Therapeutic options for children and young people with moderate-to-severe ulcerative colitis

There are ever-increasing therapeutic options for patients with ulcerative colitis, but licensing and availability for children and young people are often years behind those aged >18 years. In this issue, Ashton and colleagues review the evidence. This includes a comprehensive discussion of the standard ‘advanced’ therapies—infliximab and adalimumab. The authors review the ‘newer’ therapies including vedolizumab, ustekinumab, tofacitinab and upadacitinab where the evidence is (mostly) from adults with increasing use in patients <age 18 years. The authors discuss the mechanism of action, efficacy and potential toxicity of the different treatments including discussions about what to use when and how long to persist with. There are, of course, many unanswered questions and more research is needed. (See page 387)

Effect of combined rapid access point-of-care intestinal ultrasound clinic on the management of inflammatory bowel disease

There is increasing interest in the use of ultrasound in the assessment and management of inflammatory bowel disease. In this issue, Grunshaw and colleagues report their assessment of the use of point-of-care intestinal ultrasound in the management of inflammatory bowel disease (IBD)—277 examinations, 168 patients most scanned and reported within 2 weeks of referral. Of note, 101/227 (44%) had evidence of significant active/obstructing disease, and in patients with known IBD, this rises to 101/185 (55%). Overall, 59.5% (135) of ultrasound examinations resulted in management changes. The paper leaves us with several things to consider—the place of ultrasound in the diagnostic and treatment pathway, resources and training. Certainly linking with our radiology colleagues to develop a national training scheme would allow more widespread uptake. (See page 373)

Real-world clinical effectiveness of ustekinumab in the treatment of Crohn’s disease in the East Midlands UK

In this issue, White and colleagues report their ‘real world’ experience of ustkinumab in patients with moderate-to-severe Crohn’s disease or IBD unclassified (2016–2020, multiple sites). The primary outcome was steroid-free remission at 12/12. Data is retrospective. Most patients had had previous biologics. In the cases where data was available (see the full paper) corticosteroid-free remission was 41% (68/166) at week 16, 41% (47/115) at week 30 and 48% (38/80) at week 52. Patients who had achieved clinical remission at week 16 were more likely to achieve corticosteroid-free remission at week 52 in keeping with the product licence. The authors highlight the data set as confirming ‘real world’ experience in a large cohort but also agree that more work is needed to decide on case selection and the precise treatment plan. (See page 359)

And finally

It has been a real privilege to be the Editor in Chief of Frontline Gastroenterology for the last 6 years. I step down this month. I have enjoyed watching the journal develop and publish high-impact content to help clinicians in their practice. It is great that the journal is now six editions a year. It is great we now have an impact factor. I am indebted to many people. I have been so well supported by the fantastic editorial team, BMJ and BSG and am ever grateful to them for their hard work, commitment and enthusiastic support. I am so grateful to the authors for their submissions and reviewers for their time and expertise. I am most grateful to the readers who continue to read, like and promote the content. I would like to congratulate Dr Phillip Smith who will take over as Editor in Chief. I wish him all the best. I know he will be excellent.

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