Combination treatment with partial enteral nutrition and biologics as induction therapy for adults with active ileocolonic Crohn’s Disease: a pilot study
There is strong interest in investigating combination therapies for active Crohn’s Disease (CD) to improve response to biologics and to mitigate secondary loss of response, without increasing the risk of drug-associated side effects. Exclusive enteral nutrition is an established treatment for active CD, but tolerance is poor. In partial enteral nutrition (PEN) only part of the habitual diet is replaced by the proprietary formula, allowing patients to eat some normal food. PEN at high volume (>50% energy requirements) can prolong remission compared to unrestricted diet. Therefore, the aim of the present study is to compare clinical remission/response rates to standard treatment with adalimumab (ADA) between a group of CD patients on unrestricted diet and another group on 50% PEN. Secondary aims are to explore how these two treatments change the gut microbiome composition and its diet-related function.
Sexual dysfunction (SD) rates are higher in the Inflammatory Bowel Disease (IBD) patient population compared with the general population. Overall among IBD patients, low sexual desire and greater difficulty in achieving orgasms are the most frequently reported sexual problems. In addition, women report worse body image and lower sexual desire. Being diagnosed with major depression, undergoing surgery or suffering IBD symptoms are the usual triggers.
Despite the importance of sexual well-being, there is a lack of research focusing on sexual desire in IBD patients. This study aims to assess the prevalence of sexual dysfunction and to analyse sexual desire from a dual viewpoint: a dyadic and a solitary perspective. The intention is to describe sexual function and its possible correlations with the presence of anxiety and depression, disease activity and quality of life.
Recognizing the prevalence of sexual dysfunction in IBD patients can improve clinical practice and optimize resource planning for sexual healthcare. Early diagnosis and primary prevention can help address sexuality-related concerns in this population.
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….
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].
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.
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.
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.
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].
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.
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).
Gert de Hertogh
