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Appendectomy? The solution for ulcerative colitis

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Appendectomy? The solution for ulcerative colitis

Eva Visser 1

Affiliations

1 Amsterdam University Medical Centre, Amsterdam, Netherlands

Summary

AI Generated

The speaker presented evidence that appendectomy may maintain remission and induce remission in selected patients with ulcerative colitis, with the CURE trial showing a 20% reduction in relapse rates and the COSTA trial demonstrating 33% combined clinical and endoscopic remission in biologic-exposed active UC patients.

The speaker reported that in the CURE randomised controlled trial, appendectomy plus standard therapy was superior to standard therapy alone in maintaining UC remission at one year, with relapse rates reduced by 20% and patients requiring biological agents significantly less often.
The speaker stated that in the COSTA trial of 116 biologic-exposed active UC patients, 33% in the appendectomy group achieved combined clinical and endoscopic remission at 12 months without therapy failure, compared to 12% in the JAK inhibitor group.
The speaker reported that complication rates were very low at 4% in the active UC trial, with only minor complications unrelated to colon activity.
The speaker stated that patients with proctitis or left-sided colitis responded better than those with pancolitis, and appendiceal inflammation or appendix diameter of 6mm or more predicted response to appendectomy.
The speaker noted that median time to response after appendectomy is 12 weeks, which is slower than advanced medical therapies like JAK inhibitors.
The speaker recommended that appendectomy should be discussed earlier in the treatment pathway in collaboration between gastroenterologists and surgeons, not only when colectomy is the last resort.

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Abstract

Event

UEG Week Berlin 2025

Topics

IBD Mechanisms & Personalised Medicine Paediatrics Surgery

Session

What's new in ulcerative colitis 2025?

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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UEG Standards and Guidelines

Position Paper

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Early diet and the risk of coeliac disease. An update 2024 position paper by the ESPGHAN special interest group on coeliac disease

Hania Szajewska

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Guideline

Abstract

This position paper by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Special Interest Group on Coeliac Disease (SIG-CD) presents an update to the 2016 recommendations concerning early diet and the risk of coeliac disease (CD). This update adheres to the policy that mandates reviewing guidelines every 5 years, particularly when new data emerge. The 2024 statements and recommendations are essentially similar to the 2016 recommendations. Breastfeeding, whether any amount, exclusive, or of any duration, does not reduce the risk of developing CD. Introducing gluten into an infant's diet at any time between completed 4 months (≥17 weeks) and 12 months of age does not affect the cumulative incidence of CD, although earlier introduction may lead to earlier seroconversion and CD. In observational studies involving cohorts with a known risk for CD, consuming a high amount of gluten compared to a low amount during weaning and in the subsequent childhood years—specifically the first 2–3 years, and even up to 5 years in some studies—was associated with an increased risk for CD. However, the specific optimal amounts of gluten consumption remain undetermined due to insufficient evidence on safe thresholds, and the impact of restricting gluten in the diet of healthy children of unknown risk for CD is unknown. Thus, any recommendation on the gluten amount is currently unjustifiable for the general population and infants with known HLA risk types. There is no specific guidance on the type of gluten-containing foods to be introduced at weaning.

Publisher

European Society for Paediatric Gastroenterology, Hepatology and Nutrition

Guideline

Position Paper

Topics

Immunology Paediatrics Small Intestine & Nutrition

Citation

J Pediatr Gastroenterol Nutr. 2024;79:438–445

Published

2024

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How to handle the frail

Jonas Halfvarson 1

Affiliations

1 Örebro University, Örebro, Sweden

Summary

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Abstract

Event

UEG Week Berlin 2025

Topics

IBD Nurses Paediatrics Primary Care

Session

IBD across all ages

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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... for medical therapy in inflammatory bowel diseases

Chris Lamb 1

Affiliations

1 Newcastle Hospitals NHS Foundation Trust, Newcastle, United Kingdom

Summary

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Abstract

Event

UEG Week Berlin 2025

Topics

Colorectal IBD Surgery

Session

Predicting patient outcomes...

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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Long-term outcome post-LTx in adults

Patrizia Burra 1

Affiliations

1 University of Padua-Multivisceral Transplant Unit- Gastroenterology, Padova, Italy

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Abstract

Event

UEG Week Berlin 2025

Topics

Hepatobiliary Surgery

Session

New developments in liver transplantation

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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EVALUATION OF SUBCUTANEOUS INFLIXIMAB FOR PERIANAL FISTULA HEALING IN CROHN’S DISEASE: PRELIMINARY RESULTS FROM THE REMSILAP MULTICENTER OBSERVATIONAL COHORT STUDY

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EVALUATION OF SUBCUTANEOUS INFLIXIMAB FOR PERIANAL FISTULA HEALING IN CROHN’S DISEASE: PRELIMINARY RESULTS FROM THE REMSILAP MULTICENTER OBSERVATIONAL COHORT STUDY

Manon Haas 1, Laurent Abramowitz 2, Stephanie Hamonic 3, Amandine Landemaine 3, Guillaume Bouguen 3, Anne Laurain 2, Lucine Vuitton 4, Isabelle Etienney 5, Gauthier Pellet 6, Kristell Coat 3, Ronan Garlantezec 3, Laurent Siproudhis 3, Xavier Treton 1

Affiliations

1 Institut des MICI - Clinique Ambroise Paré Hartmann, Neuilly sur Seine, France

2 CHU Bichat, Paris, France

3 CHU Pontchaillou, Rennes, France

4 Besançon university hospital gastroenterology, Courbevoie, France

5 Diaconesses-Croix St Simon Hospital, Paris, France

6 CHU Bordeaux, Bordeaux, France

Summary

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Abstract

Introduction

Management of perianal fistulas in Crohn’s disease (CD) is challenging and requires a multidisciplinary approach, combining surgical drainage and biologic therapies, such as infliximab (IFX). Higher IFX trough concentrations have been associated with improved fistula healing rates. The subcutaneous (SC) formulation of IFX achieves 2–3 times higher and more stable trough levels compared to intravenous (IV) formulation. This study hypothesizes that SC IFX could enhance perianal fistula healing rates in CD patients.

Aims & Methods

REMSILAP study is part of the 3TLAP cohort, a French prospective multicenter observational study evaluating optimal therapeutic strategies for achieving clinical and radiological remission of perianal fistulas in CD at 12 months post-surgical drainage. The REMSILAP substudy focuses specifically on patients receiving SC IFX. Patients who received SC IFX after or within six months prior to surgical drainage were included. Baseline was defined as the day of surgical drainage. The primary outcome was the proportion of patients achieving complete clinical remission defined as Perianal Disease Activity Index (PDAI) fistula drainage subscore = 0 associated with PDAI activity restriction subscore <3 and absence of seton, and radiological remission at 12 months. Here, we present preliminary findings from REMSILAP.

Results

Among the 353 patients enrolled in the 3TLAP cohort, 54 were included in REMSILAP. The cohort consisted of 61.1% male patients, with a median age of 36 years and a median disease duration of 4.5 years. Penetrating disease (B3 phenotype) was present in 40.7%, and 33.3% had a history of surgical resection. At baseline, 40.7% of patients had quiescent disease regarding Harvey-Bradshaw index, while 5.6% had severe disease activity. Biologic exposure prior to inclusion was noted in 42.6%. Surgical drainage, with seton placement, was performed in 74.1% of patients. Forty-eight patients (88%) initiated SC IFX treatment after surgical drainage. Of the patients receiving SC IFX, 50% transitioned to SC IFX after less than three IV infusions. Among those on IV IFX at baseline, 20.4% were receiving a 10 mg/kg dose. Forty-three patients (79.6%) received SC IFX in combination with immunomodulators (azathioprine, methotrexate, or 6-mercaptopurine). The median duration of SC IFX treatment was 13.1 months, with treatment maintained for 67.5% of the follow-up period (mean: 19.3 ± 11.3 months). Forty-three patients (79.6%) were treated with a stable dose of 120 mg/14 days and 6 patients (11.1%) had an intensification of SC IFX dosage to 120mg / 7 days. At 12 months, 42 patients were evaluable for clinical outcomes. Complete clinical healing at 12 months was achieved in 11 patients (27.5%) and association of PDAI restriction subscore <3 and drainage subscore = 0 was found in 18 patients (42.9%). Thirteen patients (34.2%) from the 25 patients who had received at least 6 months of SC IFX treatment showed clinical healing at 6 months. Out of the 26 patients treated with at least 12 months of SC IFX treatment, clinical healing was achieved in 16 patients (61.5%) at 12 months. Among the 11 patients with clinical healing at 12 months, 8 (72.2%) were treated with SC IFX treatment following more than three IFX IV infusions. None of the 11 patients with available MRI date showed radiological healing at 12 months.

Conclusion

Subcutaneous infliximab following surgical drainage of Crohn’s disease perianal fistula demonstrates high treatment persistence and promising rates of fistula healing.

Disclosure

This study was funded by Celltrion Healthcare France

Event

UEG Week Berlin 2025

Topics

IBD

Submission format

Abstract

Session

Treatment of fistulas in Crohn's disease

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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ARTIFICIAL INTELLIGENCE FOR CAPSULE ENDOSCOPY IN IBD: MULTICENTER EVALUATION OF ULCER AND EROSION DETECTION

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

ARTIFICIAL INTELLIGENCE FOR CAPSULE ENDOSCOPY IN IBD: MULTICENTER EVALUATION OF ULCER AND EROSION DETECTION

Maria Almeida 1, Miguel Mascarenhas-Saraiva 1, Joana Mota 1, Miguel Martins 1, Francisco Mendes 1, Pedro Cardoso 2, Tiago Ribeiro 3, João Afonso 1, Tiago Cúrdia Gonçalves 4, Pedro Campelo 5, Cláudia Macedo 5, António Miguel Martins Pinto da Costa 6, CECILIO SANTANDER VAQUERO 7, William Preston Sonnier 8, Jack Di Palma 8, João Ferreira 9, José Berkeley Cotter 5, Guilherme Macedo 1

Affiliations

1 Centro Hospitalar São João, Porto, Portugal

2 Department of Gastroenterology, University Hospital Center of São João, Porto, Portugal

3 Centro Hospitalar Universitário de São João, Lordelo - Paredes, Portugal

4 Hospital da Senhora da Oliveira - Guimarães, Guimarães, Portugal

5 Hospital da Senhora da Oliveira, Guimarães, Portugal

6 Hospital Universitario Puerta de Hierro Majadahonda (Madrid), Madrid, Spain

7 Hosp. Universitario De La Princesa, Madrid, Spain

8 University of South Alabama, Alabama, United States

9 Faculdade de Engenharia da Universidade do Porto, Porto, Portugal

Summary

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Abstract

Introduction

Capsule endoscopy (CE) is a minimally invasive and essential tool for assessing small bowel disorders, especially Crohn’s disease. Accurate detection of ulcers and erosions is vital for evaluating disease activity, guiding treatment, and monitoring therapeutic response. Although CE has revolutionized lesion detection, its manual interpretation remains time-consuming and subject to interobserver variability. Recent advances in artificial intelligence (AI), particularly convolutional neural networks (CNNs), offer promising solutions by enhancing diagnostic accuracy, reducing variability, and improving workflow efficiency. This study aimed to develop and validate a robust AI model capable of detecting and distinguishing small bowel ulcers and erosions across multiple CE platforms and clinical centers.

Aims & Methods

In a prospective, multicenter study conducted between January 2021 and April 2024, data were collected from centers in Portugal, Spain, and the United States. Two CE devices—PillCamSB3 and Olympus EC-10—were used to analyze 137 anonymized exams. The AI-assisted readings generated by a deep learning model were compared to standard-of-care (SoC) interpretations, with an expert consensus panel serving as the reference standard. Performance metrics included sensitivity, specificity, positive and negative predictive values (PPV, NPV), and area under the receiver operating characteristic curve (AUROC).

Results

Expert consensus identified ulcers and erosions in 56 patients (40.9%). Compared to the reference standard, SoC readings achieved 60.7% sensitivity, 98.8% specificity, 97.1% PPV, 78.4% NPV, and 83.2% accuracy. In contrast, the AI-assisted model achieved 94.6% sensitivity, 80.2% specificity, 76.8% PPV, 95.6% NPV, and 86.1% accuracy. The AI model was found to be both non-inferior (p < 0.001) and statistically superior (p < 0.001) to SoC. Notably, it identified 68 lesions, nearly double those detected by SoC (35), and demonstrated consistent performance across devices and centers. The mean AI-assisted reading time was 239 seconds (SD 138 seconds) per exam.

Conclusion

The AI-assisted model significantly outperformed conventional SoC in the detection of small bowel ulcers and erosions, achieving higher sensitivity and overall accuracy while substantially reducing reading time. This is the first multicenter validation of an interoperable AI solution for CE, capable of high diagnostic performance across different devices and clinical environments. These findings highlight the potential of AI to transform endoscopic evaluation and management in inflammatory bowel disease.

Event

UEG Week Berlin 2025

Topics

Endoscopy Radiology & Imaging IBD

Submission format

Abstract

Session

Advances in the investigation of the small bowel

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

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