Pub Date : 2019-12-05DOI: 10.33590/emjgastroenterol/10312720
D. Turner
This year, the European Society for Gastroenterology Hepatology and Nutrition (ESPGHAN) joined forces with the European Federation of Crohn’s & Colitis Associations (EFCCA) to drive awareness of the hidden costs of paediatric inflammatory bowel diseases (IBD) and make the invisible visible. This feature puts the hidden cost of paediatric IBD in the spotlight and the author makes the case for policy makers to recognise the invisible cost of paediatric IBD. He pledges to take four key steps to reduce the burden of the diseases on society and improve the lives of children and their families.
{"title":"Making the Invisible Visible: The Hidden Cost of Paediatric Inflammatory Bowel Disease","authors":"D. Turner","doi":"10.33590/emjgastroenterol/10312720","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10312720","url":null,"abstract":"This year, the European Society for Gastroenterology Hepatology and Nutrition (ESPGHAN) joined forces with the European Federation of Crohn’s & Colitis Associations (EFCCA) to drive awareness of the hidden costs of paediatric inflammatory bowel diseases (IBD) and make the invisible visible. This feature puts the hidden cost of paediatric IBD in the spotlight and the author makes the case for policy makers to recognise the invisible cost of paediatric IBD. He pledges to take four key steps to reduce the burden of the diseases on society and improve the lives of children and their families.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80254760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-05DOI: 10.33590/emjgastroenterol/10312117
Megan Breuer
The symposium, entitled “Burning questions in IBD: Learnings from emerging drug options and clinical cases,” took place during the 2019 United European Gastroenterology (UEG) Week annual congress in Barcelona, Spain. Distinguished experts Prof Peyrin-Biroulet, Prof Vermeire, and Prof Panés tackled several of the outstanding questions in inflammatory bowel disease (IBD) management, focussing the discussion on treat-to-target strategies and how these could be applied in IBD management; when to initiate biologic treatments, and the factors involved in making these treatment decisions; the use of ustekinumab in ulcerative colitis (UC) management; efficacy and safety of biologics; and whether monotherapy or combined treatment is the optimal treatment approach in IBD. The experts used informative patient cases and data from current clinical studies to help illustrate the possible solutions to each ‘burning question’, incorporating questions from the audience into each discussion.
{"title":"Burning Questions in Inflammatory Bowel Disease: Learnings from Emerging Drug Options and Clinical Cases","authors":"Megan Breuer","doi":"10.33590/emjgastroenterol/10312117","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10312117","url":null,"abstract":"The symposium, entitled “Burning questions in IBD: Learnings from emerging drug options and clinical cases,” took place during the 2019 United European Gastroenterology (UEG) Week annual congress in Barcelona, Spain. Distinguished experts Prof Peyrin-Biroulet, Prof Vermeire, and Prof Panés tackled several of the outstanding questions in inflammatory bowel disease (IBD) management, focussing the discussion on treat-to-target strategies and how these could be applied in IBD management; when to initiate biologic treatments, and the factors involved in making these treatment decisions; the use of ustekinumab in ulcerative colitis (UC) management; efficacy and safety of biologics; and whether monotherapy or combined treatment is the optimal treatment approach in IBD. The experts used informative patient cases and data from current clinical studies to help illustrate the possible solutions to each ‘burning question’, incorporating questions from the audience into each discussion.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"9 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72461747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-05DOI: 10.33590/emjgastroenterol/10314458
A. Day
The specific dietary intervention known as exclusive enteral nutrition (EEN) is well-established as the preferred treatment to induce remission in children with active Crohn’s disease. The majority of children managed with EEN respond well to this intervention, with high rates of mucosal healing, improved nutrition, and enhanced bone health, with few side effects. This dietary therapy, utilising a complete nutritional liquid product, is generally well-tolerated over the short period of induction of remission, but does require substantial changes to routine oral intake and daily patterns. After a period of exclusive use of this therapy, ongoing use of the same formulae (as maintenance enteral nutrition) may prolong remission and prevent relapse. Over the last few years, new reports have advanced our understanding of the mechanisms by which EEN acts: these include modulation of the intestinal microbiota and direct anti-inflammatory effects upon the epithelium. This review highlights key outcomes of EEN in children with Crohn’s disease and highlights the current understanding of the mechanisms of action.
{"title":"Switching off Inflammation with Diet: A Review of Exclusive Enteral Nutrition in Children with Crohn’s Disease","authors":"A. Day","doi":"10.33590/emjgastroenterol/10314458","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10314458","url":null,"abstract":"The specific dietary intervention known as exclusive enteral nutrition (EEN) is well-established as the preferred treatment to induce remission in children with active Crohn’s disease. The majority of children managed with EEN respond well to this intervention, with high rates of mucosal healing, improved nutrition, and enhanced bone health, with few side effects. This dietary therapy, utilising a complete nutritional liquid product, is generally well-tolerated over the short period of induction of remission, but does require substantial changes to routine oral intake and daily patterns. After a period of exclusive use of this therapy, ongoing use of the same formulae (as maintenance enteral nutrition) may prolong remission and prevent relapse. Over the last few years, new reports have advanced our understanding of the mechanisms by which EEN acts: these include modulation of the intestinal microbiota and direct anti-inflammatory effects upon the epithelium. This review highlights key outcomes of EEN in children with Crohn’s disease and highlights the current understanding of the mechanisms of action.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79444372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-05DOI: 10.33590/emjgastroenterol/10310718
P. Kangesu, Luke Bracegirdle, D. Lloyd
A 54-year-old male with a history of multiple autoimmune arthritides was admitted following a 3-week history of progressive dysphagia with odynophagia to solids and liquids, with significant weight loss, night sweats, and exertional dyspnoea. Oesophagogastroduodenoscopy revealed an obstructing oesophageal stricture. Blood tests showed neutropaenia and high levels of inflammatory markers, suggestive of primary oesophageal malignancy. Oesophageal and bone marrow biopsies demonstrated inflammatory change not suggestive of malignancy. PET showed highly active nodules in the left lung and sigmoid colon, but the oesophagus was clear. Following a clinical rheumatology review, a differential diagnosis of inflammatory lesions, most likely secondary to systemic rheumatoid, was considered. The patient responded well to high-dose intravenous steroid therapy. Subsequent outpatient interval high-resolution CT demonstrated complete resolution of the lung nodule. He was maintained on oral prednisolone and methotrexate, having no further symptoms of dysphagia or neutropenia. A literature search revealed no published reports or case studies outlining a similar history to the reported patient: rheumatoid arthritis presenting to hospital as potential oesophageal malignancy.
{"title":"Dysphagia and Bone Marrow Failure: A Rare Neoplastic Mimic","authors":"P. Kangesu, Luke Bracegirdle, D. Lloyd","doi":"10.33590/emjgastroenterol/10310718","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10310718","url":null,"abstract":"A 54-year-old male with a history of multiple autoimmune arthritides was admitted following a 3-week history of progressive dysphagia with odynophagia to solids and liquids, with significant weight loss, night sweats, and exertional dyspnoea. Oesophagogastroduodenoscopy revealed an obstructing oesophageal stricture. Blood tests showed neutropaenia and high levels of inflammatory markers, suggestive of primary oesophageal malignancy. Oesophageal and bone marrow biopsies demonstrated inflammatory change not suggestive of malignancy. PET showed highly active nodules in the left lung and sigmoid colon, but the oesophagus was clear. Following a clinical rheumatology review, a differential diagnosis of inflammatory lesions, most likely secondary to systemic rheumatoid, was considered. The patient responded well to high-dose intravenous steroid therapy. Subsequent outpatient interval high-resolution CT demonstrated complete resolution of the lung nodule. He was maintained on oral prednisolone and methotrexate, having no further symptoms of dysphagia or neutropenia. A literature search revealed no published reports or case studies outlining a similar history to the reported patient: rheumatoid arthritis presenting to hospital as potential oesophageal malignancy.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89790944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-05DOI: 10.33590/emjgastroenterol/10311616
E. Salmo, N. Haboubi
Clear or involved resection margins have significant bearings on the outcome of colorectal cancer cases. There are two aspects of resection margins: longitudinal and circumferential. Pathological staging for rectal and colonic tumour specimens is a useful tool for providing continuous feedback to surgeons and may serve to improve the quality of surgery and pathology reporting. It is expected that a good pathology report will evaluate and audit the quality of other services such as radiology, surgery, and oncology. The aim of this paper is to outline how this parameter can be audited by surgeons and pathologists to improve both communication and standards.
{"title":"Who Audits Who Using Resection Margins: The Surgeon, or the Pathologist?","authors":"E. Salmo, N. Haboubi","doi":"10.33590/emjgastroenterol/10311616","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10311616","url":null,"abstract":"Clear or involved resection margins have significant bearings on the outcome of colorectal cancer cases. There are two aspects of resection margins: longitudinal and circumferential. Pathological staging for rectal and colonic tumour specimens is a useful tool for providing continuous feedback to surgeons and may serve to improve the quality of surgery and pathology reporting. It is expected that a good pathology report will evaluate and audit the quality of other services such as radiology, surgery, and oncology. The aim of this paper is to outline how this parameter can be audited by surgeons and pathologists to improve both communication and standards.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88476199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-05DOI: 10.33590/emjgastroenterol/10310266
S. Rauniyar
Inflammatory myofibroblastic tumour (IMT) is a very rare mesenchymal solid tumour commonly found in children and young adults, but also found to be present in older population groups. This case report presents a 33-year-old male patient who was pathologically confirmed to have an IMT of the colon after hemicolectomy and biopsy. The patient presented with abdominal pain and vomiting along with lower gastrointestinal tract bleeding. Colonoscopy of the patient revealed a fungating annular growth in the descending colon. CT also showed annular mass and inflammation of neoplastic process in the entire descending colon and mid-to-transverse colon after hemicolectomy, which may be a result of recurrence of the tumour. Surgical histopathological reports showed infiltrates of polymorphous cells consisting of lymphocytes, eosinophils, and plasma cells. The aim of this case report was to course through the history, pertinent laboratory test, and plans of management for a case of a young male with an IMT presenting with symptoms of abdominal pain and vomiting.
{"title":"A Rare Case of an Inflammatory Myofibroblastic Tumour of the Colon as a Probable Result of Tumour Recurrence after Hemicolectomy","authors":"S. Rauniyar","doi":"10.33590/emjgastroenterol/10310266","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10310266","url":null,"abstract":"Inflammatory myofibroblastic tumour (IMT) is a very rare mesenchymal solid tumour commonly found in children and young adults, but also found to be present in older population groups. This case report presents a 33-year-old male patient who was pathologically confirmed to have an IMT of the colon after hemicolectomy and biopsy. The patient presented with abdominal pain and vomiting along with lower gastrointestinal tract bleeding. Colonoscopy of the patient revealed a fungating annular growth in the descending colon. CT also showed annular mass and inflammation of neoplastic process in the entire descending colon and mid-to-transverse colon after hemicolectomy, which may be a result of recurrence of the tumour. Surgical histopathological reports showed infiltrates of polymorphous cells consisting of lymphocytes, eosinophils, and plasma cells.\u0000\u0000The aim of this case report was to course through the history, pertinent laboratory test, and plans of management for a case of a young male with an IMT presenting with symptoms of abdominal pain and vomiting.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88511131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-05DOI: 10.33590/emjgastroenterol/10314735
Z. Nabi, Arun Karyampudi, D. Nageshwar Reddy
Gastroesophageal reflux disease (GERD) is one of the most commonly encountered gastrointestinal diseases in clinical practice. Proton pump inhibitors (PPI) remain the cornerstone of the treatment of GERD. Up to one-third of patients do not respond to optimal doses of PPI and fall into the category of refractory GERD. Moreover, the long-term use of PPI is not risk-free, as previously thought. The pathophysiology of refractory GERD is multifactorial and includes reflux related and unrelated factors. It is therefore paramount to address refractory GERD as per the aetiology of the disease for optimal outcomes. The management options for PPI refractory GERD include optimisation of PPI, lifestyle modifications, and the addition of alginates and histamine-2 receptor blockers. Neuromodulators, such as selective serotonin reuptake inhibitors or tricyclic antidepressants, may be beneficial in those with functional heartburn and reflux hypersensitivity. Laparoscopic antireflux surgeries, including Nissen’s fundoplication and magnetic sphincter augmentation, are useful in patients with objective evidence of GERD on pH impedance studies with or without a hiatal hernia. More recently, endoscopic antireflux modalities have emerged as an alternative to surgery in patients with PPI-dependent and PPI-refractory GERD. Long-term data and randomised comparison studies, however, are required before incorporating endoscopic therapies in the management algorithm for refractory GERD.
{"title":"Editor’s Pick: Refractory Gastroesophageal Reflux Disease: Pathophysiology, Diagnosis, and Management","authors":"Z. Nabi, Arun Karyampudi, D. Nageshwar Reddy","doi":"10.33590/emjgastroenterol/10314735","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10314735","url":null,"abstract":"Gastroesophageal reflux disease (GERD) is one of the most commonly encountered gastrointestinal diseases in clinical practice. Proton pump inhibitors (PPI) remain the cornerstone of the treatment of GERD. Up to one-third of patients do not respond to optimal doses of PPI and fall into the category of refractory GERD. Moreover, the long-term use of PPI is not risk-free, as previously thought. The pathophysiology of refractory GERD is multifactorial and includes reflux related and unrelated factors. It is therefore paramount to address refractory GERD as per the aetiology of the disease for optimal outcomes. The management options for PPI refractory GERD include optimisation of PPI, lifestyle modifications, and the addition of alginates and histamine-2 receptor blockers. Neuromodulators, such as selective serotonin reuptake inhibitors or tricyclic antidepressants, may be beneficial in those with functional heartburn and reflux hypersensitivity. Laparoscopic antireflux surgeries, including Nissen’s fundoplication and magnetic sphincter augmentation, are useful in patients with objective evidence of GERD on pH impedance studies with or without a hiatal hernia. More recently, endoscopic antireflux modalities have emerged as an alternative to surgery in patients with PPI-dependent and PPI-refractory GERD. Long-term data and randomised comparison studies, however, are required before incorporating endoscopic therapies in the management algorithm for refractory GERD.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88772699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-05DOI: 10.33590/emjgastroenterol/10314025
S. Amisten
Prof Gralnek presented a clinical case on the management of gastrointestinal bleeding (GIB) as a result of Helicobacter pylori infection, and the role of intravenous (IV) ferric carboxymaltose (FCM) as a treatment option for iron deficiency anaemia (IDA) was discussed. IV iron is suitable for patients who have intolerance or limited or no response to oral iron, haemoglobin (Hb) <10 g/dL, or Hb >10 g/dL with cardiovascular or respiratory comorbidities. Prof Gralnek stressed that IDA is common, often underdiagnosed and undertreated, and that the choice between oral or IV iron therapy depends on the degree of anaemia, presence of inflammation, and adherence to oral iron therapy. The main objective of iron treatment is to normalise Hb and iron parameters, and gastroenterologists need to be more aware of anaemia beyond the acute GIB episodes. Prof Lanas presented a clinical case on the management of patients taking anticoagulants (AC) or antithrombotics (AT) who have anaemia due to GIB, and highlighted challenges associated with reducing the risk of bleeds while avoiding thrombotic events. Prof Lanas highlighted clinical dilemmas arising from stopping, restarting, and switching AC in patients with anaemia and GIB, as well as Hb management at discharge. He also stressed that GIB, and especially anaemia or iron storage depletion, are frequently encountered in patients taking AT, and may have a direct impact on mortality, morbidity, and quality of life (QoL). Anaemia and iron deficiency affect mortality, recovery, and QoL in patients who need a rapid restoration of Hb levels and iron stores to decrease the risk of cardiovascular events. Prof Lanas concluded by explaining that FCM therapy has a favourable safety profile, and is more effective, faster, and cost-effective compared to oral iron therapy, and therefore represents a good therapeutic option for anaemic GIB patients with elevated risk of thrombosis.
{"title":"Practical Management of Anaemia After a Gastrointestinal Bleed","authors":"S. Amisten","doi":"10.33590/emjgastroenterol/10314025","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10314025","url":null,"abstract":"Prof Gralnek presented a clinical case on the management of gastrointestinal bleeding (GIB) as a result of Helicobacter pylori infection, and the role of intravenous (IV) ferric carboxymaltose (FCM) as a treatment option for iron deficiency anaemia (IDA) was discussed. IV iron is suitable for patients who have intolerance or limited or no response to oral iron, haemoglobin (Hb) <10 g/dL, or Hb >10 g/dL with cardiovascular or respiratory comorbidities. Prof Gralnek stressed that IDA is common, often underdiagnosed and undertreated, and that the choice between oral or IV iron therapy depends on the degree of anaemia, presence of inflammation, and adherence to oral iron therapy. The main objective of iron treatment is to normalise Hb and iron parameters, and gastroenterologists need to be more aware of anaemia beyond the acute GIB episodes.\u0000\u0000Prof Lanas presented a clinical case on the management of patients taking anticoagulants (AC) or antithrombotics (AT) who have anaemia due to GIB, and highlighted challenges associated with reducing the risk of bleeds while avoiding thrombotic events. Prof Lanas highlighted clinical dilemmas arising from stopping, restarting, and switching AC in patients with anaemia and GIB, as well as Hb management at discharge. He also stressed that GIB, and especially anaemia or iron storage depletion, are frequently encountered in patients taking AT, and may have a direct impact on mortality, morbidity, and quality of life (QoL). Anaemia and iron deficiency affect mortality, recovery, and QoL in patients who need a rapid restoration of Hb levels and iron stores to decrease the risk of cardiovascular events. Prof Lanas concluded by explaining that FCM therapy has a favourable safety profile, and is more effective, faster, and cost-effective compared to oral iron therapy, and therefore represents a good therapeutic option for anaemic GIB patients with elevated risk of thrombosis.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76581773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-05DOI: 10.33590/emjgastroenterol/10311943
D. Jacobs
In these interviews, the experts clearly highlighted four key messages: 1) Too few patients with inflammatory bowel disease (IBD) are being treated with biologics, including anti-TNF-α therapies. 2) Some patients may also be receiving this treatment too late in the disease course, when structural damages have already occurred. This may be due to the high cost of originator biologics or a lack of awareness among physicians of the proven benefits of early anti-TNF-α therapy introduction. These therapies have been shown to decrease complications and disease progression. 3) The development of affordable anti-TNF-α biosimilars can facilitate greater access to these therapies and could extend their early use to more patients, with no detected safety issues in switched patients discerned to date. 4) Newer therapeutic options with other mechanisms of action are available, but for now at least, anti-TNF-α therapies are seen as ‘old but gold’.
{"title":"‘Old but Gold’ – Insights About Anti-TNF-α Therapy in the Treatment of Inflammatory Bowel Disease","authors":"D. Jacobs","doi":"10.33590/emjgastroenterol/10311943","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10311943","url":null,"abstract":"In these interviews, the experts clearly highlighted four key messages:\u0000\u00001) Too few patients with inflammatory bowel disease (IBD) are being treated with biologics, including anti-TNF-α therapies.\u0000\u00002) Some patients may also be receiving this treatment too late in the disease course, when structural damages have already occurred. This may be due to the high cost of originator biologics or a lack of awareness among physicians of the proven benefits of early anti-TNF-α therapy introduction. These therapies have been shown to decrease complications and disease progression.\u0000\u00003) The development of affordable anti-TNF-α biosimilars can facilitate greater access to these therapies and could extend their early use to more patients, with no detected safety issues in switched patients discerned to date.\u0000\u00004) Newer therapeutic options with other mechanisms of action are available, but for now at least, anti-TNF-α therapies are seen as ‘old but gold’.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87211800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-04DOI: 10.33590/emjgastroenterol/10313504
S. Webster
At the 14th Annual Congress of European Crohn’s and Colitis Organisation (ECCO), a symposium was convened to discuss the present and future of personalised care for patients with inflammatory bowel disease (IBD). IBD is not one disease: the clinical presentation, disease course, and treatment response differ in every patient. As such, personalised care is considered the best approach for effective management. Importantly, it is acknowledged that IBD is not confined to the gut. Although the predominant symptoms manifest in the organ, the inflammation is likely to be systemic. The importance of learning from and collaborating with specialists who treat associated conditions, such as spondyloarthritis (SpA), will become the key to managing IBD at the individual level. IBD is known to be influenced by genetic as well as environmental factors; however, some are yet to be identified. Advances in understanding ‘omes’ (e.g., genome, transcriptome, microbiome, etc.) and how they impact a person’s IBD journey are rapidly occurring. At the congress, experts provided their insights into recent developments in personalised care and how to optimise current tools at their disposal, as well as evolving methodologies that are anticipated to offer increased efficiency in the future, e.g., the introduction of systems biology.
{"title":"Defining the Future of Inflammatory Bowel Disease Care: The Pivotal Role of Personalised Treatment","authors":"S. Webster","doi":"10.33590/emjgastroenterol/10313504","DOIUrl":"https://doi.org/10.33590/emjgastroenterol/10313504","url":null,"abstract":"At the 14th Annual Congress of European Crohn’s and Colitis Organisation (ECCO), a symposium was convened to discuss the present and future of personalised care for patients with inflammatory bowel disease (IBD). IBD is not one disease: the clinical presentation, disease course, and treatment response differ in every patient. As such, personalised care is considered the best approach for effective management. Importantly, it is acknowledged that IBD is not confined to the gut. Although the predominant symptoms manifest in the organ, the inflammation is likely to be systemic. The importance of learning from and collaborating with specialists who treat associated conditions, such as spondyloarthritis (SpA), will become the key to managing IBD at the individual level. IBD is known to be influenced by genetic as well as environmental factors; however, some are yet to be identified. Advances in understanding ‘omes’ (e.g., genome, transcriptome, microbiome, etc.) and how they impact a person’s IBD journey are rapidly occurring. At the congress, experts provided their insights into recent developments in personalised care and how to optimise current tools at their disposal, as well as evolving methodologies that are anticipated to offer increased efficiency in the future, e.g., the introduction of systems biology.","PeriodicalId":92504,"journal":{"name":"EMJ. Gastroenterology","volume":"201 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86737717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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