Chronic pouchitis occurs in about 50% of patients undergoing a restorative proctocolectomy for ulcerative colitis. This affection represents a significant therapeutic challenge, particularly for symptomatic patients who do not respond to antibiotic treatments and biologic therapies. Several dietary approaches, including low FODMAP diets and the Mediterranean diet, have shown promising results in improving symptoms and disease burden. The rationale for dietary intervention lies in the reduction in inflammation and modulation of gut microbiota. However, conflicting results and methodological heterogeneity jeopardize the transition of these approaches from the field of research to clinical practice. Together with a nutritional approach, innovative methods of microbiota modulation, including probiotics and fecal microbiota transplantation, are emerging as safe and effective strategies in managing chronic pouchitis. This narrative review analyzes recent advancements in nutritional therapies and microbiota modulation as innovative and complementary approaches for managing chronic pouchitis. After examining microbiota modulation strategies, specifically the effectiveness of probiotics, prebiotics, and fecal microbiota transplantation in restoring microbial diversity and their potential role in alleviating symptoms, the review assesses the available clinical evidence concerning dietary interventions and their impact on gut microbiota. A comprehensive understanding of interventions aimed at modulating the microbiota is crucial for enhancing the effectiveness of conventional therapies. Such strategies may lead to significant improvements in patients’ quality of life and their perception of the disease. However, the variability in microbiota composition, the use of restrictive diets, and the lack of standardized methods for evaluating these interventions remain significant challenges. Future research is essential to improve our understanding of the underlying mechanisms and optimize clinical application.

Objective: This study investigated the radiological, clinical, and surgical factors linked to the risk of endoscopic recurrence following ileocolic resection for Crohn’s disease. Materials and Methods: We conducted a retrospective analysis of data from all patients who underwent primary ileocecal resection for Crohn’s disease in a single colorectal unit between 2004 and 2020. We analyzed the potential risk factors subdivided by the clinical, radiological, and surgical factors associated with morphological recurrence, as detected by endoscopy within 2 years after surgery. Cox regression was employed to ascertain the risk factors associated with such recurrence. Results: In total, 63 patients were included, and 24 (38%) had endoscopic recurrence. The age of the patient at the time of surgery was identified as a significant clinical factor associated with the risk of recurrence (HR: 1.04; p = 0.003), indicating that the probability of recurrence increases by 1% as the surgical age increases each year. The radiological factors associated with an increased risk of recurrence included localization in the distal ileum (HR: 3.526; p = 0.015), the number of pathological small-bowel segments affected by the disease (HR: 1.15; p = 0.004), and the total length of the pathological intestinal segment (HR: 1.002; p = 0.014). The presence of granulomas (HR: 6.003; p = 0.004) and the length of the resected bowel (HR: 1.01; p = 0.003) were surgical factors associated with a higher risk of recurrence. Conclusions: This study delineated several clinical, radiological, and surgical factors that serve as predictors for the endoscopic recurrence of Crohn’s disease after surgery.

Background: Short bowel syndrome (SBS) is a severe form of intestinal failure often associated with high output jejunostomy, fluid and electrolyte imbalance, and long-term dependence on parenteral nutrition (PN). In patients with type I SBS, restorative surgery may reduce PN dependence and enable conversion to type II or III SBS through restoration of intestinal continuity. Methods: We report our single-center experience. Between 2018 and 2025, nine adult patients with chronic type I SBS and high-output jejunostomy underwent restorative surgery within a multidisciplinary intestinal rehabilitation program. All patients were PN-dependent preoperatively, and two had intestinal failure-associated liver disease (IFALD). Surgical strategies were individualized according to residual anatomy and focused on restoration of intestinal continuity, without bowel lengthening procedures. Clinical outcomes were descriptively analyzed. Results: Intestinal continuity was successfully restored in all patients, resulting in conversion from type I to type II or III SBS. A clinically relevant improvement in intestinal function was observed in all cases, although follow-up duration was heterogeneous (range 3–60 months), with some patients still in early postoperative follow-up. Complete enteral autonomy was achieved in 3/9 patients (33%), while 6/9 patients (67%) experienced a reduction in PN requirements, including partial or nocturnal supplementation. Five of nine patients developed postoperative complications: one required reoperation and one endoscopic treatment for anastomotic bleeding. No 90-day postoperative mortality was recorded. Conclusions: In adult patients with type I SBS, restorative surgery enables anatomical and functional conversion to type II or III SBS. When performed within specialized multidisciplinary programs and guided by careful management of hostile abdomen, this approach may result in functional improvement and reduced PN dependence, although outcomes remain heterogeneous.

Background: Short bowel syndrome (SBS) is a severe form of intestinal failure often associated with high output jejunostomy, fluid and electrolyte imbalance, and long-term dependence on parenteral nutrition (PN). In patients with type I SBS, restorative surgery may reduce PN dependence and enable conversion to type II or III SBS through restoration of intestinal continuity. Methods: We report our single-center experience. Between 2018 and 2025, nine adult patients with chronic type I SBS and high output jejunostomy underwent restorative surgery within a multidisciplinary intestinal rehabilitation program. All patients were PN-dependent preoperatively, and two had intestinal failure-associated liver disease (IFALD). Surgical strategies were individualized according to residual anatomy and focused on restoration of intestinal continuity, without bowel lengthening procedures. Clinical outcomes were descriptively analyzed. Results: Intestinal continuity was successfully restored in all patients, resulting in conversion from type I to type II or III SBS. A clinically relevant improvement in intestinal function was observed in all cases. Complete enteral autonomy was achieved in three patients, while the remaining patients experienced a meaningful reduction in PN requirements, including partial or nocturnal supplementation. Five of nine patients developed postoperative complications: one required reoperation and one endoscopic treatment for anastomotic bleeding. No perioperative mortality was recorded. Conclusions: In adult patients with type I SBS, restorative surgery enables anatomical and functional conversion to type II or III SBS. When performed within specialized multidisciplinary programs and guided by careful management of hostile abdomen, this approach may result in significant functional improvement and reduced PN dependence.

Background/Objectives: The histological involvement of surgical resection margins in Crohn’s disease (CD) is an important risk factor for postoperative recurrence. The aim of this study was to evaluate the usefulness of intraoperative ultrasonography (IOUS) of the small bowel to best identify the surgical site of resection and reduce the rate of the histological involvement of margins. Methods: Consecutive patients who underwent ileocolic surgery for CD were prospectively enrolled (IOUS group) and underwent IOUS to fix the resection site. A control historical group of patients undergoing the same surgical procedures was considered and a 1:1 propensity score matching for location of disease and repeated surgery was performed. The primary endpoint was the histological involvement of resection margins. The secondary endpoint was to assess the feasibility of the method. Results: Twenty-seven patients were enrolled in the IOUS group and twenty-seven were enrolled in the non-IOUS group. The two groups were homogeneous in terms of gender, age, smoking, BMI, behavior of disease, and surgical technique. The IOUS group presented a lower rate of histological positive margins (18.5% vs. 48.1%; p = 0.021). No significant differences were found in terms of mean duration of surgery (IOUS: 254.2 min vs. non-IOUS: 225 min [SD = 49.3–77.8]; p = 0.11) or in terms of mean length of surgical specimen (IOUS: 24.1 cm vs. non-IOUS: 34.1 cm [SD = 13.5–23.1]; p = 0.058). Conclusions: IOUS of the small bowel appears to be a useful tool to obtain a lower rate of histologically positive margins with a comparable duration of surgery and no significant difference in the intestinal specimen length.