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].

Chen Sarbagili Shabat  © ECCO

After a long hiatus, the 18^th ECCO Congress finally took place in person and face-to-face, which was very exciting. The 8^th D-ECCO Workshop was full, with attendees including not only dietitians but also a great mix of specialists from all around the world. There were three Workshop sessions, on “Food science: there is more than EEN for Crohn’s Disease”, “Practical and clinical advice for the IBD dietitian” and “Psychological aspects of dietary management in IBD”. Apart from these sessions, great discussions were hosted and participated in by D-ECCO Committee Members and external speakers, and the D-ECCO Grant and Travel Awards were handed out.

Dearbhaile O'Hanlon  © ECCO

Exclusive enteral nutrition (EEN) is well established as first-line management for children with luminal Crohn’s Disease (CD) [1]. Its use in paediatrics was covered in the 2017 ECCO e-Learning Activity “Use of exclusive enteral nutrition in CD”.

The use of EEN in adults with CD is not as well established. It is often overlooked as a management tool but can be an effective therapy for adults in many scenarios. Catherine Wall and I designed an e-Learning Activity specifically covering EEN in adults with CD, and this was launched on the e-CCO Learning Platform in May 2022. The course was developed for gastroenterologists, surgeons, dietitians, nurses and other interdisciplinary medical experts interested in Inflammatory Bowel Disease(s) (IBD).

Emma Halmos  © Emma Halmos

It has long been acknowledged that Inflammatory Bowel Disease (IBD) carries a risk of malnutrition, leading to fatigue, infection, poor wound healing and poor health-related quality of life [1]. Historically, most attention has been devoted to undernutrition; however, there is now evidence that overnutrition in the form of visceral fat is associated with raised tumour necrosis factor (TNF) and poorer responses to anti-TNF agents [2], indicating that central adiposity can be just as detrimental to disease outcomes as undernutrition. Furthermore, under- and overnutrition are not mutually exclusive and nutrient deficiencies and excesses often co-exist. In the last few years, there has been a shift away from the historical approach of using rudimentary markers of malnutrition, such as weight or body mass index (BMI), which can often be misleading as assessment tools in that they may falsely detect abnormalities or miss them completely, towards more detailed body composition measures of muscle and fat mass, which reflect nutritional abnormalities more sensitively. Indeed, GLIM (Global Leadership Initiative on Malnutrition) recognises the importance of body composition in the diagnosis of malnutrition [3]. The key question now is how should we best assess our IBD patients for nutritional status in order to identify risk of poor clinical outcomes?

Eytan Wine © ECCO

Many IBD specialists take pride in their multidisciplinary team (MDT), which is of huge benefit and should be considered a necessity for this complex group of conditions. When I joined the Dietitians of ECCO (D-ECCO) Committee 3 years ago, I came with a clear appreciation of the specific role of dietitians in IBD MDTs, but I continue to learn and be amazed by how much more can and should be achieved through the contribution of IBD-focused dietitians. As a paediatric IBD specialist, I have had the privilege and pleasure of working with dietitians in our team for many years, mostly in the context of nutritional assessment and follow-up, as well as nutritional therapy. As nutritional therapy has been established as a first-line therapy for paediatric Crohn’s Disease for many years [1], it is likely that we paediatricians may have a head start in involving dietitians. While many adult centres have built excellent units [2], the specific roles of dietitians are not always appreciated [3].

Lihi Godny  © ECCO

As a part of the 17th ECCO Congress, the 7th D-ECCO (Dietitians of ECCO) Workshop was conducted virtually and included three sessions: (1) Science, moving from a causality in IBD; (2) Practicalities and pitfalls of dietary therapy in IBD; (3) MDT: More than just the MD? Case presentations and panel discussion.

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].

Lihi Godny  © ECCO

As a part of the 16th Congress of ECCO, the 6^th D-ECCO (Dietitians of ECCO) Workshop was conducted virtually, with 84 participants. The workshop was divided into three sessions: (1) Science, diet and IBD; (2) Practical clinical nutrition in IBD; and (3) Panel discussion and interactive session.

“One cannot think well, love well, sleep well, if one has not dined well.” ― Virginia Woolf

Unfortunately for many of our patients, dining well is often not an option since their disease symptoms give rise to wariness about the foods they eat. Patients are forced to consider how they may feel after a meal and to take into account their requirement for toilet facilities and ability to cope with pain. They often forego social eating to manage these aspects. This can negatively impact their social interactions, daily activities and food-related quality of life [1]. Coupled with this, patients with IBD have higher rates of depression and anxiety [2] and a higher incidence of behavioural, psychological and eating disorders [3]. Self-directed food exclusions can trigger these disorders and lead to higher nutritional risk. We need to be mindful of this when addressing diet and nutrition with our patients. It is important that we consider the implications of asking patients to modify their diets for disease or symptom management while taking into account their desire to use diet as a tool to manage their disease.