Tofacitinib as salvage therapy for 55 patients hospitalised with refractory severe ulcerative colitis: A GETAID cohort

Uzzan, M, Bresteau, C, Laharie, D, et al.

Aliment Pharmacol Ther. 2021;54:312– 9.

Aamir Saifuddin © Aamir Saifuddin

Introduction

Approximately 25% of patients with Ulcerative Colitis (UC) require admission to hospital for acute severe (ASUC) or refractory disease, with one-third suffering from multiple episodes [1]. The mainstay of initial anti-inflammatory treatment remains corticosteroids, following the seminal report from Truelove and Witts in the BMJ in 1955 [2, 3]. Here, 210 patients were randomised to standard care with oral cortisone or placebo. Significant benefit was demonstrated in the cortisone group, particularly in those at index presentation and those who had mild UC. At follow-up to 2 years, 21.5% had undergone surgery.

It is interesting that acute colectomy rates remain approximately 20% despite improvements in overall care and infliximab or ciclosporin ‘rescue’ therapy [1, 3]. The CONSTRUCT trial, reported in 2016, demonstrated no significant difference in the frequency of colectomy between these rescue medications, with surgery required in roughly 40% of steroid-refractory patients within one year.

Johan Burisch © ECCO

Dear Y-ECCO Friends,

The year is slowly coming to an end and we can start looking forward to 2022 and hopefully returning to our normal, pre-COVID existence. Next year’s ECCO Congress will be among the first major scientific meetings within our specialty to have physical attendance. I’m sure you are all looking forward to meeting colleagues and friends in real life as much as I am. Don’t forget to sign up for our Basic Science Workshop!

Charlotte Hedin © ECCO

Maria T Abreu, MD, is the Martin Kalser Endowed Chair in Gastroenterology, a Professor of Medicine, a Professor of Microbiology and Immunology, and Director of the Crohn's and Colitis Center at the University of Miami.

She is Council Chair of the American Gastroenterological Association (AGA) Institute Council and has served as Chair of the AGA’s Underrepresented Minorities Committee. She has also been appointed as Chair of the International Organization for the Study of Inflammatory Bowel Disease (IOIBD).

She was interviewed via video link in March 2021.

Central reading of ulcerative colitis clinical trial videos using neural networks

Gottlieb K, Requa J, Karnes W, et al.

Gastroenterology 2021;160:710–9.e2

Introduction

Endoscopic grading of the severity of Ulcerative Colitis (UC) is a critical component of disease assessment and particularly important for guiding therapy. Despite the availability of numerous scoring systems, such as the Mayo Endoscopic Score (eMS) and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS), widespread use in routine clinical practice is often limited, primarily due to inter-observer variability and lack of training for standardised use [1,2].

Anti-SARS-CoV-2 antibody responses are attenuated in patients with IBD treated with infliximab

Kennedy NA, Goodhand JR, Bewshea C, et al., Contributors to the CLARITY IBD study

Gut 2021;70:865–875

Jennifer Murray © Jennifer Murray

Introduction

Infection with the novel coronavirus SARS-CoV-2 leading to coronavirus disease-2019 (COVID-19) has a broad spectrum of clinical presentations and disease severity. A number of host and viral factors contribute to this heterogeneity in presentation and severity, including the host immune response [1]. Given that immune-mediated inflammatory diseases (IMIDs) including Inflammatory Bowel Disease (IBD), are characterised by immune dysregulation and use of biologic or immunosuppressive therapies, COVID-19 presents a particular challenge.

Randomised clinical trial: exclusive enteral nutrition versus standard of care for acute severe ulcerative colitis

Sahu P, Kedia S, Vuyyuru SK et al.

Aliment Pharmacol Ther. 2021;53:568–76.

Homira Ayubi © Homira Ayubi

Introduction

Acute Severe Ulcerative Colitis (ASUC) is a medical emergency which affects about 25% of UC patients at least once in their lifetime [1]. Corticosteroids are the mainstay of treatment for ASUC; however, 30%–40% of patients do not respond and eventually need medical rescue therapy or surgery [2].Medical rescue therapy (in the form of ciclosporin or infliximab) can be costly and its use can be limited by side effects. Therefore, there is a need for safe and low-cost therapy which can augment the effect of corticosteroids to induce and maintain remission.

Bram Verstockt © ECCO

Dear Y-ECCO Friends,

Due to the pandemic, we unfortunately were unable to meet and interact physically in the usual way during our most recent Y-ECCO Basic Science Workshop. However, this is exactly what Y-ECCO is about: connecting people, colleagues and friends, clinicians and scientists in order to bring basic science from the bench to the bed, and back. Every year, the Y-ECCO Committee invites outstanding senior experts to give a state-of-the-art overview on hot topics in the IBD field. Furthermore, these top-notch speakers not only moderate the discussions that follow abstract presentations but also inspire and stimulate young researchers and clinician-scientists at the start of their careers. Although this year’s workshop was virtual, we succeeded in continuing our interactive format, with excellent talks and many questions via the virtual platform chat.

Johan Burisch © ECCO

Dear Y-ECCO Friends,

Did you enjoy the virtual ECCO Congress?

I personally found it very well organised and without major technical problems. And the programme was once again fantastic! As always, it was great to witness the many dedicated and brilliant researchers/physicians who work towards improving the care of IBD patients. But let’s hope that this is the last time that we cannot meet in person.

The call for research proposals returns with opportunities for Y-ECCO Members to propose and perform a brief, focused research project with ClinCom/Y-ECCO guidance and ECCO support.

Based on the successes of the surveys jointly conducted by the Young ECCO Committee (Y-ECCO) and the Clinical Research Committee of ECCO (ClinCom) at the ECCO Congresses in the past, we are asking Y-ECCO Members to propose a new survey study.

Charlotte Hedin © ECCO

Dr. Rupa Banerjee is a senior consultant gastroenterologist in the Department of Gastroenterology and Director of the Inflammatory Bowel Diseases (IBD) Centre at the Asian Institute of Gastroenterology, Hyderabad, India. She is also Director of IBD Research with the Asian Healthcare Foundation, Hyderabad. 

Dr. Rupa established the first dedicated IBD centre of excellence in India in 2004. She has designed and maintains a 6500-patient database and biorepository for the centre detailing the demographics, type and course of disease and response to treatment in the Indian subpopulation.

Her primary focus has been optimal and affordable multidisciplinary care of IBD. The outpatient clinics run from early morning to late evening, and many of the patients are from middle- or low-income strata. The centre has adopted a large cluster of villages for screening for IBD, including blood and endoscopic evaluations free of cost to enable early diagnosis and with house-to-house surveys on the incidence and prevalence of IBD in the region.

Dr. Rupa is actively involved in research on IBD in the Asian region, focussing on the epidemiology, microbiota and genetic profile of this population for the purposes of optimisation and individualisation of the management of IBD. 

Dr. Rupa has initiated the IBD-ENC (IBD – Emerging Nations Consortium), comprising more than 20 countries in South Asia, Middle East and Africa, to promote collaborative work on IBD in these parts of the world. She has been the key person in the design of the interactive web platform for the IBD-ENC (www.ibdenc.org), which presents IBD news and the latest publications, discusses challenging cases and offers members the unique opportunity to create their own patient IBD registry.

Dr. Rupa has received support from the Helmsley Charitable Trust, USA for the Rural programme for early diagnosis of Crohn’s Disease.