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Surgery in IBD11th N-ECCO School
Year: 2020
Authors: Michel Adamina
TDM consortiumECCO'20 Vienna
Year: 2020
Authors: Konstantinos Papamichail
The liver in IBD5th H-ECCO IBD Masterclass
Year: 2020
Authors: Francesca Rosini
TofacitinibEducational Audio Podcast
Year: 2020
Authors: Konstantinos Karmiris
Transatlantic Talking Heads: Exclusive Enteral Nutrition for Paediatric IBDTransatlantic Talking Heads
Year: 2020
Authors: Traci Jester, Arie Levine, Lindsey Albenberg
Transatlantic Talking Heads: Opioids and Pain Management Transatlantic Talking Heads
Year: 2020
Authors: James Lindsay, David Rubin, Jane Andrews
UC Management11th N-ECCO School
Year: 2020
Authors: Mark Samaan
Ulcerative Colitis or Crohn’s Disease? The pathologist’s contribution5th H-ECCO IBD Masterclass
Year: 2020
Authors: Monika Tripathi
Unusual patterns of IBD5th H-ECCO IBD Masterclass
Year: 2020
Authors: Roger Feakins
Upper GI pathology in IBD – when is it really IBD?5th H-ECCO IBD Masterclass
Year: 2020
Authors: Monika Tripathi
UR-CAREECCO'20 Vienna
Year: 2020
Authors: Filip J. Baert
Very early onset IBD and the differential diagnosis of paediatric IBD5th H-ECCO IBD Masterclass
Year: 2020
Authors: Paula Borralho Nunes
Video capsule endoscopy or enteroscopy to assess small bowel Crohn’s disease: which comes first?2nd ECCO-ESGAR Basic Imaging Workshop
Year: 2020
Authors: Reena Sidhu
When IUS, when MRI in daily IBD practice? (Tandem talk)2nd ECCO-ESGAR Basic Imaging Workshop
Year: 2020
Authors: Francesca Maccioni, Kerri Novak
Y-ECCO Literature Review: Addition of azathioprine to the switch of anti-TNF in patients with IBD in clinical relapse with undetectable anti-TNF trough levels and antidrug antibodies: a prospective randomised trialECCO News Issue 1/2020
Year: 2020
Authors: Gregory Sebepos-Rogers

Anti-tumour necrosis factor-α (anti-TNF) has historically been the mainstay of biologic therapy in Inflammatory Bowel Disease (IBD). However, of those who initially respond to anti-TNF, almost 50% will suffer secondary loss of response (SLR) over subsequent years [1,2]. This SLR is primarily predicated on suboptimal anti-TNF trough levels, with or without detectable anti-drug antibodies (ADAs) [3]. Furthermore the prospective, observational study by Kennedy et al. demonstrated that suboptimal anti-TNF trough levels at week 14 predicted ADAs, low trough levels and worse clinical outcomes [4]. This risk was mitigated for both infliximab and adalimumab by the use of immunomodulators such as azathioprine. This corroborates the retrospective data from other cohorts showing how the addition of an immunomodulator can restore clinical response and favourable pharmacokinetics [5–7]. Remission rates when switching to a second anti-TNF have been shown to be lower when the reason to withdraw the first anti-TNF is SLR as compared to intolerance (45% vs 61%) [8]. In the event that SLR to anti-TNF is due to immunogenicity, a switch to another anti-TNF is associated with a risk of ADA to this new therapy [9,10]. A number of patients will also be on anti-TNF monotherapy at the time of switching having de-escalated from previous combination therapy. We know that open-ended prescription of anti-TNF with azathioprine is not without additional risk, notably infection and lymphoma [11]. Furthermore, de-escalation to anti-TNF monotherapy after a period of combination therapy has been shown in most studies not to impact on relapse rates (49% monotherapy versus 48% combination therapy) [12]. It is in precisely this important group of patients that Roblin et al. sought to compare the use of azathioprine in combination with a second anti-TNF versus this second anti-TNF as monotherapy. Over a follow-up period of 2 years, the rates of clinical and immunogenic failure, and of adverse events, were compared.

Y-ECCO Literature Review: Development and validation of a deep neural network for accurate evaluation of endoscopic images from patients with ulcerative colitisECCO News Issue 4, 2020
Year: 2020
Authors: Toer Stevens

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]. 

Nevertheless, the adoption of this target remains controversial. Further evaluation is warranted to investigate the ability and cost-effectiveness of achieving this target with the limited number of available treatment options. Furthermore, biopsy procurement and analysis is invasive, costly and time intensive. Finally, a high variability in reported histological disease activity scores is observed when comparing general pathologists with expert gastrointestinal pathologists [10]. These drawbacks limit widespread implementation, in both daily practice and clinical trials. Takenaka et al. address some of these hurdles by employing a deep neural network to enable computer-aided diagnosis of endoscopic and histological remission in patients with UC


Y-ECCO Literature Review: Expression levels of 4 genes in colon tissue might be used to predict which patients will enter endoscopic remission after vedolizumab therapy for IBDECCO News Issue 4, 2020
Year: 2020
Authors: Jonathan Digby-Bell

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].

Y-ECCO Literature Review: Higher anti-tumour necrosis factor levels are associated with perianal fistula healing and fistula closure in crohn’s diseaseECCO News Issue 2/2020
Year: 2020
Authors: Michael De Gregorio

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.