🫀 Fatigue in IBD: Where Are We With Pharmacological Treatments?

🔥 Main in 3 points:

• Modafinil, vedolizumab, and upadacitinib have shown reductions in fatigue symptoms in IBD patients.
• Vitamin B12 does not improve fatigue; high-dose thiamine may help, but evidence is mixed.
• Pharmacological options remain limited and more robust RCTs are needed.

🧪 Context:

Integrative review (10 studies, n=2935) assessing drug therapies for fatigue in IBD (Crohn’s disease & ulcerative colitis). Assessed published studies from 2017–2024 with a focus on fatigue as a primary endpoint.

📍 Practical significance:

No established drug therapy yet—consider off-label use of modafinil for disproportionate fatigue unresponsive to traditional approaches, but carefully screen for contraindications. For now, focus on optimal IBD control and address comorbid insomnia, depression, or anaemia as part of a holistic management approach.

🔗 Source — PubMed | Publisher

🫀 Postoperative Recurrence in Crohn’s Disease: What’s New in Risk and Management?

🧪 What was studied:

Narrative review of current data on postoperative recurrence (POR) in Crohn’s disease: rates, risk factors, monitoring, and efficacy of advanced therapies.

📈 Key results:

• Recurrence after ileocecal resection: 18.7% at 1y, 28% at 5y, 39.5% at 10y.
• Endoscopic recurrence in 22–53% within 18–36 months post-op.
• Risk factors: smoking, prior surgeries, penetrating/perianal disease, large small bowel involvement.
• Anti-TNFs and vedolizumab outperform conventional drugs in POR prevention; new options like JAK inhibitors, risankizumab, and ustekinumab show promise.
• Noninvasive tests (faecal calprotectin, US, MRE) may reduce endoscopy burden.

📍 What this changes in practice:

Emphasise individual risk stratification for POR in CD, incorporating noninvasive monitoring. Vedolizumab is an accepted advanced agent for prophylaxis in high-risk patients post-surgery, supported by evolving data. Regular surveillance and endoscopy-driven management remain key; emerging therapies could further personalise care.

🔗 Source — PubMed | Publisher

🧾 Liver Enzyme Changes in Pregnant IBD: When Should You Worry?

✅ Do

• Recognise that aminotransferases, γGT, and bilirubin tend to decrease during pregnancy; ALP may rise in the third trimester, mirroring healthy physiological patterns.

⚠️ With caution

• Minor enzyme fluctuations may occur with medications (e.g., vedolizumab, thiopurines, corticosteroids), but usually stay within reference ranges.

🚫 Avoid

• Attributing significant liver enzyme elevations during pregnancy in IBD to disease activity or drug toxicity without a targeted workup—these changes are seldom clinically meaningful.

🔗 Source — PubMed | Publisher