BACKGROUND:Individuals with inflammatory bowel disease (IBD) often modify their diet to manage symptoms; however, these behaviors may evolve into eating disorders, including avoidant/restrictive food intake disorder (ARFID). We assessed the risk of eating disorders and ARFID in patients with IBD compared with healthy controls (HC), explored differences by age at diagnosis, and examined associations with malnutrition and disability. METHODS:In this cross-sectional study, adult patients with confirmed IBD, stratified by pediatric- vs adult-onset, were matched with HC. ARFID risk was assessed using the Nine-Item ARFID Screen (NIAS-9) and eating disorders risk with the Eating Attitudes Test-26 (EAT-26). Nutritional status was evaluated with the Patient-Generated Subjective Global Assessment (PG-SGA) and disability with the IBD-Disk and modified IBD-Disk. RESULTS:A total of 706 participants completed questionnaires (355 IBD, 351 HC). Eating disorder risk did not differ between groups (11.3% vs 10.8%, P = .91). ARFID risk was higher in IBD (13.5% vs 5.7%, P < .001), with more fear-driven eating (P < .001) and lower picky eating (P < .001) and appetite scores (P = .033). ARFID risk did not differ by age at onset (P = .39). Independent associated factors included active disease (odds ratio [OR] 2.34, 95% confidence interval [CI] 1.10-5.01), malnutrition (OR 2.31, 95% CI 1.04-5.13), dietary changes (OR 4.32, 95% CI 1.92-9.74), and eating disorder risk (OR 7.47, 95% CI 2.95-18.90). Even in remission, ARFID risk remained elevated compared to HC (10.1% vs 5.7%, P = .03). CONCLUSIONS:ARFID risk in IBD is nearly twice that of HC and strongly associated with disease activity, malnutrition, and disability, supporting the importance of ARFID screening in routine IBD care.

BACKGROUND:Transmural healing (TH) has emerged as a therapeutic target in Crohn's disease (CD), providing a more comprehensive indicator of deep remission than mucosal healing alone. Intestinal ultrasound (IUS) is a noninvasive method for assessing TH, but its prognostic value remains insufficiently defined. OBJECTIVE:The aim of this prospective study was to evaluate whether early improvement in IUS parameters during biological therapy could predict TH at 12 months. DESIGN:This is a prospective multicenter study enrolling CD patients initiating biological therapies. IUS and Doppler parameters were assessed at baseline, 3 months, and 12 months. Delta (Δ) represented the variation in ultrasound measurements between baseline and 3 months. TH was defined as normalization of bowel wall features and absence of hypervascularization. RESULTS:A total of 142 CD patients were included. At 12 months, the TH rate was 19%, the IUS response rate was 44%. Patients achieving TH showed a significantly greater ΔBWT than nonresponders (P = .0004). On ROC analysis, a ΔBWT reduction of 1.25 mm predicted TH with 73% sensitivity and 61% specificity. IUS responders had a significantly greater ΔBWT than nonresponders (P < .0001), with the same threshold predicting response with 83% sensitivity and 57% specificity. Notably, the combination of ΔBWT and Limberg score improvement was strongly associated with both TH (OR 13.26; P < .0001) and IUS response (OR 20.9; P < .0001) at 12 months. CONCLUSION:Early reduction in BWT, especially when combined with Limberg score, is a strong predictor of TH and IUS response at 12 months, supporting the use of early IUS monitoring in clinical practice.

AIM:to assess the effectiveness and safety of Risankizumab (RZB) in a large, nationwide real-world cohort of Crohn's disease (CD) patients. METHODS:We conducted a multicentre, retrospective observational cohort of adults initiating RZB with assessments at weeks 12, 26, and 52. Co-primary endpoints were (i) week-12 steroid-free clinical remission (SFCR) (HBI <5 in the absence of systemic corticosteroids or budesonide) and (ii) week-52 endoscopic remission (SES-CD 0-2 or Rutgeerts i0-i1 post-operatively). The main effectiveness analysis was as-observed; a preplanned sensitivity analysis included patients expected to reach week-52 before database lock and applied non-responder imputation. RESULTS:We included 520 patients, 45.0% failed ≥3 and 54.8% were ustekinumab-exposed. At week 12, clinical response was 76.5% and 60.8% achieved SFCR. By week 52, SFCR was 65.6%; endoscopic remission occurred in 37.5%, while radiologic remission and transmural healing were 24.6% and 9.8%, respectively. Ustekinumab-naïve patients showed significantly superior early clinical outcomes (week-12 SFCR: 69.8% vs 53.3%) and a higher rate of endoscopic remission at week 52 (56.5% vs 28.6%) compared with ustekinumab-exposed patients. Notably, week-52 effectiveness was comparable between patients with 2 and those with ≥3 prior failures. Extra-intestinal manifestations decreased over time, while perianal disease improved modestly. In the sensitivity cohort (N = 213), SFCR was 47% at week-52. Risankizumab was well-tolerated with no new safety signals identified. CONCLUSIONS:In a large, refractory, real-world CD population, RZB induced rapid and sustained favorable clinical, endoscopic, and radiologic outcomes. Importantly, one-year effectiveness was similar in patients with 2, and ≥3 prior failures, supporting RZB as a valuable option for a refractory population.

Background and study aims Pan-enteric capsule endoscopy (CE) provides a comprehensive mucosal assessment of both the small bowel and colon in Crohn's disease (CD). However, its incremental impact on structured clinical decision-making and inter-observer agreement remains insufficiently defined. We aimed to evaluate whether the availability of CE findings influences therapeutic decisions, risk stratification and monitoring strategies in patients with CD. Patients and methods We performed a multicentre, retrospective, paired case-based study including 50 real-world CD cases (35 adults, 15 paediatric). For each case, two anonymised vignettes were generated: one incorporating clinical, biochemical and cross-sectional imaging data without CE, and one additionally including CE findings. Ten experienced inflammatory bowel disease (IBD) gastroenterologists (six adult, four paediatric) independently reviewed all vignettes in randomised order using a structured questionnaire. The primary outcome was change in therapeutic decision-making after disclosure of CE findings. Secondary outcomes included changes in risk stratification, assessment of treatment efficacy, timing of follow-up, confidence in decision-making and inter-observer agreement. Results Access to CE findings significantly modified risk assessment and treatment selection. Overall, 53.3% of risk-stratification responses and 56.7% of treatment decisions changed, with a consistent shift towards higher perceived risk and treatment escalation (p < 0.0001 for both). CE also altered monitoring strategies, increasing reliance on endoscopic/CE-based assessment (change rate 36.7%; p < 0.0001), and modestly shortened planned follow-up intervals (change rate 18.5%; p = 0.0366). Confidence scores showed no significant overall shift (p = 0.2700), despite 41.6% of individual ratings changing. Inter-observer agreement improved from fair to moderate across several domains when CE results were available. No cases with isolated colonic CD were included in the final case set, and no capsule retention occurred in the included cohort. Conclusions In this multicentre paired case-based study, pan-enteric CE substantially influenced risk stratification, treatment selection and monitoring plans in CD, while improving inter-observer agreement across several decision domains. These findings indicate that CE meaningfully affects structured clinical decision-making in selected patients, particularly when small-bowel involvement is suspected or when conventional investigations are discordant. Prospective longitudinal studies are needed to determine whether CE-guided decisions translate into improved clinical outcomes.

Intestinal ultrasound (IUS) and CT-enterography (CTE) are accurate diagnostic modalities in Crohn’s disease (CD), but their role in surgical planning for complicated cases in urgent settings has not been fully established. This study aims to evaluate the diagnostic accuracy of IUS–CTE and the impact on surgical planning in patients with complicated CD requiring urgent intervention. We conducted a prospective study including CD cases urgently hospitalized between 2022 and 2025 who underwent surgery due to bowel complications. Each patient underwent both IUS/CTE within 3 days, with surgical intervention within 1 month. Diagnostic accuracy was assessed by comparing imaging findings with intraoperative observations, considered as the reference standard. Surgeons were asked to define their intended surgical approach based on both IUS–CTE findings. The concordance between IUS- and CTE-guided strategies was assessed using Cohen’s kappa (κ) coefficient. The differential impact on surgical decision-making was quantified using the Number Needed to Diagnose ratio. Statistical analyses were performed using SPSS software, with p-values < 0.05 considered statistically significant. A total of 51 cases were enrolled (behavior B1–B2–B3: 3–31–17; location: L1–L2–L3–L4: 14–1–36–0; prior surgery: 25 cases). All patients underwent bowel resection. Stricturoplasty was performed in 4 cases, and a temporary stoma was required in 4. For the detection of strictures, IUS demonstrated a sensitivity of 78%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 55%, with a diagnostic accuracy of 82%. CTE had a sensitivity of 100%, specificity of 90%, PPV of 97%, NPV of 100%, and an accuracy of 98%. About abscess detection, IUS achieved 100% sensitivity and specificity; CTE demonstrated 100% sensitivity, 95% specificity, 67% PPV, 100% NPV, and an accuracy of 96%. For the detection of fistulas, IUS had a sensitivity of 78%, specificity of 100%, PPV of 100%, and NPV of 92%. CTE showed a sensitivity of 72%, specificity of 96%, PPV of 92%, NPV of 86%, and a diagnostic accuracy of 88%. In terms of surgical planning, IUS influenced the strategy in 64% of cases, compared with 76% for CTE (NND ratio: 19%), with agreement between the two modalities (κ = 0.72; p < 0.01). The discrepancies were observed in defining the extent of resection, particularly among patients with extensive-multifocal involvement. Surgeons considered the 19% NND ratio and 28% disagreement rate between IUS- and CTE-guided surgical strategies as clinically significant for operative decision-making. IUS-CTE are accurate imaging modalities for detecting complications in CD.CTE provides a significant advantage over IUS in guiding surgical planning during the preoperative diagnostic work-up of cases urgently admitted with complicated CD. References: 1. Kucharzik T, Tielbeek J, Carter D, Taylor SA, Tolan D, Wilkens R, Bryant RV, Hoeffel C, De Kock I, Maaser C, Maconi G, Novak K, Rafaelsen SR, Scharitzer M, Spinelli A, Rimola J. ECCO-ESGAR Topical Review on Optimizing Reporting for Cross-Sectional Imaging in Inflammatory Bowel Disease. J Crohns Colitis. 2022 May 10;16(4):523-543. doi: 10.1093/ecco-jcc/jjab180. PMID: 34628504. 2. Pruijt MJ, de Voogd FAE, Montazeri NSM, van Etten-Jamaludin FS, D’Haens GR, Gecse KB. Diagnostic Accuracy of Intestinal Ultrasound in the Detection of Intra-Abdominal Complications in Crohn’s Disease: A Systematic Review and Meta-Analysis. J Crohns Colitis. 2024 Jun 3; 18 (6): 958-972. doi: 10.1093/ecco-jcc/jjad215. PMID: 38173288; PMCID: PMC11147796. 3. Verdalle-Cazes M, Charpentier C, Benard C, Joly LM, Dacher JN, Savoye G, Savoye-Collet C. Abdominopelvic CT-scan in emergency departments for patients with suspected complications of Crohn’s disease: a single tertiary center experience. BMC Emerg Med. 2021 Oct 7; 21 (1): 113. doi: 10.1186/s12873-021-00512-5. PMID: 34620106; PMCID: PMC8496012. 4. Bartlett DJ, Ramos GP, Fletcher JG, Bruining DH. Imaging Evaluation of Inflammatory Bowel Disease Complications. Gastrointest Endosc Clin N Am. 2022 Oct; 32 (4): 651-673. doi: 10.1016/j.giec.2022.05.001. Epub 2022 Sep 7. PMID: 36202508. 5. Bettenworth D, Bokemeyer A, Baker M, Mao R, Parker CE, Nguyen T, Ma C, Panés J, Rimola J, Fletcher JG, Jairath V, Feagan BG, Rieder F; Stenosis Therapy and Anti-Fibrotic Research (STAR) Consortium.. Assessment of Crohn’s disease-associated small bowel strictures and fibrosis on cross-sectional imaging: a systematic review. Gut. 2019 Jun; 68 (6): 1115-1126. doi: 10.1136/gutjnl-2018-318081. Epub 2019 Apr 3. PMID: 30944110; PMCID: PMC6580870. Conflict of interest: Dr. Guarino, Alessia Dalila: No conflict of interest Luglio, Gaetano: No conflict of interest Camera, Luigi: No conflict of interest Rispo, Antonio: No conflict of interest Tropeano, Francesca Paola: No conflict of interest Testa, Anna: Consultant /Advisory board for Abbvie, J & J, Takeda, Ferring Nardone, Olga Maria: Advisory board fees from Eli Lilly, Nestlè, Janssen Speaker fees from AbbVie, Janssen, Eli Lilly, Ferring, Alfa Sigma, Recordati, Noòs, and Pfizer Zoretti, Aniello: No conflict of interest Sommella, Laura: No conflict of interest Calabrese, Giulio: Travel grant by Johnson and Johnson Speaker fee by Celltrion Bonacci, Livio: No conflict of interest Leo, Camilla: No conflict of interest Palumbo, Flavia: No conflict of interest Orabona, Chiara: No conflict of interest Petolicchio, Martina: No conflict of interest Castiglione, Fabiana: Honoraria from: Takeda, AbbVie, Celltrion, Johnsson Johnsson, Cadigroup, Sandoz, Pfizer, Lilly, Lionhealth, Nestlè

Background/Objectives: Intestinal ultrasound (IUS) is a non-invasive and reliable technique for the assessment and monitoring of ulcerative colitis (UC) in the era of tight disease control, although its accuracy is reduced for rectal evaluation. Its utility is further enhanced by transperineal ultrasonography (TPUS) and has also been demonstrated in patients with acute severe ulcerative colitis (ASUC) and in the postoperative assessment of ileal pouch function. Methods: We performed a narrative review on the emerging applications of IUS in UC with the findings obtained from research on the abovementioned topic on the PubMed database. Our search terms were “inflammatory bowel disease”, “IBD”, “ulcerative colitis”, “intestinal ultrasound”, “TPUS”, “HH”, “point of care ultrasound”, and “bowel ultrasound”. Results: IUS can assess UC disease activity and could be used in monitoring treatment response. Rectal assessment may represent a limitation of standard IUS, but the use of TPUS can overcome this issue, thus also allowing pouch evaluation after surgery. Another emerging application of IUS is in ASUC, a potential life-threatening condition where complete endoscopic assessment may not be feasible, so IUS could be a valid technique to assess disease extension and, in the first days, response to rescue therapy. Moreover, the use of hand-held sonography (HH), with portable ultrasonographic devices allowing point-of-care, bedside examination in various settings, is rising, showing accuracy comparable to standard techniques. Conclusions: IUS is emerging as a valuable tool in the management of patients with UC and could be an attractive option for point-of-care evaluation in the diagnosis, monitoring and prediction of long-term disease course, even after surgery or in the setting of ASUC. Complementary tools, such as TPUS and hand-held ultrasound, represent promising technologies, requiring prospective multicenter validation before routine clinical implementation.

BACKGROUND:Intestinal ultrasound (IUS) is increasingly valuable in inflammatory bowel disease (IBD) management. OBJECTIVE:This study aimed to determine the learning curve for basic and advanced IUS parameters and establish the minimum number of examinations required for diagnostic proficiency. DESIGN:We conducted a prospective, multicenter study across eight Italian tertiary IBD centers. Eight gastroenterology trainees with extensive abdominal ultrasound experience but limited IUS exposure completed standardized training comprising theoretical education, 30 supervised examinations, and 99 independent assessments. Expert sonographers independently and blindly reassessed all independent examinations using identical protocols. Interobserver agreement was quantified using Cohen's kappa coefficients across 12 predefined categories, stratified into basic (bowel wall thickness, vascularity, stratification) and advanced (fistulas, collections, strictures) findings. RESULTS:Following initial training, trainees demonstrated substantial baseline competency. Basic parameters achieved consistently high performance throughout the study period (from κ = 0.792 to κ = 0.842), while advanced findings showed more pronounced learning curves, improving from κ = 0.728 to κ = 0.854. Small bowel dilation exhibited the steepest learning trajectory (κ = 0.674 to κ = 0.921, 36.6% improvement, P = .204). Sustained primary competence (κ ≥ 0.8) was achieved by 37.5-62.5% of trainees for basic parameters within 99 examinations, with bowel wall stratification proving most challenging (37.5% success rate). CONCLUSION:This study establishes the first comprehensive, parameter-specific learning thresholds for IUS competency in IBD. Our findings demonstrate that structured training enables basic IUS proficiency within 69-112 examinations for experienced ultrasonographers, while advanced skills require extended practice. These data represent an important step toward defining evidence-based benchmarks for IUS training, supporting the development of standardized international curricula and safe clinical implementation.

Disability is increasingly recognised as a relevant long-term endpoint in inflammatory bowel disease (IBD), yet its prognostic value in clinical practice remains underexplored. Accordingly, we aimed to characterize the longitudinal trajectories of disability over time in patients with IBD. This prospective multicenter study included IBD patients previously enrolled in the IBD-Disk validation cohort and followed for 24 months. Disability was assessed using the IBD-Disk. Moderate-to-severe disability was defined as a global score >40 (1,2). Demographic and clinical characteristics, including therapy, were collected at baseline. Patients’ disability was reassessed at 24 months. Clinical relapse, IBD-related hospitalisations, and therapeutic sequencing were also recorded Of the 402 patients initially enrolled, 304 (75.6%) completed the 24-month follow-up. Of these, 170 (55.9%) had ulcerative colitis (UC) and 134 (44.1%) Crohn’s disease (CD). At baseline, 131 patients (43.1%) with moderate-to-severe disability showed higher rates of clinically active disease compared with those with mild disability (60.3% vs 39.9%; p = 0.001). After 24 months, disability trajectories varied across patients. Among those with mild disability at baseline, 40 of 173 (23.1%) progressed to moderate-to-severe disability, while 59 of 131 (45.0%) with moderate-to-severe disability improved to mild disability [Fig. 1]. Nevertheless, the overall pattern of trajectories did not show significant directional asymmetry (McNemar test χ²=3.27, p = 0.070). Baseline moderate-to-severe disability was strongly associated with clinical relapse at 24 months (HR 2.37; 95% CI 1.39–4.06; p = 0.002), and this association remained significant after adjusting for sex, type of IBD, age, biological therapy, active disease, and extraintestinal manifestations. Moderate-to-severe disability also predicted IBD-related hospitalisations (HR 3.10; 95% CI 1.15–8.39; p = 0.026). In contrast, no independent association was observed between moderate-to-severe disability and treatment sequencing (HR 1.31; 95% CI 0.84–2.03; p = 0.23), although a trend toward significance was observed [Fig. 2]. Notably, treatment sequencing was strongly associated with active disease (HR 0.53; 95% CI 0.34–0.82; p = 0.004). Overall, 14 patients (4.6%) underwent surgery at 24 months, with no significant difference between patients with moderate-to-severe and mild disability (7.6% vs 2.3%; p = 0.055). Moderate-to-severe disability was independently associated with a higher risk of clinical relapse and IBD-related hospitalisation over 24 months, supporting its role as a measure of comprehensive and sustained disease control. References: 1. Tadbiri S, et al. The IBD-disk Is a Reliable Tool to Assess the Daily-life Burden of Patients with Inflammatory Bowel Disease. Journal of Crohn’s and Colitis. 2021 May 4;15(5):766–73. 2. Tannoury J, et al. Determinants of IBD-related disability: a cross-sectional survey from the GETAID. Aliment Pharmacol Ther. 2021 May;53(10):1098–107. Conflict of interest: Dr. Nardone, Olga Maria: Advisory board fees from Eli Lilly, Nestlè, Janssen Speaker fees from AbbVie, Janssen, Eli Lilly, Ferring, Alfa Sigma, Recordati, Noòs, and Pfizer Calabrese, Giulio: Travel grant by Johnson and Johnson Speaker fee by Celltrion Caprioli, Flavio: Flavio Caprioli served as consultant to: Abbvie, Amgen, MSD, Takeda, Janssen, Roche, Celgene, Bristol-Meyers Squibb, Galapagos, Gllead, Pfizer, Mundipharma, Biogen, Ferring, Eli-Lilly, Nestlè, Lionhealth, AlfaSigma, Dr Falk, Celltrion, Abivax. He received lecture fees from Abbvie, Ferring, Takeda, Allergy Therapeutics, Janssen, Pfizer, Biogen, Sandoz, Tillotts Pharma, Vifor Pharma, AlfaSigma, Celltrion, Eli-Lilly. and unrestricted research grants from Giuliani, Sofar, MSD, Takeda, Abbvie, Celltrion, Pfizer, Actial. Fantini, Massimo Claudio: MCF has acted as a consultant for: AbbVie, AlfaSigma, Celgene, Celltrion, Gilead, Pfizer, MSD, Bristol-Meyer, Takeda, Johnson & Johnson, Roche, Galapagos, Biogen, Sandoz, Eli-Lilly, Lionhealth, Teva, Giuliani, Dr Falk Pharma, Sanofi he has received financial support for research from Johnson & Johnson and Pfizer. Onali, Sara: Consultant/lecture fees to: Abbvie, Alfasigma, MSD, Takeda, J & J, Galapagos, Pfizer, Eli Lilly Orlando, Ambrogio: Advisory board and/or lecture fees for: AbbVie, Galapagos, Celltrion, MAD, Sofar, Pfizer, Takeda, Cadigroup, Sandoz, Janssen, Eli-Lilly, Alfasigma Savarino, Edoardo Vincenzo: Personal Fees: Takeda, Abbvie, MSD, Janssen, Sofar Variola, Angela: Consultant for Abbvie, Alfasigma, Celltrion, Eli-Lilly, Johnson and Johnson, Takeda, Pfizer Speaker fee for Abbvie, Alfasigma, Celltrion, Eli-Lilly, Johnson and Johnson, Ferring, Takeda, Pfizer, Zamboni Vastarella, Josephine: No conflict of interest to declare Guarino, Alessia Dalila: No conflict of interest Rispo, Antonio: None Testa, Anna: Consultant /Advisory board for Abbvie, J & J, Takeda, Ferring Castiglione, Fabiana: Honoraria from: Takeda, AbbVie, Celltrion, Johnsson Johnsson, Cadigroup, Sandoz, Pfizer, Lilly, Lionhealth, Nestlè

Background/Objectives: Data on the real-world effectiveness and safety of selective JAK inhibitors (JAKis) in ulcerative colitis (UC) and Crohn’s disease (CD) are limited. Methods: We conducted a multicentre, retrospective study to assess clinical, biochemical, and endoscopic outcomes of selective JAKis in bio-experienced UC and CD. Results: A total of 246 patients (mean age: 40.5 ± 14.5 years; 131 UC and 115 CD) were included with a median follow-up of 7.5 months. Among the CD patients receiving upadacitinib (n = 115), 76.2% achieved clinical remission (CR) at week 12. Furthermore, 59.5% of the upadacitinib-treated UC patients (n = 100) experienced CR at week 8. Corticosteroid-free CR (CSFCR) was achieved by 76.9% of the CD patients and 80.6% of the UC patients at week 24, while 50.0% and 36.1% experienced endoscopic remission. At week 52, 66.7% of the CD and 86.2% of the UC patients achieved CSFCR, whereas 54.5% and 52.9% had endoscopic remission. In UC, the effectiveness of upadacitinib was not compromised by prior tofacitinib failure, while the upadacitinib-treated CD patients with stricturing and penetrating disease were less likely to achieve CR by the end of the induction phase (p = 0.04). C-reactive protein (p[CD] < 0.0001; p[UC] < 0.0001) and faecal calprotectin (p[CD] < 0.0001; p[UC] = 0.02) decreased significantly in both patient groups as early as week 2. Among the filgotinib-treated UC patients (n = 31), 28.6% were in CR at week 12. At week 24 and 52, 59.1% and 60% achieved CSFCR, while 0.0% and 20.0% had endoscopic remission. Both C-reactive protein (p = 0.04) and faecal calprotectin (p = 0.04) decreased significantly by week 12. Hyperlipidaemia (9.7–9.8%) was the most common adverse event. Conclusions: Selective JAKis are rapidly effective and safe for treating refractory, moderate-to-severe CD and UC.

Background Postoperative recurrence (POR) occurs in up to 70% of patients with Crohn's disease (CD). The Rutgeerts score (RS) system may overestimate the prevalence of “real” anastomotic recurrence. Hence, we aimed to compare the prevalence of anastomotic POR in CD and the presence of ulcers at anastomotic sites in patients with right-side resection for colonic cancer (CC). Methods We retrospectively selected CD and CC patients with right-side resection and anti-peristaltic stapled L-L anastomosis from 5 tertiary referral centers. All patients underwent endoscopy within 8 months of surgery. POR was scored according to the modified RS. We directly compared the prevalence of isolated anastomotic ulcers in CD (Rutgeerts i2A) and CC patients. Results We enrolled 221 CD patients and 72 CC subjects. POR was recorded in 127 CD patients (57%). Endoscopy detected anastomotic ulcers in two of the 72 CC patients (3%), one (1.4%) being early local recurrence. The presence of isolated ulcerations was significantly higher in CD patients compared to CC (19% vs 3%; p < 0.01;OR 6.3). Conclusions The prevalence of anastomotic (presumed ischemic) ulcers in CC patients is very low, but if shifted into the POR of CD, this is not representative of a real diagnostic matter. Prospective, multicenter, and direct comparative studies are needed to confirm our results.

INTRODUCTION:Inflammatory bowel disease (IBD) poses significant clinical challenges due to its chronic, disabling nature. Despite established guidelines, care standards remain inconsistent globally. In 2020, the European Crohn's Colitis Organisation (ECCO) developed quality-of-care standards. The Italian Group for the Study of IBD (IG-IBD) aimed to adapt those recommendations to Italy. METHODS:A 42-member interdisciplinary panel used a Delphi consensus to evaluate and modify ECCO statements and levels of importance, incorporating patient representatives and regional experts. Those statements were revised, some missing statements were added, and a two-round voting session was held among participants. Agreement ≥80 % was needed to approve a statement. RESULTS:From 101 ECCO statements, 112 tailored criteria were developed. In comparison to the ECCO statements, 80 were confirmed with the same level of importance, 9 were confirmed with different levels of importance, 9 points were merged in a broader statement, 3 points were dropped out during the two voting rounds, and 12 were added as new points. CONCLUSION:The adapted standards provide a framework for standardizing IBD care in Italy. This model might help other countries in aligning with ECCO standards.

Managing extraintestinal manifestations (EIMs) in inflammatory bowel disease (IBD) patients remains challenging due to considerable heterogeneity in diagnostic criteria and the lack of a standardised definition and validated diagnostic pathways. Delays in recognising and treating EIMs can lead to significant disease progression. Therefore, early detection and treatment are crucial. We aimed to assess the effectiveness of a dedicated immune-mediated inflammatory diseases (IMIDs) clinic in reducing EIM diagnostic delays and improving patients' outcomes. A single-centre observational study was conducted, including IBD patients presenting with EIMs red flags. We compared the EIMs diagnostic delay between patients who attended a multidisciplinary IMID outpatient clinic (IMID-G) and those who attended individual referral specialists representing the standard outpatient clinic group (SOC-G). We further evaluated the impact of diagnostic timing on 18-month clinical outcomes, including therapeutic changes, steroid and immunosuppressant use and biological therapy switch/swap. We enrolled 238 IBD patients, 127 in the IMID-G and 111 in the SOC-G. The average time to EIM diagnosis was 2.48 ± 1.8 and 5.36 ± 2.3 months for the IMID and SOC-Gs (Δ = 2.88 months, p = 0.005). The majority of patients received a diagnosis of peripheral arthritis (IMID-G = 37.5%; SOC-G = 33.7%) and spondyloarthropathy (IMID-G = 32.1%; SOC-G = 33.7%). No significant difference was observed in the rates of EIMs between the two groups (88.2% in IMID-G vs 92.8% in SOC-G, p = 0.27). Regarding therapeutic changes, the IMID-G reported a mean time to the first therapeutic change driven by the specialist referral of 2.96 ± 1.8 months, compared to 6.09 ± 2.5 months in the SOC-G, showing a significant difference (p = 0.007). The IMID-G had a higher frequency of biological therapy switching/swapping and adding immunosuppressive treatment than the SOC-G (p = 0.008 and p = 0.04, respectively). Survival curves revealed a significant reduction in diagnostic delay and time to treatment in the IMID-G compared to the SOC-G (log-rank test, p < 0.001). Attending a dedicated IMID clinic can enhance the diagnostic process for EIMs in IBD patients, thereby reducing diagnostic delays and allowing early interventions to avoid disease progression.

Abstract Background The prevalence of obesity in inflammatory bowel disease (IBD) has risen, with 15–40% of adults classified as obese and an additional 20–40% as overweight1. Poor dietary habits and sedentary lifestyles contribute to overweight and sarcopenia, potentially worsening IBD-related disability. This study aimed to evaluate the relationships between nutritional status, adherence to the Mediterranean diet, sarcopenia and disability in IBD patients. Methods This cross-sectional study included consecutive IBD patients attending an outpatient clinic or infusion unit between 2023-2024. Bioelectrical impedance analysis (BIA) was used to estimate the fat-free mass index (FFMI), a recognized measure of skeletal muscle mass. Physical function was assessed via gait speed (time to walk 6 meters), and handgrip strength (HGS) measured using a Jamar dynamometer. Sarcopenia was diagnosed based on FFMI, HGS, and walking speed. Disability was evaluated using the IBD-Disk questionnaire, with scores ≥40 indicating moderate-to-severe disability. Adherence to the Mediterranean diet was assessed using the Medi-Lite score, with scores <9 reflecting low adherence. Demographic, clinical, and disease-related data were collected Results A total of 95 IBD patients (58% with Crohn’s disease, CD), 57.8% female, with a median age of 42 years (IQR 26-58) were included. Clinical activity ,measured with the Harvey-Bradshaw index (HBI) had a median score of 6 (IQR 4–7) for CD, while the median pMayo score for ulcerative colitis (UC) was 4 (IQR 2–6). The median BMI was 23.60 (IQR 21-27). Overweight prevalence was 43.2% (41/95). Low adherence to the Mediterranean diet was significantly more frequent in overweight patients compared to non-overweight patients (p<0.001). Overweight was also associated with increased age (p < 0.001). Sarcopenia prevalence was 7% (7/95) and was more common in non-overweight patients than in overweight patients (p = 0.002). The median BMI among sarcopenic patients was 20.6 (18.5–25.3). The mean IBD-Disk score was 41 ± 23.2, with 46.3% of patients reporting moderate-to-severe disability. Overweight patients were more likely to experience moderate-to-severe disability compared to non-overweight patients [27 (65.9%) vs. 23 (42.6%), p = 0.02]. No significant association was found between sarcopenia and moderate-to-severe disability (p = 0.44). Conclusion Overweight is associated with low adherence to the Mediterranean diet and increased disability in IBD patients. Targeted interventions to improve adherence to the Mediterranean diet and manage overweight could potentially reduce disability in IBD patients. References 1.Singh S et al, Obesity in IBD: epidemiology, pathogenesis, disease course and treatment outcomes, Nat Rev Gastroenterol Hepatol. 2017 February ; 14(2): 110–121