Inflammatory Bowel Disease (IBD) is a chronic relapsing and remitting disease of the gut. IBD has a lifelong adverse impact on quality of life and imposes a significant burden on health care [1, 2]. The pathogenesis and course of IBD involve pathogenomic crosstalk among several complex internal components [3, 4], namely the genome [5], epigenome [3, 4], metabolome [3, 4, 6], immunome and microbiome [6–9]; this crosstalk is generally triggered through a set of external complex interactions among the exposome [10–13], dietome [14, 15], lifestyle, social and behavioural factors [16]. While some of these multi-level interactions trigger the disease, others drive the disease course. Therefore, in each IBD patient the disease arises through a (unique) combination of pathogenenomic (risk) factors or pathway that yield a specific set of disease manifestations and a specific disease course. In this context, an “individualized” therapy is required [17–19].
Owing to the COVID-19 pandemic, the 19th ECCO IBD Intensive Course for Trainees will exceptionally take place in a virtual format on Friday, July 2, 2021 (one-day duration), one week prior to the start of the main ECCO Congress. The ECCO IBD Intensive Course for Trainees has become a tradition. It is the oldest educational initiative of ECCO, dating back to 2003, before the launch of the ECCO Congress, and is the cornerstone of the Education Committee’s activities.
Our journey over the past year has been a remarkable one, and all of us have faced challenging times. As a result of the COVID-19 pandemic, this year’s ECCO Imaging Courses, including the Basic Imaging and Advanced Ultrasound Workshops, have had to move online as fully virtual meetings.
This year, the European Crohn’s and Colitis Organisation (ECCO) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) combined their expertise and resources to generate a Topical Review with a set of current practice positions to facilitate the correct and comprehensive reporting of imaging exams for Inflammatory Bowel Disease (IBD) patients.
Imaging reports are one of the most important tools for clinicians, surgeons and technical staff, and this is particularly true for those caring for IBD patients, who often present with a variety of complicated clinical features.
In these challenging times for all healthcare professionals, IBD Nurses continue to be an important part of the multidisciplinary team in managing patients with IBD. Many nurses have multiple roles and responsibilities and provide a variety of services. The exact extent and depth of care and services provided vary from country to country, depending on the education levels, the local requirements of the patients and the gastroenterology team, and the professional regulations in the individual county.
“One cannot think well, love well, sleep well, if one has not dined well.” ― Virginia Woolf
Unfortunately for many of our patients, dining well is often not an option since their disease symptoms give rise to wariness about the foods they eat. Patients are forced to consider how they may feel after a meal and to take into account their requirement for toilet facilities and ability to cope with pain. They often forego social eating to manage these aspects. This can negatively impact their social interactions, daily activities and food-related quality of life [1]. Coupled with this, patients with IBD have higher rates of depression and anxiety [2] and a higher incidence of behavioural, psychological and eating disorders [3]. Self-directed food exclusions can trigger these disorders and lead to higher nutritional risk. We need to be mindful of this when addressing diet and nutrition with our patients. It is important that we consider the implications of asking patients to modify their diets for disease or symptom management while taking into account their desire to use diet as a tool to manage their disease.
Anti-tumor necrosis factor alpha (TNFα) therapy is frequently used in the treatment of Crohn’s Disease (CD) and Ulcerative Colitis (UC) in both adult and paediatric patients. Nevertheless, primary or secondary treatment failure of anti-TNFα treatment is not uncommon [1]. Both primary and secondary treatment failures are attributed either to pharmacokinetic, pharmacodynamic and immunogenic factors or to adverse events in response to the specific agent [2]. In recent years, loss of response (LOR) during anti-TNFα treatment has commonly been approached through the use of therapeutic drug monitoring involving measurement of infliximab or adalimumab trough concentrations (TC) and anti-drug antibodies (ADAs). Therapeutic drug monitoring of anti-TNFα agents enables proper stratification of LOR into a specific type of LOR, with corresponding adjustment of treatment. In children, in line with findings in adults, it has consistently been shown that higher drug TC is associated with higher efficacy [3] and that LOR is most commonly attributable to either low TC or the development of anti-drug antibodies [4].
Paediatric-onset Inflammatory Bowel Diseases (IBDs) represent about 25%–30% of all IBDs. As in adult patients, cases are classified as Ulcerative Colitis (UC) or Crohn’s Disease (CD). In addition, a third diagnostic category, unclassified-IBD (U-IBD), can be used when a definite differential diagnosis between UC and CD is not possible.
Paediatric-onset IBDs, by definition, are those IBDs which are diagnosed in children and adolescents under the age of 17 years. They are further categorised as very early onset IBD (VEO-IBD) when the disease is diagnosed before 6 years of age, infantile IBD when the diagnosis is made before 2 years of age and neonatal-onset IBD when the patient is 28 days old or less.
I hope that you are all doing fine and that you managed to submit your abstract to the virtual ECCO Congress before the deadline. As always, we will select the best abstracts submitted by Y-ECCO Members for the Y-ECCO Award 2021. We are really excited to read about your research and, of course, hear all about it at the Congress.
DRUG SURVIVAL OF ANTI-TNF AGENTS COMPARED WITH VEDOLIZUMAB AS A SECOND-LINE BIOLOGICAL TREATMENT IN INFLAMMATORY BOWEL DISEASE: RESULTS FROM NATIONWIDE SWEDISH REGISTERS
Sara Rundquist, Michael C Sachs, Carl Eriksson, Ola Olén, Scott Montgomery, Jonas Halfvarson, SWIBREG Study Group
The advent of monoclonal antibody therapy has propelled the management of Inflammatory Bowel Disease firmly into the biologic era, with numerous biologic therapies now licensed or in various stages of development.
Anti-tumour necrosis factor (TNF) agents such as infliximab [1, 2], adalimumab [3, 4] and golimumab [5]were the first biologics to be developed and have the greatest body of evidence for their effectiveness and safety in the treatment of Crohn’s Disease (CD) and Ulcerative Colitis (UC). The arrival of biosimilars has brought down costs and made treatment with anti-TNF more widespread, such that they are the most important first-line treatment option for moderate to severe IBD.
Behrooz Alizadeh
Konstantinos Karmiris 
Marietta Iacucci
Antonino Spinelli
Pamela Baldin
Johan Burisch