It is well known that the outcomes of surgery, and especially of IBD surgery, are not merely dependent on the operative procedure but are influenced by a number of factors before, during and after surgery. The multidisciplinary team involved in the care of IBD patients has the opportunity to optimise patient care and status prior to surgery to ensure optimal outcomes and reduce the risk of complications.
When mild to moderate Crohn’s Disease is diagnosed, various dietary approaches are used as a first-line medical treatment with a view to reducing inflammatory symptoms and achieving remission. It is important that this treatment is properly guided by a (paediatric) gastroenterologist and specialised nutritionist.
Although I had to postpone my visit to Städtisches Klinikum Lüneburg due to the global COVID-19 outbreak, I was finally able to participate in intestinal ultrasound (IUS) training there in August to September 2022. I thank everyone involved in providing me with this great opportunity.
The CCL20/CCR6 axis is recognized as critical in IBD pathogenesis. However, CCR6 blockage has never been tested as therapeutic approach and no small-molecules CCR6 antagonists have been investigated as a potential anti-IBD drug candidates. Starting from our novel CCR6 antagonist (MR120), we aimed at: -designing and synthesizing more potent CCR6 antagonists; -identifying the most efficacious and tolerable anti-chemotactic CCR6 antagonist; -assessing the efficacy of MR120 and of the most promising novel derivative in adoptive transfer colitis (AT).
Up to 65% of patients with Crohn’s Disease (CD) show disease recurrence after ileocolic resection (ICR). The reasons for this high recurrence rate are still unclear, but the abnormal CD inflammatory process, supported by microbiota dysbiosis, affects all the intestinal wall layers. We explored the mutual interplay of inflammatory and microbial factors involved in CD through a systems-level study (tissue and systemic level), at the time of ICR, evaluating whether these specific factors are associated with CD recurrence.
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.
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 . In 2019, the third UK IBD Standards for adults and children were published following extensive patient and healthcare professional consultation . 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.
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 . 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 . While antidepressant medications are commonly used to treat anxiety and depression in IBD , 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.
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) .
Prior studies have demonstrated patient preferences for propofol sedation over midazolam and fentanyl sedation for outpatient colonoscopy in general . Furthermore, propofol has been shown to be safe, without severe adverse events or accidents , and nurse-administered propofol has specifically proven to be an efficient means of sedation for endoscopy in low-risk patients . 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.
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. .