In the last decade the traditional management of Inflammatory Bowel Disease (IBD), based on clinically guided treatment intensification, has been revised and the so-called treat-to-target (T2T) approach, focusing on objective and scheduled measures to monitor intestinal inflammation, has been implemented in clinical practice, both in adults and in children. The general idea behind such tight monitoring is to prevent or block intestinal damage related to persistent and uncontrolled inflammation, and to avoid long-term complications.

Pär Myrelid © ECCO

Many technical innovations are facilitating the education process involved in training a skilled surgeon today. At the same time, this process is in many ways still a joint collaboration between a master and his/her apprentice, and will continue to be so. Fruitful training in any practical setting is based on trust, from both parties, in combination with application of the experience of the master in order to sort out any perioperative complications. Beyond acquisition of the necessary technical skill, becoming a surgeon requires the development of a sound understanding of when to operate and when not to, as well as the ability to choose the right surgical option. This is, of course, important in all surgical fields but it is perhaps especially true within the field of Inflammatory Bowel Disease (IBD).

Catherine Wall  © ECCO

The low-residue diet has been a short-term dietary strategy to help reduce the symptoms of active Crohn’s Disease and Ulcerative Colitis for at least the last half century. A longer term low-residue diet is also considered appropriate for a subset of patients with intestinal strictures [1], although the evidence to support this recommendation is limited and the type (fibrotic, inflammatory or both), severity (length of stricture and diameter of the bowel lumen), number of strictures and functional properties of certain foods likely impact tolerance of foods [1].

Petra Hartmann  © ECCO

One of the main goals of ECCO is to promote IBD research as well as to foster interaction and productive collaboration among European research groups working in the IBD field. To achieve this goal, ECCO continues to award Grants, Fellowships and Travel Awards. ECCO offers IBD Nurses across Europe the opportunity to apply for the N-ECCO Travel Award and the N-ECCO Research Grant.

Naila Arebi  © ECCO

The level of confidence in evidence generated by research is reflected in various aspects of study design and underpins clinical guidelines in Inflammatory Bowel Disease (IBD). The quality of research study designs, each with inherent strengths and limitations, determines confidence in the results, and it is acknowledged that some ‘robust’ study designs may not be feasible in specific contexts [1, 2]. Experimental designs such as randomised controlled studies that are characterised by methodological rigour, may be unsuitable to study effectiveness owing to their weak external validity, which is attributable to their strict eligibility criteria. Reliance on complementary or alternative evidence from other study designs to address residual gaps in knowledge is not uncommon. Non-experimental observational study designs capture a more diverse population, albeit in a less stringent setting, resulting in several methodological limitations, including high risk of bias and unbalanced confounders [2]. The increasing digitalisation of medicine, in addition to accessible diverse sources of data, is partly responsible for recent intensification of interest in evidence generated by analysing data from observational studies with the purpose of offering new insights into the effectiveness and safety of interventions as well as understanding healthcare delivery and quality of care. The systematic analysis of data from multiple data sources outside a research setting is referred to as real-world studies (RWS), and its subsequent analysis and conclusions as real-world evidence (RWE) [3].

Michel Adamina © ECCO

Surgery is based on several principles that hold true across specialties and time trends: knowledge of the disease at hand and the surgical anatomy; understanding of the patient’s needs and values; interpersonal and communication skills; professionalism and practice-based learning in the decision to perform and the execution of a surgical procedure; and broad competencies in postoperative care and follow-up, in particular when treating patients with chronic diseases. Science, on the other hand, is led by curiosity and honesty with the desire to build knowledge and understanding of our world. In a world with limited resources and with care practice increasingly focusing on the individual needs of patients, tailored treatment is increasingly sought after. Hence, fostering excellent science in IBD surgery may translate into a quest for value-based, innovative ways of approaching disease states for which many possible treatment options exist.

Charlotte Hedin © ECCO

Maria T Abreu, MD, is the Martin Kalser Endowed Chair in Gastroenterology, a Professor of Medicine, a Professor of Microbiology and Immunology, and Director of the Crohn's and Colitis Center at the University of Miami.

She is Council Chair of the American Gastroenterological Association (AGA) Institute Council and has served as Chair of the AGA’s Underrepresented Minorities Committee. She has also been appointed as Chair of the International Organization for the Study of Inflammatory Bowel Disease (IOIBD).

She was interviewed via video link in March 2021.

Central reading of ulcerative colitis clinical trial videos using neural networks

Gottlieb K, Requa J, Karnes W, et al.

Gastroenterology 2021;160:710–9.e2

Introduction

Endoscopic grading of the severity of Ulcerative Colitis (UC) is a critical component of disease assessment and particularly important for guiding therapy. Despite the availability of numerous scoring systems, such as the Mayo Endoscopic Score (eMS) and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS), widespread use in routine clinical practice is often limited, primarily due to inter-observer variability and lack of training for standardised use [1,2].

Anti-SARS-CoV-2 antibody responses are attenuated in patients with IBD treated with infliximab

Kennedy NA, Goodhand JR, Bewshea C, et al., Contributors to the CLARITY IBD study

Gut 2021;70:865–875

Jennifer Murray © Jennifer Murray

Introduction

Infection with the novel coronavirus SARS-CoV-2 leading to coronavirus disease-2019 (COVID-19) has a broad spectrum of clinical presentations and disease severity. A number of host and viral factors contribute to this heterogeneity in presentation and severity, including the host immune response [1]. Given that immune-mediated inflammatory diseases (IMIDs) including Inflammatory Bowel Disease (IBD), are characterised by immune dysregulation and use of biologic or immunosuppressive therapies, COVID-19 presents a particular challenge.

Randomised clinical trial: exclusive enteral nutrition versus standard of care for acute severe ulcerative colitis

Sahu P, Kedia S, Vuyyuru SK et al.

Aliment Pharmacol Ther. 2021;53:568–76.

Homira Ayubi © Homira Ayubi

Introduction

Acute Severe Ulcerative Colitis (ASUC) is a medical emergency which affects about 25% of UC patients at least once in their lifetime [1]. Corticosteroids are the mainstay of treatment for ASUC; however, 30%–40% of patients do not respond and eventually need medical rescue therapy or surgery [2].Medical rescue therapy (in the form of ciclosporin or infliximab) can be costly and its use can be limited by side effects. Therefore, there is a need for safe and low-cost therapy which can augment the effect of corticosteroids to induce and maintain remission.