Silvio Danese © ECCO

Dear ECCO Friends,

Research and education are priorities in the ECCO Community. Autumn is a great time for exciting new ECCO events and is the perfect time to start planning your attendance at the ECCO’20 Congress in Vienna.

Considering the success of the ECCO-ESGAR Basic Imaging Workshop at ECCO’19, I am happy to announce that the 2^nd ECCO-ESGAR Basic Imaging Workshop will be held during ECCO’20. The focus of this workshop will be the latest imaging technologies in IBD.

Education can also be achieved through intense collaborative projects. The 18^th ECCO IBD Intensive Advanced Course will take place during ECCO’20 and will provide a multidisciplinary broad base of knowledge in IBD. Moreover, the 5^th IBD National Study Group Meeting will also be held during ECCO’20, enabling investigators to have their studies challenged and promoted at the same time.

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 Thursday to Saturday, February 13-15, 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 12-14, 2020. These activities target ECCO’s different interest groups including young gastroenterologists, surgeons, paediatricians, pathologists, 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!

PTPN2 and TiO2 in the pathogenesis of Inflammatory Bowel Disease  

Aim of the research

Titanium dioxide (TiO2) may play a pivotal role in the onset and perpetuation of chronic intestinal inflammation. These effects may be genetically triggered, and variations in IBD risk genes, such as PTPN2, may contribute critically to the detrimental effect of TiO2 in vivo. For these reasons, we will study the combined effects of the presence of disease-associated genetic PTPN2 variations and TiO2 microparticles on the development of chronic intestinal inflammation and on inflammasome activity, as well as the subsequent consequences for the host immune system, in particular innate immune responses. The study will demonstrate the relevance of TiO2 in the pathogenesis of intestinal inflammation in vivo. To address the aforementioned aims, we will:

1. Analyse whether PTPN2-mediated inflammasome activation can control TiO2-induced intestinal inflammation.
2. Demonstrate whether the presence of the disease-associated PTPN2 variant affects NLRP3 inflammasome activation and intestinal inflammatory responses to TiO2 in IBD patients.

The role of fibroblasts in the pathogenesis of Crohn’s Disease-associated fistulas and in mesenchymal stem cell therapy  

Ramona Bruckner © Ramona Bruckner

Aim of the research

Perianal fistulas are a severe and frequent complication in Crohn’s Disease (CD) patients, significantly affecting their quality of life. High recurrence rates, incomplete fistula healing and non-responding patients make the treatment challenging. Despite some novel insights, current knowledge about the pathogenesis of fistula formation is still limited. Fibroblasts are abundantly present in fistulas and were recently reported to regulate Th1 cell activity in Inflammatory Bowel Disease (IBD). Our hypothesis is that fibroblasts act as the key drivers of this disease complication by regulating inflammatory cell recruitment. We will investigate which pro-inflammatory cytokines and chemoattractants are produced by fistula-derived fibroblasts and how they influence recruitment of immune cells, leading to sustained inflammation. Our second hypothesis is that mesenchymal stem cells (MSCs) can normalise this fibroblast-driven pro-inflammatory environment.

Take your study to the next level with the IBD National Study Group Meeting at the ECCO Congress

Uri Kopylov © ECCO

The Clinical Research Committee of ECCO (ClinCom) was established with the mission of facilitating innovative clinical research in the area of Inflammatory Bowel Diseases (IBD). It acts as an organ for the delivery of advice on investigator-initiated proposals: Throughout the year, investigators who are also ECCO Members are invited to submit their protocols for an objective and in-depth review process by the Committee. 

In order to promote international scientific collaboration through cooperation of researchers from different European countries even further, ClinCom has established the IBD National Study Group Meeting, which will take place at the annual ECCO Congress. At the last ECCO Congress in Copenhagen, representatives of IBD National Study Groups gathered for the 4^th edition of the meeting. With this great platform, ClinCom enables investigators to have their studies challenged and promoted at the same time.

2nd ECCO-ESGAR Basic Imaging Workshop 

Marietta Iacucci  © ECCO

Christian Maaser © ECCO

In 2020 the Educational Programme at the ECCO Congress will again include two combined workshops devoted to IBD imaging. 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 (ESGAR).

The 2^nd ECCO-ESGAR Basic Imaging Workshop 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 Inflammatory Bowel Disease(s) (IBD). The course has been successful and highly requested in the past few years, and we have decided to run the course twice on the same day this year to enable more participants to attend.

Henit Yanai © ECCO

The 18th ECCO IBD Intensive Advanced Course, Vienna 2020

The European Crohn’s and Colitis Organisation (ECCO) brings together national groups and individuals interested in different aspects of Inflammatory Bowel Diseases (IBD). One of ECCO’s core aims is to promote education in the field of IBD and thereby improve the quality of care for IBD patients throughout Europe.

The annual ECCO IBD Intensive Advanced Course was initiated in 2003 with the general aim of providing advanced fellows and junior faculty in gastroenterology with a multidisciplinary broad base of knowledge in IBD. The course consists of lectures and workshops dealing with controversial areas of IBD pathogenesis, diagnosis and management, delivered by leading experts in the field of IBD.

Naila Arebi © ECCO

The cosmopolitan city of Tel Aviv served as the location for the 61^st ECCO Educational Workshop. On the 12 June, over 100 delegates from across Israel attended this interactive and productive workshop, which also offered plenty of opportunities for networking over coffee and lunch breaks.

Glen Doherty © ECCO

The generation of high-quality practice guidelines remains a key priority for ECCO as an organisation. Arising from an important initiative by the Governing Board, in the last year GuiCom has introduced significant changes in the way that ECCO Guidelines are created. These changes have been introduced to ensure that we are using the best methodology in the creation of our guidelines, in line with international best practice. By adopting this approach, we will ensure that ECCO Guidelines stand up to robust external scrutiny, that they remain objective and evidence based, and that conflicts of interest are not permitted to influence guideline recommendations.

Wladzia Czuber-Dochan  © ECCO

Petra Hartmann © ECCO

The ECCO IBD Nurse Education Programme was introduced in 2018, with Italy being chosen as the first country to run the Programme. The Programme consists of two face-to-face meetings, one at the beginning and one at the end of the Programme, six online modules that nurses complete as self-directed learning, and a one-week visit to an IBD centre in the home country. The Programme, which ran from November 2018 to May 2019, was coordinated by an experienced IBD Nurse, Simona Radice, with help and support from Gionata Fiorino, consultant gastroenterologist. Both Simona and Gionata work at Humanitas Hospital in Milan, where the face-to-face meetings took place.

Lihi Godny © ECCO

Total proctocolectomy with ileal pouch anal anastomosis (IPAA) is the surgery of choice for patients with refractory Ulcerative Colitis (UC). Following the first-year post operatively the pouch is adapted to the ileal content efflux and most patients have 5-8 bowel movements a day and one nocturnal. Stool and gas incontinence, episodic nocturnal soiling and use of anti-diarrheal medications are common^1–4. Since patients often relate symptoms to food (especially fruit and vegetable, dairy products and spicy foods), food avoidance is prevalent in up to 70% of the patients⁵. Therefore, patients after pouch surgery should be routinely assessed and treated by a dietitian within the setting of a multidisciplinary team⁶.

Nutritional deficiencies including iron, vitamin B12 and vitamin D are common and should be monitored and addressed⁷. Fluids and electrolytes imbalances are common in patients with increased number of bowel movements and need to be managed in order to avoid dehydration.

Michel Adamina © ECCO

The 13^th European Colorectal Congress starts on Sunday December 1, 2019 with a Masterclass in Colorectal Surgery and ends on Thursday December 5, 2019. About 1,400 participants from 80 countries are expected to attend the St. Gallen Colorectal Week (www.colorectalsurgery.eu, @ECCongress). Michel Adamina, from S-ECCO, is co-organising the meeting.

Fighting for growth in paediatric Inflammatory Bowel Disease

Amit Assa^1,2

Amit Assa © ECCO

Growth retardation is commonly seen in children diagnosed with Inflammatory Bowel Disease (IBD), mainly those with Crohn's Disease (CD). The aetiology of poor growth in children with IBD is multifactorial and includes malnutrition, poor intake, increased nutritional needs, elevated inflammatory cytokines, genetic factors (parental height, CD susceptibility genes) and corticosteroid therapy. Growth retardation may be present years before diagnosis of IBD, and it commonly persists despite disease-specific treatments, with implications for final adult height and consequent social and psychological burden.

Monika Tripathi © ECCO

Elective or emergency surgical interventions in the management of Inflammatory Bowel Disease (IBD) are mainly reserved for patients with medical refractory disease and life-threatening complications. Approximately 20%–30% of Ulcerative Colitis (UC) and 70%–80% of Crohn’s Disease (CD) patients will need surgery within the first to second decade following primary disease diagnosis [1].

Dominik Bettenworth © ECCO

Dear Y-ECCO Friends,

I hope you all are doing well.

During my summer leave, I read a book on the time horizon principle. The author supposes that the productivity of the most successful people on the planet results from the balance between three core components: Time for yourself, relationships and work. As you all, hopefully, have had sufficient time for yourself and your family during your holidays, here are some ways to expand your (professional) relationships and work skills:  

Ustekinumab exposure-outcome analysis in Crohn’s Disease only in part explains limited endoscopic remission rates

Verstockt B, Dreesen E, Noman M, Outtier A, Van den Berghe N, Aerden I, Compernolle G, Van Assche G, Gils A, Vermeire S, Ferrante M

J Crohns Colitis. 2019;13:864–72.

Introduction

Samantha Campbell © Samantha Campbell

Ustekinumab is licenced to treat moderate-severe Crohn’s Disease (CD) [1]. Ustekinumab induction is administered via intravenous (IV) infusion at a dose of 6 mg/kg at week 0, followed by a subcutaneous (SC) maintenance injection of 90 mg at week 8.

The UNITI programme demonstrated that ustekinumab can induce and maintain clinical remission. However, there is a paucity of real-life data in patients with CD receiving the mentioned IV induction and SC maintenance dosing of ustekinumab. Real-life data on therapeutic drug monitoring and biomarkers, such as faecal calprotectin, remain a relatively unexplored area with ustekinumab, with discrepancies in the literature [2, 3]. . 

Crohn’s Disease exclusion diet plus partial enteral nutrition induces sustained remission in a randomized controlled trial

Levine A, Wine E, Assa A, Boneh RS, Shaoul R, Kori M, Cohen S, Peleg S, Shamaly H, On A, Millman P, Abramas L, Ziv-Baran T, Grant S, Abitbol G, Dunn KA, Bielawski JP, Van Limbergen J

Gastroenterology. 2019;157:440–50.

Introduction

Paul Harrow © Paul Harrow

Exclusive enteral nutrition (EEN) is a safe and effective induction treatment for Crohn’s Disease (CD). It is recommended as first-line induction therapy in children and adolescents [1]. However, enteral nutrition is less well tolerated than other options like corticosteroids. A recent meta-analysis found three times as many patients withdrew from enteral nutrition therapy compared to corticosteroids even in the supported setting of clinical trials [2]. There is a clear need for a more acceptable dietary intervention. However, our understanding of the role of diet in CD is incomplete and to date specific diets have not been proven to induce remission. 

No association between pseudopolyps and colorectal neoplasia in patients with inflammatory bowel diseases

Mahmoud R, Shah SC, Ten Hove JR, Torres J, Mooiweer E, Castaneda D, Glass J, Elman J, Kumar A, Axelrad J, Ullman T, Colombel JF, Oldenburg B, Itzkowitz SH; Dutch Initiative on Crohn and Colitis

Gastroenterology. 2019;156:1333–44.e3.

Introduction

Sailish Honap © Sailish Honap

Patients with Inflammatory Bowel Disease (IBD) are at an increased risk of developing high-grade dysplasia and colorectal carcinoma [1, 2]. The risk of carcinogenesis, driven by chronic inflammation, increases with several factors, including duration and anatomic extent of colitis, family history and the presence of primary sclerosing cholangitis (PSC). European clinical guidelines for colonoscopy surveillance in this high-risk cancer population also suggest a shorter surveillance interval for those with post-inflammatory polyps (PIPs), also known as pseudopolyps [3–5]. PIPs are a common finding, more so in Ulcerative Colitis (UC) than in Crohn’s Disease, and are formed after alternating cycles of inflammation and regeneration of the epithelial mucosa. However, data are conflicting and evidence is lacking in this field as previous case control studies have reported up to a 2.5-fold increased risk [6, 7] whereas a more recent cohort study showed no significant association between PIPs and colorectal neoplasia (CRN) [8]. The authors of this study aimed to use a large cohort study to further define the risk of CRN and PIPs in patients with Inflammatory Bowel Disease.  

Charlotte Hedin © ECCO

Professor Fiona Powrie is the Director of the Kennedy Institute of Rheumatology at the University of Oxford. Her work has been seminal in defining the mechanisms that govern and regulate immune responses in the gut. Her research has revealed the pivotal role of regulatory T cells, interleukin-10, interleukin-23 and transforming growth factor-β (TGF-β) in intestinal inflammation.

Karin A. Wasmann  © Karin A. Wasmann

Karin A. Wasmann¹, IBD study group Amsterdam UMC, location AMC²

While striving to meet the quality standards for oncological care, hospitals prioritise oncological procedures more frequently, resulting in longer waiting times for surgery for benign diseases such as Inflammatory Bowel Disease (IBD). Currently in the Netherlands, oncological treatment should be started within six weeks after diagnosis and this is reinforced by the Dutch Health Care Inspectorate, insurance companies and patient organisations [1]. The situation in other European countries is similar. Additionally, since the introduction of national bowel cancer screening programmes, the demand for oncological surgical resections has risen worldwide [2–5]. The subsequent longer waiting time for benign diseases is not only inconvenient for patients, but in the case of IBD may lead to severe complications.

Denmark

Name of group: There is an interest group for IBD, but gastroenterologists with an interest in IBD are organised in “Dansk Selskab for Gastroenterologi og Hepatologi” (DSGH), which is our national society of gastroenterology and hepatology.
Number of active members: Approx. 750 members of DSGH
Number of meetings per year: There is one annual meeting lasting 2 days. In addition, a number of minor meetings are held throughout the year, one or two of which have an IBD focus. 
President and Secretary: President: Ebbe Langholz, Department of Gastroenterology, Herlev-Gentofte University Hospital Secretary: Annette Dam Fialla, Department of Gastroenterology, Odense University Hospital
National Representatives: Jørn Brynskov, Department of Gastroenterology, Herlev-Gentofte University Hospital Signe Wildt, Department of Gastroenterology, Køge University Hospital
Joined ECCO in: Denmark has been a member of ECCO since 2004
Incidence of IBD in the country: Crohn´s disease:10/100,000    Ulcerative colitis: 15/100,000

Tariq Ahmad  © Tariq Ahmad

Ian Arnott © Ian Arnott

United Kingdom

Name of group: The IBD section of the British Society of Gastroenterology (BSG).
Number of active members: Approx. The IBD section is the largest section of the BSG and has 997 members including physicians, surgeons, pathologists, radiologists, scientists, nurses, dietitians, and others interested in IBD. The IBD section committee includes nurse, trainee and patient group membership.
Number of meetings per year: The BSG holds an annual national meeting in June with two or three IBD symposia. In addition, the BSG supports or endorses numerous regional gut clubs and network meetings across the UK each year. Many of these are focused on IBD. The IBD section includes the IBD clinical research group which leads research activity across the UK.
This group holds an annual meeting every November to which all investigators are invited. In 2018, 120 delegates attended, including physicians, research nurses and research co-ordinators. 
President and Secretary: BSG president – Cathryn Edwards BSG secretary - Adrian Stanley Chairman, IBD section of the BSG – Ian Arnott Chairman of IBD clinical research group – Charlie Lees
National Representatives: Tariq Ahmad, Exeter and Ian Arnott, Edinburgh. Lynn Gray, Wirral University Hospital and Catherine Stansfield, Salford Royal are the UK representatives of N-ECCO. 
Joined ECCO in: 2003
Incidence of IBD in the country: Recent data from Scotland reveal incidence rates for UC, CD and IBDU of 19.8, 13.6 and 5.4 per 100,000 respectively (Jones GR Gut 2019)

Nensi Lusičić  © Nensi Lusičić

Vesna Oroz © Vesna Oroz

Croatia

N-ECCO National Representative:
Nensi Lusičić
Job Title: IBD Nurse

What influenced your decision to apply for the role of N-ECCO National Representative for your country?
Opportunity to become more involved in IBD.

Eveline Hoefkens © Eveline Hoefkens

Belgium

N-ECCO National Representative:
Eveline Hoefkens
Job Title: IBD Nurse

What influenced your decision to apply for the role of N-ECCO National Representative for your country?

By being a national representative, you are actively involved in N-ECCO meetings. The yearly national representatives meeting at the ECCO congress is the ideal place to expand your network. You interact with IBD nurses from other countries and share experiences. It is a great opportunity to create an international network.