Silvio Danese © ECCO

Dear ECCO Friends,

One of the ECCO Community’s major aims is to create a network for data sharing that will allow researchers to address clinical issues through collaborative projects. Epidemiology research is one of the tools of value in filling the gaps in our knowledge of Inflammatory Bowel Disease through the collection of large prospective datasets. One highlight of this issue of ECCO News is the summary of the “hot topics” in Epidemiology as they emerged from ECCO ‘19.

As soon as the ECCO’19 Congress in Copenhagen ended, our community immediately started to work towards ECCO’20. A major goal of ECCO is to offer young gastroenterologists, surgeons, paediatricians, IBD Nurses, allied healthcare professionals and scientists an opportunity to improve their knowledge through courses and workshops. In this issue, you will find an overview of the Educational Activities at ECCO’20 and the preliminary Scientific Programme.

Nuha Yassin  © ECCO

Ignacio Catalán-Serra © Ignacio Catalán-Serra

For this second issue of ECCO News in 2019, we would like to continue to review the excellent scientific content presented at the recent annual ECCO´19 annual meeting held in Copenhagen.

We would like to focus our attention this time on the contribution of the Y-ECCO Members, summarizing the five Y-ECCO Abstract Awards for this year, as well as to provide a comprehensive review of the ten awarded digital oral presentations (DOP).

We hope that this representation of high-quality research combining epidemiological, basic and clinical aspects of inflammatory bowel disease is of interest for a wide range of ECCO Members and helps encourage and inspire future innovative work.

The Scientific Programme of the 15^th Congress of ECCO provides attendees the unique opportunity to learn from the world’s leading specialists in the field of Inflammatory Bowel Diseases. Held from Wednesday to Saturday, February 12-15, 2020, the Scientific Programme is structured around basic science, translational medicine and clinical sessions. Additionally, it includes oral presentations of the 40 best abstracts of the Congress. The focus of all sessions is clinical practice founded on science with practical take home messages and, as every year, the congress registration fee includes access to all scientific sessions.

Register now and seize the opportunity to hear current and relevant studies from international experts in IBD!

The educational programme of the 15^th Congress of ECCO starts prior to the official start of the ECCO Congress and courses take place from February 12-15, 2020. These activities target ECCO’s different interest groups including young gastroenterologists, surgeons, paediatricians, IBD Nurses, dietitians, allied health professionals and scientists.

An overview of these activities can be found below. Please note that courses/workshops may run concurrently. As these educational activities have a limited capacity, we encourage you to register at your earliest convenience.

We look forward to seeing you in Vienna!

Janneke van der Woude © ECCO

During the ECCO’19 Copenhagen Congress the Scientific Committee cordially welcomed Marc Ferrante as a new member.

Marc Ferrante has been an individual member of ECCO since 2008 and has contributed to several ECCO Activities and Initiatives. He was one of the Y-ECCO Founders and Y-ECCO Chairs. His career in ECCO continued in 2015 with a position on ClinCom, and he subsequently became chair of this committee in 2017. 

Proactive adalimumab trough measurement is associated with improved treatment outcomes in children with Crohn’s Disease: The PAILOT randomised controlled trial

Amit Assa © ECCO

Loss of response (LOR) during anti-TNF treatment for Crohn's Disease (CD) is commonly approached through the measurement of trough concentration (TC) and anti-drug antibodies, with subsequent modification of treatment (reactive therapeutic drug measurement, TDM). It is appealing to speculate that tailored treatment based on routine TC and antibody measurements (proactive TDM) may assist in sustaining adequate drug levels and thus in improving efficacy and preventing the evolution of anti-drug antibodies. Nevertheless, two randomised controlled trials, the TAXIT [1] and the TAILORIX [2], have failed to demonstrate superiority of level-based over clinically based adjustment of infliximab treatment. To date, there are no prospective studies comparing proactive vs reactive TDM in paediatric CD nor are there any studies evaluating the proactive approach among adults or children treated with adalimumab. Hence, we aimed to investigate the effect of proactive drug monitoring-based treatment, in comparison with clinical and biologic-based monitoring of disease activity in children with CD treated with adalimumab.

Erwin Dreesen © ECCO

Targeting endoscopic outcomes through combined pharmacokinetic and pharmacodynamic monitoring of infliximab therapy in patients with Crohn’s Disease

In the multicentre, randomised, controlled TAILORIX trial, it was not possible to show a benefit of infliximab dose escalation based on a combination of pharmacokinetic monitoring (i.e. serum concentrations of infliximab) and pharmacodynamic monitoring (i.e. symptoms and biomarker) as compared to dose escalation based on symptoms alone [1]. However, infliximab dose escalations only commenced after the induction regimen. In the current post hoc pharmacokinetic–pharmacodynamic analysis of TAILORIX, we examined the roles of pharmacokinetic and pharmacodynamic monitoring during infliximab induction and maintenance therapy for targeting endoscopic outcomes [2].

Naila Arebi © ECCO

While the traditional role of epidemiology was the study of communicable diseases, it has evolved to a modern approach geared towards the study of the increasing incidence of non-communicable chronic diseases. Epidemiology may be defined as the collection of large sample sizes and the measurement of numerous variables from stored samples to facilitate estimation of disease risk over time, and may involve the development and use of new techniques to acquire dependent and independent variables [1]. Nevertheless, the traditional view of epidemiology remains embedded as the study of epidemics. In studying Inflammatory Bowel Disease (IBD) as an epidemic, several aspects were addressed at ECCO'19 Copenhagen Congress, including changes in the incidence/prevalence of IBD in different populations (countries), effects of therapy on surgical rates, the incidence of complications such as colorectal cancer, the impact of treatment patterns and findings in smaller sub-populations such as patients with elderly-onset and perianal Crohn’s Disease (CD). Although the modern definition carries a risk that studies will be conducted without a specific hypothesis thereby generating statistically significant observations of no clinical relevance nor benefit, the studies presented at ECCO 2019 addressed clinically important questions.

Peter Irving © ECCO

Dear ECCO Friends,

I am writing to you to thank you for attending the ECCO Congress in Copenhagen in March which was the biggest ECCO Congress to date and a wonderful success.

Among the many highlights of the Congress, our e-Learning platform was one to stand out as a record-year of new e-Learning content and functionality.

Antonino Spinelli © ECCO

GuiCom has earned the reputation of being one of the busiest ECCO Committees. Looking at the number and importance of the ongoing projects in 2019, it is evident that this fame is well deserved: it is sufficient to mention the near completion of the new Crohn’s Disease (CD) Guidelines and the launch of the upcoming Ulcerative Colitis (UC) Guidelines.

Marjo Campmans- Kuijpers © ECCO

The importance of nutrition in IBD Management is increasingly recognised. Of course, the best evidence that nutrition deserves a place in IBD Treatment is the fact that exclusive enteral nutrition (EEN) is the primary treatment in children with active Crohn’s Disease (CD). In addition, some dietary patterns are associated with the outcomes in IBD, and recently it was shown that partial enteral nutrition, accompanied by a special CD exclusion diet, is as effective as EEN and brings into remission even those patients who fail on biologics.

Yves Panis © ECCO

As chair of the S-ECCO Committee, it is my pleasure to introduce a newly elected member for 2019, Pär Myrelid, who will stay for 3 years, up to February 2022. Thus, the current members of the S-ECCO Committee are: Michel Adamina (Winterthur, Switzerland) (who will be, after me, the next chair), Yves Panis (Clichy, France) (chair up to February 2020), Christianne Buskens (Amsterdam, who will stay up to February 2021), Hagit Tulchinsky (Tel Aviv, who will also stay up to February 2021) and Pär Myrelid.

Johan Van Limbergen  © ECCO

Konstantinos Gerasimidis © ECCO

Johan Van Limbergen^1,2, Konstantinos Gerasimidis³

Crohn’s Disease (CD) is increasing in incidence worldwide [1]. In spite of increased use of immune suppression, which has markedly changed the need for in-hospital care, paediatric CD remains associated with considerable morbidity as well as increased mortality [2, 3]. The onset of disease in childhood and adolescence often interferes with growth and development, both physically and psychologically. In a subset of patients, the progressive nature of disease may be associated with a fibrotic phenotype that does not respond adequately to the currently available immune suppressive medications, yet use of these medications is still associated with increased risk of myelosuppression, opportunistic infections, immune-mediated phenomena and malignancy [2, 4–6]. 

Magali Svrcek © ECCO

Immune checkpoints (ICK) are downregulators of T cell immunity. Immune checkpoint inhibitors (ICKi), by blocking the co-inhibitory receptors on T cells to activate their cytotoxic immune function, have become a major therapeutic tool in oncology, notably for the treatment of metastatic melanoma, non-small cell lung carcinoma, renal cell carcinoma, urothelial carcinoma and mismatch repair (MMR) deficient/microsatellite-unstable tumours. In particular, therapeutic monoclonal antibodies have emerged against cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), which primarily inhibits T cell activation, and programmed cell death 1 (PD-1), which limits the effector function of activated T cells in the periphery. Food and Drug Administration-approved ICKi include ipilimumab (CTLA-4 inhibitor), pembrolizumab and nivolumab (anti-PD-1) and atezolizumab (anti-PD-L1).

Dominik Bettenworth © ECCO

Dear Y-ECCO Friends,

One of the main tasks of the Young ECCO Committee (Y-ECCO) is to offer Y-ECCO Members opportunities to expand their scientific skills and develop their own research projects. Following the last Y-ECCO Basic Science Workshop in Copenhagen, which was a great success in terms of attendance and participant feedback, plans for the 6th Y-ECCO Basic Science Workshop at the 15th Congress of ECCO in Vienna 2020 are already in full swing. The potential for the successful establishment of intestinal organoids will substantially expand the basic research on Inflammatory Bowel Diseases (IBD). In addition, experimental research should always focus on an effective translation of experimental results into the clinic in order to improve the treatment of our IBD patients in the long term. Therefore, organoids and translational basic science research will be the two main topics of the 6th Y-ECCO Basic Science Workshop. Fortunately, we were able to expand the structure of the workshop so that three awardees of the ECCO Research Fellowships Programme will present their results at the workshop and will also be available to answer all your questions regarding the pros and cons of a fellowship. 

Early combined immunosuppression may be effective and safe in older patients with Crohn’s disease: post hoc analysis of REACT

Singh S, Stitt LW, Zou G, et al.

Aliment Pharmacol Ther. 2019;49:1188–94.

Introduction

Georgina Cunningham  © Georgina Cunningham

Due to the ageing population and the chronicity of the disease, increasing numbers of patients with Inflammatory Bowel Disease (IBD) are now over the age of 60 [1]. The management of IBD in this group poses some challenges, mainly centered on the balance between risk of immunosuppression and the burden of active disease [2]. Although older IBD patients usually display a more indolent disease course, they are more likely to be hospitalised and have higher in-hospital mortality than their younger counterparts [3]. There is no doubt that there is room for improvement in our management of IBD in elderly patients, and guidance is needed to help physicians decide whether more aggressive treatment strategies, widely accepted in certain younger IBD patients [4], are also warranted in this cohort, and especially those at high risk of disease complications.

Predictors of anti-TNF treatment failure in anti-TNF-naive patients with active luminal Crohn’s disease: A prospective, multicentre, cohort study

Kennedy NA, Heap GA, Green HD, Hamilton B, Bewshea C, Walker GJ, Thomas A, Nice R, Perry MH, Bouri S, Chanchlani N, Heerasing NM, Hendy P, Lin S, Gaya DR, Cummings JRF, Selinger CP, Lees CW, Hart AL, Parkes M, Sebastian S, Mansfield JC, Irving PM, Lindsay J, Russell RK, McDonald TJ, McGovern D, Goodhand JR, Ahmad T, UK Inflammatory Bowel Disease Pharmacogenetics Study Group*

Lancet Gastroenterol Hepatol. 2019;4:341–53

Introduction

Misha Kabir  © Misha Kabir

The anti-TNF monoclonal antibodies infliximab and adalimumab have been integral to the management of Crohn’s Disease over the past two decades. However, primary non-response and secondary loss of response in the first year of treatment remain common, at 10%–40% [1–3] and 23%–46% [4] respectively. Immunogenicity has been implicated as an important predictive factor for anti-TNF therapy failure. However, target-to-treat drug and anti-drug antibody concentrations have not yet been validated in an adequately powered prospective study. The Personalised Anti-TNF Therapy in Crohn’s Disease Study (PANTS) aimed to investigate the factors that predict primary non-response, non-remission and adverse events with anti-TNF therapy in luminal Crohn’s Disease.

Rates and characteristics of postcolonoscopy colorectal cancer in the Swedish IBD population: What are the differences from a non-IBD population?

Stjärngrim J, Ekbom A, Hammar U, Hultcrantz R, Forsberg AM

Gut 2018 Dec 15; doi: 10.1136/gutjnl-2018-316651

Introduction

Rohit Rao  © Rohit Rao

Individuals with IBD have an increased risk of colorectal cancer (CRC) [1, 2]. In an effort to address this, societal guidelines recommend surveillance colonoscopy 8–10 years after diagnosis and at varying intervals thereafter, depending on risk [3, 4]. A 2017 Cochrane systematic review [5] demonstrated a benefit in this strategy, noting reductions in the development of both CRC and the rate of CRC‐associated death. Despite this, dysplasia detection is challenging and CRC still accounts for 10%–15% of all IBD deaths [6, 7]. Of further concern is the reported increased rate of post-colonoscopy colorectal cancer (PCCRC) in IBD. 

Charlotte Hedin © ECCO

Early clinical trials, the advent of biologics and the IBD Nurse and how the clinical presentation of IBD has changed over a 46-year career: The interviewee in this issue is Professor David Rampton, who has had a long career as an IBD clinician and researcher in East London. Respected by colleagues and patients alike, his career has spanned an era during which much has changed in IBD.

France

Name of group: GETAID
Number of active members: 54 GETAID centres (with 1-2 members per centre)
Number of meetings per year: 6 
President and Secretary: Laurent Peyrin-Biroulet (president), Arnaud Bourreille (secretary)
National Representatives: Stéphanie Viennot, Jérôme Filippi
Joined ECCO in: 2007
Incidence of IBD in the country: Crohn´s disease:7.6/100,000    Ulcerative colitis: 4.4/100,000

Norway

Name of group: The Norwegian IBD Group

Number of active members: The Norwegian IBD Group is organised within the Norwegian Gastroenterology Association (Norsk GastroenterologiskForening NGF). The Norwegian Gastroenterology Association has 370 active members. The IBD Group consists of 8 members elected at the Norwegian Gastroenterology Association general assembly (four members elected every second year). Approximately 100 members are active within IBD care.

Additionally,the Norwegian Nurses Organization includes a group for Gastroenterology Nurses (NSF/FSG) with 439 active members, of whom approximately 100 IBD Nurses. There is no formal IBD Nurse network but NSF/FSG arranges a yearly national IBD symposium for nurses interested in IBD.

Number of meetings per year: The IBD Group arranges a national IBD symposium annually. The Norwegian Gastroenterology Association has one national conference and one to two regional meetings in the five different health regions in Norway per year. The NSF/FSG arranges a yearly national IBD symposium for nurses interested in IBD.

President and Secretary:President the Norwegian Gastroenterology Association is Mette Vesterhus, associate professor at Haraldsplass Hospital in Bergen. Petr Ricanek MD, PhD at Akershus university hospital, is head of the IBD Group

National Representatives:Marte Lie Høivik MD PhD at Oslo University Hospital and Kristin Kaasen Jørgensen, MD PhD at Akershus university hospital. Elisabeth Finnes, IBD nurse specialist at Oslo University Hospital is the Norwegian representative in N-ECCO.

Joined ECCO in: 2005

Incidence of IBD in the country: There are no updated incidence numbers available in Norway. According to data from the IBSEN study the UC incidence was 12,8/100.000 persons/year and CD incidence 6/100.000 persons per year in the early nineties. We are awaiting updated incidence data from the ongoing IBSEN III study within 2020.