Exabis Library

1. To understand the similarity between both types of IBD regarding structural and functional damage
2. To review the risk of intestinal cancer in both types of IBD
3. To review the prevalence of extra-intestinal manifestations (EIMs) in both Crohn's disease and ulcerative colitis
4. To emphasise the impact that both UC and CD can have on patient's life (quality of life, disability, fatigue, anxiety/depression, work productivity)
5. To have an overview of the economic burden of IBD in 2021

Ulcerative proctitis (UP), defined as a colonic location limited to the rectum, is a poorly investigated condition in children, usually considered as a minor form of Ulcerative Colitis (UC). The aim of the present study was to compare the disease course of paediatric patients affected by UP at diagnosis with the other UC locations.

This multicentre retrospective observational study has been carried out starting from the data prospectively registered in the IBD Registry of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP). Seventeen IBD referral centres adhering to the registry were included in the study. Patients age 0 to 18 years, who were diagnosed with UC according to the Porto criteria starting from January 1, 2009, to May 1st, 2021 were identified. Only children with a minimum follow-up of 12 months were included in the study. Once enrolled, children were subsequently divided in two groups based on Paris classification: group 1 (E1) and group 2 (E2, E3 and E4).

Eight-hundred-eighty-five children were finally included in the study (median age at diagnosis: 11.2 years, range: 0-18 years; M/F: 434/451), of whom 176 (19.8%) belonging to group 1 and 709 (80.1%) to group 2. The median age at diagnosis was significantly higher in group 1 when compared to group 2 [11.9 (0-18) versus 11 (0-18) years, respectively; (p<0.001)]. At diagnosis, the induction therapy was significantly different with 68 (39.5%) patients of group 1 undergoing steroid therapy versus 505 (71.2%) of group 2 (p<0.001) and 79 (41.9%) of group 1 practising only mesalamine respect to 186 (26.2%) of group 2 (p<0.001).  A higher number of children from group 2 started immunosuppressive or biologic therapy as maintenance therapy at diagnosis [Group 1: 11 (6.2%) versus 173 (24.4%), respectively; (p<0.001)]. The median follow-up of our cohort was 4.5 years (range 1-13 years). At the last follow-up, 67/176 (38%) children with UP showed an extension of their disease location without significant difference when compared to group 2 [265 (37.5%); p=0.9], while 81 (45%) children from Group 1 were under immunosuppressive or biologic therapy versus 566 (79.8%) from group 2 (p<0.001). Five children (3%) of Group 1 underwent colectomy during the follow up versus 45 (6.9%) of Group 2 (p=0.06).

UP is a frequent location of paediatric onset UC and the risk of endoscopic extension of proctitis is similar to the more extensive forms. A considerable number of patients with UP required immunosuppressive or biologic therapy during the follow-up and no significant difference was observed in terms of surgery. Overall, UP cannot be considered as a minor form of UC.

In recent decades, there has been a growing appreciation that Inflammatory Bowel Disease (IBD) needs a personalized approach to treatment so that the right therapy can be given to the right patient at the right time. Indeed, the potential benefits of personalized medicine for IBD are evident. One approach may be through prognostic information, which is essential for clinical decision-making, as it provides physicians with substantial evidence that can assist them in guiding patients during their disease and treatment course. Prognostic markers, such as clinical, serological, endoscopy, fecal, and histology factors, predict the natural course of the disease, and their utility is based on the assumption that treatment stratification can impact the course of the disease. Therefore, recent literature has focused on identifying good prognostic models based on genetic/serological or clinical/demographic factors that could substantially contribute to tailoring each patient's treatment and potentially surpass a significant barrier to personalized medicine in IBD due to the lack of algorithms to guide treatment from diagnosis.

This talk will present and summarize the most recent scientific evidence of disease risk factors as prognostic tools in Crohn's disease (CD) and ulcerative colitis (UC) and provide some take-home messages on this topic such as:

-        Patients with CD and UC are so heterogeneous that a single treatment algorithm will never be suitable. Therefore, we need individualized treatment options and decisions.

-        System dynamics analysis is a methodology that addresses the inherent dynamic complexity of interactions between variables. As an alternative to traditional statistical methods, it may have the ability to translate complex clinical data into patient-friendly results.

-        Bayesian networks can be seen as an alternative to logistic regression, where statistical dependence and independence are not hidden in approximating weights but rather explicitly represented by links in a network of variables.

Monica Boirivant describes the work and the thinking behind her team’s demonstration of distinct subgroups of patients with different IL-13 expression in ulcerative colitis, with distinct clinical and microbial profiles and discusses implications for therapeutics in the context of previous negative anti-IL13 studies.