Beyond class switching in multi-refractory inflammatory bowel disease: Nine case reports and review of literature

Figure 1 Colonoscopy findings in case 2 under tofacitinib monotherapy (severely symptomatic). Ulcerative colitis with stricture, friability and ulcers, Mayo endoscopic score 2. A: Descending colon; B: Sigmoid colon.

Figure 2 Colonoscopy findings in case 2 on maintenance therapy with ustekinumab every 8 weeks and tofacitinib 5 mg twice daily (mildly symptomatic). Improvement, but still presenting ulcerative colitis with patchy areas of stricture, friability and ulcers, Mayo endoscopic score 2. A: Descending colon; B: Sigmoid colon.

Figure 3 Colonoscopy findings in case 2 on maintenance therapy with ustekinumab every 4 weeks and tofacitinib 5 mg twice daily - two years into deep remission. Scarred mucosa, Mayo endoscopic score 0. A: Transverse colon; B: Sigmoid colon.

Figure 4 Sequential healing course of perianal Crohn’s disease under upadacitinib therapy (case 3). A: Baseline postoperative appearance with seton in place at treatment initiation, showing active inflammation and exposed fistulous tract; B: Day 30: Intraoperative view demonstrating tract exposure and targeted debridement, with early reduction in local inflammatory burden; C: Day 60: Ongoing cicatrization with visible contraction of the external opening and resolution of surrounding erythema; D: Day 90: Complete closure of the external opening with mature cicatricial tissue, reflecting full postoperative fistula healing.