ELISABETH EGGERMONT (UZ/KU Leuven): Expanding the Scope of Intestinal Ultrasound as a precision tool IBD: From Early Detection to Advanced Disease Monitoring
Ulcerative colitis (UC) is traditionally viewed as a mucosal disease. However, recent advances in intestinal ultrasound (IUS) have challenged this paradigm by revealing transmural abnormalities, including but not limited to submucosal thickening and hyperechogenicity, and loss of bowel wall stratification. The histological correlates and clinical implications of these findings remain poorly understood. As treat‑to‑target strategies increasingly rely on frequent, objective, and non‑invasive monitoring, IUS has emerged as a promising tool capable of providing real‑time, point‑of‑care assessment. Yet its potential to characterize deeper‑layer pathology and predict disease behavior in UC has not been fully explored.
This project aims to elucidate the histological and clinical significance of IUS-detected transmural changes in UC, with a focus on submucosal alterations. In WP1.1, preoperative IUS findings will be correlated with transmural histopathological analysis of colectomy specimens, using H&E staining, dedicated collagen stainings, fat-specific staining, and quantitative image analysis (using QuPath), alongside a serum fibro-inflammatory biomarker panel. This will establish the biological basis of IUS abnormalities and identify sonographic parameters that reliably reflect fibrosis. In WP1.2, these fibrosis-linked IUS parameters will be applied in UC patients in endoscopic remission to determine whether residual transmural changes independently predict persistent symptoms, potentially reflecting irreversible structural remodeling.
By integrating imaging, histology, and clinical outcomes, this project seeks to define novel prognostic IUS markers, enhance understanding of transmural involvement in UC, and expand the role of IUS as a non‑invasive, cost‑effective tool for disease characterization and personalized management.
SYBREN RINCKHOUT (KU Leuven): The Gut-Immune-Brain axis: the key to understanding fatigue in Inflammatory Bowel Diseases?
Fatigue is highly prevalent in IBD and is one of the most debilitating symptoms, significantly worsening the QoL of IBD patients. Unfortunately, fatigue is still very ill understood and current anti-inflammatory treatments used in IBD insufficiently improve fatigue, resulting in persisting fatigue during remission. Recently, the gut-brain axis has been proposed to play a role in IBD-related fatigue. Additionally, recent studies using animal models have linked neuroinflammation to the persistence of fatigue during remission.
Our research aims to characterise the entire gut-immune-brain axis in active IBD patients. In a cross-sectional study design, general inflammatory markers of gastrointestinal and systemic inflammation will be accompanied with a proteomics assay to identify associations between the inflammatory profile and fatigue. For neuroinflammation, state-of-the-art brain imaging techniques will be used, tailored specifically to detect neuroinflammation. These measures will be linked to a multidimensional assessment of fatigue, as well as home assessments and wearables to track fatigue throughout daily life while accounting for physical activity. Additional actors of the gut-brain axis, such as the gut microbiome and the HPA-axis, will be included as possible confounders.
To track changes in fatigue over time and investigate the link with the inflammatory profile, a more in-depth proteomics analysis will be conducted retrospectively on a large, longitudinal study, where patients were followed up for 1 year after receiving a new advanced therapy.
Together, the results of this research project will provide in-depth knowledge about the inflammatory profile, neuroinflammation and fatigue in active IBD. A broader understanding of IBD-related fatigue will potentially lead to a more targeted therapeutic approach, thereby further improving the QoL of IBD patients