Britta Siegmund © ECCO

Dear ECCO Friends,

Spring is here and I am reflecting on the wonderful congress we had in Stockholm! The new ECCO strategy – “E” element of REACH strategy – was not only fully launched but also already addressed in all our committee meetings. The focus of this year’s congress was the letter “E” – Equitable access to IBD to care”, – expanding the outreach and inclusivity of ECCO initiatives across the globe. With 99 different countries represented at the congress and many multi-national exchanges throughout the programme, such as the Global Forum, it shows the growing network, with more plans to come. We as the Governing Board are very excited that the ECCO family shares our enthusiasm for “E” element of REACH strategy !

Spyros Siakavellas © Spyros Siakavellas

Dear ECCO friends and family,

It is my pleasure to introduce the ECCO National Representatives of Portugal Helena Tavares de Sousa and Samuel Fernandes. We had an intriguing discussion on a wide range of topics such as the challenges of treating IBD in Portugal, how GEDII their national IBD group helps with clinical management but also research projects, what Portugal is doing right in producing a lot of inspiring figures in Gastroenterology that lead the European Gastroenterology Organisations like ECCO president-elect Fernando Magro, but also for their respective areas of research interest namely intestinal fibrosis for Helena and transmural inflammation for Samuel and much more!

I hope you enjoy it as much as we did!

Spyros Siakavellas
ECCO News Associate Editor

Dear colleagues,

Welcome again to a new episode of the JCC Podcast in ECCO News!

We know that there is a "window of opportunity", where starting an effective therapy can improve outcomes in Crohn´s disease. This is also the case for early introduction of anti-TNFs but, how early should we start it to change the natural history of the disease?

To answer that question, we are featuring a brief conversation about the article Early intervention with biologic therapy in Crohn´s disease: how early is early? recently published in JCC, with first author Joana Reves from Portugal.

We hope you find it interesting and useful for your clinical practice!

Thanks for joining us.

Best regards,

Ignacio Catalan-Serra

Robin Dart © ECCO

The Y-ECCO Interview Corner is a chance to get to know people inside ECCO. Mark Samaan has been a fixture on the Y-ECCO Committee since 2018, and is the current Chair. He is a consultant gastroenterologist with an interest in IBD clinical trials. He has had an education in IBD spanning two continents and is a keen swimmer. We sat down to talk about his experience in IBD, and what it’s like to support a football team who famously achieve very little.

Submucosal injection of the RNA nucleotide GUT-1 in active ulcerative colitis patients: A randomized, double-blind, placebo-controlled phase 2a induction trial.

Atreya R, Kuhbacher T, Waldner M, et al.

J Crohns Colitis 2023. doi: 10.1093/ecco-jcc/jjad162. Online ahead of print.

Introduction

Despite an increasing number of therapeutic options for Ulcerative Colitis (UC), many patients still have disease which progresses over time, and there has been renewed interest in and improved understanding of the chronic fibrosis and remodelling that occurs in UC [1–3]. In particular, there has been a growing appreciation of both the importance of the extracellular matrix (ECM) for remodelling in UC and the potential to target the ECM with new therapeutic agents [4]. One such target is carbohydrate sulphotransferase 15 (CHST15). This is a type II transmembrane Golgi protein that biosynthesises highly sulphated disaccharide units (E-units) of chondroitin sulphate, which binds to various functional proteins and pathogenic microorganisms. Targeting this molecule in mouse models has previously been shown to offer promising signals for ameliorating colitis [5]. Based on this promising pre-clinical data, blockade of CHST15 has emerged as a potentially promising therapeutic target, and such blockade can be achieved by a silencing RNA oligonucleotide molecule called GUT-1 (previously called STNM01). A prior phase I clinical trial demonstrated the safety of GUT-1 in patients with Crohn’s Disease [6]. Accordingly, Atreya and colleagues now sought to evaluate the safety, as well as the efficacy and mode of action, of GUT-1 in patients with UC as part of a phase IIa placebo-controlled, clinical trial.

Upadacitinib induction and maintenance therapy for Crohn’s disease

Loftus Jr EV, Panes J, Lacerda AP, et al.

N Engl J Med 2023;388:1966–80. doi: 10.1056/NEJMoa2212728.

Introduction

The management of Crohn’s Disease (CD) is dependent on many factors, including disease activity, site of involvement and the need to tailor treatment for each individual patient [1]. Moreover, features such as obstruction, fistulation, strictures and abscesses can all add to the complexity of CD management. While surgery has played a large role in the management of these patients, it is by no means a cure and the risk of relapse and repeat surgeries remains high [2, 3]. Accordingly, there continues to be a large unmet need for the development of novel medications that target distinct mechanisms of action in order to provide symptomatic and endoscopic control for patients with active disease. In parallel with this need to develop new medications, there has been an increasing desire for fast-acting medications, and movement towards oral administration, which may help both to reduce costs for hospitals and patients and to enhance aspects that are important to patients, such as quality of life and work productivity [4, 5].

Intestinal barrier healing is superior to endoscopic and histologic remission for predicting major adverse outcomes in Inflammatory Bowel Disease: The Prospective ERIca Trial

Timo Rath, Raja Atreya, Julia Bodenschatz, et al.

Gastroenterology 2023;164:241–55

Introduction

Mucosal healing (MH) in both Crohn's Disease (CD) and Ulcerative Colitis (UC) has been recognised as an important treatment target for many years. Indeed, the 2021 update of the Selecting Therapeutic Targets (STRIDE) consensus reaffirmed MH as the top priority among long-term treatment objectives [1]. Nonetheless, it is important to note that endoscopic inflammation may not always mirror the histological picture. Histological healing is an emerging endpoint in IBD. This is particularly true in UC, in which it represents a deeper level of recovery with some early evidence for correlation with better long-term outcomes; for CD, however, findings have been more controversial [2, 3]. Despite the increasing focus on histology, histological scoring systems are complex, with only two validated ones, both in the setting of UC, i.e. there is no validated scoring system in the context of CD.

Dear Y-ECCO Friends,

I hope you are all well and that those of you who made the trip back to Copenhagen for UEGW had an interesting and enjoyable conference. We are now very much into the foothills of ECCO’24, which will take place in Stockholm in February, and I hope many of you have submitted your work for presentation there. I also hope that you will consider attending our 10th Y-ECCO Science Workshop, to be held on the afternoon of Wednesday, February 21, immediately prior to the main Congress itself. As always, we will have a mixture of established clinician-scientists presenting keynote lectures and up-and-coming Y-ECCO Members presenting their own original work. We’re looking forward to an inquisitive and collaborative atmosphere and it would be fantastic to see you all there!

Fibrosis and other connective tissue abnormalities are common in IBD, especially in Crohn’s Disease. The main clinical consequence is strictures, occurring most often in the small bowel or at the ileocaecal/ileocolic junction. Surgery may be necessary for stricture management.

Seamus Hussey © ECCO

2023 has been another outstanding year of emerging Inflammatory Bowel Disease (IBD) treatments – in adults.  Children and young adults remain underserved by clinical trials of IBD therapies.  While this age demographic garners much sympathy, and accounts for one-quarter of all new diagnoses, children and young adults are disenfranchised from accessing cutting-edge drug trials by virtue of age alone. Paediatric patients are the almost perfect participants – having generally fewer comorbidities, shorter disease duration and seemingly better treatment responses than adults. The additional challenges posed by trials in this age group have, however, left a relatively barren landscape of industry-sponsored trials in their wake. What, then, are the ongoing challenges, and what have industry and our drug trial community done to level the therapeutic playing field?