Exabis Library

Marieke Barnhoorn discusses the work of the team at Leiden University Medical centre to report efficacy and safety data for patients 4 years after receipt of allogeneic bone marrow-derived mesenchymal stem cells for treatment of Crohn’s disease perianal fistulae.

Review the ACG guideline process with emphasis on pressure points and areas of improvement

Lihi Godny from the Rabin Medical Center, Petah-Tikva, Israel discusses her work linking fruit consumption to microbial diversity and reduced risk of pouchitis. This work generates possibly the first practical dietary advice for patients with an ileal pouch anal anastomosis.

Histological remission is increasingly regarded as an important and deep therapeutic target for ulcerative colitis (UC). Assessment and scoring of histological images is a tedious procedure, that can be imprecise and prone to inter- and intra-observer variability. Therefore, a need exists for an automated method that is accurate, reproducible and reliable. This study aimed to investigate whether an artificial intelligence (AI) system developed using image processing and machine learning algorithms could measure histological disease activity based on the Nancy index.

A total of 200 histological images of patients with UC from a database at University Hospital, Vandoeuvre-lès-Nancy, France were used for this study. The novel AI system was used to fully characterise histological images and automatically measure Nancy index. The in-house AI algorithm was developed using state-of-the-art image processing and machine learning algorithms based on deep learning and feature extraction. The cell regions of each image, followed by Nancy index, were manually annotated and measured independently by 3 histopathologists. Manual and AI-automated measurements of Nancy index score were done and assessed using the intraclass correlation coefficient (ICC).

The 200-image dataset was divided into 2 groups (80% was used for training and 20% for testing). ICC statistical analyses were performed to evaluate AI tool and used as a reference to calculate the accuracy (Table 1). The average ICC amongst the histopathologists was 89.33 and average ICC between histopathologists and AI tool was 87.20. Despite the small number of image data, the AI tool was found to be highly correlated with histopathologists.

The high correlation of performance of the AI method suggested promising potential for IBD clinical applications. A standardised and validated histological AI-driven scoring system can potentially be used in daily IBD practice to eliminate the subjectivity of the pathologists and assess the disease severity for treatment decision.

This sub-course is adapted from the course "Anaemia in Crohn's Disease”, which was developed for gastroenterologists, surgeons, paediatricians, pathologists and other interdisciplinary medical experts interested in Inflammatory Bowel Disease(s) (IBD).  This course has been developed for all nurses who care for patients with IBD. For more advanced knowledge, please follow the main e-learning case, "Anaemia in Crohn's Disease”.

The aim of this e-learning activity is to increase competence and knowledge with regard to the management and care of patients with Crohn's Disease and anaemia in order to improve patient outcomes.

Upon completion of this activity learners will:

• Have basic knowledge about anaemia in Crohn's Disease patients
• Have basic knowledge about the symptoms and treatment of anaemia in Crohn's Disease patients

Educational objectives:
1. To understand the role of IL-12 and IL-23 in the development of IBD
2. To review the pivotal UNITI and UNIFI trials
3. To review the place of ustekinumab in IBD therapy
4. To have an overview on practical modalities of ustekinumab therapy
5. To get insight in the anti-IL23 drugs that are in development

Educational objectives:
1. To understand the role of IL-12 and IL-23 in the development of IBD
2. To review the pivotal UNITI and UNIFI trials
3. To review the place of ustekinumab in IBD therapy
4. To introduce specific IL-23 antibodies

Educational objectives:
1. To understand the mechanism of action of vedolizumab and other anti integrins
2. To review the key clinical data
3. To highlight studies from real world cohort and discuss the safety profile of Vedolizumab
4. To understand how to position Vedolizumab in clinical practice

Educational objectives:
1. To understand the mechanism of action of vedolizumab and other anti interns
2. To review the key phase III clinical data
3. To highlight studies from real world cohort and discuss the safety profile of Vedolizumab
4. To understand how to position Vedolizumab in clinical practice