ECCO Position on Harmonisation of Crohn's Disease Mucosal Histopathology.

In inflammatory bowel disease [IBD], mucosal healing is a major therapeutic target and a reliable predictor of clinical course. However, endoscopic mucosal healing is not synonymous with histological healing, and the additional benefits of including histological remission as a target are unclear. In Crohn´s disease [CD], there are few studies highlighting the value of histological remission as a therapeutic target. Histological activity can persist in CD patients who are in endoscopic remission, and the absence of histological activity may be associated with lower relapse rates. Therefore, standardisation of procedures to evaluate CD histological activity is desirable. Topics that would benefit from standardisation and harmonisation include biopsy procedures, biopsy processing techniques, the content of histological scores, and the definitions of histological remission, histological response, and histological activity. In line with these needs, the European Crohn's and Colitis Organisation [ECCO] assembled a consensus group with the objective of developing position statements on CD histology based on published evidence and expert consensus. There was agreement that definitions of histological remission should include absence of erosion, ulceration, and mucosal neutrophils; that the absence of neutrophilic inflammation is an appropriate histological target in CD; that CD histological scores, such as the Global Histological Disease Activity Score, lack formal validation; and that histological scoring systems for ulcerative colitis, including the Geboes Score, Robarts Histopathology Index, and Nancy Histological Index, can be used for scoring intestinal biopsies in CD patients.

Colorectal polyps in ulcerative colitis and Crohn's colitis.

AIM: Patients with long-standing inflammatory bowel disease (IBD) have higher risk for developing dysplasia and colorectal cancer and consequently surveillance colonoscopy is required. The colonic lesion in these patients are often flat and subtle and may be difficult to detect by white light standard endoscopy. We aimed to review the potential of novel electronic optical enhancement techniques to enhance endoscopic diagnosis and therapeutic management of dysplasia in IBD and emerging strategies that may be useful. METHODS: We identified eligible and appropriate articles by electronic search of PubMed, MEDLINE and EMBASE between January 1980 and June 2015 using key words: dysplasia, colorectal cancer and IBD, surveillance in IBD, novel endoscopic techniques in IBD, therapeutic endoscopy in IBD, endoscopic mucosal resection, endoscopic submucosal dissection, pseudopolyps, dysplasia associated lesion or mass, adenoma associated lesion or mass, chromoendoscopy, autofluorescence, virtual chromoendoscopy, confocal endomicroscopy. RESULTS: Segmental random biopsies during white-light colonoscopy have been the recommended strategy for many years. Chromoendoscopy with colonic dye spray has been gradually implemented in recent years in order to highlight abnormalities in the mucosa and target biopsies. Simultaneously, a new generation of high-definition endoscopes with electronic filter technology that provide a detailed assessment of the mucosal and vascular colonic pattern havebeen developed and these have been adopted in clinical practise. Furthermore, the introduction of confocal laser endomicroscopy (CLE) offers the possibility to assess and characterize lesions in real-time histology and it can predict dysplastic changes with high accuracy. With the evolving novel techniques and fresh evidence, modification of the current surveillance guidelines were required. Therefore, the SCENIC consensus guidelines have been recently published and have defined the best endoscopic techniques to detect and characterize dysplasia and the clinical implications and management of dysplasia in IBD patients. CONCLUSION: Many uncertainties still remain whetherdye chromoendoscopy with targeted biopsies will be established as standard practice. However, optical enhancement endoscopic techniques are promising to perform surveillance colonoscopy with targeted biopsies for better assessment and management of the dysplastic lesions in IBD. Further studies are required to determine the best strategy for the diagnosis and treatment of dysplasia in IBD patients.

Review article: dermatological complications of immunosuppressive and anti-TNF therapy in inflammatory bowel disease.

BACKGROUND: With the expanding list of medications available to treat patients with inflammatory bowel disease (IBD), it is important to recognise adverse events, including those involving the skin. Dermatological adverse events may be confused with extra-intestinal manifestations of IBD. AIM: To review drug-related dermatological manifestations associated with immunosuppressive and anti-tumour necrosis factor (anti-TNF) therapy. METHODS: The literature was searched on PubMed for dermatological adverse events in IBD. RESULTS: Present thiopurine exposure was associated with a 5.9-fold [95% confidence interval (CI), 2.1-16.4] increased risk of developing non-melanoma skin cancer (NMSC). The peak incidence is highest in Caucasians over the age of 65 years with crude incidence rates of 4.0 and 5.7/1000 patient-years for present and previous use. In anti-TNF-exposed subjects, drug-induced lupus was reported in 1% of the cases and a psoriatic rash in up to 3% of the cases. Anti-TNF monotherapy increases the risk of NMSC ~2-fold to a rate of 0.5 cases per 1000 person-years. Cutaneous lymphomas have been rarely reported in subjects on thiopurine or anti-TNF drug monotherapy. Combination therapy seems to have an additive effect on the risk of developing NMSC and lymphoma. CONCLUSIONS: Physicians need to be aware of the wide spectrum of dermatological complications of immunosuppressive and anti-TNF therapy in IBD, especially psoriasis and non-melanoma skin cancer. Vigilance and regular screening for non-melanoma skin cancer is recommended. Case discussions between gastroenterologists and dermatologists should be undertaken to best manage dermatological adverse events.

Dietary modulation of peroxisome proliferator-activated receptor gamma.

Peroxisome proliferator-activated receptor gamma (PPAR gamma) is a nuclear receptor that regulates intestinal inflammation. PPAR gamma is highly expressed in the colon and can be activated by various dietary ligands. A number of fatty acids such as polyunsaturated fatty acids or eicosanoids are considered as endogenous PPAR gamma activators. Nevertheless, other nutrients such as glutamine, spicy food or flavonoids are also able to activate PPAR gamma. As PPAR gamma plays a key role in bacterial induced inflammation, anti-inflammatory properties of probiotics may be mediated through PPAR gamma. The aims of the present review are to discuss of the potential roles of dietary compounds in modulating intestinal inflammation through PPAR gamma.

Ileo-rectal anastomosis in ulcerative colitis: results of a long-term follow-up study.

Colectomy with ileo-rectal anastomosis (IRA) was introduced in the 'fifties as an alternative to proctocolectomy with ileostomy in patients with ulcerative colitis (UC). Seventy-four patients affected by UC and submitted to IRA were followed up with clinical, endoscopic and histological controls for a median follow-up period of 9.5 years (range: 3-25 years). The long-term outcome was assessed by evaluating the course of the proctitis, the need for medical therapy, functional results, the need for rectal excision, and mortality during the follow-up. The patients were classified in three groups according to the type of the outcome (success: low-relapsing proctitis, rare or no need for medical therapy, good functional results; partial failure: relapsing proctitis with frequent need for medical therapy and/or poor functional results; failure: necessity of proctectomy). In order to define the prognostic value the clinical characteristics at surgery (age, gender, duration of disease, rectal inflammation, and type of surgery) were compared in the three groups. The long-term outcome was judged as a success in 46 patients (62%), partial failure in 19 patients (26%) and failure in 9 patients (12%). Only one patient developed cancer in the rectal stump (incidence: 1.3%). None of the clinical parameters at surgery except rectal inflammation influenced the outcome: patients showing moderate or severe inflammation in the rectum at surgery had a higher failure rate than those with mild or no inflammation (p < 0.02). These data confirm that colectomy with IRA is a safe surgical procedure with good functional results in most cases and with a low risk of cancer.(ABSTRACT TRUNCATED AT 250 WORDS)