Serum biomarkers identify patients who will develop inflammatory bowel diseases up to 5 years before diagnosis
Torres J, Petralia F, Sato T, et al.
Gastroenterology 2020;159:96–104.
Introduction
Inflammatory Bowel Disease is a chronic relapsing-remitting, immune-mediated condition with increasing prevalence globally [1]. Despite novel agents targeting different disease pathways, the likelihood of achieving sustained clinical remission and mucosal healing remains low [2]. One of the potential reasons may be that patients seek help and clinicians treat IBD once the disease is in its clinical phase. A sub-clinical phase of variable length may precede the symptoms that lead to a diagnosis and perhaps contribute to tissue damage which, once established, is difficult to reverse with currently available medical treatments.
In this study, Torres and colleagues set out to test the hypothesis that a pre-clinical phase of IBD may well be present and could be identified by proteomic markers [3].
Expression levels of 4 genes in colon tissue might be used to predict which patients will enter endoscopic remission after vedolizumab therapy for Inflammatory Bowel Diseases
Verstockt B, Verstockt S, Veny M, et al.
Clinical Gastroenterology and Hepatology. 2020;18:1142–51.
In the past few years the armamentarium of drugs used to treat Inflammatory Bowel Disease (IBD) has accelerated, with the emergence of new therapies targeting differing immune pathways (ustekinumab and tofacitinib) and lymphocyte trafficking (vedolizumab). Furthermore, a number of promising new drugs are on the horizon (JAK-1 inhibitors, IL23p19 antibodies and S1P inhibitors) [1, 2]. However, as the choice of drugs expands, so the uncertainty over which drug should be selected by the clinician also increases. Drug selection may be determined by a number of factors such as cost, mechanism of delivery (e.g. oral, intravenous or subcutaneous), presence of co-morbidities (such as malignancy or multiple sclerosis) and presence of extraintestinal manifestations. However, no drug is effective in all patients, with between 10% and 40% of patients suffering from primary and secondary loss of response [3–5].
Nowadays, IBD treatment not only targets symptomatic disease control but also aims to heal the intestinal mucosa [1] In Ulcerative Colitis (UC) there is mounting evidence that histological healing of the intestinal mucosa is associated with incremental benefit compared to endoscopic healing alone [2–8]. In a very recent meta-analysis of ten studies including 757 UC patients with complete endoscopic remission (Mayo Score 0 or equivalent) and with a minimum follow-up of >12 months, patients with histological remission had a 63% lower risk of clinical relapse (RR 0.37, 95% CI 0.24–0.56) than patients with ongoing microscopic inflammation [9].
I hope you had a nice UEG Week Virtual earlier in October. My experience with the many virtual symposia over recent months has been mixed, but I think that the virtual UEG Week worked very well, with great interactions from viewers and excellent lectures. Hopefully, we’ll be able to attend the ECCO Congress next year in person – I’m sure that you miss interacting with friends and colleagues as much as I do. But the experience at UEG Week makes me optimistic that this format can also work well.
The histological diagnosis of Inflammatory Bowel Disease (IBD) is not an easy task for a pathologist. In the modern era, personal pathology experience alone is insufficient to make a diagnosis of IBD. The information that a pathologist must know in order to evaluate IBD samples appropriately and to make a diagnosis is diverse, and for the most part should be provided by the gastroenterologists, surgeons or clinicians responsible for the care of patients. Even the most experienced pathologist cannot report a case without knowing the clinical background of the patient. Obviously, this should be the standard for all samples, not only for IBD.
Since the first reports in Wuhan, China in December 2019, the new coronavirus SARS-CoV-2 has resulted in over 40 million confirmed cases of COVID-19 globally with over 1 million deaths within just 10 months. Economies have been shattered, routine healthcare has been severely disrupted, and restrictions have been imposed on travel and social and family life in a previously unthinkable manner.
High performance in surgery has been the subject of discussion for a number of years. In IBD surgery it’s been what you might call a ‘shaggy dog’ story. For those of you unfamiliar with this term – there is an entire Wiki page dedicated to it [1]. High performance in IBD surgery has, thus far, fulfilled the criteria for such a story perfectly – it’s: long-winded, anecdotal, arguably failed to reach relevance and a bit of an anti-climax – all the essential ingredients.
Iron deficiency and iron-deficiency anaemia (IDA) are characterised by fatigue and reduced capacity for normal activities of daily living and consequently poorer quality of life. Iron deficiency is estimated to affect 60%–80% of people with IBD at some point [1]. Recurrent iron deficiency is also common and is estimated to occur in 30% of patients [1]. Given the prevalence of iron deficiency, some patients and practitioners have learned to accept this impaired quality of life as an unavoidable consequence of IBD [2]. However, correction of iron deficiency in patients without anaemia can result in improved quality of life and less fatigue and should, therefore, be an important treatment goal.
Once again, N-ECCO is offering an outstanding range of clinical and educational opportunities for nurses attending the ECCO’21 Copenhagen Congress.
The programmes for each activity continue to be developed on the basis of the evaluation forms from the previous year in order to meet your needs. Thank you so much for providing your feedback, which helps us to improve all the N-ECCO Activities.
Previous participants in GuiCom workshops at recent ECCO Congresses will have learned much about the adoption of GRADE methodology into the ECCO Guideline process and the practicalities of working with the GRADE process. For ECCO 2021, GuiCom wanted to offer participants something a little different. The GuiCom 2021 Workshop will therefore seek to place the GRADE process within the current controversies and ‘hot topics’ with respect to guidelines.
Johan Burisch
Francesca Rosini
David Wilson
Omar Faiz
Catherine Wall
Tim Raine