Inflammatory bowel diseases’ traditional management focused primarily on symptom control, often failing to prevent long-term complications such as disease progression, disabilities, hospitalizations and surgeries. The introduction of biologics and small molecules has revolutionized IBD management, enhancing inflammation control. A pivotal advance in this field is represented by the Treat-to-Target approach, which prioritizes the achievement of specific goals like endoscopic remission and biomarker normalization, thus moving beyond symptomatic relief. The STRIDE recommendations have been pivotal in shaping treatment goals, with STRIDE-II advancing this approach by adding timelines to established targets and suggesting histologic remission for UC and transmural healing for CD as supplementary objectives. Future strategies are expected to incorporate these outcomes, aiming for more comprehensive disease control. This review evaluates whether new therapeutic targets are required to address the unmet needs in IBD management and to further improve longterm patient outcomes.
{"title":"Treatment targets in IBD: is it time for new strategies?","authors":"Fabrizio Fanizzi , Ferdinando D'Amico , Laurent Peyrin-Biroulet , Silvio Danese , Axel Dignass","doi":"10.1016/j.bpg.2025.101990","DOIUrl":"10.1016/j.bpg.2025.101990","url":null,"abstract":"<div><div>Inflammatory bowel diseases’ traditional management focused primarily on symptom control, often failing to prevent long-term complications such as disease progression, disabilities, hospitalizations and surgeries. The introduction of biologics and small molecules has revolutionized IBD management, enhancing inflammation control. A pivotal advance in this field is represented by the Treat-to-Target approach, which prioritizes the achievement of specific goals like endoscopic remission and biomarker normalization, thus moving beyond symptomatic relief. The STRIDE recommendations have been pivotal in shaping treatment goals, with STRIDE-II advancing this approach by adding timelines to established targets and suggesting histologic remission for UC and transmural healing for CD as supplementary objectives. Future strategies are expected to incorporate these outcomes, aiming for more comprehensive disease control. This review evaluates whether new therapeutic targets are required to address the unmet needs in IBD management and to further improve longterm patient outcomes.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"77 ","pages":"Article 101990"},"PeriodicalIF":4.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766464","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 : 2025-08-01DOI: 10.1016/j.bpg.2025.101996
Natália Sousa Freitas Queiroz , Federica Furfaro
Management of inflammatory bowel disease (IBD) during pregnancy requires a delicate balance to ensure the health of both mother and fetus. This chapter addresses key considerations, including preconception counseling, safe therapeutic options, monitoring strategies, and the management of exacerbations during pregnancy. The guidance provided draws from current evidence and expert recommendations, aiming to support clinicians in making informed decisions that protect maternal health while minimizing fetal risks.
{"title":"Pregnancy and IBD: A practical guide for physicians","authors":"Natália Sousa Freitas Queiroz , Federica Furfaro","doi":"10.1016/j.bpg.2025.101996","DOIUrl":"10.1016/j.bpg.2025.101996","url":null,"abstract":"<div><div>Management of inflammatory bowel disease (IBD) during pregnancy requires a delicate balance to ensure the health of both mother and fetus. This chapter addresses key considerations, including preconception counseling, safe therapeutic options, monitoring strategies, and the management of exacerbations during pregnancy. The guidance provided draws from current evidence and expert recommendations, aiming to support clinicians in making informed decisions that protect maternal health while minimizing fetal risks.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"77 ","pages":"Article 101996"},"PeriodicalIF":4.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766671","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}
Diet is increasingly recognized as a modifiable factor in the pathogenesis and management of inflammatory bowel disease (IBD), particularly in mild to moderate cases. While most evidence comes from pediatric studies, adult data, especially randomized controlled trials (RCTs), remain limited. Current guidelines recommend a Mediterranean diet for patients with IBD, avoiding fruits and vegetables during disease flares. Exclusive enteral nutrition (EEN) has demonstrated therapeutic potential in pediatric Crohn's disease (CD), but data in adults are less conclusive, partly due to issues with adherence. Clinicians must routinely monitor nutritional markers such as hemoglobin, iron status, vitamins, and albumin every 6–12 months, and supplement deficiencies as required. The presence of a dedicated nutrition specialist within IBD units could improve care, as nutrition also impacts psychological well-being. In addition, the role of the microbiome and how dietary interventions can modulate it to alleviate both inflammatory and functional symptoms warrant further exploration.
{"title":"The role of diet in inflammatory bowel disease: A comprehensive review of the literature","authors":"Ilaria Faggiani , Jacopo Fanizza , Sara Massironi , Ferdinando D'Amico , Mariangela Allocca , Federica Furfaro , Tommaso Lorenzo Parigi , Gionata Fiorino , Silvio Danese , Alessandra Zilli","doi":"10.1016/j.bpg.2025.101995","DOIUrl":"10.1016/j.bpg.2025.101995","url":null,"abstract":"<div><div>Diet is increasingly recognized as a modifiable factor in the pathogenesis and management of inflammatory bowel disease (IBD), particularly in mild to moderate cases. While most evidence comes from pediatric studies, adult data, especially randomized controlled trials (RCTs), remain limited. Current guidelines recommend a Mediterranean diet for patients with IBD, avoiding fruits and vegetables during disease flares. Exclusive enteral nutrition (EEN) has demonstrated therapeutic potential in pediatric Crohn's disease (CD), but data in adults are less conclusive, partly due to issues with adherence. Clinicians must routinely monitor nutritional markers such as hemoglobin, iron status, vitamins, and albumin every 6–12 months, and supplement deficiencies as required. The presence of a dedicated nutrition specialist within IBD units could improve care, as nutrition also impacts psychological well-being. In addition, the role of the microbiome and how dietary interventions can modulate it to alleviate both inflammatory and functional symptoms warrant further exploration.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"77 ","pages":"Article 101995"},"PeriodicalIF":4.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766466","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}
{"title":"“Unraveling the mysteries of IBD: Innovations and insights into the management of Crohn's disease and ulcerative colitis”","authors":"Ferdinando D'Amico (Guest Editors), Sarah Bencardino (Guest Editors), Silvio Danese (Guest Editors)","doi":"10.1016/j.bpg.2025.102035","DOIUrl":"10.1016/j.bpg.2025.102035","url":null,"abstract":"","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"77 ","pages":"Article 102035"},"PeriodicalIF":4.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766463","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 : 2025-08-01DOI: 10.1016/j.bpg.2024.101952
Benjamin H. Mullish, Gianluca Ianiro
{"title":"Preface to special edition: Microbiome, inflammation and cancer","authors":"Benjamin H. Mullish, Gianluca Ianiro","doi":"10.1016/j.bpg.2024.101952","DOIUrl":"10.1016/j.bpg.2024.101952","url":null,"abstract":"","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"77 ","pages":"Article 101952"},"PeriodicalIF":4.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766471","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}
Biological therapies have revolutionized the management of inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). Among these, biosimilars and biobetters represent a growing area of therapeutic development. Biosimilars are nearly identical copies of original biologic drugs (reference products) with comparable safety, efficacy, and quality, but they offer the advantage of reduced costs and broader access. In contrast, biobetters, while based on existing biologics, are engineered to enhance certain properties such as efficacy, safety, or dosing convenience. Both biosimilars and biobetters play an increasingly important role in IBD treatment, expanding options for patients and helping to address economic challenges in healthcare systems. This review explores the clinical application, benefits, and challenges associated with biosimilars and biobetters in IBD, focusing on their role in achieving therapeutic goals while optimizing patient access and cost-effectiveness.
{"title":"Biobetters and biosimilars in inflammatory bowel disease","authors":"Jacopo Fanizza , Ilaria Faggiani , Mariangela Allocca , Federica Furfaro , Alessandra Zilli , Tommaso Lorenzo Parigi , Clelia Cicerone , Gionata Fiorino , Laurent Peyrin-Biroulet , Silvio Danese , Pablo Andres Olivera , Ferdinando D'Amico","doi":"10.1016/j.bpg.2025.101992","DOIUrl":"10.1016/j.bpg.2025.101992","url":null,"abstract":"<div><div>Biological therapies have revolutionized the management of inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). Among these, biosimilars and biobetters represent a growing area of therapeutic development. Biosimilars are nearly identical copies of original biologic drugs (reference products) with comparable safety, efficacy, and quality, but they offer the advantage of reduced costs and broader access. In contrast, biobetters, while based on existing biologics, are engineered to enhance certain properties such as efficacy, safety, or dosing convenience. Both biosimilars and biobetters play an increasingly important role in IBD treatment, expanding options for patients and helping to address economic challenges in healthcare systems. This review explores the clinical application, benefits, and challenges associated with biosimilars and biobetters in IBD, focusing on their role in achieving therapeutic goals while optimizing patient access and cost-effectiveness.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"77 ","pages":"Article 101992"},"PeriodicalIF":4.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766468","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}
Inflammatory bowel diseases, including Crohn's disease and ulcerative colitis, raise ongoing challenges in clinical management due to their variable courses and impact on patient quality of life. The emergence of advanced therapies, from biologics to small molecules, has prompted the need for effective sequencing strategies to optimize patient outcomes. To this date, there is no algorithm for treatment sequencing and physicians must select the safest and most effective treatment according to each individual patient. This review aims to explore the latest insights in treatment sequencing according to multiple criteria, such as prior use of anti-TNF alpha agents, prior surgery, disease phenotype and location, but also patient characteristics, such as age or history of malignancy. Treatment sequencing in IBD should be part of a clinical medicine approach and be tailored to individual patient characteristics, disease severity, and therapeutic response history. Indeed, a personalized approach of therapeutic management in inflammatory bowel diseases can improve long-term outcomes and quality of life. Ongoing research is essential to refine sequencing strategies, and better incorporate these advances into clinical practice.
{"title":"Treatment sequencing in inflammatory bowel disease: Towards clinical precision medicine","authors":"Léa Sequier , Bénédicte Caron , Sailish Honap , Ludovic Caillo , Romain Altwegg , Patrick Netter , Mathurin Fumery , Anthony Buisson , Laurent Peyrin-Biroulet","doi":"10.1016/j.bpg.2025.101994","DOIUrl":"10.1016/j.bpg.2025.101994","url":null,"abstract":"<div><div>Inflammatory bowel diseases, including Crohn's disease and ulcerative colitis, raise ongoing challenges in clinical management due to their variable courses and impact on patient quality of life. The emergence of advanced therapies, from biologics to small molecules, has prompted the need for effective sequencing strategies to optimize patient outcomes. To this date, there is no algorithm for treatment sequencing and physicians must select the safest and most effective treatment according to each individual patient. This review aims to explore the latest insights in treatment sequencing according to multiple criteria, such as prior use of anti-TNF alpha agents, prior surgery, disease phenotype and location, but also patient characteristics, such as age or history of malignancy. Treatment sequencing in IBD should be part of a clinical medicine approach and be tailored to individual patient characteristics, disease severity, and therapeutic response history. Indeed, a personalized approach of therapeutic management in inflammatory bowel diseases can improve long-term outcomes and quality of life. Ongoing research is essential to refine sequencing strategies, and better incorporate these advances into clinical practice.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"77 ","pages":"Article 101994"},"PeriodicalIF":4.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766469","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 : 2025-08-01DOI: 10.1016/j.bpg.2025.102017
Andrea Vignali, Pierpaolo Sileri
Background
Restorative proctocolectomy with ileoanal pouch is the standard procedure in ulcerative colitis patients with medical refractory disease, dysplasia or in selected patients with Crohn's disease. The advent of biologics has reduced the rate of elective colectomies, the timing of surgery and the type of the surgical approach and increased the stages of the operation.
Aim
to analyze the main chances in pouch surgery with a focus on staging, minimally invasive surgery and trans anal approach.
Results
the decision on the staging approach should be individualized according to disease severity, preoperative nutritional status, intraoperative variables and preoperative exposure to immunomodulators. A minimally invasive approach is recommended when feasible. Trans-anal ileal pouch is a promising technically demanding operation, subject to procedure specific risk and should be performed only by experienced surgeons.
Conclusion
The minimally invasive approaches are evolving, but large-scale controlled studies are needed to confirm their efficacy and safety.
{"title":"Pouch surgery for ulcerative colitis in 2025: A narrative review","authors":"Andrea Vignali, Pierpaolo Sileri","doi":"10.1016/j.bpg.2025.102017","DOIUrl":"10.1016/j.bpg.2025.102017","url":null,"abstract":"<div><h3>Background</h3><div>Restorative proctocolectomy with ileoanal pouch is the standard procedure in ulcerative colitis patients with medical refractory disease, dysplasia or in selected patients with Crohn's disease. The advent of biologics has reduced the rate of elective colectomies, the timing of surgery and the type of the surgical approach and increased the stages of the operation.</div></div><div><h3>Aim</h3><div>to analyze the main chances in pouch surgery with a focus on staging, minimally invasive surgery and trans anal approach.</div></div><div><h3>Results</h3><div>the decision on the staging approach should be individualized according to disease severity, preoperative nutritional status, intraoperative variables and preoperative exposure to immunomodulators. A minimally invasive approach is recommended when feasible. Trans-anal ileal pouch is a promising technically demanding operation, subject to procedure specific risk and should be performed only by experienced surgeons.</div></div><div><h3>Conclusion</h3><div>The minimally invasive approaches are evolving, but large-scale controlled studies are needed to confirm their efficacy and safety.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"77 ","pages":"Article 102017"},"PeriodicalIF":4.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766465","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 : 2025-06-01DOI: 10.1016/j.bpg.2025.101999
Franco Ana Rita , Arvanitakis Marianna , Teles de Campos Sara
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a technically complex and high-risk procedure for managing pancreaticobiliary diseases. The quality assessment in ERCP has evolved from relying solely on adverse events (AEs) rates to a more comprehensive approach incorporating structural, process, and outcome indicators.
Structural metrics include appropriate indications, informed consent, and procedural difficulty grading. Process metrics focus on bile duct cannulation, stone clearance, stent placement, and radiation exposure documentation. Outcome metrics assess AEs, such as post-ERCP pancreatitis and bleeding rates. Patient-reported outcome measures are valuable tools for capturing morbidity beyond traditional quality metrics.
Competency in ERCP requires structured training, continuous assessment, and mentored practice.
High-volume centres consistently demonstrate superior outcomes, reinforcing the need for centralisation and robust quality assurance programs.
Future advancements, including artificial intelligence and large-scale registries, promise to standardise practices and improve ERCP outcomes.
This review provides a comprehensive framework to measure and enhance quality in ERCP.
{"title":"How to measure quality in ERCP?","authors":"Franco Ana Rita , Arvanitakis Marianna , Teles de Campos Sara","doi":"10.1016/j.bpg.2025.101999","DOIUrl":"10.1016/j.bpg.2025.101999","url":null,"abstract":"<div><div>Endoscopic Retrograde Cholangiopancreatography (ERCP) is a technically complex and high-risk procedure for managing pancreaticobiliary diseases. The quality assessment in ERCP has evolved from relying solely on adverse events (AEs) rates to a more comprehensive approach incorporating structural, process, and outcome indicators.</div><div>Structural metrics include appropriate indications, informed consent, and procedural difficulty grading. Process metrics focus on bile duct cannulation, stone clearance, stent placement, and radiation exposure documentation. Outcome metrics assess AEs, such as post-ERCP pancreatitis and bleeding rates. Patient-reported outcome measures are valuable tools for capturing morbidity beyond traditional quality metrics.</div><div>Competency in ERCP requires structured training, continuous assessment, and mentored practice.</div><div>High-volume centres consistently demonstrate superior outcomes, reinforcing the need for centralisation and robust quality assurance programs.</div><div>Future advancements, including artificial intelligence and large-scale registries, promise to standardise practices and improve ERCP outcomes.</div><div>This review provides a comprehensive framework to measure and enhance quality in ERCP.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"76 ","pages":"Article 101999"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518649","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 : 2025-06-01DOI: 10.1016/j.bpg.2025.102024
John Anderson (Dr), Roland Valori (Dr)
Over the last 50 years, endoscopy technology and its clinical application has improved enormously. Endoscopy now provides a wide variety of non-invasive treatments, and it prevents upper and lower gastrointestinal cancer. Performing high-quality endoscopy requires a complex blend of cognitive, technical and non-technical skills. For an individual to acquire these skills requires high-quality training. Unfortunately, the development of training has lagged the advances in technology, resulting in unwarranted variation in the effectiveness of the technology. This chapter argues that to enable a more uniform high-quality endoscopic service, the solution is to improve endoscopy training. It describes what constitutes high-quality training, how new methods of training will improve the traditional training pathway and what can be done to transform endoscopy training.
{"title":"Quality in endoscopy training","authors":"John Anderson (Dr), Roland Valori (Dr)","doi":"10.1016/j.bpg.2025.102024","DOIUrl":"10.1016/j.bpg.2025.102024","url":null,"abstract":"<div><div>Over the last 50 years, endoscopy technology and its clinical application has improved enormously. Endoscopy now provides a wide variety of non-invasive treatments, and it prevents upper and lower gastrointestinal cancer. Performing high-quality endoscopy requires a complex blend of cognitive, technical and non-technical skills. For an individual to acquire these skills requires high-quality training. Unfortunately, the development of training has lagged the advances in technology, resulting in unwarranted variation in the effectiveness of the technology. This chapter argues that to enable a more uniform high-quality endoscopic service, the solution is to improve endoscopy training. It describes what constitutes high-quality training, how new methods of training will improve the traditional training pathway and what can be done to transform endoscopy training.</div></div>","PeriodicalId":56031,"journal":{"name":"Best Practice & Research Clinical Gastroenterology","volume":"76 ","pages":"Article 102024"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518655","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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