DAY 1: Section Editor Picks Best IBD Articles from the American Journal of Gastroenterology

Dr. Raymond K. Cross, of the Melissa L. Posner Institute for Digestive Health & Liver Disease at Mercy Medical Center in Baltimore, MD, reviewed his picks for the best articles on IBD published in the American Journal of Gastroenterology in the last year.

Dr. Cross summarized the findings and take-home messages from six papers on IBD published in the American Journal of Gastroenterology in the past year.

• 1) Narula et al. Ultraprocessed grains and risk of inflammatory bowel disease: results from the prospective urban rural epidemiology study. Am J Gastroenterol. 2026;121(6):1445-1454. doi: 10.14309/ajg.00000000000003700

The PURE study was a multinational prospective cohort that included 124,590 participants across 21 countries. Over a median follow-up of 12.9 years, 605 participants developed IBD: 497 ulcerative colitis (UC) and 108 Crohn's disease (CD). Multivariate analysis found that participants who consumed 19 g/day or more of ultraprocessed grains had an 86% increased risk of IBD, and that cutting out ultraprocessed foods would decrease the long-term risk of IBD by 44%. Take-home message: Eat real food to prevent IBD.

• 2) Steinsbø et al. Fecal calprotectin correlates with disease extent but remains a reliable marker of mucosal healing in ulcerative colitis. Am J Gastroenterol. 2025;120(11):2623-2631. doi: 10.14309/ajg.0000000000003339

This single-center observational study analyzed 518 visits by 254 patients with UC, rating mucosal activity by the Mayo Endoscopic Score (MES) and Nancy Histological Index (NHI) and categorizing endoscopic extent by the Montreal classification. Calprotectin rose stepwise with endoscopic extent overall, with similar associations seen among patients with endoscopically active disease (MES ≥2) and quiescent disease (MES ≤1). Despite this, the diagnostic accuracy of fecal calprotectin as a marker of mucosal healing was preserved across extent categories. Take-home message: Fecal calprotectin is a reliable biomarker in UC but may be less reliable in ulcerative proctitis.

• 3) Casas Deza et al. Patients included in clinical trials of biological drugs for inflammatory bowel disease do not represent the real-world population. Am J Gastroenterol. 2026;121(6):1424-1434. doi: 10.14309/ajg.0000000000003670

A single-center retrospective observational study examined whether all consecutive patients with CD or UC who started a biologic therapy between January 2017 and December 2022 would have met the eligibility criteria of the pivotal randomized trials for adalimumab, infliximab, golimumab, ustekinumab, and vedolizumab. Among 477 patients who received 631 biologic treatments, only 17% met trial criteria. However, there were no differences in adverse events or drug persistence between the clinical trial populations and the real-world population. Take-home message: Biologic therapies seem to work as well in real-world populations as in clinical trials.

• 4) Ahuja et al. Comparative safety of advanced therapies in patients with ulcerative colitis: an administrative claims-based study. Am J Gastroenterol. 2026;121(5):1192-1201. doi: 10.14309/ajg.0000000000003806

A retrospective cohort study used the OptumLabs Data Warehouse claims database to identify 9430 patients with UC who initiated an anti-TNF, anti-integrin, anti-IL, JAK inhibitor, or sphingosine-1-phosphate receptor modulator between 2016 and 2022, with 2.3 years of follow-up. The risk of serious infections, venous thromboembolism, and major adverse cardiovascular events were compared between the treatments. Anti-interleukin agents (HR 0.66, 95% CI 0.51–0.87) and JAK inhibitors (HR 0.66, 95%CI 0.46–0.94) had a statistically significant lower risk of serious infection than anti-TNFs. Rates of venous thromboembolism (1.4–2.0 per 100 patient-years) and major adverse cardiovascular events (0.5–1.0 per 100 patient-years) were low, with no significant differences between agents. Take-home message: JAKi and IL-23 inhibitors are associated with a decreased risk of serious infection compared to other treatments in UC.

• 5) Zurbuch et al. Previous abdominal surgery is not associated with adverse pregnancy, delivery, or neonatal outcomes in women with Crohn’s disease: results from the Pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes (PIANO) Study. Am J  Gastroenterol. 2026;121(7):1772-1776. doi: 10.14309/ajg.0000000000003947

This study examined pregnancy, delivery, and neonatal outcomes for 1046 pregnant women with CD in the prospective PIANO cohort, of whom 409 (39%) had undergone prior surgery. These patients had higher disease activity than those who had no prior surgery. The vast majority of women had a live birth. Multivariate analysis found that only higher disease activity (OR 1.14, 95%CI 1.06-1.22) and ileal disease location (OR 2.19, 95%CI 1.26-3.83) were associated with preterm birth. There was no association between prior surgery and pre-term birth or any other pregnancy, delivery, or neonatal outcome. Take-home message: Prior abdominal surgery is not associated with adverse pregnancy outcomes in women with CD.

• 6) Caldera, et al. High rates of seroprotection for measles in pediatric patients with inflammatory bowel disease. Am J Gastroenterol. 2026;121(10):2581-2584. doi: 10.14309/ajg.0000000000004050

Prompted by the ongoing US measles outbreak, the largest in 3 decades, and concerns that  immunosuppressed populations have lower seroprotection against measles, this study examined measles seroprotection in 176 pediatric patients using a high-sensitivity ELISA (Zeus) compared to a commercial assay using banked serum from the PREVENT-COVID study. By ELISA, 173 patients (98%) were seropositive, even though 87% were on immunosuppressive therapy. The 3 seronegative patients were on an anti-TNF and methotrexate. The commercial assay identified 93% as seropositive; of the 13 that were seronegative, 10 were seropositive on the Zeus ELISA. Children with IBD have high rates of measles seroprotection despite immunosuppression, and a negative result on a standard commercial assay should not be taken as evidence that a child is unprotected. Take-home message: Most pediatric patients are immune to measles; do not check titers.