Gut microbiota dysbiosis has a critical role in the pathogenesis of inflammatory bowel diseases, prompting the exploration of novel therapeutic approaches like fecal microbiota transplantation, which involves the transfer of fecal microbiota from a healthy donor to a recipient with the aim of restoring a balanced microbial community and attenuating inflammation. Fecal microbiota transplantation may exert beneficial effects in inflammatory bowel disease through modulation of immune responses, restoration of mucosal barrier integrity, and alteration of microbial metabolites. It could alter disease course and prevent flares, although long-term durability and safety data are lacking. This review provides a summary of current evidence on fecal microbiota transplantation in inflammatory bowel disease management, focusing on its challenges, such as variability in donor selection criteria, standardization of transplant protocols, and long-term outcomes post-transplantation.

Background: Vitamin D plays a crucial role in immune modulation, gut barrier integrity, and inflammation regulation, making it highly relevant in inflammatory bowel disease (IBD). IBD patients often exhibit vitamin D deficiency, which has been linked to increased disease activity, impaired mucosal healing, and a higher risk of complications, including infections and osteoporosis. Methods: This review examines the biological functions of vitamin D in maintaining intestinal homeostasis, particularly in the context of IBD. It discusses the prevalence and consequences of vitamin D deficiency in IBD, including its potential to exacerbate disease progression, impair treatment efficacy, and negatively impact long-term health outcomes. Furthermore, therapeutic strategies to address vitamin D deficiency are explored, including supplementation approaches, dosing strategies, and precision nutrition interventions that aim to personalize vitamin D management based on individual patient needs and disease characteristics. Results: By synthesizing the latest evidence, this review highlights the critical role of vitamin D in IBD management, underlining how optimal vitamin D levels may not only improve disease control but also enhance patient quality of life and reduce the risk of long-term complications associated with the disease. Conclusions: Understanding the importance of vitamin D in IBD could help refine treatment strategies and promote better health outcomes for affected individuals.

Inflammatory bowel diseases (IBD) including Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, relapsing conditions characterized by dysregulated immune responses and persistent intestinal inflammation. This review aims to examine new potential therapeutic targets in IBD starting from the STRIDE-II statements. Key targets now include clinical remission, endoscopic remission, and biomarker normalization (such as C-reactive protein and fecal calprotectin). Moreover, histologic remission, transmural remission, and in the future molecular targets are emerging as important indicators of sustained disease control. The treatment goals for inflammatory bowel disease are varied: to relieve symptoms, prevent permanent intestinal damage, promote inflammation remission, and minimize complications. Consequently, the therapeutic targets have evolved to become broader and more ambitious. Integrating these advanced therapeutic targets has the potential to redefine IBD management by promoting deeper disease control and improved patient outcomes. Further research is essential to validate these strategies and optimize their clinical implementation.

Background: Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumors with unique biological characteristics and complications, including thromboembolism. This systematic review evaluates the incidence, types, and clinical outcomes of venous thromboembolic events (VTEs) in NEN patients. Methods: A systematic search of PubMed, Scopus, and Embase was conducted to identify studies on TEs in NENs. Eligible studies included case reports, case series, and retrospective cohort studies reporting VTEs, including deep vein thrombosis (DVT), pulmonary embolism (PE), and visceral vein thrombosis (VVT). Data were extracted on tumor site, functionality, differentiation grade, and VTE type. Results: In total, 33 studies were included, comprising 26 case reports, 2 case series, and 5 retrospective cohort studies. VTE prevalence ranged from 7.5% to 33% across studies. The most common VTEs were DVT, PE, and portal vein thrombosis (PVT). A meta-analysis revealed a pooled VTE prevalence of 11.1% (95% CI: 9.07–13.53%). Pancreatic NENs exhibited the highest thrombotic burden, particularly in poorly differentiated and advanced-stage tumors. Functioning tumors, including glucagonomas and ACTH-secreting NENs, were strongly associated with VTEs, potentially related to their systemic effects on coagulation and inflammation. Conclusions: Venous thromboembolism is a significant complication in NEN patients, especially in advanced or poorly differentiated tumors. Early detection and targeted management are critical for improving outcomes. Further investigations are required to clarify the mechanisms underlying thromboembolism in NENs and to develop optimized prophylactic and therapeutic strategies tailored to this patient population.

Acute severe ulcerative colitis (ASUC) often requires surgical intervention, such as proctocolectomy with ileal pouch–anal anastomosis (IPAA). While IPAA improves patient outcomes, it can be associated with pouchitis, a common and debilitating complication characterized by inflammation of the pouch. The development of pouchitis is closely linked to dysbiosis—an imbalance in the gut microbiota. Understanding the role of the microbiota in pouch health has spurred interest in probiotics as a therapeutic strategy. Probiotics represent a promising avenue in the management of pouchitis, offering a natural and targeted approach to improving outcomes for UC patients. This review explores the role of probiotics in the management of UC patients, with a specific focus on preventing and treating pouchitis. We compare the microbiota of healthy pouches to those with pouchitis, highlighting key microbial shifts linked to disease onset and discussing the growing evidence for probiotics as a prevention and therapeutic approach. Future directions should prioritize advancing research to optimize probiotic therapies and establish personalized approaches based on individual microbiome profiles, highlighting their significant potential as a promising treatment strategy for pouchitis.

Background: Pouchitis is the most frequent long-term complication after ileal pouch–anal anastomosis (IPAA) for ulcerative colitis. This study aimed to describe current international practices, definitions, and treatment strategies among experienced clinicians. Methods: An international web-based survey was conducted in 2025, following CROSS guidelines, exploring diagnostic, monitoring, and therapeutic practices. Responses were anonymized and analyzed descriptively. Results: A total of 412 physicians from 49 countries completed the survey, mostly gastroenterologists involved in IBD care (362/412, 87.8%). Most clinicians (156/412, 37.9%) estimated a pouchitis prevalence of 26%-50% among patients with IPAA, typically occurring within the first postoperative year. Follow-up was scheduled every 3-6 months by 164/412 (39.8%) physicians, with nearly half (47.6%) reporting the use of the pouch disease activity index (PDAI). Fecal calprotectin was the preferred non-invasive monitoring tool (326/412, 79.1%), whereas intestinal ultrasound was selected by 130/412 respondents (31.69%). Endoscopy was the primary diagnostic and follow-up modality (398/412, 96.6%), with biopsies routinely taken (364/412, 88%), although 46.7% of respondents reported not using a standardized histological scoring system. Prophylactic therapy was prescribed by 222/412 (53.9%), mainly probiotics (27.7%) and rectal mesalazine (18.2%). In acute pouchitis, ciprofloxacin plus metronidazole was the preferred first-line regimen (218/412, 52.9%). For chronic antibiotic-dependent or refractory pouchitis, advanced therapies were the predominant first-line option (254/412, 61.7%), with vedolizumab (198/412, 48.1%), and infliximab (170/412, 41.3%) most frequently selected. Ustekinumab, selective IL-23 inhibitors, JAK inhibitors and S1P receptor modulators were increasingly used in refractory cases. Treatment targets were primarily clinical (156/412, 37.9%) and endoscopic (124/412, 30.1%) remission, and most respondents (246/396, 62.1%) reported performing endoscopic assessment within 3-6 months after advanced treatment initiation. Conclusions: This international survey demonstrates substantial heterogeneity in pouchitis diagnosis, monitoring, and treatment, highlighting important gaps in standardized disease assessment and treatment strategies. The findings support the need for consensus-based approaches and prospective, pouch-specific studies to improve the standardization of pouchitis care.