Harry Sokol is a prominent gastroenterologist at Saint Antoine Hospital and Sorbonne Université and the President of the French Group of Faecal Microbiota Transplantation. In this edition of the ECCO Interview Corner, Professor Sokol shares his journey into gastroenterology, his pioneering work on Inflammatory Bowel Disease (IBD) and the gut microbiome and his vision for the future research.
A biomarker-stratified comparison of top-down versus accelerated step-up treatment strategies for patients with newly diagnosed Crohn’s disease (PROFILE): a multicentre, open-label randomised controlled trial
There is debate on the optimal management of newly diagnosed active Crohn’s Disease (CD). The most commonly used treatment strategy around the world is a “step-up” treatment approach. This involves initial use of steroids at diagnosis to induce remission, followed by introduction of immunomodulators such as azathioprine to maintain that remission. Subsequently, if this treatment fails to control inflammation, patients are escalated to advanced therapies such as anti-TNF biological agents. When performed rapidly, this can be referred to as “accelerated step-up” treatment, and indeed in many countries this accelerated step-up approach is considered standard of care (conventional) treatment. An alternative treatment strategy is a more “top-down” approach , where there is early introduction of an advanced therapy, typically an anti-TNF agent.
Inflammatory Bowel Diseases (IBD), comprising the two most common subtypes of Crohn's Disease (CD) and Ulcerative Colitis (UC), are chronic inflammatory conditions of the gastrointestinal tract. Tumour necrosis factor (TNF) inhibitors, particularly infliximab, have been pivotal in the management of moderate to severe IBD. While effective, intravenous administration of infliximab typically involves regular visits to hospital-based infusion centres. Particularly from a patient convenience point of view, many individuals would prefer to administer medication at home without the need to attend infusion centres and without the need for intravenous administration. The development of a subcutaneous (SC) formulation of infliximab (CT-P13) aims to enhance patient convenience and adherence by allowing self-administration at home [1–3] . In the LIBERTY trials, Hanauer and colleagues sought to examine the efficacy and safety of CT-P13 SC as maintenance therapy in IBD, in two randomised, placebo-controlled phase 3 trials.
At present, disease activity in Inflammatory Bowel Disease (IBD) is primarily monitored using faecal calprotectin, serum C-reactive protein (CRP) and endoscopic examination [1]. Whilst these are powerful tools, all three approaches have notable limitations. Faecal calprotectin testing requires a patient either to provide a stool sample whilst attending clinic or to return with a sample at a later date. Serum CRP requires a blood sample to be taken by a healthcare professional and endoscopy is invasive. Interleukin (IL)-6, whilst not routinely used in clinical settings to monitor disease activity, is known to play a role in IBD pathogenesis by increasing T-cell resistance against apoptosis, resulting in chronic inflammation [2].
As we move into the final quarter of the year, this is the perfect time to reflect on our collective achievements and to set our sights on the exciting events that lie ahead.
At Y-ECCO, we’ve been diligently crafting an innovative programme for our upcoming Y-ECCO Science Workshop, designed to bring together our diverse community of basic scientists, clinicians and clinician-scientists. In the last edition of ECCO News, I offered a sneak peek at our shift from the Basic Science Workshop to a more inclusive Science Workshop. This transformation reflects our commitment to fostering collaboration and engagement among all Y-ECCO Members.
Histological scoring systems have been developed to standardise the assessment of microscopic inflammation, offering insights into disease severity, activity, prognosis and response to therapy. There is growing interest in the assessment of histological disease activity based on the concept that histological healing is associated with better clinical outcomes and may be the ultimate therapeutic goal, particularly in Ulcerative Colitis (UC) [1].
The treatment of children with Inflammatory Bowel Disease (IBD) presents unique challenges, largely due to the complex nature of the disease, the limitations of existing therapies in children and the common off-label use of "newer" agents. Paediatric IBD requires careful management to control inflammation, promote growth and maintain a good quality of life. The treatment armamentarium for IBD in adults has expanded rapidly in the past several years, with the approval of new biologic and small-molecule agents for moderate-to-severe Ulcerative Colitis (UC) and Crohn’s Disease (CD) [1–3]. Currently, however, only infliximab and adalimumab are approved for use in children [4, 5]. The fact that all other biologics (vedolizumab, ustekinumab and risankizumab) and new small targeted molecules (tofacitinib, upadacitinib and ozanimod) commonly used in adults have not yet been approved for use in children has led to their widespread off-label use. The use of off-label biologics is often required because approximately 15%–20% of patients with IBD experience primary non-response to anti-TNF agents and another 30%–40% lose response over time [4, 5].
Are we measuring postoperative outcomes that reflect the success of surgical intervention? Are those outcomes sufficiently sensitive to measure the success of surgical intervention? Complication rate, quality of life and disease relapse are frequently used outcome measures but they have drawbacks that must be taken into consideration. Combining these outcomes with objective measurements will provide the best account of the success of a surgical intervention. Why is this important? Because the greater the number of successful surgical interventions, the lower will be the threshold for accepting surgery as part of the treatment strategy in IBD. Lowering the threshold for acceptance of surgical intervention will convince more gastroenterologists to refer patients to surgery and will eventually enable more patients to benefit from early surgery.
Recent interest has focused on the role of ultra-processed foods (UPFs) in IBD. UPFs are foods whose constituent ingredients are of exclusive industrial availability [1]. Across Europe, 30%–60% of energy intake in the diet is from UPFs [2, 3].
What is the research on ultra-processed foods and IBD?
Higher intakes of UPFs (especially through consumption of soft drinks, processed meat, salty snacks and refined sweetened foods) are associated with a greater risk of developing IBD [4], although a meta-analysis demonstrated an increased risk for Crohn’s Disease (CD) but not Ulcerative Colitis (UC) [5]. Once a person has been diagnosed with IBD, higher intakes of UPFs are associated with a greater incidence of IBD-related surgery [6] and a higher number of episodes of active disease in UC [7].
We are pleased to invite you to ECCO 2025, the 20th Congress of ECCO, which will be held in Berlin. As you know, in 2024 the REACH strategy was successfully introduced with the objective of focusing on a single letter each year. In 2025, the focus will be on the letter ‘A’, which corresponds to the objective of Attaining Sustainable IBD Care.
Maria Manuela Estevinho
Bram Verstockt
Paula Borralho Nunes
