Abstract Background Reduced microbial production of butyrate is implicated in mucosal barrier dysfunction and immune dysregulation in inflammatory bowel disease (IBD)(1,2). Oral butyrate supplementation may support mucosal healing; however, real-world data remain scarce.To evaluate one-year safety, tolerability, and clinical, biochemical, intestinal ultrasound (IUS), and endoscopic outcomes of adjunctive oral calcium butyrate in IBD patients receiving advanced therapies. Methods A retrospective, single-center cohort was conducted between December 2024 and November 2025. Adult patients with ulcerative colitis (UC) or Crohn’s disease (CD) received oral calcium butyrate 900 mg/day (450 mg twice daily) as adjunct therapy while remaining on stable background treatment: Anti-TNF: 48% (infliximab /adalimumab) Ustekinumab: 32% Vedolizumab: 12% Upadacitinib: 8% Clinical activity scores, fecal calprotectin (FCP), CRP, ESR, IUS (bowel wall thickness BWT, Limberg Doppler), and endoscopic assessments (Mayo Endoscopic Score, SES-CD) were recorded at baseline and 12 months. Missing data (FCP 22%, IUS 12%, endoscopy 28%) were addressed using multiple imputation. Results Fifty patients were included (25 UC, 25 CD), mean age 37 ± 11 years, mean disease duration 5.9 ± 4.3 years.Safety and tolerability: treatment persistence 78%; good/very good tolerability 82%; mild gastrointestinal adverse events 16%; no serious adverse events.Clinical outcomes: clinical response 70%; clinical remission 48%; steroid-free remission 36%.Biochemical BWT Δ − 1.0 ± 0.9 mm, Doppler improvement 41%, transmural healing 18%.Endoscopy (subset): UC mucosal healing (MES 0–1) 58%; CD endoscopic response (SES-CD ≥50% reduction) 41%; endoscopic remission 18%. Conclusion Adjunctive oral calcium butyrate 900 mg/day was safe, well tolerated, and associated with improvements across clinical, biomarker, IUS, and endoscopic outcomes in a real-world cohort treated with biologics and JAK inhibitors. Findings support further controlled evaluation of butyrate as a microbiota-targeted therapeutic option in IBD. References: 1. Chapman, M. A., et al. “Butyrate oxidation is impaired in the colonic mucosa of sufferers of quiescent ulcerative colitis.” Gut 35.1 (1994): 73-76. 2. Jangi, Sushrut, et al. “Microbial butyrate capacity is reduced in inflamed mucosa in patients with ulcerative colitis.” Scientific Reports 14.1 (2024): 3479. Conflict of interest: Karakan, Tarkan: None Kilic, Guner: No conflict of interest Karataş, Ali: No conflict of interest Cindoruk, Mehmet: No conflict of interest
Doğan et al. (Thu,) studied this question.