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Compared to the general population, patients with (IBD) have a well-recognized increased risk of developing dysplasia and/or colorectal cancer (CRC), both in ulcerative colitis (UC) and Crohn’s disease (CD). Chronic inflammation is believed to promote the development of neoplasia. Adenocarcinoma complicating ulcerative colitis and Crohn’s disease develops from a precursor lesion, dysplasia or intra epithelial neoplasia, via an inflammation-dysplasia-carcinoma sequence. IBD-related dysplasia is categorized into either low-grade or high-grade dysplasia. Until recently, dysplasia was classified macroscopically into two general categories: flat dysplasia, which is endoscopically undetectable, and elevated or raised dysplasia. In 2015, the SCENIC [Surveillance for Colorectal Endoscopic Neoplasia detection and management in inflammatory bowel disease patients: International Consensus] nomenclature proposed the classification of lesions as visible or invisible to guide its clinical management. There is some evidence that flat/invisible dysplasia in IBD may have different molecular features when compared with polypoid/visible dysplasia. Adding to this complexity, several different histologic patterns of non-conventional dysplasia in IBD have been recently described that are morphologically distinct from conventional (or intestinal-type) dysplasia. At least seven subtypes have been reported, including, (i) hypermucinous; (ii) goblet cell-deficient; (iii) crypt cell dysplasia (or dysplasia with terminal epithelial differentiation); (iv) dysplasia with increased paneth cell differentiation; (v) sessile serrated lesion-like dysplasia; (iv) TSA-like; (v) ; (vi) (vii) serrated dysplasia, not other specified. There is increasing evidence that some of these non-conventional dysplasias are high-risk markers for advanced neoplasia.  However, there is limited information regarding their clinicopathologic features and clinical outcomes, in part due to the rarity of these subtypes and the likelihood that they are under-recognized

Dr. Neeraj Narula reports a post-hoc analysis of the UNITI Crohn’s trials showing that early measurement of faecal calprotectin after induction therapy predicts clinical outcomes better than baseline measurements of calprotectin and than other week 6 clinical or biomarker data.

Objective evaluation of treatment response is the gold standard in ulcerative colitis (UC). In this setting, intestinal ultrasound (IUS) is a non-invasive alternative to endoscopy. Recent studies showed change in IUS parameters after treatment initiation but studies with an endoscopic reference standard are scarce. The aim of this study was to evaluate early change of IUS parameters and determine cut-off values for endoscopic endpoints in UC patients starting anti-inflammatory treatment.

In this longitudinal prospective study consecutive patients with moderate-severe UC (baseline endoscopic Mayo score (EMS)≥2) starting an anti-inflammatory treatment were included. Clinical scores, biochemical parameters and IUS parameters were collected at baseline, after 2 (T1), 6 (T2) and 8-26 weeks (T3) around time of the second sigmoidoscopy/colonoscopy. IUS parameters were measured as previously established¹. Endoscopic remission (ER) and mucosal healing (MH) were evaluated in the sigmoid and defined as EMS=0 and EMS≤1, respectively. The ultrasonographist and endoscopist were blinded for the outcomes of endoscopy and IUS, respectively.

51 consecutive patients were included (Table 1) of whom 31 underwent a second endoscopy (MH: n=15 (45%), ER: n=9 (27%)). Two additional patients underwent colectomy and were considered non-responders. 18 patients did not undergo second endoscopy due to the COVID-19 pandemic (n=2), refusal (n=5), loss to follow-up (n=1) or treatment escalation because of clinical deterioration confirmed by IUS and biomarkers before second endoscopy was performed (n=10). Bowel wall thickness (BWT) was significantly lower from T2 onwards in patients reaching MH (p=0.026) and ER (p=0.002) at T3 (Fig 1). A significant decrease in BWT was already visible at T1 in patients receiving infliximab (p=0.001) or tofacitinib (p=0.007), but not in patients treated with vedolizumab (p=0.11) (Fig 2). Most accurate BWT cut-off values at T3 to determine MH and ER were 3.52 mm (AUROC: 0.95, 95% CI: 0.86-1.00, p<0.0001, sens: 91%, spec: 91%) and 2.98 mm (AUROC: 0.94, 95% CI: 0.85-1.00, p=0.001, sens: 87%, spec: 100%), respectively. Other IUS parameters at T3 did not improve association with MH or ER. IUS parameters at T2 that predict MH and ER are demonstrated in Table 2.


Table 1

Fig 1

Fig 2

BWT and Colour Doppler Signal 6 weeks after start of treatment are associated with and could predict MH and ER. In addition, treatment response patterns at IUS are drug-specific. Furthermore, we have provided accurate BWT cut-off values for endoscopic outcomes. In a point-of-care setting, (early) treatment evaluation with IUS could guide treatment decision in UC in order to optimize treatment response.

1. Bots et al, JCC, 2021

To provide a brief overview of the role of nutrition, diet and the dietitian in fertility, conception and pregnancy.