Inflammatory bowel disease has a high incidence and prevalence especially in young individuals in their reproductive years. Trying to conceive and being pregnant is an emotional period for those involved. In the majority of patients suffering from inflammatory bowel disease, maintenance therapy is required during pregnancy to control the disease, and disease control might necessitate introduction of new drugs during a vulnerable period. Therefore, the management of patients with a wish to conceive and during pregnancy requires specialized counselling and appropriate management including a multidisciplinary approach and close involvement of the prospective parents under a shared decision-making model. This updated consensus paper addresses these issues and is aimed to optimize pre-conceptional, pregnancy and post pregnancy counselling, including the monitoring and therapeutic management of patients with IBD patients with a wish to conceive.

Improvement of quality of life is a main objective in Inflammatory Bowel Disease (IBD) management. Data on sexual dysfunction (SD) in IBD are scarce. This study compared rates of SD between IBD patients and healthy controls (HC), and search for predictors of SD. All consecutive IBD patients seen in two tertiary centres during 2 months were invited to fulfil an anonymous validated questionnaire on their sexual function (Female Sexual Index Function and International Index of Erectile Function). Same questionnaires were fulfilled by HC and patients with Irritable Bowel Syndrome (IBS) enrolled as a second comparative group. 358 IBD patients fulfilled the questionnaire (192 women) - including 238 with Crohn’s disease and 120 with Ulcerative Colitis - 110 HC (54 women) and 107 IBS patients (54 women). In women, SD rates were 53.6% in IBD versus 28% in HC (p<0.01) and 77.5% in IBS (p=0.10 vs. IBD) patients; in men, figures were 16.9% in IBD, 7.4% in HC (p=0.64) and 26.4% in IBS (p=0.60 vs. IBD). An erectile dysfunction (ED) was reported by 43% of IBD patients, 13% of HC (p<0.01) and 55% of IBS patients (p=0.60 vs. IBD). Predictors of SD and ED were social and emotional functioning, anxiety in women and depression in men. IBD activity was not associated with SD. In IBD, 54% of women have a SD and 43% of men an ED. These rates are significantly higher than in HC, mostly driven by psychological factors, and independent from disease severity.

Biologic therapies have revolutionized the management of inflammatory bowel disease [IBD], but primary and secondary non-responses occur in a significant proportion of patients. Therapeutic drug monitoring [TDM] now has an established role in the treatment algorithm for managing secondary loss of response to anti-tumour necrosis factor [anti-TNF] agents during maintenance therapy. Data to support the use of TDM in the management of secondary loss of response to vedolizumab and ustekinumab are emerging. The potential to prevent primary non-response to biologic agents during induction is of equal, and potentially greater, clinical importance. Again, most data supporting the use of ‘proactive' TDM during induction pertains to the use of anti-TNF agents, but signals of efficacy for the use of TDM during induction with other biologic classes are now appearing. This review aims to summarize data on the use of TDM during induction to prevent pharmacokinetic primary non-response to all three classes of biologic therapy currently available for the treatment of IBD.

Summary: Background: Few data exist to help select a second biologic agent in patients with refractory ulcerative colitis (UC).Aim: To compare the efficacy of infliximab (IFX) and vedolizumab (VDZ) in UC patients who failed a first subcutaneous anti‐tumor necrosing factor (TNF) agent.Methods: Consecutive UC patients from 12 French centres starting IFX or VDZ after at least one injection of adalimumab or golimumab have been included in a retrospective study. Outcomes were clinical remission at week 14, survival without treatment discontinuation and survival without UC‐related event.Results: Among the 225 patients included, clinical remission at week 14 was achieved in 40/154 (26%) patients treated with IFX and in 35/71 (49%) treated with VDZ (P = 0.001). After a propensity score matching analysis, this difference remained significant (odds ratio: 1.67; 95% confidence interval: 1.08‐2.56; P = 0.02). With a median follow‐up of 117 weeks, survival rates without treatment discontinuation at years 1 and 3 were 50% and 29% with IFX, and 80% and 55% with VDZ, respectively (P < 0.001). Regarding survival without UC‐related event, they were 49% and 27% with IFX, and 74% and 52% with VDZ (P < 0.01).Conclusion: After failure of a first subcutaneous anti‐TNF agent, UC patients were more likely to achieve clinical remission with VDZ than those treated with IFX. Although due to prescription habits patients in the IFX group had a significantly more severe disease, these differences remained after adjustments and subgroup analyses. Such results have to be confirmed prospectively and warrant dedicated head‐to‐head trials.

Evidence for second line therapy in patients with microscopic colitis (MC) failing budesonide is scarce, although anti-tumor necrosing factors (anti-TNFs), methotrexate and azathioprine have been reported to be effective in small cohort studies. Vedolizumab, a monoclonal antibody targeting α4β7-integrin, prevents homing of T-cells to the gut. We evaluated clinical remission with vedolizumab in budesonide-refractory MC patients. We solicited gastroenterologists in Europe and Canada for cases of MC treated with vedolizumab. Vedolizumab 300 mg IV was administered at weeks 0, 2 and 6, and then every 8 weeks. Clinical remission and histological remission were defined as <3 stools per day and normalization of histology, respectively, after induction treatment. Eleven cases were retrieved [9 females, lymphocytic colitis (LC) n=5, collagenous colitis (CC) n=6]. Median (IQR) disease duration at vedolizumab initiation was 51 (29–70) months. Nine out of eleven patients had failed one immunosuppressant and ten out of eleven at least one anti-TNF agent. After 3 infusions of vedolizumab, clinical remission was observed in 5/11 patients (2 LC and 3 CC) of whom 3 remained well with maintenance therapy (median duration of 13 months). Biopsies were obtained from 9/11 patients. Histological remission was observed in 3/4 patients with clinical remission (2/3 CC, 1/1 LC) and 0/5 patients without clinical improvement. In a series of highly refractory microscopic colitis patients, vedolizumab induced clinical remission in 5/11 subjects of whom 75% normalized histology. Larger randomized trials are needed to assess the efficacy of vedolizumab in patients with MC.

Despite the introduction of biological therapies, an ileocolonic resection remains often required in patients with Crohn’s disease (CD). Unfortunately, surgery is not curative, as many patients will develop postoperative recurrence (POR), eventually leading to further bowel damage and a decreased quality of life. The 8 ^th Scientific Workshop of ECCO reviewed the available scientific data on both prevention and treatment of POR in patients with CD undergoing an ileocolonic resection, dealing with conventional and biological therapies, as well as non-medical interventions, including endoscopic and surgical approaches in case of POR. Based on the available data, an algorithm for the postoperative management in daily clinical practice was developed.