Specialization
Focus of research
Dr. Krisztina Gecse, MD, PhD is a consultant gastroenterologist in the Amsterdam University Medical Center in the Netherlands. Her research focuses on perianal fistulizing Crohn’s disease, intestinal ultrasound in inflammatory bowel diseases and predictive markers in optimizing treatment response. Dr. Gecse received research grants from the European Crohn’s Colitis Organization (ECCO), the International Bowel Ultrasound Group (IBUS), Celltrion, Boehringer Ingelheim and is co-investigator on research grants from the Helmsley Charitable Trust, Pfizer and Eli-Lilly. She has participated in several ECCO initiatives, including the guideline on extraintestinal manifestations in IBD and is currently chairing the ECCO Clinical Research Committee. She is a board member and secretary of the International Bowel Ultrasound Group, an organization supporting research and education in intestinal ultrasound.
Intestinal ultrasound (IUS) performed by gastroenterologists is an emerging, non-invasive, highly accessible and low-cost cross-sectional imaging modality for the diagnosis and follow-up of patients with inflammatory bowel disease (IBD). In the point-of-care setting IUS allows close patient monitoring and optimizing treatment strategy without delay. It reduces the need for invasive and costly imaging modalities, such as endoscopy and MRI. IUS has also been recently incorporated in international guidelines and clinical trials. Dr Gecse's current research lines includes the STRICTURE study (recruiting), a prospective study to evaluate the role of advanced IUS modalities (such as contrast-enhanced ultrasound, elastography and small intestinal contrast ultrasound) to characterize inflammation and fibrosis in patients with stricturing Crohn's disease. The DIRECT-UC (recruitment finished, follow-up in progress) study is a prospective study investigating the kinetics of response to biologic and tofacitinib treatment in patients with moderate to severe ulcerative colitis using endoscopy as gold standard. A prospective study in patients with IBD during pregnancy evaluated the feasibility and accuracy of IUS in this specific patient population (publication submitted) where non-invasive disease monitoring is of crucial importance. A prospective cohort study in patients with CD is currently under development to evaluate the predictive role of IUS for early postoperative recurrence after ileocoecal resection (recruitment has not started).
Perianal fistulizing Crohn’s disease (pCD) is a severe, yet common complication, ocurring in approximately 30% of patients with CD, imposing major impact on their quality of life. Fistula treatments include surgery, anti-TNF antibodies and mesenchymal stem cell injection for refractory cases; however the management has not been based on any ‘personalized’ approach so far. Unfortunately, up to 20% of pCD patients still end up with debilitating surgery, deviating stoma or definitive proctectomy. In collaboration with the Tytgat Laboratorium, the Department of Radiology and Surgery of the AUMC, a translational study has been set up (METC approval in progress) with the support of the Helmsley Charitable Trust. We hypothesized that it is possible to identify biomarker profiles based on tissue transcriptome and microbiome for prediction of clinical and radiological fistula response with the currently established treatment modalities in pCD. We believe that this profile can further be transposed into a protein based assay in tissue and/or peripheral blood, making the applicability and dissemination in clinical practice feasible and attractive, allowing personalized treatment instead of the current trial and error approach. Furthermore, Dr Gecse is representing the AUMC in an international research consortium, which unites high volume centers such as the KU Leuven, the University of Milan, St Marks Hospital, London and Amsterdam UMC for pCD. Recently, this multidisciplinary consortium consisting of gastroenterologists, surgeons and radiologists, has developed a Delphi consensus for the classification and prognosis of patients with perianal fistulizing CD, this being the first step to advance clinical research in pCD.