{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:44:52Z","timestamp":1792115092505,"version":"4.4.0"},"reference-count":40,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T00:00:00Z","timestamp":1782518400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Colitis-associated cancer (CAC) represents a major long-term complication in patients with ulcerative colitis (UC) and Crohn\u2019s disease (CD), the two main forms of inflammatory bowel disease (IBD). Unlike sporadic colorectal cancer, CAC develops through a distinct inflammation\u2013dysplasia\u2013carcinoma sequence driven by chronic inflammation and complex molecular alterations. Early detection of dysplasia and accurate risk stratification remain critical challenges in IBD management. Conventional surveillance strategies, including endoscopy, histopathology, and immunohistochemistry, are time-consuming, operator-dependent, and may fail to identify early neoplastic changes. In this context, artificial intelligence (AI), including machine learning (ML) and deep learning (DL), has emerged as a promising approach to improve lesion detection, molecular characterization, and predictive risk modeling. Early studies, though limited, suggest that AI-based approaches may enhance the identification of dysplasia and CAC, improve risk prediction, and support personalized surveillance strategies. Furthermore, the integration of multimodal data, including clinical, endoscopic, histological, and molecular features, may further improve predictive performance and enable precision medicine approaches in IBD. This review summarizes current evidence on AI and ML applications for CAC detection and risk prediction in IBD, discusses technical and clinical challenges, and highlights future directions for integrating AI into routine clinical practice to improve surveillance and clinical outcomes in patients with IBD.<\/jats:p>","DOI":"10.3390\/ijms27135818","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:55:11Z","timestamp":1782780911000},"page":"5818","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Machine Learning for Colitis-Associated Cancer in Inflammatory Bowel Disease: Evidence and Future Directions Toward Precision Medicine, a Narrative Review"],"prefix":"10.3390","volume":"27","author":[{"given":"Anna Lucia","family":"Cannarozzi","sequence":"first","affiliation":[{"name":"Gastrointestinal Disorders Research Unit, Fondazione IRCCS\u2014Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Massimino","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Department, and Division of Immunology, Transplantation and Infectious Disease, IRCCS Ospedale San Raffaele, 20132 Milano, MI, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4518-9949","authenticated-orcid":false,"given":"Fabrizio","family":"Bossa","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Endoscopy, Fondazione IRCCS\u2014Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Ungaro","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Department, and Division of Immunology, Transplantation and Infectious Disease, IRCCS Ospedale San Raffaele, 20132 Milano, MI, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Laura Pia","family":"Di Brina","sequence":"additional","affiliation":[{"name":"Gastrointestinal Disorders Research Unit, Fondazione IRCCS\u2014Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8831-7349","authenticated-orcid":false,"given":"Francesca","family":"Tavano","sequence":"additional","affiliation":[{"name":"Gastrointestinal Disorders Research Unit, Fondazione IRCCS\u2014Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia Pia","family":"Di Cosmo","sequence":"additional","affiliation":[{"name":"Gastrointestinal Disorders Research Unit, Fondazione IRCCS\u2014Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra Pia","family":"Bisceglia","sequence":"additional","affiliation":[{"name":"Gastrointestinal Disorders Research Unit, Fondazione IRCCS\u2014Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5289-0111","authenticated-orcid":false,"given":"Maria","family":"Guerra","sequence":"additional","affiliation":[{"name":"Gastrointestinal Disorders Research Unit, Fondazione IRCCS\u2014Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Annese","sequence":"additional","affiliation":[{"name":"Gastrointestinal Disorders Research Unit, Fondazione IRCCS\u2014Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6992-5875","authenticated-orcid":false,"given":"Francesco","family":"Cocomazzi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Endoscopy, Fondazione IRCCS\u2014Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Biscaglia","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Endoscopy, Fondazione IRCCS\u2014Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7341-1351","authenticated-orcid":false,"given":"Silvio","family":"Danese","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Department, and Division of Immunology, Transplantation and Infectious Disease, IRCCS Ospedale San Raffaele, 20132 Milano, MI, Italy"},{"name":"Faculty of Medicine, Universit\u00e0 Vita-Salute San Raffaele, 20132 Milano, MI, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Latiano","sequence":"additional","affiliation":[{"name":"Gastrointestinal Disorders Research Unit, Fondazione IRCCS\u2014Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0019-7929","authenticated-orcid":false,"given":"Orazio","family":"Palmieri","sequence":"additional","affiliation":[{"name":"Gastrointestinal Disorders Research Unit, Fondazione IRCCS\u2014Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, FG, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1002\/jgh3.12706","article-title":"Immune-mediated inflammatory diseases of the gastrointestinal tract: Beyond Crohn\u2019s disease and ulcerative colitis","volume":"6","author":"Vuyyuru","year":"2022","journal-title":"JGH Open"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Aleksandrova, K., Romero-Mosquera, B., and Hernandez, V. (2017). Diet, Gut Microbiome and Epigenetics: Emerging Links with Inflammatory Bowel Diseases and Prospects for Management and Prevention. Nutrients, 9.","DOI":"10.20944\/preprints201707.0039.v1"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1016\/j.suc.2019.08.001","article-title":"Inflammatory Bowel Disease Presentation and Diagnosis","volume":"99","author":"Flynn","year":"2019","journal-title":"Surg. Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1053\/j.gastro.2022.05.038","article-title":"Risk of Cancer in Inflammatory Bowel Diseases: Umbrella Review and Reanalysis of Meta-analyses","volume":"163","author":"Piovani","year":"2022","journal-title":"Gastroenterology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1097\/MIB.0b013e31828029c0","article-title":"Declining risk of colorectal cancer in inflammatory bowel disease: An updated meta-analysis of population-based cohort studies","volume":"19","author":"Lutgens","year":"2013","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1111\/j.1440-1746.2009.05790.x","article-title":"Colorectal cancer in inflammatory bowel disease","volume":"24","author":"Leong","year":"2009","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"156249","DOI":"10.1016\/j.prp.2025.156249","article-title":"From inflammation to carcinogenesis: Distinct pathways and clinical implications of IBD-associated colorectal cancer compared with sporadic CRC","volume":"275","author":"Kapadia","year":"2025","journal-title":"Pathol. Res. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Yamamoto-Furusho, J.K., and Gutierrez-Herrera, F.D. (2025). Molecular Mechanisms and Clinical Aspects of Colitis-Associated Cancer in Ulcerative Colitis. Cells, 14.","DOI":"10.3390\/cells14030162"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"G7","DOI":"10.1152\/ajpgi.00079.2004","article-title":"Inflammation and cancer IV. Colorectal cancer in inflammatory bowel disease: The role of inflammation","volume":"287","author":"Itzkowitz","year":"2004","journal-title":"Am. J. Physiol. Gastrointest. Liver Physiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"547","DOI":"10.4251\/wjgo.v14.i3.547","article-title":"Inflammatory bowel disease-related colorectal cancer: Past, present and future perspectives","volume":"14","author":"Majumder","year":"2022","journal-title":"World J. Gastrointest. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2361","DOI":"10.1016\/j.cgh.2025.06.035","article-title":"Advancing Inflammatory Bowel Disease-Driven Colorectal Cancer Management: Molecular Insights and Endoscopic Breakthroughs Towards Precision Medicine","volume":"23","author":"Iacucci","year":"2025","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1746","DOI":"10.1093\/ibd\/izaf065","article-title":"Rethinking the Use of Biologics in Inflammatory Bowel Disease Patients With Malignancy: Insights From the Treatment of Immune Checkpoint Inhibitor-Induced Colitis","volume":"31","author":"Lenti","year":"2025","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.1136\/gutjnl-2023-331579","article-title":"Opening the doors of precision medicine: Novel tools to assess intestinal barrier in inflammatory bowel disease and colitis-associated neoplasia","volume":"73","author":"Iacucci","year":"2024","journal-title":"Gut"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.37126\/aige.v3.i1.1","article-title":"Artificial intelligence in colorectal cancer screening in patients with inflammatory bowel disease","volume":"3","author":"Marques","year":"2022","journal-title":"Artif. Intell. Gastrointest. Endosc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1461","DOI":"10.1002\/ueg2.12655","article-title":"Inflammatory bowel disease genomics, transcriptomics, proteomics and metagenomics meet artificial intelligence","volume":"12","author":"Cannarozzi","year":"2024","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3407","DOI":"10.1016\/j.csbj.2024.09.003","article-title":"Artificial intelligence: A new tool in the pathologist\u2019s armamentarium for the diagnosis of IBD","volume":"23","author":"Cannarozzi","year":"2024","journal-title":"Comput. Struct. Biotechnol. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/s13099-025-00758-5","article-title":"Machine learning approach and internet of things technologies to unravel the complex interaction between microbiome-metabolome in inflammatory bowel disease: A new frontier in precision medicine","volume":"17","author":"Palmieri","year":"2025","journal-title":"Gut Pathog."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"E273","DOI":"10.1055\/a-1261-2944","article-title":"Can artificial intelligence help to detect dysplasia in patients with ulcerative colitis?","volume":"53","author":"Maeda","year":"2021","journal-title":"Endoscopy"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"E75","DOI":"10.1055\/a-1195-1986","article-title":"Is artificial intelligence a superior diagnostician in ulcerative colitis?","volume":"53","author":"Fukunaga","year":"2021","journal-title":"Endoscopy"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1111\/jgh.15904","article-title":"The diagnostic ability to classify neoplasias occurring in inflammatory bowel disease by artificial intelligence and endoscopists: A pilot study","volume":"37","author":"Yamamoto","year":"2022","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.igie.2023.03.004","article-title":"Development of an artificial intelligence tool for detecting colorectal lesions in inflammatory bowel disease","volume":"2","author":"Fetzer","year":"2023","journal-title":"IGIE"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1136\/gutjnl-2023-330718","article-title":"New AI model for neoplasia detection and characterisation in inflammatory bowel disease","volume":"73","author":"Abdelrahim","year":"2024","journal-title":"Gut"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Hirai, M., Kanatani, Y., Ueda, T., Sano, M., Arai, H., Miyake, Y., Tomita, N., Nemoto, S., and Suzuki, H. (2025). Analysis of Risk Factors for Colorectal Cancer Associated with Ulcerative Colitis Using Machine Learning: A Retrospective Longitudinal Study Using a National Database in Japan. Cancers, 17.","DOI":"10.3390\/cancers17233752"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Xue, T., Chen, Y., Li, X., Zhou, Z., and Chen, Q. (2025). Integrative machine learning and bioinformatics analysis to identify cellular senescence-related genes and potential therapeutic targets in ulcerative colitis and colorectal cancer. Front. Bioinform., 5.","DOI":"10.3389\/fbinf.2025.1599098"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1093\/ibd\/izab350","article-title":"Artificial Intelligence Program to Predict p53 Mutations in Ulcerative Colitis-Associated Cancer or Dysplasia","volume":"28","author":"Noguchi","year":"2022","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"253","DOI":"10.5694\/mja2.50755","article-title":"Artificial intelligence in health care: Preparing for the fifth Industrial Revolution","volume":"213","author":"Sung","year":"2020","journal-title":"Med. J. Aust."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"203","DOI":"10.5694\/mja2.50294","article-title":"Machine learning in clinical practice: Prospects and pitfalls","volume":"211","author":"Scott","year":"2019","journal-title":"Med. J. Aust."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1056\/NEJMra1814259","article-title":"Machine learning in medicine","volume":"380","author":"Rajkomar","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.csbj.2018.01.001","article-title":"Machine learning methods for histopathological image analysis","volume":"16","author":"Komura","year":"2018","journal-title":"Comput. Struct. Biotechnol. J."},{"key":"ref_30","unstructured":"Sutton, R.S., and Barto, A.G. (2018). Reinforcement Learning: An Introduction, MIT Press."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1561\/2200000006","article-title":"Learning deep architectures for AI","volume":"2","author":"Bengio","year":"2009","journal-title":"Found. Trends Mach. Learn."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"111137","DOI":"10.3748\/wjg.v31.i36.111137","article-title":"Application of deep learning-based convolutional neural networks in gastrointestinal disease endoscopic examination","volume":"31","author":"Wang","year":"2025","journal-title":"World J. Gastroenterol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"113912","DOI":"10.4253\/wjge.v18.i2.113912","article-title":"Harnessing artificial intelligence in gastrointestinal endoscopy for early detection of dysplastic lesions in inflammatory bowel disease","volume":"18","author":"Popovic","year":"2026","journal-title":"World J. Gastrointest. Endosc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/17562848251325525","article-title":"Rediscovering histology\u2014The application of artificial intelligence in inflammatory bowel disease histologic assessment","volume":"18","author":"Santacroce","year":"2025","journal-title":"Ther. Adv. Gastroenterol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1038\/s41575-025-01051-1","article-title":"AI-enabled \u2018endo-histo-omics\u2019: Breaking down intestinal barriers in IBD","volume":"22","author":"Iacucci","year":"2025","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"104694","DOI":"10.1016\/j.critrevonc.2025.104694","article-title":"Artificial intelligence and whole slide imaging, a new tool for the microsatellite instability prediction in colorectal cancer: Friend or foe?","volume":"210","author":"Cannarozzi","year":"2025","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Raposo, H. (2024). Intelligent imaging: A systematic review of artificial intelligence techniques in disease detection, segmentation, and classification. SSRN.","DOI":"10.2139\/ssrn.5342645"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1186\/s40001-025-02718-w","article-title":"A review on computer-aided diagnostic system to classify the disorders of the gastrointestinal tract","volume":"30","author":"Ramzan","year":"2025","journal-title":"Eur. J. Med. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"102020","DOI":"10.1016\/j.bpg.2025.102020","article-title":"Role of CADx in colonoscopy: Lessons from real-life studies","volume":"80","year":"2026","journal-title":"Best. Pract. Res. Clin. Gastroenterol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"109239","DOI":"10.1016\/j.cmpb.2026.109239","article-title":"Application of artificial intelligence in colonoscopy imaging for polyp analysis\u2014A systematic review","volume":"277","author":"Amirmohammadi","year":"2026","journal-title":"Comput. Methods Programs Biomed."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/13\/5818\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T04:46:12Z","timestamp":1782967572000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/13\/5818"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,27]]},"references-count":40,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["ijms27135818"],"URL":"https:\/\/doi.org\/10.3390\/ijms27135818","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,27]]}}}