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.

Marjo Campmans-Kuijpers © ECCO

Although Inflammatory Bowel Disease (IBD) has been historically associated with underweight and malnutrition, rates of obesity have been rising in patients with IBD, as in the general population. Nowadays, 15%–40% of adults with IBD are obese, and an additional 20%–40% are overweight [1]. Obesity is independently associated with higher disease burden and costs of hospitalisation in patients with IBD [2].

Catherine Wall  © ECCO

Nutrition screening tools are commonly used in clinical practice to identify patients who may be at nutrition risk. Patients identified as being at nutrition risk should be referred for nutritional assessment prior to implementation of a food and nutrition intervention as required. The use of nutrition screening tools can identify those patients most likely to benefit from a dietitian's input and can assist with the allocation of scarce dietetic resources. 

Rotem Sigall-Boneh © ECCO

In recent years, there has been increasing evidence that diet has an important role in Inflammatory Bowel Diseases and their management, from the pathogenesis of disease through to treatment and supportive therapy. Exclusive enteral nutrition (EEN) is a well-established dietary therapy that leads to induction of remission and also is associated with mucosal healing in patients with Crohn’s Disease (CD), especially in children. However, adherence to this therapy is low and it is difficult to maintain EEN for a long period. The mechanism by which EEN works is still elusive but several possibilities have been suggested. Accordingly, many groups have sought different dietary strategies to treat patients with CD or UC with several goals: Induction of remission, maintenance of remission and management of gastrointestinal symptoms.

Arie Levine © ECCO

This ECCO News Issue is the perfect opportunity for me to express awe and gratitude: awe for the dedicated dietitians of D-ECCO, who have accomplished so much, and gratitude to the Governing Board of ECCO, which detected this emerging need in IBD and supported its development within ECCO, allowing me to be part of the process.

Miranda Lomer  ©  ECCO

At least a third of patients with inactive IBD have coexisting functional bowel symptoms (e.g.  abdominal pain, bloating, increased flatulence, diarrhoea and/or constipation) and these symptoms may be mistaken for active IBD. Patients may also experience increased anxiety/depression and reduced quality of life. Objective markers of disease activity (histological and inflammatory markers, e.g. faecal calprotectin, C-reactive protein), in conjunction with assessment of clinical symptoms, help to distinguish between functional bowel symptoms and active IBD. Identification of functional bowel symptoms in inactive IBD is important to avoid unnecessary and potentially harmful treatment strategies; on the other hand, active disease should be excluded before establishing that symptoms are functional in nature.