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World J Gastrointest Pharmacol Ther. Sep 5, 2026; 17(3): 120771
Published online Sep 5, 2026. doi: 10.4292/wjgpt.120771
Published online Sep 5, 2026. doi: 10.4292/wjgpt.120771
Beyond class switching in multi-refractory inflammatory bowel disease: Nine case reports and review of literature
Jonathan Soldera, Tutor, MSc Acute Medicine and Gastroenterology, University of South Wales in association with Learna Ltd, University of South Wales, Cardiff CF37 1DL, United Kingdom
Jonathan Soldera, Department of Gastroenterology, Logan Hospital, Brisbane 4131, Que
Maria Antonia Selbach Pertile, Leticia Nodari Carobin, Daniel Jun Funatsu Brambilla, School of Medicine, Universidade de Caxias do Sul, Caxias do Sul 95070-560, Rio Grande do Sul, Brazil
Eduardo Brambilla, Department of Clinical Gastroenterology, Universidade de Caxias do Sul, Caxias do Sul 95070-560, RS, Brazil
Co-first authors: Jonathan Soldera and Maria Antonia Selbach Pertile.
Author contributions: Soldera J, Pertile MAS, Carobin LN, Brambilla DJF, and Brambilla E contributed to data collection and writing of the first draft of the manuscript; Soldera J and Pertile MAS contributed equally to this manuscript as co-first authors; Soldera J and Brambilla E critically revised the manuscript. All authors have read and approved the final version of the manuscript.
AI contribution statement: Portions of this manuscript were edited using ChatGPT solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Jonathan Soldera, MD, MSc, PhD, Tutor, MSc Acute Medicine and Gastroenterology, University of South Wales in association with Learna Ltd, University of South Wales, Llantwit Road, Pontypridd, Cardiff CF37 1DL, United Kingdom.
Received: March 9, 2026
Revised: May 15, 2026
Accepted: June 10, 2026
Published online: September 5, 2026
Processing time: 173 Days and 20.8 Hours
Revised: May 15, 2026
Accepted: June 10, 2026
Published online: September 5, 2026
Processing time: 173 Days and 20.8 Hours
Core Tip
Core Tip: Multi-refractory inflammatory bowel disease often stalls at a “near-working” partial response to an advanced therapy. This case series (n = 9) suggests that, in carefully selected patients, consolidating partial mechanistic control with structured optimization and add-on advanced combination therapy (an oral Janus kinase inhibitor plus a biologic) may convert incomplete response into deep remission and delay surgery. This approach requires phenotype-driven selection, objective reassessment anchored to endoscopic and biochemical endpoints, rigorous infection exclusion, close monitoring, and predefined stopping rules - recognizing that timely colectomy remains appropriate when objective control fails.