Fibrosis and other connective tissue abnormalities are common in IBD, especially in Crohn’s Disease. The main clinical consequence is strictures, occurring most often in the small bowel or at the ileocaecal/ileocolic junction. Surgery may be necessary for stricture management.

Very Early Onset Inflammatory Bowel Disease (VEO-IBD) is a complex subset of IBD that uniquely affects children under six years of age [1]. This category includes neonatal onset (within the first month of life), infantile onset (before two years) and early childhood onset (between two and six years) [2]. In comparison with patients with older onset IBD, those with VEO-IBD demonstrate a more heterogeneous phenotype and the aetiology is more closely related (in approximately 25%–30% of cases) to monogenic or digenic defects involving genes associated with primary immunodeficiency [3]. Moreover, VEO-IBD patients show higher rates of positive family history, a more aggressive clinical trajectory and increased resistance to conventional therapies effective in managing IBD among older patients [4].

At the 18^th Congress of ECCO in Copenhagen in 2023, many exciting projects on artificial intelligence (AI) were presented. Most of these projects focused on the role of AI in endoscopy. As a pathologist, I asked myself the following question: What about the role of AI in the histological evaluation of IBD?

The pathologist plays an important role in establishing the diagnosis and in assessing therapy response. Given that in many parts of the world IBD prevalence is still rising and histological remission may soon become a treatment target, the workload for pathologists is expected to increase. Therefore, as it promises to guide and thereby reduce time spent on biopsy assessment, AI is an interesting tool for pathologists. Moreover, it may aid the mission of H-ECCO to “raise standards of IBD pathology reporting” by mitigating problems associated with inter-observer variability.

After two years of virtual meetings, the main goal of the 18^th ECCO Congress, held in Copenhagen (March 1–4, 2023), was “Let’s get physical”. During this conference we enjoyed the face-to-face interaction, which provided a positive boost to the 8^th H-ECCO Masterclass. The aim of our meeting was not only to discuss the histopathological aspects of Inflammatory Bowel Disease but also to demonstrate the interaction between the different specialisms, which reflects the multidisciplinary collaboration in our daily practice.

Gert de Hertogh © ECCO

The 15^th Congress of ECCO was held in Vienna, Austria between February 12 and 15, 2020. During this meeting, it was decided that I would take over from Roger Feakins as second Chair of the H(istology)-ECCO Committee. The committee was at that time one of the most recently established. Its primary aim is to expand the knowledge of IBD histopathology by organising a yearly masterclass. However, the framework of ECCO also offers many other opportunities to support clinical decision-making, by linking with the other committees and by participation in the composition of ECCO Practice Guidelines, Position Statements and Topical Reviews.

Gert de Hertogh © ECCO

The past 6 months of 2022 have seen the publication of two important papers, one by F. Magro et al. (“The ECCO position on harmonisation of Crohn’s disease mucosal histopathology” [1]) and the other by I.O. Gordon et al. (“International consensus to standardise histopathological scoring for small bowel strictures in Crohn’s disease” [2]).

The H-ECCO Committee is saying goodbye to Monika Tripathi and would like to thank her for all her work on behalf of the Committee in recent years.

At the same time, as chairman of the Committee, I am very happy to welcome our new member, Aart Mookhoek. Aart currently works as a pathologist at the Institute of Pathology, University of Bern, Switzerland. He is, however, Dutch originally, and developed his passion for gastrointestinal pathology during a residency and subsequent fellowship at the University of Amsterdam, the Netherlands. Aart and I trained together on histological scoring systems for disease activity in Ulcerative Colitis and Crohn’s Disease, and we participated in a research project on this topic.

Gert De Hertogh © ECCO

Contrary to everyone’s ardent expectations and hopes, this year’s ECCO Congress was once again held virtually. While the experiences from 2021 had taught the H-ECCO Committee how to prepare for this and what to expect, we were so happy to be supported again by an excellent ECCO Office team.

Ann Driessen © ECCO

Inflammatory Bowel Disease is a longstanding recurrent inflammatory disorder that is most prevalent in Western countries but is increasing in Asiatic countries. The worldwide increase in the incidence of IBD, comprising Crohn’s Disease, Ulcerative Colitis and IBD unclassified, is having a significant impact on health care systems. Achievement of an optimal quality of care of IBD requires a multidisciplinary approach by different clinical disciplines, including pathology. Histopathology plays an essential role in the diagnosis and management of IBD. The pathologist excludes or confirms and subtypes IBD, assesses its activity and response to treatment and diagnoses preneoplastic lesions on endoscopic biopsies. Suboptimal sampling during endoscopy or insufficient clinical information, however, hampers the pathologist in making a diagnosis [1]. The main histological features of IBD are disturbance of the architecture and basal plasmacytosis, though a wide variety of disorders resemble IBD not only clinically and endoscopically but also histologically. Distinction between IBD and these mimics is essential as misdiagnosis results in delayed and incorrect management. Their differentiation is, however, not always straightforward and, in addition to a standard clinical examination, requires serology, imaging, endoscopy, histology and other investigations [2].

Gert De Hertogh © ECCO

The past 2 years, 2020 and 2021, have been challenging for everybody, but with the help of the ever-enthusiastic ECCO Organisation and their co-workers, the H-ECCO Committee was able to organise a well-attended masterclass at the recent virtual congress in July.

We divided the masterclass into four sessions: Basics of IBD, Scoring Schemes and Standards, Neoplasia and New Concepts in IBD.