It has long been acknowledged that Inflammatory Bowel Disease (IBD) carries a risk of malnutrition, leading to fatigue, infection, poor wound healing and poor health-related quality of life [1]. Historically, most attention has been devoted to undernutrition; however, there is now evidence that overnutrition in the form of visceral fat is associated with raised tumour necrosis factor (TNF) and poorer responses to anti-TNF agents [2], indicating that central adiposity can be just as detrimental to disease outcomes as undernutrition. Furthermore, under- and overnutrition are not mutually exclusive and nutrient deficiencies and excesses often co-exist. In the last few years, there has been a shift away from the historical approach of using rudimentary markers of malnutrition, such as weight or body mass index (BMI), which can often be misleading as assessment tools in that they may falsely detect abnormalities or miss them completely, towards more detailed body composition measures of muscle and fat mass, which reflect nutritional abnormalities more sensitively. Indeed, GLIM (Global Leadership Initiative on Malnutrition) recognises the importance of body composition in the diagnosis of malnutrition [3]. The key question now is how should we best assess our IBD patients for nutritional status in order to identify risk of poor clinical outcomes?
Optimisation is the action of making the best or most effective use of a situation or resource (Oxford Dictionary) but in the medical world it is preparing the patient (and the surgeon) for surgery and postoperative recovery.
The goal of “optimising” patients’ health prior to surgery is to minimise the risk of postoperative complications, decrease the length of hospital stay, reduce unplanned re-admissions and enhance overall health and surgical experience.
Over the past two decades, significant progress has been made in the understanding of the role of genetics in the pathogenesis of Inflammatory Bowel Disease (IBD): On the one hand, adult IBD studies have identified more than 250 single nucleotide polymorphisms that increase the risk of disease, though their individual and overall effect on the risk of developing IBD is small [1]. On the other hand, the expanding use of next-generation sequencing (NGS) platforms has resulted in the identification of more than 100 different rare monogenic disorders that directly cause IBD [2]. Given the central role of immune cells in sustaining immune tolerance in the gut, it is not surprising that in many cases monogenic disorders causing IBD result from pathogenic variants in genes involved in essential immune or epithelial pathways. Some patients with such disorders present with a clear immunodeficiency phenotype (e.g. chronic granulomatous disease, Wiskott-Aldrich syndrome), but in others IBD is the sole manifestation [3].
The past 6 months of 2022 have seen the publication of two important papers, one by F. Magro et al. (“The ECCO position on harmonisation of Crohn’s disease mucosal histopathology” [1]) and the other by I.O. Gordon et al. (“International consensus to standardise histopathological scoring for small bowel strictures in Crohn’s disease” [2]).
I hope you have all had time to re-charge over the summer! ECCO'23 abstract submission is currently open, with a deadline of November 21. Basic science abstracts can be considered for an Oral Presentation during the 9th Y-ECCO Basic Science Workshop, which will be held on Wednesday, March 1, 2023, between 13:05 and 15:30 CET – please tick the box if you are a Y-ECCO Member and would like to be part of this great interactive session.
For very well-known pandemic reasons, we twice had to postpone the first Y-ECCO Mentorship Forum. Our third appointment with ECCO History proved to be the right one: in June 2022 we finally succeeded in completing our first Y-ECCO Mentorship Forum. Thanks to very active Y-ECCO participants and a stellar ECCO Faculty (Ailsa Hart, Peter Irving, Charlie Lees, Janneke Van der Woude and Johan Burisch), this networking and educational event was a great success. .
Many clinicians have anecdotally observed patients opting out of colonoscopies due to unpleasantness related to the procedure, and within Inflammatory Bowel Disease (IBD) populations a number of factors have been implicated in non-adherence, including logistics, health perceptions, stress and procedure problems (including discomfort) [1].
Prior studies have demonstrated patient preferences for propofol sedation over midazolam and fentanyl sedation for outpatient colonoscopy in general [2]. Furthermore, propofol has been shown to be safe, without severe adverse events or accidents [3], and nurse-administered propofol has specifically proven to be an efficient means of sedation for endoscopy in low-risk patients [4]. Nevertheless, this area has yet to be explored in the specific cohort of IBD patients.
Modern management of IBD requires the employment of ileocolonoscopy for diagnosis, as well as for the surveillance and guidance of future management. The investigators here looked to fill the aforementioned knowledge gap through design of a trial investigating the effectiveness of deep nurse-administered propofol sedation (NAPS), versus moderate midazolam and fentanyl sedation, as a means of improving patient satisfaction and future attitude towards colonoscopies.
Inflammatory Bowel Disease (IBD) is a long-term condition of the gut which is known to impact the quality of life and social functioning of those affected due to the chronic nature of symptoms. These factors, along with communication across the gut–brain axis, cause many patients to suffer from mental health disorders such as anxiety and depression [1]. Previously, the magnitude of these comorbidities had not been established, but recent studies [1, 2] have found the prevalence to be high: a third of all patients and a half of those with an active IBD flare have been found to suffer from anxiety, while depression has been found to affect a quarter of patients and a third of those with active symptoms.
Furthermore, compared with controls, patients with IBD and mental health disorders show increased use of healthcare resources (both primary care visits and emergency secondary care visits) and increased use of antidepressant and anxiolytic medications [2]. While antidepressant medications are commonly used to treat anxiety and depression in IBD [3], understanding of how effectively these treatments are prescribed remains limited, and this is particularly true regarding the adequacy of duration of treatment in this cohort.
This population-based study was performed in the United Kingdom and used data from the primary care setting that was routinely collected electronically in general practices as part of the Clinical Practice Research Datalink (CPRD). The authors looked to review the antidepressant prescribing in primary care for those diagnosed with IBD. They focused on the rate of antidepressant treatment initiation following IBD diagnosis, the duration of antidepressant treatment according to international guidelines, potential risks of inadequate antidepressant treatment duration and general trends in antidepressant prescribing.
In the United Kingdom (UK), approximately 500,000 people live with IBD, and in the coming decade it is anticipated that the prevalence of IBD will surpass 1% of the population [1]. In 2019, the third UK IBD Standards for adults and children were published following extensive patient and healthcare professional consultation [2]. The IBD Standards cover seven domains: service design and delivery; pre-diagnosis referral pathways; management of the newly diagnosed patient; flare management, including self-management and timely access to specialist advice; surgery including pre- and postoperative care; inpatient medical care; and ongoing long-term treatment and monitoring in both secondary and primary care.
ECCO is an ever-expanding organisation with educational activities which extend throughout the year. For this ECCO News I spoke with Nicole Eichinger, the Executive Director of ECCO, to find out a bit more about her and how the ECCO Team work behind the scenes to keep this vital organisation running as smoothly as it does.
Emma Halmos
Dror Shouval
Gert de Hertogh
Charlotte Hedin
Bram Verstockt
Robin Dart