Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: retrospective long-term follow-up of the LIR!C trial  

Stevens TW, Haasnoot ML, D’Haens GR, Buskens CJ, De Groof EJ, Eshuis EJ, Gardenbroek TJ, Mol B, Stokkers PCF, Bemelman WA, Ponsioen CY on behalf of the LIR!C study group

Lancet Gastroenterol Hepatol 2020 Jun 30;S2468-1253(20)30117-5. doi: 10.1016/S2468-1253(20)30117-5. Online ahead of print.

Radha Gadhok © Radha Gadhok

Introduction

The positioning of medical therapies in the management of Crohn’s Disease (CD) continues to be debated [1] whilst surgery is reserved for cases with disease complications or failure of medical therapy.  The LIR!C trial [2] provided evidence for  surgical resection as an alternative to infliximab (IFX) in the management of localised terminal ileitis, a common presentation of CD [3].

Briefly, the LIR!C trial reported quality of life scores (IBDQ) among 143 adult patients with terminal ileitis (<40 cm) who underwent randomisation to IFX induction/maintenance or ileocaecal resection. Patients were recruited from 29 secondary and tertiary Dutch and British centres. Exclusion criteria included non-inflammatory disease, prestenotic dilatation, abscess and previous surgery. Inclusion criteria included failing at least three months of conventional therapy [immunomodulator (IM) and/or corticosteroid (CS)] [2]

No benefit of continuing vs stopping 5-aminosalicylates in patients with ulcerative colitis escalated to anti-metabolite therapy

Singh S, Kim J, Zhu W, Dulai P, Sandborn WJ, Jairath V

Aliment Pharmacol Ther. 2020;52:481–91.

Rebecca Reynolds © Rebecca Reynolds

Introduction

First introduced by Svartz in 1942, 5-aminosalicylates (5-ASAs) are a well-established and effective first-line therapy for the induction and maintenance of remission in patients with mild-to-moderate Ulcerative Colitis (UC). They remain the most frequently prescribed medication for UC and are known to be effective and well tolerated [1]. Between 87% and 98% of UC patients receive 5-ASA treatment within the first year of diagnosis and 60%–87% continue on this treatment at ten years [2, 3].

Escalation to anti-metabolites (thiopurines or methotrexate) and/or biologic or small molecule therapy is often required for UC patients with a more aggressive disease course. Whilst it is now accepted that discontinuing 5-ASA therapy when escalating to a biologic is not associated with adverse outcomes, less is known about the therapeutic benefit of continuation of 5-ASAs with an antimetabolite [2, 4].

Singh et al conducted a retrospective cohort study to evaluate the pattern of 5-ASA use in patients with UC following escalation to an antimetabolite. The study evaluated patients escalated to antimetabolite therapy (stopping 5-ASA vs short-term 5-ASA use for <6 months vs persistent 5-ASA use for >6 months) and compared the risk of clinically important complications based on the pattern of 5-ASA use in these patients. They hypothesised that continuing 5-ASA therapy would not be more beneficial than stopping it.

Prominence of ileal mucosa-associated microbiota to predict postoperative endoscopic recurrence in Crohn’s disease

Sokol H, Brot L, Stefanescu C, et al.

Gut 2020;69:462–472.

Susanna Meade © Susanna Meade

Introduction

The aetiopathogenesis of CD is multifactorial but includes the interaction between the microbiome and the host’s immune response. Up to 80% of patients with Crohn’s Disease (CD) require surgery during their lifetime and many factors are associated with postoperative recurrence (POR). Differential abundance of bacterial species is seen in patients with IBD compared with healthy individuals and several studies have suggested an association between microbiota composition and CD recurrence [1–3]. Altered mucosal gene expression and abundance of specific microbiota are associated with, and specific to, ileal CD [4].

Johan Burisch © ECCO

Dear Y-ECCO Friends,

I hope you are all doing well and have enjoyed your summer break – even if for most of us this probably wasn’t the vacation we had hoped for. I got to explore new areas of my own country, Denmark, which was surprisingly pleasant despite the Danish weather not giving us too much sun and warmth.

Ann Driessen © ECCO

Pamela Baldin © ECCO

The animal model is a useful tool to unravel different pathogenetic mechanisms, to detect biomarkers for monitoring and to test the efficacy and safety of drugs in the preclinical phase. In Inflammatory Bowel Disease (IBD) research, the mouse is the most widely used animal model. Animal models are classified into four categories, namely chemical models, cell transfer models, genetically engineered models, and congenic models. Based on the mechanism of the animal model, different aspects of the pathogenesis of intestinal inflammation in IBD are examined, such as epithelial integrity and wound healing, and innate and adaptive immunity [1].

Note: Due to the COVID-19 pandemic, the 14^th European Colorectal Congress will be virtual. The article below was submitted prior to this decision. Please refer to the ECC Congress website to check on the latest update.

Michel Adamina © ECCO

The 14^th European Colorectal Congress opens on Sunday, November 29, 2020 with a Masterclass in Colorectal Surgery and a Course in Proctology, followed by three days of expert lectures until the Congress closes on Wednesday, December 2, 2020. A carefully devised safety approach overseen by the Swiss health authorities is allowing the organisation of this large European meeting, traditionally attended by more than 1000 participants from 80 countries who travel to the St.Gallen Colorectal Week (www.colorectalsurgery.eu, @ECCongress). Michel Adamina, from S-ECCO, is co-organising the meeting.

Marjo Campmans-Kuijpers  © ECCO

During the recent COVID-19 outbreak, telemedicine was helpful in ensuring the continuation of regular care and reducing the need for outpatient visits. To optimise the treatment of Inflammatory Bowel Disease (IBD), recent guidelines recommend strict long-term monitoring of the mucosal inflammation and timely optimisation of treatment during a disease flare [1]. In traditional practice, such monitoring requires many visits to outpatient clinics by patients, which they can experience as stressful. This regular monitoring increases the workload and administration during outpatient visits and can lead to longer waiting lists. In order to address some of these issues and continue to provide patients with good and qualitatively safe care, the multidisciplinary team (MDT) together with the Dutch patient association (CCUVN) developed the telemonitoring tool MyIBDCoach. In the Netherlands, there are currently about 90,000 patients with IBD [2] and 10% of these patients are using MyIBDCoach.

Susanna Jäghult © ECCO

Wladzia Czuber-Dochan © ECCO

We know that all nurses constantly strive to enhance the standard of patient care, and this is also true for IBD services. The best way for nurses to improve patient care is by developing their knowledge and skills and applying them in clinical practice. Many nurses are actively involved in research and practice innovation projects that aim to improve patient care and quality of life. We believe that it is important to share with all nurses the information gained from such projects. The new discoveries made in your own practice may also be beneficial for colleagues and patients in other countries. N-ECCO offers a great opportunity for you to share your work with others, and we would like to invite you to tell us about the important work that you are doing in your clinic.

Antonino Spinelli  © ECCO

The ECCO Guidelines Committee (GuiCom) is known to be one of the busiest committees in the busy ECCO! 2020 has definitely been quite a challenging year so far, but no crisis will prevent us from introducing our newest Committee Member, Hannah Gordon.

Henit Yanai  © ECCO

The European Crohn’s and Colitis Organisation (ECCO) brings together national groups and individuals interested in different aspects of Inflammatory Bowel Diseases (IBD). One of ECCO’s core aims is to promote education in the field of IBD and thereby improve the quality of care for IBD patients throughout Europe.