Exclusive enteral nutrition (EEN) is well established as first-line management for children with luminal Crohn’s Disease (CD) [1]. Its use in paediatrics was covered in the 2017 ECCO e-Learning Activity “Use of exclusive enteral nutrition in CD”.
The use of EEN in adults with CD is not as well established. It is often overlooked as a management tool but can be an effective therapy for adults in many scenarios. Catherine Wall and I designed an e-Learning Activity specifically covering EEN in adults with CD, and this was launched on the e-CCO Learning Platform in May 2022. The course was developed for gastroenterologists, surgeons, dietitians, nurses and other interdisciplinary medical experts interested in Inflammatory Bowel Disease(s) (IBD).
This week my dishwasher broke down. I hadn’t ever been in this situation before, so I called my plumber. He laughed at me and told me that he didn’t do stuff like that anymore. Instead, he gave me a number for a ‘kitchen appliance repair guy’. Since when have we developed specialists in the repair of kitchen appliances? I didn’t even know that such specialists exist. How the world around us has changed in the last 25 years! I called the number and the receptionist who answered my call was direct and to the point. She asked what the appliance was. ‘A Zanussi’, I said. ‘Why?’ ‘Well, it’s because we have different engineers for the different makes’, she said in her south London patois. Anyway, I spoke with the engineer who ‘ran a diagnostic check’ over the phone by instructing me remotely to push various buttons on the machine under his instruction. In doing so he demonstrated an ability to drive at the same time as guiding me around, from memory, the control panel of my model. He clearly has the patience of Job! When he promptly arrived a day later, he laid out his tools neatly in a semi-circle on the kitchen floor. He had brought specific ‘parts’ with him that he thought he might need. After about 20 minutes the task was complete – the washer was back in working order. He asked me to sign his form and within an hour of his leaving I received electronically a feedback form to comment on his promptness, manner and efficacy. As far as kitchen appliance repair guys go, he was awesome! A true master craftsman.
The risk of thrombosis in paediatric IBD has become a hot topic in recent months, prompted by the publication of two impactful papers in Journal of Crohn’s and Colitis [1, 2]. Kuenzig and colleagues presented a large Canadian population-based study which described a vastly increased thrombosis rate in children with IBD compared to the normal population: the 5-year incidence was 31.2 per 10,000 person-years among children with IBD versus 0.8 per 10,000 person-years among children without IBD (95% confidence intervals 23.7–41.0 and 0.4–1.7, respectively) [1].
The 15th Congress of ECCO was held in Vienna, Austria between February 12 and 15, 2020. During this meeting, it was decided that I would take over from Roger Feakins as second Chair of the H(istology)-ECCO Committee. The committee was at that time one of the most recently established. Its primary aim is to expand the knowledge of IBD histopathology by organising a yearly masterclass. However, the framework of ECCO also offers many other opportunities to support clinical decision-making, by linking with the other committees and by participation in the composition of ECCO Practice Guidelines, Position Statements and Topical Reviews.
I hope you are all well and into the winter workflow. Many of us were representing IBD at the UEGW earlier in October, and many will have taken advantage of the excellent postgraduate course. Here in the ECCO Community we are excited soon to be launching The IBD Communication Toolbox. This is a series of podcasts where you can hear how IBD experts deal with questions that are commonly asked by patients. Firstly, the questions and topics addressed in the Communication Toolbox were selected in collaboration with patient representatives, ensuring that these are topics with high relevance for the IBD patients you meet in your practice.
Implications for sequencing of biologic therapy and choice of second anti-TNF in patients with inflammatory bowel disease: results from the Immunogenicity to Second Anti-TNF therapy (IMSAT) therapeutic drug monitoring study
Anti-TNF monoclonal antibodies play an important role in the management of immune-mediated inflammatory diseases, including Inflammatory Bowel Disease [1]. However, anti-TNF failure is common [2]. Loss of response is usually associated with the development of anti-drug antibodies and low anti-TNF drug levels.
The aim of this study was to evaluate the relationship between immunogenicity to a patient’s first anti-TNF therapy and immunogenicity and drug persistence to the second anti-TNF therapy, irrespective of drug sequence.
Crohn’s Disease (CD) is a chronic condition resulting in continuous or episodic inflammation that manifests endoscopically with mucosal ulcerations, strictures, bleeding and/or fistulae. Clinical response and clinical remission have been identified as immediate and medium-term treatment targets, respectively. Endoscopic remission (ER) has been recognised as a long-term treatment target, one specifically associated with improved disease outcomes and reduced bowel damage and colectomy rates [1]. Recommendations from the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) Initiative of the International Organization for the Study of IBD (IOIBD) were recently updated. In this update, it was suggested that changes in therapy should be considered in patients who do not achieve ER [2].
In current clinical practice, endoscopy remains the gold standard for assessing mucosal healing [3]. Serial endoscopic examinations are therefore typically performed in cases of IBD, beginning at diagnosis and thereafter following changes in treatment, to document disease activity and extent and assess therapeutic response.
To measure and quantify mucosal inflammation objectively, different endoscopic indices have been implemented in clinical practice and clinical trials. Among these, the Simple Endoscopic Score for Crohn’s Disease (SES-CD) and the Crohn’s Disease Endoscopic Index of Severity (CDEIS) have been the most used metrics in clinical trials [1].
Compared to the CDEIS and other indices, the SES-CD offers the advantages of both simplicity and ease of use. Furthermore, the SES-CD has proven responsive to changes in disease activity, with good intra- and inter-observer agreement [4]. The SES-CD contains four parameters, each of which receives a uniform score between 0 and 3 in all disease locations. The SES-CD therefore assumes no differential weighting of each individual parameter according to its importance in predicting ER while on active therapy. In essence, the SES-CD score lacks prognostic potential.
In a prior study, it was observed that each of the SES-CD parameters has its own prognostic value in predicting treatment response and ER; further, this value is non-linear among disease locations [5].
Krisztina Gecse is a consultant gastroenterologist at the Amsterdam University Medical Centre. She is well known to ECCO as a past Chair of ClinCom and is now at the forefront of the international push towards bowel ultrasound as President Elect of the International Bowel Ultrasound Group. I met with her to hear about her journey from Hungary to Amsterdam and how bowel ultrasound might just be your future….
The BIOCYCLE projecthas now been ongoing for more than 7 years and is approaching its end. This project, funded by the European Commission under the Horizon 2020 programme, aims to explore different aspects of the difficult issue of treatment de-escalation in moderate to severe Crohn’s Disease first requiring a combination therapy with anti-TNF and antimetabolites to control the disease. Once the disease has been stabilised, an unsolved question is whether it is possible to de-escalate therapy. This question is important for several reasons, including safety, tolerance, quality of life and costs, to name the most prominent. BIOCYCLE includes a randomised three-arm, controlled clinical trial called SPARE, conducted on 200 patients in six European countries (France, United Kingdom, Belgium, Sweden, the Netherlands and Germany) and Australia, several patients’ and health care providers’ surveys in Europe and the United States, a biomarker research programme and pharmaco-economic analysis. ECCO is mainly involved in the monitoring of the project (through IBDIM) and is the work package leader for dissemination of the results. BIOCYCLE is a 7.5-year-long project and was launched in April 2015.
It is our pleasure to introduce our conversation with the National Representatives of Italy at ECCO, Sara Onali and Marco Daperno. Sara Onali is an Associate Professor of Gastroenterology at the University of Cagliari, and Marco Daperno is a Gastroenterology Consultant at Mauriziano Hospital of Torino. In this conversation, Sara and Marco tell us about their background and expertise and they talk about our National IBD society, IG-IBD. Particularly, they tell us what IG-IBD offers to its members and which are the opportunities for research and publication with it.
In addition, they summarize the differences in IBD care among the different centers in Italy.
Gert de Hertogh
