ESPGHAN Podcast

Today’s guest is Dr Luca Scarallo, one of the rising stars in the constellation of experts in inflammatory bowel disease. Dr Scarallo – I’m tempted to call him simply “Luca,” as he was born in 1993, which makes him impossibly young – comes from Benevento, lying east and south of Naples. That city, his birthplace, has a history as impossibly long as Luca is impossibly young. It flourished under the Roman Republic and Empire, was the southern capital of the German Longbeards, the Longobardi, who ruled much of Italy fifteen hundred years ago, and belonged to the papacy for almost a millennium, till the creation of the Italian state in 1860. Unimaginable for me, whose family and native country have practically no history at all… At any rate, in flight from the weight of this enormous past, he went from the frying pan into two successive history-laden fires: * To Milan for medical education, and * To Florence for specialty training. There, he now attends children with gastrointestinal disease, having spent a year away from Florence at the Hospital for Sick Children in Toronto—a refreshingly history-poor city—as an investigator. Whilst his research interests centre on diet in inflammatory bowel disease, his chosen emphasis for this podcast interview is the use of sonography to assess the inflamed bowel – references to work in this area are supplied below. As you listen, ask yourselves these questions, please: * How do you use intestinal ultrasound in your daily practice? * Has the introduction of intestinal ultrasound in investigation and diagnosis changed your practice? * Can you imagine using intestinal ultrasound more extensively in the care of patients with inflammatory bowel diseases? Literature * Scarallo L et al. Bowel ultrasound scan predicts corticosteroid failure in children with acute severe colitis.J Pediatr Gastroenterol Nutr 2020 Jul; 71(1):46-51.Doi: 10.1097/MPG.0000000000002677. PMID: 32102087 * Kellar A et al. Intestinal ultrasound for the pediatric gastroenterologist: A guide for inflammatory bowel disease monitoring in children.Expert consensus on behalf of the International Bowel Ultrasound Group (IBUS) pediatric committee.J Pediatr Gastroenterol Nutr 2023 Feb 1; 76(2):142-148.Doi: 10.1097/MPG.0000000000003649. PMID: 36306530. PMCID: PMC9848217 * Chavannes M et al. Bedside intestinal ultrasound predicts disease severity and the disease distribution of pediatric patients with inflammatory bowel disease: A pilot cross-sectional study.Inflamm Bowel Dis 2024 Mar 1; 30(3):402-409.Doi: 10.1093/ibd/izad083. PMID: 37229656. PMCID: PMC10906360 Dr. Scarallo´s favourite song: Caruso - Lucio Dalla ESPGHAN favourite Songs can be found on Spotify [https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo?si=62ab5e3e33434312] https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo [https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo]

Dr Eytan Wine was graduated from the School of Medicine at Tel Aviv University in 1998, with training in paediatrics at Wolfson Medical Center in Holon, Israel, followed by specialty training in gastroenterology, hepatology, and nutrition at the Hospital for Sick Children in Toronto, where he also earned a PhD degree for studies in bacterially induced intestinal inflammation. His first position as an attending physician began in 2009 at the Stollery Children’s Hospital in Edmonton, Alberta, where in 2021 he was appointed to a professorship of paediatrics at the University of Alberta – which he has just left to work again in Toronto at the Hospital for Sick Children. His academic interests have centred on the interplay among diet, enteral microbiome, and intestinal inflammation. When interviewed in Helsinki, at the 2025 annual meeting of ESPGHAN, he chose, however, rather than to concentrate on his contributions in this area, instead to address the important clinical question of: * How to select initial therapy and * How to progress to longer-term therapy in patients with inflammatory bowel disease, given the sometimes bewildering array of options in both testing and treatment. He asks: * What are the best treatments for paediatric inflammatory bowel disease in 2025, and how do we define "best"? * How do we navigate a world with so many therapy options and choose the ‘best’ one for an individual patient? * Finally, does the order matter in which we deploy the weapons in our armamentarium? * Do we start with our most effective therapy or keep it for refractory cases only? All this, with the ground beneath us continually quaking and shifting... To specialise in the care of patients with inflammatory bowel disease requires substantial effort.With a guide like Dr Wine, however, one can be more confident that one is choosing well – as the references below demonstrate. Literature * Bressler B. Is there an optimal sequence of biologic therapies for inflammatory bowel disease? Therap Adv Gastroenterol 2023 Apr 5; 16:17562848231159452.Doi: 10.1177/17562848231159452. eCollection 2023. PMID: 37057077. PMCID: PMC10087655 * Spencer EA. Choosing the right therapy at the right time for pediatric inflammatory bowel disease: Does sequence matter. Gastroenterol Clin North Am 2023 Sep; 52(3):517-534.Doi: 10.1016/j.gtc.2023.05.006. PMID: 37543397 * Noor NM et al. Review article: Novel therapies in inflammatory bowel disease - An update for clinicians. Aliment Pharmacol Ther 2024 Nov; 60(9):1244-1260.Doi: 10.1111/apt.18294. PMID: 39403052 Dr. Wine´s favourite song: Michael Jakson - We are the world ESPGHAN favourite Songs can be found on Spotify [https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo?si=62ab5e3e33434312] https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo [https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo]

You’ll never guess who’s across the table from me today – well, across the miles, since we’re encountering one another via ZOOM, but either way, you’ll never guess. It’s JPGN Journal Club again with... wait for it... have you marked your score sheet, folded it in quarters, and dropped it into the sealed box? No? Too late now – because it’s Dr Jake Mann! How many of you guessed right? Jake’s Picks This Week: 1. From J Pediatr Gastroenterol NutrStock et al. from Kassel, Germany – yes, the city of Documenta, Brothers Grimm, and once the capital of the Kingdom of Westphalia under Jérôme Bonaparte (who, by the way, emancipated the Jews and brought in the metric system – good job, Jerry!). This study comes from the Children’s Hospital there: “Hydrostatic low-volume enemas in infants with birth weight ≤ 1000 g or gestational age ≤ 28 weeks: A controlled interventional study.” What’s it all about? In short, they tested whether standardizing enemas in extremely premature infants could help improve outcomes like reducing NEC, intestinal perforation, or meconium plug syndrome. The answer: Yes, standardization helped – but didn’t change the need for parenteral feeding.The bigger question lingers though – does clearing meconium early really help overall? Probably not, say the authors. The gut’s still immature, no matter what you do. Or in Starfleet speak: Primum non nocere. 2. From Clin Gastroenterol HepatolBaccarella et al., at The Children’s Hospital of Philadelphia (CHOP – and side note, I grew up 50 km away, so Philly was once my Bright Lights, Big City). “Outcomes of allogeneic hematopoietic stem cell transplant in monogenic inflammatory bowel disease.” What they found will lift your spirits: In 25 kids (23 of whom had very early-onset IBD), stem cell transplants worked beautifully. No deaths. 23 are in remission and med-free up to 10 years later. Some bumps – infections, GVHD, veno-occlusive disease – but all manageable.Interesting detail: patients with certain genetic mutations (affecting both leukocytes and epithelial cells) didn’t respond as well as those with mutations limited to immune cells. 🎉 What good news! Brava la dottoressa Baccarella, bravi tutti i dottori di Filadelfia! Literature * Baccarella A et al. Outcomes of allogeneic hematopoietic stem cell transplant in monogenic inflammatory bowel disease. Clin Gastroenterol Hepatol. 2025 May 14:S1542-3565(25)00404-5.Doi: 10.1016/j.cgh.2025.03.018PMID: 40378986 * Stock T et al. Hydrostatic low-volume enemas in infants with birth weight ≤ 1000 g or gestational age ≤ 28 weeks: A controlled interventional study. J Pediatr Gastroenterol Nutr. 2025 May 8.Doi: 10.1002/jpn3.70055PMID: 40344423

Today’s podcast is a change of pace.It showcases not only Prof Dr Amit Assa, offering his expertise in approaches to treatment of paediatric ulcerative colitis, but also Dr Vangelis Giamouris, a member of Young ESPGHAN who sits on the Education Committee. Dr Giamouris has put his head over the parapet: not your usual interviewer, but instead Vangelis will shoot questions at Prof Assa; Prof Assa will shoot answers back; and the listeners can enjoy the firefight. Vangelis, may the odds be ever in your favour! Dr Giamouris was granted his medical degree at the University of Thessaly, trained in paediatrics in Athens at the Agia Sofia Children’s Hospital, and at present works at King’s College Hospital (London). He presents three clinical scenarios that involve aspects of paediatric ulcerative colitis to Prof Assa for his perspective on diagnosis and treatment. Prof Assa is from Israel, where he trained. After a post-graduate fellowship in Toronto at the Hospital for Sick Children, he returned to Israel, where he chairs the Institute for Pediatric Gastroenterology at Kaplan Medical Center in Rehovot. He is also a full professor of pediatrics at Hebrew University in Jerusalem. In his comments on Dr Giamouris’ clinical vignettes, he illustrates the principles set out in the recently updated ESPGHAN / NASPGHAN guidelines for physicians addressing paediatric ulcerative colitis — guidelines which are cited below. Now let the games begin! Literature – pending publicationManagement of Paediatric Ulcerative Colitis, Part 1: Ambulatory Care — An Updated Evidence-based Consensus Guideline from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition and the European Crohn’s and Colitis Organization Management of Paediatric Ulcerative Colitis, Part 2: Acute Severe Colitis — An Updated Evidence-based Consensus Guideline from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition and the European Crohn’s and Colitis Organization Prof. Assa´s favourite song: James Taylor - Fire and Rain ESPGHAN favourite Songs can be found on Spotify [https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo?si=62ab5e3e33434312] https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo [https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo]

A short hop from Stockholm to Helsinki, site of the 2025 ESPGHAN annual meeting, where this interview with Prof Ola Olén was recorded – in Finland, or East Sweden, as it was known until 1809, when the Treaty of Fredrikshamn / Hamina ceded both Finland and parts of both North and West Bothnia to Russia… Only in 1917 was the Grand Duchy of Finland pried away from the fragmenting Russian empire, and, mind you, the Russians, wearing their Soviet hat, stole Karelia back in 1940. Thinking of the state of the world today, we forget history at our peril; it’s never been easy to be a Finn. Sweden, though, is where Prof Olén is based, and where he mines clinical registries of children with inflammatory bowel disease to identify risks and risk factors for susceptibilities and complications. His particular interest is the question of whether or not the risk of cancer is increased in pediatric inflammatory bowel disease, and if so – what cancers, why, and to what extent, absolute and relative? Of course this raises an important corollary question: What are physicians and families to do with the estimates of risk that his work produces? An introduction to that work is provided in the references below. LiteratureOlén O et al. Childhood onset inflammatory bowel disease and risk of cancer: A Swedish nationwide cohort study 1964–2014. BMJ 2017 Sep 20; 358:j3951. Doi: 10.1136/bmj.j3951. PMID: 28931512. PMCID: PMC5605779 Everhov Å et al. Colorectal cancer in childhood-onset inflammatory bowel disease: A Scandinavian register-based cohort study, 1969–2017. J Pediatr Gastroenterol Nutr 2022 Oct 1; 75(4):480–484. Doi: 10.1097/MPG.0000000000003574. Epub 2022 Aug 18. PMID: 36125530 Olén O et al. Increasing risk of lymphoma over time in Crohn’s disease but not in ulcerative colitis: A Scandinavian cohort study. Clin Gastroenterol Hepatol 2023 Nov; 21(12):3132–3142. Doi: 10.1016/j.cgh.2023.04.001. Epub 2023 Apr 13. PMID: 37061104 Everhov Å et al. Cancer incidence in patients with ulcerative colitis naïve to or treated with thiopurine and targeted therapies – a cohort study 2007 to 2022 with comparison to the general population. J Crohns Colitis 2025 Jun 2:jjaf091. Doi: 10.1093/ecco-jcc/jjaf091. Online ahead of print. PMID: 40455688 Dr. Olen´s favourite song: Bara bada bastu” with KAJ. ESPGHAN favourite Songs can be found on Spotify:https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo [https://open.spotify.com/playlist/0YIHKjxITLEm9XNyHyypTo]