Goedele Dewitte © Goedele Dewitte

Is there any specific training for IBD Nursing in your country?

Until this year, there was no specific training. Every IBD Nurse learned ‘on the job’, with some having the opportunity to do an observership with another IBD Nurse.

In collaboration with the Belgium IBD Nursing Association (BINAstoria), and together with rheumatology and dermatology nurses, we’ve now established a formal IMID (immune-mediated inflammatory disease) postgraduate training programme to support our profession. This postgraduate training will start in October 2024.

Is there any IBD Nurse Network in your country?

Yes, we have BINAstoria, which was set up by all the IBD study coordinators, who came together to share experiences. All IBD Nurses can be members, but so can IBD study coordinators and study nurses, IBD dietitians and IBD psychologists. The last two professions are very new and not well represented in Belgium yet.

Spyros Siakavellas © ECCO

Dear ECCO friends and family,

It is my pleasure to introduce the ECCO National Representatives of Malta Martina Sciberras and Pierre Ellul. We had a great discussion on a variety of topics such as the challenges of treating IBD in Malta, how working with a small but excellently followed cohort of patients can be a strength, how the Maltese Group of IBD is not only importing all newest developments such as intestinal ultrasound but also paving the way for younger colleagues to train and hone their skills abroad and much more!

I hope you enjoy it as much as we did!

Spyros Siakavellas
ECCO News Associate Editor

Edouard Louis © ECCO

We are pleased to introduce you UR-CARE Steering Committe Chair, Gerhard Rogler. Gerhard Rogler is Professor at University Hospital Zurich, being the Director of the Department of Gastroenterology and Hepatology.

Gerhard has been a very active member at ECCO for many years and now he overtook the task to be the Chair for UR-CARE Steering Committee.

You  assumed the position of UR-CARE Steering Committee Chair at the beginning of the year after having accompanied the project for many years. Could you please share your thoughts and views regarding UR-CARE?

From the beginning I was sure that UR-CARE is a great idea. We had to face many legal issues as we had to deal with different legislations in many countries. In addition, the European legislation with respect to data protection has changed during recent years. Therefore, the early days of UR-CARE were not easy, but I always believed in this endeavour. I remember the discussions when I was still Scientific Officer on the Governing Board: there were some concerns that UR-CARE would not “fly”. But such big projects need time to develop. Now we are at a point where UR-CARE can already provide a huge data set, many papers are being published based on this data set and a number of prospective studies are using UR-CARE as a trial platform. 

Brigida Barberio © ECCO

We are pleased to introduce you to ECCO’s new Scientific Officer, Marietta Iacucci. Marietta is Professor of Gastroenterology at University College Cork and Consultant Gastroenterologist MUH/CUH. Marietta has been a very active member at ECCO for many years and is a main pillar in the e-learning taskforce. She is a Key opinion leader in Endoscopy and future technology in the field of IBD.

What have been the key moments of your career?

I was fortunate and fascinated to work with mentors who were experts in the field of IBD and advanced imaging technologies in Germany, the United Kingdom and Japan. Under the mentorship of Professor Subrata Ghosh at Imperial College, London, I honed my skills in IBD management and precision medicine. Professor Ralf Kiesslich from Mainz, Germany and Professors Saito, Yahagi and others in Japan were key to developing in me a keen interest in optical diagnosis and minimally invasive organ-sparing endoscopic resection techniques. 

Virginia Solitano © ECCO

This issue's Interview Corner is dedicated to Fernando Magro, the current President-Elect of ECCO. Fernando Magro is a gastroenterologist and head of the Clinical Pharmacology Department at University Hospital São João in Porto, Portugal, where he also serves as a Professor of Pharmacology and Therapeutics. He is a founding member of the Portuguese Inflammatory Bowel Disease Group and an active researcher focusing on the management, treatment and prognosis of IBD. His dedication to ECCO is nothing new, as you'll read below. I took this opportunity to learn more about the academic and clinical journey of the person I'm glad to call my mentor.

Increased versus conventional adalimumab dose intervals for patients with Crohn’s disease in stable remission (LADI): a pragmatic, open-label, non-inferiority, randomised controlled trial

van Linschoten RCA, Jansen FM, Pauwels RWM, et al.

Lancet Gastroenterol Hepatol 2023;8:343–355.

Introduction

Adalimumab is an effective and safe treatment for Crohn’s Disease (CD). However, both patients and healthcare professionals may wish to mitigate medication exposure due to potential safety and economic concerns in the long term. Since a high relapse rate follows drug discontinuation, treatment de-escalation without actually stopping the medication may allow for decreasing drug exposure while maintaining efficacy. In two observational studies, de-escalation from a 2-week to a 3-week adalimumab dosing interval was successful in most of the patients, though reversal to a 2-week dosing interval was required in about 30% due to insufficient disease control [1, 2]. The Lengthening Adalimumab Dosing Interval (LADI) study is a pragmatic, open-label, multicentre, non-inferiority, parallel, randomised controlled trial conducted in the Netherlands and specifically designed to address this knowledge gap [3].

Withdrawal of immunomodulators or TNF antagonists in patients with inflammatory bowel diseases in remission on combination therapy: A systematic review and meta-analysis

Katibian DJ, Solitano V, Polk DB, et al.

Clin Gastroenterol Hepatol 2024;22:22–33.e6.

Introduction

Combination therapy with anti-TNF inhibitors (ATI) and immunomodulator (IMM) therapy remains an efficacious treatment strategy for disease control in moderate to severe Inflammatory Bowel Disease (IBD). This conclusion was largely based on the findings of landmark trials, SONIC and UC SUCCESS, which showed combination therapy to be far superior to monotherapy in achieving durable clinical and endoscopic remission in IBD [1, 2].

However, combination treatment with ATI and IMM can lead to increased risk of infection and malignancy. Whilst withdrawal of combination treatment once the patient is in disease remission can reduce the risk of treatment-related complications as well as the cost to health services, there remains a risk of relapse of previously controlled disease. At present there is no consensus amongst global clinical guidelines as to the appropriate duration of use of combination therapy. Thus, clinicians often find decisions related to withdrawal of treatment quite challenging.

Dysbiosis and associated stool features improve prediction of response to biological therapy in inflammatory bowel disease

Caenepeel C, Falony G, Machiels K, et al.

Gastroenterology 2024;166:483–495.

Introduction

The gut microbiota of patients with Inflammatory Bowel Disease (IBD) may have a role in disease aetiology and course [1]. Patients with IBD often have dysbiotic microbiota, with lower microbial diversity and cell counts, with both absolute and relative abundance of commensal microorganisms [2, 3]. Conversely, during remission following anti-inflammatory therapy, the gut microbiota has been observed to shift to a more eubiosis-like composition [3–6]. Furthermore, lower proportions of taxa with pro-inflammatory properties and mucus-degrading bacteria, as well as higher proportions of short-chain fatty acid-producing bacteria, have been associated with a higher likelihood of favourable outcomes with medical treatment [3, 5, 6]. In this study, Caenepeel and colleagues monitored changes in intestinal microbiota and stool features in order to develop and validate a predictive model to assist clinicians in determining a patient-specific therapeutic strategy.

Dear Y-ECCO Enthusiasts!

Can you believe that it’s been only four months since the last ECCO Congress? I bet that many of you are already knee-deep in exciting research for ECCO 2025 in Berlin, so mark your calendars and keep an eye open for the abstract submission deadline. You can’t miss that, as we want to see your top-notch research! Maybe you are the next Y-ECCO Best Abstract awardee!

The last decade has seen a dramatic increase in drugs available for the treatment of IBD. However, each of these novel biologics or small molecules achieves disease remission in only a relatively small proportion of patients [1].To date, implementation in clinical practice of evidence that assists in better evaluating the chance of therapy success in a particular patient for a particular drug is limited. Therefore, when choosing a drug for a patient with IBD who is starting therapy or needs to switch drugs, a trial-and-error approach may be unavoidable.

To address this unmet clinical need, several research groups have now turned their attention to biomarker discovery to allow development of an evidence-based personalised treatment strategy [2]. At this year’s Congress of ECCO in Stockholm, I had the opportunity to provide an update on the field of biomarker discovery from the perspective of a pathologist. In this issue of ECCO News, I want  to share with you the most important points from that H-ECCO Masterclass talk.