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.

The use of advanced therapies, including biologics and small molecules, has become an established clinical practice for the treatment of moderate-to-severe ulcerative colitis (UC) and Crohn’s disease (CD). However, certain patient populations, such as those with a history of cancer, are often excluded from clinical trials evaluating the efficacy and safety of these therapies. This exclusion has historically left clinicians with limited evidence to guide treatment decisions in this high-risk group. Nevertheless, emerging real-world data and updated guidelines increasingly support the safe use of advanced therapies in patients with a prior malignancy. Risk stratification and a multidisciplinary approach, including oncologist input, remain critical in optimizing patient outcomes by assessing both cancer recurrence risk and disease activity. This review aims to provide a comprehensive overview of the current evidence, address existing knowledge gaps, and offer practical insights for the management of IBD in patients with a history of cancer.

Personalized medicine is increasingly shaping the management of inflammatory bowel disease (IBD), with the goal of tailoring diagnostic and therapeutic strategies to individual patients. Intestinal ultrasound (IUS) has emerged as a pivotal, non-invasive, and repeatable tool for assessing disease activity, treatment response, and complications in both Crohn’s disease and ulcerative colitis. Beyond its role in routine monitoring, IUS enables real-time decision-making and facilitates tight control strategies, aligning with the principles of precision medicine. By combining morphological assessment with advanced techniques, such as contrast-enhanced ultrasound and elastography, IUS offers unique opportunities for risk stratification and individualized treatment planning. Moreover, its accessibility, safety, and patient acceptability make IUS particularly suited for longitudinal follow-up and early detection of therapeutic failure, thereby reducing the need for invasive procedures. This review discusses the integration of IUS into personalized IBD care pathways, highlighting current evidence, clinical applications, and future perspectives.

Inflammatory bowel diseases (IBDs), including ulcerative colitis (UC) and Crohn’s disease (CD), are consistently associated with alterations in gut microbial communities, although the extent and characteristics of these alterations vary across studies, supporting a potential role of the microbiota in disease pathogenesis and therapeutic modulation. We conducted a systematic review to synthesize current evidence on microbiota alterations in IBD and the clinical application of fecal microbiota transplantation (FMT). A total of 118 studies were included (76 focused on microbiota profiling and 42 evaluated FMT as therapy). Across heterogeneous study designs and microbial characterization methods, reduced microbial diversity was the most consistently reported alteration, generally more pronounced in CD than in UC. Depletion of Faecalibacterium prausnitzii—a key butyrate producer with anti-inflammatory properties—was commonly reported, often accompanied by functional impairment in short-chain fatty acid production. Microbial patterns were frequently associated with mucosal inflammation and varied across disease phenotypes; these patterns have been increasingly explored as predictors of treatment response and relapse, although mechanistic interpretation remains limited and causal relationships are difficult to establish. Evidence from randomized controlled trials suggests potential efficacy of FMT in UC, particularly with intensive or repeated protocols, whereas data in CD remain limited and heterogeneous, with signals of benefit often appearing transient. FMT was generally well tolerated, but long-term safety data remain scarce. Emerging multi-omic approaches are reshaping the field by integrating taxonomic and functional insights, with potential implications for risk stratification, diagnosis, prognosis, and therapeutic optimization. Further standardized, longitudinal, and mechanistically oriented studies are required to translate microbiome research into clinically actionable strategies in IBD.

Background: The therapeutic paradigm of Crohn’s disease (CD) has progressively evolved from symptom control toward objective treatment targets aimed at modifying disease course. Although endoscopic mucosal healing (MH) is currently regarded as a major treatment goal, it may inadequately reflect residual inflammation in a condition characterized by transmural bowel involvement. Consequently, transmural healing (TH), assessed through cross-sectional imaging modalities, has emerged as a potential marker of deeper disease control. Methods: A comprehensive literature review was conducted to identify studies evaluating the definition, assessment, prognostic significance, and achievability of TH in CD. Original studies, randomized controlled trials, systematic reviews, consensus statements, and international guidelines were included. Results: Accumulating evidence indicates that TH is associated with superior long-term outcomes compared with MH alone, including lower risks of hospitalization, surgery, treatment escalation, disease relapse, and bowel damage progression. However, substantial heterogeneity persists regarding the definition of TH across imaging modalities, with intestinal ultrasound and magnetic resonance enterography representing the principal tools for its assessment. Available data suggest that TH can be achieved in a meaningful proportion of patients receiving advanced therapies, particularly when treatment is initiated early in the disease course, although rates vary considerably according to therapeutic class, disease characteristics, and the definition adopted. Emerging technologies may further refine the assessment of transmural disease activity. Conclusions: TH represents a promising therapeutic target that may better capture the full burden of inflammation in CD than mucosal endpoints alone. Future efforts should focus on harmonizing imaging criteria and determining whether targeting TH can translate into meaningful disease modification and improved long-term outcomes.

Inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, are characterized by marked heterogeneity, challenging disease monitoring and individualized treatment. Despite advances in treat-to-target strategies, unmet needs persist, particularly in assessing transmural healing and optimizing therapeutic decisions. This narrative review evaluates the role of intestinal ultrasound (IUS) as a key tool for precision medicine in IBD. IUS is a non-invasive, repeatable, and cost-effective imaging modality with diagnostic accuracy comparable to endoscopy and magnetic resonance enterography, with reported sensitivities and specificities frequently exceeding 80–90% for detecting active disease. It enables real-time assessment of transmural inflammation and complications, while parameters such as bowel wall thickness and Doppler vascularity support prognostic stratification. Early reductions in bowel wall thickness (≥25–30%) have been associated with improved treatment response, allowing identification of responders within weeks of therapy initiation. IUS informs therapeutic decision-making, including initiation, optimization, and de-escalation of advanced therapies, and may reduce reliance on invasive procedures. Integration into routine care has been associated with improved disease control and cost-effectiveness. Standardization of protocols, operator training, and prospective validation are required to establish IUS as a cornerstone of precision medicine in IBD.