To compare computed tomography enteroclysis (CTE) vs small intestine contrast ultrasonography (SICUS) for assessing small bowel lesions in Crohn's disease (CD), when using surgical pathology as gold standard. From January 2007 to July 2008, 15 eligible patients undergoing elective resection of the distal ileum and coecum (or right colon) were prospectively enrolled. All patients were under follow-up. The study population included 6 males and 9 females, with a median age of 44 years (range: 18-80 years). (1) certain diagnosis of small bowel requiring elective ileo-colonic resection; (2) age between 18-80 years; (3) elective surgery in our Surgical Unit; and (4) written informed consent. SICUS and CTE were performed ≤ 3 mo before surgery, followed by surgical pathology. The following small bowel lesions were blindly reported by one sonologist, radiologist, surgeon and histolopathologist: disease site, extent, strictures, abscesses, fistulae, small bowel dilation. Comparison between findings at SICUS, CTE, surgical specimens and histological examination was made by assessing the specificity, sensitivity and accuracy of each technique, when using surgical findings as gold standard. Among the 15 patients enrolled, CTE was not feasible in 2 patients, due to urgent surgery in one patients and to low compliance in the second patient, refusing to perform CTE due to the discomfort related to the naso-jejunal tube. The analysis for comparing CTE vs SICUS findings was therefore performed in 13 out of the 15 CD patients enrolled. Differently from CTE, SICUS was feasible in all the 15 patients enrolled. No complications were observed when using SICUS or CTE. Surgical pathology findings in the tested population included: small bowel stricture in 13 patients, small bowel dilation above ileal stricture in 10 patients, abdominal abscesses in 2 patients, enteric fistulae in 5 patients, lymphnodes enlargement (> 1 cm) in 7 patients and mesenteric enlargement in 9 patients. In order to compare findings by using SICUS, CTE, histology and surgery, characteristics of the small bowel lesions observed in CD each patient were blindly reported in the same form by one gastroenterologist-sonologist, radiologist, surgeon and anatomopathologist. At surgery, lesions related to CD were detected in the distal ileum in all 13 patients, also visualized by both SICUS and CTE in all 13 patients. Ileal lesions > 10 cm length were detected at surgery in all the 13 CD patients, confirmed by SICUS and CTE in the same 12 out of the 13 patients. When using surgical findings as a gold standard, SICUS and CTE showed the exactly same sensitivity, specificity and accuracy for detecting the presence of small bowel fistulae (accuracy 77% for both) and abscesses (accuracy 85% for both). In the tested CD population, SICUS and CTE were also quite comparable in terms of accuracy for detecting the presence of small bowel strictures (92% vs 100%), small bowel fistulae (77% for both) and small bowel dilation (85% vs 82%). In our study population, CTE and the non-invasive and radiation-free SICUS showed a comparable high accuracy for assessing small bowel lesions in CD.

Background: Colonoscopy is crucial for diagnosing and monitoring inflammatory bowel disease (IBD), assessing disease activity, and detecting dysplasia. However, patient adherence to surveillance remains suboptimal due to discomfort, anxiety, and concerns about bowel preparation. Methods: This multicenter cross-sectional study assessed patient satisfaction with colonoscopy in IBD patients across three Italian centers. Participants completed pre- and post-examination questionnaires, including the Endoscopy Customer Satisfaction Questionnaire (ECSQ) and Perceived Stress Scale (PSS-10). Clinical factors, bowel preparation methods, and healthcare provider expertise were analyzed. Results: Among 444 enrolled patients, overall satisfaction was high (98.8%) but varied across procedural phases. Higher satisfaction was predicted by expert endoscopists (β = 2.11, p = 0.012), disease remission (β = 1.70, p = 0.020), and frequent endoscopic procedures in the last 24 months (β = 0.46, p = 0.041). Conversely, severe disease activity (β = −3.87, p < 0.001) was associated with lower satisfaction. Deep sedation and high-volume bowel preparation negatively impacted satisfaction. Conclusions: Optimizing bowel preparation, enhancing healthcare provider expertise, and implementing stress-reducing strategies could improve patient adherence to surveillance guidelines in IBD care.

The nutritional status in inflammatory bowel disease (IBD) is often impaired, and adherence to the Mediterranean diet (MedDiet) remains under-investigated. The aim of this study was to assess diet quality (DQ) and adherence to MedDiet in a cohort of Sardinian IBD patients. We conducted a case-control study in which 50 Crohn’s disease (CD) and 50 ulcerative colitis (UC) patients were matched with 100 healthy controls each. The Diet Quality Index (DQI-I) and Medi-Lite were used to assess DQ and adherence to MedDiet, respectively. Subgroup analysis by disease characteristics and use of advanced therapies were also carried out. DQI-I scored significantly lower in IBD, independently of disease localization and behavior (CD) and disease extent (UC): [DQI-I: CD 34.5 (IQR 33–37) vs. CTRL 40 (IQR 38.5–43) p < 0.0001; UC 34.5 (IQR 33–37) vs. CTRL 42 (IQR 40–44) p < 0.0001]. Medi-Lite scores were significantly lower in stricturing and ileo-colonic CD and in extensive UC: [Medi-Lite CD 7.5 (IQR 7–9)] vs. CTRL 9 (IQR 7–10) p = 0.0379]; [UC 8 (IQR7–10) vs. CTRL 9 (IQR 8–10.5) p = 0.0046]. IBD patients had a low DQ independently of disease type and phenotype. Patients with ileo-colonic stenosing CD or extensive UC had lower MedDiet adherence, suggesting that its benefits may be mitigated by low acceptance in specific subgroups.

Importance and Objective: Xanthine oxidase (XO) plays a key role in purine metabolism, catalyzing the oxidation of hypoxanthine to xanthine, and xanthine to uric acid (UA) with the production of superoxide anions. The accumulation of UA has been shown to initiate the inflammatory process through NLRP3 inflammasome, and the production of reactive oxygen species (ROS) contributes to inflammation-related tissue damage in different organs. This study aimed to investigate the role of XO in the pathogenesis of Inflammatory Bowel Disease (IBD) and the anti-inflammatory potential of XO inhibition. Design: XO expression and activity were assessed in the mucosa of moderately-to-severely active ulcerative colitis (UC) and Crohn’s disease (CD) patients. The functional role of XO, the activation of NLRP3 inflammasome, and the expression of proinflammatory cytokines were investigated in ex vivo intestinal organ cultures in the presence or absence of XO inhibitors. Results: In silico and in vitro analysis showed that XO mRNA and protein expression were upregulated in the UC and CD intestinal mucosa compared to controls. XO overexpression in the inflamed mucosa was associated with increased enzymatic activity, accumulation of UA and functionally linked to NLRP3-dependent IL1beta and IL18 expression. Accordingly, XO inhibitors, Allopurinol and Febuxostat, prevented NLRP3 activation, reduced Caspase1 activity and IL1beta and IL18 expression in ex vivo organ cultures of inflamed intestinal mucosa from both UC and CD patients. Conclusions and Relevance: Overexpression of XO in IBD might contribute to inflammation by promoting NLRP3 inflammasome activation and proinflammatory cytokine production.

The drug pipeline for the treatment of inflammatory bowel disease (IBD) has dramatically expanded over the last two decades, and it is expected to further grow in the upcoming years with the introduction of new agents with different mechanisms of action. However, such an increase of therapeutic options needs to be paralleled with an appropriate development of research to help physicians in the decision-making process when choosing which drug to prescribe. On the population level, comparative effectiveness research (CER) is intended to explore and identify relevant differences—in terms of both efficacy and safety outcomes—amongst different therapeutic regimens and/or strategies, in order to find the correct placement for each treatment in the therapeutic algorithm. CER revolves around three cornerstones: network meta-analyses, head-to-head trials and real-world studies, each of which has specific pros and cons, and can therefore offer answers to different questions. In this review, we aim to provide an overview on the methodological features specific to each of these research approaches, as well as to illustrate the main findings coming from CER on IBD target therapies (i.e., biologics and small molecules) and to discuss their appropriate interpretation.

Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal tract. Although the aetiology of IBD remains largely unknown, several studies suggest that an individual’s genetic susceptibility, external environmental factors, intestinal microbial flora, and immune responses are all factors involved in and functionally linked to the pathogenesis of IBD. Beyond the gastrointestinal manifestations, IBD patients frequently suffer from psychiatric comorbidities, particularly depression and anxiety. It remains unclear whether these disorders arise solely from reduced quality of life or whether they share overlapping biological mechanisms with IBD. This review aims to explore the bidirectional relationship between IBD and depressive disorders (DDs), with a focus on four key shared mechanisms: immune dysregulation, genetic susceptibility, alterations in gut microbiota composition, and dysfunction of the hypothalamic–pituitary–adrenal (HPA) axis. By examining recent literature, we highlight how these interconnected systems may contribute to both intestinal inflammation and mood disturbances. Furthermore, we discuss the reciprocal pharmacologic interactions between IBD and DDs: treatments for IBD, such as TNF-alpha and integrin inhibitors, have demonstrated effects on mood and anxiety symptoms, while certain antidepressants appear to exert independent anti-inflammatory properties, potentially reducing the risk or severity of IBD. Overall, this review underscores the need for a multidisciplinary approach to the care of IBD patients, integrating psychological and gastroenterological assessment. A better understanding of the shared pathophysiology may help refine therapeutic strategies and support the development of personalized, gut–brain-targeted interventions.