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Baseline stool metagenomic sequencing, blood biomarkers, micronutrient panels, and clinical data informed individualized plans combining diet adjustments, targeted synbiotics, selective antimicrobials, and micronutrient correction. After three months, stool frequency decreased, urgency and rectal bleeding resolved in most participants, inflammatory markers normalized, and beneficial taxa increased. Results suggest clinically meaningful improvements, warranting randomized 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Refractory IBD: AReal-World Study  \nRaluca Lupusoru 1,2,3, Lavinia Cristina Moleriu 1,*, Ruxandra Mare 3,4,5,*, Ioan Sporea 3,4,5, Alina Popescu 3,4,5, Roxana Sirli 3,4,5, Adrian Goldis 3,4,5, Camelia Nica 3,4,5, Tudor Voicu Moga 3,4,5, Bogdan Miutescu 3,4,5, Iulia Ratiu 3,4,5, Oana Belei 6,7, Laura Olariu 6, Victor Dumitrascu 8 and Radu Dumitru Dragomir 9  \nAcademic Editors: Ana Isabel Beltrán-Velasco and Sara Uceda  \nReceived: 9 December 2025  \nRevised: 21 December 2025  \nAccepted: 22 December 2025  \nPublished: 24 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Department III, Functional Science, Discipline of Medical Informatics and Biostatistics,“Victor Babes”  \nUniversity of Medicine and Pharmacy, 300041 Timisoara, Romania; [raluca.lupusoru@umft.ro](raluca.lupusoru@umft.ro)  \n2 Center for Modeling Biological Systems and Data Analysis,“Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania  \n3 Gastroenterology and Hepatology Clinic, County Emergency Hospital “Pius Brinzeu”, 300723 Timisoara, Romania; [isporea@umft.ro](isporea@umft.ro) (I.S.); [popescu.alina@umft.ro](popescu.alina@umft.ro) (A.P.); sirli.roxana@umft.ro (R.S.); [goldis.adrian@umft.ro](goldis.adrian@umft.ro) (A.G.); [camelia.foncea@umft.ro](camelia.foncea@umft.ro) (C.N.); [moga.tudor@umft.ro](moga.tudor@umft.ro) (T.V.M.); [miutescu.bogdan@umft.ro](miutescu.bogdan@umft.ro) (B.M.); [ratiu.iulia@umft.ro](ratiu.iulia@umft.ro) (I.R.)  \n4 Advanced Regional Research Center in Gastroenterology and Hepatology,“Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania  \n5 Department of Internal Medicine II, Division of Gastroenterology and Hepatology,“Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania  \n6 First Pediatric Clinic,“Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; [belei.oana@umft.ro](belei.oana@umft.ro) (O.B.); [olariu.laura@umft.ro](olariu.laura@umft.ro) (L.O.)  \n7 Disturbances of Growth and Development on Children Research Center,“Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania  \n8 Department IV, Biochemistry and Pharmacology, Discipline of Pharmacology,“Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; [dumitrascu.victor@umft.ro](dumitrascu.victor@umft.ro)  \n9 Department of Oncology,“Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; [radu.dragomir@umft.ro](radu.dragomir@umft.ro)  \n* [Correspondence: moleriu.lavinia@umft.ro](Correspondence: moleriu.lavinia@umft.ro) (L.C.M.); [mare.ruxandra@umft.ro](mare.ruxandra@umft.ro) (R.M.)  \nAbstract  \nInflammatory bowel disease (IBD) remains difficult to manage in patients who fail multiple therapeutic lines, and growing evidence suggests that alterations in the gut microbiome contribute to persistent symptoms and inflammatory activity. This study evaluated a threemonth, AI-guided, multi-omic personalized microbiome modulation program in adults with treatment-refractory IBD. Baseline stool metagenomic sequencing, blood biomarkers, micronutrient panels, and clinical data were integrated through an artificial intelligence platform to generate individualized plans combining dietary adjustments, targeted synbiotics, selective antimicrobials, and micronutrient correction. Clinical outcomes, inflammatory markers, and microbial signatures were reassessed after three months. Across 358 participants, stool frequency decreased substantially, urgency and rectal bleeding resolved in most patients, and over 70% reported a “much improved” overall condition. Inflammatory biomarkers showed marked normalization, with reductions in hs-CRP and fecal calprotectin observed in over 85% of","cbCaijnwPHpYi9Rd","https://ap.wps.com/l/cbCaijnwPHpYi9Rd","pdf",1351510,18,"English","# Abstract\n# Keywords\n# Introduction","[{\"question\":\"What population and treatment approach were evaluated in this real-world study?\",\"answer\":\"Adults with treatment-refractory IBD were enrolled and received a threemonth, AI-guided, multi-omic personalized microbiome modulation program.\"},{\"question\":\"How were personalized microbiome modulation plans generated?\",\"answer\":\"Baseline stool metagenomic sequencing, blood biomarkers, micronutrient panels, and clinical data were integrated through an AI platform to create individualized plans.\"},{\"question\":\"What clinical and inflammatory improvements were reported after three months?\",\"answer\":\"Across 358 participants, stool frequency decreased substantially, urgency and rectal bleeding resolved in most patients, and inflammatory biomarkers such as hs-CRP and fecal calprotectin normalized in the majority.\"}]","AI-Guided Multi-Omic Microbiome Modulation Improves Clinical and Inflammatory Outcomes in Refractory IBD - A Real-World Study | PDF",1790769755,45]