Andreas Kapsoritakis

Background/Objectives: Celiac disease (CD) is a chronic immune-mediated disorder triggered by gluten ingestion in genetically predisposed individuals with higher prevalence among first-degree relatives. Despite its hereditary risk, little is known about how parents with at least one child with CD perceive this risk in unaffected children. This study examined parental perceptions and dietary practices regarding CD prevention in unaffected children. Methods: A cross-sectional mixed-methods study was conducted in Greek parents using an online questionnaire for the quantitative component and semi-structured interviews for the qualitative. Quantitative data were analyzed using descriptive statistics and multivariable logistic regression analysis, while qualitative data were analyzed using framework analysis. Results: Although parents demonstrated high awareness of genetic risk, this was not translated into preventive dietary modifications. Belief in the role of diet as a preventive CD strategy emerged as the only significant predictor of dietary change. Diet was widely recognized as important for overall health or as a therapeutic regimen for children living with CD; however, it was not perceived as a preventive strategy for CD. Reported family barriers to adopting a healthy diet included financial constraints and limited guidance, whereas advice from healthcare professionals emerged as a key facilitator of dietary change. Conclusions: Although parents recognize the genetic risk of CD, they rarely implement dietary changes as CD preventive behavior for their unaffected children. These findings highlight the potential value of clearer dietary guidance and targeted professional support for families with children with CD and unaffected siblings.

Background/Objectives: Enteral nutrition (EN), delivered either exclusively (EEN) or partially (PEN) in combination with the Crohn’s Disease Exclusion Diet (CDED), represents an evidence-based dietary therapy for active Crohn’s Disease (CD), recommended in clinical guidelines. However, adherence to this therapy remains suboptimal among adult patients. This study aimed to explore the intention to repeat CDED & PEN alongside perceived factors affecting adherence to CDED & PEN in CD adult patients. Methods: A single-center, cross-sectional qualitative study was conducted between October 2025 and March 2026 at a private dietetic practice in Larissa, Greece. Semi-structured interviews were undertaken and analyzed using thematic analysis. Results: Out of the 88 patients screened, 15 adults with CD participated in semi-structured interviews. Four overarching themes emerged: (1) intention to repeat CDED & PEN, with all participants reporting willingness to repeat CDED & PEN in the event of future relapse; (2) barriers to CDED & PEN adherence, including challenges in social situations involving food; (3) facilitators of CDED & PEN adherence, such as improved symptom control and increased sense of security; and (4) dual factors affecting CDED & PEN adherence, whereby meal preparation demands, taste and variety, and social and environmental support acted as either facilitators or barriers against adherence depending on individual circumstances. Conclusions: Greek adults with CD showed strong willingness to reinitiate CDED & PEN during relapse. Addressing modifiable barriers, particularly dietary monotony and financial burden, alongside strengthening structured dietitian support and personalized dietary guidance, may help optimize adherence in clinical practice.

Background/Objectives: Although the exact etiology of Inflammatory Bowel Diseases (IBD) is not yet fully understood, recent evidence suggests that both genetic and dietary factors are involved in their pathogenesis. The aim of the present exploratory study was to investigate how first-degree relatives (FDRs) of individuals with IBD perceive familial risk and the role of diet in IBD onset and prevention. Methods: A mixed methods approach was followed. A total of 103 unaffected FDRs of individuals living with IBD in Greece participated in an online questionnaire examining demographic characteristics, disease-related knowledge, risk perception, and beliefs about the role of diet in IBD. In parallel, 16 semi-structured interviews explored participants’ beliefs, self-reported dietary practices, and the factors shaping them using a framework analysis guided by the Health Belief Model. Results: Exploratory quantitative findings indicated that belief in the role of diet was associated with higher odds of self-reported family dietary changes, while belief in genetic risk was associated with lower odds of self-reported family dietary changes. The findings did not characterize the nature, maintenance, or motivation of these changes. Qualitative findings provided a deeper understanding of participants’ beliefs, highlighting that diet was mainly viewed as relevant to IBD management rather than prevention. Fear of disease onset and healthcare professional guidance were perceived as key facilitators of dietary changes. Conclusions: Our findings highlight heterogeneous beliefs regarding familial IBD risk and self-reported family diet changes, and support future research addressing balanced familial-risk communication for unaffected FDRs.

Background/Objectives: Although the exact etiology of Inflammatory Bowel Diseases (IBD) is not yet fully understood, recent evidence suggests that both genetic and dietary factors are involved in their pathogenesis. The aim of the present exploratory study was to investigate how first-degree relatives (FDRs) of individuals with IBD perceive genetic risk and the role of diet in IBD prevention. Methods: A mixed methods approach was followed. A total of 103 unaffected FDRs of individuals living with IBD in Greece participated in an online questionnaire examining demographic characteristics, disease-related knowledge, risk perception, and beliefs about the role of diet in IBD onset and prevention. Through 16 semi-structured interviews, the beliefs of unaffected FDRs, their dietary practices and the factors affecting those practices for IBD prevention were investigated using Framework analysis guided by the Health Belief Model. Results: Quantitative findings showed that perceived importance of diet was the strongest predictor of dietary change, while genetic beliefs were associated with reduced preventive behaviors despite professional consultation. Qualitative findings provided a deeper understanding of participants’ beliefs, highlighting that diet was mainly viewed as relevant to IBD management rather than prevention. Fear of disease onset and healthcare professional guidance were perceived as key facilitators of dietary changes. Conclusions: Our findings highlight the need for individualized dietary counselling and improved risk communication, to enhance implementation of preventive dietary practices and bridge the gap between knowledge and behavior in IBD prevention.

Background/Objectives: Coeliac disease (CD) is a chronic immune-mediated disorder triggered by gluten ingestion in genetically predisposed individuals with a higher prevalence among first-degree relatives. Despite its established hereditary risk, little is known about how parents with at least one child with CD perceive this risk in their unaffected children. This study examined parental perceptions and dietary practices regarding CD prevention in unaffected children. Methods: A cross-sectional mixed-methods study was conducted. The quantitative component consisted of an online questionnaire survey in parents in Greece. Quantitative data were analyzed using descriptive statistics and multivariable logistic regression analysis. The qualitative component included semi-structured interviews with parents of children with CD and unaffected children in Greece. Data were analyzed using framework analysis. Results: Although parents demonstrated high awareness of genetic risk, this was not translated into preventive dietary modifications. Belief in the role of diet as preventive CD strategy emerged as the only significant predictor of dietary change. Diet was widely recognised as important for overall health or as a therapeutic regimen for children living with CD; however, it was not perceived as a preventive strategy for CD. Reported family barriers to adopting a healthy diet included financial constraints and limited guidance, whereas advice from healthcare professionals emerged as a key facilitator of dietary change. Conclusions: Although parents recognize the genetic risk to CD, they rarely implement dietary changes as CD preventive behavior for their unaffected children. These findings underscore the need for clearer dietary guidance and targeted professional support for families with children with CD and unaffected siblings.

Background/Objectives: Enteral nutrition (EN), delivered either exclusively (EEN) or partially (PEN) in combination with the Crohn’s Disease Exclusion Diet (CDED), represents an evidence-based dietary therapy for active Crohn’s Disease (CD), recommended in clinical guidelines. However, adherence to this therapy remains suboptimal among adult patients. This study aimed to explore the intention to repeat CDED & PEN alongside perceived factors affecting adherence to CDED & PEN in CD adult patients. Methods: A cross-sectional qualitative study was conducted. Semi-structured interviews were undertaken and analysed using thematic analysis. Results: Out of the 88 patients screened, 15 adults with CD participated in semi-structured interviews. Four overarching themes emerged: (1) intention to repeat PEN & CDED, with all participants reporting willingness to repeat CDED & PEN in the event of future relapse; (2) barriers to CDED & PEN adherence, including challenges in social situations involving food; (3) facilitators of CDED & PEN adherence, such as improved symptom control and increased sense of security; and (4) dual factors affecting CDED & PEN adherence, whereby meal preparation demands, taste and variety, and social and environmental support acted as either facilitators or barriers against adherence depending on individual circumstances. Conclusions: Greek adults with CD showed strong willingness to reinitiate CDED and PEN during relapse. Addressing modifiable barriers, particularly dietary monotony and financial burden, alongside strengthening structured dietitian support and personalized dietary guidance, may help optimize adherence in clinical practice.

Background/Objectives: Diet and mental health constitute two significant modifiable factors affecting Inflammatory Bowel Disease (IBD). The present exploratory study explores potential interrelationships between mental health and eating patterns in IBD patients in Greece. Methods: A mixed-methods approach was followed. Two hundred and eighty-three individuals living with IBD in Greece (n = 110 UC, n = 173 CD) participated in an online questionnaire survey examining demographic characteristics, anxiety, depression, and dietary attitudes. Fourteen semi-structured interviews explored the lived experiences of diet, mental health, and disease among IBD patients. Results: Quantitative study revealed that 45.77% of patients scored above the clinical cutoff for anxiety (GAD-7 ≥ 10) and 48.37% for depression (PHQ-9 ≥ 10). Patients with UC exhibited a significantly higher prevalence of moderate to severe anxiety (54.5% vs. 37.0%, p = 0.004) and depression (54.5% vs. 42.2%, p = 0.042) compared to CD. Disordered eating attitudes were present in 27.22% of the total sample, with no significant differences between diagnostic groups (p = 0.985). Thematic analysis revealed three overarching themes, namely (a) ‘life in two phases: IBD impact on health’, (b) ‘mental health and diet interplay—their perceived impact on IBD’ and (c) ‘coping strategies for managing IBD’. Conclusions: Our findings highlight the dynamic interplay among diet, mental health, and IBD experience. The study underscores the importance of developing holistic biopsychosocial interventions integrating medical, dietary, and psychological components for IBD management.

Background/Objectives: Ustekinumab has been approved for the treatment of moderate to severe ulcerative colitis. Real-world data regarding its efficacy and the discovery of predictive factors of response need to be studied further. We aimed to evaluate the efficacy and identify predictors of response to induction treatment with ustekinumab in patients with ulcerative colitis. Methods: This is a multicenter, prospective cohort study. Clinical response (CR) at week 16 was the primary endpoint, and steroid-free clinical remission (SFCRem) and endoscopic response were the secondary endpoints. Baseline histology, mucosal gene expression, and pharmacokinetics were studied for their effect on response to treatment. Results: We included 123 patients (mean age = 50.3 years). CR was recorded in 70.8% (75/106), SFCRem in 48% (59/123), endoscopic improvement in 71.4% (40/56), and mucosal healing in 28.6% (16/56). Higher PRO-stool frequency (OR = 0.49, p = 0.027), concomitant use of 5-ASA (OR = 3.69, p = 0.021), platelet number of ≥284 × 10⁹/L (OR = 6.52, p = 0.001) at baseline, and a drop in the total count of platelets by 10⁸/L (OR = 1.23, p = 0.022) at week 8 were independently associated with CR. Elevated trough levels of ustekinumab at week 16 were associated with a higher probability of endoscopic improvement (median difference = 3784 ng/mL, p = 0.013), with an optimal cut-off value of 3500 ng/mL (AUC = 0.82, 95% CI: 0.66–0.96). Increased mucosal mRNA expression for IL-23 (p = 0.007) and IL-23R (p = 0.031) at baseline was associated with increased probability of CR. Higher continuous Geboes scores at baseline were associated with a lower probability of CR (OR = 0.80, p = 0.045), with an optimal cut-off value of 14 (AUC = 0.75, 95% CI: 0.57–0.93). Conclusions: Clinical, laboratory, and molecular markers may identify patients with ulcerative colitis who are more likely to respond to ustekinumab.

Enteral feeds can be classified as two major types: commercial enteral formulas and blenderized enteral feeds. When deciding the most appropriate type of feed for a patient, several parameters need to be taken into consideration. Benefits associated with the use of blenderized tube feeds include giving a sense of normalcy to patients, having a positive impact on anthropometric indices, allowing for careful control over known food allergens, being associated with improved gastrointestinal tolerance and improved gut microbial composition (mainly in pediatric populations) and being generally less costly compared with commercial formulas. On the other hand, commercial enteral formulas have the advantages of being generally sterile, less likely to cause tube clogging and having a known and consistent nutrition composition. Further studies, specifically well-designed randomized controlled trials including adult populations, that will emphasize the impact of blenderized enteral feeds on various clinical outcomes are warranted. Clinicians need to be conscientious and educated regarding safe food practices for blended food preparation, as well as the characteristics of commercial formula options available to help assist patients in selecting the proper feed for their nutritional needs and clinical condition.

Background: Biologic agents used in patients with inflammatory bowel diseases (IBD) may influence the pathophysiology of coexistent metabolic-dysfunction associated steatotic liver disease (MASLD). This study primarily aimed to evaluate the six-month effect of infliximab or vedolizumab vs. no biologics on presumed hepatic steatosis in patients with IBD. Secondary endpoints were their effect on hepatic fibrosis and parameters related to hepatic metabolism. Methods: This prospective, non-randomized, controlled trial assigned adult bio-naïve patients with IBD into three groups: infliximab, vedolizumab, or controls (receiving no biologic). The baseline was the time of the initiation of biologic agents and the endpoint six months later. Hepatic steatosis was evaluated with transabdominal ultrasonography (Hamaguchi score), whereas controlled attenuation parameter (CAP), fatty liver index (FLI), and hepatic steatosis index (HSI) were used as surrogates. Hepatic fibrosis was evaluated with liver stiffness (LS), fibrosis-4 index (FIB-4), and nonalcoholic fatty liver disease (NAFLD) fibrosis score. Results: Sixty-six patients were assigned to infliximab (n = 26), vedolizumab (n = 14), or control (n = 26); At the endpoint, the Hamaguchi score, CAP, FLI, and HSI were not different between groups. LS was not different between groups; however, FIB-4 was increased within all groups, and NAFLD fibrosis score was increased within infliximab and control groups, without significant biologic × time interactions. Conclusions: No positive or adverse effect of infliximab or vedolizumab vs. no biologic agents was shown on presumed hepatic steatosis in patients with IBD, who have not been previously exposed to biologic agents. Although no effect of both biologic agent on LS, a slight but significant increase in FIB-4 and NAFLD fibrosis score warrants further studying.