Since the first reports in Wuhan, China in December 2019, the new coronavirus SARS-CoV-2 has resulted in over 40 million confirmed cases of COVID-19 globally with over 1 million deaths within just 10 months. Economies have been shattered, routine healthcare has been severely disrupted, and restrictions have been imposed on travel and social and family life in a previously unthinkable manner.

Omar Faiz © ECCO

High performance in surgery has been the subject of discussion for a number of years. In IBD surgery it’s been what you might call a ‘shaggy dog’ story. For those of you unfamiliar with this term – there is an entire Wiki page dedicated to it [1]. High performance in IBD surgery has, thus far, fulfilled the criteria for such a story perfectly – it’s: long-winded, anecdotal, arguably failed to reach relevance and a bit of an anti-climax – all the essential ingredients.

Catherine Wall © ECCO

Iron deficiency and iron-deficiency anaemia (IDA) are characterised by fatigue and reduced capacity for normal activities of daily living and consequently poorer quality of life. Iron deficiency is estimated to affect 60%–80% of people with IBD at some point [1]. Recurrent iron deficiency is also common and is estimated to occur in 30% of patients [1]. Given the prevalence of iron deficiency, some patients and practitioners have learned to accept this impaired quality of life as an unavoidable consequence of IBD [2]. However, correction of iron deficiency in patients without anaemia can result in improved quality of life and less fatigue and should, therefore, be an important treatment goal.

Ana Ibarra  © ECCO

Once again, N-ECCO is offering an outstanding range of clinical and educational opportunities for nurses attending the ECCO’21 Copenhagen Congress.

The programmes for each activity continue to be developed on the basis of the evaluation forms from the previous year in order to meet your needs. Thank you so much for providing your feedback, which helps us to improve all the N-ECCO Activities.

Tim Raine  © ECCO

Previous participants in GuiCom workshops at recent ECCO Congresses will have learned much about the adoption of GRADE methodology into the ECCO Guideline process and the practicalities of working with the GRADE process. For ECCO 2021, GuiCom wanted to offer participants something a little different. The GuiCom 2021 Workshop will therefore seek to place the GRADE process within the current controversies and ‘hot topics’ with respect to guidelines.

Berhooz Z. Alizadeh  © ECCO

Introduction

In the past few decades, the incidence of Inflammatory Bowel Diseases (IBD) started rising especially in industrialised Western countries, affecting more than two million Americans and Europeans [1–3]. At the turn of the twenty-first century, however, IBD became a global disease, rapidly affecting the Eastern and Southern developing nations [3–5]. So, the global prevalence of IBD is currently estimated at 0.7% and is expected to increase to 1% by 2030 [1, 3, 6].The rise in IBD has coincided with an increase in urbanisation, sanitisation, and adoption of a Western lifestyle [4], as well as advances in infrastructure, better access to healthcare, and increased awareness of community following socioeconomic development. It is therefore assumed that the primary suspect underlying the globalisation of IBD is the alteration of the human environment, called the exposome (meaning exposures to environmental and lifestyle factors throughout life, starting at conception), and the associated embracing of Western lifestyles by other nations [6].

Laurent Beaugerie © ECCO

 An interview with Gionata Fiorino

During this period when we are so tormented by the SARS-CoV-2 pandemic, Gionata Fiorino, from Humanitas Research Hospital in Milan, agreed to give us his views on the challenges of adapting IBD clinical research.

Dose-related differential effects of vedolizumab on leukocyte subsets

Sebastian Zundler © Sebastian Zundler

Aim of research

The anti-α4β7 integrin antibody vedolizumab is successfully used for the clinical treatment of IBD. However, some details of its mechanisms are still not clear. Moreover, whether dose intensification of vedolizumab therapy may also increase response rates is the subject of ongoing debate, as some previous studies have suggested a non-linear exposure–efficacy correlation. Since only a portion of patients benefit from vedolizumab therapy, further translational insights into these aspects are an important unmet need for therapy optimisation and the development of personalised treatment approaches.

Based on preliminary data we hypothesise that vedolizumab has a differential preference of binding to distinct leukocyte subsets (e.g. effector and regulatory T cells), resulting in specific profiles of targeted immune cells at a certain level of vedolizumab exposure. This may explain the suggested non-linear exposure–efficacy correlation.  Therefore, we aim to elucidate dose-dependent binding characteristics to leukocyte subsets and related functional aspects in vitro and in vivo.

Improving clinical outcomes for IBD patients undergoing colorectal surgery by using a clinically developed patient-centred mobile application

Sebastiaan van der Storm © Sebastiaan van der Storm

Aim of research

Enhanced Recovery After Surgery (ERAS) is a multidisciplinary and multimodal protocol focussing on perioperative care which has proved successful in improving clinical outcomes for patients undergoing colorectal resection. Adequate compliance with the ERAS protocol is associated with improved clinical outcome, but there is an additional gain in involving patients actively in their efforts towards recovery. Whether outcomes may be further improved by specifically focussing on active patient involvement has not previously been investigated. A mobile application with an integrated ERAS protocol could be of great potential. However, the integrated ERAS protocol might need adaptation to meet the specific needs of patients with Inflammatory Bowel Disease (IBD) undergoing colorectal surgery. 

The main objective of this study is to investigate whether a CE-marked, clinically developed patient-centred mobile application, which can be used for multiple colorectal surgical pathways, enhances outcomes for IBD patients by stimulating patient empowerment and actively involving patients in the ERAS care pathway.

Predictive (longitudinal) gut microbial markers for the diagnosis of fatigue in IBD patients

Emma Paulides © Emma Paulides

Aim of research

Fatigue is an important clinical problem in patients with IBD in remission and those with active disease. It results in a decrease in quality of life and impaired work productivity. However, little is known about its aetiology and pathophysiology, which impairs our ability to effectively treat this symptom. Evidence suggests that the intestinal microbiota act as a mediator in the bidirectional communication between the nervous system and the gut. Recent research by our group demonstrated a strong and statistically significant correlation between the microbiome and increasing fatigue scores. However, little is known about the changes in the composition of the intestinal microbiome and their influence on the diagnosis and course of fatigue.

Our aim is to identify the underlying biological mechanisms involved in IBD-related fatigue, especially the influence of longitudinal changes in the intestinal microbiome, and to reveal IBD fatigue-specific patterns.