This comparison chart features two endoscopic images of the ileal mucosa, illustrating the visual progression of inflammatory bowel disease (IBD) treatment. Image (a) depicts the initial ileoscopy, showing severe mucosal inflammation characterized by intense erythema, edema, and a friable texture. Spontaneous bleeding and loss of normal vascular patterns are evident, consistent with active pan-enteritis or ulcerative colitis. In contrast, image (b) shows a follow-up ileoscopy after five months of vedolizumab therapy. This image demonstrates significant endoscopic healing, with the mucosa appearing healthy and pale pink with visible, normal vascular architecture and an absence of friability, edema, or spontaneous bleeding. These diagnostic images serve as an educational comparison of active disease versus therapeutic remission in a clinical gastroenterology context, highlighting the efficacy of biologic therapy in restoring mucosal integrity.

Summary : This figure provides a color-coded practical guidance matrix for the choice and optimization of medical therapy in various clinical scenarios, specifically for inflammatory bowel disease (IBD) and related conditions. It categorizes different drugs and interventions by their appropriateness (recommended, can be considered, not recommended, insufficient evidence) across treatment phases and patient groups. heat-map: Title & Axes : • No explicit title, but the guidance is for "choice and optimisation of medical therapy" in IBD. • Columns (top, left to right): Induction, Maintenance, Perianal disease, Peripheral Spondyloarthropathy, Axial Spondyloarthropathy, Pregnancy, Over 65 years. • Rows (left, top to bottom): Systemic corticosteroids, Enteral release corticosteroids, Enteral Nutrition, Thiopurines monotherapy, Methotrexate, Infliximab, Adalimumab, Certolizumab, Vedolizumab, Ustekinumab, Risankizumab, Upadacitinib. Legend & Colour Coding : • Green: Recommended • Yellow: Can be considered • Red: Not recommended • Blue: Insufficient evidence Data Matrix (Selected Examples) : • Systemic corticosteroids: Green for Induction, Red for Maintenance, Red for Perianal disease, Yellow for all other columns. • Enteral release corticosteroids: Green for Induction, Red for all other columns. • Enteral Nutrition: Green for Induction, Red for all other columns. • Thiopurines monotherapy: Yellow for Induction, Green for Maintenance, Yellow for Perianal disease, Red for all other columns. • Methotrexate: Yellow for Induction, Green for Maintenance, Yellow for Perianal disease, Red for all other columns. • Infliximab, Adalimumab, Certolizumab: Green for Induction, Maintenance, Perianal disease; Red or Yellow for other columns. • Vedolizumab, Ustekinumab, Risankizumab, Upadacitinib: Green for Induction and Maintenance, with variable recommendations for other columns. • Several cells contain Roman numerals (i–xiii), likely referencing footnotes or specific clinical considerations. Design Encodings : • Each cell is color-coded according to the recommendation level. • Roman numerals in some cells indicate special notes or exceptions. • A note at the bottom: "DRUGS SHOULD BE CONSIDERED BY MERIT, NOT SEQUENCED AS CONVENTIONAL TO ADVANCED." Analysis : • Systemic corticosteroids are recommended only for induction, not for maintenance or special populations. • Most biologics (Infliximab, Adalimumab, Vedolizumab, Ustekinumab) are recommended for both induction and maintenance, but their use in pregnancy, elderly, and spondyloarthropathy is more nuanced. • Enteral release corticosteroids and enteral nutrition are only recommended for induction. • There is insufficient evidence for some drugs in certain scenarios (blue cells). • The matrix emphasizes individualized therapy selection rather than a stepwise escalation from conventional to advanced drugs.

This composite clinical figure illustrates the treatment response in a patient with XIAP deficiency-associated inflammatory bowel disease (IBD). Panel A displays pre-treatment findings including a colonoscopic view and a histopathology slide. The endoscopy shows significant mucosal inflammation characterized by marked edema, friability, spontaneous hemorrhage, and whitish fibrinous ulcerations. The adjacent H&E-stained biopsy specimen reveals nonspecific active inflammation with a dense infiltrate of mononuclear cells and neutrophils, alongside architectural disruption. Panel B presents a follow-up colonoscopic image after allogeneic cord blood transplantation (CBT). It demonstrates complete mucosal healing with the restoration of normal vascular patterns, resolution of edema, and absence of ulcerations or hemorrhage. The educational focus is on the efficacy of hematopoietic stem cell transplantation as a curative option for monogenic PIDs presenting with refractory early-onset IBD, highlighting the clinical transition from severe inflammatory pathology to endoscopic remission.

This composite clinical figure illustrates the correlation between diagnostic imaging and endoscopic findings in a patient with Inflammatory Bowel Disease (IBD) before and after biologic therapy. Panels (a) and (c) are coronal CT enteroclysis (CTE) images. Panel (a) displays an active disease state characterized by intestinal wall thickening (arrow) and increased density in the mesenteric fat (fat stranding), indicative of acute inflammation. Panel (c) shows the same region 84 days later, demonstrating therapeutic response with a reduction in wall thickness and normalization of mesenteric fat density. Panels (b) and (d) provide the corresponding endoscopic views of the ileocecal mucosa. Panel (b) reveals severe active inflammation with significant mucosal edema, erythema, and ulcerations. Panel (d) shows post-treatment resolution, featuring a smoother, non-congested mucosal surface without active ulcers or edema. This comparison serves as an educational tool for monitoring treatment efficacy in Crohn's disease using multimodality assessment, highlighting the transition from an active to an inactive inflammatory group.