Y-ECCO
15December2020

Y-ECCO Members’ Address

Johan Burisch, Y-ECCO Chair

Johan Burisch
© ECCO

Dear Y-ECCO Friends,

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.

Posted in ECCO News, Committee News, Y-ECCO, Volume 15, Issue 4

30September2020

Y-ECCO/ClinCom call for Y-ECCO Small Research Survey Proposals

At the 15th Congress of ECCO in Vienna, the Young ECCO Committee (Y-ECCO) and the Clinical Research Committee of ECCO (ClinCom) jointly conducted a survey of attendees entitled “Decision-making in IBD dysplasia management”. The results are currently being prepared for publication. This project followed on from other successful surveys which led to submission of abstracts at the ECCO Congress and publication of full manuscripts in scientific journals.

Posted in ECCO News, ClinCom, ECCO'21, Y-ECCO, Volume 15, Issue 3

30September2020

Y-ECCO Interview Corner: Britta Siegmund

Charlotte Hedin, Y-ECCO Member

Charlotte Hedin
© ECCO

Britta Siegmund is Medical Director of the Medical Department, Division of Gastroenterology, Infectiology and Rheumatology, Charité – Universitätsmedizin Berlin and holds many other important national and international roles within the scientific and medical communities. She has an extensive publication record in the mucosal immunology of IBD. She is also President-Elect of ECCO.

Posted in ECCO News, Committee News, Y-ECCO, Volume 15, Issue 3

30September2020

Y-ECCO Literature Review: Radha Gadhok

Radha Gadhok

Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: retrospective long-term follow-up of the LIR!C trial  

Stevens TW, Haasnoot ML, D’Haens GR, Buskens CJ, De Groof EJ, Eshuis EJ, Gardenbroek TJ, Mol B, Stokkers PCF, Bemelman WA, Ponsioen CY on behalf of the LIR!C study group

Lancet Gastroenterol Hepatol 2020 Jun 30;S2468-1253(20)30117-5. doi: 10.1016/S2468-1253(20)30117-5. Online ahead of print.


Radha Gadhok
© Radha Gadhok

Introduction

The positioning of medical therapies in the management of Crohn’s Disease (CD) continues to be debated [1] whilst surgery is reserved for cases with disease complications or failure of medical therapy.  The LIR!C trial [2] provided evidence for  surgical resection as an alternative to infliximab (IFX) in the management of localised terminal ileitis, a common presentation of CD [3].

Briefly, the LIR!C trial reported quality of life scores (IBDQ) among 143 adult patients with terminal ileitis (<40 cm) who underwent randomisation to IFX induction/maintenance or ileocaecal resection. Patients were recruited from 29 secondary and tertiary Dutch and British centres. Exclusion criteria included non-inflammatory disease, prestenotic dilatation, abscess and previous surgery. Inclusion criteria included failing at least three months of conventional therapy [immunomodulator (IM) and/or corticosteroid (CS)] [2]

Posted in ECCO News, Y-ECCO Literature Reviews, Committee News, Y-ECCO, Volume 15, Issue 3

30September2020

Y-ECCO Literature Review: Rebecca Reynolds

Rebecca Reynolds

No benefit of continuing vs stopping 5-aminosalicylates in patients with ulcerative colitis escalated to anti-metabolite therapy

Singh S, Kim J, Zhu W, Dulai P, Sandborn WJ, Jairath V

Aliment Pharmacol Ther. 2020;52:481–91.


Rebecca Reynolds
© Rebecca Reynolds 

Introduction

First introduced by Svartz in 1942, 5-aminosalicylates (5-ASAs) are a well-established and effective first-line therapy for the induction and maintenance of remission in patients with mild-to-moderate Ulcerative Colitis (UC). They remain the most frequently prescribed medication for UC and are known to be effective and well tolerated [1]. Between 87% and 98% of UC patients receive 5-ASA treatment within the first year of diagnosis and 60%–87% continue on this treatment at ten years [2, 3].

Escalation to anti-metabolites (thiopurines or methotrexate) and/or biologic or small molecule therapy is often required for UC patients with a more aggressive disease course. Whilst it is now accepted that discontinuing 5-ASA therapy when escalating to a biologic is not associated with adverse outcomes, less is known about the therapeutic benefit of continuation of 5-ASAs with an antimetabolite [2, 4].

Singh et al conducted a retrospective cohort study to evaluate the pattern of 5-ASA use in patients with UC following escalation to an antimetabolite. The study evaluated patients escalated to antimetabolite therapy (stopping 5-ASA vs short-term 5-ASA use for <6 months vs persistent 5-ASA use for >6 months) and compared the risk of clinically important complications based on the pattern of 5-ASA use in these patients. They hypothesised that continuing 5-ASA therapy would not be more beneficial than stopping it.

Posted in ECCO News, Y-ECCO Literature Reviews, Committee News, Y-ECCO, Volume 15, Issue 3

30September2020

Y-ECCO Literature Review: Susanna Meade

Susanna Meade

Prominence of ileal mucosa-associated microbiota to predict postoperative endoscopic recurrence in Crohn’s disease

Sokol H, Brot L, Stefanescu C, et al.

Gut 2020;69:462–472.


Susanna Meade
© Susanna Meade

Introduction

The aetiopathogenesis of CD is multifactorial but includes the interaction between the microbiome and the host’s immune response. Up to 80% of patients with Crohn’s Disease (CD) require surgery during their lifetime and many factors are associated with postoperative recurrence (POR). Differential abundance of bacterial species is seen in patients with IBD compared with healthy individuals and several studies have suggested an association between microbiota composition and CD recurrence [1–3]. Altered mucosal gene expression and abundance of specific microbiota are associated with, and specific to, ileal CD [4].

Posted in ECCO News, Y-ECCO Literature Reviews, Committee News, Y-ECCO, Volume 15, Issue 3

30September2020

Y-ECCO Members’ Address

Johan Burisch, Y-ECCO Chair

Johan Burisch
© ECCO

Dear Y-ECCO Friends,

I hope you are all doing well and have enjoyed your summer break – even if for most of us this probably wasn’t the vacation we had hoped for. I got to explore new areas of my own country, Denmark, which was surprisingly pleasant despite the Danish weather not giving us too much sun and warmth.

Posted in ECCO News, Committee News, Y-ECCO, Volume 15, Issue 3

30June2020

Y-ECCO Interview Corner: Glen Doherty

Charlotte Hedin, Y-ECCO Member

Charlotte Hedin
© ECCO

Glen Doherty is a consultant gastroenterologist at the Centre for Colorectal Disease at St Vincent's University Hospital and University College Dublin (UCD) as well as Research Director of the Centre for Colorectal Disease. In addition, he serves as an Executive Board member of the Irish Society of Gastroenterology (ISG). He joined GuiCom in 2016 and has been the chair for the last year.

Posted in ECCO News, Committee News, Y-ECCO, Volume 15, Issue 2

30June2020

Y-ECCO Literature Review: Samantha Baillie

Samantha Baillie

HLADQA1*05 genotype predicts anti-drug antibody formation and loss of response during infliximab therapy for Inflammatory Bowel Disease

Wilson A, Peel C, Wang Q, Pananos A, Kim R

Alimentary Pharmacology and Therapeutics 2020;51:356–63. doi: 10.1111/apt.15563.


Samantha Baillie
© Samantha Baillie

Introduction

The anti-TNF monoclonal antibody infliximab offers an effective treatment for patients with Inflammatory Bowel Disease (IBD) refractory to conventional immunomodulator therapies. Successful biologic therapy can lead to clinical and endoscopic remission as well as reduced hospitalisation and requirement for surgery [1].

Unfortunately, as a large protein and chimeric antibody, infliximab is immunogenic and this frequently leads to formation of anti-drug antibodies (ADA), with subsequent secondary loss of response (LOR), drug discontinuation and adverse reactions [2]. Identifying patients at increased risk of developing antibodies prior to treatment may establish which individuals require closer drug level monitoring, concomitant immunomodulator therapy and observation for adverse events.

Previous work by Sazonovs et al. identified the first genetic locus to be robustly associated with immunogenicity to anti-TNF therapies [3]. The HLADQA1*05 allele variant rs2097432, carried by approximately 40% of Europeans, significantly increased the rate of formation of infliximab ADA. In the study reviewed here, Wilson et al. aimed to independently identify whether presence of the variant allele was associated with increased risk of ADA formation, LOR, drug discontinuation and adverse events.

Posted in ECCO News, Y-ECCO Literature Reviews, Committee News, Y-ECCO, Volume 15, Issue 2

30June2020

Y-ECCO Literature Review: Michael De Gregorio

Michael De Gregorio

Higher anti-tumour necrosis factor levels are associated with perianal fistula healing and fistula closure in Crohn’s Disease

Plevris N, Jenkinson PW, Arnott ID, Jones GR, Lees CW

Eur J Gastroenterol Hepatol 2020;32(1):32–37. DOI: 10.1097/MEG.0000000000001561


Michael De Gregorio
© Michael De Gregorio

Introduction

Perianal fistulising Crohn’s Disease is a challenging phenotype affecting more than 20% of patients diagnosed with Crohn’s Disease. It is associated with debilitating symptoms and significant morbidity, with subsequent reduced quality of life and increased disease-related work disability.

Currently treatment remains challenging, incorporating surgical and medical management; the latter is driven largely by biologic agents, specifically anti-tumour necrosis factor (TNF) agents such as adalimumab (ADA) and infliximab (IFX). Whilst ADA and IFX have proven efficacy in inducing and maintaining fistula healing and closure, a significant proportion of patients fail to respond or lose response over time. Increasing evidence suggests that this is in part due to sub-therapeutic drug levels, with or without the presence of antibodies to anti-TNF agents (ATA), with higher target drug levels required for fistula healing compared to mucosal healing in Crohn’s Disease. However, data evaluating the correlation between anti-TNF levels and perianal fistula outcomes, particularly with ADA, remain limited.

The aim of this study was to assess the association between anti-TNF levels and perianal fistula healing and closure with maintenance ADA and IFX therapy.

Posted in ECCO News, Y-ECCO Literature Reviews, Committee News, Y-ECCO, Volume 15, Issue 2