who was not involved in the study. “There was even a signal for better accuracy, which is intriguing,” he added. This study points toward AI being more accurate than the physicians in reading, and that is important.

Also commenting was Miles Parkes, MD, consultant gastroenterologist at Addenbrooke’s Hospital in Cambridge, England. 

“Both the sensitivity and the specificity of the output are reassuring, but there might be some devil in the detail,” he said. “However, as a general principle the performance of this model is impressive.” 

Mascarenhas and Mendes declared no financial disclosures. Ben Horin received fees from Medtronic to attend the conference. Parkes declared no financial disclosures.

A version of this article appeared on Medscape.com.

BERLIN — Artificial intelligence (AI)–assisted capsule endoscopy (CE) readings showed higher sensitivity and accuracy in detecting ulcers and erosions in patients with inflammatory bowel disease (IBD) than did conventional readings in a first-of-its-kind, multicenter study. 

In addition to the model’s superior diagnostic performance than standard of care, it also achieved a significant reduction in the mean reading time per exam. 

Furthermore, the study clinically validated an AI model in real time for small-bowel CE. 

The AI model addresses long-standing limitations of CE interpretation, including time-consuming readings and interobserver variability.

“It’s a huge improvement on the technology readiness level of the AI model,” said senior study investigator Miguel Mascarenhas, MD, PhD, head of the precision medicine unit at the Hospital São João, Faculty of Medicine, University of Porto, Portugal. 

Until now, there has been no AI system using a CE platform that has proven so effective in so many real-life clinical settings, he explained. “This technology is set to transform endoscopic practice and clinical management in inflammatory bowel disease.” 

The findings were presented at European Crohn’s and Colitis Organisation 2025 Congress by Francisco Mendes, MD, a resident in gastroenterology, also at the Hospital São João.

 

More Lesions, Less Time

Researchers conducted the prospective study involving centers in Portugal, Spain, and the United States between January 2021 and April 2024. Two CE devices (PillCamSB3 and Olympus EC-10) were analyzed for their performance across 137 CE exams in 137 patients, 49 of whom had Crohn’s disease. AI-assisted readings were compared with standard-of-care readings, with expert board consensus considered to be the gold standard. Key performance metrics included sensitivity, specificity, positive predictive value (PPV), and negative PV (NPV). 

During expert board review, ulcers and erosions were identified in 56 patients (40.9%), with a sensitivity of 60.7%, specificity of 98.8%, a PPV of 97.1%, and an NPV of 78.4%, leading to an overall accuracy for the detection of ulcers and erosions of 83.2%.

In comparison, the AI-assisted readings outperformed conventional readings with a sensitivity of 94.6%, specificity of 80.2%, a PPV of 76.8%, an NPV of 95.6%, leading to an overall accuracy of 86.1%.

The AI-assisted model diagnosis was noninferior (P < .001) and superior (P < .001) to conventional diagnosis for detection of ulcers and erosions. The AI model demonstrated consistent performance across different CE devices and centers. 

In addition, the mean time taken per reading was under 4 minutes (239 seconds) per exam for AI, compared with around 1.0-1.5 hours for standard-of-care readings.

The increased diagnostic accuracy of this AI model done in far less time allows us to engage more with the patient and attend to other care-related tasks, Mascarenhas said. 

CE has great potential not only in IBD but also in other gastrointestinal-related screening, including colorectal cancer screening, he added. Once the bottleneck of reading time with CE is solved, it will become the first-line tool for screening.

Reading time is “one of several barriers” to integration of CE into clinical practice, Shomron Ben-Horin, MD, director, Sheba Medical Center, Tel-Aviv University, Israel, said in an interview. But it “is the most accurate modality for detection of inflammatory activity along the entire small bowel.”

Based on these study results, AI is the way to go, said Ben-Horin, who was not involved in the study. “There was even a signal for better accuracy, which is intriguing,” he added. This study points toward AI being more accurate than the physicians in reading, and that is important.

Also commenting was Miles Parkes, MD, consultant gastroenterologist at Addenbrooke’s Hospital in Cambridge, England. 

“Both the sensitivity and the specificity of the output are reassuring, but there might be some devil in the detail,” he said. “However, as a general principle the performance of this model is impressive.” 

Mascarenhas and Mendes declared no financial disclosures. Ben Horin received fees from Medtronic to attend the conference. Parkes declared no financial disclosures.

A version of this article appeared on Medscape.com.

BERLIN — An individual’s profile of antibody responses to a range of herpes viruses and encapsulated bacteria such as Streptococcus could predict the onset of inflammatory bowel disease (IBD) up to 10 years prior to diagnosis, with differential responses between Crohn’s disease and ulcerative colitis, a new study suggested.

The research was presented at the European Crohn’s and Colitis Organisation (ECCO) 2025 Congress.

“High-throughput and high-resolution antibody profiling delineates a previously underappreciated landscape of selective serological responses in inflammatory bowel disease,” said study presenter Arno R. Bourgonje, MD, PhD, of the Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City.

The discovery represents just the “tip of the iceberg” in terms of understanding how antibody response could predict IBD onset, he added. Although validation studies are ongoing, the findings “allow for novel insights into disease pathogenesis and also for allowing for disease prediction.”

In IBD, the integrity of the intestinal barrier is compromised and luminal agents, like bacteria, can leak through, which leads to immune activation, Bourgonje said.

However, only a few serological antibody responses are known to occur in IBD, such as antibodies against the yeast Saccharomyces cerevisiae and those against the cytoplasm of neutrophils, he said.

But most antibody responses are directed against bacteria, Bourgonje noted. The gut microbiome represents thousands of different bacterial species, each of which encode for thousands of different genes, representing a tremendous number of potential antigens. But conventional antibody-profiling technologies weren’t powerful enough to identify antibodies in patients with IBD that signal an immune response to potential antigens in the gut.

To get at that problem, the researchers recently leveraged a high-throughput technology called phage-display immunoprecipitation sequencing (PhIP-Seq) to look for specific immune-based biomarker signatures in the blood of individuals with IBD. This effort revealed a distinct repertoire of antibodies not only against bacteria but also against viruses and cell antigens.

The researchers next turned their sights on discovering whether they could find evidence of immunological alterations before IBD onset to enable disease prediction.

 

Predictive Signatures Found

The team used a longitudinal preclinical IBD cohort called PREDICTS (Proteomic Evaluation and Discovery in an IBD Cohort of Tri-service Subjects) that is housed in the US Department of Defense Serum Repository.

Using PhIP-Seq, the researchers analyzed serum samples from 200 individuals who developed Crohn’s disease, 200 who developed ulcerative colitis, and 100 non-IBD controls matched for age, sex, race, and study time point. The samples were collected approximately 2 years, 4 years, and 10 years prior to diagnosis as well around the time of diagnosis.

The results showed that, compared with healthy controls, the diversity of the antibody repertoire was significantly lower in the sera of individuals with preclinical Crohn’s disease (P < .05) and ulcerative colitis (P < .001), with the lowest similarity seen in people with preclinical Crohn’s disease approximately 4 years prior to their diagnosis (P < .001).

The study also found that, compared with healthy controls, antibody responses in individuals with preclinical Crohn’s disease against herpes viruses such as Epstein-Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus (HSV)–1 and HSV-2 were significantly higher approximately 10 years prior to the diagnosis of Crohn’s disease, whereas anti-Streptococcus responses were lower.

In individuals with ulcerative colitis, antibody responses to EBV, CMV, HSV-1, and influenza viruses were significantly higher than that in healthy controls approximately 10 years prior to diagnosis, whereas anti-rhinovirus responses were lower.

Further analysis demonstrated that antibody responses to CMV and EBV proteins increased over the course of the preclinical phase of Crohn’s disease vs healthy controls (P = .008 and P = .011, respectively).

Similarly, autoantibody responses to MAP kinase–activating death domain increased during the preclinical phase of ulcerative colitis vs healthy controls (P = .0025), whereas anti-Streptococcus responses decreased (P = .005).

Interestingly, no one single antibody response difference with healthy controls was able to accurately predict the onset of IBD 10 years prior to diagnosis, but distinct sets of antibody responses were, with area under the receiver operating characteristic curve of 0.90 for Crohn’s disease and 0.84 for ulcerative colitis.

 

A Promising Start

The study has potential to be useful for identifying people at risk for IBD, Robin Dart, MD, PhD, a consultant gastroenterologist at Guy’s and St Thomas Hospital, London, England, who co-chaired the session, said in an interview.

The difference in antibody responses to viral and bacterial antigens between Crohn’s disease and ulcerative colitis could point toward underlying biological mechanisms, although it is “too early to say,” Dart said.

However, “when you do these kind of big fishing exercises” and identify microbes may be implicated in IBD, “you end up finding more questions than answers,” although that “can only be a good thing,” he added.

Bourgonje noted that the study cohort consisted entirely of men enrolled in the US Army, limiting the applicability of the findings. Another limitation was that researchers were unable to control smoking, antibiotic use, and diet, all of which could have affected the results.

This study was funded by the Leona M. and Harry B. Helmsley Charitable Trust. Bourgonje declared relationships with Janssen Pharmaceuticals, Ferring, AbbVie. Other authors also declared numerous relationships.

A version of this article appeared on Medscape.com.

BERLIN — An individual’s profile of antibody responses to a range of herpes viruses and encapsulated bacteria such as Streptococcus could predict the onset of inflammatory bowel disease (IBD) up to 10 years prior to diagnosis, with differential responses between Crohn’s disease and ulcerative colitis, a new study suggested.

The research was presented at the European Crohn’s and Colitis Organisation (ECCO) 2025 Congress.

“High-throughput and high-resolution antibody profiling delineates a previously underappreciated landscape of selective serological responses in inflammatory bowel disease,” said study presenter Arno R. Bourgonje, MD, PhD, of the Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City.

The discovery represents just the “tip of the iceberg” in terms of understanding how antibody response could predict IBD onset, he added. Although validation studies are ongoing, the findings “allow for novel insights into disease pathogenesis and also for allowing for disease prediction.”

In IBD, the integrity of the intestinal barrier is compromised and luminal agents, like bacteria, can leak through, which leads to immune activation, Bourgonje said.

However, only a few serological antibody responses are known to occur in IBD, such as antibodies against the yeast Saccharomyces cerevisiae and those against the cytoplasm of neutrophils, he said.

But most antibody responses are directed against bacteria, Bourgonje noted. The gut microbiome represents thousands of different bacterial species, each of which encode for thousands of different genes, representing a tremendous number of potential antigens. But conventional antibody-profiling technologies weren’t powerful enough to identify antibodies in patients with IBD that signal an immune response to potential antigens in the gut.

To get at that problem, the researchers recently leveraged a high-throughput technology called phage-display immunoprecipitation sequencing (PhIP-Seq) to look for specific immune-based biomarker signatures in the blood of individuals with IBD. This effort revealed a distinct repertoire of antibodies not only against bacteria but also against viruses and cell antigens.

The researchers next turned their sights on discovering whether they could find evidence of immunological alterations before IBD onset to enable disease prediction.

 

Predictive Signatures Found

The team used a longitudinal preclinical IBD cohort called PREDICTS (Proteomic Evaluation and Discovery in an IBD Cohort of Tri-service Subjects) that is housed in the US Department of Defense Serum Repository.

Using PhIP-Seq, the researchers analyzed serum samples from 200 individuals who developed Crohn’s disease, 200 who developed ulcerative colitis, and 100 non-IBD controls matched for age, sex, race, and study time point. The samples were collected approximately 2 years, 4 years, and 10 years prior to diagnosis as well around the time of diagnosis.

The results showed that, compared with healthy controls, the diversity of the antibody repertoire was significantly lower in the sera of individuals with preclinical Crohn’s disease (P < .05) and ulcerative colitis (P < .001), with the lowest similarity seen in people with preclinical Crohn’s disease approximately 4 years prior to their diagnosis (P < .001).

The study also found that, compared with healthy controls, antibody responses in individuals with preclinical Crohn’s disease against herpes viruses such as Epstein-Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus (HSV)–1 and HSV-2 were significantly higher approximately 10 years prior to the diagnosis of Crohn’s disease, whereas anti-Streptococcus responses were lower.

In individuals with ulcerative colitis, antibody responses to EBV, CMV, HSV-1, and influenza viruses were significantly higher than that in healthy controls approximately 10 years prior to diagnosis, whereas anti-rhinovirus responses were lower.

Further analysis demonstrated that antibody responses to CMV and EBV proteins increased over the course of the preclinical phase of Crohn’s disease vs healthy controls (P = .008 and P = .011, respectively).

Similarly, autoantibody responses to MAP kinase–activating death domain increased during the preclinical phase of ulcerative colitis vs healthy controls (P = .0025), whereas anti-Streptococcus responses decreased (P = .005).

Interestingly, no one single antibody response difference with healthy controls was able to accurately predict the onset of IBD 10 years prior to diagnosis, but distinct sets of antibody responses were, with area under the receiver operating characteristic curve of 0.90 for Crohn’s disease and 0.84 for ulcerative colitis.

 

A Promising Start

The study has potential to be useful for identifying people at risk for IBD, Robin Dart, MD, PhD, a consultant gastroenterologist at Guy’s and St Thomas Hospital, London, England, who co-chaired the session, said in an interview.

The difference in antibody responses to viral and bacterial antigens between Crohn’s disease and ulcerative colitis could point toward underlying biological mechanisms, although it is “too early to say,” Dart said.

However, “when you do these kind of big fishing exercises” and identify microbes may be implicated in IBD, “you end up finding more questions than answers,” although that “can only be a good thing,” he added.

Bourgonje noted that the study cohort consisted entirely of men enrolled in the US Army, limiting the applicability of the findings. Another limitation was that researchers were unable to control smoking, antibiotic use, and diet, all of which could have affected the results.

This study was funded by the Leona M. and Harry B. Helmsley Charitable Trust. Bourgonje declared relationships with Janssen Pharmaceuticals, Ferring, AbbVie. Other authors also declared numerous relationships.

A version of this article appeared on Medscape.com.

BERLIN — An individual’s profile of antibody responses to a range of herpes viruses and encapsulated bacteria such as Streptococcus could predict the onset of inflammatory bowel disease (IBD) up to 10 years prior to diagnosis, with differential responses between Crohn’s disease and ulcerative colitis, a new study suggested.

The research was presented at the European Crohn’s and Colitis Organisation (ECCO) 2025 Congress.

“High-throughput and high-resolution antibody profiling delineates a previously underappreciated landscape of selective serological responses in inflammatory bowel disease,” said study presenter Arno R. Bourgonje, MD, PhD, of the Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York City.

The discovery represents just the “tip of the iceberg” in terms of understanding how antibody response could predict IBD onset, he added. Although validation studies are ongoing, the findings “allow for novel insights into disease pathogenesis and also for allowing for disease prediction.”

In IBD, the integrity of the intestinal barrier is compromised and luminal agents, like bacteria, can leak through, which leads to immune activation, Bourgonje said.

However, only a few serological antibody responses are known to occur in IBD, such as antibodies against the yeast Saccharomyces cerevisiae and those against the cytoplasm of neutrophils, he said.

But most antibody responses are directed against bacteria, Bourgonje noted. The gut microbiome represents thousands of different bacterial species, each of which encode for thousands of different genes, representing a tremendous number of potential antigens. But conventional antibody-profiling technologies weren’t powerful enough to identify antibodies in patients with IBD that signal an immune response to potential antigens in the gut.

To get at that problem, the researchers recently leveraged a high-throughput technology called phage-display immunoprecipitation sequencing (PhIP-Seq) to look for specific immune-based biomarker signatures in the blood of individuals with IBD. This effort revealed a distinct repertoire of antibodies not only against bacteria but also against viruses and cell antigens.

The researchers next turned their sights on discovering whether they could find evidence of immunological alterations before IBD onset to enable disease prediction.

 

Predictive Signatures Found

The team used a longitudinal preclinical IBD cohort called PREDICTS (Proteomic Evaluation and Discovery in an IBD Cohort of Tri-service Subjects) that is housed in the US Department of Defense Serum Repository.

Using PhIP-Seq, the researchers analyzed serum samples from 200 individuals who developed Crohn’s disease, 200 who developed ulcerative colitis, and 100 non-IBD controls matched for age, sex, race, and study time point. The samples were collected approximately 2 years, 4 years, and 10 years prior to diagnosis as well around the time of diagnosis.

The results showed that, compared with healthy controls, the diversity of the antibody repertoire was significantly lower in the sera of individuals with preclinical Crohn’s disease (P < .05) and ulcerative colitis (P < .001), with the lowest similarity seen in people with preclinical Crohn’s disease approximately 4 years prior to their diagnosis (P < .001).

The study also found that, compared with healthy controls, antibody responses in individuals with preclinical Crohn’s disease against herpes viruses such as Epstein-Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus (HSV)–1 and HSV-2 were significantly higher approximately 10 years prior to the diagnosis of Crohn’s disease, whereas anti-Streptococcus responses were lower.

In individuals with ulcerative colitis, antibody responses to EBV, CMV, HSV-1, and influenza viruses were significantly higher than that in healthy controls approximately 10 years prior to diagnosis, whereas anti-rhinovirus responses were lower.

Further analysis demonstrated that antibody responses to CMV and EBV proteins increased over the course of the preclinical phase of Crohn’s disease vs healthy controls (P = .008 and P = .011, respectively).

Similarly, autoantibody responses to MAP kinase–activating death domain increased during the preclinical phase of ulcerative colitis vs healthy controls (P = .0025), whereas anti-Streptococcus responses decreased (P = .005).

Interestingly, no one single antibody response difference with healthy controls was able to accurately predict the onset of IBD 10 years prior to diagnosis, but distinct sets of antibody responses were, with area under the receiver operating characteristic curve of 0.90 for Crohn’s disease and 0.84 for ulcerative colitis.

 

A Promising Start

The study has potential to be useful for identifying people at risk for IBD, Robin Dart, MD, PhD, a consultant gastroenterologist at Guy’s and St Thomas Hospital, London, England, who co-chaired the session, said in an interview.

The difference in antibody responses to viral and bacterial antigens between Crohn’s disease and ulcerative colitis could point toward underlying biological mechanisms, although it is “too early to say,” Dart said.

However, “when you do these kind of big fishing exercises” and identify microbes may be implicated in IBD, “you end up finding more questions than answers,” although that “can only be a good thing,” he added.

Bourgonje noted that the study cohort consisted entirely of men enrolled in the US Army, limiting the applicability of the findings. Another limitation was that researchers were unable to control smoking, antibiotic use, and diet, all of which could have affected the results.

This study was funded by the Leona M. and Harry B. Helmsley Charitable Trust. Bourgonje declared relationships with Janssen Pharmaceuticals, Ferring, AbbVie. Other authors also declared numerous relationships.

A version of this article appeared on Medscape.com.