Front Med (Lausanne). 2023 Apr 11;10:1031998. doi: 10.3389/fmed.2023.1031998.eCollection 2023.

Marco Vincenzo Lenti ^1 2, Maria Lia Scribano ³, Livia Biancone ⁴, Rachele Ciccocioppo ⁵, Daniela Pugliese ⁶, Luca Pastorelli ^7 8, Gionata Fiorino ^9 10, Edoardo Savarino ¹¹, Flavio Andrea Caprioli ¹², Sandro Ardizzone ¹³, Massimo Claudio Fantini ^14 15, Gian Eugenio Tontini ¹⁶, Ambrogio Orlando ¹⁷, Gianluca Matteo Sampietro ¹⁸, Giacomo Carlo Sturniolo ¹¹, Giovanni Monteleone ⁴, Maurizio Vecchi ¹², Anna Kohn ¹⁹, Marco Daperno ²⁰, Renata D'Incà ¹⁰, Gino Roberto Corazza ^1 2, Antonio Di Sabatino ^1 2

Author information

¹Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy.

²Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy.

³Villa Stuart, Multi-Speciality Clinic, Rome, Italy.

⁴Unit of Gastroenterology, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.

⁵Gastroenterology Unit, Department of Medicine, A.O.U.I. Policlinico G.B. Rossi and University of Verona, Verona, Italy.

⁶CEMAD Digestive Disease Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.

⁷Liver and Gastroenterology Unit, ASST Santi Paolo e Carlo, Milan, Italy.

⁸Department of Health Sciences, University of Milan, Milan, Italy.

⁹IBD Unit, Ospedale San Camillo-Forlanini, Rome, Italy.

¹⁰Department of Gastroenterology, San Raffaele Hospital and Vita-Salute San Raffaele University,, Milan, Italy.

¹¹Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.

¹²Gastroenterology and Endoscopy Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy.

¹³Gastroenterology and Digestive Endoscopy Unit, ASST Fatebenefratelli Sacco, Milan, Italy.

¹⁴Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.

¹⁵Gastroenterology Unit, Azienda Ospedaliero-Universitaria (AOU) di Cagliari, Cagliari, Italy.

¹⁶Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milano, Italy.

¹⁷Inflammatory Bowel Disease Unit, Azienda Ospedaliera Ospedali Riuniti "Villa Sofia-Cervello" Palermo, Palermo, Italy.

¹⁸Division of General and HBP Surgery, Rho Memorial Hospital, ASST Rhodense, Rho, Milano, Italy.

¹⁹Gastroenterology Operative Unit, Azienda Ospedaliera San Camillo-Forlanini FR, Rome, Italy.

²⁰Division of Gastroenterology, Ospedale Ordine Mauriziano di Torino, Turin, Italy.

Abstract

Inflammatory bowel disease (IBD), which includes Crohn's disease (CD) and ulcerative colitis (UC), is a complex, immune-mediated, disorder which leads to several gastrointestinal and systemic manifestations determining a poor quality of life, disability, and other negative health outcomes. Our knowledge of this condition has greatly improved over the last few decades, and a comprehensive management should take into account both biological (i.e., disease-related, patient-related) and non-biological (i.e., socioeconomic, cultural, environmental, behavioral) factors which contribute to the disease phenotype. From this point of view, the so called 4P medicine framework, including personalization, prediction, prevention, and participation could be useful for tailoring ad hoc interventions in IBD patients. In this review, we discuss the cutting-edge issues regarding personalization in special settings (i.e., pregnancy, oncology, infectious diseases), patient participation (i.e., how to communicate, disability, tackling stigma and resilience, quality of care), disease prediction (i.e., faecal markers, response to treatments), and prevention (i.e., dysplasia through endoscopy, infections through vaccinations, and post-surgical recurrence). Finally, we provide an outlook discussing the unmet needs for implementing this conceptual framework in clinical practice.