IBD Journal Scan
Key articles from high impact journals in last month
Editorial Recommendations
The latest Guidelines in IBD for the Clinician
Optimized Medical Management for Crohn’s Disease: ECCO Guidelines Overview
​The ECCO guidelines provide updated recommendations on medical treatments for Crohn’s disease, focusing on optimizing patient outcomes through evidence-based therapy choices. Key treatments include corticosteroids for induction of remission, immunomodulators for maintenance, and biologics like anti-TNF agents for refractory cases. The guidelines emphasize personalized treatment plans, considering patient-specific factors to maximize efficacy and minimize adverse effects.
ECCO Guidelines on Surgical Management of Crohn’s Disease
This article is the second in a two-part series presenting the European Crohn's and Colitis Organisation's (ECCO) consensus on managing Crohn’s disease. Focusing on surgical interventions, it complements the first article, which addresses medical treatment options. The surgical management guidelines cover essential aspects, including preoperative evaluation and the careful handling of drug therapies prior to surgery to optimize patient outcomes. The article also provides detailed technical advice for addressing a range of clinical situations encountered in surgical practice. Together, these two publications offer a comprehensive, evidence-based framework for clinicians to deliver optimal care in Crohn’s disease, integrating both pharmacological and surgical perspectives in a well-rounded approach.
Consensus Guidelines for Defining and Monitoring Small Bowel Strictures in Crohn’s Disease via Intestinal Ultrasound
This consensus statement establishes expert-defined standards for diagnosing and monitoring small bowel strictures in Crohn’s disease using intestinal ultrasound (IUS), filling a gap previously addressed only by CT and MR enterography guidelines. A panel of 22 experts, including gastroenterologists, radiologists, and patient representatives, evaluated 466 statements on stricture characteristics and treatment response criteria. A Crohn’s-related stricture is defined by bowel wall thickening (over 3 mm), luminal narrowing (over 50% reduction or less than 1 cm), and pre-stenotic dilation (over 2.5 cm). Criteria were also developed for assessing hyperaemia, inflammatory fat, and wall stratification. Stricture response to treatment is gauged by reductions in bowel wall thickness, stricture length, luminal narrowing, dilation, and motility issues. This guideline aims to standardize IUS assessment, supporting more consistent diagnosis, treatment monitoring, and research outcomes in Crohn's disease.
AGA Clinical Guidance on Managing Inflammatory Bowel Disease in Patients With Malignancy
This American Gastroenterological Association (AGA) Clinical Practice Update offers essential guidance on managing inflammatory bowel disease (IBD) in patients with current or prior malignancies. It outlines the risks of various cancers in IBD patients and the effects of IBD medications on these risks, aiming to support informed therapeutic choices. Developed by experts in IBD and peer-reviewed by the AGA, the update provides a framework for handling IBD medication for patients who either develop cancer or have a history of it. This commentary consolidates recent findings and expert insights to address a critical intersection of IBD and oncology care, ensuring clinicians can manage these complex cases with evidence-based strategies.
Guidelines for Genomic Diagnosis and Care Coordination in Monogenic IBD
This consensus guideline from the British Society of Gastroenterology and British Society of Paediatric Gastroenterology, Hepatology, and Nutrition provides a framework for diagnosing and managing monogenic inflammatory bowel disease (IBD) in children and adults. Monogenic IBD often presents early with treatment-resistant symptoms and is linked to over 100 gene disorders, necessitating adaptive genomic technologies. This guideline advocates for precision medicine through standardized use of genomic testing, such as exome or genome sequencing, to ensure equitable access across the UK. It details structural needs for integrating genomic diagnostics within multidisciplinary teams and offers a care pathway based on age of onset and clinical history. Additionally, it addresses the clinical handling of actionable research findings and the implications of consumer genomics, aiming to enhance patient outcomes and resource use in managing rare, genetically-driven IBD forms.
AGA Expert Guidance on Diet and Nutritional Therapies for Inflammatory Bowel Disease Management
The American Gastroenterological Association (AGA) offers an expert review of dietary and nutritional therapies for inflammatory bowel disease (IBD) management. Recognizing that diet plays a significant role in both IBD risk and treatment, the update provides best practice recommendations to manage active disease, remission, and malnutrition. Key advice includes encouraging a Mediterranean diet for overall health, considering enteral nutrition for Crohn’s disease remission, and using parenteral nutrition for severe cases or pre-surgery optimization. Screening for vitamin deficiencies and malnutrition is essential, and registered dietitians should play a central role in patient care. The review also addresses the benefits of breastfeeding in lowering childhood IBD risk and highlights the importance of managing diet to reduce complications associated with strictures, short bowel syndrome, and other IBD-related conditions.