BACKGROUND Mucosal healing (MH) has emerged as a key therapeutic target in inflammatory bowel disease (IBD), and achievement of this goal is documented by endoscopy with biopsy. However, colonoscopy is burdensome and invasive, and substitution with an accurate noninvasive biomarker is desirable. AIM To summarize published data regarding the performance of noninvasive biomarkers in assessing MH in IBD patients. METHODS We conducted a systematic review of studies that reported the performance of biomarkers in diagnosing MH in patients with IBD. The main outcome measure was to review the diagnostic accuracy of serum and fecal markers that showed promising utility in assessing MH. RESULTS We screened 1301 articles, retrieved 46 manuscripts and included 23 articles for full-text analysis. The majority of the included manuscripts referred to fecal markers (12/23), followed by circulatory markers (8/23); only 3/23 of the included manuscripts investigated combined markers (serum and/or fecal markers). Fecal calprotectin (FC) was the most investigated fecal marker for assessing MH. In ulcerative colitis, for cutoff levels ranging between 58 mcg/g and 490 mcg/g, the sensitivity was 89.7%-100% and the specificity was 62%-93.3%. For Crohn’s disease, the cutoff levels of FC ranged from 71 mcg/g to 918 mcg/g (sensitivity 50%-95.9% and specificity 52.3%-100%). The best performance for a serum marker was observed for the endoscopic healing index, which showed a comparable accuracy to the measurement of FC and a higher accuracy than the measurement of serum C-reactive protein. CONCLUSION Several promising biomarkers of MH are emerging but cannot yet substitute for endoscopy with biopsy due to issues with reproducibility and standardization.

Endoscopy has a central role in the management of inflammatory bowel disease (IBD), providing crucial data for diagnostic and therapeutic decisions, treating disease-related complications, and assisting in the early detection of dysplasia and prevention of colorectal cancer in the setting of IBD. Treatment targets have significantly shifted in IBD, focusing on achieving mucosal healing, a more meaningful endpoint than clinical remission. With the emergence of novel therapies, we aim to alter the course of the disease and prevent irreversible damage to the bowel. To that end, obtaining reliable and reproducible assessments of endoscopic disease activity has become an issue of great importance. Although several guidelines include recommendations regarding endoscopic surveillance in patients with long-standing IBD, there is an open debate regarding the best examination method and the appropriate follow-up intervals. Another important issue is whether surveillance guidelines are actually implemented in real-life practice and what is the preferred surveillance method among endoscopists. Significant changes have occurred in the endoscopic world with the development of new diagnostic and therapeutic modalities and their incorporation in everyday practice. We aimed to assess the real-life application of guideline recommendations regarding endoscopy in IBD patients and to review newly emerged data which might impact these recommendations in the near future.

Background: To date no scale has been validated to assess bubbles impairing bowel preparation. The use of different descriptions in randomized trials limit clinical interpretation. Therefore, our goal was to develop and determine reliability of a novel scale – the Colon Endoscopic Bubble Scale – CEBuS. Methods: Multicentre prospective observational study with two online evaluation phases (Phase 1 - evaluation by four expert endoscopists; Phase 2 - six expert and 13 non-expert) of 45 randomly distributed still colonoscopy images (15 per scale level). Observers assessed images twice with a 2-week interval both a) using the CEBuS (CEBuS-0 – no or minimal bubbles, covering <5% of the surface; CEBuS-1 – bubbles covering 5-50%; CEBuS-2 – bubbles covering >50%); and b) reporting the clinical action (do nothing; wash with water; wash with simethicone). Results: CEBuS provided high levels of agreement both in phase 1 (experts) and 2 (mix expert/non-expert) with intraobserver reliability – Kappa 0.82 (95%CI 0.75-0.88) vs. 0.86 (0.85-0.88) – and for interobserver agreement – ICC 0.83 (0.73-0.89) vs. 0.90 (0.86-0.94). Previous endoscopic experience had no influence on agreement comparing experts and non-experts intra- and interobserver reliability – Kappa 0.86 (0.80-0.91) vs. 0.87 (0.84-0.89) and – ICC 0.91 (0.87-0.94) vs. 0.90 (0.86-0.94), respectively. Interobserver agreement on clinical action was – ICC 0.63 (0.43-0.78) vs. 0.77 (0.68-0.84). Absolute agreement on clinical action per scale level was – CEBuS-0 85% (82-88), CEBuS-1 21% (16-26), CEBuS-2 74% (70-78). Conclusion: The CEBuS proved to be a reliable instrument to standardise the evaluation of colonic bubbles during colonoscopy. Assessment in daily practice is warranted.

Objective: Our aim was to prospectively assess bowel preparation in patients with inflammatory bowel disease (IBD) and to determine the impact of disease-related factors on preparation efficacy because few studies have addressed this issue. Methods: We conducted a retrospective analysis of data collected from a cohort of patients with IBD enrolled at a tertiary center in Bucharest, Romania. Patients were evaluated every 12 months, with each study visit including collection of clinical, biological, and endoscopic data. We reviewed 348 colonoscopies from 169 consecutive patients prospectively followed for a median length of 2 (0-6) years. Results: The median total Boston score and median score per bowel segment in our cohort were optimal at 6 (range 0-9) and 2 (maximum 3), respectively. There was no difference in bowel preparation between patients with endoscopic activity and patients with mucosal healing (median total Boston score 6). Disease-and patient-related parameters did not influence the quality of bowel preparation. Conclusions: The quality of bowel preparation in patients with IBD was optimal for our cohort, and disease-related parameters did not significantly influence preparation efficacy.

Background: The expansion of advanced therapies for inflammatory bowel disease created a lag between the development of these new therapies and their incorporation and use in daily practice. At present, no clear definitions for treatment optimization, treatment failure or criteria to abandon therapy are available. We aimed to centralize criteria for a nonresponse to all available molecules and to summarize guideline principles for treatment optimization. Methods: We conducted a systematic review of studies that reported criteria for the treatment response to all advanced therapies (infliximab, adalimumab, golimumab, ustekinumab, vedolizumab and tofacitinib) in patients with inflammatory bowel disease. Results: Across trials, criteria for a response of both patients with ulcerative colitis and Crohn’s disease are heterogenous. Investigators use different definitions for clinical and endoscopic remission, and endoscopic response and outcomes are assessed at variable time points. Current society guidelines provide heterogenous recommendations on treatment optimization. Most available data on loss of response concern anti-TNF molecules, and newer therapies are not included in the guidelines. Conclusion: The lack of clear definitions and formal recommendations provide the premise for empirical treatment strategies and premature abandonment of therapies.