BACKGROUND: to find predictive value of KRAS gene’s copy number variation (CNV_KRAS) to anti-EGFR therapy.
PATIENTS AND METHODS: a prospective cohort single-center study included 150 patients, 103 patients with colorectal cancer (CRC) and wild-type RAS/BRAF, 39 patients with colorectal cancer with somatic mutations in the KRAS gene, as well as 8 non-oncological patients (as normal controls). CNV_KRAS was determined using digital droplet PCR.
RESULTS: the clinically significant CNV_KRAS level of ≥ 9 copies established for a refusal of targeted anti-EGFR therapy. The incidence of clinically significant CNV_KRAS level in patients with wild-type RAS/BRAF was 17% (the first group of patients). Incidence of clinically significant CNV_KRAS level in patients with mutations in the KRAS gene was 3% (the second group of patients). At the I stage of CRC clinically significant CNV_KRAS was not detected in either the first or second group; at the stage II of CRC in the first group — in 14% of patients (3/22), and in the second group — not detected; at the stage III of CRC in the first group — in 21% of patients (8/39), and in the second group of patients — not detected; at the stage IV of CRC in the first group — in 17% (6/35) of patients, and in the second group of patients — in 5% (1/20). Tumor DNA was analyzed in 10 patients with the stage IV CRC from the first group who received anti-EGFR therapy to find out the clinically significant level of CNV_KRAS. Disease control was achieved in 7 out of 10 patients. The median CNV_KRAS score in the remaining three patients was higher than in the disease control group, 9.2 (9.05, 10.10) and 5.38 (4.77, 7.35) (p = 0.017).
CONCLUSIONS: detection of CNV_KRAS level of ≥ 9 copies in a malignant colon tumor is a contraindication to targeted therapy. This phenomenon occurs significantly more often in patients without somatic mutations in the RAS genes (KRAS, NRAS) and BRAF, than in patients with point mutations in the KRAS gene (p = 0.02).

AIM: to estimate the efficacy and safety of outpatient polypectomy of epithelial benign tumors of the colon.
PATIENTS AND METHODS: the prospective cohort study included 809 patients with colon polyps removed by cold loop polypectomy (CSP), hot loop polypectomy (HSP) and hot loop polypectomy with injection (HSP + injection). Intraand postoperative complications were assessed.
RESULTS: a total of 2115 colon polyps 2–20 mm (0.5 [0.4; 0,7] mm) were removed. No intraoperative complications occurred. Prophylactic clipping was performed in 6,5% of cases with a significant higher rate for larger neoplasms: 10–20 mm — 77/324 (23.8%), 6–9 mm — 43/618 (7%), 2–5 mm — 17/1173 (1.4%), p < 0.001 in the omnibus test and all pairwise comparisons. The frequency of delayed complications (within 3 days) was 0.49% (4/809 patients) IIIa according to the Clavien-Dindo classification and 0.19% (4/2115 removed neoplasms).
CONCLUSION: removal of benign epithelial neoplasms of the colon ≤ 20 mm without admission in a 24-hour hospital is associated with a low rate (0.19%) of delayed bleeding (within 3 days), so it is necessary to remove polyps less than 10 mm during screening colonoscopy.

AIM: to estimate anatomical and functional outcomes of surgical treatment for rectocele combined with rectal intussusception.
PATIENTS AND METHODS: the retrospective study included 96 patients with rectocele with internal rectal intussusception. The median age was 52 (21; 79) years. Laparoscopic rectocolposacropexy was performed in 59/96 (61%) patients with rectocele combined with high internal rectal intussusception, and Longo’s procedure was performed in 37/96 (39%) women with rectocele and low internal rectal intussusception.
RESULTS: late outcomes were estimated in 71/96 (74%) patients. The median follow up was 16 (6; 72) months. No complications occurred after laparoscopic rectocolposacropexy. Two (5%) patients had bowel movements up to 8–10 times a day after Longo procedure right after the surgery. After 2 months, bowel movements decreased to 2–3 times a day. Normal residual volume of the rectum after the Longo procedure was detected in 16/37 patients, while laparoscopic rectocolposacropexy did not affect it (p = 0.01). The median rectocele size after surgery in both groups decreased from 5.0 cm to 2.7 cm (p < 0.0001). High rectal intussusception persisted in 20/59 (34%) patients after rectocolposacropexy, low intussusception — in 15/37 (40%) after Longo procedure. According to the original scale-questionnaire, a decrease in the manifestations of SOD was noted in 20/31 (65%) patients after Longo procedure and in 14/40 (35%) patients after rectocolposacropexy (p = 0.018). Improvement in the quality of life (PFDI questionnaire) after the surgery was registered in both groups without significant differences (p = 0.2). The severity of the effect was 22 (6-48) points (p < 0.0001).
CONCLUSION: surgery for complex rectocele, regardless of the operation, does not always provide complete anatomical correction of the defects of the rectum. Laparoscopic rectocolposacropexy is inferior to the Longo procedure in functional outcomes.

AIM: to evaluate the rate and timeliness of adjuvant chemotherapy (ACT) in patients with stage II–III colon cancer (CC) after surgery in different medical units of the Arkhangelsk region and to assess its prognostic value.
PATIENTS AND METHODS: all records on patients with CC after radical surgery in 2010–2021 were extracted from the Arkhangelsk Regional Cancer Registry (ARCR). Proportions of those who received ACT, the average waiting time for ACT and survival depending on the fact of ACT in specialized oncological unit (SOU), including the Arkhangelsk Clinical Oncology Dispensary (ACOD) and non-specialized medical units (NMU). Cancer-specific survival (CSS) was assessed. The hazard ratio (HR) of death from CC was estimated by Cox regression depending on receiving ACT and the waiting time for it.
RESULTS: the database included 1032 cases (538 patients with stage III and 494 with stage II patients, who had unfavorable prognosis factors). No differences were found in ACT rate among patients with stage II CC. In stage III CC, ACT was performed in 73.5% of patients operated on in the SOU and 46.3% in NMU (p < 0.0001). The median waiting time for ACT after radical surgery in the SOU was 33.5 (17.0; 43.5) days, and 46.5 (31.0; 64.5) days in the NMUs, p < 0.0001. The five-year CSS of those who received ACT was 67,2% (95% confidence interval (CI): 60.8–72.9%), and 64.1% (95% CI: 58.8–68.1%) for those who did not receive ACT, p = 0.012. Five-year CSS after chemotherapy started within 4 weeks after radical surgery was 73.2%, for the gaps 5-8, 9–12 and more than 12 weeks 70.4%, 63.7%, and 35.4%, respectively, p = 0.002. In the adjusted model, the HR for death from ROC was 3-fold higher in patients receiving ACT at 12 + weeks (HR = 2.6 (95% CI: 1.31–5.14), p = 0.006) compared with the 0–4-week interval.
CONCLUSION: the study revealed lower and later incidence of ACT in NMU affected worse survival.

AIM: to assess the risk of severe low anterior resection syndrome (LARS) in patients with rectal cancer after combined treatment.

PATIENTS AND METHODS: from July 2022 to November 2023, 50 patients with rectal cancer underwent radiation with a total focal dose of 50–54 Gy with radiomodification with capecitabine and low anterior rectal resection with preventive ileostomy. The ileostomy was closed after 4 months. Prior to and after radiation, the anorectal function was assessed using high-resolution anorectal manometry (HRAM) and the LARS scale.

RESULTS: the most significant predicting factors for severe LARS were maximal contraction pressure and first sensation volume. Three months after ileostomy closure, the patients were divided into groups depending on the HRAM parameters. Group 1: nine patients with severe LARS (34 points on the LARS scale), with a decrease in maximal contraction pressure by ≥ 30% and an increased first sensation volume by ≥ 60%, according to HRAM. Group 2: four patients out of 36 had severe LARS (31 points on the LARS scale), with a decrease in maximal contraction pressure by 5–29% and an increased first sensation volume by 10–59%, according to HRAM. Group 3: in 5 patients with a decreased maximal contraction pressure by ≤ 4% and an increased volume of the first sensation by ≤ 9%, LARS did not develop.

CONCLUSION: a decrease in the maximal contraction pressure by 30% or more and an increase in the volume of the first sensation by 60% or more after radiation therapy can increase the risk of severe LARS. This group of patients requires prevention and correction of anorectal dysfunction.

AIM: assess the impact of neoadjuvant chemotargeted therapy in patients with colorectal cancer and synchronous liver metastases in perioperative period.

PATIENTS AND METHODS: a pilot prospective study included 30 patients with colorectal cancer and synchronous liver metastases (mCRC). The combined treatment included 3 cycles of neoadjuvant FOLFOXIRI chemotherapy with the addition of targeted agents: cetuximab (24 patients with wtKRAS) and bevacizumab (6 patients with mtKRAS) followed by radical surgery.

RESULTS: the clinical and radiological response of colorectal cancer liver metastases to neoadjuvant chemotherapy (NACT) was complete in 4 (13.3%) patients and partial in 26 (86.7%) patients. Partial response to NACT in the primary tumor occurred in all patients. Adverse events of NACT were detected in 12 (40%) patients, 1 (3.3%) of them produced grade III toxicity. All patients underwent radical surgery (R0) 3–4 weeks after NACT, 28 (93.3%) of them underwent simultaneous colorectal and liver resection. Postoperative complications occurred in 21 (70%) patients, including grade I and grade IIIa complications (according to Сlavien-Dindo classification) — 22 (73.3%) and 2 (6.7%), respectively. Histology revealed pathologic complete response (pCR) of liver metastases in 1 (3.6%) case and pathological grade 3 regression of the primary tumor (TRG3, Mandard A.M.) in 23 (76.7%) patients. Two (6.7%) patients with complete clinical and radiological response of liver metastases, who did not undergo liver resection, had no evidence of disease progression 12 months after the treatment.

CONCLUSION: in mCRC with synchronous liver metastases, NACT according to the FOLFOXIRI regimen in combination with targeted agents with a moderate toxicity profile provide significant carcinocidal effect without having a negative impact in the perioperative period. The study is ongoing to analyze 2-year disease-free and overall survival of patients.

AIM: to assess early results of pancreatoduodenalectomy with colon resection for cancer.
PATIENTS AND METHODS: a retrospective cohort two-center controlled study included 927 patients. The first group included 95 patients after рancreatoduodenalectomy with colon resection. The second group included 832 patients who underwent рancreatoduodenalectomy without resection of adjacent organs. The first group was divided into two subgroups: the first subgroup is patients with malignant neoplasms of the colon — 42, the second subgroup is patients with malignant neoplasms of other sites — 53.
RESULTS: the group of patients with рancreatoduodenalectomy and colon resection was significantly more often assessed according to the ECOG 2–3 and ASA 3 (52/95 (54.7%) vs 63/669 (9.4%), p < 0.001 and 25/95 (26.3%) vs 104/669 (15.5%), respectively). The postoperative morbidity rate, as well as their class according to Clavien-Dindo, was homogeneous in both groups. The postoperative mortality rate was higher in the group of рancreatoduodenalectomy with colon resection (13/42 (31.0%) vs 49/832 (5.9%), p = 0.004). When comparing with subgroups, the postoperative mortality rate was comparable between patients after рancreatoduodenalectomy with colon resection for colon cancer and рancreatoduodenalectomy without resection of adjacent organs (3/42 (7.1%) vs 49 / 832 (5.9%), р = 0.7), and was significantly higher in the рancreatoduodenalectomy with colon resection (10/53 (18.9%) vs 49/832 (5,9%), р < 0.001).
CONCLUSION: patients in the рancreatoduodenalectomy with colon resection group are clinically more severe, and the operation itself is accompanied by a high rate of postoperative morbidity, but a comparable with рancreatoduodenalectomy in a standard volume, without resection of adjacent organs. Рancreatoduodenalectomy with colon resection for colon cancer is also associated with a comparable rate of postoperative mortality with standard рancreatoduodenalectomy, while рancreatoduodenalectomy with colon resection for cancer of other locations is characterized by a significantly higher level of postoperative mortality.

AIM: to improve late results of pilonidal disease treatment.
PATIENTS AND METHODS: a multicenter retrospective cohort study included patients with pilonidal disease using the original new method — the main group (n = 31) and patients with Karidakis method as controls (n = 70). The recurrence rate was estimated. Six months after surgery, ultrasound, the Vancouver Scale and the SF-36 questionnaire assessed the postoperative scar, cosmetic result and quality of life.
RESULTS: the cosmetic effect of the postoperative scar was evaluated and significant differences between groups were obtained. According to the Vancouver Scale, 12 (41.4%) patients of the main group and 11 (16.9%) patients from the control group had a normal color of the postoperative scar (0 points) (p = 0.02). When assessing the pigmentation of the scar, it was found that normal pigmentation (0 points) was found in 8 (28.0%) patients of the main group, and in the control group this indicator was only 5 (8.0%) cases (p = 0.02). The pressure-resistant scar density (2 points) was 17 (59.0%) patients in the main group and 22 (34.0%) patients in the control group (p = 0.04). The scar width in the group using the new method was 1–2 mm (1 point) in 20 cases (69%), whereas in the control group, a similar scar width was recorded in 18 (28.0%) patients (p < 0.001). When evaluating the results of ultrasound of the soft tissue infiltration zone (p = 0.26) and the volume of infiltration (p = 0.36), as well as assessing the quality of life, no significant differences were found. There were no significant differences in the recurrence rate: in the main group it was 2 (6.45%), in the comparison group — 5 (7.14%) cases (p = 0.77).
CONCLUSIONS: a new original method for pilonidal disease in comparison with the Karydakis method provides a better cosmetic result

AIM: to evaluate the effect of a surgical access on postoperative morbidity and oncological safety in older patients.

PATIENTS AND METHODS: a multicenter retrospective study included 179 patients aged 60–74 years who underwent surgery for middle and low rectal cancer (T1-3N0-N2bM0) in 2021-2023. The patients were divided into 3 groups: the first ones underwent robotic (ROB) surgery (n = 62), the second — laparoscopic (LAP) surgery (n = 55), and the third — open (OPEN) surgery (n = 62). Parameters of pre-, intra-, and postoperative periods and histopathological findings were evaluated. Neural network modeling was used to predict anastomotic leakage (AL).

RESULTS: the blood loss was 150 (100; 200) ml with OPEN versus 100 (50; 100) with ROB and LAP, the operation time was 255 (210; 300) min with ROB versus 180 (150; 240) min with LAP and 140 (120; 150) min with OPEN. In ROB and LAP groups, anastomoses were formed in 61 (98.4%) and 54 (98.2%) cases compared with 45 (72.6%) cases in the OPEN group (p = 0.00001). The splenic flexure was mobilized in 54 (98.2%) cases in the LAP group, 55 (88.7%) cases in the OPEN group, and 50 (80.7%) cases in the ROB group (p = 0.01). Conversion rates were 10.9% (6/55) and 1.6% (1/62) in LAP and ROB groups, respectively (p = 0.00001). Postoperative complications in the OPEN group occurred in 48 (77.4%) cases compared with 31 (50%) and 12 (21.8%) in ROB and LAP groups (p = 0.02). Inflammatory complications predominated in the OPEN group. Distal and lateral margins, the quality of mesorectal excision, and the number of examined and affected lymph nodes did not differ. However, the good quality of mesorectal excision prevailed in ROB and OPEN groups, where as the satisfactory quality was more common in the LAP group. The most important predictors of AL were American Society of Anesthesiologists (ASA) physical status II, neoadjuvant chemoradiotherapy, stage I and IIa cancer, end-to-end anastomosis, Charlson Comorbidity Index scores of 3–4, and surgeon’s experience (20–40 operations for rectal cancer per year). The least important predictors were the level of mesenteric vessel ligation and the access.

CONCLUSIONS: the surgical access does not affect the AL rate. The histology revealed that all the 3 approaches ensure compliance with principles of oncological safety. Compared with open surgery, robotic and laparoscopic surgery result in less blood loss and faster recovery of intestinal function; however, the operation time increases.

There is no consensus on total colorectal agangliosis in children and two modalities are most often to use: Duhamel procedure and endorectal ileoanal anastomosis. The paper presents the experience of ileocolonic pouch in these patients. An original modified technique is described. All patients underwent previous diversion, more often terminal ileostomy. The follow-up was 0.6–8 years, the late results were estimated.

AIM: to evaluate caudal migration of free seton in patients with anal fistulas complicated by additional fistula tracks.
PATIENTS AND METHODS: the prospective randomized single-center study included 115 patients with transshincteric fistulas, who had one of 2 types of seton installed. The decision to choose a seton was made by randomization in 2 groups: 63 patients with a polyester braided ribbon with a fluoropolymer coating 3 mm wide (Polyester-F Braid 3 mm, “Balumed” LLC, Russian Federation) seton “T”, and the 2nd group included 52 patients with a seton polyester braided ribbon with a fluoropolymer coating with a diameter of 0.5 mm of USP conditional number 2 with a diameter of 0.5 mm was installed (Polyester-F Thread USP 2 with a diameter of 0.5 mm, “Balumed” LLC, Russian Federation) — seton “N”.
RESULTS: after 12 weeks the largest number of complete caudal migration occurred in 30/63 (47.6%; 95% CI: 34.9–60.6) patients with seton “T”, whereas in patients with seton “N” it occurred significantly less often in 7/52 (13.5%; 95% CI: 5.6–25.8) patients (p = 0.0002). Caudal seton migration with sphincter involvement of more than 1/2 was noted only in 1 patient with seton “T”, and was completely absent in patients with seton “N”.
CONCLUSION: in patients with a fistulas involving less than 1/2 of the external sphincter, it is reasonable to use a 3 mm wide fluoropolymer-coated polyester braided band as a seton, expecting caudal migration in almost half of the cases. Whereas the installation of a 0.5-mm diameter fluoropolymer-coated polyester braided thread, when more than 1/2 of the external sphincter is involved, does not lead to caudal migration.

AIM: to develop and validate hemorrhoidal disease (HD) specific national questionnaire.

MATERIALS AND METHODS: the Russian questionnaire, which included questions on the most typical HD symptoms, was developed by leading national specialists-proctologists. The regression analysis was used to evaluate linear and nonlinear relationships between the fact of the HD presence, objectively confirmed by a doctor, and the patients’ answers to the questions from the questionnaire. The final version of the questionnaire included only questions regarding clinical characteristics typical for hemorrhoids that were significantly associated with the presence of the disease. Validation of the questionnaire was performed on both training and test samples of patients to determine its sensitivity (Se) and specificity (Sp) in identifying patients with HD.

RESULTS: initially, 7 main domains reflecting the presence and severity of symptoms typical for HD were included in the questionnaire. A training sample of patients was used to search for linear and nonlinear relationships between objectively confirmed hemorrhoids and responses to questions in the initial questionnaire. The final version of the questionnaire, consisting only of questions regarding symptoms that have demonstrated to be significant predictors of hemorrhoids, was validated on a training sample (Se = 86.5%, Sp = 73.4%, and the probability of identifying a patient with HD, according to Bayes’ theorem = 66.6%). After the developed version of the questionnaire was validated on a test sample, the final screening questionnaire for HD demonstrated Se 83.7%, Sp 74.1%, and the probability of identifying patients with HD with a positive questionnaire result, calculated according to Bayes’ theorem, was 67%.

CONCLUSION: the first national questionnaire for screening HD has diagnostic characteristics indicating its high accuracy in identifying patients with HD and allowing it to be recommended for use in the general population.

Schwannoma (also known as neurilemmoma) is a type of benign tumor that originates from the myelin sheath around of peripheral nerves. It is composed of schwann cells, which are specialized cells that help to insulate nerve fibers. Schwannomas are relatively rare, accounting for only 5% of all benign tumors in the perineal region. They are usually asymptomatic and are only detected when they come into contact with other organs or structures, causing symptoms such as compression. Preoperative diagnosis of schwannoma is challenging, as it is often difficult to distinguish it from other types of tumors in the same area. The final diagnosis can only be confirmed by intraoperative histology.

The method of choice for benign neurilemmomas is complete removal, as they continue growth after resection. Removing part of the tumor may be an option in cases where removing the neoplasm en bloc could damage adjacent structures, such as anal sphincter, levators, rectum, vagina and urethra.

Clinical case: twenty-five years old female, had complaints of a tumor in the left buttock area and discomfort in a sitting position for 3 years. Pelvic MRI with intravenous contrast revealed a tumor 6.0 × 5.1 × 9.0 cm in the left ischial region. Surgical removal of the tumor was performed.

AIM: to estimate clinical approaches to rectal foreign bodies (RFBs).

PATIENTS AND METHODS: the retrospective cohort study included 47 patients (2022-2024) with suspected RFBs. Two clinical cases are presented. Case No. 1. Patient N., a 41-year-old male, was presented with RFB (a glass tumbler), introduced into the rectum without his consent. Because of RFB migration to the upper parts of the colon and risk of the intestinal perforation a laparotomy with removal of the intact foreign body was done. Case No. 2. Patient A, a 26-year-old male, was presented with RFB (a 80.0 × 7.0 cm dildo) that was transanally removed in the emergency room without anesthesia. No post-op complications developed. No any literature data of successful transanal removal of a larger RFB was found [1–5].

RESULTS: out of 47 patients, the manual transanal removal of RFBs was successful in 46 (97.9%) cases. One (2.1%) patient required laparotomy due to the high risk of rectal injury and retrograde migration of RFB to the proximal colon. A variety of RFBs (size, shape, and material), an individual, structured approach to the diagnosis and treatment is required.

CONCLUSION: clinical approach to RFBs depends on risk of intestinal perforation.

INTRODUCTION: intraoperative fluorescence navigation with indocyanine green (ICG) allows visualizing possible affected lymph nodes, which hypothetically provides more precise lateral pelvic node dissection (LPND).

AIM: to compare immediate results of lateral pelvic node dissection (LPND) combined with fluorescence navigation with ICG and conventional LPND for the treatment of metastatic lesions of lateral pelvic lymph nodes in patients with rectal cancer.

PATIENTS AND METHODS: search was performed in the PubMed library (National Library of Medicine, Bethesda, MD, USA) with keywords “indocyanine green,” “ICG“, ”lymph nodes,” “lateral lymph node dissection,” and “rectal cancer” in various combinations. Four non-randomized studies were included in meta-analysis, three retrospective and one prospective, on the outcomes of ICG use during LPND in patients with rectal cancer in the meta-analysis.

RESULTS: significantly more lymph nodes were harvested in LPND + ICG group (MD = 4.5; 95% CI: 3.0–5.9; p < 0.00001). The operation time was longer in the ICG group (MD = 32.5; 95% CI: 2.8–62.3; p = 0.03). Intraoperative blood loss was higher in conventional LPND group (MD = −52.6; 95% CI: −89.8 — −15.3; p = 0.006). Hospital stay was significantly shorter in ICG group (MD = −1.2; 95% CI: −2.0 — −0.4; p = 0.003). Patients who underwent standard LPND were significantly more likely to have postoperative urinary retention (OR = 0.4; 95% CI: 0.1–0.9; p = 0.03).

CONCLUSION: fluorescence navigation with ICG improves early results of LPND. Further accumulation of experience with dynamic follow-up of patients is crucial.

The review evaluates pathogenesis of intestinal fistulas in Crohn’s disease (CD). An idea of the possible contribution of the microbiological and genetic factor is given. The possible effect of matrix metalloproteinases and their tissue inhibitors also assessed. One of the most promising areas which can explain development of intestinal fistulas in CD is epithelial-mesenchymal transition. Further research is required to identify the cause of the complicated CD, which in future will develop correct approaches to pathogenetic therapy.

The global spread of IBD is likely due to the westernization of the diet and the environment, which leads to changes in the gut microbiome and increases the risk of disease in people with a genetic predisposition. In light of the increasing incidence of IBD worldwide, it is important to evaluate risk factors in order to develop prognostic risk models for IBD and various variants of the course of UC and CD and methods to combat these diseases. This review article examines key aspects related to the negative and beneficial effects of various factors on the development and course of IBD. The data shows that smoking (OR = 1.76; 95% CI: 1.40–2.22), obesity class II or III (OR = 1.86; 95% CI: 1.30–2.68 for CD and OR = 2.97; 95% CI: 1.75–5.17), taking antibiotics one year before the diagnosis (OR = 1.61;95% CI: 1.26–2.05 for UC and OR = 1.20; 95% CI: 1.09–1.31 for CD), nonsteroidal anti-inflammatory drugs (Relative Risk (RR) = 1.53; 95% CI: 1.08–2.16 for UC), combined oral contraceptives (UC by 3.3%; 95% ДИ: 2.1–4.4 and CD by 6.4%; 95% ДИ: 5.1–7.7), can not only increase the risks of exacerbations of IBD, but also contribute to the development of these conditions. These factors can aggravate the course of an existing disease: for example, the frequency of hospitalizations (OR = 2.35; 95% CI: 1.56–3.52) and the probability of resistance to genetically engineered biological drugs (GEBD) (OR = 1.6; 95% CI: 1.39–1.83). Dietary factors such as ultra-processed foods (RR = 1.82; 95% CI: 1.22–2.72), confectionery (≥ 100 g/day) (RR = 2.58; 95% CI: 1.44–4.62) and trans fats (RR = 1.34; 95% CI: 0.94–1.92) can have a negative impact, increasing the risk of developing IBD. Physical activity is considered as factors that have a protective effect on the course of IBD, reducing the frequency of exacerbations (RR = 0.78; 95% CI: 0.54–1.13 for UC and RR = 0.72; 95% CI: 0.55–0.94 for CD). Dietary fiber (24 g/day) reduces the risk of developing CD (RR = 0.59; 95% CI:0.39–0.90), and a large number of fruits in the diet reduces the risk of developing both UC (OR = 0.69; 95% CI: 0.49–0.96) and CD (OR = 0.57; 95% CI: 0.44–0.74).