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.

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.

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.

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.

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.

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.

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.

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. 

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.

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.