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.

Background: The Montreal classification has been widely used in Crohn's disease since 2005 to categorize patients by the age of onset (A), disease location (L), behavior (B), and upper gastrointestinal tract and perianal involvement. With evolving management paradigms in Crohn's disease, we aimed to assess the performance of gastroenterologists in applying the Montreal classification. Methods: An online survey was conducted among participants at an international educational conference on inflammatory bowel diseases. Participants classified 20 theoretical Crohn's disease cases using the Montreal classification. Agreement rates with the inflammatory bowel diseases board (three expert gastroenterologists whose consensus rating was considered the gold standard) were calculated for gastroenterologist specialists and fellows/specialists with ≤ 2 years of clinical experience. A majority vote < 75% among participants was considered a notable disagreement. The same cases were classified using three large language models (LLMs), ChatGPT‐4, Claude‐3, and Gemini‐1.5, and assessed for agreement with the board and gastroenterologists. Fleiss Kappa was used to assess within‐group agreement. Results: Thirty‐eight participants from five countries completed the survey. In defining the Montreal classification as a whole, specialists (21/38 [55%]) had a higher agreement rate with the board compared to fellows/young specialists (17/38 [45%]) (58% vs. 49%, p = 0.012) and to LLMs (58% vs. 18%, p < 0.001). Disease behavior classification was the most challenging, with 76% agreement among specialists and fellows/young specialists and 48% among LLMs compared to the inflammatory bowel diseases board. Regarding disease behavior, within‐group agreement was moderate (specialists: k = 0.522, fellows/young specialists: k = 0.532, LLMs: k = 0.577; p < 0.001 for all). Notable points of disagreement included: defining disease behavior concerning obstructive symptoms, assessing disease extent via video capsule endoscopy, and evaluating treatment‐related reversibility of the disease phenotype. Conclusions: There is significant inter‐rater disagreement in applying the Montreal classification, particularly for disease behavior in Crohn's disease. Improved education or revisions to phenotype criteria may be needed to enhance consensus on the Montreal classification.

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.

Background: Malnutrition is frequently under-investigated during remission in patients with Inflammatory Bowel Disease (IBD), despite its significant impact on clinical outcomes and quality of life. This study aimed to evaluate the increase in diagnostic performance of five nutritional screening tools (NSTs) when serially administered to IBD outpatients in sustained clinical remission. Methods: In this prospective, single-center cohort study, NSTs were administered, and body composition analysis was performed in IBD patients at baseline and after six months. At both time points, the sensitivity, specificity, predictive values, and accuracy of NSTs in detecting malnutrition and persistent malnutrition per ESPEN and GLIM criteria were evaluated, comparing repeated to single-point assessments. A sensitivity analysis using low FFMI as a reference was also performed. Results: Sixty-six IBD patients (32 Crohn’s disease; 34 ulcerative colitis) were enrolled. At baseline, 25.7% and 9% of patients were malnourished according to ESPEN and GLIM criteria, respectively, with 7.5% exhibiting low FFMI. Malnutrition prevalence increased over time to 53%, 16.6%, and 16.6%, respectively. Among NSTs, MUST and SaskIBD-NR consistently exhibited the highest specificity for malnutrition detection at baseline, at 6 months, and for persistent malnutrition for ESPEN, GLIM and low FFMI. Serial (repeated) NST administration markedly improved the specificity of all tools, compared to single-point assessments. Conclusions: Serial nutritional screening with MUST or SaskIBD-NR significantly enhances the specificity of malnutrition risk detection in IBD patients in remission, supporting the incorporation of repeated nutritional assessments into clinical practice to offer a practical strategy to enhance screening effectiveness in IBD outpatient care.

Background/Objectives: Ustekinumab, targeting the shared p40 subunit of interleukin (IL)-12 and IL-23, is an effective therapy for Crohn’s disease (CD), yet reliable predictors of response remain lacking. Given the central role of the IL-12/IL-23 axis in intestinal inflammation, we aimed to characterize the baseline mucosal expression of IL-12/IL-23 pathway components in lamina propria immune cells, and to explore their association with clinical response and remission following ustekinumab therapy. Methods: In this prospective, single-center study, biopsy-derived lamina propria mononuclear cells (LPMCs) were obtained from patients with CD prior to ustekinumab initiation. Gene expression of IL-12/IL-23 cytokine subunits and receptors was assessed by quantitative real-time PCR. Flow cytometry was performed to evaluate the distribution of T helper and innate lymphoid cell subsets and the expression of IL-23R and IL-12Rβ2. Clinical outcomes were assessed at week 16. Results: Fifteen consecutive patients were enrolled and included in the study. At week 16, 14/15 (93.3%) and 9/15 (60.0%) of patients reached clinical response and remission, respectively. No statistically significant differences in baseline mucosal gene expression of IL-12/IL-23 pathway components were observed between remitters and non-remitters. A trend toward higher expression of receptor subunits (IL23R, IL12RB1, IL12RB2) was observed in remitters, albeit with high variability and overlapping distributions. Similarly, cytokine subunits (IL23p19, IL12/IL23p40, IL12p35) showed no consistent differential expression pattern between the groups. In contrast, flow cytometry revealed a significantly higher frequency of IL-23R-expressing Th1 cells in remitters compared with non-remitters (20.6% vs. 6.8%, p = 0.009). Conclusions: Baseline transcriptional profiling of IL-12/IL-23 pathway components was not associated with remission following ustekinumab therapy. However, increased expression of IL-23R on mucosal Th1 cells identified a distinct immunological signature associated with clinical remission, suggesting that IL-23R expression on mucosal Th1 cells may represent a promising candidate biomarker that requires validation in larger independent cohorts.

Anorectal mucosal melanoma (AMM) is a rare, highly malignant tumor originating from melanocytes localized in the anorectal mucosa. It accounts for 0.5% of anorectal cancers and about 1% of all melanomas. Symptoms such as rectal bleeding, pain, tenesmus, and constipation often occur at advanced stages. Its rarity makes clinical suspicion burdensome, as it is often misdiagnosed as complicated hemorrhoids. AMM can be amelanocytic in up to 30% of cases, further complicating detection. At diagnosis, up to one third of patients present with distant metastasis. The prognosis is dismal, with a 5-year survival rate of 10%. Diagnostic protocols involve colonoscopy, endoscopic ultrasound (EUS), pelvic MRI, whole-body CT, PET scans, and transabdominal ultrasound (TUS) for liver metastases. (Malaguarnera G, et al. Oncotarget. 2018; 9(9): 8785–8800) Perineal ultrasound (PNUS) is a noninvasive tool for evaluating the anal canal and distal rectum. It has gained popularity in the standard evaluation of prostate cancer, gynecologic and urologic pathologies, and functional anorectal disorders, with high accuracy for perianal fistulas and abscesses. (Maconi G, et al. Ultraschall in Med. 2017; 38(03): 265–272). However, despite the presence of various case reports on perineal tumor diagnostic imaging, its role in diagnosing anorectal tumors is not well-studied. Here, we report a case of AMM identified initially by PNUS. Received: 27 March 2025 Accepted after revision: 10 February 2026 Article published online: 28 April 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany