Inflammatory bowel diseases (IBDs), comprising Crohn’s disease (CD) and ulcerative colitis (UC), are chronic immune-mediated inflammatory diseases of the gastrointestinal (GI) tract with still-elusive etiopathogeneses and an increasing prevalence worldwide. Despite the growing availability of more advanced therapies in the last two decades, there are still a number of unmet needs. For example, the achievement of mucosal healing has been widely demonstrated as a prognostic marker for better outcomes and a reduced risk of dysplasia and cancer; however, the accuracy of endoscopy is crucial for both this aim and the precise and reproducible evaluation of endoscopic activity and the detection of dysplasia. Artificial intelligence (AI) has drastically altered the field of GI studies and is being extensively applied to medical imaging. The utilization of deep learning and pattern recognition can help the operator optimize image classification and lesion segmentation, detect early mucosal abnormalities, and eventually reveal and uncover novel biomarkers with biologic and prognostic value. The role of AI in endoscopy—and potentially also in histology and imaging in the context of IBD—is still at its initial stages but shows promising characteristics that could lead to a better understanding of the complexity and heterogeneity of IBDs, with potential improvements in patient care and outcomes. The initial experience with AI in IBDs has shown its potential value in the differentiation of UC and CD when there is no ileal involvement, reducing the significant amount of time it takes to review videos of capsule endoscopy and improving the inter- and intra-observer variability in endoscopy reports and scoring. In addition, these initial experiences revealed the ability to predict the histologic score index and the presence of dysplasia. Thus, the purpose of this review was to summarize recent advances regarding the application of AI in IBD endoscopy as there is, indeed, increasing evidence suggesting that the integration of AI-based clinical tools will play a crucial role in paving the road to precision medicine in IBDs.

Background/Objectives: The global burden of inflammatory bowel diseases (IBDs) continues to rise, with up to 50% of patients experiencing extraintestinal manifestations. Cardiovascular diseases (CVDs) are of particular concern, ranking as the second leading cause of mortality in this population. Despite a comparatively lower prevalence of traditional cardiovascular (CV) risk factors, the persistent inflammatory milieu and immune dysregulation inherent to IBD may contribute to heightened CVD risk. In this study, following a review of the current literature, an ongoing prospective trial designed to clarify CV risk profiles in IBD patients is detailed. Methods: A cohort of patients with IBD is being enrolled for comprehensive baseline evaluation of CV risk factors, lifestyle metrics, and disease characteristics. The incidence of major adverse cardiovascular events (MACEs) will be tracked and contrasted with a gender- and age-matched non-IBD cohort over a 2-year follow-up period. In cases of MACE occurrence, a multi-omics analysis—including genomic, proteomic, transcriptomic, and microbiome profiling—will be performed, along with a parallel evaluation in matched IBD controls without MACE. An artificial intelligence (AI) framework will support the analysis of this complex dataset. Results: To date, over 150 patients with IBD have been enrolled, and detailed phenotypic data and biological samples have been collected. Conclusions: We aim to introduce an IBD-specific correction factor for existing CV risk scores upon study completion. This is particularly relevant for individuals under 40 years of age, who are often inadequately assessed by current risk stratification models

This report describes vedolizumab’s clinical efficacy and safety in a patient with severe ulcerative colitis on haemodialysis for an end-stage kidney failure. The patient was a 75-year-old man on long-standing chronic diffusive three times per week haemodialytic treatment due to vascular nephropathy. At the presentation, the patient had severe bloody diarrhoea treated with a steroid cycle with temporary benefits and then developed steroid dependence. Upon remission, the patient started vedolizumab (Entivyo^®) as maintenance therapy. After 6 weeks of induction, patient started the maintenance therapy with an infusion every 8 weeks. After the sixth infusion, the interval was prolonged to 9 weeks because of the good and fast response. Vedolizumab treatment proceeded without adverse events. However, no changes in renal function were noted during the same period, no complications were reported, and the patient regularly continued haemodialysis. At the second induction infusion (week 2) and the second maintenance infusion (week 22), we measured vedolizumab serum level before and after haemodialysis, observing no significant changes. Our case is the first report about using vedolizumab in a patient under haemodialysis, showing that vedolizumab can be safe, well tolerated, and effective in patients undergoing haemodialysis. However, more extensive trials are needed to prove its use in these patients.

Background/Objectives: Because of the chronic course of the disease, clinicians managing IBD frequently encounter patients with a prior or newly diagnosed cancer. This can be related to the specific background cancer risk in that subject, aging, familial/genetic factors, or ongoing chronic inflammation. However, a potential influence of some therapeutic agents should also be considered. This setting, in the absence of controlled trials and few open series reports available, raises issues such as correct screening, prevention, and surveillance, but also eventual modification or adaptation of the medical management. Methods and Results: Few consensus guidelines and studies are available on the management of IBD patients with a history of cancer, and therefore, we aim to review the recommendations of the current guidelines and the evidence reported in the most recent real-world cohorts. Conclusions: This review will offer (a) an understanding of the background of cancer risk in IBD patients; (b) analysis and discussion of the risk of cancer related to IBD therapy; and, finally, (c) some clues for the management of IBD in patients with a previous or current history of cancer.

Background and Objectives: Smoking is a well-established risk factor for Crohn’s disease (CD), whereas patients with ulcerative colitis (UC) who smoke may exhibit a milder disease course. The impact of smoking on the efficacy of advanced therapies (AT) in patients with inflammatory bowel disease (IBD) remains largely unknown. Materials and Methods: Patients with IBD receiving AT and with a detailed smoking history were retrospectively identified from our electronic database. The primary outcome was the rate of clinical response and remission. Secondary outcomes included endoscopic improvement, the need for AT sequencing, and surgery. Results: A total of 346 patients (136 UC and 210 CD) were analyzed, with a mean age of 47.3 years and a mean disease duration of 14.1 years (range, 0.5–48 years). Overall, 614 treatment courses were evaluated: 382 anti-TNF, 92 vedolizumab, 84 ustekinumab, 36 JAK inhibitor, 16 IL-23 inhibitor, and 4 etrasimod treatment courses. The anti-TNF effectiveness analysis included 371 infliximab/adalimumab courses after exclusion of 11 golimumab courses. A total of 107 patients (30.9%) were active smokers and 76 (21.9%) were former smokers. Anti-TNF therapy was significantly more effective in never smokers than in active smokers in the adjusted analysis (OR 1.44, 95% CI 1.04–2.00; p = 0.03), and this association remained significant in the mixed-effects model accounting for repeated treatment courses within patients (OR 1.35, 95% CI 1.01–1.80; p = 0.04). The association for advanced therapies overall was significant in the adjusted model (OR 1.25, 95% CI 1.01–1.55; p = 0.04) but was attenuated after accounting for repeated courses (OR 1.10, 95% CI 0.99–1.22; p = 0.07). No statistically significant differences were demonstrated for vedolizumab or ustekinumab, although the smaller sample sizes preclude exclusion of a clinically relevant effect. Former smokers had outcomes comparable to never smokers. Active smokers also required significantly more treatment courses than never smokers in both UC and CD (p = 0.03). Conclusions: Smoking is associated with a negative impact on the effectiveness of anti-TNF therapy in both UC and CD, highlighting the need for systematic smoking cessation counseling and patient education as an integral component of IBD management.