“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.

Marjo Campmans-Kuijpers © ECCO

Due to COVID-19, the 16^th ECCO Congress originally planned for February 2021 in Berlin was postponed to July 7–10 in the Bella Center in Copenhagen. However, in view of the current COVID-19 situation, the ECCO Governing Board had to switch to ECCO’ 21 Virtual Congress. It’s a pity we cannot meet each other live, but holding the Congress online may increase the opportunity for more people to attend both the Congress itself and our 6^th D-ECCO Workshop.

Catherine Wall © ECCO

Iron deficiency and iron-deficiency anaemia (IDA) are characterised by fatigue and reduced capacity for normal activities of daily living and consequently poorer quality of life. Iron deficiency is estimated to affect 60%–80% of people with IBD at some point [1]. Recurrent iron deficiency is also common and is estimated to occur in 30% of patients [1]. Given the prevalence of iron deficiency, some patients and practitioners have learned to accept this impaired quality of life as an unavoidable consequence of IBD [2]. However, correction of iron deficiency in patients without anaemia can result in improved quality of life and less fatigue and should, therefore, be an important treatment goal.

Marjo Campmans-Kuijpers  © ECCO

During the recent COVID-19 outbreak, telemedicine was helpful in ensuring the continuation of regular care and reducing the need for outpatient visits. To optimise the treatment of Inflammatory Bowel Disease (IBD), recent guidelines recommend strict long-term monitoring of the mucosal inflammation and timely optimisation of treatment during a disease flare [1]. In traditional practice, such monitoring requires many visits to outpatient clinics by patients, which they can experience as stressful. This regular monitoring increases the workload and administration during outpatient visits and can lead to longer waiting lists. In order to address some of these issues and continue to provide patients with good and qualitatively safe care, the multidisciplinary team (MDT) together with the Dutch patient association (CCUVN) developed the telemonitoring tool MyIBDCoach. In the Netherlands, there are currently about 90,000 patients with IBD [2] and 10% of these patients are using MyIBDCoach.

Dearbhaile O'Hanlon  © ECCO

D-ECCO is committed to promoting the essential role of dietitians within the Inflammatory Bowel Disease Multidisciplinary Team (IBD MDT). Specialist IBD dietitians in IBD units are integral to the MDT, but not all IBD units have a specialist dietitian. Dietetic services and clinical roles are likely to differ slightly from country to country, but the core roles will remain the same. The European Federation of the Associations of Dietitians (EFAD) has adopted the International Congress of Dietetic Associations (ICDA) definition of the role of the dietitian: “A person with a qualification in Nutrition & Dietetics recognized by national authority(s). The dietitian applies the science of nutrition to the feeding and education of groups of people and individuals in health and disease.”

Eytan Wine  © ECCO

D-ECCO, the Dietitians of ECCO, held its 5^th Workshop as part of the 15^th ECCO Congress in Vienna in February 2020. I will describe some of the highlights and main messages of the Workshop, which was attended by 104 registered delegates.

Catherine Wall © ECCO

Definition of collaboration (noun): 1. the action of working with someone to produce something or 2. traitorous cooperation with an enemy!⁶.

Collaborative projects, such as topical reviews, are excellent opportunities to increase communication between ECCO Members and encourage clinicians and researchers from across disclipines to work together to achieve a common goal. Furthermore, collaborative working, in clinical practice and research, allows us to appreciate and utilise the specialised perspectives of our peers. Clinical collaboration (a multidisclipinary team) provides a structured setting where cross-discipline discussion of complex clinical cases can occur. A multidisclipinary Inflammatory Bowel Disease (IBD) model of care is recommended [1] and can be effective [2, 3]; however, the structure of the team will likely vary by site depending on the aim and expertise of each IBD service [2–4].

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.

Marjo Campmans- Kuijpers © ECCO

The importance of nutrition in IBD Management is increasingly recognised. Of course, the best evidence that nutrition deserves a place in IBD Treatment is the fact that exclusive enteral nutrition (EEN) is the primary treatment in children with active Crohn’s Disease (CD). In addition, some dietary patterns are associated with the outcomes in IBD, and recently it was shown that partial enteral nutrition, accompanied by a special CD exclusion diet, is as effective as EEN and brings into remission even those patients who fail on biologics.

Dearbháile O’Hanlon  © ECCO

As a new member of the D-ECCO Committee it is a pleasure to review the 4th D-ECCO Workshop at the 14th Congress of ECCO. This year we had an excellent attendance of 140 attendees from across the multidisciplinary areas, including dietitians, nurses, physicians and clinical researchers.

The programme was divided into three sessions.