Search Results (53)

Ulcerative colitis (UC) is a type of inflammatory bowel disease without curative therapeutics. Recent studies demonstrate that Akkermansia muciniphila exerts mitigating effects on UC, but the underlying mechanisms remain unclear. In this study, we isolated a strain of A. muciniphila, designated NND9, from the feces of DSS-induced ulcerative colitis model mice and investigated its effects on UC of the mouse model. NND9 significantly alleviated UC severity in the mice by restoring gut barrier integrity through improving colonic mucus layer thickness, mitigating goblet cell depletion, and halting epithelial cell death. Mechanistically, NND9 suppressed the expression of the Tnfrsf10b gene encoding death receptor 5 (DR5) on the surface of colonic epithelial cells. Additionally, NND9 inhibited the phosphorylation of kinase 3 (RIPK3) and the pseudokinase mixed-lineage kinase domain-like protein (MLKL) associated with the necrotic apoptosis pathway, thereby reducing gut epithelial cell death. NND9 also markedly ameliorated the gut microbiome of the colitis mice. Untargeted metabolomics analysis demonstrated that NND9 modulated both tryptophan and bile acid metabolism. In conclusion, NND9 exhibits curative effects on UC by resolving inflammatory reactions of the gut mucosa through the DR5-RIPK3/p-RIPK3-MLKL/p-MLKL pathway and redressing gut dysbiosis. This study provides valuable information for the development of innovative therapeutic strategies for the treatment of UC. Full article

Objective: To analyze multiple aspects of advanced bladder endometriosis surgery, based on the experience of an endometriosis reference center. Methods: This retrospective/prospective study included 80 consecutive patients with deep bladder endometriosis treated with laparoscopic surgery. Results: In 96.3% of cases, bladder endometriosis coexisted with other organ involvement: bowel (87.5%), uterus (61.3%), and ureters (37.5%); isolated bladder lesions occurred in 3.7%. Full-thickness bladder infiltration occurred in 36.4% of patients, and 71.8% had a history of surgery. The most frequent preoperative symptoms related to multiorgan involvement were dysmenorrhea (88.7%), dyschezia (75.0%), and dyspareunia (55.7%). Dysuria (55.7%), pollakiuria (17.9%), and urinary urgency (9.0%) were also reported. Shaving was performed in 45.0% of cases, resection in 40.0%, skinning in 15.0%, with two rare cases requiring bladder augmentation with bowel insert. Of all multiorgan surgeries (96.3% of cases), the most complex 30% were performed by a bi-disciplinary team of gynecologists and urologists. Postoperative complications occurred in 8 patients (10%) and were significantly associated with larger lesions, full-thickness infiltration, trigonum involvement, multiple organs opened, and prior surgery. Conclusions: Laparoscopic management of bladder endometriosis is feasible and effective, even in complex cases. Postoperative complications were linked to disease complexity but remained low, likely due to protective techniques used by the reference team. Optimal outcomes for the most difficult cases are more likely when procedures are performed by a bi-disciplinary team involving both oncological gynecologists specialized in deep endometriosis surgery and urologists. Given the heterogeneous clinical profiles of bladder endometriosis, treatment should be carried out in specialized centers where individualized surgical strategies can be implemented. Full article

Background and Aim: Sarcopenia is increasingly recognized as a clinically significant complication of inflammatory bowel disease (IBD), influencing both medical management and surgical outcomes. Accurate and accessible diagnostic tools are essential for assessing muscle mass and function in this population. The iliopsoas (IP) muscle has traditionally been used as a marker of sarcopenia, but its deep anatomical location requires skilled operators. Conversely, the diaphragm (DM), being more superficial, may serve as a more feasible surrogate. This study aimed to assess the correlation between IP- and DM-derived ultrasound indices in patients with IBD and to explore their association with sarcopenia risk. Methods: This prospective single-center study enrolled 353 IBD patients (Crohn’s disease [CD] and ulcerative colitis [UC]). Overall, 57 patients had a SARC-F score ≥ 4 and underwent intestinal ultrasound (US). The transverse diameter of the right IP muscle was measured in triplicate, and the psoas-to-height ratio (PMTH, mm/m) was calculated. Diaphragm thickness was assessed during inspiration and expiration, and the diaphragm-to-height ratio was derived. Pearson correlation, Bland–Altman analysis and multivariable regression (adjusted for age and sex) were performed to test associations. Results: The mean IP diameter was 28.40 mm (28.82 mm in males, 27.02 mm in females), with a mean PMTH of 16.62 mm/m. Diaphragm thickness was 20.4 ± 5.0 mm at inspiration and 10.7 ± 3.5 mm at expiration, yielding a mean difference of 9.7 ± 3.4 mm. The diaphragm-to-height ratio was 0.59 ± 0.21 mm/m. Pearson correlation revealed a moderate positive association between PMTH and the diaphragm index (r = 0.3568, p < 0.05). Bland–Altman analysis disclosed a symmetrical distribution. Multivariable regression confirmed that the diaphragm index increased linearly with PMTH (β = 0.018, 95% CI 0.005–0.030; p = 0.008). Neither age nor sex significantly affected the results. Conclusions: Muscle ultrasound is a reliable and reproducible method for evaluating sarcopenia in IBD. The diaphragm, due to its superficial anatomical location and ease of measurement, shows a significant correlation with psoas muscle parameters and may serve as a practical surrogate marker in clinical practice. Larger multicenter studies are warranted to validate these findings. Full article

Background: Complete rectal prolapse (RP) is a debilitating pelvic floor disorder often accompanied by obstructed defecation syndrome (ODS), fecal incontinence, and LARS-like bowel dysfunction. Laparoscopic resection rectopexy (LRR) is an established abdominal approach; however, functional outcomes after LRR with transanal specimen extraction (LRR-TSE) are incompletely defined. Aim: To evaluate short- and long-term functional outcomes—ODS, Wexner incontinence score (WIS), and LARS—in patients undergoing LRR-TSE. Methods: This single-center cohort included 53 consecutive patients who underwent LRR-TSE between January 2013 and December 2019. Variables were prospectively recorded and analyzed retrospectively. ODS, WIS, and LARS scores were assessed preoperatively and at 3, 6, and 12 months. Longitudinal changes were analyzed using repeated-measures ANOVA with Greenhouse–Geisser correction, polynomial contrasts when appropriate, and Bonferroni-adjusted pairwise comparisons. Results: ODS improved significantly over time (p < 0.001), decreasing from 12.8 ± 3.2 preoperatively to 2.4 ± 2.1, 4.2 ± 2.2, and 5.2 ± 2.9 at 3, 6, and 12 months, respectively. LARS scores declined from 18.0 ± 12.7 at 3 months to 8.8 ± 6.8 at 6 months and 3.5 ± 4.2 at 12 months (p < 0.001). WIS showed a transient increase at 3 months (8.1 ± 5.2), followed by improvement at 6 and 12 months (3.2 ± 3.7 and 2.4 ± 3.0; p < 0.001). Sex and body mass index did not affect functional trajectories (p > 0.05), whereas patients aged ≥50 years had higher postoperative LARS and WIS scores (p < 0.05). Complications occurred in 5 patients (9.43%), including one anastomotic leak with a mortality rate of 1.85%. Full-thickness recurrence occurred in 2 patients (3.77%), and 3 developed mucosal prolapse managed with Delorme’s procedure. Conclusions: LRR-TSE is a safe and feasible minimally invasive technique that improves constipation, continence, and LARS-related bowel dysfunction. Early postoperative impairment may overestimate long-term functional severity, highlighting the need for follow-up beyond 12 months. Full article

Background: Postoperative abdominal adhesions are a common and serious complication following abdominal surgery, often leading to chronic pain, bowel obstruction, or infertility. This study aimed to evaluate the efficacy of the new starch-based absorbable hemostatic agent and dressing, BioSight, in comparison with a predicate device (4DryField^® PH) for the prevention of abdominal adhesions in a rat model. Methods: A total of 90 Sprague–Dawley rats were used to establish an intra-abdominal adhesion model and assigned to the BioSight, 4DryField^® PH, or control group. Standardized injuries were created on the cecum and parietal peritoneum, followed by application of the designated materials. Animals were sacrificed at 2, 4, and 12 weeks for macroscopic adhesion scoring and histopathological evaluation. Adhesion area, adhesion strength, and tissue thickness were assessed using established scoring systems, and local healing was examined by H&E staining. All quantitative data were analyzed using one-way ANOVA. Conclusions: In a rat peritoneal adhesion model, BioSight exhibited pronounced anti-adhesion efficacy comparable to 4DryField^® PH. Macroscopic evaluation showed consistently low adhesion scores (≤0.4) across all time points up to 12 weeks, while histological analysis confirmed reduced adhesion thickness, with BioSight displaying numerically lower values, particularly at early stages (251.3 ± 137.4 µm vs. 323.2 ± 174.6 µm at Week 2). This performance is attributed to rapid in situ hydrogel formation that provides effective temporary tissue separation, limits early fibrin deposition and inflammatory cell infiltration, and supports hemostasis. Importantly, the starch-based hydrogel exhibits a balanced biodegradation profile—persisting long enough to protect injured tissues during the critical inflammatory and fibroproliferative phases, yet undergoing complete enzymatic resorption thereafter without adverse tissue reactions. Collectively, these results highlight the anti-adhesion functionality of BioSight and support the clinical potential of plant-derived starch-based bioresorbable surgical adjuncts. Full article

Background/Objectives: Intestinal ultrasound (IUS) is increasingly used to monitor ulcerative colitis (UC), but its predictive value remains unclear. This systematic review evaluated the ability of IUS parameters and scores to predict short- and long-term treatment response, remission, and adverse outcomes in hospitalized and outpatient UC populations. Methods: A systematic review was conducted according to Cochrane and PRISMA guidelines. MEDLINE and Embase were searched for prospective studies assessing IUS as a predictor of clinical or endoscopic response, remission, relapse, or adverse outcomes in adult UC. Two reviewers independently performed screening, data extraction, and QUADAS-2 assessment. Results: Eighteen prospective studies were included: eleven outpatient studies and seven involving hospitalized patients treated with intravenous corticosteroids (IVCS). In hospitalized patients, bowel wall thickness (BWT) was the most consistent predictor of treatment failure, rescue therapy, colectomy, and clinical response. Baseline BWT showed variable performance, but once IVCS was initiated, early BWT change within 48–72 h was the strongest marker of disease trajectory. Non-responders had higher BWT and smaller reductions. A BWT ≥ 4 mm, absolute reduction ≤ 1 mm, or relative reduction ≤ 20% at 48 h reliably identified patients needing rescue therapy (area under the curve (AUC) values of 0.77 (95% confidence interval (CI) 0.71–0.74), 0.71 (95% CI 0.56–0.86), and 0.74 (95% CI 0.60–0.88)). Colectomy risk was similarly predicted: BWT < 3 mm at 48 h was associated with no colectomies, whereas BWT ≥ 4 mm or persistently elevated BWT at day 6 markedly increased risk (Odds ratio (OR) 9.5-fold (95% CI 1.4–64.0) and OR 8.3 (95% CI 1.7–40.0), respectively). Other sonographic features (loss of haustration, increased vascularity) added supplementary but less consistent value. In outpatients, BWT also demonstrated the strongest predictive accuracy. BWT ≤ 3.6 mm at 2 weeks and <3.0 mm at 6 weeks were associated with early endoscopic remission (area under the receiver operating characteristic (AUROC) of 0.87 (95% CI 0.71–1.00) and 0.82 (95% CI 0.63–1.00), respectively). Dynamic changes with ≥23–25% relative reduction predicted clinical or endoscopic response (AUROC of 0.81 (95% CI 0.61–1.00) and OR of 13.9 (95% CI 1.13–1986.85), respectively). Persistent BWT > 3.5 mm or minimal reduction (<20% or <1 mm) indicated a low likelihood of long-term remission. Composite vascularity-based indices, particularly the Milan Ultrasound Criteria (MUC), strengthened prediction: MUC ≤ 4.3 or ≥2-point reduction at 12 weeks predicted long-term remission (AUROC 0.88 (95% CI 0.750–0.952) and 0.82 (95% CI 0.68–0.91), respectively), while MUC ≥ 7.7 indicated high risk of treatment failure or colectomy (AUROC 0.77 (95% CI: 0.73–0.82)). Conclusions: Across clinical settings, BWT consistently emerged as the strongest IUS predictor of UC treatment outcomes. Early BWT change within 48–72 h in hospitalized patients and absolute BWT values at 2–6 weeks in outpatients showed high predictive accuracy for response, remission, and colectomy. Composite indices incorporating vascularity further improved prediction. These findings support the incorporation of IUS into early treatment-response algorithms and underscore the need for standardized cut-offs and multicenter validation. Full article

Background/Objectives: Heart failure (HF) causes systemic and regional haemodynamic alterations that extend beyond the heart, profoundly affecting splanchnic circulation. Venous congestion is a hallmark of heart failure (HF) and a major determinant of clinical deterioration and multiorgan dysfunction. The splanchnic venous system—comprising the portal, hepatic, and renal veins—acts as a key reservoir for intravascular volume redistribution. Conventional ultrasound (US), using grayscale and Doppler imaging, offers a direct, non-invasive approach to visualize these haemodynamic changes. This review, Part 1 of a two-part series, summarizes the current evidence and clinical applications of conventional US for assessing splanchnic, cardiac and pulmonary vascular alterations in patients with HF. Methods: A systematic review was performed in PubMed, Embase, and the Cochrane Library up to current date, following PRISMA 2020 guidelines. Eligible studies included adult human investigations evaluating splanchnic vascular changes in HF using B-mode, color Doppler, or pulsed Doppler ultrasonography. Exclusion criteria were pediatric, animal, or non-English studies and non-standard imaging methods. Data on ultrasonographic parameters, haemodynamic correlations, and prognostic value were extracted and qualitatively synthesized; Results: A total of 148 eligible studies (n ≈ 7000 patients) demonstrated consistent associations between HF severity and alterations in splanchnic, cardiac and pulmonary flow. Findings included increased bowel wall thickness, portal vein dilation with elevated pulsatility, and monophasic or reversed hepatic vein waveforms, all correlating with higher right atrial pressure and adverse clinical outcomes. The integration of these parameters into the Venous Excess Ultrasound (VExUS) framework enhanced detection of systemic venous congestion, in addition to the study of the cardiac and pulmonary circulation. Conclusions: Conventional ultrasound assessment of splanchnic vasculature provides valuable, reproducible insight into systemic congestion in HF. Incorporating hepatic and portal Doppler indices into standard evaluation protocols may improve risk stratification, optimize decongestion therapy, and guide management. Further prospective randomized and outcome-driven studies are required before VExUS-based therapeutic thresholds can be universally recommended and define prognostic thresholds. Full article

Background/Objectives: Crohn’s disease (CD) requires precise, noninvasive monitoring to guide therapy and support treat-to-target management. Magnetic resonance enterography (MRE), particularly diffusion-weighted imaging (DWI), is the preferred cross-sectional technique for assessing small-bowel inflammation. Indices such as the Magnetic Resonance Index of Activity (MaRIA) and its diffusion-weighted variant (DWI MaRIA) are widely used for grading disease activity. This study evaluated whether unsupervised clustering of MRI-derived features can complement these indices by providing more coherent and biologically grounded stratification of disease activity. Materials and Methods: Fifty patients with histologically confirmed CD underwent 1.5 T MRE. Of 349 bowel segments, 84 were pathological and classified using literature-based thresholds (MaRIA, DWI MaRIA) and unsupervised clustering. Differences between inactive, active, and severe disease were analyzed using multivariate analysis of variance (MANOVA), analysis of variance (ANOVA), and t-tests. Mahalanobis distances were calculated to quantify and compare separation between categories. Results: Using MaRIA thresholds, 5, 16, and 63 segments were classified as inactive, active, and severe (Mahalanobis distances 2.60, 4.95, 4.12). Clustering redistributed them into 22, 37, and 25 (9.26, 24.22, 15.27). For DWI MaRIA, 21, 14, and 49 segments were identified under thresholds (3.59, 5.72, 2.85) versus 21, 37, and 26 with clustering (7.40, 16.35, 9.41). Wall thickness dominated cluster-derived separation, supported by diffusion metrics and the apparent diffusion coefficient (ADC). Conclusions: Cluster-derived classification yielded clearer and more biologically consistent separation of disease-activity groups than fixed thresholds, emphasizing its potential to refine boundary definition, enhance MRI-based assessment, and inform future AI-driven diagnostic modeling. Full article

Background: Inflammatory Bowel Disease (IBD), comprising Crohn’s disease and ulcerative colitis, requires accurate assessment over time. Imaging techniques play a crucial role in diagnosis, monitoring disease activity, and guiding therapeutic response. This review summarizes the current evidence on radiologic imaging techniques in IBD, focusing on intestinal ultrasound (IUS), computed tomography enterography (CTE), magnetic resonance enterography (MRE), and other emerging technologies. Methods: A literature review was conducted using PubMed, EMBASE, Scopus, and the Cochrane Library, encompassing publications up to 31 October 2024. Results: IUS offers a non-invasive tool for assessing bowel wall thickness, vascularity, and complications. CTE and MRE provide detailed visualization of luminal and extraluminal disease, with MRE preferred for routine monitoring due to the absence of ionizing radiation. Standardized indices and scoring systems aid in objective disease activity assessment. Emerging technologies like Positron Emission Tomography (PET)/MRI and radiomics show promise in combining metabolic and morphological information for complex cases. Conclusions: Imaging has a central role in IBD management, with IUS, CTE, and MRE demonstrating high diagnostic accuracy. Radiomics and Artificial Intelligence (AI) are paving the way for precision imaging. Integrating advanced imaging techniques, scoring systems, and AI-driven analytics represents a transformative step toward more effective and individualized care for patients with IBD. Full article

Ulcerative colitis is a chronic inflammatory bowel disease characterized by persistent inflammation, immune dysregulation, gut microbiota alterations, and impaired epithelial barrier function. Lupinus albus is a legume rich in galactooligosaccharides (GOS) that functions as a prebiotic capable of modulating the gut microbiota and mitigating ulcerative colitis-related damage. This study aimed to elucidate the effect of GOS on gut microbiota modulation and the molecular mechanisms involved in epithelial restoration and inflammation reduction. Fifteen C57BL/6 mice were randomly assigned to three groups (n = 5 per group): control (CTL), ulcerative colitis (UC), and ulcerative colitis + GOS (UC + GOS). UC was induced by administering 2% dextran sulfate sodium (DSS) in drinking water for seven days. The UC + GOS group received 2.5 g/kg BW of GOS via gavage for 14 days. GOS administration improved mucus layer thickness, regulated the expression of tight junction proteins, reduced pro-inflammatory cytokine levels, and modulated the gut microbiota, preventing the loss of richness and diversity. Additionally, the expression of monocarboxylate transporters (MCTs) MCT1 and MCT4 was evaluated, and significant differences were observed between the groups across colon and cecum tissues. These findings suggest that GOS supplementation may play a potential role in attenuating ulcerative colitis by regulating the gut microbiota and the metabolic state of intestinal cells. Full article

Background/Objectives: Intraoperative frozen biopsies are essential during surgery for Hirschsprung’s disease (HD). However, this method has several limitations with the need for a faster and real-time diagnostic alternative. For this, consistent histoanatomical and morphometric differences between aganglionic and ganglionic bowel must be established. The primary objective was to compare dimensions of bowel wall layers between aganglionic and ganglionic segments histopathologically in resected rectosigmoid specimens from children with HD. Secondary objectives were to design a diagnostic algorithm to distinguish aganglionosis from ganglionosis and assess whether full bowel wall thickness correlates with patient weight and age. Methods: Each histoanatomic bowel wall layer—mucosa, submucosa, and muscularis propria’s layers—was delineated manually on histopathological images. Mean thicknesses were calculated automatically using an in-house image analysis software. Paired parametric tests compared measurements in aganglionic and ganglionic segments. Results: Resected specimens from 30 children with HD were included. Compared to aganglionic bowel, ganglionic bowel showed a thicker muscularis interna (mean 0.666 mm versus 0.461 mm, CI −0.257–(−0.153), p < 0.001), and a higher muscularis interna/muscularis externa ratio (2.047 mm versus 1.287 mm, CI −0.954–(−0.565), p < 0.001). An algorithm based on these features achieved 100% accuracy in distinguishing aganglionosis from ganglionosis. No significant difference in full bowel wall thickness was found between aganglionic and ganglionic segments, nor any correlation with patient weight or age. Conclusions: Histoanatomic layer thickness differs between aganglionic and ganglionic bowel, forming the basis of a diagnostic algorithm. Full bowel wall thickness was independent of patient weight and age. Full article

Short bowel syndrome (SBS) is characterized by insufficient intestinal length to support absorption causing malnutrition. The bowel adapts to SBS via intestinal dilation and delayed gastric emptying but still often requires long-term parenteral nutrition. Current surgical options to lengthen the bowel pose significant risks and often provide limited expansion. ‘Distraction enterogenesis’ has been proposed as a technique to induce intestinal lengthening for SBS. The deployment of the intestinal expansion sleeve (IES) device is hypothesized to result in significant intestinal lengthening in vivo. A Roux-en-Y was created in the jejunum of seven rats for isolated IES deployment. The IES was precontracted over a Bucatini noodle and inserted into the isolated roux limb. After 4 weeks of deployment, rats were sacrificed, Roux-en-Y length recorded, and histology analyzed. A paired t-test was performed to compare initial and final roux limb lengths and histopathological tissue remodeling. Intestinal distraction evaluated at 4 weeks post deployment of the IES resulted in a significant 30.2% elongation in roux limb length (43.6 ± 14.4 mm to 56.4 ± 20.8 mm (p = 0.043, n = 7). IES samples showed changes in mucosal and submucosal integrity and bowel wall thickness in response to IES lengthening. In samples with partial mucosal erosion, the basal/regenerative layers of the mucosa were preserved. Distraction enterogenesis with significant intestinal lengthening in vivo has been achieved with the IES device. Histologic changes suggest all bowel functional layers and attributes are maintained through distraction enterogenesis. Future constructs of the IES may benefit from the addition of immunomodulators. Increasing intestinal mass with these devices may complement the treatment paradigm for SBS. Full article

Objective: Intestinal ultrasound (IUS) is increasingly valued as a noninvasive tool for inflammatory bowel disease (IBD) management, offering real-time, radiation-free assessment of bowel wall thickness, vascularity, and complications. While IUS is widely adopted in Europe, data on its use in Turkey is scarce. This study aims to address this gap. Methods: A nationwide, cross-sectional survey was conducted targeting 817 adult and 150 pediatric gastroenterologists in Turkey. The survey included 26 structured questions on demographics, familiarity with and use of IUS, and barriers to implementation. Results: A total of 191 gastroenterologists participated in this survey, with 56% being adult gastroenterologists (n = 107) and 44% pediatric gastroenterologists (n = 84). Regarding whether they participated in IUS training, 73% (n = 140) of the 191 respondents stated they had not received training. There were notable differences in how IUS was utilized among gastroenterologists: 29% (n = 31) of adult gastroenterologists performed IUS independently, compared to just 2% (n = 2) of pediatric gastroenterologists (p < 0.001). In total, 63% (n = 67) of adult gastroenterologists and 46% (n = 39) of pediatric gastroenterologists reported not using IUS. Altogether, 94% (n = 179) emphasized the necessity of educational opportunities, and 86% (n = 165) favored national guidelines. Conclusions: Our findings reveal that the current application of IUS in Turkey fails to correspond with its expected advantages in managing IBD. Limited educational opportunities are a major challenge, emphasizing the necessity for coordinated educational programs and national guidelines. The expanded adoption of the IUS might significantly improve Turkey’s management of IBD. What is known: Intestinal ultrasound (IUS) is a non-invasive, cost-effective, and reliable imaging method increasingly recognized for its utility in diagnosing and monitoring inflammatory bowel disease (IBD). What is new: This is the first national survey assessing the awareness, usage patterns, and barriers to the adoption of IUS among gastroenterologists in Turkey. The study highlights significant gaps in training opportunities while also identifying strategies to promote IUS integration into routine clinical practice. The findings may encourage similar efforts in other regions where IUS remains underutilized, ultimately improving IBD management and patient outcomes globally. Full article

Artificial intelligence (AI) is rapidly transforming imaging modalities in inflammatory bowel disease (IBD), particularly in endoscopy and ultrasound. Despite their critical roles, both modalities are challenged by interobserver variability, subjectivity, and accessibility issues. AI offers significant potential to address these limitations by enhancing lesion detection, standardizing disease activity scoring, and supporting clinical decision-making. In endoscopy, deep convolutional neural networks have achieved high accuracy in detecting mucosal abnormalities and grading disease severity, reducing observer dependency and improving diagnostic consistency. AI-assisted colonoscopy systems have also demonstrated improvements in procedural quality metrics, including adenoma detection rates and withdrawal times. Similarly, AI applications in intestinal ultrasound show promise in automating measurements of bowel wall thickness, assessing vascularity, and distinguishing between inflammatory and fibrotic strictures, which are critical for tailored therapy decisions. Video capsule endoscopy has likewise benefited from AI, reducing interpretation times and enhancing the detection of subtle lesions. Despite these advancements, implementation challenges, including dataset quality, standardization, AI interpretability, clinician acceptance, and regulatory and ethical considerations, must be carefully addressed. The current review focuses on the most recent developments in the integration of AI into experimental designs, medical devices, and clinical workflows for optimizing diagnostic accuracy, treatment strategies, and patient outcomes in IBD management. Full article

Background/Objectives: Inflammatory bowel disease (IBD), encompassing Crohn’s disease and ulcerative colitis, is characterized by cycles of inflammation and tissue remodeling that can culminate in fibrosis. Differentiating between early inflammatory and fibrotic bowel wall changes remains a diagnostic challenge due to overlapping imaging features. This study aimed to assess the potential of elastography, specifically pixel histogram analysis, as a non-invasive method to identify acute inflammatory changes in a rat model of 2,4,6-trinitrobenzenesulfonic (TNBS)-induced colitis. Methods: Female CRL:Wi rats were randomized into control and experimental groups, with the latter receiving intracolonic TNBS to induce acute colitis. On day 7 post-induction, all animals underwent ultrasonographic and strain elastographic assessment of the distal colon using a standardized protocol. Histogram-based analysis of red, green, and blue pixel distributions was performed on elastographic video frames. Results were compared with histologic grading of inflammation and fibrosis using hematoxylin-eosin and Masson’s trichrome staining. Results: Rats with TNBS-induced colitis exhibited significant weight loss, increased bowel wall thickness (31.5% vs. controls, p < 0.01), and elevated elastographic pixel intensity across all color channels (p < 0.05). Histologically, experimental animals showed severe inflammation and early submucosal fibrosis. A strong positive correlation was found between elastographic histogram values and histologic fibrosis scores (r = 0.86, p < 0.01), confirming the technique’s diagnostic relevance. Conclusions: Elastographic pixel histogram analysis is a reproducible, non-invasive approach capable of distinguishing acute inflammatory changes and early fibrotic remodeling in experimental colitis. These findings support its potential application as a diagnostic adjunct in the early assessment and monitoring of IBD-related bowel wall changes. Full article