hheadmin, Author at Hospital Healthcare Europe

Press Releases

Take a look at a selection of our recent media coverage:

Test Emergency and Critical Care

1st July 2020

Test Clinical, Nursing and patient care

Test raises hopes of tackling ‘silent killer’

16th October 2019

A team from the University of Dundee School of Medicine has devised a test that detects the presence of desmosine, an amino acid that diseased aortas release into the blood and urine, which they believe can improve the diagnosis and monitoring of aortic aneurysms while possibly aiding effort to develop new therapies to slow down their progression.

Men aged 65 and over are most at risk and may be invited for ultrasound screening. If an aortic aneurysm is detected, they will be asked to attend regular follow up checks but, as aneurysms do not expand at a linear rate, this means rapid growth between screenings may be missed.

Furthermore, the size of an aneurysm does not always correlate to how close it is to rupturing. However, the Dundee researchers believe that measuring the level of desmosine is a more effective way of identifying which patients are in most urgent need of treatment.

Dr Anna Maria Choy, Senior Clinical Lecturer and Honorary Consultant Cardiologist at the University, said, “At the moment, patients are offered surgery when the aneurysm reaches a size where it is felt to be in danger of rupturing. The problem is that aortic aneurysms can progress quite unpredictably and rapidly between tests. Sometimes they stay the same for a long time then have sudden expansion and they can also rupture when not of a particularly significant size.

“All this means we need to find a better way to detect and monitor aneurysms as it is a terrible amount of uncertainty for patients and their families to live with. We established that desmosine was released into the blood when this disease was present so we looked at whether testing for this might add to the screening.

“Looking at a retrospective collection of samples from aneurysm patients, we found that not only was this effective in detecting aneurysms, it improved predicting complications and outcomes. This could potentially help to save lives by picking up danger signs missed by the current screening programme and identifying which patients should be offered surgery.”

Ruptured aortic aneurysms cause 5000 deaths in the UK each year, and are responsible for 1 in 75 deaths of men over 65. The incidence is growing as the population ages while smokers, diabetics and people with hypertension are among other at-risk groups.

Desmosine derives from elastin protein. As suggested by its name, elastin provides blood vessels with their unique elastic character to expand and stretch. When someone develops an aneurysm, this protein gets broken down and is released into blood and urine.

The Dundee team and their co-investigators from Edinburgh, Leicester and Singapore checked the desmosine levels of patients with aneurysms ranging from the very mild to extremely severe. They found it was not just an effective indicator of the size of the aneurysm but also the likelihood of the patient developing complications.

Dr Jeffrey Huang, a principal investigator who developed the desmosine assay, said, “Where available, screening programmes have helped reduce the number of fatalities but it is quite resource-intensive. It is potentially more cost-effective and patient-friendly to go to your GP for a simple blood test rather than going to hospital for an ultrasound.

“More importantly, our test has shown to be more effective in predicting outcomes than size alone so there is the potential to save lives.”

At the moment there is no medical intervention known to slow the progression of aneurysms but Dr Choy and Dr Huang believe the test they have developed can help to guide the development of therapies through clinical trials by giving faster and clearer readings of the levels of desmosine and therefore aortic destruction.

“Next we want to test this research in women who experience a higher mortality rate event though they are less likely to be diagnosed with an aneurysm,” continued Dr Choy. “It may also prove significant for people with genetic diseases that lead to diseased aortic walls. The bottom line is that in any disease of the aorta we think this amino acid may have a role to play in detection, prediction and follow up.”

Test raises hopes of tackling 'silent killer'

Catalonia

nearly 25

Tildrakizumab confirms its long-term efficacy and safety

15th October 2019

Almirall has announced the presentation of the results of 14 abstracts about efficacy and safety of long-term tildrakizumab treatment at the 28th EADV Congress by Almirall and SUN Pharma to bring the newest data about psoriasis biological therapies.

One of the studies, an open-label extension from baseline reSURFACE 1 a Phase III clinical trial and shows that, following up to 4 years of treatment with tildrakizumab 100mg, PASI and PGA response rates are high and durable. An extension study from reSURFACE 1 and reSURFACE 2 Phase III clinical trials has also been presented showing that there is no dose-dependent tildrakizumab effect on the incidence of malignancy. This is the longest data available on an IL23p19 inhibitor, the most innovative class of drugs for the treatment of moderate-to-severe psoriasis. The third study is a pooled analysis through 3 years also from reSURFACE 1 and 2 Phase III clinical trials showing that tildrakizumab was well tolerated with low SAEs and adverse effects of a subpopulation of patients 65 years of age or older.

Tildrakizumab is a humanised high-affinity anti-IL23p19 monoclonal antibody approved in Europe under the brand name Ilumetri® for the treatment of moderate-to-severe plaque psoriasis. Due to its specific mechanism of action, it selectively blocks interleukin-23 (IL-23), a key regulatory cytokine, essential in T-helper 17 cell differentiation and survival, which are the cells instrumental in the pathogenesis of psoriasis.

Long-term efficacy and safety: up to 4-year results from reSURFACE 1

According to the results of the open-label extension from reSURFACE 1, at week 64, 87% of patients achieved PASI 75, 54% PASI 90 and 31% PASI 100, respectively. And at week 208, these values were 82% for PASI 75, 56% for PASI 90 and 28% for PASI 100. In addition, the proportion of patients receiving tildrakizumab 100mg with a favorable PGA response was 65% at week 64 and 58% at week 208. Both doses were well tolerated with low rates of AEs of interest. In conclusion, these results are in line with previous tildrakizumab safety data obtained in a 148-week pooled analysis from both reSURFACE 1 and 2 Phase III clinical trials that showed the sustainability of efficacy and safety over 3 years of tildrakizumab treatment in patients with moderate-to-severe chronic plaque psoriasis who were responders to this therapy.

No dose-dependent effect on the incidence of malignancy up to 5 years of follow-up

Evidence is lacking on the long-term effect of IL-23p19 monoclonal antibodies on malignancy rates. The results of an extension study from reSURFACE 1 and reSURFACE 2 Phase III clinical trials in up to 5 years of follow-up suggest there is no dose-dependent tildrakizumab effect on the incidence of malignancy.

In reSURFACE 1, 239 patients receiving tildrakizumab 100mg and 267 receiving tildrakizumab 200mg enrolled in the extension for a mean duration of 154.2 weeks and 165.7 weeks, respectively. In reSURFACE 2, 376 patients receiving tildrakizumab 100mg and 347 receiving tildrakizumab 200mg enrolled for a mean duration of 146.8 weeks and 148.5 weeks, respectively. The exposure-adjusted malignancy rate for patients who received 100mg of tildrakizumab in reSURFACE 1 and 2 base + extension studies was 1.6 events/100 patient-years and 0.8 events/100 patient-years, respectively. The rate for patients receiving tildrakizumab 200 mg was 0.9 events/patient-years and 1.0 events/patient-years, respectively.

In reSURFACE 1, patients receiving tildrakizumab 100mg had exposure-adjusted rates of melanoma and non-melanoma skin cancers of 0.1/100 patient-years and 0.5/100 patient-years, and patients with 200mg had exposure-adjusted rates of 0.1/100 patient-years and 0.4/100 patient-years, respectively.

In reSURFACE 2, patients receiving tildrakizumab 100mg had exposure-adjusted rates of melanoma and non-melanoma skin cancers of 0.1/100 patient-years and 0.3/100 patient-years, respectively; meanwhile, the rates in patients receiving tildrakizumab 200mg were 1.1/100 patient-years and 0.5/100 patient-years, respectively.

When excluding nonmelanoma skin cancer, exposure-adjusted malignancy rates were 1.1/100 patient-years for patients receiving tildrakizumab 100mg in reSURFACE 1 and 0.5/100 patient-years for those receiving tildrakizumab 200mg in reSURFACE 1 and both doses in reSURFACE 2.

Safety in patients 65 years of age or older

Additionally, long-term data in patients 65 years of age or older was presented. In a pooled analysis after 3 years (148 weeks) of treatment from reSURFACE1, 2 clinical trials, tildrakizumab was well tolerated with low SAEs and adverse effects of special interest. No dose related increase in the rate of adverse events were observed.

Results from a pooled analysis through 3 years from reSURFACE 1 and reSURFACE 25

According to the results of 148-week pooled analysis from reSURFACE 1 and reSURFACE 2 Phase III trials have shown sustained efficacy and safety over three years of tildrakizumab use in patients with moderate-to-severe chronic plaque psoriasis who were responders (≥75% improvement in PASI) or partial responders (≥50 to 75% improvement in PASI) to tildrakizumab 100 mg at week 28.

For responders to tildrakizumab 100mg, proportions of patients (OC) achieving PASIs of <5, <3 and <1 at week 28 were 96.3%, 85.4% and 50.9%, respectively; at week 52 were 89.9%, 82.0% and 56.5%, respectively; and finally, at week 148 were 91.6%, 79.8% and 51.9%. For partial responders to tildrakizumab 100 mg, proportions of patients (OC) achieving PASIs of <5, <3 and <1 at week 52 were 58.3%, 41.7% and 19.4%, respectively; and at week 148 were 72.7%, 45.5% and 27.3%, respectively. These data confirm the robustness of the tildrakizumab data among the IL23p19 class.

The safety profile of tildrakizumab was favourable over the three years, with low rates of severe infections, malignancies, and extended MACEs (major adverse cardiovascular events) for tildrakizumab 100 and 200 mg treatment over a 148-weeks period. Exposure-adjusted incidence rates of severe infections, malignancies, NMSC (non-melanoma skin cancer), melanoma skin cancer, and extended MACEs with tildrakizumab were low and comparable to placebo, indicating in this study no increased risk of these events with tildrakizumab treatment.

About reSURFACE 1/2

ReSURFACE 1 and reSURFACE 2 included over 1800 patients from more than 200 clinical sites worldwide. According to both studies’ data, an average of 63% of patients achieved 75% of skin clearance (Psoriasis Area Sensitivity Index per PASI 75) by week 12 and an average of 78% at week 28, after only three doses. The data further showed that a higher number of patients on tildrakizumab achieved PASI 90 and 100 compared to placebo and etanercept: an average of 59% of patients achieved PASI 90 and an average of 30% reached PASI 100 at week 28. Over a year, more than 92% of patients who responded to tildrakizumab within 28 weeks maintained a PASI 75 response.

How do pro-allergic environments promote the development of asthma?

In a study published in Nature Immunology, Professors Thomas Marichal (FRS-FNRS Research Associate, Welbio and ERC investigator) and Fabrice Bureau (Welbio investigator) and their teams from GIGA ULiège identified that particular neutrophils are recruited into the lung and are responsible for allergic sensitisation and asthma development.

Coraline Radermecker, the first author of the study, first developed three models of asthma in mice induced by pro-allergic environments: excess hygiene, exposure to ozone (an air pollutant) and infection with the influenza virus. In all three models, only mice exposed to pro-allergic environments and then exposed to mites, major allergens in humans, developed symptoms of allergic asthma. She and her colleagues then observed the recruitment of specific innate immune cells, neutrophils, only in the lungs of mice exposed to pro-allergic environments. These neutrophils, once in the lung, release their DNA, causing inflammation that is conducive to the development of an allergic response such as asthma. Surprisingly, when mice exposed to pro-allergic environments are treated with compounds that prevent the recruitment of these neutrophils or the release of their DNA, mice are protected from disease development.

A recent study identified this same type of particular neutrophils in the blood of a population of American farmers, the Hutterites, exposed to a very high rate of hygiene and having a very high prevalence of allergic asthma. The latter suggests that these neutrophils are also present in humans and may be involved in the development of asthma in humans.

In addition, a molecule already used in human medicine to treat cystic fibrosis, pulmozyme, could be used to destroy DNA released by neutrophils and prevent the development of asthma in people exposed to high-risk environments.

Expert view: Recognising World Stomach Day

10th October 2019

Originally initiated by the Health Stomach Initiative, World Stomach Day aims to raise awareness of the global burden of gastric diseases and the need for further research in the field as well as improved prevention and treatment strategies.

Gastric diseases range in prevalence and severity, from common short-term occurrences of dyspepsia (indigestion), to more harmful and severe chronic disorders. These include a variety of widespread functional disorders such as irritable bowel syndrome (IBS), which can have a devastating and life-altering impact on the lives of sufferers. Gastric diseases also affect society as a whole, placing significant pressures on over-burdened healthcare systems. According to a United European Gastroenterology (UEG) report (www.ueg.eu/epaper/UEG_DigestiveHealthAcrossEurope/index.html#12), IBS, which currently affects 1 in 10 people globally, is estimated to cost €3.2 billion per year in Germany alone.

Gastric cancer

As one of the most life-threatening forms of gastric disease, gastric cancer is estimated to be the fifth most frequently diagnosed cancer and third most common cause of cancer-related death in the world. In 2018, there were 80,000 new diagnoses of stomach cancer and nearly 60,000 attributable deaths in Europe. Due to the generalised nature of the symptoms, gastric cancer is often only detected at a later stage, leading to comparatively lower survival rates than many other cancers.

Despite the general decline in gastric cancer cases globally, recent studies have uncovered a concerning link between patients with chronic autoimmune gastritis (AIG) and the development of gastric cancer. In two studies carried in the USA and Sweden, results showed that individuals with AIG had a three-fold increased risk of developing stomach carcinoid tumours and adenocarcinomas. Like other autoimmune diseases, AIG predominately affects females (3:1 ratio), potentially providing a link between AIG and the increasing incidence of gastric adenocarcinoma among young white females in the USA. The recent detection of gastric cancer amongst younger sectors of the population may indicate that declining levels of gastric cancer could reverse in the future.

Identifying and treating gastric cancer at an early stage can dramatically increase survival rates and treatment options. The 5-year survival rate for gastric cancer is currently 31% reflecting the often late-diagnosis of the condition. In comparison, the 5-year survival rate for gastric cancer more than doubles (68%) if the cancer is detected before spreading outside the stomach. Earlier detection of gastric cancer can also lead to a reduced need for aggressive treatment options and invasive surgery. Although not a certainty, precancerous lesions can be an indicator of future cancer progression and should be followed carefully. Recognising precancerous lesions in patients and subsequently monitoring them is an essential measure in reducing the incidence of and mortality rates associated with gastric cancer. The recent publication ‘Management of epithelial precancerous conditions and lesions in the stomach (MAPSII)’ clearly characterises the various lesions and management methods, encouraging a standardisation of treatment strategies across Europe for precancerous conditions and lesions in the stomach.

Recent advancements in endoscopic imaging

Decreasing global mortality relies primarily on the early detection and accurate diagnosis of gastric cancer through endoscopy. Over the last few decades, there have been a number of critical technological advancements in endoscopic imaging, improving mucosal visualisation and diagnosis. High definition endoscopy with chromoendoscopy (CE) is currently one of the most effective diagnostic methods for identifying gastric adenocarcinoma, potentially allowing for the visualisation of gastric atrophy and intestinal metaplasia (IM). Despite these advances, continual improvements in endoscopic imaging are still necessary to significantly improve the prognosis of gastric cancer.

Helicobacter pylori (H. pylori)

H. pylori is one of the greatest risk factors for gastric cancer. Often contracted during childhood, approximately two-thirds of the world’s population harbours H. pylori bacteria within the stomach. Although an important factor in the development of gastric cancer, evidence has shown that the successful eradication of H. pylori does not completely prevent the development of gastric cancer. A 2018 study suggested that H. pylori infection may only be an early event in the development of gastric cancer preparing the gastric mucosa for further changes. Further research on the gastric microbiome is required to identify the precise role of H. pylori in the development of gastric cancer, potentially opening up pathways to novel prevention and treatment strategies.

Important strides are continually being made in the treatment of H. pylori infection. Quadruple therapy is becoming increasingly common in areas with growing levels of resistance to standard triple therapy and impressive eradication rates and being achieved. More recently, vonoprazan, a potassium-competitive acid blocker has been explored as a novel treatment strategy. A large Japanese study comparing vonoprazan to proton-pump inhibitors (PPIs) demonstrated a higher eradication rate with vonoprazan. Noticeably, the eradication rates of vonoprazan combined with amoxicillin and clarithromycin in clarithromycin-resistant patients was over 80%. With a general rise in antibiotic resistance rates globally, evolving treatment options are necessary to combat H. pylori infections and associated gastric conditions.

Taking a stand against stomach diseases

Despite major advancements in the field, gastric diseases remain prominent across the globe. Concerning evidence has also suggested that a variety of gastric diseases may be increasing amongst the younger population. With the pathogenesis of many gastric conditions still being debated, further research is urgently required to improve patient outcomes and reduce the societal impact caused by these often burdensome and disruptive diseases.

References

Fallone CA, Moss SF, Malfertheiner P. Reconciliation of recent Helicobacter pylori treatment guidelines in a time of increasing resistance to antibiotics. Gastroenterology 2019;157(1):44-53.
Rugge M et al. Gastric cancer as preventable disease. Clin Gastroenterol Hepatol 2017;15(12):1833-1843
Malfertheiner P, Venerito M, Schulz C. Helicobacter pylori infection: New facts in clinical management. Curr Treat Options Gastroenterol. 2018 Dec;16(4):605-15.
Blaser MJ, Chen Y. A New Gastric Cancer Among Us. J Natl Cancer Inst 2018;110(6):549-50.
Camargo MC, Figueiredo C, Machado JC. Review: Gastric malignancies: Basic aspects. Helicobacter. 2019 Sep ; 24 Suppl 1:e12642. doi: 10.1111/hel.12642.

Mental health crisis plan access for ambulance staff to go live

Ambulance staff in areas of the UK will soon be able to access the mental health crisis plans of emergency patients while on the move, following the successful first pilot phase of the National Record Locator.

Initial tests of the new National Record Locator service gave ambulance staff in pilot areas the ability to see whether someone they were treating had a mental health crisis plan, joining up services and helping patients get the best possible care.

The pilot will now expand, giving ambulance staff the crisis plan itself so that they can make the right clinical decisions on the ground instead of taking the patient to Accident and Emergency units or referring back to other health professionals who have access to the information.

The first full record retrieval will take place in November 2019, with an additional three mental health trusts joining the nine trusts already involved with the first phase.

Mike Walker, Head of the Integrating Care programme at NHS Digital said: “This pilot has so far been a fabulous success, with over 85,000 mental health crisis plan pointers added to the database across the country since last December, so that ambulance staff are less in the dark about the people they’re on their way to help.

“Now we’ve proven that the technology works, it’s time to open it up, to new areas of specialism, new settings: putting the clinical information itself into the hands of those that need it.

“Our ambulance staff do a fantastic job, handling real-life emergencies every single day. Having access to the right information at the right time will mean fewer wasted trips to overstretched A&Es and better care for patients.”

Stuart Crichton, Chief Clinical Information Officer at London Ambulance Service, said: “Our drive to get the user experience right is being brought to life by the team at NHS Digital. Our clinicians don’t have to worry about usernames and passwords to access patient information, the security is all taken care of in the background enabling us to focus on patient care. I love it, our staff love it and this technology will change the face of how we access data across the NHS.”

Rob Shaw, Deputy Chief Executive of NHS Digital said: “This is another step on our journey to full integration of digital records, ensuring that front line staff in all settings have access to the records they need to continue delivering outstanding care.

“Services like the National Record Locator, NHS Identity and the Summary Care Record application have the potential to revolutionise the way that NHS staff work, supporting them to make more effective and timely clinical decisions, working alongside all the great, local projects also tackling the challenges around system interoperability.”

This next phase of the pilot will also see digital child health records shared by child health organisations and health visiting services, as care is transferred from one service to another. Pointers will be added for digital maternity services in successful pilot areas next year, flagging where expectant mothers are receiving care elsewhere. Mental health nurses will be able to access records when working in the community with the police, to promote joined up service provision and appropriate care.

Exercise can lessen heart damage from chemotherapy

7th October 2019

Patients with cancer should receive a tailored exercise prescription to protect their heart, reports a paper published in the European Journal of Preventive Cardiology.

‘Cancer patients are often less active than adults without cancer,’ said author Dr Flavio D’Ascenzi, University of Siena, Italy. ‘However, exercise is essential for patients diagnosed with cancer who are under treatment, irrespective of the type of treatment.’

‘Endurance training is more effective for improving cardiovascular performance and reducing inflammation, but resistance training may be a better starting point for frail cancer patients,’ he continued. ‘Other types of exercise, such as inspiratory muscle training, are safe and effective, particularly in those with thoracic cancer; therefore, the specific exercise should be chosen based on individual characteristics.’

Cardiovascular diseases are common side effects in patients with cancer. This is the result of cardiotoxicity, whereby cancer treatment impairs heart function and structure, or accelerated development of cardiovascular disease, especially when risk factors such as high blood pressure are present. Furthermore, cardiovascular diseases and cancer often share the same risk factors. Therefore, cancer patients are advised to eat healthily, quit smoking, control their weight, and exercise.

The paper highlights the importance of an individual exercise plan for each patient, taking into account personal history, cancer treatment, response to exercise, and personal preferences. Exercise should start as soon as possible, even before starting treatment such as chemotherapy.

A multidisciplinary team should be involved in formulating an exercise prescription, including oncologists, cardiologists, physical therapists, nurses, nutritionists, and psychologists. Cardiac evaluation, with exercise testing (and particularly cardiopulmonary exercise testing or lactate testing) to determine response to exercise, is the starting point. The appropriate ‘dose’ of exercise (as usually done for a drug) can then be prescribed, including the intensity, type of training, and training volume (hours/minutes of training per week).

‘Defining the intensity and volume of exercise is important for maximising the benefits of physical activity while avoiding muscular soreness, fatigue, and sleep disorders,’ said Dr D’Ascenzi.

Ongoing treatment is not a contraindication to exercise, but patients are urged to consult their doctor before starting a new activity. Specific guidance is provided: for example, patients with low haemoglobin levels should avoid high intensity activities; those with low platelet levels (needed for blood clotting) should not do contact sports. Activities that could increase the risk of fracture should be avoided in frail patients. Breathlessness or fatigue must be investigated but, after excluding associated health problems, exercise can help cope with fatigue, which is relatively common in cancer patients.

Dr D’Ascenzi concluded: ‘Physical activity before, during and after cancer treatment can counteract the negative effects of therapies on the cardiovascular system. In addition, it can relieve symptoms such as nausea and fatigue and help prevent unwanted changes in body weight.’

Exercise can lessen heart damage from chemotherapy

Crohn’s disease study identifies genetic variant with potential to personalise treatment

A UK-wide collaboration led by the University of Exeter, Royal Devon & Exeter NHS Foundation Trust and the Wellcome Sanger Institute, has demonstrated that a genetic variant carried by 40% of the population explains why some patients develop antibodies against the anti-TNF drugs, infliximab and adalimumab and lose response.

The authors conclude that a further trial is required to confirm that genetic testing prior to treatment will reduce the rate of treatment failure by facilitating the most effective choice of therapy for individual patients. The research, part-funded by Wellcome, Crohn’s & Colitis UK, Guts UK, Cure Crohn’s Colitis and supported by the NIHR, is part of a programme of work committed to finding the right drug for the right patient first time.

Published in Gastroenterology, the Personalised anti-TNF therapy in Crohn’s disease study (PANTS) looked at the clinical data and genetics of 1240 patients with Crohn’s disease starting anti-TNF treatment at 120 UK hospitals – the largest cohort of its kind.

Although anti-TNF drugs have given new hope for people with Crohn’s and Colitis, and provided an important treatment option, many patients lose response over time. One of the major reasons patients lose response is the development of an immune response to the drug (immunogenicity). Anti-TNF drugs are large, complex molecules, made inside living cells. Repeated administration causes the immune system to recognise the drug as a potential threat rather than a medicine, leading to the production of antibodies against the drug. These antibodies increase the rate at which the drugs are removed from the body. As well as reducing the effectiveness of treatment, antibodies may also cause adverse drug reactions at the time of injection or infusion. This research identified a genetic marker HLA-DQA1*05, carried by 40% of the European population that increases risk of development of antibodies against infliximab and adalimumab twofold.

PANTS study investigator Professor Tariq Ahmad, Head of the Inflammatory Bowel Disease and Pharmacogenetics Research Group at the University of Exeter, and consultant gastroenterologist at the Royal Devon and Exeter Hospital, UK, said: “We strongly believe that this type of research is essential to developing cost effective, treatment strategies for patients with inflammatory bowel disease.”

Helen Terry, Director of Research, Crohn’s and Colitis UK said: “The future of Crohn’s and Colitis treatment is personalised medicine, so the identification of a genetic marker that explains why anti-TNF drugs don’t work for some people with Crohn’s is highly significant. These results are extremely promising and with further research could lead to individualised treatment and better outcomes for the people living with these debilitating conditions.”

Manuela Volta, Research Manager at Guts UK, a charity committed to fighting digestive disorder said: “We are delighted to have supported this ground breaking study. This is an important step towards the goal of personalised medicine for people, around 1 per 200, with Crohn’s disease or ulcerative colitis. We will need a further trial to confirm that genetic testing before treatment will help people with Crohn’s and Colitis to get better and most effective personalised treatments.”