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INTRODUCTION: Perianal fistulizing disease in Crohn's disease (CD) is associated with a marked impairment in quality of life. Currently, there are no Spanish-validated disease-specific instruments available to assess this impact. The aim of this study was to cross-culturally adapt and perform an initial psychometric validation of the Crohn's Anal Fistula Quality of Life (CAF-QoL) scale in a Spanish-speaking population with CD and perianal fistulas. MATERIALS AND METHODS: The original questionnaire was translated and back-translated following international guidelines for cross-cultural adaptation. The Spanish version (Sp CAF-QoL) was then administered in a prospective cohort of patients with CD and perianal fistulas, together with four validated questionnaires assessing quality of life and disease activity. Internal consistency (Cronbach's alpha and McDonald's omega), test-retest reproducibility (Lin's concordance correlation coefficient and Bland-Altman analysis), and convergent validity (Pearson correlations) were evaluated. RESULTS: Of 178 patients contacted, 94 completed the questionnaire and 60 completed the test-retest assessment four weeks later. The scale showed excellent internal consistency (α = 0.971; ω = 0.947). Lin's concordance correlation coefficient for the global score was 0.812, indicating moderate-to-good reproducibility. Moderate correlations were observed with the IBDQ-9, HADS, and PROMIS instruments, confirming adequate convergent validity. CONCLUSIONS: The Sp CAF-QoL appears to be a valid and reproducible Spanish version of the CAF-QoL for initial use in clinical and research settings. However, multicenter validation studies are still required, as well as assessment of responsiveness to clinical change and determination of the minimal clinically important difference.

OBJECTIVES: Exclusive enteral nutrition (EEN) is the first-line treatment for pediatric Crohn's disease, but its mechanisms of action remain poorly understood. Our aim was to identify the mechanisms that could explain the anti-inflammatory effects of EEN, studying the nutritional composition and transforming growth factor-β (TGF-β) effects, in a mouse model of colitis. METHODS: Mice were treated with dextran sulfate sodium (DSS) to induce colitis. After DSS treatment, we compared two enteral nutrition formulas, and we evaluated the effect of TGF-β itself on clinical and microscopic inflammation, and intestinal permeability, by TGF-β-supplementation, -inhibition, or -deletion. Colonic crypts from DSS and EEN mice were cultured and their cellular properties were analyzed. RESULTS: Both EEN formulas improved weight recovery and disease activity index. In contrast, EEN mice treated with TGF-β formula presented faster weight recovery and decreased inflammatory parameters, with a normalized intestinal permeability, suggesting gut restitution and functionality. These functional improvements were not found in the absence of TGF-β in the formulas. Finally, organoids from colonic crypts treated with Modulen IBD® containing TGF-β showed enhanced survival and re-epithelialization capacity. CONCLUSIONS: Both EEN formulas have anti-inflammatory properties based on their nutritional composition. However, TGF-β plays a significant role in intestinal functional restitution.

BACKGROUND AND AIMS: Postoperative recurrence of Crohn's disease (CD) is common and may occur without symptoms. Ileocolonoscopy is the reference standard for detecting endoscopic recurrence, but its invasiveness limits repeated use. Intestinal ultrasound (IUS) is a non-invasive monitoring tool, although diagnostic criteria and ultrasound modalities vary across studies. We conducted a systematic review and diagnostic test accuracy meta-analysis to evaluate the performance of IUS for detecting postoperative recurrence. METHODS: PubMed/MEDLINE, EMBASE, Scopus, and the Cochrane Library were searched from inception to April 2025. Eligible studies evaluated IUS for postoperative recurrence in CD using ileocolonoscopy as the reference standard. Data were extracted to reconstruct independent 2 × 2 diagnostic tables. The primary synthesis used hierarchical bivariate binomial random-effects models to jointly estimate summary sensitivity and specificity. Heterogeneity was explored through subgroup analyses by ultrasound modality, Doppler use, contrast route, bowel wall thickness threshold, diagnostic definition, data collection period, and recurrence severity. RESULTS: Twelve studies were included in the systematic review and narrative synthesis; 11 provided reconstructable independent 2 × 2 data and were included in the bivariate meta-analysis. IUS showed high summary sensitivity of 87.6% (95% CI, 81.0%-92.1%; P < .001) and good summary specificity of 80.2% (95% CI, 60.6%-91.5%; P < .001). The false negative rate was 12.4% (95% CI, 7.9%-19.0%), the false positive rate was 19.8% (95% CI, 8.5%-39.4%), positive likelihood ratio was 4.436 (95% CI, 2.070-9.505), negative likelihood ratio was 0.154 (95% CI, 0.101-0.236), and diagnostic odds ratio was 28.8 (95% CI, 11.0-75.4). Diagnostic performance was generally consistent across studies, although differences in ultrasound protocols and bowel wall thickness thresholds, most commonly ≥3 or ≥5 mm, appeared to contribute to between-study variability. CONCLUSIONS: IUS shows high sensitivity and good specificity for postoperative recurrence surveillance in CD. Its interpretation should remain linked to ultrasound protocol, threshold, recurrence definition, and clinical context.

BACKGROUND & AIMS: Evidence for ustekinumab (UST) in pediatric inflammatory bowel disease (IBD) is limited, particularly in patients who do not respond to anti-tumor necrosis factor (anti-TNF) therapy. We conducted a meta-analysis to evaluate the efficacy and safety of UST in pediatric IBD after anti-TNF failure. METHODS: PubMed, Cochrane Library, Embase, and Web of Science were searched from inception through August 2025. We included studies reporting outcomes of UST in pediatric IBD patients with prior anti-TNF failure. Pooled estimates were calculated using fixed- or random-effects models according to heterogeneity (I2). RESULTS: Fifteen studies including 653 pediatric patients were analyzed. Pooled clinical remission rates were 57% (95% CI, 28%-86%) at 8-16 weeks and 68% (95% CI, 58%-79%) at week 52. Steroid-free clinical remission was 44% (95% CI, 38%-49%) at 8-16 weeks and 58% (95% CI, 45%-70%) at week 52. The pooled endoscopic remission rate was 42% (95% CI, 35%-49%) and a biochemical remission rate of 63% (95% CI, 40%-87%). Adverse events occurred in 20% of patients (95% CI, 9%-30%), and serious adverse events occurred in 1% (95% CI, 0%-2%). At week 52, clinical remission rates were 69% in Crohn's disease (CD) and 65% in ulcerative colitis (UC). CONCLUSION: In pediatric IBD patients with prior anti-TNF failure, UST was associated with favorable pooled remission rates and an acceptable safety profile, although substantial inter-study heterogeneity warrants cautious interpretation. These findings support UST as a feasible therapeutic option in this refractory pediatric setting; while highly generalizable to pediatric CD, the findings for the UC subgroup offer important preliminary evidence that warrants cautious interpretation due to limited precision.