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.

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.

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.

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.