High performance in surgery has been the subject of discussion for a number of years. In IBD surgery it’s been what you might call a ‘shaggy dog’ story. For those of you unfamiliar with this term – there is an entire Wiki page dedicated to it [1]. High performance in IBD surgery has, thus far, fulfilled the criteria for such a story perfectly – it’s: long-winded, anecdotal, arguably failed to reach relevance and a bit of an anti-climax – all the essential ingredients.
Since the first reports in Wuhan, China in December 2019, the new coronavirus SARS-CoV-2 has resulted in over 40 million confirmed cases of COVID-19 globally with over 1 million deaths within just 10 months. Economies have been shattered, routine healthcare has been severely disrupted, and restrictions have been imposed on travel and social and family life in a previously unthinkable manner.
The histological diagnosis of Inflammatory Bowel Disease (IBD) is not an easy task for a pathologist. In the modern era, personal pathology experience alone is insufficient to make a diagnosis of IBD. The information that a pathologist must know in order to evaluate IBD samples appropriately and to make a diagnosis is diverse, and for the most part should be provided by the gastroenterologists, surgeons or clinicians responsible for the care of patients. Even the most experienced pathologist cannot report a case without knowing the clinical background of the patient. Obviously, this should be the standard for all samples, not only for IBD.
I hope you had a nice UEG Week Virtual earlier in October. My experience with the many virtual symposia over recent months has been mixed, but I think that the virtual UEG Week worked very well, with great interactions from viewers and excellent lectures. Hopefully, we’ll be able to attend the ECCO Congress next year in person – I’m sure that you miss interacting with friends and colleagues as much as I do. But the experience at UEG Week makes me optimistic that this format can also work well.
Nowadays, IBD treatment not only targets symptomatic disease control but also aims to heal the intestinal mucosa [1] In Ulcerative Colitis (UC) there is mounting evidence that histological healing of the intestinal mucosa is associated with incremental benefit compared to endoscopic healing alone [2–8]. In a very recent meta-analysis of ten studies including 757 UC patients with complete endoscopic remission (Mayo Score 0 or equivalent) and with a minimum follow-up of >12 months, patients with histological remission had a 63% lower risk of clinical relapse (RR 0.37, 95% CI 0.24–0.56) than patients with ongoing microscopic inflammation [9].
Expression levels of 4 genes in colon tissue might be used to predict which patients will enter endoscopic remission after vedolizumab therapy for Inflammatory Bowel Diseases
Verstockt B, Verstockt S, Veny M, et al.
Clinical Gastroenterology and Hepatology. 2020;18:1142–51.
In the past few years the armamentarium of drugs used to treat Inflammatory Bowel Disease (IBD) has accelerated, with the emergence of new therapies targeting differing immune pathways (ustekinumab and tofacitinib) and lymphocyte trafficking (vedolizumab). Furthermore, a number of promising new drugs are on the horizon (JAK-1 inhibitors, IL23p19 antibodies and S1P inhibitors) [1, 2]. However, as the choice of drugs expands, so the uncertainty over which drug should be selected by the clinician also increases. Drug selection may be determined by a number of factors such as cost, mechanism of delivery (e.g. oral, intravenous or subcutaneous), presence of co-morbidities (such as malignancy or multiple sclerosis) and presence of extraintestinal manifestations. However, no drug is effective in all patients, with between 10% and 40% of patients suffering from primary and secondary loss of response [3–5].
Serum biomarkers identify patients who will develop inflammatory bowel diseases up to 5 years before diagnosis
Torres J, Petralia F, Sato T, et al.
Gastroenterology 2020;159:96–104.
Introduction
Inflammatory Bowel Disease is a chronic relapsing-remitting, immune-mediated condition with increasing prevalence globally [1]. Despite novel agents targeting different disease pathways, the likelihood of achieving sustained clinical remission and mucosal healing remains low [2]. One of the potential reasons may be that patients seek help and clinicians treat IBD once the disease is in its clinical phase. A sub-clinical phase of variable length may precede the symptoms that lead to a diagnosis and perhaps contribute to tissue damage which, once established, is difficult to reverse with currently available medical treatments.
In this study, Torres and colleagues set out to test the hypothesis that a pre-clinical phase of IBD may well be present and could be identified by proteomic markers [3].
Hemel is currently working as a dentist in London. He was diagnosed with Crohn’s Disease and within a year of getting his diagnosis he was invited to participate in a trial of an anti-TNF drug. Here he gives his view of his experience of being in a clinical trial.
It gives me great pleasure to introduce you to ECCO’s new Treasurer, Professor Janneke van der Woude. Janneke is a Consultant Gastroenterologist at the Erasmus University Medical Centre in Rotterdam. She is the clinical lead for the IBD unit and has published widely in the field. As a very active ECCO Committee and Executive Board Member since its infancy, we are really excited to get to know Prof Van Der Woude more.
The interview will comprise of a personal introduction, insights into Janneke’s professional life, her ECCO journey, some hot topic discussions and what’s in store for the future. We hope you enjoy listening to this interview by clicking on the audio link below:
Omar Faiz
David Wilson
Francesca Rosini
Johan Burisch
Charlotte Hedin 
Nuha Yassin