Practical guidelines on medical management of adults with moderate-to-severe inflammatory bowel disease
Bibliographic record
Abstract
Inflammatory bowel disease (IBD) is a chronic, relapsing inflammatory disorder that predominantly includes Crohn’s disease (CD) and ulcerative colitis (UC). IBD has emerged as a significant healthcare challenge in Saudi Arabia, with a more than fivefold increase in annual incidence over the past 2 decades. These guidelines promote high-quality, evidence-based care for adult patients with moderate-to-severe CD and UC in Saudi Arabia. These guidelines were developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. A multidisciplinary panel of 16 experts created 41 PICO questions addressing CD and UC separately. Evidence was synthesized through major databases (PubMed, EMBASE, Cochrane Library), prioritizing high-quality studies published between 2015 and 2025. Evidence certainty was categorized as high, moderate, low, or very low. Recommendations were formulated based on evidence quality, risk–benefit analyses, and clinical expertise, requiring a minimum consensus threshold of 70% for approval. A total of 38 recommendations and two good practical statements address induction and maintenance of remission with advanced therapies, combination treatment sequences, treatment optimization strategies, and management of special clinical scenarios. These Saudi national guidelines provide an evidence-based approach for managing adult patients with moderate-to-severe IBD and establish a comprehensive framework for optimizing management and treatment with advanced therapies. However, further research on local/regional real-world evidence is necessary to refine and improve the efficacy of these guidelines.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.070 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.004 |
| Bibliometrics | 0.006 | 0.004 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.004 | 0.003 |
| Research integrity | 0.008 | 0.006 |
| Insufficient payload (model declined to judge) | 0.006 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".