Chen Sarbagili Shabat  © ECCO

We were in Berlin for the 10^th D-ECCO Workshop! The workshop was full, with our largest attendance to date – 194 participants, including not only dietitians but also a great mix of specialists from all over the world. I, Chen Sarbagili (the Netherlands), opened the workshop by informing participants that the ECCO Consensus on Diet and Nutrition in IBD would be presented for the first time during this ECCO’s plenary session, as well as by presenting the various opportunities available to all IBD Dietitian Members, including the D-ECCO Grant and the D-ECCO Travel Award.

Guia Becherucci  © ECCO

The D-ECCO Travel Award offers IBD Dietitians an opportunity to visit other IBD Centres, to learn about diet and nutrition in IBD. Next Call opens in January 2025. Guia Becherucci was awarded at ECCO’24 and travelled to the University Hospitals Leuven, Belgium.

Vaios Svolos  © ECCO

Exclusive enteral nutrition (EEN) is a prescribed liquid diet providing 100% of energy intake while excluding all other foods and drinks. It uses polymeric or elemental formulas, which are equally effective, though polymeric formulas are more palatable and better tolerated over 6–8 weeks. EEN is established as an effective therapy for Crohn's Disease (CD) that induces remission in up to 80% of patients [1, 2]. The clinical benefits of EEN include (a) the reduction of inflammation, with decreases in both blood and gut inflammatory markers and induction of mucosal healing, and (b) the improvement of clinical and physical health, with promotion of clinical remission and enhancement of muscle mass and nutritional status [3]. Studies have shown that EEN induces significant changes in the microbiome; although these changes are implicated in each mechanism of action, further research is needed to provide a better understanding of diet–microbiome interactions in CD [4, 5]. In the present article, the Bradford Hill criteria [6], a set of principles used to determine causal relationships between an exposure and a disease, are employed as a framework to analyse the EEN–microbiome interactions in CD. These criteria include factors such as strength, consistency, temporality and biological plausibility [6].

Alicia Sandall  © ECCO

What are ultra-processed foods?

Recent interest has focused on the role of ultra-processed foods (UPFs) in IBD. UPFs are foods whose constituent ingredients are of exclusive industrial availability [1]. Across Europe, 30%–60% of energy intake in the diet is from UPFs [2, 3].

What is the research on ultra-processed foods and IBD?

Higher intakes of UPFs (especially through consumption of soft drinks, processed meat, salty snacks and refined sweetened foods) are associated with a greater risk of developing IBD [4], although a meta-analysis demonstrated an increased risk for Crohn’s Disease (CD) but not Ulcerative Colitis (UC) [5]. Once a person has been diagnosed with IBD, higher intakes of UPFs are associated with a greater incidence of IBD-related surgery [6] and a higher number of episodes of active disease in UC [7]. 

Emma Halmos © ECCO

Hannah Gordon © ECCO

Richard Hansen © ECCO

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.

Chen Sarbagili Shabat  © ECCO

We were in Stockholm for the 9^th D-ECCO Workshop! The workshop was full, with 162 attendees including not only dietitians but also a great mix of specialists from all over the world. Lihi Godny, the D-ECCO Chair, opened the workshop by presenting the various opportunities available to all IBD Dietitian Members, including the D-ECCO Grant and four Travel Awards.

Chen Sarbagili Shabat  © ECCO

The D-ECCO Committee would like to express gratitude to Lihi Godny, the retiring D-ECCO Chair, for her invaluable contribution in formulating and promoting a variety of opportunities for all IBD Dietitians.

As a D-ECCO Committee Member, it is my mission, along with my fellow D-ECCO’ers, to educate and train other dietitians and healthcare professionals in the field of IBD. Also, with dietary therapies and beliefs still growing and consolidating their place in the prevention and treatment of IBD, there is an emerging need for skilled dietitians to guide our patients in the different nutritional pathways throughout their disease. But what makes a dietitian skilled in the field of IBD?

Up to one-third of patients with Inflammatory Bowel Disease (IBD) have persistent bowel symptoms despite apparent control of intestinal inflammation [1]. These symptoms fit with irritable bowel syndrome (IBS), a type of disorder of gut–brain interactions (DGBI). DGBI respond poorly to the pharmacological agents that are typically used to target inflammation in IBD. Thus, as clinicians, our challenges are to identify IBS-like symptoms, which is more easily achieved in those with quiescent disease, and to find suitable treatments for control of non-inflammatory symptoms.

Inflammatory Bowel Disease (IBD) can affect women during their reproductive years. Prenatal, perinatal and postnatal factors may be associated with adverse pregnancy outcomes and can also affect the long-term health of the infant. The perinatal period raises many concerns for the patient with IBD beyond medical therapy that can be addressed by the IBD multidisciplinary team (MDT). However, there is a lack of robust evidence on perinatal holistic management in IBD, and guidelines usually do not address non-medical and nutritional management. Therefore, D-ECCO initiated a collaborative Topical Review with the aim of assessing the scientific evidence and providing expert opinion on nutritional, psychological and supportive care for women with IBD and their infants throughout the perinatal period [1].