Intraductal papillary neoplasms of the bile duct (IPNBs) represent a rare variant of biliary tumors characterized by a papillary growth within the bile duct lumen. Since their first description in 2001, several classifications have been proposed, mainly based on histopathological, radiological and clinical features, although no specific guidelines addressing their management have been developed. Bile duct neoplasms generally develop through a multistep process, involving different precursor pathways, ranging from the initial lesion, detectable only microscopically, i.e. biliary intraepithelial neoplasia, to the distinctive grades of IPNB until the final stage represented by invasive cholangiocarcinoma. Complex and advanced investigations, mainly relying on magnetic resonance imaging (MRI) and cholangioscopy, are required to reach a correct diagnosis and to define an adequate bile duct mapping, which supports proper treatment. The recently introduced subclassifications of types 1 and 2 highlight the histopathological and clinical aspects of IPNB, as well as their natural evolution with a particular focus on prognosis and survival. Aggressive surgical resection, including hepatectomy, pancreaticoduodenectomy or both, represents the treatment of choice, yielding optimal results in terms of survival, although several endoscopic approaches have been described. IPNBs are newly recognized preinvasive neoplasms of the bile duct with high malignant potential. The novel subclassification of types 1 and 2 defines the histological and clinical aspects, prognosis and survival. Diagnosis is mainly based on MRI and cholangioscopy. Surgical resection represents the mainstay of treatment, although endoscopic resection is currently applied to nonsurgically fit patients. New frontiers in genetic research have identified the processes underlying the carcinogenesis of IPNB, to identify targeted therapies.

BackgroundRisk stratification for endoscopic post-operative recurrence (ePOR) in Crohn's disease (CD) is required to identify patients who would benefit most from initiation of prophylactic medication and intensive monitoring of recurrence.AimsTo assess the current evidence on patient-related, microbial, surgical and histopathological risk factors for ePOR in patients with CD after ileocolic (re-)resection.MethodsMultiple online databases (Embase, MEDLINE, Web of Science and Cochrane Library) were searched up to March 2024. Studies with reported associations of patient-related, microbial, surgical and/or histopathological factors for ePOR (i.e., Rutgeerts' score >= i2 or modified Rutgeerts' score >= i2a) were included. The risk of bias was assessed with the Newcastle-Ottawa Scale for observational cohort studies and case-control studies.ResultsIn total, 47 studies were included (four RCTs, 29 cohort studies, 12 case-control studies, one cross-sectional study and one individual participant data meta-analysis) including 6006 patients (median sample size 87 patients [interquartile range 46-170]). Risk of bias assessment revealed a poor quality in 41% of the studies. An association was reported in multiple studies of ePOR with active smoking at and post-surgery, male sex and prior bowel resection. A heterogeneous association with ePOR was reported for other risk factors included in the current guidelines (penetrating disease, perianal disease, younger age, extensive small bowel disease and presence of granulomas in the resection specimen or myenteric plexitis in the resection margin), and other patient-related, microbial, surgical and histopathological factors.ConclusionRisk factors for ePOR in international guidelines are not consistently reported as risk factors in current literature except for active smoking and prior bowel resection. To develop evidence-based, personalised strategies, large prospective studies are warranted to identify risk factors for ePOR. Validation studies of promising (bio)markers are also required. Risk factors for ePOR in international guidelines are not consistently reported as risk factors in the current literature except for active smoking and a prior bowel resection. To develop evidence-based and personalised strategies, future large prospective studies are warranted for the identification of risk factors for ePOR in patients with CD. In addition, validation studies of promising (bio)markers are required.image

Background and aim: Lifestyle and psychosocial factors impact mucosal inflammation and well-being of Inflammatory Bowel Disease (IBD) patients. However, lifestyle assessment and interventions are not standard care. The aim of this study was to estimate the occurrence of and gather patients’ perspectives on unfavorable lifestyle and psychosocial factors in individuals with IBD. Methods: A multicenter study was conducted, enrolling IBD patients using a telemedicine platform that reports on disease activity, lifestyle, and psychosocial factors. Patients' perspectives were gathered through a nationwide online survey distributed by the Dutch IBD patient organization. Results: In the telemedicine cohort (n = 460), 16.3% followed a specific diet, and 50.7% believed diet impacted their disease or quality of life. Additionally, 67.4% did not meet exercise norms, 9.3% smoked, and 8.0% had excessive alcohol consumption (>7 units/week). About one-third experienced high stress, poor sleep regularly, and emotional distress occasionally. In the nationwide survey (n = 1126), most patients (58–91%) believed that stress, unhealthy diet, poor sleep, physical inactivity, and anxiety or depression could cause intestinal symptoms. Around 70% were motivated to change diet, stress management, and physical activity. Less than one-fifth of patients received hospital support, with the majority being satisfied. Approximately 20% of patients desired but lacked support concerning stress, physical activity, diet, and sleep. Conclusions: Patients with IBD commonly report unfavorable lifestyle and psychosocial factors, recognize their impact on intestinal symptoms, and are motivated to change, but often lack hospital support. This underscores the importance for systematic incorporation of lifestyle and psychosocial factors into patient-centered IBD care and the potential for targeted interventions.

Background: Inflammatory bowel disease (IBD) may negatively affect health-related physical fitness. However, the development of interventions to improve health-related physical fitness and thereby disease outcomes is hindered by insufficient evidence. This study compared health-related physical fitness between patients with IBD and healthy control subjects, examined associations with disease and treatment characteristics, and explored patients’ perspectives. Methods: In this cross-sectional study, 105 patients with IBD and 102 age- and sex-matched healthy control subjects performed validated tests for body fat (4-site skinfold thickness), cardiorespiratory fitness (steep ramp test), muscular strength (steep ramp test, 60-second sit-to-stand test, hand-held dynamometry), muscular endurance (isokinetic dynamometry), and flexibility (sit-and-reach test). Data on disease and treatment characteristics, fatigue, physical activity, and patients’ perspectives were collected. Results: Patients with IBD had higher body fat (29.5% vs 26.9%; P = .012), lower steep ramp test performance (peak work rate 4.2 W/kg vs 4.8 W/kg; P < .001), fewer sit-to-stand repetitions (42 vs 47; P = .002), and reduced hamstring strength (3.0 N/kg vs 3.2 N/kg; P = .011) compared with healthy control subjects. This was associated with higher age, female sex, higher body mass index, fatigue, arthritis, and multiple biologicals used. Most patients considered physical fitness important and beneficial for their symptoms, and the majority expressed interest in professional support. Conclusions: Patients with IBD have higher body fat and reduced cardiorespiratory fitness and muscular strength compared with healthy control subjects. Especially, patients with a higher age, female sex, higher body mass index, fatigue, arthritis, or multiple biologicals used are at risk for such impairments and may benefit from physical exercise interventions.

Purpose: To develop predictive equations for oxygen uptake at peak exercise (VO _2peak ) measured during a cardiopulmonary exercise test (CPET) for patients with inflammatory bowel disease (IBD) using submaximal CPET-derived parameters and the steep ramp test, along with demographic and clinical characteristics. Methods: This study included patients with IBD in remission or with mild-to-moderate disease activity who performed a CPET and a steep ramp test within 14 days. Submaximal CPET-derived parameters included oxygen uptake (VO ₂ ) at the ventilatory anaerobic threshold (VAT) and oxygen uptake efficiency slope (OUES), while the outcome of the steep ramp test was the work rate achieved at peak exercise (WR _peak ). Results: Predictive regression equations with submaximal VO ₂ at the VAT and with OUES, when combined with age and body fat percentage, explained >89% of the variance in VO _2peak (optimism-adjusted R ² = 0.895 and 0.938). Predictive capacity increased when both VO ₂ at the VAT and OUES were combined in a predictive regression equation, together with age, body fat percentage, and clinically active disease (optimism-adjusted R ² = 0.951). Steep ramp test WR _peak explained 89% of the variance in VO _2peak (optimism-adjusted R ² = 0.892). Conclusion: The highly predictive equations developed in this study support the use of the submaximal CPET and the steep ramp test as alternatives for assessing VO _2peak in patients with IBD in remission or with mild-to-moderate disease activity in clinical and research settings.

Aim: Fatigue is a common and debilitating symptom in patients with inflammatory bowel disease (IBD) and may be linked to physical fitness and physical activity. However, their interrelationships are not fully understood. More objective knowledge is needed to guide physical interventions to reduce fatigue. This study aimed to investigate the association of physical fitness and physical activity with fatigue in patients with IBD. Additionally, the association between physical fitness and physical activity was investigated. Methods: Patients with IBD in remission or with mild-to-moderate disease activity were included. Fatigue was defined as a score of ≥35 on the subjective fatigue subscale of the checklist individual strength. Physical fitness measurements were performed using gold standard methodologies for body composition, cardiorespiratory fitness, muscular strength, muscular endurance, and flexibility. Physical activity was quantified using accelerometry. Results: In total, 53 patients were included, of whom 17 (32.1%) experienced fatigue. Fatigued patients exhibited a higher fat-mass index (P = .014), lower cardiorespiratory fitness (P = .017), and less quadriceps muscular endurance (P = .026, P = .008). No differences were observed in physical activity. Multiple linear regression showed that fat-mass index and cardiorespiratory fitness independently predicted fatigue (P = .029, P = .012). Significant correlations were found between fatigue and physical fitness, but not with physical activity. Conclusions: Reduced physical fitness was associated with fatigue in patients with IBD, suggesting that enhancing physical fitness could help alleviate fatigue. Physical activity was not associated with fatigue or physical fitness, indicating that simply increasing physical activity may have limited impact on reducing fatigue or improving physical fitness in this population.