Safety and efficacy of autologous haematopoietic stem-cell transplantation with low-dose cyclophosphamide mobilisation and reduced intensity conditioning versus standard of care in refractory Crohn's disease (ASTIClite): an open-label, multicentre, randomised controlled trial

Lindsay JO, Hind D, Swaby L, et al.

Lancet Gastroenterol Hepatol 2024;9:333–45. 

Introduction

A large number of patients living with Inflammatory Bowel Disease (IBD), including Crohn’s Disease (CD), show persistent disease activity and bowel damage despite medical or surgical therapy [1]. Haematopoietic stem-cell transplantation (HSCT) is a procedure able to “reset” the immune system by replacing autoreactive lymphocytes. A total of 232 patients (data from case series, observational studies and one clinical trial) had previously undergone HSCT for CD. Although there were promising clinical results, there were also some significant associated risks, including life-threatening side effects and mortality [2]. In a previous randomised controlled trial, called ASTIC, HSCT did not demonstrate superiority over standard therapy when an extremely high bar was set for the primary endpoint, i.e. induction of sustained disease remission in CD (defined as medication-free clinical remission for 3 months without any evidence of disease activity at endoscopy or imaging). Apart from the lack of efficacy demonstrated for the primary endpoint, the HSCT arm was also hampered by a significant burden of side effects [3]. 

Artificial intelligence enabled histological prediction of remission or activity and clinical outcomes in ulcerative colitis 

Iacucci M, Parigi TL, Del Amor R, et al.
Gastroenterology 2024;164:1180–8.

Introduction

Ulcerative Colitis (UC) is characterised by episodes of recurrent inflammation affecting the colonic mucosa. Accurate assessment of disease activity and prediction of clinical outcomes are crucial for effective management. Traditionally, histological examination has been the gold standard for evaluating mucosal inflammation, but it is time-consuming and subject to inter-observer variability. Recent advances in artificial intelligence (AI) may offer a potential solution. Iacucci and colleagues explored the application of machine learning in diagnosing histological remission and predicting clinical outcomes in UC patients.

Dynamic Prediction of Advanced Colorectal Neoplasia in Inflammatory Bowel Disease

Wijnands AM, Penning de Vries BBL, Lutgens MWMD, et al.
Clin Gastroenterol Hepatol. 2024;22:1697-1708.

Introduction

Patients with colonic inflammatory bowel disease (IBD) face an elevated risk of colorectal cancer (CRC) compared to the general population.[1, 2] Colonoscopic surveillance has been shown to be associated with a reduction in CRC and CRC-related mortality in these patients.[3] Current guidelines recommend initiating surveillance 8-10 years after disease onset, with follow-ups every 1-5 years based on individual risk factors.[4–6] These factors include disease duration, severity, associated primary sclerosing cholangitis (PSC), family history of CRC, and other risks. The risk factors for CRC in IBD patients are dynamic, comprising both modifiable (inflammation, dysplasia detection, disease extent) and non-modifiable (age, family history, PSC) elements that change over time and with treatment, exerting varying influences, including protective effects, on the risk of developing CRC.[7] 

Dear Y-ECCO Friends,

As I will be stepping down as Y-ECCO Chair at the upcoming ECCO Congress in Berlin, I want to take this final “Member’s Address” as an opportunity to thank each of you for your commitment to our shared mission of supporting those living with Inflammatory Bowel Disease. Your combined dedication is driving real progress in raising awareness, advancing research and creating invaluable resources that strengthen our community. As young clinicians and researchers, you are the future our patients will rely on, so keep pushing the boundaries!

Inflammatory Bowel Disease (IBD) is characterised by chronic intestinal inflammation developing in genetically susceptible subjects in association with a dysregulated immune response, intestinal dysbiosis and environmental triggers. IBD is most often polygenic, involving more than 200 risk loci that include over 300 genes identified through genome-wide association studies. Approximately 25% of incident cases of IBD occur during childhood. Among these cases, diagnosis is most commonly made during adolescence, while in about 15% the diagnosis is established prior to six years of age, with up to 6% diagnosed before three years of age. IBD in this subgroup of patients is referred to as “very early onset IBD” (VEO-IBD) and shows significant differences from IBD in older children and in adults. VEO-IBD cases usually present with more severe clinical disease unresponsive to conventional IBD therapy and a greater proportion of cases feature underlying monogenic defects, often involving genes associated with primary immunodeficiencies (PID).

Robotics has taken the surgical community by storm and is increasingly being adopted in IBD surgery. While many see true technological advancement in robotics, by virtue of its ability to facilitate complex procedures in Crohn’s Disease and Ulcerative Colitis for the good of the patient, there remains scepticism as to whether robotics really represents a relevant game changer in IBD surgery compared to advanced standard laparoscopy. And, as always, there are two sides to the coin.

Guia Becherucci  © ECCO

The D-ECCO Travel Award offers IBD Dietitians an opportunity to visit other IBD Centres, to learn about diet and nutrition in IBD. Next Call opens in January 2025. Guia Becherucci was awarded at ECCO’24 and travelled to the University Hospitals Leuven, Belgium.

Vaios Svolos  © ECCO

Exclusive enteral nutrition (EEN) is a prescribed liquid diet providing 100% of energy intake while excluding all other foods and drinks. It uses polymeric or elemental formulas, which are equally effective, though polymeric formulas are more palatable and better tolerated over 6–8 weeks. EEN is established as an effective therapy for Crohn's Disease (CD) that induces remission in up to 80% of patients [1, 2]. The clinical benefits of EEN include (a) the reduction of inflammation, with decreases in both blood and gut inflammatory markers and induction of mucosal healing, and (b) the improvement of clinical and physical health, with promotion of clinical remission and enhancement of muscle mass and nutritional status [3]. Studies have shown that EEN induces significant changes in the microbiome; although these changes are implicated in each mechanism of action, further research is needed to provide a better understanding of diet–microbiome interactions in CD [4, 5]. In the present article, the Bradford Hill criteria [6], a set of principles used to determine causal relationships between an exposure and a disease, are employed as a framework to analyse the EEN–microbiome interactions in CD. These criteria include factors such as strength, consistency, temporality and biological plausibility [6].

Sophie Craddock  © Sophie Craddock

The N-ECCO Travel Award offers IBD Nurses an opportunity to visit other IBD Centres, to observe and learn from IBD nursing services. Next Call opens in January 2025. Sophie Craddock was awarded at ECCO’24 and travelled to the Meyer Children’s Hospital, in Florence Italy.

Michel Adamina © ECCO

The ECCO Topical Review on Predictive Models on IBD Disease Course and Treatment Response was launched in late December 2023 and a virtual kick-off meeting took place in early 2024. At the heart of this Topical Review lies the lack of a trusted model to predict clinical course in IBD patients. Indeed, the wide treatment armentarium available today, with many new drugs and therapeutic classes entering clinical practice, makes decision-making increasingly complex. While the role of medications and surgical options is addressed in the ECCO Guidelines on Therapeutics in Ulcerative Colitis and Crohn’s Disease, prediction of the optimal use and sequence of treatment options remains elusive. Although several biomarkers with the potential to foresee disease course and treatment response have been identified, none has been established in clinical practice. Hence, clinical decision-making relies on dynamic clinical assessment, together with endoscopic evaluation and C-reactive protein and faecal calprotectin measurements.