Dear ECCO friends and family,

Welcome to this interesting discussion with Dr. Tian Hong Wu first author of the exciting paper “Natural History of Crohn’s Disease Leading to Intestinal Failure: A Longitudinal Cohort Study from 1973 to 2018”. We had a great talk highlighting the most important aspects of her seminal work but also about the relevance of intestinal failure as a serious complication of Crohn’s disease, the opportunity to prevent it and how the latest developments in treatment and follow up in IBD might help this.

I hope you enjoy it as much as we did!

Spyros Siakavellas

ECCO News Associate Editor

Ignacio Catalán-Serra © ECCO

Dear ECCO Friends,

Welcome to a new interview with the National Representatives!

This time, Germany´s turn, one of the leaders in IBD in Europe. We had the pleasure to talk with Raja Atreya and Dominik Bettenworth in a wide-rage conversations covering aspects on the current status of IBD care in Germany, current Research Projects of the German IBD Society, collaboration with ECCO and potential areas of improvement.

Lastly, we exchanged impressions on the advancements in the pathophysiology of IBD, a look into the future of IBD and to the ECCO 2025 Congress in Berlin.

We hope you enjoy it!

Ignacio Catalán-Serra
ECCO News Associate Editor

Bram Verstockt is well known to many in ECCO and the wider IBD Community. He is a gastroenterologist at the University Hospitals Leuven in Belgium, Assistant Professor at KU Leuven and outgoing chair of Y-ECCO and he isn’t yet 40! A proponent of precision medicine and intestinal ultrasound, and a great collaborator and friend, we discuss his life and career in this month’s Y-ECCO Interview Corner.

Safety and efficacy of autologous haematopoietic stem-cell transplantation with low-dose cyclophosphamide mobilisation and reduced intensity conditioning versus standard of care in refractory Crohn's disease (ASTIClite): an open-label, multicentre, randomised controlled trial

Lindsay JO, Hind D, Swaby L, et al.

Lancet Gastroenterol Hepatol 2024;9:333–45. 

Introduction

A large number of patients living with Inflammatory Bowel Disease (IBD), including Crohn’s Disease (CD), show persistent disease activity and bowel damage despite medical or surgical therapy [1]. Haematopoietic stem-cell transplantation (HSCT) is a procedure able to “reset” the immune system by replacing autoreactive lymphocytes. A total of 232 patients (data from case series, observational studies and one clinical trial) had previously undergone HSCT for CD. Although there were promising clinical results, there were also some significant associated risks, including life-threatening side effects and mortality [2]. In a previous randomised controlled trial, called ASTIC, HSCT did not demonstrate superiority over standard therapy when an extremely high bar was set for the primary endpoint, i.e. induction of sustained disease remission in CD (defined as medication-free clinical remission for 3 months without any evidence of disease activity at endoscopy or imaging). Apart from the lack of efficacy demonstrated for the primary endpoint, the HSCT arm was also hampered by a significant burden of side effects [3]. 

Artificial intelligence enabled histological prediction of remission or activity and clinical outcomes in ulcerative colitis 

Iacucci M, Parigi TL, Del Amor R, et al.
Gastroenterology 2024;164:1180–8.

Introduction

Ulcerative Colitis (UC) is characterised by episodes of recurrent inflammation affecting the colonic mucosa. Accurate assessment of disease activity and prediction of clinical outcomes are crucial for effective management. Traditionally, histological examination has been the gold standard for evaluating mucosal inflammation, but it is time-consuming and subject to inter-observer variability. Recent advances in artificial intelligence (AI) may offer a potential solution. Iacucci and colleagues explored the application of machine learning in diagnosing histological remission and predicting clinical outcomes in UC patients.

Dynamic Prediction of Advanced Colorectal Neoplasia in Inflammatory Bowel Disease

Wijnands AM, Penning de Vries BBL, Lutgens MWMD, et al.
Clin Gastroenterol Hepatol. 2024;22:1697-1708.

Introduction

Patients with colonic inflammatory bowel disease (IBD) face an elevated risk of colorectal cancer (CRC) compared to the general population.[1, 2] Colonoscopic surveillance has been shown to be associated with a reduction in CRC and CRC-related mortality in these patients.[3] Current guidelines recommend initiating surveillance 8-10 years after disease onset, with follow-ups every 1-5 years based on individual risk factors.[4–6] These factors include disease duration, severity, associated primary sclerosing cholangitis (PSC), family history of CRC, and other risks. The risk factors for CRC in IBD patients are dynamic, comprising both modifiable (inflammation, dysplasia detection, disease extent) and non-modifiable (age, family history, PSC) elements that change over time and with treatment, exerting varying influences, including protective effects, on the risk of developing CRC.[7] 

Dear Y-ECCO Friends,

As I will be stepping down as Y-ECCO Chair at the upcoming ECCO Congress in Berlin, I want to take this final “Member’s Address” as an opportunity to thank each of you for your commitment to our shared mission of supporting those living with Inflammatory Bowel Disease. Your combined dedication is driving real progress in raising awareness, advancing research and creating invaluable resources that strengthen our community. As young clinicians and researchers, you are the future our patients will rely on, so keep pushing the boundaries!

Inflammatory Bowel Disease (IBD) is characterised by chronic intestinal inflammation developing in genetically susceptible subjects in association with a dysregulated immune response, intestinal dysbiosis and environmental triggers. IBD is most often polygenic, involving more than 200 risk loci that include over 300 genes identified through genome-wide association studies. Approximately 25% of incident cases of IBD occur during childhood. Among these cases, diagnosis is most commonly made during adolescence, while in about 15% the diagnosis is established prior to six years of age, with up to 6% diagnosed before three years of age. IBD in this subgroup of patients is referred to as “very early onset IBD” (VEO-IBD) and shows significant differences from IBD in older children and in adults. VEO-IBD cases usually present with more severe clinical disease unresponsive to conventional IBD therapy and a greater proportion of cases feature underlying monogenic defects, often involving genes associated with primary immunodeficiencies (PID).

Robotics has taken the surgical community by storm and is increasingly being adopted in IBD surgery. While many see true technological advancement in robotics, by virtue of its ability to facilitate complex procedures in Crohn’s Disease and Ulcerative Colitis for the good of the patient, there remains scepticism as to whether robotics really represents a relevant game changer in IBD surgery compared to advanced standard laparoscopy. And, as always, there are two sides to the coin.

Guia Becherucci  © ECCO

The D-ECCO Travel Award offers IBD Dietitians an opportunity to visit other IBD Centres, to learn about diet and nutrition in IBD. Next Call opens in January 2025. Guia Becherucci was awarded at ECCO’24 and travelled to the University Hospitals Leuven, Belgium.