Immune-mediated inflammatory diseases (IMIDs), including axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), Crohn's disease (CD), and ulcerative colitis (UC), share overlapping inflammatory pathways and frequently coexist, supporting the relevance of evaluating treatment safety across these conditions. Upadacitinib, a selective Janus kinase 1 inhibitor, is approved for multiple IMIDs; however, concerns regarding major adverse cardiovascular events (MACE) and venous thromboembolism (VTE) have emerged based on class-related safety signals. We conducted systematic review and meta-analysis of randomized controlled trials to assess the risk of MACE and VTE associated with upadacitinib compared with placebo or active comparators in patients with spondyloarthritis (SpA) and inflammatory bowel disease (IBD). A systematic search of PubMed, Embase, Cochrane Library, and ClinicalTrials.gov identified eligible trials. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Eight RCTs comprising 4,433 patients were included, of whom 2,868 received upadacitinib. Across studies, MACE and VTE events were rare in both treatment and control groups. Upadacitinib was not associated with an increased risk of MACE (RR 0.35; 95% CI 0.05-2.19; p = 0.259) or VTE (RR 0.31; 95% CI 0.04-2.55; p = 0.279) in patients with SpA and IBD, with no observed heterogeneity (I2 = 0%). However, the low number of events resulted in wide confidence intervals and limited precision, precluding definitive conclusions regarding cardiovascular and thromboembolic safety. Larger randomized controlled trials and long-term real-world studies are needed to further evaluate these outcomes.

Resveratrol (Res) is a plant polyphenol with diverse bioactivities, yet its application is limited by poor water solubility and low bioavailability. Therefore, an edible nanodelivery system composed of a zein/citric acid complex was developed to encapsulate Res@ZC-NPs showed high encapsulation efficiency, average particle size of 66.16 ± 1.19 nm and PDI of 0.176. In vitro, ZC-NPs inhibited oxidative stress-induced reactive oxygen species production and promoted cellular uptake. In vivo, the nanoparticles effectively delivered res to the colon, prolonged its retention, alleviate dextran sulfate sodium (DSS)-induced colitis in mice, preserve colonic tissue integrity, restore intestinal barrier function, and partially reshape gut microbiota composition. Overall, this study developed an oral nanosystem based on natural edible materials, providing an ideal delivery strategy for plant polyphenol-based active ingredients in treating ulcerative colitis.

Natural polysaccharides derived from Zingiber officinale (ZO) can alleviate ulcerative colitis (UC). In this study, a homogeneous glucan, ZOP-1a (250.39 kDa), was isolated from ZO and structurally characterized. ZOP-1a possessed an α-1,4-d-Glcp backbone, with branches substituted at H-6 by α-d-Glcp-(1 → 6)-α-d-Glcp-(1→ and at H-3 by α-d-Glcp-(1 → 3)-β-d-Glcp-(1→ and α-d-Glcpp-(1→ residues. In DSS-induced colitis mice, ZOP-1a markedly ameliorated colon injury, as reflected by improved body weight, colon length, and histopathological damage, inhibited NF-κB/MAPK signaling and reshaped gut microbiota dysbiosis, thereby restoring intestinal homeostasis. Moreover, ZOP-1a increased the abundance of short-chain fatty acid (SCFA)-producing bacteria, and in vitro Lactobacillus fermentation supported its potential contribution to SCFA generation. Fecal microbiota transplantation from ZOP-1a-treated colitis mice effectively alleviated UC symptoms in recipient mice. Overall, ZOP-1a may serve as a promising prebiotic candidate for maintaining intestinal homeostasis and preventing UC.

Anxiety disorders frequently emerge in contexts of chronic interpersonal stress and are often accompanied by disturbances in affect regulation and heightened sensitivity to bodily signals. In patients with chronic somatic conditions, these processes are commonly conceptualised within psychosomatic frameworks emphasising interactions between emotional regulation and stress-related bodily systems. Although psychotherapy may facilitate psychological adaptation, less is known about how dream processes reflect ongoing changes in affect regulation during treatment. The present study explores longitudinal changes in dream narratives during psychotherapy in a patient with anxiety and depressive symptoms in the context of ulcerative colitis. A qualitative, process-oriented longitudinal case study was conducted within analytically oriented psychotherapy with a 28-year-old patient. Over one year, the patient recorded dreams, from which five clinically significant dreams were selected. Dream reports were analysed alongside psychotherapy process notes and in-session associations using thematic analysis, informed by Jungian amplification. Three thematic constellations were identified: vulnerability and loss of control; threat perception and emotional overwhelm; and emerging control and agency. Early dreams reflected helplessness and heightened threat sensitivity, whereas later dreams increasingly depicted the dream-ego as capable of recognising danger and responding more adaptively. Findings suggest that dream processes may serve as indicators of changes in affect regulation and relational functioning, offering a process-sensitive window into psychotherapeutic change in psychosomatic contexts.

Inflammatory bowel diseases, encompassing Crohn's disease and ulcerative colitis, are chronic inflammatory disorders of the gastrointestinal tract. The recent expansion in advanced therapy options has not dramatically altered the ceiling of treatment efficacy. Therapeutic drug monitoring (TDM) of the serum drug levels and anti-drug antibodies has the potential to optimise treatment efficacy through dose adjustment. TDM has shown benefit with purine analogues and anti-tumour necrosis factor (TNF) therapy. Less is known about the role of TDM in non-anti-TNF advanced therapies. This review summarises the current evidence base for TDM in non-anti-TNF advanced therapies.

Ulcerative colitis (UC) demonstrates a bimodal incidence distribution, with a significant second peak and the highest prevalence observed in individuals aged ≥60 years. The pathogenesis of elderly UC involves immunosenescence-manifested by Th17/Treg imbalance and the accumulation of cells with a pro-inflammatory senescence-associated secretory phenotype (SASP)-alongside age-related dysbiosis, increased intestinal permeability, and mitochondrial dysfunction that impairs mucosal regeneration. Clinically, older patients more frequently present with left-sided colitis, characterized by anemia and weight loss, while abdominal pain is less common. Managing geriatric UC is challenging due to inadequate colonoscopy preparation and complex differential diagnosis (e.g., colorectal cancer, ischemic colitis). Furthermore, older adults face a fivefold increased risk of Clostridioides difficile infection and a sharply rising risk of colorectal cancer if diagnosed after 70 years of age. While 5-aminosalicylic acid remains the first-line therapy, it requires renal monitoring. Conversely, steroids increase infection and osteoporosis risks, thiopurines are restricted due to myelotoxicity and malignancy risks, and among biologics, vedolizumab offers better safety than anti-TNF agents. Ultimately, managing UC in older adults requires a comprehensive, multidisciplinary approach that accounts for multimorbidity, polypharmacy, nutritional status, and mental health to optimize pharmacotherapy and mitigate high-risk surgical interventions.

Collagenous colitis (CC) and ulcerative colitis (UC) are chronic inflammatory bowel diseases with distinct pathophysiological mechanisms and histological features. Their coexistence is exceptional and poses significant diagnostic and therapeutic challenges. We report the case of a 51-year-old asymptomatic woman who underwent colonoscopy after a positive faecal occult blood test, which revealed mild endoscopic changes. Serial biopsies from three colonic segments (ascending, transverse, and descending and sigmoid colon) demonstrated histological findings characteristic of active ulcerative colitis (architectural distortion, basal plasmacytosis, and crypt abscesses) coexisting with diagnostic criteria for collagenous colitis (a subepithelial collagen band measuring 15-23μm with capillary entrapment). Initial faecal calprotectin was 77.4mg/kg, rising to 1779mg/kg at three months, with subsequent normalisation (77mg/kg) following optimisation of mesalazine therapy. We review the most relevant literature on the synchronous or metachronous coexistence of these two conditions. This case underscores the importance of considering coexisting disease entities when faced with complex histological findings, even in the absence of significant symptoms.