Advances in Comprehensive Management Strategies for Inflammatory Bowel Disease

Topic Information

Dear Colleagues,

The management of inflammatory bowel disease (IBD) is a rapidly evolving field, driven by continuous advancements in diagnostics, therapeutics, and our understanding of disease pathogenesis. With the rising global incidence and prevalence of IBD, particularly in newly industrialized countries, there is an increasing demand for up-to-date, evidence-based care. The introduction of biologic agents and small molecule therapies has significantly expanded treatment options, offering targeted approaches to achieve sustained remission and mucosal healing. Alongside therapeutic innovation, there has been progress in disease monitoring, including the use of biomarkers, imaging, and endoscopic technologies to personalize treatment strategies. Emerging trends such as early intervention, treat-to-target strategies, and the integration of artificial intelligence in clinical decision-making are reshaping the standard of care. Moreover, there is growing recognition of the importance of holistic, multidisciplinary approaches that address not only inflammation but also quality of life, nutrition, mental health, and disease complications. For specialists, staying up-to-date with these developments is essential to delivering optimal patient care. This requires ongoing education, engagement with the latest clinical research, and participation in guideline updates and professional networks. As the landscape of IBD management continues to shift, a commitment to continuous learning and adaptation ensures that clinicians remain equipped to offer the most effective and individualized treatments.

We are pleased to invite you to contribute to this Topic Collection: “Advances in Comprehensive Management Strategies for Inflammatory Bowel Disease.”

This Topic aims to provide an update on the rapidly evolving field of management of IBD.

In this Topic, original research articles and reviews are welcome. Research areas may include (but not limited to) the following:

1. The burden of disability in IBD;
2. The genetic predisposition to IBD;
3. How to improve patients’ adherence and compliance;
4. Wearable devices to monitor IBD;
5. How to provide an adequate screening and surveillance for colorectal cancer;
6. Environmental risk factors for IBD;
7. Role of diet in prevention or provoking IBD;
8. Role of diet and balanced nutrition in the management of IBD.

We look forward to receiving your contributions.

Prof. Dr. Vito Annese
Prof. Dr. Vincenzo Villanacci
Prof. Dr. Fabiana Castiglione
Dr. Ferdinando D'Amico
Dr. Flavio Caprioli
Topic Editors

Keywords

Participating Journals

Journal Name	Impact Factor	CiteScore	Launched Year	First Decision (median)	APC
Diagnostics diagnostics	3.8	6.9	2011	20.4 Days	CHF 2600	Submit
Gastrointestinal Disorders gastrointestdisord	1.9	2.1	2019	19.6 Days	CHF 1400	Submit
International Journal of Molecular Sciences ijms	5.6	10.0	2000	17.5 Days	CHF 2900	Submit
Journal of Clinical Medicine jcm	3.3	5.2	2012	16.6 Days	CHF 2600	Submit
Medicina medicina	2.9	4.6	1920	17.4 Days	CHF 2200	Submit
Nutrients nutrients	5.8	10.2	2009	15.8 Days	CHF 2900	Submit
Pharmaceuticals pharmaceuticals	5.7	9.0	2004	14.3 Days	CHF 2900	Submit

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Published Papers (7 papers)

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All Diagnostics Gastrointestinal Disorders IJMS JCM Nutrients Medicina Pharmaceuticals

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20 pages, 6533 KB  

Open AccessArticle

Lactobacillus rhamnosus GG Alleviates Colitis by SLC5A12-Mediated Th17/Treg Cell Balance in Mice

by Yiling Zhang, Xianghong He, Qian Zhao, Qiming Duan, Heping Li, Rui Qin, Weifang Zuo, Kunhong Xie and Bo Han

Nutrients 2026, 18(11), 1724; https://doi.org/10.3390/nu18111724 - 28 May 2026

Viewed by 397

Abstract

Background/Objectives: Lactobacillus rhamnosus GG (LGG) is one of the most widely utilized probiotic strains with a variety of biological functions including prevention and treatment of gastro-intestinal infections and regulation of immune responses. Methods: Here, we explored the role of LGG in [...] Read more.

Background/Objectives: Lactobacillus rhamnosus GG (LGG) is one of the most widely utilized probiotic strains with a variety of biological functions including prevention and treatment of gastro-intestinal infections and regulation of immune responses. Methods: Here, we explored the role of LGG in regulating the differentiation of naïve CD4⁺ T cells and its effect on alleviating the dextran sulfate sodium (DSS)-induced colitis in mice. Results: In vitro, we showed that LGG-derived metabolites not only promoted the differentiation of naive CD4⁺ T cells into T-helper 17 cells (Th17 cells), but also selectively upregulated the expression of lactate-specific transporter solute carrier family 5 member 12 (SLC5A12). Interestingly, we manipulated a CD4⁺ T cell-monocytes co-culture and found that heated LGG-loaded monocytes modulate naive CD4⁺ T cells to differentiate preferentially into Treg cells rather than Th17 cells. To explain the above-mentioned contradiction, we used an experimental colitis model and found that LGG administration alleviated the DSS-induced colitis in mice, as indicated by decreases in weight loss and disease activity index. Moreover, SLC5A12 blockade (using a specific antibody) further reduced the colonic histological inflammatory score and decreased secretion of proinflammatory cytokines such as IFN-γ, IL-6, IL-17F, and IL-21. Notably, SLC5A12 blockade abolished the LGG-induced differentiation of the IL-17⁺CD4⁺ T (Th17) cells but significantly increased the frequency of Foxp3⁺CD4⁺ T (Treg) cells in the colonic lamina propria. Furthermore, a higher intracellular lactate concentration was observed in the colonic CD4⁺ T cells isolated from the LGG-treated colitic mice compared with other groups. Additionally, we also found elevated levels of oxidative stress indicators such as MDA and H₂O₂, as well as excessive reactive oxygen species (ROS) in colonic tissue of DSS-treated only mice, while LGG can scavenge ROS by inducing nuclear factor-erythroid 2-related factor 2 (Nrf2) expression in enterocytes. Conclusions: Altogether, these results indicate that LGG might alleviate preclinical colitis by modulating the Th17/Treg balance, and SLC5A12 blockade appears to enhance the anti-inflammatory properties of LGG. Full article

(This article belongs to the Topic Advances in Comprehensive Management Strategies for Inflammatory Bowel Disease)

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26 pages, 802 KB  

Open AccessReview

Intestinal Barrier: Mechanisms of Disruption and Strategies for Restoration in Ulcerative Colitis

by Mei-Na Wang, Chuan-Guo Liu, Jia Pan, Xiao-Gang Pang and Hui-Min Liu

Gastrointest. Disord. 2026, 8(2), 24; https://doi.org/10.3390/gidisord8020024 - 17 May 2026

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Abstract

Background: Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease. Intestinal barrier impairment represents a core pathogenic mechanism and a key therapeutic target for achieving mucosal healing and sustained remission. Methods: This narrative review summarizes intestinal barrier structure, disruption mechanisms, [...] Read more.

Background: Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease. Intestinal barrier impairment represents a core pathogenic mechanism and a key therapeutic target for achieving mucosal healing and sustained remission. Methods: This narrative review summarizes intestinal barrier structure, disruption mechanisms, barrier-targeted therapies, and non-invasive monitoring approaches. A reproducible literature search was conducted in PubMed, Web of Science, and ClinicalTrials.gov from 2015 to 2026. Results: Barrier disruption in UC involves genetic susceptibility, proinflammatory cytokines, zonulin-mediated tight junction injury, gut microbiota dysbiosis, decreased short-chain fatty acids and secondary bile acids, impaired autophagy, and an abnormal mucin 2 (MUC2)-dependent mucus layer. Validated non-invasive monitoring tools include fecal calprotectin/lactoferrin, intestinal ultrasound, diffusion-weighted magnetic resonance imaging (MRI), and intravoxel incoherent motion (IVIM). Emerging therapies focus on tight junction stabilization, epithelial regeneration, autophagy regulation, MUC2 restoration, and microbiota modulation. Conclusions: Intestinal barrier dysfunction drives the initiation and progression of UC. Barrier-based monitoring and targeted repair strategies improve UC management. Future studies should develop personalized therapies, precise microbiota engineering, and multi-dimensional digital evaluation systems. Full article

(This article belongs to the Topic Advances in Comprehensive Management Strategies for Inflammatory Bowel Disease)

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20 pages, 773 KB  

Open AccessSystematic Review

Benefits of Surgical Management in Ileocecal Crohn’s Disease: A Review of the Past Decade (2020–2026)

by Ion Balint, Roxana Zaharie, Vălean Dan, Emil Moiș, Călin Popa, Andra Ciocan, Nadim Al-Hajjar and Florin Zaharie

Medicina 2026, 62(5), 949; https://doi.org/10.3390/medicina62050949 - 13 May 2026

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Abstract

Background and Objectives: The management of localized ileocecal Crohn’s disease (CD) is undergoing a significant paradigm shift from traditional “step-up” medical escalation toward proactive early surgical intervention. With the evolution of surgical therapies as well as various minimally invasive procedures, as well [...] Read more.

Background and Objectives: The management of localized ileocecal Crohn’s disease (CD) is undergoing a significant paradigm shift from traditional “step-up” medical escalation toward proactive early surgical intervention. With the evolution of surgical therapies as well as various minimally invasive procedures, as well as a better understanding of inflammatory bowel diseases, surgery is playing a more important role in the treatment of inflammatory bowel disease. One of the most common occurrences in Crohn’s disease, the ileocecal localization can present with a lot of dilemmas regarding the optimal treatment in both adult patients and pediatric patients alike. One of the biggest challenges remains the decision between early surgery and continuous biological treatment, which can prove a challenge from multiple standpoints ranging from cost-efficiency to recurrence rate. This review highlights the latest changes in surgical management in ileocecal Crohn’s disease, focusing primarily on the anastomotic type, comparison with biological therapy, early aggressive surgery and pediatric surgery. Materials andMethods: After respecting the review criteria, 16 articles were included in our study, which emphasize the importance and the recent trends in the surgical management of the ileocecal disease. Results: All 16 articles met criteria for good quality, suggesting a low risk of bias, focusing primarily on early surgery, the role of Kono-S anastomosis as well as pediatric considerations. Conclusions: While the choice of the Kono-S anastomosis remains debatable, significant progress has been made in terms of early surgery which improves the long-term outcomes in patients while minimizing the risk of morbidity and mortality. Full article

(This article belongs to the Topic Advances in Comprehensive Management Strategies for Inflammatory Bowel Disease)

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10 pages, 490 KB  

Open AccessBrief Report

Bacterial Gastrointestinal Infections in Pediatric Inflammatory Bowel Disease (PIBD)—A Single-Center Experience of Epidemiology, Management, and Outcome

by Raffaela Miriam Planka, Almuthe Christine Hauer, Sebastian Bauchinger and Benno Kohlmaier

Diagnostics 2026, 16(9), 1411; https://doi.org/10.3390/diagnostics16091411 - 6 May 2026

Viewed by 381

Abstract

Background: Due to dysbiosis, intestinal barrier dysfunction, and immunosuppressive therapy, pediatric inflammatory bowel disease (PIBD) patients are more susceptible to infections. However, data on bacterial gastrointestinal (GI) infections in this population are scarce, and no guidelines explicitly address immunosuppressive therapy management during such [...] Read more.

Background: Due to dysbiosis, intestinal barrier dysfunction, and immunosuppressive therapy, pediatric inflammatory bowel disease (PIBD) patients are more susceptible to infections. However, data on bacterial gastrointestinal (GI) infections in this population are scarce, and no guidelines explicitly address immunosuppressive therapy management during such infections. This single-center study aims to address these knowledge gaps. Methods: A retrospective study of bacterial GI infections was conducted in PIBD patients aged 0–18 years, treated between 2011 and 2021 at the Department of Pediatrics and Adolescent Medicine, Medical University of Graz. Data to assess the study endpoints were extracted from the hospital information system. Results: A total of 139 PIBD patients were screened for bacterial GI infections. The mean follow-up time was 49 months (standard deviation ±33) and the total follow-up time amounted to approximately 473 person-years. Fourteen patients developed infections, with three experiencing them twice, resulting in 17 cases of infection. Most infections were caused by opportunistic bacteria, and 10 infections were treated with antibiotics (11 antibiotic prescriptions in total). At infection onset, 12 patients were on (combined) immunosuppressive therapy, including corticosteroids (3 patients), immunomodulators (9 patients), and/or biologics (3 patients). Six infections required escalation of immunosuppressive therapy due to increased PIBD activity. Hospitalization was required in five cases, and one Clostridioides difficile infection progressed to sepsis, necessitating intensive care unit admission. This corresponds to an incidence of three infections (95% confidence interval 1.75–4.80) and 0.2 severe infections per 100 person-years (95% confidence interval 0.01–1.11). Conclusions: The incidence of bacterial GI infections was 3 per 100 person-years (95% confidence interval: 1.75–4.80), with most cases being clinically mild. Clostridioides difficile was the most common pathogen. Immunosuppressive therapy was generally continued or intensified, when necessary, while antibiotic therapy was administered as indicated. Full article

(This article belongs to the Topic Advances in Comprehensive Management Strategies for Inflammatory Bowel Disease)

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12 pages, 2906 KB  

Open AccessArticle

Terminal Ileal Ulcers: Endoscopic Predictors for the Later Development of Crohn’s Disease

by Weiqi Zhang, Kun Zhang, Yang Yang, Haibin Dong, Shan Xie, Xiaojuan Guo, Bo Jiang, Yutang Ren and Shiming Zhou

Diagnostics 2026, 16(9), 1339; https://doi.org/10.3390/diagnostics16091339 - 29 Apr 2026

Viewed by 549

Abstract

Background: Terminal ileal ulcers (TIUs) are frequently identified during colonoscopy but are often attributed to nonspecific etiologies, potentially delaying the diagnosis of Crohn’s disease (CD). This study aimed to evaluate the utility of TIU as an early diagnostic marker and to determine whether [...] Read more.

Background: Terminal ileal ulcers (TIUs) are frequently identified during colonoscopy but are often attributed to nonspecific etiologies, potentially delaying the diagnosis of Crohn’s disease (CD). This study aimed to evaluate the utility of TIU as an early diagnostic marker and to determine whether diagnosis at the isolated TIU stage impacts long-term surgical outcomes. Methods: In this single-center, retrospective cohort study, consecutive adult patients with TIU detected via colonoscopy over a 10-year period were analyzed. Patients were stratified into CD-TIU and non-CD-TIU cohorts based on longitudinal follow-up. Clinical, endoscopic, and laboratory parameters were compared. Long-term surgical outcomes of patients diagnosed at the isolated TIU stage (Montreal classification L1) were compared with those of patients with established ileocolonic disease (Montreal classification L3). Results: Of the 66 patients included in the final analysis, 18 (27.3%) were ultimately diagnosed with CD. Specific endoscopic features—including longitudinal or fissuring ulcers (50.0% vs. 6.3%, p < 0.001), ileocecal valve deformity (50.0% vs. 18.8%, p = 0.011), and increased ulcer dimensions (9.11 mm vs. 4.60 mm, p = 0.002)—were significantly associated with a CD diagnosis. Notably, patients diagnosed at the TIU stage (CD-L1) exhibited a significantly lower surgical rate compared to those with established ileocolonic disease (CD-L3) (5.6% vs. 70.2%, p < 0.001). Conclusions: TIU, particularly when characterized by longitudinal morphology or ileocecal valve involvement, constitutes a critical early manifestation of CD. Diagnosis at the isolated TIU stage is associated with a lower long-term surgical risk compared to established ileocolonic disease, likely reflecting the influence of disease phenotype. These findings underscore the imperative for meticulous endoscopic evaluation to identify early-stage disease. Full article

(This article belongs to the Topic Advances in Comprehensive Management Strategies for Inflammatory Bowel Disease)

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17 pages, 2567 KB  

Open AccessArticle

The Assessment of Multidimensional Clinical, Biological and Patient-Reported Outcomes to Evaluate the Efficacy of Add-On Lactobacillus rhamnosus GG Supplementation in Mild Ulcerative Colitis: A Randomized Pilot Trial

by Paola Maragno, Chiara Amoroso, Simone Conforti, Marco Michelon, Ivanna Honcharyuk, Clorinda Ciafardini, Daniele Noviello, Francesco Strati, Flavio Caprioli, Federica Facciotti and Maurizio Vecchi

Nutrients 2026, 18(9), 1329; https://doi.org/10.3390/nu18091329 - 23 Apr 2026

Viewed by 867

Abstract

Background: Ulcerative colitis (UC) is a multifactorial disease characterized by aberrant mucosal immune activation in response to intestinal dysbiosis. Contemporary management strategies aim to target inflammation and microbiome alterations while reducing relapse risk. A multidimensional assessment integrating clinical, inflammatory, immune, and microbial endpoints [...] Read more.

Background: Ulcerative colitis (UC) is a multifactorial disease characterized by aberrant mucosal immune activation in response to intestinal dysbiosis. Contemporary management strategies aim to target inflammation and microbiome alterations while reducing relapse risk. A multidimensional assessment integrating clinical, inflammatory, immune, and microbial endpoints may better capture therapeutic effects beyond symptom control. Aims: To evaluate whether supplementation with Lactobacillus rhamnosus GG co-formulated with vitamin D3 (Dicoflor IBD Immuno) as an adjunct to optimized mesalamine (5-ASA) is associated with coordinated changes across clinical and biological domains in mild-to-moderate UC, using a multidimensional assessment framework. Methods: This single-center, randomized, double-blind, placebo-controlled pilot trial was conducted at Fondazione Ca’ Granda IRCCS Policlinico di Milano between May 2022 and May 2024. Thirty-six patients with mild-to-moderate UC receiving optimized 5-ASA were randomized to LGG+VitD3 (ALD3) or placebo (AP) for 4 weeks. Clinical activity, health-related quality of life (HRQoL), fecal calprotectin, peripheral immune cell subsets, and gut microbiota composition were assessed at baseline and week 4. Results: Both 5-ASA-LGG+VitD3 (ALD3)- and 5-ASA-placebo (AP)-treated patients showed significant improvement in clinical activity and HRQoL, without between-group differences. A higher proportion of clinical responders was observed in the ALD3 group, although this was not statistically significant. LGG+VitD3-supplemented patients showed reduced fecal calprotectin levels and increased frequencies of IL-22-producing CD4⁺ T cells. Microbiome analysis revealed enrichment of short-chain fatty acid-producing taxa, including Coprococcus and Fusicatenibacter, in ALD3-treated patients. Conclusions: In patients with mild UC receiving optimized 5-ASA, LGG+VitD3 supplementation does not improve short-term clinical outcomes beyond placebo but is associated with favorable modulation of inflammatory, immune, and microbial parameters, supporting the relevance of multidimensional biological endpoints in adjunctive UC management. Full article

(This article belongs to the Topic Advances in Comprehensive Management Strategies for Inflammatory Bowel Disease)

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35 pages, 1053 KB  

Open AccessReview

Biosensor-Based Detection of Calprotectin and Lactoferrin as Neutrophil-Derived Markers of Inflammatory Bowel Diseases: From Molecular Pathophysiology to Point-of-Care Platforms

by Nikita Sitkov, Andrey Ryabko, Sergei Ivanov, Yuri Cheburkin, Alexey Kolobov, Diana Khasanova, Vladimir Nikolaev, Dmitrii Kaplun and Kamil Gareev

Int. J. Mol. Sci. 2026, 27(6), 2692; https://doi.org/10.3390/ijms27062692 - 16 Mar 2026

Viewed by 1213

Abstract

Inflammatory bowel diseases (IBD) are chronic, relapsing, immune-mediated disorders that require regular and preferably noninvasive monitoring of inflammatory activity. Fecal biomarkers of neutrophilic inflammation, namely calprotectin and lactoferrin, therefore represent key analytical targets for diagnosis and longitudinal disease management. Despite their widespread clinical [...] Read more.

Inflammatory bowel diseases (IBD) are chronic, relapsing, immune-mediated disorders that require regular and preferably noninvasive monitoring of inflammatory activity. Fecal biomarkers of neutrophilic inflammation, namely calprotectin and lactoferrin, therefore represent key analytical targets for diagnosis and longitudinal disease management. Despite their widespread clinical use, existing publications predominantly address either their clinical relevance or individual technical solutions, without establishing a comprehensive engineering-translational framework for their biosensor-based implementation. This review bridges this gap by providing an integrative analysis of the molecular and biological nature of calprotectin and lactoferrin, the mechanisms underlying their appearance in fecal matrices, and the analytical constraints that directly influence the design of hybrid point-of-care (PoC) biosensor systems. We systematically compare major biosensing platforms, emphasizing sensor architecture, signal transduction mechanisms, and sample preparation strategies as critical determinants of sensitivity, selectivity, reproducibility, and clinical relevance. The novelty of this review lies in combining the pathophysiological context of neutrophilic inflammation with physicochemical and technological aspects of biosensor development, enabling a transition from laboratory prototypes to evaluation of real translational readiness. The practical significance resides in establishing a methodological basis for rational design of next-generation hybrid-integrated biosensor systems and outlining perspectives for digital analytics and artificial intelligence in clinically interpretable IBD monitoring. Full article

(This article belongs to the Topic Advances in Comprehensive Management Strategies for Inflammatory Bowel Disease)

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