Optimisation is the action of making the best or most effective use of a situation or resource (Oxford Dictionary) but in the medical world it is preparing the patient (and the surgeon) for surgery and postoperative recovery.

The goal of “optimising” patients’ health prior to surgery is to minimise the risk of postoperative complications, decrease the length of hospital stay, reduce unplanned re-admissions and enhance overall health and surgical experience.

Emma Halmos  © Emma Halmos

It has long been acknowledged that Inflammatory Bowel Disease (IBD) carries a risk of malnutrition, leading to fatigue, infection, poor wound healing and poor health-related quality of life [1]. Historically, most attention has been devoted to undernutrition; however, there is now evidence that overnutrition in the form of visceral fat is associated with raised tumour necrosis factor (TNF) and poorer responses to anti-TNF agents [2], indicating that central adiposity can be just as detrimental to disease outcomes as undernutrition. Furthermore, under- and overnutrition are not mutually exclusive and nutrient deficiencies and excesses often co-exist. In the last few years, there has been a shift away from the historical approach of using rudimentary markers of malnutrition, such as weight or body mass index (BMI), which can often be misleading as assessment tools in that they may falsely detect abnormalities or miss them completely, towards more detailed body composition measures of muscle and fat mass, which reflect nutritional abnormalities more sensitively. Indeed, GLIM (Global Leadership Initiative on Malnutrition) recognises the importance of body composition in the diagnosis of malnutrition [3]. The key question now is how should we best assess our IBD patients for nutritional status in order to identify risk of poor clinical outcomes?

W. Czuber-Dochan © ECCO

Miriam Ganon © ECCO

Ana Ibarra © ECCO

It is the time of year when we write to you with great pleasure to tell you about the N-ECCO Activities planned for the ECCO’23 Congress, to be held in Copenhagen on March 1–4, 2023. As in previous years, the N-ECCO Committee has worked hard to put together a wide range of activities covering clinical, educational and research topics.

4th ECCO Basic Imaging Workshop in Collaboration with ESGAR & IBUS

Christian Maaser © ECCO

Uri Kopylov © ECCO

In 2023 the Educational Programme at the ECCO Congress will again include two combined workshops devoted to the imaging of Inflammatory Bowel Diseases (IBD). The first will be centered on basic endoscopy, ultrasound and MRI while the second will focus on advancements in intestinal ultrasound. Both workshops will be possible thanks to the extensive cooperation of gastroenterologists with experience in intestinal imaging from ECCO and our partner societies, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and the International Bowel Ultrasound (IBUS) group.

The 4^th ECCO Basic Imaging Workshop in collaboration with ESGAR and IBUS will educate attendees in how to make a precise diagnosis and how to better direct the therapeutic management of IBD patients using the latest imaging technologies. It is designed for gastroenterologists, endoscopists, surgeons, paediatricians, pathologists and other interdisciplinary medical experts interested in diagnostic imaging and endoscopy of IBD. The course has been highly successful and much requested over the past few years, and we have decided to run it twice on the same day this year to enable more participants to attend.

Konstantinos Karmiris © ECCO

The 21st ECCO IBD Intensive Course for Trainees, Copenhagen 2023

The IBD Intensive Course for Trainees will take place over one day on Wednesday, March 1, 2023, prior to the start of the main ECCO Congress.

 The ECCO IBD Intensive Course for Trainees has become a tradition. It is the oldest ECCO Educational Initiative, having been conceived back in 2003 before the launch of the ECCO Congress, and is the cornerstone of the Educational Committee’s activities. I remember attending the “2^nd Intensive Clinical Course for Residents, Fellows and Junior Faculty”, delivered as an affiliated course during the 140^th Falk Symposium in Dubrovnik, Croatia, in 2004. This was perhaps the most comprehensive IBD course that I had ever attended as a trainee and it inspired me to further in-depth engagement with IBD.

Valerie Pittet  © ECCO

As you probably know ECCO Members have to step down and new members take their place - that means fresh ideas and various perspectives are heard, leading to renewed enthusiasm that will drive the EpiCom agenda for the future. The Epidemiological Committee  would like to welcome Ravi Misra as board member, while saying good bye to former Chair Naila Arebi.

Peter Bossuyt © ECCO

Multiple collaborations exist between ECCO Members in the collection of clinical data in a real-world setting. These observational data are an elegant addition to data from randomised controlled trials, as they reflect the efficacy and safety of clinical interventions in a more heterogeneous population who may not be included in randomised controlled trails and take into account the specific hurdles and challenges of everyday care for patients with IBD. The utility of real-world data, however, is dependent on the quality and homogeneity of the reported data. Data collection standardisation may enhance the quality of real-world evidence.

Identification of markers to predict post-operative disease recurrence in Crohn's disease.

Salomé Pinho © Salomé Pinho

Harry Sokol © Harry Sokol

Background & aim of research

Evidence suggests that the perturbation of the symbiotic relationship between microbes and the intestinal immune system contributes to IBD development even years before diagnosis. However, it is essential to understand the causes underlying the loss of gut microbial equilibrium (dysbiosis) associated with inflammation, envisioning novel disease biomarkers and therapeutic targets. The host glycocalyx (repertoire of glycans/sugar-chains at the surface of gut mucosa) constitutes a major biological interface between intestinal mucosa and microorganisms. Glycans are an essential niche for microbiota colonization and thus should be an important modulator of host-microorganisms’ interactions and a key target in IBD context that remains largely unexplored. The GOAL of this proposal is to unlock the role of gut mucosa glycome as a novel pathway that regulates host-microbiome interactions in IBD, envisioning the development of novel microbial-modulating therapies for IBD prevention and treatment.

A prospective, open-label pilot study to evaluate effector mechanisms of hyperbaric oxygen therapy in patients with moderate to severe Ulcerative Colitis: the PARADOX study (exPlanAtoRy mechanisms in pAtients with moDerate-to-severe ulcerative colitis treated with hyperbaric OXygen therapy)

Joep van Oostrom © Joep van Oostrom

Krisztina B. Gecse © ECCO

Background & aim of research

Despite the increase in treatment options, there is still a group of Ulcerative Colitis (UC) patients who do not respond to drug treatment and ultimately require proctocolectomy. Recently, hyperbaric oxygen therapy (HBOT) was shown to be effective in difficult-to-treat UC patients, with a benefit apparent after only a few days of treatment. However, the effector mechanisms and dose–response relationships remain unclear. Therefore, we aim to discover the effector mechanisms of HBOT in UC patients and the dose–response relationships.

Deciphering the role of plasmacytoid dendritic cells in gut-associated lymphoid tissues during homeostasis and Crohn's Disease

Urs Mörbe  © Urs Mörbe

Background & aim of research

Inappropriate intestinal immune responses can result in Inflammatory Bowel Diseases (IBD), such as Crohn’s Disease (CD), that require lifelong treatment or surgery. While it is now well understood that T cells are a key driver of pathogenic intestinal immune responses during CD, the underlying molecular mechanisms and roles of other local immune cells remain incompletely understood. Interestingly, previous studies have shown that plasmacytoid dendritic cells (pDC) are potent modulators of immune cell responses and are enriched in the mucosa of IBD patients. However, their precise role remains unclear. This study aims to clarify the distribution and roles of pDC during health and CD.