Early diagnosis of Hepatitis C virus (HCV) infection is a cornerstone of elimination strategies. Fourth-generation antigen/antibody combination assays, such as Elecsys HCV Duo, promise to bridge the diagnostic gap left b...Early diagnosis of Hepatitis C virus (HCV) infection is a cornerstone of elimination strategies. Fourth-generation antigen/antibody combination assays, such as Elecsys HCV Duo, promise to bridge the diagnostic gap left by antibody-only testing. In this real-world study, we assessed Elecsys HCV Duo performance using seroconversion panels and routine clinical samples, focusing on sensitivity, specificity, and positive predictive value (PPV) for active HCV detection, including challenging scenarios with low viral loads and HIV co-infections. The assay shortened the serological window by up to 203 days. When both antigen and antibody were detected, PPV reached 100%, enabling confident diagnosis without immediate RNA confirmation. The antigen component alone achieved a PPV of 97.6%, even in a low-prevalence setting (0.33%), better than previously reported assays. However, sensitivity for low viral loads (≤ 5 log IU/mL) was limited, with 95.5% of such cases missed. Elecsys HCV Duo offers a powerful tool for earlier detection and streamlined care, particularly in high-risk and resource-limited contexts. Yet, confirmatory RNA testing remains essential for low viral load cases. Broader validation is needed to confirm its utility in diverse populations, reinfection surveillance, and cost-effective screening strategies.
Peutz-Jeghers Syndrome (PJS) is caused by germline pathogenic variants in the STK11 gene and is associated with elevated lifetime risks for several cancers, including lung cancer. Currently, no formal recommendations exi...Peutz-Jeghers Syndrome (PJS) is caused by germline pathogenic variants in the STK11 gene and is associated with elevated lifetime risks for several cancers, including lung cancer. Currently, no formal recommendations exist for lung cancer screening in PJS. This structured narrative review compares lung cancer risk in PJS with lung cancer risk in individuals currently eligible for screening based on age and smoking history. PubMed and Web of Science were searched from 1/1/1980 to 9/11/2023 using the terms "Peutz-Jeghers Syndrome" AND "Cancer." Studies reporting lung cancer risk in PJS were included. Reported lung cancer risks were compared to 5-year, 10-year, and lifetime lung cancer risks in the general population based on age and pack-years of smoking. Seventeen studies were included. Across the studies, the incidence of lung cancer ranged from 0.8 to 13.3%. Studies that included lung cancer risk relative to the general population reported a relative risk range of 2.9-22.9. Cumulative risk was reported in 5 studies and surpassed 5% by age 60 (range 7 to 17%). Guidelines for low-dose CT (LDCT) lung cancer screening for individuals aged 50-80 with a smoking history of at least 20 pack-years are associated with a similar or higher threshold for lung cancer risk. The lifetime lung cancer risk for individuals with PJS is similar to current guideline-based risk thresholds for screening based on age and smoking status. Given their elevated lifetime risk, individuals with PJS may be candidates for LDCT for lung cancer screening and should be formally studied to elucidate the risks, benefits, and optimal implementation in this patient population.
Li F, Li H, Juramt D
… +3 more, Kou K, Tacke F, Chen L
BMJ Open Gastroenterol
· 2026 Jul · PMID 42392673
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Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most prevalent chronic liver disease worldwide and is tightly linked to cardiometabolic comorbidities. A major clinical focus on MASLD is th...Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most prevalent chronic liver disease worldwide and is tightly linked to cardiometabolic comorbidities. A major clinical focus on MASLD is the detection of hepatic fibrosis, which most strongly predicts liver-related events, hepatocellular carcinoma risk and mortality. While lifestyle modification and sustained weight loss remain foundational, therapeutic innovation has rapidly expanded, shifting the metabolic dysfunction-associated steatohepatitis (MASH) treatment landscape towards targeted pharmacotherapies that address metabolic stress, inflammation and fibrogenesis, particularly for moderate/advanced fibrosis (, F2/F3 fibrosis and cirrhosis). This review summarises the burden and systemic complications of MASLD, highlights endocrine influences that modulate hepatic steatosis and disease severity and emphasises the central role of fibrosis staging and non-invasive risk stratification in clinical decision-making. We then synthesise emerging pharmacotherapies across key mechanistic axes, including incretin-based agents (GLP-1 receptor agonists and dual/triple agonists), hepatocyte-directed metabolic modulators (thyroid hormone receptor-β agonists, fatty acid synthase inhibitors, acetyl-CoA carboxylase and other de novo lipogenesis inhibitors), bile acid pathway therapies (FXR agonists) and pleiotropic metabolic-fibrotic regulators (fibroblast growth factor 21 [FGF21] analogues and peroxisome proliferator-activated receptor [PPAR] agonists). We also discuss combination strategies, candidate agents with potential direct antifibrotic activity and the growing role of genetic risk stratification and hepatocyte-targeted oligonucleotide therapeutics. Finally, we outline current surrogate endpoints used in clinical trials and propose future directions towards stage-specific, mechanism-informed and combination regimens to achieve persistent MASH resolution and meaningful fibrosis regression.
Peyrin-Biroulet L, Kubassova O, Himoff J
… +18 more, Weber CR, Adsul S, Freire M, Hussaini BE, Biedermann L, Koelzer VH, Bressler B, Xiong W, Niess JH, Matter MS, Kopylov U, Barshack I, Mayer C, Magro F, Carneiro F, Maharshak N, Greenberg A, Rubin DT
United European Gastroenterol J
· 2026 Jul · PMID 42390952
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BACKGROUND: Histological assessment of mucosal biopsies in patients with ulcerative colitis (UC) can determine the activity and extent of disease and assess response to treatment. However, its widespread adoption is limi...BACKGROUND: Histological assessment of mucosal biopsies in patients with ulcerative colitis (UC) can determine the activity and extent of disease and assess response to treatment. However, its widespread adoption is limited by the time required for the advanced GI specialty training to handle and review histopathology digital images, inter- and intra-observer variability, and cost associated with the interpretation of data. Artificial intelligence, and specifically machine learning‒driven medical image processing, have emerged to help standardise and automate histopathologic assessments. METHODS: In this global study conducted with participation of 38 sites in 19 countries (global roll-out phase), we collected histopathologic slides prepared from biopsy samples from patients with UC to train an AI model to recognise various cell types and assign a disease activity score based on the Nancy histological index (NHI). Results were compared with findings from a previous iteration of the machine learning model (pilot roll-out phase). RESULTS: In total, 850 tiles were analysed and used for training, validation, and testing. Model quality, assessed using the Nancy metric, improved from 61.50% in the pilot roll-out phase to 74.82% in the current global roll-out phase. Cell detection quality (F1-score metric) also increased from 27.50% (pilot roll-out) to 58.80% (global roll-out). CONCLUSIONS: In this global roll-out, the quality of the AI model was significantly improved for both NHI scores and cell detection. Further development and implementation of the model at the participating international sites continues and may lead to a valuable and scalable tool for the analysis of disease activity in UC.
Yasuda T, Matsubayashi J, Ishikawa H
… +1 more, Takizawa K
BMJ Open Gastroenterol
· 2026 Jul · PMID 42386351
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INTRODUCTION: Early gastric cancer is characterised by subtle mucosal and colour changes that frequently lead to missed lesions during routine endoscopy, making detection difficult. Indigo carmine spraying is a classical...INTRODUCTION: Early gastric cancer is characterised by subtle mucosal and colour changes that frequently lead to missed lesions during routine endoscopy, making detection difficult. Indigo carmine spraying is a classical chromoendoscopic method to enhance mucosal surface irregularities and has been believed to have the potential to facilitate the detection of early gastric neoplasia. This method is widely used in Japan; however, whether it improves gastric neoplasm detection remains unclear. In this prospective study, we aim to evaluate the usefulness of indigo carmine spraying for detecting gastric cancer and gastric adenoma during upper gastrointestinal endoscopy in patients at high risk of gastric cancer. METHODS AND ANALYSIS: This prospective multicentre observational study will include over 30 institutions. Patients undergoing upper gastrointestinal endoscopy for surveillance after endoscopic treatment or pretreatment screening will be enrolled. The age range has been set from 20 years to 95 years, and patients for whom a biopsy will not be feasible will be excluded. Gastric observation will consist of two steps: the first will use white light imaging, followed by a second-pass observation after spraying 20-40 mL of indigo carmine at a concentration of 0.1-0.4%. The primary endpoint will be the proportion of patients with gastric cancer or adenoma lesions detected during the second-pass observation among those who undergo successful indigo carmine examination. A one-sided binomial test (α=0.05) will be used to compare the detection rate with a predefined threshold of 1.0%. We aim to enrol a total of 1050 patients to achieve 80% power. ETHICS AND DISSEMINATION: This study was approved by the Institutional Review Board of Kanagawa Cancer Center (approval number: 2025-92). Written informed consent will be obtained at the time of registration. Following completion of this research, the findings will be promptly compiled and published in appropriate academic conferences and peer-reviewed international journals. TRIAL REGISTRATION NUMBER: UMIN000059685.
BACKGROUND & AIMS: Patients with liver cirrhosis exhibit increased susceptibility to bacterial infections; however, the specific immune defects facilitating this vulnerability remain incompletely understood. We aimed to...BACKGROUND & AIMS: Patients with liver cirrhosis exhibit increased susceptibility to bacterial infections; however, the specific immune defects facilitating this vulnerability remain incompletely understood. We aimed to characterize the dysregulated intercellular crosstalk within the cirrhotic liver that compromises antibacterial defense. METHODS: We performed single-cell RNA sequencing (scRNA-seq) on livers from control and cirrhotic mice with or without bacterial infection. Inferred cellular interactions were validated using flow cytometry, targeted metabolomics, and functional assays, including ex vivo co-culture, in vivo adoptive transfer, antibody blockade, and transgenic mouse models. Clinical relevance and mechanistic conservation were established utilizing human bulk and single-cell transcriptomic datasets from GEO, alongside validation in a nationwide multicenter prospective clinical cohort (CATCH-LIFE). RESULTS: scRNA-seq and functional assays revealed a significantly depleted CD44 plasmacytoid dendritic cells (pDCs) subpopulation responsible for impaired antibacterial immunity in cirrhosis. Mechanistically, CD44pDCs do not kill bacteria directly; rather, they sense pathogens via TLR7/9 to secrete type I IFN-α, which subsequently stimulates macrophage chemotaxis, reactive oxygen species (ROS) production, and bacterial phagocytosis. The hepatic recruitment of CD44pDCs is governed by the CCL5-CCR5 axis, orchestrated by a specific subset of CCL5-associated hepatocytes (marked by Mup11 in mice). Targeted metabolomics identified that anserine, a histidine metabolite depleted in cirrhosis, intrinsically upregulates hepatocyte CCL5 expression. Anserine supplementation successfully restored the hepatocyte-pDC protective axis, significantly reducing bacterial burden and mortality in cirrhotic mice. Finally, multi-omics human data and the CATCH-LIFE cohort demonstrated that levels of CCL5, anserine, and CD44 pDCs were significantly correlated with infection incidence and clinical outcomes in patients with cirrhosis. CONCLUSION: We uncover a novel anserine-CCL5-pDC-macrophage metabolic-immune axis that is critically impaired in cirrhosis. Restoring this network offers a promising predictive and therapeutic strategy for cirrhosis-associated infections. IMPACT AND IMPLICATIONS: Patients with cirrhosis face a critically high risk of bacterial infections, yet the specific immune defects driving this susceptibility have remained elusive. This study uncovers a novel metabolic-immune mechanism wherein the histamine metabolite anserine potentiates a protective crosstalk between hepatocytes and CD44 plasmacytoid dendritic cells (pDCs). We demonstrate that this axis relies on conserved CCL5-CCR5 signaling to recruit pDCs, which subsequently orchestrate bacterial clearance via TLR7/9-mediated IFN-α secretion and macrophage activation. Importantly, these findings were validated in a multi-center prospective human cohort, showing that anserine, CCL5 and CD44 pDCs levels significantly correlate with infection incidence and clinical outcome. This uncovers a previously unrecognized metabolic-immune vulnerability in cirrhosis and suggests that anserine supplementation or targeting the CCL5-pDC axis could serve as a precision therapy to decrease infection-related mortality in cirrhosis.
Yi X, Meng C, Zhang H
… +17 more, Lu Q, Zhang K, Li X, Huang H, Jiang J, Lin Y, Xing M, Chen H, Kong G, Zhang X, Xu Y, Fang J, Zheng S, Li H, Li H, Gu Z, Ling Q
BACKGROUND & AIMS: Immune-inflammatory cascade is a dominant process mediating allograft inflammatory injury and rejection, thereby threatening the survival of both allografts and recipients. However, the primary driver...BACKGROUND & AIMS: Immune-inflammatory cascade is a dominant process mediating allograft inflammatory injury and rejection, thereby threatening the survival of both allografts and recipients. However, the primary driver of this progression remains unclear, and targeted intervention remains a critical challenge in the development of effective treatments. METHODS: Bulk RNA sequencing (RNA-seq) and single-cell RNA-seq (scRNA-seq) analyses were employed to elucidate the key mechanisms underlying allograft inflammatory injury and rejection. Subsequently, a platelet-based drug delivery platform was developed to mitigate its progression. RESULTS: Chemokine C-C motif ligand 2 (CCL2) was identified as a key molecule involved in early allograft dysfunction in clinical cohorts. CCL2 was sustainedly expressed in monocytes during the first post-transplant week, which mediated monocyte infiltration, leading to inflammatory injury and the subsequent rejection through cellular crosstalk with adaptive immune cells. Platelets could accumulate into allograft and exhibited excellent delivery efficiency. A platelet-based delivery system was engineered to interrupt CCL2-CCR2 signaling. Specifically, anti-CCL2 antibodies were covalently conjugated to the surface of platelets (PLT-aCCL2). In both ischemia reperfusion injury and orthotopic liver transplantation models, a single intravenous dose of PLT-aCCL2 attenuated CCR2 monocyte infiltration, thereby suppressing liver inflammatory injury and subsequently alleviating acute allograft rejection. scRNA-seq revealed that PLT-aCCL2 reconfigured the immune landscape of liver allograft by disrupting myeloid-T cell crosstalk. CONCLUSIONS: CCL2-CCR2 signaling is a key driver of early inflammatory injury and a critical linker bridging this process with subsequent cellular rejection. The anti-CCL2 conjugated platelets, with high drug loading efficiency, biocompatibility, and allograft-targeting capability, offers a promising therapeutic strategy for protecting liver allograft. IMPACT AND IMPLICATIONS: This study demonstrated that CCL2, dynamically interacting with CCR2 monocytes, serves as a key molecule in driving acute inflammatory injury and exacerbating subsequent cellular rejection, supported by multi-omics data from both clinical liver transplantation (LT) and an orthotopic LT mouse model. For the first time, this study reported that platelets directed anti-CCL2 antibodies to the liver allograft, disrupting the immune-inflammatory cascade driven by the CCL2-CCR2 monocyte signaling pathway, thereby protecting liver function during acute inflammation. This study also proved that PLT-aCCL2 could also alleviate acute cellular rejection via diminishing the interactions between myeloid cells and T cells, particularly between the monocytes and CD8 cytotoxic T cells.
Globus sensation is a common presenting symptom encountered by primary care physicians, otolaryngologists, and gastroenterologists. Although common, it can have a significant impact on quality of life and is often diffic...Globus sensation is a common presenting symptom encountered by primary care physicians, otolaryngologists, and gastroenterologists. Although common, it can have a significant impact on quality of life and is often difficult to treat, given lack of a standardized approach to diagnosis and management. In this concise review, we outline the various causes that may contribute to globus sensation, encompassing sinonasal processes such as post-nasal drip, esophageal conditions including laryngopharyngeal and gastroesophageal reflux, and psychological factors as well as structural abnormalities, among others. We also provide a framework on how to approach diagnosis and management of this symptom, which frequently requires multidisciplinary care between otolaryngologists and gastroenterologists. Patients with globus sensation and typical sinonasal symptoms may be empirically trialed on topical nasal sprays. Similarly, in patients with globus sensation and heartburn or regurgitation, a trial of acid suppression medications may be considered. In patients with globus sensation and alarm symptoms, urgent nasolaryngoscopy and endoscopy should be pursued. In patients with isolated globus sensation, work-up often entails nasolaryngoscopy followed by endoscopy. In these patients with a negative initial work-up, we highlight important considerations for when to consider empirical therapy vs when to pursue additional diagnostic testing, which is guided by the clinical context, severity of the patient's symptoms and impact on quality of life, and shared decision-making.
BACKGROUND & AIMS: We evaluated impact of hepatitis C treatment adherence support among people who inject drugs (PWID) in India using a precision trial design. METHODS: Treatment naïve participants with a history of drug...BACKGROUND & AIMS: We evaluated impact of hepatitis C treatment adherence support among people who inject drugs (PWID) in India using a precision trial design. METHODS: Treatment naïve participants with a history of drug injection were recruited from community-based clinics across 7 cities. All received sofosbuvir/velpatasvir once/day for 12 weeks. Failure risk was defined a priori using a prognostic score including age, sex, income, homelessness, injection frequency, depressive symptoms, quality of life indicators and sexual partners. Elevated risk were randomized 3:2:1 to high (patient navigation [PN]+flexible directly observed therapy [≥1 dose/week observed]), medium (PN contact ≥every 2 weeks) or low intensity support. Minimal risk were randomized 1:2:3 to high, medium and low intensity support. Primary outcome was sustained virologic response (SVR; HCV RNA <LLOQ 24 weeks post-randomization; intention to treat). RESULTS: 3000 were randomized (1/2021-12/2022; 2048 minimal, 952 elevated risk), 2798 (93.3%) completed SVR assessment. In minimal risk participants, SVR was 62.6%, 60.8% and 68.3% in low, medium and high intensity support, respectively. In elevated risk participants, SVR was 48.4%, 45.5% and 50.8%. 51 experienced a serious adverse event (35 deaths). In minimal risk participants, we observed superiority of high intensity (adjusted relative risk vs. low [aRR] 1.09; 95% confidence interval [CI]: 1.00-1.19; p=0.04) not medium intensity (aRR 0.97; 95% CI: 0.90-1.05) support. In elevated risk participants, there was no impact (low vs. high 0.96; 95% CI: 0.80-1.15; medium vs. high 0.89; 95% CI: 0.77-1.04). Every 10% decrease in prognostic score was associated with 1.06 increase in SVR (95% CI: 1.04-1.08). CONCLUSIONS: Prognostic scores could help target interventions more efficiently; greater adherence support and/or novel interventions are needed to improve SVR for the highest risk. CLINICAL TRIAL NUMBER: ClinicalTrials.gov NCT04652804. IMPACT AND IMPLICATIONS: This trial represents one of the largest trials to date of hepatitis C treatment. Our results, which demonstrate limited impact of adherence support interventions and sub-optimal sustained virologic response (SVR) among community-based people who inject drugs (PWID), suggest that more intensive or different tools and or strategies will be needed to support HCV elimination in populations like PWID. At the same time, these results provide strong evidence for the use of prognostic scores in trials as well as potentially in the delivery of interventions particularly when resources are scarce.
Aby ES, Hundt M, Rice J
… +31 more, Kriss M, Zhou K, Nephew L, Lieber SR, Noriega Ramirez A, Fortune BE, Tow C, Mejia P, Devuni D, Krisharao A, Rogal S, Noll A, Celaj S, Cortez Bazan N, Jones P, Shroff H, Hunt K, Mazhar A, Hughes D, Henson JB, King LY, Leventhal TM, Zhu E, Bizup G, Li L, Armstrong M, Dalvi A, Nurhussien L, Horick N, Zeng C, Ufere NN
Hepatol Commun
· 2026 Jul · PMID 42372189
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BACKGROUND: The financial impact of chronic liver disease among adults undergoing liver transplant (LT) evaluation remains understudied. We performed a cross-sectional multicenter study to explore high financial burden,...BACKGROUND: The financial impact of chronic liver disease among adults undergoing liver transplant (LT) evaluation remains understudied. We performed a cross-sectional multicenter study to explore high financial burden, defined as medical out-of-pocket expenses ≥10% of income (per prior literature), among adult LT candidates. We aimed to identify associations between high financial burden and (1) work productivity impairment; (2) financial distress (material, behavioral, and psychological consequences of financial burden); (3) financial toxicity (health-related quality of life, HRQOL). METHODS: From May 2023 to April 2024, 453 patients from 13 United States transplant centers were included. Patients completed questionnaires assessing financial burden, financial distress, financial toxicity (EuroQol EQ-5D-5L instrument), and work productivity and impairment (Work Productivity and Activity Impairment Questionnaire: Specific Health Problem Version). RESULTS: Among LT candidates, 23.3% reported a high financial burden, and only 27.6% were employed. High financial burden was associated with a higher rate of absenteeism from work (34.1% vs. 16.9%, p=0.018) among employed participants. In adjusted models, high financial burden was significantly associated with inability to pay for basic necessities (aOR 4.76, 95% CI: 2.34-9.67), delayed or foregone medical care (aOR 4.02, 95% CI: 2.30-7.02), and psychological distress (aOR 4.63, 95% CI: 1.95-10.98) but was not associated with HRQOL (EQ-5D β: -0.04, 95% CI: -0.08 to 0.00; EQ-5D-VAS β: -4.53, 95% CI: -10.1 to 1.02). CONCLUSION: These results highlight the critical importance of implementing routine screening for financial burden in this high-risk population and developing strategies to mitigate associated adverse outcomes.
Acute kidney injury (AKI) and chronic kidney disease (CKD) are common conditions among patients with cirrhosis whose development is associated with increased morbidity and mortality. Recurrent episodes of AKI within this...Acute kidney injury (AKI) and chronic kidney disease (CKD) are common conditions among patients with cirrhosis whose development is associated with increased morbidity and mortality. Recurrent episodes of AKI within this population can ultimately lead to CKD, while patients with underlying CKD are in turn more likely to experience AKI. Determining the etiology of kidney dysfunction in the setting of cirrhosis is often challenging given the considerable limitations of currently available diagnostic tools. Ongoing research into the role of novel serum and urine biomarkers may allow for more timely diagnosis and treatment of kidney injury among patients with cirrhosis. This review provides an overview of kidney dysfunction in cirrhosis with a focus on the role of these emerging biomarkers for diagnosis of AKI and CKD.
Gheorghe C, Iacob R, Mateescu B
… +25 more, Topala M, Stroie T, Meianu C, State M, Anghel MC, Trifan A, Negreanu L, Cijeschi-Prelipcean C, Seicean A, Pop C, Dumitru E, Dobru D, Goldis A, Tieraru CG, Saftoiu A, Brisc C, Jinga M, Drug V, Bataga S, Gheonea D, Grad S, Dumitrascu D, Tantau A, Gheorghe L, Diculescu M
BACKGROUND AND AIMS: Inflammatory bowel diseases (IBD), including Crohn's disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U), are increasingly recognized across Eastern Europe, including Romania, where h...BACKGROUND AND AIMS: Inflammatory bowel diseases (IBD), including Crohn's disease (CD), ulcerative colitis (UC), and IBD-unclassified (IBD-U), are increasingly recognized across Eastern Europe, including Romania, where historical data indicated low incidence. Contemporary real-time epidemiological data for our country are scarce. This study evaluated the short-term frequency and epidemiological characteristics of IBD patients presenting to major Romanian gastroenterology centers. METHODS: We conducted a prospective, cross-sectional observational study over a 14-day period in November 2024 across 18 university-affiliated tertiary gastroenterology clinical sites in Romania. All consecutive adult patients with confirmed IBD were enrolled using a centralized online platform. Demographics, disease type and phenotype, severity, and treatment were recorded and analyzed descriptively. RESULTS: A total of 1,045 patients were registered: 52.4% CD, 46.9% UC, and 0.7% IBD-U. Geographical distribution revealed a statistically significant variation, with Crohn's disease being more frequent in Southern Romania, while UC predominated in the Eastern and Central-western regions (p=0.0009). Most patients resided in urban areas, and the majority were in clinical remission at presentation. Phenotypic analysis revealed ileocolonic CD (L3) and left-sided/pancolitis UC (E2/E3) as most frequent. Severe disease history was more common in CD, and prior surgery was significantly higher in CD than UC. Smoking and appendectomy were more frequently associated with CD as previously reported. Therapeutic patterns reflected disease type: anti-TNF use predominated in CD, while other biologics and small molecules were more common in UC. Regional differences in therapy were observed, with southern centers showing higher use of novel therapies, likely reflecting a more mature IBD population, with a higher CD prevalence. Notably, the number of IBD diagnoses increased over time, correlating with Romania's GDP growth (R² = 0.89, p < 0.001), suggesting that socioeconomic factors may influence disease recognition and diagnosis. CONCLUSIONS: This study offers the most recent snapshot of IBD epidemiology in Romania, highlighting a transition toward medium-incidence patterns and growing clinical complexity. These findings provide evidence for the need to establish nationwide population-based surveillance systems and healthcare planning initiatives aimed at mitigating the rising burden of IBD.