FINE DETERMINATION OF GUT TISSUE LAYERS’ INFLAMMATION EXPLORING IMMUNE-MICROBIOTA SIGNATURES: NEW BIOMARKERS OF RECURRENCE IN SURGICAL PATIENTS WITH CROHN’S DISEASE?
Up to 65% of patients with Crohn’s Disease (CD) show disease recurrence after ileocolic resection. The reasons for this high recurrence rate are still unclear, but the abnormal CD inflammatory process, against the microbiota, affects all the intestinal wall layers. We aim to explore the mutual interplay of inflammatory and microbial factors involved in CD through a systems-level study, defining the “correlation network” of mucosa-associated microbiota (and its faecal metabolites) at the time of ileocolic resection. We will evaluate whether specific microbial/inflammatory correlations are statistically associated with early postoperative endoscopic recurrence, assessed by colonoscopy at six months.
Primary sclerosing cholangitis (PSC) is a progressive cholestatic disease and up to 80% of PSC patients have Ulcerative Colitis (PSC-UC), which presents a clinical challenge owing to the difficulty in diagnosis and increased risk for development of cancer. While several multifactorial processes, including inflammation and dysbiosis of microbiota, have been associated with PSC-UC pathogenesis, the precise molecular factors that regulate the phenotype of this disease subtype remain unknown. This research project – DYNAMIC – hypothesises that mapping the differences in DNA methylation and gene expression alterations between young PSC-UC and non-PSC-UC patients will allow us to unravel critical molecular factors that underpin this disease subtype.
Treatment outcomes of patients with Inflammatory Bowel Disease (IBD) have improved enormously due to the use of anti-tumour necrosis factor (anti-TNF) agents, but prolonged use comes with disadvantages such as infections and skin problems. Observational studies suggest that dosing interval lengthening can reduce the risk of these adverse reactions in a relevant proportion of patients, provided that they are closely monitored.
The aim of our study is to evaluate whether, in patients with IBD in sustained remission, anti-TNF dosing interval lengthening is non-inferior compared to an unchanged dosing interval with respect to maintenance of target faecal calprotectin (FC) levels.
It’s a great honour to introduce you to ECCO’s Scientific Officer, Professor Ailsa Hart. Ailsa is a Consultant Gastroenterologist and the IBD lead at St Mark’s Hospital, Harrow, London. Ailsa has been an active member at ECCO for many years and has been a great supporter of several initiatives. She has won the hearts and minds of many within and outside ECCO with her calm demeanour, hard work and bright outlook.
We hope you enjoy listening to this uplifting interview with Ailsa who gives us a sunny forecast during these challenging times. Please click on the audio link below:
Marc Ferrante was appointed assistant professor at KU Leuven (Leuven, Belgium) in 2013, and later became associate professor. He is also a staff member in the Department of Gastroenterology and Hepatology at the University Hospitals Leuven. He is a lecturer for students of Biomedical Sciences and Medicine and a coach for clinical fellows in training. He has previously been chair of both Y-ECCO and ClinCom and was appointed as a SciCom Member in 2019.
Crohn’s Disease is complicated by strictures in up to 30% of cases. Medical management with biologics is often suboptimal and surgical treatment is associated with postoperative complications and disease recurrence. Targeted therapy with endoscopic balloon dilatation (EBD) of strictures less than 5 cm has high rates of technical success (passage of endoscope through the stricture) but variable clinical success (relief of obstructive symptoms), with up to 25% of patients requiring surgery at one-year follow-up [1]. Removable fully covered metal stents are safe for the treatment of refractory strictures but the risk of stent migration is high [2].
Randomised clinical trial: high‐dose oral thiamine versus placebo for chronic fatigue in patients with quiescent inflammatory bowel disease (TARIF study)
Fatigue is a common yet poorly understood manifestation of Inflammatory Bowel Disease (IBD) and can occur independently of disease activity. A prospective cohort study of 326 IBD patients initiating biologic therapy (with infliximab, vedolizumab or ustekinumab) demonstrated fatigue was prevalent at baseline (63%)1. Whilst fewer patients reported fatigue with treatment (70% at week 14, 61% at week 30 and 61% at week 54), a third continued to experience fatigue despite achieving clinical remission. This is supported by other studies, where fatigue prevalence in quiescent disease was as high as 36% in Ulcerative Colitis (UC) and 41% in Crohn’s disease (CD)2.
In the last decade, research on the human gut microbiome and its influence on health and disease has taken flight. This has strengthened the belief that the underlying pathogenesis of Inflammatory Bowel Disease (IBD) involves an altered immune response to characteristic shifts in the composition of the gut microbiome.
After a 2020 that ended up being all about COVID-19, let’s hope that 2021 will be a normal year where we can meet and network again and put COVID behind us. I recently got my first shot of the vaccination, which was a wonderful experience of what science is capable of in times of need. In Denmark we’ve started vaccinating our IBD patients but vaccine scepticism and uncertainties about the evidence is everywhere and we as physicians are needed more than ever to inform our patients.
Although the relationship between IBD and nutrition is of longstanding interest, the attention paid to it has increased dramatically in recent years, with the inclusion of nutritional interventions in ECCO Guidelines on both paediatric and adult Crohn’s Disease (and of course many other IBD guidelines), bespoke publications such as the ECCO perioperative dietary therapy topical review and a flowering of clinical interest in Crohn’s Disease-specific diets.
This clinical interest in nutritional issues in IBD is also reflected in the exceptional interest in a December 2020 educational article in the UEG Journal “Mistakes in…” series, namely “Mistakes in nutrition in IBD and how to avoid them” by the ECCO Members Joe Meredith, Kostas Gerasimidis and Richard Russell (ueg.eu/a/268). Basic and translational scientific studies of the pathogenesis of IBD have increasingly evaluated the role of nutrition and particularly its interaction with the microbiome.
Francesco Giudici
Sudipto Das
Marleen Bouhuys
Nuha Yassin
Charlotte Hedin 
Johan Burisch
David Wilson