Continuous monitoring of CRP, IL-6, and calprotectin in Inflammatory Bowel Disease using a perspiration-based wearable device

Shahub S, Kumar RM, Lin KC, et al.

Inflamm Bowel Dis 2024 Mar 23; doi: 10.1093/ibd/izae054. Online ahead of print.

Introduction

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].   

Dear Y-ECCO Friends,

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.

Alicia Sandall  © ECCO

What are ultra-processed foods?

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]. 

Simona Radice © ECCO

Adriana Rivera Sequeiros © ECCO

Dear Colleagues,

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.

Mariangela Allocca © ECCO

Uri Kopylov © ECCO

At the 2025 ECCO Congress, the educational programme will again include two workshops dedicated to the imaging of Inflammatory Bowel Disease (IBD). These workshops, organised in collaboration with the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and the International Bowel Ultrasound (IBUS) group, aim to educate medical professionals in imaging techniques and their use in the accurate diagnosis and treatment monitoring of IBD patients.

The first workshop will focus on the fundamentals of endoscopy, intestinal ultrasound (IUS) and magnetic resonance imaging (MRI), while the second will explore recent advances in IUS. These educational opportunities are made possible by the significant collaboration between ECCO and experienced gastroenterologists and radiologists specialising in intestinal imaging.

Natalia Queiroz © ECCO

The 23rd ECCO IBD Intensive Course for Trainees, Berlin 2025

The 23^rd IBD Intensive Course for Trainees is scheduled for February 19, 2025, immediately before the start of the ECCO Congress in Berlin. This respected ECCO Educational Initiative has been a cornerstone of IBD education since its inception in 2003, predating even the ECCO Congress itself.

The course is designed to bridge the gaps often found in IBD education during gastroenterology fellowships. It offers advanced fellows a thorough and multidisciplinary exploration of IBD, helping them to deepen their expertise. Additionally, it serves as a vital platform for young clinicians from around the world to exchange knowledge, compare medical practices and build professional networks that can lead to future collaborations. Participation is by invitation, with nominations made by ECCO National Representatives.

Glen Doherty © ECCO

This summer saw the arrival of an additional novel way to participate in ECCO Education, the “Fast Facts in IBD 2024” Online Course. This live interactive online course took place on June 12, 2024 from 17:00 to 19:00 CEST. The course content was specially designed by EduCom for all gastroenterologists treating patients with IBD in their practice and was delivered in a format suited to virtual learning. 98 participants registered for this event (which was free of charge to all current ECCO Members).