Intestinal organoids have emerged as powerful in vitro system for studying epithelial biology in a tissue-relevant context. Derived from adult stem cells or patient-specific induced pluripotent stem cells, these three-dimensional structures recapitulate key features of the intestinal epithelium, including crypt-villus architecture, cellular diversity, and functional barrier properties. Recent advances have enabled the modeling of gut inflammation using organoids through defined cytokine stimulation, co-culture with immune cells, and exposure to microbial components. These approaches have provided insights into epithelial barrier dysfunction, immune–epithelial crosstalk, and disease-specific responses, particularly in inflammatory bowel disease. Innovations such as gene-editing technologies, single-cell and spatial transcriptomics, and microengineered platforms like organoid-on-chip systems have advanced organoid-based research in various contexts, laying a strong foundation for their future application in modeling inflammation. Despite these advances, challenges remain in achieving long-term immune co-culture, media compatibility, and standardized readouts. This article highlights current strategies, key limitations, and future directions for using intestinal organoids to model gut inflammation and guide translational research.
{"title":"Modeling gut inflammation using intestinal organoids: Advances, challenges, and future perspectives","authors":"Justina Guzauskiene , Deimante Valentelyte , Goda Butaite , Ugne Kulokiene , Viltaute Laukaitiene , Ruta Inciuraite , Jurgita Skieceviciene","doi":"10.1016/j.bpg.2025.102048","DOIUrl":"10.1016/j.bpg.2025.102048","url":null,"abstract":"<div><div>Intestinal organoids have emerged as powerful in vitro system for studying epithelial biology in a tissue-relevant context. Derived from adult stem cells or patient-specific induced pluripotent stem cells, these three-dimensional structures recapitulate key features of the intestinal epithelium, including crypt-villus architecture, cellular diversity, and functional barrier properties. Recent advances have enabled the modeling of gut inflammation using organoids through defined cytokine stimulation, co-culture with immune cells, and exposure to microbial components. These approaches have provided insights into epithelial barrier dysfunction, immune–epithelial crosstalk, and disease-specific responses, particularly in inflammatory bowel disease. Innovations such as gene-editing technologies, single-cell and spatial transcriptomics, and microengineered platforms like organoid-on-chip systems have advanced organoid-based research in various contexts, laying a strong foundation for their future application in modeling inflammation. Despite these advances, challenges remain in achieving long-term immune co-culture, media compatibility, and standardized readouts. This article highlights current strategies, key limitations, and future directions for using intestinal organoids to model gut inflammation and guide translational research.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"78 ","pages":"Article 102048"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145659005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.bpg.2025.102060
Sara Deleu , João Sabino
Inflammatory bowel disease (IBD), a non-communicable disease encompassing Crohn's disease and ulcerative colitis, is a chronic disorder with increasing prevalence and complex etiology. Emerging evidence highlights the gut microbiome's pivotal role in IBD pathogenesis, driving interest in microbiome-targeted therapeutic strategies. This narrative review explores the latest advancements in microbiome modulation for IBD management, encompassing antibiotics, prebiotics, probiotics, synbiotics, postbiotics, and fecal microbiota transplantation. Additionally, dietary interventions, physical activity, as well as non-bacterial microbiota components such as fungi, archaea, and bacteriophages are examined for their potential roles in restoring microbial equilibrium and mitigating intestinal inflammation. As research progresses, a multimodal approach integrating microbiota-targeted therapies with lifestyle modifications and conventional pharmacologic treatments may offer a personalized and effective strategy for IBD management.
{"title":"Cutting edge developments and novel targets in IBD: Microbiome in IBD","authors":"Sara Deleu , João Sabino","doi":"10.1016/j.bpg.2025.102060","DOIUrl":"10.1016/j.bpg.2025.102060","url":null,"abstract":"<div><div>Inflammatory bowel disease (IBD), a non-communicable disease encompassing Crohn's disease and ulcerative colitis, is a chronic disorder with increasing prevalence and complex etiology. Emerging evidence highlights the gut microbiome's pivotal role in IBD pathogenesis, driving interest in microbiome-targeted therapeutic strategies. This narrative review explores the latest advancements in microbiome modulation for IBD management, encompassing antibiotics, prebiotics, probiotics, synbiotics, postbiotics, and fecal microbiota transplantation. Additionally, dietary interventions, physical activity, as well as non-bacterial microbiota components such as fungi, archaea, and bacteriophages are examined for their potential roles in restoring microbial equilibrium and mitigating intestinal inflammation. As research progresses, a multimodal approach integrating microbiota-targeted therapies with lifestyle modifications and conventional pharmacologic treatments may offer a personalized and effective strategy for IBD management.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"78 ","pages":"Article 102060"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145659007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.bpg.2025.102054
Valentina Petito , Sara Deleu , Loris R. Lopetuso , Theresa T. Pizarro , Franco Scaldaferri
Clinical trials for inflammatory bowel disease are primarily randomized clinical trials, which have been the gold standard since the 1940s. However, these trials often focus on a specific group of patients, are expensive, and focus on one treatment option over a short period. Challenges in IBD research include environmental triggers, preclinical mechanisms, novel technologies, precision medicine, and pragmatic clinical research. Pragmatic research aims to generate evidence for real-world clinical practice by including diverse patient populations and assessing outcomes that matter to patients and healthcare providers. Advancements in biomedical research require high-quality translational research and successfully preclinical models able to convert promising laboratory results into clinical applications. Such approaches increase external validity of results, informs decision-making, optimizes care strategies, and improves outcomes for IBD patients. Specifically, increasing both internal and external validity remains a challenge in both in vitro/ex vivo and in vivo preclinical research. Therefore, we here aim to give an overview of recent advances in preclinical research models for IBD both in vitro/ex vivo and in vivo and pragmatic strategies to implement with a specific focus on microbiome research. While each model has its limitations, combining and implementing various techniques can provide a comprehensive preclinical evaluation. Advances in the field, such as personalized gut-on-a-chip models and humanized spontaneous animal models, will facilitate more pragmatic and effective strategies for identifying, evaluating, and predicting responses to potential new therapeutics in future research.
{"title":"The way forward: Towards pragmatic preclinical microbiome research in inflammatory bowel disease","authors":"Valentina Petito , Sara Deleu , Loris R. Lopetuso , Theresa T. Pizarro , Franco Scaldaferri","doi":"10.1016/j.bpg.2025.102054","DOIUrl":"10.1016/j.bpg.2025.102054","url":null,"abstract":"<div><div>Clinical trials for inflammatory bowel disease are primarily randomized clinical trials, which have been the gold standard since the 1940s. However, these trials often focus on a specific group of patients, are expensive, and focus on one treatment option over a short period. Challenges in IBD research include environmental triggers, preclinical mechanisms, novel technologies, precision medicine, and pragmatic clinical research. Pragmatic research aims to generate evidence for real-world clinical practice by including diverse patient populations and assessing outcomes that matter to patients and healthcare providers. Advancements in biomedical research require high-quality translational research and successfully preclinical models able to convert promising laboratory results into clinical applications. Such approaches increase external validity of results, informs decision-making, optimizes care strategies, and improves outcomes for IBD patients. Specifically, increasing both internal and external validity remains a challenge in both <em>in vitro/ex vivo</em> and <em>in vivo</em> preclinical research. Therefore, we here aim to give an overview of recent advances in preclinical research models for IBD both <em>in vitro/ex vivo</em> and <em>in vivo</em> and pragmatic strategies to implement with a specific focus on microbiome research. While each model has its limitations, combining and implementing various techniques can provide a comprehensive preclinical evaluation. Advances in the field, such as personalized gut-on-a-chip models and humanized spontaneous animal models, will facilitate more pragmatic and effective strategies for identifying, evaluating, and predicting responses to potential new therapeutics in future research.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"78 ","pages":"Article 102054"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.bpg.2025.102057
Mignini Irene, Iaccarino Jacopo, Esposto Giorgio, Borriello Raffaele, Galasso Linda, Coppola Gaetano, Ainora Maria Elena, Gasbarrini Antonio, Zocco Maria Assunta
Ulcerative colitis (UC) is traditionally considered a mucosal disease, with endoscopy as the gold standard for diagnosis and monitoring. However, emerging evidence increasingly supports the integration of intestinal ultrasound (IUS) as a non-invasive, accurate, and dynamic imaging modality in the management of UC. Traditionally confined to the assessment of Crohn's disease due to its transmural nature, IUS has demonstrated strong associations with clinical, endoscopic, and histologic scores in UC, enabling real-time assessment of disease activity, therapeutic response, and long-term outcomes. In this comprehensive review, we summarize the current evidence on the diagnostic and prognostic utility of IUS in UC, with a focus on validated ultrasonographic scores. Moreover, we explore novel applications of IUS in special clinical settings, including acute severe ulcerative colitis (ASUC), as well as in specific disease localizations such as proctitis and pouchitis, where transperineal ultrasound (TPUS) may offer diagnostic advantages. Furthermore, we review its emerging role in point-of-care scenarios and its utility within specific patient populations, notably pediatric patients.
{"title":"A comprehensive guide to intestinal ultrasound in ulcerative colitis","authors":"Mignini Irene, Iaccarino Jacopo, Esposto Giorgio, Borriello Raffaele, Galasso Linda, Coppola Gaetano, Ainora Maria Elena, Gasbarrini Antonio, Zocco Maria Assunta","doi":"10.1016/j.bpg.2025.102057","DOIUrl":"10.1016/j.bpg.2025.102057","url":null,"abstract":"<div><div>Ulcerative colitis (UC) is traditionally considered a mucosal disease, with endoscopy as the gold standard for diagnosis and monitoring. However, emerging evidence increasingly supports the integration of intestinal ultrasound (IUS) as a non-invasive, accurate, and dynamic imaging modality in the management of UC. Traditionally confined to the assessment of Crohn's disease due to its transmural nature, IUS has demonstrated strong associations with clinical, endoscopic, and histologic scores in UC, enabling real-time assessment of disease activity, therapeutic response, and long-term outcomes. In this comprehensive review, we summarize the current evidence on the diagnostic and prognostic utility of IUS in UC, with a focus on validated ultrasonographic scores. Moreover, we explore novel applications of IUS in special clinical settings, including acute severe ulcerative colitis (ASUC), as well as in specific disease localizations such as proctitis and pouchitis, where transperineal ultrasound (TPUS) may offer diagnostic advantages. Furthermore, we review its emerging role in point-of-care scenarios and its utility within specific patient populations, notably pediatric patients.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"78 ","pages":"Article 102057"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.bpg.2025.102059
Ulrike von Arnim , Karina Scholz
Fatigue is a burdensome, complex, and multifactorial symptom that is associated with a wide range of chronic diseases and occurs in nearly 50 % of patients with inflammatory bowel disease (IBD). Although common, physicians often fail to recognize the disabling nature of this symptom due to its subjective character and therefore treat it inadequately. Several factors can contribute to fatigue in IBD patients, including disease activity, anemia, medications, psychosomatic symptoms, and alterations in the gut–brain axis.
Managing fatigue in IBD can be challenging as it is often multidimensional. This review summarizes the available tools for diagnosing and measuring fatigue, discusses its causes, and provides treatment recommendations. We identify knowledge gaps in the diagnosis and management of fatigue and propose an algorithm to help physicians assess and treat fatigue in IBD patients. However, further research is needed to close knowledge gaps and improve fatigue management in IBD.
{"title":"Fatigue in inflammatory bowel disease","authors":"Ulrike von Arnim , Karina Scholz","doi":"10.1016/j.bpg.2025.102059","DOIUrl":"10.1016/j.bpg.2025.102059","url":null,"abstract":"<div><div>Fatigue is a burdensome, complex, and multifactorial symptom that is associated with a wide range of chronic diseases and occurs in nearly 50 % of patients with inflammatory bowel disease (IBD). Although common, physicians often fail to recognize the disabling nature of this symptom due to its subjective character and therefore treat it inadequately. Several factors can contribute to fatigue in IBD patients, including disease activity, anemia, medications, psychosomatic symptoms, and alterations in the gut–brain axis.</div><div>Managing fatigue in IBD can be challenging as it is often multidimensional. This review summarizes the available tools for diagnosing and measuring fatigue, discusses its causes, and provides treatment recommendations. We identify knowledge gaps in the diagnosis and management of fatigue and propose an algorithm to help physicians assess and treat fatigue in IBD patients. However, further research is needed to close knowledge gaps and improve fatigue management in IBD.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"78 ","pages":"Article 102059"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145659006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.bpg.2025.102051
Rossella Maresca , Giulio Calabrese , Stefano Andrea Marchitto , Tommaso Schepis , Silvia Pecere , Marcello Maida , Cristiano Spada , Sandro Sferrazza , Federico Barbaro , Olga Maria Nardone
Patients with long-standing inflammatory bowel disease (IBD) are at increased risk of developing colitis-associated neoplasia (CAN), requiring a comprehensive approach from surveillance to endoscopic management. This narrative review provides an integrated overview of the entire pathway, including surveillance strategies for dysplasia detection, characterization of lesion types, and selection of appropriate resection techniques. Real-life examples and a proposed step-up approach are presented to guide clinical practice. The choice of endoscopic resection technique depends on lesion size, morphology, and the degree of fibrosis. Conventional EMR is suitable for small, lifting lesions, while ESD is preferred for larger or fibrotic lesions to achieve en bloc resection. In addition, emerging approaches—like underwater techniques—can also provide valuable options in complex cases. However, integrating effective surveillance with personalized resection techniques is essential to improve outcomes and reduce the need for surgery in patients with IBD-associated neoplasia.
{"title":"Advanced diagnostic and resection endoscopic techniques in managing colitis-associated neoplasia: standard of care or still utopia?","authors":"Rossella Maresca , Giulio Calabrese , Stefano Andrea Marchitto , Tommaso Schepis , Silvia Pecere , Marcello Maida , Cristiano Spada , Sandro Sferrazza , Federico Barbaro , Olga Maria Nardone","doi":"10.1016/j.bpg.2025.102051","DOIUrl":"10.1016/j.bpg.2025.102051","url":null,"abstract":"<div><div>Patients with long-standing inflammatory bowel disease (IBD) are at increased risk of developing colitis-associated neoplasia (CAN), requiring a comprehensive approach from surveillance to endoscopic management. This narrative review provides an integrated overview of the entire pathway, including surveillance strategies for dysplasia detection, characterization of lesion types, and selection of appropriate resection techniques. Real-life examples and a proposed step-up approach are presented to guide clinical practice. The choice of endoscopic resection technique depends on lesion size, morphology, and the degree of fibrosis. Conventional EMR is suitable for small, lifting lesions, while ESD is preferred for larger or fibrotic lesions to achieve en bloc resection. In addition, emerging approaches—like underwater techniques—can also provide valuable options in complex cases. However, integrating effective surveillance with personalized resection techniques is essential to improve outcomes and reduce the need for surgery in patients with IBD-associated neoplasia.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"78 ","pages":"Article 102051"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.bpg.2025.102061
Emese Ivány , Bernadett Farkas , Péter Bacsur , Mariann Rutka , Noémi Gálfalvi , Klaudia Farkas (Associate Professor) , Zoltán Szepes (Professor) , Tamás Molnár (Professor)
Bowel urgency (BU) is a distressing symptom among patients with ulcerative colitis (UC), significantly impacting quality of life (QoL). Its pathophysiology is not completely understood. Despite its high prevalence, BU is not consistently assessed in clinical practice and has historically received limited attention as a research and treatment target. The aim of this narrative review was to highlight the clinical relevance of BU and to summarize current treatment approaches. Evidence suggests that mesalazine and budesonide foam may help reduce BU. Among advanced therapies, vedolizumab and Janus kinase inhibitors have demonstrated early improvements in urgency, anti-interleukin-23 antibodies have also shown promising effects. Additionally, the novel S1P receptor modulator etrasimod has been associated with symptomatic relief. Additional alternative therapies are also helpful. Despite these therapeutic options, the management of BU remains challenging. Further research and the development of targeted treatments are warranted to address this unmet clinical need.
{"title":"A narrative review on the frequency, pathophysiology and management of bowel urgency associated with ulcerative colitis","authors":"Emese Ivány , Bernadett Farkas , Péter Bacsur , Mariann Rutka , Noémi Gálfalvi , Klaudia Farkas (Associate Professor) , Zoltán Szepes (Professor) , Tamás Molnár (Professor)","doi":"10.1016/j.bpg.2025.102061","DOIUrl":"10.1016/j.bpg.2025.102061","url":null,"abstract":"<div><div>Bowel urgency (BU) is a distressing symptom among patients with ulcerative colitis (UC), significantly impacting quality of life (QoL). Its pathophysiology is not completely understood. Despite its high prevalence, BU is not consistently assessed in clinical practice and has historically received limited attention as a research and treatment target. The aim of this narrative review was to highlight the clinical relevance of BU and to summarize current treatment approaches. Evidence suggests that mesalazine and budesonide foam may help reduce BU. Among advanced therapies, vedolizumab and Janus kinase inhibitors have demonstrated early improvements in urgency, anti-interleukin-23 antibodies have also shown promising effects. Additionally, the novel S1P receptor modulator etrasimod has been associated with symptomatic relief. Additional alternative therapies are also helpful. Despite these therapeutic options, the management of BU remains challenging. Further research and the development of targeted treatments are warranted to address this unmet clinical need.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"78 ","pages":"Article 102061"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.bpg.2025.102050
Pierluigi Puca , Loris Riccardo Lopetuso , Lucrezia Laterza , Alfredo Papa , Silvio Danese , Alfredo Cesario , Andrea Damiani , Antonio Gasbarrini , Giovanni Arcuri , Franco Scaldaferri
Federated learning is an emerging paradigm in artificial intelligence that enables the training of robust models across decentralized datasets without requiring the physical transfer of sensitive data. This privacy-preserving approach has gained increasing traction in medical research, where data fragmentation and legal barriers often hinder the development of multicentric trials and AI applications.
In this review, we first provide an explanation of federated learning's process and functioning. We then provide a structured overview of its implementation in clinical research, highlighting key multicentric studies in several fields of medicine. These studies consistently demonstrate that FL achieves comparable, and in some cases superior, diagnostic and prognostic performance in comparison to centralized learning approaches, with area under the curve values often exceeding 0.80. We then consider the potential of federated learning in the context of inflammatory bowel diseases, where data heterogeneity, geographic dispersion, and patient privacy concerns currently limit the development of large-scale predictive models. In doing so, we will provide specific focus on its application in multicentric trials and basic research. Finally, aspects like semantic interoperability in federated learning and privacy issues will also be discussed.
We believe that federated learning could transform the way inflammatory bowel diseases datasets are utilized across institutions, facilitating collaborative algorithm development in areas such as treatment response prediction, endoscopic image analysis, and disease phenotyping—without compromising patient confidentiality.
{"title":"Federated learning in inflammatory bowel disease: The future of privacy-preserving Artificial Intelligence","authors":"Pierluigi Puca , Loris Riccardo Lopetuso , Lucrezia Laterza , Alfredo Papa , Silvio Danese , Alfredo Cesario , Andrea Damiani , Antonio Gasbarrini , Giovanni Arcuri , Franco Scaldaferri","doi":"10.1016/j.bpg.2025.102050","DOIUrl":"10.1016/j.bpg.2025.102050","url":null,"abstract":"<div><div>Federated learning is an emerging paradigm in artificial intelligence that enables the training of robust models across decentralized datasets without requiring the physical transfer of sensitive data. This privacy-preserving approach has gained increasing traction in medical research, where data fragmentation and legal barriers often hinder the development of multicentric trials and AI applications.</div><div>In this review, we first provide an explanation of federated learning's process and functioning. We then provide a structured overview of its implementation in clinical research, highlighting key multicentric studies in several fields of medicine. These studies consistently demonstrate that FL achieves comparable, and in some cases superior, diagnostic and prognostic performance in comparison to centralized learning approaches, with area under the curve values often exceeding 0.80. We then consider the potential of federated learning in the context of inflammatory bowel diseases, where data heterogeneity, geographic dispersion, and patient privacy concerns currently limit the development of large-scale predictive models. In doing so, we will provide specific focus on its application in multicentric trials and basic research. Finally, aspects like semantic interoperability in federated learning and privacy issues will also be discussed.</div><div>We believe that federated learning could transform the way inflammatory bowel diseases datasets are utilized across institutions, facilitating collaborative algorithm development in areas such as treatment response prediction, endoscopic image analysis, and disease phenotyping—without compromising patient confidentiality.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"78 ","pages":"Article 102050"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/S1521-6918(25)00096-4
{"title":"Copyright Information","authors":"","doi":"10.1016/S1521-6918(25)00096-4","DOIUrl":"10.1016/S1521-6918(25)00096-4","url":null,"abstract":"","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"78 ","pages":"Article 102069"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145659000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.bpg.2025.102056
Pierluigi Puca , Gaetano Coppola , Simone Parello , Ivan Capobianco , Stefania Colantuono , Franco Scaldaferri , Alfredo Papa
Inflammatory bowel diseases (IBD) are systemic inflammatory conditions increasingly recognized to confer excess risk of atherosclerotic cardiovascular disease (ASCVD), particularly in younger patients and during periods of active disease. We here synthesize evidence across epidemiology, mechanisms, risk stratification, and management at the IBD–ASCVD interface.
Across population cohorts and meta-analyses, IBD associates with modest but consistent increases in ischemic heart disease, cerebrovascular events, and peripheral arterial disease, with higher relative risks for mesenteric ischaemia and for premature events; risk escalates with inflammatory burden and flares, while traditional factors alone partially explain the association. Prolonged corticosteroid exposure correlates with adverse vascular outcomes, whereas effective control of intestinal inflammation, particularly with anti-TNF biologics, appears protective; the absolute cardiovascular risk with Janus kinase inhibitors seems largely determined by baseline risk profile and is low in appropriately selected patients.
Proposed drivers include dysbiosis and microbially derived metabolites (e.g., trimethylamine-N-oxide, imidazole propionate), intestinal barrier failure with low-grade endotoxemia and Toll-like receptor-4 activation, neutrophil- and platelet-mediated thromboinflammation, and inflammasome pathways that accelerate atherothrombosis.
For risk stratification, non-invasive vascular measures (arterial stiffness, carotid intima–media thickness, coronary artery calcium) and general calculators (SCORE2/ASCVD) are informative, though underestimation in younger patients is possible; expert guidance emphasizes mitigation of inflammatory activity, smoking cessation, prudent steroid use, and lipid monitoring with small-molecule therapy.
In conclusion, IBD confers clinically relevant ASCVD risk through immune–microbiome–barrier interactions superimposed on traditional factors. Routine cardiovascular assessment, aggressive control of intestinal inflammation, lifestyle optimization, and judicious therapy selection should be embedded in IBD care, while prospective studies refine prediction tools and test targeted preventive strategies across phenotypes and ages.
炎症性肠病（IBD）是一种系统性炎症性疾病，越来越多的人认为它会导致动脉粥样硬化性心血管疾病（ASCVD）的过度风险，尤其是在年轻患者和疾病活动期。我们在此综合了IBD-ASCVD界面的流行病学、机制、风险分层和管理方面的证据。在人群队列和荟萃分析中，IBD与缺血性心脏病、脑血管事件和外周动脉疾病的适度但持续增加相关，与肠系膜缺血和过早事件的相对风险较高相关；风险随着炎症负担和炎症发作而增加，而传统因素仅部分解释了这种关联。长期皮质类固醇暴露与不良血管结局相关，而有效控制肠道炎症，特别是使用抗tnf生物制剂，似乎具有保护作用；使用Janus激酶抑制剂的绝对心血管风险似乎主要取决于基线风险概况，并且在适当选择的患者中较低。提出的驱动因素包括生态失调和微生物衍生代谢物（例如，三甲胺- n -氧化物，丙酸咪唑），低级别内毒素血症和toll样受体-4激活的肠屏障衰竭，中性粒细胞和血小板介导的血栓炎症，以及加速动脉粥样硬化血栓形成的炎性小体途径。对于风险分层，非侵入性血管测量（动脉硬度，颈动脉内膜-中膜厚度，冠状动脉钙化）和一般计算器（SCORE2/ASCVD）提供了信息，尽管年轻患者可能被低估；专家指导强调减轻炎症活动，戒烟，谨慎使用类固醇，并用小分子治疗监测血脂。总之，IBD通过叠加传统因素的免疫-微生物-屏障相互作用赋予临床相关的ASCVD风险。常规心血管评估、积极控制肠道炎症、优化生活方式和明智的治疗选择应纳入IBD护理，而前瞻性研究应完善预测工具，并测试跨表型和年龄的针对性预防策略。
{"title":"Atherosclerotic cardiovascular disease and inflammatory bowel disease: epidemiology, pathogenesis and risk assessment","authors":"Pierluigi Puca , Gaetano Coppola , Simone Parello , Ivan Capobianco , Stefania Colantuono , Franco Scaldaferri , Alfredo Papa","doi":"10.1016/j.bpg.2025.102056","DOIUrl":"10.1016/j.bpg.2025.102056","url":null,"abstract":"<div><div>Inflammatory bowel diseases (IBD) are systemic inflammatory conditions increasingly recognized to confer excess risk of atherosclerotic cardiovascular disease (ASCVD), particularly in younger patients and during periods of active disease. We here synthesize evidence across epidemiology, mechanisms, risk stratification, and management at the IBD–ASCVD interface.</div><div>Across population cohorts and meta-analyses, IBD associates with modest but consistent increases in ischemic heart disease, cerebrovascular events, and peripheral arterial disease, with higher relative risks for mesenteric ischaemia and for premature events; risk escalates with inflammatory burden and flares, while traditional factors alone partially explain the association. Prolonged corticosteroid exposure correlates with adverse vascular outcomes, whereas effective control of intestinal inflammation, particularly with anti-TNF biologics, appears protective; the absolute cardiovascular risk with Janus kinase inhibitors seems largely determined by baseline risk profile and is low in appropriately selected patients.</div><div>Proposed drivers include dysbiosis and microbially derived metabolites (e.g., trimethylamine-N-oxide, imidazole propionate), intestinal barrier failure with low-grade endotoxemia and Toll-like receptor-4 activation, neutrophil- and platelet-mediated thromboinflammation, and inflammasome pathways that accelerate atherothrombosis.</div><div>For risk stratification, non-invasive vascular measures (arterial stiffness, carotid intima–media thickness, coronary artery calcium) and general calculators (SCORE2/ASCVD) are informative, though underestimation in younger patients is possible; expert guidance emphasizes mitigation of inflammatory activity, smoking cessation, prudent steroid use, and lipid monitoring with small-molecule therapy.</div><div>In conclusion, IBD confers clinically relevant ASCVD risk through immune–microbiome–barrier interactions superimposed on traditional factors. Routine cardiovascular assessment, aggressive control of intestinal inflammation, lifestyle optimization, and judicious therapy selection should be embedded in IBD care, while prospective studies refine prediction tools and test targeted preventive strategies across phenotypes and ages.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"78 ","pages":"Article 102056"},"PeriodicalIF":4.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145658996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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