Intestinal Research

Original Articles

IBD

Ulcerative colitis disease severity affects the speed of symptom relief under filgotinib treatment: a post hoc analysis of the phase 2b/3 SELECTION study: Masayuki Saruta, Silvio Danese, Yoshie Takatori, Toshihiko Kaise, Christine Rudolph, Marc Ferrante, Toshifumi Hibi; Intest Res 2026;24(2):329-340. Published online June 30, 2025; DOI: https://doi.org/10.5217/ir.2024.00169

Abstract PDF Supplementary Material PubReader ePub: Background/Aims
Filgotinib is an oral, once-daily, Janus kinase 1 preferential inhibitor approved for the treatment of ulcerative colitis (UC). This study aimed to assess symptomatic response with filgotinib 200 mg (FIL200) according to disease severity using baseline partial Mayo Clinic Score (pMCS).
Methods
In the phase 2b/3 SELECTION study (NCT02914522), adults with moderate-to-severe UC were randomized to receive FIL200, filgotinib 100 mg, or placebo for 11 weeks in induction studies A (biologic-naive) and B (biologic-experienced). In this post hoc analysis, symptomatic remission (Mayo rectal bleeding subscore of 0 and stool frequency subscore ≤ 1) rates were assessed daily from baseline to day 15 and fortnightly from week 2 to week 10 by baseline pMCS (pMCS ≥ 7, pMCS < 7) in patients who received induction FIL200.
Results
Of those who received FIL200 in induction studies A and B, 90 and 148 patients had a pMCS ≥ 7, and 155 and 114 had a pMCS < 7, respectively. Symptomatic remission rates were generally significantly higher in the pMCS < 7 than ≥ 7 group from day 2–15 (day 2: 8.4% vs. 1.1%, P= 0.009 [induction study A]; 8.8% vs. 0.7%, P= 0.004 [induction study B]). However, by week 10, there was no longer a significant difference in the rates between the pMCS ≥ 7 and < 7 groups (43.3% vs. 54.8%, P= 0.124 [induction study A]; 26.4% vs. 39.5%, P= 0.099 [induction study B]).
Conclusions
Symptomatic response to FIL200 occurred more rapidly in the less severe disease groups than in the more severe disease groups; however, regardless of disease severity, both groups benefited from continued FIL200 treatment.

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Miscellaneous

Bowel movement alterations predict the severity of diverticular disease and the risk of acute diverticulitis: a prospective, international study: Antonio Tursi, Daniele Piovani, Giovanni Brandimarte, Francesco Di Mario, Walter Elisei, Marcello Picchio, Gisella Figlioli, Gabrio Bassotti, Leonardo Allegretta, Maria Laura Annunziata, Mauro Bafutto, Maria Antonia Bianco, Raffaele Colucci, Rita Conigliaro, Dan L. Dumitrascu, Ricardo Escalante, Luciano Ferrini, Giacomo Forti, Marilisa Franceschi, Maria Giovanna Graziani, Frank Lammert, Giovanni Latella, Daniele Lisi, Giovanni Maconi, Debora Compare, Gerardo Nardone, Lucia Camara de Castro Oliveira, Chaves Oliveira Enio, Savvas Papagrigoriadis, Anna Pietrzak, Stefano Pontone, Ieva Stundiene, Tomas Poškus, Giuseppe Pranzo, Matthias Christian Reichert, Stefano Rodino, Jaroslaw Regula, Giuseppe Scaccianoce, Franco Scaldaferri, Roberto Vassallo, Costantino Zampaletta, Angelo Zullo, Erasmo Spaziani, Stefanos Bonovas, Alfredo Papa, Silvio Danese, DICA International Group; Intest Res 2025;23(1):96-106. Published online August 12, 2024; DOI: https://doi.org/10.5217/ir.2024.00046

Abstract PDF Supplementary Material PubReader ePub

Background/Aims
Patients with diverticular disease (DD) frequently have abnormal bowel movements. However, it is unknown whether the entity of these alterations is associated with the severity of DD. We aimed to assess bowel habits and their relationship with the severity of DD according to Diverticular Inflammation and Complication Assessment (DICA) classification, Combined Overview on Diverticular Assessment (CODA) score, and fecal calprotectin (FC).
Methods
An international, multicenter, prospective cohort study was conducted in 43 centers. A 10-point visual analog scale (VAS) was used to assess the severity of constipation and diarrhea. The association of constipation and diarrhea with DICA classification, CODA score, and basal FC was tested using non-parametric tests. Survival methods for censored observations were applied to test the association of constipation and diarrhea with the incidence of acute diverticulitis over a 3-year follow-up.
Results
Of 871 patients with DD were included in the study. Of these, 208 (23.9%) and 199 (22.9%) reported a VAS score for constipation and diarrhea at least 3 at baseline, respectively. Higher constipation and diarrhea scores were associated with increasing DICA classification, CODA score and basal FC (P< 0.001). Constipation and diarrhea scores were independently associated with an increased hazard of developing acute diverticulitis (hazard ratio [HR]_constipation = 1.15 per 1-VAS point increase, 95% confidence interval [CI], 1.04–1.27; P=0.004; and HR_diarrhea =1.14; 95% CI, 1.03–1.26; P=0.014, respectively).
Conclusions
In newly diagnosed patients with DD, higher endoscopic and combined scores of DD severity were associated with higher scores of constipation and diarrhea at baseline. Both constipation and diarrhea were independent prognostic factors of acute diverticulitis.

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Global guidelines on diverticular disease of the colon: the Fiesole Consensus report
Antonio Tursi, Giovanni Brandimarte, Francesco Di Mario, Wenjie Ma, Juozas Kupcinskas, Jaroslaw Regula, Giovanni Maconi, Peter Malfertheiner, Giovanni Barbara, Neil Stollman, Savvas Papagrigoriadis, Thomas Golda, Antonio Amato, Mauro Bafutto, Gabrio Basso
Gut.2025; : gutjnl-2025-336902. CrossRef

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Statement

IBD

Consensus recommendations for patient-centered therapy in mild-to-moderate ulcerative colitis: the i Support Therapy–Access to Rapid Treatment (iSTART) approach: Silvio Danese, Rupa Banerjee, JR Fraser Cummings, Iris Dotan, Paulo G Kotze, Rupert Wing Loong Leong, Kristine Paridaens, Laurent Peyrin-Biroulet, Glyn Scott, Gert Van Assche, Jan Wehkamp, Jesús K Yamamoto-Furusho; Intest Res 2018;16(4):522-528. Published online October 16, 2018; DOI: https://doi.org/10.5217/ir.2018.00073

Abstract PDF Supplementary Material PubReader ePub

Symptomatic ulcerative colitis (UC) can be a chronic, disabling condition. Flares in disease activity are associated with many of the negative impacts of mild-to-moderate UC. Rapid resolution of flares can provide benefits to patients and healthcare systems. i Support Therapy–Access to Rapid Treatment (iSTART) introduces patient-centered care for mild-to-moderate UC. iSTART provides patients with the ability to self-assess symptomology and self-start a short course of second-line treatment when necessary. An international panel of experts produced consensus statements and recommendations. These were informed by evidence from systematic reviews on the epidemiology, mesalazine (5-ASA) treatment, and patient use criteria for second-line therapy in UC. Optimized 5-ASA is the first-line treatment in all clinical guidelines, but may not be sufficient to induce remission in all patients. Corticosteroids should be prescribed as second-line therapy when needed, with budesonide MMX® being a preferred steroid option. Active involvement of suitable patients in management of UC flares has the potential to improve therapy, with patients able to show good accuracy for flare self-assessment using validated tools. There is a place in the UC treatment pathway for an approach such as iSTART, which has the potential to provide patient, clinical and economic benefits.

Citations

Citations to this article as recorded by

Investigate sodium orthovanadate molecular mechanisms in diabetes-aggravated ulcerative colitis, focusing on Nrf2/Keap1 antioxidant and NF-κB/IL-6 inflammatory pathways
Gurpreet Kaur, Ajay Singh Kushwah
Journal of Molecular Histology.2026;[Epub] CrossRef
Sodium orthovanadate protects against ulcerative colitis and associated liver damage in mice: insights into modulations of Nrf2/Keap1 and NF-κB pathways
Gurpreet Kaur, Ajay Singh Kushwah
Naunyn-Schmiedeberg's Archives of Pharmacology.2025; 398(2): 1557. CrossRef
Synergic effect of combined melatonin and tofacitinib on ameliorating dextran sulfate sodium-induced colitis in rat---role of JAKs/STAT, cell-stress signaling, and inflammatory-immune reaction
Chia-Lo Chang
American Journal of Clinical and Experimental Immunology.2025; 14(4): 185. CrossRef
Probiotics and inflammatory bowel disease: an umbrella meta-analysis of relapse, recurrence, and remission outcomes
Wei Liu, Shengbo Zhang, Changzheng Dong, Xia Lv, Ximin Zheng, Wei Zhao, Mehrdad Jamali, Ranasadat Abedi, Ahmad Saedisomeolia
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Healing Herbs: A Review of Herbal Treatments for Inflammatory Bowel Disease
Payal N. Vaja, Vivek P. Solanki, Dilip R. Ghusar, Siddhi K. Upadhyay, Harsh H madiya
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Management and treatment optimization of patients with mild to moderate ulcerative colitis
Ferdinando D’Amico, Ernesto Fasulo, Vipul Jairath, Kristine Paridaens, Laurent Peyrin-Biroulet, Silvio Danese
Expert Review of Clinical Immunology.2024; 20(3): 277. CrossRef
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Framework of IBD Care Delivery Across Ages
Stefan Delen, Susanna Jaghult, Irina Blumenstein, Lieven Pouillon, Peter Bossuyt
Journal of Crohn's and Colitis.2024; 18(Supplement): ii55. CrossRef
Effectiveness of Mesalamine in Patients With Ulcerative Colitis: A Systematic Review
Yurianna Santos, Arturo P Jaramillo
Cureus.2023;[Epub] CrossRef
Encoding bacterial colonization and therapeutic modality by wrapping with an adhesive drug-loadable nanocoating
Huilong Luo, Feng Wu, Xinyue Wang, Sisi Lin, Mengmeng Zhang, Zhenping Cao, Jinyao Liu
Materials Today.2023; 62: 98. CrossRef
iSTART-II: An Update on the i Support Therapy–Access to Rapid Treatment (iSTART) Approach for Patient-Centered Therapy in Mild-to-Moderate Ulcerative Colitis
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Journal of Clinical Medicine.2023; 12(3): 1142. CrossRef
A review article of inflammatory bowel disease treatment and pharmacogenomics
Nashwa Eltantawy, Islam Abd El-Hamid El-Zayyadi, Ahmed A. Elberry, Layla M. Salah, Mohamed E. A. Abdelrahim, Amira B. Kassem
Beni-Suef University Journal of Basic and Applied Sciences.2023;[Epub] CrossRef
Multinational evaluation of clinical decision-making in the treatment and management of mild-to-moderate ulcerative colitis
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Budesonide MMX in the Treatment of Ulcerative Colitis: Current Perspectives on Efficacy and Safety
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