Inflammatory bowel disease (IBD) comprises two types of chronic intestinal disorders: Crohn’s disease and ulcerative colitis. In long-standing ulcerative colitis disease activity, histological persistent inflammation has been linked to an increased risk of relapse, and long-term corticosteroid use, even when endoscopic remission is reached. In Crohn’s disease, the discontinuous nature of lesions and transmural inflammation have limited the standardized histological assessment. The current evidence from research proposes that besides clinical and endoscopic healing, the achievement of histological healing constitutes an endpoint to assess disease activity and remission in IBD patients concerning better long-term disease outcomes. Histological alterations may persist even in the absence of endoscopic lesions. For these reasons, new advanced techniques promise to revolutionize the field of IBD by improving the endoscopic and histologic assessment, disease characterization, and ultimately patient care, with an established role in daily practice for objective assessment of lesions. This review outlines the importance of including microscopic evaluation in IBD, highlighting the clinical benefits of a deep state of disease remission using validated diagnostic methods and scoring systems for daily clinical practice.

Hereditary hemorrhagic telangiectasia is a rare autosomal dominant vascular disease defined by the presence of mucosal and cutaneous telangiectasia and visceral arterio-venous malformations. The latter are abnormal capillary-free direct communications between the pulmonary and systemic circulations with the following consequences: arterial hypoxemia caused by right-to-left shunts; paradoxical embolism with transient ischemic attack or stroke and brain abscess caused by the absence of the normally filtering capillary bed; and hemoptysis or hemothorax due to the rupture of the thin-walled arterio-venous malformations (particularly during pregnancy). It is frequently underdiagnosed, commonly presenting as complications from shunting through arterio-venous malformations: dyspnea, chronic bleeding, or embolism. Arterio-venous malformations are present not only in the lungs, but can also be found in the liver, central nervous system (mainly in the brain), nasal mucosa, or the gastrointestinal tract. The first choice of therapy is embolization of the afferent arteries of the arterio-venous malformations, a minimally invasive procedure with a high efficacy, a low morbidity, and low mortality. Other therapeutic modalities are surgery (resection) or stereotactic radiosurgery (using radiation). Routine screening for arterio-venous malformations is indicated in patients diagnosed with this condition and can prevent severe complications such as acute hemorrhages, brain abscesses, or strokes. Clinicians should provide a long-term follow-up for patients with arterio-venous malformations, in an effort to detect their growth or reperfusion in case of previously treated malformations. In spite of two experts’ consensuses, it still possesses multiple therapeutic challenges for physicians, as several aspects regarding the screening and management of arterio-venous malformations still remain controversial. Multidisciplinary teams are especially useful in complex cases.

According to new research, a possible association between inflammatory bowel disease (IBD) and an increased risk of ischemic heart disease (IHD) has been demonstrated, but this concern is still debatable. The purpose of this review is to investigate the link between IHD and IBD, as well as identify further research pathways that could help develop clinical recommendations for the management of IHD risk in IBD patients. There is growing evidence suggesting that disruption of the intestinal mucosal barrier in IBD is associated with the translocation of microbial lipopolysaccharides (LPS) and other endotoxins into the bloodstream, which might induce a pro-inflammatory cytokines response that can lead to endothelial dysfunction, atherosclerosis and acute cardiovascular events. Therefore, it is considered that the long-term inflammation process in IBD patients, similar to other chronic inflammatory diseases, may lead to IHD risk. The main cardiovascular risk factors, including high blood pressure, dyslipidemia, diabetes, smoking, and obesity, should be checked in all patients with IBD, and followed by strategies to reduce and manage early aggression. IBD activity is an important risk factor for acute cardiovascular events, and optimizing therapy for IBD patients should be followed as recommended in current guidelines, especially during active flares. Large long-term prospective studies, new biomarkers and scores are warranted to an optimal management of IHD risk in IBD patients.

Background and Objectives: The COVID-19 pandemic has had a considerable impact on inflammatory bowel disease (IBD) patients by limiting their access to medical services due to restrictions and the reorganization of the healthcare systems, which affects their quality of life (QoL). We aimed to assess the impact of the COVID-19 pandemic on the QoL of patients with IBD. Materials and Methods: We conducted a descriptive observational study, which included 90 adult patients diagnosed with IBD. The study sample consisted of two subgroups: a retrospective-pre-pandemic group (group A) and a prospective-pandemic group (group B). Group A included 45 IBD patients who were evaluated in 2018. Group B included 45 patients with confirmed diagnosis of IBD, evaluated between June and December 2021—the period of the COVID-19 pandemic (prospective), consecutively recruited. All the patients filled in a QoL assessment questionnaire—IBDQ-32. Subsequently, the two samples were comparatively assessed. Results: The average values of the IBDQ scores were significantly lower in 2021 compared to those recorded in 2018: 145.56 vs. 128.3 (p < 0.05). We also we found significant differences between the subscores: IBDQ1 (p = 0.043), IBDQ2 (p = 0.034), IBDQ3 (p = 0.045), IBDQ4 (p = 0.025). Conclusions: IBDQ scores were significantly lower in 2021 compared to 2018 (p < 0.05), showing that during the COVID-19 pandemic, patients with IBD had a more influenced QoL.

Background/Aims: Direct assessment by endoscopic examination has become a “gold standard” in monitoring patients with ulcerative colitis. However, it is an invasive method, with risks and discomfort for the patients. The aim is therefore to identify a less invasive method of assessing ulcerative colitis activity compared to colonoscopy. Materials and Methods: A prospective study was conducted among 103 patients with ulcerative colitis. Calprotectin was measured by a semi-quantitative rapid test. For each patient, a complete blood count was performed; liver and kidney functions, glycaemia, serum proteins, and inflammatory markers were also evaluated. Results: The Mayo score showed direct correlations with fecal calprotectin, C-reactive protein, and the erythrocyte sedimentation rate (p<0.05) and indirect correlations with hemoglobin (p=0.139). The sensitivity and specificity of calprotectin were 98.0% and 76.7%, respectively. Subsequently, combined analysis of the markers’ sensitivity/specificity was conducted. Conclusion: The semi-quantitative rapid test proved to be a good predictor for differentiating the endoscopic active disease from the inactive one. The individual use of fecal calprotectin presents the highest sensitivity in determining the endoscopic activity. Nevertheless, in monitoring patients, combined determination of the three inflammatory markers studied [C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), calprotectin] is more useful in reducing unnecessary colonoscopies.