The world wide web and social media platforms have become an unprecedented source for sharing self-experience, potentially allowing the collection and integration of health data with patient experience

StuffThatWorks (STW) is an online open platform that applies machine learning and the power of crowdsourcing where patients with chronic medical conditions can self-report and compare their individual outcomes using a structured online questionnaire. The present study analyzed de-identified self-reported personalized comparative treatments' effectiveness for CD. The design was a cross-sectional, international, crowdsourcing, questionnaire and AI web-based study of patients with Crohn's self-reporting their outcomes by 06/11/21. A proprietary STW Bayesian inference model was built to measures the level of improvement in condition severity and clinical indicators for each treatment and ranks treatment effectiveness. A linear regression model was used to examine co-variate association with the current condition severity as the outcome. Finally, the effectiveness of first-line biological treatments was analyzed by multiple treatment comparisons model and by calculating odds ratio and 95% confidence intervals for each treatment pair.

A total of 5898 self-reported CD patients were included for the analysis. Most participants were female (76.13%) and from English speaking countries (91%). Overall, anti TNF drugs were the most reported tried treatment (71.97%) followed by steroids (46.22%) and diet (43.8%). Among Biologic therapy (BT) tried by STW CD users, Infliximab (IFX) and Adalimumab (ADA) were ranked most effective by the STW effectiveness model, by change in condition severity on 1-5 scale (mean change of 1.19 points, estimated lower-upper bounds 1.10-1.28), followed by Ustekinumab (UST) (mean 1.07, bounds 0.88-1.26), and Vedolizumab (VDZ) (mean 0.96, bounds 0.74-1.17). Bowel surgery (mean 1.19, bounds 0.98-1.40), and cannabis (mean 1.01, bounds 0.72-1.31) were also among the top 5 most effective treatments together with BT. The odds ratio was calculated for each BT pair, with IFX more effective than ADA, UST and VDZ (OR 2.34 (CI 1.88 – 2.80), 3.08 (CI 2.44 – 3,73), 7.16 (CI 6.53 – 7.80), respectively), ADA more effective than UST and VDZ (OR 1.32 (CI 0.74 - 1.9), 3.06 (CI 2.49 - 3.63), respectively), and UST more effective than VDZ (OR 2.32 (CI 1.6 - 3.05)).

We present the first online crowdsourcing platform-based study of treatment self-reported outcomes in CD. Net-based crowdsourcing patient-reported outcomes' platforms can potentially help both clinicians and patients select the best treatment for their condition.

An association between shorter disease duration and improved clinical efficacy has been shown in post hoc analyses of clinical trial data with biological therapies in Crohn’s disease (CD). The efficacy and safety of risankizumab (RZB) as induction and maintenance therapy have been recently reported. Here, the efficacy of RZB stratified by baseline CD duration is reported.

In ADVANCE (NCT03105128) and MOTIVATE (NCT03104413), patients with moderately to severely active CD received intravenous (IV) RZB induction therapy or placebo (PBO) for 12 weeks. Patients with clinical response to RZB IV induction were re-randomised in a 52-week maintenance study (FORTIFY, NCT03105102) to receive subcutaneous (SC) RZB or PBO (ie, withdrawal). For this post-hoc analysis, patient subgroups were stratified by years of CD duration at baseline (< 2, 2–5, > 5–10, and > 10 years). Induction analyses focused on patients who received RZB 600 mg IV or PBO for 12 weeks. As all patients who entered maintenance responded to RZB IV induction, maintenance analyses were limited to those patients who responded to induction and then received RZB 360 mg SC for 52 weeks. Clinical and endoscopic outcomes were evaluated using nonresponder imputation incorporating multiple imputation to handle missing data due to impact of the COVID-19 pandemic. Safety was assessed throughout the studies.

The induction and maintenance analyses included 527 patients who received RZB 600 mg IV and 141 patients who received RZB 360 mg SC, respectively. At the end of induction (week 12), patients with CD duration of < 2 years achieved higher rates of endoscopic outcomes with IV RZB induction vs patients with longer durations of disease (Figure 1), and regardless of baseline CD duration, greater proportions of RZB-treated patients achieved clinical remission (defined by stool frequency and abdominal pain), endoscopic response, endoscopic remission, and ulcer-free endoscopy vs PBO (P ≤ .05). Clinical remission rates at week 12 were numerically higher in patients with CD duration of < 5 years vs > 5 years (Figure 1). Similar results for improved clinical and endoscopic outcomes associated with shorter disease duration were observed at week 52 with RZB 360 mg SC maintenance treatment (Figure 2). RZB was well tolerated with lower rates of serious adverse events and serious infections vs PBO in induction, across CD duration subgroups.

RZB induction and maintenance therapy was effective and well tolerated with a safety profile generally similar across CD duration subgroups. Achievement of clinical and endoscopic endpoints were higher in patients with shorter duration of CD, suggesting that earlier introduction of RZB therapy may lead to improved outcomes.  

Vedolizumab (VDZ), a monoclonal antibody that targets α4β7 integrin, was approved to treat moderate-to-severe ulcerative colitis (UC) based on the presumption that it blocks T cell recruitment to the inflamed intestinal mucosa. The clinical evidence suggests that up to 50% of UC patients do not achieve disease remission under VDZ treatment. This study aims to identify changes in cell abundances and molecular pathways associated with VDZ response in UC. To this end, we included anti-tumor necrosis factor (anti-TNF)-naïve and anti-TNF-exposed patients with active UC, and utilized single-cell RNA sequencing (scRNAseq) and high-dimensional flow cytometry (Cytek) to assess the peripheral blood and the gut mucosal compartments.

Gut mucosal biopsies from inflamed and non-inflamed regions, and peripheral blood mononuclear cells (PBMCs) were obtained from UC patients 2 wks before (t0) and 14 wks after (t4) the start of VDZ administration. Response to treatment was prospectively evaluated based on endoscopic assessment (defined as a decrease in total Mayo score between t0 and t4) and physician global assessment (PGA) that incorporates disease activity score and biochemical measurements.

A total of 25 UC patients (pts) were included: 44% anti-TNF-naïve. Endoscopic response to VDZ was observed in 32% of UC pts, while 56% of pts showed response based on PGA. The VDZ response rate (by PGA) was higher in anti-TNF-naïve pts vs anti-TNF-exposed pts (82% vs 36% responders, respectively). A preliminary analysis was performed on samples from 8 (out of 25) UC pts, profiling >70,000 gut mucosal cells and >25,000 PBMCs. Within the mucosal compartment, at t0 we identified immune cells (50% of all captured cells), stromal cells (10%), and epithelial cells (40%). Upon inflammation, the proportion of immune cells increased to 70%, stromal cells to 20%, while epithelial cells depleted to 10%. Notably, all main identified immune cell lineages – T cells, B cells and myeloid cells – contributed to the expansion of the immune cell compartment in inflamed mucosa. In line with scRNAseq data, we identified all major immune cell populations and detected expression of both the classic gut-directed and the redundant trafficking integrins by Cytek.

The preliminary results substantiate our current understanding of VDZ biology in UC. We confirm that anti-TNF-naïve pts have a higher response rate to VDZ vs anti-TNF-exposed pts. With this unique cohort, our study has the power to further explore molecular mechanisms and pathways that underlie VDZ response at the single-cell level.

Non melanoma skin cancer (NMSC) is amongst the most common cancers worldwide and the incidence of both melanoma and NMSC is still rising. This is not only due to people reaching an older age, but also to the increasing amount of people receiving immunosuppressive medication. While immunosuppression in organ transplant patients serves as the most well-known model for these iatrogenic induced skin cancers, alternative forms of immunomodulating therapies, such as the biologicals, also caught attention because of their potential to disrupt skin cancer immunosurveillance.  Data on biologicals, with anti-TNFα most studied, are more controversial, however, and diverge according to the  inflammatory disease (Inflammatory Bowel Disease (IBD), psoriasis or rheumatoid arthritis) for which they are given.

1. To learn about the epidemiology of Small Bowel Adenocarcinoma. 
2. To understand the absolute risk and relative risk linked to it.  
3. To review practical management of Dysplasia/ SBA

Educational objectives
To discuss the evidence for somatic mutation in the IBD affected colonic epithelium
To consider mechanisms mutagenesis
To discuss evidence for selection pressures on mutations and their implications for cancer risk and inflammation

1. To identify the areas where standardisation of IBD pathology reporting is achievable and the areas requiring improvement. 
2. To recognise the importance of a multidiscipinary approach and good communication.
3. To consider the development of a consistent approach to the assessment and description of IBD histology.
4. To be aware of the diversity of approaches to the assessment of histological acitvity. 
4. To explore the ideal ways in which to construct the summary and conclusion of an IBD pathology report.
5. To be aware of the existence and value of guidelines and datasets in pathology generally and in IBD pathology in particular.  

Four randomized controlled trials studying faecal microbiota transplantation (FMT) in active UC patients showed variable success rates. The efficacy of FMT appears to be influenced by various factors including donor- and procedure-specific characteristics. We hypothesized that the outcome of FMT in patients with active UC could be improved by donor preselection on microbiota level, by using a strict anaerobic approach, and by repeated FMT administration.

The RESTORE-UC trial (NCT03110289) was a national, multi-centric double-blind, sham-controlled randomized trial. Active UC patients (Total Mayo score 4-10 with endoscopic sub-score ≥2) were randomly allocated (1:1) to receive 4 anaerobic-prepared superdonor (S) FMT or autologous (A) FMT (Figure 1) by permutated blocks (2 and 4) and stratified for weight, concomitant steroid use, and therapy refractoriness.
S-FMTs were selected after a rigorous screening excluding samples with Bacteroides2 enterotype, high abundances of Fusobacterium, Escherichia coli and Veillonella and the lowest microbial loads (Q1).
A futility analysis after 66% (n=72) of inclusions was planned per protocol including a modified intention-to-treat (mITT) analysis using non-responder imputation (NRI) for patients receiving at least one FMT. The primary endpoint was steroid-free clinical remission (Total Mayo ≤ 2, with no sub-score >1) at week 8.

Between March 2017-2021, 72 patients signed the ICF and 66 were randomly allocated to S-FMT (n=30) or A-FMT (n=36) and received at least one FMT. In the S-FMT and the A-FMT resp. 4 and 5 patients terminated the trial early due to worsening of colitis (4 in both arms) or FMT enema intolerance (1 A-FMT). They were included in the mITT analysis using NRI (Fig. 2). Both study arms were matched for baseline characteristics (Table 1), yet a trend (p= 0.066) towards higher concomitant biological use in the S-FMT arm was observed.
After 66% of intended inclusions, the primary endpoint was reached in 3/30 (10%) S-FMT and 5/31 (13.9%) patients randomized to A-FMT (p=0.72).
As the predefined minimum difference between both treatment arms was not attained, the study was stopped due to futility. The full set of endpoints are summarized in Table 2.Of note, no patients on concomitant biologicals reached the primary endpoint.
There were 2 serious adverse events in the A-FMT arm: dysuria requiring hospitalization and worsening of UC requiring colectomy.

In this double-blind sham-controlled trial comparing repeated administrations of anaerobic-prepared S-FMT with A-FMT in patients with active UC, no significant difference in steroid-free remission rates at week 8 were observed. The FMT procedure was generally well tolerated, and no new safety signals were observed.

Optimization and standardization of imaging reporting is currently an unmet need and would facilitate the comparison between different reports and communication between the different specialties involved in IBD. The current presentation summarizes results of a consensus guideline that has been developed by members of ECCO, IBUS and ESGAR. The consensus group identified standardized parameters and suggests how to report and how to characterize findings of cross-sectional imaging that encompasses MRI, CT, IUS, endoanal ultrasonography [EAUS] and transperineal ultrasonography [PUS] in IBD. These methods are used for diagnosis, assessment of disease activity and severity, and to detect complications and monitor disease course. Mural and extramural disease manifestations beyond the reach of the endoscope can be visualized and determined by cross sectional imaging.

The core elements of the presentation will describe the imaging parameters of assessment of disease activity and severity as well as intra- and extramural complications of IBD in a standardized manner. The presentation will suggest vital data for each reporting type, and proposes possible strategies to optimize and standardize reporting quality of cross-sectional imaging in IBD. Similarities and differences in reporting between MRI/CT and IUS will be identified and addressed. Practical examples will be provided on how to standardize reporting of individual cases in daily clinical practice.

Educational objectives:
•Synthesis and structure
•Mechanism of action
•Effects on inflammatory and immune processes
•Pharmacology  and formulations
•Efficacy of steroids as anti-inflammatory agents in inflammatory bowel diseases (IBD)
•Safety and complications

The isoperistaltic side-to side strictureplasty over the valve provdes a means to avoid ileocaecal resection in patients with stricturing terminal ieal disease.  Indications are a long segment of diseased terminal ileum (> 35 cm) or multiple adjacent strictures over a long length of bowel.
The technque has shown teo be safe with acceptable septic complications.  To imrove long-term outcome a broad inlet to the strictureplasty should be created (Sasaka modification).  About 1 in 4 patients will develop a deep remission and do not need further medical treatment.  The stricutreplasty can be monitored with flexible endoscopy.  A proximal to distal healing has been observed and a remoddeling of the bowel wall occurs (transsectional imaging). On the long-term efficacy equals the outcome of resection especially in an era of thight disease follow-up.  A surgical resection rate of 16% at 5 yrs has been noted.  The need to resect the stricutreplasty was extremely limied.
Despite those findings the complexity of the procedure hampers widespread implementation.

Data on the outcomes of surgery due to IBD in pregnant patients is scarce, and primarily dates back more than 3 decades ago. Primary aim: to evaluate the evolution of pregnancies and offspring after surgery due to IBD. Secondary aims: to describe the indications for surgery, the surgical techniques used, and the frequency of caesarean section concomitant to surgery for IBD

SCAR is a retrospective, multicenter study approved by ECCO COllaborative Network For Exceptionally Rare Case Reports (CONFER). Patients operated on due to IBD during pregnancy after 1998 (first biologic agent approved) were included. Data on patients’ demographics, IBD characteristics, medical treatments, IBD activity, pregnancy outcomes, surgery, delivery, foetal and maternal outcomes, were recorded

44 IBD patients were included (figure 1),

all singleton pregnancies. Seven patients (16%) were diagnosed with IBD during pregnancy, 75% had Crohn’s disease (51% fistulizing behavior), and 23% had ulcerative colitis. 34% had previously undergone surgery due to IBD. Several complementary examinations were performed during pregnancy without complications (figure 2)
Patients were being administered the following medications: corticosteroids (61%), biologicals (57%), thiopurines (23%) with 20% being on biologics and thiopurines. 93% of surgeries were performed in University hospitals, (2^nd Trimester: 55%; 3^rd trimester: 27%) with 77% of them being urgent surgeries (figure 3)
One patient had hemoperitoneum during surgery, and 27% had postsurgical complications. No woman died. 62.5% of deliveries were induced (figure 4),
70% of them by C-section, with 51% of mothers having a prolonged hospitalization. There were 40 newborns alive and 4 miscarriages/stillbirths (1 in the 1^st, 2 in the 2^nd, and 1 in the 3^rd trimester): 2 occurred during surgery and 2 occurred 2 weeks after surgery. 14% of the surgeries during the 2^nd trimester and 64% of those in the 3^rd trimester ended up with a simultaneous C-section or delivery.  Of the 40 newborns alive, there were 9 healthy (24%), 61% premature, and 47% with low birth weight. A total of 42% of newborns needed hospitalization (25% in the intensive care unit, mainly due to respiratory distress)

The need for surgery for IBD during pregnancy remains an extremely serious situation. Maternal and foetal mortality are lower than previously described, most likely due to better supporting care. However, even in the current years, 30% of the mothers and 80% of newborns have complications, and 25% of the offspring need admission to the intensive care unit. Therefore, surgical management should be performed by a multidisciplinary team, involving gastroenterologists, colorectal surgeons, obstetricians and neonatal specialists.

1. To define the appropriate timing between medical and surgical management of IBD
2. To review medical and surgical treatment indications of the complications of IBD  
3. To learn how to decide in multidisciplinary team between the two modalities of treatment 

This presentation will focus on how to identify risks for surgical complications in surgery for inflammatory bowel disease, as well as how to decrease the risk prior to surgery. There will also be a discussion on how to act when surgical complications have developed, as this risk is increased compared to colorectal surgery in general.

Educational objectives:
1. To review when to perform surgical resection in CD, as illustrated with a patient journey with limited L1 Crohn's disease
2. To get an insight into the surgical procedure via video presentation
3. To summarize literature on risk-stratification, the importance of proactive monitoring and individual treatments for postoperative recurrence

1. to understand when and why surgery is indicated in selected patients with UC

2. to review the different surgical options in patient operated for ulcerative colitis

3. to precise the consequences  for the patient in terme of function, quality of life and follow up, after surgery for UC, according to the operation performed

4. to have an overwiew of the best way to follow a patient after ileal pouch-anal anastomosis for ulcerative colitis

5/ to review the possible problems occurring during follow up up of patients after ileal pouch-anal anastomosis and the treatment for each problem

Discussion about incidence of colorectal cancer, small bowel cancer, and anal cancer in IBD with a focus on surgical strategies