Is Transmural Healing an Achievable Goal in Inflammatory Bowel Disease?

: In the era of treat-to-target strategies in inflammatory bowel disease (IBD), transmural healing (TH) is gaining recognition as a promising therapeutic goal. TH has been associated with significantly better long-term outcomes, including reduced rates of hospitalization, surgery, and the need for therapy escalation. Cross-sectional imaging techniques, such as intestinal ultrasound (IUS), magnetic resonance imaging (MRI), and computed tomography enterography (CTE), offer a comprehensive, non-invasive means to assess this deeper level of healing.

Biobetters and biosimilars in inflammatory bowel disease.

Biological therapies have revolutionized the management of inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). Among these, biosimilars and biobetters represent a growing area of therapeutic development. Biosimilars are nearly identical copies of original biologic drugs (reference products) with comparable safety, efficacy, and quality, but they offer the advantage of reduced costs and broader access.

The role of diet in inflammatory bowel disease: A comprehensive review of the literature.

Diet is increasingly recognized as a modifiable factor in the pathogenesis and management of inflammatory bowel disease (IBD), particularly in mild to moderate cases. While most evidence comes from pediatric studies, adult data, especially randomized controlled trials (RCTs), remain limited. Current guidelines recommend a Mediterranean diet for patients with IBD, avoiding fruits and vegetables during disease flares.

Spatiotemporal analysis of Crohn's disease reveals PECAM2 signaling at the basis of inflammation-to-fibrosis transition.

Background And Aims: Crohn's disease is a chronic inflammatory disease of the bowel, often complicated by fibrotic strictures, for which medical treatment is lacking, and surgery is commonly required. The mechanisms underlying the progression from chronic inflammation to fibrosis are not yet defined. We aim to unravel Crohn's disease pathogenesis using a cutting-edge computational pipeline combining several available tools.

Artificial intelligence in inflammatory bowel disease endoscopy - a review of current evidence and a critical perspective on future challenges.

Inflammatory bowel disease (IBD) is a chronic and relapsing immune-mediated condition with a rising global prevalence. Endoscopic diagnosis, monitoring and surveillance currently depend on individual endoscopists, introducing subjectivity, variability, delays and potential diagnostic discrepancies. Artificial intelligence (AI) is poised to transform these processes.

The Role of Vitamin D in Inflammatory Bowel Diseases: From Deficiency to Targeted Therapeutics and Precise Nutrition Strategies.

Background: Vitamin D plays a crucial role in immune modulation, gut barrier integrity, and inflammation regulation, making it highly relevant in inflammatory bowel disease (IBD). IBD patients often exhibit vitamin D deficiency, which has been linked to increased disease activity, impaired mucosal healing, and a higher risk of complications, including infections and osteoporosis.

Methods: This review examines the biological functions of vitamin D in maintaining intestinal homeostasis, particularly in the context of IBD.

JAK Inhibitors and Risk of Cancer in IBD Patients.

Janus kinase inhibitors, including tofacitinib, filgotinib, and upadacitinib, have emerged as effective therapeutic options for the management of inflammatory bowel diseases (IBDs). By targeting the JAK-STAT signaling pathway, these agents modulate immune responses and reduce inflammation. However, concerns regarding the potential risk of malignancy associated with their use have gained significant attention.

Transforming Gastrointestinal Diagnosis with Molecular Endoscopy: Challenges and Opportunities.

Molecular endoscopy represents a transformative advance in the detection, diagnosis, and management of gastrointestinal diseases, addressing the critical limitations of conventional techniques. Current diagnostic standards, such as white light endoscopy (WLE), often fail to detect early-stage lesions, particularly in high-risk populations like Barrett's esophagus or inflammatory bowel disease patients. To overcome these challenges, molecular endoscopy, using fluorescent molecular probes, may offer ultimate precision by targeting disease-specific biomarkers.

Management of Patients with IBD and History of Cancer.

The use of advanced therapies, including biologics and small molecules, has become an established clinical practice for the treatment of moderate-to-severe ulcerative colitis (UC) and Crohn's disease (CD). However, certain patient populations, such as those with a history of cancer, are often excluded from clinical trials evaluating the efficacy and safety of these therapies. This exclusion has historically left clinicians with limited evidence to guide treatment decisions in this high-risk group.

Dual Therapy in Inflammatory Bowel Disease.

Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn's disease (CD), are chronic and complex autoimmune conditions. Despite the advancements in biologics and small molecules, the therapeutic ceiling persists, posing significant treatment challenges and contributing to the concept of difficult-to-treat IBD. Dual-targeted therapy (DTT), combining two biologic agents or biologics with small molecules, has emerged as a novel approach to address this unmet need by targeting multiple inflammatory pathways simultaneously.

Unlocking hope: The future of ustekinumab biosimilars in Crohn's disease treatment.

Biologic therapies have revolutionized Crohn's disease (CD) management, but their high costs pose a significant barrier to access. Biosimilars can provide increased access to treatment because of significant cost-savings. Ustekinumab is a biological drug against interleukin 12-23 that is employed in treating moderate-to-severe CD.

Advancing Therapeutic Targets in IBD: Emerging Goals and Precision Medicine Approaches.

Inflammatory bowel diseases (IBD) including Crohn's disease (CD) and ulcerative colitis (UC) are chronic, relapsing conditions characterized by dysregulated immune responses and persistent intestinal inflammation. This review aims to examine new potential therapeutic targets in IBD starting from the STRIDE-II statements. Key targets now include clinical remission, endoscopic remission, and biomarker normalization (such as C-reactive protein and fecal calprotectin).

Role of Probiotics in the Management of Patients with Ulcerative Colitis and Pouchitis.

Acute severe ulcerative colitis (ASUC) often requires surgical intervention, such as proctocolectomy with ileal pouch-anal anastomosis (IPAA). While IPAA improves patient outcomes, it can be associated with pouchitis, a common and debilitating complication characterized by inflammation of the pouch. The development of pouchitis is closely linked to dysbiosis-an imbalance in the gut microbiota.

Advancing Colorectal Cancer Prevention in Inflammatory Bowel Disease (IBD): Challenges and Innovations in Endoscopic Surveillance.

Patients with inflammatory bowel disease (IBD) face an elevated risk of developing colorectal cancer (CRC). Endoscopic surveillance is a cornerstone in CRC prevention, enabling early detection and intervention. However, despite recent advancements, challenges persist.

Multiple Ileal and Colonic Stenoses: Is It Always Crohn's Disease?

A 62-year-old woman presented with multiple ileal and colonic stenoses, initially suspected to be Crohn's disease. Despite unremarkable endoscopic biopsies, surgery was performed due to clinical deterioration, and histological analysis confirmed the presence of metastatic breast cancer. This case highlights the importance of considering metastatic disease in the differential diagnosis of gastrointestinal (GI) strictures, particularly when inflammatory bowel disease markers are inconclusive or marginal.

Targeting mucosal healing in Crohn's disease: efficacy of novel pathways and therapeutic targets.

Introduction: Crohn's disease (CD) is a chronic inflammatory bowel disease affecting the entire gastrointestinal tract with a progressive and relapsing course. Achieving mucosal healing has emerged as a critical therapeutic goal, as it is associated with sustained clinical remission, reduced hospitalizations, and fewer surgery rates. Therefore, targeting mucosal healing is essential for long-term control in CD.

Raising the bar in ulcerative colitis management.

Ulcerative colitis (UC) is a chronic inflammatory bowel disease characterized by growing incidence and prevalence around the world in the last few decades. The range of available existing treatment and strategies for its management is being implemented. Given the introduction of newly developed molecules and the lack of specific guidelines, drug positioning may represent a tough clinical challenge.

Defining mucosal healing in randomized controlled trials of inflammatory bowel disease: A systematic review and future perspective.

Background: Mucosal healing (MH) is an established treatment goal in inflammatory bowel disease (IBD). However, various definitions of MH exist. We aimed to identify how MH is defined in randomized controlled trials (RCTs) in ulcerative colitis (UC) and Crohn's disease (CD).

Artificial intelligence: A new tool in the pathologist's armamentarium for the diagnosis of IBD.

Inflammatory bowel diseases (IBD) are classified into two entities, namely Crohn's disease (CD) and ulcerative colitis (UC), which differ in disease trajectories, genetics, epidemiological, clinical, endoscopic, and histopathological aspects. As no single golden standard modality for diagnosing IBD exists, the differential diagnosis among UC, CD, and non-IBD involves a multidisciplinary approach, considering professional groups that include gastroenterologists, endoscopists, radiologists, and pathologists. In this context, histological examination of endoscopic or surgical specimens plays a fundamental role.

The Role of Fecal Microbiota Transplantation in IBD.

Gut microbiota dysbiosis has a critical role in the pathogenesis of inflammatory bowel diseases, prompting the exploration of novel therapeutic approaches like fecal microbiota transplantation, which involves the transfer of fecal microbiota from a healthy donor to a recipient with the aim of restoring a balanced microbial community and attenuating inflammation. Fecal microbiota transplantation may exert beneficial effects in inflammatory bowel disease through modulation of immune responses, restoration of mucosal barrier integrity, and alteration of microbial metabolites. It could alter disease course and prevent flares, although long-term durability and safety data are lacking.

Gastrointestinal Ultrasound in Infectious Diseases: A Comprehensive Review.

Infectious diseases affecting the gastrointestinal tract often present diagnostic challenges due to the variability in clinical manifestations and overlapping symptoms. Ultrasound imaging has emerged as a valuable tool in the assessment of gastrointestinal pathologies, offering non-invasive and real-time visualization of anatomical structures. This review aims to explore the role of ultrasound in the diagnosis and management of infectious diseases involving the gastrointestinal tract.

Translational characterization of immune pathways in inflammatory bowel disease: insights for targeted treatments.

Introduction: The pathogenesis of inflammatory bowel disease (IBD) involves the dysregulation of multiple inflammatory pathways. The understanding of these mechanisms allows their selective targeting for therapeutic purposes. The discovery of Tumor Necrosis Factor-alpha's (TNF-α) role in mucosal inflammation ushered an exciting new era of drug development which now comprises agents targeting multiple pro-inflammatory signaling pathways, integrins, and leukocyte trafficking regulators.

Inflammatory Bowel Disease and Colorectal Cancer.

Patients with inflammatory bowel diseases (IBDs), including both ulcerative colitis (UC) and Crohn's disease (CD), are at a higher risk of developing colorectal cancer (CRC). However, advancements in endoscopic imaging techniques, integrated surveillance programs, and improved medical therapies have led to a decrease in the incidence of CRC among IBD patients. Currently, the management of patients with IBD who have a history of or ongoing active malignancy is an unmet need.