- N Engl J Med 2022; 386:e37
A 30-year-old man with Crohn’s disease presented with multiple painful ulcers in his groin and perineal area. Physical examination of the skin showed deep, linear erosions. Skin swabs were negative for bacterial, fungal, herpes simplex viral, and tubercular infections.
- N Engl J Med 2022; 386:375-383
A 14-year-old boy was admitted with fatigue, fever, joint pain, abdominal cramping, and diarrhea. He had been well until 2 weeks earlier, when fatigue and fever developed on his final day of summer camp. On the day of admission, he had pain in his shoulders and knees and a temperature...
- N Engl J Med 2021; 385:e77
A 50-year-old woman with Crohn’s disease presented with painful, shallow erosions in “snail track” formations on her dorsal tongue and inner cheek and with peripheral-blood eosinophilia. A biopsy revealed findings consistent with pyostomatitis vegetans.
- N Engl J Med 2021; 385:1302-1315
There is still no cure for inflammatory bowel disease. This review covers newer treatments that reflect our understanding of the complex pathogenesis of IBD, with a focus on clinical and endoscopic remission and more precise molecular targeting of inflammatory cascades.
- N Engl J Med 2021; 385:1280-1291
In a phase 3 trial, patients with moderately to severely active ulcerative colitis were randomly assigned to receive placebo or ozanimod, a selective sphingosine-1-phosphate receptor modulator. Clinical remission was significantly greater with ozanimod during the induction and maintenance periods. The incidence of infection was higher with ozanimod than with placebo...
- N Engl J Med 2021; 385:628-639
The ability to block specific cytokine pathways has revealed pathophysiological differences among autoimmune diseases (e.g., the efficacy of TNF inhibitors in arthritides and inflammatory bowel disorders and their inefficacy in giant-cell arteritis and multiple sclerosis), providing a framework for reclassification.
- N Engl J Med 2021; 385:265-274
A 33-year-old pregnant woman with ulcerative colitis presented at 10 weeks of gestation with fever, nausea, vomiting, abdominal pain, and headache. On hospital day 3, the systolic blood pressure declined to 70 mm Hg. Three weeks earlier, the patient had had an ulcerative colitis flare; methylprednisolone and mesalamine were administered....
- N Engl J Med 2021; 384:2156-2158
Recent findings based on a mouse model suggest that a peripheral immune mechanism may underlie the symptoms associated with abdominal pain in patients with irritable bowel syndrome.
- N Engl J Med 2021; 384:581-583
Two patients in whom severe refractory autoimmune colitis developed after cancer treatment with immune checkpoint inhibitors had a response to a course of subcutaneously administered ustekinumab, an antibody that blocks interleukin-12/23 signaling.
- N Engl J Med 2020; 383:2652-2664
Research on IBDs has identified disrupted immune responses in the gastrointestinal mucosa and putative disruptions in the gut microbiome as causative agents. This work has led to better therapeutic control of IBDs with the use of various antiinflammatory agents.
- N Engl J Med 2020; 383:684-686
Hans Fischer, who won the Nobel Prize in Chemistry in 1930 and whose work led to the synthesis of bilirubin, would be astounded by the properties of bilirubin that have since emerged and are evident in preclinical studies of inflammatory bowel disease and pancreatitis.
- N Engl J Med 2020; 383:85-88
The authors describe patients in New York City with known immune-mediated inflammatory disease in whom Covid-19 developed while they were receiving biologics, other immunomodulatory therapies, or both. The incidence of hospitalization among these patients was consistent with that among patients with Covid-19 in the general population in New York City.
- N Engl J Med 2020; 382:2374-2375
Tofacitinib is a JAK inhibitor that decreases cytokine production. In a woman with autoimmune colitis from the administration of pembrolizumab to treat her cancer, tofacitinib induced remission in 5 days, after glucocorticoids, infliximab, and vedolizumab had been ineffective. The cancer responded to immunotherapy, and the autoimmune complication resolved with tofacitinib.
- N Engl J Med 2020; 382:1543-1543
A 54-year-old man with a history of ulcerative colitis was admitted to the hospital with an intraabdominal abscess. On day 7 of his hospital stay, painful skin lesions developed on his neck. A diagnosis of Sweet’s syndrome was made.
- N Engl J Med 2020; 382:1042-1052
An 89-year-old man was evaluated for recurrent abdominal pain and bloody stools. During the previous 4 months, he had been hospitalized three times for the same symptoms. Diverticulosis and Clostridioides difficile colitis had been diagnosed, but despite treatment, symptoms persisted. After a fourth admission, a diagnosis was made.
- N Engl J Med 2020; 382:294-296
Extracorporeal photopheresis has been an effective treatment for graft-versus-host disease. In this case, it was used to treat a patient with severe autoimmune colitis induced by checkpoint-inhibitor therapy for melanoma. The extracorporeal photopheresis resulted in an increased number of immunoregulatory natural killer cells.
- N Engl J Med 2019; 381:1201-1214
Patients with moderate-to-severe ulcerative colitis were randomly assigned to receive placebo or induction doses of ustekinumab. Patients who had a response to induction therapy underwent a second randomization to maintenance therapy with ustekinumab or placebo. Ustekinumab was more effective than placebo for inducing and maintaining remission.
- N Engl J Med 2019; 381:1215-1226
In a randomized, active-controlled trial, patients with moderately to severely active ulcerative colitis were assigned to receive vedolizumab or adalimumab. At 52 weeks, vedolizumab was superior to adalimumab in terms of clinical remission and endoscopic improvement but not in corticosteroid-free clinical remission.
- N Engl J Med 2019; 381:1279-1281
Ulcerative colitis typically manifests in young adults in their 20s and 30s and can progress from mild asymptomatic rectal inflammation to debilitating extensive colitis resulting in frequent bloody stools, systemic symptoms, and colorectal cancer.1 Approximately one third of patients with distal ulcerative colitis at the time of diagnosis...