The treatment of children with Inflammatory Bowel Disease (IBD) presents unique challenges, largely due to the complex nature of the disease, the limitations of existing therapies in children and the common off-label use of "newer" agents. Paediatric IBD requires careful management to control inflammation, promote growth and maintain a good quality of life. The treatment armamentarium for IBD in adults has expanded rapidly in the past several years, with the approval of new biologic and small-molecule agents for moderate-to-severe Ulcerative Colitis (UC) and Crohn’s Disease (CD) [1–3].  Currently, however, only infliximab and adalimumab are approved for use in children [4, 5]. The fact that all other biologics (vedolizumab, ustekinumab and risankizumab) and new small targeted molecules (tofacitinib, upadacitinib and ozanimod) commonly used in adults have not yet been approved for use in children has led to their widespread off-label use. The use of off-label biologics is often required because approximately 15%–20% of patients with IBD experience primary non-response to anti-TNF agents and another 30%–40% lose response over time [4, 5].

Are we measuring postoperative outcomes that reflect the success of surgical intervention? Are those outcomes sufficiently sensitive to measure the success of surgical intervention? Complication rate, quality of life and disease relapse are frequently used outcome measures but they have drawbacks that must be taken into consideration. Combining these outcomes with objective measurements will provide the best account of the success of a surgical intervention. Why is this important? Because the greater the number of successful surgical interventions, the lower will be the threshold for accepting surgery as part of the treatment strategy in IBD. Lowering the threshold for acceptance of surgical intervention will convince more gastroenterologists to refer patients to surgery and will eventually enable more patients to benefit from early surgery.

Alicia Sandall  © ECCO

What are ultra-processed foods?

Recent interest has focused on the role of ultra-processed foods (UPFs) in IBD. UPFs are foods whose constituent ingredients are of exclusive industrial availability [1]. Across Europe, 30%–60% of energy intake in the diet is from UPFs [2, 3].

What is the research on ultra-processed foods and IBD?

Higher intakes of UPFs (especially through consumption of soft drinks, processed meat, salty snacks and refined sweetened foods) are associated with a greater risk of developing IBD [4], although a meta-analysis demonstrated an increased risk for Crohn’s Disease (CD) but not Ulcerative Colitis (UC) [5]. Once a person has been diagnosed with IBD, higher intakes of UPFs are associated with a greater incidence of IBD-related surgery [6] and a higher number of episodes of active disease in UC [7]. 

Simona Radice © ECCO

Adriana Rivera Sequeiros © ECCO

Dear Colleagues,

We are pleased to invite you to ECCO 2025, the 20th Congress of ECCO, which will be held in Berlin. As you know, in 2024 the REACH strategy was successfully introduced with the objective of focusing on a single letter each year. In 2025, the focus will be on the letter ‘A’, which corresponds to the objective of Attaining Sustainable IBD Care.

Mariangela Allocca © ECCO

Uri Kopylov © ECCO

At the 2025 ECCO Congress, the educational programme will again include two workshops dedicated to the imaging of Inflammatory Bowel Disease (IBD). These workshops, organised in collaboration with the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and the International Bowel Ultrasound (IBUS) group, aim to educate medical professionals in imaging techniques and their use in the accurate diagnosis and treatment monitoring of IBD patients.

The first workshop will focus on the fundamentals of endoscopy, intestinal ultrasound (IUS) and magnetic resonance imaging (MRI), while the second will explore recent advances in IUS. These educational opportunities are made possible by the significant collaboration between ECCO and experienced gastroenterologists and radiologists specialising in intestinal imaging.

Natalia Queiroz © ECCO

The 23rd ECCO IBD Intensive Course for Trainees, Berlin 2025

The 23^rd IBD Intensive Course for Trainees is scheduled for February 19, 2025, immediately before the start of the ECCO Congress in Berlin. This respected ECCO Educational Initiative has been a cornerstone of IBD education since its inception in 2003, predating even the ECCO Congress itself.

The course is designed to bridge the gaps often found in IBD education during gastroenterology fellowships. It offers advanced fellows a thorough and multidisciplinary exploration of IBD, helping them to deepen their expertise. Additionally, it serves as a vital platform for young clinicians from around the world to exchange knowledge, compare medical practices and build professional networks that can lead to future collaborations. Participation is by invitation, with nominations made by ECCO National Representatives.

Glen Doherty © ECCO

This summer saw the arrival of an additional novel way to participate in ECCO Education, the “Fast Facts in IBD 2024” Online Course. This live interactive online course took place on June 12, 2024 from 17:00 to 19:00 CEST. The course content was specially designed by EduCom for all gastroenterologists treating patients with IBD in their practice and was delivered in a format suited to virtual learning. 98 participants registered for this event (which was free of charge to all current ECCO Members).

The incidence and prevalence of IBD varies throughout the world, with the highest incidence seen in industrialised regions of North America and Europe [1]. Within Europe an East–West gradient has been demonstrated, with Western centres showing almost twice the incidence observed in Eastern centres [2].

The general trend in migration is from lower and middle income countries to higher income countries in Western Europe and North America.

David Drobne © ECCO

Julien Kirchgesner © ECCO

IBD manifests with numerous faces. It became clear some time ago that only by joining forces across multiple countries would we perhaps be able to identify and study rare manifestations of IBD and its complications. This was the reason why the CONFER taskforce (COllaborative Network For Exceptionally Rare case reports) was initiated under the auspices of the ClinCom committee.

Nick Powell © ECCO

ECCO is proud of its continuing commitment to support innovative IBD research through its Fellowships, Grants and Travel Awards, including our flagship Pioneer Awards. Our grant programme now extends beyond the borders of Europe with the emergence of our new Global Grant supporting IBD research for low and lower-middle income countries. All of these research efforts continue to improve our understanding of IBD and change outcomes for our patients. None of this would be possible without our community of grant reviewers who provide an invaluable scientific service to the ECCO Family and the broader field of IBD. We owe an enormous debt of gratitude to our growing reviewer network of more than 500 experts, who have reviewed over 750 applications.

In this issue of the ECCO Newsletter we really wanted to highlight two “super reviewers”, Amy Lightner and Hannah Gordon, who have gone above and beyond the call of duty and delivered the highest overall number of reviews. Thank you both! To better understand the peer review process, what motivates reviewers and why potential reviewers in the ECCO Community might want to get involved in the process, I caught up with Amy and Hannah.