{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T06:03:53Z","timestamp":1767420233535,"version":"3.48.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"McMaster University AFP Clinician Researcher"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Ulcerative colitis (UC) is a chronic inflammatory disease of the colonic mucosa, extending proximally from the rectum. However, the segmental pattern of healing in UC remains unclear. Endoscopic improvement (EI), a key therapeutic endpoint, is typically assessed using the Mayo endoscopic score (MES), which scores the worst affected area and may miss partial\/segmental healing. This study evaluates healing patterns in UC and compares conventional MES with a 3-segment MES approach for detecting treatment effects in clinical trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A post hoc analysis of HIBISCUS I\/II and GARDENIA trials was conducted in UC patients with moderate-to-severe disease (MES &amp;gt;2 up to the descending colon). The primary outcome was the proportion of anti-tumor necrosis factor\u2013treated participants achieving MES \u22641 in the descending colon, sigmoid colon, and rectum at week 10. Secondary outcomes included conventionally measured EI, segmental MES improvements, clinical response, and Patient-Reported Outcome 2 (PRO2) normalization. Outcomes were compared between adalimumab, infliximab, and placebo groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 300 participants, 217 received infliximab or adalimumab, while 83 received placebo. Healing followed a proximal-to-distal pattern, with the highest EI in the descending colon and the lowest in the rectum. Infliximab-treated patients continued this trend at week 54. Anti-tumor necrosis factor therapy significantly improved EI vs placebo (42.9% vs 19.3%; P\u2009&amp;lt;\u2009.001). No segmental MES approach outperformed conventional MES for detecting treatment effects. Combined endpoints (MES \u22641\u2009+\u2009PRO2 normalization) better captured therapeutic benefits than PRO2 alone (28.6% vs 13.3%; P\u2009=\u2009.006).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>UC healing follows a proximal-to-distal pattern. Conventional MES remains superior for detecting treatment effects over segmental MES. Further studies should explore alternative endoscopic scoring methodologies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ibd\/izaf199","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T11:38:18Z","timestamp":1754393898000},"page":"87-96","source":"Crossref","is-referenced-by-count":0,"title":["Anti-TNF Therapies Promote a Proximal-to-Distal Healing Pattern in Moderate-to-Severe Ulcerative Colitis"],"prefix":"10.1093","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9472-201X","authenticated-orcid":false,"given":"Emily C L","family":"Wong","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University , Hamilton, ON,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Parambir S","family":"Dulai","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Northwestern University , Chicago, IL,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John K","family":"Marshall","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University , Hamilton, ON,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vipul","family":"Jairath","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine, Western University , London, ON,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2088-091X","authenticated-orcid":false,"given":"Walter","family":"Reinisch","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna , Vienna,","place":["Austria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1536-8436","authenticated-orcid":false,"given":"Neeraj","family":"Narula","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University , Hamilton, ON,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,9,25]]},"reference":[{"key":"2026010301014295200_izaf199-B1","doi-asserted-by":"crossref","first-page":"100851","DOI":"10.1016\/j.disamonth.2019.02.004","article-title":"A comprehensive review and update on ulcerative colitis","volume":"65","author":"Gajendran","year":"2019","journal-title":"Dis Mon"},{"key":"2026010301014295200_izaf199-B2","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1053\/j.gastro.2006.12.038","article-title":"A review of activity indices and efficacy end points for clinical trials of medical therapy in adults with ulcerative colitis","volume":"132","author":"D\u2019Haens","year":"2007","journal-title":"Gastroenterology"},{"key":"2026010301014295200_izaf199-B3","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.cgh.2010.12.028","article-title":"Mucosal healing predicts late outcomes after the first course of corticosteroids for newly diagnosed ulcerative colitis","volume":"9","author":"Ardizzone","year":"2011","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2026010301014295200_izaf199-B4","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1093\/ecco-jcc\/jjv111","article-title":"The Modified Mayo Endoscopic Score (MMES): a new index for the assessment of extension and severity of endoscopic activity in ulcerative colitis patients","volume":"9","author":"Lobat\u00f3n","year":"2015","journal-title":"J Crohns Colitis"},{"key":"2026010301014295200_izaf199-B5","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1093\/ecco-jcc\/jjv210","article-title":"The ulcerative colitis endoscopic index of severity more accurately reflects clinical outcomes and long-term prognosis than the mayo endoscopic score","volume":"10","author":"Ikeya","year":"2016","journal-title":"J Crohns Colitis"},{"key":"2026010301014295200_izaf199-B6","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1053\/j.gastro.2020.01.006","article-title":"AGA Clinical practice guidelines on the management of moderate to severe ulcerative colitis","volume":"158","author":"Feuerstein","year":"2020","journal-title":"Gastroenterology"},{"key":"2026010301014295200_izaf199-B7","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1038\/ajg.2015.233","article-title":"Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE): determining therapeutic goals for Treat-to-Target","volume":"110","author":"Peyrin-Biroulet","year":"2015","journal-title":"Am J Gastroenterol"},{"key":"2026010301014295200_izaf199-B8","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s12876-022-02157-5","article-title":"Systematic review and meta-analysis: the advantage of endoscopic Mayo score 0 over 1 in patients with ulcerative colitis","volume":"22","author":"Viscido","year":"2022","journal-title":"BMC Gastroenterol"},{"key":"2026010301014295200_izaf199-B9","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1093\/ecco-jcc\/jjac120","article-title":"Time to endorse a sensitive method for scoring endoscopic activity of ulcerative colitis in clinical research","volume":"17","author":"Narula","year":"2023","journal-title":"J Crohns Colitis"},{"key":"2026010301014295200_izaf199-B10","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1053\/j.gastro.2023.09.049","article-title":"Using computer vision to improve endoscopic disease quantification in therapeutic clinical trials of ulcerative colitis","volume":"166","author":"Stidham","year":"2024","journal-title":"Gastroenterology"},{"key":"2026010301014295200_izaf199-B11","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/S2468-1253(21)00294-6","article-title":"Etrolizumab versus infliximab for the treatment of moderately to severely active ulcerative colitis (GARDENIA): a randomised, double-blind, double-dummy, phase 3 study","volume":"7","author":"Danese","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2026010301014295200_izaf199-B12","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S2468-1253(21)00338-1","article-title":"Etrolizumab versus adalimumab or placebo as induction therapy for moderately to severely active ulcerative colitis (HIBISCUS): two phase 3 randomised, controlled trials","volume":"7","author":"Rubin","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2026010301014295200_izaf199-B13","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1111\/apt.17753","article-title":"The assessment of segmental healing by the Modified Mayo Endoscopic Score (MMES) complements the prediction of long-term clinical outcomes in patients with ulcerative colitis","volume":"59","author":"Lenfant","year":"2024","journal-title":"Aliment Pharmacol Ther"},{"key":"2026010301014295200_izaf199-B14","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1111\/apt.14063","article-title":"Systematic review with meta-analysis: proximal disease extension in limited ulcerative colitis","volume":"45","author":"Roda","year":"2017","journal-title":"Aliment Pharmacol Ther"},{"key":"2026010301014295200_izaf199-B15","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1016\/j.cgh.2022.08.015","article-title":"Predictors of placebo induction response and remission in ulcerative colitis","volume":"21","author":"Wong","year":"2023","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2026010301014295200_izaf199-B16","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1136\/gutjnl-2011-300486","article-title":"Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS)","volume":"61","author":"Travis","year":"2012","journal-title":"Gut"},{"key":"2026010301014295200_izaf199-B17","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1002\/ibd.21480","article-title":"Measurement of disease activity in ulcerative colitis: interobserver agreement and predictors of severity","volume":"17","author":"Thia","year":"2011","journal-title":"Inflamm Bowel Dis"},{"key":"2026010301014295200_izaf199-B18","doi-asserted-by":"crossref","first-page":"otad076","DOI":"10.1093\/crocol\/otad076","article-title":"Clinical trial design in ulcerative colitis: interpreting evolving endpoints based on post hoc analyses of the vedolizumab phase 3 trials GEMINI 1 and VISIBLE 1","volume":"6","author":"Sandborn","year":"2024","journal-title":"Crohns Colitis 360"},{"key":"2026010301014295200_izaf199-B19","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1093\/ecco-jcc\/jjaa068","article-title":"Segmental histological normalisation occurs in ulcerative colitis but does not improve clinical outcomes","volume":"14","author":"Christensen","year":"2020","journal-title":"J Crohns Colitis"}],"container-title":["Inflammatory Bowel Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ibdjournal\/article-pdf\/32\/1\/87\/64395912\/izaf199.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ibdjournal\/article-pdf\/32\/1\/87\/64395912\/izaf199.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T06:01:51Z","timestamp":1767420111000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ibdjournal\/article\/32\/1\/87\/8264002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,25]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,9,25]]},"published-print":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ibd\/izaf199","relation":{},"ISSN":["1078-0998","1536-4844"],"issn-type":[{"type":"print","value":"1078-0998"},{"type":"electronic","value":"1536-4844"}],"subject":[],"published-other":{"date-parts":[[2026,1]]},"published":{"date-parts":[[2025,9,25]]}}}