Two new members joined the N-ECCO Committee in February 2024: Maria de Jong from the Netherlands and Cathy Walsh from Ireland. We all share the same mission: promoting IBD nursing in Europe, rolling out educational and research programmes, and developing patient care and education. We are looking forward to working together, and here Maria and Cathy introduce themselves and their aims while on the committee.
Diet in Inflammatory Bowel Disease has become a hot topic in recent years, pushed forward by advances in our understanding of the microbiome and the promise of nutrition as therapy, particularly in Crohn’s Disease. One of the most important questions in clinic (and yet the hardest to answer) remains “What can I eat?” or variations of the same. The reason this question is so difficult to answer is the enormous complexity in how diet overlays IBD and also the lack of high-quality scientific studies addressing this specific problem.
Caroline Nordenvall has recently joined the S-ECCO Committee. She works at the Karolinska University Hospital as an IBD surgeon and is head of the research group in colorectal surgery. She is an Associate Professor within the University.
The last decade has seen a dramatic increase in drugs available for the treatment of IBD. However, each of these novel biologics or small molecules achieves disease remission in only a relatively small proportion of patients [1].To date, implementation in clinical practice of evidence that assists in better evaluating the chance of therapy success in a particular patient for a particular drug is limited. Therefore, when choosing a drug for a patient with IBD who is starting therapy or needs to switch drugs, a trial-and-error approach may be unavoidable.
To address this unmet clinical need, several research groups have now turned their attention to biomarker discovery to allow development of an evidence-based personalised treatment strategy [2]. At this year’s Congress of ECCO in Stockholm, I had the opportunity to provide an update on the field of biomarker discovery from the perspective of a pathologist. In this issue of ECCO News, I want to share with you the most important points from that H-ECCO Masterclass talk.
Can you believe that it’s been only four months since the last ECCO Congress? I bet that many of you are already knee-deep in exciting research for ECCO 2025 in Berlin, so mark your calendars and keep an eye open for the abstract submission deadline. You can’t miss that, as we want to see your top-notch research! Maybe you are the next Y-ECCO Best Abstract awardee!
Increased versus conventional adalimumab dose intervals for patients with Crohn’s disease in stable remission (LADI): a pragmatic, open-label, non-inferiority, randomised controlled trial
van Linschoten RCA, Jansen FM, Pauwels RWM, et al.
Adalimumab is an effective and safe treatment for Crohn’s Disease (CD). However, both patients and healthcare professionals may wish to mitigate medication exposure due to potential safety and economic concerns in the long term. Since a high relapse rate follows drug discontinuation, treatment de-escalation without actually stopping the medication may allow for decreasing drug exposure while maintaining efficacy. In two observational studies, de-escalation from a 2-week to a 3-week adalimumab dosing interval was successful in most of the patients, though reversal to a 2-week dosing interval was required in about 30% due to insufficient disease control [1, 2]. The Lengthening Adalimumab Dosing Interval (LADI) study is a pragmatic, open-label, multicentre, non-inferiority, parallel, randomised controlled trial conducted in the Netherlands and specifically designed to address this knowledge gap [3].
Withdrawal of immunomodulators or TNF antagonists in patients with inflammatory bowel diseases in remission on combination therapy: A systematic review and meta-analysis
Combination therapy with anti-TNF inhibitors (ATI) and immunomodulator (IMM) therapy remains an efficacious treatment strategy for disease control in moderate to severe Inflammatory Bowel Disease (IBD). This conclusion was largely based on the findings of landmark trials, SONIC and UC SUCCESS, which showed combination therapy to be far superior to monotherapy in achieving durable clinical and endoscopic remission in IBD [1, 2].
However, combination treatment with ATI and IMM can lead to increased risk of infection and malignancy. Whilst withdrawal of combination treatment once the patient is in disease remission can reduce the risk of treatment-related complications as well as the cost to health services, there remains a risk of relapse of previously controlled disease. At present there is no consensus amongst global clinical guidelines as to the appropriate duration of use of combination therapy. Thus, clinicians often find decisions related to withdrawal of treatment quite challenging.
The gut microbiota of patients with Inflammatory Bowel Disease (IBD) may have a role in disease aetiology and course [1]. Patients with IBD often have dysbiotic microbiota, with lower microbial diversity and cell counts, with both absolute and relative abundance of commensal microorganisms [2, 3]. Conversely, during remission following anti-inflammatory therapy, the gut microbiota has been observed to shift to a more eubiosis-like composition [3–6]. Furthermore, lower proportions of taxa with pro-inflammatory properties and mucus-degrading bacteria, as well as higher proportions of short-chain fatty acid-producing bacteria, have been associated with a higher likelihood of favourable outcomes with medical treatment [3, 5, 6]. In this study, Caenepeel and colleagues monitored changes in intestinal microbiota and stool features in order to develop and validate a predictive model to assist clinicians in determining a patient-specific therapeutic strategy.
This issue's Interview Corner is dedicated to Fernando Magro, the current President-Elect of ECCO. Fernando Magro is a gastroenterologist and head of the Clinical Pharmacology Department at University Hospital São João in Porto, Portugal, where he also serves as a Professor of Pharmacology and Therapeutics. He is a founding member of the Portuguese Inflammatory Bowel Disease Group and an active researcher focusing on the management, treatment and prognosis of IBD. His dedication to ECCO is nothing new, as you'll read below. I took this opportunity to learn more about the academic and clinical journey of the person I'm glad to call my mentor.
We are pleased to introduce you to ECCO’s new Scientific Officer, Marietta Iacucci. Marietta is Professor of Gastroenterology at University College Cork and Consultant Gastroenterologist MUH/CUH. Marietta has been a very active member at ECCO for many years and is a main pillar in the e-learning taskforce. She is a Key opinion leader in Endoscopy and future technology in the field of IBD.
What have been the key moments of your career?
I was fortunate and fascinated to work with mentors who were experts in the field of IBD and advanced imaging technologies in Germany, the United Kingdom and Japan. Under the mentorship of Professor Subrata Ghosh at Imperial College, London, I honed my skills in IBD management and precision medicine. Professor Ralf Kiesslich from Mainz, Germany and Professors Saito, Yahagi and others in Japan were key to developing in me a keen interest in optical diagnosis and minimally invasive organ-sparing endoscopic resection techniques.
Maria de Jong
Cathy Walsh
Hannah Gordon
Richard Hansen
Bram Verstockt
Maria Manuela Estevinho
Brigida Barberio