Biologics Heal Proximal and Distal Small-Bowel Crohn’s Disease Comparably: CGH | October 2026

What Did the Study Find?

Investigators pooled three prospective cohorts of 99 patients starting or optimising biologic therapy, with capsule endoscopy at baseline, after induction at 14–26 weeks and at one year. Treatment comprised anti-TNF therapy in 53 patients, vedolizumab in 43 and ustekinumab in only three; 82 completed post-induction imaging and 59 completed one-year assessment.

Using a Lewis score ≥135, proximal small-bowel inflammation declined from 63% at baseline to 44% after induction and 41% at one year. Distal inflammation fell from 95% to 78% and 71%, respectively. The degree of mucosal healing did not differ significantly by location: risk difference 7% after induction and 0% at one year. With the more stringent Lewis-score threshold of 350, distal inflammation decreased from 76% to 19% at one year and proximal inflammation from 38% to 19%. pubmed.ncbi.nlm.nih.gov

Why Does It Matter?

Proximal disease is associated with poorer outcomes and may be missed by ileocolonoscopy. These findings argue against assuming that currently used biologics inherently heal distal disease better. However, treatment was not randomised, attrition was substantial, and the study cannot compare individual biologic classes.

GastroAGI Takeaway

Biologic response appears geographically consistent across the small bowel—but capsule or cross-sectional assessment remains important because substantial inflammation persisted at one year.