Exabis Library

Patients with inflammatory bowel diseases (IBD) have an excess risk of certain gastrointestinal cancers. Much work has focused on colon cancer in IBD patients, but comparatively less is known about other more rare cancers. The European Crohn's and Colitis Organization established a pathogenesis workshop to review what is known about these cancers and formulate proposals for future studies to address the most important knowledge gaps. This article reviews the current state of knowledge about small bowel adenocarcinoma, ileo-anal pouch and rectal cuff cancer, and anal/perianal fistula cancers in IBD patients.

In order to guide therapy in Ulcerative Colitis (UC),  repeated determination of intestinal inflammatory activity is essential. Endoscopy is the standard procedure to assess inflammation in UC. However innovative methods for non-invasive, uncomplicated and risk free estimation of inflammatory activity are needed as bowel preparation, patients discomfort and risk of procedural complications limit the (frequent) use of colonoscopy. Multispectral optoacoustic tomography (MSOT) is a promising new method to measure inflammation in UC. Using short and harmless impulses of NIR-lasers, it allows for determination of a specific hemoglobin-signal in the bowel-wall and therefore inflammatory activity in affected bowel segments. However, its informative value in UC has not been evaluated so far.

In 34 patients with confirmed UC, clinical activity parameters (e.g. clinical Mayo-Subscore, B-mode-sonography, C-reactive protein, white blood count) were collected and MSOT of the sigmoid was performed within 2 weeks before/after endoscopy. For MSOT, a commercially available clinical MSOT-system (Acuity Echo, iThera Medical, Munich) was used with sequential analysis of collected data on an external desktop PC. Finally, clinical data, ultrasound findings (Limberg) and MSOT-parameters (single wavelenghts 760 nm, 800 nm, 900 nm; multispectral signals hb, hbO2, hbT) were correlated with endoscopic findings (Mayo endoscopic Subscore, MES).

We found strong and significant correlation between MES and MSOT parameters 800 nm (Spearman r = 0,6599; p < 0,0001) and HbO2 (Spearman r = 0,6695; p < 0,0001), superior to sonographic evaluation of the inflammatory activity in affected bowel segments (Spearman r = 0,4914; p = 0,0023) . Simultaneously these MSOT parameters demonstrated excellent sensitivity and specifity in distinguishing moderately to highly active (MES 2,3) from inactive and mild disease (MES 0,1) (800nm: AUROC 0,9063 (p < 0,0001); sensitivity = 93,75 %, specificity = 88,89 %; HbO2: AUROC 0,9063 (p < 0,0001); sensitivity = 100 %, specificity = 88,89 %).

MSOT is a promising approach to non-invasively assess intestinal inflammation in UC and therefore monitor anti-inflammatory therapy in these patients. Further studies are required to validate these findings.

Inflammatory bowel diseases may lead to many non-neoplastic intestinal and extra-intestinal problems. 
The main intestinal complications comprise infections, obstruction, perforation fistulas etc, whereas the main extra-intestinal manifestations include skin conditions, liver and biliary diseases, eye complications, systemic infections and other systemic conditions.

Learning objectives: 
- which are the main non-neoplastic intestinal complications
- which are the main non-neoplastic extra-intestinal complications
- example and presentation of interesting histological cases

Discussion of non pharmacological strategies to maintain remission
Review of evidence for dietary intervention
Pre and probiotic therapy
Complementary therapies
Modifying the faecal microbiota
Techniques to modify stress
Vagal nerve stimulation

An increased rate of non epithelial neoplasm in IBD is described. They could be related to inflammation or to immunosuppressive treatment. The increased risk of infection related lymphomas in IBD is debated. Concerning non epithelial neoplasm related to immunosuppressive treatment they are mainly lymphomas, skin tumours and Kaposi’s sarcomas.

The main educational objective is to know and to  be aware about the presence of this rare entities.